annual report 2015/16 - newham ccg...annual report 2015/16 page 5 overview foreword from the chair...

Annual Report and Accounts 2015/16 Newham CCG: Commissioning for a healthier future

Annual report 2015/16

Contents Contents ............................................................................................................................................... 2

Performance Report ............................................................................................................................ 4 Overview ...................................................................................................................................................... 5

Foreword from the Chair ................................................................................................................... 5 Introduction from the Chief Officer .................................................................................................... 6 How the CCG works ......................................................................................................................... 7 Commissioning quality services and addressing human rights .......................................................... 8 The health of our borough ............................................................................................................... 11 Discharging our statutory duties ...................................................................................................... 12 Progress towards our strategic objectives during 2015/16 .............................................................. 14

Key achievements ...................................................................................................................................... 16 Key priorities for 2016/17 ................................................................................................................ 20 How Newham CCG measures performance ................................................................................... 20 Performance against national indicators ......................................................................................... 21 Sustainability report ........................................................................................................................ 27 Working with the public and patients ............................................................................................... 30 Working with our partners ............................................................................................................... 33 Tackling inequalities ....................................................................................................................... 34 How we spent our money ............................................................................................................... 35

Accountability Report ........................................................................................................................38 Corporate governance report ...................................................................................................................... 39

Members report .............................................................................................................................. 39 Statement of accountable officer's responsibilities .......................................................................... 51 Annual governance statement ........................................................................................................ 52

Remuneration and staff report .................................................................................................................... 75 Remuneration committee members and attendance ....................................................................... 75 Chair and elected governing body members ................................................................................... 75 Lay members .................................................................................................................................. 76 Senior managers contracts ............................................................................................................. 77 External auditor’s remuneration ...................................................................................................... 77 Consultancy expenditure ................................................................................................................ 77 Senior managers remuneration ....................................................................................................... 77 Pay multiples .................................................................................................................................. 83 Pensions benefits ........................................................................................................................... 84 Cash equivalent transfer value ........................................................................................................ 88 Real increase in CETV.................................................................................................................... 88 Audit of remuneration report ........................................................................................................... 88 Exit packages, severance payments and termination agreements .................................................. 88 Off-payroll arrangements ................................................................................................................ 88 Sickness absence data ................................................................................................................... 89 Our workforce ................................................................................................................................. 90 Equality report ................................................................................................................................ 92 Employee related issues ................................................................................................................. 92 Health and safety ............................................................................................................................ 93


Independent auditors’ report to the members of Newham Clinical Commissioning Group ............... 95

Financial Statements ..........................................................................................................................98 Introduction to accounts .............................................................................................................................. 99

Statement of comprehensive net expenditure for the year ended 31 March 2016 ........................... 99 Statement of financial position as at 31 March 2016 ..................................................................... 100 Statement of changes in taxpayers equity for the year ended 31 March 2016 .............................. 101 Statement of cash flows for the year ended 31 March 2016 .......................................................... 102 Notes to the financial statements .................................................................................................. 103


Performance Report


Overview Foreword from the Chair It has been a real honour to lead the CCG in the role of chair since being elected in October 2015. Although we face significant challenges in delivering healthcare in Newham we have been able to take a strategic view of how to transform care for the future and have delivered some excellent work that benefits local people, improves health outcomes and helps to challenge health inequalities. I have worked as a GP in Newham for 30 years so I have first-hand experience of watching the population grow, seeing the demands for healthcare change and being part of an ever-changing NHS that continually evolves to be able to meet demand and respond to changing health needs. That’s why it’s so exciting to be part of an organisation that is working with individuals, groups and organisations across East London to build a healthcare system that will actively help people stay well, reduce demand for hospital services and develop services that are efficient and provide best value for taxpayers money. As an organisation we have done our very best for local people and over the last year we have delivered on our financial targets, staying within budget and achieving a planned surplus of £6.5 million that can be reinvested into developing future health services. We have also discharged all of our statutory duties and made progress towards delivering on our strategic priorities around improving patient experience and managing demand, delivering services that ensure a healthy start in life for our children and young people and working closely with all of our GP member practices to share best practice, local knowledge and work together to effectively commission services that provide good value for money. We have made a real impact towards improving healthcare for local people through our excellent work over the last year. We have improved access to mental health services for young people and providing a peri-natal mental health service for women and their partners to help them cope after giving birth. We have improved support for patients suffering from multiple long-term conditions by continuing to deliver our integrated care programme challenging traditional healthcare barriers to provide patient-centred care. We are tackling the growing numbers of people in Newham who have tuberculosis by providing screening and treatment in GP surgeries and pharmacies improving long-term health outcomes and providing care closer to home. These are just a few of the many projects that we have delivered on that are making a real difference for Newham residents. This report brings together a wealth of other examples of how we are improving healthcare in Newham. We have also continued to invest in our patient and public engagement work to make sure the patient voice is at the very heart of all we do. This has included recruiting youth commissioners to help us design care pathways that are more sensitive to their needs, recruiting diabetes champions who raise awareness within the community, provide peer support and share feedback that helps to shape future services and reinvigorated our future generation programme to put young people at the heart of decision making. While we continue to face significant challenges associated with the poor health outcomes seen locally, the financially challenged healthcare economy and the growing demand for NHS services I feel positive that through our strategic programmes, such as Transforming Services Together and Building Healthy Communities, we can continue to deliver for our patients for years to come. Finally, I would like to thank all those who work with us towards improving the health of people living in East London including our patients, members of the public, health and social care professionals and the healthcare organisations. I look forward to continuing to work together as we continue to transform the health and wellbeing of those we serve.


Introduction from the Chief Officer 2015/16 was an exciting year for the CCG, where we started to set out our plans and laid the foundations to transform health services over the coming years. This has included the development of the transforming services together (TST) strategy and investment case, our estates strategy, which will see considerable financial investment into high quality facilities; our community health services re-procurement programme - Building Healthy Communities - that is set to radically transform how people access community based services; our children’s health commissioning work, now underway jointly with the local authority; and our integrated care programme, which is already having a positive impact on health outcomes. Alongside these major programmes of work we are currently working on our operating plan for 2016/17, which will set out our finance and activity plans with our providers, alongside plans on how providers will improve performance where necessary to achieve national standards of care. We are also developing our sustainability and transformation plan that sets out our five year plan for delivering the TST programme and our plans for commissioning locally specialised services. Our main acute health provider Barts Health still faces significant challenge to their financial position and in some areas the quality of care provided to local people. We have taken steps to address this through the development of the operating plan, our contract reviews and through our board assurance framework available on page 63 where you can read about how we identify and take steps to mitigate against the risks associated with non-delivery of national constitutional standards. 2016/17 is set to be even more eventful with key programmes of work coming to fruition, greater partnership working across the sector and a more strategic approach to shaping our future ambitions. We set out our key priorities around delivering on four major change programmes over the coming year on page 20. We look forward to building up another round of successes over the coming year in partnership with residents, patients, the local authority and our healthcare partners across East London.


How the CCG works NHS Newham Clinical Commissioning Group (CCG) is a membership body, made up of local GPs, that plans and buys public healthcare services for over 320,000 (GLA estimate, 2014) people in Newham. We plan healthcare by identifying the health needs of the population and forecasting what services might be needed in the years to come. Find out more about heath challenges we face in Newham on page 11. We are a clinically led organisation and we have a Governing Body made up of a majority of local GPs along with other independent members and representatives from partner organisations. All our Governing Body meetings are open to the public and all agendas are available on our website. Our decision making structure is detailed on page 53, we have a number of commissioning committees that undertake the detailed work in relation to development of services, identifying gaps and monitoring services. These are all chaired by GPs with the exception of the Primary Care Commissioning Committee as it is legally required to be chaired by a non-GP member. Our two key healthcare providers in Newham are Barts Health NHS Trust and East London NHS Foundation Trust who offer medical, surgical and emergency services for the local community and a range of mental health support for our residents. The main hospital in Newham is Newham University Hospital, part of Barts Health NHS Trust, who also manage Whipps Cross, Mile End and The Royal London hospitals. East London NHS Foundation Trust is the provider for community based and mental health services in Newham. We also work with Healthwatch Newham, the London Ambulance Service, NHS England and with the London Borough of Newham as part of our health and care commissioning. We participate in the local Health and Wellbeing Board for the purpose of making sure that residents and patients get better and more joined up health and social care services from the NHS and Newham Council and our CCG Chair is Co-Chair. Read about the Newham Health and Well Being Board here.

https://www.newham.gov.uk/Pages/Services/Health-and-wellbeing-board.aspx


As a publicly funded NHS organisation we are first accountable to our patients and local people and at the heart of our work as a clinical commissioning group is our engagement with local GPs, partners in Newham Council, and the local community to work out which health problems need to be tackled as a priority in Newham. We also work closely with our healthcare providers to shape the services we purchase for Newham residents. At Newham CCG, we are also responsible for making sure that the healthcare providers we buy services from are value for money and give patients the right quality of care. The standards we monitor are set out in national priorities through the national NHS operating framework, which you can read more about on the NHS England website. Commissioning quality services and addressing human rights Delivering improved patient care to meet local health needs rests at the heart of everything we do at NHS Newham CCG through our commissioning for quality strategy. Our mission, values and aims have been developed to encapsulate what we believe are the key challenges and behaviours that will enable us to deliver real change in the provision of patient centred healthcare. In addition, we have continued to work collaboratively with local partners such as Barts Health NHS Trust, East London Foundation Trust and Tower Hamlets, Waltham Forest and City and Hackney CCGs to ensure the provision of the highest quality healthcare services for people living in Newham. Newham CCG has systems in place to measure and monitor quality of services delivered by providers to influence and improve standards, such as:

Clinical quality review meetings (CQRM); these allow us to hold the providers to account for the quality of their services.

Our quality committee; where we review quality based on our ‘approach to commissioning for quality’ strategy, as well as request and receive reports pertaining to the quality of services and provide assurance to the Governing Body as a result.

Contractual levers; which have been used this year to drive up quality in areas where improvements have taken some time to come to fruition. This has been done through supportive or facilitative processes.

Quality assurance visits; these are undertaken with our providers through a structured framework. This enables us to see first-hand any improvements made and understand the quality of services.

Quality key performance metrics; these are based on national/regional or local standards and inserted into contracts with providers whose performance is then monitored on a monthly basis.

Feedback from member practices; carried out through an automated system called amber alerts. A GP practice is able to alert us to a potential quality issue in a provider organisation and we seek outcome responses from the provider for each of these alerts. Any trends are monitored by us and taken to CQRM discussions or contractual discussions with providers with the intention of improving patient experience, patient safety or general quality.

Patient feedback; this is invaluable in providing intelligence that is used in conjunction with other quality information to form a picture of services to determine if there are any potential areas of concern we should undertake further exploratory work in.

https://www.england.nhs.uk/resources/resources-for-ccgs/out-frwrk/

https://www.england.nhs.uk/resources/resources-for-ccgs/out-frwrk/


Medicines management Effective medicines management is vital in improving patients’ quality of care, health outcomes and the in balancing the costs of healthcare provision. Medicines optimisation is a patient-centred approach to ensure high quality use of medicines so that patients get the best outcomes. In order to achieve the best for our patients we have focused on:

promoting cost effective and evidence based prescribing improving the quality and safety of medicine use and supporting patients to achieve optimal

outcomes from their medicines reducing inappropriate variations in prescribing and health outcomes integrating medicines optimisation into services and care pathways supporting training for clinical and non-clinical staff in relation to medicines and evidence based

management of diseases. Our medicines management team consists of highly qualified pharmacists who work collaboratively with local clinicians, health and social care professionals, healthcare providers, Newham Local Authority, patient forums, commissioning managers, partners, community pharmacy and secondary care to ensure the best value for NHS resources while ensuring the best outcomes for our patients. Safeguarding adults Safeguarding adults is now a statutory requirement, which came into force from April 2015. This is as a direct result of provisions outlined in the Care Act 2014. Throughout 2015/16, we implemented systems and processes to comply with the statutory requirements outlined in the Care Act and now have a robust structure in place to protect people who are at risk of abuse and neglect. During 2015/16 we have also pushed forward on a number of joint ventures with our providers so that we can better safeguard adults in the borough. We have been working closely with Newham Council to ensure that patients in care homes are cared for in safe and compassionate environments. This has included undertaking reviews and assurance visits to care homes that allow for early identification of any safeguarding concerns. We have embedded reporting procedures for adult safeguarding into our quality review meetings with providers by introducing dashboards for analysis and monitoring. This provides assurance and allows us to monitor performance helping us to ensure providers are compliant with the statutory requirements for safeguarding and that systems are in place that prevent harm and abuse. We have also participated and contributed to domestic homicide reviews (DHR) and supported our GPs as they support patients at risk of domestic violence. An annual safeguarding adults report was presented to the Quality Committee in January and subsequently to the NHS Newham CCG Governing Body in February. This report will be made available on our website once it has been formally published. Safeguarding children Newham CCG fulfils its statutory safeguarding duty through its commissioning and collaborative arrangements by working closely with local partners to ensure that services are in place to respond to children who have suffered significant harm or who are at risk. We are part of a partnership that includes the Health and Wellbeing Board, the Children’s and Young People’s Trust and the Newham Safeguarding Children Board (NSCB). Along with inter-agency working we also have health practitioners embedded in local services and continually look to integrate services for our children, young people and families, to further improve access to support and advice. We have undertaken considerable activity during 2015/16 to safeguard children in the borough. We have improved the identification, management and recording of female genital mutilation (FGM) by providing training and guidance for all of our staff and member practices. This has included supporting GPs to record FGM and make referrals. This has led to an increase in referrals and is helping to safeguard women and


children from suffering harm associated with this practice. We have worked with local GPs to implement protocols for referring vulnerable pregnant women helping to reduce harm to the unborn child. We have strengthened arrangements for sharing information across our partnership to ensure that families receive the right support at the right time and we have trained our GPs so that they can effectively identify and address and safeguarding concerns. An annual safeguarding children report was presented to the Quality Committee in January and subsequently to the NHS Newham CCG Governing Body in February. The report is available on our website. Looked after children Local authorities, healthcare planners and commissioners have statutory duties to safeguard and promote the welfare of children that are in their care, including ensuring their health needs are fully assessed, that they have a health plan in place, which is regularly reviewed, and that they have access to a range of health services to meet their needs. Newham CCG plays a major role in meeting the health needs of ‘looked after children’ through commissioning effective services, delivering care through provider organisations and by providing governance and assurance that services are in place and fit for purpose. During 2015/16 we have worked with local providers to ensure that looked after children have access to a wide range of services that best meet their needs so that they receive the care and support they need in order to thrive. This includes providing all young people with a contact card so that they can get in touch with a nurse when they need to and providing foster carers with direct access to specialist nurses who can offer professional advice regarding the child in their care. This helps young people and their carers’ by making sure they are fully supported when they need it most. We have also worked with providers to ensure that initial health assessments are completed within 28 days and that these assessments inform the development of SMART health plans. It is a statutory requirement for young people going into care to have health assessments as this allows healthcare providers to ensure their health needs are identified and they are appropriately cared for. We have made sure that our providers meet these statutory obligations and provide holistic health plans for young people. We have implemented a care leaver passport in partnership with young people that

http://www.newhamccg.nhs.uk/aboutus/safeguarding.htm

http://www.newhamccg.nhs.uk/aboutus/safeguarding.htm


includes their health history. This helps them to feel in control and have a better understanding of their health, and gives them ownership of what then happens with their on-going wellbeing and good health as they move into adulthood. Internally, we have appointed to a designated professional role to work exclusively on the strategic implementation of services for looked after children. This role has the overarching responsibility of assisting the CCG to discharge their obligations to children looked after and enhancing the service provision for the children and young people. This means that we can ensure a robustness of delivery and provision helping to make our services the best they can be. We are working closely with the Children in Care Council to ensure that young people have a voice about the services they are using. This is empowering for young people who feel more engaged in their care, as well as helping them to feel valued and respected. In 2016 we will be working with the Children in Care Council (CiC) to further develop the health passport as young people have indicated that they would like to have a digital health passport. The annual report for looked after children was presented to the Quality Committee in January and subsequently to the NHS Newham CCG Governing Body in February. This report will be made available on our website once it has been formally published. The health of our borough Newham is an exciting, young borough with a population of over 324,000 (as at mid-2014), which is growing year on year due to an increase in births and migration to the borough as people choose to come and live here. The Joint Strategic Needs Assessment (JSNA) for Newham has highlighted a range of challenges in providing health services including historically poor health outcomes, the transient population, increasing numbers of people living in the borough and the diversity of the communities we serve. Our JSNA has identified that people living in Newham have a lower life expectancy in comparison to the London and England average and when considering healthy life expectancy, men are likely to face 20


years of poor health at the end of their life while for women this figure goes up to 25 years. The impact of having a population who are living with poor health for a significant period means that health resources are stretched, and quality of life for patients is often reduced. We are facing high demand on healthcare services as we see higher numbers of people with mental health issues, musculoskeletal problems, diabetes, cancers and respiratory disease. In part these numbers are due to the diversity of the borough, as there is a higher prevalence of conditions such as diabetes and cardiovascular disease among some black minority and ethnic communities. However, the greater considerations are people presenting to the NHS too late with potentially preventable conditions already at advanced stages, the local environment and individual lifestyle choices - we have high numbers of people who are inactive, who smoke and who are obese. Our health is determined by a complex mix of factors including:

income - there is a strong link between poverty and severe mental illness housing - large scale studies point to a relationship between overcrowding in childhood and

respiratory conditions in adulthood employment - disruption to the day–night cycle from shift working has shown to increase risk of

breast cancer by 21% lifestyles – smoking, obesity and inactivity contribute to the development of preventable conditions access to healthcare and other services.

In Newham we face significant challenges in addressing health inequalities seen locally, such as poor housing, overcrowding, fuel poverty, income deprivation and lifestyle factors, which is why we are working in partnership with a range local partners to:

Increase awareness of individual responsibility for taking control of and managing their own health by making decisions that will help them to live a long and healthy life Provide integrated care that challenges organisational boundaries in order to provide coordinated patient centred support for those at the greatest risk of becoming ill due to multiple long term conditions Commission local services that take account of the specific needs of our local population. This annual report sets out many ways that we are working with patients, members of the public and our local healthcare providers to transform the health of the borough. Discharging our statutory duties We certify that Newham Clinical Commissioning Group has complied with the statutory duties laid down in the National Health Service Act 2006 (as amended). (i) We have acted with a view to ensuring that health services are provided in a way which promotes the NHS Constitution and that has promoted awareness of the constitution among patients, staff and members of the public by promoting awareness of the NHS Constitution on our website, and ensuring that the principles of the Constitution run at the heart of our commissioning decisions.


(ii) We have assisted and supported NHS England (NHSE) in discharging its duties relating to securing the continuous improvement in the quality of primary medical services by establishing a Primary Care Commissioning Committee to oversee the primary care commissioning activities. In 2016/17 the CCG will develop a comprehensive primary care strategy that builds on the London wide Primary Care strategy and will focus on the following areas: 1. Accessible care - providing personalised, responsive, timely and

accessible services 2. Co-ordinated - providing patient centred, coordinated care and GP-patient continuity 3. Pro-active care – supporting and improving the health and wellbeing of the population, self-care,

health literacy, and keeping people healthy 4. Estates strategy - developing and enhancing the current estate to ensure it is fit for purpose.

(iii) We have promoted the involvement of patients, their carers’ and representatives, in decisions that relate to the prevention or diagnosis of illness in the patient, their care and treatment by ensuring that patients and public are involved in the development and consideration of proposals for changes in commissioning arrangements. To support this we work closely with key stakeholders such as Healthwatch Newham, patient and public engagement groups, the Health and Wellbeing Board, the London Borough of Newham and other local NHS providers. (iv) We have enabled patients to make choices with respect to the aspects of health services provided to them by engaging with the local community about services that they access. Full details about our patient and public engagement work is available on page 30. v) We have promoted innovation, research, education and training through a broad range of transformational initiatives including the CCG’s investment programmes covering primary care, mental health, integrated care, MSK, long term conditions such as CVD and Cancer, and children’s services. These programmes are piloting new ways of delivering healthcare services in a more integrated way to enhance care to patients. (vi) We have engaged widely when devising commissioning plans through a range of approaches including face-to-face public engagement events, drop-in sessions for people to share their views, online surveys, working with our youth commissioners, attending local events to encourage involvement, attendance at partner organisations events and meetings and by using online and offline communications channels to raise awareness about the ways that people can get involved with our decision making processes. (vii) We have taken appropriate steps to ensure that we are prepared to deal with an emergency by working with local providers including Waltham Forest and Tower Hamlets CCGs to develop incident response and threat specific plans (e.g. cold weather plans and severe weather plans) to ensure we continue to deliver critical business operations and support our partners in the event of a major incident or emergency. Full details about our emergency planning work is available on page 73. (viii) We sit on the Health and Wellbeing Board (HWBB) and contribute to the discharge of the HWBB’s functions by attending meetings and actively participating with the development of the Joint


Strategic Needs Assessment and taking account of the HWBB’s recommendations when commissioning services. (ix) We have discharged our functions with regard to the need to safeguard and promote the welfare of children by working closely with local strategic partners across the local area to improve the health and wellbeing of all children and to ensure that services are in place to respond to children who have suffered significant harm or who are at risk. Full details about our work on safeguarding children is available on page 9. (x) We have discharged our functions with regard to safeguard adults by implementing robust safeguarding accountability and reporting arrangements. We now have a robust structure in place in relation to adult safeguarding that protects people who are at risk of abuse and neglect. Full details about our work on safeguarding adults is available on page 9. (xi) We have discharged our duty to provide equitable access to medicines by delivering a high quality medicines optimisation programme that promotes the appropriate and safe use of medicines for patients with variety of diseases. Working with partners we have introduced initiatives that promote access to medicines and treatments including a programme to identify and treat latent TB in the community, medicines management in care homes and working in partnership with local hospitals to implement NICE guidelines. Full details about our work on medicines management is available on page 9. (xii) We have contributed to the preparation of the Joint Strategic Needs Assessment (JSNA) by working in partnership with the London Borough of Newham and Public Health England to decide priorities for local healthcare services. The intelligence collated is fed into the Public Health Team to enable them to produce the Joint Strategic Needs Assessment (JSNA). Progress towards our strategic objectives during 2015/16 Newham CCG has three strategic objectives that shape our work. These are:

1. To improve patient experience and better manage demand by joining up local primary, community and acute care services to help people prevent and manage long term conditions, promoting resilience and independence.

2. To secure leading quality maternity and paediatric services and a healthy start in life for its children and young people.

3. To build and harness commissioning expertise and its member practices presence in neighbourhoods to get best value from public funding every day.

We have continued to make progress towards achieving our objectives through a wide range of work detailed throughout this report. To improve patient experience and better manage demand by joining up local primary, community and acute care services to help people prevent and manage long term conditions, promoting resilience and independence Two key examples of how we have been delivering on this objective over the last year are our work to develop cancer specific extended primary care services (EPCS) and our continued work on delivering our integrated care programme. Early detection of cancer is vital to long-term outcomes, which is why we introduced the EPCS. This supports best practice by ensuring local GPs reflect on their clinical practices and identify areas for improvement. As part of this work two audits were completed, a primary care cancer audit, that reviewed cases that led to a cancer diagnosis, and a significant event audit to provide further insight into how individual cases are managed and what changes could be made to improve final outcomes. To date this has led to the introduction of a comprehensive educational programme to support early detection in primary


care, which will positively impact on cancer outcomes for Newham residents. Further work will continue to identify opportunities to work with all of our providers to prevent and manage long term conditions. Our integrated care work has continued to move forward during 2015/16 with progress made across all areas of the programme. This has included implementing the rapid response service to care for people at home who might have otherwise gone into hospital; employing eight social care navigators to support patients with multiple long-term conditions so that they can access services in a coordinated way, supporting the production of 11,000 care plans for those patients who are most likely to need hospital care and have produced a directory of services for staff so that they can understand how, when and where to refer people in the community. We are also working on our self-care and prevention agenda in partnership with public health and social care colleagues and will be launching the new community prescription service in 2016. Our work with all providers to develop and implement integrated patient centred care in Newham is improving care and outcomes for people, their carers’, their families and our communities. To secure leading quality maternity and paediatric services and a healthy start in life for its children and young people Newham has the youngest population in England and one of the highest birth rates, which is why it is so important for us to get it right in developing our services for children and young people. Over the last year we have made significant steps towards delivering on this objective through our work to develop an integrated health commissioning approach with the London Borough of Newham (LBN) and by implementing the future in mind transformation plan, transforming access to mental health services for young people. The ‘NHS Five Year Forward View’ sets out a clear direction for the NHS, making the case for change and setting out what the NHS can achieve by itself, but also where the NHS needs to forms partnerships with local communities, local authorities and employers. As there is a responsibility for both LBN and the CCG to commission services for children and young people since the beginning of 2015 we have been looking at how we can most effectively work together to improve outcomes, reduce duplication, deliver efficiencies and build resilience for children and young people in Newham. This has led to the development of an integrated health commissioning team that allows us to pool resources across both organisations and jointly commission healthcare services helping to break down barriers in how care is provided and creating an environment where we can do the best for local people. Nationally around 10% of school age children and young people have a diagnosable Mental Health problem and 75% of mental health problems in adulthood (excluding dementia) start before the age of 18. Promoting children and young people's mental health, early support, effective intervention and prompt treatment and care when needed are critical to


ensure today's children and young people and tomorrow's adults can live happy, healthy and productive lives. Here in Newham we are working to address mental health problems by implementing the future in mind transformation plan. This has included setting up a single point of access service for professionals to request support for young people identified as having a mental health disorder. This ensures that young people get faster access to mental health services. By providing fast and simple access to these preventative services we aim to improve long-term health outcomes for young people in Newham. To build and harness commissioning expertise and its member practices presence in neighbourhoods to get best value from public funding every day The unique structure of clinical commissioning groups allow member practices to input their specialist knowledge into commissioning decisions. We have built an extensive network around our members’ practices working with them in a way that has developed their commissioning knowledge and helped drive improvements in outcomes for the local population. Over the last year we have moved closer to achieving this objective through the development of practice clusters and our network meetings that bring all of our members together to agree how we commission the best services for local people. GPs have a considerable understanding of the health needs of local people - for most people they provide the first point of contact into the healthcare system, seeing people with all health problems regardless of their age, sex, or any other characteristic. To best harness this knowledge we have developed a network of eight practice clusters, made up of our 59 member practices. These clusters provide a forum for our

member practices to come together to develop their commissioning knowledge and review the effectiveness of commissioned services with a view to securing improvement and sharing best practice. This means that they can play a key role on guiding decisions about healthcare provision determined by the prevalence and incidence of illness they see in the community. Listening to our member practices when developing services is vital to getting it right. This was the case when looking at how to provide echocardiogram (ECG) diagnostic tests. As we see a high prevalence of cardiovascular disease in Newham early intervention and diagnosis is important for improving health outcomes. Our member practices identified that these tests could be provided more effectively in the community rather than at the hospital, which would allow for

quicker diagnosis, quicker testing and therefore quicker access to treatment where necessary. The commissioning of the community based service has made a real difference for our patients who are seen closer to home and get their diagnosis quicker while the cost of the community based service is considerably less than if the tests were undertaken in hospital. We will continue to work with our member practices to identify how and where we can get best value across the healthcare services we commission. Key achievements Throughout 2015/16 we have made significant progress towards transforming and developing services that meet the needs of our local communities in partnership with local people and our healthcare partners. Our key achievements include:


Being authorised for delegated commissioning – in order to provide further benefits for local people through localising decisions about primary care and being able to better integrate services for patients. As with many CCGs we applied to NHS England to take on delegated commissioning and as we have a strong performance history and good governance in place we were approved to undertake delegated commissioning from April 2016. Under delegated arrangements we will have full responsibility for commissioning primary care services. This will give us the opportunity to place a greater emphasis on our primary care workforce and lead to an improvement in outcomes, reduced inequalities and an increase in satisfaction with the services provided in primary care for local people. Developing the transforming services together strategy and investment case – to set out how we intend to radically transform healthcare across East London to best meet future demand for services. We have worked with NHS organisations from across East London to develop the strategy and investment case and launched a second phase of formal engagement on our plans in February 2016. More than 1,000 people have been involved in the programme so far including clinicians, key stakeholders and members of the public. Following formal consultation we will be finalising the strategy and investment case in the summer of 2016. Launching a new dental service at the Sir Ludwig Guttman Centre – to provide additional dental capacity in Newham. The dental service, provided by the Barts Health Dental Institute provides dental care for adults and children with dental problems with a particular focus on the needs of children. The centre boasts 23 dental chairs and as well as providing some much needed additional dental capacity in Newham the centre also provides the opportunity for dentists in training to gain experience of working in Newham. Once trainees have developed skills and experience locally we hope this will attract dentists to work in the Newham area once qualified.


