annual report and accounts 2013/14 · new health system. ... elr ccg was created in shadow form in...

Annual Report

and Accounts

2013/14 (Version 11, 2.6.2014)

East Leicestershire and Rutland CCG Annual Report 2013/14 2

Version Version Date

Versions1 - 7 Various iterations through the development of the report.

2 April 2014 –

22 April 2014

Version 8 Version prepared for draft submission on 23rd April 2014 following discussion with Corporate Management Team and members of the Audit Committee.

23 April 2014

Version 9

Revisions included: revised remuneration report; revised governance statement and an updated register of declarations.

6 May 2014

Version 10

Amendments made following Audit Committee meeting in May 2014.

Members introduction produced and approved by GP locality leads).

27 May 2014

Version 11 Feedback from the External Auditors and the Area Team taken into consideration in the revised version.

Review of content and aligned to guidance. Remuneration Report and Governance Statement updated further. Version presented to the Audit Committee for comments and approval on 2 June 2014.

30 May 2014

Version 11 Further feedback from the Audit Committee incorporated into this version.

2 June 2014


Contents

Foreword 4 Member Practices’ Introduction 5 Strategic Report 10 Members of the Governing Body Report 40 Remuneration Report 62

Statements by the Accountable Officer:

o Statement of Accountable Officer’s Responsibilities 70

o Governance Statement 71


ANNUAL REPORT

Foreword Welcome to this, the first Annual Report of East Leicestershire and Rutland Clinical Commissioning Group in our first full year since our authorisation. The last year has been a challenging one for all those staff involved in organising and delivering health care to the population of Leicestershire and Rutland. It is in this context that we are pleased that the clinical commissioning group has been able to implement a number of changes to enhance services. We also have ambitious plans for how we want to continue to improve the healthcare for everyone in the area, which is contained in our Two Year Operational Plan. Our Annual Report reviews the past year and highlights the areas of both progress and the future challenges we face in East Leicestershire and Rutland (ELR) and we commend it to you. We hope that you find it informative and we welcome any feedback you may have.

Dr Dave Briggs Mr Graham Martin Managing Director Chair


Member Practices’ Introduction This is our first Annual Report as a Clinical Commissioning Group (CCG) and as we look back on 2013/14 we can take a great deal of pride in the progress we have made as a CCG, acknowledging we faced a number of challenges in 2013/14 which we are committed to working to resolve with our providers. NHS East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) was authorised in full without conditions and therefore became fully operational as a statutory body from 1 April 2013. The implementation of the Health and Social Care Act 2012 commenced on 1 April 2013 and clinical commissioning groups (CCGs) are now the cornerstone of the new health system. Every GP practice in England is now part of a CCG. There are 211 CCGs, each commissioning care for an average of 226,000 people. ELR CCG was created in shadow form in 2011 and from the outset established a strong position in the management of local healthcare. In April 2012, we took on delegated budgetary responsibility from the Leicestershire County and Rutland PCT and became responsible for commissioning decisions, with the NHS Leicestershire County and Rutland Primary Care Trust retaining statutory obligations until ELR CCG was authorised. The Primary Care Trusts were abolished in April 2013 and ELR CCG took on full responsibility for commissioning healthcare services for residents in Blaby, Lutterworth, Market Harborough, Rutland, Melton Mowbray, Oadby and Wigston and the surrounding areas. In East Leicestershire and Rutland, we serve 315,000 people across our 34 Member Practices covering a very diverse region from some of the most rural parts of the UK to socially deprived suburbs bordering Leicester. Each practice area faces its own particular challenges. As members we need to reflect the diversity of our area and ensure the CCG is aware of differing health needs. Our Member Practices are: Blaby and Lutterworth locality Countesthorpe Health Centre Central Street, Countesthorpe Leicestershire, LE8 5QJ.

Wycliffe Medical Practice Gilmorton Road Lutterworth Leicestershire LE17 4EB

Kingsway Surgery 23 Kingsway Narborough Rd South Leicester, LE3 2JN

The Limes Medical Centre 65 Leicester Road Narborough Leicestershire, LE19 2DU

Glenfield Surgery 111 Station Road Glenfield Leicestershire, LE3 8GS.

Forest House Medical Centre 2a Park Drive Leicester Forest East Leicester, LE3 3FN

Northfield Medical Centre Villers Court, Blaby Leicestershire, LE8 4NS

Hazelmere Medical Centre 58 Lutterworth Road Blaby Leicester, LE8 4DN

Narborough Health Centre Thornton Drive, Narborough Leicestershire, LE19 2GX.

The Masharani Practice Gilmorton Road, Lutterworth Leicestershire, LE17 4EB.

Enderby Medical Centre Shortridge Lane, Enderby Leicestershire, LE19 4LY.


Melton, Rutland and Harborough locality Kibworth Health Centre Smeeton Road Kibworth Leicestershire, LE8 0LG

Market Harborough Medical Centre 67 Coventry Road Market Harborough Leicestershire, LE16 9BX

Oakham Medical Practice Cold Overton Road Oakham Rutland LE15 6NT.

Market Overton Surgery (& Somerby) Thistleton Road, Market Overton Oakham LE15 7PP

Long Clawson Medical Practice Long Clawson, Nr Melton Mowbray Leicestershire LE14 4PA

Billesdon Surgery 4 Market Place, Billesdon Leicestershire LE7 9AJ

Dr Kilpatrick & Partners 2a Station Road Kibworth Leicestershire LE8 0LN

Latham House Medical Practice Sage Cross Street Melton Mowbray Leicestershire LE13 1NX

The County Practice Syston Health Centre Melton Road, Syston Leicestershire LE7 2EQ

Empingham Medical Centre Main Street, Empingham Oakham, Rutland LE15 8PR

The Uppingham Surgery Northgate Uppingham Rutland LE15 9EG

The Jubilee Medical Practice 1330 Melton Road Syston Leicestershire LE7 2EQ

Husbands Bosworth Surgery Kilworth Road Husbands Bosworth Leicestershire LE17 6JZ

Oadby & Wigston Walk in Medical Centre 18 The Parade Oadby Leicester LE2 5BJ

Oadby and Wigston locality Bushloe End Surgery 48 Bushloe End Wigston, Leicester LE18 2BA

Central Surgery Brooksby Drive, Oadby Leicester LE2 5AA

Rosemead Drive Surgery 103 Rosemead Drive Oadby, Leicestershire, LE2 5PP.

The Croft Medical Centre 2 Glen Road, Oadby Leicestershire LE2 4PE

Wigston Central Surgery 48 Leicester Road Wigston Leicestershire LE18 1DR

South Wigston Health Centre 80 Blaby Road South Wigston Leicestershire LE18 4SE

Long Street Surgery 24 Long Street, Wigston Leicester LE18 2AH

Severn Surgery 159 Uplands Road Oadby Leicestershire, LE2 4NW

Station Road Surgery 152 Station Road Wigston Leicester LE18 2BL.

As members, we are not only part of the management structure of the CCG but also practicing GPs, seeing patients and their families regularly and are therefore able to see the health and social care system from their viewpoint, seeing powerful ‘case histories’ on an almost daily basis.


This gives us a unique insight and helps us inform the CCG to see particular areas of concern as it develops health services, and therefore help the CCG commission the right services and the right care pathways that patients require. The run up to the CCG’s accreditation engagement with practices was a cornerstone of the development of East Leicestershire and Rutland CCG’s vision, values and strategic objectives and this has continued throughout 2013/14. We know we live in challenging times for health and social care. We have a population which is increasingly living longer and year on year we are seeing higher numbers of people with increasingly complex health needs. The imperative to deliver integrated health and social care packages for people has never been greater. Our vision to meet this challenge is quite clear: “to improve health by meeting our patients’ needs with high quality and efficient services, led by clinicians, in partnership with patients and carers, delivered closer to home”. Throughout 2013/14 we have focussed on starting to transform services to enhance the quality of life for people with long-term conditions, improving quality of care, reducing inequalities in access to healthcare and improving joint working and integration with social care. A lot of focus has been on secondary care particularly following the Francis Report and the Keogh mortality review. Locally there has been a lot of focus on accident and emergency performance but there is also a marked pressure on primary care services as well. It is incumbent on all parts of the health and social care system to provide high quality care at every patient and service user touch point. The year has not been without its challenges. All three of our major providers have faced challenges in respect of their performance or quality of care. Issues with accident and emergency at University Hospitals of Leicester NHS Trust (UHL) has been well publicised and reached a peak in February 2014 with ambulances waiting with patients outside. Partners across all NHS organisations as well as social care partners are working together to ensure that improvement takes place. In September 2013 Leicestershire Partnership NHS Trust (LPT) was challenged by the Care Quality Commission (CQC) for provision on some wards at the adult mental health unit with enforcement notices issued to LPT. ELR CCG were one of the health and social care partners who contributed to the Trust’s quality improvement plan which led to the lifting of the enforcement notices but the quality improvement plan is still in place. The East Midlands Ambulance Service NHS Trust (EMAS) was also inspected by the CQC and found it had not achieved four out of six national standards. As commissioners we have been working alongside EMAS to help them address the issues they face and since the CQC report we know progress has been made. ELR also has responsibility for managing non-urgent transport for patients which is currently delivered by Arriva, and as an organisation we imposed a contract penalty in its first year of operation. Throughout the year we have been meeting regularly with Arriva to discuss issues which may be affecting its performance, as well as


ensuring it has in place appropriate action plans to achieve its targets and we look forward to improvements in 2014/15. Towards the end of the year Leicester, Leicestershire and Rutland was named as one of 11 challenged health economies – LLR faced a funding challenge of £291m by 2019. At East Leicestershire and Rutland we have recognised this over the past year and will be doing so in the future as we work together with health and social care providers as part of the Better Care Together programme. Over the next two years we will work even more closely with our clinicians, patients, members of the public, local authority partners, neighbouring CCGs and stakeholders to deliver our challenging plans. There are numerous ways in which the member practices have engaged with the CCG: there have been monthly meetings for each of our three localities areas, where a representative GP from each practice attends for clinical and commissioning discussions, there is also a monthly practice managers’ meeting where more business discussions take place. Furthermore the CCG has organised quarterly formal learning time events, where practice staff, nurses and GPs can benefit from dedicated ‘time outs’ to look at best practice, learn from each other and take that learning back to their practices to improve quality of care to their patients. At a time where there is increasing pressure on primary care, it is important for the member practices to be able to give our views on service delivery and current primary care issues, as well as to consult on the future commissioning intentions and provide challenge about both provider performance and CCG performance. To understand these views the CCG undertook quality and engagement visits with each of the practices between October and December 2013 and the outputs from these meetings have influenced the CCG commissioning intentions and operational plans for 2014 onwards, while informing the CCG contract leads of any provider issues and concerns. These practice visits were conducted by GP Board members as well as one of the corporate management team and were very well attended by a wide variety of staff in each practice, and saw in-depth discussions and challenge. In January 2013, we were able to respond to a survey in relation to these visits. All practices felt the practice visits were either very useful or useful and were inclusive to all practice staff, with all visits being both clinically and quality focussed. The results of this survey showed that a large proportion of the practices, 88%, felt that they are now more informed about the role of the CCG and 84% of practices found the information / data provided was useful or somewhat useful, however practices felt that some of it was out of date and sometimes incomplete. Member practices also said that more time was needed to discuss issues and that more feedback would be helpful from the issues raised. The process has provided valuable feedback and suggestions, with room for improvements in 2014/15. As GPs and as members of the Governing Body we constantly challenge ourselves and staff within the CCG about the effectiveness of our policies and our care. At the time of writing we had just received the results of the 360 degree stakeholder


feedback and will be using that as a mechanism to see the views of our member practices and a wider stakeholder group. Our organisational development plans are already starting to increase our effectiveness as an organisation and as we entered the new financial year had strengthened our capacity for clinical leadership by appointing two new clinical vice chairs. We as members feel that we have been very proactive in helping to shape care pathways not only in the ELR area but also across Leicester, Leicestershire and Rutland. We have had a pivotal role for example in shaping the Better Care Together programme work streams which will see care pathway development and Integrated care.

We are looking forward to working alongside our health and social care partners over the coming year to make a real difference for our patients and their families and carers.

Dr Hamant Mistry Clinical Vice Chair, GP Locality Lead Melton, Rutland and Harborough

Dr Andy Ker GP Locality Lead, Melton, Rutland and Harborough

Dr Richard Hurwood GP Locality Lead, Melton, Rutland and Harborough

Dr Graham Johnson GP Locality Lead, Blaby and Lutterworth

Dr Richard Palin GP Locality Lead, Oadby and Wigston

Dr Nick Glover GP Locality Lead, Blaby and Lutterworth


Strategic Report

The nature, objectives and strategies of the CCG

East Leicestershire and Rutland CCG (ELR CCG) successfully achieved authorisation with no conditions in the first of four authorisation waves in December 2012 in anticipation of the start of the Health and Social Care Act 2013. In the year leading up to authorisation, the CCG had been running in shadow form with delegated authority from the Leicester, Leicestershire and Rutland PCT Cluster and became a statutory body on 1 April 2013 along with 211 other CCGs

East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) now operates from its office at Thurmaston in Leicester and employed 77 staff as at end March 2014. The CCG consists of 34 member General Practices that work together to plan and design local health services. We do this by 'commissioning' or buying health and care services including:

• Planned hospital care • Urgent and emergency care • Rehabilitation care • Community health services • Non-urgent patient transport

We work with patients and health and social care partners (other CCGs, local hospitals and health providers, local authorities, local community groups) to ensure services meet local needs. We are responsible for arranging emergency and urgent care services within their boundaries, and for commissioning services for any unregistered patients who live in their area. All General Practices belong to a Clinical Commissioning Group. We work collaboratively with our partner CCGs in Leicester City and West Leicestershire to ensure continuity of care for everyone across Leicester, Leicestershire and Rutland.

Our vision, values and strategic aims are based on the views of our member practices, clinicians, our patients and carers, our staff and partner organisations. We have spent time talking and listening to people about the changes they would like to see in local healthcare and where we should be focusing our efforts. The broad themes that stood out in what people told us are:

• care delivered closer to home including access to services in patients’ own homes and other alternatives to hospital admissions

• closer working with social care to improve care pathways

• more work on prevention (reducing diseases through screening, advice and health checks)

• better quality and more effective services.


Taking into account these themes, we developed the following strategic aims:

• Transform Services and enhance quality of life for people with long-term conditions With a particular focus on COPD, diabetes, dementia, mental health and learning disabilities

• Improve the quality of care Focusing on clinical effectiveness, safety and patient experience, with specific goals to deliver excellent community health services and improve the quality of primary care

• Reduce inequalities in access to healthcare Targeting areas and population groups with the greatest need

• Improve integration of local services Between health and social care and between acute and primary/community care

• Listening to our patients and public Our commitment is to listen, and to act on, what our patients and public tell us

• Living within our means The effective use of public money.

The CCG’s vision and values are based on ethical, open and transparent behaviour and all business practices follow this approach. Organisational vision and values half-day sessions took place during November 2013 and December 2013 which led


to an organisational time-out event on 20th December 2013. The time-out event provided an opportunity for staff and officers to reflect on the CCG's visions and values and successes over the past year. These visions and values are communicated to staff on commencement in post and office holders receive contract / terms of office from HR which detail staff code of conduct and behaviour expected and the consequences of non-compliance.

Our population, the communities we serve and their health needs

The majority of the population in Leicestershire and Rutland are white British (89.4%) compared with an England average of 83.6%. The main minority ethnic groups in Leicestershire and Rutland are Asian or Asian British (4.9%) with Indian being the most significant community (3.6%) and other white, including Irish (2.6%).

The average life expectancy within East Leicestershire and Rutland is 80 years for men, and 83.9 years for women, both of which are higher than the England average. In 2011 there were 2,628 deaths of people registered with East Leicestershire and Rutland GPs, 735 of these were premature (i.e., before the age of 75). Among the premature deaths, the highest percentage was from cancer (47%), followed by cardiovascular diseases (24%), and respiratory disease (8%). Figure 1: Population of East Leicestershire and Rutland by Age:

In all, 50.6% of our population is female, which is similar to the England average of 50.2%. Almost a quarter of the population (23.7%) of East Leicestershire and Rutland is under the age of 20, and around a further quarter are aged 60 and over (25.7%)1. The number of people aged 60 and over is higher than the England average (22.3%), and our older population is predicted to increase over the next 10 years, with an estimated 31,500 additional people aged 60 years and over; 7,500 of this population will be aged over 85 years. The latest population projections (from 1 Source: 2011 census

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30-34

45-49

60-64

75-79

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2011 Female England

2011 Female East Leicestershire and Rutland CCG

2011 Male England

2011 Male East Leicestershire and Rutland CCG


the 2011 census) clearly show that East Leicestershire and Rutland has an ageing population. The health of our local population is generally better than the overall population of England. However, there is a significant number of people affected by ill health, including GP diagnosed coronary heart disease (10,837 people), hypertension (46,917 people), and diabetes (16,145 people). Accounting for 73% of all deaths, the major killers for East Leicestershire and Rutland CCG are:

• cancer (31%)

• cardiovascular disease – CVD - (29%)

• respiratory disease (12%). High numbers of people are affected by the major risk factors for ill health. In 2009/2010 it was estimated that 18.4% (47,500) of adults in East Leicestershire and Rutland are smokers, and 18.3% (47,200) binge drink alcohol. The CCG currently has high levels of non-elective activity when benchmarked against similar health economies. Without a focused approach and active intervention, the ageing population will increase the gap between expected and actual activity. Elective activity is consistent with the national average. ELR CCG consists of GP membership from 34 practices in Melton, Rutland, Market Harborough, Blaby District, Oadby and Wigston, Lutterworth and surrounding areas. We serve a registered population of around 315,000 patients, over 35,000 of whom live in neighbouring areas. Illustrated below is the location of general medical practices and the registered general practice population of each locality across our CCG. Around 46,500 patients, who live in East Leicester and Rutland, are registered with GPs in either Leicester City or other parts of Leicestershire or surrounding areas.


