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NHS Tower Hamlets CCG – Insert name of document here

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Tower Hamlets Clinical Commissioning Group

Annual Report and Accounts 2018/19

Website: www.towerhamletsccg.nhs.uk Email: [email protected]

NHS Tower Hamlets CCG – Annual Report

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Abbreviations used in this report

AC Audit Committee

AGS Annual Governance Statement

ACS Accountable Care System

BHR Barking and Dagenham, Havering and Redbridge

CCG Clinical Commissioning Group

CCP Community Commissioning Panel

CQRG Clinical Quality Review Group

CQRM Contract and Quality Review Meetings

EPPR emergency preparedness, resilience and response

F&D Finance and Delivery

FFT friends and family test

FRPB Financial Recovery Programme Board

GB Governing Body

HWB Health and Wellbeing Board

ICPB Integrated Care Partnership Board

INEL Inner North East London

JC Joint Committee

JCAF Joint Committee assurance framework

JCC Joint Commissioning Committee

MRSA Methicillin-resistant Staphylococcus aureus (a type of bacteria that is widely resistant to

antibiotics)

MSA mixed-sex accommodation

NEL north east London

NELCA North East London Commissioning Alliance

NELFT NELFT NHS Foundation Trust

NHSE NHS England

NHSI NHS Improvement

NICE National Institute for Health and Care Excellence


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PEF Patient Engagement Forum

PPI patient and public involvement

QI quality improvement

QIPP quality, innovation, productivity and prevention (a large-scale transformation

programme which aims to deliver a better quality service for less money)

RTT referral to treatment time

RSM RSM Internal Auditors

UEC urgent and emergency care

WEL Waltham Forest and East London

WELC Waltham Forest, East London and City and Hackney


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Contents Introduction ........................................................................................................................................ 5

A. PERFORMANCE REPORT ............................................................................................................ 7 A1. Performance overview ................................................................................................................ 8

A1(1) Accountable Officer’s perspective on performance .......................................................... 8 A1(2) Managing Director’s perspective on performance .......................................................... 10 A1(3) The purpose, activities and objectives of the CCG ........................................................ 11 A1(4) Our Year in Review – Commissioning Successes in 2018/19 ........................................ 16 A1(5) Working With Our Partners ............................................................................................. 19 A1(6) The key issues and risks of the CCG ............................................................................. 23 A1(7) Going concern opinion .................................................................................................... 23 A1(8) Performance summary ................................................................................................... 23 A2. Performance analysis ........................................................................................................... 25 A2(1) Financial performance .................................................................................................... 25 A2(2) How the CCG measures and checks performance ........................................................ 28 A2(3) Other performance matters ............................................................................................ 36

B. ACCOUNTABILITY REPORT ...................................................................................................... 46 B1 Corporate governance report ................................................................................................. 47 B1(1) Members’ report ............................................................................................................. 47 B1(2) Statement of Accountable Officer’s Responsibilities ...................................................... 55 B1(3) Governance Statement .................................................................................................. 56 B1(4) Head of Internal Audit Opinion ....................................................................................... 79 B1(5) Review of the effectiveness of governance, risk management and internal control ....... 83 B2. Remuneration and Staff Report ............................................................................................ 85 B2(1) Remuneration report ...................................................................................................... 86 B2(2) Staff report ...................................................................................................................... 93 Parliamentary Accountability and Audit Report ......................................................................... 102 B3(1) Audit certificate and report ........................................................................................... 103

ANNUAL ACCOUNTS .................................................................................................................... 104


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Introduction We are proud to present the 2018/19 annual report and accounts for NHS Tower Hamlets Clinical

Commissioning Group (CCG). It gives an overview of what we have achieved in the last 12 months as we

continue to strive to make Tower Hamlets a healthier and happier place to live and highlights how we have

built on our strengths in governance, finance and performance to ensure high quality services that are

continuously improving.

Tower Hamlets is a unique, dynamic and diverse borough, and our health and social care services reflect the

needs of our community. Over the last year we have continued to make significant progress working alongside

patients, the public and health and social care providers to improve our understanding of what our community

needs and to develop services that best meet those needs.

In January 2019 we were given a rating of ‘outstanding’ by NHS England (NHSE) and our system leadership

came to the fore during a year which Waltham Forest, Newham and Tower Hamlets CCGs come under one

Managing Director. Each CCG retains its own Governing Body and the majority of decision-making still takes

place at a local level. The three CCGs will work collaboratively together, alongside the NEL Commissioning

Alliance, where it is in the best interests of patients to do so.

We also made great strides in improving people’s health and wellbeing through working in partnership with

those who use our services, tapping into their personal assets and those of their communities, not least

through social prescribing which involves activities typically provided by voluntary and community sector

organisations. Examples include arts activities, gardening, cookery, healthy eating advice and a range of

sports.

We have continued to pioneer integration of care through Tower Hamlets Together, our local integrated

partnership of providers and commissioners. We would like to thank all of our partners, the London Borough of

Tower Hamlets, local healthcare partners, the Tower Hamlets GP Care Group, Healthwatch and the voluntary

and community groups that we have worked with over the last year. We have only achieved these successes

by working in partnership with these dedicated professionals and we look forward to continuing to work

together to innovate, explore and improve the health and care of people living and working in Tower Hamlets.

As we move into the new financial year, we face a new and exciting time in the NHS where integration with

local health and care partners is central to making the best use of resources and patients have ever greater

opportunities for taking an active role in their health and care choices. We remain committed to doing our very

best for local people and look forward to working together through 2019 and beyond.


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Jane Milligan Accountable Officer NHS Tower Hamlets CCG

Selina Douglas Managing Director NHS Tower Hamlets CCG

Sir Sam Everington Chair NHS Tower Hamlets CCG


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A. PERFORMANCE REPORT

Jane Milligan

Accountable Officer

24 May 2019


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A1. Performance overview

A1(1) Accountable Officer’s perspective on performance

We are proud to present the 2018/19 annual report and accounts for Tower Hamlets Clinical Commissioning

Group (CCG). It gives an overview of what we have achieved in the last 12 months as we continue to strive

to make Tower Hamlets a healthier and happier place to live.

Tower Hamlets CCG is part of the North East London Commissioning Alliance (NELCA) which brings

together the following seven CCGs – City and Hackney, Newham, Waltham Forest, Tower Hamlets, Barking

and Dagenham, Havering and Redbridge of which I AM the Accountable Officer. I am also the executive

lead for the North East London STP – the East London Health and Care Partnership. I am delighted with the

progress we have made by working closely together with our neighbouring CCGs and partners. Highlights of

this collaboration are outlined below.

At a north east London (NEL) level the Joint Commissioning Committee (JCC), which brings together

representatives from all our CCGs and local authorities, has now met several times in public. Key areas

discussed in detail include: outpatients, maternity, cancer diagnostics and urgent and emergency care. The

committee has also looked at things like performance and finance activity across the seven CCGs. The

purpose of the JCC is to discuss common issues and, in a limited number of areas, take decisions on

services that are commissioned once across NEL. The JCC meetings have been held in public with people

given the opportunity to ask questions about the issues discussed.

Engaging and involving our local population is a key priority for us and working together as seven CCGs has

enabled us to bring together our CCG Lay Members with a focus on developing a co-production charter –

aimed at working in equal partnership with the people who use our services in order to create better

outcomes.

Working together has been beneficial in a number of other areas such as the joint development of a north

east London commissioning framework which brought together our commissioning ambitions across the

whole system for the first time. We also successfully launched our integrated clinical assessment service

(NHS 111) across all of north east London in the summer of 2018 and through working collaboratively we

have also aligned approaches on areas such as acute mental health beds and health based places of safety.

Over the past year we have made great strides in developing our integrated care partnerships (ICP) –

working collaboratively with our partners. These ICPs bring together our local authority and provider

colleagues at a place based level to focus on a range of priorities and outcomes.


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City and Hackney’s focus is on children and young people’s mental health, prevention, planned and

unplanned care while BHR’s priorities include older people, frailty and end of life, children and young people,

long term conditions, mental health, medicines optimisation, maternity and cancer.

We continue to work closely with our providers who are working hard to deliver quality services for our local

population. In terms of CQC ratings we are delighted that East London Foundation Trust remains

outstanding and NELFT and Homerton remain as good. BHRUT are making progress towards moving out of

requires improvement and Barts Health NHS Trust has been taken out of quality special measures with the

Royal London Hospital moving from requires improvement to good. This is testament to the hard work and

dedication of all the staff.

Across our CCGs there have been a number of individual successes to celebrate. In Tower Hamlets, the

success of the vanguards programme has been reflected in the refreshed GP contract launched this year. In

BHR an NHS Financial Recovery Plan has been agreed with all local NHS organisations formally signed up

to and committed to delivering this. Newham CCG celebrated their HSJ award win in the autumn for their

work around tackling TB. City and Hackney has been recognised for its achievements in managing diabetes

and Waltham Forest CCG has again been recognised for its successful cancer survival rates.

Looking ahead to 2019/20 we will continue to build on these successes and focus on implementing the

requirements of the NHS Long Term Plan, using these as a basis for a refresh of our north east London plan.

The direction of travel is to keep on developing our approach to integrated care partnerships and ensuring

we are working with our partners to deliver the best care possible for our patients.

I would also like to express thanks and appreciation to our primary care members, CCG staff and members

of the public for their ongoing commitment and dedication to improving the health and wellbeing of local

people. We look forward to continuing to work together to innovate, explore and improve the health and care

of people living and working in Tower Hamlets.

The following report provides an overview of NHS Tower Hamlets CCG’s performance in 2018/19 as well as

the annual accounts.

Jane Milligan

Accountable Officer

24 May 2019


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A1(2) Managing Director’s perspective on performance

In Waltham Forest and East London (WEL), the collaborative group of CCGs that includes Newham, Waltham

Forest and Tower Hamlets is building on our history of close working to maximise the benefits for patients and

improve the quality of our services.

We know that our local populations continue to grow and often have complex health needs, meaning that we

have to innovate and transform the way we deliver services, within the resources available. By working

together we can make our resources go further and focus on improving the health outcomes of our local

populations.

As we move forward with delivering the long-term plan and implementing strategic commissioning across

WEL, we will continue to build on the partnership work we have seen over recent years through closer joined

up working with providers, local authorities and the voluntary and community sector.

A key aspect of this is working under a single management team for WEL. The implementation of a single

management team started with the appointment of the single managing director for WEL in December 2018

and it is anticipated the full team will be in place by autumn 2019. This will help to stabilise and embed new

working practices across WEL that we believe will have a positive impact on how we commission, improving

health outcomes for local people.

We are also systematically developing close and integrated working relationships with our health and care

partners across inner north east London (INEL) to develop a whole system partnership approach to

transforming services and improving the lives of people living in north east London.

City and Hackney, Newham, Tower Hamlets and Waltham Forest CCGs along with the Homerton, Barts

Health, East London Foundation Trust and North East London Foundation Trust are part of the INEL System

Transformation board (STB), which will work collectively to address the challenges facing the health and social

care system. The STB replaces the former Transforming Services Together programme (TST), which has

been responsible for a number of significant system successes across North East London including

improvements to diagnostics and the introduction of the electronic referral system.

The INEL STB is currently setting the priority areas, which include:

Outpatients – aim of reducing outpatient face to face contacts by a third

Urgent care – taking responsibility for the urgent pathway to reduce unnecessary attendance

Health and well-being of rough sleepers and homeless people – currently being scoped with local

authority and health leads

Clinical configuration and provider collaboration – we will continue to work across INEL looking at

surgical configuration across sites, mental health provision, and improved utilisation of local capacity

and maximised capital opportunities.


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Achievements we have already made include:

Outpatients - a big increase in the utilisation (98%) of the paperless e-referral system by Barts Health

and the roll out of advice and guidance for GPs to determine if referrals are necessary, via the e-

referral system.

Workforce – a 200% increase in the number of Physicians Associates employed into primary care

settings since 2016.

While we are working through a time of change, introducing new ways of working and challenging existing

system deficiencies, it is an exciting time for all those involved in developing health services as we work to

meet the needs of our local population now and into the future.

A1(3) The purpose, activities and objectives of the CCG

Our history, background and structure

The CCG is responsible for planning and buying most healthcare services in Tower Hamlets. It's our job to

identify how health services in Tower Hamlets can best meet the needs of local people, both now and in the

future and we have a statutory duty to address and reduce health inequalities in the borough. To do this, we

work closely with clinicians, patients, carers, our local authority colleagues and the local voluntary and

community sector to ensure NHS resources deliver the best possible health outcomes for our population, and

in the most efficient way.

We are a clinically-led membership organisation, made up of the 35 general practices in Tower Hamlets. Our

organisation is led by GPs and healthcare professionals who, between them, have many years’ experience

caring for patients.

We want to make a real improvement to the health of our local people. As a clinically-led organisation, we are

committed to working with our stakeholders, patients and their families – together we make the best use of

resources and staff across health and social care.

Our GP membership is involved in setting the CCG's overall aims, strategic commissioning direction and

priorities. Responsibility for detailed planning and operational commissioning of local health services is

delegated to the CCG's Governing Body.

Our borough and population

Tower Hamlets is unique. Home to around 305,000 people, the local community is diverse, with 33% from

White British or Irish ethnic groups and 67% from other ethnic groups, the largest of which (32%) is the

Bangladeshi community. Religion continues to play a prominent role in the lives of many local people, with

65% having a religious belief including 35% of residents that identify as Muslim. The borough has a young

population with 37% of people aged 20-34, compared with 20% across England as a whole.


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Tower Hamlets also has one of the fastest growing populations in London and is expected to reach around

354,000 by 2025. The borough is adjacent to commercial development, including the site of the London 2012

Olympic and Paralympic Games, Thames Gateway and projects in Canary Wharf. The borough has seen

significant residential development over the last few years and this is projected to continue, providing

opportunities for local regeneration.

The vibrancy of Tower Hamlets is also apparent in its physical and cultural assets including the many

waterways, Victoria and Mile End parks, a variety of museums and markets, and the Tower of London (from

which the borough derives its name). All of these elements contribute to the borough's unmatched sense of

place, identity and pride.

Key Health Statistics

Newham Tower Hamlets

Waltham Forest

Greater London

England

Estimated population

(2017) 353,245 317,203 283,524 8,835,500 55,609,600

% of population aged 0-15 (2015)

22.7% 20.1% 22% 13.9% 19%

% of population aged 65+ (2015)

7.3% 6.1% 10.3% 12.5% 17.7%

% of population from BAME groups (2017)

72.6% 53.6% 49.7% 42.5% ---

Unemployment rate

(2015) 6.3% 9.7% 3.9% 6.1% 5.1%

Male life expectancy

(2012-14) 79.2 78.6 79.3 80.3 79.5

Female life expectancy (2012-14)

83.1 82.3 83.9 84.2 83.2

Childhood obesity

(2015-16) 28% 27% 26% 23.2% 19.8%

Prevalence of diabetes, age 17+

8.6% 6.7% 6.8% 6.0% 6.2%


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Our Challenges – Reducing Health Inequalities

Tower Hamlets is a vibrant and dynamic London borough - based in the heart of the East End with a strong

tradition of diversity. When we commission services, to meet the health needs of all local people, we need to

consider the following key facts.

Tower Hamlets is:

Young: 37 % of our population is aged between 20-34, compared to 20% nationally

Densely populated and continues to grow: we have around 305,000 residents and this is set to grow to

354,000 by 2025

Ethnically diverse: 33% of our population are from a White British or Irish ethnic group and 67% from

other ethnic groups. The largest of which is the Bangladeshi community (32%).

Deprivation

Tower Hamlets is a borough of contrasts, it is both one of the most deprived areas in England yet it is also

home to one the country's main financial centres in Canary Wharf. The level of deprivation in the borough has

an adverse impact on the health and wellbeing of local people and places a significant demand on public

services. Tower Hamlets has the highest worklessness rate in London, at 7.7%, and the highest rate of

poverty as well – 39%. Child poverty is higher here than in any other borough as well, with 43% of children

living in poverty and rates of infant mortality and premature mortality are also significantly above the London

average.

However, the population is changing due to the level of development within the borough. In 2010, Tower

Hamlets was ranked the 7th most deprived borough in the country with 70% of people living in the 20% most

deprived areas of the country. In 2015, it was ranked the 10th most deprived with 58% living in the 20% most

deprived areas. This change reflects growth of new populations in the borough, but significant health

inequalities remain. Life expectancy is 7.7 years lower for men and 4.3 years lower for women in the most

deprived areas of Tower Hamlets compared with those living in affluent areas.

A significantly higher percentage of households in Tower Hamlets are socially rented (40%) compared to the

rest of London (24%) and, despite the substantial housing growth, high levels of overcrowding persist. The

borough also has less green space than the national average, with 0.89 hectares per 1,000 people compared

to the local open space standard of 1.2 hectares per 1,000.

Unemployment remains an issue with 64% of the working age population in work, compared to 69% across

London. Just over 3% of the borough's population provide more than 20 hours of unpaid care per week and, of

that group, more than half provide more than 50 hours.


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Sources: https://www.trustforlondon.org.uk

https://www.towerhamlets.gov.uk/lgnl/health__social_care/joint_strategic_needs_assessme/joint_strategic_ne

eds_assessme.aspx

Health Headlines

Many people in Tower Hamlets are living with a long-term condition and hospital admission rates for heart

disease and stroke are above the national average. According to the 2011 Census results, 13.5% of people in

Tower Hamlets stated they had a long-term health problem or disability that limited their day to day activities

(34,300 people). This is slightly lower than the regional and national rates (14.1% in London and 17.6% in

England).

Other health headlines include:

• We have the highest child poverty rate in the UK

• Life expectancy in Tower Hamlets remains lower than rest of country (78.7 years compared to 79.5

years nationally for males and 82.4 compared to 83.1 for females)

• 8.3% of all babies born in Tower Hamlets have a low birth weight.

• A quarter (26.8%) of children aged 10 to 11 years old are obese.

• Premature death rates from circulatory disease, cancer and respiratory disease are among the highest

in the UK.

Healthy life expectancy

The high levels of deprivation in Tower Hamlets have a direct impact on the number of years that people

remain healthy later in their lives. This means that they begin to develop multiple health problems far earlier in

life than elsewhere.

On average, a man living in the borough starts to develop health problems from the age of 61.3 compared to

63.3 in the rest of the country. For a woman, it is 55.6 compared to 63.9. Healthy life expectancy ranks 55th

lowest for men and third lowest for women among all local authorities.

This has an effect on both the demand for health services and the complexity of health issues. The annual GP

consultation rate for adults aged 50-64 in the most deprived parts of the borough is up to twice as high as in

wealthier parts of the country. The problems that people go to their GP for help with are also, on average,

more than twice as complex.

Given the significant health inequalities within the borough, the CCG takes a life course approach to planning

and commissioning services, from birth to the last years of life. The Joint Strategic Needs Assessment (JSNA),

produced by the London Borough of Tower Hamlets Public Health team, supports us to understand the health

needs of our population better.

https://www.trustforlondon.org.uk/

https://www.towerhamlets.gov.uk/lgnl/health__social_care/joint_strategic_needs_assessme/joint_strategic_needs_assessme.aspx

https://www.towerhamlets.gov.uk/lgnl/health__social_care/joint_strategic_needs_assessme/joint_strategic_needs_assessme.aspx


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Delivery of our Equalities Strategy is overseen by our Executive Committee which reports directly to our

Governing Body and provides assurance on our work in this area. The committee is chaired by a local GP. We

have a nominated lead for equalities on our Governing Body and a senior manager to drive forward our

equalities agenda.

Our corporate objectives and how we measure success

As a CCG we are always seeking to improve services and ensure the financial and other resources we are

given are used in the best way to commission safe, effective and high-quality healthcare for local people.

People's experiences and views, good and bad, help us to understand what we are getting right but more

importantly we know if we engage with service users we are better able to improve services through our

commissioning priorities. We have a statutory duty to engage with patients and we work hard to ensure that

the concerns of patients and feedback we receive is used to help us to learn and continually improve services.

Our corporate objectives relate to the CCG in its entirety, providing the organisation with a clear direction for

commissioning intentions; they reflect where we are now as a CCG, and where we want to be in the future as

well as our obligation to fulfil our statutory duties. The objectives develop our approach to performance and

risk management, and provide a framework for performance management.

They are:

a. To work in partnership to commission high-quality hospital services that are accessible, provide

the appropriate treatment in the right place, and achieve good patient outcomes for people of all

ages living in the borough

b. To commission person-centred, integrated health and care services that are sustainable and that

equally meet the mental and physical needs of our residents

c. To contribute towards a financially sustainable and responsive health and care economy which

delivers value for money and innovation and supports the appropriate use of services

d. To support local people and stakeholders to have a greater influence on services we commission

e. To promote equality both as an employer and a commissioner of health care services

f. To create a high performing and sustainable workforce that continuously learns and is engaged in

delivering our ambitions.


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A1(4) Our Year in Review – Commissioning Successes in 2018/19

Transformation

End of Life

This year the CCG implemented Coordinate My Care (CMC) to deliver better integrated, coordinated and

personalised medical care for people at end of life. Over the course of the year, CMC has been rolled out to all

Tower Hamlets GP practices and as of February 2019, 212 Tower Hamlets patients with end of life care needs

have had a CMC care plan created. The CMC plans mean that GPs are having and recording conversations

with people at the end of life about their choices and preferences and that this can then be shared with other

services involved in their care. Over 2019/20, we will be looking to increase the number of care plans in the

borough, as well as rolling this out to other services, including Barts Health and our community teams.

Cancer

During 2018/19, the CCG continued with driving its commitment to seeing cancer as long term condition and

has invested in improving recorded prevalence at local level. Since the implementation of the Cancer

Prevalence Network Incentive Scheme 2017/18, 545 more Tower Hamlets patients have been identified as

having a cancer diagnosis, equal to a 17% rise in recorded prevalence. Future plans for 2019/20 will include

continuing to pioneer mainstreaming cancer care across the north east London footprint and undertaking a

collaborative research project in primary care to review patients diagnosed with cancer between 2016 and

2018 with a view to understanding avoidable delays to diagnosis.

