Business Critical Models . ..... and Transformation Plan (STP) on pre-consultation business case on the reorganisation .
Annual Report and Accounts 2016 - 2017
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NHS Thurrock Clinical Commissioning Group Annual Report Section 14Z15 of the National Health Service Act 2006 (as amended) requires clinical commissioning groups to prepare an Annual Report and Section 17 of Schedule 1A of the National Health Service Act 2006 (as amended) requires Clinical Commissioning Groups to prepare Annual Accounts.
Contents Performance Report ..................................................................................................................................................................... 6 Performance Overview ........................................................................................................................................... 7 Introduction............................................................................................................................................................ 8 About us ................................................................................................................................................................. 9 Our place in the NHS........................................................................................................................................... 10 Background and national context – NHS Reform .......................................................................................... 10 New models of care are at the heart of NHS reform ......................................................................................... 10 Five Year Forward View (5YFV) ....................................................................................................................... 10 Essex Sustainability and Transformation Plan (STP) - The Thurrock Footprint ............................................. 10 Delivering the NHS Constitution in Thurrock ................................................................................................. 10 Commissioning Support Units (CSUs) ............................................................................................................. 11 Our local context.................................................................................................................................................. 11 Our partnerships .................................................................................................................................................. 13 Thurrock Council | Joint Strategic Needs Assessment (JSNA) ........................................................................ 13 Health and Wellbeing Board ........................................................................................................................... 14 Our Commissioning Reference Group (CRG) ................................................................................................. 14 Healthwatch Thurrock...................................................................................................................................... 14 Key facts and figures ............................................................................................................................................ 15 Performance summary ........................................................................................................................................ 17 How your money was spent................................................................................................................................ 20 Our achievements In 2016/17 ............................................................................................................................. 20 Health and Wellbeing Strategy ....................................................................................................................... 22
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Performance Analysis .......................................................................................................................................... 22 Financial Overview ............................................................................................................................................... 22 Performance Assurance and Measurement ....................................................................................................... 26 Our key areas of focus for 2017/18 .................................................................................................................... 27 Continue to evolve a high quality Sustainability and Transformation Plan .................................................. 27 System Aggregate Financial Balance .............................................................................................................. 27 Sustainability and Quality of General Practice ................................................................................................ 28 Access Standards and Ambulance .................................................................................................................. 28 Referral to Treatment (RTT) –.......................................................................................................................... 28 62 Day Cancer Waiting Standards .................................................................................................................. 28 Mental Health Access Standards..................................................................................................................... 28 Transform Care for People with Learning Disabilities .................................................................................... 28 Improvements In Quality ................................................................................................................................. 28 Key issues and risks .............................................................................................................................................. 29 Ensuring safe and high quality services .............................................................................................................. 29 Improving Quality of Care ................................................................................................................................... 30 Health and Wellbeing Strategy ........................................................................................................................... 35 Patient and Public Involvement........................................................................................................................... 36 Reducing health inequality .................................................................................................................................. 38 Continuing Healthcare Commissioning/End of Life Care .................................................................................. 38 Sustainable Development ................................................................................................................................... 40 Equality Report..................................................................................................................................................... 40 Accountability Report.............................................................................................................................................................. 41 Statement of Accountable Officer’s Responsibilities .......................................................................................... 42 Governance Statement Introduction and context .............................................................................................. 44 Scope of responsibility..................................................................................................................................... 45 Governance arrangements and effectiveness .................................................................................................... 45 Outcome of GGI Maturity Assessment ........................................................................................................... 48
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The Conflict of Interest Committee ................................................................................................................. 54 UK Corporate Governance Code .................................................................................................................... 55 -
Leadership: ............................................................................................................................................. 55
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Effectiveness: .......................................................................................................................................... 55
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Remuneration: ........................................................................................................................................ 56
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Relations with Stakeholders ................................................................................................................... 56
Discharge of Statutory Functions .................................................................................................................... 56 Risk management arrangements and effectiveness .......................................................................................... 56 Embedding risk management ......................................................................................................................... 60 Involving the Patients and Public in managing risk ........................................................................................ 60 Partnership working ......................................................................................................................................... 61 Capacity to Handle Risk ................................................................................................................................... 62 Risk Assessment ............................................................................................................................................... 63 Other sources of assurance................................................................................................................................. 65 Internal Control Framework ............................................................................................................................ 65 Identifying non-compliance ............................................................................................................................ 65 Annual audit of conflicts of interest management ......................................................................................... 66 Data Quality ..................................................................................................................................................... 66 Information Governance ................................................................................................................................. 66 Business Critical Models .................................................................................................................................. 67 Third party assurances ..................................................................................................................................... 67 Control Issues................................................................................................................................................... 68 Review of economy, efficiency & effectiveness of the use of resources ....................................................... 68 Counter fraud arrangements .......................................................................................................................... 69 Head of Internal Audit Opinion .......................................................................................................................... 70 Annual Opinion.................................................................................................................................................... 70 Reliance Placed on Third Parties ......................................................................................................................... 72 Summary of internal audit work undertaken in 2016/17 ................................................................................... 73 Review of the effectiveness of governance, risk management and internal control .................................... 74
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Conclusion........................................................................................................................................................ 75 Members Report .................................................................................................................................................. 76 Our Governing Body............................................................................................................................................ 79 Governing Body Profiles ...................................................................................................................................... 80 Register of Interests ............................................................................................................................................. 84 Member Practices ................................................................................................................................................ 88 Audit committee, pension liabilities, external audit ............................................................................................ 90 Compliments and complaints.............................................................................................................................. 90 Freedom of Information (FOI) Requests ............................................................................................................. 91 Planning for emergencies .................................................................................................................................... 91 The Local Counter Fraud Service ........................................................................................................................ 92 Statement as to disclosure to auditors................................................................................................................ 93 Disclosure of serious untoward incidents ........................................................................................................... 93 Remuneration and Staff Report .......................................................................................................................... 94 Remuneration Report for the year ending 31 March 2017 ............................................................................... 94 Staff Report for the year ending 31 March 2017 ............................................................................................. 100 Parliamentary Accountability and Audit Report (subject to audit) .................................................................. 100 Annual Accounts...................................................................................................................................................................... 101 Independent Auditor's Report ............................................................................................................................................. 129 Appendices ............................................................................................................................................................................. 135 Appendix 1: Sustainability Report ..................................................................................................................... 136 Appendix 2: Equality Report .............................................................................................................................. 139 Glossary ................................................................................................................................................................ 144 Glossary of non-financial terms................................................................................................................................. 144 Glossary of financial terms ............................................................................................................................. 147
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Performance Report
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Performance Overview We have come a long way over the last twelve months, and it has been an action-packed, challenging and successful year for us. We’ve achieved this with a lean, but innovative approach to commissioning in times of continual change across mid and south Essex. Our continuing financial agility has helped us forge ahead and keep pace. We have started to move into a new era of potential and transformation for health and care in Thurrock. This report is an opportunity for us to reflect on just how much we have achieved together for the local population, working with our staff, practices and our wider partners. Local people remain at the heart of our work and they are able to engage and be included in all aspects of service design and change so that patients can be more fully empowered in their own care, including through our Commissioning Reference Group (CRG). Our CRG remains a key forum to have meaningful engagement on service redesign and change. Chaired by one of our Governing Board Lay Members, this ensures direct access to our decision makers. We also continue to actively work with Healthwatch Thurrock on local engagement around our For Thurrock in Thurrock local transformation plan, the Sustainability and Transformation Plan (STP) on pre-consultation business case on the reorganisation of our hospital services, and proposed restructure and re-procurement of primary care facilities Because we are constantly listening and acting on what we hear, we have made significant progress towards delivering wider GP services, at scale, including through four primary care hubs which offer GP access, seven days a week. We have also achieved a modern model of integrated care through our strong partnership working with Thurrock Council evidenced by new integrated models including the Rapid Response and Assessment Service (RRAS) and the Joint Reablement Team. The total pooled fund with Thurrock Council for 2016/17 is now £28million representing an increase of £9m (50%) compared to previous year. This increase is further evidence of our goal of achieving closer alignment and integration of Health and Social care services. Using our unique brand For Thurrock in Thurrock we have worked at pace to deliver truly integrated services, including bringing 24 intermediate care beds into Thurrock and 5 specialist beds for mental health patients in Collins House. We have developed our out of hospital offer and leading the way on improving access to care closer to home with community, social and health providers working together. We are particularly proud of the work we are doing through our Accountable Care Partnerships; our Tilbury Pilot began this March 2017.
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We are able to offer tangible benefits, and are pressing ahead on developing plans for innovative Integrated Healthy Living Centres to bring first class one stop shop of diagnostics, mental health and primary care services under one roof. Despite all our efforts, high quality urgent and emergency care remains particularly challenging, for the whole Essex healthcare system. For example, A&E performance against the A&E four hour standard remains difficult. To conclude another extraordinary year, we have supported vast improvements in our primary care, with over half of our practices now rated as ‘good’ with the CQC. We have cemented our position with Thurrock Council to provide truly joined up working that is fast becoming the envy of other areas. The next year will be just as challenging as we progress our plans for integrated care but we look forward to continuing to work with our colleagues across health, acute and social care.
Dr Anand Deshpande, Chair
Mandy Ansell, Accountable Officer
May 2017
May 2017
Introduction 8
We are required to present a performance report as part of our Annual Report and Accounts, which provides our stakeholders with a balanced and comprehensive analysis of our performance during the year. In accordance with NHS guidelines, this report covers the period 1 April 2016 to 31 March 2017 and includes an overview of our achievements, details of our non-financial performance, accountability and financial statements. Our accounts have been prepared under a Direction issued by the NHS England under the National Health Service Act 2006. We certify that we have complied with the statutory duties laid down in the NHS Act 2006 (as amended by the Health & Social Care Act 2012).
About us We are responsible for the commissioning and delivery of local health care services. We purchase healthcare from hospitals, community and mental health services and some specialist services (service contracts with GPs, dentists, pharmacists and opticians are managed by NHS England). Driven by clinicians, we are supported by a wide range of professionals and strategic partners, to commission and deliver joined up seamless quality services to the public, patients and carers of Thurrock. Membership includes all 32 GP practices in Thurrock and we continue to be responsible for commissioning: - hospital services for planned and unplanned care - community health services - mental health services Our vision is that the health and care experience for the people of Thurrock will be improved as a result of our working together. To achieve this vision, we aim to design services within available resources around the agreed needs of people and by working collaboratively with our partners. We are responsible for the healthcare needs of the local population and work with local healthcare professionals, local authorities, voluntary organisations and others to make sure local people have high quality health services. We have a duty to involve and listen to patients and our local communities when making decisions about local health services. We commission healthcare from a number of different healthcare providers. Our main providers are: -
Basildon and Thurrock University Hospitals NHS Foundation Trust (BTUH)
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North East London NHS Foundation Trust (NELFT) South Essex Partnership University NHS Foundation Trust (SEPT) (see glossary on information about this provider)
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East of England Ambulance Service NHS Trust (EEAST) South Staffordshire and Shropshire Healthcare NHS Foundation Trust
Our place in the NHS Background and national context – NHS Reform NHS England leads the National Health Service (NHS) in England. It sets the priorities and direction of the NHS and encourages and informs the national debate to improve health and care. It holds organisations to account for spending this money effectively for patients and efficiently for the tax payer. We are helping to deliver key aspects of NHS reform to continue to meet the needs of our local population, to ensure we are financially sustainable whilst engaging the public in the whole process. We strongly believe in health and high quality care for all, now and for future generations.
New models of care are at the heart of NHS reform Five Year Forward View (5YFV) Published in 2014, the NHS 5YFV sets out a new shared vision for the future of the NHS based around new models of care. The 5YFV asked health systems to produce a five year Sustainability and Transformation Plan (STP). This year we also developed an ambitious GP Forward View in line with the 5YFV, which will transform primary care services and models of care in Thurrock. Essex Sustainability and Transformation Plan (STP) - The Thurrock Footprint Within Mid and South Essex, our STP is also known as the Essex Success Regime (ESR). The ESR has brought together the system leaders across this area to create a whole system plan to enable organisations to deliver high quality care for patients, reduce local health inequalities and deliver financial balance by 20/21. Our delivery role is detailed in our Operational Plan, published in April 2016. http://bit.ly/2o6EFKj Delivering the NHS Constitution in Thurrock
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We are responsible for upholding and reinforcing the requirements of the NHS Constitution. We do this by listening to and engaging with all our stakeholders and continue to reach out to a diverse network of groups within Thurrock through our partnerships.
Commissioning Support Units (CSUs) CSUs provide capacity and resources to CCGs to support the business of commissioning. This approach helps achieve economies of scale and allows CCGs to focus on direct commissioning of services for their local populations. CSUs are not statutory bodies but they are accountable to CCGs under the terms of agreed contracts and service specifications. To help us to fulfill our duties as a CCG, we purchased a range of commissioning support services from NHS North East London Commissioning Support Unit during 16/17 (excluding those with footnotes). These services included: -
Business Intelligence Contracting Financial Services Information Management and Technology Human Resources and Workforce GP Information Technology
Support services commissioned from other providers include: - Procurement and Market Management Procurement and Market Management1 - Individual Funding Requests Individual Funding Requests2 - Information Governance Information Governance3 Further information about NHS North East London CSU can be found at: www.nelcsu.nhs.uk
Our local context Thurrock is situated south of Essex and lies to the east of London on the north bank of the River Thames with an area of 165 square kilometres. It has a very diverse and growing population. The latest published estimates showed the population of Thurrock (as of June 2016) had risen from the previous year to 165,184, representing a percentage rise of 1.2%. The most significant increases from the previous year are in some of the middle and older age groups, with the number of 50-54 year olds increasing by 4.76% and those aged 65-69 years and
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70-74 years increasing by 3.26% and 3.01% respectively. Thurrock currently has a significantly greater proportion of young people than the England average and this trend is likely to continue into the future. Thurrock’s older population is lower as a percentage of total population than the England average but the there is a projected growth in older age groups, as set out by Public Health in Thurrock:
1Purchased from Attain\ 2Service hosted by NHS Basildon and Brentwood CCG 3 Service hosted by NHS Basildon and Brentwood CCG
This 1.2% increase in Thurrock’s population is around 20 per cent greater than the national population increase (0.86%), and can be attributed to two factors – “natural change” (which is the number of births minus the number of deaths) and “migration”. In 2015, there were 2,453 births and 1,222 deaths, representing a natural change of 1,231 residents. Internal migration (residents moving into Thurrock from other parts of the country) resulted in an extra 7,219 residents moving in and 7,080 moving out. A total of 1,001 people moved into the borough from areas outside England and Wales and 452 moved out. Many of the international migrants originated from the European Union accession states (particularly Poland), and from parts of Africa, contributing to new and complex demands on local services. Migration as a whole counted for 549 additional residents in the borough. The main health priorities in our area remain the reduction in the prevalence of smoking and adult and childhood obesity and improving management of long-term health conditions.
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Our partnerships We believe in the power of partnership working to achieve more together. We already work closely with our local authority partners and neighbouring CCG in Basildon and Brentwood and Basildon and Thurrock University Hospital Foundation Trust (BTUH) our acute provider, North East London Foundation Trust (NELFT) our community provider, and South Essex Partnership Trust (SEPT) our mental health provider. We also work closely with our Mid and South Essex Success Regime partners to develop the Sustainability and Transformation Plan for our area. We will continue to work in partnership with each of them to develop a more integrated workforce with the skills, experience, capability and capacity to provide care closer to home in a more holistic way as we develop our new care models for the future. Our further partnerships include: Thurrock Council | Joint Strategic Needs Assessment (JSNA) A Joint Strategic Needs Assessment is an ongoing process by which Local Authorities, CCGs and other public sector partners jointly describe the current and future health and wellbeing needs of its local population and identify priorities for action. Health inequalities underpin the JSNA, such as inequalities in life chances, opportunities, and health and wellbeing outcomes of different populations within the Borough. With a population estimate of 165,184 (June 2016), these inequalities are often stark and significant. The ultimate purpose of the JSNA process is to use the information gathered to identify local priorities and support commissioners to commission services and interventions that are based on need, which will in turn achieve better health and wellbeing outcomes and reduce health inequalities. The production of the JSNA is led by the Thurrock Health and Wellbeing Board and we continue to work in partnership with Thurrock Council to implement its recommendations. Further information: https://www.thurrock.gov.uk/healthy-living/joint-strategic-needsassessment
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Health and Wellbeing Board The CCG continues to be represented on the Health and Wellbeing Board and to jointly support development of the Health and Wellbeing Strategy, and delivery of the vision, in partnership with Thurrock Council in response to consultation feedback from Thurrock people. The vision for improving the health and well-being of Thurrock people is to add years to life and life to years, by: - reducing inequality in health and well-being - prevention is better than cure - empowering people in communities - connected services The strategy has 5 goals. The CCG are supporting delivery of these goals in partnership with Thurrock Council. Further information: https://www.thurrock.gov.uk/strategies/health-andwell-being- strategy Our Commissioning Reference Group (CRG) Our CRG is made up of representatives from Thurrock Council, Thurrock CVS (Council for Voluntary Service), Healthwatch Thurrock, Thurrock Coalition as well as health special interest groups, along with Thurrock’s Patient Participation Group (PPG) representatives from GP practices across Thurrock. Healthwatch Thurrock Healthwatch Thurrock is an independent voice for the people of Thurrock, helping to shape and improve health and social care. The organisation aims to collect and articulate people’s experience of health and social care to positively influence how services are designed and delivered – putting patients at the heart of their own care. Healthwatch Thurrock has statutory powers to hold services to account. To find out more or to get involved, visit: healthwatchthurrock.org or telephone 01375 389883
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Key facts and figures NHS Thurrock CCG was established on 1 April 2013 Headquarters Civic Offices, 2nd floor New Road Grays RM17 6SL Communities covered Borough of Thurrock Population (registered with a GP) 173,631 (as at 1 January 2017) Number of GP practices 32 Budget (for 16/17) 206.70m Number of employees As at 31 March 2017, there were 54 staff equal to 48 Whole Time Equivalents (WTE) employed by NHS Thurrock CCG Breakdown of CCG employees by gender Male – 29% (16) / Female – 71% (38) Breakdown of senior staff by gender Senior staff are considered by the Accountable Officer to be those in band 8d and above and influence system decisions: Gender Band 8d Band 9 VSM Grand Total Female 3 1 1 5 Male 2 2 Grand Total 3 3 1 7 Breakdown of Governing Body members by gender Male – 12 / Female – 6 Absences and sickness During 2016/17, 103 days were recorded as sick, this is in line with the average for organisations of this type.
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Breakdown of CCG membership by gender Male GPs – 61 (63%) / Female GPs 36 (37%)
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Performance summary In Essex, like in many parts of the country, delivering the NHS Constitutional targets and standards has proved challenging despite a series of local system initiatives. NHS Thurrock CCG is committed to working closely with our providers to put in place actions to aid delivery of constitutional targets and to ensure the best possible healthcare and outcomes for our population. However, this is often proving to be difficult to achieve because demand for services continues to rise. A&E / Urgent Care System Our Local Acute Trust, like all others has had a very challenging year. It has not been possible to achieve the 4-hour waiting time standard over the course of 16/17. This is partly because there is an increasing demand and many more people are attending A&E. Although performance remains below the 95% standard for people waiting no more than 4 hours for treatment, month on month this performance has been improving and currently 91.7% of patients being seen and treated/admitted within 4 hours for February 17. BTUH have coped better than many other Trusts in the region. We will work with the Trust to continue to improve performance throughout 2017/18. 100.00% 95.00% 90.00% 85.00% 80.00% 75.00% 70.00%
4-hour wait Target Linear (4-hour wait)
East of England Ambulance Service (EEAST) Performance EEAST continues to struggle to deliver on the Ambulance response times. More people in Thurrock were seen within the target periods. However, the percentage of people seen within the target has dropped. This is because of increased demand and more people are using the ambulance service. EEAST performance is monitored locally and regionally, through the Consortium. EEAST have a number of plans in place to improve performance in 2017/18.
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100.00% 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00%
Red 1 within 8 minutes (Monthly Cumulative) Red 2 within 8 minutes (Monthly Cumulative) Cat A19 within 19 minutes (Monthly Cumulative) Red 1 & 2 Target Cat A19 Target
Referral to Treatment (RTT) The RTT target measures the time taken from referral to treatment. 95% of people should start treatment within 18 weeks. Unfortunately, the percentage of people who are seen within 18 weeks is decreasing. The increasing referral rates are contributing to failure to deliver the 18 week standard. We are working with our GPs to improve our plans to manage demand and see more people within the waiting times target in 17/18. We are looking at ways to develop community care to reduce the reliance on hospital care. 94.0% 92.0% 90.0% 88.0% 86.0% 84.0% 82.0% 80.0% 78.0%
Incompete Pathways (RTT) Target
Cancer Services Our aim is to improve early detection and timely treatment of patients with cancer to comply with national waiting time standards. Many people receive treatment from more than one hospital. These are known as complex care pathways. We are working with our commissioning colleagues across the STP to find ways to better co-ordinate care so more people are treated within 62 days. This offers the opportunity to improve survival rates for the people of Thurrock. Plans will be monitored weekly at the new scrutiny meeting chaired by the Director
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of Operations at BTUH. Improving access to psychological therapies (IAPT) IAPT access and recovery are both on trajectory to meet the national standards. IAPT is one of Thurrock’s big successes and we will continue our focus to improve services further still. In 2017/18 we will look to improve the service so we reach more people with anxiety and depression. We know that people with long term conditions like diabetes don’t always get the help they need. We will aim to begin to address this in 2017/18.
Dementia We are aiming to ensure that people get appropriately diagnosed with dementia. It is important that people have a formal diagnosis so that they can get the help they need and plan for their future. We are continuing to screen the care and residential homes to identify those requiring an assessment and diagnosis. Our primary care team are working closely with the practices to support the identification of post diagnostic support. Graph shows rate of dementia diagnosis against targets. 67.00% 66.50% 66.00% 65.50% 65.00% 64.50% 64.00% 63.50%
Dementia Diagnosis Target
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7 day a week working Progress has been made towards seven day a week services within the local community. Working with our health hubs we have been able to increase access to 7 day a week primary care services, ensuring there is a facility available during the weekends.
How your money was spent Continuing our successful financial performance over the last three years, in 16/17 we again achieved all our statutory Financial Duties; not exceeding both the revenue allocation and the administrative costs budget. We spent £204.48m against an allocation of £206.70m, generating a cumulative surplus of £2.22m, of which £2.1m was brought forward from previous years. The chart below shows expenditure across services: How your money was spent (£m)
Total £204.48m
2016/17 Expenditure per Portfolio (£m's) 3.66 3.00 2.10
Acute Services Mental Health Services
24.18
Community Health Care
12.77
Continuing Healthcare
Total £204.48
25.51
Prescribing 114.38
NHS 111 Service Admin/Running Costs
18.88
Other
Our achievements In 2016/17 Primary Care - The four primary care health hubs are helping to deliver seven day a week primary care access to patients. We have been able to offer 27,669 new GP and Nurse appointments since they opened in 2015.
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Supported NHS England to re-procure a number of practices where GPs have retired, or where contracts have come up for re-procurement Supported public health to develop a Joint Strategic Needs Assessment for Tilbury and Purfleet Planning the service specification with the Local Authority to design and build two new primary care healthy living centres; Supported practices to achieve better results in their CQC inspections (over half now rated ‘good’) Supported the wider commissioning team in the implementation of primary care initiatives and GP Forward View
Transforming Care for People with Learning Disabilities The Essex Transforming Care Partnership Board continues to lead the agenda on improving services and support for people with Learning Disabilities (LD). Key to this agenda is to improve services in the community that people can have access to reducing the over reliance of in-patient services. To this end NHS England mandated Care and Treatment Reviews (CTRs) are undertaken routinely to ensure that people at risk of admission have targeted support to prevent avoidable admissions and also to facilitate safe and effective transfers of care to the community when an in-patient episode has occurred. Thurrock CCG and Thurrock Council have collaboratively supported the transfer of 6 of the 7 originally classified as Long Stay patients under the “Winterbourne View remit” in the last 2 years. The last patient in in this category still requires support in a hospital setting and will be facilitated to move on at the earliest possible. In April 2016 Thurrock CCG entered into co- commissioning arrangements with NHS England to deliver the Learning Disability health checks to ensure the percentage delivered is in the upper quartile for England. By end of February 2017 this arrangement had delivered health checks to 63% of the eligible number of people that is anyone with a Learning Disability aged 14+ years registered with a GP in Thurrock. The CCG set an ambitious target of 70% coverage for 2016-17 and we’re on track to achieve that; in comparison coverage in 201516 was 44%. Estates Strategy In 16/17 we achieved a number of objectives. The Local Estates Forum with membership from relevant stakeholders ensures that the estates strategy is robust and takes into account and complements our future commissioning agenda. We have developed firmer plans to build four innovative Integrated Healthy Living Centres in partnership with NHS England and Thurrock Council.
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Health and Wellbeing Strategy The CCG continues to be represented on the Health and Wellbeing Board and to jointly support development of the Health and Wellbeing Strategy, and delivery of the vision, in partnership with Thurrock Council in response to consultation feedback from Thurrock people. The CCG are supporting delivery of the key goals in partnership with Thurrock Council and seeing tangible results. Further information: https://www.thurrock.gov.uk/strategies/health-and-well-being- strategy
Performance Analysis Financial Overview In 2016/17, the CCG maintained its excellent track record established in the previous three years, by not exceeding its total revenue allocation for commissioning services. The running cost allowance for administrative management was also maintained within the allocated budget. For the year under review, we spent £204.48m against an allocation of £206.70m, generating a surplus of £2.22m. The financial plan approved by NHS England at the beginning of the year implied the delivery of an in-year surplus of £100k, thus increasing the cumulative surplus to £2.22m and this was achieved in full. The table below shows our performance against each of the financial targets set by NHS England: 31-Mar-17 Financial Duty
31-Mar-17
Maximum Performance
Duty Achieved?
Expenditure not to exceed income
£'000 208,436
£'000 206,217
Yes
Revenue resource use does not exceed the amount specified in Directions
206,695
204,476
Yes
Revenue resource use on specified matter(s) does not exceed the amount specified in Directions
203,002
200,820
Yes
Revenue administration resource use does not exceed the amount specified in Directions
3,693
3,656
Yes
A key priority for the CCG remains extracting the maximum value through effective commissioning arrangements, as the majority of our expenditure relates to commissioning healthcare services.
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While all healthcare organisations are required to deliver a continuous programme of service improvement and efficiencies, we must also demonstrate that we are properly considering the health needs of the local population and commissioning services that address those needs. The CCG also operates within a complex health and care economy with significant financial challenges and is actively engaged in the development of the STP with partner organisations to ensure long-term financial sustainability. Our overall financial management arrangements were also subject to review by our external auditors, Ernst and Young, as part of their annual review of our accounts. Expenditure Analysis In line with the trend established in previous years, expenditure on acute services accounts for more than half of the CCG’s resources. However as the implementation of our “For Thurrock in Thurrock” transformation programme and the wider STP gathers pace, this balance should be re-dressed in future years, with an increasing proportion of our resource spent on out of hospital services including community, mental health and primary care services. The table below shows the amounts spent on respective services for the year, together with the prior year comparators.
Activity Acute Services Mental Health Services Community Health Care Continuing Healthcare Prescribing NHS 111 Service Admin/Running Costs Other Total
Amount (£m) 114.38 18.88 25.51 12.77 24.18 2.10 3.66 3.00 204.48
2016/17 Proportion of the year's expenditure (%) 56% 9% 12% 6% 12% 1% 2% 1% 100%
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Amount (£m) 109.79 18.12 26.04 10.25 25.76 1.58 3.89 2.30 197.71
2015/16 Proportion of the year's expenditure (%) 56% 9% 13% 5% 13% 1% 2% 1% 100%
The following charts provide a graphic representation of the expenditure in both financial years.