Figure 2: Distribution of ELR CCG GP practices

Figure 3: Proportion of residents registered to East Leicestershire and Rutland CCG


Our priorities in 2013/14 Older people In 2011, there were approximately 81,700 people aged over 60 in East Leicestershire and Rutland, and 16,700 aged over 80. The population aged over 60 is estimated to increase by around 60% by 2030. Around 14,000 of the population aged over 75 lived alone in 2010. This number is predicted to rise to 26,200 by 2030, an increase of 87%.2 In 2010 there was an estimated 25,400 people over the age of 65 with a limiting long-term illness. By 2030, this is predicted to increase to around 42,900, an increase of 69%. The 2009 Joint Strategic Needs Analysis (JSNA) noted particular increases in dementia (63% by 2025), and hypertension (17% by 2020). Over the past year we have developed care pathways for frail and elderly people and those with long term conditions and will continue to do so over the coming year, seeing more integration of social and healthcare services. Dementia In 2010 there were estimated to be around 4,200 people over 65 in East Leicestershire and Rutland with dementia. By 2030, the number is estimated to more than double to around 8,510 people3. As advocated by the National Audit Office in their value for money report 2007, investment in improved and expanded dementia care management, incorporating earlier diagnosis, is essential to increase the quality of lives for patients and carers, the quality, effectiveness and experience of care, and to reduce both healthcare and societal costs. We have implemented an enhanced service across primary care to improve timely diagnosis and treatment of people with dementia, and we are working with local authority partners and providers to improve and expand dementia care management, while developing a shared dementia pathway and dementia hub. Respiratory disease Respiratory disease is a major cause of ill health, being the third leading cause of death in England after circulatory disease and cancer. It is also one of the principal reasons for emergency admissions to hospital and, as a result, it accounts for a substantial proportion of NHS expenditure. In England, around 23,000 people die from chronic obstructive airways disease (COPD) each year, equivalent to one death every 20 minutes. Acute exacerbation of COPD is itself a high-mortality condition: 15% of those admitted to hospital with COPD die within three months which is higher than the rate for acute myocardial infarction at 13%.

2 2012 JSNA refresh – ELR summary

3 JSNA 2012 refresh, ELR summary


Our work alongside Leicestershire Partnership NHS Trust respiratory nurse specialists is proving successful as they work with GPs and practice nurses to promote best practice in the management COPD. Primary care Evidence shows that there are significant pressures in primary care. There is an increased patient expectation, attendances have gone up 75% since 1998, and there has been a slow drift of work from secondary care and community care, which has put added pressure on staff time and resources. Our work throughout 2013/14 is helping primary care to be at the fore of the changes required to achieve our strategic aims. We have encouraged and supported general practice to come together with new systems of joint working to enable primary healthcare teams to have more time to proactively manage patients with multiple illnesses, at the end of their lives, in care homes or at risk of admission. To assist in the monitoring of key primary care information including prescribing, an individual practice level profile has been developed for all 34 practices over the past year. These formed the basis of the CCG formal practice visits in 2013. There will be a continued commitment to annual clinical visits to practices to inform our future commissioning intentions and to assure the CCG that practices are following best practice guidelines. Mental health and learning disabilities We have continued to work with our mental health providers, clinicians and service users to improve our acute mental healthcare pathway. This is so that we can improve the care provided for mental health service users in the community that promotes independence and enables individuals to be part of their communities. In times of crisis and when patients require admission to inpatient care we want to ensure that they receive high quality care that promotes recovery within safe settings. During 2013/14 we re-procured our Improving Access to Psychological Therapies (IAPT) service in partnership with West Leicestershire CCG, and committed additional investment in order to improve access to the service and to maintain our recovery rates. In the coming year we will work with local authority partners in the development and implementation of short breaks for people with learning disability that best suits the needs of our patients. Community care The CCG’s and partners’ plans for reshaping community health services are a central element of our overall plans. The use of the Better Care Fund (BCF) is a key driver of these plans, particularly with respect to integration with local authority providers to realise seven-day service ambitions.


The physical setting, from where healthcare is delivered is a critical consideration in respect of the range, accessibility and affordability of services. ELR CCG has adopted an approach that considers the setting of care services alongside the other components of service planning and delivery. This will enable us to deliver a sustainable community-based provision that reduces reliance on a bed-based model. Maternity, children and young people services Children and their families have been an important priority for the CCG in 2014/15 as we continue our Integrated Plan 2012-2015. Over the last few years we have seen an increase in the number of births and an increase in complexity. Although we have better than average or average rates of perinatal and infant mortality, as well as teenage pregnancy, it is widely accepted that we have pockets of deprivation where these rates are significantly higher. This high level of need results in a greater demand on maternity and neonatal services. A review of Maternity Services was undertaken in 2012/13 on behalf of all three LLR CCGs. Despite facing a number of issues maternity services are safe and are providing good standards of care. It also identified four key priorities and these will be taken forward in 2014/15. The population of children and young people with health-related conditions that require clinical intervention is resulting in a much higher demand for quality services closer to home. The CCG is committed to the children’s community nursing service, including expansion to deliver care seven days a week between 8am and 8pm. The children’s emergency care pathway continues to be a high priority for the CCG, additional investment will be made into aspects of the service.

Over the next couple of years we will be looking to improve access to the Children and Adolescent Mental Health Service (CAMHS) in order to improve support for acute patients. We will also review paediatric therapy pathways for 16-18 year olds, as well as ambulatory paediatric pathways and paediatric palliative care.

Quality, patient safety and experience Quality, patient safety, clinical effectiveness and the experience of patients is integral to our vision, aims and strategy in commissioning healthcare services for our population. Throughout 2013 – 2014 we have been committed to improving the quality of patient care in conjunction with our providers. We focus on clinical effectiveness, patient safety and patient experience with specific goals to deliver excellent health services and improve the quality of patient care.


Quality and Excellence Model:

We have aimed to achieve this by:

• continuously improving the quality of care delivered by our providers, including acute, mental health and community services using contractual processes as a lever

• combining commissioning and provider data with patient safety data and carer feedback, including complaints, reference groups and engagement events, to inform areas requiring improvement and attention and to ensure on-going improvement

• reducing variations in primary care for example; access to primary care services, appropriate prescribing, equitable access to health checks for all patients including hard to reach groups

• extending patient choice of provider for a range of community and mental health services through the use of local and national AQP* processes

• delivering efficiency by maximising use of community services through an integrated care approach with health and social care, to provide a seamless service for patients

• assuring delivery through collaboration with main providers ensuring ‘value for money’ for all partners.

* ‘Any qualified provider’ - AQP - is a contractual approach to offering greater healthcare choice for patients, by inviting organisations to qualify to be on a list of providers, if they qualify following an assessment of their work. They do not get paid until patients choose their services. A number of recent high profile cases (Winterbourne View [DH, 2012], the Report of the Mid Staffordshire NHS Public Enquiry by Robert Francis QC [2013], and the Savile Inquiry [2013] have identified that vulnerable people were not afforded basic standards of care and their fundamental rights to dignity were not respected. Whilst we have not faced issues of this scale, we must not allow this scale of poor quality care and abuse to occur in the services we commission.


We recognise the need for service improvements to deliver better quality of patient care and experience in the long-term, whilst reducing clinical variation, eliminating waste and delivering better value for money. We will achieve this through the development of short, medium and long-term investment in delivering the work that supports our strategic priorities. This will include accompanying programmes of work which are part of the national drive to improve cost effectiveness by enhancing quality, innovation, productivity and the prevention of ill health. Alongside this, through CCG contractual arrangements with providers we will ensure effective quality indicators are in place which allow for a greater understanding of the impact of health interventions on patients and the standard of services commissioned. During 2013 we have made considerable progress in ensuring that we have embedded effective systems to ensure that ELR CCG is able to monitor, challenge and scrutinise provider performance to ensure improvements in the quality of care commissioned. Some examples of this are:

• the development and scrutiny of ‘patient experience dashboards’ for all of our out-of-county acute contracts

• setting up regular meetings with quality leads in out of area CCGs who oversee quality contracting arrangements in Northampton General and Kettering General Hospital.

However, the CCG is not complacent. We continue to review and refresh the data sets used against the domains of the NHS Outcomes Framework and to ensure consistency and validation of data sources. Alongside this we have embedded systems which allow for feedback from service users using Healthwatch members and stakeholder events.

Patient experience

The CCG is committed to ensuring that the patient and service user voice is at the heart of what ELR CCG does. Improving patient experience has been a key area of focus for ELR CCG. During 2013/14 the CCG constructed a baseline of the various elements of patient experience data routinely collected. We have used this to identify key themes, trends and identify any information gaps and take action as required.

Patient experience dashboards have been developed for the ELR CCG main acute provider as well as the local out of county providers where ELR residents may choose to access hospital services, that is:

• University Hospitals of Leicester NHS Trust

• Kettering General Hospital NHS Foundation Trust

• United Lincolnshire Hospitals NHS Trust

• Northampton General Hospital NHS Trust

• Nottingham University Hospital NHS Trust

• Oxford University Hospitals NHS Trust

• Peterborough and Stamford NHS Foundation Trust

• University Hospitals Coventry and Warwickshire.


Nine indicators have been developed, incorporating publically available data and data sourced by contracting team colleagues. Indicators include a selection of patient safety and patient experience indicators to provide a high level overview of the quality of care being provided at each Trust. The dashboards are reported to the ELR CCG Quality and Governance Committee on a quarterly basis.

Patient safety

We have continued to focus our efforts on ensuring providers actively reduce healthcare acquired infections such as Methicillin Resistant Staphylococcus Aureus (MRSA) bacteraemia, Clostridium Difficile infection (CDI) and E Coli. The CCG had its own challenge in addressing our target and we did this by:

• undertaking an infection control review of patients in the community with a stool sample reported as positive for CDI that was sent from a GP surgery.

• addressing antimicrobial prescribing identified as not being in line with LLR antibiotic guidance for primary care

• continuing to support the combination of infection control data with the data held by the CCG Medicines Management Team in relation to QIPP and prescribing targets.

For 2014/15 we will be taking forward numerous patient safety work programmes which can be found in our two year operational plan 2014/16.

Responding to the Francis Inquiry

We welcomed the publication of the of the Francis Inquiry in February 2103 and actively engaged across the CCG including Governing Body members, staff, member practices and the practice nursing community. We developed a comprehensive plan in response to the recommendations relevant to the CCG, including those relating to organisational culture which were built into the CCG’s Visions and Values. This plan was approved by the Governing Body in May 2013 and shared with member practices via the locality mechanisms. A series of CCG wide staff events took place during the autumn to ensure all staff had the opportunity to comment and input into the development of our Vision and Values. One of the key outcomes associated with the Francis response has been the development and implementation of an automated GP intelligence reporting system. This enables real time reporting of GP concerns relating to patient safety and experience in any provider organisation. Through our contractual mechanisms we have strengthened our approach to the monitoring of quality in providers. This includes the revision of quality schedules to ensure they reflect the Francis recommendations and a proactive approach to unannounced quality visits. The new approach to quality visits incorporates a multi professional desk top review of various data sources to inform areas to visit, providers have welcomed the increased level of scrutiny and responded positively to this approach.


The Winterbourne View Concordat

The Winterbourne View Concordat aims to transform the way services are commissioned and delivered to:

• stop people being placed in hospital inappropriately

• provide the right model of care and drive up the quality of care

• ensure that by 1 June 2014 there is a rapid reduction in hospital placements.

During the summer of 2013/14 we completed a baseline assessment against the Winterbourne Concordat with Leicestershire County Council and Rutland County Council. More recently a joint Learning Disabilities Programme Board with clear terms of reference, governance structure and stakeholder reference group has been established. It includes representation from ELR CCG, local authority, Local Area Team children’s and adults’ commissioners. This Programme Board will oversee the development and delivery of the Winterbourne View action plan. The Board links back to the Health and Wellbeing Board via an Integrated Commissioning Board that includes district council representation. A stakeholder reference group has been established to support this work. This includes families of children, young people and adults, commissioners and NHS providers. It is planned to use this group as a longer term stakeholder/advisory group for the Winterbourne View delivery plan. Additional members will be brought in as required. There will be a degree of overlap with other local authorities and CCGs in the Leicester, Leicestershire and Rutland area, and particularly in relation to work with providers.

Compassion in care

We have used the publication of ‘Compassion in Practice: Nursing, Midwifery and Care Staff Our Vision and Strategy’ (DH 2012) as a key enabler to the delivery of a long-term sustainable high quality nursing and care staff workforce which support dignity in care provision. We introduced, through the inaugural GP Practice Protected Learning Time event in June 2013, the vision for practice nurses, which highlighted the practice nurse responsibility in relation to the “6Cs”. The so-called ‘6Cs’ are the values and behaviours behind the strategy: compassion, courage, commitment, caring, competence and communication. During the last year the Chief Nursing Officer for England has developed the ‘6Cs Live!’ website, which aims to build an online community of nurses and care givers across health and social care. We have been actively participating in a range of ‘6Cs Live!’ webinars that support delivery of the six action areas:


1. Helping people to stay independent, maximising well-being and improving health outcomes

2. Working with people to provide a positive experience of care 3. Delivering high quality care and measuring impact 4. Building and strengthening leadership 5. Ensuring we have the right staff, with the right skills, in the right place 6. Supporting positive staff experience.

The Chief Nurse and Quality Officer has contributed to the work across the Leicestershire and Lincolnshire Area Team to support implementation of the 6Cs action areas.

Safeguarding vulnerable people

The CCG continues to have a strong focus on safeguarding vulnerable people. We have developed and adopted a range of policies which underpin how we approach safeguarding arrangements. The Quality and Clinical Governance subcommittee of the Governing Body has oversight and scrutiny of safeguarding arrangements for the CCG. The Chief Nurse and Quality Officer is the Executive Lead for safeguarding and is a member of the Leicestershire and Rutland Local Safeguarding Children Board and Safeguarding Adult Board. The CCG is supported in its statutory duties by Designated Nurses and a Designated Doctor for safeguarding. The CCG uses the Markers of Good Practice for Children and Safeguarding Adults Framework which meets the requirements set out in ‘Safeguarding Vulnerable people in the reformed NHS - accountability and assurance framework’ published in March 2013 to assess provider compliance against statutory safeguarding duties. During 2013/14 the CCG has focussed safeguarding activities in a number of ways, including:

• our Governing Body has held an information session to understand the implications of the PREVENT agenda and impact on vulnerable people.

• a Protected Learning Time event delivered to 130 practice administration staff including safeguarding recognitions and alerts and PREVENT

• monitored safeguarding training for GPs within the member practices - current compliance is 96% for safeguarding children and 82% for safeguarding adults. (as of 1 January 2014).

Our commissioning activities and who we commission from

ELR CCG commissioned health services worth approximately £320m in 2013/14 for people registered with our practices. We held contracts ranging from small grants in the voluntary sector, to a £116m contract with the main acute provider, University Hospitals of Leicester NHS Trust (UHL).


East Leicestershire and Rutland 2013/14 expenditure

Although the picture of healthcare providers is becoming more complex with the roll out of initiatives such as ‘Any Qualified Provider’ (AQP), offering patients a wider choice of organisations to provide their care, the local services we commission remains dominated by:

• University Hospitals Leicester which provides acute hospital services at three sites in Leicester and some services in local community hospitals. UHL provides secondary care to a catchment area of approximately one million people and specialised services for up to three million people. It is one of the largest acute trusts in the country

37%

7%

1%

2%15%

2%

2%

7%

2%

1%

14%

2%2%

1%

4%

UHL Contract - £118.1m

Out of County Contracts -

£23.2m

Non Contracted Activity (Acute) -

£2.2m

Independent Sector (Acute) -

£7.2m

LPT Contract - £48.4m

Derbyshire Contract - £7.3m

EMAS Contract - £6.6m

Continuing Healthcare - £22.9m

LD Pooled Budget & Reablement

- £5.6m

Out Of Hours - £2.8m

Total Practice Prescribing -

£44.9m

Reserves - Headroom - £5m

Total Running Costs - £6.9m

Voluntary Sector - £3.4m

Other - £12.7m


• Leicestershire Partnership NHS Trust (LPT), the main provider of community health and mental health services. LPT manages most of the community-based teams serving ELR CCG and is the key provider at the six community hospitals

• East Midlands Ambulance Service NHS Trust (EMAS) provides emergency 999 and urgent care crews across Derbyshire, Leicestershire, Rutland, Lincolnshire (including North and North East Lincolnshire), Northamptonshire and Nottinghamshire.

