NHS Sutton Clinical Commissioning Group Annual Report and Accounts Working together to build the best affordable healthcare for Sutton

Transcription

1 NHS Sutton Clinical Commissioning Group Annual Report and Accounts Working together to build the best affordable healthcare for Sutton 1

2 CONTENTS Welcome from the Chair and Chief Clinical Officer Member practices introduction Strategic report Members report Remuneration report Financial review Appendix 1: Governance Statement Appendix 2: Head of Internal Audit opinion Appendix 3: Annual Accounts 2

3 WELCOME 2013/14 marks NHS Sutton CCG s first year as an organisation and this is our first annual report. It has been a busy year as clinical leaders took control of commissioning local health services. It has also been an important year for the NHS nationally and locally in Sutton as we meet the challenges the NHS will face in the future. We have an important commissioning role - we must work with our local partners and to ensure our health services continue to offer high quality care, responsive to local needs and support improved health outcomes. We are an organisation led by GPs. The clinical influence of our membership and clinical leadership on our Governing Body means that we have been able to focus on quality and clinical effectiveness this year. We understand the needs of our patients we see them every day and we are committed to working with our local partners in health and social care to realise our vision of delivering the best affordable health care for Sutton. We know that the population of our borough is increasing. People are now living longer often with one or more long term medical conditions. Meanwhile medical technology continues to advance as new or improved treatments and medicines are made available to patients. This means that there is more demand than ever on our health services, and this demand is continuing to increase. The funds available to spend on health services will not be able to keep pace with this rise in demand. To continue to provide high quality health services, we will have to make significant changes over the next few years - our plans must meet the health and financial challenges and also improve the quality of local services. Our partnerships have become even more important. We have developed effective joint working with the London Borough of Sutton and other local partners to continue to improve the health outcomes for Sutton residents. We have established a partnership relationship with the other CCGs in South West London (the South West London Commissioning Collaborative) which puts us in a strong position to work together to deliver change on a broader system-wide basis. We have also developed new relationships with other new commissioning organisations such as NHS England s specialist commissioning and primary care teams. Most importantly, throughout all our work, we have not lost our focus on our health priorities as an organisation which we identified to deliver the biggest impact on the health of people in Sutton. In this report, you will read about how our work this year has been centred around these priorities and the progress we ve made this year. Dr Brendan Hudson Dr Chris Elliott Chair Chief Clinical Officer 04 June June

4 MEMBER PRACTICES INTRODUCTION NHS Sutton CCG is a clinically-led membership organisation bringing together 27 GP practices in the borough of Sutton into one commissioning organisation. We adopted our constitution in February 2013 following consultation with member practices. Signed up to by all Sutton member practices, the document sets out the governance arrangements for the organisation. Following publication of the Francis report in February 2013, we reviewed our constitution and concluded that we were satisfied that our working practices support openness and transparency. Our constitution is available on our website at Publications/publications/Key%20publications/Sutton%20CCG%20Constitution.pdf You can find more information about our governance structure in the Governance Statement at Appendix 1. In spring 2014, we carried out a survey of the CCG s governing body members to assess their views on the effectiveness of the governing body in its first year. You can read more about this in our Governance Statement at Appendix 1. How our member practices are organised - localities in Sutton Local GPs are well placed to lead the CCG and the work we do we see and talk to our patients every day. We have developed locality (network) arrangements based on geography, patient needs, local relationships to other partners and stakeholders. The three localities in Sutton are Carshalton, Sutton and Cheam and Wallington each addressing local commissioning, service redesign and quality, innovation, productivity and prevention (QIPP) challenges. Localities are responsible for delivering the strategic objectives of the CCG as well as providing peer support to GP practices in their localities and encouraging the delivery of high quality patient care. Each locality has a lead GP who provides leadership and acts as the link between the locality and the wider CCG. The locality leads are members of the CCG s Executive Team. Localities meet a minimum of ten times a year. Our achievements as a membership organisation in 2013/14 Having local clinicians working together to plan and commission health services means that we can focus on the quality and clinical effectiveness of care more than we have been able to before. During 2013/14 we have: Worked closely together within our localities looking at appropriate referrals to secondary care and using community based services to improve patient pathways. The practices within their localities have shared and peer reviewed internal processes to allow good practice to be embedded in individual practices. Practices have engaged with the commissioning agenda by joining together and sharing information in a number of forums involving GPs, nurses, practice managers and patients. 4

5 Work in the localities around reviewing care pathways and monitoring outpatients and emergency admissions has been used as evidence for practices Quality and Productivity achievements within the Quality and Outcomes Framework. The Pharmaceutical Advisers and Community Pharmacists have attended all the locality meetings and their input has been invaluable. All three GP Locality Leads have regularly attended the CCG Executive Committee meetings and information from these meetings is shared with the Locality members. Practices have encouraged their patient representatives to attend the CCG Patient Reference Group meetings to input into the CCG s commissioning strategy and plans. Practices have improved immunisation rates for 0-2 year olds to over 95%. Practices have routinely reviewed patients regular prescriptions to ensure optimum effectiveness of medications. Looking forward 2014/15 The plan for 2014/15 is to concentrate on delivering the Government s initiative Everyone counts; planning for patients 2014/15 to 2018/19. The Localities will be fundamental in helping to deliver the challenging plans for transforming the care of patients aged 75 or older and reducing avoidable admissions. The process is in place to appoint the three GP Locality Leads for a further two year term. A new Engagement Scheme has been developed which again encourages all practices to meet and work together to improve patient pathways, share good practice and help to deliver the CCG s QIPP programme. Practices are currently meeting to discuss plans to come together to work in a federated/collaborative way across all localities The three main areas that practices will be concentrating on are: o good, cost effective prescribing o appropriate referrals to secondary care and community services to improve the patient pathways o the use of a risk stratification tool to identify those patients who are at risk of emergency admission to hospital and referral of these patients to the community and social care services to avoid such admissions 5

6 STRATEGIC REPORT Who we are and what we do NHS Sutton CCG is a clinically-led membership organisationn bringing together 27 GP practices in the borough of Sutton into one commissioning organisation. We serve a population of over 190,000 people in Sutton. We work in partnership with the local NHS hospitals, community services, mental health services, pharmacists and dentists, Sutton Council and our local community to improve health and wellbeing, reduce health inequalities and ensure people in Sutton have equal access to high quality health care services. What we do NHS Sutton CCG is responsible for overseeing the local NHSS budget of, approximately, 209 million and making sure it is spent on the best affordable health care to meet the needs of people in Sutton - helping them stay healthy, and caring for them if they become ill and need extra support. We do this by commissioning (or buying) services from local health andd other providers. The services we buy include hospital, community and mental health services. Our aim is to ensure the best affordable health caree for people in Sutton. The 2013/14 expenditure has been incurred on following healthcare groups: All Expenditure in 000s Acute Healthcare MH & LD Healthcare Community Services Primary Care 2507 Prescribing Other Running Costs

7 History of our organisation December 2011: March 2013: NHS Sutton CCG was established as shadow organisation. We received authorisation from NHS England in March 2013 with three minor conditions: One condition related to accountability for patient safety and two related to safeguarding arrangements and systems. 1 April 2013 We formally took responsibility for commissioning hospital, community and mental health services for local people. July 2013: The three minor conditions imposed on the CCG at authorisation were fully discharged following NHS England s post authorisation review of CCGs (published in July 2013). Our duties Under the National Health Service Act 2006, CCGs have a number of powers and duties. You can find full details of these on NHS England s website: In this annual report, we describe how we have fulfilled our duties and we certify that NHS Sutton Clinical Commissioning Group has complied with the statutory duties laid down in the National Health Service Act 2006 (as amended). Our Governing Body NHS Sutton CCG is overseen by a Governing Body. The function of the Governing Body is to ensure strong and effective leadership, management and accountability for the CCG. It is comprised of the following members: Chair Dr Brendan Hudson Chief Clinical Officer Dr Chris Elliott Chief Finance Officer Geoff Price Chief Operating Officer Jonathan Bates GP Dr Jonathan Cockbain GP Dr Dino Pardhanani Primary Care Nurse Karol Selvey Director of Public Health (Sutton) Dr Ellis Friedman Independent Nurse Mary McKenna Secondary Care Doctor Mr Les Ross Lay Member (Governance & Audit) Paul Sarfaty Lay Member (PPI & Quality) Sally Brearley NHS Sutton CCG is managed in an open and accessible way, which enables local people to question what the CCG does and why it does it. We meet regularly in public and publish board papers on the NHS Sutton CCG website. For further information visit: 7

8 The Governing Body is not aware of any relevant audit information that has been withheld from the clinical commissioning group s external auditors, and members of the Governing Body has taken all necessary steps to make themselves aware of relevant information and to ensure that this is passed to the external auditors where appropriate. Our Executive Committee NHS Sutton CCG is managed by an executive team which ensures strong clinical leadership for the CCG. Chief Clinical Officer Clinical Lead - Acute Contracts Clinical Lead - Urgent Care Clinical Lead - Community and Long Term Conditions Clinical Lead - Mental Health Dr Chris Elliott Dr Mark Wells Dr Jonathan Cockbain Karol Selvey Dr Chris Keers Clinical Lead - Local Care Centres and Service Redesign Dr Dino Pardhanani Clinical Lead - Prescribing Carshalton Locality Lead Sutton and Cheam Locality Lead Wallington Locality Lead Chief Operating Officer Chief Finance Officer Dr Simon Elliott/ Dr Roshni Scott Dr Ash Mirza Dr Jeff Croucher Dr Farhan Rabbani Jonathan Bates Geoff Price 8

9 Our vision and priority areas As doctors, we came together to put patients first and improve health services in Sutton. Our vision is to commission high quality health care for the people in Sutton through joint working with health and social care organisations to ensure that patients physical mental and social wellbeing needs are met and can be summed up as: Working together to build the best affordable healthcare for Sutton. We believe that patients should be at the centre of our decision-making and we will work in partnership with individuals, patient representative groups, families and carers to deliver high quality, accessible services that tackle inequalities and respond to personal needs. We will strive to establish an efficient and financially stable local healthcare system by improving primary care and community services and working closely with secondary care to redesign and deliver integrated services that bring healthcare into the community and closer to our patients homes. We work to the national objectives for the NHS set out in the NHS Outcomes Framework. The objectives are grouped into five domains covering: Preventing people from dying prematurely Enhancing quality of life for people with long term conditions Helping people to recover from episodes of ill health or injury Ensuring that people have a positive experience of care Treating and caring for people in a safe environment and protecting them from harm We also work to the areas for improvement in the NHS Mandate and recognise the expectations of the NHS as laid out in the NHS Constitution. In order for us to achieve our strategic objectives, we have identified six priority areas which we have focussed on in 2013/14: Hospital care Out of hospital care Long term conditions management Focus on mental health Jubilee Health Centre Integration and collaboration 9

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11 Our achievements this year Progress against our key priorities In 2013/14, we were able to place a much greater emphasis on developing priorities that stem from the local health needs of our population, identified from the Joint Strategic Needs Assessment (JSNA). Using key themes from our JSNA and Joint Health & Wellbeing Strategy Sutton CCG s commissioning intentions for 2013/14 were grouped according to the priority areas we identified for improving health inequalities and achieving QIPP efficiencies. Hospital care Hospital care is a vital part of the services that we have planned and funded for Sutton. It is important that local people have access to the right services and that the quality of those services is high we have worked hard during the year on this key priority. SWL collaborative commissioning a five-year plan for healthcare in south west London Clinicians have been highlighting for several years that the way in which we deliver services in the NHS needs to change. There is a broad clinical consensus on this point and reports from the Academy of Royal Colleges, NHS Confederation, the King s Fund and NHS England have all highlighted the need for change. We face a number of challenges in the years ahead: The population is ageing and up to a third of people are living with long term conditions, meaning we need to provide more and better care out of hospital and closer to where people live. We need health and social care services to work together much better nationally, the Better Care Fund has been set up to achieve this and it means money is being moved from CCG budgets for hospital care to local community services each CCG has a two-year plan for this. None of our hospitals meet all the minimum safety and quality standards set out by clinicians based on Royal College guidance the London Quality Standards and there is a variation in the quality of care between different hospitals and different times of the day, week and year. Hospitals are expected to provide seven-day services with the required level of consultant cover at all times, but we do not currently provide this in south west London and there are not enough consultants available to do so across our four acute hospitals. The NHS is unlikely to be given extra money in the foreseeable future, yet the costs of providing healthcare are rising much faster than the rate of inflation, meaning we face significant financial challenges. We need to reshape mental health services so that they achieve the highest possible standards and are focused primarily in the community. 11