Diabetes

The Healthier You: NHS Diabetes Prevention Programme (NHS DPP) identifies those at high risk of Type 2

diabetes and refers them onto a behaviour change programme. As of December 2018 we’ve had 293 people

complete the programme in Tower Hamlets and a further 413 are still actively engaged. Also, we have used

the NHS England Diabetes Transformation fund as an opportunity to focus on improvement in care for people

with Type 1 diabetes. This funding has been used to fund staff to provide multi-disciplinary care for people

with Type 1 diabetes.

Personalisation

Tower Hamlets are now at the forefront of developing Personalisation in London. We have 530 Personal

Health Budgets (PHBs), the most PHBs in London. We have also been working on improving quality of

person-centred holistic planning as part of the Personalised Care Programme (PCP), for which we have been

a demonstrator site, to help shape the roll out of this approach nationally with NHS England, the aims of which

are included in chapter one of the Long Term Plan. The main focus of the work has been working on

improving the system for adults with learning disabilities, people with severe mental health needs, people with

2 or more long term conditions and children with Special Educational Needs and Disabilities (SEND).


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Social prescribing

Social prescribing in Tower Hamlets has gone from strength to strength. We led on possibly the first

econometric evaluation of social prescribing and, based on work by the CCG’s Financial Strategy team, the

CCG was able to agree an increased, recurrent budget for the local service which has set it on a sustainable

footing for the foreseeable future. We were also delighted to hear that NHS England will make funding

available to primary care networks for social prescribing link workers, which dramatically enhance the scope

and research of the service across primary, secondary, community and social care.

Planned Care

The Planned Care programme has had some significant successes in 2018/19. The national Paper Switch Off

(PSO) programme set a contractual requirement for all GP referrals to consultant-led first outpatient

appointments to be made via the NHS e-Referral Service (eRS) from 1 October 2018. An ambitious training

and engagement process was undertaken in general practice, in collaboration with Barts Health. Utilisation of

the e-referral service is now around 97%, a significant increase from the approximately 30% utilisation prior to

the programme commencing. The e-Referral Service offers improved patient safety, transparency and

supports informed patient choice. It also offers additional features for GPs, including Advice & Guidance and

Referral Assessment Services, which aim to provide rapid access to consultant support and advice and

ensure that patients are treated in the right place at the right time.

2018/19 also saw the launch of a new Minor Eye Conditions Service (MECS) that aims to provide convenient,

high quality care for minor eye conditions in the community. MECS offers local residents an alternative to

hospital eye care and operates across five locations in Tower Hamlets. MECS helps to ensure that patients

are seen in the right service at the right time and frees up capacity in hospital for patients who need to be seen

by a specialist and increases access for patients with less complex eye issues that still require input from an

Optometrist.

Another success for the Planned Care programme in 2018/19 was a pilot project to support primary care staff

to initiate suitable, low risk patients on NOACs (Non Vitamin-K Antagonist Oral Anticoagulants). Prior to the

pilot, patients had to be referred into hospital to start NOACs, which are a type of anticoagulation medication.

This increased the time patients had to wait to start anticoagulation therapy and also presented a significant

cost pressure for the CCG. In 2018, the CCG worked with the Barts Health Anticoagulation service and the GP

Care Group to develop a new patient pathway (that aimed to deliver care quicker and closer to home) and

design training and support for primary care staff to initiate NOACs. Two training sessions have been

delivered by Barts Health to primary care staff and some practices are starting to initiate suitable patients on

NOACs. More training sessions are planned for next year and the pilot will be expanded to all practices who

wish to participate.

Limited capacity and increasing demand remains a key challenge for Planned Care, particularly in outpatients

where waiting times are long in a number of specialties. To combat this we are working closely with GPs to

reduce the variation in referral rates across the borough and encourage uptake of Advice & Guidance and


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Referral Assessment Services. The CCG is also taking a more collaborative approach to planning and

commissioning services and transformation projects in high priority areas, through our Tower Hamlets

Together (THT) partnership board, and by working with Waltham Forest, Newham and City & Hackney CCGs.

Mental Health

In 2018/19, Tower Hamlets took a lead role in the Learning from Deaths National Programme and completed

18 mortality case reviews for people with a learning disability making it the leading London CCG. Findings

from this research will influence our future commissioning and delivery of service and help us to improve the

health inequality faced by people with a learning disability by tackling their drastically lower life expectancy.

Alongside this, our continued focus on improving health outcomes for people with a learning disability has

seen us make steady improvements in the number of adults and young people who have an annual health

check in the Borough with the process being embedded within the Primary Care system for the coming years.

Working with the Community Learning Disability Service and Primary Care, we are reviewing people with a

learning disability prescribed anti-psychotic medication as part of the ‘Stopping Over Medication of people with

learning disabilities’ programme.

We have continued our commitment to the Transforming Care national programme to reduce hospital

admissions and improve care for children and adults with a learning disability and/or autism. Development of

risk registers and steering groups has brought a multitude of agencies together to address this.

We are working with Barts Health NHS Trust and Tower Hamlets Council to allow support workers and carers

to provide care to those individuals admitted to hospital ensuring continuity of care and improved experiences

whilst in hospital.

We continue to work with Tower Hamlets Council to improve employment opportunities and address the

accommodation assets within Tower Hamlets for people with a learning disability. We are reviewing the Barts

Health NHS Trust ‘Hospital Passport’ with the aim of redeveloping this onto an electronic platform.

Improving Access to Psychological Treatment (IAPT)

From 1 October 2018, the CCG has commissioned East London NHS Foundation Trust (ELFT) to provide the

Tower Hamlets Talking Therapies Service which provide IAPT and counselling services. The previous IAPT,

bilingual counselling, bereavement counselling and general counselling services were brought together

creating a single point of access through which all services can be accessed.

The new contract aims to meet the ambitions in the National Mental Health Strategy - the Five Year Forward

View, including more people accessing talking therapy, and more people with long-term health conditions

benefiting from the service. It will also mean clearer pathways between physical and mental health services

and between primary and secondary care.


19

Launch of Tower Hamlets Mental Health Crisis Line

A mental health crisis line was launched in October 2018 to support people living and working in Tower

Hamlets, provided by ELFT. The mental health crisis line is available 24 hours a day and callers will be given

support and advice from mental health professionals.

It has been designed as a ‘first port of call’ for anyone experiencing a mental health crisis and to remove the

need for those people to seek help via hospital A&E services.

This is a service to help people in Tower Hamlets when they are experiencing a real mental health situation

and they cannot reach other healthcare professionals who would normally provide the support they need. The

team can help assess the urgency of the situation and ensure the appropriate advice is provided, help is put in

place or individuals are signposted to the team or service best placed to provide the care needed.

Mental Health Employment Support

The CCG together with the Local Authority commissions the Work & Wellbeing Hub. This service provides

mental health recovery focused support that enables people to develop skills, confidence and knowledge that

supports people to achieve their training and/or employment goals. People can also get advice and

information about volunteering opportunities. The service can offer advice and support to people who are

thinking about self-employment or the development of a new social enterprise.

For people already in employment it is also able to provide job retention support who may be at risk of being

unemployed due to mental health issues. It can also provide information to employers about mental health.

The CCG is also working to increase access to Individual Placement and Support (IPS) services by 2020/21,

enabling more people who experience a severe mental illness to find and retain employment.

A1(5) Working With Our Partners

Local Integration – Tower Hamlets Together

Tower Hamlets Together (THT) is a partnership of local health and social care organisations working towards

delivering and improving integrated care in Tower Hamlets, so that our patients receive more joined up and

person-centred services. As well as the CCG the partnership includes:

• Tower Hamlets Council

• TH GP Care Group

• East London Foundation Trust

• Barts Health Trust

• TH Council for Voluntary Service


20

During 2018 the CCG continued to play a leading role in the development of Tower Hamlets Together, working

to provide services in a more coordinated way – reducing duplication and improving the experience and

outcomes for the people who need them.

From joint planning, joint commissioning, and alignment of operational health and care teams in the

community our efforts have been to work together to design services that address local priorities. At the same

time, we have been working with wider planning footprints to ensure our system as a whole secures the best

possible outcomes and maximum value for our collective investment.

Our outcomes framework and emerging working structures have been aligned across the needs of our

population rather than across diseases or services, and highlights forward thinking to support people and their

communities in helping them lead fulfilling lives. A place based approach is also being developed via the

Locality Health and Well Being Committees.

We are continuing to develop our joint infrastructure which encompasses more co-location and the joint

management of staff, as well as a shared focus on services for the whole course of life.

Key highlights from 2018/19 are:

• The recent appointment of an Independent Chair for Tower Hamlets Together Board to strengthen the

partnership’s decision making and accountability arrangements. The post holder is due to start in April

2019.

• The three life course workstreams whose membership is made up of senior and operational staff from the

partnership have taken a leading role in the delivery of the CCGs commissioning cycle. This has been the

vehicle through which opportunities have been identified to improve outcomes, reduce costs, system

duplication and promote joint working in developing system priorities.

• The appointment of a Joint Director of Integrated Commissioning between the CCG and LBTH has

helped improve partnership working with LBTH. A joint division for commissioning has been established

and this is a step in the right direction as the best means of meeting the financial challenges ahead.

A THT Finance Summit was held in August 2018 by the THT Board, where Finance Directors from each of the

partner organisations presented and agreed the following actions as priorities for 2018/19. These are:

1. Identify the resources available for the lifecourse workstreams to fully align around the populations

they are set up to serve

2. Further align and pool budgets across commissioning

3. Further align/integrate commissioning and service delivery

4. Develop a framework for governance and accountability for the THT system to include decision

making and risk share


21

The four Locality Health and Well Being Committees were established and have been meeting monthly which

has General Practice at its core. The committees have a wider remit that will involve not only the delivery of

integrated care but also delivery of the broader population health strategy. They are developing involvement

from communities which links with the learning from the Communities Driving Change (CDC) Programme led

by Public Health.

The Community Health Services ’Alliance’ contract delivers the Multi-Disciplinary Team (“MDT”) arrangements

now operating across the borough. These are supported by locality based community health teams and the

intention is to integrate mental health teams into the locality model. In addition, the council has realigned its

operational adults social care services around the locality footprints in order to integrate better with its

counterparts in health.

During the first year, as a system, progress was made to establish and mobilise the alliance partnership

between the CCG, Barts Health, East London Foundation Trust and Tower Hamlets GP Care Group for

community services. In the second year of the contract the CCG have been looking at the value added of

these partnership arrangements, by reviewing and refreshing the contractual monitoring arrangements,

together with the outcomes framework which is a core component of the contract. In particular, there is a

desire to align the community health service outcomes with those in primary care, to ensure there are system

wide incentives to support partners in collaborating to meet the health and wellbeing needs of the population.

The scope of this contract is likely to increase over time as organisations and alliance arrangements mature.

This means that the alliance will look to take on more services to potentially include the Local Authority and

Voluntary/Independent sector in the future.

We are further strengthening the framework for involvement of communities in the work of Tower Hamlets

Together. Recently all engagement leads from across Tower Hamlets came together to develop a charter for

coproduction. Working with THT partners in this way has also paved the way for the development of a THT

wide engagement framework, which outlines how local people will be involved in the emerging THT structures.

This is an ambitious plan whose aim is to embed patient involvement in the key decision-making structures

and gives local people a voice where it matters most in the system and brings all of the THT partners together

to coordinate engagement work, reduce duplication and share best practice that plays to strengths and

expertise within the THT partnership. We now have user engagement in all three lifecourse workstreams

acting as equal partners in the decisions and discussions around services.

Over the past year, we have taken a new approach to staff engagement events. We have worked with our

Tower Hamlets Together partners to create a ‘whole system’ approach to staff engagement and have

combined our efforts to hold quarterly events where the whole system can engage together and create a

streamlined mechanism for staff to have their say about all health and care services in Tower Hamlets. We

have held 14 events since 2015 with more than 1000 staff attending.


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Working as part of the East London Health and Care Partnership

The ELHCP is made up of the eight councils, seven CCGS, three hospital trusts, two community trusts,

London Ambulance Service, Community Voluntary Services, Partnership of East London Cooperatives and

seven primary care Federations that serve over 1.9 million people in north east London, and this will rise to

around 2.25 million people in the next 15 years putting exceptional pressure on our health and care services.

To address this, we must transform the way we work together to improve the health and wellbeing of local

people and create services that are sustainable and affordable. Our partnership will make sure we can do

this.

Since 2016, our partnership has delivered our Sustainability and Transformation Plan (STP) and its

programmes and projects to transform the care and health services our communities rely upon. This has

included work on workforce, mental health, urgent care, prevention and primary care.

We have:

introduced new schemes to recruit and keep GPs in our boroughs and provide new training and

development opportunities for midwives, physician associates and GP practice managers

ensured that every pregnant woman is offered information and choice of places to give birth and we

are leading the way across London in terms of continuity of carers with 26.9% of pregnant women

across East London receiving care from the same carers throughout the three phases of the maternity

journey. The London average is 18%. secured over £5 million to develop a new Cancer early

diagnosis centre and improved delivery on the cancer 62 day standard

enhanced our NHS 111 service so you not only get advice from a clinician but you can make

appointments at some of our urgent care services

secured over £7m to improve our digital infrastructure, ‘switched-off’ paper referrals for hospital

outpatient appointments and doubled the number of views of the electronic patient record making it

easier for clinicians to provide better advice and treatment – no matter where they are working

Improved support on stopping smoking and diabetes.

All of this complements and enables the local planning and delivery in each CCG. But we want to do much

more and the NHS Long Term Plan published in January 2019 gives us the opportunity to refresh our

Sustainability and Transformation Plan with much greater involvement of local people and stakeholders than

before.

For more information visit www.eastlondonhcp.nhs.uk

http://www.eastlondonhcp.nhs.uk/


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A1(6) The key issues and risks of the CCG

The local system and its challenges are outlined in ‘Challenges – Reducing Health Inequalities’ section of this

report. However, the following risks were identified by the CCG as significant during 2018/19 and remedial

work to address the issues continues:

• Failure to ensure effective systems and processes are in place to monitor, challenge and support

Barts Health NHS Trust delivery of NHS Constitution targets and CQC action plan could result in the

increased likelihood of poor quality, poor patient experience, delivery of poor clinical outcomes and the

trust remaining in special measures in the longer term.

• The financial deficit of one of our main providers, Barts Health NHS Trust.

• Overspending in a number of acute services.

• Sustainability and resilience of General Practice in Tower Hamlets.

• The newly established Community Healthcare Services Alliance failing to deliver its targets and losing

its organisational form, thus impacting the healthcare of Tower Hamlets patients

• The possible impact of the deteriorating position of Continuing Healthcare, and the resulting increase

in financial pressures and decrease in quality and performance.

• Failure to deliver the CCGs QIPP target and 2018/19 operating plan

• The CCG’s ability to meet its statutory requirements in regards to Safeguarding and Looked After

Children

• Potential impacts to the CCG in regards to the UK’s exit from the European Union

• Lack of clarity in the development of local commissioning arrangements.

A1(7) Going concern opinion

As at 31 March 2019 the CCG had net liabilities of £63,121,000 (£54,727,000 as at 31 March 2018). The

ability of the CCG to continue as a going concern is dependent upon its ability to secure future funding from

NHSE. The budget for 2019/20 has already been agreed with NHSE. On this basis, there is no reason to

believe that sufficient funding will not be made available to the CCG in the 12 months from the date of

approval of these Financial Statements.

As such the Financial Statements in Section C have been prepared on a going concern basis.

A1(8) Performance summary

CCGs are accountable for how they spend public money and achieve good value for money for their patients.

They have a wide range of statutory duties they are required to meet.


24

NHSE assesses CCGs against the national CCG Improvement and Assessment Framework.

CCGs measure and monitor performance against a range of national and local key performance indicators

(KPIs) that measure the quality of services offered to local people.

This section summarises key performance issues, with more detailed information later in this report,

particularly in the performance analysis section (A2).

Financial performance

We are accountable for how we spend public money and achieve good value for money for people in Tower

Hamlets. This is the sixth year of the CCG’s existence and good financial control and management continues

to be vital.

We aim to improve the health and wellbeing of the people in the borough by ensuring that patients and their

carers experience the highest possible standards of health and social care. We have a commissioning budget

of around £446 million to do this work, which is allocated in the finance sections in this report.

CCG Improvement and Assessment Framework

Through a number of measures, NHSE assessed the NHS Tower Hamlets CCG’s performance in the

indicators in four domains: better health, better care, sustainability and leadership. In 2017-18 NHS Tower

Hamlets CCG were rated as outstanding.

Key successes for NHS Tower Hamlets CCG were-

The quality of diabetes care and treatment.

The number of people in Tower Hamlets with a learning disability receiving an annual health check.

The number of people in Tower Hamlets diagnosed with cancer receiving treatment in a timely way.

Provision of high quality primary care.

As a CCG, we still have a much to do to improve the quality of care and the health and well-being of people in

Tower Hamlets. The key challenges being-

Improving the patient experience in cancer and maternity services.

Improving access to psychological therapies.

Primary care performance

The quality of primary care in Tower Hamlets is good and the Care Quality Commission rated all of our

practices as good or outstanding.

All of our practices offer extended access and most people rate their experience of primary care as good.


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KPI performance

We commission a range of services from a number of providers. Our main acute hospital services provider is

the Royal London Hospital, which is part of Barts Health NHS Trust. We also commission some acute services

from other providers. Our community and mental health services provider is East London NHS Foundation

Trust.

The performance analysis section below contains detailed information on the local trusts’ performance against

the KPIs, which are also summarised here:

We are doing well in the following areas:-

People are getting diagnostic tests in a timely way.

People with suspected cancer are people seen quickly.

People with psychosis are being seen within 2 weeks.

Key areas that we need to seek improvements are as follows:-

Referral to treatment times. We need to ensure people are seen in a timely way and our not waiting

more than 18 weeks.

People are not waiting more than 4hrs in Accident and Emergency.

Better access to psychological therapies for our local population.

More detail is provided in the performance analysis section that follows.

A2. Performance analysis

A2(1) Financial performance

The financial statements contained within the report provide a summary of the CCG’s financial position and

performance for 2018/19. This section of the report talks about how we manage our money and how our

financial performance is measured.

We are accountable for how we spend public money and achieve good value for money for our patients. This

is the sixth year of the CCG, and good financial control and management is vital for the development of the

organisation.


26

Funding

In 2018/19 Tower Hamlets CCG was given funding of £446,360,000 from NHSE, which included Tower

Hamlets CCG’s brought forward surplus of £13,239,000. Within the total funding given for 2018/19, the CCG is

allowed to spend £6,504,000 on the running costs of the organisation. As at 31 March 2019 the CCG had net

liabilities of £63,121,000 (£54,727,000 as at 31 March 2018).

How we spent the money

Our budget includes:

• £199 million for hospital care and ambulance services, £151.4 million of which is spent at Barts

Health NHS Trust and a total of £10.4 million spent on ambulance services

• £52 million on community health services, £35.1 million of which is spent on Tower Hamlets

Community Health Services Contract.

• £49.1 million on mental health services, £42.7 million provided by East London Foundation Trust

• £61.3 million on primary care, £45.3 million relates to primary care co-commissioning

• £33.1 million on prescribing

• £15.9 million spent on the provision of continuing healthcare

The majority of the CCG’s spend is used to purchase services from NHS Trusts and NHS Foundation Trusts.


27

How we did

The CCG has been able to invest in schemes to develop services to patients further, particularly in the

community, to help reduce demand on our acute hospitals. Some of our key achievements are:

We achieved the Mental Health Investment Standard, which requires us to invest 4% above the

previous year’s spend year on year

Our overall investment growth in the acute sector has increased by 21% over the last 5 years to

address growth in non-elective demand and outpatient referral waiting lists

We are in the second successful year of operation of our innovative alliance partnership providing

Community Health Services

We continue to invest heavily in Continuing Health Care (i.e. for people with life-limiting illnesses) where

the growth this year has been 8% compared to last year

We work very closely with LBTH to ensure we utilise the Better Care Fund to support joint working

across health and social care, bringing the total CCG & LBTH investment to £48.6m in 2018/19.

Acute (199,079)

Mental Health (49,128)

Community (52,111)

Continuing Care (15,990)

Other Non Acute (4,537)

Prescribing (33,139)

Primary Care Co-Commissioning(45,271)

Other Primary Care (16,062)


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Financial pressures

The financial environment continues to be very demanding. Our recurrent programme baseline allocation in

2018/19 increased by £13.5 million (3.7%) and over the six years as a CCG by 14.7%. However, the

population has increased significantly over this period, placing ever greater demands on the system.

Nationally, the NHS faces increasing pressures and in Tower Hamlets we are no different. Accident and

Emergency attendances have increased by 3.8% compared to last year.

Our main acute service provider, Barts Health, of which the Royal London Hospital is the prime hospital site in

our area, has consequently seen costs of acute services rise above expectations. In the year, we have been

working closely with them to ensure we provide efficient, effective services.

As set out in the 2018/19 NHS Planning Guidance, CCGs were required to hold a 0.5% reserve uncommitted

from the start of the year, created by setting aside 0.5% of the monies that CCGs were otherwise required to

spend non-recurrently locally. Majority of this reserve was used to offset the systems risk across North East

London.

In 2018/19, to comply with the requirements to meet the Sustainability and Transformation Plan control totals

across the sector, NHS Tower Hamlets CCG has transferred £1.3 million to NHS Waltham Forest CCG as part

of the systems risk agreement across North East London.

Future years

NHS Tower Hamlets CCG’s in-year funding allocation for the financial year 2019/20 will be £455.6 million, an

increase of 5.9%. In its dual role as local NHS commissioner and key partner in local public services delivery,

our challenge is to improve the quality of services and meet the needs of our local population, while managing

demand and the changing health system so that it is much more efficient and effective. In the past three years,

we achieved sound financial positions and we maintained this in 2018/19.

The plan for 2019/20 is to deliver 1.6% QIPP efficiencies in year. Wider reforms and tight financial settlements

across the public sector will continue, although we aim to set plans to withstand the impact of constraints in

resourcing that may be applied.

A2(2) How the CCG measures and checks performance

The performance management framework

The KPIs are drawn from a range of frameworks including those contained within the CCG Improvement and

Assurance Framework (IAF).


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CCG Improvement and Assessment Framework

The CCG IAF outlines the metrics that inform NHS England’s assessment of CCGs in 2018/19.

