Annual Report and Accounts
2013-2014
Contents
Member practices introduction 1 Strategic report 3 Our organisation 3 Our priorities 4 Challenges and future plans 6 Our Local Commissioning Groups (LCGs) 7 Our performance 13 Engagement and involvement 23 Where we are now 24 Strategic overview 26 Emergency planning, resilience and response 27 Better payment 28 Risk management 28 Sustainability 29 Equality report 30 Members’ report 33 Complaints handling 36 Employee consultation 37 Employees with a disability 37 Equal opportunities38 Pension liabilities 38 Sickness absence 38 External audit 39 Our Governing Body members 2013-14 39 Declarations of interest 42 Remuneration report 45 Statement of Accountable Officer’s responsibilities 49 Annual governance statement for the year ended 31 March 2014 51 Independent auditors’ report to the Members of Cambridgeshire and 65 Peterborough Clinical Commissioning Group Accounts 2013-2014 69
NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Member practices introduction The new Health and Social Care Act came into force from April 2013 which gave responsibility for clinical commissioning to the newly established Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) which is formed from 108 Member practices across the area. As we had been running in shadow form in 2012-13, we were well placed to take on the challenges brought about by this change. Our CCG is funded per head of population according to a national formula and has the lowest per capita funding in the East of England, is the lowest in the Anglia area and one of the lowest in the country.
i) In 2013-14 the CCG received £961 per head using a registered population of 883,371; ii) This was the lowest in the East Anglia area which had an average per head funding of £1,054; and iii) This information is from the NHS England‟s „Two Year Allocation‟ tables.
Along with our partners, we have been calling for a revised formula for allocations that better meet the needs of our growing and ageing population. The CCG Allocations for 2014-15 and 2015-16 have been published. The new formula goes some way to address our concerns but it will be some time before we reach a fair level of funding.
This past year has been focussed on improving quality and improving efficiency for our local population. Our three priorities for change and improvement are: Improving Healthcare for Older People; Improving End of Life Care; and Tackling Inequalities in Coronary Heart Disease. We have made significant progress on all of these throughout the year which we have detailed further in the Strategic Report. Our eight Local Commissioning Groups were key to developing these priorities and have worked hard to ensure our success. We have continued to develop our new organisation. Results of two Organisational Health Surveys in May and December show significant improvement in many areas. Areas of improvement included: Communications between staff and their managers; Staff feeling that good performance is recognised and rewarded in the CCG; and A strong belief that there is an opportunity for every member of staff to have a „voice‟ and raise ideas, concerns, and to influence the direction of CCG. It was encouraging to receive these results, given the challenges that we faced to drive up performance in a financially challenged environment. In March this year we moved staff based at Peterborough Town Hall into the City Care Centre. The move helped us make considerable savings to our running costs while also enabling us to work more flexibly. In the 2013-14 financial year we commenced a procurement process to provide improved services for all non-planned care for people over the age of 65 and adult community services. In March, we commenced the public consultation on the proposals by the four final bidders. We expect to appoint the successful bidder in September 2014, with new services commencing in early 2015.
1 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
We continually monitor and measure our performance against agreed local and national targets to ensure that the services we commission on your behalf meet your needs. We are also committed to commissioning the very best quality services for our population within our resources. In summary and looking forward, as outlined in our five year plan, our overall strategic aims over the next two years are to: Implement the Government‟s Mandate to the NHS; Commission services for a rapidly growing population with differing health need; Take a fresh approach to commissioning e.g. outcomes based; More integration; and Operate successfully within a financially-challenged health economy. The Governing Body has already had a large impact in the way the CCG delivers its business objectives, as outlined above, and will continue to do so over the coming year. Members had the opportunity to consider the performance of the CCG at its quarterly Member Practices event in April 2014, looked at the response to the stakeholder survey and considered possible response to improve GP engagement. Local Commissioning Group Chairs have also agreed the Member Foreword in light of comments made by members at the meeting. The Governing Body is currently undertaking a review of its effectiveness and will have a full development day in June. The outcomes of the review will be communicated to member practices and an action plan prepared to support the CCGs continuing development.
On behalf of the Governing Body, we would like to thank our staff, our Local Commissioning Groups, our partners and all those who we work with for their help and support over the past year.
2
NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Strategic report Our organisation NHS Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) is the third largest CCG in England covering a population of over 890,000 across 108 GP practices. It has structured itself into eight Local Commissioning Groups (LCGs) so that local clinicians can commission for local need. The CCG was licenced from 1 April 2013 under provisions enacted in the Health & Social Care Act 2012, which amended the National Health Service Act 2006 with two conditions. These relate to the two following criteria: Clear and credible plans that set out how CCGs will take responsibility for service transformation that will improve quality within available resources. CCG has a clear and credible integrated plan, which includes an operating plan for 2013- 2014, draft commissioning intentions for 2013-14 and a high-level strategic plan until 2014-15. Clear and credible plans that set out how CCGs will take responsibility for service transformation that will improve quality within available resources. CCG has detailed financial plan that delivers financial balance, sets out how it will manage within its management allowance, and any other requirements set by the NHSCB and is integrated with the Strategic Plan. NHS England reviews the conditions on a quarterly basis, linked to the CCG Assurance process led by the Area Team. These two conditions remained in place during 2013-14 and remain in place to date due to the financial challenges the CCG continues to face. The accounts have been prepared under a Direction issued by the NHS Commissioning Board under the National Health Service Act 2006 (As amended). An unqualified opinion has been given with respect to the financial statements; nevertheless, a report has been issued to the Secretary of State for Health under Section 19 of the Audit Commission Act 1998 for the breach of financial duties due to the CCG‟s deficit position.
Our vision Our vision is that the CCG is led locally by clinicians in partnership with their communities, commissioning quality services that ensure value for money and the best possible outcomes for those who use them.
Our mission To empower our communities to keep healthy and to commission good quality healthcare for all those who need it.
Our values Patient focused – Our population, patients and their families are at the centre of our thoughts and actions, and we will commission care tailored to their needs;
3 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Quality driven – We will constantly strive to be the best we can be as individuals and as an organisation and we will ensure that this is reflected in our commissioning decisions; Work locally – Through our Local Commissioning Groups working within their communities; and Excellent – Our aim is to be an excellent organisation, for our communities, clinicians and our staff.
Our priorities At the start of the CCG, the members set three key strategic clinical priorities for implementation:
The Older People's Programme aims to design and buy-in health and social care services for a defined population of older or vulnerable patients within the CCG's area. The aims are to deliver improved patient experience, better community care and reduce unplanned admissions to hospital where they can be safely avoided. Several bidders put forward their proposals at the end of 2013 and shortlisting took place in March 2014. At that time we felt we had reached a stage where we had enough information to hold a meaningful consultation and a public consultation was launched on 17 March 2014. Through this public consultation, views on the bidders‟ initial proposals will be fed into the development of the bidders‟ final proposals. A clinically-led programme has been established to take forward Improving end of life care. The rationale for selecting this priority acknowledged that the CCG already does relatively well at enabling patients to die in their preferred place of death, but there is significant variation geographically and in terms of disease. In Cambridge City 38% of deaths were in hospital, whereas in Peterborough/ Fenland the figure is 48%. A recent survey showed that ongoing improvements in End of Life Care (EOLC) are taking place in GP practices across Cambridgeshire and Peterborough. Compared to last year‟s survey results (NHS Cambridgeshire and NHS Peterborough), early analysis of the CCG‟s 2014 EOLC practice survey data shows that GPs are increasingly: Identifying patients in need of EOLC and placing them on their practice EOLC register; Holding more Multi-Disciplinary Team (MDT) meetings to discuss care for patients near the end of life; Recording meetings in both the palliative care register and the patient‟s record; discussing alternatives to admission for people on the EOLC register who have been admitted to hospital; Using the CCG EOLC electronic templates for documenting care; and Recording a patient‟s preferred place of death and “do not attempt resuscitation” orders. The survey data also shows fewer hospital discharge letters are failing to mention EOLC when appropriate to do so.
Tackling inequalities in Coronary Heart Disease: This is a formal programme of work, developed by clinicians from across the CCG working in partnership with a wide
4 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14 range of community and secondary care providers, Local Authority representatives, patient representatives and commissioning colleagues to reduce inequalities in healthcare. The aim of the programme is to reduce premature deaths arising from CHD in people aged under 75 years, with a specific focus on reducing premature death rates fastest in areas of poorest outcome ('leaving no-one behind'). Successful outcomes will require a targeted approach to effectively reduce CHD mortality rates in Cambridgeshire and Peterborough and a joined-up approach across the NHS, Public Health and Adult Social care Framework. The work of the Programme is split into four workstreams: 1. Health checks programme; 2. Cardiac rehabilitation; 3. Primary Care interventions; and 4. Decreasing smoking prevalence. On workstreams 1 and 4, the CCG is working in partnership with the Public Health teams at Peterborough City Council and Cambridgeshire County Council, so it is particularly encouraging that one of the greatest achievements that we have to report so far is the success of the Health Check Programme in Peterborough. Prevention is really important to avoid premature deaths and disability from cardiovascular disease and a Health Check can not only help pick up health conditions such as high blood pressure and diabetes, but also determine those at risk of developing heart disease or stroke. GPs can then help identify what can be done to reduce that risk. The CCG also consulted with the local Health and Wellbeing Boards and other stakeholders to identify three additional quality metrics for delivery in 2013/14 linked to the quality premium (a national incentive scheme for CCGs). The additional metrics were aligned with the CCGs clinical priorities where possible and support delivery of the Outcomes Framework. The additional quality metrics are: Reduction in the use of emergency bed days for patients aged over 75. This links to the CCG priority – Older People‟s Programme. It also links to the Outcomes Framework – Domain 4, Ensuring that people have a positive experience of care; Improving Primary Prevention 1 (Cardiovascular disease). This links to CCG priority – Reducing inequality in CHD. It also links to Outcomes Framework – Domain 1, Preventing people from dying prematurely; and Reducing maternal smoking at the time of delivery. This links to Outcomes Framework – Domain 1, Preventing people from dying prematurely. The CCG sits on four Health and Wellbeing Boards and plays an active role. We work closely with our local authority colleagues to ensure that our joint and individual strategies are aligned. An internal audit review demonstrated substantial assurance of working relationships with these bodies. The strategies are reviewed by the Boards and we also report quarterly to Governing Body on our joint work.
5 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Challenges and future plans Our strategic aims are: Empowering people to stay healthy; Improving quality, improving outcomes; and Developing a sustainable health and social care system. From these aims we have identified seven strategic goals: Prevention of ill health and promoting wellbeing for all; Keeping people safe; People have trust and confidence in us and help shape our healthcare; People are listened to throughout their care; Making best use of our NHS by giving the right care, in the right place at the right time; Services are seamless, integrated and centred around the person; and The services that we commission match the needs of our population ensuring fair access in relation to need. The Cambridgeshire and Peterborough system has been identified by Monitor/NHS England/Trust Development Authority (TDA) as one of eleven economies that face particularly deep-rooted challenges. The three national agencies have initiated a 12 week programme of intensive support for each of the eleven areas. In our case Pricewaterhouse Coopers LLP (PwC) have been appointed, and began work in April. There are four main phases to the work; diagnosis; development of solutions; planning; and implementation planning. As part of the contract, PwC are required to submit three reports to the national agencies (but not the CCG): a first report at the end of the first workstream; a second report summarising the proposed solutions; and a final report setting out the key next steps. The work is overseen by a steering group comprising NHSE/Monitor/TDA and the CCG. At the time of writing this report, the first phase of the work is complete and a report has been submitted to the national agencies. The second stage has at its core a series of 'Clinical Design Groups' which bring together clinicians to design future pathways of care, in an organisationally neutral way. The two areas that have been selected locally are urgent care and elective care. Alongside the CDGs, which focus on the clinical design, the CEOs locally are beginning to consider the possible implications for organisations and future decision making. The work is scheduled to finish at the end of June, but is being viewed as the catalyst for a much longer programme of change across the economy. In 2013-14, the CCG despite a challenging financial allocation, agreed to invest £5m through its Local Commissioning Groups. In addition, it reinvested the Marginal Rate Emergency Tariff funding of £6m, and £3m with respect to Readmission Funding. With respect to the future the CCG will continue to invest in schemes which prove their worth both clinically and financially, helping the CCG meet its objectives.
Risks are disclosed in the Annual Governance Statement.
6 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Our Local Commissioning Groups (LCGs) Our eight Local Commissioning Groups (LCGs) develop the CCG‟s strategy at a local level. Ely and Wisbech Isle of Ely and Wisbech LCGs are the two LCGs within the CCG that are the furthest away from an acute hospital provider. Patients living in these areas can therefore find it difficult to access acute hospital services. As a result of this both LCGs aim to commission high quality care for patients as near as possible to their homes. The area is fortunate to have three local community hospitals within the localities – North Cambridgeshire Hospital, Wisbech, Doddington Community Hospital and Princess of Wales Hospital, Ely. The LCGs are working towards maximising the potential usage of these sites to help achieve this aim. Much of the LCGs‟ work has been with Cambridgeshire Community Services NHS Trust (CCS) to redesign and commission services so as to make a reduction in avoidable A&E attendances and inappropriate, avoidable unplanned admissions to hospital. The LCGs have commissioned services through a number of projects that they expect will contribute to a reduction in A&E attendances and emergency admissions. These projects include: Trafford Ward project Multi-disciplinary Team (MDT) Coordinators Rapid Response Service Community Respiratory Service Community Deep Vein Thrombosis Diagnostic Pathway Integrated Community Diabetes Service Care Home project. The two LCGs also aim to commission planned care services to be delivered as close as possible to their patients. They are currently working with providers to deliver services within community hospitals and within the LCG areas. In particular they are keen to make best use of the block contract with CCS, especially for outpatient services. They have identified various cohorts of patients for whom they think service delivery can be improved. Planned care projects to improve services to patients include: Ophthalmology Referral Support Musculoskeletal Services (MSK) Sleep Apnoea Ear Nose and Throat Services(ENT) Isle of Ely and Wisbech LCGs aspire to maximise the support they give to Primary Care. They recognise that primary care is a crucial part of the care given to patients, especially in view of the difficulty some patients can experience when needing to access care outside of the LCG borders.
7 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Hunts Health (HH) and Hunts Care Partners (HCP) During 2013 -14 the two LCGs worked together on some key areas: Effective management of Primary Care Referrals The Hunts system led the development of the Referral Support service across the CCG. All referrals from practices in key specialities (excluding two-week waits for cancer referrals and urgent referrals) were sent to the triage team of GPs to ensure they met clinical threshold requirements. The aim of this was to make sure referrals were of a high quality, so that patients only needed to be referred when clinically appropriate. Delivery of PDMA Agreement Practices were required to sign up to a Practice Delivery and Membership Agreement (PDMA). The process is that practices receive four quarterly payments upon achievement of requirements as set out in their work plans, which are agreed at the start of the year with the LCG support team to: Complete the audit set by the LCG; Provide evidence of use of urgent care and how this has helped to reduce A&E attendances and supported discharges from hospital; and Provide evidence to explain the system in place for managing referrals in house – that individual practice data is reviewed and findings used to inform practice visits. Management of prescribing and medicines management The Support Medicines Management Team worked with practices to identify areas where prescribing savings could be made. Hunts Prescribing Group was formed to promote safe, evidence-based, cost-effective prescribing and medicines optimisation across all practices. Performance and contract management of providers The two LCGs are the lead commissioners for the Hinchingbrooke Healthcare NHS Trust contract. The 2013-14 contract is £82m. During this period the Trust has over performed against planned activity levels. The Trust and the contract team are currently working together to understand the reasons for this and are looking at the delivery of the QIPP (Quality, Innovation, Productivity, Prevention) plans outlined below: Reduction of consultant to consultant referrals where referrals have not been to the GP first; Reduction in clinical threshold levels where the clinical evidence does not support a procedure being performed we looked to reduce the numbers being carried out; Reduction in non GP referrals – referrals from Nurse practitioners, MSK and Ophthalmology services; Front of house redesign (resulting in a reduction in Non-Elective Inpatient via Accident and Emergency) through senior decision making as the patient presents; Reduction in GP referred emergency admissions – where a GP refers a patient as an emergency to the hospital A&E this is only after discussion with consultants;
8 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Reduction in Direct Access Radiology; Reduction in First Attendance Outpatients following a GP referral; Nursing home end of life project to increase the number of patients dying in their preferred place of death; Reduction in prescribing spend; Urgent Care Cambridgeshire divert project where the out of hours service provides treatment for minors at the front of A&E to prevent attendance at A&E; and Frequent Attender, Care Enhanced (FACE) Team.
Borderline and Peterborough Borderline LCG is made up of a group of 10 GP practices with the vision of ‘One voice, one vision, one standard of care’. The practices are located on the borders of the CCG situated in Peterborough, Northamptonshire and Cambridgeshire. Peterborough LCG serves a population of 135,800 divided over 21 GP practices. The key priorities for the Borderline and Peterborough Health System are to: Provide high quality and seamless patient-centered health and social care to local patients regardless of the challenges imposed by geographical borders; Progress transformational programmes to redesign key services enabling delivery of care within the financial envelope available; and Continue to build on existing strong working relationships with key multi-agency stakeholders thereby maximising the potential for innovation of service improvement and delivery. This year both LCGs have made good progress with their aims to develop the LCGs into robust and effective organisations. They have been working on progressing transformational programmes: Care for the frail and elderly: A number of urgent care initiatives have been introduced: Firm #2: This is now established as an important facility aimed primarily at the frail and elderly to provide specialist care outside of hospital. The GP workforce is established and is actively recruiting for more staff. To date 46 patients have accessed the service. Front Door Team: Established for seven-day working to assess A&E entrants. The team has avoided 413 unnecessary admissions from September 2013 to January 2014. Rapid Response Urgent Care: An additional 24/7 urgent care pathway has been commissioned from Bluebird Care to accept up to four referrals a day from the FIRM or A&E front door team and three referrals a day from the community, to prevent patients being admitted to hospital unnecessarily. Multi-Disciplinary Team Working (MDT): As part of the ongoing drive to enhanced the service to patients with complex needs the three cluster MDTs have each met 14 times this year. End of Life Care: To meet its commitment to the End of Life Care Programme the LCGs have implemented Gold Standards frameworks in GP practices, supported patients‟ decisions and promoted the Palliative Care Co-ordination Centre.
9 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Coronary Heart Disease: A number of measures from patient monitoring, lifestyle counselling and use of statins have been focused on reducing death from Coronary Heart Disease and emergency admissions.
Other Projects: Other transformational projects undertaken by the LCGs include: The commissioning of Evolutio, an experienced private provider, to improve optometry services to patients and reduce annual costs by £100k; Establishing an Epilepsy Nurse service and Community Continence service; and The practices in Borderline LCG have also focused on providing better access to their own services. For example „Dr First‟(initiative) at Yaxley Group practice. A good working relationship has been established between the Boards and their Patients‟ Forums ensuring that there is a positive two-way flow of information, ideas and comments between the two. Patients have been heavily involved in examining websites for the practices and there is a good spread of patient representation on various live projects under development.
CAM Health Cam Health LCG has continued to develop and strengthen over the year, with all nine member practices being actively involved. Key areas of focus over the last year have included: Continuing the development of its innovative Integrated Diabetes Service, which is providing care for type 2 diabetic patients in community settings. The objectives of this work are: - To help patients avoid the need to go to hospital; - To ensure that primary care and secondary care are developing shared, optimised plans for patients; and - To give patients better access to key services such as podiatry and dietetics; The service is supporting patients to manage their weight successfully and starting to provide evidence of better diabetic disease management through this approach; Managing frail and elderly patients, through the LCG‟s Enhanced Community Matron service, this is now supported by new Multi-Disciplinary Team Coordinators. The Matrons and MDT Cordinators work with member practices to identify patients who may be at increasing risk of admission to hospital and work together to co-ordinate and optimise the care of those patients in the community. They also provide clinical notes, which can be seen by the Out of Hours GP Service, and the LCG is working with Addenbrooke‟s Hospital to ensure that they can also access these community care records; Working to extend the current Ear Nose and Throat (ENT) community clinic from one session to three sessions per week, to allow patients fast access to an appointment in the community; Working to establish a new and innovative Dermatology Community Clinic, which will offer a Consultant Dermatologist working alongside GPs to provide fast access to advice and treatment for common dermatological conditions. The pilot started in April 2014 and will be evaluated after six months; Continuing to support and develop our services for patients with Chronic 10 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Obstructive Pulmonary Disease (COPD). This has involved sharing best practice between practice nurses and GPs, changing the location and frequency of the Pulmonary Rehab Services to make them more accessible for patients and working with the Centre for Self-Management at Addenbrooke‟s to undertake a systematic and in-depth review of patients‟ needs and how they would like to see their services improve; Implementing a new referral review system to understand the variation in primary care prescribing, and support GPs with access to advice and support to improve the quality and consistency of referrals made. The LCG hopes to build on this further in 2014 - 15 with a detailed series of pathway reviews and the possible introduction of software to support clinical decision making and the provision of top-quality patient information; Introduced a vibrant prescribing group where all practices meet regularly and have successfully implemented Prescribing Extra Therapeutic Services (PETS); and Successfully implemented a new referral support system to support clinicians in reducing the variation in referrals and support GPs.
