Annual Report and Accounts

Transcription

1 Annual Report and Accounts Commissioning high quality, sustainable and integrated services

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3 Contents FOREWORD STRATEGIC REPORT Isle of Wight NHS Clinical Commissioning Group Introduction Vision, values and aims Our population Our objectives and critical success factors Our financial allocation Our commissioning strategy Our business approach Isle of Wight NHS CCG Performance 2014/ Financial Performance Operational Performance NHS Constitution Targets and other Performance Metrics Quality measures Other Performance Progress against strategic priorities Factors affecting future performance Investments and budgets Resource management Risk management Stakeholder relationships and engagement Equality and Diversity Report Equality Analysis Employment Policies and Processes Equal Opportunities Policy Social, Community and Human Rights issues Gender information Sustainability Report Background Policy and governance Sustainable Development Management Plan Performance and progress Energy Water Waste Carbon footprint Other disclosures Going concern...27 Annual Report and Accounts 1

4 2. MEMBERS REPORT The Members and Membership Council The Governing Body Disclosure to Auditors Members interests Disclosure of personal data related incidents Emergency Preparedness Employee consultation Other disclosure Sickness absence data Equality disclosure Health and Safety Fraud External auditors remuneration Cost allocation and charges information Better Payments Practice Code and Prompt Payments Code Principles for Remedy Statement REMUNERATION REPORT Remuneration Committee Senior Manager s Remuneration Policy on Senior Managers Contracts Policy on remuneration of senior managers including performance related pay STATEMENTS BY THE ACCOUNTABLE OFFICER Statement of Accountable Officer Responsibility Governance Statement Introduction & Context Scope of Responsibility Compliance with the UK Corporate Governance Code Annual Report and Accounts

5 LIST OF TABLES Table Title A B C D E F G H I J K L M N O P Q R S T U 2014/15 QIPP Programme...10 NHS Constitution targets...17 NHS Constitution Supporting Measures /15 Quality Targets...18 Summary Budgets...22 Energy Use...26 Waste...26 Members of the Remuneration Committee...32 Senior Manager contract details...34 Senior Manager salaries and allowances...35 Senior Manager pension benefits...37 Pay multiples...38 Off payroll engagements...38 Assurance sought in relation to tax and NI obligations...39 Senior managers who are off payroll engagements...39 Attendance at governing body meetings...43 Attendance at Membership Council meetings...44 Attendance at Clinical Executive...46 Attendance at Quality and Patient Safety meetings...47 Attendance at Audit Committee meetings...49 Attendance at Remuneration Committee meetings...49 LIST OF FIGURES Fig Title 1 CCG investments in NHS Services 2014/ Carbon Emissions Waste breakdown CCG staff sickness rate Structure of sub committees Relationship of key committees...42 Annual Report and Accounts 3

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7 Foreword Welcome to this our second Isle of Wight CCG Annual Report. We hope that you will find this document informative and useful in understanding where we are now and some of the challenges we face in the near future. This last financial year has been challenging for the Isle of Wight across health and social care. During the year we were notified that the amount of money that will be made available for healthcare on the island will be reduced by 31m. We do not know how fast this will happen, but it does mean that we are entering a very difficult time where it will be increasingly important that every penny is spent wisely. We believe that greater integration of services across health and social care will be the key to creating a new sustainable system for island residents, and this is what we are seeking to achieve through the My Life a Full Life programme. This year our main NHS provider Isle of Wight NHS Trust received a CQC report identifying a number of areas requiring improvement. The CCG is working hard to ensure that the quality of services provided on the island is the very highest, and have supported the Trust with their improvement plan. The CQC has also inspected nursing and residential homes as well as GP surgeries, and while we think there is a lot of good practice on the island, we are committed to supporting providers requiring improvement to ensure all services deliver to a high standard. Despite difficult times, we have made good progress this year. Support for people with long term conditions, particularly for self-management and self-help continues to expand and improve, as does the support given to keep people out of hospital. We have developed new mental health, dementia and suicide prevention strategies. Our clinicians continue to support improvement of services on the island and put themselves forward as leaders in our system. We have welcomed three new GPs onto the Clinical Executive, and three more were appointed as GP locality champions. We have strongly supported the My Life a Full Life programme and will continue to work with partners to ensure integrated services centered around people are delivered. Dr John Rivers Chairman Helen Shields Chief Officer Annual Report and Accounts 5

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9 1. STRATEGIC REPORT 1.1. Isle of Wight NHS Clinical Commissioning Group Introduction NHS Isle of Wight Clinical Commissioning Group was authorised on 1 April It is made up of 17 GP practices, operating out of 22 buildings, and ranging in size from 2,500 to 13,000 patients with the largest practices in the areas of highest population density. It covers the Isle of Wight and works alongside a single Health and Wellbeing Board; one unitary local authority (The Isle of Wight Council) and one integrated NHS Trust (The Isle of Wight NHS Trust) covering acute, community, ambulance and mental health services. It also works in collaboration with a strong voluntary and independent sector. The CCG is based in office accommodation on a business park in Newport. The CCG commissions the majority of acute, mental health, community and ambulance services for Island residents. The largest provider of healthcare services is the Isle of Wight NHS Trust, with services mainly based out of St Mary s Hospital, Newport. The CCG also purchases a range of more specialised services from Portsmouth Hospitals NHS Trust and University Hospital Southampton Foundation Trust, together with services from Southampton NHS Treatment Centre. Choice is offered to patients willing to travel to mainland hospitals. In the community, the CCG commissions services from the Isle of Wight NHS Trust including district and specialist nursing and therapies. Primary care services are commissioned from GPs, pharmacists and opticians along with a host of smaller providers ranging from small privately operated physiotherapy providers to larger voluntary organisations such as AgeUK. Mental Health Services are commissioned from the Isle of Wight NHS Trust with placements on the mainland where services cannot be provided locally. Funded Nursing Care is commissioned on an individual basis, from a wide range of home care and nursing home providers, utilising the Any Qualified Provider Model. This is where providers are accredited to provide a service and patients are able to choose their preferred supplier. Isle of Wight NHS Trust also provides ambulance, patient transport and the 111, walk-in and Out of Hours service to Island residents, under a contract commissioned by the CCG. Annual Report and Accounts 7

10 Vision, values and aims The CCG vision is to: work with our partners to improve health outcomes and wellbeing for our patients, their carers and communities. ensure that when our patients need healthcare, their experience is positive. Commission high quality, sustainable and integrated services. guarantee that when the need arises, our people will access high quality, safe services. ensure the healthcare we commission is effective, efficient and financially sustainable. reduce the difference in life expectancy and burden of disease that exists between our most advantaged and most disadvantaged communities. ensure our practice members value their role within the CCG. This means we will commission services focused on quality, improved outcomes, and patient safety for the Island population. Services are delivered in an environment that best meets health needs with a shift towards community based services. These are commissioned to ensure Island health care provision is sustainable within the resources available. Underpinning this vision is a set of values: Our approach is clinically led and patient focused. We involve and listen to our communities knowing they have the capacity to participate in making decisions about their healthcare. We are accountable for the decisions we make. Flowing from this vision and set of values, the CCG s Governing Body signed off the long-term aims for the CCG at the point of authorisation in These aims were developed in conjunction with our members, taking into account the environment in which we operate: Our population The Island covers an area of square miles. It is predominantly rural but with urbanisation and greater population density around the seven main towns. The Island is among the 40% most deprived local authorities in England. Against a background of modest deprivation and a dispersed rural population there are some geographically defined areas with a higher concentration of people on low incomes, in poor housing, and with poor access to services; and consequently poorer health. These are in parts of Newport, Ryde and Ventnor. The registered population of the Isle of Wight at 31 March 2015 is 141,934. This is an increase of just under 500 individuals on the previous year. Of these 26.2% are aged over 65, an increase of 1.3% since At the same time there are more than 5,180 individuals over the age of 85 resident on the island and 60 over 100. With population in the older age groups expected to increase, the number of people unable to manage at least one self-care activity is expected to grow, as is the number of people living with dementia. 8 Annual Report and Accounts

11 According to the 2011 census: the Island s population is just under 97% white and the remaining 3% from a wide range of ethnic origins. 96% were born in the UK or have lived here for more than 10 years. 16.5% over 65s are in single person households. There are large numbers of people with long term conditions (LTCs) living on the island: over 45,000 people (32%) are currently estimated to have one or more LTC such as coronary heart disease, stroke, diabetes, chronic obstructive pulmonary disease and dementia. The number of people with one or more LTCs is predicted to increase by 2,500 people or 5.1% by We have identified that it is the number of people with three or more conditions who need targeted support and this group of people is predicted to rise by 30.2% or 11,300 people by Mental health status and a sense of wellbeing is an important determinant of overall health. It is estimated that over 16,000 Island people have common mental health problems. The high rates of claimants for incapacity benefits/employment support allowance that have a mental health problem correlates to the areas of deprivation. The major causes of poor health and premature death continue to be circulatory, respiratory diseases and cancer. Lifestyle is a significant contributing factor and preventable causes of poor health and health inequalities include smoking, alcohol misuse, physical inactivity and obesity. We know 20% of 0-17 year olds live in poverty and there are problems of obesity, smoking, teenage pregnancy and alcohol consumption, which are detrimental to children s health. The CCG works with Public Health in these areas Our objectives and critical success factors The CCG Governing Body set four objectives for the organisation, which are expressed in the Governing Body Assurance Framework: To implement our clinical commissioning strategy, making improvement to patient outcomes To demonstrate measurable improvement in the quality and safety of our commissioned services and the primary care services delivered by our members To meet the financial targets set for us by constructively challenging and supporting our providers, suppliers and members to work with maximum efficiency To work constructively with providers, partners and the public for the wellbeing of our patients and communities. Against these four objectives critical success factors have been set. These can be found later in this annual report, where we discuss the achievement of the organisation in this financial year. Annual Report and Accounts 9

12 Our financial allocation The CCG received 206m in 2014/15 for both programme and running costs. As part of its planning process, the CCG developed an investment programme. In line with the national guidance, the CCG planned 1.2% non-recurrent investments ( 2.4m) to support service transformation. Figure 1 provides an overview of how the CCG invested its funding in each sector of health care (2014/15). The CCG s Quality, Innovation, Productivity and Prevention (QIPP) programme summarised in Table A below is a key element of the investment framework. In 2014/15, the CCG invested 1.1m in QIPP schemes to generate savings of 2.8m. Figure 1: CCG investment in NHS services 2014/15 Contingency 0.5% Mental health services 10.8% Investments 3.0% Community services 13.2% Running Costs 1.7% Continuing care services 5.1% Acute services 50.0% Primary care services 15.7% PLAN AREA Recurrent Savings Recurrent Investment Total Frail Older People 64 (122) (58) Long Term Conditions 242 (94) 148 Planned Care 161 (12) 149 Unscheduled Care Mental Health Children & Young People - (316) (316) Maternity Medicines Management 2,170 (60) 2,110 Running Costs Primary Care - (450) (450) TOTAL 2,805 (1,053) 1,752 Table A: 2014/15 QIPP Programme 10 Annual Report and Accounts

