Annual Report & Accounts 2020/21 About this report Contents

About this report 1

The NHS South West London Clinical Commissioning Performance report 5 Group (CCG) Annual Report 2020/21 has been produced in Performance overview 6 response to the NHS England requirements as published in the Department of Health and Social Care Group Accounting Performance analysis 25 Manual 2020/21. The structure closely follows that outlined in Engaging people and communities - patient and public engagement (PPE) 62 the guidance and includes three core sections: Reducing health inequalities 86 Improving quality and safety – putting quality at the heart of the CCG 92 • The performance report - including an overview, performance analysis and performance measures Assuring delivery of performance and constitutional standards and national performance indicators 103 • The accountability report - including the members’ Freedom of Information 112 report, corporate governance report, annual governance Sustainable development 113 statement, remuneration and staff report

• Annual accounts - including the auditor’s report and Accountability report 117 financial statements Corporate governance report 118 Statement of accountable officer’s responsibilities 135 This report has been approved by the Governing Body members, and all the content has been checked for accuracy Governance statement 137 and consistency with reporting data sources and to make sure Remuneration report 149 that all requirements are met by our auditors. Staff report 155 Parliamentary accountability and audit report 172

Annual accounts 181

NHS South West London Clinical Commissioning Group The Primary Statements: 3rd Floor Statement of Comprehensive Net Expenditure for the year ended 31st March 2021 182 120 The Broadway Statement of Financial Position as at 31st March 2021 183 London SW19 1RH Statement of Changes in Taxpayers' Equity for the year ended 31st March 2021 184 www.swlondonccg.nhs.uk Statement of Cash Flows for the year ended 31st March 2021 185

2 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 3 Notes to the Accounts Accounting policies 186-190 Other operating revenue 191 Disaggregation of Income 192 Employee benefits and staff numbers 193-195 Performance Operating expenses 196 Better payment practice code 197 Report Operating leases 198-199 Net gain/(loss) on transfer by absoption 200-201 Property, plant and equipment 202 Intangible non-current assets 203 Trade and other receivables 204 Cash and cash equivalents 205 Trade and other payables 206-207 Provisions 208-209 Contingencies 210 Commitments 210 Financial instruments 210-211 Operating segments 211 Joint arrangements - interests in joint operations 212-213 Related party transactions 214 Events after the end of the reporting period 215 Losses and special payments 215 Financial performance targets 215 Analysis of charitable reserves 215

4 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 5 challenges that it brought us all. Staff have services continued to meet changing patient delivered for the people of South West needs: such as keeping patients safe and London, whilst also adapting to new ways of monitored in their own homes rather than working and being part of an organisational in hospitals; transforming GP, outpatient change. and mental health services to increase virtual access when face-to-face treatment Covid-19 in South West London: our was very restricted; NHS Trusts working response, the restart, how we reshape closely together to support a huge increase in patient numbers; and great examples of As this Annual Report explains, much of collaboration with our social care colleagues, the core-business of the CCG over the past care home partners and voluntary sector. year has been responding to the Covid-19 pandemic. In February 2020, the CCG, on As we moved into managing the recovery behalf of the South West London health and of services following the first wave of the care system, established pandemic, we changed the Gold Command the way we delivered Incident Control Room health and care services The strength of our (ICR) for the NHS in so we could continue response in South South West London. to protect and care for Performance overview Operational seven days West London last local people, and ensure a week, Gold Command year was rooted we were prepared for reported directly into in how we came the second wave in NHS England, to support together across the winter. Our CCG our NHS leaders to organisational leaders, as members of manage the incident in boundaries the South West London December 2020. We have worked hard Welcome and overview their own organisations, Recovery Board, led this to support the continuation of vital non- from the Clinical Chair and and across our wider work, and we were clear Covid NHS services as well elective recovery. health and care system. that the recovery should Accountable Officer We have listened to local people and staff be focussed on primary who have told us we must build on our The strength of our response in South West care, mental health and community services progress to address health inequalities and This is our first annual report as a South London last year was rooted in how we came as well as the acute sector. go further and faster. We have also secured West London Clinical Commissioning together across organisational boundaries much-needed capital investment to South Group (CCG), and it looks back at an and clinical networks, to work with our Our clinical priorities during the recovery West London and have led, and continue to unprecedented year. communities to keep the most vulnerable period were particularly concerned with support, two major change programmes of protected, shielded and supported. those groups of patients who had not been In this report we describe how the CCG a CCG merger and now a transition to an seeking health advice and support during the has played an important role in leading and Integrated Care System as proposed in the The most extraordinary year the NHS has first wave and understanding why Covid-19 coordinating the South West London NHS government’s White Paper. We are grateful ever faced has also made us more innovative had disproportionately affected people from response to the Covid-19 pandemic with to our CCG staff for the way they have as well as more collaborative. There are ethnic minority groups and those from more our system partners, as well as delivering responded to this international crisis and many examples in this report of how deprived areas. We developed 15 elective a successful vaccination programme since the many professional, as well as personal, colleagues have rapidly adapted to ensure recovery clinical networks, each led jointly by

6 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 7 acute and primary care clinicians, to support South London Listens programme. More Our work in the boroughs and with much needed £500m of funding for a brand restarting elective surgical operations and than 5,000 people have taken part in the NHS providers – addressing health new, state of the art hospital in Sutton. This treatments. They enabled our hospitals to initiative, and the partnership is now working inequalities and supporting non-Covid will transform services for patients from work together to manage those patients with local people and community groups to services across South West London and Surrey, as who urgently needed care. As a CCG, we co-produce solutions that will be published well as providing significant investment into were able to support these new networks as part of a two-year action plan in Summer This Annual Report also explains the different the existing St Helier and Epsom Hospitals, with experienced primary care clinicians 2021. health needs and health priorities within which will continue to provide the vast and commissioning managers, ensuring each of our six boroughs. We are committed majority of services to local people. a focus on the whole patient journey and From December 2020, we have also been to working at borough and neighbourhood coordinating patient care across different delivering the Covid vaccination programme, level to make sure that the services we Despite the pandemic, the CCG has rightly settings. with over 600,000 vaccinations administered commission for our communities, especially had an obligation to meet the ongoing to more than half a million people in South those that suffer from health inequalities, healthcare needs of the local population We have also supported and worked with West London, as at the end of March 2021. meet their needs and are accessible to and address patient experience, patient our mental health providers to ensure people Our CCG staff and primary care colleagues everyone. Our Primary Care Networks outcomes and patient with mental health needs or a learning are at the centre of this programme as we (PCNs) work at this safety. This Annual disability receive the same protection and continue to inform, engage and protect neighbourhood level, Report has a chapter support with managing their health and more of our local people into 2021. bringing together GP that summarises the wellbeing during the pandemic as other practices to provide a One of the strengths performance indicators members of the population. The impact CCG clinical leadership and the wider wide range of services for of the CCG is and quality standards of Covid-19 on our communities’ mental South West London system local people. Since July the strong and that have continued wellbeing has been significant. In the year 2019, they have been experienced clinical to be reviewed and since the pandemic began, depression rates One of the strengths of the CCG is the the footprint around leaders within it, monitored. They provide have doubled and primary care colleagues strong and experienced clinical leaders within which community-based a means for us to and this has proved are predicting and planning for a surge of it, and this has proved invaluable over the health and social care measure and assess the invaluable over the mental health issues in the future. past year in responding to the pandemic. The professionals deliver quality and productivity report outlines the work of the South West more joined-up care for past year of the services we In this report you can read about how we London Clinical Cell established by the South our communities. This commission and inform have supported our providers to conduct West London Clinical Chair in the initial approach has helped us us where to focus our virtual consultations for IAPT and been an phase of the pandemic, to set consistent support practices and attention to improve the active partner, together with local people clinical standards, ensure consistent policies their staff to adapt to care our patients receive, and organisations from across South London, across the system, including a shared new ways of working, provide effective care working in partnership with our service in the Covid-19: Preventing a Mental Health approach to infection prevention and control. to patients in a safe environment, protect the providers. In November 2020, NHS England Crisis Summit in July 2020. Following The membership was broad across health capacity of our acute hospitals, and achieve published their annual assessments of the six this summit the South London Covid-19 and care organisations and professional huge success in delivering the Covid vaccine former CCGs in South West London, which Preventing Mental Ill Health Taskforce groups. It became a source of support and programme to people across South West continued to perform well with five out of was created, with the aim of preventing advice, as well as a forum to share best London. the six achieving a “Good” rating. In what thousands of people’s lives being affected practice for clinical leaders now working in a has been a very challenging year, we are by mental illness and to develop a long-term system, as well as in individual organisations. We have worked hard to deliver high quality pleased that we maintained our performance programme to protect our communities’ services to local people in each of our six in most boroughs. mental health. South West London CCG boroughs this year, and one achievement we has also been an active participant in the are pleased to highlight is the approval for a

8 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 9 Addressing health inequalities become NHS South West London Clinical place, and making sure we hard-wire in the the NHS, social care, care homes and our Commissioning Group. Our ambition was new collaborative ways of working we have voluntary sector will build on a legacy of Underpinning all our work is the South West for each borough to continue to bring developed with our partners, as we have trust and confidence in each other developed London CCG’s commitment to addressing together health and care leaders in a local responded to Covid-19. over the past year. We wanted to take this the health inequalities that exist across system to ensure that they remained clinically opportunity to say thank you to the staff our boroughs. This past year, the Covid-19 led and retained the ability to engage We are proud of how the South West in our CCG, staff across our South West pandemic, the death of George Floyd with and consider the needs of their local London CCG has responded during the London system, as well as our communities in the United States and the Black Lives communities. The six CCG Governing Bodies past 12 months and will continue to work for their support and patience over the past Matter movement gave us opportunities agreed that by coming together we could ambitiously for local people as we move year. for authentic conversations around race, better drive-up quality and reduce variation forward. As we move into the future, racism and wider inequalities in a way that in standards and deliver better health and has not been done before. The message we care outcomes for the people in each of our have been hearing from our communities, boroughs. clinicians and staff has been clear: we Our South West must build on our London CCG is a progress going further We must build member of South West and faster to ensure London Health and on our progress that our services and going further and Care Partnership. Last employment practices year our collaborative Dr Andrew Murray Sarah Blow faster to ensure are fair, accessible and way of working was Clinical Chair Accountable Officer that our services appropriate for the formally recognised by diverse communities we and employment NHS England, and the serve and the workforce practices are fair, partnership was formally we employ. accessible and awarded Integrated Care appropriate System (ICS) status in Delivering for local April 2020. As we reflect people whilst leading on the past year, we organisational change must also look forward and consider how the government’s White As well as working in new ways in Paper, published on 11 February 2021, responding to Covid-19 over the past year, affects the South West London CCG. Subject our staff have also been working differently to legislation, the South West London Health as a result of our CCG merger, and will and Care partnership as an Integrated continue to adapt as we move forward to Care System will become a statutory NHS the likely transition to an Integrated Care organisation, and will incorporate the System from April 2022. functions of our CCG and some from NHS England. We will support this transition and From 1 April 2020, the six borough CCGs: continue to champion what has made our Croydon, Kingston, Merton, Richmond, CCG successful, including strong clinical Sutton and Wandsworth, merged to leadership and patient voice, the primacy of

10 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 11 About us • Richmond with and consider the needs of their local South West London services. Some of the communities. A single CCG could better examples included: • Sutton support this ambition by enabling health • Wandsworth • £10.1 million for children and young Our duties and care organisations to collaborate, consider the needs of local communities and people’s mental health services to transform and improve services with partners create enhanced mental health support We are responsible for commissioning Our constitution (planning and buying) NHS services for the to deliver local health and care priorities. teams (£3.7 million in 2020/21, further to £6.4 million between 2018 and people who live and work in South West Our CCG constitution sets out our Our initial work programme for the new 2020) London. With our budget of more than £2.3 responsibilities for commissioning care South West London CCG was obviously billion the services we are responsible for for patients. It also sets out the rules and disrupted due to the Covid-19 pandemic, • £1.6 million helped new and expectant commissioning include: procedures we follow to ensure probity and but nevertheless our ambitions around mums in South West London to access accountability in the day to day running of collaborative working were realised and specialist mental health teams • The services you use in your GP surgery the CCG. This is to ensure that decisions are enhanced. • £9.9 million helped us share patients’ • Community health services taken in an open and transparent way and The national NHS Long Term Plan had also health and care records between that the interests of patients and the public • Urgent and emergency care been clear in 2019 that NHS organisations organisations across South West remain central. London and gave local people better • Hospital outpatient and inpatient should work more closely together, rather joined-up care services, diagnostics and planned You can read or constitution and than in competition: meaning the end of procedures standing orders on our website at https:// the ‘NHS internal market’ or the purchaser/ swlondonccg.nhs.uk/about/constitution/ provider split. This signalled the end to NHS We had already aligned some of our • Rehabilitation services organisations having to administer complex CCGs’ decision-making with the ‘Effective • Mental health services You can also read the Handbook to the negotiations, contract monitoring and Commissioning Initiative’ and improved some NHS constitution on our website. This payment regimes at local level, the rationale of our back-office functions by bringing • Learning disabilities services explains each right and pledge in the NHS being that a single NHS South West London them together across the six organisations Constitution and the legal sources of both CCG could re-direct this resource from with reduced management overheads but Most of the services we commission are patient and staff rights and outlines the roles bureaucracy back to frontline services for improved quality, resilience and professional provided in South West London, though we all play in protecting and developing the patients. accountability. we also commission some services from NHS. our partners in neighbouring areas. All the The six CCG Governing Bodies agreed that We believed that a merger would be better services we commission are free at the point by moving to collaboration and away from for our CCG staff – with more career Becoming one South West London of use for everybody. competition, we could better drive-up quality progression across a bigger organisation, Clinical Commissioning Group and reduce variation in standards and deliver and with more opportunities for training and Our CCG is a membership organisation better health and care outcomes for the development, as well as strengthening our made up of over 180 GP practices within NHS South West London CCG was formed people in every one of our boroughs. ability to retain our expert staff. The CCG South West London. We serve just under on 1 April 2020, in a merger of the six previous South West London borough CCGs: delivered on the commitment to engage with 1.7 million people across our six diverse We had already been working together as Croydon, Kingston, Merton, Richmond, our staff through the merger and minimise boroughs: six CCGs and agreed that it supported better Sutton and Wandsworth. Our ambition compulsory redundancies resulting from the health and care outcomes of local people. process. We had fewer than five compulsory • Croydon was for each borough to continue to bring We had also been successful in previous together health and care leaders in a local redundancies as a result of the CCG merger. • Kingston years when we had worked together as six system to ensure that they remained clinically CCGs to secure national funding for our local The CCG engaged with and discussed the • Merton led and retained the ability to engage

12 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 13 case for change for merger at CCG Governing share best practice for clinical leaders now service changes did not result in unintended advice to support the prioritisation of the Body meetings in public, with our GP working in a system, as well as in individual negative consequences for patients or for recovery programme looking at the areas members in each borough, with staff, local organisations. other health and care organisations or of greatest need. The CLG also worked authorities, provider trusts, Healthwatch and communities. During recovery, this group together to capture the learning from phase other stakeholders to design a way forward The South West London Clinical Cell was also became the Service Change Oversight Group. one of the pandemic to help prepare the together for the six CCG Governing Bodies. actively engaged with the London Clinical clinical and operational response to phase 2 Advisory Group, with the leaders being core The South West London Ethics Committee over the winter. All six South West London CCG Governing members. This role was key in collectively was established to ensure wider access Bodies agreed the ambition to become a identifying and rapidly addressing emerging to ethical decision-making support and Supporting our new Primary Care single CCG, and the six GP memberships issues in the pandemic, influencing London governance. The purpose of the committee Networks voted in favour. NHS England then approved and national policies, and ensuring they took was to assist clinical teams across South West our application to become NHS South West account of the potential impact on particular London in making difficult clinical/ethical Primary Care Networks (PCNs) brought London CCG in October 2019. communities in our boroughs, as well as our decisions in a multi-disciplinary team setting together GP practices in July 2019 to provide health and care professionals. during and beyond the Covid-19 pandemic. a wider range of services for local people. CCG clinical leadership They are now the footprint around which The Clinical Cell also supported 15 elective and the wider South South West London community-based health and social care recovery clinical networks, each led jointly West London system Service Change professionals deliver more joined-up care for The CCG delivered by acute and primary care clinicians. Review Group, Ethics our communities and have achieved huge These clinical networks were originally set One of the strengths of on the commitment Committee and success in delivering the Covid vaccine to up to support restarting elective surgical the CCG is the strong to engage with Clinical Networks around 600,000 people across South West operations and treatments, enabling primary and experienced clinical our staff through London. At the beginning of the lockdown, care clinicians and our hospitals to work leaders within it, and this the merger and The Clinical Cell also GP practices had to rapidly adapt services together to manage those patients whose has proved invaluable minimise compulsory established two sub- in response to the pandemic. The CCG operations had been put on hold and most over the past year groups during wave worked with PCNs to support practices redundancies urgently needed care. As a CCG we were in responding to the one of the pandemic: and their staff to adapt to new ways of resulting from the able to support these new networks with pandemic. a South West London working, operating a telephone triage and process experienced primary care clinicians and expert Service Change Review online consultation service model to reduce commissioning managers, ensuring a focus on South West London Group and a South the risk of transmission in GP surgeries. As the whole patient journey and coordinating Clinical Cell West London Ethics well ensuring they were able to continue patient care across different settings. Committee. providing effective care to Covid patients in The South West London Clinical Chair a safe environment, whilst minimising the The remit of the multi-professional Service established the South West London Clinical Phase 2: Becoming the South West risk of infection to all staff and patients. Change Review Group was to review, advise Cell in the initial phase of the pandemic London Clinical Leadership Group Supporting patients in this way also helped and provide mitigation for operational to set consistent clinical standards, ensure to protect the capacity of our acute hospitals. consistent policies across the system, service changes that needed to be made As the initial phase of managing the including a shared approach to infection quickly during the height of the pandemic, pandemic moved to recovery, the Clinical Many practices have told us that they are keen prevention and control. The membership was particularly to deal with infection control Cell became the Clinical Leadership Group to continue the new ways of working – for broad across health and care organisations risks and the re-prioritisation of clinician (CLG) and provided rapid clinical input into example, video conferencing – and therefore and professional groups. It became a source time, especially to bolster intensive care unit the restart work and guided the “reshape” we are working to support this to happen of support and advice, as well as a forum to capacity and provide oxygen therapy for clinical transformation workstreams. This and to encourage people to get the most our sickest patients. The group ensured any group used data and professional clinical

14 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 15 benefits. As part of this we are also working Commissioning healthcare in Croydon The key challenges we are working to with practices, clinicians, and local people to each of our six boroughs address in Croydon are: understand the barriers to consulting virtually, Croydon has over 387,000 residents and • Focus on prevention and proactive to improve access for those who need it most this is growing by around 6,000 people each care by supporting people to stay well, and make sure we are always working to help We commission health and care services year. Our population is also becoming more manage their own health and maintain reduce health inequalities. for more than 1.7 million people across diverse. Over 50% of Croydon’s residents are their wellbeing by making sure they can six boroughs in South West London. from ethnic minority groups, a figure which General practice will remain at the heart of get help early. Within each of those boroughs, adjoining rises to nearly 80% for young people under the NHS, and we are taking proactive steps neighbourhoods can be made up of very the age of 25. • Unlock the power of communities by to support resilience as we move beyond different communities, each with their connecting people to their neighbours the initial pandemic response, whilst at the own set of needs and concerns. We also Croydon has the highest population of under and communities, who can provide same time making the most of opportunities provide care to people who come into 18s in London and the third highest of over unique support to stay fit and healthy to capture all the changes that have been South West London for work or leisure, 65s. There are significant health inequalities for longer. beneficial to the NHS as well as patients to and our specialist services like cancer across Croydon – for example, compared • Develop services in the heart of the provide the best care in new ways. services at The Royal Marsden or renal to Sanderstead, healthy life expectancy in community: giving people easy access services at St George’s treat people from Fieldway, one of the most deprived areas in to joined up services that are tailored to larger geographies. Croydon, is 13 years lower for men and 14 the needs of their local community. years lower for women. Although we cover a large area, we are committed to working at place level and at Croydon Council has shown that over 2,500 Read more about the health and wellbeing neighbourhood level to make sure that the families live in poverty and we are working needs of people in Croydon and our plans services we commission for our communities, with them and other health agencies to try to develop services for people in Croydon especially those that suffer from health to mitigate the impact of this on emotional, at www.swlondonccg.nhs.uk/your-area/ inequalities, meet the needs of each mental and physical health. croydon/croydon-our-plans community and are accessible to everyone

who needs them. Compared to Sanderstead, healthy life expectancy in Fieldway, one of the most deprived areas in Croydon, is Below is an overview of the population within each of our boroughs and their health 13 years 14 years One of the fastest growing lower for men lower for women issues and priorities: populations in London

2/3 51.7% of Croydon residents are Black, Child population of adults are Asian and Minority Ethnic is the largest in London overweight or obese

1 in 23% 17 of people have two It is estimated that 76% or more long term older people always or of people living with conditions often experience loneliness depression are undiagnosed

16 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 17 Kingston • A rising number of patients with Merton • Creating a network of ‘connectors’ dementia-related health problems. to link patients to wellbeing services and activities, supporting the wide Kingston has a population of around • Cardiovascular disease and cancer Merton’s population of 206,000 is growing, community of people providing health 179,600 (2018), which is ageing but are the two leading causes of death, with an increasing number of older people and wellbeing advice. relatively affluent. The physical health of followed by respiratory disease. and an increasing number of patients people in Kingston reflects the overall with complex needs and multiple co- • Developing skills for health and care • All three major causes of death have affluence of the area, with lower prevalence morbidities. People in Merton live longer staff to encourage users of services to preventable risk factors, such as of many diseases than London as a whole. than the national average, though there are engage in healthy lifestyles and support smoking, diet, exercise and excess However, like all London boroughs, it also inequalities within the borough with people people to change their behaviour alcohol consumption. has inequalities and pockets of relative in East Merton having worse health and where required. deprivation. Kingston is also diverse, with • Last years of life are lived with a shorter lives than people in West Merton. • Delivering healthy workplaces, large Tamil and Korean populations. disability for an average of 12.7 years Merton has more patients admitted to supporting our workforce to have good for men and 15.2 years for women. health and wellbeing, knowing that The main challenges we face in Kingston are: hospital as an emergency following a fall than the London average, and more people this is good for them, and those they Read more about the health and wellbeing • An increasingly older population who diagnosed with dementia. Adults in Merton support. needs of people in Kingston and our plans require more extensive health and tend to exercise less than people from other • Embedding healthy lifestyles in clinical to develop services for people in Kingston social care. boroughs. pathways. at www.swlondonccg.nhs.uk/your-area/ • Increasing numbers of older people The key challenges we are working to kingston/kingston-our-plans Read more about the health and wellbeing living alone. Projected figures show address in Merton are: needs of people in Merton and our plans that the population will grow by 9% • A single directory for health and to develop services for people in Merton at between 2017-2027, with more very wellbeing for residents and front-line www.swlondonccg.nhs.uk/your-area/merton/ old (over 90). staff. merton-our-plans

25,000 1 in 200 29% 25% children aged 15-19 are 2,735 people living with admitted to hospital common mental of 10 to 11 year olds are children have special educational due to self-harm health conditions overweight or obese needs in Kingston’s state schools 32% 1,700 of children did of children and children with an not achieve the ‘school More than 1 in 7 adults young people Education, Health Up to readiness’ years gap are providing 50 or more 18.9% surveyed in 2019 and Care Plan 6.2 were worried or Statement of standard in life expectancy between the most hours of unpaid care a week 25,000 about the Special Education deprived and least deprived areas people have of people are predicted mental health of Needs depression and/or anxiety to have hypertension their friends Merton currently supports around The number of 17,000 people over 65 carers is predicted to 8,707 9,960 1,700 11,000 4,000 grow by over 65s people in Merton people diagnosed adults aged 18 and over 27% over 65s have a live alone living with dementia with diabetes with social care needs by 2025 long term condition

18 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 19 Richmond • Unhealthy lifestyles, as well as poor Sutton • Supporting adults with learning emotional and mental wellbeing, disabilities. causing at least a third of ill health in the Richmond has a population of just under Sutton has a population of over 204,000. • Encouraging adults to make healthy borough, with obesity being a significant 200,000 and is healthy overall. However, the The health of people in Sutton is generally lifestyle choices. issue. population is ageing and with this comes the better than for England overall, with higher • Combating loneliness and social challenge of caring for increasing numbers • Rising numbers of people with multiple life expectancy than the rest of the country, isolation among older people. of people living with multiple long-term long-term conditions – which make though there is wide variation within the conditions. healthcare less affordable. borough. • Supporting older people when they The number of local people living unhealthy • An ageing population with a significant leave hospital. lifestyles that increase the risk of disease is number of older people living alone. There are several challenges facing health rising. These include things like smoking, • Increasing numbers of patients with and care services in Sutton that we are Read more about the health and wellbeing being inactive, eating a poor diet and drinking dementia-related health problems. focussing on to improve the lives of local needs of people in Sutton and our plans too much alcohol. However, a significant • Cardiovascular disease and cancer are people. Some of the key challenges that to develop services for people in Sutton at proportion of long-term conditions are the two leading causes of death, but are affecting the ability of people to start www.swlondonccg.nhs.uk/your-area/sutton/ avoidable with the adoption of healthy an increasing burden of disease and well, live well and age well in Sutton are sutton-our-plans behaviours, which we continue to promote. suffering is also due to mental ill health. highlighted below. The main challenges we face: Read more about the health and wellbeing • Improving the mental health of young • Increasing emotional wellbeing and self- needs of people in Richmond and our plans people. esteem in our school age population, to develop services for people in Richmond • Supporting parents of children and who have very high levels of reported at www.swlondonccg.nhs.uk/your-area/ young people with special educational multiple risky behaviours and substance richmond/richmond-our-plans needs. abuse, and high levels of emotional neglect in children with affluent parents.

The rate of hospital The average mental 12% admissions as a result wellbeing score for 15 year- 16% point gap of self-harm among 10- of Sutton school pupils have a olds in Richmond is the in achieving a 'good' level 24 year olds in Sutton is special educational need Estimated 8.5% of development in reception above the London average Prevalence of obesity more fourth worst (lower than the London average) of young people aged 5-16 years than doubles between between children eligible for (but similar to England) have a mental health condition reception and year 6 in London free school meals and those not Predicted 19% An estimated Nearly increase in people with a learning 22,000 15,800 Around 65,000 disability need by 2030. The 70% 1 in 10 people provided some people have a common adults have three people have developed largest increase will be in people of adults in Sutton are level of unpaid care mental disorder, such as or more long a long-term condition aged 85 years and over physically active depression and anxiety term conditions

59% of people who use The number of social care services, and over 65s is set 72% of adult carers, say they to increase by 50% 1 in 5 Delayed transfers of 50% do not get as much social almost 2,072 people consult their GP contact as they would like care from hospital have over the of over 75 year- because they are lonely reduced significantly next 20 years residents are estimated to have dementia olds live alone

20 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 21 Wandsworth • Supporting more people living with diabetes Financial position An analysis of the CCG’s net expenditure in in community settings, enabling them to be 2020/21 is set out below. Wandsworth is London’s largest inner-city supported closer to home. borough with over 332,000 people, and has • Improving the support we provide to the This information serves as a summary £m a significantly young demographic, with the frailest older people in care homes at the end of the CCG’s annual accounts including Acute 1,379.5 highest proportion of the population (31%) of their lives. the controls assurance and auditor’s aged between 30 and 44 of any council in the • Reducing childhood obesity and risky statements. Our performance against the Mental Health 271.1 country. Many people who live in the borough behaviours. key financial performance indicators is are affluent, well educated, healthy and in work. Community Services 180.9 summarised below. However, this is not the case for everyone. • Improving mental health and wellbeing for adults. Continuing Care Services 198.4 Nearly 30% of children come from income- Income and expenditure target deprived households, and a quarter of over-60s • Supporting people living with dementia and Primary Care 492.6 are in receipt of pension credits. Life expectancy reducing social isolation. For the 2020/21 financial year, the NHS Other Programme 119.4 in deprived areas of the borough is significantly operated under a different financial lower than the most affluent areas: 8.9 years Read more about the health and wellbeing Running Costs 29.9 lower for men and 6.8 years lower for women. needs of people in Wandsworth and our plans framework due to the impact of the to develop services for people in Wandsworth Covid-19 pandemic. For the first six months TOTAL 2,671.9 The main challenges we face in Wandsworth are: at www.swlondonccg.nhs.uk/your-area/ of 2020/21 the CCG was allocated funding 1% • Improving the mental health and wellbeing wandsworth/wandsworth-our-plans in line with actual expenditure incurred, of children and young people by investing including funding for the additional costs of in new services, making it easier for young Covid-19. For the second half of the financial 5% people to access support, and reducing year the CCG received a fixed level of waiting times. funding at system level, including additional 18% funding for the expected costs of Covid-19.

52% Within this funding the CCG was set a target 7% 1/3 12% of break even by NHS England. The CCG of 15 year-olds partake achieved break even in line with target. 7% Around 2,800 primary school children are in 3 or more risky children aged 5-16 have obese or overweight behaviours including 10% mental health disorders taking drugs and alcohol Expenditure by type

Approximately The CCG was allocated a total of £2,672m 44,000 ■ Acute over 18s have a Approximately 15,000 people 19,000 to spend in 2020/21 and spent £2,672m common disorder, such have diabetes and 25,000 are carers giving a surplus of £0m. About half of this ■ Mental Health as anxiety or depression on the verge of developing it expenditure was acute services (£1,380m). ■ Community Services The other significant areas of expenditure The number of ■ Continuing Care Services people aged 65 or were mental health services (£271m), ■ Primary Care over is projected 44% community health services (£181m), ■ to increase by in the Over 10,000 older Nearly 1,400 Other Programme next 20 years continuing care placements (£198m) and people live alone people have dementia ■ Running Costs primary care prescribing costs (£493m). The CCG spent £30m on the organisation’s running costs.

22 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 23 Going concern

The accounts have been prepared on a going concern. Public sector bodies are assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as evidenced by inclusion of financial provision for that service in published documents.

Performance analysis

The South West London CCG is responsible Responding to the for coordinating the South West London first wave system response to Covid-19 and providing the link between our NHS providers, our South West London system and NHS Gold Command Incident Control Room England/Improvement London region. and South West London Cells Managing the pandemic response, ensuring vital non-Covid services remained In February 2020, the CCG, on behalf of the operational, supporting the recovery of South West London ICS, established the Gold elective services, as well as overseeing the Command Incident Control Room (ICR) for vaccination programme, has been the the NHS in South West London. Operational core business of the new NHS South West seven days a week, Gold Command reported London CCG. Below is a summary of the directly into NHS England, to support our past year’s performance. NHS leaders to manage the incident in their own organisations, and across our wider

24 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 25 Service change in South West London was As well as coordinating all hospital-based South West London NHS Gold made following the receipt of national care for people in South West London, we Incident Control Room guidance around processes during a Level 4 worked with our partners in the independent National Incident and across the country in healthcare sector to make best use of line with Emergency Preparedness, Resilience capacity in independent hospitals. and Response (EPRR) incident coordination Furthermore, we continued to make sure Clinical Acute Primary Community Supply HR Comms functions. In addition, there were changes cell cell care cell cell cell cell cell agreed at the London Clinical Advisory Group that urgent cancer patients were prioritised before being endorsed and implemented by our hospitals during this time, and the locally. Decisions on these changes were Royal Marsden Hospital Cancer Hub led made through the South West London and supported this pan South West London Clinical Cell, made-up of our most senior work. health and care system. South West London Adapting our services clinicians from each of our NHS organisations ICR worked alongside other ICRs across in South West London. They reviewed service Primary care During these unprecedented times, the capital, sharing best practice, emerging changes to ensure that the impact on patient temporary service changes to hospital, trends and lessons learnt to help manage our care was comprehensively considered. The Since the start of the pandemic, our 180 community, primary care and mental health response to the pandemic as effectively as Clinical Cell also worked with clinicians GP practices have been at the front line services had to be made to enable us to possible. to ensure that the changes made were looking after suspected and confirmed continue to provide safe services and protect reviewed and considered in our recovery Covid-19 patients as well non-Covid-19 We established seven Cells which reported patients whilst treating a high number of plan discussions. London wide changes were patients. GPs and practice staff separated into and supported the work of the ICR – people with Covid-19 symptoms. made through a clinical risk- based review by these two groups of patients either within clinical, acute, primary care, community, the London Clinical Advisory Group before each practice, or by working together across supply, HR and communications. The In South West London, our focus was to being endorsed and implemented. groups of practices to do so. Practices seven cells were made up of clinicians and increase and protect the provision of high- adapted to deliver most care through remote managers across our NHS organisations in quality frontline acute and critical care For further details on the service changes consultations either by telephone or video South West London. services for patients with the most severe please see our July 2020 letter, which was consultations, continuing face-to-face complications arising from the infection, at sent to key stakeholders, including MPs, local consultations where needed and are doing At a more local level, Local Resilience Forums the same time as ensuring the safety and borough Overview and Scrutiny Committees more home visits than ever before, working coordinated the health and care response protection of non-Covid patients. There was and the South West London Joint Health hard to avoid all unnecessary hospital for each borough. It was essential that a significant shift away from face-to-face Overview and Scrutiny Committee: admissions or journeys to A&E. each part of the system worked together to appointments towards digital and telephone https://swlondonccg.nhs.uk/wp-content/ support local people in their own homes, approaches, as well as a risk-based approach uploads/2020/07/SWL-COVID-19-Service- in GP practices, in care homes, hospices, to providing diagnostics and testing during Keeping high-risk patients out of Change-Letter-17072020.pdf pharmacies and across South West London. the height of the pandemic. We followed hospital national and regional standards and South West London CCG led work to Whilst the initial media and public focus guidelines to ensure the safety of patients, Emergency and cancer patients increase care and support for more patients was on intensive care treatment within their families, and our staff as a priority. hospitals, we continued to support and focus Our Acute Cell worked hard to make sure with higher health needs in community on primary care and community services that we could provide the right number settings. This work not only aimed to help response, as well as local communities that of intensive care, acute and general care people avoid being admitted to hospital but are equally vital in our response to the virus. inpatient services across South West London. also to help patients leave hospital faster.

26 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 27 Health and social care staff worked with four The South West London Procurement up test centres at St George’s Hospital, in Recovery and the priority groups of patients: Partnership secured and delivered equipment Chessington and at Croydon University second wave for dozens of organisations whilst the Hospital for high priority staff (for example, • Residents of care homes. national supply chain solution was being put Intensive Care Unit and Emergency • Patients who need advanced care plans in place for providers in all community care Department staff and patient facing primary As the first wave ended, we moved to support end of life care. settings, playing a vital role in maintaining care clinicians). These centres expanded into a recovery phase of managing the the safe delivery of clinical and care services. to provide testing for household members pandemic. We changed the way we • Those who are severely frail. We also established a mutual aid process of those staff, easing staffing pressures delivered health and care services so we • Individuals with multiple, complex co- for organisations that were having trouble particularly on those services that were could continue to protect and care for morbidities. procuring PPE, helping more than 180 seeing a surge in activity. local people, and to ensure we were organisations access supplies, including prepared for the second wave in the The South West London Palliative Care Task care homes, hospices and local authorities. By the end of April 2020, we were able to winter. The South West London Recovery and Finish Subgroup supported GPs, hospices Our South West London organisations also extend testing for Covid-19 to our wider Board lead this work and were clear that and community health staff, worked with worked closely together sharing supplies NHS health and care family, including social the recovery must focus on primary care, vulnerable members of our community and between organisations when stocks were care and care homes, and were able to mental health and community services as their families, to provide them with the running low. provide home testing kits. We also had full well as the acute sector. advice and clinical support, around hospital test centres operational in all our acute admission. We also made sure that patients Risk assessments were undertaken for hospitals and test centres in Chessington, Our clinical priorities during the recovery had access to end-of-life medicine packs in all NHS staff, including CCG staff, with a Twickenham, Gatwick and Greenwich. period were particularly concerned with the community to enable them to remain particular focus and priority on those who Testing became more widely available at a those groups of patients who had not been safely at home and worked with pharmacy may be most affected by the pandemic; range of test centres and in the community seeking health advice and support during the colleagues to make sure the right medicines for example, those from an ethnic minority throughout the year, including all clinical first wave and understanding why Covid-19 were available 24 hours a day, seven days background, older staff, pregnant staff or services having access to PCR tests for all had disproportionately affected people from a week. We also improved access to video those with a long term or chronic condition. front-line staff with symptoms and lateral ethnic minority groups, and those from more conferencing in care homes in South West flow testing twice a week for all staff to deprived areas. London and ensured they had the right Increasing our workforce detect asymptomatic people. equipment to care for their vulnerable Our recovery programmes residents. To help us respond to the pandemic, we were able to expand our South West London Our recovery planning continued the workforce, working with the London collaborative approach adopted in the first Protecting our staff Workforce Hub and South West London wave and has been led by national guidance. We established robust testing procedures for NHS Providers, welcoming people who had The South West London Recovery Board was staff and worked hard to make sure staff had retired or who had moved to other sectors established to: the right protective equipment at the right back to the NHS, with medical students and time. There were many practical challenges volunteers further increasing our numbers. • Define the South West London recovery in doing this and our Supply Cell worked priorities. hard across health and care organisations Staff testing locally and with national suppliers to make • Scrutinise and agree quality and clinical sure we addressed any shortfalls with PPE as Early in the pandemic we increased testing impact of changes. capacity in South West London by setting quickly as possible. • Recommend financial investment or

28 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 29 disinvestment to relevant bodies. • To work in partnership with statutory Elective recovery • Stroke bodies on recovery. clinical networks • Identify where public conversations and • Community neuro-rehabilitation consultation required and work with As we entered the recovery phase, we • Respiratory statutory organisations on this. The South West London Recovery Board was set up to be supported by eight programmes developed 15 elective recovery clinical • Determine actions to meet national of work. Each of these programmes brought networks, each led jointly by acute and Working together, the clinical networks performance targets. together health and care professionals primary care clinicians. These clinical have centralised some operations in certain networks were originally set up to support • Assess recovery risks and agree and managers from across our integrated hospitals, freeing up staff and resources at restarting elective surgical operations and mitigations. care system who are experts in their field. others to continue responding to Covid-19. Together they are working to support the treatments, enabling our hospitals to work • Drive agreed innovation forward at Our networks look at other ways they can essential work to recover, reshape and together to manage those patients whose pace. work together to improve care for patients respond to each phase of the pandemic. As operations had been put on hold and by doing things such as sharing learning, • Provide regular updates and assurance well as our recovery programmes, enabler most urgently needed care. As a CCG, we standardising clinical approaches and using on recovery to the South West London programmes continue to inform and support were able to support these new networks data in a more sophisticated way. The Health and Care Partnership. all our work across the partnership. with experienced primary care clinicians and commissioning managers, ensuring networks involve acute and primary care a focus on the whole patient journey and clinicians, community providers, medicines South West London coordinating patient care across different management professionals, mental health Recovery Programmes settings. and nursing colleagues, and allied health professionals. The South West London eective recovery clinical networks are: Increasing planned surgery

• Ear, nose and throat Mental Our clinical networks helped develop a Specialised Urgent & Planned & health & Primary Integrated Strengthening • Trauma and orthopaedics and comprehensive system-wide plan for South & cancer emergency critical care learning care care communities care care musculoskeletal West London and NHS hospitals to address disabilities the new challenges created for hospitals by • Gynaecology Covid-19. • Ophthalmology We worked through the plans on how to • General surgery Supported by Enabler Programmes do this safely and identified patient groups * Workforce * Digital * Communications and engagement * Finance and at scale * • Urology by specific health conditions and treatments * Health and care landscape * Performance and quality * Estate * • Dermatology who should be prioritised for treatment. All our hospitals were involved in this work • Cardiology to make sure that we used all our available • Rheumatology resources and capacity in South West London fairly for everyone. • Neurosciences

• Neurology Despite the added challenges the pandemic has brought, by November our four acute • Pain management hospitals were able to carry out 90% of the

30 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 31 planned surgical procedures we would have • General surgery - Croydon and What we learned from the also allow us to quickly move on to rolling done at the same time the previous year. Kingston Hospitals are supporting those second wave out a Covid-19 vaccination programme from patients waiting longer for care at St December 2020. Wherever appropriate, procedures are George’s Hospital. This second wave was different from the performed as day case surgery. St George’s first in that we were able to identify and Building on our engagement with local • Gynaecology - Croydon Hospital is the Hospital has been on stand-by to open isolate positive patients and their contacts communities over the summer, we worked hub for Gynaecology, with more than additional intensive care unit beds for much more quickly, and our treatments and hard across health and care with our local 100 patients from Epsom and St Helier extremely sick patients with Covid-19. To outcomes for patients were better as we communities and voluntary sector to engage being offered the option of having their help them do this, Croydon, Kingston, St understood more about the disease. our communities and encourage uptake. surgery at Croydon Hospital rather than Helier and Epsom hospitals stepped-up waiting longer for treatment closer to specialty planned surgery. St George’s has Despite being better prepared and more By December 2020, we had flu-vaccinated home. continued to carry out a high proportion experienced, the second wave was still a over 300,000 people in South West of complex planned surgery on site, and • Ear, nose and throat - Patients who challenge, with this second surge in cases London, including 220,000 people from hundreds of patients under their care have waited longer than a year for an adding to existing winter at risk groups, more have successfully had their treatment appointment at St George’s have been pressures. Our health than 70,000 school at neighbouring Croydon and Kingston offered an appointment at Kingston and care staff worked children and over Supporting our care Hospitals. Hospital. incredibly hard to support 16,000 health and care local communities with homes to be able staff. This made us the As part of national plans, dedicated surgical the pressures of winter, to receive patients highest performing hubs for non-urgent operations have been Supporting discharge Covid-19 and recovering back from hospital CCG in London for flu set up to see more patients quickly and from delayed care during when they are well vaccination. During the second wave, the main challenge helping to reduce waiting lists: the first wave of the to patient flow through South West enough is a vital pandemic. part of making sure Improving discharge • Orthopaedics - South West London London hospitals has been the availability from hospitals and Elective Orthopaedic Centre (SWLEOC), of appropriate beds. As the number of November 2020 saw our hospitals have working with care has expanded capacity to include an Covid-19 patients being admitted increased, the national roll-out of capacity to treat new homes additional theatre seeing, allowing the infection prevention and distancing lateral flow testing kits patients measures restricted bed availability. We also them to treat an additional 125 for our front-line staff, Our primary care teams saw an increase in the number of patients patients a month. which helped reduce have worked with being readmitted and more patients having some of the staffing • Ophthalmology - Moorfields, based at partners to develop to stay in hospital for more than 14 days in pressures that our services had been subject St George’s Hospital and Epsom and St the South West London Intermediate Care both intensive care and on general wards. to, particularly in our hospitals. Helier Trust, have increased the number Pathway, which is helping is us work better This significantly impacted on patient flow. of cataract operations to around than ever with our partners across South 800 operations each month. All four We responded to these challenges by Seasonal flu vaccinations West London to support patients who have Hospitals continue to offer cataract commissioning additional high intensity different levels of care needs and discharge Together with our health and care partners, surgery. rehabilitation beds and increased capacity them safely into the community. This is the South West London CCG launched a helping us to make sure that acute hospital • Urology - In October 2020 Epsom for continuing healthcare assessments and comprehensive flu programme. With the beds are available for the patients who need Hospital became a pilot surgical hub redirected teams to support discharge. risk of both flu and Covid-19 circulating at them most. for urology surgery for Epsom, St Helier wintertime, it was more important than ever and St George’s patients. for those most at risk to get vaccinated, and Supporting our care homes to be able to

32 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 33 receive patients back from hospital when with 11 beds in February 2021. Care home Four workstreams have been identified: campaigns. they are well enough is a vital part of making patients are moved to the TADD temporarily sure our hospitals have capacity to treat new after being discharged from hospital, • Commissioning of Healthcare One of our clinicians’ major concerns for the patients. We have supported care homes in returning to their care home after having Innovation – developing new health service during the pandemic has been South West London to begin using NHS mail, a negative test for Covid-19. This initiative technologies, policies or services to help the knowledge that there are some people which has accelerated the discharge process has supported our hospitals and care improve people’s health. who may have worrying cancer symptoms who are still not contacting their GP. for patients from hospital back to their care homes release bed capacity where it was • Population Health Management – using homes. This is because patient identifiable needed and protected vulnerable care home current and historical patient data During the summer, there was a 20% information like medical records can be residents. and insights to shape and develop the decrease in the number of people being transferred securely through this system. In services we provide. referred to cancer services. Alongside this, the past, care homes had not been able to Transforming outpatient services • Digital Enablement – making sure that there was a significant delay in people receive this information electronically. all our health and care organisations receiving cancer screenings due to the Before the pandemic, work was already are using the right digital technologies pandemic, especially for breast cancer. We have also been working with local care underway between our GPs and Trusts to homes to make sure that they are using the and infrastructure to meet the needs of give patients greater control in how they Cancer referrals have increased as the year NHS England capacity reporting system, healthcare professionals and patients. manage their own conditions and access has gone on, though we are not back to as a London wide view of bed capacity in • Workforce Evolution – making sure that clinical support – including offering pre-pandemic levels yet, suggesting that care homes supports faster discharge from our health and care staff understand more remote outpatient appointments there are potentially many people in the hospital and avoiding admission where our plans and have the skills to use new to save patients time and to reduce the community who are not receiving the care possible. technologies in their day-to-day work. environmental impact of our services. and treatment they need. In response to this, From March 2020 this work accelerated, During the second wave, the main challenge we have increased communications activity with thousands of GP and outpatient to patient flow through South West The ‘NHS is here for you’ during to encourage people to attend screening if appointments available over the phone London hospitals has been the availability lock-down they are invited and to talk to their GP if they or online, helping the NHS to remain of appropriate beds. As the number of have worrying symptoms, reassuring them open while keeping patients and our Covid-19 patients being admitted increased, Reassuring local people that the NHS remains that GP practices are safe and reminding staff safe. the infection prevention and distancing open and is here for them if they need people that many appointments are now it has been a key part of our work since available over the phone or by video call. measures restricted bed availability. We also We have worked hard to improve the the pandemic began, with a focus on GP saw an increase in the number of patients compatibility of the digital systems used services, mental health services, attending You can view the ‘Keeping You Safe’ films being readmitted and more patients having in primary care and hospitals so they can hospital appointments and keeping safe. for each of our boroughs on our website at to stay in hospital for more than 14 days in communicate more effectively and make sure We saw in the first national lockdown a www.swlondonccg.nhs.uk/your-area both intensive care and on general wards. that patients receive the appropriate services drop in those accessing health services as and treatments, whilst also having access We responded to these challenges by local people were reluctant to put additional The mental health impact of the to digital self-management tools. A revised commissioning additional high intensity pressure on the NHS or risk potentially pandemic Outpatient Transformation Programme has rehabilitation beds and reintroducing contracting the virus from a health setting. been launched to undertake a review of continuing healthcare assessments and Throughout the year we have continued to We have supported and worked with South the digital systems in place and develop teams to support discharge. reassure local people through community West London and St George’s Mental Health solutions to meet the needs of both patients and stakeholder engagement and have run a Trust and with South London and Maudsley and clinicians, while addressing health We established a new Temporary Alternative series of innovative social media campaigns NHS Foundation Trust to understand the inequalities. Discharge Destination (TADD) care home to support national television and advertising mental health impact of the pandemic.