Cambridge Association To Commission Health (CATCH) CATCH LCG‟s vision is to „create the best services with our patients for the care of their health and well-being within the resources available‟. The LCG is made up of 12 practices and covers a population of 221,532 of which there are 33,182 people aged 65 years and older (15% of the total registered population). Successes include: Making progress with managing variation through consistency of referral and prescribing; Continuing to work with clinicians and our GP Clinical Leads to review clinical pathways and assure ourselves that a non-elective admission to hospital is the most clinically appropriate course of action; Reducing delayed transfers of care by a quarter; Introduced multi-disciplinary team working in practices ensuring a more personalised and responsive service for older people whilst reducing unnecessary admissions to hospital; Advancing harm reduction through alcohol by up-skilling GPs and practice staff in the use of intermittent brief interventions and reviewing commissioning plans to ensure that future services are commissioned to match health need; Tackling child poverty by appointing a children‟s lead and implementing practical mechanisms for linking children in poverty, who are identified by GPs, to other services. Also by developing a children‟s strategy with partners to deliver the best possible outcomes for children; and Making sure our services meet the needs of patients. Working with our Patient Group whose role is to represent the interests of the CATCH patient community and to help shape commissioning plans and decision-making. Other successes are around services such as: The Acute Geriatric Intervention Service (AGIS) responds to the needs of older people at a point of crisis (for example after a fall) and helps to ensure they receive the most appropriate support (rather than ending up in hospital);
11 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Medihome – an acute nursing service that cares for people in their own homes (again avoiding the need for hospital admission where possible); The Referral Support Service which ensures all referrals are appropriate to improve quality and consistency; and Ophthalmology in North Villages.
12 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14 Our performance
Financial performance targets Clinical commissioning groups have a number of financial duties under the NHS Act 2006 (as amended). The clinical commissioning group‟s performance against those duties during 2013-14 was as below and also as shown in note 42 to the Annual Accounts. These can be obtained from Tim Woods, Chief Finance Officer. Lockton House, Clarendon Road, Cambridge CB2 8FH. 2013-14 Target Performance £000s 1. Expenditure not to exceed income & the revenue resource does not exceed the amount specified in Directions 883,203 888,077 Not met by 0.55% - See table below 2. Capital resource use does not exceed the amount specified in Directions 254 254 Achieved 3. Revenue administration resource use does not exceed the amount specified in Directions with respect to Running Costs 20,800 18,719 Achieved
Table 2013-14
Performance for the year ended 2013-14 is as follows: £000 Total net operating cost for the financial year 888,077 Net operating cost plus (gain)/loss on transfers by absorption Revenue Resource Limit 883,203 Under/(Over)spend against Revenue Resource Limit (RRL) (4,874)
13 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Measurement of performance
We robustly monitor measure and report on our performance against local and national targets. During 2013-14 we have focused our attention on: Ensuring that monthly performance reviews take place with the major providers of health services in Cambridgeshire and Peterborough and cover service performance and clinical quality; Holding providers from whom we commission services to account for the responsiveness and quality of services provided; Ensuring delivery of our population‟s NHS Constitutional rights; Working closely with the NHS England Area Team to identify how well we are performing against our plans to improve services and deliver better outcomes for patients, as well as working together to assess how we and the healthcare providers from which we commission services, can best realise our full potential; and Ensuring that all key performance measurements are regularly communicated to all our stakeholders.
During the year our GP leads have been actively involved in the process of contract management and reviewing services commissioned. Clinical Commissioners are regular members of the Finance and Performance Committee. Key performance information is also reported to the CCG Governing Body. Furthermore, on a quarterly basis, the NHS England Area Team meets with us to review our effectiveness in discharging our statutory responsibilities. We have been working hard to meet increasingly challenging targets and key performance indicators associated with the NHS Outcomes Framework for 2013-14, the CCG Outcomes Indicator Set for 2013-14 and Everyone Counts: Planning for Patients 2013-14.
We have also been preparing and considering the key indicators associated with the NHS Outcomes Framework for 2014-15. The CCG will continue this work in 2014-15 with a focus on the main risk areas of Referral to Treatment, A&E standards and Infection Control. The tables below summarise 2013-14 performance on key indicators and compare performance to 2012- 13.
Please note: the figures for 2012-13 in the following tables show performance for both NHS Cambridgeshire (NHSC) and NHS Peterborough (NHSP) where appropriate.
14
NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Access to emergency care in 2013-14 Figures here relate to Ambulance responses (East of England Ambulance Service or EEAST) and maximum waiting times at Accident & Emergency (A&E).
Target 12-13 13-14 actual Performance target 13-14 target achieved? actual (EEAST)
All ambulance trusts to respond to 75% of Category A calls 73.7% 73.6% 75% (immediately life No threatening) within 8 minutes (Red 1) All ambulance trusts to respond to 75% of Category A calls (may 74.3% 69.4% 75% be life threatening but No less time critical) within 8 minutes (Red 2) All ambulance trusts to respond to 95% of Category A calls 93.6% 92.9% 95% (immediately life No threatening) within 19 minutes
The historical trend of not delivering against the above national targets continued throughout 2013-14, with performance having deteriorated overall in comparison to the prior year at both regional and local level. In general these targets have been historically met for the population residing within the urban areas of the region but not for those who reside within the outlying rural areas. However, in the current year there has also been a noticeable dip in performance in some of the urban areas. EEAST have been subject to a period of organisational instability due to significant departures within the leadership team over the past two years. However we are reassured by the recent appointment of an interim Chief Executive who has considerable experience in turning around failing ambulance trusts, most recently having led on the successful transformation of the East Midlands Ambulance Service. EEAST are currently carrying out an in depth review of their strategy and operational model with a view to improving performance at both regional and local level up to the nationally required standards. It has been agreed that we will reinvest all penalty monies and fines withheld in the current contract year to support the recovery programme.
15
NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Four-hour maximum wait in A&E from arrival to admission, transfer or discharge in 2013-14 A&E performance is monitored through the local system Urgent Care Boards (UCBs) which centre around providers. For each provider, A&E remains a key service performance element in the contract and as such contract queries are raised for under performance and remedial action plans submitted to commissioners to address under performance. Figures here relate to maximum waiting times at Accident and Emergency (A&E). 13-14 Performance 12-13 actual 13-14 target target actual Target achieved? (CCG) The proportion of patients spending No four hours or less 94.3% 94.6% 95% in all types of A&E department
The figures below relate to A&E performance at provider level. 12-13 13-14 Target Provider actual actual 13-14 target achieved? Cambridge University Hospitals Foundation 94.7% 94.4.% 95% No Trust (CUHFT) Hinchingbrooke 97.7% 96.3% 95% Healthcare NHS Trust Yes Peterborough and Stamford Hospitals 93.1% 92.4% 95% No Foundation Trust (PSHFT) Queen Elizabeth Hospital, Kings Lynn 92.8% 92.5% 95% No (QEH)
CUHFT failed to meet the A&E target in April, October, November, December and March. Underperformance has been due to a variety of factors. During the winter period, the clinical state of some patients meant that they were unable to be moved, and this combined with a high number of admissions of frail and elderly patients over the age of 85. There were also issues with delayed medical assessment capacity and staffing issues in the emergency department. Similar issues were experienced at PSHFT who failed to meet the standard for all months apart from June, November and December. The reasons for underperformance include the high number of admissions, particularly in patients over 80 years old. For example, in January, the Trust had significant capacity pressures with a high volume of older patients with respiratory-related illness. When patients have been very ill, the length of stay has been longer, which is reflected in extreme pressure on ITU services. 16
NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
The first time QEH achieved the standard in 2013-14 was in January. They also met the target in March. Underperformance has primarily been related to overall bed capacity. In order to monitor and improve performance, daily meetings have taken place such as daily operational group meetings to ensure patient flow and reduce delays in discharge, daily escalation calls with the CCG and system partners, including NHS England and daily breach meetings to analyse causes and action being taken. To address capacity issues, action has been taken to ensure that additional community beds have been commissioned and utilised, reviews are being undertaken for any lengths of stay greater than 14 days and additional staff have been recruited at CUHFT to support the Emergency Department. Internal processes are being continually reviewed such as streamlining the referrals process, reviewing community services acceptance and discharge criteria, reviewing processes for specialty assessments within A&E to speed up review and improving the utilisation of the acute nursing service to reduce pressure on CUHFT. Contractual penalties have been applied as appropriate and Remedial Action Plans are in place.
Access to planned care in 2013-14 Figures here relate to patients receiving elective or planned care following a referral made by GPs to receive treatment by the relevant provider (hospital, community provider). We are pleased to report that we have continued to meet all referral to treatment standards for 2013-14. 13-14 Target Performance 12-13 actual actual 13-14 target achieved? target (CCG) Percentage of NHSC: 91.6% patients seen within NHSP: 90.5% 90% Yes 18 weeks for 75% CCG: 91% admitted pathways Percentage of NHSC: 98.2% patients seen within 81% NHSP: 97.5% 95% Yes 18 weeks for non- CCG: 97.8% admitted pathways Percentage of patients on incomplete non- emergency NHSC: 96.5% 97% pathways (yet to NHSP: 97.1% 92% Yes start treatment) CCG: 96.8% waiting no more than 18 weeks from referral
17
NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Access to cancer services in 2013-14 These figures relate to how long patients have to wait for diagnosis or treatment. We are pleased to report that we have continued to meet all cancer standards for 2013 -14. 13-14 actual Target Performance target 12-13 actual 13-14 target (CCG) achieved? Patients seen within two weeks from an NHSC: 96.0% 97.5% urgent GP referral for NHSP: 96.9% 93% suspected cancer to CCG: 96.1% Yes date first seen Patients seen within two weeks from a referral for evaluation NHSC: 96.0% 96.7% of “breast symptoms” NHSP: 97.4% 93% Yes by a primary care CCG: 96.3% professional to date first seen Patients receiving their first definitive NHSC: 97.8% treatment for cancer 98.45% NHSP: 99.0% 96% within one month (31 Yes CCG: 98.0% days) of a decision to treat Patients receiving their subsequent Chemotherapy NHSC: 99.8% 99.9% treatment for cancer NHSP: 99.3% 98% Yes within one month (31 CCG: 99.7% days) of a decision to treat Patients receiving their subsequent NHSC: 95.9% Surgical treatment 95.8% NHSP: 97.1% 94% for cancer within one Yes CCG: 96.1% month (31 days) of a decision to treat
Patients receiving their subsequent Radiotherapy NHSC: 96.0% 96.47% Yes treatment for cancer NHSP: 94.5% 94% within one month (31 CCG: 95.7% days) of a decision to treat
18
NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Patients receiving their first definitive treatment for cancer NHSC: 85% 88.2% within two months NHSP: 87.2% 85% Yes
(62 days) of GP or CCG: 85.4% dentist urgent referral Patients receiving their first definitive treatment for cancer NHSC: 98.6% 94.27% within two months NHSP: 96.8% 90% Yes
(62 days) of a CCG: 97.8% National Screening referral
Patient safety 2013-14
Figures here relate to the number of incidences of Clostridium difficile and MRSA applicable to our CCG. Whilst we exceeded the annual ceiling for 2013-14, there has been a considerable reduction in cases compared to 2012-13. 2013-14 Target 2012-13 2013-14 Performance target actual achieved? actual ceiling (CCG) NHSC: 127 Number of incidences 159 NHSP: 44 134 of Clostridium difficile Not met No CCG: 171 Number of incidences NHSC: 9 4 of MRSA in patients NHSP: 1 0 Not met No aged 2 or over CCG: 10
Clostridium difficile CUHFT, PSHFT and QEH exceeded the ceilings confirmed in the 2013-14 Trust plans and contractual consequences have been applied as appropriate. Remedial action plans are in place, which are monitored monthly through Healthcare Associated Infections (HCAI) meetings. There is no single change which will improve performance however the key issues identified have been around communication across and between all services. CUHFT‟s communications strategy has resulted in an improvement in communication with the Infection Control team, resulting in more frequent and meaningful liaison between ward staff and infection control. All opportunities for dissemination of key messages have been taken across the organisation.
19
NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
MRSA The four cases of MRSA bacteraemia in 2013-14 were at CUHFT. The national Post Infection Review (PIR) process is undertaken to determine which provider service will be assigned each case and the appropriate learning is identified and monitored through subsequent HCAI meetings. CUHFT has staff education and audits in place with regard to MRSA decolonisation and audits have increased from once to twice monthly with results fed back to individual wards immediately.
20
NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Scorecard for NHS Constitution Delivered Delivered
Referral to treatment access times 2012-13 Threshold Mar 14 2013-14 Mar 14 2013-14 Admitted patients 91.0% 90.0% 91.42% 92.75% Yes Yes
Non-admitted patients 97.8% 95.0% 96.76% 97.81% Yes Yes
Incomplete pathways 96.8% 92.0% 97.73% 97.00% Yes Yes
Delivered Delivered
Diagnostic waits 2012-13 Threshold Mar 14 2013-14 Mar 14 2013-14 No patient should wait > 6 weeks 99.4% 99.0% 99.46% 99.46% Yes Yes Delivered Delivered
A&E waits 2012-13 Threshold Mar 14 2013-14 Mar 14 2013-14 Patients spending four hours or less in all types of A&E department CCG 94.3% 95.0% 93.79% 94.59% No No Patients spending four hours or less in all types of A&E department CUHFT 94.7% 95.0% 91.67% 94.43% No No Patients spending four hours or less in all types of A&E department Hinchingbrooke 97.7% 95.0% 95.64% 96.28% Yes Yes Patients spending four hours or less in all types of A&E department PSHFT 93.1% 95.0% 83.58% 92.39% No No Patients spending four hours or less in all types of A&E department QEH 92.8% 95.0% 95.28% 92.57% Yes No Delivered Delivered
Cancer waits 2012-13 Threshold Mar 14 2013-14 Mar 14 2013-14 2 week wait for urgent cancer referrals 96.1% 93.0% 97.87% 97.51% Yes Yes 2 week wait for breast symptom referrals 96.3% 93.0% 96.64% 96.67% Yes Yes 31 day wait to first definitive treatment for all 98.48% cancers 98.0% 96.0% 99.32% Yes Yes 31 day wait for subsequent surgery 96.1% 94.0% 94.20% 95.84% Yes Yes 31 day wait for subsequent drug 99.7% 98.0% 100.00% 99.85% Yes Yes 31 day wait for subsequent radiotherapy 95.7% 94.0% 97.89% 96.70% Yes Yes
21 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
62 day wait to first definitive treatment for all 88.24% cancers 85.4% 85.0% 89.20% Yes Yes
62 day wait following screening referral 97.8% 90.0% 95.65% 94.27% Yes Yes
Delivered Delivered
Category A ambulance 2012-13 Threshold Mar 14 2013-14 Mar 14 2013-14 Cat A calls response arriving within 8 minutes - 70.37% 73.73% Red 1 73.7% 75.0% No No Cat A calls response arriving within 8 minutes - 62.36% 69.52% Red 2 74.3% 75.0% No No
Cat A calls ambulance arriving within 19 mins 93.6% 95.0% 90.92% 92.94% No No
Delivered Delivered
Mixed sex accommodation 2012-13 Threshold Mar 14 2013-14 Mar 14 2013-14 Mixed Sex Accommodation Breaches 27 0 0 26 Yes No Delivered Delivered
Care Programme Approach 2012/13 Threshold Mar 14 2013-14 Mar 14 2013-14 % of people on CPA followed up within 7 days of discharge 93.3% 95.0% 93.8% 96.8% No Yes
Key PSHFT – Peterborough and Stamford Hospitals NHS Foundation Trust Threshold – Target 2013-14 QEH – Queen Elizabeth Hospital Kings Lynn NHS Foundation Trust CUHFT – Cambridge University Hospitals NHS Foundation Trust Hinchingbrooke - Hinchingbrooke Healthcare NHS Trust
2012-13 figures in the above table relate to NHS Cambridgeshire and NHS Peterborough, which are the predecessors to the CCG. Each indicator in the “Our Performance” section is linked to national guidance published by NHS England in the Everyone Counts guidance and technical definitions: https://www.gov.uk/government/publications/nhs-outcomes-framework-2013-to-2014
22 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Engagement and involvement In discharging its functions under the Health and Social Care Act 2012, the CCG is required to: Make arrangements to secure public involvement in the planning, development and consideration of proposals for changes and decisions affecting the operation of commissioning arrangements by ensuring that individuals to whom the services are commissioned are being or may be provided are involved:
a) In the planning of the CCG‟s commissioning arrangements; b) In the development and consideration of the proposals by the CCG for changes in commission arrangements; and c) In the decisions of the CCG affecting the operation of commissioning arrangements, where the decisions would, if made, impact on the manner in which the services are delivered. Promote the involvement of patients, their carers and representatives in decisions about their healthcare by promoting their involvement in the decisions which relate to: a) The prevention or diagnosis of illness in the patients; or b) Their care or treatment.
During the last year the CCG‟s Engagement Team has built new partnerships and developed existing partnerships (taking forward relationships already established with the former PCTs into the new commissioning organisation). Key contacts include: Patients, carers and the wider public; All staff members across the CCG including those in member practices; Local authorities, voluntary sector organisations, Healthwatch organisations, Health and Wellbeing Boards, and MPs; Other NHS bodies and regulators ie. NHS England, Monitor and the Care Quality Commission; Our providers including Cambridgeshire Community Services NHS Trust; East of England Ambulance Service NHS Foundation Trust; Cambridge University Hospitals NHS Foundation Trust; Hinchingbrooke Health Care NHS Trust; Peterborough and Stamford Hospitals NHS Foundation Trust; Cambridgeshire and Peterborough NHS Foundation Trust, and other contracted NHS provider trusts that border our area; and Local and national media. The CCG is committed to ensuring that there is a strong patient voice in helping us to design healthcare services for the future. We recognise that empowered clinical leadership must go hand in hand with strong patient and public leadership, with patients working with the organisation as „critical friends‟ and this ethos is reflected in our Communications, Engagement and Membership Strategy. There are always opportunities for our stakeholders and members of the public to engage and share their views with us. Our stakeholder newsletter, which is sent out to our stakeholder database and is posted on our website, has a facility for people to leave comments. Our Engagement Team email address is publicised on all our communications and we encourage members of the public to contact us. We respond to emails and telephone calls where we are given feedback or concerns are raised by our stakeholders or the public.
23 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
The Patient Reference Group is a Sub-Committee of the Governing Body and includes patient representatives from each of our eight Local Commissioning Groups, as well as Healthwatch Cambridgeshire and Healthwatch Peterborough. The Patient Reference Group provides constructive challenge on a broad range of work, policy development and changes to patient pathways. It is a key part of making sure that the CCG is very different from previous commissioning organisations. Alongside the Patient Reference Group, there is a range of other groups with whom we engage on a regular basis: Patient Participation Groups, Patient Forums, Healthwatch, Health Overview and Scrutiny Committees, Health and Wellbeing Boards. Taking into account the feedback we receive from these groups, we then decide on what the most appropriate means of public engagement will be at each stage of the commissioning process from planning to the consideration of specific proposals for change. Each commissioning activity we undertake will be different and the means of public involvement at each stage in the process is likely to vary. For example, at some stages of the commissioning process public involvement may be achieved through the publication of information regarding our activities, whereas at others formal consultation may be more appropriate. Our decisions on the means by which we engage the public in each commissioning activity are likely to include consideration of the following relevant factors, among others: The range of services we are proposing to change; The size of the geographical area; The number of people affected by the proposed change; and The nature of the particular stages of the commissioning process. Examples of public engagement that we started last year were our summer roadshows where we talked to the general public about Cambridgeshire and Peterborough CCG as an organisation and its priorities. We also began talking about our proposals to improve older people‟s healthcare and adult community services. In March this year, we reached a stage where we had enough information on proposals to improve older people‟s healthcare and adult community services to go out to public consultation. The public are being asked for their feedback on the initial proposals a number of organisations have put forward on how services could be delivered differently to achieve the improvements we are looking for.
Where we are now The population of Cambridgeshire and Peterborough is increasing and growing older. There are significant levels of deprivation and inequality that need to be addressed. People are living longer but there are significant differences in people‟s health. Our current system is not financially sustainable so we have set out a financial plan that we believe is realistic and one, which ensures that the services we commission are safe, of high quality and affordable. Although the situation overall is challenging, it also presents a range of strategic and operational opportunities for genuine service transformation. Our strategic aims are: Empowering people to stay healthy; Improving quality, improving outcomes; and Developing a sustainable health and social care system.