13 Our commissioning strategy Against this financial allocation, our strategy reflects the views and priorities of our membership (the Isle of Wight GP practices), our health and social care partners, including the Health and Wellbeing Board and the third sector, our patients and the general public. It also reflects areas for improvement as demonstrated in the various benchmarking analysis that has been undertaken. The conclusion is a set of priorities which we feel will improve the health and social care outcomes for the people of the Isle of Wight while living within the resources which are available. Our strategy reflects the Joint Health and Wellbeing Strategy and was subject to full consultation with the Health and Wellbeing Board, the public and other key stakeholders prior to approval. Our priority areas are: Self-Care and Self-Management We will undertake programmes of work to support people to stay healthy and have healthy lifestyles; educate people to manage long term conditions, and make information and guidance readily available. We will support the third sector to deliver programmes of prevention and support, encourage the use of assistive technologies and support a falls prevention programme. Primary Care Services We will place primary care at the centre of integrated locality teams supporting vulnerable and older people. In doing this we will seek to improve premises and IT systems, supporting formal federations/collaboration of member practices and develop a programme of work supporting workforce reconfiguration. Integrated Care We will create Integrated care delivered by locality teams, implement risk stratification and case management, including developing personalised care plans. We will secure seven day a week access to services, thereby better supporting frail older people and people living with dementia; and we will increase the number of anticipatory care plans for people in the last year of their lives. Urgent Care We will implement an urgent care coordination centre and increase the range of crisis response services available to local patients. This will include direct access GP beds; an Acute GP service and better access to urgent care within Primary Care. Supporting People to improve their Mental Health We will ensure parity of esteem by commissioning to reduce stigma and discrimination. We will focus on prevention and early intervention and improved recovery and enhanced Mental Health Reablement. We will implement our strategy for Suicide Prevention and review Child and Adolescent Mental Health Services. Other Services Areas and Key Enablers Children Planned care Safeguarding Carers Workforce development and cultural change Patient engagement Information technology Annual Report and Accounts 11

14 Our business approach Isle of Wight CCG s primary purpose is to commission health services for Island residents and those others on the Island for whom we have responsibility. We have chosen to do this through a high level of integration and collaboration with other public services based on our values (see section 1.1.2). Commissioning is carried out with a combination of inhouse staff and commissioning support services provided by NHS South, Central and West Commissioning Support Unit. The Commissioning Support Unit is a NHS support agency providing a range of services to clinical commissioning groups in the south of England Isle of Wight NHS CCG Performance 2014/ Financial Performance The CCG s financial plan and budget for 2014/15 was developed in line with the CCG s Strategy and Operational Plan, reflecting the following guidance and policies: National Planning Guidance 2014/15 Everyone Counts: Planning for Patients Isle of Wight CCG Commissioning Intentions 2014/15 NHS Mandate (Incorporating NHS Outcomes Framework, NHS Constitution) Isle of Wight Joint Strategic Needs Assessment (JSNA) The expenditure budgets were developed from discussions and negotiations with the CCG s provider organisations. The plan and budget were approved by the Governing Body. As demonstrated in Note 42 of the annual accounts, for the reporting period, the CCG met all of its financial duties. The CCG delivered a surplus of 2.55m, which is 500k better than plan and remained within its administration envelope of 25 per head of population. To manage financial risk, the CCG operated a risk-share agreement with its main provider, Isle of Wight NHS Trust. Financial overspends during 2014/15 were as follows, all of which have been taken into account in activity and financial planning for 2015/16: Portsmouth Hospitals NHS Trust contract: 0.3m (9%) cardiac and critical care activity and cardiac devices. Dermatology contract: 0.2m (22%). Non-PbR (outside of tariff) drugs & devices: 0.2m (11%) Primary Care Prescribing: 0.6m (2%) Continuing Healthcare placements: 0.4m (4%) The major financial overspends were off-set by: Return of the underspend on the national Continuing Healthcare Retrospective Claim Risk Pool, on the understanding that the CCG used the funding to improve its financial surplus: 0.5m Under-achievement in the Primary Care Prescribing Incentive Scheme: 0.4m Lower activity on non-contracted activity: 0.6m Contingency: 0.7m In relation to cash, at the year end, the CCG had a ledger balance of 57k and a physical cash balance of 60k. In accordance with NHS England Guidance, CCG s were allowed to retain up to 1.25% of their March cash drawdown, which equated to 158k for the Isle of Wight CCG. The CCG did not have any capital allocation or expenditure. 12 Annual Report and Accounts

15 Operational Performance Critical success factors As part of the Governing Body Assurance Framework (GBAF), the Governing Body set critical success factors against which the organisation has monitored its progress in 2014/15. The following table offers Governing Body s assessment of progress against these factors: Objective 1: To finalise and implement our clinical commissioning strategy, making the expected improvement to patient outcomes Critical Success Factor To achieve assured status across the domains measured in the NHS England Assurance process A Joint Adult Commissioning Board (JACB) supporting the Better Care Fund is established and working Status at 31/3/15 Partially Achieved Achieved Narrative The CCG achieved Assured with support status at the end of Q3. The final status at the end of Q4 will not be available until July In the latter part of the year a number of NHS Constitution targets have not been achieved. The local NHS Trust has struggled to meet the 18 week Referral To Treatment Time (RTT) target with backlogs of patients waiting for procedures in some specialities. As discussed below, the CCG has invested significant capacity in developing a recovery plan for these targets and supporting patients to receive treatment in a timely fashion elsewhere. The CCG started the year concerned that the domains regarding leadership and governance needed to be strengthened. To this end, the CCG successfully recruited two new GP members of the Clinical Executive and a new Director of Quality and Clinical Services, bringing the leadership up to establishment. At the same time a review of internal staffing structures have been undertaken to ensure that the organisation remain fit for purpose as the task of system transformation and integration gains traction. Internal audit reports have provided assurance that the organisation has good governance in place and is managing its business effectively. Additional resources to support governance and communications is currently being sought to strengthen these areas further. As at year end the CCG is awaiting final approval of constitution changes from NHS England regarding co-commissioning and changes to other Governing Body member arrangements. By the end of the financial year the Better Care Fund budget and services were agreed between the CCG and the Local Authority. The Joint Adult Commissioning Board was established. There remain concerns that the level of financial savings anticipated as part of the Better Care Fund will be difficult to achieve, however improved project management and evaluation processes are being implemented across the CCG to mitigate this concern. Annual Report and Accounts 13

16 Critical Success Factor The Delivery Plan has been delivered as agreed in 2014/15 Status at 31/3/15 Partially Achieved Narrative The CCG put in place an ambitious and challenging work plan for the year, and good progress has been made as captured in section NHS England directed the CCG to undertake additional planning and assurance throughout the year, which has impacted on the ability of the CCG to deliver its local work plan. This has particularly impacted on the urgent care workstream. Furthermore, failure to deliver key NHS Constitution targets had required the CCG to focus on mitigating the impact of these breaches rather than pursuing other work plans. Objective 2: To demonstrate measurable improvement in the quality and safety of our commissioned services and the primary care services delivered by our members Critical Success Factor Improvement in quality outlined within the operational plan is realised in 2014/15 Improvement in quality is seen through the achievement of contractual requirements and CQUINS by all providers The primary care strategy has been put in place and implementation begun Status at 31/3/15 Partially Achieved Achieved Partially Achieved Narrative The CQC report received by the IW Trust during the year highlighted significant shortcomings in the quality of a number of services commissioned by the CCG. An action plan has been put in place and overseen by the Chief Officer. Little progress has been made in tackling healthcare acquired infection in both hospital and community settings, with the CCG breaching its ceiling for both MRSA and C. Difficle and leading to a reduction in quality premium payable. By the end of the year risks around safeguarding children has significantly improved with the system moving out of special measures. In the latter part of the year, the CCG successfully recruited a Director of Quality and Clinical Services to provide stronger leadership within the CCG. It is felt that risks regarding quality remain high, and with the recruitment of this post, the CCG will be able to commit more resources to both quality monitoring and improvement in the next period. The CCG has actively managed and supported providers to focus on their contractual CQUINs this year. The CQUIN schemes have been achieved across all providers, although there was a small reduction in the value of payments to Isle of Wight NHS Trust. The CCG operational plan includes a high level vision and ambitions for primary care and the CCG are implementing this vision. The CCG still needs to create a separate primary care strategy. 14 annual report and accounts

17 Objective 3: To meet the financial and performance targets set for us by constructively challenging and supporting our providers, suppliers and members to work with maximum efficiency Critical Success Factor The CCG meets all its financial and performance targets as set out in the guidance for 2014/15 The CCG and IW Trust has undertaken a review of the provider cost base and agreed the Island Premium The CCG has received an acknowledgement from NHS England at the highest level that the allocation needs to be reviewed Status at 31/3/15 Partially Achieved Partially Achieved Not Achieved Narrative At the end of the financial year, the CCG met all its financial targets. As discussed in objective 1 above, the CCG did not meet key NHS constitution targets in the latter half of the year. It was hoped at the beginning of the year that a model to demonstrate the savings that the Better Care Fund projects would deliver could be developed, however this has proved to be more difficult than anticipated and remains work in progress. The CCG agreed transitional funding for the Isle of Wight NHS Trust. A fundamental cost base review was agreed early in the year but did not commence until later in the year than the CCG would have liked and is not yet complete. However, the workplan has been agreed with the IW NHS Trust. Throughout the year, the CCG has engaged robustly with NHS England to seek a review of the allocation formula (see long term risks to the CCG). The national Allocations Team visited the Island and met with the CCG and Trust to understand the position and the CCG also met with local politicians and a minister of state. Although these were positive meetings at the end of the year we have not received a definitive answer from NHS England about the way forward. annual report and accounts

18 Objective 4: To work constructively with providers, partners and the public for the wellbeing of our patients and communities Critical Success Factor The Locality model of working is in place by the end of the financial year Refresh and implement the patient and stakeholder engagement strategy The CCG scores above average in the 360 survey held annually by the CCG Status at 31/3/15 Achieved Partially Achieved Narrative Locality working groups, along with GP Locality Champions and Nurse leads are in place at the end of the financial year. The CCG has been successful, along with partners, in applying for Vanguard Status to accelerate integration. The Stakeholder Strategy was refreshed early in the year, and recruitment of a professional to support implementation of the strategy is underway. There are some areas of excellent practice within the CCG, particularly in respect of stakeholder involvement in mental health, children s services and long term conditions, and engagement is embedded in normal work processes, however this remains work in progress particularly with moves towards personcentred commissioning. Achieved The CCG response rate was higher than average at 87%. Stakeholders rated the CCG above average in most areas. Areas for improvement include their confidence in the CCG s ability to improve the quality of services, overall communication and the visibility of clinical leadership NHS Constitution Targets and other Performance Metrics Consistent performance against the NHS Constitution Standards was a challenge for the Island health and social care economy during 2014/15, with capacity in the hospital and community stretched due to increased demand and increased needs of patients. The CCG met all the national NHS Constitution Key Standards (there are 17) except 5: Standard Target Narrative Referral to Treatment Time (RTT) RTT Admitted RTT Nonadmitted Both these targets were significantly impacted by surgery cancellations due to pressures on beds over the winter period; with the RTT admitted target missed by just under 5% and non-admitted by 0.2%. Achievement of the 18 weeks RTT targets at mainland hospitals is inconsistent for Island patients due to capacity issues at those hospitals. The CCG has in place an action plan, which is addressing the backlog for our patients over the first quarter of 2015/ Annual Report and Accounts

19 Cancer Two week wait for Breast Symptoms 62 Day Urgent Referral to Treatment Although the Two Week Wait for Breast Symptoms target was missed when aggregated over the year, significant work has been undertaken to resolve the issue and it was achieved in the second half of the year and expected to be achieved in Once again there have been challenges with the capacity at mainland providers for urology and oncology affecting the 62 Day Urgent Referral to Treatment target achievement. Again the CCG is actively seeking to resolve the issues that are leading to these delays. A&E Standards <4 Hour Wait Analysis has shown this is down to the capacity constraints in the healthcare system including higher than planned attendances at the ED (at both A&E and the Walk-in Centre), higher than usual conversions from ED attendances to admissions, and bed availability issues impacted by the loss of beds in the hospital and nursing homes. Table B: NHS Constitution targets The CCG performance against the NHS Constitution Supporting Measures proved the greatest challenge this year, with the health economy achieving only one standard out of 11, of note are the following: Area Target Narrative Referral to Treatment Time (RTT) Cancelled Operations rebooked in 28 days (33 patients) Cancelled Operations for second time 28 out of 220 patients had their operation cancelled taking them beyond the 18 week timeframe and of those, 9 patients were cancelled a second time. This reflects the capacity constraints due to higher than expected admissions and the requirement to cancel planned operations to enable beds to be used for these emergency patients. An action plan is in place to recover this position in the first quarter of 2015/16. RTT > 52 week wait Four patients waited longer than 52 weeks for treatment during the last financial year. Arrangements to ensure treatment for each of these patients have been put in place, together with measures to ensure that A&E Ambulance <12 Hour Trolley Wait Same Sex Accommodation Ambulance handover within 15 minutes 6 over the year had waited longer than the standard. All these occurred on a single day, the result of the pressures experienced in A&E. There were 11 Same Sex Accommodation Breaches in 2014/15, ten at St Mary s Hospital and one at University Hospitals Trust Southampton. The Ambulance service has ongoing technological recording difficulties leading to the failure in this target. However, new recording software is being implemented and a quality audit was undertaken by the CCG to check that patients safety was not being compromised. Table C: NHS Constitution Supporting Measures Other key national targets on which the CCG is measured include Readmission Rate to Hospital within 28 days 4.8% (expected performance 4%) which was 4% higher than the previous year. Local Dementia Diagnosis rate ambitions (67%) were achieved with the CCG achieving a rate of 67% of actual diagnoses to the predicted number of patients with dementia locally. Annual Report and Accounts 17

