Annual Report and Accounts 2019/20 Statement from the CCG Chief Executive Officer ...... 3 Foreword ...... 5
SECTION 1: PERFORMANCE REPORT ...... 9 Performance Overview ...... 10 About us ...... 10 Our Strategy, Mission and Values ...... 13 The Hampshire and Isle of Wight Sustainability and Transformation Partnership (STP) ...... 15 Southampton Health and Wellbeing Strategy ...... 16 Key Risks ...... 17 Adoption of the Going Concern Basis ...... 18 Performance Summary ...... 18
SECTION 2: ACCOUNTABILITY REPORT ...... 25 Corporate governance report ...... 26 Members report ...... 26 Statement of Accountable Officer’s responsibilities ...... 48 Governance statement ...... 50 Conclusion ...... 50 Remuneration and staff report ...... 51 Staff report ...... 51 Remuneration report ...... 56
SECTION 3: FINANCIAL STATEMENTS AND NOTES ...... 69 Summary financial statements ...... 70 Glossary of financial terms ...... 81 Head of Internal Audit Report to the Chief Officers of Southampton City CCG ...... 83
APPENDICES ...... 85 Appendix A – Sustainability report ...... 86 Building a sustainable organisation ...... 86 Sustainability report ...... 87 Appendix B - Governance statement ...... 89
2 Statement from the CCG Chief Executive Officer
Across Hampshire and the Isle of Wight, the spirit of co-operation and togetherness is at the heart of everything we do, not least as we focus on our primary aim of developing the right models of care to help people stay out of hospital.
At no time has this been more important than now, as we work through the impact and consequences of the Covid-19 coronavirus pandemic, which has occupied so much of our collective focus over the latter months of this reporting year.
While we would all have preferred not to have been in this situation, there is no doubt that something like this brings out the very best in those who deliver frontline health and care services. Their dedication to duty, in the most challenging of circumstances, is an example to us all and shines a spotlight on what makes the NHS the envy of so many across the world.
Their response brings to mind, coincidentally in the 200th anniversary of her birth, the work of Florence Nightingale, who not only continued to deliver care in the most challenging of circumstances but who, in later life, became a champion of reform and better healthcare for all and an advocate for care for people in their own homes.
One of the lesser known facts is that Florence was also a statistician, and the first female fellow of the Royal Statistical Society, who revolutionised nursing through her investigative statistical work and her striking use of data visualisation. Such techniques are now utterly invaluable in the work in response to Covid-19.
Working with others was at the heart of her approach and we know that this is the best approach we have in tackling the challenges we face today, whether that’s mitigating as best we can the impact of coronavirus or ensuring that people who continue to need routine and more specialised health and care services can still be assured of the best possible outcomes.
The pages of this annual report reveal the story of our year and the progress we have continued to make in many areas as we work more closely together to transform local healthcare and respond to the ongoing challenges we face.
It is encouraging for us to be able to report that that we have made considerable progress in all of these areas over the past 12 months.
Our urgent care programme, particularly over winter, and our approach to the coronavirus pandemic are both examples of where working together has already had, and will continue to have, significant benefit. It is that spirit of cooperation that we need to embrace in future,
3 too, as we continue to focus our efforts and energies on our primary aim – improving the way that care out of hospital is delivered.
One of the most rewarding things about working as a partnership across Hampshire and the Isle of Wight is the opportunity it continually affords us to bring people together. This remains absolutely vital if we are to ensure that health and care services can continue to be delivered effectively over the next few years, encouraging people’s imagination, innovation and courage in the way we transform care.
For some this may come through working ‘at scale’ across Hampshire and Isle of Wight, or more locally with our provider partners, Southampton City Council and the voluntary sector in Southampton.
For others it may be in developing primary care networks to try and build resilience and innovation in our GP practices, where already there is encouraging progress in terms of all patients now having access to more appointments out of hours, including in the evenings and at weekends, or being able to contact their practice online for consultations, appointment booking and repeat medication ordering.
As we move further into 2020 it is even clearer now that the year ahead will continue to be a busy time for us, requiring an even greater emphasis on working together.
The long term impact of the pandemic will take some time to understand and absorb, but we remain hopeful that some of the initiatives we have introduced in its wake will be a legacy we can build from in a positive way.
At the same time we fully intend to deliver the next phase in our development as we aim to come together as one commissioning organisation for Hampshire and the Isle of Wight by April 2021. Over the past 12 months we have seen a stronger bond develop between Southampton City CCG, the Hampshire and Isle of Wight Partnership of CCGs and West Hampshire CCG, a precursor to formalising our joint working arrangements by next April.
There will continue to be challenges as well as opportunities ahead. Demand on urgent care services will still need to be managed, not just during winter but throughout the year, and the impact that the emergence of coronavirus will have on us will only be ascertained as the year progresses but in all the challenges we face, finding an effective solution is inevitably dependent on working together and pooling our knowledge, skills, commitment and resources.
Maggie MacIsaac Chief Executive Officer, NHS Southampton City CCG
4
Foreword
I am delighted to present NHS Southampton City Clinical Commissioning Group’s annual report and accounts for the 2019/20 financial year.
Our purpose as a Clinical Commissioning Group (CCG) is to meet the health and care needs of our population. We are allocated a budget to achieve this and must use it to plan and pay for (or ‘commission’) health and care services from a number of service providers (such as hospital, mental health and community trusts and GPs). We are responsible for making sure that local people get the high quality health services they need. We hope this report explains how we have worked to achieve this in the 2019/20 financial year.
Senior leadership in the CCG changed last summer. John Richards retired in June 2019 after many years as our Chief Executive Officer. John’s passion for tackling health inequalities, commitment to improving the quality of local services and determination to put the local community at the heart of all we do helped shape many of the plans we are implementing.
I was delighted to welcome Maggie MacIsaac as our new Chief Executive Officer. Maggie is hugely experienced and under her leadership we have moved forward at pace on our journey to be part of an Integrated Care System in Hampshire and the Isle of Wight. We appointed James Rimmer as our Managing Director, to provide day-to-day local leadership.
I would like to thank Maggie, James, my GP colleagues and our entire team at the CCG for working so hard throughout the year on a vast range of projects.
An exciting development in the city has been the creation of new Primary Care Networks (PCNs). These are a new way for GP practices to work together to care for populations of around 30-50,000. The aim of PCNs is to build on the core of current primary care services and enable greater provision of proactive, personalised, co-ordinated and more integrated health and social care. In Southampton our practices have worked together in clusters for a number of years, and the development of PCNs can be seen as an evolution from this successful way of working.
2019 was the fifth and final year of our CCG Five Year Strategy (2014-2019). In early 2019, work commenced on planning a new strategy for the next five years. We started by carrying out in-depth analysis into the city’s current and future health and care challenges. This revealed a stark picture of growing inequalities across the city and showed how deprivation is affecting health, such as disease prevalence, utilisation of urgent healthcare and utilisation of social care services in the city.
Partners of the Southampton health and care system agreed that a collective response was needed across NHS organisations, the Local Authority and voluntary organisations to tackle the city’s health and care challenges together. We agreed to develop a joint Southampton City Five Year Health and Care Strategy (2020-2025), and committed to work together to
5
improve health and care outcomes for the population that we serve. The strategy sets out a plan to guide the activities of all partners over the next five years to meet our shared vision, ‘a healthy Southampton where everyone thrives’.
Of course, the outbreak of COVID-19 has meant that the strategy and many of our transformational plans for the year ahead are now delayed. Since the beginning of 2020, we have worked with colleagues across Hampshire and the Isle of Wight to ensure the right plans are in place, making sure the system is ready and has capacity in the challenging times ahead. We are working with the Local Resilience Forum, as a wider multi-agency partnership made up of representatives from local public services, including the emergency services, local authorities, the NHS, the Environment Agency and others.
There is much work ahead, and the challenge for the next year will be to make sure we can continue to provide our patients with high quality services while continuing our huge efforts to tackle coronavirus. We are fortunate to work with amazing people across the system in health and care, and I would like to thank them for everything they are doing during these unprecedented times.
Despite the challenges ahead and the current focus on COVID-19, we would still like to reflect on and celebrate some of our key achievements over the past year to improve health and care services in the city.
We were one of ten cities in England to first implement Targeted Lung Health Checks to improve earlier diagnosis of lung cancer. People aged 55 to 74 who have been smokers are invited for a lung health check and, where required, a low dose CT scan. New faster diagnosis cancer pathways have also been introduced for colorectal, prostate, lung and upper gastrointestinal cancers which means that patients will now receive a positive or negative diagnosis of cancer within 28 days. We have been trialling innovative technology to increase detection in the city of cardiovascular conditions, such as Atrial Fibrillation (AF) and hypertension, to ensure patients with these conditions are identified earlier and optimally managed to prevent strokes. We have increased the number of people being referred to the National Diabetes Prevention Programme (NDPP) which supports people who are at risk of developing type 2 diabetes to help them adapt their lifestyles to reduce the chances of developing diabetes. We have continued to use our pooled budgeting arrangements with Southampton City Council to create a single fund to spend on health and social care. This is being used to jointly fund services such as rehabilitation and reablement, learning disabilities, home care and community and voluntary sector schemes. The CCG and Southampton City Council have worked with providers to develop a new model for Home Care delivery which has led to a reduction in the waits experienced for a settled care package from referral to start date. We have also launched a Community Navigation and Community Development service which promotes an increase in the breadth and depth of community based activities
6 available, and being accessed, that supports people to live well and independently in the community, promotes self-help and a culture where people help others in their community. Following a successful pilot in 2018/19, we rolled out the Enhanced Health in Care Homes (EHCH) initiative across all care homes in the city which is now being expanded into nursing homes. The initiative supports care home staff to become more confident and proactive in their care, identify and case manage those residents who are at a higher risk of hospital conveyance and admission. This has been successful in reducing ambulance call outs to care homes and emergency hospital admissions. We continued to invest in a range of primary care initiatives and services, including the Tackling Health Inequalities Local Improvement Scheme (LIS). Investment has been made available to qualifying practices in the more deprived areas of the city to develop flexible approaches and different ways of working to give their patients the best chance of achieving health outcomes which are comparable to the wider population. We have worked in partnership with Southern Health NHS Foundation Trust and Solent Mind to develop “The Lighthouse” a new community based facility that will support individuals in a recovery-focused way to manage their mental health crisis. Local residents using the facility will receive interventions in a therapeutic environment, with the facility being staffed by mental health nurses. We have worked with partners to secure NHS transformation funding to embed mental health support in NHS 111. This means that if someone calls 111 with a mental health concern, they will be directed to specialist mental health nurses who can provide specialist support. We have been successful in a trailblazer bid to develop two Mental Health Support Teams in Schools and Colleges which will cover approximately 16,000 pupils in the city. The teams will be fully operational from January 2021 and the key focus will be to deliver evidence based interventions for mild to moderate mental health issues and work with schools to develop their whole school approach. We have been working hard to ensure that Continuing Healthcare (CHC) assessments are completed in community settings, rather than at the acute hospital. To support this, we have been running a Discharge to Assess scheme with University Hospital Southampton (UHS) which discharges complex patients from the acute hospital initially to nursing homes where they can continue their stabilisation, and their ongoing care and support needs can be assessed. Throughout 2019/20, the percentage of hospital based assessments for CHC has remained below 9%, well within the national target of less than 15% of assessments being within a hospital setting. Our quality team has continued to support and work alongside a number of healthcare providers, care homes and nursing homes who have seen improvements in Care Quality Commission (CQC) ratings. This includes Southern Health where we have taken an active role in assurance processes for Serious Incidents which was
7 commended at the most recent CQC inspection. The city now has all 9 nursing homes rated ‘good’ by the CQC and the majority of the 50 care homes are rated ‘good’. We have had another successful year financially and have met all of our statutory and administrative financial duties.
The development of an Integrated Care System (ICS) across Hampshire and the Isle of Wight has been continuing through our existing Sustainability and Transformation Partnership arrangements, and is hoped to be up and running by September 2020. Across Hampshire and the Isle of Wight we have some fantastic services, however we also have some real challenges. This means that outcomes for our patients are not consistently what we would want or expect for ourselves or our families. To address this there is an even greater emphasis on organisations across health and social care working in partnership and breaking down barriers between services. All of this means that how we work as commissioners will need to change and we believe there is a strong case for starting a process of coming together through 2020 – 2021 to create something new, together. Commissioners across Hampshire and the Isle of Wight will continue the work to speak as one voice across the area.
As we look to the future, there are significant challenges ahead as we continue our efforts to manage the impact of coronavirus on our population and services. What gives us confidence is how our health and care services are now working more closely than ever before to meet the scale of the task ahead of us. As we move to the next phase, we will work with our population to ensure the NHS, such an important and valued part of our lives, can continue to deliver high quality and safe services for the people of Southampton.
Dr Mark Kelsey Clinical Chair, NHS Southampton City CCG
8 SECTION 1: PERFORMANCE REPORT
9 Performance Overview This overview section provides an insight into who makes up the CCG, how we operate, the people and organisations we work with, our strategic vision for the next five years and our key risks.
We are committed to achieving our vision of ‘a healthy Southampton where everyone thrives’ and the overview below explains how the CCG works to achieve this.
About us
Who we are and what we do NHS Southampton City Clinical Commissioning Group (CCG) was established on 1 April 2013 with a clear focus on ensuring family doctors and other clinical professionals play a leading role in deciding and directing how our local NHS resources should be used. With around 90% of local interaction with the NHS taking place in GP practices, this move was intended to shift the planning and decision-making for health services as close as possible to patients. Our purpose as a CCG is to meet the health and care needs of our population. We are allocated a budget to achieve this and must use it to plan and pay for (or ‘commission’) health and care services from a number of service providers (such as hospital, mental health and community trusts and GPs). We are responsible for making sure that local people get the high quality health services they need. A large part of our work involves working closely with the local authority, NHS England and other health and care partners to ensure the right services are in place for our community. We also make sure we listen to local people so we can act upon the views and needs of patients, carers and the public.
Our organisation We have: 26 constituent member GP practices* a budget of £417.7 million for 2019/20 covering services at acute hospitals, community services, mental health, GP services and prescribing the same boundaries as Southampton City Council, covering an area of some 28 square miles 128 staff who are responsible for supporting the planning and buying of local healthcare, including our Integrated Commissioning Unit which commissions jointly with Southampton City Council.
*The number of member practices is defined under the CCG Constitution, as the number of separate contracts held to provide GP services in Southampton.
10 The internal organisational structure is led by Maggie MacIsaac, our Chief Executive Officer. Our team of clinical leads are embedded within our structure, supporting our directors: James Rimmer is Managing Director and Chief Financial Officer, with responsibility for the day to day operation of the CCG and for our finances, planning and performance. Peter Horne is Director for System Delivery, which includes the commissioning of urgent and emergency care, planned care and the delegated commissioning of Primary Care. Peter is also the Accountable Emergency Officer for the CCG. Stephanie Ramsey is Director of Quality and Integration (Chief Quality Officer and Chief Nurse). Her remit includes a dedicated quality team, Continuing Healthcare, Medicines Management, Learning Disability, and Communication and Engagement teams. This directorate also incorporates the Integrated Commissioning Unit (ICU). The ICU is a joint commissioning team for NHS Southampton Clinical Commissioning Group and Southampton City Council. The ICU aims to deliver efficiencies across departments and improve outcomes for vulnerable adults, children and families in Southampton by putting the patient at the centre and designing services around them rather than around organisations. Since the launch of Better Care Southampton in 2015 we have been making significant progress in joining up care across Southampton. Throughout 2019/20 the ICU has been working on developing the city’s Better Care Southampton agenda, which is about linking up health, social care and community and voluntary organisations to make sure we work together with to create a strong and healthy city. From November 2018 to January 2020, Stephanie has also had the role of Interim Director of Adult Social Services at Southampton City Council.
Our population 292,348 people are registered with GP practices in the city (April 2020). 16% of the city’s population are aged between 15 and 24 (12% national) The population is growing rapidly. Southampton is experiencing population growth which is above the national average, with this trend forecast to continue. Deprivation is higher than average and around a quarter of the city’s children live in poverty. 64.2% of the city’s adults are overweight or obese (62% national) 22.3% of residents are from an ethnic group other than White British compared to 20.2% nationally (2011 Census). 18.7% of people aged over 16 years are estimated to have a common mental health disorder (16.9% national) 66.2% of women aged 50-70 screened for breast cancer in the last three years (73% national)
11 56.8% of people aged 60-74 screened for bowel cancer in the last 2.5 years (72.3% national) 22.9% of children in Year 6 are obese (20.2% national) 48% more teenage pregnancies than the England average 7% of 16-17 year olds are not in education, employment or training (5.5% national)
The below population pyramid illustrates how our population differs from the national average using GP registration data for January 2019:
Our partners In Southampton we work with the following main providers of health and care services:
26 GP practices and Southampton Primary Care Limited (SPCL) – the federation of 25 local GP practices Care UK - Southampton Treatment Centre and Minor Injuries Unit Solent NHS Trust - for a wide range of community services and child and adolescent mental health services
12 South Central Ambulance Service NHS Foundation Trust - emergency ambulances, patient transport services and the NHS111 service Southampton City Council – responsible for social care services and wider services that impact on health and wellbeing Southern Health NHS Foundation Trust - mental health and learning disability services University Hospital Southampton NHS Foundation Trust - including our main acute hospital, Southampton General and the Princess Anne Hospital
We also pay for services delivered by a range of independent and charitable organisations to provide care on our behalf and offer local people a wider choice of service location and type, and we work closely with social care providers in the city. We work very closely with a number of partners to ensure we plan and pay for the right services for local people. Other key partners include:
Southampton Healthwatch Southampton Health and Wellbeing Board Neighbouring CCGs Public Health England NHS England and Improvement Southampton Voluntary Services and other local voluntary and community organisations
Our Strategy, Mission and Values
Southampton City Health and Care Strategy (2020-2025) 2019 was the fifth and final year of our CCG Five Year Strategy (2014-2019). In early 2019, work commenced on planning a new strategy for the next five years. We started by carrying out in-depth analysis into the city’s current and future health and care challenges. This revealed a stark picture of growing inequalities across the city and showed how deprivation is affecting health, such as disease prevalence, utilisation of urgent healthcare and utilisation of social care services in the city.
Partners of the Southampton health and care system agreed that a collective response was needed across NHS organisations, the Local Authority and voluntary organisations to tackle the city’s health and care challenges together. We agreed to develop a joint Five Year Health and Care Strategy (2020-2025), and committed working together to improve health and care outcomes for the population of Southampton that we serve.
13 The Southampton City Health and Care Strategy (2020-2025) sets out a plan to guide the activities of all health and care partners in the city over the next five years. We have a shared vision and a set of goals and priorities that we all endorse.
Our vision A healthy Southampton where everyone thrives
Our vision statement means:
Healthy: strong and resilient communities that are supported to maximise their potential to live fulfilling and prosperous lives; underpinned by strong, healthy organisations working together in a climate of trust and open, business-like healthy relationships Southampton: our city’s future is our purpose, firmly shared with our partners Everyone: we are determined to tackle the unacceptable inequalities in health and wellbeing across the city, for all ages.
Our goals The vision we share is about enabling everyone to live long, healthy and happy lives, with the greatest possible independence. We will do this by:
1. Reducing inequalities and confronting deprivation 2. Tackling the city’s biggest killers 3. Working with people to build resilient communities and live independently 4. Improving mental and emotional wellbeing 5. Improving earlier help, care and support 6. Improving joined-up, whole-person care
Our priorities We want to improve outcomes for the whole population, right across the main life stages, from birth to death. Our strategy will therefore take a life course approach, focusing on the following priorities:
• Start Well - Children and young people get the best start in life, are able to achieve the best opportunities and keep as healthy and well as possible throughout their lives. • Live Well - People enjoy and are able to maintain a sense of wellbeing and good health, supported by resilient communities. • Age Well - People are able to live independently in their own homes with appropriate care and support to maintain and develop their social and community networks. • Die Well - People are supported to ensure the last stages of their life happen in the best possible circumstances, receiving the right help at the right time from the right people.
14 Our mission To ensure that care is coordinated, safe, sustainable and designed to meet the needs of the people of Southampton. This summarises what we are doing, right now, to deliver our vision. We are taking responsibility for providing leadership and co-ordination of the city’s health and care system. In practical terms, our mission demonstrates that we are setting priorities and allocating resources to make sure the local health and care system works together in a coordinated, safe and effective way. Through the Southampton City Health and Care Strategy, our Better Care Southampton programme and our work on the Hampshire and Isle of Wight Sustainability and Transformation Plan (STP), we are commissioning care that is ‘joined up’, putting our ambitions into action and ensuring that care works much more effectively for patients and service users.
Our values Our values reinforce our vision, drive our behaviour and determine what we do and the way we go about it. We reviewed our values in the autumn of 2019, to ensure they remained up to date and relevant. Our values are:
Patients first Respect, support and encourage each other Act with integrity Be relentless about the quality of care Be courageous
The Hampshire and Isle of Wight Sustainability and Transformation Partnership (STP) The STP brings together health and care organisations across a wide geography to work at scale, where this is beneficial, in order to achieve the things that can only be achieved by working in partnership. The STP is made up of every NHS organisation and local authority in Hampshire and the Isle of Wight. These organisations work together to help put in place better health, transformed quality of care delivery, and sustainable finances.
During the summer of 2018, the Prime Minister set out a funding settlement for the NHS in England for the next five years. In return, NHS England was asked to develop a Long Term Plan for the future of the service. Following this, every STP in England was requested to translate the NHS Long Term Plan into a local one, and in November 2019 the Hampshire
15 and Isle of Wight STP finalised its long term Strategic Delivery Plan, which will soon be available to view on the STP website.
Whilst the Hampshire & Isle of Wight STP describes what will be done at scale, there is a need for local areas to come together to plan and implement local actions. This is the aim of Southampton City’s Health and Care Strategy which is aligned to the priorities of the Hampshire and Isle of Wight STP plan and the NHS Long Term Plan, however it is focused on a place-based approach to address the health and care needs specific to the population of Southampton.
For our city, that means the following organisations working as a partnership: NHS Southampton City CCG; Southampton City Council; University Hospital Southampton NHS Foundation Trust; Solent NHS Trust; Southern Health NHS Foundation Trust; Southampton Primary Care Limited (GP Federation); and Southampton Voluntary Services (SVS).
A wide range of other organisations are involved in the system, such as South Central Ambulance Service (SCAS), Solent Medical Services (SMS), Hampshire Constabulary, and schools and colleges.
The evolution of the STP into an Integrated Care System (ICS) across Hampshire and the Isle of Wight has been continuing through our existing Sustainability and Transformation Partnership arrangements, and is hoped to be up and running by September 2020.
Southampton Health and Wellbeing Strategy The CCG remains an active member of Southampton’s Health and Wellbeing Board (HWBB), together with Southampton City Council. The HWBB is a subcommittee of the City Council. The role of the board is to develop joint priorities for local commissioning to ensure delivery of the right outcomes, and to provide advice, assistance or other support to improve the health and wellbeing of the city’s diverse communities.
2019 was the third year of Southampton’s Health and Wellbeing Board strategy. This sets out the outcomes that Southampton Health and Wellbeing Board wants to achieve over the next eight years, to 2025.
The strategy aims to achieve the following outcomes:
People in Southampton live active, safe and independent lives and manage their own health and wellbeing Inequalities in health outcomes are reduced Southampton is a healthy place to live and work with strong, active communities People in Southampton have improved health experiences as a result of high quality, integrated services
16 These outcomes will be achieved by working with partners across the city, and with Southampton’s communities. The strategy is available to read on the Southampton City Council website.
The Southampton Health and Wellbeing Board (HWBB) is a statutory partnership. The board meets every other month to consider the delivery of the Health and Wellbeing Strategy, Better Care and to have an oversight of any proposed significant changes and their impact on the health system in Southampton. The CCG’s Clinical Chair is Vice Chair of the HWBB and the Director of Public Health and the Joint Director of Integration are also members. The CCG plays a full and active role in the committee. The Chair of the HWBB is the Cabinet Member for Healthier and Safer City, who is also a non-voting member of the CCG Governing Body and the CCG Primary Medical Care Commissioning Committee.
Key Risks We have a robust system in place for identifying and managing risks. They are reviewed through our Senior Management Team meetings, Finance and Audit Committee, and by our Governing Body to ensure that information about risks and the actions to mitigate them is shared through the organisation and significant risks are prioritised in our action planning. During 2019/ 20 the Governing Body worked in consultation with internal audit to review the CCG’s risk appetite approach, which will be reviewed later in 2020/21. The Governing Body risk appetite statement states: The Board has a high but considered appetite for risk which will promote innovation and growth, whilst: we have zero tolerance for fraud/financial crime we have a zero tolerance for regulatory breaches we will manage reputation risk but not at the expense of transparency we will not take risks that affect the safety of services and seek to avoid poor quality of customer service provided we are committed to protecting the environment.
As we move forward it is likely that our key challenges in 2020/21 will be assessing the impact of Covid-19 and looking at what risks this will generate and the need for our commissioned services to adapt and refocus to these risks and challenges. This is likely to be a significant focus for the NHS as we look at recovery actions. Whilst it is too early to give a detailed list we expect to have to focus upon increased demand for mental health services, a growing number of people waiting for elective care, we need to consider the ongoing requirements for shielded patients, there will be planning for the ongoing care and demand for Covid 19 patients and any vaccination programmes. As part of the CCGs and partners recovery actions the CCGs risk register will be reviewed as will the CCGs commissioning plans.
17 You can find more on risk in our Governance Statement at Appendix B.
Adoption of the Going Concern Basis The CCG has produced its accounts on a going concern basis; this is in line with the Department for Health Group Accounting Manual for 2019/20 which state that we are a going concern unless we have been informed that there is an intention for the CCG to be dissolved without the transfer of function to another entity. The Covid-19 national emergency situation that arose at the end of the financial period and remains ongoing brings a new set of circumstances for the CCG. As a result of this NHS planning processes have ceased, however the government has made a pledge to the country and the NHS: The Chancellor of the Exchequer committed in Parliament last week that “Whatever extra resources our NHS needs to cope with coronavirus – it will get.” So financial constraints must not and will not stand in the way of taking immediate and necessary action - whether in terms of staffing, facilities adaptation, equipment, patient discharge packages, staff training, elective care, or any other relevant category.
We believe that this situation does not therefore lead to material uncertainty about the going concern of the CCG. Once the emergency situation is over, NHS England / Improvement will issue further guidance on returning to more “normal” operation. It is not clear at what point in the financial year this may be. The CCG has received firm allocations for 2020/21 and 2021/22, with a further 2 years’ indicative allocations. As a CCG we remain slightly under target funding (2.76%) and so receive marginally higher growth than the national average 4.3% compared to 4.04%. Whilst this funding growth is welcome, like all public sector bodies the financial challenge we face to ensure we can keep up with a growing population and demand this settlement will still be challenging yet achievable.