24 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
From these aims we have identified seven strategic goals: Prevention of ill health and promoting wellbeing for all; Keeping people safe; People have trust and confidence in us and help shape our healthcare; People are listened to throughout their care; Making best use of our NHS by giving the right care, in the right place at the right time; Services are seamless, integrated and centred around the person; and The services that we commission match the needs of our population ensuring fair access in relation to need. We have been looking at enhancing integration and joint commissioning through the Better Care Fund (BCF). In June 2013, the Government announced the creation of a £3.8bn BCF (formerly the Integration Transformation Fund). The BCF is a single pooled budget to support health and social care services to work more closely together in local areas. The BCF is intended to provide an opportunity to transform care so that people receive better integrated care and support. It encompasses a substantial level of funding and it will help deal with demographic pressures in adult social care. The BCF is an important opportunity to take the integration agenda forward at scale and pace. It is a significant catalyst for change. Whilst the Better Care Fund does not come into full effect until 2015-16, there has been a drive nationally to build momentum in planning the changes required. Locally, planning and engagement started in the latter half of 2013-14 and will continue throughout 2014-15. In Cambridgeshire and in Peterborough, there is an over-arching strategic framework in place, which includes respective Health and Wellbeing Strategies, the Older People Programme which aims to integrate and transform services and developing strategies that are focussing on the professionalisation of social work. The BCF has „touch points‟ with each of the above strategic work streams. We have drawn up a shared vision and a set of principles by which we will operate the BCF. In overview, our long-term shared vision is to „bring together all of the public agencies that provide health and social care support, especially for older people, to co- ordinate services such as health, social care and housing, to maximise individuals‟ access to information, advice and support in their communities, helping them to live as independently as possible in the most appropriate setting.‟ To be successful, this transformation will require the contribution of a range of health and social care providers as well the greater involvement of the community and voluntary sectors. Cambridgeshire County Council, Peterborough City Council and the CCG believe that the BCF offers an important opportunity to transform the health and social care system delivery in Cambridgeshire and Peterborough to meet the needs of a rapidly ageing population better and, by doing so, ease the pressure on the system more generally, enabling it to provide better services to the whole population of the county or city. The BCF offers a unique opportunity to re-think how a significant amount of public money could be more efficiently and effectively spent. Fundamentally, we believe that the BCF should be used for genuine transformation of the health and social care system in Cambridgeshire and Peterborough. By creating greater synergy, and hence efficiencies in the provision of social care and health services, these can better be better protected from pressures brought about by increasing demand and reducing budgets. The scale of this transformation opportunity is significant; it is much more than just reducing admission to hospital. Rather, it is about
25 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14 changing the whole system so that it is focused on supporting people wherever possible with person-centred and professionally-led primary care / community / social care, guided by the goal of living as independently as possible, for as long as possible.
Strategic overview The CCG has strategic focus in all areas of its work. Strategy has been developed and implemented after discussion with our Patient Reference Group and other staff and patient groups, as well as local authority representatives. The main strategies are: Two year operational plan As a health and social care system in Cambridgeshire and Peterborough, we will operate in an integrated way, putting patients‟ best interests at the heart of all decision- making to achieve the best care outcomes for patients, their carers and the population. By working together in an open and transparent way we, as commissioners and providers of care, aim to maximise the wellbeing of the population and provide the safest, highest quality care outcomes for patients in our system. We aspire to commission and provide the safest, highest quality care and best patient experience within the resources available. We will seek to maximise the amount of care provided outside hospital as close to the patient‟s home as possible. Five year plan The five year plan was developed with all healthcare partners across the Cambridgeshire and Peterborough healthcare system and ensures that the financial and quality challenges of the next few years and are robust, sustainable and deliverable. Better Care Fund The BCF is a critical part of, and is aligned to, the two year operational plan and the five year strategic plan as well as local government planning. This will require a significant degree of joint working and stakeholder engagement. Quality In line with our duties under section 14 (R) - Duty to improvement in a variety of services – Health and Social Care Act 2012, quality is at the heart of what we do as a CCG. It is the key consideration in the clinical commissioning of services and is woven into everything we undertake. The CCG Quality Strategy supports this focus and is the key driver for quality assurance of commissioned services. The aim of the strategy is to ensure continuous improvement of quality outcomes for the needs of local people. It also aims to develop robust quality assurance mechanisms to provide assurance to the CCG Governing Body and LCG Boards about the standard of quality and patient safety in commissioned services. The key priorities are to see a step change in quality improvements of health care year on year within available resources. Continuous improvement in quality must be a journey of aspirations and ambitions with measurable outcomes as milestones. Quality assurance for commissioned services is currently undertaken through Clinical Quality Review (CQR) meetings with each main provider on a monthly basis. The CQR process is led by the Local Commissioning Groups and CQRs are chaired or attended/informed by local GPs. Key quality indicators are agreed with each provider and form the basis of a Quality Dashboard, which is discussed in contract meetings and risk rated. The outcomes of these discussions form the basis of the Quality Report
26 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14 discussed in the Patient Safety and Quality Committee, a formal sub-committee of the CCG Governing Body. The CCG is also part of the East Anglia Quality Surveillance Group (QSG), which meets monthly to discuss unresolved and ongoing quality concerns of providers, and agree next steps.
Emergency planning, resilience and response Cambridgeshire and Peterborough CCG is a Category 2 Responder under the Civil Contingencies Act. The Accountable Emergency Officer and sponsor of the Major Incident Plan is the Director of Corporate Affairs, whilst the owner of the Plan is the CCG Secretary. Routine responsibility for ensuring the Major Incident Plan is up to date and fit for purpose rests with the CCG‟s Emergency Preparedness, Resilience and Response sub-group, which reports to the Clinical and Management Executive Team. Our role and responsibilities under the Civil Contingency Act are to: Co-ordinate a local NHS response to a Major Incident; Be accountable to the NHS England Local Area Team; Be a member of the Local Health Resilience Group; Develop a Command and Control structure that allows appropriate linkages to, membership of, communication with and other responses to local resilience arrangements including strategic, tactical and operational commands; Implement national policy and guidance in a local context; Demonstrate high level of preparedness of Out of Hours care and community services and ensure that they can respond at any time; Mobilise community care resources to support acute trusts and non-acute trusts; Ensure that CCG staff, Out of Hours staff and community care staff are appropriately trained and competent to plan for and to respond to a major incident with the induction process for staff including both general and specific guidance on planning and responding to major incidents; Ensure that the CCG‟s escalation plans for dealing with pressures recognise the higher-level requirements of a major incident; Develop contingency plans for business continuity in the event of a protracted incident; Ensure the resilience of its own estate, facilities and systems; Establish and maintain working relationships with other emergency services, local major organisations and other key stakeholders; Train and exercise in conjunction with local NHS partners and external multi- agency partners to an agreed schedule with the Cambridgeshire and Peterborough Local Resilience Forum (CPLRF); Take into account the needs of vulnerable groups of patients. This is particularly important in the event of a sustained major incident; Participate in Local and Regional Resilience Emergency Planning Fora; and Maintain, test and review internal capacity and emergency plans. This Major Incident Plan sets out the process by which Cambridgeshire and Peterborough Clinical Commissioning Group will respond to, manage and recover from a major incident. This Major Incident Plan has been approved by the CCG Governing Body and will be reviewed by the CCG Emergency Preparedness, Resilience and Response Sub-Group
27 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14 on an annual basis or the identification of amendments following a major incident, a test/exercise of the Plan or national, regional or local guidance. In addition, the CCG has an approved Business Continuity Plan, which compliments the Major Incident Plan.
Better payment Public Sector Payment Policy (CBI Better Payment Practice Code) The CCG has a requirement to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice whichever is later. Better Payment Practice Code – measure of compliance 2013-14 2013-14 - Non NHS Creditors Number £000’s Total bills paid in year 18,059 103,460 Total bills paid within target 17,612 101,381 Percentage of bills paid within target 97.52% 97.99% NHS Creditors Total bills paid in year 3,140 627,887 Total bills paid within target 2,517 612,258 Percentage of bills paid within target 80.16% 97.51%
Risk management As set out in our Annual Governance Statement, Within the CCG, risk management is demonstrated by: Adopting an integrated approach to risk management, whether the risk relates to clinical, organisational, health and safety or financial risk, through the processes and structures detailed in the CCG‟s Risk Management Policy; Managing risk as part of the routine line management responsibilities and consideration of funding to address „risk‟ issues (based on a risk assessment) as part of the normal business planning process; Undertaking risk assessments on both existing, new and proposed activities to ensure that; Significant risks are identified in accordance with the Risk Management Policy which provides full details on what constitutes a hazard or risk, how it should be identified and assessed; Assessments are made of their potential frequency and severity; Control measures are implemented in accordance with the Risk Management Policy; Risks are always minimised; Strategic risks are recorded on the CCG Assurance Framework (CAF) in line with the Risk Scoring Matrix; and Risks are recorded on the LCG Risk Registers, Service Performance Review Risk Registers and Programme Board Risk Registers. These are escalated as appropriate.
28 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Sustainability During Authorisation, the shadow CCG committed to a number of principles to support the Sustainability agenda. These were: Developing local understanding of the Sustainability agenda by measuring the environmental impacts of the organisation‟s activities and assessing the potential impact of environmental change on future care needs and services; Empowering staff to take responsibility for reducing the environmental impact of their own activities. This will be taken forward through the Good Corporate Citizen Model and Self-Assessment; Actively exploit the synergies between environmental sustainability and other objectives. For example, by identifying changes that may bring health or financial benefits as well as environmental ones, linking to financial sustainability; Exploring the opportunities presented by new technologies such as telehealth and telecare, and by the use of new technologies in managing the core business of the CCG; Improving medicines management and prescribing practices to reduce inefficient wasteful use of pharmaceuticals; Commissioning services that will support sustainable practices in service providers and the supply chain. Promoting the importance of using contractual levers with our main providers to encourage/incentivise change; and Engaging with patients and the public to build wider support for environmentally sustainable approaches to delivering care.
To underpin these principles, we have undertaken a number of initiatives including: Development of a new Procurement Strategy which supports principles around sustainability; Development of Accommodation Principles to support sustainability; Implementation of new technology to reduce staff travel and „MOT Your Travel‟ initiative; Development and harmonisation of a number of key HR policies which support the Sustainability Agenda including Flexible Working, Home Working and Travel to Work; Continued membership on the Cambridgeshire Travel to Work Steering Group hosted by Cambridgeshire County Council; Approval of the Information and Communication Technology (ICT) Strategy to introduce new technologies to improve efficiencies; Move to a new and more sustainable building in Peterborough; and Engagement with patients and the public around the Older People‟s programme which will look at resources across time, place and person in a way that maximises sustainability and reduce inequalities At the end of January the Sustainable Delivery Unit (funded by, and accountable to, NHS England and Public Health England to work across the NHS, public health and social care system) published Sustainable, Resilient, Healthy People & Places: A Sustainable Development Strategy for the NHS, Public Health and Social Care system. We will be using this Strategy to form our own Sustainability Strategy and Sustainability Development Action Plan (SDAP), which is currently under development and will be presented to the Governing Body for approval in July. The SDAP will cover the following principles:
29 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Leadership, engagement and development; Sustainable clinical and care models; Healthy, sustainable and resilient communities; Carbon hotspots including targets for reduction; and Commissioning and procurement. The SDAP will set targets for greenhouse gas emissions, waste minimisation and management and finite resource consumption. We will also address biodiversity and sustainable procurement.
Accommodation occupied by the CCG The CCG operates a Hub and Spoke model with our headquarters, Lockton House (Hub) and office facilities (Spokes) in each of the LCG / System Areas. Lockton House, Cambridge (Corporate / CAMHEALTH & CATCH LCGs) City Care Centre, Peterborough (Corporate / Peterborough / Borderline LCGs) Pathfinder House, Huntingdon (Hunts Health / HCP / Corporate) Exchange Tower, Wisbech (Isle of Ely / Wisbech LCGs) Doddington Community Hospital (Isle of Ely / Wisbech LCGs) Queen Street, Whittlesey (Borderline LCG)
To support this we operate a number of flexible working arrangements including: Open plan where possible; Hot-desking within „zoned‟ areas where appropriate; Fixed workstations where appropriate; Confidential offices where appropriate to meet the needs of PALS, Exceptional Cases, Continuing Care and other teams whose work is of a sensitive or confidential nature; and Touch-down facilities and home working.
Equality report In line with our duties under section 14 (T) of the Health and Social Care Act 2012, the CCG is committed to developing an organisational culture that promotes equality and diversity in the commissioning of our services, workforce and service provision with involvement of the local community sector representatives of protected characteristic groups. This has ensured that as a CCG we are equipped to meet the public sector equality duty relating to the Equalities Act 2010 but importantly all patients experience good patient care. During the year, the CCG has used the Equality Delivery System (EDS) national framework through engagement with staff and local interest groups to help improve the way in which people from different groups are treated as patients, carers and employees. The CCG agreed to take forward the EDS legacy already set into the future for Cambridgeshire.
30 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
The EDS is designed to make improvements for patients and staff and applies to people afforded protection, by the Equality Act 2010, from unfavourable treatment because of specified „protected‟ characteristics. Protected characteristics Age; Disability; Gender re-assignment; Marriage and civil partnership; Pregnancy and maternity; Race including national identity and ethnicity; Religion or belief; Sex (that is, is someone female or male); and Sexual orientation. The CCG believes that equality and diversity includes addressing health inequalities and should be embedded into all commissioning activity. Our aim is to provide equality of opportunity to all our patients, their families and carers and to proactively eliminate direct or indirect discrimination of any kind. Human Rights Act The Human Rights Act 1998 came into effect in the United Kingdom in October 2000. This means that we need to ensure our engagement and interaction with patients and service users and each other are in line with the FREDA principles. Therefore our service users, carers and staff can expect to be treated with: Fairness, Respect, Equality, Dignity and Autonomy. The CCG will aim to introduce the FREDA principle in our policies, strategies and procedures. In order to meet the legal requirements outlined above, the Equality Delivery Systems (EDS) was developed by the NHS Equality and Diversity Council established in 2009 and designed to support NHS commissioners and providers to deliver better outcomes for patients and communities and better working environments for staff, which are personal, fair and diverse. Furthermore the EDS is designed to help all staff and NHS organisations understand how equality can drive improvements and strengthen the accountability of services to patients and the public. At the heart of the EDS is a set of 18 outcomes grouped into four goals known as the EDS Outcomes Framework. These outcomes focus on the issues of most concern to patients, carers, communities, NHS staff and Boards. The four EDS goals are: 1. Better health outcomes for all 2. Improved patient access and experience 3. Empowered, engaged and included staff 4. Inclusive leadership at all levels The core component of the EDS is engagement with stakeholders, service users, staff and local community. It is people from these local interest groups that will contribute to the grading and decide how well the Trust is performing. The refreshed EDS2 (November 2013) has arisen out of NHS England‟s commitment to an inclusive NHS that is fair and accessible to all. EDS2 is also supported by the NHS Trust Development Authority. Like the original EDS, EDS2 has been designed in collaboration with the NHS and in light of evidence of how the EDS was implemented and with what result. EDS2 will
31 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14 continue into 2014-2015 and will be incorporated into the C&P CCG‟s business processes.
Achievements in 2013-14: The EDS Framework leads the Cambridgeshire and Peterborough wide provider cluster group, local interest group and staff partnerships and associated work as presented below: Rating events jointly with staff, local interest groups representative of protected characteristic groups, the CCG and provider leads; Established annual improvement plans approved by the Clinical and Management Executive Team (CMET); Established an Equality and Diversity Steering Group; Progress reported regularly to the Equality and Diversity Steering Group and CMET; Established Equality and Diversity Corporate Induction Training as a mandatory requirement; Completed over 40 Equality Impact Assessments; Established an Equality Impact Assessment Training Toolkit; The Safeguard and EDS leads trained trainers for the HealthWrap training, part of the PREVENT Department of Health requirement; and Met the requirements by 6 April 2014 to publish a compliance statement, annual report and improvement plan for EDS.
Breakdown by numbers and sex At the end of the financial year: The number of people of each sex who were on the Governing Body was: 21 people; of which seven were female and 14 male The number of senior managers of each sex who were grade VSM was: six people; of which three are female and three are male The number of people who were employees of the CCG was 282; of which 216 were female and 66 male. Taking into consideration the work above, we certify that the CCG has therefore complied with the statutory duties laid down in the NHS Act (2006) as amended. .
Accountable Officer: Dr Neil Modha Organisation: NHS Cambridgeshire and Peterborough CCG
Signature:
Date: 05/06/2014
32 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Members’ report Introduction NHS Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) became a statutory organisation on 1 April 2013, taking over most of the work of the former Primary Care Trusts, NHS Cambridgeshire and NHS Peterborough. The CCG took responsibility for the £850 million budget for Cambridgeshire, Peterborough and parts of Hertfordshire and Northamptonshire from this date.
The environment The CCG is the third largest CCG in the country and covers a population of over 890,000 people. It has structured itself into eight Local Commissioning Groups (LCGs) so that local clinicians can commission for local need. The CCG spans diverse communities with over 100 languages spoken and contains areas of great affluence as well as areas with much deprivation. There are major urban centres but the area is predominantly rural.
Member practices Practice LCG Bretton Medical Practice Borderline Hampton Heath Borderline Jenner Health Centre Borderline Nene Valley Medical Practice Borderline New Queen Street surgery Borderline Old Fletton practice Borderline Oundle Surgery, Northamptonshire Borderline Thorney Medical Practice Borderline Wansford Surgery, Northants Borderline Yaxley Group Practice Borderline Bottisham surgery Cam Health Bridge street surgery Cam Health Cherry Hinton and Brookfields Medical Practice Cam Health Dr Gant & Partners, Arbury road Cam Health East Barnwell Health Centre Cam Health Firs House surgery, Histon Cam Health Milton surgery Cam Health Newnham Walk surgery Cam Health Nuffield Road Medical Centre Cam Health Barley surgery, Herts CATCH Bourn Surgery CATCH
33 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Practice LCG Cambridge Access Centre CATCH Comberton surgery CATCH Cornford House surgery CATCH Cottenham surgery CATCH Harston surgery CATCH Huntingdon Road Surgery CATCH Lensfield Medical Practice CATCH Linton Health Centre CATCH Maple Surgery, Bar Hill CATCH Mill Road Surgery CATCH Monkfield Medical Practice, Cambourne CATCH Orchard surgery, Melbourn CATCH Over Surgery CATCH Petersfield Medical Practice CATCH Queen Edith's Medical Practice CATCH Red House Surgery CATCH Roysia surgery, Herts CATCH Royston Medical Centre, Herts CATCH Sawston Medical Centre CATCH Shelford Medical Practice CATCH Swavesey Surgery CATCH Trumpington Street Medical Practice CATCH Waterbeach Surgery CATCH Willingham Medical Practice CATCH Woodlands Surgery CATCH York Street Medical Practice CATCH Alconbury & Brampton Surgeries Hunts Care Partners Almond road Surgery Hunts Care Partners Buckden and Little Paxton Surgery Hunts Care Partners Cedar House Surgery, St Neots Hunts Care Partners Church Street Health Centre, Somersham Hunts Care Partners Cornerstone Practice, March Hunts Care Partners Cromwell Place Surgery Hunts Care Partners Mercheford house Surgery Hunts Care Partners Moat House Surgery, Warboys Hunts Care Partners Northcote House & Fenstanton surgeries Hunts Care Partners Orchard road, St. Ives Hunts Care Partners
34 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Practice LCG Parkhall Surgery, Somersham Hunts Care Partners Ramsey Health Centre Hunts Care Partners Riverside Practice, March Hunts Care Partners Spinney Surgery, St Ives Hunts Care Partners St Neots Health Centre Hunts Care Partners Wellside Surgery, Sawtry Hunts Care Partners Acorn Surgery, Huntingdon Hunts Health Charles Hicks Hunts Health Eaton Socon Health Centre Hunts Health Great Staughton Surgery Hunts Health Kimbolton Medical Centre Hunts Health Old Exchange Surgery Hunts Health Papworth Surgery Hunts Health Priory Fields Surgery Hunts Health Rainbow Surgery Hunts Health Burwell Surgery Isle of Ely Cathedral Medical Centre Isle of Ely Doddington Medical Centre Isle of Ely George Clare surgery, Chatteris Isle of Ely Haddenham Surgery Isle of Ely St George‟s Medical Centre, Littleport Isle of Ely Manea Surgery Isle of Ely Priors Field, Sutton Isle of Ely St. Mary's Surgery Isle of Ely Staploe Medical Centre, Soham Isle of Ely Ailsworth Medical Practice Peterborough Boltolph Bridge Peterborough Bushfield Medical Practice Peterborough Burghley Road Surgery Peterborough Dogsthorpe Medical Centre Peterborough Grange Medical Practice Peterborough Hodgson Centre Surgery Peterborough Huntly Grove Peterborough Lincoln Road Peterborough Millfield Medical Centre Peterborough Minster Medical Practice Peterborough North street medical practice Peterborough
35 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Practice LCG Park Medical Centre Peterborough Parnwell Medical Centre Peterborough Paston Health Centre Peterborough Thistlemoor Road Surgery Peterborough Thomas Walker Surgery Peterborough Thorpe Road surgery Peterborough Welland Medical Practice Peterborough Westgate Surgery Peterborough Westwood clinic Peterborough Clarkson Surgery Wisbech North Brink Practice Wisbech Parson Drove Surgery Wisbech Trinity Surgery Wisbech
Complaints handling Cambridgeshire and Peterborough CCG provide a high standard of patient care and services that are flexible and responsive to the needs of patients and service users. The services which we commission take into account patient insight and experience, ensuring that we get it right first time and meet people‟s needs with effective patient pathways. We are aware that this will not be without its challenges but it is one which we are committed to investing time and resources in. By understanding and responding to public concerns, we are able to define needs and identify priorities which will lead to a clearer understanding of our investment decisions and enable us to explain any service changes. Under the NHS Complaints Regulations which came into effect on 1 April 2009, patients and the public can complain to Cambridgeshire & Peterborough Clinical Commissioning Group as commissioner, if they do not wish to complain directly to the service provider. Where this right is exercised, we will work with the complainant and the provider to achieve resolution and to identify any necessary service improvements and learning outcomes. Our Complaints policy and procedure reflects the best practice principles for complaints handling promoted by the Parliamentary and Health Service Ombudsman (Principles for Remedy, Principles of Good Complaint Handling and Principles of Good Administration). In accordance with the Principles for Remedy, we place a strong emphasis upon putting things right, ensuring continuous improvement and learning from complaints. Our Patient Experience Team can assist with any aspect of the NHS complaints process and provide help, information and advice to patients and the public in relation to local health services. We use concerns and complaints as a valuable source of information about the experiences of our patients, which in turn assist in identifying any trends which enable us to improve the services that we commission.
