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(Placeholder16)APPENDIX A
APPENDIX A
Islington CCG
ANNUAL REPORT AND ACCOUNTS
2014/15
TABLE OF CONTENTS
1 Annual Report ......................................................................................................... 1
1.1 Member Practices’ Introduction ................................................................................. 1
1.2 Strategic Report ........................................................................................................ 6
1.2.1 Introduction ..................................................................................................... 6
1.2.2 Financial review 2014/15 ................................................................................ 7
1.2.3 Delivering £15.2m in savings through QIPP (quality, innovation, productivity and prevention) ......................................................................................................... 9
1.2.4 Financial outlook for 2015/16 .......................................................................... 9
1.2.5 Development and performance ..................................................................... 10
1.2.6 Sustainability Report ..................................................................................... 12
1.2.7 Equality report .............................................................................................. 13
1.2.8 Membership and employee statistics ............................................................ 14
1.2.9 Social and community issues ........................................................................ 14
1.2.10 Thank you to our partners in Islington ......................................................... 15
1.3 Members’ report ...................................................................................................... 16
1.3.1 Register of Interests ..................................................................................... 17
1.3.2 Pension liabilities .......................................................................................... 17
1.3.3 Sickness absence data ................................................................................. 17
1.3.4 External audit ............................................................................................... 17
1.3.5 Disclosure of serious untoward incidents ...................................................... 17
1.3.6 Cost allocation and setting of charges for information ................................... 17
1.3.7 Principles for remedy .................................................................................... 17
1.3.8 Employee consultation .................................................................................. 18
1.3.9 Equality and diversity .................................................................................... 18
1.3.10 Emergency preparedness, resilience and response .................................... 19
1.3.11 Statement as to disclosure to auditors ........................................................ 19
1.4 Remuneration report ............................................................................................... 20
1.4.1 Remuneration and terms of service committee ............................................. 20
1.4.2 Remuneration ............................................................................................... 20
1.4.3 Contractual arrangements ............................................................................ 20
1.4.4 Pensions....................................................................................................... 24
1.4.5 Termination agreements or exit packages .................................................... 24
1.4.6 Salary and pension entitlements of directors and senior managers .............. 24
1.4.7 Cash Equivalent Transfer Values ................................................................. 25
1.4.8 Real increase in CETV ................................................................................. 25
1.4.9 The relationship between the highest paid director and median remuneration 25
1.4.10 Off-payroll engagements ............................................................................. 25
1.4.11 Profiles of our Governing Body Members.................................................... 26
2. Statements by the accountable officer ....................................................................... 29
2.1 Statement of accountable officer’s responsibilities .................................................. 29
2.2 Governance Statement ........................................................................................... 31
2.2.1 Introduction and context ............................................................................... 31
2.2.2 Scope of responsibility .................................................................................. 31
2.2.3 Compliance with the UK Corporate Governance Code ................................. 31
2.2.4 The CCG Governance Framework ............................................................... 31
2.2.5 The CCG Risk Management Framework ...................................................... 35
2.2.6 The CCG Internal Control Framework .......................................................... 37
2.2.7 Risk Assessment in Relation to Governance, Risk Management & Internal Control .................................................................................................................... 38
2.2.8 Review of Economy, Efficiency and Effectiveness of the Use of Resources . 39
2.2.9 Review of the Effectiveness of Governance, Risk Management & Internal Control .................................................................................................................... 39
3. Annual accounts ......................................................................................................... 41
3.1 Report by the auditors to the members of the CCG ................................................. 41
3.2 Financial statements ............................................................................................... 45
Annex A ............................................................................................................................. 82
Annex B ............................................................................................................................. 84
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1 Annual Report
1.1 Member Practices’ Introduction
Islington Clinical Commissioning Group (CCG) is responsible for planning and commissioning health services for the people of Islington. Set up in 2013, our CCG is made up of 36 member GP practices across the borough. Member GP practices decide how the CCG operates by developing a constitution with a governing body made up of lay members, clinicians (GPs, nurses and a hospital doctor) and NHS managers. With a population of about a quarter of a million living in an area under six square miles, Islington is the most densely populated borough in the United Kingdom. We have a number of health and wellbeing challenges in the borough, including:
London’s fifth most deprived borough and the fourteenth most deprived in England
approximately 20% of residents enter and leave the borough each year (one of London’s most mobile populations)
at least 35,000 registered patients have one long-term condition, such as diabetes, and it is believed many more may be undiagnosed
a diverse population with a wide range of distinct health needs across both mental and physical health
about 10% of registered patients have a diagnosis of depression (amongst the highest in London)
about 25% of children aged six are obese, higher than the England average We work jointly with the London Borough of Islington on these challenges wherever possible, bringing together health and social care to make life easier for patients and take better care of them. We do this as part of a local Health and Wellbeing Board which means we share resources and priorities. We work with other clinical commissioning groups across London (Barnet, Camden, Enfield and Haringey) as well as the London Borough of Islington and NHS England, and with local people. We buy in a range of services including planned care, rehabilitation services, urgent and emergency care, (including 111 and out of hours services), most community health services (such as podiatry, district nursing and physiotherapy) and mental health and learning disability services. Many of these services are provided by local NHS organisations – Whittington Health NHS Trust, Moorfields NHS Foundation Trust, Camden and Islington NHS Foundation Trust, University College London Hospital NHS Foundation Trust and The Royal Free NHS Foundation Trust. We also buy services from not-for-profit organisations based in the local community, as well as other types of providers.
Watch a short video to find out more about Islington CCG: www.islingtonccg.nhs.uk/about-us/
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This report provides reflections on the CCG’s progress and performance on our priorities, with examples of where we have been successful in improving the health and wellbeing of those in Islington. A statement outlining the effectiveness of our Governing Body is included as part of our Governing Statement (section 2.2). Progress across our four priorities
The CCG’s member GP practices have agreed their collective aim as:
to develop a new partnership between patients and their clinicians that together commissions health services of high quality and good value for money and meets the needs of the population
We have identified four objectives together with the London borough of Islington and agreed by the Health and Wellbeing Board that will help us to achieve our vision:
1. Ensuring every child has the best start in life
2. Preventing and managing long term conditions to extend both length and quality of life and reduce health inequalities
3. Improving mental health and wellbeing, and
4. Delivering high quality, efficient services within the resources available. As commissioners of health care services for Islington, we want to use the clinical expertise of our GPs to plan, develop and buy the best possible services that will support the health and wellbeing of the people of Islington. Our second year has been focused on continuing our work as an integrated care pioneer, an approach that aims to build care around the individual, according to their needs. National Voices defines integrated care using the voice of the service user:
I can plan my care with people who work together to understand me and my carer(s), allowing me control, and bringing together services to achieve the outcomes important to me.
Our integrated care team is being driven by a talented and committed commissioning workforce that includes a network of GP clinical leaders with a solid understanding of the local community’s health needs. Alongside this, we have worked in partnership with local people in our community, who have told us their views about what it is that they need most from their care, what works well, and what they think needs to change. One of the outcomes of this work is an animated short video, which explains how joined up care works in practice.
The Story of Maggie and Rose Carers, service users, therapists, nurses, social workers and many others in Islington collaborated to produce a short, animated video about working together in new ways to get better outcomes for families, as told from the perspective of a family with complex health needs. Watch the video on Youtube: https://www.youtube.com/watch?v=3aUXW3FBNlc&feature=youtu.be Read the Guardian feature of 17 Feb 2015: http://www.theguardian.com/social-care-network/2015/feb/17/good-communication-integration-health-social-care
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At our first CCG Annual General Meeting in September 2014, our Governing Body members had the chance to hear first-hand the views of local residents about Islington’s NHS services. In addition to our AGM, we held a series of small scale, face to face events with our partners in the borough including Age UK, Manor Gardens, St Luke’s Community Centre, as well as HealthWatch Islington, amongst others. At this year’s Islington Nursing Conference, where we showcased professional excellence amongst Islington’s nursing workforce, we also featured stories and experiences from carers and patients, including an address from Ashley Brooks, the NHS National Patient Champion. The conference was themed around Dr Kate Grainger’s “Hello my name is…” campaign, which aims to have all NHS professionals introduce themselves to patients, as a way of showing compassion in care. These are some of the ways that we invite the views of all those in our community, taking particular care to listen to those who may not be heard as often, owing to language barriers, social exclusion or other factors. We have had a successful year delivering an ambitious programme of work that includes developing Islington’s primary care services in partnership with our member practices, introducing services in the community that provide a more joined up, smoother experience for those who are using them, and working with our community to address areas that they have told us need to work better for them. Islington’s service users have told us that they would like care that values mental health and physical health equally, and offers support in both areas of their health. We have responded to this by putting an emphasis on developing services that take a balanced approach to both physical health and mental wellbeing. This includes providing targeted support for those with long term conditions to help them with their physical health, and to support them to more easily find and access services. Our Healthy Child Programme offers new mothers support with all aspects of their wellbeing, including support with postnatal depression. These are just a few examples of how we are balancing the approach to both physical and mental health. Children’s health has been an area in which we have had great success this year. After years of having below average childhood immunisation rates, Islington reversed this trend and is now amongst the country’s top performing boroughs, with 98% of one-year olds now receiving a 5-in-1 vaccination against serious childhood diseases and 94% of five year olds receiving the MMR 2 vaccine. This has been achieved by clinicians
at Whittington Health NHS Trust and in GP practices working in partnership, taking practical steps such as offering more clinics, and following up with parents of unvaccinated children. We have now developed a longer term strategy that aims to put the health and wellbeing of Islington’s children into the core of all our work, and we look forward to further successes in this area in the years to come.
Islington’s dementia navigators help people to find information about housing, social care services, planning a will and many other areas.
This year’s Islington Nursing Conference used the “Hello my name is…”campaign as its theme, and included an address from Ashely Brooks, National NHS Patient Champion, on compassion in care
Islington’s rate of childhood vaccination is now amongst the top in the country, with 94% of children aged five receiving the MMR 2 vaccine
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As clinical commissioners in Islington, we play a full and active role with our partners in the wider community. The relationship between health and wider social influences is well established. In November 2014 the report of the Islington Employment Commission was published and the CCG has committed to its role in implementing the recommendations in the coming year. We will be promoting good employment practices and supporting individuals in returning to work. We are already doing some of this work with our partners in the non-profit sector, such as Hillside Clubhouse. We have commissioned Hillside Clubhouse to run an established and successful programme that supports people who would like to get back into work after a period of absence. In 2014, we established the Community Education Provider Network site with our partners. This is helping us to develop a well-trained and motivated workforce, an essential component of Islington’s health economy. Given the expected changes in our population in the coming years, we need to be working now to ensure we have the workforce with the right skill mix for our community’s future needs. Many of our challenges in health and care cut across borough boundaries. To take account of this, we have this year begun to combine our efforts with our partners in north central London – Barnet, Camden, Enfield and Haringey – taking a collaborative approach to common challenges where it makes sense such as developing better primary care. Under this co-commissioning approach, we are partnering with NHS England and CCGs across north central London to deliver a new vision for primary care. We are working toward fully setting up the north central London local committee from 1 October 2015 with the aim of improving primary care. One of the first steps the five CCGs have taken has been to work together on NHS 111 and out of hours services. The local out of hours service contract is due to end in 2016, giving us a chance to look again at the way the service operates, and consider the views of the local population to see if this can be improved. Some people in the community share strong views with us about this, so we hosted a series of community events, led by one of our local GPs, at which people could come along and ask us questions and tell us their concerns. We have heard from over 200 local people across Islington and the insight from this feedback is now being used to shape services. People with diabetes have worked with us this year, to improve this area of services, an area where we want to see better overall outcomes. Diabetes is the second most common condition in Islington, affecting around one in 20 people. People living with this condition have given us expert insight about their experience of services, allowing us to commission a more joined up service in the coming year. This will mean that a person with diabetes will tell their story once and designed so that all those involved in their care, can work in partnership with them on their care plan. After starting the year with wait lists longer than we would like in two of our main NHS providers, Moorfields NHS Foundation Trust and Whittington Health NHS Trust, we worked with both organisations to identify the cause of the backlogs and develop practical, system-wide solutions. By making changes such as simplifying the booking of appointments and holding more clinical sessions where possible, people are now getting the care they need
Islington CCG commissions the Reablement service, which supports people with long term mental ill health to make a transition back into employment. Some who have been through this programme have gone on to become reablement support workers, inspiring others to make the same successful journey that they have.
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quicker and in the place of their choosing. Making system-wide improvements also means that these changes will result in a more efficient, resilient service for the future. Across the country, all NHS organisations are confronting the challenge of increasing demand on emergency services, whilst needing to continue to provide quality of care and a good patient experience. We have worked with our main provider of these services, Whittington Health NHS Trust, to explore ways to address this pressure. For example, Whittington Health’s Ambulatory Care service, which allows patients with specific conditions to be seen, diagnosed and treated without admission, has been one of the ways in which the hospital has been able to improve care. We have also invested in a dedicated service to treat those with acute mental ill health, so that these individuals are managed by a clinical team with specialist expertise. Our investment in these two areas has relieved the need to admit as many patients into the hospital, and resulted in a better care experience for patients. With these innovative interventions in place, we expect to continue to see improved performance in emergency services next year. These improvements are resulting in more people receiving care more quickly, and are allowing us to make better use of our resources. We are pleased to have met all our financial
targets, ensuring that we are ending the year in a strong position during what has been a challenging environment. A statement of performance across all our providers is included in this document as Annex B (Assurance Framework Statement). We are aiming to improve the health of everyone in Islington, looking at all aspects of care, from how we plan services to how we work with others. Through the Choose Well campaign, we also want to help people to manage their own
health and make the most of services offered in Islington. We understand that people do not always have good experiences of local services. They may be confused by who is doing what, or find that their care falls short of what they were expecting. We are working to put this right so that our resources are used in a way that brings the most benefit to our community. For example, many people have told us that they want easier access to their local GP, and more convenient appointment times. Our primary care work programme includes new funding for primary care IT systems making it possible to book GP appointments online and sharing health information to ensure better co-ordination of care. Our GP practices have also succeeded in securing funding from the Prime Minister’s Challenge Fund to help us to expand our primary care services to offer more convenient opening hours for appointments. We hope to have new services open later in the year in the evenings and at weekends. This year’s achievements have only been possible through working in partnership with our community partners, NHS service providers, local authority, patients and carers, along with the commitment of the staff from Islington CCG member practices. For further information about services in Islington, please visit: Islington Choose Well www.islingtonccg.nhs.uk/YourHealth/ Islington Links for Living www.linksforliving.islington.gov.uk
Choose Well gives people better information about local services, and about ways in which we can all better look after our own health
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1.2 Strategic Report
1.2.1 Introduction
Islington CCG is responsible for planning and buying hospital, community and mental health services for the population of the borough. Every year we review our Joint Strategic Needs Assessment (JSNA), which sets out clinical and public health evidence about our local population. Islington CCG serves a population of just under a quarter of a million living in an area under six square miles and as such is the most densely populated borough in the United Kingdom. We have a number of health and wellbeing challenges in the borough, including:
London’s fifth most deprived borough and the fourteenth most deprived in England
approximately 20% of residents enter and leave the borough each year (one of London’s most mobile populations)
at least 35,000 registered patients have one long-term condition, such as diabetes, and it is believed many more may be undiagnosed
a diverse population with a wide range of distinct health needs across both mental and physical health
about 10% of registered patients have a diagnosis of depression (amongst the highest in London)
about 25% of children aged six are obese, higher than the England average The Governing Body is established through a constitution agreed by all our 36 member GP practices and is chaired by Islington GP, Dr Gillian Greenhough. Dr Greenhough is supported by a governing body that includes GPs, nurses, lay members, a practice manager, CCG managers and a hospital specialist. Most of our commissioning team is based in our main office in Goswell Road, Islington. Some of our commissioning team are employed jointly between ourselves and the Local Authority, reflecting our long standing partnership approach to health and social care across the borough. Our Governing Body works with our patients and partner organisations, including Local Authorities, Commissioning Support Unit and partner CCGs across north central London, to improve the health of the people of Islington as well as the health services that we all use. These priorities are being delivered through strategic plans across primary care, integrated care, urgent care and planned care. All are underpinned by patient and public engagement. The CCG’s strategic approach is also informed by national guidance designed to help us get the best outcomes for our local population. Under the National Health Service Act 2006 (as amended), NHS England has directed each CCG to prepare for each financial year, 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 CCG and of its net expenditure, changes in taxpayers’ equity and cash flows for the financial year. We certify that the clinical commissioning group has complied with the statutory duties laid down in the National Health Service Act 2006 (as amended). Islington CCG based on 2014/15 performance and 2015/16 projected performance, considers itself in a robust financial position and a going concern.
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This section provides a review of the CCG’s business at year end, including a description of risks and uncertainties, an analysis of development and performance and our financial position.1 The CCG established a corporate risk register and board assurance framework in April 2013. Risks go through a regular review cycle of:
Risk leads and governance manager updating risks;
Risk owners (the Chief Officer and Directors of the CCG) reviewing risks;
The risk register being considered by the Executive Management Team (monthly);
Relevant risks considered by the CCG’s four committees as follows:
1. Quality and Performance
2. Finance and Strategy
3. Child Protection
4. Audit
The full risk register, with amendments, is approved by the Governing Body at its bi-monthly meetings;
The Board Assurance Framework (BAF) is considered by the Audit Committee at each of its meetings.
All risks are linked to the CCG’s key priorities and the mitigation and assurance of risks is scrutinised as part of the internal audit work-plan.
1.2.2 Financial review 2014/15
The CCG’s opening resource limit for 2014/15 was £319.2m, comprising:
£307.4m commissioning of healthcare services;
£5.3m management costs;
£6.5m brought forward surplus. Various adjustments during the year totalling £4.2m resulted in a closing resource limit of £323.4m. Our main commissioning expenditure was across NHS provider contracts with Whittington Health NHS Trust, University College London Hospital NHS Foundation Trust and Camden & Islington NHS Foundation Trust. Of our total expenditure, £190m or 60%, was spent with these three providers and covered the full range of acute, community and mental health services. Smaller contracts are in place with other providers and a range of services are purchased from voluntary and community providers.
