Primary Care Commissioning Framework

Contents

...... 1 CHAIR’S INTRODUCTION ...... 6 ACCOUNTABLE OFFICER’S INTRODUCTION ...... 7 PERFORMANCE REPORT ...... 8 About us ...... 8 Our population ...... 8 Our vision...... 9 Working as a membership organisation ...... 10 Core providers ...... 10 Our structure ...... 10 Our commissioning priorities ...... 11 Key issues and risks ...... 11 Reducing inequalities ...... 12 Financial review of the year ...... 13 Achievement of Statutory Financial Duties ...... 13 Our Finances ...... 13 Going concern ...... 13 Performance measures ...... 14 Performance against the assessment framework ...... 14 Friends and Family Test – December 2015 ...... 16 Activity indicators 2015/16 ...... 16 Performance against NHS Constitution indicators ...... 17 Managing performance ...... 18 What we’ve done ...... 21 Improving services for patients ...... 21 Maternity services ...... 21 Mental health ...... 22 Urgent care ...... 24 Infant mortality ...... 25 Supporting new arrivals ...... 26 Commissioning new services ...... 28 Direct access to non-obstetric ultrasound...... 28 End of life care ...... 28 Minor Eye Conditions Service ...... 28 Developing primary care ...... 29 Primary Care Commissioning Framework ...... 29 Delegated functions (primary care commissioning) ...... 30

Weekend opening ...... 30 Community Education Provider Network ...... 31 National Skills Academy workforce analysis ...... 31 Primary care strategy ...... 32 NHS 111 contract ...... 34 West Midlands Ambulance Service contract ...... 34 Planning: looking ahead 2016-2025 ...... 34 Operational Plan 2016-17 ...... 35 Five Year Sustainability and Transformation Plan ...... 35 New models of care ...... 36 Sustainable development ...... 37 Estates ...... 37 Travel ...... 37 Procurement and suppliers’ impact ...... 38 Patient and public involvement and consultation ...... 39 Patient and Partnership Engagement model (PPE) ...... 39 ...... 40 Our Patient and Partnership Advisory Group ...... 41 Primary care ...... 43 Urgent and emergency care ...... 43 Integrated urgent care ...... 43 Non-emergency patient transport (NEPT) ...... 44 Palliative care for children and young people ...... 44 Looking forward ...... 44 Equality Awards 2016 ...... 45 Get involved ...... 45 Working with our partners ...... 46 Health and Wellbeing Boards ...... 46 Better Care Fund ...... 46 Right Care Right Here ...... 47 Midland Met Hospital ...... 48 Improving quality ...... 49 Focus on customer care ...... 49 Safeguarding ...... 49 Improving quality in primary care ...... 50 Medicines quality ...... 51 Continuing healthcare and personal health budgets ...... 52 Summary ...... 52

ACCOUNTABILITY REPORT ...... 54 Members’ report ...... 54 Our member practices...... 54 Governing Body member interests ...... 60 Disclosure of personal data related incidents ...... 60 Statement as to disclosure to auditors ...... 61 Statement of Accountable Officer’s responsibilities ...... 61 Annual Governance Statement ...... 63 Introduction and context ...... 63 Scope of responsibility ...... 63 Compliance with the UK Corporate Governance Code...... 63 The Clinical Commissioning Group Governance Framework ...... 63 Governing body committee structure ...... 66 Audit and Governance Committee ...... 66 Remuneration Committee ...... 66 Quality and Safety Committee ...... 66 Strategic Commissioning and Redesign Committee ...... 67 Finance and Performance Committee ...... 67 Partnerships Committee ...... 67 Primary Care Co-Commissioning Committee ...... 67 Patient and Partnership Advisory Group ...... 68 The Clinical Commissioning Group Risk Management Framework ...... 69 The Clinical Commissioning Group Internal Control Framework ...... 71 Review of the effectiveness of Governance, Risk Management & Internal Control ...... 73 Remuneration and staff report ...... 76 Remuneration and Terms of Service Committee ...... 76 Senior managers’ service contracts ...... 77 Single total figure remuneration table ...... 78 Pensions entitlement table ...... 79 Compensation for loss of office...... 80 Fair pay (ratio) disclosure and Pay Multiples ...... 80 Staff report ...... 82 Our staff ...... 82 Commissioning support ...... 82 New staff ...... 82 Average numbers ...... 82 Composition (by gender) ...... 83 Sickness absence data ...... 83

Staff policies and employee consultation ...... 83 Apprenticeship scheme ...... 83 Equality and diversity within our workforce ...... 84 Workforce priorities ...... 84 Employees with a disability ...... 84 Equal opportunities ...... 85 Consultancy Spend ...... 85 Off-payroll engagements ...... 85 Exit Packages, including special (non contractual) payments...... 87 Audit Statement…………………………………………………………………………………...88

FINANCIAL STATEMENTS………………………………...……………………………………...91

CHAIR’S INTRODUCTION

Overall, it’s been another successful year for Sandwell and West Birmingham Clinical Commissioning Group (CCG), with plenty of achievements to celebrate.

We’ve focused on a number of priorities, the most ambitious of which saw us take on responsibility for primary care commissioning in April 2015. We’ve aimed to reduce variation across practices – improving access, quality and patient experience. The Primary Care Commissioning Framework was introduced to help us achieve this target and I’m pleased to say that, so far, more than 97% of our practices have signed up.

Our pioneering work in this area is now being recognised on both a regional and national level. We were chosen as one of five centres of excellence, each awarded funds to develop healthcare training programmes and selected by Health Education West Midlands to host a series of clinical leaders’ events.

As part of our commitment to tackling health inequalities, we’ve looked to address high rates of infant mortality across Sandwell and West Birmingham. We’re determined to reduce this number but can’t do so alone. Partnership working is vital as we continue to develop a strategy with local stakeholders, including midwifery services, perinatal experts, GPs and the voluntary sector.

I had the honour of starting the 1,000 day countdown to the opening of the Midland Met Hospital in January and can’t wait to see it all up and running in 2018.

Elsewhere, our second Equality Awards – which were even bigger and better than the previous year’s – were held at the Hawthorns in February. It was a great opportunity to celebrate the important work done by local groups and organisations. The public were more involved than before too, with over 1,500 votes cast in the People’s Choice Award.

Looking ahead, it’s an exciting yet challenging time for the NHS, as we search for innovative ways to meet our population’s needs. I’m convinced we’re on the right track, a view shared by the Health Service Journal, who named us CCG of the Year for the second time.

The prestigious HSJ awards recognize excellence, innovation and best practice, so it was a fantastic boost to win, with the judges praising our ‘focused and compelling vision’ for integrating health and social care.

As always, it was a team effort and one which everyone deserves credit for. This is tribute to the hard work that our corporate team and member practices all put in and should act as motivation to remain ahead of the curve in terms of supporting member practices, working at scale and piloting new services.

Prof. Nick Harding OBE

Chair

ACCOUNTABLE OFFICER’S INTRODUCTION

It’s important to never lose sight of the fact that our purpose, as a CCG, is to make a difference to the lives of patients. We’ve been on a remarkable journey so far and it’s only just started.

We should be proud to have led the way when it comes to transforming services for the people of Sandwell and West Birmingham. In the last year alone there have been major developments in cardiology, mental health services, surgery, trauma, and urgent, emergency and end of life care.

Throughout this process, we’ve held listening exercises and public consultations, involving patients, carers, clinicians and partners in decision-making as much as possible. We value your views, and want to ensure that they are reflected in the services we develop.

More than just our immediate area, the CCG’s influence now extends beyond the geographical boundaries. We play an important role regionally, as lead commissioners of NHS 111 and the West Midlands Ambulance Service, and in September I was invited to become Chair of the Urgent Care Network covering the West Midlands. It’s an opportunity I’ve embraced.

We continue to set ambitious targets for the future, especially around sustainability and service development, but we’re well-placed to reach them. We couldn’t do this without all of the hard work that goes into ensuring the organisation runs as smoothly and successfully as it does. This was deservedly highlighted by our first Staff Recognition Awards ceremony in November. Congratulations to all the nominees and winners.

Last year I mentioned the good results we received from the staff survey, and I’m delighted to say that they’re even better this time around, with 92% saying they were proud to work for the CCG. All respondents understood our values and objectives, while the vast majority felt supported in their roles. This is great news, which we’ll look to build on next year.

Throughout my time here, the organisation has continued to grow. Our workforce increased when we welcomed our first apprentices in August, with one being placed in each of the four directorates. In doing so, we demonstrated a commitment to inspiring the next generation to explore careers in the NHS. Seeing the progress these young people have already made has been a real pleasure.

Finally, we launched our new vision and values almost a year ago, following a consultation with staff. They helped to decide on messages which encapsulate who we are, how we work and what we aim to achieve. More than just words on a page, I’m pleased to see people embodying them on a day-to-day basis.

Andy Williams

Accountable Officer

PERFORMANCE REPORT

About us

Set up in April 2013, we are a clinically-led membership group of 99 GP surgeries across the Sandwell and West Birmingham areas, caring for more than 552,032 patients.

Led by experienced GPs, we are responsible for improving, designing and commissioning (buying) local health services including:

 Hospital services (including accident and emergency departments)  Community healthcare e.g. district nursing and rehabilitation services  Mental health and learning disability services  Children’s services  Primary care (GP services).

We are regulated by NHS England. The CCG was licensed from 1 April 2013 under provisions enacted in the Health and Social Care Act 2012, which amended the National Health Service Act 2006.

As of 1 April 2014, we were licensed without conditions.

Our population

We extend across two council areas. The profiles of Sandwell and West Birmingham are both very different, shaping their specific needs for health services and information.

Demographics

Age

Our registered population is younger than the national average.

Deprivation

The areas we cover are some of the most deprived nationally. Birmingham is ranked 9th most deprived and Sandwell 12th most deprived population in England. The proportion of the population who are unemployed in Birmingham

8 is 11.6%, and 10.5% in Sandwell, compared to 6.5% for the United Kingdom as a whole.

Ethnicity

Our region is very diverse. The largest ethnic group is White British (50%), followed by Asian Indian (12%), Asian Pakistani (8%) and Black British/Caribbean (6%).

There is a great variation in the ethnic make-up of the wards we cover. Handsworth Wood and Lozells and East Handsworth have particularly high proportions of minority ethnic groups.

New migrant communities

The populations of Sandwell and West Birmingham will include migrants who have recently entered the UK and settled here.

They will include economic migrants, asylum seekers, refugees, illegal immigrants and individuals who entered the UK with visa clearance for study, tourism, family visits, employment or marriage.

Supporting new migrants to access primary care has been a key priority for us, as highlighted later in this report. The highest percentage of emergency admissions in Sandwell is among ‘other’ ethnic groups.

Health needs

The health of people in Sandwell and West Birmingham is generally worse than the national average. There is a high level of health inequality between the most deprived and least deprived areas in Sandwell and Birmingham with male life expectancy over ten years lower and female life expectancy over five years lower.

In addition to this there are also increased rates of obesity in both children and adults with twenty eight per cent of people over 16 being obese.

Locally there is a high rate of teenage pregnancy, smoking (over twenty two per cent of the population aged over 18 smoke) and consumption of alcohol (thirty five per cent of emergency admissions were for alcohol related liver disease). All these factors contribute to our local priorities targeting since almost ten per cent of our population report having a long- term condition, which “limits their day-to-day activity a lot”. Examples include cardiovascular disease, diabetes, chronic lung conditions and mental health problems.

Our vision

Our vision is simple to understand but more challenging to deliver: healthcare without boundaries. We want to work across boundaries to improve your health and the quality of health and social care services provided to you, by: 9

 Giving you the opportunity to benefit from healthier lifestyles  Bringing appropriate elements of care closer to home  Designing services to meet the needs of our local population.

Working as a membership organisation

As a membership organisation, involving our GP practices in our decisions is essential. To enable this we developed five local commissioning groups (LCGs) who address the needs of the population at a very local level. All our member practices belong to one of the LCGs, with an elected Chair and Vice Chair acting as voting members on our Governing Body. These local commissioning groups (LCGs) are:

 Black Country  HealthWorks  Intelligent Commissioning Federation (ICoF)  Pioneers for Health  Sandwell Health Alliance.

Prior to April 2015 we delegated authority for delivering our key work programmes and contracts to these five LCGs. Since then, they have refocused their work streams on primary care development. We continue to support all member practices to develop their skills and workforce, while ensuring that they are sustainable for the future.

Each LCG has dedicated clinical leads to aid primary care development and act as a steering group to support practices. We have introduced the Primary Care Commissioning Framework in shadow form this year and our LCG clinical leads have been integral in advising practices ahead of full mobilisation in April 2016.

Core providers

As we span two local authority boundaries, we often work with multiple providers. Our core contracts are with:

 Acute hospital (e.g. A&E, surgery): Sandwell and West Birmingham Hospitals NHS Trust (SWBH)  Community services, such as district nursing teams: Sandwell and West Birmingham Hospitals NHS Trust (Sandwell area), Birmingham Community Healthcare NHS Trust (BCHC) (West Birmingham area)  Mental health: Black Country Partnership NHS Foundation Trust (BCPFT) (Sandwell area), Forward Thinking Birmingham and Birmingham and Solihull Mental Health NHS Foundation Trust (BSMHT) (West Birmingham area)  Ambulance services: West Midlands Ambulance Service NHS Foundation Trust (WMAS)  NHS 111: From September 2015 West Midlands Doctors Urgent Care became the interim provider of NHS 111 services in Sandwell and West Birmingham. Prior to this the service was provided by West Midlands Ambulance Service NHS Foundation Trust  Out-of-hours GP services: Primecare.

Our structure

We have worked to embed clinical membership, lay and patient representation throughout all of our committees, which include:

 Audit and Governance Committee  Finance and Performance Committee  Organisational Development Committee  Partnerships Committee  Quality and Safety Committee  Remuneration Committee (no patient reps)  Strategic Commissioning and Redesign Committee  Primary Care Co-commissioning Committee.

Our commissioning priorities

In the latter part of 2013-14 we set our commissioning priorities for 2014-16. These were developed following a detailed review of our demographics, data and patient feedback.

We believe that these priorities help us to drive quality of care as well as deliver our challenging quality, innovation, productivity and prevention (QIPP) targets.

Our commissioning priorities for 2014-16 were:

 Outpatient modernisation  Mental health  Enhanced services in Primary Care  Stroke  Intermediate care  Pathway management  Long-term conditions  Urgent care  Community services  Reduce the number of patients being readmitted to hospital  Children and maternity services  End of life care.

Later in this report you will hear about our work to identify future priorities for 2016-17 and our Five Year Sustainability and Transformational Plan.

Key issues and risks

We have worked throughout 2015-16 to ensure controls and mitigation are in place to minimise risks. The principal risks are built into our Assurance Framework, which is subject to internal audit scrutiny and has been awarded significant assurance. There are mitigation plans in place for each. The key issues and risks identified were as follows:

 Development of New Models of Care  Achievement of NHS constitutional targets  Development and improvement of Primary Care  Implementation and expansion of the Better Care Fund  Failure to effectively identify and deliver the CCG efficiencies may result in financial unsustainability for future years  GP engagement and active participation  Local Authority funding cuts having a detrimental impact on health-related services for patients registered in Sandwell and West Birmingham.

Reducing inequalities

Sandwell and West Birmingham has some of the most disadvantaged communities in the country, with many areas having high levels of deprivation and health inequality. We want to address these problems.

Our Equality and Diversity Strategy 2013-2017 builds upon our commitment to equality, diversity and human rights as described in our constitution. It profiles diversity across our area and sets out our plans to address the needs of some of our most vulnerable groups. In building our strategy we used intelligence from the joint needs assessment.

This strategy is integral to our governance arrangements and is subject to regular review, ensuring that equality considerations are embedded throughout our organisation and decision making processes. Our strategic priorities and Operational Plan address the variations in health outcomes and improve the patient experience by increasing the quality of care received and bringing it closer to home. We have already incorporated equality analysis into key processes for commissioning – including service reconfiguration, business case and project development, contract specifications and service evaluations.

Financial review of the year

Achievement of Statutory Financial Duties

We have six statutory financial duties as detailed in the table below. We met or exceeded all six of our statutory duties in 2015-16

2015-16 2015-16 Duty Target Performance Achieved? £000 £000 Expenditure not to exceed income 8,778 12,006 Yes Capital resource use does not exceed the amount specified in Directions 0 0 Yes Revenue resource use does not exceed the amount specified in Directions 746,760 734,754 Yes Capital resource use on specified matter(s) does not exceed the amount specified in Directions 0 0 Yes Revenue resource use on specified matter(s) does not exceed the amount specified in Yes Directions 0 0 Revenue administration resource use does not exceed the amount specified in Directions 12,349 10,853 Yes

Our Finances

Total Income for 2015-16 was £747m

Total expenditure in 2015-16 was £735m

Expenditure on commissioning healthcare was £724m

Expenditure on running costs (ie management and administration) was £10.8m

We achieved a surplus for the year of £12m

Going concern

Public sector bodies are assumed to be going concerns where financial provision for their continued operation is outlined in published documents. Our Annual Financial Statements have been prepared on a going concern basis.

Performance measures

Performance against the assessment framework

Our contracts and performance teams regularly collect data from providers, so we can monitor how we are performing against our agreed targets. There are a range of national and local indicators, in particular the NHS Constitution, which we are asked to meet.

A well-led organisation

We have a significant and well-used framework for engaging with members to articulate and implement our vision. We continue to review the effectiveness of this framework and, in July 2015, began aligning clinical leadership to our strategic vision. This was embedded by clinical leads undertaking work plans and setting objectives.

All clinical leads are required to meet on a monthly basis to explore strategic challenges, or any associated with delivering the Primary Care Commissioning Framework. These sessions are led by different figures depending on the topics being discussed and the expertise required.

We continue to take a leading role in regional systems, such as Right Care Right Here, NHS 111, the West Midlands Ambulance Service, and Urgent Care and Stroke service redesign. In 2015 we were the only CCG in the country to become an excellence centre, in partnership with the National Skills Academy. This requires us to forge partnerships with four local CCGs and seven primary care providers to collectively address the challenges facing the primary care workforce across the region.

We have also been responsible for designing, planning and delivering a clinical leadership programme for more than 150 primary care clinicians across 24 CCGs in the West Midlands. This was delivered over a 12 month period, ending in March 2016. Due to its success, the national Vanguard development team is interested in funding it for future years at a national scale.

In order to continuously improve our performance, we have developed a culture of celebrating success, both internally and externally. This can be seen most clearly in our first Staff Celebration Awards ceremony, which recognised contributions from people across the organisation who were chosen by colleagues, the staff council and a panel of senior managers.

We use a number of means to support staff and engage them in new ways of working, including the following:

 A robust approach to Programme Management, which is built in to all systems and processes  A strong value-based Performance Development Review system, which was designed and supported by staff, with an 80% compliance rate  A continuous development opportunity for staff to expand their skills and experiences, aligned to projects and flexible resource allocation  Refocusing our priorities at the end of each year to ensure we meet local and national need

 A planned approach to Governing Body development to ensure that monthly development sessions support continuous learning and quality review of successes  Quarterly Protected Learning Time (PLT) events for all staff to explore the challenges faced by the CCG, engaging them in the design of the organisation and supporting personal and collective development  A comprehensive induction process that uses a video and pre-start date approach to ensure that all staff receive a corporate message from the senior management team and understand our vision  A review staff council representing specific constitutions within the CCG and delivering against thematic areas for support against the organisational development plan  Taking organisational development seriously across the senior leadership structure, and providing appropriate direction to internal and external partners  Providing access to a number of health and wellbeing interventions, including occupational health, staff support, social committee, and health and safety at work assessments. The health and wellbeing agenda has been expanded dramatically in 2015/16 to include the three pillars of health, as described in the Simon Stevens directive.

Last year, we also set about establishing organisational values – a set of attributes and behaviours which underpin everything we do. Staff were involved in this process from the start and together we came up with the following:

 Accountable – we will demonstrate ownership for the contribution we can make to our organisation including the ability to self-reflect, continuously learn and accept the consequences of actions  Valuing people – we will recognise the contribution that other people can make. We will value continuous learning through training, development, teaching and experience. We will challenge ourselves to think differently and to remove barriers to success  Courageous – we will be courageous in our actions, will make bold decisions and will lead on new ideas and concepts. We will be courageous in challenging quality and holding ourselves to account for delivery  Integrity – we will act with honesty, respect and integrity towards others and our population. We will make balanced and considered decisions.

Our values were launched in June 2015 and we believe they are integral to the development of a supportive and thriving organisation. We want staff to embody these values in their working lives and, as such, have incorporated them into our recruitment and personal development policies.

We’ve sought to raise awareness of our values and make them visible throughout the organisation. Our 2015 Staff Survey results indicate that this has worked, with 100% of respondents saying that they fully or partially understood what the CCG’s values are, and what they mean.

Friends and Family Test – December 2015 Friends and family test - Providers Dec-15 E.A.6. Friends and family test - A&E Total Responses 648 A&E Total Eligible SANDWELL AND WEST 14,487 E.A.6. BIRMINGHAM HOSPITALS NHS Response rate 4.47% TRUST Score wef Sept = % would 80.40% recommend E.A.6. Friends and family test - Inpatient Total Responses 1,293 INPATIENT Total Eligible 8,603 SANDWELL AND WEST E.A.6. Response rate 15.03% BIRMINGHAM HOSPITALS NHS Score TRUST wef Sept = % would 96.37% recommend E.A.6. Friends and family test - MATERNITY Total Responses 24 MATERNITY Question 1 Total Eligible SANDWELL AND WEST E.A.6. Response rate BIRMINGHAM HOSPITALS NHS Score TRUST wef Sept = % would 100.00% recommend Total Responses 66 MATERNITY Question 2 Total Eligible 454 SANDWELL AND WEST E.A.6. Response rate 14.54% BIRMINGHAM HOSPITALS NHS Score TRUST wef Sept = % would 80.30% recommend Total Responses 101 MATERNITY Question 3 Total Eligible SANDWELL AND WEST E.A.6. Response rate BIRMINGHAM HOSPITALS NHS Score TRUST wef Sept = % would 97.03% recommend Total Responses 98 MATERNITY Question 4 Total Eligible SANDWELL AND WEST E.A.6. Response rate BIRMINGHAM HOSPITALS NHS Score TRUST wef Sept = % would 97.96% recommend Activity indicators 2015/16

POD Total* Electives 7,836 Day Cases 31,968 Emergency 64,515 Outpatient 1st** 149,676 A&E 209,899 * 11 months activity forecasted to full year effect ** Only represents Outpatient (OP) 1st attendances.

Performance against NHS Constitution indicators

The below table highlights how the CCG and, where appropriate, Sandwell and West Birmingham Hospitals NHS Trust, has performed against these national pledges. Through regular contractual meetings, any missed targets are discussed with providers and action plans are put in place.

Level of Actual CCG Period Target reporting Achievement NHS Constitution Indicators

Category A calls resulting in an emergency response arriving within YTD 75% 86.23%

8minutes – Red 1

Category A calls resulting in an emergency response arriving within CCG YTD Feb-16 75% 78.16% 8minutes – Red 2 Ambulance Category A calls resulting in an ambulance arriving at the scene YTD 95% 99.08% within 19 minutes Patients should be admitted, transferred or discharged within SWBHT YTD Mar-16 95% 92.54%

A&E 4hours of their arrival at an A&E department % Patients seen within two weeks for an urgent GP referral for QTR 93% 93.59% suspected cancer % of patients seen within 2 weeks for an urgent referral for breast QTR 93% 94.77% symptoms Maximum one month (31-day) wait from diagnosis to first definitive QTR 96% 98.48% treatment for all cancers Maximum 31-day wait for subsequent treatment where that QTR 94% 98.31% treatment is surgery Maximum 31-day wait for subsequent treatment where that CCG Q3 QTR 98% 100.00% treatment is an anti-cancer drug

Cancer Waits Cancer regime Maximum 31-day wait for subsequent treatment where the QTR 94% 99.31% treatment is a course of radiotherapy Maximum two month (62-day) wait from urgent GP referral to first QTR 85% 85.16% definitive treatment for cancer

Maximum 62-day wait from referral from an NHS screening service to first QTR 90% 95.24% definitive treatment for all cancers

Maximum 62-day wait for first No definitive treatment following a QTR national 88.31% consultant's decision to upgrade the target priority Referral to Treatment - Patients on incomplete pathways waiting no MTH 92% 92.07%

more than 18 weeks from referral CCG Feb-16 RTT Referral to Treatment - No of Incomplete Pathways Waiting >52 MTH 0 5 weeks % of patients waiting 6 weeks or CCG YTD Feb-16 1% 0.68%

Diag more for a diagnosic test

HCAI measure (MRSA) 0 5 CCG YTD Mar-16

HCAI HCAI measure (Clostridium difficile 112 113 infections) Breaches of same sex CCG YTD Jan-16 0 7

MSA accommodation

All patients who have operations cancelled, on or after the day of admission (including the day of surgery), for non-clinical reasons to be offered another binding date SWBHT QTR Q3 0 0 within 28 days, or the patient’s treatment to be funded at the time

and hospital of the patient’s choice. Cancelled Operations Cancelled Breaches of Standard

Care Programme Approach (CPA):

The proportion of people under adult CCG YTD Q3 95% 97.38% MH mental illness specialities on CPA

Key:

CCG - Sandwell & West Birmingham CCG SWBHT - Sandwell & West Birmingham Hospitals NHS Trust YTD - Year to Date QTR - Quarter MTH - Month

Managing performance

Mixed sex accommodation Up to the end of March 2016, seven of our patients experienced mixed sex accommodation breaches. This was across all the local hospitals that serve our population. Two of these were at Sandwell and West Birmingham Hospitals NHS Trust, both in August. Each mixed sex accommodation breach is the subject of an exception report through Clinical Quality Review Group as part of the contract process where no trends to this have been identified.