Performance Summary Financial performance We have had another successful year financially and have met all of our statutory and administrative financial duties. We have achieved an in-year surplus of £2,788k, against a revenue resource limit of £417,713k, so 0.66%. This is in line with our plan agreed with NHS England and brings our cumulative surplus to £11,683k (2.8%). This is not lost and as per the business rules the element above 1% will be available for use in future years.
18 Our 2019/20 in-year and cumulative position is made up of: £’000
In-year surplus agreed 2,750
Additional in-year surplus achieved 38
Final in-year surplus 2,788
Brought forward cumulative surplus 8,895
Closing cumulative surplus 11,683
% of allocation 2.8%
A full set of financial statements can be found at the end of this document. Key pressure areas within our position have been acute activity £5,274k (3%) over budget; continuing healthcare packages £1,917k (7%) over budget and prescribing £1,843k (5%) over budget. These have been offset by underspending on corporate costs and managed programmes, including the contingency held by the CCG. The over spend in acute activity is primarily driven by emergency, unscheduled admissions. Acute hospital providers are paid on a cost per case basis. The money follows the patient, so as our population increases; with people living longer and facing more complicated health problems, activity and costs increase. Our financial position has been supported by the delivery of a £12.2m savings programme, with key schemes supporting people outside of hospital, reducing reliance on acute emergency hospital admissions. A significant element of our savings programme is the team of experts who work incredibly hard to ensure patients supported on individual packages of care receive regular reviews, ensuring they offer value for money and maintain high quality. This team have delivered in excess of £2m of savings in 2019/20. I certify that the CCG’s accounts have been prepared under a direction issued by the NHS Commissioning Board under the National Health Service Act 2006 (as amended). I certify that the CCG has complied with the statutory duties laid down in the National Health Service Act 2006 (as amended). I certify that the CCG has discharged its duties under the National Health Service Act 2006 (as amended), as required by the CCG Assurance Framework – for more information on the CCG’s assurance framework please see the governance statement at Appendix B.
Maggie MacIsaac Chief Executive Officer 16 June 2020
19 Constitutional standards performance Constitutional Standards and other performance metrics agreed with NHS England act as the CCG’s key performance indicators (KPIs). The table below shows the performance for the CCG in 2019/20 against the key performance standards. For further detail around each standard, an explanation of the definition, calculation and its purpose go to www.gov.uk/government/publications/the-nhs- constitution-for-england. Where data is available, indicators are refreshed on a monthly basis. We have used the metrics to help focus in on areas for improvement and developed relevant action plans. Metrics showing a deterioration or which are off track, and relevant actions to resolve, are presented and discussed at our Performance Board Meeting on a Quarterly basis. The COVID 19 crisis commenced in Q4 of 2019/20. Whilst it is difficult to state the impact this will have had on overall constitutional performance, March 2020 performance will have been significantly impacted. This impact will continue into 2020/21.
Target/ YTD 2019/20 Performance National Latest data Performance Standard A&E waits A&E <=4hrs 95% 86.33% Mar-20 Referral to Treatment (RTT) waits RTT: % of incompletes waiting 18 weeks or less 92% 81.85% Feb-20 RTT: Number of incompletes waiting >52 Weeks 0 14 Feb-20 Diagnostic waits % Patients waiting <6 weeks for a diagnostic test 99% 1.64% Feb-20 Cancer Cancer patients seen <14 days after urgent GP referral 93% 96.53% Feb-20 Breast Cancer Referrals Seen <2 weeks 93% 91.44% Feb-20 Cancer diagnosis to treatment <31 days 96% 92.03% Feb-20 Cancer Patients receiving subsequent surgery <31 days 94% 77.45% Feb-20 Cancer Patients receiving subsequent Chemo/Drug <31 days 98% 99.37% Feb-20 Cancer Patients receiving subsequent radiotherapy <31 days 94% 96.37% Feb-20 Cancer urgent referral to treatment <62 days 85% 77.07% Feb-20 Cancer Patients treated after screening referral <62 days 90% 89.58% Feb-20 Cancer Patients treated after consultant upgrade <62 days (local threshold) 86% 93.33% Feb-20 Quality Mixed Sex Accommodation Breaches 0 39 Feb-20 HCAI: C. difficile infections (CCG apportioned) 44 21 Feb-20 HCAI: MRSA blood stream infections (CCG apportioned) 0 3 Feb-20 HCAI: All Southampton City E. coli blood stream infections 104* 130 Feb-20 Mental Health Care Programme Approach (CPA) 95% 94.48% Q3 IAPT Access (Rolling 3 month access rate) 4.75% 5.19% Q3 IAPT Recovery (Rolling 3 month) 50.00% 49.09% Q3 IAPT 6 weeks (Rolling 3 month) 75.00% 97.56% Q3
20 Target/ YTD 2019/20 Performance National Latest data Performance Standard IAPT 18 weeks (Rolling 3 month) 95.00% 100.00% Q3 Dementia diagnosis rate 66.72% 66.00% Mar-20 Early Intervention in Psychosis - completed (% people seen <2 weeks) 56% 93.94% Sep-19 Children and Young People Eating Disorders - Urgent referrals within 1 week 95% 66.67% Q3 Children and Young People Eating Disorders - Routine referrals within 4 weeks 95% 90.32% Q3 Severe Mental Illness – Physical Annual Health Checks in Primary Care 60% 18.61% Q3 Wheelchair waits Wheelchairs: Children waiting less than 18 weeks for a wheelchair 64.67% 44.17% Q3 Delayed Transfers of Care (DTOC) DTOC Rate: % of all occupied beds that are occupied by a patient who is delayed 3.5% 7.4% Feb-20 Delayed Days: Daily DTOC Beds (average daily delays) 26.7 50.9 Feb-20
* Not Mandated Performance is displayed as a YTD average, where metrics are based on a waiting list (RTT and Diagnostics) or snapshot (DTOC) the latest position has been used instead. Where the standard changes throughout the year, the average has been taken (Wheelchairs). HCAI thresholds are for the year. Due to COVID-19 some metrics have been suspended, it is therefore not possible to provide the year end position.
Accident and Emergency (A&E)
A&E waits; Year to date at the end of March 2020, A&E under 4 hour waits did not achieve the 95% standard. At a national level, the 95% standard has not been achieved since July 2015 and remains a challenge at both a local and national level. We continue to work closely with University Hospital Southampton NHS Foundation Trust to support improved performance through monthly A&E Delivery Board Meetings, recovery plans and investment in a number of Quality, Improvement, Productivity and Prevention (QIPP) schemes to support a reduction in urgent care demand. Examples of these schemes in 2019/20 included: o High Intensity Users; based on a national NHS RightCare initiative, we continued to invest in an Ambulance Paramedic Practitioner to work with patients who have five or more emergency incidents per month to develop and agree a personal management plan. Significant reductions in ambulance callouts, A&E attendances and emergency admissions have been achieved for the cohort of patients targeted. o Enhanced Health in Care Homes (EHCH); we have implemented this initiative across all care homes in the city which supports care home staff to become more confident and proactive in their care, identify and case- manage residents who are at a higher risk of hospital conveyance and admission. This has been successful in reducing ambulance call outs to care homes and emergency hospital admissions. o Frailty; we invested in an older peoples’ Urgent Response clinician to work in the Ambulance call centre offering direct access for ambulance crews to community services as an alternative to a conveyance to hospital. This
21 initiative has enabled older patients to remain at home to receive a health and social care assessment and interventions, with reductions in ambulance conveyances to hospital and emergency admissions. o Alcohol; we continued to work with the specialist Alcohol Care Team at the hospital and our community drug and alcohol support service to support more people identified with an alcohol concern into treatment. This means that more people will have access to our specialised alcohol support to help reduce alcohol related harm. Large reductions in A&E attendances and emergency admissions have been achieved for the cohort of patients targeted.
Planned Care
Referral to Treatment waits; Year to date at the end of February 2020, the number of patients on an incomplete pathway waiting 18 weeks or less has not achieved the 92% standard. Performance at the Southampton Treatment Centre however recovered during the course of 2019/20 and maintained the 92% standard. The majority of the CCG level underperformance was as a result of capacity issues at University Hospital Southampton. UHS have introduced advice and guidance over a number of pathways to support GP, community providers and patients to manage their conditions without needing to be seen in the hospital. Individual pathway development work has seen improvements and changes in community pathways to re-direct referrals and activity into community providers first, leading to faster care that is closer to home. The Musculoskeletal (MSK) pathway has been redesigned throughout 2019/20 so that all GP referrals are sent to the community MSK team first for triage and assessment. The CCG continues to witness a reduction in GP Referrals; down 18% year on year, at December 2019. The CCG has undertaken a number of initiatives to reduce the waiting list, including commissioning additional activity at our independent providers and supporting University Hospital Southampton to undertake an extensive validation exercise at the end of 2019/beginning of 2020. We continue to work closely with our providers to support improved performance. As at February 2020, the CCG had 14 patients waiting more than 52 weeks. UHS Root Cause Analysis reporting for over 52 week waits commenced in December 2019; these are completed and reviewed by UHS internally. Diagnostic waits; At the end of February 2020, the number of patients waiting less than six weeks for a diagnostic test missed the 99% standard. This means that 1.64% of people referred for a diagnostic test did not receive it within the expected timeframe. The majority of underperformance was a result of breaches at University Hospital Southampton, Southampton Treatment Centre and InHealth. Cancer; Year to date at the end of February 2020, of the nine cancer standards, four have been achieved. The main areas of challenge in 2019/20 have been across three tumour sites; Urology (Prostate), Lower Gastrointestinal and Lung. There has been a significant increase in 2 week wait Lower Gastrointestinal patients seen at
22 University Hospital Southampton to date compared to the same period last year. This has resulted in a decline in 62 Day performance but does indicate an increase in early detection of cancer which is something that the CCG is actively encouraging. Urology remains challenging because of the larger volume of men needing intervention for prostate problems but the position has stabilised across 2019/20. Lung has been affected by capacity but the CCG continues to work with University Hospital Southampton NHS Foundation Trust to implement changes to their pathway for diagnostic tests to reduce waiting times.
Quality Mixed sex accommodation; Year to date at the end of February 2020, we have seen 39 mixed sex accommodation breaches, representing a significant improvement from 2018/19 where we had 379 (total year). Breaches are investigated and discussed at relevant Clinical Quality Review Meetings. Healthcare Associated Infections. Year to date at the end of February 2020, there have been; 21 cases of C.difficile infections against our maximum threshold of 44 (year total), and 3 cases of MRSA against our maximum threshold of 0. All 3 cases of MRSA were from a specific cohort of drug users and homeless or ‘sofa surfing’.
Mental Health Improving Access to Psychological Therapies (IAPT); Year to date at the end of February 2020, three of the four IAPT standards have been achieved. Recovery missed the 50% standard by 0.91% due to an increase in referrals coupled with staff sickness. It is also being reported that the acuity of patients is increasing, and this inevitably has an impact on recovery rates. Dementia; Year to date at the end of March 2020, the Dementia diagnosis standard has not been achieved however performance has improved throughout the year and the standard was met for the first month in February 2020 with 67.05% against the 66.7% standard and continues to achieve in March 2020. A number of actions have been taken to improve performance including working with the CCG's Enhanced Health in Care Homes Team to look at diagnosis rates in Care Homes, working with our Primary Care Team to raise awareness of iSPACE; dementia friendly GP practices scheme, working with Medicines Management Team to try and identify those who have been prescribed dementia related medication but do not have a diagnosis. The CCG has also commissioned a dementia navigator service and developed dementia friendly communities. Early Intervention in Psychosis; There have been changes in the reporting of this metric during 2019/20 with the data source being changed mid-year, therefore our latest reporting is to September 2019. Year to date at the end of September 2019, the standard has been achieved with 93.94% against the 56% standard. 100% was achieved for 4 consecutive months.
23 Children and Young People with Eating Disorders; Year to date at the end of December 2019, both the urgent referral within 1 week and routine referral within 4 week standards have not achieved the 95% standards. These standards are based on very low patient numbers and heavily impacted by patient choice. Severe Mental Illness; Year to date at the end of December 2019, 18.61% of patients with a Severe Mental Illness have received a Physical Annual Health Check in Primary Care against the 60% standard. This is a new metric and the CCG has seen a steady improvement across 2019/20 however the majority of checks are usually completed in Quarter 4 in conjunction with flu clinics.
Wheelchair Waits Year to date at the end of December 2019, the percentage of children waiting less than 18 weeks for a wheelchair standard has not been achieved. Some of our main challenges have been high demand coupled with staffing issues. The CCG continue to work with our provider, Millbrook, to produce an improvement plan which includes many initiatives including a focus on workforce and pathway improvements. A number of updates have been provided at the Health Overview Scrutiny Panel (HOSP). The CCG are currently re-procuring the service.
Delayed Transfers of Care (DTOC) • Year to date at the end of February 2020, the DTOC 3.5% standard has not been achieved. Some of our main challenges have been increasing levels of complexity amongst patients being discharged, high numbers of patients requiring discharge support and patients awaiting assessment by nursing and care homes following referral. A number of initiatives are in place to support a reduction in DTOC, including increased community provision in Homecare, working with University Hospital Southampton NHS Foundation Trust to reduce the number of failed discharges and roll out of Enhanced Health in Care Homes Programme. Support has been made available from NHS England Better Care and the Local Government Association to support DTOC around areas such as process mapping. Hampshire has also been offered support and a joint piece of work will focus specifically on UHS.
Maggie MacIsaac Chief Executive Officer 16 June 2020
24 SECTION 2: ACCOUNTABILITY REPORT
25 Corporate governance report
Members report
Our Governing Body
When CCGs were established in 2013 the aim was to embed clinical expertise into commissioning. As at the balance sheet date we have 26 constituent member GP practices (further information of current practices can be found on our website). As such, our organisational and governance structures have been designed to ensure that we are a clinically-led organisation with family doctors and other medical leads at the heart of our decision making.
The main way of achieving this is through our Governing Body, which comprises six local GPs, a Secondary Care Doctor, two Lay Members, the Director of Public Health, the Accountable Officer and three Executive Directors (one of whom is the Chief Nurse). There are also representatives from Healthwatch and Southampton City Council.
Key changes in 2019/20 There have been a number of changes to the CCG Governing Body membership in 2019/20 John Richards retired from his Chief Executive Officer role in June 2019, and Maggie MacIsaac became the Chief Executive Officer of the CCG. Maggie is also the Chief Executive of the Hampshire and Isle of Wight Partnership CCGs, and also West Hampshire CCG (from August 2019). Dr Mark Sopher joined the Governing Body as our new Secondary Care Doctor in April 2019, following on from Dr Peter Hockey who left in March 2019. Dr Shiba Qamar and Dr Hana Burgess joined the Governing Body in April 2019 as GP representatives. Dr Jason Horsley left his role as the Director of Public Health in October 2019, and Debbie Chase the Interim Director of Public Health started in November 2019. Grainne Siggins joined the Governing Body in February 2020.
Membership in 2019/20
The following people have been members of the Governing Body during 2019/20:
26 Dr Mark Kelsey, Clinical Chair and GP representative Dr Pritti Aggarwal, GP representative Dr Sarah Young, GP representative Dr Chris Sanford, GP representative Dr Shiba Qamar, GP representative Dr Hana Burgess, GP representative Dr Mark Sopher, Secondary Care representative Dr Jason Horsley, Joint Director of Public Health (April 2019 - October 2019) Debbie Chase, Interim Director of Public Health (November 2019 onwards) Henry Slater, Lay member for Governance Matt Stevens, Lay member for Patient and Public Involvement John Richards, Chief Executive Officer (April 2019 - June 2019) Maggie MacIsaac, Chief Executive Officer (June 2019 onwards) James Rimmer, Chief Finance Officer / Deputy Chief Executive Officer (April 2019 – June 2019) Managing Director + Chief Finance Officer (June 2019 onwards) Stephanie Ramsey, Director of Quality and Integration and Chief Nurse Peter Horne, Director of System Delivery
Non-voting members:
Lesley Gilder, Healthwatch Southampton Councillor David Shields, Chair of the Health and Wellbeing Board Grainne Siggins, Executive Director Wellbeing (Health and Adults) (February 2020 onwards)
Meet the team The following profiles for our Governing Body members include details of the committees of which they are members along with any interests and conflicts they have declared.
Dr Mark Kelsey, Clinical Chair and GP representative
Dr Mark Kelsey became Clinical Chair of the Governing Body in January 2018, having been a member of the Governing Body since the formation of the CCG in 2013. Mark trained in Southampton and has been a GP in the city since 2005. He is our GP Board lead for digital technology and the Better Care Programme.
Mark is also Clinical Lead for the Hampshire and Isle of Wight digital Transformation programme, and the Wessex Care Records programme.
Mark is a member of the following committees:
Governing Body (April 2013 – current)
27 Clinical Executive Group (April 2013 - current) Joint Commissioning Board (Chair from January 2018 - current)
He has declared the following interests and conflicts:
GP for Solent NHS Trust at Nicholstown practice (October 2016 – June 2019) Clinical Advisor for South Central and West CSU (October 2015 – April 2019) Son undertook work via a bank contract with the CCG admin team (July 2019 – December 2019) Clinical Advisor for the Hampshire and Isle of Wight STP Digital programme (October 2018 – current)
Dr Pritti Aggarwal, GP representative
Dr Pritti Aggarwal joined our Governing Body in April 2017 and is our lead for Engagement for Primary Care which includes TARGET (Time for Audit, Research, Governance, Education and Training) which gives GPs and practice nurses an essential opportunity to meet every two months to update their skills, learn about new treatments and share good practice.
Pritti trained in Cardiff and previously worked as a surgeon, she started working as a GP in Southampton in 2005. She is currently a GP partner at the Living Well partnership. Pritti also works with the University of Southampton as a module lead for primary medical care for students and lead for faculty development for primary medical care, as well as the diversity theme lead.
Pritti has worked with the CCG since 2013, supporting our System Delivery Team to make changes to services that support and diagnose people with Deep Vein Thrombosis and work to provide GPs improved access to CT KUB and cystoscopy (scans of the kidneys, ureters and bladder) amongst other changes. She has been bringing together GPs and consultants through the GP consultant liaison in Southampton in promoting greater understanding of the challenges they both face. This work has been picked up nationally by NHS England.
Pritti is a member of the following committees:
Governing Body (April 2017 – current) Clinical Executive Group (April 2017 – current)
She has declared the following interests and conflicts:
Module Lead for Primary Medical Care, faculty development for Primary Medical Care, Diversity Theme Lead at University of Southampton (declared January 2014 – current) Pritti’s spouse is a Care of Elderly Consultant at University Hospital Southampton (March 2014 – current)
28 GP Partner of the Living Well Partnership (1st January 2018 – current) The Living Well Partnership is a member of Southampton Primary Care Limited (1st January 2018 – current) Wessex Faculty Board for RCGP (1st November 2018 – current) TWVLA Secondment of work (1st November 2018 - current)
Dr Sarah Young, GP representative
Dr Sarah Young started working with the CCG safeguarding team in March 2017 as Named GP for Safeguarding Adults and in September 2018 she added the role of Designated Doctor for Looked after Children. Sarah joined our Governing Body in February 2018 and is our GP lead for cancer care and is also leading on the roll out of Lung Health Checks. Sarah trained at the University of Southampton and qualified in 2004. She worked within general medicine and oncology specialities before becoming a freelance GP. After working across practices in the city and as a lead for the out of hours service she has now settled as the lead GP at Peartree Practice. Sarah is a member of the following committees:
Governing Body (March 2017 - current) Clinical Executive Group (March 2017 - current)
Sarah has declared the following interests and conflicts:
Lead GP for Peartree Practice (February 2019 – current)
Dr Chris Sanford, GP representative
Dr Chris Sanford has been working with the CCG as a Clinical Lead since 2017. He joined our Governing Body in April 2018 and is our GP Board lead for primary care.
Chris has been a GP partner at The Living Well Partnership in Southampton since 2016. He graduated from Guy’s & St Thomas’ Medical School and has over twenty years of experience in the voluntary sector including five years as a Chief Executive.
Chris is also a Primary Care Network (PCN) Director, which has started in July 2019.
Chris is a member of the following committees:
Governing Body (April 2018 - current) Clinical Executive Group (April 2018 – current)
He has declared the following interests and conflicts:
29 GP Partner for Living Well Partnership (April 2018 – current) Living Well Partnership is a shareholder of Southampton Primary Care Limited (April 2018 – current) Adhoc Out of Hours GP work for Hantsdoc - North Hampshire Urgent Care (April 2018 – current) Chair / Trustee for debt advice charity based in London (April 2018 – current) Chair / Trustee for Sure Footing an outdoor adventure charity in the Peak District 1st April 2018 – current) Trustee for Christchurch (December 2018 – current)
Dr Shiba Qamar, GP Representative
Dr Shiba Qamar joined our Governing Body in April 2019 and has been a Clinical Lead with the CCG since 2015.
Shiba qualified in India and trained as a Paediatrician before she moved to GP training. She has been a GP for 12 years, training in Yorkshire and Liverpool, then working as a GP in Hertfordshire and Worcestershire before moving to Southampton in 2012.
Currently Shiba works as a Sessional GP in Southampton. She was a GP Partner at Bath Lodge GP Practice until September 2016 and, until February 2019; she worked at a drop-in Sexual health clinic for teenagers in Hedge End.
Shiba is very passionate about improving health outcomes in Southampton and, in her role as a Clinical Lead with the CCG, she has been involved in Gastroenterology, Gynaecology, Neurology, Urology, ENT (Ear, Nose and Throat) and most recently Diabetes. Shiba was involved in setting up a Dietician-led Community IBS Service in the city, a Women's Physiotherapist for uterine prolapse and moving pessary management from secondary care into primary care. She has also helped to increase support for GPs and Diabetes patients, by introducing the WISDOM Project in Southampton. The project enables GPs to closely monitor Type 2 Diabetics to improve their outcomes.
Shiba is a member of the following committees:
Governing Body (April 2019 - current) Clinical Executive Group (April 2019 – current) Clinical Governance Committee (April 2019 – current)
Shiba has declared the following interests and conflicts:
Undertakes ad-hoc sessions for the Southampton Primary Care Limited hub (2016 – current) Locum GP across Southampton City (October 2016 – current) Shiba’s spouse is a Consultant Paediatric Gastroenterologist at University Hospital Southampton (2011 – current)
30 GP appraiser for the Wessex Appraisal Service (October 2019 – current)
Dr Hana Burgess, GP Representative
Dr Hana Burgess has worked at the CCG as a Clinical Lead for Adult Mental Health since 2017. She has worked on the development of the Crisis Lounge and improving physical health care for people with serious mental illness. Hana will be continuing her work in mental health as well as taking on her role on the Governing Body from April 2019. She is also our Board member for Prescribing.
Hana trained in Southampton and qualified in 2006. She has a background in primary care research, having worked as an academic clinical fellow at the University of Southampton until 2013. She undertook further postgraduate studies in evidence based practice and primary health care. She has been a partner at Shirley Health Partnership since 2013.
Hana is a member of the following committees:
Governing Body (April 2019 - current) Clinical Executive Group (April 2019 – current)
Hana has declared the following interests and conflicts:
GP Partner at Shirley Health Partnership, also the Safeguarding lead for the practice (September 2013 – current) Shirley Health Partnership is a shareholder of Southampton Primary Care Limited (November 2014 – current) Hana’s spouse has a joint academic and clinical position at consultant level within the respiratory department at University Hospital Southampton (January 2019 – current)
* Note on our GP representatives - 25 of the 26 GP practices in the city are a shareholder of a GP Federation, Southampton Primary Care Limited. All GPs on our Governing Body whose practices are members of the Federation have, and will continue to be, excluded from participating in commercial discussions affected by this development.
Dr Mark Sopher, Secondary Care Representative
Dr Mark Sopher joined the Governing Body in March 2019 as our Secondary Care Board Doctor. Mark is a cardiologist. Following training in London, Mark moved in 2005 to set up a new cardiology unit at the Royal Bournemouth Hospital where he is now the clinical lead of the medical care group. He has a Master’s degree from the London School of Economics in healthcare economics and management and was previously the secondary care board doctor to the Isle of Wight CCG. He lives near Lymington and is a governor of a local school.
31 Mark is a member of the following committees:
Governing Body (April 2019 - current) Clinical Governance Committee (January 2020 – current)
Mark has declared the following interests and conflicts:
Cardiologist at Royal Bournemouth Hospital and Dorset Heart Clinic (April 2019 – current) Member of Council for the British Heart Rhythm Society (April 2019 – current) Medical advisor and shareholder for Technomed Ltd (April 2019 – current)
Debbie Chase, Interim Director of Public Health
Debbie Chase has worked as a Consultant in Public Health at Southampton City Council for six years and she joined our Governing Body in November 2019. Her background is in academic public health, having undertaken a PhD in public health research at University of Southampton and several research roles. Her specialist areas of interest are children and young peoples’ health and wellbeing, sustainable development and getting evidence into practice.
Debbie is a member of the following committees:
Governing Body (November 2019 – current) Clinical Executive Group (November 2019 – current)
Debbie declared the following conflicts of interest:
Employee of Southampton City Council (November 2019 – current)
Dr Jason Horsley, Joint Director of Public Health for Southampton and Portsmouth City Council (April 2019 – October 2019)
Dr Jason Horsley qualified in medicine in New Zealand in 1998. He worked in clinical medicine for a decade, predominantly in paediatrics, and held positions in New Zealand, Kenya, Australia, the UK and Uganda. He has been working in Public Health for the last ten years, moving to take up the post of joint director of Public Health for the Cities of Southampton and Portsmouth. Prior to this, Jason worked for the Department of Health, in the former Strategic Health Authorities and PCT’s (Primary Care Trusts) in the East of England and in South Yorkshire, and within the CCG’s and Local Authorities in South Yorkshire. He has also worked in academic settings undertaking research and teaching roles, most recently with the University of Sheffield, but he has also previously provided
32 clinical teaching to medical students from the University of Cambridge and Mbarara University of Science and Technology in Uganda.
He has a master’s degree in Public Health from the University of Sheffield, a Degree in Medicine and Human Biology from Auckland university, and is a Fellow of the Faculty of Public Health and member of the Association of Directors of Public Health.
