ACCOUNTABILITY REPORT

Transcription

1 Isle of Wight CCG Annual Report and Accounts 2017/2018

2 Contents PERFORMANCE REPORT PERFORMANCE OVERVIEW Statement from the Accountable Officer Isle of Wight Clinical Commissioning Group Our Island a unique set of healthcare challenges Who we are and how we work What we do Our financial allocation Our objectives Key Transformation Programmes Factors affecting Future Performance Performance Performance against NHS Constitution targets Quality Performance Analysis Performance Financial Performance CCG Performance CCG Assurance Framework 2017/ Sustainable Development Improve Quality Engaging people and communities Primary Care Reducing health inequality Health and Wellbeing Strategy ACCOUNTABILITY REPORT MEMBERS REPORT Members Practices Composition of Governing Body Committees Register of Interests Personal data related incidents Statement of Disclosure to Auditors Emergency Preparedness, Resilience and Response (EPRR) Modern Slavery Act Statement of Accountable Officer s Responsibilities Governance Statement Introduction & Context Scope of Responsibility... 45

3 6.3 Governance arrangements and effectiveness Membership Council Governing Body Clinical Executive Quality and Patient Safety Committee (QPSC) Audit Committee Remuneration Committee Primary Care Committee UK Corporate Governance Code Discharge of Statutory functions Risk Management arrangements and effectiveness Other Sources of Assurance Control Issues Review of Economy, Efficiency & Effectiveness of the Use of Resources Head of Internal Audit Opinion Review of the Effectiveness of Governance, Risk Management & Internal Control Remuneration and Staff Report Remuneration report Remuneration of Senior Managers Staff Report Statement of External Audit Opinion.72 Appendix 1 Statement of Annual Accounts

4 List of Tables Table Title Page 1 Better Care Fund Schemes 2017/ Summary of Interim Financial plan 18 3 NHS Constitution achievement 2017/ Financial plan variances 22 5 Summary 2017/18 QIPP schemes 24 6 CCG Performance against Objectives 24 7 Quarter 3 CCG Assurance Summary Examples of Public Engagement 35 9 List of GP Practices by Locality Members and attendance at Membership Council Members and attendance at Governing Body Members and attendance at Clinical Executive Members and attendance at Quality and Patient Safety 50 Committee 14 Members and attendance at Audit Committee Members and attendance at Remuneration Committee Members and attendance at Primary Care Committee Internal audit assessments Senior Managers Service contract details Senior Managers Service salary and allowances Senior Managers pension benefits Pay multiples Employee benefits Average number of people employed Staff sickness absence Off-Payroll engagments longer than 6 months New off-payroll engagements Off-payroll engagments/senior offical engagements 70

5 28 Trade Union Officials 71 List of Figures Fig Title Page 1 CCG % spend in 2017/ CCG % spend in 2016/ Governing Body committee structure 46

6 PERFORMANCE REPORT 1. PERFORMANCE OVERVIEW 1.1 Statement from the Accountable Officer This year marks a special milestone for the NHS - on 5 th July we celebrate 70 years since the New National Health Service was set up to, as it was publicised at the time, provide you with medical, dental and nursing care that would allow everyone rich or poor, man, woman or child to access care when needed. Seven decades on and the NHS has become a valued national institution and it is heartening to see that the values that were important then still hold true today. Back then, services and health professionals were uniting to work together for the first time under the banner of the National Health Service. They formed new ways of working and innovative partnerships, with the promise of working from revolutionary health centres to accommodate family doctors and which could also offer dentistry and other services on the spot. Now, 70 years later, we are continuing to evolve, design and develop ways in which health and care professionals (such as social care and the local voluntary sector) can work even closer together for the benefit of their local population, in a coordinated and innovative way. By working together and listening to what our communities tell us about their experiences, we can offer people the right support to manage their conditions confidently and appropriately, wherever possible, away from hospital. We all recognise the NHS today is facing some of the toughest challenges it has ever had to address. Increasing demand and pressure on finances and difficulties with recruitment of trained staff are just some of the recurring themes we face. Our role is to ensure people still receive high quality and effective care, shaped by our clinical leaders, workforce and local communities. This is why the CCG this year has started to work even closer together with its health and social care partners, through the Hampshire and Isle of Wight Sustainability and Transformation Partnership (STP) and the Island s Local Care Board, which now has membership from the CCG, Isle of Wight NHS Trust, Isle of Wight Council, One Wight Health (GP Federation) and the Voluntary Sector. The challenges reported in last year s annual report in relation to the performance and quality of health and care delivery on the Isle of Wight have continued. This has been alongside working with partners to plan and deliver the Island s comprehensive health and care service transformational change programme. There have been two key deliverables from this programme during 2017/18; the development and agreement of an acute service delivery option, from the Acute Services Redesign programme, to improve both clinical and financial 6

7 sustainability of services; and a Mental Health Services Blueprint, which will enable the modernisation and improvement of mental health services for local people. As with elsewhere in the country, emergency demand on services, particularly during the winter, have been a challenge with key targets not being achieved such as A&E four-hour waits, ambulance response times and referral to treatment times for elective activity. However, we are determined to learn from this experience and plans are in place to improve performance during 2018/19. During the early part of 2018 the Care Quality Commission (CQC) carried out a re-inspection of Isle of Wight NHS Trust, which is currently in special measures, and has a section 31 notice in place in relation to Mental Health services. Their report is due for publication in June To support and strengthen quality improvement during 2017/18, further joint working arrangements have been put in place between the Trust, CCG and their regulators (NHS England and NHS Improvement). In recognition of the challenges we are facing on 6th December 2018 NHS England gave Directions to the CCG requiring that a Capacity and Capability Review is undertaken to produce an Organisational Action Plan and that a Clinical and Financial Sustainability Plan for the Island s health services is developed. This work has been underway with then plans being developed with our partners. Recognising the strength and value in partnership working, on 1 st April 2018 the CCG joined the Hampshire CCG Partnership. I was delighted to become the CCG s Interim Accountable Officer, and look forward to working with local people and partners to develop our longer term commissioning and leadership arrangements. The Hampshire CCG Partnership was formed on 1 st April 2017, by the CCGs in Fareham and Gosport, North East Hampshire and Farnham, North Hampshire and South Eastern Hampshire. It has a single Chief Executive (Accountable Officer) and a single executive team. This Partnership allows us to work together to share resources and ideas, reduce duplication and identify areas of positive working that could be shared proactively between us. Each of the Partnership CCGs Governing Bodies remains accountable for and focussed on delivery and service improvement for their local population. On a day to day basis, the Isle of Wight CCG is led by its Deputy Chief Officer, Loretta Outhwaite. Looking forward to 2018/19, the CCG has adopted the priorities for the Hampshire CCG Partnership, which reflects what as a Partnership we are able to do at scale to support the design and plan of new models of care in our local community. The aim is to continue to shape services that: support people to stay well, join up care for people with complex needs, deliver integrated urgent and emergency care, have effective step-up and step-down services to prevent unnecessary emergency admissions and get people out of hospital sooner improve specialist care with GPs and consultants working together in new ways. 7

8 As we head into the new financial year, the CCG will continue to work together with both on and off-island health and care partners, to plan and deliver better and more sustainable services for the benefit of the people of the Isle of Wight. Interim Accountable Officer: Maggie MacIsaac Organisation: NHS Isle of Wight Clinical Commissioning Group 24 May Isle of Wight Clinical Commissioning Group The Isle of Wight NHS Clinical Commissioning Group (CCG) was formed on the 1st April 2013 following the changes that took place in the NHS as a result of the Health & Social Care Act One of the key changes involved putting clinicians in charge of commissioning the healthcare services their local community needs for both Island residents and visitors. We work in partnership with colleagues from GP Practices, hospital and community services, social care, the independent and voluntary sectors to maintain and make real improvements to the health and wellbeing of every person on the Isle of Wight. This collaborative approach is key to addressing the unprecedented challenges we are facing as the demand for health services increases. By integrating services so they are more efficient, we will be able to deliver better value for local residents and ensure the sustainability of services. 1.3 Our Island a unique set of healthcare challenges The Isle of Wight is a wonderful place to live and work, but it also has distinct challenges for commissioning healthcare services. The Island has significant health and care needs with nearly a quarter of its population aged 65 and over. As this number increases and residents live longer, more people will be living with long-term conditions (LTC). Currently it is estimated 45,000 (one in three) people locally have one or more LTC such as coronary heart disease, stroke and diabetes. There is also an increasing prevalence of dementia on the Island which will affect 21% of those aged over 65 by With around 16,000 people on the Island suffering common mental health problems there is a need to address the emotional wellbeing of residents. There is signficant economic disparity between areas on the Island which gives rise to corresponding inequalities in health and life expectancies. Commissioning services to meet these challenges places increasing demands on local resources, whilst at the same time there is a requirement to improve quality and make efficiency savings to ensure services are both clinically and financially sustainable in the 8

9 long term. 1.4 Who we are and how we work In 2017/18 the CCG was made up of 16 GP practices supported by a team of commissioning staff. It is responsible for commissioning that is planning, purchasing and monitoring - healthcare services for the Isle of Wight. At the centre of the CCG are four key bodies which are described in detail later in this report. The Membership Council, on which every Island GP practice has a nominated Practice representative and collectively holds to account and sets the strategic direction for the Governing Body; The Governing Body is responsible for overseeing the CCG s commissioning responsibilities and ensuring the group uses its resources effectively to provide quality services which meet the needs of Island residents; The Clinical Executive manages the day-to-day operations of the organisation, and is accountable to the Governing Body; The Primary Care Committee functions as a corporate decision-making body for the management of the delegated Primary Care functions and the exercise of the delegated powers. To ensure clinical input in every level of CCG work, the Island GP practices are clustered into three Locality Groups, each with a population of 30-50,000; North & East, West & Central and South Wight. These groups look at the health needs of their local communities and practices work collaboratively to improve primary care services. For more information about the various bodies and committees visit our website: we are 1.5 What we do We commission services from NHS and independent and voluntary sector providers both on and off the Island. Our vision is to commission high quality, sustainable and integrated services. Together with our partners, we are developing person-centred, coordinated health and social care on the Isle of Wight. We work to maintain and improve the quality of services, to keep patients safe and ensure services can be delivered when and where people need them. We are integrating services to make efficient use of the resources that we have in order to meet the healthcare challenges we face as a community both now and in the future. With the Isle of Wight NHS Trust and Isle of Wight Council, and our partners in the voluntary and independent sectors we aim to put in place the support, information and advice needed to help people improve the way they look after their own health so they can lead longer, healthier and more independent lives. Our Constitution, commissioning plans and other publications can be found on our website: Our financial allocation In 2017/18 the CCG received an in year allocation of 241m for both healthcare programme 9

