NHS Castle Point and Rochford Clinical Commissioning Group

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1 Appendix 1 NHS Castle Point and Rochford Clinical Commissioning Group ANNUAL REPORT AND ACCOUNTS V15 20/05/2014 Date of changes Summary of changes Responsible officer 24/04/14 - Updated foreword (drafted by KMc, approved by SG) -Profiles added PHJ 15/05/14 Reformatted and amended KMK 20/05/14 Sustainability report added. Watermarked as draft, page nos updated, reformatting. PJ/AWK 1

2 Contents Member Practices Introduction Foreword Section 1 Strategic Report Page About Us 5 Our Principles and values/mission statement 12 Our Place in the NHS 14 Our Achievements, Key Issues and Challenges 19 Our Performance 20 Improving Care 25 Ensuring Safe and High Quality Services 26 Ensuring Best Value 29 Involving and Listening to our patients 32 Working in Partnership for Better Health 33 Financial Overview 2013/14 36 Sustainability Report 38 Equality Report 32 Section 2 Members Report Our Governing Body 40 Compliments, Complaints and Concerns 45 Freedom of Information Requests 45 Our Staff 46 Statement as to Disclosure to Auditors 49 Disclosure of Serious Untoward Incidents 49 Planning for Emergencies 52 Section 3 Remuneration Report 50 Section 4 Statements by the Accountable Officer Statement of Accountable Officers Responsibilities 61 Governance Statement Section 4 Independent Auditor s Report to the Accountable Officer 77 Section 5 Glossaries of Terms 78 Section 6 Appendices Annex A Financial Statements 82 Annex B Sustainability Report 164 Annex C- Equality Report 167 2

3 MEMBER PRACTICES INTRODUCTION (Approved by CAO approval from LCGs pre FINAL report) The GP member practices in Castle Point and Rochford have had a challenging year in the last 12 months and there has been a steep learning curve for everyone. There is a very positive commitment of both NHS Castle Point and Rochford Clinical Commissioning Group (CCG) staff and Member Practices to work together to improve the healthcare for the people living in the area. There are some notable successes where GPs have worked with the CCG to make lasting improvements to the services for our residents. The development of the Community Contestability Programme, the expansion of the Single Point of Referral (SPOR) and the work around Southend University Hospital NHS Foundation Trust s Day Assessment Unit are just some instances where the CCG "fits" in the system as a valuable meeting point between the community we serve and the needs of our partner organisations such as our main local hospital. There are areas where the CCG needs to improve, not least in the way they engage with Member Practices, how they develop our relationship and how we tackle the challenges that we face going forward, but the fact that there are actions already looking at these shows that the foundations have been laid for a good working relationship. The Governing Body of the CCG has become something of a focal point for the organisation. Members are unafraid to give their opinion, often passionately and without reserve, however, opinion is always given freely and constructively, it s done with the best interests of patients at heart. This needs to continue and develop as we look at the next 12 months and the challenges we face, most significantly financial, but also in the way we work with our partners on projects such as the evolving Better Care Fund project. We start the new financial year in good stead with our two year Operational Plan in place, a five year strategic plan well under way as well as a more sound footing in terms of our own finances. Over the coming 12 months we would like to see the CCG funding some small scale pilot projects using the innovative ideas of GP practices on how to bring some care closer to patient's homes." Approved on behalf of the membership: Mike Saad Chair, Rayleigh and Rochford Locality Sunil Gupta Chair, Castle Point Locality 3

4 FOREWORD Welcome to the Annual Report for 2013/14 for NHS Castle Point and Rochford Clinical Commissioning Group (CCG). The CCG assumed legal responsibility for commissioning services in April 2013 having existed in shadow form for some months before then. At the heart of our new organisation is GP engagement and leadership in our commissioning processes and decision making alongside robust arrangements for patient and public involvement. We have faced some significant challenges in our first year as a CCG as we have aimed to improve the quality of care provided to patients in a difficult financial environment. However, we have an excellent team and we are working hard to improve clinical outcomes for the people of Castle Point and Rochford. We have successfully commissioned one of the best NHS 111 services in England; received formal recognition for our Governing Body arrangements and received praise for our excellent patient and public involvement by Essex Healthwatch. We have also commissioned intermediate community based dermatology services; undertaken a comprehensive contestability process for community services and strengthened the Single Point of Referral (health and social care) model for referring GPs. There have also being key performance areas where we have been working hard to improve. The standard that sees 95% of patients seen within four hours at the Accident and Emergency (A&E) Department in Southend Hospital was not achieved in 2013/14. We have been working with partners to try to address this with robust action plan for improvement now in place. The CCG overspent its financial allocation in 2013/14 by 0.2% ( 400,000 overspend out of a total budget of about 200million). To design successful new ways of delivering health care requires working in close partnerships, whether it s with local authorities, local providers or our patients, and we have being doing extensive work to involve the community as part of our decision-making process and we would like to thank all of those who have been involved. Not only do the majority of our member practices have well-established Patient Participation Groups, but we also have a proactive Commissioning Reference Group (our Patient/Public Engagement forum) which is integral to the commissioning and decision making of the CCG. If you would like to be part of these conversations and help shape our future, then please do not hesitate to get in touch and let us know we are always looking for more opinions as we strive to provide the best quality of health care in the area over the next few years. The NHS is facing a great challenge of improving the quality of care and outcomes provided to patients in an environment of flat cash. Our vision is to enable the people of Castle Point and Rochford to live longer, healthier and happier lives by commissioning high quality, cost- 4

5 effective, safe, caring and compassionate services in partnership with our fellow health and social care commissioners. We plan to help patients and the public have greater control and responsibilities for maintaining and improving their own health. We will support GPs to work more closely together and with community services to better manage long term conditions, support the frail elderly and reduce A&E attendances and admissions into hospitals and nursing homes. We will also work with other organisations in Essex to help the hospitals in the county to work more closely together to provide centres of excellence. We welcome your comments, ideas and suggestions on how we can all jointly help to achieve these aims. Best wishes, Dr Sunil Gupta, Clinical Accountable Officer Dr Mike Saad Chair 5

6 STRATEGIC REPORT We are required to present a strategic report in the context of the Annual Report, which provides the reader with a balanced and comprehensive analysis of the CCG s performance during the year. In accordance with NHS guidelines, this report covers the period from 1 April 2013 to 31 March 2014 and includes an overview of our achievements, details of the CCG s non-financial performance and the financial statements. The accounts have been prepared under a Direction issued by the NHS Commissioning Board under the National Health Service Act As a CCG, we have many statutory duties including: improving quality of services, reducing inequalities, public involvement and consultation, and contributing to joint health and wellbeing strategies. You can read more about how we have complied with these duties in this overview. We certify that the clinical commissioning group has complied with the statutory duties laid down in the NHS Act 2006 (as amended by the Health & Social Care Act 2012), with the exception of delivering financial balance. Dr Sunil Gupta Clinical Accountable Officer 6

7 ABOUT US NHS Castle Point and Rochford CCG was formally established on 1 April It brings together all 28 General Practitioner (GP) practices in the area and is responsible for buying the following services for over 177,000 people in Castle Point and Rochford: elective (planned) hospital care rehabilitation care urgent and emergency care most community health services mental health and learning disabilities As your local NHS we were allocated a budget every year for our local population. We used this to plan, develop and commission (buy) healthcare services on your behalf. We are responsible for the healthcare needs of the local population and work with local healthcare professionals, local authorities, voluntary organisations and others to make sure local people have high quality health services that meet their needs. We have a duty to involve and listen to patients and our local communities when making decisions about local health services. The borough of Castle Point and the district of Rochford have certain strategic services such as social services, highways and education provided by Essex County Council. Therefore, NHS Castle Point and Rochford CCG is charged with working in partnership with both of these authorities, to ensure that inequalities in health and social care provision are avoided. We are led by our Governing Body, which is principally formed of clinical representatives of our two locality groups; more detail on our Governing Body is available at Our Governing Body sets out strategy and direction, as well as ensures that the CCG is delivering its statutory duties and ambitions for the health and care of everyone who live in Castle Point and Rochford. Population Statistics Castle Point and Rochford has a registered GP population of approximately 177,000 and covers the district of Rochford and the borough of Castle Point. 15.9% of Castle Point and Rochford CCG registered population are under age 15 (England average 17.1%) and 9.3% are age 75 or over (England average 7.5%). 50.6% are female (England average 50.2%). The CCG's registered patients live in a single upper tier Local Authorities which is Essex County Council. For the CCG's main local authority, the CCG accounts for 12% of its population. Based on the average level of deprivation (measured by the IMD2010) in the LSOAs where this CCG's population live, this CCG is ranked 180 out of 212 CCGs (where 1 is the most 7

8 deprived). 3% of the CCG's population lives in an LSOA that is one of the 20% most deprived in England. This CCG's main provider is Southend University Hospital NHS FT and accounts for 46,077 (83%) of its overall admissions. These represent 43% of that provider's total admissions. Our establishment NHS Castle Point and Rochford CCG was established in shadow form on 1 April 2012, as a sub-committee of the former South East Essex Primary Care Trust. In order to become formally established, we were subject to an authorisation process during 2012/13. The authorisation process involved rigorous reviews of our governance systems, procedures and policies. Our authorisation was granted in March 2013 with only 13 conditions remaining against a range of 119 key lines of enquiry (KLOES). We were formally established on 1 April We put plans into action to address the remaining 13 conditions and in May 2013 these had been reduced to 4. Headquarters Phoenix Place, Christopher Martin Road, Basildon Essex SS14 4HG Communities covered The area has one top tier local authority (a county council) along with two borough councils: Essex County Council o Castle Point Borough Council o Rochford District Council The borough of Castle Point and the district of Rochford have certain strategic services such as social services, highways and education provided by Essex County Council. Population (registered GP) We serve a GP-registered population of approximately 177,000. Budget (for 2013/14) Total Budget as of Month ,478,000 Number of GP practices 28 Number of employees 24 Main provider of acute hospital services Southend University Hospital NHS Foundation Trust Community services provider South Essex Partnership University NHS Foundation Trust Mental health and learning disabilities provider South Essex Partnership University NHS Foundation Trust Main private hospitals providing NHS services: Spire Healthcare BMI Hospital (formerly Phoenix) Nuffield Healthcare Provider of commissioning support services NHS Central Eastern Commissioning Support Unit (CSU) Southend Clinical Commissioning Group 8

9 Where we buy your healthcare The following table gives a summary of where we commissioned services in 2013/14: Type of healthcare Community services: This includes, district nursing, health visiting, speech and language therapy, podiatry, school nursing. Hospital services: This includes outpatient clinics, operations and emergency care. Mental health services: This includes psychological therapies, community mental health teams, learning disability services. Specialist health services: This includes treatment for specialist cardiac, renal, children s, neurosciences, cancer, genetics and many more. Emergency health services and transport. Where we buy it from on your behalf South Essex Partnership University NHS Foundation Trust Southend University Hospital NHS Foundation Trust South Essex Partnership University NHS Foundation Trust Partnership arrangements with voluntary organisations NHS England Specialised Commissioning commissions these services on our behalf from specialist centres such as: Basildon and Thurrock University Hospital NHS Foundation Trust Great Ormond Street Hospital NHS Trust The Royal Marsden NHS Foundation Trust Barts & the London NHS Trust East of England Ambulance Service NHS Trust. Primary care services (GPs, dentists, opticians and pharmacies) It is important to note, that CCGs are not responsible for the commissioning of primary care services (previously commissioned by Primary Care Trusts [PCTs]). This responsibility rests with NHS England. Services commissioned by lead CCGs Some services are commissioned by one Clinical Commissioning Group, as the lead (host) commissioner, on behalf of other local CCG. The following are the lead contracts we host/lead on behalf of other Clinical Commissioning Groups who are associates to this contract: Mental Health, CAMHS and Community Services commissioned from South Essex Partnership NHS Foundation Trust; NHS 111 and GP-led Out of Hours Services commissioned from IC24 (Integrated Care 24); Palliative Care Services commissioned from Havens Hospice and Marie Curie; Mental Health Day Service Provision commissioned from South East MIND; Mental Health Employment Specialists, Recovery Point & Good Companions commissioned from Rethink; 9

10 Mental Health Residential Services commissioned from Estuary and MCCH We are associates to many other contracts including: Southend University Hospital NHS Foundation Trust Basildon and Thurrock University Hospitals NHS Foundation Trust North East London NHS Foundation Trust Spire Nuffield East of England Ambulance Service NHS Trust How your money was spent The 2013/14 financial year was a particularly challenging one, and whilst we achieved our statutory duty of remaining within our maximum cash drawdown, we returned a small deficit against our Revenue Resource Limit ( 0.4m) and thus failed to meet this statutory requirement. It is worthy of note though, that this amounts to only 0.2% of the CCG s overall revenue resource ( 203,478k). Whilst the CCG embarked upon a financial recovery action plan midyear, regrettably, we did spend above our plan in the most unpredictable and demanding areas, such as acute activity and in continuing care. 10

11 Note that the CCG did not receive a Capital Resource limit in 2013/14. For full details of annual accounts, see Appendix A. 11

12 Our principles and values / mission statement Our vision is to enable the people of Castle Point and Rochford localities to live longer, healthier and with improved quality of life through commissioning high quality health related services sensitive to local needs, putting the patient and family at the centre of their care. Our key priorities There are 10 high level priorities for the CCG: 1. Managing Elective Activity Referral Quality 2. Effective Medicines Management 3. Managing Emergency Activity Urgent Care 4. Active Support for Self-management for long term conditions 5. Managing Ambulatory Care Sensitive Conditions inc. CHF, diabetes, asthma, COPD 6. Improving the management of patients with both mental and physical health needs 7. Care co-ordination through integrated health and social care teams 8. Improving primary care management of End-of-Life Care 9. Primary Prevention 10. Secondary Prevention Looking Forward to 2014/15 The CCG has identified our key objectives for 2014/15 as set out in NHS Castle Point and Rochford Clinical Commissioning Group s Strategic Plan and Operation Plans for this period. The following diagram sets out these priorities and the enablers that that will be utilised to support delivery of each objective. 12

13 Support Strategic Plan Objectives Vision Purpose Improve the health and well-being of the Castle Point & Rochford population Transforming the care of the vulnerable elderly 1. Effective individual LTC, improving outcomes and reducing health inequalities Home, not hospital 2. Improve patient experience for both physical and mental health services Key Transformational Changes Personalised & Preventive Care 3. Drive forward transformation of specialist services, supporting centres of expertise Delivering Care outside the Hospital 4. Improve patient safety to reduce harm and increase patient confidence Planned surgical care: driving higher volume through fewer centres 5. Shifting 5% of resources from secondary to primary and community services Focus on Children and Young People 6. Integrating Health Social Care through partnership working Investment Quality in Primary Care 7. Strengthened collaborative commissioning and contracting Savings by 2018/19 Vulnerable Elderly - Commission integrated health and social care management hubs in both CCG localities to improve care for the vulnerable eldery. 1.1m Vulnerable Elderly - Developing and implementing community and acute frailty pathways including intermediate care beds and a full review of ambulatory emergency care. Home not Hospital - Treating patients in the comfort of their homes, and tailoring care to individual patient s needs through telemedicine and remote consultations Delivering care Out of Hospital: Develop and deliver Joint Activity Reduction Plan in partnership with Southend CCG and SUHFT to reduce acute based activity, focus on MSK, ophthalmology, paediatric reductions 4.3m Personalised & Preventive Care - Co-production and self-management, facilitated by technology, will be at the heart of this new model, enabling the home to safely be the location for higher acuity health care Higher Volume/Fewer Centres: Support the review of Essex acute hospitals and implement recommendations for sub-specialisation Childrens & Young People Services We will work with partners to re-commission Children Adolescent and Mental Health Services on an Essex wide basis Primary Care: CCG will invest in a programme of targeted primary care development to support the delivery of the Strategy and the associated goals to reduce the variability of primary care quality and outcomes so that patients across the localities receive the same high standard of care Enabled by Robust Contract Management Innovation Groups Research & Development Governed by ECC, CPR CCG & B&B CCG system leadership group Business Management Group of the H&W Board System wide Urgent Care Group Measured by Delivery of objectives All organisations report a financial surplus in 18/19 No provider under enhanced regulatory scrutiny due to performance concerns Values and Principles No-one tries harder for patients and the community Best outcomes for every pound invested Cohesive working to build tolerance, understanding and co-operation