2015/16 Expenditure per Portfolio (%) 1%
2% 1%
13%
Acute Services 56%
Mental Health Services Community Health Care
5%
Continuing Healthcare Prescribing NHS 111 Service
13%
Admin/Running Costs Other
9%
2016/17 Expenditure per Portfolio (%) 1%
2% 1%
Acute Services
12% 56%
Mental Health Services Community Health Care
6%
Continuing Healthcare Prescribing NHS 111 Service
13%
Admin/Running Costs Other 9%
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Better Payment Practice Code (BPPC) The Better Payment Practice Code expects an organisation to pay invoices received in accordance with the contractual terms, and all NHS organisations are required to pay their trade creditors in accordance with this code. The target is for 95% of both the value and the number of non-NHS trade creditors to be paid within 30 days of receipt of goods or a valid invoice, whichever is later, unless other payment terms have been agreed. There has been an improvement in the number of invoices and value of invoices paid during the year 2016/17 compared with 2015/16. The graphs below demonstrate that the CCG met the Better Payment Practice Code (BPPC). 31-Mar-16 31-Mar-16 Number £'000 Non-NHS Payables: CCG Total Non-NHS trade invoices paid in the year Total Non-NHS trade invoices paid within target Percentage of CCG non-NHS trade invoices paid within target NHS Payables: CCG Total NHS trade invoices paid in the year Total NHS trade invoices paid within target Percentage of CCG NHS trade invoices paid within target
8,666 8,504
43,362 43,262
98.13%
99.77%
2,554 2,428
144,558 146,329
95.07%
101.22%
Note: The BPCC % can exceed 100% whenever credit note is not processed alongside related invoice within the 30 days
Number of invoices paid within target
Invoice amounts paid within target 102
99 98
101 101 2015-16
100
2016-17
100 99
99 98
Number of invoices (%)
Amount of invoices (%)
102
97 96
2015-16
95
2016-17
94 93
92 91
98
90
97 NHS payables
NHS payables
Non-NHS Payables
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Non-NHS Payables
Performance Assurance and Measurement NHS England hold monthly performance meetings with the CCG to review performance. NHS England use the ‘Improvement and Assessment Framework’ to ensure that we are delivering our organizational objectives. The framework measures us on our contribution towards delivering the NHS Five Year Forward View. It looks at 4 areas of performance: 1. Better Health – this focusses on areas such as reducing health inequalities, improving choice, diabetes care, falls prevention and anti-microbial resistance. 2. Better care – this focusses on areas such as urgent and emergency care, maternity care, mental health and learning disabilities 3. Sustainability – this focusses on areas such as finance, estates, new models of care and delivering a paperless NHS 4. Leadership – this focusses on areas such as quality of leadership, workforce engagement, local relationships and corporate governance. To enable us to provide this external assurance, we have a robust internal governance processes. Our publicly available Board reports show that the Board receives regular reports on all of the above areas via its quality reports, finance reports, performance reports and commissioning reports. The role of the sub committees are to provide space for more detailed interrogation of issues. The minutes of our sub committees are also available with the board papers. These reports summarise how we performance manage our main health care providers. For each of the main contracts we hold regular contract monitoring meetings, quality meetings and performance meetings to ensure that the providers are delivering against the contract. Our 15/16 performance, announced in July 2016, rated the CCG as requiring improvement. The report highlighted key areas of strength including: -
Good in-house capability and engagement with partners regarding CHC. Shown good progress on developing a primary care strategy Added more capacity in the finance team following a review of the structure last year. The CCG taken a positive action to procure a new IAPT service and NHS England acknowledged the hard work.
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However, it also highlighted areas which requiring improvement. These include: -
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Improvement work in urgent and emergency care. Collaborative working across Mid and South Essex CCGs to improve performance on the cancer, diagnostics and RTT targets. Work with the new IAPT provider to address the inherited backlog issues, staff training and have agreed IAPT trajectories in place. The CCG needs to continue to move forward with the development and transformation of primary care, in context of the Five Year Forward View and recent announcements of the primary care development funding. Continue the good work you have been doing around strengthening the different aspects of a Well-led organisation. Removal of the remaining authorisation conditions. The CCG’s governing body needs to progress the establishment of a Committee in common. Ensuring that the CCG fully contributes to the development and delivery of the Success Regime and STP in Mid and South Essex. The majority of the areas which require improvement involve better joint working across the STP footprint. Significant progress has been made in in 2016/17 in developing the STP plan whilst acknowledging that there is more work to be done regarding the formal governance. The detail of our performance on cancer, diagnostics, RTT, IAPT and A&E are picked up in the performance section of the report.
Our key areas of focus for 2017/18 In line with our Operational Plan 2016-21, our key areas of focus for 2017/18 are: Continue to evolve a high quality Sustainability and Transformation Plan – The Mid and South Essex system forms the sustainability and transformation plan footprint on which all future plans are based. Thurrock CCG is one of the five NHS commissioning partners in the STP, to develop a system plan to improve the Essex health and social care system. We will be undertaking a public consultation on the future of acute hospital services across mid and south Essex. System Aggregate Financial Balance – The CCG has a strong track record of delivering financial balance. However, we recognise that the Essex system is not in financial aggregate balance. Therefore we will work with the STP to co-ordinate efforts to deliver aggregate financial sustainability.
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Sustainability and Quality of General Practice – Thurrock is recognised as having poor access to primary care due to the low numbers of doctors and practice nurses in the area. Our transformation plan and GP Forward View focusses on a number of key issues including developing the Primary Care estate, delivering extended access, developing the ‘out of hospital’ service model – Accountable Care Partnership (ACO), and supporting practices for Care Quality Commission/Local Enhanced Service delivery, and workforce issues. Access Standards and Ambulance – delivering the access standards has been challenging despite on-going system wide plans. We are working with our System Resilience Group to plan to deliver the A&E targets. We continue to work with system colleagues through the Ambulance Improvement Board to deliver the improved ambulance response times. Referral to Treatment (RTT) – We continue to work to with the hospitals to ensure that patients are seen and treated in a hospital within 18 weeks. 62 Day Cancer Waiting Standards – our aim is to improve early detection and timely treatment within waiting times standards. We have completed a Cancer Deep Dive to fully understand the cause issues that affect performance and to help us work across the system to bring performance back on track. Mental Health Access Standards – Both IAPT (Improving Access to Psychological Therapies) and EIP (Early Intervention in Psychosis) have an increased focus for access to treatment with standards being set for 2016/17 and beyond. For IAPT there are waiting time standards of 6 and 18 weeks and for EIP the standard is 2 weeks all of which Thurrock CCG is currently meeting. Mental Health remains an area of high priority for the CCG. Transform Care for People with Learning Disabilities - In April 2016, Thurrock CCG entered into a co-commissioning arrangement with NHS England to deliver the Learning Disability Health checks to ensure the percentage delivered is in the upper quartile for England. Through a concentrated effort we have almost reached our target of 70% coverage for all eligible people in 2016/17. Improvements In Quality – We will continue to drive local improvements in quality through the commissioning agenda. Since April 2016, we have had an in-house Continuing Health Care (CHC) service that allows for enhanced collaboration with the Local Authority in the support of patient care and management.
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We take very seriously our responsibility to provide the very best health services for the local population. Here are just a few of the improvements in healthcare that have been achieved over the last year:
Key issues and risks Whilst we are in a more stable financial position than some of our system CCG partners, maintaining that position gets more challenging every year. We recognize that there are still efficiencies that we can make across the system and we are committed to working together to get the most for the Thurrock pound. We have a challenging efficiency programme (QIPP Plan) and have a robust project management approach to support delivery. We also know that the system is not currently set up to cope with the rapid growth in demand for health and care services. By developing our vision of enhanced neighbourhood based teams, we will be in a better position to meet future demand pressures. We have consulted extensively on our vision. We will need to make rapid progress on mobilisation of the vision so that we can begin to make the long term changes in services to better manage care in the community. We are aware that the delivery of the constitutional standards will be a key risk in 17/18. We will work with our STP colleagues to find the best way to deliver the standards across South and Mid Essex. We are conscious that we need to work with our partner CCGs to reduce duplication and increase focus on improving delivery to patients.
Ensuring safe and high quality services The CCG complies with its contractual obligations to commission services which are safe, effective, caring, responsive and well led. There is the expectation that staff employed in the CCG and provider organisations comply with their professional registration standards, the NHS Constitution and local and national policies. Thurrock CCG has fully recruited to its quality and patient safety team to enable the effective monitoring of provider services. The CCG has reviewed the ‘My NHS’ website, which provides an overall rating for the hospital sites in this locality which is used by several providers. Thurrock CCG is the lead commissioner for North East London Foundation Trust (NELFT) Community Services in Essex. As secondary commissioners we work with other CCGs to monitor the safety and effectiveness of other provider services.
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The QPST (Quality and Patient Safety Team) review all clinical quality performance data for each of these clinical areas. The NELFT service as a whole was reviewed by the CQC during April 2016 and received an overall rating of ‘Requires Improvement’. The Essex locality of NELFT have produced an action plan to address gaps in the quality of service provision which is monitored through the Clinical Quality Review Group meetings (CQRG), observations made and evidence obtained through quality visits. The QPST (Quality and Patient Safety Team) works with the CQC to share intelligence relating to providers and reviews published reports for services relevant to Thurrock CCG’s population. Outcomes from inspections are reported to the Quality & Patient Safety Committee and any exceptions escalated to the Governing Body.
Improving Quality of Care Support has been provided to primary care (for GP Practices) and the local authority, in the monitoring of nursing/care homes and domiciliary providers, both before and after announced visits as required. Some of the GP practices have been re-visited during 2016/17 and there has been demonstrable improvement, with over 50% of the practices now being rated as good and others are working towards achieving a good rating.
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Other providers serving the Essex population have the following CQC ratings: Basildon Hospital – Good, with Maternity services rated as outstanding. Broomfield Hospital – rated as Good. Southend Hospital – rated as requires improvement. East of England Ambulance Services (EEAST) rated as requires improvement. The Quality and Patient Safety Team (QPST) continue to seek further assurances in assessing the quality of service provision. This can be on the basis of observations made and evidence obtained through the schedule of quality visits, external reports or intelligence from CQC reports and updates are provided to the monthly Clinical Quality Review Group (CQRG) meetings. The QPST are actively involved in the work with commissioners to review services and support procurement processes to enhance the quality of care. The QPST have updated the Equality/Inequality Impact Assessment Tool in line with the national guidance published in July 2016, to ensure that quality is at the heart of any service review.
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Cost improvement programmes developed by acute and community service providers are monitored through the respective CQRGs. The Chief Nurse seeks to ensure that proposed savings do not compromise the quality of service to be provided. The Chief Nurse and the QPST scrutinise data and soft intelligence including surveys and reports, to gain assurance on the quality and safety of the service provision which can be used to furnish reactive quality visits in collaboration with partner CCGs, the Local Authority, the Care Quality Commission or NHS England. The findings including areas of good practice and those for improvement are shared with the provider who will develop the action plan which is monitored by the QPST for the lead commissioner. Infection Control Key infection control ceiling trajectories for clostridium difficile infections are set by the Department of Health. The zero tolerance for MRSA bacteraemia is monitored through the Post Infection Review (PIR) processes by Public Health England. All CCG QPSTs monitor the service provider to ensure that lessons learned from any investigation are shared and embedded. Monitoring of pressure ulcers Other soft intelligence includes the reporting of pressure ulcer incidence in line with national frameworks and the serious incident policy. The QPST has been working with NELFT to review how serious incidents for pressure ulcers are investigated and reported. A Pressure Ulcer panel process has been established to undertake multi-incident investigations leading to a thematic review. These panels are attended by front line staff who provide the case history for their patients and the contributory factors to the development of the pressure ulcer. These staff are then able to take the learning directly back to their teams. The formal report is shared with the Chief Nurse and the team. At the end of the reviews NELFT produce a newsletter which is shared across the Essex locality of their organisation to share the cases and the learning. The thematic action plan is monitored through NELFTs Pressure Ulcer Working Group and progress is reported to the CCG through the Clinical Quality Reference Group (CQRG) meetings. A safe environment The NHS Safety Thermometer provides a ‘temperature check’ on harm that can be used alongside other measures of harm to measure local and system progress in providing a care environment free of harm for our patients. This is point prevalence data which is submitted on a monthly basis and discussed at CQRG Meetings with providers. This information is mainly used to triangulate performance against other reports.
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The team also reviews patient feedback from NHS Choices relating to their experiences in hospital and the Friends and Family (F&F) data for three areas - inpatients, A&E, maternity services, plus Outpatients and Day Cases. Complaints investigations and feedback provides opportunities for the CCG to link directly with the public to obtain further information about the quality of service provision. Learning from serious and other incident investigations provides background on the quality and safety of services which is also used as a basis for visits to seek assurances that learning has been embedded and changes made as a result. Safeguarding adults Adult Safeguarding is embedded in the CCG following the update of the policy and the external audit of the processes. There are strong links with Thurrock Local Authority Safeguarding Teams who were also audited by Healthwatch in order to gain assurances of their processes. The functionality of the Thurrock Safeguarding Adults Partnership Board (TSAPB) has been reviewed during the year. This Board is led by an independent chair on behalf of the three statutory partners from health, local authority and the police. The recent appointment of the Business Manager will further cement the processes to safeguarding adults and make safeguarding personal. In October 2016 the TSAPB held its first conference, ‘Making Safeguarding Matter’ which was well attended and successful in sharing its aims across the locality. The changes to legislation relating to the Mental Capacity Act (MCA) and Deprivation of Liberties safeguards (DOLS) has proven challenging, although Thurrock LA has met the required standards and performance data is monitored through the TSAPB. Independent Domestic Violence Advisors (IDVA) have been introduced to acute hospitals across Essex. BTUH has already got one post and this service will now be provided at Southend and Broomfield Hospitals, this work reflects the NICE (2016), Quality Statement for Domestic Violence and Abuse. NHS England is recommending all health professionals should have undertaken the Workshops to Raise Awareness of Prevent 3 (WRAP3) training which will be a requirement going into 2017/18. The CCG is actively supporting this Prevent Agenda and will be offering Primary Care health professionals WRAP3 training through the Time to Learn sessions due to be held in June 2017.
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There is a mandatory requirement to report staff training in Prevent and this is reported to the CQRG and the Health Executive Forum (HEF) for Essex. Safeguarding children The Chief Nurse for NHS Thurrock CCG is a statutory partner of the Thurrock Safeguarding Children’s Board. The CCG ensure its NHS commissioned providers meets their responsibilities through its commissioning arrangements. The CCG has a clearly defined safeguarding accountability and governance arrangements in place which ensure the CCG is able to fulfill all its statutory requirements including the proactive and effective management of risk. The three central imperatives of any intervention for children living with domestic abuse are: - To protect the child/children; - To support the carer (non-abusive partner) to protect themselves and their child/children; and - To hold the abusive partner accountable for their violence and provide them with opportunities to change. The CCG’s approach and response to Child Sexual Exploitation complies with national guidance. It is our collective responsibility as agencies to identify those children at risk of CSE, and ensure that swift and appropriate actions are taken to prevent on-going exploitation and safeguard from further risk of harm. The Children’s Safeguarding Team is also actively involved in the quality and safety of care across south Essex to promote the safety of children and to enhance staff knowledge following investigations and safeguarding concerns at a local and national level. During 2016-17 two serious case reviews, James and Megan were published; the learning from these cases has been shared across the locality and nationally. The safeguarding team are actively promoting the need to hear and record the ‘Voice of the Child’ during any consultations or interaction with children. The reporting of Female Genital Mutilation (FGM) is nationally mandated reporting requirement by any professional who identifies any child under 18 who have suffered FGM. The locality data indicates that the majority of cases currently reported are during maternity care. The source of the FGM has occurred outside the country and some years previous to these cases being identified.
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The Chief Nurse and Accountable Officer attend the Essex Quality Surveillance Group meetings, where soft intelligence and other information is triangulated with the wider CCG audiences, Health Education England, Local Authority and regulators. Based on this information the NHS England (East) provides assurances to NHS England. Safer Staffing The CCG monitors staffing levels together with levels of agency use on a monthly basis and they are discussed at the CQRG Meetings with providers. This is in line with Safer Staffing Initiative (June 2015). For NELFT in particular, recruitment has been highlighted as a risk on both the Trust’s and the CCG’s Risk Register. Constitutional Standards Under the NHS Constitution, patients have the right to access certain services commissioned by NHS bodies within maximum waiting times or for the NHS to take all reasonable steps to offer a range of suitable alternative providers if this is not possible. Cancer Whilst BTUH continue to report breaches in the referral to treatment standard (RTT) 62 day Cancer best practice target and 4 hour target for emergency department attendances. Brentwood and Basildon CCG, the lead commissioners for BTUH, will receive the harm reviews where there is non-compliance with the RTT and 62 day targets. It is the responsibility of the QPST to seek assurances that where there are breaches to these standards that harm has not been caused to the patient through these delays. The quality team are represented at local and Essex wide cancer meetings in order to seek assurances that any breaches have been robustly investigated, if harm has occurred this should be reported as a serious incident (SI) in line with national policy. A workshop in March 2017, arranged by the cancer network, was held to agree a format for these ‘harm reviews’ and to clarify the definition of harm, colleagues from the Essex CCGs and Acute Hospitals in Essex were represented, these definitions will be discussed at the cancer 3x3 meeting to ensure that there is standardisation for the process, themes and trends can then be developed and changes to process and services can be identified to reduce further delays and possible harm, for patients. Reduction in avoidable deaths: The QPST work with the lead commissioners to monitor Hospital Mortality and SHMI (standardised hospital mortality indices) in acute provider organisations, BTUH SHMI remains below the 100 threshold, Southend Hospital has shown some minor improvements from 1.15 -
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to 1.13 although is still higher than the expected threshold. Southend CCG is continuing to seek improvement in their performance. Our review reports from NELFT Serious incidents, (SI) mortality reviews, serious adult and children case reviews and complaints, to ensure that the learning is shared to reduce recurrence. EEAST The CCG provides quality support to monitor the EEAST contract which is led in Essex by North East Essex CCG. The Deputy Chief Nurse for Thurrock CCG is the quality lead and represents the support for the 7 Essex CCG’s in the monitoring of this contract.
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Key Areas for 2017-2018: Our QPST will continue to monitor and challenge provider organisations to maintain safe and effective services through: Contract monitoring of service provision, monitoring KPI and other quality indicators; A schedule of announced and unannounced quality visits to provide further assurances; Review of soft intelligence received from CQC and other regulators, the LA and Healthwatch; Infection prevention and control monitoring of services and outbreaks; Serious incident monitoring for themes and trends including the review of the pressure ulcer panel. Promote programmes for Primary Care Nurse education through the CEPEN funding Strengthen Primary Care workforce knowledge for the PREVENT agenda
Health and Wellbeing Strategy The CCG continues to be represented on the Health and Wellbeing Board and to jointly support development of the Health and Wellbeing Strategy, and delivery of the vision, in partnership with Thurrock Council in response to consultation feedback from Thurrock people. The vision for improving the health and well-being of Thurrock people is to add years to life and life to years, by: - reducing inequality in health and well-being - prevention is better than cure - empowering people in communities - connected services The strategy has 5 goals: Goal 1: opportunity for all – better educated children and residents who can access employment opportunities
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Goal 2: healthier environments – places and communities that keep people well and independent Goal 3: better emotional health and well-being – strengthened mental health and emotional well-being Goal 4: quality care, centred around the person – remodel health and care services so they are more joined up and focus on preventing, reducing and delaying the need for care and support Goal 5: healthier for longer – reduce avoidable ill-health and death The CCG are supporting delivery of these goals in partnership with Thurrock Council. Further information: https://www.thurrock.gov.uk/strategies/health-and-well-being- strategy
Patient and Public Involvement Throughout this report you will see examples of the impact of patient and public participation, such as using patient experience examples to consult on key transformation plans, including For Thurrock in Thurrock and engaging in plans from the Mid and South Essex STP. Patients are able to feedback on quality of care through complaints, consultations, engagement days and working closely with patient advocacy groups, such as Healthwatch Thurrock. These examples show how people’s views have helped to shape plans and services over the past year. We are honest about how things could have gone better and we learn from this doing things differently as a result. Our key forum for participation is the Commissioning Reference Group (CRG) which aims to engage with as many groups, organisations and individuals that represent current and potential service users. The involvement of Public & Patient Group’s, Healthwatch Thurrock, CVC and Thurrock Coalition along with other voluntary organisations and groups enable meaningful engagement. Over the past year we have held the CRG in different locations at different times however this has not been successful. We asked for input and have now returned to the same venue at a similar time to maintain consistency. The CCG faces the challenge of encouraging participation at a time when there is so much information for patients and the public on changes to local health and care offer. The messages can be complex and confusing with so much change going on. This includes the locality developments, Five Year Forward View, STP and Health and Social Care agenda (Better Care Fund). We aim to keep information in plain English and free from jargon and accessible. We offer information in braille or other languages on request. When we engage with people, we listen to what they want and shape our services to meet their needs.
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Commissioning Reference Group
Type of engagement
Numbers engaged with
Bi-monthly
Public meeting to discuss key issues affecting health and care in Thurrock
147
Public meeting Workshops and drop in Surveys Workshops and drop in
30 150 289 replies 35
Survey and public engagement event.
8,000 people reached 264 surveys completed
Public meeting on NHS England proposed closure
Over 400 people directly reached at public meetings.
Mid and South Essex STP July 2016 Sept 2016 March 2017 For Thurrock in Thurrock – our local STP March 2016 East Tilbury Medical Centre October 2016
Chart shows split of patient engagement between 2016/17: 400 147 774 Mid & South STP For Thurrock in Thurrock East Tilbury Medical Centre Closure CRG 8264
Key activity for the next financial year will be reaching out to harder to reach groups that we do not see represented through our current methods of engagement. We will continue to help facilitate difficult discussions in changes of services and hold public events at times and accessible places to give the whole community a chance to have their say.
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Reducing health inequality The CCG policy for EQIA has been developed to comply with the NHSE Equalities and Health Inequalities Policy 2016, this document is being ratified and is due to be approved at the next available Governing Body meeting in 2017/18. The quality team review the EQIAs for all new and revised services. In addition the CCG has reviewed the Adult Safeguarding policy and this complies with Southend Essex and Thurrock (SET) guidance which included MCA/DOLS to ensure that patients are managed appropriately and consideration is made to their mental capacity to support robust decision making to enable patient choice. The CCG has been audited on their Adult safeguarding management and achieved adequate assurance and all recommendations have been completed. During 2016 the Children’s Safeguarding audit was obtained and received a good assurance rating. Both Adults and Children’s Safeguarding training is provided through the time to learn sessions to ensure that Primary Care are fully appraised of their responsibilities to reduce inequalities. The Quality team monitors provider compliance with the mandatory Duty of Candour standard to ensure that the patients are treated with openness and honesty in the sharing of the outcome of investigations. CCG staff are required to undertake mandatory training on equality and diversity to ensure they are aware of their responsibilities, the CCG also monitor providers compliance with this requirement and the safeguarding, MCA/DOLS training.
Continuing Healthcare Commissioning/End of Life Care In April 2016, the CCG successfully established an in-house Continuing Healthcare Commissioning (CHC) team; a statutory function that had until 2016/17 been provided by a Commissioning Support Unit (CSU). CCG direct delivery of CHC has provided an opportunity to enhance the clinical assessment and financial management practice to mitigate national and local challenges within this portfolio. Within 2016/17, the CHC function of the CCG has: - Enhanced the clinical assessment and care management of patients found eligible for CHC funding; - Established a new process for procuring individual domiciliary care packages to ensure
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quality standards are achieved within a defined funding envelope; Review of all historic neuro-rehabilitation placements to ensure patients are in receipt of care appropriate to their needs; Uplift awarded to nursing and residential care homes, following the increase in National Living Wages; Continued growth in patients opting to hold a Personal Health Budget for their CHC needs; In partnership with St Luke’s Hospice the CCG has realised an increased number of patients achieving their personal preference in End of Life care; through the expansion of the Rapid Assessment Discharge Service.
End of Life Care St Luke’s Hospice has now been commissioned as the Accountable Lead Provider Organisation for NHS Thurrock CCG’s end of life care services, which will help strengthen and realise seamless care pathways for palliative and end of life patients. Additional achievements in 2016/17 have included: -
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One Response, the single point of access for end of life services, continues to experience year on year growth which has been instrumental in ensuring patients can access advice and services 24/7 Growth in the capacity and delivery of the Rapid Assessment Discharge Service (RADS); for those end of life patients wishing to receive their care within their own home; Continued delivery of End of Life Gold Standards Framework (GSF) discussions across all General Practices in Thurrock; Piloting a model of care to facilitate earlier discharge from hospital for patients with complex End of Life needs, to help inform future service delivery; Increased numbers of patients are being identified as being in the last year of life which is helping the CCG achieve its aim of ensuring a year-on-year increase of patients achieving their Preferred Place of Care / Death.
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Sustainable Development Sustainability has become increasingly important as the impact of people’s lifestyles and business choices are changing the world in which we live. In order to fulfill our responsibilities for the role we play, we have following sustainability mission statement located in our Sustainable Development Management Plan (SDMP): “Being sustainable will help us make the most of our existing resources – money, supplies, buildings and energy – without compromising the needs of future generations." One of the ways in which an organisation can embed sustainability is through the use of a SDMP. The Governing Body approved our SDMP in August 2013 and our plans for a sustainable future are well known within the organisation and clearly laid out. This is due for review in this coming year 2017/18.
Please see Appendix 1 - Sustainability Report
Equality Report Ensuring equality for all: Working towards an NHS that is personal, fair and diverse Equality is about making sure people are treated fairly and given fair chances. It’s not about treating everyone the same way, but recognising that their needs are met in different ways. Our Governing Body is formally committed to the NHS Equality Delivery System (EDS), and has been kept updated on this work. A review of our Equality & Diversity Strategy will be undertaken early in 16/17 to assess how we are performing against the new requirements of the NHS Equality Delivery System (EDS 2). A number of steps have already been taken to ensure that we fulfill our public sector equality duty: Information about the composition of our workforce has been published on the dedicated equality and diversity section of our website; Within the Equality and Diversity Strategy, we have published our interim EDS goals; The Commissioning Reference Group, comprises of representatives from all sections of the Thurrock community, and is a key vehicle for agreeing priorities with the community and assessing progress; ensuring an Equality and Diversity Policy is in place; The Lay Member (Patient and Public Involvement) is appointed as Board-level lead for Equality & Diversity; Equality impact assessments are undertaken on all CCG policies, QIPP plans and commissioning cases.
Please see Appendix 2 – Equality report
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Accountability Report
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Statement of Accountable Officer’s Responsibilities The National Health Service Act 2006 (as amended) states that each Clinical Commissioning Group (CCG) shall have an Accountable Officer and that Officer shall be appointed by the NHS Commissioning Board (NHS England). In February 2017, NHS England appointed Mandy Ansell, Accountable Officer for NHS Thurrock CCG, prior to this Mandy was the (Acting) Interim Accountable Officer. The responsibilities of an Accountable Officer, including responsibilities for the propriety and regularity of the public finances for which the Accountable Officer is answerable, for keeping proper accounting records (which disclose with reasonable accuracy at any time the financial position of the CCG and enable them to ensure that the accounts comply with the requirements of the Accounts Direction) and for safeguarding the CCG's assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities), are set out in the CCG Accountable Officer Appointment Letter. Under the National Health Service Act 2006 (as amended), NHS England has directed each CCG to prepare for each financial year financial statements in the form and on the basis set out in the Accounts Direction. The financial statements are prepared on an accruals basis and must give a true and fair view of the state of affairs of the CCG and of its net expenditure, changes in taxpayers' equity and cash flows for the financial year. In preparing the financial statements, the Accountable Officer is required to comply with the requirements of the Manual for Accounts issued by the Department of Health and in particular to:
Observe the Accounts Direction issued by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis;
Make judgments and estimates on a reasonable basis;
State whether applicable accounting standards as set out in the Manual for Accounts issued by the Department of Health have been followed, and disclose and explain any material departures in the financial statements; and,
Prepare the financial statements on a going concern basis.