12 We need to ensure that primary care and other community-based services meet the highest possible standards. We need to do more to prevent people becoming ill and to provide better information to patients. The six south west London CCGs and NHS England, who commission specialised and primary care services in south west London, are working together under the umbrella name of South West London Collaborative Commissioning to develop a five-year strategy for the local NHS. This programme replaces the Better Services Better Value (BSBV) programme which the CCGs inherited. The strategy will address the same issues highlighted by BSBV but has been widened to look at the whole health system, including primary care, community services and mental health. Delivery of our strategic partnership agenda; joined up Cost Improvement Programme (CIP) / Quality, Innovation, Productivity and Prevention (QIPP) Older People s pathway The CCG worked closely with Epsom and St Helier Hospital Trust during 2013 to develop a new pathway of care for Older People. Following a widely attended stakeholder event in April 2013, where people from many different organisations including primary and secondary care, social services, the voluntary sector and patient representatives were able to give their views, a team of clinicians and managers from the two organisations developed new ways of supporting older people both within hospital and within their own homes wherever possible. An enhanced team of occupational and physical therapists are able to support staff within the A+E department and the Acute Medical Unit to identify patients who may be able to be discharged home and receive their care in their home environment. The team will be supported by a navigator who knows the extensive range of services available in the community so that patients can be supported in the community wherever possible. In addition, Sutton CCG, in partnership with Sutton Council, commissioned Age UK to provide services for older people in Sutton which improve their health and well-being, particularly for those people with one or more long term medical conditions, and keep people as healthy as possible for as long as possible in the community. Three pilot services in Sutton have been delivered by Age UK in 2013/14 Home from Hospital, NHS Community Helpers and Caring Neighbour Scheme. The aims of all three schemes are to: Enable patients to leave hospital more quickly Prevent admission or re-admission Foster independence and resilience Keep people safe and well at home 12

13 Home from Hospital Home from Hospital (HfH) is a rapid response, seven day per week service which is integrated within the rapid response team at St Helier Hospital. HfH provides practical and emotional help for patients for up to four weeks post discharge from hospital and is aimed at patients with little or no local family/friends support networks. The support offered includes: Shopping or assisting with shopping, cleaning, preparing light meals and will act as a trigger for onward referral to other services. On average each patient receives 20 contacts from the HfH service ensuring that any issues that patients have are quickly resolved or referred onward. 200 patients have been referred to the service during 2013/14. NHS Community Helpers Community Helpers offers a bespoke emotional and befriending support to people, including well-being calls and befriending relationships. It is a mix of light touch and more intensive support depending upon individual s needs. The service helps people to reconnect to other community based social activities such as lunch clubs, exercise groups and choir groups. It is focussed on isolated people and links them to other services and support that they need but it is aimed at facilitating independence and not providing long term support. Community Helpers received 127 referrals in 2013/14. Caring Neighbour Scheme Sutton CCG s new caring neighbour scheme launched in December. The service aims to inform people over 75 years with a long term condition of the range of services and support available to them in Sutton with a particular emphasis on keeping warm and well this winter. As a starting point, each pharmacy in the borough has received a stock of the Age UK winter wrapped up guide with two thermometers to monitor room temperatures. Pharmacists will identify those patients age 75 years plus. most at risk with LTCs, and distribute the Age UK information pack to them with their prescriptions. The caring neighbour scheme will include a holistic assessment, underpinned by warm and well in winter advice, followed by twice weekly reassurance phone calls for all referrals and a fast track shopping service for vulnerable patients. All patients will be triaged and connected to a range of support services including: Voluntary sector service providers for patients and carers Referral to the crisis loan and grant scheme and/or food bank Referral to the Sutton warm rooms scheme Support with eco grant applications Winter benefit checks to ease financial worries Donated winter coats from the Age UK charity shop Quilts to keep patients warm Emergency food parcels donated by local schools and churches Connecting those who are lonely to the befriending services The Caring Neighbour scheme supported 39 people in the period 1 December March

14 Community Prevention of Admission The Community Prevention of Admission Team (CPAT) was launched on 1 October 2013, targeting elderly patients with complex health needs, often with more than one long term condition, such as diabetes or chronic obstructive pulmonary disease (COPD). The team comprises a GP, nurses and therapists who provide rapid assessment, working with health and social care partners. The team aims to keep patients at home where possible or, if they are too unwell to remain at home, providing care in a nursing home setting rather than in an acute hospital bed. This type of care is better for patients who do not need to be in hospital and helps to prevent avoidable emergency admissions. The team is receiving approximately 90 referrals a month from across Sutton and Merton. These new ways of working supports both the CCG s and Epsom and St Helier University Hospitals NHS Trust s savings programmes through reducing numbers of admissions and lengths of stay in hospital. New Urgent Care Centre - a building block to improved urgent care system We have built on the success of the Urgent Care Centre (UCC) at St Helier Hospital this year to improve the local Urgent Care system. The UCC opened on 1 August 2011 and is an important part of Sutton CCG s urgent care programme and supports two of the CCG s strategic objectives (improving both local hospital care and out of hospital care). Attendance at the UCC has grown from approximately 750 patients a month in 2011 to 1000 patients per month in The centre which is based next to the A&E department at St Helier Hospital treats patients with minor injuries or illnesses who come into the A&E department, allowing the specialist A&E staff to focus on patients with critical or life threatening conditions. Phase 2 of the development the Urgent Care Centre commenced in May 2013 with the introduction of sub-major patients being seen in the department. Since July 2013, local Sutton GPs have been seeing and treating patients in the UCC which has meant that the number of patients that can be seen at the Centre has increased by an additional 6,000 patients per year. Healthcare acquired infection performance improvement Sutton CCG reported two unavoidable cases of MRSA bacteraemia for 2013/14. Epsom and St Helier University Hospitals NHS Trust (our local acute trust) has managed their Clostridium difficile prevention using current best practice, and has one of the lowest numbers of cases in South West London. ESH reported 40 cases against a trajectory of 47 and this represents a 44% reduction in Clostridium difficile cases in 2013/14 compared to 2012/13. 14

15 Wider quality and safety agenda Quality Good, safe services that mean a good experience for those using them runs through all of our plans. The NHS defines quality as effectiveness, safety and excellent patient experience. Quality, along with prevention, productivity and innovation, is key to the commissioning of sustainable services for our community. Quality is also a key driver for minimising health inequalities, promoting equality and diversity and raising the life chances and wellbeing of our population. We expect quality to be central to all of our commissioned services, whoever provides them. By ensuring that the quality of care is good, we will ensure that the outcomes for patients are the best they can be. To achieve this, we check how patients feel about their treatment or care. Areas we will include: Healthcare Associated Infections (HCAIs) Care and compassion the 6C s Equality and diversity Safeguarding children and young people Safeguarding adults Placed people Nutrition and hydration The recommendations of the Francis Report Medicines security and management Eliminating mixed-sex accommodation Safety We have worked on projects that support providers to tackle issues of patient safety across the health community. As part of our work to care for vulnerable and older people, we have worked in partnership with acute and community providers and residential and nursing care homes on initiatives to prevent pressure ulceration, falls and infections. Ensured that the quality of care provided for vulnerable adults is closely monitored and that people with learning disabilities and complex needs have their emotional, health and wellbeing needs met at all times. Strengthened our systems to make sure we can satisfy ourselves that our provider organisations are properly reporting incidents to do with patient safety, learning from them, and have the right safety alerts in place. Continued to promote the use of the Safety Thermometer for an increasing number of providers, and reporting outcomes through an Integrated Quality and Performance report. 15

16 Healthcare Associated Infections (HCAIs) Pursuing the aspiration for zero tolerance of HCAIs, we have systematically reviewed local objective-setting across the organisations from which we commission services; this will include the review of surveillance data to monitor progress against nationallyset trajectories for specific organisms and other agreed indicators. We have continued to work with providers and the public to reduce the incidence of Clostridium difficile and to ensure excellent antibiotic stewardship, as well as supporting the goal of zero tolerance to MRSA. Early warning and quality assurance We have continued to be members of, and contributed to, the South London Quality Surveillance Group, informing NHS England, the Care Quality Commission (CQC) and other agencies about identified risks or quality issues. We have ensured that all contract review meetings are focused on the provision of high-quality and safe, effective care. We have worked with providers of care in the community to share intelligence for the promotion of quality improvement in care, such as in care homes, nursing homes and domiciliary care provision. Safeguarding Ensuring that vulnerable people are safeguarded is a vital part of the role of the CCG. We have continued to maintain a focus on the safety of vulnerable adults, children and young people. We commission services that promote and protect individual human rights, independence and wellbeing. We secure assurance that any child, young person or adult thought to be at risk, stays safe. We secure assurance that they are effectively safeguarded against abuse, neglect, discrimination, embarrassment, or poor, compassionless treatment. We want all patients to be treated with dignity and respect and to enjoy the best possible quality of life. As a CCG we continued to gain assurance that the services we commission safeguard both adults and children. Statutory duties under sections 11 and 13 of the Children Act 2004 apply to CCGs and include the duties to safeguard and promote the welfare of children, and to have an active membership role in Local Safeguarding Children Boards (LSCBs). It is known that for looked-after children, outcomes and access to healthcare are often worse than for other children and the CCG has a duty to work with local authorities to provide support and services to children in need, which we do by: Continuing to work in active partnership with two local authorities through Safeguarding Children Boards and Local Safeguarding Adult Boards and we will contribute to multi-agency agendas such as Multi-Agency Public Protection (MAPPA), Multi-Agency Risk Assessment Conferences (MARAC) and the Domestic Violence and PREVENT agenda Ensuring that all relevant health providers work together to produce Serious Case Reviews, investigations or independent management reviews 16

17 Focusing on a proactive approach to the commissioning and contracting of individual placements (contracts will include the Safeguarding Operating principles and we will run in-depth reviews of safeguarding processes for all providers) Ensuring that the voice of individuals is heard. Designing ways to ensure that people who live and work in Sutton know what signs and indicators of abuse to look out for and who to contact for advice Supporting national initiatives that safeguard vulnerable people including: The PREVENT agenda Preventing child sexual exploitation Preventing female genital mutilation Combating sexual violence Combating domestic abuse Developing and monitoring the dissemination and evaluation of outcomes of all domestic homicide reviews, Serious Case Review action plans and Serious Incidents Requiring Investigation (SIRIs) Providing training, support and supervision for named professionals across the health community Higher standards safer care Winterbourne Review We have worked with providers to ensure the recommendations made in Transforming Care: A national response to Winterbourne View Hospital are implemented. We will continue to eliminate inappropriate hospital placements for people with learning disabilities and autism, and people in NHS-funded care who have a mental health condition or challenging behaviour. The Francis Report quality drivers The Francis Report is arguably the most influential publication in recent years on the state and quality of care in the NHS. As well as reporting on the sub-standard provision of care in Mid Staffordshire NHS Foundation Trust, the report examined the role of commissioners in the failings of patient care. We are determined to learn from the failings in Mid Staffordshire NHS Foundation Trust and will continue to ensure that the many recommendations of the Francis Report are progressed. We will work with providers to ensure that these and other recommendations from the reports by Berwick and Keogh are acted upon, where relevant, by all providers of care. We will focus particularly on quality and safety issues for frail, elderly people. 17

18 Patient experience Over the past year we have worked on listening, responding and improving care by using insights gained from patient feedback. We are determined to learn more from patients and their families about their experiences, to influence our commissioning decision-making and to continue our work on improving the quality of services. Gathering experience from people who use our services We have promoted, supported and monitored the widespread use of the Friends and Family Test (FFT), and developed ways of using this to monitor the quality of commissioned pathways the FFT features on integrated Quality and Performance Dashboards and is reported to our Governing Body We have worked with providers to ensure that the most vulnerable people, whether young or old, are able to provide us with feedback and insight We have continued to improve and promote the use of the GP alerts, investing in our patient participation groups (PPGs) and working closely with our local voluntary sector including Health Watch. We have involved our Patient Reference Group (PRG) who provide a forum for dialogue between patient representatives and the CCG to deliver an effective patient voice. Staff satisfaction There is good evidence to show that satisfied, motivated and happy staff will deliver better care and outcomes for patients. We have begun to put more emphasis on the importance of staff satisfaction ensuring providers listen to the experience of their staff and promote a positive staff experience. Benchmarking providers staff satisfaction levels and reporting the results in our Quality and Performance Report, and addressing any low levels at contract review. We have promoted the use of the Staff Friends and Family Test to help us consider the quality of services. Clinical effectiveness Quality and Performance Report We have continued to develop the integrated Quality and Performance Report. One of the key roles of commissioners is to specify the quality standards to be achieved for individual services by developing quality dashboards, incorporating measures of clinical outcome, patient experience and service effectiveness and efficiency. These will enable commissioners and the public to see and understand any variation, as well as any evidence of actions being taken where improvements are identified as being required. 18

19 Out of hospital care Some services have always been provided in hospitals. In the NHS, we need to get the most out of our money and provide services in ways that are easier for people to use. Our work during the year has focused on developing out of hospital care and our achievements are highlighted below. Reduced growth in hospital referrals through use of intermediate tier services During 2013/14, 2,678 electrocardiograms (a test used to detect abnormal heart rhythms and to investigate the cause of chest pains) were carried out in GP practices in Sutton. A further 736 people receiving anticoagulation treatment to prevent blood clots had their routine monitoring undertaken in a GP practice rather than in hospital. Providing care in GP practices is more convenient for many patients and reduces referrals to hospital and their associated costs. Improved quality in primary care linked to quality premium Within the Practice Engagement Scheme practices were set targets aligned to the local priority targets that the CCG set for achievement of Quality Premium. There were three targets around improving immunisation rates in young children, increasing cost effective and safe prescribing through use of the decision support software ScriptSwitch, and improving patient participation through representation at the CCG Patient Reference Group. Achievement by each practice against these three measures is shown overleaf: 19