The framework covers a total of 58 indicators located in four domains:

Better health: this section looks at how the CCG is contributing towards improving the health and

wellbeing of its population, and bending the demand curve

Better care: this principally focuses on care redesign, performance of constitutional standards, and

outcomes, including in important clinical areas

Sustainability: this section looks at how the CCG is remaining in financial balance, and is securing good

value for patients and the public from the money it spends

Leadership across the ICS: this domain assesses the quality of the CCG’s leadership, the quality of its

plans, how the CCG works with its partners, and the governance arrangements that the CCG has in place

to ensure it acts with probity, for example in managing conflicts of interest.

This year a small number of indicators have been added and a number of updates made to existing indicators,

but the aim has been to maintain a high degree of continuity from previous years. This enables comparison

over time.

Local rating

Tower Hamlets CCG was given an overall rating of ‘Outstanding’. The CCG was also rated against the six

clinical priority areas identifying the Five Year Forward View.

IAF Clinical Priority Area IAF Assessment

Better Health

Diabetes Outstanding

Better Care

Cancer Good

Dementia Requires Improvement

Learning Disability Good

Maternity Requires Improvement

Mental Health Requires Improvement

Future development of the framework

The framework needs to be flexible to maintain its relevance and alignment to the highest local priorities for

CCGs and their partners in STPs/ICSs.

https://www.england.nhs.uk/publication/ccg-improvement-and-assessment-framework-ccg-iaf-2018-19/


30

NHS England (NHSE) and NHS Improvement (NHSI) are developing with STPs/ICSs a set of principles that

will underpin oversight:

NHSE and NHSI speaking with one voice, setting consistent expectations for local health systems

greater focus on the performance of the local healthcare system as a whole, alongside the

performance of individual providers and commissioners

working with and through the STP/ICS leadership, wherever possible, to tackle problems in individual

organisations or localities, rather than making uncoordinated national interventions. This will thereby

stimulate the further growth of self-governing systems.

This will be informed by a new integrated oversight framework that will form a key part of the regular

performance discussions between NHSE, NHSI and STPs/ICSs. Alongside this, NHSE, NHSI and STPs/ICSs

will continue to review trust-level data – and CCG-level data – to help agree when individual organisations

need support or intervention and who should provide that support or intervention.

Regulators envisage that this new framework will evolve to reflect a population-based approach to improving

health outcomes and reducing health inequalities. Development of this framework will be informed by the

long-term plan for the NHS, issued in January 2019, to ensure that the ambition described for the NHS is

captured in the metrics that they use to assess and oversee CCGs and healthcare systems in the future.

Planned Care

The Minor Eye Conditions Services (MECS) was launched in February. The service is designed to offer

convenient care for minor medical eye conditions, offering appointments with 24-48 hours at locations across

Tower Hamlets. The service has seen referrals come in from GP practices and the Emergency Department at

Royal London since it opened offering patients a more convenient way to access specialist support.

Primary care performance

Tower Hamlets primary care services continues to be the best rated in London by the Care Quality

Commission (CQC). All Practices in Tower Hamlets as of March 2019 have either been rated as providing

outstanding or good quality of care. See below:

CQC Performance 2016-

2017

2017-

2018

2018-19

General Practices rated as ‘outstanding’ by CQC: 8% 8% 8%

General Practices rated as 'good' by CQC 83% 89% 92%

General Practices rated as 'requires improvement' by CQC 6% 3% 0%

General Practices rated as 'inadequate' by CQC 3% 0% 0%


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Patients experience of GP services Primary care access – percentage of

registered population offered full extended

access

77.9% of people rated their experiences as good 100% of practices in the CCG offering ‘full

provision’

Tower Hamlets GPs continue to be the best performers in London with regards to the flu vaccination

campaign. For the over 65, under 65 and at risk as well as the pregnant women cohorts, Tower Hamlets

Primary services performed the best in London for the 2018/19 campaign.

NHS Tower Hamlets CCG monitor the performance of our providers on a monthly basis through contract

meetings. The performance monitoring is key to us ensuring that our local population are receiving good

quality care in a timely way

RTT

Patients have a right to start their non-emergency NHS consultant-led treatment within a maximum of 18

weeks from referral, unless they choose to wait longer or it is clinically appropriate that they wait longer. The

national standard is that 92% of patients should start their treatment within this time.

Barts Health NHS Trust resumed national RTT reporting from Apr-18. Year-end performance was 86.88% of

people were seen within 18 weeks at Barts Health NHS Trust. Below is the % of incomplete pathways

performance for Barts Health NHS Trust in 2018-19.

NHS Tower Hamlets CCG works closely with Barts NHS Trust to support improvements in performance.

Diagnostic waiting times

The national standard for diagnostics is that less than 1% of patients should wait six weeks or more for a

diagnostic test.

Barts NHS Trust are meeting the national standard. Current performance at the time of writing the report there

were 0.8% of people were waiting over 6 weeks for their diagnostic test and 99.2% of people were seen within

6 weeks at Barts Health NHS Trust.

Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19

86.22% 87.55% 87.57% 84.98% 87.36% 87.11% 86.52% 85.89% 84.94% 83.24% 82.53% 83.45%


99.50% 99.68% 99.75% 99.46% 99.08% 99.00% 99.04% 99.24% 99.19% 98.36% 99.61% 99.23%


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A&E total waiting times

The national standard relating to A&E is that 95% of people should be seen and treated or discharged within

four hours.

In 2018-19 for Barts Health is 85.58% of people were seen, treated or discharged within four hours. At the

Royal London Hospital 84.45% of people were seen, treated or discharged within four hours. Below is the A/E

performance for Barts Health NHS Trust for 2018-19.

NHS Tower Hamlets are working closely with Barts Health NHS Trust to support and achieve delivery of the

four-hour standard through the Accident and Emergency Delivery Board and the local Tower Hamlets Urgent

Care Working Group. We are also working closely with our general practices to ensure people are seen in the

right place at the right time through extended access in general practice.

Cancer waiting times

Cancer performance is one of the eight national priorities for delivery. There are eight national cancer waiting

times standards against which performance is monitored.

Two weeks from urgent GP referral for suspected cancer to first appointment (93%)

Two weeks from referral for breast symptoms (whether cancer is suspected or not) to first appointment

(93%)

62 days from urgent GP referral for suspected cancer to first treatment (85%)

62 days from urgent referral from NHS Cancer Screening Programmes to first treatment (90%)

62 days from a consultant's decision to upgrade the urgency of a patient to first treatment (no operational

standard set)

31 days from diagnosis (decision to treat) to first treatment for all cancers (96%)

31 days from decision to treat/earliest clinically appropriate date to second/subsequent treatment (surgery

or radiotherapy) (94%)

31 days from decision to treat/earliest clinically appropriate date to second/subsequent treatment (drug

therapy) (96%)

Barts Health NHS Trust and NHS Tower Hamlets CCG were meeting all the cancer waiting standards at the

end of quarter 4 2018-19.


86.22% 87.55% 87.57% 84.98% 87.36% 87.11% 86.52% 85.89% 84.94% 83.24% 82.53% 83.45%

All Cancers

Symptomatic

breast patients 1st Treatment 2nd/sub (surgery) 2nd/sub (Chemo) 2nd/sub (RT) Urgent Referral Screening

Operational Standard 93% 93% 96% 94% 98% 94% 85% 90%

Barts Health NHS Trust 97.5% 98.8% 98.8% 100.0% 100.0% 99.3% 85.9% 94.40%

NHS Tower Hamlets CCG 97.1% 99.3% 97.5% 100.0% 100.0% 100.0% 88.4% 100.0%

2 week wait 31 day wait 62 day wait

Description


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Mixed-sex accommodation

The NHS Operating Framework for 2012-2013 confirmed that all providers of NHS funded care are expected

to eliminate mixed-sex accommodation, except where it is in the overall best interest of the patient.

Barts Health reported 231 mixed sex accommodation breaches year to date as of January 2019. The number

of mixed sex accommodation breaches at The Royal London Hospital site have remained low with the hospital

reporting 42 year to date including 3 breaches in January 2019.

Friends and family test (FFT)

The FFT measures how likely a patient would be to recommend the ward or department to their friends and

family if they needed similar care or treatment. The table below outlines the position as of the end of quarter

three 2018.

Ward/Department Area Percentage of patients who

would recommend the ward or

department to their friends and

family at Barts Health NHS

Trust

Percentage of patients

who would recommend

the ward or department

to their friends and

family at The Royal

London Hospital

In-patients 90.6 91.5

Accident and Emergency 71.9 74.2

Maternity 97.8 97.6

Incidents of Methicillin-Resistant Staphylococcus Aureus (MRSA)

MRSA is a type of bacteria that is resistant to several widely used antibiotics. This means infections with

MRSA can be harder to treat than other bacterial infections.

The full name of MRSA is methicillin-resistant Staphylococcus aureus. It is also referred to as a "superbug".

MRSA infections mainly affect people who are staying in hospital. They can be serious, but can usually be

treated with antibiotics that work against MRSA.

The target set by NHSE for all trusts is zero tolerance of cases of MRSA.

https://www.nhs.uk/conditions/antibiotics/


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The rate of MRSA assigned bacteraemia cases for Barts Health is five year to date as of January against a

zero tolerance. The rates are below that of 17-18.

On behalf of the CCG, the North East London Commissioning Support Unit Infection Control and Prevention

Team works collaboratively with Barts Health IPC team to review all trust-apportioned MRSA. Each case is

subject to root cause analysis to support learning and prevention.

Incidents of Clostridium Difficile Infections

Clostridium difficile, also known as C. difficile or C. diff, is bacteria that can infect the bowel and cause

diarrhoea. The infection most commonly affects people who have recently been treated with antibiotics. It can

spread easily to others. C. difficile infections are unpleasant and can sometimes cause serious bowel

problems, but they can usually be treated with another course of antibiotics.

Barts Health NHS Trust has a target of 81 clostridium difficile infections. Year to date, the trust has reported

44 Trust apportioned cases. This is below the threshold of 61 YTD. At this time last year, the Trust reported 73

trust-apportioned CDI cases.

On behalf of the CCG the he North East London Commissioning Support Unit Infection

Control and Prevention Team collaboratively with Barts Health Infection Prevention and Control team

to review lapses in care for clostridium difficile infections.

Incidents of venous thromboembolism (VTE)

Venous thromboembolism (VTE) is a condition in which a blood clot (thrombus) forms in a vein. It may

dislodge from its original site and travel in the blood, a process known as embolism. It needs to be identified

and treated early.

Risk assessment for VTE is a national quality requirement and 95% of all adults admitted to hospital as

inpatients need to be risk assessed according to the criteria set out in the national VTE risk assessment tool.

Providers are required to undertake root cause analysis of any cases that meet the criteria and are not risk

assessed. Audits of provision of prophylaxis are also undertaken.

The average monthly performance for Barts Health NHS Trust was 96.8% and for the Royal London Hospital,

it was 95.8%.

Mental health - Improving Access to Psychological Therapies (IAPT)

The annual target is that 15% of those with a reported prevalence for depression should have access to

talking therapies.

Mental Health Improving Access to

Psychological

Therapy

Improving Access to

Psychological

Therapy

Improving Access to

Psychological

Therapy

Improving Access to

Psychological

Therapy


35

Rolling Quarterly

Access Rate (Sep

2018) – Published

(Target = 4.48%)

Rolling Quarterly

Access Rate

(December 2018) –

Provisional

(Target = 4.61%)

IAPT Access Rate

Contractually

agreed with

Provider to be

delivered in Q4

2018/19

Access Rate (YTD) –

Provisional

(Target = 15.0%)

3.88% 3.03% 4.75% 12.5%

NHS Tower Hamlets CCG commissioned East London Foundation Trust (ELFT) to Provide IAPT in October

2018. The CCG are working with to improve the access rate and plans are in place to roll out appointments for

people with long term conditions.

Mental health - Early Intervention Psychosis

The standard is for 50% of people experiencing a first episode of psychosis to be treated with a NICE-

approved care package within two weeks of referral.

East London Foundation Trust provide early intervention psychosis. The 50% standard has been consistently

met throughout the year with on average of 95.5% of people being seen within two weeks of referral.


36

The London Ambulance Service

The London Ambulance Service (LAS) is commissioned by Brent CCG on behalf of all London CCGs. They

monitor and manage performance on our behalf.

The national standard is that 75% of calls which are life-threatening (Cat A) should be responded to within

eight minutes.

Ambulance response times

The new ambulance dataset was introduced from August 2017, focusing on four main areas:

1. Identifying the most seriously ill patients as early as possible through processes known as ‘pre-triage

sieve’ and ‘nature of call’.

2. Giving control room staff more time (up to 240 seconds) to assess incidents through a process known

as ‘dispatch on disposition’.

3. Developing new clinical code sets and response categories using the best available clinical evidence

4. Developing new targets, indicators and measures

A2(3) Other performance matters

Sustainable development

We are committed to embedding sustainability into our operations and to encourage key partners and

stakeholders to do the same. As a CCG we must ensure that the six principles of sustainability, outlined in our

Sustainability Policy, are embedded into its business decisions.

1. Commissioning

The CCG is committed to taking a whole system approach to sustainable commissioning to seek ways to reduce

costs and resources, produce health benefits and embrace sustainable procurement.

2. Waste

We continue to move towards our aim of becoming a paperless organisation by reducing the number of printers

we have and using 'follow me' printing which cuts down on unnecessary printing and wastage. We have also

issued to all staff and Governing Body members mobile devices that enable our meetings to reduce use of paper.

3. Training

The CCG is committed to the ongoing training and education of its staff so it is able to deliver its services in the

most effective and sustainable manner possible.


37

4. Energy

The CCG is committed to minimising its consumption of non-renewable energy sources and to continually

research alternative sources and technology to reduce consumption of energy across all activities. We continue to

support the widespread use of mobile devices and tablets for all staff in meetings to reduce power consumption

and paper usage with the aim of minimising the use of paper. We have also increased the use of recycled paper

and toners for printers. Our staff are encouraged to take responsibility for energy consumption and carbon

reduction within their work environment, including turning off equipment and lights when not in use. Our motion

sensitive lighting means that we do not unintentionally leave lights on overnight.

5. Transport

The CCG is aware of the environmental impacts of its transport operations and will develop a comprehensive

management plan to focus on reducing the environmental impact of transport, including unnecessary travel. Good

practice in sustainable and healthy travel choices is promoted in a number of ways. We encourage and support

staff to take up cycling and reduce driving (in turn reducing carbon emissions). Employees also have access to

two Brompton folding bicycles for work journeys.

6. Procurement

The CCG advocates that procurement managers and suppliers working with the CCG ensure that products,

services and materials it purchases are as sustainable as practical.

Emergency preparedness, resilience and response

Under the Civil Contingencies Act (2004) NHS organisations must show that they can deal with such incidents

while maintaining services to patients. This work is referred to as ‘emergency preparedness, resilience and

response’ (EPRR).

CCGs have to meet a number of EPRR core standards and NHSE is responsible for ensuring that the CCG

meets these via an annual assurance process, where a rating of compliance is issued. Following the 2018/19

process the CCG has been issued with a compliance rating of ‘substantial’.

The United Kingdom’s Exit from the European Union – Preparedness and Response

The CCG Governing Body has retained close overview of the planning and preparations for the UK leaving the

EU. The plans had particular focus on the possibility of leaving without a secure deal but also the potential

impact of the uncertainty created by EU-Exit and any possible effects in advance of the UK leaving the EU.

NHSE Issued Guidance in December 2018 to all NHS bodies and services in contract with or supplying the

NHS. Commissioner and provider action cards within the guidance summarised the minimum expected

preparations for every organisation.

The implementation of this guidance at local level was subject to regular NHSE assurance and the following

steps taken to ensure compliance and readiness: -


38

Each STP area nominated an SRO for EU-Exit to co-ordinate activities for the CCGs and main NHS

providers within and STP. The individual acted as a contact point for NHSE regional / national teams,

commissioners, providers and local authorities for data and information requests, queries and support.

The NELCA SRO hosted teleconferences between CCG emergency planners and also with local

providers to ensure all EU-Exit related activities for commissioners / providers were carried out to time

as required by NHS England / Improvement. The key domains for preparation covered were

o Operational readiness

o Communications and engagement – with Governing Bodies, key providers (including primary

care) staff and key stakeholders via local resilience forums

o Workforce

o Medicines & medicinal products

o Clinical consumables supplies

o Non clinical consumables

o Data sharing processes and access – security and continuity

o Reciprocal healthcare arrangements and health demand

o Finance

o Assurance via NHSE

Governing Bodies and Senior Executive teams were frequently updated and able to scrutinise

activities in relation to EU exit preparations

CCGs undertook review of their Business Continuity Plans and risk registers with mitigation where

necessary.

CCGs worked with their Local Resilience Forums to identify and mitigate any potential system

impacts.

Daily and weekly situation reporting was completed by the CCG via the NHS Digital Strategic Data

Collection Service.

EU-Exit preparations and contingency planning will continue into 2019/20 until such time as stood down by

NHS England.


39

Improving quality

Barts Health NHS Trust were taken out of special quality measure in 2018 following the Care Quality

Commission (CQC) inspections. We still need to work collaboratively to improve quality of care at the Royal

London Hospital. East London Foundation Trust have been rated as an outstanding provider by the CQC.

NHS Tower Hamlets Commissioning Group have a duty to ensure that our local population are receiving

services that are safe, effective and of good quality.

As a CCG, we monitor on a monthly basis the performance and quality of services at the following meetings:-

• Governing body meetings where a report is provided on performance and quality of the services we

commission. This is an opportunity for the governing body to review the performance and quality

and make decisions on any actions that need to be taken to secure improvements in an open and

transparent way.

• Quality, Activity and Performance Committee, which is a sub-committee of our governing body.

This provides an opportunity to review performance and quality in detail and escalate to our

governing body any issues that need highlighting.

• Monthly Clinical Quality Review Meetings with our main providers. These are contractual meetings

and provide an opportunity for the CCG to seek assurance on the quality of service being provided.

• Contract review meetings where performance against the NHS constitutional standards and local

key performance indicators is reviewed and monitored.

We also undertake regular visits to our providers to seek assurance that services we commission are safe,

effective and of good quality. The visits provide us with an opportunity to get feedback from patients, relatives

and carers on their experience.

For information on CCGs’ performance against a number of indicators, please visit the My NHS website which

publishes data on NHS performance. All CCGs are assessed against a number of metrics in the following

groups: better care, better health, sustainability and well-led, and each is then given an overall score. The

overall score for Tower Hamlets CCG is ‘Outstanding’.

Quality improvement in primary care

Work has started at Wellington Way which will provide modern and expanded premises for two nearby

practices, Stroudley Walk and Merchant Street. The site will open later in the year.

The EQUIP (Enabling Quality Improvement in Practice) programme, which supports practices around QI,

resilience, and team development has seen some impressive results in Quarter 1, with an upward shift in


40

Friends and Family Results for the practices that have been participating in the programme. The team also

delivered training to colleagues in Public Health and are continuing to spread QI knowledge and skills.

The new GP Contract has been released offering a 5 year deal for GPs, with a strong emphasis on developing

Primary Care Networks for populations of 30,000-50,000 people. Tower Hamlets has led the way nationally

and will be celebrating 10 years of networks in 2019. The GP contract further strengthens our networks and

we will be working with networks and the GP Care Group over coming months to understand how we make

best use of this opportunity.

Engaging people and communities

Tower Hamlets CCG puts the voice of local people at the heart of everything we do. We believe services

should be based on local need and focus on the priority issues for our community. That is why involving

patients and the wider public is central to service planning and provision, vital for service improvement and

leads to a more positive experience of care. Involving local people also gives them a greater sense of

ownership of the health services they use and their own health.

We have sought to ensure that health services are provided in a way which promotes the NHS Constitution

and are in line with our own Public and Patient Involvement Strategy. We have promoted awareness of the

NHS Constitution and our Public and Patient Involvement Strategy among patients, staff and members of the

public through our website, key meetings and other channels.

We have the core values of the NHS Constitution embedded within our own Constitution. We take great care

to engage with patients and the wider public to ensure that they have a genuine influence in how their local

services are designed and delivered. There are seven key principles and values set out in the NHS

Constitution that guide the way it operates. Principle four states that "the NHS aspires to put patients at the

heart of everything it does."

As part of this principle, we have actively encouraged feedback from the public, patients and staff and actively

use it to improve services. We also strive to include ‘seldom heard’ voices by working with the community and

voluntary sector and other key stakeholders to use existing links into communities who might struggle to

access services or navigate the health system due to a variety of complex factors. Our aim is to create a

system that provides equal access for all, regardless of background, and we recognise the value of community

leaders and organisations in helping us to achieve this aim.

We have held our providers to account regarding the standard of patient involvement that they offer by

embedding key patient experience indicators within contracts and have worked with patient groups to identify

meaningful patient experience indicators such as the Tower Hamlets Together outcome framework.

We ensure patients are able to make informed decisions regarding their care by giving them robust

information about the healthcare services available in the borough and ensuring they have choice and control

over their care. We also ensure that information about care is offered in a variety of formats and languages to

make sure everyone is able to access and understand information about their care.


41

We have commissioned services that deliver patient-centred care and support, planning for people with long-

term conditions and mental health needs who are most at risk of a hospital admission. A key feature of this is

the care planning process where the patient and clinician work in partnership to develop a plan addressing the

patient's current and future needs. This care plan is then shared across all providers involved in the patient's

care.

We have also invested heavily to support patients taking control of their health by:

keeping our member GPs informed about quality and performance standards at our local providers, so

they can have informed conversations with their patients at the point of referral

undertaking extensive engagement with patients, the public and stakeholders to inform higher

standards of co-production in the transformation of a variety of local healthcare services. This included

working with new groups of residents including the ‘working well’ and people who use the NHS less

frequently and in different ways than other population groups.

working in partnership with the Tower Hamlets Together partners to establish a system wide approach

to engagement and involvement.

developing an outcomes framework in partnership with local people and reflecting all aspects of what

local people need to live well in Tower Hamlets.

We work closely and share best practice with our neighbouring CCGs and partners on patient and public

involvement, and have done this increasingly over the past year working with the East London Health and

Care Partnership (ELHCP). We have worked with the seven CCGs in north east London to inform the public

about ELHCP and have collaborated on workshops and events designed to gather insight about how specific

services might be improved across the ELHCP footprint.

