NHS Luton Clinical Commissioning Group

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1 NHS Luton Clinical Commissioning Group Annual Audit Letter for the year ended 31 March 2014 July 2014 Ernst & Young LLP

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3 Ernst & Young LLP Luton CCG Board NHS Luton Clinical Commissioning Group The Lodge George Street West Luton LU1 2BJ 29 July 2014 Dear Member Annual Audit Letter 2013/14 NHS Luton Clinical Commissioning Group (the CCG) was set up to take responsibility for commissioning health services for its local population. We are pleased to be appointed as the CCG s auditor. This letter reports on our first year of work as your auditor. We look forward to building our relationship with the CCG and working with you to meet future challenges. The purpose of this annual audit letter is to communicate to the Board members and external stakeholders, including members of the public, the key issues arising from our work, which we consider should be brought to the attention of the CCG. We have already reported the detailed findings from our audit work in our 2013/14 Annual Results Report to the Audit & Risk Committee on 5 June 2014, representing those charged with governance.. We do not repeat those detailed findings in this letter. The matters reported here are the most significant for the CCG. I would like to take this opportunity to thank the CCG staff for their assistance during the course of our work. The Audit Commission recently published on its website the reports that set out performance against their requirements for compliance and quality for each of the firms. We are pleased that our report 'Ernst & Young 2013/14 Annual Regulatory Compliance and Quality Report' evidences that we have achieved the top rating available. This is an excellent result which reflects our drive to deliver first-rate external audit service to our clients and it provides assurance to you on the quality of our audit work. Yours faithfully Neil Harris Director For and on behalf of Ernst & Young LLP Enc. The UK firm Ernst & Young LLP is a limited liability partnership registered in England and Wales with registered number OC and is a member firm of Ernst & Young Global Limited. A list of members XNAMEXs is available for inspection at 1 More London Place, London SE1 2AF, the firm s principal place of business and registered office.

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5 Contents Contents 1. Executive summary Key findings Control themes and observations Fees... 9 In April 2014 the Audit Commission issued a revised version of the Statement of responsibilities of auditors and audited bodies (Statement of responsibilities). It is available from the accountable officer of each audited body and via the Audit Commission s website. The Statement of responsibilities serves as the formal terms of engagement between the Audit Commission s appointed auditors and audited bodies. It summarises where the different responsibilities of auditors and audited bodies begin and end, and what is to be expected of the audited body in certain areas. The Standing Guidance serves as our terms of appointment as auditors appointed by the Audit Commission. The Standing Guidance sets out additional requirements that auditors must comply with, over and above those set out in the Code of Audit Practice 2010 (the Code) and statute, and covers matters of practice and procedure which are of a recurring nature. This Annual Audit Letter is prepared in the context of the Statement of responsibilities. It is addressed to the Members of the audited body, and is prepared for their sole use. We, as appointed auditor, take no responsibility to any third party. Our Complaints Procedure If at any time you would like to discuss with us how our service to you could be improved, or if you are dissatisfied with the service you are receiving, you may take the issue up with your usual partner or director contact. If you prefer an alternative route, please contact Steve Varley, our Managing Partner, 1 More London Place, London SE1 2AF. We undertake to look into any complaint carefully and promptly and to do all we can to explain the position to you. Should you remain dissatisfied with any aspect of our service, you may of course take matters up with our professional institute. We can provide further information on how you may contact our professional institute. EY i

6 Executive summary 1. Executive summary Background Work on setting up the CCG began before 1 April 2013 when shadow arrangements were put in place to prepare the way for the CCG to operate from day one. NHS England authorised the CCG to take on its functions from 1 April Over the course of the year, the CCG appointed the staff it needed to run its business and established its operational framework and governance arrangements. Working arrangements were also established with healthcare providers and other suppliers, other CCGs and Central Eastern Commissioning Support Unit (CSU). The CSU is part of NHS England and provides the CCG with some of its support services. Respective responsibilities Our 2013/14 audit work has been undertaken in accordance with the Audit Plan that we issued in March 2014 and is conducted in accordance with the Audit Commission s Code of Audit Practice, International Standards on Auditing (UK and Ireland) and other guidance issued by the Audit Commission. The Clinical Commissioning Group (CCG) is responsible for preparing and publishing its statement of accounts, annual report and annual governance statement. It is also responsible for putting in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources. As auditors we are responsible for: expressing an opinion: on the financial statements; on the regularity of expenditure and income; on the parts of the remuneration report to be audited; and on the consistency of the information given in the annual report with the financial statements. reporting by exception: if the annual governance statement does not comply with NHSE Guidance or is not consistent with our understanding of the CCG; to the Secretary of State for Health and NHS England if we have concerns about the legality of transactions of decisions taken by the CCG; any significant matters that are in the public interest. forming a conclusion on the arrangements the CCG has in place to secure economy, efficiency and effectiveness in its use of resources. reporting to the National Audit Office (NAO) any differences over 250,000 between the accounts template used for the production of the whole of government accounts (WGA) and the audited financial statements. EY 1