We commission acute services from out-of-county NHS trusts and a range of independent sector providers such as Spire Leicester, Nuffield Leicester and Nations Healthcare, based at the Nottingham Treatment Centre. Furthermore, ELR CCG provides grants for some voluntary sector providers including the Alzheimer’s Society (carers’ support service), Carer’s Action (carers’ support), Leicestershire Organisation for the Relief of Suffering (LOROS) for end-of-life care, and The Laura Centre (support for adults and children affected by the death of a child). We act as the co-ordinating commissioning body to manage the following contracts on behalf of all three Leicester, Leicestershire and Rutland (LLR) CCGs:

• out-of-county contracts (acute)

• out-of-county community health services

• East Midlands Ambulance Service

• non-emergency patient transport services – Arriva Transport Solutions

• any qualified provider (AQP) contracts

• Leicester, Leicestershire and Rutland voluntary sector arrangements

• community based elective care alliance arrangement

• home oxygen service contract.

ELR CCG also works with our LLR CCG partners to support the management of contracts across the three CCGs in line with the NHS Standard Contract Management Framework. The NHS Mandate sets out the ambitions for how the NHS needs to improve by 2015. The mandate plays a vital role in setting out the national strategic direction for NHS England and CCGs. Meanwhile the NHS ‘Call to Action’ challenges all NHS providers and commissioners to respond to the challenges of an ageing society, the rise of long-term conditions, rising expectations, increasing costs of providing care, limited productivity coupled with the pressure of constrained public resources that the NHS faces, in particular to address the variation in quality of care across the health system. Due to an ageing population, with increasingly complex health needs and with people living longer than ever, it is predicted that the Leicester, Leicestershire and Rutland health economy faces a challenging deficit of £291m by 2019 if we do not fundamentally redesign and transform provision moving from a bed dependent economy to a health economy that supports and manages people within their communities and homes.


Intensive modelling identifying the exact scale of the financial challenge is due for completion before the end of June 2014. At the same time, a long list of possible interventions is being developed across broad areas of care which are:

• Urgent care

• Maternity and neonates (new borns)

• Children’s services

• Learning disability

• Planned care

• Long term conditions/frail older people

• Mental health

Further work on individual models of care will be done during the summer of 2014, culminating in a final plan by the end of September. This will present options for change, to be put out for public consultation. Tackling the financial pressures creates opportunities to make changes which improve the outcomes and experience of patients and those who receive social care. In June 2013 the Government launched plans to enable further steps to be taken towards integrated health and social care via the national £3.8bn Better Care Fund (BCF). The BCF forms a critical part of, and is incorporated into, the ELR CCG NHS two-year operational plans and the five-year LLR strategic plan as well as local government planning which both get underway in 2014/15. The economic climate in which we operate remains a challenge for all NHS organisations. The CCG recognises the need for service improvements to deliver better quality of patient care and patients’ experience of the NHS in the long-term, while reducing clinical variation, eliminating waste and delivering better value for money, so, in short, to deliver high quality at a lower cost.

The NHS ‘Call to Action’ challenges all NHS providers and commissioners to respond to the challenges of an ageing society, the rise of long-term conditions, rising expectations, increasing costs of providing care, limited productivity coupled with the pressure of constrained public resources that the NHS faces, in particular to address the variation in quality of care across the health system. Therefore the focus of our plans as a CCG is to address our local challenges in relation to:

• quality issues by working closely with our providers and clinicians

• raise our performance across the NHS Outcomes Framework domains and Quality Premium*

• deliver safe high quality services

• deliver value for money – meeting our financial challenges as a health and social care economy

• focus on helping people to remain healthy for longer through promoting independence and supporting more patients to remain at home.

• taking a more life-long approach to supporting people, rather than providing only a disease-specific approach

• achieve a parity of importance for mental health with physical health – develop plans to help reduce the 20-year gap in life expectancy for people with severe mental illness.


* The NHS Outcomes Framework sets out the main areas of health and care where the NHS aims to improve; the ‘quality premium’ is intended to financially reward CCGs for improvements in the quality of the services, in health outcomes and reducing inequalities.

We have been working alongside NHS England through the Regional and Local Area Teams to support the delivery of the NHS England Business Plan. This includes developing partnerships and local clinical leadership, and ensuring that robust emergency plans are in place to deal with disasters and other major incidents. Operating and Financial Review I certify that the Clinical Commissioning Group has complied with the statutory duties laid down in the National Health Service Act 2006 (as amended by the Health & Social Care Act 2012) and prepared the accounts under the Directions issued by NHS Commissioning Board under the National Health Service Act 2006 (as amended)

Development and performance in year and in the future During 2013/14 the CCG’s Finance and Performance Committee monitored all performance indicators on a monthly basis, and is responsible for assuring the Governing Body of compliance. This in turn was assured by the NHS England’s Area Team at their checkpoint meetings with the CCG. The CCG had a total allocation of £320,337,000 in the 2013/14 financial year. NHS England had set a target for the CCG to achieve a surplus of £3,045,000. This target was achieved. The table below sets out the headline financial performance for the CCG:


ELR CCG Month 12 Financial Performance

Budget Actual Variance

£ £ £

Total allocation 320,337,000 320,337,000 0

Total Acute Commissioning 145,361,410 150,752,531 5,391,121

Total Non-acute Commissioning 105,193,829 104,391,016 (802,813)

Total Practice Prescribing 45,388,178 44,909,422 (478,756)

Total Enhanced Services 1,990,326 1,970,181 (20,145)

Miscellaneous (inc reserves) 11,588,257 8,397,805 (3,190,452)

Total Running Costs 7,770,000 6,870,182 (899,818)

Total Programmed Expenditure 317,292,000 317,291,137 (863)

Surplus £ £ £

Programme control total 3,045,000 2,146,045 (898,955)

Running Costs control total 0 899,818 899,818

Total control total 3,045,000 3,045,863 863

Overall, 2013/14 has been a difficult financial year with many decisions which lay outside of our control and which did not go in favour of the CCG. Careful control of expenditure in areas of growth and development has had to be exercised to ensure that the control total was achieved. It is important to note that as this is the first year that the CCG has been formally in operation and the task of forecasting the year-end position has been a challenge each month. The CCG had faced a Quality Improvement and Productivity Plan (QIPP) target of £6m which was achieved.


The financial performance of the whole of the health economy in 2013/14 has been difficult with the main provider of acute services (University Hospitals of Leicester NHS Trust) reporting a sizeable deficit.

The LLR CCGs have continued to work closely with the trust to ensure that services to patients have not suffered as a result of the financial problems. The Commissioning Plans of the CCGs are supportive of the trust in achieving a financial balance in the next three years. This will result in changes to the way services are currently provided and the location in which they are provided.

To this end the CCG has significant new investments in community and social care services with the aim of relieving the reliance and pressure on acute services. The CCG has also worked alongside Leicestershire Partnership NHS Trust to develop and improve inpatient services for people who have a mental health issue.

Also during this year the CCG monitored the NHS Outcomes Framework, the NHS Constitution and the new Quality Premium. The former is to drive local improvements in quality and outcomes for patients and the Constitution to ensure that patients’ rights and pledges were maintained through contracts with service providers. The Quality Premium brings together a composite of indicators from the outcomes framework and constitution, and incentivises the CCGs to improve performance.

One of the ways we measure performance is setting and monitoring Key Performance Indicators which include descriptions and measures (please see the attached tables below).

As reflected in the introduction to this report, whilst we are pleased with many areas of activity, performance against many measures was poor in several areas over the last year, with highly publicised challenges at several of our providers including accident and emergency services at Leicester Royal Infirmary, the Bradgate mental health unit (Leicestershire Partnership NHS Trust) and East Midlands Ambulance Service. During 2013 – 2014 the CCG worked closely with all service providers and partners across health and social care to support the implementation of plans to drive up quality of care and performance.


The following tables set out East Leicestershire and Rutland CCG’s position on the expected rights and pledges from the NHS Constitution 2013/14 and includes thresholds that the NHS Commissioning Board will use when assessing organisational delivery.

EAST LEICESTERSHIRE & RUTLAND CCG NHS CONSTITUTION KEY PERFORMANCE INDICATORS

Performance achieved year to data (YTD)

2013/14

Standard 2013/14 YTD

Referral to Treatment (non-admitted) 95% 95.7%

April 13-Mar 14 (All Providers)

Referral to Treatment (incomplete) 92% 94.1%


Cancer waits - two weeks from urgent GP referral

93% 94.7%


Cancer waits - two weeks from urgent referral with breast symptoms

93% 94.1%


Cancer waits - 31 days to first definitive treatment

96% 98.2%


Cancer waits - 31 days for subsequent cancer treatment (surgery)

94% 98.4%


Cancer waits - 31 days for subsequent cancer treatment (drug)

98% 100%


Cancer waits - 31 days for subsequent cancer treatment (radiotherapy)

94% 98.2%


Cancer waits - 62 days from NHS screening service to treatment

90% 94.8%


Cancer waits - 62 days for treatment following a consultant’s decision to upgrade the priority of the patient

N/A 100%


Care Programme Approach: The proportion of people under adult mental illness specialties on CPA who were followed up within 7 days of discharge from psychiatric in-patient care during the period

95% 97.8%

April 13-Mar 14 (LPT)

Cancelled ops - All patients who have operations cancelled, for non-clinical reasons, to be offered date within 28 days, or funded at the time and hospital of the patient’s choice.

95% UHL

contract

95.1% April 13-Mar 14 (All Providers)


EAST LEICESTERSHIRE & RUTLAND CCG NHS CONSTITUTION KEY PERFORMANCE INDICATORS

Performance measures not achieving (YTD)

2013/14

Standard 2013/14 YTD

Referral to Treatment (admitted) 90% 88.1%


Diagnostic waiting times 99% 98.8%


Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department

95%

84.77% YTD as at

9/4/14 (UHL only)

Category A Red 1 incidents response within 8 minutes - (conditions that may be immediately life threatening and the most time critical)

75% 71.26%

(Apr 14-Mar 14) EMAS

Category A Red 2 incidents, response within 8 minutes - (conditions which may be life threatening but less time critical than Red 1)

75% 71.46%


Category A calls resulting in an ambulance arriving at the scene within 19 minutes

95% 93.82%


Mixed Sex Accommodation Breaches

0 breaches

2 April 13 - Mar 14 (All Providers)

NB: Indicators rated as ‘amber’ meet the lower threshold, but do not meet the nationally set target. For example: Referral to treatment (admitted) has a target of 90%, the lower threshold is 85%, therefore a position of 88.7% is between the target and the lower threshold, giving an amber indicator.

The Resources, Principal Risks and Relationships that may affect long-term performance

The CCG had a healthcare income allocation of circa £320m. This was managed through the Accountable Officer and the Chief Finance Officer. The financial performance of the CCG was monitored on a monthly basis by the Governing Body and the Finance and Performance Committee chaired by a lay member.

The main financial risk that the CCG has faced throughout the year is over performance in the Acute Sector against the backdrop of significant emergency activity pressures experienced during the year. The over performance at the end of 2013/14 was £5.39m.


Acute Commissioning Variance

£

UHL Contract 1,815,691

Out of County Contracts 1,624,849

Non Contracted Activity 36,602

Independent Sector 1,913,979

5,391,121

Other key financial risks included:

• Increasing expenditure on Out of County Mental Health Placements as a result of pressure on acute mental health beds (this was also a risk to quality of care and access for patients)

• Winter Pressures across the health and social care economy

• Potential non-achievement of QIPP plans

• In year management of allocation movements as funding was stabilised.

These risks were mitigated following extensive discussions with providers of services. Where appropriate, risk sharing strategies were adopted. A number of the risks were shared on a collaborative basis with the other Leicester and Leicestershire CCGs alongside underspending in other areas.

The CCG had a total of £7,770k to spend on running costs in 2013/14. A total of £6,870k was spent.

Better payments practice code The Better Payment Practice Code requires the Clinical Commissioning Group to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later. The NHS aims to pay at least 95% of invoices within 30 days of receipt, or within agreed contract terms. Details of compliance with the code are given in the notes to the financial statements. In 2013/14 all NHS and Non-NHS invoice payments have exceeded the 95% target for number of invoices paid and also for value of invoices paid. [See note 6 in the financial statements for further details]. Prompt payments code On 28 February 2014 the CCG became an approved signatory of The Prompt Payment Code. This initiative was devised by the government with The Institute of Credit Management (ICM) to tackle the crucial issue of late payment and to help small businesses. Suppliers can have confidence in any company that signs up to the code that they will be paid within clearly defined terms, and that there is a proper process for dealing with any payments that are in dispute.


Approved signatories undertake to:

• pay suppliers on time

• give clear guidance to suppliers and resolve disputes as quickly as possible, and

• encourage suppliers and customers to sign up to the code.

Cost Allocation & Setting of Charges for information

We certify that the Clinical Commissioning Group has complied with HM Treasury’s guidance on cost allocation and the setting of charges for information..

Governing Body’s policy for managing risk The ELR CCG Governing Body is committed to commissioning safe and effective care and leading the organisation to deliver its stated objectives. It uses the approved risk management strategy and policy to lead the organisation forward to deliver its objectives. ELR CCG attaches great importance to the management of risk and acknowledges that risk can bring with it positive advantages, benefits and opportunities. The CCG therefore aims to create an environment where risk is considered as a matter of course and appropriately identified and managed. A culture of open reporting is promoted and upheld throughout the CCG to ensure that risks are identified, evaluated, documented and managed by all who may encounter them. Risk management is a core organisational process and is an integral part of its philosophy, practices and business planning and that responsibility for its implementation is accepted at all levels of the organisation. The CCG recognises the importance of involving local stakeholders in its risk management processes and of working in partnership to identify, prioritise and control shared risks, such as through collaborative arrangements. Strategic risks (or principle risks) identified are those that represent major threats to achieving the CCG’s strategic objectives or to its continued existence. Strategic risks are recorded in the Board Assurance Framework (the corporate risk register) and managed by the Corporate Management Team and regularly reported to the Audit Committee and Governing Body.

Partnerships and stakeholders

Partnership working has been vital to ELR CCG and it is the best way to bring about many of the changes we wish to see implemented. Over the last year, ELR CCG has actively engaged with partner organisations to build on existing relationships, and develop new and improved relations with clinicians, patients and carers, public members, staff, partner organisations, including local authorities, and other commissioning agencies. We have many partners, and have established key working relationships with the following:

• Leicester City CCG and West Leicestershire CCG


• Leicestershire County Council and Rutland County Council (particularly with social service commissioners and through Health and Wellbeing Boards) as well as the borough councils within our CCG boundary

• voluntary sector providers and charities

• Healthwatch Leicestershire, Healthwatch Rutland, and other patient and carer representative bodies

• Leicestershire and Rutland Children’s Safeguarding Board

• Leicestershire and Rutland Safeguarding Adults Board

• Leicestershire Police and Leicestershire Fire Services

• De Montfort University and the University of Leicester

• Greater East Midlands Commissioning Support Unit (GEM CSU).

In order to achieve our vision and values we will be working closely with our local authorities, CCGs and provider partners to develop our five-year LLR strategy. Furthermore, we are working with our local authority partners to develop our two-year plans, now known as the Better Care Fund, to ensure health and social care work more closely together. The CCG is committed to making care more integrated in order to improve health for its population. We are working with our local authority partners to ensure that resources are used effectively. We will do this through the Better Care Fund, strengthening our joint commissioning and working arrangements to deliver integrated care for older people and supporting people with long-term conditions (LTC). This is particularly crucial if our CCG is to meet its financial challenges through the transformation of care systems, and improve the quality of healthcare available from our providers. Public health input into the development and implementation of the CCG’s strategic priorities is vital, and we base our priorities and initiatives upon the Joint Strategic Needs Assessment and the Health and Wellbeing Strategy with the county councils. Public health staff continue to help the CCG to understand local needs and issues of our diverse population. This contribution is critical to both inform and develop our strategies, as well as in delivering our priorities. The CCGs priorities for the next two years (2014-16) The CCG’s Operational Plan 2014-16 details the key priorities for the next two years and our intentions to further develop partnership and collaborative working with our local authority partners, neighbouring CCGs and stakeholders in order to deliver the system redesign that is needed to address our local challenges and issues. The key priorities include:

• Reshaping community services to deliver locally based provision that enables patients to remain independent for as long as possible and have a better quality of life;

• Further integration of health and social care provision to transform care that is strong, sustainable and person centred which enables the health and social care system meet the future demands;

• Service improvements which deliver better quality care and patient experience whilst reducing clinical variation, eliminating waste and delivering better value for money;


• Reducing pressure within our urgent care system to prevent avoidable admissions and reduce length of stay for patients who could be cared for at home;

• Support general practice to come together with new ways of joint working to enable primary care health teams to have more time to proactively manage patients with multiple illnesses, at the end of life, in care homes or at risk of admission;

• Children and their families will continue to be an important priority for the CCG;

• Working with our mental health providers, clinicians and service users to improve our acute mental health pathway.

