Annual Report and Accounts 2019/20
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If you would like this report in another format – for example – large print or as a summary version, please contact the communications team by email at communications@bradford.nhs.uk or by telephoning 01274 237546.
To find out more about us:
Visit our website: www.bradfordcravenccg.nhs.uk Follow us on Twitter: @NHSBfdCraven Find our Facebook page: NHSBradfordCraven
Contact us: NHS Airedale, Wharfedale and Craven CCG Millennium Business Park Station Road, Steeton Keighley BD20 6RB Tel: 01274 237324
Within this annual report, many of the initiatives that you will read about will relate to the three Bradford district and Craven CCGs. We work closely, and share a staff team, with Bradford City CCG and Bradford Districts CCG and, where these are referenced within this document, we will refer to them as ‘the three Bradford district and Craven CCGs’.
NHS2 Airedale, Wharfedale and Craven CCG Annual report and accounts 2019/20 3
Contents Page
Foreword: Dr James Thomas, clinical chair 5
Chapter 1: Performance report 7
1 Performance overview 1.1 Our performance in 2019/20 a statement from the chief officer 7 1.2 About us 10 1.3 Our vision and principles 11 1.4 Our population 11 1.5 How we are governed 12 1.6 Our main providers of service 13 1.7 The system in which we work 14 1.8 Sustainability and transformation: our plans and priorities 18 1.9 Key risks and issues 23 1.10 Performance summary 29 1.11 Improving quality 32 1.12 Our commitment to equality and diversity 36 1.13 Financial performance overview 38 1.14 Engaging people and communities 41 1.15 Highlights of 2019/20 43
Chapter 2: Accountability report 46
1 Corporate governance report 46 1.1 Members’ report 46 1.2 Statement of accountable officer’s responsibilities 55 1.3 Governance statement 57
2 Remuneration and staff report 108 2.1 Remuneration report 108 2.2 Staff report 114
3 Parliamentary accountability and audit report 123
Chapter 3: Annual accounts 124
NHS3 Airedale, Wharfedale and Craven CCG Annual report and accounts 2019/20
Note:
This is the final annual report of NHS Airedale, Wharfedale and Craven Clinical Commissioning Group (CCG), which ceased to exist on 31 March 2020. On 1 April 2020, this CCG – together with Bradford City and Bradford Districts CCGs – was replaced by one new organisation: NHS Bradford District and Craven Clinical Commissioning Group.
In this annual report, where web links have been given to documents on the CCG’s website, readers should note that the website for Airedale, Wharfedale and Craven CCG has now been closed down. Links are therefore to the website of the new Bradford District and Craven CCG, which contains a small archive of public documents relating to Airedale, Wharfedale and Craven CCG. If you require any further information, please contact [email protected] in the first instance.
For further information about the new CCG, have a look at its website: www.bradfordcravenccg.nhs.uk 5
Foreword – Dr James Thomas
Welcome to Airedale, Wharfedale and Craven Clinical Commissioning Group’s annual report which charts our final year as a CCG.
This report looks back at our achievements over 2019/20 and shares with you some of the challenges we face as we continue our work to prevent ill-health and support our local population to stay healthy and independent for as long as possible.
With effect from 1 April 2020, we join with our member practices from Bradford City CCG and Bradford Districts CCG to form the new Bradford District and Craven CCG. This decision was unanimously supported by our practices and further builds on our already strong relationship and vision of supporting people to be “Happy, healthy at home”.
This year, we continued our work with wider commissioner and provider organisations to improve the quality of care to our residents. We believe our West Yorkshire and Harrogate Health and Care Partnership Integrated Care System (ICS) is the best way forward to make sure every pound of public money is wisely spent to continually improve care for our residents within our financial allocation. As part of this, we are working together more on a regional level within the ICS, including work to further improve mental health services, maternity services, stroke care, urgent and emergency care as well as improving people’s general wellbeing.
Our collective ambition for Bradford district and Craven is to consistently deliver high quality sustainable services through joint efforts across health and social care and our public health teams. During the year, we carried out a programme review to identify our six priority transformation programmes. These focus on reducing the incidence of diabetes, supporting our frail elderly, redesigning outpatients, improving children and young people's mental health and tackling the early number of deaths from heart and lung diseases and stroke. We have worked with providers to improve the healthcare services currently delivered and to develop new services where there are gaps.
Our clinical priorities are always shaped and informed by the views of our 16 practices. We have strong clinical leadership across the three CCGs and we continue to develop the clinical leads of the future and support our practices though a variety of programmes.
The primary care commissioning team has worked hard to support practices to improve and transform their services, both as individual practices and through collaboration with neighbouring practices. These collaborations allow them to work at scale where this makes sense and address the sustainability and resilience of
NHS5 Airedale, Wharfedale and Craven CCG Annual report and accounts 2019/20 6 practices, respond to changes in workforce and provide a balance between work and family for individual practitioners.
Some good examples of how practices have collaborated is the extended access to primary care service which has received positive patient feedback and a greater variety of health professionals who are now available as part of the wider general practice team eg physiotherapists, pharmacists and paramedics.
Demand for healthcare continues to rise; partly due to the fact that more people are living longer and have more health needs. Delivery of the four hour A&E standard is still a challenge across both acute providers as they struggle to manage increased demand and sicker patients in general. We are working with partners as part of the Bradford district and Craven urgent care and planned care programmes to manage demand and improve access to services, including 18 weeks referral to treatments times and elective surgery.
At the end of January, as we tackled an already busy winter, we faced the start of an unprecedented new challenge – the coronavirus (COVID-19) pandemic. Major incident plans and emergency responses helped to rapidly set up new ways of working but our health and care system – like others across the country and the world - had never seen anything of such significance before.
As we are still in the midst of dealing with day-to-day needs arising from the pandemic, we do not yet know the true impact it has had across our local population. However as plans to start to return to a new ‘normal’ are being prepared we are determined to carry on supporting local people’s health and care needs – as they have supported health and care staff by staying at home to slow the spread of the virus. I am immensely proud to work for the NHS and can never thank colleagues, carers and key workers enough for how they have risen to this huge challenge with compassion and courage.
Finally, I thank my practices, governing body colleagues (clinical, non-clinical and lay members) and CCG staff for the contribution they have made over the past seven years to improve care for our local population.
We will continue to support people to be “happy, healthy at home” and ensure that the views and needs of our local population are taken into account in the future.
James Thomas
Dr James Thomas Clinical chair NHS Airedale, Wharfedale and Craven CCG
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Chapter 1: Performance report 1 Performance overview
The purpose of this section is to provide a short summary of the activities of NHS Airedale, Wharfedale and Craven Clinical Commissioning Group (CCG) in 2019/20. You will find details of our main priorities, performance against these and the principal risks that we face.
1.1 Our performance in 2019/20: a statement from the accountable officer
This has been my final year serving as the Accountable Officer for three CCGs before becoming the Accountable Officer of the new Bradford District and Craven CCG. It brings to an end my relationships with different clinical chairs and I would particularly like to pay tribute to Dr Andy Withers for his exceptional leadership of Bradford Districts CCG from its establishment to its very end.
We said farewell to Akram Khan as Clinical Chair of City CCG in the summer and I thank him for bringing ambition to his leadership to do so much more to tackle inequalities. This continues with Sohail Abbas who took over from Akram and I am pleased that he will be the Deputy Clinical Chair in the new CCG continuing the fight against health inequalities.
James Thomas, who has been a fantastic chair of Airedale, Wharfedale and Craven CCG, is the new chair of Bradford district and Craven CCG and I look forward to working in partnership with James to further our ambition for the improving the population’s health and wellbeing.
From my perspective the move from three to one was not a big change for me as it has been for others as I have worked in this shared role for a few years now and for the Bradford CCGs since they were established. What I noticed when COVID-19 struck, was that we operated as one immediately and everyone, absolutely everyone, pulled together. From an organisation development and change management perspective this fast tracked us through those final stages and I expect will stand us in good stead as we consider the impact COVID-19 has had on our population and the way we address it in our new CCG strategy.
The other stand-out for me during the COVID-19 response was how well our health and care system pulled together from the start. The relationships and behaviours we have paid such attention to over the last few years proved their worth and went way beyond what we set out in our strategic partnering
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agreement. Myron Rogers1 tells us that real change happens in real work and we now need to embed the best of the changes we saw in our COVID-19 response.
Our partnerships across West Yorkshire and Harrogate have developed this year and we continue to leverage the opportunities through the integrated care system (ICS) to achieve better outcomes for the people of Bradford district and Craven.
CCG leaders are visible in leading ICS programmes and specific projects such as population health (James Thomas), carers, stroke and personalised commissioning (Andy Withers), inequalities (Sohail Abbas) and myself in the system leadership and development programme.
Over the next few months we will become clearer about the development of commissioning. While we don’t think the suggestion of one CCG per ICS is the right one for us we are nevertheless clear that some aspects of commissioning should be discharged across West Yorkshire. Equally some should be discharged in our community partnerships or primary care networks as well as in our ‘place’. Commissioning has never been a one size fits all activity or even a single ‘thing’.
The CCGs continue to be reviewed under the national improvement and assessment framework (IAF) and Bradford City retained and Bradford Districts CCGs gained an outstanding rating. Airedale, Wharfedale and Craven were rated good.
Although these ratings look at a number of areas, the ones where we have seen improvements include:
early intervention in psychosis (EIP), which has been consistently on target; A&E delivery, while below target, did start to show signs of improvement with a number of interventions impacting over the last winter period; over 52-week waiting times were down to zero across the patch (although some cancer waits in Leeds were still over this target); we continue to perform well compared to our peers on health checks for people with learning disabilities and serious mental illness and diagnosis of dementia is amongst the best in England; primary care quality improvements were evident and we ended the year with four practices outstanding, 65 good, two requiring improvement and none inadequate.
But we do need to keep up our effort and improve outcomes for our population with regard to access to improving access to psychological therapies (IAPT) particularly with a fall in access in the last three months due to COVID-19; early diagnosis of cancer; support for those with caring responsibilities; reduction of smoking in pregnancy; and the issue of managing demand and access to services so that those who need them most have better access earlier in the course of their illness or disease.
1 Myron Rogers’ maxims
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We have a great opportunity with additional resources allocated to the CCG to make greater inroads into health inequalities and we must ensure that our post COVID-19 work takes this opportunity as we know the worst impact will have been experienced by those already suffering inequalities. Although the resources came specifically for the people served by the former Bradford City CCG, we will ensure that the inequalities experienced across the whole of Bradford district and Craven remain at the forefront of our plans
Helen Hirst Chief officer NHS Airedale, Wharfedale and Craven CCG
24 June 2020
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1.2 About us
NHS Airedale, Wharfedale and Craven Clinical Commissioning Group (CCG) is the NHS organisation responsible for planning and buying (commissioning) healthcare services for over 150,000 people registered with our 16 member practices, (listed on page 53), as well as for those unregistered patients living within, or visiting, our area.
We are a clinically led organisation. Family doctors (known as GPs) and other clinicians are at the forefront of how we operate, the decisions we make and the interaction we have with the public.
We are responsible for commissioning most hospital and healthcare services in the local area and we are regulated by NHS England (NHSE). NHSE is responsible for commissioning primary care dental, optical and pharmaceutical services, as well as some specialised hospital services for people in Airedale, Wharfedale and Craven. The CCG has delegated authority from NHSE for commissioning GP services
Through clinical commissioning, doctors have the power and freedom to make decisions about the care and services they commission for their local communities, within the context of the joint strategic needs assessment (JSNA), our own plans and priorities and the valuable feedback we receive from patients and carers themselves.
Although this list is not exhaustive, some of services we commission include:
urgent and emergency care including accident and emergency (A&E), ambulance and out-of-hours services community health services and equipment planned and unplanned hospital care therapy services maternity services rehabilitation services healthcare services for children, people with mental health problems and people with learning disabilities continuing healthcare palliative and end of life care termination of pregnancy services infertility services wheelchair services home oxygen services treatment of infectious diseases.
There are some treatments, available on the NHS, which we do not commission. These include cosmetic procedures, various fertility treatments, and treatments not approved by the National Institute for Health and Care Excellence (NICE).
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Further information about our commissioning policies is on the website of the new Bradford District and Craven CCG.
Patients who wish to have treatment that is not routinely funded can ask their GP to make an individual funding request (IFR) on their behalf.
Our ambition is to transform patients’ experiences of healthcare services; significantly improve their outcomes; and to use our member practices’ creativity, talent, expertise and ability to innovate local services to help people live longer, healthier lives.
1.3 Our vision and principles
Our vision is to deliver proactive, co-ordinated, person-centred care with our health and care partners across our communities.
Our principles are that:
no-one should be in hospital unless their care cannot be delivered safely in the community 24 hours-a-day, seven days-a-week; no-one should be discharged to long-term care without the opportunity for a period of enablement; our local population should have access to, and delivery of, co-ordinated care, 24 hours-a-day, seven days-a-week, which is needs driven and not about age, condition or location.
The CCG is part of the Bradford district and Craven health and care system and, collectively, we have a shared ambition of keeping people ‘happy, healthy at home’.
1.4 Our population
We look after the health needs of more than 160,000 people, registered with family doctors in the Airedale, Wharfedale and Craven areas. Our areas cover the boundaries of two local authorities, and one county council, with approximately two-thirds of the population living in the City of Bradford Metropolitan District Council area and the remainder in the Craven District Council area of North Yorkshire.
1.4.1 Health inequalities
Life expectancy at birth: Male life expectancy at birth in Airedale, Wharfedale and Craven CCG has increased slightly from 79.5 years in 2008-12 to 79.8 years in 2013-17. Male life expectancy remains above the national average which in 2013-17 was 79.5 years.
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In 2013-17 female life expectancy in the CCG’s area increased from 81.1 years and in 2008-12 to 83.4 years. Similar to male life expectancy, female life expectancy has remained consistently above the national average (83.1 years). The gap between Airedale, Wharfedale and Craven CCG and England has also remained constant over time at -0.3 years.
Causes of death: The four main causes of death in the CCG’s area are circulatory disease (24.8%), cancer (23.9%), dementia (14.6%) and respiratory disease (12.6%).
Child excess weight: For 2016/17 – 2018/19, 21.4% of children in reception in the CCG’s area were classed as overweight or obese. This is below the national average of 22.5%. Since 2010/11 – 2012/13, the gap between Airedale, Wharfedale and Craven CCG and England has narrowed slightly from -1.2 percentage points to -1.1 percentage points, with the CCG being consistently below the national average.
By year 6, the proportion of children that are overweight or obese in the CCG’s area increased to 32.2%. This figure has increased since 2010/11- 2012/13 by 0.5 percentage points but remains below the national average of 34.3%. The gap between Airedale, Wharfedale and Craven CCG and England has widened over time from -1.8 percentage points to -2.1 percentage points in 2016/17 to 2018/19.
1.4.2 How we tackle health inequalities
Tackling health inequalities is a priority of the Airedale, Wharfedale and Craven CCG. This is a long-term process that requires partnership working to shape joint plans for the coming years.
Joint strategic needs assessments are developed with partners in public, private and voluntary sector organisations and we are party to two of these in Bradford district and Craven. They identify the health and wellbeing needs of the local population and aim to support the development of services to reduce inequalities. In addition, the Bradford and Airedale Joint Health and Wellbeing Strategy – Connecting people and place for better health and wellbeing – describes our commitment to reducing health inequalities in Bradford District. This is further supplemented by the Healthy Bradford Plan (our prevention strategy), the Children, Young People and Families Plan 2017 - 2020 and the Bradford District and Craven Mental Wellbeing Strategy 2016 – 2021.
Our focus from these plans has been on the main causes of preventable deaths including cardiovascular and respiratory diseases and cancer.
1.5 How we are governed
The council of members (CoM) holds the governing body and clinical executive to account and is the voice of our member practices. It ensures effective engagement of all of our practices and represents their interests and statutory responsibilities as members of the CCG. Each practice is represented on the CoM
NHS Airedale, Wharfedale and Craven CCG Annual report and accounts 2019/20 9 13 by a GP and a practice manager and the council normally meets six times a year.
Because we work closely with Bradford City and Bradford Districts CCGs – and therefore often have initiatives and issues in common – a number of our committees meet together on a regular basis, as committees in common.
Our governing body meets bi-monthly in public as a committee in common with Bradford City and Bradford Districts CCGs. It provides oversight and assurance of the commissioning of health and care services for people in our area. Everyone is welcome to attend and observe governing body meetings; we publish the agenda and papers on our website in advance of the meetings.
Our clinical executive meets twice monthly. Representatives of the clinical executive (the chair, another GP and our executive directors) also meet as part of the joint clinical committee, which discusses matters that we hold in common with Bradford City and Bradford Districts CCGs.
The role of the clinical executive is to drive the commissioning process and lead the development and implementation of our vision and strategy. It reviews and influences service re-design to ensure pathways of care and commissioned services meet the needs of the local population. It engages practices, localities and the population in the work of the CCG.
Following delegation of responsibilities for the commissioning of primary care from NHS England, which took effect from 1 April 2017, the primary care commissioning committee makes decisions on the review, planning and procurement of primary care services under delegated responsibility from NHS England. It meets every two months in public and we publish the agenda and papers on our website in advance of the meetings. Since June 2018 it has met as a committee in common with Bradford City and Bradford Districts CCGs.
Details of the membership of these committees are on page 64 onwards of this annual report.
1.6 Our main providers of services
We buy (commission) services for patients predominantly from Airedale NHS Foundation Trust (ANHSFT), Bradford Teaching Hospitals NHS Foundation Trust (BTHFT), and Bradford District Care NHS Foundation Trust (BDCFT), which cares for people with community health, mental health and social care needs. Specialist services are provided by Leeds Teaching Hospitals NHS Trust.
We also work with the City of Bradford Metropolitan District Council (Bradford Council), North Yorkshire County Council and Craven District Council to engage with local people to improve the health of the district. We work alongside the councils in their role as both commissioners, and providers of social care and public health.
We buy services from a number of voluntary and community organisations. They
NHS Airedale, Wharfedale and Craven CCG Annual report and accounts 2019/20 9 14 provide locally focussed projects aimed at improving people’s health and wellbeing, for example, by promoting health awareness and healthy living messages.
There are some services we jointly commission with other CCGs, for example: Yorkshire Ambulance Service, NHS 111 and the West Yorkshire GP out-of-hours service. We also buy a range of business expertise from eMBED to support us with our corporate functions.
A register of our contracts for services is available on our website.
1.7 The system in which we work
Collaboration with the two Bradford CCGs: Although each CCG is a statutory organisation in its own right, we work closely with NHS Bradford City CCG and NHS Bradford Districts CCG including sharing some of the same functions and responsibilities. For example, we have a shared team of management and staff, committees that meet in common (such as the governing body) and shared committees – such as the joint quality committee (JQC) that monitors the quality of services we buy and patients’ experiences of them, and the joint clinical board that oversees our transformation programmes.
On a day-to-day basis, we work together to secure the best possible, integrated and efficient services for people in the Bradford district and Craven. We also work with a number of other organisations and partnerships, including:
Health and wellbeing boards (HWB): We actively participate in the two local health and wellbeing boards that cover our area: Bradford and Airedale Health and Wellbeing Board. As a sub- committee of the council, the HWB brings together key people from the health and care system to work together to improve the health and wellbeing of the local population. The board has some specific responsibilities, such as approval and performance monitoring of the Better Care Fund.
Integration and change board (ICB): The integration and change board (ICB) is a group of senior leaders from across health and social care whose membership includes the hospital trusts, BDCFT, the three CCGs, GP federations, the voluntary and community sector, independent (care home and domiciliary care) sector and the council.
It is accountable to the Bradford and Airedale HWB, and acts as the executive board for our health and care system, with a number of system-wide committees and boards reporting to it. The two main system boards that we work through are our Health and Care Partnership Boards for Bradford and for Airedale, Wharfedale and Craven, which oversee transformation programmes and integrated service delivery. Through these Boards we focus on collective decision making with our partners, underpinned by our strategic partnering agreement. The system is also supported by four committees providing assurance and insight around finance and performance, quality and safety, clinical forum, and strategy.
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The work of the whole system is enabled by shared strategies which address workforce, digital, estates, and population health management.
The principal role of the ICB is implementing the vision and direction to deliver the best outcomes for local people as set out in the district’s five-year strategy.
By working together it ensures senior leadership share a common purpose across the health and social care system, set the vision and direction and enable the delivery of ‘Happy, healthy at home’ (see page 22).
The North Yorkshire commissioners’ forum: This comprises of senior leaders across CCGs and North Yorkshire County Council. Accountable to the North Yorkshire HWB, the forum focusses on strengthening the integrated commissioning agenda to support the delivery of joint and local plans. As Craven is part of North Yorkshire, we work closely with both the county council and Craven District Council in developing local plans to integrate health and social care.
Health and social care overview and scrutiny committees (HOSC): We report to two HOSCs (Bradford and North Yorkshire). These statutory committees act as a ‘critical friend’ by reviewing local health issues and considering our proposals to develop or change services.
NHS England (NHSE): NHSE commissions primary care optical, pharmaceutical and dental services and some specialised services. It is an independent organisation, working on behalf of the Department of Health. NHSE also handles patient complaints about GPs and GP practices. Since April 2017, we have had delegated authority from NHSE for commissioning GP services.
Services hosted by other CCGs: Until 31 March 2020, our medicines management service was hosted by Harrogate and Rural District CCG and, until 31 October 2019, our serious incidents team was hosted by Greater Huddersfield CCG. Both services are now in-house.
On behalf of the CCGs in West Yorkshire and Harrogate, Bradford Districts CCG hosts West Yorkshire Research and Development . The team, which helps to transform research questions into research proposals, works closely with clinicians and partners from academia to increase evidence-based innovation and knowledge exchange within clinical care settings. eMBED Health Consortium: This year eMBED – part of Kier Business Services Ltd - has provided us with a range of business expertise and support to enable us carry out our functions, for example, expertise in business intelligence, information technology and data quality. This service ceased at the end of the contract on 31 March 2020, when these services either transferred to other organisations or became an integral part of the new Bradford District and Craven CCG.
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The Health Informatics Service (THIS): From 1 April 2020, THIS became the provider of our information technology and information governance services.
North of England Commissioning Support Unit (NECS): NECS supports us with the provision of data quality services.
Bradford District Care NHS Foundation Trust (BDCFT): The trust supports us with health and safety, learning and development and human resources management, along with providing healthcare services.
Healthwatch: as an independent public watchdog, Healthwatch works with people and organisations to make positive change happen in health and social care services in the district. Healthwatch is also a key partner helping us to plan services. Healthwatch Bradford and District provides services to people living in the Airedale or Wharfedale areas; and Healthwatch North Yorkshire to those living in the Craven area.
GP practices: While continuing as independent businesses, a number of our practices are also collaborating with each other. For example, a super practice called the Modality Partnership, which includes eight local practices, and the Wharfedale, Airedale and Craven Alliance (WACA) which is formed from seven independent GP practices.
Community partnerships: Community partnerships (CPs) are Bradford district and Craven’s way of delivering joined up community health, care and wellbeing services through locally led partnerships covering communities of approximately 30-60,000 people. Within Airedale, Wharfedale and Craven CCG there are three CPs.
The aim of developing CPs was to give community-based staff and local people the opportunity to say what is important to them based on local information, to ensure that future health, care and wellbeing services meet their needs.
