Annual Report and Accounts

Transcription

1 Annual Report and Accounts

2 Cambridgeshire and Peterborough Annual Report Contents Member Practice Statement... 4 Strategic Report... 8 Our organisation... 8 Our vision... 8 Our mission... 8 Our values... 9 Our priorities Older People's Programme Improving End of Life Care Reducing health inequalities in Coronary Heart Disease (CHD) Challenges and future plans Engagement and involvement Our Local Commissioning Groups Borderline and Peterborough System Cambridge Association To Commission Health (CATCH) Cam Health Hunts Health and Hunts Care Partners Isle of Ely and Wisbech Our performance Strategic overview Two-year operational plan Five-year plan Better Care Fund Quality Emergency planning, resilience and response Better payment Risk management Sustainability Equality and Diversity Members report The environment Member practices Complaints handling Employee consultation Employees with a disability Equal opportunities Page 2

3 Pension liabilities Sickness absence External audit Our Governing Body members Declarations of interest Remuneration Report Statement of Accountable Officer s responsibilities Annual Governance Statement for the year ended 31 March Independent auditor's report and annual accounts Page

4 Cambridgeshire and Peterborough Annual Report Member Practice Statement Dr Neil Modha, Chief Clinical Officer, and Maureen Donnelly, Chair of Cambridgeshire and Peterborough Clinical Commissioning Group (CCG), on behalf of member practices Welcome to the annual report of the NHS Cambridgeshire and Peterborough Clinical Commissioning Group (CCG), and its 107 member practices on behalf of its 913,462 patients. This year has seen the CCG make some radical changes in the way we commission services. These include the innovative procurement of older people s services, greater investment in and co-commissioning of primary care, and investing in mental health to improve services, particularly in access to psychological therapies. Throughout all of this we have continued to maintain our focus on improving health outcomes, ensuring our providers deliver safe, good quality compassionate care, and making most effective use of our allocation of public money. The local challenge of an expanding, ageing population continues, with the associated increasing demand on our services. This year, with support from our MPs, councils and providers, we lobbied successfully for an uplift in our funding allocation for gaining a 5.63 percent increase, an additional 20m. Although this is one of the biggest increases given to CCGs across the country, we are still 3.12 percent (another 20million) from our target allocation from NHS England, making an impossible year more possible but still challenging. We are also pleased to report that we have delivered our financial plan by achieving financial balance, repaying our 4.9m debt from , and delivering a small surplus of 3,058k. This is a great achievement, particularly in the context of the ongoing economic pressures and against the significant challenges we have set ourselves around transforming the local health system. The surplus will be put back into our local system and will be invested back into patient care this year. Despite the risk to our financial plan we made the decision to increase our investment in mental health during , especially in Improving Access to Psychological Therapies (IAPT). The 4m investment has allowed promotion of these services to people who would not previously have been considered for referral to mental health services, giving direct access to people with long-term physical health problems. This has, and will, improve patient experience and quality of life outcomes and chimes with our values that good health and wellbeing must include good mental health care. We have also made a significant investment during , of over 4m in primary care through Improving Outcomes for Older People. This is helping practices to ensure that they have effective triage and urgent response services in place for patients aged 75 and older to reduce avoidable admissions. This funding is around 5 per head of population for each practice, which broadly equates to 50 per head for patients aged 75 and over. Page 4

5 has been an interesting year, as we developed some innovative commissioning decisions. Our Older People s Programme included a clinically-led, ground-breaking procurement leading to a five-year contract with UnitingCare (a partnership between Cambridgeshire and Peterborough NHS FT, and Cambridge University Hospitals NHS FT), signed in October 2014, designed to deliver integrated healthcare for older people using an innovative outcomes-based approach. The contract includes bringing together services in Neighbourhood Teams, One Call coordination, rapid response, a well-being service, unplanned acute care and end of life care. There are more details in the Strategic Report on page eight. We are consulting on future plans for a joint NHS 111 and GP Out of Hours (OOH) service, to start in spring/early summer 2016, which would provide a single, integrated and more flexible service and a better experience for patients. There would be a single provider rather than the current three, and a single access point for patients. GPs, clinical advisers and health advisers would work together to provide appropriate advice for different levels of illness. This procurement builds on our learning from having GPs working in the 111 service, and aims to help reduce the stress on Accident and Emergency (A&E) departments. All of our acute hospitals were on capacity alerts for much of the winter period, with sustained high levels of demand for acute care within A&E departments. Social care and community health services were also under pressure, and some patients had to wait longer than necessary for discharge to community health care or social care in the community. We continue to work closely with all of our partners to improve this position and to plan longer term sustainable solutions. Quality of services for patients is our top priority, and we are disappointed that during some of our hospitals did not always sustain the quality we know they are capable of. Cambridge University Hospitals NHS Foundation Trust had challenges around quality of service delivery (A&E, referral to treatment and cancer standards) which were compounded by issues arising from the introduction of the new Electronic Patient Record system (ehospital). This had a severe impact on our patients, and we continue to work with the hospital to resolve the problems. There are more details in the Quality section on page 36. In January 2015 we were informed of Circle s decision to withdraw from its management contract at Hinchingbrooke Health Care NHS Trust. Shortly after, the Care Quality Commission s disappointing report on the quality of care at the hospital was published. Our priority, as the commissioners of care at all of our hospitals, is to ensure that good quality care continues to be delivered safely to the patients. We are confident that, working with partner organisations, the local health system has robust plans in place to address these challenges. 5 Page

6 Cambridgeshire and Peterborough Annual Report We set ourselves the challenge to be an organisation that enables significant transformation in the health system with real benefits for patients across Cambridgeshire and Peterborough. We and our providers jointly funded a 1m system transformation fund, and we have established a System Transformation Board, chaired by Neil Modha, with Chief Executive membership from all of our main providers and representation from Cambridgeshire County Council and Peterborough City Council. This group, with executive support from Andy Vowles, our Chief Strategy Officer, is co-ordinating the development of a five-year strategic plan for the local health economy. The intention is to ensure that we jointly deliver the best possible care for the people of Cambridgeshire and Peterborough within our joint budgets. We expect to begin wider consultation on this later this year. As the CCG has the local knowledge, expertise and a strong rationale to participate more actively and formally, we have agreed to co-commission primary care with NHS England from 1 April We will set up a joint committee with the NHS England Area Team and we are exploring benefits of moving to full Delegated Authority from April 2016, subject to consultation with members in spring As part of this, in the last year, we have continued to develop our clinical engagement with member practices to help them be engaged and involved with the work of the CCG, and know that they can influence it. There are serious pressures in primary care, and we are hoping that our newly established GP-led primary care board will support members to develop sustainable future practices. Members also had the opportunity to consider the performance of the CCG at its quarterly member practices event in April Members reviewed the response to the stakeholder survey and considered a possible response to improve GP engagement. Local Commissioning Group (LCG) Boards have also agreed the Member Practice Introduction on behalf of their member practices. During we reviewed our governance and our organisational development. The Governing Body and each of its sub-committees, including LCG Boards, undertook a self-analysis effectiveness survey on their roles and performance. The review looked at how the CCG operates and what effective frameworks are in place to support decision making processes to deliver good outcomes for patients and meet our statutory requirements. The results have been collated and three key priorities were agreed and are being implemented. The first was to Develop LCG and CCG Governance, by for example strengthening reporting arrangements to the Governing Body by introducing Overview Reports from LCGs on a regular basis; developing a Concordat to replace the current Annual Accountability Agreements; and providing awareness training and development around the corporate governance agenda to LCG Boards. The second was the Review the Effectiveness of All Key Meetings, by developing an Effectiveness Checklist for each Sub-Committee; regularly reviewing cycles of business and schedule more time on GB Agenda for discussion/scrutiny; and participating in Good Governance Institute Pilots to identify any areas of good practice. Page 6

7 The third priority was to ensure that robust arrangements are in place for Financial Year End to support the audit process and deliver the Annual Accounts and Annual Report for At every Governing Body meeting we review a number of measures to assure ourselves that we continue to improve health care and outcomes. We are also assessed quarterly by NHS England as part of their assurance process. To improve and invest in the skills of the wider organisation, and to ensure a strong focus on the performance and delivery of the CCG, the Governing Body appointed Tracy Dowling to the role of Chief Operating Officer from January Tracy brings with her a wealth of knowledge and experience as both a provider and a commissioner across East Anglia. She will work with our providers and member practices to improve our urgent care services and ensure a positive patient experience. She will focus on improving the two areas where conditions remain in place on the CCG s licence: Finance and Performance. Looking back over this last year we have worked hard to embed ourselves as the NHS commissioning organisation for Cambridgeshire and Peterborough and to drive through change and improvements in local health care. Turning to , we look forward to what we hope will be another successful year, with a clear focus on the transformation and improvements we want to achieve across the local health system. On behalf of the Governing Body we would like to thank our staff, our Local Commissioning Groups, our members, partners and all those with whom we work for their help and support over the last year. Dr Neil Modha Chief Clinical Officer Maureen Donnelly Chair of Governing Body 7 Page

8 Cambridgeshire and Peterborough Annual Report Strategic Report Our organisation NHS Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) is the third largest CCG in England covering a population of over 913,462 people across 107 GP practices (108 until 31 March 2015). It has structured itself into eight Local Commissioning Groups (LCGs), so that local clinicians can commission for local need. The CCG was licenced from 1 April 2013 under provisions enacted in the Health and Social Care Act 2012, which amended the National Health Service Act 2006, with two conditions, which remain in place. These relate to the two following criteria: Clear and credible plans that set out how CCGs will take responsibility for service transformation that will improve quality within available resources. CCG has a clear and credible integrated plan, which includes an operating plan for , draft commissioning intentions for and a highlevel strategic plan until Clear and credible plans that set out how CCGs will take responsibility for service transformation that will improve quality within available resources. CCG has detailed financial plan that delivers financial balance, sets out how it will manage within its management allowance, and any other requirements set by the NHSCB and is integrated with the Strategic Plan. NHS England reviews the conditions on a quarterly basis, linked to the CCG Assurance process led by the Area Team. These two conditions remained in place during and remain in place to date due to the financial challenges the CCG continues to face. The accounts have been prepared under a direction issued by the NHS Commissioning Board under the National Health Service Act 2006 (as amended). An unqualified opinion has been given with respect to the financial statements. Our vision Our vision is that the CCG is led locally by clinicians in partnership with their communities, commissioning quality services that ensure value for money and the best possible outcomes for those who use them. Our mission To empower our communities to keep healthy and to commission good quality healthcare for all those who need it. Page 8

9 Our values Patient focused Our population, patients and their families are at the centre of our thoughts and actions, and we will commission care tailored to their needs Quality driven We will constantly strive to be the best we can be as individuals and as an organisation and we will ensure that this is reflected in our commissioning decisions Work locally Through our Local Commissioning Groups working within their communities Excellent Our aim is to be an excellent organisation, for our communities, clinicians and our staff. Our priorities At the start of the CCG, the members set three key strategic clinical priorities for implementation. These continued throughout 2014/2015: 1. Older People's Programme The vision for older people's services is: For older people to be proactively supported to maintain their health, wellbeing and independence for as long as possible, receiving care in their home and local community wherever possible For care to be provided in an integrated way with services organised around the patient To ensure that services are designed and implemented locally, building on best practice To provide the right contractual and financial incentives for good care and outcomes To work with patients and representative groups to design how we commission services. Following a 15-month design and procurement process, in October 2014 UnitingCare was selected as the Preferred Bidder for the Integrated Older People s Healthcare and Adult Community Services (OPACS) contract. UnitingCare is a consortium of Cambridgeshire and Peterborough NHS Foundation Trust and Cambridge University Hospitals NHS Foundation Trust. The five-year contract began on 1 April 2015, with UnitingCare responsible for: Urgent care for adults aged over 65, including inpatients as well as A&E services Mental Health Services for people aged over 65 Community health services for adults (over 18) and older people Other health services which support the care of people aged over Page

10 Cambridgeshire and Peterborough Annual Report An innovative framework for improving outcomes which goes beyond traditional organisational boundaries A new contracting approach which combines a capitated budget with Payment By Outcomes to enable a population approach to service delivery and align incentives in a better way than current funding mechanisms allow in a way which is consistent with the CCG s long term financial plan A five(plus two)year contract term to enable investment and transformation A Lead Provider, UnitingCare, responsible for the whole pathway, providing leadership and operational co-ordination. Commonly NHS contracts are just one or two years in length. This contract is a fiveyear contract, giving UnitingCare time to invest in and transform services for the better. A set of criteria (What do good services look like?) called an Outcomes Framework has been developed and forms part of the contract with UnitingCare. Their performance will be measured against it, with payment linked to achieving the outcomes. This will drive quality improvements across the whole service. Key features of the UnitingCare care model to be introduced in phases from 1 April 2015 onwards include: Integrated teams 17 neighbourhood teams, each supporting up to six GP practices, will provide community-based healthcare centred around the patient OneCall single point of co-ordination services will be accessible via a single telephone number, staffed by professionals with access to expert clinical advice Co-ordinated care for those most at risk working with GPs and their teams to identify patients at greatest risk of deterioration or future hospital admission and then co-ordinating the care those patients need Joint Emergency Team (JET) a 24/7 emergency service that will work alongside ambulances and out of hours GPs to undertake assessments and provide immediate treatment or care in the patient s home Wellbeing and prevention working closely with voluntary organisations and social care to deliver services and support for adults and older people to help keep people well Technology currently different organisations use different electronic patient record systems new technology will create a single view of the whole patient record. More information on UnitingCare can be found at 2. Improving End of Life Care End of Life Care (EOLC) is a key measure for quality of care in the delivery of the Integrated Older People s Pathway and Adult Community Services contract with UnitingCare. Outcome measures have been developed to ensure End of Life Care continues to be delivered throughout the duration of the five-year contract. Page 10

11 The clinically-led programme to improve End of Life Care acknowledges that the CCG already does relatively well at enabling patients to die in a place of their choice, but that there is significant variation geographically and in terms of disease. EOLC practice survey data shows that GPs are increasingly: identifying patients in need of EOLC and placing them on their practice EOLC register; holding more Multi-Disciplinary Team (MDT) meetings to discuss care for patients near the end of life; recording meetings in both the palliative care register and the patient s record; discussing alternatives to admission for people on the EOLC register who have been admitted to hospital; using the CCG EOLC electronic templates for documenting care; and recording a patient s preferred place of death and do not attempt resuscitation orders. Funding for Cambridgeshire s sitting service was secured, allowing it to continue until March 2015, supporting people with appropriate and timely end of life care in their own homes. The EOLC programme has developed a bereavement support leaflet to provide family carers with comprehensive information concerning resources and support available for bereaved people across the CCG area. The leaflet has been distributed widely to GP practices and to all the offices of the Registrars of Deaths and to Funeral Directors throughout Cambridgeshire and Peterborough. Improvements to the EOLC Clinical Template continue and latest updates have been sent out to practices with a hard copy mail out to take place in April / May Promotion of the EOLC Views in unscheduled care and settings, including the East of England Ambulance NHS Trust, continues. 3. Reducing health inequalities in Coronary Heart Disease (CHD) Reducing premature deaths arising from CHD in people aged under 75 years remains a priority for the Cambridgeshire and Peterborough Clinical Commissioning Group (CCG). Although progress is being made in reducing deaths from CHD, the latest data still shows a variation in mortality rates between different locations across the CCG. The CHD programme is targeted towards those localities most at risk of developing CHD, predominantly practices within Borderline, Peterborough and Wisbech LCGs as deprivation is a risk to developing CHD and therefore a health inequality for patients from those practices. 11 Page

12 Cambridgeshire and Peterborough Annual Report The work of the Programme is split into four workstreams: I. Health checks programme: A mobile Health Checks Service commenced in Fenland with the priority focus being on Wisbech workplaces. This has already resulted in increasing the number of health checks amongst the more hard to reach groups. The NHS Health Checks website has named it as an example of good practice and innovation. Healthy Lifestyle booklets have been developed for GPs. They include information on stopping smoking, alcohol, exercise and diet and direct patients to services across Peterborough, Cambridgeshire and Northamptonshire. II. Cardiac rehabilitation: One of the critical elements of workstream two is to establish consistent reports from all providers to ascertain where there may be gaps in provision of Cardiac Rehabilitation services. Peterborough and Stamford Hospitals NHS Foundation Trust and Cambridgeshire Community Services NHS Trust cardiac rehab teams have been working together to develop a single report and manage the referrals for the Peterborough location as a single caseload, with existing contract agreements. III. Primary Care interventions: Cardiovascular Disease (CVD) Risk Profiles have been produced for all 108 GP Practices (as of ) within the CCG. The 46 practices with the worst levels of deprivation received a profile that included some narrative specific to their practice and registered population. The intention is to refresh the CVD profiles for all practices in and recirculate them by July IV. Decreasing smoking prevalence: A smokefree service is now being delivered within Cambridgeshire and Peterborough NHS Foundation Trust where there is a Mental Health practitioner trained to deliver a 12-week programme to people with mild to moderate mental ill health. Peterborough City Council has supported a prevention programme delivered in local schools. The work has been recognised by Health Education England. Work has also commenced to roll-out training to front line staff within the council to identify and refer clients to health improvement programmes such as smoking cessation. Fenland remains a priority area for interventions. Staff from the Rosmini Migrant Community Centre have been trained to target people from the migrant community which has high smoking prevalence rates. The mobile service which provides health checks also includes the Stop Smoking Services visiting sites such as supermarkets and workplaces. The CCG sits on four Health and Wellbeing Boards and plays an active role. We work closely with our local authority colleagues to ensure that our joint and individual strategies are aligned. Peterborough Health and Wellbeing Board has identified Cardiovascular Disease (CVD) as a priority focus for preventative activity. This resulted in a recent bid to the Page 12