Jason was a member of the following committees:
Governing Body (January 2017 – October 2019) Clinical Executive Group (January 2017 – October 2019)
Jason declared the following conflicts of interest:
Jointly appointed by Southampton and Portsmouth councils, as such he is also the Director of Public Health for Portsmouth (January 2017 – October 2019) Jason’s wife is a doctor in infectious disease based at University Hospital Southampton NHS Foundation Trust (January 2017 – October 2019)
Henry Slater, Lay Member (Governance)
Henry Slater joined our Governing Body as Lay Member (Governance) in January 2019, having previously served as an Associate Lay Member. He chairs the Finance and Audit Committee and the Remuneration Committee. Henry is also a member of the Primary Care Commissioning Committee. Henry is the CCG’s Conflicts of Interest Guardian.
Henry brings to the Board several years’ experience of non-executive roles in the NHS, having been a member of the Board of Southampton City Primary Care Trust; and the Southampton, Hampshire, Portsmouth and Isle of Wight Cluster. He continues to chair Performers’ List Decision Panels for NHS England.
His professional background is in education, academia, local government, and university administration.
Henry lives in the City, and has served on the Boards of Richard Taunton Sixth Form College and Hampshire Autistic Society.
Henry is a member of the following committees:
Governing Body (January 2019 – current) Finance and Audit Committee (March 2013 – current) Remuneration Committee (January 2019 - current Primary Medical Care Commissioning Committee (April 2017 – current)
Henry has declared the following conflicts of interests:
33 Chair of Performers List Decision Panels for NHS England (2014 – current) Ordinary Member of South Central Ambulance Service, NHS Foundation Trust (April 2013 – current) Patient at Hill Lane Surgery (April 2013 – current)
Matt Stevens, Lay member (Patient and public involvement)
Matt Stevens is a teacher by profession but has also run several entertainment businesses in the city. However it is his experience as a local politician with special interest in Health and Education, that started him on the path that lead to his appointment as a Lay Member for NHS Southampton CCG.
Matt’s local government experience as a Southampton City Councillor (Peartree and Bitterne wards), as a Cabinet member for Health and Social Care and as Scrutiny Chair for Health allowed him to develop an interest and experience in health issues. Matt retired from the council in 2015 after first being elected in 1995. The local government expertise is applied to his roles on the Governing Body and Finance and Audit Committee and as chair of the Primary Medical Care Commissioning Committee.
An interest in public health and health prevention was also evident from his role of Chair of Trustees of the Charlotte Jackson Trust (Ribbons Center), an HIV support charity in the city. Matt has also served on variety of governing bodies in the city: Solent University, Southampton Voluntary Services, Thornhill Plus, Cantell School, Southampton Partnership, Southern Health NHS Foundation Trust and the Health Wellbeing Board.
Matt is a member of the following committees:
Governing Body (September 2017 - current) Finance and Audit Committee (September 2017 - current) Primary Medical Care Commissioning Committee (September 2017 – current) Remuneration Committee (September 2017 – current) Joint Commissioning Board (March 2019 – current)
Matt has declared the following conflicts of interests:
Patient at Mulberry House Surgery (April 2012 – current)
John Richards, Chief Executive Officer / CCG Accountable Officer (until June 2019)
John Richards was the Chief Executive Officer since the CCG was established and worked with the Southampton, Hampshire, Isle of Wight and Portsmouth cluster of Primary Care Trusts (PCTs) as CCGs were being developed.
34 A former PCT Chief Executive with approaching 20 years’ experience leading commissioning organisations, John is passionate about supporting clinical leaders to own the quality and cost of healthcare, creating common purpose and leading with integrity and authenticity. He is determined to bring NHS and local authority leadership together to join up care. He is also interested in working with communities to build resourcefulness.
Hampshire born and bred, John studied social anthropology at Cambridge and joined the NHS in 1988 after a brief career in the Welsh Office. From 1991 to 2006 he worked in south west Hampshire, becoming Chief Executive of Eastleigh and Test Valley South PCT in 2002 and of New Forest PCT in 2004. John then moved to be Chief Executive of NHS Plymouth until 2011.
John was a member of the following committees:
Governing Body (April 2013 – June 2019) Clinical Executive Group (April 2013 – June 2019) Primary Medical Care Commissioning Committee (April 2016 - June 2019) Joint Commissioning Board (September 2017 – June 2019)
John declared no interests and conflicts for 2019/20. He retired in June 2019.
Maggie MacIsaac, Chief Executive Officer (June 2019 – current)
Maggie MacIsaac became Chief Executive of Southampton City Clinical Commissioning Group in June 2019. She is also the Chief Executive of the Hampshire and Isle of Wight Partnership of CCGs.
Maggie MacIsaac joined the NHS as a graduate nurse. Since completing the NHS national management training scheme, Maggie has worked in many sectors of the NHS – locally, regionally and nationally - acquiring considerable experience in the value of strong partnerships. During her career she has served for many years in Director and Chief Executive roles.
She is passionate about working with partners on new ways of delivering change to positively transform healthcare and experiences for patients and the wider community.
Maggie is a member of the following Committees Governing Body (June 2019 – current) Joint Commissioning Board (June 2019 - current)
Maggie has declared the following conflicts of interests:
35 Sisters Father in Law sits on the Patient and Public Engagement Group in Whitchurch, which is in the West Hampshire patch. In this role he is also undertaking some work with North Hampshire CCG. (February 2019 – current)
James Rimmer, Chief Finance Officer and Deputy Chief Executive (until June 2019); Managing Director (June 2019 – current)
James Rimmer was the Chief Finance Officer and Deputy Chief Executive since the CCG was established. When John Richards retired as CEO, Maggie MacIsaac became the CEO and James took on the role of Managing Director.
James joined the NHS in 2001 as part of the highly regarded NHS Finance Graduate Training Scheme. He has held numerous senior finance roles working in both the commissioning and providing arms of the NHS.
James is a professionally qualified accountant, a Fellow of the Chartered Institute of Management Accountants (CIMA) and holds a master’s degree in business administration and an honours degree in accounting and finance.
As the Chief Financial Officer for the CCG James is responsible for ensuring we meet all of our statutory duties in relation to finance, providing expert financial advice to Governing Body members. He also leads on performance and is the CCG Lead Director for our relationship with NHS South, Central and West Commissioning Support Unit (our back office support services provider).
James is a member of the NHS England Allocations Steering Group, which is responsible for providing advice on the overall direction of NHS funding allocations.
James is a trustee of the Healthcare and Financial Management Association (HFMA) and chair of their Audit and Finance Committee, he is in the second of his three year term. HFMA is a registered charity and the only professional body in the UK dedicated to setting and promoting the highest standards in financial management and governance in healthcare. It encompasses a membership community that represents a third of all finance staff working in UK healthcare.
Since July 2018, James is the Co-Chair of the NHS Clinical Commissioners (NHSCC) Finance Forum and a Member of the NHSCC Board (3 year term). NHS Clinical Commissioners is a membership organisation of Clinical Commissioning Groups (CCGs) in England existing to support them in providing the independent collective voice of CCGs providing voice and influence, networks and fora for peer support, sharing good practice and development. The Finance Forum acts as the representative voice for CCG CFOs at a
36 national level and also provides an opportunity for networking and the sharing of best practice.
James is also an Independent Governor for Solent University and Chair of their Audit Committee.
James is a member of the following committees:
Governing Body (April 2013 - current) Clinical Executive Group (April 2013 - current) Primary Medical Care Commissioning Committee (April 2016 - current) Joint Commissioning Board (In attendance since September 2017 – current)
James has declared the following interests and conflicts:
Trust member in a personal capacity for; Solent NHS Trust, Southern NHS Foundation Trust, University Hospital Southampton Foundation Trust and South Central Ambulance Service NHS Foundation Trust. These roles hold no power within the respective organisations with the only involvement being through receiving a regular members’ newsletter (which is publicly available) (April 2013 - current) Executive Branch Committee Member South Central HFMA (Healthcare and Financial Management Association) (declared June 2016– current) Chair of the HFMA (Healthcare and Financial Management Association) Audit and Finance Committee (December 2016 – current) Trustee of HFMA (December 2015 - current) Member of the NHS England Allocations Steering Group (April 2016 – current) Joint Director of Finance for Hampshire and Isle of Wight Sustainability and Transformation Partnership (seconded 1 day a week from September 2017 – current) Co-Chair of the NHS Clinical Commissioners (NHSCC) Finance Forum and a Member of the NHSCC Board (declare July 2018 – current) Independent governorship - Solent University (declared October 2018 – current) and Chair of their Audit Committee
Stephanie Ramsey, Director of Quality and Integration (Chief Quality Officer and Chief Nurse)
Stephanie Ramsey has been Director of Quality and Integration and Chief Nurse since the CCG was established. Her post is a joint appointment with Southampton City Council.
Stephanie leads on strategic development and system redesign across areas that benefit from integrated commissioning. This includes leadership of the Integrated Commissioning Unit (ICU) which is a joint commissioning team comprising CCG and Council staff (established October 2013).
37 Stephanie is also our Chief Nurse and provides corporate leadership for key programmes of work including corporate and clinical governance, quality and safety, medicines management, continuing healthcare, safeguarding, patient experience and patient/public engagement. She is a nurse, midwife and health visitor and has graduate and postgraduate degrees in health psychology and management. Stephanie has several years’ experience in leadership roles for a range of NHS community care providers and has worked on secondment in the voluntary sector.
She is a member of the following committees:
Governing Body (member since April 2013 - current) Clinical Executive Group (member since April 2013 - current) Clinical Governance Committee (member since April 2013 - current) Primary Medical Care Commissioning Committee (member since April 2016 - current) Joint Commissioning Board (In attendance since September 2017 – current)
Stephanie has declared the following interests and conflicts:
Stephanie is jointly appointed with Southampton City Council (declared April 2013 - current) The Interim Director of Adult Social Services (DASS) for Southampton City Council (declared November 2018 – December 2019)
Peter Horne, CCG Director of System Delivery
Peter Horne spent 18 years in the Army as an infantry officer where his appointments covered a broad spectrum from combat operations and personnel policy to strategic procurement and training and development.
He moved to the NHS in 2005, initially as a divisional operations director within London Ambulance Service. Following this, he spent time within the regional tier of the NHS with responsibility for the management of performance, before taking up a post within local commissioning organisations in Hampshire.
Peter leads the System Delivery Directorate and is responsible for commissioning acute services for adults in both elective and urgent care; long term conditions pathways; Primary care; Strategic Estates planning; EPRR and Organisational Development.
Peter is a member of the following committees:
Governing Body (member since April 2013 - current) Clinical Executive Group (Member since April 2013 - current) Primary Medical Care Commissioning Committee (April 2016 - current)
38 Peter has declared the following interests and conflicts:
Trustee of Valley Leisure Ltd (declared April 2013 – current) Non-voting members
As part of our commitment to ensuring a breadth of skills and viewpoints we also have three non-voting members on our Governing Body:
Lesley Gilder, Healthwatch Southampton
Lesley Gilder is a representative of Healthwatch Southampton (HWS), the local body representing the patient voice. Having representation from Healthwatch on the Governing Body is vital to bringing the patient voice and a city-wide perspective to influence decision- making.
Lesley is the lead link between HWS and the CCG Governing Body. She is also a member of the CCG Clinical Governance Committee. Lesley has a background in representing patients and was a member of Southampton LINk, HWS's predecessor organisation.
Over the last two years she has been engaged in a variety of projects related to health and social care and has undertaken Patient Led Assessments of the Care Environment (PLACE) for Solent NHS Trust and University Hospital Southampton NHS Foundation Trust and taken part in the Clinical Assessment Scheme for the Hospital Trust. Lesley has also contributed to both clinical quality review meetings and to the review of a local GP practice.
Lesley's professional career has spanned both management and research most recently as a senior manager in the Library and Information Service at Southampton University and previously as a researcher in a nationally funded Library Management Research Unit. Lesley is also President and Chair of Solent Credit Union.
For more information about Healthwatch Southampton visit their website www.healthwatchsouthampton.co.uk.
Lesley is a member of the following committees:
Governing Body (member since April 2014 - current) Primary Medical Care Commissioning Committee (April 2016 - current) Clinical Governance Committee ( July 2014 - current )
She has declared the following interests and conflicts:
President of Solent Credit Union (declared 2014 – February 2020) Member of University Hospital Southampton (declared 2014 – current)
39 Councillor David Shields, Chair of the Health and Wellbeing Board
Councillor David Shields is a member of the Council’s Cabinet, with portfolio for health and social care, private sector housing and local action on climate change. He chairs the city’s Health and Wellbeing Board and, along with representing the Council on the CCG Governing Body and serves on the CCG Primary Medical Care Commissioning Committee.
David is an active campaigner for health and social care issues and has been the elected member for the Freemantle ward for five years.
He also plays an active part in regional and national networks to promote policies to improve people’s health and wellbeing and ensure greater public involvement in shaping publicly funded care services. He was a founder member of the Care Quality Commission’s (CQC’s) Healthwatch England Committee (from October 2012 – June 2014). He also supports the Local Government Association with its national programmes of work on Health and Wellbeing Board leadership and putting Health in All Policies.
David serves on the following committees:
Governing Body (January 2014 - current) Primary Medical Care Commissioning Committee (April 2016 - current) Joint Commissioning Board (member since September 2017 – current)
David has declared the following interests and conflicts:
Foundation Trust member for Southern Health, University Hospital Southampton and South Central Ambulance Service (April 2013 – current)
Grainne Siggins, Executive Director Wellbeing (Health and Adults)
Grainne started as Executive Director for Health and Adults at Southampton City Council in January 2020. This followed many years working at a senior director level in adult social care, most recently in the London Borough of Newham.
Grainne serves on the following committees:
Governing Body (February 2020 - current)
Grainne has declared no interests and conflicts for 2019/20.
40 Finance and Audit Committee The members of this Committee are: Henry Slater, Lay Member for Governance Matt Stevens, Lay Member for Patient and Public Involvement Alison Powell, Associate Lay Member June Bridle, Associate Lay Member (until October 2019)
Internal Audit, External Audit, Counter Fraud, the Chief Finance Officer, and Chief Executive Officer are all in attendance but not members.
Our Finance and Audit Committee undertakes a bi annual review of its effectiveness. This review was last undertaken in July 2019 using the model checklist from the HFMA Audit Committee Handbook. At the time of the review the Committee was found to be operating in an effective manner. The next review will be undertaken in July 2020. At the same time a review is also undertaken of the CCG’s internal and external auditors service and the CCG’s Counter Fraud Service, all of which identified no issues or concerns.
For further details regarding membership of our other sub-committees please see our Governance Statement at Appendix B.
External auditors The CCG appointed external auditors are Grant Thornton UK LLP. Grant Thornton’s work covers all matters relating to the statutory audit and value for money work to ensure the CCG conducts its business to achieve economy, efficiency and effectiveness.
The fee paid for audit services in respect of the period covered by these accounts is £43,800 including non-recoverable VAT.
This year Grant Thornton UK LLP have also undertaken an audit of our Mental Health Investment Standard reporting to NHS England. All CCGs have been set a target to invest additional funds into mental health services and NHS England set out in planning guidance that achievement of this target would be audited. The audit work this year was to look at our achievement of the standard in 2018/19, i.e. increasing spend compared to 2017/18. The CCG received an unqualified opinion on this work and this was reported to the Finance and Audit Committee. An additional fee of £12,000 including non-recoverable VAT was paid for this work, in line with NHS England guidance.
41 Statement of Disclosure to auditors Each individual who is a member of the CCG at the time the Members’ Report is approved confirms: so far as the member is aware, there is no relevant audit information of which the CCG’s external auditor is unaware that would be relevant for the purposes of their audit report; and, the member has taken all the steps that they ought to have taken in order to make him or herself aware of any relevant audit information and to establish that the CCG’s auditor is aware of it.
Using our resources wisely Managing our resources responsibly and reducing our environmental impact is one of the biggest issues we face. The UK Government has committed to taking action and has introduced the Climate Change Act with a target to cut carbon emissions. With this comes an increased expectation that the public sector will lead by example and take steps to tackle sustainability. It is estimated that the NHS alone can save £180 million per year by reducing carbon emissions and at the same time contribute to the sustainable development of services for now and for future generations. We continue to be committed to playing our part, for more details about our plans, work and progress on sustainability, see Appendix A.
Setting charges for information Under the Data Protection Act and Freedom of Information Act the CCG has the right to charge for providing some types of information. For example, if the CCG estimates that the cost of locating and retrieving the information would exceed the appropriate set limit. I certify that the CCG has complied with HM Treasury’s guidance on cost allocation and the setting of charges for information. The setting of fees and charges is subject to audit.
Modern Slavery Act NHS Southampton City CCG fully supports the Government’s objectives to eradicate modern slavery and human trafficking but does not meet the requirements for producing an annual Slavery and Human Trafficking Statement as set out in the Modern Slavery Act 2015.
Equality Act and Equality Delivery System Southampton City CCG places equality and inclusion at the heart of commissioning services for local people from vulnerable protected groups. We have made some progress in embedding equality and diversity into our decision making processes and this will be increasingly reflected in the redesign of existing services and the commissioning of all
42 services.
To ensure equality and diversity (E&D) is embedded in commissioning we:
Ensure all staff (including new starters) receive training in how to embed E&D into day-to-day practices. Ensure providers monitor fair access to services by protected groups. Build equality returns into contract reviews. Build E&D criteria into all contracts. Involve all protected groups in service design and re-design. Show “due regard” – undertake equality impact assessments on commissioning programmes, strategies and policies where appropriate. Specify required equality outcomes within service specifications. Engage local protected groups to identify health needs and any negative impacts on protected groups from healthcare changes under consideration by the CCG.
Our commissioners use the intelligence from the above sources in a number of ways, for example:
. To ensure providers monitor fair access to services by protected groups and differential satisfaction levels . To involve all protected groups in service design and re-design . To undertake equality analysis and human rights screening on early decisions, priorities, commissioning intentions, policies etc. . To specify required equality outcomes within service specifications . To engage local protected groups to identify health needs and negative impacts on protected groups from healthcare changes under consideration . To use feedback and satisfaction data to manage performance
As a public sector organisation, CCGs are required to publish relevant information to show how we meet the Equality Duty. This information has to be published by in January every year. Our report demonstrates how the CCG is meeting its Public Sector Equality Duty in relation to services commissioned and its workforce and is available on our website. The report was approved the CCG’s Clinical Governance Committee and the Governing Body in January 2020.
The CCG’s Clinical Governance Committee is accountable for monitoring the effectiveness of our Equality and Diversity and Safeguarding Strategies and the CCG impact on health inequalities as assessed in the Joint Strategic Needs Assessment. Reducing health inequalities is a key strand of our vision and objectives and we take our responsibility under section 14T of the Health & Social Care Act 2012 very seriously. Our Public Health team provides key demographic changes and health inequalities profile data
43 across the city. This information plays a pivotal role in ensuring that we commission for the diverse communities of Southampton. This role is formally incorporated into the Terms of Reference of a number of our sub committees. The Primary Care Medical Committee seeks assurance from management that the CCG provides equitable access to high quality primary medical services that improve outcomes and reduce health inequalities across the city. This is particularly relevant in relation to the agreement to approve mergers, close branch surgeries and in the operation of some of our locally enhances services. We continue to jointly undertake with Southampton City Council to further improve public health in the City and reduce health inequalities. This has formed a key part of the development of our new five year strategy for health and care.
Local scrutiny of our activities Southampton City Council’s Health Overview and Scrutiny Panel is responsible for reviewing our performance and the plans we make and holding local health service providers to account. It is made up of local councillors and undertakes the scrutiny of health and adult social care in the city.
Information about the Panel is available on Southampton City Council’s website. The NHS is also reviewed by Healthwatch Southampton, an independent champion created to gather and represent the views of local people. Anyone living the city can get involved with Healthwatch Southampton and share their views. It is also possible to join the organisation as a member to help steer the strategic direction of Healthwatch Southampton. Further information is available on their website.
Emergency preparedness As Category Two responders under the Civil Contingencies Act 2004, we are not frontline NHS responders in the event of a major emergency. That said, we still have an important role to play, operationally supporting category 1 responders, co-operating with other agencies and acting as a conduit for information – both for other responders and the public, and in assuring the preparedness plans of key local providers. We have continued to work closely with our NHS partners including NHS England, fellow CCGs, trusts, Public Health England and pharmacists on emergency planning and NHS resilience. We take part in multi-agency meetings and exercises which include the emergency services, local authorities and other key responding agencies. As part of our core standards assessment with NHS England the CCG received partially compliant with work needed with Property Services. The CCG for the latter part of 19/20 the CCG started preparations for Covid-19 ensuring our Business Continuity arrangements were in place to support the emergency response. An internal working group was set up in February 2020 to start the planning of services and
44 ensuring the staff and GP practices in Southampton were supported. As of March 2002 we moved to working within a major incident set up. The Civil Contingencies Act 2004 provides the statutory framework for planning and dealing with emergencies. The Act defines an emergency. The current situation is an emergency because it ‘threatens serious damage to human welfare’. The Act provides the power to make emergency regulations. The Coronavirus Act 2020 also contains some new statutory powers to enable responders to mitigate the impact of the COVID-19 pandemic. The Civil Contingencies Act divides local bodies into two categories, with different responsibilities:
Category 1 responders including local authorities, emergency services and some health bodies. The Act requires Cat1 responders to organise as a Local Resilience Forum in Local Resilience Areas which follow police force boundaries. Category 2 responders such as transport providers who must cooperate with category 1 responders.
Locally the Hampshire & Isle of Wight Local Resilience Forum covers Portsmouth, Isle of Wight, Southampton and the county of Hampshire. The emergency response is based around the concepts of command, control and cooperation and operates at three levels – operational, tactical and strategic.
To ensure that Southampton & South West Hampshire health and care provision is optimised to address the COVID-19 threat a multi-agency group of senior officer and clinical leaders meet daily. The purpose is to ensure effective demand and capacity modelling, provide system wide oversight, enable mobilisation of additional capacity and resource deployment, monitor risks and impact and put mitigations in place. The group will escalate issues as necessary to the Hampshire and Isle of Wight COVID-19 Health & Social Care cell, within the major incident set up as outlined above. The group will also work on recovery to business as usual.
Statement of preparedness I certify that the clinical commissioning group has an incident response plan in place, which is fully compliant with the NHS England Emergency Preparedness Framework 2013. The clinical commissioning group regularly reviews and makes improvements to its major incident plan and has a programme for regularly testing this plan, the results of which are reported to the Governing Body.
Data security Information is a vital asset, both in terms of clinically managing individual patients and also in the efficient organisation of services and resources. We aim to safeguard patient confidentiality and maintain data security whilst empowering staff within the CCG to perform their role using any relevant data by adhering to key information governance principles.
In 2019/20 we have maintained our compliance with a number of policies aimed at ensuring
45 staff know what their roles and responsibilities are in relation to handling sensitive data. The scope of these policies cover:
Data Protection Data Management and Retention IT and Cyber Security Data Quality Subject Access Requests Freedom of Information
Staff receive training (where applicable) and support in adhering to these policies and staff new to the organisation receive a data protection familiarisation and awareness session with the Head of Governance upon induction.
The CCG undertook its second year of completing the Data Security and Protection toolkit, which we were audited internally against and received ‘substantial assurance’ with no recommendations.
Reporting data security breaches
Under the Department of Health and Social Care’s Information Governance Assurance Programme, NHS organisations must include details of serious incidents requiring investigation (SIRIs) involving data loss or confidentiality breach in their annual reports. These are classified on a scale of 0-5 in terms of severity, risk to reputation and risk to individuals.
The SIRI reporting process enables us to analyse each incident, any particular trends and make adjustments to the way we work to minimise risk of future occurrence.
All reported information governance / data security incidents are logged onto our incident reporting system. During 2019/20, one data security incident was reported.
Summary of serious incidents requiring investigation involving personal data as reported to the information commissioner’s office in 2019/20
46 Date of Nature of Nature of data Number of people Notification incident Incident Involved potentially affected Steps (month)
September Information was Personal One The Information 2019 shared with a Identifiable Commissioners patient relating to Data Office (ICO) was a special notified of the allocations service breach, no procedure investigation was required and the incident was closed by the ICO.
During 2019/20, the number of incidents classified at a severity rating of 1 or 2 were:
Summary of other personal data related incidents in 2019/20 Category Nature of incident Total I Loss of inadequately protected electronic equipment, devices or 0 paper documents from secured NHS premises II Loss of inadequately protected electronic equipment, devises or 0 paper documents from outside secured NHS premises III Insecure disposal of inadequately protected electronic 0 equipment, devices or paper documents IV Unauthorised disclosure 0 V Other 0
Regulation We are committed to maintaining our compliance with national standards and targets set by the Department of Health and Social Care, NHS Litigation Authority and Public Sector Audit Appointments (PSAA), and complying with any associated governance and regulatory requirements. Information received at intervals from these bodies is used to support our decision-making on commissioning issues.
Reporting and monitoring arrangements that help us ensure that national standards and targets are met are also in place.
47 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 NHS Southampton City Clinical Commissioning Group.
The responsibilities of an Accountable Officer are set out under the National Health Service Act 2006 (as amended), Managing Public Money and in the Clinical Commissioning Group Accountable Officer Appointment Letter. They include responsibilities for: The propriety and regularity of the public finances for which the Accountable Officer is answerable 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) For safeguarding the Clinical Commissioning Group’s assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities) The relevant responsibilities of accounting officers under Managing Public Money Ensuring the CCG exercises its functions effectively, efficiently and economically (in accordance with Section 14Q of the National Health Service Act 2006 (as amended)) and with a view to securing continuous improvement in the quality of services (in accordance with Section14R of the National Health Service Act 2006 (as amended)) Ensuring that the CCG complies with its financial duties under Sections 223H to 223J of the National Health Service Act 2006 (as amended). Under the National Health Service Act 2006 (as amended), NHS England has directed each Clinical Commissioning Group to prepare for each financial year a statement of accounts in the form and on the basis set out in the Accounts Direction. The accounts are prepared on an accruals basis and must give a true and fair view of the state of affairs of the Clinical Commissioning Group and of its income and expenditure, Statement of Financial Position and cash flows for the financial year. In preparing the accounts, the Accountable Officer is required to comply with the requirements of the Government Financial Reporting Manual and in particular to: Observe the Accounts Direction issued by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis; Make judgements and estimates on a reasonable basis; State whether applicable accounting standards as set out in the Government Financial Reporting Manual have been followed, and disclose and explain any material departures in the accounts; and, Prepare the accounts on a going concern basis. Confirm that the Annual Report and Accounts as a whole is fair, balanced and
48 understandable and take personal responsibility for the Annual Report and Accounts and the judgements required for determining that it is fair, balanced and understandable.