10 and running costs, which included 3.5m of non-recurrent national funding for My Life a Full Life, the Island s New Care Model (Vanguard) programme. Within its allocation, the CCG is given an annual limit for running costs. For 2017/18 this was 3m and c1.3% of the CCG s total allocation. The running cost allocation has reduced by c15% since the CCG was set up in To provide an overview of how the CCG uses its allocation, Figure 1 below shows its expenditure across the different types of healthcare services for 2017/18. The CCG s two highest areas of spend were: Acute Services (hospital based health services) and Primary Care Services (GP practices and their prescribing of drugs). Figure 1: CCG % spend in 2017/18 Figure 2: CCG % spend in 2016/17 Running Costs 1% Other 3% Running Costs 1% Other 3% Delegated Primary Care 9% Primary Care 23% Primary Care 12% Acute 48% Acute 45% Continuing Care 7% Continuing Care 6% Community 10% Better Care Fund 8% Mental Health 10% Community 6% Mental Health 8% One of the CCG s biggest financial challenges is that its current funding allocation is 11.9% ( 22m) above the target set by the NHS CCG Allocation Formula. For 2017/18 it has meant that the CCG has been given a minimal level of growth funding of 338k (0.16%). If in order to, over time, address this distance from target. The consequence of this is the requirement for the CCG to deliver a higher percentage of savings each year, as the small amount of growth funding received does not cover the impact of inflation and increased healthcare need. If the CCG had received average growth, the funding would equate to 4m. 1.7 Our objectives The Isle of Wight CCG strategic objectives for 2017/18 were: To co-produce with the Isle of Wight NHS Trust and Isle of Wight Council system transformation and sustainability; To meet the finance and performance targets set within the operating plan working with the national allocations team in relation to the funding formula; To demonstrate measurable improvements in the quality and safety of our commissioned services; To develop the culture and governance within the CCG to deliver transformation. 10

11 The Governing Body agreed a number of critical success factors for the strategic objectives. An assessment of how the organisation has met the critical success factors can be found in the performance analysis section 3.3 of this report. 1.8 Key Transformation Programmes The Isle of Wight CCG transformation programmes support delivery of national, regional and local plans such as the Next Steps on the NHS Five Year Forward View (5YFV), the Hampshire and Isle of Wight Sustainability and Transformation Plans, the Isle of Wight Local Care Plan and the Better Care Fund (BCF). The Local System comprises Isle of Wight CCG, Isle of Wight Council and Isle of Wight NHS Trust. Our system wide objectives are as follows: Improved health and social care outcomes. People have a positive experience of care. Person centred provision. Service provision and commissioning is delivered in the most efficient and cost effective way across the whole system, leading to system sustainability. Our staff will be proud of the work they do, the services they provide and the organisations they work for and we will be employers of choice Hampshire & Isle of Wight Sustainability & Transformation Plans Over the past eighteen months, health and care organisations across Hampshire and the Isle of Wight have been working together as a Sustainability and Transformation Partnership to agree how best to meet the many opportunities and challenges facing the local health and care system around the need to empower people to stay well and to provide safe, high quality, consistent and affordable health and care to everyone. The central role of the Sustainability and Transformation Plans (STP) has been to support the local place based plans to achieve the changes that local people and local clinicians have told us they want. The plan does not replace or slow down local transformation programmes. Instead, the Hampshire and Isle of Wight health and care organisations, have come together to do the things that can be best achieved by working in partnership. While people in Hampshire and the Isle of Wight are generally living longer, many are also living with multiple long-term physical and mental health conditions. Too many people stay in hospital longer than they need to because of difficulties in getting the necessary support outside. There are increasing shortages in the number of doctors, nurses and other health workers needed, which the organisations are working in partnership to address. To deliver the STP s shared priorities we are working together across Hampshire and the Isle of Wight in ten delivery programmes: six core programmes focused on transforming the way both physical and mental health and care is delivered, and four enabling programmes to create the infrastructure, environment and capabilities to deliver successfully. The Local Care Plan is our shared system delivery plan for the STP Local Care Plan The Isle of Wight CCG, Council, and NHS Trust have agreed the Island s Local Care Plan which sets out specific priorities that, when delivered, will make the biggest difference to 11

12 services for Isle of Wight residents. These priorities focus on both improvements in hospital based services and the transformation of community based services in line with the new model of care. The Local Care Plan is a two year transformation plan, developed by system partners to drive forward delivery of the new model of care for the Island Health and Care System. Key progress in for each of the six key workstreams is detailed below: a. Acute Services Redesign Programme Significant progress has been made with the Acute Services Redesign programme in 2017/18: The Case for Change was developed and approved for use as evidence to help refine and narrow down the options. Extensive stakeholder engagement was undertaken, including over 50 separate community discussions. In response to public and stakeholder concerns about travelling for health care off Island a travel impact assessment was undertaken. An options evaluation process included a Clinical Reference Group, Local Finance Group and Workforce Group, each using their professional input to help narrow down the options, and On 1 February 2018 the CCG Governing Body approved a Blueprint for the future configuration of acute services to meet the needs of local residents based on the recommendation made by the Local Care Board. The Blueprint requires further detailed development before a business case can be finalised. The CCG will then go through the NHS England Assurance process before formal Public Consultation can start in Spring of b. Co-Ordinated Access Programme The model and specifications for an integrated urgent care service have been developed and agreed. In addition: As part of the urgent care clinical assessment service, national funding has been secured as part of the integrated pharmacy programme to meet patients medication and prescribing needs. 111 software has been upgraded to enable direct booking of GP appointments; a pilot is now underway with 3 Practices in preparation for full roll out late in c. Hospital to Home Programme The Isle of Wight continues to be one of the best performing areas for Delayed Transfers of Care, although further work is still required to improve flow and embed a home first model of care. The following is now in place: New model agreed so that patients can be safely discharged, but have their ongoing needs assessed outside of a hospital bed. Improved communications regarding the health of residents in care homes, which is more easily accessible to ambulance and hospital staff. This is now in place in 17 care homes. New patient admission booklet agreed and in place. d. New Care Model Community Service Redesign Programme 12

13 The CCG Community Service review of Trust services and the first phase of an Integrated Care Community Alliance has been developed. This brings together various organisations delivering care in new ways of working together to deliver services that will achieve common outcomes. The Alliance will commission and deliver the new model of integrated care. Heads of Agreement have been developed. Alliance leadership and management operation to commence April Within the Rehabilitation, Reablement and Recovery programme of work the procurement of Community rehabilitation beds has been completed with implementation underway between April and July Rehabilitation team changes have been agreed to commence delivery against the new specification from April 1 st The Community Wheelchair Service has been successfully re-procured; the new service is now fully operational. e. Mental Health Transformation Programme There has been significant progress on the Mental Health Transformation programme in 2017/18, which includes: The draft Blueprint for Mental Health for the Isle of Wight has been published for final comment following extensive engagement. An overarching tiered model of multi-agency mental health provision has been developed in collaboration with staff, people who use services and other stakeholders. All aspects of the service transformation will be aligned to deliver this model. Pathways of care for Mood & Anxiety Disorder, Eating Disorder, Personality Disorder and Psychosis are being redesigned in line with best practice. The business case for the Rehabilitation, Reablement and Recovery pathway has been approved by the Isle of Wight CCG, NHS Trust and Council. Work is now underway to develop and implement the plans. Following extensive engagement and joint working on community mental health services, proposals are being developed for mental health wellbeing and recovery, incorporating day services, employment support and self-help. The Safe Haven at Quay House is up and running, providing a safe place for people approaching a crisis, offering a preventative approach to mental health issues, and reducing the number of people resorting to A&E in crisis. f. Learning Disabilities Transformation Programme There has been significant progress and achievements on the Transforming Learning Disabilities programme which include: A draft Learning Disabilities commissioning strategy has been agreed following full coproduction and consultation with people with a learning disability. Specific data on learning disability is now published as a specific fact sheet within the Joint Strategic Needs Assessment (JSNA). A successful bid to the Department of Health for the purchase of independent living units for people with a learning disability has been made. The Shared Lives service has been developed, in which people with care needs are matched with an approved shared lives carer, so they share the same accommodation. A Personal Assistance noticeboard has been launched to enable those seeking a personal assistant to advertise their needs to accredited personal assistants. 13

14 1.8.3 Five Year Forward View The Next Steps on the NHS Five Year Forward view sets out the NHS main national service improvement priorities for within the constraints of achieving financial balance across the health service. Progress on key deliverables which do not sit within the Local Care Plan priorities above are set out here: a. System Resilience The System-wide winter plan was successfully co-ordinated and implemented, including: Improved system management of demand and capacity surge and escalation. An electronic system management and alert tool (SHREWD) is now operational, informing daily system-wide decision making b. Primary Care The focus for primary care has been local implementation of GP Five Year Forward View and the locally agreed Primary Care Strategy; notable achievements are as follows: Improved access and seven day working focusing on the delivery of weekday and weekend access to routine and urgent consultations for Island residents. GP and nurse appointments are available as both face to face or telephone consultations. Local implementation of the National Diabetes Prevention Programme involving six trail blazer practices on the Island. The purpose of the programme is to deliver behavioural and lifestyle intervention services for people who have been identified as being at high risk of developing Type 2 Diabetes. Practices are now close to completing a work programme, supported by the Island GP Federation, aimed at workflow optimisation. A number of practices are demonstrating a quantifiable reduction in the time GPs are spending on clinical administration. Quasar (a tool used in the reporting and monitoring of quality within primary care services)is being implemented. The Primary Care Quality committee is in the process of being established. c. Planned Care Cancer The Wessex Strategic Clinical Network has become the Wessex Cancer Alliance. The CCG has supported this development, and worked collaboratively to support the successful bids for various projects against the national Cancer Transformation Fund. Maternity The CCG has supported the work across Wessex to support establishment of a Local Maternity System to implement the vision outlined in Better Births and the Five Year Forward View. Commissioners have been involved in a pilot with the NHS Trust, engaging stakeholders and service users, including pregnant women and new mums, to test whether the Fifteen Steps Challenge a toolkit for improvement and innovation - can be adopted for use in Maternity Services. d. Dementia 14