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21 Improved support to nursing homes The Francis Inquiry makes specific recommendations in relation to frail elderly people. It is clear from this inquiry alongside inquiries such as the one undertaken into Winterbourne View that the most vulnerable patients are at the most risk from harm. Sutton CCG and the Local Authority are prioritising the care of older people and have placed particular emphasis on Nursing homes during 2013/14 providing additional support to enable and assure significant improvements in the quality and safety of care provided in this setting. A range of quality information will be shared across agencies in a more systematic manner to help identify issues earlier. NHS 111 NHS 111 (111) was introduced across England in to provide a single point of access for patients requiring urgent care quickly but when it isn t a 999 emergency. Initially, the 111 service was provided by NHS Direct. However, following their decision in July 2013 to withdraw from their joint contract to provide the 111 service for Sutton CCG and Merton CCG, both organisations undertook an interim procurement to identify an alternative provider. The provider would ensure services were maintained to conclude the existing contract term. Following a successful procurement process and mobilisation, NHS 111 services went live with Harmoni on 12 November Harmoni were chosen because the CCGs believed that they will deliver high quality, safe services and provide good value for money. They also demonstrated their ability to mobilise resources quickly to provide 111 services in Sutton before the end of the year. This arrangement ensured the continuation of a safe and sustainable service for local residents. Harmoni is the interim provider of the 111service. The arrangement will remain in place until local commissioners appoint a long term service provide to take over the contract. This will take place after March GP out of hours services co-located at St Helier Hospital Another key strand of the urgent care programme is our GP out of hours service. Following procurement, South East London Doctors on Call (SELDOC) started providing GP out of hours services from St Helier Hospital on 12 November SELDOC provides patients with an urgent face to face consultation with a doctor at times when local GPs are closed. This consultation can be face to face, via the telephone or, where clinically appropriate, a home visit. In order to access these services, patients contact NHS 111 and appointments are made over the phone. 21

22 Long term conditions management We want to help our patients with long term conditions (LTCs), such as diabetes or heart disease, to manage their conditions so that they do not get into a crisis situation. This is a key priority for the CCG and our achievements this year are highlighted below. Risk stratification tool Risk stratification tools allow us to identify the top 10% of patients with particularly complex needs who are at the greatest risk of hospital admissions. Once identified these patients are managed by multidisciplinary teams in community settings. Patients are supported and cared for in their own homes wherever possible, and appropriate, to reduce the number of avoidable hospital admissions, attendances at A&E and avoid or delay admission to care homes. Sutton CCG has invested in a risk stratification tool which is installed and used in all Sutton GP practices Medicines management for older people During 2013/14, the Medicines Management Team has worked with the GP practices within the CCG to support the safe, high quality and cost-effective use of medicines. The team has been fully complete since July 2013 and each practice now has a specific pharmacist who works with them to review prescribing to ensure that it is cost effective and in line with local and national guidance. This has been supported by provision of regular information via factsheets, shared care guidelines and a monthly report. The team has also significantly reviewed the ScriptSwitch profile to ensure that the advice and prescribing recommendations reflect current advice and have seen a substantial increase in the acceptance rate and savings associated with this piece of software. Pharmacists have piloted working with clinicians to review prescribing for patients in care homes and vulnerable housebound patients and will investigate how to further develop this for 2014/15. The Medicines Management Team has strengthened the relationship with Community Pharmacists and regularly attends the Local Pharmaceutical Committee (LPC) meetings and has locality representative community pharmacists who attend the locality meetings, disseminating key information to community pharmacist colleagues in order to enable better support and integration with the Medicines Management team priorities. Towards the end of 2013/14, electronic transmission of prescriptions has been implemented, enabling more convenient, flexible and quicker provision of medicines to patients. The Medicines Management Team and Medicines Management Committee annual reports will be available during the summer and will provide more detailed information about all of the work undertaken during 2013/14 by the Medicines Management Team. 22

23 Community Prevention of Admission The Community Prevention of Admission Team (CPAT) was launched on 1 October 2013, targeting elderly patients with complex health needs, often with more than one long term condition, such as diabetes or chronic obstructive pulmonary disease (COPD). The team comprises a GP, nurses and therapists who provide rapid assessment, working with health and social care partners. The team aims to keep patients at home where possible or if they are too unwell to remain at home, providing care in a nursing home setting rather than in an acute hospital bed. This type of care is better for patients who do not need to be in hospital and helps to prevent avoidable emergency admissions. The team is receiving approximately 90 referrals a month from across Sutton and Merton. End of Life Care Programme Co-ordinate My Care One of our key areas of focus this year was on improving end of life care for Sutton residents. We have focused our attention on giving people the right support to make it easier for them to be looked after in their place of choice at the end of their lives - be it a care home, hospice or their family home. To enable this, Sutton CCG is working with local health partners to improve end of life care in Sutton. The key element of our approach has been to encourage our local GPs to use the Coordinate My Care record. This ensures that all relevant local health partners have access to a patient s information and care plan. This multi-disciplinary approach ensures that all the professionals involved in a patient s care work together as a team. This improves the care a patient receives at the end of their life, supports their family and, importantly, ensures that patients are able to be looked after, and to die, in their preferred place. Community End of Life Care Teams The community end of life care team (EOLC) in Sutton and Merton have initiated clinical ward rounds in nursing homes to help support staff in identifying residents who may be approaching the end of life. To further support this, key educational training sessions have been developed and are being rolled out within the care homes. Nursing homes are visited once a month at least for the purpose of clinical rounds and education and training. The end of life care team also visit each GP practice within Sutton and Merton to attend a Gold Standards Framework/alternative end of life meeting per quarter. Training and education In 2013, the End of Life Care provided by Sutton and Merton CCGs was awarded a South London Health Innovation Network award for a joint proposal by the End of Life Care teams at Sutton and Merton CCGs with St Raphael s Hospice to provide training for nursing and residential home staff and carers for people living at home. 23

24 The project aims to improve the quality of care for people who are thought to be in the last year of life. Staff undertake a Royal College of Nursing accredited week long training course, organised and co-ordinated by St Raphael's Hospice and delivered by expert practitioners in palliative and end of life care. The course includes pain and symptom assessment, communication skills, spirituality, advance care planning and working with people with dementia and cognitive impairment. A series of six courses will be delivered over the year and up to 100 staff will receive training. 24

25 Focus on mental health A key priority for the CCG is to continue to develop mental health services across all age ranges, and focus on prevention and early diagnosis. Our achievements during the year include: Psychological therapies access and outcomes We believe access to services as a priority for people with mental health problems and have in 2013/14 focussed on access to local Improving Access to Talking Therapies (IAPT) services. We are currently undertaking a comprehensive review of our primary mental health services, including our Improving Access to Psychological Therapies (IAPT) provision. The aim of the new service will be to: Address access to mental health services by commissioning a Single Point of Access (SPA) Promote mental wellbeing by commissioning a care navigation system for universal and non-statutory services Promote recovery by providing care closer to home for people with stable mental health problems Establish clear referral pathways for bereavement counselling Continue to improve access to talking therapy by commissioning a comprehensive assessment element through the Single Point of Access Improve Moving to Recovery rates for talking therapy by commissioning effective treatment options for people with common mental health problems Further work will be carried out during 2014/15 to look at the development of the model and potential procurement options. Improved diagnosis and treatment of dementia We are committed to the challenge of looking at services for people with all forms of dementia. During 2013/14 we responded to the Dementia Strategy by undertaking a review of health and social care pathways. This has given us and our partners a clear priority around not only further improving our dementia diagnosis rates during 2014/15 but also to look at how services throughout Sutton can become a Dementia Friendly Community. Integrated mental health services for children and young people We are committed to delivering integrated mental health services for children and young people and have worked in partnership with the local authority to commission a single point of referral for all Child and Adolescent Mental Health Services. 25

26 The single point of referral signposts to the most appropriate mental health service including those provided by South West London & St Georges Mental Health Trust and the voluntary sector 26

27 Developing the Jubilee Health Centre The provision of community based care is a priority for us and our Out of Hospital (OOH) strategy aims to achieve 30% of all outpatient activity provided in a community setting, closer to the patients homes, by A number of local and regional initiatives such as the legacy programme from Sutton and Merton PCT (Better Healthcare Closer to Home) and the now discontinued reconfiguration programme in south west London (Better Services Better Value) have meant that Sutton CCG inherited an ongoing programme of service redesign for commissioning services out of hospital. We have been working with a number of local health partners Epsom and St Helier University Hospitals NHS Trust, Sutton and Merton Community Services (delivered by The Royal Marsden), South West London and St George s Mental Health NHS Trust, Healthwatch Sutton and local GP practices - to bring to life our vision of care closer to home by developing the services delivered from the Jubilee Health Centre (JHC) in Wallington. The development of the Jubilee Health Centre is a real success for Sutton and our vision is for it to become a vibrant, productive centre of excellence that provides high quality services within the local community. The development of the JHC is also a significant step towards our achieving the aims of our Out of Hospital strategy for community-based outpatient care. The JHC opened in May 2012, and contains two GP practices - the Wallington Family Practice and Shotfield Medical Practice. Other healthcare services (including hospital outpatient clinics, phlebotomy, physiotherapy, child health and mental health) are also offered at the Centre. During 2013, new outpatient clinics and services became available to patients at the Centre. Electrocardiography (ECG) Cardiology outpatient clinic Rheumatology outpatient clinic Dermatology outpatient clinic Increased number of phlebotomy (blood taking) clinics Weight management Diabetes tier 3 service Community special care dental service X-ray department Ultrasound Orthopaedics Respiratory Gynaecology Urology Smoking cessation Orthoptics 27

28 Integration and collaboration We recognise that we need to work closely with our partners and stakeholders so that we can be successful as an organisation. Our achievements during the year include: Community services fully aligned to CCG localities Our GP Practices are aligned to three geographical localities; Sutton and Cheam; Carshalton and Wallington, with a GP clinical lead for each locality. During 2013/14 we have been working with our community services provider to align the community nursing teams to these localities and we will continue to progress this way of working including further development of the community team and co-location. Risk management with south west London CCGs The six south west London Clinical Commissioning Groups have developed a five year risk sharing agreement. The shared pool of money with a value of 8.1m in 2013/14, contributed to by all south west London CCGs, is designed to be used only for those financial risks that could not have been foreseen at the time of submitting financial plans, and that the risk pool is an option of last resort, after CCG reserves are exhausted. In 2013/14, NHS Sutton CCG borrowed 1.5m from the risk pool fund. Joint Health and Wellbeing Strategy drives closer working with Sutton Council Locally, we have been working with our Health and Wellbeing Board partners in Sutton, including Sutton Council, Sutton Healthwatch and the Sutton Centre for the Voluntary Sector to develop a joint health and wellbeing strategy. The vision for this strategy is to: Improve the health and wellbeing of people in Sutton by working with communities and residents to increase the opportunities for all to enjoy a healthy, safe and fulfilling life and reduce health inequalities between communities. Informed by our Joint Strategic Needs Assessment (JSNA), we have identified four priority themes to help us achieve our vision: Improving and protecting health and wellbeing Improving the health and wellbeing of those who have illness or disability Improving mental health and wellbeing Reaching out, engaging and empowering communities and individuals to lead healthy lives In delivering this vision we will focus on what has worked locally, regionally and nationally. We will balance support, services and interventions, working in a partnership of organisations, communities and individuals to prevent illness and prolong healthy life, ensuring that we: Safeguard our young and vulnerable populations, particularly those at risk of harm or abuse 28

29 Reduce inequalities in health and wellbeing, recognising the needs of people from different cultural backgrounds and social circumstances Deliver high quality social care and health services, making the best use of available resources Take a whole life approach (from birth to death) The strategy, which takes into account our authorisation plan along with other complementary plans and strategies of our partners, aims to improve the health and wellbeing of people in Sutton by working with our local communities to reduce health inequalities. The Health and Wellbeing Strategy is available on Sutton Council s website: Patient Reference Group adds value to commissioning decisions The Patient Reference Group (PRG) provides a forum for dialogue between patient representatives and the CCG to deliver an effective patient voice. This will include the following: Enables patients to raise issues about local services with the CCG Enable patients to be kept abreast by the CCG of its priorities, business planning and commissioning timetables Enables the CCG to consult patients about specific current and future developments and policies, including the commissioning and quality of local services Provides patients with timely requests to assist the CCG, to allow for wider consultation through Patient Participation Groups (PPGs) and considered patient input for the CCG in taking work forward. Membership of the group is voluntary and open to patients elected or selected from individual Sutton GP Practices or Practice Participation Groups. Dr Muneeb Choudhry, Sutton CCG s clinical lead on Patient and Public Involvement (PPI) and Sally Brearley, Sutton CCG s Lay Member with responsibility for Patient and Public Involvement are members of the PRG. Healthwatch Sutton attends as an observer. Terms of reference and minutes of PRG meetings are available on Sutton CCG s website: Focus on safeguarding leads benefiting adults and children Sutton CCG has arrangements in place for ensuring that within the services we commission all staff working with children or adults who are parents are able to keep them safe. This includes ensuring safeguarding supervision and training is in place so that vulnerable children are identified early and timely intervention occurs. We work closely with partner agencies, for example, the Multi Agency Safeguarding Hub (MASH), social services, police, education, housing and the voluntary sector to share information that protects children and review cases when children have been seriously harmed or have died through abuse and/or neglect. 29