34 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 35 Across South West London, our collective We are continuing our work looking at ways patients, young people from local schools identify key issues that need addressing. NHS response to the mental health impact of the that South West London can respond to any and partners from Local Authorities, South West London CCG has supported and Covid-19 pandemic has been: increase in demand for services as a result education and voluntary sectors. been an active participant in South London of the on-going pandemic and as part of Listens. More than 5,000 people have taken • Keeping mental health services our recovery work. This has included virtual Following this summit, the South London part in the initiative, and the partnership accessible and trauma-informed. consultations for IAPT and the South West Covid-19 Preventing Mental-ill Health is now working with local people and Taskforce was created with the aim of • Continuing to plan for surges in London St George’s Recovery College - the community groups to co-produce solutions preventing thousands of people’s lives being demand. UK’s first mental health recovery study and that will be published as part of a two-year training facility providing a range of courses affected by mental illness and to develop action plan in Summer 2021. • Supporting primary care to continue and resources for service users. a long-term programme to protect our delivering good mental health care. communities’ mental health. The Taskforce Children and young people’s mental We are considering whether the right is made up of representatives from NHS • Prioritising our most vulnerable. health services are in place to support people with South West London CCG, South London • Strengthening mental health needs or and Maudsley NHS Foundation Trust, South families, The CCG, working with the South West learning disabilities (or West London and St George’s Mental workplaces, London Health and Care Partnership, has both) and transforming Health NHS Trust, Oxleas NHS Foundation communities. made children and young people’s mental In the year since services where we Trust, local authorities, Healthwatch, Public health and well-being a shared health • Meeting basic the pandemic need to do more. It will Health England, Citizens UK and experts by promotion and prevention priority. Our aim needs. began, depression also be very important experience. The taskforce identified six key is to improve children and young people’s that we ensure that themes and areas for action: rates have doubled mental health by starting earlier and giving It is important that we inequalities for these and primary care them the skills, they need to be resilient and ensure people with residents are not • Social isolation, loneliness, and colleagues are thrive. mental health needs worsened as a result of community involvement. predicting a surge of or a learning disability Covid-19. • Helping people who are at risk of losing We have listened to young people, their receive the same mental health issues their jobs cope. families, teachers, and frontline professionals protection and support in the future to develop a ‘whole school’ approach. This Preventing a Mental • Housing insecurity and environment. with managing their Health Crisis - South approach brings together school leaders with health and wellbeing London Listens • Supporting disadvantaged communities health and social care professionals to deliver during the pandemic as and groups. training and support for children and young other members of the NHS South West London • Supporting families, children, and people, their families, and teachers. The population. CCG has come together with people with young people. programme has been running since 2018, lived experiences and partner organisations gradually extending to more schools across The impact of Covid-19 on our communities’ from across the whole of South London. • Developing a long-term, joined-up the patch. Watch our video about our whole mental wellbeing has been big. In the year In July 2020, the South London Mental approach to prevention. school approach to children and young since the pandemic began, depression rates Health and Community Partnership hosted people’s mental health. have doubled and primary care colleagues the Covid-19: Preventing a Mental Health In November 2020, the South London are predicting a surge of mental health issues Crisis Summit, which was attended by more Mental Health and Community Partnership The pandemic has had a significant impact in the future. We also know that Covid-19 than 400 people. Attendees joined expert launched South London Listens, a major on the mental health of children and young is having a disproportionate impact on our panels, which included people with lived listening campaign which aims to find out people. Lockdown and schools being people from ethnic minorities. experiences, clinicians, commissioners, how Covid-19 has specifically affected the closed have created challenges including mental health of South Londoners and to fears of infection, parental issues such as

36 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 37 unemployment, and potential trauma, Communities (EPEC) hubs have been acute trust emergency departments, police, • Croydon: www.slam-iapt.nhs.uk such as in cases where domestic violence is established in all South West London London Ambulance Service and NHS 111. • Merton Uplift: prevalent. boroughs. These are evidence-based, www.mertonuplift.nhs.uk parenting support hubs running Improving Access to Psychological In response to the challenges of the • Sutton Uplift: www.suttonuplift.co.uk developmental (children, young people Therapies and Wellbeing services pandemic, mental health services have and infants) and specialist (parent (IAPT) services • Talk Wandsworth: maintained business as usual whilst conflict, ASD, AHDH, parent mental www.talkwandsworth.nhs.uk adapting as necessary, often with the use of health) parenting programmes. Parents Improving Access to Psychological Therapies • Kingston: www.icope.nhs.uk/kingston technology. This has enabled mental health receive training and accreditation to and Wellbeing services (IAPT) offer a range services not only to support children and become ‘parent group leaders’ and of talking therapy options to help manage • Richmond: young people but also to empower teachers go on to provide parenting courses symptoms of stress, worry, and low mood www.richmondwellbeingservice.nhs.uk with the tools they need to support their and support to parents in their local and to build emotional resilience. IAPT students. Across South West London we now communities. The hubs have been services provide specialist interventions and have: operating virtually during the pandemic. support including one-to-one support to help people with stress-related problems, • 10 mental health support teams • Conducted welfare checks to identify anxiety disorders, depression and trauma. supporting children and young people vulnerable children, resulting in children IAPT can also help anybody needing more throughout the pandemic. who would otherwise not have been specialist support access the help they need. flagged up being identified. • An online counselling service to support Following an initial assessment over the children and young people at home. telephone, therapies are provided either Anyone between 11 and 22 years old Increasing mental health virtually (telephone or video calls) or in GP can access Kooth for free 24 hours a day, emergency services surgeries or community venues across South 365 days a year at www.kooth.com. West London. On 30 March 2020, South West London and • Launched a website providing details St George’s Mental Health NHS Trust opened IAPT services have adapted this year to of where children and young people a new emergency service for patients with accept referrals for NHS staff for treatment can access additional support www. primary mental health problems who would regardless of whether they are registered swlondonccg.nhs.uk/your-health/ otherwise have had to go to A&E. The Orchid with a GP in the same area as the IAPT mental-health/covid19-resource-hub. Mental Health Emergency Service (MHES), service they wish to access. This approach • Delivered online workshops for children based at Springfield University Hospital, is has been taken to remove barriers to staff and teachers. an alternative to acute hospital emergency accessing mental health support during departments, enabling patients to attend a • Conducted one-to-one telephone and this challenging time and means that staff dedicated MHES set up specifically for this video call sessions with children and working in South West London will be able purpose. The service accepts patients of all young people. to receive treatment in the borough where ages, including children. they live or work. • Launched new 24-hour urgent mental health support lines for all boroughs: A screening process must take place before More information about these services we Croydon 0800 731 2864, all other south patients are referred to the service, to ensure commission can be found on the local IAPT west London boroughs 0800 028 8000 any physical health problems do not require websites: urgent medical attention. Organisations that • Empowering Parents, Empowering can refer patients to these services include

38 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 39 Covid-19 vaccination the world against Covid-19 on Tuesday 8 helping us to vaccinate eligible residents • Hawks Road Health Clinic in Kingston December 2020. At the start of January, alongside health and care staff, not only programme • Centre Court Shopping Centre in eight acute, community and mental health increasing capacity but also choice for local Wimbledon, Merton hospital-based centres in South West London people. As established community hubs The roll out of the Covid-19 vaccination expanded their vaccination clinics to become, with excellent transport links, these centres • Plough Lane football stadium in has been the biggest logistical challenge in some cases, seven day a week services to crucially make it easier for people who have Wimbledon, Merton faced by the NHS in its history. protect more people faster. Focusing on front had to continue to travel for work during the • Harlequins Stoop Stadium in line health and care workers, hospitals also pandemic to be vaccinated. All nine of our Twickenham, Richmond Building on our successful flu programme offered the vaccine to those in the eligible community vaccination sites opened by the • St Nicholas Shopping Centre in Sutton we quickly established the Covid-19 cohorts beginning with the over 80s. end of March 2021: vaccination programme with hospital hubs, • Battersea Arts Centre in Battersea, GP led vaccination centres and community Outside of the large hospitals, GP practices in • Centrale Shopping Centre in Croydon Wandsworth vaccination centres opening up across South South West London worked together in 39 • Selhurst Park football stadium in Crystal • Queen Mary’s Hospital, Roehampton in West London, complemented by an outreach Primary Care Networks to deliver the vaccine Palace, Croydon Wandsworth and roving model vaccinating care home to people in the community. The Primary residents and staff, as well as people in their Care Networks are delivering vaccinations own homes across out six boroughs. at 25 dedicated vaccination sites across the patch. Some of these sites are GP practices, We delivered more than 500,000 but many are based in community settings, vaccinations in the first 15 weeks of the like local health centres, churches and programme. community halls. We have supported these centres with a series of pop-up vaccination More than 566,741 South West London clinics across South West London in residents have received their first dose, and mosques, temples, churches and community more than 72,993 of those residents have centres to help reach further into those had their second dose at time of publication communities with lower uptake. as of 1 April 2021. All vaccination centres are led by local GPs As we move forward with the Covid-19 and practice nurses and are running on top vaccination campaign, we are keen to Engaging local communities authorities and funded the voluntary sector of business-as-usual GP practice services. This maintain the momentum as different age to reach deep into communities to engage means most primary care vaccination centres groups become eligible for the vaccine. Our South West London CCG engagement with different groups and have conversations are vaccinating three or four days a week. Up Making an appointment is quick and simple team has been working with key community and inform people about the vaccine. until March 2021, GP-led vaccination centres at nhs.uk/Covidvaccine, whilst those that groups at borough level to help inform have delivered over 70% of all vaccinations can’t use the internet can phone 119 to people in areas where uptake has been In each borough we have developed a in South West London. book their vaccination. low, to reassure them the safety of the bespoke engagement plan with our partners, vaccination and to dispel myths that to engage with communities with lower In February 2021 we started the roll out of St George’s and Croydon Hospitals were circulate on social media. More details uptake and used the vaccine data to inform several community vaccination centres in amongst the UK’s first vaccine hubs, and of this engagement can be found in the where we locate pop-up vaccination clinics places not normally associated with health Croydon safely secured its place in history engagement chapter of this Annual Report. and focus our activity. The communications and care, like sports stadiums and shopping by vaccinating one of the first people in and engagement plans for each of our six centres. These new sites play a key role in We have worked closely with local

40 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 41 boroughs are on our website at You can find details of each borough’s Health An overview of the work in Croydon www.swlondonccg.nhs.uk/Covid each of our six boroughs from and Wellbeing Board on the local authority websites: An example of how we worked and the past year Croydon has been one of the areas most are still working together, is in Croydon Croydon: affected by Covid-19 in the capital. The where, with the ‘Croydon BME (Black and Health and Wellbeing Board | Croydon council strength of our response has been built on In summer 2019 we published local Health Minority Ethnic) Forum’ and ‘Asian Resource the commitment of our workforce and the and Care Plans for each of our boroughs. Centre’ and other borough partners we Merton: success of our partnership working in the These plans were developed over more held community conversations to give Merton Health and Wellbeing Board borough. than 18 months by local people and local people the opportunity to put their (mertonpartnership.org.uk) health and care staff, helping us to make questions to a panel of experts including ‘One Croydon’ is our borough level sure that the plans are centred around the Kingston: Dr Agnelo Fernandes, Dr Nnenna Osuji and partnership between the NHS in Croydon, people who use our services, rather than Kingston Council – www.kingston.gov.uk Rachel Flowers, Croydon’s Director of Public Croydon Council and Age UK Croydon, the organisations that provide them. Health. Over 600 people from our diverse originally set up to help tackle the challenges Richmond: communities attended the first four online of an ageing population but now working to The Health and Care Plans support delivery Health and Wellbeing Board - London meetings, with more targeted engagement integrate health and social care for people of each borough’s Joint Health and Borough of Richmond upon Thames sessions held, including for care home and of all ages across the borough. Uniquely Wellbeing Strategy (JHWS), developed by domiciliary staff and Age UK’s Personal for the local NHS, we also have a single the Health and Wellbeing Board, to meet the Sutton: Independence Coordinators and Healthy management team across Croydon Health health needs identified in the boroughs’ Joint Committee details - Health and Wellbeing Living team. We have seen the success Services NHS Trust and the borough team Strategic Needs Assessment (JSNA). Each of Board - Sutton Council of this work, with increasing numbers of of the CCG, led by Matthew Kershaw, our our locality executive directors and clinical people from groups of people who were Wandsworth: place-based leader for health. chairs represent their borough on the local more reluctant or concerned about being Wandsworth Health and Wellbeing Board - authority Health and Wellbeing Board along vaccinated in the early days coming forward Wandsworth Borough Council with representatives from local NHS acute, Croydon’s Elective Centre – a ‘hospital to receive their vaccination. mental health and community providers, within a hospital’ The South West London CCG’s work in each Healthwatch, community and voluntary You can help us encourage vaccine uptake borough for the past year has been primarily The Croydon Elective Centre (CEC) at sector and other partner organisations. by directing friends and family to reliable, focussed on supporting the response to the Croydon University Hospital provides a Covid verifiable, and up-to-date sources of Covid-19 pandemic. Below is an overview for You can read the Health and Care Plans for safe zone for planned care and treatment. information, including our website each borough that outlines how each CCG each borough on our website at With restricted access to other parts of the www.swlondonccg.nhs.uk/Covid and our borough team has worked with local health www.swlondonccg.nhs.uk/your-area by hospital, the CEC provides robust infection NHS social media channels. and care partners to support and provide clicking on the name of the relevant borough control and Covid screening of patients care for our communities. and then clicking the Our plans link. and staff. This has put Croydon in a good position to avoid increasing further delays for From April 2021 we will be refreshing our patients for their elective care. The centre has Local Health and Care Plans in each borough, meant that: building on our collaborative working during the past year and what we have learned • More than 3,700 activities are currently about how we provide services for our ongoing at Croydon University Hospital communities, particularly those who suffer delivered within 18 weeks. from health inequalities.

42 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 43 • Relatively small numbers of patients of hospital. Working together, the hospital, pandemic, connecting people with the supportive environment for people waiting more than 52 weeks, but community teams, public health and GPs support services in their neighbourhood, experiencing a social mental health we recognise the impact this has on work to identify people in our community including housing and benefits support. crisis as an alternative to using other individuals. who need support after experiencing Social isolation referrals have increased to the crisis services. The service provides both Covid-19. This includes care for patients team during lockdowns. face to face and telephone and digital • We are working collaboratively across that had prolonged stays in intensive care or support depending on a client’s needs. South West London to maximise our mechanical ventilation and coordinated care The next stage of the ICN+ programme is to skills and capacity to safely care for for people who have developed respiratory work with our staff and services to develop people in the shortest time possible, Ground-breaking Croydon partnerships problems after Covid-19. By increasing GP and implement the multidisciplinary teams in whilst safely continuing to treat people recognised in national awards access to hospital consultant expertise, each of Croydon’s six localities. with the virus. including renal, neurological, cardiac and Croydon’s ground-breaking partnerships haematology, patients are better supported Mental health were praised in a prestigious national awards NHS 111 First and together we are planning to include ceremony in March therapies, rehabilitation and psychological Improving care and 2021, which celebrates Croydon was one of the first in London to services that match our local population’s support for mental health excellence in health and pilot a new approach to make it easier for needs. patients in Croydon Croydon’s care services. The 2020 people to access urgent and emergency Hospital’s Emergency ground-breaking HSJ Awards were held care – just by contacting 111 first. ‘NHS Department and in the Integrated Community Care virtually for the first 111 First’ is a national initiative that aims to community has been a partnerships Networks + (ICN+) time to recognise the support people to access the right care first focus over the last year. were praised in a dedication, innovation time, reduce A&E waiting times and protect We are working closely prestigious national Integrated Community Networks are a new and teamwork in what patients and staff from Covid-19, with fewer with our partners in awards ceremony in model of care that bring together teams of has undoubtedly been people in waiting rooms for safe social mental health trusts to March 2021, which professionals from across health, social care one of the toughest distancing. NHS 111 can book appointments find better solutions to and the community and voluntary sector to celebrates excellence years for health and directly to services across the borough, increasing demand for provide better, more joined up services for in health and care care workers. The depending on clinical need including set mental health in our Croydon patients. Our priority in Croydon services borough was highly times of arrival in A&E and the Urgent borough. Some of the is to provide proactive, preventative care commended in two out Treatment Centre, a same day call back from actions we have taken in community settings, so that people can of three nominations GP or local pharmacists for urgent repeat to ensure people with be supported to live at home for longer for patient safety and prescriptions and advice. mental health needs get and lead healthier, happier and more for leading changes to local health and care the support they need include: independent lives. services to provide more joined-up care Supporting local people with • Mental Health Assessment Unit at and support. Croydon Health Services NHS ongoing symptoms following Croydon’s first Integrated Community Care Croydon University Hospital for people Trust was highly commended for patient coronavirus Network team came together in the North safety through a new system that allows East Locality in July 2020 and includes social who have a physical and mental health clinicians to closely monitor and care for Croydon Health Services now provides workers, community nurses, occupational need, but who do not need emergency patients with and without Covid-19, to keep multidisciplinary support for GPs to help therapists and physiotherapists, personal care. people safe from the virus. The One Croydon care for those recovering post-Covid. This independence coordinators, mental health • The Recovery Space, hosted and run by Alliance was also highly commended for service aims to help people recover at home, support, pharmacy supports. Drop-in MIND Croydon, opened in September the System Leadership Initiative of the Year, keep them well and, where possible, out clinics have been held virtually due to the 2020. The space provides a safe, beating more than 1,000 entries to make it

44 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 45 to the final few. This award acknowledges by the Joint Committee on Vaccination • Enhancing rapid response services Merton and Wandsworth organisations that are working together to and Immunisation (JCVI) on 15th February. tackle health inequalities and provide better After extensive engagement with local Rapid response teams help support people in their own home or care home. To strengthen quality care. communities, it became clear that we Supporting patients with complex needs the service, GPs and social reablement teams needed to take the vaccination to additional in their own home worked even more closely with the service Delivering the Covid-19 vaccination venues - where the community were already provided by Central London Community programme in Croydon going - to encourage the uptake of the During the pandemic, keeping vulnerable vaccine amongst lower uptake groups. patients safe at home was more important Health (CLCH), our community service Croydon secured its place in history by From March 2021, our GPs, nurses and than ever and could only be achieved by provider. This enabled patients to have access vaccinating one of the first people in the pharmacists worked with local community health and care services working closely to up to 24-hour care in their home. world against Covid-19. Croydon resident groups and faith leaders to set up pop-up together. Over the past year, we continued to and long-standing NHS volunteer, George clinics at the Croydon mosque, His Grace develop integrated health and care support • Enabling patients to leave hospital and Dyer, aged 90 from Norbury in South Evangelical Church, Nightwatch Food for the most vulnerable individuals in Merton go home sooner London, received the injection at Croydon Kitchen, the Sakthy Ghanapathy temple, and Wandsworth by: University Hospital on Tuesday 8 December Centrale shopping centre, Selhurst Park In March 2020, at the start of the pandemic, health and social care teams across Merton 2020. Beginning in November 2020, Stadium and Turning point’s Lantern Hall • Supporting patients at risk of and Wandsworth set up discharge hubs Croydon GP led Primary Care Networks set centre for the homeless. These walk-in unplanned hospital admission up vaccination sites at venues across the clinics, where no appointment was needed, to enable people to go home sooner from borough to offer vaccination to those most have helped us to encourage more people Each GP practice (in Merton and hospital. Discharge processes were simplified, at risk of catching Covid-19. Vaccinations to take the vaccine amongst hesitant and Wandsworth) moved to meeting community and detailed care assessments were were successfully delivered to people in the harder to reach groups. health and social care colleagues virtually, to undertaken in the patients home rather than first four priority groups (cohorts) defined focus on how to support patients at most in hospital. risk of hospital admission and keep them at From January 2021, health and care home. We extended the Living Well service professionals in Merton and Wandsworth with Age UK which offers intensive one-to- worked together to identify patients who one support for older people with complex would benefit from leaving hospital sooner needs, and we proactively identified those in than was usual if they had the right support need of additional support. in place. To enable this to happen, GPs, hospital consultants from St George’s • Reducing isolation and maintaining Hospital, community health teams and independence CCG managers met every day in a “virtual ward round” to discuss patients who could Merton and Wandsworth Voluntary Services move out of hospital safely into the care of established a Community Response Hub in community health and care teams. These each borough to help isolated households patients were transferred home with a care and those at risk from Covid-19, helping package, which was assessed once they were with shopping and basic supplies, telephone home. befriending, access to prescription and medication, advice and practical support to The team looked at patients with and stay active and independent at home. without Covid-19, for example targeting

46 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 47 patients with heart failure, diabetes, and In December 2020, we opened a new of a single South West London wide service, them all the vaccine by 15 February. complex care needs. enhanced primary care service run by GPs with local delivery where appropriate, for and specialist urgent care nurses. This was patients also accessing local primary care, From March 2021, our GPs, nurses and pharmacists worked with local communities • Moving Covid-positive patients to a pilot scheme that provided safe, bookable social prescribing, IAPT and social care and faith groups to set up clinics in various dedicated care homes same day or routine appointments, initially support. for patients registered with a Wandsworth community locations to bring vaccinations During the pandemic, patients with Covid-19 GP and then for Merton registered patients. At a Merton and Wandsworth level we have closer to local people. Pop-ups were run at but no longer needing hospital care were The service will continue to run for a further developed a model based on a partnership New Horizon Centre Pollards Hill, Mitcham transferred to dedicated care homes to six months from April 2021, so that it between primary care, our community Family Practice, Colliers Wood Community complete their period of isolation. These can be fully evaluated, and the views and services provider and the acute hospital to Centre, Baitul Futuh Mosque, Salvation Army are called dedicated temporary alternative experiences of local people gathered, to provide an accessible and effective service. Centre, St Mark’s Church Mitcham and Shree discharge destinations (TADDs) and provided influence any future developments. Local GPs will be able to refer patients into Ghanapathy Temple all in Merton and Fazl a setting where patients could continue their a single point of access which will provide Mosque in Wandsworth. These clinics have recovery before going to their own home Other developments at QMH from spring an integrated response, enabled us to reach or care home. Working with nursing home 2021 were a large Covid-19 vaccination with care coordinated groups in the population staff and CLCH, Merton GPs and all borough site, which opened on 15 March 2021, and between a number In just six weeks who have had lower four new modular operating theatres, with of different services take up of the vaccine social care colleagues helped to establish and from the end construction beginning at the end of March depending upon the and have so far proved support two TADDs. of November 2021. The modular operating theatres and needs of individual successful in getting vaccine hub will enable the NHS in South patients. In addition 2020, our GPs set more people to take the Services at Queen Mary’s Hospital, West London to ensure patients receive the to services provided up vaccination vaccine. Throughout Roehampton treatment they need and give local people by doctors, nurses and sites across both the programme, our The Covid-19 pandemic meant that the NHS additional convenient access to the Covid-19 therapists there will be boroughs and from engagement team needed to make radical changes in the way vaccination. links to IAPT services, December 2020, worked with GPs and services work, to ensure patients and staff social care and the started to call the pharmacists and local were as safe as possible. Post-Covid-19 plans for Merton and voluntary sector. most vulnerable councils to talk to different groups and Wandsworth eligible people for As part of the response, the decision was This will be supported communities online their vaccinations taken to temporarily close the Urgent For some people, Covid-19 can cause with a public facing through virtual meetings Treatment Centre (UTC) at Queen Mary’s symptoms that last weeks or months after communications and and events, answering Hospital (QMH). This was because of the infection has gone. This is known as engagement plan. questions to help insufficient space and workforce to separate post-Covid. The London Clinical Advisory address the concerns walk-in patients with respiratory symptoms Group has published guidance to support the Delivering the Covid-19 vaccination of many people about the vaccine. You can from others attending QMH. management of post-Covid which is to be programme in Merton and Wandsworth read more about this engagement on our implemented at an Integrated Care System website as well as in the Merton Patient While the service was closed, the NHS level. In just six weeks from the end of November and Public Engagement governance and locally worked with Battersea Healthcare 2020, our GPs set up vaccination sites across assurance section. Community Interest Company (the Across South West London we are both boroughs and from December 2020, Wandsworth GP Federation), and St George’s implementing a networked approach – started to call the most vulnerable eligible Hospital NHS Trust to look at options for a centralised where necessary and local where people for their vaccinations, rapidly working service on the site over the coming winter. possible. This aims to achieve all the benefits through the first four cohorts and offering

48 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 49 were started along with a focus on falls The campaign targeted messages to the pandemic, the campaign continues to Kingston and Richmond prevention, reablement (short-term care at areas and groups that Kingston Hospital encourage more people to call NHS 111 for home) and end of life care. data showed use A&E most. A paid for social advice if they think they need to go to the Enhanced support to care homes media campaign focused on communities emergency department. Temporary Alternative Discharge Destinations within a two-mile radius of Kingston Hospital (TADDs) have been identified as short-term During the year, a number of initiatives and a one mile radius of Teddington Urgent Delivering the Covid-19 capacity, so that care home residents who were introduced to better support staff and Treatment Centre, with extra messaging in vaccination programme in Kingston are Covid-19 positive can be discharged residents in care homes in Kingston and in the area within half a mile of Kingston A&E. and Richmond Richmond. from acute hospitals to safely isolate before returning to their care home. Our engagement team held a series of Starting from the end of November 2020, A project manager worked with care home events with key groups such as parents of GP-led Primary Care Networks set up South West London CCG has also formed staff to enable them to take vital signs and young children, older vaccination services a new infection prevention support team to recognise early signs of deterioration. This people and carers, to (three in Kingston and to support care homes to answer queries early signs of deterioration work is supported promote NHS 111 and six in Richmond) offering related to infection prevention and control, Kingston and by a wider remote monitoring workstream, reassure people with any the vaccine to those to share best practice tools and to offer so that healthcare professionals can be concerns. Richmond have most at risk of catching training and support where gaps are notified automatically of any concerns, and some of the highest Covid-19. Kingston identified or where there has been an We also worked with to respond accordingly. vaccine uptake Hospital also opened a outbreak in the home. our local authority rates in South West vaccination service for iPads have been made available to all and voluntary sector London and we are staff and patients in care homes to enable them to hold Through the Covid immunisation partners to put campaign December. video consultations with health and care programme, large numbers of care home materials – posters, flyers already working on residents and staff in Kingston and Richmond messaging, events professionals, access NHS mail, connect care and adverts – on display In late January, Kingston have been vaccinated. home residents with loved ones remotely, in schools, estate offices and materials for opened South West and to get direct access to any other tools and council-owned younger people London’s first large or systems needed to support the care of New NHS 111 service and behaviour advertising hoardings in as the programme vaccination site at the residents. change campaign areas we know use A&E moves down the age Hawks Road Clinic. A most across Kingston and cohorts second large site at We have supported two population health A new service offering booked appointments Richmond. the Harlequins Rugby fellows in a project developing multi- in A&E was launched as part of local Ground opened in early disciplinary team working with care home and national plans to reduce pressure GPs were asked to February. staff in Kingston and Richmond. Advance on emergency hospital services and help make sure our standard care planning and training for care home manage social distancing within the messaging text was on their websites and Working together with council colleagues staff are other facets of this project. emergency department. the heads of the Local Pharmaceutical we have promoted the vaccine to key Councils in each borough asked their populations, which include residents from The Primary Care Network enhanced We have supported the launch with a members to display materials. Parents of ethnic minorities, those with learning service was launched, involving weekly communications and engagement behaviour children in school in each borough also disabilities and younger people. We multidisciplinary primary care “rounds” change campaign encouraging people to received a message about NHS 111 via the produced a range of different materials and addressing medication reviews and holistic “Think NHS 111 First” if they think they Achieving for Children newsletter. messaging for these groups. care. In association with this, health might need to go to A&E. and social care multi-disciplinary teams Following the second surge of the Covid-19 At the same time and throughout the

50 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 51 programme, our engagement team has themselves using a range of options – from discharge from hospital or the management Expanded primary care services worked with GPs and pharmacists and the simple information to regular monitoring and of patient risk that can be handled in the local councils to talk to different groups and management. community and primary care. Additional capacity was established at communities online, through virtual meetings short notice during the peak of Covid-19 and events, answering questions to help Two anticipatory care pilot practices started As a result, patients can be kept longer in surges to help direct patients away from the address the concerns of many people about work looking to proactively support a cohort hospital longer than is clinically required and emergency department over weekends and this new vaccine. whose health and social needs, while not are admitted into hospital because teams through to 8.30pm during the week. currently at the top of the pyramid of need are unaware or have difficulty in accessing Kingston and Richmond have some of the now, are likely to escalate to that in the community alternatives. Post Covid-19 plans for Kingston and highest vaccine uptake rates in South West near future. The objective is to sustain this Richmond London and we are already working on population with care in or near to their During the peaks of the Covid-19 pandemic, messaging, events and materials for younger homes, rather than having to escalate to primary care and acute hospital clinicians For some people, Covid-19 can cause people as the programme moves down the acute sites of care. have come together to establish a GP in- symptoms that last weeks or months after age cohorts. reach pilot service at Kingston Hospital. the infection has gone. This is known as post-Covid. The London Clinical Advisory Journey recovery hubs Working within the hospital setting, GPs Group has published guidance to support the Preventing and supporting the have offered a primary care perspective, Two hubs – one in each borough – provide management of post-Covid which is to be management of long-term ill-health advising on outreach hospital pathways support for people to prevent imminent implemented at an Integrated Care System and primary care services that are realistic Across Kingston and Richmond, we have mental health crisis. With no need for a level. alternatives to inpatient care or could been working to develop a model of care referral, the aim of the hubs is to prevent support earlier discharge. Also, through that supports the development of healthy escalation, reduce isolation, increase Across South West London we are the GP in-reach service acute hospital behaviours within our population and independence and self-management and implementing a networked approach – and primary care colleagues have worked enables people to make healthy choices improve wellbeing by drawing on strengths, centralised where necessary and local where together on the implementation of the Pulse about their lifestyle. resilience, and coping mechanisms. Both possible. This aims to achieve all the benefits Oximetry@Home service, enabling patients hubs kept going throughout the pandemic of a single South West London wide service, to be discharged with good quality access to The model of care focuses on empowering offering local people socially distanced, with local delivery where appropriate for oxygen. people to be able to self-manage any phone and online support. patients also accessing local primary care, long-term health conditions, maintaining social prescribing, IAPT and social care The GP in-reach service will be piloted for independence (within the parameters of their support. Establishing a GP in-reach pilot at a further six months. During this time, the disease) and preventing the progression of Kingston Hospital service will be evaluated to determine the disease into complexity and frailty. At a Kingston and Richmond level, acute difference the service makes to individual hospital, community services and GPs are The NHS long term plan describes the need The prevention element of the model brings patient experience, together with the impact working to identify how we are going to for more joined up and coordinated care, together NHS, council and partner services of collaborative working across primary and deliver the most effective and accessible breaking down barriers between health and to focus on issues such weight management, community services, including the reduction post-Covid service for local people. care organisations and teams to support mental health and wellbeing and risky in length of stay for patients with long-term people with long-term health conditions. behaviours such as smoking and drug use. health conditions. We have begun mapping the services which are in place across all providers (including Acute hospital medical teams aren’t always Working together, we will also support In addition, some primary care staff were voluntary sector services) and identifying if sighted on the breadth of skill of the primary people to manage long-term health issues redeployed into local hospitals to support and where there are gaps so that we can care team, or the admission avoidance such as diabetes and cardiovascular disease staff during the surges of the pandemic. develop business cases and apply for funding services that can be used to facilitate rapid

52 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 53 to fill gaps. We are engaging with colleagues Linked primary and secondary care clinician which, among other things, coordinated Sutton in IAPT, social care, public health and the leads have been established across the support to care homes and specific local voluntary sector to develop our model specialities, which is being replicated in populations, such as people with learning which is likely to include a single point of South West London arrangements. Development of the “Sutton System” difficulties or mental illness. The virtual ward access into services. This will be supported during 2020-21 and CRTs are highlighted in more detail with a public facing communications and Joint communication strategies have been below. engagement plan. adopted and, as a consequence, changes in Sutton has a long history of positive, the arrangements for access to specialists collaborative working between health • Development of engagement with and patient pathways during the pandemic Laying the foundations for the organisations and the local authority, local voluntary sector organisations have been effectively disseminated. Teamnet, Integrated Care System which provides a strong base for the new an intranet platform for practice staff, place-based arrangements that have been Collaboration between the statutory A local clinical leadership group was has been developed and promoted as a announced recently by NHS England. and voluntary sectors also accelerated established during the year, bringing repository for document storage and access significantly as part of the pandemic together clinical and managerial leads from during this time of unprecedented rapid The advent of Covid-19 created a clear response. Covid-19 generated both the Kingston, Richmond and East Elmbridge change. catalyst for change within Sutton and opportunity and the will to take engagement and Kingston Hospital, to facilitate the unleashed innovation in service development to a new level. This started with efforts Leads from acute and primary care have introduction of routine advice and guidance and in new ways of working across to support shielding residents locally and been identified to communicate about within the referral system and the London- disciplines and organisations. The pandemic extended to mobilising volunteers to service changes in the future so that adverse wide “talk before you walk” initiative. created a unifying mission in Sutton and local support the local flu vaccination campaign in unintended consequences of such changes integration was supported by the creation of Autumn 2020 and the Covid-19 vaccination do not emerge. new, agile leadership structures. In essence, programme from December onward. This two weekly inter-agency meetings were was achieved through the local “health developed; the Health & Care Executive, champions” model developed during the comprising a smaller group of key senior Covid-19 pandemic, where a key role of the leaders, and the Sutton System Leaders, Sutton Health Champions is to disseminate comprising a broader representation of important information to their community stakeholders and focusing on problem networks. solving and transformation. Sutton Volunteers, coordinated by the Sutton • Primary Care Network development Volunteer Centre, also provided important support to the Nonsuch Mansion Vaccination PCNs were crucial to the creation of agile Centre (see below). and innovative solutions to pandemic related challenges. New local structures were Deploying volunteers during Covid has developed as part of the Covid response, delivered significant value to the volunteers including a ‘virtual ward’ to support themselves as well wider social value avoidable hospital admission and hospital generated by the volunteering activity. discharge for respiratory patients (involving hospital consultants and community-based staff), and community response teams (CRTs)

54 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 55 Supporting shielded and vulnerable communication between teams throughout vulnerable patients are supported through o Non Covid-19 patients with chronic patients the week. the Community Response Team with food long-term conditions such as COPD, and medication delivery, welfare checks and heart failure, uncontrolled diabetes, We have worked to ensure that the This work was already in development coordination of statutory and non-statutory frequent callers or frequent attenders joined-up ways of working that have been as part of our Sutton Health and Care support, as appropriate. Patients are also who are at risk of hospital admission developed during this time across primary programme. However, as a result of our supported after discharge from hospital, and require multidisciplinary primary and community care are embedded into the Covid-19 response, we have seen the rapid including those with chronic diseases and and community support for a short way we work going forwards. implementation of a delivery model that long Covid. The service also actively manages period. has provided the platform for us to achieve patients who are at risk of deterioration, o Frail patients who require short • Community response teams integrated multi-disciplinary teams. where they have significant anxiety because intensive support with social and of this. A remote monitoring system, which GP practices also worked to support patients wellbeing interventions to prevent Primary Care Network Clinical Directors supports clinical management and escalation who had to shielding. These patients were unnecessary hospital admissions. have worked with partners to develop four of patients, is being piloted. Covid-19 community response teams (CRTs) contacted to discuss what shielding means, wrapped around primary care networks. any changes to their ongoing care and Phase 1 of the service Following the These multi-disciplinary teams (MDTs) include treatment, to confirm what arrangements has been designed for: implementation of community nurses, care home support they have in place for receiving medications Our partnership has Sutton Covid Virtual and to ensure they are aware of the o Adults 18 years and Ward, weekly MDT teams, learning disability (LD) nurses, Age given us a strong government support offer. over. meetings have evolved UK Sutton, community mental health, social foundation to to virtual ward rounds care, pharmacists and GPs with management o Patients with acute Social prescribing is an integral part of the quickly respond and which are held three support provided by the primary care Covid or Covid PCN’s MDT response to supporting patients provide effective, times per week with team. The MDTs support vulnerable people related symptoms identified by GPs with complex medical joined up support to input from hospital identified as shielded, care home residents who have been and social needs; those at risk of loneliness, care homes before respiratory consultants. and people at the end of their lives. In discharged from isolation and requiring support with food Between February 2021 addition, a closer relationship has developed hospital to the and during the delivery whilst self-isolating. Sutton’s Social and March 2021, total between LD nurses and the Joint Primary Community Pulse Covid-19 pandemic Prescribing Service has engaged with over of 108 patients were Care Clinical Director leads for LD. Their Oximetry @Home 500 people since 2019. admitted to the virtual co-ordinated approach to supporting LD Service. These ward, including the residential care homes has enabled targeted The community response team’s work has patients are at pulse oximetry service. support to be optimised and accessible at the been further enhanced by the development significantly higher risk of deterioration point of need. of the Sutton Covid Virtual Ward which was and this enhanced monitoring Support for care homes launched on 2 February 2021. and treatment gives confidence to This approach has transformed the existing discharging clinicians and patients that care home support team into a seven day For over five years the Sutton Health and they will be safely ‘cared for’ virtually. a week service and supported the night • Covid-19 Virtual Ward Care system has built a strong partnership nursing community team to develop closer to provide oversight and support to The Covid Virtual Ward has been developed, Covid-19 positive patients in learning working with general practice and wider care homes within Sutton. The system is with the aim of prioritising patient safety disability and elderly residential care homes. health and care teams. overseen by the Sutton Health and Care and care and delivering community Going forward, as part of phase 2, the Executive, which includes Sutton Council, wraparound services to support prevention service will support: CRT meetings are held formally on a NHS South West London, Sutton Health & of unnecessary hospital admission. The most weekly basis with regular contact and Care Alliance (health and care providers)

56 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 57 and the community and voluntary sector programme called Alert- Response and Plan The vaccine programme • Vaccinations in the community organisation. Our partnership has given (ARP), which aimed to identify and control As well as the vaccination centre at Nonsuch us a strong foundation to quickly respond outbreaks, provide on-going support and • Nonsuch Mansion Vaccination Centre and provide effective, joined up support to training on infection prevention control Mansion, Sutton’s GPs, working with Sutton care homes before and during the Covid-19 (IPC), including use of personal protective Sutton’s 23 GP Practices formed a single Health and Care Community Services, have pandemic, which is documented in our joint equipment and reduction of illness and “Primary Care Network Grouping” to deliver taken Oxford Astra Zeneca (Oxford AZ) plan - Supporting our Care Homes to remain complications. Covid-19 vaccinations using a new collaborative vaccines into the large number of residential, safe | Sutton Council model of care. The GP practices, alongside care and nursing homes across the borough, Learning from evaluation of interventions the NHS Sutton primary care transformation to vaccinate both residents and staff. The Some of our key achievements include: and response during Covid-19 is informing team and Sutton Health and Care community teams have also visited Sutton residents the development of a joint local authority services, worked as a single, blended team at home to deliver vaccinations to people • Over £2 million has been allocated to and CCG quality improvement framework to rapidly mobilise a who are housebound. Sutton’s GPs are over 100 providers to support infection that will underpin on-going support to care local vaccination service also vaccinating their control within care homes homes. for Sutton’s residents registered patients at • Every care home has received face at Nonsuch Mansion in practices across the Some feedback from care homes managers is “I like the local public to face IPC/PPE training via the Train Cheam. The vaccination borough. included below: health approach: you the Trainer Model. This covers 1,200 centre opened on 15 are not always right, staff. Since August 2020, additional December 2020, with • Outreach Sarah, Manager at Crossways, said: “I have I am not always IPC training has been delivered to 194 received support from all areas, I‘ve been staff from the GP Practices staff from domiciliary care providers, right, let’s discuss, Sutton’s GPs have set able to talk to the Infection Control Nurse working together to supported living, day centres and care let us resolve the up pop-up vaccination whenever I have had a query or question, if deliver Pfizer vaccinations homes requiring refresher course problem, let us not clinics to reach vaccine- not straight away, later on in that day. The to people living or working blame anyone, let us hesitant communities, • Provision of active management of guidelines that we have had to follow have in Sutton or registered in places of worship, at Covid-19 outbreaks and outbreak been very clear. The funding has helped with a Sutton GP. As of learn together, let us traveller sites and for the management process developed massively and we have been able to use the 31 March 2021, over support each other homeless, with plans in fund to improve our infection control/cleaning 20,000 vaccines have been and share good • Weekly care home support Q&A live place for future pop-up hours and also enable visits from families delivered at the centre. practice.” sessions providing advice and guidance, clinics for underserved (before our outbreak!). Having the current sharing learning between homes and The vaccination service populations such as testing fund has enabled us to use a member learning from the experience of care at Nonsuch Mansion unaccompanied asylum of staff specifically for swabbing/registering. homes to shape support. has been supported by seekers. She has felt really empowered in this role and over a hundred volunteers. Coordinated by • Developed and launched a new Sutton has done lots of research herself which in turn the Volunteer Centre Sutton, these volunteers Care Hub with latest guidance and has helped all of us.” Post-Covid-19 plans for Sutton support for care providers in Sutton helped support people visiting the large site. Arthur, Manager at Belmont, said: “I like They made sure people maintained social For some people, Covid-19 can cause distancing and that infection control measures symptoms that last weeks or months after During the Covid- 19 pandemic, support for the local public health approach: you are were adhered to at all times, with minimal the infection has gone. This is known as 78 Sutton care homes (28 for older people, not always right, I am not always right, let’s waiting time outside or inside the building, post-Covid. The London Clinical Advisory 43 for people with learning disabilities and discuss, let us resolve the problem, let us not helping to ensure that everybody has their Group has published guidance to support the seven for people with mental health issues) blame anyone, let us learn together, let us vaccination safely. management of post-Covid which is to be was delivered through a quality improvement support each other and share good practice.”

