NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21 About This Report

NHS South West London Clinical Commissioning Group Annual Report and Accounts 2020/21

About this report

The NHS South West London Clinical Commissioning Group (CCG) Annual Report 2020/21 has been produced in response to the NHS England requirements as published in the Department of Health and Social Care Group Accounting Manual 2020/21. The structure closely follows that outlined in the guidance and includes three core sections:

• The Performance Report - including an overview, performance analysis and performance measures • The Accountability Report - including the members’ report, corporate governance report, annual governance statement, remuneration and staff report • Auditor’s Report and Financial Statements

This report has been approved by the Governing Body members, and all the content has been checked for accuracy and consistency with reporting data sources and to make sure that all requirements are met by our auditors.

1 Contents

About this report ...... 1

1 Performance Report ...... 3

1.1 Performance overview ...... 3

1.2 Performance analysis ...... 22

1.3 Engaging people and communities Patient and public engagement (PPE) ...... 63

1.4 Reducing health inequalities ...... 91

1.5 Improving quality and safety – putting quality at the heart of the CCG ...... 97

1.6 Assuring delivery of performance and constitutional standards and national performance indicators 110

1.7 Freedom of Information ...... 121

1.8 Sustainable development ...... 122

2 Accountability report ...... 126

2.1 Corporate governance report ...... 126

2.2 Statement of Accountable Officer’s Responsibilities ...... 143

2.3 Governance Statement ...... 145

2.4 Remuneration report ...... 160

2.5 Staff report ...... 169

2.6 Parliamentary Accountability and Audit Report ...... 189

3 Annual accounts ...... 195

2 1 Performance Report

1.1 Performance overview

Welcome and overview from the Clinical Chair and Accountable Officer

This is our first annual report as a South West London Clinical Commissioning Group (CCG), and it looks back at an unprecedented year.

In this report we describe how the CCG has played an important role in leading and coordinating the South West London NHS response to the Covid-19 pandemic with our system partners, as well as delivering a successful vaccination programme since December 2020. We have worked hard to support the continuation of vital non-Covid NHS services as well elective recovery. We have listened to local people and staff who have told us we must build on our progress to address health inequalities and go further and faster. We have also secured much-needed capital investment to South West London, and have led, and continue to support two major change programmes of a CCG merger and now a transition to an Integrated Care System as proposed in the government’s White Paper. We are grateful to our CCG staff for the way they have responded to this international crisis, and the many professional, as well as personal challenges that it brought us all. Staff have delivered for the people of South West London, whilst also adapting to new ways of working and being part of an organisational change.

Covid-19 in South West London: our response, the restart, how we reshape

As this Annual Report explains, much of the core-business of the CCG over the past year has been responding to the Covid-19 pandemic. In February 2020, the CCG, on behalf of the South West London health and care system, established the Gold Command Incident Control Room (ICR) for the NHS in South West London. Operational seven days a week, Gold Command reported directly into NHS England, to support our NHS leaders to manage the incident in their own organisations, and across our wider health and care system.

The strength of our response in South West London last year was rooted in how we came together across organisational boundaries, and clinical networks to work with our communities to keep the most vulnerable protected, shielded and supported.

3 The most extraordinary year the NHS has ever faced has also made us more innovative as well as more collaborative. There are many examples in the report of how colleagues have rapidly adapted to ensure services continued to meet changing patient needs: such as keeping patients safe and monitored in their own homes rather than in hospitals; transforming GP, outpatient and mental health services to increase virtual access when face-to-face treatment was very restricted; NHS Trusts working closely together to support a huge increase in patient numbers; and great examples of collaboration with our social care colleagues, care home partners and voluntary sector.

As we moved into managing the recovery of services following the first wave of the pandemic, we changed the way we delivered health and care services so we could continue to protect and care for local people, and ensure we were prepared for the second wave in the winter. Our CCG leaders as members of the South West London Recovery Board led this work, and we were clear that the recovery should be focussed on primary care, mental health and community services as well as the acute sector.

Our clinical priorities during the recovery period were particularly concerned with those groups of patients who had not been seeking health advice and support during the first wave and understanding why Covid-19 had disproportionately affected people from ethnic minority groups, and those from more deprived areas. We developed 15 elective recovery clinical networks, each led jointly by acute and primary care clinicians to support restarting elective surgical operations and treatments. They enabled our hospitals to work together to manage those patients who urgently needed care. As a CCG, we were able to support these new networks with experienced primary care clinicians and commissioning managers, ensuring a focus on the whole patient journey and coordinating patient care across different settings.

We have also supported and worked with our mental health providers to ensure people with mental health needs or a learning disability receive the same protection and support with managing their health and wellbeing during the pandemic as other members of the population. The impact of Covid- 19 on our communities’ mental wellbeing has been significant. In the year since the pandemic began, depression rates have doubled and primary care colleagues are predicting and planning for a surge of mental health issues in the future.

In the report you can read about how we have supported our providers to conduct virtual consultations for IAPT and been an active partner, together with local people and organisations from across South London, in the Covid-19: Preventing a Mental Health Crisis Summit in July 2020. Following this summit the South London Covid-19 Preventing Mental Ill Health Taskforce was created with the aim of preventing thousands of people’s lives being affected by mental illness and

to develop a long-term programme to protect our communities’ mental health. South West London CCG has also been an active participant in the South London Listens programme. More than 5,000 people have taken part in the initiative, and the partnership is now working with local people and community groups to co-produce solutions that will be published as part of a two-year action plan in Summer 2021.

From December 2020, we have also been delivering the Covid vaccination programme with over 600,000 vaccinations administered to more than half a million people in South West London, as at the end of March 2021. Our CCG staff and primary care colleagues are at the centre of this programme as we continue to inform, engage and protect more of our local people into 2021.

CCG Clinical Leadership and the wider South West London system

One of the strengths of the CCG is the strong and experienced clinical leaders within it, and this has proved invaluable over the past year in responding to the pandemic. The report outlines the work of the ‘South West London Clinical Cell’ established by the South West London Clinical Chair in the initial phase of the pandemic, to set consistent clinical standards, ensure consistent policies across the system, including a shared approach to infection prevention and control. The membership was broad across health and care organisations and professional groups. It became a source of support and advice, as well as a forum to share best practice for clinical leaders now working in a system, as well as in individual organisations.

Our work in the boroughs and with NHS providers – addressing health inequalities and supporting non-Covid services

This Annual Report also explains the different health needs and health priorities within each of our six boroughs. We are committed to working at borough and neighbourhood level to make sure that the services we commission for our communities, especially those that suffer from health inequalities, meet their needs and are accessible to everyone. Our Primary Care Networks (PCNs) work at this neighbourhood level, bringing together GP practices to provide a wide range of services for local people. Since July 2019, they have been the footprint around which community-based health and social care professionals deliver more joined-up care for our communities, this approach has helped us support practices and their staff to adapt to new ways of working, provide effective care to patients in a safe environment, protect the capacity of our acute hospitals, and achieve huge success in delivering the Covid vaccine programme to people across South West London.

5 We have worked hard to deliver high quality services to local people in each of our six boroughs this year, and one achievement we are pleased to highlight is the approval for a much needed £500m of funding for a brand new, state of the art hospital in Sutton. This will transform services for patients from across South West London and Surrey, as well as providing significant investment into the existing St Helier and Epsom Hospitals, which will continue to provide the vast majority of services to local people.

Despite the pandemic, the CCG has rightly had an obligation to meet the ongoing healthcare needs of the local population and address patient experience, patient outcomes and patient safety. This Annual Report has a chapter that summarises the performance indicators and quality standards that have continued to be reviewed and monitored. They provide a means for us to measure and assess the quality and productivity of the services we commission and inform us where to focus our attention to improve the care our patients receive, working in partnership with our service providers. In November 2020, NHS England published their annual assessments of the six former CCGs in South West London, which continued to perform well with five out of the six achieving a “Good” rating. In what has been a very challenging year, we are pleased that we maintained our performance in most boroughs.

Addressing Health Inequalities

Underpinning all our work is the South West London CCG’s commitment to addressing the health inequalities that exist across our boroughs. This past year, the Covid-19 pandemic, the death of George Floyd in the United States and the Black Lives Matter movement gave us opportunities for authentic conversations around race, racism and wider inequalities in a way that has not been done before. The message we have been hearing from our communities, clinicians and staff has been clear: we must build on our progress going further and faster to ensure that our services and employment practices are fair, accessible and appropriate for the diverse communities we serve and the workforce we employ.

Delivering for local people whilst leading organisational change

As well as working in new ways in responding to Covid-19 over the past year, our staff have also been working differently as a result of our CCG merger and will continue to adapt as we move forward to the likely transition to an ‘Integrated Care System’ from April 2022.

From 1 April 2020, the six borough CCGs; Croydon, Kingston, Merton, Richmond, Sutton and Wandsworth CCGs merged to become NHS South West London Clinical Commissioning Group.

Our ambition was for each borough to continue to bring together health and care leaders in a local system to ensure that they remained clinically led and retained the ability to engage with and consider the needs of their local communities. The six CCG Governing Bodies agreed that by coming together we could better drive-up quality and reduce variation in standards and deliver better health and care outcomes for the people in each of our boroughs.

Our South West London CCG is a member of South West London Health and Care Partnership. Last year our collaborative way of working was formally recognised by NHS England, and the partnership was formally awarded ‘Integrated Care System’ (ICS) status in April 2020. As we reflect on the past year, we must also look forward and consider how the Government’s White Paper, published on 11 February 2021, affects the South West London CCG. Subject to legislation, the South West London Health and Care partnership as an ‘Integrated Care System’ will become a statutory NHS organisation, and will incorporate the functions of our CCG and some from NHS England. We will support this transition and continue to champion what has made our CCG successful, including strong clinical leadership and patient voice, the primacy of place, and making sure we hard-wire in the new collaborative ways of working we have developed with our partners, as we have responded to Covid-19.

We are proud of how the South West London CCG has responded during the past 12 months and will continue to work ambitiously for local people as we move forward. The NHS, social care, care homes and our voluntary sector will build a legacy of trust and confidence in each other over the past year as we move into the future. We wanted to take this opportunity to say thank you to the staff in our CCG, staff across our South West London system, as well as our communities for their support and patience over the past year.

Dr Andrew Murray Sarah Blow Clinical Chair Accountable Officer

7 - About us

1.1.2.1 - Our duties

We are responsible for commissioning (planning and buying) NHS services for the people who live and work in South West London. With our budget of more than £2.3 billion the services we are responsible for commissioning include:

• The services you use in your GP surgery • Community health services • Urgent and emergency care • Hospital outpatient and inpatient services, diagnostics and planned procedures • Rehabilitation services • Mental health services • Learning disabilities services

Most of the services we commission are provided in South West London, though we also commission some services from our partners in neighbouring areas. All the services we commission are free at the point of use for everybody.

Our CCG is a membership organisation made up of over 180 GP practices within South West London. We serve just under 1.7 million people across our six diverse boroughs:

• Croydon • Kingston • Merton • Richmond • Sutton • Wandsworth

1.1.2.2 - Our constitution

Our CCG constitution sets out our responsibilities for commissioning care for patients. It also sets out the rules and procedures we follow to ensure probity and accountability in the day to day running of the CCG. This is to ensure that decisions are taken in an open and transparent way and that the interests of patients and the public remain central.

You can read or constitution and standing orders on our website at https://swlondonccg.nhs.uk/about/constitution/

You can also read the Handbook to the NHS constitution on our website. This explains each right and pledge in the NHS Constitution and the legal sources of both patient and staff rights and outlines the roles we all play in protecting and developing the NHS.

1.1.2.3 - Becoming one South West London Clinical Commissioning Group

NHS South West London CCG was formed on 1 April 2020, in a merger of the six previous South West London borough CCGs: Croydon, Kingston, Merton, Richmond, Sutton and Wandsworth. Our ambition was for each borough to continue to bring together health and care leaders in a local system to ensure that they remained clinically led and retained the ability to engage with and consider the needs of their local communities. A single CCG could better support this ambition by enabling health and care organisations to collaborate, consider the needs of local communities and transform and improve services with partners to deliver local health and care priorities. Our initial work programme for the new South West London CCG was obviously disrupted due to the Covid-19 pandemic, but never-the-less our ambitions around collaborative working were realised and enhanced.

The national NHS Long Term Plan had also been clear in 2019 that NHS organisations should work more closely together, rather than in competition: meaning the end of the ‘NHS internal market’ or the purchaser/provider split. This signalled the end to NHS organisations having to administer complex negotiations, contract monitoring and payment regimes at local level, the rationale being that a single NHS South West London CCG could re-direct this resource from bureaucracy back to frontline services for patients.

The six CCG Governing Bodies agreed that by moving to collaboration and away from competition, we could better drive-up quality and reduce variation in standards and deliver better health and care outcomes for the people in every one of our boroughs.

We had already been working together as six CCGs and agreed that it supported better health and care outcomes of local people. We had also been successful in previous years when we had worked together as six CCGs to secure national funding for our local South West London services. Some of the examples included:

• £10.1 million for children and young people’s mental health services to create enhanced mental health support teams (£3.7 million in 2020/21, further to £6.4 million between 2018 and 2020) • £1.6 million helped new and expectant mums in South West London to access specialist mental health teams • £9.9 million helped us share patients’ health and care records between organisations across South West London and gave local people better joined-up care

We had already aligned some of our CCG’s decision-making with the ‘Effective Commissioning Initiative’ and improved some of our back-office functions by bringing them together across the six organisations with reduced management overheads but improved quality, resilience and professional accountability.

We believed that a merger would be better for our CCG staff – with more career progression across a bigger organisation, and with more opportunities for training and development, as well as strengthening our ability to retain our expert staff. The CCG delivered on the commitment to engage with our staff through the merger and minimise compulsory redundancies resulting from the process. We had fewer than five compulsory redundancies as a result of the CCG merger.

The CCG engaged with and discussed the case for change for merger at CCG Governing Body meetings in public, with our GP members in each borough, with staff, local authorities, provider trusts, Healthwatch and other stakeholders to design a way forward together for the six CCG Governing Bodies.

All six South West London CCG Governing Bodies agreed the ambition to become a single CCG, and the six GP memberships voted in favour. NHS England then approved our application to become NHS South West London CCG in October 2019.

1.1.2.4 CCG Clinical Leadership and the wider South West London system

One of the strengths of the CCG is the strong and experienced clinical leaders within it, and this has proved invaluable over the past year in responding to the pandemic.

1.1.2.5 - South West London Clinical Cell

The South West London Clinical Chair established the ‘South West London Clinical Cell’ in the initial phase of the pandemic to set consistent clinical standards, ensure consistent policies across the system, including a shared approach to infection prevention and control. The membership was broad across health and care organisations and professional groups. It became a source of support and advice, as well as a forum to share best practice for clinical leaders now working in a system, as well as in individual organisations.

The South West London Clinical Cell was also actively engaged with the London Clinical Advisory Group, with the leaders being core members. This role was key in collectively identifying and rapidly addressing emerging issues in the pandemic, influencing London and national policies, and ensuring they took account of the potential impact on particular communities in our boroughs, as well as our health and care professionals.

1.1.2.6 - South West London Service Change Review Group, Ethics Committee and Clinical Networks.

The Clinical Cell also established two sub-groups during wave one of the pandemic: a South West London Service Change Review Group and a South West London Ethics Committee.

The remit of the multi-professional Service Change Review Group was to review, advise and provide mitigation for operational service changes that needed to be made quickly during the height of the pandemic, particularly to deal with infection control risks and the re-prioritisation of clinician time especially to bolster ICU capacity and provide oxygen therapy for our sickest patients. The group ensured any service changes did not result in unintended negative consequences for patients or for other health and care organisations or communities. During recovery this group became the Service Change Oversight Group.

The South West London Ethics Committee was established to ensure wider access to ethical decision-making support and governance. The purpose of the committee was to assist clinical teams across South West London in making difficult clinical/ethical decisions in a multi-disciplinary team setting during and beyond the Covid-19 pandemic.

The Cell also supported 15 elective recovery clinical networks, each led jointly by acute and primary care clinicians. These clinical networks were originally set up to support restarting elective surgical

operations and treatments, enabling primary care clinicians and our hospitals to work together to manage those patients whose operations had been put on hold and most urgently needed care. As a CCG we were able to support these new networks with experienced primary care clinicians and expert commissioning managers, ensuring a focus on the whole patient journey and coordinating patient care across different settings.

1.1.2.7 - Phase 2: Becoming the South West London Clinical Leadership Group

As the initial phase of managing the pandemic moved to recovery, the Clinical Cell become the Clinical Leadership Group (CLG) and provided rapid clinical input into the restart work and guided the “reshape” clinical transformation workstreams. This group used data and professional clinical advice to support the prioritisation of the recovery programme looking at the areas of greatest need. The CLG also worked together to capture the learning from phase one of the pandemic to help prepare the clinical and operational response to phase 2 over the winter.

1.1.2.8 - Supporting our new Primary Care Networks

Primary Care Networks (PCNs) brought together GP practices in July 2019 to provide a wider range of services for local people. They are now the footprint around which community-based health and social care professionals deliver more joined-up care for our communities and have achieved huge success in delivering the Covid vaccine to around 600,000 people across South West London. At the beginning of the lockdown, GP practices had to rapidly adapt services in response to the pandemic. The CCG worked with PCNs to support practices and their staff to adapt to new ways of working, operating a telephone triage and online consultation service model to reduce risk of transmission in GP surgeries. As well ensuring they were able to continue providing effective care to Covid patients in a safe environment, whilst minimising the risk of infection to all staff and patients. Supporting patients in this way also helped to protect the capacity of our acute hospitals.