To the best of my knowledge and belief, I have properly discharged the responsibilities set out under the National Health Service Act 2006 (as amended), Managing Public Money and in my Clinical Commissioning Group Accountable Officer Appointment Letter. I also confirm that: as far as I am aware, there is no relevant audit information of which the CCG’s auditors are unaware, and that as Accountable Officer, I have taken all the steps that I ought to have taken to make myself aware of any relevant audit information and to establish that the CCG’s auditors are aware of that information
Maggie MacIsaac Chief Executive Officer 16 June 2020
49 Governance statement Each CCG is required to include a governance statement within its annual report that is signed by the Chief Executive Officer. This key part of the report outlines the organisation’s governance and risk obligations along with a review of effectiveness and the Head of Internal Audit opinion. The regularity of our expenditure is subject to audit by our external auditors. Our governance statement can be found in full at Appendix B.
Conclusion As you can see from this annual report we have had a busy year working to improve health services for local people. We hope you have found reading about our work interesting. If you have any comments or questions about this report please direct them to our Communications team at [email protected]
Maggie MacIsaac Chief Executive Officer 16 June 2020
50 Remuneration and staff report
Staff report We continuing to review our approaches and ways of working and we are immensely grateful to our staff for their continued efforts and commitment to getting the best possible services for the people of Southampton. Their achievements, are all the more remarkable in these particularly challenging times, underscore the importance of investing time and energy into becoming an exceptional place to work and an employer of choice.
As recorded on 31 March 2020 the CCG employed 128 staff across a number of staff groups including administrative and clerical, medical/nursing, senior managers and professional and technical staff. The gender breakdown of our staff is:
Headcount Headcount 2018/19 2019/20
Male Female Male Female Governing Body 5 3 4 4 Senior managers 3 1 3 1 Employees 25 88 23 93 Total 33 92 30 98
“Senior managers” are as defined in the remuneration report. All members of staff are counted included in only one group. Details of the CCG’s (NHS) pension scheme and calculation of its liabilities can be seen in the remuneration report and in the full set of CCG accounts under accounting policies. Analysis of staff costs between those permanently employed and other staff is shown in the Employee Benefits table below. This is subject to external audit.
2019/20 2018/19 Permanent Permanent Employees Other Total Employees Other Total Employee Benefits £'000 £'000 £'000 £'000 £'000 £'000 Salaries and wages 4,663 731 5,395 4,437 483 4,919 Social security costs 503 0 503 476 0 476 Employer Contributions to NHS Pension scheme 874 0 874 587 0 587 Other pension costs 0 0 0 0 0 0 Apprenticeship Levy 9 0 9 8 0 8 Other post-employment benefits 0 0 0 0 0 0 Other employment benefits 0 0 0 0 0 0 Termination benefits 0 0 0 0 0 0 Gross employee benefits expenditure 6,050 731 6,781 5,507 483 5,990 Less recoveries in respect of employee benefits (note 4.1.2) (561) 0 (561) (468) 0 (468) Total - Net employee benefits 5,489 731 6,221 5,039 483 5,522 Note - no employee benefits have been capitalised
51 The functional group breakdown of our staff is. This is subject to external audit.
WTE 2019/20 WTE 2018/19 Category Permanent Other Permanent Other Administration and estates 72 6 70 4 Nursing, midwifery and health visiting staff 13 2 15 2 Scientific, therapeutic and technical staff 10 0 8 1 Total 95 8 93 7
CCG spend on consultancy services in 2019/20 was £13k (£5k 2018/19).
Staff engagement and communication An organisation is only ever as good as its workforce, and making sure our staff are informed and involved is crucial to our continued development. Staff loyalty, to the CCG and the wider NHS, benefits not only the CCG but also patients by evolving local expertise and local knowledge.
We keep our team up to speed and give them the opportunity to get involved through a range of activities including face to face ‘Team Time’ briefings, newsletters, staff information sharing events, roadshows, a Staff Forum, lunch and learn sessions, polls and surveys and regular away days. We also run various informal events for staff such as Christmas events, Time to Talk and various other social gatherings to boost the sense of ‘team’, mutual understanding and camaraderie in the organisation.
In 2019/20 we built on the foundations we have developed by: Using the Staff Forum as a mechanism for feedback on issues, policies and wellbeing continuing to evolve our system of team briefing continuing with our successful away day programme developing our approach to training, particularly looking at ‘joined up’ approaches promoting and implementing our commitment to a work-life balance increasing opportunities for staff involvement in events, roadshows, consultations and other public facing work. Have embedded the work of the Wellbeing Champions into the organisation Updated the CCG’s values
52 Staff survey
At the end of 2019 the national NHS staff survey was carried out. The survey confirmed our organisation takes positive action on health and wellbeing, feel valued, look forward to coming work and feel supported by colleagues and managers.
We are particularly proud that 93% of our staff took part and that out of 66 CCG’s that took part, we ranked 3rd for overall positive scores.
It is also very encouraging that:
most of our staff agree that care of patients is our organisations top priority, almost 90% would recommend the organisation as a place to work our staff feel that if their friend or relative needed treatment they would be happy with the standard of care provided by this organisation
We are addressing areas of concern. These are mainly related to working additional hours and feeling pressure from themselves to come into work while feeling unwell and ensuring that all staff had an annual appraisal.
We continue to have a group of wellbeing champions that have been trained and who will be advocates for wellbeing around our offices.
Our staff wellbeing at work is really important to us, which is why our Wellbeing Champions have developed a wellbeing action plan of themes and activities throughout the year. Mental health at work remains a top priority of this plan.
Training and development Excellence at work does not just ‘happen’. It relies on the commitment of individuals to do the best they can, and the commitment of the CCG to support them in achieving their goals.
All staff have an annual appraisal, which formally recognises their achievements and sets benchmarks for the coming year. Skills gaps are identified and steps taken to meet any needs. These are formally recorded in personal development plans. Our approach to organisational development has also been developed over the last few years with a new look plan in place.
We have continued with a number of learning and development opportunities including focused time for discussion and feedback including: organisational development days Corporate induction and new starter programmes Team Time Courses Opportunities for shadowing and peer support Conferences and seminars.
53 Mandatory training has been completed for all staff through induction and e-learning modules. Elsewhere, we offer opportunities for staff to complete formal and informal courses (such as professional qualifications, NVQs or development days) which enable them to further develop their skills and expertise.
Maintaining clinical skills We also recognise that many of our staff have a requirement to maintain professional registration, both clinical and non-clinical. As part of the appraisal process we continue to ensure that personal development plans support any professional registration / re- registration requirements. Professional registration may be maintained through training, undertaking secondments, shadowing colleagues, access to clinical/non-clinical professional supervision or mentorship of students and we actively encourage and support these activities.
Nurse revalidation Nurse revalidation commenced on 1 April 2016. Revalidation has been introduced by the Nursing and Midwifery Council (NMC, the professional regulator for nurses and midwives) for a number of reasons, but primarily because it leads to improved practice and public protection benefits. Revalidation:
raises awareness of the Code (Code of Professional Conduct) and professional standards expected of nurses and midwives allows nurses to reflect on the role of the Code in their practice encourages nurses to stay up to date in their professional practice encourages a culture of sharing, reflection and improvement encourages nurses to engage in professional networks and discussions about their practice and strengthens public confidence in the nursing and midwifery professions. Every three years, when renewing registration with the NMC, nurses are required to show they are living by the Code’s standards of practice and behaviour. It is about promoting good practice across the whole population of nurses and midwives and is not an assessment of a nurse’s fitness to practise.
Revalidation requires nurses to meet the following requirements:
Complete 450 practice hours, or 900 if renewing as both a nurse and midwife Undertake 35 hours of continued professional development including 20 hours of participatory learning Complete five pieces of practice-related feedback Complete five written reflective accounts Undertake a reflective discussion with another registered nurse
54 Complete a health and character declaration Have in place a professional indemnity arrangement Confirmation of the above by another registered nurse, doctor or healthcare professional (who is on a professional register)
A number of nurses have now completed this process and systems are in place for nurses to be supported through revalidation. This includes action learning, access to appropriate development and training and provision of confirmers.
Supporting our staff with equality, diversity and human rights Our staff have the right to work in an environment which is free from unlawful discrimination and members of the public have the right to expect the care and treatment they receive from us to be provided in a similar environment.
We encourage all staff to fully understand equality and diversity issues so that they feel able to challenge prejudice and make reasonable adjustments in their own work areas.
Equality and diversity training for all staff remained a mandatory requirement in 2019/20 and managers continue to be tasked with promoting culture that embraces equality and diversity. With this, we have made it the responsibility of all employees to support our ambition to eliminate discrimination and disadvantage in service delivery and employment, and to manage, support or comply with this through the implementation of our equality and diversity strategy and policies.
Supporting staff wellbeing Health and wellbeing is widely acknowledged as a vital element in supporting and developing a successful workforce. Not only are there positive benefits to staff and patients there are also financial benefits to the organisation.
Building on the foundations established, we have maintained and further developed a range of Human Resource (HR) activities and policies to ensure we continue to be able to support the health and wellbeing of all our staff. These activities include:
Employee Assistance Programme HR run monthly ‘drop in’ sessions for all staff to discuss any potential HR queries they may have monthly supervision sessions held by line managers a requirement to consider health and wellbeing issues within the appraisal process regular email communications on health and wellbeing the review of HR policies with feedback sought from the Staff Forum
55 Occupational Health have offered staff ‘health checks’ Maintained the Mindful Champion programme Regular wellbeing activities run by staff Wellbeing displays
Sickness absence Details of sickness absence rates can be found on NHS Digital: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-sickness-absence- rates
Trade union facility time The Trade Union (Facility Time Publication Requirements) Regulations 2017 require CCGs to report on trade union facility time in our organisations. Facility time is paid time off for union representatives to carry out trade union activities.
In 2019 / 20, - members of CCG staff were trade union officials and no trade union facility time was spent. [This information will be shared with the final submission.]
Remuneration report The Remuneration Committee makes decisions regarding the remuneration of senior managers and clinical members. Details of the membership, number of meetings and attendance at the Remuneration Committee can be found on page 94.
Our policy on the remuneration of senior managers remains based on principles agreed nationally by the Department of Health and Social Care, taking into account market forces and benchmarking. The Chief Financial Officer and Director of System Delivery remuneration is based upon the nationally agreed pay bandings for Very Senior Managers (VSM), subject to annual appraisal and recommendations by the Remuneration Committee. The remaining member of the executive team is subject to Agenda for Change terms and conditions.
Our Clinical Chair, Chief Executive Officer and GP Governing Body members fall under the Secretary of State’s requirement to explain how the remuneration of senior managers who are paid more than £150,000 per annum, this rate increased in year following HM Treasury Guidance on Senior Pay. Our policy for setting remuneration is outlined above and follows Department of Health and Social Care principles, taking into account benchmarking and, in the case of clinical board members, the salaries they would earn as senior GP practice partners. All of the GP Board Members employed by
56 the CCG are paid the same sessional rate, with the Chair a higher level of remuneration reflecting their additional responsibilities. It should also be noted that all our GP Governing Body members and the Clinical Chair work on a part time, sessional basis and so their actual CCG remuneration is lower than the £150,000 limit.
We undertake our recruitment in line with agreed recruitment policy. All individuals employed on a very senior manager’s contract are required to give a minimum of six months’ notice in order to terminate their contract. Termination payments are made on the grounds of ill health retirement or redundancy on the same basis as for all other NHS employees as laid down in national terms and conditions and / or NHS pension scheme procedures. There were no early terminations in 2019/20 and therefore no provisions are necessary. No exit packages or redundancies were agreed in 2019/20.
Our liability in the event of an early termination will be in accordance with the very senior manager’s terms and conditions. Any termination payments are paid in accordance with the Secretary of State’s directions.
Elements of the remuneration report are subject to external audit and where this is the case it is clearly stated.
57 Salaries and allowances – subject to external audit The following table shows the salaries and allowances received by CCG Governing Body members and senior managers for 2019/20, along with the comparative figures for 2018/19:
2019/20
(d) (c) Long term (e) (b) Performance performance All pension- (f) (a) Expense pay and pay and related TOTAL Salary payments bonuses bonuses benefits (a to e) (bands of (taxable) (bands of (bands of (bands of (bands of £5,000) 1 to nearest £5,000) £5,000) £2,500) 2 £5,000) Name and Title £'000 £100 £'000 £'000 £'000 £'000 Dr Mark Kelsey, Clinical Chair 3 70 - 75 ------0 70 - 75 Dr Pritti Aggarwal, Clinical Representative 30 - 35 ------12.5 - 15 40 – 45 Mrs Hanna Burgess, Clinical Representative 4 55 - 60 ------0 55 – 60 Dr Shiba Qamar, Clinical Representative 4 55 - 60 ------22.5 - 25 80 – 85 Dr Chris Sanford, Clinical Representative 5 30 - 35 ------30 – 35 Dr Sarah Young, Clinical Representative 4 60 - 65 ------47.5 - 50 105 – 110 Mr Matthew Stevens, Lay Member (Patient and Public Involvement) 10 - 15 ------10 – 15 Mr Henry Slater, Lay Member (Governance) 10 - 15 ------10 – 15 Dr Mark Sopher, Secondary Care Doctor 5 & 6 5 -10 ------5 -10 Mr John Richards, Chief Officer 7 & 10 25 - 30 ------0 25 - 30 Mrs Margeret MacIsaac, Chief Executive (Shared) 7 & 8 20 - 25 ---- 0 - 5 ---- 0 – 2.5 20 - 25 Mr James Rimmer, Managing Director and Chief Finance Officer 9 120 - 125 ------22.5 – 25 145 – 150
Mrs Stephanie Ramsey, Director of Quality and Integration (Chief Quality Officer and Board Nurse) 10, 11 & 12 70 - 75 ------2.5 – 5 70 - 75 Mr Peter Horne, Director of System Delivery 11 110 - 115 ------22.5 – 25 135 - 140
2018/19 58 (d) (c) Long term (e) (b) Performance performance All pension- (f) (a) Expense pay and pay and related TOTAL Salary payments bonuses bonuses benefits (a to e) (bands of (taxable) to (bands of (bands of (bands of (bands of £5,000) 1 nearest £5,000) £5,000) £2,500) 2 £5,000) Name and Title £'000 £ £'000 £'000 £'000 £'000 Dr Mark Kelsey, Chair 70 - 75 ------30 – 32.5 100 – 105 Dr Richard McDermott, Deputy Clinical Chair 60 - 65 ------55 - 57.5 120 – 125 Dr Ian Ward, Clinical Representative 30 - 35 ------2.5 - 5 30 – 35 Dr Pritti Aggarwal, Clinical Representative 10 - 15 ------12.5 - 15 25 – 30 Dr Sarah Young, Clinical Representative 50 - 55 ------82.5 - 85 135 - 140 Dr Chris Sanford, Clinical Representative 30 - 35 ------30 - 35 Mrs June Bridle, Lay Member (Governance) 5 -10 ------5 -10 Mr Matthew Stevens, Lay Member (Patient and Public Involvement) 10 - 15 ------10 - 15 Mr Henry Slater, Lay Member (Governance) 0 - 5 ------0 - 5 Mr John Richards, Chief Officer 140 - 145 ------0 - 2.5 140 - 145 Mr James Rimmer, Chief Finance Officer and Deputy Chief Officer 115 - 120 ------50 - 52.5 165 - 170 Mrs Stephanie Ramsey, Director of Quality and Integration (Chief Quality Officer and Board Nurse) 65 - 70 ------0 - 2.5 65 - 70 Mr Peter Horne, Director of System Delivery 105 - 110 ------25 - 27.5 135 - 140 Dr Peter Hockey, Secondary Care Doctor 10 - 15 ------10 - 15
Maggie MacIsaac Chief Executive Officer 16 June 2020
59 Notes The CCG Clinical Chair, Deputy Clinical Chair, and all Governing Body Clinical Representatives are paid on a sessional basis - they are not full time employees of the CCG. All of these individuals are paid via the CCG through payroll for a fixed annual number of sessions. None of the Governing Body members are paid through off-payroll arrangements (see off-payroll disclosure on page 67).
1 Salary and fees: this covers both pensionable and non-pensionable amounts. These are the amounts paid or payable by the NHS body in respect of the period the senior manager held office. Notes regarding part year office holdings are included below.
2 All pension-related benefits include: • the cash value of payments in lieu of retirement benefits; and • all benefits in year from participating in pension schemes. These are the aggregate input amounts, calculated using the method set out in section 229 of the Finance Act 2004. Any contributions by the employee in the period, or transferred in amounts, are excluded from this figure. These amounts are not paid in year to individuals but are accrued over the membership of the pension scheme and payable upon retirement.
This figure will include those benefits accruing to senior managers from membership of the NHS pension scheme which is a defined benefit scheme (although accounted for by NHS bodies as if it were a defined contribution scheme).
The figures shown under “All pension related benefits” in the table above are a calculation of the real terms increase in an individual’s accrued pension benefits from the beginning to the end of the financial year. This is based on the following mandated national formula: [(20 x PE) + LSE] - [(20 x PB) + LSB] where: PE and LSE are the accrued pension and lump sum values at the end of the pension input period, and PB and LSB are the accrued pension and lump sum values as at the beginning of the input period.
The impact of this formula is to show the individual’s increase in pension resulting from contributions paid by the CCG in year, assuming an average retirement period of twenty years.
3 Dr Mark Kelsey carries out some sessions as lead for the Digital Programme across Wessex. The net CCG amount is shown above. The salary gross value is £120-125k and pension related benefits gross value is £0. A correction has been made to the calculation of the net amount. The corresponding 2018/19 value has been restated. 4 GP Governing Body members Dr Hanna Burgess, Dr Shiba Qamar and Dr Sarah Young undertake additional clinical roles for the CCG. As per NHS England guidance the above figures reflect the total remuneration paid by the entity for the individuals' services to the CCG, including remuneration for duties that are not part of their managerial role. The element of the total figure (col f) relating to non- managerial roles is: Dr Hanna Bugess £25-30k; Dr Shiba Qamar £35-40k; Dr Sarah Young £50-55k. The values for Dr Sarah Young in
60 the 2018/19 table have been restated.
5 Neither Dr Chris Sanford nor Dr Mark Sopher pay NHS Pension contributions in relation to their work for the CCG and therefore no pension values are included.
6 Dr Mark Sopher replaced Dr Peter Hockey as Secondary Care Representative on 1st April 2019. 7 Mr John Richards retired from his role as Chief Officer on 6th June 2019 with Mrs Maggie MacIsaac starting as Chief Executive Officer on 7th June 2019.
8 Maggie MacIsaac started the year as the Joint Accountable Officer and Chief Executive Officer for NHS Fareham & Gosport CCG, NHS Isle of Wight CCG, NHS North Hampshire CCG, NHS North East Hampshire & Farnham CCG and NHS South Eastern Hampshire CCG. During the year she also became the Accountable Officer and Chief Executive Officer for NHS Southampton City CCG and NHS West Hampshire CCG, and later stepped down as the Accountable Officer and Chief Executive Officer for NHS North East Hampshire and Farnham CCG. The table below shows the CCGs which Maggie MacIsaac was Accountable Officer and Chief Executive Officer for during different date periods throughout the year. Her remuneration was split equally across the total number of CCGs shown for each date period. The CCG share of her salary and pension benefit is shown in the salaries and allowances table above. The salary gross value is £165-170k; the performance gross value is £15-20k and the pension related benefits gross value is £10-12.5k.The Pensions Table below shows the total.
The Chief Executive received a retention payment which is split equally across the total number of CCGs shown above for each date period. The CCG share is shown in the salaries and allowances table. She also received a performance related payment for the Hampshire and Isle of Wight Partnership of CCGs during 2018/19. This is split equally across NHS North East Hampshire and Farnham CCG, NHS North Hampshire CCG, NHS Fareham and Gosport CCG, NHS South Eastern Hampshire CCGG and NHS Isle of Wight CCG.
61 9 Mr James Rimmer took up the role of Managing Director, along with his Chief Financial Officer role on 7th June 2019. Mr Rimmer is seconded to the Hampshire and Isle of Wight Sustainability and Transformation Partnership for a proportion of his time. The net CCG amount is shown above. The salary gross value is £130-135k and pension related benefits gross value is £20-25k.
10 As Mr John Richards and Mrs Stephanie Ramsey are over Normal Retirement Age a CETV calculation is no longer applicable
11 Mrs Stephanie Ramsey, Director of Quality and Integration (Chief Quality Officer and Board Nurse) and Mr Peter Horne, Director of System Delivery have included within their salary above an additional responsibility allowance for their additional Governing Body duties of Board Nurse and Primary Care Lead respectively.
12 Mrs Stephanie Ramsey is a joint appointment with Southampton City Council. The values above represent NHS Southampton CCG's proportionate share of her salary and pension related benefits. The salary gross value is £115-120k and pension related benefits gross value is £5-7.5k.
62 Pension benefits – subject to external audit
The following table shows the pension benefits for Governing Body members and senior managers:
2019/20 (a) (b) (c) (d) (e) (f) (g) Name and Title Real Real Total Lump Cash Real Cash increase increase accrued sum at Equivalent increase in Equivalent in in pension pension Transfer Cash Transfer pension pension at age Value at 1 Equivalent Value at 31 at lump sum pension related to April 2019 Transfer March 2020 pension at age at 31 accrued Value age pension March pension £'000 £'000 (bands of age 2020 at 31 £'000 £2,500) (bands of (bands of March £2,500) £5,000) 2020 £'000 (bands of £'000 £'000 £5,000)
£'000
Dr Mark Kelsey, Clinical Chair 0 27.5 - 30 15 - 20 25 - 30 235 0 245
Dr Pritti Aggarwal, Clinical Representative 0 - 2.5 0 - 2.5 15 - 20 30 – 35 210 11 231
Mrs Hanna Burgess, Clinical 0 - 2.5 0 10 - 15 30 – 35 197 0 207 Representative
Dr Shiba Qamar, Clinical Representative 0 - 2.5 0 - 2.5 5 -10 20 – 25 128 16 156
Dr Sarah Young, Clinical Representative 2.5 - 5 0 10 - 15 0 75 23 108
Mr John Richards, Chief Officer 0 0 55 - 60 170 – 175 1,352 0 0
Mrs Margeret MacIsaac, Chief Executive 0 – 2.5 0 70 - 75 175 – 180 1,397 25 1,484
63 (Shared)
Mr James Rimmer, Chief Finance Officer 0 - 2.5 0 35 - 40 30 – 35 381 9 418 and Deputy Chief Officer
Mrs Stephanie Ramsey, Director of Quality 0 - 2.5 2.5 - 5 55 - 60 170 – 175 1,349 0 0 and Integration (Chief Quality Officer and Board Nurse)
Mr Peter Horne, Director of System 0 - 2.5 0 20 - 25 40 – 45 415 20 461 Delivery
Notes
The CCG had no employer’s contributions to partnership pensions.
Mrs Stephanie Ramsey, Director of Quality and Integration (Chief Quality Officer and Board Nurse) is a joint appointment with Southampton City Council. The values above represent the gross value of pension benefits.
Mr John Richards and Mrs Stephanie Ramsey are both over normal retirement age and so no Cash Equivalent Transfer Value is shown for the end of the period.
GP Governing Body members Dr Hanna Burgess, Dr Shiba Qamar and Dr Sarah Young undertake additional clinical roles for the CCG. As per NHS England guidance the above figures reflect the total remuneration paid by the entity for the individuals' services to the CCG, including remuneration for duties that are not part of their managerial role.
The CETV for 1st April 2019 is as per the latest information from the Pensions Agency.
The pension benefit details do not allow for any potential adjustment from the impact of the McCloud judgement.
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 64 at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s (or other allowable beneficiary’s) pension payable from the scheme.
A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which the disclosure applies.
The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.
During the year there was a requirement from the government to adjust the indexation on part of the public service pension schemes, known as the Guaranteed Minimum Pensions (GMP). From August 2019 this affected the method used by NHS Pensions to calculate the CETV values, and therefore the method in force at 31 March 2020 is different to the method used to calculate the value at 31 March 2019. The real increase in CETV will therefore be impacted and will subsequently include any increase in CETV due to the change in GMP methodology.
Real increase in CETV
This reflects the increase in CETV that is funded by the employer. It does not include the increase in accrued pension due to inflation or contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement).
65 Pay multiples - subject to external audit Reporting bodies are required to disclose the relationship between the remuneration of the highest paid director/member in their organisation and the median remuneration of the organisation’s workforce. The banded remuneration of the highest paid director/member in NHS Southampton City CCG, being the Clinical Chair, in the financial year 2019/20 was £176.2k (£175.5k in 2018/19) (full time equivalent salary had the Clinical Chair been a full time position). This was 3.5 (3.9 in 2018/19) times the median remuneration of the workforce (excluding agency staff and staff paid on as and when “bank” contracts) which was £51k (£45k in 2018/19). The banded remuneration of the highest paid member of the Governing Body has seen a small increase (0.4%), whereas the median remuneration has increased by 13.3% as a result of the further implementation of the Agenda for Change pay deal. This has led to a decrease in the median pay ratio. Pay increases for staff are in line with the nationally agreed agenda for change pay deal, including a cost of living increase and a reformed pay structure to improve recruitment and retention. In 2019/20 no employees received remuneration in excess of the highest paid director/member. Full time equivalent remuneration for the workforce excluding the highest paid ranged from £18.8k to £171.6k (2018/19: £15k to £140k). The increase in the highest paid employee is due to the CCG now having a joint Chief Executive Officer, shared with neighbouring CCGs. The CCG pays for a proportion, not the full time equivalent remuneration used here. Total remuneration includes salary, non-consolidated performance-related pay, non- consolidated allowances, benefits-in-kind, but not severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions.
Off payroll engagements Table 1 – Off-payroll engagements longer than 6 months CCGs are required to publish information on any off-payroll engagements. The table below shows all our engagements as at 31 March 2020, for more than £245 per day and that last longer than six months:
Table 1: Number Number of existing engagements as of 31 March 2020 1 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 0 For between 2 and 3 years at the time of reporting 0 For between 3 and 4 years at the time of reporting 0 For 4 or more years at the time of reporting 0
66 This reporting is consistent with last years’ annual report and excludes categories of individuals who provide services for our patients, for example mental health assessments under the mental health act; physiotherapists, psychologists and other therapists who provide services to Continuing Healthcare Clients and GP practices where we re-imburse for ad-hoc attendances where practice staff are providing clinical input to workshop sessions. We are not engaging these individuals for more than six months. They perform ad-hoc assessments and interventions with patients. They do not therefore fall within the off-payroll guidance.
Table 2 – New off-payroll engagements Where the reformed public sector rules apply, entities must complete Table 2 for all new off- payroll engagements, or those that reached six months in duration, between 1 April 2019 and 31 March 2020, for more than £245 per day and that last for longer than 6 months.