58 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 59 implemented at an Integrated Care System Improving Consultation Residents Focus Groups IHT Listening Meetings Other Petitions and questionnaire survey residents' Events and organised feedback third party level. workshops, Healthcare Together (Ipsos MORI) depth interviews CCG outreach by local CVS received surveys (YouGov) meetings organisations Across South West London we are 11 focus 2 petitions groups implementing a networked approach – 8 public 434 with a total In 2017, Epsom and St Helier University targeted listening 'written' of 9,486 to specific centralised where necessary and local where 4,172 events with submissions signatures Hospitals NHS Trust (ESTH) published demographics Responses more than 48 possible. This aims to achieve all the benefits 751 88 a strategic outline case to address the 1000+ engagement incl: interviews participants 2 substantial attendees activities of a single South West London wide service, challenges facing both Epsom and St Helier third-party 724 NHS 655 across 3 forums organised by surveys with local delivery where appropriate for Staff the three with a total hospitals, relating to concerns around 33 groups involving CCGs of 1,160 social 3,339 patients also accessing local primary care, 26 from More clinical sustainability, financial sustainability 108 involving media posts respondents organisations 96 in nearby than 100 social prescribing, IAPT and social care participants 426 resulting in and the suitability of their estates. areas events and 1,730+ 54 easy read 6 depth meetings participants 7 comments support. engagements versions interviews engaging received via Following this, in 2018, the Improving with c. 5,000 Healthwatch At a Sutton level, acute hospitals, community 'seldom participants Sutton's Healthcare Together (IHT) programme was heard' website services and GPs are working to identify how launched by Surrey Downs, Sutton and we are going to deliver the most effective Merton Clinical Commissioning Groups (the On 3 July, the Committees in Common (CiC) Following the decision-making meeting in and accessible post-Covid service for local CCGs) – who were responsible for planning for NHS South West London and NHS Surrey July 2020, the plans were referred by London people. the majority of NHS hospital and community Heartlands CCGs met to decide on the Borough of Merton to the Secretary of State services for local people. The aim of the IHT We have begun mapping the services which way forward for the Improving Healthcare of Health, who appointed the Independent programme was to determine the potential are in place across all providers (including Together programme and the £500 million Reconfiguration Panel (IRP) to review the solutions to the challenges at ESTH for the voluntary sector services) and identifying if investment to our improve hospitals. After case and advise. In October 2020, the IRP combined geographies of the CCGs. and where there are gaps so that we can reviewing the evidence presented, including concluded their review and published their develop business cases and apply for funding In January 2020, the IHT programme the decision-making business case and advice, with the IRP Chair writing to the to fill gaps. We are engaging with colleagues launched a 12-week public consultation the feedback from the 12-week public Health Secretary stating that the “change in IAPT, social care, public health and the to ask the public for their views on three consultation, the CiC approved the £500m is essential and requires significant new voluntary sector to develop our model, options to invest £500 million of national investment for Epsom and St Helier hospitals capital investment to provide appropriate which is likely to include a single point of funding to build a new specialist emergency and a brand-new specialist hospital to be built buildings”. A copy of the IRP letter can be access into services. This will be supported care hospital – on the Epsom, St Helier in Sutton. The CiC also announced a range of found here. We welcomed this additional with a public facing communications and or Sutton hospital sites. During the measures to address issues around transport scrutiny and IRP conclusion. engagement plan. consultation, supported by our borough and travel, bed numbers and services for older ESTH is now taking the programme forward, communications and engagement teams, residents and more deprived communities, including all the recommendations under stakeholders, residents living locally and in which were raised during the recent public the new name of ‘Building Your Future neighbouring areas were invited to provide consultation. This included commissioning a Hospitals’, developing an outline business feedback through a wide range of methods, further independent ‘deprivation review’ by case which will define the design and which included a range of activities including The King’s Fund to look at the future needs plans for the new specialist emergency listening events, focus groups, community of communities in East Merton and North care hospital at Sutton, whilst refurbishing outreach and telephone surveys – these can Sutton, reviewing bus routes into Merton and outdated hospital buildings at Epsom and St be seen below together with the level of further south into Surrey beyond Epsom and Helier hospitals. response. car parking on all three sites, to make sure there is enough for patients, visitors and staff.

60 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 61 are gaps – both in terms of services and work had been done with staff across the insight from diverse communities and staff. partnership and drawing out key themes for We synthesised the findings from across the organisations to respond to. following data sources: We presented the findings to the South West • Six Healthwatch surveys of around London Recovery Board and used them to 1,000 people inform our communications and engagement priorities for the recovery work programme. • 475 people from the South West In short it was agreed that: London Citizen’s Panel

• Patient Engagement / Reference Group • There was value in sharing citizen and meetings staff insights across boroughs.

• Voluntary Sector Coordination Group • Our South West London meetings communications and engagement team would support priority areas • Centre of Independent Living meeting for recovery workstreams and within • Children and Young People trailblazer each borough, actively supported (Kooth/CAMHS/Schools) and advised by multi-agency • South West London and St George’s communications and engagement Mental Health Summit groups at borough level, including Engaging people and local authority communications leads, Although the surveys asked different Healthwatch and voluntary sector leads communities – Patient and questions there were common themes which for each borough. public engagement (PPE) included: • We would meet each programme lead and each borough lead to prioritise • Experiences of NHS services communications and engagement work • People’s concerns about Covid-19 in boroughs and across South West London. • Impacts on mental and physical wellbeing • Continue with next phase of the South The Covid-19 first wave – priority was to understand the impact West London the ‘NHS is here for • How people found out information of the pandemic on the behaviours and you’ campaign, focusing on cancer, initial activity about Covid-19 and services available attitudes of our citizens and staff. maternity and mental health, with • Using the NHS for non-Covid services. clinical advice, staff insight and insight Over the summer, through working with our During the first wave of the pandemic, and from communities. borough communications and engagement for most health and care providers, The findings were then grouped by borough groups, we conducted an in-depth mapping • Continue open and transparent including the voluntary sector, the focus and themed across our work streams to feed exercise to find out what engagement and communications with partners, citizens was on responding to the pandemic – with into our recovery work. insight has already been gathered or is and staff about essential service non-essential roles being redeployed to planned by our health and care partnership changes to keep patients and staff safe support the front line. During this period, We followed the same process for health organisations. And to identify where there during the pandemic. our communications and engagement and care staff, mapping what insight

62 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 63 Recovery work programme particularly to reflect the needs and NHS 111 First Overview of South West experiences of vulnerable and at-risk London Covid-19 vaccination groups and reduce health inequalities. During recovery and to prepare for the For urgent and emergency care, one of our programme engagement • Communicate clearly and transparently second wave, it was essential that we made priorities was NHS 111 First – developing to our patients, citizens and every effort to continue to hear and act on assets and talking to community groups to stakeholders about how we are Communications and engagement work the patient voice. Our priorities were to: reassure that NHS 111 is the safest way to adapting the NHS to manage future has been integral to the successful delivery get non-life threatening but urgent and potential Covid-19 outbreaks, and also of the biggest vaccination programme • Understand the impact of Covid and emergency care. Our aim was to encourage treat our non-Covid patients safely. in history. To support the delivery of this any changes to services. uptake in 111 and identify barriers to programme, our objectives are to: • Make informed decisions. • Make sure we are demonstrating that access. the NHS is carrying out its duty to • Adapt services if and where possible. • Build confidence in the Covid-19 involve with due regard to equalities, Elective surgery hubs vaccines. health inequalities and taking To support this, we needed to continue to: stakeholders and communities along • Manage expectations about when local Within elective care, we looked at the with us. people will receive their vaccination. • Communicate transparently and openly. support we could provide around the move • Increase uptake, particularly in priority • Target communications and to surgical hubs, a new way of working • Influence perceptions and behaviours communities and those experiencing engagement work to reduce together across acute trusts to increase of local people, increasing access to health inequalities, by listening to and inequalities, raise awareness, influence planned and elective surgical care for services and healthy behaviours. understanding local concerns and behaviour in terms of access to the local people. As people were not able to most appropriate services. For example, providing information in a factual and During this time, we continued to meet and influence where these hubs would be, our the ‘NHS is here for you’, NHS 111 unbiased way. seek advice from the South West London priorities were to: First and seasonal flu campaigns with • Support our NHS frontline teams with Community Engagement Steering Group specific priority citizen groups. • Develop clear and transparent their operational communications (CESG), made up of Healthwatch and communications about choice, around delivering the vaccine. voluntary sector representatives from the • Work with communications and transport, access reassurance to local six South West London boroughs, and with engagement professionals from our people. Together with the borough communications communications and engagement groups health and care partnership across and engagement groups, we developed at borough level, including communications each borough to support strong staff • Capture patient experience data to local communications and engagement leads from health and care organisations engagement and communication understand experience and impact. plans. These were informed by the Equality from NHS, local authority, Healthwatch and around recovery. To support this, we worked towards and Health Inequalities Impact Assessment the voluntary sector. developing a standardised metric for Work we prioritised in some of the recovery patient experience across our sites. (EHIA) and local intelligence and prioritised As agreed by the recovery board, work streams includes the NHS 111 First engagement with those communities who we allocated a communications and campaign and establishing elective surgery are eligible for the vaccine, from communities engagement lead to each recovery hubs. experiencing inequalities and where we knew workstream. This enabled us to: uptake would be lower.

• Understand where citizen and staff The overarching principles are to inform, to insight would be helpful to influence help people make the right decision for them planning and decision-making, and their families, provide information from

64 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 65 trusted sources in the community and NHS, shared through the Imam’s private broadcast also monitoring social media platforms and Borough level vaccination and co-develop the messages. channel reaching over 30,000 people. responding to misinformation and queries to engagement increase confidence. Our six borough plans have four key elements Supporting engagement in primary care to build confidence, however, the specific In Croydon, we worked with the Asian populations of focus are locally informed by We have been signposting people who have Resource Centre to create a series of short Croydon the indices of multiple deprivation and data declined their invitation to be vaccinated to Q&A films with Croydon doctors. We have a on vaccine uptake. These elements are: community sessions and are working with Merton GP fact checking video in response Building vaccine confidence and practice link workers and social prescribers to real time concerns and have produced • Broad community engagement developing community focussed to reach local people. We ran Q&A sessions a “Conversations with my Mum” video to vaccination clinics • Working with local influencers with social prescribers and link workers in highlight the experience of Black members of NHS staff talking to their parents about the • Supporting engagement in primary care Merton and are planning a larger South We funded the Asian Resource Centre of vaccine. • Social media and digital content West London session at time of publication. Croydon and Croydon BME (Black and We have made sure that our link workers Minority Ethnic) Forum to run a series of are connected to the London wide training question-and-answer sessions with clinicians Broad community engagement programme to support them to speak to from ethnic minorities, including some in local people. community languages. These online sessions We have been working with the voluntary were attended by nearly 3,000 local people. and community sector to host community To support uptake of the vaccination, three Polls at the beginning and end of each conversations, to hear and respond to personal approaches are offered by GP session showed that people left feeling both feedback, answer questions and gather practices to patients: text or letter to offer more informed and more likely to accept the insight. We champion every contact appointments, follow up with phone call invitation when it was offered. counts, supporting staff to have ‘confident from the practice, follow up call with their conversations’ with local people and patients. GP. We have been offering engagement and Feedback showed that people felt that Signposting people to our single source of primary care support to GP practices with having clinicians that looked and sounded truth, the NHS South West London CCG low uptake to support follow up on decliners like them gave reassurance that the vaccine website. in Croydon in particular. was for them. One of our insights was that people would trust the vaccine more if it Working with local influencers Social media and digital content was delivered in a culturally appropriate way. We developed a more agile approach Working with key local influencers (faith All our social media and digital content work to delivering the vaccine and have had open leaders, community champions, health care is underpinned by culturally relevant content, access clinics in Croydon Mosque, His Grace professionals) we have been leading and featuring trusted community influencers, Evangelical Church, Night Stop and Turning hosting conversations, building trust and including paid-for boosted and targeted Point, with more planned for 2021/22. confidence in the vaccine within our diverse local content on social and digital media communities. in postcodes where there is lower uptake. Croydon Vaccination Equity Task and We have been mapping and targeting local Our event for the South West London Finish Group media aimed at ethnic minority groups and Muslim communities, led by Shaykh Suliman continue to produce materials in different Dr Nnenna Osuji, Medical Director and Gani, the Imam of Purley Mosque, continued languages and formats on request. We are Deputy Chief Executive of Croydon Health to have impact through the webinar being

66 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 67 Services, has brought together a task and Merton huddle and volunteers/chaperones will be Wandsworth finish group to support uptake amongst told to proactively approach individuals with our communities throughout the Covid-19 Improving vaccination process for people with a visual impairment. The purpose of the Co-designing a pilot sensory clinic for vaccination programme. Lead clinicians, a visual impairment vaccination card is being made clearer to young people and parents with learning including Dr Agnelo Fernandes, Rachel individuals during the appointment. disabilities and autism Flowers, Director of Public Health, Dr Dev We delivered an online engagement session Malhotra and Dr Neil Goulbourne, meet with individuals who have a visual impairment Vaccinating people with learning We co-created several engagement together with Cllr Janet Campbell and and Merton Vision staff members, to help disabilities workshops for people with a learning community and voluntary leaders and the inform the vaccination programme approach disability or autism and their carers. These Croydon communications and engagement for this cohort of people. Merton Vision have We worked with Merton Mencap to provide workshops included interactive easy read network to plan together interventions that a directory and expressed they were happy to online engagement with individuals with and photo symbols content, including online will help increase confidence in the vaccine. help support the vaccination programme. learning disabilities and carers to help inform speedy quizzes, Q&As with a GP and creating the vaccination programme. Attendees shared: Zoom videos. As we move forward with the vaccine What we heard: programme, we are keen to adapt further • Concerns about needle phobic Over half of the people we spoke to were to better ensure any variation in uptake • Concern about the consistent use individuals. It would be helpful for from ethnic minority backgrounds and at amongst our communities is based on of communication preferences. individuals to work with a psychologist higher risk of the virus. We heard that many individuals being able to make an informed People get fearful of the change and to help them prepare. were experiencing barriers to having the decision. Together the group has a systematic miscommunication. • Concerns about turning down a vaccine vaccine, including stressful, unfamiliar clinical approach to optimise uptake, coordinated • It is ideal for patients to attend a more if you are unsure of the process - can we environments, unfamiliar people, the need for through a dedicated Croydon wide task and familiar setting. alleviate concerns beforehand. a slower pace and needle phobia. finish group hosted by the Local Strategic • Some vaccination centres and GP • Concerns about consent if there isn’t a Partnership. An idea was sparked and our local GP clinical reception staff have been unhelpful in carer or advocate available. supporting booking the vaccination. lead Dr Nicola Williams, together with Share Croydon virtual health network • Easy read materials would be helpful. Community, worked to overcome this by • It’s hard to type in all of your details creating a special pilot clinic. • More information needed about carer Our virtual health network of nearly and locate different information like registration. 500 local residents and voluntary sector your NHS number. There needs to be We coproduced a video with Share, featuring representatives has supported the informing a more accessible way of booking the • Can families temporarily register together a visual ‘walk through’ of what happens element of our engagement, sharing our vaccination. so they can get the vaccine together. when you come for your jab in a soothing weekly vaccination updates with more than • The purpose of the vaccination card is environment surrounded by virtual images 20,000 local people. We include information not being clearly explained. Feedback from the sessions helped to and music, such as swimming turtles to about engagement events coming up and inform conversations about the learning positively distract and for parents and carers • Concern about individuals with a visual invite people to recommend community disability clinics. Initial conversations to feel at ease about what will happen when impairment missing appointments. groups wishing to talk to us, as well as included adjustments to ensure patients are they come for their vaccine. We also made a inviting feedback on the messaging itself. comfortable. A learning disability manager ‘meet the Nurse and GP’ video, featuring a As a result of feedback, we now include What we did: has now been trained as a vaccinator. We are Zoom Q&A to provide accessible facts about bulleted highlights at the top of each email currently running community clinics, as we are the jab. Following the session, large print leaflets and for those who may not be able or want to aware it is hard for people in the middle of posters were made available at the site. The read the whole update. borough to reach some of the local centres. Due to the success of the approach the team management team organised a volunteer are planning to open the next sensory clinics

68 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 69 to more people from the community who lower than average take-up of vaccines see more men and a younger age group join We are also working closely with community have learning disabilities and autism. among people from ethnic minorities. the second session. At the beginning of the organisations in our less affluent areas to However, as Muslims, service to humanity is discussion less than half were keen to have ensure residents can engage in the discussion Pilot sensory vaccine community clinic video: our duty, and we have been clear that we fully the vaccine, but at the end all indicated they about the vaccine and put their questions Pilot sensory Covid-19 vaccination clinic - support the vaccination programme. were going to have the jab when offered it. direct to local GPs, like the “Let’s talk about YouTube the vaccine” community conversation, “We are very grateful to the NHS heroes who hosted by Castelnau Community Project. Meet the Nurse and GP and Zoom Q&A Richmond are working hard to protect the health of the Though most attendees indicated they had Video: Share Community NHS Wandsworth nation - they deserve our constant prayers and or would have the vaccine, there were a few Covid-19 Vaccine Video immense gratitude.” Healthwatch webinar maybes who when asked again at the end of the conversation had changed to saying they We have worked with several of our Wandsworth – Building confidence in the would have the vaccine. The main topics Kingston local community partners to engage with Ahmadiyya Community for discussion were: safety of the vaccine residents and communities about the in relation to fertility and pregnancy; and Together with the Ahmadiyya Muslim Covid vaccination programme. Together Listening to people living with a disability side effects and safety concerns with the Community in Wandsworth, we delivered with Healthwatch, we hosted a virtual AstraZeneca vaccine, after media coverage two evening Covid-19 vaccine engagement We organised a Covid-19 session with webinar joined by more than 300 Richmond about the potential link between the vaccine sessions with our trusted clinician Dr Ban Kingston Centre for Independent Living residents. Healthwatch Chair Julie Risley and developing blood clots – a link that has Haider and Nick Beavon, our chief pharmacist, (KCIL) which was attended by more than chaired a Q&A, with a panel including now been disproved. reaching 100 and 147 families respectively. 50 people living with a disability and their Dr Patrick Gibson, GP Borough Lead for The use of Urdu interpreters was highly carers, as part of their monthly online Richmond, Tonia Michaelides, Richmond We are also starting conversations with our valued helping to ensure the information was coffee morning. The session gave people Locality Executive Director, and Shannon younger population. The first was with Youth appropriately tailored and clear. an informal opportunity for them to put Katiyo, Richmond Council’s Director of Out Loud! (YOL!) and Kingston & Richmond questions to a clinician, including concerns Public Health. The webinar is available Youth Parliament. We answered questions Their feedback and offer to host a community about the safety of the vaccine, side effects on Healthwatch Richmond website for on wanting to understand more about the vaccine clinic led to us working together and fact checking. The session was very those who couldn’t attend and the wider speed of the trials and safety, the role of with Ahmadiyya and the Wandle Primary well received, and we have been invited population. Watch the webinar at https:// fake news and scepticism about long terms Care Network, led by Dr Laura Quinton, to back for follow up sessions to continue the www.healthwatchrichmond.co.uk/ effects and effectiveness. We discussed plan Wandsworth’s first pop up vaccination conversation about the Covid-19 vaccine. news/2021-03-19/Covid-19-vaccinations- what it means for younger people under clinic at the Fazl Mosque in Southfields. The richmond-live-webinar 18 years of age; for example, “helping us community clinic proved a great success Fact checking vaccination myths in Arabic get back to normal”. YOL! and our Youth with over 1000 members of the community Working with higher at-risk groups Council are keen to encourage debate and taking up the Covid-19 jab in just one day We held two Covid vaccine sessions entirely share information about the vaccine with We partnered with Multicultural Richmond on the National Covid Day of Reflection, in Arabic, with an Arabic speaking GP young people. They have suggested working and Richmond Council to host a Q&A which marked the anniversary of the UK’s first providing information about the Covid with the us to design social media posts event for residents from an ethnic minority national lockdown. vaccine, fact checking and reassuring around targeting younger people and having the background. The event is available on issues such as porcine content. Organised in vaccine as a future topic for their YOL!Talks Richmond Council’s YouTube channel, The National President of the Ahmadiyya partnership with Refugee Action Kingston, podcast series. Listen to the podcast at www. ensuring it is available to a wider audience Muslim Community UK, Rafiq Hayat said: these sessions reached refugees, asylum healthwatchrichmond.co.uk/news/2021-03- than those that joined on the day. Watch the seekers and permanent residents who speak 10/yoltalks-podcast-series-youth-out-loud “Recent studies have shown significantly event at www.youtu.be/uY9nYul6kV0 Arabic in the borough. We were pleased to

70 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 71 Sutton to identify and reach a number of vulnerable Vaccination take up in the Traveller • Six families have shared their personal residents, including: community contact details, which shows trust has • Sutton Housing Partnership through their been established. Reaching people experiencing health weekly welfare calls to vulnerable adults We have worked in partnership Sutton inequalities • Four families are in the process of with LD and mental health issues Housing Partnership, Cognus (Education changing surgeries from Banstead to During the pandemic, one particular Traveller Service) and the Public Health • Neighbourhood watch coordinators engagement challenge we faced in Sutton Manor Practice. who can identify and reach Sutton team at Sutton Council to help increase was how to reach the seldom heard and residents who are not on their email vaccination uptake within the Traveller • Improved working relationship among digitally excluded residents. We worked distribution list. Leaflets were dropped in community in the borough. Two visits were partners, which has led to further with our Sutton Health Champions who are housing estates in deprived areas by local embedded in all 18 wards across the borough. arranged with Sutton Housing Partnership conversation on offering health volunteers. We have 67 Sutton Health Champions, who Lead and Cognus (introductory phone calls). information for things like mental all live in the ward they reach out to and • Local volunteers through targeted The introductory visit to build trust at the health services and health checks. include members of the public, community communications (posters on lamp posts, Pastures Site and second visit to give Covid groups, residents’ associations, faith leaders leaflet drops to local shops, pharmacies vaccine (both sites). The joint team liaised The insight is fed back to the Programme and volunteers. Through the champions, we etc.) with the Traveller community to arrange an Board and project team, via bi-weekly identified effective community distribution • We reached over 20,000 residents in on-site information session and offered to vaccine planning meetings (see diagram channels (including Facebook, Twitter, Sutton’s top five deprived communities vaccinate anyone over the age of 18 on-site Instagram and email distribution) and have a below), to inform operationally how and and held engagement events with total reach of more than 180,000 residents in who wanted it, without the need to attend where the vaccine is delivered for example, various groups about the Covid total. a GP surgery. People were also able to ask the location of pop-up vaccination clinics pandemic. any questions surrounding the vaccine and The Sutton Health Champions have helped us in each borough. It also informs what receive reassurances from Dr Ellie Bernard, reasonable adjustments are made to support The story of how Health Champions enabled effective and targeted communication and Partner at The Manor Practice in Wallington. equal access. Lastly, we use the feedback engagement with Sutton residents, inclluding seldom heard and digitally excluded communities Advice was also given on the all-around to inform our messaging, and comms and Step 1: Ward Co-ordination Teams health service available from local health engagement approach. services in Sutton. 22 residents received Through extensive community asset mapping, identify and bring together 'ward What: the Covid-19 vaccination in March at The coordination teams' comprising local Councillors, Resident Associations, faith leaders etc. Pastures and The Grove. Role: Identify need and coordinate local support at grassroots level. Solution Step 2: Sutton Health Champions

What: People who live and work in Sutton that want to help keep our residents safe and healthy

Role: i) Receive key messages ii) Spread the word iii) Feedback to us

Identification and usage Local insight/connections Clear escalation points for of effective community to BME, LD and digitally ward level needs

Outcome distribution channels excluded communities

Total reach by Sutton Health Champions Strategy for engaging with the digitally is now over 170,000 residents, mostly via excluded successfully implemented. Information Facebook and Email, but also wider social distributed via newsletters and posters through Impact media and newsletters pharmacies and community resources

72 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 73 Informed by this, partner organisations women from ethnic minorities, following developed local plans to engage with their publication of a study indicating that women Bi-Borough weekly uptakevaccine dataplanning level staff. As a CCG we took the following from particular ethnic groups experienced meeting- by practice for each / actions: notably worse birth outcomes – including boroughward vaccine planning death of mother and/or baby – compared to meeting for each MDBi- weekly Engagement • Key messages in team talk and Q&A women of white (majority) ethnicities. The leadership + feedback from borough sessions. feedback from work is ongoing, but we have supported communities with Bi- weekly key stakeholders low uptake • Intranet developed as hub for ‘single it by developing interview protocols and borough vaccine planning + partners meeting for each source of truth’ for staff. a framework for the process of capturing Bi-weekly stories, delivering training in how to use vaccine planning • All staff briefings including opportunity

meeting for each this method as a research/engagement

borough each for meeting to ask questions and receive an update vaccine planning planning vaccine technique, and leading on the engagement

borough about vaccine rollout.

element of the project. Bi- weekly weekly Bi-

• Line managers to have one to one Primary care borough Public health

conversations with team members, to Urology

Bi- weekly weekly Bi- meeting for each each for meeting

vaccine planning planning vaccine

borough listen and understand any concerns, meeting for each each for meeting signpost to guidance and advice. We ran several focus groups to support

vaccine planning Pharmacyplanning vaccine the urology clinical network to standardise Bi- weekly weekly Bi- • Daily update with content promoting local events for staff to attend and ask urology pathways across South West London. questions. The aim was to ensure that patients receive the same quality of treatment, no matter where they live. Covid vaccination who felt negatively. Around three quarters We also developed a ‘Top tips’ for confident (76%) would have the vaccination if it were conversations – this was shared with all staff communications and We held two focus groups and invited local offered, while 9% would not and 15% and followed up with those in front line people to share their experience of prostate engagement with staff were undecided. Results were generally very roles. care and accessing care for frequent urinary consistent across organisations. But there tract infections (UTIs). The aims of the focus was evidence of more scepticism/reluctance Our communication and engagement Service Change, engagement group were to: to receive a vaccination among particular approach with health and care staff has in commissioning and groups of staff: Residential/domiciliary care – been informed by the insight gained • Understand and listen to people’s significant at only 42% saying yes, compared pathway redesign through a Covid staff survey – which we experiences of accessing prostate care to 76% overall average. Within certain conducted in December 2020. We had over across South West London. ethnic groups there was more hesitancy: only 2500 responses. The survey explored what 34% Caribbean/Caribbean British, African/ Maternity • Listen to suggested recommendations staff think about the Covid-19 vaccination, African British and Other Black/Black British for a future service. to help inform communications/ We have supported our Maternity Voices respondents said they would have vaccine. engagement, as well as what we could Partnership/maternity work stream to map Share why having one single pathway for do to support them to have confident While most staff (65%) felt extremely/ – via story-based interviews – the maternity prostate care (non-cancer) across South West conversations with their staff. somewhat confident to talk to others about journeys of women from ethnic minorities. London could be a good idea.Feedback the vaccination and answer questions, around This aligns with a national priority to improve gathered during the prostate focus group Most (82%) felt positively about the 1 in 3 (35%) were not so/not at all confident. services, and access to services, for/by had the following impact: vaccination; however, there were 7%

74 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 75 • The Lower Urinary Tract pathway current issues and can represent the voice of Covid-19 vaccination in late 2020 and early The voluntary and community sector in will be changed and will include their clients and support them to be more 2021. Croydon is incredibly strong and well placed signposting to prostatitis pathway. directly involved in health and wellbeing to help people improve their wellbeing. strategies and plans. We’ve have seen this in action in the • The pathway will include early Supporting Croydon’s voluntary groups collective local response to the pandemic appropriate investigations and to help reduce health inequalities and now we want to build on and develop treatments in primary care – to help Raising awareness of long-term In January 2021, the One Croydon alliance an even better quality of partnership for our advocate for greater access to imaging conditions and risk factor amongst was chosen as one of just six health borough. from primary care. Croydon’s diverse communities partnerships in England to benefit from a We have worked closely with the Asian multi-million-pound cash injection as part As a result of the UTI focus group: Trailblazer: Improving emotional support Resource Centre (ARCC) and Croydon of The Healthy Communities Together in schools - special educational needs • The frequent UTI pathway will be BME (Black and Minority Ethnic) Forum to programme, established by The King’s Fund school cluster engagement in Merton changed to include self-help remedies. carry out targeted outreach work to raise and The National Lottery Community Fund. and Sutton awareness of long-term conditions and risk • The importance of conditions which factors amongst our diverse communities. The funding will support partnership-working The Trailblazer programme was created in can lead to complicated recurrent UTI This work targeted people who are socially between the voluntary and community sector response to a high number of children who will be widely promoted. isolated or lonely, people living in deprived (VCS), the NHS and local authorities, and will were found to be self-harming across South • A urology webinar will be set up – parts of the borough, people from Black, help them make the most of their combined West London. Its objective is to reduce the training to raise awareness that an South Asian and other minority ethnic capability to improve the health of their number of children self-harming in South STI is not the only diagnosis in young groups, and people with a family history communities. West London through a ‘whole system’, patients with symptoms. of long-term conditions. Due to Covid-19 multi-agency approach, using health, One Croydon was selected from more and lockdown restrictions, which led to the education, and local authority resources to than 270 applicants after demonstrating closure of many of our smaller CVS groups, provide support in schools to parents, carers, Services to reduce social isolation and how it aims to tackle deep-rooted health ARCC and Croydon BME Forum worked and children and young people at an early loneliness in Croydon inequalities and improve the links between in partnership with member organisations stage. health and care services and the communities to hold online events, including the online As part of our mental health transformation they serve so that local needs can be better diabetes groups, online health workshops, NHS Merton is working closely with NHS programme, the Mental Health Programme met. online coffee mornings and one to one Sutton and the special educational needs Board has adopted learning from the One health check meetings. A community (SEN) cluster, focusing on SEN schools in Croydon Alliance Local Voluntary Partnership The Covid-19 pandemic has rightly drawn champions model has supported community both boroughs. The cluster is auditing framework, which has funded voluntary, attention to the health inequalities facing grassroots awareness of long-term condition practices to assess the current provision and community and social enterprises (VCSEs) to many of our residents and there’s never been risk factors, the importance of screening, where improvements can be made. Audits provide services to reduce social isolation and a more important time to continue work to early identification and self-management. will feed into the wider cluster action plan. loneliness in people over 55 years old with tackle these issues. Our vision is to transform The champions also collect community Engagement with children and young people complex health and care needs. Successful how we deliver care, and our One Croydon conversations about the barriers to will help inform the whole system approach. applicants will receive funding for a period of alliance has been working hard to do this engagement, awareness of services, health two years and this will allow new approaches since 2017, empowering local people and Support on the project has an emphasis on information and community dynamics. to be developed, piloted and evaluated communities and bringing together health providing resources and materials to the We were able to adapt this model and where this would not otherwise be possible. and care to create cohesive services, and we schools, to help support the teachers to the networks and connections made for VCSEs have knowledge of the needs and know we need to do more to help reduce deliver the engagement sessions. holding ‘community conversations’ about the strengths of their clients, are aware of local health inequalities.

76 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 77 We have begun initial conversations with the to improve their health. plan the six working groups which will each Crisis Retreat in Kingston and Richmond cluster, sharing best practice engagement, have a membership of representatives who discussing what level of engagement will We have supported the team to engage with access learning disability services to shape The Crisis Retreat is a place for adults work with each school and what reasonable the Patient Engagement Group (PEG). The services going forward. To enable their experiencing a mental health crisis who adjustments need to be made to ensure all PEG has providing views on the project and inclusion and reduce the digital barriers to need short-term crisis intervention as an students can access the session and provide it’s aims and will help to support and share taking part exacerbated by the pandemic, we alternative to hospital admission. The service feedback. local content that could be used on W:ISH. are delighted that we have matched funding is for residents living in the boroughs of with the council to provide accessibility Kingston or Richmond. We are meeting with each school to help enabled computers and digital devices and Coproducing the delivery of the joint The local engagement team were asked support the planning and delivery of the support for all to take part. council / NHS Learning Disability engagement sessions. to gather experience of the Retreat as part Strategy in Wandsworth of a wider commissioning review of the The Neuro Voices Strategy in service. Our engagement objectives were Optimal ageing in Merton We delivered eight engagement sessions Wandsworth to understand guests’ experiences of the reaching nearly 80 people to inform and service; to involve a range of guests in terms The overall aim of the project is to compress test the joint Wandsworth NHS South West Our Patient and Public Involvement Reference of diversity, gender and geography (both the period of disability and dependency at London CCG and council Learning Disability Group and Thinking Partners group have Kingston and Richmond residents); and to end of life and therefore reduce the need for Strategy 2021-2026 from the point of supported the clinical networks by helping work with the manager to recruit guests health and social care. view of people who use and need learning to shape the Neuro Voices Strategy which willing to take part in the engagement. disability services. You can read the LD has an overarching aim to reimagine and The project is a population health Engagement Report. rethink how services are delivered to improve management approach to change attitudes We analysed guest feedback collated by the patient experience of neurology services the Retreat over the last 12 months and and culture around ageing, and as a result This resulted in a chapter and overarching reflecting the diversity and complexity of alongside this undertook more focused help older people ‘live longer better’. key priority of the Wandsworth Learning the needs of people living with neurological engagement by telephone interviews with Disability Commissioning Strategy 2021-26 conditions and their family members from There are two main strands to the project: 17 guests or former guests to gain a more in titled: My Voice is Heard – Coproduction. across South West London. depth understanding of their experiences. • Engaging directly with citizens, giving We also supported a Wandsworth Work started by codesigning the care them content through a new digital Overall, the majority of feedback community grant project to develop pathway between primary care and the platform called the Wellness Interactive was positive, with just two areas for simulation video training so that people with clinical assessment hub at St George’s Support Hub (W:ISH). The aim is for consideration, namely the length of stay a learning disability can train NHS staff in Hospital and is being informed by our W:ISH to signpost people to existing and food and cooking arrangements. The coproduction and to develop annual health work in partnership with Healthwatch on information that is relevant to them – findings and recommendations have been check appointments and health action plans. Wandsworth experiences of digital and particularly lots of the great campaigns shared with commissioners to be considered telephone health and care appointments. The and resources created and developed as part of the service review which will You can watch the Baked Bean video training referral process now captures important data by third sector organisations. inform future commissioning. session at https://www.youtube.com/ to address inequalities and reduce barriers to • Creating ‘Live Longer Better’ networks watch?v=10ip3fMzt9k access. This includes communication needs, ‘The staff actually care about you and get to in each borough. The plan is to digital capability to identify when virtual know you. In hospital you are just a patient bring together social and healthcare We have been working together with consultations are appropriate and enable and don’t really matter.’ advocacy organisations in the borough professionals to create a network of better access. to improve accessibility of the Learning individuals interested in counteracting ‘….. I feel that five days is too short for Disability Clinical Reference Group and to ageism and empowering older people someone with a crisis and it should instead

78 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 79 be a minimum of 10 days. You’re expected to propose a revised model of therapy Patient and public practice from across its membership – to get better from a crisis in five days.’ delivery across local authority and CCG engagement governance and showcasing innovative practice. commissioned services based on quality, assurance Keeping safe and staying well this innovation and financial efficacy. To support patient and community voice at winter in Richmond a strategic level we have both Healthwatch Two listening events were held with Sutton Quality assurance is vital. We have several and CVS representation on the programme Place Family Centre (SPCF) and we heard During Autumn/Winter 2020 we held mechanisms to support good practice board, primary care commissioning from approximately 20 local parents with conversations with local patient and engagement across our work. committee and Governing Body. community groups about keeping safe and both small children and teenagers. Several parents explained their stories in some detail staying well over the winter months, which We run a Community Engagement Steering We also support the borough PPE leads to and they often mixed positive experiences covered getting the flu jab, NHS services are Group, comprising local Healthwatch meet as a network. Our patient and public with frustrations. There were several clear still open, including reminding people about organisations, community voluntary services engagement professionals from across South themes and these were applicable to both how to access services using NHS 111. We (CVS) and our borough patient and public West London meet on a regular basis to NHS and Cognus therapy services. had a fun virtual discussion with Multicultural engagement (PPE) leads. It is chaired by discuss and advise on shared engagement Richmond’s ethnic elders’ group which the lay member for patient and public work and challenges; progress professional The patient feedback has fed directly into the included a quiz to check the facts or fiction involvement (PPI). The purpose of the development and offer peer support. We recommendations of the report. For example, about the flu jab. Some were unsure about group is to ensure best practice community have been meeting since August 2018 and a number of parents spoke about how the flu jab but very interested in finding out engagement is at the heart of our work discussed, reviewed, and refined a number of they felt group interventions slowed down more about the Covid vaccine which had just across South West London. However, it was engagement activities – drawing from local their journey to get the support that they been approved. agreed that while we are managing a level learning and practise. Our focus this year has need. A recommendation of the review is to 4 pandemic, the focus of the work has been been on engaging local communities on the complete a deep dive into patient’s journeys vaccination programme. And while many The Sutton Crisis Café led by the recovery agenda. through speech and language therapy and sessions are run locally, we have also come consider whether group interventions are We are developing a Crisis Café for service The groups aim to: together to run sessions across boroughs, inappropriate for some patient groups. users that are experiencing mental health like for the Tamil community, as well as Parents also spoke of the hand offs between • Assure the quality of NHS South West crisis. This supports NHS long term plans to a session for Muslims across South West the NHS and local authority providers to be London CCG communications and deliver on community mental health crisis London. of poor quality. An operational development engagement plans and activities – to pathways and will benefit service users, group will be convened with both agencies ensure that decisions made by the CCG carers and emergency services, with better having to work together to improve patient are informed by good practice PPE and Croydon access to health services and reduction of transitions. that the Integrated Care System builds A&E attendances and admissions. The café appropriate PPE into their work. • We work closely with Healthwatch is due to open in autumn 2021 and we Croydon who are involved in some worked closely with service users, carers, • Provide two-way communication of our key South West London and commissioners, the service provider and between borough place level borough committees, such as Croydon clinical lead to design the service. and members of the Community Health and Wellbeing Board; Croydon Engagement Steering Group to Shadow Health and Care Board; One ensure local work is connected with Improving therapy services in Sutton Croydon Board; One Croydon Specialist South West London level work where and Engagement Group; Preventative We have been working with Sutton Council appropriate. and Proactive Care Board. Other on the Therapies Review, which aims • Support information sharing and good committees where there is oversight

80 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 81 of patient and public engagement (CCG) is responsive to the needs and regularly in our Healthwatch Liaison important as many of our patients activities are listed below: wishes of Merton residents. meetings about upcoming projects. travel from other parts of London.