The CCG is working in partnership with NHS England and other Leicester, Leicestershire CCG partners, Local Authorities and providers to formulate a five year strategy that focuses on some strategic health priorities.

Involving patients, service users and the public

Involving and informing people is a critical part of delivering our CCG’s vision and lies at the heart of what we do. When our organisation was established in shadow form in 2011, we sought views on what people wanted us to focus on. As a result our vision and strategic aims were directly influenced by what our patients, partners and stakeholders, staff and clinicians told us. We remain committed to this approach and to continuous improvement of the way in which we involve local people in planning, influencing and improving local healthcare.

Position of the organisation

The CCG has applied DH national guidance and policies to the production of the financial statements. GEM CSU has followed the same process. No use has been made of financial instruments (including derivatives). There been no significant transactions that are outside the normal trading activities of our organisation in the 2013/14 financial year. There are no pension liabilities. The CCG is not impacted by interest rate changes. The CCG has established effective standard financial management arrangements, including:

• standing orders and standing financial instructions

• committee structures, including the Audit Committee and the Finance and Performance Committee

• scheme of reservation and delegation

• internal financial/management reporting

• key financial systems such as accounts payable and receivable, cash and bank

• internal audit, including arrangements for liaison between internal audit and the CSU's commissioning support unit's internal audit provider and

• counter-fraud and corruption.

The CCG followed up PCT legacy issues effectively and has followed DH guidance on legacy issues, in particular in relation to transfer of balances. The CCG has included in its balance sheet all relevant transferred assets - these only relate to fixed assets (value of £956k) per the latest guidance from NHS E.


Disclosure: legacy balance transfers

In accordance with the Health and Social Care Act 2012, Strategic Health Authorities and Primary Care Trusts were dissolved on 1 April 2013 and their assets and liabilities transferred to successor bodies in the NHS or to other entities. Under the terms of the Property Transfer Schemes (Health and Social Care Act 2012 Leicester City Primary Care Trust and Health and Social Care Act 2012 Leicestershire County and Rutland Primary Care Trust) and their supporting Schedules, a number of assets and liabilities were transferred from Leicester City Primary Care Trust and Leicestershire County and Rutland Primary Care Trust to the CCG on that date. The most significant of these were fixed assets to the value of £956k.

The accounting arrangements in respect of these transfers are outlined in Note 1.5 to the Annual Accounts. We certify that the clinical commissioning group has complied with the statutory duties laid down in the National Health Services Act 2006 (as amended).

Sustainability Report ELR CCG operates from a single unit based in Thurmaston, Leicestershire. The property is leased and Raynsway are the landlords with NHS Horizons supporting the building maintenance through a contract with a facility management team. There is a requirement for the CCG to publish an annual Sustainability Report using a national standard template, however, in this first year of its operation the information required to populate the template is not available. It has been requested. The lack of available data and the need to use the year 2013/14 as our baseline means that the CCG is not in a position to be able to report on its progress in meeting the NHS Carbon emissions target of a 10% reduction by 2015. The CCG recognises that good maintenance and care of the environment contributes a great deal to the long term health of people, their social well-being and economic prosperity. The CCG is committed to promoting environmental sustainability and to continually improve the quality of its services and environmental performance, this includes embedding sustainability into behaviours by staff and other partners within the building, concentrating on reduction of paper, increased recycling and energy and carbon reduction. The CCG is in the process of updating its Sustainability Strategy and sustainable development plan to reflect the recent publication of the ‘Sustainable, Resilient, Health People and Places - A sustainable Development Strategy for the NHS, Public Health and Social Care system’ in January 2014. Reducing carbon emissions, protecting natural resources, preparing communities for extreme weather events and promoting healthy lifestyles and environments are key to the concept. The aim is also to reduce the negative impact on the environment by managing energy use and reducing waste by switching to other sources of energy, improving recycling facilities or using fewer disposable items.


Organisations are being encouraged to develop a local strategy, measure their success with regular reporting, and evaluate their progress as well as joining up with local Health and Wellbeing Boards. The review of the sustainable development plan will be reflective of the outcome of the good corporate citizen self-assessment tool which identifies how the organisation is meetings the NHS commitment to reduce its carbon footprint. As the organisation is in its first year the CCG is committed to taking a whole system approach to sustainable commissioning and is seeking ways to reduce costs and resources, produce health benefits and embrace sustainable procurement. Progress has not been what we had hoped for in the first year but looking forward to 2014/15 the focus will be on three key themes:

• staff awareness

• waste energy and carbon reduction

• travel and transport By focusing on these key areas this will enable the CCG to provide high quality sustainable health care and commit to embedding sustainability into its operations. In delivering these themes we will utilise all of the available support to organisations such as the Carbon Trust and the NHS Sustainable Development Unit. Sustainability issues are included in our analysis of risks facing our organisation, there is a statutory duty to assess the risks posed by climate change and the outcome of these risk assessments inform the review and management of the local policies and procedures in place.

Equality and Diversity Report

NHS East Leicestershire and Rutland Clinical Commissioning Group is committed to eliminating discrimination, advancing equality of opportunity and fostering good relations between different groups of people as set out in the CCG's Equality and Diversity Strategy 2012 – 2015.

As an authorised public sector organisation the CCG is required by the Equality Act 2010 to work in ways that ensures equality and inclusion is embedded into all of its functions. There are a number of duties which the CCG must address, as follows: Public Sector Equality Duty In the exercise of its functions the CCG must have due regard to the need to:

a. Eliminate discrimination, harassment and victimisation and any other conduct that is prohibited by or under the Equality Act 2010

b. Advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it

c. Foster good relations between persons who share a relevant protected characteristic and persons who do not share it.


Specific Duties

a. The CCG must prepare and publish one or more equality objectives it thinks it should achieve to support the PSED (above). The objectives must be published not later than 13 October 2013 and at intervals of not greater than four years. Each objective must be specific and measurable.

b. The CCG must publish information, not later than 31 January each year, to demonstrate compliance with the PSED (above). The information published must relate to persons who share a relevant protected characteristic who are:

• Its employees (only when employing 150 people or more); • Other persons affected by its policies and practices.

Equality Objectives 2013 – 2015 The CCG’s Equality Objectives for 2013 – 2015 are: i) Addressing needs of older people and access to services a. Year 1 – undertake baseline to identify what access looks like at present and identify gaps. Aligning this to the duty to have regard to reducing health inequalities, improving access and health outcomes. b. Year 2 – review the results of the baseline and identify areas to address / change. Develop plans for improving access for older people as identified through the baseline. ii) Targeting provision and access to seldom heard people and groups – travelling families, BME, LGBT, rural deprivation a. Year 1 – define what is meant by “seldom heard individuals, groups / communities” in relation to East Leicestershire and Rutland population in comparison to Leicester, Leicestershire and Rutland. Review how the CCG is currently engaging with these groups and how these mechanisms can be strengthened. Identify and map existing mechanisms of engagement through which the CCG accesses / or can access these groups / communities to gather intelligence. Consider how the CCG engages with the local authorities in strengthening engagement with these groups / communities. b. Year 2 – using the information / intelligence gathered in year 1, identify how the CCG is going to target / prioritise provision. iii) Access to early intervention and prevention of Mental Health issues a. Year 1 – evaluate and understand local mental health issues in relation to young people and other groups. Review access to early intervention and identify what is currently available in order to prioritise and improve health outcomes across East Leicestershire and Rutland. b. Year 2 – baseline to be undertaken will determine actions for year 2. For example this could be work with young people to identify mechanisms for improving


access to mental health services. Year 2 will be about using the information to improve outcomes for patient and prioritise mental health services. The CCG has analysed and assessed its equality performance by reviewing various sources of information including feedback from engagement activities with our patients, carers, community groups and staff over the last 12 months in preparation for reviewing the commissioning intentions. As a result of this work the CCG has identified a number of actions and developed the three equality objectives listed above. The equality objectives have been developed to make sure that they are relevant to the CCG’s role as a commissioner; with focus on outcomes for our patients. This way, the CCG can make sure that the focus of the organisation stays on the areas that will have the greatest impact on improving services for our patients. The proposed equality objectives are aligned with the CCG’s strategic aims and refreshed draft commissioning intentions. The CCG’s Involving and Informing Strategy also sets out the CCG’s commitment to reaching out to all members of the CCG’s community using multiple approaches that meet the needs of individuals and groups and all engagement activity takes full account of the nine protected characteristics.

The CCG will work on developing a detailed action plan to ensure measurable actions and milestones are in place over the next two years to enable us to achieve our equality objectives.

Publication of Information

The CCG became an authorised public sector organisation on 1 April 2013, in line with the re-organisation of the NHS brought about by the Health and Social Care Act 2012.

As a new and developing organisation, the level of detail that is currently available to demonstrate how the CCG is complying with the Public Sector Equality Duty continues to be improved.

In meeting the duty to publish information the CCG has collected evidence which should provide an understanding of how the CCG is approaching equality and inclusion in its activities. The table of evidence, which we published on our website http://www.eastleicestershireandrutlandccg.nhs.uk/equality-diversity-and-human-rights , demonstrates how the CCG has begun its approach to equality and inclusion and how it will be continuing to develop this over the next year in line with its strategic priorities and equality objectives.

Workforce

NHS East Leicestershire and Rutland CCG employed 77 members of staff (headcount figure as at 31 March 2014) and, therefore it is not required to produce detailed staff profiles by protected characteristics. This also protects the privacy of employees as any profiles of protected characteristics may allow individuals to be identified. The table below provides an overview of the number of persons of each sex who were on the Governing Body and the number of persons of each sex who were employees of the CCG as at 31 March 2014:


Sex All employees Governing Body

All members of the Governing Body

GP members on the Governing Body

Disclosed 77 16 6 Female 68 4 Male 9 12 6 Total 77 16 6

The CCG is committed to ensuring the working environment is inclusive and appropriate support is provided to any member of the organisation that may require it.

All of the CCG's internal workforce policies have been developed, and continued to be updated, in line with current legislative requirements, including the Equality Act 2010. These policies cover the recruitment, selection and appointment process as well as all aspects of working for the CCG.

In addition, the CCG has developed its organisational vision and values to support continued organisational development in supporting and valuing the diversity of its employees and creating an inclusive working environment.

Information relating to activities of the CCG

In order to structure the available evidence that demonstrates how the CCG is working to meet the Public Sector Equality Duty (PSED), the CCG utilised the following guidance:

• Technical Guidance of the Public Sector Equality Duty England, Equality and Human Rights Commission (EHRC), Jan 2013;

• Equality Delivery System (EDS) and EDS2, NHS England, Nov 2013.

Equality and inclusion work is an on-going activity for the CCG that will be consistently incorporated across all of its functions.

Dr David Briggs Managing Director (Accountable Officer)

4 June 2014


Members of the Governing Body Report

NHS East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) is led by a Governing Body comprising elected GP members, a secondary care clinician and lead nurse and independent lay members as detailed below. Name Position Mr Graham Martin Lay Chair Dr Hamant Mistry Clinical Vice Chair / Melton, Rutland and

Harborough GP Locality Lead Dr David Briggs Managing Director (Accountable Officer) Dr Nicholas Glover Blaby and Lutterworth GP Locality Lead

Dr Graham Johnson Blaby and Lutterworth GP Locality Lead Dr Simon Wooding (up to 9th September 2013)

Melton, Rutland and Harborough GP Locality Lead

Dr Richard Hurwood (from 1st October 2013)


Dr Andrew Ker Melton, Rutland and Harborough GP Locality Lead

Dr Richard Palin Oadby and Wigston GP Locality Lead Mr Warwick Kendrick Independent Lay Member

Mr Alan Smith Independent Lay Member Dr Tabitha Randell Consultant Paediatric Endocrinologist

(secondary care clinician) Mrs Carmel O'Brien Chief Nurse and Quality Officer Mrs Karen English Chief Finance Officer Mr Paul Sherriff (from October 2012 - May 2013)

Chief Corporate Affairs Officer

Mrs Jane Chapman Chief Strategy and Planning Officer Mr Tim Sacks Chief Operating Officer

Dr Tim Daniel Consultant in Public Health Medicine (in attendance)


Governing Body members’ profiles

Dr David Briggs Managing Director (Accountable Officer) Dr Briggs qualified as a doctor in 1996 after studying at Leicester Medical School. He became a GP Principal practicing in Melton Mowbray in 2001 and was a professional executive committee member for NHS Leicestershire County and Rutland Primary Care Trust for five years until Clinical Commissioning Groups (CCGs) formed. In April 2011, as part of reforms to the NHS, Dr Briggs was

elected by his peers to the role of clinical chair of East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG). Throughout 2011/12 his ability to place clinicians at the forefront of decision making strengthened leadership within ELR CCG. Dr Briggs was appointed to the role of managing director (the organisation's accountable officer), leaving full-time general practice. In addition to managing the business of ELR CCG, Dr Briggs plays a key leadership role across the local NHS as part of the collaborative working arrangements between the three Leicester, Leicestershire and Rutland CCGs. He also leads the planned care project which covers referrals for routine services for patients with already known medical conditions. Dr Briggs is passionate about improving health services for local patients and has been instrumental in developing the patient-focussed culture in ELR CCG.

Mr Graham Martin Chair Mr Martin worked in the NHS for over ten years and has recently retired from leading the European operations of a large international management consulting firm. He is an advisor on healthcare and human resource issues to Management consulting firms and is a practicing Executive Coach. He has long-standing connections with the NHS and has been a non-executive director for Nottingham City Hospital

NHS Trust, a lay member with the Leicestershire County and Rutland community services board and more recently with East Leicestershire and Rutland Clinical Commissioning Group. Mr Martin holds an MA(Econ), Post graduate Diploma in Management Studies and is a Fellow of the Charted Institute of Personnel and Development.


Dr Hamant Mistry Clinical Vice Chair

Dr Mistry is a partner at Market Harborough Medical Centre. He qualified at St George's Hospital Medical School in London with a BSc in Pharmacology in 1985 and a MBBS in 1989, qualifying as a GP at Oxford GP Vocational Training Scheme in 1993 with MRCGP. In 1995 Dr Mistry became a GP partner at Market Harborough Medical Centre and in 2006 he became a Fellow of the Royal College of GPs. His areas of interest in general practice include medicines

management, commissioning and developing services in primary care. Dr Mistry was a GP member of the Professional Executive Committee with Melton, Rutland and Harborough Primary Care Trust (PCT) and Leicestershire County and Rutland PCT between 2001 and 2011, and was appointed the clinical lead and clinical vice chair of East Leicestershire and Rutland Clinical Commissioning Group in 2012. Dr Mistry has a special interest in elective care, community hospitals and transforming clinical pathways. Working across the health and social care community in Leicester, Leicestershire and Rutland he sits on the Urgent Care board; the Health and Wellbeing Board; the Better Care Together group; and chairs the Commissioning Collaborative Group on a rotating basis. He is the clinical lead for East Midlands Ambulance Service, NHS 111 and continuing health care across the three CCGs in Leicester, Leicestershire and Rutland. In addition he sits on the project board for the St Luke's Hospital development in Market Harborough and chairs the ELR CCG strategy and development group. Dr Mistry is to leave the CCG at the end of June 2014 in order to deliver full time care to his list of patients

Dr Graham Johnson Locality lead – Blaby and Lutterworth Dr Johnson is a partner at Wycliffe Medical Practice in Lutterworth. He attended the University of Nottingham Medical School where he achieved a first class BMedSci (hons) degree in 1992, followed by a BMBS (hons) in 1994. In 1995 he worked at the Queen's Medical Centre hospital in Nottingham, before completing a GP Vocational Training Scheme in Nottingham from 1995-1998. In 1998 Dr

Johnson qualified as a GP and started work at Wycliffe Medical Practice. His areas of interest include prescribing and cardiovascular medicine, and between 2006 and 2010 he worked as a clinical assistant in cardiology at Glenfield Hospital in Leicester. He is a governing body member for East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) and is the clinical lead for mental health across the three CCGs in Leicester, Leicestershire and Rutland.


One of two locality leads for Blaby and Lutterworth, Dr Johnson is also a member of the ELR CCG quality and clinical governance committee and is one of two board members on the Leicester, Leicestershire and Rutland Serious Incident review group.

Dr Nick Glover Locality lead – Blaby and Lutterworth Nick gained a Bachelor of Medicine and Bachelor of Surgery (MBChB) degree at Leicester Medical School in 1992 and a Diploma Royal College of Obstetricians and Gynaecologists (DRCOG) in 1996. He completed his training in general practice in Leicester (MRCGP) in 1996 and becoming a GP partner at Northfield Medical Centre in Blaby in 1997. He has been training doctors coming into general practice since 2005.