1 A risk management framework is included in the Governance Statement (see s2.2). A statement on
assurance, detailing how we have discharged our duties under the National Health Service Act 2006, is included (see Annex B).
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In summary, Table 1 below provides an overview of Islington CCG’s financial performance against core financial targets in 2014/15.
Table 1. Achievement against core 2014/15 financial targets
Plan Actual Achieved
To stay within plan and deliver a surplus of £8.2m £6.5m2 £8.2m √
To meet our cash target £286.5m £286.5m √
To deliver our QIPP savings programme £15.2m £14.9m √ To deliver our investment programme (strategic / internally generated, £8.2m, as well as nationally funded, £4.1m)
£12.3m £12.3m √
To meet our running cost allowance £5.9m £5.2m √
To meet the better payment practice code target (value) 95% 96% √
To meet the better payment practice code target (volume) 95% 90% x Although we did not deliver the full QIPP savings programme, the 98.2% achieved is considered a good outcome of performance. We spent a total of £315.3m across commissioning areas and management costs (see breakdown in Fig. 1).
Fig. 1 Overall Islington CCG spending during 2014/15
Pressures on the financial position this year included performance on acute contracts, where our plans were exceeded by £5.9m (2.9%). The main pressure was UCLH NHS Foundation
2 Although the official expenditure target for 2014-15 was to maintain the £6.5m brought forward
surplus, increases of £0.7m (pooled continuing healthcare claims not required during the year) and £1m (contribution towards London-wide request for additional surpluses), were agreed with NHS England. Performance was therefore measured against an adjusted target of £8.2m
66%
14%
7%
7%
2%2%
2%
Acute & integrated care
Mental health
Community
Primary care prescribing
Primary care schemes
Other commissioning
Running costs
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Trust performance, which was £3.9m (7.1%) above plan. There were significant variations within this overall position and looking forward, plans will be adjusted to reflect performance over the year. The overall position would have been improved by underperformance of £1.2m had Whittington Health NHS Trust not been on a block contract. The mental health budget overspent by £0.9m (2.2%), due to charge exempt overseas visitor activity. National funding for this activity is one year in arrears and accounting rules prohibit accruing for income that is not certain, which charge exempt overseas visitor activity classifies as. Underspends in other areas, notably in continuing care, which was £1.5m (15.9%) below plan, helped generate the £1m contribution towards additional surpluses requested by NHS England (London). 1.2.3 Delivering £15.2m in savings through QIPP (quality, innovation,
productivity and prevention) Managing the in-year position has been achieved through a combination of delivering the savings programme, and releasing reserves for investments and acute over performance. The CCG planned a savings programme of £15.2m across a range of schemes, representing 5% of our allocation. Slippage in various referral management schemes was largely mitigated by over performance in other areas, including the impact of the ambulatory care service on non-elective admissions at the Whittington Hospital. 1.2.4 Financial outlook for 2015/16 Allocation Plans have been set to achieve a 1.9% surplus target of £6.5m for 2015/16, i.e. the underlying 2014/15 surplus that will be returned to the CCG in 2015/16. In order to achieve this position a challenging 4% QIPP programme is required. This equates to £12m and comprises a combination of transformational schemes and transactional/budget reduction savings. A national requirement to reduce running costs by 10% in 2015/16 has been planned for during 2014/15 and the CCG has taken active steps over the latter half of the year to reduce its management cost base accordingly. This has been achieved through a staff restructuring that concentrated on moving staff onto permanent contracts and through renegotiation of the CCG’s service level agreement with North & East London Commissioning Support Unit. Strategic outlook The main strategic financial focus is delivering the investment required for the Better Care Fund (BCF) initiatives and developing integrated and primary care to meet growing acute activity pressures. These programmes will look to move patient care closer to home and into the community. Planning assumptions In accordance with national planning requirements, the following assumptions have been made in setting financial plans for 2015/16:
demographic growth of 1.77%, based on the latest Office for National Statistics projections;
general inflation of 1.93% as advised by NHS England, 2.28% for mental health services and 4% for prescribing costs;
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payment tariffs based on the options implemented by NHS providers (see below);
non-demographic growth has been set at 1% to cover pressures over and above activity and cost;
a 0.5% contingency (£1.6m) and 1% non-recurrent (£3.1m) fund.
Under normal circumstances, prices for NHS services are determined by the national tariff. Following objections from the majority of providers, implementation of the tariff for 2015/16 has been delayed, resulting in use of the ‘enhanced tariff option’. Where the enhanced tariff option has not been agreed with a provider, a default tariff position has been applied. These are the 2014/15 prices less any opportunity to generate CQUIN (commissioning for quality and innovation) payments. CQUINs are normally 2.5% of contract value. Risks The main financial risks remain the agreement of acute contract values to reflect the appropriate level of activity, risks around tariff assumptions and the impact on contract values where different tariff options are being used across providers. To mitigate this risk and reflect historical performance, acute demand reserves and a small contingency has been set aside in 2015/16 plans. In total the value of these funds is £3.5m, reflecting the levels of overperformance in previous years. Other risks identified include:
the Better Care Fund and the requirement to achieve savings through non-elective admission reductions of 3.5%, or £1.3m;
Delivery of acute contract productivity metrics (£4m);
2014/15 local system resilience arrangements, i.e. winter planning, required in 2015/16. Allocations compared to expenditure are £1m different.
1.2.5 Development and performance Last year we told you about our work across seven main areas:
How you experience services 1. Patient experience
2. Safety of services
3. Clinical effectiveness
How we commission services 4. Patient and community engagement
5. Primary Care
6. Urgent Care
7. Ensuring high quality, efficient services
We have made progress on these areas over the past 12 months. Below are some of the developments we are most proud of.
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How you experience services
Patient experience: Islington CCG has begun work on an integrated digital health and social care record, which includes the development of person held record. This means the information you want shared will be available to people in your health and care team. It also means you will have easier access to your health and care records.
We have also launched an animation to staff that explains what integrated care in Islington looks like and what a great impact it can have on the people we support. The animation is available on You Tube for anyone to view:
https://www.youtube.com/watch?v=3aUXW3FBNlc&feature=youtu.be
Safety of services: We are working closely with local partners to build on the work put in place last year in the areas of child protection, adult safeguarding and community safety.
To further build on this partnership work, Islington is poised to start a new training and development programme to improve the quality of care offered in local nursing homes. The new Care Certificate will replace national minimum training standards and common induction standards. The new certificate will be rolled our nationally from April 2015.
Clinical effectiveness: We have invested in developing new community services this year. Two of these are our new community gynaecology service, which will start in April 2015, and an enhanced community service supporting the care of leg ulcers in the community. We also saw over 90% of women who had a baby had a new birth visit within 14 days.
At the Whittington hospital we have establish a new team focused on improving the care of people with mental illness. The new team is focused on supporting those with mental illness get back home as soon as possible. The service has reported a dramatic reduction in length of stay for those they support.
How we commission services
Patient and community engagement: Within the last year we have expanded and developed our involvement work and our work with the third sector to deliver wellbeing services and support for local people – including community asset building. We have built good relationships with some key organisations and are focusing on continuing to create relationships across the third sector in Islington.
Some of the projects we have developed this year, with the third sector, have been:
Community Wellbeing Project with Help on Your Doorstep and Cripplegate Foundation which gathered insight and working with people living on New River Green Estate
Delivery and development of Patient Participation Groups with Voluntary Action Islington
Working with Body and Soul on a number of engagement and facilitation projects We have also been interested in hearing more formally about how we are doing. In April 2014, Ipsos MORI carried out a survey independently to invite views from all those who work in partnership with the CCG. Questions included everything from the quality of its leadership team to the way in which it engages and builds relationships with organisations involved in health and care across Islington. Over 90% of those working with Islington CCG say that they feel the organisation has a strong leadership team in place that is working well with local partners, according to the results of the survey.
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We will be able to keep receiving this feedback through a new tool launch by Health Voice Islington that allows users of NHS services to tell Islington CCG their views. The online survey consists of six short questions that can be completed in as little as sixty seconds using any internet connected device, including smart phones, tablets or PCs.
Primary Care: Our focus during the past 12 months has been to develop ways to improve the capacity for self-care. This means we have supported programmes which teach parents, carers and patients about their long term conditions.
We have also worked towards developing a more personal approach to primary care. Neighbourhoods in Islington are diverse and we want primary care services to reflect the unique needs of each community.
As part of the locality development work, this year marked the start of a Long Term Conditions Locally Commissioned Service where almost all GP practices signed up to participate. The service enables Islington CCG to invest £1.2m in the systematic implementation of enhanced care planning for all patients with a long term condition. The service will run for three years.
We have also added additional support for children in primary care. Additional clinics staffed by nurses with expertise in caring for children are now available throughout Islington.
Urgent Care: We have been speaking to many of you about how we are seeking to improve urgent care in Islington, and in particular around NHS 111 and out of hours services. We have been developing our plans to re-commission these key services with your input (see also s. 1.1 Member Practices Introduction).
We have also launched a new Enhanced Virtual Ward service at Whittington Hospital. The service is led by community matrons with support from local GPs. The service enables people with urgent, but not emergency needs, to see a community matron within 2 hours.
One hundred and four children have used our new Hospital at Home service, which enables nurses to provide previously hospital-based care in the community. Feedback about the service has been positive. It has been described as an “excellent service, very professional, staff friendly, helpful, punctual [and] clear communicators.”
Ensuring high quality, efficient services: We have launched the use of two new tools to help us better understand the impact of services we commission. The Patient Activation Measure is based on a survey you fill out. The information is shared with your GP so he or she can tailor their support to your needs.
The second tool is a survey we are sending to everyone in the borough with a long term condition. Your feedback helps us commission services that enable you to live the best life possible with a long term condition.
To acknowledge the important role nurses play in Islington, we held Islington’s annual nursing conference built around the theme of “Hello my name is…” Dr Kate Granger’s national campaign. There were market stalls, local and national speakers, and interactive Vox Pops, where clinicians and patients could share their views on what the terms “care” and “compassion” meant to them.
1.2.6 Sustainability Report
We remain committed to the Government’s target for the environment including lower carbon emissions and sustainability. Reducing the amount of energy used in our organisation contributes to this goal. Below are examples of ways we are doing this:
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Smarter working - We use smarter working to make efficient use of our office space. As part of a network across the 12 sites in north central London, our staff are able to log on from remote sites, reducing the need for travel.
Recycling - We have an office recycling programme in place to minimise the amount of waste we generate.
Paperless meetings - As part of an effort to minimise use of paper, Governing Body and senior management team members all access documents on tablet computers. This reduces the time and resources involved in production of meeting papers.
These efforts are part of our organisation-wide effort to be as efficient as possible and contributes to the NHS’s commitment to reduce its overall carbon footprint by 10% between 2009 and 2015.
1.2.7 Equality report
It is the policy of Islington CCG that all staff, public and patients will be treated equitably, fairly and with respect. Selection for employment, promotion, training or any other benefit will be on the basis of aptitude and ability. All employees will be helped and encouraged to develop their full potential and the talents and resources of the workforce will be fully utilised to maximise the efficiency of the organisation. Staff may not discriminate directly or indirectly, or harass patients, the public or anyone they come into contact with as a result of their work. Islington CCG is committed to reflecting in its workforce the diversity of the population we serve. We are committed to operating fully in the spirit of the Equality Act 2010. We work hard to make sure we meet our legal duties under the Act and take opportunities to promote equality in everything we do. Over the past year, we used the NHS Delivery System 2, to look into how accessible our services are for local people, and to identify specific ways that we could promote equality and diversity in Islington. Our programme of engagement over the course of the year has furnished us with views and insights from a broad cross-section of patient groups in Islington. Based on the evidence from working with these groups, and analysis using the Equality Delivery System, the following objectives were recommended:
Understanding the current situation for Islington community who need to use interpreting and translating services within primary care services.
Improving the collection of demographic data on the nine protected characteristics3 across Islington health services.
3 The nine protected characteristics are listed in NHS England’s Equality Delivery System 2 (Nov 2013)
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These equality objectives have been developed through our work with our partners at the Council as part of the annual Joint Strategic Needs Assessment (JSNA), which provides us with an evidence base and framework for commissioning health and social care services. As part of our commissioning work, we also looked beyond the JSNA, to include views groups who are well known to experience significant health inequalities. 1.2.8 Membership and employee statistics Our Governing Body has 17 members on the payroll, of which 6 are male and 11 are female. Further to the above there is one female senior manager at ‘Very Senior Manager (VSM)’grade. In total, Islington CCG currently has 55 employees, of which 20 are male and 35 are female. 1.2.9 Social and community issues Islington CCG is committed to playing a full and active role within the wider community. The relationship between health and wider social influences is well established. In November 2014 the report of the Islington Employment Commission was published and the CCG has committed to its role in implementing the recommendations in the coming year. We will be promoting good employment practices and supporting individuals in returning to work. We are already doing some of this work with our partners in the non-profit sector, such as Hillside Clubhouse. We have commissioned Hillside Clubhouse to run an established and successful programme that supports people who would like to get back into work after a period of absence. In addition to supporting the Employment Commission’s work, in 2014 we established the Community Education Provider Network site, which is helping us to develop a well-trained and motivated workforce, an essential component of Islington’s health economy. Given the expected changes in our population in the coming years, we need to be working now to ensure we have the workforce with the right skill mix for our community’s future needs. As part of this, we work with these local partners:
Women’s strategy group (mental health)
Islington Borough Users Group
HealthWatch Islington
Body & Soul
Voluntary Action Islington
Diabetes UK (Islington)
Cripplegate Foundation
We continue to develop and create new relationships through our work. We hold quarterly meetings with the third sector in Islington. Third sector open discussion forum: this helps to link up local third sector organisations and begin to map the ways they can support the local community, as well as building relationships with our third sector, this helps us reach out to those who experience barriers in accessing services. We are working with the organisation Cripplegate Foundation to help us identify the skills which are within the voluntary sector – providing opportunities for this group to bid for work and non-traditional services.
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Islington CCG has developed the Community Wellbeing Project. This project is in partnership with Islington Giving and is being delivered by Help on your Doorstep (a local charity) in the New River Green Estate. Help on your Doorstep already have a lot of local knowledge and run the Good Neighbours scheme on the estate – so they have a good relationship with the local community to deliver this project. This project has four elements to it:
Research and insight with local community into their needs and skills
Design with local community to meet their needs and use their skills
Delivery by local community
Evaluation with local community
The purpose of this project is to support the local community to deliver a project which supports their wellbeing. It has given us an opportunity to evaluate how these projects work, and where the successes and flaws are. A key part of the project is the insight gathering. The project is now in its second year and has been highly successful. Wellbeing support via a series of activities has been set up on the estate as well as the local football team (which was set up by young men living on the estate receiving proper support to develop). 1.2.10 Thank you to our partners in Islington We acknowledge and thank all those across the borough who have given us their time and energy to help inform our decisions. Whether it has been on urgent care development, improving community nursing, improving 111 & GP OOH services, helping us focus on the needs of people in their last years of life or one of the many other projects. We are very grateful. Alison Blair Accountable Officer 28 May 2015
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1.3 Members’ report This section provides information about Islington CCG Governing Body members, including details of terms of service.4 Table 2. Islington CCG Governing Body Members5
Elected Members Role
Gillian Greenhough Chair (GP)
Katie Coleman Joint Vice Chair (GP)
Jo Sauvage Joint Vice Chair (GP)
Sharon Bennett – to June 2014 Central Locality GP Representative (GP)
Jennie Hurley Practice Nurse Representative
Sabin Khan Salaried/Sessional GP Representative
Stephen Rogers - from June 2014 North Locality GP Representative
Karen Sennett South Locality GP Representative
Deborah Snook/Ian Huckle (Mr Huckle from June 2014)
Joint Practice Manager Representative
Co-opted Members Role
Rathini Ratnavel – from June 2014 South East Locality GP Representative
Appointed Members Role
Mo Akmal Secondary Care Hospital Clinician
Sorrel Brookes Lay Member (Audit Committee Member)
Anne Weyman Lay Vice Chair (Chair Audit Committee)
Executive Members Role
Alison Blair Chief Officer (Accountable Officer)
Ahmet Koray Chief Finance Officer
Martin Machray Director, Quality and Integrated Governance
Non-voting Members Role
Paul Sinden Director of Commissioning
Phillip Watson Director of Healthwatch Islington
Simon Galczynski Service Director for Adult Social Care (Local Borough of Islington)
Robbie Bunt Local Medical Committee Representative
Julie Billett Director of Public Health (Camden and Islington)
4 Information about all CCG committees is included in our Governance Statement (s. 2.2). 5 Dates of service are detailed in the Remuneration Report s1.4 (Table 4).
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The Governing Body is enriched by the attendance and contribution of observers from members of the public and our key stakeholders. They have brought fresh perspectives and challenge that have contributed to the strength of our decision making. Details of membership of other committees are provided as part of the Governance Statement at section 2.2 page 28.
1.3.1 Register of Interests
The CCG publishes a full register of interests online at www.islingtonccg.nhs.uk, under About Us > Register of Interests.
1.3.2 Pension liabilities
The accounting policy note for pension liabilities is shown in note 1.8.2 of the annual accounts and note 3.4 covers pension costs. Section 1.4 of the annual report provides details of senior managers’ pensions.
1.3.3 Sickness absence data
Details relating to staff sickness are included under the employee benefits note within note 3.3 of the annual accounts.
1.3.4 External audit
External audit services are being provided by KPMG LLP (12th Floor, 15 Canada Square, London E14 5GL) for the 2014/15 financial year. Costs associated with this service are as follows. Table 3. External Audit costs 2014/15
Component of audit Fee (including VAT)
Audit Services £89,040
Further Assurance Services None
Other Services None
Total £89,040
1.3.5 Disclosure of serious untoward incidents
A statement of Data Security, including information about serious untoward incidents, is included with the Governance Statement.
1.3.6 Cost allocation and setting of charges for information
We certify that the CCG has complied with HM Treasury’s guidance on cost allocation and the setting of charges for information.