• The Local Strategic Partnership brings • The group is a forum for patient and • Over this last year we have worked in • Wandsworth Community Grant together Healthwatch; voluntary public representatives to inform and partnership, reaching over 600 people Scheme awarded 12 grants community social enterprises (VCSE); influence the planning, designing and to understand how telephone and to community and grassroots local business, faith and voluntary delivery of local health services. Those video appointments are working. You organisations to address digital groups and public sector organisations who are buying and planning services can read the Wandsworth experiences exclusion and the reduce inequalities in to commit resource to improving come to our PEG at an early stage. of digital and telephone health and access to health and wellbeing support Croydon in the areas of health, crime care appointments report. This year, during the pandemic. You can read a • The group is comprised of community and work. we have supported assembly topics, summary of the projects on our website and voluntary organisation focussed on PPI and addressing health www.swlondonccg.nhs.uk • Croydon’s local voluntary partnership representatives, local services users and inequalities. is supported by the King’s Fund local residents. • Together with Wandsworth Council to develop the voluntary sector in • The Thinking Partners Group, chaired we continue to jointly commission • Healthwatch Merton have Croydon and ensuring they are involved by Dr Sian Job, works collaboratively the Wandsworth Voluntary Sector representation on the Merton Health in partnership working and that their with NHS Wandsworth to assure Coordination Service, which serves and Care Together board. This board voice, and those of their users is heard. us in relation to our approaches to to support and build the capacity of supports the implementation of the addressing health inequalities. It voluntary organisations and community • The Localities Board oversees locality- local health and care plan and has also offers members the opportunity groups in Wandsworth to connect, based integration of services with a oversight. to network and deepen their collaborate and communicate both strong emphasis on integration of • Bi-weekly meeting with Healthwatch understanding of how to work with each other and the local health the voluntary sector with statutory Merton allow the NHS Merton together. Thinking Partners supports and social care system to work together teams via local talking points and engagement team to co-plan our aims to continually improve our to promote health equality. social prescribing. Voluntary sector engagement and allow Healthwatch to approach to promoting equality - organisations and Healthwatch are support engagement at a local level. ensuring equality and diversity is members. factored into decision-making. Kingston and Richmond • One Croydon Communications and • The Patient and Public Involvement Engagement Group coordinates Wandsworth Reference Group (PPIRG), chaired • The Kingston and Richmond communication and engagement by Sarah Rackham, ensures that the communications and engagement across the One Croydon Partnership – a • We work very closely with Healthwatch voice of the Wandsworth community group brings together communications ‘responsible enabler’ in the governance Wandsworth who are involved directly is at the heart of our commissioning. and engagement professionals structure. in several South West London and The current membership includes working in both boroughs across place level CCG committees, ensuring representatives from the voluntary the NHS, councils, Healthwatch the community perspective shapes our sector, community partners and and the voluntary sector. The group Merton discussions. members of PPG groups. Each which meets monthly to work on • We make the most of opportunities partner organisation or network has local joint projects, share knowledge, • The Patient Engagement Group (PEG) for involvement by sharing our plans links right across the community, map stakeholders and coordinate is an active group, contributing to the early, so that we can dovetail with one not limited to Wandsworth but also plans for involving local people. Our continuous improvement of services in another and avoid duplication. We transcending geographical boundaries focus this year has been to gather Merton, ensuring that the South West plan joint work and share information to neighbouring boroughs, which is local population and communities’ London Clinical Commissioning Group

82 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 83 insight about the pandemic and is open to anyone living in Kingston acts as an engagement and equalities include RCVS’ health and wellbeing vaccination programme to inform our to attend to hear updates about and reference group for the CCG in the network for local VCS; Richmond users borough comms and engagement share their views on local healthcare borough. The group, with members and carers group and the health and plans and activities to support local services with the CCG. During the drawn from key voluntary sector social care co-production group. outbreak plans, and vaccine uptake year, the main focus of this forum and community organisations, and hesitancy. As well as NHS South is providing feedback and receiving Healthwatch Richmond, Richmond West London CCG insight work, updates on the Covid-19 pandemic CVS and Richmond Council, has Sutton our Healthwatch in each borough and local vaccination programme. We provided valuable insight into how we gathered residents’ experiences also regularly attend and participate adapt our engagement with our local • Sutton Healthwatch and voluntary of services from March – October in Kingston Voluntary Action’s (KVA) communities during the pandemic and sector partners, including Community 2020. We have worked together health and wellbeing network. There particularly around the vaccination Action Sutton, Age UK Sutton and to identify borough approaches to have also been regular NHS test and programme. There has been a focus Sutton Carer Centre, form part of reaching into communities who have trace and vaccination update sessions on how we can work in partnership to the Sutton Systems Leader Meetings. been disproportionately affected by hosted by the KVA. reach into communities experiencing Our partners have played a vital role the pandemic, experiencing health the greatest health inequalities at • Due to the pandemic the planned for in enabling us to reach the most inequalities and where there is vaccine a very local community level. This CCG local borough committee was vulnerable people during the Covid hesitancy; for example, virtual Covid-19 work is starting to see results through not able to meet as anticipated. In the pandemic. conversations, webinars and podcasts the local community conversations interim senior local CCG executives • Sutton Healthwatch are members of and development of Council Covid around the Covid vaccine and planned and clinical leads met regularly with the Sutton Health and Care Executive champion networks. conversations about community led Healthwatch Richmond officers to and contribute to local decision making health approaches to wellbeing. ensure a dialogue at this level was through support and challenge at The PPG network, a forum for PPG maintained. Healthwatch is also a System Leaders and Sutton Restoration Kingston representatives to come together and member of the local primary care Board meetings. share information and ideas about their management group. • Aligned to the borough PPGs moved successfully online and communications and engagement has provided a valuable network for group we have recently established Richmond PPG representatives to stay in touch an engagement partnership group to and learn from each other during the coordinate Covid vaccine engagement past year. Members have also provided • Locally we have moved our established activities with key partners to avoid valuable insight and feedback on the channels online to ensure regular duplication and enhance our collective local vaccination programme, as well as engagement with our communities, activities. The group has worked taking an active part in volunteering at either directly with patients or via together to support the roll out of vaccination sites. local voluntary and community the Healthwatch Kingston vaccine sector organisations. These include • Richmond CVS coordinates several experience survey, with partners working with our GP practice patient forums with local voluntary and providing translated material and participation groups (PPGs) via our PPG community organisations and people promoting it via their social media and network and specific interest groups via with lived experience of services, which other channels. our community involvement group. the CCG takes part in to maintain • The Kingston patient and public ongoing engagement with local • Our community involvement group forum meets every 6-8 weeks and communities and patient groups. These

84 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 85 satisfaction and better patient safety. • Advancing equality of opportunity between people who share a relevant We are working to ensure that everybody protected characteristics and people is treated with dignity and respect at who do not share it. work. We have a duty to call out racism • Fostering good relations between and discrimination whenever we see or people who share a relevant protected experience it and to create an environment characteristic and those who do not that enables people to raise any concerns. share it.

We all have a part to play in creating a fairer • Being transparent about how they society and our CCG has a special role in are responding to the equality duty, helping to reduce health inequalities in our and are required to publish relevant, communities. We understand how important proportionate information showing it is to all of us that the NHS commissions compliance annually. and provides services that are fair, accessible and flexible to meet the needs of our diverse We are determined to carry out these duties communities. and ensure they inform how we plan and operate as an organisation. We understand and recognise that:

Reducing health inequalities • People can experience inequalities, Addressing health inequalities discrimination, harassment and other across South West London barriers.

• Patients should be at the centre of our The South West London CCG is committed decision making, and we can deliver to addressing the health inequalities that to review how we support and develop Our approach to equality, high quality, accessible services that exist across our boroughs. everyone who works for us. diversity and inclusion tackle inequalities and respond to personal needs. The Covid-19 pandemic, the death of In the summer, we held a series of George Floyd in the United States and the engagement events with staff across the • An environment of dignity, tolerance As we develop as one NHS South West Black Lives Matter movement has sparked CCG to identify priorities and together we and mutual respect should be created, London CCG, we are determined to take opportunities for authentic conversations have developed an action plan to address maintained and experienced by all our this opportunity to create a meaningful around race, racism and wider inequalities these. We continued to host monthly patients and staff. and positive work environment, making in a way that has not been done before, listening events throughout the year. This South West London a great place to live starting a national debate on racism and is important because studies show that a The Equality Act 2010 places a requirement on and work. race in the UK. The message we have been motivated, included and valued workforce public bodies to demonstrate how they are: hearing from our communities, clinicians We are proud of our diverse staff, and our helps increase job satisfaction, high • Eliminating discrimination, harassment and staff has been clear. We must build on Governing Body and senior management productivity, and retention of best talents. and victimisation and any other our progress going further and faster to team are committed to creating a culture For our patients in South West London, this conduct that is prohibited by or under ensure that our services and employment where everybody thrives. Coming together means they will receive high quality patient the Act. practices are fair, accessible, appropriate for care, which leads to increased patient as a new organisation is an opportunity the diverse communities we serve and the

86 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 87 workforce we employ. Having set a joint Covid-19 groups of people has informed our NHS Workforce Race Equality objective as a system to address equality, vaccination strategy, helping us to protect Standard (WRES) diversity and inclusion we are currently more of the most vulnerable people in our assessing what more the system needs it The Public Health England report communities more quickly. to do in this area. Two immediate clinical ‘Disparities in the risk and outcomes of The NHS Workforce Race Equality Standard priorities that we are working on are to COVID-19’, published in August 2020, We know that, for most people, the most (WRES) is used across the NHS to narrow reduce health inequalities are diabetes confirms that the impact of Covid-19 has important and trusted influences in their lives the gap between the treatment of and hypertension. We are looking at these replicated existing health inequalities and, are their friends and family. Our engagement ethnic minority and white staff through priorities and others with the ambition of in some cases, has increased them. teams and clinical leads in each borough collection, analysis and acting on specific creating a three-part South West London have been working with key community workforce data. In addition, the WRES aims These results improve our understanding of Equality, Diversity and Inclusion (EDI) groups like local BME (Black and Minority) to improve diversity of leadership and the the pandemic and will help in formulating programme covering: Forums and resource centres to help experience of staff from ethnic minorities the future public health response to it. The influence people and to reassure of them the within an organisation. • Community: listening to local people largest disparity found was by age. Among safety of the vaccination, and to dispel myths and partners, taking what we have people already diagnosed with Covid-19 that circulate on social media. There are nine indicators, all of which draw a heard and learnt to shape the services people who were 80 or older were seventy direct comparison between white and ethnic we provide so that they are reflective times more likely to die than those under 40. Many of our vaccination centres are in places minority staff experience. Four focus on and responsive to the needs of our of worship, with local religious leaders workforce data, four are based on data from Risk of dying among those diagnosed with communities. supporting our staff and volunteers to both the national NHS Staff Survey questions, and Covid-19 was: take up their offer of the vaccine, and in • Clinical: Taking action to target one indicator considers whether the Board many cases volunteering as vaccinators differential health outcomes to address • Higher for males than females. membership is broadly representative of the themselves. During March 2021, we ran a health inequalities. overall workforce. • Higher for those living in the more series of pop-up walk-in vaccination clinics • Staff: bringing together our workforce deprived areas than those living in the in mosques across South London, with This year is the first year that CCGs’ analysis to help shape our priorities and set least deprived. local Imams encouraging those who had against the WRES indicators are published. our goals to ensure equitable and fair been invited for a vaccination but had been • Higher for those in ethnic minority This data allows us to take action to improve working practices are adopted across hesitant to take up the offer to receive their groups than in white ethnic groups. against these indicators. Areas where we will all of our organisations. vaccination. take action are:

These inequalities largely replicate existing We all have a vital role to play in creating • Recruitment: white staff are 1.8 times inequalities in mortality rates in previous an environment where our approach can more likely to be appointed than staff years, except for ethnic minority groups, flourish. It is clear that change must happen from ethnic minorities, this is higher as mortality was previously higher in white at borough, neighbourhood and South than London average of 1.6. ethnic groups. West London level and so we are working • Disciplinary processes: staff from ethnic alongside local authorities to harness their To keep our staff safe as we start to plan minorities are 1.59 times more likely knowledge of their communities to make future ways of working, we are assessing to undergo a disciplinary process than sure our actions make a real difference. This the needs of each individual staff member, white staff. This is above average for is Everybody vs Racism. including considering the higher risks from London; however, there are a very small Covid-19 for staff from ethnic minorities. number of disciplinaries in the CCG making it hard to compare. The varying impact of Covid-19 on different

88 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 89 • Percentage of staff experiencing ethnic minorities report experience of Public Sector Equality Duty Equality Delivery System harassment and bullying/abuse from discrimination at work from managers, reports other staff: 23.6% of white staff report which is below London average of experiencing harassment and bullying 16.4%. The Public Sector Equality Duty (PSED) (below London average) and 32.1% consists of general and specific duties The Equality Delivery System (EDS) is of staff from ethnic minorities report An action plan has been developed to for public authorities to meet under the a system that helps NHS organisations experiencing harassment and bullying address these themes. This plan has been Equality Act 2010, as set out above. improve the services they provide for staff (8.5% above the London average). co-designed with staff who attended our their local communities and provide We have a responsibility to demonstrate listening events. The action plan focuses on better working environments, free of • Percentage of staff believing how we as an organisation are meeting four key themes and links to the NHS People discrimination, for those who work in the the organisation provides equal our legal duties and are required to publish Plan and the Race Plan for London. The four NHS, while meeting the requirements of opportunities for career progression information annually showing how we themes are: the Equality Act 2010. and promotion: The staff survey comply. shows that 88.3% of white staff in • Culture and leadership The EDS was developed by the NHS, for the the CCG (same as London average) Equality analyses NHS, taking inspiration from existing work believe the organisation provides equal • Recruitment and good practice. NHS South West London opportunities for career progression • Development CCG and all NHS providers in South West and promotion compared to 52.9% All projects commissioned by NHS South London have implemented the Equality of ethnic minority staff (below London • Education West London CCG are required to Delivery System. average of 65.8), representing a 35% complete an Equality Analysis prior to Achieving real change in equality, diversity implementation. difference between white staff and You can read more about our approach to and inclusion will take time, there are no staff from ethnic minorities. equality, diversity and inclusion, including our quick fixes. We will need to take time to This is to ensure that the project has • Percentage of staff experiencing plans and policies, on our website at www. develop understanding and empathy, and considered the impact it will have on those discrimination at work from managers/ swlondonccg.nhs.uk/about/equality-diversity- we will do this through engagement and communities it affects. team leader: 9.5% of staff from and-inclusion. education. We have developed a system to ensure that appropriate assessments are carried out at the right time. Equality Analyses form a key part of our documentation on every project.

90 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 91 Joint Strategic Oversight Group (JSOG). This Working with the Care year we have changed our quality assurance Quality Commission processes, so no undue pressure is put on providers whilst they focus on responding to the Covid-19 pandemic. We have disbanded We have quarterly engagement meetings our Clinical Quality Review Group, and with the Care Quality Commission (CQC) now join internal quality meetings at all during which we review and discuss the provider organisations, including acute, quality and safety of all organisations mental health, community and independent that provide health services in South West providers. This approach has not only London. reduced the pressure on providers and freed up valuable time for staff in all organisations, We also work with providers that may it has also further developed our partnership have CQC improvement plans and support working and a collaborative approach to any the CQC to monitor these. This includes issues. having additional focus meetings with those providers and the CQC. We monitor patient experience through national data, including the Friends and CQC reports on all services in South West Family Test and National Patient Surveys, in London are available on the CQC website at conjunction with locally sourced information www.cqc.org.uk. Improving quality and from providers’ complaints departments and their Patient Advice and Liaison Services Quality monitoring safety – putting quality (PALS). Providers also report on patient and assurance of primary care experience in their quality reports. Due to at the heart of the CCG Covid we have adjusted our face-to-face visits and have started quality monitoring Quality is reviewed through monitoring through desktop peer to peer visits. a wide range of data covering patient experience, practice delivery of services, We work closely with our GP membership achievement against national indicators; and local Healthwatch, who feed back any for example, delivery of learning disability We are committed to ensuring the Monitoring quality issues or concerns raised with them by healthchecks, and reports from other highest levels of quality in the health patients. We actively seek feedback from organisations that assess practices, services we commission. We monitor the our patients and local community on a especially the Care Quality Commission quality of services in South West London We are proud of the effective quality range of issues and services. We also seek (CQC). using quality oversight processes to assurance processes we have in place in feedback routinely through a strong patient measure performance against the quality South West London. engagement network in each borough and There are also routes for practices and other standards we have set and those that are include members of our GP practices’ patient providers to report concerns to the CCG The Quality and Performance Oversight set nationally. These standards address participation groups and specific service user through the Make a Difference alerts system Committee oversees these processes, which patient experience, patient outcomes and groups. and those relating to primary care are also include working with the Care Quality patient safety. reviewed by the PCQRG. Where potential Commission (CQC) and attendance at the issues are identified, either at practice or

92 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 93 borough level support is offered to practices Kingston and Richmond in July 2020. Make We have put together a series of measures Over the last year we have provided to address and improve on these areas. a Difference was implemented in Croydon in to further support care homes residents and telehealth kits to nursing homes and are January 2021. staff this year. Some of the measures were working with care homes and clinical leads The challenge over 2020-21 has been that prescribed by national guidance, so now all across South West London on a wider roll due to the Covid-19 pandemic much of the Whilst initially the MkAD system was set care homes: out. As well as care homes for older people, data normally reviewed to assess quality was up for GPs and healthcare professionals in in 2021 we will be providing telehealth kits not being collected, as practices focused on primary care to highlight any concerns to • Have a nominated GP lead. to care homes for mental health patients and changing their ways of working to deliver the CCG, the system is also available for any • Are supported by primary care with people with learning disabilities. the Covid response. However, there has been healthcare professionals from other providers weekly check ins and multi-disciplinary ongoing communication between the CCG, to raise an alert and is not exclusive to those We have supported care homes in South team support. practices and clinical leads to ensure issues in primary care. West London to begin using NHS mail, which and concerns are raised, and the CCG has • Have access to pharmacy support. has accelerated the discharge process for A MkAD alert can be used to raise concerns been able to provide support to practices to • Are aligned to a Primary Care Network patients from hospital back to their care regarding a range of issues, including poor address these. (PCN), apart from one care home that homes. This is because patient identifiable quality of clinical care, issues with referral is registered with a GP in Westminster. information like medical records can be Making a difference or discharge processes, clinical pathways, or transferred securely through this system. service provision and may relate to clinical In addition to the national guidance, we Most care homes are now using NHS Mail, or non-clinical issues. It is not a replacement have provided ongoing nursing and therapy and we hope to support all care homes in The Make A Difference (MkAD) system for the complaint mechanism, nor is it support to care homes for older people South West London to use NHS Mail or other is a quality alert, management and for reporting serious clinical concerns or through the In-Reach and therapy teams secure email services this year. monitoring system that was implemented incidents. It is intended to act as an early alongside wider support from dieticians and across South West London this year. The warning/feedback system, providing We introduced our E-Red bag initiative, speech therapists. system was designed to implement the intelligence that can be used to address any which sees documents being sent recommendations of the Francis Inquiry wider quality issues, facilitate shared learning Our Behaviour and Challenging electronically by the care home to acute (2013). with services and inform the commissioning Communication Team has been supporting hospitals when residents are transferred process and service redesign. staff in care homes to care for their residents by ambulance, across South West London The system is a simple, user-friendly online who are experiencing behavioural and this year. These documents are linked form for healthcare professionals to flag Care homes emotional difficulties associated with a to residents’ personal records, allowing any concerns (usually relatively minor ones), mental health diagnosis and/or dementia. a smoother and safer handover of care issues, compliments, and good practice that The team have also provided mental health between providers. We are now working they have become aware of through contact Although we have no formal and wellbeing support to the staff in care with our acute hospitals and care homes to with their patients. This feedback is relayed to commissioning or oversight role with many homes during the pandemic. accelerate the uptake of this initiative, with the relevant provider, who is responsible for care homes, this year we have worked particular focus on making sure that care investigating and resolving anything that is closer than ever with our partners in the We have had an intensive focus on infection homes meet the required data security and raised as a concern, and for responding to the care sector supporting them through prevention and control in our care homes protection standards. healthcare professional that reported the alert. the pandemic, particularly on infection this year and have provided intensive training prevention and control. We value the course for care home staff. This training is We have provided training to care home staff The MkAD system was implemented across commitment the care homes have taken supplemented by weekly Infection Prevention on spotting the soft signs of deterioration in Wandsworth GP practices as an early adopter with us in providing the safest possible and Control webinars for all health and care residents (RESTORE2/NEWS 2 training). in 2013. The system was introduced in services for the most vulnerable people in providers in South West London. Merton in 2018, in Sutton in 2019, and our community.

94 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 95 Infection prevention and control assurance assessment peer reviews to through a team of super trainers and We have increased the work of our Joint control give us a deeper understanding of infection trainers. During the second wave we Intelligence Groups to highlight any safety prevention and control practice across South developed an IPC training package that is and safeguarding concerns in our care West London. These peer reviews focussed tailored specifically to working safely in care homes during the pandemic. All our providers in South West London on: homes and offered this training to all 366 have a governance framework in place for care homes in South West London. We do everything we can to make sure the management of infection prevention • The Director of Infection Prevention and the services we commission are safe and and control (IPC), working in line with Control role and the infection control Serious incidents and never compliant with all statutory safeguarding team at each organisation. regulations. We also have procedures to the Health and Social Care Act (2008), the events help us recognise, report and respond to guidance updated in 2015. • IPC governance and policies and safeguarding issues promptly. procedures. Infection prevention and control work is led There have been no serious incidents or • IPC information provision. Pathways and processes have been by Dr Gloria Rowland, who took the position never events in the CCG during 2020/21. introduced across the health and social of Chief Nurse at both South West London • The testing and communication care partnerships to help identify the Health and Care Partnership and NHS South approaches for staff and patients. We are responsible for performance West London CCG in early January 2021. managing serious incidents that take place safeguarding needs of vulnerable children • Reviewed individual Trust Board in any NHS or independent provider that and adults. In commissioning safe and Assurance Framework (BAF) documents Through a weekly South West London we commission service from, allowing us to effective services to meet these needs, the that had previously been reviewed by provider forum, the IPC medical and nursing quickly identify any recurring themes and outcomes for those children and young the Care Quality Commission (CQC) teams across the area have undertaken a trends. Incidents are managed in line with people who have experience of care are earlier in the year. programme of work in the last year covering the National Serious Incident Framework. greatly improved. a wide range of areas including: It is vital that we learn lessons from serious Our safeguarding team supports our Learning was incorporated into key lines incidents to help reduce patient harm in the colleagues in primary care to develop their • IPC policies and procedures have been of enquiry arising from Covid-19 outbreak future. updated in line with the most recent incident at the Hillingdon Hospitals NHS own safeguarding systems and processes. guidance. Foundation Trust and other infection Safeguarding adults and The safeguarding team have strengthened outbreaks. the quality assurance process for primary • Developing testing arrangements for children care, offering peer review and support for staff and patients. Our infection prevention and control group safeguarding leads. • Infection outbreak management. publishes weekly reports which are reviewed Safeguarding aims to support adults, young by the CCG’s Clinical Leadership Group. • FIT testing for staff and personal people and children to live a life that is free Domestic violence protective equipment (PPE). from abuse and neglect. It involves a range This year we have prioritised supporting care of measures to protect people in the most Since the start of the pandemic there has • Pathway management in accordance homes in South West London by providing vulnerable circumstances. been an increase in incidents relating to with Public Health England’s “Covid comprehensive training packages, webinars domestic violence and abuse. Local boroughs 19: Guidance for the remobilisation of and networking and support sessions. This year, the pandemic and lockdowns have adopted new ways of working and increased services within health and care settings. During the first wave of the pandemic, we meant increased violence and abuse. We the frequency of the Multi Agency Risk Infection Prevention and Control offered all care homes in the area training have worked closely with our partners in Assessment Conference (MARAC) to ensure Recommendations” (September 2020). for working safely, including training for policing, education, care and local authority oversight of domestic violence and abuse. donning and doffing protective and personal departments to risk assess and protect the The MARAC is a regular strategic partnership equipment and basic hand decontamination We have completed infection prevention and most vulnerable children and adults. meeting chaired by the police public

96 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 97 protection lead, and includes representatives domestic servitude and organ harvesting. reviewers, managers of services and together the borough teams data and from the NHS, local authority social services practitioners, family/carers representative and information to enable reporting as NHS and education departments. All partners We are committed to ensuring that there is advocates, health representative for example, South West London CCG. review and provide an update on the status no modern slavery or human trafficking in GPs, psychiatrist in learning disabilities • Development of work around contracts of identified risks and raise new risks and any part of our business activity and, in so services, Child Death Overview Panel to ensure compliance, quality and concerns. far as is possible, to hold our suppliers to members, patient representatives. standardisation. account to do likewise. In September 2020, we implemented We have been commended for our • Developing a set of principles for CHC Identification and Referral to Improve Safety Prevent performance in the LeDeR reviews by NHS in South West London, allowing a (IRIS) in Croydon. This is a training and England. South West London approach with support programme for GP practices, giving Safeguarding duties include the Prevent local delivery mechanisms. staff the confidence and skills to talk to strategy, which aims to protect vulnerable How to report a safeguarding concern patients about domestic violence and abuse. individuals from being groomed into terrorist As a result of the Covid-19 pandemic, CHC The other five South West London boroughs’ activity or supporting terrorism. Visit gov.uk Safeguarding concerns can be raised with has been suspended twice during the year domestic violence forums are reviewing how to report illegal or harmful information, the relevant local authority safeguarding which led to teams dealing with uncertainty the IRIS system is working in Croydon with a pictures or videos you’ve found on the team 24 hours a day, seven days a week by and delays and a backlog of assessments, view to implementing in their boroughs. internet about terrorism or extremism. All of any person who feels they are being abused which has provided some unique challenges our safeguarding mandatory training now as well as relatives, teachers, friends, carers, for the local and central teams. To address The designated professionals continue to includes Prevent. neighbours, members of the public, health this, we have utilised additional staff to work collaboratively across the statutory and social care staff or any person who has assess the backlog of patients, used a trusted partnership with local domestic abuse The Learning Disability Mortality Review any concerns. assessor model and worked with local services to disseminate updated guidance (LeDeR) authorities to agree the cases in a timely relating to this issue and represent the CCG In an emergency always call 999. manner. at all commissioned domestic homicide The Learning Disability Mortality Review Safeguarding contact details for Croydon, reviews. NHS South West London CCG is (LeDeR) programme supports local areas to PALS and complaints Kingston, Merton, Richmond, Sutton and represented and proactively involved with the review the deaths of people with learning Wandsworth are available on our website London domestic violence and abuse clinical disabilities (deaths include from age 4 and at www.swlondonccg.nhs.uk/about/ As part of our commitment to continually reference group to ensure national updates above), helping to promote and implement governance/safeguarding. improve the quality of local health services are reflected at a local and regional level. the review process, and providing support to we value all feedback we receive, either as local areas to take forward lessons learned Continuing Healthcare a compliment or a complaint. Modern slavery and human trafficking in the reviews to make improvements to service provision. The LeDeR also collates and This information is used to help us manage Modern slavery is the recruitment, shares anonymised information about the From April 2020, NHS South West London our performance and highlight any areas movement, harbouring or receiving of deaths of people with learning disabilities CCG took a single approach to the oversight where we could make improvements. children, women or men through the use so that common themes, learning points of Continuing Healthcare (CHC) as part of All complaints received are responded to of force, coercion, abuse of vulnerability, and recommendations can be identified the Moving Forward Together programme. individually via our complaints process. To deception or other means for the purpose and taken forward into policy and practice This has included: make sure that complaints are reviewed of exploitation. Individuals may be trafficked improvements. and monitored at the highest level our into, out of or within the UK, and they • The development and recruitment Accountable Officer reviews all responses may be trafficked for a number of reasons, Our LeDeR steering group is attended to a central support team who bring to complaints and our Quality Committee including sexual exploitation, forced labour, by representatives from adult social care,

98 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 99 receives regular reports detailing complaints these, 130 related to issues for which CCG is Addressing complaints during the The Complaints and PALS service also deal received including how they have been responsible for investigating and responding pandemic with a significant number of enquiries and handled. to. We also received 102 complaints informal concerns, from the public and MPs. relating to issues which we are not directly In light of the impact of Covid-19 on During 202/21 there were 655 such contacts. Our complaints policy and procedure responsible for, which were forwarded to the NHS services, NHS England issued advice The areas giving rise to most contacts were: has adopted the principles as outlined appropriate organisation for investigation stating that the process for handling formal in the Parliamentary and Health Service and reply. These included complaints for NHS complaints should be paused between March Covid-19 (almost entirely 188 contacts Ombudsman’s principles of good complaints provider Trusts, GPs, dentists and community and July 2020 to allow staff healthcare to relating to the roll out of the handling, principles of good administration pharmacies. concentrate on providing care to patients vaccine) and principles of remedy. We work and responding to the challenges of the closely with local health service providers, Of the complaints we received in 2020/21, pandemic. During this time, we could only Primary care (GPs, NHS 66 contacts monitoring the standard of complaints two have been referred to the Parliamentary investigate and respond to complaints dentists, community handling, ensuring all complainants are and Health Service Ombudsman. where urgent attention was needed. All pharmacies) informed of their statutory rights under the other complaints were acknowledged and Other NHS organisations 51 contacts NHS Constitution. This includes being given For those complaints that were within recorded and any potential patient safety the information about the NHS complaints the CCG's remit, the most commonly actions were identified and implemented Assisted conception (eligibility 33 contacts service provided by a local advocacy team complained about areas were: immediately, before being fully investigated criteria, can funding be and the option to take their complaint to and responded to. transferred, freezing of eggs) the Parliamentary and Health Ombudsman Continuing healthcare 41 complaints General commissioning 29 contacts (assessment for eligibility if they are not satisfied with the way the Patient Advice and Liaison Services process, payment) Mental health commissioning 17 contacts complaint has been dealt with. (PALS) (access to services, availability Mental health 12 complaints The complaints we receive and manage and funding) commissioning (access to Members of the Patient Advice and Liaison are about the services we commission services, availability and Service (PALS) always listen carefully to Continuing healthcare 13 contacts locally, whilst complaints about GP services funding) the concerns raised by patients and their (assessment for eligibility are handled by NHS England. We use loved ones, and provide advice or make process, payment) the Parliamentary and Health Service General commissioning 8 complaints recommendations, where possible, as to the Ombudsman’s six principles of remedy to Finance (payment of invoices) 12 contacts Covid-19 (Shielding status, 8 complaints best way forward for the patient or member address concerns and complaints: availability of vaccine) of the public. Compliments to the CCG 12 contacts

• Getting it right Assisted conception 5 complaints Whilst it is not always possible to resolve a Individual funding requests 6 contacts (requests for funding for • Being customer focused (eligibility criteria) concern to the service user’s satisfaction, the PALS team can give information about treatment/medication not • Being open and accountable routinely provided on the NHS) We very much value the views of patients support services and voluntary organisations • Acting fairly and proportionately and other people who experience the that may be able to help. We believe that a Patient transport (facilitating 5 contacts • Putting things right services we commission. We consider any successful PALS service helps reduce anxiety transport when necessary) complaint or enquiry about these services for those who use our services and helps • Seeking continuous improvement as a vital part of reviewing and, where people navigate the health and care system, necessary, improving them. whilst also reducing the number of issues Last year, between 1 April 2020 to 31 March that go on to become formal complaints. 2021, we received 232 formal complaints. Of Themes from PALS are escalated.

100 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 101 Contacting PALS

You can get in touch with PALS by calling 0800 026 6082 between 9am and 5pm, Monday to Friday. If no-one is available to take your call, please leave a message and someone will call you back. You can also email PALS at [email protected]

How to make a complaint, comment or compliment

Write to us at:

Complaints and compliments NHS South West London Clinical Commissioning Group, 120 The Broadway, Wimbledon, London SW19 1RH Or email [email protected] or call us on 0800 026 6082. Assuring delivery of performance and constitutional standards and national performance indicators

NHS England assesses the performance guidance for the NHS for the next five of each CCG through a national years, with 2020/21 being the first year. Improvement and Assessment Framework. The metrics for oversight and assessment However, due to the Covid-19 pandemic, purposes were intended to include the and the need to release capacity across the headline measures described in the NHS to support the response, the collection NHS Long Term Plan Implementation and publication of some of the performance Framework against which the success of indicators were paused between April the NHS will be assessed. These Long Term and June with subsequent extensions into Plan measures were to be used as the Quarters 2, 3 and 4 of 2020/21. cornerstone of the mandate and planning

102 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 103 Below is a summary of the performance to manage patient pathways from referral Our performance against the standard at Diagnostic - Performance 2020/21 indicators that have continued to be through outpatient appointments, diagnostic end January 2021 (the latest published data) 100% collected as, despite the pandemic, the CCG tests and onto treatments while safeguarding is reported at 74.95% showing a decrease 90% has an obligation to meet the healthcare patient care. of 10.1 percentage points compared to 12 80% needs of the population within their care. months previously. Throughout 2020/21 70% The performance indicators provide a means While the Covid-19 infection situation available capacity has focussed primarily on for us to measure and assess the quality and improved between August 2020 and the most clinically urgent patients, this has 60% December 2020, and providers invested in productivity of the services we commission in turn led to the number of non-urgent 50% and to inform us where to focus our being able to deliver more patient contacts patients waiting more than 52 weeks to 40% attention to improve the care our patients through telephone and virtual appointments, increase to 2,814 at the end of January receive working in partnership with our the overall reduction in available capacity 2021. 30% service providers. for routine appointments and surgery has Jul 20 Jan 21 Jun 20 Oct 20 Sep 20 Apr 20 Dec 20 Nov 20

led to longer waiting times for some patient Aug 20 Diagnostic test waiting times May 20 Over this financial year we have worked pathways through 2020/21. well together in response to both waves of The operational standard is that no more We have worked jointly with independent Covid-19, providing mutual support at times than one per cent of patients should be Estimated diagnosis rate for people with sector providers in the area to ensure use of of differential challenge in the system. waiting more than six weeks or more for a dementia Covid-free capacity, to increase the numbers diagnostic test. of patients treated and to ensure urgent Referral to Treatment (RTT) A timely diagnosis enables people living with cancer and specialist treatments continued to In light of the response to the first wave dementia, and their carers/families to access The operational standard is that 92% of plan with clinical networks working closely of Covid-19 at the start of 2020/21, April treatment, care and support, and to plan in patients should be waiting no more than 18 to monitor prioritised lists and mitigating for saw a significant reduction in performance advance in order to cope with the impact weeks for elective treatment. any delays that might otherwise arise due to against the diagnostic standard. Since then, of the disease. A timely diagnosis enables the pandemic. performance continuously improved while primary and secondary health and care In March 2020 NHS England issued guidance providers have invested in reconfiguring services to anticipate needs, and working RTT - Performance 2020/21 that all non-urgent elective activity be estates and used independent sector and together with people living with dementia, 100% suspended for three months to free up the community capacity to deliver diagnostic plan and deliver personalised care plans maximum inpatient and critical care capacity 90% tests safely, supporting emergency, cancer and integrated services, thereby improving for the response to Covid-19. Further and elective pathways. outcomes. guidance was issued in December 2020 to 80% again reduce inpatient activity in response to NHS South West London CCG performance Despite the challenges of delivering services 70% the second wave of Covid-19. against the standard at end January 2021 during the coronavirus pandemic, NHS 60% (the latest published data) is reported at South West London CCG maintained good During the first national lockdown, the 75.22%. performance levels against this metric during 50% Royal College of Surgeons issued guidance 2020/21 that consistently met and exceeded to support prioritisation of patients waiting 40% the monthly national benchmark of 66.7%, on trust waiting lists for treatment. These with latest performance achieving 67.7% (as

clinical priority categories were based on Jul 20 of 28 February 2021) for residents aged 65 Jan 21 Jun 20 Oct 20 Apr 20 Sep 20 Dec 20 Nov 20 Aug 20 May 20 the condition and treatment requirements and over. and included a timeframe to each surgical procedure. This prioritisation enabled trusts NHS South West London CCG has a

104 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 105 dedicated Memory Assessment Service for worked closely with our local providers and and social distancing measures, which affect A&E - All Type Performance - 2020/21 five of the six boroughs provided by South implemented adjustments to the IAPT service performance at the front door, ambulance 100% West London and St George’s Mental Health model to enable remote/online therapy offloading, A&E target and patient flow 95% NHS Trust, this helps the CCG to offer sessions to take place which have worked throughout the hospital have affected shorter waiting times, joint care planning and well for most service users. performance against the four hour wait 90% a greater focus on supporting people to live standard as overall attendance figures. 85% well and independently. The CCG continues to meet with local providers regularly to understand the issues Over this financial year, we have developed 80% related to performance. The CCG scrutinises new ways of working and changes to patient Improving Access to Psychological and tests action plans as needed, ensuring pathways to manage patient flow through 75% Therapies (IAPT) that the CCG understands the risks and A&E and into the wider clinical care settings 70% Around one in six adults in England suffer uncertainty in continued achievement of the whilst maintaining a safe environment standards. for patients and staff. In addition, the Jul 20

from a common mental health problem, Jan 21 Jun 20 Oct 20 Feb 21 Sep 20 Apr 20 Dec 20 Nov 20 Aug 20 May 20 such as depression or an anxiety disorder. opening of the Primary Care Hub at the The effectiveness of local IAPT services is IAPT Access Rate - 2020/21 Queen Mary’s site in Roehampton has 6% measured using this indicator and the IAPT provided additional capacity for urgent and Transforming care for people with routine, booked GP and other community recovery rate, which focuses on the recovery 5% learning disabilities (LD) of patients completing a course of treatment. treatment appointments to the residents in 4% Wandsworth. The impact of the pandemic and associated During 2020/21 the NHS in London national lockdowns has been detrimental to 3% committed to delivering an IAPT access Following an initial drop in both the number services offering regular health checks for of attendances at the start of the first standard of 6.25% and a recovery rate of 2% people on the learning disabilities register 50% in Quarter 4. NHS South West London national lockdown and A&E performance due to the reduction in face-to-face GP 1% CCG’s access rate performance is currently against the four hour standard, the appointments. Whilst our primary care attendance figures have started to increase 4.99% (as of 31 December 2020, for Quarter 0% partners have made tremendous efforts to 3) and achieved an outturn of 51.3% for again at A&E departments in South West improve the delivery of learning disability London trusts, though they remain lower the recovery rate (year to date as of 31 Jul 20 health checks following the relaxing of the Jun 20 Oct 20 Apr 20 Sep 20 Dec 20 Nov 20 Aug 20 May 20 December 2020). than previous years with February 2021 lockdown rules, the challenges associated seeing approximately 60% of the activity with undertaking these appointments These targets have proved challenging to A&E four hour wait standard seen in February 2020. physically presented by social distancing meet during 2020/21 following the impact and shielding inevitably puts meeting the of the coronavirus pandemic, where the The national standard is that 95% of patients performance target at risk. number of referrals received substantially should have their treatment completed, or decreased, and social distancing regulations be admitted, within four hours in an A&E We continue to work with individual GP meant local providers were unable to department. practices to ensure continuous training and continue to offer face to face appointments support is made available to GP practice staff for periods of time during the year. Attendances at A&E departments at the and we remain committed to improving the four acute South West London trusts have provision of learning disability health checks To maintain the delivery of these important been severely impacted by the escalation of across the patch. services to our resident population during Covid-19 infection rates over the past 12 the coronavirus pandemic, the CCG has months. Infection, prevention and control

106 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 107 Physical health checks for people with Cancer waiting times pandemic. The CCG also achieved the 93% The number of completed treatments severe mental illness standard in each month, except March 2020 reduced in the first quarter of the year as There are nine cancer waiting time standards where performance was 92.7%. However, the country went into lockdown, and of This indicator monitors the proportion of the captured under three main groupings: the number of appointments completed those treated a larger proportion were people on the Severe Mental Illness (SMI) GP in March was still high (4,479) compared treated beyond the 62-day threshold. June • 2 Week Waits (93% standard). register receiving six physical health checks to the following month, when the number and July 2020 saw a larger volume of within the last 12 months. • 31-Days first (96%) and subsequent of urgent cancer referrals seen dropped patients who had waited over 104 days from treatments. to 1,870. The volume of two-week wait referral to receiving treatment. Treatment As with the health checks for people on the referrals increased each month afterward, levels resumed from the start of quarter learning disabilities register, the health checks • 62-Days referral to treatment (85% returning to pre-pandemic levels in autumn. two with performance improving and so for those on the SMI register have also standard). Despite this, performance in quarter one far, peaking in August and December with been adversely impacted by the pandemic remained above standard, indicating a 84% of pathways treated within 62 days. and associated reduction in face-to-face GP Although NHS England asked trusts to reduction in urgent GP referrals in the spring However, the impact of the festive break appointments and the challenges posed by postpone all elective treatments by the months. Performance against the standard and the second wave of Covid-19 meant social distancing and shielding. middle of April 2020, it also stipulated that at the end of January 2021 was 95.3%, that performance in January was 76.8%. ‘cancer treatment and other clinically urgent with all acute trusts in South West London However, the CCG has outperformed the To improve performance several actions have care should continue unaffected’. performing above the national standards. national average in all months (except July) been taken over this past year, these include: In South West London we have delivered since the start of the pandemic. • Employment of dedicated staff to make strong performance against the cancer Cancer 2 Week Wait - 2020/21 In January 2021 our acute hospitals’ plans for tailored contact with patients to explain waiting times standards in comparison 100% increasing outpatient and diagnostic capacity and underscore the importance of the with the rest of London and nationally. 98% were approved, and a number of waiting list health checks and encourage them to Working with RM Partners (the West London initiatives commended focussing on further make an appointment. Cancer Alliance which brings together NHS 96% increasing capacity and access to services. acute trusts, community services, primary • Engaging with the voluntary sector to 94% work with people with SMI to bring care, commissioners, public health and the voluntary sector) we have been able 92% Cancer 62 Day - 2020/21 them to their appointments. 90% to protect cancer surgery throughout the • Appointments, or in some cases 90% pandemic, with over 1,800 patients from 85% outreach, that are designed to be more across South West London being treated at 88% enabling to those with SMI to attend. the Royal Marsden, the designated green 80%

West London Cancer Hub. We have also Jul 20 Jan 21

• Ensure that as much of the check is Jun 20 Oct 20 Apr 20 Sep 20 Dec 20 Nov 20

Aug 20 75% May 20 done in advance remotely to minimise worked with RM Partners on media and contact time for the physical check to publicity campaigns to boost awareness of 70% NHS South West London has been the be able to reassure those with SMI that potential cancer symptoms to increase access highest performing CCG in London for the 65% risks are being minimised. to GPs and referrals to cancer services, and number of patients treated within 62 days of to increase public confidence. 60% • Any other reasonable adjustments referral throughout the year, demonstrating to assist with the process, such as good resilience and continued provision of NHS South West London CCG’s 2-Week Jul 20 Jan 21 Jun 20 Oct 20 Apr 20 Sep 20 Dec 20 Nov 20 Aug 20 May 20 additional dedicated time for the Wait performance has exceeded the national cancer treatments. checks to be completed. average every month since the start of the

108 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 109 CCG assurance annual has been a very challenging year, we are NHSE Oversight Framework Patient and organisation to put patients at the heart of assessments pleased that we maintained our performance Community Engagement Indicator for all that we do. in most boroughs. Sutton’s overall 2019/20 assessment of ‘Requires Improvement’ was The criteria used to assess CCGs is grouped This year the NHS Oversight Framework primarily due to the CCG’s financial deficit in We also received the final scores from the under five themed domains, as follows: for 2019/20 replaced the CCG 2019/20. The efforts of all our staff, member NHS Oversight Framework Patient and A. Governance Improvement and Assessment Framework practices, partners and communities are key Community Engagement Indicator for (IAF) and the provider Single Oversight to driving improvements in our work and it 2019/20. All boroughs achieved a green or B. Annual reporting is especially pleasing to see that Richmond green star rating (the highest possible rating), Framework. C. Day-to-day practice improved its rating from the previous year. which is an excellent result and reflects In November 2020, NHS England published Next year, instead of six assessments NHS the hard work of our engagement leads in D. Feedback and evaluation the boroughs and the commitment of our their annual assessments of the six former South West London CCG will be assessed as E. Equalities and health inequalities CCGs in South West London, which one organisation. continued to perform well with five out of 2019/20 scores the six achieving a “Good” rating. In what NHS Croydon CCG 2019/20 results 2019/20 2018/19 Domain A Domain B Domain C Domain D Domain E Final score RAGG rating RAGG rating 3 3 3 1 3 13 Green Green Borough 2016/17 2017/18 2018/19 2019/20 NHS Merton CCG

Requires Domain A Domain B Domain C Domain D Domain E Final score RAGG rating Croydon Inadequate Good Good Improvement 3 2 3 2 3 13 Green Green

NHS Kingston CCG Merton Good Good Good Good Domain A Domain B Domain C Domain D Domain E Final score RAGG rating 3 3 3 3 3 15 Green star Green Kingston Good Good Good Good NHS Richmond CCG

Domain A Domain B Domain C Domain D Domain E Final score RAGG rating Requires Richmond Good Good Good Improvement 3 3 3 3 3 15 Green star Green NHS Sutton CCG Requires Requires Requires Sutton Good Improvement Improvement Improvement Domain A Domain B Domain C Domain D Domain E Final score RAGG rating 3 3 3 3 3 15 Green star Green Wandsworth Good Good Good Good NHS Wandsworth CCG

Domain A Domain B Domain C Domain D Domain E Final score RAGG rating 3 2 3 2 2 12 Green Green

110 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 111 Sustainable Freedom of Information development

We are committed to being open and we hold: The NHS Long Term Plan includes several 2019. Without accelerated action there will transparent. The Freedom of Information commitments related to health and the be increases in the intensity of heatwaves, (FOI) Act 2000 gives members of the • Who we are and what we do. environment, including efforts to tackle more frequent storms and flooding, and public a right to request access to all types • What we spend and how we spend it. climate change, reduce single-use plastics, increased spread of infectious diseases such of recorded information held by public • What are our priorities and how we are improve air quality, and minimise waste as tick-borne encephalitis and vibriosis. authorities. doing. and water use. Nationwide, the NHS has already reduced This year, we received 272 FOI requests. We • How we make decisions. Climate change poses a major threat to our its carbon emissions by 26% in the last 10 responded to 250 of these within 20 days. • Our policies and procedures. health as well as our planet. The environment years, (NHS Carbon Footprint Plus, including • Lists and registers. As well as responding to requests for is changing, that change is accelerating, and supply chain) exceeding its commitments • Services we offer. information, we must publish information this has direct and immediate consequences under the Climate Change Act. proactively. The Freedom of Information for our patients, the public and the NHS. In doing so, we have learnt that many of Act requires every public body to have The scheme is designed to increase the actions needed to tackle climate change a publication scheme, approved by the transparency. Members of the public should Improving health by tackling directly improve patient care and health and Information Commissioner’s Office (ICO), and be able to routinely access information that climate change wellbeing. to publish information covered by the scheme. is in the public interest and is safe to disclose. Without the publication scheme, members of This is because many of the drivers of climate The scheme sets out our commitment to the public may not know what information we Climate change threatens the foundations change are also the drivers of ill health make certain classes of information routinely have available. of good health, with direct and immediate and health inequalities. For example, the available, such as policies and procedures, consequences for our patients, the public and combustion of fossil fuels is the primary minutes of meetings, annual reports and Find out more about Freedom of Information, the NHS. The situation is getting worse, with contributor to ill-health from air pollution. financial information. make an information request and read nine out of the 10 hottest years on record Best estimates suggest that over one-third of our publication scheme on our website at occurring in the last decade and almost 900 new asthma cases might be avoided because The seven classes of information are broad www.swlondonccg.nhs.uk/contact-us/data- people killed by heatwaves in England, in and cover all the formal types of information protection-and-freedom-of-information of efforts to cut carbon emissions.