Each CP has a community leadership team who are working together to share their knowledge, ideas and expertise to support each other in understanding their roles and how they can work better together to improve the lives and experiences of people in the local community. This new way of working enables CPs to involve and empower their local teams to design, develop and set up new ways of delivering health, care and wellbeing services which they lead on. It provides opportunities for community staff to work in different ways with other organisations.
These teams have led on the development, design, implementation and evaluation of service improvement initiatives. Such initiatives aim to secure the most efficient and effective use of existing and future resource which will support people to receive care, support and wellbeing services closer to home and enable them to achieve the Bradford system vision of remaining happy, healthy at home.
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Primary care networks: In July 2019 a new five year GP contract was introduced to encourage and support practices to form Primary Care Networks (PCNs) to work more closely together to create economies of scale, improve quality, develop the workforce, reduce waste and deliver enhanced care and support to local populations. Within Airedale, Wharfedale and Craven CCG there are two PCNs: The Modality Partnership and the Wharfedale, Airedale and Craven Alliance.
We are currently working to understand the implications of operating two models and how we can encourage and support joined up working to achieve the best outcomes for the local communities being served.
People’s Board: The People’s Board are members of the public from across the diverse communities that make up Bradford district and Craven. Their role is to challenge and support us, and to bring different perspectives into our decision- making.
We were one of the first areas of the NHS to try the idea of a People’s Board. It’s one of the ways that we make sure people’s voices influence the decisions we make. The People’s Board meets every month to have open and honest conversations about our strategies and plans. Their role is to represent the views of patients, carers and people in our area; give feedback on, and help develop, our strategies and plans; be proactive in discussing health and care services; and to work with us to identify trends and issues in our local communities.
PPGs and the Patient Network: At the heart of our approach to involving patients and the public are our member GP practices across the three CCG areas, and their patient participation groups (PPGs). There are so many volunteers working in practices and making a difference through a range of activities from setting up walking groups or self-care events, supporting clinics, or helping gather patient feedback.
The CCGs have brought these volunteers together into the Patient Network, a thriving forum for learning and sharing effective ways to engage with people at practice-level. As community partnerships and primary care networks develop, we are working to refresh the patient network model.
Engaging People: Engaging People is a voluntary and community sector (VCS) partnership project, commissioned by the Bradford district and Craven CCGs to carry out public engagement on our behalf. The partnership includes local organisations CNet, HALE, and BTM. Engaging People do projects that link to CCG priorities and work streams, helping us reach out to hear the voices and views of diverse groups or communities, particularly potentially disadvantaged groups.
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1.8 Sustainability and transformation: our plans and priorities
1.8.1 Airedale Health and Care Partnership
The Airedale Wharfedale and Craven (AWC) Health and Care Partnership is one of two partnerships of the Bradford District and Craven Place.
Its function is to act as a collaborative body that will ensure the engagement, alignment, refinement of resource allocation and shared programme decision making of all the parties in the AWC health and care system. The AWC Health and Care Partnership Board is responsible for delivering on the AWC part of the Bradford District and Craven place vision.
Local system vision: Building on our long-standing partnership working and relationships across the health and care system, the AWC Health and Care Partnership started the year by helping firm up a strong and clear vision for the system which is now owned by all system partners across the Bradford District and Craven place. Our vision for our population is that people will be healthier, happier, and have access to high quality care that is clinically, operationally and financially stable. In short, our shared place vision is happy, healthy at home.
Strategic partnering agreement: Strong system leadership, partnership and collaborative working have been demonstrated through the collective effort and putting together of our strategic partnering agreement (SPA) which sets out and formalises our partnership working and system leadership arrangements. It has supported the CCG to deliver its functions in new and effective ways by breaking down traditional barriers, for example by supporting the move to new contracting models. It has set a strong basis for working together as a system going forward – for example, through the finance and performance committee and quality committee. It has also enabled the CCG and the system to align itself and present as a strong partnership to the regulators. As a system we have been recognised nationally for our partnership working. The CCG and its partners continually and actively promote and live by the agreements, values and principles of our SPA and will refer back to it if and when things don’t go so well.
Building on the sign off and agreement of the SPA, our focus throughout the year has been on implementing and delivering on change and different ways of working through new partnership arrangements. To mitigate concerns around safety and statutory responsibilities, these remain with individual partners but system and partnership decisions are made as a collective response to system sustainability and quality challenges
Dynamic risks: As a system we introduced a dynamic risk log as an enabler to ensure the Health and Care Partnership Board have system oversight. The approach provides individuals, sectors and organisations the opportunity to raise risks and important issues from their respective perspectives in the short (immediate), medium and long term. This has helped facilitate a new type of conversation with a system perspective lens, exploring support offers and mitigating actions, and clarification of system risk owners.
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Forward planning: To ensure proactive system and partnership conversations the board continues to build into its forward plan key system discussions – for example, financial and activity plans, system operational plans, local authority budget proposals, voluntary and community sectors capacity.
System programmes and governance: We undertook a system programme review and, as a result, a more focused arrangement to programmes is being adopted along with more streamlined governance arrangements. As part of this, three main portfolios have been agreed: prevention and early help; planned care; and urgent care.
Six initial priority programmes have been agreed and will be delivered through the following principles:
using and strengthening our community assets; empowering people to manage their own health; considering opportunities across the patient journey from self-care to specialist care and beyond; contributing to a left shift towards prevention (primary, secondary and tertiary); utilising clinical and population engagement; doing things once across the system with all of our partners; following the principles outlined in the SPA for making and taking of decisions; planning and delivering services using the most appropriate footprint; learning from others and innovating; utilising our enabler strategies.
Community partnerships have continued to go from strength to strength. Work at individual community partnership level continues to progress well with a strong focus on asset-based community development approaches and the involvement of local people.
Recognising the momentum and progress within community partnerships, the Health and Care Partnership Board focused on how the board, community partnerships and the system work together. This helps to get the best out of the community partnership approach to meet the health and care and wider system challenges.
We recognise and agree the need for bold leadership which includes taking risks – for example, by commissioning services in different ways. Community partnerships are seen as core and central to delivering on the system priorities.
1.8.2 West Yorkshire and Harrogate Health and Care Partnership
Since the Partnership began in 2016, we have worked hard with our partners to build the relationships needed to deliver better health and care in West Yorkshire
NHS Airedale, Wharfedale and Craven CCG Annual report and accounts 2019/20 9 20 and Harrogate to support people to improve their lives.
As a proud and valued partner, we are pleased with the progress we have made. Together we are sharing and spreading good practice across the area, and ultimately saving more lives by improving people’s health and wellbeing.
Key achievements include:
• developing an award-winning programme to support 260,000 carers; • hospitals working together for the first 72 hours of critical stroke care; • launching the Yorkshire and Humber Care Record to improve people’s care • setting up a new community eating disorder service; • establishing a health and care champions network for people with learning disabilities; • working with organisations like Healthwatch who talked to over 1800 people about the NHS Long Term Plan; • securing the largest share of national capital investment totalling £883m for 10 schemes, including building new adult, and children hospital in Leeds, which will benefit the whole area; • setting up the first suicide bereavement service for West Yorkshire and Harrogate; • increasing the number of people, nearly 8,000, who now have their hypertension better controlled to safe limits. Importantly this could help prevent 65 deaths, 122 strokes and 82 heart attacks over the next five years.
We know that more needs to be done to give everyone the very best start and every chance to live a long and healthy life. This includes working with partners in the wider economy to create good jobs and increase everyone’s prosperity with investment in skills, housing, culture and infrastructure.
Only by working together can we truly achieve this.
Our local and West Yorkshire and Harrogate relationships are very important to us because we have the biggest impact on people’s lives when there is shared commitment by all.
We are active partners on the Partnership Board and have signed a memorandum of agreement to set out our commitment to work together. This has included, for example, Airedale, Wharfedale and Craven CCG being an active part of Mental Health, Learning Disabilities and Autism Programme Board, Joint Committee of Clinical Commissioning Groups etc.
The Partnership’s Draft Five Year Plan, belongs to us all. It sets out our ambitions for the 2.7million people living across the area and also highlights the priorities where we have agreed to work on together across West Yorkshire and Harrogate, for example mental health, cancer, urgent care, maternity services, and tackling health inequalities - we know sadly exist.
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Our ambitions include:
increasing the years of life that people live in good health, and reducing the gap in life expectancy by 5% in our most deprived communities by 2024; reducing the gap in life expectancy for people with mental health, learning disabilities and autism by 10% by 2024; reducing health inequalities for children living in households with the lowest incomes, including halting the trend in childhood obesity; increasing early diagnosis of cancer, ensuring at least 1,000 more people have the chance of curative treatment; reducing suicide by 10% overall by 2020/21 and achieving a 75% reduction in targeted areas by 2022; reducing anti-microbial resistance infections by 10% by 2024 and reducing antibiotic use by 15%; reducing stillbirths, neonatal deaths, and brain injuries by 50%, and reducing maternal morbidity and mortality, by 2025; having a more diverse leadership that better reflects the broad range of talent in our area; becoming a global leader in responding to the climate emergency; strengthening local economic growth by reducing health inequalities and improving skills.
Our shared goal is to join things up locally and at a West Yorkshire and Harrogate level, to connect organisations and people in ways that make better care easier - whether this is support delivered by local groups, services delivered in people’s homes or the treatment that is best provided in a hospital.
The West Yorkshire Association of Acute Trusts is part of West Yorkshire and Harrogate Health and Care Partnership. West Yorkshire Association of Acute Trusts (WYAAT) is an innovative collaboration which brings together the NHS trusts who deliver acute hospital services across West Yorkshire and Harrogate. It is about local hospitals working in partnership with one another to give patients access to the very best facilities and staff.
The six hospitals trusts that make up WYAAT are:
Airedale District Hospital NHS Foundation Trust Bradford Teaching Hospitals NHS Foundation Trust Calderdale & Huddersfield NHS Foundation Trust Harrogate & District NHS Foundation Trust Leeds Teaching Hospitals NHS Trust Mid Yorkshire Hospitals NHS Trust
WYAAT’s vision is to create a region-wide, efficient and sustainable healthcare system that embraces the latest thinking and best practice so it consistently delivers the highest quality of care and the best possible outcomes for our patients.
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To find out more about the West Yorkshire and Harrogate Health and Care Partnership, visit the website, or follow @wyhpartnership on Twitter.
1.8.3 Happy, healthy at home: a plan for the future of health and care in Bradford district and Craven
‘Happy, healthy at home’ – a plan revised and published in November 2017 – is the next step in the development of joined up planning by the health and care system in Bradford district and Craven.
The plan was informed by our greater understanding of what people want and need following the ‘Big conversation: our say counts’ engagement which took place in summer 2017 and aimed to hear the views of as many people as possible.
It is owned by the health and wellbeing board and delivery is led by the integration and change board. The plan complements our joint health and wellbeing strategy and sets out the key actions needed to achieve three aims:
better outcomes, so that more people are living longer in better health, and good health enjoyed by everyone rather than being determined by where live; better services that meet people’s needs; providing access to the highest quality interventions, delivered by teams with the best expertise, at the times people want, through the routes they prefer; better use of resources: reducing waste, arranging services to avoid delay and duplication, and working together to keep people well.
By listening to people and working together we understand where we need to change, and many improvements have already begun.
1.8.4 Sustainable development summary
We are committed to continually developing our sustainable working practices within our organisation, through our commissioning and with our member practices and staff, because sustainable development has good health and wellbeing at its heart.
Many local people in Bradford District and Craven will live longer and expect their lives to be healthier and happier than those of their predecessors.
The system-wide vision described in the Bradford District and Craven plan for the future of heath and care, happy, healthy at home, reflects this: to create a sustainable health and care economy that supports people to be healthy, well and independent.
Over the last year, we have been on a journey to dissolve the three CCGs across our area and to create a new organisation, NHS Bradford District and Craven CCG. Through this work, we have further streamlined our governance and ways of working – building on our existing shared working arrangements - to continue our progress in reducing duplication and driving efficiencies.
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We have further developed our system collaborative arrangements through health and care partnerships and our communities and have spearheaded initiatives ranging from a whole system event to attract young people into the wide range of health and care careers to encouraging staff to observe plastic free Tuesdays.
In further developing our engagement with local people – and how we capture feedback about their experiences – we have progressed a system approach incorporating the extension of our Grass Roots patient experience reporting, driving a movement for change across health and care in line with happy, healthy at home, and further building capacity in our communities.
We refresh our learning and development offer on an ongoing basis to staff to ensure skills and experience are fit for the future and have continued with our staff driven programme of community support.
1.9 Key risks and issues
1.9.1 Key issues from the risk register
The governing body assurance framework (GBAF)/strategic risk log is the key mechanism for identifying and monitoring the management of the key risks affecting the achievement of our strategic objectives. The GBAF, which is shared across the Bradford district and Craven CCGs, is reviewed and approved as a fair reflection of the CCG’s strategic risk position by the governing body at least annually. The full CCG GBAF can be found in the governing body papers on our website and is summarised below.
Move- ment Strategic since Strategic Risk
Objective Sept
Jan 2020 Jan Sept2018
Sept2017 2017
March2018 March2019
1. Working 1.1 There is a risk that unwarranted variations in 16 16 16 16 16 collaboratively, we will quality and care cannot be effectively tackled develop and deliver due to shortfalls in workforce capacity, capability targeted programmes and skills resulting in failure to close the care to address the gaps in and quality gap. the quality and outcomes of our health 1.2 There is a risk that our efforts may not have 16 16 16 16 12 and social care. We the impact we desire due to some determinants will reduce of quality and outcomes which lie outside of the unwarranted variations control of health and social care resulting in a in the quality and care failure to close the care and quality gap. provided for our
NHS Airedale, Wharfedale and Craven CCG Annual report and accounts 2019/20 9 24
Move- ment Strategic since Strategic Risk
Objective Sept
Jan 2020 Jan Sept2018
Sept2017 2017
March2018 March2019 patients and residents. 1.3 There is a risk that the care and support N/A 16 16 16 16 We will improve market in Bradford and Airedale will become outcomes and increasingly unstable due to workforce, experience for our increasing complexity of the needs of people patients and residents living in care homes and funding issues, leading to closure or de-registration of nursing home provision. This will result in a market that is unable to accept and care for patients, destabilising the wider health and care sector and impacting on the quality of care experienced by our patients.
2.1 There is a risk that we fail to gain sufficient 12 12 12 12 12 organisational traction towards integrated commissioning, due to a range of factors, 2. Working including ‘programme creep’, staff attitude to collaboratively, we will change and weak leadership, resulting in failure develop and deliver to achieve the strategic objective. targeted programmes to address the gaps in 2.2 There is a risk of fractured relationships with 9 9 9 9 9 the levels of health partners due to growing financial pressures and wellbeing within the health and care system, particularly in experienced by our areas such as continuing healthcare, out-of- population hours, learning disability and substance misuse, resulting in negative impact on the commitment to integration.
3.1 There is a risk that the medium term 16 16 16 16 16 financial plan does not deliver financial 3. Working sustainability for the three CCGs due to under collaboratively, we will delivery of Quality, Innovation, Productivity and maximise value for Prevention (QIPP) plans resulting in financial money in the use of targets not being achieved. healthcare services to ensure we can deliver 3.2 There is a risk that the two Health and Care 16 16 16 16 16 financial sustainability Partnerships are not financially sustainable due and service to the system financial gap not being closed transformation resulting in action from the regulators.
4. Working 4.1 There is a risk of provider organisations not 12 12 12 8 4 collaboratively, we will committing to the development of a HCP across develop Health and AWC due to their perceived organisational risks Care Partnerships resulting in failure to achieve an HCP by 2021. (HCPs) in Bradford and in Airedale, 4.2 There is a risk of some provider 12 12 12 9 4 Wharfedale and organisations not committing to the development Craven to provide of a HCP across Bradford due to their perceived sustainable, effective, organisational risks resulting in failure to achieve efficient and high a Bradford HCP by 2021. quality health, care and support services to the local populations
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Move- ment Strategic since Strategic Risk
Objective Sept
Jan 2020 Jan Sept2018
Sept2017 2017
March2018 March2019
5. Working 5.1 There is a risk that we are unable to 16 16 12 9 9 collaboratively, we will sufficiently change patient behaviour, sufficiently improve the levels of reshape GP behaviour and embed social self-care and ill-health prescribing, due to the normal factors associated prevention to enable with ‘change and resistance, resulting in failure and empower people to achieve the strategic objective. to better help themselves, live well and maintain their independence and dignity for as long as possible 6.1 There is a risk that the corporate cultures 6 6 6 3 2 6. Working and behaviours within individual organisations collaboratively we will continue to emphasise competition rather than ensure that the acute collaboration as a means to deliver healthcare, collaboration resulting in risking the effectiveness of the programme being led collaboration programme. by the local acute trusts and West 6.2 There is a risk that the changes to acute and 12 12 12 12 12 Yorkshire mental mental health services required to achieve health trusts improves financial sustainability are not acceptable to key the clinical and stakeholders, eg patients, the public or elected financial sustainability representatives, and cannot be implemented. of acute physical and This would result in the failure of the mental health services, programme’s goals. complements the development of out of 6.3 There is a risk that the transformation 9 9 9 9 9 hospital services and required across the health and care system is underpins the delivery compromised due to workforce capacity, of key quality and capability and skills shortfalls, technological and/ performance or data access issues and by out of date or objectives including unaffordable models of service which are constitutional preferred by some interest groups. This will standards result in clinical and financial instability.
7. We will continue to 7.1 There is a risk that staff struggle to adapt to 12 12 12 8 8 review and develop new, externally facing system-focus roles due to our internal resources, the need for role flexibility and the normal factors structures and associated with change, resulting in failure to processes to ensure develop as an organisation. that we are able to achieve our strategic objectives and meet NHS constitutional standards Total strategic risk score 148 164 160 143 129 Average risk score 12.6212.96 12.67 11.36 10.36 Table 1: summary of GBAF
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Total Strategic Risk Score 180 160 140 164 160 148 Figure 1: Total 120 143 strategic risk 129 100 score 80 84 84 84 84 60 75 40 20 0 Sep-17 Mar-18 Sep-18 Mar-19 Jan-20
Total Risk Score Total Risk Appetite
Average Risk Score 25
20 Figure 2: 12.62 12.96 12.57 Average 15 11.36 10.36 strategic risk score 10 5.8 6 6 6 6 5
0 Sep-17 Mar-18 Sep-18 Mar-19 Jan-20
Average Risk Score Average Risk Appetite
As reported to the governing body in January 2020:
the CCGs have made progress in reducing the total and average strategic risk scores over the period of the GBAF;
in particular, progress has been made in reducing the risks relating to partnership working and collaboration across the local health and care system and which are linked to the CCGs ‘enabling’ (SR 4, 5, 6 and 7) strategic objectives;
limited progress has been made during the period in directly reducing the strategic risks linked to ‘core’ strategic objectives (eg SR1, 2 and 3 closing the quality and outcomes gap, closing the health and wellbeing gap, closing the financial cap), however, the fruition of the ‘enabling’ objectives will assist with the achievement of the ‘Core objectives’ in the longer term.
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The GBAF is supported by the corporate risk register which records the operational risks faced by the organisations. Risk register reports, focussing on high level risks (those scoring 15 or more) are provided to each of the governing body public meetings and can be found in the governing body papers on our website.
1.9.2 Emergency preparedness, resilience and response (EPRR)
NHS England is responsible for the management of any health response to major emergencies and for leading incidents involving public health outbreaks. The Civil Contingencies Act (CCA) 2004 places duties on CCGs to make local arrangements to deal with emergencies, at the same time as maintaining services to patients and assisting other responders in preparing for emergencies.
The NHS EPRR framework also places a number of key responsibilities on CCGs which include:
collaborating, co-ordinating and co-operating in planning for, and responding to, an incident or emergency; ensuring contracts with provider organisations contain relevant EPRR elements and are adhered to; supporting NHS England in discharging its EPRR functions and duties locally; fulfilling our responsibilities as a category two responder under the Civil Contingencies Act, including maintaining business continuity plans; and co-operating and sharing information with category one and other category two responders.
Our 2019 self-assessment against NHS England’s core EPRR standards indicates we are ‘substantially’ compliant and our annual EPRR report provides further assurance to the governing body and NHS England. The CCG also self-assessed as ‘substantially’ compliant against the core standards in 2018.
We have incident response plans in place, and are an active member of the West Yorkshire Local Health Resilience Partnership (LHRP), working with other organisations to develop and share plans in preparation for any health incidents.
Together with our health and care partners, we have joint plans that describe how we will work together during periods, such as winter, when services are busy and under pressure. The CCGs have 24/7 on-call arrangements where providers can escalate issues if they cannot maintain delivery of core services. This on call-rota is staffed by directors and associate directors from the Bradford District and Craven CCGs. On- call staff train regularly to ensure they have the skills and knowledge to respond to incidents, and representatives attend exercises of other organisations to act as players and observers.
In the past year, we have attended an exercise under the Control of Major Accident Hazards (COMAH) Regulations 2015. We attended an exercise run by North Yorkshire Country Council to test the North Yorkshire and York Mass Treatment and Vaccination Plan. The exercise was to ensure that all partner organisations
NHS Airedale, Wharfedale and Craven CCG Annual report and accounts 2019/20 9 28 understood their roles and responsibilities where there is a health protection incident or outbreak requiring mass treatment or vaccination. The CCG was part of a similar meeting for the Bradford District area to refine the Bradford memorandum of understanding for public health incidents and outbreaks. We also held our annual local desk top exercise to test our winter plan. All these events test multi-agency response and recovery arrangements.
The UCI World Championship Cycle Race came to the Bradford District and Craven area for three days in September 2019. All partners in the local system completed a risk assessment for the event and communications were shared with staff and GP practices to ensure that they were aware of the potential disruption.
We continue to review and make improvements to our business continuity plan, which has been updated to reflect the closure of the three CCGs and formation of the new Bradford District and Craven CCG.
In relation to Brexit, the CCG has an action plan to ensure that all requirements of the guidance are addressed, with a lead identified for each area. Progress on the action plan is reported to the joint finance and performance committee. The CCG attended NHS England’s Brexit preparation workshops and attended the Bradford system Brexit preparation meetings.
In 2019, an internal audit of the business continuity function was undertaken by Audit Yorkshire. The four opinion levels are high, significant, limited and low. The overall opinion of the current business continuity position was rated as ‘significant’.
1.9.3 Our response to COVID-19
On 31 December 2019, the World Health Organization was informed of the first cases of what would later be identified as COVID-19. At the end of January 2020, CCGs were asked by NHS England to provide assurance on primary care’s readiness to respond. The first known cases in UK also occurred at the end of January 2020.
In mid-February, the CCGs established a Bradford district and Craven planning group to prepare for how the local system would respond to COVID-19 cases. The national NHS England team established weekly webinars attended by CCG staff. These were led by Keith Willett, the NHS Strategic Incident Director, to provide NHS organisations with updates on the latest situation and the actions that local areas needed to take.
In early March, the CCGs entered their formal command and control arrangements and established internal gold, silver and bronze work streams. Our senior leadership team undertook the role of gold command. A specific silver health and care system work stream continued to operate throughout. We set up an incident control centre to ensure that we could respond promptly to COVID related queries and issues.