1.3.7 Principles for remedy
The Parliamentary and Health Service Ombudsman document on the principles for remedy guides public bodies on providing remedies for injustice or hardship resulting from their maladministration or poor service. Within the Parliamentary and Health Service Ombudsman’s jurisdiction, the guidance sets out what public bodies should do to put things right when they have gone wrong and the approach to recommending remedies. Islington CCG incorporated the principles for remedy within its complaints policy and through welcoming feedback on its services from service users and their relatives and/or carers. Complaints are treated as an ongoing learning opportunity, leading to the prevention or
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recurrence of incidents and complaints. Steps are taken to ensure that it is easy to make written concerns or complaints about the service, throughout the organisation. The policy aims to:
promote ease of access for complainants to raise concerns;
empower staff to receive and, where appropriate, respond to complaints;
support a rapid, open, fair, conciliatory approach to complaints which meets the needs of the complainant whilst supporting learning;
promote a ‘one-stop shop’ approach to complaints that relate to more than one organisation, with unified handling of complaints across health and social care boundaries where possible;
help the identification and management of persistent complainants; and
make good complaints handling a high profile organisational activity.
1.3.8 Employee consultation
Islington CCG undertook a successful staff engagement process in 2014. The purpose and outcome of the staff engagement process was to:
Strengthen and focus the staff establishment and structure;
Add new roles to the overall establishment;
Amend current roles to provide a clearer focus on the strategic challenges of the CCG;
Move from long-standing, temporary arrangements to more permanent roles; and therefore
Provide greater certainty and assurance to current members of the CCG about their roles in the organisation.
1.3.9 Equality and diversity
In accordance with the CCG’s Equality & Diversity Policy, all Islington CCG staff will be treated equitably, fairly and with respect. Selection for employment, promotion, training or any other benefit will be on the basis of aptitude and ability. All employees will be helped and encouraged to develop their full potential and the talents and resources of the workforce will be fully utilised to maximise the efficiency of the organisation.
Islington CCG is committed to reflecting in its workforce the diversity of the population it serves.
The CCG undertakes annual equality reviews by examining workforce data against protected characteristics.
The CCG is committed to ensure that each manager will work to:
create an environment in which individual differences and the contributions of all our staff are recognised and valued.
ensure all staff are aware of the policy, and the reasons for the policy.
support the completion of the annual equality audit and the review of findings.
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1.3.10 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. The CCG has taken appropriate steps to ensure it can deal with a relevant emergency. As a category 2 responder under the Civil Contingencies Act, the CCG has developed and adopted a business continuity plan. This sets out how the CCG will respond to any one or more of a range of key scenarios:
loss of access to premises
loss of key staff
loss of key partners/stakeholders
loss of key services As part of our business continuity planning we have entered into a reciprocal agreement with Camden CCG whereby we can use each other’s main office in the event of an emergency that requires it and that in the event of an emergency in Camden or Islington that requires that CCG to follow its business continuity plan, the other CCG will if need be follow its own business continuity plan to provide such support as is needed. In addition the CCG has shared surge management and on-call arrangements with North and East London Commissioning Support Unit; and Barnet, Camden, Enfield and Haringey CCGs.
1.3.11 Statement as to disclosure to auditors
Each individual who is a member of the Governing Body at the time the Members’ Report is approved confirms:
so far as the member is aware, that there is no relevant audit information of which the CCG’s external auditor is unaware; 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 CCG’s auditor is aware of that information.
Alison Blair Accountable Officer 28 May 2015
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1.4 Remuneration report The NHS has adopted the recommendations outlined in the Greenbury Report in respect of the disclosure of senior managers’ remuneration and the manner in which it is determined. Senior managers are defined as those persons in senior positions having authority or responsibility for directing or controlling the major activities of the CCG. This means those who influence the decisions of the CCG as a whole rather than the decisions of individual directorates or departments. Such persons include advisory and lay members. This report outlines how those recommendations have been implemented by the CCG in the year to 31 March 2015.
1.4.1 Remuneration and terms of service committee
CCGs are required to have a remuneration committee to oversee the pay, terms and conditions of service of senior managers. The main function of the committee is to make recommendations to the board on the remuneration, allowances and terms of service of other officer members to ensure that they are fairly rewarded for their individual contribution to the organisation, having regard for the organisation’s circumstances and performance, and taking into account national arrangements.
1.4.2 Remuneration
We operate a system of performance-related pay for those senior management posts subject to the ‘Very Senior Managers (VSM)’ pay framework. There has been no payment of performance related pay during the year ending 31 March 2015. Future performance related pay for directors will be subject to the terms and conditions of service for very senior managers and will be considered by the remuneration committee. No compensation was payable during the year and no amounts are included that are payable to third parties for the services of senior managers. In the event of redundancy standard NHS packages will apply.
1.4.3 Contractual arrangements
The Chief Officer and other CCG directors are on permanent contracts, subject to a three month notice period.
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Table 4. Salaries and allowances of senior managers 2014/15 (auditable)
Salary (bands
of £5,000)
All Pension Related Benefits (bands of £2,500)
Total (bands
of £5,000)
Co
mm
en
ced
&
En
ded
£'000 £’000 £’000
Voting Members – Executive Directors
Ms Alison Blair Chief Officer 120-125 (5-7.5) 115-120 01/04/2013
Mr Ahmet Koray
Chief Finance Officer 100-105 0-2.5 105-110 01/04/2013
Mr Martin Machray
Director of Quality & Integrated Governance
90-95 30-32.5 120-125 01/04/2013
Voting Members – Elected Members
Dr Gillian Greenhough*
Chair 85-90 0 85-90 01/04/2013
Dr Josephine Sauvage*
Joint Vice Chair (Clinical) 55-60 0 55-60 01/04/2013
Dr Katie Coleman*
Joint Vice Chair (Clinical) 55-60 0 55-60 01/04/2013
Dr Sharon Bennett*
Central Locality GP Member
5-10 0 5-10 01/04/2013
to 14/06/2014
Dr Stephen Rogers*
North Locality GP Member
15-20 0 15-20 01/10/2013
Dr Karen Sennett*
South Locality GP Member
20-25 0 20-25 01/04/2013
Dr Sabin Khan* Salaried GP Representative
35-40 0 35-40 01/04/2013
Mr Ian Huckle Joint Practice Manager Representative
0-5 0 0-5 15/06/2014
Ms Deborah Snook
Joint Practice Manager Representative
0-5 0 0-5 01/04/2013
Ms Jennie Hurley*
Practice Nurse Representative
5-10 0 5-10 01/04/2013
Voting Members – Co-opted Members
Dr Rathini Ratnavel*
South Locality GP Member
20-25 0 20-25 01/04/2013
Lay Members and Appointed Members
Mr Mohammed Akmal
Secondary Care Clinician 10-15 0 10-15 01/04/2013
Ms Sorrel Brookes
Lay Member 10-15 0 10-15 01/04/2013
Ms Anne Weyman
Vice Chair (Non-Clinical) 10-15 0 10-15 01/04/2013
to 31/03/2015
Non-Voting Directors
Mr Paul Sinden Director of Commissioning 100-105 27.5-30 130-135 01/04/2013
Dr Dominic Roberts
Clinical Director 45-50 135-
137.5 180-185 07/07/2014
Dr Robbie Bunt*
Local Medical Committee Representative
10-15 0 10-15 01/04/2013
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Notes The governing body GP, practice nurse and manager posts were novated when the CCG was established, with terms that expired on 14 June 2014. They were re-elected for a term between 2 to 4 years from 15 June 2014. As the members were not changed, the information above is presented as though they were in post for the full year. No senior managers received other remuneration from the CCG, benefits in kind or bonus payments. *GP members with a contract for services and therefore disclosed under off-payroll engagements. All pension related benefit applies to those receiving pension contributions only. The amount included here comprises all pension related benefits, including: the cash value of payments (whether in cash or otherwise) in lieu of retirement benefits; and, all benefits in year from participating in pension schemes. For defined benefit schemes, the amount included here is the annual increase in pension entitlement determined in accordance with the ‘HMRC’ method. In summary, this is as follows: Increase = ((20 x PE) +LSE) – ((20 x PB) + LSB), where:
PE is the annual rate of pension that would be payable to the director if they became entitled to it at the end of the financial year;
PB is the annual rate of pension, adjusted for inflation, that would be payable to the director if they became entitled to it at the beginning of the financial year;
LSE is the amount of lump sum that would be payable to the director if they became entitled to it at the end of the financial year; and,
LSB is the amount of lump sum, adjusted for inflation, that would be payable to the director if they became entitled to it at the beginning of the financial year.
NB: Dr Khan’s remuneration includes arrears to cover unpaid salary in previous years. Dr Ratnavel began the year as an elected member and was then co-opted from July.
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Table 4.1 Salaries and allowances of senior managers 2013/14 (auditable)
Salary (bands of £5,000)
All Pension Related Benefits (bands of £2,500)
Total
(bands of £5,000)
Co
mm
en
ced
&
En
ded
£'000 £’000 £’000
Voting Members – Executive Directors
Ms Alison Blair Chief Officer 120–125 152.5–155 275–280 01/04/2013
Mr Ahmet Koray
Chief Finance Officer 100–105 102.5–105 205–210 01/04/2013
Mr Martin Machray
Director of Quality & Integrated Governance
85–90 35-37.5 120-125 01/04/2013
Voting Members – Elected Members
Dr Gillian Greenhough
Chair 85 90 0 85–90 01/04/2013
Dr Josephine Sauvage
Joint Vice Chair (Clinical)
55–60 0 55–60 01/04/2013
Dr Katie Coleman
Joint Vice Chair (Clinical)
55–60 0 55–60 01/04/2013
Dr Sharon Bennett
Central Locality GP Member
20–25 0 20–25 01/04/2013
Dr Anjan Chakraborty
North Locality GP Member
0–5 0 0–5 01/04/2013
> 31/07/2013
Dr Karen Sennett
South Locality GP Member
20-25 0 20-25 01/04/2013
Dr Rathini Ratnavel
South Locality GP Member
20–25 0 20–25 01/04/2013
Dr Sabin Khan Salaried GP Representative
10–15 0 10–15 01/04/2013
Ms Deborah Snook
Practice Manager Representative
5–10 0 5–10 01/04/2013
Ms Jennie Hurley
Practice Nurse Representative
5–10 0 5–10 01/04/2013
Voting Members – Co-opted Members
Dr Stephen Rogers
North Locality GP Member
5–10 0 5–10 01/10/2013
Lay Members and Appointed Members
Mr Mohammed Akmal
Secondary Care Clinician
10–15 0 10–15 01/04/2013
Ms Sorrel Brookes
Lay Member 10–15 0 10–15 01/04/2013
Ms Anne Weyman
Vice Chair (Non-Clinical)
10–15 0 10–15 01/04/2013
Non-Voting Directors
Mr Paul Sinden Director of Commissioning
95–100 30-32.5 120-125 01/04/2013
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Dr Robbie Bunt Local Medical Committee Representative
5–10 0 5–10 01/04/2013
1.4.4 Pensions
All staff, including senior managers, are eligible to join the NHS pension scheme. The scheme has fixed the employer’s contribution at 14% of the individual’s salary as per the NHS Pensions regulations. Employee contribution rates for CCG officers and practice staff, and the prior year comparators, are as follows: Table 5. Member contribution rates before tax relief (gross)
Scheme benefits are set by NHS Pensions and are applicable to all members. Past and present employees are covered by the provisions of the NHS pension scheme. Full details of how pension liabilities are treated are shown in note 3.4 of the annual accounts.
1.4.5 Termination agreements or exit packages
Termination arrangements are applied in accordance with statutory regulations as modified by national NHS conditions of service agreements (specified in Agenda for Change), and the NHS pension scheme. Specific termination arrangements will vary according to age, length of service and salary levels. The remuneration committee will agree any severance arrangements.
1.4.6 Salary and pension entitlements of directors and senior managers
The following schedules disclose further information regarding remuneration and pension entitlements. Table 6. Pension benefits of senior managers
£000
Real increase
in pension at age 60
Real increase
in pension
lump sum at aged 60
Total accrued pension at age 60
at 31st March 2015
Lump sum at age 60 related to accrued
pension at 31st March
2015
Cash equivalent
transfer value at
31st March 2015
Real increase in cash
equivalent transfer
value
Cash equivalent
transfer value at 31st March 2014
(bands of £2,500)
(bands of £2,500)
(bands of £5,000) (bands of £5,000)
Board members
Ms Alison Blair 0-2.5 0-2.5 40-45 120-125 707 29 660
Mr Ahmet Koray 0-2.5 0-2.5 25-30 75-80 396 20 366
Mr Martin Machray 0-2.5 5-7.5 30-35 90-95 579 51 514
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Senior managers
Mr Paul Sinden 0-2.5 5-7.5 20-25 60-65 350 40 302
Dr Dominic Roberts 2.5-5 12.5-15 10-15 35-40 162 61 77
There are no entries in the cases of members with non-pensionable remuneration or GP members with a contract for services.
1.4.7 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. CETVs are calculated in accordance with the Occupational Pension Schemes (Transfer Values) Regulations 2008. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.
1.4.8 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.
1.4.9 The relationship between the highest paid director and median remuneration
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 mid-point of the banded remuneration of the highest paid member of the CCG in the financial year 2014-15 was £123k (unchanged from 2013-14). This was 2.5 times (2013-14, 2.6) the median remuneration of the workforce, which was £48k (2013-14, £47k). In 2014-15, no individuals (unchanged from 2013-14) received remuneration in excess of the highest paid member. Remuneration ranged from £5k to £123k (2013-14, £18k to £123k). Total remuneration includes salary, non-consolidated performance-related pay, and benefits-in kind. It does not include severance payments, employer pension contributions and the cash equivalent transfer value of pensions.
1.4.10 Off-payroll engagements
Following the Review of Tax Arrangements of Public Sector Appointees published by the Chief Secretary to the Treasury on 23 May 2012, CCGs must publish information on their highly
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paid and/or senior off-payroll engagements. Payments to GP practices for the services of employees and GPs are deemed to be off-payroll engagements. Table 7. Off-payroll engagements
Number
Engagements as of 31 March 2015, for more than £220 per day and that last longer than six months
15
Of which, the number that have existed:
for between two and three years at the time of reporting 15
New engagements between 1 April 2014 and 31 March 2015, for more than £220 per day and that last longer than six months
1
Number of the above which include contractual clauses giving the CCG the right to request assurance in relation to income tax and National Insurance obligations
1
Number for whom assurance has been requested 1
Of which:
assurance has been received 1
Number of off-payroll engagements of governing body members, and/or, senior officers with significant financial responsibility, during the year
10
Number of individuals that have been deemed governing body members, and/or, senior officers with significant financial responsibility, during the financial year (this figure includes both off-payroll and on-payroll engagements)
20
All current engagements and none of the new engagements are governing body members. 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.
1.4.11 Profiles of our Governing Body Members
Our Governing Body is made up of elected and non-elected members, drawn from a range of clinical and lay backgrounds. This provides the CCG with a range of views and expertise across health and social care. Elected Members
Dr Gillian Greenhough - Chair Dr Greenhough is a local Islington GP and has been Chair of the CCG for three years. She has a background in public health as well as in general practice and has been elected to Chair the CCG by all GPs in the 37 practices across Islington. Dr Katie Coleman - Joint Vice Chair (Clinical) Dr Coleman is the Joint Vice Chair (Clinical) of Islington CCG. Her clinical lead portfolio includes; patient and public participation; the Primary Care Strategy; children’s services and maternity services. Dr Coleman is currently the Chair of the Patient and Public Participation Committee. Dr Josephine Sauvage - Joint Vice Chair (Clinical)
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Dr Sauvage is a local GP at the City Road medical Practice and is the Joint Vice Chair (Clinical) of Islington CCG. Dr Sauvage leads on the integrated care strategy, delivering person centred, and co-ordinated care for those with complex or long term conditions. Dr Sauvage is currently the Chair of the Strategy and Finance Committee. Jennie Hurley – Practice Nurse Representative Ms Hurley is practice nurse representative on the Governing Body as well as a member of the Patient and Public Participation committee. Ms Hurley is the lead on last year of life care. Dr Sabin Khan – Salaried/Sessional GP Representative Dr Khan is the salaried/sessional GP representative on the Governing Body and is the Individual Funding Request Panel Chair. Dr Khan is a member of the Quality and Performance Committee. Dr Rathini Ratnavel – South Locality GP Representative Dr Ratnavel is a local practicing GP leading on Safeguarding Adults and is a member of the CCG Audit Committee. Dr Stephen Rogers – North Locality GP Representative Dr Rogers is based at the Hornsey Rise practice and was co-opted to the Governing Body, to represent the North Locality in November 2013. Dr Karen Sennett – South Locality GP Representative Dr Sennett is a GP from the South Locality and is the GP Governing Body lead for quality, cancer, chronic obstructive pulmonary disease and liver pathways. Dr Sennett is a member of the Quality and Performance Committee and is the CCG Caldicott Guardian. Deborah Snook – Practice Manager Representative Ms Snook is the Practice Manager Representative, with responsibility for learning disabilities and direct access diagnostics. Ms Snook is a member of the Strategy and Finance Committee. Ian Huckle – Practice Manager Representative Mr Huckle has been the Practice Manager of the Rise Group Practice in Hornsey Rise for the past five years. He arrived with many transferrable skills stemming from a 20 year career with Barclays Bank and subsequent roles involving large scale people and operational management. Appointed Members
Anne Weyman - Lay Vice Chair Ms Weyman is the Lay Vice Chair of Islington CCG with responsibility for governance and chair of the Audit Committee and is a member of the Islington Health and Wellbeing Board. Mr Mo Akmal – Secondary Care Clinician Mr Akmal is a consultant orthopaedic spinal surgeon and Chief of Trauma & Orthopaedic Surgery at Imperial College Healthcare NHS Trust. Sorrel Brookes – Lay Member Ms Brookes is the lay member on the Islington CCG Governing Body with responsibility for patient and public participation and chairs the Quality and Performance Committee of the CCG. Executive
Alison Blair – Chief Officer
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Ms Blair is the Chief Officer of Islington CCG. Her role is to provide executive leadership, to develop and implement strategies involving the members, partners, the public and patients. Ahmet Koray – Chief Finance Officer Mr Koray is the Chief Finance Officer with responsibility for all financial aspects, performance reporting and the Programme Management Office (PMO) function across Islington CCG. Martin Machray – Director - Quality and Integrated Governance Mr Machray is the Director of Quality and Integrated Governance and the Executive Nurse for Islington CCG. A declaration of interests register including all governing body members and senior managers is available on the website (www.islingtonccg.nhs.uk). Alison Blair Accountable Officer 28 May 2015
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2. Statements by the accountable officer
2.1 Statement of accountable officer’s responsibilities
The National Health Service Act 2006 (as amended) states that each CCG shall have an Accountable Officer and that Officer shall be appointed by the NHS Commissioning Board (NHS England). NHS England has appointed the Chief Officer to be the Accountable Officer of the CCG. 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 CCG and enable them to ensure that the accounts comply with the requirements of the Accounts Direction) and for safeguarding the CCG’s assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities), are set out in the CCG Accountable Officer Appointment Letter. Under the National Health Service Act 2006 (as amended), NHS England has directed each CCG to prepare for each financial year financial statements in the form and on the basis set out in the Accounts Direction. The financial statements are prepared on an accruals basis and must give a true and fair view of the state of affairs of the CCG 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 CCG Accountable Officer Appointment Letter.