Cancelled operations At the end of quarter three (December) Sandwell and West Birmingham Hospitals NHS Trust reported 116 cancelled operations for non-clinical reasons. All patients met the standard of

18 being offered another binding date within 28 days. We are working with the hospital trust to ensure that patients are inconvenienced as little as possible, and that safe care is provided.

Referral to treatment Patients have the right to expect to wait no longer than 18 weeks from their GP referral to treatment on Incomplete pathways, when clinically appropriate. At the end of February we were meeting the 92% target with 92.07%.

A&E Performance We have a remedial action plan in place with our main acute provider which reports to the System Resilience Group and the Urgent Care Programme Board with representatives from health and social care. Weekly performance calls at Chief Executive / Accountable Officer level look at resolving operational issues more immediately whilst the medium and long term actions are completed.

52 week waits for operations At the end of February, five patients had to wait over 52 weeks for their operation. This has increased on last year when zero patients waited over 52 weeks for the same period. In order to address this issue and learn lessons moving forward, we undertake a root cause analysis report for each individual case.

Cancer referral to treatment There are a number of targets within the NHS Constitution relating to cancer treatment:

 Two week wait for an urgent appointment: For all cancers at the end of Quarter 3 (Dec), we are exceeding the 93% national target with 93.59% and 94.77% for breast symptoms  31 day cancer diagnosis to treatment: Patients have the right to expect their first treatment within one month of diagnosis. At the end of Quarter 3 we are exceeding the 96% national target with 98.48%  62 day wait from urgent referral to treatment: Improvements have been seen in this category and year to date at the end of Quarter 3 we are currently achieving the 85% national target with 85.16%  Sandwell and West Birmingham CCG established a Cancer Steering Group in December, 2015 to enable them to develop and deliver Cancer services and hit, if not exceed, national targets.

Outcomes measures Improving outcomes and securing high quality care is the primary purpose of the NHS in England. The CCG has set baseline plans for five key measures to help us improve outcomes for our communities.

Secure additional years of life – Potential years of life lost (PYLL) from causes considered amenable to healthcare:

2012 (Baseline year) 2014 During the first two years of monitoring against the 2599 2950.5 new baseline, whilst there has been a reduction we were not able to achieve the planned reduction.

Increase the quality of life for people with long term conditions – health related quality of life score for people with long term conditions:

2012/13 (Baseline 2014/15 Unfortunately, following an improvement in 13/14, the year) health related quality of life score for 14/15 has

69.5 68.5 worsened.

Reduce the amount of time people unnecessarily spend in hospital – Composite of all avoidable emergency admissions:

2012/13 (Baseline 2014/15 Unfortunately, avoidable admissions increased in the year) figures published for 2014/15. 2812 3012.5

Reduce the number of people reporting very bad care in hospitals – Patient experience of hospital care – average number of negative responses per 100 patients:

2012 (Baseline year) 2014 The average number of negative responses has 125.3 117.6 reduced further in 2014.

Reduce the number of people reporting very bad primary care (GP, out of hours and dentistry) – Patient experience of primary care – average number of negative responses per 100 patients:

2012/13 (Baseline 2014/15 Following a reduction in 13/14 unfortunately the year) average number of negative responses increased in 9.9 10.6 14/15.

What we’ve done

Improving services for patients

During 2015-16 our staff and clinical leads have worked together to improve services for our patients. We have been working across health and social care from birth right through to end of life care.

To enable us to improve services, we made significant investment into the health and social care system on a range of initiatives including:

 Funding more dementia nurses  Improving access to psychological therapies  Improving mental health and eating disorder service provision  Developing the Primary Care Commissioning Framework  Supporting 7 day access to continuing healthcare  Supporting weekend opening in general practice  Increasing tuberculosis testing.

You will hear about many of these improvements throughout this report.

Maternity services

The NHS Five Year Forward View sets out plans for a major national review of the commissioning of maternity services, assessing current provision, and considering how services should develop to meet the changing needs of women and babies, by:

 Reviewing the UK and international evidence and making recommendations on safe and efficient models of maternity services, including midwife-led units  Seeking to ensure that the NHS supports and enables women to make safe and appropriate choices of maternity care for them and their babies  Supporting NHS staff, including midwives, to provide responsive care.

The review reflects upon significant improvements in the quality and outcomes of maternity services and also upon the increasing complexity of cases. It recognises that despite the progress made there is still a great deal of scope for improvement. It also finds meaningful differences across the country, and further opportunities to improve the safety of care and reduce stillbirths.

The review makes recommendations in seven key areas:

 Personalised care  Continuity of carer  Better postnatal and perinatal mental health care  A fairer and more precise payment system  Safer care  Multi-professional working  Working across boundaries.

Locally we have established a clinically-led working group and are working with our partners to develop plans to respond to the recently published recommendations, delivering the required improvements in services and patient experience.

Mental health

Mental health has been a priority for us in 2015-16. We have been working on a number of initiatives to improve care, particularly in times of crisis.

One such initiative has been as a proud partner in the Mental Health Crisis Concordat for Birmingham, Sandwell and Solihull. This Concordat brings together the multiple-agencies (including the Police, probation service and local authorities) that support a patient’s mental health needs when they are in crisis, outlining their roles and responsibilities.

Another partnership we have working in over the past year is as part of Forward Thinking Birmingham. Forward Thinking Birmingham was appointed following a consultation and procurement exercise during 2014-15. During which the CCGs across Birmingham appointed Forward Thinking Birmingham to provide the new community mental health services for children and young adults aged up to 25. They officially launched in October 2015.

This partnership is led by Birmingham Children’s Hospital NHS Foundation Trust, which is working with Worcestershire Health and Care NHS Trust, Priory Health Care, Beacon UK and The Children’s Society. It offers a completely new way of providing mental health services and has proposed some creative solutions to make services accessible for young people.

We need to identify mental health issues as early as possible to ensure the best outcomes for our children and young adults. We’re proud that we’ve worked with patients to launch a groundbreaking new community mental health service, which will:

 Reduce the stigma that still surrounds mental health  Be easy for children and young adults to use  Support them as they get older  Enable them to be healthy  Support them to live full and independent lives.

A phased approach was introduced as the service gradually took on full responsibility for 0- 25 mental health services in Birmingham. For more information on the new service visit their website at https://forwardthinkingbirmingham.org.uk/.

We’re also really pleased with the progress of the mental health crisis car. This winter we continued to commission the service.

Working in partnership with the Police and other CCGs in the Black Country area we commissioned the car to respond to 999 calls. The car includes a joint team of a paramedic, police officer and community psychiatric nurse, who can undertake a mental health assessment, giving advice and signposting as needed. It’s been a real success so far, with prompt responses and positive feedback. Importantly, we are helping to support patients in real need to get the right care, rather than being taken to A&E or spending a night in custody. It also saves time and resource which can be better spent elsewhere.

Improving access to psychological therapies (IAPT)

Over the past 12 months our clinical leads for mental health, Dr Arun Saini and Dr Liz England, have been working with partners to improve access to psychological therapies and we’re starting to see some positive results.

Earlier this year we worked with the other CCGs across Birmingham to introduce additional capacity by commissioning two providers. We hope this will support more patients to access services and seek help early on.

Although the additional capacity has been focused on the Birmingham side, we are looking at what support is needed in Sandwell too.

This is only one part of a wider medium-term plan, which is currently in development, to provide access to coherent primary care and community support – linking available services to ensure people receive help when, and where, they need it.

We adhere to the following IAPT targets:

 IAPT roll out: Number of people who receive psychological therapies (entering treatment) – 15% of prevalence rate  IAPT recovery rate: 50% for people who receive psychological therapies.

Child and Adolescent Mental Health Services (CAMHS)

We have been working with our partners to develop plans to transform mental health services for local children and young people which will improve prevention and early intervention activity.

We have engaged with children and young people, submitted a local plan that was fully assured by NHS England and established a local CAMHS Transformation Board, involving the local authority, schools, educational psychology and NHS England.

Our main areas of focus are on eating disorder services, re-designing crisis assessment and home treatment, establishing a place of safety facility, and additional investment into emotional wellbeing services. This will be led by the local authority and improved data management and sharing across the system.

We face a number of challenges but remain fully committed to improving emotional health and wellbeing for all children and young people whilst seeking to identify and remove any barriers. We will continue to strengthen relationships with all stakeholders and we intend to identify and close gaps in services.

£1m funding to support local people with learning disabilities

We’re also excited to be part of a group that has been awarded £1 million to improve care for people with learning disabilities.

This is a national scheme led by Technology SME v-connect, and our area has been chosen as a pilot site. The project aims to connect patients with their primary, secondary or social care professionals, as well as family members, through their TV, tablet or mobile device.

We're hoping this will help people with learning disabilities to remain in their community, become more engaged in activities, increase their independence and improve their health and wellbeing.

Throughout 2016-17 we will be working with partners to help deliver this programme in Sandwell and West Birmingham.

Urgent care

The urgent and emergency care programme has been established to oversee the development of a sustainable system-wide approach to supporting patients in the community as an alternative to non-elective hospital admissions and A&E attendances within the Sandwell and West Birmingham health system.

We held a listening exercise in early 2015 and an urgent care provider stakeholder forum in March 2015 and as a result we began to co-design the future urgent and emergency care system. All partners agreed to work collaboratively and a ‘co-design’ event was held in June 2015 to progress system wide plans. The key themes that came out strongly throughout the co-design event were:

 Self-care/ prevention/ education (empowering patients to take greater responsibility, supported by effective communications)  Workforce (scale of challenge and skillset)  Robust IT systems required  Refocusing NHS 111  Hub and spoke model (integrated multi-disciplinary approach between primary care, community services, social care and mental health)  Resources  Commissioning differently.

A number of workstreams have been identified which will support the delivery of an integrated service. Our programme plan and workstreams have undergone an iterative process to ensure that the scope of the work and timing of key projects considers national, regional and local developments.

Our Urgent Care Programme Board is focused on ensuring that the future work plan delivers improved services, with minimum disruption to access. This approach supports the timing of the delivery of key procurements, the introduction of the new Midland Met Hospital and the development of new models of care.

The urgent care programme supports the implementation of the urgent care reconfiguration for Midland Met Hospital and the Sandwell Urgent Care Centre in accordance with system plans under Right Care Right Here.

Our focus is now upon the next phase of the programme to:

 Deliver an integrated NHS 111 and out of hours service that optimises the opportunity to maximise clinical expertise and infrastructure  Sandwell and West Birmingham Hospitals NHS Trust workstream delivery of transition from the two A&E services to the Midland Met A&E and delivery of the Sandwell Urgent Care Centre  Build on improving ‘same day’ access via the Primary Care Commissioning Framework (PCCF)  Extend the current walk-in centre allowing time to embed PCCF changes and the introduction of Midland Met Hospital and Sandwell Urgent Care Centre  Continue to scope the opportunities of delivering improved integrated urgent care services  Support the delivery of the intermediate care strategy and respective work plan  Work with West Midlands Ambulance Service to deliver more ‘see and treat’ pathway  Strengthening of the Urgent Care Patient Advisory Group 24

 Review and refresh the Communication and Engagement Plan.

In July 2015 our Governing Body and Sandwell and West Birmingham Hospitals Trust approved proposals to:

 Locate emergency cardiology services at City Hospital  Locate emergency surgery and trauma assessment services at Sandwell Hospital.

From autumn 2018 these services will be provided at the new Midland Met Hospital, but we didn’t want to wait until this time to deliver better care for patients.

During the listening exercise held earlier in January to March 2015, 64% of patients agreed that change was necessary, but we know that they raised some important concerns around travel times and costs, especially for visitors.

During 2015, Sandwell and West Birmingham Hospitals NHS Trust, and the Right Care Right Here Programme Team worked with the West Midlands Ambulance Service (WMAS), to be assured that patients can continue to be treated in the recommended times. We also provided additional funding to support the ambulance service with the changes.

We’re pleased to announce that the services were successfully transferred, with cardiology services moving in August 2015 and emergency surgery and trauma assessment services moving in November 2015.

Sandwell and West Birmingham Hospitals NHS Trust have been working with patients and clinicians to ensure people were aware of the changes and know where to go for the right care.

We are confident these changes will improve the care that patients receive, with clinicians available to cover 24 hours a day seven days a week, ensuring timely senior decision making and ensuring that patients receive the right treatment within the recommended times.

Infant mortality

In 2015-16 our key equality priority was to tackle infant mortality. We know Sandwell and West Birmingham has one of the highest rates of infant mortality in England, which we are keen to address. The issues that lead to infant mortality are complex and multi-faceted, so a joint response was needed.

Representatives of partner organisations within primary care, voluntary, health and local authority sectors were invited to come together for an Infant Mortality Stakeholder Summit, held on 20 October 2015. Approximately 70 delegates were in attendance from a range of organisations, including midwifery services, perinatal experts, GPs and the voluntary sector.

Following a number of presentations from key speakers, group discussions focused on:

 Identifying the top three challenges in relation to infant mortality  Developing a shared vision of excellence  Exploring barriers and solutions  Considering the conditions for success, how it will be measured and evidenced  Determining how organisations can support each other to work collaboratively.

The feedback received from our stakeholders provided us with invaluable insight that will be used to develop a joint Infant Mortality Strategy during 2016.

Recognising that infant mortality may disproportionately impact diverse communities, in January 2016, we commissioned (Birmingham Race Action Partnership (BRAP) to map rates across our footprint and test out the effectiveness of targeted, evidence-based infant mortality behavior change interventions within the communities most at risk. The mapping will help inform the development of the joint strategy, whilst we will know more about the impact of the behavior change programmes towards the end of 2016.

Supporting new arrivals

During 2015 we have been very busy ensuring that new arrivals to our area know of local primary care services and are able to access them. This will help them to remain healthy or manage minor illnesses without unnecessarily accessing costly secondary care services. We have done this in a number of ways:

Syrian refugees - In 2015, the Prime Minister announced that 20,000 Syrian refugees would be resettled in the UK over the next five years. The first arrivals were drawn from established refugee camps as part of the Vulnerable Persons Relocation (VPR) scheme. More than 50 local authorities agreed to take on their share, with Birmingham originally accepting nine refugees before Christmas.

We supported the refugees to become registered with local GP practices, giving them full access to all forms of primary and secondary care. The GPs were fully briefed about the families or individuals they were seeing. We ensured a first appointment was booked before arrival to assess their current condition and establish any healthcare needs.

The same process was followed in January when 15 more Syrian refugees arrived. The experience required us to work quickly and sensitively with different agencies, including local authorities, Red Cross, the police and housing organisations. We are pleased to have supported a smooth transition to the local area and will continue to liaise with these agencies over care for current refugees and any future arrivals.

Education and awareness – We commissioned Rights and Equality Sandwell to develop our Peer Health Champion Scheme for voluntary sector organisations and community groups. Participants will cascade key health messages to vulnerable and at risk community groups, using appropriate language and formats. This will include messages to new arrivals as well as existing populations.

The scheme will provide the many voluntary and community sector organisations that support vulnerable groups with access to bespoke training, giving them the confidence and skills to share health information. The voluntary sector tells us that people are more responsive to messages from those in positions of trust, and hope that together we can address the myths and misinformation that lead to people making poor health choices.

In 2015 we focused on the Flu and Choose Well campaigns. In 2016 we will focus on antibiotic resistance, self-care, healthy pregnancy, how the NHS/primary care operates, mental wellbeing and resilience.

Asylum seeker health service provision – In 2015, we also took on responsibility for commissioning health services for asylum seekers being processed through the Initial Accommodation Hostel Service covering the whole of the Midlands region.

Using the knowledge and skills our commissioners and GPs have acquired, following our investment in the migrant health agenda, we were able to quickly develop a new and more responsive service for asylum seekers. We know that if we can start to educate new arrivals about the health service at the earliest opportunity, we can help them to access the right services for their needs.

The new services commissioned at short notice included extending an existing health screening service provided by Virgin Assura, arranging for a new medicines management scheme to be run from a 100 hour pharmacy near the Stone Road Centre, and engaging with the voluntary sector to provide support for expectant mothers and young families, as well as individuals suffering mental distress.

On 18 January 2016, our new Atwood Green Health Unit opened. The service allows patients who may speak little or no English to receive care on site rather than travelling around an unfamiliar city, accessing ambulance or A&E services.

This is an example of how our staff and partners have identified a need within our local community and responded quickly and decisively to develop a bespoke service, which is helping to support some of our most vulnerable people, and ensure they receive the right treatment at the right time.

Commissioning new services

Direct access to non-obstetric ultrasound

One of our big priorities this year was procuring direct access to the non-obstetric ultrasound service. On 1 October 2015 Health Harmonie took on the contract.

The new service is being provided across a range of local centres, to help reduce the need for patients to go to hospital. We have also been working with Health Harmonie to ensure that images follow the patient and there is no unnecessary duplication of investigation. Improving patient experience is at the heart of all this work.

End of life care

Over the past two years we have been working with patients and carers to review our end of life care services. Following a competitive procurement exercise in 2015, we’re pleased to announce that we awarded a contract for a new, innovative end of life service to Sandwell and West Birmingham Hospitals NHS Trust. They will be taking on the new service from 1 April 2016 with a staggered approach to new elements that have not traditionally existed in our area before.

As the main contract provider, the hospital trust will be working with local voluntary organisations to deliver a range of support packages for patients. The support they offer will include:

 A co-ordination hub, which can bring together the different services a patient might need to support them to die at home  An Urgent Response Team specifically trained to support patients at the end of their life, to avoid a crisis admission to hospital  A holistic end of life support structure to include hospice, day hospice, home from home beds, a sitting service, bereavement support etc.

We have been working towards this for a number of years, and hope it will improve the quality of care patients can expect towards the end of their lives. It should give patients greater choice over where they die; with more support to do so at home rather than in hospital.

Minor Eye Conditions Service

A new service called MECS (Minor Eye Conditions Service) was launched on 1 March, 2016. We hope this means local patients will be able to benefit from increased access to urgent eye care appointments.

Primary Eyecare Heart of West Midlands Ltd will be providing the service, following a procurement exercise carried out in 2015. Patients will be able to access urgent advice and support from some local opticians, rather than having to visit their GP or A&E.

The trained opticians will be able to assess your condition and help advise on the best treatment. This should reduce pressures on GP and A&E services.

Developing primary care

On 1 April 2015 we took on delegated commissioning responsibility for general practices from NHS England. This followed engagement with our member practices, where over 70% of them voted for us to take on full responsibility.

Primary care is often the first point of contact for a patient. If we can improve services for patients, we can support more people to stay healthy and reduce demand for other parts of the system.

We established a Primary Care Co-commissioning Committee to manage any conflicts of interest as a GP member organisation. A national directive has mandated that it is not clinically led, so this is chaired by Ranjit Sondhi, Vice Chair of the CCG. Ranjit is supported by our other lay members and key partners, including Healthwatch and Local Medical Committee representation.

As part of this work to support our member practices, we introduced five Primary Care Development Managers, who are aligned to our 99 member practices. They work closely with practice managers and clinical leads to improve quality within practices, support member engagement and identify opportunities to share best practice across the CCG.

We have committed £20 million of new money into primary care spread over three years – 2014-2017. This is part of the wider Right Care Right Here programme, developing quality, sustainable primary care fit for the future

Primary Care Commissioning Framework

Listening to patients’ and clinicians’ feedback, we know that supporting primary care is a major priority for us. We are investing significantly to help improve and support GP services.

This is a real opportunity to further develop primary care, offer our patients an enhanced service and reduce variation in services across the 99 practices we commission.

During 2015-16 staff and clinicians worked together to develop new standards and services for primary care, called the Primary Care Commissioning Framework. The Framework brings together a set of standards that build on the core GP contract that is set nationally. We’re really pleased that 97% of our practices have signed up to deliver the framework from 1 April 2016.

The framework aims to support:

The standards we are introducing include:

 Improving access to general practice for our patients  Supporting information to carers  Encouraging uptake of vaccines

 Efficient medicines prescribing  Helping patients stay healthy for longer, with signposting to appropriate support and advice  Improving access, including exploring new technology for appointments  Working collaboratively with other services including community nursing teams and social care.

Practices have been working on these areas in early 2016 and we hope patients should start to see the improvements during 2016-17.

Delegated functions (primary care commissioning)

Since taking on responsibility for commissioning (buying) GP services from April 2015, we’ve aimed to:

 Improve primary care quality (equity of services, access and training)  Better support our members  Enable members to have leadership and influence over investment in primary care  Enable members to help design and influence Quality and Outcomes and primary care frameworks  Commission integrated primary, secondary and community care – realising the Right Care Right Here vision.

Across the CCG we commission 99 General Medical Services contracts, but cover more than 99 practices as many have branch surgeries. As part of the delegation agreement, we have set up a new governance model which was nationally mandated by NHS England.

We have established a Primary Care Co-Commissioning Committee, whose first meeting was held in public on 3 April 2015. The committee is heavily lay member led and contains six independent members, including the Chair and Vice Chair. In order to manage conflicts of interest, there is only one voting GP on the committee. Other representatives come from the following organisations:

 Health and Wellbeing Boards in Sandwell and Birmingham  Healthwatch in Sandwell and Birmingham  Local Medical Committees in Sandwell and Birmingham  NHS England.

The committee meets monthly and has made a number of significant decisions in relation to the delegated function of commissioning primary care. Over the last 12 months it has put into place a number of policies and procedures to assist the organisation in decision making and enable the smooth running of services for our patients.

Conflicts of interest are robustly managed and documented. The committee actively manages the risk and issues register in line with our embedded governance process.

Weekend opening

Patients have told us that they want improved access to GP appointments. One of the ways we are doing this is by supporting practices to open at weekends. This will involve an investment of £1.9 million. We’re working with practices to explore how weekend working can offer a better deal for patients.

The scheme is flexible and practices are able to look at the needs of their patients and identify if opening on a Saturday or Sunday, or both will benefit patients. We know that some of our smaller practices cannot deliver this alone, so we are encouraging practices to think about working in partnerships.

As of February 2016 over 50% of our practices, covering more than 330,000 patients, have signed up to deliver weekend appointments, offering over 900 extra per weekend.

Community Education Provider Network

We know that two of the biggest challenges facing the NHS, at a local and national level, are capacity and skills within the primary care workforce. During 2015-16 we reviewed our workforce capability and identified opportunities to improve care.

We have secured national funding to help support us in developing the primary care workforce. At our Annual General Meeting in September, we were formally announced as one of five excellence centres. The National Skills Academy has made £1.9m available over three years, to support us to develop healthcare training. This funding will help us to better connect with local education providers to commission targeted training for primary care, in particular for Agenda for Change Bands 1-4. By involving the local community, we also hope to encourage more people to have a career in the NHS.

In addition, our Primary Care Development Team has also been successful in securing resources from Health Education West Midlands to become a Community Education Provider Network. This means we will receive £150,000 funding over three years.

This funding will help us to employ a co-ordinator, with a clinical background, to work with around 294 practices from across Birmingham and the Black Country as part of the National Skills Academy to identify potential educational placements focused mainly on nursing but potentially broadening out to other areas such as apprenticeships.