15 Work has commenced to update the Isle of Wight Living Well with Dementia Strategy and amended to include Older Peoples Mental Health. The business case for the re-provision of Older People s Intensive Support and beds pathway has been approved by the Isle of Wight CCG, NHS Trust and Council. Work is now underway to implement the plans. e. Children and Young People The CCG has completed a series of workshops with partners, families and young people to inform and refresh the Isle of Wight Children and Young People s Mental Health Local Transformation Plan. The CCG intends to develop a single point of access for Improved Access to Psychological Therapies from This has been shared with the Isle of Wight NHS Trust, Barnardos and the Isle of Wight Youth Trust, and was approved by CCG Clinical Executive. The CCG has worked closely with the Isle of Wight NHS Trust to commission a NICE compliant Autism Assessment and Diagnostic service and a joint proposal has been developed to address the significant backlog of referrals as well as respond to new referrals. The Primary Care Committee approved the Children and Young People s Autism Spectrum Assessment and Diagnostic Local Incentive Scheme for GPs to undertake the screening and referral process. The Paediatric Assessment Unit capital business case has been approved and a draft specification has been shared with the Isle of Wight NHS Trust. f. Urgent and Emergency Care Delivery Plan The Island has developed a local Urgent and Emergency Care (UEC) Blueprint for the implementation and delivery of the 7 pillars of the National UEC Delivery Plan: Ambulance 111 Online 111 Telephony GP Access Urgent Treatment Centres Hospital (flow) Hospital to Home This future model has been designed to meet local need, based on national best practice, to ensure quality, access and affordability, whilst achieving the best possible experience for the patient. This is being developed and delivered as part of the Local Care Plan Hospital to Home and Coordinated Access Programmes, the Integrated Improvement Framework and the Better Care Plan, as a system wide response from health, adult social care and the voluntary sector Better Care Fund (BCF) and Improved Better Care Fund (ibcf) The BCF is a single pooled budget for local health and social care services which has been created as a national requirement to drive greater integration of commissioning and provision. As of 2017 this also includes the Improved Better Care Fund (ibcf), new, time-limited funding to support system transformation, which tapers off over the next 3 years. 15

16 The total BCF fund is: m, including ibcf 3.2m m, including ibcf 2.1m Our approach for was to use the combined BCF & ibcf resource to support whole system change and transformation. The Isle of Wight system was supported to develop an outcomes focussed BCF plan, aligned under 3 headings: Building Individual and Community Resilience; Developing, Regaining and Sustaining Independence; Living as Independently as Possible. The Local Care Plan has taken account of the BCF planning process for 2017/19 and has mapped the three key BCF outcomes and the individual schemes against the six Local Care Board priorities. Our plan for 2018/19 will be to further develop implementation plans to build on the work already started, particularly with our new models of care. The BCF scheme funding breakdown for 2017/18 is shown in the table below: Table 1: Better Care Fund Schemes 2017/18 BCF FINANCES 2017/18 CCG Contribution Council Contribution Total LOCALITY / COMMUNITY MODEL 8,035 2,654 10,689 HOSPITAL TO HOME ASC DELIVERING CARE CLOSE TO HOME CARERS LIVING WELL SUPPORT FOR PROVIDERS PROMOTING INDEPENDENCE (EQUIPMENT) REHABILITATION, REABLEMENT & RECOVERY INTEGRATED MENTAL HEALTH PROVISION LEARNING DISABILITY SERVICES (LD) 1,126 2,772 3,899 5,319 1,995 7,314 1, , ,601 7,010 EMPLOYMENT SUPPORT PROTECTION OF ADULT SOCIAL CARE CARE ACT , ,213 TOTAL 18,689 17,188 35,878 The Council was awarded 3.2m in ibcf funds for 2017/18; this decreases to 2.1m in 2018/19 and to 1.08m in 2019/20. As highlighted above, these funds have been used to implement the key priorities set out in national guidance around: reducing delayed transfers of care; providing 16

17 support for providers; and addressing pressures in adult social care. These additional funds have also been used to secure improvement in local demand management (e.g., by delivering assured access to a co-ordinated early help offer across the voluntary and community sector), increase the levels of care delivered in people s own homes (e.g. the levels of home based reablement) and raise professional practice and leadership standards across providers. The Local Care Board (LCB) oversees the BCF, including the financial, performance and risk aspects. The LCB reports to and is accountable to the Isle of Wight Health and Wellbeing Board. (see section 3.9) 1.9 Factors affecting Future Performance For 2018/19 the CCG has received an allocation of 234.9m. Under NHS England s CCG funding formula, the CCG s core services allocation for 2018/19 is 8.72% ( 16m) above target, which means that until the percentage falls to below 5%, the CCG will receive minimum growth funding each year. This has reduced the distance from target gap for 2017/18 to 11% due to inflation not being funded thus closing the gap. For 2018/19 the CCG has therefore only received growth funding of 0.1m (0.1%). The CCG has been allocated 1.5m of the additional 600 million national funding which has been be distributed to CCGs on a fair shares basis. The CCG is actively working with the NHS England national allocations team to understand and address the causes of the Island s significant distance from target allocation. The Interim financial plan as signed off by the Governing Body on 29 March delivers a breakeven position for 2018/19. Because of the significant financial challenge for the Isle of Wight system the interim financial plan has unmitigated risks of 8.4m. The control total of breakeven has been set at Strategic Transformation Partnership (STP) level. Any cost pressures or overspending areas for 2017/18 have been taken into account in the financial planning for 2018/19. To illustrate how the CCG s spending plans support its strategic objectives table 2 below provides an overview of the 2018/19 financial plan. 17

18 Table 2: Summary of Interim Financial Plan Revenue Resource Limit /19 Recurrent 234,787 Non-Recurrent 150 Total In-Year allocation 234,937 Income and Expenditure Acute 112,702 Mental Health 24,657 Community 23,312 Continuing Care 16,373 Primary Care 28,846 Other Programme 2,710 Primary Care Co-Commissioning 22,081 Total Programme Costs 230,681 Running Costs 3,081 Contingency 1,175 Total Costs 234,937 Underspend/ (Overspend) 0 2. Performance 2.1 Performance against NHS Constitution targets Patients to start treatment within a maximum of 18 weeks from referral Achieved: 83.55% Target: 92% Performance improved ahead of the planned recovery trajectory in the first half of the year meaning the waiting list reduced considerably, however the second half was impacted by the onset of Winter pressures reducing bed availability for elective operations. Patient choice has been promoted with the use of mainland providers as alternative sites for treatment, however, issues with capacity at the two nearest mainland Trusts has limited the benefit gained from use of these Trusts. Patients admitted, transferred or discharged within 4 hours of arrival at A&E Achieved: 85.17% Target: 95% Accident and Emergency services have continued to be affected by the problems of patient flow through the local hospital and into community settings. Despite investing in additional contingency capacity over winter months throughout the health and care system, performance did not materially improve. The System Resiliance Group continue to monitor and improve plans. In comparison recent months demonstrate comparable performance rates to the national average. Max 62 day wait from urgent GP referral to first definitive treatment for cancer Achieved: 77.48% Target: 85% Six of the nine cancer treatment pathways consistently met the National target in 2017/18 with an overall achievement of seven targets for the year. 18

19 2.2 Quality The CCG continually monitors the reasons that patients did not receive treatment within 62 days. This is often as a result of complex treatment requirements, delays to capacity or the transfer of patients between the Isle of Wight NHS Trust and mainland specialist cancer centres. Patient choice also continued to feature as a cause for missing the intended time period for treatment, particularly at the earlier 2 week referral point. Ambulance response Times (Category A, Red1 within 8 minutes) Achieved: 60.21% Target:75% There are a number of targets for ambulance in respect of response times for catagories of calls. The service failed to meet the target for the 3 key measures including Category A Red 1 due to capacity issues and consequential delays in handing patients over to the Accident and Emergency Department. The number of reported incidents have increased. There has been a focus on improved planning of ambulance services and also interaction with Accident and Emergency to reduce handover delays at the Trust to help improve the response times achieved. New National performance measures and indicator sets will be reported on from April Diagnostics, People should wait less than 6 weeks for tests Achieved: 97.91% Target: 99% Performance for diagnostic tests was affected by two significant issues in 2017/18 : a backlog in audiology tests at Portsmouth Hospitals NHS Trust in the summer and on-going delays to colonoscopys at the Isle of Wight NHS Trust. There is a local shortage of qualified staff staff which is compunded by a National shortage of specialists in this field. Performance for the latter demonstrated recovery in the third quarter of the year as has the overall rate for performance. Considerable local service transformation is underway across our challenged health economy. The CCG remains focussed on assuring quality of service provision; which includes robust monitoring of patient safety, patient experience, effectiveness of clinical outcomes and staff experience. With the Isle of Wight NHS Trust currently under Special Measures, considerable emphasis continues to be placed on gaining assurance, whilst supporting the Trust, to ensure compliance with regulatory requirements. As part of the response to the Care Quality Commission (CQC) findings, the Trust has launched a getting to good leadership and culture programme. This programme aims to ensure the exiting from special measures and continuation of the improvement journey, with the anticipation of being rated good by CQC by The CCG supports this programme and in recognition of the support required, has bolstered its quality and safeguarding team. We have also recruited Mental Health and Infection Prevention and Control Specialists. Quality Assurance and Improvement Systems A number of forums exist across Wessex and the STP footprint seeking confirmation of quality assurance. The Hampshire Isle of Wight (HIOW) Quality Board and the HIOW Health and Wellbeing Group provide strategic, political and clinical oversight. The Wessex wide Quality Surveillance Group, Primary Care Quality Hub and the Safeguarding forum, also provide additional system wide assurance. 19