36 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Employee consultation The CCG has created a framework for consulting with staff and their representatives. A Trade Union Recognition Agreement was ratified on 2 October 2013. The CCG has committed to working in partnership with trade unions to ensure the long-term commitment to achieving efficiency and success with the aim of improving our services to patients, employees and communities we serve. This agreement is carried out through a Joint Consultative and Negotiating Partnership, which meets regularly and comprises membership of staff representatives and managers of the CCG. The CCG has developed robust mechanisms for consulting and engaging with staff. There is a set of internal bulletins, called the Connected series, which provide comprehensive information for staff via email and the extranet. In addition there is a programme of staff briefings, which are held bi-monthly and are rolled out to LCG offices to enable as many staff as possible to attend. The Chief Clinical Officer usually leads these sessions with senior management support. During the Authorisation process a Staff Away Day was held to which all staff were invited. This proved to be very popular and a further Away Day was held in September 2013. It has been agreed to run these as annual events. The staff away day was so successful it won a Silver award at the prestigious Chartered Institute of Public Relations award. Staff engagement has become a cornerstone of our Organisational Development and workforce plans. The last year has been a period of significant and substantial change for employees. Throughout the year staff have been involved through formal and informal consultation processes. The Communications and Human Resources teams are co-located within the Corporate Affairs Directorate. This has enabled more effective dissemination of information and has made it easy for the teams to share information and work together. An organisational health survey was conducted early in the year and was repeated after six months. The results of this survey showed positive reaction to a range of tools we are using to support staff and managers. There is still more work to do to improve communications between the central CCG functions and the Local Commissioning Groups.
Employees with a disability The CCG is committed to the NHS Equality Delivery System and is working with an improvement plan. Statistics about this protected characteristic are collected and reported on to the CCG Remuneration and Terms and Conditions Sub Committee. A quarterly report is considered. Recruitment practices have been revised and a new up-to-date policy on the recruitment and selection of staff has been implemented. This requires recruiting managers to offer an interview to all disabled applicants who meet the essential criteria for the job. We have been awarded the „Two Ticks‟ positive about disabled people award for our commitment to supporting employees with a disability.
37 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Equal opportunities The CCG has a range of employment equality policies procedures and practices in place including an equal opportunities policy. The CCG has worked with the NHS Equality Delivery System and has published an Equality and Diversity Improvement Plan 2013-14. Equality and diversity training is mandatory for all staff and training available includes a half day awareness course, online training, awareness raising at corporate induction and cultural awareness training. We do an equality impact assessment for all our plans, policies and business cases.
Pension liabilities Past and present employees are covered by the provisions of the NHS Pension Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/Pensions. Further detail can be found at note 4.5 in the Annual Accounts and specific disclosures with respect to Pensions are included in the Remuneration Report. These can be obtained from Tim Woods, Chief Finance Officer. Lockton House, Clarendon Road, Cambridge CB2 8FH.
Sickness absence The CCG has sickness absence levels of: 2013 number of days Total days lost 999 Total staff years 250 Average working days lost 4
The data for staff sickness absence is supplied by the Department of Health on a Calendar Year basis.
The CCG has a Managing Sickness Absence and Attendance at Work Policy and Procedure, which was formally adopted in October 2013. This provides a comprehensive framework for managing sickness absence and gives the trigger points for employees on sickness absence of when to initiate management action to manage poor attendance and the process for dealing with staff who develop long term sickness problems. Monthly statistics are provided by Serco1, reviewed by HR and management action is taken where appropriate. The sickness absence rate has been below the national average for the NHS of 4.24% from statistics reported by the Health and Social Care Information Centre (HSCIC) in November 2013. The workforce report provides this information to the CCG‟s Remuneration and Terms of Service Committee.
1 Serco is an international services company
38 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
External audit The CCG‟s external auditors are PricewaterhouseCoopers LLP (PwC). Their fees, for the 2013-14 statutory audit totalled £136,000 less a £10,000 rebate from the Audit Commission for this year only. PwC has been appointed by Monitor/NHS England and TDA to look at a separate piece of work due to Cambridgeshire and Peterborough being identified as one of the eleven economies facing challenges. The CCG has made sure that the policy for auditor‟s independence has not been compromised.
Each individual who is a member of the Governing Body at the time the Members‟ Report is approved confirms: So far as the member is aware, that there is no relevant audit information of which the CCG‟s external auditor is unaware and That the member has taken all the steps they ought to have taken as a member in order to make them self aware of any relevant audit information and to establish that the CCG‟s auditor is aware of that information.
Our Governing Body members 2013-14 Member of Governing Body Sub Name Title Committees Chair, Remuneration & Terms of Service Maureen Donnelly Lay Chair Committee, Finance & Performance, Patient Safety & Quality Committee Chair - Audit Committee, Chair - Service Performance Framework Review Group, Glen Clark Lay Member Finance & Performance Committee, Remuneration & Terms of Service Committee Chair – Patient Safety & Quality Committee, Chair – Patient Reference Rebecca Stephens Lay Member Group, Audit Committee, Remuneration & Terms of Service Committee Chair – Finance & Performance Committee, Audit Committee, Dr Edward Libbey Lay Member Remuneration & Terms of Service Committee Chair, Clinical & Management Executive Team, Strategic Clinical & Management Chief Clinical Team, Finance & Performance Committee, Dr Neil Modha Officer Remuneration & Terms of Service Committee, Service Performance Framework Review Group Chair – Strategic Clinical Prioritisation Group, Audit Committee, Remuneration & Vice-Chair Terms of Service Committee, CATCH Dr Geraldine Linehan GP Member LCG, Clinical & Management Executive CATCH Team, Strategic Clinical & Management Executive Team
39 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Hunts Health LCG, Patient Reference GP Member Dr David Roberts Group (Pool), Strategic Clinical & Hunts Health Management Executive Team CamHealth LCG, Patient Reference GP Member Group (Pool), Strategic Clinical & Dr Arnold Fertig CamHealth Executive Management Team, Audit Committee (Pool) Chair – Isle of Ely LCG, Patient Safety & Quality Committee, Patient Reference GP Member Dr John Jones Group (Pool), Strategic Clinical & Isle of Ely Management Executive Team, Audit Committee (Pool) Deputy-Chair – Finance & Performance GP Member Sub-Committee, Remuneration & Terms of Dr David Irwin Hunts Care Service Committee, Audit Committee, Partners Hunts Care Partners LCG, Strategic Clinical & Management Executive Team Chair – Wisbech LCG, Finance & GP Member Dr Tim Webster Performance Committee, Strategic Clinical Wisbech LCG & Management Executive Team GP Member Chair – Peterborough LCG, Strategic Dr Michael Caskey Peterborough Clinical & Management Executive Team LCG Chair – Borderline LCG, Deputy-Chair - GP Member Patient Safety & Quality Committee, Dr Richard Withers Borderline LCG Strategic Clinical & Management Executive Team Remuneration & Terms of Service Committee, Patient Safety & Quality Secondary Care Dr Christopher Scrase Committee, Strategic Clinical Prioritisation Doctor Member Group, Strategic Clinical & Management Executive Team Patient Safety & Quality Committee, Executive Nurse Strategic Clinical Prioritisation Group, Member Jill Houghton Clinical & Management Executive Team, Director of Strategic Clinical & Executive Management Quality Team Finance & Performance Committee, Strategic Clinical Prioritisation Group, Chief Finance Tim Woods Clinical & Management Executive Team, Officer Strategic Clinical & Executive Management Team, Audit Committee (In attendance) Finance & Performance Committee, Patient Safety & Quality Committee, Remuneration & Terms of Service Chief Operating Andy Vowles Committee, Service Performance Review Officer Group, Clinical & Management Executive Team, Strategic Clinical & Management Executive Team
40 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Co-opted Strategic Clinical Prioritisation Group Director of Dr Liz Robin Clinical & Management Executive Team, Public Health - Strategic Clinical & Management Team Cambridgeshire Co-opted Director of Public Health – Sue Mitchell Peterborough (To October 2013) Co-opted members (with speaking but not voting rights) Name Title Member of Governing Body Sub Committees Jessica Bawden Director of Patient Reference Group, Deputy Chair Corporate Affairs - Service Performance Review Group, Clinical & Management Executive Team, Strategic Clinical & Management Executive Team Harper Brown Director of Finance & Performance Committee, Contracting & Strategic Clinical Prioritisation Group, Commissioning Clinical & Management Executive Team, Strategic Clinical & Management Executive Team Sarah Shuttlewood Interim Director of Patient Safety & Quality Committee, Performance & Finance & Performance Committee, Delivery (From Clinical & Management Executive June 2013) Team, Strategic Clinical & Management Executive Team
Patient Safety & Quality Committee, Director of Finance & Performance Committee, Performance & Victoria Corbishley Clinical & Management Executive Delivery (to June Team, Strategic Clinical & Management 2013) Team In attendance (with speaking rights) Secretary to Audit Committee, Patient Safety & Quality Committee, Finance & Performance Committee, Strategic Clinical Prioritisation Group, Patient Sharon Fox CCG Secretary Reference Group, Remuneration & Terms of Service Committee, Service Performance Review Group, Clinical & Management Executive Team, Strategic Clinical & Executive Management Team A short biography of each member of the Governing Body is available on the CCG‟s website: http://www.cambridgeshireandpeterboroughccg.nhs.uk/whos-who.htm
41 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Declarations of interest In line with our Conflicts of Interest Policy, a Register of Interests is maintained and can be viewed on our website or on request by contacting our CCG Secretary on 01223 725581. Governing Body members who hold a Company Directorship with companies who are likely to do business or seek (or may seek) to do business with the NHS are set out below:
Name Title Declaration of Interest Maureen Donnelly Lay Chair Partner Governor at Cambridge University Hospitals Foundation Trust Rebecca Lay Member Owner/Director – Syntax Communications Ltd Stephens Member – Cambridgeshire and Peterborough NHS Foundation Trust Partner Governor of Peterborough and Stamford Hospitals NHS Foundation Trust Non-Executive Director – Cambridgeshire and Peterborough Probation Trust Occasionally contracted to do work by Greater Peterborough Partnership Dr Neil Modha Chief Clinical GP Partner Thistlemoor Medical Centre O(Family (Parents) Partners at Thistlemoor f Medical Centre) f i Thistlemoor Healthcare & Management cSecretary e(Parents – Directors of Thistlemoor r Healthcare and Management) (Parents - Graham Young Chemist) Primary Care Research Centre (Receipt of funding/grants) Dr Geraldine Vice-Chair of Non-principal at Woodlands Surgery, Station Linehan Governing Road Cambridge Body Holds a small number of shares in CAMDOC GP Member Member of Steering Group for Research CATCH LCG Application Board, PCT, University Cambridge and CATCH Commissioning Evaluation Project Previously involved in joint application for research bid between RAND, University of Cambridgeshire and NHS Cambridgeshire – may take part in further research applications Member of Local Medical Committee
42 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Dr David Roberts GP Member GP, Great Staughton Surgery Hunts Health Member of Hunts Health LCG Director Aquarius Systems Limited Dr David Irwin GP Member General Practice senior partner of Buckden Hunts Care and Little Paxton surgeries Partners LCG Partner of Dermatology Clinic Community Service Ltd (DCCSL) Dr John Jones GP Member Partner, Staploe Medical Centre (PMS, Isle of Ely Dispensing, Clinical Trials, Teaching Practice LCG Director Eagletie Limited Director Eaglebond Limited Director Staploe Medical Services Limited Shareholder and Director in Holding Company (Eagletie Limited) that own the Pharmacy which operates from the Staploe Medical Centre, Soham Dr Tim Webster GP Member, Partner North Brink Practice Wisbech LCG Director North Brink Pharmacy Shareholder, Cura Heathcare Dr Michael GP Member GP principal, 21 years, Senior Partner, Park Caskey Peterborough Medical Centre LCG General practitioner with special interest – Neurology – Peterborough City Hospital Member of Sutton Parish Council Director – Peterborough Directors Commissioning Ltd (A GP partner and salaried doctor are GPSIs in Dermatology and Rheumatology working with Peterborough City Hospital secondary care units (Not Dr Caskey but – Drs Mulla and Wood respectively who work primarily of this practice.) Dr Richard GP Member Partner at GP Yaxley Group Practice Withers Borderline Member of Cambridge Local Medical LCG Committee (Confirmed no longer a member 14.10.13) Chair of Borderline LCG
43 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Dr Arnold Fertig GP Member Occasional GP Locum, Nuffield Road Medical CATCH Centre Small number of Propdoc Shares (less than 5%) Voluntary Organisation: Member of Community Navigators Steering Group (Care Network) Dr Edward Libbey Governing Department Of Health Legacy Team (Audit Body Lay Chair of both Cambridgeshire PCT & Member Peterborough PCT as well as Norfolk PCT and Waveney PCT for three months – April 2014 to June 2014) Andy Vowles Chief Spouse is an employee of CUHFT Operating Officer Dr Liz Robin Co-opted GP Director of Public Health for Cambridgeshire, Member employed by Cambridgeshire County Council Tim Woods Chief Finance Non-Executive Director of NHS Elect – Officer publicly funded consultancy company which works with NHS providers and commissioners.
We certify that the clinical commissioning group has complied with HM Treasury‟s guidance on cost allocation and the setting of charges for information.
We certify that the CCG has incident response plans in place, which are fully compliant with the NHS Commissioning Board Emergency Preparedness Framework 2013. The CCG regularly reviews and makes improvements to its major incident plan and has a programme for regularly testing this plan, the results of which are reported to the Governing Body.
Accountable Officer: Dr Neil Modha Organisation: NHS Cambridgeshire and Peterborough CCG
Signature:
Date: 05/06/2014
44 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14 Remuneration Report
Membership of Remuneration Committee
Name Position Maureen Donnelly Chair Glen Clark Lay Member (Audit & Remuneration) Edward Libbey Lay Member (Finance & Performance) Rebecca Stephens Lay Member (Patient & Public Participation) Dr Neil Modha Chief Clinical Officer (Accountable Officer) Andy Vowles Chief Operating Officer Dr Geraldine Linehan GP Governing Body Member Dr David Irwin GP Governing Body Member Dr Christopher Scrase Secondary Care (Hospital) Doctor Governing Body Member
Policy on the remuneration of senior managers Remuneration payments made to the Non Executive directors and Governing Body members are set nationally by the Secretary of State. The remuneration for Officer Directors is set by the Remuneration Committee, having regard to comparative salary data and the labour market. No remuneration was waived by members and no compensation was paid for loss of office. No payments were made to co-opted members and no payments were made for golden hellos.
Where individual national review bodies govern salaries, then the national rates of increase have been applied. Where national review bodies do not cover staff, then increases have been in line with the percentage notified by the NHS Chief Executive and approved by the Remuneration Committee. For 2013/14 this was 0%. Any increases above that limit have been on the basis of increased responsibilities or promotion.
Policy on Performance Conditions The CCG’s Remuneration & Terms of Service Committee set standards in conjunction with the Chief Clinical Officer, Chief Operating Officer and Lay Chair, who has held regular appraisals and 1:1 supervision sessions with the individuals concerned. The Lay Chair sets individual targets for the Chief Operating Officer and Chief Clinical Officer based on the performance of the CCG in relation to national and local targets set out in the CCG service plans. The Remuneration & Terms of Service Committee takes the financial circumstances of the organisation into consideration in making pay awards, as well as Advance letters advice from the Department of Health. All uplifts were discussed with and decided by the Remuneration & Terms of Service Committee and its relevant Sub-Groups, which is supported by a Human Resource (HR) professional. Middle managers receive their targets through cascade of organisational objectives with advice and support from HR. The annual cost of living uplift is awarded by the Remuneration & Terms of Service Committee based on National Guidance.
Policy on duration of contracts, notice periods and termination payments Senior manager contracts are subject to 3 - 6 months' contractual notice due to the time it takes to replace a senior manager. Termination payments are in accordance with NHS policy and negotiated with trades unions. Contracts, where possible, are permanent except for project work, due to the legislation giving fixed term contracts similar employment rights. During times of change the organisation resorts to fixed term contracts and secondments, but this is becoming increasingly regulated.
Service Contracts Unexpired Early Date of term (if termination Name Position Contract applicable) terms Dr Neil Modha Chief Clinical Officer (Accountable Officer) 1-Jun-12 N/A N/A Andy Vowles Chief Operating Officer 3-Apr-12 N/A N/A Jill Houghton Director of Quality (Nurse Member) 1-Feb-13 N/A N/A Tim Woods Chief Finance Officer 1-Sep-12 N/A N/A Jessica Bawden Director of Corporate Affairs 23-Dec-12 N/A N/A Harper Brown Director of Commissioning and Contracting 1-Sep-12 N/A N/A Sarah Shuttlewood Interim Director of Performance & Delivery 12-Jun-13 N/A N/A
GPs are appointed to serve on the GP Governing Body and submit invoices for meetings attended and other non-clinical services provided to the CCG.
45 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Remuneration Report (audited information) 2013-14 Name Title Salary and Fees Taxable Benefits (Rounded Pension related benefits Total (Bands (Bands of £5,000) to the nearest £00) (Bands of £2,500) of £5,000) Executive Directors £000 £00 £000 £000 Dr Neil Modha Chief Clinical Officer (Accountable Officer) 80 - 85 - 107.5 - 110 190 - 195 Andy Vowles Chief Operating Officer 115 - 120 - 135 - 137.5 250 - 255 Jill Houghton Director of Quality (Nurse Member) 95 - 100 1 167.5 - 170 265 - 270 Tim Woods Chief Finance Officer 120 - 125 - 45 - 47.5 165 - 170 Jessica Bawden Director of Corporate Affairs 85 - 90 - 30 - 32.5 115 - 120 Harper Brown Director of Commissioning and Contracting 105 - 110 - 10 - 12.5 115 - 120 Sarah Shuttlewood Interim Director of Performance & Delivery (From 12 June 2013) 70 - 75 - 115 - 117.5 185 - 190 Victoria Corbishley Director of Performance & Delivery (To 12 June 2013) 20 -25 - 2.5 - 5 20 -25
GP Governing Body Members Dr Geraldine Linehan (Vice Chair) CATCH *100 - 105 - *100 - 105 Dr Michael Caskey Peterborough *40 - 45 - *40 - 45 Dr Arnold Fertig Cam Health *80 - 85 - *80 - 85 Dr David Irwin Hunts Care Partners *35 - 40 - *35 - 40 Dr John Jones Isle of Ely *35 - 40 - *35 - 40 Dr David Roberts Hunts Health *55 - 60 - *55 - 60 Dr Tim Webster Wisbech *15 - 20 - *15 - 20 Dr Richard Withers Borderline *50 - 55 - *50 - 55
Chair and Lay Members Maureen Donnelly Chair 35 - 40 - 35 - 40 Glen Clark Lay Member (Audit & Remuneration) 10 - 15 - 10 - 15 Edward Libbey Lay Member (Finance & Performance) 5 - 10 - 5 - 10 Rebecca Stephens Lay Member (Patient & Public Participation) 5 - 10 - 5 - 10
Dr Christopher Scrase Secondary Care (Hospital) Doctor Governing Body Member 15 - 20 - 15 - 20
Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director in their organisation and the median
The banded remuneration of the highest paid director in the CCG in the financial year 2013-14 was £120k to £125k. This was 3.72 times the median remuneration of the workforce, which was £32,898. Remuneration ranged from £5,580 to £121,000. In 2013/14, no employees received remuneration in excess of the highest director.
* Salaries and Fees for GPs on the GP Governing Body represents meetings attended and services provided in addition to Governing Body meetings.
GP Governing Body Members are paid through Invoices raised by practices, companies owned by the individuals and the individuals themselves. Therefore deemed to be off-payroll engagements.
Pension related benefits GP Governing Body Members make pension contributions from their remuneration to the NHS Pensions Agency. The Agency have not provided details of their pension values to the CCG. No pensions contributions are made on behalf of the chairman and lay members.