Nick is the locality lead for Blaby and Lutterworth and a GP governing body member. With a main responsibility for primary care, he sits on the quality and clinical governance committee, the primary care development group, and the serious incident sign-off group.

Dr Andy Ker

Locality lead - Melton, Rutland and Harborough

Andy is a senior partner at Oakham Medical Practice in Rutland. In 1983 he trained as a doctor at Westminster Medical School in London, achieving a MBBS, and then completed his GP Vocational Training in Guildford in 1987. He went on a travelling "gap year" in 1989 where he ended up working for six months in general practice in Christchurch, New Zealand.

He started work as a GP in Oakham in 1990 and has a particular interest in the musculoskeletal system. He has also worked as an appraiser and trainer of GPs and been a prison medical officer. Andy is a governing body member for East Leicestershire and Rutland Clinical Commissioning Group and the locality lead for Melton, Rutland and Harborough. He is the clinical lead for community services and out of county contracts. His project work includes leading the dementia strategy and developing the integrated health and social care strategy, and he also sits on the Rutland Health and Wellbeing Board.


Dr Richard S Hurwood Locality lead – Melton, Rutland and Harborough Richard has worked at The County Practice based at Syston Health Centre since 1984, becoming a senior partner in 2000. He studied medicine at Guy's Hospital medical school in London and graduated MBBS from The University of London in 1977. Richard has been involved in GP and medical student education, and has served on South Charnwood Primary Care Group and Melton, Rutland and Harborough Primary Care Trust's Professional Executive Committee. He was also

a member of Rutland Accident Care Scheme (now EMICS) from 1997 to 2004. He has served as an officer in the Territorial Army and is a Deputy Lieutenant of Leicestershire. Richard represents the Syston, Long Clawson and Melton Mowbray practices within the Melton, Rutland and Harborough locality and is a governing body member with portfolio responsibilities for prescribing and urgent care.

Dr Richard Palin Locality lead – Oadby and Wigston Dr Palin has been a GP Partner at Bushloe End Surgery in Wigston since 2004. He is currently the locality lead representing practices in Oadby and Wigston and a governing body member.

Dr Tabitha Randell Secondary Care Clinician Tabitha has been a consultant paediatrician since 2003. She graduated from Manchester Medical School in 1992 with an MBChB degree and further qualified as MRCP(UK) in 1996 and FRCPCH in 2005. After completing specialist paediatric training in the West Midlands and Sydney, Australia, Tabitha worked as a consultant paediatrician at Stafford General Hospital from

March 2003 to October 2005. She then became consultant in paediatric endocrinology and diabetes at Nottingham University Hospitals in October 2005, and is the Deputy Head of Service for Nottingham Children's Hospital. Tabitha has been the secondary care representative on East Leicestershire and Rutland Clinical Commissioning Group's governing body since November 2012.


Mrs Carmel O'Brien Chief Nurse and Quality Officer Carmel took up the role of Chief Nurse and Quality Officer for East Leicestershire and Rutland Clinical Commissioning Group in May 2012. She has a strong background in quality and patient safety, with over 25 years' experience in both clinical and management roles across acute, community and primary care.

Carmel studied in the West Midlands, becoming a registered general nurse in 1989 and a registered midwife in 1991, and worked for three years as a midwife in Australia. She has a BA in Health Studies and a Masters in Leadership across Health and Social Care. She was previously the associate director for nursing and quality for NHS Leicestershire County and Rutland Community Health Services and the associate director for quality for NHS Leicestershire County and Rutland Primary Care Trust.

Mr Tim Sacks Chief Operating Officer Tim joined the NHS in 2003 through the national management training scheme, bringing eight years work experience in the private sector from a large insurance company and a Masters in Health Care Management. Following strategic and operational roles in West Kent PCT, Medway Foundation Trust and the NHS Confederation, he moved to the Leicester, Leicestershire and Rutland health community in 2005 and carried out predominately

operational roles at Leicester University Hospitals and as head of primary care at Leicestershire County and Rutland PCT. Tim joined East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) during its shadow period in 2011 and was appointed to his current role as chief operating officer in February 2013. Tim welcomes the opportunity to work closely with GPs, stakeholders and patients to collaboratively deliver high quality care.


Jane Chapman

Chief Strategy and Planning Officer

Jane began her career in health in 1996 when she joined Leicester Royal Infirmary. She held a variety of positions in both administration and management. Prior to this she was a weapon analyst with the Royal Navy and she served from 1976 until 1982 on HMS Excellent. She then worked within the retail sector and held a position as a training and development manager for Next from 1988 to 1996.

Jane has spent all of her NHS career working in Leicestershire, apart from three years when she worked for the Arden Cancer Network in Warwickshire. She was part of the award-winning Leicestershire Lung Cancer Team. In 2003 Jane completed a post graduate diploma in Health and Social Care at De Montfort University. She joined Leicestershire County and Rutland Primary Care Trust in 2007 and was the associate director for the 18 weeks programme and then the deputy director of contracting, procurement and performance. She was appointed to her current role as chief strategy and planning officer for East Leicestershire and Rutland Clinical Commissioning Group in May 2012.

Mrs Karen English

Chief Finance Officer and Deputy Accountable Officer

Karen joined East Leicestershire and Rutland Clinical Commissioning Group as chief finance officer in January 2013. She studied BA (Hons) in Business Studies at Liverpool, and a Post Graduate Diploma in Managing and Commissioning in Primary Care in Southampton in 2005.

Since joining the NHS as a Graduate Trainee from the private sector in 1983, Karen has held a range of senior finance roles for a variety of NHS organisations. Her wealth of experience includes working at an executive level within the NHS and she has substantial and successful experience as a senior finance professional in complex health environments in the North West and West Midlands. Karen is a member of the Institute of Public Finance and Accountancy (CIPFA) and a CIPFA consultation panel member.


Mr Warwick Kendrick

Independent Lay Member - Finance & Performance

Warwick studied accountancy at Birmingham College of Commerce and was admitted as a Fellow of the Chartered Institute of Management Accountants (FCMA) in 1982.

He has held senior finance appointments including Group Financial Controller and Company Secretary of Vislink Plc, and senior posts with BOC Healthcare, Mannesmann Group and MacLellan Group Plc.

In 2001 Warwick established his own consultancy business providing accountancy services, financial and commercial advice, business development, strategic planning and general business advice to public and private companies.

Between 2006 and 2011 Warwick was a Non Executive Director of Leicestershire County and Rutland Primary Care Trust and was Chair of the Audit Committee, and Finance and Performance, Charitable Funds and Competition and Procurement Committees. Following the NHS reforms in 2011 Warwick was appointed an Independent Lay Member of East Leicestershire and Rutland Clinical Commissioning Group and chairs the Audit Committee and Quality and Clinical Governance Committee. He is also a member of the Remuneration Committee.

Mr Alan Smith

Independent Lay Member Alan has been an independent lay member of East Leicestershire and Rutland Clinical Commissioning Group since January 2013. He is a Governing Body and Audit Committee member, and also chairs the Finance and Performance and Remuneration Committees.

Alan has held a range of senior finance appointments during his career including group finance director and group

managing director of Anglian Water plc, as well as working in local authority posts. He has also worked in non-executive, part-time positions for several pharmaceutical and biotech companies including Acambis Plc, Avlar Bioventures, CeNeS Pharmaceuticals and Medical Device Innovations Ltd. He is a member of the Chartered Institute of Public Finance and Accountancy (Honours) and completed an Advanced Management Programme at Harvard Business School in 1992.


Members of committees of the Governing Body Members of the committees of the Governing Body are contained within the table below.

Title First Name

Last Name

Governing Body

Audit Committee

Finance and Performance Committee

Quality and Clinical

Governance Committee

Remuneration Committee

Strategy, Planning and

Commissioning Committee

Dr David Briggs �

Mrs. Karen English � �

Mrs. Jane Chapman � � �

Mrs. Carmel O'Brien � � �

Mr. Timothy Sacks � � � �

Dr Nicholas Glover � �

Dr Richard Hurwood �

Dr Graham Johnson � �

Dr Andy Ker � � �

Dr Hamant Mistry � � Chair

Dr Richard Palin � �

Dr Tabitha Randell � � �

Dr Tim Daniel � � �

Mr. Graham Martin Chair � �

Mr. Warwick Kendrick � Chair � Chair �

Mr. Alan Smith � � Chair Chair

Please see the Governance Statement on for details of our committees. Details in respect of Governing Body members’ declarations of interest are as follows.

Declarations of Interest Register

(as at end 31 March 2014)

Name Job Title Category 1 - Directorships

Category 2 - Remunerated employment, office, profession etc.

Category 3 - Appointments

Category 4 - Membership

Category 5 - Ownership

Category 6 - Shareholdings

Cate

go

ry 7

- G

ifts

an

d H

osp

itality

- s

ee s

ep

ara

te r

eg

iste

r

Category 8 - Misc

Dr David Briggs

Managing Director

N/A N/A N/A Member of the British Medical Association.

N/A N/A Former partner at Latham House Medical Practice.

Wife is a partner at St John’s Medical Centre in Lincolnshire. This Practice is also a minor shareholder in Ladhams which is a provider of community care services.

Dr Nicholas Glover

GP Board Member/ Blaby and Lutterworth Locality Lead

N/A GP Partner at Northfield Medical Centre, Blaby. GP Trainer, East Midlands Deanery.

N/A Member of the Royal College of General Practitioners, British Medical Association and member of the Leicestershire Local Medical Committee.

N/A The Northfield Medical Centre is a minor shareholder in Leicester, Leicestershire and Rutland Provider Company Ltd. (LLR Provider Company Ltd).

N/A








Category 8 - Misc

Dr Graham Johnson

GP Board Member/ Blaby and Lutterworth Locality Lead

N/A GP Partner at Wycliffe Medical Practice.

N/A Member of the Leicestershire Local Medical Committee.

N/A Wycliffe Medical Practice is a minor shareholder in Leicester, Leicestershire and Rutland Provider Company Ltd. (LLR Provider Company Ltd).

N/A

Dr Hamant Mistry

GP Board Member/ Melton, Rutland and Harborough Locality Lead

N/A GP Partner at Market Harborough Medical Centre and Husbands Bosworth Surgery.

Practice is a provider of minor injury services.

N/A Fellow of Royal College of GPs and British Medical Association Member.

N/A Market Harborough Medical Centre and Husbands Bosworth Surgery are minor shareholders in Leicester, Leicestershire and Rutland Provider Company Ltd (LLR Provider Company Ltd). Shareholder Market Harborough Medical Services Limited. Owner of Market Harborough Pharmacy.

N/A








Category 8 - Misc

Dr Richard Hurwood

(from October 2013)


N/A GP Principal at The County Practice Syston Health Centre.

Deputy Lieutenant of Leicestershire

Member of British Medical Association. Royal College of GPs.

Syston Health Consortium (1 of 10 partners owning Syston Health Centre)

The County Practice is a shareholder in Leicester, Leicestershire and Rutland Provider Company Ltd. (LLR Provider Company Ltd).

Registered with GP in the area. Wife is an acupuncturist in private practice.

Dr Simon Wooding (until 9

th

September 2013)


Director of Long Clawson Medical Services Ltd.

GP Partner at Long Clawson Medical Practice.

My wife is a partner in Latham House Medical Practice, Melton Mowbray. My wife is also employed by Derbyshire Community Health Service to provide Ear, Nose and Throat Clinical Services at Melton Mowbray Hospital.

N/A Member of Leicestershire Local Medical Committee (wife is also).

Member of British Medical Association.

N/A Minor shareholder in Leicester, Leicestershire and Rutland Provider Company Ltd. (LLR Provider Company Ltd) (as is wife).

N/A








Category 8 - Misc

Dr David Andrew James Ker


N/A GP Partner in Oakham Medical Practice and Market Overton and Somerby Surgery.


N/A Member of the British Medical Association and Royal College of General Practitioners.

N/A Minor Shareholder in the Leicester, Leicestershire and Rutland Provider Company Ltd. (LMC Provider Company Ltd). Oakham Medical Practice and Market Overton and Somerby Surgery are minority shareholders in The Leicester, Leicestershire and Rutland Provider Company Ltd. (LLR Provider Company Ltd).

Wife is a partner at Oakham Medical Practice and Market Overton and Somerby Surgery. The Practices are minority shareholders in The Leicester, Leicestershire and Rutland Provider Company Ltd. (LLR Provider Company Ltd).

Dr Richard Palin

GP Board Member/ Oadby and Wigston Locality Lead

N/A GP Partner at Bushloe End Surgery, Wigston. GP at HMYOI Glen Parva. Leicestershire Partnership Trust Clinical Director HMYOI Glen Parva HMP Gartree and HMP Leicester.

Member Royal College of General Practitioners and British Medical Association Member.

N/A N/A N/A








Category 8 - Misc

Mr Warwick Kendrick

Independent Lay Member

N/A N/A N/A Member of Chartered Institute of Management Accountants (CIMA).

N/A N/A N/A

Mr Graham Anthony Martin

Independent Lay Chair

N/A Ad-hoc consulting work for Hay Group, an international management consulting firm that does provide services for the NHS. Adviser for Beamans Management Consultants (Isle of Man).

N/A N/A N/A N/A N/A

Mr Alan Frederick Smith


N/A N/A N/A Member of the Chartered Institute of Public Finance and Accountancy.

N/A N/A N/A








Category 8 - Misc

Mr Tim Sacks

Chief Operating Officer

N/A N/A N/A N/A N/A N/A Wife is a partner at Oakham Medical Practice (from 1st July 2013).


Mrs Carmel O'Brien

Chief Nurse and Quality Officer

N/A N/A N/A Member of Royal College of Nursing.

N/A N/A N/A

Mr Paul Sherriff

(from October 2012 - May 2013)


N/A N/A N/A

Health and Care Professions Council (HCPC) Reg. No. CH12158.

N/A N/A N/A

Mrs Karen English

Chief Finance Officer

N/A N/A N/A Member of Chartered Institute of Public Finance and Accountancy.

Hold a 30% share in GEC Ltd (a consultancy business).

N/A N/A








Category 8 - Misc

Mrs Jane Chapman

Chief Strategy and Planning Officer

Partner is owner of Hollyview Health – business consultancy, predominantly healthcare, likely to undertake business with the local NHS.

N/A N/A Member of the Institute of Health Care Management.

See Directorship section.

N/A N/A

Dr Tim Daniel

Consultant in Public Health Medicine

N/A Consultant in Public Health Medicine – Leicestershire County Council (from 01.04.2013); East Midlands Public Health Foundation Programme Director for LNR; Salaried GP Kegworth and Gotham Medical Practice; Sessional GP for Nottingham Emergency Medical Services.

N/A Member of Royal College of General Practitioners and British Medical Association. Fellow of Faculty of Public Health

N/A N/A N/A








Category 8 - Misc

Dr Tabitha Louise Randell

Consultant Paediatric Endocrinologist (Board member: secondary care clinician)

N/A Consultant Paediatric Endocrinologist, Nottingham University Hospitals NHS Trust.

Clinical Lead for Paediatric Diabetes, NHS Diabetes (until 31.03.13). Associate Clinical Professor, Warwick Medical School.

N/A Member of British Society of Paediatric Endocrinology and Diabetes. Member of British Medical Association. Fellow of the Royal College of Paediatrics and Child Health.

N/A N/A N/A


Sickness absence data

ELR CCG’s staff consisted of 93 employees at the end of the year. We recognise the valuable contribution made by each employee to the delivery of its services and we are committed to the promotion of their health, safety and well-being. The organisation is also committed to acting as a reasonable employer at all times in dealing with employees who suffer ill health or incapacity either of a temporary or permanent nature. In order to maintain and promote a healthy organisation and ensure the continued provision of high quality patient care, it is essential that absence due to ill health is monitored and managed effectively and that managers and employees are aware of their responsibilities in this process. While accepting that some absence due to ill health is inevitable, high absence rates not only affect individuals but place increased pressure on colleagues which may ultimately lead to a deterioration in services that ensure overall quality of patient care. To that end we have prepared a policy and procedure on ‘Managing absence due to ill health’.

Staff sickness absence 2013-14 Number

Total days lost 855

Total staff years 74

Average working days lost 12 The CCG’s absence rates outlined in the table above, at an average of 12 days per employee per year, are relatively high and exceed the target set by the Department of Health. However, the average absence rates are affected significantly by a small number of staff who have taken long term sick leave. If the absence data for those 6 staff is removed then the average rate falls to 5 days per employee per year.

External audit The CCG’s external auditor is Grant Thornton UK LLP and the annual external audit fee for 2013/14 is £77,000 (excluding VAT) relating to the statutory audit.