Many practices have told us that they are keen to continue the new ways of working for example, video conferencing – and therefore we are working to support this to happen and to encourage people to get the most benefits. As part of this we also are working with practices, clinicians, and local people to understand the barriers to consulting virtually, to improve access for those who need it most and make sure we are always working to help reduce health inequalities.

General practice will remain at the heart of the NHS, and we are taking pro-active steps to support resilience as we move beyond the initial pandemic response, whilst at the same time making the most of opportunities to capture all the changes that have been beneficial to the NHS as well as patients to provide the best care in new ways.

- Commissioning healthcare in each of our six boroughs

We commission health and care services for more than 1.7 million people across six boroughs in South West London. Within each of those boroughs, adjoining neighbourhoods can be made up of very different communities, each with their own set of needs and concerns. We also provide care to people who come into South West London for work or leisure, and our specialist services like cancer services at The Royal Marsden or renal services at St George’s treat people from larger geographies.

Although we cover a large area, we are committed to working at place level and at neighbourhood level to make sure that the services we commission for our communities, especially those that suffer from health inequalities, meet the needs of each community and are accessible to everyone who needs them.

Below is an overview of the population within each of our boroughs and their health issues and priorities:

1.1.3.1 - Croydon

Croydon has over 387,000 residents and this is growing by around 6,000 people each year. Our population is also becoming more diverse. Over 50% of Croydon’s residents are from ethnic minority groups, a figure which rises to nearly 80% for young people under the age of 25.

Croydon has the highest population of under 18s in London and the third highest of over 65s. There are significant health inequalities across Croydon – for example, compared to Sanderstead, healthy life expectancy in Fieldway, one of the most deprived areas in Croydon, is 13 years lower for men and 14 years lower for women.

Croydon Council has shown that over 2,500 families live in poverty and we are working with them and other health agencies to try to mitigate the impact of this on emotional, mental and physical health.

The key challenges we are working to address in Croydon are:

• Focus on prevention and proactive care by supporting people to stay well, manage their own health and maintain their wellbeing by making sure they can get help early. • Unlock the power of communities by connecting people to their neighbours and communities, who can provide unique support to stay fit and healthy for longer. • Develop services in the heart of the community: giving people easy access to joined up services that are tailored to the needs of their local community

Read more about the health and wellbeing needs of people in Croydon and our plans to develop services for people in Croydon at www.swlondonccg.nhs.uk/your-area/croydon/croydon-our-plans

1.1.3.2 - Kingston

Kingston has a population of around 179,600 (2018), which is ageing but relatively affluent. The physical health of people in Kingston reflects the overall affluence of the area, with lower prevalence of many diseases than London as a whole. However, like all London boroughs it also has inequalities and pockets of relative deprivation. Kingston is also diverse, with large Tamil and Korean populations.

The main challenges we face in Kingston are:

• An increasingly older population who require more extensive health and social care. • Increasing numbers of older people living alone. Projected figures show that the population will grow by 9% between 2017-2027, with more very old (over 90). • A rising number of patients with dementia-related health problems. • Cardiovascular disease and cancer are the two leading causes of death, followed by respiratory disease. • All three major causes of death have preventable risk factors such as smoking, diet, exercise and excess alcohol consumption. • Last years of life are lived with a disability for an average of 12.7 years for men and 15.2 years for women.

Read more about the health and wellbeing needs of people in Kingston and our plans to develop services for people in Kingston at www.swlondonccg.nhs.uk/your-area/kingston/kingston-our-plans

1.1.3.3 - Merton

Merton’s population of 206,000 is growing with an increasing number of older people and an increasing number of patients with complex needs and multiple co-morbidities. People in Merton live longer than the national average, though there are inequalities within the borough with people in East Merton having worse health and shorter lives than people in West Merton.

15 Merton has more patients admitted to hospital as an emergency following a fall than the London average, and more people diagnosed with dementia. Adults in Merton tend to exercise less than people from other boroughs.

The key challenges we are working to address in Merton are:

• A single directory for health and wellbeing for residents and front-line staff. • Creating a network of ‘connectors’ to link patients to wellbeing services and activities, supporting the wide community of people providing health and wellbeing advice. • Developing skills for health and care staff to encourage users of services to engage in healthy lifestyles and support people to change their behaviour where required. • Delivering healthy workplaces, supporting our workforce to have good health and wellbeing, knowing that this is good for them, and those they support. • Embedding healthy lifestyles in clinical pathways.

Read more about the health and wellbeing needs of people in Merton and our plans to develop services for people in Merton at www.swlondonccg.nhs.uk/your-area/merton/merton-our-plans

16 1.1.3.4 - Richmond

Richmond has a population of just under 200,000 and is healthy overall. However, the population is ageing and with this comes the challenge of caring for increasing numbers of people living with multiple long-term conditions.

The number of local people living unhealthy lifestyles that increase the risk of disease is rising. These include things like smoking, being inactive, eating a poor diet and drinking too much alcohol. However, a significant proportion of long-term conditions are avoidable with the adoption of healthy behaviours, which we continue to promote.

The main challenges we face:

• Increasing emotional wellbeing and self-esteem in our school age population, who have very high levels of reported multiple risky behaviours and substance abuse, and high levels of emotional neglect in children with affluent parents. • Unhealthy lifestyles, as well as poor emotional and mental wellbeing, causing at least a third of ill health in the borough, with obesity being a significant issue. • Rising numbers of people with multiple long-term conditions – which make healthcare less affordable. • An ageing population with a significant number of older people living alone. • Increasing numbers of patients with dementia-related health problems. • Cardiovascular disease and cancer are the two leading causes of death, but an increasing burden of disease and suffering is also due to mental ill health.

Read more about the health and wellbeing needs of people in Richmond and our plans to develop services for people in Richmond at www.swlondonccg.nhs.uk/your-area/richmond/richmond-our- plans

1.1.3.5 - Sutton

Sutton has a population of over 204,000. The health of people in Sutton is generally better than for England overall with higher life expectancy than the rest of the country, though there is wide variation within the borough.

There are several challenges facing health and care services in Sutton that we are focussing on to improve the lives of local people. Some of the key challenges that are affecting the ability of people to start well, live well and age well in Sutton are highlighted below.

• Improving the mental health of young people. • Supporting parents of children and young people with special educational needs. • Supporting adults with learning disabilities. • Encouraging adults to make healthy lifestyle choices. • Combating loneliness and social isolation among older people. • Supporting older people when they leave hospital.

Read more about the health and wellbeing needs of people in Sutton and our plans to develop services for people in Sutton at www.swlondonccg.nhs.uk/your-area/sutton/sutton-our-plans

1.1.3.6 - Wandsworth

Wandsworth is London’s largest inner-city borough with over 332,000 people, and has a significantly young demographic, with the highest proportion of the population (31%) aged between 30 and 44 of any council in the country. Many people who live in the borough are affluent, well educated, healthy and in work. However, this is not the case for everyone.

Nearly 30% of children come from income-deprived households, and a quarter of over-60s are in receipt of pension credits. Life expectancy in deprived areas of the borough is significantly lower than the most affluent areas: 8.9 years lower for men and 6.8 years lower for women.

The main challenges we face in Wandsworth are:

• Improving the mental health and wellbeing of children and young people by investing in new services, making it easier for young people to access support, and reducing waiting times. • Supporting more people living with diabetes in community settings, enabling them to be supported closer to home. • Improving the support we provide to the frailest older people in care homes at the end of their lives. • Reducing childhood obesity and risky behaviours. • Improving mental health and wellbeing for adults. • Supporting people living with dementia and reducing social isolation.

Read more about the health and wellbeing needs of people in Wandsworth and our plans to develop services for people in Wandsworth at www.swlondonccg.nhs.uk/your-area/wandsworth/wandsworth- our-plans

- Financial position

This information serves as a summary of the CCG’s annual accounts including the controls assurance and auditor’s statements. Our performance against the key financial performance indicators is summarised below.

Income and expenditure target

For the 2020/21 financial year, the NHS operated under a different financial framework due to the impact of the COVID-19 pandemic. For the first six months of 20/21 the CCG was allocated funding in line with actual expenditure incurred, including funding for the additional costs of COVID-19. For the second half of the financial year the CCG received a fixed level of funding at system level including additional funding for the expected costs of COVID-19.

Within this funding the CCG was set a target of break even by NHS England. The CCG achieved break even in line with target.

Expenditure by type

The CCG was allocated a total of £2,672m to spend in 2020/21 and spent £2,672m giving a surplus of £0m. About half of this expenditure was acute services (£1,380m). The other significant areas of expenditure were mental health services £271m, community health services £181m, continuing care placements £198m and primary care prescribing costs £493m. The CCG spent £30m on the organisation’s running costs.

An analysis of the CCG’s net expenditure in 2020/21 is set out below.

£m

Acute 1,379.5

Mental Health 271.1

Community Services 180.9

Continuing Care Services 198.4

Primary Care 492.6

Other Programme 119.4

Running Costs 29.9

TOTAL 2,671.9

Going concern

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

1.2 Performance analysis

The South West London CCG is responsible for coordinating the South West London system response to Covid-19 and providing the link between our NHS providers, our South West London system and NHS England/Improvement London region. Managing the pandemic response, ensuring vital non-Covid services remained operational, supporting the recovery of elective services as well as overseeing the vaccination programme has been the core business of the new NHS South West London CCG. Below is a summary of the past year’s performance.

Responding to the first wave

1.2.1.1 Gold Command Incident Control Room and South West London ‘Cells’

In February 2020, the CCG, on behalf of the South West London ICS, established the Gold Command Incident Control Room (ICR) for the NHS in South West London. Operational seven days a week, Gold Command reported directly into NHS England, to support our NHS leaders to manage the incident in their own organisations, and across our wider health and care system. South West London ICR worked alongside other ICRs across the capital, sharing best practice, emerging trends and lessons learnt to help manage our response to the pandemic as effectively as possible.

We established seven cells which reported into and supported the work of the ICR – clinical, acute, primary care, community, supply, HR and communications. The seven cells were made up of clinicians and managers across our NHS organisations in South West London.

At a more local level Local Resilience Forums coordinated the health and care response for each borough. It was essential that each part of the system worked together to support local people in their own homes, in GP practices, in care homes, hospices, pharmacies and across South West London.

Whilst the initial media and public focus was on intensive care treatment within hospitals, we continued to support and focus on primary care and community services response, as well as local communities. that are equally vital in our response to the virus.

3.1.2 - Adapting our services

During these unprecedented times temporary service changes to hospital, community, primary care and mental health services had to be made to enable us to continue to provide safe services and protect patients whilst treating a high number of people with Covid-19 symptoms.

In South West London, our focus was to increase and protect the provision of high-quality frontline acute and critical care services for patients with the most severe complications arising from the infection, at the same time as ensuring the safety and protection of non-coronavirus patients. There was a significant shift away from face-to-face appointments towards digital and telephone approaches, as well as a risk-based approach to providing diagnostics and testing during the height of the pandemic. We followed national and regional standards and guidelines to ensure the safety of patients, their families, and our staff as a priority.

Service change in South West London was made following the receipt of national guidance around processes during a Level 4 National Incident and across the country in line with Emergency Preparedness, Resilience and Response (EPRR) incident coordination functions. In addition there were changes agreed at the London Clinical Advisory Group before being endorsed and implemented locally. Decisions on these changes were made through the South West London Clinical Cell, made-up of our most senior clinicians from each of our NHS organisations in South West London. They reviewed service changes to ensure that the impact on patient care was comprehensively considered. The Clinical Cell also worked with clinicians to ensure that the changes made were reviewed and considered in our recovery plan discussions. London wide changes were made through a clinical risk- based review by the London Clinical Advisory Group before being endorsed and implemented.

For further details on the service changes please see our July 2020 letter, which was sent to key stakeholders including MPs, local borough Overview and Scrutiny Committees and the South West London Joint Health Overview and Scrutiny Committee: https://swlondonccg.nhs.uk/wp- content/uploads/2020/07/SWL-COVID-19-Service-Change-Letter-17072020.pdf

• Emergency and cancer patients

Our South West London Acute Cell worked hard to make sure that we could provide the right number of intensive care, acute and general care inpatient services across South West London. As well as coordinating all hospital-based care for people in South West London, we worked with our partners in the independent healthcare sector to make best use of capacity in independent hospitals.

Furthermore, we continued to make sure that urgent cancer patients were prioritised by our hospitals during this time, and the Royal Marsden Hospital Cancer Hub led and supported this pan South West London work.

• Primary care

Since the start of the pandemic, our 180 GP practices have been at the front line looking after suspected and confirmed Covid-19 patients as well non-Covid-19 patients. GPs and practice staff separated these two groups of patients either within each practice, or by working together across groups of practices to do so. Practices adapted to deliver most care through remote consultations either by telephone or video consultations, continuing face-to-face consultations where needed and are doing more home visits than ever before, working hard to avoid all unnecessary hospital admissions or journeys to A&E.

1.2.1.2 Keeping high-risk patients out of hospital

South West London CCG led work to increase care and support for more patients with higher health needs in community settings. This work not only aimed to help people avoid being admitted to hospital but also to help patients leave hospital faster.

Health and social care staff worked with four priority groups of patients:

• Residents of care homes. • Patients who need advanced care plans to support end of life care.

24 • Those who are severely frail. • Individuals with multiple, complex co-morbidities.

The South West London Palliative Care Task and Finish Subgroup supported GPs, hospices and community health staff, worked with vulnerable members of our community and their families to provide them with the advice and clinical support, around hospital admission. We also made sure that patients had access to End-of-Life medicine packs in the community to enable them to remain safely at home and are worked with pharmacy colleagues to make sure the right medicines are available 24 hours a day, seven days a week. We also improved access to video conferencing in care homes in South West London and ensured they had the right equipment to care for their vulnerable residents.

1.2.1.3 Protecting our staff

We established robust testing procedures for staff and worked hard to make sure staff had the right protective equipment at the right time. There were many practical challenges in doing this and our ‘South West London Supply Cell’ worked hard across health and care organisations locally and with national suppliers to make sure we addressed any shortfalls with PPE as quickly as possible.

The South West London Procurement Partnership secured and delivered equipment for dozens of organisations whilst the national supply chain solution was being put in place for providers in all community care settings, playing a vital role in maintaining the safe delivery of clinical and care services. We also established a mutual aid process for organisations that were having trouble procuring PPE, helping more than 180 organisations access supplies, including care homes, hospices and local authorities. Our South West London organisations also worked closely together sharing supplies between organisations when stocks were running low.

Risk assessments were undertaken for all NHS staff, including CCG staff, with a particular focus and priority on those who may be most affected by the pandemic for example those from an ethnic minority background, older staff, pregnant staff or those with a long term or chronic condition.

25 1.2.1.4 Increasing our workforce

To help us respond to the pandemic, we were able to expand our South West London workforce working with the London Workforce Hub and South West London NHS Providers, welcoming people who had retired or who had moved to other sectors back to the NHS, with medical students and volunteers further increasing our numbers.

1.2.1.5 Staff testing

Early in the pandemic we increased testing capacity in South West London by setting up test centres at St George’s Hospital, in Chessington and at Croydon University Hospital for high priority staff (for example, Intensive Care Unit and Emergency Department staff and patient facing primary care clinicians). These centres expanded to provide testing for household members of those staff, easing staffing pressures particularly on those services that were seeing a surge in activity.

By the end of April 2020, we were able to extend testing for Covid-19 to our wider NHS health and care family, including social care and care homes, and were able to provide home testing kits. We also had full test centres operational in all our acute hospitals and test centres in Chessington, Twickenham, Gatwick and Greenwich. Testing became more widely available at a range of test centres and in the community throughout the year, including all clinical services having access to PCR tests for all front-line staff with symptoms and lateral flow testing twice a week for all staff to detect asymptomatic people.

- Recovery and the second wave

As the first wave ended, we moved into a recovery phase of managing the pandemic. We changed the way we delivered health and care services so we could continue to protect and care for local people, and to ensure we were prepared for the second wave in the winter. The South West London Recovery Board lead this work and were clear that the recovery must focus on primary care, mental health and community services as well as the acute sector.

Our clinical priorities during the recovery period were particularly concerned with those groups of patients who had not been seeking health advice and support during the first wave, and

26 understanding why Covid-19 had disproportionately affected people from ethnic minority groups, and those from more deprived areas.

1.2.2.1 Our Recovery Programmes

Our recovery planning continued the collaborative approach adopted in the first wave and has been led by national guidance.

The South West London Recovery Board was established to:

• Define the South West London recovery priorities. • Scrutinise and agree quality and clinical impact of changes. • Recommend financial investment or disinvestment to relevant bodies. • Identify where public conversations and consultation required and work with statutory organisations on this. • Determine actions to meet national performance targets. • Assess recovery risks and agree mitigations. • Drive agreed innovation forward at pace. • Provide regular updates and assurance on recovery to the South West London Health and Care Partnership. • To work in partnership with statutory bodies on recovery.

The South West London Recovery Board was set up to be supported by eight programmes of work. Each of these programmes brought together health and care professionals and managers from across our integrated care system who are experts in their field. Together they are working to support the essential work to recover, reshape and respond to each phase of the pandemic. As well as our recovery programmes, enabler programmes continue to inform and support all our work across the partnership.

27 1.2.2.2 Elective Recovery Clinical Networks

As we entered the recovery phase, we developed 15 elective recovery clinical networks, each led jointly by acute and primary care clinicians. These clinical networks were originally set up to support restarting elective surgical operations and treatments, enabling our hospitals to work together to manage those patients whose operations had been put on hold and most urgently needed care. As a CCG we were able to support these new networks with experienced primary care clinicians and commissioning managers, ensuring a focus on the whole patient journey and coordinating patient care across different settings.

