NHS Southwark CCG (SCCG) Audit Committee Minutes of the meeting on 27 September 2017 Room 102, 160 Tooley Street Present: Richard Gibbs Lay Member, SCCG (Chair) [RG] Robert Park Lay member, SCCG [RP] Joy Ellery Lay member, SCCG [JE] Andrew Nebel Lay member, SCCG [AN] Dr. Yvonneke Roe GP Clinical Lead, SCCG [YR] In attendance: Christine Caton Interim Chief Financial Officer, SCCG [CC] Joe Farnell Internal Auditor, KPMG [JF] Martin Taylor Security Management Specialist, TIAA [MT] Nick Atkinson Internal Auditor, R UK [NA] Sheetal Mukkamala Governance and Assurance Manager [] (minutes) Apologies: Dr. Noel Baxter Clinical Lead, SCCG [NB] Malcolm Hines Chief Financial Officer, SCCG [MH] Andrew Bland Chief Officer, SCCG [AB] Melanie Alflatt Counter Fraud Specialist, TIAA [MA] 1. Introductions ACTIONEE The chair welcomed everyone to first committee meeting for FY 17/18. There was a round of introductions. Apologies were noted from Dr. Noel Baxter, Andrew Bland and Melanie Alflatt. He welcomed Christine Caton, the Interim Financial Officer covering for Malcolm Hines. There was a round of introduction. 2. Declarations of Interest No conflicts of interests related to the business of the meeting were declared. 3. Minutes of the meeting held on 26 May 2017 JF requested a change in his title to external auditor to reflect KPMG s new role as the external auditor for 2017/18. Similarly, NA asked for John Elbake s title to internal auditor to reflect role for 2017/18. Action: to reflect changes as requested. The minutes were approved to be an accurate record of the meeting. 1
4. Enc B - Matters arising Action Log There was a single action on the log which was noted as completed and thus agreed for closure. 5. Enc C Progress Report Presenting the Internal Audit Progress Report, NA congratulated the CCG on achieving Substantial Assurance all 3 audits completed thus far this is the highest possible rating given by the auditors. The audit findings for Risk Management and Board Assurance Framework (BAF), Performance Management and Financial Management and QIPP were incorporated into the progress report. NA stated that the CCG had made good progress completing 20 of the 22 outstanding actions from the previous year. The committee discussed the two outstanding actions as below: 1) link actions to target score on the BAF (low priority) - NA declared that this action was important in order to demonstrate that action is being taken to achieve the target score and thus demonstrate the effectiveness of mitigation. confirmed the action was being picked up. 2) have ART KPIs for Better Care Fund (BCF) schemes (Medium priority) - CC informed the committee that the BCF plan submitted on 11 September contained an evaluation plan to ensure delivery of the schemes. JE commented that setting ART indicators can be a challenging task and requested NA to furnish some good practice examples. NA agreed to explore. JF recalled that the audit findings had revealed satisfactory detail on indicators and it was the timebound element of them that needed refinement. Assurance Map: NA described the Assurance Map, elaborating on the lines of defence mentioned in the report and their significance in the assurance function. RG informed the committee that the Assurance Map had received comments from him after which it had been shared with the T for actions. He envisaged the map as a tool for determining next year s audit plan rather than having much significance in the current year. The committee discussed the six areas highlighted by the assurance map as areas needing further assurance. It decided that areas in which the IGP received satisfactory assurance through monthly IAF and quality reports were: - Urgent care system outcomes - Local A&E Delivery Board governance - Incident reporting from providers. The CCG would need to seek further assurance in: 2
- GP Federation performance management - Commissioning and contracts register - Estates strategy Performance Management: NA spoke to the performance management audit which had no recommendations. He reported that the audit had been awarded substantial assurance on the basis of actions taken by CCG holding providers to account on performance and where needed, the CCG had taken meaningful action. The committee acknowledged the challenges facing main providers but felt assured of CCG s actions in holding providers to account. Risk Management and BAF: NA presented the report with three low priority recommendations. He highlighted the issue that some risks were being better updated than others, he advised that every gap should have an associated ART action. assured the committee that the governance team was picking up this action. NA confirmed that the team is ensuring the BAF is updated regularly by all risk owners and directors. Noting the benchmarking report that compared the six SEL CCG BAFs, the committee observed that Southwark CCG looked like an outlier with most number of risks on the BAF and most number of extreme risks. The committee advised using the 5x5 risk scoring matrix more efficiently. The committee also debated if this was due to splitting risks into its constituent parts where other CCGs have an aggregated approach or whether the CCG was being over-cautious in assessing risks. JE cautioned against altering the scores of BAF risks as that would lead to confusion. As the CFO for Lambeth CCG, CC offered to conduct an informal comparison to their BAF to check for any obvious aberrations. RG requested for any findings to be brought back to this committee or taken to the IGP for further discussion. Financial Management and QIPP: This was the last audit report presented by NA. RG pointed out a typo on page 34 - #1.4 non-compliance with controls should be 3 and not 22. Action: NA to amend the typo on page 34 #1.4 of the report. The committee discussed the report s findings with three recommendations. Responding to RP s concern on reliance on block contracts for CCG s main providers, CC assured that at each contracting round the CCG deliberates and debates the value brought by having block contracts in place. She confirmed that QIPP monitoring continues in the block contract environment too. NA 3