20 Quality measures The CCG is continually seeking to improve and strengthen assurance arrangements in respect of quality and safety of the services it commissions, and during 2014/15 it has sought to implement the recommendations of various national publications including Everyone Counts, Safer Staffing and Winterbourne: Transforming Care. The CCG sets quality metrics for all contractors through its contractual arrangements, collects intelligence on quality, safety and patient experience which is then used to inform its work programme. The CCG achieved 50% of the Quality Premium payable in 2014/15. The performance against quality premium targets during this financial year included: Target Status Narrative Local Target: Increase the number of diabetic patients whose last cholesterol was 5mmol or less Achieved Working with the GP practices throughout the year, the CCG has achieved its target of 71%. Local Target: Improve the rate of Patient Safety Medication Error Reporting Standardised Hospital Mortality rate Venous Thromboembolism (VTE) screening in hospital Achieved Achieved Achieved All GP practices reported the actions taken in the light of recommendations to reduce medication errors to the CCG. 20% of suggestions were reported as actioned. The CCG has seen small improvements but remain at the top end of the expected range. 98.7% of all inpatients were recorded as screened for VTE Never events Achieved None reported for the CCG in 2014/15 Healthcare acquired infection MRSA target Healthcare acquired infection C.Difficile Reduction in Pressure Ulcers (local stretch target) Not achieved One reported incident early in the year against a target of zero. Not achieved 32 cases were reported against a target of no more than 20 for the year. Not achieved The stretching local target of 50% (Grades 2, 3, & 4 both in hospital and in the community) was not achieved in any category. The publicity campaign improved awareness and reporting of pressure ulcers, however this target remains a high priority. Table D: Quality Targets 2014/15 18 Annual Report and Accounts

21 The Friends and Family Test (FFT) response rates and scores have both improved over the year for A&E and In-patients, however there has been a decline in performance since the beginning of 2015, likely a reflection again of the A&E and bed pressures seen over this period. At the end of the year the Maternity FFT had shown considerable improvements in response rate (29% at end February 2015) compared to national rates of 24.4% and satisfaction rates better than or in line with national satisfaction rates. The targets associated with reducing Years of Life Lost from causes amenable to healthcare and Emergency Admissions rates reduction will not be finalised until after this report is published, but current estimates indicate a positive outcome. Following the CQC inspection of the Isle of Wight NHS Trust in June 2014, which resulted in an overall rating of requires improvement, the CCG is supporting the Trust to implement a quality improvement plan to ensure all areas that require action have taken the necessary steps. Separately, Isle of Wight NHS Trust achieved 94% of the quality improvement schemes (CQUINs) set out by the CCG in the contract for services Safeguarding The CCG, through its designated nurses for both Children and Adults, the Chief Officer and the Director of Quality and Clinical Services, actively participates in the local Safeguarding Children and Adult Boards working closely with the local authority, public health, police and the third sector to ensure oversight and scrutiny on all safeguarding issues. The CCG supports both boards financially to ensure robust serious case reviews and board administration are undertaken effectively Other Performance GP referral rates were 2% above plan with consultant to consultant referral rates 9% above plan. Primary care prescribing and inflation (at January 2015) was 2.8% being 0.5% above England inflation rate but well below the 8% expected inflation rate. The CCG performed well against organisation management indicators with mandatory training achievement at 93.9% (meeting the local target); 99% appraisals completed, extremely low sickness absence rates and an annual staff turnover rate of 11.4% in line with the national average for CCGs Complaints The CCG managed 17 complaints during 2014/15, the majority regarding the IW NHS Trust where the complainant asked the CCG to manage the complaint. Of the complaints made regarding CCG commissioned services, two themes emerged regarding Paediatric Occupational Therapy and continuing care assessments. The CCG has systems in place to monitor all forms of feedback and to ensure that there is transparency, improved patient safety and better care for patients as a result of listening to patient experience. Further work needs to be undertaken in 2015/2016 to bring these systems together to enable data from different sources to be analysed together. Annual Report and Accounts 19

22 Progress against strategic priorities Self-care and self-management 2014/15 was an extremely productive year in terms of Self Care and Self-Management, and the CCG was instrumental in the creation of roadshows around the island and an IsleHelp event in Newport in November was a huge success. Through the My Life a Full Life programme, the CCG supported the creation of The IsleHelp Hub, a single point of access for information, advice and guidance, opened in the centre of Newport. The Community Directory created alongside this project is accessible via the My Life, A Full Life and Isle of Wight Council websites. A Care Navigator pilot, based in GP Surgeries, has proved successful and is being rolled out island-wide with joint funding between the CCG and Big Lottery Fund. During the year, grant funding under a prospectus have been made to voluntary organisations to undertake a variety of successful innovative and developmental projects, such as Singing for Breathing to improve the lung health of people with breathing problems. Educational support for patients such as the Know your Levels campaign aimed to reduce the incidence of strokes, cancer support group work to assist in the delivery of the Cancer Recovery Package. The provision of Type 2 diabetes education and Digital Inclusion work have had enthusiastic uptake with excellent outcomes. Work has also started to enable patients to review and share their health data, preventing duplication of work and providing more accurate and timely information, with the piloting of Patient Passports and islandwide personalised care plans Primary Care Services The creation of a primary care strategy has been a major focus this year with development work undertaken with primary care professionals and stakeholders. This will culminate in a written document in 2015/16, which will express the long term ambition for primary care on the island. The CCG has provided practical support to encourage the creation of a GP collaborative: One Wight Health, which was incorporated in January The Collaborative is taking centre stage in the providing a collective voice for primary care as the integration programme of work matures. A series of pilots have been undertaken in GP practices using funding aimed at improving care for patients aged over 75. Practices have been commissioned to test a range of interventions from structured ward rounds in nursing homes, to employing pharmacists in practice to support patients and paramedics undertaking visits, to creation of an app to allow patients to communicate more effectively with the practice. The CCG has also provided support to practices to improve their ability to create and manage care plans for patients, and provide follow-up and support. Locally commissioned services in pharmacy were extended in year with the commissioning of a minor ailments service enabling people to access basic medication in pharmacy without the need for a prescription. The provision of just-in-case boxes for medicines for people at end of life was also reinvigorated Integrated Care Significant progress has been made towards delivering integrated care. The new model has been agreed and locality lead nurses, senior social workers and GP Champions have been appointed as part of the first step in delivering integrated teams. These teams will be operational by June Workshops have been held on end of life care and we will be consulting on a new end of life strategy in 2015/16. The implementation of anticipatory care plans has been fully rolled out. Further work needs to be undertaken on the development of one common personal care plan and improving access to 7 day services in the community. The CCG signed a Section 75 pooled budget for the Better Care Fund (BCF) supporting integrated care between the IOW Council and the CCG. Locally we have developed plans which between both organisations contribute 20m into the BCF to support joint working and integrated service provision. 20 Annual Report and Accounts

23 Supporting people to improve their mental health The CCG has led the development of the Isle of Wight Mental Health Strategy; the Isle of Wight Suicide Awareness and Prevention Strategy; and Living Well with Dementia. These joint strategies with partner organisations have undergone extensive public consultation and received a great deal of support. All strategies have action plans which are now being implemented. The CCG has completed the work on the mental health rehabilitation pathway and there is improved access to support to reduce mainland placements and facilitate more prompt return to the Island. The IAPT service review was undertaken and proposals developed to improve performance in psychological therapies. This has been successful with the introduction of Silver Cloud and Psychology Online and the IAPT performance targets have been achieved Urgent Care An Acute GP working in A&E has now been fully implemented and funded recurrently. The service which triages GP referrals to the hospital for urgent care is reducing the number of non-elective admissions particularly surgical admissions. The Crisis Response service is an excellent example of integrated care which has also been fully implemented in This multidisciplinary team supports people for up to 72 hours in their own home and arranges ongoing support if required for people, who may otherwise have been admitted to hospital or a care home. Work is nearing completion on an Urgent Care Strategy. A System Resilience Group has been set up on a multiagency basis and numerous pilots have been put in place to improve access to services. The group delivered a clear action plan in 2014/15 for full implementation in 2015/ Other Areas Children The legal duties for the Special Educational Needs and Disability (SEND) reforms came into force in September The implementation of the new duties has involved partnership working with children and young people, parents, social care, education and voluntary organisations. The CCG has produced in conjunction with the Local Authority a local offer, which is accessible through Hampshire County Council website. Joint planning is now underway to provide support across all agencies for children requiring extra support both at home and school. The CCG embarked on a review of emergency paediatric pathways following the CQC inspection of IW NHS Trust and a further review will continue into the next reporting period. The implementation of personal budgets for children and families has begun, giving greater independence choice and control to children and their families. Annual Report and Accounts 21

24 1.3. Factors affecting future performance Investments and budgets Under NHS England s CCG funding formula, the CCG s allocation for 2015/16 is 18.4% (c 31m) above target. This is the third highest in England. For 2015/16 this has meant that CCG has received the lowest level of growth funding (1.4%, excluding 1m system resilience funding). Whilst there is no indication within the current national planning guidance that CCGs will be moved at pace to allocation targets, the CCG is not complacent and continues to engage with NHS England to understand why there is such a significant impact on the Isle of Wight and to develop an appropriate response based on the outcome. To illustrate how the CCG s investment plan supports its strategic objectives, the table below provides a comparison of the 2014/15 and 2015/16 budgets. There is a reduction in investment in acute services and an increase in primary care and community services. Summary of budgets 2014/15 Opening Budgets / Acute services 101, ,148 Mental health services 21,973 23,938 Community services 26,713 30,177 Continuing care services 10,324 11,799 Primary care services 31,802 33,896 Contingency (0.5%) 1,025 1,053 Headroom: non-recurrent expenditure 2.5% 4,988 2,008 Other expenditure 1,084 2,325 Running Costs 3,478 3,121 Total expenditure 202, ,464 Surplus 2,050 2,100 Allocation 204, ,564 Table E: Summary of budgets During the year, the investment programme was revisited and updated to take into account any slippage in the investment programme and additional funding available through underspends. As a consequence, the CCG made the following non-recurrent investments. 1m to My Life a Full Life Programme 1.6m support to IW NHS Trust for additional cost pressures e.g. medical locums 0.3m support to IW NHS Trust for CQC action plan following CQC visit 0.1m Community schemes 0.1m Mental Health schemes The CCG s over-arching investment strategy has been and will continue to be, to move investment away from the acute/hospital setting, into community and primary care services. This is in line with the Island s Health & Social Care Vision of reducing/avoiding hospital admissions through enhanced support in community and primary care settings Resource management Staff and clinical leadership A key strength of the CCG is its experienced group of core staff, its clinical leads and the relationships that have been built up with providers, contractors and patient groups over a number of years. The CCG has invested the majority of its administration budget employing the people who carry out its functions on its behalf. Staff turnover and sickness is very low Systems and processes The continued improvement to systems and processes has been achieved through an active internal audit programme. New internal auditors were appointed at the start of this financial year and have completed a full programme of work. As discussed in section 4 of this report, the CCG has received an opinion of reasonable assurance from the auditors. The CCG places a strong focus on the management of corporate risk and performance with reporting at all key governing body sub committees and at the Governing 22 Annual Report and Accounts