To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my CCG Accountable Officer Appointment Letter.
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Signed by Mandy Ansell, Accountable Officer, NHS Thurrock CCG
May 2017
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Governance Statement Introduction and context NHS Thurrock CCG is a body corporate established by NHS England on 1 April 2013 under the National Health Service Act 2006 (as amended). The clinical commissioning group’s statutory functions are set out under the National Health Service Act 2006 (as amended). The CCG’s general function is arranging the provision of services for persons for the purposes of the health service in England. The CCG is, in particular, required to arrange for the provision of certain health services to such extent as it considers necessary to meet the reasonable requirements of its local population. As at 1 April 2016, the clinical commissioning group is subject to any directions from NHS England issued under Section 14Z21 of the National Health Service Act 2006 as follows: - NHS Thurrock CCG continued to be licensed with two conditions (placed upon the CCG during the ‘authorisation’ process) relating to the permanent appointment of an Accountable Officer (AO) and the impact of the lack of a permanent appointment on the capacity and capability of the senior in-house management team to maintain 5
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strategic oversight within available resources , and three directions. The first direction related to the appointment of the AO and the remaining two related to contracts. However, from 1st February 2017, following the appointment of the (Acting) Interim Accountable Officer into the substantive Accountable Officer post (following a national recruitment process), NHS England has lifted the conditions and directions relating to the Accountable officer and consequently one condition remained. On 21 February 2017, the CCG was given a new set of Directions by NHS England following an investigation report into potential governance issues commissioned by NHS England (in August 2016). This arose from a qualification of the ‘value for money opinion’ of the External Auditors report for the year ended 31st March 2016, that the CCG had not made appropriate arrangements to secure economy, efficiency and effectiveness in their use of resources, due to the lack of a permanent Accountable Officer. Issues to be addressed focused on the Accountable Officer appointment (which at the point of commissioning by NHSE, had not been resolved by the CCG), the Exercise of CCG Functions, and Executive Team and Senior Management Appointments. The CCG Remuneration Committee is overseeing a detailed improvement plan to facilitate the removal of the Directions, some of which are already complete. On 31st March 2017, NHS Thurrock CCG, along with NHS Southend CCG and NHS Castlepoint and Rochford CCG, was given a set of Directions instructing the 3 CCGs to work together with NHS Basildon and Brentwood CCG and Mid Essex CCG. Specifically the CCGs are directed to form a joint committee to manage those commissioning functions that are best suited to delivering once, across the system footprint that
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describes the Mid and South Essex Sustainability and Transformation plan. Copies of the Directions issued by NHS England have been published on the CCG website www.thurrockccg.nhs.uk and are also available on the NHS England website NHS Thurrock CCG has continued to manage the conditions through liaison with NHS England with a view to resolving this matter and expect the final condition (in relation to ‘Authorisation’) to be lifted in early 2017/2018. In the intervening period, the Accountable Officer working closely with the Executive team, has provided stability and enables NHS Thurrock CCG to continue its role unaffected operationally. The CCG has been working to resolve the issues identified and ensure minimal impact on the financial position as well as ensuring excellent continued leadership in the delivery of CCG objectives. Steps are also being taken (via the improvement plan) to actively address the outstanding conditions and directions with the aspiration that they will be removed by NHS England during 2017. Scope of responsibility As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the clinical commissioning group’s policies, aims and objectives, whilst safeguarding the public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out under the National Health Service Act 2006 (as amended) and in my Clinical Commissioning Group Accountable Officer Appointment Letter. I am responsible for ensuring that the clinical commissioning group is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity. I also have responsibility for reviewing the effectiveness of the system of internal control within the clinical commissioning group as set out in this governance statement.
Governance arrangements and effectiveness The main function of the governing body is to ensure that the group has made appropriate arrangements for ensuring that it exercises its functions effectively, efficiently and economically and complies with such generally accepted principles of good governance as are relevant to it. The National Health Service Act 2006 (as amended), at paragraph 14L(2)(b) states: The main function of the governing body is to ensure that the group has made appropriate arrangements for ensuring that it complies with such generally accepted principles of good
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governance as are relevant to it. The governance framework of NHS Thurrock CCG is set out in the CCG’s Constitution. The Constitution has been refreshed during the year to ensure it is current, and in particular reflects the new joint commissioning arrangements that have been established around learning disability health checks. The governance arrangements established in the original Constitution (based on the Model Constitution Framework for CCGs (NHS England, October 2012) remained largely unchanged. This refresh took place during spring and was approved by NHS England on 16 June 2016. The Constitution sets out the way in which the CCG is governed and how it discharges its statutory functions via membership and committee arrangements to ensure that the principles of good governance are observed and practiced in the way it conducts its business. A procedural framework exists to support the Constitution and provide direction to members and staff in the delivery of CCG objectives, for example Standing Orders, Standing Financial Instructions, a Scheme of Reservation and Delegation and a suite of policies reflecting all aspects of business and good governance have been established and published on the CCG website and intranet. The Governing Body membership as at 31 March 2017 comprised: - Chairman (GP) - Accountable Officer - Chief Finance Officer - Three Lay Members1 (one leading on governance, who is also the Deputy Chair, one leading on Patient & Public Involvement (PPI), and a third member providing support, in particular to facilitate good practice around managing conflicts of interest) - Chief Nurse - Secondary Care Specialist Doctor - Nine GP Governing Body Members (one vacancy, from 1st January 2017) - A Practice Manager (non-voting) The following officers are invited to attend the Governing Body meetings and present reports on matters in relation to commissioning and partnership working: - Director of Commissioning (CCG) - Director of Transformation (CCG) 1
The CCG had engaged a sessional Lay Member throughout 2015/16 to support committee arrangements. After a specific recruitment process, that member was appointed to a substantive Lay Member post, in accordance with the NHS England guidance on conflicts of interest that requires CCGs to have three Lay Members. The CCG was in the process of updating its constitution, which would include reflecting the change to a third Lay Member.
46
-
Director of Public Health (Thurrock Council) Director of Adult Services (Thurrock Council) Chief Operating Officer, HealthWatch
The Lay Member PPI vacancy during 2015/16 was filled from April 2016 and consequently the CCG had a full complement of Lay Members, which coincided with NHS England guidance around the need for three Lay Members. The tenure of office of GP and Practice Manager Governing Body members came to an end as at 31 December 2016. A programme of work was organised from summer 2016 to facilitate the election process up until the new Governing Body was established from January 2017, which was conducted by the Local Medical Council. During the 2016/17 year, the Governing Body met on a monthly basis, with alternate meetings (except one) being Governing Body development sessions. Five development sessions were held in total with seven meetings held in public. The average attendance at Governing Body meetings was 88%2 (66% in 15/16; 77% in 14/15). All meetings throughout the year were quorate. The bar chart below demonstrates attendance at the Governing Body meeting for the different groups who attend. The period of vacancy for the Secondary Care Consultant (August 2016 to February 2017) has meant that overall representation for the Secondary Care Consultant at the Governing Body was reduced (42%). Therefore adjusted figures have been presented below (see footnote).
Governing Body Attendance 2016/17 97%
Executive Officers 74%
GP Members
85%
Lay Members
100%
Secondary Care Specialist 83%
Non-Voting Member
79%
Invited to attend
2
Figures have been adjusted to remove vacancies (secondary care consultant vacancy from August 2016 to February 2017 inc), and long-term sickness of one Board Member who did not attend any meetings.
47
An assessment of Governing Body business was carried out to ensure that the focus of discussion and debate remained on the roles of strategy, leadership, governance and transparency and holding the executive to account for the delivery of CCG objectives. The pie chart below depicts the focus of Governing Body activity, which is reflective of the role of the CCG and the environment in which it currently operates. The delivery of the CCG strategy runs throughout each of these areas, which has empowered the CCG to deliver its strategic aims over the last year.
Governing Body Business 2016/17 Quality and Clincal 28%
28%
Finance 8% 19%
Commissioning
17% Partnership Working Governance & Risk Management
The effectiveness of the Governing Body was assessed differently during 2016/17 because of the election of a majority of new GP Members. Instead, a comprehensive induction and Board development programme was established over a period of three days (two specific induction days as well as a Board development session), accompanied by an extensive ‘new member orientation pack’ provided to support members. In addition to this, a Governing Body skills self-assessment was also carried out to determine whether the composition of the Governing Body was appropriate to enable effective working. A desktop exercise was also carried out to assess the maturity of systems of governance at the CCG against the criteria set out by the Good Governance Institute (GGI) (as part of the Governance programme commissioned by NHS England). Outcome of GGI Maturity Assessment: The assessment model sets five levels to reaching ‘mature’ governance arrangements. During the year four areas moved up to the next level of maturity, but the remaining seven stayed at the same level, which was primarily due to the change of the CCG Board to a number of new members and the introduction of new Directions for the CCG to address. The following table sets out the assessment in more detail and shows how the CCG has progressed over the last three years. 48
Area and
Statement
Level
15/16
14/15
Level 4 – Maturity
3
2
1
1
Level 4 – Maturity
3
2
Level 2 –
2
2
Level 4 – Maturity
4
4
Level 3 – Results
3
3
Direction of
Demonstrated
Travel
16/17
Clarity of
External stakeholders recognise distinctive CCG
Purpose
approach and understand aims. CCG can identify examples of where purpose has been delivered.
Leadership and
The Governing Body is focusing on reaching the
Level 2 – Early
Strategic
strategic goals and is using instruments such as
Progress
Direction
the assurance framework to deliver these. Plans to motivate clinical leaders of the future have been agreed. Business / operational plans are in
place, and reflect marketplace context and
Effectiveness of
Local providers, partner organisations, and other
Relationships
stakeholders agree that the CCG is materially
strategic goals.
influencing their plans and performance. CCG contribution valued by partners. Membership
Members general engaged in CCG business and
Support
participate at various levels in decision-making. Members comply with decisions and policies
Early Progress
agreed by the CCG. Pubic and
Leaders in the CCG value community input as a
Community
source of insight that helps make better decisions;
Engagement
CCG is able to demonstrate that public/community engagement has led to change. Engagement methods in line with sound
social science practice.
Quality and
CCG decisions and operational plans can be
Safety Structures
linked to formal CCG structures and systems to improve care standards in line with evidence-
49
Area and
Statement
Level
15/16
14/15
Level 3 – Results
3
1
Level 3 – Results
3
2
Level 3 –
2
2
Level 3 – Results
3
3
Level 2 –
2
2
Direction of
Demonstrated
Travel
16/17
and Systems
base. New responsibilities such as collaborative commissioning have been formalised. Systems are in place that enables the CCG to deliver its duty of
care, including safeguarding.
Focus on
Identifiable changes in referral patterns towards
Outcomes
operational goals. Early signs of desired process changes taking place. Patient and carer experience positive outcomes,
Better Decision-
There is a consensus amongst the membership
Making
and stakeholders that CCG decisions have been thoughtfully made and are fair. Evidence has been used when decisions are made. Conflict of
interest issues routinely recognised and managed.
Control Systems
The Governing Body members agree that the governance mechanisms in place are useful and reliable. Performance data and system
Results
recognised as fit for purpose by the Governing Body. These mechanisms are felt to have contributed to the good running of the CCG.
Legal and
CCG Performance reports and reviews of
Regulator
operations show progress towards goals relating
Compliance
to legal duties, such as equalities, integration and quality of care.
Organisational
Examples of better working practices being
Effectiveness
adopted. Routine review of governance mechanisms agreed. Personal development plans agreed for key staff and governing body
50
Early Progress
Area and
Statement
Level
Direction of
Demonstrated
Travel
16/17
15/16
14/15
members.
The Governing Body has progressed along the pathway for the development of its Governance Arrangements. An Organisational Development Plan is also being developed, which includes a plan for developing the Governing Body further, which will be delivered during 17/18. To support the Governing Body in carrying out its duties effectively, a number of subcommittees have been established. A review of committee effectiveness during the year highlighted the potential for the QIPP Committee to work more effectively. Consequently the Transformation and Sustainability Committee (TASC) was created to better reflect a committee accountable for both the QIPP agenda and the long-term transformation plans of the CCG. The remit and terms of reference of all Governing Body sub-committees have been reviewed in year and are available on our website, in summary:
The Audit Committee met six times during the year. The audit committee has delegated responsibility for ensuring that adequate assurances have been received over the CCG systems of internal control, and to provide an independent and objective review on its financial systems, financial information and compliance with laws, guidance and regulations governing the NHS. All meetings were quorate with an average attendance of 83% (78% in the previous year). The Audit Committee approved work programmes for Internal and External Audit as well as the CCG’s Local Counter Fraud Specialist (LCFS). Regular reports have been received from each assurance provider which has informed the management of risk through the CCG Governing Body Assurance Framework (GBAF). The Audit committee has also monitored recommendations and taken pro-active measures to call on management to bring forward corrective actions where appropriate. An annual selfassessment of the effectiveness of the committee has been conducted along-side a review of the work of the committee over the year, which has been collated into an annual report to the Governing Body. 51
Developments in year to the structure and content of the GBAF have been well received and have provided a more structured approach to receiving assurance on CCG key risks. This has been enhanced by requesting management to attend the committee to discuss risks within the GBAF and Corporate Risk Register (CRR). The Integrated Governance Group reports into the Audit Committee and meets on a bimonthly basis. The group has no delegated powers, but rather is a group with membership of the CCG Chair, (Acting) Interim Accountable Officer, Chief Nurse, Chief Finance Officer, Practice Manager Governing Body Member, Head of Corporate Governance and Head of Business Support. The purpose of the group is to process and deliver good governance practices across the CCG. The group met six times during the year (one meeting being held virtually by circulation of papers). Regular reports were provided on IGG business to the Audit Committee. The Quality and Patient Safety Committee (QPSC) met on a monthly basis and has delegated responsibility for providing assurance over the quality of services commissioned on behalf of the Thurrock population to ensure quality, safety and a positive patient experience and that the CCG’s statutory responsibilities are met. Three meetings were not quorate, but no decisions were made at those meetings. Average attendance at the committee was 63% (84% in the previous year)
-
-
-
-
The Quality and Patient Safety Committee: Is supported by the Quality Team, who have been working to optimise the monitoring of the quality of service provision and this has led to the Quality Team being fully established within the CCG. In addition the Continuing Healthcare (CHC) and Personal Health Budget (PHB) teams were brought in-house (within the Quality Team) from 1st April 2016. Seeks assurance that the CCG’s commissioning strategy fully embraces all elements of quality (patient experience, effectiveness and patient safety) keeping in mind that the strategy and response may need to adapt and change. Has oversight of the risk management systems and processes in relation to quality, which is embedded into committee business through the assurances it seeks and in turn provides to the Governing Body (as set out in the paragraphs below). The committee also ensures that the risk profile is appropriate and that new risks or changes to existing risks are added to the risk registers as they arise. Provides assurance that commissioned services are being delivered in a high quality and safe manner, ensuring that quality sits at the heart of everything the CCG does, which includes commissioning services together with other CCGs. Assurances are gained through the programme of quality visits, review of performance reports, CQC/Regulator reports and minutes of Clinical Quality Review Group (CQRG) meetings. 52
-
-
-
-
-
-
Provider performance is monitored against national targets and standards set by the CQC, Monitor and any other relevant regulatory bodies. Examples include receiving minutes from the North East London Foundation Trust (NELFT) CQRG meetings, which are attended by the Quality Team. Robust pre-meetings are now held in preparation for the CQRG and contract negotiation meetings, which has resulted in those meetings being more productive and effective. Monthly East of England Ambulance Service NHS Trust reports for the locality contract have also been received and monitored closely to enhance assurances around EEAST as one of the CCGs continually highest risk areas. Has oversight of and therefore receives assurances on the controls and processes in place for the management and reporting for serious incidents (SIs) and compliance with the National SI framework, including the reporting of Never Events, theme and trend analysis, with the purpose of keeping the Governing Body appraised of concerns and risks which require escalation in a timely and appropriate manner. There is a strong focus on the sharing of learning and this is supported by the CCG through the bimonthly Harm Free Care meeting. Has oversight of complaints and concerns received by the CCG in relation to quality issues. This includes receipt of a quarterly report on the cases received by the CCG. Ensure that ‘lessons are learnt’ from national enquiries/reports relating to good practice and that where appropriate national guidance is incorporated in CCG processes (and those of providers) to strengthen clinical practice (such as NICE guidance). Seek assurance that Cost Improvement Programmes (CIP) and Quality, Innovation, Productivity and Prevention (QIPP) projects are adequately assessed so as not to impact adversely (in an unmanageable way) on the quality of services delivered. In fact, equality and quality impact assessments are undertaken whenever there are changes to new or existing services. Seek assurance that adequate controls exist over Medicines Optimisation team processes for provider and primary care services. Receive and scrutinise independent investigation reports relating to patient safety issues and agree publication plans, these include serious case and domestic homicide reviews for both adults and children safeguarding concerns. Such reports provide a detailed insight into provider performance, and also inform the CCG of areas of poor practice that may need to be addressed across a wider area. Receive evidence and learning from the Pan Essex Quality Surveillance Group (EQSG), attended by the Accountable Officer and the Chief Nurse, which is disseminated to the Quality Team to ensure the CCG is acting upon any key issues arising. Reviews and endorses all clinical and safety related policies prior to their consideration by the CCG Governing Body. An annual self-assessment of the effectiveness of the committee has also been conducted along-side a review of the work of the committee over the year, which has been collated into an annual report to the Governing Body. 53
-
The Finance & Performance Committee met on a monthly basis (although two meetings were cancelled due to unforeseen circumstances) and has delegated responsibility for scrutiny of the financial performance of the CCG, to ensure that financial issues are being appropriately managed and escalated where necessary, as well as reviewing the performance of the main services commissioned by the CCG. Three meetings were not quorate, however no decisions were made at the meetings, but rather recommendations were made to the Governing Body to take those decisions. There was an average attendance of 83% (75% in the previous year).
-
The committee work-plan ensured that a review of all the services the CCG provides and contracts was carried out across the year, in terms of performance, finances and any key risks that were fed into the GBAF. The committee played a large part in ensuring the CCG met its statutory duties of financial performance, including delivering the mandated surplus, as well as maintaining the work program across running costs and programme budgets.
-
An annual self-assessment of the effectiveness of the committee has also been conducted along-side a review of the work of the committee over the year, which has been collated into an annual report to the Governing Body.
-
The Transformation and Sustainability Committee (TASC), formally the QIPP Committee, responsible for ensuring the delivery of the Quality, Innovation, Productivity and Prevention initiative and for accountability for the CCG Transformation programme met 11 times during the year with an average attendance of 69% (previously 85%). One meeting was not quorate, however, no decisions were made at that meeting. The Remuneration Committee met 12 times during the year, having delegated authority as an independent committee responsible for making decisions on behalf of the Governing Body on all aspects of the remuneration and terms of service of CCG Executive, staff and Governing Body Members to ensure that fairness, equity and consistency is applied in the remuneration and performance management process. The terms of reference of the committee has been reviewed and updated during the year. All meetings were quorate with 92% attendance. The Conflict of Interest Committee met 3 times during the year, having delegated authority as an independent committee responsible for making decisions on behalf of the Governing Body where the Governing Body (or sub-committee) is considered to be conflicted in such a way that they are unable to make a decision because that committee would no longer be quorate having excluded conflicted members. All meetings were quorate and attendance was 100%. Decisions made, were reported back to the Governing Body for noting. 54
Two additional groups are in place to enhance our GP Member and Public engagement as follows: -
The Commissioning Reference Group (CRG), responsible for the scrutiny and management of the commissioning function, reporting into the Quality and Patient Safety Committee and the Governing Body. The Group has enabled the CCG to engage the public, better understanding their needs and views to ensure that we are actively responsive in the way that we support the delivery of integrated care. The CRG met five times during the year and was attended by members of the public and patient groups, reports feeding back the work of the group were presented to the Governing Body meetings throughout the year.
-
The Clinical Engagement Group (CEG), providing the forum for engagement with Practices over clinical functions and pathways, reporting into the Governing Body. The Group ensures that the pathways experienced by our patients are innovative and effective in meeting the needs of our local population. The CEG met 12 times during the year and was well attended by practice representatives, with reports provided to each Governing Body meeting on discussions and outcomes from the CEG. UK Corporate Governance Code NHS Bodies are not required to comply with the UK Code of Corporate Governance. However, we have reported on our corporate governance arrangements by drawing upon best practice available, including those aspects of the UK Corporate Governance Code we consider to be relevant to NHS Thurrock CCG and best practice, as follows: -
-
Leadership: The governance framework for NHS Thurrock CCG is set out within the CCG Constitution (summarised below) and provides for effective leadership by the Governing Body who are collectively responsible for the long-term success of the CCG. There is a clear division of responsibility between the Governing Body Members and the role of Executive Officers and a comprehensive induction process for new Members of the Governing Body has been conducted to continually develop how they interact to promote and ensure good leadership. Effectiveness: NHS Thurrock CCG’s Constitution defines the mechanisms for effectiveness, supported by a suite of policies and procedures governing operational effectiveness. This includes transparent recruitment processes accompanied by training and continued professional development for members of the Governing Body and core staff. A skills matrix assessment has been carried out during induction to assess the composition of the Board and this will be used to inform the Board development process in 2017/18. Accountability: Defined below, the Risk Management Framework enables the CCG to pro-actively manage and report on risk. This is achieved via the Governing Body 55
-
-
Assurance Framework and Corporate Risk Register, supported by assurances from the CCG Internal and External Auditors who scrutinise the CCG systems of internal control. Remuneration: A formal and transparent procedure is in place for the remuneration of executive and lay members of the Governing Body. A delegated sub-committee of independent (Lay) members is responsible for the remuneration of Governing Body Executive Officers and CCG staff members. Executive Governing Body Members are responsible for decisions in relation to Lay Members remuneration (in accordance with national guidance). Relations with Stakeholders: The CCG continues to work closely with all stakeholders, particularly patients and members of the public who are involved in the development of the CCG wherever possible. Our Commissioning Reference and Clinical Engagement Groups as well as public Governing Body meetings are the primary mechanisms by which we achieve good engagement. Furthermore, we now have a ‘joint’ working arrangement with the Local Authority delivering the ‘For Thurrock In Thurrock’ brand.
Discharge of Statutory Functions During establishment, the arrangements put in place by the CCG and explained within the Corporate Governance Framework were developed with extensive expert external legal input, to ensure compliance with the all relevant legislation. That legal advice also informed the matters reserved for Governing Body decision and the scheme of delegation. In light of recommendations of the 1983 Harris Review, the CCG has reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislative and regulations. As a result, I can confirm that the clinical commissioning group is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions. Responsibility for each duty and power has been clearly allocated to a lead Director. Directorates have confirmed that their structures provide the necessary capability and capacity to undertake all of the CCG’s statutory duties.
Risk management arrangements and effectiveness The CCG Risk Management Strategy was updated for 16/17 to reflect the CCGs current level of risk maturity, and was approved by the Audit Committee and then Governing Body in June 2016. The policy and strategy sets out the risk framework for the CCG (the method by which the CCG identifies, assesses, reviews, updates and reports on risk) as well as providing an assessment of how the CCG performed against the HM Treasury framework for Risk Management Systems; establishing an action plan of how the CCG can mature and 56
develop its risk systems. The CCG operates a combined Governing Body Assurance Framework (GBAF) and Corporate Risk Register (CRR), which is the CCG’s principal tool for monitoring and managing the risks to the achievement of its strategic objectives and statutory duties. The GBAF captures the CCGs ‘extreme’ rated risks, scoring 15 or above and the CRR records and monitors the low, moderate and high rated risks. The GBAF and CRR are updated on a bimonthly basis to coincide with public Board meetings. This formal review involves one-toone meetings between the Head of Corporate Governance and each risk owner (one of the executive officers) to review changes in the controls and assurances and progress against agreed actions since the previous review. The GBAF and CRR are then scrutinised in detail by the Audit Committee, Quality and Patient Safety Committee and the Finance and Performance Committee prior to submission and formal approval by the Governing Body at one of its meetings in public. This provides an opportunity for the public to be informed of NHS Thurrock CCG risk management processes and also to participate in discussions and action plans related to the management of those risks. The GBAF follows the nationally recognised approach used within the NHS, which has been audited and deemed appropriate by the CCG Internal Auditors. The following key areas are highlighted within the GBAF: - Strategic Objective and the Directorate Objective to which the risk relates; - The risk description (and the consequence of that risk); - A risk assessment as to the consequence of the risk and the likelihood of the risk occurring (including both an inherent and residual risk rating) Lead responsible for risk and the date of last assessment; - Committee responsible for the risk; - The control framework in place to protect/manage the risk area; - The risk appetite; - The direction of travel; - A sparkline showing how the risk has changed over time; - The rationale for the current score; - Key Performance Indicators (target and actual scores); - The assurances received (from internal or external sources) as to how the control framework is operating, and whether they are providing positive or negative assurance (i.e. the controls are or are not working); - A gap analysis of any missing controls or assurance.
57
Risk Category
Appetite
Acceptable Risk Score
Achieving financial balance both within the CCG and
Financial Statutory
Low
5
Duties
in the wider local health economy is both a strategic priority and a statutory duty. Therefore the CCG will not accept any risk that (if realised) will threaten this.
Fraud and negligent
Rationale
The CCG will not tolerate financial losses from fraud Low
5
financial loss
and negligent conduct as this represents corporate failure to safeguard public resources. We hold patient and staff safety in the highest regard and will not accept any risks that threaten
Clinical Quality and
Low
5
Patient Safety
this. The CCG will commission high quality services for our patients. We will only rarely accept risks which threaten that goal.
Regulatory / Compliance
The CCG will comply with all applicable legislation Low
5
and will not accept any risk which (if realised) would result in non-compliance. The CCG will maintain high standards of conduct
Reputation
Low
5
and will not accept risks that may cause reputational harm because it could undermine public and stakeholder confidence. The CCG will work with its member practices and
Partnerships,
other organisations (including but not restricted to
Engagement and
Moderate
8
Collaborative
best outcome for patients and communities. We are willing to accept the risks associated with a
Working
Innovation
other CCGs and Local Authorities) to ensure the
collaborative approach. High
12
We encourage a culture of innovation and are 58
willing to accept risks associated with this approach where they do not threaten risk areas that the CCG are not prepared to accept (as defined above e.g. quality patient care / safety). The CCG accepts that provider performance is Provider Performance
Moderate
8
challenged and the CCG has little ability to affect change over the performance of another party, other than to influence and encourage.
Commissionin g
National Policy
Clinical Engagement
Innovative Moderate
8
approaches
for
commissioning
incorporate an inherently high level of risk, which can impact on the delivery of outcomes.
Low
5
The CCG will follow national policy.
The CCG places importance on the positive effects Low
5
of clinical engagement and will endeavour to manage issues that risk this.