Recruiting and training four diabetes youth commissioners – who are helping us to review the diabetes pathway for children and young people by informing the commissioning of these services. We worked with UCLP partners to recruit young people with diabetes and provide appropriate training so that they could participate effectively. By having our youth commissioners working alongside us our commissioning of diabetes services for children and young people will be more sensitive to their needs. Creating an integrated children’s health board - that oversees the integration of children and young people’s services. Working with the London Borough of Newham (LBN) we have jointly created this integrated board by bringing together staff from the CCG, children’s services and the public health team at LBN. This will allow us to ensure that services are integrated meaning that children in the borough will receive consistent and coordinated care that truly meets their needs. Improving readmissions rates in Newham mental health services – by working with the service provider to identify the cause of the high readmission rates being seen in April 2015. The review showed the patients who were being readmitted were patients with substance misuse issues, chaotic lifestyles, personality disorders or who had housing issues so we provided further support for this group of patients as part of their discharge by providing access to community mental health teams and developing patient centred care plans with these patients. This has seen the readmission rate drop below the threshold of 7.5%. Reducing the number of hospital acquired pressure ulcers - by working with the service provider to undertake thematic reviews that allowed us to identify areas of improvement in the nursing care being delivered to our patients. This led to focused work taking place with nurses on wards around prevention, including focused education and support to identify and manage individual patient needs. This saw a reduction in pressure ulcers from an average of 13.6 per month to an average of 6.75 per month. We will continue to challenge and address areas of poor patient care to improve the experience for Newham patients. Improving quality and patient safety on inpatient wards – by undertaking quality assurance visits to inpatient wards at Newham University Hospital throughout the year. This helps us to observe first-hand the care and experience of patients on the ward and allows us to request quality improvements where necessary. Through this process we have influenced over 80 improvement actions, such as the replacement of a broken sink in a ward area and the introduction of multi-language welcome signs at the entrance to each ward. These improvements help to improve the environment and the experience for our patients. Developing a general practice quality intelligence dashboard – to offer a greater insight into the quality and performance of general practices in Newham. From April 2015 we achieved delegated authority for co-commissioning general practice services in Newham, therefore it was vital to understand performance in our local practices so that we can identify areas of concern and best support our GPs to make improvements where necessary. Having this insight means that we improve the quality of care being delivered to patients and help to deliver better outcomes. Developing a latent tuberculosis treatment service in primary care settings – in order to reduce the numbers of people with drug resistant tuberculosis (TB) in the borough. Newham has the highest incidence of TB in the UK with a rate of 107 cases per 100,000 people - and many people do not realise they have TB until too late, which then requires complex treatment. By developing this service and providing access to screening and treatment in primary and community care settings this means that people with TB can be identified earlier and cared for closer to home. This helps to improve long term health outcomes and improves our patients’ experience. Undertaking nursing home medication reviews – so that we can ensure people being cared for in these settings receive safe and high quality care. Many of the people being cared for in nursing homes are on multiple medications to manage a range of conditions, which makes it vital to review their medication regularly. During 2015/16 we undertook medication reviews across the six nursing homes based in


Newham to review medications practices and provide training for carers where necessary. Undertaking these reviews helps to improve quality of care by ensuring the safe and effective use of medications. Enhancing peri-natal mental health services – by commissioning an overall care package with a peri-natal support psychologist in the community, as part of the Improving Access to Psychological Therapies

(IAPT) team, and a mental health midwife based at Newham University Hospital. We are the first CCG in east London to have introduced this cohesive service that offers women and their partners who need support following pregnancy access to a dedicated peri-natal service straight after birth. This helps to tackle mental health issues before they escalate and improves the experience of these services for our patients. Securing funding to deliver our future in mind child and adolescent mental health services (CAMHS) transformation plan – this means that we have been able to provide a single point of access to mental health services for professionals working with young people. This provides faster access to treatment and more choice of the method of support such as online or over the phone. Providing fast access to these services is vital as national research indicates that more than half of adults with mental health problems were diagnosed in childhood but less than half of these were treated at the time. By working with a wide range of local partners to develop our plan to transform CAHMS we aim to have a positive impact on the long term of health of young people living in Newham. Recruiting and training 11 type 2 diabetes champions – who are working with us to support people with type 2 diabetes and raising awareness about the condition. The long-term conditions team worked with the Patient and Public Engagement Manager to recruit Newham residents to become champions. The champions received training in type 2 diabetes, commissioned by NCCG from Diabetes

UK, and have regular support meetings with the CCG and LBN. This helps to provide other people in the community with peer support and ensures that we receive feedback via the champions from people living with type 2 diabetes. Implementing the rapid response service as part of the integrated care programme – to provide additional support for people identified as very high risk or high risk through their care plans so that they can access immediate healthcare support without needing to go to hospital. The deployment of the rapid response service is undertaken following a clinical telephone triage, accessed through a single contact number, where staff will assess a patient’s eligibility and suitability to be seen and supported by the service. If eligible a package of care will be put into place within 12 hours. This is an exciting move forward in providing integrated care that offers the best solution and experience for our patients. Introducing multi-disciplinary meetings as part of the integrated care programme – to bring together staff from different disciplines who can contribute their knowledge, skills and experience into developing coordinated care plans for and with patients with complex healthcare needs. These multi-disciplinary team (MDT) meetings bring together staff from across all local healthcare providers so that the needs of the patient can be met across traditional healthcare boundaries ensuring continuity of care and an improved patient experience.


Launching the diabetes prevention programme - to help people at high risk of developing diabetes type 2 to change their lifestyles. We are leading the implementation of the programme across East London, together with Newham Council, and were one of 27 areas across the country to be chosen to be part of the first stage of the Healthier You: NHS Diabetes Prevention Programme. GPs will invite people they know to be at high risk to enrol and they will receive tailored help including education on healthy eating and lifestyle and bespoke physical exercise programmes to lose weight, which will be delivered as part of our community prescription programme. This will help to challenge health inequalities by supporting people living in East London to take control over their health outcomes. Key priorities for 2016/17 We have four major change programmes planned for 16/17 that will contribute to the overall delivery of the Operational Plan, Sustainability and Transformation Plan and the overall vision of providing accessible care in the right place at the right time. The first is Transforming Services Together (TST). This is a Waltham Forest and East London (WEL) programme that aims to deliver 13 high impact transformation projects across the WEL footprint. The programme is focused around two key areas that we believe will help people stay well, reduce the need to access hospital services and make our services more efficient, these are ‘stronger and sustainable hospitals’ and ‘care close to home’. Formal engagement on the strategy and investment case took place between 29 February and 22 May 2016. We will start to deliver on the strategy once engagement is complete and the strategy and investment case has been finalised. The second is the transformation of children's community health services. This programme is being delivered jointly with the London Borough of Newham. Engagement with all stakeholders, but specifically targeted to young people, their families and carers, took place between 5 April and 31 May 2016. The programme is focused on a range of objectives that aim to deliver services at a neighbourhood level. It is also planned that there will be an element of vertical integration with paediatricians from Barts Health offering peer support for community based services. It is intended that this 'no wrong door' approach will assist children and families access universal and specialist services in a localised setting. It is envisaged that the newly transformed services will go live in quarter 4 2016/17. The third major change programme is the transformation of adult based community services. Building Healthy Communities is our two year programme of redesign and re-procurement of the existing community based provision and the scoping of how hospital based services can be redesigned to deliver efficient, modern community healthcare across Newham. Find out how we have been engaging our local communities in this work on page 32. The final programme will concentrate on our role as a level three primary care commissioner, whereby we now have delegated responsibility from NHS England for the commissioning of primary care services. To support this a primary care strategy will be developed, underpinned by an estates strategy, to further advance the 'health hubs' model. This is a core piece of work that will be crucial to the success of other programmes noted above. How Newham CCG measures performance The CCG has a robust process to manage performance of its providers through regular monthly contract meetings with provider trusts to review key performance indicators such as waiting times to access services and quality standards. A series of national and local targets on waiting times, guide these discussions and performance against these targets are summarised on the next page.

http://www.transformingservices.org.uk/


Performance against national indicators

Apr 15 May 15

June 15

July 15

Aug 15

Sept 15 Oct 15 Nov

15 Dec 15 Jan 16 Feb 16 Mar 16 15/16 YTD 2015/16 Target

Operating Plan standards

18 weeks RTT (excluding Barts Health)

95.51%

95.04%

94.50%

94.55%

94.05%

94.29%

94.15%

94.57% 93.24% 93.59

% 93.36

% 93.54

% 94.22% 92%

2 Week Cancer Waits 88.79%

92.96%

95.22%

94.99%

94.24%

94.26%

93.92%

94.86% 97.28% 95.34

% 96.1% 95.81% 94.48% 93%

A&E: 4 hours 89.67%

91.09%

91.43%

90.19%

91.58%

89.56%

87.71%

87.29% 87.41% 89.27

% 88.98

% 87.43 88.84% 95%

Constitutional Pledges

Diagnostic Waits (>6 weeks) 3.71% 1.61% 0.77% 0.47% 0.49% 0.23% 0.61% 1.09% 1.67% 1.27% 0.46% 0.45% 1.09% 1%

Cancelled Operations (Barts Health)

Q1 Q2 Q3 Q4 78.68% 100%

77.% 79.17% 81.89% 90.59% Cancer Waiting Times 1st appointment < 2 weeks referral for Breast Symptoms

98.53%

95.45%

96.05%

98.26% 100% 99.32

% 98.96

% 97.44

% 98.61% 98.04% 97.5% 100% 98.09% 93%

Cancer Waiting Times 31 days to 1st treatment

93.48%

88.24%

89.47%

92.45%

90.91%

95.65%

98.33%

96.23% 97.87% 96.55

% 94.2% 100% 94.44% 96%

Cancer Waiting Times: 31 days for subsequent treatment to Surgery

100% 75.00% 100% 100% 100% 100% 100% 83.33

% 100% 100% 100% 90.00% 95.69% 94%

Cancer Waiting Times: 31 days for subsequent treatment to Chemo.

100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 98%

Cancer Waiting Times 31 days for subsequent treatment to Radiotherapy

95.24%

96.00% 100% 94.74

% 100% 100% 100% 100% 100% 100% 100% 100% 98.83% 94%

Constitutional Standards – MENTAL HEALTH

7 day follow up after Psychiatric Admission

Q1 Q2 Q3 Q4 96.23% 95%

96.79% 100% 94.38% 93.83%


Local Newham CCG Primary Care indicators Targets are calculated cumulatively & monthly for this indicator

Apr 15 May 15

June 15 July 15 Aug 15 Sept

15 Oct 15 Nov 15 Dec 15 Jan 16 Feb 16 Mar 16 Target

Patients with Type 2 diabetes with a Care Plan 32.8% 40.5% 49.3% 55.7% 64.0% 68.6% 73.4% 77.7% 83.3% 50%


18weeks referral to treatment For the 18 week wait for referral to treatment target, the 92% standard was met up to February 2016 with performance at 93.41%, and no patients were waiting longer than 52 weeks at the end of the reporting month. However, it is important to note that this does not include data for either Barts Health or the Homerton; neither of which are currently reporting RTT performance nationally. There has been an increase in demand for elective surgery and the number of elective inpatient and day case surgical procedures undertaken in Newham have grown by 4.5% in 2015/16. GP referrals to outpatient services also grew by 1.5% reflecting the population growth in the borough. Outpatient first and follow up attendances grew by 6.9% and 2.3% respectively in 2015/16 reflecting both population growth and the additional patients seen through RTT waiting time backlog. A&E – 4 hours Newham University Hospital is one of four hospitals that make up Barts Health NHS Trust, and that report on the four hour target. For 2015/16, the Trust’s overall achievement was 88.01% of people were treated within four hours. Although the Trust, did not meet the target overall, our local hospital, Newham University Hospital achieved 95.2%, making our local A&E one of the highest performing hospitals in the country. We know our patients attend a range of hospitals for A&E attendances, and therefore we continue to work with Barts Health Trust to ensure that this standard is achieved going forward. Homerton University Hospital NHS Foundation Trust achieved the target with provisional performance for the year at 95.16%. It is worth noting that Newham University Hospital saw a significant increase in the number of patients attending the A&E department particularly in the later months of the year, with a 21% increase in attendances in January and February 2016 compared to the same period the previous year. Overall for 2015/16, attendances grew by 2% on the previous year. Finally emergency admissions to our local hospitals have grown by 2.7% overall in 2015/16. CAT-A calls <8 minutes Newham CCG is currently not meeting the Category A Red 1 Ambulance calls target as at February 2016. Performance against the eight minute response time standard is measured at provider level and so reflects London Ambulance Service (LAS) performance as a whole. LAS performance for the year as at January 2016 is 67.9% against the standard of 75%. The LAS has developed an improvement plan as a result of the Care Quality Commission (CQC) report published on 27 November 2015, which the CCG is monitoring through our Quality Committee. Diagnostic waits >6 weeks For the six week maximum wait for diagnostic tests, the 1% target was just missed with 1.19% of patients waiting longer than six weeks for the reporting period up to January 2016. Remedial action plans have been signed off by CCGs and the providers for diagnostic areas that have not achieved this target and it is expected that performance will improve over the coming months.


Cancelled operations (Barts Health) There have been a number of breaches in meeting the 100% cancelled operations target of carrying out surgery within 28 days for any patient whose operation is cancelled on the day leading to overall performance of 79.41% at January 2016. To address this, the cancelled operations policy within the Trust has been updated to ensure that cancellations are escalated as appropriate and rebooked within 28 days. Cancer waiting times While we have met some of our cancer targets we need to do better to drive up standards and ensure that we meet all standards to provide the best care for local people, therefore, enhancing cancer services is key priority for us. We have established a range of initiatives in line with the cancer task force report 2015, focusing around earlier diagnosis, enhancing the patient experience and raising survival rates in Newham. We have partnered with Cancer Research UK and Macmillan Cancer Support to implement and develop tools to support GPs/HCP’s to more easily identify symptoms that may suggest cancer, thus resulting in earlier referral for testing, diagnosis and treatment. A cancer task group for Newham CCG is now in place involving the chair, chief officer and commissioners from Newham CCG, stakeholders from Newham public group is to collectively agree and oversee the implementation of strategic initiatives to improve early diagnosis and cancer outcomes in Newham, throughout the entire patient pathway, with an initial focus on earlier detection, prevention and public awareness of cancer. In meeting some of the standards we have found that some treatment pathways for certain tumour types are complex and challenging, particularly where interventions occur across multi-sites and even multi providers. To address this we are reviewing the some pathways to identify efficiencies and improve patient outcomes. Additionally we are working with our acute providers to ensure they have the necessary capacity and with the introduction from April 2016 of a breach re-allocation, we hope this will identify further elements along pathways that may require additional attention. Seven day follow up after psychiatric admission Newham CCG is on track to meet the target to see 95% of patients within seven days after discharge from receiving psychiatric inpatient care with performance at 97.06% at January 2016. We will continue to work with our providers to ensure that Newham residents receive the highest quality services. Standards around same-sex accommodation Newham CCG had a total of 39 mixed sex accommodation (MSA) breaches between April 2015 and January 2016. Majority (92%) of breaches are Newham residents at The Royal London Hospital site from the Adult Critical Care Unit, particularly around step down from critical care to inpatient wards. Barts Health through its quality improvement plan has a work stream for emergency care and patient flow, which is looking at pathways across the Trust and the health economy to reduce the number of MSA breaches. NHS Constitution Our governing body produces an annual commissioning plan that promotes awareness of and has regard to the NHS Constitution. Specifically, we aim to commission services in a way that sets out clearly what patients, the public and staff can expect from the NHS and in return, what the NHS expects from them. We have our own constitution, which sets out how we intend to do business through our


governance structure as a clinical commissioning group. The full document can be viewed in the governance section of our website. Better care fund metrics The Better Care Fund (BCF) is a highly ambitious programme announced by the Government in the June 2013 spending review. It aims to ensure closer integration between health and social care, putting person centred care and wellbeing at the heart of decision making by a single pooled budget between the CCG and the local council. The funding agreement between the two bodies in Newham is in excess of the minimum requirements at a total of £119.18m. This demonstrates the commitment from both the CCG and the London Borough of Newham (LBN) to the aspirations of the BCF and the direction of travel that both organisations are committed too. Newham CCG and LBN colleagues have worked collaboratively on an ambitious vision for the BCF and both partners are committed to its implementation and for real ‘step-change’ within the local health economy. Our vision is to utilise system resources through the integrated commissioning of services across health and care in order to drive a landscape of integrated provision of services at a local level. The Joint Health and Wellbeing Strategy provides the platform for our vision to become realised through common and shared themes that are reflected in all our key initiatives including integrated care, Transforming Service Together, care closer to home, sustainability and transformation plans (STPs) and the Five Year Forward View. The common and overlapping themes are:

• Building personal and economic resilience – investment in self-care and prevention • Keeping residents out of hospital • Ensuring early discharge from hospital • Tackling long term conditions

http://www.newhamccg.nhs.uk/aboutus/nhs-newham-ccg-constitution.htm

http://www.newhamccg.nhs.uk/aboutus/nhs-newham-ccg-constitution.htm


• Providing care closer to home • Offering a single point of contact, wherever possible • Improving primary and community care to keep residents out of hospital • Improving the quality of services • Giving children the best start in life • Encouraging partnership and integration • Reducing health inequalities.

The integrated care programme is a key enabler to the delivery of our vision - to provide joined up health and social care services. Our approach to delivering integrated care within the BCF is to bring together services in a co-ordinated way which are more responsive to the community; reduce the likelihood of people falling between the gaps of services; ensure that prevention and early identification of conditions is a primary focus aligned with self-care/management capability; and to enable treatment to be provided within the community where possible as opposed to hospital settings. Schemes to deliver the BCF plan are integral to the integrated care programme and there are significant inter-dependencies on adult social care services being delivered in an integrated way with secondary and primary care health services across Newham. To address this we have protected adult social care services recognising the additional burdens from the implementation of new legislation (Care Act 2014). Our vision is that this will not only deliver significant improvements for patients and customers, but deliver key financial benefits to enable a financially sustainable model over both the medium and long term. For 2015/16 the key national performance measures monitored on a quarterly basis by NHS England to monitor the outcomes of the Better Care Fund were met. This includes the targets for:

• Number of unplanned admissions into hospital • Permanent admissions into residential care • Number of people getting reablement that are at home 91 days after discharge • Delayed transfers of care

The BCF is managed through a Section 75 agreement and is based on a template section 75 agreement prepared by solicitors, Bevan Brittan, on behalf of the national BCF programme office. The overall delivery of the BCF is monitored through our BCF Governance and Delivery Group, which is co-chaired by the CGG and LBN. For 2016/17, it has been confirmed that the BCF will be increased to a mandated minimum of £3.9 billion to be deployed locally on health and social care through pooled budget arrangements between local authorities and clinical commissioning groups. The local flexibility to pool more than the mandatory amount will remain. The CCG and LBN are currently developing a revised BCF plan for submission in April 2016. Friends and family test The NHS friends and family test (FFT) was created to help service providers and commissioners understand whether patients are happy with their services, or where improvements are needed. At Barts Health the FFT is provided across inpatient wards, emergency care and in the maternity department. From April 2015 to January 2016 an average of 95.2% of


responses recommended Barts Health inpatient wards, (Newham hospital average 96%) comparing favourably to the England average of 82% and the London average of 89%. During the same period in the Barts Health A&E department an average of 92% of responses recommended these services (Newham Hospital average 91%), which is higher than the England and London average of 88%. In maternity services provided by Barts Health an average of 93% of respondents recommended antenatal care (Newham hospital average 92%); 96% of respondents recommended the Trust and Newham Hospital site for their care during birth; 89% of respondents recommended the ward-based postnatal care (Newham hospital average 88%); and an average of 98% of respondents recommended the Trust for their community postnatal care. At East London Foundation Trust patients being cared for across the City and Hackney Centre for Mental Health, East Ham Care Centre, Newham Centre for Mental Health, The Coborn Centre for Adolescent Mental Health and The Tower Hamlets Centre for Mental Health are asked to provide feedback using the FFT. At the Newham Centre for Mental Health 80% of respondents would recommend the hospital based services and 92% of respondents would recommend the community based services. However, response rates are currently quite low and ELFT are working to improve their response rates so that the results are more reflective of the number of patients being cared for. Since December 2014 GP practices have provided their patients with the opportunity to feedback about their services using the FFT. Patients are not necessarily asked to offer feedback after every appointment or contact with the practice, but are made aware of the opportunity to feedback through this route. From April 2015 to February 2016 an average of 72% of respondents said they would recommend Newham GP practices to their friends and family, however, to date there has been a low number of people choosing to provide feedback using the FFT. Newham GP practices are working on improving their response rates. Sustainability report As an NHS organisation, and a spender of public funds, we have an obligation to work in a way that has a positive effect on the communities we commission and procure healthcare services for. Sustainability means spending public money well, the smart and efficient use of natural resources and building healthy, resilient communities. By making the most of social, environmental and economic assets we can improve health both in the immediate and long term in ways that take account of the rising cost of natural resources. We acknowledge this responsibility to our patients, local communities and the environment by working hard to minimise our footprint. As a part of the NHS, public health and social care system, it is our duty to contribute towards reducing the carbon footprint of the NHS, public health and social care system by 34% (from a 1990 baseline) by 2020, equivalent to a 28% reduction from our 2013 baseline. It is our aim to meet this target by reducing our carbon emissions 28% by 2020 using 2013 as our baseline year.


Policies In order to embed sustainability within our business it is important to explain where sustainability features in our processes and procedures.

Area Is sustainability considered? Commissioning (environmental) Yes Commissioning (social impact) Yes Suppliers' impact Yes Travel No

One of the ways an organisation can embed sustainability is through the use of a sustainable development management plan (SDMP). We will be developing an SDMP in the near future for consideration by the Board. As an organisation that acknowledges its responsibility towards creating a sustainable future, we also work towards achieving that goal by running awareness campaigns that promote the benefits of sustainability to our staff. Climate change brings new challenges to our business both in direct effects to healthcare estates, but also to health. Examples from recent years include the effects of heat waves, extreme temperatures and prolonged periods of cold, floods, droughts etc. We have identified the need for the development of a board approved plan for future climate change risks affecting our area. Partnerships As a commissioning and contracting organisation, we need effective contract mechanisms to deliver our ambitions for sustainable healthcare delivery. The NHS policy framework already sets the scene for commissioners and providers to operate in a sustainable manner. Crucially for us as a CCG, evidence of this commitment will need to be provided in part through contracting mechanisms. The table shows the sustainability information about providers of our commissioned services. More information on these measures is available here: http://www.sduhealth.org.uk/policy-strategy/reporting/sdmp-annual-reporting.aspx

Organisation Name SDMP On track for 34%

reduction GCC

Healthy travel plan

Adaptation SD Reporting score

Barts Health NHS Trust Yes Yes Yes Yes No Data not available

Homerton University Hospital NHS Foundation Trust No No No No No Good

East London NHS Foundation Trust Yes Yes No No No Poor

London Ambulance Service NHS Trust No No Yes Yes No Data not available

Moorfields Eye Hospital NHS Foundation Trust Yes No Yes Yes No Good

University College London Hospitals NHS Foundation Trust Yes Yes No No Yes Minimum

Performance Organisation As a part of the NHS, public health and social care system, it is our duty to contribute towards the level of ambition set in 2014 of reducing the carbon footprint of the NHS, public health and social care system by

http://www.sduhealth.org.uk/policy-strategy/reporting/sdmp-annual-reporting.aspx

http://www.sduhealth.org.uk/policy-strategy/reporting/sdmp-annual-reporting.aspx


34% (from a 1990 baseline) equivalent to a 28% reduction from a 2013 baseline by 2020. It is our aim to meet this target by reducing our carbon emissions 10% by 2015 using 2007 as the baseline year. Prior to moving to Unex Tower, NHS Property Services provided the facilities management functions for Warehouse K, this included managing energy and utility consumption and cost, this meant that the CCG did not have a formal plan on carbon emissions reductions. We have recently relocated from Warehouse K to Unex Tower where we will be managing all utility and energy consumption and cost directly with the landlord. As the new facility uses the BRE’s Environmental Assessment Method, the leading and most widely used environmental assessment method for buildings, we have reduced our overall footprint by moving into this new building, we are also expecting to see a reduction to our overall carbon footprint in future years. Here's how we have performed to date: Energy Newham CCG has spent £41,043.88 on energy in 2015/16.This is a 2.3% decrease on energy spend from prior year. We will continue to look at ways that we can reduce the impact we have and to maximise the social, environmental and economic assets available to us.

Resource 2013/14 2014/15 2015/16

Gas Use (kWh) 0 0 0

tCO2e 0.0 0.0 0.0

Oil Use (kWh) 0 0 0

tCO2e 0 0 0

Coal Use (kWh) 0 0 0

tCO2e 0 0 0

Electricity Use (kWh) 370,354 341,340 314,634

tCO2e 207.4 211.4 180.9

Total Energy CO2e 207.4 211.4 180.9

Total Energy Spend £ 42,012 £ 41,596 £ 41,044

2013/14 2014/15 2015/16Variance 102 87 104Waste Water

(m3) 408 346 415

Water Volume(m3) 510 433 519

0200400600800

10001200

Volu

me

(m3)

Water Usage 13/14-15/16

0.050.0

100.0150.0200.0250.0

2013/14 2014/15 2015/16

Car

bon

(tCO

2e)

Carbon Emissions -Energy Use

Gas Oil Coal Electricity


Working with the public and patients As an organisation we put person-centred care at the heart of all we do, developing programmes that aspire to empower patients, carers and the community to take control of their care and wellbeing. An important aspect of this is listening to the patient voice and during 2015/16, we have continued to actively engage patients, service users, carers and the voluntary sector in procurement, contract and service monitoring, service planning, design, redesign and decommissioning, as well as engaging on our commissioning intentions and strategy development. Our Patient and Public Engagement (PPE) Strategy sets out our approach to engagement to ensure that we meet our legal duties, as well as the principles enshrined in the NHS Constitution. Our annual PPE report that sets out how we meet our statutory obligations was submitted to NHS England demonstrating how we met our statutory duties during 2015/16, as well as delivering on the principles of ‘community ownership’ embedded in the PPE strategy. The strategy and the PPE statutory obligations report can be viewed here: http://www.newhamccg.nhs.uk/GetInvolved/patient-and-public-involvement.htm

160.0170.0180.0190.0200.0210.0220.0

2013/14 2014/15 2015/16

Carbon Emissions tCO2e

CarbonEmiisionstCO2e

2013/14 2014/15 2015/16

Electricity Consumed and Cost TrendTotal Energy Spend (All Energy)

Consumed (kWh)

http://www.newhamccg.nhs.uk/GetInvolved/patient-and-public-involvement.htm


Working with patient representatives As part of our redesign and commissioning of an integrated musculoskeletal (MSK) service for Newham we recruited two patient representatives to work with us. Since being recruited to the programme our patient representatives have participated in all engagement events with the providers and attended all workshops to input into the structure and governance of the new provider organisation and the clinical modelling work. They have also been involved in helping to shape the new model of care and the clinical pathways. As with our other patient representatives across our commissioning portfolio, the MSK patient representatives will also be part of the mobilisation planning workshops and the contract award decisions. Although the procurement of the 111 service has been delayed, we have continued to work in partnership with Healthwatch Newham to recruit two patient representatives to input into the programme. These representatives will continue to work with us to develop and deliver the integrated urgent care procurement, using the learning from the 111 re-procurement to ensure the new service meets the needs of local people. Working with young people Through Future Generation, our collaborative approach to shaping health services for children and young people, we have undertaken engagement activities that put young people at the heart of decision making:

We worked with the local youth councillors to develop our Future in Mind Transformation Plan for mental health services. Newham’s youth councillors represented the CCG at the Mayor’s Show asking fellow young people: “What does a good mental health service for young people look like?” Prior to the event, the youth councillors took part in a two day media training programme organised by the CCG and delivered by Reprezent 107.3 FM – the Sound of Young London to help them take on the role of reporters during the event. Though we are at the early stages of the developing the plan for mental health services, young people have been invited to join the steering group to give feedback and monitor the outcomes. As we move forward the group will also help to formulate the tender process.