Table 2: Number Number of new engagements, or those that reached six months in duration, between 1 April 2019 and 31 March 2020 1 Of which, the number: Number assessed as caught by IR35 1 Number assessed as not caught by IR35 0
Number engaged directly (via PSC contracted to department) and are on the entity’s payroll 1 Number of engagements reassessed for consistency / assurance purposes during the year 0 Number of engagements that saw a change to IR35 status following the consistency review 0
Table 3 – Off-payroll board member / senior official engagements
For any off-payroll engagements of Board members and / or senior officials with significant financial responsibility between 1 April 2019 and 31 March 2020
Table 3: Number Number of off-payroll engagements of Governing Body members, and/or, senior officers with significant financial responsibility, during the financial 0 year Total number of individuals on payroll and off-payroll that have been deemed “Governing Body members, and/or, senior officials with significant 14 financial responsibility”, during the financial year. This figure should include both on payroll and off-payroll engagements
67 NHS commissioning support services Commissioning Support Units (CSUs) were developed as part of the NHS reforms that created CCGs. CSUs deliver support services across a number of CCGs by providing expert skills, experience and advice in more effective ways than might otherwise be possible for some CCGs. NHS England currently hosts all commissioning support units. In 2019/20 we used the services of NHS South, Central and West CSU to provide our information technology, human resources, financial services, business intelligence, and contracting support services. We have worked together throughout the year to ensure the strong partnership between our two organisations continues and we receive the support services needed to deliver our targets and achieve our goals.
Maggie MacIsaac Chief Executive Officer 16 June 2020
68 SECTION 3: FINANCIAL STATEMENTS AND NOTES
69 Summary financial statements The CCG met all its financial duties for 2019/20. The CCG is required to ensure that expenditure does not exceed the amount of funding allocated by NHS England and, within this, to ensure that administrative expenditure does not exceed the running cost allocation:
2019/20 Allocation Expenditure Total surplus / (deficit) £’000 £’000 £’000
Admin 6,168 5,098 1,070 Programme 402,650 400,932 1,718 Total in year 408,818 406,030 2,788 Brought forward surplus 8,895 8,895 Total 417,713 406,030 11,683
The CCG in-year outturn position is slightly better than plan at a surplus of £2,788k. This brings the cumulative surplus to £11,683k (2.8%). The CCG has produced its accounts on a going concern basis; this is in line with the Department for Health Group Accounting Manual for 2019/20 which states that we are a going concern unless we have been informed that there is an intention for the CCG to be dissolved without the transfer of function to another entity. The CCG has received no such intention. The Covid-19 national emergency situation that arose at the end of the financial period and remains ongoing brings a new set of circumstances for the CCG. As a result of this NHS planning processes have ceased, however the government has made a pledge to the country and the NHS:
The Chancellor of the Exchequer committed in Parliament last week that “Whatever extra resources our NHS needs to cope with coronavirus – it will get.” So financial constraints must not and will not stand in the way of taking immediate and necessary action - whether in terms of staffing, facilities adaptation, equipment, patient discharge packages, staff training, elective care, or any other relevant category.
We believe that this situation does not therefore lead to material uncertainty about the going concern of the CCG.
The breakdown of the surplus is: £’000
In-year surplus agreed 2,750
Additional in-year surplus achieved 38
70 Final in-year surplus 2,788
Brought forward cumulative surplus 8,895
Closing cumulative surplus 11,683
% of allocation 2.8%
Statement of comprehensive net expenditure for the year ended 31 March 2020
2019/20 2018/19 £’000 £’000 Income from sale of goods and services (686) (1,186) Other operating income (0) 0 Total operating income (686) (1,186)
Staff costs 6,781 5,990 Purchase of goods and services 398,433 386,871 Depreciation and impairment charges 0 0 Provision expense 922 1,138 Other Operating Expenditure 580 936 Total operating expenditure 406,716 394,935
Net Operating Expenditure 406,030 393,749 Finance income 0 0 Finance expense 0 0 Net expenditure for the year 406,030 393,749
Net (gain)/loss on transfer by absorption 0 0
Total net expenditure for the year 406,030 393,749
Other Comprehensive Expenditure Items which will not be reclassified to net operating costs Net (gain)/loss on revaluation of PPE 0 0 Net (gain)/loss on revaluation of Intangibles 0 0 Net (gain)/loss on revaluation of Financial Assets 0 0 Actuarial (gain)/loss in pension schemes 0 0 Impairments and reversals taken to Revaluation Reserve 0 0
Items that may be reclassified to Net Operating costs
71 Net gain/loss on revaluation of available for sale financial 0 0 assets Reclassification adjustment on disposal of available for sale 0 0 financial assets Sub total 0 0
Comprehensive Expenditure for the year ended 31 March 2020 406,030 393,749
Statement of financial position as at 31 March 2020 2019/20 2018/19 £’000 £’000 Non-current assets: Property, plant and equipment 0 0 Intangible assets 0 0 Investment property 0 0 Trade and other receivables 2 3 Other financial assets 0 0 Total non-current assets 2 3
Current assets: Inventories 0 0 Trade and other receivables 6,946 3,469 Other financial assets 0 0 Other current assets 0 0 Cash and cash equivalents 702 641 Total current assets 7,648 4,110
Non-current assets held for sale 0 0
Total current assets 7,648 4,110
Total assets 7,650 4,113
Current liabilities Trade and other payables (24,031) (21,057) Other financial liabilities 0 0 Other liabilities 0 0 Borrowings 0 0 Provisions (1,905) (1,397) Total current liabilities (25,936) (22,454)
Non-Current Assets plus/less Net Current Assets/Liabilities (18,286) (18,341)
Non-current liabilities Trade and other payables 0 0 Other financial liabilities 0 0 Other liabilities 0 0 72 Borrowings 0 0 Provisions (2,620) (2,265) Total non-current liabilities (2,620) (2,265)
Assets less liabilities (20,906) (20,606)
Financed by Taxpayers’ Equity General fund (20,906) (20,606) Revaluation reserve 0 0 Other reserves 0 0 Charitable reserves 0 0 Total taxpayers’ equity (20,906) (20,606)
The financial statements on pages 71 to 75 were approved by the Finance and Audit Committee on behalf of the Governing Body on 16 June 2020 and signed by:
Maggie MacIsaac Chief Executive Officer 16 June 2020
73 Statement of cash flows for the year ended 31 March 2020
2019/20 2018/19 £’000 £’000 Cash flows from operating activities Net operating expenditure for the financial year (406,030) (393,749) Depreciation and amortisation 0 0 Impairments and reversals 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 (Increase)/decrease in inventories 0 0 (Increase)/decrease in trade and other receivables (3,477) (207) (Increase)/decrease in other current assets 0 0 Increase/(decrease) in trade and other payables 2,975 (995) Increase/(decrease) in other current liabilities 0 0 Provisions utilised (59) (98) Increase/(decrease) in provisions 922 1,138 Net cash inflow / (outflow) from operating activities (405,669) (393,911) 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 (405,669) (393,911)
Cash flows from financing activities Net funding received 405,731 394,097 Other loans received 0 0 Other loans repaid 0 0
74 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 405,731 394,097
Net increase / (decrease) in cash and cash equivalents 62 186
Cash and cash equivalents at the beginning of the financial year 641 456 Effect of exchange rate changes on the balance of cash and cash equivalents held in foreign currencies 0 0 Cash and cash equivalents (including bank overdrafts) at the end of the financial year 703 642
Cash and cash equivalents at the end of the financial year includes the CCG’s share of the pooled budgets with Southampton City Council and the balance on the prepaid cards held by Personal Health budget clients The summary financial statements shown above are taken from the CCG annual accounts for 2019/20. The summary financial statements are intended to highlight and summarise the key financial information contained in the annual accounts. If you would like a full set of the accounts please contact:
Chief Financial Officer NHS Southampton City Clinical Commissioning Group CCG Headquarters Oakley Road Southampton SO16 4GX
75 Better Payment Practice Code and Prompt Payments Code
The Better Payment Practice Code requires the CCG to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later.
The NHS aims to pay at least 95% of invoices within 30 days of receipt, or within agreed contract terms. The CCG’s performance against this target, split between Non-NHS and NHS suppliers was:
2019/20 2019/20 2018/19 2018/19
number £’000 number £’000
Non-NHS Payables
Total Non-NHS trade invoices paid in the year 24,057 111,160 25,957 107,063
Total Non-NHS trade invoices paid within target 23,966 110,797 25,920 106,904
Percentage of Non-NHS trade invoices paid 99.62% 99.67% 99.86% 99.85% within target
NHS Payables
Total NHS trade invoices paid in the year 3,085 256,436 2,938 248,639
Total NHS trade invoices paid within target 3,080 256,109 2,924 248,209
Percentage of NHS trade invoices paid within 99.84% 99.87% 99.52% 99.83% target
The CCG is in the process of becoming an approved member of the Prompt Payments Code. This initiative was devised by the government with the Institute of Credit Management (ICM) to tackle the crucial issue of late payment and to help small businesses. Suppliers can have confidence in any company that signs up to the code that they will be paid within clearly defined terms, and that there is a proper process for dealing with any payments that are in dispute.
Approved signatories undertake to:
pay suppliers on time give clear guidance to suppliers and resolve disputes as quickly as possible encourage suppliers and customers to sign up to the code.
76 Related party transactions
Our Governing Body members and senior managers declare any conflicts of interest and these are outlined in the “Our Governing Body” section on page 26. Where the Governing Body member or senior manager has a controlling role (shown in brackets below) in an entity any transactions the CCG had with those entities is outlined below:
77 Receipts Amounts Amounts Payments from owed to due from to Related Related Related Related Party Pary Party Party 2019/20 £'000 £'000 £'000 £'000 Advising Communities, Dr Chris Sanford (Chair 0 0 0 0 and Trustee) British Heart Rhythm, Dr Mark Sopher (Member of 0 0 0 0 Council) Chessel Practice - Dr Sarah Young (Clinical 2,230 0 68 0 Lead) 1 Bath Lodge Practice - Dr Sarah Young (Clinical 741 0 0 0 Lead) 1 Christ Church Southampton - Dr Chris Sanford 0 0 0 0 (Trustee) HFMA (Healthcare and Financial Management Association) - Mr James Rimmer (Trustee and 6 0 0 0 Audit Committee Chair) HIOW STP operated by South Eastern Hampshire CCG - Mr James Rimmer (Seconded 50 (194) 0 (9) CFO 2 days per week) Living Well Partnership (LWP) - Dr Pritti Aggarwal 3,745 0 0 0 (GP Partner), Dr Chris Sanford (GP Partner) 2 Peartree Practice, Dr Sarah Young (Lead GP 0 0 0 0 Salaried) 1 Shirley Health Partnership, Dr Hana Burgess (GP 720 0 0 0 Partner) Solent Credit Union - Ms Lesley Gilder 0 0 0 0 (President) Solent University - Mr James Rimmer (Independent Governor and Audit Committee 3 0 0 0 Member) Southampton City Council - Mrs Stephanie Ramsey (Interim Director of Adult Social Services 12,007 (3,292) 660 (341) DASS), Dr Debbie Chase (Interim Director of Public Health) Southampton Primary Care Ltd - Dr Pritti Aggarwal, Dr Chris Sanford, Dr Hana Burgess, Dr 3,878 0 0 0 Shiba Qamar (Shareholders)
Sure Footing - Dr Chris Sanford (Trustee) 0 0 0 0
Technomed Ltd (suppliers of ECG equipment), Dr 0 0 0 0 Mark Sopher (Shareholder and Medical Advisor)
Valley Leisure Ltd - P Horne (Trustee) 0 0 0 0 Wessex Appraisal Service, Dr Shiba Qamar (GP 0 0 0 0 Appraiser) Total 23,380 (3,486) 728 (350)
1 Chessel and Bath Lodge practices have merged in year to form the Peartree Practice. As coding on the national system is updated transactions will appear under the new name.
78 2 Living Well Partnership has merged with other practices and hence the increase over 2018/19 value..
NHS Southampton City CCG had a significant number of material transactions with Southampton City Council. These transactions include related pooled budgets and special placements.
The Department of Health and Social Care 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. For example:
NHS England
NHS Foundation Trusts
NHS Trusts
NHS Litigation Authority
NHS Business Services Authority
Our Chief Executive Officer, Maggie MacIsaac is also CEO of a number of other neighbouring CCGs and these NHS Bodies are therefore deemed as a related party due to the interest that the Chief Executive Office has with each of them. • NHS Fareham and Gosport CCG • NHS Isle of Wight CCG • NHS North Hampshire CCG • NHS North East Hampshire and Farnham CCG (until 30th November 2019) • NHS South Eastern Hampshire CCG • NHS West Hampshire CCG
79 Receipts Amounts Amounts Payments from owed to due from to Related Related Related Related Party Pary Party Party 2018/19 £'000 £'000 £'000 £'000
Chessel Practice - Dr Sarah Young (Clinical Lead) 1,301 0 26 0
Bath Lodge Practice - Dr Sarah Young (Clinical Lead) 1,187 0 67 0
Christ Church Southampton - Dr Chris Sanford (Trustee) 0 0 0 0
HFMA (Healthcare and Financial Management Association) - Mr 14 0 2 0 James Rimmer (Trustee) HIOW STP operated by South Eastern Hampshire CCG - Mr 77 (242) 0 0 James Rimmer (Seconded CFO 2 days per week) Living Well Partnership (LWP) - Dr Richard McDermott (GP Partner), Dr Ian Ward (GP Partner), Dr Pritti Aggarwal (GP 1,448 0 22 0 Partner), Dr Chris Sanford (GP Partner) Local Improvement Finance Trust Ltd (LIFT) - Mr Peter Horne 0 0 0 0 (Board member)
Oakhaven Hospice Trust - Dr Peter Hockey (Board Member) 0 0 0 0
Portsmouth City Council - Dr Jason Horsley (Public Health 5 0 0 0 Director)
Portsmouth CCG - Dr Jason Horsley (Board Member) 18 0 0 0
Solent Credit Union - Ms Lesley Gilder (President) 0 0 0 0
Solent Medical Services - Dr Richard McDermott; Dr Ian Ward 2,267 (3) 103 0 (Shareholders)
Solent University - Mr James Rimmer (Independent Governor) 9 0 0 0
Southampton City Council - Mrs Stephanie Ramsey (Interim Director of Adult Social Services DASS), Dr Jason Horsley 13,712 (2,055) 86 (1,042) (Public Health Director)
Southampton Primary Care Ltd - Dr Richard McDermott, Dr Ian 2,364 0 122 0 Ward, Dr Pritti Aggarwal, Dr Chris Sanford (Shareholders)
Sure Footing - Dr Chris Sanford (Trustee) 0 0 0 0
Valley Leisure Ltd - P Horne (Trustee) 0 0 0 0
Total 22,400 (2,300) 428 (1,042)
80 Glossary of financial terms
Administration and programme expenditure:
HM Treasury has determined that CCGs should report administration and programme expenditure. Administration costs are defined as non-frontline expenditure whereas programme expenditure relates to the direct provision of healthcare and healthcare related services.
Borrowings:
Amounts owed by the CCG for items financed by PFI.
Cash flow statement:
This summarises the money coming in and out of the CCG in the accounting period.
Creditors:
Money owed by the CCG, including amounts owing to suppliers and providers.
Current assets:
These are assets expected to be converted to cash within one year.
Current liabilities:
Amount owing to the CCG expected to be paid within a year.
Employee benefits:
Staff salary and pensions.
Income
Monies received from additional sources to that received from the Department of Health and Social Care. It includes contributions from our partners in the health economy to jointly commissioned schemes, e.g. system resilience.
Intangible assets:
Items such as software licences.
Net operating costs:
The costs incurred by the CCG in purchasing healthcare for the population. These include, employee benefits, the cost of purchasing healthcare together with overhead costs.
Non-current assets:
81 These relate to assets held for a period beyond a year.
Non-current assets held for sale:
Land and buildings identified for disposal by the CCG.
Other financial assets:
Investments held by the CCG in companies formed under the LIFT initiative.
PFI
Private finance initiative – a way of creating ‘public-private partnerships’ by funding public infrastructure projects with private money.
Property, plant and equipment:
Items owned by the CCG for continuing use in its work. The CCG holds very few fixed assets, e.g. land, buildings, IT equipment etc. choosing instead to rent these items.
Provisions:
Amounts set aside for future known liabilities.
Revenue resource limit:
The budget allocation given to the CCG by the Department of Health and Social Care. The CCG’s net operating costs are matched against this limit to measure financial performance.
Statement of comprehensive net expenditure:
This document details the net operating costs of the CCG, together with any items that change the value of the taxpayers’ equity in the CCG.
Trade and other receivables:
Money owed to the CCG at the balance sheet date.
82 Head of Internal Audit Report to the Chief Officers of Southampton City CCG
Head of Internal Audit Opinion (HoIA) on the effectiveness of the system of internal control for the year ended 31 March 2020 The purpose of my annual HoIA Opinion is to contribute to the assurances available to the Accountable Officer and the Governing Body which underpin the Governing Body’s own assessment of the effectiveness of the organisation’s system of internal control. This Opinion will in turn assist the Governing Body in the completion of its Annual Governing Statement. We note from the February Finance & Audit Committee meeting that the CCG is currently reporting it is on plan to deliver an in-year surplus of £2,750k (0.7%), with a cumulative position, including the brought forward surplus from previous years, of £11,645k (2.8%). Our opinion on the organisation’s system of internal control has taken this factor into account. My opinion is set out as follows: 1. Overall opinion; 2. Basis for the opinion; and 3. Commentary.
1. Reasonable 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 2. The basis for forming my opinion is as follows: i. An assessment of the design and operation of the underpinning Assurance Framework and supporting processes; and ii. An assessment of the range of individual opinions arising from risk-based audit assignments, contained within internal audit risk-based plans that have been reported throughout the year. This assessment has taken account of the relative materiality of these areas and management’s progress in respect of addressing control weaknesses. Additional areas of work that may support the opinion will be determined locally but are not required for Department of Health purposes e.g. any reliance that is being placed upon Third Party Assurances.
3. Commentary – see page 104 for a summary of completed internal audit work.
Mike Townsend, Head of Internal Audit TIAA Ltd 17 April 2020
83 Share your views with us
Throughout this report we have detailed our commitment to gathering and acting on feedback. We know that learning from and engaging with local people is the best way to ensure that the services we commission and deliver are safe, effective, of a high standard and meet local needs.
If you have any comments or questions about this report or any of our work, you can contact us using the details below.
Comments or queries about this annual report:
The Communications team NHS Southampton City CCG Commissioning Headquarters Oakley Road Southampton SO16 4GX
Tel: 023 8029 6038 Email: [email protected]
Comments, compliments and complaints about local services:
Patient Experience Service NHS Southampton City CCG Commissioning Headquarters Oakley Road Southampton SO16 4GX
Tel: 023 8029 6066 Email: [email protected]
Alternative versions of our annual report:
We can make this annual report available in the following formats and versions: translated large print braille audio.
Please contact us on 023 8029 6066 or at [email protected] for more information.
84 APPENDICES
85 Appendix A – Sustainability report
Building a sustainable organisation The NHS is committed to reducing its environmental impact and managing its resources responsibly. As a CCG firmly rooted in our community we are keen to play our part in this to ensure a healthy future for our city. This year we continued to make progress in ensuring sustainability is an integral part of our organisation. We continue to monitor our sustainability action plan that compliments the sustainability policy and have carefully monitored the resources we use. Everything from the amount of mileage travelled to the amount of energy and water we use has been captured with a view to reducing our carbon footprint.
Sustainability policy Our sustainability policy and sustainable development management plan sets the vision for how we will embrace our corporate social responsibility as well as a framework for helping us to understand how we are progressing in social, environmental and financial terms. Through this approach we will make continuous progress towards our aim of being a low carbon organisation. Built around the goals of the national Sustainable Development Strategy (2014), what was the good corporate citizenship assessment model and the principles of national best practice, our approach will deliver a new model of healthcare which positively contributes to a healthier environment and to healthy lives. In summary, the purpose of our policy is to: conceptualise our ambitions in relation to social, environmental and financial sustainability underpin and inform the content of our sustainable development management plan demonstrate local progress towards the achievement of the vision and goals of the Sustainable Development Strategy place our commitment to sustainability and carbon reduction within the context of national guidance and statutory obligation and policy requirements.
86 Our progress
During 2019 /20 we continued to: make staff aware of their sustainability responsibilities through the staff newsletter and at induction involved staff in green initiatives, promoting the NHS Sustainability Day and highlighting key sustainability facts continued promotion of video and telephone conferencing including Skype for Business to reduce staff travel and subsequent carbon footprint highlighted sustainability information and tips in our CCG staff newsletter raise awareness of facilities already available such as cycle racks, cycle scheme and have continued to improve our shower and changing facilities. Updated our Green Travel Plan Updated the Bike Sheds
Sustainability report As in 2018/19, the CCG is not required to produce a full sustainability report. However, as part of our effort to encourage an awareness of our effects on the environment we have collated the following report. Unfortunately, the information we receive from NHS Property Services, the owners of our headquarters, is not exhaustive and relates principally to energy, waste and water. We have therefore captured this data along with other information we hold relating to our carbon footprint below.
Monitoring our carbon footprint As a key part of the health and care system, it is our duty to contribute towards the level of ambition set in 2014 of reducing the carbon footprint of the NHS by 10% from a 2007 baseline by 2020.
We continue to work towards this challenging target by ensuring we follow best practice for carbon reduction in all of our work.
Overall performance
Mileage
Last year our staff clamed mileage of 99,909 which is an increase compared with 52,130,km in 2018/19. Controls are in place to monitor this going forward, all mileage outside of the Southampton area has to be authorised by an executive in advance.
87 CCG Headquarters
We share our headquarters building with NHS England Wessex Area Team and as such we are given figures for energy and water use along with waste generated on a whole building basis. We have therefore based our calculations below on the fact that we occupy 40.5% of the building.
Energy and water usage information is provided by NHS Property Services who we lease our headquarters from. Due to the current Covid emergency they have been unable to provide us with this information for 2019/20.
Energy
Energy usage can vary hugely due to seasonal variations. The CCG spent £25,499 on energy in 2018 / 19. This was an increase on the previous year. Staff are encouraged to look at ways they can improve sustainability.
Waste
We ensure that our staff think about waste by recycling, printing only when necessary, and using electronic copies of documents wherever possible. Recyclable waste is disposed of in appropriate bins which are widely available across our office space.
Water
Staff have access to water coolers working off the mains water supply to ensure people do not run the water until it is cold. We also provide water heaters in all of the kitchens to ensure excess water is not re-boiled in kettles and only what is needed is used.
88 Appendix B - Governance statement
Introduction and context NHS Southampton City CCG is a body corporate established by NHS England on 1 April 2013 under the National Health Service Act 2006 (as amended).
The clinical commissioning group’s statutory functions are set out under the National Health Service Act 2006 (as amended). The CCG’s general function is arranging the provision of services for persons for the purposes of the health service in England. The CCG is, in particular, required to arrange for the provision of certain health services to such extent as it considers necessary to meet the reasonable requirements of its local population.
As at the date of publishing these accounts, NHS Southampton City Clinical Commissioning Group is not subject to any directions from NHS England issued under Section 14Z21 of the National Health Service Act 2006 (as amended), and has not been since its inception.
Scope of responsibility As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the clinical commissioning group’s policies, aims and objectives, whilst safeguarding the public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out in my Clinical Commissioning Group Accountable Officer Appointment Letter.
I am responsible for ensuring that the clinical commissioning group is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity. I also have responsibility for reviewing the effectiveness of the system of internal control within the clinical commissioning group as set out in this governance statement.
Compliance with the UK Corporate Governance Code NHS bodies are not required to comply with the UK Corporate Governance Code. However, as a CCG, 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.
Therefore this Governance Statement is intended to demonstrate the clinical commissioning group’s compliance with the best practice elements set out in Code. For the financial year ended 31 March 2020, and up to the date of signing this statement, we have not complied 89 with the provisions set out in the Code, or applied the principles of the Code.
The Clinical Commissioning Group Governance Framework The main function of the governing body is to ensure that the group has made appropriate arrangements for ensuring that it exercises its functions effectively, efficiently and economically and complies with such generally accepted principles of good governance as are relevant to it.
The clinical commissioning group is accountable for exercising the statutory functions of the group. It may grant authority to act on its behalf to:
(a) Any of its members (b) Its Governing Body (c) Employees (d) Committees or sub-committees of the group
The extent of the authority to act of the respective bodies and individuals depends on the powers delegated to them by the group as expressed through:
(a) The group’s scheme of reservation and delegation. (b) For committees, their terms of reference
Our committees On the establishment of the CCG we developed and published a Constitution for our organisation. The Constitution has been subject to regular updates.
The Constitution sets out the arrangements for meeting our responsibilities for commissioning care for our population. It describes the governing principles, rules and procedures that we have established to ensure probity and accountability in the day to day running of the CCG; to ensure that decisions are taken in an open and transparent way and that the interests of patients and the public remain central to the goals of the group.
The description below summarises the details of our committees that are set out in our Constitution, a copy of which can be found on our website.
Governing Body
Responsible for setting the vision and strategy of the CCG, the Governing Body approves commissioning plans, monitors performance against plans and provides assurance of strategic risk. Membership is made up of:
the Clinical Chair (who is to be an elected representative of a member practice) 90 five further clinical representatives of member practices one lay member to lead on Governance (Audit, Remuneration and Conflicts of Interest Guardian) one lay member (our Vice Chair) to lead on patient and public participation matters one registered nurse who is an executive director of the CCG one secondary care specialist doctor the Chief Executive Officer the Chief Finance Officer (Deputy Chief Executive) Director of Public Health the Director of System Delivery
The following ‘observer’ members have full speaking but no voting rights:
up to two representatives nominated by the Local Authority patient representative (Health watch)
A board effectiveness review was undertaken in February 2020. The Terms of Reference were updated in June 2019
Clinical Executive Group
This Group is responsible for providing the CCG Governing Body with strong clinical leadership which will shape and deliver the CCG’s key objectives. It also approves clinical policies and other delegated functions. The Governing Body has approved and keeps under review the Terms of Reference for this committee, which includes information on its membership and that the Chair has changed during the year.
An effectiveness review of the Clinical Executive Group was undertaken in March 2020. The Terms of Reference were last updated in May 2019.
Clinical Governance Committee
Clinical Governance Committee provides the CCG Governing Body with an assurance and scrutiny function in relation to quality including patient safety, patient experience and clinical effectiveness, drive improvements in healthcare assurance in NHS Southampton City CCG’s commissioned services and provide assurance that all elements of the integrated governance agenda are brought together in order to realise continuous improvement in the quality of services. The Governing Body has approved and keeps under review the Terms of Reference for this committee, which includes information on its membership and that the Chair has changed during the year.