7 Executive summary 1.3 Audit findings Summarised below are the results of our work across all of our areas of audit responsibility: Area of work Result Opinion on the: Financial statements Unqualified the accounts reported fairly on the CCG s finances. Regularity of income and expenditure Qualified financial transactions were conducted within the CCG legal framework, however there was a qualification as in 2013/14 the CCG breached its statutory duty to breakeven, with a reported deficit of 5.3million. Parts of remuneration report to be audited Consistency of the Annual Report with the financial statements Reports by exception: No matters to report the remuneration report was prepared properly within the rules set. Financial information in the Annual Report was consistent with the Annual Accounts. Consistency of Governance Statement Referrals to the Secretary of State and NHS England The final version of the Governance Statement was consistent with our understanding of the CCG. A report to the Secretary of State and NHS England was made on 28 February 2014 under section 19 of Audit Commission Act 1998 to reflect the breach in breakeven duty for 2013/14 financial year. Public interest report No matters to report in the public interest. Value for money conclusion Reporting to the National Audit Office (NAO) in line with group instructions We reported an other matter in relation to the breach of statutory duty and the CCG s ongoing forecast deficit position into 2014/15 and 2015/16 financial years. This is likely to be the subject of a further referral to the Secretary of State and NHS England under section 19 of the Audit Commission Act No matters to report EY 2

8 Executive summary As a result of the above we also have to: Issue a report to those charged with governance of the CCG communicating significant findings resulting from our audit. Issue a certificate that we have completed the audit in accordance with the requirements of the Audit Commission Act 1998 and the Code of Practice issued by the Audit Commission Audit results report issued on 5 June Issued on 5 June 2014 EY 3

9 Key findings 2. Key findings 2.1 Financial statement audit The Annual Report and Financial Statements are an important tool for the CCG to show how it has used public money and how it can demonstrate its financial management and financial health. We audited the CCG s Financial Statements in line with the Audit Commission s Code of Audit Practice, International Standards on Auditing (UK and Ireland) and other guidance issued by the Audit Commission and issued an unqualified audit report on 5 June The CCG has experienced a challenging first 15 months. As a new organisation it had to establish a framework to run the business which included using a new national accounting system. Late and changing guidance from NHS England on a number of issues also presented additional difficulties. The underlying process for producing the Financial Statements was good. Finance staff talked to us early in the process about the key issues and emerging guidance. The CCG delivered its draft Financial Statements and Annual Report by the deadline set by NHS England. We received the majority of the supporting working papers we requested. However, in some cases, it proved difficult to identify the individual transactions that made up the balances reported, which made it difficult and timeconsuming to select samples to undertake our detailed testing. The CCG were able to provide additional explanations to support these balances and once samples were selected, the CCG was able to provide the evidence we needed for our testing. We worked closely with the finance team through the audit; and staff mostly responded to our audit questions promptly. The draft Annual Report and Governance Statement provided by the deadline was incomplete and required significant revisions to meet the guidance. It went through several iterations during the audit, resulting in additional audit time and work, which we have reflected in a variation to our planned 2013/14 audit fee. The final Annual Report and Governance Statement was also not received until the day we gave our audit opinion. However, as the CCG now has a base to build upon it should not be as problematic next year. The CCG need to apply the learning from this year and ensure a robust draft is given alongside the accounts, and the relevant review processes are built into the timetable. Our detailed findings were reported to the Audit & Risk Committee 5 June The key findings are summarised as follows: Significant risk 1: As identified in ISA (UK & Ireland) 240, management is in a unique position to perpetrate fraud because of their ability to directly or indirectly manipulate accounting records and prepare fraudulent financial statements by overriding controls that otherwise appear to be operating effectively. Additionally the Health Act 2012 requires the CCG to operate within its revenue resource limit. Given these pressures we identified a significant risk that the financial statements could be manipulated to achieve breakeven. There were no matters arising from our work. EY 4

10 Key findings Other audit risk 1: This was the first year of operation for the CCG and CSU. In the run up to the preparation of the financial statements there was uncertainty over the content of the finalised CCG Annual Reporting Guidance. The audit opinion deadline had also been brought forward to 6 June. Given these issues we identified a risk regarding capacity and the ability to deliver the Financial Statements by the required deadline. The CCG presented the financial statements for audit by the 23 April deadline. The Annual Report and Annual Governance Statement were also submitted in time although they were in draft and revisions were being made. The audit opinion was given on 5 June. The underlying process for producing the financial statements was good. Other audit risk 2: The transfer of opening legacy balances from the predecessor PCT was not clear in the run up to the Financial Statements being completed. The CCG only received immaterial property, plant and equipment balances, with legacy balances for the more material continuing healthcare claims resting with NHS England at 31 March This reduced the risk around opening balances. However, there were potential accounting complications if the CCG had 2013/14 expenditure on balances that had not transferred to the CCG. We confirmed the only balances transferred to the CCG on 1 April 2013 were the PPE balances. Based on the testing carried out we gained assurance that subsequent transactions in respect of legacy balances were excluded from the CCG s 2013/14 expenditure and revenue. Errors in the financial statements We found a small number of errors in the Financial Statements most of which were corrected. These included disclosure errors, revisions to Annual Report and Governance statement, the remuneration report and related party transactions note. There was one error which the CCG chose not to amend in relation to netting off income and expenditure. These errors, corrected or uncorrected did not affect the CCG s overall expenditure or impact on its financial position. Looking ahead to 2014/15 we have established a good foundation for working with the CCG and we aim to work with finance staff to improve the accounts closure, submission and audit process in the future.. EY 5