A number of work streams have been managed through CCG COVID-19 action, and risk and issues, logs. Some of the key COVID-19 work streams have been:
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leading the development of a local community testing service; supporting primary care to set up and run the red hubs to manage patients with COVID symptoms; establishing a testing centre at Marley Fields that has been a national top performer; providing IT support to primary care to establish remote triaging and consultations; re-designing services through the Care@Home work stream to support the COVID-19 response; supporting restoration and recovery as the COVID-19 pandemic entered its second phase.
The new Bradford District and Craven CCG will be reviewing how the CCGs responded to the COVID-19 pandemic and what lessons can be learned.
In 2020/21, in response to the COVID-19 pandemic, all detailed financial planning was suspended and NHS England and NHS Improvement issued guidance on revised arrangements for NHS contracting and payment, and revised financial management for CCGs. The arrangements set-out in this guidance apply to the end of July 2020. NHS England and NHS Improvement guidance also confirms that the Government has issued a mandate to NHS England for the continued provision of services in England in 2020/21 and that CCG allocations have been set for the remainder of 2020/21. While these allocations may be subject to minor revision as a result of the COVID-19 financial framework, the guidance has been clarified to inform CCGs that they will be provided with sufficient funding for the year.
1.10 Performance summary
In the absence, this year, of the performance analysis section of this annual report (as a result of organisations working on the COVID-19 pandemic), this report includes a shorter summary of the CCG’s performance.
CCGs are statutory organisations responsible to their governing body for the delivery of both their statutory and constitutional duties, and improvements in the health outcomes of their population. Our constitutional duties include delivery of a range of national access targets for both hospital and mental health services. Performance for 2019/20 is shown in table 2 overleaf:
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Target Q1 Q2 Q3 18 week referral to treatment waits 92% 91.70% 90.70% 89.40% Diagnostics <1% 5.70% 3.90% 3.60% A&E 4 hours * 95% 87.30% 89% 82.20% Cancer 2 week wait 93% 90.90% 85.90% 93.40% Cancer 2 week wait (breast) 93% 86.40% 92.30% 90.30% Cancer 31 day (first treatment) 96% 98.80% 98.40% 98.20% Cancer 31 day (subsequent treatment 94% 89.50% 97% 95.90% surgery) Cancer 31 day - (anti-cancer drugs) 98% 100% 100% 99.00% Cancer 31 day - (radiotherapy) 94% 100% 95.00% 98% Cancer 62 day 81% 85.40% 86% 80.80% Cancer 62 day (NHS screening) 90% 100% 95.80% 93% Cancer 62 day (consultant referral 90% 64.70% 92.60% 95.80% upgrade) 4.75% for 2018-19 rising to IAPT access 4.40% 4.30% 4.30% 5.5% by the end of 2019-20. IAPT 6 week waits 75% 97% 97.90% 97.10% IAPT 18 week waits 95% 100% 100% 100% IAPT recovery 50% 58.30% 61.90% 60.20% Early Intervention in psychosis - % seen 53% 67.50% 80.80% 85% within 2 weeks Care programme approach (CPA): 95% 94.90% 100% 97.80% follow up within 7 days of discharge Table 2: NHS constitutional targets* A&E performance is for main provider trust (Airedale NHS Foundation Trust)
NHS England has a statutory duty to make an annual assessment of CCG performance. It meets this duty through its NHS Oversight Framework (NHSOF), which contains 60 indicators grouped within five theme areas: new service models; preventing ill-health and reducing inequalities; quality of care and outcomes; leadership and workforce; finance and use of resources. During 2019/20 NHS England/Improvement held quarterly and annual checkpoint review meetings with the CCG and extended this to all system leaders across Bradford district and Craven for the annual checkpoint. The CCG’s overall rating for 2018/19 was GOOD, our Quality of Leadership rating was GREEN in England and our in year financial performance was rated AMBER.
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At the time of writing this annual report, the 2019/20 year-end assessment for the performance of the CCG was not available but will be published on the NHSE website in July 2020. At present, the CCG is performing above the England average in a number of areas. However, there is always room for improvement, and the CCG uses these metrics to identify areas for further work.
1.10.1 Summary of progress on our key priorities
Respiratory: The CCG aims to improve the pathway of care from diagnosis, ensuring improved management of respiratory diseases with a view to reducing avoidable hospital admissions. Overall, providing good quality, evidence-based clinical care is the key to achieving the aim of this programme. We aim to correctly diagnose those with chronic obstructive pulmonary disease (COPD) and help put a stop to preventable asthma deaths.
A respiratory template has been designed to sit on Assist to ensure all GPs are offering the correct advice to patients, referring to the appropriate departments, administering rescue packs and ensuring patients are on the correct medication.
Community COPD nurses are driving forward the issues around new inhaler therapies and COPD bundles incorporating self-management. We have raised awareness of earlier diagnosis, improved clinical management and supported self-management of respiratory disease.
The most common cause of COPD is smoking and one in five people in the Bradford area smoke so helping people quit will be a significant part of reducing the number of people with develop COPD.
We are also working with our partners across West Yorkshire and Harrogate to develop protocols and pathways across a wider patch to ensure consistency of care delivery. The focus is on pulmonary rehabilitation (PR) and spirometry. PR is a cost-effective way to support people with lung conditions such as COPD to exercise safely, to help them to understand their condition and to reduce their risk of exacerbation. We need to ensure that patients have access to PR classes and that they are culturally sensitive to our local population. We have secured MyCOPD licences to use within our PR service to reach as many patients as possible.
Spirometry is the key diagnostic tool to find out if someone has COPD. Our workforce will be skilled to undertake the test and to interpret the results accurately and to work with the individual to develop a tailored care plan.
Cardiovascular: Across West Yorkshire and Harrogate (WY&H) the multi-award winning work developed and led by Bradford Districts CCG - Bradford’s Healthy Hearts - has been rolled out, and has now also received national recognition for the improvement in care management. The West Yorkshire and Harrogate Healthy Hearts programme started with hypertension management this year, followed by cholesterol management and diabetes from 2020/21.
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Cancer: We continue to support national educational and promotional campaigns including smoking cessation, as well as cancer screening services such as breast, bowel and cervical cancer. Through continuing to educate people and promote services, we aim to improve local uptake of services ultimately improving both patient outcomes and experience.
Improvements to bowel screening include the Yorkshire Cancer Research and Enable2 project using interpreters to phone non-responders to encourage uptake of bowel screening is complete and has led to around 40% of those contacted agreeing to complete the test. This pilot will be further rolled out in 2020 through the Reducing Inequalities in City programme.
Bradford improving cancer survival (BICS) programme aims to diagnose at an early stage in order to greatly improve cancer survival and our rate of diagnosis of cancer at an early stage is improving, with just below half of people receiving their diagnosis early and we need to improve this result as we want to continue to increase the proportion of people diagnosed in stage 1 or 2 of the cancer in support of the national ambition which rises to three-quarters by 2028.
You can read more about our performance on our website and in our archived board papers.
1.11 Improving quality
Clinical commissioning groups are responsible for the quality of commissioned services. To fulfill this function the CCG focuses on patient safety, delivering agreed outcomes, improving patient experience, flexible and sustainable models of care to meet individual needs, and having the right leadership across the system.
We are dedicated to delivering and developing high quality, safe, effective and innovative healthcare services that meet the needs of local people. To be assured that this is happening, the governing body receives regular reports quality matters, the outcomes of deep dives (for example, into cancer services) and quality walk-rounds in care homes.
Under the direction of the system quality committee and the joint quality committee (JQC), we take a methodical approach to understanding, monitoring, analysing and acting on a range of quality data and information, using curiosity as an underpinning principle. We triangulate and assess a range of quality metrics and associated information for exceptions, along with local intelligence and workforce data to elicit a quality picture/position of services.
As part of our mainstream contractual process each main provider has a contract quality management group (CQMG) which is supported by patient safety and quality sub groups (PSQSG). The latter provides an opportunity for us to delve deeper with the provider on quality areas within scope and enables
NHS Airedale, Wharfedale and Craven CCG Annual report and accounts 2019/20 9 33 us to identify areas that may require further understanding or interrogation. Over the last year this has enabled identification of several quality areas which required a further ‘deep dive’ and subsequent presentation and discussion at the JQC. Following JQC discussion, this has often resulted in further challenge or action for providers to ensure delivery of high quality, effective services of positive patient experience.
To deliver the NHS constitution standards and the ‘must dos’ we ensure all quality measures are based on the best available evidence and monitor them accordingly. We work with our providers to ensure that quality requirements are adhered to and co-ordinate rapid intervention when quality and safety is compromised, where appropriate.
Our providers must meet a number of essential quality and safety standards set out by the Care Quality Commission (CQC). As service commissioners, our contracts include other quality requirements for providers that are above the essential CQC requirements. Alongside the CQC we support providers to celebrate areas of strength and improvement and target areas of challenge.
We are a member of the West Yorkshire quality surveillance group. This group enables Commissioners and regulators to discuss and share system- wide quality concerns and intelligence.
Nationally, the NHS standard contract provides us with a mechanism for setting a consistent approach to quality requirements. Quality accounts are a vehicle for shared understanding of quality improvement priorities with our providers, and include mandatory reporting on a core set of quality indicators. Importantly, providers are encouraged to celebrate excellence, champion quality improvements initiates and outline progress with external requirements such as national audits.
As part of our delegated responsibility to commission GP primary care services, we have a duty to improve the quality of such services. Ultimately, this is discharged through the JQC which oversees the roll out of the Primary Care Quality Assurance Framework.
We are continually reviewing available information and data to ensure effective and efficient service delivery and also that the best possible outcomes for people are provided. We use the monitoring of outcomes data to inform and review our priorities, areas of emphasis, and work plans through regular reporting to clinical board, governing body and JQC. We use nationally published data and regularly benchmark with similar CCGs to so that we can identify where we can learn from others to improve our outcomes.
Patient safety is about maximising the things that go right and minimising the things that go wrong. It is integral to the NHS definition of quality in healthcare, alongside effectiveness and patient experience.
We are committed to fulfilling the ambitions outlined in the National Patient Safety
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Strategy (2019)
The NHS Long Term Plan describes the development of new ways of working in primary and community care that can increase the focus on safety. Our primary care networks provide an opportunity to promote a safety culture and focus on continuous improvement.
The system which the CCG is part of has a collective intent to improve safety by recognising that the way we learn, treat staff and involve patients in incident investigation can be improved.
Responding appropriately when things go wrong in healthcare is a key way we can continually improve the safety of services delivered. We strive to reduce the occurrence of avoidable harm and have robust assurance mechanisms in place. We monitor patient safety with all our providers and ensure that all serious incidents (including ‘never events’) are reported and robustly investigated. Appropriate action plans are developed as a result of incidents and learning is shared and, most importantly, put in into practice.
Taking a previously outsourced serious incident service in-house has further strengthened our continuous improvement of the serious incident systems and processes. We meet regularly with our main NHS providers, attend providers’ patient safety and learning assurance groups to discuss details and ensure any necessary actions are implemented to maximise learning to improve patient.
1.11.1 Safeguarding
Safeguarding adults and children remains a priority for the CCG. The safeguarding team works collaboratively across the health economy and ensures the CCG is meeting its obligations in relation to safeguarding. These obligations include the statutory duty for CCGs to discharge their functions with due regard to safeguarding children and adults at risk of abuse, within both their internal processes and their role as commissioners of health care for the local population (Safeguarding Vulnerable People in the NHS – Accountability and Assurance Framework. NHS England, 2015).
The CCGs are committed to working in partnership with provider organisations and all members of the local Safeguarding Boards, to help ensure that children and adults at risk of abuse are identified and protected from harm in Bradford district and Craven.
You can read more about our safeguarding role on our website.
1.11.2 Complaints and principles for remedy
It is a priority for the CCG to have local people at the heart of our work, to hear what people think and to use this information as we make decisions about services and to tell people how we have used their views. Sometimes things go
NHS Airedale, Wharfedale and Craven CCG Annual report and accounts 2019/20 9 35 wrong, and when they do we make sure that concerns and complaints are investigated to help us learn lessons and improve services.
Between 1 April 2019 and 31 March 2020 we received seven formal complaints from patients, or on their behalf, in relation to Airedale, Wharfedale and Craven CCG. The majority, six cases, (86%) involved our personalised commissioning department (PCD) and five of these involved our processes and continuing healthcare (CHC) funding. Of these five, two related to the additional charges requested by care homes and one concerned a breach of confidentiality. The remaining complaint related to the outcome of an IFR (individual funding request) and the way in which this was handled.
Thirty one people also contacted us raising concerns and enquiries in relation to the CCG, of these 45% (14 cases) were in relation to our PCD which included CHC funding decisions, assessments, processes and communication. Nine cases (29%) involved our commissioning and care pathways. Five (16%) of cases involved IFR (individual funding request) decisions and processes, two of these cases were in connection to referrals for BANDS (Bradford and Airedale Neurological Development Service – the adult autism service).
In addition, another 58 complaints and concerns were raised with the CCG about our commissioned services. Of these 57% (33 cases) involved secondary care services - that is, those provided in our hospitals and other providers of NHS services - and 41% (24 cases) related to primary care services provided by our GP practices. The other case involved a service commissioned by North Yorkshire Local Authority.
There were a further 51 contacts made from patients where their GP practice was not given (and therefore we could not map them to a specific CCG in Bradford district and Craven). The majority of these contacts 35% (18 cases) were about our hospitals and other NHS providers; 14% (7 cases) were in relation to the CCG’s commissioning; and 14% (7 cases) involved GP primary care services. In all these cases, advice was given or the complaint or concern was passed on to the appropriate organisation for investigation and a response.
Our chief officer also dealt with 17 enquiries from our local MPs who raised issues and concerns on behalf of their constituents about NHS services. These included seven cases (41%) about the care and treatment provided to individuals by our hospitals and other providers of NHS care, and one case involving GP prescribing. Four cases involved the CCG’s commissioning and/or funding issues and two cases related to the proposal to create one CCG.
The main issues within complaints and concerns raised about secondary care were about aspects of care and treatment and communication. The main issues involving our GP practices were also about care and treatment, which included referrals, prescriptions and followed by communication and the manner and attitude of staff.
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The CCG was notified of three complaints where our patients approached the Parliamentary and Health Service Ombudsman (PHSO) as they remained dissatisfied with the outcome of their complaints locally. Two cases involved continuing healthcare (CHC) funding, and specifically with regard to the additional charges requested by care homes. The PHSO asked the CCG to re-open these cases to investigate further and respond directly to the complainants. The other case was an informal enquiry in relation to a complaint about an individual’s eligibility for CHC funding and communication.
The CCG has fully adopted the Principles for Remedy in which the Parliamentary and Health Service Ombudsman (PHSO) has set out six principles for remedy which include getting it right, being customer-focussed, being open and accountable, acting fairly and proportionately, putting things right and seeking continuous improvement. A full explanation of the principles can be found at www.ombudsman.org.uk and are referred to within our policy for the management of compliments, comments, concerns and complaints.
1.12 Our commitment to equality and diversity
We are committed to reducing health inequalities and to promoting equality and diversity for patients, communities and for our staff. We adhere to the Equality Act 2010 and the Public Sector Equality Duty
The Equality Act requires public bodies to publish at least one specific and measurable equality objective every four years. Following extensive engagement with CCG staff and the local community and voluntary sector in 2018 we agreed the following equality objectives:
Equality objective Progress made in implementation
Reduce health Community Connectors is a social prescribing service inequalities by which provides individual support to people referred by improving access to their GPs to help them get involved in local community- health services and based activities. The service has a diverse staff group increased support and is well used by people of Pakistani heritage. for self-care and prevention for The National Diabetes Prevention Programme (and protected groups formerly, Bradford Beating Diabetes) identifies local people at risk of developing diabetes and supports them to reduce that risk. It reaches a range of people including a good proportion of men, Black and Asian people and people living in deprived areas.
Improve Our Engaging People work reaches a broad range of engagement and people and supports smaller community groups to communication with make sure that people’ voices are heard. This has protected groups gathered rich insight from a broad range of people living across the CCG area on subjects including
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smoking cessation in pregnancy, over the counter treatments, domestic abuse and sexual violence services, the local carers’ service and end of life care.
Promote inclusive Analysis of NHS Jobs data shows that good numbers leadership and staff of BAME people apply for jobs and are shortlisted but development then not appointed. Specific CCG recruitment and progression selection training is provided to staff involved in recruitment.
Table 3: Progress against equality objectives
We use equality impact assessments (EIAs) to measure the impact of our decisions on equalities and to consider how they may affect the local population, particularly in relation to people with protected characteristics. The assessments also help to identify actions we can take to reduce or remove any negative impacts. We use EIAs as a tool to analyse and consider a range of information, including engagement, to inform our decision-making, both as an employer and commissioner.
Working with our key stakeholders, representing the interests of our diverse communities, we have been using the national Equality Delivery System 2 (EDS2), to assess and grade our progress. In November 2019, with our three local NHS foundation trusts, we held a focus group with representatives from the local voluntary and community sector, the local authority and Healthwatch for this purpose. Performance was assessed as “developing” which means that activity has taken place to include improve equality in specified areas but that more work is needed, particularly in measuring the impact of activity.
Feedback from community representatives has been used to shape a new set of NHS equality objectives for 2020-2024.
To ensure that our staff members do not experience discrimination, harassment and victimisation we have a range of policies to support staff. The implementation of these policies, along with occupational health support, helps ensure the retention of staff. They also ensure access for all of our employees, including disabled staff members to training, career development and promotion opportunities.
We recognise that in order to remove the barriers experienced by disabled people, we need to make reasonable adjustments for our disabled employees. We continue to be accredited to the Disability Confident Employer scheme.
We have continued to deliver our face-to-face mandatory equality and diversity training to all of our staff. Following feedback, the training has been redeveloped and now focuses on how to effectively intervene to challenge any stereotyped views or myths expressed about people with protected characteristics.
In April 2015, the NHS Workforce Race Equality Standard (WRES) became a mandatory requirement which requires NHS organisations to demonstrate progress against nine indicators. The CCGs’ WRES report is available on the website along
NHS Airedale, Wharfedale and Craven CCG Annual report and accounts 2019/20 9 38 with its action plan.
As a commissioner of health care, we have a duty to ensure that all of our local healthcare service providers are meeting their statutory duties under the Equality Act 2010 Public Sector Equality Duty. We do this by sharing good practice with the equality and diversity leads in our NHS Trusts and by working together to make best use of the equality delivery system. The Trusts also submit annual report updates on progress with meeting their equality objectives, on which the CCG gives detailed feedback.
We do this in two ways. The equality and diversity leads from the CCGs and our three local NHS trusts regularly to share good practice and develop joint strategy and implementation projects. We work together to make best use of the Equality Delivery System for example and share learning about interventions that work in reducing inequalities.
In addition to this, the trusts and independent sector providers submit to the CCGs annual update reports on progress in meeting their equality objectives (this includes progress with national initiatives like WRES and the Accessible Information Standard) and the CCG provides detailed feedback.
You can read more about our progress on equality and diversity on the new Bradford District and Craven CCG website.
1.13 Financial performance overview
In 2019/20, revenue resources of £258.7m were available to the CCG, comprising £249.9m for the commissioning of healthcare services (programme allocation), £3.4m for administration costs (running cost allocation) and £5.4m brought forward from last year.
The programme allocation included a national growth uplift of £12.6m (5.44%) on the 2018/19 resource baseline which represented the first year of the long term funding settlement for the NHS announced in January 2019. The overall increase on programme allocation was used to fund local healthcare service demand pressures and national policy requirements.
The running cost allocation remained at the same value as last year, which given pay cost pressures, represented a real terms reduction.
Overall, the CCG has continued to manage its resources effectively and met its statutory financial duties to keep revenue expenditure within available revenue resources, and to keep administration costs within the CCG’s running cost allocation. Overall, the CCG achieved a break-even position against its expenditure budget of £253.3m. Therefore, the total cumulative surplus for the CCG remains at £5.4m and this will be carried forward to 2020/21 for drawdown in future years.
The CCG did not have a capital resource limit or any capital expenditure in 2019/20.
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Our actual expenditure in 2019/20 across the main budget areas is shown below:
Total CCG net expenditure – 2019/20 (£253.3m)
Acute healthcare expenditure of £129.6m in 2019/20 was incurred as follows:
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For 2019/20, the CCG had a savings target of £5.0m, set against a number of schemes which targeted areas such as planned care, prescribing and urgent care. This was alongside schemes aimed to improve quality and deliver greater value money in the use of CCG resources.
For the year, the CCG achieved savings of £2.95m through a combination of savings and cost avoidance with the greatest savings being on prescribing, personalised commissioning and planned care. The £2.0m shortfall in the savings programme was funded by the use of non-recurrent budget underspends and contingency funds set aside to manage financial risk.
During the year the CCG has continued to develop new schemes that are expected to deliver further cost savings in 2020/21, but their implementation is likely to be delayed due to the need to direct resources to support the response to the COVID-19 pandemic.
Looking ahead, the CCG’s resource allocations from next year will form part of the new Bradford District and Craven CCG (formed from the merger of the three former CCGs in the Bradford District and Craven), but the challenges remain relating to increasing healthcare demand in excess of funding growth. Therefore, the financial outlook for our local health system will be challenging and will require further cost savings to be made over the medium term.
For 2020/21, the new CCG will need to manage its resources in line with the temporary financial management arrangements introduced in response to the COVID-19 pandemic, working with local health and care partners to move towards more normal working arrangements and to establish a firm financial footing for 2021/22 onwards.
1.13.1 Annual accounts – 2019/20 Our accounts have been prepared in accordance with the directions issued by the NHS Commissioning Board to show a true and fair view of the financial affairs of the CCG. These accounts comply with the requirements of the Department of Health group manual for accounts 2019/20.
The full accounts for the CCG are shown on page 124 onwards.
1.13.2 External audit KPMG LLP acts as our external auditor and the following services have been provided during the year:
Statutory audit services - total fees of £43,200.
No other services were provided.
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1.14 Engaging people and communities
Airedale, Wharfedale and Craven CCG is strongly committed to engaging with and involving local people in what we do. Often we work with the two other CCGs in Bradford District and Craven for this purpose. There are lots of different ways to take part, and we work with partners and providers to make sure people’s views and experiences are at the heart of commissioning health care.
We have continued to invest in and develop our People’s Board which brings different and valuable perspectives into the heart of commissioning. Engaging People, our grant funded programme with voluntary and community sector partners, continues to help us develop trusted relationships with local people and build capacity within communities, particularly those facing inequalities.
This report picks up a few highlights from engagement activity during this year, further detail and engagement reports are published on our websites.
One CCG: In May 2019, we engaged with local people and organisations on the proposal to create one new CCG to replace the three existing CCGs in Bradford district and Craven. Our approach to engagement was shaped by working with the People’s Board and local Healthwatch organisations, and culminated in a five week engagement period. The engagement report formed an important part of the information which was shared with members to inform their decision, published on our websites and sent to everyone who took part.
Following the decision to pursue the creation of a new CCG, we have built on the insight from our engagement to review and evaluate our structures for and approach to engaging with local people and communities. Since June we have worked with members of our Patient Network and our People’s Board to explore how to ensure stronger public voice and influence in commissioning.
We have involved local people in plans for the design of a new website for the new CCG, holding a number of focus groups in September 2019 to understand what information people wanted to find on a CCG website, and to gather ideas about design and accessibility.