The CCG’s risk assessment process ensures a consistent approach is taken to the evaluation and monitoring of risk in terms of assessing the consequence of risk and the likelihood of it occurring using the classification matrix system based on the Australian and New Zealand National Standard for Risk Management (AS/NZ 4630:1999). Both the consequence and likelihood of risk are scored on a scale of 1 to 5 (5 representing the highest risk or certainty of it occurring). The combined score is then categorised as Low Risk (scores between 1 and 3), Moderate Risk (scores between 4 and 6), High Risk (scores between 8 and 12), and Extreme Risk (scores between 15 and 25). The Governing Body has defined the amount of risk that it is prepared to accept, tolerate or be exposed to at any one point in time; its risk appetite. The risk appetite varied depending on the category of risk as set out in the table below: If a risk score is higher than the appetite for that particular category of risk, the Governing Body accept that more action will need to be taken to manage the risk down to an acceptable level. The risk lead is therefore required to manage the risk by on-going monitoring of performance and strengthening the control frameworks in place to reduce the likelihood of risk. 59
This will include seeking assurances as to how controls have been established and if they are operating well, in practice. Once the risk score has reduced to the acceptable risk appetite, it will be considered tolerable (although it will continue to be monitored as part of the CRR and the CCGs governance structures rather than by ‘rigorous’ management). The risk appetite was revisited again during the year to set the appetite and a target risk score has been introduced. Embedding risk management Risk management has been embedded in the activity of NHS Thurrock CCG in each Directorate. The relevant extract of the GBAF and CRR is discussed as a standing agenda item of all committees and risks are discussed periodically at team meetings. Changing the review of the GBAF and CRR to bi-monthly has enabled more effective review and management of risk at those meetings. Incident reporting is also openly encouraged and feeds into the CCG risk management processes to demonstrate how risks have changed and inform updates to the GBAF and CRR. Risk management is an integral part of CCG Governing Body and committee business, whereby each item discussed at a meeting is essentially managing a risk associated with CCG objectives. There was no explicit record of this because it was inherent within the report presented and discussions held. A new process has now been embedded whereby agenda items are now mapped to GBAF/CRR risks. This means that the Governing Body will now always discuss issues in the context of CCG risks. Involving the Patients and Public in managing risk Mapping the GBAF to Governing Body agenda items also better informs the Patients and Public of CCG risks and enables them to engage more effectively when the GBAF (and on an annual basis the CRR) are presented at public Governing Body meetings. Reports are made available to the public on the CCG website. The involvement of public stakeholders is also largely delivered through the Commissioning Reference Group. The group discusses risks that are public and patient facing and raise issues of concern to feed into the CCG Governing Body meetings and the overarching risk management process. 2015 saw the launch of four locality based health hubs giving patients access to weekend GP and nurse appointments, and setting the foundations for our healthy living centres; the first step to our strategy for the provision of care For Thurrock in Thurrock. The vision provides locality based healthcare delivering new sustainable, less complex care pathways aligned with the Five Year Forward View (document from NHS England) and our local (Thurrock) Health and Wellbeing Strategy. This dovetails with the current thinking (and allows us to influence) the context of the Mid and South Essex STP (the Essex Success Regime), where services are best delivered over a wider footprint. Ultimately the aim of the vision is to improve the lives of Thurrock residents, reduce inequalities and move care (where possible) closer to home. 60
Our public engagement strategy For Thurrock in Thurrock began in December 2015 with stakeholder engagement. This has continued in 2016/17, with briefings to the public Governing Body meetings, publicised on our website, via leaflets and now a ‘newsletter’. We are still in the early stages of implementing the programme, but feedback from the public and patients has been extremely positive and gives us the confidence that we can meet one of our greatest challenges to date in delivering innovative solutions to patient facing risks. Partnership working is important to the CCG to enable the delivery of wider community health objectives. This is demonstrated by the level of partnership working reported to and noted within the Governing Body meetings. Two representatives from the Local Authority attend CCG Governing Body meetings (Director of Public Health and Director of Adult Services), and the Accountable Officer and other members of the executive team sit on multi-agency groups and Governing Bodies such as the Health and Wellbeing Board, Local Safeguarding Adults and Children Boards and the South Essex CCGs Collaborative Forum, where risks are discussed and managed collectively. Information and decisions from these groups are reflected in the CCG’s risk registers where relevant. Furthermore, the CCG vision (articulated above) fully aligns to the local Health and Wellbeing Strategy which requires close partnership working with a number of bodies, who have signed up to the strategy to ensure it is delivered for the benefit of the Thurrock community. Our successes in partnership working, in particular to deliver ‘For Thurrock in Thurrock’, are evidenced in how the CCG and Local Authority are working jointly to own and deliver the brand, using the Better Care Fund to deliver joint projects that form part of our transformation plan. Measures aimed to prevent risk have been established through the strategic development and implementation of organisation risk management and corporate governance frameworks, which form part of the CCGs Internal Control Framework, set out below. Risks are pro-actively identified to predict potential control failures allowing the CCG to prevent risks from occurring where possible. Furthermore, where the CCG is not satisfied that a potential risk has been adequately managed to an acceptable level, action plans are re-drafted until an acceptable position is reached. One example was demonstrated in the succession planning processes for Governing Body (GP and Practice Manager) elections. The risks related to a potential inability to recruit new members to the Governing Body, leaving vacancies and difficulties in decision making and also of recruiting new Members who lacked the skills and experience to operate effectively. Efforts to prevent these risks started in the summary with an awareness campaign, developing a comprehensive ‘election pack’ to keep potential applicants fully informed regarding the process and the role. CCG officers engaged with the Local Medical Council who conducted the election 61
process. Furthermore a very detailed induction programme was developed. This included an induction pack to keep new members informed about CCG processes and good governance, as well as a three day induction, two days focused on bringing members up to speed with each of the CCG Directorates and how the CCG operates, good governance practices, mandatory training on risk management, information governance and conflicts of interest; as well as an externally facilitated extended session on the role of the Board Members. In addition, the Board Seminar in January 2017 also provided an introduction to how meetings are conducted. The Integrated Governance Group also assisted in supporting committees during the period of change from one Governing Body to the next where quoracy could potentially be an issue. Deterring risk is achieved by publicising the consequences of non-compliance for example by explaining in policies the actions that will be taken (e.g. disciplinary proceedings) where policy is not followed. Pro-active Security and Counter Fraud programmes also seek to deter fraud by raising awareness among staff and strengthening the reporting of fraud and incidents; as reporting of issues increase, so does the deterrent effect of publicising any wrong doing. Current risks are managed through the risk systems and framework described above whereby actions are taken to strengthen internal control mechanisms that govern the risk area concerned. Strong internal control mechanisms signify a lower likelihood of risks being realised and so the CCG manages current risks by strengthening those control mechanisms to reduce likelihood scores and consequently the overall score of each identified risk area. Where the CCG has no direct input to internal control mechanisms it manages the risk through contract monitoring and working in partnership with the organisation who owns the risk (e.g. Acute Providers). Capacity to Handle Risk The Accountable Officer has overall responsibility for the ensuring that the CCG has the necessary capacity to effectively identify and manage risk. The Accountable Officer provides executive leadership to the risk management process. The Chief Finance Officer has delegated responsibility for managing the strategic development and implementation of financial risk management. The Chief Nurse has delegated responsibility for managing the strategic development of clinical risk management and clinical governance. The Head of Corporate Governance has operational responsibility for risk management, including the regular review of the GBAF. 62
All executive officers and senior managers are responsible for ensuring that appropriate and effective risk management processes are in place within their designated areas and scope of responsibility. Seminars on risk management for CCG staff took place in July 2016 and September 2016 and Governing Body members and Officers took place in July 2016 and January 2017. Specialist training for Governing Body members on the management of conflicts of interest and the detection and prevention of fraud was provided during the 16/17 year. The CCG obtains specialist support and advice in relation the management of risk associated with business continuity and emergency planning, resilience and response (EPRR) from a specialist EPRR team which is hosted by NHS Mid Essex CCG. This team provides services to all CCGs in Essex and operates under a service level agreement which is formally monitored on a bi-monthly basis. Specialist support and advice in relation to information security risks are obtained from the Information Governance Team hosted by NHS Basildon and Brentwood CCG. Risk Assessment Risk assessments have been carried in each directorate against directorate objectives which are aligned to overarching strategic objectives using the method described above. For each risk an inherent and residual risk (considering the likelihood of risk in the given control framework) score has been recorded for each risk. Continued efforts are made to strengthen controls where residual risks remain above the CCG Risk Appetite. The year-end risk profile of the CCG is shown in the graph below:
CCG Risk Profile - April '17 30 25 20 15 10 5 0 Jun-16
Aug-16 Low
Oct-16
Dec-16
Medium
High
Feb-17 Extreme
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Apr-17
There are currently 51 risks held within the overarching GBAF and CRR. The significant increase in the number of recorded risks as the year has progressed has resulted from the embedding of the risk management process where the CCG is being more pro-active in the identification and recording of risks, but also as a result of the quality risks having been reviewed and amended to better reflect individual risks. Therefore a number of risks have been closed and replaced by multiple individual risks, which accounts for the high number of new risks. 19 of those risks are rated ‘extreme’ and therefore are reported to the Governing Body via the GBAF as CCG strategic risks. The top five CCG risks at the year-end were: -
-
-
-
-
The suitability and sustainability of Primary Care (QPS04). IF a limited opportunity to recruit to vacancies and increasing number of practices deemed inadequate by CQC is not properly managed THEN the shortage of primary care workforce to meet the growing demand could be RESULTING IN late diagnosis and increased demand on unplanned care services. Services provided by the East of England Ambulance Services NHS Trust (EEAST) (QPS05). IF EEAST performance against target does not improve THEN there could be significant patient safety issues RESULTING IN potential harm or reputational damage to the organisation. Constitutional Standards (BTUH): Referral to Treatment (RTT) (CG07) IF BTUH fail to meet the 18wk RTT target THEN there could be a potential deterioration in patient outcomes and failure to deliver statutory duties RESULTING IN sanctions, poor ratings from NHS E or reputational damage to the CCG. Constitutional Standards (BTUH): Cancer waiting times (CG08). IF BTUH fail to meet the Cancer target THEN there could be a potential deterioration in patient outcomes and failure to deliver statutory duties RESULTING IN sanctions, poor ratings from NHS E or reputational damage to the CCG. Continuing Healthcare (Finance) (FM05). IF the CCG does not appropriately manage the provision of CHC services THEN there could be an increase in CHC patients and related costs RESULTING IN an increase in unplanned costs. In managing these key risks the CCG has established a new ‘Primary Care Team’, who are supporting GP Practices with their governance arrangements to enable sustainable development; continuing healthcare financial risks have been managed through offsetting CCG finances and the quality team are working with CCG colleagues to gain assurance and actively work in partnership with Providers to improve achievement of constitution standards. Two significant in-year risks in relation to finance and QIPP have been mitigated by yearend by way of meeting the required surplus and financial duty. 64
The risk relating to the CCG licence (GV01), has fluctuated during the year as the Accountable Officer took up the permanent post, but the CCG received further directions, as referred to at the outset of the statement. This has been successfully managed as to have little or no impact on the running of the CCG. The Governing Body has been kept informed of the changing risk profile throughout the year. Each item of the Governing Body business provides assurance over how CCG risks are being managed and performance reporting has informed Governing Body Members how those risk processes have affected each risk area.
Other sources of assurance Internal Control Framework A system of internal control is the set of processes and procedures in place in the clinical commissioning group to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it can therefore only provide reasonable and not absolute assurance of effectiveness. The framework of internal control describes how staff should act and what measures should be taken to protect the achievement of CCG Objectives; this is set out within the CCG Constitution, a suite of policy documentation and associated procedures (which are regularly updated to ensure they reflect current legislation, guidance and good practice thinking). A rigorous training programme ensures that staff are fully versed in correct procedure and can avoid any pitfalls that could lead to risk exposure. This includes specialist training for certain staff, as required by legislation and good practice and is complemented by raising staff awareness regularly at team meetings and through newsletters. Currently the CCG has an average training rate of 90% for mandatory training, which includes Fire Safety, Safeguarding, Risk Management, Manual Handling and Information Governance. Identifying non-compliance Regular monitoring and incident reporting highlights any issues of non-compliance or where controls require strengthening, which is reported through the appropriate committee who are tasked with ensuring actions are taken to address those issues and further assurance is sought to verify the adequacy of the internal control in that particular area. Learning lessons from adverse and serious incidents, complaints and concerns, internal audit recommendations, performance management and individual peer reviews, benchmarking information from NHS England, regulators such as the Care Quality 65
Commission and from national inquiries and reviews enables the CCG to embed learning from other organisations and further develop our own systems of internal control. The Audit Committee is the primary committee charged with monitoring the CCG systems of Internal Control, supported operationally by the Head of Corporate Governance who has delegated responsibility for managing the strategic development and implementation of organisational risk management and corporate governance, ensuring that it is embedded within the organisation. Examples of how this has been achieved is the delivery of training to all staff and Governing Body Members to ensure that risk management is fully understood. Annual audit of conflicts of interest management The revised statutory guidance on managing conflicts of interest for CCGs (published June 2016) requires CCGs to undertake an annual internal audit of conflicts of interest management. To support CCGs to undertake this task, NHS England has published a template audit framework. The CCG Internal Auditors, Mazars LLP have carried out the annual internal audit of conflicts of interest, which resulted in an ‘Adequate’ assurance opinion. One priority two recommendation was made in relation to publishing the CCG procurement decisions register, which has been implemented immediately. In addition, three ‘good practice’ recommendations have (priority 3) been made regarding updating the gifts and hospitality register to fully reflect the requirements of the guidance, updating the CCG Constitution and the prompt return of conflicts of interest forms. Data Quality The Governing Body are provided with a range of quantitative and qualitative information throughout the year. This information relates to all aspects of the performance of the CCG and the providers from whom the CCG commissions services. The Governing Body has expressed no dissatisfaction with the quality or quantity of information that they have received from the CCG during 16/17. However, there is an opportunity to better understand the information requirements of the Governing Body, particularly given there are new members. Information Governance The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal identifiable information. The NHS Information Governance Framework is supported by an information governance toolkit and the annual submission process provides assurances to the clinical commissioning group, other organisations and to individuals that personal 66
information is dealt with legally, securely, efficiently and effectively. Thurrock CCG has submitted v14 of the IG Toolkit, covering the financial year 16/17 and has submitted as "Satisfactory” i.e. level 2 against all criteria. We place high importance on ensuring there are robust information governance systems and processes in place to help protect patient and corporate information. We have established an information governance management framework and are developing / have developed information governance processes and procedures in line with the information governance toolkit. We have ensured all staff undertake annual information governance training and have implemented a staff information governance handbook to ensure staff are aware of their information governance roles and responsibilities. There are processes in place for incident reporting and investigation of serious incidents. We have developed information risk assessment and management procedures and a programme has been established to fully embed an information risk culture throughout the organisation against identified risks. Business Critical Models The CCG confirms that it takes steps to identify all business critical models as part of our work around asset registers. The CCG has not developed or purchased any business critical models that have supported its planning in 2016/17. We are aware of the recommendations for the public sector made in the McPherson report and will apply them as and when we place reliance on business critical models to support the CCG. Third party assurances NHS Thurrock CCG uses North East London Commissioning Support Unit (NELCSU) for the provision of financial and other transactional based services described in ‘Our place in the NHS’. Further to this, functions such as the payment of invoices are delivered by ‘NHS Shared Business Services’ (NHS SBS). The internal auditors of both NELCSU and NHS SBS undertake reviews of the framework of internal control and provide a ‘Service Auditor Report’ to the CCG to confirm the controls that are operating, commenting on their application in practice. The outcome of these reviews are considered by NHS Thurrock CCG Internal Auditors who provide conclusions on the reports within their Head of Internal Audit Opinion, which reads: Since a number of processes in respect of the CCG’s key financial systems have been outsourced, we have sought to rely on third party assurances where these are available. NHS Shared Business Services (SBS) are contracted by NHS England to provide an Integrated Single Financial Environment (ISFE) service to all the CCGs in England. We expect to receive the independent Service Auditor Report from Grant Thornton UK LLP in respect of the controls in place at SBS over the ISFE once they have completed their audit work. 67
We have received an interim Service Auditor Report, produced by Deloitte, regarding the controls operated by North East London Commissioning Support Unit (NELCSU) on behalf of the CCG for the period from 1st April 2016 to 30th September 2016. Whist the interim report did not raise any significant areas of concern, we are still awaiting the receipt of a Service Auditor Report to cover the period from 1st October 2016 to 29th February 2017. The contents of these outstanding reports may have an impact on our overall opinion and this will therefore be issued once both Service Auditor Reports have been received. (Source: Mazars LLP Interim Head of Internal Audit Opinion Annual 2016/17)
Control Issues There have been no significant control issues faced by the CCG. However, we are aware that the delivery of the constitutional standards will be a key risk in 17/18. We will work with our STP colleagues to find the best way to deliver the standards across South and Mid Essex. We are conscious that we need to work with our partner CCGs to reduce duplication and increase focus on improving delivery to patients. Review of economy, efficiency & effectiveness of the use of resources Ensuring economy, effectiveness and efficiency in the use of resources is an important principle of the CCG and is outlined in the corporate governance framework adopted by the Governing Body. To ensure economy, efficiency and effectiveness in the use of resources is achieved; appropriate procurement procedures are in place, including the tendering of goods and services where necessary. Part of the role of the internal audit service that the CCG commissions involves reviewing, appraising and reporting upon the use of resources within the organisation. A key priority for the CCG looking forward is to ensure that maximum value for money is being achieved through effective commissioning arrangements, as the majority of the CCG’s expenditure is spent on commissioning healthcare services. While all healthcare providers are required to deliver a continuous programme of QIPP, the CCG must also demonstrate that it is properly considering the health needs of the local population and commissioning those services that address those needs. The CCG uses the Joint Strategic Needs Assessment (JSNA) and the Commissioning for Value tools alongside other benchmarking tools to ensure identification of the areas for review to identify future QIPP schemes. Leadership for the strategy and direction in ensuring economy, efficiency and effectiveness in the use of resources comes from the Governing Body. The on-going monitoring of CCG progress is undertaken by the Audit Committee through the management and direction of the internal audit programme and regular reviews of risk, and also by the Board through receipt of regular financial and commissioning updates. 68
During 16/17 the CCG has continued to work with NHS and social care colleagues across South Essex in developing system-wide Quality, Improvement, Productivity and Prevention plans setting out how the we will respond to the challenging financial climate in which the NHS and the wider public sector will operate over the coming years. Work has also begun on joint working across the CCGs within the Essex Success Regime and the governance leads of each CCG are working together to establish good governance. The CCG’s overall financial management arrangements and use of resources were also subject to review by the CCG’s external auditors as part of their annual review of the CCG’s accounts. Counter fraud arrangements Under the NHS Standard Contract introduced in 2012/13, all organisations providing NHS services are required to have appropriate anti-fraud arrangements in place. In 2015/16, NHS Protect introduced the ‘Standards for Commissioners: Fraud, Bribery and Corruption’ to assist organisations with this process. It incorporates a requirement that the CCG employs or contracts a qualified person or persons to undertake the full range of anti-fraud work, and that it produces a risk based workplan that details how it will approach anti-fraud and corruption work. The Standards also require an annual report showing how the Standards have been met, and any areas in which corrective actions are needed to address a failure to do so. There is a significant focus on the achievement of outcomes rather than simply reporting on tasks completed. The CCG commission Local Counter Fraud Specialist services from Mazars LLP who deliver an annual plan that ensures compliance with the requirements of NHS Protect (as outlined above). Consequently the CCG has an assigned Accredited Counter Fraud Specialist (LCFS) contracted to undertake counter fraud work proportionate to identified risks through both the pro-active delivery of an annual workplan and through the re-active work responding to potential fraud. The Audit Committee receives an annual report from the LCFS (received a the 20 th April 2017 meeting) highlighting how the service has ensured compliance against the Standards for Commissioners, which is supported by completion of the self-review tool and submitted by the Chief Finance Officer; as the member of the Executive member of the Governing body responsible for tackling fraud, bribery and corruption.
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Head of Internal Audit Opinion Scope of the Internal Audit Opinion In giving our annual audit opinion, it should be noted that assurance can never be absolute. The most that the internal audit service can provide to the CCG is a reasonable assurance that there are no major weaknesses in risk management, governance and control processes. The matters raised in this report are only those which came to our attention during our internal audit work and are not necessarily a comprehensive statement of all the weaknesses that exist, or of all the improvements that may be required. In arriving at our opinion, we have taken the following matters into account: •
The results of all audits undertaken during the year ended 31 March 2017, including an assessment of the design and operation of the underpinning Assurance Framework and supporting processes;
•
Whether or not any Priority 1 or Priority 2 recommendations have not been accepted by management and the consequent risks;
•
The effects of any material changes in the organisation’s objectives or activities;
•
Matters arising from previous reports to the Audit Committee and/or Governing Body;
•
Whether or not any limitations have been placed on the scope of internal audit;
•
Whether there have been any resource constraints imposed upon us which may have impinged on our ability to meet the full internal audit needs of the organisation;
•
An assessment of the assurances received from third party assurance providers, received in the form of Service Auditor Reports compliant with the International Standard on Audit Engagements (ISAE) 3402; and
•
What proportion of the organisation’s internal audit needs have been covered to date.
Annual Opinion Our overall opinion, based on the work performed to the 31st March 2017, is that adequate assurance can be given that there is a generally sound system of internal control, designed to meet the CCG’s objectives, and that controls are generally being applied consistently. However, some weakness in the design and/or inconsistent application of controls puts the 70
achievement of particular objectives at risk. In reaching this opinion the following factors were taken into particular consideration: Governance and Risk Management Our opinion in this area was informed through our audit of Governance, Assurance Framework and Risk Management, for which we provided an ‘Adequate Assurance’ opinion. No significant issues were raised as a result of the work undertaken in 2016/17 and It is therefore our opinion that the Assurance Framework and associated processes are sufficient to meet the requirements of the 2016/17 Annual Governance Statement and contribute to an effective system of internal control, designed to manage the significant risks identified by the CCG. Internal Control We have completed eight audits in the year where we provided a formal assurance level. One was given a ‘Good’ level of assurance (Quality of Care), six were given an ‘Adequate’ level of assurance (Financial Systems Key Controls; Governance, Assurance Framework and Risk Management; Quality, Innovation, Productivity and Prevention; Safeguarding Adults; Continuing Healthcare Costs; and Conflicts of Interest), and one was given a ‘Limited’ level of assurance (Personal Health Budgets). We also issued a report relating to the CCG’s Information Governance Toolkit. However, due to the nature of the work performed and the fact that this was advisory in nature, no opinion was provided, although recommendations were made. During the year, we have made one ‘Priority 1’ and 18 ‘Priority 2’ new recommendations. Twelve recommendations categorised as ‘Priority 3’ were also made. In respect of the follow up of recommendations, the CCG has an established process for tracking the implementation of recommendations made by internal audit and enabling management to report on their status at each Audit Committee meeting. During the year we reviewed the implementation of recommendations as they fell due and confirmed the reported implementation status of recommendations reported by management. All recommendations made during the year were accepted by Management.
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Reliance Placed on Third Parties Since a number of processes in respect of the CCG’s key financial systems have been outsourced, we have sought to rely on third party assurances where these are available. NHS Shared Business Services (SBS) are contracted by NHS England to provide an Integrated Single Financial Environment (ISFE) service to all CCGs. We have received the independent Service Auditor Report from Price Waterhouse Coopers LLP (PwC) in respect of the controls in place at SBS over the ISFE. PwC concluded that: In our opinion, in all material respects, based on the criteria described in the Service Organisation’s management statement in section: a)
b)
c)
the description in sections III and IV fairly presents the Service Finance & Accounting Services as designed and implemented throughout the period from 1 April 2016 to 31 March 2017; the controls related to the control objectives stated in the description were suitably designed to provide reasonable assurance that the specified control objectives would be achieved if the described controls operated effectively throughout the period from 1 April 2016 to 31 March 2017and customers applied the complementary user entity controls referred to in the scope paragraph of this assurance report; and the controls tested which, together with the complementary user entity controls referred to in the scope paragraph of this assurance report, if operating effectively, were those necessary to provide reasonable assurance that the control objectives stated in the description were achieved, operated effectively throughout the period from 1 April 2016 to 31 March 2017.
As a result of the work undertaken by PwC, we are happy that there are no exceptions that would adversely affect our Head of Internal Audit Opinion. Whilst we have not yet received the Service Auditor Report from Deloitte in respect of the control in place at North East London CSU, we have discussed the outcomes of this work with NELCSU and the exceptions that have been identified as a result of the work performed by Deloitte. None of the exceptions identified relate to any of the services that the CCG has procured from NELCSU and they therefore have no bearing on our opinion.
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Summary of internal audit work undertaken in 2016/17 The following reviews were undertaken during the 2016/17 audit year: Days
Recommendations
Level of Assurance (If appropriate)
Budget
Actual
Priority 1 (Fundamental)
Priority 2 (Significant)
Priority 3 (Housekeeping)
Total
Total agreed by Management
Financial Systems Key Controls
Adequate
12
12
-
4
4
8
8
Governance, Assurance Framework and Risk Management
Adequate
10
10
-
4
-
4
4
Quality, Innovation, Productivity and Prevention
Adequate
8
8
-
1
2
3
3
Safeguarding Adults
Adequate
8
8
-
2
2
4
4
Continuing Healthcare Costs
Adequate
10
10
-
2
-
2
2
Good
8
8
-
-
1
1
1
Limited
6
6
1
2
-
3
3
No opinion given
8
8
-
2
-
2
2
Adequate
8
8
-
1
3
4
4
N/A – Follow Up
6
6
Audit Management
14
14
Totals
98
98
Auditable Area
Quality of Care Personal Health Budgets IG Toolkit Conflicts of Interest Follow Ups
%
1
18
12
31
31
3%
58%
39%
100%
100%
We use the following levels of assurance and recommendation classifications within our audit reports: Assurance Level
Definition
Good Assurance
There is a sound system of internal control designed to achieve the organisation’s objectives. The control processes tested are being consistently applied.
Adequate Assurance
While there is a basically sound system of internal control, there are weaknesses, which put some of the organisation’s objectives at risk. The level of non-compliance with some of the control processes may put some of the organisation’s objectives at risk.
Limited Assurance
Weaknesses in the system of internal controls are such as to put the organisation’s objectives at risk. The level of noncompliance puts the organisation’s objectives at risk.
Nil Assurance
Control processes are generally weak leaving the processes/systems open to significant error or abuse. Significant non-compliance with basic control processes leaves the processes/systems open to error or abuse.
Recommendation Grading
Definition
1
Major issues for the attention of senior management and the Audit Committee.
2
Important issues to be addressed by management in their areas of responsibility.
3
Minor issues resolved on site with local management.
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Review of the effectiveness of governance, risk management and internal control My review of the effectiveness of the system of internal control is informed by the work of the internal auditors and the executive managers and clinical leads within the CCG who have responsibility for the development and maintenance of the internal control framework. I have drawn on performance information available to me. My review is also informed by comments made by the external auditors in their annual audit letter and other reports. Our GBAF provides me with evidence that the effectiveness of controls that manage risks to the CCG achieving its principles objectives have been reviewed. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Governing Body, the Audit Committee, Integrated Governance Group, Quality and Patient Safety Committee and the Finance and Performance Committee and a plan to address weaknesses and ensure continuous improvement of the system is in place. I am assured through the GBAF (presented at Governing Body meetings) that internal controls have been established around CCG risks, where controls are documented and reviewed as part of the on-going GBAF update process. During the year, the level of information used within the GBAF to assess internal controls has steadily increased and includes both assurances resulting from the review of controls as well as performance reports that provide indicators as to the effectiveness of controls. The Executive Officers also share responsibility for maintaining and developing systems of internal control and provide assurance at corporate meetings as to their effectiveness. Our Internal Auditors, Mazars LLP also provide a significant contribution to my assessment of the effectiveness of the overall system of internal control, including a review of the effectiveness of the GBAF and risk management process that underpin the system of internal control. The Audit Committee (at the outset of the year) agreed the strategic and annual internal audit plan confirming that the plan reflects CCG risks and will provide reasonable assurance, by completing a number of internal audit reviews, that the system of internal control is adequate and operating as expected. Following completion of the audit, Mazars LLP were able to provide ‘adequate’3 assurance that a generally sound system of internal control operates to meet the needs of the CCG objectives and that controls are generally applied in a consistent manner, as set out in the 3
Mazars LLP have aligned the Head of Internal Audit Opinion to those used for their individual audit assignments. The ‘adequate’ assurance opinion therefore correlates with the significant assurance opinion provided last year.