46 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Remuneration Report - Pension entitlements (audited information) Name and title Real increase Lump sum Total accrued Lump sum Cash Cash Real increase Employer's in pension at at age 60 pension at age at age 60 Equivalent Equivalent in Cash contribution age 60 related to 60 at 31 related to Transfer Transfer Equivalent to stakeholder real increase March 2014 accrued Value at Value at Transfer pension in pension (bands of pension at 31-Mar 31 March Value (rounded to (bands of (bands of £5,000) 31 March 2014 2013 nearest £00) £2,500) £2,500) 2014 (bands of £5,000) £000 £000 £000 £000 £000 £000 £000 £00 Dr Neil Modha, Chief Clinical Officer 5 - 7.5 15 - 17.5 5 - 10 20 - 25 86 24 61 - Andy Vowles, Chief Operating Officer 5 - 7.5 17.5 - 20 25 - 30 85 - 90 438 320 111 - Jill Houghton, Director of Quality 7.5 - 10 15 - 17.5 45 - 50 100 - 105 898 706 177 - Tim Woods, Chief Finance Officer 2.5 - 5 7.5 - 10 45 - 50 145 -150 997 897 80 - Jessica Bawden, Director of Corporate Affairs 0 - 2.5 5 - 10 5 - 10 20 - 25 115 83 30 - Harper Brown, Director of Commissioning and Contracting 0 - 2.5 2.5 - 5 25 - 30 75 - 80 599 548 39 - Sarah Shuttlewood, Interim Director of Performance & Delivery 5 - 7.5 15 - 17.5 30 - 35 100 - 105 620 494 115 - Victoria Corbishley, Director of Performance & Delivery* (left 12/06/13) 0 - 2.5 - 5 - 10 - 56 51 1 -
GP Governing Body Members make pension contributions from their remuneration to the NHS Pensions Agency. The Agency have not provided details of their pension values to the CCG.
No pensions contributions are made on behalf of the chairman and lay members.
*Victoria Corbishley was a member of the 2008 NHS pension scheme which means she is not entitled to a lump sum.
47 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Cash Equivalent Transfer Values
A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme.
They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.
Real Increase in CETV
This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period.
Off-payroll engagements
For all off-payroll engagements as of 31 March 2014, for more than £220 per day and that last longer than six months:
Number Number of existing engagements as of 31 March 2014 12 Of which, the number that have existed: for less than one year at the time of reporting 2 for between one and two years at the time of reporting 10 for between 2 and 3 years at the time of reporting - for between 3 and 4 years at the time of reporting - for 4 or more years at the time of reporting -
The CCG has undertaken a risk based assessment as to whether assurance is required that the individual is paying the correct amount of Tax and NI. The CCG has concluded that the risk of significant exposure in relation to these individuals is minimal.
For all new off-payroll engagements between 1 April 2013 and 31 March 2014, for more than £220 per day and that last longer than six months:
Number Number of new engagements between 1 April 2013 and 31 March 2014 12 Number of new engagements which include contractual clauses giving the CCG the right to request assurance in relation to income tax and National Insurance obligations - Number for whom assurance has been requested - Of which: assurance has been received - assurance has not been received - engagements terminated as a result of assurance not being received, or ended before assurance received. -
The CCG has undertaken a risk assessment and concluded that engagement without contractual clauses allowing it to seek assurance on individuals tax obligations would not result in significant exposure for the CCG.
The above disclosure has not been audited and there is no requirement for the information to be audited.
Accountable Officer: Dr Neil Modha
Organisation: NHS Cambridgeshire and Peterborough CCG
Signature:
Date:
48 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Statement of Accountable Officer’s responsibilities
The National Health Service Act 2006 (as amended) states that each Clinical Commissioning Group shall have an Accountable Officer and that Officer shall be appointed by the NHS Commissioning Board (NHS England). NHS England has appointed the Chief Clinical Officer to be the Accountable Officer of the Clinical Commissioning Group.
The responsibilities of an Accountable Officer, including responsibilities for the propriety and regularity of the public finances for which the Accountable Officer is answerable, for keeping proper accounting records (which disclose with reasonable accuracy at any time the financial position of the Clinical Commissioning Group and enable them to ensure that the accounts comply with the requirements of the Accounts Direction) and for safeguarding the Clinical Commissioning Group‟s assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities), are set out in the Clinical Commissioning Group Accountable Officer Appointment Letter.
Under the National Health Service Act 2006 (as amended), NHS England has directed each Clinical Commissioning Group to prepare for each financial year financial statements in the form and on the basis set out in the Accounts Direction. The financial statements are prepared on an accruals basis and must give a true and fair view of the state of affairs of the Clinical Commissioning Group and of its net expenditure, changes in taxpayers‟ equity and cash flows for the financial year.
In preparing the financial statements, the Accountable Officer is required to comply with the requirements of the Manual for Accounts issued by the Department of Health and in particular to:
Observe the Accounts Direction issued by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis; Make judgements and estimates on a reasonable basis; State whether applicable accounting standards as set out in the Manual for Accounts issued by the Department of Health have been followed, and disclose and explain any material departures in the financial statements; and, Prepare the financial statements on a going concern basis.
To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my Clinical Commissioning Group Accountable Officer Appointment Letter, except for revenue expenditure in excess of resource limits which was not intended by Parliament and did not confirm to the authorities which govern them.
The external auditors have issued a qualified regularity opinion and a qualified value for money conclusion in relation to the CCG‟s breach of its statutory financial duty. A qualified opinion has also been issued in relation to the remuneration report due to difficulties in obtaining pension information from the NHS Pensions Agency for the GP
49 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Governing Body members. The CCG requested this information in advance of the notified deadlines but it was not disclosed by the Agency.
Accountable Officer: Dr Neil Modha Organisation: NHS Cambridgeshire and Peterborough CCG
Signature:
Date: 05/06/2014
50 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Annual governance statement for the year ended 31 March 2014
1.Introduction The CCG was licenced from 1 April 2013 under provisions enacted in the Health & Social Care Act 2012, which amended the National Health Service Act 2006 with two conditions. These relate to the two following criteria: Clear and credible plans that set out how CCGs will take responsibility for service transformation that will improve quality within available resources. CCG has a clear and credible integrated plan, which includes an operating plan for 2013- 2014, draft commissioning intentions for 2013-14 and a high-level strategic plan until 2014-15. Clear and credible plans that set out how CCGs will take responsibility for service transformation that will improve quality within available resources. CCG has detailed financial plan that delivers financial balance, sets out how it will manage within its management allowance, and any other requirements set by the NHSCB and is integrated with the Strategic Plan. NHS England reviews the conditions on a quarterly basis, linked to the CCG Assurance process led by the Area Team. These two conditions remained in place during 2013-14 and remain in place to date due to the financial challenges the CCG continues to face. The CCG operated in shadow form prior to 1 April 2013, to allow for the completion of the licencing process and the establishment of function, systems and processes prior to the clinical commission group taking on its full powers. This Annual Governance Statement reflects arrangements from 1 April 2013 to 31 March 2014.
2. Scope of responsibility As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the CCG‟s policies, aims and objectives, whilst safeguarding the public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out in my CCG Accountable Officer Appointment Letter. I am responsible for ensuring that the clinical commissioning group is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity. The CCG has worked closely with other organisations throughout the year through a variety of relationships such as: Service level agreements and contracts with other NHS organisations to deliver health services to agreed specifications, and in line with our Quality Dashboard and NHS Constitution targets; Legal agreements with our Local Authorities including the operation of Section 75 Agreements; Performance management arrangements with the NHS England Anglia Area Team;
51 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
With patients through the a number of different forums including our Patient Reference Group, Patient Participation Groups, Cambridgeshire Healthwatch, Peterborough Healthwatch; With partners such as local authorities including social care, GPs carrying out joint needs assessments, strategic planning and joint commissioning; Accountability to NHS England for the performance of functions and meeting statutory duties set out in the NHS England CCG Assurance Framework Balanced Scorecard; With local partners to promote the objectives of our local Health and Wellbeing Board strategies and through partnership working, formal Partnership Boards and pooled funding arrangements; With the Multi-Agency Local Adult Safeguarding and Multi-Agency Local Children‟s Safeguarding Boards; and With wider communities through public engagement, through our Governing Body meetings in public, publication of various corporate documents and plans, and production of the Annual Report and Annual Accounts.
3. Compliance with the UK Corporate Governance Code Whilst the detailed provisions of the UK Corporate Governance Code are not mandatory for public sector bodies, compliance is considered to be good practice. As a new organisation, the Governing Body has not yet conducted a formal review of its effectiveness. It plans to do this during the first quarter of 2014-15 through a self- assessment which will include reviewing some of principles of the Corporate Governance Code. The outcomes of the self- assessment will be reported and discussed at the Governing Body Development Session in June 2014.
4. The governance framework of the organisation The National Health Service Act 2006 (as amended), at paragraph 14L(2)(b) states: The main function of the Governing Body is to ensure that the group has made appropriate arrangements for ensuring that it complies with such generally accepted principles of good governance as are relevant to it. The Governing Body has met monthly in public over the last year. There was good attendance from all Governing Body members at each meeting and attendance is recorded within the minutes of each meeting. The Governing Body was served by the following Committees: Eight Local Commissioning Groups (LCGs); - Borderline LCG - CamHealth LCG - CATCH LCG - Hunts Care Partners LCG - Hunts Health LCG - Peterborough LCG - Isle of Ely LCG - Wisbech LCG Audit Committee; Finance & Performance Committee; Patient Safety and Quality Committee; Remuneration and Terms of Service Committee;
52 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Patient Reference Group; Clinical and Management Executive Team; Strategic Clinical Prioritisation Group; Service Performance Review Group. There was good attendance at Sub-Committee meetings and this is recorded within the minutes of each meeting.
The eight LCGs are designed to maintain local focus, clinical and patient engagement in commissioning, design locally responsive services and drive innovation. Every practice within the CCG area is a member of an LCG. The LCGs are constituted formally as committees of the CCG Governing Body to enable delegation of funding and commissioning responsibilities to them in line with the CCG Operating Model.
The Audit Committee chaired by the Governing Body Lay Member Governance, provides the Governing Body with an independent and objective view of the NHS C&P CCG‟s financial systems, financial information and compliance with laws, regulations and directions governing the NHS C&P CCG in so far as they relate discharging their statutory duties. The Committee seeks to ensure that there is an effective system of internal control and provide an objective review of systems and reports presented by Internal External Audit and Local Counter Fraud Services, and provides the Governing Body with assurance that the CCG‟s governance, including financial, clinical and risk management processes are conducted within best practice guidelines set out in the Audit Committee Handbook.
The Finance & Performance Committee chaired by the Governing Body Lay Member for Finance and Performance providing scrutiny of the CCG‟s performance and financial functions, ensuring that the CCG meets its statutory financial duty,including oversight of financial risk and delivery of QIPP.
The Patient Safety and Quality Committee chaired by the Governing Body Lay Member for Patient and Public Involvement, providing scrutiny of the CCG‟s performance and processes relating to patient safety and quality within the services we commission. The Committee also provides the link to the Multi-Agency Local Adult Safeguarding and Multi-Agency Local Children‟s Safeguarding Boards, of which the CCG are members, and provides regular reporting to the Governing Body.
The Remuneration and Terms of Service Committee chaired by the Governing Body Lay Chair, makes recommendations to the Governing Body on determinations about the remuneration, fees and other allowances for employees and for people who provide services to the NHS C&P CCG and on determinations about allowances under any pension scheme that the NHS C&P CCG may establish as an alternative to the NHS Pension Scheme. The Committee will also agree all HR and associated policies and procedures on behalf of the CCG Governing Body linked to Terms and Conditions of Employment for CCG and associated staff/clinicians as appropriate. The Committee also has responsibility for Workforce Performance and implementation of the Organisational Development Plan. To address conflicts of interest, the Committee has
53 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14 three Sub-Groups – GP Remuneration, Very Senior Manager Pay and Lay Member Pay.
The Patient Reference Group chaired by Governing Body Lay Member for Patient and Public Involvement provides an independent view of the work of the CCG that is external to the day-to-day running of the organisation. It will also help to ensure that, in all aspects of the CCG‟s business the public voice of the local population is heard and that opportunities are created and protected for patient and public empowerment in the work of the CCG.
The Clinical and Executive Management Team (CMET), chaired by the Chief Clinical Officer, which has delegated day to day operational responsibility for running the organisation. The following Sub-Groups report to CMET: Financial Recovery Plan Programme Management Board; Information Governance and IM&T Steering Group; Emergency Planning, Resilience and Response Sub-Group; Equality and Diversity Sub-Group; Accommodation and Sustainability Sub-Group; HR Sub-Group.
The Strategic Clinical Prioritisation Group chaired by the Governing Body GP Vice- Chair, acts as the expert group analysing and proposing strategic service to the CCG Governing Body in relation to clinical priorities and prescribing. The Group advises on the clinical service priorities most likely to deliver on the CCG‟s strategic and corporate objectives; consider and approve business cases recommended by the Clinical Policies Forum (CPF) and Joint Prescribing Group (JPG) on behalf of the Governing Body; receive clinical policies and prescribing policies and approve them for ratification by the Governing Body.
The Service Performance Review Framework Sub-Group chaired by the Governing Body Lay Member for Governance, which oversees the Commissioning Support Functions of the CCG, and provides feedback to the Governing Body on a quarterly basis The Governing Body meets in public on a monthly basis and the Agenda is divided into four key areas – General Issues, Quality and Governance, Finance and Performance and Strategy. The Governing Body receives reports on the activities of all its Sub- Committees on a regular basis. The Governing Body also receives detailed overview reports on the work of the Audit Committee which includes progress against External Audit progress reports, Internal Audit and Counter Fraud and the CCG Assurance Framework. The Audit Committee reviews its Audit Committee Self-Assessment Check-List regularly. The CCG has met throughout the year with NHS England Anglia Area Team to review the CCG‟s performance against key national and local targets, with a particular focus on performance, including financial performance and progress against the CCG‟s Financial Recovery Plan.
54 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
The CCG Governing Body is committed to ensuring that it complies with all aspects of Corporate Governance. This is maintained through the CCG‟s Constitution, Register of Interests, Register of Gifts and Hospitality, Whistleblowing Policy and the Complaints Policy. The Governing Body holds regular Development Sessions. Governing Body to Board meetings with our main providers are also conducted. The Governing Body was also served by the following four Programme Boards who oversee our Strategic Priorities: Older People; End of Life Care; Health Inequalities and Coronary Heart Disease; Children and Young People. These Programme Boards report to the Governing Body on a regular basis.
5. The CCG Risk Management Framework Within the CCG, risk management is demonstrated by: Adopting an integrated approach to risk management, whether the risk relates to clinical, organisational, health and safety or financial risk, through the processes and structures detailed in the CCG‟s Risk Management Policy; Managing risk as part of the routine line management responsibilities and consideration of funding to address „risk‟ issues (based on a risk assessment) as part of the normal business planning process; Undertaking risk assessments on both existing, new and proposed activities to ensure that: i) Significant risks are identified in accordance with the Risk Management Policy which provides full details on what constitutes a hazard or risk, how it should be identified and assessed; ii) Assessments are made of their potential frequency and severity; iii) Control measures are implemented in accordance with the Risk Management Policy; iv) Risks are always minimised; v) Strategic risks are recorded on the CCG Assurance Framework (CAF) in line with the Risk Scoring Matrix; and vi) Risks are recorded on the LCG Risk Registers, Service Performance Review Risk Registers and Programme Board Risk Registers. These are escalated as appropriate. Staff members at all levels of the organisation contribute to the identification and assessment of risk through LCGs, Directorates and at our Main Provider Performance Management and Clinical Quality Review Days. The Risk Management actions that have been taken this year include: Strengthening of LCG Risk Registers and the development of the CAF; Development of the Service Performance Review (SPR) Risk Registers; Development of the Programme Board Risk Registers; Development of the CCG‟s risk statement during 2014-2-15 in discussion with the Governing Body; Maintenance of governance policies and the Risk Management Policy;
55 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Testing of our emergency planning and business continuity planning arrangements; and Development of our information governance arrangements and Information Governance Toolkit scores. The control environment is supported by regular review of our Constitution, including Standing Orders, Scheme of Delegation and Standing Financial Instructions, directions on fraud, programme of Internal Audit, budgetary control systems and information to support performance and risk monitoring processes.
6. The CCG internal control framework A system of internal control is the set of processes and procedures in place in the clinical commissioning group to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it can therefore only provide reasonable and not absolute assurance of effectiveness. The system of Internal Control has been in place in the CCG for the year ended 31 March 2014 and up to the date of approval of the Annual Report and Annual Accounts.
6.1 Information governance The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal identifiable information. The NHS Information Governance Framework is supported by an information governance toolkit and the annual submission process provides assurances to the clinical commissioning group, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively. The CCG is committed to ensuring that Information Governance is an integral part of the CCG's Risk Management Policy and operational planning. The Information Governance and IM&T Steering Group prioritises its work programme and provides regular exception reporting to CMET. The IG and IM&T Steering Group is attended by the Caldicott Guardian, SIRO and is chaired by the GP Clinical Lead for Information Governance and IM&T. There are processes in place for incident reporting and investigation of serious incidents. We are developing information risk assessment and management procedures and a programme will be established to fully embed an information risk culture throughout the organisation. The CCG submitted and published a GREEN „satisfactory‟ rating for its self-assessment on the Information Governance Toolkit for 2013-2014. This submission and final publication was required by October 2013 in order to coincide with the deadline for CCGs to apply for Accredited Safe Haven (ASH) status. No additional submission is required at year end March 2014. Health and Social Care Information Centre (HSCIC) have approved the CCGs self- assessment submission as „Satisfactory‟ after having reviewed the evidence uploaded
56 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14 to the IG Toolkit website. Formal notification of Stage 1 ASH accreditations is anticipated and a Controlled Environment for Finance (CEfF) is being set up.
6.2 Pension obligations As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the scheme regulations are complied with. This includes ensuring that deductions from salary, employer‟s contributions and payments into the scheme are in accordance with the scheme rules, and that member pension scheme records are accurately updated in accordance with the timescales detailed in the regulations.
6.3 Equality, diversity & human rights obligations Control measures are in place to ensure that all the organisation‟s obligations under equality, diversity and human rights legislation are complied with. As Accountable Officer, I am assured by the relevant aspects of the NHS Constitution that the Governing Body (through the Remuneration & Terms of Service Committee receives assurance on and regular monitoring of workforce performance. A mechanism is also in place for undertaking and reviewing equality impact assessments. An Equality and Delivery System is now in place and this is overseen by the Equality and Delivery Steering Group which reports to CMET. All EDS Goals are linked to the risks contained in the CCG Assurance Framework and Risk Register.
6.4 Sustainable development obligations The CCG is required to report its progress in delivering against sustainable development indicators. We are developing plans to assess risks, enhance our performance and reduce our impact, including against carbon reduction and climate change adaptation objectives. This includes establishing mechanisms to embed social and environmental sustainability across policy development, business planning and in commissioning. The CCG, through the Local Health Partnership Forum, has undertaken a climate change risk assessment and developed an Adaption Plan, to support its emergency preparedness and civil contingency requirements, as based on the UK Climate Projections 2009 (UKCP09), to ensure that this organisation‟s obligations under the Climate Change Act are met. We will ensure the CCG continues to comply with its obligations under the Climate Change Act 2008, including the Adaptation Reporting power, and the Public Services (Social Value) Act 2012. We are also setting out our commitments as a socially responsible employer.
7. Risk assessment in relation to governance, risk management & internal control The CAF identifies the CCG‟s strategic objectives and risks, the controls that are currently in place to minimise the risk and the sources of assurance to those controls. The system of regular review of the CAF by the Governing Body provides evidence to the Annual Governance Statement. The Governing Body has reviewed gaps in key controls and assurance and progress on management actions to address the gaps.
57 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
The CAF assesses the likelihood of an event occurring combined with the possible consequences to provide a standard approach to the assessment of risk. Calculating the risk supports the prioritisation of action plans and the reduction of risks is therefore managed through this process. The Internal Audit review of the CAF provided substantial assurance. The CAF is regularly reviewed by the Clinical and Management Executive Team and input is also provided by the Patient Safety & Quality Committee and Finance and Performance Committees as required. It is scrutinised at each Audit Committee and is presented at each Governing Body meeting in public through the Chief Clinical Officer and Chief Operating Officer Report. Recommendations arising from the Internal Audit review that were designed to further develop and strengthen the CAF will be taken forward during 2014-2015. The CAF identified a number of risks to achieving our Strategic Aims which are being managed through actions linked to the CAF to mitigate these risks. These are as follows: High Risks - Risks requiring immediate action by Director/Executive Management Team/Governing Body: Failure to Safeguard Children; Failure to Safeguard Adults; Risk of skilled workforce not available within CCG commissioned services; Achievement of the Financial Plan for 2013/14; Risk to Delivery of QIPP and System Reform Plan; Failure to achieve key performance targets; Risk to delivery of the Urgent Care Network Plans; Risk of Ambulance service failing to meet required levels of performance; Insufficient capacity and capability to deliver all goals; and Risk relating to CCG access to Patient Confidential Data.