We recruited four youth

commissioners living with diabetes as part of the Newham Diabetes Youth Project. Our youth commissioners have helped to run workshops on the future of diabetes services and to raise awareness of the condition. During the workshops, young people and their families were invited to share their experiences and views on the existing services with experts, providers and clinicians and then offered their suggestions on how they could be improved so that we can develop services that meet the needs of those using them.


Engaging the local community The second phase of engagement on the Transforming Services Together programme was launched in February 2016. During the earlier phase of engagement we worked with more than 1,000 people from three boroughs including clinicians; stakeholder organisations; patient representatives; patients and members of the public to develop the strategy and investment case that was published in the first quarter of 2016. During this phase of engagement, we asked local people whether we are focusing on the right challenges and whether our proposals will result in a better, more sustainable health service for the residents of East London. Formal engagement on the strategy and investment case took place between 29 February and 22 May 2016. As a central aspect of developing our Estates Strategy for 2016 – 2026 we have been talking to patients, partners and members of the public to understand what they would describe as a quality environment. To support this our primary care team held drop-in sessions to talk through our plans at community festival, we held a workshop with our patient participation group members and we held a public engagement event to provide an opportunity for local people to input into the development of the strategy. As a result of the feedback we received we will be aiming to build the following suggestions into the strategy:

Premises located near good public transport links Accessibility for those with special physical needs, e.g. changing facilities, wheelchair access Ensuring facilities meet high standards of energy conservation Provision of a telephone service to improve access and support self-help where appropriate Aiming to offer a one-stop service for care closer to home.

During 2015 we began to have discussions with our community to understand how we can best transform community health services to meet their needs. As we undertake the re-procurement of our community


health services, it is our intention to work in equal partnership with patients to develop a new model of care that reflects the needs of our community. To date we have been undertaking face-to-face engagement and have taken account of existing feedback gathered through our providers, Healthwatch Newham, from PPE activities, focus groups in the community and a Q&A session with our Community Reference Group. Supporting patient and public engagement Alongside engagement on specific programmes, as detailed above, we also engage patients and the public through our ongoing forums including the Patient Forum, Community Reference Group and the Health and Social Care Network. These forums provide a regular platform for the organisation to consult patients and the voluntary sector on some of our key commissioning decisions. As these forums are led by patients and the voluntary sector they also serve as a mechanism for the community to share any emerging issues with us regarding the services we commission. As our PPE strategy outlines we have invested in developing patient participation groups (PPGs) so that they can effectively represent the patient voice in local healthcare development. As part of the development of PPGs members of the group and the supporting practice staff are offered training by a third sector organisation, a PPG best practice toolkit, as well as outreach activities to raise awareness and promote the important role PPGs have to play in empowering patient voice in primary care. Going forwards, we know that the demand for patient and public engagement in primary care will increase and it is our intention to build on the work we have done with PPGs to strengthen how we engage with patients in primary care. Working with our partners Newham CCG recognises that to improve health and wellbeing outcomes for Newham residents, particularly people who are most disadvantaged, requires building and establishing effective partnerships. That’s why we work closely with a wide range of partner organisations to challenge health inequalities and help people lead healthy and happy lives. In the coming year we will continue to work with local partners to achieve the best health outcomes for local people, taking account of national and local drivers on integrating health and social care acting as part of our approach. London Borough of Newham We are working more closely with Newham Council to commission health and social services so people who require both health and social care can receive them as an integrated service. This means services are more tailored to individual needs, and can be delivered more efficiently and effectively. The integrated care programme and the joint commissioning of community children services, through our integrated children’s health board, are examples of our commitment to partnership working. We play a key role as joint lead partner on the Health and Wellbeing Board, which is the principal forum in the borough to oversee work to improve health and social outcomes in the borough. As part of our work to challenge health inequalities the CCG and London Borough of Newham have agreed an ambitious Better Care Fund Plan for 2016/17. We are also an active member of the adult and children’s safeguarding boards, where decisions are made on how we collectively support vulnerable and at-risk persons. Our key providers Local acute hospital services are mainly provided by Barts Health NHS Trust. Our local hospital is Newham University, but Newham residents also access services at Whipps Cross, The Royal London and through Homerton University Hospital NHS Trust. Local community based and mental health services are mainly provided by East London Foundation NHS Trust. We have established a number of mechanisms to work together with all of our providers to drive quality improvement and performance to ensure that we can provide the very best services for local people. The WEL (Waltham Forest, Tower Hamlets and Newham CCGs) Newham CCG together with Waltham Forest and Tower Hamlets CCGs make up the Waltham Forest and East London (WEL) collaborative. Working together allows for more effective commissioning of services from Barts Health, which spans the three boroughs, and allows us to work closely on issues that affect all


three CCGs, as well as sharing knowledge and experience on specific projects. Shared teams support the three CCGs in key areas such as contract management and integrated care. We have also established commissioning alliances across the three boroughs in key service areas such as children and maternity. Transforming Services Together The Transforming Services Together programme, established by Newham, Tower Hamlets and Waltham Forest CCGs sets out our plans to work in partnership to deliver high-quality, safe and sustainable services for local people. We have developed these plans in partnership with patients, the public and their representatives and with staff from across our provider organisations including Barts Health NHS Trust; neighbouring CCGs – in particular, City and Hackney CCG, Barking and Dagenham CCG, Havering CCG and Redbridge CCG; Homerton University Hospital NHS Trust; East London NHS Foundation Trust; North East London NHS Foundation Trust; local authorities (including public health teams) – in particular the London Boroughs of Newham; Tower Hamlets; Waltham Forest; and Redbridge; NEL Commissioning Support Unit; NHS England – responsible for specialised commissioning; and the Trust Development Authority. We will continue to test our ideas with staff, local communities, partners and patient representatives, through meetings, workshops and other methods of engagement as these plans are developed further. Our strategy aims to:

support the health and wellbeing strategies of our boroughs, helping people to stay healthier and manage illness; and to access high-quality, appropriate care, earlier and more easily

change the culture of how we commission and deliver care increase involvement of patients and carers in co-production and shared decision-making maximise the use of the assets in our communities and voluntary sector commission activity to be in fit-for-purpose settings of care, often closer to home focus some surgery in fewer locations to improve patient outcomes and experiences and drive up

efficiencies acknowledge the importance of supporting people’s mental health and well-being ensure the system is flexible enough to respond to changing demands help set our finances on a path of sustainability in a challenging environment.

Tackling inequalities In this section we summarise how we collaborate as part of the Health and Wellbeing Board to effectively tackle health inequalities. We have shared this section with our HWB Board colleagues and incorporated their feedback where received. In Newham we have considerable health inequalities and are increasingly seeing greater income disparities. We are committed to tackling these health inequalities and work closely with the council and other partners through the Health and Wellbeing Board to drive forward improvements to health and social care services, which aim to reduce health inequalities. We also recognise that it is more important than ever to integrate equality considerations into all aspects of our commissioning. A key part of the work on tackling health inequalities has been to collaborate with our partners on the Health and Wellbeing Board. The CCG is a joint chair of the Board and works with partners from London Borough of Newham, East London Foundation Trust, Healthwatch Newham, UCL Partners, University of East London and local voluntary organisations. The CCG has worked effectively with partners and


stakeholders to agree a Joint Strategic Needs Assessment that has enabled the Board to set wellbeing and health priorities that address key health challenges such as obesity, smoking and hypertension. The Board is currently reviewing the priorities and the Health and Wellbeing Strategy and there is a commitment from all partners that a ‘prevention’ strategy is vital as part of a sustainable approach to tacking health inequalities. As part of ensuring our commissioning plans address health inequalities, we undertake equalities impact assessments on all procurements that take into account:

Health outcomes Statutory and demographic specific equality groups (equality assessment) Health inequalities Travel and access

We are committed to upholding the Human Rights Act 2000 and we have complied with all equality legislation to ensure that we commission the best possible health care services for the people of Newham. During 2015/16 we updated the EDS2 and completed the workforce race equality standard and during 2016/17 we will be reviewing and updating our equality strategy making sure that this is aligned with public health priorities and the equalities protected characteristics. How we spent our money We are accountable for what we do with public money. In 2015/16, we achieved good value for money for our patients. We were given a revenue resource limit of £477.852 million from NHS England. This was made up of recurrent funding allocation (the money we get each year) of £461.738 million. This allocation equated to £1,225 per registered person in Newham for patient care (excluding admin costs).


Of the £477.852 million, £16.114 million was non-recurrent funding – money which we have been given this year only. As this is non-recurrent funding, we did not take this into account in our long-term planning. In April 2015, the Governing Body agreed our annual operating plan that sets out how we will commission services over the coming year in order to deliver on our commissioning strategy. These plans included achieving a surplus of £6.500 million for financial year 2015/16, which we have achieved, delivering a surplus of £6.518 million. This shows an overachievement of surplus of £0.018 million. We spent money on services as follows:

Capital Our capital spend was £1.440 million, against an annual capital budget of £1.487 million. CCGs are set two financial targets, and in the financial year 2015/16, we met both. Revenue resource limit The revenue resource limit sets a limit on the net expenditure of the organisation. We were required to achieve a surplus of 1% of allocation in the financial year 2015/16 and exceeded this by delivering a surplus of £6.518 million. Capital resource limit We have to keep our capital expenditure (the money we spend on something that we then own, such as a building or piece of equipment, within a ‘capital resource limits (CRL) ’, which is set by NHS England. Our limit for the year was set at £1.487 million and we spent £1.440 million on capital expenditure for 2015/16.

, Acute, 228,311, 48%

, Mental health, 46,110,

10%

, Community services, 40,437, 9%

, Non-other acute services, 47,925,

10%

, Primary care, 101,285, 21%

, Corporate, 7,266, 2%

Acute

Mental health

CommunityservicesNon-other acuteservicesPrimary care

Corporate


We did not have a cash funding limit; an internal cash limit was set by NHS England for internal controls purposes. However, we have managed our cash position efficiently so as not to affect the payment of creditors. Future financial plan NHS Newham CCG’s funding allocation for the financial year 2016/17 will be £482.613 million. This includes the £6.518 million surplus carried forward from 2015/16. In its dual role as local NHS commissioner and key partner in local public services delivery, our challenge is therefore to improve the quality of services and meet the needs of our local population, while managing demand and the changing health system so that it is much more efficient and effective. In both 2013/14 and 2014/15 we achieved sound financial positions and we maintained that in 2015/16. The five year plan submitted in 2014/15 showed we intend to deliver 2.5% QIPP each year. We have successfully achieved our target in 2015/16. The wider reforms and tight financial settlements across public sector and the NHS will impact on us and present a challenge, although we are better placed than some to withstand the impact of any constraints in resourcing that may be applied. The full accounts are also available on our website www.newhamccg.nhs.uk

The performance report was approved by the Governing Body on 26 May 2016 and signed on its behalf by: Steve Gilvin Chief Officer 26 May 2016

http://www.newhamccg.nhs.uk/


Accountability Report


Corporate governance report Members report Full details about our governance arrangements, our committees and their responsibilities can be found in the annual governance statement from page 52 along with information about data security and associated breaches and disclosure statements. The members report details the composition of the Governing Body, a list of our member practices, the members of our committees and the register of interests. CCG Governing Body

Title Dates Voting clinical members Dr Zuhair Zarifa Chair 1/4/15 – 14/10/15 1/4/15 – 31/3/16 Dr Ashwin Shah Deputy Chair 1/4/15 – 31/3/16 Dr Prakash Chandra Chair 14/10/15 – 31/3/16 1/4/15 – 31/3/16 Dr Jim Lawrie 1/4/15 – 01/3/16 Dr Bhupinder Kohli 1/4/15 – 31/1/16 Dr Stuart Sutton 1/4/15 – 31/3/16 Dr Elizabeth Goodyear 1/4/15 – 31/3/16 Dr Ambady Gopinathan 1/4/15 – 31/3/16 Dr Muhammad Naqvi 1/4/15 – 31/3/16 Dr Rima Nicole Vaid 1/4/15 – 31/3/16 Dr Saravanan Chellapan

1/7/15 – 31/3/16

Voting non-executive directors Wayne Farah Lay Member for Patient Engagement (Vice-Chair) 1/4/15 – 31/3/16 Paul Hendrick Lay Member for Governance 1/4/15 – 31/3/16 Andrea Lippett Lay Member for Remuneration 1/4/15 – 31/3/16 Officers and voting members Steve Gilvin Chief Officer 1/4/15 – 31/3/16 Chad Whitton Chief Finance Officer 1/4/15 – 31/3/16 Hazel Trotter Practice Manager 1/4/15 – 31/3/16 Grainne Siggins Executive Director for Adults Social Care, LBN 1/4/15 – 31/3/16 Dr Rizwan Hasan Secondary Care Consultant 1/4/14 – 31/3/15 Sofia Roupakia Healthwatch Representative 1/4/14 – 30/11/15 Fiona Smith Registered Nurse 1/4/15 – 31/3/16 Augustina Eyeson Practice Nurse 1/4/15 – 02/12/15 Non-voting members Meradin Peachey

Director of Public Health, London Borough of Newham 1/4/16 – 31/3/16


List of Newham CCG member practices

Abbey Road Medical Practice (Dr Yates) Liberty Bridge Road (Dr M Jones)

Balaam Street Practice (Dr Al-Mudallal) Lord Lister Health Centre (Dr Abiola)

Barking Road Medical Practice (Dr Olatigbe ) Lord Lister Health Centre (Dr Driver)

Birchdale Road Medical Practice (Dr B.K. Sinha) Lord Lister Health Centre (Dr Swedan)

Boleyn Medical Centre (Dr Chalabi & Dr MSK Khan) Manor Park Medical Centre (Dr Dhariwal)

Boleyn Road Practice ( Dr Rafiq) Market Street (Dr A Orimoloye) Claremont Clinic (Dr Wood) Newham Medical Centre (Dr Ahmed)

Cumberland Road Medical Practice (Dr Gonsai) Newham Transitional Team (Dr Duncan Trathen & Dr Kensah) E15 4ES

Custom House Surgery (Dr Zarifa) Plashet Medical Centre (Dr K. Mahmud)

DMC Health Care 1 (Dr Jane Muir Taylor) Royal Docks Medical Centre (Dr Lawrie)

DMC Vicarage Lane (Dr Jane Muir Taylor) Sangam Surgery (Dr P Chandra)

Dr Bhadra Surgery Sinha Medical Centre (Dr AK Sinha)

Dr CM Patel St Bartholomew Surgery (Barking Road, Dr Patel)

Dr Krishnamurthy Surgery Star Lane Medical Centre (Dr Fang)

Dr Lwin Medical Practice (Dr Lwin) Stratford Health Centre (Dr Chang)

Dr PCL Knight's Practice Stratford Village Surgery (Dr Shah)

Dr Ruiz – St Lukes Medical Centre (Dr Ruiz) The Azad Practice (Dr Azad)

Dr S.Qureshi's Practice (Dr Qureshi) The Practice - Albert Road (Dr Choudhury)

Dr Samuel & Dr Khan's Practice The Project Surgery (Dr F. Hussein)

E12 Health Centre (Dr B Kohli) The Shrewsbury Surgery (Dr Sri-Ganeshan)

E12 Medical Practice (Dr Kugapala) The Summit Practice (Dr Yesufu)

East End Medical Centre (Dr Basu) The Surgery (Dr Arslan Arshad)

East Ham Medical Centre (Dr Mandavilli) Tollgate Health Centre (Dr Watt)

Esk Road Medical Practice (Dr Venugopal) Upper Road Medical Centre (Dr Zakaria)

Essex Lodge (Dr Higgins) Upton Lane Medical Centre (Dr Shanker)

Glen Road Medical Centre (Dr Rao) West Ham Medical Practice (Dr Bhowmik)

Greengate Medical Practice (Dr Kalhoro) Westbury Road Medical Centre (Dr Saidur Rahman) Lantern Health (Main Site: Dr Davision, 236-252 High Street E15 2JA) Woodgrange Medical Practice (Dr Y Patel)

Lathom Medical Centre (Dr Reena Patel) Wordsworth Health Centre (Dr Andy Pople)

Leytonstone Medical Practice (Dr Kohli)


Committee members

Committee/ Position

Executive Audit Remuneration Quality Finance Procurement Information Management and Technology

Chair

Zuhair Zarifa Paul Hendrick Andrea Lippett Stuart Sutton Zuhair Zarifa Zuhair Zarifa Bhupinder Kohli

Member and SMT Lead

Penny Emerson Chad Whitton (not a member)

Satbinder Sanghera (not a member)

Chetan Vyas Chad Whitton Ian Tritschler Annette Breslin

Members Chair of Cluster Leads Ashwin Shah Steve Gilvin Chetan Vyas Ian Tritschler Satbinder Sanghera Chad Whitton

Wayne Farah Andrea Lippett Riswan Hasan

Wayne Farah Paul Hendrick Ashwin Shah Steve Gilvin Chad Whitton

Wayne Farah Fiona Smith Andrea Lippett Riswan Hasan Saem Ahmed Meradin Peachey Ashwin Shah GP vacancy

Paul Hendrick Ashwin Shah Steve Gilvin Lei Wei

Steve Gilvin Ashwin Shah Penny Emerson Chad Whitton Lee Walker

David King Mohsin Patel Simon Wade William Matata Non-voting members Gary McGuinness Annette Breslin Peter Conoulty Dona Shine David Bartlett Daniel Woodruffe Simon Fewer Keith Prescott Jayne Callaghan Pranoti Shah Farya Siddique Madhurima Bhadra Anil Shah Raf Patel

Committee/ Position

Primary Care Commissioning

Acute Commissioning

Mental Health Commissioning

Children and Maternity Commissioning

Community Commissioning

Urgent Care Medicines Management

Integrated Care

Chair

Prakash Chandra Wax Naqvi Lizzy Goodyear Jim Lawrie Olufemi Daramola

Saidur Rahman (Prescribing)

Ashwin Shah

Joint Chair(s) Andrea Lippett and Wayne Farah

None None None None None Barry Sullman (CVD and Prescribing)

Grainne Siggins


Lead Support(s) None Ambady Gopinathan

Lise Hertel (Mental Health)

Bapu Sathyajith (Children’s Immunisation)

Rima Vaid Wax Naqvi None Rima Vaid Yusef Patel

Clinical Lead/ Officer

None Philip Abiola (Cancer)

None None Anil Shah (Learning Disability)

None None Steve Gilvin

Clinical Lead/ Officer

None Duncan Trathen (COPD & TB)

None None Nusrat Jabeen (End of Life)

None None Chad Whitton

Clinical Lead None None None None Nazmul Husain (Elderly Care)

None None None

Clinical Lead None None Vacancy None None None None None CCG Lead SMT Officer

None Penny Emerson Penny Emerson Satbinder Sanghera

Ian Tritschler Ian Tritschler Chetan Vyas Penny Emerson

CCG Lead Commissioner

None Ian Tritschler Sarah Garner Trudy Cross/ John Dunning (joint)

Tafadzwa Mugwagwa

Julie Van Bussel

Bola Sobuto Simon Wade

LBN Adult None Bridget Shallow Sally Parkinson None Jill Britton Bridget Shallow

None None

LBN Children None None Simon Munk Colin Michel None None None None LBN Public Health

None None Margaret Eni-Olutu

Rutaja K-Johnston Hilary Guite None None Hilary Guite

Representatives

F Smith S Gilvin C Whitton Anil Shah C Furness M Peachey G Cairns S Roupakia A Asika

None None None None Tendai Mnangagwa Helen page Suki Kaur Billy Ward Lee Walker Helen Pace Emmanuel Ncube Alison Glynn Rosie Martin Giles Walsh Kendel Fairley

Wajid Qureshi Gemma Heath Maninder Kaur Singh Manisha Patel Nakul Arora Sailesh Patel Ruma Rahman Satpal Puaar

Acute Mental health Community Urgent Child and maternity


Directors/ members interests Governing Body members

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Ambady Gopinathan (Dr) 24/02/2016

GP Principal GP WSI (miNilr surgery)

Nil Nil Nil Nil Nil Nil Nil

Andrea Lippett 10/02/2016

Nil Nil Nil Nil Nil Nil Nil Partner is a Niln- exec Director at Barts Health

Ashwin M. Shah (Dr) 15/02/2016

Partner and Chair of First 4 Health Group / Practices

Knighthood & Co Ltd. shareholder with wife Dr Sudha Shah

Nil Nil LMC member Executive Member

Nil Nil First4Health Federation / Newham GP Co- Op Chair Board member

Chad Whitton 10/02/2016

Nil Fawell Whitton PFC Ltd

Nil Nil Nil Nil Nil Partner is a Director of Fawell Whitton PLC Ltd

Elizabeth Goodyear (Dr) 27/01/2016

Salaried GP Wordsworth Health Centre / Clinical lead for Maternity and Children

Nil Nil Nil Nil Salaried family planning and sexual health doctor East London Foundation Trust

Nil Nil

Fiona Smith 18/01/2016

Nil Director of Honesta Partners Ltd

Nil 75% shareholder of Honesta Partners Ltd

Nil Nil Nil Contracted by Barts Health as Interim Managing Director for the Whipps Cross Hospital site


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Grainne Siggins 05/02/2016

Nil Nil Nil Nil Trustee (National Policy Lead) for the Association of Director of Adult Social Services (ADASS)

In 2014/15 ADASS received funding via an SLA from NHS England

Nil Registered with Health Professions Council as an Occupational Therapist / Member of ADASS / Member of British Association of Occupational Therapists Hazel

Trotter 10/02/2016

Practice Manager at Market Street Health Group


Meradin Peachey 10/02/2016

Nil Director of Public Health Newham Council

Nil Nil Vice President of Faculty of Public Health

Nil Nil Nil

Muhammad Naqvi (Dr) 11/02/2016

Salaried GP and GP partner at Woodgrange

Nil Nil Nil Trustee of Frenford clubs, Ilford (registered charity / voluntary organisation)

Employed by Woodgrange Medical Practice

Nil Nil

Prakash Chandra (Dr) 10/02/2016

Senior GP Partner, providing primary healthcare including enhanced services, QOF and general practice services to virtual ward. My wife is a partner in the practice.

Medical Director, Prime Practice Partnership (partner)

My practice (Sangam surgery),is/ Will be a member of GP federation of practices

Nil Trustee - BMGCT - a voluntary charitable trust working with disabled persons both in UK and overseas.

Prime Practice Partnership - Medical Director

Nil Nil

Rima Nicole Vaid (Dr) 10/02/2016

Full time Salary GP at Essex Lodge Practice



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Rizwan Hasan (Dr) 15/01/2016

Nil Nil Nil Nil Nil Consultant Anaesthetist and Chair LNC Hinchingbrooke Health Care NHS Trust

Nil Nil

Saravanan Chellapan (Dr) 07/08/2015

Nil Nil Nil Nil Nil Nil Nil Nil

Steve Gilvin 10/02/2016


Stuart Sutton (Dr) 20/01/2016

Part-time partner and PMS contract holder at Tollgate Medical Centre

Director, R Sutton Ltd (Non-medical) - personal

Nil Nil Nil Nil Member of: Labour Party / British Medical Association / Gay and Lesbian Association of Doctors and Dentists

Wayne Farah 09/02/2016

Nil Nil Farah Associates Ltd.

Nil Chair Migrants Rights Network / Director Adcris CIC

Nil MRN & ADCRIS

Nil

Zuhair Zarifa (Dr) 18/01/2016

P/T GP at Custom House Teach and Training practice – partner

Premium Second Care Limited - 50% Director. 50% Spouse.

GPWSI surgeon in primary care. Works for Newham CCG as GPWSI through contract with PFSE. Nil interests in PFSE

Nil Nil Nil Nil Nil


Clinical leads

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Anil Shah (Dr) 15/02/2016

GP Partner – Dr Driver and Partners


Bapu Sathyajith (Dr) 04/02/2016

NCCG Childhood Immunisation Lead Sessional GP Out of Hours GP: Newham GP Co-op


Barry Sullman (Dr) 07/10/2014

Partner Balaam Street Surgery

Nil Nil Nil Nil GP Co-op Doctor Nil Nil

Bhupinder Kohli (Dr) 01/10/2014

Partner at E12 Health Centre - PMS practice in Manor Park holding a contract of services with NHS England / First4Health Federation - GP federation - member of the Clinical Reference Group

Healthcare Leaderships Systems – Director with Partner (Wife) Innovate Healthcare Ltd

Patient First Social Enterprise / Director and Chairman

Director and Chairman of Patient First Social Enterprise / Innovate Healthcare Director

Chairman of Patient First Social Enterprise

Newham Asian Women’s Project / Health Care Leadership Ltd / Eternal Alliance Ltd

Nil IT support to East London Foundation Trust

Dr Debasis Roychoudh ury 18/08/2015



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Duncan Trathen (Dr) 25/09/2014

Standard GP care Nil Nil Nil Nil Nil Nil Nil

Elizabeth Goodyear (Dr) 27/01/2016

Salaried GP – Wordsworth Health Centre / Clinical lead for Maternity and Children

Nil Nil Nil Nil Salaried family planning and sexual health doctor East London Foundation Trust

Nil Nil

Kavita Gaur 11/03/2016

Salaried GP E12 Health Employee of Director of Patient First


Philip Abiola (Dr) 29/02/2016

GP Principal Director Femta Medical Services Ltd

Nil Yes as above Nil

Saidur Rahman (Dr) 18/01/52016

GP Principal- Westbury Road Medical Practice / GP Principal- Plashet Medical Centre

Director - Patient First

Achal Ltd - Director

LMC – Vice Chairman Newham

GPSI –MSK – Patient First Social Enterprise

Shahzada Khan (Dr) 18/01/2016

GP Partner - Vicarage Lane Health Centre GMS practice

Director of SK Diabetes Services Ltd

Nil Nil Nil Nil Nil SK Diabetes Rep Occasional sponsorship from pharmaceutical companies to attend educational conferences

Subir Sen (Dr) 07/10/2014

Nil Nil Nil Nil Associate Director, Primary Care, Barts Health NHS Trust

Nil Nil GPwSI in Cardiology Newham CCG


Cluster leads

Mem

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Barry Sullman (Dr) 07/10/2014

Partner Balaam Street Surgery

Nil Nil Nil Nil GP Co-op Doctor Nil Nil

Jim Lawrie (Dr) 10/02/2016

GP Principal Royal Docks Practice / Part of local federation first4health / GP tutor and trainer for London deanery

Medical Director – Prime Practice Partnership / Director of Blue Isle property services company

Nil Nil Trustee of Richard House Children’s Hospice (until July 2015) / Chairman of Newham GP co- operative / Clinical governance director of patient first social enterprise / Board member Local Medical Committee Board member of the national self-care forum

Honorary clinical lecturer QMUL / Member of Chain online international network / Member of media medics

Nil Interim Board member of the Newham Health Collaborative Nilminated by the CCG cluster chair to oversee CCG Board interests in the formation of the Health collaborative

Nadeem Faruq (Dr) 03/03/2016

GP Principal - Market Street Health (personal interest)

NIL NIL NIL NIL Nil Nil Work as GPwSI in MSK medicine, PFSE / Paid into IRI Medical Services Ltd

Nusrat Jabeen (Dr) 11/08/2015

Salaried GP Nil Nil Nil Nil Nil Nil Nil

Nazmul Hussain 18/01/2016

Salaried GP at Wordsworth HC



Mem

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Saidur Rahman (Dr) 18/02/2016

GP Principal- Westbury Road Medical Practice / GP Principal- Plashet Medical Centre

Director - Patient First

Achal Ltd - Director

LMC – Vice Chairman Newham

Nil Nil Nil

Stuart Sutton (Dr) 20/01/2016

Part-time partner and PMS contract holder at Tollgate Medical Centre

Director, R Sutton Ltd (Non-medical) - personal

Nil Nil Nil Nil Member of: Labour Party / British Medical Association / Gay and Lesbian Association of Doctors and Dentists


Senior management team

Mem

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Chad Whitton 10/02/2016

Nil Fawell Whitton PFC Ltd.