Alison Blair Accountable Officer 28 May 2015
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2.2 Governance Statement 2.2.1 Introduction and context The CCG was licenced from 1 April 2013 under provisions enacted in the Health & Social Care Act 2012, which amended the National Health Service Act 2006. As at 1 April 2014, the CCG was licensed without conditions.
2.2.2 Scope of responsibility As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the CCG’s policies, aims and objectives, whilst safeguarding the public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out in my CCG Accountable Officer Appointment Letter. I am responsible for ensuring that the CCG is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity. 2.2.3 Compliance with the UK Corporate Governance Code Whilst the detailed provisions of the UK Corporate Governance Code are not mandatory for public sector bodies, compliance with the relevant principles of the code is considered to be good practice. This Governance Statement is intended to demonstrate how the CCG had regard to the principles set out in the code considered appropriate for CCGs for the financial year ended 31 March 2014. 2.2.4 The CCG 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. Constitution: The CCG’s constitution sets out the arrangements put in place to meet its responsibilities for commissioning health care for Islington residents. It sets out the membership of the CCG, accountability, the governance structure including decision-making arrangements and Governing Body roles and responsibilities, and the management of conflicts of interest. Governing Body: The Governing Body is responsible for ensuring that the CCG has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with the principles of good governance. The Governing Body comprises fifteen voting members including nine elected posts, three executives, two lay members, and a secondary care doctor. The Vice-Chair (Clinical) post is currently filled by a job share, as is the post of Practice Manager Representative. In addition meetings are attended by the Director of Commissioning and observers with speaking rights from Healthwatch Islington, the London Borough of Islington, the Local Medical Committee
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and Islington Public Health. Full membership details are set out as part of the Members’ Report at section 1.2 of this Annual Report. During the course of the year one elected member resigned her post and a co-opted member was appointed. This arrangement will stand until the electoral term ends in June 2015. The Governing Body has met in public on seven occasions in 2014/15 and has also held six seminar sessions. Details of the attendance at public meetings of individual members is set out at Annex A. On average, members attended 87% of all such meetings. In addition to the commitment to good governance set out in the CCG’s Constitution the Governing Body has adopted and works to the spirit of:
the Nolan Principles (selflessness, integrity, objectivity, accountability, openness, honesty and leadership);
the Code of Conduct for NHS Boards;
the Code of Practice on Openness in the NHS;
the Code of Conduct: Managing conflicts of interest where GP practices are potential providers of CCG commissioned services.
Conflicts of Interests and Register of Interests: Islington CCG is committed to the principles of transparent and open decision making. The Conflicts of Interest Policy has been adopted to ensure that decisions made by the CCG will be taken, and seen to be taken, without any possibility of the influence of external or private interests. The CCG keeps a register of interests which is reviewed regularly and updated as necessary. This is published on the CCG’s website. Review of Effectiveness: The Governing Body has been operating in either shadow or authorised status for over three years and has periodically taken time to reflect on its collective performance. Using the UK Corporate Governance Code (2014), members considered their effectiveness against the main principles of:
Leadership
Effectiveness
Accountability
Relations with stakeholders The Governing Body’s overall reflection of 2014/15 has been that they have performed satisfactorily against all of these. However they also recognise that the Governing Body continually needs to challenge itself to improve. Committees: The Governing Body has established five committees including two statutory committees which are the Audit Committee and the Remuneration Committee. Our non-statutory committees are the Patient and Public Participation Committee, the Quality and Performance Committee and the Strategy and Finance Committee. Details of the membership of all committees during 2014/15 is set out at Annex A and their full terms of reference are available on the CCG’s website.
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Fig. 2 Islington CCG Organisational Chart
Audit Committee This committee was chaired by Anne Weyman during 2014/15.
Purpose and aim: The Committee provides oversight of the establishment and maintenance of integrated governance, risk management and internal control systems to support the achievement of the CCG’s strategic objectives.
Highlights of reports that the Committee has received reports on: • Progress against the internal audit programme from Baker Tilly Business
Services Limited including the Head of Internal Audit Opinion and an assessment of fraud risk and the counter fraud programme;
• External audit issues from KPMG; • The Governing Body Assurance Framework; • Waivers to tender and quotation procedures; and • A review of Governing Body committee effectiveness.
Meetings: The Audit Committee has met five times in 2014/15. Details of the attendance of individual committee members is set out at Annex A. On average, members attended 87% of all meetings.
Remuneration Committee
This committee was chaired by Anne Weyman during 2014/15.
Purpose and aim: The Committee makes recommendations to the Governing Body about pay, remuneration and conditions of service for employees of the CCG and others who provide services to the CCG.
Highlights of reports: Decisions taken by the Committee in 2014/15 concerned the remuneration of Governing Body clinician members and clinical leads.
Meetings:
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The Remuneration Committee has met three times in 2014/15. Details of the attendance of individual committee members is set out at Annex A, which shows that members achieved a 100% attendance record.
Patient and Public Participation Committee This committee is chaired by Dr Katie Coleman.
Purpose and aim: The Committee is responsible for the development, implementation and oversight of the CCG’s Patient & Public Participation and Equality and Diversity Strategy.
Highlights of reports that the Committee has received reports on: • patient and public participation in the CCG’s key strategic programmes
including integrated care, primary care, and urgent care; • patient and public participation in the development of the Five Year Plan; • the work of Healthwatch; and • progress against the Equality and Diversity work plan.
Meetings: The Patient and Public Participation Committee has met five times in 2014/15. Details of the attendance of individual committee members is set out at Annex A. On average, members attended 96% of all meetings.
Quality and Performance Committee
This committee is chaired by Sorrel Brookes.
Purpose and aim: The committee is responsible for the oversight and monitoring of the quality of commissioned services including patient experience and safety; the effectiveness of commissioned services; and the performance against service delivery indicators.
Highlights of reports that the Committee has received reports on: • Regular update reports from providers on quality and performance matters; • Regular performance reports on key performance indicators; • Complaints; and • Serious Incidents.
Meetings: The Quality and Performance Committee has met twelve times in 2014/15. Details of the attendance of individual committee members is set out at Annex A. On average, members attended 84% of all meetings.
Strategy and Finance Committee This committee is chaired by Dr Jo Sauvage.
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Purpose and aim: The committee has responsibility for financial monitoring and has oversight of the development and implementation of strategic plans including associated financial plans.
Highlights of reports that the Committee has received reports on: • The delivery of the financial plans and the Quality, Innovation, Productivity
and Prevention (QIPP) Programme; • The contracting process; • Performance against each of the four key strategic programmes including
integrated care, primary care, urgent care, and planned care; • The development of the Operating Plan and the Five Year Plan; and • Local Commissioned Services;
Meetings: The Strategy and Finance Committee has met twelve times in 2014/15. Details of the attendance of individual committee members is set out at Annex A. On average, members attended 89% of all meetings.
2.2.5 The CCG Risk Management Framework
The CCG established a corporate risk register and board assurance framework in April 2013. Risks go through a regular review cycle of:
Risk leads and Integrated Governance Manager review and update risks
Risk owners (the Chief Officer and Directors of the CCG) review risks
The risk register is considered by the Executive Management Team monthly
Relevant risks are considered by these four committees:
• Quality and Performance • Finance and Strategy • Audit
The full risk register, with amendments, is approved by the Governing Body at its bi-monthly meetings
The board assurance framework is considered by the Audit Committee at each of its meetings
All risks are linked to the CCG’s key priorities and the mitigation and assurance of risks is scrutinised as part of the internal audit work-plan. The CCG through the use of its committee paper proforma front cover sheet requires all risks relating to the content in the reports to be highlighted including an equality impact assessment and also whether there is any patient and public involvement. In addition to this, there are a number of further mechanisms by which risks are identified. These are explained below. Risk leads work collaboratively with stakeholders to identify and implement mitigating controls. Examples include joint working with the Local Authority on managing risks around Commissioning Healthcare, or working with our Patient and Public Participation groups to manage risks around the proper handling of, and learning from, patient complaints.
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In addition our committees and Governing Body have representation on them from key stakeholders. There is at least one patient representative on each of our committees, and our Governing Body has observers from Public Health, HealthWatch Islington and the Local Authority. Incidents, Complaints and Claims: All incidents, complaints and claims are reported and managed in line with the respective policies. Any risks identified as part of these processes are managed in line with relevant policies. Policies: All risks identified through the development and implementation of policies are assessed and managed through the risk management process. External Assessments: A number of external assessments and audits are undertaken each year. All risks identified in relation to the requirements of an external assessment are assessed and managed through the risk management process. National Guidance / Safety Alerts: There is a process in place for managing the dissemination and implementation of relevant NICE guidance, national guidance, and safety alerts. All risks identified in relation to implementation of guidance are assessed and managed through the risk management process. Internal Audit: Internal Audit provide an independent and objective opinion on the effectiveness of risk management and governance within the organisation. All risks identified through this process are assessed and managed through the risk management system. Risk Rating Matrix: It is common for risks to be rated one a scale of one to five for likelihood and impact, with five being the highest. Risks rated 1-6 inclusive are green; 8-12 inclusive are amber; and those rated 15 or higher are red. Likelihood: The assessment of likelihood uses a scale from highly unlikely to almost certain. Anything that is certain to occur is not a risk, and should not be managed using the risk register. Impact: The assessment of risk impact is described in terms of clinical impact, financial impact, or reputational impact. The Governing body consider the guidance on risk impact in their assessment, noting that a clinical impact of three is defined as the minimum threshold for a risk that relates to an SI and as such a rating of five cannot be applied to anything that is not considered an SI.
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Risk ‘Heat Map’: A risk ‘heat map’ is used as a basis to illustrate risks both prior to and post mitigation. This heat map also highlights additional risks for inclusion or deletion. Risks that have had their ratings increased or decreased are marked. The Review Cycle: The review cycle runs from one meeting of the Governing Body to the next. The Integrated Governance Manager, in discussion with the risk owners and risk leads, keeps the risk register updated and draft papers for each review meeting. Review meetings include:
Executive Team meetings
Committee meetings, looking at risks relating to each committee’s remit
The Audit Committee to consider the full risk register Appropriate controls and actions need to be agreed and taken to reduce all risks to an acceptable level, or where it is not possible to reduce the level of risk ensure that it is managed appropriately. The appointed Local Counter Fraud Specialist for the CCG compiled an annual work plan relating to the management of fraud related risks that was based around the following key areas: Proactive work programme:
Awareness and Development (Creating an Anti-Fraud Culture)
Managing Organisational Fraud Risk (Compliance with the NHS Counter Fraud Strategy and CIPFA Red Book “Managing The Risk Of Fraud”)
Compliance, Governance and Reporting (Taking Action To Tackle The Problem) Reactive Work Programme:
Investigations, Sanctions and Redress (Taking Action To Tackle The Problem)
2.2.6 The CCG Internal Control Framework
A system of internal control is the set of processes and procedures in place in the CCG 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. Each risk has an assigned risk lead and a risk owner. The risk lead is responsible for keeping the risk up to date and providing evidence of the mitigating controls. Any changes to the risk and the evidence supporting this are then signed off by the risk owner, who is typically an executive director. Every CCG committee then considers and comments on the risks within its remit. After this the full risk register is considered and commented on by the Governing Body. The Audit
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Committee considers the full risk register to ensure the appropriate risk management systems are in place, and are being adhered to. Risk leads and owners typically review their risks monthly, while the review cycle from Governing Body meeting to Governing Body meeting lasts two months. There are therefore six cycles of risk reviews each year. 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 CCG, 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 management framework and information governance processes and procedures in line with the information governance toolkit. We have ensured all staff undertake annual information governance training and have developed a range of guidance 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 Director of Quality and Integrated Governance has been designated as Senior Information Risk Owner for the CCG.
2.2.7 Risk Assessment in Relation to Governance, Risk Management &
Internal Control
During 2014/15 the following risks were red-rated pre-mitigation, and amber post-mitigation: Information governance There are a number of risks facing the CCG around information governance: CCGs may generally not access patient identifiable data without explicit consent or where it is for the purposes of direct care, and we operate in an environment where there is a lack of knowledge of the standards for accessing information and of the responsibilities of individual bodies. The CCG and its stakeholders are at risk of reputational and financial consequences if appropriate processes for data collection, transmission, analysis and storage are not in place. The risk is mitigated through the establishment of information governance processes and procedures in line with the information governance toolkit, the CCG’s Accredited Safe Haven status, and regular induction and refresher training for staff. Patients’ complaints There is a risk of loss of patient confidence in the system for making complaints, arising from the fragmentation of responsibilities across a range of organisations and the consequent complexity of the system. Without this information the CCG is unable to learn from patient experience or work with providers of health care to implement improvements. The risk is mitigated through the provision by the CCG of clear signposting through the complaints
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system, the inclusion of a representative of Healthwatch Islington on key committees, and committee-level monitoring of complaints.
2.2.8 Review of Economy, Efficiency and Effectiveness of the Use of
Resources
The Governing Body is responsible for ensuring that the CCG uses its resources economically, efficiently and effectively. To achieve this it ensures that the CCG has robust financial controls in place, including appropriate financial policies, expenditure approval limits for staff, robust procurement processes, clearly defined budget-holding responsibilities, and regular reporting of financial performance to committees, the management team, and the Governing Body. All Business Cases for major investment include a detailed financial analysis and are subject to scrutiny by the Strategy and Finance Committee and the Governing Body. The CCG’s internal auditors review key financial systems annually, both within the CCG and at the North and East London Commissioning Support Unit (the CSU), which provides a range of financial support services to the CCG. All reviews carried out in 2014/15 have received an opinion of reasonable or substantial assurance.
2.2.9 Review of the Effectiveness of Governance, Risk Management &
Internal Control
As Accountable Officer I have responsibility for reviewing the effectiveness of the system of internal control within the CCG. Capacity to Handle Risk: There is a Governing Body and management commitment to effective risk management across the CCG. The Governing Body and all committees have clearly defined responsibilities for risk management. All staff are invited to undertake local risk training to ensure they can identify, describe and evaluate a risk. Our induction programme includes mandatory training on high risk areas such as information governance and equality and diversity. Guidance provided to staff reflects professional best practice. Review of Effectiveness: My review of the effectiveness of the system of internal control is informed by the work of the internal auditors and the executive managers and clinical leads within the CCG who have responsibility for the development and maintenance of the internal control framework. I have drawn on performance information available to me. My review is also informed by comments made by the external auditors in their annual audit letter and other reports. The Board Assurance Framework itself provides me with evidence that the effectiveness of controls that manage risks to the CCG achieving its principles objectives have been reviewed. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Governing Body and the Audit Committee and plans to address weaknesses and ensure continuous improvement of the system are in place. Following completion of the planned audit work for the financial year for the CCG and the quality assurance work for the CSU, the Head of Internal Audit issued an independent and objective opinion on the adequacy and effectiveness of the CCG’s system of risk management, governance and internal control. During the year Internal Audit did not issue any audit reports with a conclusion of limited or no assurance, and the Head of Internal Audit concluded that:
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Based on the work undertaken in 2014/15, significant assurance can be given that there is a generally sound system of internal control which is designed to meet the organisation’s objectives, and that controls are being applied consistently in all the areas reviewed.