The Terms of Reference were last updated in June 2019. An effectiveness review of the Clinical Governance Committee was undertaken in March 2020
91 Finance and Audit Committee
The Finance and Audit 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 group in so far as they relate to finance. The Governing Body has approved and keeps under review the terms of reference for this committee, which includes information on its membership. The membership of the Finance and Audit Committee for 2019/20 can be found at page 41. An effectiveness review of Finance and Audit Committee was undertaken in July 2019. The Terms of Reference were last updated in January 2019
Remuneration Committee
This Committee makes recommendations to the Governing Body on determinations about the remuneration, fees and other allowances for employees and for people who provide services to the group, and on determinations about allowances under any pension scheme that the group may establish as an alternative to the NHS pension. The Governing Body has approved and keeps under review the terms of reference for the Remuneration Committee, which includes information on the membership of the Committee. The Terms of Reference were last updated in November 2019
Primary Medical Care Commissioning Committee
The Committee has been established in accordance with the above statutory provisions to enable the members to make collective decisions on the review, planning, commissioning and procurement of primary care services in Southampton under delegated authority from NHS England.
In performing its role the Committee will exercise its management of the functions in accordance with the agreement entered into between NHS England and Southampton City CCG, which will sit alongside the delegation and terms of reference.
The role of the Committee shall be to carry out the functions relating to the commissioning of primary medical services under section 83 of the NHS Act.
An effectiveness review of Primary Medical Care Commissioning Committee was undertaken in March 2020. The Terms of Reference were updated in June 2019
92 Joint Commissioning Board
Southampton City Council and Southampton City Clinical Commissioning Group (CCG) have developed a shared ambition for change ‘Integrated Health and Wellbeing Commissioning allows the city to push further and faster towards our aim of completely transforming the delivery of health and care in Southampton, so that it is better integrated, delivered as locally as possible, person centred and with an emphasis on prevention and intervening early to prevent escalation’.
The Joint Commissioning Board encourages collaborative planning, ensures achievement of strategic objectives and provides assurance to the governing bodies of the partners of the integrated commissioning fund on the progress and outcomes of the work of the integrated commissioning function.
The Terms of Reference were last updated in May 2019. An effectiveness review of the Joint Commissioning Board was been undertaken in March 2020.
Committees will only be able to establish their own sub-committees, to assist them in discharging their respective responsibilities, if this responsibility has been delegated to them by the CCG or the committee they are accountable to. Such committees may include persons other than members or employees of the Clinical Commissioning Group.
93 Board and sub-committee membership attendance records for the year ended 31 March 2020 -
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Name Position 5 6 (2 12 ning a ( ( ( ( ( ( m Rem er m Com o i Clinical Fina C Clinical ov Pr G Joint Commissioning Commissioning Joint
GP Board Dr Mark 5/5 6/9 Member/ 2/2 2/4 Kelsey Clinical Chair Dr Shiba GP Board 5/5 9/9 8/12 Qamar Member Dr Chris GP Board 5/5 8/9 Sanford Member Dr Hana GP Board 5/5 8/9 Burgess Member Dr Pritti GP Board 5/5 6/9 Aggarwal Member
Dr Sarah GP Board 4/5 8/9 Young Member
Chief John 1/1 2/5 0/9 1/6 Executive Richards* Officer Chief Maggie 1/4 Executive 0/4 MacIsaac** Officer Chief James 5/5 6/9 4/6 3/4 Financial 5/5 Rimmer Officer Director of Stephanie Quality and 4/5 7/9 12/12 1/6 4/4 Ramsey Integration / Chief Nurse Director of Peter 3/5 6/9 5/6 System Horne Delivery
Lay Member Henry Slater 5/5 5/5 2/2 6/6 (Governance)
94 Lay Member Matt (patient and 5/5 3/5 2/2 5/6 4/4 Stevens public involvement)
Dr Mark Secondary 4/5 2/12 Sopher Care Doctor
Joint Director Dr Jason of Public 1/3 2/5 Horsley*** Health Interim Debbie Director of 2/2 3/4 Chase**** Public Health
*John Richards retired from his role as CEO in June 2019 **Maggie MacIsaac joined as the CEO from June 2019 onwards ***Dr Jason Horsley left his role as the Director of Public Health in October 2019 ***Debbie Chase joined as the Interim Director of Public Health from November 2019
This table just lists members of the CCG’s Governing Body attendance at Board and sub committees of which they are members of, other members attend these meetings as part of the Terms of Reference
The CCG has undertaken several processes in year to assist in the evaluation of the Governing Body: Governing Body development sessions Governing Body briefing sessions Appraisals An internal audit review of Risk and the Board Assurance Framework providing “substantial” assurance.
Highlights of Governing Body committee reports
The Governing Body has maintained it’s agreed annual cycle of business and routinely reports on: quality (covering patient safety, experience and effectiveness) performance (including financial performance incorporating financial risks and opportunities, CQUIN performance, and contract activity and performance) Board Assurance Framework Managing Director reports, including items of significance that need to be highlighted to the Governing Body. Governing Body have also been kept well briefed on Covid preparedness Ratifying policies and receiving corporate updates
95 Highlights of other committee reports
Each committee has maintained its agreed annual cycle of business and routinely reports on: Clinical Governance Committee - Quality reports including safeguarding, feedback on all main providers, continuing healthcare and nursing home information, infection control, SIRI’s, patient experience, freedom of information reports and a briefing on Brexit arrangements Clinical Executive Group – Clinical pathways, emergency planning, finance and performance targets Finance and Audit – Updates from internal and external audit, counter fraud, Conflicts of Interest, gifts and hospitality, risk register and a briefing on Brexit Remuneration Committee – Determine pay for the Executive Team, review HR policies, evaluate the performance of the Executive Team Primary Medical Care Commissioning Committee – Local Enhanced Services, Primary Care strategy, Direct Enhanced Services Joint Commissioning Board – Better Care Fund Quarterly Reports, Quality, Performance
The Clinical Commissioning Group Risk Management Framework NHS Southampton City CCG manages risk by: clarifying strategic objectives, management and delivery arrangements identifying strategic and operational risks and challenges to those objectives assessing risks managing/mitigating risks and issues reviewing and reporting on risks and issues.
The CCG Governing Body is ultimately and collectively responsible for effective risk management within the organisation. The CCG Governing Body discharges its functions in this respect both by setting and monitoring compliance with requirements for risk management within the CCG and by directing a framework for robust risk identification. The Governing Body also provides challenge to the risk score if necessary. In order to promote achievement of its strategic objectives, it is essential the CCG identifies, measures, mitigates and monitors any strategic risks which could frustrate or prevent achievement of such objectives. The Board Assurance Framework (BAF) is the principal means by which the Governing Body identifies, measures and monitors strategic risks to the delivery of its objectives. The BAF is also a means by which the Governing Body records steps which have been or will be taken with a view to mitigating such risks. The CCG Governing Body also ensures that it receives full visibility of significant non-strategic risks by means of reviewing extracts of the most significant risks from the CCG Risk Register. 96 The CCG Governing Body approves the BAF at the start of the financial year, in line with new strategic objectives, reviews the overall BAF bi-monthly and directs the Finance and Audit Committee to review specific risk detail. The Senior Management Team (SMT) is responsible for reviewing an effective system of risk management across the whole of the CCG’s activities that supports the achievement of its objectives. The role of SMT is also to provide challenge to the risk score if necessary. All managers and clinical leads within the CCG are accountable for the day-to- day management of risks of all types within their area of responsibility. They are charged with ensuring that risk assessments are undertaken throughout their area of responsibility on a proactive basis and that preventive action is carried out where necessary. They are also responsible for seeking advice about implementation of risk reduction plans:
ensuring that appropriate and effective risk management processes are in place within their designated area and scope of responsibility; and that all staff are made aware of the risks within their work environment and of their personal responsibilities implementing and monitoring any identified risk management control measures within their designated area and scope of responsibility ensuring that they are appropriate and adequate ensuring that risks are captured on the Risk Register.
All staff are responsible for: maintaining an understanding of risk management principles being familiar with the risk management framework prompt reporting of incidents, accidents and near misses using the CCG incident form taking reasonable care for their own safety and the safety of others coming into contact with CCG staff.
The CCG has set out its values and behaviours and these include fostering an open and transparent approach to risk management wherever possible. Our work as clinical commissioners can only be successful if we develop effective working relationships with all our stakeholders including neighbouring CCGs, Southampton City Council, Southampton Health and Wellbeing Board and our patients and the public. To this end we will ensure that all risk management developments and ideas are shared with stakeholders to create the most effective environment for understanding and mitigating the risks we face. Mindful of the CCG’s obligations in respect of public involvement and consultation and its duties to promote integration, the CCG expressly acknowledges the potential importance of information gleaned from patients, members of the public for whom services are being or may be provided, and from partner health and social care organisations in effective identification of risk. The risk register will be the tool that records the main threats to the CCG’s objectives and ensures that these risks are being managed by controls that are known to be working. A 97 guide has been produced to describe how Southampton City CCG’s risk register is populated and managed and a one page summary. The risks are reviewed bi-monthly by the CCG Senior Management Team. Any performance issues relating to maintenance of the risk register will be escalated to the relevant committee. All other risk issues are raised at the Finance and Audit Committee for the CCG. All exceptions are escalated to the CCG Governing Body. All significant corporate risks link to the CCG Strategic Risk Register which also references the sources of information to satisfy the Governing Body that effective control measures are in place. For each risk, the CCG risk register defines a risk score which is a measurement of the probability of the risk materialising and its potential impact.
Risk assessment
As part of its role in ensuring effective direction of the CCG, the Governing Body continuously seeks assurances on the detection and management of significant issues through the use of the Board Assurance Framework and Clinical Governance Committee.
Significant risks identified during 2019/20 have included:
Failure of the A&E standard, Cancer standard and Referral to Treatment Time- this would result in the CCG not meeting the NHS Constitution requirements. Ensuring high quality and safety of commissioned services – this includes monitoring quality improvement action plans, such as ensuring safe levels of staffing Significant progress has been made with implementing the BetterCare scheme including development of integrated working, effective rehab and reablement, supporting carers, services to reduce falls. Despite this whole system transformational change overall performance is off track and locality integrated working is variable and further work is required to increase effectiveness. The development of Primary Care Networks needs to be supported alongside this Pressures on the sustainability of Primary Care, due to increasing demand, workforce supply constraints and risks to viability of some practices Failure to achieve its in year breakeven position in line with its approved financial plan Due to COVID-19 if there is a substantial level of staff absence then the CCG's ability to undertake all their key activities will be compromised resulting in considerable service delivery impacts
We are also conscious of the financial challenges that operate in the Public Sector; locally across the HIOW STP footprint there are a number of our partner’s commissioners and providers either operating in financial deficit or with significant financial challenges to achieve their set control totals. We also recognise the challenges faced by our local authority partners and the financial pressures they face in relation to adult and children’s social care. As a CCG we take an active role in the HIOW Suitability and Transformation 98 Partnership to identify efficiencies and programmes of work which can be delivered at scale to benefit patients and the public.
The risk register is monitored bi-monthly by SMT who collectively review each of the risks, the controls and mitigating actions to ensure they are on track. All new risks are added onto the risk register as and when they arise during the financial year and are subject to the same scrutiny.
The principal risks to compliance are set out earlier in the main report. The sections above provide an overview of how we monitor and manage risks in the CCG.
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.
Annual audit of conflicts of interest management The revised statutory guidance on managing conflicts of interest for CCGs (published June 2016) requires CCGs to undertake an annual internal audit of conflicts of interest management. To support CCGs to undertake this task, NHS England has published a template audit framework. An internal audit was conducted on conflicts of interest for the fourth year running in line with the revised statutory guidance, providing “substantial” assurance with no recommendations.
Information governance The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal identifiable information. The NHS Information Governance Framework is supported by the Data Protection and Security 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
99 an information governance management framework and have developed 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.
We have a suite of policies in place outlining data security arrangements and these are audited throughout the year to ensure staff understand their roles and responsibilities.
The CCG gained ‘substantial’ assurance in the recent internal audit of the Data Protection and Security toolkit with no recommendations.
Third party assurances The CCG gains assurance from third party sources that our systems and processes for internal control are robust. These include input from our internal auditors and our counter fraud service. Both of whom attend the Finance and Audit Committee and give updates at each meeting as to their findings and opinions. An update from the Chief Financial Officer on any other third party assurance is also a standing item on the Finance and Audit Committee agenda.
Control Issues NHS Southampton City CCG does not currently face any significant control issues. The reviews of Internal Audit have generally issued assessments of either “substantial” or “reasonable” assurance and no significant issues have been reported.
Review of economy, efficiency and effectiveness of the use of resources As Accountable Officer I have the responsibility for reviewing the effectiveness of the system of internal control. This is informed by the work of the internal auditors, executive directors and GP Governing Body members who have the responsibility for the development and maintenance of the internal control framework. The following processes have been implemented to review the effectiveness of the system of internal control: annual review of committee structures and terms of reference internal audit of Board Assurance Framework and risk management process the risk register and BAF is challenged and reviewed by SMT, and the Governing Body on a bi-monthly basis. 100 Internal audit of Conflicts of Interest
Each year the CCG Governing Body receives the Operational Plan and associated Financial Plan for the CCG. These are discussed and approved by the Governing Body.
In year Financial Performance against plan is monitored by the CCG Governing Body bi- monthly. The Finance and Performance report presented includes finances, activity, constitutional standards, delivery against QIPP targets and monitoring of other key trends and KPIs. The CCG QIPP programme is monitored in detail by the Business Management Team, which is a sub-committee of Clinical Executive Group. CEG discuss and approve all QIPP schemes prior to them being built into the financial plan.
The finance report includes reporting against the CCG running cost allocation and the cost of central management costs.
In 2019/20 NHS England and NHS Improvement introduced a new system for assessing and rating commissioner and provider performance – the NHS Oversight Framework (NHSE OF) replaced the CCG Improvement and Assessment Framework. It is intended as a focal point for joint work, support a dialogue between NHS England and NHS Improvement, CCGs, providers, sustainability and transformation partnerships (STPs), and integrated care systems. The metric is presented and discussed at the CCG Performance Board on a quarterly basis.
NHS England have paused the CCG assessment work because of covid-19, therefore the CCG has yet to receive their year-end rankings. Our latest Quality of Leadership ranking is for Quarter 2 2019/20 where we were rated Amber.
As a result of the Covid-19 emergency NHS England have suspended the 2020/21 Planning process, including the completion of financial plans.
Delegation of Functions The CCG Scheme of Delegation outlines where functions have been delegated internally. Where this is the case feedback from delegation chains regarding business, use of resources and responses to risk and the extent to which in-year targets have been met is through the review of the effectiveness of sub-committees and the receipt and scrutiny of minutes and actions from sub-committees. Sub-committee Terms of Reference are reviewed and signed- off annually by the Governing Body.
Review of the effectiveness of governance, risk management and internal control Capacity to handle risk As Accountable Officer, I am accountable for governance and risks relating to the running of the CCG. The Director of Quality and Integration (Chief Nurse) is the nominated lead for clinical governance and quality, providing the executive leadership for this agenda.
101 The Clinical Governance Committee is a group which brings together and formalises the key elements of safety, patient experience, clinical effectiveness and quality governance across its providers in a co-ordinated way. This committee is chaired by our Chief Nurse with clinical input from our GP Board member for clinical governance.
The CCG’s Head of Governance is responsible for developing and overseeing the risk management strategy, internal systems, procedures and risk structures. This post is also responsible for coordinating risk management activities and ensuring risk information and reports are compiled to help inform the senior management team and Governing Body. The Head of Business also liaises externally on behalf of the CCG and ensures that emergency planning, business continuity plans are established and plan of audit and feedback is in place. Risk management is included on the staff corporate induction for awareness of how to escalate any risk issues.
Counter fraud arrangements The CCG is committed to reducing fraud, bribery and corruption within the NHS and will seek appropriate disciplinary, regulatory, civil and criminal sanctions against fraudsters and where possible will seek to recover losses. The CCG are also working to ensure that it meets the standards set out in the NHS Protect Standards for Commissioners: Fraud, Bribery and Corruption and that it already has the following in place. That an Accredited Counter Fraud Specialist is contracted to undertake counter fraud work proportionate to identified risks. The CCG Finance and Audit Committee receives a report against each of the Standards for Commissioners at least annually. There is executive support and direction for a proportionate proactive work plan to address identified risks. A member of the executive board is proactively and demonstrably responsible for tackling fraud, bribery and corruption. Appropriate action is taken regarding any NHS Protect quality assurance recommendations.
The Counter Fraud specialist also attends the CCG’s Finance and Audit committee and each quarter provides a written update to the committee and an annual report against their work plan
Review of effectiveness 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
102 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 Finance and Audit Committee and Clinical Governance Committee. If appropriate, a plan to address weaknesses and ensure continuous improvement of the system will be put in place. The Board Assurance Framework itself provides me with evidence that the effectiveness of controls that manage risks to the clinical commissioning group achieving its principles objectives have been reviewed. The following key processes are in place to ensure that resources are used economically, efficiently and effectively: Scheme of Delegation, Standing Orders and Standing Financial Instructions approved by the Governing Body. These key documents include arrangement for - setting and monitoring financial budgets - delegation of authority - performance management - achieving value for money in procurement. Robust processes used for procurement Monitoring of contracts
The Governing Body gains assurances from the Finance and Audit Committee in respect of ensuring appropriate financial arrangements are in place and to provide assurance to the Governing Body on financial matters. The CCG also has a robust monitoring system to ensure that it delivers the objectives through bi monthly performance reports.
Head of Internal Audit Opinion Following completion of the planned audit work for the financial year for the Clinical Commissioning Group, the Head of Internal Audit issued an independent and objective opinion on the adequacy and effectiveness of the Clinical Commissioning Group’s system of risk management, governance and internal control. The Head of Internal Audit concluded in summary that:
“TIAA is satisfied that, for the areas reviewed during the year, “reasonable” 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.”
103 The full statement can be found in our Annual Report above on page 83.
During the year, Internal Audit issued the following audit reports: Area of Audit Level of Assurance Given
Safeguarding – Looked After Children Reasonable Primary Care Commissioning and Contracting Reasonable Payroll and Human Resources Substantial Commissioning and Contract Management Reasonable Risk Management and BAF Substantial Key Financial Controls Reasonable Governance – Conflicts of Interest Substantial Data Security and Protection Toolkit Substantial
Data quality Any data received by the Governing Body has been validated and verified by CCG directors and staff. The majority of the data used is provided by our Commissioning Support Unit, as generally, the CCG does not have access to patient identifiable data (PID), following the implementation of the NHS reforms. However, our Continuing Health Care, Quality and Medicines Management teams do have access to PID following Governing Body approval which was reviewed for 2018/19 in line with GDPR. This was felt necessary to ensure we maintain quality of care for patients. Data quality is controlled and validated as part of routine processing and we are committed to ensuring the procedures adhered to are robust and regularly reviewed.
Business critical models We have an appropriate framework and environment to provide quality assurance of business critical models, in line with the recommendations in the Macpherson Report for government departments and their arm’s length bodies. Having reviewed the guidance around business critical models and the detail held by HM Treasury, although CCGs make use of the models we do not own them, and are unable to change their content. For example the models include the CCG allocations formula and the modelling for the national tariff; we receive the outputs of these models but have no control or input to their use.
104 Data security We have submitted a satisfactory level of compliance within the Data Protection and Security toolkit assessment, achieving ‘substantial assurance’ as part of our internal audit programme.
Discharge of statutory functions Arrangements put in place by the clinical commissioning group and explained within the corporate governance framework have been 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 legislature and regulations. As a result, I can confirm that the Clinical Commissioning Group is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions.
Responsibility for each duty and power has been clearly allocated to a lead director. Directorates have confirmed that their structures provide the necessary capability and capacity to undertake all of the Clinical Commissioning Group’s statutory duties.
Conclusion My review confirms that NHS Southampton City CCG has a sound governance system that supports the achievement of our policies, aims and objectives and that no significant internal control issues have been identified and that any remaining issues have been or are being addressed.
Maggie MacIsaac Chief Executive Officer 16 June 2020
105 Independent auditor's report to the members of the Governing Body of NHS Southampton City Clinical Commissioning Group
Report on the Audit of the Financial Statements
Opinion We have audited the financial statements of NHS Southampton City Clinical Commissioning Group (the ‘CCG’) for the year ended 31 March 2020, which comprise the Statement of Comprehensive Net Expenditure, the Statement of Financial Position, the Statement of Changes in Taxpayers Equity, the Statement of Cash Flows and notes to the financial statements, including a summary of significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and International Financial Reporting Standards (IFRSs) as adopted by the European Union, and as interpreted and adapted by the Department of Health and Social Care Group Accounting Manual 2019 to 2020. In our opinion, the financial statements:
• give a true and fair view of the financial position of the CCG as at 31 March 2020 and of its expenditure and income for the year then ended; and
• have been properly prepared in accordance with International Financial Reporting Standards (IFRSs) as adopted by the European Union, as interpreted and adapted by the Department of Health and Social Care Group Accounting Manual 2019 to 2020; and
• have been prepared in accordance with the requirements of the Health and Social Care Act 2012.
Basis for opinion We conducted our audit in accordance with International Standards on Auditing (UK) (ISAs (UK)) and applicable law. Our responsibilities under those standards are further described in the ‘Auditor’s responsibilities for the audit of the financial statements’ section of our report. We are independent of the CCG in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK, including the FRC’s Ethical Standard, and we have fulfilled our other ethical responsibilities in accordance with these requirements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion.
The impact of macro-economic uncertainties on our audit Our audit of the financial statements requires us to obtain an understanding of all relevant uncertainties, including those arising as a consequence of the effects of macro-economic uncertainties such as Covid- 19 and Brexit. All audits assess and challenge the reasonableness of estimates made by the Accountable Officer and the related disclosures and the appropriateness of the going concern basis of preparation of the financial statements. All of these depend on assessments of the future economic environment and the CCG’s future operational arrangements.
Covid-19 and Brexit are amongst the most significant economic events currently faced by the UK, and at the date of this report their effects are subject to unprecedented levels of uncertainty, with the full range of possible outcomes and their impacts unknown. We applied a standardised firm-wide approach in response to these uncertainties when assessing the CCG’s future operational arrangements. However, no audit should be expected to predict the unknowable factors or all possible future implications for an entity associated with these particular events.
Conclusions relating to going concern
We have nothing to report in respect of the following matters in relation to which the ISAs (UK) require us to report to you where:
• the Accountable Officer’s use of the going concern basis of accounting in the preparation of the financial statements is not appropriate; or
Grant Thornton UK LLP. 1 • the Accountable Officer has not disclosed in the financial statements any identified material uncertainties that may cast significant doubt about the CCG’s ability to continue to adopt the going concern basis of accounting for a period of at least twelve months from the date when the financial statements are authorised for issue. In our evaluation of the Accountable Officer’s conclusions, and in accordance with the expectation set out within the Department of Health and Social Care Group Accounting Manual 2019 to 2020 that the CCG’s financial statements shall be prepared on a going concern basis, we considered the risks associated with the CCG’s operating activities, including effects arising from macro-economic uncertainties such as Covid-19 and Brexit. We analysed how those risks might affect the CCG’s financial resources or ability to continue operations over the period of at least twelve months from the date when the financial statements are authorised for issue. In accordance with the above, we have nothing to report in these respects. However, as we cannot predict all future events or conditions and as subsequent events may result in outcomes that are inconsistent with judgements that were reasonable at the time they were made, the absence of reference to a material uncertainty in this auditor's report is not a guarantee that the CCG will continue in operation.
Other information The Accountable Officer is responsible for the other information. The other information comprises the information included in the Annual Report and Accounts, other than the financial statements and our auditor’s report thereon. Our opinion on the financial statements does not cover the other information and, except to the extent otherwise explicitly stated in our report, we do not express any form of assurance conclusion thereon. In connection with our audit of the financial statements, our responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or our knowledge obtained in the audit or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether there is a material misstatement in the financial statements or a material misstatement of the other information. If, based on the work we have performed, we conclude that there is a material misstatement of the other information, we are required to report that fact. We have nothing to report in this regard.
Other information we are required to report on by exception under the Code of Audit Practice Under the Code of Audit Practice published by the National Audit Office in April 2015 on behalf of the Comptroller and Auditor General (the Code of Audit Practice) we are required to consider whether the Governance Statement does not comply with the guidance issued by the NHS Commissioning Board or is misleading or inconsistent with the information of which we are aware from our audit. We are not required to consider whether the Governance Statement addresses all risks and controls or that risks are satisfactorily addressed by internal controls. We have nothing to report in this regard.
Opinion on other matters required by the Code of Audit Practice
In our opinion:
• the parts of the Remuneration and Staff Report to be audited have been properly prepared in accordance with IFRSs as adopted by the European Union, as interpreted and adapted by the Department of Health and Social Care Group Accounting Manual 2019 to 2020 and the requirements of the Health and Social Care Act 2012; and
• based on the work undertaken in the course of the audit of the financial statements and our knowledge of the CCG gained through our work in relation to the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources, the other information published together with the financial statements in the Annual Report for the financial year for which the financial statements are prepared is consistent with the financial statements.
Grant Thornton UK LLP. 2 Opinion on regularity required by the Code of Audit Practice
In our opinion, in all material respects the expenditure and income recorded in the financial statements have been applied to the purposes intended by Parliament and the financial transactions in the financial statements conform to the authorities which govern them.
Matters on which we are required to report by exception Under the Code of Audit Practice, we are required to report to you if:
• we issue a report in the public interest under Section 24 of the Local Audit and Accountability Act 2014 in the course of, or at the conclusion of the audit; or
• 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 expenditure, 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 make a written recommendation to the CCG under Section 24 of the Local Audit and Accountability Act 2014 in the course of, or at the conclusion of the audit. We have nothing to report in respect of the above matters.
Responsibilities of the Accountable Officer and Those Charged with Governance for the financial statements As explained more fully in the Statement of Accountable Officer's responsibilities the Accountable Officer is responsible for the preparation of the financial statements in the form and on the basis set out in the Accounts Directions, for being satisfied that they give a true and fair view, and for such internal control as the Accountable Officer determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, the Accountable Officer is responsible for assessing the CCG’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless they have been informed by the relevant national body of the intention to dissolve the CCG without the transfer of its services to another public sector entity. The Accountable Officer is responsible for ensuring the regularity of expenditure and income in the financial statements. The Finance and Audit Committee is Those Charged with Governance. Those Charged with Governance are responsible for overseeing the CCG’s financial reporting process.
Auditor’s responsibilities for the audit of the financial statements Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements. A further description of our responsibilities for the audit of the financial statements is located on the Financial Reporting Council’s website at: www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditor’s report.