11 Key findings 2.2 Value for money conclusion We carry out sufficient and relevant work to conclude whether the CCG has put in place proper arrangements to secure economy, efficiency and effectiveness in the use of resources. This is known as our value for money conclusion. For 2013/14, the Audit Commission recognised that CCGs were new organisations where arrangements had been developing since their authorisation. The Audit Commission provided greater flexibility in its guidance to auditors which allowed us to focus on the local risks in the CCG s first year of existence. We carried out the work required as follows: We reviewed the Governance Statement. We reviewed the results of the work of other regulatory bodies or inspectorates and considered the impact on our responsibilities. This was mainly the NHS England authorisation process. We considered the guidance from the Audit Commission, for the need for risk based work. We undertook risk-based work considering guidance from the Audit Commission, focusing on financial planning and management due to the pressures to make financial targets, as set out in our Audit Plan. We considered the CCG s strategic and financial planning arrangements and the achievement of financial targets. The CCG has a statutory duty to ensure that its revenue resource use in any financial year does not exceed the amount specified by NHS England (Section 223I(3) of the National Health Service Act The CCG spent 5.3 million in excess of the amount specified by NHS England for 2013/14. Expenditure in excess of the amount specified is unlawful and we referred this to the Secretary of State under section 19(a)/(b) of the 1998 Audit Commission Act on 28 February The CCG has produced a financial recovery plan which outlines the QIPP targets, commissioning plans and cost reductions necessary to ensure in the medium term the CCGs budgets and expenditure do not exceed amounts specified by NHS England. However, the CCG is forecasting a deficit for the 2014/15 financial year of 6.9 million and has set a budget which reflects this. This will also be subject to a referral to the Secretary of State under section 19(a)/(b) of the 1998 Audit Commission Act during our 2014/15 audit. The CCG is working closely with NHS England to accelerate efforts to improve its financial position and implement more rigorous acute contract management and monitoring. 2.3 Department of Health group instructions We reported to the National Audit office (NAO) on 5 June 2014 the outcomes of our review of your accounts template conducted under the departmental account group instructions issued by the NAO. We did not identify any areas of concern. 2.4 Annual governance statement We are required to consider the completeness of disclosures in the CCG s annual governance statement (AGS), identify any inconsistencies with the other information of which we are aware from our work, and consider whether it complies with Department of Health guidance. EY 6

12 Key findings We worked with the CCG to agree a number of revisions to the draft AGS to ensure it was compliant with the Annual Reporting Guidance and fully reflected the CCG s arrangements and developments during 2013/14. EY 7

13 Control themes and observations 3. Control themes and observations As part of our work, we obtained an understanding of internal control sufficient to plan our audit and determine the nature, timing and extent of testing performed. Although our audit was not designed to express an opinion on the effectiveness of internal control, we are required to communicate to you significant deficiencies in internal control identified during our audit. Our audit plan set out that in the first year of the CCG s existence we would carry out a fully substantive audit and not seek to rely in controls. We have not identified any significant deficiencies in the design or operation of an internal control that might result in a material misstatement in your financial statements. EY 8

14 Fees 4. Fees Our proposed fee for 2013/14 is 10,544 higher than the scale fee set by the Audit Commission. The scale fee includes a first year premium of 6,200 funded by the Audit Commission. Proposed final fee Planned fee Scale fee Total Audit Fee Code work 75,644 68,000 68,000 Referral to Secretary of state 2, Total Fee 78,544 68,000 68,000 In February 2014, we undertook additional work under statutory powers to make a referral to the Secretary of State under section 19 of the Audit Commission Act An additional fee of 2,900 was charged for this work. This extra fee has been approved by the Audit Commission. As part of our code work an additional review of the CCG s Financial Recovery Plan (FRP) was necessary to assess the CCG s financial resilience. The additional fee for this element of additional code work is 1,543, subject to Audit Commission approval. The finalisation and sign off of the financial statements took significant additional audit resource to enable the required submissions to be made by NHS England s statutory deadlines. A number of iterations of financial statements, Annual Report and Governance Statement were received in the days before the submission deadline, which created additional work for the audit team. The additional fee proposed for this element of additional opinion work is 6,101, which is subject to Audit Commission approval. EY 9

15 EY Assurance Tax Transactions Advisory Ernst & Young LLP Ernst & Young LLP. Published in the UK. All rights reserved. The UK firm Ernst & Young LLP is a limited liability partnership registered in England and Wales with registered number OC and is a member firm of Ernst & Young Global Limited. Ernst & Young LLP, 1 More London Place, London, SE1 2AF. ey.com

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