30 Sutton CCG is a member of the Sutton Safeguarding Children Board, a multi-agency statutory partnership tasked with improving outcomes for children, monitoring and holding to account all public and private organisations with regards to their arrangements to safeguard children and young people (0-18 years). Sutton CCG chairs the Policy and Procedure Subgroup for the Sutton Safeguarding Children s Board. Sutton CCG is also part of Sutton Safeguarding Adults Board. This is a partnership of all the organisations in Sutton involved in protecting vulnerable adults, including Sutton s adult social services and community service, the police, local health service providers and voluntary organisations. Together they work to promote the safety and wellbeing of vulnerable people. Sutton CCG chairs the Quality and Assurance Sub group of the Sutton Safeguarding Adults Board. 30

31 Our ambition for 2014/16 Sutton CCG has developed a strategic plan for the coming two years please see our plan on a page overleaf. This sets out the priority areas for programmes of work for the CCG. This strategy has been developed in conjunction with our key stakeholders and partners to ensure that we are focussed on the needs of our population. 31

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33 Health and wellbeing Our borough Sutton is a vibrant place to live. We have an increasingly diverse and multicultural population that is adding to the richness of our community. From the 2011 census, Sutton s population is 191,123. However, the population of Sutton is changing. It is a young borough compared to the England average with children and young people aged 0-19 making up almost a quarter (23.5%) of the population. This is expected to rise by almost 20% by 2021, compared to 14.5% for London and 7.9% for England as a whole. The child population and the parent-age population (35-44) is also higher than the England average and increasing at a faster rate. The change suggests a significant inward migration of people to Sutton. The age profile is also increasing. Over 65-year olds make up 14.3% of the population and this is forecast to rise by 18.7% by 2021, in line with London. In the 2011 census, a fifth of people in Sutton were from black, Asian and ethnic minority groups. Taking into account people from non-british white communities (mainly South African, Polish and Irish) almost three in ten people come from ethnic minority, making Sutton s profile more like London and less like England as a whole. Sutton is a healthy place to live with good life expectancy (higher than the national and London average) for both men and women and fewer people dying from avoidable conditions. Fewer children live in poverty and there is less infant mortality compared to London and the England average. Overall the borough has good educational attainment and less long-term unemployment. However, inequalities are increasing. Sutton has areas that are in the 20% most deprived in the country and certain areas have become more deprived since 2007 There has been a significant widening of inequalities for both men and women between and and the difference in life expectancy has also increased from 5.4 years to 8.1 for men and from 5.8 years to 7.9 for women. Health and Wellbeing Board The Health and Wellbeing Board (HWB) considers matters relating to the provision of public health services and the commissioning of adult social services and children's services across health and social care and the impact of these on the health and wellbeing of the local population. 33

34 Joint Strategic Needs Assessment We are also working with our partners in Public Health and the London Borough of Sutton to respond to a Joint Strategic Needs Assessment (JSNA), which analysed the health needs of our local population. We are using the JSNA to inform and guide our planning and funding of health and well-being services in the borough. The JSNA can be found at Better Care Fund Announced in June 2013, the Better Care Fund (BCF) has been created to ensure a transformation in integrated health and social care. The BCF is a single pooled budget supporting health and social services to work more closely together in local areas. Local areas are required to develop plans for the use of this fund, overseen by Health and Wellbeing Boards. The Better Care Fund submission formed part of our Operating Plan submission and was developed jointly between the CCG and Council, with consultation with other stakeholders including acute healthcare providers, staff in health and social care and local residents. The Better Care Fund (BCF) for Sutton is some 600K in , increasing to 14.7m in The Better Care Fund will support a range of schemes, including the integration of community health and social services staff to work in a seamless way based on the three CCG localities for the GPs, integrated working in the community and at the interface with local acute hospital services and the alignment of mental health services with these arrangements. This integration work will also encompass community equipment, the work of the learning disability clinical health team and related areas of provision. This work will support the development of seven-day services to support hospital discharges and unnecessary weekend admissions, better data sharing across health and social care and a joint approach to assessment supported by a multidisciplinary team working approach and risk stratification. Improvement will be mapped against the six metrics used to assess progress. These are: A reduction in permanent admissions of older people to residential and nursing care homes; An increase in the proportion of older people who were still at home 91 days after discharge from hospital into reablement/rehabilitation services; A reduction in delayed transfers of care from hospital measured by the number of delayed days; A reduction in the number of avoidable emergency admissions measured by the average per month; An improvement in patient/service user experience: and An improvement in the dementia diagnosis rate compared to estimated prevalence 34

35 It is important to note that the approach in Sutton will go considerably beyond those areas of service for which the funding will be pooled in 2015/16. Service areas such as mental health and part of acute care provision are being aligned with those areas within the funding pool in order to generate the greatest impact and move from an archipelago of islands to integration to something much closer to being a comprehensive system of integration. The work to set in place this integrated system of care is now underway in order to be best prepared for the pooling of Better Care Fund resources from April

36 Local NHS partners South West London Collaborative Commissioning CCGs in South West London have recognised the need to come together, to share and align strategic priorities and commissioning intentions on issues that are of common interest to all six organisations. They have collectively agreed a model for commissioning support that: Ensures commissioning resources are predominantly locally based, for example each CCG will retain local lead commissioners for both acute and non acute commissioning as well as support to develop local CCG strategies, QIPP and service redesign work. A common set of commissioning support functions purchased from the South London Commissioning Support Unit (CSU). Identifies a small set of areas where CCGs wish to collaborate to support clinical commissioning o Acute commissioning o Mental health o Out of hospital o Strategy o Continuing healthcare o Risk sharing To support this a governance structure was put in place that allows clinicians and managers across the six CCGs to come together to set strategic direction, review progress, agree a direction of travel and hold each other to account. The CCGs have created two forums to support collaboration SWL CCGs Strategy Group and SWL CCGs Accountable Officers Group. Discussions that take place at a collaborative level will support decision making at Board level within each CCG. Accountability and responsibility for decision making sits with the Board of CCGs, in line with good governance, whilst the collaborative provides a forum for the six CCGs to work through issues relevant to the group. Our vision is to work together to build the best affordable healthcare for Sutton, we do this in partnership with our local NHS providers and commission hospital, community and mental health services from them. The main provider of acute hospital services in Sutton is Epsom and St Helier University Hospital NHS Trust, community health services are provided by Sutton and Merton Community Services and South West London and St George s Mental Health Trust provide mental health services. 36

37 Epsom and St Helier University Hospital NHS Trust As the main provider of acute hospital services in Sutton, Epsom and St Helier University Hospitals NHS Trust has two 24 hour A&E departments and provides an extensive range of general and specialist medical services. The Trust employs approximately 4,000 staff across its hospitals and is supported by over 450 volunteers. Some key achievements from this year: CQC report: Epsom, Sutton and St Helier hospitals were given the lowest possible risk rating by the health watchdog the Care Quality Commission (CQC) in a new national scheme that measures hospitals against 150 indicators, published in October The CQC measured hospitals against a wide range of factors, including death rates, serious errors and patient surveys. From this data, all 161 hospital trusts in the country were given a risk rating of between one to six (one being highest risk and six being lowest). Epsom, Sutton and St Helier were given the best rating of six. Maternity survey: A patient survey conducted by the Care Quality Commission showed that midwives, doctors and other staff at Epsom and St Helier hospitals are providing new parents and their babies with a high level of care. 171 women who gave birth at the Trust in February 2013 took part in the survey and the results place the Trust as one of the best performing maternity units in the region and a strong performer nationally. Hip fracture care: St Helier Hospital is providing elderly patients who have a fractured hip with the best care in the country, according to the new National Hip Fracture Database National Report St Helier Hospital has topped the list for best practice a measurement that takes into account eight different standards to identify the best of hip fracture care. More information about Epsom and St Helier s can be found on the Trust s website. South West London and St George s Mental Health Trust About the Trust The Trust was formed in 1994 but has a long history of providing mental health services for more than 160 years. The headquarters are at Springfield University Hospital in Tooting and the Trust also operates from nearly 100 other locations, providing community and hospital psychiatric services to Kingston, Merton, Richmond, Sutton and Wandsworth. Key achievements include: 37

38 Liaison psychiatry: The South West London and St George's Mental Health Trust (SWLSTG) liaison psychiatry team at St Helier Hospital, provide immediate access to specialist mental health support for people being treated for physical health problems, and help to treat patients with a wide range of issues, including dementia, alcohol dependence and drug addiction. The team, who help to support people with mental health issues while they are patients at St Helier Hospital were named as 'excellent' by the Psychiatric Liaison Accreditation Network (PLAN), in the annual national scheme run by the Royal College of Psychiatrists, ensuring they stay at the highest rating for the third consecutive year. More information about South West London and St George s can be found on the Trust s website. In addition, St George s Healthcare NHS Trust provides specialist acute services for Sutton residents and The Royal Marsden NHS Foundation Trust (Sutton Branch) provides specialist cancer services. St George s Healthcare NHS Trust About the Trust St George's Healthcare NHS Trust is the largest healthcare provider in south west London. Their main site, St George s Hospital in Tooting one of the country s principal teaching hospitals is shared with St George's, University of London, which trains medical students and carries out advanced medical research. With nearly 8,000 staff, St George's Healthcare serves a population of 1.3 million across south west London. A large number of services, such as cardiothoracic medicine and surgery, neurosciences and renal transplantation, also cover significant populations from Surrey and Sussex, totalling around 3.5 million people. St George s Hospital is the designated heart attack centre, hyper acute stroke unit and major trauma centre for south west London. More information about St George s Healthcare can be found on the Trust s website. The Royal Marsden NHS Foundation Trust About the Trust The Royal Marsden is a world-leading cancer centre specialising in cancer diagnosis, treatment, research and education. Together with their academic partner, The Institute of Cancer Research, The Royal Marsden forms the largest comprehensive cancer centre in Europe with a combined staff of 4,628. Through this partnership, they undertake ground-breaking research into new cancer drug therapies and treatments. 38

39 The Trust also has an academic partnership with Mount Vernon Cancer Centre. This combined partnership enhances their research programmes and their contribution to the NHS in finding new and better ways to treat patients diagnosed with cancer. The Trust has two hospitals: one in Chelsea, London, and another in Sutton, Surrey. They also have a Chemotherapy Medical Daycare Unit at Kingston Hospital and provide Sutton and Merton Community Services. The Royal Marsden was founded in 1851 by William Marsden. His vision was to create a pioneering cancer hospital dedicated to excellence in the study, treatment and care of people with cancer. Today the Trust continues to build on this legacy, constantly raising standards to improve the lives of the 50,000 cancer patients from across the UK and abroad that they see each year. More information about The Royal Marsden can be found on the Trust s website. Sutton and Merton Community Services (delivered by The Royal Marsden NHS Foundation Trust) Patients cared for in the community by Sutton and Merton Community Services (SMCS) staff benefit from The Royal Marsden s ethos of personalised care, evidence based medicine and excellence in care and to ensure safe and speedy discharge from hospital back into the community. SMCS employs over 850 healthcare staff, including nurses, physiotherapists, occupational therapists, dieticians, podiatrists, speech and language therapists as well as some specialist medical staff in the family planning service. 39

40 Working in partnership Engaging with partners and the public Local patients and residents are at the heart of what NHS Sutton CCG does. The CCG has developed a number of ways in which local people can get involved in having a say and informing the development of our plans. During the year, Sutton CCG has engaged with a variety of stakeholders: Annual stakeholder engagement events We have held two major stakeholder events in Sutton. The aim was to discuss with the local population Sutton CCG s commissioning intentions and plans; feedback on the CCG s progress, share information and listen to local people s views. Both events were very well attended, over 70 local stakeholders attended our event in February this year, where attendees had the opportunity to discuss and feedback on our key priorities for the coming year and feedback from the discussions has helped inform the CCG s commissioning plans for 2014/15. Local engagement activity Sutton CCG has been invited to attend many local meetings with key stakeholders for the CCG to understand better local people s concerns and receive feedback which can then be used to inform the decisions the CCG makes about commissioning healthcare services in Sutton. Examples of key engagement activity includes: o We have established two Commissioning Advisory Groups led by carers and services users to inform commissioning decision making and priority setting. o Attendance at Healthwatch Sutton meeting where the CCG s commissioning intentions were presented in the context of the NHS A Call to Action. o Attendance at carers groups in Sutton including the Sutton Carers Delivery Group and Sutton Carers Forum o Older people were a key theme for engagement. The CCG attended a deliberative event on dementia and the To be older peoples event. Joint working with Healthwatch Sutton Healthwatch Sutton (HWS) has worked in partnership with Sutton CCG to develop local patient participation groups. During 2013/14, HWS has supported the development of Patient Participation Groups (PPGs) and engagement with the Patient Reference Group (PRG) across Sutton. 40