20 3. Performance Analysis 3.1 Performance The CCG monitors a series of NHS Constitutional Targets that are set nationally. These primarily cover waiting periods for treatments and response times for emergency services. Performance across the system has been disappointing this year due to capacity pressures throughout the health and care system. Progress with major service change has started and is being scaled up to deliver the fundamental system transformation required to improve care for patients. A summary of performance against the key targets is shown below: Table 3: NHS Constitution achievement 2017/18 Up to the end of January 2018, the CCG had reported 131 breaches of mixed sex accommodation (MSA), the majority (127) of which had occurred at the Isle of Wight NHS Trust. The rise in numbers (compared with 2016/17), has resulted from a revised methodology for the counting of MSA being applied in 2017/18, with patients that have ended their period of 20

21 treatment in critical care now being captured i.e. this is now reported as a Mixed Sex breach if there is no appropriate bed available within 4 hours, since the patient should be returned to a stepdown/general ward with the appropriate facilities, as the privacy and dignity of those both recovering and still requiring critical care could otherwise be compromised. There have also been nine individuals who waited on trolleys in A&E for more than 12 hours and 16 patients waiting more than 52 weeks for an operation or procedure both measured against a target of zero. Performance against Cancer 62 day waits has been inconsistent across the year, but Ambulance performance failed to meet target for the majority of 2017/18. The service has been reviewing plans for complying with the new national Ambulance Response Programme and is working on solutions to report against the new standards prior to the installation of a new Computer Aided Dispatch (CAD) system. Initial indications are that the service is performing relatively well against a number of indicators within the set of new standards although failing the old standards. Trajectories for 2017/18 reflect a step change of improvement aimed at recovering and sustaining performance at the constitutional standards. These trajectories are supported by agreed action plans and capacity plans. 3.2 Financial Performance The CCG s financial plan and budget for 2017/18 was developed in line with the CCG s Strategy and Operational Plan and were approved by the Governing Body. In recognition of the CCG s unprecedented financial challenge NHS England have provided non-recurrent support in 2017/18 of 2m which has off-set the non-delivery of QIPP and overspends supporting the CCG to meet its financial targets in 2017/18. Although the CCG achieved a break-even position for 2017/18, the CCG has an underlying deficit of 2.4m to be addressed in 2018/19. As demonstrated in Note 26 of the annual accounts, for the reporting period, the CCG met all of its financial duties against the in-year allocation. As set out in the 2017/18 NHS Planning Guidance, CCGs were required to hold 0.5% ( 1.037m) to be released to the bottom line to support the National position as part of the business rules. In 2017/18 there was also a further requirement to release benefits of lower drug prices to the bottom line ( 237k). Therefore, to comply with this requirement, NHS Isle of Wight CCG has released its 0.5% reserve and drug benefit to the bottom line, resulting in a surplus for the year of 1.276m. To achieve its financial position, the CCG planned Quality, Innovation, Productivity and Prevention (QIPP) savings programme was 12.9m (5.6%) The CCG delivered savings of 8.2m. (Further details are in Section 3.2) 21

22 Table 4: Financial plan variances YTD Budget ( 000) YTD Actual ( 000) YTD Variance ( 000) Notified Resource limit 241, ,020 0 Application Acute 110, ,357 (845) Mental Health 20,460 21,886 (1,425) Community 9,144 11,068 (1,925) Better Care Fund 17,811 18,013 (201) Children's 2,097 2, Continuing Care 14,870 15,157 (287) Primary Care 55,043 54, Other Commisioning Schemes (196) (694) 498 Vanguard funding 3,546 3,546 0 Reserves 3, ,606 1% Risk Reserve 1, ,037 Total 7,993 2,852 5,141 Running Costs 3,090 3,087 3 Total Application of funds 241, ,744 1,276 Surplus 0 1,276 1,276 A summary of the key variances to the 2017/18 financial plan is as follows:- Savings (QIPP) schemes, in relation to Isle of Wight NHS Trust associated schemes under achieved in 2017/18. The total savings target in relation to the Trust was 10m, of which 6m was taken out of the contract at the start of the year. In terms of the CCG position these 6m savings have been achieved in 2017/18. The balance of 4m was part of a risk share agreement with the Trust with the agreement that when savings were realised they would be removed from the contract. Due to a range of factors in 2017/18 these savings were not delivered; Acute Services 845k overspend Isle of Wight NHS Trust QIPP under-delivery 1.7m was off-set by an underspend on the Mainland NHS contracts of 0.5m and Non-Payment by Result drugs 0.5m which are outside routine costs and an underspent on Winter Pressures of 0.7m; Mental Health 1,425k overspend Isle of Wight NHS Trust QIPP under-delivery of 652k and an overspend on the special placement budgets and Non NHS providers of 617k; Community 1,925k overspend Isle of Wight NHS Trust QIPP under-delivery of 1,783k and overspends with Non-NHS community providers of 150k; Better Care Fund 201k overspend Isle of Wight NHS Trust QIPP under-delivery of 159k and back-log costs for wheelchair equipment of 31k; 22

23 Continuing Healthcare (CHC) overspend of 287k - CHC have delivered QIPP savings of 200k against a target of 600k. A change programme was introduced to transform processes and achieve improved outcomes in relation to both quality and cost. This work is on-going Primary Care 741k underspend - Urgent Care Centre overspend of 677k due to cost pressures for the Isle of Wight NHS Trust in providing the service. This was offset by an underspend of 697k on the transformational primary care funding. An allocation of 899k was received in 2017/18. The GP extended hours working commenced in October and targets were met even though the allocation was not spent in full. In terms of delegated Primary Care there was an underspend 120k on premises grants due to a delay in implementation, 300k underspend due to premises allocations being higher than cost and 216k planned underspend in relation to Delegated Primary Care s contribution to the 1% contingency and 0.5% risk reserve as per the business rules. Other 5.1m underspend - release of the 0.5% ( 1.037m) to improve CCG s bottom line in line with business rules, total non-recurrent support received in 2017/18 to support bottom line and 500k of un-utilised balance sheet items relating to 2016/17. The budget also includes the non-recurrent support which off-sets overspends described above The CCG has remained within its running cost allocation for 2017/18 which is a statutory requirement to do so. Quality, Innovation, Productivity and Prevention (QIPP) To meet the planned break-even position, the CCG achieved a 8.2m Quality, Innovation, Productivity and Prevention (QIPP) savings programme. The QIPP target for 2017/18 was 12.9m (5.6%), which is 2-3 times the level usually achieved by the CCG, due to a combination of minimal growth (c 300k) funding for 2017/18, increasing demand for healthcare services and an inability to deliver sufficient recurrent savings in 2016/17. To recognise the risk around the delivery of the savings (QIPP) schemes relating to the Isle of Wight NHS Trust, a risk-share agreement was put in place to cover the 10m savings plan, where it was agreed that the CCG would apply 6m (c60%) of the savings to the 2017/18 contract. In relation to the remaining 4m savings, the agreement was that they would be applied as and when further confidence in delivery and ability to stretch has been secured. A summary of the schemes delivered is provided below. 23

24 Table 5: Summary of 2017/18 QIPP savings schemes year-end position Cash balance In relation to cash, at the year end, the CCG had a cash balance of 79k. In accordance with NHS England cash management policy CCG s were allowed to retain up to 1.25% of their March cash drawdown, which equated to 224k for the Isle of Wight CCG. The CCG did not have any capital allocation or expenditure. 3.3 CCG Performance As part of the Governing Body Assurance Framework (GBAF), the Governing Body set critical success factors against which the organisation monitors its progress. The following table offers Governing Body s assessment of progress against these factors: Table 6: CCG performance against objectives Objective 1: To co-produce with the Isle of Wight NHS Trust and Isle of Wight Council system transformation and sustainability Critical Success Factor To co-produce system transformation and participate effectively in the local delivery system planning processs ensuring delivery of all plans the CCG has agreed to lead in Achieved Partially achieved Not achieved Evidence Partially achieved Key progess has been made in the six workstreams Acute Service Review Co-ordinated access Hospital to Home Community Service review Mental health transformation Learning Disabilities transformation 24

25 To complete the Acute Service Re-design project to the agreed project plan and ensure that the CCG has undertaken all actions within its power To lead the mental health re-configuration programme and the mental health five year forward programme To implement the project plans with the GP Five Year Forward view and the local primary care strategy Achieved Achieved Achieved Case for change developed. Stakeholder engagement led to a travel impact assessment. Options evlauation process led to a number of options. Governing Body approved an option to be developed into a fomal business case The draft Blueprint for Mental Health for the Isle of Wight has been published for final comment following extensive engagement. An overarching tiered model of multi-agency mental health provision has been developed in collaboration with staff, people who use services and other stakeholders. The CCG implemented 7 day working from Oct 2017 A workforce survey has been carried out and signposting training for receptionists has been procured Priority estates projects are being taken forward Transformation funding has been made available and allocated Objective 2: To meet the finance and performance targets set within the operating plan working with the national allocations team in relation to the funding formula Critical Success Factor To meet the NHS Constitution targets Achieved Evidence Partially achieved Not achieved Not achieved A&E - 4 hour wait standard failed to meet the 95% target due to continued system wide pressures. Diagnostics - Diagnostics failed due to capacity issues at both the Isle of Wight Trust and Portsmouth Hospital but has since recovered the backlog. Ambulance - failed to meet the 3 key measures including Category A Red 1 due to capacity issues and delays in patients handover to the Emergency Department. New standard will apply in 2018/19 Cancer - Out of the nine cancer pathway targets the key target of 62 days urgent referral to treatment was missed predominantly due to capacity or the transfer of patients between the IOW Trust and mainland specialist cancer centres. RTT - 18 Weeks Referral to Treatment. This was ahead of plan until December when elective treatments were cancelled to ensure capacity for emergency care. This was in line with national directives. 25