Nil Nil Partner is Trustee of Charity Birth Companions

Nil Nil Partner is a director of Fawell Whitton PFC Ltd

Chetan Vyas 01/02/2016

Nil Nil Nil Nil Nil Nil Nil Wife is an employee at Newham CCG

Satbinder Sanghera 27/01/2016

Nil Nil Nil Nil Nil Nil East Village Trustee (appointed by CCG). Willowfield School GoverNilr Steve

Gilvin 10/02/2016


Selina Douglas 02/02/2016

Nil Nil Nil Nil Nil Nil Nil Turning Point – Son works there

Ian Tritschler 10/02/2016



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 has appointed the Chief Officer to be the Accountable Officer of the Clinical Commissioning Group. The responsibilities of an Accountable Officer, including responsibilities for the propriety and regularity of the public finances for which the Accountable Officer is answerable, for keeping proper accounting records (which disclose with reasonable accuracy at any time the financial position of the Clinical Commissioning Group and enable them to ensure that the accounts comply with the requirements of the Accounts Direction) and for safeguarding the Clinical Commissioning Group’s assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities), are set out in the clinical commissioning group accountable officer appointment letter. Under the National Health Service Act 2006 (as amended), NHS England has directed each Clinical Commissioning Group to prepare for each financial year financial statements in the form and on the basis set out in the Accounts Direction. The financial statements are prepared on an accruals basis and must give a true and fair view of the state of affairs of the Clinical Commissioning Group and of its net expenditure, changes in taxpayers’ equity and cash flows for the financial year. In preparing the financial statements, the Accountable Officer is required to comply with the requirements of the Manual for Accounts issued by the Department of Health and in particular to:

Observe the accounts direction issued by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis;

Make judgements and estimates on a reasonable basis; State whether applicable accounting standards as set out in the Manual for Accounts issued by the

Department of Health have been followed, and disclose and explain any material departures in the financial statements; and,

Prepare the financial statements on a going concern basis. To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my clinical commissioning group accountable officer appointment letter. I also confirm that:

as far as I am aware, there is no relevant audit information of which the entity’s auditors are unaware, and that as Accountable Officer, I have taken all the steps that I ought to have taken to make himself or herself aware of any relevant audit information and to establish that the entity’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.

Steve Gilvin Accountable Officer 26 May 2016


Annual governance statement Introduction and context The clinical commissioning group was licenced from 1 April 2013 under provisions enacted in the Health and Social Care Act 2012, which amended the National Health Service Act 2006. As at 1 April 2015, the clinical commissioning group was licensed without conditions. Scope of responsibility As Accounting 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 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.

Compliance with the UK Corporate Governance Code We are not required to comply with the UK Corporate Governance Code. However, we have reported on our corporate governance arrangements by drawing upon best practice available, including those aspects of the UK Corporate Governance Code we consider to be relevant to the clinical commissioning group and best practice. Details of our corporate governance statement are set out in our governance framework as part of this annual governance statement. The clinical commissioning group governance framework The National Health Service Act 2006 (as amended), at paragraph 14L(2)(b) states: ‘The main function of the governing body is to ensure that the group has made appropriate arrangements for ensuring that it complies with such generally accepted principles of good governance as are relevant to it.’ The governance structure of NHS Newham CCG was designed to ensure that there was a balance between having robust governance arrangements for the organisation and being able to be flexible and responsive to organisational priorities. The governance structure of NHS Newham CCG is highlighted in the chart below.


Newham CCG has effective governance processes in place to ensure quality and patient safety, with clear accountability and reporting arrangements. Accountability for quality lies with the Chief Officer and the Quality Committee. A wide range of key staff and clinicians are responsible and involved in the quality assurance processes supporting the CCG – demonstrating that quality and patient safety is embedded in our commissioning processes. We have eight geographically close GP clusters. All clusters report into an elected board. Since April 2015, along with the WEL CCGs, Newham CCG has been authorised as a delegated (full) co-commissioner for the commissioning, contract monitoring and performance management of the 59 practices in agreement with NHSE jointly. Practices Individual practices are responsible for the planning and management of patient care and the tracking of care as patients move through the system. They operate within the GMS/PMS/APMS care contract, but commission for individual patients as they make referrals. It is expected that practices will meet, as they do currently in clusters to review quality of care being provided and to involve local service users. We will also expect practices to review, with the support of the CCG management team, resources used from both prescribing budgets and indicative secondary care/community health budgets. Practice clusters Newham CCG is structured so that individual practices are grouped into clusters led by an elected cluster lead who represents the views of the cluster at board level. The clusters act as a liaison between individual GP practices and the CCG Governing Body and executive to ensure that local healthcare needs are highlighted and met. Clusters meet monthly to review, share learning and problem solving, providing a key forum in which ideas and innovation are shared to improve delivery and provision of health services to patients. Cluster meetings are an important element of the CCG governance structure as practices act as the ‘powerhouse’ to generate solutions to improve patient care and health outcomes. Local intelligence is communicated to inform wider commissioning intentions within the commissioning cycle. They collectively assess the local quality of care achievement against CCG standards and best practice. The eight commissioning clusters are configured along the following criteria:

Each practice cluster serves a population of 40,000 or above Each practice cluster is made up of collection of whole practices Have a geographical alignment that is reflective of the practice registered population Practices with more than one location are represented at that geographical cluster Aligned to the London Borough Newham wards where possible.

Cluster leads and clinical leads Cluster leads and clinical leads provide the clinical leadership and support required to ensure safe and effective health commissioning. They provide a focal point for building clinical understanding and ownership of the strategic agenda with their peers and clinicians from other professions. This group makes recommendations around clinical pathways, protocols and policies on behalf of the CCG Committee.


Commissioning committees The commissioning committees have a remit and responsibility for acute trusts, mental health, community health and children and maternity services working in partnership with the London Borough of Newham. They are comprised of clinicians (with a clinical chair), CCG managers and external representatives. They are accountable to the Governing Body and report on performance, QIPP delivery, developing strategic goal and report to the Executive Committee. The four commissioning committees have a remit and responsibility for:

Obtaining expected performance from providers against activity, finance, performance and other requirements

Developing strategic goals to recommend to the CCG Governing Body as part of planning

Ensuring QIPP delivery within contracts Actively engaging providers with regards to

issues/ concerns Undertaking detailed investigative pieces of

work identified by the Quality Committee should there be any quality concerns

Reporting to the Executive Committee. Quality committee The Quality Committee reports directly to the Governing Body and provides a focus for keeping the quality of services at the centre of the CCG’s work. This committee has oversight of the CCG’s response to the Francis Report and how we respond to its recommendations. The Quality Committee has a remit and responsibility for:

Taking a holistic view of quality of commissioned services across all providers.

Reviewing the quality of primary care Ensuring the Francis Report recommendations for commissioners are embedded in the business of

the CCG Monitoring the performance of providers against quality indicators and CQUINs Commissioning deep dive quality work from commissioning committees Providing quality inputs into the transformation programmes Reviewing CGC guidance and CQC provider reports, subsequently working with providers to

improve the quality of care provided Reviewing and monitoring actions plans to support quality improvements to ensure they are fit for

purpose Reporting to the CCG Governing Body.

Audit committee The Audit Committee reviews the establishment and maintenance of an effective system of integrated governance, risk management and internal control, across the whole of the CCG’s activities (both clinical and non-clinical), that supports the achievement of the CCG’s objectives. In particular, the committee reviews the adequacy and effectiveness of:


All risk and control related disclosure statements (in particular the Annual Governance Statement), together with any accompanying head of internal audit statement, external audit opinion or other appropriate independent assurances, prior to endorsement by the Governing Body

The underlying assurance processes that indicate the degree of achievement of corporate objectives, the effectiveness of the management of principal risks and the appropriateness of the above disclosure statements

The policies for ensuring compliance with relevant regulatory, legal and code of conduct requirements and related reporting and self-certification

The policies and procedures for all work related to fraud and corruption as required by NHS Protect The North East London Commissioning Support Unit (CSU) Assurance Group and associated

assurance statements as provided through the work of the service auditor Reporting carried out by the internal auditors for NHS England and any individual quality assurance

reports carried out on behalf of the clinical commissioning groups who use the CSU. In carrying out this work the committee primarily uses the work of internal audit, external audit and other assurance functions, but is not limited to these sources. It also seeks reports and assurances from directors and managers as appropriate, concentrating on the over-arching systems of integrated governance, risk management and internal control, together with indicators of their effectiveness. Remuneration committee The Remuneration Committee reports to the Governing Body their decisions on determinations about the remuneration, fees and other allowances for employees and for people who provide services to the group and on determinations about allowances under any pension scheme that the group may establish as an alternative to the NHS pension scheme. In making decisions the committee will:

Comply with current disclosure requirements for remuneration Ensure that all remuneration packages are linked to the group’s performance management

framework with clear performance targets Have regard to national legislation relating to equal pay acts and equality acts Seek independent advice, where necessary, about remuneration for individuals Ensure that decisions are based on clear and transparent criteria Have full authority to commission any reports or surveys it deems necessary to help it fulfil its

obligations Uphold the seven ‘Nolan Principles’ Manage the business of the committee by way of risk Be responsible for the development of patient and public engagement within the scope of its

responsibilities. Integrated care committee The Integrated Care Committee is a sub-committee of the Governing Body. The committee provides updates to and from the Health and Wellbeing Board and WELC Integrated Care Board as required. The purpose of the committee is to ensure the development and coordination of integrated care and associated care pathways working with the other CCG committees and working groups including acute, community, urgent care and mental health committees. All programme committee members are responsible for:

Approving the high-level plan, defining its content and also authorising any deviation from it Understanding programme plans and monitoring progress against these Understanding and acting on any issues that affect the successful delivery of the programme Ensuring that quality management principles and processes are applied Brokering relationships with stakeholders both within and outside the programme


Providing delegated authority, as required, to ensure the programme meets its objectives Being aware of the broader perspective, including equality and diversity issues, and how they affect

the programme Providing assurance that all programme deliverables have been delivered satisfactorily Overseeing the evaluation arrangements for programme Setting up task and finish groups as considered relevant to deliver nine integrated care initiatives

Executive committee The Executive Committee has been formed comprising clinicians and CCG managers, the Chief Operating Officer and Chief Financial Officer. This is a key forum to integrate the outputs of the programme boards and manage the detail of commissioning decisions, and ensuring the strategic direction determined by the Governing Body is followed. The Executive Committee has a remit and responsibility for:

Ensuring the CCG is on track to deliver against the operating plan, QIPP plans and all transformation programmes

Receiving reports from the QIPP leads on delivery against QIPP plans to take a holistic view of delivery

Acting as a programme management committee to quality assure the work of each of the commissioning committees and transformation programmes

Supporting the committees and programmes to unblock any areas that affect their ability to deliver Reporting to the CCG Governing Body.

Practice council The Governing Body is accountable to the practice member council. The practice member council provides a platform for all GP member practices of the CCG to scrutinise, question and serve as a forum for debate with the Governing Body. In addition the Governing Body has delegated the function of approving changes to the Constitution (subject to NHS England approval) to its practice member council. Membership of clinical commissioning group A body which is a provider of primary care services (holding a general medical services, personal medical services or alternative personal medical services contract) in the London Borough of Newham can apply to become a member of the CCG under the following conditions:

If the provider holds a contract for the provision of primary medical services

It is a primary care services provider in the relevant locality

It has duly submitted an application to the NHS England.

NHS Newham CCG Governing Body The Governing Body is responsible for the strategic direction of the CCG and for assuring the achievement of the key health, wellbeing, service, financial, and performance targets of the CCG. The Governing Body is accountable to the public, member practices and NHS England. Key functions and areas of focus for the Governing Body are as follows:


Ensuring the group has appropriate arrangements in place to exercise its functions effectively,

efficiently and economically and in accordance with the groups principles of good governance Determining the remuneration, fees and other allowances payable to employees or other persons

providing services to the group and the allowances payable under any pension scheme it may establish under paragraph 11(4) of Schedule 1A of the 2006 Act, inserted by Schedule 2 of the 2012 Act

Approving any functions of the group that are specified in regulations Leading and developing a clear vision and strategy for the group Approving commissioning plans and consultation arrangements and performance monitoring of

those plans Providing assurance against any strategic risks Agreeing the CCG annual report and accounts.

Newham CCG elections took place in September 2014. The following nominations were received unopposed and consequently elected for each cluster:

North East 1 Cluster, Dr Prakash Chandra North East 2 Cluster, Vacant North East 3 Cluster, Dr Liz Goodyear North West 1 Cluster, Dr Ashwin M Shah MBE North West 2 Cluster, Dr Muhammad Naqvi Central 3 Cluster, Dr Rima Nicole Vaid South 1 Cluster, Dr Zuhair Zarifa South 2 Cluster, Vacant South 3 Cluster, Dr Stuart Sutton Central 2 Cluster, Dr Gopinathan was elected. Central 1 Cluster, Dr Saravanan Chellappan

Elections will be held in June 2016 for new GP Governing Body members. Appointment of chair of the board Dr Zuhair Zarifa resigned as Chair of the Board on 14 October 2015 and Dr Prakash Chandra was appointed as Chair on 14 October 2015. Attendance at governing body and quality committee meetings Table 1 shows attendance at each Governing Body meetings throughout the year 2015/16. The annual average attendance was 76%.


Table 1

Name Title

Ap

ril

May

Jun

e

July

Sep

tem

be

r

Oct

ob

er

De

cem

be

r

Jan

(I)

Jan

(II)

Feb

ruar

y

Elected Voting Members

Dr Prakash Chandra

Chair Elected GP Representative

Dr Ashwin Shah Deputy Chair, Elected GP Representative

Dr Elizabeth Goodyear Elected GP Representative

Dr Ambady Gopinathan Elected GP Representative

Dr Rima Vaid Elected GP Representative

Dr Bhupinder Kohli Elected GP Representative

Dr Jim Lawrie Elected GP Representative

Dr Mohammad Naqvi Elected GP Representative

Dr Stuart Sutton Elected GP Representative

Dr Saravanan Chellappan Elected GP Representative

Dr Zuhair Zarifa Elected GP Representative

Appointed Voting Members

Wayne Farah Vice-Chair, Lay Member Patient & Public Engagement

Paul Hendrick Lay Member, Governance

Andrea Lippett Lay Member, Remuneration

Dr Rizwan Hasan Secondary Care Clinician

Steve Gilvin Chief Officer

Chad Whitton Chief Finance Officer

Augustina Eyeson Elected Nurse Representative

Hazel Trotter Practice Manager Representative

Fiona Smith Registered Nurse

Sofia Roupakia Health Watch Representative

Grainne Siggins Director of Adult Social Care, London Borough of Newham

Non- Voting Members

Meradin Peachey Director of Public Health, London Borough of Newham


Table 2 details the attendance statistics of the Audit Committee. The annual average attendance was 73%.

Table 2

Name Title

22

/04

/20

15

28

/05

/20

15

29

/07

/20

15

22

/10

/20

15

11

/02

/20

16

Andrea Lippett Lay Member, Remuneration Chad Whitton Chief Finance Officer

Dr Rizwan Hasan Secondary Care Clinician Lei Wei Deputy Chief Finance Officer

Paul Hendrick Lay Member, Governance Wayne Farah Vice-Chair, Lay Member Patient & Public Engagement

Table 3 details the attendance statistics of the Quality Committee. The annual average attendance was 67%.

Table 3

Name Quality Committee

Title 3

0/0

4/2

01

5

25

/06

/20

15

30

/07

/20

15

27

/08

/20

15

24

/09

/20

15

26

/10

/20

15

26

/11

/20

15

28

/01

/20

16

25

/02

/20

16

Stuart Sutton (Dr.) GP Board Member (QIPP & CSP Lead)

Chetan Vyas Director of Quality and Development

Andrea Lippett Lay Member Board & Quality Lead

Wayne Farah Vice-Chair, Lay Member Patient & Public Involvement

Fiona Smith Registered Nurse Member of the Board

Dr Rizwan Hasan Secondary Care Consultant Member of the Board

Meradin Peachey Public Heath Director (LBN)

Saem Ahmed Quality and Development Manager

Dr Ashwin Shah MBE Deputy Chair


Assessment of governing body (board) effectiveness All NHS Newham CCG governing body members have undertaken a personal development programme and appraisals to ensure their effectiveness. This is done through a variety of methods and processes: Appraisals Development

sessions Standing report at all

Governing Body Meetings Individually and collectively understand what is expected of them

Effectively carry out its functions in relation its provision of strategic leadership to the organisation

Monitor the implementation of the strategic plans that it sets for the organisation.

Are assured that a sound system of internal control and risk management is in place within the organisation and is functioning effectively

Provide leadership to the organisation in the delivery of quality improvement

Maintain an effective collaborative working relationship exists between the board and the executive management team on the one hand and, the board and its internal and external stakeholders on the other hand.

Makes effective use of Governing Body meetings.

Are satisfied that they make meaningful, informed and robust contributions to discussions at board meetings and that the processes in place to facilitate the conduct of the Governing Body meetings are sufficiently supportive to members of the board

There were no departures from the clinical governance framework and no concerns raised with regard to the Board’s compliance. The clinical commissioning group risk management framework Risk management is embedded in NHS Newham CCG’s governance structure. The Audit Committee is responsible for scrutinising risk management policies and procedures. Accountable to the Governing Body, the committee provides the Governing Body with an independent and objective view of financial systems, financial information and compliance with laws, regulations and directions governing the CCG in so far as they relate to finance. The Executive Committee is responsible for approving internal control arrangements, risk sharing and pooling agreements. The Chief Officer is responsible for approving arrangements for business continuity and emergency planning. The Chief Finance Officer is responsible for approving counter fraud, security management and risk management arrangements. The Governing Body is responsible for approving and monitoring the board assurance framework (BAF). Risk management strategy The board assurance framework is the primary mechanism for internal and external assurance that the CCG is sighted on its risks and has a robust system of internal control. The primary purpose of the framework is to:

Act as a mechanism for alerting and appraising the Governing Body of the main risks to achieving the CCG’s strategic objectives as set out in the operating plan


List, evaluate and provide assurance to the Governing Body regarding the mitigations in place to reduce the likelihood or impact of the risk

Summarise the remedial or proposed actions that further mitigate the likelihood or impact of the risk

Board assurance framework risks are linked to the core strategic objectives of the CCG, as outlined in the operating plan. These are:

1. To improve patient experience and better manage demand by joining up local primary, community and acute care services to help people prevent and manage long term conditions, promoting resilience and independence.

2. To secure leading quality maternity and paediatric services and a healthy start in life for its children and young people.

3. To build and harness commissioning expertise and its member practices presence in neighbourhoods to get best value from public funding every day.

It is recognised that a number of the risks highlighted in the framework will be linked to the above strategic objectives. The framework is reviewed by the CCG Risk Manager in conjunction with relevant senior management risk leads and reported to the Governing Body on a monthly basis to ensure that risks are being proactively managed and that early trends in risks are identified and appropriate actions taken to reduce and mitigate risk. Monthly reports to Governing Body include a summary of movements in risk and comparison of current risk to end of year target. Risk management is embedded into the CCG at all levels of the organisation. A systematic and consistent approach to risk management has been established. This extends from board assurance to operational risk by way of standardised risk registers that are used throughout the organisation to identify, monitor and report on operational risks to enable effective assessment and escalation of risks to Board where appropriate. The board assurance framework and risk registers are comprehensive in scope and cover all strategic and operational areas of the CCG. Local information governance (IG) policies and relevant national guidance is made available to all CCG staff through our intranet and communications are also sent via email to alert staff to any changes or updates in IG policy or guidance. As an employer with staff entitled to membership of the NHS pension scheme, control measures are in place to ensure all employer obligations contained within the scheme regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments into the scheme are in accordance with the scheme rules and that member pension scheme records are accurately updated in accordance with the timescales detailed in the regulations. Control measures are in place to ensure that all the CCG’s obligations under equality, diversity and human rights legislation are complied with. The CCG has undertaken risk assessments and carbon reduction delivery plans are in place in accordance with emergency preparedness and civil contingency requirements, as based on UKCIP 2009 weather projects, to ensure the CCG’s obligations under the Climate Change Act and the adaptation reporting requirements are complied with.


Board assurance framework

Risk ID Risk Summary Risk Owner Initial Risk

Rating Latest Forecast Trend

End of Year Target

Review Date

BAF.01 Failure to meet NHS Constitutional standards Steve Gilvin 16 16

12 21-Mar-2016

BAF.02 Failure to agree appropriate healthcare contracts in a timely manner for 2015-16 Selina Douglas;

Ian Tritschler 9 6

6 17-Mar-2016

BAF.03 Failure to deliver the Integrated Care Strategy Selina Douglas; Ian Tritschler

16 6

6 22-Mar-2016

BAF.04 Failure to effectively monitor and manage performance and activity levels of acuteand non-acute

providers

Selina Douglas;

Ian Tritschler 16 8

8 17-Mar-2016

BAF.04.01 Failure to effectively monitor and manage performance and activity levels of acute providers Selina Douglas; Ian Tritschler

16 8

8 17-Mar-2016

BAF.04.02 Failure to effectively monitor and manage performance and activity levels of non-acute providers Selina Douglas;

Ian Tritschler 16 8

8 17-Mar-2016

BAF.05 Failure to progressively develop and review the CCGs corporate governance structure to ensure the CCG is able to discharge its duties

Satbinder Sanghera

8 8

8 14-Mar-2016

BAF.06 Failure to effectively monitor and manage the quality of commissioned services for all healthcare

providers Chetan Vyas 8 8

8 15-Mar-2016

BAF.06.01 Failure to effectively monitor and manage the quality of commissioned services for Barts Health Saem Ahmed; Chetan Vyas

8 8

8 15-Mar-2016

BAF.06.02 Failure to effectively monitor and manage the quality of commissioned services for East London

Foundation Trust

Saem Ahmed;

Chetan Vyas 8 8

8 15-Mar-2016

BAF.07 Failure to plan for a sustainable financial future Chad Whitton 12 12

8 14-Mar-2016

BAF.08 Failure to embed and develop Primary Care Co-Commissioning Neil Hamer 12 12

8 01-Mar-2016

BAF.09 Failure to specify organisational support requirements and ensure they are delivered through the Commissioning Support Unit

Satbinder Sanghera

9 6

6 14-Mar-2016

BAF.10 Failure to participate in and deliver, both collectively and locally, the TST Programme of change Steve Gilvin 16 12

12 22-Mar-2016

BAF.11 Failure to develop a market development strategy and provider partnering networks Ian Tritschler 16 8

8 17-Mar-2016

BAF.12 Failure to develop GP Provider Partnerships Steve Gilvin;

Andreas

Lambrianou

16 8

12 11-Mar-2016

BAF.13 Failure to develop the role of GP Practices and Clusters as Commissioners Neil Hamer 16 12

12 01-Mar-2016

BAF.14 Failure to maintain effective engagement and collaborative working arrangements with stakeholders

Steve Gilvin; Satbinder

Sanghera

6 6

6 15-Mar-2016

BAF.15 Failure to organise the develop the skills and competencies of staff, board, clinical and cluster leads to deliver the organisational objectives of the CCG

Saem Ahmed; Chetan Vyas

6 6

6 15-Mar-2016


Risk assessment In accordance with Public Sector Internal Audit Standards, the Head of Internal Audit (HoIA) is required to provide an annual opinion, based upon and limited to the work performed, on the overall adequacy and effectiveness of the organisation’s risk management, control and governance processes (i.e. the organisation’s system of internal control). This is achieved through a risk-based plan of work, agreed with management and approved by the Audit Committee, which should provide a reasonable level of assurance, subject to the inherent limitations described below. The opinion does not imply that internal audit have reviewed all risks and assurances relating to the organisation. The opinion is substantially derived from the conduct of risk-based plans generated from a robust and organisation-led assurance framework. As such, it is one component that the Governing Body takes into account when writing this annual governance statement. The clinical commissioning group internal control framework A system of internal control is the set of processes and procedures in place to ensure the CCG delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to evaluate the likelihood of

those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it can therefore only provide reasonable and not absolute assurance of effectiveness. The governance framework and accountability of committees to the Governing Body supported by financial management arrangements provide assurance that the system of internal control has been in place in the CCG for the year ended 31 March 2016 and up to the date of approval of the annual report and accounts.

Information governance Risks to data security were managed by governance and IT in collaboration with externally procured information governance specialist support from NEL CSU. Mapping exercises for personal data flow and information assets were undertaken to allow clear identification of risks and clear plans to mitigate and/or reduce risks where required. The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal identifiable information. The NHS Information Governance Framework is supported by an information governance toolkit and the annual submission process provides assurances to the CCG, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively. The CCG places high importance on ensuring there are robust information governance systems and processes in place to help protect patient and corporate information. The CCG has established an information governance management framework and are developing information governance processes and procedures in line with the information governance toolkit. All staff are required to undertake basic information governance training and awareness via the HSCIC IG online training tool in 2015/16. This involved successful completion of the ‘introduction to information governance’ online training module. Additionally, key staff directly involved in IG related roles (IG Lead, SIRO and Caldicott Guardian) and information asset owners and administrators successfully completed additional modules.


There are processes in place for incident reporting and investigation of serious incidents. The CCG is developing information risk assessment and management procedures and a programme will be established to fully embed an information risk culture throughout the organisation against identified risks. Cost allocation and setting of charges for information Newham CCG has complied with HM Treasury’s guidance on cost allocation and the setting of charges for information. Better payments practice code The Better Payments Practice Code requires the CCG to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later. Details of compliance with the code are given in Note 6 of the accounts on page 111. Policy on countering fraud and corruption NHS Newham CCG has in place a designated counter fraud service, which is provided by RSM (formerly Baker Tilly Risk Advisory Services LLP). A risk based approach is employed at the CCG ensuring that resources are directed where required. We endeavour to ensure that the CCG has maximum resilience for both anti-fraud and bribery prevention by undertaking directed, local, proactive exercises to test the CCG’s processes. This enables us to review and update policies and procedures and provide training to CCG Staff when required. For financial year 2015/16, we have:

Worked closely with key staff, members and external advisors to ensure an anti-fraud culture is embedded throughout the CCG and that workstreams are directed appropriately.

Provided specific training to the Governing Body, as well as broader awareness training across the entire CCG workforce.

Participated in the National Fraud Initiative, a data matching exercise designed to identify staff and creditor fraud against the CCG.

Represented the CCG at NHS Protect forums, to obtain information about national fraud trends and best practice methods of preventing, deterring and detecting fraud against the CCG.

Reviewed counter fraud protocols for HR, payroll and communications staff to ensure that these areas of the CCG are fully conversant with the counter fraud function’s requirements.

Maintained designated pages on the CCG’s intranet; this is to be used as both a point of contact for CCG staff as well as an area for highlighting counter fraud news, issues and updates.

Pension obligations As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the scheme regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments into the scheme are in accordance with the scheme rules, and that member pension scheme records are accurately updated in accordance with the timescales detailed in the regulations.


Equality, diversity and human rights obligations Control measures are in place to ensure the CCG complies with the required public sector equality duty set out in the Equality Act 2010. Further details are set out in our equality report on page 92. Sustainable development obligations Newham CCG is required to report its progress in delivering against sustainable development indicators. The CCG is working to assess risks, enhance performance and reduce its impact, including against carbon reduction and climate change adaptation objectives. This includes establishing mechanisms to embed social and environmental sustainability across policy development, business planning and in commissioning. Newham CCG ensures compliance with its obligations under the Climate Change Act 2008, including the adaptation reporting power, and the Public Services (Social Value) Act 2012. The CCG is working with NHS Property Services to meet our sustainability obligations through efficient use of estates. We are also setting out our commitments as a socially responsible employer. Review of economy, efficiency and effectiveness of the use of resources The financial policies (standing financial instructions), procedures and scheme of delegations, supplemented by in-year financial management by budget holders, ensure that adequate financial controls are in place. The annual internal audit programme is approved by the Audit Committee and ensures audits coverage on use of resources is included. In addition, the financial case is assessed for all major programmes. This is in line with commissioning priorities and scrutinised by the transformation programme and Executive Committee. Financial performance is also reported to committees and presented at each Governing Body meeting by the Chief Finance Officer. Review of the effectiveness of governance, risk management and internal control As Accounting Officer I have responsibility for reviewing the effectiveness of the system of internal control within the clinical commissioning group. My review of the effectiveness of the system of internal control is informed by the work of the internal auditors and the executive managers and clinical leads within the clinical commissioning group who have responsibility for the development and maintenance of the internal control framework. I have drawn on performance information available to me. My review is also informed by comments made by the external auditors in their annual audit letter and other reports. Our assurance framework provides me with evidence that the effectiveness of controls that manage risks to the clinical commissioning group achieving its principles objectives have been reviewed. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Governing Body, the Audit Committee and Quality Committee, if appropriate and a plan to address weaknesses and ensure continuous improvement of the system is in place. I have drawn on performance information available to me. My review is also informed by comments made by the external auditors in their management letter and other reports. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Audit Committee and a plan to address weaknesses and ensure continuous improvement of the system is in place. Executive managers within the organisation who have responsibility for the development and maintenance of the system of internal control provide me with assurance. The BAF itself provides me with evidence that the effectiveness of controls that manage the risks to the organisation achieving its principal objectives have been reviewed.