41 Ten GP practices already had PPGs in place and have been provided with additional support, six GP practices have been supported to set up and run PPGs In addition, HWS have: o Promoted the HWS PPG toolkit including at PPG workshops to enable Practice Managers to set up their own groups. o Designed and delivered two PPG workshops with a further workshop planned. o Attended individual PPG meetings. (April to Nov 2013). o Attended Locality meetings to raise the profile of the PPG and HWS. o Increased number of PPGs across Sutton. (In the first six months an additional three PPGs were set up). o Attended and delivered presentations to Practice Managers meetings. o All HWS presentations delivered across the borough include slides about the PPG and PRG. o Promoting PPGs to all HWS members through newsletter and website. o HWS has a Director on the Patient Reference Group representing HWS views. Patient Reference Group The Patient Reference Group (PRG) provides a forum for dialogue between patient representatives and the CCG to deliver an effective patient voice. This will include the following: o Enables patients to raise issues about local services with the CCG o Enable patients to be kept abreast by the CCG of its priorities, business planning and commissioning timetables o Enables the CCG to consult patients about specific current and future developments and policies, including the commissioning and quality of local services o Provides patients with timely requests to assist the CCG, to allow for wider consultation through Patient Participation Groups (PPGs) and considered patient input for the CCG in taking work forward. Membership of the group is voluntary and open to patients elected or selected from individual Sutton GP Practices or Practice Participation Groups 41

42 Dr Muneeb Choudhry, Sutton CCG s clinical lead on Patient and Public Involvement (PPI) is a member of the PRG and Sally Brearley, Sutton CCG s Lay Member with responsibility for Patient and Public Involvement are member of the PRG. Healthwatch Sutton attends as an observer. Terms of Reference and minutes of PRG meetings are available on Sutton CCG s website: NHS Call to Action NHS Call to Action was a national programme of engagement that aimed to allow everyone to contribute to the debate about the future of health and care provision in England. The programme was intended to be the broadest, deepest and most meaningful public discussion that the service has ever undertaken. The engagement was patient and public centred through hundreds of local, regional and national events as well as through online and digital resources. Call to Action aimed to: Build a common understanding about the need to renew our vision of the health and social care services, particularly to meet the challenges of the future Give NHS stakeholders (patients, clinicians, commissioners, etc.) an opportunity to tell us how to maintain current NHS values in the face of future pressures Gather ideas and solutions to develop both the CCG s two year operating plan and five year strategic commissioning plan. In Sutton, engagement activities for Call to Action complemented our existing engagement and strategic planning. The call to action themes formed a key part of our discussions at our stakeholder event held in February 2014 to celebrate the first year anniversary of Sutton CCG. The feedback is being incorporated into our two-year operating plan and will inform our five-year strategic commissioning plan, setting out our commitments to patients and how services will improve, which is being developed in collaboration with the other CCGs in south west London. NHS Call to Action feedback will also shape the national vision, identifying what NHS England should do to drive service change. 42

43 Patient Advice and Liaison Service The CCG provides a Patient Advice and Liaison Service (PALS) to deal with information requests, issues and concerns raised by patients and members of the public. There have been 106 PALS enquiries received in 2013/14. In 2012/13, the PALS office took 1234 calls from residents and patients, so there is a clear reduction in the number of enquiries received, which again is a result of handing over responsibility for all primary care PALS enquiries to NHS England. It is also of note that prior to April NHS Sutton and Merton PCTs were a single organisation, so the figures for 2012/13 reflect the numbers across both boroughs. Of the 106 PALS queries, 37 were redirected to NHS England as they were primary care enquiries and 46 PALS enquiries were related directly to the CCG, with queries relating to contact details and processes under the new ways of working within the NHS. The PALS office works closely with the CCG s directly commissioned services to ensure that concerns are dealt with promptly and services are improved. Benefits from the involvement of the PALS 2013/14 include: The PALS office has provided a single point of contact for enquiries and signposting for the public and MPs, enabling a smoother navigation of the new systems in the NHS since April This has ensured that the CCG PALS team has developed a detailed directory of contact details and information. There have been a number of PALS enquiries relating to podiatry services, and these have been passed on to the team to enable a review of the way in which podiatry services are commissioned and delivered within the borough. Complaints NHS Sutton CCG encourages feedback, positive and negative, so that we can make improvements based directly on the concerns of patients and the public. During 2013/14, there were 67 formal complaints, compared with 175 in 2012/13. The reduction is the result of handing over responsibility for all primary care complaints to NHS England on 1 April It is also of note that prior to April NHS Sutton and Merton PCTs were a single organisation, so the figures for 2012/13 reflect the numbers across both boroughs. Of the 67 complaints, six were legacy complaints that were received initially within the 2012/13 period. 11 of the complaints received were found to relate to primary care and information and guidance was given to complainants to enable them to contact NHS England. 43

44 15 of the remaining complaints received during 2013/14 related directly to treatment and care provided by acute hospital trust and one related to community services. The CCG worked in collaboration with these organisations to resolve the complaints. There were also seven complaints relating to assessment and access within commissioned services and one regarding the 111 service. 24 complaints related directly to the CCG and the main themes from these were: o Access and eligibility for services which totalled 16 complaints including those relating to individual funding requests considered by the CCG. o Funding for cognitive behavioural therapy, provision of foot health services to people over 75 years and access to in vitro fertilisation (IVF). o There were three complaints relating to treatment, two about processes and pathways, two complaints relating to continuing care services and one regarding prescriptions and medicines management. The investigations into complaints about the CCG have resulted in changes and learning to ensure that public and patients, for example: Complaint regarding end of life care received and continuing care payments in relation to this. The local MP was also involved on behalf of the family, and requested that the CCG consider retrospective payments to the family for the care they delivered. The continuing care team has reviewed the case and agreed terms with the family, and this has also provided the opportunity for the team to review the process by which continuing care payments are made to family carers. Complaint regarding the closure of Children and Adolescent Mental Health Services (CAMHS) services in the borough. The CCG is working with providers to review provision of CAMHS services, and concerns raised by the public and patients relating to this are forming part of this process. In response to complaints about the IVF funding process, Sutton CCG has committed to working with Merton CCG to review the IVF funding process in 2014/15. 44

45 Complaints about care following the Ombudsman s principles The Health Service Ombudsman is responsible for handling complaints from the public that relate to maladministration and has set out the six principles which underpin this work, which are to: Get it right Be customer focused Be open and accountable Act fairly and proportionately Put things right Seek continuous improvement The CCG continues to work hard to meet the standards set within these principles, working closely with partner agencies such as Healthwatch, hospital trusts and NHS England to ensure a robust service which reflects the principles of being open and enabling continuous improvement to meet the needs of residents within the borough. 45

46 Performance review The CCG plays a pivotal role in monitoring the performance of our providers and ensuring that Sutton residents receive the best possible healthcare. The CCG manages the performance of providers primarily through contract monitoring meetings and clinical quality review group meetings. These two forums report into the Quality and Executive Committees (sub-committees of Sutton CCG s Governing Body) which monitor governance, performance and compliance across all commissioned services. During 2013/14, Sutton CCG s performance has been measured against a range of indicators designed to answer the following four questions: Are local people getting good quality care? Are patient rights under the NHS Constitution being promoted? Are health outcomes improving for local people? Is the CCG commissioning services within their financial allocations? The CCG Board receives a bi-monthly report summarising performance against all indicators with an exception report of causes, action plans and reports from the working groups. In its first year of operation, Sutton CCG has performed well against the following indicators: 18-week maximum waiting time from referral to treatment for inpatients and outpatients 6-week maximum waiting time for diagnostic tests 4-hour A&E waiting time Cancer 2-week waiting time Cancer 31-day waiting time from diagnosis to first and subsequent treatments Cancer 62-day waiting time for first treatment following urgent GP referral or referral from NHS screening service Ambulance response times Mental Health Care Programme Approach seven-day follow-up Patient experience of hospital care Minimising Clostridium Difficile infections Areas that have been particularly challenging include: Number of patients waiting over 52 weeks Breaches of same sex accommodation Every case of a patient waiting over 52 weeks for treatment, or being admitted to mixed sex accommodation in breach of guidelines, is investigated and action plans requested if necessary from the provider organisation, to ensure that lessons are learned and processes revised from any poor practice identified. 46

47 Sutton CCG Delivery Dashboard 2013/14 A summary of performance against each indicator throughout the year is provided below. 47

48 48

49 Quality review One of NHS Sutton Clinical Commissioning Group s (Sutton CCG) key objectives is to commission the best, affordable healthcare in Sutton. This is a commitment to ensure high quality patient centred care. Sutton CCG constantly seeks assurance about the safety of services, and proactively seeks opportunities to improve the quality of the services provided. The CCG establishes quality expectations in their contracts with healthcare providers, monitors them regularly, and holds providers to account for their performance. When errors occur, the CCG works with the providers to ensure that reasons are identified and lessons learned to reduce the risk of any recurrence. Supporting the Quality Agenda The changes to the structure of the NHS in Sutton in 2013/14 included the appointment of a Director of Quality. The beginning of the year involved establishing the foundations detailing how the CCG will ensure that the quality agenda across Sutton is a high priority, and that patients receive the best possible care and treatment. Francis Report Recommendations Sutton CCG undertook a review of the recommendations from the Francis Report into the events at Mid Staffordshire NHS Foundation Trust. An action plan was developed to address the recommendations of the report, and builds on the quality and safety agenda already identified within the CCG. The CCG review considered all the recommendations, and whether they were specific to the commissioners or for others. Many of the recommendations related directly to the providers and the CCG wrote to those that it commissions to receive their response to the Francis Report. The CCG agreed to evaluate progress against their action plan every six months. The mid-year review shows that good progress has been made across all recommendations. Many actions have been fully implemented, and it will be important to continue to review these areas to ensure they are being applied effectively. Clinical Quality Review Groups Regular programmes of Clinical Quality Review Groups (CQRGs) are held with acute, community services and mental health providers. CQRG meetings are chaired by CCG Clinical Leads, and provide a robust mechanism where commissioners and providers work together to identify opportunities for improvement that will ensure delivery of safe and effective services, and drive up quality. Relationships have become well established to support local accountability and respond to local needs and requirements. 49

50 Commissioning for Quality and Innovation The CCG has monitored every provider s quarterly performance against the CQUIN (Commissioning for Quality and Innovation) requirements. Good progress has been made by all providers in relation to achievement of their CQUIN in 2013/14, with most being fully met. At the time of writing this report, Sutton CCG will be reviewing evidence from the providers in order to confirm the final end of year positions. Infection Prevention and Control Sutton CCG remains strongly committed to reducing Healthcare Associated Infections (HCAI), particularly working with providers to target a reduction in Methicillin Resistant Staphylococcus Aureus (MRSA) and Clostridium Difficile. Post Infection Review is undertaken on all these infections to understand the cause and ensure we learn from incidents. Sutton CCG reported two cases of unavoidable MRSA for 2013/14 and 26 cases of Clostridium Difficile against a trajectory of 37. The profile of infection control has risen significantly over the last year. The CCG will continue to work with providers and other stakeholders to understand patterns of infection and target prevention. Patient Experience Provider patient experience is monitored through national data including the Friends and Family Test and National Inpatient Survey, in conjunction with information from Complaints and Patient and Liaison Service. Additionally, patient experience is reported on by providers in their quality reports to the CCG, and informed through quality visits by CCG staff, which includes specific assessment on feedback about patient experience. Any feedback from the above is assessed for its level of concern and if the concern is an issue of patient safety, immediate action is taken between the CCG and the provider whilst other concerns are addressed through the provider s CQRG. Patient Safety Never Events Never Events are serious patient safety incidents that should not occur if known best practice guidance has been followed. Sutton CCG providers reported one Never Event in 2013/14. Serious Incidents Serious Incidents are events, usually unexpected, which caused, or had the potential to cause, serious harm. Serious Incidents are not exclusively clinical issues; 50

51 equipment failure or the loss of personal data for example, may have consequences that make them Serious Incidents. Serious incident reporting and management requirements are included within our provider contracts. CCGs have a responsibility to ensure that provider organisations from which it commissions healthcare services have robust systems to manage any Serious Incidents which occur. Regular provider Serious Incident Meetings chaired by Director of Quality, to review Serious Incident investigations, lessons learned and action plans. Evaluation templates developed and implemented for reviewing the quality of Serious Incident investigation reports. o Training events to improve reporting with specific focus on Maternity and Pressure ulcers. o Analysis of Serious Incidents and outcomes provided to the CCG Quality Committee and Governing Body as part of our Quality and Performance Report. Continued development of the management and monitoring processes at the CCG for all provider Serious Incidents including smaller contracts. Monitoring Healthcare Associated Infections Epsom and St Helier University Hospitals NHS Trust (our local acute trust) (ESH) has managed their Clostridium difficile prevention using current best practice, and has one of the lowest number of cases in south West London. ESH reported 40 cases against a trajectory of 47 and this represents a 44% reduction in trust Clostridium Difficile cases in 2013/14 compared to 2012/13. Mental Health The CCG continue to see access to services as a priority for people with mental health problems and have in 2013/14 focussed on access to local Improving Access to Talking Therapies (IAPT) services. This will continue with a remodelling of Primary Mental Health Care as a whole with its focus being on universal access to ensure people are navigated to and through their care. Another focus this year has been the care of our older population with mental health problems. Using the 15 Step Visit approach to look at environment and care we have highlighted and monitored concerns with our service providers. We have seen the development of a borough wide Autism Diagnosis and Adult Attention Deficit Hyperactivity Disorder Diagnosis Pathways which enable GPs to make referrals to Specialists when needed. 51