25 Body itself. Clear lines of accountability are established across all parts of the organisation feeding into these committees. These arrangements provide high levels of assurance to the Clinical Executive and Governing Body Technology to support the delivery of our functions The CCG has entered into a development agreement with Prescribing Services Ltd for a software system called Eclipse. Eclipse is aimed at improving the quality and safety of prescribing amongst our GP membership and is supporting a national pilot into improving patient safety. Under this agreement the CCG receives free use of this product in return for supporting the development process Intangible assets The CCG had no assets that meet the definition of an intangible asset during this reporting period. Please refer also to the resources management information provided in the Governance statement Risk management The principle risks faced by The CCG are captured in a Governing Body Assurance Framework linked to the long term objectives of the Group. At the end of this reporting period, the Governing Body had identified the following key risks and uncertainties in year: Funding Allocation: the CCG identified risks related to NHS England s new CCG funding formula. At the beginning of 2014/15 the Group s financial allocation was 21.4% (c 35m) above target (for 15/16 it is now c `31m). Whilst there has been no indication within the national planning guidance that CCGs will be moved at pace to the new allocation, the CCG has been actively working with NHS England to understand why there is such a significant impact on the Isle of Wight and to develop an appropriate response based on the outcome. Financial Issues - In response to the national Information Governance changes, which restricted the personal identifiable data a CCG could view, in 2014/15 the CCG put in place successful processes whereby the Commissioning Support Unit undertook the validating of any non-contracted activity invoices on the CCG s behalf. Provider Issues - The I W NHS Trust requires and will continue to require funding above tariff due to the diseconomies of scale within the local health economy. During 2014/15 the CCG worked with the Trust to develop a Cost Base Review exercise, which when it delivers (by the end of August 2015), will provide much greater understanding of the Trust s costs in relation to inefficiencies and diseconomies of scale. This will enable the Trust, working in partnership with the CCG, to develop local tariff variations and modifications ready for 2016/17. It will also support the financial aspects of New Models of Care work being undertaken as part of the NHS Vanguard programme Stakeholder relationships and engagement Stakeholder relationships remain strong, and have been an area of focus this year as the financial outlook for Island public services worsens. Relationships with both the Local Council and the Isle of Wight NHS Trust and our members remain close and enabled the CCG to be one of four partners in a successful bid to become a Vanguard site implementing new models of care. The CCG works closely with HealthWatch, commissioning them to undertake a specific piece of consultation work on patient views about the future of the local Walk-in Centre. A representative from HealthWatch is a member of the Quality and Patient Safety Committee. The Governing Body meetings continue to be held in different locations across the Island seeking to engage with as many people as wish and raising the profile of the CCG and its role locally. Annual Report and Accounts 23

26 The CCG refreshed the stakeholder strategy this year, however has not yet secured the resources required to implement it. In the meantime patient engagement in commissioning remains strong, particularly in areas concerning mental health, children and long term conditions Equality and Diversity Report The CCG has published its equality objectives, reports on these annually and sets new objectives at least every four years. The current targets are: Objective one seeks to embed the advancement of equality into day to day business of the CCG and actively accelerate progress towards its objectives. The CCG ensures a narrative on equality is provided to the Governing Body and each of its subcommittees on every paper and decision; and has implemented mandatory Equality and Diversity training for all staff. Objective two seeks to improve physical health checks amongst those with serious mental illness. This continues to be an area of work and is being implemented across mental health services through contractual mechanisms and is part of the quality improvement programme in primary care. The third objective is about helping people to help themselves by taking control of their health and setting their own goals and ambitions. This work stream is monitored against the protected characteristics to understand what areas the CCG should particularly target in rolling out projects such as care planning and patient passports (access to medical records) Equality Analysis The Equality Act (2010) requires public organisations to eliminate unlawful discrimination, advance equality of opportunity and foster good relations between people who may or may not share a protected characteristic. To achieve this we are required to analyse the effect of any policy, strategy, business case, and project or service change. The CCG has developed a template to support staff to consider equality impact and to identify where analysis is required. This template particularly helps staff to make a judgement in respect of the duty of due regard such that decisions with greater impact are more carefully scrutinised. We encourage the use of equality analysis at an early stage and again towards the end of a project so that any evidence gaps can be considered as part of the stakeholder engagement element of the project. The results of this analysis are reported to those committees where decisions are made to ensure that a fully rounded decision can be arrived at Employment Policies and Processes The CCG reviews and updates its employment policies and processes on a cycle in conjunction with our HR provider Equal Opportunities Policy The CCG s equality policy embraces the requirement to offer equal opportunities to all staff and job applicants recognising that it has a legal and moral responsibility to ensure that neither it nor its employees discriminate directly, indirectly or by way of victimisation. All policies used within the CCG apply equally to both disabled and non-disabled staff with the understanding that it must have due regard and need to take steps to enable an individual with a disability to access certain types of career development or training. Our policy applies to all staff, contractors who are on site, students and volunteers Social, Community and Human Rights issues As discussed in the Sustainability Report section in this Annual Report, the CCG has this year developed a Social Value Policy. The aim of this policy is to ensure that the provisions of the Social Value Act 2010 are embedded in the buying processes of the CCG. 24 Annual Report and Accounts

27 The Human Rights Act (HRA) 1998 sets out a range of rights that have implications for the way the CCG buys services and manages its workforce. The CCG has ensured that our service specifications meet the requirements of the Act. When recruiting staff we apply a values-based approach seeking to recruit people who are compassionate as well as competent. The CCG maintains a whistleblowing policy to facilitate this process. As part of our Equality analysis, issues relating to the HRA are taken into account Gender information This report is required to detail the genders of those serving in specified roles. In accordance with that requirement, we can confirm that the CCG has 80 permanent staff of which 64 are female and 16 are male. A number of our staff work part time so this is equivalent to 63.7 whole time staff. The GP Membership Body comprises eleven males and six females and the Governing Body five males and three females. Within the CCG senior leadership team there are two further senior managers who are female Sustainability Report Background Sustainability has become increasingly important as the impact of peoples lifestyles and business choices change the world in which we live. We acknowledge this responsibility to our patients, local communities and the environment by striving to minimise our carbon footprint and adhering to sustainable development principles. The CCG is committed to purchasing health care in a way that supports the UK sustainable development agenda and contributes to environmental improvements, regeneration and reducing health inequalities Policy and governance As part of its Sustainability Policy the CCG is committed to the concept of holistic commissioning, which actively takes into account the determinants of health that affect individuals, groups and wider population of the Isle of Wight. In 2014/15, the CCG has developed a Social Value Policy to further formalise how we comply with the Public Service (Social Value) Act This provides a framework to ensure that our commissioning processes such as service design, tendering and contracting will improve the environmental sustainability and social value of services at the same time as improving quality Sustainable Development Management Plan The CCG has used the Sustainable Development Unit (SDU) Strategy for the Health and Care System to develop its vision for a sustainable healthcare system which protects and improves health within environmental and social resources. In line with the SDU requirements, the CCG has developed a Sustainable Development Management Plan (SDMP) to refine a strategy and a set of actions to progress the sustainability agenda. We have developed a joint Sustainable Development Management Plan which will be ratified in June We have also engaged with the Isle of Wight Council to ensure that that there is a shared vision across the health and care system Performance and progress Over the last two years we have concentrated our efforts on tackling our direct impacts, such as relocating to an energy efficient building with energy and water efficient technologies, implementing office recycling, making pool bikes available to our staff for short distance business travel. We now want to focus on actions to improve the sustainability performance of our commissioning. Annual Report and Accounts 25

28 Energy The CCG works from a modern purpose built office building with a high energy efficiency rating. This includes high grade insulation, energy efficient lighting and controls and intelligent controlled heating and tele/video conferencing facilities to reduce the need to mainland travel. Resource 2013/ /15 Gas Us e (kwh) 0 0 tco2e 0 0 Oil Us e (kwh) 0 0 tco2e 0 0 Carbon Emissions - Energy Use Coal Us e (kwh) 0 0 tco2e 0 0 Electricity Us e (kwh) tco2e Tota l Energy CO2e Tota l Energy Spend 13, , Table F: Energy Use / /15 Gas Oil Coal Electricity Figure 2: Carbon Emissions Water In 2014/15 the CCG consumed 340m3 of water. Our toilets are fitted with water efficient technologies and we are taking practical actions to reduce our water consumption (such as using a water efficient dishwasher for our staff kitchen) Waste All of the CCG waste is office type waste. In 2014/15 about 50% of our waste was sent for recycling (materials recovery), while the residual part (black bag waste) was sent to an energy from waste plant on the island. Waste 2013/ /15 Recycling/ (tonnes) 2 2 reuse tco2e Other (tonnes) 2 2 tco2e Landfill (tonnes) 0 0 tco2e 0 0 Total Waste (tonnes) 4 4 % Recycled or Re-used Total Waste CO2e Table G: Waste Waste Breakdown 2013/ /15 Recycling/reuse Other Landfill Figure 3: Waste breakdown 26 Annual Report and Accounts

29 Carbon footprint Using the NHS Sustainable Development Unit (SDU) reporting template, we estimate our carbon footprint for 2014/15 at approximately 79,114 tco2e. Being a CCG, the overwhelming majority of our carbon footprint is indirect and a result of our commissioning activities as opposed to our operations and estate Other disclosures Going concern NHS Isle of Wight CCG Governing Body is required to assess and satisfy itself that it is appropriate to prepare the financial statements on a going concern basis for at least 12 months from the date of the accounts. To carry out the task the Governing Body has over the year considered factors that individually or collectively, might cast doubt on the going concern assumption. These issues are concerned with financial risk, operating losses (historical and current), non-achievement of savings plans or other financial targets, cash flow problems, loss of staff or management without replacement, serious non-compliance with regulatory or statutory requirements. The Governing Body is able to confirm there are no material uncertainties that may cast significant doubt about the Group s ability to continue as a going concern for at least 12 months beyond the date of the 2014/15 statement of accounts. We certify that the CCG has complied with the statutory duties laid down in the NHS Act 2006 (as amended). The accounts were prepared under Direction: NHSCB under NHS Act Signed, Helen Shields Accountable Officer 28 May 2015 Annual Report and Accounts 27

30 2. MEMBERS REPORT This report has been produced by the Governing Body on behalf of the CCG. (See Governance statement for diagram of relationship of committees) The Members and Membership Council NHS Isle of Wight Clinical Commissioning Group is made up of 17 GP practices grouped to form the three Island Localities listed below: West and Central North and East South Wight The Dower House, Carisbrooke Medical Centre Medina Healthcare Brookside Health Centre Cowes Medical Centre Tower House Surgery Esplanade Surgery Garfield Road East Cowes Surgery St. Helen s Medical Centre Argyll House Shanklin Medical Centre Sandown Health Centre Ventnor Medical Centre Beech Grove, Brading Grove House South Wight Medical Each practice is represented at the CCG Membership Council, which acts as the Electoral College for the CCG to elect member clinicians onto the Clinical Executive. It also approves the process for recruiting and removing non-elected members from the Governing Body and agrees the CCG s overarching vision, values and overall strategic direction The Governing Body The Governing Body is responsible for overseeing key relationships concerning the CCG s statutory functions. The Governing Body comprises Dr John Rivers (Chairman), Helen Shields (Chief Officer and Accountable Officer), Dr Joanna Hesse (Clinical Executive GP), David Newton (Lay Advisor Public and Patient Involvement), Loretta Outhwaite (Chief Finance Officer), Frederick Psyk (Deputy Chair/Lay Advisor Audit), Dr Ian Reckless (Secondary Care Doctor) and Dr Mark Rawlinson, (Governing Body Nurse). Feeding into the Governing Body, are four Committees that reflect the key responsibilities of the organisation. These are: The Audit Committee, providing the Governing Body with an independent and objective view of Governance and financial systems, financial information and compliance with laws, regulations and directions. The Remuneration Committee, making recommendations to the Governing Body on determinations about the remuneration, fees and other allowances for employees and for people who provide services to the CCG. The Quality and Patient Safety Committee, ensuring that all decisions are safe and effective and that they improve the quality of care experienced by patients. The Clinical Executive, taking responsibility for month-on-month operational oversight of the CCG, developing and recommending strategy, undertaking the bulk of the commissioning function and ensuring that clinical decision making remains central to its work. 28 Annual Report and Accounts