Data Quality: The Governing Body considered data quality as part of its review of its effectiveness, and concluded that the quality of data is satisfactory. It remains committed however to the continuous improvement of the quality of the data used in carrying out its duties. Business Critical Models: An appropriate framework and environment is in place to provide quality assurance of business critical models. Data Security: We have submitted a satisfactory level of compliance with the information governance toolkit assessment. There were no data breaches at or caused by Islington CCG during 2014/15. Discharge of Statutory Functions: During establishment, the arrangements put in place by the CCG and explained within the Corporate Governance Framework were developed with extensive expert external legal input, to ensure compliance with all relevant legislation. That legal advice also informed the matters reserved for Membership Body and Governing Body decision and the scheme of delegation. In light of the Harris Review, the CCG has reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislation and regulations. As a result, I can confirm that the CCG is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions. Responsibility for each duty and power has been clearly allocated to a lead director. Directorates have confirmed that their structures provide the necessary capability and capacity to undertake all of the CCG’s statutory duties. Conclusion There have been no significant internal control issues identified during the course of 2014/15. Alison Blair Accountable Officer 28 May 2015
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3. Annual accounts
3.1 Report by the auditors to the members of the CCG
42
43
44
45
3.2 Financial statements
Statement of Comprehensive Net Expenditure for the year ended 31 March 2015
2014-15 2013-14
Note £000 £000
Total income and expenditure
Employee benefits 3.1.1 4,030 3,535
Operating expenses 4 313,743 304,262
Other operating revenue 2 (2,496) (1,500)
Total comprehensive net expenditure for the year
315,277 306,297
Of which:
Administration income and expenditure
Employee benefits 3.1.1 1,904 1,519
Operating expenses 4 3,440 3,931
Other operating revenue 2 (125) (154)
Net administration expenditure for the year 5,218 5,296
Programme income and expenditure
Employee benefits 3.1.1 2,126 2,015
Operating expenses 4 310,303 300,331
Other operating revenue 2 (2,371) (1,346)
Net programme expenditure for the year 310,058 301,000
CCG final position
Revenue resource limit 323,484 313,738
Total comprehensive net expenditure (315,277) (306,297)
Surplus 8,207 7,441
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Statement of Financial Position as at 31 March 2015
31 March
2015 31 March
2014 Note £000 £000
Non-current assets
Property, plant and equipment 7 0 60
Total non-current assets 0 60
Current assets
Trade and other receivables 8 4,445 2,505
Cash and cash equivalents 9 69 109
Total current assets 4,513 2,614
Total assets 4,513 2,674
Current liabilities
Trade and other payables 11 (36,195) (29,783)
Total current liabilities (36,195) (29,783)
Total assets less net current liabilities (31,682) (27,109)
Non-current liabilities
Provisions 12 (500) (500)
Total non-current liabilities (500) (500)
Total assets less liabilities (32,182) (27,609)
Financed by taxpayers’ equity
General fund (32,182) (27,612)
Revaluation reserve 0 3
Total taxpayers' equity (32,182) (27,609)
The notes on pages 47 to 74 form part of this statement The financial statements on pages 43 to 46 were approved by the Governing Body on 26 May 2015 and signed on its behalf by: Alison Blair
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Statement of Changes In Taxpayers Equity for the year ended 31 March 2015
General fund
Revaluation reserve
Total
reserves
£000 £000 £000 Changes in taxpayers’ equity for 2014-15
Balance at 1 April 2014 (27,612) 3 (27,609)
Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2014-15
Net operating expenditure for the financial year
(315,277) 0 (315,277)
Release of reserves to the Statement of Comprehensive Net Expenditure
0 (3) (3)
Net recognised NHS Clinical Commissioning Group expenditure for the financial year
(315,277) (3) (315,280)
Net funding 310,707 0 310,707
Balance at 31 March 2015 (32,182) 0 (32,182)
Changes in NHS Commissioning Board taxpayers’ equity for 2013-14
Net operating costs for the financial year
(306,297) (306,297)
Net recognised NHS Commissioning Board expenditure for the financial year
(306,297) 0 (306,297)
Net funding 278,628 0 278,628
Balance at 31 March 2014 (27,612) 3 (27,609)
Accountable Officer 29 May 2015
48
49
Statement of Cash Flows for the year ended 31 March 2015
2014-15 2013-14
Note £000 £000
Cash flows from operating activities
Net operating expenditure for the financial year (315,277) (306,297)
Impairments and reversals 4 60 0
Increase in trade & other receivables 8 (1,942) (2,505)
Increase in trade & other payables 10 6,411 29,783
Increase in provisions 11 0 500
Net cash outflow before financing (310,747) (278,519)
Cash flows from financing activities
Grant in aid funding received 310,707 278,628
Net cash inflow from financing activities 310,707 278,628
Net increase/(decrease) in cash & cash equivalents 9 (40) 109
Cash & cash equivalents at the beginning of the financial year
109 0
Cash & cash equivalents at the end of the financial year
69 109
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Notes to the financial statements
1 Accounting Policies
NHS England has directed that the financial statements of clinical commissioning groups (CCGs) shall meet the accounting requirements of the Manual for Accounts issued by the Department of Health. Consequently, the following financial statements have been prepared in accordance with the Manual for Accounts 2014-15 issued by the Department of Health. The accounting policies contained in the Manual for Accounts follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to CCGs, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Manual for Accounts permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the CCG for the purpose of giving a true and fair view has been selected. The particular policies adopted by the CCG are described below. They have been applied consistently in dealing with items considered material in relation to the accounts.
1.1 Going Concern
These accounts have been prepared on the going concern basis.
Public sector bodies are assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as evidenced by inclusion of financial provision for that service in published documents.
Where a CCG ceases to exist, it considers whether or not its services will continue to be provided (using the same assets, by another public sector entity) in determining whether to use the concept of going concern for the final set of Financial Statements. If services will continue to be provided the financial statements are prepared on the going concern basis.
1.2 Accounting Convention
These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities.
1.3 Acquisitions & Discontinued Operations
Activities are considered to be ‘acquired’ only if they are taken on from outside the public sector. Activities are considered to be ‘discontinued’ only if they cease entirely. They are not considered to be ‘discontinued’ if they transfer from one public sector body to another.
1.4 Movement of Assets within the Department of Health Group
Transfers as part of reorganisation fall to be accounted for by use of absorption accounting in line with the Government Financial Reporting Manual, issued by HM Treasury. The Government Financial Reporting Manual does not require retrospective adoption, so prior year transactions (which have been accounted for under merger accounting) have not been restated. Absorption accounting requires that entities account for their transactions in the period in which they took place, with no restatement of performance required when functions transfer within the public sector. Where assets and liabilities transfer, the gain or loss resulting is recognised in the Statement of Comprehensive Net Expenditure, and is disclosed separately from operating costs.
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Other transfers of assets and liabilities within the Department of Health Group are accounted for in line with IAS 20 and similarly give rise to income and expenditure entries.
1.5 Pooled Budgets
Where the CCG has entered into a pooled budget arrangement under Section 75 of the National Health Service Act 2006, it accounts for its share of the assets, liabilities, income and expenditure arising from the activities of the pooled budget, identified in accordance with the agreement.
If the CCG is in a “jointly controlled operation”, it recognises:
the assets the CCG controls;
the liabilities the CCG incurs;
the expenses the CCG incurs; and,
the CCG’s share of the income from the pooled budget activities.
If the CCG is involved in a “jointly controlled assets” arrangement, in addition to the above, it recognises:
CCG’s share of the jointly controlled assets (classified according to the nature
of the assets);
the CCG’s share of any liabilities incurred jointly; and,
the CCG’s share of the expenses jointly incurred.
1.6 Critical Accounting Judgements & Key Sources of Estimation Uncertainty
In the application of the CCG’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period, or in the period of the revision and future periods if the revision affects both current and future periods.
1.6.1 Critical Judgements in Applying Accounting Policies
There have been no critical judgements, apart from those involving estimations (see below) that management has made in the process of applying the CCG’s accounting policies that have the most significant effect on the amounts recognised in the financial statements.
1.6.2 Key Sources of Estimation Uncertainty
The following are the key estimations that management has made in the process of applying the CCG’s accounting policies that have the most significant effect on the amounts recognised in the financial statements.
Partially Completed Spells
Expenditure relating to patient care spells that are part-completed at the year-end are apportioned across the financial years on the basis of length of stay at the end of the reporting period compared to expected total length of stay.
Accruals
For goods and/or services that have been delivered but for which no invoice has been received/sent, the CCG makes an accrual based on the contractual arrangements that are in place and its legal obligations.
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Prescribing
NHS England actions monthly cash charges to the CCG for prescribing contracts. These are issued approximately six-eight weeks in arrears. The CCG uses a forecast provided by the NHS Business Authority to estimate the full year expenditure.
Maternity Pathways
Expenditure relating to all antenatal maternity care is made at the start of a pathway. At the year-end, part completed pathways are therefore treated as prepayments. The CCG agrees to use the figures calculated by the local provider organisations.
1.7 Revenue
Revenue in respect of services provided is recognised when, and to the extent that, performance occurs, and is measured at the fair value of the consideration receivable.
Where income is received for a specific activity that is to be delivered in the following year, that income is deferred.
1.8 Employee Benefits
1.8.1
Short-term Employee Benefits
Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees, including bonuses earned but not yet taken.
The cost of leave earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry forward leave into the following period.
1.8.2 Retirement Benefit Costs
Past and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, general practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the CCG of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period.
For early retirements other than those due to ill health, the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to expenditure at the time the CCG commits itself to the retirement, regardless of the method of payment.
Some employees are members of the Local Government Superannuation Scheme, which is a defined benefit pension scheme. The scheme assets and liabilities attributable to those employees can be identified and are recognised in the CCG’s accounts. The assets are measured at fair value, and the liabilities, at the present value of the future obligations. The increase in the liability arising from pensionable service earned during the year is recognised within operating expenses. The expected gain during the year from scheme assets is recognised within finance income. The interest cost during the year arising from the unwinding of the discount on the scheme liabilities is recognised within finance costs. Actuarial gains and losses
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during the year are recognised in the general reserve and reported as an item of other comprehensive net expenditure.
1.9 Other Expenses
Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable.
1.10 Property, Plant & Equipment
1.10.1 Recognition
Property, plant and equipment is capitalised if:
it is held for use in delivering services or for administrative purposes;
it is probable that future economic benefits will flow to, or service potential will be
supplied to the CCG;
It is expected to be used for more than one financial year;
the cost of the item can be measured reliably; and,
the item has a cost of at least £5,000; or,
collectively, a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or,
1.10.2 Valuation
All plant and equipment are measured initially at cost, representing the cost directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. All assets are measured subsequently at fair value.
HM Treasury has adopted a standard approach to depreciated replacement cost valuations based on modern equivalent assets and, where it would meet the location requirements of the service being provided, an alternative site can be valued.
Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost includes professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for assets held at fair value. Assets are revalued and depreciation commences when they are brought into use.
Fixtures and equipment are carried at depreciated historic cost as this is not considered to be materially different from fair value.
1.10.3 Subsequent Expenditure
Where subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised. Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing carrying value of the item replaced is written-out and charged to operating expenses.
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1.11 Depreciation & Impairments
Freehold land, properties under construction, and assets held for sale are not depreciated.
Otherwise, depreciation is charged to write off the costs or valuation of property, plant and equipment and intangible non-current assets, less any residual value, over their estimated useful lives, in a manner that reflects the consumption of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over which the CCG expects to obtain economic benefits or service potential from the asset. This is specific to the CCG and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are depreciated over their estimated useful lives.
At each reporting period end, the CCG checks whether there is any indication that any of its non-current assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its amount.
A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Where an impairment loss subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the recoverable amount but capped at the amount that would have been determined had there been no initial impairment loss. The reversal of the impairment loss is credited to expenditure to the extent of the decrease previously charged there and thereafter to the revaluation reserve.
1.12 Leases
Leases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All other leases are classified as operating leases.
1.12.1 The CCG as Lessee
Property, plant and equipment held under finance leases are initially recognised, at the inception of the lease, at fair value or, if lower, at the present value of the minimum lease payments, with a matching liability for the lease obligation to the lessor. Lease payments are apportioned between finance charges and reduction of the lease obligation so as to achieve a constant rate on interest on the remaining balance of the liability. Finance charges are recognised in calculating the CCG’s surplus/deficit.
Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term.
Contingent rentals are recognised as an expense in the period in which they are incurred.
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Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether they are operating or finance leases.
1.12.2 The CCG as Lessor
Rental income from operating leases is recognised on a straight-line basis over the term of the lease. Initial direct costs incurred in negotiating and arranging an operating lease are added to the carrying amount of the leased asset and recognised on a straight-line basis over the lease term.
1.13 Cash & Cash Equivalents
Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value.
1.14 Provisions
Provisions are recognised when the CCG has a present legal or constructive obligation as a result of a past event, it is probable that the CCG will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties. Where a provision is measured using the cash flows estimated to settle the obligation, its carrying amount is the present value of those cash flows using HM Treasury’s discount rate as follows:
timing of cash flows (0 to 5 years inclusive): minus 1.50%
timing of cash flows (6 to 10 years inclusive): minus 1.05%
timing of cash flows (over 10 years): plus 2.20%
all employee early departures: 1.30%
When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the receivable is recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the receivable can be measured reliably.
A restructuring provision is recognised when the CCG has developed a detailed formal plan for the restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by starting to implement the plan or announcing its main features to those affected by it. The measurement of a restructuring provision includes only the direct expenditure arising from the restructuring, which comprises those amounts that are both necessarily entailed by the restructuring and not associated with on-going activities of the entity.
1.15 Clinical Negligence Costs
The NHS Litigation Authority operates a risk pooling scheme under which the CCG pays an annual contribution to the NHS Litigation Authority which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although the NHS Litigation Authority is administratively responsible for all clinical negligence cases the legal liability remains with the CCG.
1.16 Non-clinical Risk Pooling
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The CCG participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the CCG pays an annual contribution to the NHS Litigation Authority and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due.
1.17 Continuing Healthcare Risk Pooling
In 2014-15, a risk pool scheme has been introduced by NHS England for continuing healthcare claims, for claim periods prior to 31 March 2013. Under the scheme, the CCGS contributes annually to a pooled fund, which is used to settle the claims.
1.18 Contingencies
A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the CCG, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or the amount of the obligation cannot be measured sufficiently reliably. A contingent liability is disclosed unless the possibility of a payment is remote.
A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the CCG. A contingent asset is disclosed where an inflow of economic benefits is probable.
Where the time value of money is material, contingencies are disclosed at their present value.
1.19 Financial Assets
Financial assets are recognised when the CCG becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred.
All the CCG's financial assets are loans and receivables.
1.19.1 Loans & Receivables
Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market. After initial recognition, they are measured at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method.
The effective interest rate is the rate that exactly discounts estimated future cash receipts through the expected life of the financial asset, to the initial fair value of the financial asset.
At the end of the reporting period, the CCG assesses whether any financial assets are impaired. Financial assets are impaired and impairment losses recognised if there is objective evidence of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the estimated future cash flows of the asset.
For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset’s carrying amount and the present
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value of the revised future cash flows discounted at the asset’s original effective interest rate. The loss is recognised in expenditure and the carrying amount of the asset is reduced through a provision for impairment of receivables.
If, in a subsequent period, the amount of the impairment loss decreases and the decrease can be related objectively to an event occurring after the impairment was recognised, the previously recognised impairment loss is reversed through expenditure to the extent that the carrying amount of the receivable at the date of the impairment is reversed does not exceed what the amortised cost would have been had the impairment not been recognised.
1.20 Financial Liabilities
Financial liabilities are recognised on the statement of financial position when the CCG becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired.
Financial liabilities are initially recognised at fair value.
1.21 Value Added Tax
Most of the activities of the CCG are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.
1.22 Foreign Currencies
The CCG’s functional currency and presentational currency is sterling. Transactions denominated in a foreign currency are translated into sterling at the exchange rate ruling on the dates of the transactions. At the end of the reporting period, monetary items denominated in foreign currencies are retranslated at the spot exchange rate on 31 March. Resulting exchange gains and losses for either of these are recognised in the CCG’s surplus/deficit in the period in which they arise.
1.23 Losses & Special Payments
Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature, they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled.
Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had the clinical commissioning group not been bearing its own risks (with insurance premiums then being included as normal revenue expenditure).
1.24 Accounting Standards issued but not yet adopted
The Government Financial Reporting Manual does not require the following Standards and Interpretations to be applied in 2014-15, all of which are subject to consultation:
IFRS 9: Financial Instruments;
IFRS 13: Fair Value Measurement;
IFRS 14: Regulatory Deferral Accounts;
IFRS 15: Revenue for Contract with Customers.
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The application of the Standards as revised would not have a material impact on the accounts for 2014-15, were they applied in that year.
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2 Other operating revenue
2014-15 2014-15 2014-15 2013-14
Total Admin Programme Total
£000 £000 £000 £000
Education, training and research
126 0 126 30
Non-patient care services to other bodies
2,343 125 2,218 1,330
Other revenue
27 0 27 140
Total other operating revenue
2,496 125 2,371 1,500
Admin revenue is revenue received which is not directly attributed to the provision of healthcare or healthcare services.
Revenue is totally from the supply of services. Other operating revenue includes receipt of grant funding that is not directly allocated to the General Fund. No cash was received from NHS England under this category.
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3 Employee benefits and staff numbers
3.1 Employee benefits 2014-15
Total Admin Programme
Total Permanent Employees Other Total
Permanent Employees Other Total
Permanent Employees Other
£000 £000 £000 £000 £000 £000 £000 £000 £000
Salaries and wages 3,473 2,681 792 1,600 1,345 254 1,873 1,336 537
Social security costs 258 258 0 139 139 0 119 119 0
Employer contributions to NHS Pension scheme
299 299 0 165 165 0 135 135 0
Net employee benefits excluding capitalised costs
4,030 3,238 792 1,904 1,649 254 2,126 1,589 537
Employee benefits 2013-14 Total Admin Programme
Total
Permanent Employees
Other Total Permanent Employees
Other Total Permanent Employees
Other
£000 £000 £000 £000 £000 £000 £000 £000 £000
Salaries and wages 3,024 2,510 514 1,269 1,138 131 1,755 1,372 383
Social security costs 240 240 0 117 117 0 123 123 0
Employer contributions to NHS Pension scheme
270 270 0 133 133 0 137 137 0
Net employee benefits excluding capitalised costs
3,535 3,020 514 1,519 1,388 131 2,015 1,632 383
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As per the manual for accounts the overarching principle is that transactions should be accounted for in accordance with accounting standards, with all treatments having been agreed by both parties. Generally, this means revenue income and expenditure should be recorded gross unless the transaction is of a non-trading nature and an organisation is deemed to be acting solely as an agent and does not gain any economic benefit from the transaction. Therefore employee benefits are shown on a net basis. Only the element of the salary relating to the CCG has been recorded as expenditure as in substance the employee works for both organisations and the recharge is merely an administrative arrangement.
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3.2 Average number of people employed
2014-15 2013-14
Total
Permanently employed
Other
Total
Number Number Number Number
Total 57 50 7 43
3.3 Staff sickness absence
2014-15 2013-14
Number Number
Total days lost 190 53
Total staff years 42 40
Average working days lost
5
1
Staff years constitutes the average full time equivalent of staff and therefore the average days available for work.
3.4 Pension costs Past and present employees are covered by the provisions of the NHS Pension Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. The scheme is an unfunded, multi-employer defined benefits scheme. Individual NHS bodies are therefore unable to identify their shares of the underlying scheme assets and liabilities. The scheme is therefore accounted for as if it were a defined contribution scheme: the cost to the CCG of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period. The scheme was actually valued as at 31 March 2012 and details can be found on the NHS Pensions website.