My review is also informed by:

Scrutiny from our external auditors Information governance assurance toolkit compliance submission The CCG’s internal monitoring and review process for its quality of commissioned services Reports by internal and external audit Robust incident and complaints monitoring processes, ensuring compliance with national serious

incident reporting Executive Committee’s review of the plans to support the 2015/16 QIPP programme and

consequential financial impacts The Audit Committee provides assurance that there exists effective financial and performance

management regimes and stewardship within the CCG Assurance on fraud and potential fraud is provided through the work of the local counter fraud

officer who provides updates, communications and training on all appropriate counter fraud issues to CCG staff. The officer also attends the Audit Committee to report on fraud and bribery issues.

Following completion of the planned audit work for the financial year for the clinical commissioning group, the Head of Internal Audit issued an independent and objective opinion on the adequacy and effectiveness of the CCG’s system of risk management, governance and internal control. There are no other issues we consider significant for reporting. Risk assessment in relation to governance, risk management and internal control Risk ratings are determined in consultation between the governance director and the risk lead and take into consideration the following criteria, which helps to provide a standardised baseline for the assessment and grading of risk throughout the organisation:

Estimated severity of risk Objectives/projects Harm/injury to patients, staff, visitors and others Potential for complaints/claims Service/business disruption Staffing and competence Financial Inspection/audit Adverse publicity.

As with all risks identified, the way in which a particular risk is managed and recorded was proportionate to its potential for damaging or harming the interests of the CCG. All of the risks are managed through board assurance framework (BAF) and reported to the Governing Body. Significant risks identified during the financial year 2015/16 were:

BAF.01 Failure to meet NHS Constitutional standards This could result in:

Risk to the CCG as a result of provider failure to deliver upon agreed targets including national standards

A reduced ability to deliver local service improvements for patients Reputational risk - including the increased risk of performance management measures from NHS

England Adverse media coverage


Mitigation

Control Control Description Control Assurance(s)

BAF.01a NHS Standard Contract The NHS Standard Contract provides a number of contract clauses to

facilitate the tracking of performance against NHS Constitutional Standards and incentivise delivery. This is both in the form of nationally mandated financially penalties and the issuing of Contract Performance

Notices (CPNs).

a. Completed and signed Contract Documentation

b. Contract Performance Notices (CPNs) c. Remedial Action Plans (RAPs)

BAF.01b Contract Review Group (CRG)

The CRG is a contractual requirement between Commissioner and Provider – General Condition 8 (GC8). This is the main contract meeting

each month and is the forum for escalation of non-contract compliance, which includes a provider not delivering the NHS Constitutional requirements.

a. CRG Terms of Reference b. CRG Meeting Minutes.

BAF.01c Newham Site Steer Co Meeting

Monthly meeting of Urgent Care working group to oversee the delivery of A&E standards

a. Terms of Reference for site level meetings. b. Meeting Minutes of site specific meetings. c. Reporting packs produced by the Trust.

d. UC working group e. A & E standards

BAF.01d RTT, Diagnostics and

Cancer Monthly meeting

Monthly meeting to review Barts Health Trust delivery of the RTT,

Diagnostics and Cancer National Targets.

a. RTT, Diagnostics and Cancer Monthly Meeting

Terms of Reference. b. RTT, Diagnostics and Cancer Monthly Meeting

Minutes. c. Reporting packs produced by the Trust.

BAF.01e Performance Reports to Acute Commissioning Committee

Reports produced by NEL CSU, for the CCGs Acute Commissioning Committee, to advise group members on current provider performance

against NHS Constitutional Standards.

a. Weekly and Monthly Performance Reports produced by NEL CSU.

b. Specific deep dive analysis sub reports c. Terms of reference

BAF.01f Performance Report to

Board

High level report, which draws to Board members attention, provider’s

delivery of NHS Constitutional Standards for their patients.

a. High level summary Performance Report submitted

to the Board b. Additional reports providing more granular analysis,

forming a sub report to 6a. c. WIP not fully effective

BAF.01g Joint Management Team Meeting (JMT)

Meeting of Executive Directors of Waltham Forest, East London and the City CCGs.

a. Terms of Reference for the JMT. b. Meeting minutes for the JMT.

c. Adhoc reports to the JMT.

BAF.01h Clinical Strategy Group Meeting (CSG)

Meeting of the Clinical Chairs and Executive Directors of Waltham Forest, East London and the City CCGs.

a. Terms of Reference for the CSG. b. Meeting minutes for the CSG.

c. Adhoc reports to the CSG.

BAF.01i System Resilience Group Meeting (SRG)

Quarterly meeting of senior representatives of the local SRG healthcare providers, NHS Commissioners and Local Government Commissioners.

a. Terms of Reference for the SRG. b. Meeting minutes for the SRG.

c. Adhoc reports to the SRG. d.Six weekly meeting - will be moving to monthly

BAF.01j Commissioning

Collaborative Committee (CCC)

Monthly meeting of the Barts Health Contract lead CCGs Chief Officer,

Waltham Forest, East London and the City CCGs Chief Finance Officers and Associate CCGs Chief Finance Officers.

a. Terms of Reference for the CCC.

b. Meeting minutes for the CCC. c. Adhoc reports to the CCC.

Action Due Date Assigned To Expected Outcome Latest Update

BAF.01a Issue a CPN to Barts

Health NHS Trust for non-compliance with the NHS

Constitution.

30-Sep-2015 Lee Eborall; Steve Gilvin

Completed

RTT - No report received. Suspended on data quality

issues A& E - Performance has stayed the same and not

recovered

BAF.01i System Resilience Group (SRG)

29-Feb-2016 Steve Gilvin

On Track New arrangements will be in place from 1 April

BAF.10 Failure to participate in and deliver, both collectively and locally, the TST programme of change

This could result in:

Failure to plan or shift care out of hospital Implementation not delivering the intended benefits of the strategy Failure to deliver transformational changes to the system as this requires cross-system working and

system leaders’ agreement to adopt new ways of working, whilst managing day-to-day performance Non-engagement of patients and public on the TST programme and changes, leading to a lack of

support from these groups and difficulties in implementing changes Financial constrains in a challenged health economy.


Mitigation


BAF.10a Programme Structure Programme structure includes representatives from all 3 CCG’s. Newham chief officer is SRO for Primary Care, pathway redesign, Population

health informatics and Estates. Work stream execs Ian Tritschler, Satbinder Sanghera and Chetan Vyas lead on UECC, IC, CYP and OD.

a. Programme contacts

BAF.10b Monthly TST work stream

exec meeting

Monthly work stream exec meetings are held with execs to ensure robust

discussions and monitoring of work stream risks & issues.

a. Work stream exec meeting minutes & actions

b. Status reports from each work stream c. Work stream exec meeting pack

BAF.10c Monthly TST Strategic Partnership board

Monthly strategic partnership board meetings are held with collaboratively with WF, TH and Newham CCG CFO’s, Barts Health,

Homerton, TDA, NHSE, LA, ELFT and NELFT to ensure robust discussions and monitoring of programme risks & issues.

a. Board meeting minutes & actions b. Board pack

BAF.10d Twice weekly TST Rapid

development of strategy and financial outputs conference call

Twice weekly calls held with WEL CCG’s to rapidly respond in between

board meetings to any blocks or areas of concern.

a. Attendance List

b. Stopped at end of December. Strategy doc finalised & approved. Gone for consultation

BAF.10e TST Work stream

workbook and project managers delivery meeting

TST work stream workbooks completed weekly by project managers and

work stream execs designed to capture delivery, risks and issues, scope and financial assessments. Visited in weekly delivery meeting with programme team to discuss areas of concern.

a. Work stream workbook example

BAF.10f Primary Care work stream governance & meetings

Monthly board with representation across WEL. SRO is Newham chief officer Delivery/operational meeting with representation across WEL

Advisory Group meeting with representation across WEL

a. Board attendees

BAF.10g Urgent & Emergency Care work stream governance &

meetings

Monthly urgent & emergency care steering group. Exec lead is Ian Tritschler

a. Steering group attendees

BAF.10h Surgery work stream governance & meetings

Clinical Reference Group with attendance from WELC, Homerton and Barts.

a. CRG Agenda b. CRG Pack

c. CRG Attendees

BAF.10i Children & Young People work stream governance & meetings

Fortnightly catch up with CYP exec lead (Satbinder Sanghera) Monthly Paeds commissioning alliance with representation across WEL Diabetes project (monthly meeting) with representation across WEL

a. Peads alliance attendees b. Diabetes project attendees

BAF.10j Maternity work stream governance & meetings

Maternity commissioning alliance with representation across WELC. a. Maternity commissioning alliance agenda b. Maternity commissioning alliance TOR

BAF.10k Population Health informatics governance & meetings

Local leads, project managers and CIO attend weekly meetings at Newham CCG to discuss IT for delivery for TST. Further control through

programme board and steering group.

a. Action notes for weekly delivery meeting b. Minutes & actions from IPB meeting

c. Minutes & actions from Steering group

BAF.10l Workforce governance & meetings

Workforce working group meet monthly with WEL to discuss key issues impacting East London.

a. Workforce agenda b. Workforce action notes

BAF.10m OD work stream TST health check conducted to inform action plan a. OD health check results

BAF.10n Estates governance &

meetings

Quarterly Whole System Estates Working Group:

WEL CCGs, 3x borough councils, NHS Property Services, Community Health Partnerships, NHSE, Barts, ELFT, NELFT, Homerton, Healthy

Urban Development Unit

a. Systems estates workshop minutes

BAF.10o Integrated Care governance & meetings

Monthly meetings with representation across WELC IC Operations Group

Contracting & Reimbursement Steering Group Capitation Working Group Commissioning Intentions Task & Finish Group – first meeting for the

16/17 round will be taking place next week Evaluation Steering Group

Metrics Working Group Care Planning Task & Finish Group

a. Actions b. C&R Actions

c. Metrics group actions d. ToR capitation group e. ToR CR steering group

f. ToR evaluation steering group g. Evaluation steering group

h. ToR i. ToR Ops Group j. WELC actions 15k. WELC care plan

BAF.10p LTFM governance & meetings

Monthly meetings with representation from all 3 CCG’s, Homerton and Barts

a. Status reports

BAF.13 Failure to develop the role of GP practices and clusters as commissioners This could result in:

GPs not commissioning appropriate services for their population Inappropriate pathways


Increased referrals and activity in acute Patients not being treated at the right place, time and by the right provider Demand management not streamlined resulting in increased burden on NHS resources.

Mitigation


BAF.13.01 Quarterly meetings of eight GP cluster groups (based on the new

configuration from April 2015 and geographically aligned) as commissioning clusters meetings – 4 each year out of 12 monthly held cluster meetings

GP leads attend as part of the CCG LIS incentive scheme and contribute

to the CCG commissioning intention plans

a. GP Cluster meetings minutes, notes and action lists

b. GP attendance lists at these meetings c. LIS Incentive scheme 15/16 d. CCG Operating plan and commissioning intentions

plans

BAF.13.02 Quarterly GP commissioning event (West Ham Football Club evening events) – All practices are represented at these events. Topics and table discussions feed into the CCGs commissioning intentions and service

plans

GP leads and practice staff attend as part of the CCG LIS incentive scheme

a. Cluster Evening Event minutes, notes, presentations b. GP / Practice staff attendance list c. LIS incentive scheme 15/16 CCG operating plan and

commissioning intentions plans

BAF.13.03 Monthly Cluster Leads meetings – All commissioning clusters to be

represented by a GP lead at a CCG held meeting monthly to discuss service pathways, commissioning plans feeding into both commissioning and provider elements

GP leads elected by cluster practices every 2 years and appointed to

undertake and attend CCG meetings

a. Cluster leads meeting minutes, notes and action

lists b. GP attendance lists at these meetings c. CCG Operating plan and commissioning intentions

plans

BAF.13.04 CCG / CSU provide community, acute and other party activity and performance data for Newham practices based, with benchmarking and

cluster/practice levels for comparison

a. CCG / CSU data material provided to practices b. GP cluster meeting minutes, notes and action lists

BAF.13.05 CSU / contracts team on behalf of the CCG provide training to GP leads and practices to skill them as commissioners for their clusters and providers linked to the patient lists of their practices

GP practice members to differentiate their role as individual GP practice

providers, federation providers in future and commissioners for their patient lists

a. CSU training material b. Training dates and attendance lists

Action Due Date Assigned To Expected Outcome Latest Update

BAF.13.01 31-Mar-2016 Neil Hamer

Likely to be

Overdue

a. Training material in draft available b. Training dates and meetings not yet agreed or

offered to practices

Capacity to handle risk Individual directors and senior management risk leads are accountable for the risks within their directorates. BAF risks are subject to monthly review by the Governing Body and other risk registers are regularly reviewed at committee and transformation programme level by committee chairs in conjunction with the CCG Governance and Risk Manager. Where required, risks to be escalated to the BAF may be additionally discussed and reviewed by the Executive Committee to assure the Governing Body that risks within the organisation are effectively monitored and managed. All staff are encouraged to be proactive in considering and evaluating risks as part of their day-to-day work. It is the responsibility of senior line managers to ensure that staff within their directorates have an appropriate level of training and awareness of the organisation’s approach to risk management. Roles and responsibilities The whole Governing Body is collectively accountable for maintaining a sound system of internal control and is responsible for putting in place arrangements for gaining assurance about the effectiveness of that overall system. This annual governance statement (AGS) is an annual statement by the Accountable Officer, on behalf of the Governing Body, setting out:


how the individual responsibilities of the Accountable Officer are discharged with regard to maintaining a sound system of internal control that supports the achievement of policies, aims and objectives

the purpose of the system of internal control as evidenced by a description of the risk management and review processes, including the assurance framework process

the conduct and results of the review of the effectiveness of the system of internal control including any disclosures of significant control failures together with assurances that actions are or will be taken where appropriate to address issues arising.

The CCG’s assurance framework is one of the key mechanisms that the Accountable Officer uses in developing the annual governance statement. Head of internal audit opinion In accordance with the Public Sector Internal Audit Standards, the head of internal audit is required to provide an annual opinion, based upon and limited to the work performed, on the overall adequacy and effectiveness of the organisation’s risk management, control and governance processes. The opinion should contribute to the organisation's annual governance statement. Following completion of the planned audit work for the financial year for the clinical commissioning group, the Head of Internal Audit issued an independent and objective opinion on the adequacy and effectiveness of the clinical commissioning group’s system of risk management, governance and internal control. The Head of Internal Audit concluded that: ‘The organisation has an adequate and effective framework for risk management, governance and internal control.’ Complaints and principles for remedy We have put robust processes in place to ensure complaints and comments made by patients and service users are used by commissioning leads to monitor quality of services. We commission NEL CSU to provide a dedicated complaints support function through their Patient Experience and Effectiveness Team (PEET). The reporting schedule provided by the CSU includes weekly status reports, quarterly reports and an annual report. These are shared with the CCG’s Patient and Public Engagement Manager, Quality and Development Manager and the WELC POD CSU’s Clinical Quality Assurance Consultant. In addition the CSU compiles data for complaints received about commissioning decisions on the KO41 (a) data collection to the Data Collections Team at the Health and Social Care Information Centre. This is a mandatory return for all NHS organisations receiving written complaints, which the CSU submits on behalf of the CCG. For CCGs it will mainly be complaints relating to commissioning and funding issues. All complaints relating to commissioning and funding issues are investigated by the relevant CCG commissioning lead and response letters to the complainant are reviewed and signed by the CCG’s Chief Officer.


The CSU also provides the CCG with regular analysis reports, using national survey data including the patient reported outcome measures (PROMs), patient-led assessment of the care environment (PLACE) and the NHS staff survey, to develop insight into patient experience. We are committed to ensuring our complaints handling is transparent so that people can make an informed choice. What we do with the feedback is also important and we have a number of ways this data is used to make change. Provider complaints are also discussed at clinical quality review meetings (CQRMS), where assurance is sought from the provider on improvements being made to address patient complaints. We have a process in place called ‘amber alerts’ managed by the CCG Quality Team, where GPs are able to make complaints about provider services. This process is owned by the Quality Team in the CCG and allows for thematic analysis of emerging issues and themes. We have an agreement with Healthwatch Newham to share patient experience data that includes feedback from complaints, to ensure we develop a more robust way to understand patient experience and have a mechanism to identify themes and trends that influence the commissioning and monitoring of health services. Patients also have an opportunity to give us feedback through our patient forums, as well as our varied patient and public engagement activities. These processes ensure that we are able to deliver on our obligation to meet the health service ombudsman’s six principles for remedy and that we manage any complaints about our work in accordance with the NHS complaints procedures and the health service ombudsman’s principles for remedy as set out below. Getting it right Where maladministration or poor service has led to injustice or hardship, as the public body responsible we take steps to provide an appropriate and proportionate remedy. Being customer focused We promptly identify and acknowledge maladministration and poor service, and apologise for them. Being open and accountable Where necessary we provide clear guidance about the criteria we use for deciding remedies. Our staff know the circumstances in which they may offer remedies, and what they may and may not offer. Acting fairly and proportionately Remedies will be fair, reasonable and proportionate to the injustice or hardship suffered. Putting things right Where maladministration or poor service has led to injustice or hardship, we will try to offer a remedy that returns the complainant to the position they would have been in otherwise. If that is not possible, the remedy will compensate them appropriately. Remedies will also be offered, where appropriate, to others who have suffered injustice or hardship as a result of the same maladministration or poor service. Seeking continuous improvement Part of a remedy may be to ensure that changes are made to our policies, procedures, systems, staff training or all of these, to ensure that the maladministration or poor service is not repeated. It is important for us to ensure that lessons learnt are put into practice. Data quality The Governing Body takes data quality seriously. Our approach is to ensure data quality is embedded across everything we do directly and/or through our contracted relationship with NEL CSU and key acute and community providers.


Business critical models We certify that Newham CCG has incident response plans in place that are fully compliant with the NHS Commissioning Board Emergency Preparedness Framework 2013. We regularly review and make improvements to our major incident plan and have a programme for regularly testing this plan, the results of which are reported to the Governing Body. Emergency preparedness, resilience and response is defined by a series of statutory responsibilities under the Civil Contingencies Act 2004 and Health and Social Care Act 2012 that require NHS organisations to maintain a robust capability to plan for and respond to incidents or emergencies that could impact on their communities. In accordance with the aforementioned legislation, Newham CCG works with Waltham Forest and Tower Hamlets CCGs to develop incident response and threat specific plans (e.g. cold weather plans and severe weather plans) to ensure we continue to deliver critical business operations and support our partners in the event of a major incident or emergency. Furthermore the CCG operates through the CSU a robust on-call system 24 hours a day, seven days a week, 365 days a year to further ensure resilience across the local health economy. Our organisation is fully engaged within the local and regional emergency planning structure with regular representation at borough resilience forums North East and North Central CCG operational meetings and quarterly convened NHSE strategic meetings. The CCG also participates in multi-agency exercises to ensure a proactive and coordinated approach to emergency preparedness.

Newham CCG is committed to implementing an integrated and dynamic business continuity management system and emergency prevention, preparedness and response capability to ensure the continued delivery of safe and effective healthcare commissioning and management across Newham and North East London with our CCG partners. During 2014/15 the CCG has: Focused on our assurance process including a self-assessment of capability against emergency preparedness resilience and response national core standards. We undertook this exercise with NHSE along with our neighbouring CCGs Been rated as ‘substantially compliant’ in the 2014/15 London NHS Assurance Report. We are currently implementing the action plan that we developed as part of that process Commissioned surge support from NEL CSU Worked closely with other key partners including NHS England to ensure that we are sufficiently prepared to help others in the event of a wider scale event. Data security We have submitted a satisfactory level of compliance with the information governance toolkit assessment and we are currently assessed as fully level 2 IG toolkit compliant.


There was an incident of data breach with data flowing from the CSU and provider to NCCG without being pseudonymised and via non secure e-mail i.e. not through NHS.net. The SIRO, Caldicott Guardian and information governance lead were informed and measures taken to prevent recurrence with the staff members concerned given additional training. Information governance training and awareness was reviewed at the CCG and guidance issued to staff via the CCG’s newsletter. Incidents related to personal disclosure of personal data There were no incidents involving data loss or confidentiality breaches in the financial year 2015/16. Disclosure of relevant information to auditors We confirm that so far as we are aware, that there is no relevant audit information of which the clinical commissioning group’s external auditor is unaware. We have taken all the steps that we ought to have taken as a member in order to make ourselves aware of any relevant audit information and to establish that the clinical commissioning group’s auditor is aware of that information. Discharge of statutory functions I can confirm that correct arrangements are in place for the discharge of statutory functions, these have been checked for any irregularities and are legally compliant, in line with the recommendations in the Harris Review. During establishment, the arrangements put in place by the clinical commissioning group and explained within the corporate governance framework were developed with extensive expert external legal input, to ensure compliance with the all relevant legislation. That legal advice also informed the matters reserved for Membership Body and Governing Body decision and the scheme of delegation. In light of the Harris Review, the CCG has reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislation and regulations. As a result, I can confirm the CCG is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions. Responsibility for each duty and power has been clearly allocated to a lead executive. Directorates have confirmed their structures provide the necessary capability and capacity to undertake all of the CCG’s statutory duties. Conclusion 2015/16 was the third year of operations for the CCG. It is clear that we have made good progress. The internal and external auditors' reports considered by the Audit Committee during 2015/16 did not raise any significant internal control issues. I am satisfied that the systems outlined in this statement reflect that the CCG has operated with generally sound systems of internal control. Steve Gilvin Accounting Officer 26 May 2016


Remuneration and staff report Remuneration committee members and attendance

Name Post 10/6/15 03/12/15 24/3/16 Andrea Lippett NCCG – Lay Member Remuneration ● ● ● Paul Hendrick NCCG – Non Executive Lay Member for Governance ● ● ● Wayne Farah NCCG - Vice-Chair, Lay Member Patient & Public Engagement ● Dr Ashwin Shah NCCG GP Elected member & Deputy Chair of Board ● ● ●

Chair and elected governing body members Dr Prakash Chandra, Chair and Elected GP Representative Prakash has been a GP in Newham since 1986, firstly as a partner in a group practice and latterly taking over a small single handed practice, which has developed into a partnership with a list size of 7000. He has been at the forefront of developing a group of federated practices with clear succession plan, service development and premises development for 22000 patients. Dr Chandra played a pivotal role in bringing GPs together to improve patient care, experience and outcome. He was a founding member of the Newham GP forum, Newham Multifund, and Newham Health Partnership Clinical Commissioning Group. Dr Ashwin Shah, Elected GP Representative Ashwin has over 30 years’ in primary care in Newham. His main interest is primary care development and improving quality of patient care. He previously served as Chair of Newham Health Partnership Clinical Commissioning Group and has also served as PEC Chair for Newham PCT. During his time as Chair of Newham Health Partnership, Ashwin played a pivotal role in developing the locality and cluster model of clinical commissioning which has been adopted across Newham. Dr Zuhair Zarifa, Elected GP Representative Dr Zuhair Zarifa is an experienced GP and surgeon in primary care, with over 25 years working in an inner city GP practice. As chair of Newham CCG from July 2012 until he stepped down in September 2015, he was an inspirational leader for health service development. He now continues to serve as a Board Member. He has been a leading local voice in health reform, unifying GPs and successfully improving health outcomes for local people. He brings with him a wealth of experience, having also served as chair of Newham Inner-City Multifund, chair of Newham Commissioning Group and chair of Newham Primary Care Group. Dr Elizabeth Goodyear, Elected GP Representative Elizabeth (Lizi) qualified from Barts and the London School of Medicine and Dentistry in 2004, and completed junior and GP training posts Newham University Hospital/Newham VTS between 2004 and 2008. Since 2008 she has been a salaried GP at Wordsworth Health Centre. Her interests are in sexual health, contraception, women’s and family health, maternity and gynaecology. Since 2012, Lizi has assumed the roles of clinical lead for maternity for Newham CCG and is the CCG’s joint commissioning lead. She has worked with public health and the local authority to commission high quality healthcare provision in the areas of learning disabilities, continuing care/long term conditions, substance misuse and child health. Dr Ambadi Gopinathan, Elected GP Representative Ambadi has been a GP principal at Greengate Medical Centre in Newham since 1991. He is a GPWSI in minor surgery. He has been a member of the LMC since 1992, and has a strong commissioning background, having previously sat on the board of the Newham Multifund, Newham Primary Care Group, and as an executive of Newham PCT. Dr Gopinathan has assumed the role of planned care lead for NCCG. Dr Muhammad Naqvi, Elected GP Representative Dr Naqvi qualified from Barts and the London in 2003. He has worked for 12 years in Newham and for seven years as a GP in Forest Gate. Dr Naqvi has this year qualified as a GP Trainer. He has a keen


interest in commissioning and primary care strategy. Along with board and cluster duties he is also an urgent care clinical lead. Dr Rima Vaid, Elected GP Representative Rima is a salaried GP at Essex Lodge and has been working at the practice since qualifying as a general practitioner in 2012.Rima qualified from Barts and the London School of Medicine and completed her clinical foundation years and GP training posts in Newham University Hospital. As a newly appointed board member she is committed to maintaining and improving primary care services in the borough. Dr Bhupinder Kohli, Elected GP Representative Bhupinder is an experienced GP and GP trainer with an interest in primary care IT and informatics and health intelligence. He is based in Manor Park in East London at E12 Health a practice with 11,000 patients. This practice was formed in 2002 and in has a record of being an innovative practice, which leads on GP training, IT developments and Staff training. He was co-founder of the Newham Innercity Multifund which was the largest and one of the most successful Multifunds in London. He was also Chair of the Newham Primary Care Group when it won the PCG of the year award from the HSJ in 1999. He is Chairman of Patient First Social Enterprise an AQP which provides community specialist clinics in Newham. He has been pivotally involved in several major projects to practically support and motivate GP to improve the quality of Primary Care both in groups and individually on a variety of projects ranging from peer review, clinical audit and clinical governance. Dr Jim Lawrie MBE, Elected GP Representative Jim has worked as a GP in the East End of London for the last 20 years and has worked in Newham since 1992. In 1994 he set up the Newham out of hours co-operative with two other GPs. He has been a Trustee of Richard House Children’s Hospice, is the Chairman of Newham GP Co-operative, the Clinical Governance Director of Patient First Social Enterprise, a Board member of the Local Medical Committee and a Board member of the National Self-Care Forum. In 2000, Jim was awarded an MBE for his work over 12 years as part of the Whitechapel Mission. Jim also plays a key role in supporting future GPs and has been teaching GP trainees and medical students for the last 14 years and is a lecturer at Queen Mary University London. He has also recently trained as a tutor for post graduate doctors, doing a work based training programme in general practice. Dr Stuart Sutton, Elected GP Representative Stuart is a GP partner at Tollgate Medical Centre and has been working in Newham since 2008 when he started his GP training posts having graduated and completed his initial hospital training in Newcastle upon Tyne. In 2012 he was one of the core team who developed NHS Change Day, the largest single improvement event in the NHS’s history. He was a 2011-12 ‘Darzi’ Clinical Leadership and Management Fellow (jointly run by the Kings Fund and Manchester Business School) and spent a year working on quality improvement projects at the London Ambulance Service. As well as focussing on day to day clinical care Stuart has interests in quality improvement and equality and diversity as well as leading for education on the Board. Lay members Wayne Farah, Lay Member for Patient Engagement (Vice-Chair) Wayne has extensive experience in the public sector, having worked as a social worker, HR Professional and Senior Policy Officer within local government. He has over 25 years’ experience as a community organiser, and has held some senior positions in a range of community organisations including Chair of An Viet Housing Association, Somali Relief Association, trustee of Trustee of Medicine Du Monde UK, Vision Care for Homeless People, and he is currently Chair of The Migrants Rights Network. Wayne was a non-executive Director within NHS Newham for ten years, holding various positions and responsibilities, including that of vice chair of Newham PCT, Chair of the Provider Board, and chair of the Performance Committee. Paul Hendrick, Lay Member for Governance Paul is an experienced non-executive director working principally in the public sector in the fields of health (at both provider and commissioner levels), regional economic development and social housing, guiding


organisations to deliver high quality services with active service-user involvement. He draws on over 30 years international experience gained as senior finance professional the fields of financial management, treasury and corporate finance, working with major international public companies such as Akzo Nobel NV, Courtaulds plc and the British National Oil Corporation. Within the NHS he has served as board member of the Healthcare Purchasing Consortium, board member and Audit Chair of NHS Newham, board member, Audit Chair and Chair of Risk and Assurance on the East London Consortium of Primary Care Trusts and Chair of Newham University Hospital NHS Trust. Andrea Lippett, Lay Member for Remuneration Andrea has 20 years business and management experience as a broadcast, media, marketing, and commercial specialist, within advertising agencies, ITV plc and independent consultancy. She has lived in east London since 1986, and is committed to helping to drive the quality of health services forward for all residents. Senior managers contracts Details of the senior managers are stated below. Contracts in Newham CCG became effective on the dates shown below. Where no end dates are shown, individuals are currently still in post.