We are also responsible for giving an opinion on the regularity of expenditure and income in the financial statements in accordance with the Code of Audit Practice.
Grant Thornton UK LLP. 3 Report on other legal and regulatory requirements – Conclusion on the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources
Matter on which we are required to report by exception - CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources Under the Code of Audit Practice, we are required to report to you if, in our opinion we have not been able to satisfy ourselves that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2020. We have nothing to report in respect of the above matter.
Responsibilities of the Accountable Officer As explained in the Governance Statement, the Accountable Officer is responsible for putting in place proper arrangements for securing economy, efficiency and effectiveness in the use of the CCG's resources.
Auditor’s responsibilities for the review of the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources We are required under Section 21(1)(c) and Schedule 13 paragraph 10(a) of the Local Audit and Accountability Act 2014 to be satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources and to report where we have not been able to satisfy ourselves that it has done so. 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. 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 April 2020, as to whether in all significant respects, 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 2020, and to report by exception where we are not satisfied. 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 be satisfied that the CCG has put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources.
Report on other legal and regulatory requirements – Certificate We certify that we have completed the audit of the financial statements of NHS Southampton City Clinical Commissioning Group in accordance with the requirements of the Local Audit and Accountability Act 2014 and the Code of Audit Practice.
Use of our report This report is made solely to the members of the Governing Body of the CCG, as a body, in accordance with Part 5 of the Local Audit and Accountability Act 2014. Our audit work has been undertaken so that we might state to the members of the Governing Body of the CCG those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the CCG and the members of the Governing Body of the CCG, as a body, for our audit work, for this report, or for the opinions we have formed.
Jackson Murray
Jackson Murray, Key Audit Partner
Grant Thornton UK LLP. 4 for and on behalf of Grant Thornton UK LLP, Local Auditor
Bristol 23 June 2020
Grant Thornton UK LLP. 5 NHS SOUTHAMPTON CITY CLINICAL COMMISSIONING GROUP ANNUAL ACCOUNTS FOR THE FINANCIAL YEAR ENDED 31st MARCH 2020 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
CONTENTS Page Number
The Primary Statements:
Statement of Comprehensive Net Expenditure for the year ended 31st March 2020 3 Statement of Financial Position as at 31st March 2020 4 Statement of Changes in Taxpayers' Equity for the year ended 31st March 2020 5 Statement of Cash Flows for the year ended 31st March 2020 6
Notes to the Accounts Note No. Accounting policies 1 7 Other operating revenue 2 12 Revenue 3 13 Employee benefits and staff numbers 4 14 Operating expenses 5 17 Better payment practice code 6 18 Income generation activities 7 18 Investment revenue 8 18 Other gains and losses 9 18 Finance costs 10 18 Net gain/(loss) on transfer by absorption 11 19 Operating leases 12 19 Property, plant and equipment 13 19 Intangible non-current assets 14 19 Investment property 15 19 Inventories 16 19 Trade and other receivables 17 20 Other financial assets 18 21 Other current assets 19 21 Cash and cash equivalents 20 21 Non-current assets held for sale 21 21 Analysis of impairments and reversals 22 21 Trade and other payables 23 22 Other financial liabilities 24 22 Other liabilities 25 22 Borrowings 26 22 Private finance initiative, LIFT and other service concession arrangements 27 22 Finance lease obligations 28 22 Finance lease receivables 29 22 Provisions 30 23 Contingencies 31 24 Commitments 32 24 Financial instruments 33 24 Operating segments 34 26 Joint arrangements - interests in joint operations 35 27 Related party transactions 36 28 Events after the end of the reporting period 37 29 Third party assets 38 29 Losses and special payments 39 29 Financial performance targets 40 29 Analysis of charitable reserves 41 29
2 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
Statement of Comprehensive Net Expenditure for the year ended 31 March 2020
2019-20 2018-19 Note £'000 £'000
Income from sale of goods and services 2 (686) (1,186) Other operating income 2 0 (0) Total operating income (686) (1,186)
Staff costs 4 6,781 5,990 Purchase of goods and services 5 398,433 386,871 Depreciation and impairment charges 5 0 0 Provision expense 5 922 1,138 Other Operating Expenditure 5 580 936 Total operating expenditure 406,716 394,935
Net Operating Expenditure 406,030 393,749
Finance income 0 0 Finance expense 10 0 0 Net expenditure for the year 406,030 393,749
Net (Gain)/Loss on Transfer by Absorption 0 0 Total Net Expenditure for the Financial Year 406,030 393,749
Other Comprehensive Expenditure Items which will not be reclassified to net operating costs Net (gain)/loss on revaluation of PPE 0 0 Net (gain)/loss on revaluation of Intangibles 0 0 Net (gain)/loss on revaluation of Financial Assets 0 0 Actuarial (gain)/loss in pension schemes 0 0 Impairments and reversals taken to Revaluation Reserve 0 0
Items that may be reclassified to Net Operating Costs Net gain/loss on revaluation of available for sale financial assets 0 0 Reclassification adjustment on disposal of available for sale financial assets 0 0 Sub total 0 0
Comprehensive Expenditure for the year ended 31 March 2020 406,030 393,749
The notes on pages 7 to 29 form part of this statement
3 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
Statement of Financial Position as at 31 March 2020
2019-20 2018-19
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 2 3 Other financial assets 18 0 0 Total non-current assets 2 3 Current assets: Inventories 16 0 0 Trade and other receivables 17 6,946 3,469 Other financial assets 18 0 0 Other current assets 19 0 0 Cash and cash equivalents 20 702 641 Total current assets 7,648 4,110
Non-current assets held for sale 21 0 0
Total current assets 7,648 4,110
Total assets 7,650 4,113
Current liabilities Trade and other payables 23 (24,031) (21,057) Other financial liabilities 24 0 0 Other liabilities 25 0 0 Borrowings 26 0 0 Provisions 30 (1,905) (1,397) Total current liabilities (25,936) (22,454)
Non-Current Assets plus/less Net Current Assets/Liabilities (18,286) (18,341)
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 (2,620) (2,265) Total non-current liabilities (2,620) (2,265)
Assets less Liabilities (20,906) (20,606)
Financed by Taxpayers’ Equity General fund (20,906) (20,606) Revaluation reserve 0 0 Other reserves 0 0 Charitable Reserves 0 0 Total taxpayers' equity: (20,906) (20,606)
The notes on pages 7 to 29 form part of this statement
The financial statements on pages 3 to 29 were approved on behalf of the Governing Body by the Finance and Audit Committee on 16th June 2020 and signed on its behalf by:
Maggie MacIsaac Accountable Officer 16th June 2020 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
Statement of Changes In Taxpayers Equity for the year ended 31 March 2020
Revaluation Other Total General fund reserve reserves reserves £'000 £'000 £'000 £'000 Changes in taxpayers’ equity for 2019-20
Balance at 01 April 2019 (20,606) 0 0 (20,606)
Transfer between reserves in respect of assets transferred from closed NHS bodies 0 0 0 0 Adjusted NHS Clinical Commissioning Group balance at 31 March 2019 (20,606) 0 0 (20,606)
Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2019-20 Net operating expenditure for the financial year (406,030) 0 0 (406,030)
Net gain/(loss) on revaluation of property, plant and equipment 0 0 0 0 Net gain/(loss) on revaluation of intangible assets 0 0 0 0 Net gain/(loss) on revaluation of financial assets 0 0 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 other investments and Financial Assets (excluding 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 (406,030) 0 0 (406,030)
Net funding 405,731 0 0 405,731
Balance at 31 March 2020 (20,906) 0 0 (20,906)
Revaluation Other Total General fund reserve reserves reserves £'000 £'000 £'000 £'000 Changes in taxpayers’ equity for 2018-19
Balance at 01 April 2018 (20,954) 0 0 (20,954)
Transfer of assets and liabilities from closed NHS bodies 0 0 0 0 Adjusted NHS Clinical Commissioning Group balance at 31 March 2018 (20,954) 0 0 (20,954)
Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2018-19 Impact of applying IFRS 9 to Opening Balances 0 0 0 0 Impact of applying IFRS 15 to Opening Balances 0 0 0 0 Net operating costs for the financial year (393,749) 0 0 (393,749)
Net gain/(loss) on revaluation of property, plant and equipment 0 0 0 0 Net gain/(loss) on revaluation of intangible assets 0 0 0 0 Net gain/(loss) on revaluation of financial assets 0 0 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 (393,749) 0 0 (393,749)
Net funding 394,097 0 0 394,097
Balance at 31 March 2019 (20,606) 0 0 (20,606)
The notes on pages 7 to 29 form part of this statement
5 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
Statement of Cash Flows for the year ended 31 March 2020 2019-20 2018-19 Note £'000 £'000 Cash Flows from Operating Activities Net operating expenditure for the financial year (406,030) (393,749) Depreciation and amortisation 5 0 0 Impairments and reversals 5 0 0 Non-cash movements arising on application of new accounting standards 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 (3,477) (207) (Increase)/decrease in other current assets 0 0 Increase/(decrease) in trade & other payables 23 2,975 (995) Increase/(decrease) in other current liabilities 0 0 Provisions utilised 30 (59) (98) Increase/(decrease) in provisions 30 922 1,138 Net Cash Inflow (Outflow) from Operating Activities (405,669) (393,911)
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 Non-cash movements arising on application of new accounting standards 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 (405,669) (393,911)
Cash Flows from Financing Activities Grant in Aid Funding Received 405,731 394,097 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 Non-cash movements arising on application of new accounting standards 0 0 Net Cash Inflow (Outflow) from Financing Activities 405,731 394,097
Net Increase (Decrease) in Cash & Cash Equivalents 20 62 186
Cash & Cash Equivalents at the Beginning of the Financial Year 641 456
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 703 642
The notes on pages 7 to 29 form part of this statement
6 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
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 Group Accounting Manual issued by the Department of Health and Social Care. Consequently, the following financial statements have been prepared in accordance with the Group Accounting Manual 2019-20 issued by the Department of Health and Social Care. The accounting policies contained in the Group Accounting Manual 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 Group Accounting Manual permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the clinical 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 a 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 Pooled Budgets The clinical commissioning group has entered into a pooled budget arrangement with Southampton City Council in accordance with Section 75 of the National Health Service Act 2006. Under the arrangement, funds are pooled for a range of health and social activities and note 35 provides details of the income and expenditure. Where the pool is hosted by the clinical commissioning group, it 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
The Clinical Commissioning Group has a S75 agreement with Southampton City Council for the Better Care Fund, which incorporates £79m of CCG contracts which are commissioned by the Integrated Commissioning Unit who work across the CCG and council. The work of the BCF is overseen by the Joint Commissioning Board. Whilst strategy and commissioning intentions are set jointly by the JCB and ICU, contracts are held by the separate organisations and under IFRS10 joint control is not established.
1.4 Revenue The Clinical Commissioning Group receives funding through a revenue resource allocation received from NHS England and included on the Statement of Change in Taxpayers Equity. Revenue received from other sources is minimal and includes: ● Prescribing rebate schemes ● Recovery of employee benefits (i.e. staff recharges to the local authority) The transition to IFRS 15 has been completed in accordance with paragraph C3 (b) of the Standard, applying the Standard retrospectively recognising the cumulative effects at the date of initial application. In the adoption of IFRS 15 a number of practical expedients offered in the Standard have been employed. These are as follows; ● As per paragraph 121 of the Standard the clinical commissioning group will not disclose information regarding performance obligations part of a contract that has an original expected duration of one year or less, ● The clinical commissioning group is to similarly not disclose information where revenue is recognised in line with the practical expedient offered in paragraph B16 of the Standard where the right to consideration corresponds directly with value of the performance completed to date. ● The FReM has mandated the exercise of the practical expedient offered in C7(a) of the Standard that requires the clinical commissioning group to reflect the aggregate effect of all contracts modified before the date of initial application. Revenue in respect of services provided is recognised when (or as) performance obligations are satisfied by transferring promised services to the customer, and is measured at the amount of the transaction price allocated to that performance obligation. Where income is received for a specific performance obligation that is to be satisfied in the following year, that income is deferred. Payment terms are standard reflecting cross government principles. The value of the benefit received when the clinical commissioning group accesses funds from the Government’s apprenticeship service are recognised as income in accordance with IAS 20, Accounting for Government Grants. Where these funds are paid directly to an accredited training provider, non-cash income and a corresponding non-cash training expense are recognised, both equal to the cost of the training funded.
7 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
Notes to the financial statements
1.5 Employee Benefits 1.5.1 Short-term Employee Benefits Salaries, wages and employment-related payments, including payments arising from the apprenticeship levy, are recognised in the period in which the service is received from employees, including bonuses earned but not yet taken. 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.
1.5.2 Retirement Benefit Costs Past and present employees are covered by the provisions of the NHS Pensions Schemes. These schemes are unfunded, defined benefit schemes that cover NHS employers, General Practices and other bodies allowed under the direction of the Secretary of State in England and Wales. The schemes are not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the schemes are accounted for as though they were defined contribution schemes: the cost to the clinical commissioning group of participating in a 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. The schemes are subject to a full actuarial valuation every four years and an accounting valuation every year.
1.6 Purchase of goods and services Purchase of goods and services are recognised when the goods or services are received. The majority of the clinical commissioning group spend is on healthcare related services. They are measured at the fair value of the consideration payable.
1.7 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.
1.8 Grants Payable Where grant funding is not intended to be directly related to activity undertaken by a grant recipient in a specific period, the clinical commissioning group recognises the expenditure in the period in which the grant is paid. All other grants are accounted for on an accruals basis.
1.9 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.
1.9.1 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.
1.10 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.
8 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
Notes to the financial statements
1.11 Provisions Provisions are recognised when the clinical commissioning group has a present legal or constructive obligation as a result of a past event, it is probable that the clinical commissioning group will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties. Where a provision is measured using the cash flows estimated to settle the obligation, its carrying amount is the present value of those cash flows using HM Treasury’s discount rate as follows:
Early retirement provisions are discounted using HM Treasury’s pension discount rate of minus 0.5% (2018-19: positive 0.29%) in real terms. All general provisions are subject to four separate discount rates according to the expected timing of cash flows from the Statement of Financial Position date:
● A nominal short-term rate of 0.51% (2018-19: 0.76%) for inflation adjusted expected cash flows up to and including 5 years from Statement of Financial Position date. ● A nominal medium-term rate of 0.55% (2018-19:1.14%) for inflation adjusted expected cash flows over 5 years up to and including 10 years from the Statement of Financial Position date. ● A nominal long-term rate of 1.99% (2018-19: 1.99%) for inflation adjusted expected cash flows over 10 years and up to and including 40 years from the Statement of Financial Position date. ● A nominal very long-term rate of 1.99% (2018-19: 1.99%) for inflation adjusted expected cash flows exceeding 40 years from the Statement of Financial Position date.
When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the receivable is recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the receivable can be measured reliably.
A restructuring provision is recognised when the clinical commissioning group has developed a detailed formal plan for the restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by starting to implement the plan or announcing its main features to those affected by it. The measurement of a restructuring provision includes only the direct expenditures arising from the restructuring, which are those amounts that are both necessarily entailed by the restructuring and not associated with on-going activities of the entity.
1.12 Clinical Negligence Costs NHS Resolution operates a risk pooling scheme under which the clinical commissioning group pays an annual contribution to NHS Resolution, which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although NHS Resolution is administratively responsible for all clinical negligence cases, the legal liability remains with clinical commissioning group.
1.13 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 Resolution 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.
1.14 Contingent Liabilities and Contingent Assets 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, contingent liabilities and contingent assets are disclosed at their present value.
9 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
Notes to the financial statements
1.15 Financial Assets Financial assets are recognised when the clinical commissioning group becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred.
Financial assets are classified into the following categories: ● Financial assets at amortised cost; ● Financial assets at fair value through other comprehensive income and; ● Financial assets at fair value through profit and loss. The classification is determined by the cash flow and business model characteristics of the financial assets, as set out in IFRS 9, and is determined at the time of initial recognition.
1.15.1 Financial Assets at Amortised cost Financial assets measured at amortised cost are those held within a business model whose objective is achieved by collecting contractual cash flows and where the cash flows are solely payments of principal and interest. This includes most trade receivables and other simple debt instruments. After initial recognition these financial assets are measured at amortised cost using the effective interest method less any impairment. The effective interest rate is the rate that exactly discounts estimated future cash receipts through the life of the financial asset to the gross carrying amount of the financial asset.
1.16 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.
1.16.1 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 and Social Care, which are carried at historic cost. The effective interest rate is the rate that exactly discounts estimated future cash payments through the life of the asset, to the net carrying amount of the financial liability. Interest is recognised using the effective interest method.
1.17 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.
1.18 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).
NHS Southampton City CCG had no losses or special payments in 2019/20.
1.19 Critical Accounting Judgements and Key Sources of Estimation Uncertainty In the application of the clinical commissioning group's accounting policies, management is required to make various judgements, estimates and assumptions. These are regularly reviewed.
1.19.1 Critical accounting judgements in applying accounting policies The following are the judgements, apart from those involving estimations, that management has made in the process of applying the clinical commissioning group's accounting policies and that have the most significant effect on the amounts recognised in the financial statements.
● The clinical commissioning group has reviewed all Pooled Budget arrangements in light of accounting standards and has determined that joint control exists in the Joint Equipment Store; Domiciliary Care and the Safeguarding Boards; and that joint control does not exist in the Better Care Fund.
10 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
Notes to the financial statements
1.19.2 Sources of estimation uncertainty
There are no assumptions in the accounts about the future and other sources of estimation uncertainty that have a significant risk of resulting in a material adjustment to the carrying amounts of assets and liabilities within the next financial year. The most significant estimate is around prescribing costs. The total estimate is below the materiality level and therefore the risk that it is materially misstated is minimal.
1.20 Accounting Standards That Have Been Issued But Have Not Yet Been Adopted The Department of Health and Social Care GAM does not require the following IFRS Standards and Interpretations to be applied in 2019- 20. These Standards are still subject to HM Treasury FReM adoption, with IFRS 16 being for implementation in 2020-21, and the government implementation date for IFRS 17 still subject to HM Treasury consideration.
● IFRS 16 Leases – HMT have confirmed that this standard will be effective from 1 April 2021 as adapted and interpreted by the FReM. ● IFRS 17 Insurance Contracts – Application required for accounting periods beginning on or after 1 January 2021, but not yet adopted by the FReM: early adoption is not therefore permitted.
The CCG has commenced the assessment of the application of IFRS 16 to its financial statements. This commenced with work to identify leases which are currently operating leases and should be reclassified as finance leases as well as a broader review of recurring expenditure streams where right to use assets may be embedded in contracting arrangements. The work has progressed to March 2020, when the CCG revised its operational priorities and working patterns to deal with the COVID19 pandemic and combined with the decision to defer the implementation of IFRS16 in the NHS to 1 April 2021 means that it has not been practical to complete this work or present it for audit. The work to identify the impact of this standard is expected to recommence in Autumn 2020, but from the review and work that has been done to date suggests that the standard will not have a material impact on the CCG's accounts.
11 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
2 Other Operating Revenue 2019-20 2018-19 Total Total £'000 £'000
Income from sale of goods and services (contracts) Education, training and research 0 0 Non-patient care services to other bodies 32 561 Patient transport services 0 0 Prescription fees and charges 0 0 Dental fees and charges 0 0 Income generation 0 0 Other Contract income 94 157 Recoveries in respect of employee benefits 561 468 Total Income from sale of goods and services * 686 1,186
Other operating income Rental revenue from finance leases 0 0 Rental revenue from operating leases 0 0 Charitable and other contributions to revenue expenditure: NHS 0 0 Charitable and other contributions to revenue expenditure: non-NHS 0 0 Receipt of donations (capital/cash) 0 0 Receipt of Government grants for capital acquisitions 0 0 Continuing Health Care risk pool contributions 0 0 Non cash apprenticeship training grants revenue 0 0 Other non contract revenue 0 0 Total Other operating income 0 0
Total Operating Income * 686 1,186
* Total does not add up. This is due to roundings.
12 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
3 Revenue
3.1 Disaggregation of Revenue - Revenue from sale of good and services (contracts)
Non-patient care Recoveries in Education, training Patient transport Prescription fees Dental fees and Other Contract services to other Income generation respect of employee and research services and charges charges income bodies benefits £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Source of Revenue NHS 0 32 0 0 0 0 0 88 Non NHS 0 0 0 0 0 0 94 473 Total 0 32 0 0 0 0 94 561
Non-patient care Recoveries in Education, training Patient transport Prescription fees Dental fees and Other Contract services to other Income generation respect of employee and research services and charges charges income bodies benefits £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Timing of Revenue Point in time 0 32 0 0 0 0 94 561 Over time 0 0 0 0 0 0 0 0 Total 0 32 0 0 0 0 94 561
3.2 Transaction price to remaining contract performance obligations
Contract revenue expected to be recognised in the future periods related to contract performance obligations not yet completed at the reporting date Revenue expected Revenue expected Revenue expected 2019-20 Total from Other DHSC from Non-DHSC Group from NHSE Bodies Group Bodies Bodies £000s £000s £000s £000s Not later than 1 year 0 0 0 0 Later than 1 year, not later than 5 years 0 0 0 0 Later than 5 Years 0 0 0 0 Total 0 0 0 0
13 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
4 Employee benefits and staff numbers
4.1.1 Employee benefits Total 2019-20
Permanent Employees Other Total £'000 £'000 £'000 Employee Benefits Salaries and wages 4,663 731 5,395 Social security costs 503 0 503 Employer Contributions to NHS Pension scheme 874 0 874 Other pension costs 0 0 0 Apprenticeship Levy 9 0 9 Other post-employment benefits 0 0 0 Other employment benefits 0 0 0 Termination benefits 0 0 0 Gross employee benefits expenditure * 6,050 731 6,781
Less recoveries in respect of employee benefits (note 4.1.2) (561) 0 (561) Total - Net admin employee benefits including capitalised costs * 5,489 731 6,221
Less: Employee costs capitalised 0 0 0 Net employee benefits excluding capitalised costs * 5,489 731 6,221
4.1.1 Employee benefits Total 2018-19
Permanent Employees Other Total £'000 £'000 £'000 Employee Benefits Salaries and wages 4,437 483 4,919 Social security costs 476 0 476 Employer Contributions to NHS Pension scheme 587 0 587 Other pension costs 0 0 0 Apprenticeship Levy 8 0 8 Other post-employment benefits 0 0 0 Other employment benefits 0 0 0 Termination benefits 0 0 0 Gross employee benefits expenditure * 5,507 483 5,990
Less recoveries in respect of employee benefits (note 4.1.2) (468) 0 (468) Total - Net admin employee benefits including capitalised costs * 5,039 483 5,522
Less: Employee costs capitalised 0 0 0 Net employee benefits excluding capitalised costs * 5,039 483 5,522
4.1.2 Recoveries in respect of employee benefits 2019-20 2018-19 Permanent Employees Other Total Total £'000 £'000 £'000 £'000 Employee Benefits - Revenue Salaries and wages (561) 0 (561) (468) Social security costs 0 0 0 0 Employer contributions to the NHS Pension Scheme 0 0 0 0 Other pension costs 0 0 0 0 Other post-employment benefits 0 0 0 0 Other employment benefits 0 0 0 0 Termination benefits 0 0 0 0 Total recoveries in respect of employee benefits (561) 0 (561) (468)
* Total does not add up. This is due to roundings.
14 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
4.2 Average number of people employed 2019-20 2018-19 Permanently Permanently employed Other Total employed Other Total Number Number Number Number Number Number
Total 95 8 103 93 7 99
Of the above: Number of whole time equivalent people engaged on capital projects 0 0 0 0 0 0
4.4 Exit packages agreed in the financial year
NHS Southampton City CCG made no payments in 2019-20 or 2018-19 with regards to exit packages.
Analysis of Other Agreed Departures
NHS Southampton City CCG made no such payments in 2019-20 or 2018-19.
15 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
4.5 Pension costs
Past and present employees are covered by the provisions of the two NHS Pension Schemes. Details of the benefits payable and rules of the Schemes can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. Both are unfunded defined benefit schemes that cover NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State for Health and Social Care in England and Wales. They are not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, each scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating in each scheme is taken as equal to the contributions payable to that scheme for the accounting period.
In order that the defined benefit obligations recognised in the financial statements do not differ materially from those that would be determined at the reporting date by a formal actuarial valuation, the FReM requires that “the period between formal valuations shall be four years, with approximate assessments in intervening years”. An outline of these follows:
4.5.1 Accounting valuation
A valuation of scheme liability is carried out annually by the scheme actuary (currently the Government Actuary’s Department) as at the end of the reporting period. This utilises an actuarial assessment for the previous accounting period in conjunction with updated membership and financial data for the current reporting period, and is accepted as providing suitably robust figures for financial reporting purposes. The valuation of the scheme liability as at 31 March 2020, is based on valuation data as at 31 March 2019, updated to 31 March 2020 with summary global member and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate prescribed by HM Treasury have also been used.
The latest assessment of the liabilities of the scheme is contained in the report of the scheme actuary, which forms part of the annual NHS Pension Scheme Accounts. These accounts can be viewed on the NHS Pensions website and are published annually. Copies can also be obtained from The Stationery Office.
4.5.2 Full actuarial (funding) valuation
The purpose of this valuation is to assess the level of liability in respect of the benefits due under the schemes (taking into account recent demographic experience), and to recommend contribution rates payable by employees and employers.
The latest actuarial valuation undertaken for the NHS Pension Scheme was completed as at 31 March 2016. The results of this valuation set the employer contribution rate payable from April 2019 to 20.6%, and the Scheme Regulations were amended accordingly.
The 2016 funding valuation was also expected to test the cost of the Scheme relative to the employer cost cap set following the 2012 valuation. Following a judgment from the Court of Appeal in December 2018 Government announced a pause to that part of the valuation process pending conclusion of the continuing legal process.