13 British Heart Foundation describing a House of Care Model of intervention. It is acknowledged that there are shared priorities described by the CCG and the Board. More information on these priority areas can be found at Challenges and future plans Our strategic aims are: Empowering people to stay healthy Improving quality, improving outcomes Developing a sustainable health and social care system. From these aims we have identified seven strategic goals: Prevention of ill health and promoting wellbeing for all Keeping people safe People have trust and confidence in us and help shape our healthcare People are listened to throughout their care Making best use of our NHS by giving the right care, in the right place at the right time Services are seamless, integrated and centred around the person The services that we commission match the needs of our population ensuring fair access in relation to need. The GP leads on the CCG s Governing Body have been involved in planning and priority setting for next year. We are planning to establish a number of clinical programmes which would form the overarching structure of the CCG s operational delivery plan for They are: Older People s Services Urgent care for people aged under 65 Planned care Prevention and Long Term Support the mobilisation of the UnitingCare contract for Older People s Services. Ensure close integration with primary care to meet the needs of older people. To ensure that the Better Care Fund (BCF) builds integration and keeps older people well and independent for as long as possible. To address the avoidable causes of hospital admission, reducing urgent care demand. To develop effective clinical triage at access points for urgent care to ensure patients are directed to the right service building on learning from 111 and GP in A&E pilots. Ensure the adherence to clinical thresholds to ensure that only clinically effective treatments are undertaken. Redesign planned care pathways to reduce the number of hospital attendances and improve speed of treatment. Enhance the CHD programme to address the wider 13 Page

14 Cambridgeshire and Peterborough Annual Report Conditions (LTCs) Primary Care Prescribing Children s Services Mental Health Continuing Health Care (CHC) issues of cardiovascular disease. Support development of initiatives to reduce obesity rates. Support physical health checks for people with Learning Disabilities. Progress joint commissioning of primary care services with NHS England. Support the further development of multidisciplinary teams (MDTs) with the 5 per head for older people. Progress three Prime Minister s Challenge Fund bids to develop primary care. Develop Quality, Innovation, Productivity and Prevention (QIPP) schemes to actively manage medicines within budget. Support care homes with pharmacist teams undertaking medicines reviews. Ensure medicines reviews are undertaken to support safety. Address long waiting times in Child and Adolescent Mental Health Services (CAMHS). Review emergency care pathways for children to provide better support to parents and children. Utilise Parity of Esteem monies to strengthen existing mental health services including Improving Access to Psychological Therapies (IAPT) access, crisis resolution services and causes of frequent attendance at A&E. 5.6% increase in funding for mental health services. Redesign of CHC assessment and placement processes. Review commissioning of placements to secure better value and faster placement. Reduce delayed transfers of care (DTOCs). As well as planning for next year, we also need to think more long term. There are national drivers, such as the NHS Five Year Forward View, and local challenges that mean we need to think about how we can continue to deliver the best we can for patients within the funding that we have. Cambridgeshire and Peterborough is one of eleven Challenged Health Economies identified nationally, and has received centrally funded support to identify the key challenges and suggest how they might be addressed, particularly in the context of developing five-year plans. This nationally-supported programme was commissioned by NHS England, Monitor and the NHS Trust Development Authority (TDA). PricewaterhouseCoopers (PwC) was selected to undertake this 12-week piece of work for the Cambridgeshire and Peterborough health economy, which commenced on 7 April Page 14

15 The System Transformation Programme, which is a joint programme funded and staffed by all the NHS organisations in Cambridgeshire and Peterborough, is looking at this longer term strategy. They will be considering how services may have to change or adapt to be able to continue providing the level of care we want to deliver, while living within our financial means. Intelligence gained from Joint Strategic Needs Assessments (JSNAs), and other sources of evidence, has been used to learn more about the health needs of our population. Our key challenges have been identified as follows: The Cambridgeshire and Peterborough health system is not financially sustainable and if nothing is done it will face a financial gap of at least 250million by 2018/19 The population of Cambridgeshire and Peterborough is increasing and there will be a greater proportion of older people in five years time Demand for mental health services continues to increase There are significant levels of deprivation and inequality that need to be addressed People are living longer and health outcomes are generally good but there are significant differences in people s health across our system Our health system has multiple stakeholders. The programme team is being hosted by Cambridgeshire and Peterborough Clinical Commissioning Group but is a cross-system programme involving: Cambridge University Hospitals NHS Foundation Trust Peterborough and Stamford Hospitals NHS Foundation Trust Hinchingbrooke Health Care NHS Trust Cambridgeshire and Peterborough NHS Foundation Trust Cambridgeshire Community Services NHS Trust Papworth Hospital NHS Foundation Trust. The work of the team focusses on the following areas, with prevention incorporated into the work of all of the workstreams: System Design (incorporating elective and non-elective care) Children and maternity Mental health Older people and vulnerable adults Primary care. There are four phases to the System Transformation Programme: Agree Framework and Baseline Design and Propose Change and Construct Implementation , We are currently in the Design and Propose phase where, through engagement with stakeholders, we are developing ideas only about what could change. 15 Page

16 Cambridgeshire and Peterborough Annual Report This phase lasts until June 2015 after which there will be engagement and consultation on the ideas that have come out of the Design and Propose phase. Risks are disclosed in the Annual Governance Statement. Engagement and involvement In discharging its functions under the Health and Social Care Act 2012, the CCG is required to: Make arrangements to secure public involvement in the planning, development and consideration of proposals for changes and decisions affecting the operation of commissioning arrangements by ensuring that individuals to whom the services are commissioned, are being or may be provided are involved: a) in the planning of the CCG s commissioning arrangements; b) in the development and consideration of the proposals by the CCG for changes in commissioning arrangements; and c) in the decisions of the CCG affecting the operation of commissioning arrangements, where the decisions would, if made, impact on the manner in which the services are delivered. Promote the involvement of patients, their carers and representatives in decisions about their healthcare by promoting their involvement in the decisions which relate to: a) the prevention or diagnosis of illness in the patients; or b) their care or treatment. During the last year the CCG s Engagement Team has built new partnerships and developed existing partnerships. Key contacts include: Patients, carers and the wider public All staff members across the CCG including those in member practices Local authorities, voluntary sector organisations, Healthwatch organisations, Health and Wellbeing Boards, and MPs Other NHS bodies and regulators i.e. NHS England, Monitor and the Care Quality Commission Our providers including Cambridgeshire Community Services NHS Trust; East of England Ambulance Service NHS Trust; Cambridge University Hospitals NHS Foundation Trust; Hinchingbrooke Health Care NHS Trust; Peterborough and Stamford Hospitals NHS Foundation Trust; Cambridgeshire and Peterborough NHS Foundation Trust, and other contracted NHS provider trusts that border our area Local and national media. The CCG is committed to ensuring that there is a strong patient voice in helping us to design healthcare services for the future. We recognise that empowered clinical Page 16

17 leadership must go hand in hand with strong patient and public leadership, with patients working with the organisation as critical friends and this ethos is reflected in our Communications, Engagement and Membership Strategy. There are always opportunities for our stakeholders and members of the public to engage and share their views with us. Our stakeholder newsletter, which is sent out to our stakeholder database and is posted on our website, has a facility for people to leave comments. Our Engagement Team address is publicised on all our communications and we encourage members of the public to contact us. We respond to s and telephone calls where we are given feedback, or concerns are raised by our stakeholders or the public. The Patient Reference Group is a Sub-Committee of the Governing Body and includes patient representatives from each of our eight Local Commissioning Groups, as well as Healthwatch Cambridgeshire and Healthwatch Peterborough. The Patient Reference Group provides constructive challenge on a broad range of work, policy development and changes to patient pathways. Alongside the Patient Reference Group, there is a range of other groups with whom we engage on a regular basis: Patient Participation Groups, Patient Forums, Healthwatch organisations, Health Overview and Scrutiny Committees / Health Committees, Health and Wellbeing Boards and Local health Partnerships. Taking into account the feedback we receive from these groups, we then decide on what the most appropriate means of public engagement will be at each stage of the commissioning process from planning to the consideration of specific proposals for change. Each commissioning activity we undertake will be different and the means of public involvement at each stage in the process is likely to vary. For example, at some stages of the commissioning process public involvement may be achieved through the publication of information regarding our activities, whereas at others formal consultation may be more appropriate. Our decisions on the means by which we engage the public in each commissioning activity are likely to include consideration of the following relevant factors, among others: The range of services we are proposing to change The size of the geographical area The number of people affected by the proposed change The nature of the particular stages of the commissioning process. Examples of public engagement that we have started during this financial year are: Continued engagement through the mobilisation stage of the Older People s and Adult Community Services Project Engagement on the development of our five-year plans; this has developed into the System Transformation Programme and involves a wide range of partner organisations as well as patient, public and voluntary sector involvement We have formally consulted on proposed changes to the 111 and GP Out of Hours Services We have continued to engage with local people and patient representatives on changes to local services such as the procurement of a community Ear, Nose and Throat triage service for Borderline and Peterborough patients. 17 Page

18 Cambridgeshire and Peterborough Annual Report Where we are now The population of Cambridgeshire and Peterborough is increasing and we have an increasing number of older people in the population. There are significant levels of deprivation and inequality that need to be addressed. People are living longer but there are significant differences in people s health. These inequalities have remained constant. As well as demands on our health system because of our increasing population each year demand for healthcare goes up because of other factors. We think that most of this extra demand is related to the impacts of increasing obesity in our population. Our current system is not financially sustainable and so we are working as a system with all the organisations involved in healthcare, patients and clinicians to develop medium-term plans that we believe are realistic and which ensure that the services we commission are safe, of high quality and affordable. Although the situation overall is challenging, it also presents a range of strategic and operational opportunities for genuine service transformation. Our strategic aims are: To keep people at the centre of all that we do Empowering people to stay healthy Improving quality, improving outcomes Developing a sustainable health and social care system. Page 18

19 Our Local Commissioning Groups NHS Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) is organised into eight local groups, known as Local Commissioning Groups or LCGs. The eight LCGs are part of the wider Clinical Commissioning Group and develop the CCG s strategy at a local level. Borderline and Peterborough System This year both LCGs have made good progress with their aims to develop the LCGs into robust and effective organisations. A good working relationship has been established between the Boards and their Patients Forums ensuring that there is a positive two-way flow of information, ideas and comments between the two. Patients have been heavily involved in examining websites for the practices and there is a good spread of patient representation on various live projects under development. 30 practices serving a total of 252,638 patients within Peterborough, North Cambridgeshire and Northamptonshire A significant cohort reside in the UK s fastest growing city and face a unique range of health challenges as a result of ethnic mix, impact of immigration, significant pockets of deprivation and a large proportion of manual workers Life expectancy in Peterborough is generally lower than that for the UK, with people from lower socioeconomic groups living 9.5 years fewer for men and 5.2 years fewer for women Deprivation rates are higher with 23.6% of children living in poverty. 20.7% (433) of children are classified as obese, worse than the average for England Increased levels of teenage pregnancy and smoking at time of delivery are worse than the England average. Borderline and Peterborough LCGs Organisational Priorities To provide high quality and seamless patient centred health and social care to local patients regardless of the challenges imposed by geographical borders To progress transformational programmes to redesign key services enabling delivery of care within the financial envelope available To continue to build on existing strong working relationships with key multiagency stakeholders thereby maximising the potential for innovation of service improvement and delivery Improve care for the frail and elderly Improve care for those towards the end of their life Improve care for those with Coronary Heart Disease Improve quality through local review of care pathways driven by need or inequality Deliver safe and cost effective use of medicines and reduce waste Better care for patients with mental health needs in hospital. 19 Page

20 Cambridgeshire and Peterborough Annual Report Some of our achievements A successful innovative Prime Minister s Challenge Fund bid in March next steps are to engage with stakeholders and patients to develop the implementation programme for the Borderline and Peterborough system The Care Home Educator has avoided 60 inappropriate admissions in three months A community based Ear, Nose and Throat service has been procured and commences in April Cambridge Association To Commission Health (CATCH) CATCH LCG s vision is to create the best services with our patients for the care of their health and wellbeing within the resources available. The LCG is made up of 28 practices and covers a population of just over 227,000. Some of our achievements Introduction of a Referral Support Service for GPs to provide advice on pathways of care and avoid referral to hospital if primary or community services are available A triage system for ophthalmology referrals and minor eye conditions has been introduced in the community to reduce the need for patients to go to hospital for care CATCH has led the development of a Primary Care Urgent Care service at weekends and evenings so that patients attending the A&E department can see a GP if they do not need hospital services Continued development of multi-disciplinary team working in practices ensuring a more personalised and responsive service for older people who can be cared for in their own home rather than being admitted to hospital The Chronic Obstructive Pulmonary Disease (COPD) initiative has involved sharing best practice between practice nurses and GPs, changing the location and frequency of the Pulmonary Rehab Services to make them more accessible for patients. This work has resulted in patients being cared for in their own homes rather than being admitted to hospital The Lipid Clinic pathway has been reviewed and as a result more patients will be managed by their GP in , rather than attending the hospital as an outpatient The Acute Geriatric Intervention Service has supported elderly patients in a community setting by providing urgent access, treatment and onward referral to community services. Page 20

21 Cam Health Cam Health members believe that it is through more effective integration of services that better quality and cost effectiveness, and a better experience for patients and carers can be achieved. Cam Health LCG has continued to develop and strengthen over the year, with all nine member practices being actively involved. Some of our achievements Continuing the development of its innovative Integrated Diabetes Service, which has expanded in year to include type 1 as well as type 2 diabetic patients. A full evaluation of this service is taking place to see if it should be offered to more patients across the Cambridge area. Cam Health has continued to work on managing frail and elderly patients in the community rather than admit them to hospital via Multi Disciplinary Teams (MDTs) of primary and community staff supported by Community Matrons. The team identifies patients who may be at increased risk of admission to hospital and works together to co-ordinate and optimise the care of those patients in the community. They also provide clinical notes, which can be seen by the Out of Hours GP Service, and the LCG is working with Addenbrooke s Hospital to ensure that they can also access these community care records. A Dermatology Community Clinic has been established and offers a Consultant Dermatologist working alongside GPs to provide fast access to advice and treatment for common dermatological conditions. In conjunction with the Alzheimer s Society charity a dementia support worker is offering appointments to patients with Alzheimer s either in their GP practice or their own home. A Long-Term Conditions Nurse is working with a selected cohort of patients who are aged to assess whether improved self-management will lead to reduced admissions and increased employment rates in people with long-term conditions. The results from this pilot will be available in autumn The Chronic Obstructive Pulmonary Disease (COPD) initiative has involved sharing best practice between practice nurses and GPs, changing the location and frequency of the Pulmonary Rehab Services to make them more accessible for patients. This work has resulted in patients being cared for in their own homes rather than be admitted to hospital. The Acute Geriatric Intervention Service has supported elderly patients in a community setting by providing urgent access, treatment and onward referral to community services. 21 Page

22 Cambridgeshire and Peterborough Annual Report Hunts Health and Hunts Care Partners The two LCGs focussed strongly on delivering a very challenging savings plan for the year. This consisted of reducing demand on hospital services by managing patients in primary care and community services. The LCGs have achieved some success in this and have finished the year within one percent of the budget set for hospital services over the year. Some of our achievements The main programmes that went into this were managing GP referrals through a Referral Support Service. All the local practices engaged with this service and it had a significant impact in improving the quality of referrals, so that only those patients that absolutely needed to went into secondary care (hospital) services. The LCGs piloted, and have now permanently funded, a community cancer care service run from Hinchingbrooke Hospital. It aims to support patients dealing with cancer in their homes for those patients that are suffering from cancer or have completed their treatment and need some support. A community Musculoskeletal service that GPs can refer to for patients to be assessed by specialist practitioner physiotherapists was also commissioned by the LCGs. This enables in depth assessment and management in the community rather than patients going into hospital. This has been very effective in managing patients closer to home and has reduced the demand for hospital-based orthopaedic services. The LCGs worked closely with Hinchingbrooke Hospital to develop an Emergency Nurse Practitioner service in the hospital A&E for the management of A&E patients that present with minor injuries and illnesses. The aim of this was to reduce the demand on the hospital A&E. The LCGs took a lead role in the System Resilience Group (SRG) that oversees emergency care in the system. Through this group Emergency Care Intensive Support team (ECIST) was called in to provide external support to Hinchingbrooke and the wider system about how best to configure urgent care services for the local population. Through the SRG the LCGs also significantly increased funding and capacity for patients to be discharged, with a reablement care package, to their own homes. This has allowed patients to be discharged sooner and resulted in improved patient outcomes, with over 50% of patients that go through this pathway regaining independence. The LCGs set an incentive and engagement scheme called a Practice Delivery Membership Agreement (PDMA) with all our practices to encourage them to support the LCG commissioning agenda. All practices signed up to the PDMA and it delivered significant benefits, including a virtual diabetes service for high risk patients and working with the Medicines Management Team to prescribe in the most effective ways. Page 22