This is a fantastic opportunity for us to invest in local healthcare training and ultimately improve care for patients.

National Skills Academy workforce analysis

In April and May 2015, the Primary Care Co-Commissioning Committee agreed to support our application. We were successful in our bid, becoming one of five excellence centres across the country, and the only CCG to be awarded this status.

As part of this three year pilot we have developed a regional membership group to ensure a governance framework. We have been working in collaboration with the following organisations, who have all agreed to be part of the regional group, covering a population of approximately 1.2 million people:

 Birmingham South Central CCG  Birmingham Cross City CCG  Dudley CCG  GP provider/federations  BIG – Birmingham GP Provider Organisation Cross City  Our Health Partnership Birmingham Cross City  Dudley Future Proof for Health LTD, Dudley CCG  South Doc services  Badger GP provider services

 Eastern Birmingham GP Provider Company  Modality GP Super-partnership.

Coming together to cover such a large population enables us to assess the needs and skills of the entire primary care workforce. The first two years will be focused solely on general practice with a workforce and skills gap analysis undertaken early in 2016. This will enable us to identify what gaps we will have in the next five to ten years and develop educational programmes to help address them.

We intend to work with our communities to focus on developing three distinct groups;

 Young people aged 16 to 24 who want to develop their career in primary care  The current primary care workforce who want to develop their skills or where there is a skill gap  People who are long-term out of work and looking to return.

Our work will take three years to complete, with on-going evaluation.

Primary care strategy

Primary care services are the foundation of the local health system. Over 90% of all patient contact with the health service happens in primary care, with general practitioners (GPs) being the key gatekeepers to hospital and other specialist healthcare services. We recognise that to deliver a sustainable health and social care system, we must have a strong primary care service. In particular, we know we need to develop primary care services that are:

 Stable  High quality  Accessible  Focused on prevention – helping patients to stay healthy for longer.

As a clinically-led membership organisation, we are uniquely placed to deliver improvements in primary care. Our strategy aims to build on this.

We have developed ten priorities for primary care, which are based on:

 What patients, carers and our local communities have told us about their current primary care experiences and what they want to see changed now and in the future  What member practices have told us about their key concerns and how these should be addressed now and in the future  Our wider strategic aims and priorities  National best practice and guidance.

Our vision for local general practice in 2020:

 Accessible, high-quality, comprehensive healthcare services available to all  An excellent care experience for patients, carers and families  Patients and carers participating as partners in their care, empowered to make informed decisions  An expanded, skilled, resilient and adaptable general practice workforce  Community-based premises for delivering care, teaching, training and research that are fit for the future and are conducive to better health and wellbeing  Less fragmentation of care through co-ordination and collaboration across boundaries, supported by joint commissioning arrangements 32

 Reduced health inequalities and increased community self-sufficiency  Greater use of information and technology to improve wellbeing, health and care  Improved understanding and management of inappropriate variations in quality  More community-led research, development and quality improvement.

NHS 111 contract

It’s been another successful year for the West Midlands NHS 111 telephone advisory and support service, for which we’re the lead commissioner. The service saw large call volume increases of 29% compared to last year. Despite the growth in demand, the service remains steady. The national target of less than 5% of calls abandoned after 30 seconds was achieved every month since September 2015. On average, 1% of calls were abandoned after 30 seconds, 96% of calls were answered within 60 seconds and 16% of calls were called back. Of all triaged calls in 2015, 9% were referred to 999 and 7% were recommended to attend an emergency department.

The CCG contracts in the West Midlands region for the provision of NHS 111, GP Led OOH services and other associated urgent care services are coming to an end. This is a good opportunity, and one that we are taking, to align the integration of these services for the benefit of the patient. We are running a competitive process to procure a high quality Integrated Urgent Care Service and the award of the contract will be announced in autumn 2016.

Ultimately, this re-procurement aims to drive more efficient and effective use of specialist NHS resources to provide patients with the right care, at the right time. This will mean a seamless approach to urgent health care services in the Midlands. The new service will offer patients improved access to a 24/7 urgent clinical assessment and an advice and treatment service – bringing together NHS 111, GP out of hours and clinical advice.

West Midlands Ambulance Service contract

Sandwell & West Birmingham CCG is the host commissioner of the contract with WMAS on behalf of the 22 West Midlands CCGs. 2015-16 out turned with exceptional performance seeing WMAS being the only ambulance provider to meet the three national Ambulance Service KPIs. This is an exceptional achievement of which we should all be proud.

The service has witnessed an increase in activity, however this was in line with commissioned levels of activity. This is indeed another success factor compared to previous years where significant levels of over performance have been witnessed.

However across health economies there has been times of significant demand and pressure in the system for urgent care ambulances, which as commissioners we have been keen to understand and manage across such economies. This will be key component of local SRGs in 2016-17

2015 - 16 has provided an excellent baseline year for developing the Paramedic Pathfinder approach to improved management of patients in the community setting, avoiding unnecessary conveyance to hospital. This together with other major transformational opportunities being persued e.g. the Electronic Patient Record (EPR) and the Paramedic at Home workstream within the Urgent & Emergency Care Review, are exciting prospects for 2016-17.

S&WB CCG has and will continue to support the national programmes of work in the areas of improving ambulance services to become part of the solution to urgent and mobile patient care.

Planning: looking ahead 2016-2025

During spring 2016 we started looking ahead to the future and establishing our commissioning priorities.

On 21 January we held our annual commissioning intentions stakeholder event. It was fantastic to see so many partners, patients and clinicians there.

It was an opportunity for us to reflect on how we performed against our 2014-16 priorities and plan for the year ahead. We heard what matters most to local people, as we continue to shape the services you want to see.

Several key themes emerged from the event, including the need to work closely with the voluntary sector, support carers and develop primary care. It was good to know that we are heading in the right direction but there is always more to be done.

We are now reviewing everyone’s feedback as we develop our Operational Plan for 2016- 17, which will be submitted to NHS England in April 2016.

Operational Plan 2016-17

Our Operational Plan outlines where we will focus our efforts and resources during the next financial year, to deliver better care for patients and increase efficiency.

There are a number of national targets for CCGs to meet, as well as local opportunities for us to make a difference:

 Reduce excess deaths by increasing the level of consultant cover in hospitals at weekends  Improve access to out of hours care by integrating and redesigning NHS 111, urgent care centres and GP out of hours  Improve access to primary care at weekends and in the evenings  Return the system to “aggregate financial balance”  Address the sustainability and quality of general practice  Achieve access standards for A&E and ambulance waits  Achieve referral to treatment targets, with patients waiting no more than 18 weeks  Deliver the NHS Constitution cancer waiting standards  Achieve the two new mental health access standards  Meet the dementia diagnosis rate of at least two thirds of the estimated number of people with dementia  Transfer care for local people with learning disabilities  Improve quality, especially for organisations in special measures.

While we still need to deliver the day job, which is commissioning quality care for patients, these areas are the ones where we think we can make the biggest difference during 2016- 17.

Five Year Sustainability and Transformation Plan

In December 2015 NHS England set out its planning guidance for CCGs, which requires us to produce a five year strategy - intended to be an “ambitious local blueprint for accelerating the Five Year Forward View”.

Importantly, this is to be delivered on a bigger footprint, with CCGs expected to collaborate. We will be working with CCGs, providers and local authorities in the Black Country area to develop a joint five year strategy, which will also be closely aligned to the one for Birmingham and Solihull.

New models of care

The national Five Year Forward View was published in October 2014, setting out a shared vision for the future of the NHS. Developing new models of care for patients is central to that vision. The aim is to reduce barriers between different NHS and social care services, including primary and secondary care.

Across the country GP federations and provider organisations are taking part in pilots to test these new models of care. Locally, we are supporting two such vanguards:

 Mental health: Mental Health Alliance for Excellence, Resilience, Innovation and Training (MERIT)  Primary care: Modality Partnership

The Modality Partnership of GP practices in Sandwell and Birmingham has been recognised as a multispecialty community provider. Together with Digital Life Sciences they are piloting a new way of using digital technology to improve healthcare, with greater access to GPs through instant messaging and Skype. We will continue to explore innovative approaches like these in order to best meet patient demand.

As a CCG we are supporting the development of these vanguards, to ensure learning can be shared amongst emerging models and providers.

Sustainable development

In order to embed sustainability within our business it is important to explain where sustainability features in our processes and procedures. We consider the key areas of impact to be:

• Estates • Travel • Procurement (environmental and social impact of decisions) • Suppliers’ impact.

One of the ways in which an organisation can embed sustainability is through the use of a Sustainable Development Management Plan (SDMP).

Climate change brings new challenges to our business not only in direct effects to the healthcare estates, but also to patient health. Examples in recent years include the effects of heat waves, extreme temperatures and prolonged periods of cold, floods, droughts etc. The organisation has identified the need for the development of a board approved plan for future climate change risks affecting our area.

Under our Right Care Right Here programme we are committed to bringing care closer to home, which will have a positive impact on the environment with the potential for reduced travelling for patients. A number of other initiatives are also based on a local footprint, including the Healthy Communities and Community Offer pilots, which will support the local economy and environment. See the partnerships section to find out more on these schemes.

Estates

Since the 2007 baseline year, the NHS has undergone a significant restructuring process and one which is still on-going. As a part of the NHS, it is our duty to contribute towards the goal set in 2009 of reducing the carbon footprint of the NHS by 10% (from a 2007 baseline) by 2015.

2015/16 was the third operational year of the CCG. Following the recent NHS reorganisation, CCGs are not responsible for the direct management of the estates that they occupy; this responsibility transferred to NHS Property Services and NHS Community Health Partnerships.

We occupy two main premises: Kingston House in West Bromwich is the main headquarters, with some space also being occupied at the Lyng Centre, also in West Bromwich. Both of these properties are managed by NHS Property Services, and we are charged for this. NHS Property Services is unable to provide data in respect of our carbon usage for 2015/16.

However, it is their intention to make this available for future years, which will enable our performance against the planned reduction of 10% noted above to be measured.

Travel

Our staff give consideration to the requirement to travel as part of their job requirements, avoiding the need wherever possible. The use of information technology to support this in the form of voice conferencing is encouraged, and the potential for other technologies is considered. Where travel is necessary, staff make use of public transport where practicable and car sharing wherever possible.

Procurement and suppliers’ impact

As part of the procurement process, the sustainability of potential suppliers is considered by seeking information on their approach to environmental and social issues. Where contracts are awarded, the NHS Standard Contract is used. This contract requires the providers of services to take all reasonable steps to minimise any adverse environmental impacts and to demonstrate progress against the NHS carbon reduction strategy, climate change adaptation, mitigation and sustainable development. We are also committed to working with providers to ensure the minimum wage is adhered to.

Patient and public involvement and consultation

It’s been another busy year for our communications and engagement team, who have continued to strengthen the patient and partnership voice throughout the organisation. There are many ways in which we already involve patients, carers and wider stakeholders in our work, but we know there is still more we can do.

A key objective for 2015-16 was to increase patient and public engagement across the CCG, using a wide range of approaches. We were keen to build on existing good practice, while developing new ways of working, to ensure the patient voice is at the heart of all that we do: from the recruitment of our workforce, to being the driving force behind service change.

Patient and Partnership Engagement model (PPE)

We are extremely proud of our PPE model, which continues to embed the patient and partnership voice throughout our governance structures and the service redesign process.

Our Patient and Partnership Advisory Group

Name Role Ranjit Sondhi Co-Chair, SWBCCG, and lead for Public Involvement and Consultation (Chair of the group) Richard Nugent Indepent Co-Member and Vice Chair, SWBCCG Pam Jones Black Country LCG Patient Representative Trevor Fossey Black Country LCG Patient Representative Chris Vaughan ICoF LCG Patient Representative Alison Hortin HealthWorks Patient Representative Zulfigar Khan HealthWorks Patient Representative Vacant position ICoF LCG Patient Representative Awtar Ghataora Pioneers for Health Patient Representative Inderjeet Kaur Phull Pioneers for Health Patient Representative Deska Howe Sandwell Health Alliance Patient Representative Graham Price Sandwell Health Alliance Patient Representative John Clothier Sandwell Healthwatch Representative Vacant position Birmingham Healthwatch Representative Leona Bird Sandwell Council of Voluntary Organisations Tracey O’Brien Birmingham Voluntary Services Council Geoff Foster Voluntary and Community Sector Health and Social Care Forum (Sandwell) Vacant position Voluntary and Community Sector Health and Social Care Forum (Birmingham)

All members of our Patient and Partnership Advisory Group (PPAG) have worked hard to ensure that we have robust processes and plans in place for public involvement and consultation. All Patient Members are appointed through a selection process. During this year we have recruited new members to the group and are currently working with our HR and organisational development specialist to create a PPAG Development Plan – ensuring that we continue to invest in and value its contribution.

Primary care

Between 1 September and 16 October 2015 we ran a listening exercise with patients, the public, member practices and our wider stakeholders, who were invited to complete our survey (either online or in paper form) and speak to us at local community network meetings.

We wanted to hear feedback on GP services in Sandwell and West Birmingham, both what works well and what could be improved. The insight that we gained is helping us to build a better service for the future.

Urgent and emergency care

During February and March 2015 we sought feedback on urgent and emergency care services. As part of this listening exercise, we held an urgent care stakeholder forum on 25 March, where members expressed a desire to work with providers in the co-design and co- production of the new urgent and emergency care system.

Two further events were held, on 22 April and 30 June respectively, to explore how a collaborative approach could lead to more effective and sustainable outcomes. Senior stakeholders from partner organisations, patients and representatives from the voluntary and community sector took part.

Integrated urgent care

In September 2015 a set of commissioning standards for integrated urgent care (IUC) were released by NHS England. They brought together lessons learned from the national NHS 111 pilots and introduced the concept of integrated urgent care, which incorporates services such as NHS 111, out of hours services and a clinical hub model.

A local design and delivery group has been established to provide guidance on the service specification and procurement process. Led by the engagement team, a detailed public and patient engagement plan was developed, which identified the following themes:

 Patients and carers have a good experience of the signposting element of NHS 111  Patients and carers appreciate the NHS 111 service getting health appointments on their behalf  A slow and variable ring back response from clinical staff at NHS 111  Too many scripted and repetitive questions by NHS 111 call handlers  Lack of empathy by call handlers  Lack of interpreting support  Some confusion and lack of awareness (particularly amongst people for whom English isn’t a first language) of what NHS 111 does.

This feedback has been passed to the regional team who are developing the core service specifications for NHS 111 and out of hours. They have been requested to ensure that these themes are addressed through the specification and those who have contributed will hear back from the engagement team.

Non-emergency patient transport (NEPT)

Together with three neighbouring CCGs – Birmingham South Central, Birmingham CrossCity, and Solihull – we asked the public what they want to see from non-emergency patient transport (NEPT) services in the West Midlands.

NEPT helps eligible patients, who are unable to travel by private or public transport, get to routine hospital appointments, and be transferred between health services or return to their home address. It aims to provide free transport which is safe, timely and comfortable, and may involve an escort or carer travelling with the patient if necessary.

There are currently different standards of service in place at each of the region’s six NHS trusts, but these contracts will soon be coming to an end. So from May to August 2015 we asked the public about NEPT in Birmingham, Solihull and Sandwell, so that their views could help us develop a high quality and universal service.

We invited responses via a questionnaire, which was made available at a series of events, public meetings and drop-in sessions across various hospital sites. Overall, we held 70 engagement events with our stakeholders and the general public and received 509 responses to our survey. Since the formal consultation ended we have been analysing the feedback we received and acting on it.

Informed by your views the procurement process for a new NEPT service – which will replace existing ones at six NHS trusts from 2017 – is now underway. A new Eligibility Criteria Policy and Patient Charter is also being rolled out this year and will be fully implemented in 2017.

Palliative care for children and young people

We’re also working with Birmingham South Central and Birmingham CrossCity CCGs to look at improving care for children and young people with palliative needs. Services are currently inconsistent and don’t meet national guidelines in all areas.

Our vision is for all patients and their carers to have access to high quality, consistent end- of-life care, with accurate identification and proactive management of all of their palliative needs: physical, social, psychological, spiritual and cultural.

These recommendations were published in Your Journey, Your Care leaflets, with different versions made available for adults and young people. This was followed by a survey asking whether the public agreed with our proposals for change and to let us know what was important to them about end-of-life care.

Surveys could be completed online or in paper form and the Birmingham-wide listening exercise, which was promoted by all three CCGs, closed in February. A separate listening exercise for Sandwell was held in April.

Looking forward

We have some challenging and exciting work ahead of us this year, which will focus on the following priorities:

 End of life care – including formal consultation around day hospice provision

 The development of a CCG member practice scheme  Co-designing a Corporate Social Responsibility Strategy with our partners in the voluntary and community sector  Improving the health outcomes of homeless people  The development of a ‘Patients in Control’ scheme.

Equality Awards 2016

On 25 February we held our second Equality Awards ceremony. This event celebrates the work of local organisations and people who deliver quality care to vulnerable groups and communities. In keeping with our Equality priority, this year we had a specific award to recognise those that help to reduce the infant mortality risk to mothers and babies.

We also introduced a new People’s Choice Award for 2016, the winner of which was chosen solely by the public and patients. We had a fantastic response, with over 1,500 votes received.

The ceremony was hosted by Sameena Ali Khan, a local ITV news reader who is passionate about the NHS and equality agenda. The event was a great success, allowing everyone to celebrate our collective achievements, network with partners and consider new innovations to ensure equality remains a priority for all.

To see the finalists and winners visit our website at www.sandwellandwestbhamccg.nhs.uk.

Get involved

We launched our ‘Get Involved Membership’ last year and are delighted with how many individual and partner organisations have registered with us so far. This is a free membership, which anyone can join, in order to:

 Share your experiences of local healthcare services  Find out about our work and the latest events and activities  Get involved in service change.

It is a great way to find out what’s happening in your local area. Members receive regular updates on different areas of our work, including how to get involved in listening exercises or formal consultations.

To become a member email us at [email protected] or phone a member of the team on 0121 612 1447.

Working with our partners

Health and Wellbeing Boards

The CCG is an active member of both Birmingham and Sandwell Health and Wellbeing Boards, GP Directors play key roles in determining the Boards priorities and ensuring resources are mobilised to help achieve those priorities.

The focus during 2015/16 was:

Birmingham Health and Wellbeing Board Sandwell Health and Wellbeing Board

 Better Care Fund  Better Care Fund  integrated/coordinated services that are Establishing the following priorities resilient and sustainable, focusing on  helping people stay healthier for longer collective action the effectiveness and  helping people stay safe and support coordination of the system communities  maximising the independence of adults  supporting Right Care Right Here  improving outcomes for children and  working together to join up services families  working closely with local people, partners and providers of services

In 2015/16, we worked in partnership with Local Authorities to;

 Developed the health and Wellbeing Strategies  Scope and develop plans to deliver integrated approaches to address system wide issues Developed and implemented the Better Care Fund plans.

Better Care Fund

Our vision for better care throughout the local economy is based on our engagement with local citizens. They have told us that we should focus on:

 Prevention: helping to prevent people becoming ill or dependent.  Rehabilitation: ensuring people recover from illness or dependency.  Care: ensuring people with long term conditions or dependency receive effective, quality care and support, with dignity.

Local partners have identified a number of strategic priorities that will help us deliver this vision, these are:-

 Integration between health and social care providing opportunities to do things differently.  A new relationship with communities, so that people are better supported and enjoy access to a range of local support options.

 Transforming public services, breaking down boundaries between the council, health, our partners and our communities.  Investing for the future, by supporting initiatives that deliver long term savings whilst improving health, public health and social care outcomes.

We recognise that the success of the Better Care Fund at delivering person-centred, coordinated care through greater integration of health and social care services is dependent upon developing a shared agreement between partners to use health and social care funding in new and innovative ways.

Our achievements through our Better Care Fund schemes across Sandwell and West Birmingham in 2015/16 include:

 Establishment of Multi-disciplinary teams  New hospital discharge process helping to reduce delayed transfers of care  7 day working for hospital discharge teams, reablement and prevention-focused services  Investment in wellbeing co-ordinators  Investment in dementia cafes and training for carers around health crises  Investment in innovative primary care schemes aimed at reducing emergency hospital admissions  7 day admission and discharge across Intermediate Care and Enhanced Assessment Bed units  Investment in community wellbeing services aimed at improving community resilience and personal independence.

The continuation of the Better Care Fund into 2016/17 and beyond offers further opportunities to bring together existing joint working and shared visions into a single consolidated plan for each of our Sandwell and West Birmingham populations, ratified by the Health & Wellbeing Boards for Sandwell and Birmingham. Sandwell & West Birmingham CCG will continue to work in partnership with our Local Authority partners to deliver our shared objectives for Better Care.

Right Care Right Here

For over 10 years, health and social care organisations have been working together as part of the Right Care Right Here Partnership to transform services locally. The vision is for a sustainable, integrated health and social care system in Sandwell and West Birmingham by 2025.

The partnership has been strengthened this year, with a new Independent Chair, Robin Morrison, and Programme Director, Angela Poulton, appointed in August 2015. Following this, partners have refreshed the vision and strategic direction for the programme and work is starting to pick up pace. The overall goal remains delivery of the Right Care Right Here vision – a sustainable, integrated health and social care system in Sandwell and West Birmingham by 2025. Right Care Right Here

We have also welcomed a number of new partners to the programme during 2015, including West Midlands Ambulance Service NHS Foundation Trust and emerging GP federations.

To help us achieve our aim, the programme has set up a number of work streams, cutting across all aspects of health and social care: 47

 Planned care  Mental health  Primary care  Community health and care (integrating social care, intermediate care and community care)  Urgent care  Public health/prevention  Regeneration.

Midland Met Hospital

Construction of the new state of the art Midland Met Hospital in Smethwick is at the heart of the Right Care Right Here vision.

On 22 January, partners came together to mark the start of a 1,000 day countdown to its opening in 2018. This is a real milestone for local people and brings us one step closer to delivering better care for patients.

Working with Sandwell and West Birmingham Hospitals NHS Trust, our engagement team has been visiting community groups to update everyone on progress with the new hospital, and how this fits into our wider Right Care Right Here programme. Over the next few years we will be working with local communities to keep local people, staff and clinicians informed and involved.

We want to go much further than the new hospital development, by ensuring the right services are available in the community to help reduce admissions to hospital. Our new work streams will help us to achieve this, along with our work on primary care, planned care and prevention.

Improving quality

We have a proactive approach to quality, focusing on: getting the basics right, putting the patient first and going beyond the minimum requirements. At the heart of our approach is delivering the ‘6Cs’: Care, Compassion, Competence, Communication, Courage and Commitment. To deliver this we have invested in a strong in-house quality department, with over 80 staff working in safeguarding, continuing healthcare, medicines quality and risk management.

By bringing all of these teams under the quality directorate, it enables us to have a strong grip on quality across the local healthcare system. We have embedded systems and processes in place, which enable us to commission high quality and safe services for registered patients.

Focus on customer care

In 2013 we set up our Time2Talk team, which is the centre of our quality department, encouraging people to report any compliments, concerns or complaints. This intelligence is logged on our Datix reporting system, and is viewed daily to help us respond to any serious incidents and identify trends. Importantly, this information is fed directly into our contractual and quality meetings with providers, so customer feedback is leading to real improvements within health services.

We also have a Learning from Experience Group, which reviews the outcomes of investigations and shares any lessons with the wider organisation.

We want to strengthen our Time2Talk service in 2016-17 as we continue our responsibilities for commissioning primary care. By handling minor concerns proactively, we are seeing a reduction in the number of concerns escalating to complaints. During 2015-16 we have seen a significant improvement in the proportion of complaints to concerns (from 30% to 70%).

Safeguarding

We continue to fulfill our statutory obligations within Section 11 of The Children Act (2004) and actively demonstrate a commitment to safeguarding all children within the community we serve.

Our Children’s Safeguarding Unit is directly line managed by the Chief Officer for Quality and works closely with the Children’s Commissioning Team, whilst fully supporting the priorities and governance arrangements within the organisation.

Our Quality and Safety Committee monitors safeguarding arrangements and receives monthly safeguarding children reports. The Governing Body receives quarterly reports from the designated professionals.

There is a strong commitment to safeguarding children at an executive level, and we are fully engaged with the Sandwell and Birmingham safeguarding children boards. We contribute to serious case reviews and domestic homicide reviews in both local authorities.