Significant Risks - Risks requiring urgent executive management team action linked with Action Plan Risk of potential poor quality services from providers which the CCG commissions; Risk to maintaining quality and performance of provider services; Risks associated with on-going retrospective CHC claims process; Failure to achieve delivery of the Strategic Priority Programmes (Older People/CHD/End of Life Care); Failure to engage with public and patients around service changes; Implementation of new regulatory regime for Foundation Trusts; Failure to implement NHS 111 Service; Risk to maintaining the quality of Provider Out of Hours Service; Failure to deliver robust Organisational Development Plan for the CCG; Risk of poor information governance such as non-compliance with the data Protection Act, FOI Act and other legislation relevant to the services it commissions; Risk to breaching the Bribery Act 2010; and Risk to robust major incident and business continuity planning.
58 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Moderate Risks - Risks requiring assessment and action planning allocated to Directorates: Some GPs/Clinicians not fully engaged in commissioning; and Risk to maintaining robust CCG governance arrangements. The CAF identifies a number of gaps in controls. The Management Action Plans to address these are as follows: Each strategic risk listed above has been included in the CAF and will continue to be reported and monitored through the governance structures that have been established for the new organisation; and Improved Financial Recovery Plan and QIPP monitoring and reporting processes have been implemented in the latter part of the year to provide the CCG, through the Financial Recovery Plan Programme Board.
8. Review of economy, efficiency & effectiveness of the use of resources Through the Finance and Performance Committee, key processes are applied to ensure that resources are used economically, efficiently and effectively. This also includes scrutiny of the CCG‟s performance and financial functions. The Committee oversees the CCG‟s financial risks and delivery of the QIPP Programme. The Committee also regularly reviews the CAF. The Committee reports to the Governing Body at each meeting.
9. Review of the effectiveness of governance, risk management and internal control As Accounting Officer, I have responsibility for reviewing the effectiveness of the system of internal control within the CCG.
9.1 Capacity to handle risk The Governing Body provides leadership to ensure that risk management is embedded within the organisation. This includes development of the Integrated Plan which identifies the key objectives and related risks. As Accountable Officer, I ensure that sufficient resources are invested in managing risk, and I am supported in this task by the Director of Quality (Caldicott Guardian) who holds Governing Body-level responsibility for clinical risks. The Director of Corporate Affairs holds Governing Body-level responsibility for non-clinical risks. Up to December 2013, the Senior Information Risk Owner role was held by the Director of Performance and Delivery. From January 2014, this responsibility transferred to the Director of Corporate Affairs. Leadership is given to the risk management process through Executive Directors, Clinical Governing Body Members and Lay Members via the Audit Committee, Patient Safety and Quality Committee, Finance and Performance Committee and the Clinical and Management Executive Team. Staff are trained and equipped to manage risk in a way that is appropriate to their authority and duties and this is done through a documented system of risk assessment, formal and ad hoc training and from meetings with them to identify and manage risk. Guidance is provided to staff by the Governance Team who provide templates on how
59 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14 to undertake risk assessments, produce risk registers and business continuity plans and embed risk management in the activity of the organisation. The CCG is supported by Risk Management resources within SERCO which provides support in terms of advice, development and training.
9.2 Review of effectiveness As Accountable Officer, I have responsibility for reviewing the effectiveness of the system of internal control. My review is informed in a number of ways. The Head of Internal Audit provides me with an opinion on the overall arrangements for gaining assurance through the CAF and on the controls reviewed as part of the Internal Audit work. Executive Directors within the organisation who have responsibility for the development and maintenance of the system of internal control provides me with assurance. The CAF itself provides me with the evidence that the effectiveness of controls that manage the risks to the organisation achieving its corporate objectives have been reviewed. My review is also informed by Internal and External Audit. I have been advised of the implications of the result of my review of the effectiveness of the system of internal control by the Governing Body and the Audit Committee as described in Section 7. A plan to address weaknesses and ensure continuous improvements of the system of internal control will be put in place. The Governing Body and its associated Committees, together with Internal Audit, maintain a regular review of the effectiveness of the process of internal control. My review is also informed by: The Information Governance Toolkit Assessment; Our Research Governance Framework; Any external reviews; My attendance at key governance meetings; Reports from Internal Audit and the Head of Internal Audit Opinion; NHSLA Membership and Risk Management Assessment; External Audit‟s assessment of the CCG‟s arrangements for economy, efficiency and effectiveness in the use of its resources; and The NHS England CCG Assurance Framework and Quarterly Assurance Meetings held between the CCG and the Anglia Area Team. This focuses on the CCG Assurance Framework Balanced Scorecard which provides ratings as follows: - Are local people getting good quality care? - Are patients‟ rights under the Constitution being promoted? - Are health outcomes for local people improving? - Are CCGs commissioning services within their financial allocation? - Are conditions of CCG authorisation being addressed and removed?
I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the following Committee Structure: The Governing Body, which has responsibility for setting the overall direction, agreeing the CCG‟s strategic aims corporate objectives, assessing and managing strategic risks to the delivery of those objectives and monitoring progress through regular performance monitoring reports;
60 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
The eight Local Commissioning Groups who maintain local focus, clinical and patient engagement in commissioning, design locally responsive services and drive innovation; The Audit Committee which works to an annual cycle of business linked to the Audit Committee Handbook and provides assurance to the Governing Body; and The Finance & Performance Committee) which reviews financial risk and performance of providers commissioned to provide services to the patients of Cambridgeshire and Peterborough; The Patient Safety and Quality Committee which is responsible for ensuring clinical risk is managed; The Remuneration and Terms of Service Committee, which is responsible for agreeing Very Senior Managers Pay, monitoring Executive Director performance and monitoring Workforce Performance and the Organisational Development Plan; The Clinical and Management Executive Team which meets regularly to support the achievement of the Operational Plan and deals with day to day risk; The Patient Reference Group which provides an independent view of the work of the CCG that is external to the day-to-day running of the organisation and ensures the public voice of the local population is heard and that opportunities are created and protected for patient and public empowerment in the work of the CCG; The Strategic Clinical Prioritisation Group which advises on the clinical service priorities most likely to deliver on the CCG‟s strategic and corporate objectives; consider and approves business cases recommended by the Clinical Policies Forum (CPF) and Joint Prescribing Group (JPG); The Service Performance Review Group which oversee the delivery of the CCG‟s commissioning support function; GP Governing Body Members, Governing Body Members, Executive Directors, Local Chief Officers and Deputy/Assistant Directors; Internal Audit, which has reviewed the effectiveness of the design and operation of the controls in the areas covered by its risk-based Operational Plan.
As set out in the Head of Internal Audit Opinion for 2013-14, 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. Progress against implementation of all Internal Audit recommendations is regularly reviewed by the Audit Committee. Management Actions taken are confirmed by specific, formal follow-up by Internal Audit and this is independently reported to the Audit Committee.
During the year the Internal Audit issued the following reports with a conclusion of Insufficient Assurance Assignment Opinion Completion of work associated with Authorisation Conditions Insufficient/Assurance (Note 1) Continuing Care -clearance of Insufficient/Assurance back log cases (Note 2)
61 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Note 1- The insufficient opinion given for the achievement of authorisation conditions was mainly influenced by the CCG‟s financial planning processes with the CCG anticipating a deficit in year. Actions have been taken to bolster control in this area with the introduction of a financial improvement team and enhancements to the Project Management Office function. Note 2- The other insufficient opinion related to the review of processes for the clearance and settlement of continuing care claims. Recommendations included the need to review and revisit calculations of the potential CCG liabilities and assessment of resource requirements to clear claims in a timely fashion in order to minimise potential interest penalties. Recommendations made were accepted and confirmed as implemented by management. The CCG did not meet its statutory obligation duty to break even in 2013-2014, and has ended the year with a deficit of £4.9m. A Financial Recovery Plan Programme Board, reporting to the Clinical and Management Executive Team has been put in place to monitor the CCG‟s Financial Recovery Pan. With the exception of the internal control issues that I have outlined in this Annual Governance Statement, my review confirms that the CCG has a generally sound system of internal controls that supports the achievement of its policies, aims and objectives. The control issues have been or are being assessed.
9.3 Data quality Data quality is reviewed at various levels within the CCG across the various data sources we use. For our main commissioning datasets we have procured the service of a DSCRO (Data Service for Commissioners Regional Office) which validates the information we use to monitor contracts and pathways. Theses validation checks include DQ checks e.g. missing information (NHS Number, Dates), incorrect information (Date mismatch, incorrect prices, invalid e.g. an 85 year old admitted under paediatrics). For more aggregate information e.g. performance against targets (18wks, Cancer, A&E) we triangulate information from multiple sources e.g. provider reporting and national reporting. We also compare different views e.g. commissioner level and provider level to ensure consistency.
9.4 Business critical models Modelling and forecasting forms a fundamental part of the process between providers and commissioners. Each year contracts are constructed to forecast spend and activity values for the following year. These are then monitored in year with forecasts updated monthly to identify position against plans and year end outturn. Quality assurance of this process is given by the involvement of both providers and commissioners in the construction and monitoring process. This peer review ensures models are built on robust assumptions, with the most up to date and accurate data. The different perspectives ensure that plans are realistic but still give challenge in relation to system transformation.
62 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
9.5 Data security As set out above, we have submitted a satisfactory level of compliance with the information governance toolkit assessment. The CCG is required to publish all Serious Incidents (SIs) relating to loss of personal data involving confidentiality breaches in its Annual Report. There have been (at the time of writing) no breaches involving loss of data reported during 2013-2014.
CAPCCG summary of other personal data related incidents in 2013-14 Category Nature of incident Total I Loss/theft of inadequately protected electronic equipment, devices or - paper documents from secured NHS premises II Loss/theft of inadequately protected electronic equipment, devices or - paper documents from outside secured NHS premises III Insecure disposal of inadequately protected electronic equipment, - devices or paper documents IV Unauthorised disclosure -
V Other – Categorised at Level 1 (SIRI non reportable incidents) 6
10. Discharge of statutory functions During establishment, the arrangements put in place by the CCG and explained within the Corporate Governance Framework were developed based on National Guidance to ensure compliance with the all relevant legislation. The CCG is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions. Responsibility for each duty and power has been clearly allocated to a lead Director. Directorates have confirmed that their structures provide the necessary capability and capacity to undertake all of the CCG‟s statutory duties.
11. Conclusion The CCG has faced a significant financial challenge in 2013-14 due a combination of factors a) pressure on acute contracts; b) issues with respect to our baseline allocation; c) less than full delivery of planned savings. This is a serious financial position and the organisation is doing its utmost to mitigate this in order for the CCG to meet its statutory financial duty. A complexity in establishing the correct financial baseline for CCGs has been the disaggregation of funding for Specialised Commissioning. This area of commissioning is the responsibility of the NHS England through its designated Area Teams. The CCG received an initial allocation which had made an estimate of the funds for Specialised Commissioning. There was then a further rebasing exercise which was carried out at the mid-year point. Whilst this exercise did result in the CCG receiving additional funds for CCG commissioned services in London Hospitals, the overall and net impact adversely affected the CCG on both an income and expenditure basis. This along with activity pressures in the acute hospital spend and less than full delivery of
63 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14 planned savings lead to the CCG moving from its planned £2.4m surplus to a deficit position. Recovery plans were swiftly implements which has reduced the deficit from its highest forecast deficit of £8.6m to the final reported position of £4.9m. The external auditors have issued a qualified regularity opinion and a qualified value for money conclusion in relation to the CCG‟s breach of its statutory financial duty. A qualified opinion has also been issued in relation to the remuneration report due to difficulties in obtaining pension information from the NHS Pensions Agency for the GP Governing Body members. The CCG requested this information in advance of the notified deadlines but it was not disclosed by the Agency. A Turnaround Team was commissioned from Deloitte to provide the CCG with 13 weeks of support to help to reduce the deficit. The focus of their work was on the delivery of key projects and to strengthen the Programme Management Office. A review of the governance arrangements supporting the financial recovery was also undertaken, with the development of a Financial Recovery Plan Programme Board reporting directly to the Clinical and Management Executive Team and the Finance & Performance Committee. As set out in the NHS England‟s „Two Year Allocation tables‟, the per head allocation shows that our CCG is the lowest in the Anglia area. Along with our partners, we have been calling for a revised formula for allocations that better meet the needs of our growing and ageing population. The CCG Allocations for 2014-15 and 2015-16 have been published. The new formula goes some way to address our concerns but it will be some time before we reach a fair level of funding.
The CCG has faced significant challenges around delivery of the NHS Constitution target in A&E and Ambulance Response performance is still below the required standard. There remains uncertainty regarding the status of NHS Continuing Healthcare claims and discussions with the Area Team continue. In relation to the CCG Quality Premium, the CCG is forecasting a financial deficit and will not therefore receive the Quality Premium in 2014-15. The CCG self-assessment is amber/red in relation to Hospital Acquired Infections. Notwithstanding the financial position, this would have also impacted on the CCG receiving the premium in 2014-15.
The CCG‟s authorisation conditions remain in place at the end of 2013-14.
Accountable Officer: Dr Neil Modha Organisation: NHS Cambridgeshire and Peterborough CCG
Signature:
Date: 05/06/2014
64 Independent auditors’ report to the Members of Cambridgeshire and Peterborough Clinical Commissioning Group
Report on the financial statements
Our opinion In our opinion the financial statements, defined below: give a true and fair view, of the state of the Clinical Commissioning Group’s affairs as at 31 March 2014 and of its net operating costs for the year then ended 31 March 2014; and have been properly prepared in accordance with the accounting policies directed by the NHS Commissioning Board with the approval of the Secretary of State. This opinion is to be read in the context of what we say in the remainder of this report.
What we have audited The financial statements, which are prepared by Cambridgeshire and Peterborough Clinical Commissioning Group (“CCG”), comprise: the Statement of Financial Position as at 31 March 2014; the Statement of Comprehensive Net Expenditure for the year then ended; the Statement of Changes in Taxpayers’ Equity for the year then ended; the Statement of Cash Flows for the year then ended; and the notes to the financial statements, which include summary of significant accounting policies and other explanatory information. The financial reporting framework that has been applied in their preparation is the accounting policies directed by the NHS Commissioning Board with the approval of the Secretary of State. In applying the financial reporting framework, the Accountable Officer has made a number of subjective judgements, for example in respect of significant accounting estimates. In making such estimates, they have made assumptions and considered future events.
What an audit of financial statements involves We conducted our audit in accordance with International Standards on Auditing (UK and Ireland) (“ISAs (UK & Ireland)”). An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of: whether the accounting policies are appropriate to the CCG’s circumstances and have been consistently applied and adequately disclosed; the reasonableness of significant accounting estimates made by the Accountable Officer; and the overall presentation of the financial statements. In addition, we read all the financial and non-financial information in the annual report to identify material inconsistencies with the audited financial statements and to identify any information that is apparently materially incorrect based on, or materially inconsistent with, the knowledge acquired by us in the course of performing the audit. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report. We are also required to obtain evidence sufficient to give reasonable assurance that the expenditure and income reported in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them.
65 Opinions on other matters prescribed by the Code of Audit Practice
In our opinion the information given in the Annual Report for the financial year for which the financial statements are prepared is consistent with the financial statements. Basis for qualified opinion on remuneration report The CCGs Remuneration Report is incomplete as it does not contain the required GP pensions disclosures as specified in the CCG Annual Reporting Guidance. The CCG has requested the pensions information however at the time of signing our opinion the information had not been provided. The omitted information is set out below: The 'All Pension Related Benefits' column (column E) within the Salaries and Allowances table for GPs who acted in a Director/Senior Manager role (and who received pensionable income) at the CCG during the year. The CETV disclosures for GPs who acted in a Director/Senior Manager role at the CCG (and who received pensionable income) during the year. Qualified opinion on remuneration report In our opinion, except for the effects of the matter described in the basis for qualified opinion paragraph above, the part of the Remuneration Report to be audited has been properly prepared in accordance with the requirements directed by the NHS Commissioning Board and, in all material respects the expenditure and income has been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them.
Basis for qualified opinion on the application of expenditure and income for the purposes intended by Parliament The CCG was, in the financial year ended 31 March 2014, in breach of the ‘breakeven duty’ set out at paragraph 2(1) of Schedule 5 to the National Health Service Act 2006
Qualified opinion on the application of expenditure and income for the purposes intended by Parliament In all material respects the expenditure and income has not been applied to the purposes intended by Parliament and the financial transactions do not conform to the authorities which govern them.
Other matters on which we are required to report by exception
We have referred a matter to the Secretary of State under section 19 of the Audit Commission Act 1998 because the CCG was, in the financial year ended 31 March 2014, in breach of the ‘breakeven duty’ set out at paragraph 2(1) of Schedule 5 to the National Health Service Act 2006.
Responsibilities for the financial statements and the audit
Our responsibilities and those of the Accountable Officer As explained more fully in the Statement of Accountable Officer’s Responsibilities set out on page 49 of the annual report the Accountable Officer is responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view in accordance with the accounting policies directed by the NHS Commissioning Board with the approval of the Secretary of State. Our responsibility is to audit and express an opinion on the financial statements in accordance with Part II of the Audit Commission Act 1998, the Code of Audit Practice 2010 for local NHS bodies issued by the Audit Commission and ISAs (UK & Ireland). Those standards require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors. This report, including the opinions, has been prepared for and only for the Governing Body of Cambridgeshire and Peterborough CCG in accordance with Part II of the Audit Commission Act 1998 as set out in paragraph 44 of the Statement of Responsibilities of Auditors and of Audited Bodies (Local NHS bodies) published by the Audit Commission in April 2014, and for no other purpose. We do not, in giving these opinions, accept or assume responsibility for any other purpose or to any other person to whom this report is shown or into whose hands it may come save where expressly agreed by our prior consent in writing.
66 Conclusion on the CCG’s arrangements for securing economy, efficiency and effectiveness in the use of resources
Qualified conclusion On the basis of our work, having regard to the guidance issued by the Audit Commission in October 2013, we have identified instances where Cambridgeshire and Peterborough CCG has not put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources for the year ending 31 March 2014. Basis for qualified conclusion In considering the CCG’s arrangements, we identified that the CCG breached its statutory breakeven duty in 2013/14. In addition, due to concerns of the NHS England Local Area Team over the CCG’s future financial plans, the two conditions imposed on the CCG on its authorisation have not yet been lifted.
What a review of the arrangements for securing economy, efficiency and effectiveness in the use of resources involves We have undertaken our audit in accordance with the Code of Audit Practice, having regard to the guidance issued by the Audit Commission in October 2013. We have considered the results of the following: our review of the Governance Statement; the work of other relevant regulatory bodies or inspectorates, to the extent that the results of this work impact on our responsibilities at the CCG; and our locally determined risk-based work, including review of turnaround plans and arrangements put in place to address outstanding authorisation conditions.
Our responsibilities and those of the CCG The CCG is responsible for putting in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources, to ensure proper stewardship and governance, and to review regularly the adequacy and effectiveness of these arrangements. We are required under Section 5 of the Audit Commission Act 1998 to satisfy ourselves that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. The Code of Audit Practice issued by the Audit Commission requires us to report to you any matters that prevent us being satisfied that the CCG has put in place such arrangements..
Certificate
We certify that we have completed the audit of the financial statements of Cambridgeshire and Peterborough CCG in accordance with the requirements of Part II of the Audit Commission Act 1998 and the Code of Audit Practice issued by the Audit Commission.
Clive Everest
Clive Everest (Senior Statutory Auditor) for and on behalf of PricewaterhouseCoopers LLP Chartered Accountants and Statutory Auditors 10 Bricket Road St Albans Herts AL1 3JX
9 June 2014
67 (a) The maintenance and integrity of the Cambridgeshire and Peterborough CCG website is the responsibility of the directors; the work carried out by the auditors does not involve consideration of these matters and, accordingly, the auditors accept no responsibility for any changes that may have occurred to the financial statements since they were initially presented on the website. (b) Legislation in the United Kingdom governing the preparation and dissemination of financial statements may differ from legislation in other jurisdictions.
68 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Statement of Comprehensive Net Expenditure for the year ended 31 March 2014 2013-14 Note £000
Administration Costs and Programme Expenditure Gross employee benefits 4 13,029 Other costs 5 880,429 Other operating revenue 2 (5,381) Net operating costs before interest 888,077
Net operating costs for the financial year including absorption transfers 888,077
Of which: Administration Costs Gross employee benefits 4 12,168 Other costs 5 6,551 Other operating revenue 2 (116) Net administration costs before interest 18,603
Programme Expenditure Gross employee benefits 4 861 Other costs 5 873,878 Other operating revenue 2 (5,265) Net programme expenditure before interest 869,474
Total comprehensive net expenditure for the year 888,077
69 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Statement of Financial Position as at 31 March 2014 31 March 2014
Note £000 Non-current assets: Property, plant and equipment 13 530 Total non-current assets 530 Current assets: Inventories 16 182 Trade and other receivables 17 9,150 Cash and cash equivalents 20 2,443 Total current assets 11,775
Total assets 12,305
Current liabilities Trade and other payables 23 59,957 Total current liabilities 59,957
Total Assets less Current Liabilities (47,652)
Non-current liabilities -
Total Assets/ (Liabilities) Employed (47,652)
Financed by Taxpayers’ Equity General fund (47,652) Total taxpayers’ equity: (47,652)
There are no comparative figures available for the year ending 31 March 2013 as the year ending 31 March 2014 is the first year of operation of the clinical commissioning group.
