Annual Report and Accounts 2016/17

Transcription

1 Annual Report and Accounts 2016/17 1

2 Contents 1. Performance overview Statement from the Chair and Accountable Officer The purpose and activities of the CCG Our vision and who we are How the CCG works and its activities Transforming care in the Central London area and North West London What would this mean for me in Central London? Taking forward devolution in health and care for London Working with partners to achieve our vision and our values Health of the CCG area Achievements 2016/ Priorities 2017/ Health and wellbeing strategy Key issues and risks Performance summary Overview of the CCG s finances How we spent your money Underlying financial position Performance Analysis How the CCG measures performance Development and performance during the year Financial targets (See note 4 in the Financial Statements) Funding allocations Accident and Emergency Department (A&E) Referral to treatment (RTT) Diagnostic waiting times Cancer waiting times Improved Access to Psychological Therapies (IAPT) Dementia diagnosis Health Care Associated Infection (MRSA and C.Difficile) Sustainable Development Improve quality Quality and patient safety Safeguarding children and adults Pressure ulcers Patient and public involvement Reducing health inequality Members Report Member practices Composition of Governing Body Committees, including Audit Committee

3 3.4. Register of Interests Personal data related incidents Statement of disclosure to Auditors Modern Slavery Act Statement of the Accountable Officer s responsibilities Governance statement Introduction and context Scope of responsibility Governance arrangements and effectiveness CCG Constitution and structure Governing Body Audit Committee Finance and Performance Committee Central London CCG s Quality and Safety Committee Joint Committees with delegated decision-making authority Primary care co-commissioning Primary Care (Local) Co-commissioning Group CWHHE Investment Committee CWHHE Health & Safety Committee Other joint committees Clinical Board Shaping a Healthier Future (SaHF) Implementation Programme Board Performance of the Governing Body UK corporate governance code Discharge of statutory functions Risk management arrangements and effectiveness Risk management strategy Embedding risk management Public stakeholders engagement Control mechanism Risk assessment and risk profile Risks to governance, compliance, management and internal control Principal risks to compliance Other sources of assurance Internal control framework Annual audit of conflicts of interest management Data Quality Information Governance Business Critical Models Health and safety Complaints Emergency planning preparedness and resilience

4 5.9. Control issues Review of effectiveness Review of economy, efficiency & effectiveness of the use of resources Counter fraud arrangements Head of Internal Audit Opinion Review of the effectiveness of governance, risk management and internal control Capacity to handle risk Conclusion Remuneration Report Remuneration Committee Policy on the remuneration of senior managers Chair and Clinical Directors Lay Members Executive Directors Executive Directors performance related pay Remuneration of very senior managers Compensation on early retirement or for loss of office (subject to audit) Payments to past senior managers (subject to audit) Fair pay disclosure (subject to audit) Definition of Senior Managers Senior Managers - Salaries and allowances (subject to audit) Senior Managers Salaries and allowances - joint appointments (subject to audit) Senior Managers - Pension benefits (subject to audit) Staff Report Number of senior managers by band Staff numbers and costs Staff composition Staff sickness Staff policies Equality Expenditure on consultancy Off-payroll engagements Exit packages (has been subject to audit) Parliamentary Accountability and Audit Report Financial Statements 9. Independent Auditor s report to the members of the Governing Body of NHS Central London Clinical Commissioning Group

5 Performance report 5

6 1. Performance overview Welcome to the 2016/17 annual report for Central London Clinical Commissioning Group (CCG). This opening performance overview provides a summary of what Central London CCG has achieved in the past 12 months, as well as looking at some of its future priorities and how we ve discharged our functions Statement from the Chair and Accountable Officer Our annual report is an opportunity to reflect upon our achievements for the past year, and set out our ambitions for 2017/18. Central London CCG is proud of its progress over the past year. Under the Governing Body s clinical leadership, the CCG has achieved several important milestones during this period. Along with the four other CCGs in the CWHHE Collaborative, Central London CCG published part one of its Strategic Outline Case (SOC), which sets out the business case for a 513million investment to transform NHS services and care across North West London. This cash boost would be used for the refurbishment of Central Middlesex Hospital and other local improvements. 140m is earmarked to build two new hubs; Church Street, and Central Westminster Hub. 69million will be used to improve GP surgeries, and around 300million to make local hospital facilities safer and more efficient. Meanwhile, the completion of the North West London Sustainability and Transformation Plan (STP), which has been submitted to NHS England for approval, gives Central London CCG a working blueprint to follow in shifting the focus of healthcare towards prevention, primary care, and patient choice, and away from outdated acute-heavy models of care. It has been a challenging year for the NHS across the nation, and the Central London CCG area is in no way exempt from the obvious and very real need to find a solution promptly to these well-publicised challenges. It is unlikely that next year will see any easy answers to the question of how the NHS can marry finite resources with escalating demand. Along with every commissioner in the country, Central London CCG will need to manage this issue in a timely and responsible way; indeed, our collective ability to do so is critical to the future of the NHS itself. The North West London STP will form a significant part of the solution. As set out in the North West London STP, our priorities for improving care are split into five Delivery Areas (DAs). These Delivery Areas are: improving your health and wellbeing better care for people with long-term conditions better care for older people improving mental health services safe, high quality and sustainable services. In the Our Plans section of this report we will expand upon each area and set out how our ambitions match these DAs. Central London CCG is further ahead with these plans than most other regions of England. Our clinical leadership has already taken the tough decision to enter voluntary turnaround and assess all contracts to ensure they are delivering best value. 6

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8 1.2. The purpose and activities of the CCG Our vision and who we are NHS Central London Clinical Commissioning Group (CCG) is the GP-led organisation responsible for planning and buying (commissioning) health services for the people living in Westminster (not including the Queen s Park and Paddington area of the borough, which is covered by West London CCG). Central London CCG was set up in April 2013 under the Health and Social Care Act Central London CCG is made up of 35 GP member practices that in 2016/17 served an estimated registered patient population of 197,000. We are committed to improving the care provided to patients, reducing health inequalities and raising the quality and standards of GP practices within our allocated budget. Our vision for health care in Central London CCG is ambitious and together with our partners we wish to transform health care. Everyone living, working and visiting Westminster should have the opportunity to be well and live well to be able to enjoy being part of our capital city and the cultural and economic benefits it offers. For this to happen, the health service needs to turn the current model, which directs most resources into caring for people when they become ill, on its head. The new model must support patients to stay well and take more control of their own health and wellbeing, as close to home as possible. It is also important that the new model of care is sustainable and that we effectively use the resources we have to meet the needs of people today without causing problems for future generations How the CCG works and its activities Central London CCG puts local GPs at the heart of deciding what health services local people need and receive. All of our GPs use their experience and knowledge to influence and shape the decisions the CCG makes, with some more heavily involved as representatives of the CCG Council of Members and Governing Body. The CCG Chair is elected by the Governing Body members. Representatives include GPs, practice staff, lay members, a secondary care consultant and CCG officers. It is the Governing Body that steers the running of the CCG, supported by a team of officers, who together undertake service development, contracting and performance management of local health services. We work with clinicians, patients and carers to make sure local health and social care services are effective and coordinated. The CCG has an annual allocation of 300m, and also hosts the Strategy and Transformation directorate which has an additional budget of 18m on behalf of all eight CCGs in North West London. The CCG buys a range of services including: Planned surgery (elective hospital care) Rehabilitation care Urgent care and emergency care Community health services Mental health and learning disability services 8

9 Some primary care services. Our aim is to ensure the highest quality of care is delivered by the organisations best qualified to do so for the diverse needs of our patients, carers and the public, and at the best value for money so that we spend public money wisely. Each year, Central London CCG develops and publishes our plans for the year ahead. Our priorities for 2016/17 included: Working with our local NHS Trusts to ensure delivery across all national standards. Continuing to invest in and develop more out of hospital services with a focus on developing integrated services across health and social care. Continuing to improve services for people with long-term and mental health conditions. Working to reduce emergency hospital admissions through a broad range of initiatives. This year the CCG voted to take control of its budget to buy GP services directly, moving away from joint commissioning by the CCG and NHS England. GPs and CCG members voted in February in favour of managing our own budget for primary care (called delegated commissioning). For patients it will mean from 1 April 2017 we will be able to take full responsibility for the management of our primary care medical services allowing us to tailor our services more effectively to meet local patients needs. This new way of working will also give patients more opportunity to input. Find out more about the CCG and how it works at Transforming care in the Central London area and North West London In 2016 Central London CCG joined with Westminster City Council and other local partners to look at what we wanted to do locally to make this happen and feed this into the wider North West London Sustainability and Transformation Plan (STP). The STP which covers the eight boroughs in NW London takes its starting point from the national NHS Five Year Forward View strategy and translates it for our local situation. NHS Five Year Forward View The NHS Five Year Forward View is a strategy for the NHS in England. It describes the gaps in health and social care; how the quality of NHS care can be variable; and the existence of widespread health inequalities and preventable illnesses. People s needs are changing, new treatments are emerging every day, and there are challenges in areas such as mental health, cancer and support for frail older patients. The NHS Five Year Forward View also sets out the benefits of new ways of delivering care; the critical importance of better public health and preventing ill health; how services across health and social care need to be joined up; and patients and communities need to be empowered; why primary care needs to be strengthened; and the need for further efficiencies in the health service. 9

10 Why we need an STP Many people live in an unhealthy situation and make unhealthy choices: Only half of our population is physically active. Half of over-65s live alone and over 60 per cent of adult social care users want more social contact. Many people are living in poverty. People with serious long-term mental health needs live 20 years less than those without. The quality and efficiency of some services could be improved Over 30 per cent of patients in acute hospitals do not need to be there, and could be treated in or nearer to home. In NW London 1,500 people under 75 die each year from cancer, heart diseases and respiratory illness. If we were to reach the national average, we would save 200 lives a year. Over 80 per cent of people want to die at home, but only 22 per cent do so. The cost of health and social care is outstripping the budget. Despite a growing NHS budget, if we don t take action, there will be a 1.3billion shortfall across NW London by Local authorities have faced cuts in adult social care budgets. Our aims and priorities We aim to improve: health and wellbeing care and quality efficiency, to balance the budget. 10

11 Delivery area 1: Improving your health and wellbeing Your health is affected by the environment and communities you live and work in and the choices you make. Your local NHS and councils want to support you to have a healthy life by: Reducing loneliness by encouraging everyone to be part of their local community. Supporting campaigns to increase self-care; to prevent cancer; and to reduce the stigma of mental health problems. Encouraging exercise and healthier eating; and reducing smoking and drinking. Encouraging employment for people with a learning disability or mental health problem. Tackling issues that affect health such as housing, employment, schools and the environment. Supporting children to get the best start in life by increasing immunisation rates, tackling childhood obesity and providing more mental health care and support. Delivery area 2: Better care for people with long-term conditions With many different organisations involved in care for people with health conditions, services can be confusing and vary in quality. We want to coordinate services better, and help every patient with a long-term mental or physical condition to get the care and support they need to manage their condition by: Catching cancers earlier and starting treatment more quickly. Developing new ways of preventing and managing long-term conditions, like diabetes Improving access to mental health services. Helping the voluntary sector to support self-care; for instance offering people with long-term conditions access to expert patient programmes and increasing the availability of personal health budgets. Delivery area 3: Better care for older people We are pleased that so many of our residents are living longer than previous generations thanks to better medicines, new treatments and cures. We want to improve care for our older people by: Tackling the lack of nursing and care homes. Providing specialist teams which can react quickly when there is a problem. Commissioning all services for older people with local government and coordinating care between the NHS, social care and other organisations. Improving end of life care and supporting people to die in the place of their choice. Delivery area 4: Improving mental health services Many of us have a difficulty with our mental health at some point in our lives. Poor mental health has the potential to affect our physical health. We want to support people with serious and long-term mental health problems, learning disabilities, autism or challenging behaviour by: Providing a more proactive service focused on recovery. Supporting more GPs to become experts in mental health care. 11

12 Improving early intervention services and crisis support services; and introduce 24/7 mental health A&E teams. Improving child and adolescent services, particularly in the evenings and weekends. Delivery area 5: Safe, high quality and sustainable services Whilst the vast majority of care in NW London is of a high quality, we know there is more to do and we can make services more efficient. Our buildings and ways of working make it difficult to take advantage of new technology and this means the health services is not as efficient as other public or high street services. We want to: Provide more services at night and weekends, particularly assessments by a consultant and access to vital tests. Introduce specialist children s assessment units and improve children s services, for example by recruiting more children s nurses. Make the most of new technology to save everyone time and worry, and improve services. Concentrate our skills and experience where they make the biggest difference for patients. What will primary, intermediate and hospital care look like? Primary care There will be a greater focus on keeping people healthy, with more health screening and better management of long-term conditions There will be more appointments earlier in the day, later at night, and at weekends. Already 280,000 patients can use online consultations and 60,000 can use video consultations. We want everyone to be able to use online advice if they wish. GP practices will work together and in partnership with other services. Patients won t have to go to lots of different places to get simple treatments. Other health professionals will take on some responsibilities from GPs, like treating coughs, colds and minor injuries. Intermediate care Intermediate health and social care will respond more quickly when people become ill. To help people get home as soon as they are medically fit, more services will be available in, or close to people s homes; in GP practices; in local services hubs or in hospitals. Hospital services Concentrating specialist doctors, teams and equipment in 24/7 hospitals leads to better outcomes for patients. In 2012 the NHS agreed to reduce the number of major hospitals in NW London from nine to five. This will improve urgent care, planned surgery, maternity services and children s care. The five major hospitals will be at Chelsea and Westminster, Hillingdon, Northwick Park, St Mary's and West Middlesex Four other hospital sites are also receiving investment to improve their buildings and provide enhanced services either as local hospitals with an A&E department (Charing Cross Hospital and Ealing Hospital), or to specialise in things like preplanned procedures, such as hip operations, and areas such as cancer care (Central Middlesex Hospital and Hammersmith Hospital). 12

13 No substantive changes to A&Es in Ealing or at Charing Cross will be made until there are sufficient alternatives in place through local services or in other major hospitals. Our residents responsibilities Our plans are dependent on people recognising their responsibility to: Look after themselves Ask for help when necessary Use services sensibly and fairly Be an active part of their own community. Supporting the transformation To transform services and make them sustainable, we need to invest in our workforce and digital technology, improve our buildings and make services more efficient. Workforce We need to recruit and retain a permanent workforce that works in multi- disciplinary teams with new roles and careers. Invest 15million in developing, educating and training staff, to support changing population needs. Establish leadership development forums to drive transformation and share good practice and learning. Digital Increase the use of technology to reduce unnecessary trips to and from hospital Reduce paper and share electronic care records across the NHS to make sure patients are properly cared for at all times. Patient records, online information and support should be readily available and understood by patients and carers so they can become more involved in their own care. Use population care data to make better decisions about future services and to support integrated health and social care. Buildings and facilities Share facilities between health, social care and local government and develop local service hubs to maximise the use of space, be more efficient and make services more integrated. Use an investment fund of up to 100million to improve the condition of primary care buildings and facilities. Improve hospital buildings and facilities and introduce new ways of working which will reduce the 625million we need to maintain outdated buildings What would this mean for me in Central London? Improving your visit to your GP practice 13

14 Improved GP practice buildings and facilities, making them accessible, more attractive to visit and provide more services. Developing more out of hospital services to create out of hospital hubs New out of hospital hubs will be developed at Church Street and Central Westminster. Hubs join up care for patients, linking GP and hospital care, and reduce the need for lots of appointments in different places. They particularly help people who suffer from many illnesses and need regular health and social care support. Hubs will also provide more services at weekends. Since early 2017, we have been to patients, residents and staff about the new services being provided in Central London. Across NW London, this investment could: Save around 334 lives per year Prevent around 20,000 stays in hospital by 2024 by treating people earlier, and closer to home Keep people well Save you time and travel, with many more outpatient appointments taking place without having to visit the hospital, for example in a community hub or using technology Taking forward devolution in health and care for London Central London CCG has joined with other partners at local, multi-borough and sub-regional (STP) areas to look at how devolution in health and care can be taken forward in London. During 2016/17, five London devolution pilots have explored how more local powers, resources and decision-making could accelerate the improvements in health and care that Londoners want to see. The devolution work has highlighted the importance of working at different levels in London under the three themes of prevention, integration and estates. It is also clear that transformation must be locally led and that many services can only be delivered at the borough or smaller locality level, whereas others are more appropriately aggregated across boroughs or London-wide. The forthcoming London Health and Care Devolution Memorandum of Understanding (MoU) will include commitments by national bodies to enable these improvements to go further and faster, based on the different ambition and appetite of local areas Working with partners to achieve our vision and our values Central London CCG works in partnership with a wide range of organisations to ensure that our residents receive the health and social care services that they need. These organisations include: Central London Healthcare (GP Federation for Central London) and individual GP practices Westminster City Council Imperial College Healthcare NHS Trust Chelsea and Westminster Hospital NHS Foundation Trust Central and North West London NHS Foundation Trust 14

15 Central London Community Healthcare NHS Trust Providers outside of Westminster (for example University College London Hospitals, Guy s and St Thomas NHS Foundation Trust) Central London CCG s user panel Healthwatch Westminster Voluntary and community organisations The Metropolitan Police The Westminster Health and Wellbeing Board, of which the CCG Chair is a member, is of particular importance. The board is made up of representatives from the local authority, the NHS and the voluntary sector, and is the place for key partners to work together to improve the health and wellbeing of our population. CWHHE Collaborative Central London CCG works with West London, Hammersmith and Fulham, Hounslow and Ealing CCGs in the CWHHE Collaborative. Working in a collaborative means we have a stronger influence. It also allows us to provide greater scrutiny and influence on any decision that affects our area. Improving patient safety and the quality of services local people get from our hospitals and other providers are just two areas we have more influence on if we join together. For example, we have a collaborative safeguarding team, working across the five CCGs providing support to us all. Alongside the CCG s dedicated team, we also share a larger collaborative team with a number of shared posts. This includes our Chief Officer, Chief Financial Officer, Director of Nursing, Quality and Safety, and Director of Compliance. North West London Collaboration of Clinical Commissioning Groups We are also part of the North West London Collaboration of Clinical Commissioning Groups, which includes eight CCGs (Brent, Harrow, Hillingdon, Central London, West London, Hammersmith and Fulham, Hounslow and Ealing). We work together on a range of programmes to improve the quality of health services and share a number of support services to help deliver effective and efficient commissioning. Central London CCG hosts a range of support services for the five CWHHE CCGs including finance, quality and performance. In addition, Brent CCG hosts a number of shared services such as communications, human resources, information technology, business information and commissioning and performance management from which we all benefit. The Office of London CCGs coordinates collaborative working across the 32 CCGs in London. Working in this way allows CCGs to manage collective commissioning arrangements and strategic change that crosses CCG boundaries. It also promotes shared learning to improve performance Health of the CCG area 15

16 Understanding our population the Health and Wellbeing of the Central London CCG area In Westminster, the day-time population, which includes workers and tourists, may be up to a million people on an average weekday. Our population is characterised by a large proportion of young working age residents, high levels of migration in and out of the borough, and ethnic and cultural diversity. Men and women living in Westminster have much higher life expectancy rates than the averages for the rest of London and England. Many residents are very affluent, and experience correspondingly good health. However, there are also residents with poorer health in the areas of social housing, predominantly focused in the north west of the borough. These residents experience large health inequalities compared to the rest of Westminster. Westminster generally performs well on health indicators. There are, however, significant differences in life expectancy and mortality between and within electoral wards in Westminster. The gap in life expectancy between the most and least deprived 10% of the population is 11.3 years for men and 7.9 for women (Westminster Health Profile 2015, Public Health England 2015). In addition, the most deprived fifth of the population live with disability for 21 years compared with those in the least deprived fifth who live with disability for 11 years. This is the largest gap in England and has an impact on residents economic dependence. Public Health identifies the principal cause of premature death for people under 75 years of age as cancer, followed by cardiovascular disease (including heart disease and stroke). A significant number of people also die from lung disease. This pattern is broadly similar to the rest of the country. Approximately a third (35%) of children under 16 in Westminster live in poverty according to official definitions, which is higher than the London average of 27%, and the England average of 21%. In , Central London CCG had the fourth highest population with severe and enduring mental illness known to GPs in the country (3,306 people registered with Westminster practices). Challenges continue in supporting those with severe mental illness in maintaining good mental and physical health (e.g. through health checks), being in employment and being in secure housing. In some cases, patients are being treated in secondary care when they could be treated in a community setting more efficiently. A Joint Strategic Needs Assessment (JSNA) has also been completed to assess they key health and wellbeing needs of young adults age Key objectives are to identify the gaps in provision of services for young people, capture the unique health and wellbeing needs and issues affecting young adults, and identify how to improve early interventions in issues which could affect people s long term outcomes. The Joint Strategic Needs Analysis (JSNA) reports can be found online at and should be referred to in order to understand the full, complex picture of the health and wellbeing of people who live in the area Central London CCG covers Achievements 2016/17 Central London CCG aims to deliver high performing, good quality and cost effective hospital and community based healthcare for our residents. Over the past year we have introduced many new services and progressed many programmes and initiatives. 16