112 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 113 Sustainability in South West Our contracts with providers set out In Autumn 2020 The NHS Net Zero Working from home London requirements to ensure that they Report was published. This report sets are compliant with NHS Sustainable out what the NHS has achieved to date The last year has seen most CCG Development policy and with the Climate and describes the environmental impact staff working from home. The use of The Climate Change Act 2008 sets a legally Change Act. We seek to assure ourselves of health services. It also describes the collaborative IT solutions has allowed binding framework to reduce carbon of their compliance annually. opportunities in the areas of estate us to deliver our corporate meetings emissions, mitigate and adapt to climate and facilities, medicines, supply chain, virtually, which has reduced the need for change. At NHS South West London Being part of an Integrated Care System travel and transport, food, catering and travel between meeting locations which CCG, we are committed to the smart and has further empowered us in delivering nutrition and research, innovation and has provided environmental benefits. As efficient use of natural resources, to reduce a more integrated approach to the offsetting. the government relaxes the restrictions both immediate and long term social, provision and delivery of health and social around Covid-19 we are planning to environmental and economic risks. We care. As well as improving outcomes for The NHS Net Zero report commits the create more availability of office space consider the impact on sustainability of our patients, we anticipate a more joined up NHS to becoming the world’s first net to our teams. We will initially adopt a policies, decisions and approach will have zero national health service with two core phased approach of allowing teams to actions: a beneficial effect targets: come together in our Wimbledon office, on the delivery of a with the opening of other office premises • In our more environmentally • For the emissions we control directly under review. commissioning sustainable local (the NHS Carbon Footprint), we will reach net zero by 2040, with an We want to capitalise on the benefits of of healthcare Many of the drivers health system, ambition to reach an 80% reduction virtual meetings and maintain a ‘virtual by services – ensuring of climate change through greater we support sharing of resources, by 2028 to 2032. default’ approach to our main committee are also the drivers meetings, reducing the need for people environmental and including estate and • For the emissions we can influence of ill health and to travel between meetings. social sustainability infrastructure, that (our NHS Carbon Footprint Plus), we health inequalities in our processes will lead to greater will reach net zero by 2045, with an We are now engaging with all our and decisions. efficiencies over time. ambition to reach an 80% reduction teams to find the right balance between by 2036 to 2039. As we come out • As an organisation working from home and working in the of the second wave, NHS England – taking actions to NHS net zero office, to create the most productive and have stepped up their scrutiny of be a responsible environmentally friendly ways for our The government the progress made in this agenda in organisation in teams to work. has committed to reaching net zero respect of environmental and social individual organizations and wider carbon by 2050. This means significantly sustainability. systems. reducing emissions as well as off-setting • In our relationship with our member using carbon capture. The NHS accounts We are now developing a South practices – to promote sustainable for 5% of the UK’s carbon footprint, West London ICS Green Plan, and development across all our member equivalent to the whole carbon footprint plan to launch a South West London practices. of Cyprus. Green Network made up of partner organisations and large local employers, like Transport for London, this year.

114 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 115 2. Accountability report

116 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 117 Our Governing Body This included the deployment of remote working and meeting platforms to maintain openness and transparency with the live NHS South West London CCG’s Governing streaming and recording of our public Body was established following the meetings. merger of the six borough CCGs in April 2020. Under the CCG’s constitution and At various times over the past year, our Standing Orders, the Governing Body’s response to the Covid-19 pandemic GP representatives either transferred to and our invocation of a Command and the new organisation, have been elected Control structure have meant we have not by their local memberships or, with local implemented a usual cycle of business for membership agreement, have been the Governing Body or its committees. For extended in their roles. Our lay members example, in order to prioritise resource and Corporate governance report were appointed, from the previous CCGs in line with the guidance provided from NHS to the Governing Body via an expression England & Improvement, some meetings of interest exercise. Our Local Medical have not been held. Governing Body Councils, local authorities, Healthwatch members and our key stakeholders have organisations and the voluntary sector been kept informed of the CCG’s response to from across South West London are all the Covid-19 pandemic throughout the year. The CCG’s work is overseen by an elected represented on the Governing Body. Members’ Report The role of our Governing Body is to: Governing Body, which is chaired by Dr Our Governing Body meets in public every Andrew Murray, a GP at the Nelson Health other month, and we encourage our • Oversee and ensure that the CCG has NHS South West London CCG is a clinically Centre in Merton. Sarah Blow is the community to join us to find out about appropriate arrangements in place led member organisation and covers Accountable Officer for NHS South West the work we’re doing. Details of public to exercise its functions effectively, the London boroughs of Croydon, London CCG. efficiently and economically and in Kingston, Merton, Richmond, Sutton and Governing Body meetings, and meeting accordance with the CCG’s principles of Wandsworth. This means that GPs make All Governing Body members have specific papers are published on the CCG website good governance. decisions about local health services by areas of responsibility and sit on committees at www.swlondonccg.nhs.uk/about/ using their local knowledge to improve of the Governing Body. The members governance/our-governing-body • Make sure that decisions about services and focus resources where there is exercise their constitutional rights in respect changes to local health services are During 2020/21, NHS South West London greatest need. of the CCG through a membership group. made in an open and transparent way. CCG strengthened governance arrangements Each member practice has a representative by invoking its Command and Control The CCG is made up of 180 GP practices on the membership group. A number of sub-committees support our framework in response to the Covid-19 and is responsible for a budget of around Governing Body to carry out its statutory £2.6 billion. Together the GP practices have a pandemic, to support the local and national Member practices by locality duties. Please see a summary of our joint decision making model. In this period of registered population of 1,709,000 patients Governing Body members below, followed uncertainty and instability, the organisation (as of 1 March 2021). The membership is Our member practices work across 39 by a table detailing their attendance at has embraced new ways of working and represented by a Governing Body of local primary care networks spanning six meetings of the Governing Body and its new technologies to ensure the appropriate GPs, a nurse representative, a secondary care boroughs. A table of member practices is committees during 2020/21. scrutiny and assurance was maintained in the doctor and lay members, supported by a included in Appendix A at the end of this safe delivery of services at pace and scale. management team. document.

118 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 119 Governing Body Members patronage of HRH The Prince of Wales. Integrated Urgent Care Clinical Governance local Healthwatch to take forward the group and Chair of the National NHS integration of health and social care to better In the last couple of years Andrew has co- Pathways Clinical Governance group serve the needs of the Kingston community. chaired the South West London clinical involving representatives of the royal medical senate and has led work on Children and colleges, and he was previously the National Young People’s Mental Health. He has GP Lead for Urgent & Emergency Care for Dr Andrew Murray Dr Vasa Gnanapragasam overseen the Whole School Approach to the Royal College of General Practitioners Clinical Chair GP Borough Lead emotional wellbeing receiving funding (UK). for Merton Dr Andrew Murray trained at Cambridge for 14 national trailblazer pilots, covering and Oxford universities and then moved to approximately 50% of pupils in South West Agnelo is also Vice Chair of Croydon’s Health Dr Vasa Gnanapragasam has been a GP South West London in 2000, straight after London, the largest cluster in the country. and Wellbeing Board and co-Chair of the since 1996. He worked for 16 years at graduating. He completed his GP training Health Board in Croydon. the Emergency department at St George’s in August 2004 and joined the partnership As Merton CCG Chair, Andrew promoted a Hospital helping to develop his awareness at The Church Lane Practice in Merton Park community-based and holistic approach to He was awarded the MBE for “services to of NHS clinical practice in both primary care and has practised as a GP principal in Merton health and ensured closer working with the Medicine and Healthcare” by Her Majesty and secondary care. He finds the challenge since then. He oversaw the merger of his Local Authority, particularly around action on the Queen (2004) and Fellowship of the of looking after the diverse population practice with Cannon Hill Lane Medical health inequalities through the Health and Royal College of General Practitioners (2006). of London intellectually stimulating and Practice in April 2015 to form the Nelson Wellbeing Board. personally rewarding. Vasa is a partner at a Medical Practice and now practises out of practice in Merton. Andrew was subsequently appointed Chair the Nelson Health Centre. Dr Naz Jivani of NHS South West London CCG and Clinical Vice Chair and GP Vasa has an interest in diabetes, Andrew was involved in practice-based has provided senior clinical leadership to Borough Lead for Kingston cardiovascular disease, frailty and patient commissioning, set up and led a local GP South West London through the Covid-19 engagement. Since 1999 he has held many provider company, worked as a GP appraiser pandemic, chairing the Clinical Leadership Dr Naz Jivani has been a GP in Kingston portfolios in Merton serving as lead for in Sutton and Merton for 5 years, was a Group and the Specialised & Cancer since 1996 and is a partner at The Groves cardiovascular disease, long term conditions, member of Merton Local Medical Committee Recovery Programme. Medical Centre, New Malden. He specialises medicines management, community services for 7 years, as well as chairing Merton, in musculoskeletal conditions and is currently and planned care. He is currently clinical Sutton and Wandsworth Local Medical leading a programme of improvements in co-lead for urology and stroke in South Committees from 2011 to 2013, when he Dr Agnelo Fernandes this area. He is also Clinical Lead for South West London. Vasa has found leading the moved from this role to join Merton CCG as GP Borough Lead West London and Kington Planned Care and discussion and responding to questions at Clinical Chair. for Croydon MSK Transformation Programmes. Covid vaccine webinars most fulfilling.

He also has an interest in developing Dr Agnelo Fernandes has been a GP in He is currently a Board Member of the Vasa has been actively involved in education, world healthcare, education and Thornton Heath, Croydon for 31 years. NHS Clinical Commissioners, representing training, workforce development and quality community development and helped to His interests include dermatology, quality London. He also Co-Chairs the Kingston assurance since 2002. He is a GP trainer and set up a community health worker training improvement of health services through Health and Wellbeing Board. appraiser and is also a Foundation Doctor programme in Myanmar which has so far innovation and transformation and teaching supervisor. He was a module lead on the Naz is the GP Borough Chair for Kingston. trained nearly 1000 health workers. He and training. He is a GP Trainer and a pioneering physician associate programme In this role he works alongside other GPs, served for a number of years as a trustee Governor at Royal Russell School, Croydon. at St George’s, University of London for health and care professionals, Kingston and chair of the charity supporting this ten years and has been teaching since its He is also the Chair of the pan-London Hospital, Kingston Council, and Kingston’s work (Health and Hope) which received the founding in 2008. He was promoted to

120 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 121 Senior Lecturer in PA education in 2014. its inception in 2013 and was appointed Clinical Lead for Cardiovascular Disease in as Joint Clinical Director in 2018. Dino Wandsworth for many years she now co- As GP Borough Lead for Merton, Vasa was elected as Joint Primary Care Network chairs the South West London Cardiology Dr Jeffrey Croucher looks forward to supporting the effective Clinical Director for Central Sutton in 2019. Network. GP Borough Lead for Sutton integration and delivery of health and care He is Chair of the Epsom and St Helier services across South West London to better April to October 2020 University Hospitals A&E Delivery Board and serve the needs of the people of Merton and is NHS Sutton CCG Clinical Director Lead for David Smith South West London. Dr Jeffrey Croucher has been the GP the Sutton Joint Financial Recovery plan with Non-Clinical Vice Chair and Borough Lead for Sutton up to October Epsom and St Helier University Hospitals NHS Finance Chair Lay Member 2020, prior to which he was appointed Trust. Dr Patrick Gibson Clinical Chair of Sutton CCG in July 2016, David Smith is a qualified accountant and He joined the NHS South West London CCG GP Borough Lead for having previously undertaken the role of member of the Chartered Institute of Public Governing Body in October 2020. Richmond Sutton and Cheam Locality Lead. As a local Finance and Accountancy. After more than GP, with a special interest in Musculoskeletal 42 years working in the NHS, David retired Dr Patrick Gibson practices at Essex House, Medicine, and GP Trainer, Dr Croucher has from full-time work at the end of 2017. Dr Nicola Jones Barnes. Patrick has held several board and supported Sutton residents since 2003. Clinical Vice Chair and clinical leadership roles, with particular focus David’s early career was in finance GP Borough Lead for on Whole System Work, cardiovascular Dr Croucher continues to undertake his roles before moving into performance Wandsworth and cancer. He has held liaison roles with clinical role from the Benhill and Belmont GP management and commissioning. David Kingston and Queen Mary’s Hospitals. Centre in Sutton. He trained at St George’s In addition to supporting the Chair, Nicola’s has previously served in a joint post as the Hospital, Tooting and has subsequently portfolio includes clinical leadership of Director of Adult Social Services for the He was a member of Richmond’s clinical worked and lived locally over the last 30 primary care and the Covid-19 vaccine Royal Borough of Kingston upon Thames executive team and chaired the Richmond years. programme. and Chief Officer of Kingston CCG. In this and Barnes membership engagement role, he led the transformation of the care group. In 2012, Patrick’s thinking on care Nicola has been a GP since 1995. She systems in Kingston, integrating service management was heavily influenced by has been a primary care advisor to the delivery models, and health and adult social a whole system leadership programme, Department of Health and has experience care commissioning. He was also Chief Dr Dino Pardhanani supported by the King’s Fund, which of commercial organisations as well as an Executive of Oxfordshire CCG and lead the GP Borough Lead for Sutton put relationship building at the heart of NHS background. She gained an MBA from Sustainability and Transformation Partnership transformational work. October 2020 – present London Business School in 1999 and has covering Buckinghamshire, Oxfordshire, and developed management expertise in a variety Berkshire West. Patrick’s motivation is to reduce inequalities Dr Dino Pardhanani graduated from St of roles but remains utterly rooted in NHS in health outcomes and to create life-long George’s Hospital Medical School in 1999 clinical practice and primary care. She enjoys With his experience working in the NHS and mental health resilience through attention in and has been a GP since 2003. Dino joined the challenges of practicing in inner London with CCGs, David is pleased to be working in the early years. Mulgrave Road Surgery as a partner in 2004 with its diversity and pathology. NHS South West London CCG, contributing to and has worked as a GP with a special the strategy of the CCG and the wider system interest (GPwSI) in Ear, Nose and Throat Nicola has an interest in cardiovascular as we strive to deliver consistently high quality disorders for 15 years and was awarded a disease and women’s health and, as well of care. David chairs the Finance Committee; Master’s in Business Administration in 2016. as seeing patients, is the managing partner chairs the Remuneration Committee and is a of a group of practices in a Primary Care member of the Audit Committee. Dino has worked with NHS Sutton CCG from Network in Wandsworth. Having been the

122 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 123 Anthony’s hospital until 2014 and undertaking Governance at Kent and Medway Social Care Sarah is responsible for leading the Paul Gallagher work as a FIPO (Federation of Independent Partnership Trust and Executive Nurse at NHS partnership through the changing NHS Audit Chair Lay Member Practitioner Organisations) accredited appraiser Medway. In addition, she has current Non- landscape as well as being accountable and Conflicts of Interest for doctors in the independent sector. Executive Board experience for a Provider for balancing financial budgets, achieving Guardian NHS Trust Board. performance targets, commissioning and Paul Gallagher is a chartered accountant Before joining NHS Croydon CCG in overseeing governance and quality, as well as and has experience as a lay member on the September 2019, Les served six years as a Pippa is currently the Independent Nurse ways of working and communications. Governing Bodies for the former CCGs in Sutton CCG Governing Body member as representative for NHS South West London South West London. Secondary Care representative and was CCG’s Governing Body, where she maintains Sarah holds an MBA, PG Dip in Healthcare particularly involved in the quality agenda an essential focus on clinical quality, safety Systems Management and a BA (Hons) Paul began his career in local government where he gained his Information Governance and effectiveness and Chairs the South West History and Humanities and is based in and has since held a number of senior expertise in holding the role of Caldicott London Quality and Performance Committee. Wimbledon. She lives in Sutton with her leadership roles in the private sector, Guardian. family and has two grown up sons. managing and supplying IT, professional and support services to both private and public Susan Gibbin Patient and Public sector organisations. Paul currently works Sarah Blow in management consulting and advises Involvement Lay Member and Freedom to Speak Accountable Officer James Murray companies on finance transformation, Up Guardian Chief Finance Officer strategy and operations. Sarah has over 20 years of experience in the Susan has worked in and with the NHS NHS. She is an experienced Chief Executive James has over 30 years’ experience In his role as Chair of the Audit Committee for more than 30 years in an executive, and has led programmes across partnerships working within the NHS across a number of and Conflicts of Interest Guardian, Paul is consultancy and more recently in a non- while working widely across systems to different organisations, including provider, committed to ensuring accountable delivery executive capacity. Susan has vast experience improve services and deliver sustainability. commissioning and regulatory functions. of health and care for the community. of working with commissioning and provider Sarah has held operational and strategic roles James has been the Chief Finance Officer for organisations in both Health and Education, with Local Authorities, providers and the the South West London Alliance of CCGs for offering experience in strategic and critical Department of Health, and recognises the the past three years. thinking, governance and partnership importance of a strong collaborative approach. Dr Les Ross working. Susan is also the CCG’s Freedom to Sarah has been working in South West Secondary Care Doctor Speak Up Guardian. London as Accountable Officer for NHS Dr Leslie (Les) Ross was clinical consultant in South West London CCG alongside being the women’s health department at St Helier the Senior Responsible Officer for the ICS for 25 years until retirement in October Pippa Barber (Integrated Care System) known as South 2012, with experience in both Obstetrics, Independent West London Health and Care Partnership Gynaecology, ultrasound, cancer diagnostics Registered Nurse since February 2017. and subfertility / IVF and was clinical director Pippa Barber has nearly 40 years’ experience In 2020 Sarah oversaw the merger of the for 3 years. While retired from an NHS in the NHS. She has significant Board South West London Alliance of CCGs Consultant post since the end of 2012, Les experience in a number of Executive and Croydon CCG, into the current, continued to undertake some private practice roles across a range of Provider and single, NHS South West London Clinical held duties as the Responsible Officer and Commissioning Trusts, latterly as the Commissioning Group. Medical Advisory Committee chair at St Executive Director of Nursing and

124 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 125 Governing Body and sub-committee meetings Committees of the When discharging their delegated functions, Governing Body the Governing Body and committees operate in accordance with their approved terms of The Governing Body met five times in 2020/21. The January 2021 meeting was cancelled due The Governing Body has established sub- reference. to the CCG concentrating its resources on the response to the Covid-19 pandemic. committees as described below. The extent of authority to act of these committees Governing Body membership and meeting attendance depends on the powers delegated to them by the CCG, as described in its Scheme of Reservation and Delegation (Appendix 4b of Meetings Name Role the CCG’s constitution), which sets out: attended

• Decisions that are reserved to the Dr Andrew Murray NHS South West London CCG Clinical Chair 5/5 membership as a whole.

Dr Agnelo Fernandes Croydon, elected GP Borough Lead 3/5* • Decisions delegated to the Governing Body and its committees. Dr Naz Jivani Kingston, elected GP Borough Lead 4/5* • Decisions delegated to individual Dr Vasa Gnanapragasam Merton, elected GP Borough Lead 5/5 members and employees.

Dr Patrick Gibson Richmond, elected GP Borough Lead 4/5 The CCG remains accountable for all its functions, including those that it has Dr Jeff Croucher Sutton, elected GP Borough Lead (up to Oct 2020) 3/3 delegated. In discharging their delegated responsibilities, the Governing Body and its Dr Dino Pardhanani Sutton, elected GP Borough Lead 2/2 committees are required to:

Dr Nicola Jones Wandsworth, elected GP Borough Lead 5/5 • Comply with the principles of good NHS South West London CCG, Deputy Chair & Lay governance. David Smith 5/5 member Finance • Operate in accordance with the CCG’s Paul Gallagher Lay Member, Audit Chair 5/5 Scheme of Reservation and Delegation.

• Comply with the CCG’s Standing Dr Les Ross Secondary Care Doctor 5/5 Orders. Susan Gibbin Lay Member, Public & Patient Engagement 5/5 • Comply with the CCG’s arrangements Pippa Barber Independent Registered Nurse 5/5 for discharging its statutory duties.

• Where appropriate, ensure that Sarah Blow NHS South West London CCG Accountable Officer 5/5 members have had the opportunity James Murray NHS South West London Chief Finance Officer 5/5 to contribute to the CCG’s decision- making process through the membership group. *A representative deputy was present for one (September) meeting

126 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 127 Audit Committee assure itself that relevant risks, particularly Remuneration Committee provisions of any national agreements and financial, are appropriately identified and NHS England and Improvement guidance, The Audit Committee is responsible managed within a robust system of internal The Remuneration Committee is responsible where appropriate. for reviewing the establishment and control. The Committee is also responsible for advising the Governing Body in meeting maintenance of an effective system of for seeking appropriate assurance functions their responsibilities to ensure appropriate With the exception of Lay Members, the governance, risk management and internal on relating to ensuring arrangements for remuneration, allowances and terms of Committee also has the power to make control, across the whole of the CCG’s counter-fraud and audit work programmes. service for the CCG Chair, Accountable recommendations on fees and other activities that support the achievement of Officer, senior managers remunerated allowances for all individuals directly the CCG’s objectives. A key purpose of the The Audit Committee met seven times under the Very Senior Manager (VSM) Pay appointed by the CCG as workers or committee is to monitor the integrity of during 2020/21 in order to discharge its Framework, Governing Body clinical posts, employees. the financial statements of the CCG and responsibilities. and clinical lead corporate roles; at all times having proper regard to the organisation’s The Remuneration Committee met seven times during 2020/21 in order to discharge Meetings circumstances and performance, the Name Role attended its responsibilities.

Paul Gallagher Lay Member, Audit Chair 7/7 Meetings Name Role attended NHS South West London CCG, Deputy Chair & Lay David Smith 7/7 member Finance NHS South West London CCG, Deputy Chair & Lay David Smith 7/7 member Finance Dr Agnelo Fernandes Croydon, elected GP Borough Lead 6/7* Paul Gallagher Lay Member, Audit Chair 7/7 Dr Dino Pardhanani Sutton, elected GP Borough Lead 1/3 Susan Gibbin Lay Member, Public & Patient Engagement 7/7 Dr Jeff Croucher Sutton, elected GP Borough Lead (up to Oct 2020) 4/4

Dr Les Ross Secondary Care Doctor 7/7

*Representative present for September 2020 meeting

128 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 129 Primary Care Commissioning Committee of services. Patients, members of the public Quality, Performance and Oversight London. The Committee provides assurance and other stakeholders are invited to attend Committee to the Governing Body, that required The Primary Care Commissioning Committee the Committee. performance outcomes are delivered with meets in public, and its purpose is to enable The Committee is responsible for overseeing, associated risks identified and, where the members to make collective decisions Due to the impact of the pandemic and understanding, reviewing, and ensuring a possible, mitigated. on the review, planning and procurement the ensuing Command and Control robust quality strategy is in place and that of primary care services in South West arrangements, the Primary Care this maximises the quality and safety of The Quality and Performance Oversight London, under delegated authority from NHS Commissioning Committee met four times services for the population of South West Committee met seven times during 2020/21. England. in public during the year, as opposed to the planned six meetings in the first year as set Meetings Name Role The Committee aims to ensure that out in the committee’s Terms of Reference, attended appropriate primary care services are which form a part of the constitution. In commissioned to serve the needs of residents addition to the public meetings, urgent Pippa Barber Independent Registered Nurse 7/7 and improve the efficiency, effectiveness, decision-making meetings were established economy and quality of services, reduce to ensure continuity of oversight and Susan Gibbin Lay Member, Public & Patient Engagement 6/7 inequalities and promote the involvement of authorisation as required within the patients and the public in the development committee’s remit. Dr Nicola Jones Wandsworth, elected GP Borough Lead 6/7

Dr Patrick Gibson Richmond, elected GP Borough Lead 6/7 Meetings Name Role attended Dr Les Ross Secondary Care Doctor 7/7

Susan Gibbin Lay Member, Public & Patient Engagement 4/4 Gloria Rowland Chief Nurse/Executive Director of Quality 1/1

Dr Les Ross Secondary Care Doctor 4/4 Executive Director Systems Planning Performance and Jonathan Bates 6/7 Delivery Executive Director Systems Planning Performance and Jonathan Bates 2/2 Delivery (Primary Care SRO up to March 2021)

Locality Executive Director Merton and Wandsworth Mark Creelman 2/2 (Primary Care SRO from Jan 2021)

Deputy Senior Responsible Officer, South West London Health and Care Partnership / Executive Director of Karen Broughton 0/4 Strategy and Transformation, NHS South West London CCG

130 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 131 Finance Committee the drivers behind any variances against the NHS South West London CCG Register of interests and plans, ensure any risks have been identified, ‘Committees in Common’ management of conflict of The Committee is established to ensure that and mitigating actions have been taken to a robust financial strategy is in place and to address these whilst providing assurance NHS South West London CCG’s constitution interests oversee the system of financial management, to the Governing Body about delivery and provides for a mechanism that allows including the review of financial plans and sustained performance. specified functions to be delegated to a The CCG operates a robust policy for the the current and forecast financial position of designated committee, which may meet with management of conflicts of interest. A the CCG and Borough budgets. The Finance Committee met 11 times during delegated committees of other CCGs in a register of declared interests is published 2020/21. Committees in Common (CiC) arrangement, on the website at www.swlondonccg.nhs. The Committee also aims to understand with the agreement of the Governing Body. uk/wp-content/uploads/2020/07/SWL-COI- REGISTER_-June-2020.pdf Meetings Name Role Improving Healthcare Together 2020- attended 2030 All attendees are required to declare their interests as a standing agenda item for every NHS South West London CCG, Deputy Chair & Lay David Smith 11/11 During 2019/20, NHS South West London member Finance, Finance Committee Chair Governing Body, committee or working CCG, alongside Surrey Heartlands CCG, group meeting before the item is discussed. agreed the establishment of the Improving Dr Les Ross Secondary Care Doctor 11/11 Healthcare Together: 2020-2030 Committees To protect the integrity of decision-making, in Common (CiC) arrangement, to enable arrangements for managing conflicts of Dr Naz Jivani Kingston, elected GP Borough Lead 8/11 the participating CCG Committees to interest and potential conflicts of interest consider the same issues at the same time have been established. These include Dr Vasa Gnanapragasam Merton, elected GP Borough Lead 9/11 in relation to any significant change to the excusing potentially conflicted members from commissioning of acute services at Epsom deliberations where appropriate. Paul Gallagher Lay Member, Audit Chair 9/11 and St Helier University Hospitals Trust, as part of collaborative decision making for Personal data Pippa Barber Independent Registered Nurse 9/11 the Improving Healthcare Together (IHT) related incidents programme. Under the arrangement, each James Murray NHS South West London Chief Finance Officer 11/11* CCG Committee has delegated authority to make decisions about the matters within the There have been no Serious Untoward *representative present at three meetings scope of this CiC on behalf of its own CCG Incidents relating to data security breaches, and without the need to be ratified by its that required onward reporting to the Governing Body. Information Commissioner.

The IHT Committees in Common met twice during 2020-21.

There were no other CiC delegations during 2020-21.

132 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 133 Statement of disclosure Modern Slavery Act to auditors Statement of Accountable NHS South West London CCG fully supports Each individual who is a member of the the Government’s objectives to eradicate Officer’s responsibilities CCG at the time the Members’ Report is modern slavery and human trafficking. approved confirms: Our Slavery and Human Trafficking • So far as the member is aware, there is Statement for the financial year ending 31 The National Health Service Act 2006 and other irregularities). March 2020 is published on our website. (as amended) states that each Clinical no relevant audit information of which • The relevant responsibilities of Commissioning Group shall have an the CCG’s auditor is unaware that accounting officers under Managing Accountable Officer and that Officer shall would be relevant for the purposes of Public Money. their audit report be appointed by the NHS Commissioning Board (NHS England). NHS England has • Ensuring the CCG exercises its • The member has taken all the steps appointed the Sarah Blow to be the functions effectively, efficiently and that they ought to have taken in Accountable Officer of NHS South West economically (in accordance with order to make him or herself aware London Clinical Commissioning Group. Section 14Q of the National Health of any relevant audit information and Service Act 2006 (as amended)) and to establish that the CCG’s auditor is The responsibilities of an Accountable Officer with a view to securing continuous aware of it. are set out under the National Health Service improvement in the quality of services Act 2006 (as amended), Managing Public (in accordance with Section14R of the Money and in the Clinical Commissioning National Health Service Act 2006 (as Group Accountable Officer Appointment amended)). Letter. They include responsibilities for: • Ensuring that the CCG complies with its financial duties under Sections 223H • The propriety and regularity of to 223J of the National Health Service the public finances for which the Act 2006 (as amended). Accountable Officer is answerable.

• For keeping proper accounting records Under the National Health Service Act 2006 (which disclose with reasonable (as amended), NHS England has directed accuracy at any time the financial each Clinical Commissioning Group to position of the Clinical Commissioning prepare for each financial year a statement of Group and enable them to ensure accounts in the form and on the basis set out that the accounts comply with in the Accounts Direction. The accounts are the requirements of the Accounts prepared on an accruals basis and must give Direction). a true and fair view of the state of affairs • For safeguarding the Clinical of the Clinical Commissioning Group and Commissioning Group’s assets (and of its income and expenditure, Statement hence for taking reasonable steps for of Financial Position and cash flows for the the prevention and detection of fraud financial year.

134 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 135 In preparing the accounts, the Accountable CCG’s auditors are unaware, and that Officer is required to comply with the as Accountable Officer, I have taken requirements of the Government Financial all the steps that I ought to have taken Governance Statement Reporting Manual and in particular to: to make myself aware of any relevant audit information and to establish that • Observe the Accounts Direction the CCG’s auditors are aware of that issued by NHS England, including the information. Introduction aims and objectives, whilst safeguarding relevant accounting and disclosure the public funds and assets for which I • The annual report and accounts and context requirements, and apply suitable am personally responsible, in accordance as a whole is fair, balanced and accounting policies on a consistent with the responsibilities assigned to me in understandable and that I take personal basis. NHS South West London Clinical Managing Public Money. responsibility for the annual report and Commissioning Group is a body corporate • Make judgements and estimates on a accounts and the judgments required I also acknowledge my responsibilities as established by NHS England on 1 April 2020 reasonable basis. for determining that it is fair, balanced set out under the National Health Service under the National Health Service Act 2006 and understandable. Act 2006 (as amended) and in my Clinical • State whether applicable accounting (as amended). standards as set out in the Government Commissioning Group Accountable Officer Financial Reporting Manual have been Sarah Blow The clinical commissioning group’s statutory Appointment Letter. followed and disclose and explain any Accountable Officer functions are set out under the National I am responsible for ensuring that the material departures in the accounts. Health Service Act 2006 (as amended). The South West London Clinical Commissioning Group clinical commissioning group is administered CCG’s general function is arranging the • Prepare the accounts on a going Date: 11 06 21 prudently and economically and that provision of services for persons for the concern basis. resources are applied efficiently and purposes of the health service in England. effectively, safeguarding financial propriety • Confirm that the Annual Report and The CCG is, in particular, required to arrange and regularity. I also have responsibility for Accounts as a whole is fair, balanced for the provision of certain health services reviewing the effectiveness of the system and understandable and take personal to such extent as it considers necessary to of internal control within the clinical responsibility for the Annual Report and meet the reasonable requirements of its local commissioning group as set out in this Accounts and the judgements required population. for determining that it is fair, balanced governance statement. and understandable. As of 1 April 2020, the clinical commissioning group is not subject to any Governance arrangements To the best of my knowledge and belief, I directions from NHS England issued under and effectiveness have properly discharged the responsibilities Section 14Z21 of the National Health Service set out under the National Health Service Act Act 2006. 2006 (as amended), Managing Public Money The main function of the Governing Body and in my Clinical Commissioning Group Scope of responsibility is to ensure that the group has made Accountable Officer Appointment Letter. appropriate arrangements for ensuring that it exercises its functions effectively, I also confirm that: As Accountable Officer, I have responsibility efficiently and economically and complies for maintaining a sound system of internal with such generally accepted principles of • As far as I am aware, there is no control that supports the achievement of good governance as are relevant to it. relevant audit information of which the the clinical commissioning group’s policies,

136 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 137 NHS South West London CCG’s constitution Discharge of of Good Practice 2011 (HM Treasury and of progress through the Committee sets out how it shall fulfil its statutory duties statutory functions Cabinet Office) that we consider to be structure to the Governing Body ensure and the primary governance rules for the relevant to the CCG. These are especially appropriate action is taken to manage CCG. It complies with National Health reflected in this report in describing review of risks. Service Act 2006 (as amended) and relevant The arrangements put in place by NHS Governing Body effectiveness and the CCG’s guidance issued by NHS England. The CCG is South West London CCG and explained risk management arrangements. The capacity to handle risk section describes a clinically led membership organisation and within the corporate governance the range of systems and processes in is accountable for exercising the statutory framework were developed to ensure Risk management place to embed risk management more functions of the CCG. compliance with all relevant legislation. arrangements and broadly in the CCG’s activities including the effectiveness requirement for equality impact assessments The Governing Body comprises: In light of recommendations of the 2013 to accompany papers to the Governing Body. Harris review, the CCG has reviewed all • One Chair – who shall be an elected GP the statutory duties and powers conferred The CCG has a robust internal control The CCG is fully committed to complying on it by the National Health Service Act • Six elected GPs – one from each mechanism to allow it to prevent, manage with the public sector equality duty set 2006 (as amended) and other associated Borough and mitigate risks. out in the Equality Act 2010, both as an legislative and regulations. I can confirm employer and a commissioner of health • Two Independent Members: that the CCG is clear about the legislative The Internal Control Framework section services and publishes these arrangements o A Secondary Care Specialist requirements associated with each of the below describes the governance structure of on our website. The Lay Member for Patient o A Registered Nurse statutory functions for which it is responsible, the CCG, while the risk assessment section and Public Involvement (PPI) assures the including any restrictions on delegation of (described over the following pages) describes CCG’s duty to engage the public is given a • The Accountable Officer those functions. our approach to risk management and appetite profile at the Governing Body. Members of • The Chief Finance Officer for risk, explaining the key components of the the public are also able to attend meetings Responsibility for each duty and power internal control structure. Combined, these of the Governing Body and Primary Care • Three lay members with experience of: has been clearly allocated to members of arrangements underpin the CCG’s ability to Commissioning Committee. the Senior Management Team who ensure o Finance, governance and audit control risk through a combination of: the necessary capability and capacity to o Patient and Public Involvement Board assurance and risk undertake all of the CCG’s statutory duties. • Prevention – the CCG’s structures, management framework o Finance, planning, commercial and governance arrangements, policies, procurement expertise/experience UK Corporate Governance procedures and training minimise the within the NHS Code likelihood of risks crystallising. The Board Assurance Framework (BAF) provides assurance to the Governing Body • Deterrence – staff are made aware that Committees of the Governing Body and on the delivery of its corporate objectives. failure to comply with key policies and membership of each are described within the We are not required to comply with the UK procedures, such as the Standards of Member’s Report. Corporate Governance Code. The BAF has been designed to provide Business Conduct Policy or the Fraud, assurance on the delivery and impact of Bribery and Corruption Policy, will be However, we have reported on our Corporate the priority programmes as well as the risks taken seriously by the CCG and could Governance arrangements by drawing upon threatening delivery and therefore impact on lead to disciplinary action, or dismissal. best practice available, including those corporate objectives being achieved. It sets out aspects of the UK Corporate Governance • Management of risk – once risks mitigating actions for the risks and timescales Code and the Corporate Governance in are identified the arrangements for in respect of these actions being completed. Central Government Departments: Code ongoing monitoring and reporting

138 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 139 Priority areas managed under Governing Body and committee reporting priority areas and associated risks. scales of impact and likelihood of adverse the CCG’s objectives arrangements prompt authors to consider events. The scale is scored from 1-25 (with that key aspects of risk have been reviewed. The BAF forms the basis for the Governing 1 being the least severe and 25 being the Body to assess its position regarding most). The risk will continue to be managed achieving its corporate objectives. It uses Risk assessment in relation to at D=director level with oversight by the Capacity to handle risk principal risks to achieve those objectives as governance, risk management and committee relevant to the risk as well as the foundation for assessment. It considers The responsibilities of directors and internal control oversight from the Audit Committees in the current level of control alongside the committees are set out in the NHS South common. This allows: level of assurance that can be placed West London Clinical Commissioning The Senior Management Team is against those controls. • The appropriate level of investigation Group Constitution and the accompanying responsible for oversight of the risk management process, its members and causal analysis to be carried out. Scheme of Delegation, as well as the The BAF has been created from three core review both Risk Registers and the Board • Identification of the level at which the governance reporting lines. Timely and areas of the CCG’s more detailed Corporate Assurance Framework (BAF) as part of their risk will be managed, the assigning accurate information to assess risk and Risk Register: ensure compliance with the CCGs statutory business cycle, and the management of all of priorities for remedial action and obligations, is submitted in line with the NHS South West London CCG corporate • Risks with a significant residual score, determination of whether the risk will CCG’s annual plan of committee work. The risks are overseen by an Executive Director. for example, those that score over 15. be accepted. Governing Body has rigorous oversight of It evaluates the status of risks, identifies • Those risks that we believe are either the performance of the CCG, via formal new risks and monitors effectiveness The areas of high risk for NHS South West likely to be growing in significance Governing Body meetings, seminars of the CCG’s board assurance and risk London CCG are: or that we wish to flag to the Audit and through assurances received from management control systems. Committee as posing a risk to committees and audits. Using the residual risk rating (i.e. after The Audit Committee provides scrutiny and delivering essential areas of work. controls are taken into account), there are The overall responsibility for the management independent assurance to the Governing three risks of significant nature (significant of risk lies with the Accountable Officer. Body on the effectiveness of the CCG’s Overarching risks that collate and risks are those on the risk register scored at The Governing Body collectively ensures board assurance and risk management summarise several more detailed risks 15 and above): that robust systems of internal control processes. present on the risk register. For example, and management are in place. These finance. • RRSWLCCG008 – The impact of The Governing Body reviews the content arrangements, and the enhancements that elective Referral to Treatment (RTT) of the BAF twice a year as a means of The CCG views risk management as key to have been made to them, are described in (including diagnostic and cancer assessing the current level. the successful delivery of its business and the Risk Assessment section of this report. pathways) remains committed to ensuring staff are All other sub committees of the Governing • RRSWLCCG051 – NHS Constitution Risk management capacity has been equipped to assess, manage, escalate and Body review those risks specific to their area Standards developed across the CCG in a number report risks. This ensures a comprehensive and are made aware of significant changes of ways during the year. The statutory overview of all the risks affecting the • RRSWLCCG101 – Roll out of Covid-19 to the risk register at each meeting. and mandatory training programme organisation and facilitates decision making Vaccination Program Across South about those risks that need immediate West London includes numerous elements relevant to Operational management of the BAF is treatment and those that the organisation risk management, including information provided by the CCG’s Governance and can tolerate for a specified amount of time. governance, health and safety, fire safety, Corporate Services team. Regular meetings safeguarding adults and children and counter are held with manager leads to review The CCG uses an NHS standard risk scoring fraud. progress and performance of each of the matrix (CASU 2002) to determine the