Engagement training for our staff and partners: To embed our commitment to engagement across the organisation, and support all our staff to engage effectively with people and communities, we worked with NHSE to deliver the '10 steps to effective engagement' training course for our staff and partners across the system.
Youth volunteering project: With match-funding from NHS England’s Takeover Challenge we were able to employ a graduate intern for six months to lead a collaborative project on youth volunteering and participation. As part of this project group of young people from Bradford were supported to take part in the national Youth Voice summit, where they met with senior leaders including Sir Simon Stevens to discuss their expectations and experiences linked to the Long Term Plan.
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Working in partnership with local Trusts and Volunteering Bradford, we have established a successful youth volunteering hub which has been co-designed with young people. The hub supports young people to develop the skills and confidence needed for participation and volunteering roles and connects them to roles across the system.
Volunteers from this group took part in our system-wide careers event, showcasing opportunities in health and care to over 400 young people from schools across Bradford District and Craven.
End of life care: Working with our VCS partners Engaging People, we carried out engagement activity to shape the development of an End of Life strategy for Bradford District and Craven. We worked with faith groups, small VCS organisations and directly with communities to focus on understanding people’s feelings about preparing for end of life and what’s most important to them.
Happy, healthy, at home: Building on the 2017 #oursaycounts engagement, we worked with Healthwatch Bradford and District to deliver a follow up project, developing insight and engagement models that will support the 14 community partnerships.
A three-month engagement period involved extensive outreach across the 14 community partnerships in the district, gathering insight on how people stay healthy in their communities through self-care and local involvement. There were 58 focus groups and 56 separate outreach sessions carried out in public spaces, involving a wide range of groups and individuals from different backgrounds, age groups and walks of life. The project also commissioned an artist who worked with the communities involved to produce an illustration of feedback and a short film on different perspectives about being happy, healthy, at home.
Engagement reports for each community partnership area and an overall report drawing on themes throughout the district will be published. Healthwatch will continue working with community partnerships to develop models for effective engagement at a local level.
How we’ve engaged with local people and communities through Covid-19
Our engagement team has worked closely with partners across the system to support the cascade of key public health messages to local people and communities, particularly those who are most vulnerable. We have used our resources and networks to support the provision of information in community languages and accessible formats.
Working closely with VCS partners and local Healthwatch, we have gathered informal insight about people’s experiences of accessing health and care services during this time. Responding to concerns and identified gaps, this work has focused on specific issues or communities, including eastern European communities and families with young children. This data has been compiled
NHS Airedale, Wharfedale and Craven CCG Annual report and accounts 2019/20 9 43 through our Grassroots process and has also been shared widely, including with our quality committee, population health team, and system partners, in order to inform decision-making. This insight has also contributed to reports compiled by the West Yorkshire and Harrogate Health and Care Partnership.
As part of a wider system response, our engagement team are connecting with researchers from the Born in Bradford programme, council officers and VCS colleagues to explore how ‘soft intelligence’ gathered from a range of sources can build our picture of how communities have been impacted by the pandemic.
Our usual engagement structures and regular meetings have been cancelled during the coronavirus outbreak. We have kept in touch with people by establishing a newsletter sent out by email or post to people on our engagement database, sharing key messages and signposting to advice and information. Planned engagement projects and formal consultations have been put on hold; plans to restart this work will begin over the coming months.
Consultations: no formal consultations took place in 2019/20.
Communications and engagement strategy: a copy of our communications and engagement strategy is available here – it is currently being updated for the Bradford District and Craven CCG.
On our website, you can read more about our approach to engagement and read feedback from engagement work with patients, the public and other stakeholders.
1.15 Highlights of 2019/20
NHS Rainbow Badge: In October 2019 we worked with our three local NHS Trusts to launch the NHS Rainbow Badge as a system. The badge aims to educate staff on the inequalities facing LGBT+ people when accessing healthcare in order to work together to reduce these and ensure services are inclusive and accessible for all. To date, over 1,570 NHS colleagues have received face-to-face training before wearing a rainbow badge or lanyard. The campaign continues to grow, with training now being developed online. Staff who wear the badge have completed their training and pledged, and are regularly updated on issues affecting the LGBT+ community and additional training sessions.
The system-wide steering group behind the launch, which includes LGBT+ people and allies, continues to meet regularly to develop further initiatives – including engaging with local LGBT+ organisations to gain a deeper understanding of the experiences of local LGBT+ people when accessing NHS services.
Care Navigation: This year we have continued to roll out Care Navigation – a scheme designed to allow simple and quick signposting when a patient calls to book a GP appointment. Designed to ensure patients are able to access the right care from the right person, first time, Care Navigation expanded during 2019 to provide quick and easy access to additional voluntary and community services via GP
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To date, 66 practices have signed-up to the scheme with over 620 members of reception staff completing accredited training to ensure they are signposting correctly. Over 90% of all signposts completed when a patient calls to book a GP appointment are accepted by the patient and plans are in place to further expand the range of services available through Care Navigation at practices across Bradford district and Craven.
The communications campaign to support the launch and ongoing promotion of Care Navigation has been adopted by CCGs and GP federations in other areas of the country and includes materials for people with learning disabilities, those who are deaf/Deaf and people with vision impairment.
New lease of life for Castleberg Hospital: Following a consultation in 2018, we approved plans to re-open Castleberg Hospital, subject to major work to repair and refurbish the building. The first patients were welcomed by staff at Castleberg Hospital on Monday 7 October. The hospital provides bed-based intermediate care – often called ‘step-up and step-down’ care – for 10 people. It also provides short-term nursing care, pain relief and support for some people as they near the end of their life.
The experienced nursing, therapy and domestic services teams providing care and support at the hospital include an equal mix of new and returning staff. They continuing the hospital’s long-held tradition of providing a high-quality, friendly and caring service for people living in Craven.
Strategic partnering agreement to keep people happy, healthy at home: In spring 2019, health and care organisations, including our CCG, agreed to work together – through a strategic partnering agreement (SPA) – to keep people happy, healthy at home. The SPA brings together the NHS, local authority, voluntary and community sector organisations to transform and integrate services for local people. One of the key aims is to create sustainable, integrated and high quality services against the challenge of increasing demand. Over the next few years, services will be developed so local people are supported to take action and stay healthy, well and independent throughout their whole life. Prevention and early intervention will be an integral part of the work of the partnership with a greater focus on healthy lifestyles and self-care. Where people need access to care and support, it will be available through proactive joined up health, social care and wellbeing services.
Living Well: In June 2019, in partnership with Bradford Council, we celebrated the launch of Living Well. This is a new self-care and prevention initiative which is all about empowering people to make changes to improve their health and wellbeing. A full week of events and activities took place to help promote the new Living Well service and website. During the events, over 2,000 people proactively pledged to make one change to their lifestyle – 52% of these pledges were around moving more.
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Inspiring young people to pursue a career in health and care: On 4 March 2020, we held a careers fair in partnership with local health, care and voluntary organisations. It was open to students from across Bradford district and Craven and aimed to give them a taste of the wide range of career opportunities available in our sector.
Over 80 different health, care, independent and voluntary and community careers were showcased at the event to over 700 students. The event also gave students the opportunity to take part in interactive activities and workshops, giving them a taste of the practical side of a career in health and care. The event also addressed wider issues to support people in developing a career such as health and wellbeing, relationships and living in the wider world.
Creating one CCG for Bradford district and Craven: In June 2019, following a public consultation, we made the decision, along with NHS Bradford City CCG and NHS Bradford Districts CCG to form one single CCG for Bradford district and Craven, effective from 1 April 2020.
The plan to create one CCG is based on a national requirement of all CCGs to reduce their administration costs by 20% by 31 March 2020. The savings will be re-invested in patient care. In Bradford district and Craven, this equates to a £2.5m fall in administration costs from 1 April 2020. Reducing the number of CCGs will contribute approximately £1million of the planned savings.
A single CCG will give us a stronger voice in the new strategic partnerships between local statutory and other organisations, and in the West Yorkshire and Harrogate Health and Care Partnership. It will provide a fresh opportunity to re- think and evolve the way that we commission services and ensure that services are increasingly more relevant to the communities we serve.
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Chapter 2: Accountability report
1 Corporate governance report
1.1 Members’ report
1.1.1 Member profiles
Helen Hirst, accountable officer
Helen became the accountable officer for the three CCGs in the Bradford district and Craven – Airedale, Wharfedale and Craven, Bradford City and Bradford Districts – in October 2016 having previously been in the same role for Bradford City and Districts CCGs since their establishment in 2013.
In the last few years she has also had interim roles with NHS England (Director of CCG Development) and with the Vale of York CCG (accountable officer).
Helen has worked in Bradford since 1992 and was the deputy chief executive of the former Bradford and Airedale Teaching Primary Care Trust (PCT).
In 2010 Helen took a two-year secondment with the Department of Health as programme director for primary care commissioning as part of the NHS Commissioning Board establishment team.
Helen is very active through the West Yorkshire and Harrogate health and care partnership leading the system leadership and development programme and providing commissioning leadership to the mental health, learning disabilities and autism programme.
Outside of work Helen spends most of her time with her family and as her daughter’s taxi service! Fourteen year olds have very busy lives!
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Dr James Thomas, clinical chair
James is originally from London where he carried out his medical training and initially worked. He moved to Yorkshire in 1995 and trained as a GP in the Airedale area. In 2002, James joined Modality Fisher Medical Centre in Skipton as GP partner
He is passionate about education in local primary care services and teaches medical students, young doctors and GPs. He was the school lead for GP trainers for Health Education England in Yorkshire and Humber.
James is a GP executive at Airedale, Wharfedale and Craven CCG and has been the clinical chair at the CCG since 2017. He is also the Joint Senior Responsible Officer for the West Yorkshire and Harrogate Heath and Care Partnership Improving Population Health Programme and the clinical lead for Improving Planned Care across West Yorkshire and Harrogate Health and Care Partnership. He feels strongly that partnership working with people, communities and organisations across our West Yorkshire and Harrogate partnership is paramount to success of improving the health and care of Airedale, Wharfedale and Craven population.
Julie Lawreniuk, chief finance officer/deputy chief officer (until 31 August 2019)
Julie is a qualified accountant who has worked in the NHS since 1991. During this time, she has worked in a number of senior finance roles across West Yorkshire including, more recently, joint chief finance officer for Calderdale and Greater Huddersfield CCGs and executive director of finance and efficiency for NHS Calderdale. Julie is married and lives in Bradford. She has two grown up daughters and is a passionate supporter of Bradford City football club. Julie retired from the NHS in August 2019 and now fulfils a number of non-executive director and
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trustee roles.
Robert Maden, chief finance officer (from 1 September 2019)
Robert is a qualified accountant who has worked in the NHS since 1991 in a number of deputy finance director roles. He covered the role of chief finance officer of Bradford City and Bradford Districts CCGs for a short spell during 2016, and became chief finance officer on 1 September 2019.
Dr Peter Brunskill FRCOG, secondary care consultant
Peter is a consultant obstetrician and gynaecologist who held a post at Airedale General Hospital from 1991 to 2009 and worked as a locum consultant in various Hospitals in the UK and the Isle of Man from 2009 to 2017.
At Airedale Hospital he developed a number of new and innovative clinical services and led the gynaecological cancer team. From 1992 to 1996, he was chair of the district audit committee and the theatre management group, from 2005 to 2008. He played an active role in the development of maternity IT services, maternity risk management and the gynaecology out-patient facilities.
Since leaving Airedale Hospital, Peter has continued to live in the area and in addition to undertaking consultant locums, he works as a medicolegal expert witness in the UK, Ireland and elsewhere. He is an active medical teacher both for the Advanced Life Support Group in the UK and for the Liverpool School of Tropical Medicine in Africa.
His main passions outside work are golf and the success of Burnley Football Club.
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Angie Clegg, registered nurse
Angie qualified as a nurse at St James’ Hospital in Leeds in 1984. Since then she has worked as a nurse, clinical leader, consultant nurse, lecturer, senior manager and director in Leeds, Bradford and Airedale. She has been awarded a BSc in health studies from Leeds Metropolitan University and an MSc in leadership and advanced practice from her studies at Bradford University. As a nurse leader, Angie’s research, publications and area of expertise includes innovations in intermediate care, out of hospital care, advanced practice, clinical leadership and quality.
Pam Essler, lay member (patient and public involvement) and deputy chair
Pam has a long-standing involvement with the NHS - as a lay person at a local, regional and national level. She was chair of Airedale Primary Care Trust (PCT) before Bradford and Airedale Teaching Primary Care Trust was formed, where she was deputy chair.
She has also been associated with the voluntary sector for many years and is at present Chair of Bradford and Airedale Citizens Advice and Keighley Healthy Living. She is also trustee of a number of local charities.
For the three CCGs in Bradford district and Craven, Pam is chair of the individual funding request committee.
She has four grandchildren, who she spends lots of time with and jokingly refers to looking after them as her new exercise regime.
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Neil Fell, lay member (governance)
Neil has worked in numerous NHS roles over many years. After a short period in industry he began his NHS career in Rotherham in 1974. Between 1974 and 1986, he held a number of accounting positions with Rotherham and Sheffield health authorities. In 1986, he joined Bradford Area Health Authority as chief internal auditor and held a number of management roles before he was appointed as director of finance in 1993. He was an executive director at Bradford Health Authority and at the Airedale Primary Care Trust (PCT) until 2007.
Since then he has had a variety of finance related roles as a consultant, finance director and financial trustee.
Married with a grown-up family, he is a fellow of the Association of Chartered Certified Accountants. When not working he enjoys hill walking, fishing and watching most sports – particularly football.
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Bryan Millar, lay member (finance)
Bryan retired as chief executive of Bradford Teaching Hospitals NHS Foundation Trust (BTHFT) in August 2014, having worked in the NHS since 1977 in a variety of roles within Yorkshire and the North East of England. After occupying a number of posts at district and regional health authorities, he joined Northgate and Prudhoe NHS Trust becoming their director of finance and performance management in 1993.
He became director of finance at Bradford Community Health NHS Trust in 1999 before moving to Bradford South and West Primary Care Trust where he was director of finance and deputy chief executive. Bryan joined BTHFT in October 2005. He is a fellow of the Association of Chartered Certified Accountants.
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In addition to his former role as chief executive of BTHFT, Bryan was also a board member of Health Education England, Yorkshire and the Humber (and chair of its finance, governance and risk committee), chair of the local comprehensive research network partnership group, and director of Medipex (an intellectual property company and NHS innovation hub).
Nancy O’Neill, executive director/deputy chief officer
Nancy qualified as a registered general nurse in 1984 before going on to work as a practice nurse providing health promotion and long- term conditions services.
With the development of primary care groups in 1998, Nancy was appointed to the role of nurse representative on the board of Bradford City Primary Care Group. During this time she completed a degree in community health and developed an interest in implementing clinical governance in practice.
After completing a masters in quality assurance in health and social care, Nancy held a number of director posts in NHS commissioning organisations with responsibility for service development and ensuring effective systems for managing clinical and organisational risk and governance.
Nancy also has significant experience in operational management, having spent a number of years in the post of chief operating officer for an arm’s length NHS provider organisation with around 2,000 staff and over 50 different services. More recently, Nancy has been working across health and social care organisations to develop and implement an effective strategy for promoting collaboration through the development of effective relationships.
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Outside work, Nancy’s main passions are her four grandchildren, travelling and watching rugby league.
Michelle Turner, director of quality and nursing
Michelle Turner has been director of quality and nursing for Airedale, Wharfedale and Craven, Bradford Districts and Bradford City CCGs since 2016 and for the latter two CCGs since 2013. She qualified as a general nurse in 1989 in Cambridge, and as a health visitor and district nurse in London in 1994. She holds a BSc in community health and an MSc in contemporary health and social care policy. She practised as a health visitor in London’s inner city for over a decade before entering management and leadership. Prior to her substantive director post Michelle had interim executive roles in the transformation of services and primary care for primary care trusts in London and Bradford. She enjoys spending time with her husband and cats and living the rural life. She is a member of her local community residents’ association and enjoys litter picking with her community and photography.
Sarah Muckle, public health representative
Sarah is Bradford’s director of public health. She worked previously in Bradford as deputy director of public health and in Kirklees as acting director of public health, as well as a public health consultant in both the primary care trust (PCT) and local authority. Some of her key achievements include developing a community-based chronic pain service which achieved national recognition and informed a national chronic pain strategy and Royal College of General Practitioners (RCGP) commissioning guidance, development of an online self-care tool that was nominated for a national award, and development of a nationally recognised self-care programme.
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Sarah started her public health career in the Scottish Borders working in a role focused on applying public health knowledge and skills in primary care and community services to embed principles around improving health, protecting health and reducing health inequalities.
1.1.2 Member practices
Our member practices are:
Addingham Medical Centre2 IG Medical (Ilkley Moor and Cross Hills Group Practice1 Grassington)2 Dyneley House Surgery2 Ilkley and Wharfedale Medical Farfield Group Practice1 Practice2 Fisher Medical Centre1 Kilmeny Group Medical Practice1 Grange Park Surgery2 Ling House Medical Centre2 Haworth Medical Practice1 North Street Medical Practice3 Holycroft Surgery1 Oakworth Medical Practice1 Silsden Group Practice1 1 Modality Partnership Townhead Surgery2 2 Wharfedale, Airedale, Craven Alliance 3 Affinity Care
1.1.3 Composition of the governing body
The composition of the governing body can be found on page 64 onwards of this annual report. 1.1.4 Committee(s), including audit committee The composition of the committees of the CCG and committees of the governing body can be found on page 64 onwards of this annual report.
1.1.5 Register of interests
Our registers of interests can be found on our website.
1.1.6 Personal data related incidents
During 2019-20 NHS Airedale, Wharfedale and Craven CCG reported one incident via the Data Protection and Information Toolkit to NHS Digital and the Information Commissioner’s Office (ICO). The incident arose following an appeal against a continuing healthcare funding decision and was due to the use of a form on which the CCG’s postal address had not been updated following the CCG’s premises move from Douglas Mill to Scorex House in October 2019 (the incident occurred a month later).
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Consequently, legal documents submitted by the patient’s family to the CCG were delivered to the wrong address. The documents were later returned to the patient’s family by Royal Mail, with the envelope having been opened then re-sealed and marked as ‘return to sender’. We have been unable to identify if the envelope had been opened by someone at the CCG’s previous premises or by officials in the postal service.
In line with NHS data protection breach assessment criteria, this incident would not have been deemed of a level that required reporting to the ICO. However, following receipt of a complaint from the ICO, whom the patient’s family had contacted, the incident was retrospectively logged. It also transpired that a staff member within the personalised commissioning department had been aware of the data breach prior to the ICO complaint but had not reported this internally as an incident.
We have had no further correspondence from the ICO in relation to the incident reported. With respect to the ICO complaint, we have confirmed the following remedial actions have been taken:
The personalised commissioning department undertook a review of all template forms and letters and ensured that all included the correct postal address.
In addition, the personalised commissioning department has undertaken a whole system review of paper documentation systems, with a view to increasing the level of electronic communications where appropriate.
Relevant staff in the personalised commissioning department have had refresher training in what constitutes an information governance incident/data breach and the process for reporting these internally.
The Caldicott Guardian and executive director who lead the personalised commissioning department were informed of the incident and the ICO complaint.
A further eight data/information governance related CCG incidents or near misses were reported during the year across the Bradford district and Craven CCGs; none of these were classed as ‘serious’ or required reporting to the NHS Digital and the ICO. All incidents reported within the CCG are reviewed by the audit and governance committee.
1.1.6 Statement of disclosure to auditors
Each individual who is a member of the CCG at the time the members’ report is approved confirms:
so far as the member is aware, there is no relevant audit information of which the CCG’s auditor is unaware that would be relevant for the purposes of the audit report; the member has taken all the steps that they ought to have taken in order to make him or herself aware of any relevant audit information and to establish
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that the CCG’s audit committee is aware of it. 1.1.7 Modern Slavery Act
We fully support the government’s objectives to eradicate modern slavery and human trafficking but do not meet the requirements for producing an annual slavery and human trafficking statement as set out in the Modern Slavery Act.
1.2 Statement of accountable officer’s responsibilities
The National Health Service Act 2006 (as amended) states that each clinical commissioning group (CCG) shall have an accountable officer and that officer shall be appointed by the NHS Commissioning Board (NHS England). NHS England has appointed Helen Hirst to be the Accountable Officer of Airedale, Wharfedale and Craven CCG.
The responsibilities of an accountable officer are set out under the National Health Service Act 2006 (as amended), Managing Public Money and in the clinical commissioning group accountable officer appointment letter. They include responsibilities for:
the propriety and regularity of the public finances for which the accountable officer is answerable; keeping proper accounting records (which disclose with reasonable accuracy at any time the financial position of the clinical commissioning group and enable them to ensure that the accounts comply with the requirements of the Accounts Direction; for safeguarding the clinical commissioning group’s assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities); the relevant responsibilities of accounting officers under Managing Public Money; ensuring the CCG exercises its functions effectively, efficiently and economically (in accordance with section 14Q of the National Health Service Act 2006 (as amended)) and with a view to securing continuous improvement in the quality of services (in accordance with Section14R of the National Health Service Act 2006 (as amended)); ensuring that the CCG complies with its financial duties under sections 223H to 223J of the National Health Service Act 2006 (as amended).
Under the National Health Service Act 2006 (as amended), NHS England has directed each clinical commissioning group to prepare for each financial year a statement of accounts in the form and on the basis set out in the Accounts Direction.
The accounts are prepared on an accruals basis and must give a true and fair view of the state of affairs of the clinical commissioning group and of its income and expenditure, statement of financial position and cash flows for the financial year.
In preparing the accounts, the accountable officer is required to comply with the
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requirements of the Government Financial Reporting Manual and in particular to:
observe the Accounts Direction issued by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis; make judgements and estimates on a reasonable basis; state whether applicable accounting standards as set out in the Government Financial Reporting Manual have been followed, and disclose and explain any material departures in the accounts; and prepare the accounts on a going concern basis; and confirm that the Annual Report and Accounts as a whole is fair, balanced and understandable and take personal responsibility for the Annual Report and Accounts and the judgements required for determining that it is fair, balanced and understandable.
To the best of my knowledge and belief, and subject to the disclosure set out below, (eg directions issued, s30 letter issued by external auditors), I have properly discharged the responsibilities set out under the National Health Service Act 2006 (as amended), Managing Public Money and in my Clinical Commissioning Group Accountable Officer Appointment Letter.
I also confirm that:
as far as I am aware, there is no relevant audit information of which the CCG’s auditors are unaware, and that as accountable officer, I have taken all the steps that I ought to have taken to make myself aware of any relevant audit information and to establish that the CCG’s auditors are aware of that information.
Helen Hirst Accountable officer NHS Airedale, Wharfedale and Craven CCG
24 June 2020
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1.3 Governance statement
1.3.1 Introduction and context
NHS Airedale, Wharfedale and Craven CCG is a body corporate established by NHS England on 1 April 2013 under the National Health Service Act 2006 (as amended).
The clinical commissioning group’s statutory functions are set out under the National Health Service Act 2006 (as amended). The CCG’s general function is arranging the provision of services for persons for the purposes of the health service in England. The CCG is, in particular, required to arrange for the provision of certain health services to such extent as it considers necessary to meet the reasonable requirements of its local population.