17 Delegated Commissioning In February 2017 each member practice voted overwhelmingly for the CCG to take on primary care commissioning from NHS England. A primary care commissioning committee will be established in April 2017, to ensure the effective decision-making power over primary care in our area. It will include a range of non-conflicted clinical, executive and lay members. Extended Access Seven day access to a GP is one of the 19 services delivered by GP surgeries as part of the Local Services Strategy. Commissioned through the local GP Federation, the other 18 services include blood pressure monitoring, anticoagulation services for those on bloodthinning medication, complex wound management, electrocardiograms (ECGs), and some mental health services. All 35 GP practices in the CCG area will be working together to deliver these services to a common standard so that they are available to all patients in a convenient location. 18 new Local Services available in the community 18 new treatments are now available locally for patients in a GP surgery. These 18 services are: ABPM or Ambulatory Blood Pressure Monitoring (When your blood pressure is tested every 30 minutes for 24 hours) Phlebotomy (blood tests) Case Finding, Care Planning and Case Management (to support patients at high risk of hospital admission or with complex health and social care needs) Coordinate My Care (to support patients with end of life care) Diabetes - High Risk of Diabetes Diabetes - Level 1 (Monitoring) Diabetes - Level 2 (Initiation of Insulin) ECG (Electrocardiogram) Homeless people specialist services Mental health (common complex problems) Mental health (serious) Near Patient Monitoring (for patients who take specific high risk medicines and need frequent blood tests and monitoring) Ring Pessary (a device inserted into the vagina to hold the uterus or other pelvic organs in place) Spirometry testing (a breathing test to help diagnose and monitor certain lung conditions) Warfarin Monitoring (a medicine that stops blood clotting) Warfarin Advanced Monitoring (a medicine that stops blood clotting) Weekend and evening GP access Wound care Patients tell us they trust their GP, and it will be on their GP s instruction that they will be referred to receive their care either at their own GP surgery, or at another surgery nearby. These services will be regulated and provided by well-trained experts. Patients will be referred to the site that specialises in the particular treatment that they need. With the patient s explicit and informed consent, the practice they are referred to will be able to 17

18 access their NHS patient record to help them provide the best possible care. To help better serve our population, GPs are enabled to act as both provider and coordinator of services. In order to do this, GPs across North West London have organised themselves into GP Federations. Central London CCG patients get tailored help to beat Type 2 Diabetes Patients living in the Central London CCG area at high risk of Type 2 diabetes are being invited to join a programme helping them avoid developing the condition by changing their lifestyles. It is part of the new national Healthier You: NHS Diabetes Prevention Programme. New career framework for diagnostic radiographers In November 2016 The NHS in North West London launched a new competency-based career framework to increase career opportunities for diagnostic radiographers working in the NW London area. All hospitals in the NW London area have signed up to using the framework. NW London is the first NHS region to introduce a dedicated career framework to support radiographers with their career development, making this a really exciting time to join one of the fourteen hospitals. NHS England transformation fund Following the momentum built at an NWL diabetes workshop in November 2016, a bid was successfully coordinated and submitted to NHS England for diabetes transformation funds in the following four areas: achievement of NICE recommended treatment targets; multidisciplinary foot teams; diabetes inpatient specialist nurses; and structured education. Care Coordination Service (CCS) The CCG has worked with its provider partners in North West London to redesign services to support better coordination across health and social care for patients. Patients have been leading contributors to the discussion on what is needed to deliver an effective, joined-up health system in the future. The Care Coordination Service provides coordination and referral support. It also supports practices in proactively caring for those patients who would benefit from this enhanced model of care. Pan-London care for homeless people Central London CCG along with Lambeth CCG is the Joint Lead Commissioner for the Healthy London Homeless Health Programme. This is one of 13 programmes being run across London. The CCG is working hard to produce a set of Commissioning Intentions on behalf of the 32 London CCGs in time for the next commissioning round in September. The Health Services for Homeless People Programme is looking to improve services and access to those services for the homeless population in London. The Better Health for London report summarised some of the key health issues and needs and extreme health inequalities of London s homeless population, which our current system of healthcare struggles to meet. There are national and (many) local services, but at times they are fragmented, poorly coordinated and often inappropriate for service users needs. Patient care can fall through the gaps and boundaries between care settings and services if patients do not meet criteria for treatment. 18

19 Suicide intervention training Suicide intervention training has been commissioned for clinicians and community and voluntary sector staff across Hammersmith and Fulham, Central and West London. Over 150 staff have attended the training and the response has been very positive. The training has been commissioned for further delivery in 2017/18. A workshop was held in January for staff across the NHS, Public Health, the local authority and community and voluntary sector organisations. This workshop was designed to help draw up an action plan for suicide prevention across the three CCGs. This will be developed further in 2017/18. London Healthy Workplace Charter and Time to Change Central London CCG was awarded the Healthy Workplace Charter commitment level. One element of the CCG s action plan involved a commitment to work towards signing the Time to Change pledge. Time to Change is a campaign led by charities Mind and Rethink to destigmatise mental health issues and to ensure that people feel able to open up about their mental health and seek support when necessary. Community Champion partnership working The Community Champions are local volunteers who receive high quality training, organised by Public Health and local housing providers, to help them improve local health and wellbeing and to reduce inequalities. The majority of Champions are from black and ethnic minority communities and are able to provide support and work with the CCG to ensure key messages and opportunities are expressed in the way which best suits their friends, families and neighbours. Over the course of 2016/17, Central London CCG has worked in close partnership with local Community Champions to deliver key projects and campaigns, such as Stay well this winter. Child and Adolescent Mental Health Services (CAMHS) The new CAMHS services are now well embedded. The Children and Young People Eating Disorder service and the Out of Hours Crisis service have been funded by Central London CCG as part of the CAMHS Transformation plans, and are delivering collaboratively across the eight CCGs in North West London. Central London CCG children and young people can access the Out of Hours crisis services at either Chelsea and Westminster hospital or St Mary s. The Eating Disorders service has its hub at Vincent Square part of Chelsea and Westminster Hospital. Central and North West London Foundation Trust (CNWL) is commissioned by Central London CCG to provide both services for children and young people who access a GP from Central and West London CCG s. Other CAMHS transformation plans for Central London CCG include: an attachment parent/child under-fives project based at Churchill Gardens and Portman Children s Centres. MIND delivering group work and 1-1 sessions for young people in several secondary schools in Westminster. Co-production activities continue with Rethink Young Mental Health Champions contributing to a sustainable training programme for the CYP workforce, planning a Young People s conference in November 2017 and reviewing CAMHS services with commissioners. Maternity services Changes to maternity services in NW London have improved care and ensured delivery of many new standards set out in the National Maternity Review Better Births, released in Improvements include: 19

20 Meeting the London standard for the ratio of midwifes to births. 100 new midwives have been recruited. More consultants available day and night. Better continuity in care, by providing postnatal and antenatal care in the same hospital. Our improvements have been recognised nationally and funding has been provided to test a range of new ways of working to transform maternity services further. Children s services Changes to children s services in NW London have improved care for all children, with: Better access day and night, seven days a week, to more senior children s doctors in five hospitals across NW London. More inpatient and paediatric assessment beds at: West Middlesex, Hillingdon, Northwick Park, St Mary s and Chelsea and Westminster hospitals. Four new paediatric assessment units, providing same day care in a purpose built environment for patients who need treatment, but don t need to be in A&E or need an admission to hospital, reducing average length of stay in hospital by 12 hours. An extra 48 paediatric nurses and 10 paediatric consultants in place. Over three-quarters (79%) of existing children s services remain at Ealing Hospital, including a 24/7 urgent care centre, day time clinics and outpatient services. Mental health services In 2016/17 new mental health services were launched including: A new 24/7, year round service providing support, advice and information for those who experience mental health illness, their carers and professionals. Reducing A&E attendances for people in mental health crisis by a year. A new specialist assessment, treatment and support service for pregnant women or women who have given birth within the past year. A new service for children and young people affected by eating disorders. Accepting self-referrals from young people and children, parents, as well as GPs, health and other professionals, including teachers. Aiming to reduce 200 crisis visits per year Priorities 2017/18 Central London CCG s priorities for 2017/18 have been agreed in partnership with a wide range of stakeholders. They focus on the areas of greatest need detailing how, where and when services will be commissioned. Our strategic priorities for 2017/18 are: Radically upgrading prevention and wellbeing, engaging with and informing people about how to look after themselves to avoid escalation to health or social care services Eliminating unwarranted variation and improving long term conditions - transforming primary care - provider development primary care estate and primary care workforce development Achieving better outcomes and experiences for older people - improving emergency and urgent care pathways, ensuring maintenance of the 95% A&E target 20

21 Ensuring we have safe, high quality sustainable services - addressing the workforce challenges in primary and community care Improving outcomes for children and adults with mental health needs - Ensuring the system has the capacity and capability to deliver (workforce, Organisational Development, IT primary care etc). We want to commission care that is personalised, localised, integrated, and centralised. Some of our priorities are detailed below and reflect our focus on improving local services, hospital services and mental health. Primary Care Transformation The main aim of the programme is to place primary care at the heart of whole system working, and improve access to GP services. Primary care, and in particular general practice, is at the centre of our collaborative vision. The aims are for patients to benefit from: Improved health outcomes, equity of access, reduced inequalities and better patient experience. Services that are joined up, coordinated and easy to use. More services available, closer to homes. High quality out-of-hospital care. More local patient and public involvement in developing services, with a greater focus on prevention, staying healthy and patient empowerment. As we move through this year, our priority areas in 2017/18 are as follows: Approving the new model of primary care through the primary care commissioning committees and implementing this across North West London to ensure it s a fundamental part of an integrated care offer for patients. Working to ensure that all necessary enablers are in place to support the new model of care rollout (including workforce, technology and contracts). Putting the right support in place to nurture and grow GP federations so they are able to deliver sustainability in the long-term. Progressing with the primary care estates strategy that takes into account the development of local services hubs across Central London. The long-term plan is to develop three hubs or health and wellbeing centres: in Lissom Grove in the north of the borough, at South Westminster Centre for Health. We are also actively looking for a location for a hub in the centre of the borough. These hubs will provide a range of integrated services, closer to people s homes. Integrated care Our Whole Systems Integrated Care (WSIC) programme is about giving people more say over their care, when and where they receive it, so that care is planned jointly between patients, their carers and the teams that support them. By involving patients and carers on the journey from day one, we have a much better chance of achieving our vision: care that enables each of us to help ourselves. By widening access to services that aren t necessarily provided by the NHS, such as local buddying schemes and exercise groups run by third sector parties, we can better support people to maintain independence and lead full lives as active participants in their communities. This work and the progress in integrating service design and delivery over the last 2 years demonstrates the benefits that can be realised from a fully joined up approach. But pockets of excellence do not necessarily translate into sustainable transformation and we believe 21

22 that the best way to truly embed the progress being made is through the development of implementation of Accountable Care Partnerships (ACPs). If WSIC is about bringing service delivery together in an integrated way, ACPs are about bringing organisations together, removing organisational barriers and establishing (and incentivising) a clear shared responsibility for delivering fully integrated care. During 2017/18 we will be further developing our plans for the implementation of ACPs to begin in April 2018 and we will continue to involve and work with our patients, residents and partners throughout. Priorities in the year ahead also include developing our Community Independence Service (CIS). The service involves a team with a GP, a social worker, a hospital consultant, a community matron, nurses and therapists, a health and social care coordinator, and a personal case manager to support the patients by providing care in their own home. We have also introduced the Patient Activation Measure (PAM) tool which gives clinicians a better understanding of the knowledge, confidence, and skills a patient can bring to managing their own care. The tool has been piloted in approximately 200 practices and is not being implemented within multiple services. In addition, plans are in place to produce a menu of self-care programmes for patients; training for staff; and work to empower third sector partners to deliver self-care support. Having put in a bid to NHSE for 1,020 free licences (1 per person) to use in this financial year, CL CCG has been trialling Patient Activation Measures (PAM), through its Care Co-ordination Service, since December So far, 354 PAM assessments have been conducted in 7 of its General Practices. The resulting score from the PAM assessment determines a patient s ability to manage their own care and understand their long-term condition. The intention is for clinicians to then tailor the interventions provided to assess individuals, with a view to making them more confident to manage their own health and well-being. These patients will, therefore, be reassessed in the near future to see whether this is happening. Any changes to scores can also be used to evaluate the effectiveness of interventions used. In 2017/18, we have the promise of a further 7,980 free licences from NHSE and, by 2021, will have been granted 60,000. Pan London Homelessness The CCG will be working on a number of initiatives related to improving our homeless population s experience of healthcare. This will include continuing investment in hepatitis C clinics, improving care planning, and increasing GP and nursing input into existing services. The Better Care Fund The programme across North West London has been finalised. Central London CCG is using the Better Care Fund Patient Experience Insights Project to ensure that: patient experience and local engagement data is collected and analysed in a way which is consistent across Central London, West London and Hammersmith and Fulham CCGs. The data is used to its full potential to produce a variety of thematic reports that can help to shape and influence the CCG strategy, service redesign and Equality Impact Assessments; and that the information we are gathering is properly triangulated with that received from other sources such as our providers and NHS Choices. Improving the experiences of people with learning disabilities 22

23 In 2017/18 the focus will be on the implementation of year 2 of the Transforming Care Partnership plan. Positive Behaviour Support training will also be rolled out across our health and social care economy including families and third sector organisations. The Learning Disabilities community services offer will be reviewed to ensure that what we are offering facilitates an ordinary life for people with learning disabilities. Community Services Central London Community Healthcare is the current main provider of Community Services for Central London CCG, West London CCG and Hammersmith and Fulham CCG. The CCGs and the provider are currently working together in transforming the services, ensuring the successful delivery of the North-West London Sustainability and Transformation Plan (STP) for 2017/18 and 2018/19. This will support and enable the transition towards Accountable Care Partnerships (ACPs) and the delivery of whole systems working. The programme of work was launched, to achieve the following objectives: To gain efficiencies in the commissioning of services, by designing services which represent better value for money. To remove duplication through multiple commissioned services. To improve the quality of services provided to patients, by improving integration of community services with the wider system Health and wellbeing strategy The Westminster Health and Wellbeing Board is a joint partnership with the local authority, CCG and the voluntary and community sector representatives. The Board aims to improve the health and wellbeing of Westminster s communities by bringing together the leadership of key organizations to plan and work in partnership, identify local needs and inequalities, monitor performance and develop effective plans and services. The Board is a statutory body under the Health and Social Care Act 2012, which requires it to discharge a number of statutory functions including the publication of a Joint Strategic Needs Assessment, Joint Health and Wellbeing Strategy and Pharmaceutical Needs Assessment. The Health and Wellbeing Board has regular meetings to review progress of the strategy and are assessing the impact of our programmes on health outcomes for the Borough. The Board meets 5 to 6 times a year and all members of the public are invited to attend. Space is given to allow questions from the public and throughout the meeting there are opportunities for people attending to participate in agenda items under discussion. In April 2016 the Board started a refresh of its strategy in collaboration with a range of stakeholders, including patients, providers, staff and local businesses. The vision is to plan future health and wellbeing services that will effectively tackle Westminster's unique health concerns. Engagement activity began in April 2016, where local residents and organisations identified key health and wellbeing themes that were most important to them. The strategy was published for public consultation in July and closed on 16 October During the consultation period, engagement events took place with providers, local businesses and the public. The strategy acts as the vehicle for our local Sustainability and Transformation Plans. Our initial workshop to identify priorities was well attended by over 40 representatives including patients, community and voluntary sector organisations, CCG members and Local 23

24 Authority representatives. Further engagement events have informed the strategy further and will be incorporated into defining the final strategy and delivery. Providers came together to inform us on their views with representation from 10 of our providers and valuable input was received to help shape the strategy. A public event has also been held and this encouraged around 30 people to find out more about the strategy and give their views on the plans. There were also around 20 people engaged with providing stalls or activities on the day that improve health and wellbeing. The event with local businesses attracted around 40 representatives and there was lots of interest from those who attended to get more involved in the implementation stage. Engagement with our stakeholders ensures that we are better equipped to transform health and care in Westminster, with a focus on prevention, self-care, wellbeing and effective community care outside of hospitals. The strategy was published on 13 December 2016 and we are currently working closely with local authority and voluntary and community sector partners to develop a shared implementation plan for 2017/18. Click here to find out more about Westminster s Health and Wellbeing Strategy Key issues and risks A major risk for the CCG is its financial position. Central London CCG received support of 1.4m from other CWHHE CCGs in 2016/17, without which the CCG would not have achieved its control total. The CCG also faces restricted uplifts in future years as it is overcapitated, i.e. receives more funding per head than other equivalent CCGs and has been informed that because of this allocation increases will be minimal over the next few years. In response to this, the CCG has adopted voluntarily a turnaround approach during this financial year. The CCG assessed its key risks and uncertainties throughout the year using the board assurance framework and risk register. The board assurance framework sets out the risks to delivering our strategic objectives and how these risks are managed. The assurance framework is presented to the Governing Body at its meetings in public, so that members can review the risks and mitigations and receive assurances that the risks are being managed. Further details on risk are included in the governance statement. The highest scoring risks for CWHHE CCGs at March 2017 were: Risk 5: Primary Care: risk that primary care is unable to deliver the required services due to lack of ability to act at scale, workforce, or estates issues, preventing us from delivering our Out of Hospital strategy. Risk 8: Pace of change and prioritisation: risk that we try to take on too many change programmes leading to loss of focus, ineffective delivery, unintended impacts on equalities, organisational fatigue, and difficulties in retaining high calibre staff. Risk 9: Data and information: risk that we do not make effective use of the data across the health and social care system and turn it into meaningful information, shared appropriately, to support effective decision making and improvements to delivery of care. Risk 10: Governance structures: risk that governance within our CCG and across NW London is not operating in a way that enables us to make effective shared decisions. 24

25 1.9. Performance summary Overview of the CCG s finances Central London CCG met its financial targets in 2016/17 and ended the year having met its planned surplus of 5.8m. The CCG reported a final surplus of 8.53m this included the 1% system risk share release that was budgeted for as per NHS guidance. As set out in the 2016/17 NHS Planning Guidance, CCGs were required to hold a 1% reserve uncommitted from the start of the year, created by setting aside the monies that CCGs were otherwise required to spend non-recurrently. This was intended to be released for investment in Five Year Forward View transformation priorities to the extent that evidence emerged of risks not arising or being effectively mitigated through other means. In the event, the national position across the provider sector has been such that NHS England has been unable to allow CCGs 1% non-recurrent monies to be spent. Therefore, to comply with this requirement, NHS Central London CCG has released its 1% reserve to the bottom line, resulting in an additional surplus for the year of 2.73m. This additional surplus will be carried forward for drawdown in future years. Although all five CCGs in the CWHHE collaborative (Central London, West London, Hammersmith and Fulham, Hounslow and Ealing) are autonomous organisations with separate financial targets and budgets, the CCGs share some senior management (including the Accountable Officer and Chief Finance Officer) and a common financial strategy. All five CCGs have agreed to participate in a financial risk sharing arrangement. During 2016/17, Central London CCG was provided with support of 1.43m by West London and Hounslow CCGs. This followed the agreed principles of the financial risk share between the CCGs. The CCG s full annual accounts have been prepared under a direction issued by NHS England under the National Health Service Act 2006 (as amended). NHS England has directed that the financial statements of CCGs shall meet the accounting requirements of the Manual for Accounts issued by the Department of Health. The accounting policies contained in the Manual for Accounts follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to clinical commissioning groups, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Central London CCG s accounts have been prepared on a going concern basis, i.e. it has been assumed that the organisation will continue operating into the future. Public sector bodies are generally assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as is the case in the NHS and for CCGs. From 1 April 2013, Central London CCG has been responsible for commissioning (i.e. planning and purchasing) local health services; excluding primary care and specialised services, which are commissioned by NHS England. Previously Primary Care Trusts (PCTs) had responsibility for the full range of services. Some of the providers the CCG commissions from include Imperial College Healthcare NHS Trust (who run Hammersmith, Queen Charlotte s, St Mary s and Charing Cross hospitals), Chelsea & Westminster NHS Foundation Trust (who run West Middlesex hospital as well as 25

26 Chelsea & Westminster), Central London Community Health NHS Trust and Central and North West London NHS Foundation Trust. The CCG covers the borough of Westminster but works closely with the four other CCGs in the CWHHE collaborative, as well as Brent, Harrow and Hillingdon CCGs. All eight CCGs together form the North West London (NWL) Collaboration. A shared financial strategy has been agreed across NWL Collaboration of CCGs. This comprises two elements. The first relates to a central budget which funds the Strategy and Transformation team which operates across NWL, as well as provider support for transformation change and other shared costs of transformation across the health economy. This element is hosted by Central London. Central London CCG made a contribution of 1.73m from its allocation to the running of this team in 2016/17. The second part relates to a transfer of funding between the CCGs to allow those CCGs with more financial flexibility to support those with a more constrained position in order to ensure all CCGs in North West London are able to invest in common commissioning strategies such as Shaping a Healthier Future and out of hospital services. Central London CCG neither received support from nor contributed to this part of the strategy in 2016/17. Overall it has been a difficult year financially and the CCG faces further challenges in the future. Many of the providers the CCG commissions from have also faced financial challenge, as have Local Authority partners and other stakeholders in the local health economy. This means that working closely with partners to deliver real transformational change both in Central London CCG and throughout North West London is even more important than ever How we spent your money The following chart gives a breakdown by service of the CCG s spend against the final 300.1m allocation for 2016/17. This comprised spend of 291.6m and delivery of a 8.5m surplus. In addition Central London CCG hosted North West London s financial strategy funds of 15.6m, to which the CCG made a contribution of 1.7m. 26