23 Isle of Ely and Wisbech Isle of Ely and Wisbech LCGs are the two LCGs within the CCG that are the furthest away from an acute hospital provider. Patients living in these areas can therefore find it difficult to access acute hospital services. As a result of this, both LCGs aim to commission high quality care for patients as near as possible to their homes. The area is fortunate to have three local community hospitals within the localities North Cambridgeshire Hospital in Wisbech, Doddington Community Hospital and Princess of Wales Hospital in Ely. The LCGs are working towards maximising the potential usage of these sites to help achieve this aim. Some of our achievements Much of the LCGs work last year ( ) was in partnership with Cambridgeshire Community Services NHS Trust (CCS) to redesign and commission services so as to reduce avoidable A&E attendances and inappropriate, avoidable unplanned admissions to hospital. The LCGs commissioned services through a number of projects that contributed to a reduction in A&E attendances and emergency admissions, while improving patient satisfaction. This year the LCGs will work closely with UnitingCare to ensure that urgent care for the over 65s is of the best possible quality and provided in the most accessible place. The LCGs are also implementing a programme of schemes to help provide an improved urgent care service for the under 65s. These include: o Maximising the use of appropriate, safe and local alternatives to A&E o Maximising the potential for joint working between 111/Out of Hours medical services and Minor Injury Units o Reducing variation in the usage of urgent care services between GP practices, so as to promote equality of access to services and to ensure that services are used most effectively and efficiently. The LCGs also aim to commission planned care services to be delivered as close as possible to their patients. They are currently working with providers to deliver services within community hospitals and within the LCG areas. In particular they are keen to make best use of the block contract with CCS, especially for outpatient services. They have identified various cohorts of patients for whom they think service delivery can be improved. Planned care projects to improve services to patients include: o Ophthalmology o Referral support o Musculoskeletal services (MSK) o Sleep Apnoea o Ear Nose and Throat Services (ENT) o Dermatology. Isle of Ely and Wisbech LCGs aspire to maximise the support they give to primary care. They recognise that primary care is a crucial part of the care given to patients and that high quality primary care is the foundation to all other services that patients rely on. 23 Page

24 Cambridgeshire and Peterborough Annual Report Our performance Financial performance targets Clinical Commissioning Groups have a number of financial duties under the National Health Service Act 2006 (as amended). The Clinical Commissioning Group s performance against those duties during was as below and also as shown in note 42 of the Annual Accounts. These can be obtained from Tim Woods, Chief Finance Officer, Lockton House, Clarendon Road, Cambridge CB2 8FH Target Performance Duty achieved? 1. Expenditure not to exceed income and the revenue resource does not exceed the amount specified in Directions 000s 908, ,110 Achieved 2. Capital resource use does not exceed the amount specified in Directions 0 0 Achieved 3. Revenue resource use does not exceed the amount specified in Directions 908, ,110 Achieved 4. Revenue administration resource use does not exceed the amount specified in Directions with respect to Running Costs 18,887 18,866 Achieved Table Performance for the year ended is as follows: Total net operating cost for the financial year 905,110 Net operating cost plus (gain)/loss on transfers by absorption Revenue Resource Limit 908,168 Under/(Over)spend against Revenue Resource Limit (RRL) 3,058 Page 24

25 Measurement of performance We robustly monitor, measure and report on our performance against local and national targets. During we have focused our attention on: Ensuring that monthly performance reviews take place with our major providers of health services in Cambridgeshire and Peterborough and cover service performance and clinical quality Holding providers from whom we commission services to account for the responsiveness and quality of services provided Ensuring delivery of our population s NHS constitutional rights Working closely with the NHS England Local Area Team to identify how well we are performing against our plans to improve services and deliver better outcomes for patients Ensuring that all key performance measurements are regularly communicated to all our stakeholders. During the year, our GP leads have been actively involved in the process of contract management and reviewing services commissioned. Clinical Commissioners are regular members of the Finance and Performance Committee. Dr Abby Richardson is the GP contract lead for the Huntingdonshire system and chairs the monthly Strategic Quality and Exception Contract meeting. Dr Emma Tiffin, clinical lead for mental health services and the locality based clinical leads for mental health services meet regularly with providers to review pathways and consider service improvements. One example of this is increasing access to Psychological therapy services. Key performance information is also reported to the CCG Governing Body. Furthermore, on a quarterly basis, the NHS England Area Team meets with us to review our effectiveness in discharging our statutory responsibilities. We have been working hard to meet increasingly challenging targets and key performance indicators associated with the NHS Outcomes Framework for , the CCG Outcomes Indicator Set for and Everyone Counts: Planning for Patients We have also been preparing and considering the key indicators associated with the NHS Outcomes Framework for The CCG will continue this work in with a focus on the main risk areas of Referral to Treatment, A&E standards and Infection Control. The tables below summarise performance on key indicators and compare performance to Page

26 Cambridgeshire and Peterborough Annual Report Access to cancer services in These figures relate to how long patients have to wait for diagnosis or treatment. We are pleased to report that we have continued to meet all cancer standards for Performance target actual actual target Target achieved? Patients seen within two weeks from an urgent GP referral for suspected cancer to date first seen Patients seen within two weeks from a referral for evaluation of breast symptoms by a primary care professional to date first seen 97.5% 95.3% 93% Yes 96.7% 95.4% 93% Yes Patients receiving their first definitive treatment for cancer within one month (31 days) of a decision to treat Patients receiving their subsequent chemotherapy treatment for cancer within one month (31 days) of a decision to treat Patients receiving their subsequent surgical treatment for cancer within one month (31 days) of a decision to treat Patients receiving their subsequent Radiotherapy treatment for cancer within one month (31 days) of a decision to treat 98.5% 97.6% 96% Yes 99.9% 99.8% 98% Yes 95.8% 94.2% 94% Yes 96.7% 96.7% 94% Yes Page 26

27 Target Performance target actual actual target achieved? Target Performance target Patients receiving their actual actual target achieved? first definitive treatment Patients for receiving cancer within their two 88.2% 86.0% 85% Yes first definitive months treatment (62 days) of for cancer GP or within dentist two urgent 88.2% 86.0% 85% Yes months referral (62 days) of GP or Patients dentist urgent receiving their referral first definitive treatment Patients for receiving cancer within their two 94.3% 92.0% 90% Yes first definitive months treatment (62 days) of a for cancer National within Screening two 94.3% 92.0% 90% Yes months referral (62 days) of a National Screening referral Access to emergency care in Figures Access here to emergency relate to ambulance care in responses (East of England Ambulance Service NHS Trust Figures or here EEAST) relate and to ambulance maximum waiting responses times (East at Accident of England & Emergency Ambulance (A&E). Service NHS Trust or EEAST) and maximum waiting times at Accident & Emergency (A&E). Performance Performance target target All ambulance All ambulance trusts trusts to to respond respond to 75% to 75% of of Category Category A calls A calls (immediately (immediately life life threatening) threatening) within within 8 8 minutes minutes (Red (Red 1) 1) All ambulance All ambulance trusts trusts to to respond respond to 75% to 75% of of Category Category A calls A calls (may (may be life be life threatening threatening but but less less time time critical) critical) within within 8 minutes 8 minutes (Red (Red 2) 2) All ambulance All ambulance trusts trusts to to respond respond to 95% to 95% of of Category Category A calls A calls (immediately (immediately life life threatening) threatening) within within minutes minutes Target Target actual actual actual actual target target achieved? achieved? 73.7% 73.7% 71.0% 71.0% 75% 75% No No 69.5% 69.5% 62.8% 62.8% 75% 75% No No 92.9% 92.9% 91.2% 91.2% 95% 95% No No The The historical historical trend trend of not of not delivering delivering against against the the above above national national targets targets continued continued into into , , with with performance performance having having deteriorated deteriorated overall overall in comparison in comparison to the to the previous previous year year at both at both regional regional and and local local level. level. There There have have however, however, been been signs signs of improvement of improvement with with EEAST EEAST achieving achieving Red Red 1 regionally 1 regionally in February in February for for the the first first time time since since 27 Page 27 Page

28 Cambridgeshire and Peterborough Annual Report September In February 2015 their Red1/2 19 minute performance was also the highest it has been, at 93.9% in March 2015 since January EEAST is currently carrying out an in-depth review of its strategy and operational model with a view to improving performance at both regional and local level up to the nationally required standards. Three root causes and actions being taken are: Shortage of qualified paramedics EEAST is recruiting 400 student paramedics and up-skilling Emergency Care Assistants (ECAs) to technicians and technicians to paramedics. Delays in A&E and lack of alternatives to A&E the CCG is introducing Hospital Ambulance Liaison Officers (HALOs) to speed up arrival in A&E, GPs in A&E to free up capacity, and identifying gaps in services commissioned. Increased demand for EEAST 999 services a review of NHS 111 ambulance dispatches takes place bi-weekly, and the CCG and EEAST are working with care homes to avoid unnecessary ambulance dispatches. The CCG is part of a consortium of commissioners which oversees the contract and delivery of services with EEAST. This consortium meets on a regular basis and also considers strategic issues. This group will specifically agree how the reinvestment of penalties and fines will be reinvested for the benefit of local patient outcomes. Access to planned care in Figures below relate to patients receiving elective or planned care following a referral made by GPs to receive treatment by the relevant provider (e.g. hospital, community provider). We are pleased to report that we have continued to meet all referral to treatment standards for Performance target actual actual target Target achieved? Percentage of patients seen within 18 weeks for admitted pathways Percentage of patients seen within 18 weeks for nonadmitted pathways Percentage of patients on incomplete non-emergency pathways (yet to start treatment) waiting no more than 18 weeks from referral 92.9% 90.1% 90% Yes 97.8% 96.6% 95% Yes 97.3% 94.8% 92% Yes Page 28

29 (yet to start treatment) waiting no more than 18 weeks from referral Four-hour maximum wait in A&E from arrival to admission, transfer or discharge Four-hour maximum wait in A&E from arrival to admission, transfer or discharge in in A&E performance is monitored through the local System Resilience Groups (SRGs) A&E performance is monitored through the local System Resilience Groups (SRGs) which centres on acute hospitals and involves all providers in that system. For each which centres on acute hospitals and involves all providers in that system. For each provider, A&E remains a key service performance element in the contract and as such provider, A&E remains key service performance element in the contract and as such contract queries are raised for under performance and remedial action plans are contract queries are raised for under performance and remedial action plans are submitted to commissioners to address under performance. submitted to commissioners to address under performance. Figures here relate to maximum waiting times at Accident and Emergency (A&E). Figures here relate to maximum waiting times at Accident and Emergency (A&E). Performance target Performance target actual actual actual) actual) target target Target Target achieved? achieved? The proportion of The patients proportion spending of four patients hours spending or less in four all types hours of A&E or less department in all types of A&E department 94.6% 88.3% 95% No 94.6% 88.3% 95% No The figures below relate to A&E performance at provider level. The figures below relate to A&E performance at provider level. Provider Provider actual actual actual actual target target Target Target achieved? Cambridge University Hospitals Hospitals NHS NHS Foundation Trust Trust (CUHFT) (CUHFT) Hinchingbrooke Healthcare NHS NHS Trust Trust (HHCT) (HHCT) Peterborough and and Stamford Stamford Hospitals Hospitals NHS NHS Foundation Trust Trust (PSHFT) (PSHFT) The The Queen Queen Elizabeth Hospital, Hospital, Kings Kings Lynn, Lynn, NHS NHS Foundation Trust Trust (QEH) (QEH) 94.4% 94.4% 83.8% 83.8% 95% 95% No No 96.3% 96.3% 92.6% 92.6% 95% 95% No No 92.4% 92.4% 85.9.% 85.9.% 95% 95% No No 92.6% 92.6% 90.8% 90.8% 95% 95% No No CUHFT CUHFT failed failed to meet to meet the the A&E A&E target target in every in every month month of of Underperformance 29 Page 29 Page

30 Cambridgeshire and Peterborough Annual Report has been due to a variety of factors. Average daily A&E attendances were higher than the previous year between April 2014 and November 2014 before returning to levels seen in or below since December. There have been capacity and staffing pressures across the trust. Productivity and workflow have suffered following the implementation of the new clinical information system at Addenbrooke s (E-Hospital). The number of Delayed Transfers of Care (DToC) bed days has also increased over the year. PSHFT also failed to meet the standard for every month of the year and the contributory factors are similar to those at CUHFT. Average daily A&E attendances at PSHFT were higher than the previous year between April 2014 and December 2014 before returning to levels seen in or below since January. The number of DToC bed days has increased over the year, partly due to an increasingly frail population and also due to complex, multi agency discharge arrangements. It has been identified that improvements to patient flow within the hospital are required and this work programme is being implemented. HHCT has failed the A&E target due to poor performance between September 2014 and February The main reason for this was reduced flow from hospital to community services one key reason was due to a lack of available home care. HHCT has also experienced a spike in DToC bed days in this period. Issues within the hospital relating to the effectiveness of the discharge process and time taken to senior clinical review within the A&E department have also been identified. The trust s performance in March did deliver against the 95% standard. QEH failed to meet the A&E target in every month of with the exception of September. The Trust has continued to have difficulties with flow through and out of the hospital. An increase in age and frailty of patients admitted and the delays to discharge have adversely affected bed occupancy, impacting on flow. In order to improve performance and monitor recovery across the whole CCG daily escalation calls have taken place and a daily SRG scorecard is in place for each system. A weekly four-hour recovery meeting takes place as well as the SRG operational and strategic group meetings. Internal processes are being continually reviewed at all providers and recruitment issues are being addressed where appropriate. CUHFT, PSHFT and HHCT are all planning a breaking the cycle week with support from partners across the system. Contractual notices and penalties have been applied as appropriate and Remedial Action Plans are in place. Additional community capacity has been secured where this is required and available. Page 30

31 Patient safety Figures here relate to the number of incidences of Clostridium difficile and MRSA applicable to our CCG. The annual ceiling for has been exceeded. Performance target actual actual ceiling Target achieved? Number of incidences of Clostridium difficile Number of incidences of MRSA in patients aged 2 or over No No Clostridium difficile The number of sanctioned cases at HHCT and QEH exceed the ceilings confirmed in the trust plans and contractual consequences have been applied as appropriate. Remedial action plans are in place, which are monitored monthly through Healthcare Associated Infections (HCAI) meetings. MRSA The three cases of MRSA bacteraemia assigned to the CCG in were at outof-area providers. The national Post Infection Review (PIR) process is undertaken to determine which provider service will be assigned each case and the appropriate learning is identified and monitored through subsequent HCAI meetings. 31 Page

32 Cambridgeshire and Peterborough Annual Report Scorecard for NHS Constitution Referral to treatment access times Threshold Mar Delivered Feb 15 Delivered Admitted patients 92.9% 90.0% 87.9% 90.1% No Yes Non-admitted patients 97.8% 95.0% 94.3% 96.6% No Yes Incomplete pathways 97.3% 92.0% 90.9% 94.8% No Yes Diagnostic waits Threshold Mar Delivered Mar 15 Delivered No patient should wait > 6 weeks 99.5% 99.0% 98.2% 97.9% No No A&E waits Threshold Mar Delivered Mar 15 Delivered Patients spending four hours or less in all types of A&E department Patients spending four hours or less in all types of A&E department Patients spending four hours or less in all types of A&E department Patients spending four hours or less in all types of A&E department Patients spending four hours or less in all types of A&E department CCG 94.6% 95.0% 85.8% 88.3% No No CUHFT 94.4% 95.0% 75.9% 83.8% No No Hinchingbrooke 96.3% 95.0% 95.6% 92.6% Yes No PSHFT 92.4% 95.0% 87.0% 85.9% No No QEH 92.6% 95.0% 92.5% 90.8% No No Cancer waits Threshold Mar Delivered Mar 15 Delivered week wait for urgent cancer referrals 97.5% 93.0% 88.6% 95.3% No Yes 2 week wait for breast symptom referrals 96.7% 93.0% 83.9% 95.4% No Yes 31 day wait to first definitive treatment for all cancers 98.5% 96.0% 97.4% 97.6% Yes Yes 31 day wait for subsequent surgery 95.8% 94.0% 96.6% 94.2% Yes Yes 31 day wait for subsequent drug 99.9% 98.0% 100.0% 99.8% Yes Yes 31 day wait for subsequent radiotherapy 96.7% 94.0% 97.5% 96.7% Yes Yes Page 32

33 Cancer waits Threshold Mar Delivered Mar 15 Delivered day wait to first definitive treatment for all cancers 88.2% 85.0% 87.2% 86.0% Yes Yes 62 day wait following screening referral 94.3% 90.0% 97.2% 92.0% Yes Yes Category A ambulance Threshold Mar Delivered Mar 15 Delivered Cat A calls response arriving within 8 minutes - Red 1 Cat A calls response arriving within 8 minutes - Red % 75.0% 73.8% 71.0% No No 69.5% 75.0% 67.6% 62.8% No No Cat A calls ambulance arriving within 19 minutes 92.9% 95.0% 93.9% 91.2% No No Mixed sex accommodation Threshold Mar Delivered Mar 15 Delivered Mixed sex accommodation breaches Yes No Care Programme Approach (CPA) 2013/14 Threshold Mar Delivered Mar 15 Delivered % of people on CPA followed up within 7 days of discharge 96.8% 95.0% 99.0% 96.1% Yes Yes Key PSHFT Peterborough and Stamford Hospitals NHS Foundation Trust Threshold Target QEH Queen Elizabeth Hospital Kings Lynn NHS Foundation Trust CUHFT Cambridge University Hospitals NHS Foundation Trust Hinchingbrooke - Hinchingbrooke Healthcare NHS Trust Each indicator in the Our Performance section is linked to national guidance published by NHS England in the CCG Assurance guidance and technical definitions: Page 33