14 Our place in the NHS: Background and national context NHS Reform The Health and Social Care Act (March 2012) made many major changes to the way the NHS is managed. The key areas of the Act are that it: Establishes an independent NHS Board to allocate resources and provide commissioning guidance Increases GPs powers to commission services on behalf of their patients (through Clinical Commissioning Groups) Strengthens the role of the Care Quality Commission Develops Monitor, the body that currently regulates NHS foundation trusts, into an economic regulator to oversee aspects of access and competition in the NHS Cuts the number of health bodies to help meet the Government's commitment to cut NHS administration costs by a third, including abolishing Primary Care Trusts and Strategic Health Authorities. Source: This means that, with effect from 1 April 2013, PCTs and Strategic Health Authorities were abolished and new organisations were formally established including: CCGs (Clinical Commissioning Groups), CSUs (Commissioning Support Units) and NHS England. Additional duties have been placed on local authorities, including joined up commissioning of local NHS services, social care and public health. Commissioning Support Units (CSUs) Commissioning Support Units (CSUs) were formally established on 1 April CSUs provide capacity and resources to clinical commissioners as an extension of their local team to ensure that commissioning decisions are informed and processes structured. This approach will help achieve economies of scale and allow CCGs to focus on direct commissioning of services for their patients. CSUs are not statutory bodies and therefore have no statutory functions. They are accountable to clinical commissioners. To help us to fulfil our duties as a CCG, we buy a range of commissioning support services from NHS Central Eastern CSU. These services include: 14

15 For further information about NHS Central Eastern CSU visit: In addition, the CCG receive services from Southend CCG under a shared service arrangement. These services and their associated costs are detailed below; Service Line TOTAL Quality 137,680 Medicines Management 224,605 Safeguarding Total Price payable 453,076 NHS England NHS England (NHSE) was formally established from 1st April NHSE is a national organisation whose role is to commission high quality primary care services, support and develop CCGs as well as assessing and assuring performance, direct commissioning (including specialised services), managing and cultivating local partnerships and stakeholder relationships including representation on Health and Wellbeing Boards. More information is available at 15

16 NHS Property Services Ltd NHS Property Services Ltd was established on 1st April Its role is to manage and develop around 3,600 NHS facilities nationally, from GP practices to administrative buildings. For more information visit: Public Health England Public Health England (PHE) which was established on 1 April 2013 as the authoritative national voice and expert service provider for national health. PHE's mission is to protect and improve the nation's health and wellbeing and to reduce health inequalities. It is an agency of the Department of Health and operationally independent from the department. Public Health moving to Local Authorities From 1st April 2013, the public health function formally transferred from PCTs to Local Authorities. Health and Wellbeing Boards A key part of the Government s Health and Social Care Act (2012) is the establishment of a statutory Health and Wellbeing Board in every upper tier authority. These Boards offer the opportunity for system-wide leadership to improve both health outcomes and health and care services. In particular, they have a duty to promote integrated working, and drive improvements in health and wellbeing by promoting joint commissioning and integrated delivery. Health and Wellbeing Boards (established on 1 April 2013) are responsible for: Leading on the production of the Joint Strategic Needs Assessment (JSNA) - an assessment of local health and wellbeing needs across healthcare, social care and public health. Producing a Joint Health and Wellbeing Strategy in response to the JSNA, which provides a strategic framework for local commissioning plans. The Boards bring together locally elected councillors with key commissioners, including representatives of CCGs, directors of public health, children s services and adult social services and a representative of local Healthwatch (the new patients representative body see below). Residents can attend Essex Health and Wellbeing meetings, the dates of which are available on the website Minutes of previous meetings are also available here. Alternatively, you can get dates and times of upcoming meetings, and find out more about the Board by ing health.andwellbeing@essex.gov.uk 16

17 Healthwatch Healthwatch Essex is a new independent voice for the people of Essex, helping to shape and improve health and social care. Launched in 2013, its aim is to collect and articulate people s lived experience of health and social care to positively influence how services are designed and delivered putting patients at the heart of their own care. It also has powers in law to hold services to account. Healthwatch Essex works in partnership with NHS and social care authorities, the many voluntary groups across Essex and directly with the public, to collect people s voice, but also to raise the profile of good patient engagement and involvement. Volunteers play a central role and are recruited and trained to collect people s stories and represent their voice. Through their Voice Network, Healthwatch Essex can build on the expertise and experience of voluntary organisations who can share the views and needs of their members and beneficiaries. Already in its first year, over 700 people have become members of Healthwatch Essex and are speaking out about their experiences. To find out more or to get involved, go to or ring NHS Constitution The NHS Constitution became law in November It enshrines the original principle of the NHS when it was founded over 60 years ago the NHS belongs to the people and the Constitution sets out rights and responsibilities for staff and for patients and the public. For more information, visit As a CCG, we are responsible for upholding and reinforcing the requirements of the NHS Constitution. We do this by: Monitoring compliance against the performance standards set out in the NHS Constitution and working with providers to develop recovery plans to improve performance where necessary. Reviewing patient feedback and complaints and ensuring that lessons learned from incidents are appropriately cascaded to prevent a reoccurrence. Encouraging patient engagement and feedback through a variety of different forums, including our Commissioning Reference Group. Supporting staff to comply with the NHS Constitution through implementation of the Essex Workforce Strategy and CCG training, research and education plans. To ensure that NHS Castle Point and Rochford CCG is compliant with the NHS Constitution, we nominated our Accountable Officer, Dr Sunil Gupta, as Constitution Champion. Meanwhile, the executive summary for all NHS Castle Point and Rochford CCG Governing Body papers made reference to which aspects of the NHS Constitution were covered by that paper, which ensured that the NHS Constitution was referred to in our mainstream business. Examples of the NHS Constitution operating in this area include: 17

18 Over 10% of patients accessing Improving Access to Psychological Therapies (IAPT) services. A choice of providers continued to be offered across south Essex. Targets relating to ensuring that patients are not asked to share sleeping or bathroom facilities with members of the opposite sex, except on the rare occasions where you need very specialised or urgent care are being achieved locally. The CCG continued to meet statutory deadlines to respond to complaints. 18

19 OUR ACHIEVEMENTS, KEY ISSUES AND CHALLENGES From the 1 April 2013 to the 31 March 2014 NHS Castle Point and Rochford CCG has successfully delivered the following key objectives: Successful roll out of NHS 111 across south Essex. Commissioning of community based intermediate care dermatology service. Successful undertaking of community contestability process. 0 MRSA bacteraemias. 11.5% of patients requiring access to psychological therapies were treated. Achievement of the NHS Constitution s cancer standards (acknowledging the challenges remain). Accredited as an information safe haven and compliance against level two information governance toolkit. Progressing implementation of Dementia QIPP scheme and enhancing dementia services project with local authorities. 10% reduction in unplanned hospitalisation for bronchiolitis, gastroenteritis, asthma, febrile illness and head injury in under 19s Key challenges continue to be: Maintenance of the commissioning processes Addressing poor performance against ambulance standards Working with all partners to ensure safe provision of care Ensure clear understanding and interpretation of data, to ensure the correct decision are made Maintaining current momentum in IAPT services to meet increased performance targets in 2014/15. Managing our commissioning support services and anticipated transition of services during 2014/15. Managing other organisations expectations Driving forward whole economy programmes to reduce HCAI Maintain delivery of the HCAI QIPP plan and associated IPC work 19

20 OUR PERFORMANCE Performance against national targets The NHS Operating Framework for 2013/14 sets out the indicators and milestones noted below, which all health trusts must have regard to when planning healthcare services. They are used to assess how CCGs are delivering against key healthcare objectives set by the Department of Health for that period. In 2013/14 NHS Castle Point and Rochford CCG has been able to demonstrate strong progress and achievements in these areas, although there were also some targets that posed significant challenges and where further work is needed to achieve the expected levels of performance. The local progress that we are making benefits in many ways from the contributions of our partners, including NHS provider trusts and local authorities. We are continuing to build on the strong partnership working that has been achieved. Key areas for further improvement Although performance has improved in referral to treatment and cancer waiting times there remain key elements that require further improvement and action plans have been developed with our providers. These include: Recovery plans in place to deliver 15% IAPT target by March

21 Review of urgent care services to improve performance against the 4 hour waiting times measure Review of ambulance services to be undertaken to improve performance across the East of England Ensure continue to meet Cancer Waiting Times standards Description of Measure Indicator Construction Target/Plan 2013/14 Performance 2013/14 Cancer waits - % of patients seen within two weeks of an urgent GP referral for suspected cancer Denominator: All patients urgently referred with suspected cancer by their GP (GMP or GDP) who were first seen within a period Numerator: Patients urgently referred with suspected cancer by their GP (GMP or GDP) who were first seen within 14 calendar days within a period 93% 95.25% YTD@Feb 14 Cancer Waits - % of patients seen within two weeks of an urgent referral for breast symptoms where cancer is not initially suspected Denominator: All patients urgently referred for evaluation/investigation of breast symptoms by a primary or secondary care professional within a period, excluding those referred urgently for suspected breast cancer who were first seen within the period. Numerator: Patients urgently referred for evaluation/investigation of breast symptoms by a primary or secondary care professional during a period (excluding those referred urgently for suspected breast cancer) who were first seen within 14 calendar days during the period. 93% 96.95% YTD@Feb 14 Cancer Waits - % of patients receiving first definitive treatment within one month of cancer diagnosis Cancer Waits 31 days standard for subsequent cancer treatment Surgery Cancer waits 31 day standard for subsequent treatment anti cancer drug regimens (Chemotherapy) Denominator: Total number of patients receiving first definitive treatment for cancer within a given period for all cancers Numerator: Number of patients receiving first definitive treatment for cancer within 31 days of receiving a diagnosis (decision to treat) within a given period for all cancers Denominator: Total number of patients receiving subsequent surgery within a given period, including patients with recurrent cancer. Numerator: Number of patients receiving subsequent surgery within a maximum waiting time of 31-days during a given period, including patients with recurrent cancer. Denominator: Total number of patients receiving a subsequent/adjuvant anti-cancer drug regimen within a given period, including patients with recurrent cancer. Numerator: Number of patients receiving a subsequent/adjuvant anti-cancer drug regimen within a maximum waiting time of 31-days during a given period, including patients with recurrent cancer. 96% 98.32% YTD@Feb 14 94% 95.8% YTD@Feb 14 98% 99.52% YTD@Feb 14 21

22 Description of Measure Indicator Construction Target/Plan 2013/14 Performance 2013/14 Cancer Waits 31 day standard for subsequent treatments radiotherapy Denominator: Total number of patients receiving subsequent/adjuvant radiotherapy treatment within a given period, including patients with recurrent cancer. Numerator: Number of patients receiving subsequent/adjuvant radiotherapy treatment within a maximum waiting time of 31-days during a given period, including patients with recurrent cancer. 94% 98.22% YTD@Feb 14 Cancer Waits - % of patients receiving first definitive treatment for cancer with 62 days of an urgent GP referral for suspected cancer Cancer Waits - % of patients receiving first definitive treatment for cancer within 62 days of referral from NHS Cancer Screening Service Cancer Waits - % of patients receiving first definitive treatment for cancer within 62 days of a consultant decision to upgrade their priority status Stroke - % of people to have a stroke who spend at least 90% of their time in hospital on a stroke unit Stroke - % of Transients Ischemic Attack (TIA) cases with a higher risk of stroke assessed/treated within 24 hours Denominator: Total number of patients receiving first definitive treatment for cancer following an urgent GP (GDP or GMP) referral for suspected cancer within a given period, for all cancers Numerator: Number of patients receiving first definitive treatment for cancer within 62-days following an urgent GP (GDP or GMP) referral for suspected cancer within a given period, for all cancers Total number of patients receiving first definitive treatment for cancer following referral from an NHS Cancer Screening Service within a given period Number of patients receiving first definitive treatment for cancer within 62-days following referral from an NHS Cancer Screening Service during a given period Total number of patients receiving first definitive treatment for cancer following a consultant decision to upgrade their priority status within a given period Numerator: Number of patients receiving first definitive treatment for cancer within 62- days of a consultant decision to upgrade their priority status. Denominator 1: number of people who have a stroke who admitted to hospital Numerator 1: number of people who spend at least 90% of their time on a stroke unit Denominator 2: number of people who have a TIA who are high risk Numerator 2: number of people who have a TIA who are scanned and treated within 24 hours 85% 87.43% YTD@Feb 14 90% 91.38% YTD@Feb 14 ~ 100% YTD@Feb 14 80% 90.5% FOT 60% 84.6% FOT 22

23 Description of Measure Indicator Construction Target/Plan 2013/14 Performance 2013/14 Mental health Early intervention in psychosis the number of new cases of psychosis served by early intervention teams Numerator: The number of new cases of psychosis served by early intervention teams Denominator: The number of new patients taken on by Early Intervention teams in the year Q3 Mental Health No. of home treatment episodes carried by Crisis Resolution/ Home Treatment teams Numerator: The number of admissions to the trust's acute wards that were gate kept by the crisis resolution home treatment teams Denominator: The total number of admissions to the trust's acute wards 100% Mental Health Care programme approach (CPA) Mental Health IAPT proportion of people that enter psychological services treatment against the level of need in the population Mental health IAPT - Proportion of people who have completed treatment who are moving to recovery Numerator: The number of people under adult mental illness specialties on CPA who were followed up (either by face to face contact or by phone discussion) within 7 days of discharge from psychiatric in-patient care. Denominator: The total number of people under adult mental illness specialties on CPA who were discharged from psychiatric in-patient care. All patients discharged from a psychiatric in-patient ward are regarded as being on CPA. Numerator: The number of people who receive psychological therapies Denominator: The number of people who have depression and/or anxiety disorders (local estimate based on Psychiatric Morbidity Survey) Numerator: The number of people who have completed treatment having attended at least two treatment contacts and are moving to recovery (those who at initial assessment achieved "caseness and at final session did not) Denominator: (The number of people who have completed treatment within the reporting quarter, having attended at least two treatment contacts) minus (The number of people who have completed treatment not at clinical caseness at initial assessment) Q3 12.6% 11.5% YTD@Feb 14 50% 52.7% YTD@Feb 14 23

24 Description of Measure Indicator Construction Target/Plan 2013/14 Performance 2013/14 Referral to treatment (RTT) waits % of Admitted patients waiting 18 weeks or less RTT waits % of Non admitted patients with completed pathways waiting 18 weeks or less The percentage of admitted pathways within 18 weeks for admitted patients whose clocks stopped during the period on an adjusted basis The percentage of non-admitted pathways within 18 weeks for non-admitted patients whose clocks stopped during the period 90% Feb 14 95% Feb 14 RTT waits - % waiting at the end of the month on an incomplete pathway The percentage of incomplete pathways within 18 weeks for patients on incomplete pathways at the end of the period >92% 14 24

25 IMPROVING CARE The CCG complies with its contractual obligations in the commissioning of services ensuring that these are safe, effective and ensure the compliance of providers against CQUINs (Commissioning for Quality and Innovation) and KPIs (Key Performance Indicators) which are set and agreed on an annual basis. NHS Castle Point and Rochford CCG acts as the lead commissioners for South Essex Partnership NHS Foundation Trust (Mental Health, CAMHS and Community services) and are associate commissioners for Southend University Foundation Hospital Trust. We are also the lead commissioners for the South Essex NHS 111 and aligned Out of Hours services. The Quality Team and Contract Leads seek assurances and assess the quality of service provision through monthly Clinical Quality Review Group (CQRG) meetings in addition to securing evidence identified through quality visits. NHS Castle Point and Rochford CCG act as the lead commissioners for the South Essex CCGs with regards to the South Essex Partnership Trust (SEPT) contract and hold a monthly contract meeting focusing on the quality of Mental Health, Community, CAMHS (Children and Adolescent Mental Health Services) and Children s Services. The commissioners are actively involved in service redesign and procurement processes but ensure that the quality of their services is assessed through the use of Quality Impact assessments (QIA). Through the CQRG the SEPT services Cost Improvement Plans are monitored to ensure that proposed savings do not compromise the quality of service to be provided. Assurances are sought from lead commissioners to ensure that the same methodologies are applied to ensure the continuation of high quality care provision. 25