The South West London Elective Recovery Clinical Networks are:

• Ear, Nose and Throat (ENT) • Cardiology • Trauma and Orthopaedics and • Rheumatology Musculoskeletal • Neurosciences • Gynaecology • Neurology • Ophthalmology • Pain Management • General Surgery • Stroke • Urology • Community Neuro-Rehabilitation • Dermatology • Respiratory

Working together, the clinical networks have centralised some operations in certain hospitals, freeing up staff and resources at others to continue responding to Covid-19.

Our networks look at other ways they can work together to improve care for patients by doing things such as sharing learning, standardising clinical approaches and using data in a more sophisticated way. The networks involve acute and primary care clinicians, community providers, medicines management professionals, mental health and nursing colleagues, and allied health professionals.

1.2.2.3 Increasing planned surgery

Our Clinical Networks helped develop a comprehensive system-wide plan for South West London and NHS hospitals to address the new challenges created for hospitals by Covid-19.

We worked through the plans on how to do this safely and identified patient groups by specific health conditions and treatments who should be prioritised for treatment. All our hospitals were involved in this work to make sure that we used all our available resources and capacity in South West London fairly for everyone.

Despite the added challenges the pandemic has brought, by November our four acute hospitals were able to carry out 90% of the planned surgical procedures we would have done at the same time the previous year.

Wherever appropriate procedures are performed as day case surgery. St George’s Hospital has been on stand-by to open additional intensive care unit beds for extremely sick patients with Covid- 19. To help them do this, Croydon, Kingston, St Helier and Epsom hospitals stepped-up specialty planned surgery. St George’s has continued to carry out a high proportion of complex planned surgery on site, and hundreds of patients under their care have successfully had their treatment at neighbouring Croydon and Kingston Hospitals.

As part of national plans, dedicated surgical hubs for non-urgent operations have been set up to see more patients quickly and helping to reduce waiting lists:

• Orthopaedics South West London Elective Orthopaedic Centre (SWLEOC), has expanded capacity to include an additional theatre seeing, allowing them to treat an additional 125 patients a month. • Ophthalmology Moorfields based at St George’s Hospital and Epsom and St Helier Trust have increased the number of cataract operations to around 800 operations each month. All four Hospitals continue to offer cataract surgery. • Urology In October 2020 Epsom Hospital became a pilot surgical hub for urology surgery for Epsom, St Helier and St George’s patients. • General surgery Croydon and Kingston Hospitals are supporting those patients waiting longer for care at St George’s Hospital.

• Gynaecology Croydon Hospital is the hub for Gynaecology, with more than 100 patients from Epsom and St Helier being offered the option of having their surgery at Croydon Hospital rather than waiting longer for treatment closer to home. • Ear, Nose and Throat Patients who have waited longer than a year for an appointment at St George’s have been offered an appointment at Kingston Hospital.

1.2.2.4 Supporting Discharge

During the second wave, the main challenge to patient flow through South West London hospitals has been the availability of appropriate beds. As the number of Covid-19 patients being admitted increased, the infection prevention and distancing measures restricted bed availability. We also saw an increase in the number of patients being readmitted and more patients having to stay in hospital for more than 14 days in both intensive care and on general wards. This significantly impacted on patient flow.

We responded to these challenges by commissioning additional high intensity rehabilitation beds and increased capacity for Continuing HealthCare assessments and redirected teams to support discharge.

1.2.2.5 What we learned from the second wave

This second wave was different from the first in that we were able to identify and isolate positive patients and their contacts much more quickly, and our treatments and outcomes for patients were better as we understood more about the disease.

Despite being better prepared and more experienced, the second wave was still a challenge, with this second surge in cases adding to existing winter pressures. Our health and care staff worked incredibly hard to support local communities with the pressures of winter, Covid-19 and recovering from delayed care during the first wave of the pandemic.

November 2020 saw the national roll-out of lateral flow testing kits for our front-line staff, which helped reduce some of the staffing pressures that our services had been subject to, particularly in our hospitals.

1.2.2.6 Seasonal flu vaccinations

Together with our health and care partners, the South West London CCG launched a comprehensive flu programme. With the risk of both flu and Covid-19 circulating at winter time, it was more important than ever for those most at risk to get vaccinated, and also allow us to quickly move on to rolling out a Covid-19 vaccination programme from December 2020.

Building on our engagement with local communities over the summer, we worked hard across health and care with our local communities and voluntary sector to engage our communities and encourage uptake.

By December 2020, we had flu-vaccinated over 300,000 people in South West London, including 220,000 people from at risk groups, more than 70,000 school children and over 16,000 health and care staff. This made us the highest performing CCG in London for flu vaccination.

1.2.2.7 Improving discharge from hospitals and working with care homes

Our Primary Care Teams have worked with partners to develop the South West London Intermediate Care Pathway, which is helping is us work better than ever with our partners across South West London to support patients who have different levels of care needs and discharge them safely into the community. This is helping us to make sure that acute hospital beds are available for the patients who need them most.

Supporting our care homes to be able to receive patients back from hospital when they are well enough is a vital part of making sure our hospitals have capacity to treat new patients. We have supported care homes in South West London to begin using NHS mail, which has accelerated the discharge process for patients from hospital back to their care homes. This is because patient identifiable information like medical records can be transferred securely through this system. In the past, care homes had not been able to receive this information electronically.

We have also been working with local care homes to make sure that they are using the NHS England capacity reporting system, as a London wide view of bed capacity in care homes supports faster discharge from hospital and avoiding admission where possible.

During the second wave, the main challenge to patient flow through South West London hospitals has been the availability of appropriate beds. As the number of Covid-19 patients being admitted

increased, the infection prevention and distancing measures restricted bed availability. We also saw an increase in the number of patients being readmitted and more patients having to stay in hospital for more than 14 days in both intensive care and on general wards.

We responded to these challenges by commissioning additional high intensity rehabilitation beds and reintroducing Continuing HealthCare assessments and teams to support discharge.

We established a new Temporary Alternative Discharge Destination (TADD) care home with 11 beds in February 2021. Care home patients are moved to the TADD temporarily after being discharged from hospital, returning to their care home after having a negative test for Covid-19. This initiative has supported our hospitals and care homes, released bed capacity where it was needed and protected vulnerable care home residents.

1.2.2.8 Transforming outpatient services

Before the pandemic, work was already underway between our GPs and Trusts to give patients greater control in how they manage their own conditions and access clinical support – including offering more remote outpatient appointments to save patients time and to reduce the environmental impact of our services. From March 2020 this work accelerated with thousands of GP and outpatient appointments available over the phone or online, helping the NHS to remain open while keeping patients and our staff safe.

We have worked hard to improve the compatibility of the digital systems used in primary care and hospitals so they can communicate more effectively and make sure that patients receive the appropriate services and treatments whilst also having access to digital self-management tools. A revised Outpatient Transformation Programme has been launched to undertake a review of the digital systems in place and develop solutions to meet the needs of both patients and clinicians, while addressing health inequalities.

Four workstreams have been identified:

• Commissioning of Healthcare Innovation – developing new technologies, policies or services to help improve people’s health. • Population Health Management – using current and historical patient data and insights to shape and develop the services we provide.

32 • Digital Enablement – making sure that all our health and care organisations are using the right digital technologies and infrastructure to meet the needs of healthcare professionals and patients. • Workforce Evolution – making sure that our health and care staff understand our plans and have the skills to use new technologies in their day-to-day work.

1.2.2.9 The ‘NHS is here for you’ during lock-down

Reassuring local people that the NHS remains open and is here for them if they need it has been a key part of our work since the pandemic began, with a focus on GP services, mental health services, attending hospital appointments and keeping safe. We saw in the first national lockdown a drop in those accessing health services as local people were reluctant to put additional pressure on the NHS or risk potentially contracting the virus from a health setting. Throughout the year we have continued to reassure local people through community and stakeholder engagement and have run a series of innovative social media campaigns to support national television and advertising campaigns.

One of our clinicians’ major concern for the health service during the pandemic has been the knowledge that there are some people who may have worrying cancer symptoms who are still not contacting their GP.

During the summer, there was a 20% decrease in the number of people being referred to cancer services. Alongside this, there was a significant delay in people receiving cancer screenings due to the pandemic, especially for breast cancer.

Cancer referrals have increased as the year has gone on, though we are not back to pre-pandemic levels yet, suggesting that there are potentially many people in the community who are not receiving the care and treatment they need. In response to this we have increased communications activity to encourage people to attend screening if they are invited and to talk to their GP if they have worrying symptoms, reassuring them that GP practices are safe and reminding people that many appointments are now available over the phone or by video call.

You can view the ‘Keeping You Safe’ films for each of our boroughs on our website at www.swlondonccg.nhs.uk/your-area

1.2.2.10 The mental health impact of the pandemic

We have supported and worked with South West London and St George’s Mental Health Trust and with South London and Maudsley NHS Foundation Trust to understand the mental health impact of the pandemic. Across South West London, our collective response to the mental health impact of the Covid-19 pandemic has been:

• Keeping mental health services accessible and trauma-informed. • Continuing to plan for surges in demand. • Supporting primary care to continue delivering good mental health care. • Prioritising our most vulnerable. • Strengthening families, workplaces, communities. • Meeting basic needs.

It is important that we ensure people with mental health needs or a learning disability receive the same protection and support with managing and their health and wellbeing during the pandemic as other members of the population.

The impact of Covid-19 on our communities’ mental wellbeing has been big. In the year since the pandemic began, depression rates have doubled and primary care colleagues are predicting a surge of mental health issues in the future. We also know that Covid-19 is having a disproportionate impact on our people from ethnic minorities.

We are continuing our work looking at ways that South West London can respond to any increase in demand for services as a result of the on-going pandemic and as part of our recovery work. This has included virtual consultations for IAPT and the South West London St George’s Recovery College - the UK's first mental health recovery study and training facility providing a range of courses and resources for service users.

We are working through considering whether the right services are in place to support people with mental health needs or learning disabilities (or both) and transforming services where we need to do more. It will also be very important that we ensure that inequalities for these residents are not worsened as a result of Covid-19.

34 1.2.2.11 Preventing a Mental Health Crisis - South London Listens

NHS South West London CCG has come together with people with lived experiences and partner organisations from across the whole of South London. In July 2020 the South London Mental Health and Community Partnership hosted the Covid-19: Preventing a Mental Health Crisis Summit was attended by more than 400 people. Attendees joined expert panels which included people with lived experiences, clinicians, commissioners, patients, young people from local schools and partners from Local Authorities, education and voluntary sectors.

Following this summit the South London Covid-19 Preventing Mental-ill Health Taskforce was created with the aim of preventing thousands of people’s lives being affected by mental illness and to develop a long-term programme to protect our communities’ mental health. The Taskforce is made up of representatives from NHS South West London CCG, South London and Maudsley NHS Foundation Trust, South West London and St George’s Mental Health NHS Trust, Oxleas NHS Foundation Trust, local authorities, Healthwatch, Public Health England, Citizens UK and experts by experience. The taskforce identified six key themes and areas for action:

• Social isolation, loneliness, and community involvement. • Helping people who are at risk of losing their jobs cope. • Housing insecurity and environment. • Supporting disadvantaged communities and groups. • Supporting families, children, and young people. • Developing a long-term, joined-up approach to prevention.

In November 2020 the South London Mental Health and Community Partnership launched South London Listens, a major listening campaign which aims to find out how Covid-19 has specifically affected the mental health of South Londoners and to identify key issues that need addressing. NHS South West London CCG has supported and been an active participant in South London Listens. More than 5,000 people have taken part in the initiative, and the partnership is now working with local people and community groups to co-produce solutions that will be published as part of a two- year action plan in Summer 2021.

1.2.2.12 Children and Young People’s Mental Health

The CCG, working with the South West London Health and Care Partnership has made children and young people’s mental health and well-being a shared health promotion and prevention priority. Our aim is to improve children and young people’s mental health by starting earlier and giving them the skills, they need to be resilient and thrive.

We have listened to young people, their families, teachers, and frontline professionals to develop a ‘whole school’ approach. This approach brings together school leaders with health and social care professionals to deliver training and support for children and young people, their families, and teachers. The programme has been running since 2018, gradually extending to more schools across the patch. Watch our video about our whole school approach to children and young people’s mental health.

The pandemic has had a significant impact on the mental health of children and young people. Lockdown and schools being closed have created challenges including fears of infection, parental issues such as unemployment, and potential trauma such as in cases where domestic violence is prevalent.

In response to the challenges of the pandemic mental health services have maintained business as usual whilst adapting as necessary, often with the use of technology. This has enabled mental health services not only to support children and young people but also to empower teachers with the tools they need to support their students. Across South West London we now have:

• 10 mental health support teams supporting children and young people throughout the pandemic. • An online counselling service to support children and young people at home. Anyone between 11 and 22 years old can access Kooth for free 24 hours a day, 365 days a year at www.kooth.com • Launched a website providing details of where children and young people can access additional support www.swlondonccg.nhs.uk/your-health/mental-health/covid19-resource- hub • Delivered online workshops for children and teachers. • Conducted one-to-one telephone and video call sessions with children and young people. • Launched new 24-hour urgent mental health support lines for all boroughs: Croydon 0800 731 2864, all other south west London boroughs 0800 028 8000

36 • Empowering Parents, Empowering Communities (EPEC) hubs have been established in all south west London boroughs. These are evidence-based, parenting support hubs running developmental (children, young people and infants) and specialist (parent conflict, ASD, AHDH, parent mental health) parenting programmes. Parents receive training and accreditation to become ‘parent group leaders’ and go on to provide parenting courses and support to parents in their local communities. The hubs have been operating virtually during the pandemic. • Conducted welfare checks to identify vulnerable children, resulting in children who would otherwise not have been flagged up being identified.

1.2.2.13 Increasing Mental Health Emergency Services

On 30 March 2020 South West London and St George’s Mental Health NHS Trust opened a new emergency service for patients with primary mental health problems who would otherwise have had to go to A&E. The Orchid Mental Health Emergency Service (MHES) based at Springfield University Hospital is an alternative to acute hospital Emergency Departments, enabling patients to attend a dedicated MHES set up specifically for this purpose. The service accepts patients of all ages, including children.

A screening process must take place before patients are referred to the service, to ensure any physical health problems do not require urgent medical attention. Organisations that can refer patients to these services include Acute Trust Emergency Departments, Police, London Ambulance Service and NHS 111.

1.2.2.14 Improving Access to Psychological Therapies and Wellbeing services (IAPT) services

Improving Access to Psychological Therapies and Wellbeing services (IAPT) offer a range of talking therapy options to help manage symptoms of stress, worry, and low mood and to build emotional resilience. IAPT services provide specialist interventions and support including one-to-one support to help people with stress-related problems, anxiety disorders, depression and trauma. IAPT can also help anybody needing more specialist support access the help they need. Following an initial

assessment over the telephone, therapies are provided either virtually (telephone or video calls) or in GP surgeries or community venues across South West London.

IAPT services have adapted this year to accept referrals for NHS staff for treatment regardless of whether they are registered with a GP in the same area as the IAPT service they wish to access. This approach has been taken to remove barriers to staff accessing mental health support during this challenging time and means that staff working in South West London will be able to receive treatment in the borough where they live or work.

More information about these services we commission can be found on the local IAPT websites:

• Croydon: www.slam-iapt.nhs.uk • Merton Uplift: www.mertonuplift.nhs.uk • Sutton Uplift: www.suttonuplift.co.uk • Talk Wandsworth: www.talkwandsworth.nhs.uk • Kingston: www.icope.nhs.uk/kingston • Richmond: www.richmondwellbeingservice.nhs.uk

- Covid-19 vaccination programme

The roll out of the Covid-19 vaccination has been the biggest logistical challenge faced by the NHS in its history.

Building on our successful flu programme we quickly established the Covid-19 vaccination programme with hospital hubs, GP led vaccination centres and community vaccination centres opening up across South West London, complemented by an outreach and roving model vaccinating care home residents and staff as well as people in their own homes across out six boroughs.

We delivered more than 500,000 vaccinations in the first 15 weeks of the programme.

More than 566,741 South West London residents have received their first dose, and more than 729,93 of those residents have had their second dose at time of publication as of 1 April 2021.

As we move forward with the Covid-19 vaccination campaign, we are keen to maintain the momentum as different age groups become eligible for the vaccine. Making an appointment is quick

38 and simple at nhs.uk/Covidvaccine, whilst those that can’t use the internet can phone 119 to book their vaccination.

St George’s and Croydon Hospitals were amongst the UK’s first vaccine hubs, and Croydon safely secured its place in history by vaccinating one of the first people in the world against Covid-19 on Tuesday 8 December 2020. At the start of January eight acute, community and mental health hospital-based centres in South West London expanded their vaccination clinics to become in some cases seven day a week services to protect more people faster. Focusing on front line health and care workers, hospitals also offered the vaccine to those in the eligible cohorts beginning with the over 80s.

Outside of the large hospitals, GP practices in South West London worked together in 39 Primary Care Networks to deliver the vaccine to people in the community. The Primary Care Networks are delivering vaccinations at 25 dedicated vaccination sites across the patch. Some of these sites are GP practices, but many are based in community settings like local health centres, churches and community halls. We have supported these centres with a series of pop-up vaccination clinics across South West London in mosques, temples, churches and community centres to help reach further into those communities with lower uptake.

All vaccination centres are led by local GPs and practice nurses and are running on top of business- as-usual GP practice services. This means most primary care vaccination centres are vaccinating three or four days a week. Up until March 2021 GP-led vaccination centres have delivered over 70% of all vaccinations in South West London.