31 2.3. Disclosure to Auditors Each of the Group s Governing Body members confirms: that so far as the member is aware, that there is no relevant audit information of which the CCG s external auditor is unaware; and that the member has taken all the steps 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 CCG s auditor is aware of that information Members interests The CCG maintains a register of members interest which can be accessed at Disclosure of personal data related incidents There have been no incidents that have fallen within the criteria for reporting via the Information Governance Toolkit as specified by the Department of Health Emergency Preparedness The CCG complies with the NHS Commissioning Board Emergency Preparedness Framework. The CCG is a category 2 responder and works within the Wessex EPRR plan and is an active member of the Wessex Local Resilience Forum Employee consultation The CCG is committed to ensuring the involvement of all of its key stakeholders in the process of creating and delivering its strategic aims. We recognise that those employed by the CCG either as member practices or directly employed staff form an essential stakeholder group and that strong, two-way communication and engagement is essential to the successful delivery of the CCG strategy. Formal consultation with employees takes place through a partnership committee organised and operated by our Commissioning Support Unit, however the CCG has an informal staff forum ensuring that all areas and levels of the organisation are able to bring issues to the CCG management. As a smaller organisation we are able to hold meetings where every member of staff can be present. The Accountable Officer undertakes monthly staff briefings to ensure that all staff are kept abreast of key developments and issues within the CCG including the financial and economic factors affecting our performance. In addition the CCG uses a cascade system through the senior management to ensure staff are informed and involved in any issues affecting their interest. Through appraisal and performance management staff are aware of their contribution to the objectives and performance of the CCG. The CCG continues to develop an extranet for both staff and CCG members offering access to key policies and protocols, progress on work plans and other key documents. annual report and accounts

32 2.8. Other disclosure Sickness absence data The CCG sickness rate is on average just over 1% with a low of 0.4% in May 2014 and a high of 2.3% in March The level of sickness experienced in the CCG remains low Equality disclosure The CCG has comprehensive policies in relation to disabled employees and equal opportunities, which are available on request Better Payments Practice Code and Prompt Payments Code The CCG is signed up to the Better Payments Practice Code and the Prompt Payments Code. Details of the CCG s performance are included in the relevant note to the accounts Health and Safety The CCG has an excellent record on health and safety and as a responsible employer encourages staff to report any incidents. In 2014/15, there were no reports of assaults against staff and no reports submitted to the Health and Safety Executive. The CCG has a comprehensive policy covering health, safety and security April - 14 May - 14 June - 14 July - 14 Aug - 14 Sept - 14 Oct - 14 Nov - 14 Dec - 14 Jan - 15 Feb - 15 Mar - 15 Figure 4: sickness rate Fraud The CCG has a robust and effective counter fraud service provided by Hampshire and Isle of Wight Fraud and Security Management Service. This minimises the cost of fraud and corruption and ensures funds are available to improve patient care External auditors remuneration The CCG is required to declare any remuneration paid to auditors in respect of any non-audit work undertaken by them. It can confirm that the external auditors have not undertaken any non-audit work for the CCG in 2014/ Cost allocation and charges information The CCG certifies that the CCG has complied with HM Treasury s guidance on cost allocation and the setting of charges for information. 30 Annual Report and Accounts

33 Principles for Remedy Statement The CCG has policies in place for handling complaints and claims management that adhere to the six principles of good practice. These are: Getting it right Being customer focused Being open and accountable Acting fairly and proportionately Putting things right Seeking continuous improvement This ensures that effective and timely investigation and response can be instigated for any claim, including allegations of clinical negligence, public liability or personal injury and also works to reduce the occurrence of incidents and events, which may give rise to future claims. The CCG adheres to the Health Service Parliamentary Ombudsman and NHS Litigation Authority Guidelines which require NHS organisations to consider and provide, where appropriate, remedies for injustice or hardship resulting from maladministration or poor service. Where hardship has occurred as a result of a complaint, every effort is made to redress the injustice or hardship. The CCG will acknowledge and apologise for maladministration and poor service, explaining, if it can be determined, why the failure occurred. In addition to receiving a written response from us, a complainant may be offered a meeting with clinical or managerial staff, depending on the nature of the complaint. A full outline can be found in the CCG Complaints, compliments and concerns policy on the CCG website Complaints%20Compliments%20and%20Concerns%20Policy.pdf Annual Report and Accounts 31

34 3. Remuneration Report The Group s Remuneration Report has been prepared in line with the 2014/15 Reporting Guidance. All CCG senior managers who hold or have held office during the reporting year are included in the report. Senior managers are defined as being: those persons in senior positions, having authority or responsibility for directing or controlling the major activities of the clinical commissioning group. This means those who influence the decisions of the clinical commissioning group as a whole rather than the decisions of individual directorates or departments. Such persons include advisory and lay members. Taking the above definition into account, the Accountable Officer, has confirmed the following people to be Senior Managers: Members of the Governing Body Members of the Clinical Executive CCG Senior Management Team, who are members of the CCG Officers Group Remuneration Committee During this period, the Remuneration Committee chair was Frederick Psyk, Governing Body Lay Advisor for Governance. He started in this role in April Other members of the Remuneration Committee were: Name Title Start Date End Date Dr Joanna Hesse Clinical Executive/Governing Body Member 01/04/13 n/a David Newton Lay Advisor for Public and Patient Involvement 01/04/13 n/a Dr Ian Reckless Governing Body Secondary Care Doctor 04/09/13 n/a Dr Mark Rawlinson Governing Body Nurse 01/04/14 n/a Table H: Members of Remuneration Committee Please see the table in the Governance Statement for attendance at the four meetings of the Remuneration Committee that were held in 2014/15. Other advisors The following people provided advice to the remuneration committee during the reporting period: CCG Employees: Helen Shields, Chief Officer Others: Marthie Turner, Principal HR Business Partner, NHS South Central CSU, and Liza Walter Nelson, NHS South Central CSU South Central CSU provides HR services and advice via a Service Level Agreement (SLA); an annual fee is paid to cover all HR services On behalf of the Remuneration Committee Chair, the Chief Officer requested that the CCG s HR service supplier provided Senior HR attendance at each committee meeting to provide the members with expert HR advice on employment legislation and NHS HR policy. On the basis that the advisor is employed by an external organisation, the Committee was satisfied that the advice received was independent and objective. 32 Annual Report and Accounts

35 3.2. Senior Manager s Remuneration Policy on Senior Managers Contracts Duration of contracts and notice periods The duration of contract and notice period for senior managers is dependent on their terms and conditions. The Chief Officer, Chief Finance Officer, Deputy Chief Officer and Head of Primary Care and Corporate Business are appointed on a permanent basis. The Chief Officer s notice period is six months in line with VSM. The Chief Finance Officer s notice period was agreed by the Remuneration committee and set at six months during this reporting period. For the other senior posts, which are Agenda for Change contracts, it is three months. Termination payments In the event of a decision by the CCG to terminate the employment of any member of staff, reckonable service will be used and will be calculated on the basis of the service up to the date of the termination of the contract, based on the current Agenda for Change rules. 2 rate equivalent to the non- executive directors for the Isle of Wight NHS Trust and the equivalent terms and conditions apply. The Secondary Care Doctor and Governing Body Nurse are paid at a rate equivalent to their substantive positions and compensated for any expenses in relation to their travel and attendance at CCG meetings. The 2014/15 post holders opted for their substantive organisations to recharge for their time and expenses. The Head of Primary Care and Corporate Business, the Director for Quality and Clinical Services and all GP appointments receive an annual uplift equivalent to that agreed by the NHS for staff under Agenda for Change. Changes in salary for the Chief Officer, Chief Finance Officer, Deputy Chief Officer and Lay Members, are agreed by the Remuneration Committee. There are no plans to change the CCG s remuneration policy within the next financial year. The next table provides a summary in relation to each Senior Manager s service contract Policy on remuneration of senior managers including performance related pay In setting the pay for the CCG s three most senior officers, the committee agreed to use the VSM contract terms and conditions for the appointment of the Accountable Officer (AO). During 2014/15 the Committee considered the employment arrangements for the Chief Finance Officer, which resulted in a change in employment arrangements from VSM to Agenda for Change. The terms and conditions for the Deputy Accountable Officer, Head of Primary Care and Corporate Business and the Director for Quality and Patient Services remain on an Agenda for Change in line with its policy. For the GP appointments, including the Chair, pay and conditions remain in line with NHS Agenda for Change policy. Lay Members continue to be paid at a 2 redundancy.aspx Annual Report and Accounts 33

36 Senior managers service contract details Name Title Contracted Hours Date of contract Unexpired term (end date) Notice period Provision for termination Helen Shields Chief Officer Full time 1/4/13 No end date 6 months See Loretta Outhwaite Chief Finance Officer Full time 1/4/13 No end date 6 months See Gillian Baker Deputy Chief Officer Full time 1/4/13 No end date 3 months In line with A4C Caroline Morris Head of Primary Care & Corporate Business Full time 1/4/13 No end date 3 months In line with A4C Dr John Rivers GP Chair 4.5 sessions per week Dr Sarah Bromley GP Executive 2 sessions per week Dr Peter Coleman GP Executive 1 sessions per week Dr David Isaac GP Executive 1.5 sessions per week Dr Joanna Hesse GP Executive 2 sessions per week 1/4/ /16 3 months In line with A4C 1/4/13 31/03/16 End date In line with A4C 1/4/13 31/03/15 3 months In line with A4C 1/4/13 31/-3/15 3 months In line with A4C 1/4/13 31/03/17 3 months In line with A4C Frederick Psyk Lay Member: Governance 4 sessions per month 1/4/13 31/03/16 None, as fixed term None, as fixed term David Newton Lay Member: Public & Patient Involvement 4 sessions per month 1/4/13 31/03/16 None, as fixed term None, as fixed term Dr Ian Reckless Secondary Care Doctor 4 sessions per month 1/4/13 4/09/17 None, as fixed term None, as fixed term Dr Mark Rawlinson Governing Body Nurse 4 sessions per month 1/4/14 10/5/15 None, as fixed term None, as fixed term Dr Anitha Ande GP Executive 1 session per week 1/4/14 31/03/17 3 months In line with A4C Loretta Kinsella Interim Director of Quality and Clinical Services Table I: Senior Manager contract details Full Time 1/4/14 31/3/15 3 months In line with A4C 34 Annual Report and Accounts

37 Salaries and allowances Table J below provides the details in relation to senior manager s salaries and allowances paid during 2014/15. This table is subject to audit. 2014/ /14 Name and title Salaries & Fees Expense payments (taxable) Perf pay & bonuses Longterm perf pay & bonuses All pension related benefits Total Salaries & Fees Expense payments (taxable) Perf pay & bonuses Longterm perf pay & bonuses All pension related benefits Total Bands of 5,000 Nearest 00 Bands of 5,000 Bands of 5,000 Bands of 2,500 Bands of 5,000 Bands of 5,000 Nearest 00 Bands of 5,000 Bands of 5,000 Bands of 2,500 Bands of 5,000 '000 '00 '000 '000 '000 '000 '000 '00 '000 '000 '000 '000 SHIELDS, H Chief Officer OUTHWAITE, L Chief Finance Officer BAKER, G Deputy Chief Officer MORRIS, C Head of Primary Care & Corporate Business KINSELLA, L Interim Director of Quality & Clinical Services RIVERS, J GP Chair BROMLEY, S GP Exec ANDE, A GP Exec COLEMAN, P GP Exec Note Note 5 Note Note Note ISAAC, D GP Exec HESSE J GP Exec PSYK, F Lay Member: Governance NEWTON, D Lay Member: Public & Patient Involvement RAWLINSON, M Governing Body Nurse RECKLESS, I Secondary Care Doctor 5-10 Note Note Note Note 3 Note Note 3 Note Note 4 Note Note 4 Note 4 Table J: Senior manager salaries and allowances 2014/15. Annual Report and Accounts 35