As of 1 April 2019, the clinical commissioning group is not subject to any directions from NHS England issued under Section 14Z21 of the National Health Service Act 2006.
1.3.2 Scope of responsibility
As accountable officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the clinical commissioning group’s policies, aims and objectives, whilst safeguarding the public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out under the National Health Service Act 2006 (as amended) and in my Clinical Commissioning Group Accountable Officer Appointment Letter.
I am responsible for ensuring that the clinical commissioning group is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity. I also have responsibility for reviewing the effectiveness of the system of internal control within the clinical commissioning group as set out in this governance statement.
1.3.3 Governance arrangements and effectiveness
The main function of the governing body is to ensure that the group has made appropriate arrangements for ensuring that it exercises its functions effectively, efficiently and economically and complies with such generally accepted principles of good governance as are relevant to it. The following sections set out how this main function is achieved.
1.3.4 Constitution and governance structure
Our governance framework is clearly set out in the constitution. Our original constitution was approved by the NHS Commissioning Board in January 2013 as part of the CCG establishment process. As we have developed our structures further and in response to legislative changes, amendments have been necessary to
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the constitution and these have been approved by member practices and NHS England.
Our constitution sets out a commitment that we will promote good governance and proper stewardship of public resources in pursuing our goals and in meeting our statutory duties. Good corporate governance arrangements are critical to achieving our objectives and are reflected in the duties of the committees and sub-committees; and in the roles of CCG officers.
The CCG’s scheme of reservation and delegation sets out those decisions that are:
reserved to the membership as a whole; delegated to the CCG’s committees and sub-committees, the governing body, its committees and sub-committees, individual members and employees
In March 2019 CCG members approved a revised version of the constitution which was updated in line with the new CCG model constitution issued during the year and which was approved by NHS England in July 2019.
Terms of reference for committees of the CCG and committees of the governing body are available and our governance structure, from 1 July 2017, when collaborative governance arrangements were established with NHS Bradford Districts CCG and NHS Bradford City CCG, is shown below:
Figure 3: CCG governance structure during 2019/20
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1.3.5 Membership body and governing body
Council of members
Role: The council of members plays a crucial role in ensuring engagement of all members in the development and operation of our CCG, including a key role in holding the clinical executive and governing body to account. The council of members is accountable to the member practices.
Key responsibilities: The council of members
agrees the overall vision, values and strategic direction of the group; reviews the effectiveness of the governing body and holds it to account for the delivery of its functions; approves the selection and appointment process for governing body and (where applicable) clinical executive members and arrangements for succession planning; recommends the appointment of the accountable officer to NHS England; works effectively with all GPs and primary care clinical and practice staff to contribute to the practice’s views into commissioning decisions; considers and approves applications to NHS England in respect to changes to the constitution, the CCG’s standing orders, scheme of reservation and delegation and prime financial policies; maintains a positive and responsive relationship with NHS England and member practices; sets a culture of continuously improving the services for patients, carers, communities and member practices.
Membership and attendance: The council of members has representation from a clinician from each of the CCG’s member practices; this representative cannot be an elected GP member of the clinical executive. Practice managers also attend council of members meetings but legally are unable to act as member practice representatives (who must be a healthcare professional). On behalf of the membership, the chair is elected by the member practice representatives of the council of members. Dr Caroline Rayment is chair of the council of members.
The council of members has met six times during 2019/20, including the 2018/19 CCG annual general meeting held jointly in public with the governing body and clinical executive in September 2019 and a joint meeting with the council of members of Bradford City CCG and the council of representatives of Bradford Districts CCG in February 2020. Attendance by practice is shown overleaf.
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Townhead Surgery 6
Silsden and Steeton Medical Practice 4
Oakworth Medical Practice 4
North Street Surgery 3
Ling House Medical Centre 6
Kilmeny Group Medical Practice 4
Ilkley and Wharfedale Medical Pracdtice 4
IG Medical 6
Holycroft Surgery 4
Haworth Medical Practice 4
Grange Park Surgery 6
Fisher Medical Centre 4
Farfield Group Practice 4
Dyneley House Surgery 6
Cross Hills Group Practice 4
Addingham Medical Centre 0
0 1 2 3 4 5 6
Figure 4: 2019/20 attendance at council of members
Council of members highlights 2019/20
Approved: Membership: the application to NHS England to Practice establish a new CCG for Bradford Representatives district and Craven from 1 April 2020. the application of the organisational change policy for the appointment to governing body and senior leadership team posts in the new CCG. 100% the constitution for the new CCG. the terms of reference for committees of
the CCG. Standing agenda Items the council’s own terms of reference, following review. Declaration of interests
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Received: Minutes of previous the 2018/19 accounts and annual report meetings at a joint meeting in public with the Action log governing body and clinical executive. Clinical chair’s Report regular financial position and QIPP Members questions and updates for both the CCG and the wider answers – this is a health and care system. significant agenda item at all updates from the West Yorkshire and meetings Harrogate health and care partnership Updates on local, system updates on the development of primary and national developments care networks and community partnerships. regular updates on the development of a new CCG for Bradford district and Craven, including: o proposed new governance arrangements, organisation structures and new ways of working o consideration of future ways to engage members
Conclusion: The council of members has fulfilled its role and responsibilities.
Governing body
The governing body normally meets in public six times per annum; during 2019/20, an additional meeting was held to approve the 2019/20 financial plan.
Since July 2017, these meetings have been held as ‘committees in common’ with the governing bodies of NHS Bradford Districts CCG and NHS Bradford City CCG. In addition to meetings in public, the governing body and the clinical executive have joint strategy and development sessions up to six times a year. During 2019-20, all of these sessions were held jointly with NHS Bradford Districts CCG and NHS Bradford City CCG.
Role: The governing body is responsible for ensuring that appropriate arrangements are in place to exercise its functions effectively, efficiently and economically; and in accordance with our principles of good governance.
Key responsibilities: The governing body has responsibility for
ensuring that the CCG has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with the CCG’s principles of good governance (its main function). determining the remuneration, fees and other allowances payable to employees or other persons providing services to the CCG and the
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allowances payable under any pension scheme it may establish under paragraph 11(4) of schedule 1A of the 2006 Act, inserted by schedule 2 of the 2012 Act. approving any functions of the CCG that are specified in regulations. monitoring performance in line with our reporting mechanisms. providing assurance to the CCG that its committees are undertaking their functions in accordance with the constitution. approving the financial plan.
Membership and attendance:
Dr James Thomas Clinical chair and elected GP Vacant Elected GP - this non-statutory governing body role was not filled during 2019/20 Pam Essler Lay member, patient and public involvement and deputy chair Neil Fell Lay member, governance Bryan Millar Lay member, finance Angie Clegg Registered nurse Peter Brunskill Secondary care consultant Helen Hirst Chief officer Julie Lawreniuk Chief finance officer and deputy chief officer (to 31 August 2019) Robert Maden Chief finance officer (from 1 September 2019) Michelle Turner Director of quality and nursing Nancy O’Neill CCG executive director
In addition to the members above, Sarah Muckle, director of public health at Bradford Metropolitan Distract Council, attends governing body meetings in a non- voting, advisory capacity.
7 6 5 4 3 2 1 0
Possible Actual
Figure 5: 2019/120 attendance at governing body
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Governing body highlights 2019/20
The governing body: Membership supported the application to NHS England to create a new CCG for 18% Bradford district and Craven from 1 April 2019 considered the following strategic 46% themes (which include a patient story element): 36% o personalised commissioning o planned care o living well Lay Executive GP o urgent and emergency care o community partnerships o carers’ strategy Standing agenda items: approved the 2019/20 operational and financial plans Declaration of interests reviewed and approved the Minutes of previous meetings emergency planning, preparedness Action log and resilience self-assessment, Chair and chief officer’s report statement of compliance and (including updates on the clinical improvement plans executive, the joint clinical approved amendments to the policy committee, the council of members on conflicts of interests and and the joint committee of West standards of business conduct and Yorkshire and Harrogate CCGs the policy on the offer and receipt of Quality report gifts, hospitality and sponsorship Finance, contracting and approved the policy on joint working performance report with the pharmaceutical and related Strategic partnerships report industries Bradford health and care approved the governing body partnership report assurance framework as a fair Reports from committee chairs reflection of the CCG’s strategic risk High level risk report position Minutes of JQC, JFPC, PCCC, received assurance on the process audit and governance and for the creation of one CCG for remuneration committees Bradford District and Craven INVOLVE engagement tracker undertook a review of governing Questions from the public body effectiveness approved revisions to the terms of Annual reports received: reference of the audit and governance committee and primary Audit and governance committee care commissioning committee External audit letter approved pay awards for staff Safeguarding outside of agenda for change, in
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line with recommendations from the Emergency preparedness, remuneration committee. resilience and response Human resources
Conclusion: The governing body has fulfilled its role and responsibilities.
1.3.6 Committees of the CCG and committees of the governing body
Clinical executive
The clinical executive is a committee of the CCG and as such is accountable to member practices via the council of members. Assurance on the work of the clinical executive is provided to the governing body via the clinical chair’s report.
Role: The clinical executive is responsible for leading the development of the CCG’s vision and strategy, developing and approving commissioning plans and overseeing the commissioning process.
Membership and attendance:
Dr James Thomas Elected GP and clinical chair Dr Brendan Kennedy Elected GP Dr Graeme Summers Elected GP Dr Jake Jeffrey Elected GP Vacant Elected GP – this role was not appointed to during 2019/20 Vacant Elected GP – as above Helen Hirst Chief officer Julie Lawreniuk Chief finance officer and deputy chief officer (to 31 August 2019) Robert Maden Chief finance officer (from 1 September 2019) Michelle Turner Director of quality and nursing Nancy O’Neill CCG executive director
There is a standing invitation for a public health representative from Bradford Metropolitan District Council to attend clinical executive meetings in a non-voting, advisory capacity.
The clinical executive met on fourteen occasions during 2019/20. Attendance is recorded below.
The frequency of joint clinical committee meetings was increased from once to twice per month in the period September to December 2019 and the number of clinical executive meetings reduced. From January 2020, the senior leadership team of the new CCG meeting in shadow form took over the role previously held by both the clinical executive and the joint clinical committee.
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14 12 10 8 6 4 2 0
Possible Actual
Figure 6: 2018/19 attendance at clinical executive
Clinical executive highlights 2019/20
The clinical executive: Membership received the polypharmacy review project and formally agreed that WACA and Modality will host the teams which will deliver the scheme for two years. 40% agreed extra sessional support for the Assist team for 12 months. discussed the service level agreement with 60% NHS Harrogate and District CCG for medicines management. received a demonstration of the RaidR tool and agreed to support the use of the tool for GP Executive population health management. agreed to reduce the number of clinical executive meetings and increase the number of JCC meetings Standing or regular agenda considered the proposal for the Valley View items short-term residential care unit and have received regular updates on progress. Declarations of interest discussed the MSK wellness service and Minutes of the previous meeting considered the notice period for the service. and action log agreed the approach for the short- and long- Updates from finance (including term options detailed in the Settle scoping the financial recovery plan), report. performance, contracting and were asked to support the extension of the current contract arrangements for the QIPP extended access service to March 2021 (for Updates relating to the WY&H approval by the governing body) joint committee of CCGs, the have been kept informed of policies and Bradford district and Craven pathways that have been agreed at West system and the AWC health
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Yorkshire level. and care partnership received the Local Industrial Strategy. Updates relating to new CCG ratified the minutes of the area prescribing development committee. Risk register (bi-monthly) and agreed the recommendation to give notice to key risk updates from JQC and de-commission enhanced primary care. JFPC received a paper regarding estate priorities in Keighley and supported to move to the next
stage of the options. Reaffirmed their support
of an option of a new build if it is affordable within the parameters that have been set out.
Conclusion: The clinical executive has fulfilled its role and responsibilities.
Joint clinical committee (JCC)
Role: The purpose of the JCC is to operate as a joint committee of the three Bradford District and Craven CCGs with delegated decision-making for the discharge of specific commissioning functions as set out in its terms of reference and annual work plan. In addition, the JCC acts as a key forum for communications and information sharing between the clinical executives/executive group of the three Bradford District and Craven CCGs.
As part of the move towards the establishment of the new CCG for Bradford District and Craven, the frequency of JCC meetings was increased from once to twice per month in the period September to December 2019 and the number of clinical executive meetings reduced. From January 2020, the senior leadership team of the new CCG meeting in shadow form took over the role previously held by JCC.
Key responsibilities: the JCC
reviews and approves commissioning statements and policies. reviews and makes recommendations to each CCG’s governing body on the Bradford district and Craven CCGs’ memorandum of understanding that governs collaborative working arrangements. informs CCG input to the joint committee of the West Yorkshire and Harrogate CCGs. has delegated decision-making for system wide strategic commissioning areas as set out in the JCC work plan - for 2019/20 these have been: - acute provider collaboration - mental health and learning disabilities - urgent and emergency care - children and young people - cancer - planned care - medicines optimisation
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has established the joint individual funding request panel (JIRFP) as a sub- committee of JCC and receives reporting from the panel on its work
Membership and attendance:
Dr Akram Khan Clinical chair – BC (to 31 July 2019) Dr James Thomas Clinical chair – AWC (JCC chair from 1 October 2019; prior to this the role of JCC Chair rotated between Dr Akram Khan, Dr James Thomas and Dr Andy Withers) Dr Andy Withers Clinical chair – BD Dr Brendan Kennedy Elected GP – AWC Dr Sohail Abbas Elected GP/clinical chair from 1 August 2019 - BC Dr Louise Clarke Elected GP – BD Dr Junaid Azam Elected GP - BC Helen Hirst Chief officer Julie Lawreniuk Chief finance officer (to 31 August 2019) Robert Maden Chief finance officer (from 1 September 2019) Michelle Turner Director of quality and nursing Nancy O’Neill Executive director - AWC Liz Allen Executive director – BC Ali Jan Haider Executive director – BD
Key: BC – Bradford City CCG BD – Bradford Districts CCG AWC – Airedale, Wharfedale and Craven CCG
There is a standing invitation for a representative from public health (Bradford Metropolitan District Council) to attend JCC meetings in an advisory, non-voting capacity.
12 10 8 6 4 2 0
Possible Actual
Figure 7: 2019/20 attendance at JCC
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Joint clinical committee highlights 2019/20
Received updates on and input to the Membership following: medicines optimisation reducing prescribing levels of over the
counter medicines and low value medicines 50% 50% system-wide equality and diversity referral analysis and West Yorkshire HIP report patient safety strategy GP Executive LAMP programme anticoagulation services quality improvement strategy Standing and regular agenda items Approved, supported, endorsed or Declarations of interest recommended: Minutes of the last meeting adoption of the obesity surgery and action log. commissioning policy for adults Finance, performance, recurrent investment for a band 4 post contracting, QIPP and within the BDCFT children looked after team quality to address capacity issues for initial health Corporate risk register assessments for children looked after (CLA) Joint committee of the West national guidance for flash glucose Yorkshire and Harrogate monitoring CCGs. funding support for implementation of the Bradford District and statutory guidance for child death reviews Craven health and care business intelligence commissioning system. intentions adoption of a commissioning policy for open MRI scanner the organisation design principles and the proposed principles for job design for the new CCG the terms of reference for the transition programme board the carers’ strategy the functions of the medicines and prescribing team a contract extension until 31 March 2020 for GP streaming at BTHFT. agreed to pilot a model for complex weight management for children and young people – Bradford City CCG only. discussed public health support and agreed that instead of a formal memorandum of
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understanding between the new CCG and public health, the strategic partnering agreement (SPA) will be utilised with a focus on the health and care partnership boards
Conclusion: The joint clinical committee has fulfilled its role and responsibilities.
Senior leadership team (SLT)
The SLT began meeting in January 2020 as part of the move towards the establishment of the new CCG. The SLT, which meets weekly, replaced the clinical executives/executive of each CCG and the joint clinical committee.
Role: The role of the senior leadership team is to: a) lead the development of CCG vision and strategy b) develop and approve commissioning plans and policies c) oversee the commissioning process d) oversee the operating plans of the CCG
Dr James Thomas Clinical chair (co-chair of SLT) Helen Hirst Chief officer (co-chair of SLT) Robert Maden Chief finance officer Dr Sohail Abbas Strategic clinical director of population health and wellbeing/deputy clinical chair Dr Louise Clarke Strategic clinical director of strategy and planning Dr Junaid Azam Strategic clinical director of transformation and change Dr Dave Tatham Strategic clinical director of keeping well in hospital Dr Graeme Summers Strategic clinical director of keeping well in the community Nancy O’Neill Strategic director of transformation and change/deputy chief officer Michelle Turner Strategic director of quality and nursing Liz Allen Strategic director of organisation effectiveness Ali Jan Haider Strategic director of keeping well at home Dr Mutaz Aldawoud Chief clinical information officer
There is a standing invitation for a representative from public health (Bradford Metropolitan District Council) to attend SLT meetings in an advisory, non-voting capacity, as well as for the integration and change board programme director (James Drury) and system finance executive lead (Andrew Copley). In addition, Dr Andy Withers, BD Clinical Chair (retiring 31.03.20) continued attending SLT meetings during April and May as part of the COVID-19 response.
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SLT met 10 times from January 2020 and attendance is set out below:
10 9 8 7 6 5 4 3 2 1 0
Possible Actual
Figure 8: 2019/20 attendance at SLT
Senior leadership team highlights 2019/20 (from January 2020)
Kept an overview of the work ongoing in Membership the move to one CCG, the GPIT data quality service provision 2020/21,
Bradford IT transition from eMBED to 46% The Health Informatics Service (THIS) 54% and the system programme and governance review. Executive GP Agreed that a task and finish group should be convened to identify a solution to the ongoing problem of Standing or regular agenda items issuing death certificates out of normal Declarations of interest hours (bank holidays). Minutes of the last meeting and Supported the Reducing Inequalities in action log City (RIC) proposals around central Updates on finance, performance, locality integrated care service (CLICS) contracting, quality and risk and primary care workforce expansion Updates on children’s services Supported a proposal for funding for Updates and decision log from community partnerships associate leadership team Supported an invest to save proposal meeting for prescribing Joint committee of the West Discussed the BMDC draft budget and Yorkshire and Harrogate CCGs. responded to the BMDC CEO Bradford district and Craven Agreed to adopt the commissioning health and care system policy: access to infertility treatment v11 and the revised commissioning policy
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for rhinoplasty, rhino-septoplasty and septoplasty. Supported a proposal to produce a business case to procure a digital system to enable the collection, analysis and reporting of the quality charter dataset. Reviewed progress made in regard to meeting the statutory duties placed on the CCG and NHS health service providers in respect of CLA, children’s autism (assessment and diagnosis) Agendas from mid-March moved to predominantly impact of COVID-19 on all areas of CCG business
Conclusion: The senior leadership team has fulfilled its role and responsibilities.
Joint quality committee (JQC)
Role: The role of the JQC is to review and provide assurance to the governing bodies of Bradford Districts CCG, Bradford City CCG and Airedale, Wharfedale and Craven CCG on the degree to which services commissioned by the CCGs are safe, effective and deliver the best outcomes for local populations.
The scope of the JQC is all services commissioned by the CCGs, including those delegated by NHS England (GP services), for children, young people and adults including those services that are jointly commissioned with the local authority and those services commissioned from the voluntary and community sectors.
For a full list of JQC’s detailed responsibilities, please see the terms of reference document on our website.
Membership and attendance
David Richardson Lay member for patient and public involvement –BD (chair) and for BC from 1 May 2019 Max McLean Lay member for patient and public involvement – BC (to 30 April 2019) Pam Essler Lay member for patient and public involvement – AWC Angie Clegg Registered nurse – AWC, BC, BD Peter Brunskill Secondary care consultant - AWC John Young Secondary care consultant – BC, BD Dr Graeme Summers Executive GP – AWC (to 30 June 2019) Dr James Thomas Executive GP and clinical chair – AWC (from 1 July 2019)
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Dr Andy Withers Executive GP and clinical chair – BD Michelle Turner Director of quality and nursing Fiona Jeffrey Associate director of corporate affairs Healthwatch Lay representative from Healthwatch
JQC held 12 meetings during 2019/20 and attendance is detailed below:
12 10 8 6 4 2 0
Possible Actual
Figure 9: 2019/20 attendance at JQC
Joint quality committee highlights 2019/20
In addition to standing and regular items, other agenda items are identified through exception reporting, persistent quality Membership concerns or discussions emerging from 18% local, regional or national initiatives or issues.
During 2019/20 these have included deep 18% dive discussions and reports on: 64%
research and development cancer Lay & Professional GP Executive
stroke services children’s services including 0-19, Standing/regular agenda items CAMHS, autism, SEND, CLA review suicide deep dive Declaration of interests BDCFT serious incident deep dive Minutes of previous meetings IT incident action plan and action log LeDeR and learning from all deaths Quality report supported by the one quality approach across the local grassroots (patient experience) system and performance reports
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ethnic audit Serious concerns/incidents reviewed the committee’s report effectiveness, its work plan and its Updates from the Bradford terms of reference district and Craven system quality committee JQC risk register report (every second meeting) Annual reports: CCG and provider safeguarding adults and children reports, care home report Issues to highlight to clinical board/executive and governing bodies
Conclusion: The JQC is achieving and delivering its role, responsibilities and functions.
Joint finance and performance committee (JFPC)
Role: The role of the joint finance and performance committee is to advise and support the governing body through performance oversight of key financial and performance indicators/targets, including QIPP, as specified in the CCGs’ strategic and operational plans.
For a full list of JFPC’s detailed responsibilities, please see the terms of reference document on our website.
Membership and attendance:
Neil Fell Lay member for governance – AWC (chair) Bryan Millar Lay member for finance – AWC, BC, BD Julie Lawreniuk Chief finance officer – AWC, BC, BD (to 31 August 2019) Robert Maden Chief finance officer – AWC, BC, BD (from 1 September 2019) Nancy O’Neill Director: AWC health and care partnership Liz Allen Director: Bradford health and care partnership Dr Dave Tatham Elected GP – BD
The joint finance and performance committee met 12 times during 2019/20 and attendance has been as follows:
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12
10
8
6
4
2
0 Neil Fell Bryan Julie Robert Nancy Liz Allen Dr Dave Millar Lawreniuk Maden O’Neill Tatham
Possible Actual
Figure 10: 2019/20 attendance at JFPC
Joint finance and performance committee highlights 2019/20
At each meeting JFPC has monitored the finance and Membership performance position of each of the Bradford and District CCGs. 17%
In particular JFPC has reviewed the 33% operation of the fixed income contracts between the CCGs and the three Bradford Foundation Trusts, the challenges and achievements against QIPP targets and their impact on individual CCG financial performance and 50% performance against NHS Constitution and operational plan Lay Executive GP targets. The CCG has met its statutory financial duties in 2019/20. Standing agenda items In alternate months the committee has received reports in respect of Declarations of interest the financial and performance risks Minutes of the last meeting and action held on the CCG risk register and log reviewed both the risk scores and Performance report the actions being taken to address Contracting report those risks. QIPP report Finance report In addition, JFPC has also received Issues to highlight to clinical in-depth presentations and reports board/executive and governing bodies covering other significant areas of JFPC risk register (every second
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CCG expenditure: meeting)
Mental health and learning disability investments, Continuing care and personalised budget arrangements and Primary care expenditure Emergency planning resilience and response arrangements.