The committee noted that QIPP oversight is monitored at the IGP and routine progress updates are provided by the CFO in their finance reports. The committee approved the Progress Report and accepted the audit findings for Performance Management, Risk Management and BAF and Financial Management and QIPP. Enc D-G were circulated for information only. The committee noted the documents circulated for information. 6. Enc H-K - Local Counter Fraud Services Report and attachments: MT presented the report on behalf of Melanie Alflatt, the LCFS for Southwark CCG. Speaking on cybercrime training (Enc K) being offered by TIAA Ltd., MT advised that the training was open to all staff in the CCG and will be offered shortly. NA advised the committee that cyber-security is one of the audits scheduled for the year but awareness training will be good for the CCG. On prescribing fraud risk, YR requested an update on the work being carried out by MA. MT answered that the areas being looked into were contract fraud and high value claims. Regarding conflict of interests (CoI) work, RG pointed out that there is already a planned internal audit on CoI and cautioned against any duplication. MT and NA jointly responded that while TIAA would look into the veracity of declarations, R would assess adherence to systems and processes and compliance with national CoI guidance. On continuing care work, CC updated the committee that SEL collaborative work was underway to look at retrospective payments, specification of which has been shared with internal auditors and the LCFS. Majority of the work will be completed by National Fraud Initiative (NFI) which will look across the public sector. Action: to ensure FraudStop! And Fraud Alert flyers are uploaded to Members and Staff zone and staff made aware. The committee accepted the Counter Fraud Services Report and noted its attachments. 7. Enc L (1-2) Local Security Management Services Report and poster: MT presented the report updating the committee on the progress made since the last meeting. He advised that the security policies had all been reviewed were now in place. Conflict resolution training is being conducted for staff and had recently completed GB training too. 4
JE enquired about the roll-out of Counter terror training that had been mentioned at the last meeting. MT replied that the training is being finalised and will be available in the next few months. AN noted that the significance of counter-terror training is based on the location of the CCG headquarters in a high-profile area and not connected to the nature of the CCG s business. The committee accepted the Local Security Management Services Report with attachments. 8. Enc M Southwark CCG Annual Audit Letter: CC presented this item for information from Grant Thornton UK LLP. The letter confirmed an unqualified audit opinion for year ending March 2017 for Southwark CCG. The committee noted the Annual Audit Letter for assurance. 9. Chief Financial Officer s Report: Enc P: Annual Audit Committee Report to CCG Governing Body: This item highlighted the work of the Audit Committee during the year 2016-17. It was presented to the Audit Committee to approve for submission to the Governing Body for assurance. RG pointed out that the report needs to mention the Lessons Learned items discussion at December audit committee as it had informed two extremely useful GB seminars earlier in the year. Action: to add Lessons Learned section to the report. Speaking on service auditor reports (SAR) for the current financial year, CC informed the committee that NHS England were preparing to provide an additional SAR related to primary care commissioning support function. This report will aim to provide assurance on Capita s handling of payments after several CCGs with delegated commissioning came very close to a qualified opinion last year. The two reports that will be provided are Type 1 (Oct-Dec 2017) and Type 2 (Jan-March 2018). JF added that as external auditors, KPMG will keep abreast with any developments from NHS England on year end audits. YR expressed concern over the current Primary Care Support Services (PCSS) service with GP pensions and payments being delayed and clinical notes not arriving on time which is a patient safety issue. RG advised that issues of concern related to PCSS be picked up directly with the Director of Integrated Commissioning and the primary care team. JF requested correction of KPMG Ltd. to KPMG LLP. On page 2, NA asked for inclusion of sentence there were no audits with 5
partial assurance. Action: to effect changes suggested by auditors to the Annual Audit Committee Report. The committee approved the report (pending changes) and recommended it to the Governing Body. Enc N (1,2) Waiver s and Tender Ratification Report The committee reviewed the items on the report and in particular discussed the high value waivers and tenders in relation to SEL procurement and those related to putting in place urgent GP care-taking arrangements following CQC action. JE suggested that colour coding of items in the report may help analysis by reason of waivers undertaken. RG asked the CCG to look into colour coding by reasons on different items on the waivers report. Action: CCG to consider colour coding of items on the waivers report The committee approved the Waivers and Tender Ratification Report for the period April-September 2017. MH Local Security Management Services Contract Verbal Update: CC provided a verbal update on progress being made on LS procurement which was due to end in October 2017. She briefed the committee on latest discussions with TIAA managers on the contract. Leading the procurement on behalf of the 6 SEL CCGs, CC offered to keep the committee updated on progress. The committee noted the verbal update on LS contract. Enc O Counter Fraud Letter of Engagement This item was presented to the committee to note. The committee noted the item. Enc Q (1,2,3) - Registers for publication The registers for declaration of interests, gifts and hospitality and procurement decisions were presented to the committee for approval. The Registers for declaration of interests, gifts and hospitality and procurement decisions were approved by the committee. 10. Date of the next Audit Committee: Wednesday 20 December 2017, 12.30-2.30pm 6