In February 2021 we started the roll out of several community vaccination centres in places not normally associated with health and care like sports stadiums and shopping centres. These new sites play a key role in helping us to vaccinate eligible residents alongside health and care staff, not only increasing capacity but also choice for local people. As established community hubs with excellent transport links, these centres crucially make it easier for people who have had to continue to travel for work during the pandemic to be vaccinated. All nine of our community vaccination sites opened by the end of March 2021:

• Centrale Shopping Centre in Croydon • Selhurst Park football stadium in Crystal Palace, Croydon • Hawks Road Health Clinic in Kingston • Centre Court Shopping Centre in Wimbledon, Merton • Plough Lane football stadium in Wimbledon, Merton

39 • Harlequins Stoop Stadium in Twickenham, Richmond • St Nicholas Shopping Centre in Sutton • Battersea Arts Centre in Battersea, Wandsworth • Queen Mary’s Hospital, Roehampton in Wandsworth1

1.2.3.1 Engaging local communities

Our South West London CCG engagement team has been working with key community groups at borough level to help inform people in areas where uptake has been low to reassure of them the safety of the vaccination and to dispel myths that circulate on social media. More details of this engagement can be found in the engagement chapter of this Annual Report.

We have worked closely with local authorities and funded the voluntary sector to reach deep into communities to engage with different groups and have conversations and inform people about the vaccine.

In each borough we have developed a bespoke engagement plan with our partners to engage with communities with lower uptake and used the vaccine data to inform where we locate pop-up vaccination clinics and focus our activity. The communications and engagement plans for each of our six boroughs are on our website at www.swlondonccg.nhs.uk/Covid

An example of how we worked and are still working together, is our Croydon with the ‘Croydon BME (Black and Minority Ethnic) Forum’ and ‘Asian Resource Centre’ and other borough partners to hold community conversations to give local people the opportunity to put their questions to a panel of

1 Update infographic on publication

experts including Dr Agnelo Fernandes, Dr Nnenna Osuji and Rachel Flowers, Croydon’s Director of Public Health. Over 600 people from our diverse communities attended the first four online meetings, with more targeted engagement sessions for held including for care home and domiciliary staff and Age UK’s Personal Independence Coordinators and Healthy Living team. We have seen the success of this work with increasing numbers of people from groups of people who were more reluctant or concerned about being vaccinated in the early days coming forward to receive their vaccination.

You can help us encourage vaccine uptake by directing friends and family to reliable, verifiable, and up-to-date sources of information including our website www.swlondonccg.nhs.uk/Covid and our NHS social media channels.

- An overview of the work in each of our six boroughs from the past year

In summer 2019 we published local Health and Care Plans for each of our boroughs. These plans were developed over more than 18 months by local people, and health and care staff, helping us to make sure that the plans are centred around the people who use our services rather than the organisations that provide them.

The Health and Care Plans support delivery of each borough’s Joint Health and Wellbeing Strategy (JHWS) developed by the Health and Wellbeing Board, to meet the health needs identified in the boroughs’ Joint Strategic Needs Assessment (JSNA). Each of our locality executive directors and clinical chairs represent their borough on the local authority Health and Wellbeing Board along with representatives from local NHS acute, mental health and community providers, Healthwatch, community and voluntary sector and other partner organisations.

You can read the Health and Care Plans for each borough on our website at www.swlondonccg.nhs.uk/your-area by clicking on the name of the relevant borough and then clicking the Our plans link.

You can find details of each borough’s Health and Wellbeing Board on the local authority websites:

Croydon: Health and Wellbeing Board | Croydon council

Merton: Merton Health and Wellbeing Board (mertonpartnership.org.uk)

41 Kingston: Kingston Council – www.kingston.gov.uk

Richmond: Health and Wellbeing Board - London Borough of Richmond upon Thames

Sutton: Committee details - Health and Wellbeing Board - Sutton Council

Wandsworth: Wandsworth Health and Wellbeing Board - Wandsworth Borough Council

The South West London CCG’s work in each borough for the past year has been primarily focussed on supporting the response to the Covid-19 pandemic. Below is an overview for each borough that outlines how each CCG borough team has worked with local health and care partners to support and provide care for our communities.

From April 2021 we will be refreshing our Local Health and Care Plans in each borough, building on our collaborative working during the past year and what we have learned about how we provide services for our communities, particularly those who suffer from health inequalities.

- Croydon

Croydon has been one of the areas most affected by Covid-19 in the capital. The strength of our response has been built on the commitment of our workforce and the success of our partnership working in the borough.

‘One Croydon’ is our borough level partnership between the NHS in Croydon, Croydon Council and Age UK Croydon, originally set up to help tackle the challenges of an ageing population but now working to integrate health and social care for people of all ages across the borough. Uniquely for the local NHS, we also have a single management team across Croydon Health Services NHS Trust and the borough team of the CCG, led by Matthew Kershaw our place-based leader for health.

1.2.5.1 Croydon’s Elective Centre – a ‘hospital within a hospital’

The Croydon Elective Centre (CEC) at Croydon University Hospital provides a Covid safe zone for planned care and treatment. With restricted access to other parts of the hospital, the CEC provides robust infection control and Covid screening of patients and staff this has put Croydon is in a good position to avoid increasing further delays for patients for their elective care. The centre has meant that:

• More than 3,700 activities are current ongoing at Croydon University Hospital delivered within 18 weeks. • Relatively small numbers of patients waiting more than 52 weeks, but we recognise the impact this has on individuals. • working collaboratively across South West London to maximise our skills and capacity to safely care for people in the shortest time possible, whilst safely continuing to treat people with the virus.

1.2.5.2 NHS 111 First

Croydon was one of the first in London to pilot a new approach to make it easier for people to access urgent and emergency care – just by contacting 111 first. ‘NHS 111 First’ is a national initiative that aims to support people to access the right care first time, reduce A&E waiting times and protect patients and staff from Covid-19 with fewer people in waiting rooms for safe social distancing. NHS 111 can book appointments directly to services across the borough, depending on clinical need including set times of arrival in A&E and the Urgent Treatment Centre, a same day call back from GP or local pharmacists for urgent repeat prescriptions and advice.

1.2.5.3 Supporting local people with ongoing symptoms following coronavirus

Croydon Health Services now provides multidisciplinary support for GPs to help care for those recovering post-Covid. This service aims to help people recover at home, keep them well and, where possible, out of hospital. Working together the hospital, community teams, public health and GPs work to identify people in our community who need support after experiencing Covid-19. This includes care for patients that had prolonged stays in intensive care or mechanical ventilation and coordinated care for people who have developed respiratory problems after Covid-19. By increasing GP access to hospital consultant expertise including renal, neurological, cardiac and haematology patients are better supported and together we are planning to include therapies, rehabilitation and psychological services that match our local population’s needs.

1.2.5.4 Integrated Community Care Networks +

Integrated Community Networks are a new model of care that brings together teams of professionals from across health, social care and the community and voluntary sector to provide better, more joined up services for Croydon patients. Our priority in Croydon is to provide proactive, preventative care in community settings, so that people can be supported to live at home for longer and lead healthier, happier and more independent lives.

Croydon’s first Integrated Community Care Network team came together in the North East Locality in July 2020 and includes social workers, community nurses, occupational therapists and physiotherapists, personal independence coordinators, mental health support, pharmacy supports. Drop-in clinics have been held virtually due to the pandemic connecting people with the support services in their neighbourhood, including housing and benefits support. Social isolation referrals have increased to the team during lockdowns.

The next stage of the ICN+ programme is to work with our staff and services to develop and implement the multidisciplinary teams in each of Croydon’s six localities.

1.2.5.5 Mental health

Improving care and support for mental health patients in Croydon Hospital’s Emergency Department and in the community has been a focus over the last year. We are working closely with our partners in mental health trusts to find better solutions to increasing demand for mental health in our borough. Some of the actions we have taken to ensure people with mental health needs get the support they need include:

• Mental Health Assessment Unit at CUH for people who have a physical and mental health need, but who do not need emergency care. • The Recovery Space hosted and run by MIND Croydon opened in September 2020. The space provides a safe, supportive environment for people experiencing a social mental health crisis as an alternative to using other crisis services. The service provides both face to face and telephone and digital support depending on a client’s needs.

1.2.5.6 Ground-breaking Croydon partnerships recognised in national awards

Croydon’s ground-breaking partnerships were praised in a prestigious national awards ceremony in March 2021, which celebrates excellence in health and care services. The 2020 HSJ Awards were held virtually for the first time to recognise the dedication, innovation and teamwork in what has undoubtedly been one of the toughest years for health and care workers. The borough was highly commended in two out of three nominations for patient safety and for leading changes to local health and care services to provide more joined-up care and support. Croydon Health Services NHS Trust was highly commended for patient safety through a new system that allows clinicians to closely monitor and care for patients with and without Covid-19, to keep people safe from the virus. The One Croydon Alliance was also highly commended for the System Leadership Initiative of the Year, beating more than 1,000 entries to make it to the final few. This award acknowledges organisations that are working together to tackle health inequalities and provide better quality care.

1.2.5.7 Delivering the Covid-19 vaccination programme in Croydon

Croydon secured its place in history by vaccinating one of the first people in the world against Covid- 19. Croydon resident and long-standing NHS volunteer, George Dyer, aged 90 from Norbury in South London, received the injection at Croydon University Hospital on Tuesday 8 December 2020. Beginning in November 2020, Croydon GP led Primary Care networks set up vaccination sites at venues across the borough to offer vaccination to those most at risk of catching Covid- 19. Vaccinations were successfully delivered to people in the first four cohorts by 15th February. After extensive engagement with local communities, it became clear that we needed to take the vaccination to additional venues -where the community were already going - in order to encourage the uptake of the vaccine amongst lower uptake groups. From March 2021, our GP’s, nurses and pharmacists worked with local community groups and faith leaders to set pop-up clinics at the Croydon mosque, His Grace Evangelical Church, Nightwatch Food Kitchen, the Sakthy Ghanapathy temple, Centrale shopping centre, Selhurst Park Stadium and Turning point’s Lantern Hall centre for the homeless. These walk-in clinics, where no appointment was needed, have helped us to encourage more people to take the vaccine amongst hesitant and harder to reach groups.

45 - Merton and Wandsworth

1.2.6.1 Supporting patients with complex needs in their own home

During the pandemic, keeping vulnerable patients safe at home was more important than ever and could only be achieved by health and care services working closely together. Over the past year, we continued to develop integrated health and care support for the most vulnerable individuals in Merton and Wandsworth by:

• Supporting patients at risk of unplanned hospital admission

Each GP practice (in Merton and Wandsworth) moved to meeting community health and social care colleagues virtually, to focus on how to support patients at most risk of hospital admission and keep them at home. We extended the Living Well service with Age UK which offers intensive one-to-one support for older people with complex needs, and we proactively identified those in need of additional support.

• Reducing isolation and maintaining independence

Merton and Wandsworth Voluntary Services established a Community Response Hub in each borough to help isolated households and those at risk from Covid-19 helping with shopping and basic supplies, telephone befriending, access to prescription and medication, advice and practical support to stay active and independent at home.

• Enhancing rapid response services

Rapid response teams help support people in their own home or care home. To strengthen the service GPs and social reablement teams worked even more closely with the service provided by Central London Community Health (CLCH), our community service provider. This enabled patients to have access to up to 24-hour care in their home.

• Enabling patients to leave hospital and go home sooner

In March 2020, at the start of the pandemic health and social care teams across Merton and Wandsworth set up discharge hubs to enable people to go home sooner from hospital. Discharge processes were simplified, and detailed care assessments were undertaken in the patients home rather than in hospital.

From January 2021, health and care professionals in Merton and Wandsworth worked together to identify patients who would benefit from leaving hospital sooner than was usual if they had the right

support in place. To enable this to happen GPs, hospital consultants from St George’s Hospital, community health teams and CCG managers met every day in a “virtual ward round” to discuss patients who could move out of hospital safely into the care of community health and care teams. These patients were transferred home with a care package, which was assessed once they were home.

The team looked at patients with and without Covid-19, for example targeting patients with heart failure, diabetes, and complex care needs.

• Moving Covid-positive patients to dedicated care homes

During the pandemic patients with Covid-19 but no longer needing hospital care were transferred to dedicated care homes to complete their period of isolation. These are called dedicated temporary alternative discharge destinations (TADDs) and provided a setting where patients could continue their recovery before going to their own home or care home. Working with nursing home staff and CLCH, Merton GPs and all borough social care colleagues helped to establish and support two TADDs.

1.2.6.2 Services at Queen Mary’s Hospital, Roehampton

The Covid-19 pandemic meant that the NHS needed to make radical changes in the way services work to ensure patients and staff were as safe as possible.

As part of the response the decision was taken to temporarily close the Urgent Treatment Centre (UTC) at Queen Mary’s Hospital. This was because of insufficient space and workforce to separate walk-in patients with respiratory symptoms from others attending QMH.

While the service was closed, the NHS locally worked with Battersea Healthcare Community Interest Company (the Wandsworth GP Federation), and St George’s Hospital NHS Trust to look at options for a service on the site over the coming winter.

In December 2020 we opened a new enhanced primary care service run by GPs and specialist urgent care nurses. This was a pilot scheme that provided safe, bookable same day or routine appointments initially for patients registered with a Wandsworth GP and then for Merton registered patients. The service will continue to run for a further six months from April 2021 so that it can be fully evaluated, and the views and experiences of local people gathered, to influence any future developments.

Other developments at Queen Mary’s from spring 2021 were a large Covid-19 vaccination site, which opened on 15 March 2021 and four new modular operating theatres with construction beginning at the end of March 2021. The modular operating theatres and vaccine hub will enable the NHS in south west London to ensure patients receive the treatment they need and give local people additional convenient access to the Covid-19 vaccination.

1.2.6.3 Post-Covid-19 plans for Merton and Wandsworth

For some people, Covid-19 can cause symptoms that last weeks or months after the infection has gone. This is known as post-Covid. The London Clinical Advisory Group has published guidance to support the management of post-Covid which is to be implemented at an integrated care system level.

Across South West London we are implementing a networked approach – centralised where necessary and local where possible. This aims to achieve all the benefits of a single South West London wide service, with local delivery where appropriate for patients also accessing local primary care, social prescribing, IAPT and social care support.

At a Merton and Wandsworth level we have developed a model based on a partnership between primary care, our community services provider and the acute hospital to provide an accessible and effective service. Local GPs will be able to refer patients into a single point of access which will provide an integrated response, with care coordinated between a number of different services depending upon the needs of individual patients. In addition to services provided by doctors, nurses and therapists there will be links to IAPT services, social care and the voluntary sector.

This will be supported with a public facing communications and engagement plan.

1.2.6.4 Delivering the Covid-19 vaccination programme in Merton and Wandsworth

In just six weeks from the end of November 2020, our GPs set up vaccination sites across both boroughs and from December 2020, started to call the most vulnerable eligible people for their vaccinations rapidly working through the first four cohorts and offering them all the vaccine by 15 February.

From March 2021, our GPs, nurses and pharmacists worked with local communities and faith groups to set up clinics in various community locations to bring vaccinations closer to local people. Pop-ups were run at New Horizon Centre Pollards Hill, Mitcham Family Practice, Colliers Wood community centre, Baitul Futuh Mosque, Salvation Army Centre, St Mark’s Church Mitcham and Shree Ghanapathy Temple all in Merton and Fazl Mosque in Wandsworth. These clinics have enabled us to reach groups in the population who have had lower take up of the vaccine and have so far proved successful in getting more people to take the vaccine. Throughout the programme, our engagement team worked with GPs and pharmacists and the local councils to talk to different groups and communities online through virtual meetings and events, answering questions to help address the concerns of many people about this new vaccine. You can read more about this engagement on our South West London CCG website as well as in the Merton Patient and Public Engagement governance and assurance section.

- Kingston and Richmond

1.2.7.1 Enhanced support to care homes

During the year, a number of initiatives were introduced to better support staff and residents in care homes in Kingston and in Richmond.

A project manager worked with care home staff to enable them to take vital signs and to recognise early signs of deterioration. This early signs of deterioration work is supported by a wider remote monitoring workstream, so that healthcare professionals can be notified automatically of any concerns, and to respond accordingly. iPads have been made available to all care homes to enable them to hold video consultations with health and care professionals, access NHS mail, connect care home residents with loved ones remotely, and to get direct access to any other tools or systems needed to support the care of residents.

We have supported two population health fellows in a project developing multi-disciplinary team working with care home staff in Kingston and Richmond. Advance care planning and training for care home staff are other facets of this project.

The primary care network enhanced service was launched, involving weekly multidisciplinary primary care “rounds” addressing medication reviews and holistic care. In association with this,

health and social care multi-disciplinary teams were started along with a focus on falls prevention, reablement (short-term care at home) and end of life care.

Temporary Alternative Discharge Destinations (TADDs) have been identified as short-term capacity so that care home residents who are Covid-19 positive can be discharged from acute hospitals to safely isolate before returning to their care home.

South West London CCG has also formed a new infection prevention support team to support care homes to answer queries related to infection prevention and control, to share best practice tools and to offer training and support where gaps are identified or where there has been an outbreak in the home.

Through the Covid immunisation programme large numbers of care home residents and staff in Kingston and Richmond have been vaccinated.

1.2.7.2 New NHS 111 service and behaviour change campaign

A new service offering booked appointments in A&E was launched as part of local and national plans to reduce pressure on emergency hospital services and help manage social distancing within the emergency department.

We have supported the launch with a communications and engagement behaviour change campaign encouraging people to “Think NHS 111 First” if they think they might need to go to A&E.