38 Notes: Note 1: Employee is no longer contributing to the NHS Pension Scheme. Note 2: These are non-executive director posts and therefore do not receive pensionable remuneration. Note 3: Employed by Southampton University & recharged for salary plus employer s on- costs & expenses related to CCG attendance (4 sessions per month) Note 4: Employed by Oxford University Hospitals NHS Trust & recharged for salary plus employer s on-costs & expenses related to CCG attendance (4 sessions per month) Note 5: Despite several requests, NHS Pensions Agency has not supplied this information for this employee Note 6: NHS Pensions Agency does not disclose this information if the number of days of scheme membership is below a certain level, as they are in this case. Dr Sarah Bromley was only in post part-year: 1st April to 30th September 14. Loretta Kinsella was only in post part-year: 1st January to 31st March 15 All pension related benefits is calculated on the basis of how much an employee would receive over a 20 year period of retirement. So, for example, if an employee s pension benefits have increased by 2,000 in the year and their lump sum receivable on retirement has gone up by 5,000 in the year, the increase shown would be 2,000 x 20 years + 5,000, so 45,000. During the reporting period, the NHS Isle of Wight CCG has not made any payments to past senior managers. During the reporting period, NHS Isle of Wight CCG has not made any payments made for loss of office. Back row L-R Frederick Psyk, Dr Ian Reckless, Dr John Rivers, David Newton. Front row L-R Loretta Outhwaite, Helen Shields, Mark Rawlinson, Joanna Hesse. 36 annual report and accounts

39 Benefits Table K below provides a summary of the Senior Manager s pension benefits for 2014/15. This table is subject to audit. Name and title Real increase in pension at age 60 Real increase in pension lump sum at age 60 Total accrued pension at age 60 at 31st March 15 Lump sum at age 60 related to accrued pension at 31st March 15 Cash equivalent transfer value (CETV) at 31st March 14 Cash equivalent transfer value (CETV) at 31st March 15 Real increase in cash equivalent transfer value Employer s contribution to stakeholder pension Bands of 2,500 Bands of 2,500 Bands of 5,000 Bands of 5, SHIELDS, H Chief Officer OUTHWAITE, L Chief Finance Officer BAKER, G Deputy Chief Officer n/a n/a n/a MORRIS, C Head of Primary Care & Corporate Business KINSELLA, L Interim Director of Quality & Clinical Services RIVERS, J GP Chair BROMLEY, S GP Exec ANDE, A GP Exec COLEMAN, P GP Exec n/a n/a Note 1 Note 1 Note 1 Note 1 Note 1 Note 1 Note 1 n/a n/a n/a Note 1 Note 1 Note 1 Note 1 Note 1 Note 1 Note 1 n/a ISAAC, D GP Exec Note n/a HESSE J GP Exec n/a Notes: Note 1: These employees are no longer in the NHS Pension Scheme. Table K: Senior Manager Pension Benefits Note 2: Dr David Isaac works for another NHS organisation and 40% of the pension disclosed here relates to this employment There is no disclosure for the Lay Members, as they do not qualify for the NHS Pension Scheme. The Secondary Care Doctor and Nurse Advisor are employed by other bodies and their CCG related working time recharged. Their pension information is not available to the CCG and has therefore not been disclosed. annual report and accounts

40 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. It should be noted that the calculations below are based on the salary people would earn if they were working full time. Within the CCG, 36% of staff work on a part-time basis. 2014/15 Lead executive total earnings 150,878 Median total earnings 34,876 Ratio 4.33 Table L: Pay Multiples The banded remuneration of the highest paid member of the Membership Body/Governing Body in the clinical commissioning group in the financial year 2014/15 was 150,878. In 2013/14 this was 132,210. The increase relates to a salary adjustment made, in line with the CCG Remuneration Policy for this staff group, to compensate for the cessation of employer s pension contributions. The remuneration of the highest paid member of staff was 4.33 times the median remuneration of the workforce, which was 34,876. In 2013/14 the figures were 3.26 times and 40,558. The median has reduced due to a reduction in the number of clinical leads and medical director s retirement (part-time posts with a full-time equivalent salary in excess of 100k) and a small increase in lower grade posts. The ratio has increased due to the increase in the lead executive s total earnings and because the median has fallen, as explained above. In 2014/15 no employees received remuneration in excess of the highest paid member of the Membership Body/Governing Body. Excluding the highest paid director, remuneration ranged from 17,425 to 133,130. In 2013/14 the figures were 16,271 to 128,210. The majority of CCG members of staff are subject to Agenda for Change terms and conditions. Therefore, if staff were not due an increment, they received a 1% non- consolidated pay award. Total remuneration includes salary, non-consolidated performance-related pay and benefit-in-kind. It does not include severance payments, employer pension contributions and the cash equivalent transfer value of pensions Off-payroll engagements As part of this annual report, CCGs must publish information on their highly paid and/or senior off-payroll engagements. Off-payroll engagements as of 31 March 2015, for more than 220 per day and that last longer than six months are shown in Table M below: No. Number that have existed: 5 For less than one year at the time of reporting 2 For between one and two years at the time of reporting For between two and three years at the time of reporting Total number of existing engagements as of 31 March 2015 Table M: Off-Payroll Engagements as of 31st March Annual Report and Accounts

41 Two of the off-payroll engagements shown above relate to GP clinical leads, one who worked for half a session per week and the other undertaking ad-hoc sessions, which equated to less than half a session per week. Their costs are invoiced by their practices. Two of the off-payroll engagements relate to the Secondary Care Doctor and Nurse Advisor, one of whom is employed by an NHS Trust and the other by a University, with their CCG related costs recharged to the CCG. The remaining off-payroll engagement relates to the Interim Director of Quality and Clinical Services, who was seconded from another CCG and costs recharged to our CCG. 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. Table N shows that the CCG has not sought formal assurance for any off-payroll engagements, in relation to Income Tax and National Insurance obligations. This is for the following reasons: For those engagements relating to GPs, whose Practice invoiced for their time, the Practice accountant would have ensured the individual was paying an appropriate amount of tax. For those engagements relating to the Secondary Care Doctor, Nurse Advisor and Interim Director of Quality and Clinical Services, their substantive employers would have ensured that the correct tax had been paid. From 2014/15 the CCG s policies only allowed for offpayroll engagements in the following circumstances: For Secondary Care Doctor, Governing Body Nurse and Lay Member appointments: where the postholder opts for their substantive employer to be reimbursed for their CCG time and expenses. For Clinical Lead appointments: where the postholder works less than two sessions per week for the CCG or is working part-time on a short, fixedterm project and their Practice invoices for their time and expenses. Number of new engagements, or those that reached six months in duration, between 1 April 2014 and 31 March 2015 Number of the above which include contractual clauses giving the CCG the right to request assurance in relation to Income Tax & National Insurance obligations Number for whom assurance has been requested 0 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 Table N: Assurance sought in relation to Income Tax & NI Obligations As explained above and as Table O below demonstrate, three employees who meet the definition of Senior Manager are off-payroll engagements. Number of off-payroll engagements of Membership Body and / or Governing Body members, and / or, senior officials with significant financial responsibility, during the financial year Number of individuals that have been deemed Membership Body and / or Governing Body members, and/or, senior officials with significant financial responsibility, during the financial year (this figure includes both offpayroll and on-payroll engagements) Table O: Senior Managers who are off-payroll engagements Signed, Helen Shields Accountable Officer 28 May Annual Report and Accounts 39

42 4. STATEMENTS BY THE ACCOUNTABLE OFFICER 4.1. Statement of Accountable Officer Responsibility 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 NHS England. NHS England has appointed Helen Shields, Chief Officer to be the Accountable Officer of NHS Isle of Wight 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 CCG and enable them to ensure that the accounts comply with the requirements of the Accounts Direction) and for safeguarding the CCG s assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities), are set out in the Clinical Commissioning Group Accountable Officer Appointment Letter. Under the National Health Service Act 2006 (as amended), NHS England has directed each CCG to prepare for each financial year financial statements in the form and on the basis set out in the Accounts Direction. The financial statements are prepared on an accruals basis and must give a true and fair view of the state of affairs of the CCG and of its net expenditure, changes in taxpayers equity and cash flows for the financial year. In preparing the financial statements, the Accountable Officer is required to comply with the requirements of the Manual for Accounts issued by the Department of Health and in particular to: Observe the Accounts Direction issued by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis; Make 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. Helen Shields Accountable Officer 28 May Annual Report and Accounts

43 4.2. Governance Statement Introduction & Context NHS Isle of Wight CCG was licensed from 1 April 2013 under provisions enacted in the Health & Social Care Act 2012, which amended the National Health Service Act The CCG has now operated successfully for a second year and as at 1 April 2015, the Group continues to be licensed without conditions Scope of Responsibility As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the CCG 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 CCG is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity Compliance with the UK Corporate Governance Code Whilst the detailed provisions of the UK Corporate Governance Code are not mandatory for public sector bodies, compliance with the principles it contains is considered to be good practice. For the financial year ended 31 March 2015, and up to the date of signing this statement, the CCG has not sought to comply with the provisions set out in the code, but has applied the principles of the Code 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. NHS Isle of Wight CCG has a Membership Council, Governing Body and a series of Governing Body subcommittees. Statutory responsibilities have been delegated as set out in the Strategic Scheme of Delegation within Group s Constitution. This provides for the majority of decisions to be made by the Clinical Executive a clinically-driven subcommittee of the Governing Body. The relationship between the committees is shown in the next diagram: Annual Report and Accounts 41

44 Governing Body Audit Committee Remuneration Committee Quality and Patient Safety Committee Clinical Executive CCG Membership Council 17 Members Membership defined as all primary care contracts with registered lists Meets 1 or 2 x per year - supporting strategy and receiving feedback from Governing Body Makes up electoral collage for election to Governing Body One member one vote May no confidence Governing Body CCG Governing Body CCG Chairman and Lead Clinician 1 Elected Clinician Accountable Officer Chief Finance Officer Lay Member (audit and deputy chiar) Lay member - PPI Nurse Secondary Care Doctor Function - to ensure arrangements in place for CCG to fulfil statutory functions Figure 5: Structure of sub committees Clinical Executive AO CCG Lead Clinician 5 Elected Cliniicians CEO CCG Clinical Director Function: to oversea day to day and detailed work The Governing Body The Governing Body is concerned with ongoing assurance within the CCG as described within the CCG s Constitution. It makes decisions on specific issues, largely concerned with the strategy of the CCG, as set out in the Strategic Scheme of Delegation and in the event that the Clinical Executive is unable to act due to conflicts of interest. During the reporting period, the Governing Body: Figure 6: Relationship of key committees refreshed the CCG Strategy and approved the year s operational plan. It also noted the joint strategies for Mental Health, Suicide and Dementia produced with the Local Authority overseen the implementation of internal audit report recommendations across the Governing Body Committees, improved Committee Terms of Reference and strengthened internal governance arrangements further developed systems and processes for approving and progressing towards the CCG s longer term objectives and updated the Assurance Framework and critical success factors reviewed the terms of office of clinical executive members and agreed succession planning for the Chair submitted a bid to engage in commissioning core primary care services jointly with NHS England considered and approved a range of clinical priority statements including thresholds for the treatment for varicose veins and assisted conception services approved the overarching safeguarding strategy and signing up to the domestic abuse pledge approved the Emergency Preparedness, Resilience and Response (EPRR) plans for the organisation and the wider health economy approved matters in which the Clinical Executive had a conflict of interest, in particular the continuation of Anticoagulation Services in primary care and arrangements for improving services for patients over 75 in primary care 42 Annual Report and Accounts