27 Underlying financial position The CCG s in-year surplus agreed with NHS England was 8.53m (3.1% of RRL). This was achieved with the CCG having an underlying deficit of 0.87m; the difference between the in-year surplus and the underlying position is that the latter does not take into account inyear allocations, slippage on investment plans, balance sheet gains and other non-recurrent items it is seen as a measure of the CCG s financial resilience and its ability to cope with risks and financial pressures. 2. Performance Analysis 2.1. How the CCG measures performance Central London CCG has a statutory duty to report on the performance of a number of services defined nationally within the NHS Constitution, Everyone Counts Guidance from 2014/15 to 2018/19 (Operating Framework) and the NHS Mandated Outcomes Framework. Performance of the CCG is monitored by the senior management team, and is also regularly reviewed at key system and operational meetings with providers and other commissioners. Performance of the CCG is also regularly (and as requested) reported to NHSE as part of the quarterly assurance cycle. As part of the Improvement and Assessment Framework CCGs work under, you can keep up to date with the performance of the CCG and the wider local NHS by typing your postcode into the new My NHS website. 27

28 2.2. Development and performance during the year Although there have been areas of improvement in Central London CCG s performance in 2016/17, there remain areas where Central London CCG needs to improve performance in collaboration with providers. A summary of performance across the range of NHS Constitution standards is provided in the subsequent paragraphs. The CCG s performance is regularly reported to NHS England for assessment Financial targets (See note 4 in the Financial Statements) CCGs have a number of financial duties under the National Health Service Act 2006 (as amended) regarding the use of its resources. For 2016/17, Central London CCG s performance against each is summarised below: Expenditure not to exceed its income For 2016/17 Central London CCG achieved its control total of 8.53m. Capital resource use not to exceed the amount specified in directions For 2016/17 Central London CCG did not have a capital allocation. Revenue resource use not to exceed the amount specified in directions For 2016/17 Central London CCG net revenue expenditure totalled 291.6m, against a revenue resource limit of 300.1m. In addition NHS England has placed the following additional controls on clinical commissioning groups use of resources: Capital resource use on specified matters not to exceed the amount specified in directions For 2016/17 Central London CCG did not have a capital allocation. Revenue resource use on specified matters not to exceed the amount specified in directions For 2016/17 Central London CCG did not have any resources allocated with specific directions. Revenue administration resource use not to exceed the amount specified in directions For 2016/17 Central London CCG had a target of 4.5m and actual performance of 4.5m and so achieved a surplus of 0m (running cost). A surplus on programme allocation of 8.53m and a surplus of 0m on running costs together equal Central London CCG s surplus of 8.53m Funding allocations NHS England has been working to address historical inequities in funding across local health economies. New funding calculations for CCG allocations (the money the CCG receives from NHS England for its local health services) includes population growth (based on 2011 census information and GP patient list sizes), the effect of relative deprivation and poverty 28

29 on health need, the impact of an ageing population and geographical cost differences across England. For 2016/17 Central London CCG received an increase amounting to 1.4% on the 2015/16 funding baseline of m. This meant Central London CCG received 3.79m growth funding in 2016/17. For 2017/18 the CCG has received an increase in allocation of 0.16% on the funding received in 2016/17, amounting to 0.45m. With this increase in funding, the CCG s gap between the funding it receives and the target funding allocation will decrease from 20.71% to 17.83% Accident and Emergency Department (A&E) Achievement of the A&E 4-hour wait target continues to be challenging for Central London CCG with the year to date position at 86.3% at Imperial College Healthcare NHS Trust (ICHT) and 86.9% at Chelsea Westminster Hospital Trust (CWHT). Work has been ongoing throughout the year with our acute hospital providers to improve patient flow and reduce delayed transfers of care. 29

30 Referral to treatment (RTT) The Referral to Treatment incomplete target (percentage of incomplete patients seen within 18 weeks) is the main national access performance indicator. The indicator reports the percentage of patients on incomplete pathways within 18 weeks against the total number of patients on an incomplete pathway as at the end of a calendar month. 30

31 Central London CCG performance year to date is 86.8%; performance against the standard was not achieved this year due to the need to prioritise non-elective admissions and cancer procedures. Central London CCG continues to work closely with Imperial College Healthcare NHS Trust (ICHT) to ensure sufficient capacity within specialties with high demand. The CCG s backlog comprises of 73.9% at ICHT, 10.3% at Chelsea and Westminster NHS Foundation Trust and 15.8% at other organisations. 18 weeks RTT - Incomplete Pathway - Central London CCG 100.0% 95.0% 90.0% 85.0% 80.0% 75.0% 70.0% 65.0% 60.0% 55.0% 50.0% Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Last 12 Months 91.3% 90.5% 89.8% 90.0% 88.9% 87.3% 87.6% 87.0% 88.6% 88.0% 86.6% 86.8% Prev. Year 91.8% 91.1% 91.4% Standard 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% Diagnostic waiting times The diagnostic waiting times target (for 15 key diagnostic tests and procedures) states that 99% of all patients should wait no more than 6 weeks for their diagnostic test. Performance against the standard has not been met since September and Central London CCG has agreed a recovery plan and trajectory with the providers to ensure compliance in 2017/ % 3.50% 3.00% 2.50% 2.00% 1.50% Diagnostic Waits (6 Weeks) - NHS Central London (Westminster) CCG Diagnostic Waits 1.00% 0.50% 0.00% Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 31

32 Cancer waiting times Central London CCG is currently not meeting the national standard at 72.2% for 62 Day waits for first definitive treatment. Improvements are being supported thought the NWL Secondary and Primary Care Cancer Boards. Initiatives to improve performance include weekly intertrust performance discussions, weekly real-time reporting to understand the Trusts in-month performance positions and demand and capacity reviews across the Trusts (supported by the Transforming Cancer Services Team). Trusts have also signed up to a Cancer Waiting Time Performance Agreement which outlines key actions to support the delivery of the standards throughout 2017/ Improved Access to Psychological Therapies (IAPT) Central London CCG has maintained a good level of performance in both access and recovery rates in recent months. The year to date positions for both IAPT Access and Recovery is meeting the national standards. IAPT Access and Recovery rates are being achieved by the main provider Central North West London (CNWL). CNWL is working closely with Central London CCG to improve appropriate referral rates into the service, specifically focusing on increasing appropriate referrals for older adults, carers and hard to reach groups. An extensive programme of direct contact with other health professionals and third sector groups is also underway. 32

33 Dementia diagnosis Central London CCG is currently performing well against dementia diagnosis standard of 76.3% allocated to the CCG by NHS England against the estimated prevalence (age 65+) within the local population of Work is ongoing between the CCG and primary care providers to ensure this position is maintained and further improved upon. 2016/17 Month CCG Planning Close of 15/16 Apr 16 May 16 Jun 16 Jul 16 Aug 16 Sep 16 NHS % Central % % % 1% % % London CCG Oct % Nov % Dec % Jan % Feb % Health Care Associated Infection (MRSA and C.Difficile) Cases of Methicillin Resistant Staphylococcus Aureus (MRSA) Blood Stream Infections (BSIs) are reported and reviewed in line with the national reporting requirements. There were 2 cases in the Central London CCG area which were subject to a Post Infection Review (PIR). ( All MRSA cases are subject to a PIR process). Outcomes of the PIR are aimed at attributing responsibility for the learning actions and are shared across the health economy. Not all cases have a clear source, or a set of learning actions for prevention, and as such, are attributed to a third party. Below are tables of 2016/17 MRSA BSIs. MRSA cases April March 2017 CCG Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Central

34 Methicillin Sensitive Staphylococcus Aureus (MSSA) BSI While MRSA has been the principal cause of concern, nationally it is recognised that MSSA is on the increase and is now reported. Although there are no national targets for MSSA BSIs, cases identified in hospital settings are reviewed while there are no investigations undertaken for community acquired cases. Escherichia coli (E. coli) BSIs There has been a significant increase in E. coli BSIs over the years and the government announced a 50% target to reduce gram-negative bloodstream infection (GNBs) particularly focusing Ecoli blood stream infections by Currently, there are no investigations undertaken for these cases in the community, but future plans will include all E.coli cases being subject to a PIR process. Since a significant number of cases are linked to urinary sepsis, action plans are in place to reduce risks of urinary tract infections. Clostridium difficile Infections (C diff) Central London CCG continues to make progress in reducing the number of C diffs. Cases in acute settings are subject to a Root Cause Analysis (RCA) to try and identify lapses in care. Any such lapse is followed up with individual remedial actions identified aimed at preventing similar cases. C diff Cases April March 2017 CCG Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Central Sustainable Development As an NHS organisation, and as a spender of public funds, we have an obligation to work in a way that has a positive effect on the communities for which we commission and procure healthcare services. Sustainability means spending public money well, the smart and efficient use of natural resources and building healthy, resilient communities. By making the most of social, environmental and economic assets we can improve health both in the immediate and long term even in the context of the rising cost of natural resources. We acknowledge this responsibility to our patients, local communities and the environment by working hard to minimise our carbon footprint. It is our duty to contribute towards the level of ambition set in 2014 of reducing the carbon footprint of the NHS, public health and social care system by 34% (from a 1990 baseline). The majority of the environmental and social impacts are through the services we commission. We work with our providers through the contracting process to make sure sustainability is factored into the services they offer local people Improve quality Central London CCG has a statutory duty to discharge its duty under Section 14R of the National Health Service Act 2006 (as amended) to report on the performance of a number of 34

35 services defined nationally within the NHS Constitution, Everyone Counts Guidance for 2015/16 (Operating Framework) and the NHS Mandated Outcomes Framework. Performance of the CCG is monitored by the senior management team, and is also regularly reviewed at key system and operational meetings with providers and other commissioners. Performance of the CCG is also regularly (and as requested) reported to NHS England as part of the quarterly assurance cycle. Central London CCG works with the other CCGs in NW London with each taking a lead commissioning role for the main contracts with NHS Trusts and other providers. Although there have been areas of improvement in Central London CCG s performance, there remain areas where Central London CCG needs to improve performance in collaboration with commissioned providers. A summary of performance across the range of NHS Constitution standards is provided in the subsequent paragraphs Quality and patient safety Central London CCG works closely with a number of organisations (statutory and nonstatutory) to ensure that the services we commission for our population has quality (encompassing patient safety, health outcomes, quality improvement and patient experience) at their core; similarly, clinical commissioner-led service, pathway redesign and transformation has improving quality at its heart. One of the Committees of the Governing Body is the Quality and Patient Safety Committee. This Committee leads on quality, ensuring that there are robust systems and processes in place to monitor the quality of commissioned services, whilst assuring the Governing Body that identified clinical risks are acted upon and mitigated. Regular reports are brought to this Committee focusing on: Safeguarding, Infection Control and Prevention, Complaints, Patient Experience, Equalities, Emergency Planning, Patient Safety and Integrated Quality and Performance. Working collaboratively with our partner organisations, a key area of ongoing focus is to build upon work related to quality improvement, enabling leadership in patient safety and culture development that encourages learning and sharing across a whole system to become embedded in service delivery and clinical practice. Examples of work to date include the ongoing development of clinical networks for Infection Control and Prevention and Pressure Ulcer Prevention and Management along with patient safety focused 'Sharing the Learning' workshops that bring organisations and individuals together to share and learn as a system. Underpinning the CCG s approach to understanding quality is a number of different approaches. This includes the use of dashboards, feedback from people who access commissioned services including experience and involvement, thematic reviews, deep dives and supportive clinical visits, working with NHS Improvement and NHS England on specific areas Safeguarding children and adults Ensuring robust systems and processes to fulfil our statutory safeguarding responsibilities are in place is a central component to our role as clinical commissioners. Central London CCG has a statutory responsibility to ensure that both they and the organisations that they commission from have systems and processes in place to safeguard children and vulnerable adults. 35

36 Central London CCG is a member of the Local Safeguarding Children Board (LSCB) and Local Safeguarding Adults Board (LSAB). As a member of these Boards, the CCG works in partnership with others to fulfil their safeguarding responsibilities. The CCG works closely with both Boards to ensure that there are effective NHS safeguarding arrangements are in place, across both NHS, private and voluntary sector providers, including care homes. We have a CCG safeguarding team that includes a Designated Nurse and Doctor for Safeguarding Children, a Designated Nurse and Doctor for Looked after Children and a Designated Adult Safeguarding and Clinical Quality Manager. The team also includes a Named GP for children to support safeguarding in primary care. The CCG works with the Child Death Overview Panel (CDOP) to ensure that child deaths are reviewed effectively. This includes provision of a Designated Paediatrician for Unexpected Deaths and Designated Nurse who work to ensure that all lessons learned are shared promptly and appropriately. In terms of assurance, each provider is required to produce a quarterly safeguarding report. The report includes information (key performance indicators) pertaining to training, supervision of staff, female genital mutilation, PREVENT (radicalisation identification and awareness) and the Mental Capacity Act. On receipt, the report is reviewed by the CCG with the Provider at their Clinical Quality Group and, if required, issues are then escalated to the CCG s Quality and Patient Safety Committees and the Local Safeguarding Board (Child or Adult). The CCG can therefore be assured that its safeguarding arrangements are in place or, where there are gaps, mitigating actions have been taken and that the trusts from which it commissions its services have safeguarding arrangements in place Pressure ulcers A significant aspect of patient safety continues to be in relation to pressure ulcers. A North West London Pressure Ulcer Clinical Network has been revitalised to engage all of the main acute and community NHS Trusts in NW London to work with the CCGs to share good practice and initiatives to reduce the risk of pressure ulcers. It endorses a collaborative approach between acute and community providers to implement education and practice improvements across NW London Patient and public involvement During 2016/17 we focused on engaging local patients and residents in the delivery of our commissioning programmes and various committees. Some areas of involvement included contract monitoring, contract negotiations, procurements, service evaluations, service redesign, finance and strategic planning. The CCG achieved good results following an assurance session with NHS England, with a rating of outstanding for meeting our collective duty and of good for meeting the individual duty for patient participation. Developing the User Panel and Patient Participation Groups (PPGs) One of the key priorities for 2016/17 was ensuring an effective User Panel and assisting our member practices to develop effective Patient Participation Groups (PPGs). 36

37 The User Panel continues to play a vital role in shaping our services and governing our organisation and the Chair of the User Panel is a full voting member of the CCG s Governing Body. The User Panel is a group of patients and residents from Westminster that support Central London CCG to engage and consult with its local population and citizens. Healthwatch Westminster is also a voting member of the User Panel, as they are a key partner in championing the voice of local people. CCG User Panel members are also part of the Healthwatch Westminster Committee. PPGs play a key role in supporting the delivery of the CCG s transformation programmes. We set up a PPG Task & Finish group that included members of the User Panel to support PPGs where there were no current members on the User Panel. The CCG also started to review the support for both the User Panel and PPGs, holding an exploratory workshop on 1 March 2017 to look at ways to develop the group. Stakeholder and provider engagement To facilitate stakeholder and provider engagement we arrange seminars, events and meetings where we communicate and discuss significant elements affecting our services. The meetings are well represented and positive contributions from our stakeholders and providers have supported the CCG to make beneficial strategic decisions as well as enable providers to build strong links with patients and residents. Michael Morton (Central London CCG Governing Body lay member) has been a key CCG representative for the Imperial College Health Partners organisation which brings together NHS providers of healthcare services, CCGs and leading universities across North West London. The partnership aims to deliver real improvements in health and prosperity for the residents and patients in this area. The CCG is committed to supporting providers with their engagement activity. Learning disability self-assessment framework We work in partnership with the Advocacy Project to host workshops for local patients with learning disabilities. This informs our improvement plans to address the health inequalities faced by people with learning disabilities. Autism We work with people on the autistic spectrum and their carers to inform our stocktake of services for people with autistic spectrum conditions. Over the past year we have involved local patients on the Autism Partnership Board. Carers We work with the Carers Joint Partnership Board to inform commissioning intentions and improve the delivery of carer services. We have also worked in partnership with Royal College of General Practice and third sector partners to develop and maintain an information resource of services for health professionals (including GPs) to refer carers and young carers. Black, Minority and Ethnic (BME) community We jointly commission with West London and Hammersmith & Fulham CCGs the BME Health Forum. The forum undertakes pieces of work and facilitates events which bring together diverse individuals, groups, and organisations from the community, voluntary and 37

38 statutory sector who collectively have shared interests in the healthcare needs and provision of services to BME communities. Long-Term conditions In 2016/17 we offered the Expert Patient Programme to local patients to help improve their confidence in managing their Long-Term Conditions. Training courses are available for local patients to help them increase their confidence; improve their quality of life; and help them manage their condition more effectively. Diabetes User Group (DUG) & the Diabetes Champions Central London, along with West London CCG, Hammersmith & Fulham CCG and Public Health, collectively commission the DUG which provides a targeted forum that carries out engagement with the local community to ensure that the voices of the local population contribute directly to the provision and development of local diabetes services, with particular emphasis on the role of prevention, identification and education. Community Champions project We engage with the local authority on the Community Champions (CC) project. Community Champions are local people who volunteer to support the health and wellbeing of local residents. They promote access to and awareness of local services and motivate residents towards improving their health and wellbeing. Online and media engagement Central London CCG continues to maintain its website with relevant and up to date copy. We have linked our social media platforms, added more interactive features such as videos and we have set up new social media channels for Twitter and YouTube to aid our effectiveness at reaching more of our population who use these platforms. We are looking at ways of further involving the local community in our public committee meetings and this has included a trial project of broadcasting our Governing Body meetings using Periscope and live tweeting during the meeting. Using social media has allowed us to network more successfully and steadily increase our audience engagement. We also work closely with GP practices to develop their media content for screens in patient waiting rooms Reducing health inequality Central London CCG aims to improve health outcomes and reduce inequalities for its patients. This involves ensuring thorough engagement with, and drawing on, the expertise of residents, patients, services providers and third sector organisations. This is critical in shaping services that are high quality, value for money and that reflect the needs of our diverse population. The involvement and active participation of stakeholders helps us to meet our public equality duties by: Identifying at an early stage in the design and development of services whether the service is free of unlawful discrimination or impacts adversely on any group of service users. Advancing equality by helping to ensure that services are accessible to all who need the service 38

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41 Accountability report 41

42 Corporate Governance Report The Corporate Governance Report outlines the composition and organisation of the CCGs governance structures and how they support the achievement of the CCGs objectives. The Corporate Governance Report comprises: Members Report; Statement of the Accountable Officer s Responsibilities; and Annual Governance Statement. 3. Members Report Central London CCG is responsible for planning and commissioning health services for the people of the London Borough of Westminster (excluding Queen s Park and Paddington. Set up in 2013, the CCG operates in accordance with its Constitution with a governing body made up of lay members, clinicians and executive directors Member practices Central London CCG has 35 member practices and a registered patient population of approximately 202,000. In any working day the population rises to a million people. Belgravia Surgery Cavendish Health Centre Connaught Square Practice Covent Garden Medical Centre Crawford Street Surgery Crompton Medical Centre Dr Hickey s Surgery Dr Shakarchi's Practice Dr Victoria Muir's Practice Fitzrovia Medical Centre Great Chapel Street Medical Centre Imperial College Health Centre King's College Health Centre Lanark Medical Centre Lisson Grove Health Centre Little Venice Medical Centre Maida Vale Medical Centre Pimlico Health at the Marven Marylebone Health Centre Mayfair Medical Centre Millbank Medical Centre Newton Medical Centre North West London Medical Centre Paddington Green Health Centre Randolph Surgery The Royal Mews Surgery Soho Square General Practice Soho Square Surgery 42

43 St John's Wood Medical Practice Third Floor Medical Centre Victoria Medical Centre Wellington Health Centre Westbourne Green Surgery Westminster School Surgery Woodfield Road Surgery 3.2. Composition of Governing Body The main function of the Governing Body is to ensure that Central London CCG has appropriate arrangements in place to ensure it exercises its functions effectively, efficiently and economically, and in accordance with any generally accepted principles of good governance that are relevant to it. The Governing Body leads on the setting of vision and strategy approves commissioning plans, monitors performance against plan, and provides assurance of strategic risks. During 2016, Dr Yal Heidari stepped down as a GP member of the Governing Body at Central London CCG. Dr Sheila Neogi was later elected. In 2016/17 the members of the Governing Body have been as follows: Name Dr Neville Purssell Philip Young Dr Mona Vaidya Dr Sheila Neogi Dr Paul O Reilly Dr Afsana Safa Dr Simon Gordon Dr Adel Baluch Dr Niamh McLaughlin Gail Spiller Maxine Radcliffe Michael Morton Dominique Kleyn Nafsika Thalassis Clare Parker Jules Martin Keith Edmunds Dr Alan Hakim Jonathan Webster Ben Westmancott Position Chair Deputy Chair & Lay Member Vice Chair GP member lead GP member lead GP member lead GP member lead GP member lead GP member lead Co-opted member practice manager Co-opted member practice nurse Lay Member Lay Member Chair of User Panel Chief Officer Managing Director Chief Financial Officer Secondary Care Consultant Nurse member Director of Compliance (adviser in attendance) 3.3. Committees, including Audit Committee 43