34 Cambridgeshire and Peterborough Annual Report Indicator Source Description Referral to Treatment (RTT) Waiting Times Unify2 RTT data collection ( Proportion of patients waiting < 18 weeks for elective / planned treatment following referral admitted/nonadmitted and incomplete pathways Diagnostic Waiting Times Proportion of patients waiting < 6 weeks for diagnostic procedure. A&E Waiting Times Daily returns direct from providers unvalidated. Cancer Waiting Times Proportion of patients spending four hours or less in all types of A&E department Proportion of patients being seen within the various waiting time standards for cancer Ambulance Response Performance Monthly performance report from EEAST Proportion of Cat A calls arriving within agreed response time. Mixed Sex Accommodation Breaches Number of patients affected by mixed sex accommodation breach Care Programme Approach Proportion of people on CPA followed up within 7 days of discharge C.difficile Number of incidences of Clostridium difficile MRSA Number of incidences of MRSA Page 34

35 Strategic overview The CCG has strategic focus in all areas of its work. Strategy has been developed and implemented after discussion with our Patient Reference Group (PRG) and other staff and patient groups, as well as local authority representatives. The main strategies are: Two-year operational plan CCGs are required to draw up a two-year operational plan ( to ) which sets out how the local NHS will implement national and regional policy and meet the needs of our population within the financial resources available. In our plan, we gave a commitment to working in an integrated way, putting patients best interests at the heart of decision-making so that we could achieve the best care outcomes for them, their carers and the population as a whole. We set for ourselves an aspiration to commission safe, high quality care and to ensure that care could be provided as much as possible outside of a hospital clinical setting to a clinical setting at or close to the patient s home. Our plan signalled a major shift in the commissioning of care for older people and those who need adult community services through the innovative Older People s Programme. Along with the implementation of the Better Care Fund across the CCG area (which includes part of North Hertfordshire and Northamptonshire), we set out our commitment to increase and improve the integration of services in partnership with Local Authorities and key stakeholders. We also set out an ambitious clinical service transformation agenda which will continue into the financial year Five-year plan In May 2014 the CCG published a five-year plan that was developed with all healthcare partners across the Cambridgeshire and Peterborough healthcare system and ensures that the financial and quality challenges of the next few years are robust, sustainable and deliverable. A System Transformation Programme has been formed to develop the plan further and to design changes to the health system. A refreshed change document is expected to be produced in late summer Better Care Fund In the June 2013 Spending Round, the Government announced the creation of a 3.8bn Better Care Fund (BCF), which is a single pooled budget intended to provide an opportunity to transform health and care so that people receive better integrated care and support. The BCF is an important opportunity to take the integration agenda forward at scale and pace and is a significant catalyst for change. The national BCF conditions include reducing non-elective admissions, protecting social care services, creating more services operating seven days a week to prevent admissions and support timely discharge, improve data sharing between organisations and establishing joint assessments with one accountable lead professional. During the CCG agreed BCF plans with the four local authorities within our geography: Cambridgeshire, Peterborough, Hertfordshire and Northamptonshire. 35 Page

36 Cambridgeshire and Peterborough Annual Report The plans were approved by NHS England in February The BCF plans for include m committed funds for Cambridgeshire and m committed funds for Peterborough. The majority of the Fund has been drawn from the CCG s core allocation. The Better Care Fund Plan and pooled budgets came into full effect in April The two Health and Wellbeing Boards are the accountable bodies for BCF Plan implementation and oversight of the pooled budgets. In Cambridgeshire and in Peterborough, there is an overarching strategic framework in place which includes alignment with existing integration initiatives. These include the joint older people strategy, and Transforming Lives, the new approach to social work for adults and older people in Cambridgeshire and the Older People and Adult Community Services (OPACS) Contract which is a vehicle for major transformation from 1 April The specific service transformation projects that were scoped and agreed as part of the BCFs were as follows: Data Sharing aims to deliver an effective and secure joint approach to data sharing across the whole system, enabling improved co-ordination and integration of services for adults and older people. Seven Day Working aims to expand seven day working to ensure that discharge planning is undertaken according to patient need, not organisational availability. Person-Centred System aims to ensure that care and support are planned and co-ordinated by primary multi-disciplinary teams of professionals working closely with primary care agencies particularly focussing upon people identified as at risk of becoming frail or requiring hospital admission in the future. Information and Communication aims to develop and deliver high quality sources of information and advice based on the individual needs of the population, not on organisational boundaries. Ageing healthily and Prevention aims to develop community-based preventative services to support and enable older people in particular to enjoy long and healthy lives, to feel safe within their communities, thus promoting independence and preventing people from requiring long-term health and social care needs. These projects will be implemented from April 2015 onwards. BCF plans also commit to reducing non-elective admissions by one percent by quarter three in Quality Quality is at the heart of what we do and is woven into everything we undertake. In autumn 2014, we put in place a CCG Quality Promise to support this focus and to be the key driver for quality assurance of commissioned services. The Quality Promise sets out to patients and other stakeholders how we make quality the fundamental building block upon which all services are commissioned and monitored. The CCG s Five Year Strategic Plan articulates the imperative for fundamental change and service redesign across the Cambridgeshire and Peterborough system. Any period of change affords an opportunity to innovate and do things better, and the Page 36

37 Quality Promise ensures quality is the cornerstone of this future development of healthcare services across the whole system in Cambridgeshire and Peterborough. This means that a quality perspective is the backdrop against which all innovation and change will be considered and the lens through which services will be planned, commissioned and evaluated. In essence the Quality Promise will be an explicit driver for change and continuous improvement in service delivery, and the custodian of positive patient experiences. It gives a series of high level statements, backed by explicit requirements expected from current and future providers of healthcare in respect of quality, safety and patient experience. The Quality Promise makes a commitment to patients and the public that the CCG: places patients at the centre of everything, ensuring their voices and experiences as service users and carers are heard when services are being planned, commissioned and evaluated, and act as a driver for service improvement; works in partnership with patients and other stakeholders to facilitate whole system seamless working which transcends organisational and professional boundaries to achieve improved patient outcomes; drives a culture of learning and continuous improvement, engages with clinical staff, makes best possible use of technology and data to improve patient safety and experience; and enhances the adoption and spread of evidence based practice; oversees the implementation of recommendations from Francis, other national reports, and the Dignity and Compassionate Care requirements set out in the national nursing strategy to include improving communication, care, compassion, courage to challenge, competency and commitment to make this happen; and supports providers to develop a well-trained, appropriately resourced, responsive workforce to deliver the right care, in the right place, at the right time. During , we have worked with our providers to implement the Quality Promise and drive quality improvement. We have used a range of quality assurance mechanisms including monthly clinical quality reviews and meetings, announced and unannounced visits, themed reviews and deep dives, monitoring of serious incidents and learning, triangulation of intelligence and partnership working with other commissioners of services and national regulators. These not only ensure that an early warning of potential system failure is in place to prevent compromising patient care and to prevent and resolve quality issues, but also to promote improvement through sharing of best practice and learning across the health economy. The monitoring of serious incidents includes managing the learning from any Never Events in our health economy. Never Events are serious incidents that are wholly preventable as guidance or safety recommendations that provide strong systemic protective barriers are available at a national level and should have been implemented by all healthcare providers. During five Never Events were reported relating to CCG patients; two wrong implants, two retained foreign objects 37 Page

38 Cambridgeshire and Peterborough Annual Report and one wrong site surgery. Learning has been identified and implemented from each of these events to prevent recurrence, and has been shared with all relevant providers. New quality initiatives implemented in include: Embedding systems and processes to support the reduction of Clostridium difficile to an irreducible minimum in hospital settings, and piloting this approach in primary care Developing support for GP practices to further enhance safeguarding children Introducing a contract for our Continuing Health Care patients in care homes with a set of quality indicators which will further develop the provision of good quality care in this setting Continuing to work across the health and social care system through a Quality Network and Health Executive for safeguarding adults and children to continuously improve quality of care and safeguard the vulnerable in our population Embraced the national Sign Up to Safety scheme, pledging to take forward a range of actions for improvement, and ensuring providers also take forward action plans for the initiative. The presentation of quality intelligence to the CCG and LCGs has been developed to ensure each LCG has the key information relating to the quality of provider services relevant to their population, and the actions being taken to address any concerns. This provides assurance to the LCG Boards that quality issues are monitored and addressed, and highlights any areas where local action is required or further information is required. The main focus of all the work we do with providers of healthcare is to ensure excellent outcomes for the population of Cambridgeshire and Peterborough and drive continuous improvement informed by patient and carers needs and experiences. Emergency planning, resilience and response Cambridgeshire and Peterborough CCG is a Category 2 Responder under the Civil Contingencies Act. The Accountable Emergency Officer and sponsor of the Incident Response Plan is the Director of Corporate Affairs, whilst the owner of the Plan is the CCG Secretary. Routine responsibility for ensuring the Incident Response Plan is up to date and fit for purpose rests with the CCG s Emergency Preparedness, Resilience and Response sub-group, which reports to the Clinical and Management Executive Team. Our role and responsibilities under the Civil Contingency Act are to: co-ordinate a local NHS response to a Major Incident; be accountable to the NHS England Local Area Team; be a member of the Local Health Resilience Group; develop a Command and Control structure that allows appropriate linkages to, membership of, communication with and other responses to local resilience arrangements including strategic, tactical and operational commands Page 38

39 implement national policy and guidance in a local context; demonstrate high level of preparedness of Out of Hours care and community services and ensure that they can respond at any time; mobilise community care resources to support acute trusts and non-acute trusts; ensure that CCG staff, Out of Hours staff and community care staff are appropriately trained and competent to plan for and to respond to a major incident with the induction process for staff including both general and specific guidance on planning and responding to major incidents; ensure that the CCG s escalation plans for dealing with pressures recognise the higher-level requirements of a major incident; develop contingency plans for business continuity in the event of a protracted incident; ensure the resilience of its own estate, facilities and systems; establish and maintain working relationships with other emergency services, local major organisations and other key stakeholders; train and exercise in conjunction with local NHS partners and external multiagency partners to an agreed schedule with the Cambridgeshire and Peterborough Local Resilience Forum (CPLRF); take into account the needs of vulnerable groups of patients. This is particularly important in the event of a sustained major incident participate in Local and Regional Resilience Emergency Planning Fora; and maintain, test and review internal capacity and emergency plans. This Incident Response Plan sets out the process by which Cambridgeshire and Peterborough Clinical Commissioning Group will respond to, manage and recover from a major incident. This Incident Response Plan has been approved by the CCG Governing Body and will be reviewed by the CCG Emergency Preparedness, Resilience and Response Sub-Group on an annual basis or the identification of amendments following a major incident, a test/exercise of the Plan or national, regional or local guidance. In addition, the CCG has an approved Business Continuity Plan, which complements the Incident Response Plan. The CCG undertook a self-assessment process against the NHS England Emergency Preparedness, Resilience and Response (EPRR) Core Standards for Following peer review across the Cambridgeshire and Peterborough Health System, the CCG was able to declare Full Compliance against the Core Standards for This was endorsed by the Local Health Resilience Partnership. 39 Page

40 Cambridgeshire and Peterborough Annual Report Better payment Public Sector Payment Policy (CBI Better Payment Practice Code) The CCG along with all NHS and public sector organisations aims to pay a minimum of 95% of valid invoices by the due date, or within 30 days of receipt, whichever is the later. The table below shows that for this was achieved for non NHS organisations in terms of the number of invoices, although was below this for value due to a small number of larger accounts which were over the 30 days. For NHS organisations this is reversed; almost all invoices in terms of value were paid within the 30 days, however in terms of the numbers of invoices, the percentage was below 95% due to small value Non Contractual Activity accounts which take extra validation time (as was the same in the comparison). Better Better Payment Payment Practice Practice Code Code measure measure of compliance of compliance Number Number 000 s 000 s Number Number 000 s 000 s - Non - Non NHS NHS Creditors Creditors Total Total bills bills paid paid in year in year 22,498 22, , ,58918,059 18, , ,460 Total Total bills bills paid paid within within target target 22,010 22, , ,41517,612 17, , ,381 Percentage Percentage of bills of bills paid paid within within target target 97.83% 97.83% 86.75% 86.75% 97.52% 97.52% 97.99% 97.99% NHS NHS Creditors Creditors Total Total bills bills paid paid in year in year 3,967 3, , ,8213,140 3, , ,887 Total Total bills bills paid paid within within target target 3,057 3, , ,7692,517 2, , ,258 Percentage Percentage of bills of bills paid paid within within target target 77.06% 77.06% 99.37% 99.37% 80.16% 80.16% 97.51% 97.51% Risk management As set out in our Annual Governance Statement, risk management within the CCG is demonstrated by: Adopting an integrated approach to risk management, whether the risk relates to clinical, organisational, health and safety or financial risk, through the processes and structures detailed in the CCG s Risk Management Policy Managing risk as part of the routine line management responsibilities and consideration of funding to address risk issues (based on a risk assessment) as part of the normal business planning process Undertaking risk assessments on existing, new and proposed activities to ensure that: significant risks are identified in accordance with the Risk Management Policy which provides full details on what constitutes a hazard or risk, how it should be identified and assessed; assessments are made of their potential frequency and severity; control measures are implemented in accordance with the Risk Management Policy; risks are always assessed, and reduced or minimised where possible; Page 40

41 strategic risks are recorded on the CCG Assurance Framework (CAF) in line with the Risk Scoring Matrix; high risks are required to have a detailed action plan which is managed by the Senior Risk Owner and overseen by the relevant Sub-Committee of the Governing Body and; risks are recorded on the LCG Risk Registers, Service Performance Review Risk Registers and Programme Board Risk Registers. These are escalated as appropriate. Sustainability During Authorisation, the shadow CCG committed to a number of principles to support the Sustainability agenda. These were: Developing local understanding of the Sustainability agenda by measuring the environmental impacts of the organisation s activities and assessing the potential impact of environmental change on future care needs and services Empowering staff to take responsibility for reducing the environmental impact of their own activities. This will be taken forward through the Good Corporate Citizen Model and Self-Assessment Actively exploit the synergies between environmental sustainability and other objectives. For example, by identifying changes that may bring health or financial benefits as well as environmental ones, linking to financial sustainability Exploring the opportunities presented by new technologies such as telehealth and telecare, and by the use of new technologies in managing the core business of the CCG Improving medicines management and prescribing practices to reduce inefficient wasteful use of pharmaceuticals Commissioning services that will support sustainable practices in service providers and the supply chain. Promoting the importance of using contractual levers with our main providers to encourage/incentivise change Engaging with patients and the public to build wider support for environmentally sustainable approaches to delivering care. To underpin these principles, we have undertaken a number of initiatives including: Development of a new Procurement Strategy which supports principles around sustainability Development of Accommodation Principles to support sustainability Implementation of new technology to reduce staff travel and MOT Your Travel initiative Development and harmonisation of a number of key HR policies which support the Sustainability Agenda, including Flexible Working, Home Working and Travel to Work Continued membership on the Cambridgeshire Travel to Work Steering Group hosted by Cambridgeshire County Council 41 Page

42 Cambridgeshire and Peterborough Annual Report Approval of the Information and Communication Technology (ICT) Strategy to introduce new technologies to improve efficiencies Move to a new and more sustainable building in Peterborough Engagement with patients and the public around the Older People s Programme which will look at resources across time, place and person in a way that maximises sustainability and reduces inequalities The CCG and Local Authorities are taking forward the development and expansion of TeleHealth and Telecare through the Better Care Fund We now have an approved Sustainability Strategy and Sustainable Delivery Action Plan which is monitored by the Accommodation and Sustainability Working Group. We have also identified a Governing Body Champion, the Chief Finance Officer. Accommodation occupied by the CCG The CCG operates a Hub and Spoke model with our headquarters, Lockton House (Hub) and office facilities (Spokes) in each of the LCG / System Areas: Lockton House, Cambridge (Corporate / Cam Health and CATCH LCGs) City Care Centre, Peterborough (Corporate / Borderline and Peterborough LCGs) Pathfinder House, Huntingdon (Hunts Health and Hunts Care Partners LCGs / Corporate) Exchange Tower, Wisbech (Isle of Ely and Wisbech LCGs) Doddington Community Hospital (Isle of Ely and Wisbech LCGs) Queen Street, Whittlesey (Borderline LCG). To support this we operate a number of flexible working arrangements including: Open plan where possible Hot-desking within zoned areas where appropriate Fixed workstations where appropriate Confidential offices where appropriate to meet the needs of Patient Experience Team (PET), Exceptional Cases, Continuing Care and other teams whose work is of a sensitive or confidential nature Touch-down facilities and home working. Equality and Diversity During the year the Cambridgeshire and Peterborough CCG introduced the CCG s Equality and Diversity Strategy, which demonstrates the commitment to promote equality and value the diversity of our staff and service users. The Equality and Diversity Strategy and its improvement plan aim to improve the way the CCG commissions services from other NHS organisations. The CCG works with service providers and the Local Commissioning Groups to improve the health of its local community by assessing what the health needs are and providing and developing services that respond to those needs. Page 42