45 Table P below indicates the members of the Governing Body during this reporting period (2014/15) and their attendance at meetings held in public: Table P: Attendance at Governing Body Meetings Name Title June July Sept Nov Jan Mar Dr J Rivers Chairman F Psyk Lay Advisor for Governance and Deputy Chair Dr M Rawlinson Governing Body Nurse Dr J Hesse Clinical Executive member and GP D Newton Lay Advisor for Patient and Public Involvement L Outhwaite Chief Finance Officer Dr I Reckless Secondary Care Doctor H Shields Chief Officer In the latter part of the financial year, the Governing Body met in seminar form to review its progress, the Group s constitution and the terms of reference for the sub committees, particularly in the light of the creation of a new sub-committee for primary care that is joint with NHS England. It determined that the constitution would be changed such that the membership of the Governing Body could be increased by two members (one executive and one non-executive) to improve the resilience of the Governing Body and its sub committees, altering the balance between Executive and independent lay members to GP members to allow the organisation to engage more fully with the primary care commissioning agenda and is a first step towards formal delegation of primary care commissioning responsibilities. The time commitments expected of the lay and external members of the Governing Body were also confirmed. The Governing Body has also approved the creation of a Joint Adult Commissioning Board with the Local Authority that will take responsibility for services commissioned under the Better Care Fund, representing a significant step towards integrating health and social care commissioning for the future. Following review, the CCG is further improving the arrangements for the Governing Body: Reviewing the decision making structures to allow for full delegation of primary care commissioning in a future year. Further refine the terms of reference for the Joint Adult Commissioning Board in line with the section 75 pooled budget agreement Changes the CCG constitution to take account of the changing nature and scope of CCG responsibilities Ongoing review of the learning needs of Governing Body members to improve the body s oversight of the CCG. Annual Report and Accounts 43

46 The Membership Council The Membership Council has specific responsibilities to ensure that the Governing Body retains the confidence of the membership and to participate in the development of the overarching clinical strategy of the CCG. It also acts as the electoral college to the Clinical Executive on the expiry of clinical executive terms. The Membership Council have met twice during the year. Once to review the annual report 2013/14 and agree changes to the constitution to support succession for clinical executive members and second to agree new terms of reference of committees proposed by the Governing Body and approve joint commissioning arrangements with NHS England for primary care. An election for two new Clinical Executive members was undertaken by the Membership Council with two nominations made. A mandate vote was held after which Dr Michele Legg and Dr Ben Browne were mandated onto the Clinical Executive. Table Q below indicates the members of the Membership Council and their attendance/involvement during the reporting period: Name Surgery Other roles within CCG Meeting July 2014 Dr Andreas Lehmann Medina Healthcare Chair, West and Central Locality Member Individual Funding Request Panel Meeting Jan 2015 Dr Jagannadha Boorle Cowes Medical Centre Practice representative, West and Central Locality Dr Petrina Williams Grove House Surgery Dr Spencer Fox Tower House Surgery Dr Peter Hill South Wight Medical Dr Mira Hueppe St Helens Medical Centre Clinical Lead, Respiratory services Dr Jayne King/Dr Ida McCarthy Carisbrooke Health Centre Dr Michelle Legg Tower House Clinical Lead, Frail Elderly and Dementia Member of Primary Care Prescribing Committee Practice representative, North and East locality Dr Martin Lock Ventnor Medical Centre Practice representative, South Locality Dr Avril Martin Argyll House Surgery Chair, North and East Locality Dr Bhaswati Majumdar Garfield Road Surgery Practice representative, North and East Locality Dr Chris Andrews East Cowes Medical Centre Dr Hugh Trowell Sandown Health Centre Practice representative, South Locality Dr Cath Miskin/ Dr Cabrini Salter Shanklin Medical Centre Dr George Thomson Brookside Health Centre Member of Primary Care Prescribing Committee Dr Timothy Whelan / Dr Stephen Selby Dower House Surgery Practice representative, West and Central Locality Dr Mouli Akundi Beech Grove Surgery CCG Practice representative, South Locality Table Q Attendance at Membership Council 44 Annual Report and Accounts

47 The Clinical Executive The Clinical Executive is responsible for month-on-month operational oversight of the CCG, undertaking the bulk of the commissioning function and ensuring that clinical decision making remains central to its work. Dr Anitha Ande was elected onto the Clinical Executive with effect from 1 April 2014 and Dr Joanna Hesse started her second term. During the year, Dr Sarah Bromley resigned her position and Dr John Partridge retired. Loretta Kinsella was appointed Interim Director of Quality and Clinical Services and took her place on the Clinical Executive. The key achievements of the Clinical Executive are as follows: recommended the Clinical Commissioning Strategy to the Governing Body. recommended the No Health without Mental Health strategy, the Suicide Prevention Strategy and the Dementia Strategy for approval. funded additional Mental Health re-ablement and a Mental Health Serenity Project. requested the development of a new care model for Dementia Intensive Treatment Service (DITS). and inpatient services for people with Dementia. approved a business case to increase access to psychological therapies (IAPT) leading to a significant improvement in performance. reviewed and supported the terms of reference for the new Joint Adult Commissioning Board that will span the CCG and Local Authority. approved funding for locality based community nurses under the My Life a Full Life programme. received and reviewed monthly reports regarding the performance of the CCG against the key performance indicators and NHS Constitution targets. overseen the production of the operational resilience plans. requested the development of an action plan to recover the Referral to Treatment Time Target. monitoring the CCG risk register under delegated authority from the Governing Body. Appointed Dr John Rivers Caldicott Guardian and approved the Caldicott Guardian work plan. Annual Report and Accounts 45

48 This year issues regarding both the quality and financial sustainability of the Isle of Wight NHS Trust has featured at the Clinical Executive, where updates have been received from the Trust on the financial framework agreements and the CQC Inspection. The Clinical Executive expressed concern with slow progress in taking forward the cost base exercise at the Trust. In terms of the operation of the committee itself, the Clinical Executive reviewed its terms of reference in year and membership, concluding that no material changes should be made at this point in time. The members of the Clinical Executive and their attendance during the reporting period were: Name Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar ANDE, Anitha BROMLEY, Sarah 4 COLEMAN, Peter ELKHEIR, Rida 5 HESSE, Joanna ISAAC, David KINSELLA, Loretta 6 OUTHWAITE Loretta 7 8 RIVERS, John SHIELDS, Helen Table R: Attendance at the Clinical Executive The Quality and Patient Safety Committee (QPSC) The Quality and Patient Safety Committee is a nonstatutory committee established by the Governing Body responsible for ensuring that the CCG acts with a view to securing continuous quality improvement in commissioned services; oversees safeguarding and ensures that systematic assurance on the quality of services commissioned by the CCG is provided to the Governing Body. The Committee welcomed Joanna Smith, the new Local Healthwatch manager onto the committee and took the opportunity to review its terms of reference. A number of small changes were made which were subsequently submitted to NHS England for approval. The Committee requested that an internal audit of some aspects of safety and quality should be undertaken. It will also receive more formal performance management reports on a regular basis and a quality dashboard is in development. 4 Left the CCG from October Deputy from public health attended 6 Joined the CCG in December Deputy attended 8 Deputy attended 46 Annual Report and Accounts

49 Key achievements have been: Received reports and registered concern and sought remedial actions regarding a number of quality measures, in particular the local pressure ulcer stretch target and the number of Clostridium Difficile cases. Received regular reports regarding local progress in implementing Deprivation of Liberty Safeguards. The Committee registered concerns that the IW NHS Trust did not have the capacity to meet its safeguarding responsibilities, although the CQUIN scheme put in place to address this was met by the end of the year. Monitored the implementation of a remedial action plan following the CQC inspection at the IW NHS Trust, It was assured that, while there are opportunities for improvement, appropriate levels of support and challenge were in place by commissioners. As part of the ac tion plan arising from CQC Safer Staffing levels are being monitored at the request of the committee. Recommended an updated Safeguarding Policy to the Governing Body, and noted the increase in child safeguarding activity. Required action be taken to improve Friends and Family response rates and these did improved towards the end of the year. Required work to be undertaken to understand the IW NHS Trust complaints procedures following reports that the Isle of Wight NHS Trust had the highest number of ombudsman investigated complaints in the country per patient treated. Received a detailed patient experience report (in relation to complaints managed by the CCG). Other areas that the QPSC has reviewed include the performance regarding achievement of the 2 week breast cancer referral target; the CCG s approach to NICE Compliance; the number of falls at IW NHS Trust; the level of District Nursing provision out of hours and completion of SIRIs at the IW NHS Trust. Attendance at the Quality and Patient Safety Committee is as follows for the reporting period: Name Jun Jul Oct Nov Feb Mar NEWTON, David (Chair ) ISAAC, David KEATS, Tracey (CCG Adult Safeguarding) SMITH, Lorraine (CCG Consultant Nurse Child Safeguarding) RECKLESS, Ian KINSELLA, Loretta not in post SMITH, Joanna (HealthWatch) not in post RAWLINSON, Mark SHIELDS, Helen Table S: Attendance at QPSC Annual Report and Accounts 47

50 The Audit Committee The Audit Committee is a statutory committee responsible for providing the Group with an independent and objective review of its financial systems, compliance with laws, guidance and regulations and overseeing the Group s risk management and governance processes. Of particular note this year, the Audit Committee has: continued to review the format and processes used in preparing the assurance framework such that it is fit for use by the Governing Body reviewed the Annual Audit Plan, the programme for preparation of the Annual Accounts and the process for preparing this Annual Governance Statement reviewed the integration of risk management across all functions and satisfied itself that adequate integrated systems exist to manage risks reviewed the work of the internal auditors, the audit programme, reports and management actions reviewed external audit briefings and their annual audit plan challenged and received assurance from management throughout the year, including reviewing the management actions developed after the CQC report on the performance of the Isle of Wight NHS Trust reviewed the systems for financial reporting to the Governing Body, in-year financial adjustments and the programme for preparation of the annual accounts. At each meeting in-year performance was reviewed together with any system concerns or variations to the Scheme of Reservation and Delegation, Standing Orders and Prime Financial Policies. The interim budget and finance plan for 2015/16 was also reviewed and recommended for approval to the Governing Body reviewed of the effectiveness of the Audit Committee. 48 Annual Report and Accounts

51 The membership of the Audit Committee and their attendance at meetings during this reporting period were: Name Apr May Jun Sept Dec Mar PSYK, Fredrick (Chair) COLEMAN, Peter RECKLESS, Ian Table T: Attendance at Audit Committee The Remuneration Committee The Remuneration Committee is a statutory committee required to make recommendations to the Governing Body regarding the remuneration and fees for Clinical Commissioning Group employees, and for others providing services to the group and allowances under pension schemes other than the NHS pension scheme. The Remuneration Committee has reviewed the salaries and terms and conditions of the Chief Officer, Deputy Chief Officer and Chief Financial Officer. The members of the remuneration committee during the reporting period and their attendance are indicated below Name June Sept Nov Mar PSYK, Fredrick (Chair) HESSE, Joanna NEWTON, David RAWLINSON, Mark RECKLESS, Ian Table U: Attendance at Remuneration Committee NHS Isle of Wight Clinical Commissioning Group Risk Management Framework The Clinical Commissioning Group has adopted an integrated risk management framework which is available on the CCG web site ( nhs.uk). The framework covers the identification, management and reporting of key corporate, service and strategic risks and outlines the responsibilities of the Governing Body and its sub committees in managing those risks. Appetite for Risk During this financial year, the Governing Body has reviewed the approved risk matrix and considered the appetite for risk. This risk matrix has been readopted by the Governing Body and provides support to individuals within the organisation to assess the levels of risk that are being run and the activities that will be required to mitigate that risk. The identification of risk is threaded through all CCG business and staff are encouraged to identify risk whether financial or non-financial through normal business processes. Risk is a standing item on a number of agendas both a governing body level and at operational committees within the Group. The CCG has devised templates for staff to enable them to create, modify and remove risks from the risk register. These templates are moderated by senior management before the risks are discussed at both the Clinical Executive and Quality and Patient Safety Committee. Incidents and SIRIs Incidents within the local health economy are routinely reported via a local system, with the member practices encouraged to report incidents that are then reviewed internally and considered by Clinical Governance leads to embed learning points. The same system is used to report Serious Incidents Requiring Investigation (SIRIs). Annual Report and Accounts 49