26 To achieve financial balance and deliver the QIPP programme Partially achieved The CCG delivered a surplus of 1.276m; the inyear balance was achieved but the QIPP plan was not delivered in full and this will have implications for 2018/19. Objective 3: to demonstrate measurable improvements in the quality and safety of our commissioned services Critical Success Factor To take all the actions available to the CCG to ensure the provider compliance with the Health and Care Act 2008 regulations and standards Achieved Partially achieved Not achieved Evidence Partially achieved A number of CQC inspections of providers of our commissioned services have been carried out and whilst a number of commissioned services have been assessed as providing good or outstanding services, the largest provider of commissioned services, the Isle of Wight NHS Trust, has been rated as inadequate. The CCG has provided a great deal of support to the Isle of Wight NHS Trust, particularly with regards to Mental Health Services where a Mental Health Clinical Quality Lead has been appointed to ensure appropriate specialist input and support is provided. The CCG has also supported in a number of other ways such as assisting in revising processes, attending assurance visits collaboratively with the Trust, and providing training in areas such as the Mental Capacity Act. Whilst undertaking this support to the CCG has continued to undertake its assurance role, including monitoring contractual requirements and CQUIN achievements. The CCG has continued to monitor and support commissioned services across all providers via their quality schedules and with regular meetings to discuss quality and performance. 26

27 Objective 4: To develop the culture and governance within the CCG to deliver transformation Critical Success Factor To develop and improve the governance framework within the CCG to take account of the Local Delivery System and System Transformation Partnership To improve stakeholder and staff engagement in support of the organisation s objectives and key work programmes Achieved Partially achieved Not achieved Evidence Partially Achieved The CCG commissioned a governance review and as a result of NHS England directions has also had capacity and capability review. The recommendations from this review will inform the changes to the local governance arrangements. The CCG has joined the Hampshire Partnership which will help to develop commissioning at scale for some healthcare and is a member of the Local Care Board to focus on commissioning local services for the Island. Partially achieved A new communications team have been put in place and a regular staff newsletter is now in place. A new communications strategy has been drafted and a public and patient involvement policy is being finalised. 3.4 CCG Assurance Framework 2017/18 A new CCG Assurance Framework was introduced in 2016/17 which has continued through to 2017/18. This focusses around key facets of our functions which are: Leadership and Sustainability that are rated by our Regional NHS England Team based on assessments of areas such as the CCG s financial position and plans along with the strength of our relationships, engagement and governance. Better Health and Better Care based on the assessment of 43 different clinical performance indicators which are benchmarked against all other CCG s. Many of these are grouped around key clinical priorities such as Dementia, Mental Health and Cancer. For the year 2016/17 the overall final position of the CCG published in July 2017 had been rated as Requires Improvement. The full and latest indicator ratings can be found on the: This included Leadership and Sustainability both rated as Amber. In respect of the clinical priorities Dementia was rated as outstanding, Cancer Needing Improvement and Mental Health Needing Improvement. The indicator ratings are updated at various stages of the year and final ratings for 2017/18 will be published around July At the time of publishing the annual report ratings up to Quarter 3 were available. 27

28 Table 7: Summary of CCG Assurance framework at the end of quarter 3 Domain Number of indicators IOW CCG in best quartile IOW CCG in worst quartile Better Health Better Care Sustainability Leadership Total Sustainable Development Background The CCG is committed to purchasing health care in a way that supports the UK sustainable development agenda and contributes to environmental improvements, regeneration and reducing health inequalities Policy and governance As part of its Sustainability Policy the CCG is committed to the concept of holistic commissioning, which actively takes into account the determinants of health that affect individuals, groups and the wider population of the Isle of Wight. The CCG works to a strategy and framework to ensure that our commissioning processes such as service design, tendering and contracting takes account of environmental sustainability and social value of services at the same time as improving quality Sustainable Development Management Plan In line with the SDU requirements, the CCG has a Sustainable Development Management Plan (SDMP) and strategy to progress the sustainability agenda. This plan was created jointly with the Isle of Wight NHS Trust. In the last year we have continued to promote the principles of sustainable development throughout the organisation especially through the My Life a Full Life Programme. This programme helps people to manage their own health and wellbeing whilst improving the quality of care and support that services provide. The CCG is housed in an energy efficient building with energy and water efficient technologies and has a bike pool for staff travelling short distances. The CCG has an effective recycling scheme whereby under desk bins have been removed and replaced with shared waste stations. As a result 50% recycling rates for premises were achieved. Systems are in place to recycle batteries and toners and cartridges, electronic and electrical waste. 28

29 3.6 Improve Quality The CCG has a duty under the Health and Social Care Act 2012 (section 14R) to improve the quality of the services that it commissions Quality Assurance On island, scrutiny arrangements are extensive. The Quality Improvement Plan Oversight Group (QIPOG) is a joint NHS Improvement and NHS England meeting, which aims to hold the Isle of Wight NHS Trust to account while the Trust is in special measures and also seeks assurance from Island system partners. Formal quality monitoring by the CCG of the Trust s performance occurs at the quarterly Clinical Quality Review Meeting (CQRM). Internal CCG quality oversight is primarily undertaken through the Quality and Patient Safety Committee (QPSC), a sub-group of the Governing Body. To enhance assurance arrangements and reduce duplication within the system, the CCG plan is to use this Committee as a vehicle to consolidate system-wide quality assurance and service improvement monitoring. A proposal has recently been approved to combine the existing functions of the QPSC with those of the Isle of Wight Local Care Board (LCB) Quality Group, to create a single forum for system wide oversight. This system-wide Quality Committee will be comprised of providers and commissioners, include service user representation and would be chaired by a lay member Quality Frameworks The CCG has been developing Quality Frameworks across all of our commissioned services. These Frameworks, which will be introduced early in 2018/19, aim to enhance our confidence and certainty by reviewing information and data gathered through a number of different routes. This will include gathering feedback from those who use the services and also those who visit, but also take account of the views of visiting professionals. Other data sources will include information being reported by the Providers via contractual or regulatory reporting systems. The CCG also gains assurance through undertaking site and individual service visits to observe day to day operational services and evidence of safe practices Primary Care As the CCG has delegated authority for Primary Care, it is now responsible for monitoring the quality and responding to concerns from General Practices. As independent Providers, Practices remain accountable for the quality of their services and must have their own quality monitoring systems in place. However, as commissioners, the CCG is responsible for the oversight of Quality Assurance within this sector. A key area of the CCG focus has been the development of a Quality Framework, which will provide an essential underlying structure to quality surveillance activities. The Quality Surveillance and Reporting tool (QUASAR), which is an electronic data capture system for collating quality measures and intelligence, is being rolled out within General Practice to help implement the NHS England Serious Incident Framework. This system enables early sign-posting of service failure and identifies priority areas for improvement. A Primary Care Quality sub-group, reporting to the Primary Care Committee (PCC), is being launched as a forum that will focus on Quality Assurance and Improvement activities. This Committee will develop systems, processes and working relationships, ensuring quality monitoring is robust and consistent. 29

30 3.6.4 Care Homes and Homecare Services Substantial progress towards an integrated approach to quality oversight of these services has been achieved during 2017/18 by the CCG and the Isle of Wight Council. An integrated Quality Team is in place to develop a robust method to understand quality and safety issues within these commissioned services. Developmental work and testing has been underway since the third quarter of 2017, in preparation for the implementation of a new Quality Framework from April The Quality Team is working with Healthwatch Isle of Wight to engage with Experts by Experience as part of the monitoring process. They will undertake joint service level visits with the Quality Team, and gather feedback from service users, through structured interviews, questionnaires and the use of comment cards. The team is also exploring options for electronic feedback via web-based solutions Mental Health Services Quality Assurance within Mental Health Services ensures that there are systems in place to monitor and address people s experience and engagement, people s safety and the clinical effectiveness and outcomes of the services provided. The CCG s current priorities focus on gaining assurance and supporting the Isle of Wight NHS Trust in addressing the Section 31 and Regulation 17 requirements resulting from the CQC s inspection visits during 2016/17. As a result of the enforcement action, the CCG has undertaken a gap analysis mapping CQC identified deficits within the IOW NHS Trust s services, to extensive action plans. Oversight of these plans forms a large part of the current assurance processes. As with all of the other commissioned services, a Quality Framework is being developed for Mental Health, Learning Disability and CAMH services. Local Quality Indicators are being developed to provide additional assurance. As with other services, announced and un-announced service-level assurance visits are also undertaken Infection Prevention and Control To enhance the CCG s existing resource, from October 2017 the CCG has recruited an experienced Infection, Prevention and Control (IPC) Nurse Specialist through a Service Level Agreement with Southampton City CCG. This post provides oversight and leadership, and is supported by a new band 6 nurse specialist developmental post. Priorities include: Development of an IPC program geared to the needs of the CCG; based on the revised Code of Practice 2015 Ensuring that infection, prevention and control is embedded within the wider commissioning process and detailed within contracts. Embedding IPC within the wider Quality Framework for services, also linking with the Medicines Optimisation team s oversight of Antimicrobial Stewardship. Establishing IPC pathways in primary care; Nursing Home; and Social Care Home providers; To complete the work of the Task and Finish group focused on urinary catheters; this will aid drive the stated aim of reducing Gram-negative Blood Stream Infections (GNBSI) 30