Our Safeguarding Children Unit and the joint Birmingham team, hosted by Birmingham South Central CCG, have provided support for primary care member practices by employing the clinical expertise of named GPs for safeguarding children and named professionals for primary care.

GP safeguarding leads forums, held on a quarterly/bi-monthly basis, are facilitated by the named GP and named professional and provide safeguarding leads with updates on current topics relevant to practice, e.g. PREVENT, child sexual exploitation (CSE) and female genital mutilation (FGM). This is also a forum where GPs can share good practice and raise concerns, as well as be informed of new developments in safeguarding arrangements. Safeguarding leads are required to feed messages back into their practices.

Launched with the help of the CCG, Multi-Agency Safeguarding Hubs (MASH) in Sandwell and Birmingham are now well-established. They are the first port of call for anyone with a child safeguarding concern with an improvement on quality and timelines of screening information sharing, and decision making by partner agencies.

We continue to work closely with multi-agency partners in tackling child sexual exploitation (CSE) through the Birmingham Safeguarding Children Board’s Strategic CSE Subgroup and the Sandwell Safeguarding Children Board’s Health Forum. Our Designated Nurse is a representative on NHS England’s CSE Subgroup, contributing to the implementation of the Health Working Group Report on Child Sexual Exploitation recommendations (January 2014), and ensuring that best practice is disseminated locally. The Designated Nurse from the Birmingham team contributes to CSE meetings, ensuring that health agencies are recognised as key partners in addressing the issue.

On 17 February 2016 we held a summit at the Bethel Convention Centre which aimed to raise awareness of CSE, how to spot the signs and act upon them. More than 100 health professionals from all disciplines were in attendance to hear a personal account from a family affected by CSE and watch our new video – Know the Signs and can be viewed on our YouTube channel.

The Strategic Lead for Domestic Abuse recognised the need to commission a service to help support the early identification of domestic abuse within general practice. Identification and Referral to Improve Safety (IRIS) was commissioned as a pilot programme at the end of 2014, with a successful bid for money being agreed by Sandwell Children Safeguarding Board. IRIS is a domestic violence training, support and referral programme for primary care staff. It was nominated and shortlisted for the Primary Care Award at our 2016 Equality Awards.

Promoting the health and wellbeing of looked after children (LAC) remains a priority for the designated professionals, ensuring health assessments are undertaken within statutory timescales and are quality assured. A health passport for LAC was launched in July 2015 and has been recognised as innovation in practice.

Improving quality in primary care

Primary care development was identified as a key priority. Since we assumed delegated responsibility for general practice services, a range of quality improvement activities have been implemented. These include:

 Enhanced training – over £108,000 invested in training which practices would otherwise have had to pay for individually. This included the introduction of an enhanced training programme, enabling practice staff to access mandatory and other important training either face-to-face or online  Protected learning – over 400 GPs, nurses and practice managers have attended our quarterly Protected Learning Time (PLT) events. For the first time, separate events were held for clinical and non-clinical staff, with a separate, targeted PLT for practice

managers. This has meant more focused and relevant learning for specific staff groups  Support for Care Quality Commission inspections – practices can request support through our quality team, including pre-inspection support visits, mock inspections and access to a range of self-assessment tools and templates  Nurse revalidation – new software has been purchased to support nurse revalidation. This is an online tool designed to make the appraisal and revalidation process as simple as possible. All practice nurses and CCG employed nurses can access this system, which is similar to a GP appraisal system and will enable nurse registrants to be ready for revalidation. This will ensure improved public protection as nurses maintain safe and effective working practices in line with the requirements of professional registration  Development of a quality dashboard – the on-going development of our primary care quality dashboard enables our staff to proactively identify GP practices where additional support may be required  Joint contract and quality monitoring framework – our quality and contract teams worked jointly to develop and implement a primary care contract and quality monitoring framework. The framework was initially launched as a pilot with 10 GP practices receiving a joint contract and quality monitoring visit prior to the formal launch. The visits have been quality-led to allow improvement support to be offered, as opposed to issuing contractual breaches where there are gaps in compliance. Following the evaluation of this pilot, it is intended that the framework will be fully implemented from April 2016 onwards  Learning from incidents and significant events – we delivered an increased number of incident and significant event training and education sessions, with practice staff at all levels encouraged to attend. This resulted in a continued increase in incident reporting, enabling lessons to be learned from incidents and minimising the likelihood of reoccurrence.

Medicines quality

Our medicines quality team, led by Dr Gwyn Harris, has worked on a number of targeted campaigns to support improved medicines prescribing.

We have an innovative model for medicines quality, which enables a small, highly skilled in- house team to significantly reduce inefficiencies in prescribing. Clinical pharmacists and pharmacy technicians are aligned to the LCGs, to offer bespoke support and analysis. These technicians work at an area level to review the prescribing data, current practices and procedures. Advice and support is provided, but practices have taken responsibility for delivering change.

During 2015-16 the team has made improvements in the following areas:

 Wound management – the team has been working across boundaries to harmonise local wound care formularies. We have seen a good uptake of the tissue viability training events for practice nurses. The team has presented at training events and discussed wound care prescribing issues. We have focused on reducing wastage, with prescribing data from September 2015 showing that £74,966 less has been spent compared to 2014-15. The wound care work was a finalist for the General Practice Awards in 2015  Diabetes – over the past three years the team has led a targeted programme around type 2 diabetes. In the last 12 months our medicines quality team has organised a series of events to enhance primary care knowledge around diabetes medication and 51

has launched its bespoke learning needs assessment. This work achieved national recognition and was a finalist for the General Practice Awards in 2015  Sip feeds – our medicines quality team won the General Practice Commissioner of the Year Award in 2015 for its malnutrition community project. This project has not only improved quality markers such as malnutrition screening, but also saved an estimated £750,000 within 12 months. The February 2016 prescribing figures show that within 12 months we have dropped from the 5th highest spending CCG nationally to the 126th. This is the largest and quickest improvement on prescribing spend within the country  Antibiotics – the team has successfully delivered a campaign to drive down the total volume of antibiotics prescribed, by organising two educational sessions for the highest prescribing GPs to attend. The team has also begun to raise awareness of antibiotic resistance to 16-18 year olds using debate kits  Pain – in partnership with secondary care specialists, the medicines quality team delivered a bespoke training event based around revising the pain assessment tools. The event was attended by every practice in the CCG and was an overwhelming success, with another planned for next year

Continuing healthcare and personal health budgets

In Sandwell and West Birmingham we are offering personal health budgets to people who live in their own home, are registered with a Sandwell and West Birmingham GP, and are eligible for fully funded NHS continuing healthcare (CHC) – a package of care that is arranged and funded by the NHS for people who are not in hospital but have complex on- going healthcare needs and a primary need for health interventions.

Personal health budgets are now offered across all disciplines – i.e. learning disabilities, mental health and children – as a new way of commissioning, allowing patients more of a say in their own health and wellbeing.

Patients, or their representatives, work in partnership with their continuing healthcare coordinator to plan and agree the budget that is right for them. This enables patients to choose their own health and wellbeing goals, setting out how the budget will be spent to achieve them.

There is a lot to consider, and our dedicated CHC team will work with patients and carers to help decide if a personal health budget is right for them. Even if a patient chooses not to have a personal health budget, they can still have greater involvement in planning their healthcare through developing a care plan. Already some patients are benefitting from managing their own personal health budget.

Summary

Overall, our approach to quality has led to:

 Positive patient feedback  A further 50% increase in incident reporting, and importantly an increase of “very low” graded incidents reported (from 5% of ‘very low’ reports in April 2015 to 25% in January 2016). This shows more GPs are proactively reporting smaller incidents and concerns, which enables us to identify trends and mitigate against the risk of more serious incidents happening in future  Continued elimination of grade four pressure ulcers

 Continued low incidence rate of grade three pressure ulcers (averaging two per month)  A trend towards zero serious incidents reported in general practice. By encouraging practices to use Datix we hope to see increased reporting with fewer significant incidents and more lower grade incidents  No never events reported in Sandwell and West Birmingham Hospitals Trust for more than eight months  Improved prescribing, as a result of GP education.

Signed

Andy Williams

Accountable Officer

NHS Sandwell and West Birmingham CCG

26 May 2016

ACCOUNTABILITY REPORT

Members’ report

Our member practices

Intelligent Commissioning Federation (ICoF)

Practice Name Address Summerfield Family Practice Summerfield Primary Care Centre, Winson Green Road, Winson Green, Birmingham B18 7AL Bloomsbury Health Centre Bloomsbury Health Centre, 63 Rupert Street, Nechells, Birmingham B7 5DT Newtown Health Centre Newtown Health Centre, 171 Melbourne Avenue, Newtown, Birmingham B19 2JA Crompton Road Surgery Crompton Road Surgery, 93 Crompton Road, Handsworth, Birmingham, B20 3QP Rotton Park Medical Centre Rotton Park Medical Centre, 264 Rotton Park Road, Edgbaston, Birmingham B16 0LU Church Road Surgery Church Road Surgery, 28 Church Road, Aston, Birmingham B6 5UP Heathfield Family Centre Heathfield Family Centre, 131-133 Heathfield Road, Handsworth, Birmingham B19 1HL Lozells Medical Practice Lozells Medical Practice, Finch Road PCC, Finch Road, Lozells, Birmingham B19 1HS City Health Centre City Health Centre, 449 City Road, Edgbaston, Birmingham B17 8LG Al-Shafa Medical Practice Al-Shafa Medical Practice, 5-7 Little Oaks Road, Aston, Birmingham B6 6JY Burbury Medical Centre Burbury Medical Centre, 311 Burbury Street, Lozells, Birmingham, B19 1TT Cavendish Medical Practice Cavendish Medical Practice, 2a Cavendish Road, Birmingham, B16 0HZ Summerfield Primary Care Summerfield Primary Care Centre, 134 Heath Street, Centre Winson Green, Birmingham B18 7AL Halcyon Medical Centre Halcyon Medical Centre, Lower Ground Floor, Boots the Chemist, 67-69 High St, Birmingham B4 7TA Summerfield Group Practice Summerfield Primary Care Centre, 134 Heath Street, Winson Green, Birmingham B18 7AL Victoria Road Medical Centre Victoria Road Medical Centre, 229-233 Victoria Road, Aston, Birmingham B6 5HP

The Hyman Practice The Hyman Practice, Colston Health Centre, 30 Bath Row, Lee Bank, Birmingham, B15 1LZ/Attwood Green HC Newport Medical Practice Newport Medical Practice, 1 Newport Road, Balsall Heath, Birmingham B12 8QE Broadway Health Centre Broadway Health Centre, Cope Street, Ladywood, Birmingham, B18 7BA Soho Health Centre Soho Health Centre, 247-251 Soho Road, Handsworth, Birmingham B21 9RY Summerfield GP and Urgent 134 Heath Street, Winson Green, Birmingham B18 7AL Care Centre Queslett Medical Centre Queslett Medical Centre Surgery, 522 Queslett Road, Great Barr, Birmingham, B43 7DY

Black Country

Practice Name Address Horseley Heath Surgery Horseley Heath Surgery, 14 Horseley Heath, Tipton, DY4 7QU Warley Medical Centre Warley Medical Centre, Ambrose House, Kingsway, Oldbury, B68 0RT Regis Medical Centre Regis Medical Centre, Darby Street, Rowley Regis, B65 0BA Oakham Surgery Oakham Surgery, 213 Regent Road, Tividale, B69 1RZ Black Country Family Black Country Family Practice, Neptune Health Park, Practice Sedgley Road West, Tipton, DY4 8PX The Practice, Old Hill Medical Old Hill Medical Centre, Priest House, Priest Street, Cradley Centre Heath, B64 6JN Tividale Family Practice Tividale Family Practice, Portway Lifestyle Centre, Newbury Lane, Oldbury, B69 1HE Church View Surgery Church View Surgery, 239 Halesowen Road, Cradley Heath, B64 6JE Whiteheath Medical Centre Whiteheath Medical Centre, Badsey Road, Oldbury, B69 1JE Haden Vale Surgery Haden Vale Surgery, 50 Barrs Road, Cradley Heath, B64 7HG The Victoria Surgery The Victoria Surgery, Victoria Road, Tipton, DY4 8SS Glebefields Surgery Glebefields Health Centre, St Mark’s Road, Tipton, DY4 0SN Walford Street Surgery Walford Street Surgery, 19 Walford Street, Tividale, B69

2LD The Spires Health Centre The Spires Health Centre, Victoria Street, Wednesbury, WS10 7EH Malling Health Great Bridge 18 The Great Bridge Centre, Charles Street, West Bromwich, B70 0BF Malling Health Parsonage Parsonage Street, West Bromwich, B71 4DL Street

HealthWorks

Practice Name Address Dr Arora’s Practice, Lyng Lyng Centre For Health, Frank Fisher Way West Bromwich Centre for Health B70 7AW Shanklin House Shanklin House, 190 Aston Lane, Handsworth, Birmingham, B20 3HE Hawes Lane Surgery Hawes Lane Surgery, Hawes Lane, Rowley Regis, B65 9AF St James’ Medical Practice St James’ Medical Practice, 85 Crocketts Road, Handsworth, Birmingham, B21 0HR Enki Medical Practice Enki Medical Practice, 55 Terrace Road, Lozells, Birmingham B19 1BP Handsworth Wood Medicial Handsworth Wood Medicial Centre, 110-114 Church Lane, Centre Handsworth Wood, Birmingham, B20 2ES Laurie Pike Health Centre Laurie Pike Health Centre, 2 Fentham Road, Aston, Birmingham B6 6BB Handsworth Medical Practice Handsworth Medical Practice, 4 Trafalgar Road, Handsworth, Birmingham B21 9NH Grove Lane Surgery Grove Lane Surgery, 110-114 Church Lane, Handsworth, Birmingham, B20 2ES Five Ways Health Centre Five Ways Health Centre, Ladywood Middleway, Ladywood, Birmingham B16 8HA The Smethwick Medical The Smethwick Medical Centre, Regent Street, Smethwick, Centre B66 3BQ Norvic Family Practice Norvic Family Practice, 110 Norman Road, Smethwick, B67 5PU Carters Green Medical Carters Green Medical Centre, 396-400 High Street, Town Centre Centre, West Bromwich B70 9LB Great Barr Group Practice Great Barr Group Practice, 912 Walsall Road, Great Barr, Birmingham, B42 1TG Bearwood Road Surgery Bearwood Road Surgery, 348 Bearwood Road, Smethwick,

B66 4ES Drs P Pal & S Jemahl 33 Newton Road, Great Barr,Birmingham, B43 6AA New Street Surgery New Street Surgery, New Street, Hill Top, B70 0HN Linkway, Lyng Centre for Lyng Centre for Health, Frank Way, West Bromwich, B70 Health 7AW Hill Top Medical Centre Hill Top Medical Centre, 15 Hill Top Road, Oldbury, B68 9DU Rood End Medical Centre Rood End Medical Centre, Western Road, Oldbury, B69 4LZ Ann Jones Family Health Ann Jones Family Health Centre, 52 Chesterton Road, Centre Sparkbrook, Birmingham, B12 8HE City Road Medical Centre City Road Medical Centre, 5 City Road, Edgbaston, Birmingham, B16 0HH

Pioneers for Health

Practice Name Practice Address Soho Health Centre Soho Health Centre, 247-251 Soho Road, Handsworth, Birmingham, B21 9RY Holly Road Surgery Holly Road Surgery, 139 Hamstead Road, Handsworth, Birmingham, B20 2BT Holyhead Primary Healthcare Holyhead Primary Healthcare Centre, 1 St James Road, Centre Handsworth, Birmingham, B21 0HL Hamstead Road Surgery Hamstead Road Surgery, 168 Hamstead Road, Handsworth, Birmingham, B20 2QR Tower Hill Partnership Tower Hill Partnership Medical Practice, 433 Walsall Road, Medical Practice Perry Barr, Birmingham, B42 1BT Hockley Medical Practice 60 Lion Court, Carver Street, Birmingham, B1 3AL The Surgery, The Slieve Hockley Medical Practice, 2 The Slieve, Handsworth Wood, Birmingham, B20 2NR

Sandwell Health

Practice Name Practice Address Village Medical Centre Village Medical Centre, 158a Crankhall Lane, Wednesbury, WS10 0EB The Surgery, Sundial Lane Sundial Lane, Great Barr, Birmingham, B43 6PA Oldbury Health Centre Oldbury Health Centre, Albert Street, Oldbury, B69 4DE St Paul’s Partnership – Lyng Lyng Centre for Health, West Bromwich, B70 7AW

Medical Dr Bhalia’s Practice, Soho Soho Health Centre, Soho Road, Birmingham, B21 0RY Health Centre St Paul’s Surgery St Paul’s Surgery, 222 St Paul’s Rd, Smethwick, B66 1HB Bearwood Medical Centre Bearwood Medical Centre, 176 Milcote Road, Smethwick, B67 5BP Saraphed Medical Centre 60 Arden Road, Smethwick, B67 6AJ St Paul’s Partnership – Dr Lyng Centre for Health, West Bromwich, B70 7AW Dewan Jubilee Health Centre Jubilee Health Centre, 1 Upper Russell Street, Wednesbury, WS10 7AR Hill Top Surgery Hill Top Surgery, 68 Hill Top, West Bromwich, B70 0PU Park House Surgery Park House Surgery, 134 Newton Road, Great Barr, Birmingham, B43 6BT Dr Pathak’s Practice, Primary Primary Care Centre, 6 High Street, West Bromwich, B70 Care Centre 6JX Hill Top Medical Centre Hill Top Medical Centre, 88 Hill Top, West Bromwich, B70 0RT The Surgery, Lodge Road Lodge Road, Smethwick, B67 7LU Warley Road Surgery Warley Road Surgery, 118 Warley Road, Oldbury, B68 9SZ Stone Cross Medical Centre Stone Cross Medical Centre, 291 Walsall Road, Stone Cross, West Bromwich, B71 3LN Dog Kennel Lane Surgery Dog Kennel Lane Surgery,64 Dog Kennel Lane, Oldbury, B68 9LZ Dartmouth Medical Centre Dartmouth Medical Centre, 1 Richard Street, West Bromwich, B70 9JL Dr Haque’s Practice, Primary Primary Care Centre, 6 High Street, West Bromwich, B70 Care Centre 6JX Crankhall Lane Medical Crankhall Lane Medical Centre, 156 Crankhall Lane Medical Centre Centre, Wednesbury, WS10 0EB Marshall Street Surgery Marshall Street Surgery, 45-46 Marshall Street, Smethwick, B67 7NA Oakeswell Health Centre Oakeswell Health Centre, Brunswick Park Road, Wednesbury, WS10 9HP Cambridge Street Surgery Cambridge Street Surgery, 1 Cambridge Street, West Bromwich, B70 8HQ Hawthorns Medical Practice Hawthorns Medical Centre, 94 Lewisham Road, Smethwick, B66 2DD Oakwood Surgery Oakwood Surgery, 40 Izons Road, West Bromwich, B70 58

8PG Great Bridge Partnership for 10 Slater Street, Great Bridge, Tipton, DY4 7EY Health – Sai Surgery and Cordley Street Dr Pathak’s Surgery, Primary Primary Care Centre, Redwood Road, Walsall, West Care Centre Midlands, WS5 4LB Kirpal Medical Practice, Soho Primary Care Centre, 6 High Street, West Bromwich, Health Centre Birmingham, B70 6JX Causeway Green Surgery Causeway Green Surgery, 158 Causeway Green Road, Oldbury, B68 8LJ The Surgery, Clifton Lane Clifton Lane, West Bromwich, B71 3AS Swanpool Medical Centre Swanpool Medical Centre, St Mark’s Road, Tipton

Chair and Accountable Officer

Chair – Professor Nick Harding OBE

Accountable Officer – Mr Andy Williams

Our Governing Body members

Name Role Dr Nick Harding Chair Mr Ranjit Sondhi Vice Chair Dr Ayaz Ahmed Vice Chair, Sandwell Health Alliance Dr Basil Andreou Chair, Sandwell Health Alliance LCG Ms Jyoti Atri Public Health Representative Dr Sirjit Bath Vice Chair, Pioneers for Health Dr Vijay Bathla Chair, Pioneers for Health Dr Felix Burden Secondary Care Specialist Mr Jon Dicken Chief Officer, Operations Mr James Green Chief Finance Officer Mrs Julie Jasper Lay Member Mrs Sharon Liggins Chief Officer, Partnerships Dr Inderjit Marok Vice Chair, ICoF LCG Ms Therese McMahon Board Nurse Dr Samar Mukherjee Chair, ICoF LCG Mr Richard Nugent Independent Committee Member Mrs Claire Parker Chief Officer, Quality Ms Janette Rawlinson Independent Committee Member Dr George Solomon Chair, Black Country LCG 59

Dr Ram Sugavanam Vice Chair, HealthWorks Dr Ian Sykes Vice Chair, Black Country LCG Mr Andy Williams Accountable Officer

To see biographies for each of our Governing Body members please visit our website: www.sandwellandwestbhamccg.nhs.uk

Our Audit and Governance Committee members

Name Role Mrs Julie Jasper Lay Member of the Governing Body, Audit Lead Chair Dr Felix Burden Secondary Care Specialist Doctor, Vice Chair Dr Vijay Bathla GP, Chair of Finance and Performance Committee Ms Therese McMahon Board Nurse Mr Richard Nugent Independent Committee Member Ms Janette Rawlinson Independent Committee Member Mr Ranjit Sondhi Lay Member of the Governing Body (Patient and Public Involvement)

For details of the Remuneration Committee please see the Remuneration Report. For details, and membership, of all other committees please see the Governance Statement.

Governing Body member interests

To view the declarations of interest for our Governing Body members please see our website at www.sandwellandwestbhamccg.nhs.uk. Alternatively, please contact our Time2Talk team on 0121 612 4110 or write to us at:

Sandwell and West Birmingham CCG Kingston House 438-450 High Street West Bromwich B70 9LD

Disclosure of personal data related incidents

In 2015-16 there were three personal data related incidents reported. They are as follows:

 Files were discovered on a shared drive containing patient names, dates of birth, NHS and examination numbers. 10,061 patients were affected  Folders which were previously restricted access were accessible to all CCG staff. More than 4000 patient details were affected, some containing highly sensitive information  Documents received from a provider, containing person identifiable data for five patients, were saved in the shared drive by a member of CCG staff.

Following each incident, the Chief Officer for Quality has reinforced to the relevant team the importance of observing information governance processes in everyday tasks. We are also working to ensure that all staff are fully compliant with information governance training and that procedures are embedded across the organisation.

An information governance working group has now been set up and meets to discuss best practice. They are leading on a project to review all files and folders that are saved on the shared drive. This will involve restricting access to certain folders, password protecting others, archiving information that is not accessed on a regular basis, and destroying anything that is no longer needed.

Statement as to disclosure to auditors

Each individual who is a member of the Governing Body at the time the Members’ Report is approved confirms:

 So far as the Governing Body member is aware, there is no relevant audit information of which the CCG’s auditor is unaware.  That the member has taken all the steps they should have taken to make themselves aware of any relevant audit information and to establish that the CCG’s auditor is aware of that information.

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 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 judgments and estimates on a reasonable basis; 61

 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.

Signed

Andy Williams

Accountable Officer

NHS Sandwell and West Birmingham CCG

26th May 2016

Annual Governance Statement

Introduction and context

The clinical commissioning group was licenced from 1 April 2013 under provisions enacted in the Health and Social Care Act 2012, which amended the National Health Service Act 2006.

As at 1 April 2015, the clinical commissioning group was licensed without conditions

The CCG is a membership organisation involving 99 GP practices serving around 552,032 patients across the Sandwell and West Birmingham areas. The CCG is broken down further into five local commissioning groups: Black Country, HealthWorks, ICoF, Pioneers for Health and Sandwell Health Alliance. These groups address the needs of the population on a very local level.

The CCG's mission is to work across boundaries to improve the health of the communities we serve, and the quality of health and social care services provided to those communities. We do this by giving patients and the wider population the opportunity to benefit from healthier lifestyles, bringing appropriate elements of care closer to home, and designing services to meet the needs of the local population.

Scope of responsibility

As Accounting Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the clinical commissioning group’s policies, aims and objectives, whilst safeguarding the public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out in my Clinical Commissioning Group Accountable Officer Appointment Letter.

I am responsible for ensuring that the clinical commissioning group is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity.