43 The Equality and Diversity Strategy sets out how the CCG will meet its equality duties as set out in the Equality Act The Strategy has been developed to not only meet statutory requirements, but to achieve its aims to embed the principles of the Equality Act 2010 throughout the CCG, LCGs and services. The Equality and Diversity System (EDS) requires NHS organisations to work against four goals: Better health outcomes for all Improved patient access and experience Empowered, engaged and well-supported staff Inclusive leadership at all levels. These are aligned with the Care Quality Commission (CQC) Essential Standards and the NHS Constitution. Year on year, progress will be made to achieve the long term objectives though the development and review of the CCG s equality objectives. The equality objectives for are: To work with stakeholders to ensure inclusion and engagement with all groups of the community in the planning and commissioning of services To work with protected and disadvantaged groups to identify specific needs in order to ensure patients are aware of services available, thereby eliminating any inequalities and improving access and experience A requirement to provide mandatory Equality and Diversity (E&D) training for all staff at all levels, including provider organisations To ensure that equality is everyone s business by embedding the competency framework throughout the organisation to support improved equality in health outcomes and workforce diversity. The Health and Social Care Act 2012 states that each CCG must act in such a way as to reduce inequalities between patients with respect to their ability to access health services and reduce inequalities between patients with respect to their health outcomes. The Equality Act 2010 contains special provisions for public sector bodies, known as the Public Sector Equality Duty (PSED). This is made up of a general duty and specific duties which are intended to help performance of the general duty. The general duties are to: Eliminate unlawful discrimination, harassment, victimisation and any other conduct prohibited by the Equality Act 2010 Advance equality of opportunity between people who share a protected characteristic and people who do not share it Foster good relations between people who share a protected characteristic and people who do not share it. 43 Page

44 Cambridgeshire and Peterborough Annual Report Where we are now In March 2015, the CCG held its annual regional grading event with stakeholders from both Cambridgeshire and Peterborough. The Equality Delivery System (EDS) grading process allows us to undertake a thorough review of our practices and processes through the collection of evidence on a range of fronts including engagement, commissioning, service delivery and employment. The grading is: Red (Undeveloped): People from all protected groups fare poorly compared with people overall OR evidence is not available Amber (Developing): People from only some protected groups fare as well as people overall Green (Achieving): People from most protected groups fare as well as people overall Purple (Excelling): People from all protected groups fare as well as people overall. The CCG presented its objectives incorporating the eight EDS outcomes to the panel. The panel was asked to take into account the grading we had given ourselves and, based on our evidence, either to agree or disagree with our own rating. The stakeholder panel members agreed that good progress had been made to embed the process in all CCG business activity. However more effort is required in terms of engagement and analysis of data of all protected characteristics groups. Based on the outcomes, the CCG was rated Amber. A more detailed Equality and Diversity Annual Report will be published shortly to demonstrate our achievements during the year Cambridgeshire and Peterborough CCG is dedicated to developing an organisational culture that promotes inclusion and embraces diversity ensuring that the focus on equality is maintained and strengthened across the local NHS during the year Accountable Officer: Organisation: Signature: Dr Neil Modha NHS Cambridgeshire and Peterborough CCG Date: 28 May 2015 Page 44

45 Members report This section outlines the infrastructure of NHS Cambridgeshire and Peterborough Clinical Commissioning Group (CCG); who our practice members are and our Governing Body members; what is the environment in which the CCG functions; and how we involve and support our staff. (This is not the Member s Statement on page two of the report). The environment The CCG is one of the largest CCGs in the country and covers a population of over 913,462 people (January 2015 registered patient population data). It has structured itself into eight Local Commissioning Groups (LCGs) so that local clinicians can commission for local need. The CCG spans diverse communities with over 100 languages spoken and contains areas of great affluence as well as areas with much deprivation. There are major urban centres but the area is predominantly rural. Member practices Practice Bretton Medical Practice Hampton Heath Jenner Health Centre Nene Valley Medical Practice New Queen Street surgery Old Fletton practice Oundle Surgery, Northamptonshire Thorney Medical Practice Wansford Surgery, Northants Yaxley Group Practice Bottisham surgery Bridge street surgery Cherry Hinton and Brookfields Medical Practice Dr Gant & Partners, Arbury road East Barnwell Health Centre Firs House surgery, Histon Milton surgery Newnham Walk surgery Nuffield Road Medical Centre Barley surgery, Herts Bourn Surgery LCG Borderline Borderline Borderline Borderline Borderline Borderline Borderline Borderline Borderline Borderline Cam Health Cam Health Cam Health Cam Health Cam Health Cam Health Cam Health Cam Health Cam Health CATCH CATCH 45 Page

46 Cambridgeshire and Peterborough Annual Report Practice Cambridge Access Centre Comberton surgery Cornford House surgery Cottenham surgery Harston surgery Huntingdon Road Surgery Lensfield Medical Practice Linton Health Centre Maple Surgery, Bar Hill Mill Road Surgery Monkfield Medical Practice, Cambourne Orchard surgery, Melbourn Over Surgery Petersfield Medical Practice Queen Edith's Medical Practice Red House Surgery Roysia surgery, Herts Royston Medical Centre, Herts Sawston Medical Centre Shelford Medical Practice Swavesey Surgery Trumpington Street Medical Practice Waterbeach Surgery Willingham Medical Practice Woodlands Surgery York Street Medical Practice Alconbury & Brampton Surgeries Almond road Surgery Buckden and Little Paxton Surgery Cedar House Surgery, St Neots Church Street Health Centre, Somersham Cornerstone Practice, March Cromwell Place Surgery Mercheford house Surgery Moat House Surgery, Warboys Northcote House & Fenstanton surgeries Orchard road, St. Ives Practice Parkhall Surgery, Somersham Page Ramsey 46 Health Centre Riverside Practice, March LCG CATCH CATCH CATCH CATCH CATCH CATCH CATCH CATCH CATCH CATCH CATCH CATCH CATCH CATCH CATCH CATCH CATCH CATCH CATCH CATCH CATCH CATCH CATCH CATCH CATCH CATCH Hunts Care Partners Hunts Care Partners Hunts Care Partners Hunts Care Partners Hunts Care Partners Hunts Care Partners Hunts Care Partners Hunts Care Partners Hunts Care Partners Hunts Care Partners Hunts Care Partners LCG Hunts Care Partners Hunts Care Partners Hunts Care Partners

47 Practice Parkhall Surgery, Somersham Ramsey Health Centre Riverside Practice, March Spinney Surgery, St Ives St Neots Health Centre Wellside Surgery, Sawtry Acorn Surgery, Huntingdon Charles Hicks Eaton Socon Health Centre Great Staughton Surgery Kimbolton Medical Centre Old Exchange Surgery Papworth Surgery Priory Fields Surgery Rainbow Surgery Burwell Surgery Cathedral Medical Centre Doddington Medical Centre George Clare surgery, Chatteris Haddenham Surgery St George s Medical Centre, Littleport Manea Surgery Priors Field, Sutton St. Mary's Surgery Staploe Medical Centre, Soham Ailsworth Medical Practice Boltolph Bridge Bushfield Medical Practice Burghley Road Surgery Dogsthorpe Medical Centre Grange Medical Practice Hodgson Centre Surgery Huntly Grove LCG Hunts Care Partners Hunts Care Partners Hunts Care Partners Hunts Care Partners Hunts Care Partners Hunts Care Partners Hunts Health Hunts Health Hunts Health Hunts Health Hunts Health Hunts Health Hunts Health Hunts Health Hunts Health Isle of Ely Isle of Ely Isle of Ely Isle of Ely Isle of Ely Isle of Ely Isle of Ely Isle of Ely Isle of Ely Isle of Ely Peterborough Peterborough Peterborough Peterborough Peterborough Peterborough Peterborough Peterborough 47 Page

48 Cambridgeshire and Peterborough Annual Report Lincoln Road (from 1 April 2015, joint with North Street as Boroughbury Practice) Millfield Medical Centre Minster Medical Practice North street medical practice (from 1 April 2015, joint with Lincoln Road as Boroughbury Practice) Park Medical Centre Parnwell Medical Centre Paston Health Centre Thistlemoor Road Surgery Thomas Walker Surgery Thorpe Road surgery Welland Medical Practice Westgate Surgery Westwood clinic Clarkson Surgery North Brink Practice Parson Drove Surgery Trinity Surgery Peterborough Peterborough Peterborough Peterborough Peterborough Peterborough Peterborough Peterborough Peterborough Peterborough Peterborough Peterborough Peterborough Wisbech Wisbech Wisbech Wisbech Complaints handling Cambridgeshire and Peterborough CCG aims to commission a high standard of patient care and services that are flexible and responsive to the needs of patients and service users. The services which we commission take into account patient insight and experience, ensuring that we get it right first time and meet people s needs with effective patient pathways. We are aware that this will not be without its challenges but it is one in which we are committed to investing time and resources. By understanding and responding to public concerns, we are able to define needs and identify priorities which will lead to a clearer understanding of our investment decisions and enable us to explain any service changes. Under the NHS Complaints Regulations which came into effect on 1 April 2009, patients and the public can complain to Cambridgeshire and Peterborough Clinical Commissioning Group as commissioner, if they do not wish to complain directly to the service provider. Where this right is exercised, we will work with the complainant and the provider to achieve resolution and to identify any necessary service improvements and learning outcomes. Our complaints policy and procedure reflects the best practice principles for complaints handling promoted by the Parliamentary and Health Service Ombudsman Page 48

49 (Principles for Remedy, Principles of Good Complaint Handling and Principles of Good Administration). In accordance with the Principles for Remedy, we place a strong emphasis upon putting things right, ensuring continuous improvement and learning from complaints. Our Patient Experience Team (PET) can assist with any aspect of the NHS complaints process and provide help, information and advice to patients and the public in relation to local health services. We use concerns and complaints as a valuable source of information about the experiences of our patients, which in turn assists in identifying any trends which enables us to improve the services that we commission. The PET provides support to patients, carers, members of the public and staff. We help to resolve queries and concerns quickly and efficiently with a view to improving the outcome of care in the process and providing information to ensure that contact is as easy as possible. The PET also provides support with a range of issues, enquiries, concerns and complaints and uses the intelligence gained from these sources as a means by which the patient experience can be monitored and used as an indicator of the quality of care and services that we commission. As part of the Quality Directorate, PET works closely with the CCG s Performance and Contracting colleagues, highlighting any issues regarding service quality and performance. This ensures crucial patient feedback is captured and taken forward resulting in appropriate service improvements. The PET also works closely with the CCG s Communications and Engagement team to ensure consistency in information which needs to be passed to our service users. Patient Experience Annual Activity Cambridgeshire & Peterborough and Peterborough CCG CCG Chart showing total Total number No of Contacts of contacts per per Service: service: 1 April to March 2015 Fig. 1 16% (n=218) 31% (n=406) C&P CCG Commissioned Services Primary Care 53% (n=691) For the period 1 April 2014 to 31 March 2015, PET dealt with a total of 1315 contacts, which is an increase of 450 when compared to the previous year (861 in ). The Chart at Fig. 1 (above) illustrates that 31 percent of contacts related to issues which required a direct response from the CCG, 53 percent were issues raised in 49 Page

50 Cambridgeshire and Peterborough Annual Report relation to services commissioned by the CCG and 16 percent of contacts related to issues pertaining to services provided by our primary care colleagues. In line with the NHS Complaints process, enquirers were advised and signposted to the relevant agencies where appropriate. Where the CCG was required to provide a direct response, all correspondence was logged, details noted, and an investigation carried out in line with the CCG s policy. An example of where the CCG has used patient feedback to improve services was when the PET received concerns about its policy for prescribing for coeliac disease sufferers; units allowed and items provided on prescription. The CCG listened to suggestions from various sources and reviewed its policy to provide for additional products which would enable patients to have an assortment of foods on prescription. The CCG has recently revised its policy for the management of complaints and concerns to demonstrate its commitment to ensuring that any issues which come to us are appropriately investigated. We appreciate that we are not always in a position to share good news but, where possible, we always aim to be open and honest in our communication. Listening to patients enables us to create a culture of being open, learning from mistakes and putting things right. Employee consultation The CCG continues to consult regularly with staff and their representatives on all matters that affect their employment and their wellbeing whilst at work. In addition to the quarterly Joint Consultative and Negotiating Partnership meetings the CCG has established a Health, Safety and Wellbeing Forum which has membership that includes CCG staff, their representatives and CCG Managers. The Trade Union Recognition Agreement which was ratified on 2 October 2013 has remained in force. The CCG has developed robust internal mechanisms for formally consulting and engaging with staff which has included a set of CCG template documents and a clear Organisational Change Policy and Procedure. All new staff attend an induction programme and there are regular staff briefing and manager briefing sessions. The Staff Development Day has now become an annual event and in 2014 there was a greater emphasis on development with the CCG learning together as a whole organisation. As part of the CCG s commissioning strategy the CCG has created a Social Partnership Forum which meets regularly to review the impact of commissioning and procurement activity on staff and organisations in the Cambridgeshire and Peterborough Health system. The Communications team, and the Organisational Development (OD) and Human Resources (HR) teams, continue to work closely together to ensure that CCG staff and key stakeholders are kept informed of any changes that affect them and to ensure their needs and points of view are taken into account. Page 50

51 This year the CCG took part in the NHS Staff Survey and work is currently being undertaken to understand the detail of the results and to create a CCG Improvement Plan which will include a CCG People Management Strategy. Employees with a disability The CCG is committed to the NHS Equality Delivery System and has continued to work through its improvement plan. Statistics about protected characteristics are collected and continue to be reported quarterly to the CCG Remuneration and Terms and Conditions HR Sub Committee. There is a well established Equality and Diversity Steering Group which monitors application of the policy. Recruitment practices are continuously reviewed through the Recruitment Steering Group. The training of managers involved in the recruitment of staff continues and now all interview panels will have at least one member who is trained in the equalities aspects. A managers induction is being implemented and this will ensure line managers are aware of their duties in this respect. The CCG works closely with the Occupational Health Service to ensure that we are responsive to the needs of employees with disabilities and to make reasonable adjustments to their work as required. The CCG continues to display the Two Ticks Positive About Disabled People award for the CCG s commitment to supporting employees with a disability and to offer an interview to applicants who meet the essential criteria for a job and have informed us they have a disability. The CCG is a member of the Mindful Employer Charter and displays the logo in recruitment to demonstrate it is positive about mental health. The CCG s Health, Safety and Wellbeing Forum is developing an employee strategy to improve the welfare of all employees. A programme of regular events is also being established. The CCG recognises its duty to provide a healthy work environment and to promote healthy lifestyle choices amongst staff. Equal opportunities The CCG has a comprehensive range of employment equality policies, procedures and practices in place including an equal opportunities policy which are aimed at producing a diverse workforce. The CCG has worked with the NHS Equality Delivery System and has an Equality and Diversity Improvement Plan which is monitored and updated. There is an Equality and Diversity Steering Group which meets regularly and is chaired by the Chief Clinical Officer. This group ensures the CCG s compliance with all aspects of the Equality Act During the Workforce Race Equality Standard will be implemented. Devised by the Equality and Diversity Council (EDC) this standard will collect data about the CCG in such a way as to commence the process of addressing workforce equality issues by demonstrating progress against a number of indicators. 51 Page

52 Cambridgeshire and Peterborough Annual Report Equality and diversity training is mandatory for all staff and training available includes a half day awareness course, online training, and awareness raising at corporate induction. Equality impact assessments are undertaken for all our plans, policies and business cases. CCG Gender distribution as at March Category Distribution (by number) Female Male Members of the Governing Body 9 16 All other senior managers (including all 4 2 managers at grade VSM not included above) All other employees (not included in either category above) Pension liabilities 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 Further detail can be found at note 4.5 in the Annual Accounts and specific disclosures with respect to Pensions are included in the Remuneration Report. These can be obtained from Tim Woods, Chief Finance Officer, Lockton House, Clarendon Road, Cambridge CB2 8FH. Sickness absence The CCG continues to report below average sickness figures. The total cost of this to the CCG in terms of money paid for time spent absent is 168,170. Staff sickness absence and ill health retirements (note 4.3 from the full accounts) Number Number Total Days Lost 999 1,380 Total Staff Years Average working Days Lost Although this is still comparing relatively favourably with the rest of the NHS, where the national average is four percent, there is still room for improvement. The OD and HR Team monitors and reports sickness absence monthly to managers and quarterly through the Workforce Report to both the Clinical Management Executive Team and the Remuneration and Terms of Service Committee. Page 52

53 Managers are actively encouraged to manage both long term and short term sickness absence, to promote the use of return to work interviews and, where relevant, the creation of compassionate exit strategies. Wellbeing at work is actively promoted by CCG Safety Awareness Weeks and the availability of a confidential wellbeing support service provided by Insight. The service offers support to individual staff members through a range of interventions and advice to managers on options that are available to support their staff. More recently the CCG has promoted the availability of IAPT self-referral services. External audit The CCG s external auditors are PricewaterhouseCoopers LLP (PwC). Their fees, for the statutory audit totalled 118,000, plus an additional charge for of 15,116. In line with the Audit Commission s guidance, this fee is arrived at in relation to the audit risks profile of the CCG and is at a comparable level to PwC was also during this year appointed by Monitor, NHS England and the Trust Development Authority (TDA) to look at a separate piece of work due to Cambridgeshire and Peterborough being identified as one of the 11 health economies facing challenges. The CCG has made sure that the policy for auditor s independence has not been compromised. Each individual who is a member of the Governing Body at the time the Members Report is approved, confirms: So far as the Governing Body members are aware, that there is no relevant audit information of which the CCG s external auditor is unaware That the members have taken all the steps they ought to have taken as a member in order to make them self aware of any relevant audit information and to establish that the CCG s auditor is aware of that information. Finally, the CCG has been informed by the Audit Commission that for the next audit period, the organisation s External Auditors will be Ernst & Young LLP. This follows a detailed selection process undertaken by the Audit Commission and we look forward to working with the new team from 1 April We also thank members from PWC who have undertaken this role for the first two years of the CCG s existence. Our Governing Body members Name Title Member of Governing Body Sub Committees Maureen Donnelly Lay Chair Chair, Remuneration and Terms of Service Committee, Finance and Performance, Patient Safety and Quality Committee 53 Page