31 3.6.7 Safeguarding Safeguarding Adults, Children and Looked after Children (LAC), continues to be a priority for the CCG. In 2017/18 finding adequate resources to support safeguarding functions has been a significant challenge across our health economy, particularly across Primary Care and the Safeguarding Adult Team in the Isle of Wight NHS Trust. However, clear improvements have been made in 2017/18. These improvements have included; The CCG Head of Safeguarding and Designated Nurse for Safeguarding Adults, Children and Looked after Children, is providing a leadership role across both the CCG and the Isle of Wight NHS Trust. This new model will help improve understanding and provide enhanced safeguarding practice, with staff integrated into one safeguarding team for health. Recruitment of a Primary Care Lead Nurse for Safeguarding for a period of one year to support GP practices with safeguarding processes for adults and children. This will ensure timely responses for safeguarding enquiries, and liaison with other services supporting safeguarding. Development of a more engaged model for working with the nursing home, care home and the Domiciliary Care Sector, focused on quality improvement and support. Aimed at supporting system resilience across this sector and minimising the threat of Provider closure or placement restrictions, due to quality issues. Improved governance systems and processes which will improve the quality of information being shared with the Isle of Wight NHS Trust and CCG Executive and Board members, ensuring that they are fully sighted on the issues of concern. Being integrated with the Trust, the Head of Safeguarding and Designated Nurse for Health will be able to comprehensively represent the overall health sector, ensuring the sector remains abreast of all key issues and changes to legislation Continuing Healthcare In May 2017 a full review of the Continuity Health Care (CHC) and Specialist Placements service was undertaken by the CCG. This review identified specific challenges relating to the resourcing and capability within these work streams. The NHS Continuing Healthcare Strategic Improvement Programme (CHC SIP) was launched in April 2017, in order to provide fair and equitable access to NHS Continuing Healthcare in a way which ensures better patient outcomes, better experience and better use of commissioning resources. To enable the delivery of the CHC SIP programme together with improved patient experience, an extensive transformation plan has been developed and is being implemented Earl Mountbatten Hospice Training Programme To drive forward the quality improvement agenda and increase support for Care Home and Homecare Providers the CCG and Isle of Wight Council have been working with the Earl Mountbatten Hospice to create a bespoke training programme, which will be delivered over the next 3 years. This initiative, funded through the Improved Better Care Fund (IBCF), will focus on the raising of standards across the whole independent sector market place, supporting Providers to improve quality and safety Commissioning for Quality and Innovation (CQUIN) All current CQUIN indicators are nationally prescribed, and as an integrated provider the Isle of Wight NHS Trust is participating in all of the schemes. We are also working with Care Homes 31

32 and The Earl Mountbatten Hospice on the delivery of CQUIN schemes where appropriate. Current schemes, which for the first time have been designed for implementation over a two year period, have been designed to support the ambitions of the NHS Five Year Forward View. We will be continuing to monitor delivery of CQUIN schemes, and will be ensuring updated guidance being released for the second year of the schemes in 2018/19 is adhered to Complaints and Concerns The CCG encourages feedback, positive and negative, so that improvements can be made based directly on the concerns of patients and the public. During 2017/18 the CCG received 11 formal complaints which were managed in line with the NHS complaints procedure. Of the complaints raised six were in relation to delays in treatment following changes to commissioned providers, and two related to Continuing Health Care. There were 79 concerns received by the CCG during the same period. The main areas were waits for appointments, changes to commissioned services and concerns related to provider services at the Isle of Wight NHS Trust Serious Incidents The CCG performance manages and quality assures serious incidents relating to any NHS or independent provider with which it has a contract. Incidents are managed in line with the NHS England Serious Incident Framework. Throughout 2017/18 the CCG has had oversight of 149 serious incidents occurring at the Isle of Wight NHS Trust (compared to 60 the previous year), 8 serious incidents declared within Primary Care and 6 serious incidents occurring at providers other than the Isle of Wight NHS Trust relating to Isle of Wight patients Medicines Optimisation Prescribing is the most common intervention in the NHS across all sectors, and after staffing costs, accounts for the second highest area of expenditure in the NHS. Medicines optimisation encompasses clinical assessment, monitoring and review of individual patients, medicines delivery services, review of repeat prescribing systems, clinical audit, health education, risk management, disease prevention, formularies, guidelines and prescribing indicators. This activity ensures that the right patients get the right choice of medicine, at the right time. The Medicines Optimisation Team work to ensure that medicines within the CCG are prescribed safely, effectively and provide value for money. There are a team of pharmacist s technicians and nurses based in GP practices who work closely with GPs. Areas of particular focus during 2017/18 has been work with GP practices to review the list of medicines that patients are prescribed (polypharmacy), assessing variation in antibiotic prescribing, work within care homes and with domiciliary care providers to further improve the management of medicines through education, and providing more access to medicines through community pharmacy. Polypharmacy: There has been national recognition that Polypharmacy, the term given to the concurrent use of several medicines by one individual, can lead to adverse reactions, side effects, medicine interactions and impaired quality of life. During 2017/18 GP practices and CCG pharmacists have teamed up to systematically assess the medicines of patients as part of a Polypharmacy Scheme. More than 3,000 reviews (which is 2% of the island population) have 32

33 been undertaken which has resulted in patients having more streamlined medicine regimes with a significant reduction in medicines waste and improved quality of medicines taking. Reducing variation in antibiotic prescribing: Antibiotics are medicines used to prevent and treat bacterial infections. Antibiotic resistance occurs when bacteria change in response to the use of these medicines. Antibiotic resistance is therefore a major risk and the World Health Organisation have highlighted tackling antibiotic resistance is a high priority. GP Practices and the medicines optimisation team have been focussing on safer use of antibiotics, the aim being to reduce variation in prescribing and therefore resistance on the island. Peer review and benchmarking has been used to drive further improvements and has resulted in a reduction in prescribing variation. Care Homes/Domiciliary Care Providers: The Medicines Optimisation Team has developed medicines management training, accredited by the Nursing and Midwifery Council (NMC) specifically for care staff. This has been rolled out to care staff and during 2017/18 more than 400 staff have been trained. Feedback and satisfaction has been excellent and the team plan to further extend the training in 2018/19. Improving access to medicines: Contracts with community pharmacies have been reviewed resulting in additional medicines being made available for smoking cessation and minor ailments. 3.7 Engaging people and communities The CCG has a duty under the Health and Social Care Act 2012 (section 14Z2) to involve patients and members of the public in the planning, development and delivery of services that it commission. The Governing Body meetings are held in different locations across the Island seeking to engage with as many people as possible and raising the profile of the CCG and its role locally. The CCG works closely with HealthWatch Isle of Wight, and they provide a representative on the Quality and Patient Safety Committee as well as the Primary Care Committee. The CCG has engaged with patients, families and other key organisations in a variety of ways over the last years and over a number of different issues, for example: Acute Service Re-design A comprehensive programme of stakeholder engagement has been planned across the key phases of the programme culminating in the formal Public Consultation process later in the year. In accordance with these re-design plans, a programme of stakeholder engagement on the case for change and the emerging broad possible scenarios for change has been completed. Following the outcome of the Clinical Commissioning Group Governing Body, the next phase of this work will be broadened to focus on the preferred option and planning, preparing and testing materials for public consultation later in The Acute Service Redesign programme has been led by clinicians from the outset, to ensure that the development of the draft proposals has been shaped by those involved in leading and delivering these services on the Island. 33

34 Patients and representatives, from both the Patients Council and Healthwatch Isle of Wight have also had a key voice throughout the process, taking part in the initial workshops with clinicians as they reviewed historical reports and examined a wide range of service data, and during key stages as the proposals evolved. They played an important role in ensuring that the patients voice was at the heart of the process and to ensure patient experience and insight was a continual challenge and guide as the proposals were developed. Staff from the Isle of Wight NHS Trust, the Isle of Wight Clinical Commissioning Group and the Isle of Wight Council (particularly those from adult and children s social care services) and union representatives were also provided with information at various key stages in the process via a wide range of communication tools including written briefings, face-face briefings, information on the intranet, and regular newsletter updates. They were also given opportunities to engage in discussions and share their views with the programme and clinical lead at drop in sessions or scheduled meetings. Other stakeholders were provided with updates and opportunities to engage with and influence discussions including Wessex Strategic Clinical Senate, Solent Acute Alliance Partners and the Sustainability and Transformation Partnership (STP). Advice on key clinical issues was sought and obtained from the relevant Royal Colleges. Formal briefing meetings with Regulators, NHS England and NHS Improvement, have also taken place regularly throughout the process. Specific groups of stakeholders such as the Local MP, the Isle of Wight Council s Health and Care Policy and Scrutiny Committee, Council Cabinet members, the Health and Wellbeing Board, Clinical Commissioning Group Clinical Executive, Clinical Commissioning Group Governing Body, Trust Board and Trust Leadership Committee, Primary Care Partners, Trust Members and the Local Care System Stakeholder Reference Group were also given regular updates both through formal public meetings and informal private briefings Long term conditions group Representatives from a number of local patient groups focusing on supporting people suffering with long term conditions e.g. respiratory, diabetes, breast cancer meet up to 6 times a year to discuss issues and changes at local, regional and national level across the Health and social care system that are likely to impact on both themselves and the members they represent. They have been an active voice in the Acute Service Re-design consultation and continue to be part of that process. The group have given feedback on proposed changes to the rehabilitation, re-ablement and recovery model, the wheelchair service and the developing model of integrated care Fifteen Steps Challenge A pilot for maternity services led by Service User Voice Policy Manager Maternity Transformation Programme NHS England. Isle of Wight NHS Trust was part of a rural Trust pilot service to trial the use of the national Fifteen Steps Challenge quality improvement tool in a Maternity setting. This national tool is normally used in acute or mental health settings. The event involved talking to pregnant women and new mums, as well as a number of other stakeholders from various organisations. The pilot involved walking through antenatal clinic, maternity ward and labour suite settings in small mixed teams to consider their first impressions of the ward or service from the perspective of a service user, recording how it appears, looks, sounds, smells etc. The outcomes will help the Trust to make improvements to 34