Engagement with Tower Hamlets Together – towards a system-wide approach

Over the past year, we have been embedding a whole system approach to involvement working with our

Tower Hamlets Together (THT) partners (East London Foundation Trust, Barts Health, Healthwatch, Tower

Hamlets Council for Voluntary Services, London Borough of Tower Hamlets and the GP Care Group) to

combine our efforts and create a streamlined mechanism for patients to have their say about all health

services in Tower Hamlets.

Working with THT partners in this way has also paved the way for the development of a THT wide

engagement framework, which outlines how local people will be involved in the emerging THT structures. This

is an ambitious plan whose aim is to embed patient involvement in the key decision-making structures and

gives local people a voice where it matters most in the system. It also brings all of the THT partners together

to coordinate engagement work, reduce duplication and share best practice that plays to strengths and

expertise within the THT partnership.


42

Community Commissioning Panel

2018/19 was the second year of the Community Commissioning Panel (CCP) being in place at the CCG. The

aim of our CCP is to bring a local voice to decision-making and help shape healthcare in Tower Hamlets from

a patient’s perspective. Twelve people from diverse backgrounds who live in Tower Hamlets make up the

CCP.

The CCP provides the patients’ voice and perspective on appropriate committees, focus groups and patient

panels that feed into our decision-making processes. This enables us to improve and enhance services and

identify areas for improvement. The CCP also provides challenge where appropriate to ensure the needs of

service users, patients and carers remain central to the way we work while providing support to the CCG to

maximise involvement of key community groups and individuals.

In order for the panel to influence commissioning in a meaningful way, it is integrated into our formal

governance structure and is chaired by the Patient and Public Involvement (PPI) lay member who sits on the

Governing Body. This lay member is able to champion the work and purpose of the panel to the Governing

Body and to other key stakeholders.

This year, the CCP helped shape over 15 pieces of work. Some key achievements include:

• shaping the CCG PPI evaluation and action plan and commissioning intensions 2018-19 for areas

such as urgent and primary care and reviewing the design of consultation tools such as

questionnaires;

• improving and enhancing services, for example contributing ideas around improvements to urgent and

primary care

• identifying areas for improvement, for example helping to identify how engagement plans and

materials for pain management and the promotion of different birthing options could be improved.

• providing challenge to ensure the needs of service users, patients and carers remain central to the

way we work, for example in suggesting new ways of communicating with people on the medicines

optimisation and supporting a re-design of marketing materials.

Patient stories

We have promoted the involvement of patients, their carers and representatives in decisions that relate to their

care in a variety of ways, including filmed ‘patient stories’ that focus on a specific patient’s experience of using

a health service in Tower Hamlets.

The patient stories are shared at the beginning of each Governing Body meeting and provide patient insight

into a specific service while providing suggestions for improvement or the opportunity to share best practice

and success stories both internally and externally. The videos are also available to view on the THCCG

website www.towerhamletsccg.nhs.uk/our-work/tell-us-your-story.htm

http://www.towerhamletsccg.nhs.uk/our-work/tell-us-your-story.htm


43

The patient stories are another way that the CCG ensures patients’ voices and opinions are not only heard but

are given the platform to influence change wherever possible.

NHS England Assurance Rating

In the website-based review of our Public and Patient Involvement activities, undertaken by NHS England in

Sept 2017, we achieved a Green Star Rating in July 2018, one of only two given in the London region. We are

awaiting the results of the recent assessment in March 2019. This assessment reflects the innovative

approaches we have taken to meeting our statutory duty to involve patients in all that we do.

Reducing inequalities and the health and wellbeing strategy

The local system and its challenges are outlined in ‘Challenges – Reducing Health Inequalties’ section of this

report. The CCG works closely with Tower Hamlets Council and other partners across the health, voluntary

and community sectors as part of the Tower Hamlets Health and Wellbeing Board. After seeking input from

local residents, carers, health professionals and patient groups, the Board has developed a health and

wellbeing strategy to tackle inequalities and improve health and wellbeing for everyone in the borough. Read

the strategy on the council’s website.

The Health and Wellbeing Board sits at the apex of the borough’s health and social care partnerships, and

includes senior representatives from the local authority, the CCG, Barts Health, East London Foundation Trust

(ELFT) and the local voluntary sector. As part of its work, it has been consulted on the CCG’s Annual Report

and has supported its development to ensure it accurately communicates the CCG’s and Health and Social

Care sector’s successes and challenges in 2017/18 and the CCG’s contribution to the delivery of the joint

health and wellbeing strategy.

The Tower Hamlets Health and Wellbeing Board has identified integration of health and care services as one

of its five priorities for 2019/20 and beyond. The THT system will support the Tower Hamlets Health and

Wellbeing Board with delivering against this priority, including the discharge of its duty under s.195 of the

Health & Social Care Act 2012 to encourage health and social care services to work in an integrated manner.

There is a recognition from Tower Hamlets CCG and the London Borough of Tower Hamlets that both

organisations need to work together to tackle the wider determinants of health and wellbeing. Working in

partnership will create real opportunities to learn from each other’s experiences and lessons and create a

more joined up coherent system of care for the residents of Tower Hamlets. This will improve outcomes and

service user experience, two of the key priority areas for staff and senior management. It should also drive

improvements in the quality of care and services commissioned and in turn deliver efficiencies and savings

necessary to keep the system sustainable now and in the future. Tower Hamlets is driving joint working

through the work of the Joint Commissioning Executive, which is another key component of the Tower

Hamlets Together system.

https://www.towerhamlets.gov.uk/lgnl/health__social_care/health_and_wellbeing_board/latest_news.aspx


44

Equality disclosures

The CCG works towards an Equality and Diversity strategy which provides a blueprint for creating an inclusive

environment for all staff and a framework to tackle health inequality in the way we commission services. The

key objectives are:

• establishing a robust evidence base to inform commissioning

• improving access to services

• embedding patient and stakeholder involvement in commissioning

• developing leadership capacity and competency

In support of the delivery of this strategy, the CCGs Equality and Diversity Working Group (EDWG) meets

every 6 weeks, to drive the objectives of the strategy and provide assurance to the wider organisation that the

CCG is meeting its duties under the Equalities Act 2010. The group has representatives from teams across

the CCG. The CCGs lay member for Patient and Public involvement is the Governing Body’s champion for

equality and diversity.

Equalities Work in 2018/19

Equality and Diversity is critical in ensuring we achieve our strategic objectives and commission services that

meet the needs of the patients we serve. During 2017/18, we began to strengthening links with agencies in the

borough that have supported us with our equality and diversity learning and development needs and

commissioning processes throughout 2018/19. An excellent example of this is our work with the East London

Out Project as part of a piece of work to improve protected characteristics data collection in our commissioned

services.

During 2018/19 we worked closely with our providers to ensure progression with the Workforce Race Equality

Standard (WRES), which seeks to enable employees from black and minority ethnic backgrounds (BAME) to

have equality of access to career opportunities and ensure they work in a fair and inclusive workplace. The

CCG Governing Body received assurance from Barts Health and ELFT in January 2019, who presented their

current position against the WRES and wider diversity and inclusion objectives. The trusts showcased

information on the programmes they have in place to improve work and career opportunities for BAME

colleagues including staff networks, career development and mentoring programmes that have won national

recognition opportunities to learn from role models in senior positions, including the Chief Executive of ELFT,

Navina Evans. The trusts noted progress against WRES indicators as well as highlighting the journey of

improvement they are on.

With the aim of creating an environment that is inclusive and celebrates equality and diversity, the EDWG

oversees a comprehensive programme of activities that enable this for the CCG workforce. Throughout the

year we celebrate and promote equality and diversity through a range of national campaigns including LGBT

Awareness Month, Pride, Black History Month and International Women’s Day. During Black History month


45

for example we held a session for staff to come and discuss experiences as BAME employees, within the NHS

and our organisation. The session saw a range of BAME and non-BAME colleagues coming together to share

these experiences, positive and negative, and sought to enable wider reflection and understanding. We

ensure our health related campaigns have an equality and diversity focus, for example Movember, Cervial

Screen Awareness Month and World Aids Day and we have celebratory events around key religious festivals

including Eid, Diwali and Christmas, which involve staff bringing and sharing food and coming together to learn

about each other’s cultures.

We also ensure that our approach to learning and development and staff engagement seeks to creative

equality and inclusivity at all levels. For example, our staff development session ‘Working Together’ focused

on how professionals collaborate to establish and maintain a positive workplace culture where staff both

understand and value equality and diversity, welcome the challenges it brings, as well as the opportunities it

offers to address and eliminate discrimination, bullying and harassing behaviour wherever it occurs. The

session allowed staff to discuss workplace scenarios based on the nine protected characteristics and start to

have deeper conversations with a focus on unconscious bias. At an individual level, we encourage staff to

consider and discuss their personal development with an equalities perspective, encouraging people to

undertake mentoring with people they feel act as role models to support their development needs and

promoting and supporting staff to apply for national leadership development programmes with an equality and

diversity perspective, for example the NHS Leadership Academy programme ‘Ready Now’ for BAME

employees. We run breakfast sessions to give staff the opportunity to develop relationships with and hear

from the organisation’s senior managers. An inspirational session in February 2018 focused on the career

experiences of a Black female senior manager, giving staff the time and space to consider how her story

reflects their experiences and discuss ideas about empowerment, as well as help people develop trust, feel

solidarity and see a role model.

As our Equality and Diversity Strategy runs from 2016-2020 and as we look towards working more

collaboratively with neighboring CCGs, we will assess and audit our current approach to equalities and

diversity, to seek to continue our strengths and identify areas for development when establishing new ways of

working.


46

B.1 ACCOUNTABILITY REPORT

Jane Milligan

Accountable Officer

24 May 2019


47

B1 Corporate governance report

The purpose of the corporate governance report is to explain the composition and organisation of the CCG’s

governance structures and how they support the achievement of our objectives.

B1(1) Members’ report

Full details about our governance arrangements, our committees and their responsibilities can be found in the

annual governance statement along with information about data security and associated breaches and

disclosure statements. The members report details the composition of the Governing Body, a list of our

member practices, the members of our committees and the register of interests. Unless otherwise specified,

the time period relating to the membership of all committees is for the financial year and up to the signing of

the annual report and accounts.

Member profiles

The Chair of the CCG is Sir Sam Everington, a local GP who has worked in Tower Hamlets since 1989 and is

currently based in Bromley by Bow. Our Accountable Officer is Jane Milligan, who has worked locally in the

NHS for the past 17 years in both provider and commissioner roles. Since December 2017, Jane has been the

Accountable Officer for the North East London Commissioning Alliance, the alliance of the seven CCGs

across North East London.

NHS Tower Hamlets CCG maintains local accountability via its Membership, its Governing Body and the role

of the CCG’s Managing Director. 2018/19 saw the continued progression of the CCG’s integrated approach to

commissioning across wider footprint and, in December 2018, Selina Douglas became the CCG’s Joint

Managing Director across Waltham Forest, Tower Hamlets and Newham CCGs and the first joint Managing

Director for commissioning in Inner East London. Until November 2018, the CCG Managing Director post was

held by Simon Hall.

Our website gives more details about our Governing Body, including profiles of members:

www.towerhamletsccg.nhs.uk

Member practices

Over 2018/19, the CCG's membership was made up of 35 local general practices. These member practices

are grouped together in eight commissioning networks and work in pairs to form larger localities (North West,

North East, South West and South East). Details are shown below and a full list of these practices can also be

found on the CCG website here:

http://www.towerhamletsccg.nhs.uklabout/ccg-member-practices.htm.

http://www.towerhamletsccg.nhs.uklabout/ccg-member-practices.htm


48

The CCG’s membership elects GP representatives from the Tower Hamlets primary care footprint in

accordance with our constitution. These GPs, who are allocated a locality each to represent, form the clinical

leadership of the CCG. An overview of the composition of the Governing Body and its committees, including a

full list of the Governing Body members, can be found in the Governance Statement included in this report.

Composition of Governing Body

The members are detailed below and more information about the Governing Body and its work is contained in

the Governance Statement (section B1(3) of this report).

Name Title Responsibilties

Executive Members

Jane Milligan Single Accountable Officer Single Accountable Officer –

NELCA CCGs


49

Executive Lead – East London

Health and Social Care

Partnership

Henry Black Chief Finance Officer / Joint

Chief Finance Officer

Chief Finance Officer – NELCA

Finance Lead – East London

Health and Social Care

Partnership

Senior Information Risk Owner

Simon Hall Managing Director (Until

November 2018)

Managing Director (Until

November 2018)

Selina Douglas Joint WEL Managing Director Joint WEL Managing Director

(From December 2018)

Warwick Tomsett Joint Director of Integrated

Commissioning

Commissioning & Integration

Lay Members

Noah Curthoys Lay Member for Corporate

Affairs

Audit Committee

Remuneration Committee

IFR Panel

Joint Commissioning Committee

Strategic and Finance

Investment Committee (Chair)

Julia Slay Lay Member for Public and

Patient Involvement

Patient and Public Involvement


Primary Care Co-

Commissioning Committee

(Chair)

Mariette Davis Lay Member for Governance

and Audit Chair

Audit Committee (Chair)

Conflict of Interest Guardian


50


Primary Care Co-

Commissioning Committee

Strategic and Finance

Investment Committee

Performance and Quality

Committee

Independent Clinicians

Maggie Buckell Registered Nurse Remuneration Committee

(Chair)

Children & Young People

Programme Lead

Safeguarding Children Lead

Primary Care Commissioning

Committee


CQRM (Chair)

Tan Vandal Secondary Care Doctor (Until

September 2018)

Performance and Quality

Committee (Chair)

Finance Performance and

Quality Committee

Barts Health CQRM

Audit Committee

Primary Care Commissioning

Committee


GP Network Representatives

Sam Everington Chair of Tower Hamlets CCG Chair Of CCG

Chair of Chairs (NELCA)


51


Khyati Bakhai Locality Representative (From

November 2018)

Prescribing

Rajeevi Sanjeevi Locality Representative (From

November 2018)

Safeguarding Adults

Shah Ali Locality Representative Planned Care

Victoria Tzortziou-Brown Locality Representative Principal Clinical Lead

Integrated Care Lead

Last Years of Life Lead

Research and Development

Lead

Sarit Patel Network Representative (Until

October 2018)

Children and Young People

Lead

Imrul Kayes Network Representative (Until

October 2018)

Education and Workforce

Equality and Diversity

Judith Littlejohns Network Representative (Until

October 2018)

Mental Health Lead

Adult Safeguarding

Osman Bhatti Network Representative (Until

October 2018)

Caldicott Guardian*


and Continuing Care Lead

Caldicott Guardian (*role

continued as clinical lead)

Information Technology

Lead

Isabel Hodkinson Network Representative (Until

October 2018)

Principal Clinical Lead

Prescribing

Primary Care Transformation

Practice Members


52

Virginia Patania Practice Manager

Representative

Urgent Care Lead

EQUIP Lead

Linda Aldous Practice Nurse Representative Children & Maternity

Prescribing

Local Authority Representatives

Somen Banerjee Director of Public Health Local Authority Representative

Denise Radley Corporate Director, Health,

Adults & Community

Local Authority Representative

The following members of staff are not voting members of the Governing Body but are part of the

Senior Management Team:

Name Role Responsibilities

Ellie Hobart Acting Director of

Corporate Affairs

Patient and Public Engagement

Membership Engagement

Organisation Development and Education

Corporate Governance

Archna Mathur Director of Quality and

Performance

Quality

Performance

Safeguarding

WEL Winter Director

Sandra Moore Deputy Director of Quality

and Performance

Quality

Performance

Safeguarding

Andrea Antoine Deputy Director of

Finance

Finance

Steve Collins Finance Advisor

Finance


53

Jenny Cooke Deputy Director of Primary

and Urgent Care

Primary Care

Urgent Care

Estates and GP IT

Rahima Miah Deputy Director of

Commissioning

Commissioning and Transformation

Carrie Kilpatrick Deputy Director of Mental

Health Commissioning

Mental Health

Committees and Governance Structure

Details of membership of other committees are also contained in the Governance Statement.

Register of Interests

We publish a register of members’ and senior managers’ interests on the CCG’s website. This is updated as

and when changes are notified to the CCG.

http://www.barkingdagenhamccg.nhs.uk/About-us/Our-governing-body/register-of-interests.htm


54

The register gives details of company directorships or other significant interests held by members and senior

managers where those companies are likely to do business, or are possibly seeking to do business with the

NHS, where this may conflict with their managerial responsibilities.

Personal data related incidents

The NHS Information Governance (IG) Framework sets the processes and procedures by which the NHS

handles information about patients and employees, in particular personal identifiable information. The

framework is supported by an IG 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 IG systems and processes in place to help protect

patient and corporate information. We have established an IG management framework and have implemented

IG processes and procedures in line with the IG toolkit. We ensure all staff undertake annual IG training and

have provided staff with guidance on their IG roles and responsibilities.

We use local clinical and corporate incident management and reporting tools to record and report incidents

and record all internal incidents. We notify the Department of Health and the Information Commissioner’s

Office (ICO) of serious incidents that require investigation via the national IG incident reporting tool.

During the reporting period, the CCG has had 0 serious incidents involving data loss or confidentiality

breaches that require formal reporting to the ICO.

Statement of disclosure to auditors

Each individual who is a member of the GB at the time the Members’ Report is approved confirms:

so far as the member is aware, there is no relevant audit information of which the CCG’s auditor is

unaware that would be relevant for the purposes of their audit report

the member has taken all the steps that they ought to have taken in order to make him or herself aware of

any relevant audit information and to establish that the CCG’s auditor is aware of it.

Modern Slavery Act

NHS Tower Hamlets CCG fully supports the Government’s objectives to eradicate modern slavery and human

trafficking but does not meet the requirements for producing an annual Slavery and Human Trafficking

Statement as set out in the Modern Slavery Act 2015.


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B1(2) Statement of Accountable Officer’s Responsibilities

The National Health Service Act 2006 (as amended) (the NHS Act 2006) states that each Clinical

Commissioning Group (CCG) shall have an Accountable Officer and that Officer shall be appointed by the

NHS Commissioning Board (NHS England). NHS England has appointed Jane Milligan to be the Accountable

Officer of Tower Hamlets CCG.

The responsibilities of an Accountable Officer are set out under the NHS Act 2006, Managing Public Money

and in the Clinical Commissioning Group Accountable Officer Appointment Letter. They include

responsibilities for:

The propriety and regularity of the public finances for which the Accountable Officer is answerable;

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);

Safeguarding the CCG’s assets (and hence for taking reasonable steps for the prevention and

detection of fraud and other irregularities);

The relevant responsibilities of accounting officers under Managing Public Money,

Ensuring the CCG exercises its functions effectively, efficiently and economically (in accordance with

Section 14Q of the NHS Act 2006) and with a view to securing continuous improvement in the quality

of services (in accordance with Section14R of the NHS Act 2006),

Ensuring that the CCG complies with its financial duties under Sections 223H to 223J of the NHS Act

2006.

Under the NHS Act 2006 (as amended), NHS England has directed each CCG to prepare for each financial

year a statement of accounts in the form and on the basis set out in the Accounts Direction. The accounts 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

income and expenditure, Statement of Financial Position and cash flows for the financial year.

In preparing the accounts, the Accountable Officer is required to comply with the requirements of the

Government Financial Reporting Manual 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 Government Financial Reporting

Manual have been followed, and disclose and explain any material departures in the accounts;

and,

Confirm that the Annual Report and Accounts as a whole is fair, balanced and understandable

and take personal responsibility for the Annual Report and Accounts and the judgements required

for determining that it is fair, balanced and understandable.


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To the best of my knowledge and belief, I have properly discharged the responsibilities set out under the

National Health Service Act 2006 (as amended), Managing Public Money and in my Clinical Commissioning

Group Accountable Officer Appointment Letter.

I also confirm that:

as far as I am aware, there is no relevant audit information of which the CCG’s auditors are unaware, and that

as Accountable Officer, I have taken all the steps that I ought to have taken to make myself aware of any

relevant audit information and to establish that the CCG’s auditors are aware of that information.

B1(3) Governance Statement

Introduction and context

NHS Tower Hamlets CCG is a body corporate established by NHS England on 1 April 2013 under the National

Health Service Act 2006 (as amended).

The CCG’s statutory functions are set out under the National Health Service Act 2006 (as amended). The

CCG’s general function is arranging the provision of services for persons for the purposes of the health service

in England. The CCG is, in particular, required to arrange for the provision of certain health services to such

extent as it considers necessary to meet the reasonable requirements of its local population.

As at 1 April 2018, the CCG is not subject to any directions from NHS England issued under Section 14Z21 of

the National Health Service Act 2006.

Scope of responsibility

As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports

the achievement of the clinical commissioning group’s policies, aims and objectives, whilst safeguarding the

public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned

to me in Managing Public Money. I also acknowledge my responsibilities as set out under the National Health

Service Act 2006 (as amended) and in my Clinical Commissioning Group Accountable Officer Appointment

Letter.

I am responsible for ensuring that the clinical commissioning group is administered prudently and

economically and that resources are applied efficiently and effectively, safeguarding financial propriety and

regularity. I also have responsibility for reviewing the effectiveness of the system of internal control within the

clinical commissioning group as set out in this governance statement.

Governance arrangements and effectiveness

The main function of the governing body is to ensure that the group has made appropriate arrangements for

ensuring that it exercises its functions effectively, efficiently and economically and complies with such

generally accepted principles of good governance as are relevant to it.


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The overarching governance arrangements are set out in the Constitution which includes the CCG

Governance Structure, Standing Orders, Prime Financial Policies and the Scheme of Reservation and

Delegation. The CCG has delegated to the Governing Body decision making and responsibility for the delivery

of all its duties with the exception of decisions to:

• Determine the arrangements by which the members of the group approve those decisions that are

reserved for the membership.

• Consider and approve applications to NHS England on any matter concerning changes to the group's

constitution, including terms of reference for the group's Governing Body and its committees,

• membership of committees, the overarching scheme of reservation and delegated powers,

arrangements for taking urgent decisions, standing orders and prime financial policies.

• Approve of the group's overarching scheme of reservation and delegation.

• Approve the arrangements for identifying practice members to represent practices in matters

concerning the work of the group, and

• Appoint clinical leaders to represent the group's membership on the group's Governing Body, for

example through election (if desired).

• Approve the appointment of Governing Body members, the process for recruiting and removing non-

elected members to the Governing Body (subject to any regulatory requirements) and succession

planning.

• Approve arrangements for identifying the group's proposed Accountable Officer.