The scheme is subject to a full actuarial valuation every four years (until 2004, every five years) and an accounting valuation every year. An outline of the principles of valuation is as follows: 3.4.1 Full actuarial (funding) valuation The purpose of this valuation is to assess the level of liability in respect of the benefits due under the scheme (taking into account its recent demographic experience), and to recommend the contribution rates to be paid by employers and scheme members. The last such valuation, which determined current contribution rates, was undertaken as at 31 March 2004 and covered the period from 1 April 1999 to that date. The conclusion from the 2004 valuation was that the scheme had accumulated a notional deficit of £3.3 billion against the notional assets as at 31 March 2004.
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In order to defray the costs of benefits, employers pay contributions at 14% of pensionable pay, and up to April 2008, most employees had paid 6%, with manual staff paying 5%. Following the full actuarial review by the Government Actuary undertaken as at 31 March 2004, and after consideration of changes to the scheme taking effect from 1 April 2008, this valuation report recommended that employer contributions could continue at the existing rate of 14% of pensionable pay, from 1 April 2008, following the introduction of employee contributions on a tiered scale from 5% up to 8.5% of their pensionable pay depending on total earnings. On advice from the scheme actuary, contributions may be varied from time to time to reflect changes in the scheme’s liabilities. 3.4.2 Accounting valuation
A valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period by updating the results of the full actuarial valuation.
Between the full actuarial valuations at a two-year midpoint, a full and detailed member data-set is provided to the scheme actuary. At this point the assumptions regarding the composition of the scheme membership are updated to allow the scheme liability to be valued. The valuation of the scheme liability as at 31 March 2011 is based on detailed membership data as at 31 March 2008 (the latest midpoint) updated to 31 March 2011 with summary global member and accounting data. The latest assessment of the liabilities of the scheme is contained in the scheme actuary report, which forms part of the annual NHS Pension Scheme (England and Wales) Resource Account, published annually. These accounts can be viewed on the NHS Pensions website. Copies can also be obtained from The Stationery Office. 3.4.3 Scheme provisions The scheme provides defined benefits, which are summarised below. This list is an illustrative guide only, and is not intended to detail all the benefits provided by the scheme or the specific conditions that must be met before these benefits can be obtained: • the scheme is a “final salary” scheme. Annual pensions are normally based on 1/80th for the 1995 section and of the best of the last three years pensionable pay for each year of service, and 1/60th for the 2008 section of reckonable pay per year of membership. Members who are practitioners as defined by the scheme regulations have their annual pensions based upon total pensionable earnings over the relevant pensionable service; • with effect from 1 April 2008, members can give up some of their annual pension for an additional tax free lump sum, up to a maximum amount permitted under HM Revenue & Customs rules. This new provision is known as “pension commutation”; • annual increases are applied to pension payments at rates defined by the Pensions (Increase) Act 1971, and are based on changes in retail prices in the twelve months ending 30 September in the previous calendar year; • early payment of a pension, with enhancement, is available to members of the scheme who are permanently incapable of fulfilling their duties effectively through illness or infirmity. A death gratuity of twice final year’s pensionable pay for death in service, and five times their annual pension for death after retirement is payable;
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• for early retirements other than those due to ill health, the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to the statement of comprehensive net expenditure at the time the CCG commits itself to the retirement, regardless of the method of payment; and,
• members can purchase additional service in the scheme and contribute to money purchase additional voluntary contributions run by the Scheme’s approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers.
4 Operating expenses
2014-15 2014-15 2014-15 2013-14 Total Admin Programme Total £000 £000 £000 £000
Gross employee benefits
Employee benefits excluding governing body members 3,504 1,378 2,126 3,140
Executive governing body members 526 526 0 394
Total gross employee benefits 4,030 1,904 2,126 3,534
Other costs
Services from other CCGs and NHS England 3,485 2,162 1,323 3,197
Services from foundation trusts 129,376 0 129,376 118,764
Services from NHS trusts 122,118 0 122,118 120,038
Services from other NHS bodies 0 0 0 1,205 Purchase of healthcare from non-NHS bodies 27,874 0 27,874 29,395
Chair and non-executive members 205 205 0 200
Supplies and services – clinical 0 0 0 319
Supplies and services – general 242 8 234 12
Consultancy services 1,100 239 861 863
Establishment 757 (47) 804 2,300
Transport 2 2 0 4
Premises 843 642 201 490 Impairments of property, plant and equipment 60 60 0 0
Audit fees 89 89 0 98
Prescribing costs 23,872 0 23,872 24,924
GPMS/APMS and PCTMS 2,884 0 2,884 1,688
Other professional fees excluding audit 242 76 165 81
Education and training 150 5 145 185
Provisions 0 0 0 500
CHC Risk Pool contributions 445 0 445 0
Total other costs 313,743 3,440 310,303 304,263
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Total operating expenses 317,773 5,344 312,429 307,797
Admin expenditure is expenditure incurred that is not a direct payment for the provision of healthcare or healthcare services.
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2014-15 2014-15 2014-15 2013-14 Total Admin Programme Total £000 £000 £000 £000
Gross operating expenses 317,773 5,344 312,429 307,797
Revenue (2,496) (125) (2,371) (1,500)
Net operating expenses 315,277 5,218 310,058 306,297
5 Better Payment Practice Code
Measure of compliance 2014-15 2014-15 2013-14 2013-14
Number £000 Number £000
Non-NHS payables
Total Non-NHS trade invoices paid in the year
5,101 35,619 4,573 28,718
Total Non-NHS trade Invoices paid within target
4,806 31,286 3,935 23,777
Percentage of Non-NHS trade invoices paid within target
94.22% 87.84% 86.05% 82.79%
NHS payables
Total NHS trade invoices paid in the year
2,752 250,864 2,042 232,803
Total NHS trade invoices paid within target
2,271 244,890 1,623 219,494
Percentage of NHS trade invoices paid within target
82.52% 97.62% 79.48% 94.28%
Total
Total trade invoices paid in the year 7,853 286,483 6,615 261,521
Total trade invoices paid within target 7,077 276,176 5,558 243,271
Percentage of total trade invoices paid within target
90.12% 96.40% 84.02% 93.02%
6 Operating leases
6.1 As lessee
6.1.1 Payments recognised as an expense
2014-15 2013-14
Buildings Total Total
£000 £000 £000
Minimum lease payments 468 468 375
Total 468 468 375
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While our arrangements with NHS Property Services Limited fall within the definition of operating leases, the rental charge for future years has not yet been agreed. Consequently this note does not include future minimum lease payments for these arrangements.
7 Property, plant and equipment
Furniture & Fittings Total
£000 £000
Cost or valuation at 1 April 2014 60 60
Impairments charged (60) (60)
Cost or valuation at 31 March 2015 0 0
Net book value at 31 March 2015 0 0
Revaluation reserve balance for property, plant & equipment
Furniture & Fittings Total
£000's £000's
Balance at 1 April 2014 3 3
Other movements (3) (3)
At 31 March 2015 0 0
8 Trade and other receivables
Current Current
2014-15 2013-14
£000 £000
NHS receivables: revenue 1,291 823
NHS prepayments and accrued income 2,134 1,292
Non-NHS receivables: revenue 920 317
Non-NHS prepayments and accrued income 86 14
VAT (0) 49
Other receivables 13 9
Total 4,445 2,504
Included above:
NHS maternity pathways prepayment 1,752 1,121
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The great majority of trade is with NHS England. As NHS England receives funding from the Department of Health which it then distributes to CCGs for the purpose of commissioning services, no credit scoring is considered necessary.
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8.1 Receivables past their due date but not impaired
2014-15 2013-14
£000 £000
By up to three months 3 149
By three to six months 0 0
By more than six months 7 0
Total 10 149
The CCG did not hold any collateral against receivables outstanding at 31 March 2015.
9 Cash and cash equivalents
2014-15 2013-14 £000 £000
Balance at 1 April 2014 109 0
Net change in year (40) 109
Balance at 31 March 2015 69 109
Made up of:
Cash with the Government Banking Service 69 109
Cash and cash equivalents as in statement of financial position
69 109
Balance at 31 March 2015 69 109
10 Analysis of impairments
10.1 Analysis of impairments: property, plant and equipment Impairments charged to the statement of comprehensive net expenditure
2014-15 2013-14 £000 £000
Other (60) 0
Total charged to annually managed expenditure (60) 0
Total impairments of property, plant and equipment (60) 0
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11 Trade and other payables
Current Current
2014-15 2013-14
£000 £000
NHS payables: revenue 10,877 12,464
NHS accruals and deferred income 12,847 5,274
Non-NHS payables: revenue 3,987 967
Non-NHS accruals and deferred income 7,932 10,179
Social security costs 39 38
Tax 45 41
Other payables 466 821
Total 36,195 29,784
Other payables include outstanding pension contributions of £67k at 31 March 2015.
NHS accruals include £339k for partially completed spells.
12 Provisions
Non-
current Total
Non-
current Total
2014-15 2014-15 2013-14 2013-14
£000 £000 £000 £000
Other 500 500 500 500
Total 500 500 500 500
Other Total
£000s £000s
Balance at 1 April 2014 500 500
Balance at 31 March 2015 500 500
Expected timing of cash flows:
Between one and five years 500 500
Balance at 31 March 2015 500 500
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13 Financial instruments
13.1 Financial risk management
Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities.
Because the CCG is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The CCG has limited powers to borrow or invest surplus funds, and financial assets and liabilities are generated by day-to-day operational activities, rather than being held to change the risks facing the CCG in undertaking its activities.
Treasury management operations are carried out by the finance department, within parameters defined formally within the CCG standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the CCG and internal auditors.
13.1.1 Currency risk
The CCG is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The CCG has no overseas operations and therefore low exposure to currency rate fluctuations.
13.1.2 Interest rate risk
The CCG borrows from government for capital expenditure, subject to affordability as confirmed by NHS England. The borrowings are for 1 to 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The CCG therefore has low exposure to interest rate fluctuations.
13.1.3 Credit risk
Because the majority of its revenue comes from parliamentary funding, the CCG has low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables from customers, as disclosed in the trade and other receivables note.
Under the Accounts Direction issued by NHS England on 12 February 2014, NHS England is responsible for accounting for liabilities relating to NHS Continuing Healthcare claims relating to periods of care before establishment of the CCG. However, the legal liability remains with the CCG. The total value of legacy NHS Continuing Healthcare provisions accounted for by NHS England on behalf of this CCG at 31 March 2015 is £1,112k (at 31 March 2014, £1,209k). The provision is in respect of the CCG's share of potential restructuring costs arising from the reconfiguration of North London provider services.
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13.1.3 Liquidity risk
The CCG is required to operate within revenue and capital resource limits, which are financed from resources voted annually by Parliament. The CCG draws down cash to cover expenditure, as the need arises and is not, therefore, exposed to significant liquidity risks.
13.2 Financial assets
Loans and
Receivables Total 2014-15 2014-15 Receivables: £000 £000
NHS 1,291 1,291
Non-NHS 920 920
Cash at bank and in hand 69 69
Other financial assets 13 13
Total at 31 March 2015 2,294 2,294
Loans and
Receivables Total 2013-14 2013-14 Receivables: £000 £000
NHS 823 823
Non-NHS 317 317
Cash at bank and in hand 109 109
Other financial assets 9 9
Total at 31 March 2014 1,258 1,258
13.3 Financial liabilities
Other Total 2014-15 2014-15 Payables: £000 £000
NHS 23,725 23,725
Non-NHS 12,386 12,386
Total at 31 March 2015 36,111 36,111
Other Total 2013-14 2013-14 Payables: £000 £000
NHS 17,738 17,738
Non-NHS 11,146 11,146
Total at 31 March 2014 28,884 28,884
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14 Pooled budgets
The CCG and consolidated group entered into five pooled budgets with the London Borough of Islington and other NHS organisations. The pool is hosted by the London Borough of Islington. As a commissioner of healthcare services, the CCG makes contributions to the pool, which are then used to purchase healthcare services.
The CCG accounts for its share of the assets, liabilities, income and expenditure of the pool as determined by the pooled budget agreement.
The CCG's contributions to the pooled budgets are as follows:
2014/15 contributions
CCG LBI
Whittington NHST
Total
£000 £000 £000 £000 Intermediate Care (DETOC's)
4,641
2,066
30 6,737
Learning Difficulties
3,587
25,655
29,242
MH Commissioning Adult MH
2,154
2,410
4,564
Carers
95
960
1,055
MHCOP
2,334
3,036
5,370
12,811 34,127 30 46,968
2013/14 contributions
CCG LBI
Whittington NHST
Total
£000 £000 £000 £000 Intermediate Care (DETOC's)
4,641
2,066
30 6,737
Learning Difficulties
3,558
25,454
29,012
MH Commissioning Adult MH
2,064
2,410
4,474
Carers
95
960
1,055
MHCOP
2,277
2,962
5,239
12,635 33,852 30 46,517
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15 Intra-government and other balances
Current Receivables
Non-current Receivables
Current
Payables
Non-current
Payables
2014-15 2014-15 2014-15 2014-15 £000 £000 £000 £000 Balances with:
Other central Government bodies
0 0 891 0
Local authorities 859 0 2,649 0
Balances with NHS bodies:
NHS bodies outside the departmental group
1,238 0 522 0
NHS trusts and foundation trusts
2,188 0 23,203 0
Total of balances with NHS bodies
3,426 0 23,725 0
Bodies external to Government
160 0 8,930 0
Total balances at 31 March 2015
4,445 0 36,195 0
Current
Receivables Non-current Receivables
Current Payables
Non-current
Payables
2013-14 2013-14 2013-14 2013-14 £000 £000 £000 £000 Balances with:
Other central Government bodies
0 0 79 0
Local authorities 321 0 348 0
Balances with NHS bodies:
NHS bodies outside the departmental group
821 0 869 0
NHS trusts and foundation trusts
1,294 0 16,869 0
Total of balances with NHS bodies
2,115 0 17,738 0
Bodies external to Government
68 0 11,619 0
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Total balances at 31 March 2014
2,504 0 29,784 0
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16 Related party transactions
Details of related party transactions with individuals are as follows:
Individual and position in CCG Payments to Related
Party
Receipts from
Related Party
Amounts owed to Related
Party
Amounts due from Related Party
£000 £000 £000 £000 Dr Gillian Greenhough - Chair
South Islington GP Alliance Ltd 269 0 0 0
Dr Katie Coleman - Vice Chair
South Islington GP Alliance Ltd 269 0 0 0
Dr Josephine Sauvage - Vice Chair
South Islington GP Alliance Ltd 269 0 0 0
Dr Karen Sennett - South Locality GP Member
South Islington GP Alliance Ltd 269 0 0 0
Dr Rathini Ratnavel - Co-opted GP Representative
South Islington GP Alliance Ltd 269 0 0 0
Mr Ian Huckle and Dr Stephen Rogers are both members of the CCG and shareholders in Wish Limited, a consortium of eight general practices providing doctors for the Urgent Care Centre at the Whittington Hospital NHS Trust. The CCG commissions services provided from the Trust as part of a block contract. The Trust then contracts directly with Wish Limited and the CCG has no direct contract with Wish Limited. CCGs are clinically led membership organisations made up of general practices. The members of the CCG are responsible for determining the governing arrangements for their organisations, which they are required to set out in a constitution.
The members of the CCG are contained within Appendix B of the constitution. Where payments have been made to these practices, these are listed below. The majority of the payments are in relation to agreed locally commissioned services and some prescribing costs.
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Payments to Related
Party
Receipts from
Related Party
Amounts owed to Related
Party
Amounts due from Related
Party £000 £000 £000 £000
Amwell Practice 152 0 0 0
Andover Medical Centre 92 0 0 0
Archway Primary Care Team 149 0 0 0
Beaumont Practice 48 0 0 0
Barnsbury Medical Practice 33 0 0 0
Bingfield Street Surgery 16 0 0 0
City Road Medical Centre 177 0 0 0
Clerkenwell Medical Practice 197 0 0 0
Dartmouth Park Practice 83 0 0 0
Elizabeth Avenue Group Practice 184 0 0 0
Family Practice London 66 0 0 0
Goodinge Group Practice 182 0 0 0
Group Practice at River Place 242 0 0 0
Hanley Primary Care Centre 56 0 0 0
Highbury Grange Medical Practice 112 0 0 0
Holloway Medical Clinic 37 0 0 0
Islington Central Medical Centre 230 0 0 0
Killick Street Health Centre 284 0 0 0
Ko & Partner 64 0 0 0
Medical Centre Holloway Road 70 0 0 0
Mildmay Medical Practice 148 0 0 (7)
Miller Practice 201 0 0 0
Mitchison Road Surgery 123 0 0 0
Northern Medical Centre 195 0 0 0
Partnership Primary Care Centre 65 0 0 0
Pine Street Medical Centre 40 0 0 0
New North Health Centre 32 0 0 0
Rise Group Practice 113 0 0 0
Ritchie Street Group Practice 154 0 0 0
Roman Way Medical Centre 60 0 0 0
Sobell Medical Centre 48 0 0 0
St Johns Way Medical Centre 219 0 0 0
St Peters Street Medical Centre 168 0 0 0
Stroud Green Medical Practice 92 0 0 0
Tufnell Surgery 58 0 0 0
Village Practice London 105 0 0 0
The Department of Health is regarded as a related party. During the year the CCG has had a significant number of material transactions with entities for which the Department is regarded as the parent. For example:
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Payments to
Related Party
Receipts from
Related Party
Amounts owed to Related Party
Amounts due from Related Party
£000 £000 £000 £000 NHS North & East London Commissioning Support Unit
3,826 (18) 226 (18)
The Whittington Hospital NHS Trust 104,462 (31) 5,439 (609)
University College London Hospitals NHS Foundation Trust
61,629 0 7,788 (1,173)
Camden & Islington NHS Foundation Trust 36,649 0 2,215 0
Royal Free London NHS Foundation Trust 10,428 0 2,071 (31)
London Ambulance Service NHS Trust 7,838 0 110 0
Moorfields Eye Hospital NHS Foundation Trust
6,491 0 2,513 0
In addition, the CCG has had a number of material transactions with local government bodies. Most of these transactions have been with the London Borough of Islington in respect of joint enterprises.