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45 4. Statement of the Accountable Officer s responsibilities The National Health Service Act 2006 (as amended) states that each Clinical Commissioning Group shall have an Accountable Officer and that Officer shall be appointed by the NHS Commissioning Board (NHS England). NHS England has appointed the Chief Officer to be the Accountable Officer of Central London CCG. The responsibilities of an Accountable Officer are set out under the National Health Service Act 2006 (as amended), Managing Public Money and in the Clinical Commissioning Group Accountable Officer Appointment Letter. They include responsibilities for: The propriety and regularity of the public finances for which the Accountable Officer is answerable; Keeping proper accounting records (which disclose with reasonable accuracy at any time the financial position of the Clinical Commissioning Group and enable them to ensure that the accounts comply with the requirements of the Accounts Direction); Safeguarding the Clinical Commissioning Group s assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities); The relevant responsibilities of Accounting Officers under Managing Public Money; Ensuring the CCG exercises its functions effectively, efficiently and economically (in accordance with Section 14Q of the National Health Service Act 2006 (as amended)) and with a view to securing continuous improvement in the quality of services (in accordance with Section14R of the National Health Service Act 2006 (as amended)); Ensuring that the CCG complies with its financial duties under Sections 223H to 223J of the National Health Service Act 2006 (as amended). 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 Clinical Commissioning Group and of its net expenditure, changes in taxpayers equity and cash flows for the financial year. In preparing the financial statements, the Accountable Officer is required to comply with the requirements of the Group Accounting Manual 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 Group Accounting Manual 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 under the National Health Service Act 2006 (as amended), Managing Public Money and in my Clinical Commissioning Group Accountable Officer Appointment Letter. I also confirm that: 45

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47 5. Governance statement 5.1. Introduction and context Central London CCG is a body corporate established by NHS England on 1 April 2013 under the National Health Service Act 2006 (as amended). The clinical commissioning group s statutory functions are set out under the National Health Service Act 2006 (as amended). The CCG s general function is arranging the provision of services for persons for the purposes of the health service in England. The CCG is, in particular, required to arrange for the provision of certain health services to such extent as it considers necessary to meet the reasonable requirements of its local population. As at 1 April 2016, the clinical commissioning group is not subject to any directions from NHS England issued under Section 14Z21 of the National Health Service Act Scope of responsibility As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the clinical commissioning group s policies, aims and objectives, whilst safeguarding the public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out under the National Health Service Act 2006 (as amended) and in my Clinical Commissioning Group Accountable Officer Appointment Letter. I am responsible for ensuring that the clinical commissioning group is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity. I also have responsibility for reviewing the effectiveness of the system of internal control within the clinical commissioning group as set out in this governance statement Governance arrangements and effectiveness CCG Constitution and structure 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 CCG has made appropriate arrangements for ensuring that it complies with such generally accepted principles of good governance as are relevant to it. The overarching governance arrangements are set out in the Constitution which includes standing orders, prime financial policies, instructions and the scheme of reservation and delegation. The CCG has delegated to the Governing Body decision making and responsibility for the delivery of all its duties with the exception of: Determine the arrangements by which the members of the CCG approve those decisions that are reserved for the membership. Consideration and approval of applications to NHSE on any matter concerning changes to the CCG s constitution, including terms of reference for the CCG s Governing Body, its committees, membership of committees, the overarching scheme of reservation and delegated powers, arrangements for taking urgent decisions, standing orders and prime financial policies. 47

48 Approve the arrangements for identifying practice members to represent practices in matters concerning the work of the CCG and appointing clinical leaders to represent the CCG s membership on the CCG s Governing Body, for example through election (if desired). Approve the appointment of Governing Body members, the process for recruiting and removing non-elected members to the Governing Body (subject to any regulatory requirements) and succession planning. The Governing Body has supplemented the governance framework by the formal adoption of: the Nolan Principles on Standards in Public Life; the Code of Conduct and Accountability for NHS Boards; the CCG Code of Conduct; Standards of Business Conduct (incorporating Gifts, Hospitality and Sponsorship) Policy; Anti-Bribery Policy; and, a Conflicts of Interest Policy. Using the NHSE guidance The Functions of Clinical Commissioning Groups and published legal guidance, the CCG has reviewed its statutory duties and is satisfied that it has in place all the necessary complete and lawful arrangements to ensure the proper discharge of those functions Governing Body To undertake and ensure the systematic discharge of its functions and duties, the CCG established a Governing Body and committees. Details of their roles are set out below. The functions of the Governing Body are: Commissioning community and secondary healthcare services (including mental health services) for: All patients registered with its member GP practices, and All individuals who are resident within the Central London CCG geographical area who are not registered with a member GP practice of any CCG (e.g. Unregistered). Commissioning emergency care for anyone present in the Central London CCG area. Paying its employees remuneration, fees and allowances in accordance with the determinations made by Central CCG s Governing Body and determining any other terms and conditions of service of the CCG s employees. Determining the remuneration and travelling or other allowance of members of its Governing Body via its Remuneration Committee To discharge these duties, the Governing Body has met on seven occasions during the year with voting members in attendance as follows: Name Position Present Absent Dr Neville Purssell Chair 6 1 Philip Young Deputy Chair & Lay Member 5 2 Dr Mona Vaidya Vice Chair 6 1 Dr Sheila Neogi GP member lead 7 0 Dr Paul O Reilly GP member lead 7 0 Dr Afsana Safa GP member lead 5 2 Dr Simon Gordon GP member lead 6 1 Dr Adel Baluch GP member lead

49 Dr Niamh McLaughlin GP member lead 7 0 Gail Spiller Co-opted member practice manager 5 2 Maxine Radcliffe Co-opted member practice nurse 7 0 Michael Morton Lay Member 7 0 Dominique Kleyn Lay Member 6 1 Nafsika Thalassis Chair of User Panel 7 0 Clare Parker Chief Officer 7 0 Jules Martin Managing Director 6 1 Keith Edmunds Chief Financial Officer 5 2 Dr Alan Hakim Secondary Care Consultant 6 1 Jonathan Webster Nurse member Audit Committee The Committee reviews the establishment and maintenance of effective systems of governance, risk management and internal control across the whole of the CCG s activities, designed to support the achievement of the CCG s objectives. Its work dovetails with that of the CCG s committees. The Audit Committee reviews the adequacy and effectiveness of: All risk and control related disclosure statements (in particular the Annual Governance Statement), together with any appropriate independent assurances, prior to endorsement by the CCG Governing Body. The underlying assurance processes that indicate the degree of achievement of each of the CCG s objectives, the effectiveness of the management of principal risks and the appropriateness of the above disclosure statements. The policies for ensuring compliance with relevant regulatory, legal and code of conduct requirements and related reporting and self-certification. The policies and procedures for all work related to fraud, bribery and corruption as set out in the NHS Protect Standards for commissioners and as required by NHS Protect. In carrying out this work, the Audit Committee primarily utilises the work of internal audit, external audit and other assurance functions, but will not be limited to these sources. It also seeks reports and assurances from directors and managers as appropriate, concentrating on the over-arching systems of integrated governance, risk management and internal control, together with indicators of their effectiveness. This will be evidenced through the Audit Committee s use of an effective assurance framework to guide its work and that of the audit and assurance functions that report to it. In discharging these responsibilities, the Audit Committee has focused on the establishment of effective policies and procedures to control financial performance and to ensure compliance with relevant regulatory and legal requirements. This work has included overseeing counter fraud arrangements, reviewing the financial control environment assessments, closely monitoring the contracting database developments, monitoring the refinement of risk management and overseeing the extension of internal audit and counter fraud contracts. 49

50 At each meeting, the committee also reviewed the risk management and assurance framework arrangements to ensure effective management of the CCG s strategic, operational and collaboration risks. The Committee recognised that conflicts of interest, perceived or real posed a particular challenge for the CCG. To ensure that all dealings were beyond reproach, it oversaw the ongoing development of the conflicts of interest policy, specific arrangements to oversee the co-commissioning of primary care services with NHS England and, transparency in the management of conflicts of interest. In so doing, the Committee met on seven occasions with attendance as follows: Philip Young Lay Member Chair - Lay member (Audit & 7/7 Governance) Dominique Kleyn Lay Member, Central Lay member 6/7 London CCG Michael Morton Lay Member, Central Lay Member 4/7 London CCG Alan Hakim Secondary Care Consultant, CWHHE CCGs (Chair) Secondary Care Consultant members of the Governing Bodies (Deputy Chair) 6/7 The Audit Committee meets in common with the other CWHHE CCGs Audit Committees and the Chair and Secondary Care Consultant are members common to each. Members of the other CCGs Audit Committees were: Simon Tucker, Lay Member, West London CCG; Rohan Hewavisenti, Lay Member, Hammersmith and Fulham CCG; Trevor Woolley, Lay Member, Hounslow CCG; and Dr Raj Chandok, GP Governing Body Member Finance and Performance Committee The purpose of this committee is to provide assurance to the Governing Body that financial plans are robust and that risks to delivering financial obligations are being managed appropriately. It operates to a programme of business, agreed by the Governing Body that is flexible to new and emerging priorities and risks. The general areas of responsibility for the committee are to: Seek assurance that the commissioning plan and strategy for the CCG is sustainable and affordable, keeping in mind that the strategy and response may need to adapt and change. Provide assurance that commissioned services are being delivered in an efficient and effective manner, ensuring that quality sits at the heart of everything the CCG does. This includes jointly commissioned services. Oversee and be assured that effective management of risk is in place to manage and address the finance of the CCG and to be able to monitor performance. Receive and scrutinise independent investigation reports relating to finance and agree publication plans. Receive and scrutinise business plans and make recommendations to the Governing Body. 50

51 Receive and scrutinise QIPP and other savings plans and make recommendations to the Governing Body. Receive and scrutinise a medium term financial strategy and make recommendations to the Governing Body. Ensure adequate resources and capabilities are in place to allow the CCG to develop proper financial plans and accounts. Ensure a clear escalation process, including appropriate trigger points, is in place to enable appropriate engagement of external bodies on areas of concern. The key areas of focus include the overall financial position, delivery of QIPP and planning for the following year, as well as performance of the main providers of care. During the past year, the Committee met on eleven occasions with attendance as follows: Name Position Comments Present Absent Dr Paul O Reilly Chair 11 0 Dominique Kleyn Deputy Chair 10 1 Dr Adel Baluch GP Representative 10 1 Gail Spiller Practice Manager 9 2 Helen Troalen Keith Edmunds Jules Martin Matthew Bazeley Philippa Mardon Deputy Chief Finance Officer Chief Finance Officer Managing Director Managing Director Deputy Managing Director Started in May 2016 Until May Elke Taylor Head of Finance 9 2 Nafsika Thalassis User Panel Chair 1 10 Chris Neill Deputy Managing Director Started in August Central London CCG s Quality and Safety Committee The duties of the local Quality and Safety Committee are driven by the priorities for the CCG and any associated risks or areas of quality improvement and therefore operates to a programme of business that is flexible, agreed by the Governing Body. The general areas of responsibility for the committee are to: Seek assurance that the commissioning plan and strategy for the CCG fully reflects all elements of quality. Provide assurance that commissioned services are being delivered in a high quality and safe manner, ensuring that quality sits at the heart of everything the CCG does. Oversee and be assured that effective management of risk is in place to manage and address clinical governance issues. Oversee the process and compliance issues concerning serious incidents requiring investigation. 51

52 Seek assurance on the performance of NHS organisations in terms of the Care Quality Commission, Monitor and any other relevant regulatory bodies. Scrutinise independent investigation reports relating to patient safety issues and agree publication plans. Ensure a clear escalation process, including appropriate trigger points, is in place to enable appropriate engagement of external bodies on areas of concern. Ensure the CCG complies with information governance requirements to new and emerging priorities and risks. The CQC reports on providers, the CAMHS service and approval of service specification and care pathway changes designed to improve patient care. In order to discharge these responsibilities, the committee met on ten occasions during the year. Name Position Comments Present Absent Dr Mona Vaidya Chair 8 2 Dr Sheila Neogi GP and CLCCG Governing Body Member 9 1 GP and CLCCG Dr Niamh Governing Body McLaughlin Member 7 3 Practice Nurse and Maxine Radcliffe CLCCG Co-opted GB Member 3 7 Jonathan Webster Ashfaq Khan Mary Mulix Jules Martin Matthew Bazeley Chris Neill Director of Quality and Patient Safety CWHHE and GB member Assistant Director of Quality and Patient Safety CWHHE Assistant Director of Quality and Patient Safety CWHHE (obo Jonathan Webster) Managing Director Managing Director Deputy Managing Director Started May 2016 Until May 2016 Started August Michael Morton GB Lay Member 6 4 Nafsika Thalassis User Panel Chair 6 4 Carena Rogers Molly Larkin Mak Inayat Eva Hrobonova Healthwatch Representative 2 8 Designated Nurse - Adults Safeguarding 6 4 Designated Nurse - Children's Safeguarding 8 2 Deputy Director of Public Health

53 5.4. Joint Committees with delegated decision-making authority Primary care co-commissioning The CCG s primary care joint co-commissioning committee was established in April Since then, it has met in common every quarter with the joint committees of the other seven North West London CCGs (Central London, West London, Hammersmith and Fulham, Ealing, Brent, Hillingdon and Harrow). The meetings in common have focused on devising a coordinated North West London approach to key strategic issues, such as the implementation of the Strategic Commissioning Framework and strategic approaches to estates development and the PMS review. Locally, the joint committees have focused on formulating CCG-specific commissioning intentions for the re-investment of the local PMS premium, the development of local estates strategies and the deployment of funds through the Primary Care Transformation Fund. The private sections of the local meetings have considered confidential practice issues, including contract performance. The joint committees have worked hard to engage local stakeholders (including Healthwatch and the Health and Wellbeing Boards) in co-commissioning. Through the North West London primary care transformation team, the joint committees have also supported lay member co- commissioning education sessions, including on the local primary care landscape, primary care finance, and the methodologies of the PMS review Primary Care (Local) Co-commissioning Group Primary care co-commissioning will enable the CCG to ensure that primary care acts as a driver for ambitious plans to transform the local health and care economy, both locally and across North West London. The joint committee: Is the commissioning body that decides how GP services are going to be delivered locally. Decisions will be taken jointly between the CCG and NHS England. Any decisions taken outside the joint committee will be according to the standing operating procedures (approved policies) and where urgent decisions, as defined in NHS England s London-wide operating model, might be required; It will develop and adopt an operating model, which will set out the detailed decisionmaking processes required to support effective co-commissioning, to be referenced and evidenced as part of each of the relevant business areas dealt with at the meetings; Will review and agree the framework by which contract and contract performance management will be undertaken. A memorandum of understanding between the joint committee, performance directorate and contracting team will make explicit the duties and responsibilities of all parties in contract and performance management; and Will demonstrate its transparency to local people, as well as the CCG and NHS England, by meeting in public, both when meeting locally and when meeting in common. 53

54 NHS England will conduct routine contract management of GMS, PMS and APMS contracts as before, together with offering and monitoring delivery of Directed Enhanced Services. Where issues are identified, this will include liaison with practices, development of appropriate action or improvement plans, and then monitoring delivery of these plans. The joint committee will receive aggregate reports on this routine contract and performance management. Name Position Comments Present Absent Neville Purssell GP, CLCCG GB Chair 6 3 Mona Vaidya GP, CLCCG GB Vice Chair Deputy to Neville Purssell 3 6 Niamh McLaughlin GP, CLCCG GB Member Second GP 8 1 Clare Parker Chief Officer, CWHHE 0 9 Matthew Bazeley Jules Martin Chris Neill Rosalyn King Keith Edmunds Peter Buckman Alan Hakim Managing Director, CLCCG Managing Director, CLCCG Deputy Managing Director, CLCCG Director of Health Outcomes, CLCCG Chief Financial Officer, CWHHE Deputy Chief Financial Officer, CWHHE Secondary Care GB Member Until May From May From September Until August Deputy to Keith Edmunds Jonathan Webster Nurse GB Member 1 8 Mary Mullix Ashfaq Khan Deputy Nurse GB Member Assistant Director for Quality, Nursing and Patient Safety Deputy to Jonathan Webster Deputy to Jonathan Webster Dominique Kleyn Chair, GB Lay Member 8 1 Michael Morton Liz Wise Deputy Chair, GB Lay Member Director of Primary Care Commissioning (London), NHS England Jo Ohlson Director of Commissioning and Operations (NW London), NHS England

55 Julie Sands Head of Primary Care (NW London), NHS England 4 5 Nick Sodhi Deputy Head of Primary Care (NW London), NHS England Deputy to Julie Sands 3 6 David Finch Medical Director (NW London), NHS England 0 9 Mark Spencer Assistant Medical Director 0 9 Jane Betts LMC Representative Non-voting advisor 2 7 Katie Bramell- Stainer LMC Representative Non-voting advisor 3 6 Lesley Williams LMC Representative Non-voting advisor CWHHE Investment Committee The Investment Committee provides a forum for resolving issues and making recommendations to Governing Bodies where the CCG Governing Bodies face conflicts of interest. The committee considers decisions referred to it by the CCG Governing Bodies and makes recommendations on how to proceed or ratifies the processes employed to address conflict of interest issues. The committee can make decisions on behalf of the Governing Body when asked to do so by the Governing Body. Membership consists of: Lay member for audit, remuneration and conflict of interest matters (Chair); an additional lay member from each of the CCGs; Secondary Care Consultant governing body member for each CCG; Chief Officer; Chief Finance Officer; and CCG Chairs. Lay members and secondary care consultants are considered independent members unless they themselves have a conflict of interest with an item being discussed. The CCG chairs are also members of the committee but are not able to vote when they are conflicted. Name Title Total attendance Philip Young Chair, Lay Member Governance Lead, CWHHE CCGs Simon Tucker Lay member, West London CCG 4/9 Trevor Woolley Lay member, Hounslow CCG 6/9 Rohan Hewavisenti Lay Member, Hammersmith & Fulham CCG 7/9 Dominique Kleyn* Lay Member, Central London CCG 6/9 7/9 55

56 Dr Alan Hakim Secondary Care Consultant, CWHHE CCGs 6/9 Clare Parker Accountable Officer, CWHHE CCGs 6/9 1 Keith Edmunds Chief Finance Officer. CWHHE CCGs 7/9 1 Dr Neville Purssell Chair, Central London CCG 8/9 1 Dr Fiona Butler Chair, West London CCG 5/9 Dr Tim Spicer Chair,Hammersmith and Fulham CCG 5/9 Dr Nicola Burbidge Chair, Hounslow CCG 8/9 Dr Mohini Parmar Chair, Ealing CCG 5/ CWHHE Health & Safety Committee In January 2016, the CWHHE CCGs Governing Bodies agreed to establish a joint committee whose primary purpose is to provide a formal forum for devising, developing and promoting controls and initiatives to improve standards, and compliance therewith, of health and safety across CWHHE. Whilst the CCG s over-arching Health and Safety policy and strategy remains a matter for the Governing Body, it has delegated authority to the Committee for the approval of the specific H&S policies (e.g. fire safety, manual handling etc.). The Committee produces a Health and Safety plan and reports formally twice a year to the Governing Body on it progress with implementation. Chaired by the CWHHE Director of Compliance, each CCG and the staff side are represented. The CWHHE Secondary Care Doctor, Alan Hakim, is the independent Governing Body member. The Committee met four times in 2016/ Other joint committees North West London (NWL) CCGs collaboration board (a non-statutory joint committee for consultation and for decision making in limited areas) The collaboration board brings together the chairs, chief officers, all shared directors and Lay and Member Healthwatch representatives from across the eight NW London CCGs to discuss joint strategic objectives and proposals. This allows the NWL CCGs to establish consensus across NW London before proposals and recommendations are discussed in each CCG. The board also serves to foster views among clinical commissioners to feed into the new monthly joint health and care transformation group (JHCTG), a non-decision making group established with local authority and provider community representation to provide sector-wide system leadership for the oversight of the NW London Sustainability and Transformation Plan (STP). The collaboration board serves to guide the CCGs approach to developing joint strategy, including business intelligence and informatics strategy, and also spent time at the beginning 1 Attendance includes that of nominated Deputies Louise Proctor (for Clare Parker 1/1), Helen Troalen and Eva Horgan (for Keith Edmunds 2/2 and 1/1 respectively), Dr Mona Vaydia (for Neville Purssell 1/1) and Dr Raj Chandok (for Mohini Parmar 2/2). 56