26 ENSURING SAFE AND HIGH QUALITY SERVICES Castle Point and Rochford Patient Experience Principles Our aim is to listen to, and learn from, our patients experiences. It is recognised that there is a link between the Patient Engagement and Patient Experience agenda and we ensure that there is a co-ordinated approach to both. As a CCG we ensure that we are listening to the needs of our patients and commissioning value for money, quality services dependant on local need. The aim of Patient Engagement is to improve our understanding of needs and views of local people, giving people information and mechanisms to influence service development supporting the delivery of integrated care. We held two successful Call to Action events in 2013 to ensure we have a forum where we can meet face-to-face with members of the local populations and answer questions in a timely and productive way. In the case of Patient Experience, our work relates to viewing health care based on individual patient s experience. Our philosophy for capturing and using patient experience is as follows: NHS Castle Point & Rochford CCG.. will ensure our providers put in place appropriate processes to monitor patient experience to include local and national initiatives, and to hold them to account ensure that our providers are aware that we expect our patients to be treated as individuals expect our providers to involve voluntary and carer groups to encourage patients to share their stories of care will address and challenge poor care that results in an unnecessarily poor patient experience and ensure changes are made where they are needed aim to use targeted initiatives to ensure inclusivity to include e.g. vulnerable groups where knowledge of patient experience is often low expect our providers to use all this data/feedback from patients and triangulate with other intelligence e.g. from incidents/complaints then to take action and make changes where they can and be honest about where they can t. These statements are taken from our patient experience report and are integral to the monitoring of service provision, which will ensure patients receive safe, reliable and high quality services which are monitored by the CCG. The Quality Team act on behalf of the Chief Nurse for the CCG and seek assurances through the triangulation of data and soft intelligence on the quality and safety of service provision by providers from whom we commission services on behalf of the public. 26

27 The soft intelligence data can either be nationally-published information and benchmarking in the case of Patient Safety Thermometer data and Friends and Family testing, or local data sourced through the NHS Choices website or local Serious Incident (SI) reports. This data is used as a basis to monitor and review providers standards of care, which may be sought formally through reports at the Clinical Quality Review Groups or through quality assurance visits. Any findings and recommendations are delivered to the provider and the outcomes of any action plans are monitored to ensure that progress is made to improve the quality of care and services. Infection Control There are key infection control target trajectories for Clostridium difficile infections which are set by Public Health England. The core CCG team is supported by an Infection Control team who provide their expertise in supporting providers to aspire achievement of these trajectories. There continues to be a zero tolerance for MRSA bacteraemias, in 2013/14 there have not been any reported by either Trust. Infection concerns are subject to rigorous review through a root cause analysis investigation and the report following any bacteraemia is submitted as a Post Infection review directly to Public Health England. Providers are assessed according to the CQC s outcome standards, to ensure the safety and suitability of processes and premises. Other soft intelligence includes the reporting of pressure ulcer incidence in line with national frameworks and the serious incident policy. The CCG monitors these reports and the data sourced through the Patient Safety Thermometer (PST) reporting. The PST is a point prevalence audit undertaken on one day per month, for incidence of pressure ulcers, fall, compliance with VTE risk assessment and prophylaxis and catheter associated urinary tract infections. The Quality Team, on behalf of the Chief Nurse, also view patient feedback in the form of NHS choices relating to their experiences in the acute trusts, and the community, CAMHS and Mental Health Services. The new staff, family and friends data will be available and, commencing in April 2014, will add a varied perspective on care and service provision and will provide more timely feedback than the annual staff surveys. The CCG occasionally receive complaints relating to the providers, CCGs and also our GPs colleagues, which are either investigated or locally or forwarded to the appropriate provider or commissioner for the service. Complaints investigations and feedback provides opportunities for the CCG to link directly with the public to obtain further information about the quality of service provision. Learning from Serious Incident investigations and other incident investigations provides background on the quality and safety of service and this is also used as a basis for visits to seek assurances that learning has been embedded and changes made as a result. The Quality team has a Safeguarding Adults Lead and there is direct liaison with the Local Authority Care Quality Commission (CQC), the Continuing Healthcare Team and Monitor, to 27

28 support quality visits to acute providers and care homes where there are concerns relating to Adult Safeguarding, Mental Capacity Act (MCA) and Deprivation of Liberties safeguards (DOLS). The lead also supports staff in the CCG and GP practices with Domestic Homicide Review (DHR) processes, when such investigations are required. This includes sharing the outcome and learning in written monthly reports. The Children s Safeguarding team are also actively involved in the ensuring quality and safety of care across South Essex sharing learning from investigations. The Quality Team are actively involved in the production of reports sharing this information across the CCGs and also the Essex-wide reporting of service provision through the Quality Surveillance group meeting, where this information is triangulated with the wider CCG audiences, the deanery local authority and regulators. Based on this information the Area Team provide assurances through to NHS England. 28

29 ENSURING BEST VALUE The NHS budget is under increasing pressure. Demand for healthcare continues to rise; linked to a growing and ageing population, the availability of new drugs and technologies together with misguided or inappropriate use of essential services such as A&E; all of which is leading to a significant financial challenge. In order to meet the challenges of the coming years, we need to use our NHS funds more imaginatively and effectively. We need to develop different ways of delivering healthcare services, introducing new healthcare providers to provide more choice. We need to move appropriate services into the community, offering patients care closer to where they live. As part of the national changes, the Department of Health abolished the Use of Resources assessment for 2010/11 onwards and replaced it with a Value for Money (VFM) conclusion to be made by BDO who are NHS Castle Point and Rochford CCGs external auditors. Their conclusion is given in the financial statements section of this report and is based upon an assessment by the auditor as to how far NHS Castle Point and Rochford CCG has put in place proper arrangements for securing, economy, efficiency and effectiveness in its use of resources and financial resilience. QIPP QIPP (Quality, Innovation, Productivity and Prevention) is the umbrella term used to describe the approach the NHS is taking at local, regional and national levels to reform its operations and redesign services in light of the above. It is intended to ensure that the economic climate does not change the focus of our direction of travel but puts quality at the heart of the NHS. Its key objectives include: Improving quality and productivity Engaging and empowering staff QIPP and the Health and Social Care Act (2012) The Act outlines the Government s commitment to ensuring that QIPP supports the NHS to make efficiency savings, which can be reinvested back into the service to continually improve the quality of care. QIPP and Commissioning schemes implemented in 2013/14 include: Community Dermatology An audit at Basildon Hospital showed that around 30 per cent of activity seen at the acute Trust was for intermediate skin conditions which could be treated and managed within the community. A community service was commissioned via an AQP (Any Qualified Provider) process for patients with intermediate skin conditions. Following the AQP there are now two providers offering the service in locations across the CCG area. The service offers a local alternative for patients, increased choice and has seen a reduction in acute activity. Redesign of Day Assessment Services at Southend Hospital 29

30 The phase one redesign of the Day Assessment Unit has been a key part of the wider pathway development for the frail elderly. Initially undertaken to support winter pressures and increase capacity, the unit recruited additional medical staff, improved same day access to enable GPs to refer patients for a same day assessment, made improvements to medication to take away to ensure prompt discharge, improved patient transport and increased the number of bookable appointments available. The launch of NHS 111 In south Essex, the NHS 111 service has been a prime example of how innovation can be introduced which benefits both users and the health service. Castle Point and Rochford CCG led the commissioning of this service across South Essex. NHS 111 is a new service introduced to make it easier for people to access local NHS healthcare services. People can call 111 when they need medical help fast but it s not a 999 emergency. NHS 111 is available 24 hours a day, 365 days a year. Calls are free from landlines and mobile phones. Early on in the planning process the decision was taken to have the same provider for both the NHS 111 service and the out-of-hours service which created a number of system benefits including improved telephone triage, which in turn reduces unnecessary referrals to the out-of-hours service which are therefore in a better position to support patients and other parts of the system such as A&E. Castle Point & Rochford CCG has also received a number of compliments from out-of-hours doctors around the higher quality of referrals they are receiving from NHS 111, as well as positive feedback from patients. There is a strong emphasis with the NHS 111 service on ensuring local accountability. This local emphasis is borne out by the fact that there is a strong local GP Clinical Lead which has helped to ensure that safety and clinical effectiveness is always paramount and the service is locally owned. The quality of data a localised service produces also benefits commissioners who have found that it alerts them to local issues such as revising ways of sharing test results in out of hours, providing a local solution to a national issue. The service allows commissioners to drilldown into what s needed for other issues, especially around unplanned care, as a direct result of the information NHS 111 provides. The feedback that the Castle Point & Rochford CCG has received since the service started last year has been overwhelmingly positive, between April and December 2013, 86% of those that responded to the provider s survey either Fairly Satisfied or Very Satisfied with the service they experienced. 30

31 Community Contestability Programme Castle Point and Rochford CCG, along with the other CCGs in South Essex, has undertaken a review programme of community services to ensure they are efficient and of sufficiently high quality. Service review groups consisting of a range of people, including patient representatives, met to assess each of the community services and make recommendations for improvements. The schedule of 28 assessments have now been completed and have provided a health check of the current service provision including how services are performing against contractual requirements and what service users and stakeholders think of the services they receive, as well as a review of quality outcomes and value for money. A number of assessments suggested short term actions to address more immediate concerns whilst longer term actions are implemented. Across all service assessments, there were no concerns identified regarding the quality and safety of the services. The recommendations have been developed into a single improvement plan; the actions will be put into place in the coming months and the services will be continually assessed to ensure the quality remains high. Single Point of Referral The Single Point of Referral (SPOR) was improved by ensuring that all call handlers underwent training, there was an increase in clerical capacity, the capacity of social care has been increased, an additional senior nurse was recruited, and the service is now able to access SystemOne. Examples of other QIPP schemes include: Commissioning enhanced medical for intermediate care rehabilitation/reablement beds in the locality Producing self-management tools for patients with COPD Befriending Commissioning health coaching for primary care clinicians to enable them to better support patients with long term conditions Commissioning community based DVT screening services and 24 hour ECG (cardiac) diagnostic service Supporting primary care to implement a number of admission avoidance schemes, to maintain patient in their own homes during times of crisis or exacerbation Implementing a new Lower Back Pain Pathway Commissioning a GP Crisis Line for GPs to have access to a Mental Health Clinician 8am to 8pm for advice to reduce A&E attendances and deliver more appropriate care and support. Psychological Interventions to Stroke and COPD Commissioning DIST (Dementia Intensive Support Team) team to prevent hospital admissions 31

32 INVOLVING AND LISTENING TO OUR PATIENTS Castle Point and Rochford CCG is proud of its achievements in engaging with the public and involving the local population in our decision-making processes. Currently 18 of our 28 member practices have a Patient Participation Group in operation. In addition, the CCG is indebted to its Commissioning Reference Group (CRG), which consists of a panel of members from across Castle Point and Rochford who meet monthly to give their opinions on a wide range of healthcare issues ranging from current commissioning cases to ways in which we can further engage and inform the public about the work of the CCG. The CCG also carries out a number of face-to-face events throughout the year, taking the opportunity to talk to members of the public and gather their views both with bespoke healthcare-focused Call to Action events, as well as in more informal settings as part of larger events such as the Castle Point Show. The CCG aims to include and involve the population as it grows and develops as an organisation. The CCG also takes seriously its role of informing the public about health issues. The Commissioning Reference Group has been a key part of a successful pan-south Essex CCG campaign to promote the benefits of using the NHS 111 service as well as a campaign to raise awareness of the importance of avoiding A&E unless necessary. The CCG has used innovative educational tools to try and embed a cultural shift away from dialing 999 to dialing 111 if it is not a medical emergency including helping to publish a children s book which has been circulated to appropriate audiences in the area to promote awareness in youngsters of the 111 service. The CCG plans to continue these and other campaigns, over the coming 12 months, to further promote and engage the public in the work it does. 32

33 WORKING IN PARTNERSHIP FOR BETTER HEALTH Joint Strategic Needs Assessment A Joint Strategic Needs Assessment (JSNA) is an ongoing process by which local authorities, clinical commissioning groups and other public sector partners jointly describe the current and future health and wellbeing needs of its local population and identify priorities for action. The JSNA is not just about health and personal social care services; it is also about the wider aspects of health including poverty, employment, education, public safety, housing and the environment. The ultimate purpose of the JSNA process is to use the information gathered to identify local priorities and support commissioners to commission services and interventions that are based on need, which will in turn achieve better health and wellbeing outcomes and reduce health inequalities. The production of the JSNA is led by the Essex Health and Wellbeing Board in the Castle Point and Rochford CCG area. The vision of the Essex Health and Wellbeing Board is that, by 2018 residents and local communities in Essex will have: Greater choice, control, and responsibility for health and wellbeing services. Life expectancy overall will have increased and the inequalities within and between our communities will have reduced. Every child and adult will be given more opportunities to enjoy better health and wellbeing. The Essex health system influences many factors that affect our communities health and wellbeing, from housing, to education, to social care, to leisure opportunities, to healthcare. Castle Point and Rochford CCG is committed to working closely with our partners and with our communities to ensure that we contribute effectively to the achievement of this vision and jointly make Essex an even better place to be. We are in formal strategic partnership with our partners through the Essex Health and Wellbeing Board. The Health and Wellbeing Board is responsible for developing and implementing the Essex Health & Wellbeing Strategy, which outlines the key priorities for improving health and wellbeing for all of the county s residents and can be viewed in full on the Essex County Council website. Integration of Health and Social Care and the Better Care Fund One of our biggest priorities as part of the Health and Wellbeing Board is to contribute to the adaptation of health and social care needs to the changing needs of our population. Over the next few years we will focus more on the individual needs of people, their families and carers increasing the input of individual people into how and where they are cared for. 33

34 The services the CCG plans, buys and monitors on your behalf will become more joined up, supporting people to look after themselves better, to lead independent lives and to get the right services, quickly, when they need help. The CCG is working with local people, voluntary organisations, Essex County Council and local NHS partners to make sure these are the right changes to secure the best possible services for the future. These are challenging times in the NHS and social care sector. Demand for services is rising faster than funding. The costs of drugs, care and new technology continues to rise and our population is changing, with an increasing number of older people, who tend to have greater health and social and care needs. The NHS has always had to respond and adapt to changing times, we are working closely with colleagues at Essex County Council to develop a new way of planning and buying health and social care for local people through integrating our commissioning processes. Our aim is for people to be offered seamless health and social care, based in their own home or local community wherever possible care which is high quality and good value for money. This aim is being supported by a national programme called the Better Care Fund (BCF). The BCF provides an opportunity to transform local services so that people are provided with better integrated care and support. It encompasses a substantial level of funding to help local areas manage the changing demands and improve long term sustainability. The BCF is an important enabler to take integration forward at scale and pace, acting as a significant catalyst for change. Traditionally, health and social care has been organised more around specific services, rather than the needs of each individual person. This has led to people sometimes receiving fragmented care, delivered by many different people. Some care is duplicated, some care may be missing. The BCF is supporting us to plan and buy health and social care which: Puts people at the centre of their care Promotes self-care and prevention Supports carers Is based in the home or community where possible Is joined up and seamless Is high quality Is value for money We are working with service users and colleagues at Essex County Council to:- Look at how health and social care services are currently provided Explore which service users, and which services, could benefit from integration Define the outcomes that those services should be providing Develop and agree a new model of care centred around the individual 34

35 For example, people with dementia may currently receive a variety of services from the NHS and Essex County Council. Several contracts might be involved, each with different performance measures. We want people to receive a joined up service, where providers are working together to make sure that people with dementia are diagnosed earlier and have earlier treatment and support. We will set out the quality standards and outcomes that people should receive and then monitor providers closely to make sure that this happens. 35