54 Cambridgeshire and Peterborough Annual Report Glen Clark Lay Member Chair Audit Committee, Chair Service Performance Framework Review Group, Remuneration and Terms of Service Committee Rebecca Stephens Lay Member Chair Patient Safety and Quality Committee, Chair Patient Reference Group, Audit Committee, Remuneration and Terms of Service Committee Edward Libbey (to June 2014) Lay Member Chair Finance and Performance Committee, Audit Committee, Remuneration and Terms of Service Committee Christopher Boden (from December 2014) Dr Neil Modha Dr Geraldine Linehan (to 31 March 2015) Dr Simon Brown (from April 2014) Dr Mark Brookes (from April 2014) Dr John Jones Dr David Irwin Dr Andrew Wordsworth (from April 2014) Lay Member Chief Clinical Officer Vice-Chair GP Member CATCH GP Member Hunts Health GP Member Cam Health GP Member Isle of Ely GP Member Hunts Care Partners GP Member Wisbech LCG Chair Finance and Performance Committee, Audit Committee, Remuneration and Terms of Service Committee Chair, Clinical and Management Executive Team, Strategic Clinical and Management Team, Finance and Performance Committee, Remuneration and Terms of Service Committee, Service Performance Framework Review Group Chair Strategic Clinical Prioritisation Group, Audit Committee, Remuneration and Terms of Service Committee, CATCH LCG, Clinical and Management Executive Team, Strategic Clinical and Management Executive Team Hunts Health LCG, Patient Reference Group (Pool), Strategic Clinical and Management Executive Team Cam Health LCG, Patient Reference Group (Pool), Strategic Clinical and Executive Management Team, Finance and Performance Committee Chair Isle of Ely LCG, Patient Safety and Quality Committee, Patient Reference Group (Pool), Strategic Clinical and Management Executive Team, Audit Committee (Pool) Deputy-Chair Finance and Performance Sub-Committee, Remuneration and Terms of Service Committee, Audit Committee, Hunts Care Partners LCG, Strategic Clinical and Management Executive Team Chair Wisbech LCG, Finance and Performance Committee, Strategic Clinical and Management Executive Team Page 54

55 Dr Michael Caskey Dr Richard Withers (to August 2014) Dr Gary Howsam (from September 2014) GP Member Peterborough LCG GP Member Borderline LCG GP Member Borderline LCG Chair Peterborough LCG, Strategic Clinical and Management Executive Team Chair Borderline LCG, Deputy-Chair - Patient Safety and Quality Committee, Strategic Clinical and Management Executive Team Chair Borderline LCG, Strategic Clinical and Management Executive Team Dr Christopher Scrase Jill Houghton Tim Woods Andy Vowles Tracy Dowling (from January 2015) Dr Liz Robin Secondary Care Doctor Member Executive Nurse Member Director of Quality Chief Finance Officer Chief Operating Officer (to Dec 2014) Chief Strategy Officer (from July 2014) Chief Operating Officer Co-opted Director of Public Health Cambridgeshire (and Peterborough from March 2015) Remuneration and Terms of Service Committee, Patient Safety and Quality Committee, Strategic Clinical Prioritisation Group, Strategic Clinical and Management Executive Team Patient Safety and Quality Committee, Strategic Clinical Prioritisation Group, Clinical and Management Executive Team, Strategic Clinical and Executive Management Team, Finance and Performance Committee Finance and Performance Committee, Strategic Clinical Prioritisation Group, Clinical and Management Executive Team, Strategic Clinical and Executive Management Team, Audit Committee (In attendance) Finance and Performance Committee, Patient Safety and Quality Committee, Remuneration and Terms of Service Committee, Service Performance Review Group, Clinical and Management Executive Team, Strategic Clinical and Management Executive Team Finance and Performance Committee, Patient Safety and Quality Committee, Remuneration and Terms of Service Committee, Service Performance Review Group, Clinical and Management Executive Team, Strategic Clinical and Management Executive Team Strategic Clinical Prioritisation Group 55 Page

56 Cambridgeshire and Peterborough Annual Report Co-opted members (with speaking but not voting rights) Name Title Member of Governing Body Sub Committees Jessica Bawden Harper Brown (to October 2014) Sarah Shuttlewood Director of Corporate Affairs Director of Contracting and Commissioning Acting Director of Performance and Delivery In attendance (with speaking rights) Patient Reference Group, Deputy Chair - Service Performance Review Group, Clinical and Management Executive Team, Strategic Clinical and Management Executive Team Finance and Performance Committee, Strategic Clinical Prioritisation Group, Clinical and Management Executive Team, Strategic Clinical and Management Executive Team Patient Safety and Quality Committee, Finance and Performance Committee, Clinical and Management Executive Team, Strategic Clinical and Management Executive Team Sharon Fox CCG Secretary Secretary to Audit Committee, Patient Safety and Quality Committee, Finance and Performance Committee, Strategic Clinical Prioritisation Group, Patient Reference Group, Remuneration and Terms of Service Committee, Service Performance Review Group, Clinical and Management Executive Team, Strategic Clinical and Executive Management Team A short biography of each member of the Governing Body is available on the CCG s website: Declarations of interest In line with our Conflicts of Interest Policy, a Register of Interests is maintained and can be viewed on our website or on request by contacting our CCG Secretary on Governing Body members who hold a Company Directorship with companies which are likely to do business or seek (or may seek) to do business with the NHS are set out below: Name Title Declaration of Interest Maureen Donnelly Lay Chair Partner Governor at Cambridge University Hospitals NHS Foundation Trust Page 56

57 Glen Clark Lay Member Directorships: Marshall of Cambridge Aerospace Ltd Marshall of Cambridge (Engineering) Aeropeople Ltd Marshall Aerospace U.S Inc. Marshall Aerospace Netherlands B.V. Marshall Aerospace Canada Inc. Marshall Aerospace Australia Pty Ltd AeroAcademy Ltd Slingsby Aerospace Ltd Slingsby Aviation Ltd Slingsby Ltd Slingsby Advanced Composites Ltd Slingsby Holdings Ltd Marshall Land Systems Ltd Marshall Specialist Vehicles Ltd LifTow Ltd Marshall Aviation Services Ltd Flairjet Ltd Lorica Systems UK Ltd Marshall Aircraft Sales Ltd Rebecca Stephens Lay Member Owner/Director Syntax Communications Ltd Member Cambridgeshire and Peterborough NHS Foundation Trust Partner Governor of Peterborough and Stamford Hospitals NHS Foundation Trust Non-Executive Director Cambridgeshire and Peterborough Probation Trust Occasionally contracted to do work by Greater Peterborough Partnership Edward Libbey (to June 2014) Christopher Boden (From December 2014) Lay Member Lay Member Department of Health Legacy Team (Audit Chair of both Cambridgeshire PCT and Peterborough PCT as well as Norfolk PCT and Waveney PCT for three months April 2014 to June 2014) Chairman World Energy Solutions (a US Corporation) Director Edward Libbey Consultants Ltd (Coowned with Dianne Libbey) Director The British Institute of Energy Economics Director Numismay Ltd Director Cabsaver Management Ltd Member of City of London Corporation Member of the Conservative Party 57 Page

58 Cambridgeshire and Peterborough Annual Report Dr Neil Modha Dr Geraldine Linehan (to 31 March 2015) Dr Simon Brown (from April 2014) Chief Clinical Officer Vice-Chair of Governing Body GP Member CATCH LCG GP Member Hunts Health GP Partner Thistlemoor Medical Centre (Family (Parents) Partners at Thistlemoor Medical Centre) Thistlemoor Healthcare and Management Secretary Graham Young Chemist, Secretary (Parents Directors of Thistlemoor Healthcare and Management) (Parents Graham Young Chemist) Primary Care Research Centre (Receipt of funding/grants) Dr Emma Hamilton Salaried GP Market Deeping Non-principal at Woodlands Surgery, Station Road Cambridge Holds a small number of shares in CAMDOC Member of Steering Group for Research Application Board, PCT, University of Cambridge and CATCH Commissioning Evaluation Project Previously involved in joint application for research bid between RAND, University of Cambridge and NHS Cambridgeshire may take part in further research applications Member of Local Medical Committee Partner The Old Exchange Surgery, East Street, St Ives Dr Mark Brookes (from April 2014) GP Member CamHealth GP Partner, Nuffield Road Medical Centre Friends and relations who work at CUHFT Recently received grant from the Health Foundation for a project on which I am working with staff from CUHFT Dr John Jones GP Member Isle of Ely LCG Senior Partner, Staploe Medical Centre Director and Shareholder, Eagletie Limited (which owns the pharmacy operating from Staploe Medical Centre) Director and Shareholder, Eaglebond Limited Director and Shareholder, Staploe Medical Services Limited Company Secretary, Cambridge Informatics Limited Director, DDWS Limited Page 58

59 Dr David Irwin Dr Andrew Wordsworth (from April 2014) Dr Michael Caskey GP Member Hunts Care Partners LCG GP Member Wisbech LCG GP Member Peterborough LCG Dr Richard Withers (to GP Member August 2014) Borderline LCG General Practice senior partner of Buckden and Little Paxton surgeries Partner of Dermatology Clinic Community Service Ltd (DCCSL) Son employed by Cambridgeshire and Peterborough CCG GP, Trinity Surgery, Wisbech Child Protection Lead Diabetic Lead Financial interest in North Cambridgeshire Hospital, Wisbech, ACES, CURA and TS3 (Trinity Surgery Skin Service). GP principal, 21 years, Senior Partner, Park Medical Centre General practitioner with special interest Neurology Peterborough City Hospital Member of Sutton Parish Council Director Peterborough Directors Commissioning Ltd Partner at GP Yaxley Group Practice Chair of Borderline LCG Dr Gary Howsam (from Sept 2014) GP Member Borderline LCG Partner, Commissioning Lead Dr Scott & Partners Whittlesey Hon. Secretary of East Anglian Faculty of RCGP Dr Christopher Scrase Secondary Care Doctor Member None Jill Houghton Tim Woods Director of Quality; Nurse Member Chief Finance Officer None Non-Executive Director of NHS Elect publicly funded consultancy company which works with NHS providers and commissioners Non Local Authority Employer Representative on the Cambridgeshire County Council Local Government Pension Board 59 Page

60 Cambridgeshire and Peterborough Annual Report Andy Vowles Chief Operating Officer (to Dec 2014) Spouse is an employee of CUHFT Partner Governor at Newnham Primary School Chief Strategy Officer (from July 2014) Tracy Dowling Dr Liz Robin Jessica Bawden Harper Brown (to October 2014) Sarah Shuttlewood Chief Operating Owner of small holiday letting property portfolio Officer (from Jan no link to NHS 2015) Husband employed by East Coast Community Health Care Co-opted Director of Public Health for Cambridgeshire and Director of Public Peterborough, employed by Cambridgeshire Health County Council Director of Spouse employed by University Technical Corporate Affairs College, Cambridge which is sponsored by Director of Contracting and Commissioning Interim Director of Performance and Delivery CUHFT, Papworth and CPFT Director of SALAAM Healthcare Consultancy Member of UEA Health Services Consultancy Steering Group Headway Cambridgeshire (Friend of Chief Executive) None We certify that the Clinical Commissioning Group has complied with HM Treasury s guidance on cost allocation and the setting of charges for information. We certify that the CCG has incident response plans in place, which are fully compliant with the NHS Commissioning Board Emergency Preparedness Framework 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. Accountable Officer: Organisation: Signature: Dr Neil Modha NHS Cambridgeshire and Peterborough CCG Date: 28 May 2015 Page 60

61 Page 61 Remuneration Report Membership of Remuneration Committee Name Position Maureen Donnelly Chair Glen Clark Lay Member (Audit and Remuneration) Rebecca Stephens Lay Member (Patient and Public Participation) Dr Neil Modha Chief Clinical Officer (Accountable Officer) Andy Vowles Chief Operating Officer (To 31 December 2014) Tracy Dowling Chief Operating Officer (From 1 January 2015) Dr Geraldine Linehan GP Governing Body Member Dr David Irwin GP Governing Body Member Dr Christopher Scrase Secondary Care (Hospital) Doctor Governing Body Member Policy on the remuneration of senior managers Remuneration payments made to the Non Executive directors and Governing Body members are set nationally by the Secretary of State. The remuneration for Officer Directors is set by the Remuneration Committee, having regard to comparative salary data and the labour market. No remuneration was waived by members and no compensation was paid for loss of office. No payments were made to co-opted members and no payments were made for golden hellos. Where individual national review bodies govern salaries, then the national rates of increase have been applied. Where national review bodies do not cover staff, then increases have been in line with the percentage notified by the NHS Chief Executive and approved by the Remuneration Committee. For this was 0%, with the exception of GP attendance rates, see note below, ( %). Any increases above that limit have been on the basis of increased responsibilities or promotion. The cost of a session paid to a GP for attendance at a meeting or for other CCG work was increased from 250 to 285 (representing a 14% increase).

62 Cambridgeshire and Peterborough Annual Report Policy on Performance Conditions The CCG s Remuneration and Terms of Service Committee set standards in conjunction with the Chief Clinical Officer, Chief Operating Officer and Lay Chair, who has held regular appraisals and one-to-one supervision sessions with the individuals concerned. The Lay Chair sets individual targets for the Chief Operating Officer and Chief Clinical Officer based on the performance of the CCG in relation to national and local targets set out in the CCG service plans. The Remuneration and Terms of Service Committee takes the financial circumstances of the organisation into consideration in making pay awards, as well as Advance letters advice from the Department of Health. All uplifts were discussed with and decided by the Remuneration and Terms of Service Committee and its relevant Sub-Groups, which is supported by a Human Resource (HR) professional. Middle managers receive their targets through cascade of organisational objectives with advice and support from HR. The annual cost of living uplift is awarded by the Remuneration and Terms of Service Committee based on national guidance. Policy on duration of contracts, notice periods and termination payments Senior manager contracts are subject to three to six months contractual notice due to the time it takes to replace a senior manager. Termination payments are in accordance with NHS policy and negotiated with trades unions. Contracts, where possible, are permanent except for project work, due to the legislation giving fixed-term contracts similar employment rights. During times of change the organisation resorts to fixed-term contracts and secondments, but this is becoming increasingly regulated. Service Contracts Date of Contract Unexpired term (if applicable) Early termination terms Name Position Dr Neil Modha Chief Clinical Officer (Accountable Officer) 1-Jun-12 N/A N/A Andy Vowles Chief Strategy Officer 3-Apr-12 N/A N/A Jill Houghton Director of Quality (Nurse Member) 1-Feb-13 N/A N/A Tim Woods Chief Finance Officer 1-Oct-12 N/A N/A Jessica Bawden Director of Corporate Affairs 23-Dec-12 N/A N/A Tracy Dowling Chief Operating Officer 1-Jan-15 N/A N/A Sarah Shuttlewood Interim Director of Performance & Delivery 12-Jun-13 N/A N/A GPs are appointed to serve on the GP Governing Body and submit invoices for meetings attended and other non-clinical services provided to the CCG. Page 62

63 Remuneration Report (audited information) Name Title Salary and Fees (Bands of 5,000) Taxable Benefits (Rounded to the nearest 00) Pension related benefits (Bands of 2,500) Total (Bands of 5,000) Salary and Fees (Bands of 5,000) Taxable Benefits (Rounded to the nearest 00) Pension related benefits (Bands of 2,500) Executive Directors Dr Neil Modha Chief Clinical Officer (Accountable Officer) Chief Strategy Officer (w.e.f. 09 July Andy Vowles previously Chief Operating Officer) Chief Operating Officer (From 01 January Tracy Dowling 2015) Jill Houghton Director of Quality (Nurse Member) Tim Woods Chief Finance Officer Jessica Bawden Director of Corporate Affairs Director of Commissioning and Contracting Harper Brown (To 07 October 2014) Interim Director of Performance & Delivery Sarah Shuttlewood (From 12 June 2013) Director of Performance & Delivery (To 12 Victoria Corbishley June 2013) Total (Bands of 5,000) GP Governing Body Members Dr Geraldine CATCH *85-90 * *100 - Page 63

64 Cambridgeshire and Peterborough Annual Report Linehan (Vice Chair) Dr Michael Caskey Peterborough *25-30 * *40-45 Dr Mark Brookes Cam Health (From April 2014) *20-25 Dr Arnold Fertig Cam Health (To 31 March 2014) - * *80-85 Dr David Irwin Hunts Care Partners *50-55 * *35-40 Dr John Jones Isle of Ely *35-40 * *35-40 Dr Simon Brown Hunts Health (From April 2014) *35-40 Dr David Roberts Hunts Health (To 31March 2014) - * *55-60 Dr Andrew Wordsworth Wisbech (From April 2014) *5-10 Dr Tim Webster Wisbech (To 31 March 2014) * *15-20 Dr Richard Withers Borderline (To 30 August 2014) *10-15 * *50-55 Dr Gary Howsam Borderline (From 01 Sept 2014) *35-40 Chair and Lay Members Maureen Donnelly Chair Glen Clark Lay Member (Audit and Remuneration) Christopher Boden Edward Libbey Rebecca Stephens Dr Christopher Scrase Lay Member (Finance and Performance) (From 01 Dec 2014) 0-5 Lay Member (Finance and Performance) (To 30 June 2014) Lay Member (Patient and Public Participation) Secondary Care (Hospital) Doctor Governing Body Member 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 director in the CCG in the financial year was 120k to 125k ( was 120k to 125k). This was 3.72 times ( was 3.72 times) the median remuneration of the workforce, which was 32,898 ( was 32,898). Remuneration ranged from 4,968 to 121,000 ( was 5,580 to 121,000). In Page 64