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‘Head of Internal Audit Opinion’ section below. Review of the system of internal control is a key responsibility of the Audit Committee. Throughout the year, this committee has reviewed and endorsed key elements of the system of internal control, including the risk management policy and strategy, the conflicts of interest policy and standards of business conduct policy, the work of the internal and external auditors and the local counter fraud specialist (LCFS). The Governing Body receives assurance on the work of the Audit Committee by means of receipt of minutes at Governing Body meetings. The Lay Member (Governance), who is also Chair of the Audit Committee, verbally highlights issues pertinent to the system of internal control during Governing Body meetings. Neither the Audit Committee nor the Governing Body has expressed significant concerns about the adequacy of the system of internal control during the 16/17 year. Conclusion I concur with the Head of Internal Audit Opinion cited above that during the 2016/17 year, there has been a generally sound system of internal control, designed to meet the organisation’s objectives, and that controls have been generally applied consistently. No significant internal control issues have been identified.
6
Source: National Health Service England, The NHS Thurrock Clinical Commissioning Group Directions 2013 (No.2), as amended.
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Members Report Our member practices comprise 32 GP practices which vary in patient population and General Practitioner numbers. We are aligned to the boundaries of Thurrock Council and this is a great advantage for the planning and delivery of services. GP members meet once a month to discuss and plan healthcare service delivery. Attendees at our monthly Clinical Engagement Group (CEG) meetings are committed and engagement remains good. This financial year we held our GP elections and successfully recruited four new GP members to our Board. They began their three year tenure in January 2017. The new members assumed responsibility for planned and unplanned care; quality and patients safety; finance and estates and medicines management. Our GPs and other allied clinicians are always involved in the process of developing plans and strategies such as the two-year and five-year operational plans. Their suggestions and views are actively sought and incorporated in our decisions. In the last year, our clinical members have been very involved in developing work streams that will be a huge benefit for the people of Thurrock. Examples include: IAPT (Improving Access to Psychological Therapies) One of our members led on the development of a new model for improving access to psychological therapies in primary care. He has carried forward our commitment to embed the ethos that people with long term conditions have access to psychological support when they need it. Inclusion Thurrock, a new mental health service for Thurrock began operation in April 2016. In October 2016 we officially launched our Recovery College in partnership with Thurrock Mind and Inclusion Thurrock (a first for Thurrock), which has proved successful in helping people to regain control of their mental health and provides opportunities for people to live meaningful and satisfying lives. Primary Care GP Health Hubs Thurrock Health Hubs were officially launched in July 2015 with Saturday and Sunday appointments, followed by the introduction of a pilot Wednesday evening appointments service from March 2016. The current health hubs operate in the four locality areas: Grays, Tilbury, Corringham and South Ockendon. They have improved access to GP services. This was further supported by additional funding from NHS England, which allowed our hubs to open during the evening seven days a week from January 2017 to March 2017.
76
This provided more routine appointments out of hours and reduced pressure on existing GP services during the day. This is the second year of running and they are proving to be a successful addition to existing services. Members were also constantly updated on our financial performance and their role in helping to ensure the achievement of financial targets. Member’s queries regarding our finance and future planning were always taken into account. The members, through the board representatives, were also able to have their views and suggestions heard and fully participate in how we function. Diabetes Services A new national programme launched in March 2016: Healthier You: the NHS Diabetes Prevention Programme for those at high risk of developing type 2 diabetes will help between 400 and 500 patients in Thurrock take steps to improve their own health. The local programme is part of a national campaign to stop the increase of type 2 diabetes. Essex is part of the first wave of areas to launch their programmes in 2016. Those patients identified at high risk of type 2 diabetes will have access to personalised help to reduce their risk, including education on healthy eating and lifestyle, advice on losing weight and bespoke physical exercise programmes. Promotion of this programme has been on-going with GP practices. The South West Essex Diabetes Network, established in 2014 and led by Dr Anjan Bose, clinical lead and tutor strengthened its existing relationships in diabetes care and built upon its training and learning resources for GPs and nurses. Any Qualified Provider (AQP) Member practices have been actively engaged in a primary care development programme, their participation has meant that all practices are more prepared to participate in future AQP procurement. Accountable Care Partnerships (ACP) The past year has seen us gain more formal agreement from system partners to the formation of an Accountable Care Partnership (ACP) on our journey towards and accountable care organization. We will be testing the concept initially in one of the localities before rolling it out across the CCG. We’re bringing together networks of GPs in each locality, to provide the GP voice and help shape the ACP model as it develops. The ACP will be the vehicle through which our patient-centred services closer to home will be delivered. This is also linked to our work under our transformation programme, For Thurrock in Thurrock. 77
Care Quality Commission (CQC) Our primary care development team have been working tirelessly with our 32 practices on providing guidance prior to CQC visits to help practices through the process of inspection. The primary care team has provided support to improve practice and performance. Out of 29 inspections this financial year, we now have 19 practices rated as ‘Good’ from a baseline of only 3 ‘Good’ practices last year. A tangible achievement to celebrate. The CCG has completed its annual 360 Degree Stakeholder Survey, which is central to our assurance process to monitor our relationships with stakeholders. We will be analysing the data and continue to include recommendations in our organisational development work. Approved on behalf of the CCG membership by the Clinical Engagement Group
Dr Vaiyapuri Raja
Chair Clinical Engagement Group May 2017
78
Our Governing Body The Governing Body is our accountable body and is held to account for the organisation’s performance. The Governing Body includes a majority of clinical professionals, to ensure clinical leadership and accountability. All of the Governing Body members included here below were in post throughout the 16/17 year. Governing Body members and their positions: Name until Dec 2016 Dr Anand Deshpande Dr Thamotherampilla t Nimal-Raj (left 31 Dec 16) Ms Lesley Buckland
Ms Mandy Ansell
Mr Ade Olarinde Ms Jane FosterTaylor Dr Rajan Mohile Dr Lakhvir Grewal (left 31 Dec 16) Dr Raymond Arhin (left 31 Dec 16) Dr Anil Bansal (left 31 Dec 16) Dr Anjan Bose
Role Chair Interim Accountable Officer until mid Sept 2016.
Then Governing Body GP Member Deputy Chair and Lay Member, Governance and Audit Acting (Interim) Accountable Officer
Name from Jan 2017 Dr Anand Deshpande Dr Anil Kallil
Role
Ms Lesley Buckland
Deputy Chair and Lay Member, Governance and Audit Accountable Officer
Ms Mandy Ansell (from 1 February) Mr Ade Olarinde Ms Jane FosterTaylor Dr Rajan Mohile
Chief Finance Officer Chief Nurse Governing Body GP Member Governing Body GP Member Governing Body GP Member Governing Body GP Member Governing Body GP Member
Dr Vikram Bhat Dr Luis Leighton Dr Henry Okoi Dr Anjan Bose
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Chair Governing Body, GP Member (Quality and Patient Safety Lead)
Chief Finance Officer Chief Nurse Governing Body GP Member Governing Body GP Member Governing Body GP Member Governing Body GP Member Governing Body GP Member
Dr Peter Martin (retired 31 Dec 2016) Dr Vaiyapuri Raja
Governing Body GP
Mr Trevor Hitchcock
Lay Member
Governing Body GP Member
Dr Vaiyapuri Raja
Governing Body GP Member
Dr Suparna Das (left 30 Sept 16)
Secondary Care Consultant
Dr Julia Hill
Mr Russell Vine
Practice Manager Member (nonvoting)
Mr Russell Vine
Secondary Care Consultant from 1 March 2017 Practice Manager Member (nonvoting)
Ms Liv Corbishley
Lay Member, Patient and Public Involvement since April 2016
Ms Liv Corbishley
Lay Member, Patient and Public Involvement
Governing Body Profiles Name Dr Anand Deshpande
Ms Mandy Ansell
Ms Jane Foster –Taylor
Position
Profile
Chair – GP
Dr Deshpande has been our Chair since 1 April 2013. He practices as a GP in Stanford-le-Hope.
Accountable Officer
Mandy has a BSc (Hons) Physiotherapy from the Royal London Hospital and a Master’s Degree from City University. In the last 35 years, Mandy has held positions as a clinician, professional manager and general manager in acute hospitals and primary care in Bristol, London and Essex. She has led a number of high profile projects in the last five years in South Essex including the transition to CCGs . Jane is a registered General Nurse, with 36 years nursing experience, including general nursing, midwifery, health visiting and key strategic roles in Quality and Patient Safety. As the Chief Nurse for NHS Thurrock CCG, Jane serves on a number committees. These include the Children’s
Chief Nurse
80
Safeguarding Board, Adult Safeguarding Board, Quality and Patient Safety Committee and Clinical Quality Review Groups for both the NELFT and BTUH contracts. Mr Ade Olarinde
Chief Finance Officer
Ade is a Chartered Management Accountant with more than twenty years' experience in the NHS. He has previously worked within acute, community and mental health trusts and has been based in south Essex for the last seven years. Ade sits on the Audit and Finance and Performance Committees
Dr Thamotherampillat Nimal-Raj
GP and Safeguarding Lead
Dr Nimal-Raj works as a GP at surgeries in Purfleet and East Tilbury.
Dr Lakhvir Grewal
GP and Joint Clinical Engagement Group Chair
Dr Grewal qualified as a GP in 2007. He is a partner at Chafford Hundred Medical Centre. His role was co-chair of CEG, clinical lead on CQRG, clinical lead of the Quality & Patient Safety group.
Dr Raymond Arhin
QIPP
Dr Raymond Arhin qualified as a GP six years ago. He received his GP training at Stifford Clays Health Centre and Basildon and Thurrock University Hospital NHS Trust. He was chair of the CCG’s QIPP Programme (Quality, Innovation, Productivity and Prevention) and is also a GP Partner at Aveley Medical Centre.
GP and Committee Chair
Dr Anjan Bose
GP and Clinical Lead and Tutor
Dr Bose is the Clinical lead and Educational tutor in Thurrock CCG. He has been a GP since 1992 and specialises in Pulmonology and Diabetes.
Dr Rajan Mohile
GP and Mental Health Lead
Dr Vaiyapuri Raja
Joint Clinical
Dr Mohile has been a member of the CCG Governing Body since April 2013. He is Mental Health Lead for the CCG and works as a GP in Grays . Dr Raja is a GP partner at Horndon on Hill Practice. He qualified as a GP six years ago
81
Engagement GP and Committee Chair - Unplanned Care Lead (until Jan 2017)
and received his GP training at Basildon and Thurrock University Hospital NHS Trust and Dr Coburn and Partners GP Surgery in Orsett. He is currently chair of the Clinical Engagement Group and Unplanned Care lead until Jan 2017
Ms Lesley Buckland
Deputy Chair and Lay Member, Governance and Audit
Lesley's professional background is in Human Resource Management. She has also held senior management roles within the NHS and within a London based University. She has also had non- executive roles within the NHS for 15 years, including Vice Chair of a PCT, Chair of Remuneration Committee.. Lesley is also a member of the Quality and Patient Safety Committee and is Chair of the Audit Committee.
Dr Suparna Das (left September 2016)
Secondary Care Consultant
Dr Das has more than 19 years' experience as an anaesthetist. A consultant anaesthetist, she trained as a Specialist Registrar in anaesthetics at Guy's, St Thomas' and King's College hospitals in London. Following an MBA with distinction from Leeds University Business School, she has worked in NHS management roles as well as a management consultant. Was Chair of Finance and Performance Committee
Dr Peter Martin (retired)
GP and Medicines Management Lead
Dr Martin has been a GP since 1988. He trained at the Royal London Hospital before qualifying in 1983. He has worked in Chelmsford, Southend and Basildon Hospitals and undertook his General Practice training in Wickford. He was the clinical lead for Medicines Management.
Dr Anil Bansal
GP and Planned Care Lead (Dec 2016)
Dr Bansal has been a GP since 1983. He is a GP surgeon specialising in Vasectomy and Minor Surgery. He received his GP training at Manchester Brunswick Health Centre. He was the Planned Care lead until December 2016.
82
Mr Russell Vine
Quality and Patient Safety
Russell has been Practice Manager at Hassengate Medical Centre since 1993 and Chair of the Practice Management Network which currently has 3,500 practices. He serves on the Quality and Patient Safety Committee.
Ms Liv Corbishley
Lay Member, PPI
Liv’s background is as a Business and Marketing Consultant across sport, investment and telecoms sectors globally. She sits on the Health and Well-being Board, Commissioning Reference Group, Audit and Remuneration Committee's. She is passionate about accessibility for all to services that support good health and wellbeing.
New members since January 2017 Dr Anil Kallil
Quality and patient safety
Dr Kallil has been working as a GP in Orsett for 10 years. Before this he worked in Hospital Medicine. Dr Kallil is one of the clinical leads for the Thurrock Health Hubs. He has been a former board member and interim medical director for a former outof-hours primary care provider. Dr Kallil was also a board member for Thurrock Primary Care Trust before it was officially granted the legal status as Clinical Commissioning Group. He is the Chair of the Quality and Patient Safety Committee.
Dr Luis Leighton
Dr Henry Okoi
Chair of Finance and Performance, and Estates Representative Medicines Management Lead
83
GP at Aveley Medical Centre. Chair of Finance and Performance Committee and Estates representative. Dr Okoi completed GP training in Slough in August 2006 and has been working in Thurrock as a GP since October 2006. In December 2015 Dr Okoi completed a Masters Degree in Healthcare Leadership from the University of Birmingham and was given a Senior NHS Leadership Award by the NHS Leadership Academy Elizabeth Garrett
Anderson Programme. Dr Okoi is also a GP Trainer, having completed post-graduate certificate in Medical Education from the University of Bedfordshire in July 2013. Dr Vikram Bhat
Planned and Unplanned Care Lead.
Dr Vikram Bhat joined the CCG Board in January 2017 for a three year period., MBBS (MYSORE), DRCOG (Royal College of OBG), MRCGP, (Royal College of GPs). Dr Bhat has been practising as lead GP of Sai Medical Centre since 2014. He is the clinical lead for Diabetes, Respiratory and Children’s Safeguarding and locality lead for Tilbury Hub Services. Dr Bhat is currently supervising the For Thurrock in Thurrock programme; with Tilbury as Phase 1 of the project.
Mr Trevor Hitchcock
Lay Member
Trevor is a Thurrock resident of 15 years and has spent 12 years working for a key strategic partner to the NHS (DHL Supply Chain). Trevor has also previously served as a Sessional lay member for the NHS Thurrock Clinical Commissioning Group on the Audit, Remuneration, Finance and Performance and Conflict of Interest Committees. Over this time Trevor gained the respect and confidence of his peers, allowing him to respectfully challenge and scrutinise information and explanations provided by others.
Dr Julia Hale
Secondary Care Consultant
Dr Hale is a Secondary Care Consultant. Joined 1 March 2017, at the time of writing this report we had not obtained a full profile.
Register of Interests All members of the Governing Body, Clinical Leads and the Sessional Lay Member are reminded at regular intervals throughout the year to update the Register of Interests within 28 days of the change occurring, in line with the CGG’s Conflicts of Interest policy.
84
Members of the CCG Governing Body (Board), Clinical Leads and Lay Member – Declarations of Interest correct as at 31 March 2017. Name and Role within NHS
Business Interests
Thurrock CCG
Charity/
Contracting
Voluntary
for NHS
Organisation
Services
None
None
declared
declared
Other Interests
Ms A Ansell, Board Member Accountable
None declared
None declared
Officer Dr L Leighton – GP Board
GP – Aveley
None
None
Member -
Medical Centre
declared
declared
None declared
Finance Lead
Dr V Bhat – GP Board Member -
Medical Centre
-
Unplanned / Planned Lead
GP Lead – Sai
-
GP weekend
(Family Member)
Hub
-
Director VMI TA Ltd
-
Astar Zeneca
Essex Medical Society (peer group)
for Diabetes Daughter, Mrs N Masson, an employee of Dr A Bose, GP
Locum GP
MSD Pharmaceuticals
Board Member,
Member of the
None
None
Ltd, occasionally
Clinical Lead &
Multi- Consortium
declared
declared
sponsors Time to Learn
Tutor
Co Ltd
sessions for the CCG – Work as a Locum at Balfour Surgery
Ms L Buckland, Board Member -
Chair
Lay Member and Audit / Remuneration Committee Chair/Deputy
Tapestry None declared
Charity in Havering Trustee
Chair
85
None declared
None declared
- Senior Manager at Active Surrey Ms L Corbishley
County Sports
– Board Member
Partnership
- PPI Lay
- Freelance
Member
Business &
Chairman of Kingston Women’s
None
none
Centre
Marketing Consultant
- Member of South -
Board Member CCG Chair
Essex Local Medical
consortium –
Committee (LMC)
Personal
Dr A Deshpande,
Director, Multi-
Director
-
Commissioning Group T/B Ltd.
-
- Executive Member of None
None
declared
declared
Director,
British Medical Association (BMA) Referral Council – Cambridge
Medical Defence
- MCG lead practice for
Shield Ltd.
hubs in the Thurrock CCG Area
Ms J FosterTaylor, Board Member - Chief
None declared
None
None
declared
declared
None declared
Nurse
- GP – Principal - Advantage Medic Board Member Dr H Okio – GP Medicine Management Lead Dr A Kallil – GP Board Member -
NHS Business Partners Dr J Hamilton
Ltd
Ms D Hamilton
- Partnership of
N Dicoi
East London CoOperative
Anesi Federation
GP Partner
Wife – Dr
Quality Lead
Venkatakristanon
86
-
- GP Principal,
Sixth Form College
Dr R Mohile, GP
Chadwell Medical
President,
Board Member -
Centre
Grays
Macmillan
Thurrock
Cancer
Mental Health Lead
- Director, South Essex Diabetes
Governor, Palmers
Rotary Club
-
Personal (dormant company)
-
Wife working in NHS assistant
Service
practice manager Finance business
Mr T Hitchcock, Board Member -
partner for None declared
Lay Member
Neopost – supplier of
None declared
None declared
office equip to NHS Mr A Olarinde,
Director of Forum
Board Member -
616 Ltd (a
None
None
Chief Finance
members social
declared
declared
Officer
club)
None declared
Member of South Essex Local Medical
Honorary Dr V Raja, GP
Committee (LMC)
Chairman,
Board Member
GP Principal, The
BMA South
None
and Co-Chair of
Surgery - Horndon
Essex LMC
declared
CEG
Member
Supporting EHL – Director – Non profit Wife – Malar Raja –
South Essex
Consultant Gynaecologist BTUH
- Practice Manager / Partner, Mr R Vine, Board Member Practice Manager
Hassengate Medical Centre
- Steering Group member of new GP provider
Chair of Practice
None
Management
declared
Network
company anesi healthcare ltd
87
None declared
- Employed by Dr Julia Hale –
Barts Health NHS
Secondary Care
Trust
Consultant
- Basildon & Brentwood CCG
Member of the Medical Advisory Committee
Director PWC
for CORUM – BAAF
Member Practices Chafford Hundred Medical Centre
Drake Road, Chafford Hundred, Essex, RM16 6RS
The Dell Medical Centre
111 Orsett Road, Grays, Essex, RM17 5HA
Acorns Surgery
Queensgate Centre, Orsett Road, Grays, Essex, RM17 5DF
The Dilip Sabnis Medical Centre
Linford Road, Chadwell St Mary, Essex, RM16 4JW
Balfour Medical Centre
2 Balfour Road, Grays, Essex, RM17 5NS
Sancta Maria Centre
Daiglen Drive, South Ockendon, Essex, RM15 5SZ
St Clements Health Centre
London Road, West Thurrock, Essex, RM20 4AR
Ash Tree Surgery
33 Fobbing Road, Corringham, Essex, SS17 9BG
The Surgery in Orsett
63 Rowley Road, Orsett, Essex, RM16 3ET
Neera Medical Centre
2 Wharf Road, Stanford-le-Hope, Essex, SS17 0BY
The Pear Tree Surgery
Pear Tree Close, South Ockendon, Essex, RM15
Derry Court Medical Centre
Derry Court, Derry Avenue, South Ockendon, Essex, RM15 5GN 7 The Sorrells, Stanford-le-Hope, Essex, SS17 7DZ
The Sorrells Surgery The Health Centre The Rigg Milner Surgery
Crammavill Street, Stifford Clays, Grays, Essex, RM16 2AP 2 Bata Avenue, East Tilbury, Essex, RM18 8SD
88
College Health
85 Coronation Avenue, East Tilbury, Essex, RM18 8SW
Aveley Medical Centre
22 High Street, Aveley, Essex, RM15 4AD
Chadwell Medical Centre
1 Brentwood Road, Chadwell St Mary, Essex, RM16 4JD
The Surgery
12 Milton Road, Grays, Essex, RM17 5EZ
Purfleet Care Centre
Tank Hill Road, Purfleet, Essex, RM19 1SX
College Health
57 Calcutta Road, Tilbury, Essex, RM17 7QZ
Sai Medical Centre
105 Calcutta Road, Tilbury, Essex, RM17 7QA
The Surgery
High Road, Horndon-on-the-Hill, Essex, SS17 8LB
Medic House
Ottawa Road, Tilbury, Essex, RM18 7RJ
The Shehadeh Medical Centre
Quebec Road, Tilbury, Essex, RM18 7RB
The Health Centre
London Road, Tilbury, Essex, RM18 8EB
Hassengate Medical Centre East Thurrock Medical Centre
Southend Road, Stanford-le-Hope, Essex, SS17 0PH 34 East Thurrock Road, Grays, Essex, RM17 6SP
The Health Centre
Darenth Lane, South Ockendon, Essex, RM15 5LP
Prime Care Medical Centre
167 Bridge Road, Grays, Essex, RM17 6DB
The Thurrock Health Centre
55-57 High Street, Grays, Essex, RM17 6NB
The Grays Surgery
78 High Street, Grays, RM17 6HU
89
Audit committee, pension liabilities, external audit Audit Committee The Audit Committee is responsible for reviewing our governance arrangements and systems of internal control and for ensuring an appropriate relationship with both internal and external auditors is maintained. The following individuals comprise our Audit Committee: -
Ms Lesley Buckland, Deputy Chair and Lay Member, Governance and Audit Ms Elizabeth Corbishley, Lay Member for Patient and Public Involvement Mr Trevor Hitchcock, Lay Member
Full details of other committee members and sub-committees as well as our Governing Body members’ declarations of interest are given in the Annual Governance Statement. Pension liabilities The CCG’s Annual Accounts detail the accounting policy adopted regarding the NHS pension scheme liabilities and this can be found in the Financial Statements. External audit Appointed by the Audit Commission, Ernst & Young is our external auditor. The Audit Commission was abolished in April 2015 and the Public Sector Audit Appointments Ltd (PSAA) took over the management of existing audit service contracts until the conclusion of 2016/17 accounts audit work. The total planned fee for the 16/17 audit was £56,620 relating exclusively to the provision of audit services.
Compliments and complaints Concerns and complaints provide us with valuable information about the experiences of our patients so that we can improve the services that we commission. Compliments help us to find out what we are doing well so that we can share best practice, improving further still, local health services. Under the current NHS Complaints Regulations, patients and the public can make their complaints to us as a commissioner, if they do not wish to complain directly to a provider. During 16/17, we received 31 complaints (82 in the previous year). In each case, we worked with the complainant and the provider (where applicable) to achieve resolution in the majority of cases and to identify service improvements and learning outcomes. 90
Our Complaints and Concerns Policy reflects the best practice principles for complaints handling advocated by the Parliamentary & Health Service Ombudsman (Principles for Remedy, Principles of Good Complaint Handling and Principles of Good Administration). In accordance with the Principles for Remedy, we place a strong emphasis upon putting things right and ensuring continuous improvement and learning from complaints.
Freedom of Information (FOI) Requests The Freedom of Information Act 2000 gives a general right of access to recorded information held by public authorities, subject to certain conditions and exemptions. We received 224 requests were received in 16/17. 99.1% were responded to within the statutory timescale of 20 working days. We certify that Thurrock CCG has complied with HM Treasury’s guidance on setting charges for information.
Planning for emergencies Within the Civil Contingencies Act, CCGs have a duty to be prepared for incidents and emergencies. CCGs are classed as a “category two” responder and are seen as a “co-operating body”. This means we are less likely to be involved in the heart of the planning, but we will be heavily involved in incidents that affect the health sector through co-operation in response and sharing of information. The Essex CCGs have an Emergency Preparedness, Resilience and Response (EPRR) and Business Continuity Strategy to ensure that we can respond in accordance with the Civil Contingencies Act 2004, Health and Social Care Act 2012 and the NHS England national policy and guidance, including the New NHS England EPRR Framework 2015 and NHS England EPRR core standards. In July 2016, the CCG Emergency planning team undertook a self-assessment against the NHS England EPRR Core Standards. There were four levels of compliance that could be achieved: full, substantial, partial and non-compliant. The CCG achieved “full ” compliance. This is a improvement on 2015 -2016 as substantial work has been undertaken in the following areas:-
business continuity planning; training and exercising; pandemic flu preparedness.
All CCGs in Essex share a generic Incident Response and Incident Coordination Centre Plan, which details establishing an Incident Coordination Centre and an Incident Response Team within the local CCG. These plans have been updated during 2016 to include the increasing expectations placed upon CCGs by NHS England in the event of an incident. 91
Business Continuity Management (BCM) is a statutory requirement for all Essex CCGs. Suitable plans aligned to the international Business Continuity Standard ISO22301 have been established to enable the CCG to respond to an internal incident/disruption. The BCM process is supported by a CCG Business Continuity Management System and Policy and the CCG’s individual Business Continuity Plan (BCP). The Policy and Plan are being reviewed as part of the annual BCM review process. The CCG BCP outlines the response and recovery arrangements and how the CCG would mitigate the impact of a business disruption on the operations and reputation of the CCG. The CCG Emergency Planning team has strengthened partnership working with NHS England Midlands and East (East) and with local providers and has also ensured the CCG is a key partner in the Essex Local Resilience Forum.
The Local Counter Fraud Service The Local Counter Fraud Service is provided by Mazars LLP (as referred to in the Governance report). The NHS Standard Contract stipulates that all organisations providing NHS services have appropriate anti-fraud arrangements in place. NHS Protect has since published ‘Standards for Commissioners: Fraud, Bribery and Corruption’ to assist organisations with this process. These standards incorporate a requirement that we employ or contract a qualified person or persons to undertake the full range of anti-fraud work. We are committed to minimising the occurrence of fraud or corruption within our organisation. The Local Counter Fraud Specialist (LCFS) meets with our Chief Finance Officer, and attends Audit Committee meetings to report on the work achieved. The LCFS also have direct access to the Chair of the Audit Committee and works to ensure that counter fraud is integrated into all our activity in a positive way. Throughout the past financial year the counter fraud culture has continued to be embedded into our organisation and work has been undertaken against each of the four key sections that follow NHS Protects’ National Counter Fraud strategy to include ‘Strategic Governance’, ‘Inform and Involve’; ‘Prevent and Deter’ and ‘Hold to Account’. We take a positive stance in countering fraud against the organisation and the NHS in general and actively seek to ensure that an appropriate, yet proportionate response is taken to allegations of fraud and corruption. Where appropriate the most appropriate sanctions and redress are applied.
92
Statement as to disclosure to auditors Each individual who is a member of the CCG at the time the Members’ Report is approved confirms: So far as the member is aware, there is no relevant audit information of which the CCG’s auditor is unaware that would be relevant for the purposes of their audit report. The member has taken all the steps that they ought to have taken in order to make him or herself aware of any relevant audit information and to establish that the CCG’s auditor is aware of it.
Disclosure of serious untoward incidents As provided in the CCG's Governance Statement, there have been no Serious Untoward Incidents involving or confidentiality breaches over the last year
93
Remuneration and Staff Report Remuneration Report for the year ending 31 March 2017 Remuneration Committee Report Membership of the Remuneration Committee comprised of the following during 16/17: • Lesley Buckland, Deputy Chair and Lay Member, Governance and Audit (Chair of Remuneration Committee) • Trevor Hitchcock, Lay Member • Elizabeth Corbishley, Lay Member, Patient and Public Involvement The committee met on thirteen occasions and they were quorate each time they met. The CCG’s corporate governance manual mandates the Remuneration Committee to make recommendations to the board on appropriate remuneration for board members and executive officers. Policy on Remuneration of Senior Managers Throughout the 16/17 year, NHS Thurrock CCG remunerated its officers, including the Chief Finance Officer and Chief Nurse, using the national Agenda for Change framework and terms and conditions. The exception to this was in relation to the (Acting) Interim Accountable Officer and the Interim Accountable Officer, remunerated using the Very Senior Managers framework. Senior Managers Performance Related Pay The CCG does not operate a performance related pay scheme for managers. Policy on Senior Managers Contracts The CCG has no senior manager contracts other than that used for the Accountable Officer role. Senior Managers Service Contracts The Accountable Officer, Chief Finance Officer and Chief Nurse posts are established on a permanent basis. The Accountable Officer has now being recruited on a substantive basis, and the post holder assumed duty on 1 February 2017. Clinicians working for the CCG do so under an “Office Holder” agreement for a term of three years.