36 FINANCIAL OVERVIEW 2013/14 Financial duties NHS Castle Point and Rochford CCG did not meeting its statutory financial duties recording a deficit of 0.4m by the end of the financial year. This was 2.5m below the target surplus set for the CCG. i. Remain within Revenue Resource Limit (RRL) RRL 203,478k Performance 203,852k ii. Remain within Maximum Cash Drawdown (MCD) MCD 196,398k Bank balance as at 31/3/14 170k The NHSE Annual Accounts Guidance states that CCGs should manage their cash balances at the bank as at 31st March 2014 to be no greater than 1.75% of the monthly drawdown for March 2014 or 250k. The statutory duty was, therefore, achieved for 2013/14. iii. Remain within Capital Resource Limit N/A in 2013/14 Capital expenditure The PCT did not receive a Capital Resource limit in 2013/14. The granting of capital resources to CCGs in future financial years remains unclear at present. Value for money Ensuring value for public money is an important principle of the CCG. To ensure value for money is achieved, appropriate procurement procedures are in place, including the tendering of goods and services where necessary. This includes a separate procurement group, with Lay Member and Executive membership. A key priority for the CCG looking forward is to ensure that maximum value for money is being achieved through effective commissioning arrangements, as the majority of the CCGs expenditure is spent on commissioning healthcare services. While all healthcare providers are required to deliver a continuous programme of QIPP, the CCG also must demonstrate that it is properly considering the health needs of the local population and commissioning those services that address those needs. ] During 2013/14 the CCG has been working with our NHS and social care colleagues across South Essex in developing system-wide Quality, Improvement, Productivity and Prevention plans setting out how the we will respond to the challenging financial climate in which the NHS and the wider public sector will operate over the coming years. These joints plans have formed part of the 2014/15 contractual negotiation process with our main acute provider and underpinned the community contestability project undertaken in year. 36

37 With over 2m of the CCGs running costs committed to commissioning support services, the CCG has also undertaken a review of all support services commissioned in accordance with make, share, buy guidance issued by NSH England, in anticipation of the current SLA end date at the end of September In April 2014, our current CSU signalled intentions not to enter into the current Lead Provider Framework process and thus the transition of these services to ensure both value for money and effectiveness will be an immediate priority in 2014/15. Statement to be added/included once External Audit VFM opinion received. Better Payments Practice Code The Better Payment Practice Code requires the clinical commissioning group to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later. The NHS aims to pay at least 95% of invoices within 30 days of receipt, or within agreed contract terms. Details of compliance with the code are given in the notes to the financial statements. Prompt payments code The clinical commissioning group adheres to the principles set out by The Prompt Payment Code and has started the application process to became an approved signatory. This initiative was devised by the government with The Institute of Credit Management (ICM) to tackle the crucial issue of late payment and to help small businesses. Suppliers can have confidence in any company that signs up to the code that they will be paid within clearly defined terms, and that there is a proper process for dealing with any payments that are in dispute. Approved signatories undertake to: Pay suppliers on time; Give clear guidance to suppliers and resolve disputes as quickly as possible; and, Encourage suppliers and customers to sign up to the code. 2014/15 financial plans Balanced budgets have been set for 2014/15 within the CCG, though the CCG has requested a relaxation of business rules in relation to the 1% surplus requirement to 0.3m surplus. This represents a year on year improvement in financial performance and south Essex systems challenges, notwithstanding the resulting requirement to deliver significant efficiency savings through our Quality, Innovation, Productivity and Prevention programme ( 4.5m). Our challenge remains to maintain and improve the quality of services we commission on behalf of the local population whilst delivering significant productivity savings. Please see Appendix A for the full set of financial statements for the year ended 31March

38 SUSTAINABILITY REPORT SUSTAINABILITY AND CARING FOR OUR ENVIRONMENT Sustainability has been recognised at a national level as an integral part of delivering high quality healthcare efficiently. We are required to produce a Sustainability Report as part of our annual report, covering our performance on greenhouse gas emissions, waste management, and use of finite resources, in line with HM Treasury guidance (see Appendix B). A framework for reporting sustainability information as part of the annual NHS financial reporting process has been developed by the NHS Sustainable Development Unit and the Department of Health, to support Trusts in meeting the above mandate and to help monitor how every NHS organisation contributes towards meeting the national target of a 10% cut in NHS wide carbon emissions by 2015, and a 34% cut in the overall national carbon footprint by 2020, the latter enshrined in the Climate Change Act. The CCG has been part of the Castle Point and Rochford Sustainability Task and Finish Group which includes Local Authorities, Public Health and Local Providers. This Group has achieved several things including: Set up a website which contains a lot of helpful information about how organisations can become Sustainable and reduce their Carbon emissions. The website is at Circulated to GPs in Castle Point and Rochford information on where patients can do more exercise. Work hard to try to encourage an increase in the number of school children walking to school. Increased knowledge about Sustainability by organising a Green Christmas competition amongst Primary Schools. 38

39 EQUALITY REPORT Equality means ensuring that everyone is able to participate in all of our activities and access all health services on an equal footing. Diversity acknowledges that there are differences between people which should be recognised, and respected. We aim to commission healthcare services that are equitable to everyone regardless of age, disability, gender re-assignment, marriage and civil partnership, pregnancy and maternity, race, ethnicity or national origin, religion or belief, gender, sexual orientation, domestic circumstances, trade union membership (or non-membership), socio-economic or employment status. We also aim to recruit and retain a diverse and inclusive workforce. Over the last year we have worked with colleagues in the other south Essex CCGs to ensure that we uphold the principles of the Equality and Diversity Act (2010). We are currently revisiting our action plan to ensure that we are meeting all our statutory responsibilities. Presentations at our Commissioning Reference Group have been titled Access for All as we are proud that, as commissioners, we adhere to our legal requirements in every commissioning decision we make. Please see Appendix C indicative Equality Workforce Information report as produced in January 2014 with regard to the public equality duty. 39

40 MEMBERS REPORT OUR GOVERNING BODY The Governing Body is the accountable body of the CCG and is held to account for the organisation s performance. The Governing Body includes a majority of clinical professionals, to ensure clinical accountability. The Governing Body includes lay members to ensure that the views of the community are represented, provide independent judgement and ensure good corporate governance and proper husbandry of public funds. NHS Castle Point and Rochford CCG has been authorised since 1 st April 2013, with four conditions as at 1 st April The member practices of the CCG are listed below: GPs Practice Name Address Bajen & Partner Rochford Medical Practice Southwell House, Back Lane, Rochford, SS4 1AY Dr Bajen Dr Blasco Dr Iruskieta Dr Fernando Brown & Partners Grafton Surgery, Central Canvey Long Road, Canvey Island, SS8 0JA Dr BJ Brown Dr S Azeem Dr SB Noorah Dr W Wong Dr O Aderonmu Primary Care Centre Chaudhury Central Canvey Primary Care Long Road, Canvey Island, SS8 0JA Dr PK Chaudhury Centre Chavda & Partners New Health Centre 1 Third Avenue, Canvey Island, SS8 9SU Dr Jaggish Chavda Dr M Sukumaran Dr L Panthagani Dr S Jothimurugan Dr E Bhimani Connor & Partners Dr S Connor Dr C A Donnelly Dr J Rouse Dr D Subasinghe Riverside Medical Centre 175 Ferry Road, Hullbridge, SS5 6JH Cyrus & Partners Dr CS Cyrus Dr K Jarasuriya Dr S Tucker Dr S Mahmud Dr L Liu Dr Babar Dr S Khawaja Freel & Partners Dr JF Freel Dr KR Seath Dr MA Saad Dr R Srivastava Dr R Rothnie Dr FN Ansari Dr M Ozturk Church View Surgery Branch Surgery: Jones Family Practice 55 Southend Road Hockley, SS5 4PX Great Wakering Medical Centre 40 Burley House, High Street, Rayleigh, SS6 7DY 274 High Street, Great Wakering, SS3 0HX

41 Gardiner Dr R Gardiner Ghauri & Partner Dr JB Ghauri Dr AJ Ghauri Gill & Partner S Gill KJK Dhillon Hiscock & Partners Dr SC Hiscock Dr SK Gupta Dr MM Zin Dr MM Gale Dr MR Khan Dr C Rose Dr S Chana Dr R Ramoutar Jayaweera Dr AHI Jayaweera Jena & Partner Dr R Jena Dr Linacero Gracia Kamdar & Partners Dr MK Kamdar Dr MI Mujahid Mr SN Rai Dr P Swami Dr Sureshkuma Dr S Patel Dr RK Prasad Khalil & Partners SM Khalil Dr AK Srivastra Dr M Dastagir Dr N Salwan Kothari & Partners Dr CU Kothari Dr D Nanda Dr A Brezina Dr B Hart Dr K Porter Dr M Metcalfe Dr AJ Puzey Kuriakose Dr B Kuriakose Dr J Abeynayake Dr A Masud Lester & Partners Dr MJ Lester Dr JA Lemmens Dr LA Tan Dr S Whitear Dr A Afzal Belle Vue Medical Practice Hawesbury Surgery Benfleet Surgery Rushbottom Lane Surgery Downhall Park Surgery The Island Surgery, Central Canvey Primary Care Centre Oaklands Surgery, Central Canvey Primary Care Centre Essex Way Surgery The Puzey Family Practice Greensward Surgery The Hollies 271 Rayleigh Road, Benfleet, SS7 3XF 1a Hawesbury Road, Canvey Island, SS8 0EX 12 Constitution Hill, Benfleet, SS7 1ED 91 Rushbottom Lane, Benfleet, SS7 4EA 49 Rawreth Lane, Rayleigh, SS6 9QD Long Road, Canvey Island, SS8 0JA Long Road, Canvey Inland, SS8 0JA 34 Essex Way, Benfleet, SS7 1LT Southwell House, Back Lane, Rochford, SS4 1AY Greensward Lane, Hockley, SS5 5HQ 41 Rectory Road, Hadleigh, SS7 2NA 41

42 Lewis & Partners Dr C Lewis Dr DS Taylor Dr AP Kerry Dr ML Beltran Dr C Horner Dr R Genthe Dr R Tisi Dr T Wright Dr L Saville Dr A Rehal Dr O Arikawe Dr Whiting Patel PA Dr PA Patel Patel RM & Partners Dr RM Patel Dr RJN Baker Dr AL Swamy Dr K Siddiqui Rahman &Partner Dr HU Rahman Dr DRV Bowen Ramanathan & Partner Dr S Ramanathan Dr J Tharmaratnam Singh Dr B Singh Dr S Merali Dr L Brown Sodipo Dr JA Sodipo Dr E Kalanzi Dr O McKeever Waiwaiku Dr KN Waiwaiku Dr C Volkmar-Sierra Audley Mills Surgery Hart Road Surgery Rushbottom Lane Surgery William Harvey Surgery Ashingdon Medical Practice Branch Surgery: Dome Caravan Park Lower Road Hockley SS5 5LU 1 Village Green Canewdon SS4 3QF Leigh Beck Surgery, Central Canvey Primary Care Centre The Practice Leecon Way Branch Surgery: The Practice Hawkwell 2 Hawkwell Park Drive Hawkwell SS5 4HB High Road Family Doctors 57 Eastwood Road, Rayleigh, SS6 7JF 85 Hart Road, Thundersley, SS7 3PR 91 Rushbottom Lane, Benfleet, SS7 4EA 391 Long Road, Canvey Island, SS8 0JH 83 London Road, Rayleigh, SS6 9HR 57 Lascelles Garden, Ashingdon, SS4 3BW Long Road, Canvey Island, SS8 0JA 1 Leecon Way, Ashingdon Gardens, Rochford, SS4 1TU 119 High Road, Benfleet, SS7 5LN 42

43 The members of the Governing Body are listed below: Voting Governing Body Members Dr Mike Saad Chairman Dr Sunil Gupta Clinical Accountable Officer Mr Rob Peters Vice Chairman, Lay Member (Governance) Mr Kevin McKenny Chief Operating Officer Ms Victoria Gunn Chief Finance Officer Ms Patricia D Orsi Executive Nurse Dr Roger Gardiner GP Representative Mrs Gillian Hind Lay Member (PPI) Dr Mahesh Kamdar GP Representative Dr Biju Kuriakose GP Representative Dr Mark Metcalfe GP Representative Dr Kashif Siddiqui GP Representative Dr D.S Taylor GP Representative Dr Rachel Liebmann Secondary Care Consultant Percentage Attendance at Meetings 88% 100% 88% 88% 88% 100% 100% 88% 100% 100% 100% 100% 88% 63% Governing Body Observers with Speaking Rights Ms Michelle Angell Head of Performance and Corporate Services Mr Steve Doherty Practice Manager Representative Helen Taylor Local Authority Representative Miss Emily Hughes Head of Commissioning Mr Barry McCarthy Public Representative and Chair of the Commissioning Reference Group Dr Daniel Showell Public Health Consultant The average attendance of voting members at Governing Body meetings during 2013/14 was 91.5%. Governing Body members declarations of interest can be found in Governing Body Profiles section of the Remuneration Report. 43

44 Details of members of other committees and sub-committees and details on all committees and sub-committees can be found below. The structure of committees can be found in the Governance Statement. Audit Committee Our Audit Committee is responsible for reviewing the establishment and maintenance of an effective system of governance, risk management and internal control, across the whole of the CCG s activities that supports the achievement of the CCG s objectives. The Audit Committee is chaired by the CCG s Lay Member for Governance and as a sub-committee to the Governing Body, regularly submits its minutes to the Governing Body and produces an annual report of its activities. The following individuals form the membership of the CCG s Audit Committee: Core Membership Audit Committee Member % attendance at meetings Rob Peters, Chairman, Lay Member - Governance 100% Dr Shan Whitear, GP Representative 80% Steve Doherty, Practice Manager representative 100% Gill Hind, Lay member (Patient & Public 60% Engagement) Michael Spoor, Lay member 100% Attendance: Chief Finance Officer Head of Performance and Corporate Services Internal Auditors External Auditors Counter Fraud Officer / Security Management Officer The average attendance of Audit Committee meetings during 2013/14 was 83.5%. The Chair of the CCG Governing Body shall not be a member of the committee, but will be entitled to attend each meeting. Audit arrangements BDO are our external auditors, appointed by the Audit Commission. The total planned fee for the 2013/14 audit was 81,600. No other work was carried out by BDO during 2013/14. Pension liabilities The CCGs annual accounts detail the accounting policy adopted regarding the NHS pension scheme liabilities and this can be found in note 4.5 of the accounts in Appendix A. 44

45 COMPLIMENTS, COMPLAINTS AND CONCERNS Concerns and complaints provide us with valuable information about the experiences of our patients so that we can improve the services that we commission. Compliments help us to find out what we are doing well so that we can share best practice, improving still further local health services. The CCG s Complaints and Concerns Policy reflects the best practice principles for complaints handling advocated by the Parliamentary & Health Service Ombudsman (Principles for Remedy, Principles of Good Complaint Handling and Principles of Good Administration). In accordance with the Principles for Remedy, we place a strong emphasis upon putting things right and ensuring continuous improvement and learning from complaints. Under the NHS Complaints Regulations which came into effect on 1 April 2009, patients and the public can make their complaint to CPR CCG as a commissioner, if they do not wish to complain directly to the provider. During 2013/14, the CCG received 23 complaints about commissioner services from patients or carers who wished to exercise this right. In each case, the CCG worked with the complainant and the provider to achieve resolution in the majority of cases and to identify service improvements and learning outcomes. We also received 0 no of compliments As a result of feedback with regards to the newly launched NHS 111 service we as a CCG were in a strong position to review and change the delivery of the new telephone advice line and to become one of the first successful launches in the country. FREEDOM OF INFORMATION REQUESTS The Freedom of Information Act (2000) gives a general right of access to recorded information held by public authorities, subject to certain conditions and exemptions. The CCG received 189 (Apr 13-Jan14) FOI requests during We certify that the clinical commissioning group has complied with HM Treasury s guidance on setting charges for information. 45

46 OUR STAFF Staff numbers (as at March 2014) There were Whole Time Equivalents (WTE) employed by NHS Castle Point and Rochford CCG. The actual headcount for NHS Castle Point and Rochford CCG stands at 33 employees. The staffing profile of NHS Castle Point and Rochford CCG is comprised of the following: Equal Opportunities The organisation is committed to equal opportunities for all staff. NHS Castle Point and Rochford CCG does not have any employees who have declared that they have a disability. See our Equality Report for more information. The CCG is an equal opportunities employer and as such recruits under the Equality two ticks scheme. Recruitment and Selection (including both external and internal recruitment/promotion) procedures follows NHS Employers good practice guidance and meets NHS Employment Checks Standards. The CCG has access to HR and Occupational Health advice in order to support any employees who fall within the scope of the Equality Act Each employee is different and the support will be tailored depending on the circumstances. The CCG has an Equality and Diversity (E&D) working group which addresses all issues relating to E&D within the CCG, and specifically addresses the Equality delivery system approach. All Equality Impact Assessments are reviewed by the E&D group. Staff sickness Staff Group Total WTE Administrative and Clerical Nursing and Midwifery Registered 1 Grand Total The total days lost for NHS Castle Point and Rochford CCG stands at (WTE calendar days lost), out of 8, (WTE calendar days available) resulting in an average absence of 1.36%. 46