57 of the contracts round providing feedback on the approach to be taken to the annual contracts rounds, led by the NWL CCGs director of contracting, performance and procurement. In limited areas, the board has delegated authority from the CCGs in which it can take joint decisions. For instance, it takes decisions in response to the recommendations of NWL CCGs Policy Development Group on Individual Funding Requests (IFRs) and Planned Procedures with a Threshold (PPwTs) as to what healthcare treatment may be funded in the boroughs and against which criteria. In all other cases regarding financial investment, the CCGs respective local Standing Financial Instructions are adhered to and the local decision making routes are followed. A key focus of collaboration during 2016/17 was to accelerate and deepen the development of the NW London STP, with a large contingent of the board s membership also meeting regularly together with a range of stakeholders via the Strategic Planning Group for NW London. Since the publication of the STP, the board s strategy meetings have been reorientated to ensure that health commissioners explore in depth the progress within and across the five delivery areas and three enablers of the STP, and provide rigorous challenge to the executive arm of the sector Clinical Board The Clinical Board provides clinical advice for the Shaping a Healthier Future (SaHF) reconfiguration programme, ensuring that the approach to implementation across primary and secondary care is clinically sound and that clinical safety and quality are protected during the implementation period. Responsibilities include: Monitor and manage clinical risk to patients and the clinical delivery of services across North West London during reconfiguration implementation, agreeing collective action to address any issues. Lead clinical implementation planning, in particular advising on safe sequencing of change and readiness for change. Provide expert clinical advice on other programme deliverables if needed, including local workstream deliverables To seek advice where necessary from: o The North West London Clinical Senate (once established) o The Governing Body o The Clinical Networks - expert advisory groups of clinicians in the key areas of Maternity, Paediatrics and Emergency and Urgent Care. To commission the Clinical Networks and Clinical Implementation Groups to provide advice on any specialty-specific implementation issues Shaping a Healthier Future (SaHF) Implementation Programme Board The Implementation Programme Board oversees the implementation of the Shaping a Healthier Future reconfiguration programme in line with decisions taken by the North West London Joint Committee of Primary Care Trusts (NWL JCPCT) formed in 2012 and comprises the eight North West London PCTs and three neighbouring PCTs (Camden, Richmond, Wandsworth). Programme Board responsibilities are to: Bring together local commissioners and local providers to jointly manage reconfiguration implementation; Plan, manage progress, resolve issues and manage risks and interdependencies; Receive and discuss progress reports from workstream leads; 57

58 Track system wide delivery of QIPP and CIP and enabling projects as they pertain to the delivery of shaping a healthier future (SaHF) reconfiguration by, for example delivery of admissions avoidance and reductions in length of stay; Receive and discuss key programme deliverables, in particular: o System-wide deliverables such as common modelling assumptions; and o OBC and FBCS for capital expenditure; Ensure the different parts of the programme maintain sufficient focus on issues relating to clinical risk, workforce, travel and access, equalities and carers and that appropriate patient engagement continues; and Ensure appropriate links are made with other strategic programmes and organisations outside North West London Performance of the Governing Body The Governing Body has considered the means by which it can review its effectiveness and has adopted an annual programme of self-assessment. The outcome of the self-assessment is formally reported at a meeting of the Governing Body and an associated action plan developed. Committees and sub-committees will follow a similar process with the outcomes considered by the Governing Body as part of a wider annual review of performance. In addition, with the assistance of an external consultant, the CCG has conducted regular organisational development seminars where the Governing Body developed and utilised its own bespoke appraisal process UK corporate governance code We are not required to comply with the UK Corporate Governance Code. However, we have reported on our corporate governance arrangements by drawing upon best practice available, including those aspects of the UK Corporate Governance Code we consider to be relevant to the clinical commissioning group and best practice Discharge of statutory functions In light of recommendations of the 1983 Harris Review, the clinical commissioning group has reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislative and regulations. As a result, I can confirm that the clinical commissioning group is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions. Responsibility for each duty and power has been clearly allocated to a lead Director. Directorates have confirmed that their structures provide the necessary capability and capacity to undertake all of the clinical commissioning group s statutory duties Risk management arrangements and effectiveness Risk management strategy 58

59 The Risk Management and Assurance Strategy outlines Central London CCG s approach to risk management and its vision in relation to assurance systems. The CCG has a responsibility to ensure that they are effectively governed in accordance with best practice across corporate, clinical and financial governance. Every activity that the CCG undertakes or commissions others to undertake on its behalf, brings with it some element of risk that has the potential to threaten or prevent the organisation achieving its objectives. Risk management aims to draw attention to actual or potential problems and to encourage the appropriate response to them; risks are managed by the people who have the greatest ability to control them. Successful risk management involves: Identifying and assessing risks; Taking action to anticipate or manage them; Monitoring them and reviewing progress in order to establish whether further action is necessary or not; and Ensuring effective contingency plans are in place. Through the management of risk the CCG seeks to minimise, though not necessarily eliminate, threats, and maximise opportunities. Where this is done well, this ensures the safety of our patients, visitors, and staff, and that as an organisation the Governing Body and management is not surprised by risks that could, and should, have been foreseen. Strategic and business risks are not necessarily to be avoided, but, where relevant, can be embraced and explored in order to grow business and services, and take opportunities in relation to the risk. Considered risk taking is encouraged, together with innovation within authorised and defined limits. The priority is to reduce those risks that impact on safety, and reduce our financial, operational and reputational risks through awareness, competence and management. The CCG risk management processes ensure that risks are identified, assessed, controlled, and when necessary, escalated. These main stages are carried out through: Clarifying objectives Identifying risks to the objectives Defining and recording risks Completion of the risk register and identifying actions Escalation of risks. The risks to which the CCG are specifically exposed are identified by: Internal methods such as complaints, claims, identification of trends, audits, QIPP related risks, project risks, patient satisfaction surveys, whistle-blowing and monitoring the quality of commissioned services. External methods - HM Coroner reports, media, national reports, new legislation, surveys, reports from assessments/inspections by external bodies (CQC), reviews of partnership working, horizon-scanning. Liaison through practice visits, locality meetings, GP Forums, patient engagement forums, practice feedback forms and Practice Manager Meetings. 59

60 The consequences of some risks, or the action needed to mitigate them, can be such that it is necessary to escalate the risk to a higher management level. For example, it might be escalated from a Directorate (work stream) Risk Register to a Corporate Register, or from the Team Risk Register to the Directorate Risk Register. It should be reviewed by the assigned committee. The Governing Body is responsible for determining the nature and extent of the significant risks it is willing to take in achieving its strategic objectives. By articulating its appetite for risk taking the Governing Body makes clear that: Some element of risk taking is necessary to allow the CCG to seize important opportunities. Risk taking is more acceptable in some areas than in others. There is a point at which the management of a risk should be immediately escalated to the direct oversight of the senior management team. A formal risk appetite statement sets a clear process for the management of risk and enhances the reporting of any instances where the appetite and specific risk thresholds are reached. In the review and monitoring process, there is particular focus on the controls that have been applied to each risk and the extent of the assurances that the actions are proving effective Embedding risk management Our processes for embedding risk management include: RAISING AWARENESS - Staff will have an awareness and understanding of the risks that affect patients, visitors, and staff. Risk Identification line managers will encourage staff to identify risks to ensure there are no unwelcome surprises. Staff will not be blamed or seen as being unduly negative for identifying risks. Accountability staff will be identified to own the actions to tackle risks. Communication there will be active and frequent communication between staff, stakeholders and partners. COMPETENCE - Staff will be competent at managing risk. Training staff will have access to comprehensive risk guidance and advice; those who are identified as requiring more specialist training to enable them to fulfil their responsibilities relevant to their roles will have this provided internally. Behaviour and culture senior management will lead change by example, ensuring risks are identified, assessed and managed. All staff members are encouraged to identify risks. MANAGEMENT - Activities will be controlled using the risk management process and staff are empowered to tackle risks. Risk assessment and management - risks will be assessed and acted upon to prevent, control, or reduce them to an acceptable level. Staff will have the freedom and authority, within defined parameters, needed to take action to tackle risks, escalating them where necessary. Contingency plans will be put in place where required. 60

61 Process the process for managing risk will be reviewed to continually improve. This will be integrated with our processes for providing assurance, and the processes of our stakeholders and any relevant third parties. Measuring performance exposure to risk will be measured with the aim of reducing this over time. The culture of risk management will also be measured and improved during the lifetime of this strategy Public stakeholders engagement Central London CCG actively promotes patient and public involvement via partnership working via effective external and internal communication, website and intranet. The process for managing risk will be reviewed to continually improve. This will be integrated with our processes for providing assurance, and the processes of our stakeholders and any relevant third parties Control mechanism There are different operational levels of risk governance in the CCG: Governing Body Audit Committee Quality and Safety Committee Remuneration Committee Investment Committee Primary Care (Local) Co-commissioning Group. Risk Management by the Governing Body is underpinned by a number of interlocking systems of control. The Governing Body reviews risk principally through the following three related mechanisms: The Board Assurance Framework (BAF) sets out the strategic objectives, identifies risks in relation to each strategic objective along with the controls in place and assurances available on their operation. The CCG Corporate Risk Register is the corporate high level operational risk register used as a tool for managing risks and monitoring actions and plans against them. Used correctly it demonstrates that an effective risk management approach is in operation within the organisation. The Audit Committee and other Governing Body Committees exist to provide scrutiny and assurance of the robustness of risk processes and to support the Governing Body. Each work stream, team and directorate will have a forum, best practice directs, where risk is discussed, including the risk register, actions, and any required escalation. The CCG has both formal and informal mechanisms for identifying risks to achieving its objectives. One element of pro-active risk management is prevention. Prevention is embedded within the operation of the CCG through: Incident reporting policy which recognises that the vast majority of NHS patients receive high standards of care but acknowledges that incidents do occur and encourages prompt reporting as a key part of risk management. 61

62 The risk evaluation of every decision the Governing Body and its committees are asked to make. The impact assessment of all policies, practices, procedures and decisions to ensure equality and diversity compliance. Prevention of risk Horizon-scanning can identify positive areas for the CCG to develop its business and services, taking opportunities where these arise. The CCG will work collaboratively with partner organisations and statutory bodies to horizon scan and be attentive and responsive to change. By implementing formal mechanisms to horizon scan the CCG is better able to respond to changes or emerging issues in a planned structured coordinated way. Issues identified through horizon scanning should link into and inform the business planning process. As an approach it should consider ongoing risks to commissioned services. Central London Governing Body has the responsibility to horizon-scan and formally communicates matters in the appropriate forum relating to their areas of accountability. Deterrent to risks arising Although internal controls are in place, reliance on external organisations to perform key functions exposes the CCG to some risk of fraud and bribery. Measures to mitigate these risks are included in the Counter Fraud policy and work plan. Operational risks are recorded and managed through the Corporate Risk Register or through the Board Assurance Framework if it is deemed that they could impact on the achievement of strategic objectives. The risks in both documents record the risk, its causes and the effects, and are rated according to severity which is calculated using weighted values for the likelihood of the risk occurring and the consequences if it does occur. Risks are categorised as either low, moderate, high or extreme Risk assessment and risk profile Each risk is assigned a target risk rating and if the Governing Body is satisfied that the level of risk has reduced to that level and is fully mitigated, it may direct that the risk be removed from the assurance framework. A formal risk appetite statement sets a clear process for the management of risk and enhances the reporting of any instances where the appetite and specific risk thresholds are reached. The Governing Body will review its risk appetite on an annual basis or during times of increased uncertainty or adverse changes. The periodic review and arising actions will be informed by an assessment of risk maturity, which in turn enables the Governing Body to determine the organisational capacity to control risk. The Governing Body has a Risk Appetite Matrix, which uses specific risk domains. It scores each risk against the national Risk Scoring Matrix, determining a category of Low, Moderate, High or Significant. 62

63 Risks to governance, compliance, management and internal control As part of the approved internal audit plan for 2016/17, internal auditors were asked to undertake an audit of the CCG s Board Assurance Framework and Risk Management and Information Governance. The internal auditors concluded that the CCG has adequate and effective framework for risk management, governance, internal control and information governance. They have identified further enhancements to the framework of risk management, governance, internal control and information governance to ensure that it remains adequate and effective. Using the risk and control framework described above, risk assessment is conducted in a systematic manner across all aspects of the CCG s strategic and operational goals. The major risks confronting the organisation are set out below; the risks and the controls applied to them are actively scrutinised throughout the year by the Governing Body, responsible committees and the senior management team. Each risk is assigned a target risk rating and if the Governing Body is satisfied that the level of risk has reduced to that level, it may direct that the risk be removed from the assurance framework Principal risks to compliance Using the risk and control framework, risk assessment is conducted in a systematic manner across all aspects of the CCG s strategic and operational goals. The major risks confronting the organisation are set out below. The risks and the controls applied to them are actively scrutinised throughout the year by the Governing Body, responsible committees and the senior management team. Each risk is assigned a target risk rating and if the Governing Body is satisfied that the level of risk has reduced to that level and is fully mitigated, it may direct that the risk be removed from the assurance framework. A formal risk appetite statement sets a clear process for the management of risk and enhances the reporting of any instances where the appetite and specific risk thresholds are reached. Responsibilities of Directors The Board is responsible for the strategic direction of the CCG and for assuring the achievement of key health, wellbeing, financial, performance and service targets. The Board is directly accountable to the public, GP member practices of the CCG and NHS England. To support the Governing Body in carrying out its duties effectively, a number of Committees have been established - see section 5. The committees are chaired by both lay members and GP members of the CCG Governing Body as appropriate. The remit and terms of reference of these committees have been reviewed in year Other sources of assurance Internal control framework A system of internal control is the set of processes and procedures in place in the clinical commissioning group to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. 63

64 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 Managing Director is accountable for ensuring that appropriate controls are in place and that the controls are being monitored. This involves maintaining systems to: Identify and assess risk Ensure risk owners are nominated to populate and update risk registers Implement effective risk mitigations Report risk in accordance with the integrated risk management strategy Ensure all managers and staff members are aware of their responsibilities under the Risk Management and Assurance Strategy Annual audit of conflicts of interest management The revised statutory guidance on managing conflicts of interest for CCGs (published June 2016) requires CCGs to undertake an annual internal audit of conflicts of interest management. To support CCGs to undertake this task, NHS England published a template audit framework. The Internal Audit was undertaken in March 2017 and the CCG has agreed an action plan to bring itself into full compliance with the statutory guidance, including through the: Development and publication of a register of Procurement Decisions; Updating its conflict of interest policy in line with the extant statutory guidance; and Implementation of mandatory Conflicts of Interest training, once such is made available by NHS England Data Quality The CCG has robust processes and governance arrangements in place to ensure that the quality of data used by the membership body and Governing Body is accurate and fit for purpose. All data that is forwarded to the Governing Body has been discussed and analysed at a minuted committee meeting prior to being submitted for discussion, noting or a formal decision at the Governing Body Information Governance The CCG has policies and controls in place to ensure that we are able to protect and maintain the confidentiality, integrity and availability of our electronic data, as well as our physical and information assets. The CCG seeks assurances from our IT department regarding the robustness of our network infrastructure, and also the back up and business continuity processes in the event of a loss of service. 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 this annual submission process provides assurances to the clinical commissioning group, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively. 64

65 The CCG places high importance on ensuring that there are robust information governance systems and processes in place to help protect patient and corporate information. We have established an information governance management framework and are developing information governance processes and procedures in line with the information governance toolkit. We have ensured that all staff undertake annual information governance training and that there are processes in place for incident reporting and investigation of serious incidents. We have also developed information risk management procedures, and a programme to fully embed an information risk culture throughout the organisation has commenced. Furthermore, a significant advisory audit was undertaken to test the coverage and veracity of our Information Governance Toolkit submissions prior to the 31 March 2017 deadline. The audit process, which was undertaken across all five CWHHE CCGs has enabled the establishment of a comprehensive and robust system and processes that provide robust assurance of Information Governance Toolkit compliance Business Critical Models The CCG has an appropriate framework and environment in place to provide quality assurance of business critical models, in line with the recommendations in the Macpherson report. All business critical models have been identified and that information about quality assurance processes for those models has been provided to the Shaping a Healthier Future (SaHF) Implementation Programme Board Health and safety Central London, West London, Hammersmith and Fulham, Hounslow and Ealing CCGs have secured professional health and safety and fire safety support to fulfil the role of the competent person. Advice, support and training are available for all staff. A training needs analysis has been undertaken and health and safety training forms part of the core mandatory training identified for all CCG staff. The modules provided are as follows: Fire safety Moving and handling Health, safety and welfare. The CCGs will continue to provide training, and monitor the uptake by staff during 2017/18 and report performance on all aspects to the Governing Body via the Health & Safety Committee Complaints The NHS believes complaints are a valuable source of feedback, which help to shed light on the quality of local health services. A national complaints process applies to all NHS organisations and seeks to provide complainants with explanation and, where appropriate, an apology, and the correction for an error or other remedial action. 65

66 The NHS also seeks to learn from complaints and improve procedures to prevent problems being repeated. The NHS complaints procedure adheres to the Principles for Remedy published by the Parliamentary and Health Service Ombudsman. From 1 April 2016 to 31 March 2017 the CCG received a total of 41 complaints. Eleven of these related to the commissioning decisions taken by the CCG and were investigated and responded to under the NHS Complaints Procedure. Nine complaints were about primary care contractors and were forwarded to NHS England for investigation and response. Twenty-one complaints were about other providers and were forwarded to the appropriate organisations for investigation and response. Where appropriate, the CCG requests a copy of the final response for monitoring purposes Emergency planning preparedness and resilience Emergency preparedness, resilience and response is defined by a series of statutory responsibilities under the Civil Contingencies Act 2004 and Health and Social Care Act 2012 which require NHS organisations to maintain a robust capability to plan for, and respond to, incidents or emergencies that could impact on their communities. In accordance with the aforementioned legislation, Central London CCG works with West London, Hammersmith and Fulham, Hounslow and Ealing CCGs to develop incident response and threat specific plans, e.g. cold weather plans and severe weather plans to ensure we continue to deliver critical business operations and support our partners in the event of a major incident or emergency. Furthermore, the CCG operates a robust on-call system 24 hours a day, seven days a week, 365 days a year to further ensure resilience across the local health economy. Our organisation is fully part of the local and regional emergency planning structure with regular representation at borough resilience forums and participates in multi-agency exercises, ensuring a proactive and coordinated approach to emergency preparedness. Central London, West London, Hammersmith and Fulham, Hounslow and Ealing CCGs are committed to collaboratively implementing an integrated and dynamic business continuity management system and emergency prevention, preparedness and response capability to ensure the continued delivery of safe and effective healthcare commissioning and management across outer North West London. We certify that Central London CCG has incident response plans in place, which are fully compliant with the NHSE Emergency Preparedness Guidance. The CCG regularly reviews and makes improvements to its major incident plan and has a programme for regularly testing this plan, the results of which are reported to the Governing Body Control issues As flagged in the Head of Internal Audit s Opinion 5.11, Central London CCG hosts an IT service on behalf of the North West London CCGs and work in early 2016/17 raised concerns around some of the expenditure committed and also some of the accounting practices including the use of accruals. Following further Internal Audit work a more detailed external investigation is underway. However, by reducing the numbers of Contractors working at the CCG and stopping the previous poor practice around use of accruals, the risk of recurrence has been reduced materially. 66

67 Internal Audit work relating to Cyber Security received partial assurance and a structured and monitored action plan is in place and on target for completion by Q2 2017/ Review of effectiveness My review of the effectiveness of the system of internal control is informed by the work of the internal auditors and the executive managers and clinical leads within the clinical commissioning group who have responsibility for the development and maintenance of the internal control framework. I have drawn on performance information available to me. My review is also informed by comments made by the external auditors in their annual audit letter and other reports. Our assurance framework provides me with evidence that the effectiveness of controls that manage risks to the clinical commissioning group achieving its principle objectives have been reviewed. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Governing Body, its committees, including the Audit Committee and Quality committee and am assured that appropriate plans to address weaknesses and ensure continuous improvement are in place Review of economy, efficiency & effectiveness of the use of resources Jointly with Ealing, West London, Hammersmith and Fulham and Hounslow CCGs, we have established a collaborative arrangement to share a leadership team and work together to become effective commissioners. This collaborative agreement enables: The joint commissioning of high quality care The CCG to tackle cross borough issues Maximum influence in negotiating and managing contracts with key providers Shaping of the provider landscape in North West London Economies of scale In addition, the CCG is one of eight North West London CCGs who are working collaboratively to deliver improvements to services across the area. Initiatives have included joint approaches on: Primary Care Co-commissioning with NHS England A common financial strategy to deliver Shaping a Healthier Future Counter fraud arrangements Central London CCG does not tolerate fraud and bribery within the NHS. The intention is to eliminate all NHS fraud and bribery as far as possible. The aim of the Anti-Fraud and Anti- Bribery Policy is to protect the property and finances of the NHS and of patients in our care. The CCG is committed to taking all necessary steps to counter fraud and bribery. To meet its objectives, it has adopted the seven-stage approach developed by NHS Protect: Creation of an anti-fraud culture Maximum deterrence of fraud Successful prevention of fraud which cannot be deterred 67