Name Post Title Contract type

Contract start date in the CCG

Contract end date

Steve Gilvin Chief Officer VSM April 2013 Selina Douglas Deputy Chief Officer VSM February 2016 Chad Whitton Chief Finance Officer VSM July 2013 Chetan Vyas Director of Quality and

Development AfC 9 February 2013

Satbinder Sanghera Director of Partnerships and Governance

AfC 9 May 2013

Ian Tritschler Director of Acute and Community Commissioning

AfC 9 April 2015

Luke Readman Chief Information Officer VSM May 2015 30/4/2016 Senior managers are on the senior managers pay framework, have a permanent contract and are subject to a six month notice period except in the case of summary or immediate dismissal. Very senior managers (VSM) on a one year fixed term contract are subject to a three month notice period. Compensation for loss of office is based on the terms and conditions laid out under Agenda for Change. External auditor’s remuneration The appointed external auditor for NHS Newham CCG is KPMG LLP. The statutory audit fee for the financial year 2015/16 is £81,090 (VAT inclusive). There are no fees for non-statutory services. Consultancy expenditure

2015-16 2015-16 2015-16 2014-15 Total Admin Programme Total

£0 £0 £0 £0 594,229 142,229 452,000 701,213

Senior managers remuneration The table below shows the salaries and allowances of senior managers in 2015/16.


Note Name Title

2015/16 Dates served

Sala

ry

Expe

nse

Paym

ents

(ta

xabl

e)

Perf

orm

ance

pa

y an

d B

onus

es

Long

term

Pe

rfor

man

ce

pay

and

bonu

ses

All

Pens

ion

Rel

ated

B

enef

its

Tota

l

From

To

(bands of £5000)

(to nearest £100)

(bands of £5000)

(bands of £5000)

(bands of

£2,500) (bands of

£5000)

£000 £00 £000 £000 £000 £000 Stephen Gilvin Chief Officer 110 - 115 0 0 0 22.5 - 25 135 - 140 01/04/15 31/03/16

Chad Whitton Chief Financial Officer 100 - 105 0 0 0 52.5 - 55 155 - 160 01/04/15 31/03/16

1 Penny Emerson Deputy Chief Officer 160 - 165 0 0 0 0 160 - 165 01/04/15 30/09/15

Selina Douglas Deputy Chief Officer 15 - 20 0 0 0 35 - 37.5 50 - 55 01/02/16 31/03/16

4 Wayne Farah Vice-Chair, Lay Member for Patient Engagement 10 - 15 0 0 0 0 10 - 15 01/04/15 31/03/16

Paul Hendrick Lay Member, Governance 10 - 15 0 0 0 0 10 - 15 01/04/15 31/03/16

Andrea Lippett Lay Member, Governance 10 - 15 0 0 0 0 10 - 15 01/04/15 31/03/16

Zuhair Zarifa GP member 65 - 70 0 0 0 0 65 - 70 01/04/15 31/03/16

4 Ashwin Shah GP member 60 - 65 0 0 0 0 60 - 65 01/04/15 31/03/16

Prakash Chandra GP member 60 - 65 0 0 0 0 60 - 65 01/04/15 31/03/16

2 & 4 Elizabeth Goodyear GP member 30 - 35 0 0 0 0 30 - 35 01/04/15 31/03/16

Ambadi Gopinathan GP member 30 - 35 0 0 0 0 30 - 35 01/04/15 31/03/16

4 Bhupinder Kholi GP member 25 - 30 0 0 0 0 25 - 30 01/04/15 31/03/16

Jim Lawrie GP member 25 - 30 0 0 0 0 25 - 30 01/04/15 31/03/16

Rima Nicole Vaid GP member 50 - 55 0 0 0 0 50 - 55 01/04/15 31/03/16

2 & 4 Stuart Sutton GP member 30 - 35 0 0 0 0 30 - 35 01/04/15 31/03/16


Note Name Title

2015/16 Dates served

Sala

ry

Expe

nse

Paym

ents

(ta

xabl

e)

Perf

orm

ance

pa

y an

d B

onus

es

Long

term

Pe

rfor

man

ce

pay

and

bonu

ses

All

Pens

ion

Rel

ated

B

enef

its

Tota

l

From

To

(bands of £5000)

(to nearest £100)

(bands of £5000)

(bands of £5000)

(bands of

£2,500) (bands of

£5000)

£000 £00 £000 £000 £000 £000

2 & 4 Saravanan Chellappan GP member 25 - 30 0 0 0 0 25 - 30 01/07/15 31/03/16

4 Muhammad Naqvi GP member 50 - 55 0 0 0 0 50 - 55 01/04/15 31/03/16

Fiona Smith Registered Nurse 25 - 30 0 0 0 0 25 - 30 01/04/15 31/03/16

Hazel Trotter Practice Nurse 0 - 5 0 0 0 0 0 - 5 01/04/15 31/03/16

Augustine Eyeson Practice Nurse 0 - 5 0 0 0 0 0 - 5 01/04/15 02/02/15

3 Michele Olphonce Practice Nurse 0 0 0 0 0 0 24/03/16 31/03/16

Rizwan Hasan CCG Member Secondary Care Clinician 10 - 15 0 0 0 0 10 - 15 01/04/15 31/03/16

3 Charlotte Ladyman Health Watch Representative 0 0 0 0 0 0 01/04/15 01/04/15

3 Sophia Roupakia Health Watch Representative 0 0 0 0 0 0 01/04/15 16/12/15

3 Grainne Siggins Director for Adults, LBN 0 0 0 0 0 0 01/04/15 31/03/16

3 Meradin Peachey Director of Public Health LBN 0 0 0 0 0 0 01/04/15 31/03/16

3 Susan Milner London Borough of Newham 0 0 0 0 0 0 01/04/15 31/03/16

Chetan Vyas Director of Quality and Development 100 - 105 0 0 0 0 100 - 105 01/04/15 31/03/16

Satbinder Sanghera

Director of Partnerships and Governance 90 - 95 0 0 0 0 90 - 95 01/04/15 31/03/16

Jane Lindo Deputy Director of Delivery 90 - 95 0 0 0 0 90 - 95 01/04/15 31/03/16

Ian Tritschler Director of Acute and Community 85 - 90 0 0 0 0 85 - 90 01/04/15 31/03/16


Notes

1. Paid through Agency. 2. In 2014/15, the Department of Health issued guidance stating that pension disclosures are not required for GP Governing Body members who have a

contract for service, and for whom the CCG is making pension contributions. Therefore, for these members, no Pension Related Benefits figures are required. Additionally, the guidance states that the salary figures for these members should include employer pension contributions.

3. No salary or allowances are paid to these members. 4. Employed under separate contracts for different services.

The table below shows the salaries and allowances of senior managers in 2014/15. 2014/15

Note Name Title

Sala

ry

Expe

nse

Paym

ents

(ta

xabl

e)

Perf

orm

ance

pa

y an

d B

onus

es

Long

term

Pe

rfor

man

ce

pay

and

bonu

ses

All

Pens

ion

Rel

ated

B

enef

its

Tota

l

Dat

e St

arte

d

Dat

e En

ded

(if a

pp.)

(bands of

£5000)

(to nearest £100)

(bands of

£5000) (bands

of £5000) (bands of £2,500)

(bands of £5000)

£000 £000 £000 £000 £000 £000 Steve Gilvin Chief Officer 105 -

110 0 0 0 32.5 - 35 140 - 145

1 Chad Whitton Chief Finance Officer 105 - 110

0 0 0 (15) - (12.5) 90 - 95

2 Penny Emerson Deputy Chief Officer 90 - 95 0 0 0 0 90 - 95 01/12/14

Wayne Farah Vice-Chair, Lay Member for Patient Engagement 10 - 15 0 0 0 0 10 - 15

Paul Hendrick Lay Member, Governance 10 - 15 0 0 0 0 10 - 15

Andrea Lippett Lay Member, Remuneration 10 - 15 0 0 0 0 10 - 15

Zuhair Zarifa Chair 90 - 95 0 0 0 0 90 - 95

Ashwin Shah Deputy Chair 60 - 65 0 0 0 0 60 - 65

Prakash Chandra GP member 30 - 35 0 0 0 0 30 - 35

3 Elizabeth Goodyear GP member 30 - 35 0 0 0 0 30 - 35


2014/15

Note Name Title

Sala

ry

Expe

nse

Paym

ents

(ta

xabl

e)

Perf

orm

ance

pa

y an

d B

onus

es

Long

term

Pe

rfor

man

ce

pay

and

bonu

ses

All

Pens

ion

Rel

ated

B

enef

its

Tota

l

Dat

e St

arte

d

Dat

e En

ded

(if a

pp.)

(bands of

£5000)

(to nearest £100)

(bands of

£5000) (bands

of £5000) (bands of £2,500)

(bands of £5000)

£000 £000 £000 £000 £000 £000 Ambadi Gopinathan GP member 30 - 35 0 0 0 0 30 - 35

3 Lise Hertel GP member 10 - 15 0 0 0 0 10 - 15

Bhupinder Kohli GP member 30 - 35 0 0 0 0 30 - 35

Jim Lawrie GP member 30 - 35 0 0 0 0 30 - 35

Rima Nicole Vaid GP member 20 - 25 0 0 0 0 20 - 25 31/07/14

3 Hardip Nandra GP member 10 - 15 0 0 0 0 10 - 15 31/07/14

3 Stuart Sutton GP member 30 - 35 0 0 0 0 30 - 35

Muhammad Naqvi GP member 20 - 25 0 0 0 0 20 - 25 31/07/14

4 Franco LaFaci CCG Member Practice Manager 0 0 0 0 0 0 11/08/14

Hazel Trotter Practice Nurse 0 - 5 0 0 0 0 0 - 5

Fiona Smith Registered Nurse 0 - 5 0 0 0 0 0 - 5 03/09/14

Augustina Eyeson Practice Nurse 0 - 5 0 0 0 0 0 - 5 24/10/14

Rizwan Hasan CCG Member Secondary Care Clinician 10 - 15 0 0 0 0 10 - 15

3 Mark Santos Healthwatch Representative 0 0 0 0 0 0 10/09/14

3 Charlotte Ladyman Health Watch Representative 0 0 0 0 0 0 10/09/14

3 Graeme Betts Executive Director for Strategic Commissioning and Community, LBN 0 0 0 0 0 0 10/09/14

3 Grainne Siggins Director for Adult Social Care LBN 0 0 0 0 0 0 10/09/14

3 Meradin Peachey Director of Public Health LBN 0 0 0 0 0 0 12/02/15


2014/15

Note Name Title

Sala

ry

Expe

nse

Paym

ents

(ta

xabl

e)

Perf

orm

ance

pa

y an

d B

onus

es

Long

term

Pe

rfor

man

ce

pay

and

bonu

ses

All

Pens

ion

Rel

ated

B

enef

its

Tota

l

Dat

e St

arte

d

Dat

e En

ded

(if a

pp.)

(bands of

£5000)

(to nearest £100)

(bands of

£5000) (bands

of £5000) (bands of £2,500)

(bands of £5000)

£000 £000 £000 £000 £000 £000

3 Jane Leaman Newham Borough Interim Director Public Health 0 0 0 0 0 0 08/01/15

3 Susan Milner London Borough of Newham 0 0 0 0 0 0 01/04/14 12/02/15

Chetan Vyas Director of Quality and Development 95 - 100 0 0 0 30 - 32.5 125 - 130

5 Satbinder Sanghera Director of Partnerships and Governance 90 - 95 0 0 0 835 - 837.5 925 - 930

Jane Lindo Deputy Director of Delivery 90 - 95 0 0 0 17.5 - 20 105 - 110

Margaret Chirgwin Programme Director 10 - 15 0 0 0 0 - 2.5 10 - 15 31/05/14

Scott Hamilton Deputy Chief Executive/Director of Delivery 25 - 30 0 0 0 2.5 - 5 25 - 30 30/06/14

Notes

1. The Pensions Related Benefits (PRB) figure is calculated using the method set out in the Finance Act 2004(1), and includes using pension and lump sum figures. The PRB figure for this member is showing as negative because the pension only increased slightly in 2014/15 as a result of reduced working hours in 2014/15. Additionally, the member is in both the 1995 and 2008 sections of the NHS Pension scheme. The lump sum from the 1995 section is ‘preserved’, and there is no lump sum in the 2008 scheme unless purchased.

2. Paid through an agency. 3. No salary or allowances are paid to these members. 4. In 2014/15, the Department of Health issued guidance stating that pension disclosures are not required for GP Governing Body members who have a

contract for service, and for whom the CCG is making pension contributions. Therefore, for these members, no Pension Related Benefits figures are required. Additionally, the guidance states that the salary figures for these members should include employer pension contributions. Where appropriate, the corresponding figures relating to 2013/14 have also been restated in the table on the next page.

5. The high Pensions Related Benefits figure is as a result of the transfer, in 2014/15, of significant years’ membership from a local authority pension scheme. Therefore, membership is much higher in 2014/15 than it was in 2013/14.


Explanatory notes relating to new guidance issued by the Department of Health relating to GP governing body members are below:

GPs with a contract for service are not classed as employees of the CCG, and are considered to be ‘off-payroll’. This is notwithstanding that, under Her Majesty’s Revenue and Custom’s (HMRC) rules, CCGs are required to deduct income tax and national insurance at source for these individuals. Newham CCG complies with this requirement for all of its GP governing body members;

For those GPs with a contract for service, the 2015/16 salary figures now include employer pension contributions, and this is reflected in the table above.

Disclosures relating to the CCG’s off-payroll engagements are shown at page 88 of this annual report. Pay multiples Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director in their organisation and the median remuneration of the organisation’s workforce. The calculations are based on the full-time equivalent staff of the CCG at the reporting period end date on an annualised basis. The banded remuneration of the highest paid member of the NHS Newham CCG in the financial year 2015/16 was £110k to £115k (2014/15: £105k to £110k). This was 2.72 (2014/15: 2.98) times the median remuneration of the workforce, which was £41,218 (2014/15: £36,708). Remuneration ranged from £0 to £5k and £155k to £160k (2014/15: £0 to £5k and £105k to £110k). The lower figure relates to the amount attributable to the CCG for a single member of staff in the shared management support structure. In 2015/16, seven (2014/15, 0) employees received remuneration in excess of the highest-paid director/member. Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind, but not severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions. There are two directors whose salaries fall under the same range as the highest paid director. One of these joined in February and the salary has been annualised as per the guidance.

2014/15 2015/16

The banded remuneration of the highest paid director / member £105k - £110k £110k - £115k

Median remuneration of the CCG workforce £39,908 £41,218

Ratio of highest paid director / member to median paid employee 2.97 2.72

No. of employees who were paid more than the highest paid director/member 0 7

Remuneration ranges in the year £0 - £5k

to £115k - £120k

£0 - £5k to

£155k - £160k


Pensions benefits Pension Contribution Rates All staff, including senior managers, are eligible to join the NHS Pension Scheme. The scheme has fixed the employer’s contribution at 14.3% of the individual’s salary as per the NHS Pension regulations. Employee contribution rates for CCG officers and practice staff are as follows:

Full-time pensionable pay/earnings used to determine contribution rate 2015/16

Full-time pensionable pay/earnings used to determine contribution rate

2016/17

Up to £15,431.99 5.0% Up to £15,431.99 5.0%

£15,432.00 to £21,477.99 5.6% £15,432.00 to £21,477.99 5.6%

£21,478.00 to £26,823.99 7.1% £21,478.00 to £26,823.99 7.1%

£26,824.00 to £47,845.99 9.3% £26,824.00 to £47,845.99 9.3%

£47,846.00 to £70,630.99 12.5% £47,846.00 to £70,630.99 12.5%

£70,631.00 to £111,376.99 13.5% £70,631.00 to £111,376.99 13.5%

£111,377.00 and over 14.5% £111,377.00 and over 14.5%

Scheme benefits are set by NHS Pensions and are applicable to all members. Past and present employees are covered by the provisions of the NHS Pension Scheme. All employees are covered by the provisions of the NHS pension Scheme. For full details of how pension liabilities are treated please refer to Note 4 - Employee Benefits, in the financial statements.


Pension benefits of senior managers The table below shows the pension benefits of senior managers in 2015/16.

2015/16

Note Name Title Rea

l inc

reas

e in

pe

nsio

n at

re

tirem

ent a

ge

Rea

l inc

reas

e in

pe

nsio

n lu

mp

sum

at

retir

emen

t age

Tota

l acc

rued

pe

nsio

n at

age

60

at 3

1st M

arch

20

16

Lum

p su

m a

t ag

e 60

rela

ted

to a

ccru

ed

pens

ion

at 3

1st

Mar

ch 2

016

Cas

h eq

uiva

lent

tr

ansf

er v

alue

at

1st A

pril

2015

Rea

l inc

reas

e in

ca

sh e

quiv

alen

t tr

ansf

er v

alue

Cas

h eq

uiva

lent

tr

ansf

er v

alue

at

31st

Mar

ch 2

016

Empl

oyer

s co

ntrib

utio

n to

st

akeh

olde

r pe

nsio

n

Dates served

(bands of £2,500)

(bands of £2,500)

(bands of £5,000)

(bands of £5,000)

(to nearest £1,000)



(to nearest £1,000) From To

£000 £000 £000 £000 £000 £000 £000 £00

Stephen Gilvin Chief Officer 0 - 2.5 5 - 7.5 40 - 45 130 - 135 848 41 899 0 01/04/2015 31/03/2016 3 Chad Whitton Chief Financial Officer 2.5 - 5 (2.5) - 0 10 - 15 10 - 15 165 39 206 0 01/04/2015 31/03/2016 1 Selina Douglas Deputy Chief Officer 0 - 2.5 0 0 - 5 0 0 3 16 0 01/02/2016 31/03/2016

3 Chetan Vyas Director of Quality and Development (2.5) - 0 (2.5) - 0 20 - 25 60 - 65 303 0 298 0 01/04/2015 31/03/2016

2&3 Satbinder Sanghera

Director of Partnerships and Governance

(5) - (2.5) 0 40 - 45 0 510 0 494 0 01/04/2015 31/03/2016

3 Jane Lindo Deputy Director of Delivery (2.5) - 0 (5) - (2.5) 30 - 35 90 - 95 571 0 563 0 01/04/2015 31/03/2016

3 Ian Tritschler Director of Acute and Community 0 - 2.5 (2.5) - 0 30 - 35 90 - 95 521 17 543 0 01/04/2015 31/03/2016

Where applicable, the real increase in pensions, lump sums and CETV's are based on figures from the member's employment in previous organisations. Notes

1. This member has no preserved Scheme membership prior to 01/02/2016 and therefore there are no figures for last year. 2. No lump sum as the member is in the 2008 Section of the NHS Pension Scheme. 3. In order to calculate the "real" increase in lump sum and CETV, the Consumer Price Index inflation rate has been applied to last year's figure: this has

generated a very small negative decrease in year. As non-executive members do not receive pensionable remuneration, there will be no entries in respect of pensions for non-executive members.


The Pensions Related Benefits (PRB) figure is calculated using the method set out in the Finance Act 2004(1), and includes using the member's current and prior year pension and lump sum figures. Where there has been only a small increase in pension and lump sum benefits current year compared to last year, this formula can sometimes generate a negative figure. Where this is the case, Department of Health guidance states that a "zero" should be substituted for any negative figures.

2014/15

Not

e

Name Title Rea

l inc

reas

e in

pe

nsio

n at

age

60

Rea

l inc

reas

e in

pe

nsio

n lu

mp

sum

at

age

d 60

Tota

l acc

rued

pe

nsio

n at

age

60

at 3

1st M

arch

201

5

Lum

p su

m a

t age

60

rela

ted

to

accr

ued

pens

ion

at

31st

Mar

ch 2

015

Cas

h eq

uiva

lent

tr

ansf

er v

alue

at

1st A

pril

2014

Rea

l inc

reas

e in

ca

sh e

quiv

alen

t tr

ansf

er v

alue

Cas

h eq

uiva

lent

tr

ansf

er v

alue

at

31st

Mar

ch 2

015

Empl

oyer

s co

ntrib

utio

n to

st

akeh

olde

r pe

nsio

n

(bands of

£2,500)

(bands of

£2,500) (bands of £5,000)

(bands of £5,000)





Dat

e En

ded

(if a

pp.)

£000 £000 £000 £000 £000 £000 £000 £000

Steve Gilvin Chief Officer 0 - 2.5 5 - 7.5 40 - 45 125 - 130 762 65 848 0

1 Chad Whitton Chief Finance Officer 0 - 2.5 (2.5) - 0 5 - 10 10 - 15 142 20 165 0

Chetan Vyas Director of Quality and Development 0 - 2.5 5 - 7.5 20 - 25 60 - 65 261 35 303 0

2 / 3 Satbinder Sanghera

Director of Partnerships and Governance

40 - 42.5 0 40 - 45 0 14 496 510 0

Jane Lindo Deputy Director of Delivery 0 - 2.5 2.5 - 5 30 - 35 90 - 95 518 39 571 0

2 Margaret Chirgwin Programme Director 0 0 0 - 5 0 48 0 51 0 31/05/14

2 Scott Hamilton Deputy Chief Executive/Director of Delivery 0 - 2.5 0 5 - 10 0 70 1 77 0 30/06/14

Note

1. After applying inflation to the 2013/14 pension lump sum (LS) figure (to identify the real increase in LS between the two years), a very small decrease is shown. This is because the lump sum in both 2013/14 and 2014/15 is the same. The member is in both the 1995 and 2008 sections of the NHS Pension schemes. The lump sum from the 1995 Section is "preserved", and the 2008 Section does not include a lump sum.


2. The member is in the 2008 Section of the NHS Pension Scheme, therefore no lump sum figure is applicable. 3. The pension, lump sum and Cash Equivalent Transfer Values are high in 2014/15 as a result of the transfer, in 2014/15, of significant years’

membership from a local authority pension scheme. After applying inflation to the 2013/14 pension lump sum (LS) figure (to identify the real increase in LS between the two years), a very small decrease is shown. This is because the lump sum in both 2013/14 and 2014/15 is the same because the member is in both the 1995 and 2008 sections of the NHS

Pension schemes, and the 2008 Section does not include a lump sum.


Certain individuals disclosed in the salary and allowances table are not included in the pension benefits table. The reasons for this include:

some non-executive members do not receive pensionable remuneration; or

an executive director may have opted out of the pension scheme; or

pension disclosures are not required for GP governing body members who have a contract for service. This is a change from last year’s Department of Health guidance.

Cash equivalent transfer value A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s (or other allowable beneficiary’s) pension payable from the scheme. CETVs are calculated in accordance with the Occupational Pension Schemes (Transfer Values) Regulations 2008. Real increase in CETV This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period. Audit of remuneration report Please note that the full remuneration report is subject to audit, apart from remuneration committee report, senior manager service contracts, and off-payroll engagements. Exit packages, severance payments and termination agreements There have been no exit package or voluntary severance payments made in 2015/16. There have been no termination agreements in the financial year 2015/16. Off-payroll arrangements Off payroll engagements as of 31 March 2016, for more than £220 per day and that last longer than six months are as follows: Number The number that have existed:

For less than one year at the time of reporting 5 For between one and two years at the time of reporting 1 For between two and three years at the time of reporting 0 For between three and four years at the time of reporting 0 For four or more years at the time of reporting 0

Total number of existing engagements as of 31 March 2015 6


All existing off payroll engagements, outlined above, have at some point been subject to a risk based assessment as to whether assurance is required that the individual is paying the right amount of tax and, where necessary, that assurance has been sought. Number Number of new engagements, or those that reached six months in duration, between 1 April and 31 March 2016

3

Number of the above which include contractual clauses giving the clinical commissioning group the right to request assurance in relation to Income Tax and National Insurance obligations

0

Number for whom assurance has been requested. Of which, the number: For whom assurance has been received 0 For whom assurance has not been received 0 That have been terminated as a result of assurance not being

received 0

Number Number of off-payroll engagements of Membership Body and/or Governing body members, and/or, Senior Officials with significant financial responsibility, during the financial year

1

Number of individuals that have been deemed Membership Body and/or Governing Body members, and/or, senior officials with significant financial responsibility, during the financial year

6

Number Number of clinical Board Members whose contract for services is management via payroll arrangements

6

Sickness absence data For information on sickness absence within NHS Newham CCG, see the employee benefits in note 4.3 of the Financial Statements. Newham CCG has a robust absence management policy and procedure which enables managers to address sickness absence issues, both short and long-term, in a fair, consistent and equitable manner. All absences are responded to by a line manager in a return to work discussion. Consideration is given to whether staff have hit short-term absence triggers. These triggers are either four occasions of absence in any 12 month period or 12 days of absence in any 12 month period. Where an individual fails to maintain regular attendance deemed acceptable for the organisation, a formal attendance monitoring meeting will be held. The purpose of the meeting is to provide support and assistance to overcome any short-term issues, patterns or problems which are identified. At this stage an action plan of improvement will be set. The process may eventually result in dismissal if the absence continues. Long-term absence is classed as at least four weeks continuous absence. In cases of long-term absence, line managers conduct regular review meetings to discuss possible courses of action should the absence continue. These may include rehabilitation and return to work requirements, redeployment or ill-health retirement. The average sickness from April 2015 – March 2016 is 1.1% across the CCG.


Our workforce Under the Equality Act 2010 it is essential that the CCG collects and reports on its current relevant workforce information. We therefore update our workforce information on a regular basis to ensure that current policies, practices and support mechanisms remain relevant to the needs and requirements of the workforce. It is recognised that Newham CCG is a small organisation employing 54 staff and the duty to report allows for some modification of the information provided against the protected characteristics to ensure an individual staff member cannot be identified. We have exercised caution in providing this information. Key highlights These charts have been taken from the Equality Report January 2016 and are based on the workforce of the CCG as of October 2015.

White – British is the largest ethnic group reflecting 26% (14) followed by Indian reflecting 15% (8). Females represent 59% (32) of the workforce and males 41% 19% of the workforce are Christian, 50% either do not wish to disclose their religion or are unknown. 2% of the workforce has disclosed they are disabled; the unknown category has decreased by 14%

on last year’s figures. 52% (28) are married while 41% (22) are single. Heterosexuals represent 43% of respondents.


Equality report Equality Duty We are committed to meeting our equality and diversity duty across all our policies and functions. Over the last one year, we have been working with our patients, partners and providers to address issues relating to health inequalities in the community particularly amongst certain protected groups. We recognise that while we set and implement equality objectives, and publish our annual equality performance report to meet the public sector equality duty, we must continue to work with our patients, staff and stakeholders to ensure continuous improvement in advancing equality. More information about various equality and diversity activities can be found in our January 2016 Equality Report on our website. Key achievements in 2015/16 Equality Delivery System (EDS2)

We have implemented EDS2 to manage our equality and diversity performance in the organisation. We have set up a working group to support our EDS2 work including equality the objective setting

process. We are working with our providers to ensure effective use of EDS2 in grading equality performance

Workforce Race Equality Standard (WRES)

We have published our WRES baseline report in 2015. We are working with NEL Commissioning Support Unit and our providers to implement the WRES. The WRES report feeds into our equality objective setting and EDS2 grading processes.

Equality Objectives

Our Equality Objectives are delivered through various activities including commissioning, workforce and engagement.

We have an annual integrated equality objectives action plan which brings together EDS2 and the WRES.