Conclusion: JFPC has assessed its performance against its terms of reference and concluded that the committee works effectively, has a good level of support and has fulfilled its role and responsibilities.
Joint committee of the West Yorkshire and Harrogate CCGs
Role: The joint committee is part of the WY&H Health and Care Partnership, with delegated authority to take commissioning decisions at West Yorkshire and Harrogate level on specific programmes including: cancer, elective care/standardisation of commissioning policies, mental health, stroke and urgent care. The committee aims to ensure that its decisions include public and patient engagement, clinical input and have authority from the CCGs.
The committee has a work plan, memorandum of understanding and terms of reference, which were agreed by the members of each CCG. The committee’s work plan reflects the partnership priorities for which the CCGs believe collective decision making is essential.
Although it can only make decisions on the programmes of work that have been delegated to it, the committee also makes recommendations to the CCGs on other matters where it feels that a WY&H-wide approach would be beneficial.
Meetings, attendance and highlights: The joint committee meets formally in public every second month, with development and strategy sessions in intervening months. Each CCG is represented at the committee by the clinical chair and accountable officer (with one vote between them).
For further details, including meeting highlights and attendance during 2019/20, please see the committee’s annual report which is available on its website.
Primary care commissioning committee (PCCC)
The PCCC meets in public six times per annum. Since May 2018, these meetings have been held as ‘committees in common’ with the PCCCs of Bradford Districts CCG and Bradford City CCG.
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Role: NHS England has delegated to the CCG authority to exercise the primary care commissioning functions set out in schedule 2 in accordance with section 13Z of the NHS Act. The committee has been established in accordance with the above statutory provisions to enable the members to make collective decisions on the review, planning and procurement of primary care services in the Airedale, Wharfedale and Craven CCG area under delegated authority from NHS England.
Key responsibilities: The committee carries out the following functions relating to the commissioning of primary medical services under section 83 of the NHS Act including:
• GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract); • newly designed enhanced services (“local enhanced services” and “directed enhanced services”); • design of local incentive schemes as an alternative to the quality outcomes framework (QOF); • decision making on whether to establish new GP practices in an area; • approving practice mergers; • making decisions on ‘discretionary’ payments (eg returner/retainer schemes); • planning primary medical care services - including needs assessment; reviewing primary medical care services; • co-ordinating a common approach to the commissioning of primary care services generally;
Membership and attendance: As required by the delegation agreement with NHS England and CCG guidance on conflicts of interest management:
• the PCCC has a lay and executive majority (the two GPs on the PCCC have a non-voting role); and • the chair of the PCCC does not also act as the chair of the CCG’s audit committee.
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Neil Fell Lay member for governance (chair) Pam Essler Lay member for patient and public involvement Bryan Millar Lay member for finance Angie Clegg Registered nurse Peter Brunskill Secondary care consultant Helen Hirst Chief officer Julie Lawreniuk Chief finance officer (to 31 August 2019) Robert Maden Chief finance officer (from 1 September 2019) Michelle Turner Director of quality and nursing Nancy O’Neill CCG executive director Dr James Thomas Clinical chair (non-voting) Vacant Elected GP (non-voting)
In addition to the members above, the following groups have standing invitations to attend PCCC meetings: NHS England, Bradford Healthwatch, Public Health (CBMDC), YOR Local Medical Committee.
The PCCC has met six times during 2019/20 and attendance is detailed below:
6 5 4 3 2 1 0
Possible Actual
Figure 11: 2019/20 attendance at PCCC
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Primary care commissioning committee highlights 2019/20
Highlights of the PCCC’s work have included: Membership
a development session with the 18% LMC and GP representatives to consider the development of primary care network applications 46% approving primary care network applications and received updates on their implementation 35% approving the equitable funding review and standard access scheme Lay & Professional Executive receiving regular practice quality GP (non-voting) and performance reports, including detailed reports of any practices on ‘enhanced surveillance’ receiving an update on the primary Standing agenda items medical care commissioning Declarations of interest strategy Minutes of the last meeting and receiving the GP annual e- matters arising declaration report Contract assurance and approving local policies and performance report guidance: contract mergers, list GP enhanced surveillance report closures, temporary assignment of Questions from the public on lists and managed patient allocation agenda items receiving an update on the GP contract agreement 2020/21 to 2023/24 receiving the internal audit of Primary Care and Contract Oversight and Management of Functions reviewing the effectiveness of the PCCC
Conclusion: The PCCC has fulfilled its role and responsibilities.
Audit and governance committee
The audit and governance committee meets in common with the audit and governance committees of NHS Bradford Districts CCG and NHS Bradford City CCG.
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Role: To review and provide assurance to the governing body on the adequate and effective operation of the CCG’s overall internal control system, with particular responsibilities related to financial reporting and management.
Responsibilities:
Monitors the integrity of the financial statements and any formal announcements relating to the CCG’s financial performance Ensures that there is an effective internal audit function that meets mandatory NHS internal audit standards and provides appropriate independent assurance to the committee, accountable officer and CCG Reviews the arrangements for integrated governance and risk management activities within the CCG Critically reviews the CCG’s financial reporting and internal control principles Ensures there is an appropriate relationship with both internal and external auditors Reviews the work and findings of the external auditors and consider the implications and management’s responses to their work Ensures adequate arrangements are in place for countering fraud, bribery and corruption Maintains an overview of the adequacy and effectiveness of information governance (IG) activities and provides assurance to the governing body that risks associated with IG are being managed Maintains an overview of the adequacy and effectiveness of health and safety (H&S) activities and provides assurance to the governing body that risks associated with H&S are being managed Reviews the findings of other significant assurance functions, both internal and external and consider the implications for the governance of the CCG
Membership and attendance
Bryan Millar Lay member for finance (chair) Neil Fell Lay member for governance Angie Clegg Registered nurse Pam Essler Lay member for patient and public involvement (alternate member if required for quorum purposes – not required to attend in 2019/20)
The audit and governance committee has met five times during 2019/20; two meetings in May 2019 relating to the review and approval of the 2018/19 accounts and annual report, and three standard committee meetings. Attendance at these meetings is detailed below:
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5
4
3
2
1
0 Bryan Millar Neil Fell Angie Clegg
Possible Actual
Figure 12: 2019/20 attendance at A&G
Audit and governance committee highlights 2019/20
Approved the 2018/19 annual report and Membership accounts. Received the 2018/19 head of internal audit opinion and external audit’s ISA 260 summary of audit findings report. Approved the 2018/19 internal audit and counter fraud annual plans. 100% Approved the 2018/19 external audit Lay & Professional plan.
Monitored the work of internal and Standing agenda items external audit and CCG implementation Declaration of interests of recommendations arising Minutes of previous meetings Reviewed the performance of internal and action log and external audit Internal audit and counter fraud Received assurance on the development progress reports of the new CCG External audit progress reports Received a report on the mental health and technical updates investment standard Corporate risk and assurance Reviewed and approved a number of report (includes risk information governance and health and register/GBAF/conflicts of safety policies interest management/ Reviewed the committees own compliance with standing effectiveness and its terms of reference orders and standing financial Reviewed the results of effectiveness instructions, CCG incidents, assessments undertaken by other mandatory training compliance, committees etc) Undertook simulation training (challenged Information governance report
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CCG scenario) facilitated by external Health and safety report audit A&G committee work programme
Conclusion: The audit and governance committee has fulfilled its role and responsibilities.
Remuneration committee
Role: The committee makes recommendations to the governing body on pay, remuneration and conditions of service for employees of the CCG who are outside of the national Agenda for Change pay system (such as very senior managers) and people who provide services to the CCG (such as clinical leaders). In addition, the committee receives assurance on the objective setting and performance review processes for elected GPs and senior management.
Membership and attendance:
Pam Essler Lay member for patient and public involvement (chair) Neil Fell Lay member for governance Bryan Millar Lay member for finance Angela Clegg Registered nurse Peter Brunskill Secondary care consultant (alternate member for registered nurse)
The committee is supported by independent advice from our HR providers, Bradford District Care NHS Foundation Trust.
There have been four meetings of the remuneration committee during 2019/20; these were held in common with the remuneration committees of the Bradford Districts and Bradford City CCGs with part of one meeting relating to Bradford City CCG only, where assurance on the performance review process for clinical executive members was considered. Attendance details are shown overleaf:
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4
3
2
1
0 Pam Essler Neil Fell Bryan Millar Angie Clegg
Possible Actual
Figure 13: 2019/20 attendance at Remuneration Committee
Remuneration committee highlights 2019/20
Received assurance on the 2018/19 Membership performance review process for the chief officer, chief finance officer, director of nursing and quality, CCG executive director, ICB programme director and the clinical executive, including the clinical chair – and details of their 2019/20 objectives. 100% Lay & Professional Considered and made recommendations to the governing body on the remuneration of the deputy chief officer and chief Standing items finance officer Declaration of interests Considered national guidance and made Minutes of previous meeting recommendations to the governing body and action log on a pay award for those outside of agenda for change Considered and made recommendations for the senior leaders’ pay structure for the new CCG Reviewed the committee’s effectiveness and its terms of reference
Conclusion: The remuneration committee has fulfilled its role and responsibilities
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1.3.7 UK Corporate governance code
Whilst the UK corporate governance code is not mandatory for NHS bodies, compliance, where applicable, is considered to be good practice. This governance statement is intended to demonstrate our compliance with the applicable principles set out in the code.
For the financial year ended 31 March 2020, and up to the date of signing this statement, we have had regard to the provisions set out in the code and complied with the spirit of the code, insofar as they are applicable to the public sector and the responsibilities of clinical commissioning groups as established under the Health and Social Care Act 2012.
A review of our compliance against the UK corporate governance code (updated during 2018/19) was reported to the audit and governance committee in July 2019. The review found the CCG complies with the spirit of the code and identified a few areas where arrangements could be strengthened, specifically around the appraisal process for the clinical chair and the lay and professional healthcare members of the governing body and the exit interview process. These points have been addressed in the development of arrangements for the new CCG.
1.3.8 Discharge of statutory functions
In light of recommendations of the 1983 Harris Review, the clinical commissioning group has reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislative and regulations. As a result, I can confirm that the clinical commissioning group is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions.
Responsibility for each duty and power has been clearly allocated to a senior lead. Teams have confirmed that their structures provide the necessary capability and capacity to undertake all of the clinical commissioning group’s statutory duties.
1.3.9 Risk management arrangements and effectiveness
We have had a comprehensive integrated risk management framework (IRMF) in place since establishment. The IRMF was reviewed and updated to apply across the three Bradford district and Craven CCGs from July 2017. It describes our approach to managing risk, our risk appetite, our risk management objectives and the processes in place to ensure these objectives are achieved.
Our risk management objectives are to:
effectively identify, report and manage risk ensure clear accountability for the management and reporting of risk effectively capture and learn from mistakes to reduce future risks ensure and evidence statutory and regulatory compliance effectively manage partnership and project risks.
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We monitor and report on risk in two key ways:
The governing body assurance framework (GBAF)/strategic risk log focuses on strategic/long-term risks to the delivery of our strategic objectives. This is a shared GBAF across the three Bradford district and Craven CCGs and is normally reviewed twice per annum. A single review was undertaken during 2019/20 and reported to the governing body in January 2020.
The corporate risk register focuses on more operational risks that may rise and fall within relatively short time periods. The corporate risk register is reviewed and updated six times a year and is shared across the Bradford district and Craven CCGs. Whilst a number of risks are shared across the three CCGs, there are a number of CCG specific risks; our on-line risk register system allows risk to be monitored and reported at both individual CCG level and collectively.
Risk appetite
Our aim is to minimise the risk of harm wherever possible to service users, the public, staff, members and other stakeholders. However, we also recognise the need to take considered risks in some areas (for example, transformation/re-design of services) and that an overly risk averse approach can be a threat to the achievement of some strategic objectives.
All risks on our risk register and assurance framework specify the target risk score (that is, the level at which the risk can be tolerated). The acceptability of the target risk score is subject to review by senior management and the relevant committee as part of the normal review and reporting process for the risk register and assurance framework.
Other controls to manage risk
Our key control mechanisms of the corporate risk register, GBAF and incident reporting and learning systems, are complemented by a range of other control mechanisms designed to deliver assurance on the prevention of risk and management of current risks. These include:
an approved standards of business conduct and conflicts of interest policy, which has been reinforced by training for governing body and senior management team members and senior staff involved with service development and contracting. approval of a counter fraud, bribery and corruption policy, which has been reinforced by mandatory training for both employees and governing body members. a business continuity plan which sets out our contingency plans to maintain an effective service in the event of a critical incident. undertaking regular health and safety, fire and premises risk assessments.
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in-house equality and diversity expertise to ensure that we are compliant with the Equality Act 2010 Public Sector Equality Duty. All our staff have participated in equality and diversity training appropriate to their role. This equips them to identify our policies, governing body papers and improvement programmes that will need a detailed equality impact assessment to identify and mitigate any potential adverse impact on any group of local people with an Equality Act protected characteristic. The head of equality and diversity provides expert support with these assessments.
Involving public stakeholders in managing risks which impact on them
We engage with patients and carers to improve current services and inform the development of new or reviewed services. In addition, we produce a monthly Grass Roots report of patient views/feedback which is reported to the joint quality committee. This insight helps us to identify any gaps or potential risks to current or future service delivery. Please see page 41 of this report to read more about how we involve local people and other stakeholders in our work.
Capacity to handle risk
Effectiveness of governance structures
All committees of the CCG and committees of the governing body have documented terms of reference, approved by the body to whom they are accountable, which are reviewed annually, or more regularly if required. Work programmes are maintained and regularly reviewed for all key groups and committees.
The effectiveness of the governing body and its committees is reviewed regularly. Committee reviews were undertaken during the second quarter of the year, with findings considered by each committee and reported to the audit and governance committee. Findings were also considered at a governing body and clinical executive development session in August 2019. A number of learning points and opportunities to strengthen arrangements were identified and taken forward as part of the development of the new CCG.
During 2019/20 internal audit have reviewed our arrangements for the governance of our health and care partnerships and their conclusion is detailed below:
An opinion of ‘significant assurance’ has been provided for the review on the basis that good progress has been made in implementing the arrangements as set out in the strategic partnering agreement (SPA). It is recognised that the health Significant and care partnerships (HCPs) are on a journey and that the governance arrangements will need to continue evolving in response to this. The HCPs have been involved in several initiatives since the adoption of the SPA to keep the arrangements and ways of working together under review and to further develop them.
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Work is currently underway to review the programmes that underpin the system transformation work and the associated decision taking and making responsibilities. The audit has identified a number of points that confirms that this is an area that requires further clarification. The audit has also identified a number of other points in the governance arrangements put in place to date and in the associated documentation. Recommendations have been made to support further strengthening and development of the health and care partnerships’ governance structures and frameworks.
Recommendations have also been made to review the reporting to the governing bodies of the CCGs for consistency and also to improve transparency of decisions taken.
During 2019/20 internal audit have reviewed our arrangements for the management and oversight of primary care contracts and their conclusion is detailed below:
The audit has concluded that in respect of contract oversight and management functions delegated to the CCGs by NHS England the controls are operating effectively. The responsibilities of the CCGs for this are discharged through the primary care commissioning committee (PCCC) for each of the three CCGs which meet in common.
Examination of PCCC, joint quality committee (JQC) and contract assurance group (CAG) terms of reference and minutes confirmed that there are effective arrangements in place for managing and monitoring accessibility and quality of GP services. The audit noted that the primary care team works closely with the quality team and CQC in monitoring primary care practices.
Significant The CCGs have arrangements in place to carry out quality and contract assurance review of all practices over a three year period. Testing confirmed that a summary of the visits and any identified actions are produced and the latter followed up for implementation. CAG and the PCCC are both informed of the progress on action plans and any issues with non-compliance escalated
Processes are in place for the management of poorly performing GP practices. At the time of the audit the CCGs had four practices on surveillance. The PCCC was requested to approve the recommendation to move three of these practices to routine surveillance.
Although there have been no practice closures, three
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mergers/relocations have taken place in the last twelve months. The CCGs closure and relocation process was revised to address the recommendations made by the CAG to improve the process initially put in place.
Internal audit review our risk management and board assurance framework annually and their conclusion for 2019/20 was:
The audit has provided an opinion of ‘high assurance’ that a comprehensive integrated risk management framework (IRMF) has been implemented across the CCGs and has continued to be embedded and operated effectively during 2019/2020.
The framework has continued to meet the needs of the CCGs both as individual statutory bodies and for collaborative working. The framework was due for review in June 2019 but High has been deferred, in agreement with the audit and governance committees, in recognition of the planned merger from 1 April 2020.
The recommendations made in the previous year’s report, Risk Management 13/2019 have been implemented. Although risk owners have been reminded of the requirement the recording of timeframes for addressing gaps in controls still remains an issue.
Responsibilities of the senior management team and committees
Our principal risks to achieving our strategic objectives are set out in the governing body’s assurance framework. Each of the principal risks has an identified senior management team lead. Twice per annum the risk lead is responsible for reviewing the risk, assessing the key controls for mitigating the risk and sources of assurance, identifying positive assurance and any gaps in control or assurance, as well as taking forward specific actions within the timescales outlined.
The roles and responsibilities of staff as owners of risks on the corporate risk register and senior management team as reviewers are clearly set out in the IRMF. This ensures that there is clarity about the levels of accountability for the management and monitoring of risks. The senior management team is expected to ensure that there are robust control measures in place to manage identified risks and that the appropriate assurances are generated.
Reporting lines and accountabilities between the governing body, committees and the senior management team
The reporting lines and accountabilities are set out in the Integrated Risk Management Framework and reflected in committee terms of reference. As stated earlier, the senior management team undertakes a formal review of all risks at the
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beginning of each reporting cycle and identifies any new risks or changes to risk score as they arise.
Following review by the senior management team, the risk register is submitted to the appropriate committee (JQC or JFPC) for review. Each committee has clear responsibility for the monitoring of existing risks and identification of further risks as set out in its terms of reference. The CCG risk register is then reported in full to the clinical executive/joint clinical committee. High level risks (those scoring 15 or more on a matrix with a maximum score of 25) are reported to the governing body, as well as details of new and closed risks.
The audit and governance committee provides assurance on the effectiveness of the risk management system to the governing body. It is supported in this by annual review of the system by internal audit.
Timely and accurate information to assess risks to compliance with the clinical commissioning group’s licence
The assessment of risks is a continuous process informed by:
staff or the senior management team identifying new risks or changes to risk profile financial, contracting and performance reports, which are submitted on a monthly basis to the joint finance and performance committee quality reports submitted monthly to the joint quality committee discussions taking place at partnership meetings, committees, clinical executive and governing body
Degree and rigour of oversight of our performance by the governing body
At each of its meetings, the governing body provides challenge and scrutiny of a suite of reports which focus on the delivery of the key performance targets, quality, safety, financial and contractual requirements. They are:
clinical chair’s report (including updates on the work of the clinical executive, joint clinical committee and the joint committee of West Yorkshire and Harrogate CCGs) chief officer’s report finance, performance and contracting report quality report strategic partnership report Bradford Health and Care Partnership report high level risk register engagement tracker minutes from the joint finance and performance committee, the joint quality committee, the primary care commissioning committee, the audit and governance committee and the remuneration committee
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The reports provide a RAG (red, amber, and green) rating for all our main performance targets and, where adequate performance is not being achieved, the governing body is provided with an overview of remedial action.
This oversight, which has been supported by the detailed work of the committees, has placed us in a strong position to deliver our performance and financial targets this year and ensure mitigating actions, that are regularly monitored, have been developed for areas of underperformance.
Staff training to manage risk as appropriate to their authority and duties
All staff are required to do mandatory training on data security awareness, fire safety, health and safety, manual handling, fraud awareness, safeguarding (including adults, children and the ‘Prevent’ anti-radicalisation initiative) and equality, diversity and human rights. Staff receive other mandatory training appropriate to their roles (eg infection prevention for clinical staff, conflicts of interest for ‘decision- taking staff’) and further training as agreed with line managers and detailed in personal development plans.
Learning from incidents, near misses and from good practice is shared via our normal communication channels (team meetings, staff briefings, etc.) and via reporting to committees.
A comprehensive suite of policies and procedures is available for staff and the maintenance of our policy framework is reviewed by the audit and governance committee. Detailed guidance is available for users of the on-line risk register system and to support the maintenance of the GBAF. Support on any aspect of our risk management framework is available to staff via the governance team or external advisors as required (IG, data protection officer, health and safety, counter fraud, internal audit, etc).
Risk assessment
Risk assessments in relation to governance, risk management and internal control are carried out through a number of mechanisms including:
Through internal governance arrangements taking account of: risk assessment guidance in the IRMF, self-assessment activity, review of our constitution, new national guidance or regulations and external inquiries. Through the annual internal audit plan by Audit Yorkshire. The plan is developed from a risk assessment of all areas of our activities and work undertaken in line with the plan is reported to the audit and governance committee. Through external audit throughout the year by KPMG, which includes attendance at the audit and governance committee and focused pieces of external audit work as set out in the auditors annual work plan, culminating in the risk review undertaken prior to annual reporting and accounts.
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Detailed guidance on risk assessment is provided in our integrated risk management framework.
Major risks to governance, risk management and internal control
We have identified fourteen key risks to the achievement of strategic objectives. These are detailed in the governing body assurance framework, along with the controls in place to manage these risks, the mechanisms by which we receive assurance on the management of these risks and planned actions to address any gaps in control and/or assurance. The governing body assurance framework is reviewed, updated and submitted to the governing body for approval at least annually. The GBAF can be viewed on our website.
Of these fourteen strategic risks, only one is considered to relate directly to governance, risk management or internal control; details of this risk are provided below. The CCG’s other strategic risks are related to partnership working, provider delivery and wider system level (local health economy) issues and developments.
Risk Key actions to mitigate risk Means to assess outcome Staff struggle to Standard staff support Staff survey adapt to new, mechanisms; regular one- feedback externally facing to-one meetings with line Sickness and system-focus managers, personal turnover rates roles due to the development plans, etc. Delivery of CCG need for role Staff briefing and objectives and flexibility and the communication channels, statutory duties normal factors including weekly staff associated with update immediately after change, resulting the senior management in failure to team meeting develop as an Organisational organisation. development programme
Table 4: strategic risks related directly to governance, risk management or internal control
The governing body assurance framework is supported by the corporate risk register which details the CCG’s operational risks and their management.
As at the end of March 2019 there were a total of 39 open risks on the corporate risk register, with nine of these risks classed as ‘major’ (that is, scoring 15 or more). Of these nine ‘major’ risks, two risks are considered to relate to governance, risk management or internal control (other major risks relate to provider delivery and health economy wide issues). Both of these risks were newly identified in-year.
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Risk summary Key actions to Means to mitigate risk assess outcome There is a risk that the CCG will TUPE transition Monitoring via be unable to deliver a fully meetings JFPC effective business intelligence HR to HR Staff service from 1 April when the discussions feedback eMBED contract comes to an CCG induction and end and the service transfers staff development in-house due to: (i) limited process internal resource to manage the transfer, (ii) difficult TUPE- related issues and (iii) morale and motivation within the team who will transfer.