140 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 141 Other sources through the commissioning cycle, adding March 2021 and up to the date of approval committees. The quality of information of assurance value and delivering outcomes, to ensure of the annual report and accounts. received to direct decision making is also the procurement of quality services that assured through the service level specification are tailored to local needs and deliver Annual audit of Conflicts of Interest arrangements with the North East London sustainable outcomes and value for money. Commissioning Support Unit (NELCSU) and Internal Control Framework management the use of contractual arrangements with the The CCG has established an effective A system of internal control is the set of The revised statutory guidance on managing commissioned providers. The Governing Body organisational structure with clear lines of processes and procedures in place in the conflicts of interest for CCGs (published are confident that the information they are authority and accountability, which guards Clinical Commissioning Group to ensure it June 2016 and further updated in June presented with has been through appropriate against inappropriate decision making and delivers its policies, aims and objectives. It is 2017) requires CCGs to undertake an review and scrutiny, and that it continues to delegation of authorities enabling us to designed to identify and prioritise the risks, annual internal audit of conflicts of interest develop with organisational needs. meet our statutory duties and follow best to evaluate the likelihood of those risks management. To support CCGs to undertake practice guidelines. Work to ensure that we being realised and the impact should they this task, NHS England has published a Information governance promote and demonstrate the principles be realised, and to manage them efficiently, template audit framework. and values of good governance and the effectively and economically. The NHS Information Governance Framework review of governance related risks takes An internal audit of the CCG’s conflicts of sets the processes and procedures by which The system of internal control allows risk place at Senior Management Team meetings interest process was carried out in early 2021. the NHS handles information about patients to be managed to a reasonable level rather and assurance is provided by the Audit The audit found many areas of good practice and employees, in particular personal than eliminating all risk; it can therefore Committee to the Governing Body with but highlighted one high priority action identifiable information. only provide reasonable and not absolute insight from Internal Audit. The Committee relating to the completeness of the CCG’s assurance of effectiveness. also ensures that, in non-financial and Conflict of Interests register. The CCG is in The NHS Information Governance Framework non-clinical areas that fall within the remit the process of delivering a number of actions is supported by the Data Security and Our governance structures are used to of its terms of reference, appropriate to address this recommendation, further Protection Toolkit (DSPT) and the annual ensure effective oversight of operational standards are set and compliance with strengthening its conflict of interest processes. submission process provides assurances to and strategic decisions and compliance with them is monitored. We have considered the the Clinical Commissioning Group, other the NHS regulatory environment. Details effectiveness of our governance framework Data quality organisations and to individuals that personal of the Governing Body responsibilities and and processes and raised no significant information is dealt with legally, securely, those of its committees are outlined above concerns on governance related matters this The Governing Body regularly receive reports efficiently and effectively. and described in further detail within the year. that cover financial, governance, compliance, constitution. performance and quality matters for the CCG. The DSPT came into force for the 2018-19 The system of internal control is based on financial year and replaces the information Ensuring effective risk management, an ongoing process designed to identify The CCG has a business intelligence and governance toolkit. The DSPT is now the financial management and compliance with and prioritise the risks to the achievement performance function which monitors how recognised standard for cyber and data statutory duties is high on the list of our of the policies, aims and objectives of the local providers are performing against key security within the NHS. The toolkit requires priorities. We have implemented policies, CCG, to evaluate the likelihood of those performance indicators. This information is the CCG to demonstrate compliance with systems and processes to reduce exposure risks being realised and the impact should reported to the Governing Body on a regular ten data security standards along with in these areas and to ensure that we are they be realised, and to manage them basis. demonstrable compliance with the General legally compliant. Each committee and efficiently, effectively and economically. Data Protection Regulations (GDPR). group oversees risks and policies relating The data contained in the reports is subject to their area of responsibility. Clinicians The system of internal control has been in to significant scrutiny and review, both We have been working with our information and management work in partnership place in the CCG for the year ended 31 by management and by Governing Body governance team from NELCSU, in respect

142 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 143 of submission of the DSPT. The DSPT is based • South West London CCG’s Information Control issues • There is a clearly defined process for on the 10 National Data Guardian (NDG) Governance response to the Covid-19 the consideration of business cases standards. NHS South West London CCG pandemic followed best practice and and saving opportunities to ensure completed all 89 mandatory assertions, and met all legal requirements. No significant control issues have been transparency and value for money is 43 of the 57 non-mandatory assertions. The identified at the CCG during 2020/21. upheld. • The control environment designed to CCG published the 2020-21 submission with ensure that South West London CCG • The Commercial Procurement Advisory ‘Standards Met’ on 31 March 2021, ahead Review of economy, managed its data sharing arrangements Group evaluate the robustness of of the submission cut off which was 30 June in accordance with the Control of efficiency and effectiveness proposed business cases before these 2021. Patient Information (COPI) Notice, were of the use of resources are then considered by the Finance fit for purpose and that information Committee. The CCG places high importance on ensuring was only shared as appropriate • The Quality and Performance Oversight there are robust information governance The Governing Body, through its and where suitable data sharing Committee are accountable for systems and processes in place to protect meetings, retains primary oversight of arrangements are in place. overseeing a robust, organisation-wide patient and corporate information. We have the appropriateness of arrangements in system of quality and performance. an information governance management place within the organisation to exercise The outcome of the audit was that • The Finance Committee ensures that framework, including information its functions in an effective, economic substantial assurance was provided; all the finances of the CCG are scrutinised governance processes and procedures in and efficient manner. It is my role as recommendations were swiftly implemented. to ensure budgets are managed in an line with the DSPT. We have ensured all staff Accountable Officer to retain overall appropriate and timely manner. It will undertake annual information governance executive responsibility for the use of our Business critical models ensure that the Governing Body is fully training. There are processes in place for resources. incident reporting and investigation of aware of any financial risks which may serious incidents. We continue to develop The organisation has a number of key materialise throughout the year. It works The CCG confirms that an appropriate information risk assessment and management processes and internal mechanisms that alongside the Audit Committee to ensure quality assurance framework is in place procedures and a programme is in place provide assurance that we are operating within financial probity in the organisation. and is used for all business critical to fully embed an information risk culture our statutory authority: • These committees have, on behalf of analytical models. throughout the organisation against identified the Governing Body, an overview of all • Within our constitution there are clearly aspects of finances (including capital risks. Third party assurances defined standards for conducting spend and cash management). How we look after business, Standing Orders, Scheme of Reservation and Delegation along with information securely The CCG relies on a number of third party Counter fraud arrangements providers (such as NHS SBS, NHS BSA, NEL Prime Financial Policies that ensure the CSU) to provide a range of transactional effective management and protection of The Senior Information Risk Owner (SIRO) processing services ranging from finance to assets and public funds. Counter fraud arrangements are in place for NHS South West London CCG is the data processing. • Key policies are in operation in respect of in the CCG to ensure compliance with Chief of Staff; he is a member of the Senior contract management and procurement standards set by the NHS Counter Fraud Leadership Team and attends Governing Our requirements for the assurance provided that ensure effective operational and Authority Standards for Commissioners: Body meetings. by these organisations are reviewed every financial performance whilst ensuring we Fraud, Bribery and Corruption. year. Appropriate formal assurances are operate within regulatory frameworks • An accredited counter fraud specialist is In response to the Covid-19 pandemic, RSM obtained to supplement routine customer/ and reduce the likelihood and impact of contracted to undertake counter fraud were requested to conduct an in-depth audit supplier performance oversight arrangements. risk. to provide assurance that: work proportionate to identified risks.

144 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 145 • The CCG’s Audit Committee receives Scope and limitations of internal audit with management / lead individual. Factors and findings which have informed progress reports throughout the year work • The opinion is based on the testing we our draft opinion and an annual report against each of have undertaken, which was limited to Based on the work undertaken in 2020/21 the standards for commissioners. the area being audited, as detailed in there is a generally sound system of internal • There is executive support and direction The organisation has an the agreed audit scope. control, designed to meet the CCG’s for a proportionate proactive work plan adequate and effective • Where strong levels of control have objectives, and controls are generally being to address identified risks. framework for risk been identified, there are still instances management, governance and applied consistently. • Regular fraud related communications where these may not always be internal control. are shared with CCG staff and training is effective. This may be due to human delivered to all staff. However, our work has error, incorrect management judgement, Topics judged relevant for consideration as part of the annual governance • The local counter fraud specialist meets identified further enhancements management override, controls being statement with the director of finance and internal to the framework of risk by-passed or a reduction in compliance. audit to agree tasks to be undertaken as management, governance and • Due to the limited scope of our audits, internal control to ensure that it Based on the work we have undertaken to part of the workplan. there may be weaknesses in the control remains adequate and effective. date on the CCG’s system on internal control, system which we are not aware of, or • The local counter fraud specialist also we do not consider that within these areas which were not brought to attention. has regular liaison with the director of there are any issues that need to be flagged finance to discuss any concerns that • It remains management’s responsibility as significant control issues within the Annual come to light throughout the year. to develop and maintain a sound system Governance Statement (AGS). The CCG may The formation of the opinion is achieved • A member of the executive team (the of risk management, internal control wish to consider the issues raised in the partial through a risk-based plan of work, agreed Chef Finance Officer) is proactively and and governance, and for the prevention assurance internal audit reports highlighted with management and approved by the audit demonstrably responsible for tackling and detection of material errors, loss below when determining whether anything committee. fraud, bribery and corruption. or fraud. The work of internal audit should be highlighted within the Annual should not be seen as a substitute for Governance Statement. The CCG should The opinion is subject to inherent limitations, There have been no assessments from the management’s responsibilities around also consider whether any other issues have as detailed below: NHS Counter Fraud Authority but should one the design and effective operation of arisen as well as recognise the challenging these systems. occur an action plan would be taken forward • The opinion does not imply that environment within which the CCG is following any recommendation made. internal audit has reviewed all risks and • Our internal audit work for 2020/21 operating, including the results of any external assurances relating to the organisation. has been undertaken through the reviews. substantial operational disruptions Head of Internal • The opinion is substantially derived caused by the Covid-19 pandemic. Audit opinion from the conduct of risk-based In undertaking our audit work, plans generated from a robust and we recognise that there has been organisation-led assurance framework. Following completion of the planned audit a significant impact on both the As such, the assurance framework is one work for the financial year for the clinical operations of the organisation and its component that the Governing Body commissioning group, the Head of Internal risk profile, and our annual opinion takes into account in making its annual Audit issued an independent and objective should be read in this context. governance statement (AGS). opinion on the adequacy and effectiveness of the clinical commissioning group’s system • The opinion is based on the findings and of risk management, governance and conclusions from the work undertaken, internal control. the scope of which has been agreed

146 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 147 During the year, Internal Audit issued the following audit reports: Area of Audit Level of Assurance Given Remuneration report Data Sharing and Data Security Substantial Assurance Financial Governance during Covid-19, Part 1 Substantial Assurance Financial Controls Substantial Assurance Under the Government Financial Reporting Remuneration policy Financial Governance during Covid-19, Part 2 Substantial Assurance Manual NHS bodies are required to prepare Procurement and Contract Management Partial Assurance a remuneration report that is published as part of their annual report and financial Remuneration for Governing Body members, Conflict of Interests – Part 2 Partial Assurance accounts. This report must contain including the Accountable Officer and Chief Primary Care Commissioning Reasonable Assurance information about the remuneration of Finance Officer, is determined on the basis Risk Management Part 2 (Draft) Reasonable Assurance (pay received by) senior managers. of reports to the Remuneration Committee, Senior managers are defined as people in senior taking into account national guidance on Advisory reports were issued in the following Our assurance framework provides me positions having authority or responsibility for pay rates, any independent evaluation of the areas: with evidence that the effectiveness of directing or controlling the major activities of post and national and market rates. controls that manage risks to the Clinical • Financial Governance the Clinical Commissioning Group. This means Commissioning Group achieving its principal All other managers are covered by terms and • Conflicts of Interest – Part 1 those who influence the decisions of the objectives have been reviewed. conditions set out in the national NHS Agenda CCG as a whole rather than the decisions of • Risk Management – Part 1 for Change arrangements. Individual staff individual directorates or departments. • Governance I have been advised on the implications of performance is assessed as part of the staff • Data Security Protection Toolkit the result of this review by: To ensure remuneration is in line with national appraisal process, which includes objective guidance, current good practice and ensures setting and annual reviews with line managers. • Continuing Healthcare • The Governing Body value for public money, the CCG has set up a In line with national guidance and the Agenda • The Quality, Safety and Performance remuneration committee. for Change programme, staff progress through Committee Review of the effectiveness of The committee, which is accountable to the an incremental pay scale if their performance governance, risk management • The Audit Committee Governing Body, makes recommendations on during the year has been in line with agreed and internal control • The Executive Management Team the remuneration, fees and other allowances targets and objectives. • Internal audit for employees and for people who provide services to the CCG. This includes advising on Senior managers’ My review of the effectiveness of the salaries for the CCG’s most senior staff (known Conclusion performance related pay system of internal control for this year has as Very Senior Managers). It would also make been informed by the work of the internal recommendations on allowances under any Internal Audit has not identified any The CCG does not have a policy of auditors, executive managers and clinical pension scheme that the CCG may establish as significant issues that need to be flagged as performance related pay for senior managers. leads within the Clinical Commissioning significant control issues within the Annual an alternative to the NHS pension scheme. Group who have responsibility for the Governance Statement. Senior managers’ development and maintenance of the Remuneration internal control framework. Sarah Blow committee report service contracts Accountable Officer I have also drawn on performance information A summary of the duties and the The CCG’s policy concerning permanent available to me. My review is also informed by South West London Clinical Commissioning Group membership of the remuneration senior managers’ contracts is that they comments made by the external auditors in Date: 11 06 21 committee is included within the have no end date, with a notice period of their annual audit letter and other reports. governance section of the Annual Report. 6 months.

148 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 149 Payments to past senior managers - audited Les Ross, Secondary Care Consultant 10 to n/a n/a n/a n/a 10 to 15 15

The CCG has not made any payments to past senior managers. Lucie Waters, Locality Executive 120 to n/a n/a n/a 127.5 to 245 to Director Sutton 125 130 250

Senior manager remuneration - audited Mark Creelman, Locality Executive 60 to n/a n/a n/a 37.5 to 100 to Director Merton and Wandsworth 65 40 105 (from September 2020) (1) The table below discloses salaries and allowances paid by the CCG to Directors of significant Matthew Kershaw, Placed Based 110 to n/a 10 to 15 n/a n/a 120 to influence in 2020/21. Leader for Health Croydon (2) 115 125

Naz Jivani, Elected GP Lead Kingston 115 to n/a n/a n/a n/a 115 to Borough 120 120

Name and title Nicola Jones, Elected Governing Body 135 to n/a n/a n/a n/a 135 to Member Wandsworth Borough 140 140 Salary and/or fees (bands of £5,000) £000 benefits Taxable to the(rounded £100) nearest £ Annual performance bonuses related (bands of £5,000) £000 Long-term performance bonusesrelated (bands of £5,000) £000 All pension related benefits (bands of £2,500) £000 TOTAL (bands of £5,000) £000 Patrick Gibson, Elected Governing 80 to n/a n/a n/a n/a 80 to Agnelo Fernandes, Elected GP Lead 90 to n/a n/a n/a n/a 90 to Body Member 85 85 Croydon Borough 95 95 Paul Gallagher, Lay Member for Audit 10 to n/a n/a n/a n/a 10 to Andrew Murray, SWLCCG Chair 100 to n/a n/a n/a n/a 100 to and Conflicts of Interest Guardian 15 15 105 105 Pippa Barber, Independent Nurse 15 to n/a n/a n/a n/a 15 to Charlotte Gawne, Director of 120 to n/a n/a n/a 25 to 145 to 20 20 Communications and Engagement 125 27.5 150 Sarah Blow, Accountable Officer 145 to n/a n/a n/a 32.5 to 180 to David Smith, Governing Body Deputy 10 to n/a n/a n/a n/a 10 to 150 35 185 Chair & Lay Member Finance 15 15 Susan Gibbin, Lay Member Patient 10 to n/a n/a n/a n/a 10 to Dino Pardhanani, Elected GP Lead 45 to n/a n/a n/a n/a 45 to Public and Engagement 15 15 Sutton Borough (from October 2020) 50 50 Tonia Michaelides, Locality Executive 120 to n/a n/a n/a 22.5 to 145 to Geoff Croucher, Elected GP Lead 30 to n/a n/a n/a n/a 30 to Director Richmond and Kingston 125 25 150 Sutton Borough (up to October 2020) 35 35 Vasa Gnanapragasam, Elected GP Lead 60 to n/a n/a n/a n/a 60 to Gloria Rowland, Chief Nurse and 25 to n/a n/a n/a 55 to 80 to Merton Borough 65 65 Director of Quality (from January 2021) 30 57.5 85

James Blythe, Locality Executive 60 to n/a n/a n/a n/a 60 to Notes Leader for Health Croydon and is on Director Merton and Wandsworth (up 65 65 the payroll of Croydon Health Services to September 2020) 1. Mark Creelman is the Locality Executive NHS Trust, his total annual salary is in James Murray, Chief Finance Officer 145 to n/a n/a n/a n/a 145 to Director Merton and Wandsworth since the range of £225k-£230k. South West 150 150 September 2020 and is on the payroll London CCG is responsible for 50% of Jonathan Bates, Executive Director 120 to n/a n/a n/a 25 to 145 to of NEL CSU, his total annual salary is in his costs. Systems Planning Performance and 125 27.5 150 the range of £145k-£150k. South West Delivery London CCG is responsible for 82% of As this is the first of year of South West his costs. Karen Broughton, Executive Director 135 to n/a n/a n/a 30 to 165 to London CCG it is not possible to provide Strategy and Transformation 140 32.5 170 2. Matthew Kershaw is the Placed Based equivalent prior year comparators.

150 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 151 Pensions entitlement table - audited Notes figures shown relate to the benefits that the individual has accrued as a consequence 1. South West London CCG does of their total membership of the pension Where the CCG contributed to pension schemes for senior managers, the benefits are shown not make any employer’s pension scheme, not just their service in a senior in the table below: contribution in respect of James Blythe. capacity to which disclosure applies. 2. South West London CCG does The CETV figures and the other pension not make any employer’s pension details include the value of any pension contribution in respect of James benefits in another scheme or arrangement Murray. which the individual has transferred to the 3. Mark Creelman is the Locality Executive NHS pension scheme. They also include Name and title Director Merton and Wandsworth since any additional pension benefit accrued to September 2020 and is on the payroll the member as a result of their purchasing of NEL CSU. South West London CCG additional years of pension service in is responsible for 82% of his costs, but the scheme at their own cost. CETVs we are showing the full benefits. are calculated within the guidelines and Real increase in pension at age Real increase (bands of £2,500) £000 in pension lump sum atReal increase pension age (bands of £2,500) £000 accrued pension at age 31 Total 2021 (bands of £5,000) March £000 to accruedLump sum at pension age related 2020 (bands of £5,000) pension at 31 March £000 Cash equivalent transfer value at 31 March 2021 £000 Cash equivalent transfer value at 31 March 2020 £000 in cash equivalent transferReal increase value £000 contribution to stakeholders Employer’s pension £000 4. As this the first of year of South framework prescribed by the Institute and Charlotte Gawne, Director of 0 to 0 35 to 70 to 652 602 22 0 West London CCG is it not possible Faculty of Actuaries. Communications and Engagement 2.5 40 75 to provide equivalent prior year The benefits and related CETVs do not allow Gloria Rowland, Chief Nurse and 2.5 0 to 25 to 50 to 443 390 43 0 comparators. Director of Quality to 5 2.5 30 55 for a potential adjustment arising from the McCloud judgement (a legal case concerning Jonathan Bates, Executive Director 0 to 0 45 to 90 to 787 732 24 0 Cash equivalent transfer age discrimination over the manner in Systems Planning Performance and 2.5 50 95 Delivery values - audited which UK public service pension schemes introduced a CARE benefit design in 2015 James Blythe, Locality Executive n/a n/a n/a n/a n/a n/a n/a n/a for all but the oldest members who retained Director Merton and Wandsworth (1) A cash equivalent transfer value (CETV) a Final Salary design). is the actuarially assessed capital value of James Murray, Chief Finance Officer n/a n/a n/a n/a n/a n/a n/a n/a (2) the pension scheme benefits accrued by a Real increase in CETV member at a particular point in time. Karen Broughton, Executive Director 2.5 0 45 to 85 to 812 751 28 0 Strategy and Transformation to 5 50 90 The benefits valued are the member’s This reflects the increase in CETV that is accrued benefits and any contingent spouse’s Lucie Waters, Locality Executive 5 to 12.5 40 to 85 to 765 623 114 0 funded by the employer. Director Sutton 7.5 to 15 45 90 (or other allowable beneficiary’s) pension payable from the scheme. It does not include the increase in accrued Mark Creelman, Locality Executive 2.5 0 to 15 to 0 to 5 255 207 23 0 pension due to inflation or contributions paid Director Merton and Wandsworth (3) to 5 2.5 20 A CETV is a payment made by a pension by the employee (including the value of any Sarah Blow, Accountable Officer 2.5 0 45 to 85 to 864 797 32 0 scheme or arrangement to secure pension benefits transferred from another scheme or to 5 50 90 benefits in another pension scheme or arrangement). arrangement when the member leaves a Tonia Michaelides, Locality Executive 0 to 0 40 to 75 to 721 670 23 0 scheme and chooses to transfer the benefits Director Richmond and Kingston 2.5 45 80 accrued in their former scheme. The pension

152 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 153 Compensation on early retirement or for loss of office

There were no early retirements or loss of office payments made in 2020/21.

Payments to past members

There were no payments to past members during 2020/21.

Pay multiples - audited

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 governing body member in the financial Staff report year 2020/21 was £145k-£150k per annum. This was 2.6 times the median remuneration of the workforce, which was £55k. The workforce includes only permanent staff and excludes off payroll engagements. Number of senior managers Band Number in March 2021 In 2020/21, zero employees received Very Senior remuneration in excess of the highest-paid 9 Manager director/member. Remuneration ranged from The majority of roles in the CCG are paid in £21k to £116k. accordance with the national Agenda for Band 9 23 Change pay scales Band 8D 30 Total remuneration includes salary, non- consolidated performance-related pay, Total 62 benefits-in-kind, but not severance payments. It does not include employer These figures include only staff employed pension contributions and the cash directly through South West London CCG’s equivalent transfer value of pensions. payroll.

154 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 155 Staff numbers and costs - audited Disability

Disability Headcount Percentage FTE

Permanently Other staff Total No 384 82.23% 361.93 employed staff Category Not declared 47 10.06% 44.80 Cost, Average Cost, Average Cost, Average Prefer not to answer 17 3.64% 15.92 £000 WTE £000 WTE £000 WTE Yes 19 4.07% 18.00

A: Ambulance staff 0 0.0 0 0.0 0 0.0 Grand Total 467 100.00% 440.65

G: Administration and estates staff 27,961 362.0 5,534 40.9 33,495 402.9

H: Healthcare Assistants and other 0 0.0 0 0.0 0 0.0 support staff

M: Medical and Dental staff 173 1.6 0 0.0 173 1.6 Yes 4.07%

N: Nursing, Midwifery and health 3,064 36.2 693 2.0 3,757 38.2 Prefer Not To Answer 3.64% visiting staff

P: Nursing, midwifery and health 0 0.0 0 0.0 0 0.0 Not Declared 10.06% visiting learners

S: Scientific, therapeutic and 3,548 51.2 11 0.2 3,539 51.4 No 82.23% technical staff

U: Healthcare science 0 0.0 0 0.0 0 0.0 0.00% 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% Total 34,746 451.0 6,238 41.1 40,984 494.1

Staff composition and clinical leads. Monitoring will continue to identify any priority areas to address.

Equalities for staff As of 31 March 2021

An equalities breakdown of staff by six The following tables are a profile of the CCG categories, in line with guidance, is available relating to the main protected characteristics. and key areas are presented regularly to the CCG in the form of workforce reports. Tables Tables do not include Governing Body do not include Governing Body members members/clinical leads.

156 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 157 Ethnic origin Sexual orientation

Ethnic origin Headcount Percentage FTE Sexual orientation Headcount Percentage FTE A White - British 210 44.97% 195.55 Bisexual 2 0.43% 2.00 B White - Irish 8 1.71% 8.00 C White - Any other White background 31 6.64% 30.20 Gay or lesbian 10 2.14% 10.00 CA White English 4 0.86% 4.00 CB White Scottish 2 0.43% 2.00 Heterosexual or straight 371 79.44% 350.19 CP White Polish 1 0.21% 1.00 Not stated (person asked but declined to 83 17.77% 77.47 CY White Other European 1 0.21% 1.00 provide a response) D Mixed - White & Black Caribbean 2 0.43% 1.91 E Mixed - White & Black African 4 0.86% 3.80 Undecided 1 0.21% 1.00 F Mixed - White & Asian 3 0.64% 3.00 G Mixed - Any other mixed background 7 1.50% 6.60 Grand Total 467 100.00% 440.65 GF Mixed - Other/Unspecified 2 0.43% 1.60 H Asian or Asian British - Indian 42 8.99% 36.33 J Asian or Asian British - Pakistani 7 1.50% 6.24 K Asian or Asian British - Bangladeshi 6 1.28% 5.60 Undecided 0.21% L Asian or Asian British - Any other Asian background 14 3.00% 13.90 LB Asian Punjabi 1 0.21% 1.00 LF Asian Tamil 1 0.21% 1.00 Not stated (person asked but 17.77% LH Asian British 2 0.43% 2.00 declined to provide a response) LK Asian Unspecified 1 0.21% 1.00 79.44% M Black or Black British - Caribbean 25 5.35% 24.30 Heterosexual or Straight N Black or Black British - African 44 9.42% 43.80 P Black or Black British - Any other Black background 2 0.43% 2.00 2.14% PC Black Nigerian 1 0.21% 1.00 Gay or Lesbian PD Black British 1 0.21% 1.00 PE Black Unspecified 1 0.21% 1.00 Bisexual 0.43% R Chinese 8 1.71% 7.91 S Any Other Ethnic Group 5 1.07% 5.00 SA Vietnamese 1 0.21% 1.00 Z Not Stated 30 6.42% 27.92

Grand Total 467 100.00% 440.65 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00%

158 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 159 Religious belief Age range

Religious belief Headcount Percentage FTE Age band Headcount Percentage FTE

Atheism 63 13.49% 61.99 21-25 13 2.78% 12.30

Buddhism 2 0.43% 1.91 26-30 28 6.00% 27.10

Christianity 202 43.25% 191.49 31-35 58 12.42% 56.73

Hinduism 26 5.57% 21.78 36-40 63 13.49% 57.78

I do not wish to disclose my religion/belief 121 25.91% 113.60 41-45 70 14.99% 65.28

Islam 19 4.07% 17.87 46-50 65 13.92% 62.25

Other 21 4.50% 19.80 51-55 83 17.77% 79.77

Sikhism 13 2.78% 12.23 56-60 61 13.06% 58.09

Grand Total 467 100.00% 440.65 61-65 24 5.14% 19.85

66-70 2 0.43% 1.50

Grand Total 467 100.00% 440.65 Atheism 13.49%

Buddhism 0.43% 21-25 2.78%

Christianity 43.25% 26-30 6.00%

Hinduism 5.57% 31-35 12.42%

36-40 13.49% I do not wish to disclose 25.91% my religion/belief 41-45 14.99% Islam 4.07% 46-50 13.92%

Other 4.50% 51-55 17.77%

56-60 13.06% Sikhism 2.78% 61-65 5.14%

66-70 0.43% 0.00% 0.00% 10.00% 20.00% 30.00% 40.00% 50.00%

0.00% 5.00% 10.00% 15.00% 20.00%

160 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 161 Gender civil partnership; trade union membership; plans. Training is available to staff to responsibility for dependents or any other support personal development and career The following figures exclude directors and staff on the payrolls of other CCGs who are part- condition or requirement which cannot be progression. recharged to South West London CCG. shown to be justifiable. Staff consultation Gender Headcount Percentage FTE Staff who have a disability are protected under the Equality Act 2010, as disability is a Female 347 74.30% 322.15 Employee consultation is covered by an “protected characteristic”. The CCG makes agreed CCG wide change management Male 120 25.70% 118.50 sure that the requirements and reasonable policy. Grand Total 467 100.00% 440.65 adjustments necessary for employees with a disability are considered both during each Freedom to Speak Up Guardian stage of the recruitment process and during employment. Sickness absence data Staff turnover percentages The CCG has a Freedom to Speak up Guardian that staff can contact if they have Our Sickness Absence Policy confirms that a workplace issue or concern that they do where an employee becomes disabled The CCG sickness absence percentage rate is The staff turnover figure, based on a not wish to bring up with their manager during their employment, we will make any presented regularly to the CCG in the form 12-month rolling average, as of 31 March or through other channels. Susan Gibbin, necessary reasonable adjustments required of workforce reports. was 12.32%. Governing Body Member and Patient and in accordance with the Equality Act to Public Involvement Lay Member, is NHS enable the employee to return and remain Individual sickness absence cases are This is broadly comparable with the NHS South West London CCG’s Freedom to Speak at work. The types of adjustments may managed by the line manager with advice CCG average turnover rate of 12.1%. Up Guardian. No issues were raised through include adjustments to work base, working and support from HR. with the Freedom to Speak Up Guardian hours, redeploying the employee to another Staff policies and during 2020/21. An occupational health service is available suitable position and providing any necessary other information equipment to assist the employee to perform to provide professional clinical advice to line Trade union facility time managers within the CCG. their role. reporting requirements The CCG also has access to an employee Staff policies related to disabilities Pay and personal development assistance programme which offers The CCG promotes a working environment Between April 2020 and March 2021, we confidential access to emotional and practical The majority of our staff are paid in in which all parties and procedures had two staff trade union representatives. support, including legal and financial advice. accordance with the national NHS Agenda relating to recruitment, selection, training, for Change pay scales. promotion and employment are free Both are full time members of staff and Number of days lost in year 2,352.10 from unfair discrimination, ensuring that are supported with reasonable time off We have statutory and mandatory training Number of staff employed in year 433.39 no employee or prospective employee is within working hours to attend to trade requirements and reporting procedures in discriminated against, whether directly or union business as per the CCG’s Partnership Average working days lost in year 5.43 place to ensure compliance. This training indirectly on the grounds of age; disability; Working Agreement. is provided both in-house and as online gender reassignment; pregnancy and Note that total staff years represents the e-learning. number of potential worked days across maternity; race including ethnic or national whole of permanent workforce. origins, nationality; religion belief; sex We have an annual appraisal system to (gender); sexual orientation; marriage and support staff and set personal development

162 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 163 Staff engagement Where we’re doing less well: 2020 NHS Staff Survey Results > Theme results > Overview

• 43% of respondents said that senior managers try to involve staff in NHS Staff Survey important decisions (compared to 51% environment environment The CCG commissioned Picker Institute in 2019). - bullying & harassment Safe - violence Safety culture Staff engagement working Team Europe to run an online 2020 National Staff • 65% of respondents said that the diversity Equality, & inclusion Health & wellbeing Immediate managers Morale Quality of care Safe 10 Survey during October and November 2020. organisation acts fairly in terms of career progression (compared to 78% 9 A total of 347 of the 419 eligible staff took in 2019). 8 part in the survey, giving a response rate of 83%. This was higher than the average • 86% of respondents said that they 7 response rate and provides more meaningful have not experienced discrimination 6 results. We are grateful to everyone who from manager/team leader or other 5 completed the survey. colleagues (compared to 94% in 2019).

Score (0-10) Score 4 • 73% of respondents said that their The results of the survey were published in immediate manager values their work 3 March 2021. We are pleased to see there (compared to 75% in 2019) have been significant improvements in 2 a number of areas. However, there are a • 38% of respondents said that senior 1 number of areas where we need to take managers act on staff feedback 0 action. (compared to 42% in 2019) Best 10.0 8.8 8.3 8.0 7.8 9.8 10.0 8.7 8.2 8.2 Where we’re doing well: Your Org 8.7 6.6 6.9 5.9 6.7 8.6 10.0 6.4 6.9 6.5 During April 2020, we are holding interactive Average 9.5 6.9 7.6 6.4 7.0 8.9 10.0 7.1 7.2 7.0 • 80% of respondents said that they are sessions with our teams to review the Worst able to make suggestions to improve findings and develop actions to address the 8.5 5.7 6.9 5.6 6.1 8.2 9.9 6.4 6.3 6.1 the work of their team/dept (an issues raised. A sub-group of the Governing Responses 342 342 344 340 186 329 344 339 344 344 increase of 5% from last year). Body will steer the development of our action plan. • 80% of respondents said that they are Staff pulse check • They experience an equal, diverse, and satisfied with opportunities for flexible inclusive organisation. working patterns (an increase of 1% In July 2020 we invited staff to take part in • They have clear objectives and from last year). a pulse check survey to find out how they understand how their role fits in. • 75% of respondents said that feel about working for the CCG and whether care of patients/service users is the our organisational values are reflected in • They enjoy flexible working organisation’s top priority (an increase everyday behaviours. arrangements and having good of 2% from last year). technology. Most of those who completed the survey • They have a supportive line manager. • 74% of respondents said that their agreed that: immediate manager takes a positive • They have regular contact with their interest in their health and well-being • The organisation keeps staff safe, and teams. (an increase of 2% from last year). looks after their health and wellbeing.

164 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 165 However, feedback suggested that we work at home and making sure that people working in the office. We believe this We have also supported a number of staff seemed to be doing less well at involving and had the equipment they needed. Senior will allow more flexibility, innovation and to complete either the Mental Health First listening to our staff. managers undertook one to one assessments collaboration, allowing our staff to structure Aider or Mental Health Champion training with staff in July, and again in December, to their days around their commitments. programmes. These individuals are available Looking at the responses from staff who check the wellbeing of each staff member to provide support to staff, signposting them identified themselves as from an ethnic working at home and to make sure that Staff Health and Wellbeing Network to professional help and to challenge mental minority background, these staff were everyone had the IT equipment and furniture health stigma in the workplace. We have also less likely to feel positively about the they need to do their job effectively. Staff This year, we formed a new Staff Health published a range of emotional wellbeing organisation. We paid attention to the were able to access up to £150 to buy and Wellbeing Network. Made up of staff and mental health resources on our intranet feedback from this survey and other listening additional IT equipment and a further £150 from across the organisation, the network to help staff identify sources of support such events and have responded to the issues to buy any office equipment needed like organises a range of activities to support as OurNHSPeople, access to wellbeing Apps raised. Following this survey, we appointed desks and chairs. all staff maintain and improve the mental and signposting to local Improving Access to a new Director for Equality, Diversity and and physical health and wellbeing. Activities Psychological Therapies (IAPT) services. Inclusion, who ran a series of listening events Some people have not been able to work include mindfulness sessions, exercise and over the summer to learn more about the from home. For staff who have needed activity challenges and social events. Internal communications mechanisms experiences of our staff. More detail about to come into the office who meet the this work and the actions we are taking exemption criteria, we have undertaken risk We have published and signpost to a wide We have built on the progress we made last is available in the ‘Equality, Diversity and assessments at each site and made sure that range of health and wellbeing resources on year to further develop staff communication Inclusion’ section of this report. appropriate measures are in place to ensure our intranet that are free for all staff. channels and enable staff to remain and feel their safety. The safety measures we have connected with colleagues. We have run a series of staff focus groups taken for these staff include making sure Mental health and emotional wellbeing and listening events to better understand the desks are socially distanced and have screens support South West London CCG intranet issues raised in the staff pulse check and to and Covid-19 infection control and cleaning develop solutions. Our action plan revolves processes are implemented. Alongside our mental health service partners, With the merger of the former six borough- around the four key areas: we are working to understand the mental based CCGs into one South West London As more people are vaccinated, we are health impact of the pandemic on our staff CCG, it was important to bring together • Employee voice – staff experience and talking to our staff about how we use our and how we can best support those who sources of information, news and support health and wellbeing. offices in the future. We are keen to learn are stressed, anxious or suffering from low onto one platform that all CCG staff • Engaging managers – making sure staff what the benefits of working from home moods. For many of us these are issues members could access. A new Intranet was get the support they need. have been for staff, and what staff have that will resolve themselves, but for many designed, built and launched and is now missed about being in the office. • Strategic narrative – where staff fit in. others these feelings may become long term the single source of internal information concerns. for our staff. It features multimedia content • Integrity – how the organisation’s We hope to be able to reopen our offices in such as videos and photographs, a calendar values are reflected in everyday July 2021. Our absolute priority is keeping Staff are able to access an Employee of events and has user-generated content behaviours. everyone safe, so will only reopen if we are Assistance Programme (EAP) which provides areas where staff can post their own blog, convinced it will not put staff at unnecessary personal support, including counselling, and discussion, photo, or add a comment to any risk. We want to continue the new ways life management and is available 24 hours a New Ways of Working of the pages. of working we have established over the day, any day of the year. last year so, at first, we will only open our This year we established a New Ways of offices in Wimbledon. Our aim is to create Working programme, supporting staff to a new working culture with less desk based

166 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 167 Team Talk the government white paper on becoming People and Organisational Our aim is to make NHS South West London an Integrated Care System, and we continue Development Strategy CCG a great place to work. To achieve this We hold monthly virtual staff briefings to hold monthly listening events as part of we will work in partnership with our trade called ‘Team Talk’ which are presented by our equality, diversity and inclusion work. union colleagues and focus on: a senior director in each place/ directorate Our draft People and Organisational for CCG staff in each place/ directorate. In • Caring for our staff. Daily communications update Development Strategy sets out our this way, scheduling has flexibility to suit approach to shaping our organisational • Supporting our staff to develop. local arrangements and approximately half From Monday to Friday, we publish an email culture and supporting our staff. • Having the very best employment of the scheduled time is dedicated to key based daily communications update which practices in place. local messages. To ensure consistency across goes to all CCG staff and other key people The strategy was developed with insight the CCG, the other half of the briefing is across our system. The update covers staff gathered from staff at listening events over • Recognising the work and commitment spent on key messages for the whole of news, keeping well, training, vacancies, local the summer and incorporates the four of our staff. the organisation. Topics are influenced by priority areas set out in the NHS People Plan: and national news, as well as an example • Working to make sure our staff is feedback from staff and organisational of a current social media campaign. The • Looking after our people with quality representative and inclusive of the priorities. These regular briefings are an publication is highly regarded as an internal health and wellbeing support for populations we serve. important channel of staff communication communications channel amongst our staff. everyone. and enable staff to directly speak with their The daily frequency enables fast-moving • Involving our staff to help us transform local management team. news to be cascaded, with articles often • Belonging in the NHS with a particular and improve the way we work. supported with links to further content on focus on the discrimination that some • Developing compassionate and All staff briefings the Intranet. staff face, ensuring the NHS is inclusive inclusive leaders. and diverse. Every six weeks, Sarah Blow, Accountable Leadership Forum • New ways of working capturing Officer, presents a virtual all staff briefing. Expenditure on consultancy innovation, much of it led by NHS The virtual nature of the briefing has The Leadership Forum brings together CCG people. Upskilling staff, supporting staff increased staff engagement as evidenced by senior managers every month to: learning and development and being The reported expenditure on consultancy the numbers of staff using the meeting chat flexible. was £1,261k in 2020/21. feature to either make a comment or ask a • Enable them to manage change question. It has also improved attendance as effectively for themselves and for their • Growing for the future. How we there is no need to travel and attendance is teams. recruit, train and keep our staff, and not limited by the size of the room. welcome back colleagues who want to • Share relevant system and regional return. information and detail with their teams. Listening events • Network and share ideas.