Disclosure of serious untoward incidents A Serious Incident (SI) is defined as an incident that occurred in relation to NHS-funded healthcare (including the community) which resulted in one or more of the following:

• unexpected or avoidable death or severe harm of one or more patients, staff or members of the public

• a ‘never event’ - defined as Serious Incidents although not all ‘never events’ necessarily result in severe harm or death. (See Never Events Framework)

• a scenario that prevents, or threatens to prevent, an organisation’s ability to continue to deliver healthcare services, including data loss,


property damage or incidents in population programmes like screening and immunisation where harm potentially may extend to a large population

• allegations, or incidents, of physical abuse and sexual assault or abuse

• and / or loss of confidence in the service, adverse media coverage or public concern about healthcare or an organisation.

All incidents that are identified as meeting the criteria for external reporting are logged onto the National Strategic Executive Information System (STEIS) within two working days. The incident is then allocated a grading 0, 1 or 2, see table below. Grade Description

Grade 0 Used when it is initially unclear whether or not the incident qualifies as a Serious Incident at this early stage. It can be upgraded or downgraded with agreement from the Commissioners. Grade 1 This level of incident will require a Comprehensive Root Cause Analysis (RCA Level 2 Investigation), as defined by the NPSA National Framework for

Grade 2 Incidents considered as h igh r isk. This level of investigation will require a Comprehensive RCA (RCA level 2 Investigation) or an Independent Investigation (RCA level 3), as defined by the NPSA National Framework for Reporting and Learning from Serious Incidents

All SIs are subject to a thorough investigation which includes:

• establishing the facts

• highlighting any areas of good practice

• identifying any service delivery problems, care delivery problems, contributory factors, root cause(s), any learning points and actions required to minimise the same type of incident happening again.

Providers are allocated a timeframe for submission of final reports; 45 days for Grade 1 and 60 days for Grade 2. On completion of the investigation, the report is submitted to the commissioners for closure. The Patient Safety Serious Incident (SI) Sign Off group which contains GPs, nursing and quality contracting representatives from each Clinical Commissioning Group (CCG) has the delegated responsibility to ensure that the investigations submitted for closure are robust, of a high quality and have an auditable action plan with recommendations to prevent a reoccurrence. During 2013/14 SIs occurring in provider organisations could not be reported on via location or CCG area, due to this information not being available. However following amendments to the national STEIS system and East Leicestershire and Rutland CCG’s local SI database this will now be possible moving forward into 2014/15.


111

74

4

0

20

40

60

80

100

120

Leicestershire Partnership

NHS Trust

University Hospitals of

Leicester

Other Provider

Serious Incidents by Provider (Excluding Pressure Ulcers) April 2013 - March 2014

Total

169

148

6

0

20

40

60

80

100

120

140

160

180


NHS Trust


Leicester

Other Provider

Serious Incidents by Provider (Including Pressure Ulcers)April 2013 - March 2014

Total

0

3

00

1

2

3

4

5


NHS Trust


Leicester

Other Provider

Never Events by Provider

Total


We place high importance on ensuring there are robust information governance systems and processes in place to help protect patient and corporate information. There are processes in place for incident reporting and investigation of serious incidents relating to information governance. Further detail about information governance is available in the CCG’s Governance Statement.

Principles for Remedy ELR CCG’s Policy for Dealing with Complaints is guided by the Principles of Good Complaints Handling published by the Parliamentary and Health Service Ombudsman for public bodies:

• getting it right

• being customer focussed

• being open and accountable

• acting fairly and proportionately

• putting things right

• seeking continuous improvement. This is how we interpret the principles and how we will handle complaints:

• complaints are dealt with efficiently and confidentially

• complaints are properly investigated, monitored and recorded

• complainants receive, so far as reasonably practicable, assistance to enable them to understand the procedure or advice on where assistance should be available

• complainants receive a timely and appropriate response

• complainants are told of the outcome of the investigation of their complaint and action is taken, if necessary, in the light of the outcome of a complaint

• the process for dealing with complaints should be, and be seen to be, impartial and fair to both staff and complainant alike

• complainants will be treated with respect and courtesy

• complainants will not be discriminated against for making a complaint and making a complaint will not adversely affect future treatment

• information will be provided to senior management to help services to be reviewed and improved

• all complainants will receive a sympathetic and caring response and, where appropriate, an apology given or an expression of regret

• staff will receive appropriate training in handling complaints.

Employee Consultation Employee engagement is the extent to which employees feel passionate about their jobs, are committed to the organisation, and put discretionary effort into their work. Engaged employees are motivated to do more. Evidence shows there is a clear relationship between satisfied, engaged and happy staff and better care for patients. In November 2013, the organisation held vision and values staff events which were attended by all staff and were designed to provide staff with a greater understanding


of the CCG’s vision and values and how members of staff contribute to the CCG’s six strategic aims. This culminated in an organisation-wide event in December 2013 which included a celebration of the CCG’s achievement during the year and the contributions and impact our staff have made to the CCG’s performance. The Equality Report provides further detail about the CCG’s workforce.

Emergency preparedness, resilience and response We certify that the clinical commissioning group has incident response plans in place, which are fully compliant with the NHS Commissioning Board Emergency Preparedness Framework 2013. The clinical commissioning group regularly reviews and makes improvements to its major incident plan and has a programme for regularly testing this plan, the results of which are reported to the Governing Body.

Statement as to Disclosure to Auditors Each individual who is a member of the Governing Body, at the time of the Governing Body Members’ Report is approved, confirms:

• So far as the member is aware, that there is no relevant audit information of which the clinical commissioning group’s external auditor is unaware; and,

• That the member has taken all the steps that they ought to have taken as a member in order to make them self aware of any relevant audit information and to establish that the clinical commissioning group’s auditor is aware of that information.

Dr David Briggs Managing Director (Accountable Officer) 4 June 2014


Remuneration Report As a public sector body, Clinical Commissioning Groups are required to disclose information about senior managers’ remuneration. The disclosure includes the remuneration of ‘those in senior positions having authority or responsibility for directing or controlling the activities of the NHS body’; this has been interpreted as Chief Officers, Lay member and GPs who are members of the CCG’s Governing Body many of whom are not directly employed by the CCG. The Remuneration Committee is made up of the following members:

Name Position

Mr Alan Smith Independent Lay Member, Remuneration Committee Chair

Mr Warwick Kendrick


Mr Graham Martin Lay Chair

The Remuneration Committee, which comprises of the Chairman of the Governing Body and the two Independent Lay Members, reviews the remuneration arrangements of its most senior managers including the sessional rates for GP members of the Governing Body, taking into account market rates and agenda for change pay awards determined nationally. The Committee held 4 meetings during 2013 – 2014 all of which were quorate and attended by all three members.

Policy on Remuneration of Senior Managers

East Leicestershire and Rutland Clinical Commissioning Group’s Accountable Officer is remunerated according to the Very Senior Manager (VSM) Framework. NHS England’s Remuneration Guidance for Chief Officers (where the senior manager also undertakes the accountable officer role) and Chief Finance Officers. This guidance has been used to set the Managing Director, Chief Finance Officer and Chief Nurse and Quality Officers’ salary.

All other chief officers employed by East Leicestershire and Rutland Clinical Commissioning Group are paid according to the NHS Agenda for Change pay scale at a level that is consistent with the contents of the officer’s job role.

East Leicestershire and Rutland Clinical Commissioning Group commissioned Greater East Midlands Commissioning Support Unit and an accountancy firm specialising in health to undertake regional benchmarking of GP CCG Governing Body remuneration rates in other parts of the country and provide clarity on the legal issues relating to the employment status of GPs serving on CCG Governing Bodies.

Following this review recommendations were made by the Remuneration Committee to the Governing Body. The recommendations were approved by the Governing Body (the GP members of the Governing Body absented themselves from the meeting at this point) and have been used to set the pay for the GP members for


2013/14. GP members are, for employment purposes, treated as office holders of the CCG. They are paid via the payroll, with deductions taken at source.

Independent lay members are remunerated at rates in line with those previously paid to nonexecutive directors under the guidelines set out by the Appointments Commission.

Senior managers’ performance related pay

The accountable officer is the only chief officer that is eligible to receive performance related pay under the VSM Framework. The Chair of the Governing Body assesses the accountable officer’s performance against the objectives and makes a recommendation to the Remuneration Committee of the bonus that should be awarded. There were no bonus payments made in 2013-14.

Policy on senior managers’ contracts

All chief officers, excluding the managing director, are employed under the agenda for change terms and conditions.

Senior managers’ service contracts

GP Member practices elected the GP members of East Leicestershire and Rutland CCG’s Governing Body to their posts for a period of three years from 1 April 2013. Six months’ prior notice must be given in writing by either party to terminate the agreement early.

The independent lay members are appointed for a term of 3 years from when they commenced in post. The secondary care clinician position on the Governing Body was appointed for three years from commencement in post following an open recruitment process.

Payments to Past Senior Managers

There have been no payments outside of contractual entitlements made to CCG senior managers in this financial year.

Salaries and allowances The table below shows the remuneration (excluding any employer’s National Insurance contributions) for all Governing Body Board members irrespective of their employment status with the CCG. Salary includes:

• all amounts paid or payable by the NHS body including recharges from any other health body


• the gross cost of any arrangement whereby a senior manager receives a net amount and an NHS body pays income tax on their behalf

• any financial loss allowances paid in place of remuneration

• geographical allowances such as London weighting, and

• any other allowance which is subject to UK taxation and any ex-gratia payments.

Salary excludes:

• recharges to any other health body

• reimbursement of out-of-pocket expenses

• reimbursement of "travelling and other allowances" (paid under determination order) including home to work travel costs

• taxable benefits

• employers' superannuation and National Insurance contributions

• performance related bonuses (these are recorded separately)

• golden hellos and compensation for loss of office (these are recorded separately), and

• any amount paid which the director must subsequently repay.


Salary & Pension Disclosure Tables Salaries and allowances

Name & Title Salary (bands

of £5,000) *Expense payments

(taxable) total to nearest £100

Performance pay and bonuses

(bands of £5,000)

Long term performance pay

and bonuses (bands of £5,000)

All pension-related benefits

(bands of £2,500)

TOTAL (bands of

£5,000)

£000 £00 £00 £000 £000 £000

Dr David Briggs - Managing Director and Accountable Officer 140 - 145 - - - 22.5 - 25 165 - 170

Jane Chapman - Chief Strategy and Planning Officer 85 - 90 - - - 5 - 7.5 95 - 100

Karen English - Chief Finance Officer and Deputy Accountable Officer 100 - 105 - - - 0 - 2.5 105 - 110

Carmel O’Brien - Chief Nurse and Quality Officer 75 - 80 - - - 67.5 - 70 145 - 150

Timothy Sacks4 - Chief Operating Officer 65 - 70 12 - - 32.5 - 35 100 - 105

Paul Sherriff5 - Chief Corporate Affairs Officer (to 19/05/2013) 10 - 15 - - - 57.5 - 60 70 - 75

Dr Nick Glover6 - Locality Representative 60 - 65 - - - 87.5 - 90 150 - 155

Dr Richard Hurwood7 - Locality Representative (from 01/10/2013) 30 - 35 - - - 5 - 7.5 40 - 45

Dr Graham Johnson - Locality Representative 65 - 70 - - - 35 - 37.5 105 - 110

Dr Andy Ker - Locality Representative 60 - 65 - - - 252.5 - 255 315 - 320

Dr Hamant Mistry - Locality Representative 70 - 75 - - - 180 - 182.5 255 - 260

Dr Richard Palin - Locality Representative 60 - 65 - - - 227.5 - 230 290 - 295

Dr Simon Wooding8 - Locality Representative (to 09/09/2013) 25 - 30 - - - 120 - 122.5 150 - 155

Dr Tabitha Randell9 - Secondary Care Clinician 30 - 35 - - - - 30 - 35

Dr Tim Daniels10

- Public Health Consultant n/a n/a n/a n/a n/a n/a

Mr Graham Martin11

- Governing Body Chair 25 - 30 - - - - 25 - 30

Mr Warwick Kendrick - Independent Lay Member 10 - 15 - - - - 10 - 15

Mr Alan Smith - Independent Lay Member 5 - 10 - - - - 5 - 10

4 The expense payments and benefits in kind of £1.2k relates to Tim Sacks' lease car

5 Paul Sherriff left the CCG on 19 May 2013

6 Dr’s Glover to Wooding are Office Holders and not employees of the CCG

7 Dr Richard Hurwood was appointed to the CCG on 1 October 2013

8 Dr Simon Wooding left the CCG on 9 September 2013

9 Dr Tabitha Randell is employed by Nottingham University Hospitals NHS Trust, to whom the CCG reimburses a proportion of her salary

10 Dr Tim Daniels is employed by Leicestershire County Council, there is no charge for his time

11 Messrs Martin, Kendrick and Smith are Independent Lay Members and are not employees of the CCG


Pension Benefits

Name and title

Real increase in pension at age 60 (bands of £2,500)

Real increase in pension lump sum at age 60 (bands of £2,500)

Total accrued pension at age 60 at 31 March 2014 (bands of £5,000)

Lump sum at age 60 related to accrued pension at 31 March 2014 (bands of £5,000)

Cash Equivalent Transfer Value at 1 April 2013 (nearest £1,000)

Cash Equivalent Transfer Value at 31 March 2014 (nearest £1,000)

Real increase in Cash Equivalent Transfer Value (nearest £1,000)

Employer’s contribution to stakeholder

pension12

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

Dr David Briggs - Managing Director and Accountable Officer 0 - 2.5 5 - 7.5 10 - 15 35 - 40 142 175 30 n/a

Jane Chapman - Chief Strategy and Planning Officer 0 - 2.5 0 - 2.5 10 - 15 35 - 40 222 247 21 n/a

Karen English - Chief Finance Officer and Deputy Accountable Officer13

0 - 2.5 (0) - (2.5) 20 - 25 55 - 60 398 455 49 n/a

Carmel O’Brien - Chief Nurse and Quality Officer 2.5 - 5 10 - 12.5 25 - 30 75 - 80 369 447 70 n/a

Timothy Sacks - Chief Operating Officer 0 - 2.5 5 - 7.5 5 - 10 25 - 30 99 130 28 n/a

Paul Sherriff - Chief Corporate Affairs Officer (to 19/05/2013) 0 - 2.5 0 - 2.5 20 - 25 60 - 65 243 293 6 n/a

Dr Nick Glover - Locality Representative14

2.5 - 5 10 - 12.5 10 - 15 30 - 35 93 163 68 n/a

Dr Richard Hurwood - Locality Representative (from 01/10/2013)15

0 - 2.5 0 - 2.5 0 - 5 0 - 5 0 9 5 n/a

Dr Graham Johnson - Locality Representative 0 - 2.5 5 - 7.5 5 - 10 15 - 20 63 94 29 n/a

Dr Andy Ker - Locality Representative16

10 - 12.5 32.5 - 35 10 - 15 40 - 45 68 280 211 n/a

Dr Hamant Mistry - Locality Representative 7.5 - 10 22.5 - 25 5 - 10 25 - 30 28 179 150 n/a

Dr Richard Palin - Locality Representative 10 - 12.5 30 - 32.5 10 - 15 35 - 40 40 198 156 n/a

Dr Simon Wooding - Locality Representative (to 09/09/2013) 0 - 2.5 5 - 7.5 5 - 10 20 - 25 46 147 44 n/a

Dr Tabitha Randell 17

- Secondary Care Clinician n/a n/a n/a n/a n/a n/a n/a n/a

Dr Tim Daniels - Public Health Consultant18

n/a n/a n/a n/a n/a n/a n/a n/a

Mr Graham Martin - Governing Body Chair19

n/a n/a n/a n/a n/a n/a n/a n/a

12 Contributions to stakeholder pension are not applicable to ELRCCG Senior Managers

13 Karen English is a member in both 1995 section and 2008 section of the Pension Scheme (2008 section does not include lump sum unless purchased hence the decrease in pension

lump sum)

14 Dr’s Glover to Wooding are Office Holders therefore the disclosure figures have been provided for officer service only and do not include any benefits in respect of practitioner

service

15 Dr Richard Hurwood was appointed to the CCG on 1 October 2013, and his office of membership began on 1 October 2013

16 Dr’s Ker, Mistry and Palin’s pension increase is significantly high as this compares pension lump sums as at 31st March 2014 with the pension lump sums relating to the last time they

were in the equivalent officer employment.

17 Dr Tabitha Randell is employed by Nottingham University Hospitals NHS Trust, to whom the CCG reimburses a proportion of her salary. The CCG do not hold information for this

individual’s pension

18 Dr Tim Daniels is employed by Leicestershire County Council. The CCG do not hold information for this individual’s pension 19 Messrs Martin, Kendrick and Smith are Independent Lay Members and are not employees of the CCG. As Non-Executive members do not receive pensionable remuneration, there will

be no entries in respect of pensions for Non-Executive members.