Compliance with the UK Corporate Governance Code

We are not required to comply with the UK Corporate Governance Code. However, we have reported on our corporate governance arrangements by drawing upon best practice available, including those aspects of the UK Corporate Governance Code we consider to be relevant to the clinical commissioning group and best practice. We comply with the key principles of the code, which set out good practice in the areas of leadership; effectiveness; accountability; remuneration and relationships with key stakeholders of the CCG.

The Clinical Commissioning Group Governance Framework

The National Health Service Act 2006 (as amended), at paragraph 14L(2)(b) states:

The main function of the governing body is to ensure that the group has made appropriate arrangements for ensuring that it complies with such generally accepted principles of good governance as are relevant to it.

The Constitution, including standing orders, prime financial policies and scheme of reservation and delegation have been reviewed by both the Audit and Governance Committee and Governing Body to ensure they accurately reflect the governance context in 63 which the CCG operates. The amendments made to the Constitution have not fundamentally altered the way the CCG operates nor how it meets its statutory duties, but have enabled the CCG to ensure it works effectively and meets the requirements of its members.

The governing body has the following voting members:

• Chair (a GP) • Accountable Officer • Chief Finance Officer • Nine GP members • Two lay members (one acts as Vice Chair) • One secondary care doctor • One nurse representative

The following non-voting members:

• Chief Officer (Quality) • Chief Officer (Partnerships) • Chief Officer (Operations) • Two independent committee members • Public health representative

In addition the following individuals regularly attend the meeting:

• Communications lead • Deputy Chief Officer, quality

The governing body has appointed the following individuals to key governance posts:

• Caldicott Guardian - Dr Sam Mukherjee • Senior Information Risk Officer - Claire Parker

The governing body is responsible for the overall management and performance of the CCG and approves its long-term objectives and strategy. The CCG is a GP led organisation, which is reflected at a Governing Body level through our LCG chairs and vice chairs. We also recognise the valuable impartial role played by our lay members and independent committee members, ensuring our decisions are fair and reflective of our local population at both a governing body and committee level. While day-to-day management is delegated to the chief officers, there is a formal schedule of matters reserved for the board within the CCG Constitution. This provides a framework for the governing body and members to oversee the CCG’s business. The scheme of reservation and delegation clearly outlines the breakdown of responsibilities reserved by members and those delegated to the governing body, its committees and other senior managers within the CCG.

The governing body members bring a range of skills and experience to their role on the governing body to ensure the balance, completeness and appropriateness of discussions and determinations.

The governing body is held in public every month and actively encourages questions from the public as part of the agenda. Attendance at the governing body meetings during 2015/16 has been recorded as follows (‘’ denotes attendance).

Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar ‘15 ‘16 Dr Nick Harding, Chair            Mr Ranjit Sondhi, Vice           Chair Dr Felix Burden,            Secondary Care Specialist Mr James Green,            Chief Finance Officer Dr Vijay Bathla, Chair,           Pioneers for Health Dr Sirjit Bath, Vice            Chair, Pioneers for Health Dr George Solomon,           Chair, Black Country LCG Dr Ian Sykes, Vice           Chair, Black Country LCG Dr Basil Andreou,            Chair, Sandwell Health Alliance LCG Dr Ayaz Ahmed, Vice            Chair, Sandwell Health Alliance Dr Samar Mukherjee,            Chair, ICoF LCG Dr Inderjit Marok, Vice             Chair, ICoF LCG Dr Ram Sugavanam,      Vice Chair, HealthWorks Mr Andy Williams,           Accountable Officer Mrs Sharon Liggins,        Chief Officer, Partnerships Mr Jon Dicken, Chief           Officer, Operations Mrs Claire Parker,             Chief Officer, Quality 65

Mrs Julie Jasper, Lay           Member Ms Janette Rawlinson,           Independent Committee Member Ms Therese McMahon,           Board Nurse Richard Nugent,          Independent Committee Member Jyoti Atri, Public     Health Representative

Governing body committee structure

The governing body committee structure was reviewed on a regular basis throughout

2015/16, to ensure it was appropriately supported to effectively discharge its functions. Each committee has terms of reference which have been approved by the governing body and provides a robust framework for the functions and duties of these committees to be discharged in a manner that ensures the Governing Body retains sufficient oversight of the proper performance of their delegated functions. Each committee receives a regular set of reports, as outlined within their terms of reference and reports to the governing body after each meeting.

The governing body committees include:

Audit and Governance Committee

The Audit and Governance Committee, chaired by the lay member for governance, has approved terms of reference that are in line with the Audit Committee Handbook, as published by the Healthcare Financial Management Association (HFMA) and Department of Health. The Committee provides the Governing Body with an independent and objective view of the CCG’s financial systems, financial information and compliance with laws, regulations and directions governing the CCG. The Audit and Governance Committee gives assurance to the Governing Body that risk is being managed appropriately within the CCG.

The committee has delegated authority from the Governing Body to approve the Annual Financial Statements; the draft Annual Report and the annual accounts.

Remuneration Committee

The Remuneration Committee, chaired by a lay member, makes determinations about the remuneration, fees and other allowances for Governing Body members and clinical leads, employees and/or persons who provide services to the CCG

Quality and Safety Committee

The Quality and Safety Committee, is chaired by the GP lead for quality. It meets monthly and is accountable to the governing body. This committee assures the governing body on the management of quality, safety and risk within the CCG. It monitors the work of the clinical quality review meetings with our main providers and the work of the Care Quality 66

Commission locally (for example their assessments of nursing homes). It also reviews the red risks associated with quality and the serious incident reports.

Strategic Commissioning and Redesign Committee

The Strategic Commissioning and Redesign Committee, chaired by the GP lead for commissioning, meets monthly and is accountable to the governing body. This committee drives forward the strategic commissioning objectives of the CCG and considers proposals for the redesign of clinical services. The committee assures the governing body that the commissioning intentions of the CCG are being implemented in accordance with the strategy, and that the necessary procurement processes are being adhered to when services are being commissioned.

Finance and Performance Committee

The Finance and Performance Committee is chaired by the GP lead for finance and meets on a monthly basis. It is accountable to the governing body for the effective oversight of financial performance and performance against healthcare standards. The committee receives monthly reports regarding the financial position of the CCG with analysis of significant variances, along with a forecast outturn position for the financial year. It also receives a detailed analysis of both CCG and main NHS Trust providers' performance against operational standards which covers constitutional rights of patients’ access to healthcare. Where necessary the Finance and Performance Committee will take corrective action to ensure robust delivery against required standards.

Partnerships Committee

The Partnerships Committee, chaired by the GP lead for partnerships, is in place to ensure that the governing body has appropriate arrangements to improve the quality of care and the health and wellbeing of patients, through effective partnership working. The committee has a role to develop partnerships with key stakeholders including Birmingham City Council, Sandwell Metropolitan Borough Council, local NHS providers, other CCGs, the voluntary and independent sectors and the Right Care Right Here partners to further the governing body’s key objectives. The committee also reviews the arrangements to consult and engage with patients and the public.

Primary Care Co-Commissioning Committee

The Primary Care Co-commissioning Committee was introduced from 1 April 2015, to take responsibility for decision making regarding the commissioning of primary care medical services under delegated arrangements from NHS England and is chaired by Ranjit Sondhi. It is responsible for the delegated resources of £74m, for the Governance Arrangements to support commissioning of Primary Care services and for developing of primary care services.

The relationship between the governing body and its committees is shown through the committee structure below:

Patient and Partnership Advisory Group

PPAG – Patient and Partnership Advisory Group is part of our Patient and Partnership Engagement Model It is chaired by the Vice Chair of the CCG, it has an ICM as its Vice Chair and links into the Governing Body through them. There is feedback to the governing body as a formal part of the agenda.

There are 2 patient representatives per LCG, recruited from local practices a combination of Healthwatch, and the local voluntary and community sector through the 2 infrastructure organisations (BVSC & SCVO), and through the 2 local Health and Social Care Forums. Eighteen representatives in total.

The primary role is to offer assurance to the Governing Body that we are fulfilling our statutory duty under the HSC Act 2006 around information and involvement. They offer a patient view of the world, great insight and challenge the process/approach/outcome as and when necessary. The diagram below shows the relationships that the Group has with other Committees.

These arrangements are subject to assurance by the Audit and Governance Committee, which receives independent reports from internal and external auditors regarding these arrangements.

I am confident that these arrangements are suitable to adequately discharge the statutory and regulatory functions of the CCG.

The Clinical Commissioning Group Risk Management Framework

The CCG has a risk management strategy and policy requiring a department level identification, assessment and management of risks with escalation of significant and /or persistent risks through the committees of the governing body. The Audit and Governance Committee reviews the risk register regularly and reports to the governing body, providing assurance that risks are being monitored and mitigated, and highlighting any exceptions.

The CCG’s risk management strategy sets out the role and responsibility of the Accountable Officer and other key officers in relation to risk management. The chief officer and GP lead for quality provide clinical leadership for clinical governance and in particular quality and safety within the providers that the CCG commissions from. Equality impact assessments are embedded in our core business case procedures

Decisions relating to the management of risk are now able to occur as close as practicable to the risk source. Root cause analyses are undertaken for all serious incidents (SIs). SIs that occur within commissioned services are monitored as are the resulting root cause analyses. All never-events occurring in commissioned services are closely monitored by the CCG and representatives from the quality and safety team attend all table-top reviews to ensure the root causes are identified and lessons are learnt to avoid the event occurring again.

The CCG has reviewed the mechanism for learning lessons to ensure that this happens across the health economy.

The Clinical Commissioning Group works with its Local counter Fraud Specialist to provide training and awareness as a deterrent to fraud risks arising

The red risk register holds the high operational risks and the financial consequences of the risk are identified where appropriate. These are categorised as ‘red’ on the 5x5 risk scoring matrix. Again, there is a lead director identified who puts an action plan in place and ensures that the risk is mitigated. The red risk register is reviewed regularly at the responsible committee, who in turn provide assurance through to the Audit and Governance.

Risk Assessment

The CCG has adopted a risk management strategy which clearly explains how to assess risk. All risks are captured on the web-based Datix system and each committee of the governing body has appropriate risks allocated to them.

Risk management is undertaken proactively to address every element of the CCG’s activities. The CCG has adopted the NHS Litigation Authority risk matrix to score risks against consequence and likelihood. The risks have been identified with the governing body and the register developed by requesting each risk owner to describe; the risk, current controls, and action to mitigate or reduce the risk. Through this process, the governing body has identified its high level current and potential risks. It has assessed them for potential frequency and severity, and attributed a score to each. Mitigating actions are identified and each risk is then reassessed in order to derive a revised score. These scores indicate the level of residual risk that applies to a particular activity, and are used to identify where further mitigating actions may be required.

The risk assessment process is overseen by the Audit and Governance Committee. The identified risk owners review and update their risks on a periodic basis. The Audit and Governance Committee is responsible for the monitoring and review of the assurance framework and associated processes, and provides assurance to the governing body.

The CCG also receives assurance that risk management activities and systems are being appropriately identified and managed through the following:

• Progress against its strategic and operational objectives • Statistical and trend reporting of incidents, along with reporting of complaints and claims to the governing body and relevant committees • Correlation between incidents/near miss reporting and dates of their occurrence • Receiving assurance from internal and external audit that the CCG’s risk management systems are effective • Information governance toolkit compliance

The CCG successfully managed and mitigated a number of significant risks during 2015/16, in particular those relating to the delivery of performance standards in urgent care and patient treatment waiting times.

The principal risks for the CCG during the year have related to quality, finance, and primary care devolution.

The risks in relation to quality have focused on capacity and skills concerns in primary care in order to facilitate the transfer of care out of hospitals, and the risk of focusing on targets and outcomes at the detriment of patient experience.

The financial risks have related to the impact of establishing the Better Care Fund, identifying effective QIPP savings, and the consequential impact of the financial constraints of local authorities.

Primary care risks have arisen due to the proposed devolution of commissioning responsibilities from NHS England to the CCG effective from 1 April 2015. These have been mitigated through ensuring sufficient capacity is employed within the CCG, and through undertaking appropriate due diligence reviews.

The Internal Auditors have raised concerns over recruitment systems as part of their review, resulting in a limited audit opinion. An action plan is in place and these issues are in the process of being resolved. Further details of this are included in the Head of Internal Audit Opinion.

The Clinical Commissioning Group 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 at the CCG for the year ended 31 March 2016 and up to the date of approval of the annual report and accounts.

The governing body takes the risk of fraud very seriously, and commissioned the service of a local counter-fraud specialist throughout 2015/16, and there are cases currently being investigated. This service is pro-active in identifying and investigating potential fraudulent activities. The counter-fraud specialist attends the Audit and Governance Committee on a quarterly basis to provide updates on the current plan, highlight any relevant guidance and to give assurance of any investigations.

The CCG and its members recognise the importance of managing conflicts of interest.

Accordingly, a register of members' interests is maintained and updated regularly. All meeting agendas of the governing body and committees include guidance and definitions of interests, and time is allocated at the start of the meeting for such declarations to be made. All Lay Members have been on conflict of interest training provided by NHSE.

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 its rules, and that member pension scheme records are accurately updated in accordance with the timescales detailed in the regulations.

Control measures are in place to ensure that all the CCG’s obligations under equality, diversity and human rights legislation are complied with.

The CCG has undertaken risk assessments, and carbon reduction delivery plans are in place in accordance with emergency preparedness and civil contingency requirements, as based on UKCIP 2009 weather projects, to ensure that this clinical commissioning group’s 71 obligations under the Climate Change Act and the Adaptation Reporting requirements are complied with.

Risks to data security are managed through the implementation of good information governance practice, including staff training and awareness, effective system security, appointment of a senior information risk owner and Caldicott Guardian, and development of data flow mapping and the assignment of data owners and administrators

The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal identifiable information. The NHS Information Governance Framework is supported by an information governance toolkit and the annual submission process provides assurances to the clinical commissioning group, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively.

We place high importance on ensuring there are robust information governance systems and processes in place to help protect patient and corporate information. We have established an information governance management framework and are developing information governance processes and procedures in line with the information governance toolkit. We have ensured all staff undertake annual information governance training and have implemented a staff information governance handbook to ensure staff are aware of their information governance roles and responsibilities.

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 against identified risks. & effectiveness of the

Through its monthly reporting arrangements the CCG produces a comprehensive finance report which covers financial performance for the year to date, and an assessment of the forecast out-turn position.

In addition the finance report provides:

• RAG ratings against a number of key metrics as set out in the NHS England Assurance Framework • Summary analysis of variances against the financial plan and mitigating actions where appropriate • Detailed commentary for major areas of commissioning expenditure • A risks and mitigations statement relating to the forecast out-turn • A Statement of Financial Position (Balance Sheet) • Detail of the CCG’s compliance against the Better Payment Practice Code.

The finance report is reviewed in detail at the CCG’s Finance and Performance Committee each month, with a summary of the key highlights presented to the Governing Body. The finance report features as part of the monthly Governing Body papers.

During the annual financial planning process, regular updates and presentations are provided to the Governing Body to outline progress against contracting targets and provide an assessment of the level of savings that will be required to finance the organisation’s expenditure commitments for the year ahead and over the medium term. The Governing Body then considers its approach to meeting savings accordingly.

A number of key internal audit reviews have been undertaken to provide additional assurance, and suggested control enhancements captured on an action plan, the 72 implementation of which is monitored. The Head of Internal Audit has provided a significant assurance opinion on the effectiveness of the system of internal control.

The external auditor has undertaken a value for money assessment to inform their formal opinion of the CCG. Both internal and external reviews have reported positively on the use of resources in terms of the CCG’s economy, efficiency and effectiveness. (

The CCG has the budget for Primary Care Commissioning delegated from NHS England. In order to ensure the budgets are used efficiently and effectively the CCG has put in place the Primary Care Co Commissioning Committee which has overall responsibility for the oversight over Primary Care commissioning by the CCG. This committee is able to highlight concerns to the CCG Board and to NHS England. Primary care Co-Commissioning has also been subject to review by Internal Audit who have given moderate assurance and given agreed actions to improve controls.

Review of the effectiveness of Governance, Risk Management & Internal Control

As Accounting Officer, I have responsibility for reviewing the effectiveness of the system of internal control within the clinical commissioning group.

As Accountable Officer, I have overall responsibility for risk management and the arrangements to support this are clearly articulated to all staff through the CCG Board Assurance Framework and risk management strategy.

The governing body is responsible for overseeing the delivery of our strategy and is supported in this regard by the work of its committees, which review risks related to their remit. The governing body gains independent assurance of the effectiveness of its risk management processes through the work of internal audit and the external audit programmes of work.

Our strategy clearly details the leadership, responsibility and accountability for risk management activities throughout the CCG. To this end, I am supported by the senior management team who oversee risk management activities for their areas of responsibility. The CCG operates an open culture and all staff are encouraged to openly discuss and share concerns which may relate to risks, serious incidents and near misses through discussions with managers, quality and governance teams.

My review of the effectiveness of the system of internal control is informed by the work of the internal auditors and the executive managers and clinical leads within the clinical commissioning group who have responsibility for the development and maintenance of the internal control framework. I have drawn on performance information available to me. My review is also informed by comments made by the external auditors in their annual audit letter and other reports

Our assurance framework provides me with evidence that the effectiveness of controls that manage risks to the clinical commissioning group achieving its principles objectives have been reviewed.

I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Governing Body, the Audit Committee and risk/ clinical governance/ quality committee, if appropriate and a plan to address weaknesses and ensure continuous improvement of the system is in place.

Following completion of the planned audit work for the financial year for the clinical commissioning group, the Head of Internal Audit issued an independent and objective opinion on the adequacy and effectiveness of the clinical commissioning group’s system of risk management, governance and internal control. The Head of Internal concluded that:

“My overall opinion is that significant assurance can be given that there is a generally sound system of internal control, designed to meet the organisation’s objectives, and that controls are generally being applied consistently. However, some weakness in the design and/or inconsistent application of controls put the achievement of particular objectives at risk”

The Head of Internal Audit highlighted concerns regarding systems in place for the delivery of QIPP, primary care commissioning, partnership working, commissioning arrangements (children’s services), Better Care Fund and recruitment processes.

During the year, internal audit issued no audit reports with a conclusion of no assurance and one report, for recruitment processes with limited assurance.

The governing body regularly reviews the adequacy of the data quality utilised to support decision making.

I can confirm an appropriate framework and environment is in place to provide quality assurance of business critical models, in line with the recommendations in the Macpherson report and that all business critical models have been identified and that information about quality assurance processes for those models has been provided to the Analytical Oversight Committee, chaired by the Chief Analyst in the Department of Health.

This framework is informed by the role of the Audit and Governance Committee and internal audit programme to review systems of internal control to identify areas for improvement. The CCG also has a rigorous performance management framework which it uses to monitor delivery of services from its third party contractors.

The CCG has developed its business continuity arrangements, which identify those business processes which need to be recovered as a priority in the event of business disruption.

We have submitted a satisfactory level of compliance with the information governance toolkit assessment.

There were three serious data security breaches in the year, two of which have now been closed and one where closure has been requested. Details are below.

• Files were discovered on a shared drive containing patient names, dates of birth, NHS and examination numbers. 10,061 patients were affected • Folders which were previously restricted access were accessible to all CCG staff. More than 4000 patient details were affected, some containing highly sensitive information in some cases • Documents received from a provider, containing person identifiable data for five patients, were saved in the shared drive by a member of CCG staff.

Following each incident, the Chief Officer for Quality has reinforced to the relevant team the importance of observing information governance procedures in everyday tasks. We are also working to ensure that all staff are fully compliant with information governance training and that procedures are embedded across the organisation.

An information governance working group has now been set up and meets to discuss best practice. They are leading on a project to review all files and folders that are saved on the 74 shared drive. This will involve restricting access to certain folders, password protecting others, archiving information that is not accessed on a regular basis, and destroying anything that is no longer needed.

During establishment, the arrangements put in place by the clinical commissioning group and explained within the Corporate Governance Framework were developed with extensive expert external legal input, to ensure compliance with the all relevant legislation. That legal advice also informed the matters reserved for Membership Body and Governing Body decision and the scheme of delegation.

In light of the Harris Review, the clinical commissioning group has reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislative and regulations. As a result, I can confirm that the clinical commissioning group is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions.

Responsibility for each duty and power has been clearly allocated and the CCG operating structure provides the necessary capability and capacity to undertake all of the CCG’s statutory duties.

No significant internal control issues have been identified during 2015/16. A number of control weaknesses have been identified, and these are highlighted within this report.

Signed

Andy Williams

Accounable Officer

26th May 2016

Remuneration and staff report

Remuneration and Terms of Service Committee

The committee was established in order to determine the remuneration and terms of service for the Governing Body members. The membership details for the committee are set out below:

Name Role Mr Ranjit Sondhi Chair of the Remuneration Committee Mrs Julie Jasper Chair of Audit and Governance Committee Dr Felix Burden Secondary Care Specialist Doctor Ms Janette Rawlinson Independent Committee Member Mr Richard Nugent Independent Committee Member Ms Therese McMahon Board Nurse

The Remuneration Committee met three times during 2015-16.

Jun ‘15 Jul Mar ‘16 Mr Ranjit Sondhi    Mrs Julie Jasper    Dr Felix Burden    Ms Janette Rawlinson   Mr Richard Nugent   Ms Therese McMahon

Pay for Governing Body members and other senior staff was mainly on nationally determined pay rates. Where pay was determined locally this was agreed by the committee. It was the responsibility of the committee in its discussions to:

 Determine the remuneration and conditions of service of the senior team  Review the performance of the Chief Accountable Officer and other senior team members and determine annual salary awards, if appropriate  Ensure proper calculation and scrutiny of termination payments taking account of appropriate national guidance, along with advising on and overseeing appropriate contractual arrangements for such staff  Consider any severance payments of the Accountable Officer and other senior staff, seeking HM Treasury approval as appropriate in accordance with the guidance ‘Managing Public Money’  Advise on and oversee appropriate contractual arrangements for staff, including redundancy arrangements in line with national or local contracts of employment and appropriate guidance or legislation  To review the Terms of Reference of the committee for submission to the Governing Body  Agree any recruitment and retention premiums or any retention schemes, subject to national guidance and/or relevant terms and conditions of service 76

 The policy on Governing Body members and senior staff contracts was that they were permanent, except where an explicit fixed-term role was identified. The standard notice period was six months. The contract was a standard contract used for all CCG staff so there were no end dates.

Senior managers’ service contracts

We have two members of staff on Very Senior Manager pay and contracts. This senior manager contract includes the ability to attract an annual performance related payment subject to meeting a number of performance indicators both personally and related to the organization as a whole.

In June 2015 the remuneration committee met and reviewed the performance of the Chief Finance Officer and the Accountable Officer. Due to both members of staff achieving exceptional performance ratings a performance related bonus was awarded.

However, both members of staff thanked the organisation for the recognition of their performance and rejected the performance related pay based on the position of the national freeze on increments for the other members of the senior team.