Learning from the ‘Moving Forward • Provide time out for learning and Together’ consultation, we recognised that it development. was important to hold staff listening events when further organisational changes are likely to take place to capture how staff are feeling about specific topics. This year, we held a number of listening events regarding

168 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 169 Table 2: New off-payroll engagements Table 3: Off-payroll engagements / Off-payroll engagements Number senior official engagements Where the reformed public sector rules Number of off-payroll engagements of board members, and/or senior officers For all off-payroll engagements as of 31 apply, entities must complete Table 2 for all For any off-payroll engagements of board 30 March 2021, for more than £245 per day new off-payroll engagements, or those that members, and/or, senior officials with with significant financial responsibility, during the financial year and that lasted longer than six months reached six months in duration, between 1 significant financial responsibility, between 1 were as follows: April 2020 and 31 March 2021, for more April 2020 and 31 March 2021 Number of individuals that have been than £245 per day and that last for longer deemed Governing Body members, and/or senior officers with significant 24 Number than 6 months: financial responsibility during the financial year. This figure includes both Number of existing arrangements 30 off-payroll and on-payroll engagements. as of 31 March 2021. Number

Of which, the number that have existed: Number of new engagements or those that reached six months in 30 for less than one year at the time of duration between 1 April 2020 and 30 Exit packages, including special (non-contractual) payments reporting 31 March 2021. for between one and two years at Of which… During 2020-21 there were the following exit packages at South West London CCG. 0 the time of reporting Number assessed as caught by IR35 15 for between 2 and 3 years at the 0 Number assessed as not caught by time of reporting 15 IR35 for between 3 and 4 years at the 0 time of reporting for between 4 or more years at the Number engaged directly (via PSC 0 time of reporting contracted to the entity) and are on 0 Exit package cost band (inc. any special payment element Number of compulsory redundancies Cost of compulsory redundancies Number of other departures Cost of other agreed departures number of exit Total packages cost of exit Total packages Number of departures specialwhere payments have been made Cost of special payment element included in exit packages the departmental payroll Number £ Number £ Number £ Number £ Number of engagements reassessed Less than 1 3,450 - - 1 3,450 - - The CCG confirms that all existing off-payroll for consistency / assurance 0 £10,000 engagements, outlined above, have at some purposes during the year point been subject to a risk based assessment £10,000 - 3 57,020 - - 3 57,020 - - Number of engagements that saw £25,000 as to whether assurance is required that the a change to IR35 status following 0 individual is paying the right amount of tax the consistency review. £25,001 - 1 30,000 - - 1 30,000 - - £50,000 and, where necessary, that assurance has been sought £50,001 ------£100,000

£100,001 ------£150,000

£150,001 ------–£200,000

>£200,000 ------

TOTALS 5 90,470 - - 5 90,470

170 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 171 responsibilities for the audit of the financial be prepared on a going concern basis, we statements’ section of our report. We are considered the inherent risks associated Parliamentary Accountability independent of the CCG in accordance with with the continuation of services currently the ethical requirements that are relevant to provided by the CCG In doing so we have Audit Report our audit of the financial statements in the had regard to the guidance provided UK, including the FRC’s Ethical Standard, in Practice Note 10 Audit of financial and we have fulfilled our other ethical statements and regularity of public sector responsibilities in accordance with these bodies in the United Kingdom (Revised Independent auditor's report to the members of the Governing Body requirements. We believe that the audit 2020) on the application of ISA (UK) 570 evidence we have obtained is sufficient Going Concern to public sector entities. We of NHS South West London Clinical Commissioning Group and appropriate to provide a basis for our assessed the reasonableness of the basis opinion. of preparation used by the CCG and the Report on the Audit of the In our opinion, the financial statements: CCG’s disclosures over the going concern Conclusions relating to going concern period. Financial Statements • give a true and fair view of the financial position of the CCG as at 31 March We are responsible for concluding on Based on the work we have performed, 2021 and of its expenditure and the appropriateness of the Accountable we have not identified any material Opinion on financial statements income for the year then ended; Officer’s use of the going concern basis uncertainties relating to events or conditions of accounting and, based on the audit that, individually or collectively, may cast We have audited the financial statements • have been properly prepared in evidence obtained, whether a material significant doubt on the CCG’s ability to of NHS South West London Clinical accordance with international uncertainty exists related to events or continue as a going concern for a period Commissioning Group (the ‘CCG’) for accounting standards as interpreted conditions that may cast significant doubt of at least twelve months from when the the year ended 31 March 2021, which and adapted by the Department on the CCG’s ability to continue as a going financial statements are authorised for comprise the Statement of Comprehensive of Health and Social Care Group concern. If we conclude that a material issue. Net Expenditure, the Statement of Financial Accounting Manual 2020 to 2021; and uncertainty exists, we are required to Position, the Statement of Changes • have been prepared in accordance with In auditing the financial statements, we draw attention in our report to the related in Taxpayers Equity, the Statement of the requirements of the National Health have concluded that the Accountable disclosures in the financial statements or, if Cash Flows and notes to the financial Service Act 2006, as amended by the Officer’s use of the going concern basis such disclosures are inadequate, to modify statements, including a summary of Health and Social Care Act 2012. of accounting in the preparation of the the auditor’s opinion. Our conclusions are significant accounting policies. The financial financial statements is appropriate. based on the audit evidence obtained up reporting framework that has been applied to the date of our report. However, future in their preparation is applicable law and Basis for opinion The responsibilities of the Accountable events or conditions may cause the CCG to international accounting standards in Officer with respect to going concern We conducted our audit in accordance with cease to continue as a going concern. conformity with the requirements of the are described in the ‘Responsibilities International Standards on Auditing (UK) Accounts Directions issued under Schedule of the Accountable Officer and Those (ISAs (UK)) and applicable law, as required In our evaluation of the Accountable 15 of the National Health Service Act 2006, Charged with Governance for the financial by the Code of Audit Practice (2020) Officer’s conclusions, and in accordance as amended by the Health and Social Care statements’ section of this report. (“the Code of Audit Practice”) approved with the expectation set out within the Act 2012 and interpreted and adapted by by the Comptroller and Auditor General. Department of Health and Social Care the Department of Health and Social Care Our responsibilities under those standards Group Accounting Manual 2020 to 2021 Other information Group Accounting Manual 2020 to 2021. are further described in the ‘Auditor’s that the CCG’s financial statements shall The Accountable Officer is responsible

172 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 173 for the other information. The other Governance Statement does not comply Opinion on regularity of income and We have nothing to report in respect of the information comprises the information with the guidance issued by NHS England expenditure required by the Code of above matters. included in the Annual Report, other or is misleading or inconsistent with the Audit Practice than the financial statements and our information of which we are aware from Responsibilities of the Accountable In our opinion, in all material respects the auditor’s report thereon. Our opinion on our audit. We are not required to consider Officer and Those Charged with expenditure and income recorded in the the financial statements does not cover the whether the Governance Statement Governance for the financial statements other information and, except to the extent addresses all risks and controls or that risks financial statements have been applied to otherwise explicitly stated in our report, are satisfactorily addressed by internal the purposes intended by Parliament and As explained more fully in the Statement we do not express any form of assurance controls. the financial transactions in the financial of Accountable Officer's responsibilities, conclusion thereon. statements conform to the authorities which the Accountable Officer, is responsible for We have nothing to report in this regard. govern them. the preparation of the financial statements In connection with our audit of the financial in the form and on the basis set out in the statements, our responsibility is to read Opinion on other matters required by Matters on which we are required to Accounts Directions, for being satisfied the other information and, in doing so, the Code of Audit Practice report by exception that they give a true and fair view, and for consider whether the other information is such internal control as the Accountable materially inconsistent with the financial In our opinion, based on the work Under the Code of Audit Practice, we are Officer determines is necessary to enable the statements or our knowledge obtained undertaken in the course of the audit: required to report to you if: preparation of financial statements that are in the audit, or otherwise appears to be free from material misstatement, whether • the parts of the Remuneration and • we issue a report in the public interest materially misstated. If we identify such due to fraud or error. material inconsistencies or apparent Staff Report to be audited have been under Section 24 of the Local Audit material misstatements, we are required properly prepared in accordance with and Accountability Act 2014 in the In preparing the financial statements, the to determine whether there is a material international accounting standards in course of, or at the conclusion of the Accountable Officer is responsible for misstatement in the financial statements conformity with the requirements of audit; or assessing the CCG’s ability to continue as the Accounts Directions issued under or a material misstatement of the other • we refer a matter to the Secretary of a going concern, disclosing, as applicable, Schedule 15 of the National Health information. If, based on the work we State under Section 30 of the Local matters related to going concern and using Service Act 2006, as amended by have performed, we conclude that there Audit and Accountability Act 2014 the going concern basis of accounting unless the Health and Social Care Act 2012 is a material misstatement of the other because we have reason to believe that they have been informed by the relevant and interpreted and adapted by the information, we are required to report that the CCG, or an officer of the CCG, is national body of the intention to dissolve the Department of Health and Social Care fact. about to make, or has made, a decision CCG without the transfer of its services to Group Accounting Manual 2020 to which involves or would involve the another public sector entity. We have nothing to report in this regard. 2021; and body incurring unlawful expenditure, or The Accountable Officer is responsible for • based on the work undertaken in the is about to take, or has begun to take ensuring the regularity of expenditure and Other information we are required to course of the audit of the financial a course of action which, if followed to income in the financial statements. report on by exception under the Code statements and our knowledge of the its conclusion, would be unlawful and of Audit Practice CCG, the other information published likely to cause a loss or deficiency; or The Audit Committee is Those Charged together with the financial statements Under the Code of Audit Practice published • we make a written recommendation to with Governance. Those Charged with in the annual report for the financial by the National Audit Office in April 2020 the CCG under Section 24 of the Local Governance are responsible for overseeing year for which the financial statements on behalf of the Comptroller and Auditor Audit and Accountability Act 2014 in the CCG’s financial reporting process. are prepared is consistent with the General (the Code of Audit Practice) we the course of, or at the conclusion of financial statements. are required to consider whether the the audit.

174 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 175 Auditor’s responsibilities for the audit of detect material misstatements in respect of • We enquired of management, Internal recorded close to and after 31 March the financial statements irregularities, including fraud. Audit and the Audit Committee, whether 2021 they were aware of any instances of non- – assessing the extent of compliance Our objectives are to obtain reasonable Owing to the inherent limitations of an audit, compliance with laws and regulations with the relevant laws and regulations assurance about whether the financial there is an unavoidable risk that material or whether they had any knowledge of as part of our procedures on the statements as a whole are free from material misstatements in the financial statements actual, suspected or alleged fraud. related financial statement item. misstatement, whether due to fraud or error, may not be detected, even though the • We assessed the susceptibility of the and to issue an auditor’s report that includes audit is properly planned and performed in • These audit procedures were designed CCG’s financial statements to material our opinion. accordance with the ISAs (UK). to provide reasonable assurance that the misstatement, including how fraud might financial statements were free from fraud occur, by evaluating management's Reasonable assurance is a high level of The extent to which our procedures are or error. However, detecting irregularities incentives and opportunities for assurance but is not a guarantee that an capable of detecting irregularities, including that result from fraud is inherently more manipulation of the financial statements. audit conducted in accordance with ISAs (UK) fraud is detailed below: difficult than detecting those that result This included the evaluation of the risk will always detect a material misstatement from error, as those irregularities that result • We obtained an understanding of the of management override of controls and when it exists. Misstatements can arise from from fraud may involve collusion, deliberate legal and regulatory frameworks that are fraudulent expenditure recognition. We fraud or error and are considered material if, concealment, forgery or intentional applicable to the CCG and determined determined that the principal risks were individually or in the aggregate, they could misrepresentations. Also, the further that the most significant which are in relation to: reasonably be expected to influence the removed non-compliance with laws and directly relevant to specific assertions economic decisions of users taken on the – Journals, management estimates and regulations is from events and transactions in the financial statements are those basis of these financial statements. transactions outside the course of reflected in the financial statements, the related to the reporting frameworks business; and less likely we would become aware of it. A further description of our responsibilities (international accounting standards and for the audit of the financial statements the National Health Service Act 2006, as – Fraudulent expenditure recognitions, • The team communications in respect of is located on the Financial Reporting amended by the Health and Social Care and specifically the completeness of potential non-compliance with relevant Council’s website at: www.frc.org.uk/ Act 2012 and interpreted and adapted expenditure. laws and regulations, including the potential for fraud in revenue and/ auditorsresponsibilities . This description by the Department of Health and Social • Our audit procedures involved: forms part of our auditor’s report. Care Group Accounting Manual 2020 to or expenditure recognition, and the – evaluation of the design effectiveness 2021). significant accounting estimates related We are also responsible for giving an opinion of controls that management has in to the CCG’s Prescribing Accrual. • We enquired of management and the on the regularity of expenditure and income place to prevent and detect fraud; Audit Committee, concerning the CCG’s • Assessment of the appropriateness of the in the financial statements in accordance – journal entry testing, with a focus on policies and procedures relating to: collective competence and capabilities with the Code of Audit Practice. unusual and high risk journals; of the engagement team included – the identification, evaluation and – challenging assumptions and consideration of the engagement team's: Explanation as to what extent the audit compliance with laws and regulations; judgements made by management in – understanding of, and practical was considered capable of detecting – the detection and response to the risks its significant accounting estimate in experience with audit engagements irregularities, including fraud of fraud; and respect of the Prescribing Accrual; of a similar nature and complexity Irregularities, including fraud, are instances – the establishment of internal controls – substantive procedures to confirm through appropriate training and of non-compliance with laws and to mitigate risks related to fraud the completeness of operating participation or non-compliance with laws and regulations. We design procedures in line expenditure with a particular emphasis – knowledge of the health sector and regulations. with our responsibilities, outlined above, to on year end accruals and transactions economy in which the CCG operates

176 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 177 – understanding of the legal and Report on other legal and Responsibilities of the Accountable • Governance: how the CCG ensures regulatory requirements specific to the regulatory requirements – Officer that it makes informed decisions and CCG including: properly manages its risks; and the CCG’s arrangements for As explained in the Governance Statement, – the provisions of the applicable • Improving economy, efficiency and the Accountable Officer is responsible legislation securing economy, efficiency effectiveness: how the CCG uses for putting in place proper arrangements and effectiveness in its use of information about its costs and – NHS England’s rules and related for securing economy, efficiency and performance to improve the way it guidance resources effectiveness in the use of the CCG's manages and delivers its services. resources. – the applicable statutory provisions.

• In assessing the potential risks of Matter on which we are required We document our understanding of the Auditor’s responsibilities for the review material misstatement, we obtained an to report by exception – the CCG’s arrangements the CCG has in place for each of the CCG’s arrangements for securing understanding of: arrangements for securing economy, of these three specified reporting criteria, economy, efficiency and effectiveness in efficiency and effectiveness in its use of gathering sufficient evidence to support – the CCG’s operations, including the its use of resources our risk assessment and commentary in our nature of its operating revenue and resources Auditor’s Annual Report. In undertaking expenditure and its services and We are required under Section 21(1)(c) Under the Code of Audit Practice, we are our work, we consider whether there is of its objectives and strategies to of the Local Audit and Accountability Act required to report to you if, in our opinion, evidence to suggest that there are significant understand the classes of transactions, 2014 to be satisfied that the CCG has made we have not been able to satisfy ourselves weaknesses in arrangements. account balances, expected financial proper arrangements for securing economy, that the CCG has made proper arrangements statement disclosures and business efficiency and effectiveness in its use of for securing economy, efficiency and risks that may result in risks of material resources. We are not required to consider, effectiveness in its use of resources for the misstatement. nor have we considered, whether all aspects year ended 31 March 2021. of the CCG's arrangements for securing – the CCG's control environment, economy, efficiency and effectiveness in its including the policies and procedures Our work on the CCG’s arrangements use of resources are operating effectively. implemented by the CCG to ensure for securing economy, efficiency and effectiveness in its use of resources is not compliance with the requirements of We undertake our review in accordance with yet complete. The outcome of our work the financial reporting framework. the Code of Audit Practice, having regard will be reported in our commentary on to the guidance issued by the Comptroller the CCG’s arrangements in our Auditor’s and Auditor General in April 2021. This Annual Report. If we identify any significant guidance sets out the arrangements that fall weaknesses in these arrangements, these within the scope of ‘proper arrangements’. will be reported by exception in our Audit When reporting on these arrangements, the Completion Certificate. We are satisfied that Code of Audit Practice requires auditors to this work does not have a material effect on structure their commentary on arrangements our opinion on the financial statements for under three specified reporting criteria: the year ended 31 March 2021. • Financial sustainability: how the CCG plans and manages its resources to ensure it can continue to deliver its services;

178 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 179 Report on other legal and regulatory requirements – Delay in certification of completion of the audit 3. Annual We cannot formally conclude the audit and issue an audit certificate for the NHS South West London CCG for the year accounts ended 31 March 2021 in accordance with the requirements of the Local Audit and Accountability Act 2014 and the Code of Audit Practice until we have completed our work on the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources.

Use of our report

This report is made solely to the members of the Governing Body of the CCG, as a body, in accordance with Part 5 of the Local Audit and Accountability Act 2014. Our audit work has been undertaken so that we might state to the members of the Governing Body of the CCG those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the CCG and the members of the Governing Body of the CCG, as a body, for our audit work, for this report, or for the opinions we have formed.

180 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 181 1. Primary statements Statement of Financial Position as at 31 March 2021 31st March 2021 1st April 2020 Statement of Comprehensive Net Expenditure for the year ended Note £'000 £'000 31 March 2021 Non-current assets: Property, plant and equipment 9 347 1,232 2020-21 Intangible assets 10 16 141 Note £'000 Total non-current assets 363 1,373

Income from sale of goods and services 2 (20,728) Current assets: Trade and other receivables 11 19,765 31,788 Other operating income 2 (13,462) Cash and cash equivalents 12 473 687 Total operating income (34,190) Total current assets 20,238 32,475

Staff costs 4 40,984 Total assets 20,600 33,848 Purchase of goods and services 5 2,664,755 Current liabilities Depreciation and impairment charges 5 1,010 Trade and other payables 13 (219,954) (174,997) Provision expense 5 (1,715) Provisions 14 - (904) Total current liabilities (219,954) (175,901) Other Operating Expenditure 5 1,015

Total operating expenditure 2,706,050 Non-Current Assets plus/less Net Current Assets/Liabilities (199,354) (142,053)

Net (Gain)/Loss on Transfer by Absorption 142,923 Non-current liabilities Provisions 14 - (870) Total Net Expenditure for the Financial Year 2,814,783 Total non-current liabilities - (870)

Comprehensive Expenditure for the year 2,814,783 Assets less Liabilities (199,354) (142,923)

Financed by Taxpayers’ Equity General fund (199,354) (142,923) Total taxpayers' equity: (199,354) (142,923)

The notes on pages 186 to 215 form part of this statement The balances as at 1st April 2020 relate to those transferred by absorption (note 8) The financial statements on pages 181 to 215 were approved by the Governing Body on 10th June 2021 and signed on its behalf by: Sarah Blow Accountable Officer 11 06 2021

182 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 183 Statement of Changes In Taxpayers Equity for the year ended Statement of Cash Flows for the year ended 31 March 2021 31 March 2021 General fund Total reserves £'000 £'000 2020-21 Note £'000 Changes in taxpayers’ equity for 2020-21 Cash Flows from Operating Activities Net operating expenditure for the financial year (2,671,860) Balance at 01 April 2020 0 0 Depreciation and amortisation 5 1,010 Adjusted NHS Clinical Commissioning Group balance at 1st April 2020 0 0 (Increase)/decrease in trade & other receivables 10 12,023 Increase/(decrease) in trade & other payables 12 44,957

Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2020-21 Provisions utilised 13 (59) Net operating expenditure for the financial year (2,671,860) (2,671,860) Increase/(decrease) in provisions 13 (1,715) Net Cash Inflow (Outflow) from Operating Activities (2,615,643)

Transfers by absorption to (from) other bodies (142,923) (142,923) Net Recognised NHS Clinical Commissioning Net Cash Inflow (Outflow) before Financing (2,615,643) Group Expenditure for the Financial year (2,814,783) (2,814,783) Cash Flows from Financing Activities Net funding 2,615,430 2,615,430 Grant in Aid Funding Received 2,615,430 Balance at 31 March 2021 (199,354) (199,354) Net Cash Inflow (Outflow) from Financing Activities 2,615,430

The notes on pages 186 to 215 form part of this statement Net Increase (Decrease) in Cash & Cash Equivalents 11 (214)

Cash & Cash Equivalents at the Beginning of the Financial Year 0 Transfers from other public bodies under absorption 687 Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year 473

The notes on pages 186 to 215 form part of this statement

184 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 185 Notes to the financial statements 1.7 Critical Accounting Judgements & Key Sources of Estimation Uncertainty In the application of the clinical commissioning group’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. 1 Accounting Policies Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions NHS England has directed that the financial statements of clinical commissioning groups shall meet the accounting requirements to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in of the Group Accounting Manual issued by the Department of Health and Social Care. Consequently, the following financial the period of the revision and future periods if the revision affects both current and future periods. statements have been prepared in accordance with the Group Accounting Manual 2020-21 issued by the Department of Health The following are the critical judgements, those involving estimations that management has made in the process of applying the and Social Care. The accounting policies contained in the Group Accounting Manual follow International Financial Reporting clinical commissioning group’s accounting policies that have the most significant effect on the amounts recognised in the financial Standards to the extent that they are meaningful and appropriate to clinical commissioning groups, as determined by HM statements: Treasury, which is advised by the Financial Reporting Advisory Board. Where the Group Accounting Manual permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the clinical - £29.4m for the final two months prescribing expenditure has been based on forecast information supplied by NHS Business commissioning group for the purpose of giving a true and fair view has been selected. The particular policies adopted by the Services Authority. clinical commissioning group are described below. They have been applied consistently in dealing with items considered material - £12.9m as an estimate of additional continuing care expenditure based on CCG client databases and trends. in relation to the accounts. - £14.6m Covid-19 accrual has been calculated and accrued based on bids collated on the CCG's central Covid-19 project 1.1 Going Concern database. These accounts have been prepared on a going concern basis. - £11.3m estimate of Service Development Funds has been calculated from information received from budget holders cross Public sector bodies are assumed to be going concerns where the continuation of the provision of a service in the future is referenced with allocations received. anticipated, as evidenced by inclusion of financial provision for that service in published documents. 1.8 Operating Segments Where a clinical commissioning group ceases to exist, it considers whether or not its services will continue to be provided (using Income and expenditure are analysed in the Operating Segments note and are reported in line with management information the same assets, by another public sector entity) in determining whether to use the concept of going concern for the final set of used within the clinical commissioning group. financial statements. If services will continue to be provided the financial statements are prepared on the going concern basis. 1.9 Revenue 1.2 Accounting Convention In the application of IFRS 15 a number of practical expedients offered in the Standard have been employed. These are as follows: These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant • As per paragraph 121 of the Standard the clinical commissioning group will not disclose information regarding performance and equipment, intangible assets, inventories and certain financial assets and financial liabilities. obligations part of a contract that has an original expected duration of one year or less, 1.3 CCG Merger • The clinical commissioning group is to similarly not disclose information where revenue is recognised in line with the practical NHS South West London CCG was approved by NHS England to operate from 1 April 2020 and was created from the merger of expedient offered in paragraph B16 of the Standard where the right to consideration corresponds directly with value of the NHS Croydon, Kingston. Merton, Richmond, Sutton and Wandsworth CCGs. Closing balances from the 6 predecessor CCGs were performance completed to date. transferred to NHS South West London CCG at 1 April 2020. The transfer of balances is detailed in Note 8 of these accounts. As • The FReM has mandated the exercise of the practical expedient offered in C7(a) of the Standard that requires the clinical a result of the merger, other than for the Statement of Financial Position and related notes, comparative figures for the previous commissioning group to reflect the aggregate effect of all contracts modified before the date of initial application. financial year have not been provided as the CCG did not exist in 2019-20. The main source of funding for the Clinical Commissioning Group is from NHS England. This is drawn down and credited to the Transfers as part of reorganisation fall to be accounted for by use of absorption accounting in line with the Government Financial general fund. Funding is recognised in the period in which it is received. Reporting Manual, issued by HM Treasury. The Government Financial Reporting Manual does not require retrospective adoption, Revenue in respect of services provided is recognised when (or as) performance obligations are satisfied by transferring promised so prior year transactions (which have been accounted for under merger accounting) have not been restated. Absorption services to the customer, and is measured at the amount of the transaction price allocated to that performance obligation. accounting requires that entities account for their transactions in the period in which they took place, with no restatement of Where income is received for a specific performance obligation that is to be satisfied in the following year, that income is deferred. performance required when functions transfer within the public sector. Where assets and liabilities transfer, the gain or loss resulting is recognised in the Statement of Comprehensive Net Expenditure, and is disclosed separately from operating costs. Payment terms are standard reflecting cross government principles. Significant terms require that 95% of undisputed, valid invoices should be paid within 30 days. Other transfers of assets and liabilities within the Department of Health and Social Care Group are accounted for in line with IAS 20 and similarly give rise to income and expenditure entries. The value of the benefit received when the clinical commissioning group accesses funds from the Government’s apprenticeship service are recognised as income in accordance with IAS 20, Accounting for Government Grants. Where these funds are paid 1.4 Charitable Funds directly to an accredited training provider, non- cash income and a corresponding non-cash training expense are recognised, both From 2013-14, the divergence from Government Financial Report Manual that NHS Charitable Funds are not consolidated with equal to the cost of the training funded. bodies' own returns is removed. Under the provisions of IAS 27: Consolidated & Separate Financial Statements, those Charitable 1.10 Employee Benefits Funds fall under common control with NHS bodies are consolidated within entities' accounts. 1.10.1 Short-term Employee Benefits The Governing Body does not consider the activities of the charity to be material to NHS South West London CCG and accordingly has decided not to consolidate the Charitable Funds accounts with that of the CCG. Salaries, wages and employment-related payments, including payments arising from the apprenticeship levy, are recognised in the period in which the service is received from employees, including bonuses earned but not yet taken. On 13th January 2021, the Corporate Trustee of the Funds (the NHS SW London CCG Governing Body) determined that the charitable funds previously held by Kingston CCG are granted to the Kingston Hospital NHS Foundation Trust Charitable Funds The cost of leave earned but not taken by employees at the end of the period is recognised in the financial statements to the and as a consequence the Kingston CCGs’ Charitable Fund closed on 31st March 2021 with the net assets distributed to the extent that employees are permitted to carry forward leave into the following period. Kingston Hospital NHS Foundation Trust Charitable Fund. 1.10.2 Retirement Benefit Costs 1.5 Joint arrangements Past and present employees are covered by the provisions of the NHS Pensions Schemes. These schemes are unfunded, defined Arrangements over which the clinical commissioning group has joint control with one or more other entities are classified as joint benefit schemes that cover NHS employers, General Practices and other bodies allowed under the direction of the Secretary arrangements. Joint control is the contractually agreed sharing of control of an arrangement. A joint arrangement is either a joint of State in England and Wales. The schemes are not designed to be run in a way that would enable NHS bodies to identify operation or a joint venture. their share of the underlying scheme assets and liabilities. Therefore, the schemes are accounted for as if they were a defined contribution scheme; the cost recognised in these accounts represents the contributions payable for the year. The CCG has a joint operation which are activities undertaken in conjunction with one or more parties which are performed through a separate entity. The clinical commissioning group records its share of the income and expenditure, gains and losses, For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full assets, liabilities and cash flows in its own accounts. amount of the liability for the additional costs is charged to expenditure at the time the clinical commissioning group commits itself to the retirement, regardless of the method of payment. 1.6 Pooled Budgets The schemes are subject to a full actuarial valuation every four years and an accounting valuation every year. South West London CCG has entered into pooled budget arrangements under Section 75 of the National Health Service Act 2006 with 5 of the Local London Boroughs (Croydon, Kingston, Merton, Richmond, Sutton and Wandsworth), relating to the 1.11 Other Expenses commissioning of health and social care services within the Better Care Fund. The clinical commissioning group accounts for its Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are share of the assets, liabilities, income and expenditure arising from the activities of the pooled budget, identified in accordance measured at the fair value of the consideration payable. with the pooled budget arrangement. The Section 75 agreements clearly sets out the accounting, risk share and governance 1.12 Grants Payable arrangements. Where grant funding is not intended to be directly related to activity undertaken by a grant recipient in a specific period, the The accountable bodies for the Better Care Fund are the Local Authorities who hold the funds apart from Croydon where the clinical commissioning group recognises the expenditure in the period in which the grant is paid. All other grants are accounted CCG holds the fund. They are managed through a joint management committee. for on an accruals basis.

186 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 187 1.13 Property, Plant & Equipment reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are 1.13.1 Recognition depreciated over the shorter of the lease term and the estimated useful life. Property, plant and equipment is capitalised if: At each reporting period end, the clinical commissioning group checks whether there is any indication that any of its property, • It is held for use in delivering services or for administrative purposes; plant and equipment assets or intangible non-current assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its • It is probable that future economic benefits will flow to, or service potential will be supplied to the clinical commissioning group; amount. Intangible assets not yet available for use are tested for impairment annually. • It is expected to be used for more than one financial year; A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment • The cost of the item can be measured reliably; and, charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. • The item has a cost of at least £5,000; or, Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Where an impairment loss • Collectively, a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assets subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the recoverable amount but capped are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal at the amount that would have been determined had there been no initial impairment loss. The reversal of the impairment loss is dates and are under single managerial control; or, credited to expenditure to the extent of the decrease previously charged there and thereafter to the revaluation reserve. • Items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or 1.15 Leases collective cost. Leases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All Where a large asset, for example a building, includes a number of components with significantly different asset lives, the other leases are classified as operating leases. components are treated as separate assets and depreciated over their own useful economic lives. 1.15.1 The Clinical Commissioning Group as Lessee 1.13.2 Measurement Property, plant and equipment held under finance leases are initially recognised, at the inception of the lease, at fair value or, if All property, plant and equipment is measured initially at cost, representing the cost directly attributable to acquiring or lower, at the present value of the minimum lease payments, with a matching liability for the lease obligation to the lessor. Lease constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner payments are apportioned between finance charges and reduction of the lease obligation so as to achieve a constant rate on intended by management. interest on the remaining balance of the liability. Finance charges are recognised in calculating the clinical commissioning group’s IT equipment and furniture and fittings that are held for operational use are valued at depreciated historic cost where these assets surplus/deficit. have short useful economic lives or low values or both, as this is not considered to be materially different from current value in Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are existing use. recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term. NHS South West London CCG does not own any land or buildings. On the dissolution of former NHS Primary Care Trusts, all land Contingent rentals are recognised as an expense in the period in which they are incurred. and buildings were transferred to NHS Property Services or Community Health Partnerships. Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether 1.13.3 Subsequent Expenditure they are operating or finance leases. Where subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised. 1.16 Cash & Cash Equivalents Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. carrying value of the item replaced is written- out and charged to operating expenses. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to 1.14 Intangible Assets known amounts of cash with insignificant risk of change in value. 1.14.1 Recognition In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and Intangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the that form an integral part of the clinical commissioning group’s cash management. clinical commissioning group’s business or which arise from contractual or other legal rights. They are recognised only: 1.17 Provisions • When it is probable that future economic benefits will flow to, or service potential be provided to, the clinical commissioning Provisions are recognised when the clinical commissioning group has a present legal or constructive obligation as a result of a past group; event, it is probable that the clinical commissioning group will be required to settle the obligation, and a reliable estimate can be • Where the cost of the asset can be measured reliably; and, made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties. • Where the cost is at least £5,000. South West London CCG was formed by the merger of six South West London CCGs (Croydon, Kingston, Merton, Richmond, Software that is integral to the operating of hardware, for example an operating system, is capitalised as part of the relevant Sutton and Wandsworth) on 1st April 2020. Two of these six borough places had previously held provisions for Continuing item of property, plant and equipment. Software that is not integral to the operation of hardware, for example application Healthcare Restitutions for periods after 31st March 2013. During the course of 2020/21 the CCG has reversed these provisions software, is capitalised as an intangible asset. Expenditure on research is not capitalised but is recognised as an operating expense as unused and these two borough places now report restitutions in line with the four other borough places. Known certain in the period in which it is incurred. Internally-generated assets are recognised if, and only if, all of the following have been restitution case are accounted for via accrued expenditure and is reported as part of the Continuing Healthcare spend of the CCG. demonstrated: Subsequent to the above adjustment, the CCG does not hold any provisions as at 31st March 2021. • The technical feasibility of completing the intangible asset so that it will be available for use; 1.18 Continuing Healthcare Risk Pooling • The intention to complete the intangible asset and use it; In 2014-15 a risk pool scheme was been introduced by NHS England for continuing healthcare claims, for claim periods prior to • The ability to sell or use the intangible asset; 31 March 2013. Under the scheme clinical commissioning group contribute to a pooled fund, which is used to settle the claims. • How the intangible asset will generate probable future economic benefits or service potential; 1.19 Clinical Negligence Costs • The availability of adequate technical, financial and other resources to complete the intangible asset and sell or use it; and, NHS Resolution operates a risk pooling scheme under which the clinical commissioning group pays an annual contribution to • The ability to measure reliably the expenditure attributable to the intangible asset during its development. NHS Resolution, which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although NHS 1.14.2 Measurement Resolution is administratively responsible for all clinical negligence cases, the legal liability remains with South West London CCG. Intangible assets acquired separately are initially recognised at cost. The amount initially recognised for internally-generated The total value of Clinical Negligence provisions carried by the NHSLA on behalf of the CCG is disclosed at note 13 intangible assets is the sum of the expenditure incurred from the date when the criteria above are initially met. Where no 1.20 Non-clinical Risk Pooling internally-generated intangible asset can be recognised, the expenditure is recognised in the period in which it is incurred. The clinical commissioning group participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both Following initial recognition, intangible assets are carried at current value in existing use by reference to an active market, are risk pooling schemes under which the clinical commissioning group pays an annual contribution to the NHS Resolution and, or, where no active market exists, at the lower of amortised replacement cost or the value in use where the asset is income in return, receives assistance with the costs of claims arising. The annual membership contributions, and any excesses payable in generating . Internally-developed software is held at historic cost to reflect the opposing effects of increases in development costs respect of particular claims are charged to operating expenses as and when they become due. and technological advances. Revaluations and impairments are treated in the same manner as for property, plant and equipment. 1.21 Contingent liabilities and contingent assets 1.14.3 Depreciation, Amortisation & Impairments A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the Freehold land, properties under construction, and assets held for sale are not depreciated. occurrence or non- occurrence of one or more uncertain future events not wholly within the control of the clinical commissioning Otherwise, depreciation and amortisation are charged to write off the costs or valuation of property, plant and equipment and group, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the intangible non-current assets, less any residual value, over their estimated useful lives, in a manner that reflects the consumption obligation or the amount of the obligation cannot be measured sufficiently reliably. A contingent liability is disclosed unless the of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over which the clinical possibility of a payment is remote. commissioning group expects to obtain economic benefits or service potential from the asset. This is specific to the clinical A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or commissioning group and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are non-occurrence of one or more uncertain future events not wholly within the control of the clinical commissioning group. A

188 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 189 contingent asset is disclosed where an inflow of economic benefits is probable. 2. Other Operating Revenue Where the time value of money is material, contingent liabilities and contingent assets are disclosed at their present value. 1.22 Financial Assets 2020-21 Financial assets are recognised when the clinical commissioning group becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the Total contractual rights have expired or the asset has been transferred. Financial assets are classified into the following categories: £'000 • Financial assets at amortised cost; Income from sale of goods and services (contracts) • Financial assets at fair value through other comprehensive income and ; • Financial assets at fair value through profit and loss. Education, training and research - The classification is determined by the cash flow and business model characteristics of the financial assets, as set out in IFRS 9, and is determined at the time of initial recognition. Non-patient care services to other bodies 20,165 1.22.1 Financial Assets at Amortised cost Other Contract income 563 Financial assets measured at amortised cost are those held within a business model whose objective is achieved by collecting contractual cash flows and where the cash flows are solely payments of principal and interest. This includes most trade receivables Total Income from sale of goods and services 20,728 and other simple debt instruments. After initial recognition these financial assets are measured at amortised cost using the effective interest method less any impairment. The effective interest rate is the rate that exactly discounts estimated future cash receipts through the life of the financial asset to the gross carrying amount of the financial asset. 1.22.2 Impairment Other operating income For all financial assets measured at amortised cost or at fair value through other comprehensive income (except equity instruments Rental revenue from operating leases 262 designated at fair value through other comprehensive income), lease receivables and contract assets, the clinical commissioning group recognises a loss allowance representing the expected credit losses on the financial asset. Charitable and other contributions to revenue expenditure: non-NHS 1 The clinical commissioning group adopts the simplified approach to impairment in accordance with IFRS 9, and measures the loss allowance for trade receivables, lease receivables and contract assets at an amount equal to lifetime expected credit losses. For Other non contract revenue 13,198 other financial assets, the loss allowance is measured at an amount equal to lifetime expected credit losses if the credit risk on the financial instrument has increased significantly since initial recognition (stage 2) and otherwise at an amount equal to 12 month Total Other operating income 13,462 expected credit losses (stage 1). HM Treasury has ruled that central government bodies may not recognise stage 1 or stage 2 impairments against other government departments, their executive agencies, the Bank of England, Exchequer Funds and Exchequer Funds assets where repayment is ensured by primary legislation. The clinical commissioning group therefore does not recognise loss allowances for Total Operating Income 34,190 stage 1 or stage 2 impairments against these bodies. Additionally Department of Health and Social Care provides a guarantee of last resort against the debts of its arm's lengths bodies and NHS bodies and the clinical commissioning group does not recognise allowances for stage 1 or stage 2 impairments against these bodies. For financial assets that have become credit impaired since initial recognition (stage 3), expected credit losses at the reporting date are measured as the difference between the asset's gross carrying amount and the present value of the estimated future cash flows discounted at the financial asset's original effective interest rate. Any adjustment is recognised in profit or loss as an impairment gain or loss. 1.23 Financial Liabilities Financial liabilities are recognised on the statement of financial position when the clinical commissioning group becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de- recognised when the liability has been discharged, that is, the liability has been paid or has expired. 1.24 Value Added Tax Most of the activities of the clinical commissioning group are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT. 1.25 Losses & Special Payments Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled. Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had the clinical commissioning group not been bearing its own risks (with insurance premiums then being included as normal revenue expenditure). 1.26 Accounting Standards That Have Been Issued But Have Not Yet Been Adopted The Department of Health and Social Care GAM does not require the following IFRS Standards and Interpretations to be applied in 2020-21. These Standards are still subject to HM Treasury FReM adoption, with IFRS 16 being for implementation in 2022/23, and the government implementation date for IFRS 17 still subject to HM Treasury consideration. • IFRS 16 Leases – The Standard is effective 1 April 2022 as adapted and interpreted by the FReM. • IFRS 17 Insurance Contracts – Application required for accounting periods beginning on or after 1 January 2021, but not yet adopted by the FReM: early adoption is not therefore permitted.

190 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 191 3.1 Disaggregation of Income - Income from sale of good and services (contracts) 4. Employee benefits and staff numbers 4.1.1 Employee benefits Non-patient care services to other Other Contract bodies income £'000 £'000 Total 2020-21 Source of Revenue Employees Other Total NHS 3,799 - £'000 £'000 £'000 Non NHS 16,366 563 Employee Benefits Total 20,165 563 Salaries and wages 26,789 6,238 33,027 Social security costs 3,117 0 3,117

Non-patient care Employer Contributions to NHS Pension scheme 4,674 0 4,674 services to other Other Contract Apprenticeship Levy 60 0 60 bodies income Termination benefits 106 0 106 £'000 £'000 Gross employee benefits expenditure 34,746 6,238 40,984 Timing of Revenue Point in time 20,165 563 Total 20,165 563

192 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 193 4.2 Average number of people employed 4.4 Pension costs Past and present employees are covered by the provisions of the two NHS Pension Schemes. Details of the benefits payable and 2020-21 rules of the Schemes can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. Permanently Both are unfunded defined benefit schemes that cover NHS employers, GP practices and other bodies, allowed under the employed Other Total direction of the Secretary of State for Health and Social Care in England and Wales. They are not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Number Number Number Therefore, each scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating in Total 451 43 494 each scheme is taken as equal to the contributions payable to that scheme for the accounting period. In order that the defined benefit obligations recognised in the financial statements do not differ materially from those that would be determined at the reporting date by a formal actuarial valuation, the FReM requires that “the period between formal valuations shall be four years, with approximate assessments in intervening years”. An outline of these follows:

4.4.1 Accounting valuation 4.3 Exit packages agreed in the financial year A valuation of scheme liability is carried out annually by the scheme actuary (currently the Government Actuary’s Department) as at the end of the reporting period. This utilises an actuarial assessment for the previous accounting period in conjunction with 2020-21 updated membership and financial data for the current reporting period, and is accepted as providing suitably robust figures for financial reporting purposes. The valuation of the scheme liability as at 31 March 2021, is based on valuation data as 31 March 2020-21 2020-21 2020, updated to 31 March 2021 with summary global member and accounting data. In undertaking this actuarial assessment, Compulsory Other agreed the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate prescribed by HM Treasury have also redundancies departures been used. The latest assessment of the liabilities of the scheme is contained in the report of the scheme actuary, which forms part of the Number £ Number annual NHS Pension Scheme Accounts. These accounts can be viewed on the NHS Pensions website and are published annually. Less than £10,000 1 3,450 - Copies can also be obtained from The Stationery Office.

£10,001 to £25,000 3 57,020 - 4.4.2 Full actuarial (funding) valuation £25,001 to £50,000 1 30,000 - The purpose of this valuation is to assess the level of liability in respect of the benefits due under the schemes (taking into account recent demographic experience), and to recommend contribution rates payable by employees and employers. £50,001 to £100,000 - - - The latest actuarial valuation undertaken for the NHS Pension Scheme was completed as at 31 March 2016. The results of this £100,001 to £150,000 - - - valuation set the employer contribution rate payable from April 2019 to 20.6% of pensionable pay. The 2016 funding valuation was also expected to test the cost of the Scheme relative to the employer cost cap that was set following the 2012 valuation. In £150,001 to £200,000 - - - January 2019, the Government announced a pause to the cost control element of the 2016 valuations, due to the uncertainty Over £200,001 - - - around member benefits caused by the discrimination ruling relating to the McCloud case. Total 5 90,470 - The Government subsequently announced in July 2020 that the pause had been lifted, and so the cost control element of the 2016 valuations could be completed. The Government has set out that the costs of remedy of the discrimination will be included in this process. HMT valuation directions will set out the technical detail of how the costs of remedy will be included in the valuation process. The Government has also confirmed that the Government Actuary is reviewing the cost control mechanism As a single exit package can be made up of several components each of which will be counted (as was originally announced in 2018). The review will assess whether the cost control mechanism is working in line with original government objectives and reported to Government in April 2021. The findings of this review will not impact the 2016 valuations, separately in this table, the total number will not necessarily match the total number in the table with the aim for any changes to the cost cap mechanism to be made in time for the completion of the 2020 actuarial valuations. above, which will be the number of individuals.

These tables report the number and value of exit packages agreed in the financial year. The expense associated with these departures may have been recognised in part or in full in a previous period.

Redundancy and other departure costs have been paid in accordance with the NHS National Terms and Conditions (Agenda for Change) guidelines.

Exit costs are accounted for in accordance with relevant accounting standards and at the latest in full in the year of departure.

The Remuneration Report includes the disclosure of exit payments payable to individuals named in that Report.