Equality Objectives are refreshed by using EDS2 which includes engaging stakeholders. Equality Analysis

We carry out equality analysis of policies and services based on relevance. We provide equality and diversity training to staff that are responsible for commissioning services

and engaging patients and carers. We will refresh our guidance and template in 2016/17 in light of recent policy change. We are in the process of updating our Equality and Diversity Strategy which will include our equality

objectives for 2016-20. Employee related issues At Newham CCG, we value the contribution of our staff and of staff side collective representation and this is reflected in how serious we are about employee consultation, this means the provision and exchange of information and instructions which enable our organisation to function efficiently and for employees to be properly informed about developments. This relates to the information provided, the channels through which it is delivered and the way it is communicated. Newham CCG believes that only through an effective partnership with our staff will we achieve the ambitious agenda that the CCG has set for itself over the next five years. Consultation is the process by which CCG management and employees or their representatives jointly examine and discuss issues of mutual concern. It involves seeking acceptable solutions to problems through a genuine exchange of views and information.

http://www.newhamccg.nhs.uk/Downloads/News-and-Publications/Policies-and-procedures/Newham%20CCG-Equality%20Information%202016.pdf

http://www.newhamccg.nhs.uk/Downloads/News-and-Publications/Policies-and-procedures/Newham%20CCG-Equality%20Information%202016.pdf


Consultation does not remove the right of our managers to manage – we expect our managers to still make the final decision – but it is important that the views of employees will be sought and considered before decisions are taken. Indeed, in certain circumstances consultation with independent recognised trade unions is a formal requirement. Our position is that information and consultation are imperative for an effective organisation. We have internal processes in place that encourage staff to exchange views, ideas, issues, and receive instructions. Staff are also encouraged to discuss problems and consider development and changes to the organisation’s structure and design. The methods we use include:

Management newsletter - produced monthly, this bulletin updates staff on key organisational and HR issues and is designed to be used by managers when briefing their teams.

Staff barometer - the CCG ask all staff regularly for their views about a variety of work issues including work/home life balance, morale, workload etc.

Staff champions - a group comprising of staff from across different directorates identify issues that colleagues feel most concerned about and develop ideas to improve the work environment. Staff champions also attend senior management team every two months to provide feedback on key work issues and agree next steps.

Staff meetings - in addition to regular team meetings for all CCG teams, there is also a monthly staff meeting to consider key work issues and in particular performance, financial, strategy and policy considerations. This is led by the chief officer but provides an open forum for all staff to engage and discuss any pressing matters with colleagues.

CCG intranet – is the single most effective communication tool for NHS Newham CCG as it is accessible to all GP practices and to CCG staff. It contains a wide range of information from referral processes, to news items and upcoming events, to all policies and procedures.

Staff are consulted with on all HR policies and are provided with an opportunity to offer their feedback and there is formal consultation with all recognised Trade Unions. The same Trades unions also meet senior managers across Waltham Forest, Tower Hamlets and Newham on a quarterly basis to agree policies from the three boroughs and to represent their members on key issues. As well as direct staff consultation, we recognise the following unions as the appropriate trade unions and professional bodies for the purpose of sole collective bargaining rights for staff:

British Medical Association (BMA) UNISON Unite Managers In Partnership (MiP) Royal College of Nursing (RCN)

Health and safety NHS Newham CCG fulfils its statutory obligations under the Health and Safety at Work Act (1974), and the Workplace (Health, Safety and Welfare) Regulations (1992), to ensure the health, safety and welfare of its staff, clients, contractors and visitors using its premises. NHS Newham CCG also ensures the highest standards of health and safety are demonstrated by the healthcare providers procured. In delivering its responsibilities the organisation collaborates with the services provided by NHS Property Services, North East London Commissioning Support Unit and onsite services, which prior to December


2015 these were delivered by Excel Management at our head office in Warehouse K. In December 2015 the CCG moved to new premises in Stratford. A new health and safety policy has been commissioned through a qualified expert and will be going to Governing Body for approval in early summer 2016. The post of facilities manager has been added to the permanent establishment of the CCG in recognition of the need to ensure compliance with health and safety obligations as well as ensuring sustainable work space and staff support services. Key elements of ensuring compliance with obligations are:

A designated competent person and health and safety advisor An Occupational health service Local security management Local office health and safety inspections Alarm testing and fire drills Availability of First Aiders Health and Safety Induction and periodic training

In relation to the healthcare providers we commission, all contractors engaged by the CCG have a responsibility, as specified in the relevant contract documents, to carry out their work in a safe manner in respect of their own staff, subcontractors, CCG staff, premises, patients and members of the public. The accountability report was approved by the Governing Body on 26 May 2016 and signed on its behalf by: Steve Gilvin Chief Officer 26 May 2016


Independent auditors’ report to the members of Newham Clinical Commissioning Group We have audited the financial statements of Newham CCG for the year ended 31 March 2016 on pages 99 to 124 under the Local Audit and Accountability Act 2014. These financial statements have been prepared under applicable law and the accounting policies directed by the NHS Commissioning Board with the consent of the Secretary of State as relevant to the Clinical Commissioning Groups in England. We have also audited the information in the Remuneration and Staff Report that is subject to audit. This report is made solely to the Members of the Governing Body of Newham CCG, as a body, in accordance with Part 5 of the Local Audit and Accountability Act 2014. Our audit work has been undertaken so that we might state to the Members of the Governing Body of the CCG, as a body, those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Members of the Governing Body of the CCG, as a body, for our audit work, for this report or for the opinions we have formed. Respective responsibilities of the Accountable Officer and auditor As explained more fully in the Statement of Accountable Officer’s Responsibilities set out on page 51, the Accountable Officer is responsible for the preparation of financial statements which give a true and fair view and is also responsible for the regularity of expenditure and income. Our responsibility is to audit, and express an opinion on, the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors. We are also responsible for giving an opinion on the regularity of expenditure and income in accordance with the Code of Audit Practice prepared by the Comptroller and Auditor General under the Local Audit and Accountability Act 2014 (‘the Code of Audit Practice’). As explained in the Annual Governance Statement the Accountable officer is responsible for the arrangements to secure economy, efficiency and effectiveness in the use of the CCG's resources. We are required under Section 21(1)(c) of the Local Audit and Accountability Act 2014 to be satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. Section 21(5)(b) of the Local Audit and Accountability Act 2014 requires that our report must not contain our opinion if we are satisfied that proper arrangements are in place. We are not required to consider, nor have we considered, whether all aspects of the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively. Scope of the audit of the financial statements An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of: whether the accounting policies are appropriate to the CCG’s circumstances and have been consistently applied and adequately disclosed; the reasonableness of significant accounting estimates made by the Accountable Officer, and the overall presentation of the financial statements. In addition we read all the financial and non-financial information in the annual report and accounts to identify material inconsistencies with the audited financial statements and to identify any information that is apparently materially incorrect based on, or materially inconsistent with, the knowledge acquired by us in the course of performing the audit. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report. In addition, we are required to obtain evidence sufficient to give reasonable assurance that the expenditure and income recorded in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them.


Scope of the review of arrangements for securing economy, efficiency and effectiveness in the use of resources We have undertaken our review in accordance with the Code of Audit Practice, having regard to the guidance on the specified criterion issued by the Comptroller and Auditor General in November 2015, as to whether the CCG had proper arrangements to ensure it took properly informed decisions and deployed resources to achieve planned and sustainable outcomes for taxpayers and local people. The Comptroller and Auditor General determined this criterion as that necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the CCG put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2016. We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we undertook such work as we considered necessary to form a view on whether, in all significant respects, the CCG had put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources. Opinion on financial statements In our opinion the financial statements:

give a true and fair view of the financial position of the CCG as at 31 March 2016 and of its net operating expenditure for the year then ended; and

have been properly prepared in accordance with the accounting policies directed by the NHS Commissioning Board with the consent of the Secretary of State as relevant to Clinical Commissioning Groups in England.

Opinion on regularity In our opinion, in all material respects the expenditure and income have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them. Opinion on other matters In our opinion:

the parts of the Remuneration and Staff Report subject to audit have been properly prepared in accordance with the accounting policies directed by the NHS Commissioning Board with the consent of the Secretary of State as relevant to Clinical Commissioning Groups in England

the other information published together with the audited financial statements in the Annual Report and Accounts is consistent with the financial statements.

Matters on which we are required to report by exception We are required to report to you if:

in our opinion, the Governance Statement does not comply with guidance issued by the NHS Commissioning Board;

we refer a matter to the Secretary of State under section 30 of the Local Audit and Accountability Act 2014 because we have reason to believe that the CCG, or an officer of the CCG, is about to make, or has made, a decision which involves or would involve the body incurring unlawful expenditure, or is about to take, or has begun to take a course of action which, if followed to its conclusion, would be unlawful and likely to cause a loss or deficiency; or

we issue a report in the public interest under section 24 of the Local Audit and Accountability Act 2014; or

we make a written recommendation to the CCG under section 24 of the Local Audit and Accountability Act 2014; or

we are not satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2016.


We have nothing to report in respect of the above responsibilities. Certificate We certify that we have completed the audit of the accounts of Newham CCG in accordance with the requirements of the Local Audit and Accountability Act 2014 and the Code of Audit Practice. Neil Hewitson for and on behalf of KPMG LLP, Statutory Auditor Chartered Accountants 15 Canada Square Canary Wharf London E14 5GL


Financial Statements


Introduction to accounts We are accountable for what we do with public money. In 2015/16, we achieved good value for money for our patients. We were given a revenue resource limit of £477.852 million from NHS England. This was made up of recurrent funding allocation (the money we get each year) of £461.738 million. This allocation equated to £1,225 per registered person in Newham for patient care (excluding admin costs). Of the £477.852 million, £16.114 million was non-recurrent funding – money which we have been given this year only. As this is non-recurrent funding, we did not take this into account in our long-term planning. In April 2015, the Governing Body agreed our annual operating plan that sets out how we will commission services over the coming year in order to deliver on our commissioning strategy. These plans included achieving a surplus of £6.500 million for financial year 2015/16, which we have achieved, delivering a surplus of £6.518 million. This shows an overachievement of surplus of £0.018 million. The notes on pages 103-124 form part of the accounts statements. Statement of comprehensive net expenditure for the year ended 31 March 2016

2015-16 2014-15 Note £000 £000

Total Income and Expenditure Employee benefits 4.1.1 8,607 7,259 Operating Expenses 5 466,115 398,173 Other operating revenue 2 (3,388) (2,989) Net operating expenditure before interest 471,334 402,443

Of which: Administration Income and Expenditure Employee benefits 4.1.1 3,668 3,845 Operating Expenses 5 3,908 4,625 Other operating revenue 2 (310) (157) Net administration costs before interest 7,266 8,313 Programme Income and Expenditure Employee benefits 4.1.1 4,939 3,414 Operating Expenses 5 462,207 393,548 Other operating revenue 2 (3,078) (2,832) Net programme expenditure before interest 464,068 394,130 Total comprehensive net expenditure for the year 471,334 402,443


Statement of financial position as at 31 March 2016 2015-16 2014-15

Note £000 £000 Non-current assets:

Property, plant and equipment 8 2,447 1,399 Total non-current assets 2,447 1,399 Current assets: Trade and other receivables 9 4,872 5,521 Cash and cash equivalents 10 40 98 Total current assets 4,912 5,619

Total assets 7,359 7,018 Current liabilities Trade and other payables 11 (54,874) (44,364) Provisions 12 (1,683) (1,683) Total current liabilities (56,557) (46,047) Non-Current Assets plus/less Net Current Assets/Liabilities (49,198) (39,029) Financed by Taxpayers’ Equity General fund Total taxpayers' equity:

The financial statements were approved by the Governing Body on 26 May 2016 and signed on its behalf by: Steve Gilvin Chief Officer 26 May 2016


Statement of changes in taxpayers equity for the year ended 31 March 2016

General fund Note £000 2015-16

Changes in taxpayers’ equity for 2015-16

Balance at 1 April 2015 (39,029) Changes in CCG taxpayers’ equity for 2015-16 Net operating expenditure for the financial year SOCNE (471,334)

Net Recognised CCG Expenditure for the Financial Year (471,334) Net funding SCF 461,165 Balance at 31 March 2016 (49,198)

General fund

£000 2014-15

Changes in taxpayers’ equity for 2014-15

Balance at 1 April 2014 (39,642) Changes in CCG taxpayers’ equity for 2014-15 Net operating costs for the financial year SOCNE (402,443)

Net Recognised CCG Expenditure for the Financial Year (402,443)

Net funding SCF 403,056

Balance at 31 March 2015 (39,029)


Statement of cash flows for the year ended 31 March 2016 2015-16 2014-15

Note £000 £000 Cash Flows from Operating Activities

Net operating expenditure for the financial year SOCNE (471,334) (402,443) Depreciation and amortisation 8 392 312 Decrease/(Increase) in trade & other receivables 9 650 (2,793) Increase in trade & other payables 11 10,526 934 Provisions utilised 12 0 (733) Decrease in provisions 12 0 1,663 Net Cash Outflow from Operating Activities (459,766) (403,060)

Cash Flows from Investing Activities Payments for property, plant and equipment (1,457) (116) Net Cash Inflow Outflow from Investing Activities (1,457) (116)

Net Cash Outflow before Financing (461,223) (403,176)

Cash Flows from Financing Activities Grant in Aid Funding Received 461,165 403,056 Net Cash Inflow from Financing Activities SOCITE 461,165 403,056

Net Decrease in Cash & Cash Equivalents 10 (58) (120)

Cash & Cash Equivalents at the Beginning of the Financial Year 98 218

Cash & Cash Equivalents at the End of the Financial Year 40 98


Notes to the financial statements 1. Accounting policies NHS England has directed that the financial statements of NHS Newham CCG shall meet the accounting requirements of the Manual for Accounts issued by the Department of Health. Consequently, the following financial statements have been prepared in accordance with the Manual for Accounts 2015-16 issued by the Department of Health. The accounting policies contained in the Manual for Accounts follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to NHS Newham CCG, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Manual for Accounts permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the NHS Newham CCG for the purpose of giving a true and fair view has been selected. The particular policies adopted by the NHS Newham CCG are described below. They have been applied consistently in dealing with items considered material in relation to the accounts. 1.1 Going concern These accounts have been prepared on the going concern basis (despite the issue of a report to the Secretary of State for Health under Section 30 of the Local Audit and Accountability Act 2014). Public sector bodies are assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as evidenced by inclusion of financial provision for that service in published documents. Where NHS Newham CCG ceases to exist, it considers whether or not its services will continue to be provided (using the same assets, by another public sector entity) in determining whether to use the concept of going concern for the final set of Financial Statements. If services will continue to be provided the financial statements are prepared on the going concern basis. The statement of financial position of NHS Newham CCG as at 31 March 2016 shows a net liability position. This is as a result of the timing of working capital, and the very low level of non-current assets held, and not as a result of going concern or cash flow issues. 1.2 Accounting convention These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities. 1.3 Movement of assets within the Department of Health group Transfers as part of reorganisation fall to be accounted for by use of absorption accounting in line with the Government Financial Reporting Manual, issued by HM Treasury. The Government Financial Reporting Manual does not require retrospective adoption, so prior year transactions (which have been accounted for under merger accounting) have not been restated. Absorption accounting requires that entities account for their transactions in the period in which they took place, with no restatement of performance required when functions transfer within the public sector. Where assets and liabilities transfer, the gain or loss resulting is recognised in the Statement of Comprehensive Net Expenditure, and is disclosed separately from operating costs. Other transfers of assets and liabilities within the Department of Health Group are accounted for in line with IAS 20. 1.4 Pooled budgets Where the NHS Newham CCG has entered into a pooled budget arrangement under Section 75 of the National Health Service Act 2006 the NHS Newham CCG accounts for its share of the assets, liabilities,


income and expenditure arising from the activities of the pooled budget, identified in accordance with the pooled budget agreement. If the NHS Newham CCG is in a “jointly controlled operation”, the NHS Newham CCG recognises:

The liabilities the NHS Newham CCG incurs; and The expenses the NHS Newham CCG incurs;

If the NHS Newham CCG is not involved in a ‘jointly controlled assets’ arrangement. 1.5 Critical accounting judgements and key sources of estimation uncertainty In the application of NHS Newham CCG’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods. 1.5.1 Critical judgements in applying accounting policies No critical judgement, apart from those involving estimations (see below) that management has made in the process of applying NHS Newham CCG’s accounting policies that have the most significant effect on the amounts recognised in the financial statements: 1.5.2 Key sources of estimation uncertainty The following are the key estimations that management has made in the process of applying the NHS Newham CCG’s accounting policies that have the most significant effect on the amounts recognised in the financial statements:

Partially completed spells - Expenditure relating to patient care spells that are part-completed at the year-end are notified by the provider Trusts through the NHS Agreement of Balances exercise.

Maternity pathways - Expenditure relating to all antenatal maternity care is made at the start of a pathway. As a result, at the year-end part completed pathways are treated as a prepayment. NHS Newham CCG agrees to use the figures calculated by the local providers.

Prescribing liabilities - NHS England actions monthly cash charges to NHS Newham CCG for prescribing contracts. These are issued approximately six weeks in arrears. NHS Newham CCG uses information provided by the NHS Business Authority as part of the estimate of full year expenditure.

Accruals - For goods and / or services that have been delivered by the end of the financial year, but for which no invoice has been received, NHS Newham CCG has accrued for these liabilities based on the contractual arrangements that are in place.

1.6 Revenue Revenue in respect of services provided is recognised when, and to the extent that, performance occurs, and is measured at the fair value of the consideration receivable. Where income is received for a specific activity that is to be delivered in the following year, that income is deferred. 1.7 Employee benefits 1.7.1 Short-term employee benefits Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees, including bonuses earned but not yet taken.


The cost of leave earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry forward leave into the following period. 1.7.2 Retirement benefit costs Past and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS Newham CCG of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period. For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to expenditure at the time NHS Newham CCG commits itself to the retirement, regardless of the method of payment. 1.8 Other expenses Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable. Expenses and liabilities in respect of grants are recognised when the NHS Newham CCG has a present legal or constructive obligation, which occurs when all of the conditions attached to the payment have been met. 1.9 Plant and equipment 1.9.1 Recognition Property, plant and equipment is capitalised if:

It is held for use in delivering services or for administrative purposes; It is probable that future economic benefits will flow to, or service potential will be supplied to NHS

Newham CCG; It is expected to be used for more than one financial year; The cost of the item can be measured reliably; and, The item has a cost of at least £5,000; or, Collectively, a number of items have a cost of at least £5,000 and individually have a cost of more

than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or,

Items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or collective cost.

Where a large asset, for example a building, includes a number of components with significantly different asset lives, the components are treated as separate assets and depreciated over their own useful economic lives. 1.9.2 Valuation All plant and equipment are measured initially at cost, representing the cost directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. All assets are measured subsequently at valuation. Fixtures and equipment are carried at depreciated historic cost as this is not considered to be materially different from current value in existing use.


1.9.3 Subsequent expenditure Where subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised. Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing carrying value of the item replaced is written-out and charged to operating expenses. 1.10 Depreciation, amortisation and impairments Depreciation is charged to write off the costs of plant and equipment, less any residual value, over their estimated useful lives, on a straight line basis. The estimated useful life of an asset is the period over which NHS Newham CCG expects to obtain economic benefits or service potential from the asset. This is specific to NHS Newham CCG and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis. At each reporting period end, NHS Newham CCG checks whether there is any indication that any of its tangible non-current assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its amount. The minimum and maximum useful economic lives of different classes of assets are disclosed in Note 8.1 1.11 Leases Leases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All other leases are classified as operating leases. 1.11.1 NHS Newham CCG as lessee Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term. Contingent rentals are recognised as an expense in the period in which they are incurred. Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether they are operating or finance leases. 1.12 Cash and cash equivalents Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value. In the statement of cash flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the NHS Newham CCG’s cash management. 1.13 Provisions Provisions are recognised when the NHS Newham CCG has a present legal or constructive obligation as a result of a past event, it is probable that the NHS Newham CCG will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties. 1.14 Clinical negligence costs The NHS Litigation Authority operates a risk pooling scheme under which the NHS Newham CCG pays an annual contribution to the NHS Litigation Authority which in return settles all clinical negligence claims. The


contribution is charged to expenditure. Although the NHS Litigation Authority is administratively responsible for all clinical negligence cases the legal liability remains with the NHS Newham CCG. 1.15 Non-clinical risk pooling The NHS Newham CCG participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the NHS Newham CCG pays an annual contribution to the NHS Litigation Authority and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due. 1.16 Continuing healthcare risk pooling In 2014-15 a risk pool scheme was been introduced by NHS England for continuing healthcare claims, for claim periods prior to 31 March 2013. Under the scheme NHS Newham CCG contribute annually to a pooled fund, which is used to settle the claims. 1.17 Financial assets Financial assets are recognised when the NHS Newham CCG becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred. All financial assets are classified as loans and receivables. 1.17.1 Loans and receivables Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market. After initial recognition, they are measured at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method. At the end of the reporting period, NHS Newham CCG assesses whether any financial assets are impaired. Financial assets are impaired and impairment losses recognised if there is objective evidence of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the estimated future cash flows of the asset. For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset’s carrying amount and the present value of the revised future cash flows discounted at the asset’s original effective interest rate. The loss is recognised in expenditure and the carrying amount of the asset is reduced through a provision for impairment of receivables. If, in a subsequent period, the amount of the impairment loss decreases and the decrease can be related objectively to an event occurring after the impairment was recognised, the previously recognised impairment loss is reversed through expenditure to the extent that the carrying amount of the receivable at the date of the impairment is reversed does not exceed what the amortised cost would have been had the impairment not been recognised. 1.18 Financial liabilities Financial liabilities are recognised on the statement of financial position when the NHS Newham CCG becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired. 1.19 Value added tax Most of the activities of the NHS Newham CCG are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.


1.20 Losses and special payments Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled. Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had the NHS Newham CCG not been bearing its own risks (with insurance premiums then being included as normal revenue expenditure). 1.21 Joint operations Joint operations are activities undertaken by the NHS Newham CCG in conjunction with one or more other parties but which are not performed through a separate entity. The NHS Newham CCG records its share of expenditure; gains and losses; liabilities; and cash flows. 1.22 Accounting standards that have been issued but have not yet been adopted The Government Financial Reporting Manual does not require the following Standards and Interpretations to be applied in 2015-16, all of which are subject to consultation:

IFRS 9: Financial Instruments IFRS 14: Regulatory Deferral Accounts IFRS 15: Revenue for Contract with Customers

The application of the standards as revised would not have a material impact on the accounts for 2015-16, were they applied in that year. 2. Other operating revenue


£000 £000 £000 £000 Education, training and research 158 0 158 257 Non-patient care services to other bodies 3,129 355 2,774 2,623 Other revenue 101 (45) 146 107 Total other operating revenue 3,388 310 3,078 2,987

Administrative revenue is revenue received that is not directly attributable to the provision of healthcare or healthcare services. Revenue in this note does not include cash received from NHS England, which is drawn down directly into the bank account of NHS Newham CCG and credited to the General Fund. 3. Revenue

2015-16 2015-16 2015-16 2014-15 Total Admin Programme Total £000 £000 £000 £000

From rendering of services 3,388 310 3,078 2,987 Total 3,388 310 3,078 2,987

Revenue is totally from the supply of services. NHS Newham CCG receives no revenue from the sale of goods.


4. Employee benefits and staff numbers 4.1.1 Employee benefits

2015-16 Total Admin Programme

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£000 £000 £000 £000 £000 £000 £000 £000 £000 Employee Benefits

Salaries and wages 7,972 3,109 4,863 3,243 2,139 1,104 4,729 970 3,759 Social security costs 313 313 0 213 213 0 100 100 0 Employer Contributions to NHS Pension scheme 322 322 0 212 212 0 110 110 0 Gross employee benefits expenditure 8,607 3,744 4,863 3,668 2,564 1,104 4,939 1,180 3,759 Net employee benefits excluding capitalised costs 8,607 3,744 4,863 3,668 2,564 1,104 4,939 1,180 3,759

4.1.2 Employee benefits

2014-15 Total Admin Programme

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£000 £000 £000 £000 £000 £000 £000 £000 £000 Employee Benefits

Salaries and wages 6,718 2,251 4,467 3,502 1,650 1,852 3,216 601 2,615 Social security costs 301 301 0 188 188 0 113 113 0 Employer Contributions to NHS Pension scheme 240 240 0 155 155 0 85 85 0 Gross employee benefits expenditure 7,259 2,792 4,467 3,845 1,993 1,852 3,414 799 2,615 Net employee benefits excluding capitalised costs 7,259 2,792 4,467 3,845 1,993 1,852 3,414 799 2,615

4.2 Average number of people employed

2015-16 2014-15

Total Permanently

employed Other Total Number Number Number Number

Total 79 44 35 73


4.3 Staff sickness absence and ill health retirements 2015-16 2014-15

Number Number Total Days Lost 55 42 Total Staff Years 51 34 Average working days lost 1.1 1.2

Ill health retirement costs are met by the NHS Pension Scheme and this was nil in 2015-16 (nil 2014-15). 4.4 Exit packages agreed in the financial year There were no exit packages during the year (nil 2014-15). 4.5 Pension costs Past and present employees are covered by the provisions of the NHS Pension Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. The Scheme is an unfunded, defined benefit scheme that covers NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The Scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the Scheme is accounted for as if it were a defined contribution scheme: the cost to the clinical commissioning group of participating in the Scheme is taken as equal to the contributions payable to the Scheme for the accounting period. The Scheme is subject to a full actuarial valuation every four years (until 2004, every five years) and an accounting valuation every year. An outline of these follows: 4.5.1 Full actuarial (funding) valuation The purpose of this valuation is to assess the level of liability in respect of the benefits due under the Scheme (taking into account its recent demographic experience), and to recommend the contribution rates to be paid by employers and scheme members. The last such valuation, which determined current contribution rates was undertaken as at 31 March 2012 and covered the period from 1 April 2008 to that date. Details can be found on the pension scheme website at www.nhsbsa.nhs.uk/pensions. For 2015-16, employers’ contributions of £321,743 were payable to the NHS Pensions Scheme (2014-15: £238,672) were payable to the NHS Pension Scheme at the rate of 14.3% of pensionable pay (2014-15: 14%). The scheme’s actuary reviews employer contributions, usually every four years and now based on HMT Valuation Directions, following a full scheme valuation. The latest review used data from 31 March 2012 and was published on the Government website on 9 June 2014.These costs are included in the NHS pension line of note 4.1.1. 5. Operating expenses

2015-16 2015-16 2015-16 2014-15 Total Admin Programme Total £000 £000 £000 £000

Gross employee benefits

Employee benefits excluding governing body members 8,337 3,398 4,939 6,989 Executive governing body members 270 270 0 270 Total gross employee benefits 8,607 3,668 4,939 7,259 Other costs Services from other CCGs and NHS England 4,136 2,316 1,820 6,369 Services from foundation trusts 110,478 0 110,478 108,607

http://www.nhsbsa.nhs.uk/pensions

http://www.nhsbsa.nhs.uk/pensions



Services from other NHS trusts 198,064 0 198,064 198,450 Purchase of healthcare from non-NHS bodies 32,569 0 32,569 29,370 Chair and Non Executive Members 158 158 0 153 Supplies and services – clinical 0 0 0 210 Supplies and services – general 16,973 49 16,924 2,233 Consultancy services 596 83 513 596 Establishment 2,033 126 1,907 1,518 Transport 0 0 0 1 Premises 3,103 818 2,285 2,315 Depreciation 392 0 392 312 Audit fees 81 81 0 108 General dental services and personal dental services 0 0 0 1,500 Prescribing costs 41,062 0 41,062 37,880 Pharmaceutical services 0 0 0 3 General ophthalmic services 7 0 7 3 GPMS/APMS and PCTMS * 54,044 7 54,037 5,213 Other professional fees excl. audit 1,127 208 919 864 Research and development (excluding staff costs) 0 0 0 33 Education and training 616 62 554 198 Provisions 0 0 0 1,663 CHC Risk Pool contributions 676 0 676 574 Total other costs 466,115 3,908 462,207 398,173 Total operating expenses 474,722 7,576 467,146 405,432

Administration expenditure is expenditure incurred that is not a direct payment for the provision of healthcare or healthcare services. * The increase in expenditure in 2015/16 is because NHS Newham CCG was approved to take on delegated responsibility for the co-commissioning of GP services from the 1st April 2015. The new primary care co-commissioning arrangements are part of a series of changes set out in the NHS Five Year Forward View. The payments made and due to practices in 2015/16 under these arrangements are included in this figure. 6. Better Payment Practice Code