The campaign targeted messages to the areas and groups that Kingston Hospital data showed use A&E most. A paid for social media campaign focused on communities within a two-mile radius of Kingston Hospital and a one mile radius of Teddington Urgent Treatment Centre with extra messaging in the area within half a mile of Kingston A&E.

Our engagement team held a series of events with key groups such as parents of young children, older people and carers to promote NHS 111 and reassure people with any concerns.

We also worked with our local authority and voluntary sector partners to put campaign materials – posters, flyers and adverts – on display in schools, estate offices and council-owned advertising hoardings in areas we know use A&E most across Kingston and Richmond.

GPs were asked to make sure our standard messaging text was on their websites and the heads of the Local Pharmaceutical Councils in each borough asked their members to display materials. Parents of children in school in each borough also received a message about NHS 111 via the Achieving for Children newsletter.

Following the second surge of the Covid-19 pandemic, the campaign continues to encourage more people to call NHS 111 for advice if they think they need to go to the emergency department.

1.2.7.3 Delivering the Covid-19 vaccination programme in Kingston and Richmond

Starting from the end of November 2020, GP-led Primary Care Networks set up vaccination services (three in Kingston and six in Richmond) offering the vaccine to those most at risk of catching Covid- 19. Kingston Hospital also opened a vaccination service for staff and patients in December.

In late January, Kingston opened South West London’s first large vaccination site at the Hawks Road Clinic. A second large site at the Harlequins Rugby Ground opened in early February.

Working together with council colleagues we have promoted the vaccine to key populations which include residents from ethnic minorities, those with learning disabilities and younger people. We produced a range of different materials and messaging for these groups.

At the same time and throughout the programme, our engagement team has worked with GPs and pharmacists and the local councils to talk to different groups and communities online through virtual meetings and events, answering questions to help address the concerns of many people about this new vaccine.

Kingston and Richmond have some of the highest vaccine uptake rates in South West London and we are already working on messaging, events and materials for younger people as the programme moves down the age cohorts.

1.2.7.4 Preventing and supporting the management of long-term ill-health

Across Kingston and Richmond, we have been working to develop a model of care that supports the development of healthy behaviours within our population and enables people to make healthy choices about their lifestyle.

The model of care focuses on empowering people to be able to self-manage any long-term health conditions, maintaining independence (within the parameters of their disease) and preventing the progression of disease into complexity and frailty.

The prevention element of the model brings together NHS, council and partner services to focus on issues such weight management, mental health and wellbeing and risky behaviours such as smoking and drug use.

Working together, we will also support people to manage long-term health issues such as diabetes and cardiovascular disease themselves using a range of options – from simple information to regular monitoring and management.

Two anticipatory care pilot practices started work looking to proactively support a cohort whose health and social needs, while not currently at the top of the pyramid of need now, are likely to escalate to that in the near future. The objective is to sustain this population with care in or near to their homes, rather than having to escalate to acute sites of care.

1.2.7.5 Journey recovery hubs

Two hubs – one in each borough – provide support for people to prevent imminent mental health crisis. With no need for a referral, the aim of the hubs is to prevent escalation, reduce isolation, increase independence and self-management and improve wellbeing by drawing on strengths, resilience, and coping mechanisms. Both hubs kept going throughout the pandemic offering local people socially distanced, phone and online support.

1.2.7.6 Establishing a GP in-reach pilot at Kingston Hospital

The NHS long term plan describes the need for more joined up and coordinated care, breaking down barriers between health and care organisations and teams to support people with long-term health conditions.

Acute hospital medical teams aren’t always sighted on the breadth of skill of the primary care team, or the admission avoidance services that can be used to facilitate rapid discharge from hospital or the management of patient risk that can be handled in the community and primary care.

As a result, patients can be kept longer in hospital longer that is clinically required and are admitted into hospital because teams are unaware or have difficulty in accessing community alternatives.

During the peaks of the Covid-19 pandemic, primary care and acute hospital clinicians have come together to establish a GP in-reach pilot service at Kingston Hospital.

Working within the hospital setting, GPs have offered a primary care perspective, advising on outreach hospital pathways and primary care services that are realistic alternatives to inpatient care or could support earlier discharge. Also, through the GP in-reach service acute hospital and primary care colleagues have worked together on the implementation of the Pulse Oximetry@Home service, enabling patients to be discharged with good quality access to oxygen.

The GP in-reach service will be piloted for a further six months. During this time the service will be evaluated to determine the difference the service makes to individual patient experience, together with the impact of collaborative working across primary and community services including the reduction in length of stay for patients with long-term health conditions.

In addition, some primary care staff were redeployed into local hospitals to support staff during the surges of the pandemic.

1.2.7.7 Expanded primary care services

Additional capacity was established at short notice during the peak of Covid-19 surges to help direct patients away from the emergency department over weekends and through to 8.30pm during the week.

1.2.7.8 Post-Covid-19 plans for Kingston and Richmond

Across South West London we are implementing a networked approach – centralised where necessary and local where possible. This aims to achieve all the benefits of a single South West

53 London wide service, with local delivery where appropriate for patients also accessing local primary care, social prescribing, IAPT and social care support.

At a Kingston and Richmond level, acute hospital, community services and GPs are working to identify how we are going to deliver the most effective and accessible post-Covid service for local people.

We have begun mapping the services which are in place across all providers (including voluntary sector services) and identifying if and where there are gaps so that we can develop business cases and apply for funding to fill gaps. We are engaging with colleagues in IAPT, social care, public health and the voluntary sector to develop our model which is likely to include a single point of access into services. This will be supported with a public facing communications and engagement plan.

1.2.7.9 Laying the foundations for the integrated care system

A local clinical leadership group was established during the year bringing together clinical and managerial leads from Kingston, Richmond and East Elmbridge and Kingston Hospital to facilitate the introduction of routine advice and guidance within the referral system and the London-wide “talk before you walk” initiative.

Linked primary and secondary care clinician leads have been established across the specialities which is being replicated in South West London arrangements.

Joint communication strategies have been adopted and, as a consequence, changes in the arrangements for access to specialists and patient pathways during the pandemic have been effectively disseminated. Teamnet has been developed and promoted as a repository for document storage and access during this time of unprecedented rapid change.

Leads from acute and primary care have been identified to communicate about service changes in the future so that adverse unintended consequences of such changes do not emerge.

54 - Sutton

1.2.8.1 Development of the “Sutton System” during 2020-21

Sutton has a long history of positive, collaborative working between health organisations and the local authority which provides a strong base for the new place-based arrangements that have been announced recently by NHS England.

The advent of Covid-19 created a clear catalyst for change within Sutton and unleashed innovation in service development and in new ways of working across disciplines and organisations. The pandemic created a unifying mission in Sutton and local integration was supported by the creation of new, agile leadership structures. In essence, two weekly inter-agency meetings were developed; the Health & Care Executive comprising a smaller group of key senior leaders and the Sutton System Leaders comprising a broader representation of stakeholders and focusing on problem solving and transformation.

• Primary Care Network development

PCNs were crucial to the creation of agile and innovative solutions to pandemic related challenges. New local structures were developed as part of the Covid response, including a ‘virtual ward’ to support avoidable hospital admission and hospital discharge for respiratory patients (involving hospital consultants and community-based staff), and community response teams (CRTs) which, among other things, coordinated support to care homes and specific local populations such as people with learning difficulties or mental illness. The virtual ward and CRTs are highlighted in more detail below.

• Development of engagement with local voluntary sector organisations

Collaboration between the statutory and non-statutory sectors also accelerated significantly as part of the pandemic response. Covid-19 generated both the opportunity and the will to take engagement to a new level. This started with efforts to support shielding residents locally and extended to mobilising volunteers to support the local flu vaccination campaign in Autumn 2020 and the Covid- 19 vaccination programme from December onward. This was achieved through the local “health champions” model developed during the Covid-19 pandemic where a key role of the Sutton Health Champions is to disseminate important information to their community networks.

Sutton Volunteers, coordinated by the Sutton Volunteer Centre, also provided important support to the Nonsuch Mansion Vaccination Centre (see below).

Deploying volunteers during Covid has delivered significant value to the volunteers themselves as well wider social value generated by the volunteering activity.

1.2.8.2 Supporting shielded and vulnerable patients

We have worked to ensure that the joined-up ways of working that have been developed during this time across primary and community care are embedded into the way we work going forwards.

• Community Response Teams

Primary Care Network Clinical Directors have worked with partners to develop four Covid-19 community response teams wrapped around primary care networks. These multi-disciplinary teams (MDTs) include community nurses, care home support teams, learning disability (LD) nurses, Age UK Sutton, community mental health, social care, pharmacists and GPs with management support provided by the primary care team. The MDTs support vulnerable people identified as shielded, care home residents and people at the end of their lives. In addition, a closer relationship has developed between LD nurses and the Joint PCN CD leads for LD. Their co-ordinated approach to supporting LD residential care homes has enabled targeted support to be optimised and accessible at the point of need.

This approach has transformed the existing care home support team into a seven day a week service and supported the night nursing community team to develop closer working with general practice and wider health and care teams.

CRT meetings are held formally on a weekly basis with regular contact and communication between teams throughout the week.

This work was already in development as part of our Sutton Health and Care programme. However, as a result of our Covid-19 response, we have seen the rapid implementation of a delivery model that has provided the platform for us to achieve integrated multi-disciplinary teams.

GP practices also worked to support patients who had to shielding. These patients were contacted to discuss what shielding means, any changes to their ongoing care and treatment, to confirm what arrangements they have in place for receiving medications and to ensure they are aware of the government support offer.

Social prescribing is an integral part of the PCN’s MDT response to supporting patients identified by GPs with complex medical and social needs; those at risk of loneliness, isolation and requiring support with food delivery whilst self-isolating. Sutton’s Social Prescribing Service has engaged with over 500 people since 2019.

The Community Response Team’s work has been further enhanced by the development of the Sutton Covid Virtual Ward which was launched on 2 February 2021.

• Covid-19 Virtual Ward

The Covid Virtual Ward has been developed with the aim of prioritising patient safety and care and delivering community wraparound services to support prevention of unnecessary hospital admission. The most vulnerable patients are supported through the Community Response Team with food and medication delivery, welfare checks and coordination of statutory and non-statutory support as appropriate. Patients are also supported after discharge from hospital, including those with chronic diseases and long Covid. The service also actively manages patients who are at risk of deterioration where they have significant anxiety because of this. A remote monitoring system which supports clinical management and escalation of patients is being piloted.

Phase 1 of the service has been designed for:

o Adults 18 years and over o Patients with acute Covid or Covid related symptoms who have been discharged from hospital to the Community Pulse Oximetry @Home Service. These patients are at significantly higher risk of deterioration and this enhanced monitoring and treatment gives confidence to discharging clinicians and patients that they will be safely ‘cared for’ virtually. o Covid-19 positive patients in learning disability and elderly residential care homes. o Going forward, as part of phase 2, the service will support: o Non Covid-19 patients with chronic long-term conditions such as COPD, heart failure, uncontrolled diabetes, frequent callers or frequent attenders who are at risk of hospital admission and require multidisciplinary primary and community support for a short period. o Frail patients who require short intensive support with social and wellbeing interventions to prevent unnecessary hospital admissions. o Following the implementation of Sutton Covid Virtual Ward, weekly MDT meetings have evolved to virtual ward rounds which are held three times per week with input

from hospital respiratory consultants. Between February 2021 and March 2021, total of 108 patients were admitted to the virtual ward, including the pulse oximetry service.

1.2.8.3 Support for Care Homes

For over five years the Sutton Health and Care system has built a strong partnership to provide oversight and support to care homes within Sutton. The system is overseen by the Sutton Health and Care Executive, which includes, the Sutton Council, NHS South West London CCG Sutton Borough Team, Sutton Health & Care Alliance (health and care providers) and the community and voluntary sector organisation. Our partnership has given us a strong foundation to quickly respond and provide effective, joined up support to care homes before and during the Covid-19 pandemic which is documented in our joint plan - Supporting our Care Homes to remain safe | Sutton Council

Some of our key achievements include:

• Over £2 million has been allocated to over 100 providers to support infection control within care homes • Every care home has received face to face IPC/PPE training via the Train the Trainer Model. This covers 1,200 staff. Since August 2020, additional IPC training has been delivered to 194 staff from domiciliary care providers, Supported Living, day centres and care homes requiring refresher course • Provision of active management of Covid-19 outbreaks and outbreak management process developed • Weekly care home support Q&A live sessions providing advice and guidance, sharing learning between homes and learning from the experience of care homes to shape support. • Developed and Launched a new Sutton Care Hub with latest guidance and support for Care Providers in Sutton

During the Covid- 19 pandemic support for 78 Sutton care homes (28 for older people, 43 for people with learning disabilities and seven for people with mental health issues) was delivered through a quality improvement programme (Alert- Response and Plan - ARP) which aimed to identify and control outbreaks, provide on-going support and training on infection prevention control (IPC) including use of Personal Protective Equipment and reduction of illness and complications.

Learning from evaluation of interventions and response during Covid-19 is informing the development of a joint local authority and CCG quality improvement framework that will underpin ongoing support to care homes.

Some feedback from care homes managers is included below:

Sarah, Manager at Crossways said: “I have received support from all areas, I‘ve been able to talk to the Infection Control Nurse whenever I have had a query or question if not straight away, later on in that day. The guidelines that we have had to follow have been very clear. The funding has helped massively and we have been able to use the fund to improve our infection control/cleaning hours and also enable visits from families (before our outbreak!!). Having the current testing fund has enabled us to use a member of staff specifically for swabbing/registering. She has felt really empowered in this role and has done lots of research herself which in turn has helped all of us”

Arthur, Manager at Belmont said: “I like the local public health approach “you are not always right, I am not always right, let’s discuss, let us resolve the problem, let us not blame anyone, let us learn together, let us support each other and share good practice.”

1.2.8.4 The vaccine programme

• Nonsuch Mansion Vaccination Centre

Sutton’s 23 GP Practices formed a single “Primary Care Network Grouping” to deliver Covid-19 vaccinations using a new collaborative model of care. The GP practices, alongside the NHS Sutton primary care transformation team and Sutton Health and Care community services worked as a single, blended team to rapidly mobilise a local vaccination service for Sutton’s residents at Nonsuch Mansion in Cheam. The vaccination centre opened on 15 December 2020, with staff from the GP Practices working together to deliver Pfizer vaccinations to people living or working in Sutton or registered with a Sutton GP. As of 31 March 2021, over 20,000 vaccines have been delivered at the centre.

The vaccination service at Nonsuch Mansion has been supported by over a hundred volunteers. Coordinated by the Volunteer Centre Sutton, these volunteers helped support people visiting the large site. They made sure people maintained social distancing and that infection control measures were adhered to at all times, with minimal waiting time outside or inside the building, helping to ensure that everybody has their vaccination safely.

• Vaccinations in the community

As well as the vaccination centre at Nonsuch Mansion, Sutton’s GPs, working with Sutton Health and Care Community Services, have taken Oxford Astra Zeneca (Oxford AZ) vaccines into the large number of residential, care and nursing homes across the borough, to vaccinate both residents and staff. The teams have also visited Sutton residents at home to deliver vaccinations to people who are housebound. Sutton’s GPs are also vaccinating their registered patients at practices across the borough.

• Outreach

Sutton’s GPs have set up pop-up vaccination clinics to reach vaccine-hesitant communities, in places of worship, at traveller sites and for the homeless, with plans in place for future pop-up clinics for underserved populations such as unaccompanied asylum seekers.

1.2.8.5 Post-Covid-19 plans for Sutton

At a Sutton level, acute hospitals, community services and GPs are working to identify how we are going to deliver the most effective and accessible post-Covid service for local people.

- Improving Healthcare Together

In 2017, Epsom and St Helier University Hospitals NHS Trust (ESTH) published a strategic outline case to address the challenges facing both Epsom and St Helier hospitals, relating to concerns around clinical sustainability, financial sustainability and the suitability of their estates. Following this, in 2018, the Improving Healthcare Together (IHT) programme was launched by Surrey Downs, Sutton and Merton Clinical Commissioning Groups (the CCGs) – who were responsible for planning the majority of NHS hospital and community services for local people. The aim of the IHT programme was to determine the potential solutions to the challenges at ESTH for the combined geographies of the CCGs.

In January 2020, the IHT programme launched a 12-week public consultation to ask the public for their views on three options to invest £500 million of national funding to build a new specialist emergency care hospital – on the Epsom, St Helier or Sutton hospital sites. During the consultation supported by our borough communications and engagement teams, stakeholders, residents living locally and in neighbouring areas were invited to provide feedback through a wide range of methods which included a range of activities including listening events, focus groups, community outreach and telephone surveys– these can be seen below together with the level of response.

On 3 July the Committees in Common (CiC) for NHS South West London and NHS Surrey Heartlands CCGs met to decide on the way forward for the Improving Healthcare Together programme and the £500 million investment to our improve hospitals. After reviewing the evidence presented, including the decision-making business case and the feedback from the 12-week public consultation the Committee approved the £500m investment for Epsom and St Helier hospitals and a brand-new specialist hospital to be built in Sutton. The Committees in Common also announced a range of measures to address issues around transport and travel, bed numbers and services for older residents and more deprived communities, which were raised during the recent public consultation. This included commissioning a further independent ‘deprivation review’ by The King’s Fund to look at the future needs of communities in East Merton and North Sutton, reviewing bus routes into Merton and further south into Surrey beyond Epsom and car parking on all three sites, to make sure there is enough for patients, visitors and staff.

Following the decision-making meeting in July 2020, the plans were referred by London Borough of Merton to the Secretary of State of Health, who appointed the IRP (Independent Reconfiguration Panel) to review the case and advise. In October 2020, the IRP concluded their review and published their advice, with the IRP Chair writing to the Health Secretary stating that the “change is

62 essential and requires significant new capital investment to provide appropriate buildings” a copy of the IRP letter can be found here. We welcomed this additional scrutiny and IRP conclusion.