The Governing Body has supplemented the governance framework by the formal adoption of the Nolan

Principles on Standards in Public Life, the Code of Conduct and Accountability for NHS Boards, the CCG

Code of Conduct, Standards of Business Conduct Policy, Gifts and Hospitality Policy, Anti-Bribery Policy, and

a Conflicts of Interest Policy.

Using the NHS England guidance "The Functions of Clinical Commissioning Groups" and published legal

guidance, the CCG has reviewed its statutory duties and is satisfied that it has in place all the necessary

complete and lawful arrangements to ensure the proper discharge of those functions.

To undertake and ensure the systematic discharge of its functions and duties, the membership established a

Governing Body and complementary sub committees. Details of their roles are set out in the following

sections.

The CCG Constitution

Our Constitution sets out the principles and processes that the organisation will adhere to in delivering its role

and functions. It describes how the Governing Body will operate, confirms matters reserved for Governing

Body decision, and other areas where certain powers will be delegated within the organisation. It sets out our


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key processes for decision making, including arrangements for securing transparency in the decision making

of the CCG and the Governing Body, and the arrangements for discharging its duties with regard to registers

of interest and managing conflicts of interest. We review these arrangements each year to ensure they remain

fit for purpose, enabling us to do everything within our power to support the commissioning of the best

possible NHS services for the residents of Tower Hamlets.

Our governance structure was created to ensure that clinicians and patients remain at the heart of decision

making, whilst delivering on the CCG's corporate objectives. We oversaw a number of internal governance

changes, where the Governing Body voted to delegate authority to new committees, and reorganise the

CCG’s Governance structure to better correspond with local partner structures and provide clarity and focus

for two areas of high risk to the CCG’s Corporate Objectives; quality and finance. The resulting structure saw

the establishment of the North East London Commissioning Alliance Joint Commissioning Committee.

In addition, we recognised that our Governing Body needed to continue to be resilient and robust in regards to

local leadership and supporting the wider health economy. In order to support these developments, the CCG

adjusted of the composition of the Governing Body, reducing 8 network representatives to 4, with GP

representatives elected on a borough wide basis and then allocated a lead locality. This limits duplication of

effort between CCG and the local GP Federation, reduces number of meetings and frees up experienced

clinical leadership capacity to support local transformation. The minimum of GP partners on the Governing

Body has been reduced from 5 to 3, and the number of salaried GPs has been reduced from 2 to 1. The Chair

of the CCG remains a GP and is an additional Governing Body member to the locality representatives. Clinical

leadership and majority on CCG Governing Body has been maintained throughout these changes and has

released valued resource in to other areas of the Tower Hamlets healthcare system.

The CCG also applied for and was granted the following constitutional changes:

Addition of the ability to hold ‘Committees in Common’ with other CCGs. This supports the development of

local governance arrangements and allows for a joint approach when it is recognised by the CCG

Governing Bodies that it is beneficial to do so.

Delegation of responsibility for education is now given to the Community Education Provider Network

(CEPN). This ensures that there is a localised and provider-led model for the planning and delivery of

education and training for the health and social care workforce within the community.

Adjustment of maximum term of office from 6 to 9 years for Governing Body Members. This is to ensure

stability of leadership at the CCG during a time of change and aligns the terms of office with best

governance practice.

Addition of new protocols for Membership engagement, where a joint forum (Primary Care Forum) in

partnership with the local GP Federation will be the main avenue for membership engagement. Conditions

in which decisions pertaining to the constitution or where courses of action can be agreed are outlined.

This minimises the risk of duplication in Tower Hamlets Healthcare system meetings and frees up


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experienced clinical leadership capacity to support transformation at local level. It will enable greater focus

on the delivery of integrated care at a locality level by combining provider and commissioning discussions.

These changes were reflected in our constitution after Membership Approval and submission to NHS England

in April 2018. Our submission met NHS England standards for applying for constitutional changes as per NHS

England Guidelines published here:

https://www.england.nhs.uk/publication/procedures-for-clinical-commissioning-groups-to-apply-for-constitution-

change-merger-or-dissolution/

Highlights of the Work of the Governing Body Committees

The roles of each of the Governing Body committees are set out below. The committees have authority under

the scheme of delegation to establish sub-committees or sub-groups to enable them to fulfil their role.

Each of the Governing Body committees has terms of reference and is authorised by the Governing Body to

pursue any activity within them and within the Scheme of Reservation and Delegation of Powers. The

Schemes of Delegation of each Governing Body committee are referenced within the CCG Constitution and

are available on the CCG website: www.towerhamletsccg.nhs.uk.

During 2018/19 the Governing Body met on six occasions in public. Business items for each meeting were

recorded on an annual planner and the meeting agendas were structured to address key matters of

performance, operations, commissioning and strategy. The main areas of focus for the Governing Body

throughout year were:

Community Health Services Alliance development

Developing local sustainable system transformation

North East London Sustainability and Transformation Plan

London Health Care Devolution

WEL System Transformation

The quality of service providers including Care Quality Commission (CQC) findings

Re-procurement of Urgent and Emergency Care Services (111)

Establishment of governance arrangements to support new ways of working, both borough-led and

North East London-led

Establishment and appointment of key leadership roles such as the Managing Director and Joint Chief

Finance Officer

WRES and Quality Statements from key providers

Presentations from local providers such as the GP Care Group, Accelerate CIC, Barts Health and the

East London Foundation Trust

https://www.england.nhs.uk/publication/procedures-for-clinical-commissioning-groups-to-apply-for-constitution-change-merger-or-dissolution/

https://www.england.nhs.uk/publication/procedures-for-clinical-commissioning-groups-to-apply-for-constitution-change-merger-or-dissolution/

http://www.towerhamletsccg.nhs.uk/


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Local winter planning and A&E Recovery

Agreement of the Better Care Fund Initiative

Strategic Finance Management

Constitution Adjustments

Governing Body

22.05.2018 Sam Everington, Simon Hall, Jane Milligan, Henry Black, Mariette Davis, Isabel

Hodkinson, Judith Littlejohns, Victoria Tzortziou-Brown, Tan Vandal, Noah Curthoys,

Linda Aldous, Maggie Buckell, Julia Slay, Somen Banerjee, Osman Bhatti, Shah Ali,

Virginia Patania, Archna Mathur, Denise Radley, Ellie Hobart, Alison Blair, Steve

Collins.

24.07.2018 Sam Everington, Simon Hall, Jane Milligan, Henry Black, Mariette Davis, Isabel

Hodkinson, Judith Littlejohns, Victoria Tzortziou-Brown, Noah Curthoys, Linda

Aldous, Maggie Buckell, Julia Slay, Warwick Tomsett, Somen Banerjee, Osman

Bhatti, Virginia Patania, Archna Mathur, Ellie Hobart, Steve Collins.

25.09.2018 Sam Everington, Simon Hall, Jane Milligan, Mariette Davis, Victoria Tzortziou-Brown,

Linda Aldous, Maggie Buckell, Julia Slay, Warwick Tomsett, Virginia Patania, Archna

Mathur, Ellie Hobart, Steve Collins

27.11.2018 Sam Everington, Simon Hall, Jane Milligan, Henry Black, Mariette Davis, Victoria

Tzortziou-Brown, Linda Aldous, Maggie Buckell, Julia Slay, Warwick Tomsett,

Virginia Patania, Archna Mathur, Noah Curthoys, Shah Ali, Rajivi Sanjeevi, Khyati

Bakhai, Ellie Hobart, Ellie Hobart, Steve Collins, Jenny Cooke.

22.01.2019 Sam Everington, Selina Douglas, Jane Milligan, Henry Black, Mariette Davis, Victoria

Tzortziou-Brown, Linda Aldous, Maggie Buckell, Julia Slay, Warwick Tomsett,

Virginia Patania, Archna Mathur, Noah Curthoys, Shah Ali, Rajivi Sanjeevi, Khyati

Bakhai, Somen Banerjee, Ellie Hobart, Steve Collins, Sandra Moore

26.03.2019 Sam Everington, Selina Douglas, Henry Black, Mariette Davis, Victoria Tzortziou-

Brown, Linda Aldous, Maggie Buckell, Julia Slay, Virginia Patania, Noah Curthoys,

Shah Ali, Rajivi Sanjeevi, Somen Banerjee, Ellie Hobart, Steve Collins, Sandra

Moore.


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The Audit Committee

The Audit Committee is a statutorily mandated committee of the CCG, established in accordance with the

CCG Constitution. Its role is to seek assurance that financial reporting and internal control principles are

applied, and to maintain an appropriate relationship with the organisation's auditors, both internal and

external.

The Audit Committee offers scrutiny of and advice to, the Governing Body about the reliability and

robustness of the CCG's processes of internal control.

The Audit Committee (under its terms of reference) provides an annual report of its work to the Governing

Body. The Committee met six times during the period and was quorate at each meeting. The third member

to the Audit Committee was not recruited to as the Committee moved towards meeting in common with

other WEL CCGs. The committee's cycle of business enables it to carry out the key objectives necessary

to support its assurances regarding the effectiveness of the organisation's internal controls. The

committee's key areas of focus during the year included:

• Review of emerging governance arrangements for new organisational structure with formation of

North East London Commissioning Alliance and East London Healthcare Partnership

• Assurance from CCG managers regarding Continuing Healthcare

• Assurance from NELCA directors regarding CSU-inhousing and NELCA developments

• Review of CCG arrangements in regards to Business Continuity Planning and the UKs Exit from

the European Union

• Risk management and the Board Assurance Framework

• Assurance on current governance arrangements

• The management of conflicts of interest

• Financial risks and waivers of standing orders

• Amendments to the Constitution

• Internal audit reports

• Reports from counter fraud specialists

• Year-end financial statements and annual governance statement

• Liaison with internal and external auditors

• Review of internal control system through internal audit

The Audit Committee met 6 times during 2018/19:

Audit Committee

08.05.2018 Mariette Davis, Noah Curthoys


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Audit Committees Meeting in Common

2018/19 also saw the first Audit Committees meeting in common between Waltham Forest and Tower Hamlets

CCGs, with Newham to joining the Committees meeting in common later in April 2019.

Meeting in common has allowed useful discussion, contrast and comparison to take place whilst ensuring

each CCG continues to meet it statutory functions and legal requirements. The Audit Committees meeting in

common have supported the extensive governance PMO work programme which is reviewing areas of

commonality across the WEL CCGs and best practice, with the view that it will eventually form the basis of

future joint working across WEL.

The Remuneration Committee

The Remuneration Committee is a statutorily mandated committee of the CCG, established in

accordance with the CCG Constitution. Its aim is to set and review the salaries and pensions for Very

Senior Managers (VSM), which presently are the Accountable Officer, Managing Director and Joint

Director of Commissioning and Chief Finance Officer.

In addition, the committee oversees the remuneration of any member of the CCG not covered by national

agreed pay scales.

The Remuneration Committee met twice in 2018/19.


26th June 2018 Maggie Buckell, Mariette Davis, Noah Curthoys, Jane Milligan

20th March 2019 Maggie Buckell, Noah Curthoys, Julia Slay, Steve Collins, Sam Everington

Remuneration Committees Meeting in Common

2018/19 also saw the continuation of Remuneration Committees meeting in common between NEL CCGs and

Newham, Waltham Forest and Tower Hamlets CCGs. Meeting in common across NEL and WEL has allowed

for useful discussion, mutual agreement and robust scrutiny of joint or shared VSM appointments and their

associated remuneration.


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The Performance, Activity and Quality Committee

The Performance, Activity and Quality Committee monitors the CCG's performance and quality of providers

commissioned by the CCG. Safeguarding activity is monitored through the safeguarding subcommittee which

reports to and provides advice to the Performance, Activity and Quality Committee.

The Performance, Activity and Quality Committee was established during 2017/18 along with the Strategic

Finance and Investment Committee as a result of the internal governance changes that were implemented in

order to provide more focus on performance and quality and better support the development of partnership

working.

The Performance, Activity and Quality Committee met 8 times during 2018/19.

Performance and Quality Committee

25.04.2018 Mariette Davis, Simon Hall, Sandra Moore

23.05.2018 Mariette Davis, Simon Hall, Sandra Moore, Andrea Antoine, Warwick Tomsett,

27.06.2018 Mariette Davis, Simon Hall, Carrie Kilpatrick, Sandra Moore, Andrea Antoine,

Warwick Tomsett

25.07.2018 Sandra Moore, Mariette Davis

26.09.2018 Mariette Davis, Sandra Moore

31.10.2018 Sandra Moore, Mariette Davis, Andrea Antoine

28.11.2018 Sandra Moore, Mariette Davis

27.02.2019 Sandra Moore, Mariette Davis, Andrea Antoine

Executive Committee

The Executive Committee is made up of the CCG senior management team, and the Governing Body Chair,

Vice-Chair and principal clinical leads and is a committee that holds key management oversight of many areas

of CCG Business. The committee's duties include key strategic and clinical management of the CCG,

management of financial performance against plans, promote the development, partnership and resilience of

healthcare and social care providers and partners and provide clinical and organisation scrutiny of business

cases, strategies and all other commissioning decisions where necessary. During 2018/19, the Committee

focused on work areas such as:

• Governing Body advice and agenda setting

• Strategic and System Development

• Local healthcare strategy development


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• Equality and Diversity including Work Race Equality Standards (WRES) and promotion of strategy

• Emergency Preparedness, Resilience and Response

• General Practice Resilience

• Policy setting and agreement

• Winter Planning

• Local and system governance and risk management

The Executive Committee met six times during 2018/19.

Executive Committee

24.04.2018 Simon Hall, Archna Mathur, Sam Everington, Jenny Cooke, Alison Blair, Steve

Collins

19.06.2018 Simon Hall, Archna Mathur, Sam Everington, Jenny Cooke, Steve Collins, Ellie

Hobart, Isabel Hodkinson.

07.08.2018 Simon Hall, Archna Mathur, Sam Everington, Jenny Cooke, Steve Collins, Ellie

Hobart, Isabel Hodkinson, Warwick Tomsett

18.10.2018 Simon Hall, Sam Everington, Steve Collins, Ellie Hobart, Isabel Hodkinson,

Sandra Moore.

15.01.2019 Selina Douglas, Sam Everington, Steve Collins, Ellie Hobart, Isabel Hodkinson,

Sandra Moore, Victoria Tzortziou Brown, Jenny Cooke, Osman Bhatti.

19.02.2019 Ellie Hobart, Isabel Hodkinson, Victoria Tzortziou Brown, Jenny Cooke, Osman

Bhatti

Primary Care Commissioning Committee

Delegated commissioning arrangements took effect from April1 2015. Tower Hamlets CCG established a

Primary Care Commissioning Committee as a Committee of the Governing Body with responsibility for

delegated commissioning arrangements. The Committee is quorate with three of the seven voting members

in attendance, with at least one Lay member present. Non-voting GP observers are excluded from Committee

discussions and decisions regarding topics where they have a conflict of interest. The Primary Care

Commissioning Committee is made up of the following roles:

Voting members: Lay Member for PPI (Chair), Governing Body Nurse (Vice Chair) , Lay member for

Governance, Governing Body Secondary Care Consultant, CCG Chief Finance Officer, Independent

Clinical Adviser, CCG Accountable Officer.

Non-voting members: Health and Wellbeing Board representative, Public Health representative, Healthwatch


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representative, LMC representative, two additional CCG GP representatives, NHS England representative.

The functions delegated by NHS England, and upon which the Committee makes decisions include:

decisions in relation to Enhanced Services,

decisions in relation to Local Incentive Schemes (including the design of such schemes),

decisions in relation to the establishment of new GP practices (including branch surgeries)

and closure of GP practices,

decisions about 'discretionary' payments,

decisions about commissioning urgent care (including home visits as required) for out of

area registered patients,

the approval of practice mergers,

planning primary medical care services in the Area, including carrying out needs

assessments,

undertaking reviews of primary medical care services in the Area,

decisions in relation to the management of poorly performing GP practices and including,

without limitation, decisions and liaison with the CQC where the CQC has reported non

compliance with standards (but excluding any decisions in relation to the performers list),

management of the Delegated Funds in the Area

Premises Costs Directions Functions,

coordinating a common approach to the commissioning of primary care services with other

commissioners in the Area where appropriate,

• Other ancillary activities that are necessary in order to exercise the Delegated Functions.

The Committee met on six occasions during the year with attendance at follows.

Primary Care Commissioning Committee Attendance

11.04.2018 Julia Slay, Maggie Buckell, Mariette Davis, Tan Vandal, Steve Collins, Virginia

Patania, Jenny Cooke

11.07.2018 Julia Slay, Maggie Buckell, Mariette Davis, Steve Collins, Virginia Patania,

Jenny Cooke, Simon Hall

12.09.2018 Julia Slay, Maggie Buckell, Mariette Davis, Simon Hall, Steve Collins, Jenny

Cooke,

14.11.2018 Julia Slay, Mariette Davis, Virginia Patania, Jenny Cooke

16.01.2019 Maggie Buckell, Selina Douglas, Virginia Patania, Jenny Cooke


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13.02.2019 Julia Slay, Mariette Davis, Jenny Cooke, Virginia Patania,

The Strategic Finance and Investment Committee

The Strategic Finance and Investment Committee oversees the planning and strategic direction of the CCG,

with the delegated authority to approve medium-term financial plans (3 to 5 years), and from it the annual

operating plans for each year to ensure the organisation is making financial decisions that support the strategic

direction of care and ensure plans are affordable, sustainable and enable statutory duties and business planning

rules to be met. SFIC is the committee that provides recommendations to the Governing Body, on an annual

basis, that the commissioning intentions are affordable and approve requests for new in-year investments and

confirming funding source. Additionally, SFIC is the CCG vehicle to oversee the CCG process for managing

clinical procurement activity, with the Procurement Working Group reporting into SFIC on a monthly basis. The

Strategic Finance and Investment Committee was established during 2017/18 as a result of the internal

governance changes that were implemented in order to better support the development of partnership working.

The monitoring of finance was previously conducted by the Finance, Performance and Quality Committee which

was stepped down in 2017.

The procurement working group oversees the detailed supervision of procurements and provides a clear

audit trail for the Strategic Finance and Investment Committee.

Key areas of review included:

• Quality, Innovation, Productivity and Prevention Management

• Commissioning Proposals

• Medium/Long Term Strategic analytic Output

• Commissioning Intentions

• Contract Variation Process 2019/20

• Procurement decisions and awards

• Transformation programmes

• Operating plan 18/19

• Long term financial planning

Strategic Finance and Investment Committee

21.03.2018 Sam Everington, Simon Hall, Isabel Hodkinson, Steve Collins Mariette Davis, Andrea Antoine, Victoria Tzortziou Brown

20.04.2018 Andrea Antoine, Steve Collins, Jenny Cooke


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16.05.2018 Noah Curthoys, Steve Collins, Andrea Antoine

20.06.2018 Noah Curthoys, Mariette Davis, Andrea Antoine, Steve Collins, Warwick Tomsett

18.07.2018 Noah Curthoys, Andrea Antoine, Steve Collins, Warwick Tomsett

22.08.2018 Andrea Antoine, Sandra Moore, Elliot Hobart

19.09.2018 Noah Curthoys, Mariette Davis, Simon Hall, Victoria Tzortziou Brown, Andrea Antoine, Warwick Tomsett Steve Collins

17.10.2018 Victoria Tzortziou Brown, Mariette Davis, Steve Collins

21.11.2019 Noah Curthoys, Mariette Davis, Victoria Tzortziou Brown, Steve Collins, Warwick Tomsett, Andrea Antoine.

19.12.2018 Noah Curthoys, Steve Collins, Andrea Antoine, Carrie Kilpatrick, Rahima Miah, Jenny Cooke

30.01.2019 Noah Curthoys, Mariette Davis, Warwick Tomsett, Andrea Antoine, Steve Collins

27.02.2019 Noah Curthoys, Mariette Davis, Warwick Tomsett, Steve Collins

19.03.2019 Noah Curthoys, Mariette Davis, Steve Collins, Andrea Antoine

Locality Board

The Locality Board was established to provide a formal platform for two-way dialogue between CCG constituent

practices and the governing body. It has a key role in ensuring the CCG develops and maintains effective two-way

engagement between the governing body members and member practices. The Locality Board also ensures that

feedback from localities is used to support decision making in developing health services for Tower Hamlets.

Individual Funding Request (IFR) Panel

The Individual Funding Request panel oversees cases where an individual funding request can be made by a

clinician treating a patient if they believe that there are clinical circumstances that are exceptional and the patient

would benefit from a treatment or service that isn’t routinely offered by the NHS. The management of Individual

Funding Requests for Tower Hamlets CCG, Waltham Forest and Newham CCGs has been outsourced to the

North East London Commissioning Support Unit, and our Governing Body Lay Member for Corporate Affairs,

Noah Curthoys, is a member and our CCG representative.

The responsibility of the IFR panel and appeal panels includes:


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To uphold and work within the legal context to decision making, Consider and determine eligible IFRs

where the clinical commissioning group is the responsible commissioner of NHS care, according to

the principles set out in the CCG's IFR policy, and in the IFR panel and appeal panel terms of

reference

Refer to the relevant CCG adopted clinical policies to determine whether a patient who does not meet

the criteria in the policy can be considered to be exceptional taking the information provided within

the application into account

The appeal panel will review applications where the applicant appeals the decision making process

of the IFR panel and does not provide any new information for consideration.

IFR panel and appeal panel Chair

The chair is responsible for ensuring that:

• Reasonable effort has been made to acquire adequate data and intelligence to inform the decision

• All material factors have been taken into account and that immaterial factors have been appropriately

handled

• The rationale for the decision has been explicitly recorded, against the terms of this policy, and that

the conflicting arguments have been managed

• They are available to approve the minutes and letters within the specified time frame following IFR

panel meetings and to ensure that decisions made are correctly reflected

• The IFR panel meetings are quorate in line with the Terms of Reference.

• The Chair is accountable to their CCG Governing Body for the delivery of this role.

Governance Developments in North East London

Our 2017/18 Annual Report introduced the new approaches in which the NHS in North East London proposed

to address the significant challenges of providing care for a growing population and continuing to meet the

health needs of some of the most deprived areas in the UK. In order to achieve quality services for our

patients, Tower Hamlets CCG and its partners and colleagues in the local health and social care system have

come to together and recognised a greater need for partnership working to address the pressures in the health

and social care system and achieve the aims of the NHS Long Term plan and the Sustainability and

Transformation Plan.