There is a risk that we are Local Reporting to unable to meet our statutory implementation JQC obligations when the new group set up with Reporting to liberty protection safeguards key partners, Safeguarding (LPS) are implemented (date including local Boards not yet clear, currently forecast authorities and for not before October 2020) trusts. due to a lack of systems and Some work done to structures to authorise scope activity deprivation of liberty under the numbers. new regulations. Implementation plan in draft Agreement reached that the designated nurse for safeguarding adults will work full-time on this project August - October 2020. Table 5: open risks classed as “major” that relate to governance, risk management or internal control
1.3.9 Other sources of assurance
Internal control
The system of internal control is the set of processes and procedures in place in the clinical commissioning group to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically.
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The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it can therefore only provide reasonable and not absolute assurance of effectiveness.
The effective working of the system of internal control is achieved through the:
operation of the governing body, clinical executive and committees in accordance with clear terms of reference and delegated responsibilities as described in the scheme of delegation and reservation; annual review of governing body and committee effectiveness; the management of key risks to the achievement of our strategic objectives as identified in the governing body’s assurance framework; the management of operational risks as identified in the corporate risk register; establishment, maintenance and review of operational policies across all areas of business, including reviews on the application of those policies; application of appropriate financial accounting and financial management procedures as described in the standing financial instructions; regular reporting of performance on our duties and responsibilities to the governing body and clinical executive; review of the effectiveness of the system of internal control carried out by the internal and external audit functions; and quarterly CCG assurance submission to NHS England.
Annual audit of conflicts of interest management
The revised statutory guidance on managing conflicts of interest for CCGs (published June 2017) requires CCGs to undertake an annual internal audit of conflicts of interest management. To support CCGs to undertake this task, NHS England has published a template audit framework. This audit has been undertaken for the three Bradford district and Craven CCGs by Audit Yorkshire, our internal auditors, and their conclusion is detailed below:
The review has confirmed that the clinical commissioning groups (CCGs) can demonstrate that there are, in the main, effective arrangements in place to manage potential conflicts of interest (COIs) during the performance of CCG business.
A review of the recommendations from the previous COI audit (report 14/2019) confirmed that management have taken action Significant to address the findings of this audit, with seven out of the eight recommendations being implemented in full. In respect of the remaining recommendation (which related to ensuring an adequate audit trail to support the register of procurement decisions), management highlighted that although action had been taken, the process was not yet working optimally. Further recommendations have therefore been made to address this aspect of the CCGs’ COI arrangements.
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The audit confirmed that the CCGs have the required arrangements in place to comply with the Managing Conflicts of Interest: Revised Statutory Guidance for CCGs 2017 (statutory guidance) and, in respect of COI matters, with the NHS Oversight Framework 2019/20: CCG Metrics Technical Annex.
In testing the application of controls some improvement areas were identified. Many of these were however relatively minor points; for example we noted that although within meeting minutes the recording of COIs and the related actions to mitigate any potential risks was significantly improved than seen during the 2018/19 COI audit, further opportunities for improvement still exist.
The key areas for attention related to:
maintaining an adequate audit trail where procurement decisions have been taken; and ensuring processes are in place and effective so that the CCG can be confident that all staff understand their responsibilities as outlined in the Policy on the Offer and Receipt of Gifts, Hospitality and Sponsorship and the Conflicts of Interest and Business Conduct Policy.
Emergency preparedness, resilience and response: assurance statement
CCGs are required to publish a statement of compliance as part of emergency preparedness, resilience and response assurance arrangements, as follows:
Yorkshire and the Humber Local Health Resilience Partnership (LHRP) Emergency Preparedness, Resilience and Response (EPRR) assurance 2019- 2020
Statement of compliance
NHS Airedale, Wharfedale and Craven CCG; Bradford Districts CCG and Bradford City CCG (hereafter referred to as Bradford District and Craven CCGs) have undertaken a self-assessment against required areas of the EPRR Core standards self-assessment tool v1.0.
Where areas require further action, the Bradford District and Craven CCGs will meet with the LHRP to review the attached core standards, associated improvement plan and to agree a process ensuring non-compliant standards are regularly monitored until an agreed level of compliance is reached.
Following self-assessment, the organisation has been assigned as an EPRR assurance rating of ‘substantial’ (from the four options in the table overleaf) against the core standards.
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I confirm that the above level of compliance with the core standards has been agreed by the organisation’s board/governing body along with the enclosed action plan and governance deep dive responses.
Helen Hirst Accountable officer NHS Airedale, Wharfedale and Craven CCG
24 June 2020
1.3.10 Data quality
Under the current arrangements around the handling of confidential data we are not permitted to handle, process or view any patient identifiable data which includes NHS number, postcode or date of birth. As a result, the processing of this provider supplied confidential data is undertaken by the Yorkshire DSCRO (Data Services for Commissioners regional office). At present this team is hosted by NECS (North of England CSU) and all staff have the required legal status under NHS Digital terms and conditions.
The business intelligence service (including data quality) was provided by eMBED Health Consortium up to 31 March 2020 (thereafter transferring in-house). Business intelligence staff undertake regular key analyses to support the CCGs in monitoring
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key performance targets as well as providing reports to assist with the CCG’s contracting and commissioning functions. In addition, the business intelligence team regularly monitors the flow of information from providers to ensure they are meeting their contractual obligations. The business intelligence team is also responsible for monitoring the quality of the data being submitted and this is discussed with the main providers at regular contract meetings. Where issues around data quality or non-receipt of datasets are unresolved at this level, this is escalated to the joint finance and performance committee and included on the corporate risk register, where appropriate.
All information provided to the CCG undergoes rigorous data quality checking processes to ensure the highest quality of data is provided to the governing body and council of members. Both are reviewing their effectiveness during 2019/20 and no issues were raised with regards to the quality of data reported.
1.3.11 Information governance
The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular person identifiable information. The framework is supported by an the data security and protection toolkit and the annual submission process provides assurances to the clinical commissioning group, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively.
Specialist information governance support is provided to the CCG by eMBED Health Consortium and our data protection officer is Susan Hall, IG Specialist at Audit Yorkshire.
Submission of the 2019/20 data protection and security toolkit was deferred from 31 March 2020 to 30 September 2020 for the majority of NHS organisations. As merging CCGs, we were still required to submit our toolkit on the original date. We declared compliance with 103/106 mandatory standards in the toolkit; the remaining standards will be addressed early in 2010/21 following our move to a new IT and IG services provider (The Health Informatics Service). During the year, our internal auditors reviewed our toolkit submission evidence and their opinion is set out below:
The review has identified that the three CCGs have sufficient evidence to support submission of the data and security protection toolkit (assurance limited to the sample examined). Suggestions to improve the evidence held were made during the course of the audit and were addressed by the CCGs. Significant Some recommendations have been made to strengthen the process and procedures going forwards and to support further compliance with the standards. The recommendations do not impact on the overall effectiveness of the toolkit self-assessment process and outcome.
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We place high importance on ensuring there are robust information governance systems and processes in place to help protect patient and corporate information. We have established an information governance policy framework and have developed information governance processes and procedures in line with the DSP toolkit and the requirements of GDPR. We ensure all staff undertake annual information governance training and have implemented a staff information governance handbook to ensure staff are aware of their information governance roles and responsibilities. We remind staff regularly of the need to ensure that person identifiable information is secure at times. Risks relating to data security are mitigated by ensuring all laptops are encrypted and that unencrypted devices (USB sticks, etc) are unable to operate on personal computers. During 2019/20 alerts and guidance relating to cyber-security risks were circulated to staff several times. Cybersecurity training for the governing body and clinical executive was provided in May 2019.
Our chief finance officer is the nominated senior information risk owner (SIRO) with responsibility for information governance. Our director of nursing and quality is the nominated Caldicott Guardian with responsibility for the confidentiality of patient data. Regular reports on information governance matters and progress against our information governance work-plan are reported to the audit and governance committee.
There are processes in place for incident reporting and the investigation of incidents. Nine data/information governance related CCG incidents or near misses were reported internally during the year across the Bradford district and Craven CCGs; only one of these was classed as reportable to the NHS Digital and the ICO and this related to NHS Airedale, Wharfedale and Craven CCG. All incidents reported within the CCG are reviewed by the audit and governance committee.
1.3.12 Business critical models
In the Macpherson report Review of Quality Assurance of Government Analytical Models, published in March 2013, it was recommended that the governance statement should include confirmation that an appropriate quality assurance framework is in place and is used for all business critical models. Business critical models were deemed to be analytical models that informed government policy. We can confirm that in 2019/20 the CCG has not developed any analytical models which have informed government policy.
Our IG framework ensures that business critical systems are identified and managed effectively. As part of this framework information asset owners have been identified that cover the range of business systems used by the CCG. The responsibility of information asset owners includes the maintenance of an information asset register and data flow map relevant to their organisational remit, the maintenance of service continuity plans for business critical systems and the continuity of key skills to operate such systems.
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1.3.13 Third party assurances
For functions that are carried out on behalf of the CCG by third parties, we receive assurance from the organisation or their auditors that appropriate systems and internal control are in operation. We receive services from the following organisations and details of assurances received for 2019/20 are provided below:
NHS Shared Business Services (provision of financial and accounting services and primary care payments services) – service auditor’s report: reasonable assurance with the exception of qualified opinions for the nine control objectives set out in the report. Due to the COVID pandemic it was not possible to undertake testing of these controls at SBS’s site in India or to test these controls by any other means. NHS Digital (payments to GP contractors) [excluding work undertaken by sub-service excluding work undertaken by organisations Capita and NHS Shared Business Services organisations Capita and NHS Shared Business Services] – service auditor’s report: reasonable assurance with the exception of a qualified opinion relating to controls over the system (technical architecture) change process. Capita (payments to GP contractors) – service auditors report: delayed due to COVID pandemic, this report was not available at the time of publication of the annual report. NHS Business Services Authority (prescription pricing services) – service auditors report: reasonable assurance. eMBED Health Consortium (provision of IT, business intelligence, information governance, freedom of information, procurement and equality and diversity services) – assurance provided via contract management arrangements. North East Commissioning Service (provision of data services for commissioners) – assurance provided via contract management arrangements. Bradford District Care NHS Foundation Trust (provision of payroll services, human resources, learning and development and health and safety services) – assurance on payroll services provided to consortium members, including the CCG; assurance on other services provided via contract management arrangements.
1.3.14 Control Issues
There were no significant control issues arising during 2019/20.
1.3.15 Review of economy, efficiency and effectiveness of the use of resources
The governing body reviews and approves the budget for the financial year to ensure that the use of CCG resources reflect its commissioning priorities and are applied to the delivery of key performance targets, including efficiency targets and financial balance.
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The governing body receives a comprehensive finance, performance and contracting report from the chief finance officer at each of its meetings. The joint finance and performance committee advises and supports the governing body in providing assurance on the delivery of key targets.
The clinical executive and joint clinical committee (and latterly the senior leadership team of the new CCG operating in shadow form) scrutinise and track the delivery of key financial and service priorities, outcomes and targets, as well as leading the development and monitoring of remedial action where performance is below plan.
Our audit and governance committee takes the lead role, on behalf of the accountable officer and governing body, in maintaining and reviewing the effectiveness of the system of internal control, including financial control. The audit and governance committee advises and assures the governing body upon the adequacy and effective operation of the organisations’ overall internal control system focussing upon the framework of risks, controls and assurances that underpin the delivery of the organisations objectives and to review the disclosure statements that flow from those assurance processes.
We have agreed a robust and ambitious approach to the QIPP challenges faced by the NHS to maximise value for money across all services. The governing body receives regular updates on the QIPP programme through the finance and contracting reports. Reporting and discussions on QIPP are a standing item at meetings of the clinical executive and council of members, whilst detailed scrutiny of performance against the QIPP plan is undertaken by the joint finance and performance committee. We are forecasting that we will achieve 59% of planned QIPP savings for 2019/20.
Our external auditors, KPMG LLP, have undertaken a range of work against their 2019/20 plan. Our internal auditors, Audit Yorkshire, have completed the programme of a risk-based plan of work, agreed with management and approved by the audit committee, which was designed to provide a reasonable level of assurance, for 2019/20. We have agreed action plans with auditors to improve our control environment.
NHS England has a statutory duty to make an annual assessment of CCG performance. It meets this duty through its NHS Oversight Framework (NHSOF), which contains 60 indicators grouped within five theme areas:
new service models preventing ill-health and reducing inequalities quality of care and outcomes leadership and workforce finance and use of resources
During 2019/20 NHS England/Improvement held quarterly and annual checkpoint review meetings with the CCG and extended this to all system leaders across Bradford district and Craven for the annual checkpoint. The CCG’s overall rating for
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2018/19 was GOOD, our Quality of Leadership rating was GREEN and our in year financial performance was rated AMBER.
At the time of writing this annual report, the 2019/20 year-end assessment for the performance of the CCG was not available but will be published on the NHSE website in July 2020. At present, the CCG is currently performing above the England average in a number of areas. However, there is always room for improvement, and the CCG uses these metrics to identify areas for further work.
1.3.16 Delegation of functions
The council of members has oversight of the functions delegated to the governing body, clinical executive and committees via reporting to its meetings and on its review and receipt of the CCG annual report.
The governing body has oversight of the functions delegated to committees through its overview of CCG performance and specifically via:
receipt and review of performance reports (finance and contracting, performance and quality) receipt and review of the clinical chair’s report (which provides updates on clinical executive, JCC and the joint committee of the West Yorkshire and Harrogate CCGs) receipt and review of committee minutes (JFPC, JQC, PCCC, A&G and remuneration committee) and the INVOLVE engagement tracker
Where functions are carried out on behalf of the CCG by third parties, there are regular meetings to review performance against contracts and work programmes. In addition we receive an annual assurance statement from the auditors of these third parties that appropriate systems and internal control are in operation. These organisations are specified in the third party assurance section of this report (page 97).
1.3.17 Counter-fraud arrangements
We have access to a local counter-fraud specialist (LCFS) to meet the requirements set out in the standard commissioning contract. Their work is risk-based and in-line with the government’s National Fraud Strategy and Chartered Institute of Public Finance and Accountancy (CIPFA) Managing the Risk of Fraud document, which are considered as best practice when countering fraud. A counter fraud, bribery and corruption policy is in place and the chief finance officer is the executive lead for this area.
A counter-fraud, bribery and corruption plan is developed by the LCFS annually and is approved by the audit and governance committee. The plan includes a significant proactive element. The committee receives reporting against this plan at each of its meetings.
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During the year, the LCFS has provided alerts to our CCG on frauds relating to bank mandates, personal health budgets, cancellation of training courses and phishing emails; these alerts are sent to the chief financial officer and then disseminated as appropriate to staff and/or CCG members. The LCFS also provided a number of face-to-face training sessions for staff and governing body members and published an anti-crime newsletter which was widely circulated. We participate in the annual national fraud initiative. Two reactive investigations were undertaken during the year across the three Bradford district and Craven CCGs. One of these found no evidence of fraud and the other investigation is ongoing.
1.3.18 Head of internal audit opinion on the effectiveness of the system of internal control at NHS Bradford Districts Clinical Commissioning Group for the year ended 31 March 2020
Following completion of the planned audit work for the financial year for the clinical commissioning group, the head of internal audit issued an independent and objective opinion on the adequacy and effectiveness of the clinical commissioning group’s system of risk management, governance and internal control. The head of internal audit concluded that:
Head of internal audit opinion on the effectiveness of the system of internal control at Airedale, Wharfedale And Craven Clinical Commissioning Group for the year ended 31 March 2020
Roles and responsibilities
On behalf of the clinical commissioning group the governing body is collectively accountable for maintaining a sound system of internal control and is responsible for putting in place arrangements for gaining assurance about the effectiveness of that overall system.
The governance statement is an annual statement by the accountable officer, on behalf of the clinical commissioning group and the governing body, setting out:
how the individual responsibilities of the accountable officer are discharged with regard to maintaining a sound system of internal control that supports the achievement of policies, aims and objectives; the purpose of the system of internal control as evidenced by a description of the risk management and review processes, including the Assurance Framework process; the conduct and results of the review of the effectiveness of the system of internal control including any disclosures of significant control failures together with assurances that actions are or will be taken where appropriate to address issues arising.
The organisation’s assurance framework should bring together all of the evidence required to support the governance statement requirements.
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In accordance with the public sector internal audit standards, the head of internal audit is required to provide an annual opinion, based upon and limited to the work performed, on the overall adequacy and effectiveness of the organisation’s risk management, control and governance processes (i.e. the organisation’s system of internal control). This is achieved through a risk-based plan of work, agreed with management and approved by the audit committee, which should provide a reasonable level of assurance, subject to the inherent limitations described below.
The opinion does not imply that Internal Audit has reviewed all risks and assurances relating to the organisation. As such, it is one component that the clinical commissioning group and governing body take into account in making its governance statement.
The head of internal audit opinion
The purpose of my annual head of internal audit opinion is to contribute to the assurances available to the accountable officer, the commissioning clinical group and governing body which underpin the assessment of the effectiveness of the organisation’s system of internal control. This opinion will in turn assist the organisation in the completion of its governance statement.
My opinion is set out as follows:
1. Overall opinion; 2. Basis for the opinion; 3. Commentary.
My overall opinion is that o Significant assurance can be given that there is a generally sound system of internal control, designed to meet the organisation’s objectives, and that controls are generally being applied consistently. However, some weaknesses in the design and/or inconsistent application of controls, put the achievement of particular objectives at risk.
The basis for forming my opinion is as follows:
1. An assessment of the design and operation of the underpinning Assurance Framework and supporting processes; and
2. An assessment of the range of individual opinions arising from risk-based audit assignments, contained within the internal audit risk-based plan, that have been reported throughout the year. This assessment has taken account of the relative materiality of these areas and management’s progress in respect of addressing control weaknesses.
The commentary below provides the context for my opinion and together with the opinion should be read in its entirety.
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The design and operation of the assurance framework and associated processes
Since 2017/2018 Airedale, Wharfedale and Craven Clinical Commissioning Group (AWCCCG) has been operating through a joint management and governance structure with its two neighbouring CCGs, Bradford Districts and Bradford City Clinical Commissioning Groups. In light of the collaborative governance structure an Integrated Risk Management Framework was agreed in June 2017. This was due for review in 2019/20 but due to the pending merger of the three CCGs it has been agreed to review and adopt the revised framework for the new CCG from 1 April 2020.
The current framework recognises that the three CCGs remain separate statutorily accountable bodies. A corporate risk register is maintained that can report at all levels, including governing body, individual CCG and committee level. The risk register is reviewed at least six times a year with a timetable being in place to govern the review and reporting cycle.
The governing body is well sighted on risks. Strategic risks are reported via the strategic risk register (assurance framework) twice a year and high level risks are reported to the governing body every cycle. To support the governing body in obtaining assurance the joint finance and performance and joint quality committees have been nominated to maintain oversight of specific risk areas. Risks are also received and reviewed by the joint clinical committee.
An audit of the framework has been completed in 2019/2020 and this has confirmed that the arrangements are embedded and operating in practice. A high assurance opinion was awarded.
The range of individual opinions arising from risk-based audit assignments, contained within risk-based plans that have been reported throughout the year
The 2019/20 internal audit plan was approved by the audit and governance committee on 14 March 2019. The work of internal audit continues to focus on the design and implementation of core processes to underpin the delivery of the CCG’s strategic objectives.
Internal audit reports carry one of four possible opinions. These give the recipient an indication of the level of assurance that can be taken that the processes of control within the area audited are adequate. The four opinions used are:
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Opinion level Opinion definition
High assurance can be given that there is a strong system of HIGH internal control which is designed and operating effectively to (STRONG) ensure that the system’s objectives are met.
Significant assurance can be given that there is a good system of SIGNIFICANT internal control which is designed and operating effectively to (GOOD) ensure that the system’s objectives are met and that this is operating in the majority of core areas.
Limited assurance can be given as whilst some elements of the LIMITED system of internal control are operating, improvements are (IMPROVEMENT required in the system’s design and/or operation in core areas to REQUIRED) effectively meet the system's objectives.
Low assurance can be given as there is a weak system of internal LOW control and significant improvement is required in its design (WEAK) and/or operation to effectively meet the system's objectives.
An action plan is agreed with management for each audit report. In order to monitor the implementation of agreed actions an update on progress is provided to each audit and governance committee.
In summary the Internal Audit assurance reports issued in the year have generated the “significant assurance” opinion highlighted on the previous page.
Internal Audit also supports the organisation when undergoing process design/redesign through the completion of advisory audit work. These audits are designed to provide advice as opposed to an assurance level. Three pieces of advisory work have been undertaken in 2019/2020. The most notable relates to the work to transition to ‘One CCG’ where Internal Audit has acted as a ‘critical friend’ and has supported the due diligence process.
Where variances from the plan have occurred these have been undertaken with the approval of the chief financial officer and the audit and governance committee. No departures from the plan that are material for the purposes of this opinion have occurred.
The outcome of the assurance audit reports from the 2019/2020 audit plan as at 1 June are summarised below:
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Audit Area Assurance Level Primary medical care commissioning and Substantial contracting Health care partnership governance Significant arrangements Contract management Significant QIPP Significant Risk management and assurance framework High Core financial systems Significant Continuing healthcare Fieldwork complete Conflicts of interest Significant Data security protection toolkit Significant Business continuity planning Significant
Actions plans have been agreed with management to address the recommendations made in the above agreed reports.
Status of limited assurance opinion reports from 2018/2019
There were two limited assurance opinion reports in 2018/2019. An update is provided below for each.
Personal health budgets (06/2019)
The key risks identified in the audit in 2018/19 related to local procedures not reflecting the latest national guidance, overdue annual assessments, surplus funds on personal health budgets (PHB) accounts and the accuracy and currency of PHB records. All actions were due for completion by 30 June 2019.
It had been planned to undertake a further audit in 2019/20 to verify the implementation of recommendations and to provide assurance that revisions to processes had been effective. Full completion of the recommendations was dependent upon the creation of a new role in the finance department. An individual was recruited to the role and started work addressing the relevant recommendations. However, this individual was subsequently off sick for a significant period of time, which has delayed full completion of the actions. This, combined with the impact of COVID-19, has meant we have not been in a position to be able to undertake a full follow up the audit report. We have therefore agreed with the CCG to put this on hold and to complete as part of the 2020/21 audit that is currently planned for Quarter 3.
We have tracked the status of recommendations as part of the routine monitoring process. This has been reported to the audit and governance committee throughout the year. Of the 10 recommendations eight have been reported as complete. Work is ongoing to embed the process for auditing and reviewing balances and in reviewing the accuracy and currency of PHB records. The latter primarily relates to some legacy arrangements that are being reviewed to bring them in line with current practices. Whilst the majority of recommendations are
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reported as complete these outstanding points remain as a gap in the control environment.
Mental Health Act S117 (07/2019)
This audit was conducted jointly with the local authority and covered the whole system. The key risks related to funding care services in another district, patients receiving insufficient or excessive care as a result of care plans not making clear the Section 117 after care needs, risk of disputes and inefficiencies due to the joint policy agreement being out of date and care being provided not being regularly reassessed in a timely manner. A detailed joint action plan between the CCG and the local authority was put in place to address the recommendations made. The majority of actions were due for implementation by 31 October 2019.
We had planned to undertake a follow up of the audit at the end of March 2020 to allow for the completion of actions and the embedding of revised processes. This has been impacted by COVID-19. In addition, of the 16 recommendations 13 were linked to the agreement of a revised point policy and operating procedure between the CCG and the local authority. However, the revised policy is still in draft and therefore these actions are still not reported as complete. The draft policy has now been reviewed by the legal team for both the CCG and the local authority and is awaiting final changes before approval. At the last reported update actions to review the register of Section 117 patients was also still underway.