52 Community services The quality alert process highlighted a number of missed community nursing visits. SMCS have implemented a new patient allocation/management system (T Card system) within the nursing bases which is well developed in other services nationally. The system has now been rolled out to all SCCG localities and provides double checking of allocated visits on a daily basis so that any potential missed visits are identified and addressed on the allocated day. SMCS has undertaken service improvement/redesign work including reviewing capacity and demand; implementing strategies to manage Did Not Attends (DNAs) and exploring innovative models of service delivery which will address the needs of the service. Physiotherapy performance has been managed via monthly CQRG and the monthly contract monitoring meetings. Performance has increased significantly month on month with December performance: 68% of routine referrals assessed with 6 weeks and 66% of urgent referrals assessed within 1 week Community Prevention of Admissions Team The Community Prevention of Admissions Team (CPAT) was developed in 2013 to support the reduction of inappropriate emergency admissions to hospital by providing rapid assessment and intervention within 2-4 hours of referral. The team of highly skilled community nurses and therapists provide the service seven days per week providing holistic assessment; access to community diagnostics; comprehensive nursing interventions including prescribing, ordering equipment and care planning. CPAT enable patients to remain at home and avoid going into hospital by assessing the patient, dealing with any immediate needs and signposting onto health and social care services depending on patient need. Priorities for Improvement In this section, we give examples of some priorities which will be a focus for in particular. Pressure Ulcers The Director of Quality has established a local network to target the identification and care of pressure sores that occur in patients residing in their own homes and therefore not directly under the care of a hospital or their community provider. The network will draw on advice from acute and community care providers as well as Public Health, the Local Authority and Health and Wellbeing Board. This systemwide approach to community pressure ulcers aims to reduce the total prevalence of pressure ulcers in the Sutton population. CCG Francis Action Plan The CCG aims for continual development and improvement of their response to Francis. Areas that will be progressed over the next few months include: Development of relationships with other agencies and regulators Developing a framework to ensure that the safe transfer of patients is achieved, should immediate suspension of a contract take place 52

53 The triangulation of patient feedback sources Finding more ways to hear about the experiences of patients in real time and following care, especially for vulnerable groups. Using workforce data in an intelligent and meaningful way to identify potential Working with our host Trust new quality team to seek out new ways to improve the quality of care patients receive Working with our local authority partners to improve safeguarding process and at the heart of this ensuring the person at the centre of the investigation is considered at every level Announced Visits A programme of real time Quality Monitoring and Quality Assurance visits was developed by the CCG during the second half of 2013/14. These visits involve members of the CCG, including quality and contracting teams and CCG General Practitioner representatives, visiting services and ward areas in the main providers. This provides an opportunity to review the safety and effectiveness of care and to listen to the views and experiences of patients, relatives and staff to gain a rounded perspective of the quality of care. The programme was rolled out in late 2013/14. The schedule will continue to be implemented, with a number of visits planned for 2014/15. Areas of good practice and improvement will be identified and can be used to support development of action plans in conjunction with the provider organisation. Care homes Work continues with the London Borough of Sutton to develop and share intelligence. Joint visits have been made following quality concerns to a number of homes and joint action plans agreed. Regular contact and discussions with the CQC in regard to quality concerns in local homes have occurred. Support to the homes to improve care is being supported through a community contract CQUIN in 2014/15 and a number of workshops that will be held in This includes information the CCG receives on continuing care placement and funded nursing care placements. The Designated Nurse and Service Improvement Lead are holding a Nursing and Care home forum in April: the aim of the forum is to support and share good practice and develop a more in-depth understanding of Safeguarding issues. Our intention is to hold two or three forums per year with a focus on health issues. 53

54 Equality Report Overview In 2011, the Department of Health introduced a new tool for monitoring equality outcomes called the Equality Delivery System (EDS). This year Sutton CCG made significant progress in undertaking the assessment in order to establish a baseline for its position regarding equalities. The EDS gives NHS organisations an opportunity to improve fairness in service commissioning and performance evaluation for the benefit of the whole community patients, carers and staff. It also enhances collaboration with local stakeholders and interest groups by enable the analysis of service commissioning, provision and performance which leads to clearer identification of equality objectives and ensures compliance with statutory equality obligations. The EDS will enable Sutton CCG to meet the aims of the Equality Act 2010 which is a legal requirement of all public organisations to take the necessary actions to achieve: Elimination of unlawful discrimination. Advancement of equality of opportunity. Fostering of good relations between individuals and communities. The strengths and gaps highlighted through the EDS have supported the CCG to understand where it needs to focus attention in order to improve equalities performance within all its functions. These are reflected in an Equality Objectives and Action Plan developed by the CCG. As commissioners of services, Sutton CCG recognises that it must account for not only its own organisational equality performance but also that of the providers of services that it commissions. The results of the EDS baseline assessment and feedback from patient groups highlighted the work that the CCG needs to do with its provider organisations around equality and diversity. When making decisions about the services to be commissioned Sutton CCG ensures that equality and diversity intelligence informs its decisions by routinely using the Joint Strategic Needs Assessment (JSNA) and by carrying out Equality Analysis. Sutton CCG has prepared commissioning plans which look carefully at population needs based on demographics, health inequalities and access to services. At the heart of these strategies is a key objective to reduce health inequalities, improve outcomes for patients ensuring services are accessible and responsive to patients. Sutton CCG published its Public Sector Equality Duty report including Equality Objectives and Action Plan on 31 January Please click here to view the report %20SCCG%20Annual%20Equality%20report.pdf 54

55 Achievements during 2013/14 include: Partnership working to tackle health inequalities In 2013/14 Sutton CCG has continued to work closely with London Borough of Sutton, particularly with its work around health and wellbeing. This includes tackling health inequalities through a number of Public Health initiatives including: re-launch of the LiveWell scheme, a healthy lifestyle programme, and supporting rollout of NHS Health Checks. Another significant development is the JSNA to ensure real-time access to data and improve navigation which should assist commissioners to better use public health data. A series of social marketing projects have been undertaken in a range of areas such as physical activity in young adults and use of physical health services by people with severe mental illness. Commissioning for Equality Three commissioning priorities were identified for assessment using the NHS England Equality Delivery System framework: Mental Health reviewing the Improving Access to Psychological Therapies (IAPT) service; Older People looking at the Complex Older People s pathway and Jubilee Health Centre services. Evidence-based assessments will be carried out using two overarching criteria: Better health outcomes for all and Improved patient access and experience. Engagement with Council and voluntary partners, patients and public has ensured the patient voice is represented and used to support the development of improvement plans for each commissioning area. Listening to patients The CCG continually aims to improve the ways in which local people are involved in our activities. A well-established Patient Reference Group is supported by Sutton Healthwatch to discuss, challenge and influence decisions on areas of work within the CCG. Healthwatch has also been supporting the development of GP practice-based Patient Participation Groups. Equality Analysis (previously Equality Impact Assessments) Equality Analysis forms part of Sutton CCGs commissioning cycle and is considered during the redesign of a service or policy to ensure that the needs of our community groups are being met. Equality Analysis is integrated into the commissioning process enabling commissioners to assess impacts and inform decision making. 55

56 Our staff Communicating and Engaging There are a number of ways in which the CCG communicates and engages with its staff. These include: A south west London staff partnership forum where managers and staff from the six south west London CCGs meet to discuss and consult on issues. A number of CCG away days have been held throughout the year which includes all the Governing Body members, Management Team and staff. Staff members were instrumental in putting together a Staff Charter for the CCG which has been agreed by the Governing Body. There are regular team briefings with the staff and Chief Officer. Training and development There is a statutory and mandatory training policy in place and reporting procedures for staff to undertake statutory and mandatory training which is provided both on line via e-learning from Skills for Health and inhouse. Training is reported back to the CCG. All staff have had appraisals and have objectives and personal development plans (PDPs). Following a training needs analysis a Prince 2 training course was commissioned and has been undertaken by a number of CCG staff who had identified this as a training need. There is also a training study leave policy for supporting training and development with an application policy for access to funds to support training agreed as part of PDPs and other vocational training. Employee consultation-details of action taken Employee consultation is covered by an agreed CCG wide Organisational Change Policy. Policy on Disabled Employees Disabled staff are protected under the terms of the Disability Discrimination Act. The sickness absence policy confirms that if an employee is disabled or becomes disabled, the CCG is legally required under the Equality Act 2010 to make reasonable adjustments to enable the employee to continue working for example, providing an ergonomic chair or a power-assisted piece of equipment. CCGs must make sure the individual is not disadvantaged because of their disability. 56

57 Equalities for Staff An equalities breakdown of staff by six categories in line with guidance is available and is presented quarterly to the CCG in the form of workforce reports. Monitoring will continue to identify any priority areas to address. At the end of 2013/14 financial year Male Female Male Female Male Female Members and Governing Body 9 3 Very Senior Managers (VSM) 1 Employees of the CCG 6 17 Sickness absence The CCG Sickness Absence percentage rate is presented quarterly to the CCG in the form of workforce reports. Individual sickness absence cases are managed by the line manager with advice and support from Human Resources. An Occupational Health (OH) service is available to provide professional medical advice to the CCG. Staff can access OH for a self-referral and can access the OH Counselling service. The CCG also has access to an employee assistance programme which is provided by Right Management, which offers unlimited confidential access to emotional and practical support, including legal and financial advice. 57

58 Emergency preparedness Following authorisation as a Clinical Commissioning Group (CCG) and implementation of the Health and Social Care Act 2012 CCGs became category two responders from 1 April 2013, providing support to the NHS England (London) in any emergency situation rather than having lead responsibility. As a category two responder CCGs have had defined roles and responsibilities under the Civil Contingencies Act 2004 with a requirement to act in accordance with the NHS Guidance for Emergency Planning NHS England (London) outlined the responsibilities for CCGs in guidance which include: A duty to cooperate and support NHS England (London) with regard to Emergency Preparedness, Resilience and Response (EPRR) in planning and response and a mechanism in place to support NHS England (London) to effectively mobilise all providers (that the CCG commissions) should the need arise. To provide local knowledge and information as is reasonably practical. To ensure contracts with NHS-funded provider organisation contain relevant emergency preparedness, resilience (including business continuity) and response elements. To maintain business continuity plans for the CCG. We liaise with our health services for assurance that they have plans to enable them to continue to function in a crisis and participated in the NHS England London-led process of EPRR assurance across our providers. Emergency preparedness information is included within provider contracts. Sutton CCG participated in local exercises with stakeholder organisations to test both internal and external resilience arrangements. I certify that the clinical commissioning group has incident response plans in place, which are fully compliant with the NHS Commissioning Board Emergency Preparedness Framework The clinical commissioning group regularly reviews and makes improvements to resilience plans to ensure continued health provision for the health economy and has a programme for regularly testing this plan, the results of which will be reported to the Governing Body. Dr Chris Elliott, Chief Clinical Officer 58

59 Information Governance NHS Sutton CCG recognises that Information Governance (IG) is an integral part of risk management. It is therefore committed to ensuring that it meets the required compliance standards of the IG Toolkit to ensure the secure and confidential handling of all personally identifiable data. There is a formal process for co-ordinating the self-assessment against the IG requirements, supported by IG experts. This assessment is then independently audited to ensure assurance that sufficient evidence is in place to support the attainment levels assigned by the CCG. Each year a comprehensive IG action plan is agreed and implementations monitored by the IG Steering Group to ensure any gaps are identified and improvements made. The action plan has an emphasis on ensuring that staff complete the mandated modules of the IG e-learning programme and raising the importance of security and confidentiality in accordance with the Care Records Guarantee. Reported Information Governance Incidents There were no serious incidents (categorised as 3-5) reported by NHS Sutton CCG during 2013/14 There were no minor incidents (categorised as 1-2) reported by NHS Sutton CCG during 2013/14 59

60 MEMBERS REPORT Member practices NHS Sutton CCG is a clinically-led membership organisation bringing together 27 GP practices in the borough of Sutton into one commissioning organisation. We serve a population of over 190,000 people in the London Borough of Sutton. NHS Sutton CCG is made up of three, geographically based, localities each with a GP lead. Carshalton Locality Lead Dr Ash Mirza Bishopsford Road Medical Centre Carshalton Fields Surgery Chesser Surgery Faccini House Surgery Green Wrythe Surgery Hackbridge Medical Centre Sutton Medical Centre Wandle Valley Health Centre Wrythe Green Surgery Sutton and Cheam Locality Lead Dr Jeff Croucher Benhill and Belmont GP Centre Cheam Family Practice GP Centre - Brennan GP Centre - Leghari GP Centre - Longley Dr Grice and Partners Grove Road Practice Mulgrave Road Practice Robin Hood Lane Dr Seyan and Partners Well Court Surgery Wallington Locality Lead Dr Farhan Rabbani Beddington Medical Centre Beeches Surgery Maldon Road Surgery Manor Practice Park Road Medical Centre Shotfield Medical Practice Wallington Family Practice Wallington Medical Centre 60