North East London CCG Governance Developments – The North East London Commissioning Alliance

(NELCA) and Waltham Forest and East London (WEL)

In order to facilitate the success of these changes and continue the quality provision of care to patients both

locally and at a system level, governance arrangements to support partnership working was an area of focus

for the CCG in 2018/19. Work has continued to develop across local footprints in North East London to


69

establish these new arrangements, namely closer working with our CCG colleagues in Waltham Forest and

Newham and the North East London Commissioning Alliance, made of the 7 CCGs in North East London.

CCGs in North East London Commissioning Alliance (NELCA) acknowledged that in order to support much

needed developments, adjustments to both local and system governance would need to take place in order to

enhance the ability for CCGs to work in partnership with each other for the benefit of local patients, promote

an aligned commissioning strategy to support long term viability of local acute providers, promote a clear and

constructive commissioning system and work with Local Authority Partners to provide a truly integrated service

for patients.

These key developments included:

Recruitment and appointment of Joint Chief Finance Officer for Tower Hamlets CCG, Waltham

Forest CCG, Newham CCG, Barking, Havering and Redbridge CCGs and City and Hackney

CCGs.

Recruitment of a Managing Director for Waltham Forest, Tower Hamlets and Newham CCGs

(called the Joint WEL Managing Director)

Recruitment of senior executives at NELCA to lead on areas such as Transformation

First Audit Committees Meeting in Common held between Tower Hamlets CCG and Waltham

Forest CCG

Respective NEL CCG Governing Bodies felt that undertaking certain functions once across the NEL CCGs

would release valuable time and resource within the North East London health economy, in turn allowing

added focus for the local, borough based integrated care systems. It was also agreed that establishing these

governance systems would promote working together across larger footprints and reduce duplicity in work

streams.

The Tower Hamlets Governing Body recognised that the appointment of a joint Managing Director, with the

appropriate governance in place, would provide stable leadership across a wider geographical location,

support collaboration between CCGs and would further enable essential transformation resources to be

transferred to WEL and NEL. The Tower Hamlets CCG Governing Body also felt that it would provide an

opportunity to more effectively manage the complex issues faced by local providers that could impact on the

quality of services and equality of care being delivered in Tower Hamlets and across North East London. The

Tower Hamlets CCG Governing Body therefore approved the recruitment of a Joint WEL Managing Director,

with Selina Douglas (previously Newham CCG’s Managing Director) being successfully recruited to the role in

November 2018.

The Joint NELCA Commissioning Committee was established, with combined membership of NEL CCGs and

Lay Members to drive areas which will be approached at NEL level such as:

• the commissioning of specialist services


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• the strategic development of primary care

• the commissioning of services common to all such London Ambulance Service (LAS) and services

outside the scope of the ACSs

• the agreement of acute services strategy including the approaches to payment

• workforce development

• development of the framework for commissioning of local ACSs

• first line of communication for NHSE on critical areas of system performance and change and the

delivery of the Five Year Forward View (FYFV)

• Committees in Common for functions where CCGs wish to collaborate at a system level.

Whilst many of the governance arrangements are currently in their infancy or working in shadow form, it is a

significant step towards working together across North East London to meet the needs of current and future

patients in a sustainable way and close the gaps in health, finance and quality of care.

With these changes in motion, it was also recognised that local accountability and the achievement of local

CCG objectives would still need to be maintained and supported in order to ensure the development and

delivery of each local integrated care system, which in Tower Hamlets is Tower Hamlets Together. More

information on Tower Hamlets Together is available in the ‘Working With Our Partners’ Section.

Governance Management at Tower Hamlets Clinical Commissioning Group

UK Code of Corporate Governance

Whilst the detailed provisions of the UK Corporate Governance Code are not mandatory for public sector

bodies, compliance is considered to be good practice. This Governance Statement is intended to demonstrate

the CCG’s compliance with the principles set out in the Code (insofar as this applies to CCGs).

For the financial year ended 31 March 2019, and up to the date of signing this statement, we complied with the

provisions set out in the Code, and applied the principles of the Code.

Discharge of statutory functions

In light of recommendations of the 2013 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 legislative

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.


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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 the CCG’s statutory

duties.

Risk management arrangements and effectiveness

The CCG uses a fully embedded comprehensive risk management framework which has been designed to

identify strategic and operational risks, responsibilities, and mitigating actions at directorate and system levels.

Risks are identified in a number of ways, including proactive risk assessments, performance reports, service

alerts, incident reports, complaints, audit and regulator reports and activity and financial forecasts. The CCG

identifies categories for its risks against the CCG’s strategic objectives which are outlined in the performance

section of this report. The CCG Governing Body does not willingly accept risks that significantly impact on our

ability to deliver against our strategic, corporate, principal or business objectives but we recognise that risks

are influenced by both internal and external factors and that the degree of their control and assurances will

vary upon the level of stakeholder influence.

The Senior Management Team and Governing Body have a responsibility for identifying and managing risks to

the organisations key strategic objectives. Additionally, individual teams are accountable for managing

operational risks associated with their areas of responsibility. Each Senior Manager is responsible for ensuring

that the Board Assurance Framework reflects key risks, controls and assurances related to strategic

objectives, and that these are reviewed regularly.

Through CCG Committees, Governing Body and committee reports, the Senior Management Team and the

Corporate and Team Risk Registers, high level risks are escalated to the Governing Body using the Board

Assurance Framework as the reporting tool to outline the controls, mitigations, appetite and actions.

Each Board Assurance Framework risk identified is assigned a Lead Committee, Governing Body Lead and

Management Lead. The risk, its mitigations and its gaps are discussed in the lead committee in order to

provide assurance to the Governing Body that the risk has appropriate controls in place and that objectives

are pursued within the CCG’s predetermined risk parameters. Horizon scanning also takes place at committee

level, as well as at Governing Body meetings and OD sessions, and deep dives are requested by the Audit

Committee for areas which appear to be challenged or require additional oversight and scrutiny.

The Board Assurance Framework and the supporting establishment and maintenance of the CCG’s system of

integrated governance, risk management and internal controls are reviewed by the Audit Committee ensure

the achievement of the CCG's strategic and operational objectives.

Capacity to handle risk

There is a Governing Body and management commitment to effective risk management across the CCG. The

Governing Body reviews its risk appetite at least on an annual basis and more (especially during times of

increased uncertainty or adverse changes). The periodic review and arising actions will be informed by an


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assessment of risk maturity, which in turn enables the Governing Body to determine the organisational

capacity to manage risk.

The Governing Body and all committees have clearly defined responsibilities for risk management including

review and discussion of risk registers, escalation of risks to the Board Assurance Framework and providing

effective and detailed narrative to the Governing Body. All staff are invited to undertake local risk training to

ensure they can identify, describe and evaluate a risk and our induction programme includes mandatory training

on high risk areas such as information governance, equality and diversity, safeguarding and health and safety.

Guidance, both specialist materials and induction packages, are based on best practice in order to ensure that

staff reflect current and high levels of professionalism and align to accepted healthcare industry standards.

Specialist Information Governance, Corporate Governance and Organisational Development expertise is sought

from specialists from the Information Governance Directorate of the NEL CSU in order to bolster the

understanding and management of risk and inform its management.

Risk assessment

At an operational level, the individual CCG teams review all relevant risks each quarter ensuring that risks are

effectively identified, assessed, managed and monitored providing assurance and tracking of effective internal

controls that provide reasonable assurance of effective and efficient operations, financial stewardship, probity

and compliance with laws and policies.

Incident reporting processes have been communicated to all staff through briefings and information on the

CCG file sharing structures and intranet. An incident reporting policy has been implemented and processes to

ensure learning from incident reports is captured and fed into the risk management process.

CCG has a varying risk appetite, responding to areas where it is required to take on risk to develop

transformation. The following risks were identified by the CCG as significant during 2018/19 and remedial

work to address the issues continues:

• Failure to ensure effective systems and processes are in place to monitor, challenge and support

Barts Health NHS Trust delivery of NHS Constitution targets and CQC action plan could result in

the increased likelihood of poor quality, poor patient experience, delivery of poor clinical outcomes

and the trust remaining in special measures in the longer term.

• The financial deficit of one of our main providers, Barts Health NHS Trust.

• Overspending in a number of acute services.

• Sustainability and resilience of General Practice in Tower Hamlets.

• The newly established Community Healthcare Services Alliance failing to deliver its targets and

losing its organisational form, thus impacting the healthcare of Tower Hamlets patients


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• The possible impact of the deteriorating position of Continuing Healthcare, and the resulting

increase in financial pressures and decrease in quality and performance.

• Failure to deliver the CCGs QIPP target and 2018/19 operating plan

• The CCG’s ability to meet its statutory requirements in regards to Safeguarding and Looked After

Children

• Potential impacts to the CCG in regards to the UK’s exit from the European Union

• Lack of clarity in the development of local commissioning arrangements.

The CCG approached all risks with vigour, and ensured mitigations were in place in order to address the

severity and likelihood via consistent review by the Governing Body and its committees to ensure that actions

to address any gaps had been implemented. We will continue to work to address areas where a current risk

rating exceeds the organisation's risk appetite for that risk.

Other sources of assurance

Internal control framework

A system of internal control is the set of processes and procedures in place in the clinical commissioning

group to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to

evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage

them efficiently, effectively and economically.

The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it

can therefore only provide reasonable and not absolute assurance of effectiveness.

The CCG's strategic objectives have been in place since the beginning of 2017/18 and were set by the

Governing Body. From these objectives, the main risks to their achievement were identified at a risk

identification workshop with Governing Body members in 2018/19. The BAF and the Corporate Risk Register

are the key control measures used in the management of risk and have been in place since April 1 2013.

Each risk identified is attributed a senior manager risk lead and lead committee of the Governing Body who

are held accountable for the management of these risks. The BAF is refreshed bi-monthly through meetings

with the senior manager risk leads and is reported to the Audit Committee and the Governing Body.

The management processes for the BAF were reviewed in 2018/19 by our internal auditors, and we received

“reasonable assurance” opinion with a small number of recommendations and examples of best practice to be

implemented. The Internal Audit Opinion noted that, “taking account of the issues identified, the Governing

Body can take reasonable assurance that the controls upon which the organisation relies to manage the

identified risk(s) are suitably designed, consistently applied and operating effectively.” Overall, RSM UK noted


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a number of well-designed controls with good application, highlighting NHS Tower Hamlets CCG’s proactive

approach to appropriate risk management.

Annual audit of conflicts of interest management

The revised statutory guidance on managing conflicts of interest for CCGs (published June 2016) requires

CCGs to undertake an annual internal audit of conflicts of interest management. To support CCGs to

undertake this task, NHS England has published a template audit framework.

Tower Hamlets CCG commissioned Risk Assurance Services LLP (RSM) to conduct audits on the CCG’s

internal controls including the CCG’s Conflict of Interest and Gifts and Hospitality Functions. RSM report to the

Governing Body board via the Governing Body’s Audit Committee, which is chaired by the CCG’s Lay Member

for Governance and Conflict of Interest Guardian, Mariette Davis. RSM conduct audits based on a plan

approved by the Audit Committee at the beginning of the financial year and report at every audit Committee on

their findings and recommended actions the CCG should implement.

In January 2019, an audit was undertaken by RSM at Tower Hamlets Clinical Commissioning Group (CCG) to

evaluate the design and operating effectiveness of the arrangements that the CCG has in place to manage

conflicts of interest and gifts and hospitality, including compliance with NHS England’s statutory guidance on

managing conflicts of interest for CCGs. After an extensive review of the CCG’s Conflict of Interest and Gifts

and Hospitality controls, RSM considered the CCG to be fully compliant and received a substantial opinion

which indicates Conflicts of Interest arrangements to be strong. The audit highlighted many well designed and

applied controls, noting that the CCG followed best practice and had initiated areas of control that supported

the effective management of Conflicts of Interest.

Recommendations for the improvement of the application and administration of the CCG’s Conflicts of Interest

procedures were actioned in February 2019 and RSM reported these findings and subsequent actions to the

March 2018 Audit Committee.


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Data quality

We use an array of data from various sources to support our Governing Body and our strategic and

operational decision making and we recognise the importance that data quality plays in both service provision

and service planning. Our Senior Management review the quality of information that supports and influences

our governance, working with the Governing Body’s committees to ensure the quality of data used by the

Governing Body is accurate and fit for purpose. All data that is forwarded to the Governing Body has been

discussed and analysed at a committee meeting prior to being submitted for discussion, noting or a formal

decision at the Governing Body.

In line with the “need to know” principles set out in the Caldicott 2 Information Governance Review Report, the

CCG ensures that information presented to the Governing Body and other governance forums does not

include any personally identifiable data and that commercially sensitive information is not made publicly

available. In the CCG’s Annual Governing Body Survey, 94% of Governing Body members were confident in

the quality of the data they had received.

Information governance

The NHS Information Governance Framework sets the processes and procedures by which the NHS handles

information about patients and employees, in particular personal identifiable information. The NHS

Information Governance Framework is supported by an information governance toolkit and the annual

submission process provides assurances to the clinical commissioning group, other organisations and to

individuals that personal information is dealt with legally, securely, efficiently and effectively.

We place high importance on ensuring there are robust information governance systems and processes in

place to help protect patient and corporate information. We have established an information governance

management framework and are developing information governance processes and procedures in line with

the information governance toolkit. We have ensured all staff undertake annual information governance

training and have implemented a staff information governance handbook to ensure staff are aware of their

information governance roles and responsibilities.

The information assets provided by the Commissioning Support Unit to the CCG are covered by the

overarching Information Technology Service Level Agreement between the CSU and the CCG. For these

assets they are then further protected by the CSU IT infrastructure controls, data disaster recovery and

backup services and network security controls including firewalls, antivirus and encryption programs.

There are also role based access controls for information assets which staff require which are approved by

NEL CSU IT once signed off by local managers so that staff have only access to those assets which are

needed for their work and at the right level of access especially for services using personal data.


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The CSU operates as an Accredited Safe Haven (ASH) and as a Controlled Environment for Finance to

ensure that patient confidential data is used in ways that prevent the identity of individuals to whom that data

relates from being identified and thereby limiting the personal confidential data received by the CCG.

The CCG conducted a Data Flow Mapping exercise to identify and record uses of data across the organisation

and the controls in place to ensure its legitimate and secured use. Any potential new flows at the CCG are

reviewed with the CSU IG team to ensure any potential risks to the data are assessed and any actions

required are implemented.

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 of face to face training,

awareness materials and information sessions has been established to fully embed an information risk culture

throughout the organisation against identified risks. As part of this embedded culture of Information

Governance best practice, this year saw the introduction of the CCG’s Information Governance Steering

Group, chaired by the CCG’s Senior Information Risk Owner and is made up of key CCG leaders, data users

and governing body members to ensure the CCG’s oversight of information governance risk is robust and is

championed by all levels of staff.

The CCG’s historic approach to Information Governance provided a substantial platform to reach compliance

by GDPR’s introduction on 25 May 2018 and work has continued beyond the introduction of the Regulation,

where the CCG has worked with the CSU to introduce new policies and procedures which are reflective of

best practice and guidance as released by the Information Commissioners Office.

As part of the CCG’s annual Information Governance processes, the CCG assessed itself using the Data

Security Toolkit against established standards in the areas of Information Governance Management,

Confidentiality and Data Protection Assurance, Information Security Assurance and Clinical Information

Assurance. The CCG were assessed as fully compliant in all relevant standards.

Business critical models

An appropriate framework and environment is in place to provide quality assurance of business critical models

via NEL CSU, in line with the recommendations in the Macpherson report. No business critical models have

been identified that require information about quality assurance processes for those models to be provided to

the Analytical Oversight Committee chaired by the Chief Analyst in the Department of Health.

Third party assurances

The CCG commissions NEL CSU to run elements of our commissioning function – such as contracting,

business intelligence, communications and HR. The service standards are monitored as part of an SLA and

the Audit Committee receives regular auditor reports on contracted-for services.


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Control issues

There were no control issues identified via the Month 9 Governance Statement return.

Review of economy, efficiency and effectiveness of the use of resources

The CCG has a comprehensive governance and reporting framework in place to monitor the use of resources,

identify any issues and ensure the appropriate measures are taken to address any variance from plans. The

Governing Body receives regular summary reports concerning the CCG's financial performance, and has

delegated authority both to the Strategic Finance and the Audit Committee to conduct more detailed scrutiny

and report back.

Strategic Finance and Investment Committee (SFIC) convenes monthly to scrutinise the detailed operational

financial performance of the CCG. The committee receives detailed and timely reports covering both corporate

CCG management costs and all aspects of commissioning spend, as well as considering key risks and

opportunities. The committee reviews the reports in detail and instructs the relevant CCG management function

to carry out investigations into areas of concern, and prepare remedial action plans if necessary. The SFIC is

chaired by the Lay Member for Corporate Affairs and is also attended by the lay Member for Governance,

Managing Director, Director of Integrated Commissioning and the Chief Finance Officer.

The Audit Committee is chaired by the Governing Body Lay Member for Governance. The Lay Member for

Corporate Affairs and the Secondary Care Clinician are also members. The Audit Committee performs the role

of oversight and scrutiny of CCG policies, procedures and systems of internal control, with a particular focus

on the Board Assurance Framework ensuring that conflicts of interest are managed in line with the CCG's

Constitution.

Underpinning the CCG's governance framework are the Prime Financial Polices which set out the key business

rules which govern the organisation, including internal control, audit, standards of business conduct and

budgetary control. They also incorporate the scheme of delegation. This sets out the level of authority to act

and make decisions which has been delegated from the CCG Governing Body to the various executive

committees, in addition to the authorisation limits set by the Governing Body for the management posts within

the organisation to authorise expenditure.

CCG Internal Audit Arrangements

The reports issued following our internal audit reviews have received substantial or reasonable assurance

opinions and have not identified any significant control issues. The CCG is a delegated commissioner of

primary care and its arrangements for managing this function are subject to regular review by internal audit

and the Audit Committee. Other areas of significant risk are also reviewed and in 2018/19 this focused on

statutory functions (such as conflict of interest management and Finance Management), governance


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arrangements as new collaborative working is developed and additional areas such as QIPP and Continuing

Healthcare.

Delegation of functions

Much of the CCG's commissioning spend is covered by functions contracts delegated to commissioned by the

CCG to the North East London Commissioning Support Unit (NEL CSU) through a service level agreement.

The nature of the CSU as an arm's length but not fully independent entity means that NHSE do not have

comprehensive processes of internal audit or controls assurance in place, instead commissioning an external

supplier to conduct a service audit and prepare a report for customers at the end of the year.

To address this significant area of business management and risk, RSM Risk Assurance Services LLP have

been commissioned by Tower Hamlets CCG to conduct a more comprehensive assurance process of the

CSU in addition to the CCG’s internal audit contract. With support from the Internal Auditors, the Chief Finance

Officer and relevant directors meet with the CSU lead staff regularly to discuss performance and agree actions

where there are concerns.

The CSU provides advice and support across many areas of commissioning to 12 clinical commissioning

groups in the North Central and East London areas, including the following for Tower Hamlets CCG:

• Procurement Services

• Continuing Healthcare Management

• Contract Management

• Human Resources

• Complaints

• Information Governance

• Communications

• IT Services

RSM UK’s CSU Quality Assurance Audit Plan covers these delegated areas. In 2018/19 RSM stated that the

CSU have been assigned reasonable assurance opinions in all areas reviewed, with the exception of the

review of Procurement where a partial assurance opinion was assigned. This means that the Governing Body

can take partial assurance that the controls to manage risks were suitably designed and consistently applied,

and that action was needed to strengthen the control framework to manage the identified risks.

Based on the work undertaken in 2018/19, RSM UK stated that there is a generally sound system of internal

control, designed to meet the CCG’s objectives, and controls are generally being applied consistently.


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Counter fraud arrangements

NHS Tower Hamlets Clinical Commissioning Group is committed to tackling fraud and bribery and ensuring

that all staff are aware of the reporting lines that should be followed should any suspicions or concerns arise.

The CCG has contracted an accredited Local Counter Fraud Specialist (LCFS) from RSM UK, whose purpose

is to raise fraud awareness across the CCG, ensure weaknesses within systems are identified, making

recommendations where necessary to strengthen these and that the organisation has the necessary controls

in place to mitigate the risk of fraud or bribery occurring.

LCFS are also responsible for investigating allegations of fraud and bribery and managing the work plan and

annual submission against the NHS Counter Fraud Authorities Standards 2018/19. It is recognised that the

existence of fraud and bribery prevents NHS funds providing maximum benefit to patients and that this needs

to be reduced to an absolute minimum through awareness, fostering a supportive reporting culture and

ensuring counter fraud arrangements are considered at all points of the commissioning cycle.

The LCFS provides an accessible point of contact for any concerns regarding fraud or bribery issues. In order

to achieve greater awareness, during 2018/19, LCFS has provided fraud and bribery training for the Governing

Body members, CCG employees, GPs and practice staff via the locality meetings.

Additionally, as part of the Counter Fraud Specialist Service:

• The CCG Audit Committee receives a report against each of the Standards for Commissioners at least

annually. There is executive support and direction for a proportionate proactive work plan to address

identified risks.

• Appropriate action is taken regarding any NHS Counter Fraud Authority quality assurance

recommendations.

The Chief Finance Officer, as an executive member of the Governing Body, is proactively and demonstrably

responsible for tackling fraud, bribery and corruption and works closely with the CCG’s Governance Team and

Governing Body to ensure that appropriate counter fraud work is proactive and proportionate in addressing

identified risks. The Chief Finance Officer also provides executive support and direction for the LCFS work

plan, and attends the Audit Committee, Executive Committee and Governing Body to ensure appropriate link

in within the CCG Governance Structure and leadership.

B1(4) Head of Internal Audit Opinion

In accordance with Public Sector Internal Audit Standards, the head of internal audit is required to provide an

annual opinion, based upon and limited to the work performed, on the overall adequacy and effectiveness of

the organisation’s risk management, control and governance processes. The opinion should contribute to the

organisation's annual governance statement.