Single total figure remuneration table

2015-16 2014-15 Long- Annual Annual term Taxabl Perfor Taxabl Perfor Perfor e mance Long- e mance mance Benefit Relate term Benefit Relate Relate All s d Performa All Salary & s d d Pension Salary & (Round Bonuse nce Pension Fees (Round Bonuse Bonuse Related Fees ed to s Related Related Total (bands ed to s s Benefits Total (bands of the (bands Bonuses Benefits (bands of the (bands (bands (bands (bands £5,000) nearest of (bands of (bands of of £5,000) nearest of of of of £00) £5,000) £5,000) £2,500)* £5,000) £00) £5,000) £5,000) £2,500)* £5,000)

Name and title Title £000 £00 £000 £000 £000 £000 £000 £00 £000 £000 £000 £000 Dr Nicholas 155- Harding Chair 140-145 0 0 0 0 140-145 160 0 0 0 0 155-160

Mr Ranjit Sondhi Lay Director 15-20 0 0 0 0 15-20 10-15 0 0 0 0 10-15 Mrs Julie Jasper Lay Director 15-20 0 0 0 0 15-20 10-15 0 0 0 0 10-15 Clinical member – Secondary Dr Felix Burden Care Doctor 25-30 0 0 0 0 25-30 30-35 0 0 0 0 30-35 Ms Therese McMahon Board Nurse 10-15 0 0 0 0 10-15 0-5 0 0 0 0 0-5 Ms Janette Independent Committee Rawlinson Member 10-15 0 0 0 0 10-15 5-10 0 0 0 0 5-10 Independent Committee Richard Nugent member 10-15 0 0 0 0 10-15 5-10 0 0 0 0 5-10 135- Mr Andy Williams Accountable Officer 135-140 0 0 0 0 135-140 140 0 0 0 87.5-90 225-230 115- Mr James Green Chief Finance Officer 115-120 0 0 0 17.5-20 135-140 120 0 0 0 10-12.5 130-135 Dr Vijay Bathla Chair, Pioneers for Health LCG 55-60 0 0 0 0 55-60 60-65 0 0 0 0 60-65 Vice Chair, Pioneers for Health Dr Sirjit Bath LCG 55-60 0 0 0 0 55-60 30-35 0 0 0 0 30-35 Dr George Solomon Chair, Black Country LCG 50-55 0 0 0 0 50-55 60-65 0 0 0 0 60-65 Dr Ian Sykes Vice Chair, Black Country LCG 40-45 0 0 0 0 40-45 15-20 0 0 0 0 15-20 Chair, Sandwell Health Dr Basil Andreou Alliance LCG 115-120 0 0 0 0 115-120 90-95 0 0 0 0 90-95 Vice Chair, Sandwell Health Dr Ayaz Ahmed Alliance LCG 55-60 0 0 0 0 55-60 10-15 0 0 0 0 10-15 Dr Samar Mukherjee Chair, ICoF LCG 55-60 0 0 0 0 55-60 60-65 0 0 0 0 60-65 Dr Inderjit Marok Vice Chair, ICoF, LCG 40-45 0 0 0 0 40-45 30-35 0 0 0 0 30-35

Dr Ram Sugavanam Vice Chair of HealthWorks 55-60 0 0 0 0 55-60 45-50 0 0 0 0 45-50 Mr Jon Dicken Chief Officer - Operations 95-100 0 0 0 42.5-45 140-145 90-95 0 0 0 22.5-25 115-120 Mrs Claire Parker Chief Officer – Quality 85-90 0 0 0 10-12.5 100-105 85-90 0 0 0 15-17.5 105-110 Mrs Sharon Liggins Chief officer – Partnerships 85-90 0 0 0 37.5-40 125-130 80-85 0 0 0 15-17.5 100-105 The content and notes to the salary entitlements table and pension liabilities table have been audited

Pensions entitlement table

The content and notes to the salary entitlements table and pension liabilities table have been audited

Lump sum at Real Increase in pension age Cash Cash Real increase Real Increase in pension lump Total accrued related to equivalent equivalent in cash Employers pensions at sum at pension pension at accrued pension transfer value transfer value equivalent contribution to pension age age pension age at at 31 March at 31 March at 31 March transfer value partnership Name Title 31 March 2016 2016 2015 2016 pension

(bands of £2500) (bands of (bands of (bands of £2500) £5000) £5000)

£000 £000 £000 £000 £000 £000 £000 £000

Mr Andy Williams Accountable Officer 0 0 50-55 155-160 925 941 5 0 Mr James Green Chief Finance Officer 0-2.5 0 30-35 95-100 473 494 15 0 Mr Jon Dicken Chief Officer - Operations 0-2.5 5-7.5 40-45 120-125 697 754 49 0 Mrs Claire Parker Chief Officer – Quality 0-2.5 0 10-15 35-40 227 243 13 0 Mrs Sharon Liggins Chief officer – Partnerships 0-2.5 0-2.5 25-30 80-85 460 501 36 0

The table discloses the pension entitlements of the CCG executive directors and senior managers at the end of the year, and the changes during the year. In line with the NHS Manual for Accounts 2015-16 only disclosure of pension benefits arising from the CCG pension contributions paid by the CCG to the NHS Pensions Agency.

Pension contributions for GP directors are included in the payments which the CCG makes to GPs for their services. The GPOs pay these over with their practice pensions. The GPs are on the CCG payroll to comply with the HM Revenue and Customs requirement for income tax and national insurance to be deducted from the GPs’ service payments and paid to HMRC by the CCG

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 membership of the pension scheme. This may be for more than just their service in a senior capacity to which disclosure applies (in which case this fact will be noted at the foot of the table.) 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 in accordance with the Occupational Pension Schemes (Transfer Values) Regulations 2008

On 16 March 2016, the Chancellor of the Exchequer announced a change in the Superannuation Contributions Adjusted for Past Experience (SCAPE) discount rate from 3.0% to 2.8%. This rate affects the calculation of CETV figures in this report. Due to the lead time required to perform calculations and prepare annual reports, the CETV figures quoted in this report for members of the NHS Pension scheme are based on the previous discount rate and have not been recalculated

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.

Compensation for loss of office

In 2015/16 one employee was compensated for loss of office. This was based on the statutory redundancy pay for 2 years’ service. Details are shown in the exit packages section on page 85 and in the full accounts.

Fair pay (ratio) disclosure and Pay Multiples

Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director in their organisation and the median remuneration of the organisation’s workforce.

The banded remuneration of the highest paid member of the governing body in Sandwell and West Birmingham CCG in the financial year 2015/16 was £140,000 to £145,000 (2014-15 £140,000). This was 3.97 times the median remuneration of the workforce, which was £35,891 (2014/15 the highest paid member of the Governing Body was paid 3.8 times the median remuneration of £37,000).

In 2015/16, no employees received remuneration in excess of the highest-paid member of the governing body. Remuneration ranged from £15,000 to £145,000 (2014-15 £16,000 to £140,000). Total remuneration includes salary, non-consolidated performance-related pay, benefits in-kind, but not severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions

The contents of the remuneration report have been audited

Signed

Andy Williams

Accountable Officer

NHS Sandwell and West Birmingham CCG

26 May 2016

Staff report

Our staff

We employ 184 members of staff (including Governing Body members) who work within four key directorates:

 Quality: Safeguarding, Continuing Healthcare, Risk, Customer Care and Medicines Quality  Partnerships: Engagement, Healthy Communities Pilot Development, Equality and Diversity, Primary Care Development  Operations, including Commissioning and Service Redesign  Finance including Performance Management and Contracting.

Commissioning support

We buy support, including IT, HR and communications, from the NHS Midlands and Lancashire Commissioning Support Unit. Following a competitive tender process undertaken in 2015, we appointed Arden and Greater East Midlands Commissioning Support Unit to be our main provider of commissioning services from 1 April 2016, with Midlands and Lancashire Commissioning Support Unit continuing to provide IT and Business Intelligence services.

New staff

In order to manage and support contracted practices the CCG took on a new primary care team. Using the management budget, we strengthened our staffing team across the CCG in a number of areas:

 Quality and safety  Finance  Patient engagement  Performance and contracting  Time2Talk service.

Average numbers

% by participation Staff grouping Full-time Part-time

Governing Body 47.62% 52.38%

Other Senior Management (Band 8C+) 92.86% 7.14%

All other employees 78.52% 21.48%

Grand total 76.09% 23.91%

Composition (by gender)

Headcount by gender % by gender

Staff grouping Female Male Totals Female Male Governing Body 6 16 22 23.8% 76.2% Other Senior 7 7 14 50.0% 50.0% Management (Band 8C+) All other employees 127 22 149 85.2% 14.8% Grand total 139 45 184 75.54% 24.46%

Sickness absence data

FTE days FTE days Month Absence rate lost available April 2015 192.60 4538.91 4.24% May 2015 230.56 4851.79 4.75% June 2015 76.60 5017.88 1.53% July 2015 65.60 5252.94 1.25% August 2015 97.80 5292.72 1.85% September 2015 107.40 5111.63 2.10% October 2015 116.47 5358.27 2.17% November 2015 64.20 5114.13 1.26% December 2015 113.96 5388.75 2.11% January 2016 257.33 5370.08 4.79% Yearly cumulative 1322.52 51297.11 2.58%

Staff policies and employee consultation

We have a number of mechanisms to meaningfully engage and consult with staff. We have a formal Partnership Recognition Agreement that recognises four unions to negotiate with us on conditions relating to staff, including formal consultation.

In addition to the formal mechanisms we have a well-established Staff Council that is made up of representatives from each department and the Accountable Officer and Senior HR and OD Associate. The Staff Council is chaired by an elected member of the council and membership is reviewed annually. The council meets monthly and considers all aspects of staff satisfaction and organisational development.

Apprenticeship scheme

We currently work in partnership with Learning Works to attract and retain business administration apprentices. Learning Works is a community based NHS project dedicated to helping local people access employment in the health sector via a range of work experience, apprenticeship, volunteering and adult learning opportunities. Learning Works is also supported by a partnership of agencies (community, voluntary and public sector) committed to ensuring that those who will most benefit from the opportunity being offered are able to access it. We

83 were pleased to launch our apprentice programme during summer 2015, which involved four placements across the CCG – one in each directorate.

Equality and diversity within our workforce

Our workforce has grown considerably since last year, from 148 staff to 184. Figures show that:

 We employ considerably more women (139) than men (45), a trend which is reflected across the NHS  Over 40% of our workforce are from black and minority ethnic groups.  Black and minority ethnic groups remain under-represented amongst our Governing Body members (4.76%) and senior management (14.28%)  Almost half of our staff do not wish to disclose their religious belief (47.28%) or sexual orientation (48.91%)  We employ very few people with a disability (2.17%), although a large proportion of staff decided not to disclose or define their status  The majority of our staff are aged between 35-54 (59.78%).

To view a detailed analysis of the equality and diversity of our workforce, visit our website.

Workforce priorities

Following this analysis, we are committed to:

 Developing an equality and diversity workforce action plan to include a commitment to delivering the Workforce Race Equality Standard  Raising awareness amongst staff and Governing Body of why equality monitoring data is important and what we use it for  Improving confidence amongst staff of disclosing disability, sexual orientation, religion or belief

Employees with a disability

Employing people with a disability is important for any organisation providing services for the public as staff need to reflect the many and varied experiences of those they serve. In the provision of health services it is perhaps even more important, as people with disabilities make up a significant proportion of the population, and those with long-term conditions use the services of the NHS. Our commitment to people with disabilities includes:

 People with disabilities who meet the minimum criteria for a job vacancy are guaranteed an interview  The reasonable adjustments that people with disabilities might require in order to take up a job or continue working in a job are proactively considered  Our equality and diversity training includes awareness of a range of issues impacting on people with disabilities  The organisation ensures any employee who needs training, either because they work with people with disabilities, or because they have acquired an impairment or medical condition, receives the necessary training.

Equal opportunities

We ensured we were compliant with the Public Sector Equality Duty set out in the Equality Act 2010. This means we strive to:

 Eliminate unlawful discrimination, harassment and victimisation, and other conduct prohibited by the Act  Advance equality of opportunity between people who share a protected characteristic and those who do not  Foster good relations between people who share a protected characteristic and those who do not

Protected characteristics include age, disability, gender reassignment, pregnancy and maternity, race, religion or belief, gender, sexual orientation, and marriage and civil partnership.

We have been working closely with the Staff Council to review a number of our policies for staff. Several of these outline how we expect our staff to behave and the values we expect them to uphold. These policies cover topics including bullying and harassment, flexible working and managing sickness absence. We will be continuing to review our other policies and will also be developing an Equal Opportunities Policy for staff.

We publish an annual Equality Report on our website that sets out how we have met the public sector equality duty.

Consultancy Spend

In 2015-16 the CCG spent £1,446,000 on consultancy services (2014-15 £2,001,000)

Off-payroll engagements

Table 1 For all off-payroll engagements as of 31 March 2016, for more than £220 per day and that last longer than six months:

Number Number of Existing Engagements as of 31 March 2016 3 Of Which, the number that have existed: For less than one year at the time of reporting 1 for between one and two years at the time of reporting 1 for between 2 and 3 years at time of reporting 1 for between 3 and 4 years at time of reporting 0 for 4 or more years at time of reporting 0

Off-payroll engagements Table 2 For all new off-payroll engagements between 1 April 2015 and 31 March 2016, for more than £220 per day and that last longer than six months:

Number Number of new engagements, or those that reached six months in duration, between 1 April 2015 and 31 March 2016Existing Engagements as of 31 March 2016 4 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 3 Number for whom assurance has been requested 4 Of which: assurance has been received 4 assurance has not been received 0 engagements terminated as a result of assurance not being received 0 Table 3: For any off-payroll engagements of board members, and/or, senior officials with significant financial responsibility, between 1 April 2015 and 31 March 2016

Number Number of off-payroll engagements of board members, and /or senior officers with significant financial responsibility, during the financial year 0 Total no. of individuals on payroll and off-payroll that have been deemed "board members and/ or senior officials with significant financial responsibility", during the financial year. This figure should include both on payroll and off-payroll engagements 21

Exit Packages, including special (non contractual) payments

Departures Departures Other Other Compulsory Compulsory where special where special Agreed Agreed Total Total Redundancies Redundancies payments have payments have Departures Departures been made been made Number £' Number £' Number £' Number £' Less than 1 1,425 1 1,425 £10,000 £10,001 to 1 13,133 1 13,133 £25,000 Total CCG 1 1,425 1 13,133 2 14,558 0 0 Redundancy and other departure costs have been paid in accordance with the provisions of the Agenda for Change Redundancy Scheme. Exit costs in this note are accounted for in full in the year of departure. Where the CCG has agreed early retirements, the additional costs are met by the CCG and not by the NHS pensions scheme. Ill-health retirement costs are met by the NHS pensions scheme and are not included in the table

Details of the other agreed departures are shown in the table below:

Other Other Agreed Other Agreed Agreed Departures Departures Departures Number £' £' Contractual payments in lieu of notice 1 13,133 0

Total CCG 0 0 0

Andy Williams Accountable Officer NHS Sandwell and West Birmingham CCG 26 May 2016

INDEPENDENT AUDITOR'S REPORT TO THE MEMBERS OF THE GOVERNING BODY OF NHS SANDWELL AND WEST BIRMINGHAM CCG

We have audited the financial statements of NHS Sandwell and West Birmingham CCG for the year ended 31 March 2016 on pages 92 to 118 under the Local Audit and Accountability Act 2014. These financial statements have been prepared under applicable law and the accounting policies directed by the NHS Commissioning Board with the consent of the Secretary of State as relevant to the Clinical Commissioning Groups in England. We have also audited the information in the Remuneration and Staff Report that is subject to audit. ·

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

Respective responsibilities of the Accountable Officer and auditor

As explained more fully in the Statement of Accountable Officer's Responsibilities set out on page 61, the Accountable Officer is responsible for the preparation of financial statements which give a true and fair view and is also responsible for the regularity of expenditure and income. Our responsibility is to audit, and express an opinion on, the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards require us to comply with the Auditing Practices Board's Ethical Standards for Auditors. We are also responsible for giving an opinion on the regularity of expenditure and income in accordance with the Code of Audit Practice prepared by the Comptroller and Auditor General under the Local Audit and Accountability Act 2014 ('the Code of Audit Practice').

As explained in the Annual Governance Statement the Accountable officer is responsible for the arrangements to secure economy, efficiency and effectiveness in the use of the CCG's resources. We are required under Section 21(1)(c) of the Local Audit and Accountability Act 20 14 to be satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. Section 21(5)(b) of the Local Audit and Accountability Act 2014 requires that our report must not contain our opinion if we are satisfied that proper arrangements are in place.

We are not required to consider, nor have we considered, whether all aspects of the CCG's arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively.

Scope of the audit of the financial statements

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 and accounts 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 im-plications for our report.

In addition, we are required to obtain evidence sufficient to give reasonable assurance that the expenditure and income recorded in the financialstatements have been applied to the purposes

intended by Parliament and the financial transactions conform to the authorities which govern them.

Scope of the review of arrangements for securing economy, efficiency and effectiveness in the use of resources

We have undertaken our review in accordance with the Code of Audit Practice, having regard to the guidance on the specified criterion issued by the Comptroller and Auditor General in November 2015, as to whether the CCG had proper arrangements to ensure it took properly informed decisions and deployed resources to achieve planned and sustainable outcomes for taxpayers and local people. The Comptroller and Auditor General determined this criterion as that necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the CCG put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2016.

We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we undertook such work as we considered necessary to form a view on whether, in all significant respects, the CCG had put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources.

Opinion on financial statements

In our opinion the financial statements:

• give a true and fair view of the financial position of the CCG as at 31 March 2016 and of its net operating expenditure for the year then ended; and

• have been properly prepared in accordance with the accounting policies directed by the NHS Commissioning Board with the consent of the Secretary of State as relevant to Clinical Commissioning Groups in England.

Opinion on regularity

In our opinion, in all material respects the expenditure and income have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them.

Opinion on other matters

In.our opinion :

o the parts of the Remuneration and Staff Report subject to audit have been properly prepared in. accordance with the accounting policies directed by the NHS . Commissioning Board with the consent of the Secretary of State as relevant to Clinical Commissioning Groups in England; and

• the other information published together with the audited financial statements in the Annual Report and Accounts is consistent with the financial statements.

Matters on which we are required to report by exception

We have to report to you if:

• in our opinion, the Governance Statement does not reflect compliance with guidance issued by the NHS Commissioning Board;

• we refer a matter to the Secretary of State under section 30 of the Local Audit and Accountability Act 2014 because we have reason to believe that the CCG, or an officer of the CCG, is about to make, or has made, a decision which involves or would involve the body incurring unlawful expenditu re, or is ·about to take, or has begun to take a course of action which, if followed to its conclusion, would be unlawful and likely to cause a loss or deficiency ;or

• we issue a report in the public interest under section 24 of the Local Audit and Accountability Act 2014; or

• we make a written recommendation to the CCG under section 24 of the Local Audit and Accountability Act 2014; or

• we are not satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2016.

We have nothing to report in respect of the above responsibilities.

Certificate

We certify that we have completed the audit of the accounts of NHS Sandwell and West Birmingham CCG in accordance with the requirements of the Local Audit and Accountability Act 2014 and the Code of Audit Practice.

Andrew Bostock for and on behalf of KPMG LLP, Statutory Auditor

Chartered Accountants One Snowhill Snowhill Queensway Birmingham B46GH

27 May 2016

Primary financial statements and notes

Sandwell and West Birmingham CCG - Annual Accounts 2015-16

CONTENTS Page Number

The Primary Statements:

Statement of Comprehensive Net Expenditure for the year ended 31st March 2016 92 Statement of Financial Position as at 31st March 2016 93 Statement of Changes in Taxpayers' Equity for the year ended 31st March 2016 94 Statement of Cash Flows for the year ended 31st March 2016 95

Notes to the Accounts Accounting policies 96 Other operating revenue 102 Revenue 102 Employee benefits and staff numbers 103 Operating expenses 106 Better payment practice code 107 Income generation activities 107 Investment revenue 107 Other gains and losses 107 Finance costs 107 Net gain/(loss) on transfer by absorption 108 Operating leases 108 Property, plant and equipment 108 Intangible non-current assets 108 Investment property 108 Inventories 108 Trade and other receivables 109 Other financial assets 110 Other current assets 110 Cash and cash equivalents 110 Non-current assets held for sale 110 Analysis of impairments and reversals 110 Trade and other payables 111 Deferred revenue 111 Other financial liabilities 111 Borrowings 111 Private finance initiative, LIFT and other service concession arrangements 111 Finance lease obligations 111 Finance lease receivables 111 Provisions 112 Contingencies 113 Commitments 113 Financial instruments 113 Operating segments 114 Pooled budgets 115 NHS Lift investments 115 Related party transactions 116 Events after the end of the reporting period 117 Losses and special payments 117 Third party assets 118 Financial performance targets 118 Impact of IFRS 118 Analysis of charitable reserves 118 Intra-government and other balances 118

91 Sandwell and West Birmingham CCG - Annual Accounts 2015-16

Statement of Comprehensive Net Expenditure for the year ended 31-March-2016 2015-16 2014-15 Note £000 £000

Total Income and Expenditure Employee benefits 4.1.1 8,057 6,460 Operating Expenses 5 742,614 635,066 Other operating revenue 2 (15,917) (16,165) Net operating expenditure before interest 734,754 625,361

Investment Revenue 8 0 0 Other (gains)/losses 9 0 0 Finance costs 10 0 0 Net operating expenditure for the financial year 734,754 625,361 Net (gain)/loss on transfers by absorption 11 0 0 Total Net Expenditure for the year 734,754 625,361

Of which: Administration Income and Expenditure Employee benefits 4.1.1 5,337 4,109 Operating Expenses 5 7,011 7,809 Other operating revenue 2 (1,495) (1,574) Net administration costs before interest 10,852 10,344

Programme Income and Expenditure Employee benefits 4.1.1 2,720 2,351 Operating Expenses 5 735,604 627,257 Other operating revenue 2 (14,422) (14,591) Net programme expenditure before interest 723,902 615,017

Other Comprehensive Net Expenditure 2015-16 2014-15 £000 £000 Impairments and reversals 22 0 0 Net gain/(loss) on revaluation of property, plant & equipment 0 0 Net gain/(loss) on revaluation of intangibles 0 0 Net gain/(loss) on revaluation of financial assets 0 0 Movements in other reserves 0 0 Net gain/(loss) on available for sale financial assets 0 0 Net gain/(loss) on assets held for sale 0 0 Net actuarial gain/(loss) on pension schemes 0 0 Share of (profit)/loss of associates and joint ventures 0 0 Reclassification Adjustments On disposal of available for sale financial assets 0 0 Total comprehensive net expenditure for the year 734,754 625,361

The notes on pages 96 to 111 form part of this statement

92 Sandwell and West Birmingham CCG - Annual Accounts 2015-16

Statement of Financial Position as at 31-March-2016 2015-16 2014-15

Note £000 £000 Non-current assets: Property, plant and equipment 13 0 0 Intangible assets 14 0 0 Investment property 15 0 0 Trade and other receivables 17 0 0 Other financial assets 18 0 0 Total non-current assets 0 0 Current assets: Inventories 16 0 0 Trade and other receivables 17 5,547 5,048 Other financial assets 18 0 0 Other current assets 19 0 0 Cash and cash equivalents 20 337 268 Total current assets 5,884 5,316

Non-current assets held for sale 21 0 0

Total current assets 5,884 5,316

Total assets 5,884 5,316

Current liabilities Trade and other payables 23 (41,843) (41,114) Other financial liabilities 24 0 0 Other liabilities 25 0 0 Borrowings 26 0 0 Provisions 30 (3,570) (1,956) Total current liabilities (45,413) (43,070)

Non-Current Assets plus/less Net Current Assets/Liabilities (39,529) (37,754)

Non-current liabilities Trade and other payables 23 0 0 Other financial liabilities 24 0 0 Other liabilities 25 0 0 Borrowings 26 0 0 Provisions 30 0 0 Total non-current liabilities 0 0

Assets less Liabilities (39,529) (37,754)

Financed by Taxpayers’ Equity General fund (39,529) (37,754) Revaluation reserve 0 0 Other reserves 0 0 Charitable Reserves 0 0 Total taxpayers' equity: (39,529) (37,754)

The notes on pages 111 to 118 form part of this statement

The financial statements on pages 92 to 95 were approved by the Governing Body on 19 May 2016 and signed on its behalf by:

Andy Williams Chief Accountable Officer Sandwell and West Birmingham CCG

93 Sandwell and West Birmingham CCG - Annual Accounts 2015-16

Statement of Changes In Taxpayers Equity for the year ended 31-March-2016 Revaluation Other Total General fund reserve reserves reserves £000 £000 £000 £000 Changes in taxpayers’ equity for 2015-16

Balance at 1 April 2015 (37,754) 0 0 (37,754)

Transfer between reserves in respect of assets transferred from closed NHS bodies 0 0 0 0 Adjusted NHS Clinical Commissioning Group balance at 1 April 2015 (37,754) 0 0 (37,754)

Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2015-16 Net operating expenditure for the financial year (734,754) (734,754)

Net gain/(loss) on revaluation of property, plant and equipment 0 0 Net gain/(loss) on revaluation of intangible assets 0 0 Net gain/(loss) on revaluation of financial assets 0 0 Total revaluations against revaluation reserve 0 0 0 0

Net gain (loss) on available for sale financial assets 0 0 0 0 Net gain (loss) on revaluation of assets held for sale 0 0 0 0 Impairments and reversals 0 0 0 0 Net actuarial gain (loss) on pensions 0 0 0 0 Movements in other reserves 0 0 0 0 Transfers between reserves 0 0 0 0 Release of reserves to the Statement of Comprehensive Net Expenditure 0 0 0 0 Reclassification adjustment on disposal of available for sale financial assets 0 0 0 0 Transfers by absorption to (from) other bodies 0 0 0 0 Reserves eliminated on dissolution 0 0 0 0 Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year (734,754) 0 0 (734,754)