Epsom and St Helier University Hospitals NHS Trust is now taking the programme forward including all the recommendations under the new name of ‘Building Your Future Hospitals’, developing an outline business case which will define the design and plans for the new specialist emergency care hospital at Sutton, whilst refurbishing outdated hospital buildings at Epsom and St Helier hospitals.

1.3 Engaging people and communities Patient and public engagement (PPE)

The Covid-19 first wave – initial activity

During the first wave of the pandemic, for most health and care providers, including the voluntary sector, the focus was on responding to the pandemic – with non-essential roles being redeployed to support the front line. During this period, our communications and engagement priority was to understand the impact of the pandemic on the behaviours and attitudes of our citizens and staff.

Over the summer, through working with our borough communications and engagement groups, we conducted an in-depth mapping exercise to find out what engagement and insight has already been gathered or is planned by our health and care partnership organisations. And to identify where there are gaps – both in terms of services and insight from diverse communities and staff. We synthesised the findings from across the following data sources:

• Six Healthwatch surveys of around 1,000 people • 475 people from the South West London Citizen’s Panel • Patient Engagement / Reference Group meetings • Voluntary Sector Coordination Group meetings • Centre of Independent Living meeting • Children and Young People trailblazer (Kooth/CAMHS/Schools) • South West London and St George’s Mental Health Summit

Although the surveys asked different questions there were common themes which included:

63 • Experiences of NHS services • People’s concerns about Covid-19 • Impacts on mental and physical wellbeing • How people found out information about Covid-19 and services available • Using the NHS for non-Covid services.

The findings were then grouped by borough and themed across our work streams to feed into our recovery work.

We followed the same process for health and care staff, mapping what insight work had been done with staff across the partnership and drawing out key themes for organisations to respond to.

We presented the findings to the South West London Recovery Board and used them to inform our communications and engagement priorities for the recovery work programme. In short it was agreed that:

• There was value in sharing citizen and staff insights across boroughs. • Our South West London communications and engagement team would support priority areas for recovery workstreams and within each borough, actively supported and advised by multi-agency communications and engagement groups at borough level including local authority communications leads, Healthwatch and voluntary sector leads for each borough. • We would meet each programme lead and each borough lead to prioritise communications and engagement work in boroughs and across South West London. • Continue with next phase of the South West London the ‘NHS is here for you’ campaign, focusing on cancer, maternity and mental health, with clinical advice, staff insight and insight and from communities. • Continue open and transparent communications with partners, citizens and staff about essential service changes to keep patients and staff safe during the pandemic.

Recovery work programme

During recovery and to prepare for the second wave, it was essential that we made every effort to continue to hear and act on the patient voice. Our priorities were to:

• Understand the impact of Covid and any changes to services

• Make informed decisions • Adapt services if and where possible

To support this, we needed to continue to:

• Communicate transparently and openly • Influence perceptions and behaviours of local people, increasing access to services and healthy behaviours

During this time, we continued to meet and seek advice from the South West London Community Engagement Steering Group (CESG, made up of Healthwatch and voluntary sector representatives from the six South West London boroughs) and with communications and engagement groups at borough level, including communications leads from health and care organisations from NHS, Local Authority, Healthwatch and the voluntary sector.

As agreed by the recovery board, we allocated a communications and engagement lead to each recovery workstream. This enabled us to:

• Understand where citizen and staff insight would be helpful to influence planning and decision-making, particularly to reflect the needs and experiences of vulnerable and at-risk groups and reduce health inequalities. • Communicate clearly and transparently to our patients, citizens and stakeholders about how we are adapting the NHS to manage future potential Covid-19 outbreaks, and also treat our non-Covid patients safely. • Make sure we are demonstrating that the NHS is carrying out our Duty to Involve with due regard to equalities, health inequalities and taking stakeholders and communities along with us. • Target communications and engagement work to reduce inequalities, raise awareness, influence behaviour in terms of access to the most appropriate services. For example, the ‘NHS is here for you’, NHS 111 First and seasonal flu campaigns with specific priority citizen groups. • Work with communications and engagement professionals from our health and care partnership across each borough to support strong staff engagement and communication around recovery.

Work we prioritised in some of the recovery work streams includes the NHS 111 First campaign and establishing elective surgery hubs.

NHS 111 First

For urgent and emergency care one of our priorities was NHS 111 First – developing assets and talking to community groups to reassure that NHS 111 is the safest way to get non-life threatening but urgent and emergency care. Our aim was to encourage uptake in 111 and identify barriers to access.

Elective surgery hubs

Within elective care, we looked at the support we could provide around the move to surgical hubs, a new way of working together across acute trusts to increase planned and elective surgical care for local people. As people were not able to influence where these hubs would be, our priorities were to:

• Develop clear and transparent communications about choice, transport, access reassurance to local people. • Capture patient experience data to understand experience and impact. To support this we worked towards developing a standardised metric for patient experience across our sites.

Overview of South West London Covid-19 vaccination programme engagement

Communications and engagement work has been integral to the successful delivery of the biggest vaccination programme in history. To support the delivery of this programme our objectives are to:

• Build confidence in the Covid-19 vaccines. • Manage expectations about when local people will receive their vaccination. • Increase uptake, particularly in priority communities and those experiencing health inequalities, by listening to and understanding local concerns and providing information in a factual and unbiased way. • Support our NHS frontline teams with their operational communications around delivering the vaccine.

66 Together with the borough communications and engagement groups, we developed local communications and engagement plans. These were informed by the Equality and Health Inequalities Impact Assessment (EHIA) and local intelligence and prioritised engagement with those communities who are eligible for the vaccine, from communities experiencing inequalities and where we knew uptake would be lower.

The overarching principles are to inform to help people make the right decision for them and their families, provide information from trusted sources in the community and NHS, and co-develop the messages.

Our six borough plans have four key elements to build confidence in the communities above, however, the specific populations of focus are locally informed by the indices of multiple deprivation and data on vaccine uptake. These elements are:

• Broad community engagement • Working with local influencers • Supporting engagement in primary care • Social media and digital content

Broad community engagement

67 We have been working with the voluntary and community sector to host ‘community conversations’, to hear and respond to feedback, answer questions and gather insight. We champion ‘every contact counts’ supporting staff to have ‘confident conversations’ with local people and patients. Signposting people to our ‘single source of truth’ NHS South West London CCG website.

Working with local influencers

Working with key local influencers (faith leaders, community champions, health care professionals) we have been leading and hosting host conversations building trust and confidence in the vaccine within our diverse communities.

Our event for the South West London Muslim communities led by Shaykh Suliman Gani, the Imam of Purley Mosque, continued to have impact through the webinar being shared through the Imam’s private broadcast channel reaching over 30,000 people.

Supporting engagement in primary care

We have been signposting people who have declined their invitation to be vaccinated to community sessions and are working with practice link workers and social prescribers to reach local people. We ran Q&A sessions with social prescribers and link workers in Merton and are planning a larger South West London session at time of publication. We have made sure that our link workers are connected to the London wide training programme to support them to speak to local people.

To support uptake of the vaccination, three personal approaches are offered by GP practices to patients: text or letter to offer appointments, follow up with phone call from the practice, follow up call with their GP. We have been offering engagement and primary care support to GP practices with low uptake to support follow up on decliners in Croydon in particular.

Social media and digital content

All our social media and digital content work is underpinned by culturally relevant content featuring trusted community influencers, including paid-for boosted and targeted local content on social and digital media in postcodes where there is lower uptake. We have been mapping and targeting local

68 media aimed at ethnic minority groups and continue to produce materials in different languages and formats on request. We are also monitoring social media platforms and responding to misinformation and queries to increase confidence.

In Croydon, we worked with the Asian Resource Centre to create a series of short Q&A films with Croydon doctors. We have a Merton GP fact checking videos in response to real time concerns and have produced a “Conversations with my Mum” video to highlight the experience of Black members of NHS staff talking to their parents about the vaccine.

Borough level vaccination engagement

1.3.6.1 Croydon

Building vaccine confidence and developing community focussed vaccination clinics

We funded the Asian Resource Centre of Croydon and Croydon BME (Black and Minority Ethnic) Forum to run a series of question-and-answer sessions with clinicians from ethnic minorities and including some in community languages. These online sessions were attended by nearly 3,000 local people. Polls at the beginning and end of each session showed that people left feeling both more informed and more likely to accept the invitation when it was offered. Feedback showed that people felt that having clinicians that looked and sounded like them gave reassurance that the vaccine was for them. One of our insights was that people would trust the vaccine more if it was delivered in a culturally appropriate way. We developed a more agile approach to delivering the vaccine and have had open access clinics in Croydon Mosque, His Grace Evangelical Church, Night Stop and Turning Point, with more planned for 2021/22.

Croydon Vaccination Equity Task and Finish Group

Dr Nnenna Osuji, Medical Director and Deputy Chief Executive of Croydon Health Services, has brought together a task and finish group to support uptake amongst our diversities throughout the Covid-19 vaccination programme. Lead clinicians including Dr Agnelo Fernandes, Rachel Flowers, Director of Public Health, Dr Dev Malhotra and Dr Neil Goulbourne meet together with Cllr Janet Campbell and community and voluntary leaders and the communications and engagement work to plan together interventions that will help increase confidence in the vaccine.

As we move forward with the vaccine programme we are keen to adapt further to better ensure any variation in uptake amongst our communities is based on individuals being able to make an informed decision. Together the group has a systematic approach to optimise uptake, coordinated through a dedicated Croydon wide task and finish group hosted by the Local Strategic Partnership.

Croydon – The virtual health network

Our virtual health network of nearly 500 local residents and voluntary sector representatives has supported the informing element of our engagement; sharing our weekly vaccination updates with more than 20,000 local people. We include information about engagement events coming up and invite people to recommend community groups wishing to talk to us, as well as inviting feedback on the messaging itself. As a result of feedback we now include bulleted highlights at the top of each email for those who may not be able or want to read the whole update.

1.3.6.2 Merton

Improving vaccination process for people with a visual impairment

We delivered an online engagement session with individuals who have a visual impairment and Merton Vision staff members to help inform the vaccination programme approach for this cohort of people. Merton Vision have a directory and expressed they were happy to help support the vaccination programme.

What we heard:

• Concern about the consistent use of communication preferences. People get fearful of the change and miscommunication. • It is ideal for patients to attend a more familiar setting. • Some vaccination centres and GP reception staff have been unhelpful in supporting booking the vaccination. • It’s hard to type in all of your details and locate different information like your NHS number. There needs to be a more accessible way of booking the vaccination. • The purpose of the vaccination card is not being clearly explained. • Concern about individuals with a visual impairment missing appointments.

What we did:

70 Following the session, large print leaflets and posters were made available at the site. The management team organised a volunteer huddle and volunteers/chaperones will be told to proactively approach individuals with a visual impairment. The purpose of the vaccination card is being made clearer to individuals during the appointment.

Vaccinating people with learning disabilities

We worked with Merton Mencap to provide online engagement with individuals with learning disabilities and carers to help inform the vaccination programme. Attendees shared:

• Concerns about needle phobic individuals. It would be helpful for individuals to work with a psychologist to help them prepare. • Concerns about turning down a vaccine if you are unsure of the process - can we alleviate concerns beforehand. • Concerns about consent if there isn't a carer or advocate available. • Easy read materials would be helpful. • More information needed about carer registration. • Can families temporarily register together so they can get the vaccine together.

Feedback from the sessions helped to inform conversations about the learning disability clinics. Initial conversations included adjustments to ensure patients are comfortable. A learning disability manager has now been trained as a vaccinator. We are currently running community clinics, as we are aware it is hard for people in the middle of borough to reach some of the local centres.

1.3.6.3 Wandsworth

Co-designing a pilot sensory clinical for young people and parents with learning disabilities and autism

We co-created several engagement workshops for people with a learning disability or autism and their carers. These workshops included interactive easy read and photo symbols content including online speedy quizzes, Q&As with a GP and creating Zoom videos.

Over half of the people we spoke to were from ethnic minority backgrounds and at higher risk of the virus. We heard that many were experiencing barriers to having the vaccine including stressful unfamiliar clinical environments, unfamiliar people, the need for a slower pace and needle phobia.

71 An idea was sparked and our local GP clinical lead Dr Nicola Williams together with Share Community worked to overcome this by creating a special pilot clinic.

We coproduced a video with Share featuring a visual ‘walk through’ of what happens when you come for your jab in a soothing environment surrounded by virtual images and music such as swimming turtles to positively distract and for parents and carers to feel at ease about what will happen when they come for their vaccine. We also made a ‘meet the Nurse and GP’ video featuring a Zoom Q&A to provide accessible facts about the jab.

Due to the success of the approach the team are planning the next sensory clinics open to more people from the community who have learning disabilities and autism.

Pilot sensory vaccine community clinic video: Pilot sensory Covid-19 vaccination clinic - YouTube

Meet the Nurse and GP and Zoom Q&A Video: Share Community NHS Wandsworth Covid-19 Vaccine Video

Wandsworth – Building confidence in the Ahmadiyya Community

Together with the Ahmadiyya Muslim Community in Wandsworth we delivered two evening Covid-19 Vaccine engagement sessions with our trusted clinicians Dr Ban Haider and Nick Beavon, our Chief Pharmacist reaching 100 and 147 families respectively. The use of Urdu interpreters was highly valued helping to ensure the information was appropriately tailored and clear.

Their feedback and offer to host a community vaccine clinic led to us work together with Ahmadiyya and the Wandle Primary Care Network led by Dr Laura Quinton to plan Wandsworth’s first pop up vaccination clinic at the Fazl Mosque in Southfields. The community clinic proved a great success with over 1000 members of the community taking up the Covid-19 jab in just one day on the National Covid Day of Reflection which marked the anniversary of the UK's first national lockdown.

The National President of the Ahmadiyya Muslim Community UK, Rafiq Hayat said:

“Recent studies have shown significantly lower than average take-up of vaccines among people from ethnic minorities, however as Muslims, service to humanity is our duty, and we have been clear that we fully support the vaccination programme.

“We are very grateful to the NHS heroes who are working hard to protect the health of the nation - they deserve our constant prayers and immense gratitude.”

1.3.6.4 Kingston

Listening to people living with a disability

We organised a Covid-19 session with Kingston Centre for Independent Living (KCIL) which was attended by more than 50 people living with a disability and their carers as part of their monthly online coffee morning. The session gave people an informal opportunity for them to put questions to a clinician including concerns about the safety of the vaccine, side effects and fact checking. The session was very well received, and we have been invited back for follow up sessions to continue the conversation about the Covid-19 vaccine.

Fact checking vaccination myths in Arabic

We held two Covid vaccine sessions entirely in Arabic, with an Arabic speaking GP providing information about the Covid vaccine, fact checking and reassuring around issues such as porcine content. Organised in partnership with Refugee Action Kingston, these sessions reached refugees, asylum seekers and permanent residents who speak Arabic in the borough. We were pleased to see more men and a younger age group join the second session. At the beginning of the discussion less than half were keen to have the vaccine but at the end all indicated they were going to have the jab when offered.

1.3.6.5 Richmond

Healthwatch webinar

We have worked with several of our local community partners to engage with residents and communities about the Covid vaccination programme. Together with Healthwatch we hosted a virtual webinar joined by more than 300 Richmond residents. Healthwatch Chair Julie Risley chaired a Q&A with a panel including Dr Patrick Gibson, GP Borough Lead for Richmond, Tonia Michaelides, Richmond Locality Executive Director and Shannon Katiyo, Richmond Council’s Director of Public Health. The webinar is available on Healthwatch Richmond website for those who couldn’t attend and the wider population. Watch the webinar at https://www.healthwatchrichmond.co.uk/news/2021-03-19/Covid-19-vaccinations-richmond-live- webinar

Working with higher at-risk groups

We partnered with Multicultural Richmond and Richmond Council to host a Q&A event for residents from an ethnic minority background. The event is available on Richmond Council’s YouTube channel ensuring it is available to a wider audience than those that joined on the day. Watch the event at www.youtu.be/uY9nYul6kV0

We are also working closely with community organisations in our less affluent areas to ensure residents can engage in the discussion about the vaccine and can put their questions direct to local GPs, like the “Let’s talk about the vaccine” community conversation hosted by Castelnau Community Project. Though most attendees indicated they had or would have the vaccine there were a few maybes who when asked again at the end of the conversation had changed to saying they would have the vaccine. The main topics for discussion where safety of the vaccine in relation to fertility and pregnancy; side effects and safety concerns with AstraZeneca vaccine after media coverage about the potential link between the vaccine and developing blood clots – a link that has now been disproved.

We are also starting conversations with our younger population. The first was with Youth Out Loud! (YOL!) and Kingston & Richmond Youth Parliament. We answered questions on wanting to understand more about the speed of the trials and safety, the role of fake news and scepticism about long terms effects and effectiveness. We discussed what it means for younger people under 18 years of age, for example, “helping us get back to normal”. YOL! and our Youth Council are keen to encourage debate and share information about the vaccine with young people. They have suggested working with the us to design social media posts targeting younger people and having the vaccine as a future topic for their YOL!Talks podcast series. Listen to the podcast at www.healthwatchrichmond.co.uk/news/2021-03-10/yoltalks-podcast-series-youth-out-loud

1.3.6.6 Sutton

Reaching people experiencing health inequalities

During the pandemic, one particular engagement challenge was we faced in Sutton was how to reach the seldom heard and digitally excluded residents. We worked with our Sutton Health Champions who are embedded in all 18 wards across the borough. We have 67 Sutton Health Champions, who all live in the ward they reach out to and include members of the public, community groups, residents’ associations, faith leaders and volunteers. Through the champions, we identified

74 effective community distribution channels (including Facebook, Twitter, Instagram and email distribution) and have a total reach of more than 180,000 residents in total. The Sutton Health Champions have helped us to identify and reach a number of vulnerable residents, including:

• Sutton Housing Partnership through their weekly welfare calls to vulnerable adults with LD and mental health issues • Neighbourhood watch coordinators who can identify and reach Sutton residents who are not on their email distribution list. Leaflets were dropped in housing estates in deprived areas by local volunteers. • Local volunteers through targeted comms (posters on lamp posts, leaflet drops to local shops, pharmacies etc.) • We reached over 20,000 residents in Sutton’s top five deprived communities and held engagement events with various groups about the Covid pandemic.