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The Head of Internal Audit Opinion

For the 12 months ended 31 March 2019, our head of internal audit opinion for NHS Tower Hamlets Clinical

Commissioning Group is as follows:

Scope and limitations of our work

The formation of our opinion is achieved through a risk-based plan of work, agreed with management and

approved by the audit committee. Our opinion is subject to inherent limitations, as detailed below:

• the opinion does not imply that internal audit has reviewed all risks and assurances relating to the

organisation;

• the opinion is substantially derived from the conduct of risk-based plans generated from a robust and

organisation-led assurance framework. As such, the assurance framework is one component that the

Governing Body takes into account in making its annual governance statement (AGS);

• the opinion is based on the findings and conclusions from the work undertaken, the scope of which

has been agreed with management / lead individual;

• the opinion is based on the testing we have undertaken, which was limited to the area being audited,

as detailed in the agreed audit scope;

• where strong levels of control have been identified, there are still instances where these may not

always be effective. This may be due to human error, incorrect management judgement, management

override, controls being by-passed or a reduction in compliance;

• due to the limited scope of our audits, there may be weaknesses in the control system which we are

not aware of, or which were not brought to our attention; and

• it remains management’s responsibility to develop and maintain a sound system of risk management,

internal control and governance, and for the prevention and detection of material errors, loss or fraud.

The work of internal audit should not be seen as a substitute for management’s responsibilities around

the design and effective operation of these systems.

Factors and findings which have informed our opinion

Based on the work undertaken in 2018/19, there is a generally sound system of internal control, designed to

meet the CCG’s objectives, and controls are generally being applied consistently. We have however issued


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one partial assurance report on Procurement stemming from the CSU Quality Assurance Plan (details can be

found further below). All remaining reports issued following our internal audit and quality assurance reviews

have received Substantial or Reasonable assurance opinions and have not identified any significant control

issues

CCG Internal Audit Plan

The reports issued following our internal audit reviews have received substantial or reasonable assurance

opinions and have not identified any significant control issues.

Substantial Assurance

• Financial Planning, Budget Setting, Delivery and Reporting – Substantial Assurance

• Conflicts of Interest – Substantial Assurance

• QIPP - WELC CCGs joint report Effectiveness – Substantial Assurance

Reasonable Assurance

• NEL CCGs joint report Commissioning and Contract Management – Reasonable Assurance

• QIPP - WELC CCGs joint report Design and Application – Reasonable Assurance

• Primary Care Delegated Commissioning –Reasonable Assurance

• Board Assurance Framework – Reasonable Assurance

We have issued the Advisory report relating to NELCA Governance and Workstreams which is in draft. In

addition, we also conducted an Assurance Mapping exercise.

As part of all of the abovementioned reviews we have identified some areas for improvement and where

those were highlighted, we have agreed actions with management with agreed deadlines for implementation.

These are followed up on a regular basis and their status reported to each meeting of the Audit Committee. At

the April 2019 meeting of the Audit Committee there were no overdue outstanding management actions.

Where the NELCA Governance report is in draft, we have proposed management actions and are collating

feedback from across the North East London CCGs, before confirming the management actions and finalising

the report.

CSU Quality Assurance Plan

We have provided reasonable assurance in the areas reviewed, with the exception of the review of

Procurement where a partial assurance opinion was assigned, meaning that the Governing Body can take

partial assurance that the controls to manage risks were suitably designed and consistently applied, and that

action was needed to strengthen the control framework to manage the identified risks.


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Procurement

Two main areas within the Procurement process have driven the partial assurance opinion. It should be noted

that exceptions within our testing were only applicable to certain CCGs, whilst the controls assessed were

applicable to all CCGs to which NELCSU provide the service.

The first area we found issues in related to the Conflicts of Interest arrangements which meant that the CoI

documentation for two procurement exercises were not held, whilst for two procurement exercises no registers

of interests were held on the corresponding procurement files.

The second main area is around ensuring the SLA in place between the individual CCGs and the CSU clearly

documents the roles and responsibilities around Procurement and is subsequently signed off by both parties.

This would enable the expectations of both the CCGs and the CSU to be clarified.

Other issues related to the monitoring and reporting on Procurement activity produced by the CSU and the

feedback mechanism in place around customer (CCG) service feedback following individual procurement

exercises, so lessons can be learnt if required.

The CCG have provided additional commentary regarding this assurance opinion below.


We also issued the following reviews with Reasonable Assurance opinions:

• GP IT – Reasonable Assurance

• IT Business Continuity and Disaster Recovery – Reasonable Assurance

• Individual Funding Requests – Reasonable Assurance

• HR Support – Reasonable Assurance

• Acute and Non-Acute Contracting and Data Quality and Performance Management (Draft) –


• Provider Quality Management – Quality Assurance (Draft) - Reasonable Assurance

We issued an Advisory report on General Data Protection Regulations and a further advisory report currently

in draft on Data Security Protection Toolkit.

Topics judged relevant for consideration as part of the annual governance statement

Based on the work we have undertaken to date on the CCG’s system on internal control, we do not consider

that within these areas there are any issues that need to be flagged as significant control issues within the

Annual Governance Statement (AGS), although the CCG may wish to consider the potential significance of

the control issues identified during the course of the CSU Procurement review which was assigned a partial

assurance opinion. The CCG may wish to consider whether any other issues have arisen, as well as

recognise the challenging financial environment within which the CCG is operating, including the results of any


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external reviews, when determining whether anything should be highlighted within the Annual Governance

Statement.

CCG Commentary on CSU Procurement Assurance Opinion

An audit of the North East London Commissioning Support Unit’s Procurement service, which is delivered on

behalf of the CCG, was conducted as part of the approved Assurance Plan for 2018/19. This review assessed

the various processes and controls in place at the CSU to ensure that the CCG is provided with a high-quality

service, achieves the highest value for money from the procurement process and ensures that the procurement

process is open, transparent and is in line with NHS requirements. The review focused on the service provided

to the 12 North East London CCGs and included the service provided to Tower Hamlets CCG. A Partial

Assurance Opinion was issued, predominately based on the review of the overall procurement process

undertaken by the CSU on behalf of the CCGs.

RSM raised several management actions in relation to the application of the control framework. The audit

acknowledged that a number of actions requires the CSU to work with the CCGs to establish and agree the

procurement processes, clarify roles and responsibilities between the organisations and highlighted the need

for the service specifications between the parties to be strengthened. In addition, the review raised several areas

of note in relation to conflict of interest management during the procurement process. The CCG conducted an

investigation during 2018-19 in relation to a COI breach during a procurement process for a pilot service. Due

to this, the CCG issued a number of actions for the CSU to complete, above and beyond those raised in the

audit report. We will continue to work with our CCG colleagues and NEL CSU colleagues to achieve delivery of

these management actions, and have implemented local improvement plans which have been built on the review

of the procurement strategy, its accompanying processes and the establishment of the procurement working

group at the CCG.

B1(5) Review of the effectiveness of governance, risk management and internal

control

As Accountable Officer I have responsibility for reviewing the effectiveness of the system of internal control

within the CCG.

My review of the effectiveness of the system of internal control is informed by the work of the internal auditors,

executive managers and clinical leads within the clinical commissioning group who have responsibility for the

development and maintenance of the internal control framework. I have drawn on performance information

available to me. My review is also informed by comments made by the external auditors in their annual audit

letter and other reports.

Our assurance framework provides me with evidence that the effectiveness of controls that manage risks to the

clinical commissioning group achieving its principles objectives have been reviewed.


84

I have been advised on the implications of the result of this review by:

The board

The audit committee

If relevant, the risk / clinical governance / quality committee

Internal audit

Other explicit review/assurance mechanisms.

Conclusion

I am satisfied the systems outlined in this statement reflect an organisation that operates with effective and

sound systems of internal control and confirm that there have been no internal control issues to report during

2018/19.


85

B2. Remuneration and Staff Report The remuneration and staff report sets out the CCG’s remuneration policy for directors and senior managers,

reports on how that policy has been implemented and sets out the amounts awarded to directors and senior

managers.


86

B2(1) Remuneration report


Details regarding the Remuneration Committee Membership and agreements are highlighted in the

governance section of this report.

Policy on the remuneration of senior managers

The Remuneration Committee is a statutorily mandated committee of the CCG, established in accordance with

the CCG Constitution. Its aim is to set and review the salaries and pensions for very senior managers (VSM),

during 2018/19. In addition, the committee oversees the remuneration of any member of the CCG not covered

by national agreed pay scales.

The Committee will exercise delegated authority from the CCGs Governing Body to agree rates of

remuneration for CCG members and very senior management staff. This will cover:

• all aspects of salary (including any performance-related elements/bonuses)

• provisions for other benefits, including pensions and cars

• arrangements for termination of employment and other contractual terms

The Remuneration Committee will make recommendations to the Governing Body on determinations about

the remuneration, fees and other allowances for employees and for people who provide services to the group

and on determinations about allowances under any pension scheme that the group may establish as an

alternative to the NHS pension scheme.

Further information about the Remuneration Committee, such as key areas of discussion and membership,

can be found in the annual governance statement.

Remuneration of Very Senior Managers

During 2018/19, one senior manager’s combined salary across NELCA, was more than £150,000 per annum

(the salary of the Prime Minister).

The pay was determined by the NELCA remuneration committee in line with the national guidance for VSM

salaries. Salary levels have been benchmarked against equivalent roles in the other 4 London CCG

Commissioning Alliances and London Providers.

The Accountable Officer was appointed within 16 months, with the market tested through an open competitive

process.

Contractual arrangements


87

The chair, clinical directors and lay members are appointed by the CCG. Clinical directors and lay members

are on fixed term contracts of up to nine years in length, depending on individual circumstances. The

Accountable Officer and other Executive Directors are on permanent contracts, subject to the notice periods of

either three or six months.

Senior manager remuneration (including salary and pension entitlements) (subject to audit)

The table below shows the Salaries and Allowances of Senior Managers in 2018/19.

Notes:

1. The NEL Commissioning Alliance Accountable Officer is the appointed officer for 7 CCGs: NHS Barking and Dagenham, Havering, Redbridge, Waltham Forest, Newham, Tower Hamlets and City and Hackney. Her total salary in 2018/19 across all organisations was Salary: £ 150k to £155k; Pension Related Benefits: £62.5k to £65k; Total: £215k to £220k. The Accountable Officer for the CCG receives an agreed annual salary. An element of this annual salary may be reclaimed in future periods if it is determined that objectives set for that individual have not been achieved.

Salary

Expense

Payments

(taxable)

Performance

pay and

Bonuses

Long term

Performance

pay and

bonuses

All Pension-

Related

Benefits

Total

(bands of

£5000)

(to nearest

£100)

(bands of

£5000)

(bands of

£5000)

(bands of

£2,500)

(bands of

£5000)

£000 £00 £000 £000 £000 £000

Executive Director

1Ms Jane Milligan NELCA Accountable Officer 20k to 25k 0 0k to 5k 0 7.5k to 10k 30k to 35k 01/04/2018 31/03/2019

2

Mr Henry Black Chief Finance Officer - Tow er Hamlets

& Waltham Forest CCG

to 30 November 2018 (TH CCG share)

NELCA Chief Finance Officer

from 1 December 2018 (TH CCG

share)

50k to 55k 0 0 0 25k to 27.5k 75k to 80k 01/04/2018 31/03/2019

4 Mr Simon Hall Acting Managing Director

to 30 November 2018

85k to 90k 0 0 0 70k to 72.5k 155k to 160k 01/04/2018 30/11/2018

3 & 4 Selina Douglas WEL Managing Director

from 1 December 2018

10k to 15k 0 0 0 2.5k to 5k 15k to 20k 01/12/2018 31/03/2019

Non-Executive Director

Linda Aldous Practice Nurse - Governing Body

Member

15k to 20k 0 0 0 0 15k to 20k 01/04/2018 31/03/2019

Shah Ali GP - Governing Body Member 15k to 20k 0 0 0 0 15k to 20k 01/04/2018 31/03/2019

Dr Khyati Bakhai Commissioning Netw ork 5 & 6

Representative

from 1 October 2018

5k to 10k 0 0 0 0 5k to 10k 01/10/2018 31/03/2019

7 Somen Banerjee LA Representative, Director of Public

Health

0 0 0 0 0 0 01/04/2018 31/03/2019

4 Osman Bhatti GP - Governing Body Member

to 30 September 2018

5k to 10k 0 0 0 0 5k to 10k 01/04/2018 30/09/2018

Maggie Buckell Registered Nurse Representative 15k to 20k 0 0 0 0 15k to 20k 01/04/2018 31/03/2019

Noah Curthoys Lay Member for Corporate Affairs 10k to 15k 0 0 0 0 10k to 15k 01/04/2018 31/03/2019

Mariette Davis Lay member on Governing Body 10k to 15k 0 0 0 0 10k to 15k 01/04/2018 31/03/2019

Sam Everington Chair 110k to 115k 0 0 0 0 110k to 115k 01/04/2018 31/03/2019

4&5 Isabel Hodkinson Principal Clinical Lead


60k to 65k 0 0 0 0 60k to 65k 01/04/2018 30/09/2018

4&5 Dr Mohammed Imrul Kayes Commissioning Netw ork 2

Representative


5k to 10k 0 0 0 0 5k to 10k 01/04/2018 30/09/2018

4 Judith Littlejohn GP Partner Board Member


10k to 15k 0 0 0 0 10k to 15k 01/04/2018 30/09/2018

Virginia Patania Practice Manager - Governing Body

Member

15k to 20k 0 0 0 0 15k to 20k 01/04/2018 31/03/2019

7 Denise Radley LA Representative - Corporate

Director, Health, Adults & Community

0 0 0 0 0 0 01/04/2018 31/03/2019

Dr Rajivi Sanjeevi Commissioning Netw ork 3 & 4

Representative

from 1 October 2018

5k to 10k 0 0 0 0 5k to 10k 01/10/2018 31/03/2019

Julia Slay Lay Member, Lead for Patient and

Public Involvement

10k to 15k 0 0 0 0 10k to 15k 01/04/2018 31/03/2019

5&6 Dr Victoria Tzortziou Brow n Principal Clinical Lead 65k to 70k 0 0 0 0 65k to 70k 01/04/2018 31/03/2019

4 Tan Vandal Secondary Care Consultant

to 31 May 2018

0k to 5k 0 0 0 0 0k to 5k 01/04/2018 31/05/2018

Note Name Title

2018/19 Dates served

From To


88

2. The NEL Commissioning Alliance Chief Finance Officer is the appointed officer for 7 CCGs: NHS Barking and Dagenham, Havering, Redbridge, Waltham Forest, Newham, Tower Hamlets and City and Hackney with effect from 1st December 2018. Until 20th November 2018 the Chief Finance Officer was appointed across NHS Tower Hamlets and Waltham Forest CCG’s. His total salary in 2018/19 across all organisations was Salary: £ 135k to £140k; Pension Related Benefits: £70k to £72.5k; Total: £205k to £210k.

3. The WEL Managing Director is the appointed officer for 3 CCGs with effect from 1st December 2018 - Waltham Forest, Newham and Tower Hamlets. Her total salary in 2018/19 across three organisations was: £ 125k to £130k; Pension Related Benefits: £27.5k to £30k; Total: £157.5k to £160k. The WEL Managing Director receives an agreed annual salary. An element of this annual salary may be reclaimed in future periods if it is determined that objectives set for that individual have not been achieved.

4. These members were in post for part of the 2018/19 financial year.

5. These members are GP’s with a contract for service and salary figure includes employer pension contributions

6. Salary includes £24k for non-governing body services

7. No remuneration is paid to these members for their Governing Body services

The table below shows the Salaries and Allowances of Senior Managers in 2017/18

Notes:

1. Ms Jane Milligan held the position of Accountable Officer for NHS Tower Hamlets CCG throughout the period. However

from 1 December 2017 she took on the Accountable Officer role for NHS Barking and Dagenham, Havering, Redbridge,

Waltham Forest, Newham, Tower Hamlets and City and Hackney. Her total salary for the 12 month period for these NHS

Salary

Expense

Payments

(taxable)

Annual

Performance

pay and

Bonuses

Long term

Performance

pay and

bonuses

All Pension-

Related

Benefits

Total

(bands of

£5000)

(to nearest

£100)

(bands of

£5000)

(bands of

£5000)

(bands of

£2,500)

(bands of

£5000)

£000 £00 £000 £000 £000 £000

Executive Directors

1 Ms Jane MilliganChief Officer to 30 Nov 2017

90 to 95 0 0 0 17.5 to 20 105 to 110 01/04/2017 30/11/2017

1 Ms Jane Milligan NELCA Accountable Officer from 1 Dec

2017 5 to 10 0 0 0 0 to 2.5 5 to 10 01/12/2017 31/03/2018

Mr Simon Hall Acting Chief Officer

Acting Managing Director115 to 120 0 0 0 50 to 52.5 165 to 170 01/04/2017 31/03/2018

2 Mr Henry BlackChief Finance Officer to 31 Jan 2018

115 to 120 0 0 0 20 to 22.5 120 to 125 01/04/2017 31/01/2018

2 Mr Henry Black

Chief Finance Officer - Tower Hamlets &

Waltham Forest CCG

(TH CCG share) from 1 Feb 2018

5 to 10 0 0 0 0 to 2.5 10 to 15 01/02/2018 31/03/2018

3 Mr Josh PotterInterim Director of Commissioning

Deputy Director of Commissioning20 to 25 0 0 0 62.5 to 65 85 to 90 01/04/2017 30/06/2017

3 Ellie Hobart Acting Commissioning Director 25 to 30 0 0 0 0 25 to 30 01/07/2017 31/10/2017

Alison Blair Acting Commissioning Director 80 to 85 0 0 0 0 80 to 85 01/11/2017 31/03/2017

Other Members

Julia SlayLay Member, Lead for Patient and Public

Involvement10 to 15 0 0 0 0 10 to 15 01/04/2017 31/03/2018

Maggie Buckell Registered Nurse Representative 20 to 25 0 0 0 0 20 to 25 01/04/2017 31/03/2018

Mariette Davis Lay member on Governing Body 10 to 15 0 0 0 0 10 to 15 01/04/2017 31/03/2018

Tan Vandal Secondary Care Consultant 25 to 30 0 0 0 0 25 to 30 01/04/2017 31/03/2018

Noah Curthoys Lay Member for Corporate Affairs 10 to 15 0 0 0 0 10 to 15 01/04/2017 31/03/2018

Sam Everington Chair 105 to 110 0 0 0 0 105 to 110 01/04/2017 31/03/2018

4 Isabel Hodkinson Principal Clinical Lead 125 to 130 0 0 0 0 125 to 130 01/04/2017 31/03/2018

4&5 Dr Victoria Tzortziou Brown Principal Clinical Lead 65 to 70 0 0 0 0 65 to 70 01/04/2017 31/03/2018

Judith Littlejohn GP Partner Board Member 15 to 20 0 0 0 0 15 to 20 01/04/2017 31/03/2018

6 Somen BanerjeeLA Representative, Director of Public

Health0 0 0 0 0 0 01/04/2017 31/03/2018

Osman Bhatti GP - Governing Body Member 15 to 20 0 0 0 0 15 to 20 01/04/2017 31/03/2018

3 Dr Sarit Patel Commissioning Network 4 Representative 5 to 10 0 0 0 0 5 to 10 01/04/2017 30/09/2017

Shah Ali GP-Governing Body Member 15 to 20 0 0 0 0 15 to 20 01/04/2017 31/03/2018

Virginia PataniaPractice Manager - Governing Body

Member15 to 20 0 0 0 0 15 to 20 01/04/2017 31/03/2018

4 Dr Mohammed Imrul Kayes Commissioning Network 2 Representative 15 to 20 0 0 0 0 15 to 20 01/04/2017 31/03/2018

Linda Aldous Practice Nurse - Governing Body Member 15 to 20 0 0 0 0 15 to 20 01/04/2017 31/03/2018

6 Denise RadleyLA Representative - Director of Adult

Services0 0 0 0 0 0 01/04/2017 31/03/2018

Note Name Title

2017/18 Dates served

From To


89

roles was £140k-£145k, expenses £nil and pension-related benefits £27.5k-£30k. Corresponding entries are shown in the

other CCG accounts.

2. Mr Henry Black held the position of Chief Financial Officer for NHS Tower Hamlets CCG throughout the period. However

from 1 February 2018 he took on the Chief Financial Officer role for Tower Hamlets and Waltham Forest. His total salary

for the 12 month period for these NHS roles was £115k-£120k, expenses £nil and pension-related benefits £25k-£27.5k.

Corresponding entries are shown in Waltham Forest CCG accounts.

3. These members were in post for part of the 2017/18 financial year.

4. This member is a GP with a contract for services and salary figure includes employer pension contributions

5. Salary includes £21k for non-governing body services.

6. No remuneration is paid to these members for their Governing Body services.

Pension benefits at 31 March 2018 (subject to audit)

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 (or other allowable beneficiary’s) pension payable from the scheme.

A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another

pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits

accrued in their former scheme. The pension figures shown relate to the benefits that the individual has

accrued as a consequence of their total membership of the pension scheme, not just their service in a senior

capacity to which disclosure applies.

The CETV figures and the other pension details include the value of any pension benefits in another scheme

or arrangement which the individual has transferred to the NHS pension scheme. They also include any

additional pension benefit accrued to the member as a result of their purchasing additional years of pension

service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed

by the Institute and Faculty of Actuaries.

Real increase in CETV

This reflects the increase in CETV that is funded by the employer. It does not include the increase in accrued

pension due to inflation or contributions paid by the employee (including the value of any benefits transferred

from another scheme or arrangement).

Pension Contribution Rates

All staff including senior managers are eligible to join the NHS pension scheme. The scheme has fixed the employer’s

contribution at 14.38% of the individual’s salary, per NHS pension regulations. Employee contribution rates for CCG

officers and practice staff are as follows:


90

Pension Benefits of Senior Managers

The table below shows the Pension Benefits of Senior Managers in 2018/19.

Note:

1. The NEL Commissioning Alliance Accountable Officer and the NEL Commissioning Alliance Chief Finance Office are the

appointed officers for 7 CCGs: NHS Barking and Dagenham, Havering, Redbridge, Waltham Forest, Newham, Tower Hamlets and City and Hackney. Their total Pensions figures are shown above.

2. The WEL Managing Director is the appointed officer for 3 CCGs with effect from 1st December 2018 - Waltham Forest, Newham and Tower Hamlets. Her total Pensions figure are shown above.