68 Prompt detection of fraud which cannot be prevented Professional investigation of detected fraud Effective sanctions, including appropriate legal action against people committing fraud and bribery Effective methods of seeking redress in respect of money defrauded. The CCG will take all necessary steps to counter fraud and bribery in accordance with this policy, the NHS Counter Fraud and Bribery Manual, the policy statement Applying Appropriate Sanctions Consistently published by NHS Protect and any other relevant guidance or advice issued by NHS Protect. Central London, West London, Hammersmith and Fulham, Hounslow and Ealing CCGs also have a policy on Standards of Business Conduct and Gifts and Hospitality. Both of these can be found at Head of Internal Audit Opinion For the 12 months ended 31 March 2017, the head of internal audit opinion for Central London Clinical Commissioning Group is as follows: Head of internal audit opinion 2016/2017 The organisation has an adequate and effective framework for risk management, governance and internal control. However, our work has identified further enhancements to the framework of risk management, governance and internal control to ensure that it remains adequate and effective. Factors and findings which have informed our opinion We have detailed below the reports issued where significant control weaknesses were found or where any NO ASSURANCE or PARTIAL ASSURANCE opinions were given. Central London CCG hosts an IT service on behalf of the North West London CCGs. Concerns were raised around some of the expenditure committed and some of the invoices raised by suppliers. Internal Audit conducted a review to help determine the potential financial value of any issues. A more detailed external investigation is now taking place in this regard. The CCG has already acted to reduce the risk moving forwards, both by reducing the numbers of Contractors working at the CCG and tightening controls on supplier invoices. The Cyber Security review was given a PARTIAL ASSURANCE opinion. It confirmed the CCG s known risks and the need for Security Improvement Projects (SIP) that will bring enhanced technologies to manage cyber threats. A number of control deficiencies were found across various cyber security themes including Firewalls and Internet Gateways; Secure Configuration; User Access Control; Malware Protection and Patch Management. Management has agreed an action plan and is in the process of implementing the agreed actions. We issued the following REASONABLE ASSURANCE reports: Clinical Governance 68

69 Contracting, contract award process and conflicts of interest Budgetary Control and Financial Reporting Financial Feeder Systems GP Performance and Out of Hospital Service - Common Specification Payroll Feeder Systems Conflicts of Interest We have also issued ADVISORY reports on Management Consultants Follow up, Succession Planning, Board Assurance Framework and Information Governance Toolkit. Further issues relevant to this opinion We have also reviewed the Service Auditor Report from the internal auditors of NHS Shared Business Services, who via a contract with NHS England, provide services to the CCG. The Service Auditor Report did not raise any significant control issues which impact on this opinion. Issues judged relevant to the preparation of the annual governance statement Based on the work we have undertaken on the CCG s system on internal control, we would anticipate some reference to the control weaknesses identified around IT expenditure. In all other regards we do not consider there to be any issues that need to be flagged as significant control issues within the Annual Governance Statement (AGS). However, the CCG may wish to consider whether any other issues have arisen, including the results of any external reviews, which should be included in the Annual Governance Statement. Scope of the opinion The opinion does not imply that internal audit has reviewed all risks and assurances relating to the organisation. The opinion is substantially derived from the conduct of risk-based plans generated from a robust and organisation-led assurance framework. As such, the assurance framework is one component that the board takes into account in making its annual governance statement (AGS) Review of the effectiveness of governance, risk management and internal control As Accounting Officer, I have responsibility for reviewing the effectiveness of the system of internal control within the clinical commissioning group Capacity to handle risk As the Accountable Officer I have overall responsibility for risk management and discharge this by: Continually promoting risk management and demonstrating leadership, involvement and support Ensuring an appropriate committee structure is in place and ensuring each receives regular risk reports Nursing that the Governing Body, management team, clinical directors and senior managers are appointed with managerial responsibility for risk management. 69

70 All risk owners have been trained in the risk management process and this has been supplemented with written guidance. In addition, on a regular basis, the Head of Governance and CWHHE Compliance team assists risk owners to review the controls and assurances in respect of each risk. By these means good practice is shared between all CWHHE CCGs. The Governing Body is responsible for the performance management of the integrated risk management strategy and systems of clinical, financial and organisational control. It oversees the overall system of risk management and assurance to satisfy itself that the CCG is fulfilling its organisational responsibilities and is supported in that function by its committees: The Audit Committee, in line with the NHS Audit Committee Handbook, ensures the CCG has an effective process is in place with regards to risk management and monitors the quality of the assurance framework, referring significant issues to the Governing Body The Quality and Patient Safety Committee has overarching responsibility for clinical risk management, information governance and health and safety risks The Finance and Performance Committee continuously assesses financial and non-financial risks relating to the QIPP plans and ensures the CCG has in place measures and mitigations to manage risk. After every meeting, each Committee reports its findings on risk management to the next Governing Body meeting. In this way, the CCG is assured that risk is effectively controlled and that its governance statement is valid. In addition to the leadership of the risk management process, each strategic risk is owned by both a clinical member of the Governing Body and an executive member of the Governing Body. It is overseen by the Director of Quality & Safety in respect of clinical risks, the Chief Finance Officer in respect of financial risks and by the Chief Operating Officer in respect of all other risks. In this way, leadership of, and commitment to, the risk management process is demonstrated at the highest level Conclusion No significant internal control issues have been identified as part of our review of our governance arrangements, beyond the IT and Cyber Security issues flagged at 5.8 and in the Head of Internal Audit s opinion In relation to both of those issues, I am assured that timely, correct and effective remedial action has been taken and robust action is in hand to mitigate the risks going forward. 70

71 Remuneration and staff report 71

72 6. Remuneration Report Remuneration Committee The remuneration committee is responsible for agreeing, with the Governing Body, the framework for the remuneration and conditions of service of CCG staff including the Governing Body members, and reviewing the ongoing appropriateness and relevance of the remuneration policy. The membership consists of: Lay member lead for audit, remuneration and conflict of interest matters (Chair); Secondary Care Consultant member of the Governing Body; and Lay member lead for Patient and Public Participation Matters. The remuneration committee meets in common with Ealing, Hammersmith and Fulham, Hounslow and West London CCGs. It has met once this year with member attendance as follows: Philip Young Lay Member Chair - Lay member (Audit & 1/1 Governance) Alan Hakim Secondary Care Secondary Care Consultant 1/1 Consultant, CWHHE CCGs (Chair) members of the Governing Bodies (Deputy Chair) Dominique Kleyn Lay Member, Central London CCG Lay Member, Central London CCG 1/1 This is a meeting in common with the remuneration committees of the other CCGs in the CWHHE Collaborative. Other attendees are: Javed Khan (Lay Member, Hounslow CCG) Jane Wilmot (Lay Member, H&F CCG) Simon Tucker (Lay Member, West London CCG) The Committee also approved a number of HR-related policies and proposals in correspondence over the course of the year Policy on the remuneration of senior managers This remuneration policy covers clinicians, lay members and Executive Directors Chair and Clinical Directors The Chair and Clinical Directors have a fixed-term Governing Body contract, and there is a three year rolling programme of elections to the Governing Body. Once elected for a term, they are subject to a three month notice period. There is no provision in their contract for compensation for early termination upon the expiry of the initial period or after re-election. Details of the clinical directors are stated below: Name Role Contract Start Dates Contract End Date Dr Neville Purssell Chair 7 October Sept

73 Dr Mona Vaidya Vice Chair 7 October Sept 2018 Dr Niamh McLaughlin GP member 7 October Sept 2018 Dr Paul O Reilly GP member 01 April Sept 2018 Dr Adel Baluch GP Member 7 October Sept 2018 Dr Afsana Sana GP member 1 November October 2019 Dr Sheila Neogi GP Member 1 November October 2019 Simon Gordon GP Member 7 October October Lay Members The lay members listed below have a Letter of Engagement stating the duties and accountabilities of the organisation and themselves. The lay members are subject to a four week notice period. On termination of the appointment, they are only entitled to accrued fees as at the date of termination together with reimbursement of any expenses properly incurred prior to that date. Contracts became effective on the dates shown below: Name Role Contract Start Contract End date Date Philip Young Lay member 01 April March (audit chair) Michael Morton Lay member 01 April June 2017 Dominique Kleyn Lay member 12 January January Executive Directors Executive directors are on the senior managers pay framework, have a permanent contract and are subject to a six month notice period except in the case of summary or immediate dismissal. Compensation for loss of office is based on the terms and conditions laid out under Agenda for Change. Details of the substantive executive directors are stated below: Senior Executive Manager Role Contract Start Date Contract End Date Clare Parker Accountable Officer 5 January 2015 Keith Edmunds Chief Financial Officer 1 September 2015 Matthew Bazeley Managing Director 1 October June 2016 Jules Martin Managing Director 9 May 2016 Ben Westmancott Director of Compliance 1 April 2013 Jonathan Webster Director of Quality, Nursing and Patient Safety 1 April Executive Directors performance related pay 2 Reappointed in May

74 The performance of all CCG staff, including directors and senior managers, is reviewed between April and March of each year in accordance with the CCG s annual Performance Review Process. The CCG established a process for a consolidated pay increase, as well as a mechanism for a non-consolidated performance related pay bonus for senior managers (as shown in the table above). The non-consolidated element of the performance related pay has been replaced and the revised Senior Manager Pay and Reward Policy came into effect from 1 st April All pay progression payments for directors and senior managers employed on the senior Manager Pay range are linked to annual appraisal of performance and the CCG achieving its strategic objectives in line with the Senior Manager Pay & Reward Policy. Performance awards for 2016/17 will be determined in the first quarter of 2017/18. The performance of the Accountable Officer is appraised by the Chair. The performance of CCG Directors is appraised by the Accountable Officer Remuneration of very senior managers The Accountable Officer of NHS Central London CCG is paid in excess of 142,500 per annum, however it should be noted that this remuneration is for services provided across the five CCGs; NHS Central London, West London, Hammersmith & Fulham, Hounslow & Ealing CCGs. The Remuneration Committee advises the Governing Body of an appropriate remuneration for the Accountable Office based on services provided to the five CCGs. In addition, the CCG Chair, who is part time, would be paid in excess of 142,500 on a pro rata basis and this remuneration has been advised by the Remuneration Committee to the Governing Body who remain accountable for taking decisions on the remuneration and terms of service for senior managers 6.4. Compensation on early retirement or for loss of office (subject to audit) There has been no compensation on early retirement or loss of office payments Payments to past senior managers (subject to audit) There have been no payments made to past senior managers Fair pay disclosure (subject to audit) Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director in their organisation and the median remuneration of the organisation s workforce. The banded remuneration of the highest paid Governing Body member in Central London CCG during the financial year 2016/17 was 167k (2015/16: 165k). This was 3.06 (2015/16: 2.97) times the median remuneration of the workforce, which was 54.4k (2015/16: 55.5k).Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind but not severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions. 74

75 In 2016/17 seven employees remuneration was in excess of the highest paid member when calculated on an annualised basis. Remuneration including agency and other temporary employees range from 19.3k to 274k (2015/16 restated: 20.8k to 176k). In 2016/17 the workforce median calculation is based on the average cost of staff on the Central London CCG payroll plus staff recharged in from the CWHHE Collaboration and the BHH Federation and on an annualised basis to remove any fluctuations caused by employee turnover, and only includes agency and other temporary employees covering staff vacancies. This includes staff directly working for Central CCG, as well as a small number of in-housed Commissioning Support Service staff costs shown in full Definition of Senior Managers The Department of Health Group Manual for Accounts 2016/17 defines Senior Managers as: Those persons in senior positions having authority or responsibility for directing or controlling the major activities of the NHS body. This means those who influence the decisions of the entity as a whole rather than the decisions of individual directorates or departments. It is usually considered that the regular attendees of the entity s board meetings are its senior managers. Senior Managers is therefore taken to be all members of the CCG s Governing Body, including Lay Members. 75

76 6.8. Senior Managers - Salaries and allowances (subject to audit) Name and Title Notes Salary (bands of 5,000) Expense payments (taxable) to nearest 100* Performance pay and bonuses (bands of 5,000) Long- term performance pay and bonuses (bands of 5,000) All pensionrelated benefits Total Salary (bands of 2,500) (bands of 5,000) (bands of 5,000) Expense payments (taxable) to nearest 100* Performance pay and bonuses (bands of 5,000) Long- term performance pay and bonuses (bands of 5,000) All pensionrelated benefits (bands of 2,500) Total (bands of 5,000) Governing Board Members Dr Neville Purssell - Chair Dr Mona Vaidya - Vice Chair Dr Sheila Neogi - GP Member (from 1st Apr 2016) Dr Paul O'Reilly - GP Member Dr Afsana Safa - GP Member Dr Adel Baluch - GP Board Member Dr Simon Gordon - GP Board Member Dr Niamh Dodd (McLaughlin) - GP Board Member Michael Morton - Lay Member Dominique Kleyn - Lay Member for Co-Commissioning Mr Matthew Bazeley - Managing Director (from 1st Nov 13 to 3rd June 16) Jules Martin - Managing Director (from 9th May 16) Nafsika Thalassis - Chair of user panel Eva Hrobonova - Consultant in public health (adviser in attendance) Rachel Wigley - Borough lead director for tri-borough adult and social care Gail Spiller - Co-opted Practice Manager Maxine Radcliffe - Nurse Practitioner and Outreach Lead Clare Parker - Accountable Officer Keith Edmunds - Chief Financial Officer Jonathan Webster - Director of Nursing, Quality & Safety Ben Westmancott - Director of compliance (adviser in attendance) Philip Young - Lay Member Dr Alan Hakim - Secondary Care Consultant These members are paid by local authority. 2. Paid by Central London CCG but their costs have been shared across Central, West, Hammersmith and Fulham, Hounslow and Ealing CCGs. The average weighting for each CCG is as follows: Central London CCG 16%, West London CCG 26%, Hammersmith & Fulham CCG 12%, Hounslow CCG 19%, Ealing CCG 27%. Their full year salary is shown in the table below. *Note: Taxable expenses and benefits in kind are expressed to the nearest

77 6.9. Senior Managers Salaries and allowances - joint appointments (subject to audit) The following Senior Managers work across Central London, West London, Hammersmith and Fulham, Hounslow and Ealing CCGs and their costs have been shared across these CCGs. This table gives their total salaries and allowances. The salaries and allowances table 6.8 only shows Central London CCG s share of their costs. Name and Title Notes Salary (bands of 5,000) Expense payments (taxable) to nearest 100* Performance pay and bonuses (bands of 5,000) Long- term performance pay and bonuses (bands of 5,000) All pensionrelated benefits Total Salary (bands of 2,500) (bands of 5,000) (bands of 5,000) Expense payments (taxable) to nearest 100* Performance pay and bonuses (bands of 5,000) Long- term performance pay and bonuses (bands of 5,000) All pensionrelated benefits (bands of 2,500) Total (bands of 5,000) Clare Parker - Accountable Officer Keith Edmunds - Chief Financial Officer Jonathan Webster - Director of Nursing, Quality & Safety Ben Westmancott - Director of compliance (adviser in attendance) Philip Young - Lay Member Dr Alan Hakim - Secondary Care Consultant Definitions Salary and fees All amounts paid or payable by the clinical commissioning group; including recharges from any other health body but excludes recharges to other health bodies. Expense payments (taxable) This is the gross value of taxable expenses and benefits before tax. Performance pay and bonuses - These comprise money or other assets received or receivable for the financial year as a result of achieving performance measures and targets relating to a period ending in the relevant financial year. Long term performance pay and bonuses - These comprise money or other assets received or receivable for periods of more than one year. All pension related benefits This figure includes those benefits accruing to Senior Managers from membership of the NHS Pensions Scheme which is a defined benefit scheme (although accounted for by NHS bodies as if it were a defined contribution scheme). In summary, for defined benefit schemes, the amount included here is the annual increase in pension entitlement. Zero amounts are shown for individuals for whom: The CCG does not pay into a pension scheme, or the all pension benefit figure is a negative number. Total This is the total of all the above columns and does not necessarily represent the total the individual personally received from the CCG. 77

78 6.10. Senior Managers - Pension benefits (subject to audit) Pension Entitlements Name and Title Real Real Total Lump sum Cash Real Cash increase increase / accrued at pension Equivalent increase in Equivalent in pension at decease pension at age related Transfer in Cash Transfer pension age in pension pension age to acrued Value at Equivalent Value at lump sum at pension Transfer Notes pension age at 31 March at 31 March 1 April Value 31 March (bands of (bands of (bands (bands 2,500) 2,500) of 5,000) of 5,000) Employer's contribution to stakeholder pension Governing Board Members Dr Neville Purssell - Chair Dr Mona Vaidya - Vice Chair Dr Sheila Neogi - GP Member (from 1st Apr 2016) Dr Paul O'Reilly - GP Member Dr Afsana Safa - GP Member Dr Adel Baluch - GP Board Member Dr Simon Gordon - GP Board Member (2.5-5) (6) 13 0 Dr Niamh Dodd (McLaughlin) - GP Board Member Michael Morton - Lay Member Dominique Kleyn - Lay Member for Co-Commissioning Mr Matthew Bazeley - Managing Director (from 1st Nov 13 to 3rd June 16) Jules Martin - Managing Director (from 9th May 16) Nafsika Thalassis - Chair of user panel Eva Hrobonova - Consultant in public health (adviser in attendance) Rachel Wigley - Borough lead director for tri-borough adult and social care (adviser in attendance) Gail Spiller - Co-opted Practice Manager (5-7.5) (42) 0 0 Maxine Radcliffe - Nurse Practitioner and Outreach Lead (2.5-5) (0) 25 0 Clare Parker - Accountable Officer Keith Edmunds - Chief Financial Officer Jonathan Webster - Director of Nursing, Quality & Safety Ben Westmancott - Director of compliance (adviser in attendance) Philip Young - Lay Member Dr Alan Hakim - Secondary Care Consultant (5-7.5) The disclosure for these individuals who are shared across organisations is the gross amount and not the individual Clinical Commissioning Groups share. Notes to pension benefits table: 78

79 1. Figures are supplied by the NHS Pensions Agency and are based on their employment as Governing Body Members of the CCG only. Pension relating to Practitioner employments are not included. 2. Members in the 2015 scheme do not receive a lump sum. 3. The disclosure for these individuals who are shared across Central London, West London, Hammersmith and Fulham, Hounslow and Ealing CCGs is their total amount and not their share applicable to each individual CCG. Certain Members do not receive pensionable remuneration or have opted out of the pension scheme and therefore there are no entries in respect of pensions for these Members. No lump sum is shown for Members who only have membership in the 2008 scheme unless they chose to move their 1995 scheme benefits under choice. No CETV is shown for pensioners, Members over age 60 (1995 section) or over age 65 (2008 section). A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member s accrued benefits and any contingent spouse s (or other allowable beneficiary s) pension payable from the scheme. CETVs are calculated in accordance with the Occupational Pension Schemes (Transfer Values) Regulations Real Increase in CETV - this reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period. On 16 March 2016, the Chancellor of the Exchequer announced a change in the Superannuation Contributions Adjusted for Past Experience (SCAPE) discount rate from 3.0% to 2.8%. This rate affects the calculation of CETV figures in this report. Due to the lead time required to perform calculations and prepare annual reports, the CETV figures quoted in this report for members of the NHS Pension scheme are based on the previous discount rate and have not been recalculated. 79

80 7. Staff Report 7.1. Number of senior managers by band Number Band 3 (two currently vacant) VSM Senior Manager Pay 7.2. Staff numbers and costs 2016/ /16 Permanent Other Total Total Average staff number The staff numbers for 2016/17 include staff from the NWL Strategy and Transformation and CWHHE collaboration which are employed through Central London CCG, as well as local CCG staff Staff composition Female Male Governing Body 6 4 Other senior managers and 2 2 clinical leads (not included in Governing Body figures) CCG staff These are the local CCG and hosted cancer service staff gender breakdown. It excludes NWL Strategy and Transformation staff as this information was not available Staff sickness The management and reporting of sickness is supported by a comprehensive absence management policy and advice from the Human Resources team which covers the eight North West London CCGs. Human Resources provide regular HR Core Skills training for CCG managers, including the efficient use of sickness absence management protocols to refresh knowledge and reminding mangers of their role in the management of absence Number Number Total days lost Total staff Average working days lost Staff policies During the course of the year all of the HR policies have been updated and approved. An HR policy briefing that included all the HR policies with a brief explanation of with each policy and its content has been circulated. The policies and briefing are also available for all staff on the intranet. In addition, training sessions on specific policies have been held for staff and managers within the CCGs. 80