61 Our Governing Body/Board Our Board is clinically-led and consists of elected GP representatives of member practices, a primary care nurse, an independent nurse, a secondary care consultant and two lay members, the Chair, the Chief Clinical Officer, the Chief Operating Officer, the Chief Financial Officer and the director of public health for Sutton. These are all voting members of the Board. The Chair of the CCG is Dr Brendan Hudson. The Board of NHS Sutton Clinical Commissioning Group is the body appointed with the main function of ensuring that appropriate arrangements are in place for compliance with the NHS Health Act 2006 (section 26 of the 2012 Act) and such generally accepted principles of good governance that are relevant to it. The Board does this through its main function which is to ensure that the CCG has appropriate arrangements in place to undertake its functions effectively, efficiently and economically and in accordance with the CCG s principles of good governance. Dr Chris Elliot has been Chief Clinical Officer throughout the year and up to the signing of the annual report and accounts. Dr Brendan Hudson has been the Chair throughout the year and up to the signing of the annual report and accounts. Board meetings are held bi-monthly in public (and from March 2014 audio recordings of meetings are available on the CCG s website Committees of the Board Please see our Governance Statement at Appendix 1. All of the committees above are accountable to the Board and the Board has approved and keeps under review the terms of reference for the committees, which includes information on the membership of the committees. You can find more information about our committees in the Governance Statement (Appendix 1). Profiles of our Board are available as part of or remuneration report. Board elections Please see our Governance Statement at Appendix 1. Annual evaluation of the Board s effectiveness Please see our Governance Statement at Appendix 1. 61

62 Managing our risks Full details of NHS Sutton CCG s approach to risk management can be found in the Accounts and the Annual Governance Statement at Appendix 1. Pension liabilities (obligations) Information on how pension liabilities (obligations) are treated and relevant pension schemes are found in our Governance Statement at Appendix 1. Statement as to disclosure to Auditors Each individual who is a member of Sutton Clinical Commissioning Group (CCG) confirms : so far as the member is aware, that there is no relevant audit information of which the CCG s auditor is unaware that the member has taken all the steps they ought to have taken as a member to make them self aware of any relevant audit information and to extablish that the CCG s auditor is aware of that information. 62

63 REMUNERATION REPORT Remuneration Committee Report The Remuneration Committee comprises of 3 members and has met on two occasions during the past year. Chair of the committee is Paul Sarfaty. A full list of members, their roles and the number of meetings each attended is below. Name of Member Role Date joined committee Date left committee (if applicable) Paul Sarfaty Chair N/A 2 Dr Chris Elliott Chief Clinical N/A 2 Officer Les Ross Secondary Care Consultant N/A 2 No of committee meetings attended In addition to the members listed above, the following CCG employees provided the committee with advice which was material to the committee s deliberations. Name Role Service Jonathan Bates Chief Operating Officer Advice Geoff Price Chief Finance Officer Advice The following persons who are not employees of the CCG also provided advice to the committee. The South London Commissioning Support Unit provides HR advice and support to the CCG in accordance with an agreed Service Level Agreement. This includes advice and support to the Remuneration Committee including agreeing agendas with the Chair of the Committee and preparing and presenting papers at Committee meetings. The advice given to the Remuneration Committee is based on National Guidance and benchmarking information. The HR Business Partner is appointed by the CSU. 1.1 Remuneration Policy The Committee s deliberations are carried out within the context of national pay and remuneration guidelines, local comparability and taking account of independent advice regarding pay structures. Business expenses are reimbursed in accordance with the CCG policy based on national guidelines. There are no benefits in kind. 1.2 Senior Managers Performance Related Pay The CCG does not have a policy of performance related pay for senior managers. 63

64 1.3 Senior Managers Service contracts The CCG s policy concerning senior managers contracts is that they are permanent contracts, with a notice period of 3 months. There have been no termination payments in year nor any awards to current or former members of the Governing Body or other senior manager. Should there be termination of contract liabilities in future, and none are planned, these would be in accordance with national NHS policy. 1.4 Senior Managers Salaries and Allowances 2013/14 ( audited ) All 12 members of the Governing Body are deemed to be individuals with significant financial responsibility during the financial year and are therefore regarded as senior managers. No other CCG senior managers have significant financial responsibility. Name and title Total salary and fees ( bands of 5,000 ) Pension benefit ( bands of 2,500 ) ( and see note below ) Governing Body ( GB ) Members Dr B Hudson Chair Dr C Elliott - Chief Clinical Officer Dr J Cockbain - GP ( as GB member ) 5-10 Dr J Cockbain - GP ( as clinical lead, see below ) Dr DPardhanani GP ( as GB member ) 5-10 Dr D Pardhanani GP ( as clinical lead, see below ) Ms K Selvey - Primary Care Nurse ( as GB 5-10 member ) Ms K Selvey - Primary Care Nurse ( as clinical lead, see below ) Ms M McKenna - Independent Nurse Mr L Ross - Secondary Care Doctor Mr P Sarfaty - Lay Member - Governance & Audit Ms S Brearley - Lay Member - PPI & Quality 5-10 Mr J Bates - Chief Operating Officer Mr G Price - Chief Finance Officer Dr E Friedman Director of Public Health 0 No Governing Body member, or any other senior manager, received any performance related pay or bonus, or taxable benefit. As well as being a Governing Body member, Dr J Cockbain is the CCG s clinical lead for Urgent and Emergency Care; Dr D Pardhanani is the CCG s clinical lead for planned care; and Ms K Selvey is the clinical lead for long term conditions. The pension benefit figure is based on the HMRC method for calculating the increase in the annual pension entitlement for deferred benefit schemes. It is not the same as the cost to the CCG of its contribution in respect of the individual concerned (the employer s contribution). 64

65 Dr E Friedman is an employee of the London Borough of Sutton and receives no remuneration from the CCG. 1.5 Senior Managers Pension Benefits 2013/14 ( audited ) Name and title Real increase in pension at age 60 (bands of 2,500) Real increase in pension lump sum at aged 60 (bands of 2,500) Total accrued pension at age 60 at 31 March 2014 (bands of 5,000) Lump sum at age 60 related to accrued pension at 31 March 2014 (bands of 5,000) Cash Equivalent Transfer Value at 31 March 2013 Cash Equivalent Transfer Value at 31 March 2014 Real increase in Cash Equivalent Transfer Value Employer s contribution to partnership pension Geoff Price Jonathan Bates NHS organisations are required to disclose the pension benefits for those persons disclosed as senior managers of the organisation, where the clinical commissioning group has made a direct contribution to a pension scheme. Due to the nature of clinical commissioning groups, some GPs have served as office holders of NHS Sutton CCG. However, for GPs who work under a contract for services with the CCG, they are not considered to hold a pensionable post and so no pension disclosure is required. From 1 April 2013, NHS England became the employing agency for all types of GPs and pensions contributions have been made by NHS England. Where fees for service have been paid directly to GPs practice, the practice is the employing agency and not the CCG. 1.6 Pay Multiples (audited) Reporting bodies are required to disclose the relationship between the remuneration of the highest paid director in their organisation and the median remuneration of the organisation s workforce. The banded remuneration of the highest paid director in the financial year 2013/14 was 100k-105k. This was 2.73 times the median remuneration of the workforce, which was 35k-40k. 1.7 Off-payroll Engagements Off-payroll engagements during the year were 3 in number and related to individuals where the CCG inherited an existing arrangement. These off-payroll engagements have been subject to confirmation that the individual is paying the right amount of tax and national insurance, and assurance has been sought and received in all cases. 65

66 From 01 April 2014 all remuneration to members of the Governing Body is paid via the CCG payroll or direct to the GP s Practice. This is also the case for GPs who provide services to the CCG as clinical leads. 66

67 Governing Body/Board Members Chair - Dr Brendan Hudson Brendan has been a GP in Sutton for twenty years and has held a wide variety of roles within the NHS including: Chair of Sutton Primary Care Group, Joint Chair of Sutton Consortium and a member of NHS Sutton and Merton Professional Executive Committee. Brendan has also been a local councillor and Mayor of Sutton, giving a unique insight into the potential benefits of integrating health and social care. Chief Clinical Officer - Dr Chris Elliott Chris has been a GP in Sutton for thirty years and has held a large number of positions within the NHS including Chair of the Nelson Commissioning Group, Joint Chair of The Federation and a member of NHS Sutton and Merton Professional Executive Committee. Chris also chairs the Clinical Quality Review Group for Epsom & St. Helier NHS Trust. Chief Operating Officer - Jonathan Bates Jonathan has worked in the NHS for eighteen years holding senior positions in commissioning and provider environments. Jonathan has worked in Sutton for the last six years, prior to this he was the Director of Commissioning for two PCTs in Kent. He holds an MBA from Kingston University. Chief Finance Officer - Geoff Price Geoff has worked in the health care sector for 25 years including 20 years with the NHS. A Chartered Accountant, Geoff has held senior financial positions in a variety of NHS organisations including commissioner and provider environments. GP Member - Dr Dino Pardhanani Dino has been a GP at Mulgrave Road Surgery in Sutton for the last nine years and his main areas of clinical interest are Ear, Nose and Throat (ENT). He has been actively involved in GP commissioning throughout his career and was a Board member of Sutton Consortium as well as QIPP lead for Local Care Centres and Planned Care Service Redesign. GP Member - Dr Jonathan Cockbain Jonathan has been a GP in Carshalton at the Chesser Surgery for the last thirteen years and his main area of clinical interest is urgent care. He has led the work to develop a 5m Urgent Care Centre at St Helier Hospital and is the CCG QIPP lead on urgent care. Jonathan has been involved in GP commissioning for many years, initially as a member of Sutton Primary Care Group Board and more recently as Joint Chair of Sutton Consortium. 67

68 Secondary Care Consultant Mr Leslie Ross Les spent 25 years as a Consultant Obstetrician and Gynaecologist at St Helier Hospital. He has held various management roles such as Clinical Director, Director of Health Informatics, NCEPOD Local Reporter and Consultant Appraisal lead for the Trust. He has worked with Primary Care to implement Choose and Book and with the Primary Care Trust to develop outreach clinics. He has been Chair of the St Anthony's Hospital Medical Advisory Committee for 12 years and is GMC Responsible Officer for St Anthony's Hospital and St Raphael's Hospice. He is the Caldicott Guardian for NHS Sutton CCG. Independent Nurse Mary McKenna Mary spent over 30 years working for the NHS, of which she spent 10 years as a senior operational manager and director of women s services at a London NHS Trust. She has been responsible for organisational change in the structure of maternity / women s services at every level from finance to policy and delivery of integrated care. She was also on the NHS London Maternity Service Improvement Board. She is a nurse and a registered midwife. Mary was awarded a Master s degree in Health Management in 2003 (City University London). Mary was called to the Bar in Director of Public Health, Sutton Dr Ellis Friedman Dr Friedman qualified as a doctor in 1977 and following junior doctor posts in hospital medicine, trained in public health, becoming a Consultant in Dr Friedman, the Director of Public Health (DPH) of Sutton, has 25 years experience as a DPH, with a reputation for achievements across public health and health services at local, regional and national levels. Dr Friedman brings particular expertise in screening, cancer and heart disease prevention and child protection. For many years he was a Regional Director of Cancer Screening Quality Assurance. Dr Friedman is a member of the London Borough of Sutton Health and Wellbeing Board. Primary Care Nurse / Allied Health Professional Member - Karol Selvey Karol has worked as a Nurse Practitioner (and more recently a Nurse Partner) at the Old Court House Surgery in Sutton for the last 21 years. Karol is a published author on practice nursing and is a contributing lecturer on the Practice Nurse course at St George's and Kingston University. Karol leads the CCG Tier 2 diabetes service and teaches on primary care management of diabetes. Karol has co-chaired the local practice nurse forum for many years and has established the Nurse Forum for the CCG. Karol is also the QIPP lead for Long Term Conditions and Community services and has been involved in clinical commissioning for many years initially as a member of Sutton PCG. 68

69 Lay member (Patient & Public Engagement & Quality) - Sally Brearley Sally has been a strong advocate of patients and their carers in Sutton for many years. Sally was the Chief Officer of Sutton Community Health Council and has also held a number of senior positions in Sutton Local Involvement Network (LINk). Sally was also invited by Professor Steve Field to be a member of the Future Forum workstream commissioning by the government in 2011 and therefore has recent policy experience on the drivers for change in the NHS. Lay member (Governance & Audit) - Paul Sarfaty Paul s career in industry included 33 years with Air Products and Chemicals, a Fortune 500 multinational company, where he specialised in financial analysis and control, audit and acquisition integration, with roles of increasing responsibility in the UK, continental Europe and the Far East. 69

70 Register of interests NHS Sutton CCG s latest register of interest is made publicly available at the CCG s Board meetings and can be found on the CCG s website: The Register for 2013/14 is available overleaf. The Board is not aware of any relevant audit information that has been withheld from the clinical commissioning group s external auditors, and members of the Governing Body take all necessary steps to make themselves aware of relevant information and to ensure that this is passed to the external auditors where appropriate. 70