16 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
5 Operating expenses 2019-20 2018-19 Total Total £'000 £'000
Purchase of goods and services Services from other CCGs and NHS England 1 2,177 2,180 Services from foundation trusts 205,144 204,059 Services from other NHS trusts 42,012 39,251 Provider Sustainability Fund 0 0 Services from Other WGA bodies 1 2 Purchase of healthcare from non-NHS bodies 65,905 63,326 Purchase of social care 0 0 General Dental services and personal dental services 0 0 Prescribing costs 38,582 36,541 Pharmaceutical services 80 67 General Ophthalmic services 0 0 GPMS/APMS and PCTMS 41,561 38,256 Supplies and services – clinical 0 0 Supplies and services – general 575 644 Consultancy services 13 5 Establishment 696 716 Transport 4 3 Premises 1,421 1,588 Audit fees 2 44 47 Other non statutory audit expenditure · Internal audit services 3 32 32 · Other services 2 12 7 Other professional fees 84 51 Legal fees 52 40 Education, training and conferences 38 57 Funding to group bodies 0 0 CHC Risk Pool contributions 0 0 Non cash apprenticeship training grants 0 0 Total Purchase of goods and services 398,433 386,871
Depreciation and impairment charges Depreciation 0 0 Amortisation 0 0 Impairments and reversals of property, plant and equipment 0 0 Impairments and reversals of intangible assets 0 0 Impairments and reversals of financial assets · Assets carried at amortised cost 0 0 · Assets carried at cost 0 0 · Available for sale financial assets 0 0 Impairments and reversals of non-current assets held for sale 0 0 Impairments and reversals of investment properties 0 0 Total Depreciation and impairment charges 0 0
Provision expense Change in discount rate 0 0 Provisions 922 1,138 Total Provision expense 922 1,138
Other Operating Expenditure Chair and Non Executive Members 335 341 Grants to Other bodies 240 578 Clinical negligence 5 5 Research and development (excluding staff costs) 0 12 Expected credit loss on receivables 0 0 Expected credit loss on other financial assets (stage 1 and 2 only) 0 0 Inventories written down 0 0 Inventories consumed 0 0 Other expenditure 0 0 Total Other Operating Expenditure 580 936
Total operating expenditure * 399,935 388,946
1 Services from other CCGs and NHS England relates to the recharge for services received from NHS South, Central and West Commissioning Support Unit who are hosted by NHS England. 2 Grant Thornton UK LLP provide external audit to the CCG. The limitation in the liability of the auditors is £500k. External audit remuneration excluding irrecoverable VAT is £36.5k. They have also provided non-statutory audit work for £10k (also excluding irrecoverable VAT) which related a review of the CCGs Mental Health Investment Standard spend (included under "Other Services").
3 TIAA Ltd provide internal audit to the CCG. * Total does not add up. This is due to roundings.
17 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
6 Better Payment Practice Code
6.1 Better Payment Practice Code
Measure of compliance 2019-20 2019-20 2018-19 2018-19 Number £'000 Number £'000 Non-NHS Payables Total Non-NHS Trade invoices paid in the Year 24,057 111,660 25,957 107,063 Total Non-NHS Trade Invoices paid within target 23,966 110,797 25,920 106,904 Percentage of Non-NHS Trade invoices paid within target 99.62% 99.23% 99.86% 99.85%
NHS Payables Total NHS Trade Invoices Paid in the Year 3,085 256,436 2,938 248,639 Total NHS Trade Invoices Paid within target 3,080 256,109 2,924 248,209 Percentage of NHS Trade Invoices paid within target 99.84% 99.87% 99.52% 99.83%
6.2 The Late Payment of Commercial Debts (Interest) Act 1998
NHS Southampton City CCG made no such payments in 2019-20 or 2018-19.
7 Income Generation Activities
NHS Southampton City CCG has not undertaken any income generation activities as at 31 March 2020.
8 Investment revenue
NHS Southampton City CCG has not received any investment revenue as at 31 March 2020.
9 Other gains and losses
NHS Southampton City CCG made no other gains or losses during 2019-20 or 2018-19.
10 Finance costs
NHS Southampton City CCG has no obligations under PFI or LIFT contracts as at 31 March 2020. NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
11 Net gain/(loss) on transfer by absorption
Transfers as part of a reorganisation fall to be accounted for by use of absorption accounting in line with the Government Financial Reporting Manual, issued by HM Treasury. The Government Financial 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.
NHS Southampton City CCG has not received any net gain/(loss) on transfer by absorption.
12 Operating Leases
NHS Property Services invoice rental charges for occupation of NHS Southampton City CCG headquarters in Oakley Road in Southampton and for the cost of void space that the CCG is deemed responsible for. In 2018/19 the rental charges for both were included as lease expenses. In 2019/20, following guidance from NHS England, only the cost of the CCG's occupation of its headquarters is included. The comparable value for 2018/19 is £126k, with void space being £405k.
12.1.1 Payments recognised as an Expense 2019-20 2018-19 Buildings Other Total Buildings Other Total £'000 £'000 £'000 £'000 £'000 £'000 Payments recognised as an expense Minimum lease payments 123 2 126 531 2 533 Contingent rents 0 0 0 0 0 0 Sub-lease payments 0 0 0 0 0 0 Total * 123 2 126 531 2 533
12.1.2 Future minimum lease payments 2019-20 2018-19 Buildings Other Total Buildings Other Total £'000 £'000 £'000 £'000 £'000 £'000 Payable: No later than one year 123 2 126 0 2 2 Between one and five years 617 4 621 0 6 6 After five years 370 0 370 0 0 0 Total * 1,110 7 1,117 0 8 8
* Total does not add up. This is due to roundings.
12.2 As lessor
NHS Southampton City CCG does not lease any premises in the capacity of Lessor as at 31 March 2020.
13 Property, plant and equipment
NHS Southampton City CCG does not own any assets classified as property, plant or equipment as at 31 March 2020.
14 Intangible non-current assets
NHS Southampton City CCG has no intangible non-current assets as at 31 March 2020.
15 Investment property
NHS Southampton City CCG has no investment property as at 31 March 2020.
16 Inventories
NHS Southampton City CCG has no inventories as at 31 March 2020.
19 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
17 Trade and other receivables
17.1 Trade and other receivables Current Non-current Current Non-current 2019-20 2019-20 2018-19 2018-19 £'000 £'000 £'000 £'000
NHS receivables: Revenue 220 0 322 0 NHS receivables: Capital 0 0 0 0 NHS prepayments 5,007 0 1,245 0 NHS accrued income 333 0 218 0 NHS Contract Receivable not yet invoiced/non-invoice 0 0 0 0 NHS Non Contract trade receivable (i.e. pass through funding) 0 0 0 0 NHS Contract Assets 0 0 0 0 Non-NHS and Other WGA receivables: Revenue 681 0 1,104 0 Non-NHS and Other WGA receivables: Capital 0 0 0 0 Non-NHS and Other WGA prepayments 318 0 210 0 Non-NHS and Other WGA accrued income 377 0 336 0 Non-NHS and Other WGA Contract Receivable not yet invoiced/non-invoice 0 0 0 0 Non-NHS and Other WGA Non Contract trade receivable (i.e. pass through funding) 0 0 0 0 Non-NHS Contract Assets 0 0 0 0 Expected credit loss allowance-receivables (2) 0 (3) 0 VAT 12 0 37 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 and accruals 0 2 0 3 Total Trade & other receivables 6,946 2 3,469 3
Total current and non current * 6,948 3,471
Included above: Prepaid pensions contributions 0 0
The great majority of trade is with NHS England. As NHS England is funded by Government to provide funding to clinical commissioning groups to commission services, no credit scoring of them is considered necessary.
The level of trade with non-NHS organisations is immaterial and is covered by contractual terms, therefore no credit scoring of them is considered necessary.
Of the £900k of the Revenue Receivables above, £512k of the amount above has subsequently been recovered up to 20th April 2020.
17.2 Receivables past their due date but not impaired 2019-20 2019-20 2018-19 2018-19 DHSC Group Non DHSC DHSC Group Non DHSC Bodies Group Bodies Bodies Group Bodies £'000 £'000 £'000 £'000 By up to three months 4 299 300 299 By three to six months 4 0 0 0 By more than six months 0 0 0 0 Total 8 299 300 299
Of the amounts not impaired but past their due date, £0k of DHSC and £24k of the non DHSC group have been recovered up to 20th April 2020.
NHS Southampton City CCG did not hold any collateral against receivables outstanding as at 31 March 2020.
17.3 Loss allowance on asset classes Trade and other receivables - Non Other financial Total DHSC Group assets Bodies £'000 £'000 £'000 Balance at 01 April 2019 (3) 0 (3) Lifetime expected credit loss on credit impaired financial assets 0 0 0 Lifetime expected credit losses on trade and other receivables-Stage 2 0 0 0 Lifetime expected credit losses on trade and other receivables-Stage 3 0 0 0 Credit losses recognised on purchase originated credit impaired financial assets 0 0 0 Amounts written off 0 0 0 Financial assets that have been derecognised 0 0 0 Changes due to modifications that did not result in derecognition 0 0 0 Other changes 1 0 1 Total (2) 0 (2)
* Total does not add up. This is due to roundings.
20 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
18 Other financial assets
NHS Southampton City CCG had no other financial assets as at 31 March 2020.
19 Other current assets
NHS Southampton City CCG had no other current assets as at 31 March 2020.
20 Cash and cash equivalents 2019-20 2018-19 £'000 £'000 Balance at 01 April 2019 641 456 Net change in year 61 185 Balance at 31 March 2020 702 641
Made up of: Cash with the Government Banking Service 175 189 Cash with Commercial banks 0 0 Cash in hand 1 528 452 Current investments 0 0 Cash and cash equivalents as in statement of financial position * 702 641
Bank overdraft: Government Banking Service 0 0 Bank overdraft: Commercial banks 0 0 Total bank overdrafts 0 0
Balance at 31 March 2020 702 641
No patients' money is held by NHS Southampton City CCG.
* Total does not add up. This is due to roundings.
1 Cash in hand includes NHS Southampton City CCG share of the pooled budgets cash balances held by Southampton City Council and the balance on the prepaid cards held by Personal Health Budget clients.
21 Non-current assets held for sale
NHS Southampton City CCG has no assets held for sale as at 31 March 2020.
22 Analysis of impairments and reversals
NHS Southampton City CCG has no assets held as at 31 March 2020 and therefore there were no impairments or reversals.
21 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
Current Non-current Current Non-current 23 Trade and other payables 2019-20 2019-20 2018-19 2018-19 £'000 £'000 £'000 £'000
Interest payable 0 0 0 0 NHS payables: Revenue 470 0 1,803 0 NHS payables: Capital 0 0 0 0 NHS accruals 2,927 0 2,876 0 NHS deferred income 0 0 0 0 NHS Contract Liabilities 0 0 0 0 Non-NHS and Other WGA payables: Revenue 2,359 0 1,643 0 Non-NHS and Other WGA payables: Capital 0 0 0 0 Non-NHS and Other WGA accruals 15,856 0 12,831 0 Non-NHS and Other WGA deferred income 0 0 0 0 Non-NHS Contract Liabilities 0 0 0 0 Social security costs 1 0 76 0 VAT 0 0 0 0 Tax 3 0 66 0 Payments received on account 0 0 0 0 Other payables and accruals 2,415 0 1,760 0 Total Trade & Other Payables * 24,031 0 21,056 0
Total current and non-current * 24,031 21,056
NHS Southampton City CCG has not included any liabilities for people, due in future years under arrangements to buy out the liability for early retirement over 5 years.
Other payables include £4,258.02 of outstanding pension contributions as at 31 March 2020.
* Total does not add up. This is due to roundings.
24 Other financial liabilities
NHS Southampton City CCG has no other financial liabilities as at 31 March 2020.
25 Other liabilities
NHS Southampton City CCG has no other liabilities as at 31 March 2020.
26 Borrowings
NHS Southampton City CCG has no borrowings as at 31 March 2020.
27 Private finance initiative, LIFT and other service concession arrangements
REMOVED FROM CCG CSU TEMPLATE
28 Finance lease obligations
NHS Southampton City CCG has no finance lease obligations as at 31 March 2020.
29 Finance lease receivables
NHS Southampton City CCG has no finance lease receivables as at 31 March 2020.
22 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
30 Provisions Current Non-current Current Non-current 2019-20 2019-20 2018-19 2018-19 £'000 £'000 £'000 £'000 Pensions relating to former directors 0 0 0 0 Pensions relating to other staff 0 0 0 0 Restructuring 0 0 0 0 Redundancy 0 0 0 0 Agenda for change 0 0 0 0 Equal pay 0 0 0 0 Legal claims 0 0 3 0 Continuing care 960 411 514 220 Other 945 2,209 880 2,045 Total 1,905 2,620 1,397 2,265
Total current and non-current * 4,525 3,663
Continuing Legal Claims Care Other Total £'000 £'000 £'000 £'000
Balance at 01 April 2019 3 735 2,925 3,663
Arising during the year 0 770 778 1,548 Utilised during the year 0 (34) (25) (59) Reversed unused (3) (100) (524) (627) Unwinding of discount 0 0 0 0 Change in discount rate 0 0 0 0 Transfer (to) from other public sector body 0 0 0 0 Transfer (to) from other public sector body under absorption 0 0 0 0 Balance at 31 March 2020 0 1,371 3,154 4,525
Expected timing of cash flows: Within one year 0 960 945 1,905 Between one and five years 0 411 2,209 2,620 After five years 0 0 0 0 Balance at 31 March 2020 0 1,371 3,154 4,525
Provisions CHC - The provision included for NHS Continuing Healthcare relates to a number of named clients who have appealed NHS Southampton City CCG's decision on eligibility. The value is based on an estimate of the potential liability and the probability of the liability materialising.
Primary Care - A provision has been calculated to allow for the historic rent reviews that are due for all GP practices up until 31st March 2020.
Market Rent - A provision has been made to allow for the cost of NHS Property Services move to market rent to be passed to non-NHS providers.
A provision has been made for the non recovery of income from chargeable overseas patients. These patients are charged by the acute Trust, with the CCG picking up the share of the cost when debts are written off. This process began in 2015/16. National figures suggest that 50% of this debt is recovered (National Audit Office report - HC 728). We have therefore made a provision for 75% of the older outstanding liability from April 2015 to March 2019 and 25% from the current financial year.
The CCG has provision for dilapidation costs for the occupation of our headquarters at Oakley Road and space at the Royal South Hants Hospital which we would be responsible for under the Heads of Terms of the lease that we have agreed with NHS Property Services.
NHS Southampton City CCG currently has no Clinical Negligence claims held by the NHSLA.
* Total does not add up. This is due to roundings.
23 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
31 Contingencies
Following a review, NHS Southampton City CCG has no contingencies as at 31 March 2020.
32 Commitments
32.1 Capital commitments
NHS Southampton City CCG has no contracted capital or other financial commitments as at 31 March 2020.
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.
NHS Southampton City CCG is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. NHS Southampton City CCG 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 NHS Southampton City CCG's 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
NHS Southampton City CCG 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. NHS Southampton City CCG therefore has low exposure to currency rate fluctuations.
33.1.2 Interest rate risk
NHS Southampton City CCG may borrow from government for capital expenditure, subject to affordability as confirmed by NHS England. The borrowings are for 1 to 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. NHS Southampton City CCG therefore has low exposure to interest rate fluctuations.
33.1.3 Credit risk
The majority of NHS Southampton City CCG's revenue comes via parliamentary funding, therefore NHS Southampton City CCG has low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables from customers, as disclosed in the trade and other receivables note.
33.1.4 Liquidity risk
NHS Southampton City CCG is required to operate within revenue and capital resource limits, which are financed from resources voted annually by Parliament. NHS Southampton City CCG draws down cash to cover expenditure, as the need arises. NHS Southampton City CCG is not, therefore, exposed to significant liquidity risks.
33.1.5 Financial Instruments
As the cash requirements of NHS England are met through the Estimate process, financial instruments play a more limited role in creating and managing risk than would apply to a non-public sector body. The majority of financial instruments relate to contracts to buy non-financial items in line with NHS England's expected purchase and usage requirements and NHS England is therefore exposed to little credit, liquidity or market risk.
24 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
33 Financial instruments cont'd
33.2 Financial assets
Financial Assets Equity Instruments measured at designated at amortised cost FVOCI Total 2019-20 2019-20 2019-20 £'000 £'000 £'000
Equity investment in group bodies 0 0 Equity investment in external bodies 0 0 Loans receivable with group bodies 0 0 Loans receivable with external bodies 0 0 Trade and other receivables with NHSE bodies 428 428 Trade and other receivables with other DHSC group bodies 501 501 Trade and other receivables with external bodies 684 684 Other financial assets 0 0 Cash and cash equivalents 702 702 Total at 31 March 2020 2,315 0 2,315
Financial Assets measured at Equity Instruments amortised cost designated at FVOCI Total 2018-19 2018-19 2018-19 £'000 £'000 £'000
Equity investment in group bodies 0 0 Equity investment in external bodies 0 0 Loans receivable with group bodies 0 0 Loans receivable with external bodies 0 0 Trade and other receivables with NHSE bodies 474 474 Trade and other receivables with other DHSC group bodies 401 401 Trade and other receivables with external bodies 1,105 1,105 Other financial assets 3 3 Cash and cash equivalents 641 641 Total at 31 March 2019 2,624 0 2,624
The carrying value is a reasonable proxy for fair value for short term payables and receivables.
33.3 Financial liabilities
Financial Liabilities measured at amortised cost Other Total 2019-20 2019-20 2019-20 £'000 £'000 £'000
Loans with group bodies 0 0 Loans with external bodies 0 0 Trade and other payables with NHSE bodies 520 520 Trade and other payables with other DHSC group bodies 11,449 11,449 Trade and other payables with external bodies 12,058 12,058 Other financial liabilities 0 0 Private Finance Initiative and finance lease obligations 0 0 Total at 31 March 2020 24,027 0 24,027
Financial Liabilities measured at amortised cost Other Total 2018-19 2018-19 2018-19 £'000 £'000 £'000
Loans with group bodies 0 0 Loans with external bodies 0 0 Trade and other payables with NHSE bodies 221 221 Trade and other payables with other DHSC group bodies 11,879 11,879 Trade and other payables with external bodies 7,053 7,053 Other financial liabilities 1,760 1,760 Private Finance Initiative and finance lease obligations 0 0 Total at 31 March 2019 20,913 0 20,913
The carrying value is a reasonable proxy for fair value for short term payables and receivables.
25 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
34 Operating segments
NHS Southampton City CCG and consolidated group consider they have only one segment; commissioning of healthcare services.
Gross Income Net expenditure Total assets Total liabilities Net assets expenditure £'000 £'000 £'000 £'000 £'000 £'000 Commissioning of Healthcare 406,716 (686) 406,030 7,650 (28,556) (20,906) Total 406,716 (686) 406,030 7,650 (28,556) (20,906)
34.1 Reconciliation between Operating Segments and SoCNE
2019-20 £'000 Total net expenditure reported for operating segments 406,030 Reconciling items: Total net expenditure per the Statement of Comprehensive Net Expenditure 406,030
34.2 Reconciliation between Operating Segments and SoFP
2019-20 £'000 Total assets reported for operating segments 7,650 Reconciling items: Total assets per Statement of Financial Position 7,650
2019-20 £'000 Total liabilities reported for operating segments (28,556) Reconciling items: Total liabilities per Statement of Financial Position (28,556)
26 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
35 Joint arrangements - interests in joint operations
CCGs should disclose information in relation to joint arrangements in line with the requirements in IFRS 12 - Disclosure of interests in other entities.
NHS Southampton City CCG has entered into four pooled budgets with Southampton City Council.
The pooled budgets are hosted as follows:
Host Domiciliary Care Southampton City Council Local Safeguarding Childrens' Board Southampton City Council Local Safeguarding Adults' Board Southampton City Council Joint Equipment Store Southampton City Council
35.1 Interests in joint operations Amounts recognised in Entities books ONLY Amounts recognised in Entities books ONLY 2019-20 2018-19 Name of arrangement Parties to the arrangement Description of principal activities Assets Liabilities Income Expenditure Assets Liabilities Income Expenditure £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Domiciliary Care Services NHS Southampton City CCG Residential, domicilary care and continuing care 100 (100) (1,401) 1,401 218 (218) (1,314) 1,314 and Southampton City services to support Council
Local Safeguarding Childrens' NHS Southampton City CCG Multi-agency board to oversee the safeguarding of 5 0 47 47 6 0 (30) 30 Board and Southampton City Council children and other bodies
Local Safeguarding Adults' NHS Southampton City CCG Multi-agency board to oversee the safeguarding of 17 0 12 12 20 (1) (9) 9 Board and Southampton City Council adults and other bodies
Joint Equipment Store NHS Southampton City CCG Contract for storage, delivery and reconditioning of 70 (70) 831 831 74 (74) (804) 804 and Southampton City equipment to maintain clients’ independence at Council home
35.2 Interests in entities not accounted for under IFRS 10 or IFRS 11
NHS Southampton City CCG do not have any interests in entities not accounted for under IFRS 10 or IFRS 11.
27 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
36 Related party transactions
Details of related party transactions with individuals are as follows:
2019/20 Payments to Receipts Amounts Amounts Related Party from owed to due from £'000 Related Related Related Pary Party Party £'000 £'000 £'000 Advising Communities, Dr C Sanford (Chair and Trustee) 0 0 0 0 British Heart Rhythm, Dr M Sopher (Member of Council) 0 0 0 0 Chessel Practice - Dr S Young (Clinical Lead) 1 2,230 0 68 0 Bath Lodge Practice - Dr S Young (Clinical Lead) 1 741 0 0 0 Christ Church Southampton - Dr C Sanford (Trustee) 0 0 0 0 HFMA (Healthcare and Financial Management Association) - J Rimmer (Trustee and Audit Committee 6 0 0 0 Chair) HIOW STP operated by South Eastern Hampshire CCG - J Rimmer (Seconded CFO 2 days per week) 50 (194) 0 (9)
Living Well Partnership (LWP) - Dr Pritti Aggarwal (GP Partner), Dr C Sanford (GP Partner) 2 3,745 0 0 0 Peartree Practice, Dr S Young (Lead GP Salaried) 1 0 0 0 0 Shirley Health Partnership, Dr H Burgess (GP Partner) 720 0 0 0 Solent Credit Union - L Gilder (President) 0 0 0 0 Solent University - J Rimmer (Independent Governor and Audit Committee Member) 3 0 0 0 Southampton City Council - S Ramsey (Interim Director of Adult Social Services DASS), Dr D Chase 12,007 (3,292) 660 (341) (Interim Director of Public Health) Southampton Primary Care Ltd - Dr P Aggarwal, Dr C Sanford, Dr H Burgess, Dr S Qamar 3,878 0 0 0 (Shareholders) Sure Footing - Dr C Sanford (Trustee) 0 0 0 0 Technomed Ltd (suppliers of ECG equipment), Dr M Sopher (Shareholder and Medical Advisor) 0 0 0 0 Valley Leisure Ltd - P Horne (Trustee) 0 0 0 0 Wessex Appraisal Service, Dr S Qamar (GP Appraiser) 0 0 0 0
1 Chessel and Bath Lodge practices have merged in year to form the Peartree Practice. As coding on the national system is updated transactions will appear under the new name. 2 Living Well Partnership has merged with other practices and hence the increase over 2018/19 value.
Our Chief Executive Officer, Maggie MacIsaac is also CEO of a number of other neighbouring CCGs and these NHS Bodies are therefore deemed as a related party due to the interest that the Chief Executive Office has with each of them.
• NHS Fareham and Gosport CCG • NHS Isle of Wight CCG • NHS North Hampshire CCG • NHS North East Hampshire and Farnham CCG (until 30th November 2019) • NHS South Eastern Hampshire CCG
2018-19 Payments to Receipts Amounts Amounts Related Party from owed to due from Related Related Related Party Party Party £'000 £'000 £'000 £'000 Chessel Practice - Dr S Young (Clinical Lead) 1,301 0 26 0 Bath Lodge Practice - Dr S Young (Clinical Lead) 1,187 0 67 0 Christ Church Southampton - Dr C Sanford (Trustee) 0 0 0 0 HFMA (Healthcare and Financial Management Association) - J Rimmer (Trustee) 14 0 2 0 HIOW STP operated by South Eastern Hampshire CCG - J Rimmer (Seconded CFO 2 days per week) 77 (242) 0 0
Living Well Partnership (LWP) - Dr R McDermott (GP Partner), Dr I Ward (GP Partner), Dr P Aggarwal 1,448 0 22 0 (GP Partner), Dr C Sanford (GP Partner) Local Improvement Finance Trust Ltd (LIFT) - P Horne (Board member) 0 0 0 0 Oakhaven Hospice Trust - Dr P Hockey (Board Member) 0 0 0 0 Portsmouth City Council - Dr J Horsley (Public Health Director) 5 0 0 0 Portsmouth CCG - Dr J Horsley (Board Member) 18 0 0 0 Solent Credit Union - L Gilder (President) 0 0 0 0 Solent Medical Services - Dr R McDermott; Dr I Ward (Shareholders) 2,267 (3) 103 0 Solent University - J Rimmer (Independent Governor) 9 0 0 0 Southampton City Council - S Ramsey (Interim Director of Adult Social Services DASS), Dr J Horsley 13,712 (2,055) 86 (1,042) (Public Health Director) Southampton Primary Care Ltd - Dr R McDermott, Dr I Ward, Dr P Aggarwal, Dr C Sanford 2,364 0 122 0 (Shareholders) Sure Footing - Dr C Sanford (Trustee) 0 0 0 0 Valley Leisure Ltd - P Horne (Trustee) 0 0 0 0
The Department of Health and Social Care is regarded as a related party as they are the parent of our organisation. 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. For example: NHS England NHS Foundation Trusts NHS Trusts NHS Litigation Authority NHS Business Services Authority
28 NHS Southampton City Clinical Commissioning Group - Annual Accounts 2019-20
37 Events after the end of the reporting period
NHS Southampton City CCG do not have any events after the end of the reporting period.
38 Third party assets
NHS Southampton City CCG held no third party assets as at 31 March 2020.
39 Losses and special payments
NHS Southampton City CCG have made no losses or special payments during the financial year 2019/20.
40 Financial performance targets
NHS Southampton City CCG have a number of financial duties under the NHS Act 2006 (as amended). NHS Southampton City CCG performance against those duties was as follows:
2019-20 2019-20 2018-19 2018-19 Target Performance Target Performance £'000 £'000 £'000 £'000 Expenditure not to exceed income 409,504 406,716 395,714 394,935 Capital resource use does not exceed the amount specified in Directions 0 0 0 0 Revenue resource use does not exceed the amount specified in Directions 408,818 406,030 394,528 393,749 Capital resource use on specified matter(s) does not exceed the amount specified in Directions 0 0 0 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 6,168 5,098 5,919 4,975
NHS Southampton City Clinical Commissioning Group’s in-year surplus is £2,788k, with a cumulative position of £11,683k (2.8%), broken down as below:
£’000 In-year surplus agreed 2,750 Additional in-year surplus achieved 38 Final in-year surplus 2,788 Brought forward cumulative surplus 1 8,895 Closing cumulative surplus 11,683 % of allocation 2.8%
1 The brought forward cumulative surplus is the carried forward surplus from 2018/19 (£9,645k) less allowable drawdown utilised in year (£750k) as agreed by NHS England as a result of our increased surplus achieved in 2018/19.
41 Analysis of charitable reserves
NHS Southampton City CCG has no charitable reserves as at 31 March 2020.
29