We have continued to track implementation during the year and we will complete the audit to verify effective implementation of the actions as soon as possible in 2020/21. In the interim we have obtained a copy of the draft revised policy to check if it incorporates the agreed actions where appropriate. The outcome of this review has been fed back to the CCG with comments for further consideration alongside the comments that have been received from the legal team.
At this point in time 15 of the 16 actions are still reported as open and assurance cannot yet be provided that the gaps in the control environment have been sufficiently addressed.
Impact of COVID-19
In response to COVID-19 it was necessary to adjust the timing and/or scope for a small number of audits that were still being completed in March 2020. These changes have not been sufficient enough to impact on the ability to provide an opinion as the bulk of audit work had been completed by the time the CCG moved into full response mode to the crisis.
NHS organisations have had to move quickly to put measures in place to enable them to respond to COVID-19 and we fully appreciate that staff who we would usually engage with for planned work have been focused on service delivery, and our focus in this respect has been on supporting this response in any way we can.
NHS organisations are facing unprecedented levels of risk as a result of COVID-19
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and many business critical controls are under massive pressure as the response to the coronavirus (COVID-19) emergency situation requires NHS organisations to operate differently to normal business.
Audit Yorkshire has provided support including offering staff for re-deployment and has issued a number of publications as well as sharing and incorporating NHS England and Improvement guidance, NHS Counter Fraud Authority and HfMA briefings. We also developed and shared a document ‘Governance in the context of COVID-19’ to support our members and clients in reviewing their governance arrangements in this time of national emergency. The document provides an easy to consider checklist of key guidance that has been issued in recent weeks and allows for self-assessment in considering the key risks presented by COVID-19, helping to highlight those areas being managed well or not so well. We intend to follow up on the results of this assessment early in 2020/21.
Helen Kemp-Taylor Head of Internal Audit and Managing Director Audit Yorkshire 1 June 2020
1.3.19 Review of the effectiveness of governance, risk management and internal control
My review of the effectiveness of the system of internal control is informed by assurance from executive managers and clinical leads within the clinical commissioning group who have responsibility for the development and maintenance of the internal control framework. I have drawn on performance information available to me. My review is also informed by internal and external auditor reviews and assurance reviews by NHS England.
Our assurance framework provides me with evidence that the effectiveness of controls that manage risks to the clinical commissioning group achieving its principles objectives have been reviewed.
I have been advised on the implications of the result of this review of the effectiveness of the system of internal control by the governing body and the audit and governance committee and plans to address weaknesses and ensure continuous improvement of the system are in place.
The CCG’s overall rating for 2018/19 was GOOD, our Quality of Leadership rating was GREEN indicating that our CCG is performing well in regards to its leadership capability and capacity, our approach quality improvement, strong governance and decision making and progress towards introducing new models of care and transforming services fit for the future. Our in year financial performance was rated AMBER.
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Conclusion
It is my conclusion, based on the information submitted and my belief about the effectiveness of the systems and processes within the CCG that no significant control issues have been experienced during the year.
Helen Hirst Accountable officer NHS Airedale, Wharfedale and Craven CCG
24 June 2020
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2 Remuneration and staff report
2.1 Remuneration report
This report provides details of the policy regarding the remuneration of senior managers employed by the CCG, how this policy has been implemented and the amounts awarded in 2019/20. Comparative information for 2018/19 is also shown.
For the purposes of this report senior managers are defined as members of the clinical commissioning group's governing body and director level members of the clinical commissioning group's clinical board.
2.1.1 Remuneration committee
Details of the remuneration committee, including its role, responsibilities and membership, can be found on page 82 of this report.
2.1.2 Policy on the remuneration of senior managers
Senior manager remuneration levels are set by the remuneration committee on the following basis:
Accountable officer/chief Remuneration guidance for CCGs as issued finance officer/lay members by NHS England
Other CCG directors Very senior managers’ pay framework
Clinical officers Annual equivalent salary based on GP remuneration levels
Annual pay uplifts are made in line with Secretary of State determinations for basic pay uplifts and the application of local performance review processes for any other changes in remuneration.
As part of our assurance process, personal objectives are set for clinical commissioning group directors and performance against these objectives is reviewed formally by the accountable officer each year. The remuneration committee assesses the performance of the accountable officer, chief finance officer and staff on ‘very senior manager’ contracts and makes appropriate recommendations to the governing body regarding any proposed changes in remuneration, taking into account relevant guidance, benchmarking information and local circumstances
2.1.3 Senior managers’ contract terms
The CCG’s senior managers are employed on the following contract terms:
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Post Status Duration Notice period
Accountable officer Officer Not fixed 6 months Chief finance officer Officer Not fixed 6 months Director Officer Not fixed 3 months Clinical chair Office holder Fixed (3 years) 3 months Clinical /lay members Office holder Fixed (up to 3 years) 3 months Table 6 employment contract terms for senior managers
There are no special payments due on termination of a contract. In the event of early contract termination, a senior manager would receive any applicable statutory entitlement to a redundancy payment and any entitlements due under the NHS pension scheme if they are a member of this.
Service contract details for each senior manager who served during the year were:
Name Contract Contract end Notice period start date date (where applicable)
Helen Hirst 1 October 2016 N/A 6 months Dr James Thomas 2 September 31 March 2020 3 months 2014 Julie Lawreniuk 1 May 2016 31 August 2019 6 months Robert Maden 1 September N/A 6 months 2019 Peter Brunskill 1 April 2013 31 March 2020 3 months Angie Clegg 1 January 2013 31 March 2020 3 months Pam Essler 1 April 2013 31 March 2020 3 months Neil Fell 2 January 2014 31 March 2020 3 months Bryan Millar 1 June 2017 31 March 2020 3 months Nancy O’Neill 20 December N/A 3 months 2018 Michelle Turner 1 April 2017 N/A 3 months Dr Brendan 1 April 2013 31 March 2020 3 months Kennedy Dr Graeme Summers 1 April 2013 31 March 2020 3 months Dr Jake Jeffrey 3 April 2017 31 March 2020 3 months Table 7 service contract details for senior managers
2.1.4 Senior manager remuneration (including salary and pension entitlements)
Table 8 (subject to audit): provides details of the remuneration paid to each senior manager employed by the clinical commissioning group in 2019/20, together with comparative information for 2018/19. Where the post is a shared appointment with another clinical commissioning group, only the appropriate share of the remuneration is shown in the table. Total remuneration for shared
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posts is shown in a note to the table.
Table 9 (subject to audit): provides details of the accrued benefits under the NHS pension scheme for each senior manager employed by the clinical commissioning group in 2019/20, together with comparative information for 2018/19, where the clinical commissioning group paid superannuation contributions into the NHS pension scheme.
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Airedale Wharfedale and Craven Clinical Commissioning Group
Table 8 - Single Total Figure Remuneration Table 2018-19
Expense Long-term All Pension Expense Long-term All Pension Payments Performance pay Performance pay Related Benefits Payments Performance pay Performance pay Related Benefits Name Title Salary (taxable) and bonuses and bonuses ***** Total Salary (taxable) and bonuses and bonuses **** Total
(bands of £5,000) rounded to £00 (bands of £5,000) (bands of £5,000) (bands of £2,500) (bands of £5,000) (bands of £5,000) rounded to £00 (bands of £5,000) (bands of £5,000) (bands of £2,500) (bands of £5,000) £000 £00 £000 £000 £000 £000 £000 £00 £000 £000 £000 £000 Dr James Thomas Clinical Chair 75-80 20-22.5 95-100 70-75 17.5-20 85-90 Helen Hirst Chief Officer ** 45-50 45-50 45-50 45-50 Julie Lawreniuk Chief Finance Officer (to 31/8/19) ** 15-20 15-20 40-45 5-7.5 45-50 Robert Maden Chief Finance Officer (from 1/9/19) ** 15-20 12.5-15 30-35 Pam Essler Governing Body Lay Member *** 10-15 10-15 10-15 10-15 Angie Clegg Governing Body Registered Nurse ** 5-10 5-10 5-10 5-10 Peter Brunskill Governing Body Secondary Care Consultant 15-20 15-20 15-20 15-20 Dr Bruce Woodhouse Council of Members Chair (to 31/1/19) 5-10 5-10 Bryan Millar Governing Body Lay Member ** 5-10 5-10 5-10 5-10 Neil Fell Governing Body Lay Member 15-20 15-20 15-20 15-20 Sue Pitkethly Executive Director (to 19/12/18) 70-75 70-75 Nancy O'Neill Executive Director (from 20/12/18) 105-110 50-52.5 160-165 25-30 0-2.5 25-30 Michelle Turner Director of Quality and Nursing ** 35-40 5-7.5 40-45 35-40 12.5-15 45-50 Dr Colin Renwick GP Executive Group Member (to 31/3/19) 55-60 55-60 Dr Graeme Summers GP Executive Group Member 45-50 45-50 45-50 45-50 Dr Brendan Kennedy GP Executive Group Member 45-50 45-50 45-50 45-50 Dr Jake Jeffrey GP Executive Group Member 40-45 15-17.5 60-65 35-40 35-40
** Posts shared between Bradford Districts CCG (33.3%), Bradford City CCG (33.3%) and Airedale, Wharfedale & Craven CCG (33.3%)
*** Governing Body Lay Member salary includes one session for role as Chair of Independent Funding Review Panel; £000 (0-5)
The information included in the table represents the CCG's share of salaries and allowances for these posts. The total cost for these members of staff are: Helen Hirst Chief Officer ** 140-145 140-145 140-145 140-145 Julie Lawreniuk Chief Finance Officer (to 31/8/19) ** 50-55 50-55 120-125 17.5-20 140-145 Robert Maden Chief Finance Officer (from 1/9/19) ** 55-60 40-42.5 95-100 Angie Clegg Governing Body Registered Nurse ** 25-30 25-30 25-30 25-30 Bryan Millar Governing Body Lay Member ** 15-20 15-20 15-20 15-20 Michelle Turner Director of Quality and Nursing ** 105-110 15-17.5 125-130 105-110 37.5-40 145-150
***** All Pensions Related Benefits represent those benefits accruing to senior managers from membership of the NHS Pension Scheme, calculated using values supplied by the NHS Business Services Authority and used in applying the "HMRC" method formula set out in the NHS Manual For Accounts and Greenbury Disclosure guidance.
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Airedale Wharfedale and Craven Clinical Commissioning Group
Table 9 - Pensions Entitlement Table 2018-19 Name Real increase Real increase Total accrued Lump sum at Cash Real increase Cash Employer's Real increase Real increase Total accrued Lump sum at Cash Real increase Cash Employer's in pension at in pension pension at pension age Equivalent in Cash Equivalent contribution to in pension at in pension pension at pension age Equivalent in Cash Equivalent contribution to pension age lump sum at pension age related to Transfer Value Equivalent Transfer Value stakeholder pension age lump sum at pension age related to Transfer Value Equivalent Transfer Value stakeholder pension age at 31 March accrued at 1 April 2019 Transfer Value at 31 March pension pension age at 31 March accrued at 1 April 2018 Transfer Value at 31 March pension 2020 pension at 31 **** ***** 2020 **** 2019 pension at 31 **** ***** 2019 **** March 2020 March 2019
(bands of £2,500) (bands of £2,500) (bands of £5,000) (bands of £5,000) (bands of £2,500) (bands of £2,500) (bands of £5,000) (bands of £5,000) £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Dr James Thomas Clinical Chair 0-2.5 0 15-20 30-35 267 16 295 0 0-2.5 2.5-5 15-20 30-35 216 36 267 0 Julie Lawreniuk Chief Finance Officer ** 0 0 40-45 130-135 990 0 0 0 0-2.5 2.5-5 40-45 130-135 849 108 990 0 Robert Maden Chief Finance Officer ** 0-2.5 5-7.5 40-45 120-125 849 56 975 0 0 Sue Pitkethly Executive Director 0 0 0 45-50 140-145 0 0 0 0 Nancy O'Neill Executive Director 2.5-5 7.5-10 25-30 80-85 570 67 657 0 0-2.5 0-2.5 20-25 70-75 496 51 570 0 Michelle Turner Director of Quality and Nursing ** 0-2.5 0 45-50 105-110 825 23 874 0 2.5-5 7.5-10 40-45 105-110 687 111 825 0 Dr Jake Jeffrey GP Executive Group Member 0-2.5 0-2.5 10-15 25-30 154 14 175 0 0 0 5-10 20-25 139 7 154 0
** Posts shared between Bradford Districts CCG (33.3%), Bradford City CCG (33.3%) and Airedale, Wharfedale & Craven CCG (33.3%)
However, the information included in the table reflects 100% of pension benefits for the shared posts
**** A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member's accrued benefits and any contingent spouse's (or other allowable beneficiary's) pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.
***** The Real Increase in CETV reflects the increase in CETV that is funded by the employer. It does not include the increase in accrued pension due to inflation or contributions paid by the employee (including the value of any benefits transferred from another pension scheme or arrangement).
Some individuals included on the Remuneration Table are not included on the Pensions Table. This is because some posts are not pensionable (Governing Body lay members) or individuals have chosen to opt-out on the pension scheme.
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2.1.5 Pension benefits as at 31 March 2019
See table 8 on page 111
2.1.6 Cash equivalent transfer values
See table 9 on page 112
Real increase in CETVs
See table 9 on page 112
2.1.7 Compensation on early retirement or loss of office
There were no payments made in 2019/20, or in 2018/19, relating to compensation on early retirement or for loss of office.
2.1.8 Payments to past members
There were no payments made to past senior managers in 2019/20, or in 2018/19.
2.1.9 Fair pay disclosure (subject to audit)
Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director/member in their organisation and the median remuneration of the organisation’s workforce.
The mid-point of the banded remuneration of the highest paid member of the governing body in the clinical commissioning group in the financial year 2019/20 was £137,500 (2018/19: £137,500). This was 3.69 times the median remuneration of the workforce, which was £37,267 (2018/19: 3.75 times the median remuneration which was £36,644).
In 2019/20, no employees received remuneration in excess of the highest paid member of the governing body.
Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind, but not severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions. In 2019/20 remuneration ranged from £3,216 to £139,964 (2018/19: £6,561 to £139,964).
NHS Airedale, Wharfedale and Craven CCG Annual report and accounts 2019/20 9 114
2.2 Staff report
Under the shared management arrangements all of our shared staff are employed by Airedale, Wharfedale and Craven, Bradford City and Bradford Districts CCGs.
2.2.1 Number of senior managers
For the purpose of these figures senior managers by band are any employees band 8a and above, including board/director, medical and dental staff. The number of senior managers at 31 March 2020 was as follows:
Band Permanently Other employed Band 8a 25 1 Band 8b 24 2 Band 8c 3 1 Band 8d 10 0 Band 9 0 0 Board/director 9 0 Medical Staff 3 0 Total 74 4 Table 10: number of senior managers at 31 March 2020
The information in tables 10 relates to the total number of staff employed jointly by the three Bradford district and Craven CCGs.
2.2.2 Staff numbers and costs (subject to audit)
The information included in table 11 overleaf reflects only the clinical commissioning group’s share of total staff numbers and costs for 2019/20 and 2018/19.
NHS Airedale, Wharfedale and Craven CCG Annual report and accounts 2019/20 9 115
116
Staff composition
At 31 March 2020, the total number of staff employed by the Bradford district and Craven CCGs was 218, of whom 169 are female and 49 are male, and 132 worked full-time and 86 worked part-time. These figures exclude non-exec directors/lay governing body members and staff on external secondment.
The information in tables 12 and 13, and figures 13 and 14, below relate to the total number of staff employed jointly by the three Bradford district and Craven CCGs.
Band Full-time Part-time Band Male Female 1 0 0 1 0 0 2 1 0 2 0 1 3 10 10 3 1 19 4 9 10 4 5 14 5 13 11 5 10 14 6 24 16 6 7 33 7 27 11 7 7 31 8a 13 13 8a 5 21 8b 19 7 8b 10 16 8c 2 2 8c 0 4 8d 8 2 8d 1 9 9 0 0 9 0 0 Board/ 6 1 Board/ 3 4 director director Medical 0 3 Medical 0 3 staff staff Total 132 86 Total 49 169 Table 12: numbers of staff by band Table 13: Number of staff by band and and working hours gender
NHS Airedale, Wharfedale and Craven CCG Annual report and accounts 2019/20 9 117
30
25
20
15
10
5
0
Full Time Part Time
Figure 13: staff by band and employee category
35 30 25 20 15 10 5 0
Male Female
Figure 14: staff by band and gender
2.2.4 Sickness absence data Sickness absence data for the CCG can be found on the NHS Digital website.
Sickness absence is managed under the CCG’s policy for absence management and requires both employees and managers to actively report and discuss periods of sickness absence, including return to work interviews and attending formal absence management meetings once the CCG triggers for absence have been invoked.
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Employee healthcare (occupational health) support ensures that employees are supported in a timely and appropriate manner and that staff have access to the interventions needed.
2.2.5 Staff policies The CCG HR policies and procedures are important functional elements to ensuring that staff do not experience discrimination, harassment and victimisation:
acceptable standards of behaviour policy and procedure (this includes dignity at work, victimisation and harassment issues) equal opportunities and diversity employment policy flexible working policy recruitment and selection policy maternity, adoption and parental leave (including shared parental leave) policy whistleblowing and raising concerns policy retirement policy education, training and development policy study leave policy employment break policy grievance policy alcohol, drugs and substance misuse policy secondment, acting up policy managing sickness absence policy annual and special leave policy pay progression policy organisational change policy working time regulation policy managing concerns with performance policy disciplinary policy
The implementation of these policies, along with occupational health support, ensures the continuation of employment and provision of appropriate training to any employee, who becomes disabled and ensures access for all CCG employees, including disabled staff members to training, career development and promotion opportunities.
All policies are due to be reviewed in May/June 2020 to incorporate any changes following the creation of the new Bradford District and Craven CCG.
2.2.6 Trade union facility time
NHS Airedale, Wharfedale and Craven, Bradford City and Districts CCGs do not have any trade union stewards for recognised unions at the organisation. Individuals can join and be a member of a recognised union. The policy on trade union and recognition and facilities and time off for trade union representatives is in place to support.
NHS Airedale, Wharfedale and Craven CCG Annual report and accounts 2019/20 9 119
Within the context of this agreement and the exclusion of others, the CCGs currently recognise the following trade unions/societies:
UNISON Managers in Partnership UNITE - AMICUS Royal College of Nursing British Medical Association GMB
An employee who chooses not to join will not be the subject of any discrimination by the CCGs or a trade union.
2.2.7 Other employee matters
The CCG engaged with Bradford District Care NHS Foundation Trust staff side representatives, who act on behalf of the CCGs, to consult with them about staff restructuring and proposals for the creation of the new Bradford District and Craven CCG. CCG management attended staff partnership meetings in October 2019 which resulted in staff side representatives attending and holding staff meetings at CCG sites.
2.2.8 Health and safety of our staff
Bradford District Care NHS Foundation Trust became our provider of health and safety competency advice from 1 March 2016. The agreed work plan included the provision of the following outputs and there were regular meetings during the year to review delivery:
risk assessments: first aid, security, premises and fire review and development of relevant policies monitoring and (where appropriate) investigation of reported incidents health and safety and fire training circulation of relevant health and safety information via the staff bulletin
Reports were presented to audit and governance committee meetings giving an overview of the operational health and safety activity during each quarter and to provide assurance that any health and safety risks have been identified and are being managed. Reports included any Health and Safety Executive national priorities/new guidance issued during this timeframe,
The committee noted the following assessments (which identified a low level of risk) and action plans arising at our Scorex House premises:
health, safety and security assessment fire safety assessment
NHS Airedale, Wharfedale and Craven CCG Annual report and accounts 2019/20 9 120
The standard for mandatory training attendance is 90% of staff, our figures for staff mandatory and health and safety training as at March 2020 are detailed below:
fire safety (yearly – alternating between on-line and classroom training) – 79% health and safety (three yearly – on-line) – 85% moving and handling (three yearly – on-line) – 83%
There were a total of 20 health and safety incidents or near misses reported across the Bradford district and Craven CCGs during 2019/20
Number Violence and aggression against staff 1 Staff accident 4 Equipment 5 Security 7 Other health and safety 3 Total: 20
Actions taken as a result of these incidents include: all architraves at Scorex House being checked and secured if required; ID badges and SmartCards cancelled; staff advised to be extra vigilant around Scorex House following an incident of aggression and lighting checks in the Scorex House car park. There were no RIDDOR incidents reportable to the Health and Safety Executive.
2.28 Expenditure on consultancy
The clinical commissioning group spent £32,000 on external consultancy in 2019/20 (compared to £10,000 in 2018/19).
2.2.9 Off-payroll engagements
The clinical commissioning group has engaged a number of individuals that are paid through their own companies and as such, are responsible for their own tax and national insurance arrangements. The number of these engagements and how long they have been in place is:
(a) Off-payroll engagements as at 31 March 2020, for more than £245 per day that lasts longer than six months:
Number
Number of existing engagements as of 31 March 2019 0 of which, the number that have existed: for less than one year at the time of reporting for between one and two years at the time of reporting
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for between two and three years at the time of reporting for between three and four years at the time of reporting for four or more years at the time of reporting
Table 14: off-payroll engagements as at 31 March 2020, for more than £245 per day that lasts longer than six months
All existing off-payroll engagements have at some point been subject to a risk based assessment.
(b) New off-payroll engagements between 1 April 2019 and 31 March 2020, for more than £245 per day and that last longer than six months:
Number
Number of new engagements, or those that reached six months 0 in duration, between 1 April 2018 and 31 March 2019 of which: number assessed as IR35 being applicable number assessed as IR35 being not applicable
number engaged directly (via PSC contracted to 0 department) and are on the departmental payroll number of engagements reassessed for 0 consistency/assurance purposes during the year number of engagements that saw a change to 0 IR35 status following the consistency review
Table 15: New off-payroll engagements between 1 April 2019 and 31 March 2020, for more than £245 per day and that last longer than six months
(c) Off-payroll engagements of board members and/or senior officials with significant financial responsibility, between 1 April 2019 and 31 March 2020
Number of off-payroll engagements of board members, and/or 0 senior officers with significant financial responsibility, during the financial year.
Total number of individuals on payroll and off-payroll that have 14 been deemed “board members, and/or, senior officials with significant financial responsibility”, during the financial year. This figure should include both on payroll and off-payroll engagements.
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Table 16: Off-payroll engagements of board members and/or senior officials with significant financial responsibility, between 1 April 2019 and 31 March 2020
Helen Hirst Accountable officer NHS Airedale, Wharfedale and Craven CCG
24 June 2020
NHS Airedale, Wharfedale and Craven CCG Annual report and accounts 2019/20 9 123
3 Parliamentary accountability and audit report
NHS Airedale, Wharfedale and Craven CCG is not required to produce a parliamentary accountability and audit report. Disclosures on contingent liabilities, losses and special payments, gifts and fees and charges are included as notes in the financial statements of this report at pages 154 and 160. An audit certificate and report is also included in this annual report at page 127.
Helen Hirst Accountable officer NHS Airedale, Wharfedale and Craven CCG
24 June 2020
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CHAPTER 3: ANNUAL ACCOUNTS
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