71 Sutton Clinical Commissioning Group Governing Body: Register of Declared Interests 2013/14 (Date of most recent update ) All interests declared as of unless otherwise stated. Details Start date with CCG: unless otherwise stated Dr Brendan Hudson Clinical Chair Dr Chris Elliott Clinical Chief Officer Jonathan Bates Chief Operating Officer Paul Sarfaty Lay Member: Chair of the Audit Committee/ Vice Chair Geoff Price Chief Finance Officer Sally Brearley Lay Member: Patient and Public Engagement Lead Interest Partner and Principal of The Grove Practice, 83 Grove Road, Sutton, SM1 2DB Member of Sutton Horizon Healthcare Limited (ceased in August 2013) Member of Sutton and Merton Local Medical Committee President of Sutton Catanion Circle (until April 2014) Member of British Medical Council, RCGP and Liberal Democrats Wife - Tutor at Carshalton College Occasional Interviews with Sutton Guardian Newspaper Former Councillor for Sutton Council GP Partner Benhill and Belmont GP Practice Sutton Healthcare Services - Director None Feughside Limited Director Air Products & Chemicals Inc. (APD) - Shareholder Consultant for Caldwell and Braham, a firm of Chartered Accountants based in the City of London None Sutton Healthwatch - Member National Nursery Research Unit, Kings College London - Visiting fellow 71

72 Sutton Clinical Commissioning Group Governing Body - Register of Declared Interests 2013/14 (Date of most recent update ) All interests declared as of unless otherwise stated. Mr Les Ross Secondary Care Consultant Member Mary McKenna Independent Nurse Dr Jonathan Cockbain GP Board Member Dr Dino Pardhanani GP Board Member Ellis Friedman Director of Public Health Karol Selvey Primary Care Nurse Board Member Chair of Medical Advisory Committee St Anthony's Hospital, Cheam GMC Responsible Officer for St Anthony's Hospital Son employed by Sutton Council Barrister at Holborn Chambers Shareholder Sutton Horizon Healthcare Ltd. (due to close August 2013) GP Partner Chesser GP Practice GP Partner Mulgrave Road Director of London - Aesthetica Ltd Owner of London Aesthetica Ltd Director of Sutton Horizon Healthcare Limited (ceased in August 2013) None Nurse Practitioner/Partner at The Old Court House - Dr Grice & Partners 72

73 FINANCIAL REVIEW Introduction The CCG commissions and provides healthcare services to meet the needs and improve the health of the population of London Borough of Sutton. The main NHS providers are Epsom & St Helier University Hospitals NHS Trust, St George s Healthcare NHS Trust, South West London and St Georges Mental Health Trust, and The Royal Marsden NHS Foundation Trust (for community services). The CCG faced significant financial challenges in financial year 2013/14 as it inherited an underlying deficit and is below target resource allocation. However, the CCG ended the year meeting its financial target of a 2.1 million surplus or 1% of resource limit but this was after securing additional resource of 1.5m from the SW London CCG s risk pool and utilising reserves. The main driver for this position was the 2013/14 acute contract overspending of some 5 million, although there was also a prescribing overspend. This results in the CCG having an underlying recurrent deficit of around 1.6m going forward into 2014/15. A significant contributory factor is the fact that the CCG is around 10% below its target resource limit in 2013/14, a position that is being largely remedied by the 'pace of change (POC) policy over the next 5 years. Going forward the CCG has a 5 year long term financial plan for the period 2014/15 to 2018/19. This includes known allocations for the first two years and estimates for the following three years. These include the welcome increase in allocations that address historic underfunding. Financial year 2014/15 will be challenging as the CCG addresses the underlying deficit and funds certain unavoidable acute services pressures and investments in community services. However, the CCG intends to establish a firm financial footing in 2014/15 so that moving forward it can meet the challenges of Everyone Counts and commission high quality services for its population whilst maintaining financial sustainability. 2013/14 Financial Performance The CCG achieved its target of a 1% surplus. The following section outlines achievement against its other financial targets: The CCG had an underspending of 119K against its 4,500K running cost allocation. The CCG had drawn its entire cash limit for the year and had 71K remaining in its bank account. The CCG did not require any capital funding in 2013/14. Compliance with the Better Payment Practice code ( BPPC ) shows that 87%of non-nhs invoices by number and value met the BPPC against the target of 95%. The CCG plans to meet the target in 2014/15. 73

74 CCG Running Costs The CCG s running costs in were 4,381K. This has been calculated in accordance with the Department of Health's definition of running costs. As well as the cost of the CCG s management team, this total includes central functions and the South London Commissioning Support Unit charge for commissioning support functions. The running cost allocation was 4,500k. Of the 119k underspend, 87k was transferred to support health care ( program ) costs. CCGs are permitted to supplement their program allocation from the running cost allocation but not the other way around. Annual Accounts The full annual accounts together with the Statement of Accountable Officer s Responsibilities and Independent Auditors Report are included at Appendix 3. Signed on behalf of the Board Chris Elliott Accountable Officer Geoff Price Chief Finance Officer 04 June June

75 Appendix 1 Governance Statement Introduction and Context The clinical commissioning group was licensed from 1 April 2013 under provisions enacted in the Health & Social Care Act 2012, which amended the NHS Act The clinical commissioning group operated in shadow form prior to 1 April 2013, to allow for the completion of the licensing process and the establishment of function, systems and processes prior to the clinical commission group taking on its full powers. As at 1 April 2013, the clinical commissioning group was authorised with just three conditions; one around accountability for patient safety and two around safeguarding arrangements and systems. On receipt of further evidence and assurance on these matters, the NHSE removed these conditions in May 2013 so that the CCG was fully authorised with no conditions. 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 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. Compliance with the Corporate Governance Code We are not required to comply with the UK Corporate Governance Code. 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 the CCG and best practice The Clinical Commissioning Group Governance Framework 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 governance as are relevant to it. 75

76 Sutton Clinical Commissioning Group s constitution sets out the principles and methods that the clinical commissioning group will adhere to in delivering its role and functions. It describes how the Governing Body will operate, confirms matters reserved for Board decision, and other areas where certain powers of the Board will be delegated within the organisation. It sets out its key processes for decision-making, including arrangements for securing transparency in the decision-making of the CCG and its governing body; and the arrangements for discharging its duties with regard to registers of interest and managing conflicts of interest. The clinical commissioning group intends to review these arrangements each year to ensure they remain fit for purpose, enabling the organisation to do everything within its power to support the commissioning of excellent NHS services for Sutton residents. Committee Structure SCCG Membership SCCG Governing Body Quality Executive Audit Finance Remuneration Nominations Governing Body In its first year of operation, the Governing Body s main priority has been to govern effectively and in doing so build patient, public and stakeholder confidence that healthcare services commissioned by Sutton CCG are in safe hands. This has been achieved by working with the public and stakeholders to build confidence in the following areas: Quality and safety of health services Investment of resources that deliver the best possible health outcomes for patients in Sutton Accessible and responsive health services Grassroots opportunities to shape health services to meet local needs Allocation of resources in a way that is fair, efficient, effective and economic Quality Committee The Quality Committee has met monthly throughout the year, with the remit of providing assurance to the Governing Body that commissioned services are being 76

77 delivered in a high quality and safe manner. The Quality Committee has been vital in ensuring that quality sits at the heart of everything the clinical commissioning group does which is reflected in the audit of Quality Governance undertaken as part of the approved internal audit plan for 2013/14. Audit Committee The Audit Committee is established in accordance with NHS Sutton Clinical Commissioning Group s (SCCG) Constitution. The terms of reference set out the membership, remit, responsibilities and reporting arrangements of the Committee. Members of the Committee are appointed by the Board. The Committee comprises three non executive members of the Governing Body. The Lay Member, Governance and Audit, is Chair of the Audit Committee. The Chairman of the CCG is not a member of the Committee. Current Members are: Paul Sarfaty (Chair), Mary McKenna ( Independent Nurse ), Dr Dino Pardhanani ( GP ) The following individuals / organisations usually attend meetings: The Chief Financial Officer The Chief Clinical Officer ( Accountable Officer ) Internal and External Audit representatives Local counter fraud and security management (NHS Protect) representatives South London Commissioning Support Unit finance representative The Audit Committee has met quarterly during the year and has reviewed the establishment and maintenance of an effective system of governance, risk management and internal control. This has covered the whole of the organisations activities and has supported the achievement of the organisations objectives through close supervision of the Board Assurance Framework. Finance Committee The CCG Finance Committee meets monthly and reviews in detail in year financial performance; reviews the long term financial plan and makes recommendation to the Governing Body; and receives reports from the Charitable Funds Committee ( see below ). The Committee comprises three non executive members of the Governing Body. Current Members are: Dr Brendan Hudson ( Chair ), Paul Sarfaty ( Lay member governance and audit ), and Les Ross ( Secondary care consultant ). The following individuals usually attend meetings: 77

78 The Chief Financial Officer The Chief Operating Officer Remuneration and Nominations Committee During 2013/14, the Remuneration Committee s primary aim has been oversight of remuneration and terms of service for the Governing Body, Chief Operating Officer and Directors. Charitable Funds Committee On 1 st April 2013, the management of the Sutton and Merton Primary Care Trust Charitable Funds was transferred to Sutton Clinical Commissioning Group and the Governing Body acts as Corporate Trustee for the Sutton and Merton CCGs Charitable Funds. The Governing Body has delegated the day to day management of the funds to a Charitable Funds Committee with lay member representation from Sutton and Merton CCGs. This Committee currently reports to the Sutton CCG Finance Committee. During 2013/14, this committee has overseen the management, administration and accounting arrangements for these Charitable Funds. 78

79 Committee membership and attendance Present Apols GOVERNING BODY MEETING ATTENDANCE 2013/14 GB = Full meeting S = Seminar SUTTON Apr GB May GB Jun GB Jul GB Aug No Meeting Sep GB Oct No Meeting Nov GB Dec S Jan GB Feb GB/S Mar Jonathan Bates Sally Brearley Dr Jonathan Cockbain Dr Ellis Friedman Dr Chris Elliott Dr Brendan Hudson Ms Mary McKenna Dr Dino Pardhanani Geoff Price Mr Les Ross Paul Sarfaty Karol Selvey AUDIT COMMITTEE MEETING ATTENDANCE 2013/14 Meetings Quarterly SUTTON May Aug Nov Feb Dr Chris Elliott Ms Mary McKenna Dr Dino Pardhanani Paul Sarfaty CHARITABLE FUNDS COMMITTEE MEETING ATTENDANCE 2013/14 Formed December 2013 SUTTON Dec Feb Mar Sally Brearley 79

80 Paul Sarfaty QUALITY COMMITTEE ATTENDANCE 2013/14 Meetings Monthly SUTTON Apr May Jul Jul Aug No mtg Sep Oct Nov Dec Jan Feb Mar tbc Sally Brearley Dr Chris Elliott Jonathan Bates Mary McKenna Hilary Smith Geoff Price Simon Elliott Mary Hopper Karol Selvey Jonathan Cockbain Les Ross Dr Ellis Friedman Adrian Davy NOMINATIONS COMMITTEE MEETING ATTENDANCE 2013/14 Meetings Bi-annually SUTTON Dec Mar Dr Brendan Hudson Les Ross Paul Sarfaty REMUNERATION COMMITTEE MEETING ATTENDANCE 2013/14 Meetings Bi-annually SUTTON Apr Dec Dr Chris Elliott Les Ross Paul Sarfaty 80

81 EXECUTIVE COMMITTEE MEETING ATTENDANCE 2013/14 Meetings Monthly SUTTON Apr 17 May 29 Jun 19 Jul 24 Aug No mtg Sep 18 Oct 9 Nov 13 Dec 11 Jan 15 Feb 26 Mar 12 Dr Chris Elliott Jonathan Bates Geoff Price Dr Ash Mirza Dr Jeff Croucher Dr Farhan Rabbani Dr Mark Wells Dr Jonathan Cockbain Karol Selvey Dr Chris Kears Dr Dino Pardhanani Dr Simon Elliott EXECUTIVE/QIPP COMMITTEE MEETING ATTENDANCE 2013/14 Meetings Monthly SUTTON Apr 24 May 22 Jun 26 Jul 31 Aug 28 Sep 25 Oct 30 Nov 27 Dec 18 Jan 29 Feb 12 Mar 26 TBC Dr Chris Elliott Jonathan Bates Geoff Price Dr Ash Mirza 81

82 Dr Jeff Croucher Dr Farhan Rabbani Dr Mark Wells Dr Jonathan Cockbain Karol Selvey Dr Chris Kears Dr Dino Pardhanani Dr Simon Elliott 82

83 Assessment of effectiveness During the early part of 2014, Foresight Partnership, who supported thee CCG through authorisation, was commissioned to conduct a Governing Body Health Review. Their report, presented and discussed by the Governing Body at a seminar inn April 2014, summarised the feedback on the t Governing Body s overall performancp ce and effectiveness, from Governing Body members, member practices and internal and external stakeholders. The report included an overview of the results, and a summary of areass of strength and areas for development. It then provided results for each question showing overall respondent averages as well as comments where offered. At the Governing Body seminar, members discussed the findings of thee in-depth interviews, GB observation and online survey. As a group, key emerging themes from the Governing Body Health review were discussed and in the light of thesee themes, ideas were shared to shape a Governing Bodyy development plan which w aimss to move Sutton CCG from good to excellent over the next 6-12 months. The Clinical Commissioning Group Risk Management Framework Sutton CCG has developed a comprehensive risk management framework whichh is in principle designed to identify specific risks, responsibilities and mitigating actions at both a 83