94
Thurrock CCG Remuneration Report 16/17 (subject to audit)
NAME
TITLE
(bands of £5,000)
Expense payments (Taxable) to the nearest £100
£000
£00
2016-17 Performance Long -term pay and bonuses performance pay and bonuses (bands of (bands of £5000) £5000) £000 £000
Dates served All pensionrelated benefits (bands of £2,500) £000
Total Commenced
85-90
0
0
0
40-42.5
130-135
01-Apr-13
0
0
0
0-2.5
120-125
01-Mar-14
Executive Nurse
85-90
11
0
0
42.5-45
130-135
01-Apr-13
GP Interim Accountable Officer / GP Board Member ** Practice Manager Governance and Audit Lay Member & Deputy CCG Chair GP CCG Chair GP Joint Clinical Engagement Group Chair GP QIPP Committee Chair GP Clinical Lead GP Mental Health Lead GP Joint Clinical Engagement Group Chair *** Secondary Care Clinician GP Medicines Management Lead GP Planned Care Lead GP Quality & Patient Safety Committee Chair GP Medicines Management Lead GP Finance & Performance Committee Chair GP Planned & Unplanned Care Lead Secondary Care Clinician Lay member for Patient and Public Involvement Lay member
35-40
0
0
0
2.5-5.0
35-40
01-Apr-13
5-10 20-25 55-60 5-10 10-15 10-15 15-20 35-40 0-5 5-10 0-5 0-5 0-5 0-5 0-5 0-5 5-10 0-5
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0-2.5 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5-10 20-25 55-60 5-10 10-15 10-15 15-20 35-40 0-5 5-10 0-5 0-5 0-5 0-5 0-5 0-5 5-10 0-5
01-Apr-13 01-May-13 01-Apr-13 01-Apr-13 01-Apr-13 01-Apr-13 01-Apr-13 01-Apr-13 01-Apr-13 01-Apr-13 01-Jan-14 01-Jan-17 01-Jan-17 01-Jan-17 01-Jan-17 01-Mar-17 01-Apr-16 01-Feb-17
Chief Finance Officer
Amanda Ansell (full time)
Acting Interim Accountable Officer / Accountable Officer
Jane Foster - Taylor (full time) Dr Thamotherampillat Nimal-Raj
*
Ceased
£5000) £000
115-120
Ade Olarinde (full time)
Russel Vine Lesley Buckland Dr Anand Deshpande Dr Lakhvir Grewal Dr Raymond Arhin Dr Anjan Bose Dr Rajan Mohile Dr Vaiyapuri Raja Dr Suparna Das Dr Peter Martin Dr Anil Bansal Dr Anil Kallil Dr Henry Okoi Dr Luis Leighton Dr Vikram Bhat Dr Julia Hale Liv Corbishley Trevor Hitchcock
Salary
31-Dec-16
31-Dec-16 31-Dec-16
31-Dec-16 31-Dec-16
* - Ms A Ansell held office as (Acting) Interim Accountable Officer until 1st Febtuary 2017, when she was appointed Accountable Officer on a substantive basis. ** - Dr T Nimal-Raj reverted from Interim Accountable Officer to GP Board on 18th September 2016 and left the Board on 31 December 2016 upon expiry of his term. *** - Dr V Raja assumed sole chairmanship of the Clinical Engagement Group on 1st January 2017. Note: The negative movement in pensions related benefits are as a result of correction of previously overstated notional full time salary calculation.
The pension-related benefit figures quoted do not represent cash payments made to an individual's pension provider. The quoted figures provided by NHS Pensions Agency are an estimation of the increase in the accrued pension over their estimated pensionable life. Where an individual joins the pension fund after a significant gap, this can result in a higher estimate than would normally be expected. However, the pension benefit figures are expected to return to normal levels in the second year of disclosure.
Thurrock CCG Remuneration Report 15/16 NAME
TITLE
2015-16 Expense Performance Long -term All pensionpayments pay and bonuses performance related (Taxable) to pay and bonuses benefits the nearest £100 (bands of (bands of (bands of £5000) £5000) £2,500) £00 £000 £000 £000
Salary (bands of £5,000) £000
Ade Olarinde (full time) Amanda Ansell (full time) Jane Foster - Taylor (full time) Dr Thamotherampillat Nimal-Raj Russel Vine Len Green Lesley Buckland Dr Anand Deshpande Dr Lakhvir Grewal Dr Raymond Arhin Dr Anjan Bose Dr Rajan Mohile Dr Vaiyapuri Raja Dr Suparna Das Dr Peter Martin Dr Anil Bansal
Chief Finance Officer (Acting) Interim Accountable Officer * Chief Nurse GP Interim Accountable Officer * Practice Manager Deputy Chair /and PPI Engagement Lay Member Governance and Audit Lay member GP CCG Chair GP Joint Clinical Engagement Group Chair GP QIPP Committee Chair GP Clinical Lead GP Mental Health Lead GP Joint Clinical Engagement Group Chair Secondary Care Clinician GP Medicines Management Lead GP Planned Care Lead
Dates served Total Commenced
£5000) £000
80-85
0
0
0
5-7.5
90-95
01-Apr-13
115-120 80-85 70-75 10-15 10-15 20-25 55-60 10-15 5-10 15-20 15-20 30-35 10-15 5-10 5-10
0 3 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0-2.5 82.5-85 0 0 0 0 0 5-7.5 47.5-50 0 132.5-135 25-27.5 0 52.5-55 0
120-125 165-170 70-75 10-15 10-15 20-25 55-60 15-20 55-60 15-20 150-155 55-60 10-15 60-65 0
01-Mar-14 01-Apr-13 01-Apr-13 01-Apr-13 01-Apr-13 01-May-13 01-Apr-13 01-Apr-13 01-Apr-13 01-Apr-13 01-Apr-13 01-Apr-13 01-Apr-13 01-Apr-13 01-Jan-14
* The CCG is working with NHS England to appoint a permanent Accountable Officer.
•
95
Ceased
30-Jun-15
Pension Benefits (subject to audit) Certain members do not receive pensionable remuneration therefore there will be no entries in respect of pensions for certain members The table shows the Pension Benefits of Senior Managers in 2016/17 Name and Title
Real increase Real increase in Total accrued Lump sum at Cash equivalent Real increase in Cash Employers in pension at pension lump pension at pension age transfer value at cash equivalent equivalent contribution pension age sum at pension pension age at related to accrued 1st April 2016 transfer value transfer to age 31st March 2017 pension at 31st value at 31st stakeholder March 2017 March 2017 pension (bands of (bands of (bands of £2,500) £2,500) £5,000) (bands of £5,000) £000 £000 £000 £000 £000 £000 £000 £00
Board Members Ade Olarinde Amanda Ansell Jane Foster - Taylor
Chief Finance Officer Accountable Officer Chief Nurse
GP/ Clinical Members Dr Thamotherampillat Nimal-Raj Dr Lakhvir Grewal Dr Raymond Arhin Dr Rajan Mohile Dr Vaiyapuri Raja
GP Interim Accountable Officer GP Joint Clinical Engagement Group Chair GP QIPP Committee Chair GP Mental Health Lead GP Joint Clinical Engagement Group Chair
0-2.5 0-2.5 2.5-5
5-7.5 2.5-5 7.5-10
25-30 50-55 23-35
85-90 160-165 90-95
478 1,145 517
57 52 70
541 1,211 594
0 0 0
0-2.5 0-2.5 (5)-(7.5) (5)-(7.5) 0-(2.5)
0-2.5 0-(2.5) (7.5)-(10.0) (17.5)-(20.0) (2.5)-(5.0)
10-15 5-10 5-10 5-10 10-15
40-45 25-30 25-30 25-30 35-40
303 115 200 288 213
(306) 11 (57) (109) 4
0 127 145 182 219
0 0 0 0 0
A cash equivalent transfer value (CETV) A cash Equivalent transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s (or other allowable beneficiary’s) pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries. Real increase in CETV This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period. 96
Compensation on early retirement or for loss office (subject to audit) Liabilities of £0, due in future years under arrangements to buy out the liability for early retirement over 5 years (31 March 2017: £0). Payments to past members (subject to audit) Liabilities of £0, due in future years under arrangements to buy out the liability for early retirement over 5 years (31 March 2017: £0). Pay Multiples (subject to audit) Reporting bodies are required to disclose the relationship between the remuneration of the highest paid member in their organisation and the median remuneration of the organisation’s workforce. The banded remuneration of the highest paid member in Thurrock CCG in the financial year 2016/17 was £115k-£120k (2015/16: £115k-120k). This was 3.3 times (2015/16: 3.6) the median remuneration of the workforce, which was £35,393 (2015/16: £33,145). In 2016/17, No employee received remuneration in excess of the highest-paid member. Remuneration ranged from £0 to £118k (2015/2016: £0 to £118k) Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind, but not severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions.
The banded remuneration of the highest paid director / member Median remuneration of the CCG workforce Ratio of highest paid director / member to median paid employee No. of employees who were paid more than the highest paid director / member Remuneration ranges in the year
2016/17 £115k to £120k £35,393 3.3 0 £0k to £118k
2015/16 £115k to £120k £33,145 3.6 0 £0k to £118k
In 2016/17 the median remuneration of the CCG workforce has increased slightly causing the ratio to drop from 3.6 to 3.3. This is a result of the recruitment of additional senior managers in respect of the Quality and Patient Safety team. Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind, but not severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions. Off Payroll Engagements Off-payroll engagements Table 1
97
For all off-payroll engagements as of 31 March 2017, for more than £220 per day and that last longer than six months: Number Number of existing engagements as of 31 March 2017
1
Of which, the number that have existed: for less than one year at the time of reporting
0
for between one and two years at the time of reporting
1
for between 2 and 3 years at the time of reporting
0
for between 3 and 4 years at the time of reporting
0
for 4 or more years at the time of reporting
0
New Off-payroll engagements Table 2 For all new off-payroll engagements between 1 April 2016 and 31 March 2017, for more than £220 per day and that last longer than six months: Number Number of new engagements, or those that reached six months in duration, between 1 April 2016 and 31 March 2017
1
Number of new engagements which include contractual clauses giving NHS Thurrock CCG the right to request assurance in relation to income tax and National Insurance obligations
1
Number for whom assurance has been requested
1
Of which: assurance has been received
1
assurance has not been received
0
engagements terminated as a result of assurance not being received
0
Off-payroll engagements Table 3 Table 3: For any off-payroll engagements of board members, and/or, senior officials with significant financial responsibility, between 1 April 2016 and 31 March 2017 Number of off-payroll engagements of board members, and/or senior officers with significant financial responsibility, during the financial year (1) Total no. of individuals on payroll and off-payroll that have been deemed “board members, and/or, senior officials with significant financial responsibility”, during the financial year. This figure should include both on payroll and off-payroll engagements.(2)
98
0
0
Exit packages, including special (non-contractual) payments (subject to audit) Table 1: Exit Packages Number of departures where special payments have been made
Cost of special payment element included in exit packages
£s
WHOLE NUMBERS ONLY
£s
6,148
0
nil
Exit package cost band Number of Cost of Number of other Cost of other Total number Total cost of (inc. any special compulsory compulsory departures departures of exit exit packages payment element redundancies redundancies agreed agreed packages £s Less than £10,000
0.5
3,074
£s 0.5
3,074
1
Agrees to A below
WHOLE NUMBERS ONLY 1
£10,000 - £25,000 £25,001 - £50,000 £50,001 - £100,000 £100,001 - £150,000
£150,001 –£200,000 >£200,000 TOTALS
1
6,148
Redundancy and other departure cost have been paid in accordance with the provisions of Mutually Agreed Resignations (MARS) contractual costs. Exit costs in this note are accounted for in full in the year of departure. Where Thurrock CCG has agreed early retirements, the additional costs are met by Thurrock CCG and not by the NHS Pensions Scheme. Ill-health retirement costs are met by the NHS Pensions Scheme and are not included in the table. Table 2: Analysis of Other Departures Agreements
Total Value of agreements
Number
£000s
0.5*
3.074
0.5*
3.074
1
A – agrees to total in table 1
Voluntary redundancies including early retirement contractual costs Mutually agreed resignations (MARS) contractual costs Early retirements in the efficiency of the service contractual costs Contractual payments in lieu of notice* Exit payments following Employment Tribunals or court orders Non-contractual payments requiring HMT approval** TOTAL
*The post was jointly funded with the Thurrock Council 99
Staff Report for the year ending 31 March 2017 Staff numbers There were 54 staff equal to 48 Whole Time Equivalents (WTE) employed by NHS Thurrock CCG as at 31 March 2017. Equal Opportunities We are committed to equal opportunities for all staff. We are an equal opportunities employer and as such recruit under the Equality ‘two ticks’ scheme. Recruitment and Selection (including both external and internal recruitment/promotion) procedures follows NHS Employers ‘good practice guidance’ and meets NHS Employment Checks Standards. We have access to HR and Occupational Health advice in order to support any employees who fall within the scope of the Equality Act 2010. We currently employ no staff who declared a disability. (See Appendix 2 for full report) Staff sickness FTE days sick – 103 days up to 31 March 2017. Absence is supportively managed within our organisation, with an absence management policy addressing both short term and long term absence. All staff are supported through any absences, with return to work meetings conducted following periods of absence and referrals made to Occupational Health for support in achieving a regular sustained attendance at work. Persistent short term absence is addressed through formal procedures. Staff communications We continue to implement a number of measures to ensure that our staff voices can be heard. This includes face to face weekly staff briefing sessions whilst our communications team utilises a range of communications channels to ensure good communications between staff at all levels. These channels include a weekly bulletin and regular emails.
Parliamentary Accountability and Audit Report (subject to audit) NHS Thurrock CCG is not required to produce a Parliamentary Accountability and Audit Report. Disclosures on remote contingent liabilities, losses and special payments, gifts, and fees and charges are included as notes in the Financial Statements of this report at note 40. An audit certificate and report is included in this Annual Report [pages 129-134].
100
Annual Accounts
101
Entity Name
Thurrock CCG
This Year
2016 - 17
This year ended
31st March 2017
This year commencing
1st April 2016
Accountable Officer
Mandy Ansell
102
Thurrock CCG - Annual Accounts 2016-17 Statement of Comprehensive Net Expenditure for the year ended 31 March 2017 Note
2016-17 £'000
2015-16 £'000
Income from sale of goods and services Other operating income Total operating income
2 2
(1,572) (169) (1,741)
(635) (95) (730)
Staff costs Purchase of goods and services Depreciation and impairment charges Provision expense Other operating expenditure Total operating expenditure
4 5 5 5 5
2,816 203,089 3 56 252 206,217
1,998 196,164 3 34 241 198,441
Total Net Expenditure for the year
204,476
197,711
Comprehensive Expenditure for the year ended 31 March 2017
204,476
197,711
103
Thurrock CCG - Annual Accounts 2016-17 Statement of Financial Position as at 31 March 2017
Note
2016-17
2015-16
£'000
£'000
Non-current assets: Property, plant and equipment Total non-current assets
13
1 1
4 4
Current assets: Trade and other receivables Cash and cash equivalents Total current assets
17 20
2,165 37 2,202
4,148 66 4,214
2,202
4,218
(12,310) (207) (12,517)
(14,188) (151) (14,340)
(10,315)
(10,121)
0
0
Assets less Liabilities
(10,315)
(10,121)
Financed by taxpayers’ equity General fund Total taxpayers' equity:
(10,315) (10,315)
(10,121) (10,121)
Total assets Current liabilities Trade and other payables Provisions Total current liabilities
23 30
Non-current assets plus/less Net Current Assets/Liabilities Total non-current liabilities
The notes on pages 107 to 128 form part of this statement
The financial statements on pages 103 to 106 were approved by the Governing Body on 31st May 2017 and signed on its behalf by:
Accountable Officer Mandy Ansell
104
Thurrock CCG - Annual Accounts 2016-17 Statement of Changes In Taxpayers Equity for the year ended 31 March 2017 General fund £'000
Revaluation reserve £'000
Total reserves £'000
Changes in taxpayers’ equity for 2016-17 Balance at 01 April 2016 Transfer between reserves in respect of assets transferred from closed NHS bodies Adjusted NHS Clinical Commissioning Group balance at 31 March 2017 Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2016-17 Net operating expenditure for the financial year
(10,121)
0
(10,121)
0 (10,121)
0 0
0 (10,121)
(204,476)
(204,476)
Net gain/(loss) on revaluation of financial assets
0
0
Total revaluations against revaluation reserve
0
0
0
Transfers between reserves
0
0
0
(204,476)
0
(204,476)
Net funding
204,282
0
204,282
Balance at 31 March 2017
(10,315)
0
(10,315)
Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year
General fund £'000
Other reserves £'000
Total reserves £'000
Changes in taxpayers’ equity for 2015-16 Balance at 01 April 2015 Transfer of assets and liabilities from closed NHS bodies as a result of the 1 April 2013 transition Adjusted NHS Clinical Commissioning Group balance at 31 March 2016 Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2015-16 Net operating costs for the financial year
(10,327)
0
(10,327)
0 (10,327)
0 0
0 (10,327)
(197,711)
Net gain/(loss) on revaluation of financial assets
(197,711) 0
0
Total revaluations against revaluation reserve
0
0
0
Movements in other reserves
0
0
0
(197,711)
0
(197,711)
Net funding
197,916
0
197,916
Balance at 31 March 2016
(10,121)
0
(10,121)
Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year
The notes on pages 107 to 128 form part of this statement
105
Thurrock CCG - Annual Accounts 2016-17 Statement of Cash Flows for the year ended 31 March 2017 Note Cash Flows from Operating Activities Net operating expenditure for the financial year Depreciation and amortisation (Increase)/decrease in trade & other receivables Increase/(decrease) in trade & other payables Increase/(decrease) in provisions Net Cash Inflow (Outflow) from Operating Activities
2016-17 £'000
2015-16 £'000
(204,476) 3 1,983 (1,878) 56 (204,311)
(197,711) 3 (2,414) 2,187 34 (197,900)
0 0
0 0
(204,311)
(197,900)
Cash Flows from Financing Activities Grant in Aid Funding Received
204,282
197,916
Net Cash Inflow (Outflow) from Financing Activities
204,282
197,916
(29)
17
66
49
0
0
37
66
5 17 23 30
Cash Flows from Investing Activities Interest received Net Cash Inflow (Outflow) from Investing Activities Net Cash Inflow (Outflow) before Financing
Net Increase (Decrease) in Cash & Cash Equivalents
20
Cash & Cash Equivalents at the Beginning of the Financial Year Effect of exchange rate changes on the balance of cash and cash equivalents held in foreign currencies Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year
The notes on pages 107 to 128 form part of this statement
106
Thurrock CCG - Annual Accounts 2016-17 Notes to the financial statements 1
1.1
1.2
1.3
1.4
1.5
1.5.1
1.5.2
1.6
1.7 1.7.1
Accounting Policies NHS England has directed that the financial statements of clinical commissioning groups shall meet the accounting requirements of the Group Accounting Manual issued by the Department of Health. Consequently, the following financial statements have been prepared in accordance with the Group Accounting Manual 2016-17 issued by the Department of Health. The accounting policies contained in the Group Accounting Manual follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to clinical commissioning groups, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Group Accounting Manual permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the clinical commissioning group for the purpose of giving a true and fair view has been selected. The particular policies adopted by the clinical commissioning group are described below. They have been applied consistently in dealing with items considered material in relation to the accounts. Going Concern These accounts have been prepared on the going concern basis (despite the issue of a report to the Secretary of State for Health under Section 30 of the Local Audit and Accountability Act 2014). Public sector bodies are assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as evidenced by inclusion of financial provision for that service in published documents. Where a clinical commissioning group ceases to exist, it considers whether or not its services will continue to be provided (using the same assets, by another public sector entity) in determining whether to use the concept of going concern for the final set of Financial Statements. If services will continue to be provided, the financial statements are prepared on the going concern basis. Accounting Convention These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities. Movement of Assets within the Department of Health Group Transfers as part of reorganisation fall to be accounted for by use of absorption accounting, in line with the Government Financial Reporting Manual, issued by HM Treasury. The Government Financial Reporting Manual does not require retrospective adoption, so prior year transactions (which have been accounted for under merger accounting) have not been restated. Absorption accounting requires that entities account for their transactions in the period in which they took place, with no restatement of performance required when functions transfer within the public sector. Where assets and liabilities transfer, the gain or loss resulting is recognised in the Statement of Comprehensive Net Expenditure, and is disclosed separately from operating costs. Other transfers of assets and liabilities within the Department of Health Group are accounted for in line with IAS 20 and similarly give rise to income and expenditure entries. Pooled Budgets Where the clinical commissioning group has entered into a pooled budget arrangement under Section 75 of the National Health Service Act 2006 the clinical commissioning group accounts for its share of the assets, liabilities, income and expenditure arising from the activities of the pooled budget, identified in accordance with the pooled budget agreement. If the clinical commissioning group is in a “jointly controlled operation”, the clinical commissioning group recognises: · The assets the clinical commissioning group controls; · The liabilities the clinical commissioning group incurs; · The expenses the clinical commissioning group incurs; and, · The clinical commissioning group’s share of the income from the pooled budget activities. If the clinical commissioning group is involved in a “jointly controlled assets” arrangement, in addition to the above, the clinical commissioning group recognises: · The clinical commissioning group’s share of the jointly controlled assets (classified according to the nature of the assets); · The clinical commissioning group’s share of any liabilities incurred jointly; and, · The clinical commissioning group’s share of the expenses jointly incurred. Critical Accounting Judgements & Key Sources of Estimation Uncertainty In the application of the clinical commissioning group’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods. Critical Judgements in Applying Accounting Policies The following are the critical judgements, apart from those involving estimations (see below) that management has made in the process of applying the clinical commissioning group’s accounting policies that have the most significant effect on the amounts recognised in the financial statements: The BCF (Better Care Fund) has been reviewed and determined to be a Pooled Budget with Thurrock Council. Key Sources of Estimation Uncertainty The following are the key estimations that management has made in the process of applying the clinical commissioning group’s accounting policies that have the most significant effect on the amounts recognised in the financial statements: Prescribing Creditor - The charges are a combination of Prescription Pricing Authority reporting currently having a time lag of one month which generates the main proportion of the balance and the time lag of the cash advance payments for prescribed drugs. The accrual is based on the estimated balance for 2016-17 that will be payable in 2017-18. Revenue Revenue in respect of services provided is recognised when, and to the extent that, performance occurs, and is measured at the fair value of the consideration receivable. Where income is received for a specific activity that is to be delivered in the following year, that income is deferred. Employee Benefits Short-term Employee Benefits Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees, including bonuses earned but not yet taken. The cost of leave earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry forward leave into the following period.
107
Thurrock CCG - Annual Accounts 2016-17 Notes to the financial statements 1.7.2
1.8
1.9 1.9.1
1.9.2
1.9.3
1.10
Retirement Benefit Costs Past and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the clinical commissioning group of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period. For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to expenditure at the time the clinical commissioning group commits itself to the retirement, regardless of the method of payment. Some employees are members of the Local Government Superannuation Scheme, which is a defined benefit pension scheme. The scheme assets and liabilities attributable to those employees can be identified and are recognised in the clinical commissioning group’s accounts. The assets are measured at fair value and the liabilities at the present value of the future obligations. The increase in the liability arising from pensionable service earned during the year is recognised within operating expenses. The expected gain during the year from scheme assets is recognised within finance income. The interest cost during the year arising from the unwinding of the discount on the scheme liabilities is recognised within finance costs. Actuarial gains and losses during the year are recognised in the General Reserve and reported as an item of other comprehensive net expenditure. Other Expenses Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable. Expenses and liabilities in respect of grants are recognised when the clinical commissioning group has a present legal or constructive obligation, which occurs when all of the conditions attached to the payment have been met. Property, Plant & Equipment Recognition Property, plant and equipment is capitalised if: · It is held for use in delivering services or for administrative purposes; · It is probable that future economic benefits will flow to, or service potential will be supplied to the clinical commissioning group; · It is expected to be used for more than one financial year; · The cost of the item can be measured reliably; and, · The item has a cost of at least £5,000; or, · Collectively, a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or, · Items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or collective cost. Where a large asset, for example a building, includes a number of components with significantly different asset lives, the components are treated as separate assets and depreciated over their own useful economic lives. Valuation All property, plant and equipment are measured initially at cost, representing the cost directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. All assets are measured subsequently at valuation. Land and buildings used for the clinical commissioning group’s services or for administrative purposes are stated in the statement of financial position at their re-valued amounts, being the fair value at the date of revaluation less any impairment. Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that would be determined at the end of the reporting period. Fair values are determined as follows: · Land and non-specialised buildings – market value for existing use; and, · Specialised buildings – depreciated replacement cost. HM Treasury has adopted a standard approach to depreciated replacement cost valuations based on modern equivalent assets and, where it would meet the location requirements of the service being provided, an alternative site can be valued. Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost includes professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for assets held at fair value. Assets are re-valued and depreciation commences when they are brought into use. Fixtures and equipment are carried at depreciated historic cost as this is not considered to be materially different from current value in existing use. An increase arising on revaluation is taken to the revaluation reserve except when it reverses an impairment for the same asset previously recognised in expenditure, in which case it is credited to expenditure to the extent of the decrease previously charged there. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Gains and losses recognised in the revaluation reserve are reported as other comprehensive income in the Statement of Comprehensive Net Expenditure. Subsequent Expenditure Where subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised. Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing carrying value of the item replaced is written-out and charged to operating expenses. Depreciation, Amortisation & Impairments Freehold land, properties under construction, and assets held for sale are not depreciated. Otherwise, depreciation and amortisation are charged to write off the costs or valuation of property, plant and equipment and intangible noncurrent assets, less any residual value, over their estimated useful lives, in a manner that reflects the consumption of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over which the clinical commissioning group expects to obtain economic benefits or service potential from the asset. This is specific to the clinical commissioning group and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are depreciated over their estimated useful lives.