47 Absence is low within NHS Castle Point and Rochford CCG, averaging at 1.36%, well below the NHS average of 4.24% (2012 figures). The average days lost per employee at NHS Castle Point and Rochford CCG is 4.64 compared with the NHS national average of 9.5 days (2012 figures). Absence is supportively managed within the CCG, with the absence management policy addressing both short term and long term absence. Staff are supported through any absences, with return to work meetings conducted following periods of absence and referrals made to Occupational Health for support in achieving a regular sustained attendance at work. Persistent short term absence is addressed through formal procedures. Internal communications / staff consultation Castle Point & Rochford CCG is proud of the communications culture it has started embedding throughout the organisation, both internally and externally. As well as starting to effect change in terms of public engagement and communications, the CCG ensures there is a regular flow of information between staff and GPs. A GP newsletter sent out to all Member Practices details the work the CCG has done in the last month and contains best practice updates, there s also an internal staff newsletter which details achievements and highlights the contribution of individuals to the work of the CCG as well as their achievements outside work such as fundraising and charitable challenges. The CCG doesn t underestimate the importance of face-to-face internal communications either. Monthly staff briefings are held so the Clinical Accountable Officer can brief staff on what other parts of the organisation are working on, as well as update on projects with other CCGs and other local authority partners. These meetings have been especially valuable over the last six months to keep staff informed of the CCGs financial position and achieve a common awareness of the financial and economic factors affecting the performance of the CCG. 47

48 The communication works both ways as the senior management team also have an item at the end of each staff session to answer questions from staff about possible organisational developments and future projects. The hard work of staff is also recognised at these face-to-face sessions as quarterly the CCG recognises its Seasonal Stars members of staff who have been nominated by their colleagues for going above and beyond in terms of the work they do and the contribution they make to the organisation. When messages need to be cascaded to staff urgently, there is also the facility for all staff s to be used. It s in these ways that the CCG has shown it is committed to staff communication to consult, inform and involve employees in the growth and development of the organisation. The national NHS staff survey In 2013 CCGs were given the opportunity to take part in the national staff survey. Although NHS Castle Point and Rochford CCG did not participate, the CCG implemented a number of measures to ensure that staff voices would be heard. This includes regular staff briefing session, weekly all staff communications via and inclusion within the Essex CCG Joint Staff Forum. Staff consultation The CCG is committed to involving staff in decision making at all levels. An Executive Board Member sits on the Essex CCG Joint Staff Forum, which includes a mix of Executive Directors, Recognised Trade Unions and Staff Representatives. 48

49 PLANNING FOR EMERGENCIES Within the Civil Contingencies Act, we have a duty to be prepared for incidents and emergencies. As a CCG, we are a category two responder and are seen as a co-operating body. We are therefore less likely to be involved in the heart of the planning, but we will be heavily involved in incidents that affect the health sector through co-operation in response and sharing of information. The CCG has joint (integrated) arrangements for major incidents (including establishing an Incident Coordination Centre) with the NHS England Essex Area Team through the Essex Area Team Major Incident Response Plan. In addition the CCG has an Emergency Preparedness, Resilience and Response Scope and Policy. Suitable Plans aligned to ISO22301 are established to enable the CCG to respond to an internal incident/disruption with a Business Continuity Scope and Policy, Incident Management Plan (Business Continuity Plan) and Locality Service Level Plans. As such the CCG is compliant with the NHS England Emergency Preparedness Framework 2013 and Core Standards. We 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 its major incident plan and has a programme for regularly testing this plan, the results of which are reported to the Governing Body. STATEMENT AS TO DISCLOSURE TO AUDITORS Each individual who is a member of the Governing Body at the time the Members Report is approved confirms: So far as the member is aware, that there is no relevant audit information of which the clinical commissioning group s external auditor is unaware; and, That the member has taken all the steps that they ought to have taken as a member in order to make them self aware of any relevant audit information and to establish that the clinical commissioning group s auditor is aware of that information. Disclosure of Serious Untoward Incidents A disclosure is made in the Governance Statement. The CCG has had no Serious Untoward Incidents relating to data security breaches at level 1 or above during the year. 49

50 REMUNERATION REPORT FOR THE YEAR ENDING 31 MARCH 2014 The tables and related narrative notes for salaries and allowances of senior managers, pension benefits of senior managers and pay multiples included in this report have been audited. Remuneration Committee report The remuneration and procurement committee is established in accordance with NHS Castle Point and Rochford s clinical commissioning group constitution, standing orders and scheme of delegation. The committee s terms of reference set out the membership, remit, responsibilities and reporting arrangements of the committee and shall have effect as if incorporated into the clinical commissioning group s constitution and standing orders. The committee operates in 2 sections: A & B with part A s remit covering remuneration, namely: a) The Committee will make recommendations to the Governing Board on determinations about pay and remuneration for employees of the CCG, and people who provide services to the CCG, and allowances under pension scheme. b) The Committee will make recommendations to the Governing Board about determining the remuneration and conditions of service for the employed members of the Board. c) The Committee will make recommendations to the Governing Board after reviewing the performance of the Accountable Officer and Chief Operating Officer. d) The Committee will make recommendations to the Governing Board after considering severance payments for the Accountable Officer and all other employees. e) The Committee will make recommendations to the Governing Board after considering procurement proposals that do not include the possibility of any financial or service impact on any individual GP Practice within the CCG. f) The Committee will advise the Governing Board on the adequacy of HR arrangements operating within the CCG. g) Review plans produced by the Chairs and/or Accountable Officer which set out appropriate succession planning for clinical posts and senior officers, taking into account the challenges and opportunities facing the CCG, and what skills and expertise are therefore needed on the Board in the future. The committee is appointed by the clinical commissioning group from amongst its Governing Board members. The following are core members of the Committee: Rob Peters - Lay Member Governance Gill Hind - Lay Member PPE Dr Rachel Liebmann - Secondary Care Board Member Dr Mike Saad - CCG Chair The Committee is chaired by the Lay Member Governance and in the event of split decisions, the Committee chair has a second, deciding vote. 50

51 Attendance at the Committee by other officers will is at the discretion of the Lay Members, who should ensure that appropriate professional advice is available as required. This has been exercised within 2013/14 with both the Chief Finance Officer and Head of Human Resources (CSU) attending for specific items. The Committee is required to meet at least 4 times per year under its Terms of Reference, but also meets as required. The need for any meetings in addition to a quarterly cycle will be determined by the Committee chair who will ensure that members have at least 7 days notice of all meetings. The average attendance of members at Remuneration Committee meetings during the 2013/14 year was 68%. The policy of the remuneration All senior managers, with the exception of the Clinical Accountable Officer and GP Governing Body members, are subject to Agenda for Change terms and conditions, with the Clinical Accountable Role subject to the VSM framework. The salary of the Clinical Accountable Officer and Executive Governing Body members is determined by the Remuneration Committee, with national and local guidance (provided by the Chief Operating Officer and Head of Human Resources) being taken into account in all decisions. Performance Conditions The performance of all staff (including the Clinical Accountable Officer, Executive members and Senior Managers) is monitored and assessed through the use of a robust appraisal system. A formal appraisal review is undertaken at least annually. There are no performance related pay elements contained in any contracts for 2013/14. Relevant proportions of remuneration Agenda for Change contracts do not contain provision for performance related remuneration. There is therefore no proportion of remuneration which is subject to performance conditions. However under the terms of the VSM Pay Scales there is the potential for performance related pay under the terms and conditions of the contract. Policy on the duration of contracts, notice periods and termination payments The duration of contracts is determined by the duration of the roles and responsibilities to be undertaken. The contracts of the Clinical Accountable Officer, Executive Directors and other Senior Managers are permanent unless it applies to a time limited project or funding in which case contracts will be offered as a fixed term contract. GP Governing Body members contracts are for a three year period. The notice period applying to the Clinical Accountable Officer is 6 months (CCG initiated) or 3 months (CAO initiated), other than in cases of summary dismissal. Remaining Executive Directors and Senior Managers is in accordance with Agenda for Change conditions (max 12 weeks). Any termination payments would be in accordance with relevant contractual, legislative and Inland Revenue requirements. 51

52 Payments to past Senior Managers NHS Castle Point and Rochford have not made any significant awards to past Senior Managers during the period ending 31 March Salary and Pension Entitlements Similar to the CCG s predecessor organisation (south east Essex PCT and south west Essex PCT) in previous years, the information for salaries, benefits in kind and pensions entitlements is required to be detailed in the annual report. This information can be found in this report on page 55. There are no elements of remuneration, outside of the standard terms and conditions of the contracts of employment of senior managers with the exception of Dr Roger Gardiner who is also employed as NHS 111 Clinical Lead (see off payroll). The annual accounts detail the accounting policy adopted regarding the NHS pension scheme liabilities and this can be found in note 1 of the full annual accounts. The remuneration report and pay multiples can be found below: *Where any individual does not hold office for the full financial year, the dates are noted in the report and only remuneration relating to the period that an executive position was held are included in this report. Other remuneration (where shown) relate to payments for other positions held within the PCT at the same time, but which are separate to the positions noted in this report. Payments for Loss of Office No payments have been made during 2013/14 in relation to Loss of Office. Payments to Past Senior Managers Newly established from the 1 April 2013, no payments of money or other assets have been made to any individual who was not a senior manager during the financial year but has previously been a senior manager at any time. 52

53 Pension Benefits Certain Members do not receive pensionable remuneration therefore there will be no entries in respect of pensions for certain Members or where an individual may have opted out. A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member s accrued benefits and any contingent spouse s pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries Real Increase in CETV - This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period. Pay Multiples 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 member of the Governing Body in clinical commissioning group in the financial year was 105, ,000 ( , N/a). This was 1.95 times ( , N/a) the median remuneration of the workforce, which was 49,397( , N/a). In , no ( , N/a) employees received remuneration in excess of the highest paid member of the Membership Body/Governing Body. Remuneration ranged from 1,956 to 106,855 ( : N/a). 53

54 Off-Payroll Engagements Off payroll engagements as of 31 March 2014, for more than 220 per day and that last longer than six months are as follows: Number The number that have existed: For less than one year at the time of reporting 3 For between one and two years at the time of reporting 0 For between two and three years at the time of reporting 0 For between three and four years at the time of reporting 0 For four or more years at the time of reporting 0 Total number of existing engagements as of 31 March All existing off-payroll engagements, outlined above, have at some point been subject to a risk based assessment as to whether assurance is required that the individual is paying the right amount of tax and, where necessary, that assurance has been sought. Number of new engagements, or those that reached six months in duration, between 1 April 2013 and 31 March 2014 Number of the above which include contractual clauses giving the clinical commissioning group the right to request assurance in relation to Income Tax and National Insurance obligations Number for whom assurance has been requested Of which, the number: For whom assurance has been received For whom assurance has not been received That have been terminated as a result of assurance not being received Number In any cases where, exceptionally, the clinical commissioning group has engaged without including contractual clauses allowing the clinical commissioning group to seek assurance as to their tax obligations, or where assurance has been requested and not received, without a contract termination, the clinical commissioning group should set out the reasons for this.] [Provide details of the length of time each of these exceptional engagements lasted <<to be signed and dated by the Accountable Officer>> 54

55 GOVERNING BODY PROFILES GOVERNING BODY PROFILES The following table sets out the members of the Governing Body, their representation on formal sub-committees and declarations of interest as at March 2014, unless the Governing Body member was not in office at that time (as indicated by the appointment end dates). In the latter cases, the declarations of interest are the latest declarations received during the period of their Governing Body membership. Voting Governing Body Members Name, Title, Committees, Declarations of interest Dr Mike Saad Chairman Committees: Finance & Performance; Quality & Governance; Remuneration & Governance Declarations of interest: GP, Wakering Medical Practice Dr Sunil Gupta Clinical Accountable Officer Committees: Finance & Performance; Quality & Governance Declarations of interest: GP, Dr Hiscock & Partners; GP Trainer; Examiner RCGP; Member of East of England Local Education & Training Board; Member of Essex Health & Wellbeing Board; Member of Programme Board of NHS Leadership Academy; Member of NHS England Expert Working Group on Patient Safety in Primary Care; Member of Quality Working Group of NHS Commissioning Assembly; Member of Steering Group of NHS Commissioning Assembly: Member of the Board of Essex Faculty of RCGP; Member of East of England Clinical Senate Council; Member of Board of the Postgraduate Medical Institute of Anglia Ruskin University; Member of Essex Partnership Board; Member of Essex Employment and Skills Board; Has written a book on Clinical Commissioning; Wife is a Consultant Community Paediatrician in Colchester Hospital. Mr Rob Peters Vice Chairman, Lay Member (Governance) Committees: Audit (Chair); Finance & Performance; Quality & Governance; Remuneration & Procurement (Chair) Declarations of interest: Occasional consultancy Profile Dr Mike Saad has been the GP Principal at the Wakering Medical Centre since He is also the Joint Chair of the CCG having previously been a member of the South East Essex PCT CCG Executive Board, the South East Essex Local Medical Committee as well as spending time in 2005 as a GP Member of the American Health Care Review Group for the NHS. Mike is married with three daughters and lives in Southend. Dr Sunil Gupta has been a GP in Benfleet since He has been the Accountable Officer of Castle Point & Rochford CCG since September His previous roles have included Primary Care Tutor for Castle Point from 2002 until 2007, member of the Fitness to Practice Panel of the General Medical Council from 2006 until 2014 and Trustee of the Queen's Nursing Institute from 2007 until Other previous roles have included Training Programme Director for Basildon GP Vocational Training Scheme from 2007 to 2012 and Chair of the Professional Executive Committee of NHS South East Essex from 2007 to He is particularly interested in improving Patient Safety and was a Member of the East of England Clinical Programme Board for Patient Safety from 2009 to Sunil has worked with a fellow GP Trainer to collect a large amount of helpful documents including on Commissioning and Patient Safety at Rob Peters is a Certified Accountant and spent most of his working career in public services, including as an NHS Finance Director for 15 years. He also spent two years at the Department of Health leading a national finance project. After leaving the NHS employment he worked for a few years as a freelance Management Consultant in public services. 55

56 work, mainly for NHS organisations. Working temporarily with SEPT and NELFT to recruit some of their finance staff. Mr Kevin McKenny Chief Operating Officer Committees: Quality & Governance; Finance & Performance Declarations of interest: Wife is senior nurse at Southend Hospital; Daughter works for private care agency in Southend called Doris Jones ; Share a football season ticket for Premier League club with a Director at SEPT. Ms Victoria Gunn Chief Finance Officer Committees: Quality & Governance; Finance & Performance Committee Declarations of interest: Previous employee of Southend University Hospital NHS Foundation Trust and Cambridge University Hospital. Ms Patricia D Orsi Executive Nurse Committees: Quality & Governance Declarations of interest: Nil Rob has held NED roles (as Audit Committee chair) in PCTs for seven years and is currently Lay Member Governance, Audit Committee Chair and Board vice Chair for Castle Point & Rochford CCG. Within his finance career, Rob s particular interests have been sound governance and training for both junior finance staff and managers who find finance a mystery. Outside the Finance agenda he has also maintained a particular interest in Mental Health & Learning Disability services. Kevin McKenny began his NHS career in 1980 qualifying as a Registered Mental Health Nurse and later a General Nurse specialising in Oncology Nursing. He spent nearly 10 years as Essex Cancer Network Director creating a successful network with its strengths based on strong clinical engagement and strategic vision. In May 2010, Kevin moved into a Senior Commissioning role as Associate Director of Commissioning at NHS South Essex PCT. With specific responsibility for service redesign and Practice Based Commissioning (PBC), Kevin quickly developed strong relationships with GPs which has been central to the successful development of emerging CCGs in South East Essex. Victoria Gunn joined the CCG as Chief Finance Officer in April 2013 having spent four years working in finance management roles in acute trusts, including two years at both Southend University Hospital and Cambridge University Hospitals. A member of the Chartered Institute of Management Accountants, Victoria spent her early career in corporate financial management in companies such as BT, Britvic and IBM. Latterly, however, her focus has been on contract and finance consultancy in NHS settings. Tricia commenced her nurse training in 1983 at St Thomas Hospital London. She has worked in a variety of care settings including Acute, but the majority of her career was in General Practice. She developed her autonomous role from a treatment room Practice Nurse to an Advanced Nurse Practitioner and was credited with being one of the leading Practice Nurses in the country by the RCN. Tricia is passionate about patient safety and compassionate care and sees her role as a commissioning Director of Nursing to champion these elements in commissioned services. She believes that primary care has the potential to provide more opportunities for care delivery and 56