Mr Warwick Kendrick - Independent Lay Member n/a n/a n/a n/a n/a n/a n/a n/a

Mr Alan Smith - Independent Lay Member n/a n/a n/a n/a n/a n/a n/a n/a


Cash Equivalent Transfer Values A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their membership of the pension scheme. This may be for more than just their service in a senior capacity to which disclosure applies (in which case this fact will be noted at the foot of the table). The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries. Real Increase in CETV This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period. 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 banded remuneration of the highest paid member of the Governing Body in the Clinical Commissioning Group in the financial year 2013/14 was £140,000 - £145,000. This was 4.05 times the median remuneration of the workforce, which was £34,530. In 2013/14, no employees received remuneration in excess of the highest-paid member of the Governing Body and their banded remuneration ranged from £5,000 to £105,000. 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. Exit Packages Two redundancy payments were made based on contractual entitlement. No payments have been made that either exceed contractual amounts and/or could be defined as special severance payments requiring HM Treasury approval.


Off-payroll engagements Off-payroll engagements Table 1: Off-payroll engagements as of 31 March 2014, for more than £220 per day and that last longer than six months are as follows:

Number

Number of existing engagements as of 31 March 2014 8

Of which, the number that have existed:

for less than one year at the time of reporting 8

for between one and two years at the time of reporting 0

for between 2 and 3 years at the time of reporting 0

for between 3 and 4 years at the time of reporting 0

for 4 or more years at the time of reporting 0

Off-payroll engagements Table 2: 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 2013 and 31 March 2014

10

Number of new en gagements which include contractual clauses giving the East Leicestershire and Rutland CCG the right to request assurance in relation to income tax and National Insurance obligations

10

Number for whom assurance has been requested 10

Of which:

assurance has been received 9

assurance has not been received 1

engagements terminated as a result of assurance not being received 0

Number of off-payroll engagements of board members, and/or senior officers with significant financial

responsibility, during the year20

0

Number of individuals that have been deemed “board members, and/or senior officers with significant financial responsibility” during the financial year. This figure includes both off-payroll and on-payroll engagements

3

Dr David Briggs Managing Director (Accountable Officer) 4 June 2014

20 There were no off-payroll engagements of board members as there were no board members recruited via agency.

Statements by the Accountable Officer

Statement of the Managing Director’s responsibilities as the Accountable Officer of NHS East Leicestershire and Rutland Clinical Commissioning Group The National Health Services 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 Managing Director 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 Services 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. Dr David Briggs Managing Director (Accountable Officer) 4 June 2014


Governance Statement

Introduction and Context The clinical commissioning group was licensed from 1 April 2013 under provisions enacted in the Health and Social Care Act 2012, which amended the National Health Service Act 2006. The clinical commissioning group operated in shadow form prior to 1 April 2013, to allow for the completion of the licensing process and the establishment of function, systems and processes prior to the clinical commissioning group taking on its full powers. As at 1 April 2013, the clinical commissioning group was licensed without conditions. NHS East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG or the CCG) is a membership organisation which comprises 34 GP member practices across three localities: Melton Mowbray, Rutland and Market Harborough; Oadby and Wigston; and Blaby and Lutterworth. The CCG is responsible for commissioning healthcare services for patients across the three localities. Information about the commissioning priorities and the population the CCG serves can be found in the Strategic Report section of this document.

Scope of responsibility As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the clinical commissioning group’s policies, aims and objectives, whilst safeguarding the public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out in my Clinical Commissioning Group Accountable Officer Appointment Letter. I am also 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 CCG and best practice. For the financial year ended 31 March 2014, and up to the date signing this statement, the CCG has applied the principles of the Code as we have considered relevant to the CCG including drawing on other best practice available. This is evident, for example through the following:

o there was clear division of responsibilities between the Membership Body, the Governing Body and the executive responsibilities for


running the organisation. The Chair was responsible for leading the Governing Body and ensuring it is effective in its role, and organising appropriate development sessions support the Governing Body’s role.

o the Committees of the Governing Body consisted of a balance of skill, knowledge, independence and experience for them to carry out duties and responsibilities.

o information was supplied to the Governing Body and its committees in

a timely manner and of a quality that enables the clinical commissioning group to discharge its duties.

o the Governing Body assessed the nature and extent of the significant

risks it is willing to take in achieving the strategic objectives of the clinical commissioning group; and it maintains a sound system of risk management and internal control.

o The Remuneration Committee had oversight of the arrangements in

relation to policy on the remuneration of members of the Governing Body.

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 clinical commissioning group has in place a Constitution, which provides its corporate governance framework, as agreed by its member practices. The CCG’s Constitution consists the following: information about the membership, Standing Orders, Scheme of Reservation and Delegation and Prime Financial Policies. The Scheme of Reservation and Delegation clearly details matters reserved to the membership and authority delegated to the Governing Body, its committees and officers. The clinical governance group reviewed its Constitution in May 2013 and again in May 2014, with external legal support, ensuring that governance arrangements remain current, robust, fit for purpose and remain in line with legal functions and duties. The composition of the Governing Body was refined and roles strengthened in line with the review of the Constitution in 2013 – 2014. The Prime Financial Policies and the Scheme of Reservation and Delegation are underpinned by Detailed Financial Policies and an Operational Scheme of Delegation respectively. The clinical commissioning group Membership consists 34 GP Practices as detailed below:


Blaby and Lutterworth locality Countesthorpe Health Centre Central Street, Countesthorpe, Leicestershire. LE8 5QJ.

Wycliffe Medical Practice Gilmorton Road, Lutterworth, Leicestershire, LE17 4EB.

Kingsway Surgery 23 Kingsway Narborough Road South, Leicester, LE3 2JN.

The Limes Medical Centre 65 Leicester Road, Narborough, Leics LE19 2DU

Glenfield Surgery 111 Station Road, Glenfield, Leicestershire, LE3 8GS.

Forest House Medical Centre 2a Park Drive, Leicester Forest East, Leicester, LE3 3FN.

Northfield Medical Centre Villers Court, Blaby, Leicestershire, LE8 4NS.

Hazelmere Medical Centre 58 Lutterworth Road, Blaby, Leicester, LE8 4DN.

Narborough Health Centre Thornton Drive, Narborough Leicestershire, LE19 2GX.

The Masharani Practice Gilmorton Road, Lutterworth, Leicestershire, LE17 4EB.

Enderby Medical Centre Shortridge Lane, Enderby Leicestershire, LE19 4LY.

Melton, Rutland and Harborough locality Kibworth Health Centre Smeeton Road, Kibworth, Leicestershire, LE8 0LG.

Market Harborough Medical Centre 67 Coventry Road, Market Harborough, Leicestershire, LE16 9BX.

Oakham Medical Practice Cold Overton Road Oakham, Rutland, LE15 6NT.

Market Overton Surgery (& Somerby) Thistleton Road, Market Overton, Oakham, Leicestershire, LE15 7PP.

Long Clawson Medical Practice Long Clawson, Nr Melton Mowbray Leicestershire, LE14 4PA.

Billesdon Surgery 4 Market Place, Billesdon Leicestershire, LE7 9AJ.

Dr Kilpatrick & Partners 2a Station Road Kibworth, Leicestershire, LE8 0LN.

Latham House Medical Practice Sage Cross Street Melton Mowbray, Leicestershire, LE13 1NX.

The County Practice Syston Health Centre Melton Road, Syston Leicestershire, LE7 2EQ.

Empingham Medical Centre Main Street, Empingham Oakham, Rutland Leicestershire, LE15 8PR

The Uppingham Surgery Northgate Uppingham, Rutland, Leicestershire, LE15 9EG.

The Jubilee Medical Practice 1330 Melton Road Syston, Leicestershire, LE7 2EQ.

Husbands Bosworth Surgery Kilworth Road Husbands Bosworth Leicestershire, LE17 6JZ.

Oadby & Wigston Walk in Medical Centre 18 The Parade, Oadby, Leicester, LE2 5BJ.

Oadby and Wigston locality Bushloe End Surgery 48 Bushloe End, Wigston, Leicestershire, LE18 2BA

Central Surgery Brooksby Drive, Oadby Leicester, LE2 5AA.

Rosemead Drive Surgery 103 Rosemead Drive Oadby, Leicestershire, LE2 5PP.


The Croft Medical Centre 2 Glen Road, Oadby Leicestershire, LE2 4PE.

Wigston Central Surgery 48 Leicester Road Wigston Leicestershire, LE18 1DR.

South Wigston Health Centre 80 Blaby Road South Wigston Leicestershire, LE18 4SE.

Long Street Surgery 24 Long Street, Wigston Leicestershire, LE18 2AH.

Severn Surgery 159 Uplands Road Oadby Leicestershire, LE2 4NW.

Station Road Surgery 152 Station Road Wigston Leicestershire, LE18 2BL.

The clinical commissioning group is led by a Governing Body comprising elected GP members, a secondary care clinician and lead nurse and independent lay members as detailed below. Name Position

Mr Graham Martin Lay Chair Dr Hamant Mistry Clinical Vice Chair / Melton, Rutland and

Harborough GP Locality Lead Dr David Briggs Managing Director Dr Nicholas Glover Blaby and Lutterworth GP Locality Lead Dr Graham Johnson Blaby and Lutterworth GP Locality Lead Dr Simon Wooding (up to 9th September 2013)


Dr Richard Hurwood (from 1st October 2013)


Dr Andrew Ker Melton, Rutland and Harborough GP Locality Lead

Dr Richard Palin Oadby and Wigston GP Locality Lead Mr Warwick Kendrick Independent Lay Member Mr Alan Smith Independent Lay Member Dr Tabitha Randell Consultant Paediatric Endocrinologist

(secondary care clinician) Mrs Carmel O'Brien Chief Nurse and Quality Officer

Mrs Karen English Chief Finance Officer Mr Paul Sherriff (from October 2012 - May 2013)


Mrs Jane Chapman Chief Strategy and Planning Officer Mr Tim Sacks Chief Operating Officer Dr Tim Daniel Consultant in Public Health Medicine (in

attendance) The overall responsibility for the management of internal control lies with me as the Accountable Officer. The Governing Body, in line with authority delegated to it by the Membership, collectively and individually ensured that robust systems of internal control and management were in place. This responsibility was supported through an effective committee structure, including joint committees established with the local authorities; and collaborative arrangements established with Leicester City CCG and West Leicestershire CCG in respect of services commissioned collaboratively across the three CCGs. In 2013 – 2014 the committee structure of the CCG was as per the table below, which also details committee members:


Title First Name

Last Name

Governing Body

Audit Committee

Finance and Performance Committee

Quality and Clinical

Governance Committee

Remuneration Committee

Strategy, Planning and

Commissioning Committee

Dr David Briggs �

Mrs. Karen English � �

Mrs. Jane Chapman � � �

Mrs. Carmel O'Brien � � �

Mr. Timothy Sacks � � � �

Dr Nicholas Glover � �

Dr Richard Hurwood �

Dr Graham Johnson � �

Dr Andy Ker � � �

Dr Hamant Mistry � � Chair

Dr Richard Palin � �

Dr Tabitha Randell � � �

Dr Tim Daniel � � �

Mr. Graham Martin Chair � �

Mr. Warwick Kendrick � Chair � Chair �

Mr. Alan Smith � � Chair Chair

The committee structure has supported the identification and management of internal controls and risks as follows :

a) Audit Committee – the Audit Committee (statutory committee), which is accountable to the group’s governing body. The Audit Committee has responsibility for reviewing and ensuring that the organisation has established and is maintaining robust and effective systems of integrated governance, risk management and internal control across all areas of its business. It is responsible for providing assurance to the Governing Body that the Corporate Management Team has appropriate and adequate systems in place to ensure links between risk management, financial risk, corporate and clinical governance. The Audit Committee reviewed the Board Assurance Framework to provide assurance to the Governing Body that the organisation’s risk management processes are effective and risks are being effectively controlled. The Committee received regular reports on the work and findings of the internal and external auditors; reports from counter fraud team; reports from management in relation to follow-up and progress in relation to implementation of audit recommendations. The Audit Committee received a formal opinion from the Head of Internal Audit on the degree of assurance that can be derived from the system of internal control. The Audit Committee is chaired by an independent lay member. The Committee has a schedule to meet at least 6 times a year, which it has done so in 2013 – 2014 with all meetings being quorate, well attended and supported by the Head of Corporate Governance and Legal Affairs.


b) Remuneration and Nominations Committee – the Remuneration and Nominations Committee (statutory committee), is accountable to the group’s governing body makes recommendations to the governing body on determinations about the remuneration, fees and other allowances for employees and for people who provide services to the group and on determinations about allowances under any pension scheme that the group may establish as an alternative to the NHS pension scheme. The governing body has approved and keeps under review the terms of reference for the remuneration committee, which includes information on the membership of the remuneration committee. In addition, the governing body has delegated the approval of arrangements for identifying the group’s proposed accountable officer as detailed within the Scheme of Reservation and Delegation. The Remuneration and Nominations Committee is chaired by an Independent Lay Member. The Committee convened as required during the year with all meetings being quorate and supported by the Head of Corporate Governance and Legal Affairs in relation to corporate governance matters.

c) Quality and Clinical Governance Committee – the Quality and

Clinical Governance Committee, which is accountable to the group’s governing body seeks assurance and has oversight of quality and clinical governance mechanisms, ensuring quality and patient safety is integral to commissioning processes and to the monitoring arrangements for all commissioned services. The Quality and Clinical Governance Committee monitored risks in relation to patient safety (e.g. themes and trends from incidents and serious incidents), quality of care and patient experience (e.g. themes and trends from patient surveys, complaints); more recently in February 2014 and March 2014 included the review of the information governance toolkit compliance and information governance related risk; and ensured systems and processes change to mitigate these risks. Risks identified through this Committee were brought to the attention of the Governing Body and monitored through the Committee. Information Governance reports are presented and reviewed at the Quality and Clinical Governance Committee providing assurance in relation to information governance risks. The Committee is chaired by an Independent Lay Member and meets on a monthly basis. The Committee held 11 meetings during 2013 – 2014 and all meetings were quorate.

d) Finance and Performance Committee – the Finance and

Performance Committee, which is accountable to the group’s governing body, oversees the development of the annual financial plan. The Finance and Performance Committee monitored performance and risks relating to finance and the performance of the main providers and approves corrective action should excess variances occur. The Committee monitored income and expenditure against planned levels and makes recommendations to the governing body. The Committee is chaired by an Independent Lay Member. The Committee held 10 meetings during 2013 – 2014, of which one was not quorate.


e) Strategy, Planning and Commissioning Committee – the

Strategy, Planning and Commissioning Committee is a committee of the Governing Body and was established in December 2013. Its purpose is to oversee the development and delivery of the CCG’s commissioning plans, strategies and intentions, ensuring effective monitoring arrangements are in place and risks associated with this escalated to the Governing Body, ensuring the total resource available is invested in good quality services that support the delivery of the commissioning intentions. The Committee is chaired by the clinical vice chair. The Committee meets on a monthly basis and since its establishment in December 2013 it has held 4 meetings until March 2014 and all meetings have been quorate.

The clinical commissioning group has joint committees with the following local authorities:

• Leicestershire County Council

• Rutland County Council. In addition, collaborative arrangements have been established under a Memorandum of Agreement with Leicester City Clinical Commissioning Group and West Leicestershire Clinical Commissioning Group in respect of services commissioned collaboratively across the three organisations and this arrangement reports to the Governing Body. During 2013 – 2014 the Governing Body evaluated its own performance through facilitation by an external consultant which led to the development of Board Development programme for the members of the Governing Body, both individually and collectively. Governing Body development sessions have taken place at agreed intervals during 2013 – 2014 which involved sessions focusing on roles, responsibilities, enhancing leadership skills and focusing on collective and individual responsibility. These sessions are aimed to support members of the Governing Body to function more effectively as a Governing Body. Information sessions have also taken place for members of the Governing Body providing them with an opportunity for Governing Body members to, for example, review national guidance / initiatives in greater depth and its implications on the clinical commissioning group’s business; develop further insight into performance issues with key providers; enhance their knowledge on a specific topics; and receive detailed information on key national requirements. Governing Body members’ attendance record at both the Governing Body development / information sessions and the public meetings of the Governing Body are positive, all meetings of the Governing Body throughout 2013 – 2014 have been quorate with the exception of one; and all or the majority of the of the Governing Body members being present.


The Clinical Commissioning Group Risk Management Framework Risk management is an integral part of good management processes and the proactive and continuous management of risk is essential to the efficient and effective delivery of an organisation’s objectives. The organisation’s Risk Management Strategy and Policy sets the strategic and operational frameworks of successful management and evaluation of risk. The CCG’s chosen method of risk scoring is based on the Australian and New Zealand risk management standard AS/NZ 4360:1999, which is widely adopted. ELR CCG adopted a common framework for the assessment and analysis of all risks whether they are clinical, financial, information or organisational. The actions required to manage the risks were documented on the risk registers, which were updated as risks continued to be assessed and treated. A two-tier process involving local directorate based registers and a corporate register (Board Assurance Framework) have been implemented to reflect the organisation’s risk profile. The aim of the two tier approach was to ensure that the strategic picture did not become clouded by the day to day risk management issues that can and were dealt with as a matter of course at local level, whilst still providing a clear route for significant local issues to influence the strategic risk profile. The Board Assurance Framework (corporate risk register), which aligned to the CCG strategic aims and objectives, provided the organisation with a comprehensive method for the effective and focused management of the principle risks with action plans in place to mitigate risks identified. During 2013 – 2014 the Board Assurance Framework has been reviewed and updated on a regular basis. This included reviewing the risk profile of the CCG, format of the Board Assurance Framework and level of risks to escalate. The Audit Committee, Governing Body members and the Corporate Management Team have been integral in the review and development of the Board assurance Framework and format; and in the review of the risk profile and oversight of individual risks and action plans. The Corporate Management Team has been and continues to be responsible for ensuring corporate risks facing the CCG are current; have been captured and evaluated appropriately; and actions undertaken in a timely manner.