108
Thurrock CCG - Annual Accounts 2016-17 Notes to the financial statements
1.11
1.11.1
1.11.2
1.12
1.13
1.14
1.15
1.16
1.17
At each reporting period end, the clinical commissioning group checks whether there is any indication that any of its tangible or intangible noncurrent assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its amount. Intangible assets not yet available for use are tested for impairment annually. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Where an impairment loss subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the recoverable amount but capped at the amount that would have been determined had there been no initial impairment loss. The reversal of the impairment loss is credited to expenditure to the extent of the decrease previously charged there and thereafter to the revaluation reserve. Leases Leases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All other leases are classified as operating leases. The Clinical Commissioning Group as Lessee Property, plant and equipment held under finance leases are initially recognised, at the inception of the lease, at fair value or, if lower, at the present value of the minimum lease payments, with a matching liability for the lease obligation to the lessor. Lease payments are apportioned between finance charges and reduction of the lease obligation so as to achieve a constant rate on interest on the remaining balance of the liability. Finance charges are recognised in calculating the clinical commissioning group’s surplus/deficit. Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term. Contingent rentals are recognised as an expense in the period in which they are incurred. Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether they are operating or finance leases. The Clinical Commissioning Group as Lessor Amounts due from lessees under finance leases are recorded as receivables at the amount of the clinical commissioning group’s net investment in the leases. Finance lease income is allocated to accounting periods so as to reflect a constant periodic rate of return on the clinical commissioning group’s net investment outstanding in respect of the leases. Rental income from operating leases is recognised on a straight-line basis over the term of the lease. Initial direct costs incurred in negotiating and arranging an operating lease are added to the carrying amount of the leased asset and recognised on a straight-line basis over the lease term. Cash & Cash Equivalents Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value. In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the clinical commissioning group’s cash management. Provisions Provisions are recognised when the clinical commissioning group has a present legal or constructive obligation as a result of a past event, it is probable that the clinical commissioning group will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties. Where a provision is measured using the cash flows estimated to settle the obligation, its carrying amount is the present value of those cash flows using HM Treasury’s discount rate as follows: · Timing of cash flows (0 to 5 years inclusive): Minus 2.70% (previously: minus 1.55%) · Timing of cash flows (6 to 10 years inclusive): Minus 1.95% (previously: minus 1.%) · Timing of cash flows (over 10 years): Minus 0.80% (previously: minus 0.80%) When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the receivable is recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the receivable can be measured reliably. A restructuring provision is recognised when the clinical commissioning group has developed a detailed formal plan for the restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by starting to implement the plan or announcing its main features to those affected by it. The measurement of a restructuring provision includes only the direct expenditures arising from the restructuring, which are those amounts that are both necessarily entailed by the restructuring and not associated with on-going activities of the entity. Clinical Negligence Costs The NHS Litigation Authority operates a risk pooling scheme under which the clinical commissioning group pays an annual contribution to the NHS Litigation Authority which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although the NHS Litigation Authority is administratively responsible for all clinical negligence cases the legal liability remains with the clinical commissioning group. Non-clinical Risk Pooling The clinical commissioning group participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the clinical commissioning group pays an annual contribution to the NHS Litigation Authority and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due. Continuing healthcare risk pooling In 2014-15 a risk pool scheme was introduced by NHS England for continuing healthcare claims, for claim periods prior to 31 March 2013. Under the scheme clinical commissioning group contribute annually to a pooled fund, which is used to settle the claims. Carbon Reduction Commitment Scheme Carbon Reduction Commitment and similar allowances are accounted for as government grant funded intangible assets if they are not expected to be realised within twelve months, and otherwise as other current assets. They are valued at open market value. As the clinical commissioning group makes emissions, a provision is recognised with an offsetting transfer from deferred income. The provision is settled on surrender of the allowances. The asset, provision and deferred income amounts are valued at fair value at the end of the reporting period.
109
Thurrock CCG - Annual Accounts 2016-17 Notes to the financial statements 1.18
1.19
1.19.1
1.19.2
1.19.3
1.20
1.20.1
1.20.2
1.21
1.22
1.23
1.24
Contingencies A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence or nonoccurrence of one or more uncertain future events not wholly within the control of the clinical commissioning group, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or the amount of the obligation cannot be measured sufficiently reliably. A contingent liability is disclosed unless the possibility of a payment is remote. A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the clinical commissioning group. A contingent asset is disclosed where an inflow of economic benefits is probable. Where the time value of money is material, contingencies are disclosed at their present value. Financial Assets Financial assets are recognised when the clinical commissioning group becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred. Financial assets are classified into the following categories: · Financial assets at fair value through profit and loss; · Held to maturity investments; · Available for sale financial assets; and, · Loans and receivables. The classification depends on the nature and purpose of the financial assets and is determined at the time of initial recognition. Financial Assets at Fair Value Through Profit and Loss Embedded derivatives that have different risks and characteristics to their host contracts, and contracts with embedded derivatives whose separate value cannot be ascertained, are treated as financial assets at fair value through profit and loss. They are held at fair value, with any resultant gain or loss recognised in calculating the clinical commissioning group’s surplus or deficit for the year. The net gain or loss incorporates any interest earned on the financial asset. Available For Sale Financial Assets Available for sale financial assets are non-derivative financial assets that are designated as available for sale or that do not fall within any of the other three financial asset classifications. They are measured at fair value with changes in value taken to the revaluation reserve, with the exception of impairment losses. Accumulated gains or losses are recycled to surplus/deficit on de-recognition. Loans & Receivables Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market. After initial recognition, they are measured at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method. Fair value is determined by reference to quoted market prices where possible, otherwise by valuation techniques. The effective interest rate is the rate that exactly discounts estimated future cash receipts through the expected life of the financial asset, to the initial fair value of the financial asset. At the end of the reporting period, the clinical commissioning group assesses whether any financial assets, other than those held at ‘fair value through profit and loss’ are impaired. Financial assets are impaired and impairment losses recognised if there is objective evidence of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the estimated future cash flows of the asset. For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset’s carrying amount and the present value of the revised future cash flows discounted at the asset’s original effective interest rate. The loss is recognised in expenditure and the carrying amount of the asset is reduced through a provision for impairment of receivables. If, in a subsequent period, the amount of the impairment loss decreases and the decrease can be related objectively to an event occurring after the impairment was recognised, the previously recognised impairment loss is reversed through expenditure to the extent that the carrying amount of the receivable at the date of the impairment is reversed does not exceed what the amortised cost would have been had the impairment not been recognised. Financial Liabilities Financial liabilities are recognised on the statement of financial position when the clinical commissioning group becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired. Financial Guarantee Contract Liabilities Financial guarantee contract liabilities are subsequently measured at the higher of: · The premium received (or imputed) for entering into the guarantee less cumulative amortisation; and, · The amount of the obligation under the contract, as determined in accordance with IAS 37: Provisions, Contingent Liabilities and Contingent Assets. Other Financial Liabilities After initial recognition, all other financial liabilities are measured at amortised cost using the effective interest method, except for loans from Department of Health, which are carried at historic cost. The effective interest rate is the rate that exactly discounts estimated future cash payments through the life of the asset, to the net carrying amount of the financial liability. Interest is recognised using the effective interest method. Value Added Tax Most of the activities of the clinical commissioning group are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT. Losses & Special Payments Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled. Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had the clinical commissioning group not been bearing its own risks (with insurance premiums then being included as normal revenue expenditure). Joint Operations Joint operations are activities undertaken by the clinical commissioning group in conjunction with one or more other parties but which are not performed through a separate entity. The clinical commissioning group records its share of the income and expenditure; gains and losses; assets and liabilities; and cash flows. Accounting Standards That Have Been Issued But Have Not Yet Been Adopted The Government Financial Reporting Manual does not require the following Standards and Interpretations to be applied in 2016-17, all of which are subject to consultation: · IFRS 9: Financial Instruments ( application from 1 January 2018) · IFRS 14: Regulatory Deferral Accounts ( not applicable to DH groups bodies) · IFRS 15: Revenue for Contract with Customers (application from 1 January 2018) · IFRS 16: Leases (application from 1 January 2019) The application of the Standards as revised would not have a material impact on the accounts for 2016-17, were they applied in that year.
110
Thurrock CCG - Annual Accounts 2016-17 2 Other Operating Revenue
Education, training and research Non-patient care services to other bodies Other revenue Total other operating revenue
2016-17 Total
2016-17 Admin
2016-17 Programme
2015-16 Total
£'000
£'000
£'000
£'000
0 1,572 169 1,741
0 119 0 119
0 1,453 169 1,622
5 630 95 730
2016-17 2016-17 Admin Programme £'000 £'000 119 1,622 0 0 119 1,622
2015-16 Total £'000 730 0 730
3 Revenue
From rendering of services From sale of goods Total
2016-17 Total £'000 1,741 0 1,741
111
Thurrock CCG - Annual Accounts 2016-17 4. Employee benefits and staff numbers 4.1.1 Employee benefits
2016-17
Total £'000
Total Permanent Employees £'000
Other £'000
Employee Benefits Salaries and wages Social security costs Employer Contributions to NHS Pension scheme Termination benefits Gross employee benefits expenditure
2,307 239 264 6 2,816
2,084 239 264 6 2,593
223 0 0 0 223
Total - Net admin employee benefits including capitalised costs
2,816
2,593
223
Net employee benefits excluding capitalised costs
2,816
2,593
223
4.1.1 Employee benefits
2015-16 Total £'000
Total Permanent Employees £'000
Other £'000
Employee Benefits Salaries and wages Social security costs Employer Contributions to NHS Pension scheme Termination benefits Gross employee benefits expenditure
1,643 155 199 0 1,998
1,616 155 199 0 1,970
27 0 0 0 27
Total - Net admin employee benefits including capitalised costs
1,998
1,970
27
Net employee benefits excluding capitalised costs
1,998
1,970
27
4.1.2 Recoveries in respect of employee benefits There were no recoveries in respect of employees in 2016-17 (2015-16 Nil)
112
Thurrock CCG - Annual Accounts 2016-17 4.2 Average number of people employed 2016-17 Permanently employed Number
Total Number Total Of the above: Number of whole time equivalent people engaged on capital projects
2015-16 Other Number
Total Number
49
46
3
39
0
0
0
0
4.3 Staff sickness absence and ill health retirements 2016-17 Number 225 71 3.2
Total Days Lost Total Staff Years Average working Days Lost
2015-16 Number 70 37 1.9
There were no ill health retirements during 2016-17 (2015-16 Nil)
4.4 Exit packages agreed in the financial year
Less than £10,000 Over £10,001 Total
2016-17 Compulsory redundancies Number £ 0.5 3,074 0 0 0.5 3,074
2016-17 Other agreed departures Number £ 0.5 3,074 0 0 0.5 3,074
2016-17 Total Number 1 0 1
£ 6,148 0 6,148
The above refers to one exit package which consisted of 50% compulsory redundancy cost and 50% a contractual payment in lieu of notice.
Less than £10,000 Over £10,001 Total
Less than £10,000 Over £10,001 Total
2015-16 Compulsory redundancies Number £ 0 0 0
0 0 0
2016-17 Departures where special payments have been made Number £ 0 0 0 0 0 0
2015-16 Other agreed departures Number £ 0 0 0
0 0 0
2015-16 Total Number 0 0 0
2015-16 Departures where special payments have been made Number £ 0 0 0 0 0 0
Analysis of Other Agreed Departures 2016-17
Contractual payments in lieu of notice Total
Other agreed departures Number £ 0.5 3,074 0.5 3,074
113
2015-16 Other agreed departures Number £ 0 0
0 0
£ 0 0 0
Thurrock CCG - Annual Accounts 2016-17 4.5 Pension costs Past and present employees are covered by the provisions of the NHS Pension Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/Pensions. The Scheme is an unfunded, defined benefit scheme that covers NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The Scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the Scheme is accounted for as if it were a defined contribution scheme: the cost to the clinical commissioning group of participating in the Scheme is taken as equal to the contributions payable to the Scheme for the accounting period. The Scheme is subject to a full actuarial valuation every four years (until 2004, every five years) and an accounting valuation every year. An outline of these follows: 4.5.1 Full actuarial (funding) valuation
The purpose of this valuation is to assess the level of liability in respect of the benefits due under the Scheme (taking into account its recent demographic experience), and to recommend the contribution rates to be paid by employers and scheme members. The last such valuation, which determined current contribution rates was undertaken as at 31 March 2012 and covered the period from 1 April 2008 to that date. Details can be found on the pension scheme website at www.nhsbsa.nhs.uk/pensions. For 2016-17, employers’ contributions of £274k were payable to the NHS Pensions Scheme (2015-16: £210k) at the rate of 14.3% of pensionable pay. The scheme’s actuary reviews employer contributions, usually every four years and now based on HMT Valuation Directions, following a full scheme valuation. The latest review used data from 31 March 2012 and was published on the Government website on 9 June 2012. These costs are included in the NHS pension line of note 4.1.
114
Thurrock CCG - Annual Accounts 2016-17 5. Operating expenses 2016-17 Total £'000 Gross employee benefits Employee benefits excluding governing body members Executive governing body members Total gross employee benefits
2016-17 Admin £'000
2016-17 Programme £'000
2015-16 Total £'000
2,398 418 2,816
1,183 418 1,601
1,216 0 1,216
1,550 448 1,998
Other costs Services from other CCGs and NHS England Services from foundation trusts Services from other NHS trusts Purchase of healthcare from non-NHS bodies Chair and Non Executive Members Supplies and services – general Consultancy services Establishment Premises Depreciation Audit fees Prescribing costs GPMS/APMS and PCTMS Other professional fees excl. audit Education and training Provisions CHC Risk Pool contributions Total other costs
1,779 118,380 19,211 37,762 252 827 356 260 1,009 3 52 22,846 158 72 22 56 355 203,400
1,073 0 0 0 252 37 342 119 238 0 52 0 0 53 7 0 0 2,174
706 118,380 19,211 37,762 0 790 14 141 770 3 0 22,846 158 19 15 56 355 201,226
2,001 115,363 17,883 33,156 241 2,025 514 241 531 3 56 23,319 159 5 23 34 887 196,443
Total operating expenses
206,217
3,775
202,442
198,441
Admin expenditure is expenditure incurred that is not a direct payment for the provision of healthcare or healthcare services. Purchase of healthcare from non-NHS bodies, includes payments made to Thurrock Council for the Better Care Fund. Internal audit fees are included in "Other professional fees excl. audit".
115
Thurrock CCG - Annual Accounts 2016-17 6.1 Better Payment Practice Code Measure of compliance
2016-17 Number
2016-17 £'000
2015-16 Number
2015-16 £'000
Non-NHS Payables Total Non-NHS Trade invoices paid in the Year
8,666
43,362
7,343
36,479
Total Non-NHS Trade Invoices paid within target
8,504
43,262
7,165
36,013
98.13%
99.77%
97.58%
98.72%
Percentage of Non-NHS Trade invoices paid within target NHS Payables Total NHS Trade Invoices Paid in the Year Total NHS Trade Invoices Paid within target Percentage of NHS Trade Invoices paid within target
2,554
144,558
2,358
137,821
2,428 95.07%
146,329
2,199
137,473
101.22%
93.26%
6.2 The Late Payment of Commercial Debts (Interest) Act 1998 No interest nor compensation was paid under this legislation in 2016-17 (2015-16 Nil)
7 Income Generation Activities The clinical commissioning group did not undertake any income generation activities in 2016-17 (2015-16 Nil)
8. Investment revenue The clinical commissioning group had no investment revenue in 2016-17 (2015-16 Nil)
9. Other gains and losses The clinical commissioning group had no other gains or losses in 2016-17 (2015-16 Nil)
10. Finance costs
The clinical commissioning group had no finance costs in 2016-17 (2015-16 Nil)
116
99.75%
Thurrock CCG - Annual Accounts 2016-17 11. Net gain/(loss) on transfer by absorption
Transfers as part of a reorganisation fall to be accounted for by use of absorption accounting in line with the Government Financial Reporting Manual, issued by HM Treasury. The Government Financial Reporting Manual does not require retrospective adoption, so prior year transactions (which have been accounted for under merger accounting) have not been restated. Absorption accounting requires that entities account for their transactions in the period in which they took place, with no restatement of performance required when functions transfer within the public sector. Where assets and liabilities transfer, the gain or loss resulting is recognised in the Statement of Comprehensive Net Expenditure, and is disclosed separately from operating costs. No gain or loss arose on the transfer of assets by absorption to the clinical commissioning group in 2016-17 (2015-16 Nil)
12. Operating Leases 12.1 As lessee NHS Property Services charges the clinical commissioning group for the use of properties occupied. Despite no leases being formally in place, the substance of these arrangements suggest otherwise. 12.1.1 Payments recognised as an expense Buildings £'000 Payments recognised as an expense Minimum lease payments Total
848 848
2016-17 Total £'000
Other £'000 12 12
861 861
Buildings £'000 443 443
2015-16 Total £'000
Other £'000 6 6
449 449
12.1.2 Future minimum lease payments Whilst our arrangements with NHS Property Services Limited fall within the definition of operating leases, rental charge for future years has not yet been agreed . Consequently this note does not include future minimum lease payments for the arrangements.
117
Thurrock CCG - Annual Accounts 2016-17 13 Property, plant and equipment
Plant & machinery £'000 24
Transport equipment £'000 10
Furniture & fittings £'000 3
Cost/Valuation at 31 March 2017
24
10
3
37
Depreciation 01 April 2016
24
7
2
33
0
3
1
3
24
10
2
36
Net Book Value at 31 March 2017
0
0
1
1
Purchased Total at 31 March 2017
0 0
0 0
1 1
1 1
Owned
0
0
1
1
Total at 31 March 2017
0
0
1
1
Plant & machinery £'000 24
Transport equipment £'000 10
Cost/Valuation At 31 March 2016
24
Depreciation 01 April 2015
2016-17 Cost or valuation at 01 April 2016
Charged during the year Depreciation at 31 March 2017
Total £'000 37
Asset financing:
2015-16 Cost or valuation at 01 April 2015
Furniture & fittings £'000
Total £'000 3
37
10
3
37
24
5
1
30
0
3
1
3
24
7
2
33
Net Book Value at 31 March 2016
0
3
1
4
Purchased
0
3
1
4
Total at 31 March 2016
0
3
1
4
Owned
0
3
1
4
Total at 31 March 2016
0
3
1
4
Charged during the year Depreciation at 31 March 2016
Asset financing:
No assets have been revalued.
118
Thurrock CCG - Annual Accounts 2016-17 13 Property, plant and equipment cont'd
13.1 Additions to assets under construction The clinical commissioning group had no additions to assets under construction in 2016-17 (2015-16 Nil)
13.2 Donated assets The clinical commissioning group had no donated assets in 2016-17 (2015-16 Nil) 13.3 Government granted assets The clinical commissioning group had no government granted assets in 2016-17 (2015-16 Nil)
13.4 Property revaluation The clinical commissioning group does not own any properties, and therefore, no revaluation was required or carried out.
13.5 Compensation from third parties The clinical commissioning group did not receive any compensation from third parties in 2016-17 (2015-16 Nil) 13.6 Write downs to recoverable amount The clinical commissioning group did not have any write downs in 2016-17 (2015-16 Nil)
13.7 Temporarily idle assets The net book value of temporarily idle assets was as follows: The clinical commissioning group had no temporarily idle assets as at 31 March 2017 (31 March 2016 Nil) 13.8 Cost or valuation of fully depreciated assets The clinical commissioning group had no fully depreciated assets as at 31 March 2017 (31 March 2016 Nil)
13.9 Economic lives
Plant & machinery Transport equipment Furniture & fittings
Minimum Life (years) 0 1 2
Maximum Life (Years) 0 1 4
14 Intangible non-current assets The clinical commissioning group had no intangible non-current assets in 2016-17 (2015-16 Nil)
119
Thurrock CCG - Annual Accounts 2016-17 15 Investment property The clinical commissioning group had no investment property in 2016-17 (2015-16 Nil)
16 Inventories The clinical commissioning group had no inventories at 31 March 2017 (31 March 2016 Nil)
17 Trade and other receivables
Current 2016-17 £'000
Non-current 2016-17 £'000
Current 2015-16 £'000
NHS receivables: Revenue NHS receivables: Capital NHS prepayments NHS accrued income Non-NHS and Other WGA receivables: Revenue Non-NHS and Other WGA receivables: Capital Non-NHS and Other WGA prepayments Non-NHS and Other WGA accrued income Provision for the impairment of receivables VAT Total Trade & other receivables
216 0 827 38 176 0 597 0 0 310 2,165
Total current and non current
2,165
4,149
0
0
Included above: Prepaid pensions contributions
0 0 0 0 0 0 0 0 0 0 0
Non-current 2015-16 £'000
2,905 0 759 57 31 0 361 28 0 7 4,149
The great majority of trade is with NHS England. As NHS England is funded by Government to provide funding to clinical commissioning groups to commission services, no credit scoring of them is considered necessary.
17.1 Receivables past their due date but not impaired
2016-17 £'000
By up to three months By three to six months By more than six months Total
2015-16 £'000 12 0 0 12
92 0 7 99
£8k of the amount above has subsequently been recovered post the statement of financial position and £4k was cancelled by issuing a credit note in May. The clinical commissioning group did not hold any collateral against receivables outstanding at 31 March 2017 (31 March 2016 Nil)
17.2 Provision for impairment of receivables The clinical commissioning group had no provisions for impairment of receivables as at 31 March 2017 (31 March 2016 Nil)
120
0 0 0 0 0 0 0 0 0 0 0
Thurrock CCG - Annual Accounts 2016-17 18 Other financial assets 18.1 Current The clinical commissioning group had no current financial assets as at 31 March 2017 (31 March 2016 Nil) 18.2 Non-current The clinical commissioning group had no non current financial assets as at 31 March 2017 (31 March 2016 Nil) 18.3 Non-current: capital analysis The clinical commissioning group had no non current capital as at 31 March 2017 (31 March 2016 Nil)
19 Other current assets The clinical commissioning group had no other current assets as at 31 March 2017 (31 March 2016 Nil)
20 Cash and cash equivalents 2016-17 £'000 Balance at 01 April 2016 Net change in year Balance at 31 March 2017 Made up of: Cash with the Government Banking Service Cash in hand Cash and cash equivalents as in statement of financial position Bank overdraft: Government Banking Service Total bank overdrafts Balance at 31 March 2017
66 (29) 37
2015-16 £'000 49 17 66
37 0 37
66 0 66
0 0
0 0
37
66
The clinical commissioning group held no patients’ money at 31 March 2017 (31 March 2016 Nil)
21 Non-current assets held for sale The clinical commissioning group had no non-current assets held for sale as at 31 March 2017 (31 March 2016 Nil)
22 Analysis of impairments and reversals The clinical commissioning group had no impairments or reversals of impairments recognised in expenditure during 2016-17 (2015-16 Nil)
121
Thurrock CCG - Annual Accounts 2016-17
23 Trade and other payables
Current 2016-17 £'000
NHS payables: revenue NHS accruals NHS deferred income Non-NHS and Other WGA payables: Revenue Non-NHS and Other WGA accruals Non-NHS and Other WGA deferred income Social security costs Tax Other payables and accruals Total Trade & Other Payables
4,311 1,013 0 2,344 3,943 30 37 33 598 12,310
Total current and non-current
12,310
Non-current 2016-17 £'000
Current 2015-16 £'000
0 0 0 0 0 0 0 0 0 0
Non-current 2015-16 £'000
4,969 2,190 100 1,486 4,706 0 25 27 685 14,188 14,188
Included above are liabilities of £0, due in future years under arrangements to buy out the liability for early retirement over 5 years (31 March 2016: £0). Other payables include £43k outstanding pension contributions at 31 March 2017 (31 March 2016 £34k)
24 Other financial liabilities The clinical commissioning group had no other financial liabilities as at 31 March 2017 (31 March 2016 Nil)
25 Other liabilities The clinical commissioning group had no other liabilities as at 31 March 2017 (31 March 2016 Nil)
26 Borrowings The clinical commissioning group had no borrowings as at 31 March 2017 (31 March 2016 Nil)
27 Private finance initiative, LIFT and other service concession arrangements The clinical commissioning group had no private finance initiative, LIFT or other service concession arrangements that were excluded from the Statement of Financial Position as at 31 March 2017 (31 March 2016 Nil)
28 Finance lease obligations The clinical commissioning group had no finance lease obligations as at 31 March 2017 (31 March 2016 Nil)
29 Finance lease receivables The clinical commissioning group had no finance lease receivables as at 31 March 2017 (31 March 2016 Nil)
122
0 0 0 0 0 0 0 0 0 0
Thurrock CCG - Annual Accounts 2016-17 30 Provisions Current 2016-17 £'000 Continuing care Other Total
173 34 207
Total current and non-current
207 Continuing Care £'000
Balance at 01 April 2016 Arising during the year
Non-current 2016-17 £'000 0 0 0
Current 2015-16 £'000
Non-current 2015-16 £'000 117 34 151
0 0 0
151
Other £'000
117
Total £'000 34
151
56
0
56
Balance at 31 March 2017
173
34
207
Expected timing of cash flows: Within one year Between one and five years After five years
173 0 0
34 0 0
207 0 0
Balance at 31 March 2017
173
34
207
Under the Accounts Direction issued by NHS England on 12 February 2014, NHS England is responsible for accounting for liabilities relating to NHS Continuing Healthcare claims relating to periods of care before establishment of the clinical commissioning group. However, the legal liability remains with the CCG. The total value of legacy NHS Continuing Healthcare provisions accounted for by NHS England on behalf of this CCG at 31 March 2017 is £173k, (31 March 2016 £2.38m).
31 Contingencies
Contingent liabilities High court action lodged against the CCG due to be heard on the 22nd May 2017 the outcome of which is currently uncertain
Contingent assets The clinical commissioning group had no contingent assets as at 31 March 2017 (31 March 2016 Nil)
123
Thurrock CCG - Annual Accounts 2016-17 32 Commitments 32.1 Capital commitments The clinical commissioning group had no contracted capital commitments not otherwise included in these financial statements as at 31 March 2017 (31 March 2016 Nil)
32.2 Other financial commitments The clinical commissioning group had no non-cancellable contracts (which are not leases, private finance initiative contracts or other service concession arrangements) as at 31 March 2017 (31 March 2016 Nil)
33 Financial instruments 33.1 Financial risk management Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities.
As the NHS Clinical Commissioning Group is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The clinical commissioning group has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the clinical commissioning group in undertaking its activities. Treasury management operations are carried out by the finance department, within parameters defined formally within the NHS Clinical Commissioning Group standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the NHS Clinical Commissioning Group and internal auditors. 33.1.1 Currency risk The NHS Clinical Commissioning Group is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The NHS Clinical Commissioning Group has no overseas operations. The NHS Clinical Commissioning Group and therefore has low exposure to currency rate fluctuations. 33.1.2 Interest rate risk
The Clinical Commissioning Group borrows from government for capital expenditure, subject to affordability as confirmed by NHS England. The borrowings are for 1 to 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The clinical commissioning group therefore has low exposure to interest rate fluctuations. 33.1.3 Credit risk As the majority of the NHS clinical commissioning groups' revenue comes from parliamentary funding, the NHS clinical commissioning group has low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables from customers, as disclosed in the trade and other receivables note. 33.1.4 Liquidity risk
NHS Clinical Commissioning Group is required to operate within revenue and capital resource limits, which are financed from resources voted annually by Parliament. The NHS Clinical Commissioning Group draws down cash to cover expenditure, as the need arises. The NHS Clinical Commissioning Group is not, therefore, exposed to significant liquidity risks.
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Thurrock CCG - Annual Accounts 2016-17 33 Financial instruments cont'd 33.2 Financial assets Loans and Receivables 2016-17 £'000 Receivables: · NHS · Non-NHS Cash at bank and in hand Total at 31 March 2017
Total 2016-17 £'000
255 176 37 468
255 176 37 468
Loans and Receivables 2015-16 £'000 Receivables: · NHS · Non-NHS Cash at bank and in hand Total at 31 March 2017
Total 2015-16 £'000
2,962 59 66 3,088
2,962 59 66 3,088
33.3 Financial liabilities Other 2016-17 £'000 Payables: · NHS · Non-NHS Total at 31 March 2017
Total 2016-17 £'000
5,325 6,886 12,210
5,325 6,886 12,210
Other 2015-16 £'000 Payables: · NHS · Non-NHS Total at 31 March 2017
Total 2015-16 £'000
7,159 6,878 14,037
7,159 6,878 14,037
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Thurrock CCG - Annual Accounts 2016-17 34 Operating segments The clininical commissioning group and consolidated group consider they have only one segment: commissioning of healthcare services as reported in the Statement of Financial Position and Statement of Comprehensive Net Expenditure. The clinical commissioning group also had only the one segment: commissioning of healthcare services in 2015-16
35 Pooled budgets
The NHS Clinical Commissioning Group share of the income and expenditure handled by the pooled budget in the financial year were: 2016-17 £'000 Income Expenditure
2015-16 £'000
15,715
14,630
(15,715)
(14,630)
The Lead Commissioner for the Better Care Fund (BCF) in 2016-17 was Thurrock Council. the Health and Wellbeing Board (HWB) was charged with responsibility for the BCF; the HWB delegated monthly monitoring to the Integrated Commissioning Executive (ICE). The ICE comprised senior executives across the CCG and Thurrock Council and was jointly chaired by the Accountable Officer of the CCG and The Director of Adult Social Care from Thurrock Council.