65 2015, no employees received remuneration in excess of the highest director ( none). * Salaries and Fees for GPs on the GP Governing Body represents meetings attended and services provided in addition to Governing Body meetings. ** Total remuneration includes salary, non-consolidated performance related pay, benefits in kind as well as severance payments. It does not include pension contributions and the cash equivalent transfer of value of pensions. GP Governing Body Members are paid through invoices raised by practices, companies owned by the individuals and the individuals themselves. Therefore deemed to be off-payroll engagements. Pension related benefits GP Governing Body Members make pension contributions from their remuneration to the NHS Pensions Agency. The Agency have not provided details of their pension values to the CCG. No pension contributions are made on behalf of the chairman and lay members. Remuneration Report - Pension entitlements (audited information) Name and title Real increase in pension at age 60 (bands of 2,500) 000 Lump sum at age 60 related to real increase in pension (bands of 2,500) 000 Total accrued pension at age 60 at 31 March 2015 (bands of 5,000) 000 Lump sum at age 60 related to accrued pension at 31 March 2015 (bands of 5,000) 000 Cash Equivalent Transfer Value at 31-Mar Cash Equivalent Transfer Value at 31 March Real increase in Cash Equivalent Transfer Value 000 Dr Neil Modha, Chief Clinical Officer Employer's contribution to stakeholder pension (rounded to nearest 00) 00 Page 65

66 Cambridgeshire and Peterborough Annual Report Andy Vowles, Chief Strategy Officer Tracy Dowling, Chief Operating Officer ( w.e.f. 01/01/15) Jill Houghton, Director of Quality ** Tim Woods, Chief Finance Officer , Jessica Bawden, Director of Corporate Affairs Harper Brown, Director of Commissioning and Contracting (left 07/10/14) Sarah Shuttlewood, Interim Director of Performance and Delivery Victoria Corbishley, Director of Performance and Delivery* (left 12/06/13) GP Governing Body Members make pension contributions from their remuneration to the NHS Pensions Agency. The Agency have not provided details of their pension values to the CCG. No pension contributions are made on behalf of the chairman and lay members. *Victoria Corbishley was a member of the 2008 NHS pension scheme which means she is not entitled to a lump sum. ** Jill Houghton has transferred her 1995 membership to the 2008 scheme. This affects the lump sum entitlement which is effectively frozen as the 2008 scheme does not have one. The real increase uplifts the previous year's lump sum by 2.7% less the present year, which has the same value, which produces a negative value. Manual for Accounts guidance requests negatives are replaced by a zero value. Cash Equivalent Transfer Values A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member s accrued benefits and any contingent spouse s pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total Page 66

67 membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries. Real Increase in CETV This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period. Off-payroll engagements For all off-payroll engagements as of 31 March 2015, for more than 220 per day and that last longer than six months: Number Number of existing engagements as of 31 March Of which, the number that have existed: for less than one year at the time of reporting 5 for between one and two years at the time of reporting 6 for between 2 and 3 years at the time of reporting - for between 3 and 4 years at the time of reporting - for 4 or more years at the time of reporting - The CCG has undertaken a risk based assessment as to whether assurance is required that the individual is paying the correct amount of Tax and NI. The CCG has concluded that the risk of significant exposure in relation to these individuals is minimal. For all new off-payroll engagements between 1 April 2014 and 31 March 2015, for more than 220 per day and that last longer than six months: Page 67

68 Cambridgeshire and Peterborough Annual Report Number Number of new engagements between 1 April 2014 and 31 March Number of new engagements which include contractual clauses giving the CCG the right to request assurance in relation to income tax and National Insurance obligations - Number for whom assurance has been requested - Of which: assurance has been received - assurance has not been received - engagements terminated as a result of assurance not being received, or ended before assurance received. - The CCG has undertaken a risk assessment and concluded that engagement without contractual clauses allowing it to seek assurance on individuals tax obligations would not result in significant exposure for the CCG. The above disclosure has not been audited and there is no requirement for the information to be audited. Accountable Officer: Dr Neil Modha Organisation: NHS Cambridgeshire and Peterborough CCG Signature: Date: Page 68

69 Statement of Accountable Officer s responsibilities Under the National Health Service Act 2006 (as amended) 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 Clinical Officer to be the Accountable Officer of the Clinical Commissioning Group. The responsibilities of an Accountable Officer, including responsibilities for the propriety and regularity of the public finances for which the Accountable Officer is answerable, for keeping proper accounting records (which disclose with reasonable accuracy at any time the financial position of the Clinical Commissioning Group and enable them to ensure that the accounts comply with the requirements of the Accounts Direction) and for safeguarding the Clinical Commissioning Group s assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities), are set out in the Clinical Commissioning Group Accountable Officer Appointment Letter. Under the National Health Service Act 2006 (as amended), NHS England has directed each Clinical Commissioning Group to prepare for each financial year financial statements in the form and on the basis set out in the Accounts Direction. The financial statements are prepared on an accruals basis and must give a true and fair view of the state of affairs of the Clinical Commissioning Group and of its net expenditure, changes in taxpayers equity and cash flows for the financial year. In preparing the financial statements, the Accountable Officer is required to comply with the requirements of the Manual for Accounts issued by the Department of Health and in particular to: observe the Accounts Direction issued by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis; make judgements and estimates on a reasonable basis; state whether applicable accounting standards as set out in the Manual for Accounts issued by the Department of Health have been followed, and disclose and explain any material departures in the financial statements; and prepare the financial statements on a going concern basis. To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my Clinical Commissioning Group Accountable Officer Appointment Letter. Accountable Officer: Organisation: Signature: Dr Neil Modha NHS Cambridgeshire and Peterborough CCG Date: 28 May Page

70 Cambridgeshire and Peterborough Annual Report Annual Governance Statement for the year ended 31 March Introduction The CCG was licenced from 1 April 2013 under provisions enacted in the Health and Social Care Act 2012, which amended the National Health Service Act 2006 with the following conditions: 3.1.1B Clear and credible plans that set out how CCGs will take responsibility for service transformation that will improve quality within available resources. CCG has a clear and credible integrated plan, which includes an operating plan for , draft commissioning intentions for and a high-level strategic plan until C Clear and credible plans that set out how CCGs will take responsibility for service transformation that will improve quality within available resources. CCG has detailed financial plan that delivers financial balance, sets out how it will manage within its management allowance, and any other requirements set by the NHSCB and is integrated with the Strategic Plan. There are now quarterly reviews of the conditions to see if they can be lifted. This Annual Governance Statement reflects arrangements from 1 April 2014 to 31 March Scope of responsibility As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the CCG s policies, aims and objectives, whilst safeguarding the public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out in my CCG Accountable Officer Appointment Letter. I am responsible for ensuring that the Clinical Commissioning Group is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity. The CCG has worked closely with other organisations throughout the year through a variety of relationships such as: Service level agreements and contracts with other NHS organisations to deliver health services to agreed specifications, and in line with our Quality Dashboard and NHS Constitution targets Legal agreements with our Local Authorities including the operation of Section 75 Agreements Page 70

71 Performance management arrangements with the NHS England Anglia Area Team With patients through a number of different forums including our Patient Reference Group, Patient Participation Groups, LCG Patient Forums, Healthwatch Cambridgeshire and Healthwatch Peterborough With partners such as Local Authorities including social care, GPs carrying out joint needs assessments, strategic planning and joint commissioning Accountability to NHS England for the performance of functions and meeting statutory duties set out in the NHS England CCG Assurance Framework Balanced Scorecard With local partners to promote the objectives of our local Health and Wellbeing Board strategies and through partnership working, formal Partnership Boards and pooled funding arrangements With the Multi-Agency Local Adult Safeguarding and Multi-Agency Local Children s Safeguarding Boards With wider communities through public engagement, through our Governing Body meetings in public, publication of various corporate documents and plans, and production of the Annual Report and Annual Accounts. 3. Compliance with the UK Corporate Governance Code Whilst the detailed provisions of the UK Corporate Governance Code are not mandatory for public sector bodies, compliance is considered to be good practice. The Governing Body conducted a formal review of its effectiveness during May 2014 through a self-assessment which included some of the principles of the Corporate Governance Code. The outcomes of the selfassessment were reported and discussed at the Governing Body Development Session in June An Action Plan was developed as a result of the process and this is being taken forward by the Corporate Governance Team. 4. The Governance Framework of the Organisation The National Health Service Act 2006 (as amended), at paragraph 14L(2)(b) states: The main function of the Governing Body is to ensure that the group has made appropriate arrangements for ensuring that it complies with such generally accepted principles of good governance as are relevant to it. The Governing Body has met eight times in public over the last year. There was good attendance from all Governing Body members at each meeting and attendance is recorded within the minutes of each meeting. The Governing Body was served by the following Committees: Eight Local Commissioning Groups (LCGs): Borderline LCG CamHealth LCG 71 Page

72 Cambridgeshire and Peterborough Annual Report CATCH LCG Hunts Care Partners LCG Hunts Health LCG Peterborough LCG Isle of Ely LCG Wisbech LCG Audit Committee Finance and Performance Committee Patient Safety and Quality Committee Remuneration and Terms of Service Committee Patient Reference Group Clinical and Management Executive Team Strategic Clinical Prioritisation Group Service Performance Review Group. There was good attendance at Sub-Committee meetings and this is recorded within the minutes of each meeting. The eight LCGs are designed to maintain local focus, clinical and patient engagement in commissioning, design locally responsive services and drive innovation. Every practice within the CCG area is a member of an LCG. The LCGs are constituted formally as committees of the CCG Governing Body to enable delegation of funding and commissioning responsibilities to them in line with the CCG Operating Model. The Audit Committee chaired by the Governing Body Lay Member for Governance, provides the Governing Body with an independent and objective view of the CCG s financial systems, financial information and compliance with laws, regulations and directions governing the CCG insofar as they relate to discharging their statutory duties. The Committee will also ensure that there is an effective system of internal control and provide an objective review of systems and reports presented by Internal and External Audit and Local Counter Fraud Services, and provides the Governing Body with assurance that the CCG s governance, including financial, clinical and risk management processes are conducted within best practice guidelines set out in the Audit Committee Handbook. The Finance and Performance Committee, chaired by the Governing Body Lay Member for Finance and Performance, providing scrutiny of the CCG s performance and financial functions, ensuring that the CCG meets its statutory financial duty, including oversight of financial risk and delivery of Quality, Innovation, Prevention and Performance (QIPP). The Patient Safety and Quality Committee, chaired by the Governing Body Lay Member for Patient and Public Involvement, providing scrutiny of the CCG s performance and processes relating to patient safety and quality within the services we commission. The Committee also provides the link to the Multi-Agency Local Adult Safeguarding and Multi-Agency Local Children s Page 72

73 Safeguarding Boards, of which the CCG is a member, and provides regular reporting to the Governing Body. The Remuneration and Terms of Service Committee, chaired by the Governing Body Lay Chair, makes recommendations to the Governing Body on determinations about the remuneration, fees and other allowances for employees and for people who provide services to the CCG and on determinations about allowances under any pension scheme that the CCG may establish as an alternative to the NHS Pension Scheme. The Committee will also agree all HR and associated policies and procedures on behalf of the CCG Governing Body linked to Terms and Conditions of Employment for CCG and associated staff/clinicians as appropriate. The Committee also has responsibility for workforce performance and implementation of the Organisational Development Plan. To address conflicts of interest, the Committee has three Sub-Groups: GP Remuneration, Very Senior Manager Pay and Lay Member Pay. The Patient Reference Group, chaired by Governing Body Lay Member for Patient and Public Involvement, provides an independent view of the work of the CCG that is external to the day-to-day running of the organisation. It also helps to ensure that, in all aspects of the CCG s business, the public voice of the local population is heard and that opportunities are created and protected for patient and public empowerment in the work of the CCG. The Clinical and Executive Management Team (CMET), chaired by the Chief Clinical Officer, has delegated the day-to-day operational responsibility for running the organisation. The following Sub-Groups report to CMET: Financial Recovery Plan Programme Management Board Information Governance and Information Management and Technology (IM&T) Steering Group Emergency Planning, Resilience and Response Sub-Group Equality and Diversity Sub-Group Accommodation and Sustainability Sub-Group HR Sub-Group. The Strategic Clinical Prioritisation Group, chaired by the Governing Body GP Vice-Chair, acts as the expert group analysing and proposing strategic service to the CCG Governing Body in relation to clinical priorities and prescribing. The Group advises on the clinical service priorities most likely to deliver on the CCG s strategic and corporate objectives; considers and approves business cases recommended by the Clinical Policies Forum (CPF) and Joint Prescribing Group (JPG) on behalf of the Governing Body; receives clinical policies and prescribing policies and approves them for ratification by the Governing Body. The Service Performance Review Framework Sub-Group, chaired by the Governing Body Lay Member for Governance, which oversees the Commissioning Support Functions of the CCG, and provides feedback to the Governing Body on a quarterly basis. 73 Page

74 Cambridgeshire and Peterborough Annual Report The Governing Body meets in public on a bi-monthly basis and the agenda is divided into four key areas general issues, Quality and Governance, Finance and Performance and Strategy. The Governing Body receives reports on the activities of all its Sub-Committees on a regular basis. The Governing Body also receives detailed overview reports on the work of the Audit Committee which includes progress against External Audit progress reports, Internal Audit and Counter Fraud and the CCG Assurance Framework. The Audit Committee reviews its Audit Committee Self- Assessment Checklist regularly. The CCG has met throughout the year with NHS England Anglia Area Team to review the CCG s performance against key national and local targets, with a particular focus on performance, including financial performance and progress against the CCG s Financial Recovery Plan. The CCG Governing Body is committed to ensuring that it complies with all aspects of Corporate Governance. This is maintained through the CCG s Constitution, Register of Interests, Register of Gifts and Hospitality, Whistleblowing Policy and the Complaints Policy. In line with NHS England s publication of Statutory Guidance in the Management of Conflicts of Interest, a new Conflicts of Interest Policy has been developed and is in the process of being implemented across the CCG. The Governing Body holds regular Development Sessions. Governing Body to Board meetings with our main providers are also conducted as appropriate. The Governing Body was also served by the following Programme Boards who oversee our Strategic Priorities: Older People End of Life Care Reducing Health Inequalities in Coronary Heart Disease Children and Young People 111 and Out of Hours Primary Care. These Programme Boards report to the Governing Body on a regular basis. 5. The CCG Risk Management Framework Within the CCG, risk management is demonstrated by: adopting an integrated approach to risk management, whether the risk relates to clinical, organisational, health and safety or financial risk, through the processes and structures detailed in the CCG s Risk Management Policy; managing risk as part of the routine line management responsibilities and consideration of funding to address risk issues (based on a risk assessment) as part of the normal business planning process; Page 74

75 undertaking risk assessments on both existing, new and proposed activities to ensure that: i) significant risks are identified in accordance with the Risk Management Policy which provides full details on what constitutes a hazard or risk, how it should be identified and assessed; ii) assessments are made of their potential frequency and severity; iii) control measures are implemented in accordance with the Risk Management Policy; iv) risks are always assessed, and reduced or minimised where possible; v) strategic risks are recorded on the CCG Assurance Framework (CAF) in line with the Risk Scoring Matrix; and vi) risks are recorded on the LCG Risk Registers, Service Performance Review Risk Registers and Programme Board Risk Registers. These are escalated as appropriate. Staff at all levels of the organisation contribute to the identification and assessment of risk through LCGs, directorates and at our Main Provider Performance Management and Clinical Quality Review Days. The Risk Management actions that have been taken this year include: Strengthening of LCG Risk Registers and the development of the CAF Development of the Service Performance Review (SPR) Risk Registers Development of the Programme Board Risk Registers Development of the CCG s risk statement and implementation of Action Plans for unacceptable risks Maintenance of governance policies and the Risk Management Policy Testing of our emergency planning and business continuity planning arrangements Development of our information governance arrangements and Information Governance Toolkit scores. The control environment is supported by regular review of our Constitution, including Standing Orders, Scheme of Delegation and Standing Financial Instructions, directions on fraud, programme of Internal Audit, budgetary control systems and information to support performance and risk monitoring processes. 6. The CCG 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. 75 Page