Each directorate and had a directorate (operational) risk register where they monitored their local risks. Risks were linked to strategic aims / objectives and the likelihood and impact were assessed to ascertain risk appetite depending on the category of risk, the inherent risk and residual risk and individual leads were assigned to actions. The Board Assurance Framework was built around the proactive and reactive assessment of risks that may have an impact on the achievement of corporate objectives. This simplified reporting and the prioritisation of action plans which, in turn, allowed for more effective performance management. Strategic and operational risks on the corporate and local risk registers were regularly reviewed by the Corporate Management Team with the objective of ensuring risks were effectively managed. These registers were used to record risks using the 5 x 5 risk scoring matrix. Risks were reported and escalated in line with the CCG’s Risk Management Strategy and Policy.


The Risk Management Strategy and Policy is due for a review in 2014 - 2015 to ensure that the governance arrangements for managing corporate business risks and operational risks continue to be robust and reflect the ongoing changing requirements of the organisation. Summary updates and reports on the status of key risks were presented to the Corporate Management Team (CMT) via the Performance CMT meetings and at every meeting of the Audit Committee and at agreed intervals to the Governing Body. Whilst the CCG considered risks to the organisation in meeting its objectives and to its staff, it also considered those to whom a service is provided, the organisations and also the patients themselves. The CCG received risk reports and, where appropriate, assurances and mitigation plans from those organisations from which it commissioned a service. The Internal Audit programme of work has been completed and the Head of Internal Audit has provided an opinion of significant assurance.

The Clinical Commissioning Group Internal Control Framework A system of internal control is the set of processes and procedures in place in the clinical commissioning group to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it can therefore only provide reasonable and not absolute assurance of effectiveness. The system of internal control has been in place in the clinical commissioning group for the year ended 31 March 2014 and up to the date of the approval of the Annual Report and Accounts. The organisation continued to operate through its comprehensive committee structure which ensures identification, robust management, reporting and accountability for risk management. The Governing Body sought assurance through regular review of the Board Assurance Framework at the Governing Body meetings, outcomes from the Corporate Management Team meetings and the Audit Committee (e.g. in relation to effectiveness of internal control mechanisms). The Quality and Clinical Governance Committee received assurance reports to monitor areas of risk e.g. safeguarding, patient safety, serious incidents, etc. The Finance and Performance Committee received assurance reports in relation to financial and performance risks. Regular summary reports from both the Finance and Performance Committee and the Quality and Clinical Governance Committee were presented to the Governing Body drawing the Governing Body’s attention to key financial; and patient safety and quality risks respectively. In addition, reports on specific updates and areas of risk were directly reported to the Governing Body including reports on safeguarding adults and children and serious incident reports. The Governing Body


reviewed these reports and sought assurance to demonstrate that providers are learning from incidents. All these groups had a role to provide regular monitoring to identify themes and trends for learning and sustained improvements. In addition the Governing Body received assurance reports demonstrating compliance with statutory obligations including compliance with the Public Sector Duty of Equality. Delivery of the Risk Management Strategy and Policy was also achieved through the implementation of associated policies and procedures, for example, health and safety policies / procedures, incident reporting, claims policy, Counter Fraud Policy, HR policies etc. Progress and performance in achieving the aims of the strategy and adherence to the policy was monitored by the Corporate Management Team, the Chief Nurse and Quality Officer (as the executive lead) and ultimately the Governing Body via the Audit Committee. The policies and procedures in place across the CCG aimed to, as far as possible, prevent the identified risks from arising; policies, procedures and codes of conduct were made available to staff through various mechanisms including through the CCG newsletter. Statutory and mandatory training included raising awareness about countering fraud, identifying potential risks and also identifying where risks may have materialised (for example, through the incident reporting process). Equality analysis is integral to core business processes, policies and processes across the organisation. Relevant systems and processes were implemented to support the policies and procedures, for instance the CCG’s Constitution (which includes the Standing Orders, Scheme of Reservation and Delegation and Prime Financial Policies) clearly stipulated the delegations to budget holders which was then reflected within the Shared Business Service system to ensure appropriate level of authorisation is obtained for approval of invoices. Where risks have materialised the Corporate Management Team would review the controls in place to determine how the controls need to be improved and whether assurances need to be sought from alternative sources. Control measures are in place to ensure that all the clinical commissioning group’s obligations under equality, diversity and human rights legislation are complied with. Information Governance The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal identifiable information. The NHS Information Governance Framework is supported by an information governance toolkit and the annual submission process provides assurances to the clinical commissioning group, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively. We place high importance on ensuring there are robust information governance systems and processes in place to help protect patient and corporate information. We have established an information governance framework and have developed and continue to further develop information governance processes and procedures in line with the information governance toolkit. We have ensured all staff undertake


annual information governance training and have implemented a staff information governance handbook / leaflets to ensure staff are aware of their information governance roles and responsibilities. There are processes in place for incident reporting and investigation of serious incidents. We are developing information risk assessment and management procedures and a programme will be established to fully embed an information risk culture throughout the organisation. The CCG had in place an Information Governance Strategy and Policy. The final year end self-assessment for 2013 – 2014 was agreed at the Quality and Clinical Governance Committee in March 2014. Specific requirements were submitted to Internal Audit for which the Auditor’s provided an opinion of “significant assurance”. Information risks are clearly defined within the Risk Management Strategy and Policy including the role of the Senior Information Risk Officer and the Information Asset Owners, which supports the requirements for identifying and managing information risk. The NHS Data Mapping exercise was undertaken during 2013 - 2014 and involved identification of personal identifiable information (PII) data flows into and out of the organisation. Systems and processes are in place to ensure the security of data; and to ensure encryption of all electronic PII data transfers, e.g., via email and PII held on mobile devices such as laptops. All staff are required to complete the annual e-learning training module on information governance. In addition, the CCG’s Corporate Management Team has mandated that all staff attend an organisation specific information governance training event arranged on-site and facilitated by the information governance lead. 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 that the clinical commissioning group complies with the required public sector equality duty set out in the Equality Act 2010. Sustainable Development Obligations The clinical commissioning group is required to report its progress in delivering against sustainable development indicators. We are developing plans to assess risks, enhance our performance and reduce our impact, including against carbon reduction and climate change adaptation objectives. This includes establishing mechanisms to embed social and


environmental sustainability across policy development, business planning and in commissioning. We will ensure the clinical commissioning group complies with its obligations under the Climate Change Act 2008, including the Adaptation Reporting power, and the Public Services (Social Value) Act 2012. We are also setting out our commitments as a socially responsible employer.

Risk Assessment in Relation to Governance, Risk Management and Internal Control The Corporate Management Team and members of the Governing Body in the main identified the risks considering the political, economic, social, technological environment (PEST analysis) in which the CCG operates. In the regular review of the Board Assurance Framework, risks identified from “bottom-up” are also considered, for example, review of directorate level risk registers, cluster of incidents, cluster of complaints, through performance management arrangements. Risk identification and management had been incorporated into key processes within East Leicestershire and Rutland CCG ensuring embeddedness of the principles of risk management and encouraging a proactive approach to identifying risks. The core business processes, for instance, included the review of risk and the impact on strategic decision making. The organisation’s business cases required leads to identify the risk of not implementing a scheme and the benefits realisation of the scheme. In addition, it includes the requirement to undertake equality analysis for each case of need. The following principal risks were identified and captured within the Board Assurance Framework during 2013 – 2014; the following risks are as at end March 2014:

• The quality of care provided by providers does not match commissioner’s expectation with respect to quality and safety.

• Patients and the public may not be able to influence CCG decisions within all stages of the commissioning cycle through consultation and engagement.

• The CCG fails to engage with key external stakeholders to inform the development of strategies and plans.

• An innovative organisational culture and organisational development may not be actively encouraged.

• The CCG fails to ensure effective contract monitoring through hosted contracting arrangements which results in over performance of contracts and poor outcomes for patients.

• The CCG fails to deliver the outcomes of the programmes of care as identified in the Annual Plan as a result of external influences e.g. changes in demand across providers, Local Area Team etc. In particular failure to deliver its plans on planned and unplanned care.


• Inability to deliver against the QIPP agenda resulting in failure to transform services.

• Capacity of primary and community services to manage left shift.

• Patients could receive sub-optimal care as a result of increasing pressures in urgent care pathway.

• In year over performance in acute sector (including Independent and out of county providers) continues throughout the year and culminates in a large overspend against the SLA by the end of the year. The financial risk is further increased by the pressures in the Urgent Care pathway.

• The quality of care provided by UHL does not match commissioner’s expectation with respect to quality and safety, due to a deterioration in performance across a number of areas: poor performance across the urgent care pathway; deterioration in RTT performance; 62 day cancer waits at speciality level; sustained reduction in pressure ulcers remains challenging; disparity of SHMI across sites (high SHMI at LRI site); and inconsistency in FFT across wards. This risk was escalated to the Board Assurance Framework in December 2013.

Review of Economy, Efficiency and Effectiveness of the Use of Resources

The effectiveness of the use of resources and financial performance of the CCG was monitored on a monthly basis by the Governing Body and the Finance and Performance Committee which is a Committee of the Governing Body chaired by a lay member. Corporate risks in respect of financial performance and use of resources are captured in the Board Assurance Framework and directorate level risk registers and reported to the Audit Committee at each meeting and the Governing Body every six months.

In addition, where services were commissioned collaboratively in 2013 – 2014 with Leicester City CCG and West Leicestershire CCG provider performance was monitored via the collaborative arrangements. This in the main was through the Performance Collaborative Board and the Commissioning Collaborative Board arrangements for which principles of collaboration are detailed within the Memorandum of Agreement between the three CCGs.

The main financial risk that the CCG has faced throughout the year is the over performance in the acute sector against the backdrop of significant emergency activity pressures experienced during the year. The over performance at the end of 2013/14 was £5.39m.

The Audit Committee included within the internal audit plan for 2013 – 2014 the following audit reviews: Budgetary Control and Financial Reporting; and Key Financial Systems – Payroll. Both audit reviews were provided with an opinion of “significant assurance”. These reports identified areas where efficiency could be gained, for example, the Budgetary Control audit report identified areas where the


reporting system could be used to support budget holders by working with the system provider to ensure the system is user-friendly. The Finance Team in conjunction with the Finance and Performance Committee also reviewed the content of finance reports to the Governing Body and the Finance and Performance Committee. Reassessing the adequacy of the reports ensured that information was portrayed more clearly for the Finance and Performance Committee and the Governing Body enabling them to develop a better understanding of the position and make decisions based on the information.

Review of the Effectiveness of Governance, Risk Management and Internal Control As the Accountable Officer I have responsibility for reviewing the effectiveness of the system of internal control within the clinical commissioning group. Capacity to Handle Risk As stated above, the overall responsibility for the management of risk lies with me as the Accountable Officer and operational implementation with the Corporate Management Team. The Governing Body collectively and individually ensured that robust systems of internal control and management were in place. This responsibility was supported through an effective Governing Body and committee structure as detailed earlier. Specialist advice on risk assessment and management has been available to the organisation through: the organisation’s Head of Corporate Governance and Legal Affairs, Health and Safety Adviser (external), the Information Security lead (external); Information Governance support (external) Local Security Management Consultant (external, and the Local Counter Fraud specialist.. Over the last year there has been continued increase in awareness at all levels of the organisation of the importance and relevance of risk management to operational processes. This has been through team meetings, one-to-one meetings with individuals, the requirement for all staff to complete the e-learning and face-to-face training modules covering all aspects of risk (e.g. information, health and safety), circulation of a variety of policies e.g. finance budget manual, prime and operational financial policies, information security and information governance policies, clinical policies, policy on Fraud, Corruption and bribery, risk management strategy and policy etc. Review of Effectiveness My review of the effectiveness of the system of internal control is informed by the work of the internal auditors and the executive managers (the Corporate Management Team) 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 reports. The Board Assurance Framework itself provides me with evidence that the effectiveness of controls that manage risks to the clinical commissioning group achieving its principle objectives have been reviewed.


I have been advised on the implications of the result of my review of effectiveness of the system of internal control by the Governing Body, the Audit Committee, the Quality and Clinical Governance Committee, the Finance and Performance Committee, the Strategy, Planning and Commissioning Committee, and the performance and commissioning collaborative boards. A plan to address weaknesses and ensure continuous improvement of the system is in place. The processes and committees that have been integral to maintaining and reviewing the effectiveness of the system of internal control include: the Governing Body; the Audit Committee; Quality and Clinical Governance Committee; Finance and Performance Committee; Strategy, Planning and Commissioning Committee; internal audit; quarterly checkpoint assurance meetings with the NHS England Area Team Leicestershire and Lincolnshire. The specific role of the Governing Body and its committees in reviewing effectiveness of systems of internal control and risk management is provided earlier. 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:

In providing an opinion for the 2013/14 financial year, it is important to reflect on the environment in which the CCG has been required to function and the impact such an unprecedented period of change and development will have on the operation of control. However, the system of internal control is designed to manage risk to a reasonable level rather than eliminate all risk of failure. From my review of your systems of internal control, primarily through the operation of your Assurance Framework and the individual assignments I have undertaken, I am providing Significant Assurance that there is generally sound system of internal control, designed to meet the organisation’s objectives, and that controls are generally being applied consistently.

During the year the Internal Audit did not issue any audit report with a conclusion of limited assurance. During the year the Internal Audit did not issue any audit report with a conclusion of no assurance. I am not aware of any deficiencies as a result of risks that have materialised. I confirm neither have there been any serious incidents in the last year involving personal data where the incident is attributable to the CCG. The CCG continues to monitor risks at both operational and corporate level, including review of systems, processes and policies to ensure ongoing continuous improvement in systems. An internal audit was carried out by Deloitte LLP during 2013 – 2014 which reviewed the processes / procedures of Greater East Midlands Commissioning Support Unit (GEM CSU). The findings of the report concluded that there was reasonable assurance that appropriate controls were in place in GEM CSU. Furthermore, many of the exceptions noted in this internal audit report did not apply to Leicestershire based customers of GEM CSU. For those exceptions noted or


process improvements that did relate to Leicestershire CCGs, GEM CSU has confirmed that an action plan is currently being produced. ELR CCG has therefore concluded that the findings of this report would not adversely affect the opinion given by our own internal auditors. Data Quality Good information underpins sound decision making within the CCG. The CCG is committed to improving data quality and information flows throughout the organisation and in particular through its committees to the Governing Body and to the membership. Following feedback throughout the year from Governing Body members and its committees the quality of both qualitative and quantitative data and information has improved. This has enabled information in relation to performance monitoring and consideration of future commissioning of services to be based on more current information. Internal audit have undertaken various audits throughout the year where the quality of both data and information was reviewed to provide assurance to the Audit Committee and the Governing Body.

Data Security

We have submitted a satisfactory level of compliance with the information governance toolkit assessment. Discharge of Statutory Functions 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 all relevant legislation. Legal advice also informed the matters reserved for the Membership Body and Governing Body decision and the scheme of delegation. In light of the Harris Review, the clinical commissioning group has reviewed all of the statutory duties and powers conferred on it by the National Health Services Act 2006 (as amended) and other associated legislation and regulations. As a result, I can confirm that the clinical commissioning group is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegations of those functions. Responsibility for each duty and power has been clearly allocated to a lead Director. Directorates have confirmed that their structures provide the necessary capability and capacity to undertake all of the clinical commissioning group’s statutory duties.

Conclusion There are no significant internal control issues that have been identified. Dr David Briggs Managing Director (Accountable Officer) 4 June 2014


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Somali Waxaan ku siin karnaa bug-yarahaan oo ku qoran luqado iyo habab kale sida farta indhoolaha Braille iyo daabacad far waa-wayn markii aad soo codsato. Fadlan la soo xiriir qaybta Ka-qaybgalka iyo Dhex-gelidda, lambarka telefoonka waa 0116 295 1486. Polish

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Hindi

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Urdu

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Arabic

يمكننا تقديم نسخ من ھذه النشرة بلغات أخرى وصيغ مثل برايل والطباعة الكبيرة في الطلب. يرجى اiتصال انخراط

.1486 295 0116وزارة، والھاتف وإشراك


East Leicestershire and Rutland CCG Unit 2-3 (Ground Floor)

Bridge Business Park 674 Melton Road

Thurmaston Leicestershire

LE4 8BL

Telephone: 0116 295 5105

www.eastleicestershireandrutlandccg.nhs.uk

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