57 wishes to use her experiences to ensure that any such transition is done in a way that protects the interests of patients but increases personal choice to have care closer to home. Dr Roger Gardiner GP Representative Committees: Finance & Performance Declarations of interest: Principal Belle Vue Medical Practice Mrs Gillian Hind Lay Member (PPI) Committees: Audit, Finance & Performance; Quality & Governance (Chair); Remuneration & Procurement Declarations of interest: Chair, Adoption & Fostering Panel, London Borough of Newham Children s Dept. Dr Roger Gardiner has worked as a GP in Castle Point & Rochford for 33 years. He is a GP with a Special Interest in Substance Misuse and is the lead on a number of projects for both south Essex and the CCG. For south Essex he leads on NHS 111, the out of hours service and the Ambulance Service, he s also the CCGs lead on Unplanned Care, Continuing Health Care and Quality. Dr Gardiner is married to a dentist and has two daughters, both of whom work in medicine. Gill Hind worked in Southend Further Education College for many years mainly teaching adults and developed a special interest in adult numeracy issues. She then worked as an Education Advisor for the BBC before moving to the Financial Services Authority. Now retired, she has her own consultancy and works on a variety of projects. Gill became a Non-Executive Director for NHS SE Essex Primary Care Trust in 2006 where her main role was as Chair of Community Services during the move to separation from the PCT in April She has an interest in diabetes and chaired the Clinical Network. She was a Governor of Southend University Hospital FT. In 2011 she started working with the CCG and in 2012 was appointed as a Lay Member with special responsibility for patient and public engagement. She wanted to ensure that the CCG maintained the provision of quality services and was pleased to take on the role of chairing Quality & Governance Committee among her other responsibilities. Gill left the CCG in April 2014 as she plans to move away from the area. Dr Mahesh Kamdar GP Representative Profile awaiting confirmation Committees: Quality & Governance Declarations of interest: GP, Oaklands Surgery; Partner, Estuary Health Care Services, Wife is Director and shareholder of Essex Ultrasound & Medical Services; Wife is partner in Estuary Health Care Services; Interest declared in Essex Research Network Dr Biju Kuriakose GP Representative Dr Biju Kuriakose is the GP Principal at the Greensward Surgery in Hockley having qualified in 57

58 Committees: Quality & Governance Declarations of interest: GP, Greensward Surgery, Hockley Dr Mark Metcalfe GP Representative Committees: Nil Declarations of interest: GP Principle, Puzey Family Practice, Associate Medical Director IC24; Private health screening GP at Spire Wellesley for BUPA Wellness. (Governing Body Member from October 2013) Dr Kashif Siddiqui GP Representative Committees: Quality & Governance Declarations of interest: GP, Dr R.M. Patel & Partners As well as being a member of the CCG Governing Body, Dr Kuriakose is the CCGs Cardiovascular Lead, a GP trainer and primary care tutor. Dr Mark Metcalfe qualified as a Doctor in 2004, and as a GP in 2008, having trained at Guy s, King s College and St Thomas School of Medicine. With specific interests in out-of-hours care and training junior doctors, he works mainly as a GP partner at the Puzey Family Practice based in Rochford. Dr Kashif Siddiqui graduated from Royal Free and University College Medical School in 2005, and has been a GP principal for 18 months at Dr RM Patel and Partners, Benfleet. In addition he is a member of both the Royal College of Physicians and Royal College of General Practitioners, which has allowed him to appreciate the importance of primary and secondary care working collaboratively in an integrated fashion, to achieve the best health and wellbeing outcomes for patients. Currently Dr Siddiqui is the clinical lead for patient and public involvement for Castle Point & Rochford CCG. He is a passionate advocate of promoting an inclusive, open and transparent culture of health care within Castle Point and Rochford, ensuring that the public, patients and clinicians are at the heart of every decision made. When not at the GP surgery, in his spare time he enjoys travelling abroad and playing cricket. Dr D.S Taylor GP Representative Profile awaiting confirmation Committees: Finance & Performance (Chair) Declarations of interest: GP, Audley Mills Surgery; LMC Director; Director, White Hart Pub; Director, Pills 2 U Dr Rachael Liebmann Secondary Care Consultant Committees: Remuneration & Procurement Declarations of interest: Consultant, Maidstone & Tunbridge Wells NHS Trust; Trustee, Royal College of Pathologists; Lead for RCPath Consulting; GMC Dr Rachael Liebmann is Registrar of The Royal College of Pathologists. She has an interest in commissioning quality, regional pathology reconfiguration and clinical leadership. In her role as Registrar she has co-ordinated production of key performance indicators for quality pathology commissioning. In 2011 Rachael helped to establish RCPath Consulting which provides 58

59 Performance Assessment Team Leader; Husband is CEO of Medway Foundation Trust independent authoritative advice on pathology service issues. Rachael chaired the multidisciplinary Kent and Medway Cancer Network Breast Group for several years, before being appointed Clinical Director of the Kent and Medway Pathology Network, with leadership of all pathology services for a population of 1.7 million. In the field of education Rachael chaired the regional Specialty Training Committee for five years and was the national recruitment lead for Histopathology until Rachael represented the College on the Founding Council of the Faculty of Medical Leadership and Management and is a member of the Clinical Senate Council for South East Coast. Governing Body Observers with Speaking Rights Name, Title, Committees, Declarations of interest Ms Michelle Angell Head of Performance and Corporate Services Committees: Finance & Performance; Quality & Governance Declarations of interest: Brother works for NEPT Mr Steve Doherty Practice Manager Representative Committees: Audit Declarations of interest: Practice Business Manager, Audley Mills Surgery; Shareholder in Audley Mills Opticians Profile Michelle Angell has worked for the NHS for 14 years, holding a number of senior management positions in corporate governance and performance across the NHS in south Essex. Prior to becoming the Head of Performance for the CCG, Michelle was the Assistant Director of Performance for South Essex PCT and an Interim AD of Turnaround, she was part of the delivery team which implemented a 51m turnaround plan for South West Essex PCT. Steve Doherty is the Practice Business Manager at Audley Mills Surgery in Rayleigh. He has worked for the Practice for more than 20 years having previously worked in London for a building society. Steve is the Practice Manager Representative on the CCG board and he is officially a non-voting member with speaking rights. Steve sees his role on the board to speak up for all those who work in General Practice and to put their point of view and the views of patients. Mr Simon Griffiths Local Authority Representative Committees: Nil Declarations of interest: Essex County Council Director for Commissioning and Delivery (Observer from 1 st April 2013 to May 2013) 59

60 Miss Emily Hughes Head of Commissioning Committees: Nil Declarations: Nil Emily Hughes began her NHS career in 2003 at Mid Essex Hospital Services NHS Foundation Trust before moving into commissioning in late In June 2013 she was appointed Head of Commissioning by the newly authorised Castle Point & Rochford CCG and is responsible for delivering a number of different projects, from service redesigns to QIPP schemes. Emily also looks after the operational processes of commissioning, responding to issues with providers and ensuring the health system is running as smoothly as possible. Mr Barry McCarthy Public Representative and Chair of the Commissioning Reference Group Committees: Nil Declarations of interest: Director of CAVS (Observer from 1 st April 2013 to 1 st November 2014) Mr Nick Presmeg Local Authority Representative Committees: Nil Declarations of interest: Essex County Council Director for Commissioning and Delivery (Observer from 1 st May 2013 to 1 st January 2014) Dr Daniel Showell Public Health Consultant Committees: Quality & Governance; Remuneration & Procurement Declarations of interest: Nil Ms Helen Taylor Local Authority Representative Dr Daniel Showell qualified as a GP in 1997 before spending three years working as a primary care doctor in Lesotho, Southern Africa. He then practiced in Norfolk and Suffolk before retraining in Public Health and becoming a consultant to South East Essex PCT. Dr Showell transferred to Essex County Council in 2012 and provides public health support to the CCG. Committees: Nil Declarations of interest: Essex County Council Director for Integrated Commissioning and Vulnerable People (Observer since 1 st January 2014) 60

61 Statement of Accountable Officer s Responsibilities The National Health Service Act 2006 (as amended) states that each Clinical Commissioning Group shall have an Accountable Officer and that Officer shall be appointed by the NHS Commissioning Board (NHS England). NHS England has appointed Dr Sunil Gupta to be the Accountable Officer of the Clinical Commissioning Group. The responsibilities of an Accountable Officer, including responsibilities for the propriety and regularity of the public finances for which the Accountable Officer is answerable, for keeping proper accounting records (which disclose with reasonable accuracy at any time the financial position of the Clinical Commissioning Group and enable them to ensure that the accounts comply with the requirements of the Accounts Direction) and for safeguarding the Clinical Commissioning Group s assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities), are set out in the Clinical Commissioning Group Accountable Officer Appointment Letter. Under the National Health Service Act 2006 (as amended), NHS England has directed each Clinical Commissioning Group to prepare for each financial year financial statements in the form and on the basis set out in the Accounts Direction. The financial statements are prepared on an accruals basis and must give a true and fair view of the state of affairs of the Clinical Commissioning Group and of its net expenditure, changes in taxpayers equity and cash flows for the financial year. In preparing the financial statements, the Accountable Officer is required to comply with the requirements of the Manual for Accounts issued by the Department of Health and in particular to: Observe the Accounts Direction issued by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis; Make judgements and estimates on a reasonable basis; State whether applicable accounting standards as set out in the Manual for Accounts issued by the Department of Health have been followed, and disclose and explain any material departures in the financial statements; and, Prepare the financial statements on a going concern basis. To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my Clinical Commissioning Group Accountable Officer Appointment Letter. Dr Sunil Gupta Accountable Officer 16 th May

62 Governance Statement Introduction & Context The Castle Point and Rochford Clinical Commissioning Group (CCG) was licenced from 1 April 2013 under provisions enacted in the Health & Social Care Act 2012, which amended the National Health Service Act The CCG operated in shadow form prior to 1 April 2013, to allow for the completion of the licencing 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 CCG was licensed with four conditions and no directions, as set out below. 1. CCG must have a clear and credible integrated plan that meets authorisation requirements. 2. CCG must have detailed financial plan that delivers financial balance, sets out how it will manage within its management allowance, and is integrated with the commissioning plan. 3. Demonstrate that Quality, Innovation, Productivity and Prevention (QIPP) plans are integrated within all plans and clearly explain any changes to existing QIPP plans. 4. Provide evidence that there is a clear and time-limited resolution path to recover where the area covered by the CCG is not on track to meet the plan for Scope of Responsibility The CCG has robust plans in place to ensure that the remaining conditions are removed during the first review of 2014/15. 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. The CCG recognises the UK Corporate Governance Code as best practice and has complied to the extent appropriate for the nature and size of the organisation. 62

63 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. The following diagram outlines the governance structure of NHS Castle Point and Rochford CCG and shows the sub-committees reporting into the CCG Governing Body. CASTLE POINT & ROCHFORD CCG GOVERNANCE STRUCTURE System wide Urgent Care Network Health & Wellbeing Board Collaborative Commissioning Group Urgent Care Steering Group Urgent Care Operations Task Group Primary Care Education Group CCG GOVERNING BOARD IFR Panel LCG s Weekly Exec Meeting JSDB Quality Board Quality & Governance Sub-Committee Finance & Performance Sub-Committee Audit Committee (Sub-Committee) Remco + Procurement Sub-Committee Financial Recovery Action Group Key: Reporting to Accountable to Reporting to and Accountable to: Quality & Governance Sub-Committee Quality Board CCG Comm Reference Group Quality Surveillance Group Equality & Diversity Group Information Governance Sub-Committee Other Contract Groups inc. - SUHFT - EEAST - Hospices Southend Adult Safeguarding Board Essex Adult Safeguarding Board Essex Health Executive Forum NB: NHS 111 also reports to the Quality & Governance Sub-Committee 63

64 Other Contract Groups Host Collaborative Southend CCG - Alzheimer's Society Meds Mgt. Southend CCG - Bailey Housing (incl MCCH) quality Basildon MIND IMHA/Forensic EEAST Advocacy DMC Healthcare Essex County Council Estuary Housing Association Fairhaven's Hospice Little Havens Hospice MACA (Mental After Care Association) Marie Curie MH OLS - Resettlement (Britannia lodge) MH OLS - Resettlement (Oakwood Lodge) MH Specialist - secure placements & ED NCA - Out of Area Treatments NHS Cost per case NHS 111 (IC24) Out of Hours (IC24) Rethink (Employment) Rethink (Good companions) South Essex Partnership NHS FT - CAMHS South Essex Partnership NHS FT - Community South Essex Partnership NHS FT - MH Tavistock & Portman Transport - Non emergency patient Dr Idrees Befriending (CAVS) BPH Rosedale Rehab Beds Essex CSV NHS 111/OOH Clinical Planned Care (Weekly) NHS 111 / OOH Contract Group NHS 111 /OOH CQRG Community Contestability (Fortnightly) Finance & Performance Sub-Committee Essex MH Commissioning Board Essex MH QIPP Meeting Unplanned Care (Weekly) QIPP Workstream Meetings Prescribing (Fortnightly) SEPT Contract Management Group SEPT Contract Technical Group IAPT Working Group Children and Young People (Fortnightly) Children &Young People Clinical Leads Meeting SEPT CQRG PBR Task Group MH and LD (Fortnightly) The Governing Body meets on a bi-monthly basis and as of 31 March 2014 its voting members comprised the Chairman, six GP members, one Secondary Care Consultant representative, four Executive Directors, including the Accountable Officer, and two Lay Members. In the light of the organisational changes arising from the authorisation of the CCG from 1 st April 2013, the Governing Body has ensured that a strong focus has been maintained on the management of this transition whilst continuing to assure itself of the performance of the whole organisation in delivering its financial and other objectives. The Governing Body has used a variety of methods to judge its effectiveness. It is regularly monitoring an action plan to improve its effectiveness. There has been good attendance at Governing Body meetings. The Governing Body has promoted the NHS Codes of Conduct and Accountability via its Principles and Values as set out in the Constitution for the CCG which were adopted on 28 th March 2013 and assessed itself as being compliant with these Codes as part of its annual review of effectiveness. This assessment also identified that the Board is compliant with the relevant principles of the Corporate Governance Code in relation to providing effective leadership, having an appropriate balance of skills, experience, independence and knowledge to enable Board members to discharge their duties and responsibilities effectively, presenting a balanced and understandable assessment of the CCG s position in its financial and other reporting, and ensuring that Executive remuneration is set appropriately To support the Governing Body in carrying out its duties effectively, sub-committees reporting to the Governing Body are formally established. The remit and terms of reference of these sub-committees have been reviewed during the year to ensure robust governance and assurance. Each sub-committee submits its minutes regularly to the Governing Body and produces an annual report of its activities and any key findings. 64