76 Cambridgeshire and Peterborough Annual Report The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it can therefore only provide reasonable, and not absolute, assurance of effectiveness. The system of Internal Control has been in place in the CCG for the year ended 31 March 2015 and up to the date of approval of the Annual Report and Annual Accounts. 6.1 Information Governance The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal identifiable information. The NHS Information Governance Framework is supported by an information governance toolkit and the annual submission process provides assurances to the Clinical Commissioning Group, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively. The CCG is committed to ensuring that Information Governance is an integral part of the CCG's Risk Management Policy and operational planning. The Information Governance and IM&T Steering Group prioritises its work programme and provides regular exception reporting to CMET. The IG and IM&T Steering Group is attended by the Caldicott Guardian, Senior Information Risk Owner (SIRO) and is chaired by the GP Clinical Lead for Information Governance and IM&T. There are processes in place for incident reporting and investigation of serious incidents. We are developing information risk assessment and management procedures and a programme will be established to fully embed an information risk culture throughout the organisation. The CCG submitted and published a GREEN satisfactory rating for its self-assessment on the Information Governance Toolkit for Pension Obligations As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the scheme regulations are complied with. This includes ensuring that deductions from salary, employer s contributions and payments into the scheme are in accordance with the scheme rules, and that member pension scheme records are accurately updated in accordance with the timescales detailed in the regulations. 6.3 Equality, Diversity and Human Rights Obligations Control measures are in place to ensure that all the organisation s obligations under equality, diversity and human rights legislation are complied with. As Accountable Officer, I am assured by the relevant Page 76

77 aspects of the NHS Constitution that the Governing Body, through the Remuneration and Terms of Service Committee, receives assurance on and regular monitoring of workforce performance. A mechanism is also in place for undertaking and reviewing equality impact assessments. An Equality and Delivery System (EDS) is now in place and this is overseen by the Equality and Delivery Steering Group which reports to CMET. All EDS Goals are linked to the risks contained in the CCG Assurance Framework and Risk Register. 6.4 Sustainable Development Obligations The CCG is required to report its progress in delivering against sustainable development indicators. The CCG now has an approved Sustainability Strategy and a Sustainable Development Action Plan which was approved by the Governing Body on 3 March The Strategy has enabled the CCG to put in place arrangements to assess risks, enhance our performance and reduce our impact, including against carbon reduction and climate change adaptation objectives. This includes establishing mechanisms to embed social and environmental sustainability across policy development, business planning and in commissioning. The CCG, through the Local Health Resilience Partnership, has undertaken a climate change risk assessment and developed an Adaption Plan, to support its emergency preparedness and civil contingency requirements, as based on the UK Climate Projections 2009 (UKCP09), to ensure that this organisation s obligations under the Climate Change Act 2008 are met. We will ensure the CCG continues to comply with its obligations under the Climate Change Act 2008, including the Adaptation Reporting power, and the Public Services (Social Value) Act We are also setting out our commitments as a socially responsible employer. 7. Risk Assessment in Relation to Governance, Risk Management and Internal Control The CCG Assurance Framework and Risk Register (CAF) identifies the CCG s strategic objectives and risks, the controls that are currently in place to minimise the risk and the sources of assurance to those controls. The system of regular review of the CAF by the Governing Body provides evidence to the Annual Governance Statement. The Governing Body has overseen regular assessment of the risks associated with achieving the CCG s strategic objectives and risks, has reviewed gaps in key controls and assurance to address those risks, and monitored management actions to address the gaps. The CAF assesses the likelihood of an event occurring combined with the possible consequences to provide a standard approach to the assessment of risk. Calculating the risk supports the prioritisation of action plans and the reduction of risks is therefore managed through this process. 77 Page

78 Cambridgeshire and Peterborough Annual Report The Internal Audit review of the CAF provided Substantial Assurance. The CAF is regularly reviewed by the Clinical and Management Executive Team and input is also provided by the Patient Safety and Quality Committee and Finance and Performance Committee as required. It is scrutinised at each Audit Committee and is presented at each Governing Body meeting in public through the Chief Clinical Officer s Report. Recommendations arising from the Internal Audit review that were designed to further develop and strengthen the CAF have been taken forward in and included development of a Risk Statement to reflect the CCG s risk appetite and introduction of target risks. The CAF identified a number of risks to achieving our Strategic Aims which are being managed through actions linked to the CAF to mitigate these risks. These are as follows (as at ): a) High Risks Risk to delivery of the Urgent Care Network Plans Failure to achieve key performance targets Risk to Delivery of QIPP and System Reform Plan Failure to Safeguard Children Risk of potential poor quality services from providers which the CCG commissions Risk of Ambulance service failing to meet required levels of performance Failure to engage with Member Practices and wider stakeholders. b) Significant Risks Failure to Safeguard Adults Risk to delivery of the Cambridgeshire and Peterborough Health and Care System insufficient resources across the system for Phase 2 Risk of skilled workforce not available within CCG commissioned services Failure to achieve delivery of the Strategic Priority Programmes (Older People/Coronary Heart Disease//End of Life Care) Risks to the mobilisation of the Older People and Adult Community Services Contract Impact of the Specialist Commissioning Review and potential for joint commissioning Risks to the implementation of the procurement of the combined Out of Hours and NHS 111 Service Failure to deliver service transformation due to pressures and challenges facing primary care and insufficient or uncoordinated resources for commissioning primary care Risk to the maintaining of robust CCG governance arrangements Risk relating to the national programme for IT contract expiry Failure to implement robust contract management processes Failure to deliver robust Organisational Development Plan for the CCG Insufficient capacity and capability to deliver all goals. Page 78

79 c) Moderate Risks Failure to achieve Financial Statutory Duty Risks associated with ongoing retrospective Continuing Health Care (CHC) claims process Failure to engage with public and patients around service changes Risk of poor information governance such as non-compliance with the Data Protection Act, Freedom of Information Act (FOI) and other legislation relevant to the CCG and the services it commissions Risk to implementation of National Sustainability Agenda Risk to Breaching the Bribery Act 2010 Risk to robust major incident and Business Continuity Planning. Through the assessment of these risks, the CAF sets out the gaps in controls and the Management Actions that are required to mitigate the risk. Where risks remain High, additional scrutiny is set out below: Action plans for each High Risk (Red) have been introduced and are monitored by the relevant Sub-Committee in line with the CCG s Risk Statement. Continued Financial Recovery Plan and QIPP monitoring and reporting processes through the Financial Recovery Plan Programme Board. Regular review of Patient Safety and Quality risks, through reporting on the Quality Dashboard and by assurance to the Patient Safety and Quality Committee. 8. Review of Economy, Efficiency and Effectiveness of the Use of Resources Through the Finance and Performance Committee, key processes are applied to ensure that resources are used economically, efficiently and effectively. This also includes scrutiny of the CCG s performance and financial functions. The Committee oversees the CCG s financial risks and delivery of the QIPP Programme. The Committee also regularly reviews the CAF. The Committee reports to the Governing Body at each meeting. 9. Review of the Effectiveness of Governance, Risk Management and Internal Control As Accountable Officer, I have responsibility for reviewing the effectiveness of the system of internal control within the CCG. 9.1 Capacity to Handle Risk The Governing Body provides leadership to ensure that risk management is embedded within the organisation. This includes development of the Integrated Plan which identifies the key objectives and related risks. As Accountable Officer, I ensure that sufficient resources are invested in managing risk, and I am supported in this task by the Director of Quality 79 Page

80 Cambridgeshire and Peterborough Annual Report (Caldicott Guardian) who holds Governing Body-level responsibility for clinical risks. The Director of Corporate Affairs holds Governing Body-level responsibility for non-clinical risks. Leadership is given to the risk management process through Executive Directors, Clinical Governing Body Members and Lay Members via the Audit Committee, Patient Safety and Quality Committee, Finance and Performance Committee and the Clinical and Management Executive Team. Staff are trained and equipped to manage risk in a way that is appropriate to their authority and duties and this is done through a documented system of risk assessment, formal and ad hoc training and from meetings with them to identify and manage risk. Guidance is provided to staff by the Governance Team who provide templates on how to undertake risk assessments, produce risk registers and business continuity plans and embed risk management in the activity of the organisation. The CCG is supported by Risk Management resources within SERCO which provides support in terms of advice, development and training. 9.2 Review of Effectiveness As Accountable Officer, I have responsibility for reviewing the effectiveness of the system of internal control. My review is informed in a number of ways. The Head of Internal Audit provides me with an opinion on the overall arrangements for gaining assurance through the CAF and on the controls reviewed as part of the Internal Audit work. Executive Directors within the organisation who have responsibility for the development and maintenance of the system of internal control provides me with assurance. The CAF itself provides me with the evidence that the effectiveness of controls that manage the risks to the organisation achieving its corporate objectives have been reviewed. My review is also informed by Internal and External Audit. I have been advised of the implications of the result of my review of the effectiveness of the system of internal control by the Governing Body and the Audit Committee as described in Section 7. A plan to address weaknesses and ensure continuous improvements of the system of internal control will be put in place. The Governing Body and its associated Committees, together with Internal Audit, maintain a regular review of the effectiveness of the process of internal control. My review is also informed by: The Information Governance Toolkit Assessment Our Research Governance Framework Any external reviews My attendance at key governance meetings Reports from Internal Audit and the Head of Internal Audit Opinion NHSLA Membership and Risk Management Assessment Page 80

81 External Audit s assessment of the CCG s arrangements for economy, efficiency and effectiveness in the use of its resources The NHS England CCG Assurance Framework and Quarterly Assurance Meetings held between the CCG and the Anglia Area Team. This focuses on the CCG Assurance Framework Balanced Scorecard which provides ratings as follows: Are local people getting good quality care? Are patients rights under the Constitution being promoted? Are health outcomes for local people improving? Are CCGs commissioning services within their financial allocation? Are conditions of CCG authorisation being addressed and removed? I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the following Committee Structure: The Governing Body, which has responsibility for setting the overall direction, agreeing the CCG s strategic aims, corporate objectives, assessing and managing strategic risks to the delivery of those objectives and monitoring progress through regular performance monitoring reports The eight Local Commissioning Groups who maintain local focus, clinical and patient engagement in commissioning, design locally responsive services and drive innovation The Audit Committee which works to a well-developed audit plan and provides assurance to the Governing Body The Finance and Performance Committee which reviews financial risk and performance of providers commissioned to provide services to the patients of Cambridgeshire and Peterborough The Patient Safety and Quality Committee which is responsible for ensuring clinical risk is managed The Remuneration and Terms of Service Committee, which is responsible for agreeing Very Senior Managers Pay, monitoring Executive Director performance and monitoring Workforce Performance and the Organisational Development Plan The Clinical and Management Executive Team which meets regularly to support the achievement of the Operational Plan and deals with day-to-day risk 81 Page

82 Cambridgeshire and Peterborough Annual Report The Patient Reference Group which provides an independent view of the work of the CCG that is external to the day-to-day running of the organisation and ensures the public voice of the local population is heard and that opportunities are created and protected for patient and public empowerment in the work of the CCG The Strategic Clinical Prioritisation Group which advises on the clinical service priorities most likely to deliver on the CCG s strategic and corporate objectives; consider and approve business cases recommended by the Clinical Policies Forum (CPF) and Joint Prescribing Group (JPG) The Service Performance Review Group which oversees the delivery of the CCG s commissioning support function GP Governing Body Members, Governing Body Members, Executive Directors, Local Chief Officers and Deputy/Assistant Directors Internal Audit, which has reviewed the effectiveness of the design and operation of the controls in the areas covered by its risk-based Operational Plan. Internal Audit s overall opinion for the year ended 31 March 2015 is that Significant Assurance can be given that there is a generally sound system of internal control, designed to meet the organisation s objectives, and that controls are generally being applied consistently. However, some weakness in the design and/or inconsistent application of controls put the achievement of particular objectives at risk and this will be addressed via Management Action Plans agreed between Internal Audit and Executive Director leads for each area. Progress against implementation of all Internal Audit recommendations is regularly reviewed by the Audit Committee. Management Actions taken are confirmed by specific, formal follow-up by Internal Audit and this is independently reported to the Audit Committee. The CCG achieved its statutory obligation duty to break even in , and has ended the year with a surplus of 3,058k. A Financial Recovery Plan Programme Board, reporting to the Clinical and Management Executive Team, has been in place to monitor the CCG s Financial Recovery Plan. With the exception of the internal control issues that I have outlined in this Annual Governance Statement, my review confirms that the CCG has a generally sound system of internal controls that supports the achievement of its policies, aims and objectives. The control issues have been or are being assessed. Page 82

83 9.3 Data Quality Data quality is reviewed at various levels within the CCG across the various data sources we use. For our main commissioning datasets we have procured the service of a DSCRO (Data Service for Commissioners Regional Office) which validates the information we use to monitor contracts and pathways. These validation checks include Data Quality checks e.g. missing information (NHS Number, Dates), incorrect information (Date mismatch, incorrect prices, invalid admissions e.g. an 85 year old admitted under paediatrics). For more aggregate information e.g. performance against targets (18wks, Cancer, A&E) we triangulate information from multiple sources e.g. provider reporting and national reporting. We also compare different views e.g. commissioner level and provider level to ensure consistency. 9.4 Business Critical Models Modelling and forecasting forms a fundamental part of the process between providers and commissioners. Each year contracts are constructed to forecast spend and activity values for the following year. These are then monitored in year with forecasts updated monthly to identify position against plans and year-end outturn. Quality assurance of this process is given by the involvement of both providers and commissioners in the construction and monitoring process. This peer review ensures models are built on robust assumptions, with the most up to date and accurate data. The different perspectives ensure that plans are realistic but still give challenge in relation to system transformation. 9.5 Data Security As set out above, we have submitted a satisfactory level of compliance with the information governance toolkit assessment. The CCG is required to publish all Serious Incidents (SIs) relating to loss of personal data involving confidentiality breaches in its Annual Report. There have been (at the time of writing) no breaches involving loss of data reported during SUMMARY OF CAPCCG SERIOUS INCIDENTS INVOLVING PERSONAL DATA AS REPORTED TO THE INFORMATION COMMISSIONER S OFFICE IN 2014/15 Date of Incident Nature of Incident Nature of Data Involved Number of People Potentially Affected Notification of Steps 83 Page

84 Cambridgeshire and Peterborough Annual Report CAPCCG SUMMARY OF OTHER PERSONAL DATA RELATED INCIDENTS IN Category Nature of incident Total I Loss/theft of inadequately protected electronic 2 equipment, devices or paper documents from secured NHS premises II Loss/theft of inadequately protected electronic 0 equipment, devices or paper documents from outside secured NHS premises III Insecure disposal of inadequately protected electronic 1 equipment, devices or paper documents IV Unauthorised disclosure 2 V Other Categorised at Level 1 (SIRI non reportable incidents) Discharge of Statutory Functions During establishment, the arrangements put in place by the CCG and explained within the Corporate Governance Framework were developed based on national guidance to ensure compliance with the all relevant legislation. The CCG is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions. Responsibility for each duty and power has been clearly allocated to a lead Director. Directorates have confirmed that their structures provide the necessary capability and capacity to undertake all of the CCG s statutory duties. 11. Conclusion The CCG commenced the year with a significant QIPP financial challenge of 33.34m. We had plans in place to deliver the full QIPP using a variety of contractual and transformational programmes, some of which proved challenging in achieving the full planned impact. As it became apparent that some of the QIPP plans would not deliver the required savings, a decision was made to develop an urgent recovery programme to reverse the adverse financial trend. The financial gap that was needed to ensure the organisation was able to breakeven following acute contract over performance and QIPP non-delivery was assessed as c 3m. A Recovery Plan was created to monitor each action within the recovery plan to secure maximum delivery. The total recovery plan identified schemes of around 6.5m, which provided some head room to cover shortfalls across the different areas. At year end, 86% ( 5.6m) of the recovery plan was delivered, resulting in the CCG reporting a (pre audit) year-end surplus of 3,058,000. This means that the CCG has met and exceeded our statutory breakeven financial duty at the end of the year. We have also been able to re-pay our debt from last year of 4.9 million. Robust governance processes have been maintained throughout Page 84

85 the year through the Financial Recovery Programme Board which was established during The organisation has made good progress this year, however, acknowledges External Audit s qualified conclusion of the CCG s economy, efficiency and effectiveness of the use of resources for , given the financial challenges and uncertainties the Cambridgeshire and Peterborough health system has as a whole going into The CCG Governing Body will continue to monitor our progress through the governance arrangements described above. The CCG has continued to face significant challenges around delivery of the NHS Constitution targets in A&E, Referral to Treatment and Cancer targets. Our progress to recover this position has been robustly challenged by NHS England through our Quarterly CCG Assurance Meetings and escalation meetings with NHS England Regional Team in respect of A&E at CUHFT and PSHFT. We are working closely with our Provider Trusts to improve the position and this has been closely monitored by the Finance & Performance Sub-Committee. With the achievement of the statutory financial balance, and achievement of some national and local standards, we anticipate and are pleased that the CCG will receive an element of the Quality Premium for The CCG has taken on Co-Commissioning of primary care with NHS England for The CCG will ensure that robust governance arrangements are established to take this forward. This includes the need for robust management of Conflicts of Interests, which is reflected in the statutory Guidance produced by NHS England in December 2014 and reflected in our new Conflicts of Interest Policy. The CCG continues to review the effectiveness of its governance arrangements, including its Sub-Committees and this supports a cycle of continued improvement. The CCG s Authorisation Conditions remain in place at the end of , however, we await notification from NHS England as to whether these can be removed subject to our financial position and status of our Operational Plan for Accountable Officer: Organisation: Signature: Dr Neil Modha NHS Cambridgeshire and Peterborough CCG Date: 28 May Page

86 Cambridgeshire and Peterborough Annual Report Our opinion What we have audited What an audit of financial statements involves Page 86

87 Our responsibilities and those of the Accountable Officer Basis for qualified conclusion 87 Page

88 Cambridgeshire and Peterborough Annual Report Qualified conclusion What a review of the arrangements for securing economy, efficiency and effectiveness in the use of resources involves Our responsibilities and those of the CCG Page 88

89 NHS Cambridgeshire and Peterborough CCG Annual Accounts Page