Net funding 732,979 0 0 732,979 Balance at 31 March 2016 (39,529) 0 0 (39,529)

Revaluation Other Total General fund reserve reserves reserves £000 £000 £000 £000 Changes in taxpayers’ equity for 2014-15

Balance at 1 April 2014 (43,204) 0 0 (43,204) Transfer of assets and liabilities from closed NHS bodies as a result of the 1 April 2013 transition 0 0 0 0 Adjusted NHS Commissioning Board balance at 1 April 2014 (43,204) 0 0 (43,204)

Changes in NHS Commissioning Board taxpayers’ equity for 2014-15 Net operating costs for the financial year (625,357) (625,357)

Net gain (loss) on available for sale financial assets 0 0 0 0 Net gain (loss) on revaluation of assets held for sale 0 0 0 0 Impairments and reversals 0 0 0 0 Net actuarial gain (loss) on pensions 0 0 0 0 Movements in other reserves 0 0 0 0 Transfers between reserves 0 0 0 0 Release of reserves to the Statement of Comprehensive Net Expenditure 0 0 0 0 Reclassification adjustment on disposal of available for sale financial assets 0 0 0 0 Transfers by absorption to (from) other bodies 0 0 0 0 Reserves eliminated on dissolution 0 0 0 0 Net Recognised NHS Commissioning Board Expenditure for the Financial Year (625,357) 0 0 (625,357) Net funding 630,807 0 0 630,807 Balance at 31 March 2015 (37,754) 0 0 (37,754)

The notes on pages 96 to 118 form part of this statement

94 Sandwell and West Birmingham CCG - Annual Accounts 2015-16

Statement of Cash Flows for the year ended 31-March-2016 2015-16 2014-15 Note £000 £000 Cash Flows from Operating Activities Net operating expenditure for the financial year (734,754) (625,361) Depreciation and amortisation 5 0 0 Impairments and reversals 5 0 0 Movement due to transfer by Modified Absorption 0 0 Other gains (losses) on foreign exchange 0 0 Donated assets received credited to revenue but non-cash 0 0 Government granted assets received credited to revenue but non-cash 0 0 Interest paid 0 0 Release of PFI deferred credit 0 0 Other Gains & Losses 0 0 Finance Costs 0 0 Unwinding of Discounts 0 0 (Increase)/decrease in inventories 0 0 (Increase)/decrease in trade & other receivables 17 (498) 3,408 (Increase)/decrease in other current assets 0 0 Increase/(decrease) in trade & other payables 23 729 (8,897) Increase/(decrease) in other current liabilities 0 0 Provisions utilised 30 (759) (326) Increase/(decrease) in provisions 30 2,372 653 Net Cash Inflow (Outflow) from Operating Activities (732,910) (630,523)

Cash Flows from Investing Activities Interest received 0 0 (Payments) for property, plant and equipment 0 0 (Payments) for intangible assets 0 0 (Payments) for investments with the Department of Health 0 0 (Payments) for other financial assets 0 0 (Payments) for financial assets (LIFT) 0 0 Proceeds from disposal of assets held for sale: property, plant and equipment 0 0 Proceeds from disposal of assets held for sale: intangible assets 0 0 Proceeds from disposal of investments with the Department of Health 0 0 Proceeds from disposal of other financial assets 0 0 Proceeds from disposal of financial assets (LIFT) 0 0 Loans made in respect of LIFT 0 0 Loans repaid in respect of LIFT 0 0 Rental revenue 0 0 Net Cash Inflow (Outflow) from Investing Activities 0 0

Net Cash Inflow (Outflow) before Financing (732,910) (630,523)

Cash Flows from Financing Activities Grant in Aid Funding Received 732,979 630,807 Other loans received 0 0 Other loans repaid 0 0 Capital element of payments in respect of finance leases and on Statement of Financial Position PFI and LIFT 0 0 Capital grants and other capital receipts 0 0 Capital receipts surrendered 0 0 Net Cash Inflow (Outflow) from Financing Activities 732,979 630,807

Net Increase (Decrease) in Cash & Cash Equivalents 20 69 284

Cash & Cash Equivalents at the Beginning of the Financial Year 268 (16)

Effect of exchange rate changes on the balance of cash and cash equivalents held in foreign currencies 0 0

Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year 337 268

The notes on pages 96 to 118 form part of this statement

95 Sandwell and West Birmingham CCG - Annual Accounts 2015-16

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 2015-16 issued by the Department of Health. The accounting policies contained in the Manual for Accounts follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to 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.

1.1 Going Concern These accounts have been prepared on the going concern basis. Public sector bodies are assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as evidenced by inclusion of financial provision for that service in published documents. Where a 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 Acquisitions & Discontinued Operations

Activities are considered to be ‘acquired’ only if they are taken on from outside the public sector. Activities are considered to be ‘discontinued’ only if they cease entirely. They are not considered to be ‘discontinued’ if they transfer from one public sector body to another.

1.4 Movement of Assets within the Department of Health Group Transfers as part of reorganisation fall to be accounted for by use of absorption accounting in line with the Government Financial Reporting Manual, issued by HM Treasury. The Government Financial Reporting Manual does not require retrospective adoption, so prior year transactions (which have been accounted for under merger accounting) have not been restated. Absorption accounting requires that entities account for their transactions in the period in which they took place, with no restatement of performance required when functions transfer within the public sector. Where assets and liabilities transfer, the gain or loss resulting is recognised in the Statement of Comprehensive Net Expenditure, and is disclosed separately from operating costs. Other transfers of assets and liabilities within the Department of Health Group are accounted for in line with IAS 20 and similarly give rise to income and expenditure entries.

1.5 Charitable Funds From 2014-15, the divergence from the Government Financial Reporting Manual that NHS Charitable Funds are not consolidated with bodies’ own returns is removed. Under the provisions of IAS 27: Consolidated & Separate Financial Statements, those Charitable Funds that fall under common control with NHS bodies are consolidated within the entities’ accounts.

1.6 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. If the clinical commissioning group is in a “jointly controlled operation”, the clinical commissioning group recognises: · The assets the clinical commissioning group controls; · The liabilities the clinical commissioning group incurs; · The expenses the clinical commissioning group incurs; and, · The clinical commissioning group’s share of the income from the pooled budget activities. If the clinical commissioning group is involved in a “jointly controlled assets” arrangement, in addition to the above, the clinical commissioning group recognises: · The clinical commissioning group’s share of the jointly controlled assets (classified according to the nature of the assets); · The clinical commissioning group’s share of any liabilities incurred jointly; and, · The clinical commissioning group’s share of the expenses jointly incurred.

1.7 Critical Accounting Judgements & Key Sources of Estimation Uncertainty In the application of the clinical commissioning group’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. 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. The Clinical Commissioning Group is a partner in a Better Care Fund pooled budget for Birmingham and a Better Care fund Pooled Budget in Sandwell as well as Mental Health Pooled Budgets

1.7.1 Critical Judgements in Applying Accounting Policies The following are the critical judgements, apart from those involving estimations (see below) 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:

96 Sandwell and West Birmingham CCG - Annual Accounts 2015-16

Notes to the financial statements

 Premises occupied by the Clinical Commissioning Group are owned and managed by NHS Property Services Limited and NHS Community Health Partnerships Limited, and a charge is levied from these Companies to the CCG. Management treats these arrangements as operating leases, as substantially all of the risks and rewards of ownership reside with the premises owners.

· The clinical commissioning group’s management have made a critical judgement in relation to the Better Care Fund (BCF) accounting policies. The substance of each programme that forms part of the BCF Pooled Budget has been assessed as to whether it meets the principles within IFRS 11: ‘Joint Arrangements’. Specific programmes have been assessed as either: (1) Joint Commissioning arrangements under which each Pool Partner accounts for their share of expenditure and balances with the end provider; (2) Lead Commissioning arrangements under which the lead commissioner accounts for expenditure with the end provider and other partners report transactions and balances with the lead commissioner; or (3) Sole Control arrangements under which the provisions of IFRS 11 do not apply.  The Clinical Commissioning Group is responsible for meeting the costs associated with the care of eligible patients' under the Continuing Healthcare criteria. Claims received during the year but not formally assessed by the year end are reviewed against key criteria, and judgements are made in respect of their likely success. Provision is made for those deemed probable under IAS 37, whilst those for which a possible payout is likely are disclosed as contingent liabilities.

1.7.2 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:  The CCG reviews all outstanding debts for recoverability, and makes specific provision for 100% of the value of non NHS debts for which settlement is uncertain.  The Clinical Commissioning Group recognises the cost of drug prescribing based on data received from the NHS Prescription Pricing Authority (PPA). Reports are received on a monthly basis, but reflect transactions up to the end of February only. March costs are estimated using PPA forecast levels of expenditure during March.  The value of expected claims for Continuing Healthcare are estimated based on the number of days a patient has spent in a care home, multiplied by the daily charge of that provider and provided for within gross expenditure.  The CCG receives charges for the treatment of registered patients at out of area providers with which the CCG does not have a formal contract (as activity levels are low). Estimates are made in respect of the value of activity for which invoices have not been received by the year end based on detailed analysis of historical performance. The costs of this activity are provided for within gross expenditure.  Healthcare providers raise charges for patient care activity, once the patient has been discharged. CCGs and providers recognise that some patients will have received treatment at the year end, but not yet discharged. Provision is made for the estimated cost of these "Partially Completed Spells" delivered within the financial year based on the time a patient has been admitted for as a proportion of the overall expected length of stay. The value is agreed with the healthcare provider.  National Payment by Results rules under which providers are reimbursed for the costs of provision of maternity services require an advance payment for the full costs of antenatal and postnatal care upon initial registration with a midwife. An element of the care for some patients will be delivered after the year end. The value of this prepayment is estimated based on the amount of treatment each patient has received in the financial year as a proportion of the overall expected treatment cost, recognising that costs do not accrue equally throughout the ante and post natal terms. The value is agreed with the providers of maternity care.  The cost of healthcare provision included within gross expenditure is based on activity monitoring information maintained by healthcare providers and validated by the CCG. Final data is not available until after the CCG has published its financial statements, and therefore costs in respect of this activity are estimated based on historical activity performance levels. The estimates are agreed with provider organisations, and reflected within gross income in their financial statements.  The Clinical Commissioning Group received delegated funding for Primary care Co-commissioning. All transactions are processed by NHS England and the Clinical Commissioning Group records the transactions within its ledger based on information received from NHS England. The Clinical Commissioning Group is reliant on the information received from NHS England and accounts for the transactions based on the information received.

1.8 Revenue Revenue in respect of services provided is recognised when, and to the extent that, performance occurs, and is measured at the fair value of the consideration receivable. Where income is received for a specific activity that is to be delivered in the following year, that income is deferred.

1.9 Employee Benefits

1.9.1 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.

1.9.2 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. For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to expenditure at the time the clinical commissioning group commits itself to the retirement, regardless of the method of payment.

1.10 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.

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Notes to the financial statements

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.

1.11 Property, Plant & Equipment 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.

1.12 Intangible Assets 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.

1.13 Depreciation, Amortisation & Impairments Freehold land, properties under construction, and assets held for sale are not depreciated.

Otherwise, depreciation and amortisation are charged to write off the costs or valuation of property, plant and equipment and intangible non- current assets, less any residual value, over their estimated useful lives, in a manner that reflects the consumption of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over which the 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. Assets held under finance leases are depreciated over their estimated useful lives.

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.

1.14 Donated Assets

Donated non-current assets are capitalised at their fair value on receipt, with a matching credit to Income. They are valued, depreciated and impaired as described above for purchased assets. Gains and losses on revaluations, impairments and sales are as described above for purchased assets. Deferred income is recognised only where conditions attached to the donation preclude immediate recognition of the gain.

1.15 Government Grants The value of assets received by means of a government grant are credited directly to income. Deferred income is recognised only where conditions attached to the grant preclude immediate recognition of the gain.

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Notes to the financial statements

1.16 Non-current Assets Held For Sale Non-current assets are classified as held for sale if their carrying amount will be recovered principally through a sale transaction rather than through continuing use. This condition is regarded as met when: · The sale is highly probable; · The asset is available for immediate sale in its present condition; and, · Management is committed to the sale, which is expected to qualify for recognition as a completed sale within one year from the date of classification. Non-current assets held for sale are measured at the lower of their previous carrying amount and fair value less costs to sell. Fair value is open market value including alternative uses. The profit or loss arising on disposal of an asset is the difference between the sale proceeds and the carrying amount and is recognised in the Statement of Comprehensive Net Expenditure. On disposal, the balance for the asset on the revaluation reserve is transferred to the general reserve. Property, plant and equipment that is to be scrapped or demolished does not qualify for recognition as held for sale. Instead, it is retained as an operational asset and its economic life is adjusted. The asset is de-recognised when it is scrapped or demolished.

1.17 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.

1.17.1 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.

1.17.2 The Clinical Commissioning Group as Lessor Amounts due from lessees under finance leases are recorded as receivables at the amount of the clinical commissioning group’s net investment in the leases. Finance lease income is allocated to accounting periods so as to reflect a constant periodic rate of return on the clinical commissioning group’s net investment outstanding in respect of the leases. Rental income from operating leases is recognised on a straight-line basis over the term of the lease. Initial direct costs incurred in negotiating and arranging an operating lease are added to the carrying amount of the leased asset and recognised on a straight-line basis over the lease term.

1.17 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.

1.18 Private Finance Initiative Transactions HM Treasury has determined that government bodies shall account for infrastructure Private Finance Initiative (PFI) schemes where the government body controls the use of the infrastructure and the residual interest in the infrastructure at the end of the arrangement as service concession arrangements, following the principles of the requirements of IFRIC 12. The clinical commissioning group therefore recognises the PFI asset as an item of property, plant and equipment together with a liability to pay for it. The services received under the contract are recorded as operating expenses. The annual unitary payment is separated into the following component parts, using appropriate estimation techniques where necessary: · Payment for the fair value of services received; · Payment for the PFI asset, including finance costs; and, · Payment for the replacement of components of the asset during the contract ‘lifecycle replacement’.

1.19 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.

1.20 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.

1.21 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.

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Notes to the financial statements

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.

1.22 Clinical Negligence Costs

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.

1.23 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.

1.24 Continuing healthcare risk pooling In 2014-15 a risk pool scheme was introduced by NHS England for continuing healthcare claims, for claim periods prior to 31 March 2013. Under the scheme clinical commissioning groups contribute annually to a pooled fund, which is used to settle the claims. The scheme continued during 2015-16 and is expected to continue for 2016-17 also. 1.25 Carbon Reduction Commitment Scheme Carbon Reduction Commitment and similar allowances are accounted for as government grant funded intangible assets if they are not expected to be realised within twelve months, and otherwise as other current assets.

1.26 Contingencies

A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence or non- occurrence of one or more uncertain future events not wholly within the control of the clinical commissioning group, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or the amount of the obligation cannot be measured sufficiently reliably. A contingent liability is disclosed unless the possibility of a payment is remote. A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the clinical commissioning group. A contingent asset is disclosed where an inflow of economic benefits is probable. Where the time value of money is material, contingencies are disclosed at their present value.

1.27 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. All of the CCGs financial assets are classified as loans and receivables based on their nature and purpose as determined at the time of initial recognition

1.27.1 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.

1.28 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 derecognised 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.

1.28.1 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.

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Notes to the financial statements

1.29 Value Added Tax Most of the activities of the clinical commissioning group are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.

1.30 Foreign Currencies The clinical commissioning group’s functional currency and presentational currency is sterling. Transactions denominated in a foreign currency are translated into sterling at the exchange rate ruling on the dates of the transactions. At the end of the reporting period, monetary items denominated in foreign currencies are retranslated at the spot exchange rate on 31 March. Resulting exchange gains and losses for either of these are recognised in the clinical commissioning group’s surplus/deficit in the period in which they arise.

1.31 Third Party Assets Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the clinical commissioning group has no beneficial interest in them.

1.32 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).

1.33 Joint Ventures Material entities over which the clinical commissioning group has joint control with one or more other parties so as to obtain economic or other benefits are classified as joint ventures. Joint ventures are accounted for using the equity method. Joint ventures that are classified as ‘held for sale’ are measured at the lower of their carrying amount or ‘fair value less costs to sell’.

1.34 Joint Operations Joint operations are activities undertaken by the clinical commissioning group in conjunction with one or more other parties but which are not performed through a separate entity. The clinical commissioning group records its share of the income and expenditure; gains and losses; assets and liabilities; and cash flows.

1.35 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.

1.36 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 2015-16, all of which are subject to consultation: · IFRS 9: Financial Instruments · IFRS 14: Regulatory Deferral Accounts · IFRS 15: Revenue for Contract with Customers

The application of the Standards as revised would not have a material impact on the accounts for 2015-16, were they applied in that year.

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2 Other Operating Revenue 2015-16 2015-16 2015-16 2014-15 Total Admin Programme Total £000 £000 £000 £000

Recoveries in respect of employee benefits 0 0 0 0 Patient transport services 0 0 0 0 Prescription fees and charges 832 0 832 923 Dental fees and charges 0 0 0 0 Education, training and research 3 3 0 0 Charitable and other contributions to revenue expenditure: NHS 0 0 0 0 Charitable and other contributions to revenue expenditure: non-NHS 0 0 0 134 Receipt of donations for capital acquisitions: NHS Charity 0 0 0 0 Receipt of Government grants for capital acquisitions 0 0 0 0 Non-patient care services to other bodies 14,785 1,194 13,591 14,694 Continuing Health Care risk pool contributions 0 0 0 0 Income generation 0 0 0 0 Rental revenue from finance leases 0 0 0 0 Rental revenue from operating leases 0 0 0 0 Other revenue 298 298 0 414 Total other operating revenue 15,917 1,495 14,422 16,165

Items included in other revenue include: Return of unutilised NHS111 funding £200k Right care right here programme management costs £48k Stroke Project £44k

Non-patient care services to other bodies: NHS 111 income amounted to £14,441k Additional revenue received in relation to NHS 111 Pilots £158k

3 Revenue 2015-16 2015-16 2015-16 2014-15 Total Admin Programme Total £000 £000 £000 £000 From rendering of services 15,917 1,495 14,422 16,165 From sale of goods 0 0 0 0 Total 15,917 1,495 14,422 16,165

Revenue is totally from the supply of services. The Clinical Commissioning Group receives no revenue from the sale of goods.

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4. Employee benefits and staff numbers

4.1.1 Employee benefits 2015-16 Total Admin Programme

Permanent Permanent Permanent Total Employees Other Total Employees Other Total Employees Other £000 £000 £000 £000 £000 £000 £000 £000 £000 Employee Benefits Salaries and wages 6,854 5,875 979 4,538 3,880 658 2,316 1,995 321 Social security costs 507 507 0 342 342 0 165 165 0 Employer Contributions to NHS Pension scheme 696 696 0 457 457 0 239 239 0 Other pension costs 0 0 0 0 0 0 0 0 0 Other post-employment benefits 0 0 0 0 0 0 0 0 0 Other employment benefits 0 0 0 0 0 0 0 0 0 Termination benefits 0 0 0 0 0 0 0 0 0 Gross employee benefits expenditure 8,057 7,078 979 5,337 4,679 658 2,720 2,399 321

Less recoveries in respect of employee benefits (note 4.1.2) 0 0 0 0 0 0 0 0 0 Total - Net admin employee benefits including capitalised costs 8,057 7,078 979 5,337 4,679 658 2,720 2,399 321

Less: Employee costs capitalised 0 0 0 0 0 0 0 0 0 Net employee benefits excluding capitalised costs 8,057 7,078 979 5,337 4,679 658 2,720 2,399 321

4.1.1 Employee benefits 2014-15 Total Admin Programme

Permanent Permanent Permanent Total Employees Other Total Employees Other Total Employees Other £000 £000 £000 £000 £000 £000 £000 £000 £000 Employee Benefits Salaries and wages 5,382 5,032 350 3,396 3,149 247 1,986 1,883 103 Social security costs 469 469 0 315 315 0 154 154 0 Employer Contributions to NHS Pension scheme 609 609 0 398 398 0 211 211 0 Other pension costs 0 0 0 0 0 0 0 0 0 Other post-employment benefits 0 0 0 0 0 0 0 0 0 Other employment benefits 0 0 0 0 0 0 0 0 0 Termination benefits 0 0 0 0 0 0 0 0 0 Gross employee benefits expenditure 6,460 6,110 350 4,109 3,862 247 2,351 2,248 103

Less recoveries in respect of employee benefits (note 4.1.2) 0 0 0 0 0 0 0 0 0 Total - Net admin employee benefits including capitalised costs 6,460 6,110 350 4,109 3,862 247 2,351 2,248 103

Less: Employee costs capitalised 0 0 0 0 0 0 0 0 0 Net employee benefits excluding capitalised costs 6,460 6,110 350 4,109 3,862 247 2,351 2,248 103

4.1.2 Recoveries in respect of employee benefits The Clinical Commissioning Group did not receive any recoveries in respect of employee benefits during the year to 31st March 2016

103 Sandwell and West Birmingham CCG - Annual Accounts 2015-16

4.2 Average number of people employed 2015-16 2014-15 Permanently Total employed Other Total Number Number Number Number

Total 172 155 17 135

Of the above: Number of whole time equivalent people engaged on capital projects 0 0 0 0

4.3 Staff sickness absence and ill health retirements 2015-16 2014-15 Number Number Total Days Lost 886 721 Total Staff Years 161 136 Average working Days Lost 5.5 5.3

2015-16 2014-15 Number Number Number of persons retired early on ill health grounds 0 0

£000 £000 Total additional Pensions liabilities accrued in the year 0 0

Ill health retirement costs are met by the NHS Pension Scheme

4.4 Exit packages agreed in the financial year

2015-16 2015-16 2015-16 Compulsory redundancies Other agreed departures Total Number £ Number £ Number £ Less than £10,000 1 1,425 0 0 1 1,425 £10,001 to £25,000 0 0 1 13,133 1 13,133 Total 1 1,425 1 13,133 2 14,558

2014-15 2014-15 2014-15 Compulsory redundancies Other agreed departures Total Number £ Number £ Number £ £10,001 to £25,000 1 13,950 0 0 1 13,950 Total 1 13,950 0 0 1 13,950

Analysis of Other Agreed Departures 2015-16 2014-15 Other agreed departures Other agreed departures Number £ Number £ Contractual payments in lieu of notice 1 13,133 0 0 Total 1 13,133 0 0

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

104 Sandwell and West Birmingham CCG - Annual Accounts 2015-16

4.5 Pension costs

Past and present employees are covered by the provisions of the NHS Pension Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/Pensions.

The Scheme is an unfunded, 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:

4.5.1 Full actuarial (funding) valuation

The purpose of this valuation is to assess the level of liability in respect of the benefits due under the Scheme (taking into account its recent demographic experience), and to recommend the contribution rates to be paid by employers and scheme members. The last such valuation, which determined current contribution rates was undertaken as at 31 March 2012 and covered the period from 1 April 2008 to that date. Details can be found on the pension scheme website at www.nhsbsa.nhs.uk/pensions.

For 2015-16, employers’ contributions of £696,000 were payable to the NHS Pensions Scheme (2014-15: £609,000) were payable to the NHS Pension Scheme at the rate of 14.3% of pensionable pay. The scheme’s actuary reviews employer contributions, usually every four years and now based on HMT Valuation Directions, following a full scheme valuation. The latest review used data from 31 March 2012 and was published on the Government website on 9 June 2014.