194 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 195 5. Operating expenses 6.1 Better Payment Practice Code 2020-21 Total Measure of compliance 2020-21 2020-21 £'000 Number £'000 Purchase of goods and services Non-NHS Payables Services from other CCGs and NHS England 17,259 Services from foundation trusts 917,685 Total Non-NHS Trade invoices paid in the Year 64,304 651,334 Services from other NHS trusts 828,864 Services from Other WGA bodies 15 Total Non-NHS Trade Invoices paid within target 63,430 636,417 Purchase of healthcare from non-NHS bodies 384,704 Percentage of Non-NHS Trade invoices paid within target 98.64% 97.71% Purchase of social care 3,573 Prescribing costs 180,742 Pharmaceutical services - NHS Payables General Ophthalmic services 42 GPMS/APMS and PCTMS 257,260 Total NHS Trade Invoices Paid in the Year 6,809 1,776,085 Supplies and services – clinical 2,348 Supplies and services – general 36,924 Total NHS Trade Invoices Paid within target 6,551 1,770,243 Consultancy services 1,302 Percentage of NHS Trade Invoices paid within target 96.21% 99.67% Establishment 19,462 Transport 1,292 Premises 9,356 Audit fees 252 Other non statutory audit expenditure · Internal audit services 141 · Other services 72 Other professional fees 2,169 Legal fees 250 Education, training and conferences 1,044 Total Purchase of goods and services 2,664,755 Depreciation and impairment charges Depreciation 885 Amortisation 125 Total Depreciation and impairment charges 1,010 Provision expense Provisions (1,715) Total Provision expense (1,715) Other Operating Expenditure Chair and Non Executive Members 721 Grants to Other bodies 160 Research and development (excluding staff costs) 155 Expected credit loss on receivables (34) Other expenditure 13 Total Other Operating Expenditure 1,015 Total operating expenditure 2,665,066

Limitation on auditor's liability - In accordance with the terms of engagement with the trust's external auditors, Grant Thornton UK LLP, its members, partners and staff (whether contract, negligence or otherwise) in respect of services provided in connection with or arising out of the audit shall in no circumstances exceed £2million in the aggregate in respect of all such services. To note that Grant Thornton UK LLP do not provide Internal audit services for the CCG Audit Fees are £200k exclusive of VAT’ Other services are in respect of the Mental Health Investment Standard Returns and were £60k exclusive of VAT

196 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 197 7. Operating Leases 7.2 As lessor 7.1 As lessee 7.2.1 Rental revenue

7.1.1 Payments recognised as an Expense 2020-21 2019-20 £'000 £'000 2020-21 Recognised as income Buildings Total Contingent rents 262 100 £'000 £'000 Payments recognised as an expense Total 262 100 Minimum lease payments 2,140 2,140 Total 2,140 2,140

Whilst our arrangements with NHS Property Services Limited fall within the definition of operating leases, rental charges for future years has not been agreed . Consequently this note does not include future minimum lease payments for these arrangements.

7.1.2 Future minimum lease payments

2020-21 Buildings Total £'000 £'000 Payments recognised as an expense No later than one year 75 75 Between one and five years 211 211 After five years 500 500 Total 786 786

198 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 199 8. Net gain/(loss) on transfer by absorption which they took place, with no restatement of performance required when functions transfer within the public sector. NHS Croydon CCG, NHS Kingston CCG, NHS Merton CCG, NHS Richmond CCG, NHS Sutton CCG and NHS Wandsworth CCG merged from 1st April 2020 to form NHS South West London CCG Where assets and liabilities transfer, the gain or loss resulting is recognised in the Statement of Comprehensive Net Expenditure, and is disclosed separately from operating costs. Transfers as part of a reorganisation fall to be accounted for by use of absorption accounting in line with the Government Financial Reporting Manual, issued by HM Treasury. The Government Financial The table below identifies the Statement of Financial Position at 1st April 2020 for the six former Reporting Manual does not require retrospective adoption, so prior year transactions have not been CCGs. The corresponding net debit reflecting the loss is recognised within the income and expenses restated. Absorption accounting requires that entities account for their transactions in the period in as disclosed within the Statement of comprehensive Net expenditure, but outside operating activities.

Total NHS Croydon NHS Kingston NHS Merton NHS Richmond NHS Sutton NHS Wandsworth CCG CCG CCG CCG CCG CCG 1st April 2020 1st April 2020 1st April 2020 1st April 2020 1st April 2020 1st April 2020 1st April 2020 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Transfer of property plant and equipment 1,232 131 95 135 79 81 712

Transfer of intangibles 141 0 65 32 0 44 0

Transfer of inventories 0 0 0 0 0 0 0

Transfer of cash and cash equivalents 687 109 73 31 157 229 87

Transfer of receivables 31,788 4,916 2,790 3,813 2,022 2,585 15,663

Transfer of payables (174,997) (37,655) (27,637) (18,322) (23,867) (23,595) (43,921)

Transfer of provisions (1,774) 0 (870) 0 (904) 0 0

Net Gain (Loss) on Transfer by Absorption (142,923) (32,499) (25,485) (14,312) (22,513) (20,656) (27,458)

200 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 201 9. Property, plant and equipment 10. Intangible non-current assets

Buildings Computer excluding Information Furniture & Software: dwellings technology fittings Total Purchased Total 2020-21 £'000 £'000 £'000 £'000 2020-21 £'000 £'000

Cost or valuation at 01 April 2020 1,919 1,919 Cost or valuation at 01 April 2020 38 5,309 52 5,399

Cost / Valuation At 31 March 2021 1,919 1,919 Cost/Valuation at 31 March 2021 38 5,309 52 5,399

Amortisation 01 April 2020 1,778 1,778 Depreciation 01 April 2020 38 4,077 52 4,167

Charged during the year 125 125 Charged during the year - 885 (0) 885 Amortisation At 31 March 2021 1,903 1,903 Depreciation at 31 March 2021 38 4,963 52 5,052

Net Book Value at 31 March 2021 16 16 Net Book Value at 31 March 2021 - 347 0 347

Purchased 16 16 Purchased - 347 0 347 Total at 31 March 2021 16 16 Total at 31 March 2021 - 347 0 347

Asset financing: The balances as at 1st April 2020 relate to those transferred by absorption (note 8)

Owned - 347 0 347 Total at 31 March 2021 - 347 0 347 10.1 Economic lives

The balances as at 1st April 2020 relate to those transferred by absorption (note 8) Minimum Life Minimum Life (years) (years) Computer software: purchased 3 3

9.1 Economic lives

Minimum Life Minimum Life (years) (years) Buildings excluding dwellings 3 3 Information technology 3 3 Furniture & fittings 3 3

202 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 203 11.1 Trade and other receivables 11.3 Loss allowance on asset classes Current Non-current Trade and other 2020-21 2020-21 receivables - Non Other financial £'000 £'000 DHSC Group assets Bodies NHS receivables: Revenue 6,982 - £'000 £'000 NHS prepayments - - NHS accrued income 1,761 - Balance at 01 April 2020 (1,389) - Non-NHS and Other WGA receivables: Revenue 5,439 - Lifetime expected credit losses on trade and other receivables-Stage 2 34 - Non-NHS and Other WGA prepayments 3,731 - Total (1,355) - Non-NHS and Other WGA accrued income 2,580 - Expected credit loss allowance-receivables (1,355) - The balances as at 1st April 2020 relate to those transferred by absorption (note 8) VAT 620 - Other receivables and accruals 7 - Total Trade & other receivables 19,765 - 12. Cash and cash equivalents 2020-21 £'000 Total current and non current 19,765 Balance at 01 April 2020 687 Included above: Net change in year (214) Balance at 31 March 2021 473 Prepaid pensions contributions - Made up of: 11.2 Receivables past their due date but not impaired Cash with the Government Banking Service 473 2020-21 2020-21 Cash and cash equivalents as in statement of financial position 473 DHSC Group Non DHSC Group Bodies Bodies Balance at 31 March 2021 473 £'000 £'000 By up to three months 511 3,769 The balances as at 1st April 2020 relate to those transferred by absorption (note 8) By three to six months 195 145

By more than six months 2,755 1,180 Total 3,461 5,094

204 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 205 13. Trade and other payables The 2020/21 Other Payable Figure of £71.2m Can be broken down into the following areas;

Current Non-current £m 2020-21 2020-21 £'000 £'000 Payroll and Pension Accruals 2.5 Approved but unpaid general invoices 0.4 NHS payables: Revenue 3,104 - Un-approved general invoices 0.6 NHS accruals 11,039 - Service Development Accruals 11.3 Non-NHS and Other WGA payables: Revenue 47,872 - Covid-19 Accruals 14.6 Non-NHS and Other WGA accruals 85,221 - Acute Accruals 0.3 Non-NHS and Other WGA deferred income 607 - Mental Health Accruals 7.6 Social security costs 478 - Community Accruals Including Continuing Healthcare 17.5 Tax 452 - Primary Care Accruals Including IT 10.5 Other payables and accruals 71,182 - Running Cost Accruals 1.4 Total Trade & Other Payables 219,954 - Other Accruals 4.5 71.2 Total current and non-current 219,954

Other payables include £2,500,210 outstanding pension contributions at 31 March 2021

206 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 207 14. Provisions Under the Accounts Direction issued by NHS England on 12 February 2014, NHS England is Current Non-current responsible for accounting for liabilities relating to NHS continuing healthcare claims relating 2020-21 2020-21 to periods of care before the establishment of Clinical Commissioning Groups. However, the £'000 £'000 legal liability remains with the CCG. The total value of NHS Continuing Healthcare provisions NHS payables: Revenue accounted for by NHS England on behalf of the CCG at 31 March 2021 is £320k. Continuing care - - Legal claims are calculated from the number of claims currently lodged with the NHS Litigation Total - - Authority and probabilities provided by them. £7,500 is included in the provisions of the NHS Total current and non-current - Litigation Authority as at 31 March 2021 in respect of employer liabilities of NHS South West London CCG.

The balances as at 1st April 2020 relate to those transferred by absorption (note 8).

Pensions Pensions Relating to Relating to Agenda for Continuing Former Directors Other Staff Restructuring Redundancy Change Equal Pay Legal Claims Care Other Total

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Balance at 01 April 2020 ------1,774 - 1,774

Utilised during the year ------(59) - (59)

Reversed unused ------(1,715) - (1,715)

Balance at 31 March 2021 ------

Expected timing of cash flows:

Within one year ------

Between one and fiveyears ------

After fiveyears ------

Balance at 31 March 2021 ------

208 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 209 15. Contingencies 17. Financial instruments cont'd The CCG had no outstanding claims in 2020/21 that are considered to have a likelihood that deems them reportable as a contingent liability in 2020/21. 17.2 Financial assets Under the Accounts Direction issued by NHS England on 12 February 2014, NHS England is responsible for accounting Financial Equity for liabilities relating to NHS continuing healthcare claims relating to periods of care before the establishment of Clinical Assets Instruments Commissioning Groups. However, the legal liability remains with the CCG. The total value of NHS Continuing Healthcare measured at designated contingent liabilities accounted for by NHS England on behalf of the CCG at 31 March 2021 is £1,230k. amortised cost at FVOCI Total 16. Commitments 2020-21 2020-21 2020-21 NHS South West London CCG has no reportable commitments at 31st March 2021. £'000 £'000 £'000 Trade and other receivables with NHSE bodies 7,853 7,853 17. Financial instruments The fair value of assets and liabilities as detailed in notes 17.2 and 17.3 are the same as the carrying value Trade and other receivables with other DHSC group bodies 4,166 4,166 17.1 Financial risk management Trade and other receivables with external bodies 3,395 3,395 Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities. Cash and cash equivalents 473 473 Because NHS clinical commissioning group is financed through parliamentary funding, it is not exposed to the degree Total at 31 March 2021 15,887 - 15,887 of financial risk faced by business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The clinical commissioning group has limited powers to borrow or invest surplus funds and financial assets and liabilities are The above figure for Trade and other receivables excludes the following which are classed as generated by day-to-day operational activities rather than being held to change the risks facing the clinical commissioning group in undertaking its activities. non financial assets - Prepayments, £3,731k and VAT receivable, £620k. Treasury management operations are carried out by the finance department, within parameters defined formally within the NHS clinical commissioning group standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the NHS clinical commissioning group and internal auditors. 17.3 Financial liabilities 17.1.1 Currency risk The NHS clinical commissioning group is principally a domestic organisation with the great majority of transactions, assets Financial and liabilities being in the UK and sterling based. The NHS clinical commissioning group has no overseas operations. The Liabilities NHS clinical commissioning group and therefore has low exposure to currency rate fluctuations. measured at

17.1.2 Interest rate risk amortised cost Other Total 2020-21 2020-21 2020-21 The clinical commissioning group borrows from government for capital expenditure, subject to affordability as confirmed by NHS England. The borrowings are for 1 to 25 years, in line with the life of the associated assets, and interest is £'000 £'000 £'000 charged at the National Loans Fund rate, fixed for the life of the loan. The clinical commissioning group therefore has low exposure to interest rate fluctuations. Trade and other payables with NHSE bodies 825 825 Trade and other payables with other 17.1.3 Credit risk DHSC group bodies 45,492 45,492 Because the majority of the NHS clinical commissioning group and revenue comes parliamentary funding, NHS clinical commissioning group has low exposure to credit risk. The maximum exposures as at the end of the financial year are in Trade and other payables with external bodies 172,101 172,101 receivables from customers, as disclosed in the trade and other receivables note. Total at 31 March 2021 218,418 - 218,418 17.1.4 Liquidity risk NHS clinical commissioning group is required to operate within revenue and capital resource limits, which are financed The above figure for Trade and other payables excludes liabilities for Social security costs from resources voted annually by Parliament. The NHS clinical commissioning group draws down cash to cover (£478k), Tax (452k) and Non NHS and Other WGA deferred income (607k) as these are defined expenditure, as the need arises. The NHS clinical commissioning group is not, therefore, exposed to significant liquidity risks. as non financial liabilities.

17.1.5 Financial Instruments As the cash requirements of NHS England are met through the Estimate process, financial instruments play a more limited 18. Operating segments role in creating and managing risk than would apply to a non-public sector body. The majority of financial instruments relate to contracts to buy non-financial items in line with NHS England's expected purchase and usage requirements and The CCG has just one operating segment which is the commissioning of healthcare NHS England is therefore exposed to little credit, liquidity or market risk.

210 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 211 19. Joint arrangements - interests in joint operations London Borough of Richmond hosts a Better Care Fund pooled budget for the Borough. Under Note 1.5 (Joint Operations) and note 1.6 (Pooled budgets) of these accounts provide further these arrangements funds are pooled under section 75 of the NHS Act 2006. NHS South West information on pooled budgets. London CCG contributes to the pool for the services delivered as a provider of healthcare. Members to the BCF pool account for transactions and balances directly with providers. Partners are solely 19.1 Interests in joint operations liable for any overspends to services commissioned exercise of their statutory functions South West London CCG hosts a Better Care Fund pooled budget with the London Borough of London Borough of Sutton hosts a Better Care Fund pooled budget for the Borough. Under these Croydon. Under these arrangements funds are pooled under section 75 of the NHS Act 2006. arrangements funds are pooled under section 75 of the NHS Act 2006. NHS South West London NHS South West London CCG contributes to the pool for the services delivered as a provider of CCG contributes to the pool for the services delivered as a provider of healthcare. Members to healthcare. Members to the BCF pool account for transactions and balances directly with providers. the BCF pool account for transactions and balances directly with providers. Under the section 75 Subject to the requirements of National Guidance and the Better Care Fund plan the agreed return financial risk is shared on the basis of the financial contribution to the BCF total fund. of underspends is in the following proportions: CCG 70%; Council 30% London Borough of Wandsworth hosts a Better Care Fund pooled budget for the Borough. Under Royal Borough of Kingston hosts a Better Care Fund pooled budget for the Borough. Under these these arrangements funds are pooled under section 75 of the NHS Act 2006. NHS South West arrangements funds are pooled under section 75 of the NHS Act 2006. NHS South West London London CCG contributes to the pool for the services delivered as a provider of healthcare. Members CCG contributes to the pool for the services delivered as a provider of healthcare. Members to the to the BCF pool account for transactions and balances directly with providers. Partners are solely BCF pool account for transactions and balances directly with providers. Partners are solely liable for liable for any overspends to services commissioned exercise of their statutory functions any overspends to services commissioned exercise of their statutory functions NHS South West London CCG's shares of assets/liabilities and income and expenditure handled by London Borough of Merton hosts a Better Care Fund (including community equipment) pooled the pooled budgets in the financial year were: budget for the Borough. Under these arrangements funds are pooled under section 75 of the NHS Act 2006. NHS South West London CCG contributes to the pool for the services delivered as a provider of healthcare. Members to the BCF pool account for transactions and balances directly with providers. Partners are solely liable for any overspends to services commissioned exercise of their statutory functions

Amounts recognised in Entities books ONLY 2020-21

Name of arrangement Parties to the arrangement Description of principal activities Assets Liabilities Income Expenditure £'000 £'000 £'000 £'000

Better Care Fund South West London CCG & London Borough of Croydon Provision of Health & Social Care 0 0 0 10,094

Better Care Fund South West London CCG & Royal Borough of Kingston Provision of Health & Social Care 0 0 0 8,167

Better Care Fund South West London CCG & London Borough of Merton Community Health and Social Care services 0 0 (96) 13,644

Better Care Fund South West London CCG & London Borough of Richmond upon Thames Community Health and Social Care services 0 0 0 6,050

Better Care Fund South West London CCG & London Borough of Sutton Community Health and Social Care services 0 0 (6,090) 13,329

Better Care Fund South West London CCG & London Borough of Wandsworth Community Health and Social Care services - - (363) 23,362

212 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 213 20. Related party transactions 21. Events after the end of the reporting period

Details of related party transactions with individuals are as follows: There are no events after the end of the reporting period that require disclosure

2020/21 Amounts due Payments to Receipts from Amounts owed from Related 22. Loses and special payments Related Party Related Party to Related Party Party £'000 £'000 £'000 £'000 NHS South West London Clinical Commissioning Group suffered no reportable losses or made St George's University Hospitals any special payments to report in 2020/21. NHS Foundation Trust 378,669 0 (8,902) 0 Croydon Health Services NHS Trust 268,529 0 (23) 136 Epsom & St Helier University Hospitals NHS Trust 256,487 (1,260) (96) 4 23. Financial performance targets Kingston Hospital NHS Foundation Trust 222,856 0 (262) 41 South West London & St George's NHS Clinical Commissioning Group have a number of financial duties under the NHS Act 2006 Mental Health NHS Trust 150,051 0 (350) 0 (as amended). Chelsea & Westminster NHS Hospitals Foundation Trust 83,716 0 (69) 0 NHS Clinical Commissioning Group performance against those duties was as follows: London Ambulance Services NHS Trust 59,807 0 (3) 0 South London and Maudsley NHS Foundation Trust 55,444 0 (338) 0 2020-21 The Royal Marsden NHS Foundation Trust 43,340 (50) 0 43 Target Performance Variance Target Guys & St Thomas NHS Foundation Trust 37,816 0 (919) 78 £'000 £'000 £'000 Met King's College Hospital NHS Foundation Trust 29,983 0 (10) 0 Expenditure not to exceed income 2,706,109 2,706,050 (59) Yes Moorfields Eye Hospital NHS Foundation Trust 29,628 0 0 0 Capital resource use does not exceed the Houslow and Richmond Community amount specified in Directions - - - N/A Healthcare NHS Trust 29,126 0 (1,381) 185 Revenue resource use does not exceed the London Borough of Croydon 31,644 (120) (10,128) 780 amount specified in Directions 2,671,919 2,671,860 (59) Yes London Borough Of Sutton 22,842 (9,510) (5,418) 3,164 Capital resource use on specified matter(s) does London Borough of Wandsworth 16,580 (1,091) (3,384) 233 not exceed the amount specified in Directions - - - N/A London Borough of Richmond upon Thames 13,281 (84) (4,991) 208 Revenue resource use on specified matter(s) does Royal Borough of Kingston upon Thames 12,047 (4,911) (8,121) 812 not exceed the amount specified in Directions - - - N/A London Borough of Merton 9,593 (4,550) (1,590) 391 Revenue administration resource use does not Your Healthcare CIC 26,445 0 (25) 0 exceed the amount specified in Directions 30,726 29,890 (836) Yes The Church Lane Practice 7,191 0 0 0 The Groves Medical Centre 4,724 0 (17) 0 Brocklebank Group Practice 3,584 0 0 0 Benhill & Belmont Practice 3,080 0 0 0 24. Analysis of charitable reserves Stonecot Surgery 2,426 0 0 0 NHS South West London CCG is the corporate trustee of Kingston charitable funds. The Mulgrave Road Surgery 2,092 0 0 0 Governing Body does not consider the activities of the charity to be material to NHS South West South Norwood Medical Practice 1,496 0 0 0 London CCG. As set out in note 1.4 the Charity has been closed and accordingly there are no Haling Park Medical Practice 941 0 0 0 net assets at 31 March 2021.

The Department of Health and Social Care is regarded as a related party. During the year NHS South West London CCG has had a significant number of material transactions with entities for which the Department is regarded as the parent Department The materiality level set for these transactions is £27m which is 1% of the clinical commissioning group's total operating expenses

In addition, NHS South West London Clinical Commissioning Group has had a number of transactions with local government bodies.

The above practices have GPs or nurse practitioners on executive committees of the CCG and have received payments in respect of practice and clinical services commissioned by the CCG.

214 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 215 Appendices

216 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 217 Appendix A: Member practices by Locality 2021 19 Haling Park Partnership 96 Brighton Road, South Croydon, CR2 6AD GPnet5

20 Hartland Way Surgery 1 Hartland Way, Croydon, CR0 8RG Croydon GP Super Network No. Practice Name Address PCN 21 Headley Drive Surgery 117a Headley Drive, New Addington, Croydon, CR0 0QL Selsdon Addington & Shirley Croydon (49 Practices) 22 Keston Medical Practice Purley War Memorial Hospital, 856 Brighton Road, Purley, CR8 Keston Moorings & 1 Addington Medical 7 Gravel Hill, Addington, Croydon, CR0 0JA Selsdon Addington 2YL Parkside Practice Parkway, New Addington, Croydon, CR0 0JA & Shirley 23 Leander Family Practice 949 London Road, Thornton Heath, CR7 6JE Primary Care North 2 Ashburton Park Medical 416 Lower Addiscombe Road, Addiscombe, Croydon, CR0 7AG Croydon GP Super Croydon Centre Network 24 London Road Medical 515 London Road, Thornton Heath, CR7 6AR Mayday South 3 Auckland Surgery 84a Auckland Road, Upper Norwood, SE19 2DF One Thornton Practice Heath 25 Mersham Medical Centre 30 Norbury Road, Thornton Heath, CR7 8JN One Thornton 4 Birdhurst Medical Practice 1 Birdhurst Avenue, South Croydon, CR2 7DX GPnet5 Heath

26 Mitchley Avenue Surgery 116 Mitchley Avenue, South Croydon, CR2 9HH Selsdon Purley & 5 Bramley Avenue Surgery 1b Bramley Avenue, Coulsdon, CR5 2DR Selsdon Purley & Coulsdon Health Coulsdon Health 27 Moorings Medical Practice 2a Valley Road, Kenley, CR8 5DN Keston Moorings & 6 Brigstock and South 141 Brigstock Road, Thornton Heath, CR7 7JN Primary Care North Parkside Norwood Medical Croydon Partnership 28 Morland Road Surgery 1 Morland Road, Croydon, CR0 6HA Croydon GP Super Network 7 Brigstock Family Practice 83 Brigstock Road, Thornton Heath, CR7 7JH Primary Care North Croydon 29 New Addington Group Fieldway, 15a Danebury, New Addington, Croydon, CR0 9EU Selsdon Addington Practices & Shirley 8 Broom Road Medical 23 Broom Road, Shirley, Croydon, CR0 8NG Selsdon Addington Practice & Shirley 30 Norbury Health Centre 2b Pollards Hill North, Norbury, SW16 4NL Primary Care North Croydon 9 Broughton Corner 87 Thornton Road, Thornton Heath, CR7 6BH Primary Care North Medical Centre Croydon 31 North Croydon Medical 518 London Road, Thornton Heath, CR7 7HQ Mayday South Centre 10 Country Park Practice Woodside Health Centre, 3 Enmore Road, South Norwood, Croydon GP Super SE25 5NT Network 32 Old Coulsdon Medical 2a Court Avenue, Coulsdon, CR5 1HF Selsdon Purley & Practice Coulsdon Health 11 Denmark Road Surgery Woodside Health Centre, 3 Enmore Road, South Norwood, Croydon GP Super SE25 5NT Network 33 Parchmore Medical Centre 97 Parchmore Road, Thornton Heath, CR7 8LY One Thornton Heath 12 East Croydon Medical 59 Addiscombe Road, Croydon, CR0 6SD Croydon Link Practice 34 Parkside Group Practice 27 Wyche Grove, South Croydon, CR2 6EX Keston Moorings & Parkside 13 Edridge Road Community Impact House, 2 Edridge Road, Croydon, CR0 1FE Croydon Link Health Centre 35 Portland Medical Centre 184 Portland Road, South Norwood, SE25 4QB Croydon GP Super Network 14 Eversley Medical Practice 501 London Road, Thornton Heath, CR7 6AR Mayday South 36 Queenhill Medical Practice 31 Queenhill Road, South Croydon, CR2 8DU Selsdon Addington & Shirley 15 Fairview Medical Centre 69 Fairview Road, Norbury, SW16 5PX Primary Care North Croydon 37 Selhurst Medical Centre 27 Selhurst Road, South Norwood, SE25 5QA Croydon GP Super Network 16 Farley Road Medical 53 Farley Road, South Croydon, Surrey, CR2 7NG Selsdon Addington Practice 125 Holmbury Grove, Forestdale, Croydon, Surrey, CR0 9AQ & Shirley 38 Selsdon Park Medical 97 Addington Road, South Croydon, CR2 8LG Selsdon Purley & Practice Coulsdon Health 17 Friends' Road Medical 49-51 Friends Road, Croydon, CR0 1ED GPnet5 Practice 39 Shirley Medical Centre 334/370 Wickham Road, Shirley, Croydon, CR0 8BH Croydon GP Super Network 18 Greenside Group Practice 88 Greenside Road, Croydon, CR0 3PN Croydon GP Super 26 Lennard Road, Croydon, CR0 2UL Network

218 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 219 40 South Norwood Hill 103a South Norwood Hill, London, SE25 6BY One Thornton 60 Hook Surgery The Merritt Medical Centre, Merritt Gardens, Chessington, KT9 Chessington and Medical Centre Heath 2GY Surbiton

41 St James' Medical Centre 189a St. James's Road, Croydon, CR0 2BZ Croydon Link 61 Kingston Health Centre 10 Skerne Road, Kingston Upon Thames, KT2 5AD Kingston 1a Castle Hill Avenue, Croydon, CR0 0TH

42 Stovell House Surgery 188 Lower Addiscombe Road, Addiscombe, Croydon, CR0 6AH GPnet5 62 Langley Medical Practice Surbiton Health Centre, Ewell Road, Surbiton, KT6 6EZ Surbiton Health Centre

43 The Addiscombe Surgery 139 Northway Road, Croydon, CR0 6JJ Croydon GP Super 63 Manor Drive Medical 3 The Manor Drive, Worcester Park, KT4 7LG New Malden & 395a Addiscombe Road, Croydon, CR0 7LJ Network Centre Worcester Park

44 Thornton Heath Medical 61a Gillett Road, Thornton Heath, CR7 8RL One Thornton 64 Orchard Practice Orchard Gardens, Chessington, KT9 1AG Canbury Churchill Centre Heath Orchard Berrylands

45 Thornton Road and Valley 299 Thornton Road, Croydon, CR0 3EW Mayday South 65 Red Lion Road Surgery 1a Red Lion Road, Surbiton, KT6 7QG Chessington and Park Surgery Valley Park Surgery, Healthy Living Centre, Franklin Way, Surbiton Croydon, CR0 4YD 66 Roselawn Surgery 149 Malden Road, New Malden, KT3 6AA New Malden & 46 Upper Norwood Group 130 Church Road, Upper Norwood, SE19 2NT One Thornton Worcester Park Practice Heath 67 St Alban's Medical Centre 212 Richmond Road, Kingston Upon Thames, KT2 5HF Kingston 47 Violet Lane Medical 231 Violet Lane, Croydon, CR0 4HN GPnet5 Practice 68 Sunray Surgery 97 Warren Drive South, Tolworth, Surbiton, KT5 9QD Chessington and 48 Whitehorse Practice 87 Whitehorse Road, Croydon, CR0 2JJ Croydon GP Super Surbiton Network 69 Village Surgery 157-159 High Street, New Malden, KT3 4BH New Malden & 49 Woodcote Medical 32 Foxley Lane, Purley, CR8 3EE Selsdon Purley & Worcester Park 140 Chipstead Valley Road, Coulsdon, CR5 3BB Coulsdon Health 70 West Barnes Surgery 229 West Barnes Lane, New Malden, KT3 6JD New Malden & Kingston (21 Practices) Worcester Park

50 Berrylands Surgery Ewell Road, Surbiton, KT6 6EZ Canbury Churchill Merton (22 Practices) Orchard Berrylands 71 Alexandra Road Surgery 39 Alexandra Road, Wimbledon, SW19 7JZ North West 51 Brunswick Surgery Ewell Road, Surbiton, KT6 6EZ Surbiton Health Merton Centre 72 Central Medical Centre 42-46 Central Road, Morden, SM4 5RT Morden 52 Canbury Medical Centre 1 Elm Road, Kingston Upon Thames, KT2 6HR Canbury Churchill Orchard Berrylands 73 Colliers Wood Surgery 58 High Street Colliers Wood, Colliers Wood, SW19 2BY North Merton 53 Central Surgery Surbiton Health Centre, Ewell Road, Surbiton, KT6 6EZ Surbiton Health Lavender Fields Surgery, 182 Western Road, Mitcham, CR4 3RB Centre 74 Cricket Green Medical 75-79 Miles Road, Mitcham, CR4 3DA East Merton 54 Chessington Park Surgery Merritt Gardens, Chessington, KT9 2GY Chessington and Practice Surbiton 75 Figges Marsh Surgery 182 London Road, Mitcham, CR4 3LD East Merton 55 Churchill Medical Centre Clifton Road, Kingston Upon Thames, KT2 6PG Canbury Churchill 1 Evesham Terrace, St Andrew’s Road, Surbiton, KT6 4DS Orchard Berrylands 164 Tudor Drive, Kingston-Upon-Thames, KT2 5QG 76 Francis Grove Surgery The Courtyard, 8 Francis Grove, Wimbledon, SW19 4DL West Merton 56 Claremont Medical Centre 2a Glenbuck Road, Surbiton, KT6 6BS Chessington and Surbiton 77 Grand Drive Surgery 132 Grand Drive, Raynes Park, SW20 9EA South West 57 Fairhill Medical Practice 81 Kingston Hill, Kingston Upon Thames, KT2 7PX Kingston Merton 14 Fairfield South, Kingston Upon Thames, KT1 2UJ Penrhyn Rd, Kingston Upon Thames, KT1 2EE 78 Lambton Road Medical 1 Lambton Road, Raynes Park, Wimbledon, SW20 0LW West Merton Practice 58 Groves Medical Centre 171 Clarence Avenue, New Malden, KT3 3TX New Malden & Worcester Park 79 Merton Medical Practice 12-17 Abbey Parade, South Wimbledon, SW19 1DG North Merton 59 Holmwood Corner 134 Malden Road, New Malden, KT3 6DR New Malden & Surgery Worcester Park

220 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 221 80 Mitcham Family Practice 55 Mortimer Road, Mitcham, CR4 3HS North Merton 100 Hampton Hill Medical 94-102 High Street, Hampton Hill, Hampton, TW12 1NY Teddington Centre

81 Mitcham Medical Centre 81 Haslemere Avenue, Mitcham, CR4 3PR North Merton 101 Hampton Medical Centre Lansdowne, 49a Priory Road, Hampton, TW12 2PB Hampton 886 Garratt Lane, Tooting, SW17 0NB

82 Morden Hall Medical 256 Morden Road, SW19 3DA Morden 102 Hampton Wick Surgery Tudor House, 26 Upper Teddington Road, Kingston Upon Teddington Centre Thames, KT1 4DY

83 Nelson Medical Practice Kingston Road, London SW20 8DA South West 103 Jubilee Surgery Whitton Corner Health and Social Care Centre, Percy Road, West Twickenham Merton Twickenham, TW2 6JL

84 Ravensbury Park Medical Ravensbury Lane, Morden Road, Mitcham, CR4 4DQ Morden 104 Kew Medical Practice 14 High Park Road, Kew, Richmond, TW9 4BH Richmond Centre

85 Riverhouse Surgery East Road, Wimbledon, SW19 1YG North Merton 105 Paradise Road Surgery Paradise Road Practice, 37 Paradise Road, Richmond, TW9 1SA Richmond

86 Rowans Surgery 1 Windermere Road, Streatham, SW16 5HF East Merton 106 Park Road Surgery 37 Park Road, Teddington, TW11 0AU Hampton

87 Stonecot Surgery 115-117 Epsom Road, Sutton, SM3 9EY Morden 107 Parkshot Medical Practice 18 Parkshot, Richmond, TW9 2RG Richmond

88 Tamworth House Medical 341 Tamworth Lane, Mitcham, CR4 1DL East Merton 108 Richmond Lock Surgery Richmond Lock Surgery, 300 St. Margarets Road, Twickenham, West Twickenham Centre TW1 1PS

89 Vineyard Hill Road 67 Vineyard Hill Road, Wimbledon, SW19 7JL North West 109 Richmond Medical Group Quadrant House, Levett Square, Kew, Richmond, TW9 4FF Sheen & Barnes Surgery Merton Sheen Lane Health Centre, 70 Sheen Lane, SW14 8LP

90 Wide Way Medical Centre Wide Way, Mitcham, CR4 1BP East Merton 110 Seymour House & Lock 55a Lock Road Ham TW10 7LJ Richmond Road Surgeries 154 Sheen Road, Richmond, TW9 1UU

91 Wimbledon Medical 79 Pelham Road, Wimbledon, SW19 1NX North West 111 Staines Road Medical 325 Staines Road, Twickenham, TW2 5AU West Twickenham Practice Merton Centre

92 Wimbledon Village 35a High Street Wimbledon, SW19 5BY North West 112 Thameside Medical Thames House, 180-194 High Street, Teddington, TW11 8HU Teddington Surgery Merton Practice

113 The Green Surgery & Fir The Green Surgery, 1b The Green, Twickenham, TW2 5TU Teddington Richmond (25 Practices) Road Surgery Fir Road Surgery, 50 Fir Road, Hanworth, TW13 6UJ

93 Acorn Practice 29-35 Holly Road, Twickenham, TW1 4EA West Twickenham 114 Twickenham Park Surgery 17 Rosslyn Road, Twickenham, TW1 2AR West Twickenham

94 Broad Lane Surgery 71 Broad Lane, Hampton, TW12 3AX Hampton 115 Vineyard Surgery 35 The Vineyard, Richmond, TW10 6PP Richmond

95 Crane Park Surgery Whitton Corner Health and Social Care Centre, Percy Road, East Twickenham 116 Woodlawn & Oak Lane Woodlawn Medical Centre, 19 Powder Mill Lane, Twickenham, East Twickenham Twickenham, TW2 6JL Medical Centres TW2 6EE Oaklane Medical Centre, 6 Oak Lane, Twickenham, TW1 3PA 96 Cross Deep Surgery 4 Cross Deep, Twickenham, TW1 4QP East Twickenham 117 York Medical Practice St Johns Health Centre, Oak Lane, Twickenham, TW1 3PA East Twickenham

97 Dr Johnson & Partners Sheen Lane Health Centre, 70 Sheen Lane, SW14 8LP Sheen & Barnes Sutton (23 Practices) 98 Essex House Surgery Station Road, Barnes, SW13 0LW Sheen & Barnes 118 Beeches Surgery 9 Hill Road, Carshalton, SM5 3RB Wallington

99 Glebe Road Surgery 1 Glebe Road, Barnes, SW13 0DR Sheen & Barnes 119 Benhill & Belmont GP 54 Benhill Avenue, Sutton, SM1 4EB Cheam and South Centre 1 Station Approach, Belmont, Sutton, SM2 6DD Sutton

222 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 223 120 Bishopsford Road Practice 191 Bishopsford Road, Morden, SM4 6BH Carshalton Wandsworth (40 Practices)

121 Carshalton Fields Surgery 11 Crichton Road, Carshalton, SM5 3LS Carshalton 141 Alton Practice 208-210 Roehampton Lane, Roehampton, SW15 4LE West Wandsworth

122 Cheam Family Practice The Knoll, Parkside, Cheam, Sutton, SM3 8BS Cheam and South 142 Balham Health Centre 120 Bedford Hill, Balham, SW12 9HS Balham, Tooting & 263 Gander Green Lane, Sutton, SM1 2HD Sutton Furzedown

123 Cheam GP Centre 322 Malden Road, Cheam, SM3 8EP Cheam and South 143 Balham Park Surgery 236 Balham High Road, SW17 7AW Nightingale Sutton

124 Chesser Practice Elmhurst Court, 121 Wrythe Lane, Carshalton, SM5 2RT Carshalton 144 Battersea Fields Practice 3 Austin Road, Battersea, SW11 5JP Battersea 115 Thessaly Road, SW8 4EJ

125 Faccini House Surgery 64 Middleton Road, Morden, SM4 6RT Carshalton 145 Battersea Rise Group 17 Battersea Rise, Battersea, SW11 1HG Battersea Practice

126 Green Wrythe Surgery 411a Green Wrythe Lane, Carshalton, SM5 1JL Carshalton 146 Bedford Hill Family 120-124 Bedford Hill, Balham, SW12 9HS Balham, Tooting & Practice Furzedown

127 Grove Road Practice 83 Grove Road, Sutton, SM1 2DB Central Sutton 147 Begg Practice - St John's Entrance B, 162 St John's Hill, Wandsworth, SW11 1SW Wandsworth Hill Surgery

128 Hackbridge Medical 138 London Road, Hackbridge, Wallington, SM6 7HF Carshalton 148 Bolingbroke Medical Wakehurst Road, Battersea, SW11 6BF Wandsworth Centre Centre

129 James O'Riordan Practice 70 Stonecot Hill, Sutton, SM3 9HE Cheam and South 149 Bridge Lane Group 20 Bridge Lane, Battersea, SW11 3AD Battersea Sutton Practice

130 Maldon Road Surgery 35 Maldon Road, Wallington, SM6 8BL Wallington 150 Brocklebank Group 249 Garratt Lane, Wandsworth, SW18 4DU Brocklebank Practice

131 Manor Road Practice 6 Mollison Square, Wallington, SM6 9DW Wallington 151 Chartfield Surgery The Surgery, 30 Chartfield Avenue, Putney, SW15 6HG Prime Wandsworth 57 Manor Road, Wallington, SM6 0DE

132 Mulgrave Road Surgery 48 Mulgrave Road, Belmont, Sutton, SM2 6LX Central Sutton 152 Chatfield Health Care Chatfield Road, Battersea, SW11 3UJ Wandsworth

133 Park Road Surgery 1a Park Road, Wallington, SM6 8AW Wallington 153 Clapham Junction Medical 7 Farrant House, Winstanley Road, SW11 2EJ Wandsworth Practice

134 Robin Hood Lane Robin Hood Lane, Sutton, SM1 2RJ Central Sutton 154 Danebury Avenue 351 Danebury Avenue, Roehampton, SW15 4DU West Wandsworth Medical Centre Surgery (The Health Centre) 155 Earlsfield Surgery 2-4 Steerforth Street, SW18 4HH Wandle 135 Shotfield Medical Practice Jubilee Health Centre, Shotfield, Wallington, SM6 0HY Wallington

156 Elborough Street Surgery 81 Elborough Street, Wandsworth, SW18 5DS Wandle 136 Sutton Medical Centre 181 Carshalton Road, Sutton, SM1 4NG Carshalton

157 Falcon Road Medical 47 Falcon Road, Battersea, SW11 2PH Wandsworth 137 The Old Court House Throwley Way, Sutton, SM1 4AF Central Sutton Practice Surgery 158 Grafton Medical Partners Trevelyan House, 160 Tooting High Street, SW17 0RT Grafton Medical 138 Wallington Family Practice Jubilee Health Centre West, Shotfield, Wallington, SM6 0HY Wallington 103 Macmillan Way, SW17 6AT Partners 219 Upper Tooting Rd, Tooting, SW17 7TG 139 Wallington Medical 52 Mollison Drive, Wallington, SM6 9BY Wallington 159 Greyswood Practice 66 Eastwood Street, Streatham, SW16 6PX Balham, Tooting & Centre Furzedown

140 Wrythe Green Surgery Wrythe Lane, Carshalton, SM5 2RE Carshalton 160 Heathbridge Practice Heathbridge Med Practice, 125 Upper Richmond Road, Putney, Prime Wandsworth SW15 2TL

224 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 225 161 Junction Medical Centre Arches 5-8, Clapham Junction Station, 5-8 Grant Road, SW11 Wandsworth 2NU

162 Lavender Hill Group 19 Pountney Road, Battersea, SW11 5TU Battersea Practice

163 Mayfield Surgery 246 Roehampton Lane, Roehampton, SW15 4AA Prime Wandsworth

164 Nightingale Practice 105 Nightingale Lane, Balham, SW12 8NB Nightingale

165 Open Door & Bec Family 62 Upper Tooting Road, Tooting, SW17 7PB Balham, Tooting & Practice 47 Boundaries Road, Balham, SW12 8EU Furzedown

166 Putneymead Group 266 Upper Richmond Road, SW15 6TQ West Wandsworth Medical Practice

167 Queenstown Road 14 Queenstown Road, Battersea, SW8 3RX Battersea Surgery

168 Southfields Group 492 Merton Road, Wandsworth, SW18 5AE Wandle Practice

169 St Paul’s Cottage Surgery 114 Augustus Road, SW19 6EW Brocklebank

170 Streatham Park Surgery 91 Mitcham Lane, Streatham, SW16 6LY Balham, Tooting & 139 Franciscan Road, SW17 8DS Furzedown

171 The Haider Practice 162 St John's Hill, Wandsworth, SW11 1SW Brocklebank

172 The Practice Furzedown 88e Eardley Road, Streatham, SW16 6BL Balham, Tooting & Furzedown

173 The Roehampton Surgery 105, Carslake Road, Putney Heath, SW15 3DD West Wandsworth 191 Roehampton Lane, Roehampton, SW15 4HN

174 Thurleigh Road Practice 88a Thurleigh Road, Balham, SW12 8TT Nightingale

175 Tooting Bec Surgery 313 Balham High Road, SW17 7BA Balham, Tooting & Furzedown

176 Tooting South Medical 22 Otterburn Street, Tooting, SW17 9HQ Balham, Tooting & Centre Furzedown

177 Triangle Surgery Triangle House, 2 Broomhill Road, Wandsworth, SW18 4HX Wandle

178 Trinity Medical Centre (Drs 278-280 Balham High Road, Balham, SW17 7AL Balham, Tooting & Shah & Partners) Furzedown

179 Tudor Lodge Health 8c Victoria Drive, Wimbledon, SW19 6AE Prime Wandsworth Centre

180 Wandsworth Medical 90-92 Garratt Lane, Wandsworth, SW18 4DD Wandle Centre

226 | NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 | 227 NHS South West London Clinical Commissioning Group 3rd Floor 120 The Broadway London SW19 1RH www.swlondonccg.nhs.uk

228 | NHS South West London Clinical Commissioning Group