The Pensions Related Benefits (PRB) figure is calculated using the method set out in the Finance Act 2004(1), and includes using the member's current and prior year pension and lump sum figures. Where there has been only a small increase in pension and lump sum benefits current year compared to last year, this formula can sometimes generate a negative figure. Where this is the case, Department of Health guidance states that a "zero" should be substituted for any negative figures. Certain individuals disclosed in the Salary and Allowances table are not included in the Pension Benefits table. The reasons for this include:

Non-Executive members do not receive pensionable remuneration;

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

For those Governing Body members who are GPs, and who have a contract for service, for their Governing Body duties, pension benefits disclosures are not required.

The table below shows the Pension Benefits of Senior Managers in 2017/18

Full time pensionable pay/earnings

used to determine contribution rate2018/19

Full time pensionable pay/earnings

used to determine contribution rate2017/18

Up to £15,431.99 5.00% Up to £15,431.99 5.00%

£15,432.00 to £21,387.99 5.60% £15,432.00 to £21,477.99 5.60%

£21,488.00 to £26,823.99 7.10% £21,478.00 to £26,823.99 7.10%

£26,824.00 to £49,472.99 9.30% £26,824.00 to £47,845.99 9.30%

£49,473.00 to £70,630.99 12.50% £47,846.00 to £70,630.99 12.50%

£70,631.00 to £111,376.99 13.50% £70,631.00 to £111,376.99 13.50%

£111,377.00 and over 14.50% £111,377.00 and over 14.50%

Real increase in

pension at

pension age

Real increase in

pension lump

sum at pension

age

Total accrued

pension at

pension age at

31st March 2019

Lump sum at

pension age

related to accrued

pension at 31st

March 2019

Cash equivalent

transfer value at

1st April 2018

Real increase in

cash equivalent

transfer value

Cash equivalent

transfer value at

31st March 2019

Employer's

contribution to

stakeholder

pension

(bands of £2,500) (bands of £2,500) (bands of £5,000) (bands of £5,000) (to nearest

£1,000)

(to nearest

£1,000)

(to nearest

£1,000)

(to nearest

£1,000)

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

Ms Jane Milligan NELCA Accountable Officer 2.5k to 5k 2.5k to 5k 45k to 50k 110k to 115k 732 137 899 0

Mr Henry Black Chief Finance Officer - Tower Hamlets


to 30 November 2018 (TH CCG share)

NELCA Chief Finance Officer

from 1 December 2018 (TH CCG

share)

2.5k to 5k 5k to 7.5k 25k to 30k 55k to 60k 312 90 431 0

Mr Simon Hall Acting Managing Director

to 30 November 2018

2.5k to 5k 2.5k to 5k 50k to 55k 125k to 130k 803 97 991 0

Selina Douglas WEL Managing Director

from 1 December 2018

0k to 2.5k 0 5k to 10k 0 57 20 96 0

2018/19

Name Title


91

1. The NEL Commissioning Alliance Accountable Officer is the appointed officer for 7 CCGs: NHS Barking and Dagenham,

Havering, Redbridge, Waltham Forest, Newham, Tower Hamlets, City and Hackney. Her total Pensions figures are shown

below.

2. The Chief Finance Officer is the appointed officer for NHS Tower Hamlets CCG and, from 1st February, NHS Waltham

Forest CCG. His total Pensions figures are shown below:

Real increase in

pension at

pension age

Real increase in

pension lump

sum at pension

age

Total accrued

pension at

pension age at

31st March 2018

Lump sum at

pension age

related to accrued

pension at 31st

March 2018

Cash equivalent

transfer value at

1st April 2017

Real increase in

cash equivalent

transfer value

Cash equivalent

transfer value at

31st March 2018

Employer's

contribution to

stakeholder

pension


£1,000)

(to nearest

£1,000)

(to nearest

£1,000)

(to nearest

£1,000)

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

Ms Jane Milligan

Chief Officer to 30 Nov 2017

NELCA Accountable Officer

from 1 Dec 2017

0 to 2.5 -2.5 to 0 40 to 45 100 to 105 666 59 732 0

Mr Simon Hall

Acting Chief Officer

Acting Managing Director

2.5 to 5 2.5 to 5 45 to 50 115 to 120 710 86 803 0

Mr Henry Black

Chief Financial Officer to 30 Nov 2017

Chief Finance Officer - Tower Hamlets



0 to 2.5 -2.5 to 0 20 to 25 50 to 55 272 6 312 0

Mr Josh Potter

Interim Director of Commissioning

Deputy Director of Commissioning

0 to 2.5 0 to 2.5 15 to 20 30 to 35 123 9 161 0

Ellie Hobart Acting Commissioning Director -2.5 to 0 0 20 to 25 0 210 -1 210 0

Name

2017/18

Title

Real increase in

pension at

pension age

Real increase in

pension lump

sum at pension

age

Total accrued

pension at

pension age at

31st March 2018

Lump sum at

pension age

related to accrued

pension at 31st

March 2018

Cash equivalent

transfer value at

1st April 2017

Real increase in

cash equivalent

transfer value

Cash equivalent

transfer value at

31st March 2018

Employer's

contribution to

stakeholder

pension


£1,000)

(to nearest

£1,000)

(to nearest

£1,000)

(to nearest

£1,000)

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

Ms Jane Milligan

Chief Officer to 30 Nov 2017

NELCA Accountable Officer

from 1 Dec 2017

0 to 2.5 -2.5 to 0 40 to 45 100 to 105 666 59 732 0

Real increase in

pension at

pension age

Real increase in

pension lump

sum at pension

age

Total accrued

pension at

pension age at

31st March 2018

Lump sum at

pension age

related to accrued

pension at 31st

March 2018

Cash equivalent

transfer value at

1st April 2017

Real increase in

cash equivalent

transfer value

Cash equivalent

transfer value at

31st March 2018

Employer's

contribution to

stakeholder

pension


£1,000)

(to nearest

£1,000)

(to nearest

£1,000)

(to nearest

£1,000)

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

Mr Henry Black

Chief Financial Officer to 31 Jan 2018

Chief Finance Officer - Tower Hamlets



0 to 2.5 -2.5 to 0 20 to 25 50 to 55 272 6 312 0


92

Compensation on early retirement of for loss of office

No payments of this kind took place in financial year of 2018/19.

Payments to past members

No payments of this kind took place in financial year of 2018/19.

Termination agreements or exit packages (subject to audit)

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.

During the financial year there were no payments made in relation to payments to past members.

Pay multiples (subject to audit)

Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid

director/member in their organisation and the median remuneration of the organisation’s workforce.

The banded remuneration of the highest paid director/Member in NHS Tower Hamlets CCG in the financial year

2018/19 was £110k - £115k (2017/18: £115k - £120k). This was 5.08 times (2017/18: 2.69) the median

remuneration of the workforce, which was £21,786 (2017/18: £43,618).

In 2018/19, 1 employee received remuneration in excess of the highest-paid director/Member. Remuneration

ranged from £0k - £5k to £135k - £140k (2017/18: £0k - £5k to £115k - £120k)

Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind, but not

severance payments. It does not include employer pension contributions and the cash equivalent transfer

value of pensions.

The median pay in 18/19 has reduced significantly compared to 2017/18. This relates to the change in

accounting treatment from Gross to Net Accounting, which results in staff costs now being shared across

NELCA and the STP. This impacts inversely on the ratio of median pay to highest-paid, which has increased

to 5.08 times in 2018/19 from 2.69 in 2017/18.


93

B2(2) Staff report

Staff numbers and composition (subject to audit)

Staff costs

2018-19

Permanent

Employees Other Total

Permanent


Permanent


£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Employee Benefits

Salaries and wages 1,861 283 2,145 2,356 1,541 3,897 4,218 1,824 6,042

Social security costs 213 0 213 343 0 343 556 0 556

Employer contributions to the NHS Pension Scheme 183 0 183 386 0 386 569 0 569

Other pension costs 0 0 0 0 0 0 0 0 0

Apprenticeship Levy 15 0 15 0 0 0 15 0 15

Other post-employment benefits 0 0 0 0 0 0 0 0 0

Other employment benefits 0 0 0 0 0 0 0 0 0

Termination benefits 7 0 7 0 0 0 7 0 7

Gross employee benefits expenditure 2,280 0 283 2,563 3,085 0 1,541 4,626 5,365 0 1,824 7,189

Less recoveries in respect of employee benefits 0 0 0 0 0 0 0 0 0

Total - Net admin employee benefits including capitalised

costs 2,280 283 2,563 3,085 1,541 4,626 5,365 1,824 7,189

Less: Employee costs capitalised 0 0 0 0 0 0 0 0 0

Net employee benefits excluding capitalised costs 2,280 283 2,563 3,085 1,541 4,626 5,365 1,824 7,189

2017-18

Permanent


Permanent


Permanent


£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Employee Benefits

Salaries and wages 1,859 675 2,534 3,461 1,744 5,205 5,320 2,419 7,739

Social security costs 210 0 210 376 0 376 586 0 586

Employer contributions to the NHS Pension Scheme 207 0 207 416 0 416 622 0 622

Other pension costs 0 0 0 0 0 0 0 0 0

Apprenticeship Levy 13 0 13 0 0 0 13 0 13

Other post-employment benefits 0 0 0 0 0 0 0 0 0

Other employment benefits 0 0 0 0 0 0 0 0 0

Termination benefits 0 0 0 0 0 0 0 0 0

Gross employee benefits expenditure 2,289 675 2,964 4,253 1,744 5,997 6,541 2,419 8,961

Less recoveries in respect of employee benefits 0 0 0 0 0 0 0 0 0

Total - Net admin employee benefits including capitalised

costs 2,289 675 2,964 4,253 1,744 5,997 6,541 2,419 8,961

Less: Employee costs capitalised 0 0 0 0 0 0 0 0 0

Net employee benefits excluding capitalised costs 2,289 675 2,964 4,253 1,744 5,997 6,541 2,419 8,961

Total

TotalAdmin Programme

Admin Programme

Staff Type Male Female

Employees 31% 69%

VSM 40% 60%


94

Sickness absence data

Our sickness absence rate is defined as the percentage of Full Time Equivalent days lost, from those that were

available to be worked within the period in question.

Source: NHS Digital - Sickness Absence Publication - based on data from the ESR Data Warehouse

Period covered: January to December 2018

ESR does not hold details of normal number of days worked by each employee. Data on days available and days recorded sick

are based on a 365-day year.

Average Annual Sick Days per FTE has been estimated by dividing the estimated number of FTE-days sick by the average

FTE, and multiplying by 225 (the typical number of working days per year).

There may be inconsistencies between these data and the statutory basis for accounts, in terms of the organisation against

which staff are reported for a particular month.

Total FTE Days Lost

Sum of FTE Days Available

Average Annual Sick Days per FTE

Occurrences (Months of Data)

Tower Hamlets CCG (08V)

405 32835 2.8 12


95

Staff policies

We have developed our equality and diversity strategy which provides a framework to support the CCG in

delivering its strategic priorities and focus on the public sector equality duty in the provision of services and to

our workforce. The strategy contains the mechanisms to ensure equality and diversity is integral in day to day

business planning and decision making processes and informs our policies relating to staff at the CCG.

The nine protected characteristics under the public sector equality duty include disabled staff. We have made

full and fair consideration to job applicants who are disabled and have adapted the recruitment process

accordingly in order to enable them to participate fully in the process.

In 2018/19 we trained several members of staff at the CCG as Display Screen Equipment (DSE) assessors,

and conducted a local awareness plan to raise the profile of the Health and Safety (Display Screen

Equipment) Regulations 1992 which applies to a majority of CCG staff. The initial DSE assessment is now

included as part of staff inductions and periodically reviewed during staff appraisal processes. As part of this

work, we have adapted a number of work stations to better suit our staff and their individual needs.

After consultation with our staff through lunch meetings and staff surveys, we reviewed our flexible working

policy in order to give more transparency in the process and support managers to assess business needs

against requests.

Where the CCG has staff who are disabled we ensure adjustments are made to allow full integration into the

workforce including training and learning development opportunities. A copy of our equality and diversity

strategy can be found on the NHS Tower Hamlets CCG website. www.towerhamletsccg.nhs.uk.

Trade union facility time

Number of employees who were relevant union officials during the relevant period

Full-time equivalent employee number

1 1

B1: Relevant union officials

Percentage of time Number of employees

0% N/A

1%-50% 1

51%-99% N/A

100% N/A

Percentage of time spent on facility time

Total cost of facility time 0

http://www.towerhamletsccg.nhs.uk/


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Total pay bill 0

Percentage of the total pay bill spent on facility time 0

Percentage of pay bill spent on facility time

Time spent on paid trade union activities as a percentage of total paid facility time hours

3%

Paid trade union activities

Other staff matters

Developing our workforce

Our workforce is our most important resource and we are committed to supporting people to learn, develop

and grow. We recognise that people need to learn within their current roles and to have opportunities to

develop their potential for new roles and responsibilities. The ongoing learning and development of our

workforce is especially important in times of change where adaptability and collaboration is crucial.

Enabling learning and development is crucial for our whole workforce; our staff, Governing Body and Clinical

Leads. Through the engagement of our workforce, we seek to embed a learning culture that enables people

to develop the skills, knowledge and experience needed to achieve our vision, objectives and develop their

own potential. Our appraisal processes hones in on performance development through feedback and

development activities that are eclectic and suited to learning needs. We promote learning through

relationships and networks such as mentoring, coaching and peer support, encouraging people to reflect on

the goals they seek to achieve and how these relationships could support these needs.

We run monthly lunch and learn sessions which see staff from across the organisation coming together to

learn about a particular topic or area as a group. For example, sessions on fraud awareness, safeguarding

and quality improvement. In supporting our organisation through change and development we plan and

deliver specific development for teams and groups of staff, such as sessions for finance colleagues across

organisations allowing them to consider how change feels, develop new relationships and focus on where

they could work more collaboratively or for business managers, focusing on developing confidence in public

speaking, understanding ways of working and getting the best from each other and developing improvement

projects.

At the clinical level, we run monthly OD sessions for our Governing Body and clinical leads, giving our senior

leaders time to undertake deep dive analysis into specific areas of work or develop new strategic direction,

develop leadership skills, hone relationships with partners and maintain a high level of expertise within

important areas required as the Governing Body of the CCG, including conflicts of interest, safeguarding and

patient and public involvement. We ran a comprehensive induction programme for new members of our

Governing Body this year to enable them to develop the skills and relationships required to govern the CCG


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effectively. This saw new members meeting with senior leads across partner organisations, buddying with

outgoing members for peer support and undertaking specific training and 1-1 executive coaching.

We are committed to the ensuring the safety and welfare of our workforce. We work hard to ensure new

starters comply with the statutory legislation and mandatory requirements identified by national and local

guidelines and all staff, Governing Body members and Clinical Leads must undertake and keep up to date

with mandatory training requirements.

Our overall 2018/19 compliance rate for mandatory training was 96%. The table below shows the compliance

levels for each of the six mandatory training modules.

Mandatory training module Compliance

Information Governance 95%

Conflicts of Interest 92%

Safeguarding Adults – level 1 99%

Safeguarding Children – level 1 98%

Equality, Diversity and Human Rights 97%

Engaging with our staff

The engagement and involvement of our workforce is central to the way that we operate and achieve our

goals. We believe that staff know what works and we want to hear from staff about their experience of

working for the organisation. Through this co-design we create a culture that is high performing and supports

staff motivation and well-being.

We have a range of ways in which we consistently engage and involve staff. At an individual level we ensure

that managers undertake regular 1-1s and provide best practice for these. At a team level we make sure team

meetings and team huddles occur frequently, with consistency and are engaging and open, with a back and

forth flow of information and ideas. We have a staff committee which oversees all areas of OD, with

nominated representatives from each team providing ideas, steer and acting as a voice for the workforce.

Committee members act as conduits and advocates for their teams, consulting, engaging and taking forward

actions and bringing feedback and items to the committee.

The committee has a formal link to CCG senior management team (SMT) who are given feedback and

required to action recommendations and report back to the committee. For all staff we run bi-annual away

days, monthly ‘watercooler’ sessions where staff get to hear from and ask questions of the Managing Director

and SMT and focused opportunities to spend time with, learn from and work with leaders through breakfast

sessions.


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We have taken part in the national staff survey for the fourth year, a commitment which we feel is extremely

important, although not mandatory for CCGs. This year we also ran our third staff awards programme,

presented at our Christmas party and worked with partners to host an excellent garden party in celebration of

the 70th birthday of the NHS, seeing over 800 local people, patients and staff come together to share in our

history and celebrate the achievements of the NHS.

Health and well-being

For people to thrive at work they need to feel empowered, engaged, motivated and valued and our overall

approach to OD, staff engagement, learning and development underpins our ambition to create this type of

culture and environment at Tower Hamlets CCG. As well as these fundamentals, we provide and offer a

range of activities that support physical and mental health and well-being including yoga, meditation, fruit

supplied to the office to offer healthy snacks and an annual sports day! We publicise a programme of national

campaigns that support health and well-being including mental health and healthy eating weeks. Going

forward we would like to work with our WEL CCG colleagues to develop a new programme of work that will

support staff health and well-being as our organisations work together.

Education, training, research and development

As a CCG, we have a key role in developing the commissioning system and improving outcomes by using

and promoting innovation, research, education and training. We know high quality commissioning is

underpinned by robust research evidence and this is an integral part of managing a healthcare system.

In light of this, we have adopted an evidence-based approach and culture with our commissioning functions

that promotes research, innovation, education and training as the key delivery mechanisms to achieve

improvement and better outcomes for patients.

We have promoted innovation, research, education and training through our research and evaluation

strategy, led by a Governing Body clinical lead. We aim to build a culture of research locally through

leadership, partnership and professional development and education.

We have supported the development of our Community Education Provider Network (CEPN) to ensure our

future workforce has the right skills for the NHS of tomorrow. We continue to fund protected learning time

sessions for the primary care workforce, which is delivered in partnership with CEPN.


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As part of our ongoing commitment to an evidenced based approach, we commission the Clinical

Effectiveness Group and Queen Mary University to undertake research on our behalf and identify best

practice in commissioning. We are also members of UCLP, an academic science health partnership, in

which we have actively sought to create and develop improvements for local people.

We have embedded a quality improvement approach across general practice, supporting practices to use data

and a learning approach to develop the capacity and capability to make sustainable improvements to the care

and experience patients receive.

Expenditure on consultancy

Expenditure on consultancy for 2018/19 is shown in the table below:

Total (£000) Admin Programme

40 0 40

Off-payroll engagements

Table 1: Off-payroll engagements longer than 6 months For all off-payroll engagements as at 31 March 2019, for more than £245 per day and that last longer than six months:

Number

Number of existing engagements as of 31 March 2019 14

Of which, the number that have existed:

for less than one year at the time of reporting 6

for between one and two years at the time of reporting 4

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

for between 3 and 4 years at the time of reporting 1

for 4 or more years at the time of reporting 0

Table 2: New off-payroll engagements

Where the reformed public sector rules apply, entities must complete Table 2 for all new off-payroll engagements, or those that reached six months in duration, between 1 April 2018 and 31 March 2019, for more than £245 per day and that last for longer than 6 months:

Number

Number of new engagements, or those that reached six months in duration, between 1 April 2018 and 31 March 2019

22

Of which:

Number assessed as caught by IR35 8

Number assessed as not caught by IR35 14


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Number engaged directly (via PSC contracted to department) and are on the departmental payroll

0

Number of engagements reassessed for consistency / assurance purposes during the year 14

Number of engagements that saw a change to IR35 status following the consistency review 0

Table 3: Off-payroll engagements / senior official engagements

For any off-payroll engagements of Board members and / or senior officials with significant financial responsibility, between

01 April 2018 and 31 March 2019.

Number of off-payroll engagements of board members, and/or senior officers with significant financial responsibility, during the financial year.

1

Total no. of individuals on payroll and off-payroll that have been deemed “board members, and/or, senior officials with significant financial responsibility”, during the financial year. This figure should include both on payroll and off-payroll engagements.

21

Exit packages, including special (non-contractual) payments

Redundancy and other departure cost have been paid in accordance with the provisions of Agenda for Change. Exit costs in this note are accounted for in full in the year of departure. Where Tower Hamlets CCG has agreed early retirements, the additional costs are met by Tower Hamlets CCG and not by the NHS Pensions Scheme.

Ill-health retirement costs are met by the NHS Pensions Scheme and are not included in the table.

Number of

compulsory

redundancies

Cost of

compulsory

redundancies

Number of

other

departures

agreed

Cost of

other

departures

agreed

Total

number of

exit

packages

Total cost

of exit

packages

Number of

departures

where special

payments

have been

made

Cost of

special

payment

element

included in

exit

packages

WHOLE

NUMBERS

ONLY £s

WHOLE

NUMBERS

ONLY £s

WHOLE

NUMBERS

ONLY £s

WHOLE

NUMBERS

ONLY £s

Less than

£10,000

1 6,844

£10,000 -

£25,000

£25,001 -

£50,000

£50,001 -

£100,000

£100,001 -

£150,000


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£150,001 -

£200,000

>£200,000

TOTALS 1 6,844 Agrees to A

below

Agreements Total Value

of

agreements

Number £000s

Voluntary redundancies including early retirement contractual costs

Mutually agreed resignations (MARS) contractual costs

Early retirements in the efficiency of the service contractual costs

Contractual payments in lieu of notice*

Exit payments following Employment Tribunals or court orders

Non-contractual payments requiring HMT approval**

TOTAL A – agrees to

total in table 1

As a single exit package can be made up of several components each of which will be counted separately in this Note, the total number above will not necessarily match the total numbers in Table 1 which will be the number of individuals.

*any non-contractual payments in lieu of notice are disclosed under “non-contracted payments requiring HMT approval” below.

**includes any non-contractual severance payment made following judicial mediation, and amounts relating to non-contractual payments in lieu of notice.

No non-contractual payments were made to individuals where the payment value was more than 12 months’ of their annual salary.

The Remuneration Report includes disclosure of exit packages payable to individuals named in that Report.


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Parliamentary Accountability and Audit Report

Tower Hamlets CCG is not required to produce a Parliamentary Accountability and Audit Report. Disclosures

on remote contingent liabilities, losses and special payments, gifts, and fees and charges are included as

notes in the Financial Statements of this report. An audit certificate and report is also included in this Annual

Report at section B3(1) below.


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B3(1) Audit certificate and report


104

ANNUAL ACCOUNTS

Jane Milligan

Accountable Officer

28 May 2019


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