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5. Operating expenses 2015-16 2015-16 2015-16 2014-15 Total Admin Programme Total £000 £000 £000 £000 Gross employee benefits Employee benefits excluding governing body members 7,732 5,012 2,720 6,135 Executive governing body members 325 325 0 325 Total gross employee benefits 8,057 5,337 2,720 6,460

Other costs Services from other CCGs and NHS England 36,841 2,851 33,990 35,674 Services from foundation trusts 148,964 22 148,942 151,019 Services from other NHS trusts 292,484 12 292,471 295,643 Services from other NHS bodies 1 0 1 0 Purchase of healthcare from non-NHS bodies 88,440 0 88,440 55,178 Chair and Non Executive Members 657 657 0 703 Supplies and services – clinical 22 0 22 13 Supplies and services – general 436 161 275 556 Consultancy services 1,446 1,193 253 2,001 Establishment 845 330 515 703 Transport 5 3 2 4 Premises 4,040 581 3,459 4,520 Impairments and reversals of receivables 868 28 840 18 Inventories written down 0 0 0 0 Depreciation 0 0 0 0 Amortisation 0 0 0 0 Impairments and reversals of property, plant and equipment 0 0 0 0 Impairments and reversals of intangible assets 0 0 0 0 Impairments and reversals of financial assets · Assets carried at amortised cost 0 0 0 0 · Assets carried at cost 0 0 0 0 · Available for sale financial assets 0 0 0 0 Impairments and reversals of non-current assets held for sale 0 0 0 0 Impairments and reversals of investment properties 0 0 0 0 Audit fees 86 86 0 114 Other non statutory audit expenditure · Internal audit services 74 74 0 77 · Other services 13 13 0 1 General dental services and personal dental services 0 0 0 0 Prescribing costs 85,746 0 85,746 83,130 Pharmaceutical services 0 0 0 0 General ophthalmic services 0 0 0 38 GPMS/APMS and PCTMS 76,779 0 76,779 3,142 Other professional fees excl. audit 824 815 9 758 Grants to other public bodies 0 0 0 0 Clinical negligence 11 11 0 11 Research and development (excluding staff costs) 0 0 0 0 Education and training 241 162 79 192 Change in discount rate 0 0 0 0 Provisions 2,372 0 2,372 653 Funding to group bodies 0 0 0 CHC Risk Pool contributions 1,410 0 1,410 884 Other expenditure 11 11 0 34 Total other costs 742,614 7,011 735,604 635,066

Total operating expenses 750,671 12,348 738,324 641,526

Notes: 1 The increase in GPMS/APMS and PCTMS costs is due to the delegation of Primary Care budgets to the the CCG. The value of the delegated budget is £73.982m

2 The increase in Purchase of Healthcare from non-NHS bodies is due to the following: New care models pilot £2.710m Primary Care innovation fund £0.760m Better Care Fund £17.114m NHS111 £8.295m Birmingham Equipment Loans store £0.834m Mental Health Services £0.849m

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6.1 Better Payment Practice Code

Measure of compliance 2015-16 2015-16 2014-15 2014-15 Number £000 Number £000 Non-NHS Payables Total Non-NHS Trade invoices paid in the Year 14,919 108,833 11,249 62,643 Total Non-NHS Trade Invoices paid within target 14,285 104,653 10,835 57,475 Percentage of Non-NHS Trade invoices paid within target 95.8% 96.2% 96.3% 91.8%

NHS Payables Total NHS Trade Invoices Paid in the Year 3,568 488,083 3,446 498,195 Total NHS Trade Invoices Paid within target 3,441 486,158 3,226 489,548 Percentage of NHS Trade Invoices paid within target 96.4% 99.6% 93.6% 98.3%

6.2 The Late Payment of Commercial Debts (Interest) Act 1998 2015-16 2014-15 £000 £000

Amounts included in finance costs from claims made under this legislation 0 0 Compensation paid to cover debt recovery costs under this legislation 0 0 Total 0 0

7 Income Generation Activities

The Clincial Commissioning Group does not undertake any income generation activites

8. Investment revenue

The Clinical Commissioning Group did not receive investment revenue during the year to 31 March 2016

9. Other gains and losses

The Clinical Commissioning Group did not incur any other gains or losses during the year to 31 March 2016

10. Finance costs

The Clinical Commissioning Group did not incur any finance costs during the year to 31 March 2016

107 Sandwell and West Birmingham CCG - Annual Accounts 2015-16

11. Net gain/(loss) on transfer by absorption

The CCG did not incur any gains or losses on transfer by absorption during the year to 31 March 2016

12. Operating Leases

12.1 As lessee

The CCG has payments with NHS Property Services Ltd and NHS Community Health Partnerships Ltd during the year in relation to the occupation of premises transferred to those companies on 1 April 2013. Although there are no formal lease agreements in place, the CCG, NHS Property Services Ltd and Community Health Partnerships Ltd deem these to be operating leases, and account for them as such. No detail is currently available to split the charges from CHP and NHSPS for accomodation so all costs are currently shown below. 12.1.1 Payments recognised as an Expense 2015-16 2014-15 Land Buildings Other Total Land Buildings Other Total £000 £000 £000 £000 £000 £000 £000 £000 Payments recognised as an expense Minimum lease payments 0 3,366 10 3,376 0 4,520 11 4,531 Contingent rents 0 0 0 0 0 0 0 0 Sub-lease payments 0 0 0 0 0 0 0 0 Total 0 3,366 10 3,376 0 4,520 11 4,531

Whilst our arrangements with Community Health Partnership's Limited and NHS Property Services Limited fall within the definition of operating leases, rental charge for future years has not yet been agreed . Consequently this note does not include future minimum lease payments for the arrangements.

12.1.2 Future minimum lease payments 2015-16 2014-15 Land Buildings Other Total Land Buildings Other Total £000 £000 £000 £000 £000 £000 £000 £000 Payable: No later than one year 0 0 0 0 0 - - 0 Between one and five years 0 0 0 0 0 - - 0 After five years 0 0 0 0 0 - - 0 Total 0 0 0 0 0 0 0 0

12.2 As lessor

12.2.1 Rental revenue The CCG did not receive any rental revenue during the year to 31 March 2016

12.2.2 Future minimum rental value The CCG does not have any future rental revenue during the year to 31 March 2016

13 Property, plant and equipment

The Clinical Commissioning Group had no property, plant or equipment assets as at 31 March 2016.

14 Intangible non-current assets

The Clinical Commissioning Group had no intangible assest as at 31 March 2016.

15 Investment property

The Clinical Commissioning Group had no investment property as at 31 March 2016.

16 Inventories

The Clinical Commissioning Group had no inventories as at 31 March 2016.

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17 Trade and other receivables Current Non-current Current Non-current 2015-16 2015-16 2014-15 2014-15 £000 £000 £000 £000

NHS receivables: Revenue 1,578 0 911 0 NHS receivables: Capital 0 0 0 0 NHS prepayments 2,129 0 2,224 0 NHS accrued income 630 0 532 0 Non-NHS receivables: Revenue 1,559 0 693 0 Non-NHS receivables: Capital 0 0 0 0 Non-NHS prepayments 394 0 520 0 Non-NHS accrued income 239 0 307 0 Provision for the impairment of receivables (1,026) 0 (171) 0 VAT 9 0 31 0

Private finance initiative and other public private partnership arrangement prepayments and accrued income 0 0 0 0 Interest receivables 0 0 0 0 Finance lease receivables 0 0 0 0 Operating lease receivables 0 0 0 0 Other receivables 36 0 0 0 Total Trade & other receivables 5,547 0 5,047 0

Total current and non current 5,547 5,047

Included above: Prepaid pensions contributions 0 0

The great majority of trade is with other NHS bodies, including other Clinical Commissioning Groups as commissioners for NHS patient care services. As Clinical Commissioning Groups are funded by Government to buy NHS patient care services, no credit scoring of them is considered necessary.

17.1 Receivables past their due date but not impaired 2015-16 2014-15 £000 £000

By up to three months 2,056 1,021 By three to six months 48 47 By more than six months 29 36 Total 2,133 1,104

£447k 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 2016.

17.2 Provision for impairment of receivables 2015-16 2014-15 £000 £000

Balance at 01-April-2015 (171) (255)

Amounts written off during the year 0 102 Amounts recovered during the year 13 0 (Increase) decrease in receivables impaired (868) (18) Transfer (to) from other public sector body 0 0 Balance at 31-March-2016 (1,026) (171)

Debt impaired includes all non NHS debt over three months overdue. This includes debt where recovery processes are taking place. Also impaired are debts under three months overdue where the issues delaying the older debt being paid relate to this debt too. 2015-16 2014-15 £000 £000 Receivables are provided against at the following rates: NHS debt 0 0 All debt considered to require to be provided for. 100% 100%

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18 Other financial assets

The Clinical Commissioning Group had no other financial assets as at 31 March 2016.

19 Other current assets

The Clinical Commissioning Group had no other current assets as at 31 March 2016.

20 Cash and cash equivalents

2015-16 2014-15 £000 £000 Balance at 01-April-2015 268 (16) Net change in year 69 284 Balance at 31-March-2016 337 268

Made up of: Cash with the Government Banking Service 178 109 Cash with Commercial banks 0 0 Cash in hand 159 159 Current investments 0 0 Cash and cash equivalents as in statement of financial position 337 268

Bank overdraft: Government Banking Service 0 0 Bank overdraft: Commercial banks 0 0 Total bank overdrafts 0 0

Balance at 31-March-2016 337 268

Patients’ money held by the clinical commissioning group, not included above 0 0

The actual cash book balance of the Clinical Commissioning Group at the balance sheet date was £178k. However, in accordance with the requirements of IAS 31: Interests in Joint Ventures, the CCG is required to reflect its share of the income, expenditure, assets and liabilities associated with the pooled budget arrangements in which it partakes (see note 35). As the host of the Sandwell Mental Health Pooled budget, this technical adjustment requires £159k cash to be recognised which is disclosed as Cash in hand.

21 Non-current assets held for sale

The Clinical Commissioning Group had no other non-current assets as at 31 March 2016.

22 Analysis of impairments and reversals

The Clinical Commissioning Group had no impairments or reversals as at 31 March 2016.

110 Sandwell and West Birmingham CCG - Annual Accounts 2015-16

Current Non-current Current Non-current 23 Trade and other payables 2015-16 2015-16 2014-15 2014-15 £000 £000 £000 £000

Interest payable 0 0 0 0 NHS payables: revenue 4,242 0 4,293 0 NHS payables: capital 0 0 0 0 NHS accruals 2,423 0 4,415 0 NHS deferred income 15 0 0 0 Non-NHS payables: revenue 18,919 0 13,694 0 Non-NHS payables: capital 0 0 0 0 Non-NHS accruals 15,780 0 18,236 0 Non-NHS deferred income 69 0 34 0 Social security costs 91 0 67 0 VAT 0 0 0 0 Tax 104 0 99 0 Payments received on account 0 0 0 0 Other payables 200 0 277 0 Total Trade & Other Payables 41,843 0 41,114 0

Total current and non-current 41,843 41,114

Other payables include £109k outstanding pension contributions at 31 March 2016

24 Other financial liabilities The Clinical Commissioning Group had no other financial liabilities as at 31 March 2016

25 Other liabilities The Clinical Commissioning Group had no other liabilities as at 31 March 2016

26 Borrowings The CCG had no borrowings in the year ending 31 March 2016

27 Private finance initiative, LIFT and other service concession arrangements

The Clinical Commissioning Group had no private finance initiative, LIFT or other service concession as at 31 March 2016.

28 Finance lease obligations

The Clinical Commissioning Group had no finance lease obligations as at 31 March 2016.

29 Finance lease receivables

The Clinical Commissioning Group had no finance lease receivables as at 31 March 2016.

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30 Provisions Current Non-current Current Non-current 2015-16 2015-16 2014-15 2014-15 £000 £000 £000 £000 Continuing care 302 0 399 0 Other 3,268 0 1,557 0 Total 3,570 0 1,956 0

Total current and non-current 3,570 1,956

Pensions Relating to Pensions Former Relating to Agenda for Continuing Directors Other Staff Restructuring Redundancy Change Equal Pay Legal Claims Care Other Total £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s

Balance at 01-April-2015 0 0 0 0 0 0 0 400 1,557 1,957

Arising during the year 0 0 0 0 0 0 0 39 3,268 3,308 Utilised during the year 0 0 0 0 0 0 0 (125) (634) (759) Reversed unused 0 0 0 0 0 0 0 (12) (924) (936) Unwinding of discount 0 0 0 0 0 0 0 0 0 0 Change in discount rate 0 0 0 0 0 0 0 0 0 0 Transfer (to) from other public sector body 0 0 0 0 0 0 0 0 0 0 Balance at 31-March-2016 0 0 0 0 0 0 0 302 3,268 3,570

Expected timing of cash flows: Within one year 0 0 0 0 0 0 0 302 3,268 3,570 Between one and five years 0 0 0 0 0 0 0 0 0 0 After five years 0 0 0 0 0 0 0 0 0 0 Balance at 31-March-2016 0 0 0 0 0 0 0 302 3,268 3,570

The Continuing Care provisions relate to an outstanding case (£262k) plus new CHC appeals (£39k) The other provisions relate to NCAs (£298k), Abortive fees (£124k), Invoices received but disputed with suppliers (£1,759k) MH Stranded costs (£623k) and Activity not yet charged for at year end (£464k)

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31 Contingencies 2015-16 2014-15 £000 £000 Contingent liabilities Continuing Healthcare 124 160 Learning Disabilities Disputed Cases 0 457 Older People Sec 117 recharges 1,320 0 Net value of contingent liabilities 1,444 617

Contingent assets Net value of contingent assets 0 0

The Older People Section 117 patients relates to charges received from SMBC where the PCT doesn't recognise these patients. These charges have been disputed

The Continuing Healthcare Contingency relates to patients assessed as not meeting the CHC criteria, but the decision is being appealled.

32 Commitments The Clinical Commissioning Group had no capital or other non-cancellable financial commitments as at 31 March 2016.

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.

The NHS Clinical Commissioning Group is financed through parliamentary funding and, it is therefore 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 NHS Clinical Commissioning Group standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the NHS Clinical Commissioning Group and internal auditors.

33.1.1 Currency risk

The NHS 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 NHS Clinical Commissioning Group has no overseas operations. The NHS Clinical Commissioning Group and therefore has low exposure to currency rate fluctuations.

33.1.2 Interest rate risk

The Clinical Commissioning Group borrows from government for capital expenditure, subject to affordability as confirmed by NHS England. The borrowings are for 1 to 25 years, in line with the life of the associated assets, and interest is 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

The majority of the NHS Clinical Commissioning Group and revenue comes parliamentary funding therefore the, NHS Clinical Commissioning Group has low exposure to credit risk. The maximum exposure as at the end of the financial year is in receivables from customers, as disclosed in the trade and other receivables note.

33.1.3 Liquidity risk

NHS Clinical Commissioning Group is required to operate within revenue and capital resource limits, which are financed from resources voted annually by Parliament. The NHS Clinical Commissioning Group draws down cash to cover expenditure, as the need arises. The NHS Clinical Commissioning Group is not, therefore, exposed to significant liquidity risks.

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33 Financial instruments cont'd

33.2 Financial assets

At ‘fair value through profit and Loans and Available for loss’ Receivables Sale Total 2015-16 2015-16 2015-16 2015-16 £000 £000 £000 £000

Embedded derivatives 0 0 0 0 Receivables: · NHS 0 2,208 0 2,208 · Non-NHS 0 1,798 0 1,798 Cash at bank and in hand 0 337 0 337 Other financial assets 0 36 0 36 Total at 31-March-2016 0 4,378 0 4,378

At ‘fair value through profit and Loans and Available for loss’ Receivables Sale Total 2014-15 2014-15 2014-15 2014-15 £000 £000 £000 £000

Embedded derivatives 0 0 0 0 Receivables: · NHS 0 911 0 911 · Non-NHS 0 693 0 693 Cash at bank and in hand 0 268 0 268 Other financial assets 0 0 0 0 Total at 31-March-2015 0 1,872 0 1,872

33.3 Financial liabilities

At ‘fair value through profit and loss’ Other Total 2015-16 2015-16 2015-16 £000 £000 £000

Embedded derivatives 0 0 0 Payables: · NHS 0 6,665 6,665 · Non-NHS 0 34,899 34,899 Private finance initiative, LIFT and finance lease obligations 0 0 0 Other borrowings 0 0 0 Other financial liabilities 0 0 0 Total at 31-March-2016 0 41,565 41,565

At ‘fair value through profit and loss’ Other Total 2014-15 2014-15 2014-15 £000 £000 £000

Embedded derivatives 0 0 0 Payables: · NHS 0 8,708 8,708 · Non-NHS 0 32,221 32,221 Private finance initiative, LIFT and finance lease obligations 0 0 0 Other borrowings 0 0 0 Other financial liabilities 0 0 0 Total at 31-March-2015 0 40,929 40,929

34 Operating segments

The Clinical Commissioning Group consider it has only one segment: commissioning of healthcare services.

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35 Pooled budgets

The clinical commissioning group were party to pooled budget arrangements during the year for Mental Health Services and for the Better Care Fund. The pools were established under section 75 of the NHS Act 2006.

The NHS Clinical Commissioning Group shares of the income and expenditure handled by the pooled budget in the financial year were:

Mental Health Pooled Budgets

The CCG has entered pooled budgets for Community Mental Health Services with Sandwell MBC and with Birmingham Cross City CCG Memorandum accounts for these pools are shown below Sandwell & Birmingham West Cross City Birmingham Income & Expenditure Account CCG CCG Sandwell MBC Total £000 £000 £000 £000

Contributions 34 288 160 481 Adjustment to Contributions 1 (1)

Total Contributions 34 289 159 481

Expenditure 481 Surplus / Deficit 0

Sandwell & Birmingham West Cross City Birmingham SOFP CCG CCG Sandwell MBC Total £000 £000 £000 £000

Share of Pool Debtors 159 159

Share of Cash 159 (159)

TOTAL ASSETS 0 159 0 159

Share of Creditors (159) (159)

TOTAL LIABILITIES 0 (159) 0 (159)

Better Care Fund Pooled Budgts NHS Sandwell and West Birmingham CCG is part of two Better Care Fund Pooled Budgets in 2015/16. Details of these are shown in the Memorandum accounts below:

Sandwell and Birmingham Birmingham West Cross City South and Birmingham Birmingham CCG Central CCG CCG City Council Total £000 £000 £000 £000 £000

Contributions to the Fund 54,978 19,223 12,043 9,496 95,740

Expenditure on Service Provision 95,592

Balance Carried Forward 148

Sandwell and West Birmingham CCG Sandwell MBC Total 2015/16 2015/16 2015/16

Contributions to the Fund 23,192 905 24,097

Expenditure on Service Provision 23,147

Balance Carried Forward 950

36 NHS Lift investments

The CCG had no NHS LIFT Investments as at 31 March 2016

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37 Related party transactions

Details of related party transactions with individuals are as follows: Receipts Amounts Amounts Payments to from owed to due from Related Related Related Related Party Party Party Party £000 £000 £000 £000 Dr Basil Andreou Oldbury Health Centre 2,435 Dr George Solomon Black Country Family Practice 1,876 3 Tipton Care Organisation 364 Dr Ian Sykes Royal College of General Practitioners 8 Your Health Partnership 495 53 Dr Inderjit Marok Summerfield Group Practice 656 Rotton Park Medical Practice 617 Dr Nick Harding Handsworth Wood Medical Centre 1,904 Modality/ Vitality Partnership 5,684 68 859 Dr Ram Sugavanan Royal College of General Practitioners 8 Smethwick Medical Centre 1,954 Modality/ Vitality Partnership 5,684 68 859 Dr Sam Mukherjee Newtown and Aston Pride Health Centres 2,342 Royal college of General Practitioners 8 Dr Sirjit Bath Tower Hill Partnership 2,326 Royal College of General Practitioners 8 Walsall Road Medical Ltd 1 Dr Syed Ayaz Ahmed Village Medical Centre 755 Dr Vijay Bathla Royal College of General Practitioners 8 Soho Health Centre - GMS Practice 1,456 Mr Richard Nugent Sandwell Council of Voluntary Organisations (SCVO) 39 Mrs Julie Jasper NHS Dudley CCG 8 1,182 Mrs Jyoti Atri Sandwell Metropolitan Borough Council 21,360 1,076 1,343 1,064 Ms Janette Rawlinson Sandwell Council of Voluntary Organisations (SCVO) 39 Ms Therese McMahon TMcMahon Consultancy 15

Payments recorded against GPs on the Governing Body have been to their GP Practices, or to companies in which they have an influential position. Payments to other members are to organisations they have an interest in. These figures exclude payments made to individuals for Governing Body membership. All transactions were undertaken under NHS Terms and Conditions.

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 are listed below. NHS Birmingham Cross City CCG Birmingham Community Healthcare NHS Trust NHS Birmingham South Central CCG Sandwell & West Birmingham Hospitals NHS Trust NHS Coventry & Rugby CCG University Hospitals Coventry & Warwickshire NHS Trust NHS Dudley CCG Walsall Healthcare NHS Trust NHS England Birmingham & Solihull Mental Health NHS Foundation Trust NHS Herefordshire CCG Birmingham Children's Hospital NHS Foundation Trust NHS Redditch & Bromsgrove CCG Birmingham Women's NHS Foundation Trust NHS South Warwickshire CCG Black Country Partnership NHS Foundation Trust NHS South Worcestershire CCG Heart of England NHS Foundation Trust NHS Solihull CCG The Royal Orthopaedic Hospital NHS Foundation Trust NHS Walsall CCG The Dudley Group NHS Foundation Trust NHS Warwickshire North CCG University Hospitals Birmingham NHS Foundation Trust NHS Wolverhampton CCG West Midlands Ambulance Service NHS Foundation Trust NHS Wyre Forest CCG

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 Birmingham City Council and Sandwell Metropolitan Borough Council.

116 Sandwell and West Birmingham CCG - Annual Accounts 2015-16

38 Events after the end of the reporting period

There are no events after the end of the reporting period that require disclosure

39 Losses and special payments

39.1 Losses

The total number of NHS Clinical Commissioning Group losses and special payments cases, and their total value, was as follows:

Total Number of Total Value Total Number Total Value Cases of Cases of Cases of Cases 2015-16 2015-16 2014-15 2014-15 Number £'000 Number £'000 Administrative write-offs 0 868 0 18 Fruitless payments 0 0 0 0 Store losses 0 0 0 0 Book Keeping Losses 0 0 0 0 Constructive loss 0 0 0 0 Cash losses 0 0 0 0 Claims abandoned 0 0 0 0

Total 0 868 0 18

The item shown as Administrative write-off above is the provision included by the CCG for the Impairment of Receivables (see note 17.2). As this is a provision for impairment and not an actual write off this has not been reported to the CCG as a loss and will be reported if and when write off of this debt actually occurs.

39.2 Special payments The CCG made no Special Payments in 2015/16

117 Sandwell and West Birmingham CCG - Annual Accounts 2015-16

40 Third party assets The Clinical Commissioning Group had no third party assets as at 31 March 2016.

41 Financial performance targets

NHS Clinical Commissioning Group have a number of financial duties under the NHS Act 2006 (as amended). NHS Clinical Commissioning Group performance against those duties was as follows:

2015-16 2015-16 2014-15 2014-15 Target Performance Target Performance £000 £000 £000 £000 Expenditure not to exceed income 8,778 12,006 8,000 8,778 Capital resource use does not exceed the amount specified in Directions 0 0 250 0 Revenue resource use does not exceed the amount specified in Directions 746,760 734,754 634,135 625,357 Capital resource use on specified matter(s) does not exceed the amount specified in Directions 0 0 250 0 Revenue resource use on specified matter(s) does not exceed the amount specified in Directions 0 0 0 0 Revenue administration resource use does not exceed the amount specified in Directions 12,349 10,853 12,700 10,347

42 Impact of IFRS Accounting under IFRS had no impact on the results of the clinical commissioning group during the 2015-16 financial year.

43 Analysis of charitable reserves

The Clinical Commissioning Group had no charitable reserves as at 31 March 2016.

44 Intra Government and Other Balances

Current Non-current Non-current Receivables Receivables Current Payables Payables

£'000 £'000 £'000 £'000 Balances with: · Other Central Government bodies 0 0 1220 0 · Local Authorities 1301 0 5247 0

Balances with NHS bodies: · NHS bodies outside the Departmental Group 23 0 0 0 · NHS bodies within the NHS England Group 1846 0 6285 0 · NHS Trusts and Foundation Trusts 2468 0 4496 0 Total of balances with NHS bodies: 4337 0 10781 0

· Public Corporations and Trading Funds 0 0 0 0 · Bodies external to Government -91 0 24595 0

Total Balances at 31 March 2016 5547 0 41843 0

Balances with: · Other Central Government bodies 31 0 284 0 · Local Authorities 501 0 4803 0 · NHS bodies outside the Departmental Group 1077 0 1406 0 · NHS bodies within the NHS England Group 0 0 0 0 · NHS Trusts and Foundation Trusts 2591 0 7302 0 · Public Corporations and Trading Funds 0 0 0 0 · Bodies external to Government 847 0 27319 0 Total Balances at 31 March 2015 5047 0 41114 0

118 Sandwell and West Birmingham CCG Kingston House 438-450 High Street West Bromwich B70 9LD

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