Measure of compliance 2015-16 2015-16 2014-15 2014-15 Number £000 Number £000

Non-NHS Payables

Total Non-NHS Trade invoices paid in the Year 9,429 53,229 8,759 47,332 Total Non-NHS Trade Invoices paid within target 8,815 48,147 8,272 40,182 Percentage of Non-NHS Trade invoices paid within target 93.49% 90.45% 94.44% 84.89% NHS Payables Total NHS Trade Invoices Paid in the Year 2,731 324,078 2,961 316,173 Total NHS Trade Invoices Paid within target 2,482 308,189 2,650 295,069 Percentage of NHS Trade Invoices paid within target 90.88% 95.10% 89.50% 93.33%


7. Operating expenses 7.1 As lessee 7.1.1 Payments recognised as an expense

2015-16 2014-15 Buildings Other Total Buildings Other Total £000 £000 £000 £000 £000 £000

Payments recognised as an expense

Minimum lease payments 2,782 7 2,789 2,285 9 2,294 Total 2,782 7 2,789 2,285 9 2,294

NHS Newham CCG occupied property owned and managed by Community Health Partnerships Limited and NHS Property Services Limited until Jan 2016. For 2015/16 (also 2014/15), a transitional occupancy rent based on annual property cost allocations was agreed, and is included in the minimum lease payments above. Whilst our arrangements with Community Health Partnership Limited and NHS Property Services Limited fall within the definition of operating leases, the rental charge for future years has not yet been agreed . Consequently this note does not include future minimum lease payments for this arrangement only. 7.1.2 Future minimum lease payments

2015-16 2014-15 Buildings Other Total Other £000 £000 £000 £000

Payable:

No later than one year 1,429 7 1,436 9 Between one and five years 7,980 35 8,015 9 After five years 9,426 0 9,426 0 Total 18,835 42 18,877 18

The future lease payments relate to the formal lease for Unex Tower. The CCG relocated the HQ from Warehouse K which was a NHS Property Service building with no formal lease in place for the CCG as a tenant. 8. Property, plant and equipment

2015-16 Plant &

machinery Information technology

Furniture & fittings Total

£000 £000 £000 £000 Cost or valuation at 01-April-2015 1,171 389 373 1,933 Additions purchased 769 62 609 1,440 Cost/Valuation at 31-March-2016 1,940 451 982 3,373 Depreciation 01-April-2015 278 113 143 534 Charged during the year 161 125 106 392 Depreciation at 31-March-2016 439 238 249 926 Net Book Value at 31-March-2016 1,501 213 733 2,447 Purchased 1,501 213 733 2,447 Total at 31-March-2016 1,501 213 733 2,447 Asset financing: Owned 1,501 213 733 2,447 Total at 31-March-2016 1,501 213 733 2,447


8.1 Property, plant and equipment

2014-15 Plant &

machinery Information technology

Furniture & fittings Total

£000 £000 £000 £000 Cost or valuation at 01-April-2015 1,171 333 265 1,769 Additions purchased 0 56 108 164 Cost/Valuation At 31-March-2016 1,171 389 373 1,933 Depreciation 1 April 2014 118 11 93 222 Charged during the year 160 102 50 312 Depreciation at 31 March 2015 278 113 143 534 Net Book Value at 31 March 2015 893 276 230 1,399 Purchased 893 276 230 1,399 Total at 31 March 2015 893 276 230 1,399 Asset financing: Owned 893 276 230 1,399 Total at 31 March 2015 893 276 230 1,399

8.2 Economic lives

Minimum Life (years) Maximum Life (Years) Transport equipment 5 10 Information technology 3 5 Furniture and fittings 5 10

9. Trade and other receivables

Current

2015-16 2014-15 £000 £000

NHS receivables: Revenue 669 771 NHS receivables: Capital 2,983 2,420 NHS prepayments 919 1,712 NHS accrued income 0 4 Non-NHS receivables: Revenue 83 612 Non-NHS prepayments 213 0 Non-NHS accrued income 5 2 VAT 4,872 5,521 Other receivables 4,872 5,521 Total Trade and other receivables 669 771 Total current and non-current 2,983 2,420

The great majority of trade is with NHS England as NHS England is funded by Government to provide funding to clinical commissioning groups to commission services, no credit scoring of them is considered necessary. 9.1 Receivables past their due date but not impaired

2015-16 2014-15 £000 £000

By up to three months 539 1,351 By three to six months 19 0 By more than six months 54 19 Total 612 1,370


£24,000 of the amount above has subsequently been recovered post the statement of financial position date. 10. Cash and cash equivalents

2015-16 2014-15 £000 £000

Balance at 01-April 98 218 Net change in year (58) (120) Balance at 31-March 40 98 Made up of: Cash with the Government Banking Service 40 98 Cash and cash equivalents as in statement of financial position 40 98

11. Trade and other payables

Current

2015-16 2014-15 £000 £000

NHS payables: revenue 15,153 15,818 NHS accruals 3,801 5,627 Non-NHS payables: revenue 11,294 4,442 Non-NHS payables: capital 40 56 Non-NHS accruals 23,357 17,859 Non-NHS deferred income 592 25 Social security costs 53 42 VAT Payable 0 29 Tax 70 55 Other payables 514 411 Total Trade & Other Payables 54,874 44,364 Total current and non-current 54,874 44,364

Other payables include £52,412 outstanding pension contributions at 31 March (2014-15 £40,319). 12. Provisions

Current

2015-16 2014-15 £000 £000

Other 1,683 1,683 Total 1,683 1,683

Total current and non-current 1,683 1,683 Other Other 2015-16 2014-15 £000s £000s

Balance at 01-April 1,683 753 Arising during the year 0 1,684 Utilised during the year 0 (733) Reversed unused 0 (21) Balance at 31-March 1,683 1,683

Expected timing of cash flows: Within one year 1,683 1,683 Balance at 31-March 1,683 1,683


Newham CCG have made a provision for exit costs for Warehouse K and Community House premises. The lease break for Warehouse K has been actioned and building has been decanted with the head office relocating to Unex Tower. The lease for Community House expires end May 2016, with liability of dilapidations falling to the CCG. NHS Property Services are yet to provide the full exit costs for both sites therefore the provision is rolled over to 2016/17. Under the Accounts Direction issued by NHS England on 12 February 2014, NHS England is responsible for accounting for liabilities relating to NHS Continuing Healthcare claims relating to periods of care before establishment of the clinical commissioning group. However, the legal liability remains with the CCG. The total value of legacy NHS Continuing Healthcare provisions accounted for by NHS England on behalf of NHS Newham CCG at 31 March 2016 is £676K. 12.1 Contingent liabilities There are no contingent liabilities that require disclosure in 2015/16 (nil in 2014-15). 13. Financial instruments 13.1 Financial risk management Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities. Because NHS Clinical Commissioning Group is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The clinical commissioning group has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the clinical commissioning group in undertaking its activities. Treasury management operations are carried out by the finance department, within parameters defined formally within the NHS Clinical Commissioning Group standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the NHS Clinical Commissioning Group and internal auditors. 13.1.1 Currency risk The NHS Clinical Commissioning Group is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The NHS Clinical Commissioning Group has no overseas operations. The NHS Clinical Commissioning Group and therefore has low exposure to currency rate fluctuations. 13.1.2 Interest rate risk The Clinical Commissioning Group borrows from government for capital expenditure, subject to affordability as confirmed by NHS England. The borrowings are for 1 to 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The clinical commissioning group therefore has low exposure to interest rate fluctuations. 13.1.3 Credit risk Because the majority of the NHS Clinical Commissioning Group and revenue comes parliamentary funding, NHS Clinical Commissioning Group has low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables from customers, as disclosed in the trade and other receivables note. 13.1.3 Liquidity risk NHS Clinical Commissioning Group is required to operate within revenue and capital resource limits, which are financed from resources voted annually by Parliament. The NHS Clinical Commissioning Group draws


down cash to cover expenditure, as the need arises. The NHS Clinical Commissioning Group is not, therefore, exposed to significant liquidity risks. 13.2 Financial assets

Loans and Receivables Loans and Receivables 2015-16 2014-15 £000 £000

Receivables:

· NHS 669 771 · Non-NHS 1,002 1,712 Cash at bank and in hand 40 98 Other financial assets 5 2 Total at 31-March-2016 1,716 2,583

13.3 Financial liabilities

Other Other 2015-16 2014-15 £000 £000

Payables:

· NHS 18,954 21,445 · Non-NHS 35,205 22,822 Total at 31-March-2016 54,159 44,267

14. Pooled budgets The NHS Newham CCG share of expenditure handled by the pooled budget in the financial year was:

2015-16 2014-15 £000 £000

Expenditure 4,046 0 On 1 April 2015 NHS Newham CCG entered into a section 75 pooled budget arrangements with London Borough of Newham. In line with IFRS11 joint control over the pooled funds exists. The CCG and the local authority have entered into commissioning arrangements whereby the risks and rewards of any contractual obligations remain with the respective commissioner holding the contract. All financial risks and rewards appropriate to the CCGs are included within the statement of comprehensive net expenditure. 15. Related party transactions 15.1 Related party transactions non-NHS 2015/16 The transactions listed below are in relation to interests declared, other than those relating to member general practices, Department of Health bodies, other government departments and central and local government bodies.

2015/16 Payments to Related Party

Receipts from Related Party

Amounts owed to Related Party

Amounts due from Related Party

£000 £000 £000 £000 Active Newham 51 0 0 0 Hinchingbrooke Health Care NHS Trust 11 0 7 0 Newham GP Co-Operative Ltd 1,041 0 153 0 Patientfirst Social Enterprise 1,555 0 343 0


Queen Mary University Of London 4 0 0 0 Richard House Trust 121 0 0 0 UCL Partners 18 (33) 0 21

Clinical commissioning groups are clinically led membership organisations made up of general practices. The members of the clinical commissioning group are responsible for determining the governing arrangements for their organisations, which they are required to set out in a constitution. The members of Newham Clinical Commissioning Group are contained within the constitution. Where payments have been made to these practices, these are listed below. The majority of the payments are in relation to agreed locally enhanced services and some prescribing costs.



Amounts owed to

Related Party

Amounts due from Related

Party £000 £000 £000 £000

Abbey Road Health Centre 40 0 0 0 Balaam Street Practice 24 0 0 0 Birchdale Road Medical Centre 17 0 0 0 Boleyn Medical Centre 44 0 15 0 Chalabi & Khan 31 0 0 0 Claremont Clinic 101 0 0 0 Custom House Surgery 51 0 16 0 DC Healthcare 1 9 0 0 0 DC Vicarage Lane 10 0 0 0 Dr Amshah & Partner Stratford Village Surgery 31 0 18 0 Dr Azad Practice Account 54 0 6 0 Dr Cm Patel 32 0 0 0 Dr Cap Raina & Dr A Arshad 56 0 3 0 Dr G Kugapala & Partner 57 0 0 0 Dr I Basu & Dr Ski Basu 26 0 0 0 Dr Kalhoro & Partner 35 0 0 0 Dr Kavita Gaur 2 0 0 0 Dr Knight 13 0 0 0 Dr N Bhadra Romford Rd 36 0 0 0 Dr Rb Gonsai 30 0 0 0 Dr Rg Higgins & Partners 99 0 8 0 Dr Rs Venugopal 7 0 0 0 Dr S Dhariwal Romford Road 5 0 0 0 Dr S Rafiq 104 0 0 0 Dr Samuel & Dr Khan 64 0 0 0 Dr Samuel Olatigbe & Parveen Akhtar 26 0 0 0 Dr Yi Patel & Partners 50 0 0 0 Drs Pr Dubal & N Patel 17 0 0 0 Drs Umrani & Qureshi 11 0 0 0 E12 Health Centre 161 0 68 0 East End Medical Centre 12 0 9 0 East Ham Medical Centre 28 0 0 0 Essex Lodge I Health 196 0 25 0 Glen Road Medical Centre 78 0 0 0


Graham Practice 147 0 25 0 Krishnamurthy Katherine Road 24 0 5 0 Lantern Health Chic 90 0 11 0 Lathom Road Medical Centre 26 0 10 0 Leytonstone High Road 11 0 0 0 Leytonstone Medical Centre 10 0 5 0 Liberty Bridge Road Practice 13 0 0 0 Lord Lister Health Centre Dr Abiola 15 0 0 0 Lord Lister Health Centre Dr Driver 101 0 18 0 Market Street Health Group 122 0 33 0 Newham Medical Centre 36 0 0 0 Plashet Medical Centre 16 0 0 0 Practice Albert Road 1 0 0 0 Prince Regent Lane 13 0 0 0 Project Surgery 32 0 0 0 Qureshi Stopford Rd 15 0 0 0 Royal Docks Medical Practice 83 0 0 0 Sangam GP Surgery 87 0 0 0 Shrewsbury Road Surgery 204 0 0 0 Sinha Medical Teaching Practice 16 0 0 0 St Bartholomews Surgery 97 0 0 0 St Lukes Health Centre 20 0 0 0 Star Lane Medical Centre 121 0 0 0 Stratford Health Centre 62 0 2 0 Stratford Village Surgery 10 0 10 0 Swedan Lord Lister Health Centre 17 0 0 0 Tollgate Medical Centre 87 0 0 0 Upper Road Medical Centre 42 0 4 0 Upton Lane Medical Centre 66 0 0 0 West Ham Medical Practice 19 0 8 0 Westbury Road Medical Practice 51 0 0 0 Woodgrange Medical Practice 89 0 25 0 Yesufu Summit Medical Practice 19 0 1 0

Related party transactions non-NHS 2014/15 The transactions listed below are in relation to interests declared, other than those relating to member general practices, Department of Health bodies, other government departments and central and local government bodies.



Amounts owed to

Related Party


Party

£000 £000 £000 £000 Essex Lodge I Health 184 (0) 15 0 First For Health Federation Ltd 128 (0) 0 0 Hinchingbrooke Health Care NHS Trust 10 (0) 1 0 Newham GP Co-Operative Ltd 1,052 (0) 373 0 Patientfirst Social Enterprise 1,405 (1) 6 0 Queen Mary University Of London 159 (0) 49 0


Richard House Trust 102 (0) 11 0 Royal College Of General Practitioners 1 (0) 0 0 SK Diabetes Services Ltd 1 (0) 0 0 UCL Partners 0 (69) 0 (19)

Clinical commissioning groups are clinically led membership organisations made up of general practices. The members of the clinical commissioning group are responsible for determining the governing arrangements for their organisations, which they are required to set out in a constitution.



Amounts owed to

Related Party


Party £000 £000 £000 £000 Abbey Road Health Centre 49 0 0 (2) Balaam Street Practice 32 0 0 0 Birchdale Road Medical Centre 10 0 0 0 Boleyn Medical Centre 18 0 0 0 Brohi Leytonstone Road 9 0 0 0 Chalabi & Khan 67 0 0 0 Claremont Clinic 84 0 0 0 Custom House Surgery 76 0 0 0 DMC Healthcare 15 0 1 0 DMC Healthcare 1 8 0 0 0 DMC Vicarage Lane 13 0 0 0 Dr Amshah & Partner Stratford Village Surgery

50 0 0 0 Dr Azad Practice Account 50 0 0 0 Dr CM Patel 24 0 1 0 Dr CP Raina & Dr A Arshad 40 0 3 0 Dr G Kugapala & Partner 38 0 0 0 Dr I Basu & Dr SK Basu 25 0 3 0 Dr I Inayatullah 20 0 0 0 Dr Kalhoro & Partner 42 0 0 0 Dr Knight 41 0 0 (1) Dr N Bhadra Romford Rd 30 0 0 0 Dr P C L Knight 17 0 0 0 Dr RB Gonsai 22 0 2 0 Dr RG Higgins & Partners 51 0 5 0 Dr RS Venugopal 12 0 2 0 Dr S Dhariwal Romford Road 12 0 0 0 Dr S Rafiq 67 0 21 0 Dr Samuel & Dr Khan 56 0 0 0 Dr YI Patel & Partners 84 0 0 0 Drs PR Dubal & N Patel 39 0 0 0 Drs Umrani & Qureshi 16 0 0 0 E12 Health Centre 110 0 0 0 East End Medical Centre 5 0 0 0 East Ham Medical Centre 23 0 0 0 Glen Road Medical Centre 81 0 2 0 Graham Practice 111 0 23 0


Katherine Road Medical Centre 8 0 0 0 Krishnamurthy Katherine Road 16 0 0 0 Lantern Health CIC 86 0 4 0 Lathom Road Medical Centre 12 0 0 0 Leytonstone High Road 8 0 0 0 Liberty Bridge Road 9 0 0 0 Lord Lister Health Centre Dr Abiola 31 0 1 0 Lord Lister Health Centre Dr Driver 49 0 0 0 Market Street Health Group 143 0 27 0 Newham Medical Centre 44 0 0 0 Practice Albert Road 13 0 0 0 Prince Regent Lane 26 0 0 0 Project Surgery 27 0 0 0 Qureshi Stopford Rd 19 0 0 0 Royal Docks Medical Practice 50 0 0 0 Sangam GP Surgery 60 0 0 0 Shrewsbury Road Surgery 176 0 4 0 Sinha Medical Teaching Practice 10 0 0 0 St Bartholomews Surgery 82 0 0 0 St Lukes Health Centre 21 0 1 0 Star Lane Medical Centre 100 0 9 0 Stratford Health Centre 57 0 2 0 Swedan Lord Lister Health Centre 20 0 0 0 Tollgate Medical Centre 97 0 0 0 Upper Road Medical Centre 38 0 1 0 Upton Lane Medical Centre 54 0 0 0 West Ham Medical Practice 31 0 0 0 Westbury Road Medical Practice 49 0 0 0 Woodgrange Medical Practice 23 0 0 0 Yesufu Summit Medical Practice 13 0 0 0

15.2 Related party transactions NHS and other government 2015/16 The Department of Health is regarded as a related party. During the year NHS Newham CCG has had a significant number of material transactions with entities for which the Department of Health is regarded as the parent department, and NHS England the parent entity. Those organisations where either income or expenditure was greater than £250k are disclosed below:

2015/16 Payments

to Related

Party

Receipts from

Related Party

Amounts owed to Related

Party

Amounts due from

Related Party

£000 £000 £000 £000 Barking, Havering & Redbridge University Hospitals NHS Trust 3,680 0 2 0 Barts Health NHS Trust 179,092 (25) 3,389 (2109) Basildon & Thurrock University Hospitals NHS Foundation Trust 268 0 147 0 Chelsea And Westminster Hospital NHS Foundation Trust 508 0 112 0 East London NHS Foundation Trust 88,408 (6) 1,482 3 Great Ormond Street Hospital NHS Foundation Trust 479 0 0 (121) Guy's & St Thomas' NHS Foundation Trust 2,612 0 134 0 Homerton University Hospital NHS Foundation Trust 6,218 (158) 1,811 (19) Imperial College Healthcare NHS Trust 886 0 257 0 King's College Hospital NHS Foundation Trust 644 0 502 0


2015/16 Payments

to Related

Party

Receipts from

Related Party


Party

Amounts due from

Related Party

Lewisham & Greenwich NHS Trust 552 0 415 0 London Ambulance Service NHS Trust 11,184 0 269 0 London North West Healthcare NHS Trust 374 0 32 0 Moorfields Eye Hospital NHS Foundation Trust 4,103 (55) 44 (32) NHS England 2,465 (68) 1,258 (46) NHS North & East London CSU 3,902 (231) 521 0 NHS Tower Hamlets CCG 765 (416) 559 (408) NHS Waltham Forest CCG 1,248 (183) 1,373 (24) North East London NHS Foundation Trust 821 0 257 0 North Middlesex University Hospital NHS Trust 334 0 71 0 Royal Brompton & Harefield NHS Foundation Trust 314 0 107 0 Royal Free London NHS Foundation Trust 915 0 296 0 Royal National Orthopaedic Hospital NHS Trust 689 0 23 (100) St George's University Hospitals NHS Foundation Trust 277 0 125 0 University College London Hospitals NHS Foundation Trust 4,080 0 44 (576) Community Health Partnerships 285 0 0 0 NHS Property Services 1,651 0 251 0

In addition, NHS Newham CCG has had a number of material transactions with other government departments and other central and local government bodies. Most of these transactions have been with local authorities.

2015/16

Payments to

Related Party

Receipts from

Related Party

Amounts owed to Related Party

Amounts due from

Related Party

£000 £000 £000 £000 HM Revenue and Customs 389 0 123 (213) National Health Service Pension Scheme 315 0 52 0 Newham London Borough Council 3,514 (1850) 10,872 (516)

Related party transactions NHS and other government 2014/15 The Department of Health is regarded as a related party. During the year NHS Newham CCG has had a significant number of material transactions with entities for which the Department of Health is regarded as the parent department, and NHS England the parent entity. Those organisations where either income or expenditure was greater than £250k are disclosed below:

2014/15

Payments to

Related Party

Receipts from

Related Party


Party

Amounts due from

Related Party

£000 £000 £000 £000 Barking Havering And Redbridge Hospitals NHS Trust 4,387 0 0 0 Barts Health NHS Trust 171,195 (2) 12,418 (2087) Basildon & Thurrock University Hospitals NHS Foundation Trust 251 0 62 0 Chelsea And Westminster Hospital NHS Foundation Trust 338 0 54 0 Community Health Partnerships 0 0 322 0 East London NHS Foundation Trust 90,670 (2) 456 (30) Great Ormond Street Hospital NHS Foundation Trust 653 0 0 (105) Guys & St Thomas Hospital NHS Foundation Trust 2,307 0 499 0


2014/15

Payments to

Related Party

Receipts from

Related Party


Party

Amounts due from

Related Party

Homerton University Hospital NHS Foundation Trust 3,863 (25) 862 (25) Imperial College Healthcare NHS Trust 672 0 264 (11) King`s College Hospital NHS Foundation Trust 602 0 266 0 Lewisham & Greenwich NHS Trust 363 0 244 0 London Ambulance Service NHS Trust 10,924 0 510 0 Mid Essex Hospitals Services NHS Trust 266 0 0 (91) Moorfields Eye Hospital NHS Foundation Trust 3,874 (22) 126 (22) NHS England 2,383 (179) 595 (66) NHS Lambeth CCG 261 (29) 0 (1) NHS North And East London CSU 4,956 (272) 540 (73) NHS Property Services Ltd 3,078 0 251 0 NHS Tower Hamlets CCG 730 (435) 281 (274) North East London NHS Foundation Trust 470 0 45 0 Royal Free London NHS Foundation Trust 655 0 363 0 Royal National Orthopaedic Hospital NHS Trust 846 0 6 (93) University College London Hospitals NHS Foundation Trust 3,814 0 1,133 (33) Whittington Hospital NHS Trust 301 0 28 (2)

In addition, NHS Newham CCG has had a number of material transactions with other government departments and other central and local government bodies. Most of these transactions have been with local authorities.

Payments to Related

Party

Receipts from

Related Party


Party

Amounts due from Related Party

£000 £000 £000 £000 London Borough Of Newham 10,160 (1992) 3,519 (1648) National Health Service Pension Scheme 231 0 40 0 HM Revenue and Customs 290 0 126 0 15.3 Related party transactions primary care co-commissioning 2015/16 Newham CCG was approved to take on delegated responsibility for the co-commissioning of GP services from the 1st April 2015. The new primary care co-commissioning arrangements are part of a series of changes set out in the NHS Five Year Forward View. The payments made to practices in 2015/16 under these arrangements are shown below. Accrued payments to these practices, although included in Newham CCG's 2015/16 operating expenses (Note 5), are not shown at individual practice level as the data has not been provided to the CCG.

Payments to

Related Party

Receipts from

Related Party


Party

Amounts due from

Related Party

£000 £000 £000 £000 Abbey Road Medical Practice 882 0 0 0 Balaam Street Practice 727 0 0 0 Barking Road Medical Centre 309 0 0 0 Birchdale Road Medical Centre 351 0 0 0 Boleyn Medical Centre 1,405 0 0 0 Boleyn Road Practice 669 0 0 0


Payments to

Related Party

Receipts from

Related Party


Party

Amounts due from

Related Party

Claremont Clinic 1,205 0 0 0 Cumberland Medical Centre 419 0 0 0 Custom House Surgery 1,600 0 0 0 DMC Healthcare 1 96 0 0 0 DMC Vicarage Lane 613 0 0 0 Dr Cm Patel 210 0 0 0 Dr CP Raina 418 0 0 0 Dr N Driver & Partners 677 0 0 0 Dr NB Bhadra 452 0 0 0 Dr PCL Knight 537 0 0 0 Dr Pi Abiola 409 0 0 0 Dr R Samuel & Partner 753 0 0 0 Dr S Qureshi 186 0 0 0 Dr SKS Swedan 317 0 0 0 Dr T Krishnamurthy 192 0 0 0 Dr T Lwin 529 0 0 0 E12 Health 1,318 0 0 0 E12 Medical Centre 441 0 0 0 East End Medical Centre 699 0 0 0 East Ham Medical Centre 313 0 0 0 Esk Road Medical Centre 271 0 0 0 Essex Lodge 1,165 0 0 0 Glen Road Medical Centre 771 0 0 0 Greengate Medical Centre 874 0 0 0 Katherine Road Medical Centre 129 0 0 0 Lantern Health Carpenters Road 1,639 0 0 0 Lathom Road Medical Centre 493 0 0 0 Leytonstone Road Medical Centre 359 0 0 0 Liberty Bridge Road Practice 1,011 0 0 0 Manor Park Medical Centre E12 5aj 212 0 0 0 Market Street Health Group 1,502 0 0 0 Newham Medical Centre 774 0 0 0 Newham Transitional Prim Care Team 696 0 0 0 Plashet Road Medical Centre 380 0 0 0 Royal Docks Medical Practice 1,037 0 0 0 Sangam Surgery 776 0 0 0 Sinha Medical Centre 947 0 0 0 Star Lane Medical Centre 1,980 0 0 0 St Bartholomew’s Surgery 1,153 0 0 0 Stratford Health Centre 843 0 0 0 Stratford Village Surgery 1,136 0 0 0 The Azad Practice 783 0 0 0 The Graham Practice 1,396 0 0 0 The Practice Albert Road 770 0 0 0 The Project Surgery 483 0 0 0 The Ruiz Medical Practice 333 0 0 0 The Shrewsbury Centre 1,577 0 0 0 The Summitt Practice 247 0 0 0 Tollgate Medical Centre 2,004 0 0 0 Upper Road Medical Centre 345 0 0 0


Payments to

Related Party

Receipts from

Related Party


Party

Amounts due from

Related Party

Upton Lane Medical Centre 934 0 0 0 West Ham Medical Practice 309 0 0 0 Westbury Road Medical Practice 415 0 0 0 Woodgrange Medical Practice 1,402 0 0 0 NHS Property Services 83 0 0 0

16. Financial performance targets NHS Newham CCG has a number of financial duties under the NHS Act 2006 (as amended). NHS Newham CCG performance against those duties was as follows:

2015-16 2015-16 2015-16 2014-15 2014-15 2014-15 Target Performance Achieved Target Performance Achieved £000 £000 £000 £000 £000 £000 Expenditure not to exceed income 482,727 476,163 Y 418,560 405,599 Y Capital resource use does not exceed the amount specified in directions 1,487 1,440 Y 175 166 Y Revenue resource use does not exceed the amount specified in Directions 477,852 471,334 Y 415,395 402,443 Y Revenue administration resource use does not exceed the amount specified in directions 7,284 7,266 Y 8,369 8,313 Y

17. Losses and special payments There are no losses or special payments that require disclosure in 2015/16 (nil in 2014-15). 18. Events after the end of the reporting period Primary care co-commissioning delegated CCGs 2016/17 NHS England recently announced details of the Clinical Commissioning Groups approved to take on greater delegated responsibility or to jointly commission GP services from 1 April 2016. The new primary care co-commissioning arrangements are part of a series of changes set out in the NHS Five Year Forward View. Newham CCG has been approved under delegated commissioning arrangements which mean that the CCG will assume full responsibility for contractual GP performance management, budget management and the design and implementation of local incentive schemes from 1 April 2016.

Newham CCG 4th Floor, Unex Tower

Station Street Stratford

London E15 1DA Tel: 020 3688 2300

Email: [email protected] Web: www.newhamccg.nhs.uk Twitter: @NHSNewhamCCG

mailto:[email protected]

http://www.newhamccg.nhs.uk/

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