The notes on pages 73 to 99 form part of this statement.
The financial statements on pages 69 to 99 were approved by the Governing Body on 5 June 2014 and signed on its behalf by:
Accountable Officer Dr Neil Modha
70 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Statement of Changes In Taxpayers’ Equity for the year ended 31 March 2014 General Total fund reserves Note £000 £000 Changes in taxpayers’ equity for 2013-14 Balance at 1 April 2013 - - Transfer of assets and liabilities from closed NHS Bodies as a result of the 13, 14 & 16 593 593 1 April 2013 transition Adjusted CCG balance at 1 April 2013 593 593
Changes in CCG taxpayers’ equity for 2013-14 Net operating costs for the financial year (888,077) (888,077)
Net Recognised CCG Expenditure for the Financial Year (887,484) (887,484) Net funding 839,832 839,832 Balance at 31 March 2014 (47,652) (47,652)
71 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Statement of Cash Flows for the year ended 31 March 2014 2013-14 Note £000 Cash Flows from Operating Activities Net operating costs for the financial year (888,077) Depreciation and amortisation 13 & 14 135 (Increase)/decrease in trade & other receivables 17 (9,150) Increase/(decrease) in trade & other payables 23 59,957 Net Cash Inflow/ (Outflow) from Operating Activities (837,135)
Cash Flows from Investing Activities (Payments) for property, plant and equipment 13 (254) Net Cash Inflow/ (Outflow) from Investing Activities (254)
Net Cash Inflow/ (Outflow) before Financing (837,389)
Cash Flows from Financing Activities Net funding received 839,832 Net Cash Inflow/ (Outflow) from Financing Activities 839,832
Net Increase/ (Decrease) in Cash & Cash Equivalents 20 2,443
Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year 2,443
72 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Notes to the financial statements
1 Accounting Policies
NHS England has directed that the financial statements of clinical commissioning groups shall meet the accounting requirements of the Manual for Accounts issued by the Department of Health. Consequently, the following financial statements have been prepared in accordance with the Manual for Accounts 2013-14 issued by the Department of Health with reference to the CCG Annual Reporting Guidance. The accounting policies contained in the Manual for Accounts follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to clinical commissioning groups, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Manual for Accounts permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the clinical commissioning group for the purpose of giving a true and fair view has been selected. The particular policies adopted by the clinical commissioning group are described below. They have been applied consistently in dealing with items considered material in relation to the accounts.
In accordance with the Directions issued by NHS England comparative information is not provided in these Financial Statements.
The accounting arrangements for balances transferred from predecessor PCTs ("legacy" balances) are determined by the Accounts Direction issued by NHS England on 12 February 2014. The Accounts Directions state that the only legacy balances to be accounted for by the CCG are in respect of property, plant and equipment (and related liabilities) and inventories. All other legacy balances in respect of assets or liabilities arising from transactions or delivery of care prior to 31 March 2013 are accounted for by NHS England. The impact of the legacy balances accounted for by the CCG is disclosed in note 11 to these financial statements. The CCG's arrangements in respect of settling NHS Continuing Healthcare claims are disclosed in note 30 to these financial statements.
1.1 Going Concern
These accounts have been prepared on the going concern basis despite the issue of a report to the Secretary of State for Health under Section 19 of the Audit Commission Act 1998 for the actual breach of financial duties.
Public sector bodies are assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as evidenced by inclusion of financial provision for that service in published documents.
Where a clinical commissioning group ceases to exist, it considers whether or not its services will continue to be provided (using the same assets, by another public sector entity) in determining whether to use the concept of going concern for the final set of Financial Statements. If services will continue to be provided the financial statements are prepared on the going concern basis.
1.2 Accounting Convention
These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities.
1.3 Movement of Assets within the Department of Health Group
Transfers as part of reorganisation fall to be accounted for by use of absorption accounting in line with the Government Financial Reporting Manual, issued by HM Treasury. The Government Financial Reporting Manual does not require retrospective adoption, so prior year transactions (which have been accounted for under merger accounting) have not been restated. Absorption accounting requires that entities account for their transactions in the period in which they took place, with no restatement of performance required when functions transfer within the public sector. Where assets and liabilities transfer, the gain or loss resulting is recognised in the Statement of Comprehensive Net Expenditure, and is disclosed separately from operating costs.
73 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Notes to the financial statements
Other transfers of assets and liabilities within the Department of Health Group are accounted for in line with IAS 20 and similarly give rise to income and expenditure entries.
For transfers of assets and liabilities from those NHS bodies that closed on 1 April 2013, HM Treasury has agreed that a modified absorption approach should be applied. For these transactions only, gains and losses are recognised in reserves rather than the Statement of Comprehensive Net Expenditure.
1.4 Pooled Budgets
Where the clinical commissioning group has entered into a pooled budget arrangement under Section 75 of the National Health Service Act 2006 the clinical commissioning group accounts for its share of the assets, liabilities, income and expenditure arising from the activities of the pooled budget, identified in accordance with the pooled budget agreement.
1.5 Critical Accounting Judgements & Key Sources of Estimation Uncertainty
In the application of the clinical commissioning group‟s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods.
1.5.1 Critical Judgements in Applying Accounting Policies There were no Critical Judgements made by the clinical commissioning group's management.
1.5.2 Key Sources of Estimation Uncertainty The following are the key estimations that management has made in the process of applying the clinical commissioning group‟s accounting policies that have the most significant effect on the amounts recognised in the financial statements: Property, Plant & Equipment are depreciated over their estimated useful lives on a straight line basis, as disclosed in Note 13.
The clinical commissioning group's status as a Community Admission Body is yet to be finalised and therefore the clinical commissioning group has decided not to include in full, liability relating to the Cambridgeshire Local Government Pension Scheme. The in-year liability is immaterial and full IAS19 accounting and related disclosures are not warranted as disclosed in note 4.4.4.
1.6 Revenue
Revenue in respect of services provided is recognised when, and to the extent that, performance occurs, and is measured at the fair value of the consideration receivable.
Where income is received for a specific activity that is to be delivered in the following year, that income is deferred.
74 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Notes to the financial statements
1.7 Employee Benefits
1.7.1 Short-term Employee Benefits Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees, including bonuses earned but not yet taken. The cost of leave earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry forward leave into the following period.
1.7.2 Retirement Benefit Costs Past and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the clinical commissioning group of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period.
Some employees are members of the Cambridgeshire Local Government Pension Scheme, which is a defined benefit scheme adminstered in accordance with LGPS regulations as disclosed in note 4.4.4.
1.8 Other Expenses
Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable.
Expenses and liabilities in respect of grants are recognised when the clinical commissioning group has a present legal or constructive obligation, which occurs when all of the conditions attached to the payment have been met.
1.9 Property, Plant & Equipment
1.9.1 Recognition Property, plant and equipment is capitalised if: It is held for use in delivering services or for administrative purposes; It is probable that future economic benefits will flow to, or service potential will be supplied to the clinical commissioning group; It is expected to be used for more than one financial year; The cost of the item can be measured reliably; and, The item has a cost of at least £5,000; or, Collectively, a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or, Items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or collective cost.
Where a large asset, for example a building, includes a number of components with significantly different asset lives, the components are treated as separate assets and depreciated over their own useful economic lives.
1.9.2 Valuation All property, plant and equipment are measured initially at cost, representing the cost directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. All assets are measured subsequently at fair value.
HM Treasury has adopted a standard approach to depreciated replacement cost valuations based on modern equivalent assets and, where it would meet the location requirements of the service being provided, an alternative site can be valued.
75 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Notes to the financial statements
Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost includes professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for assets held at fair value. Assets are re-valued and depreciation commences when they are brought into use.
Fixtures and equipment are carried at depreciated historic cost as this is not considered to be materially different from fair value.
An increase arising on revaluation is taken to the revaluation reserve except when it reverses an impairment for the same asset previously recognised in expenditure, in which case it is credited to expenditure to the extent of the decrease previously charged there.
1.9.3 Subsequent Expenditure Where subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised. Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing carrying value of the item replaced is written-out and charged to operating expenses.
1.10 Intangible Assets
1.10.1 Recognition Intangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the clinical commissioning group‟s business or which arise from contractual or other legal rights. They are recognised only: When it is probable that future economic benefits will flow to, or service potential be provided to, the clinical commissioning group; Where the cost of the asset can be measured reliably; and, Where the cost is at least £5,000.
Intangible assets acquired separately are initially recognised at fair value. Software that is integral to the operating of hardware, for example an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software that is not integral to the operation of hardware, for example application software, is capitalised as an intangible asset. Expenditure on research is not capitalised but is recognised as an operating expense in the period in which it is incurred. Internally-generated assets are recognised if, and only if, all of the following have been demonstrated: The technical feasibility of completing the intangible asset so that it will be available for use; The intention to complete the intangible asset and use it; The ability to sell or use the intangible asset; How the intangible asset will generate probable future economic benefits or service potential; The availability of adequate technical, financial and other resources to complete the intangible asset and sell or use it; and, The ability to measure reliably the expenditure attributable to the intangible asset during its development.
1.10.2 Measurement The amount initially recognised for internally-generated intangible assets is the sum of the expenditure incurred from the date when the criteria above are initially met. Where no internally-generated intangible asset can be recognised, the expenditure is recognised in the period in which it is incurred.
Following initial recognition, intangible assets are carried at fair value by reference to an active market, or, where no active market exists, at amortised replacement cost (modern equivalent assets basis), indexed for relevant price increases, as a proxy for fair value. Internally-developed software is held at historic cost to reflect the opposing effects of increases in development costs and technological advances.
76 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Notes to the financial statements
1.11 Depreciation, Amortisation & Impairments
Depreciation and amortisation are charged to write off the costs or valuation of plant and equipment and intangible non-current assets, less any residual value, over their estimated useful lives, on a straight line basis. The estimated useful life of an asset is the period over which the clinical commissioning group expects to obtain economic benefits or service potential from the asset. This is specific to the clinical commissioning group and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis.
At each reporting period end, the clinical commissioning group checks whether there is any indication that any of its tangible or intangible non-current assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its amount. Intangible assets not yet available for use are tested for impairment annually.
A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Where an impairment loss subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the recoverable amount but capped at the amount that would have been determined had there been no initial impairment loss. The reversal of the impairment loss is credited to expenditure to the extent of the decrease previously charged there and thereafter to the revaluation reserve.
1.12 Leases
Leases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All other leases are classified as operating leases.
1.12.1 The Clinical Commissioning Group as Lessee Property, plant and equipment held under finance leases are initially recognised, at the inception of the lease, at fair value or, if lower, at the present value of the minimum lease payments, with a matching liability for the lease obligation to the lessor. Lease payments are apportioned between finance charges and reduction of the lease obligation so as to achieve a constant rate on interest on the remaining balance of the liability. Finance charges are recognised in calculating the clinical commissioning group‟s surplus/deficit.
Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term.
Contingent rentals are recognised as an expense in the period in which they are incurred.
Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether they are operating or finance leases.
1.13 Inventories
Inventories are valued at the lower of cost and net realisable value using the first-in first-out cost formula. This is considered to be a reasonable approximation to fair value due to the high turnover of stocks.
1.14 Cash & Cash Equivalents
Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value.
In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the clinical commissioning group‟s cash management.
77 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Notes to the financial statements
1.15 Provisions
Provisions are recognised when the clinical commissioning group has a present legal or constructive obligation as a result of a past event, it is probable that the clinical commissioning group will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties. Where a provision is measured using the cash flows estimated to settle the obligation, its carrying amount is the present value of those cash flows using HM Treasury‟s discount rate as follows: Timing of cash flows (0 to 5 years inclusive): Minus 1.90% Timing of cash flows (6 to 10 years inclusive): Minus 0.65% Timing of cash flows (over 10 years): Plus 2.20% All employee early departures: 1.80%
When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the receivable is recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the receivable can be measured reliably.
A restructuring provision is recognised when the clinical commissioning group has developed a detailed formal plan for the restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by starting to implement the plan or announcing its main features to those affected by it. The measurement of a restructuring provision includes only the direct expenditures arising from the restructuring, which are those amounts that are both necessarily entailed by the restructuring and not associated with on- going activities of the entity.
1.16 Clinical Negligence Costs
From 1 April 2000, the NHS Litigation Authority (NHSLA) took over the full financial responsibility for all Existing Liabilities Scheme (ELS) cases unsettled at that date and from 1 April 2002 all Clinical Negligence Scheme for (CNST) cases. Provisions for these are included in the accounts of the NHSLA and not in the accounts of the individual NHS bodies.
The NHS Litigation Authority operates a risk pooling scheme under which the clinical commissioning group pays an annual contribution to the NHS Litigation Authority which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although the NHS Litigation Authority is administratively responsible for all clinical negligence cases the legal liability remains with the clinical commissioning group.
1.17 Non-clinical Risk Pooling
The clinical commissioning group participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the clinical commissioning group pays an annual contribution to the NHS Litigation Authority and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due.
1.18 Financial Assets
Financial assets are recognised when the clinical commissioning group becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred.
Financial assets are classified into the following categories: Financial assets at fair value through profit and loss; Held to maturity investments; Available for sale financial assets; and, Loans and receivables.
78 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Notes to the financial statements
The classification depends on the nature and purpose of the financial assets and is determined at the time of initial recognition.
1.18.1 Loans & Receivables Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market. After initial recognition, they are measured at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method.
Fair value is determined by reference to quoted market prices where possible, otherwise by valuation techniques.
The effective interest rate is the rate that exactly discounts estimated future cash receipts through the expected life of the financial asset, to the initial fair value of the financial asset.
At the end of the reporting period, the clinical commissioning group assesses whether any financial assets, other than those held at „fair value through profit and loss‟ are impaired. Financial assets are impaired and impairment losses recognised if there is objective evidence of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the estimated future cash flows of the asset.
For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset‟s carrying amount and the present value of the revised future cash flows discounted at the asset‟s original effective interest rate. The loss is recognised in expenditure and the carrying amount of the asset is reduced through a provision for impairment of receivables.
If, in a subsequent period, the amount of the impairment loss decreases and the decrease can be related objectively to an event occurring after the impairment was recognised, the previously recognised impairment loss is reversed through expenditure to the extent that the carrying amount of the receivable at the date of the impairment is reversed does not exceed what the amortised cost would have been had the impairment not been recognised.
1.19 Financial Liabilities
Financial liabilities are recognised on the statement of financial position when the clinical commissioning group becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired.
Loans from the Department of Health are recognised at historical cost. Otherwise, financial liabilities are initially recognised at fair value.
1.19.1 Other Financial Liabilities After initial recognition, all other financial liabilities are measured at amortised cost using the effective interest method, except for loans from Department of Health, which are carried at historic cost. The effective interest rate is the rate that exactly discounts estimated future cash payments through the life of the asset, to the net carrying amount of the financial liability. Interest is recognised using the effective interest method.
1.20 Value Added Tax
Most of the activities of the clinical commissioning group are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.
79 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
Notes to the financial statements
1.21 Losses & Special Payments
Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled.
Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had the clinical commissioning group not been bearing its own risks (with insurance premiums then being included as normal revenue expenditure).
1.22 Research & Development
Research and development expenditure is charged in the year in which it is incurred, except insofar as development expenditure relates to a clearly defined project and the benefits of it can reasonably be regarded as assured. Expenditure so deferred is limited to the value of future benefits expected and is amortised through the Statement of Comprehensive Net Expenditure on a systematic basis over the period expected to benefit from the project. It should be re-valued on the basis of current cost. The amortisation is calculated on the same basis as depreciation.
1.23 Accounting Standards That Have Been Issued But Have Not Yet Been Adopted
The Government Financial Reporting Manual does not require the following Standards and Interpretations to be applied in 2013-14, all of which are subject to consultation: IAS 19: employer contributions to defined benefit pension schemes (amendment) IAS 27: Separate Financial Statements IAS 28: Investments in Associates & Joint Ventures IAS 32: Financial Instruments – Presentation (amendment) IAS 36: recoverable amount disclosures (amendment) IFRS 9: Financial Instruments IFRS 10: Consolidated Financial Statements IFRS 11: Joint Arrangements IFRS 12: Disclosure of Interests in Other Entities IFRS 13: Fair Value Measurement
The application of the Standards as revised would not have a material impact on the accounts for 2013-14, were they applied in that year.
80 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
2 Other Operating Revenue 2013-14 2013-14 2013-14 Total Admin Programme £000 £000 £000
Recoveries in respect of employee benefits 37 37 - Education, training and research 302 3 299 Non-patient care services to other bodies 628 42 586 Other revenue 4,414 34 4,380 Total other operating revenue 5,381 116 5,265
Admin revenue is revenue received that is not directly attributable to the provision of healthcare or healthcare services.
Revenue in this note does not include cash received from NHS England, which is drawn down directly into the bank account of the CCG and credited to the General Fund.
3 Revenue
Revenue is totally from the supply of services. The clinical commissioning group receives no revenue from the sale of goods.
81 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
4. Employee benefits and staff numbers
4.1.1 Employee benefits 2013-14 Total Admin Programme Total Permanent Other Total Permanent Other Total Permanent Other Employees Employees Employees £000 £000 £000 £000 £000 £000 £000 £000 £000 Employee Benefits Salaries and wages 10,991 9,396 1,595 10,217 8,971 1,246 774 425 349 Social security costs 798 798 - 767 767 - 31 31 - Employer Contributions to NHS Pension scheme 1,240 1,240 - 1,184 1,184 - 56 56 - Gross employee benefits expenditure 13,029 11,434 1,595 12,168 10,922 1,246 861 512 349
Less recoveries in respect of employee benefits (note 4.1.2) (37) (37) - (37) (37) - - - - Total - Net admin employee benefits including capitalised costs 12,992 11,397 1,595 12,131 10,885 1,246 861 512 349
Net employee benefits excluding capitalised costs 12,992 11,397 1,595 12,131 10,885 1,246 861 512 349
4.1.2 Recoveries in respect of employee benefits 2013-14 Total Permanent Other Employees £000 £000 £000 Employee Benefits - Revenue Salaries and wages (37) (37) - Total recoveries in respect of employee benefits (37) (37) -
The figures detailed in the Other column in the above table include staff members under short-term contract and agency staff.
82 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
4.2 Average number of people employed 2013-14 Permanently Total employed Other
Number Number Number
Total 265 245 20
4.3 Staff sickness absence and ill health retirements 2013-14 Number Total Days Lost 999 Total Staff Years 250 Average working Days Lost 4
83 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
4.4 Pension costs The majority of past and present employees are covered by the provisions of the NHS Pension Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/Pensions.
The Scheme is an unfunded, defined benefit scheme that covers NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The Scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities.
Therefore, the Scheme is accounted for as if it were a defined contribution scheme: the cost to the clinical commissioning group of participating in the Scheme is taken as equal to the contributions payable to the Scheme for the accounting period.
The Scheme is subject to a full actuarial valuation every four years (until 2004, every five years) and an accounting valuation every year. An outline of these follows:
4.4.1 Full actuartial (funding) valuation The purpose of this valuation is to assess the level of liability in respect of the benefits due under the Scheme (taking into account its recent demographic experience), and to recommend the contribution rates to be paid by employers and scheme members. The last such valuation, which determined current contribution rates was undertaken as at 31 March 2004 and covered the period from 1 April 1999 to that date. The conclusion from the 2004 valuation was that the Scheme had accumulated a notional deficit of £3.3 billion against the notional assets as at 31 March 2004.
In order to defray the costs of benefits, employers pay contributions at 14% of Pensionable pay and most employees had up to April 2008 paid 6%, with manual staff paying 5%.
Following the full actuarial review by the Government Actuary undertaken as at 31 March 2004, and after consideration of changes to the NHS Pension Scheme taking effect from 1 April 2008, his Valuation report recommended that employer contributions could continue at the existing rate of 14% of Pensionable pay, from 1 April 2008, following the introduction of employee contributions on a tiered scale from 5% up to 8.5% of their Pensionable pay depending on total earnings. On advice from the scheme actuary, scheme contributions may be varied from time to time to reflect changes in the scheme‟s liabilities.
4.4.2 Accounting valuation A valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period by updating the results of the full actuarial valuation.
Between the full actuarial valuations at a two-year midpoint, a full and detailed member data-set is provided to the scheme actuary. At this point the assumptions regarding the composition of the scheme membership are updated to allow the scheme liability to be valued.
The valuation of the scheme liability as at 31 March 2011 is based on detailed membership data as at 31 March 2008 (the latest midpoint) updated to 31 March 2011 with summary global member and accounting data.
The latest assessment of the liabilities of the Scheme is contained in the scheme actuary report, which forms part of the annual NHS Pension Scheme (England and Wales) Resource Account, published annually. These accounts can be viewed on the NHS Pensions website. Copies can also be obtained from The Stationery Office.