35 the wards and maternity services and provide valuable information to the commissioners about patients needs Children s & Young People, Mental Health, Learning Disabilities and Dementia The team recognise the importance of island communities and actively listen to Island people in the planning of commissioned services. When reviewing or developing services the team invites local island residents to share their ideas, concerns and experiences with us, as they value their views on what is working well and what is not and what they would like island services to look like. During , a number of public engagement events were held to support: The Mental Health Transformation Programme The Learning Disability Transformation Programme The Isle of Wight s Transformation Plan for Children and Young People s Mental Health (2017 Refresh). Holding these events has provided us with valuable information to support what the local people would like their services to offer. Table 8: Examples of public engagement Date Area Event Name Venue Attendance Outcome July 2017 Suicide Awareness and Prevention Westridge Centre, Ryde September 2017 November 2017 December 2017 December 2017 March 2018 April 2018 Isle of Wight s Transformation Plan for Children and Young People s Mental Health (2017 Refresh) Mental Health Transformation Programme Mental Health Transformation Programme Mental Health Blue Print Mental Health Blue Print Suicide Prevention and Awareness Stakeholder Event Consultation Event X2 Day Service Provision From Surviving to Thriving Developing and Island MH Blue Print Public Consultation 1 st - Quay Art Centre, Newport 2 nd Northwood House, Cowes Quay Arts Centre, Newport Riverside Centre, Newport Riverside Centre Online Island Private and Voluntary Sector Organisations Stakeholders and parents attended both events 20 people who use and support the islands current day services Approximately 80 plus side stands supported by service providers showcasing there services Island Private and Voluntary Sector Organisations Input into the development of the Isle of Wight Suicide Awareness and Prevention Action Plan. *The Suicide Awareness and Prevention Steering Group continue to meet quarterly. Collated information used to refresh - Isle of Wight s Transformation Plan for Children and Young People s Mental Health (2017 Refresh) Development of Community based mental health support, individuals are triaged and tell their story once and following a holistic assessment given access to a range of services that suite their needs Decision and voting on the preferred models for supporting individuals /get-involved/mental-healthblueprint /get-involved/mental-healthblueprint 35

36 Mental Health Transformation Programme As part of the Mental Health Transformation Programme we have established a number of Task and Finish Groups which also include participation by multi agency partners and individuals with lived experience. These include areas such as: Employment Workshops Day Service Provision workshops The Safe Haven Provision Dementia and Older Person Pathway Review (known as the Dementia Steering Group) Living well with a learning disability on the Isle of Wight Co-production Process The process for writing the strategy Living well with a learning disability on the Isle of Wight began in November 2016, with a questionnaire, co-produced with the Learning Disability Partnership Group (LDPG), for people with a learning disability and or autism on the Isle of Wight, in preparation for a visit from the Local Government Association Peer Review team. The survey was posted to all adults with a learning disability known to Adult Social Care. The results of this questionnaire were reviewed, and three priorities were identified as the most important to people living on the Isle of Wight with a learning disability; Staying healthy Keeping safe Living my life The commissioner worked with the Learning Disability Partnership Group to produce a plan on a page for the strategy, in both long and easy read formats. A workshop was hosted by the LDPG for people with a learning disability and their families, to talk about what the three priorities meant to them. The Task and Finish Group then began writing the strategy, again both in long and easy-read versions, and regularly checked in with the Learning Disability Partnership Group on the progressing documents. The public consultation, supported by People Matter Isle of Wight, ran from 1 st December st January 2018 to ensure that they were able to reach a wider group and that everyone who wanted to was able to contribute to the consultation. Surveys were available online and in hard copy. Members of the Task and Finish Group also organised two public meetings, and attended focus groups with a school, the Pathways programme at the Isle of Wight College, a social group, three day opportunity providers, and two providers of residential and supported living. A meeting was also held with a representative from Autism Inclusion Matters. During the consultation period, the views of at least 224 people were taken. This included at least 103 people with a learning disability. The number of people with a learning disability on the Isle of Wight known to services is approximately 600. The results were collated and discussed at the February Task and Finish Group. A consultation feedback summary document was produced to inform the decision-making. The required changes were made to the strategy, and the final version was agreed. In March 2018, the Task and Finish Group began producing the accessible Living Well Work Plan for 2018, which it was agreed would be updated on a six monthly basis so that the public could be kept informed of the progress of the Learning Disability Transformation Work. Some actions on the action plan were suggestions from the public from the consultation period. 36

37 A strategy launch is scheduled for 30 th April 2018, and will include speakers, stalls from providers, and a dance performance from a day opportunity provider. 3.8 Primary Care During 2017/18, the CCG approved and published a primary care strategy which sets out the way in which primary care will develop over the coming 5 years. The CCG will be investing 1.8m over the next two years into primary care to improve the resilience of the sector alongside commissioning a number of new services including providing all patients with seven day access to routine primary care. Primary Care providers are engaged in a number of programmes aimed at changing the way that they work and the way that patients can interact with them. During the year the CCG procured e-consult, a package which will allow patients to access their GP digitally and which will be rolled out in We are seeing a move towards the use of online services to book appointments and request prescriptions, with the CCG achieving more than 60% of all prescriptions being transmitted directly to pharmacies. We have also secured training for receptionists to help signpost patients to the right service; and behind the scenes we have been working on workflow changes which aimed at freeing up GP time from administration and allowing them to spend more time with patients. Changes in the workforce have continued with a cohort of Advanced Nurse Practitioners graduating from Southampton University having completed a two year course fully funded by the CCG. These nurses are able to see and treat a wide range of patients in primary care and add both capacity and resilience into our primary care providers. The CCG continues to work through the One Public Estate programme in partnership with the Local Authority to develop new a new GP surgery for Newport, and under its delegated responsibilities has made a number of grants to support minor improvement works in existing buildings. This year, we are beginning to see the benefits of significant investment in GP IT, with the first full year s use of SystmOne TPP. Through the GP Federation, One Wight Health, the CCG has been promoting the use of shared templates and a single way of working across primary care. Of particular note, primary care has worked particularly closely with the Earl Mountbatten Hospice to create common processes to support people in receipt of palliative and end of life care. The CCG has also begun the roll out of mobile technology providing lap tops to each practice to support more flexible working. The resilience of practices remains a key concern for the CCG, and as part of the wider transformation programme, practices that have been identified as at risk have received tailored packages of support. This programme will continue over the coming year as the circumstances of practices change. 3.9 Reducing health inequality The CCG has a duty under the Health and Social Care Act 2012 (section 14T) to reduce health inequalities. The CCG has published its equality objectives: Objective one seeks to embed the principle of equality into day to day business of the CCG. 37

38 The CCG ensures a narrative on reducing inequality is provided to the Governing Body and each of its subcommittees on every paper and decision; and has implemented mandatory Equality and Diversity training for all staff. Objective two seeks to improve physical health checks amongst those with serious mental illness. This continues to be an area of work and is being implemented across mental health services through contractual mechanisms and is part of the quality improvement programme in primary care. Objective three is about helping people to help themselves by taking control of their health and setting their own goals and ambitions. This work stream is monitored against the protected characteristics to understand what areas the CCG should particularly target in rolling out projects such as care planning and access to medical records. The Equality Act (2010) requires public organisations to eliminate unlawful discrimination, advance equality of opportunity and foster good relations between people who may or may not share a protected characteristic. To achieve this we are required to analyse the effect of any policy, strategy, business case, and project or service change. The CCG has developed a template to support staff to consider equality impact and to identify where analysis is required. We encourage the use of equality analysis at an early stage and again towards the end of a project so that any evidence gaps can be considered as part of the stakeholder engagement element of the project. The results of this analysis are reported to those committees where decisions are made to ensure that a fully rounded decision can be arrived at Health and Wellbeing Strategy The Isle of Wight Health and Wellbeing Board (HWB) brings together key partners with a common vision, working to promote health and wellbeing, build resilient communities and reduce inequalities to improve the quality of life on the Isle of Wight. The health and wellbeing strategy sets out key local themes: Health inequalities are reducing so the gap in health and life expectancy between the more wealthy and less well-off becomes smaller; People feel supported to achieve their potential to live a full life regardless of age, disability or disease; Health and wellbeing are improving; Neighbourhoods are inclusive places where people are able to contribute to ensure they are healthy, safe, resilient and sustainable. The CCG Chair and Chief Officer are members of the Health and Wellbeing Board and in the last year the following items were discussed by the Board: Health and Wellbeing business plan and the development of a new strategy; Sustainability and Transformation Partnership to consider the key actions required to deliver the following work programmes: o Sustainability and Transformation plan o Primary Care Strategy; 38

39 o Acute Service Re-design; Prevention and Early Intervention Strategy and implementation plan Discussion on A Mentally Healthy Island, Our Blueprint for Mental Health Isle of Wight NHS Trust Improvement plan - a progress update; Care Closer to Home: New strategy for Adult Social Care report looking at milestones, resources and outcomes; Better Care Fund reports; Minutes of the Local Care Board; Updates on the Care Quality Commission Inspection. 39

40 ACCOUNTABILITY REPORT 4. MEMBERS REPORT This report has been produced by the Governing Body on behalf of the CCG. 4.1 Members Practices NHS Isle of Wight Clinical Commissioning Group is made up of 16 GP Practices grouped to form the three Island Localities listed below: Table 9: GP Practices by locality West and Central North and East South Wight The Dower House, Newport Carisbrooke Medical Centre, Medina Healthcare, Newport Tower House Surgery, Ryde Esplanade Surgery, Ryde East Cowes Surgery, Shanklin Medical Centre, Sandown Health Centre, Ventnor Medical Centre, Brookside Health Centre, St. Helen's Medical Centre, Beech Grove, Brading Freshwater Argyll House, Ryde Grove House, Ventnor Cowes Medical Centre, South Wight Medical, Each practice is represented at the CCG Membership Council, which acts as the electoral college for the CCG to elect member clinicians onto the Clinical Executive. It also approves the process for recruiting and removing non-elected members from the Governing Body and agrees the CCG s overarching vision, values and overall strategic direction. 4.2 Composition of Governing Body The Governing Body is responsible for overseeing key relationships concerning the CCG s statutory functions. The membership of the Governing Body has changed over the last 12 months. The Chief Officer Helen Shields retired in February and was succeeded by Loretta Outhwaite who was appointed as the acting Accountable Officer until 31 March The Governing Body Nurse Lindsay Voss resigned in October 2017 and the Governing Body appointed Melanie Rogers Director of Nursing and Quality to the post in February The Secondary Care Doctor Dr Ian Reckless resigned after completing his full term and Dr Mark Sopher was appointed. In 2017/18, the Governing Body comprised: o Dr Michele Legg (chair), o Helen Shields (Chief Officer and Accountable Officer) until 9 February 2018, o Loretta Outhwaite (Chief Finance Officer & Deputy Chief Officer) (Acting Accountable Officer) from 10 February 2018 to 31 March 2018, o Melanie Rogers (Director of Nursing and Quality), o Dr Timothy Whelan (Clinical Executive GP), o Carole Truman (Lay member Patient Public Involvement), o Martyn Davies (Deputy Chair/Lay Member Governance), o Laurence Taylor (Lay Member Chair of Primary Care Committee), 40