Payments to
Related Party
Receipts from
Related Party
Amounts owed to Related Party
Amounts due from Related Party
£000 £000 £000 £000
London Borough of Islington 13,638 (825) 2,649 (859)
16.1 Related party transactions 2013-14
Details of related party transactions with individuals are as follows:
The transactions listed below are in relation to interests declared, other than those relating to member general practices.
Individual and position in CCG
Payments to
Related Party
Receipts from
Related Party
Amounts owed to Related
Party
Amounts due from Related
Party £000 £000 £000 £000 Dr Gillian Greenhough – Chair South Islington GP Alliance Ltd 243 0 0 0 Dr Katie Coleman - Vice Chair South Islington GP Alliance Ltd 243 0 0 0 Dr Josephine Sauvage - Vice Chair South Islington GP Alliance Ltd 243 0 0 0 Dr Rathini Ratnavel - Elected GP Representative
South Islington GP Alliance Ltd 243 0 0 0
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CCGs are clinically led membership organisations made up of general practices. The members of the CCG are responsible for determining the governing arrangements for their organisations, which they are required to set out in a constitution. The members of Islington CCG are contained within Appendix B of the constitution. Where payments have been made to these practices, these are listed below. The majority of the payments are in relation to agreed locally enhanced services and some prescribing costs.
Payments to
Related Party
Receipts from
Related Party
Amounts owed to Related
Party
Amounts due from Related
Party £000 £000 £000 £000 Amwell Practice 91 0 0 0 Andover Medical Centre 61 0 0 0 Archway Primary Care Team 73 0 0 0 Beaumont Practice 32 0 0 0 Bingfield Primary Care Centre 19 0 0 0 Bingfield Street Surgery 11 0 0 0 City Road Medical Centre 83 0 0 0 Clerkenwell Medical Practice 157 0 0 0 Dartmouth Park Practice 42 0 0 0 Elizabeth Avenue Group Practice 121 0 0 0 Family Practice London 34 0 0 0 Goodinge Group Practice 94 0 0 0 Group Practice at River Place 118 0 0 0 Hanley Primary Care Centre 18 0 0 0 Highbury Grange Medical Practice 64 0 0 0 Holloway Medical Clinic 23 0 0 0 Islington Central Medical Centre 108 0 0 0 Killick Street Health Centre 160 0 0 0 Ko and Partners 35 0 0 0 Medical Centre Holloway Road 30 0 0 0 Mildmay Medical Practice 61 0 0 8 Miller Practice 117 0 0 0 Mitchison Road Surgery 104 0 0 0 Northern Medical Centre 90 0 0 0 Partnership Primary Care Centre 42 0 0 0 Pine Street Medical Centre 33 0 0 0 Prebend Street (New North Health Centre) 22 0 0 0 Rise Group Practice 41 0 0 0 Ritchie Street Group Practice 85 0 0 0 Roman Way Medical Centre 39 0 0 0 Sobell Medical Centre 30 0 0 0 St John’s Way Medical Centre 117 0 0 0 St Peter’s Street Medical Centre 92 0 0 0 Stroud Green Medical Practice 45 0 0 0 Tufnell Surgery 39 0 0 0 Village Practice London 56 0 0 0 Wedmore Gardens Surgery 14 0 0 0 The Department of Health is regarded as a related party. During the year the CCG has had a significant number of material transactions with entities for which the Department is regarded as the parent. For example:
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Payments to
Related Party
Receipts from
Related Party
Amounts owed to Related
Party
Amounts due from Related
Party £000 £000 £000 £000 NHS North & East London Commissioning Support Unit
4,138 (154) 0 (207)
Whittington Hospital NHS Trust 102,638 (37) 5,166 (84) University College London Hospitals NHS Foundation Trust
57,146 0 5,384 (1,055)
Camden & Islington NHS Foundation Trust 35,201 0 2,498 0 Royal Free London NHS Foundation Trust 9,588 0 816 (25) London Ambulance Service NHS Trust 7,616 0 91 0 Barts Health NHS Trust 4,658 0 78 (4) Central & North West London Mental Health NHS Foundation Trust
4,273 0 225 0
Homerton University Hospital NHS Foundation Trust
3,603 0 118 (12)
Moorfields Eye Hospital NHS Foundation Trust
3,788 0 615 0
In addition, the CCG has had a number of material transactions with local government bodies. Most of these transactions have been with the London Borough of Islington in respect of joint enterprises.
Payments to
Related Party
Receipts from
Related Party
Amounts owed to Related
Party
Amounts due from Related
Party £000 £000 £000 £000 London Borough of Islington 13,631 (628) 347 (321)
17 Financial performance targets
CCGs have a number of financial duties under the NHS Act 2006 (as amended). Performance against those duties was as follows:
Measure
2014-15 2014-15 Duty
Achieved 2014-15 Target Target Performance
£'000 £'000
Expenditure not to exceed income Surplus 6,449 8,207
Yes
Revenue resource use does not exceed the amount specified in Directions
Net operating expenditure
323,484 315,277
Yes
Revenue resource use on specified matters does not exceed the amount specified in Directions
Net programme expenditure
311,666 310,058
Yes
Revenue administration resource use does not exceed the amount specified in Directions
Net admin expenditure
5,866 5,218
Yes
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2013-14 Target 2013-14 2013-14 Duty Achieved Measure Target Performance
£'000 £'000
Expenditure not to exceed income Surplus 5,948 7,441 Yes
Revenue resource use does not exceed the amount specified in Directions
Net operating expenditure
313,738 306,297 Yes
Revenue resource use on specified matters does not exceed the amount specified in Directions
Net programme expenditure
302,490 301,000 Yes
Revenue administration resource use does not exceed the amount specified in Directions
Net admin expenditure
5,300 5,296 Yes
Target net operating expenditure is the sum of net programme expenditure, net admin expenditure and the surplus.
Although the official expenditure target for 2014-15 was to maintain the £6,449k brought forward surplus, increases of £734k (pooled continuing healthcare claims not required during the year) and £1,000k (contribution towards London-wide request for additional surpluses), were agreed with NHS England. Performance was therefore measured against an adjusted target of £8,183k.
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Annex A This annex sets out the attendance records of individual Governing Body members and gives details of committee membership and attendance. Table 8. Meeting attendance and committee membership
Name
Position
Attendance record
Go
ve
rnin
g
Bo
dy
Au
dit
Co
mm
ittee
Re
mu
ne
ratio
n C
om
mitte
e
Pa
tien
t &
Pu
blic
Pa
rticip
atio
n
Co
mm
ittee
Qu
ality
&
Pe
rform
an
ce
C
om
mitte
e
Stra
teg
y &
Fin
an
ce
Co
mm
ittee
Mo Akmal Secondary care doctor 71%
Dr Sharon Bennett
GP representative to June 2014
100% 50%
Julie Billett Public Health representative
86%
Alison Blair Chief Officer 100%
Sorrel Brookes Lay member 100% 100% 100% 100% 92%
Dr Robbie Bunt Local Medical Committee representative
43%
Dr Katie Coleman Joint Vice Chair and GP representative
100% 100%
Simon Galzynski LB Islington representative
71%
Dr Gillian Greenhough
Chair and GP representative
100%
Ian Huckle/Deborah Snook (job share)
Practice Manager representative
86% 100% 100%
Jennie Hurley Practice Nurse representative
100% 80%
Dr Sabin Khan GP representative 86% 92%
Ahmet Koray Chief Finance Officer 100% 75% 100%
Martin Machray Director of Quality & Integrated Governance
100% 100% 83%
Dr Rathini Ratnavel
GP representative 71% 60%
Dr Stephen Rogers
GP representative from June 2014
86% 100%
Dr Jo Sauvage Joint Clinical Vice Chair 86% 83%
Dr Karen Sennett GP representative 86% 83%
Paul Sinden Director of Commissioning
86%
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Phillip Watson HealthWatch Islington representative
86%
Anne Weyman Lay Vice Chair 100% 100% 100% 75%
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Annex B
ASSURANCE FRAMEWORK STATEMENT Introduction As part of CCG annual report requirements, CCG’s have a duty to provide information within their annual report which makes a self-certification about continued delivery of statutory duties. An outline of this information is included below. 1. Acted with a view to ensuring that health services are provided in a way which promotes the NHS Constitution, and that it has promoted awareness of the NHS Constitution among patients, staff and members of the public The NHS Constitution articulates a series of rights and pledges for patients, service users and staff. Many of these rights and pledges are encapsulated in performance measures, and the CCG monitors its performance against these measures. The table below forms part of the Performance Report which is discussed each month at the CCG Quality and Performance Committee. Table 9. Performance against NHS Constitution
Indicator Name Target Direction 2013/14 2014/15
Diagnostic waits > 6 weeks 99.0% Higher is better 98.6% 97.5%
Four Hour maximum wait in A&E - Whittington Health
95.0% Higher is better 95.0% 94.8%
Four Hour maximum wait in A&E - UCLH 95.0% Higher is better 95.0% 94.6%
Mixed Sex Accommodation Breaches 0 Lower is better 96 61
Cancer waits: 2 week GP referral to appointment 93.0% Higher is better 94.7% 93.8%
Cancer waits: 2 week breast symptomatic target 93.0% Higher is better 93.1% 92.5%
Cancer waits: 1 month diagnosis to treatment 96.0% Higher is better 99.3% 97.4%
Cancer waits: 1 month diagnosis to treatment subsequent drug treatment
98.0% Higher is better 100.0% 100.0%
Cancer waits: 1 month diagnosis to treatment subsequent surgery
94.0% Higher is better 96.4% 96.0%
Cancer waits: 1 month diagnosis to treatment subsequent radiotherapy
94.0% Higher is better 99.5% 98.9%
Cancer waits: 2 month urgent GP referral to treatment
85.0% Higher is better 87.3% 79.8%
Cancer waits: 2 month wait following consultant's decision to upgrade the priority
- Higher is better 84.4% 92.3%
Cancer waits: 2 month NHS screening service referral to treatment
90.0% Higher is better 100.0% 87.5%
CPA 7 day follow up 95.0% Higher is better 97.4% 97.7%
Referral to Treatment - Admitted 90.0% Higher is better 88.9% 86.5%
Referral to Treatment - Non Admitted 95.0% Higher is better 95.4% 94.4%
Referral to Treatment - incomplete pathways 92.0% Higher is better 90.5% 93.4%
Ambulance category A calls: 8 minute response times (RED1)
75.0% Higher is better 77.4% 69.0%
Ambulance category A calls: 8 minute response times (RED2)
75.0% Higher is better 75.3% 60.1%
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Where areas of poor performance are identified the CCG meets with the relevant providers to understand the associated challenges and to devise a realistic recovery plan and trajectory. Islington CCG, as with many other CCGs in London, has struggled to deliver many of the access targets in 2014/15.
The 4-Hour A&E target has been a particular challenge in the second half of the financial year.
Also, the measures associated with Ambulance waiting times have deteriorated this year as London Ambulance Service has struggled to maintain adequate staffing levels.
Furthermore, many providers developed large backlogs of patients against the Referral to Treatment Targets. NHS England provided health economies with additional funding to hospitals to clear these backlogs. Consequently, performance was poor in 2014/15 but Trusts will begin 2015/16 in a much stronger position.
2. Assisted and supported NHS England in discharging its duties relating to securing the continuous improvement in the quality of primary medical services
The CCG has worked with local GPs and practices to develop a Primary Care Strategy to develop and improve the quality of primary care in Islington. We liaise directly with the Medical Director from NHS England to raise and discuss issues relating to primary care services in Islington. We also actively work with local GPs to raise and address issues relating to the quality of local services. Performance Indicators are reported at the monthly Quality and Performance Committee. GP colleagues contribute to the recovery plans where performance is off-target, particularly those that overlap with primary care such as infection control and GPs contributing to child case conferences. 3. Promoted the involvement of patients, their carers and representatives in decisions that relate to the prevention or diagnosis of illness in the patient, their care and treatment Mental health: Peer Support Workers Service users are ‘experts by experience’ and the creation of paid peer support worker roles, in services, ensures this is recognised and utilised. They undertake the same duties and receive the same training as support workers employed through other routes, with additional support. Camden & Islington Foundation Trust has appointed peer support workers in local Crisis Teams.
Mental health joint commissioning has procured a peer support model of ‘Reablement’. This provides intensive short term support to service users with the aim of increasing their independence and reducing the need for on-going or high level services.
Recovery Colleges
Ambulance category A calls: 19 minute response times
95.0% Higher is better 97.9% 91.8%
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Islington CCG has commissioned a Recovery College and is working with Camden & Islington Foundation Trust and the Centre for Mental Health to develop this transformational service. A recovery college delivers comprehensive peer-led education and training programmes within mental health services, with strong links to education for staff, patients and their carers.
The aim is for people who use mental health services to become experts in their own self-care and develop the skills they need for living and working, managing their symptoms, finding a job, remaining stable, find somewhere safe to live and help them maintain supportive relationships with family and friend. It will enable large NHS organisations to take a big step on the road toward peer support, and help to tackle the stigma around mental ill health. 4. Enabled patients to make choices with respect to the aspects of health services provided to them Insight Projects We carry out research and insight projects that help the CCG understand the experience of patients who use the services we commission. We have undertaken numerous projects within the last year (and will continue to do so).
Last Years of Life and Voice for Change: there was no qualitative patient insight for Last Years of Life, an insight research project was delivered and an ongoing service user group which meets monthly and feeds directly into Last Years of Life Steering Group. The engagement for the group is held face to face, virtually and over the phone. A Dying Matters event was also held in May with over 100 attendees. There is a yearly insight report which compares the experience and a long with the regular feedback shapes the strategy and work plan.
OOHs / NHS 111: as part of the reprocurement process for NHS 111 and Out of Hours services, Islington CCG has spoken with local residents to find out their views on accessing the service, what their current experience is and how they would like the service to be developed. We heard directly from over 200 people at face to face events held in Islington, and asked people their views through an online survey.
Islington Borough User Group (iBUG): the mental health service user group: Mental Health Joint Commissioning invested in a five year contract with iBUG from 2012-13 for them to promote the views of Islington past and current MH service users. It does this through a range of activities; open monthly meetings, monthly Patients’ Council at the Highgate Mental Health Centre where detained and very ill service users are able to articulate their concerns and priorities to the Islington Borough User Group Patient Council volunteers, quarterly inpatient and community forums where senior managers from Camden Islington Foundation Trust, Balfour Beatty and Joint Commissioning are informed and challenged by service users, mystery shopping and service user interviews to inform commissioning and contract management. Among other things they have:
• Challenged the clinical effectiveness and poor patient experience • Successfully advocated for the development of a Recovery College and the
Phoenix Peer-to-Peer support model
We also have a series of patient stories at Governing Body learning seminars. These stories tell an individual’s experience but are used to highlight a wider picture for the governing body and to help them think about the wider community’s experience of
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using services across the system. These stories than inform discussion and planning sessions.
Practice Participation Groups: we hold quarterly open community meetings that are advertised through our local practices and practice participation groups.
Visual Design Narrative: It is important that as we collect insight we are able to share these views back to the local community and frontline staff – and show how qualitative insight and evidence is impacting on the design and development of services. In our regular conversations with the community we also need a way of visually showing what the current problems are that we have mapped out through insight work with them, and other evidence. We want to explore ways we can demonstrate the journey taken and the journey we are going on as a patient and community focused organisation. The Young Foundation has been commissioned to deliver this work. There are four projects across the year working with the local community (and research we have already gathered). We have so far developed an animation, a poster which shows a patient’s journey and are currently developing a training tool for staff.
Equalities and Diversity Work: A key part of our insight work is to engage with and listen to people within the community who can often go unheard and yet can be some of the most vulnerable group and have the highest needs. Often the experiences of using services and the system is that they are difficult to access, understand and do not meet their needs nor are supportive. We, therefore, have a special strand to our engagement work which looks specifically at those groups who fall under the nine protected characteristics and inclusion health groups. This includes:
an annual meeting which identifies equality issues in Islington (run in conjunction with HealthWatch)
an Equalities rolling programme which has started in June 13. This includes workshops and focus groups with the above mentioned groups to understand in more depth their specific needs and challenges / obstacles.
the Refugee and Migrant forum, where we attend and have made a commitment to continue attending as and when they need us to.
Children Children’s services have an engagement officer who undertakes all engagement related to children and young people in health. In the last year they have undertaken:
Involving young people with HealthWatch Islington
Young carers insight and photography project
Self-management pilot programme for young people and families with epilepsy and asthma (continuing)
Young mothers and fathers have been involved in providing feedback around their experiences of Family Nurse Partnership (a service for first-time young mothers) and other services available for young parents in the borough – this feedback will be used to inform service development
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You’re Welcome: You’re Welcome is a ‘mystery shopping’ programme to ensure that health services are ‘young people friendly’. Six services were engaged this year including a GP practice, three children’s centres, sexual health provision and the Tavistock and Portman
Youth Health Forum: the forum brings together practitioners and young people to develop health and wellbeing support for young people.
Involvement in Children’s and Adolescent Mental Health Services (CAMHS): young people have been involved in all recruitment panels for new CAMHS clinicians this year. Community CAMHS have used You're Welcome recommendations to inform service development
Tenders and Contract reviews: young service-users contributed to the development of the service specification for the Family Drug and Alcohol service. 5. Promoted innovation, research, education and training Islington CCG has a strong record of working in a supportive and developmental manner with stakeholders. Highlights include: CCG Workforce Development The CCG is committed as part of the Organisational Development Plan, to both develop its current commissioning workforce and putting in place succession plans for our staff, designed to support a future clinical commissioning workforce. We use essential skills training so as an organisation, we can make sure all staff in-corporate core training into the decisions we make and services we commission. A robust appraisal system exists for all employees which includes a Professional Development Plan (PDP), including identified training, development and learning that is tailored to each employee’s development. Staff are supported to reach their PDPs by their managers and an allocated staff development budget. The Governing Body is supported via a robust induction plan and has their learning and development needs assessed as part of their PDPs with the Chair.