81 Equality The CCG is committed to equality of opportunity for all employees and is committed to employment practices, policies and procedures which ensure that no employee, or potential employee, receives less favourable treatment on the grounds of sex, race, ethnic or national origin, sexual orientation, marriage and civil partnership, religion or belief, age, pregnancy and maternity, trade union membership, disability, domestic circumstances, social and employment status, HIV status, gender reassignment, political affiliation or any other personal characteristic. Diversity is viewed positively and, in recognising that everyone is different, the unique contribution that each individual s experience, knowledge and skills can make is valued equally. The promotion of equality and diversity is actively pursued through policies and ensures that employees receive fair, equitable and consistent treatment. It also ensures that employees, and potential employees, are not subject to direct or indirect discrimination. The CCG works with Access to Work, when appropriate and is committed to support disabled staff both into and at work. Our aim is to support current and prospective employees who have a disability. The CCG is currently at Level 1, Disability Confident employer and is working towards becoming a level 3 Disability Confident employer. It is a condition of employment that all employees respect and act in accordance with our equality and diversity policy. Failure to do so will result in the disciplinary procedure being instigated, which could result in termination of employment. 7.6 Expenditure on consultancy During the year, Central London CCG incurred 3.45m on consultancy services. This was largely attributed to work undertaken for the Strategy & Transformation team. 7.7 Off-payroll engagements Table 1 Off-payroll engagements longer than 6 months For all off-payroll engagements as of 31 March 2017, for more than 220 per day and that last longer than six months are as follows: Number Number of existing engagements as of 31 March of which, the number that have existed: For less than 1 year at the time of reporting 10 For between 1 and 2 years at the time of reporting 15 For between 2 and 3 years at the time of reporting 3 For between 3 and 4 years at the time of reporting 0 For 4 or more years at the time of reporting 2 Table 2 New off-payroll engagements For all new off-payroll engagements between 1 April 2016 and 31 March 2017, for more than 220 per day and that last longer than six months: Number 81

82

83 8. Parliamentary Accountability and Audit Report NHS Central London CCG is not required to produce a Parliamentary Accountability and Audit Report. There are no disclosures to report and an audit certificate and report is also included in this Annual Report. 83

84 Financial statements 84

85 Data entered below will be used throughout the workbook: Entity name: NHS Central London CCG This year Last year This year ended 31-March-2017 Last year ended 31-March-2016 This year commencing: 01-April-2016 Last year commencing: 01-April-2015

86 NHS Central London CCG - Annual Accounts CONTENTS Page Number The Primary Statements: Statement of Comprehensive Net Expenditure for the year ended 31st March Statement of Financial Position as at 31st March Statement of Changes in Taxpayers' Equity for the year ended 31st March Statement of Cash Flows for the year ended 31st March Notes to the Accounts Accounting policies 7-13 Other operating revenue 14 Revenue 14 Employee benefits and staff numbers Operating expenses 18 Better payment practice code 19 Operating leases 20 Trade and other receivables 21 Cash and cash equivalents 22 Trade and other payables 23 Provisions 24 Contingencies 25 Commitments 25 Financial instruments Operating segments 27 Pooled budgets 28 Related party transactions 29 Events after the end of the reporting period 30 Losses and special payments 30 Financial performance targets 30 Impact of IFRS 30 Analysis of charitable reserves 30 2

87 NHS Central London CCG - Annual Accounts Statement of Comprehensive Net Expenditure for the year ended 31 March Note '000 '000 Income from sale of goods and services 2 (9,024) (22,219) Other operating income 2 (4,898) (1,322) Total operating income (13,922) (23,541) Staff costs 4 19,336 8,526 Purchase of goods and services 5 285, ,400 Provision expense Other Operating Expenditure Total operating expenditure 305, ,874 Net Operating Expenditure 291, ,333 Net expenditure for the year 291, ,333 Net Gain/(Loss) on Transfer by Absorption 0 0 Total Net Expenditure for the year 291, ,333 Comprehensive Expenditure for the year ended 31 March , ,333 The notes are on pages 7 to 30 form part of this statement 3

88

89 NHS Central London CCG - Annual Accounts Statement of Changes In Taxpayers Equity for the year ended 31 March 2017 Changes in taxpayers equity for General fund '000 Total reserves '000 Balance at 01 April 2016 (26,333) (26,333) Changes in NHS Clinical Commissioning Group taxpayers equity for Net operating expenditure for the financial year (291,575) (291,575) Net funding 287, ,115 Balance at 31 March 2017 (30,793) (30,793) Changes in taxpayers equity for General fund '000 Total reserves '000 Balance at 01 April 2015 (23,130) (23,130) Changes in NHS Clinical Commissioning Group taxpayers equity for Net operating costs for the financial year (292,333) (292,333) Net funding 289, ,130 Balance at 31 March 2016 (26,333) (26,333) The notes are on pages 7 to 30 form part of this statement 5

90 NHS Central London CCG - Annual Accounts Statement of Cash Flows for the year ended 31 March Note '000 '000 Cash Flows from Operating Activities Net operating expenditure for the financial year (291,575) (292,333) (Increase)/decrease in trade & other receivables 8 16,645 (13,371) Increase/(decrease) in trade & other payables 10 (12,983) 16,262 Increase/(decrease) in provisions Net Cash Inflow (Outflow) from Operating Activities (287,464) (288,825) Cash Flows from Financing Activities Grant in Aid Funding Received 287, ,130 Net Cash Inflow (Outflow) from Financing Activities 287, ,130 Net Increase (Decrease) in Cash & Cash Equivalents 9 (349) 305 Cash & Cash Equivalents at the Beginning of the Financial Year Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year The notes are on pages 7 to 30 form part of this statement 6

91 NHS Central London CCG - Annual Accounts Notes to the financial statements 1 Accounting Policies NHS England has directed that the financial statements of Clinical Commissioning Groups shall meet the accounting requirements of the Group Accounting Manual issued by the Department of Health. Consequently, the following financial statements have been prepared in accordance with the Group Accounting Manual issued by the Department of Health. The accounting policies contained in the Group Accounting Manual follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to Clinical Commissioning Groups, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Group Accounting Manual permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the Clinical Commissioning Group for the purpose of giving a true and fair view has been selected. The particular policies adopted by the Clinical Commissioning Group are described below. They have been applied consistently in dealing with items considered material in relation to the accounts. 1.1 Going Concern These accounts have been prepared on the going concern basis. Public sector bodies are assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as evidenced by inclusion of financial provision for that service in published documents. Where a Clinical Commissioning Group ceases to exist, it considers whether or not its services will continue to be provided (using the same assets, by another public sector entity) in determining whether to use the concept of going concern for the final set of Financial Statements. If services will continue to be provided the financial statements are prepared on the going concern basis. 1.2 Accounting Convention These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities. 1.3 Acquisitions & Discontinued Operations Activities are considered to be acquired only if they are taken on from outside the public sector. Activities are considered to be discontinued only if they cease entirely. They are not considered to be discontinued if they transfer from one public sector body to another. 1.4 Movement of Assets within the Department of Health Group Transfers as part of reorganisation fall to be accounted for by use of absorption accounting in line with the Government Financial Reporting Manual, issued by HM Treasury. The Government Financial Reporting Manual does not require retrospective adoption, so prior year transactions (which have been accounted for under merger accounting) have not been restated. Absorption accounting requires that entities account for their transactions in the period in which they took place, with no restatement of performance required when functions transfer within the public sector. Where assets and liabilities transfer, the gain or loss resulting is recognised in the Statement of Comprehensive Net Expenditure, and is disclosed separately from operating costs. Other transfers of assets and liabilities within the Department of Health Group are accounted for in line with IAS 20 and similarly give rise to income and expenditure entries. For transfers of assets and liabilities from those NHS bodies that closed on 1 April 2013, HM Treasury has agreed that a modified absorption approach should be applied. For these transactions only, gains and losses are recognised in reserves rather than the Statement of Comprehensive Net Expenditure. 1.5 Charitable Funds There are no Charitable Funds held by the Clinical Commissioning Group. 1.6 Pooled Budgets Where the Clinical Commissioning Group has entered into a pooled budget arrangement under Section 75 of the National Health Service Act 2006 the Clinical Commissioning Group accounts for its share of the assets, liabilities, income and expenditure arising from the activities of the pooled budget, identified in accordance with the pooled budget agreement. If the Clinical Commissioning Group is in a jointly controlled operation, the Clinical Commissioning Group recognises: The assets the Clinical Commissioning Group controls; The liabilities the Clinical Commissioning Group incurs; The expenses the Clinical Commissioning Group incurs; and, The Clinical Commissioning Group s share of the income from the pooled budget activities. If the Clinical Commissioning Group is involved in a jointly controlled assets arrangement, in addition to the above, the Clinical Commissioning Group recognises: The Clinical Commissioning Group s share of the jointly controlled assets (classified according to the nature of the assets); The Clinical Commissioning Group s share of any liabilities incurred jointly; and, The Clinical Commissioning Group s share of the expenses jointly incurred. 1.7 Critical Accounting Judgements & Key Sources of Estimation Uncertainty In the application of the Clinical Commissioning Group s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods. 7

92 NHS Central London CCG - Annual Accounts Notes to the financial statements Critical Judgements in Applying Accounting Policies The following are the critical judgements, apart from those involving estimations (see below) that management has made in the process of applying the Clinical Commissioning Group s accounting policies that have the most significant effect on the amounts recognised in the financial statements: 1.7.1a Corporate Recharge within the CWHHE Collaborative NHS Central London CCG initially pays for a range of corporate costs which are incurred by all of the CCGs in the Collaborative (NHS Central London CCG, NHS West London CCG, NHS Hammersmith & Fulham CCG, NHS Hounslow CCG and NHS Ealing CCG). NHS Central London CCG then recharges the other CCGs. There is both a running cost and a programme element to these costs. In some instances, individual CCGs do not use the shared department and so do not pick up a share of the costs. In general, costs are apportioned to CCGs as follows: the local structure is funded first, and then the remainder of the cost is split based on affordability (running costs) and surplus size (programme). The exceptions to this are where there are costs specific to individual CCGs (in Safeguarding and Quality), those agreed as a five-way equal split (Out of Hospital services) and those based on usage of the building 15, Marylebone Road, the costs of which are apportioned based on desk space b Operating a Risk Share between the CWHHE Collaborative The five CCGs in the CWHHE Collaborative established the principles of a risk share in June 2013 related to high cost activity which is difficult to plan for at an individual CCG level but is more predictable over the larger population of the five CCGs. The risk share was extended in January 2015 to cover the wider system risks emerging during the year and cover any pressures arising from the disaggregation of PCT budgets. The risk share is also flexed on an affordability basis. The risk share was re-affirmed by Governing Bodies in January Central London CCG received a risk share of 1.43m in 2016/17, compared to 10.9m in 2015/ c Accounting for in-housed Commissioning Support Services The eight CCGs in North West London ceased acquiring Commissioning support services (CSS) from NWL Commissioning Support Unit (CSU) from 1st October From this date the eight CCGs brought Commissioning support services in-house. The CCGs manage the CSS budget as a shared budget which each CCG both pays into and for which each CCG hosts some costs. All CCGs are net contributors to costs that are hosted by Brent CCG. In the annual accounts, the CCGs each fully account (gross) for the element of the CSS shared budget that they hold. This is shown in the accounts as follows: - All CCGs show gross staff costs i.e. the full costs of all CSS staff paid directly by them. - Gross staff costs are adjusted for charges in and charges out. - All CCGs show gross expenditure costs on each of the appropriate lines within the expenditure note in the accounts. - Brent CCG show the income received from other CCGs in their operating revenue note in the accounts under the "Non-patient care services to other bodies line in respect of non pay charges and recoveries in respect of employee benefits line in respect of pay charges. - Central London CCG show their expenditure with Brent CCG in the operating expenses note in the accounts under "Services from other CCGs and NHS England" line in respect of non pay charges and the "gross employee benefits" line in respect of pay charges d NWL Financial Strategy A shared financial strategy has been agreed across the North West London (NWL) Collaboration of CCGs. This comprises two elements: Part A: The first (Part A) relates to a central budget which funds the Strategy and Transformation team which operates across North West London, as well as provider support for transformation change and other shared costs of transformation across the health economy. Central London CCG made a contribution to Part A of 1.7m in 2016/17. There was originally a Part B of the strategy but this has now ceased. Part C: The second part (Part C) of the North West London Financial Strategy (NWLFS) relates to a transfer of funding between the CCGs to allow those CCGs with more financial flexibility to support those with a more constrained position in order to ensure all CCGs in North West London are able to invest in common commissioning strategies such as Shaping a Healthier Future and out of hospital services. The allocation was transferred between CCGs using the revenue transfer process facilitated by NHS England and the central budget was hosted by Central London CCG. Central London, Hammersmith & Fulham, West London and Brent CCGs were contributors to the North West London Financial Strategy Part C, with Hillingdon, Hounslow and Harrow as beneficiaries. Central London CCG was neither a contributor nor a beneficiary of Part C e NHS 111 Shared Commissioning Arrangement NHS West London CCG commissioned 111 service from London Central & West Unscheduled Care on behalf of NHS Hammersmith & Fulham CCG and NHS Central London CCG. NHS West London CCG acts as an agent and each CCG is responsible for its proportionate share of total costs. This arrangement has been in place from 1 April The service cost is recharged out to CCGs based on the population size on a net accounting basis f 1.7.1f Urgent Care Centre Central London CCG Commissions the service for Urgent Care Centre from the Vocare Group with the service based at Imperial College Healthcare NHS Trust. Central London CCG then recharges the costs to the responsible commissioners within the North West London (NWL) sector and across England. The recharge is based on activity information and invoices are raised on a monthly basis. Bad Debt Provisions The CCGs provide for bad debts based on an agreed sliding scale based on age of the debt and likelihood of recovery Key Sources of Estimation Uncertainty The following are the key estimations that management has made in the process of applying the Clinical Commissioning Group s accounting policies that have the most significant effect on the amounts recognised in the financial statements: 8

93 NHS Central London CCG - Annual Accounts Notes to the financial statements Prescription Pricing Authority Expenditure Prescription Pricing Authority - The Prescription Pricing Authority (PPA) currently provides us with details of the monthly expenditure incurred by Independent Contractors in respect of Pharmacy contract payments and drug costs. There is approximately a two month delay in notifying the CCG of its expenditure for a particular month. The CCG has therefore applied estimation techniques based on previous trends, expenditure profiles, forecasts from PPA and local knowledge from our Prescribing Advisors. Cost data has been received up to the end of February for drugs Acute Contracts Expenditure There is a monthly closedown of the acute contracts activity data and post reconciliation data gets rolled into the next monthly reconciliation data. Providers use the monthly reconciliation data to inform their monthly Service Level Agreement Monitoring (SLAM) reports. The latest available SLAM information, Month 11 SLAM data available at the beginning of April, has been used to estimate the full year activity levels and expenditure under service level agreements by including agreed activity to month 11 and pre-validated month 12 activity. In addition NHS creditors and accruals have been informed by the M12 Agreement of Balances exercise where forecast full year costs are agreed. 9

94 NHS Central London CCG - Annual Accounts Notes to the financial statements Recognition of Expenditure The CCG has used various techniques to estimate the appropriate levels of expenditure to be included in the accounts. These include basing forecasts on actual expenditure incurred to date extrapolated to a full year, using internal databases (such as Continuing Care), local knowledge from managers and past experience Market Forces Factor impact During 2016/17, Chelsea & Westminster NHS Foundation Trust merged with West Middlesex University Hospital NHS Trust to form one entity called Chelsea & Westminster NHS Foundation Trust. As a result of this, the impact of Market Forces Factor was harmonised across the Trust, leading to an increase in cost to Hounslow CCG, who primarily commission from the former West Middlesex Trust where the MFF was lower, and a decrease in cost to Central London, Hammersmith & Fulham and West London CCGs who primarily commission from the former Chelsea & Westminster site. In order to manage this transition, it was agreed that Central London CCG would pay to Hounslow CCG 513k on a non-recurrent basis. 1.8 Revenue Revenue in respect of services provided is recognised when, and to the extent that, performance occurs, and is measured at the fair value of the consideration receivable. Where income is received for a specific activity that is to be delivered in the following year, that income is deferred. 1.9 Employee Benefits Short-term Employee Benefits Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees, including bonuses earned but not yet taken. The cost of leave earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry forward leave into the following period Retirement Benefit Costs Past and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the Clinical Commissioning Group of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period. For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to expenditure at the time the Clinical Commissioning Group commits itself to the retirement, regardless of the method of payment Other Expenses Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable. Expenses and liabilities in respect of grants are recognised when the Clinical Commissioning Group has a present legal or constructive obligation, which occurs when all of the conditions attached to the payment have been met Property, Plant & Equipment Recognition Property, plant and equipment is capitalised if: It is held for use in delivering services or for administrative purposes; It is probable that future economic benefits will flow to, or service potential will be supplied to the Clinical Commissioning Group; It is expected to be used for more than one financial year; The cost of the item can be measured reliably; and, The item has a cost of at least 5,000; or, Collectively, a number of items have a cost of at least 5,000 and individually have a cost of more than 250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or, Items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or collective cost. Where a large asset, for example a building, includes a number of components with significantly different asset lives, the components are treated as separate assets and depreciated over their own useful economic lives. 10

95 NHS Central London CCG - Annual Accounts Notes to the financial statements Subsequent Expenditure Where subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised. Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing carrying value of the item replaced is writtenout and charged to operating expenses Intangible Assets Recognition Intangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the Clinical Commissioning Group s business or which arise from contractual or other legal rights. They are recognised only: When it is probable that future economic benefits will flow to, or service potential be provided to, the Clinical Commissioning Group; Where the cost of the asset can be measured reliably; and, Where the cost is at least 5,000. Intangible assets acquired separately are initially recognised at fair value. Software that is integral to the operating of hardware, for example an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software that is not integral to the operation of hardware, for example application software, is capitalised as an intangible asset. Expenditure on research is not capitalised but is recognised as an operating expense in the period in which it is incurred. Internally-generated assets are recognised if, and only if, all of the following have been demonstrated: The technical feasibility of completing the intangible asset so that it will be available for use; The intention to complete the intangible asset and use it; The ability to sell or use the intangible asset; How the intangible asset will generate probable future economic benefits or service potential; The availability of adequate technical, financial and other resources to complete the intangible asset and sell or use it; and, The ability to measure reliably the expenditure attributable to the intangible asset during its development Measurement The amount initially recognised for internally-generated intangible assets is the sum of the expenditure incurred from the date when the criteria above are initially met. Where no internally-generated intangible asset can be recognised, the expenditure is recognised in the period in which it is incurred. Following initial recognition, intangible assets are carried at current value in existing use by reference to an active market, or, where no active market exists, at the lower of depreciated replacement cost or the value in use where the asset is income generating. Internally-developed software is held at historic cost to reflect the opposing effects of increases in development costs and technological advances Depreciation, Amortisation & Impairments Depreciation and amortisation are charged to write off the costs or equipment and intangible non-current assets, less any residual value, over their estimated useful lives, in a manner that reflects the consumption of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over which the Clinical Commissioning Group expects to obtain economic benefits or service potential from the asset. This is specific to the Clinical Commissioning Group and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are depreciated over their estimated useful lives. At each reporting period end, the Clinical Commissioning Group checks whether there is any indication that any of its tangible or intangible noncurrent assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its amount. Intangible assets not yet available for use are tested for impairment annually. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Where an impairment loss subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the recoverable amount but capped at the amount that would have been determined had there been no initial impairment loss. The reversal of the impairment loss is credited to expenditure to the extent of the decrease previously charged there and thereafter to the revaluation reserve Leases Leases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All other leases are classified as operating leases The Clinical Commissioning Group as Lessee Property, plant and equipment held under finance leases are initially recognised, at the inception of the lease, at fair value or, if lower, at the present value of the minimum lease payments, with a matching liability for the lease obligation to the lessor. Lease payments are apportioned between finance charges and reduction of the lease obligation so as to achieve a constant rate on interest on the remaining balance of the liability. Finance charges are recognised in calculating the Clinical Commissioning Group s surplus/deficit. Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term. Contingent rentals are recognised as an expense in the period in which they are incurred. Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether they are operating or finance leases. 11

96 NHS Central London CCG - Annual Accounts Notes to the financial statements 1.15 Cash & Cash Equivalents Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value. In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the Clinical Commissioning Group s cash management Provisions Provisions are recognised when the Clinical Commissioning Group has a present legal or constructive obligation as a result of a past event, it is probable that the Clinical Commissioning Group will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties Clinical Negligence Costs The NHS Litigation Authority operates a risk pooling scheme under which the Clinical Commissioning Group pays an annual contribution to the NHS Litigation Authority which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although the NHS Litigation Authority is administratively responsible for all clinical negligence cases the legal liability remains with the Clinical Commissioning Group Non-clinical Risk Pooling The Clinical Commissioning Group participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the Clinical Commissioning Group pays an annual contribution to the NHS Litigation Authority and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due Continuing healthcare risk pooling In a risk pool scheme was introduced by NHS England for continuing healthcare claims, for claim periods prior to 31 March Under the scheme the Clinical Commissioning Group contribute annually to a pooled fund, which is used to settle the claims Contingencies A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence or nonoccurrence of one or more uncertain future events not wholly within the control of the Clinical Commissioning Group, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or the amount of the obligation cannot be measured sufficiently reliably. A contingent liability is disclosed unless the possibility of a payment is remote. A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the Clinical Commissioning Group. A contingent asset is disclosed where an inflow of economic benefits is probable. Where the time value of money is material, contingencies are disclosed at their present value Financial Assets Financial assets are recognised when the Clinical Commissioning Group becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred. Financial assets are classified into the following categories: Loans and receivables. The classification depends on the nature and purpose of the financial assets and is determined at the time of initial recognition. 12