84 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
4.4 Pension costs
4.4.3 Scheme Provisions The NHS Pension Scheme provides defined benefits, which are summarised below. This list is an illustrative guide only, and is not intended to detail all the benefits provided by the Scheme or the specific conditions that must be met before these benefits can be obtained:
• The Scheme is a “final salary” scheme. Annual pensions are normally based on 1/80th for the 1995 section and of the best of the last three years pensionable pay for each year of service, and 1/60th for the 2008 section of reckonable pay per year of membership. Members who are practitioners as defined by the Scheme Regulations have their annual pensions based upon total pensionable earnings over the relevant pensionable service;
• With effect from 1 April 2008 members can choose to give up some of their annual pension for an additional tax free lump sum, up to a maximum amount permitted under HM Revenue & Customs rules. This new provision is known as “pension commutation”;
• Annual increases are applied to pension payments at rates defined by the Pensions (Increase) Act 1971, and are based on changes in retail prices in the twelve months ending 30 September in the previous calendar year;
• Early payment of a pension, with enhancement, is available to members of the Scheme who are permanently incapable of fulfilling their duties effectively through illness or infirmity. A death gratuity of twice final year‟s pensionable pay for death in service, and five times their annual pension for death after retirement is payable;
• For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to the statement of comprehensive net expenditure at the time the clinical commissioning group commits itself to the retirement, regardless of the method of payment; and,
• Members can purchase additional service in the Scheme and contribute to money purchase AVC‟s run by the Scheme‟s approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers.
4.4.4 Cambridgeshire Local Government Pension Scheme (LGPS) Seven staff who remained part of the Cambridgeshire Local Government Pension Scheme (LGPS), transferred to the clinical commissioning group along with all other transferring staff as at 1 April 2013. One of the six has since become employed by Cambridgeshire County Council, so as at 31 March 2014; there are six members of staff retaining membership of the LGPS.
With respect to this issue and the PCT accounts, the position was „The liability as at 31 March 2013 arising from the LGPS transferred to the Department of Health and any crystallisation of this was understood to have crystallised as at 1 April 2013, as part of the Department of Health liabilities and NHS Legacy balances.
During 2013-14, the clinical commissioning group has deducted employee contributions for these 6 staff and also paid employer contribution and the total of these have been paid to the LGPS. As from 1 April 2014 the employer contribution rate will be 23.6%.
As at 31 March 2014 to regularise the payment to the LGPS the clinical commissioning group has applied to be a Community Admission Body as recognised by the pension fund. To complete this, the LGPS has asked that the Department of Health act as the guarantor to this agreement. The Department of Health have not agreed to be the guarantor and are still considering the matter.
Nevertheless, the Department of Health legal team had asked for the LGPS to draw up a contribution rate assessment for the Community Association Body on a „share of deficit basis‟. This has calculated for the seven transferring staff a share of assets totalling £584,000 and a share of liabilities totalling £1,349,000, producing a £765,000 deficit as at commencement. The clinical commissioning group would anticipate that an opening liability should be allocated to the Clinical commissioning group from the NHS Legacy balances and we will incorporate this into communication with the Department of Health as the clinical commissioning group continues to reach a finalised Community Admission Agreement. This liability has therefore not been recognised within the accounts.
During 2013-14, there may be further net pension liabilities arising in respect of the six members of staff but as these are not material and as the Community Admission Body is yet to be finalised, the clinical commissioning group does not intend to issue a statement from the actuary in regards to the accrued assets and liabilities in relation to the pension scheme as at 31 March 2014. However, as the in-year liabilities are immaterial it is the judgement of the clinical commssioning group that full IAS19 accounting and related disclosures are not warranted. However, the clinical commissioning group will reassess this for 2014-15.
85 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
5. Operating expenses 2013-14 2013-14 2013-14 Total Admin Programme £000 £000 £000 Gross employee benefits Employee benefits excluding governing body members 12,140 11,279 861 Executive governing body members 889 889 - Total gross employee benefits 13,029 12,168 861
Other costs Services from other CCGs and NHS England 5,506 149 5,357 Services from foundation trusts 434,769 78 434,691 Services from other NHS trusts 207,353 7 207,346 Services from other NHS bodies 2 - 2 Purchase of healthcare from non-NHS bodies 109,405 (144) 109,549 Chair and lay membership body and governing body members 97 97 - Supplies and services – clinical 2,271 - 2,271 Supplies and services – general 4,342 2,926 1,416 Consultancy services 384 384 - Establishment 2,459 1,117 1,342 Transport 6 4 2 Premises 48 45 3 Depreciation 134 134 - Amortisation 1 1 - Audit fees 126 126 - Other auditors' remuneration · Internal audit services 88 88 - Prescribing costs 105,659 - 105,659 Pharmaceutical services 1,368 - 1,368 General opthalmic services 128 - 128 GPMS/APMS and PCTMS 4,106 - 4,106 Other professional fees excl. audit 1,604 1,487 117 Research and development (excluding staff costs) 518 - 518 Education and training 30 29 1 Other expenditure 25 23 2 Total other costs 880,429 6,551 873,878
Total operating expenses 893,458 18,719 874,739
Admin expenditure is expenditure incurred that is not a direct payment for the provision of healthcare or healthcare services.
86 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
6.1 Better Payment Practice Code Measure of compliance 2013-14 2013-14 Number £000 Non-NHS Payables Total Non-NHS Trade invoices paid in the Year 18,059 103,460 Total Non-NHS Trade Invoices paid within target 17,612 101,381 Percentage of Non-NHS Trade invoices paid within target 97.52% 97.99%
NHS Payables Total NHS Trade Invoices Paid in the Year 3,140 627,887 Total NHS Trade Invoices Paid within target 2,517 612,258 Percentage of NHS Trade Invoices paid within target 80.16% 97.51%
The Better Payment Practice Code requires the CCG to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later.
6.2 The Late Payment of Commercial Debts (Interest) Act 1998 The clinical commissioning group had no costs for the late payment of commercial debts (Interest) Act 1998.
7 Income Generation Activites The clinical commissioning group does not undertake any income generation activities.
8. Investment revenue The clinical commissioning group had no investment revenue.
9. Other gains and losses The clinical commissioning group had no other gains and losses.
10. Finance costs The clinical commissioning group had no finance costs.
11. Net gain/(loss) on transfer by absorption There were no transferred function(s) that gave rise to a recognised gain or loss.
87 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
12. Operating Leases 12.1 As lessee 12.1.1 Payments recognised as an Expense 2013-14 Other Total £000 £000 Payments recognised as an expense Minimum lease payments 13 13 Contingent rents 24 24 Total 37 37
12.1.2 Future minimum lease payments 2013-14 Other Total £000 £000 Payable: No later than one year 11 11 Between one and five years 69 69 Total 80 80
£1,348k has been paid to NHS Property Services Ltd for the running costs of property assigned to the clinincal commissioning group.
There is no lease agreement with NHS Property Services Ltd and therefore no amounts are included within the above Note. This value is included in Note 5 Operating Expenses under Supplies and services – general.
88 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
13 Property, plant and equipment Plant & Information Furniture & Total 2013-14 machinery technology fittings £000 £000 £000 £000 Cost or valuation at 1 April 2013 - - - - Transfer of assets from closed NHS bodies as a result of the 1 April 2013 transition 49 336 25 410 Adjusted Cost or valuation at 1 April 2013 49 336 25 410
Additions purchased - 229 25 254 At 31 March 2014 49 565 50 664
Charged during the year 8 117 9 134 At 31 March 2014 8 117 9 134
Net Book Value at 31 March 2014 41 448 41 530
Purchased 41 448 41 530 Total at 31 March 2014 41 448 41 530
Asset financing:
Owned 41 448 41 530 Total at 31 March 2014 41 448 41 530
Revaluation Reserve Balance for Property, Plant & Equipment No revaluation carried out in 2013-14.
13.5 Compensation from third parties The clinical commissioning group did not receive any compensation from third parties for assets impaired, lost or given up.
13.6 Write downs to recoverable amount There were no assets written down to recoverable amounts or any reversals of previous write downs.
13.7 Temporarily idle assets The clinical commissioning group did not hold any temporarily idle assets.
13.8 Cost or valuation of fully depreciated assets The clinical commisssioning group did not hold any fully depreciated assets.
13.9 Economic lives Minimum Maximum Life (years) Life (Years) Plant & machinery 1 5 Information technology 1 4 Furniture & fittings 1 5
89 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
14 Intangible non-current assets Computer Total Software: 2013-14 Purchased £000 £000 Cost or valuation at 1 April 2013 - - Transfer of assets from closed NHS bodies as a result of the 1 April 2013 transition 1 1 Adjusted Cost or valuation at 1 April 2013 1 1 At 31 March 2014 1 1
Charged during the year 1 1 At 31 March 2014 1 1
Net Book Value at 31 March 2014 - -
Total at 31 March 2014 - -
15 Investment property The clinical commissioning group had no investment property as at 31 March 2014.
16 Inventories Other Total £000 £000 Balance at 1 April 2013 - - Transfer of assets from closed NHS bodies as a result of the 1 April 2013 transition 182 182 Adjusted balance at 1 April 2013 182 182
At 31 March 2014 182 182
90 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
17 Trade and other receivables Current 2013-14 £000
NHS receivables: Revenue 5,455 NHS prepayments and accrued income - Non-NHS receivables: Revenue 503 Non-NHS prepayments and accrued income 2,556 VAT 115 Operating lease receivables 12 Other receivables 509 Total 9,150
Total current and non current 9,150
Other receivables include 2013/14 balances with Local Authorities £225k, National Institute for Health Research Design (NIHR) £69k and Prescribing recharges £113k. The great majority of trade is with other NHS bodies. As these are funded by Government to provide funding to clinical commissioning groups to commission services, no credit scoring of them is considered necessary. There are no non-current trade and other receivables.
17.1 Receivables past their due date but not impaired 2013-14 £000
By up to three months 584 By three to six months 16 Total 600
£399,124 of the amount above has subsequently been recovered post the statement of financial position date. The clinical commissioning group did not hold any collateral against receivables outstanding at 31 March 2014.
18 Other financial assets The clinical commissioning group had no other financial assets as at 31 March 2014.
19 Other current assets The clinical commissioning group had no other current assets as at 31 March 2014.
91 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
20 Cash and cash equivalents
2013-14 £000 Balance at 1 April 2013 - Net change in year 2,443 Balance at 31 March 2014 2,443
Made up of: Cash with the Government Banking Service 2,443 Cash in hand 0 Cash and cash equivalents as in statement of financial position 2,443
Balance at 31 March 2014 2,443
Patients‟ money held by the clinical commissioning group, not included above -
21 Non-current assets held for sale The clinical commissioning group had no non-current assets held fo sale as at 31 March 2014.
22 Analysis of impairments and reversals The clinical commissioning group had no impairments or reversals.
92 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
23 Trade and other payables Current 2013-14 £000 NHS payables: revenue 14,404 NHS accruals and deferred income 11,479 Non-NHS payables: revenue 3,701 Non-NHS accruals and deferred income 28,079 Social security costs 121 Tax 127 Other payables 2,046 Total 59,957
Total payables (current and non-current) 59,957
24 Other financial liabilities The clinical commissioning group has no other financial liabilities.
25 Other liabilities The clinical commissioning group has no other liabilities.
26 Borrowings The clinical commissioning group has no borrowings.
27 Private finance initiative, LIFT and other service concession arrangements The clinical commissioning group has no private finance initiative, LIFT or other service concession arrangements.
28 Finance lease obligations The clinical commissioning group has no finance lease obligations.
29 Finance lease receivables The clinical commissioning group has no finance lease receivables.
30 Provisions Legal claims are calculated from the number of claims currently lodged with the NHS Litigation Authority and the probabilities provided by them.
£2,566,200 is included in the provisions of the NHS Litigation Authority as at 31 March 2014 in respect of clinical negligence liabilities of the clinical commissioning group.
Under the Accounts Direction issued by NHS England on 12 February 2014, NHS England is responsible for accounting for liabilities relating to NHS Continuing Healthcare claims relating to periods of care before establishment of the clinical commissioning group. However, the legal liability remains with the CCG. The total value of legacy NHS Continuing Healthcare provisions accounted for by NHS England on behalf of this CCG at 31 March 2014 is £9,487k.
31 Contingencies The clinical commissioning group had no contingencies.
93 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
33 Financial instruments 33.1 Financial risk management Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities. Because the clinical commissioning group is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The clinical commissioning group has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the clinical commissioning group in undertaking its activities. Treasury management operations are carried out by the finance department, within parameters defined formally within the clinical commissioning group‟s standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the clinical commissioning group‟s internal auditors.
33.1.1 Currency risk The clinical commissioning group is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The clinical commissioning group has no overseas operations. The clinical commissioning group therefore has low exposure to currency rate fluctuations.
33.1.2 Interest rate risk The clinical commissioning group did not make any borrowings in 2013-14 but could borrow from government for capital expenditure, subject to affordability as confirmed by NHS England. The borrowings are for 1 to 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The clinical commissioning group therefore has low exposure to interest rate fluctuations.
33.1.3 Credit risk Because the majority of the clinical commissioning group‟s revenue comes parliamentary funding, the clinical commissioning group has low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables from customers, as disclosed in the trade and other receivables note.
33.1.4 Liquidity risk The clinical commissioning group is required to operate within revenue and capital resource limits agreed with NHS England, which are financed from resources voted annually by Parliament. The clinical commissioning group draws down cash to cover expenditure, from NHS England, as the need arises. The clinical commissioning group is not, therefore, exposed to significant liquidity risks.
94 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
33 Financial instruments cont’d
33.1 Financial assets Loans and Total Receivables 2013-14 2013-14 £000 £000 Receivables: · NHS 5,455 5,455 · Non-NHS 503 503 Cash at bank and in hand 2,443 2,443 Other financial assets 510 510 Total at 31 March 2014 8,911 8,911
33.2 Financial liabilities Other Total 2013-14 2013-14 £000 £000 Payables: · NHS 25,883 25,883 · Non-NHS 31,780 31,780 Total at 31 March 2014 57,663 57,663
95 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
34 Operating segments Net expenditure £'000 Acute Services 500,719 Mental Health Services 92,056 Community Services 144,794 Primary Care 124,401 Transformation 2,534 CCG Central Budgets 4,971 Running Costs 18,615 888,090
34.1 Reconciliation between Operating Segments and SoCNE 2013-14 £'000 Total net expenditure reported for operating segments 888,090 Reconciling items: Running Costs (13) Total net expenditure per the Statement of Comprehensive Net Expenditure 888,077
96 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
35 Pooled budgets
The clinical commissioning group entered into two pooled budget agreements with Cambridgeshire County Council. Under the arrangements, funds are pooled under S75 of the NHS Act 2006 for Integrated Community Equipment Services (ICES) and the Learning Disability Partnership (LDP).
The ICES and LDP are hosted by Cambridgeshire County Council. As a commissioner of healthcare services, the clinical commissioning group makes contributions to the pools, which are then used to purchase healthcare services. The clinical commissioning group accounts for its share of the assets, liabilities, income and expenditure of the pool as determined by the pooled budget agreement.
The contribution to the LDP for the year was £14,379k, which represents a share of 19.7% with the remaining contribution of 80.3% made by Cambridgeshire County Council.
The contribution to the ICES for the year was £2,146k, which represents a share of 48.4% with the remaining contribution of 51.6% made by Cambridgeshire County Council.
36 NHS Lift investments
The clinical commissioning group has no LIFT schemes.
37 Intra-government and other balances Current Current Receivables Payables
2013-14 2013-14 £000 £000 Balances with: · Local Authorities 656 1,794
Balances with NHS bodies: · NHS bodies outside the Departmental Group 1,276 1,004 · NHS Trusts and Foundation Trusts 4,179 24,879 Total of balances with NHS bodies: 5,455 25,883
· Bodies external to Government 3,039 32,280
Total balances at 31 March 2014 9,150 59,957
97 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
38 Related party transactions During the year the Board Members or members of the key management staff or parties related to them have undertaken material transactions with the clinical commissioning group as follows: Certain local General Practitioners sit on the clinical commissioning governing body. During the year payments were made to those General Practitioner's practices, in line with the practices‟ role as independent contractors. The payments below were made to the practices and not to the doctors personally for services provided by those practices. In addition, there have been transactions in the ordinary course of the clinical commissioning group‟s business with a number of provider Trusts with which Directors of the cinical commissioning group are connected. Details of directors‟ and senior managers‟ remuneration are given in the Remuneration Report included in the clinical commissioning group‟s Annual Report. Details of related party transactions with individuals are as follows: 31 March 2014 Receipts Amounts Amounts Payments from owed to due from to Related Related Related Related Party Party Party Party £000 £000 £000 £000 Dr Michael Caskey, Senior Partner, Park Medical Centre 92 - - - Dr Arnold Fertig, Occasional Locum, Nuffield Road Med Centre 220 - - - Dr David Irwin, Senior Partner, Buckden Practice 462 - - - Dr John Jones, Partner, Staploe Medical Centre 79 - - - Dr Geraldine Linehan, Non Principal, Woodlands Surgery 14 - - - Dr Neil Modha, Partner, Thistlemoor Med Centre 140 - - - Dr David Roberts, Senior Partner, Great Staughton Practice 70 - - - Dr Tim Webster, Partner, North Brink Practice 73 - 3 - Dr Richard Withers, Partner, Yaxley Group Practice 113 - 9 - Dr David Irwin, Partner, Dermatology Clinic Community Service 129 - 2 - (DCCSL) Dr Geraldine Linehan, Shareholder, Urgent Care Cambridgeshire 6,503 (156) 10 (3) Maureen Donnelly, Partner Governor, Cambridge University 185,206 (31) 5,546 (82) Hospitals NHS FT Andy Vowles, Spouse employee of, Cambridge University 185,206 (31) 5,546 (82) Hospitals NHS FT Rebecca Stephens, Member, Cambridgeshire & Peterborough 70,205 - 684 - NHS FT
The Department of Health is regarded as a related party. During the year the clinical commissioning group has had a significant number of material transactions with entities for which the Department is regarded as the parent Department. These entities with material values are listed below: £000 £000 £000 £000
Cambridge University Hospitals NHS Foundation Trust 185,206 (31) 5,546 (82) Cambridgeshire & Peterborough NHS Foundation Trust 70,205 - 684 - Papworth Hospital NHS Foundation Trust 12,590 - 373 - Peterborough and Stamford Hospitals NHS Foundation Trust 122,707 - 5,518 (6) Queen Elizabeth Hospital Kings Lynn NHS Foundation Trust 25,004 - - (1,223) NHS England 5 (1,143) 496 (1,068) Cambridgeshire Community Services NHS Trust 78,108 - 1,410 (622) East & North Hertfordshire NHS Trust 1,841 - - (195) East of England Ambulance Service NHS Trust 25,726 - 1,461 - Hinchingbrooke Health Care NHS Trust 84,301 - 5,070 (1,094) Health Education England 3 (304) - (1) Department of Health - (1,799) - (27)
In addition, the clinical commissioning group has had a number of material transactions with other government departments and other central and local government bodies. Most of these transactions have been with Cambridgeshire County Council and Peterborough City Council, see below for values. Cambridgeshire County Council 16,492 101 (394) Peterborough City Council 2,026 1,653 (247)
98 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14
39 Events after the end of the reporting period
There are no post balance sheet events which will have a material effect on the financial statements of the clinical commissioning group or consolidated group.
40 Losses and special payments 40.1 Losses
The total number of clinical commissioning group losses and special payments cases, and their total value, was as follows: Total Number of Total Value of Cases Cases 2013-14 2013-14 Number £'000 Cash losses 1 1 Total 1 1
40.2 Special payments The clinical commissioning group made no special payments.
41 Third party assets The clinical commissioning group did not hold any cash or cash equivalents on behalf of other parties as at 31 March 2013.
42 Financial performance targets Clinical commissioning groups have a number of financial duties under the National Health Service Act 2006 (as amended). The clinical commissioning group‟s performance against those duties was as follows:
2013-14
Maximum Performance Duty Duty £000 £000 Achieved?
Expenditure not to exceed income 883,203 888,077 No
Capital resource use does not exceed the amount specified in Directions 254 254 Yes
Revenue resource use does not exceed the amount specified in Directions 883,203 888,077 No
Revenue administration resource use does not exceed the amount specified in Directions 20,800 18,719 Yes
Expenditure is defined as the aggregate of gross expenditure on revenue and capital in the financial year; and, income is defined as the aggregate of the notified maximum revenue resource, notified capital resource and all other amounts accounted as received in the financial
As the clinical commissioning group has breached its Financial duty to break even, the clinical commissioning group auditors are under duty to make a report to the Secretary of State for Health under Section 19 of the Audit Commission Act 1998.
99
Follow us on Twitter
NHS Cambridgeshire and Peterborough Clinical Commissioning Group Lockton House Clarendon Road Cambridge CB2 8FH
Telephone: 01223 725400 Fax: 01223 725401 Website: www.cambridgeshireandpeterboroughccg.nhs.uk This document has been produced by Cambridgeshire and Peterborough CCG’s Communications Team. © CAPCCG 2014 If you would like this document in large print, audio, Braille, alternative format or a different language, please contact the Communications Team on 01223 725325 or email [email protected]