52 Service Development In the development of business cases to support new commissioning arrangements, the CCG uses equality impact assessments, along with a risk management review to determine the final shape of services. During this reporting period the CCG has also reviewed the need to extend impact assessments across the sustainability agenda and in particular to create clear guidance on the implementation of the Social Value Act Patient and Stakeholder feedback NHS Isle of Wight Clinical Commissioning Group supports professionals, patients and the general public to provide a mix of formal and informal feedback to the CCG regarding the quality and effectiveness of the services that it commissions. Comments are fed back to the Quality and Commissioning Teams and used to compare against other information that the CCG may have. Member practices are routinely encouraged to report areas of concern particularly in relation to clinical risk and communication issues. Issues arising from these systems are then discussed with the relevant providers and learning encouraged. Issues which have wide resonance across multiple stakeholder and patient groups are considered as part of the CCG strategy and consulted on widely NHS Isle of Wight CCG Internal Control Framework The internal control framework is the set of processes and procedures in place in the CCG to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, 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 CCG s key control mechanisms are as follows: Policies, procedures and guidelines The CCG has put in place a range of policies and procedures to support the proper identification and mitigation of risk, making it clear that risk is inherent in all activity and the CCG is not risk adverse but risk aware 9. These policies and procedures are kept under review. Governing Body Assurance Framework The Governing Body Assurance Framework, developed from the approved organisational aims and objectives, identifies key critical success factors for the organisation and the risks associated with achievement of those success factors. This document is largely aimed at identifying risks before they arise and seeking to mitigate the likelihood of their occurrence. This document is updated for each Governing Body meeting where it is reviewed. An Internal Audit Review of this document indicated reasonable assurance in-year. Risk Register The CCG s Integrated Risk Register captures existing and real risk requiring risk owners to undertake regular review and seek mitigation of those risks. It is reviewed monthly at the Clinical Executive, in summary at each Governing Body meeting and at a variety of internal meetings to ensure that risk has been appropriately identified and is well managed and mitigated. An Internal Audit review of this process indicated reasonable assurance in-year. Incident reporting culture The CCG has developed an incident reporting culture amongst both staff and member practices. It supports staff and members to embed improvements to processes and to pick up issues at an early stage and seek resolution. 9 CCG Integrated Risk Management Framework, P11, para Annual Report and Accounts

53 Support The CCG retains the expertise of internal audit and counter fraud services to make a deeper assessment of areas of management responsibility to ensure that processes have been properly developed and are being followed. For instance, regular newsletters regarding fraud are circulated to all staff. 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 CCG, 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 information. We have established an information governance management framework and information governance processes and procedures in line with the information governance toolkit. All staff undertake annual information governance training and a staff information governance handbook ensures 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 established to fully embed an information risk culture throughout the organisation. All information flows have been mapped and risk assessed. In particular the Clinical Commissioning Group has paid attention to complying with the new rules regarding commissioner access to Personal Identifiable Information (PID) and new arrangements put in place. 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 I am assured through the Equality and Diversity report as set out in the strategic report section of this annual report that control measures are in place to ensure that NHS Isle of Wight Clinical Commissioning Group complies with the required public sector equality duty set out in the Equality Act Sustainable Development Obligations The CCG is required to report its progress in delivering against sustainable development indicators and is working in partnership with the IW NHS Trust to implement a Sustainable Development Management Plan (SDMP). I am assured that the CCG has developed a plan to assesses risks, enhance our performance and reduce our impact on the environment, including ensuring we achieve our carbon reduction and climate change adaptation objectives. This incorporates mechanisms to embed social and environmental sustainability across policy development, business planning and commissioning. I am assured that the CCG complies with its obligations under the Climate Change Act 2008, including the Adaptation Reporting power, and the Public Services (Social Value) Act Annual Report and Accounts 51

54 Risk Assessment in Relation to Governance, Risk Management and Internal Control The CCG has implemented governance, risk management and internal control processes and subjected these to both internal scrutiny through the various committees of the Governing Body as well as a comprehensive internal audit programme (see below). No material gaps have been identified in relation to governance and risk management. An internal audit of governance processes has offered reasonable assurance to the CCG. The CCG through the Governing Body Assurance Framework and the Integrated Risk Register identified the following key risks to the organisation in relation to governance and internal control during the reporting period 2014/15: Concerns regarding succession planning for the Clinical Executive. This risk was mitigated in the short term with the Membership agreeing to extend the term of the current chair while a new GP was identified and prepared for the role and successful elections undertaken for two new members of the Clinical Executive Following concern regarding the transparency of decision making within the CCG, a review of common practice was undertaken across other CCGs, providing assurance to the CCG that its practices are in line with other CCGs. Concerns regarding the capability of the organisation to deliver its work programme. All departments have reviewed their structures in year and made some changes to the scope and responsibility of some roles. In the light of the New Models of Care Vanguard Programme, capacity to deliver both the core day to day service and the transformation required remains of concern at the end of the reporting period. The CCG was without a Clinical Director for much of the year following a disappointing recruitment process early in the year. The Chief Officer therefore took a lead in ensuring the safeguarding and quality agenda remained a priority while Medicines Management was overseen by Primary Care Review of Economy, Efficiency & Effectiveness of the Use of Resources The CCG aims to maximise the impact of each pound spent supporting the health and wellbeing of those for whom we are responsible. The decision to invest in, disinvest in or redesign a commissioned service requires a judgement of whether the expected health benefits will justify the costs. The diversity in the Group s portfolio makes it difficult to produce comparable measures of what constitutes good value for money for many services. As the CCG is relatively small and geographically isolated, we have a strong focus on ensuring the sustainability of the services we commission. This means we do not necessarily seek the cheapest or easiest solution, but we seek to understand what is driving our and our providers costs and make sure that we are getting the desired quality at the lowest reasonable price. I am assured that the CCG plans, implements and measures the outcomes of the services it commissions according to a commissioning cycle which informs the steps taken in order to justify investment or disinvestment. It pays particular attention to the evidence base in developing business cases for change including ensuring focus on reviewing and following NICE guidance and other reliable evidence sources. Through Quality Innovation Productivity and Prevention (QIPP) plans, which form part of the planning requirements for the financial year, it seeks to predict the improvement expected and where possible measures that objectively. This process is overseen by the Clinical Executive. 52 annual report and accounts

55 The CCG is required to manage its business within a maximum administration budget. I am assured that in all our work, we seek to achieve our objectives with the minimum of bureaucracy consistent with good governance. The Governing Body is supported in its review of the extent to which the CCG is achieving its ambition through the Integrated Performance Report and the Governing Body Assurance Framework. This looks both at the measures we have agreed and those expected of us and the organisation s ability to manage and mitigate any risks to us achieving our objectives. The Audit Committee, through the internal audit programme, reviews the systems and processes employed by the Group ensuring that there are no serious threats to the achievement of its aims. Finally, NHS England undertakes its own assurance processes through quarterly reviews of CCG results against key metrics based on a number of domains. 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 My review of the capacity of the organisation to handle risk is drawn from my own experience of risk management within the organisation, comprising a range of monthly reviews of the risk register together with an internal audit report reviewing the processes and procedures employed by the CCG. The CCG has an Integrated Risk Register covering the breadth of our operations. This is reviewed on a monthly basis by the Chief Officer in conjunction with senior management and discussed at the Clinical Executive with a summary report presented to each Governing Body. Each risk is updated monthly with an expected completion date and the steps that will be taken to mitigate the risk. This includes a clear narrative demonstrating the actions taken throughout the life of the risk. Staff have had risk management training aimed at improving the recognition and mitigation of risk. A series of templates and prompts to ensure that risks are codified and submitted to the CCG s risk register are in place. All new risks are reviewed by the senior management team to ensure that the risk rating has been properly applied and feedback given to staff. annual report and accounts

56 Review of Effectiveness My review of the effectiveness of the system of internal control is informed by the work of the internal auditors, the executive officers and staff within the CCG who have responsibility for the development and maintenance of the internal control framework. I have drawn on performance information available to me. My review is also informed by comments made by the external auditors in their management letter and other reports. The Governing Body Assurance Framework itself provides me with evidence that the effectiveness of controls that manage risks to NHS Isle of Wight Clinical Commissioning Group achieving its principles objectives have been reviewed. During the year the Governing Body has sought to develop the internal control environment further, ensuring a thorough review of the Governing Body Assurance Framework together with the Integrated Performance Report. The Audit Committee has taken oversight of the financial budgeting, planning and key risks during the year as well as overseeing a comprehensive first year internal audit programme. Clinical Governance has been overseen by the Chief Officer and the Director of Quality and Clinical Services, working with the GP Clinical Governance Leads, and the Clinical Effectiveness Committee - both reporting to the Quality and Patient Safety Committee. During the year a review of internal quality process has been undertaken following the CQC inspection of IW NHS Trust to ensure that the CCG processes in support of quality were in good order. 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 Patient Safety Committee, and a plan to address weaknesses and ensure continuous improvement of the system is in place. 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. Of particular note, the CCG for the second year running received no internal audit opinions that indicated limited or no assurance. As part of my review of Governance, I have received the following opinion from the Head of Internal Audit on the Effectiveness of the System of Internal Control for the Year ended 31 March 2015: The purpose of my annual Head of Internal Audit opinion is to contribute to the assurances available to the Accountable Officer and the Governing Body which underpin the Governing Body s own assessment of the effectiveness of the organisation s system of internal control. This Opinion will in turn assist the Governing Body in the completion of its AGS. My opinion is set out as follows: 1) Overall opinion; 2) Basis for the opinion; and 3) Commentary. My overall opinion is that: Reasonable 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 weakness in the design and/or inconsistent application of controls, put the achievement of particular objectives at risk; The basis for forming my opinion is as follows: An assessment of the design and operation of the underpinning Assurance Framework and supporting processes; and An assessment of the range of individual opinions arising from risk -based audit assignments, contained within internal audit risk-based plans that have been reported throughout the year. This assessment has taken account of the relative materiality of these 54 Annual Report and Accounts

57 areas and management s progress in respect of addressing control weaknesses. Additional areas of work that may support the opinion will be determined locally but are not required for Department of Health purposes e.g. any reliance that is being placed upon Third Party Assurances Data Quality I am assured that data quality is reviewed in all the tools used by the CCG to inform the Governing Body and Membership, particularly in relation to strategic planning and performance management. The Governing Body finds the reports they receive acceptable in terms of providing assurance regarding the performance of the CCG and have no material concerns regarding the quality of data provided. Business Critical Models The CCG has reviewed the business models that it uses and identified those which are considered business critical. It has further familiarised itself with the Macpherson report into Quality Assurance of Business Critical Models published by HM Treasury in The majority of the tools used by the CCG are nationally provided benchmarking tools or Business Intelligence tools provided through our Commissioning Support Unit. The CCG does not use any systems which require submission to the Analytical Oversight Committee of the Department of Health. Data Security The CCG achieved compliance with level two of the information governance toolkit assessment, as audited by an internal audit report. There have been no serious incidents relating to data security breaches reported to the Information Commissioner in this reporting period. Indemnities and Insurances The CCG, adopted a clause within the constitution during 14/15 that confers indemnity on those Governing Body members, officers and others working on behalf of the CCG whereby those who have acted honestly and in good faith will not have to meet out of his or her own personal resources any personal civil liability which is incurred in the execution of his or her governance functions, save where the person has acted recklessly The CCG holds insurance with the NHS Litigation Authority. There are no outstanding balances that require reporting. Discharge of Statutory Functions The CCG has reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislative and regulations. As a result, I can confirm that the CCG 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 officer. Each function has confirmed that its structures provide the necessary capability and capacity to undertake all of the clinical commissioning group s statutory duties. Conclusion I confirm that no significant internal control issues have been identified. Helen Shields Accountable Officer 28 May 2015 Annual Report and Accounts 55

58 56 annual report and accounts