41 4.3 Committees o Dr Ian Reckless (Secondary Care Doctor) until Sept 17, o Dr Mark Sopher (Secondary Care Doctor) from Oct 17, o Lindsay Voss (Governing Body Nurse) until Oct 17, o Lesley Macleod (Interim Chief Finance Officer) since March 18. The Governing Body has delegated responsibility to the following five Committees according to the scheme of delegation in the CCG constitution. These are: The Audit Committee, provide the Governing Body with an independent and objective view of Governance and financial systems, financial information and compliance with laws, regulations and directions; The Remuneration Committee, makes recommendations to the Governing Body on the remuneration, fees and other allowances for employees and for people who provide services to the CCG; The Quality and Patient Safety Committee, ensures that all decisions are safe and effective and that they improve the quality of care experienced by patients; The Clinical Executive, is responsible for the monthly operational oversight of the CCG, developing and recommending strategy, undertaking the majority of the commissioning function and ensuring that clinical decision making remains central to its work; The Primary Care Committee, takes delegated responsibility for primary care commissioning from NHS England and for decisions relating to the overall strategy, management of budgets and operational oversight of the management of primary care The Membership of these committees together with their attendance at meetings can be found in the Governance Statement at section Register of Interests The CCG maintains a register of members interests which can be viewed on the CCG website: Personal data related incidents During 2017/18 there were no information governance serious incidents requiring investigation (SIRI) reported to the Information Commissioners Office (ICO). 4.6 Statement of Disclosure to Auditors Each individual who is a member of the CCG at the time the Members report is approved confirms: so far as the member is aware, that there is no relevant audit information of which the CCG s external auditor is unaware that would be relevent for the purposes of their report; and the member has taken all the steps they ought to have taken in order to make him or herselves aware of any relevant audit information and to establish that the CCG s auditor is aware of it. 41

42 4.7 Emergency Preparedness, Resilience and Response (EPRR) The CCG needs to be able to plan for, and respond to, a wide range of incidents that could impact on health or patient care. These could be anything from prolonged period of severe pressure on services, extreme weather conditions, an outbreak of an infectious disease, a major transport accident or industrial action. The CCG is a category 2 responder as defined by the Civil Contingencies Act The key responsibilities are: Membership of the Hampshire & Isle of Wight Local Health Resilience Partnership; Participating in training and exercises which are used to test response plans; Assisting with the local co-ordination of emergencies in partnership with the NHS England (Wessex); Ensuring a 24 hour a day, seven day a week on-call system; Ensuring compliance with the national core standards for EPRR for both CCG and NHS funded healthcare providers. The CCG and Isle of Wight NHS Trust completed a self-assessment of their compliance with the NHS EPRR core standards. The Isle of Wight CCG was rated by NHS England (Wessex) as substantially compliant with the core standards and the Isle of Wight NHS Trust as non compliant. The CCG has worked with the Trust and the NHS England (Wessex) as part of this assurance process. NHS England (Wessex) represents the NHS at the Hampshire and Isle of Wight Local Resilience Forum (LRF) meetings. 4.8 Modern Slavery Act The Isle of Wight CCG fully supports the Government s objectives to eradicate modern slavery and human trafficking but does not meet the requirements for producing an annual Slavery and Human Trafficking statement as set out in the Modern Slavery Act

43 5. Statement of Accountable Officer s Responsibilities The National Health Service Act 2006 (as amended) states that each Clinical Commissioning Group shall have an Accountable Officer and that Officer shall be appointed by the NHS Commissioning Board (NHS England). NHS England appointed Loretta Outhwaite to be the Acting Accountable Officer of NHS Isle of Wight CCG from 10 February 2018 to 31 March 2018 following Helen Shields retirement on 9 February. The CCG joined the Hampshire CCG Partnership on 1 April 2018 when Maggie MacIsaac was appointed interim Accountable Officer. The responsibilities of an Accountable Officer are set out under the National Health Service Act 2006 (as amended), Managing Public Money and in the Clinical Commissioning Group Accountable Officer Appointment Letter. They include responsibilities for: The propriety and regularity of the public finances for which the Accountable Officer is answerable, 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), For safeguarding the Clinical Commissioning Group s assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities). The relevant responsibilities of accounting officers under Managing Public Money, Ensuring the CCG exercises its functions effectively, efficiently and economically (in accordance with Section 14Q of the National Health Service Act 2006 (as amended)) and with a view to securing continuous improvement in the quality of services (in accordance with Section 14R of the National Health Service Act 2006 (as amended)), Ensuring that the CCG complies with its financial duties under Sections 223H to 223J of the National Health Service Act 2006 (as amended). Under the National Health Service Act 2006 (as amended), NHS England has directed each 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 Group Accounting Manual issued by the Department of Health and in particular to: Observe the Accounts Direction issued by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis; Make judgements and estimates on a reasonable basis; State whether applicable accounting standards as set out in the Group Accounting Manual issued by the Department of Health have been followed, and disclose and explain any material departures in the financial statements; and, Prepare the financial statements on a going concern basis. 43

44 To the best of my knowledge and belief, and subject to the disclosures set out below, I have properly discharged the responsibilities set out under the National Health Service Act 2006 (as amended), Managing Public Money and in my Clinical Commissioning Group Accountable Officer Appointment Letter. Disclosure: The CCG was issued with directions by NHS England on 6 December Full details can be found on NHS England website: I also confirm that: as far as I am aware, there is no relevant audit information of which the CCG s auditors are unaware, and that as Accountable Officer, I have taken all the steps that I ought to have taken to make myself aware of any relevant audit information and to establish that the CCG s auditors are aware of that information. that the annual report and accounts as a whole is fair, balanced and understandable and that I take personal responsibility for the annual report and accounts and the judgments required for determining that it is fair, balanced and understandable. Interim Accountable Officer: Maggie MacIsaac Organisation: NHS Isle of Wight Clinical Commissioning Group 24 May

45 6. Governance Statement 6.1 Introduction & Context NHS Isle of Wight Clinical Commissioning Group is a body corporate established by NHS England on 1 April 2013 under the National Health Service Act 2006 (as amended). The Clinical Commissioning Group s statutory functions are set out under the National Health Service Act 2006 (as amended). The CCG s general function is arranging the provision of services for persons for the purposes of the health service in England. The CCG is, in particular, required to arrange for the provision of certain health services to such extent as it considers necessary to meet the reasonable requirements of its local population. As at 6 December 2017 the Clinical Commissioning Group is subject to directions from NHS England issued under Section 14Z21 of the National Health Service Act A copy of the directions can be found at: Scope of Responsibility As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the Clinical Commissioning Group s policies, aims and objectives, whilst safeguarding the public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out under the National Health Service Act 2006 (as amended) and in my Clinical Commissioning Group Accountable Officer Appointment Letter. I am responsible for ensuring that the Clinical Commissioning Group is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity. I also have responsibility for reviewing the effectiveness of the system of internal control within the Clinical Commissioning Group as set out in this governance statement. 6.3 Governance arrangements and effectiveness The main function of the Governing Body is to ensure that the group has made appropriate arrangements for ensuring that it exercises its functions effectively, efficiently and economically and complies with such generally accepted principles of good governance as are relevant to it. NHS Isle of Wight CCG has a Membership Council, Governing Body, Primary Care Committee (for delegated functions) and a series of Governing Body subcommittees. Statutory responsibilities have been delegated as set out in the Strategic Scheme of Delegation within the Group s Constitution. This provides for the majority of decisions to be made by the Clinical Executive a clinically-driven subcommittee of the Governing Body. 45

46 Figure 3 - Governing Body and Sub-Committee Structure Governing Body Isle of Wight Primary Care Committee Audit Committee Remuneration Committee Quality & Patient Safety Committee Clinical Executive 6.4 Membership Council The Membership Council has specific responsibilities to ensure that the Governing Body retains the confidence of the membership and to participate in the development of the overarching clinical strategy of the CCG. It also acts as the Electoral College to the Clinical Executive on the expiry of clinical executive terms. Table 10: Members and Attendance at Membership Council Name Practice Dr Adam Poole GP Argyll House, Ryde X X Dr Monica Vloemans GP Medina Healthcare X Dr Peter Hill GP South Wight Medical Centre X Dr Simon Giles GP Shanklin Medical Centre Dr Chris Andrews GP East Cowes Medical Centre Dr Judith Moore GP Carisbrooke Health Centre X Dr George Thomson GP Brookside Health Centre, Freshwater X Dr Oliver Culk GP Tower House Surgery, Ryde X Dr Jagannadha Boorle GP Cowes Medical Centre X X Dr Oomen John GP Ventnor Medical Centre X Dr Mira Hueppe GP St Helens Medical Centre X Dr Hugh Trowell GP Sandown Health Centre (chair) Dr Spencer Fox GP Esplanade Surgery, Ryde Dr Stephen Doggett GP Grove House, Ventnor Dr Richard Loach GP Beech Lodge, Brading X X Dr Stephen Selby GP Dower House X X 46