In 16-17 the total value of the pool was £27,639k, which included the CCGs contribution of £15,715k. At the end of 201617 the pool had an underspend of £8k. In 15-16 the total value of the pool was £18,019k, which included the CCGs contribution of £14,766k. At the end of 201516 the pool had an underspend of £180k; of which £136k was allocated to the CCG.
36 NHS Lift investments The clinical commissioning group had no NHS LIFT investments as at 31 March 2017 (31 March 2016 Nil)
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Thurrock CCG - Annual Accounts 2016-17 37 Related party transactions Details of related party transactions with individuals are as follows: Receipts Amounts Amounts Payments from owed to due from to Related Related Related Related Party Party Party Party £000 £000 £000 £000 Dr Leighton L practice Dr Jones SR Practice Dr Mohile RV Practice Dr Roy BB Practice Dr Suntharanlingam R Practice Dr Abela T Practice Dr AM Davies & Dr CS Jayakumar Dr Colburn M Practice Dr Tresidder NJ Practice Dr Bansal A Practice Dr Deshpande AM Practice Dr Headon OT Practice Dr Bellworthy SV Practice Dr Pattara & Dr Raja The Shehadeh Medical centre Dr Yadava N Practice Dr Joseph L Practice Dr Abeyewardene AK Practice Primecare Medical Centre Dr Yasin SA Practice Dr Masson KK Practice Dr Cheung KK Practice Dr Ramachandran MK Practice Dr Okoi East Tilbury Medical Centre Dr Deveraja VC Practice Dilip Sabins Medical Centre PMS Dr Patel PJ Practice Acorns Purfleet Care Centre St Clements Health Centre Thurrock Health Centre Lakeside Medical Diagnostics Trevor Hitchcock
18 8 6 4 1 18 14 9 34 22 3 22 4 3 17 6 3 7 8 7 4 5 2 8 2 4 0 6 0 6 2 5 169 3
1 2 2 0 0 1 3 0 1 0 0 1 0 0 5 0 0 0 1 1 0 0 0 0 0 0 1 0 3 0 3 1 17 0
Member Practice & GP Board member (Dr Arhin & Dr Leighton) Member Practice Member Practice & GP Board Member Member Practice Member Practice Member Practice & GP Board Member (Dr Grewal) Member Practice Member Practice & GP Board Member (Dr Kalil) Member Practice & Practice Manager Board Member (Mr R Vine) Member Practice & GP Board Member Member Practice & CCG Board Chair Member Practice & GP Board Member (Dr Peter Martin) Member Practice Member Practice & GP Board Member (Dr Raja) Member Practice Member Practice Member Practice Member Practice Member Practice Member Practice Member Practice Member Practice Member Practice Member Practice & GP Board Member Member Practice Member Practice Member Practice Member Practice & GP Board Member (Dr Bhat) Member Practice Member Practice Member Practice Member Practice Organisation providing diagnostics, Dr Nimal Raj, Director Sessional Lay member
Executive Board Members had no Related Party Transactions to disclose The Department of Health is regarded as a related party. During the year the clinical commissioning group (CCG) has had a significant number of material transactions with entities for which the Department is regarded as the parent Department. The main ones are as follows: Basildon & Thurrock University Hospitals NHS Foundation Trust North East London NHS Foundation Trust South Essex Partnership University NHS Foundation Trust East of England Ambulance Service NHS Trust Southend University Hospital NHS Foudation Trust Barking Havering & Redbridge University Hospital NHS Trust BARTS Health NHS Trust Mid Essex Hospital Services NHS Trust Other entities the CCG for which the Department is regarded as the parent • NHS England; • NHS Foundation Trusts; • NHS Trusts; • NHS Litigation Authority; and, • NHS Business Services Authority. In addition, the clinical commissioning group has had a number of material
In addition, the clinical commissioning group has had a number of material transactions with other government departments and other central and local government bodies. Most of these transactions have been with Thurrock Unitary Authority.
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Thurrock CCG - Annual Accounts 2016-17 38 Events after the end of the reporting period There are no events after the end of the reporting period which will have a material effect on the financial statements of the clinical commissioning group (2016 Nil)
39 Third party assets The clinical commissioning group held no third party assets as at 31 March 2017 (31 March 2016 Nil)
40 Financial performance targets NHS Clinical Commissioning Group have a number of financial duties under the NHS Act 2006 (as amended). NHS Clinical Commissioning Group performance against those duties was as follows: NHS Act Section Expenditure not to exceed income
2016-17 Target £'000
2016-17 Performance £'000
223H (1)
208,436
206,217 Duty achieved
Revenue resource use does not exceed the amount specified in Directions
223I (3)
206,695
204,476 Duty achieved
Revenue resource use on specified matter(s) does not exceed the amount specified in Directions
223J (2)
203,002
200,820 Duty achieved
Revenue administration resource use does not exceed the amount specified in Directions
223J (3)
3,693
3,656 Duty achieved
2015-16 Target £'000
2015-16 Performance £'000
Expenditure not to exceed income
223H (1)
200,559
198,441 Duty achieved
Revenue resource use does not exceed the amount specified in Directions
223I (3)
199,829
197,711 Duty achieved
Revenue resource use on specified matter(s) does not exceed the amount specified in Directions
223J (2)
195,810
193,818 Duty achieved
Revenue administration resource use does not exceed the amount specified in Directions
223J (3)
4,019
3,893 Duty achieved
41 Impact of IFRS Accounting under IFRS had no impact on the results of the clinical commissioning group during 2016-17 (2015-16 Nil)
42 Analysis of charitable reserves The clinical commissioning group held no charitable funds as at 31 March 2017 (31 March 2016 Nil)
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Independent Auditor's Report
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INDEPENDENT AUDITOR’S REPORT TO THE MEMBERS OF THE GOVERNING BODY OF NHS THURROCK CCG
We have audited the financial statements of NHS Thurrock CCG for the year ended 31 March 2017 under the Local Audit and Accountability Act 2014. The financial statements comprise the Statement of Comprehensive Net Expenditure, the Statement of Financial Position, the Statement of Changes in Taxpayers’ Equity, the Statement of Cash Flows and the related notes 1 to 42. The financial reporting framework that has been applied in their preparation is applicable law and International Financial Reporting Standards (IFRSs) as adopted by the European Union, and as interpreted and adapted by the 2016-17 HM Treasury’s Financial Reporting Manual (the 2016-17 FReM) as contained in the Department of Health Group Accounting Manual 2016/17 and the Accounts Direction issued by the NHS Commissioning Board with the approval of the Secretary of State as relevant to the National Health Service in England (the Accounts Direction). We have also audited the information in the Remuneration and Staff Report that is subject to audit, being: the table of salaries and allowances of senior managers and related narrative notes on page 95;
the table of pension benefits of senior managers and related narrative notes on page 96;
the tables of exit packages on page 99;
the analysis of staff numbers and costs and related notes on page 100; and
the table of pay multiples and related narrative notes on page 97.
This report is made solely to the members of the Governing Body of NHS Thurrock CCG in accordance with Part 5 of the Local Audit and Accountability Act 2014 and for no other purpose as set out in paragraph 43 of the Statement of Responsibilities of Auditors and Audited Bodies published by Public Sector Audit Appointments Limited. Our audit work has been undertaken so that we might state to the members of the Governing Body of the CCG those matters we are required to state to them in an auditor's report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the members as a body, for our audit work, for this report, or for the opinions we have formed.
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Respective responsibilities of the Accountable Officer and Auditor As explained more fully in the Statement of Accountable Officer’s Responsibilities set out on page 42, the Accountable Officer is responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view and is also responsible for ensuring the regularity of expenditure and income. Our responsibility is to audit and express an opinion on the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors. We are also responsible for giving an opinion on the regularity of expenditure and income in accordance with the Code of Audit Practice prepared by the Comptroller and Auditor General as required by the Local Audit and Accountability Act 2014 (the "Code of Audit Practice"). As explained in the Annual Governance Statement the Accountable officer is responsible for the arrangements to secure economy, efficiency and effectiveness in the use of the CCG's resources. We are required under Section 21(1)(c) of the Local Audit and Accountability Act 2014 to be satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. Section 21(5)(b) of the Local Audit and Accountability Act 2014 requires that our report must not contain our opinion if we are satisfied that proper arrangements are in place. We are not required to consider, nor have we considered, whether all aspects of the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively. Scope of the audit of the financial statements An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of:
whether the accounting policies are appropriate to the CCG’s circumstances and have been consistently applied and adequately disclosed; the reasonableness of significant accounting estimates made by the Accountable Officer; and the overall presentation of the financial statements.
In addition, we read all the financial and non-financial information in the annual report and accounts to identify material inconsistencies with the audited financial statements and to identify any information that is apparently materially incorrect based on, or materially inconsistent with, the knowledge acquired by us in the course of performing the audit. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report.
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In addition, we are required to obtain evidence sufficient to give reasonable assurance that the expenditure and income recorded in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them. Scope of the review of arrangements for securing economy, efficiency and effectiveness in the use of resources We have undertaken our review in accordance with the Code of Audit Practice, having regard to the guidance on the specified criterion issued by the Comptroller and Auditor General in November 2016, as to whether the CCG had proper arrangements to ensure it took properly informed decisions and deployed resources to achieve planned and sustainable outcomes for taxpayers and local people. The Comptroller and Auditor General determined this criterion as that necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the CCG put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2017. We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we undertook such work as we considered necessary to form a view on whether, in all significant respects, the CCG had put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources. Opinion on regularity In our opinion, in all material respects the expenditure and income reflected in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them. Opinion on the financial statements In our opinion the financial statements:
give a true and fair view of the financial position of NHS Thurrock CCG as at 31 March 2017 and of its net operating costs for the year then ended; and have been properly prepared in accordance with the Health and Social Care Act 2012 and the Accounts Directions issued thereunder.
Opinion on other matters In our opinion:
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the parts of the Remuneration and Staff Report to be audited have been properly prepared in accordance with the Annual Report Directions made under the National Health Service Act 2006 (as amended by the Health and Social Care Act 2012); and the other information published together with the audited financial statements in the annual report and accounts is consistent with the financial statements.
Matters on which we are required to report by exception We have nothing to report in respect of the following matters: in our opinion the governance statement does not comply with the guidance issued by the NHS Commissioning Board; or we refer a matter to the Secretary of State under section 30 of the Local Audit and Accountability Act 2014 because we have reason to believe that the CCG, or an officer of the CCG, is about to make, or has made, a decision which involves or would involve the body incurring unlawful expenditure, or is about to take, or has begun to take a course of action which, if followed to its conclusion , would be unlawful and likely to cause a loss or deficiency; or we issue a report in the public interest under section 24 of the Local Audit and Accountability Act 2014; or we make a written recommendation to the CCG under section 24 of the Local Audit and Accountability Act 2014. In respect of the following we have matters to report by exception:
proper arrangements for securing economy, efficiency and effectiveness
Basis for qualified conclusion on reporting by exception As noted in the Introduction and Context of the Annual Governance Statement, on 21 February 2017, the CCG was given a new set of Directions by NHS England following an investigation report into potential governance issues commissioned by NHS England (in August 2016). The CCG therefore remains under Directions as at 31 March 2017. The Directions relate to: • • •
the appointment of an accountable officer (which was done on 1 February 2017); strengthening arrangements to ensure the proper exercise of functions; procedures to be followed in relation to executive team and senior appointment.
This is evidence of weaknesses in proper arrangements for taking properly informed decisions, in relation to acting in the public interest, through demonstrating and applying the principles and values of sound governance. 133
Qualified conclusion on reporting by exception On the basis of our work, having regard to the guidance issued by the C&AG in November 2016, with the exception of the matter reported in the basis for qualified conclusion paragraph above, we are satisfied that, in all significant respects, CCG put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2017.
Certificate We certify that we have completed the audit of the accounts of NHS Thurrock CCG in accordance with the requirements of the Local Audit and Accountability Act 2014 and the Code of Audit Practice.
Debbie Hanson for and on behalf of Ernst & Young LLP Luton 31 May 2017
The maintenance and integrity of the NHS Thurrock CCG web site is the responsibility of the directors; the work carried out by the auditors does not involve consideration of these matters and, accordingly, the auditors accept no responsibility for any changes that may have occurred to the financial statements since they were initially presented on the web site. Legislation in the United Kingdom governing the preparation and dissemination of financial statements may differ from legislation in other jurisdictions
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Appendices Appendix 1: Sustainability Report Appendix 2: Equality Report
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Appendix 1: Sustainability Report: Introduction Sustainability has become increasingly important as the impact of people’s lifestyles and business choices are changing the world in which we live. In order to fulfil our responsibilities for the role we play, NHS Thurrock CCG has the following sustainability mission statement located in our Sustainable Development Management Plan (SDMP): “Being sustainable will help us make the most of our existing resources – money, supplies,
buildings and energy – without compromising the needs of future generations."
Policies One of the ways in which an organisation can embed sustainability is through the use of a SDMP. The Governing Body approved our SDMP in August 2013 (currently under review) so our plans for a sustainable future are well known within the organisation and clearly laid out. Sustainability has been built in as a feature of a number of our key policies, processes and procedures such as travel, procurement (both environment and social impact) and supplier relations. This will enable us to embed sustainability within our core business. Embedding Sustainability: The Thurrock Transformation Plan NHS Thurrock CCG continues to work closely with all of it stakeholders (Patients, the Public, Primary Care, Local Providers, the Local Authority, and Healthwatch) to develop a new model of care ‘For Thurrock in Thurrock’. The transformation programme is now well established to the extent that the Local Authority have also adopted the brand so that we are working in partnership on additional projects such as ‘Living Well in Thurrock’, ‘Stronger Together’ and other initiatives designed to support resilient communities. The work to develop healthy living centres, providing care closer to home, continues so patients can be managed in a more holistic manner; reducing attendance at A&E, with care delivered in the community wrapped around the Thurrock localities. Running in parallel to the plans for the healthy living centres is the joint working with Public Health to understand the needs of the public (Joint Strategy Needs Assessment) and that’s what helps us to tackling health inequalities and challenges such as obesity and smoking cessation can reduce the reliance patients have on the NHS, which in turn will reduce the impact on resources that affects our Carbon Footprint. We are still in the early stages of implementing our transformation plan, but are already starting to introduce new services which will support locality provision. Early indications are that the programme is being well received by patients, the public and our partners.
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Further information on ‘For Thurrock in Thurrock’ can be found on our website www.thurrockccg.nhs.uk. Good Corporate Citizen Assessment One of the ways in which we measure our impact as an organisation on corporate social responsibility (CSR) is through the use of the Good Corporate Citizenship (GCC) tool. We updated our GCC assessment in April 2017 (for the 2016/17 financial year), scoring 63% an increase from our previous assessment of 60% and 52% respectively over the previous two years. The breakdown of our scoring is shown below: Please note that the section on buildings is geared towards large hospital trusts and not towards CCGs like Thurrock who are tenants in a modern building. Sections of the online assessment cannot be skipped, therefore it was answered to the best of our ability with the help of colleagues in NHS Property Services Ltd.
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Our achievements on sustainability during the 2016/17 year include: -
-
-
-
-
-
Maintaining the appointment of a Board Member Sustainability Lead, this is the Board Practice Manager Member. This helps us to ensure that sustainability is a key component of the CCG; Risk assessment processes have considered, but not highlighted any cause for concern in relation to sustainability. We continue to promote effective use of resources in paper and fuel consumption. Members more frequently use iPad technology at meetings and have reduced the need to print Board and Committee papers. Teleconferencing services continue to be promoted to reduce travel requirements. Staff also share transport wherever possible. The CCG has also received an 80” video conferencing screen, which will be used for meetings where it is more appropriate for staff to stay at their location rather than drive to meet another colleague. The Good Corporate Citizen assessment has been carried out again to inform a refreshed Sustainable Development Management Plan for 2017/18. We have worked jointly with Health and Wellbeing Boards on sustainability issues has ensured that all CCG working groups and attendances at voluntary sector groups has supported and championed the sustainability agenda. We have developed and tested robust business continuity arrangements both internally and with health and social care partners in Essex to ensure that services are sustainable and resilient in the event of events such as flooding, power failure or other major interruptions; Embedded sustainability in our procurement processes to make sure that we commission services that are environmentally, socially and economically sustainable.
Conclusions NHS Thurrock CCG is beginning to embed sustainability into how it operations and the services it commissions. The following recommendations are made setting out the next steps for the sustainability project: -
We will refresh our Sustainable Development Management Plan in May 2017, and formally assess our performance again every six months. The outcome of these assessments will be reported in public at a Governing Body meeting and will be made available on our website.
-
We will update our action plan to further develop current levels of compliance with the GGC over the next year. We will establish an assurance process to report back to the Integrated Governance Committee on developments throughout the year. We will review how we can quantify the impact of our actions in developing sustainable practices.
-
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Appendix 2: Equality Report Introduction Ensuring equality for all: Working towards an NHS that is personal, fair and diverse Equality is about making sure people are treated fairly and given fair chances. It’s not about treating everyone the same way, but recognising that their needs are met in different ways. The Governing Body is formally committed to the NHS Equality Delivery System (EDS), and has been kept updated on this work. A review of the CCG’s Equality and Diversity Strategy will be undertaken early in 2016/17 to reflect the new requirements of the NHS Equality Delivery System (EDS 2). A number of steps have already been taken to ensure that the CCG fulfils its public sector equality duty: -
-
Information about the composition of the CCG’s workforce has been published on the dedicated equality and diversity section of the CCG website; Within the Equality and Diversity Strategy, the CCG has published its interim EDS goals; Equality and Diversity (including a refresh of the EDS goals) was discussed with the CCG’s Commissioning Reference Group (CRG). The CRG, comprising representatives from all sections of the Thurrock community, will be a key vehicle for agreeing priorities with the community and assessing progress; Equality and Diversity Policy in place; Lay Member (Patient and Public Involvement) appointed as Board-level lead for Equality and Diversity; Equality impact assessments are undertaken on all CCG policies, QIPP plans and commissioning cases.
Thurrock CCG staff profiles There are a total of 54 staff working at Thurrock CCG, of those 48 are on payroll and 6 are contractors. We have 48 FTE staff. Disability There are no staff registered as disabled in 2016/17
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Ethnicity
Gender
Religion
140
Age Band
Length in service in current employment
141
Employee Category
Employee Category/Gender
Assignment Category
Pay Band/Gender – FTE Staff Gender Female Male Grand Total
Band Band Band Band Band Band Band Band Band Band Grand VSM 3 4 5 6 7 8a 8b 8c 8d 9 Total 3 3 4 7 7 7 1 3 1 1 37 1 1 4 1 2 2 0 11 3
1
4
8
7
142
7
8
3
3
3
1
48
Absence Data. 01-Apr-2016 to 31-Mar-2017 Absence % (FTE) 0.7%
Absence Days 103
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Glossary Glossary of non-financial terms Term Care pathway
Clinical Commissioning Group (CCG)
Civil Contingencies Act 2004
Commissioning Community services
Commissioning Support Unit (CSU)
Definition The route that a patient will take from their first point of contact with an NHS or Social Services member of staff (usually their GP), through referral, to the completion of their treatment. Formally established on 1 April 2013, Clinical Commissioning Groups (CCGs) are statutory bodies responsible for commissioning most healthcare – planning, buying and monitoring services to meet the needs of their local communities. Provides a single framework for UK civil protection against any challenges to society – it focuses on local arrangements and emergency powers. The review, planning and purchasing of health and social services. Health or social care and services provided outside of hospital. They can be provided in a variety of settings including clinics and in people's homes. Community services include a wide range of services such as district nursing, health visiting services and specialist nursing services. Commissioning Support Units will provide capacity to clinical commissioners as an extension of their local team to ensure that commissioning decisions are informed and processes structured. This approach will help achieve economies of scale and allow clinical commissioning groups to focus on direct commissioning of services for their patients.
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Enhanced services
Enhanced services are: i) essential or additional services delivered to a higher specified standard, for example, extended minor surgery ii) services not provided through essential or additional services They are services provided by GPs, over and above the core (essential and additional) services to their patients.
Equality Delivery System (EDS)
The EDS has been designed nationally as an optional tool launched in 2011 to support NHS commissioners and providers to deliver better outcomes for patients and communities and better working environments for staff, which are personal, fair and diverse. The EDS is all about making positive differences to healthy living and working lives. An equality impact assessment involves assessing the likely or actual effects of policies or services on people in respect of disability, gender and racial equality. It helps us to make sure the needs of people are taken into account when we develop and implement a new policy or service or when we make a change to a current policy or service. NHS 111 is a new service introduced to make it easier for people to access local NHS healthcare services. People can call 111 when they need medical help fast but it’s not a 999 emergency. NHS 111 is available 24 hours a day, 365 days a year. Calls are free from landlines and mobile phones. The total care of patients whose disease is incurable. Control of pain, of other symptoms, and of psychological, social and spiritual problems is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families. Primary Care Trusts were abolished on 31 March 2013. Prior to that they were responsible for the planning and securing of health services and improving the health of the local population. The provider has merged since April 2017 with North Essex Partnership Trust to form a single provider, EPUT (North Essex Partnership University Trust)
Equality Impact Assessment (EQIA)
NHS111
Palliative Care
Primary Care Trust (PCT)
South Essex Partnership University NHS Foundation Trust (SEPT)
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ESR (Essex Success Regime) This is the term sometimes used for the Sustainability and Transformation plan for the NHS. Launched in 2016, STPs are set up to focus on changes to improve efficiencies and quality of care with in the NHS. The Quality and Patient A team of people at the CCG who work together with Safety Team healthcare professionals to ensure care is safe and of a good quality.
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Glossary of financial terms Term Accounting Policies
Budget
Capital Expenditure
Capital Resource Limit
Cash Limit
Revenue Resource Limit
Definition The Accounting Policies are the accounting rules that the CCG has followed in preparing its accounts. These policies are based on International Financial Reporting Standards and the Treasury’s Financial Reporting Manual. The Department of Health’s Manual for Accounts and Capital Accounting Manual detail how these rules should apply to CCGs. One of the main policies is that income and expenditure is recognised on an accruals basis, meaning it is recorded in the period in which services are provided even though cash may or may not have been received or paid out. A Budget usually refers to a list of all planned and expected future expenses and revenues. A budget is set at the beginning of the financial year. Capital Expenditure is money spent on buying non-current assets (fixed assets) or to add to the value of an existing fixed asset with a useful life that extends beyond a year. The Capital Resource Limit (CRL) is the amount allocated each year to the CCG for capital expenditure. The CCG must not spend more than the CRL on capital items. The Cash Limit (CL) is a limit set by the Government on the amount of cash which a CCG may spend during a given financial year. The CCG must ensure that the net amount of cash flowing out of the CCG over the financial accounting period is not more than the CL. The Revenue Resource Limit (RRL) is the total amount that the CCG may spend on the services that it commissions. This limit is set for the CCG at the start of the financial year by the Department of Health and may change on a monthly basis depending on changes to allocations to the CCG for either commissioning or provider functions. Each CCG has a statutory duty not to spend more than its RRL. The RRL takes into account all accrued income and expenditure irrespective of whether income has been received or bills paid.
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Depreciation
Impairments
Depreciation refers to the fact that assets with finite lives lose value over time. Depreciation involves allocating the cost of the fixed asset (less any residual value) over its useful life to the Statement of Comprehensive Net Expenditure (SCNE). This will cause an expense to be recognised on the SCNE while the net value of the asset will decrease on the Statement of Financial Position. Impairments are the losses in the values of non-current assets compared to those values recorded on the Statement of Financial Position. A CCG is required to undertake routinely revaluation reviews of its fixed assets or undertake an impairment review when there is a decline in an asset’s value. The impairment (loss) is treated in the same way as depreciation, as a cost in the Statement of Comprehensive Net Expenditure (SCNE), if the change in the value of the asset is permanent.
Intangible Assets [formerly Intangible Fixed Assets]
Intangible Assets are invisible or ‘soft’ assets of an organisation that, nevertheless, have a real current market value and contribute to the (future) operation/income generation of the organisation and may include software licences, trademarks and research development expenditure.
International Financial Reporting Standards
International Financial Reporting Standards (IFRS) are the international accounting standards that the Department of Health require CCGs to follow when they prepare their accounts. 09-10 was the first year in which PCTs (the predecessors to CCGs) were required to prepare IFRS compliant accounts, having previously used UK reporting standards.
Losses and Special Payments
Losses and Special Payments are payments that Parliament would not have foreseen healthcare funds being spent on, for example fraudulent payments, personal injury payments or payments for legal compensation.
NHS Payables (formerly known as NHS Creditors)
An NHS Payable is an amount owed to an NHS organisation for services rendered or goods supplied to the CCG or to patients of the CCG.
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Statement of Comprehensive Net Expenditure (formerly known as Operating Cost Statement)
The Statement of Comprehensive Net Expenditure (SCNE) records the costs incurred by the CCG during the year, net of miscellaneous income (which is income other than the CCG’s main funding from the Department of Health which is credited to the general fund on the Statement of Financial Position and not treated as income on the SCNE). It includes non-cash expenses such as depreciation. Under government accounting rules the SCNE shows the net resources used by the CCG in commissioning and providing healthcare rather than the surplus or deficit for the year as shown in the income and expenditure account by NHS trusts. The comprehensive net expenditure is debited to the general fund on the Statement of taxpayers equity.
Over Spend
Over Spend occurs when more money is spent than was allowed within the cash limit, revenue resource limit or capital limit, or that was planned in the budget.
Pooled budget
A Pooled Budget is a joint arrangement with other bodies, such as local authorities and other CCGs to pool funds for a specific purpose. Each body has to account for its own contribution to the pool within their accounts. Contributions would generally include the resources normally used for the identified services, together with partnership and other grants specific to the services. The host partner will manage the financial affairs of the pooled fund. The pooled budget manager is responsible for managing the pooled fund on behalf of the host authority, and for providing information to enable the partners to monitor the effectiveness of the pooled fund arrangements.
Procurement
Procurement is the acquisition of goods and/or services, generally through a contract, at the best possible total cost, in the right quantity and quality, at the right time and in the right place for the direct benefit of the CCG and its patients.
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Property, plant & equipment (formerly Tangible Fixed Assets)
Property, plant and equipment are assets that individually (or with integrally linked other items) cost more than £5,000 and are held for longer than one year and include: land, buildings, transport equipment, IT and furniture and fittings.
Provisions
A Provision is a liability arising from a past event where it is probable the CCG will have to settle and a reliable estimate can be made of the amount to be paid. Statement of Cash The Statement of Cash Flows (SCF) shows the effect of the CCG’s Flows operating activities on its cash position. Statement of Changes The purpose of the Statement of Changes in Taxpayers’ Equity is in Taxpayers’ Equity to highlight financial transactions that may not be reflected in the (formerly Statement of Statement of Comprehensive Net Expenditure, but which affect Recognised Gains and the CCG’s reserves as shown in the “Financed by” section on the Losses) Statement of Financial Position. For example, “(Reduction)/Additions in the General Fund due to the transfer of assets to/from NHS bodies and the Department of Health”. Statement of Financial Position (formerly Balance Sheet)
The Statement of Financial Position provides a view of the CCG’s financial position at a specific moment in time – usually the end of the financial year. It shows assets (everything the CCG owns that has monetary value), liabilities (money owed to external parties) and taxpayers’ equity (public funds invested in the CCG).
Tendering
Tendering is the process by which one can seek prices and terms for a particular service/project to be carried out under a contract.
Trade and other Payables (Non-NHS) (formerly known as Non-NHS Creditors) Trade and other receivables (formerly Debtors)
Trade and other Payables Creditors are non-NHS organisations owed money by the CCG for goods and services provided to the CCG, e.g. for utilities, equipment, etc.
Under Spend
Under Spend occurs when less money is spent than was allowed within the cash limit or that was planned in the budget.
Trade and other receivables represent money owed to the CCG at the Statement of Financial Position date for services rendered or goods supplied by the CCG to the receiver.
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