97 NHS Central London CCG - Annual Accounts Notes to the financial statements Loans & Receivables Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market. After initial recognition, they are measured at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method. Fair value is determined by reference to quoted market prices where possible, otherwise by valuation techniques. The effective interest rate is the rate that exactly discounts estimated future cash receipts through the expected life of the financial asset, to the initial fair value of the financial asset. At the end of the reporting period, the Clinical Commissioning Group assesses whether any financial assets, other than those held at fair value through profit and loss are impaired. Financial assets are impaired and impairment losses recognised if there is objective evidence of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the estimated future cash flows of the asset. For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset s carrying amount and the present value of the revised future cash flows discounted at the asset s original effective interest rate. The loss is recognised in expenditure and the carrying amount of the asset is reduced through a provision for impairment of receivables. If, in a subsequent period, the amount of the impairment loss decreases and the decrease can be related objectively to an event occurring after the impairment was recognised, the previously recognised impairment loss is reversed through expenditure to the extent that the carrying amount of the receivable at the date of the impairment is reversed does not exceed what the amortised cost would have been had the impairment not been recognised Financial Liabilities Financial liabilities are recognised on the statement of financial position when the Clinical Commissioning Group becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are derecognised when the liability has been discharged, that is, the liability has been paid or has expired. Loans from the Department of Health are recognised at historical cost. Otherwise, financial liabilities are initially recognised at fair value Value Added Tax Most of the activities of the Clinical Commissioning Group are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT Losses & Special Payments Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled. Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had the Clinical Commissioning Group not been bearing its own risks (with insurance premiums then being included as normal revenue expenditure) Accounting Standards That Have Been Issued But Have Not Yet Been Adopted The Government Financial Reporting Manual does not require the following Standards and Interpretations to be applied in , all of which are subject to consultation: IFRS 9: Financial Instruments IFRS 14: Regulatory Deferral Accounts IFRS 15: Revenue for Contract with Customers IFRS 16: Leases The application of the Standards as revised would not have a material impact on the accounts for , were they applied in that year. 13

98 NHS Central London CCG - Annual Accounts Other Operating Revenue Total Total '000 '000 Prescription fees and charges Education, training and research 3, Charitable and other contributions to revenue expenditure: non-nhs 0 27 Non-patient care services to other bodies 5,253 22,006 Other revenue 4,842 1,146 Total other operating revenue 13,922 23,541 Notes: 1. Programme expenditure is revenue expenditure that is relating to the provision of healthcare or healthcare services. 2. Admin revenue is revenue received that is not directly attributable to the provision of healthcare or healthcare services. 3. Revenue in this note does not include cash received from NHS England, which is drawn down directly into the bank account of the CCG and credited to the General Fund. 3 Revenue Total Total '000 '000 From rendering of services 13,922 23,541 Total 13,922 23,541 14

99 NHS Central London CCG - Annual Accounts Employee benefits and staff numbers Employee benefits Total Total Permanent Employees Other '000 '000 '000 Employee Benefits Salaries and wages 17,663 7,401 10,262 Social security costs Employer Contributions to NHS Pension scheme Termination benefits (30) (30) 0 Gross employee benefits expenditure 19,336 8,943 10, Employee benefits Total Total Permanent Employees Other '000 '000 '000 Employee Benefits Salaries and wages 7,448 3,730 3,718 Social security costs Employer Contributions to NHS Pension scheme Termination benefits Gross employee benefits expenditure 8,526 4,808 3,718 15

100 NHS Central London CCG - Annual Accounts Average number of people employed Total Permanently employed Other Total Permanently employed Other Number Number Number Number Number Number Total The increase in staff numbers is due to increase in S&T and Collaboration. 4.3 Staff sickness absence and ill health retirements Number Number Total Days Lost Total Staff Years Average working Days Lost 5 3 Staff sickness absence figures are provided by the Department of Health and cover the calendar year. 4.4 Exit packages agreed in the financial year The Clinical Commissioning Group has not agreed any exit packages during ( : 42.66k). 16

101 NHS Central London CCG - Annual Accounts Pension costs Past and present employees are covered by the provisions of the NHS Pension Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at The Scheme is an unfunded, defined benefit scheme that covers NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The Scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the clinical commissioning group of participating in the scheme is taken as equal to the contributions payable to the Scheme for the accounting period. The Scheme is subject to a full actuarial valuation every four years (until 2004, every five years) and an accounting valuation every year. An outline of these follows: Full actuarial (funding) valuation The purpose of this valuation is to assess the level of liability in respect of the benefits due under the Scheme (taking into account its recent demographic experience), and to recommend the contribution rates to be paid by employers and scheme members. The last such valuation, which determined current contribution rates was undertaken as at 31 March 2012 and covered the period from 1 April 2008 to that date. Details can be found on the pension scheme website at For , employers contributions of 828k were payable to the NHS Pensions Scheme ( : 587k) were payable to the NHS Pension Scheme at the rate of 14.3% of pensionable pay. The scheme s actuary reviews employer contributions, usually every four years and now based on HMT Valuation Directions, following a full scheme valuation. The latest review used data from 31 March 2012 and was published on the Government website on 9 June 2014.The change in employer contribution took effect from 1st April 2015 and the employer contribution rate moved from 14.0% to 14.3%. These costs are included in the NHS pensions line in note 3. 17

102 NHS Central London CCG - Annual Accounts Operating expenses Total Total '000 '000 Gross employee benefits Employee benefits excluding governing body members 19,033 8,256 Executive governing body members Total gross employee benefits 19,336 8,526 Other costs Services from other CCGs and NHS England 1,307 12,035 Services from foundation trusts 108, ,398 Services from other NHS trusts 89,737 98,358 Services from other WGA bodies Purchase of healthcare from non-nhs bodies 50,940 41,362 Chair and Non Executive Members Supplies and services general 2, Consultancy services 3,435 15,459 Establishment 2, Transport 7 5 Premises 305 3,660 Impairments and reversals of receivables (45) (86) Audit fees Other non statutory audit expenditure Internal audit services 46 0 Other services 6 0 Prescribing costs 21,568 21,286 GPMS/APMS and PCTMS 2,291 2,390 Other professional fees excl. audit Education and training Provisions CHC Risk Pool contributions 416 1,040 Other expenditure 25 0 Total other costs 286, ,348 Total operating expenses 305, , Classification of consultancy and agency expenditure The CCG reviewed consultancy expenditure for 2015/16 to determine whether some expenditure should have been classified as agency and, therefore, be recorded as such. The 2016/17 expenditure has been appropriately classified as consultancy or agency. This has reduced consultancy expenditure in 2016/17 compared to prior year by 12.02m, with employee expenditure increasing by 4.1m against prior year. The CCG has also recruited into permanent positions during 2016/17 to reduce the reliance on agency staff. This has increased employee costs by a further 6.7m. 18

103 NHS Central London CCG - Annual Accounts Better Payment Practice Code Measure of compliance Number '000 Number '000 Non-NHS Payables Total Non-NHS Trade invoices paid in the Year 14,826 88,227 11,991 78,125 Total Non-NHS Trade Invoices paid within target 14,152 82,670 10,590 74,158 Percentage of Non-NHS Trade invoices paid within target 95.45% 93.70% 88.32% 94.92% NHS Payables Total NHS Trade Invoices Paid in the Year 3, ,881 4, ,330 Total NHS Trade Invoices Paid within target 3, ,803 3, ,525 Percentage of NHS Trade Invoices paid within target 96.02% 99.96% 94.04% 99.15% 19

104 NHS Central London CCG - Annual Accounts Operating Leases 7.1 As lessee The Clinical Commissioning Group pays NHS Property Services. These payments, although not under a formal lease or contract have been determined under IFRIC 4 to be a lease arrangement Payments recognised as an Expense Buildings Other Total Buildings Other Total '000 '000 '000 '000 '000 '000 Payments recognised as an expense Minimum lease payments (78) 3 (75) 3, ,389 Total (78) 3 (75) 3, ,389 20

105 NHS Central London CCG - Annual Accounts Trade and other receivables Current Current '000 '000 NHS receivables: Revenue 9,643 11,731 NHS prepayments NHS accrued income 4,251 19,370 Non-NHS and Other WGA receivables: Revenue 1,829 1,800 Non-NHS and Other WGA prepayments Non-NHS and Other WGA accrued income (5) 21 Provision for the impairment of receivables (22) (67) VAT (192) 286 Other receivables and accruals Total Trade & other receivables 17,054 33,699 Total current and non current 17,054 33, Receivables past their due date but not impaired '000 '000 By up to three months 3,531 1,170 By three to six months By more than six months Total 4,392 1, Provision for impairment of receivables '000 '000 Balance at 01 April 2016 (67) (154) Amounts written off during the year 0 0 Amounts recovered during the year (Increase) decrease in receivables impaired 4 (32) Balance at 31 March 2017 (22) (67) 21

106 NHS Central London CCG - Annual Accounts Cash and cash equivalents '000 '000 Balance at 01 April Net change in year (349) 305 Balance at 31 March Made up of: Cash with the Government Banking Service Cash and cash equivalents as in statement of financial position

107 NHS Central London CCG - Annual Accounts Trade and other payables Current Current '000 '000 NHS payables: revenue 11,483 19,948 NHS accruals 7,643 15,189 Non-NHS and Other WGA payables: Revenue 9,475 7,193 Non-NHS and Other WGA accruals 16,537 16,287 Non-NHS and Other WGA deferred income 14 0 Social security costs Tax Other payables and accruals Total Trade & Other Payables 46,310 59,293 Total current and non-current 46,310 59,293 Other payables include 238k outstanding pension contributions at 31 March 2017 (2015/16 : 188k) 23

108 NHS Central London CCG - Annual Accounts Provisions Current Non-current Current Non-current '000 '000 '000 '000 Other 1, ,175 0 Total 1, ,175 0 Total current and non-current 1,624 1,175 Other '000 Total '000 Balance at 01 April ,175 1,175 Arising during the year 1,007 1,007 Utilised during the year 0 0 Reversed unused (558) (558) Balance at 31 March ,624 1,624 Expected timing of cash flows: Within one year 1,624 1,624 Balance at 31 March ,624 1,624 Arising during the year under other provisions are listed in the following; * Dilapidation and other costs associated with the lease expiration of a building utilised by the CCG; 522k * On-going cost for HMRC investigations into payment of tax and national insurance by contractors engaged by Central London CCG and recharged to the other CCGs 485k Reversed unused during the year relates to SHSOP ( 558k) 24

109 NHS Central London CCG - Annual Accounts Contingencies The NHS Clinical Commissioning Group had no contingent assets or liabilities as at 31 March 2017 (2015/16 : 0) 13 Commitments 13.1 Capital commitments The NHS Clinical Commissioning Group had no contracted capital commitments not otherwise included in these financial statements as at 31 March 2017 ( : nil) Other financial commitments The NHS Clinical Commissioning Group had no non-cancellable contracts (which are not leases, private finance initiative contracts or other service concession arrangements) as at 31 March 2017 ( : nil). 14 Financial instruments 14.1 Financial risk management Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities. Because NHS Clinical Commissioning Group is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The clinical commissioning group has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the clinical commissioning group in undertaking its activities. Treasury management operations are carried out by the finance department, within parameters defined formally within the NHS Clinical Commissioning Group standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the NHS Clinical Commissioning Group and internal auditors Currency risk The NHS Clinical Commissioning Group is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The NHS Clinical Commissioning Group has no overseas operations and, therefore, has low exposure to currency rate fluctuations Interest rate risk The Clinical Commissioning Group borrows from government for capital expenditure, subject to affordability as confirmed by NHS England. The borrowings are for 1 to 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The clinical commissioning group therefore has low exposure to interest rate fluctuations Credit risk Because the majority of the NHS Clinical Commissioning Group and revenue comes parliamentary funding, NHS Clinical Commissioning Group has low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables from customers, as disclosed in the trade and other receivables note Liquidity risk NHS Clinical Commissioning Group is required to operate within revenue and capital resource limits, which are financed from resources voted annually by Parliament. The NHS Clinical Commissioning Group draws down cash to cover expenditure, as the need arises. The NHS Clinical Commissioning Group is not, therefore, exposed to significant liquidity risks. 25

110 NHS Central London CCG - Annual Accounts Financial instruments cont'd 14.2 Financial assets Loans and Receivables Loans and Receivables '000 '000 Receivables: NHS 13,893 31,102 Non-NHS 1,824 1,821 Cash at bank and in hand Other financial assets Total at 31 March ,859 33, Financial liabilities Other Other '000 '000 Payables: NHS 19,126 35,137 Non-NHS 26,792 23,871 Total at 31 March ,918 59,008 26

111 NHS Central London CCG - Annual Accounts Operating segments Gross expenditure Income Net expenditure Total assets Total liabilities Net assets '000 '000 '000 '000 '000 '000 Commsioning of HealthCare 305,497 (13,922) 291,575 17,141 (47,934) (30,793) Total 305,497 (13,922) 291,575 17,141 (47,934) (30,793) Gross expenditure Income Net expenditure Total assets Total liabilities Net assets '000 '000 '000 '000 '000 '000 Acute 133,312 (3,155) 130,157 0 Community Health 41,542 (832) 40,710 0 Continuing Care 14,735 (163) 14,572 0 Mental Health 58,762 (110) 58,652 0 Prescribing 20,768 (56) 20,712 0 Primary Care 8,329 (786) 7,543 0 Running Costs 5,252 (765) 4,487 0 CWHHE Risk Share 0 (1,431) (1,431) 0 Other (includes Programme administration & estates) 1,615 (1,028) Other (SAHF) 21,181 (5,595) 15,586 Unallocated 0 17,141 (47,934) (30,793) 305,497 (13,921) 291,575 17,141 (47,934) (30,793) Gross expenditure Income Net expenditure Total assets Total liabilities Net assets '000 '000 '000 '000 '000 '000 Acute 126, , Community 39,591 (854) 38, Continuing Care 14,977 (113) 14, Mental Health 56,297 (335) 55, Prescribing 20,737 (148) 20, Primary Care 8,888 (56) 8, Corporate 5,388 (811) 4, Other 42,122 (19,442) 22, Unallocated ,135 (60,468) (26,333) Total 314,092 (21,759) 292,333 34,135 (60,468) (26,333) The Chief Operating Decision Maker (CODM) is considered to be the Governing Body, which evaluates performance of the organisation based on net expenditure of the segments. The statement of financial position, and cash flow statements are not reported on a segmental basis. 27

112 NHS Central London CCG - Annual Accounts Pooled budgets The Clinical Commissioning Group (CCG) has entered a pooled budget with Westminster City Council under Section 75 of the NHS Act This is a virtual pooled budget and is in respect of the Better Care Fund (BCF) and incorporates the pooled budget for Community Equipment Services, along with non pooled budgets, integrated and joint commissioning arrangements between the CCG and WCC. The BCF was announced by the Government in the June 2013 spending round to drive the transformation of local services to ensure that people receive better and more integrated care and support. The fund is to be deployed locally on health and social care through pooled budget arrangements between local authorities and Clinical Commissioning Groups. The NHS Clinical Commissioning Group shares of the income and expenditure handled by the pooled budget in the financial year were: '000 '000 Income 0 0 Expenditure (33,539) (28,504) 28

113 NHS Central London CCG - Annual Accounts Related party transactions Members of the Governing Body are required to declare any interests that they hold, either directly or through family members, in organisations other than the Clinical Commissioning Group. Where the CCG receives income or incurs expenditure with those organisations, the organisations are known as related parties and the transactions must be reported. Those transactions, together with the nature of the interest and the nature of the transaction, are shown below. The Local Enhanced Services (LES) and Network Plan payments relate to services provided by the practice in which the CCG member is a partner rather than payments to CCG members themselves. The payment is the total paid to the practices as a whole before taking into account practice expenses in delivering services. During the year none of the Governing Body Members or members of the key management staff or parties related to them has undertaken any material transactions with Central London CCG except those listed below: Clinical Commissioning Board Member Name of related party Nature of interest Nature of transaction Payments to Related Party 000 Receipts from Related Party 000 Amounts owed to Related Party 000 Amounts due from Related Party 000 Philip Young St David's Nursing Home Trustee Continuing Health Care Provider Clare Parker Health Education England Associate Finance Member Investment & Activity Planning 26 (3,771) 15 0 Keith Edmunds West London Health Partnership Director Health Consultancy Dr Paul O'Reilly* Doctor Hickey Surgery Partner Primary Care Payment Dr Simon Gordon Iplato Members of clinical advisory board Patient Care Messaging Dr Mona Vaidya* Kings College Health Centre GP/ Partner Primary Care Payment Maxine Radcliffe* Great Chapel Street Medical Centre Lead Nurse Primary Care Payment Dr Niamh McLaughlin* Millbank Medical Centre Partner Primary Care Payment Dr Simon Gordon Newton Medical Centre Partner Primary Care Payment Dr Adel Baluch* Cavendish Health Centre Partner Primary Care Payment Dr Neville Purssell* Paddington Green Health Centre Partner Primary Care Payment Dr Afsana Safa* Marylebone Health Centre Partner Primary Care Payment Dr Sheila Neogi* Pimlico The Marven Dr Adel Baluch*, Dr Simon Gordon*, Dr Afsana Safa*, Dr Niamh McLaughlin*, Dr Paul O'Reilly* & Dr Sheila Neogi* Dr Alan Hakim London Central & West UC St John & St Elizabeth Partner GP Independent Consultant Primary Care Payment Unscheduled Care Collaborative Provider of primary, secondary & community based services. 1, , * Central London GP Federation practice membership. Details of related party transactions with the GP Federation is shown below: GP Federation Nature of interest Nature of transaction Payments to Related Party 000 Central London Healthcare 30 practices are members Practices in the borough including those in which the CCG Board Members are Partners or Salaried GPs are members of the Federation Receipts from Related Party 000 Amounts owed to Related Party 000 Amounts due from Related Party 000 1, practices are Associates Soho Square and Randolph The Department of Health is regarded as a related party and NHS England is regarded as parent entity. During the year Central London CCG has had a significant number of material transactions with the Department, and with other entities for which the Department is regarded as the parent Department. The entities with transactions greater than 1% of Central London CCG net operating cost for the financial year are: A Trusts Expenditure Income Payables Receivables '000 '000 '000 '000 West London Mental Health Trust (17) Royal National Orthopaedic NHS trust The Whittington Hospital NHS trust (8) London North West Healthcare NHS Trust 702 (80) 784 (80) Barts Health NHS Trust 1, London Ambulance Service NHST 11, Central London Community Healthcare NHS Trust 17, (12) Imperial Healthcare NHS Trust 56,370 (436) 4,546 (426) B Foundation Trusts St George's University Hospitals NHS Foundation Trust South London & Maudsley NHS Foundation Trust Royal Brompton & Harefield NHS Foundation Trust (23) Camden & Islington NHS F Trust The Hillingdon Hospitals NHS Foundation Trust (15) King's College Hospital NHS Foundation Trust 1, Moorfields Eye Hospital NHS Foundation Trust 1, The Royal Marsden NHS Foundation Trust 1, (24) Royal Free London NHS FT 4, Guys & St Thomas NHS F Trust 15, ,380 0 University College London NHSFT 17, Chelsea & Westminster NHS F Trust 17,637 (12) (524) (221) Central & North West London NHS F Trust 44,489 (1,418) 3,787 (34) C CCGs NHS Hammersmith & Fulham CCG 117 (164) 358 (4,066) In addition, the clinical commissioning group has had a number of material transactions with other government departments and other central and local government bodies. Most of these transactions have been with Westminster City Borough Council in respect of joint enterprises. D Local Authorities Ealing London Borough Council Westminster City Council 26,879 (1,110) 4,578 (1,008) E Others NHS England - CORE 71 (1,113) 713 (1,054) NHS Midlands and Lancashire CSU NHS Property Services ,981 0 HM Revenue and Customs Trust Statement National Health Service Pension Scheme

114 NHS Central London CCG - Annual Accounts Events after the end of the reporting period There are no post balance sheet events which will have a material effect on the financial statements of the Clinical Commissioning Group. There was a non-adjusting event after the reporting period- primary care delegated budgets. This will give the Clinical Commissioning Group an additional allocation of 28m in in order to commission core primary care services 19 Losses and special payments The Clinical Commissioning group has no losses and special payments cases as at 31 March 2017 ( : nil). The CCG incurred an estimated loss of 43k in 2015/16 relating to a transaction which is under investigation by NHS Protect. 20 Financial performance targets NHS Clinical Commissioning Group have a number of financial duties under the NHS Act 2006 (as amended). NHS Clinical Commissioning Group performance against those duties was as follows: Target Performance Target Performance '000 '000 '000 '000 Expenditure not to exceed income 314, , , ,092 Revenue resource use does not exceed the amount specified in Directions 300, , , ,333 Revenue administration resource use does not exceed the amount specified in Directions 4,503 4,487 4,663 4, Impact of IFRS NHS Clinical Commissioning Group has no IFRS impact during the financial year Analysis of charitable reserves NHS Clinical Commissioning Group has no charitable reserves as at 31 March 2017 ( : nil) 30

115 9. Independent Auditor s report to the members of the Governing Body of NHS Central London Clinical Commissioning Group 115

116