Vaccination take up in the Traveller community

We have worked in partnership Sutton Housing Partnership, Cognus (Education Traveller Service and the Public Health team at Sutton Council to help increase vaccination uptake within the Traveller community in the borough. Two visits were arranged with Sutton Housing Partnership Lead and Cognus (introductory phone calls). The introductory visit to build trust at the Pastures Site and second visit to give Covid vaccine (both sites). The joint team liaised with the Traveller community to arrange an on-site information session and offered to vaccinate anyone over the age of 18 on-site who wanted it, without the need for the Traveller to attend a GP surgery. Travellers were also able to ask any questions surrounding the vaccine and receive reassurances from Dr Ellie Bernard, Partner at The Manor Practice in Wallington. Advice was also given on the all-around health service available from local health services in Sutton. 22 Travellers received the Covid-19 vaccination in March at The Pastures and The Grove.

• Six families have shared their personal contact details with Senior Engagement Manager (Sutton) which shows trust has been established • Four families are in the process of changing surgeries from Banstead to Manor Practice • Improved working relationship among partners which has led to further conversation on offering health information to the Traveller site for things like mental health services and health checks.

The insight is fed back to the Programme Board and project team, via bi-weekly vaccine planning meetings (see diagram below), to inform operationally how and where the vaccine is delivered for example, the location of pop-up vaccination clinics in each borough. It also informs what reasonable adjustments are made to support equal access. Lastly, we use the feedback to inform our messaging, and comms and engagement approach.

Covid vaccination communications and engagement with staff

Our communication and engagement approach with health and care staff has been informed by the insight gained through Covid staff survey – which we conducted in December 2020. We had over 2500 responses. The survey explored what staff think about the Covid-19 vaccination, to help inform communications /engagement, as well as what we could do to support them to have confident conversations with their staff.

Most (82%) felt positively about the vaccination; however, there were 7% who feel negatively. Around three quarters (76%) would have the vaccination if it were offered, while 9% would not and 15% were undecided. Results were generally very consistent across organisations. But there was evidence of more scepticism/ reluctance to receive a vaccination among particular groups of staff: Residential/Domiciliary Care – significant at only 42% saying yes, compared to 76% overall average. Within certain ethnic groups there was more hesitancy: only 34% Caribbean/Caribbean British, African/African British & Other Black/Black British respondents said they would have vaccine.

While most staff (65%) felt extremely/somewhat confident to talk to others about the vaccination and answer questions, around 1 in 3 (35%) are not so/not at all confident.

Informed by this, partner organisations developed local plans to engage with their staff. As a CCG we took the following actions:

• Key messages in team talk and Q&A sessions

• Intranet developed as hub for ‘single source of truth’ for staff • All staff briefings including opportunity to ask questions and receive an update about vaccine rollout • Line managers to have 121 conversations with team members to listen and understand any concerns, signpost to guidance and advice. • Daily update with content promoting local events for staff to attend and ask questions.

We also developed a ‘Top tips’ for confident conversations – will was shared with all staff and followed up with those in front line roles.

Service Change, engagement in commissioning and pathway redesign

1.3.8.1 Maternity

We have supported our Maternity Voices Partnership/Maternity work stream to map – via story- based interviews – the maternity journeys of women from ethnic minorities. This aligns with a national priority to improve services, and access to services, for/by women from ethnic minorities following publication of a study indicating that women from particular ethnic groups experienced notably worse birth outcomes – including death of mother and/or baby – compared to women of white (majority) ethnicities. The work is ongoing, but we have supported it by developing interview protocols and a framework for the process of capturing stories, delivering training in how to use this method as a research/engagement technique, and leading on the engagement element of the project.

1.3.8.2 Urology

We ran several focus groups to support the urology clinical network to standardise urology pathways across South West London. The aim was to ensure that patients to receive the same quality of treatment, no matter where they live.

We held two focus groups and invited local people to share their experience of prostate care and accessing care for frequent UTIs. The aims of the focus group were to:

• Understand and listen to people’s experiences of accessing prostate care across South West London.

78 • Listen to suggested recommendations for a future service. • Share why having one single pathway for prostate care (non-cancer) across South West London could be a good idea. • Feedback gathered during the prostate focus group had the following impact: • The Lower Urinary Tract pathway will be changed and will include signposting to prostatitis pathway. • The pathway will include early appropriate investigations and treatments in Primary Care – to help advocate for greater access to imaging from Primary Care • As a result of the UTI focus group: • The frequent UTI pathway will be changed to include self-help remedies • The importance of conditions which can lead to complicated recurrent UTI will be widely promoted • A urology webinar will be set up – training to raise awareness that an STI is not the only diagnosis in young patients with symptoms.

1.3.8.3 Services to reduce social isolation and loneliness in Croydon

As part of our mental health transformation programme, the Mental Health Programme Board has adopted learning from the One Croydon Alliance Local Voluntary Partnership framework with has funded VCSEs to provide services to reduce social isolation and loneliness in people over 55 years old with complex health and care needs. The mental health commissioning team has worked with a number of voluntary and community sector organisations to develop a local voluntary partnership mental health approach to award grants to VCSEs which deliver services to Croydon residents and provide or arrange for services to those which the CCG has a statutory function for adults with an identified mental health need. This enables successful VCSEs to work in new and flexible ways with communities to develop new solutions to persistent challenges and to reach out to people who aren’t often heard to offer a vital source of insight, both about issues and possible solutions. Successful applicants will receive funding for a period of two years and will allow approaches to be developed, piloted and evaluated where this would not otherwise be possible VCSEs have knowledge of the needs and strengths of their clients, are aware of current issues and can represent the voice of their clients and support them to be more directly involved in health and wellbeing strategies and plans.

1.3.8.4 Raising awareness of long-term conditions and risk factor amongst Croydon’s diverse communities

Our Primary Care and Community Care have funded the Asian Resource Centre and Croydon BME (Black and Minority Ethnic) forum to carry out targeted outreach work to raise awareness of long- term conditions and risk factor amongst our diverse communities. This work targeted people who are socially isolated or lonely, people living in deprived parts of the borough, people from Black, South Asian and other minority ethnic groups and people with a family history of long-term conditions. Due to Covid-19 and lockdown restrictions, which led to the closure of many of our smaller CVS groups, ARCC and Croydon BME Forum worked in partnership with member organisations to hold online events including the online diabetes groups, online health workshops, online coffee mornings and one to one health check meetings. A community champions model has supported community grassroots awareness of long-term condition risk factors, the important of screening, early identification and self-management. The champions also collect community conversations about the barriers to engagement, awareness of services, health information and community dynamics. We were able to adapt this model and the networks and connections made for holding ‘community conversations’ about the Covid-19 vaccination in late 2020 and early 2021.

1.3.8.5 Supporting Croydon’s voluntary groups to help reduce health inequalities

In January, the One Croydon alliance has been chosen as one of just six health partnerships in England to benefit from a multi-million-pound cash injection as part of The Healthy Communities Together programme, established by The King's Fund and The National Lottery Community Fund.

The funding will support partnership-working between the voluntary and community sector (VCS), the NHS and local authorities, and will help them make the most of their combined capability to improve the health of their communities.

One Croydon was selected from more than 270 applicants after demonstrating how it aims to tackle deep-rooted health inequalities and improve the links between health and care services and the communities they serve so that local needs can be better met.

The Covi-19 pandemic has rightly drawn attention to the health inequalities facing many of our residents and there’s never been a more important time to continue work to tackle these issues. Our vision is to transform how we deliver care, and our One Croydon alliance has been working hard to do this since 2017, empowering local people and communities and bringing together

80 health and care to create cohesive services, and we know we need to do more to help reduce local health inequalities.

The voluntary and community sector in Croydon is incredibly strong and well placed to help people improve their wellbeing. We’ve have seen this in action in the collective local response to the pandemic and now we want to build on and develop an even better quality of partnership for our borough.

1.3.8.6 Trailblazer: Improving emotional support in Schools - Special Educational Needs school cluster engagement in Merton and Sutton

The Trailblazer programme was created in response to a high number of children who were found to be self-harming across South West London. Its objective is to reduce the number of children self- harming in South West London through a ‘whole system’, multi-agency approach, using health, education, and local authority resources to provide support in schools to parents, carers, and children and young people at an early stage.

NHS Merton is working closely with NHS Sutton and the Special Educational Needs cluster, focusing on SEN schools in both boroughs. The cluster is auditing practices to assess the current provision and where improvements can be made. Audits will feed into the wider cluster action plan. Engagement with CYP will help inform the whole system approach.

Key learning from previous work with cluster schools, included; it would be helpful for teachers to lead/co-lead the session or be present in the room, to ensure the questions asked were suitable for the students. Therefore, support on the project has an emphasis on providing resources and materials to the schools, to help support the teachers to deliver the engagement sessions.

We have begun initial conversations with the cluster, sharing best practice engagement, discussing what level of engagement will work with each school and what reasonable adjustments need to be made to ensure all students can access the session and provide feedback.

We are meeting with each school to help support the planning and delivery of the engagement sessions.

81 1.3.8.7 Optimal Ageing in Merton

The overall aim of the project is to compress the period of disability and dependency at end of life and therefore reduce the need for health and social care.

The project is a population health management approach to change attitudes and culture around ageing, and as a result help older people ‘live longer better’.

There are two main strands to the project:

• Engaging directly with citizens giving them content through a new digital platform called the Wellness Interactive Support Hub (W:ISH). The aim is for W:ISH to signpost people to existing information that is relevant to them – particularly lots of the great campaigns and resources created and developed by third sector organisations. • Creating ‘Live Longer Better’ networks in each borough. The plan is to bring together social and healthcare professionals to create a network of individuals interested in counteracting ageism and empowering older people to increase their health-span.

We have supported the team to engage with the Patient Engagement Group. The PEG has providing views on the project and it’s aims and will help to support and share local content that could be used on W:ISH.

1.3.8.8 Coproducing the delivery of the Joint Council / NHS Learning Disability Strategy in Wandsworth

We delivered eight engagement sessions reaching nearly 80 people to inform and test the Joint Wandsworth NHS South West London CCG and Council Learning Disability Strategy 2021-2026 from the point of view of people who use and need Learning Disability services. You can read the LD Engagement Report

This resulted in a chapter and overarching key priority of the Wandsworth Learning Disability Commissioning Strategy 2021-26 titled: My Voice is Heard – Coproduction.

We also supported a Wandsworth community grant project to develop simulation video training so that people with a Learning Disability can train NHS staff in coproduction and to develop annual health check appointments and health action plans.

You can watch the Baked Bean video training session at https://www.youtube.com/watch?v=10ip3fMzt9k

We have been working together with advocacy organisations in the borough to improve accessibility of the Learning Disability Clinical Reference Group and to plan the six working groups which will each have a membership of representatives who access Learning Disability services to shape services going forward. To enable their inclusion and reduce the digital barriers to taking part exacerbated by the pandemic, we are delighted that we have matched funding with the Council to provide accessibility enabled computers and digital devices and support for all to take part.

1.3.8.9 The Neuro Voices Strategy in Wandsworth

Our Patient and Public Involvement Reference Group and Thinking Partners group have supported the clinical networks by helping to shape the Neuro Voices Strategy which has an overarching aim to reimagine and rethink how services are delivered to improve the patient experience of Neurology services reflecting the diversity and complexity of the needs of people living with neurological conditions and their family members from across South West London.

Work started by codesigning the care pathway between primary care and the clinical assessment hub at St Georges Hospital and is being informed by our work in partnership with Healthwatch on Wandsworth experiences of digital and telephone health and care appointments. The referral process now captures important data to address inequalities and reduce barriers to access. This includes communication needs, digital capability to identify when virtual consultations are appropriate and enable better access.

1.3.8.10 Crisis Retreat in Kingston and Richmond

The Crisis Retreat is a place for adults experiencing a mental health crisis who need short-term crisis intervention as an alternative to hospital admission. The service is for residents living in the boroughs of Kingston or Richmond.

The local engagement team were asked to gather experience of the Retreat as part of a wider commissioning review of the service. Our engagement objectives were to understand guests’ experiences of the service; to involve a range of guests in terms of diversity, gender and geography (both Kingston & Richmond residents); and to work with the Manager to recruit guests willing to take part in the engagement.

83 We analysed guest feedback collated by the Retreat over the last 12 months and alongside this undertook more focused engagement by telephone interviews with 17 guests or former guests to gain a more in depth understanding of their experiences.

Overall, the majority of feedback was positive, with just two areas for consideration namely the length of stay and food and cooking arrangements. The findings and recommendations have been shared with commissioners to be considered as part of the service review which will inform future commissioning.

‘The staff actually care about you and get to know you. In hospital you are just a patient and don’t really matter’

‘….. I feel that five days if too short for someone with a crisis and it should instead be a minimum of 10 days. You’re expected to get better from a crisis in five days.’

1.3.8.11 Keeping safe and staying well this winter in Richmond

During Autumn/Winter 2020 we held conversations with local patient and community groups about Keeping safe and staying well over the winter months, which covered getting the flu jab, NHS services are still open including reminding people about how to access services using NHS 111. We had a fun virtual discussion with Multicultural Richmond’s ethnic elders’ group which included a quiz to check the facts or fiction about the flu jab. Some were unsure about the flu jab but very interested in finding out more about the Covid vaccine which had just been approved.

1.3.8.12 The Sutton Crisis Café

NHS Sutton CCG is developing a Crisis Café for service users that are experiencing mental health crisis. This supports the NHS long term plans to deliver on community mental health crisis pathways and will benefit service users, carers and emergency services with better access to health services and reduction of A&E attendances and admissions. There are other benefits within the business case.

• The Crisis Café Implementation Group includes service users, carers, commissioners, service provider and clinical lead. Other key colleagues are invited as and when their expertise is required in supporting the delivery of the programme.

84 • Stakeholder engagement 1) with Clinicians, Service Users and Carers. We had excellent responses to the surveys produced and completed; all of which have supported and provided evidence for developing the service. • Stakeholder engagement Workshops 2) with clinical providers including Police, LAS and Social Services; and Service Users, Carers, other third sector organisations. Excellent attendance and extremely helpful discussions for the service. From the summaries of everyone’s comments, actions/recommendations are being produced. • Service specification completed; waiting feedback from the Trust and to incorporate analysis from the Stakeholder engagement Workshops where applicable. • Location for the pilot has been confirmed. Sutton Mental Health Foundation premises.

1.3.8.13 Improving therapy services in Sutton

We have been working with Sutton Council on The Therapies Review, which aims to propose a revised model of therapy delivery across Local Authority and CCG commissioned services based on quality, innovation and financial efficacy.

Two ‘listening’ events were held with SPCF and we heard from approximately 20 local parents with both small children and teenagers. Several parents explained their stories in some detail and they often mixed positive experiences with frustrations. There were several clear themes and these were applicable to both NHS and Cognus therapy services.

The patient feedback has fed directly into the recommendations of the report. For example, a number of parents spoke about how they felt group interventions slowed down their journey to get the support that they need. A recommendation of the review is to complete a deep dive into patient’s journey through speech and language therapy and consider whether group interventions are inappropriate for some patient groups. Parents also spoke of the hand offs between the NHS and local authority providers to be of poor quality. An operational development group will be convened with both agencies having to work together to improve patient transitions.

PPE governance and assurance

Quality assurance is vital. We have several mechanisms to support good practice engagement across our work.

85 We run a Community Engagement Steering Group comprising local Healthwatch organisations, CVSs and our borough PPE leads. It is chaired by the lay member for PPI. The purpose of the group is to ensure best practice community engagement is at the heart of our work across South West London. However, it was agreed that while we are managing a level 4 pandemic, the focus of the work has been led by the recovery agenda.

The groups aim to:

• Quality assure NHS South West London CCG communications and engagement plans and activities – to ensure that decisions made by the CCG are informed by good practice PPE and that the ICS builds appropriate PPE into their work. • Provide two-way communication between borough place level and members of the Community Engagement Steering Group to ensure local work is connected with South West London level work where appropriate. • Support information sharing and good practice from across its membership – showcasing innovative practice.

To support patient and community voice at a strategic level we have both Healthwatch and CVS representation on the programme board, primary care commissioning committee and Governing Body.

We also support the borough PPE leads to meet as a network. Our patient and public engagement professionals from across south west London meet on a regular basis to discuss and advise on shared engagement work and challenges; progress professional development and offer peer support. We have been meeting since August 2018 and discussed, reviewed, and refined a number of engagement activities – drawing from local learning and practise. Our focus this year has been on engaging local communities on the vaccination programme. And while many sessions are run locally, we have also come together to run sessions across boroughs, like for the Tamil community as well as a session for Muslims across South West London.