The CCG wants to attract, develop and retain skilled and valuable employees to ensure we have the right people, in the right roles with the capabilities, commitment and behaviours needed for current and future organisational success. As part of our work to ensure stability for the future, we put in place a programme of staff development designed to support and retain individuals who can make a positive difference to organisational performance and drive improvements in patient care. Key to this is developing leaders for the future. Inspiring leaders are encouraged to develop their management and leadership skills, and this year we are also committed to supporting new and existing managers to develop their line-management knowledge and skills. Islington has been working for nearly two years across a broad stakeholder group to develop our approach to Integrated Care. The vision for this work is to deliver a step change improvement in health and social care outcomes for our population, by taking a whole system approach to service planning and delivery and supporting the population to better manage their health through mobilising their own abilities and the assets of the community. With our partners we have an ambition to deliver a better patient experience and outcome through more co-ordinated and personalised care as well as population level health improvement based on an approach of prevention and early intervention.
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Early success includes the development of multi-disciplinary teleconferences across the four Islington localities which have reviewed over 250 highly complex patients over the last year. The teleconference provides the opportunity for different professionals to come together to discuss individual patients.
More recently the Test and Learn sites have been piloted and evaluation of these sites will be used to identify if there is a need to develop new roles, what training and development would be needed to roll out multi-disciplinary teams on a larger scale and what support team members feel they would need to support the integration agenda Community Education Provider Network (CEPN) In 2014 our bid was accepted by Health Education England North Central East London (HENCEL) to become one of five pilot Community Education Provider Network (CEPN) sites. The CEPN brings together health and social care providers, the voluntary sector and Higher education institutes to ensure that plans are in place to ensure that Islington has the right staff, with the right skills, culture and behaviour to meet the changing needs of the local population. The aim of the CEPN is to develop a local community-based workforce to meet the needs of local population. Several work streams were developed including a locality offer to design a care planning approach and integrated working. The CEPN forms part HENCEL’s strategic intention to develop a bottom up approach to the development of educational initiatives within Islington. It aligns directly with Islington’s Pioneer status and the desire for education and workforce development to link in with new models of care, based primarily within the community. Our CEPN is one of our main drivers for workforce development across the borough, and specifically for developing clinical leaders for the future. The CCG takes a strategic leadership role to focus on our five year objectives. Four key focal themes were identified through the CEPN. The four overarching themes are:
Integrated care
Workforce planning for current needs and future models of care
Development of unqualified/unregistered education and development
Develop undergraduate training programmes-focusing on nurses in the first instance The CEPN will enter phase 2 in 2015/16 with new priorities being set aligned to further develop those set in the previous year. The CEPN will continue to he hosted by Whittington health. Integrated Care Pioneer Islington’s vision, “Working together to deliver better care with the people of Islington”, reflects a desire to develop more co-ordinated and person-centred care for our residents and to use integrated care to improve the overall health of our population. Highlights of the last year include:
Developing an evaluation framework which has been designed using a series of driver diagrams across the projects so that we are clear of the outcomes we want to achieve.
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New approaches to supported self-management by using Patient Activation Measures – we are using innovative approaches to understand the level of skills and motivation within our local population so that we can target offers of self-management more appropriately
A bottom up approach to service design – we have two test and learn sites that are working together to design new ways of working with the patient at the centre
Value Based Commissioning The CCG has been working with service users and local providers to develop service models in diabetes and mental health (psychosis) that meet the health and care outcome priorities for service users. To do this we have worked with service users and providers to develop for a hierarchy of outcomes and service model, and are now developing contract and payment models that make a closer link between delivery of those outcomes important to service users and payment to service providers. We call this process value based commissioning. The new service models for diabetes and mental health (psychosis) will be introduced during 2015/16. The service models that have been designed will support multi-disciplinary team working and education. By closely monitoring the outcomes being achieved we, with service users and providers, will be able to ensure we are achieving the best possible value for service users, and will be able to assess the impact of changes in service provision on achievement of outcomes.
6. Consulted widely when devising its commissioning plans In preparation for two year plans being developed in 14/15, the CCG consulted with patients and the public regarding its commissioning plans. This was undertaken by the commissioning groups pertinent to particular service areas and patient groups, for example, mental health and learning disability, or at a wider, strategic level, when the Director of Commissioning has presented to Islington patient groups. Patient groups are still ‘plugged into’ the wide CCG commissioning structure and we regularly feedback on progress on our plans.
During 2014/15 there has been a shift in the structure of long term planning and the expectation on behalf of the Secretary of State that some planning and commissioning should be undertaken in collaboration with other CCGs in north central London. A transformation programme is underway, overseen by the Chief Officers of all north central London CCGs (Islington, Camden, Haringey, Enfield and Barnet boroughs). Each of these work streams, for example Primary Care, has patient participation integrated into the structure of service design and decision making. This builds on work already undertaken across CCG boundaries, for instance in Urgent Care, where patient choice and behaviour dictates how we commission a new model of care.
We are now working on our local commissioning programme over the years up to 2020. This is being done hand in hand with our local partners, particularly the Whittington Health NHS Trust and Camden and Islington Foundation Trust and in line with new opportunities in co-commissioning primary care and developing new models of care in the capital. A strategy of how we consult with patients and the public on this longer term plan will be presented to the Patient and Public Participation Committee shortly.
7. Taken appropriate steps to secure that it is properly prepared for dealing with a relevant emergency
The CCG has taken appropriate steps to ensure it can deal with a relevant emergency.
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As a category 2 responder under the Civil Contingencies Act, the CCG has developed and adopted a business continuity plan. This sets out how the CCG will respond to any one or more of a range of key scenarios:
Loss of access to premises
Loss of key staff
Loss of key partners/stakeholders
Loss of key services
As part of our business continuity planning we have entered into a reciprocal agreement with Camden CCG whereby we can use each other’s main office in the event of an emergency that requires it and that in the event of an emergency in Camden or Islington that requires that CCG to follow its business continuity plan, the other CCG will if need be follow its own business continuity plan to provide such support as is needed. In addition the CCG has entered into shared on-call arrangements with North and East London Commissioning Support Unit; and Barnet, Camden, Enfield and Haringey CCGs.
8. Co-operated with its Health and Wellbeing Board in relation to the discharge of the Health and Wellbeing Board’s functions It is a duty of the Health and Wellbeing Board to promote the integration of services across the NHS, public health and the local authority in order to improve efficiency, secure better care and, ultimately, improve health and wellbeing outcomes for the local community.
Amongst other things, the Health and Wellbeing Board is responsible for the mutual obligation on the Local Authority and NHS commissioners to prepare an assessment of relevant needs and a Joint Health and Wellbeing Strategy (JHWS) for the borough.
This Islington JHWS 2013-2016 was developed by the Board and is our shared vision to reduce health inequalities and improve the health and wellbeing of Islington, its communities and residents. The focus for this strategy is predominantly on the health and social care related factors that influence health and wellbeing. The important underlying determinants of health and wellbeing are addressed through other key strategies of the Local Authority and partners. The strategy emphasises the importance of partnership working and joint commissioning of services to achieve a more focused use of resources and better value for money. The strategy has been informed by our Joint Strategic Needs Assessment and consultation with residents, strategic partners and other stakeholders.
We have identified three outcomes that will help deliver this vision. They are:
1. Ensuring every child has the best start in life;
2. Preventing and managing long term conditions to enhance both length and quality of life and reduce health inequalities; and
3. Improving mental health and wellbeing
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This year we have contributed to the delivery of the Islington JHWS in the following ways:
Working with Islington Council we have developed a Child Health Strategy which focuses on implementation of an early intervention and prevention approach across all professionals. The strategy has been informed by a Children and Young People’s Health Needs Assessment carried out by Public Health.
The Pioneer Programme (Islington CCG and Islington Council’s integrated health and social care programme) has been ensuring that all work on Long Term Conditions is aligned to the local vision for Integrated Care.
We have worked jointly with our HWB partners and local providers to develop Islington’s bid for the Better Care Fund, a national fund aimed at supporting integrated working across health and social care locally that are approved by the Health and Wellbeing Board.
As part of a move towards Integrated Digital Care Records & Patient hand-held record we are awaiting the outcome of our submitted ‘Technology Fund 2’ bid to the Department of Health and have published the tender document for the Integrated Digital Care Record (IDCR) and Patient Held Record (PHR).
We have procured a new community development worker service from Hillside clubhouse which will identify and address inequalities in mental health and address some of the barriers faced by people from excluded communities.
We have begun a new contract for Dementia Navigators
We have invested in new long-term conditions matrons working with people with serious mental illness to address poor outcomes from physical illness.
We have procured a new parental mental health service to support the families in need agenda
A pilot primary care mental health service based in general practice began in June. The overall aim of the service is to increase the access of mental health clients within GP care to physical health care assessment, specialist physical and mental health support and relevant non statutory organisations. The service will be based within GP practices included in the pilot, and provide consultation and advice to GPs as well as direct care.
Islington CCG plays a full and active part in the Board and four of its Governing Body are full members. They are:
Dr. Gillian Greenhough, Chair
Dr. Jo Sauvage, Joint Clinical Vice-Chair
Alison Blair, Chief Officer
Martin Machray, Director of Quality and Integrated Governance
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10. Discharged its functions with regard to the need to safeguard and promote the welfare of children and adults Children Islington CCG complies with the requirements of the Children Acts 1989 and 2004 to discharge its duties with regards to safeguarding and promoting the welfare of children. Additionally it works in accordance with the following key national, statutory guidance – “Working together to Safeguard Children 2013” “Safeguarding Vulnerable People in the reformed NHS – accountability and assurance framework” 2013 to be replaced on the 1st April 2015 by Safeguarding Vulnerable People in the NHS – Accountability and Assurance Framework; reflecting recent developments across the health system to further clarify roles and expectations. Section 11 of the Children Act 2004 sets out the particular duties of agencies in relation to child safeguarding and as a member agency of Islington Safeguarding Children Board, Islington CCG undertakes an audit of their compliance with Section 11 every 2 years. Accountability, structure and governance arrangements The Chief Officer of Islington CCG has overall responsibility for the organisation’s child safeguarding arrangements and is a member of the Islington Safeguarding Children Board. The Director of Quality and Integrated Governance is the Executive lead for safeguarding. The CCG is responsible for securing the expertise of designated professionals on behalf of the local health system. A designated nurse for child protection whole-time-equivalent is employed by Islington CCG. The designated doctor for child protection (0.4 whole-time-equivalent) is employed by Whittington Health and works for Islington CCG through a service level agreement with the Trust A named GP for child protection (0.2 whole-time equivalent) is in post. Islington CCG has a Child Protection committee which meets quarterly and is chaired by the vice-clinical chair/children’s lead for Islington CCG. This committee reports to the Quality and Performance Committee 6 monthly or more frequently by exception and has a robust work-plan focussing on the following themes
Child protection and safeguarding training – provision and uptake
Performance monitoring – commissioned services/provider trusts
Quality monitoring of child safeguarding arrangements and practice – GPs/other Independent contractors
GP engagement with child protection and safeguarding
CCG engagement with child protection and safeguarding including identification of key risks
Child Death Review arrangements
Monitoring Serious Case Reviews and Serious Incidents
Networking with other NHS organisations
Preparation for/ response to child safeguarding inspections by regulatory bodies – Care Quality Commission/Ofsted
Response to national and London wide child safeguarding recommendations.
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An annual report on child protection and safeguarding is prepared by the designated nurse and doctor (child protection) and is presented to the Quality and Performance Committee and to the Islington CCG Governing Body. The Islington CCG has a Child Safeguarding Policy in place which is available on the Islington CCG intranet. Achievements in children’s safeguarding 2014/15
Islington CCG has monitored and sought assurance on implementation of the intercollegiate document “Safeguarding Children and young people: roles and competencies for health care staff” in all provider organisations. Via the designated nurse staff training compliance is reported monthly to the CCG.
The designated nurse (child protection) has attended provider safeguarding committees on behalf of the CCG to monitor, challenge and seek assurance that national and local guidance is being implemented in regard to the identification and management of child safeguarding matters, including e.g. FGM, CSE, and DV in health care settings and in the wider multi-disciplinary work.
There has been excellent local health service engagement in the Islington Multi- Agency Safeguarding Hub - MASH
GPs have been well represented at multi agency training provided by the Islington Safeguarding Children Board and their contribution to Child Protection Conferences is monitored by the Named GP and CCG
The Child Safeguarding referral pathway and key contacts list have been shared with all independent contractors in Islington and have been incorporated into the “Map of Medicine” tool for Islington GPs.
Arrangements are in now place for the “flagging” of Harmoni/Care UK GP Out of Hours service records with details re any Islington children who are subject to a Child protection plan.
The “IRIS” domestic violence support project for Islington GP practices and pharmacies is now in place. A Clinical Lead, Advocate Educator, and relevant staff have received training and training is being delivered to local general practice teams. This project has been funded by the Islington CCG investment panel.
Safeguarding Adults This year, Islington CCG has fully complied with national guidance surrounding safeguarding vulnerable people, not only adhering to the explicit requirements, but in its continuing commitment to the spirit of protecting the most vulnerable adults in our communities. The imminent implementation of the Care Act 2014 will create a new legal framework for how local authorities and other parts of the health and care system should protect adults at risk of abuse or neglect. The guidance due for the Care Act will be more prescriptive about what will be required from all agencies.
A key responsibility for the organisation is to ensure that commissioned services provide safe systems that safeguard adults at risk of abuse or neglect. In seeking this assurance the organisation will start to monitor health care providers against a set of regionally agreed safeguarding standards.
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In the reporting period the workload has continued to escalate; there has been a range of safeguarding activity including emerging scandals that have impacted on national and local workloads. Many emerging themes have had a significant history and are not new issues to consider. The emergence of the PREVENT6 agenda; increasing concern regarding the identification and management of female genital mutilation (Islington has had the first prosecution case in relation to this); extremely poor standards of care for vulnerable adults highlighted in residential and community care settings; a significant increase in deprivation of liberty applications; and the identification of poor quality of care in many care settings of adults with learning difficulties. Designated Professional for Safeguarding Adults: the CCG, in preparation of the Care Act, has appointed a Designated Professional who came into post in October 2014. This role has been designed to build a combination of subject matter expertise and clinical expertise to ensure that safeguarding arrangements for safeguarding adults across the health economy are robust and that the residents of Islington receive safe, effective high quality care. The post holder works across the health economy to build clinical awareness of the safeguarding adult agenda by working with providers of commissioned services to ensure that vulnerable adults are safe from harm and abuse. The post holder is a source of professional specialist advice on ‘safeguarding adults’ issues to staff within the organisation, partner agencies and health professionals across the health economy. Network approach: All the North Central London CCG Designated Leads have agreed a network approach to the delivery of some of the statutory strategic safeguarding functions to promote resilience, reduce variations in provision, ensure consistency in delivery and enable the development of a sustainable and flexible commissioning safeguarding workforce. Serious Case Reviews: in Islington there has been one serious case review in this period of reporting. The purpose of the review was to identify improvements that are needed and to consolidate good practice with the aim of delivering sustainable improvement and the prevention of death, serious injury or harm. Mental Capacity Agenda (MCA): continues to evolve and increase in workload. The House of Lords Select Committee was highly critical of the implementation of MCA in all services, including the NHS. It is imperative that work continues to develop practitioner knowledge and understanding of the legislation and their roles and responsibilities. The CCG continues to work with the council to focus on this area of work. The CCG has also included a specific KPI within the contract to gain assurance from commissioned services around effective and appropriate use of the MCA. The Deprivation of Liberty Safeguards (DOLS): work also continues to evolve due to the Cheshire West ruling, which significantly lowered the threshold for what constitutes a DOL application. There has been an almost tenfold increase in the number of DOLS applications since the ruling. There is significant ongoing work with the local authority around ensuring that
6 The Prevent agenda requires healthcare organisations to work with partner organisations to contribute to the prevention of terrorism by safeguarding and protecting vulnerable individuals who may be at a greater risk of radicalisation and making safety a shared endeavour. NHS England, 18 Sept 2013 Gateway ref 00410
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there is a risk led priority system to work through the increased work load, and with services in understanding the delays and the inherent challenges such an increase has caused. Assurance and Accountability Frameworks: We currently await revised and updated guidance to review implications for the organisations Safeguarding responsibilities. Safeguarding Standards: A review of the existing Safeguarding standards currently within contractual requirements has taken place, it is anticipated these will be embedded in all contracts within the next 12 months. For the adult agenda, the increased scrutiny and challenge for services will require significant support to embed and begin the change in culture to a patient led approach to safeguarding. Training and Development: the CCG has carried out an organisational learning needs analysis for safeguarding adults and the Mental Capacity Act (MCA) and commissioned relevant training programmes in partnership with the local authority. The CCG has also had oversight of a training programme on Safeguarding Adults and the MCA for GPs in the borough. During 2014 the partnership board has held conferences for professionals and service users that have been well attended and highly regarded. The board has also held events to understand the implications of the Care Act; Making Safeguarding Personal and the Prevention elements of the Act. Representation at Regional and Local Networks: the CCG has representation on NHS England London Safeguarding Adults and PREVENT meetings. It continues to work jointly with the Council adult safeguarding team and are a leading partner in the Safeguarding Adults Partnership Board. The CCG’s Director of Quality and Integrated Governance is the vice chairman of the Board and commissioners play active roles in all aspects of adult safeguarding. The agenda continues to evolve and its workload continues to escalate in line with national direction, new legislation, emerging scandals and findings from critical incidents and serious case reviews. The underpinning message however remains the same in that safeguarding is everyone’s business irrespective of role or position. It is a commissioning, provider and community responsibility to safeguard and protect the most vulnerable adults and children in our society. The vulnerable adult must remain at the centre and motivation of our actions. 11. Co-operated in relation to the preparation of Joint Strategic Needs Assessments The Joint strategic needs assessment (JSNA) is a process led by public health to jointly describe the current and future health and wellbeing needs of the local population. The intelligence gathered has supported us in the identification of priorities and has helped determine what actions need to be taken to buy the right services for the local population to improve health and wellbeing and reduce inequalities. The production of a JSNA is a statutory requirement for Health and Wellbeing Boards.
In Islington a publically accessible web- based ‘Evidence Hub’ has been developed which hosts evidence, data, strategies, intelligence and policies. The Evidence Hub helps to share information across and within organisations and to inform the development of evidence-based and needs-based commissioning plans and priorities. In essence, the Evidence Hub is Islington’s JSNA and can be accessed at:
http://evidencehub.islington.gov.uk