65 The main sub-committees providing assurance to the Governing Body are: Audit Committee this Committee has delegated authority from the Governing Body to review and approve the Annual Accounts and Annual Report and provides assurance to the Governing Body on the organisation s Quality and Governance, Risk Management and Internal Control, Internal and External Audit; Counter Fraud and Financial Reporting arrangements. The average attendance of members at Audit Committee meetings during the 2013/14 year was 83.5%. The Audit Committee approves an annual work programme for the CCG s Local Counter Fraud Service. Regular reports against this programme are received at Audit Committee meetings, which are attended by the Local Counter Fraud Specialist, with particular scrutiny being given to the implementation of required actions. The Audit Committee also takes proactive measures by identifying potential risk areas and, where necessary, calling on management to bring forward corrective actions. Quality and Governance Committee this Committee provides assurance to the Governing Body on the systems and processes by which the CCG leads, directs and controls its functions in order to achieve organisational objectives, safety and quality of services. The Quality and Governance Committee also reviews the arrangements in place for the discharge of the CCG s statutory functions in relation to Employment practice, Equality and Diversity, Safeguarding, Health and Safety, Information Governance, patient consultation and involvement, and Complaints handling to ensure that there are no irregularities and that the CCG is legally compliant. The average attendance of members at Quality and Governance Committee meetings during the 2013/14 year was 84%. Finance and Performance Committee this Committee provides assurance to the Governing Body that financial issues are being appropriately managed and escalated where necessary and reviewing the performance of the main services commissioned by the CCG. The average attendance of members at Finance and Performance Committee meetings during the 2013/14 year was 83%. Local Commissioning Groups (LCGs) the CCG Constitution established two locality based commissioning groups to ensure appropriate engagement with our GP constituent members. One Locality Commissioning Group covers Rayleigh and Rochford area and the other Locality Commissioning Group covers the Castle Point area. The LCGs are responsible for providing clinical review and feedback for all clinical commissioning cases prior to submission to the CCG Governing Body for approval. The CCG has followed the recommendations outlined in the Mapping the Gap report issued by the Institute of Chartered Secretaries and Administrators and identified that over 60% of the Governing Body agenda is focussed on strategic issues. This was necessary due to the CCG entering financial recovery during June 2013 and local providers struggling with the delivery against NHS Constitution standards. 65

66 The CCG has circulated a survey of effectiveness to all Governing Body sub-committees and this will support the development of annual reports from the: Audit Committee Finance and Performance Committee Quality and Governance Committee Information Governance Subcommittee The CCG will be undertaking a similar review of the Governing Body in May The Clinical Commissioning Group Risk Management Framework The CCG has in place a risk management strategy that is reviewed annually and distributed to all staff and key partners. The Quality and Governance Committee is responsible for developing and endorsing the Risk Management Strategy, which is ultimately approved by the Governing Body. The Board Assurance Framework (BAF) is the CCG s principal tool for monitoring and managing the risks to the achievement of its strategic objectives and statutory duties. The CCG has combined the Board Assurance Framework and Corporate Risk Register to ensure appropriate monitoring and review of all risks across our organisation. The Joint Assurance Framework (JAF) and Corporate Risk Register includes the top local priorities (principal objectives) for 2013/14 identified in the CCG s Integrated Plan, identifies the effectiveness of the key controls to manage the risks against achievement of these priorities and the assurance provided for those controls, and includes the operational risks, the controls and assurance in place, any actions to be taken to reduce the level of risk. The Joint Assurance Framework and Corporate Risk Register is updated on an ongoing basis with a formal review undertaken bi-monthly. The formal review comprises of one to one meetings with the Corporate Services Officer and each risk owner to review changes in the controls and assurances and progress against actions agreed since the last review. A gap action plan is in place to monitor the progress of actions taken formally and will be taken to the Audit Committee for scrutiny from May The register is reviewed as a standing item on both the Audit Committee and Quality and Governance Committee agendas. The CCG has adopted the Australia / New Zealand risk management model. This provides a generic model for identifying, prioritising and dealing with risk in any situation whether at a local or corporate level. The CCG s risk assessment process ensures a consistent approach is taken to the evaluation and monitoring of risk in terms of the assessment of likelihood and consequence. The most significant risks to the organisation are identified through discussions at the Governing Body, Quality and Governance Committee and Audit Committee meetings and are reviewed by the Governing Body at its meetings in public on a quarterly basis. Each of 66

67 these risks has an associated action plan to address any gaps in control or assurance and these are also monitored by the Governing Body. The CCG s stakeholder risks are fed into the CCG s joint JAF and Corporate Risk Register through the following mechanisms: Presentation of the joint JAF and Corporate Risk Register at public Governing body meetings with encouragement from the CCG Chair for members of the public to actively participate. CCG staff who attend stakeholder meetings such as the Essex Health and Wellbeing Board, Urgent Care Network and other multi-agency groups / boards are required to feed key risks back into the CCG s JAF/Corporate Risk Register where appropriate. Escalation of key performance issues by providers to the CCG. During the year there were no reported lapses of data security. During 2013/14 the CCG appointed an Interim Recovery Director and part of their role has been to be review the current governance arrangements within the CCG and identify areas of risk to the CCG in compliance of our statutory duties. As a result of this an action plan has been developed and implementation of these actions is overseen by the CCG Governing Body. The CCG has yet to define the amount of risk that it is prepared to accept, tolerate or be exposed to at any one point in time its risk appetite against a range of risk categories. The agreed risk appetite needs to be recorded for each risk on the CCG Joint Assurance Framework and Corporate Risk Register in order to enable the Governing Body to identify those risks where more work needs to be done to bring the risk ratings to a level it is prepared to tolerate. This work is to be undertaken following a facilitated risk appetite training session with the Governing Body during 2014/15. The partnership mechanisms described previously are used to explore potential risks which may impact upon other organisations and public stakeholders. Additionally there are a number of cross organisation forums which support the process for identifying partnership risks. The CCG provides statutory and mandatory training for all staff groups and sessions on risk management, health and safety, safeguarding, equality and diversity and information governance. Articles on risk management and health and safety regularly feature in internal bulletins and newsletters and internal training has been provided on risk management, adding a risk onto the Joint Assurance Framework and Corporate Risk Register and incident reporting to all staff. The CCG Governing Body has also attended a Risk Management session held by our Internal Auditors during July The CCG has a policy on the reporting and investigation of adverse incidents. Face-to-face training and written guidance and training had been provided to CCG staff in order to support the implementation of the policy. 67

68 The Clinical Commissioning Group Internal Control Framework A system of internal control is the set of processes and procedures in place in the clinical commissioning group to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it can therefore only provide reasonable and not absolute assurance of effectiveness. The system of internal control has been in place in NHS Castle Point and Rochford CCG for the year ended 31 March 2014 and up to the date of approval of the annual report and accounts. Information Governance The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal identifiable information. The NHS Information Governance Framework is supported by an information governance toolkit and the annual submission process provides assurances to the clinical commissioning group, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively. We place high importance on ensuring there are robust information governance systems and processes in place to help protect patient and corporate information. We have established an information governance management framework and have developed information governance processes and procedures in line with the information governance toolkit. We have ensured all staff undertake annual information governance training and have implemented a staff information governance resource guide to ensure staff are aware of their information governance roles and responsibilities. There are processes in place for incident reporting and investigation of serious incidents. We have developed information risk assessment and management procedures and a programme is being established to fully embed an information risk culture throughout the organisation. Pension Obligations As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the scheme regulations are complied with. This includes ensuring that deductions from salary, employer s contributions and payments into the scheme are in accordance with the scheme rules, and that member pension scheme records are accurately updated in accordance with the timescales detailed in the regulations. Equality, Diversity & Human Rights Obligations Control measures are in place to ensure that the clinical commissioning group complies with the required public sector equality duty set out in the Equality Act

69 To ensure that any changes to clinical services do not impact negatively on quality of services, equity of access and safety of patients, all clinical commissioning cases are subject to Quality Impact Assessments and Equality and Diversity Impact Assessments prior to approval. This process is led by the CCG s Quality Team and overseen by the CCG s Chief Nurse. Sustainable Development Obligations NHS Castle Point and Rochford CCG has a Sustainable Development Management Plan (SDMP) which was approved by the Governing Body in December We are further developing plans to assess risks, enhance our performance and reduce our impact, including against carbon reduction and climate change adaptation objectives. This includes establishing mechanisms to embed social and environmental sustainability across policy development, business planning and in commissioning. We will ensure the clinical commissioning group complies with its obligations under the Climate Change Act 2008, including the Adaptation Reporting power and the Public Services (Social Value) Act We are also setting out our commitments as a socially responsible employer. 69

70 Risk Assessment in Relation to Governance, Risk Management & Internal Control The Governing Body has overall accountability for ensuring that the CCG has an effective programme for managing all types of risk and delegated the responsibility for ensuring that key strategic risks are identified and evaluated and that adequate responses are in place and monitored. The Audit Committee has responsibility for reviewing the establishment and maintenance of an effective system of governance, risk management and internal control, across the whole of the CCG s activities that supports the achievement of the CCG s objectives. The Audit Committee is chaired by a Lay Member and, as a sub-committee of the Governing Body, regularly submits its minutes to the Governing Body and produces an annual report of its activities. The Quality and Governance Committee assists the CCG in the identification and management of operational risks. Operational risks are monitored on a bi-monthly basis by the Quality and Governance Committee and reported to the Governing Body via the joint Assurance Framework and Corporate Risk Register. The Quality and Governance Committee is chaired by a Lay Member and, as a sub-committee of the Governing Body, regularly submits its minutes to the Governing Body and produces an annual report of its activities. The Financial and Performance Committee is responsible for ensuring that performance of the relevant providers is monitored and improved and also that the CCG does not overspend its financial allocation. The top five risks to the CCG have remained largely consistent throughout the year and have comprised: Capacity to adequately manage health care contracts and to deliver savings. Insufficient capacity to deliver QIPP and statutory requirements. (This is directly related to the CCG not overspending its financial allocation). Insufficient assurance that Continuing Healthcare Assessment Reviews are undertaken within the appropriate timeframe. Lack of assurance that the provider service has sufficient robust arrangements in place to train workforce prevention, recording and reporting of incidents, or identifying high risk domestic abuse. QIPP Dementia Challenging Behaviour Scheme: risk of adverse publicity and legal challenge. Review of Economy, Efficiency & Effectiveness of the Use of Resources Ensuring economy, effectiveness and efficiency in the use of resources is an important principle of the CCG and is outlined in the CCG s Constitution adopted by the Governing Body and our member practices. To ensure economy, efficiency and effectiveness in the use of resources is achieved; appropriate procurement procedures are in place, including the tendering of goods and services where necessary. Part of the role of the internal audit service that the CCG commissions involves reviewing, appraising and reporting upon the use of resources within the organisation. 70

71 A key priority for the CCG looking forward is to ensure that maximum value for money is being achieved through effective commissioning arrangements, as the majority of the CCG s expenditure is spent on commissioning healthcare services. While all healthcare providers, are required to deliver a continuous programme of QIPP, the CCG also must demonstrate that it is properly considering the health needs of the local population and commissioning those services that address those needs. The CCG uses the Joint Strategic Needs Assessment (JSNA) and other benchmarking tools to ensure identification of the areas for review to identify future QIPP schemes. Leadership for the strategy and direction in ensuring economy, efficiency and effectiveness in the use of resources comes from the Governing Body and Board to Board sessions held with local providers and neighbouring CCG. The on-going monitoring of CCG progress is undertaken by the Audit Committee through the management and direction to the internal audit programme and regular reviews of risk, and also by the Board through receipt of regular financial and commissioning updates. During 2013/14 the CCG has been working with our NHS and social care colleagues across South Essex in developing system-wide QIPP plans setting out how the we will respond to the challenging financial climate in which the NHS and the wider public sector will operate over the coming years. The CCG s overall financial management arrangements and use of resources were also subject to review by the CCG s external auditors as part of their annual review of the CCG s accounts. Review of the Effectiveness of Governance, Risk Management & Internal Control As Accounting Officer I have responsibility for reviewing the effectiveness of the system of internal control within the CCG. Capacity to Handle Risk The Chief Nurse has delegated responsibility for managing the strategic development of clinical risk management and clinical governance. The Chief Finance Officer has delegated responsibility for managing the strategic development and implementation of financial risk management. The Chief Operating Officer had delegated responsibility for managing the strategic development and implementation of organisational risk management and corporate governance. All Executives and managers are responsible for ensuring that appropriate and effective risk management processes are in place within their designated areas and scope of responsibility. The risk management process is co-ordinated by the Head of Performance and Corporate Services for non-clinical risks. Lessons are learnt through incidents, complaints and issues, internal audit recommendations, performance management and individual peer reviews, benchmarking information from the National Patient Safety Agency (NPSA), Essex Area Team, national inquiries and reviews. These lessons are shared with appropriate staff 71

72 groups, via monthly staff briefings, Staff Involvement Group meetings, team meetings and through the organisation s internal newsletter, and Local Security Management newsletters. Risk prevention and deterrence is also undertaken via pro-active security and counter fraud risk reviews, pro-active risk assessments, the dissemination of guidance on the requirements of the CCG s Standing Orders and Standing Financial Instructions, monitoring compliance against key CCG policies such as Information Governance, and regular staff awareness raising. Staff have been trained and equipped to manage risk in a way appropriate to their authority and duties. This has been supported through formal training of the CCG s Governing Body in risk management and conflicts of interests on the 29 th August 2013, provided by RSM Tenon and risk management and incident training provided to all CCG staff internally on the 24 th September This training included awareness raising in relation to supporting policies such as the Risk Management Strategy, Risk Assessment Policy, Counter Fraud Policy and Incident Reporting Policy and formal training on how to add a risk to the CCG s risk register. The Governing Body received Counter Fraud training, provided by TIAA on the 23 rd October 2013 and this included a section on the 2010 Bribery Act. The CCG has ensured that all Governing Body members and CCG staff have attended Counter Fraud and Information Governance training during the year and the Counter Fraud specialist has attended the CCG s Time To Learn session with all practices represented and provided a session on Counter Fraud and Conflicts of interest. The CCG obtains specialist support and advice in relation the management of risk associated with business continuity and emergency planning, resilience and response (EPRR) from a specialist EPRR team which is hosted by NHS Mid Essex. This team provides services to all CCGs in Essex and operates under a service level agreement which is formally monitored on a bi-monthly basis. Review of Effectiveness My review of the effectiveness of the system of internal control is informed by the work of the internal auditors and the executive managers and clinical leads within the clinical commissioning group who have responsibility for the development and maintenance of the internal control framework. I have drawn on performance information available to me. My review is also informed by comments made by the external auditors in their management letter and other reports. The Joint Board Assurance Framework itself provides me with evidence that the effectiveness of controls that manage risks to the clinical commissioning group achieving its principles objectives have been reviewed. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Governing Body, the Audit Committee and Quality and Governance Committee, if appropriate and a plan to address weaknesses and ensure continuous improvement of the system is in place. The joint Board Assurance Framework and Corporate Risk Register and gap action plan provide me with assurance that the controls in place are effectively managing the risks to the CCG in achieving our organisational objectives, as set out in the CCG s Operational Plan. 72

73 Each risk within the framework has been linked to the relevant CCG s organisational objectives to identify to impact should the risk not be appropriately managed. Review of the system of internal control is a key responsibility of the Audit Committee. Throughout the year, this committee has reviewed and endorsed key elements of the system of internal control, including the standing orders, standing financial instructions and scheme of delegation, the work of the local counter fraud service (LCFS) and the implementation of the conflicts of interest policy. The Governing Body receives assurance on the work of the Audit Committee by means of receipt of minutes at Governing Body meetings. The Lay Member (Governance), who is also Chair of the Audit Committee, verbally highlights issues pertinent to the system of internal control during Governing Body meetings and provides an annual report at year end. Neither the Audit Committee nor the Governing Body have expressed significant concerns about the adequacy of the system of internal control during the 2013/14 year, notwithstanding the conclusion of the Head of Internal Audit detailed below. Following completion of the planned audit work for the financial year for the clinical commissioning group, the Head of Internal Audit issued an independent and objective opinion on the adequacy and effectiveness of the clinical commissioning group s system of risk management, governance and internal control. The Head of Internal Audit concluded that: Based on the work undertaken in 2013/2014, significant assurance can be given that there is a generally sound system of internal control, designed to meet the organisation s objectives, and that controls are generally being applied consistently. However, some weaknesses were identified that put the achievement of particular objectives at risk. The key risks and issues are: Conflicts of Interest This was given a red opinion with issues identified in respect of not all Governing Body members and executives having completed a declaration on the register of interests, registers of interest had not been established at the localities, conflicts of interest was not a standing agenda item at all locality meetings, and declarations had not been completed by contractors who participated in tenders. Governance Whilst we were able to provide some assurance, a number of issues were identified in respect of some of the risks reviewed. It was difficult to trace how risks from the corporate risk register were escalated to the assurance framework where required, little evidence in minutes reviewed of challenge by members of the Governing Body, lack of regular scrutiny and challenge of KPI s (Key Performance Indicators) and the lack of a Governing Board Organisational Development Plan. Strategic Commissioning & QIPP The PMO (Programme Management Office) function was not successfully implemented and resulted in significant weaknesses in the monitoring and reporting framework for the CCG. 73

74 Due to significant control design and application weaknesses identified in respect of monitoring, reporting, reviewing and improving performance of QIPP, this report was given a red opinion. There is a clear action plan to address these issues which has been agreed with management. Accounts Payable South Essex Wide This was given a red opinion with issues identified around performance monitoring, delegation lists, Standing Financial Instructions and the lack of knowledge of some aspects of the system by CSU (Commissioning Support Unit) staff. Follow up undertaken during the year on the 4 reports above confirmed that all issues identified had been addressed. Risk Management & Assurance Framework (Draft) Whilst undertaken as an advisory review, a number of issues were identified in respect of the Risk Management Strategy being out of date, no risk appetite set, operational risks not all clearly identified, no locality risk registers in place, Audit Committee terms of reference required updating, risks not sufficiently detailed and lack of detail in respect of assurances. Although this report is at draft stage we have been provided with assurances by management as part of our debrief process that these recommendations have been accepted and appropriate action will be taken. Response to the comments by the Head of Internal Audit is: All the issues in the Conflict of Interest report have been addressed except the register of interests at the localities is in the process of being established. Commissioning Support Unit The Commissioning Support Unit was a new organisation in April 2013 and the Service Auditor report flagged some issues in its first report. The latest report from the Services Auditor now concludes the previous concerns have been addressed. The CCG has been monitoring performance of the Commissioning Support Unit against the action plan. Data Quality The CCG has had issues with data quality throughout 2013/14, in the main as a result of Section 251 being introduced nationally and the impact upon accessing data. To overcome these issues the CCG has put in place an information sharing protocol with local providers and data flows have resumed. This has been supported by the successful application made by the CCG to become an accredited Safe Haven for information, enabling the CCG to receive patient identifiable information. As part of this process the CCG submitted a satisfactory level of compliance with the information governance toolkit assessment at level two. 74

75 The CCG use a number of mechanisms to check data quality throughout the organisation, including benchmarking information and comparison against previous datasets to identify areas that stand out as being potentially inaccurate. A Data Quality Policy has been adopted from the predecessor PCT and is available to staff. The CCG is reliant on the CSU s staff in a number of areas to provide accurate information and has worked with them to improve the quality of data provided. The CCG has been impacted by the introduction of a new Patient Administration System within our main acute provider and this did impact on data quality during the transition period, although the level of risk was reduced due to the additional agency staff recruited to support the process. Data Security Of the 28 requirements all except one achieved a satisfactory attainment of level 2. One requirement was submitted at level 1, the pseudonymisation project within the CCG had not been fully implemented and embedded, at the time of submission in October The CCG has had no Serious Untoward Incidents relating to data security breaches at level 1 or above during the year. Discharge of Statutory Functions During establishment, the arrangements put in place by the CCG and explained within the Corporate Governance Framework were developed with extensive expert external legal input, to ensure compliance with the all relevant legislation. That legal advice also informed the matters reserved for Membership Body and Governing Body decision and the scheme of delegation. The CCG overspent by 0.4m out of a budget of 200m in so it did not meet the Statutory Function of not overspending its financial allocation. In light of the Harris Review, the clinical commissioning group has reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislative and regulations. As a result, I can confirm that the clinical commissioning group is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions. Responsibility for each duty and power has been clearly allocated to a lead Director. Directorates have confirmed that their structures provide the necessary capability and capacity to undertake all of the clinical commissioning group s statutory duties. Conclusion As Accountable Officer of NHS Castle Point and Rochford CCG, I support the Head of Internal Audit Opinion stating that during 2013/14 there has been a generally sound system of internal control, designed to meet the organisations objectives, and that controls are generally being applied consistently. As stated in the Head of Internal Audit Opinion report there were no significant control issues remaining following implementation of audit recommendations throughout the year. Dr Sunil Gupta 75

76 Accountable Officer 22 nd April

77 INDEPENDENT AUDITOR S REPORT TO THE ACCOUNTABLE OFFICER FOR NHS CASTLE POINT & ROCHFORD CCG <<to be provided by auditors at later stage>> 77

78 GLOSSARIES OF TERMS USED IN THIS ANNUAL REPORT Glossary of non-financial terms Term Care pathway Clinical Commissioning Group (CCG) Civil Contingencies Act 2004 Commissioning Community services Commissioning Support Unit (CSU) Enhanced services Equality Delivery System (EDS) Equality Impact Assessment (EIA) NHS111 Palliative Care Primary Care Trust (PCT) Definition The route that a patient will take from their first point of contact with an NHS or Social Services member of staff (usually their GP), through referral, to the completion of their treatment. Formally established on 1 April 2013, Clinical Commissioning Groups (CCGs) are statutory bodies responsible for commissioning most healthcare planning, buying and monitoring services to meet the needs of their local communities. Provides a single framework for UK civil protection against any challenges to society it focuses on local arrangements and emergency powers. The review, planning and purchasing of health and social services. Health or social care and services provided outside of hospital. They can be provided in a variety of settings including clinics and in people's homes. Community services include a wide range of services such as district nursing, health visiting services and specialist nursing services. Commissioning Support Units will provide capacity to clinical commissioners as an extension of their local team to ensure that commissioning decisions are informed and processes structured. This approach will help achieve economies of scale and allow clinical commissioning groups to focus on direct commissioning of services for their patients. Enhanced services are: i) essential or additional services delivered to a higher specified standard, for example, extended minor surgery ii) services not provided through essential or additional services They are services provided by GPs, over and above the core (essential and additional) services to their patients. The EDS has been designed nationally as an optional tool launched in 2011 to support NHS commissioners and providers to deliver better outcomes for patients and communities and better working environments for staff, which are personal, fair and diverse. The EDS is all about making positive differences to healthy living and working lives. An equality impact assessment involves assessing the likely or actual effects of policies or services on people in respect of disability, gender and racial equality. It helps us to make sure the needs of people are taken into account when we develop and implement a new policy or service or when we make a change to a current policy or service. NHS 111 is a new service introduced to make it easier for people to access local NHS healthcare services. People can call 111 when they need medical help fast but it s not a 999 emergency. NHS 111 is available 24 hours a day, 365 days a year. Calls are free from landlines and mobile phones. The total care of patients whose disease is incurable. Control of pain, of other symptoms, and of psychological, social and spiritual problems is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families. Primary Care Trusts were abolished on 31 March Prior to that they were responsible for the planning and securing of health services and improving the health of the local population. Glossary of financial terms Term Accounting Policies Budget Definition The Accounting Policies are the accounting rules that the CCG has followed in preparing its accounts. These policies are based on International Financial Reporting Standards and the Treasury s Financial Reporting Manual. The Department of Health s Manual for Accounts and Capital Accounting Manual detail how these rules should apply to CCGs. One of the main policies is that income and expenditure is recognised on an accruals basis, meaning it is recorded in the period in which services are provided even though cash may or may not have been received or paid out. A Budget usually refers to a list of all planned and expected future expenses and revenues. A budget is set at the beginning of the financial year. 78

79 Capital Expenditure Capital Resource Limit Cash Limit Revenue Resource Limit Depreciation Impairments Intangible Assets [formerly Intangible Fixed Assets] International Financial Reporting Standards Losses and Special Payments NHS Payables (formerly known as NHS Creditors) Statement of Comprehensive Net Expenditure (formerly known as Operating Cost Statement) Over Spend Capital Expenditure is money spent on buying non-current assets (fixed assets) or to add to the value of an existing fixed asset with a useful life that extends beyond a year. The Capital Resource Limit (CRL) is the amount allocated each year to the PCT for capital expenditure. The PCT must not spend more than the CRL on capital items. The Cash Limit (CL) is a limit set by the Government on the amount of cash which a CCG may spend during a given financial year. The CCG must ensure that the net amount of cash flowing out of the CCG over the financial accounting period is not more than the CL. The Revenue Resource Limit (RRL) is the total amount that the PCT may spend on the services that it commissions. This limit is set for the CCG at the start of the financial year by the Department of Health and may change on a monthly basis depending on changes to allocations to the CCG from the Strategic Health Authority for either commissioning or provider functions. Each CCG has a statutory duty not to spend more than its RRL. The RRL takes into account all accrued income and expenditure irrespective of whether income has been received or bills paid. Depreciation refers to the fact that assets with finite lives lose value over time. Depreciation involves allocating the cost of the fixed asset (less any residual value) over its useful life to the Statement of Comprehensive Net Expenditure (SCNE). This will cause an expense to be recognised on the SCNE while the net value of the asset will decrease on the Statement of Financial Position. Impairments are the losses in the values of non-current assets compared to those values recorded on the Statement of Financial Position. A CCG is required to undertake routinely revaluation reviews of its fixed assets or undertake an impairment review when there is a decline in an asset s value. The impairment (loss) is treated in the same way as depreciation, as a cost in the Statement of Comprehensive Net Expenditure (SCNE), if the change in the value of the asset is permanent. Intangible Assets are invisible or soft assets of an organisation that, nevertheless, have a real current market value and contribute to the (future) operation/income generation of the organisation and may include software licences, trademarks and research development expenditure. International Financial Reporting Standards (IFRS) are the international accounting standards that the Department of Health require CCGs to follow when they prepare their accounts was the first year in which CCGs were required to prepare IFRS compliant accounts, having previously used UK reporting standards. Losses and Special Payments are payments that Parliament would not have foreseen healthcare funds being spent on, for example fraudulent payments, personal injury payments or payments for legal compensation. An NHS Payable is an amount owed to an NHS organisation for services rendered or goods supplied to the CCG or to patients of the CCG. The Statement of Comprehensive Net Expenditure (SCNE) records the costs incurred by the CCG during the year, net of miscellaneous income (which is income other than the PCT s main funding from the Department of Health which is credited to the general fund on the Statement of Financial Position and not treated as income on the SCNE). It includes non cash expenses such as depreciation. Under government accounting rules the SCNE shows the net resources used by the CCG in commissioning and providing healthcare rather than the surplus or deficit for the year as shown in the income and expenditure account by NHS trusts. The comprehensive net expenditure is debited to the general fund on the Statement of taxpayers equity. Over Spend occurs when more money is spent than was allowed within the cash limit, revenue resource limit or capital limit, or that was planned in the budget. 79

80 Pooled budget Procurement Property, plant & equipment (formerly Tangible Fixed Assets) Provisions Statement of Cash Flows Statement of Changes in Taxpayers Equity (formerly Statement of Recognised Gains and Losses) Statement of Financial Position (formerly Balance Sheet) Tendering Trade and other Payables (Non-NHS) (formerly known as Non-NHS Creditors) Trade and other receivables (formerly Debtors) Under Spend A Pooled Budget is a joint arrangement with other bodies, such as local authorities and other CCGs, to pool funds for a specific purpose. Each body has to account for its own contribution to the pool within their accounts. Contributions would generally include the resources normally used for the identified services, together with partnership and other grants specific to the services. The host partner will manage the financial affairs of the pooled fund. The pooled budget manager is responsible for managing the pooled fund on behalf of the host authority, and for providing information to enable the partners to monitor the effectiveness of the pooled fund arrangements. Procurement is the acquisition of goods and/or services, generally through a contract, at the best possible total cost, in the right quantity and quality, at the right time and in the right place for the direct benefit of the CCG and its patients. Property, plant and equipment are assets that individually (or with integrally linked other items) cost more than 5,000 and are held for longer than one year and include: land, buildings, transport equipment, IT and furniture and fittings. A Provision is a liability arising from a past event where it is probable the CCG will have to settle and a reliable estimate can be made of the amount to be paid. The Statement of Cash Flows (SCF) shows the effect of the CCGs operating activities on its cash position. The purpose of the Statement of Changes in Taxpayers Equity is to highlight financial transactions that may not be reflected in the Statement of Comprehensive Net Expenditure, but which affect the CCGs reserves as shown in the Financed by section on the Statement of Financial Position. For example, (Reduction)/Additions in the General Fund due to the transfer of assets to/from NHS bodies and the Department of Health. The Statement of Financial Position provides a view of the CCGs financial position at a specific moment in time usually the end of the financial year. It shows assets (everything the CCG owns that has monetary value), liabilities (money owed to external parties) and taxpayers equity (public funds invested in the CCG). Tendering is the process by which one can seek prices and terms for a particular service/project to be carried out under a contract. Trade and other Payables Creditors are non-nhs organisations owed money by the CCG for goods and services provided to the CCG, e.g. for utilities, equipment, etc. Trade and other receivables represent money owed to the CCG at the Statement of Financial Position date for services rendered or goods supplied by the CCG to the receiver. Under Spend occurs when less money is spent than was allowed within the cash limit or that was planned in the budget. 80

81 Appendix A Financial Statements - DRAFT APPENDICES Appendix A - FINANCIAL STATEMENTS Appendix B SUSTAINABILITY REPORT Appendix C EQUALITY WORKFORCE INFORMATION 81

82 Appendix A Financial Statements - DRAFT 82

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112 Appendix A Financial Statements - DRAFT 5. Operating expenses Total Admin Programme Gross employee benefits Employee benefits excluding governing body members Executive governing body members Total gross employee benefits 1,154 1,154 - Other costs Services from other CCGs and NHS England 1,980 1, Services from foundation trusts 133, ,908 Services from other NHS trusts 14,883-14,883 Services from other NHS bodies Purchase of healthcare from non-nhs bodies 19,623-19,623 Chair and lay membership body and governing body members Supplies and services clinical Supplies and services general 3, ,789 Consultancy services Establishment Transport Premises 1, ,318 Impairments and reversals of receivables Inventories written down Depreciation Amortisation Impairments and reversals of property, plant and equipment Impairments and reversals of intangible assets Impairments and reversals of financial assets Assets carried at amortised cost Assets carried at cost Available for sale financial assets Impairments and reversals of non-current assets held for sale Impairments and reversals of investment properties Audit fees Other auditor s remuneration Internal audit services Other services General dental services and personal dental services Prescribing costs 26,895-26,895 Pharmaceutical services General opthalmic services GPMS/APMS and PCTMS Other professional fees excl. audit Grants to other public bodies Clinical negligence Research and development (excluding staff costs) Education and training Change in discount rate Other expenditure - - (0) Total other costs 204,121 3, ,844 Total operating expenses 205,275 4, ,844 Admin expenditure is expenditure incurred that is not a direct payment for the provision of healthcare or healthcare services. 112

113 Appendix A Financial Statements - DRAFT 113

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162 Appendix B Sustainability Report - DRAFT Appendix B - SUSTAINABILITY REPORT Sustainability Report Over recent years, the impacts caused by climate changes, such as adverse weather conditions are becoming ever more evident. These impacts can cause significant disruptions, affecting each and every one of us. Castle Point and Rochford CCG recognise the strong link between sustainability and the health of the public; we also recognise that we must ensure sustainable development is embedded in all our functions. Castle Point and Rochford CCG Governing body approved our Sustainable Development Management Plan (SDMP) in September 2013 so our plans for a sustainable future are clearly laid out and well known throughout the organisation. We have measured our impact as an organisation on corporate social responsibility (CSR) through the use of the Good corporate Citizenship (GCC) tool. The last time we used the GCC assessment was in April 2014, scoring 41% overall. The breakdown of our scoring is shown in the graph below: It should be noted that the sections of the assessment on buildings and facilities are geared towards large acute hospital trusts and not towards CGGs, like Castle Point & Rochford who are tenants in a modern building. However, all sections of the assessment are required to be completed, with less than 10% marked as not applicable, we have answered these sections to the best of our ability. Our achievements on sustainability during the 2013/14 year include: Developed and tested robust business continuity arrangements both internally and with health and social care partners in Essex to ensure all services are sustainable and resilient in the event of adverse weather conditions, power failure or other major interruptions. Made progress in changing working practices to reduce our paper and fuel consumption, including distribution of Governing Body and committee papers electronically as standard and an increased use of teleconferencing. Reviewed car leasing options available to CCG staff with a view to encouraging the use fuel efficient models. 162

163 Appendix B Sustainability Report - DRAFT We will formally reassess our performance every six months and the outcomes of these assessments will be reported in public at a Governing Body meeting and reports made available on our website. 163

164 Appendix C Equality Report - DRAFT Appendix C EQUALITY WORKFORCE INFORMATION 164

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