1.3.9.1 Croydon PPE governance and assurance

• We work closely with Healthwatch Croydon who are involved in some of our key South West London and borough committees such as Croydon Health and Wellbeing Board; Croydon Shadow Health and Care Board; One Croydon Board; One Croydon Specialist

86 and Engagement Group; Preventative and Proactive Care Board. Other committees where there is oversight of patient and public engagement activities are listed below: • The Local Strategic Partnership brings together Healthwatch; voluntary community social enterprises (VCSE); local business, faith and voluntary groups and public sector organisations to commit resource to improving Croydon in the areas of health, crime and work. • Croydon’s local voluntary partnership is supported by the King’s Fund to develop the voluntary sector in Croydon and ensuring they are involved in partnership working and that their voice, and those of their users is heard. • The Localities Board oversees locality-based integration of services with a strong emphasis on integration of the voluntary sector with statutory teams via local talking points and social prescribing. Voluntary sector organisations and Healthwatch are members. • One Croydon Communications and Engagement Group coordinates Comms and Engagement across the One Croydon Partnership – a ‘responsible enabler’ in the governance structure.

1.3.9.2 Merton PPE governance and assurance

• The Patient Engagement Group (PEG) is an active group, contributing to the continuous improvement of services in Merton, ensuring that the South West London Clinical Commissioning Group (CCG) is responsive to the needs and wishes of Merton residents. • The group is a forum for patient and public representatives to inform and influence the planning, designing and delivery of local health services. Those who are buying and planning services come to our Patient Engagement Group at an early stage. • The group is comprised of community and voluntary organisation representatives, local services users and local residents. • Healthwatch Merton have representation on the Merton Health and Care Together board. This board supports the implementation of the local health and care plan and has oversight. • Bi-weekly meeting with Healthwatch Merton allow the NHS Merton engagement team to co-plan engagement and allow Healthwatch to support engagement at a local level.

87 1.3.9.3 Wandsworth PPE governance and assurance

• We work very closely with Healthwatch Wandsworth who are involved directly in several South West London and place level CCG committees, ensuring the community perspective shapes our discussions. • We make the most of opportunities for involvement by sharing our plans early, so that we can dovetail with one another and avoid duplication. We plan joint work and share information regularly in our Healthwatch Liaison meetings about upcoming projects. • Over this last year we have worked in partnership reaching over 600 people to understand how telephone and video appointments are working. You can read the Wandsworth experiences of digital and telephone health and care appointments Report. This year, we have supported assembly topics, focussed on PPI and addressing Health Inequalities. • The Thinking Partners Group, Chaired by Dr Sian Job works collaboratively with NHS Wandsworth to assure us in relation to our approaches to addressing health inequalities. It also offers members the opportunity to network and deepen their understanding of how to work together. Thinking Partners supports our aims to continually improve our approach to promoting equality - ensuring equality and diversity is factored into decision- making. • The Patient and Public Involvement Reference Group (PPIRG) chaired by Sarah Rackham ensures that the voice of the Wandsworth community is at the heart of our commissioning. The current membership includes representatives from the voluntary sector, community partners and members of PPG groups. Each partner organisation or network has links right across the community, not limited to Wandsworth but also transcending geographical boundaries to neighbouring boroughs, which is important as many of our patients travel from other parts of London. • Wandsworth Community Grant Scheme awarded 12 grants to community and grassroots organisations to address digital exclusion and the reduce inequalities in access to health and wellbeing support during the pandemic. You can read a summary of the projects on our website www.swlondonccg.nhs.uk2 • Together with Wandsworth Council we continue to jointly commission, the Wandsworth Voluntary Sector Coordination Service which serves to support and build the capacity of voluntary organisations and community groups in Wandsworth to connect, collaborate

2 Insert full link when information published

and communicate both with each other and the local health and social care system to work together to promote health equality.

1.3.9.4 Kingston and Richmond communications and engagement group

• The Kingston & Richmond communications and engagement group brings together communications and engagement professionals working in both boroughs across the NHS, councils, Healthwatch and the voluntary sector. The group which meets monthly to work on local joint projects, share knowledge, map stakeholders and coordinate plans for involving local people. Our focus this year has been to gather local population and communities’ insight about the pandemic and vaccination programme to inform our borough comms and engagement plans and activities to support local outbreak plans, and vaccine uptake and hesitancy. As well as NHS South West London CCG insight work our Healthwatch in each borough gathered residents’ experiences of services from March – October 2020. We have worked together to identify borough approaches to reaching into communities who have been disproportionately affected by the pandemic, experiencing health inequalities and where there is vaccine hesitancy, for example, virtual Covid-19 conversations, webinars and podcasts and development of Council Covid champion networks.

1.3.9.5 Kingston PPE governance and assurance

• Aligned to the Borough CE group we have recently established an engagement partnership group to coordinate Covid vaccine engagement activities with key partners to avoid duplication and enhance our collective activities. The group has worked together to support the roll out of HWK vaccine experience survey, with partners providing translated material and promoting it via their social media and other channels. • The Kingston patient and public forum meets every 6-8 weeks and is open to anyone living in Kingston to attend to hear updates about and share their views on local healthcare services with the CCG. During the year the main focus of this forum is providing feedback and receiving updates on the Covid-19 pandemic and local vaccination programme. We also regularly attend and participate in Kingston Voluntary Action’s (KVA) health and wellbeing network. There have also been regular NHS test and trace and vaccination update sessions hosted by the KVA.

• Due to the pandemic the planned for CCG local borough committee has not been meeting as anticipated. In the interim senior local CCG executives and clinical leads meet regularly with Healthwatch Richmond officers to ensure a dialogue at this level is maintained. Healthwatch is also a member of the local primary care management group.

1.3.9.6 Richmond PPE governance and assurance

• Locally we have moved our established channels online to ensure regular engagement with our communities either directly with patients or via local voluntary and community sector organisations. These include working with our GP practice patient participation groups (PPGs) via our PPG network and specific interest groups via our community involvement group. • Our community involvement group acts as an engagement and equalities reference group for the CCG in the borough. The group with members drawn from key voluntary sector and community organisations, Healthwatch Richmond, Richmond CVS and Richmond Council has provided valuable insight into how we adapt our engagement with our local communities during the pandemic and particularly around the vaccination programme. There has been a focus on how we can work in partnership to reach into communities experiencing the greatest health inequalities at a very local community level. This work is starting to see results through the local community conversations around the Covid vaccine and planned conversations about community led health approaches to wellbeing. The PPG network, a forum for PPG representatives to come together and share information and ideas about their PPGs moved successfully online and has provided a valuable network for PPG representatives to stay in touch and learn from each other during the past year. Members have also provided valuable insight and feedback on the local vaccination programme as well as taking an active part in volunteering at vaccination sites. • Richmond CVS coordinates several forums with local voluntary and community organisations and people with lived experience of services which the CCG takes part in to maintain ongoing engagement with local communities and patient groups. These include RCVS’ health and wellbeing network for local VCS; Richmond users and carers group and the health and social care co-production group.

90 1.3.9.7 Sutton PPE governance and assurance

• Sutton Healthwatch and voluntary sector partners including Community Action Sutton, Age UK Sutton and Sutton Carer Centre form part of the Sutton Systems Leader Meetings. Our partners have played a vital role in enabling us to reach the most vulnerable people during the Covid pandemic. • Sutton Healthwatch are members of the Sutton Health and Care Executive and contribute to local decision making through support and challenge at System Leaders and Sutton Restoration Board meetings. • Voluntary sector representatives also form part of the Sutton Systems Leader Meetings (Community Action Sutton, Age UK Sutton and Sutton Carer Centre).

1.4 Reducing health inequalities

Our approach to equality, diversity and inclusion

As we develop as one NHS South West London CCG, we are determined to take this opportunity to create a meaningful and positive work environment, making South West London a great place to live and work.

We are proud of our diverse staff, and our Governing Body and senior management team are committed to creating a culture where everybody thrives. Coming together as a new organisation is an opportunity to review how we support and develop everyone who works for us.

In the summer, we held a series of engagement events with staff across the CCG to identify priories and together we have developed an action plan to address these. We are continuing to host monthly listening events throughout this year. This is important because studies show that a motivated, included and valued workforce helps increase job satisfaction, high productivity, and retention of best talents. For our patients in south west London, this means they will receive high quality patient care, which leads to increased patient satisfaction and better patient safety.

We are working to ensure that everybody is treated with dignity and respect at work. We have a duty to call out racism and discrimination whenever we see or experience it and to create an environment that enables people to raise any concerns.

91 We all have a part to play in creating a fairer society and our CCG has a special role in helping to reduce health inequalities in our communities. We understand how important it is to all of us that the NHS commissions and provides services that are fair, accessible and flexible to meet the needs of our diverse communities.

We understand and recognise that:

• People can experience inequalities, discrimination, harassment and other barriers • Patients should be at the centre of our decision making, and we can deliver high quality, accessible services that tackle inequalities and respond to personal needs • An environment of dignity, tolerance and mutual respect should be created, maintained and experienced by all our patients and staff

The Equality Act 2010 places a requirement on public bodies to demonstrate how they are:

• Eliminating discrimination, harassment and victimisation and any other conduct that is prohibited by or under the Act • Advancing equality of opportunity between people who share a relevant protected characteristic and people who do not share it • Fostering good relations between people who share a relevant protected characteristic and those who do not share it • Being transparent about how they are responding to the equality duty, and are required to publish relevant, proportionate information showing compliance annually.

We are determined to carry out these duties and ensure they inform how we plan and operate as an organisation.

Addressing health inequalities across South West London

The South West London CCG is committed to addressing the health inequalities that exist across our boroughs. The Covid-19 pandemic, the death of George Floyd in the United States and the Black Lives Matter movement has sparked opportunities for authentic conversations around race, racism and wider inequalities in a way that has not been done before, starting a national debate on racism and race in the UK. The message we have been hearing from our communities, clinicians and staff has been clear. We must build on our progress going further and faster to ensure that our

92 services and employment practices are fair, accessible, appropriate for the diverse communities we serve and the workforce we employ. Having set a joint objective as a system to address equality, diversity and inclusion we are currently assessing what more the system needs it to do in this area. Two immediate clinical priorities that we are working on are to reduce health inequalities are diabetes and hypertension. We are looking at these priorities and others with the ambition of creating a three-part South West London Equality, Diversity and Inclusion (EDI) programme covering:

• Community: listening to local people and partners, taking what we have heard and learnt to shape the services we provide so that they are reflective and responsive to the needs of our communities. • Clinical: Taking action to target differential health outcomes to address health inequalities. • Staff: bringing together our workforce to help shape our priorities and set our goals to ensure equitable and fair working practices are adopted across all of our organisations.

We all have a vital role to play in creating an environment where our approach can flourish. It is clear that change must happen at borough, neighbourhood and South West London level and so we are working alongside local authorities to harness their knowledge of their communities to make sure our actions make a real difference. This is Everybody vs Racism.

Covid-19

The Public Health England report ‘Disparities in the risk and outcomes of COVID-19’ published in August 2020 confirms that the impact of Covid-19 has replicated existing health inequalities and, in some cases, has increased them.

These results improve our understanding of the pandemic and will help in formulating the future public health response to it. The largest disparity found was by age. Among people already diagnosed with Covid-19 people who were 80 or older were seventy times more likely to die than those under 40.

Risk of dying among those diagnosed with Covid-19 was:

93 • Higher for males than females • Higher for those living in the more deprived areas than those living in the least deprived • Higher for those in ethnic minority groups than in white ethnic groups.

These inequalities largely replicate existing inequalities in mortality rates in previous years, except for ethnic minority groups, as mortality was previously higher in white ethnic groups.

To keep our staff safe as we start to plan future ways of working, we are assessing the needs of each individual staff member, including considering the higher risks from Covid-19 for staff from ethnic minorities.

The varying impact of Covid-19 on different groups of people has informed our vaccination strategy, helping us to protect more of the most vulnerable people in our communities more quickly.

We know that, for most people, the most important and trusted influences in their lives are their friends and family. Our engagement teams and clinical leads in each borough have been working with key community groups like local BME (Black and Minority) Forums and resource centres to help influence people and to reassure of them the safety of the vaccination, and to dispel myths that circulate on social media.

Many of our vaccination centres are in places of worship, with local religious leaders supporting our staff and volunteers to both take up their offer of the vaccine, and in many cases volunteering as vaccinators themselves. During March 2021, we ran a series of pop-up walk-in vaccination clinics in mosques across South London, with local Imams encouraging those who had been invited for a vaccination but had been hesitant to take up the offer to receive their vaccination.

NHS Workforce Race Equality Standard (WRES)

The NHS Workforce Race Equality Standard (WRES) is used across the NHS to narrow the gap between the treatment of ethnic minority and white staff through collection, analysis and acting on specific workforce data. In addition, the WRES aims to improve diversity of leadership and the experience of staff from ethnic minorities within an organisation.

There are nine indicators, all of which draw a direct comparison between white and ethnic minority staff experience. Four focus on workforce data, four are based on data from the national NHS Staff

Survey questions, and one indicator considers whether the Board membership is broadly representative of the overall workforce.

This year is the first year that CCGs’ analysis against the WRES indicators are published. This data allows us to take action to improve against these indicators. Areas where we will take action are:

• Recruitment: white staff are 1.8 times more likely to be appointed than staff from ethnic minorities, this is higher than London average of 1.6. • Disciplinary Processes: staff from ethnic minorities are 1.59 more likely to undergo a disciplinary process than white staff. This is above average for London, however there are a very small number of disciplinaries in the CCG making it hard to compare. • Percentage of staff experiencing harassment and bullying/abuse from other staff: 23.6% of white staff report experiencing harassment and bullying (below London average) and 32.1% of staff from ethnic minorities report experiencing harassment and bullying staff (8.5% above the London average). • Percentage of staff believing the organisation provides equal opportunities for career progression and promotion: The staff survey shows that 88.3% of white staff in the CCG (same as London average) believe the organisation provides equal opportunities for career progression and promotion compared to 52.9% of ethnic minority staff (below London average of 65.8), representing a 35% difference between white staff and staff from ethnic minorities. • Percentage of staff experiencing discrimination at work from managers/Team leader: 9.5% of staff from ethnic minorities report experience of discrimination at work from managers, which is below London average of 16.4%.

An action plan has been developed to address these themes. This plan has been co-designed with staff who attended our listening events. The Action Plan focuses on four key themes and links to the NHS People Plan and the Race Plan for London. The four themes are:

• Culture and leadership • Recruitment • Development • Education

Achieving real change in equality, diversity and inclusion will take time, there are no quick fixes. We will need to take time to develop understanding and empathy, and we will do this through engagement and education.

Contact Melissa Berry, Programme Director of Equality, Diversity and Inclusion confidentially on [email protected]

Public Sector Equality Duty

The Public Sector Equality Duty (PSED) consists of general and specific duties for public authorities to meet under the Equality Act 2010, as set out above. We have a responsibility to demonstrate how we as an organisation are meeting our legal duties and are required to publish information annually showing how we comply.

Equality analyses

All projects commissioned by NHS South West London CCG are required to complete an Equality Analysis prior to implementation. This is to ensure that the project has considered the impact it will have on those communities it affects.

We have developed a system to ensure that appropriate assessments are carried out at the right time. Equality Analyses form a key part of our documentation on every project.

Equality Delivery System reports

The Equality Delivery System (EDS) is a system that helps NHS organisations improve the services they provide for their local communities and provide better working environments, free of discrimination, for those who work in the NHS, while meeting the requirements of the Equality Act 2010. The EDS was developed by the NHS, for the NHS, taking inspiration from existing work and good practice. NHS South West London CCG and all NHS providers in South West London have implemented the Equality Delivery System.

You can read more about our approach to equality, diversity and inclusion, including our plans and policies, on our website at www.swlondonccg.nhs.uk/about/equality-diversity-and-inclusion

96 1.5 Improving quality and safety – putting quality at the heart of the CCG

We are committed to ensuring the highest levels of quality in the health services we commission. We monitor the quality of services in South West London using quality oversight processes to measure performance against the quality standards we have set and those that are set nationally. These standards address patient experience, patient outcomes and patient safety.

Monitoring quality

We are proud of the effective quality assurance processes we have in place in South West London. The Quality and Performance Oversight Committee oversees these processes, which include working with the Care Quality Commission (CQC) and attendance at the Joint Strategic Oversight Group (JSOG). This year we have changed our quality assurance processes so no undue pressure is put on providers whilst they focus on responding to the Covid-19 pandemic. We have disbanded our Clinical Quality Review Group, and now join internal quality meetings at all of provider organisations, including acute, mental health, community and independent providers. This approach has not only reduced the pressure on providers and freed up valuable time for staff in all organisations, it has also further developed our partnership working and a collaborative approach to any issues.

We monitor patient experience through national data including the Friends and Family Test and National Patient Surveys, in conjunction with locally sourced information from providers’ complaints departments and their Patient Advice and Liaison Services (PALS). Providers also report on patient experience in their quality reports. Due to Covid we have adjusted our face-to-face visits and have started quality monitoring through desktop peer to peer visits.

We work closely with our GP membership and local Healthwatch, who feed back any issues or concerns raised with them by patients. We actively seek feedback from our patients and local community on a range of issues and services. We also seek feedback routinely through a strong patient engagement network in each borough and include members of our GP practices’ patient participation groups and specific service user groups.

Working with the Care Quality Commission

We have quarterly engagement meetings with the Care Quality Commission (CQC) during which we review and discuss the quality and safety of all organisations that provide health services in South West London. We also work with providers that may have CQC improvement plans and support the CQC to monitor these. This includes having additional focus meetings with those providers and the CQC.

CQC reports on all services in South West London are available on the CQC website at www.cqc.org.uk

Quality monitoring and assurance of primary care

Quality is reviewed through monitoring a wide range of data covering patient experience, practice delivery of services, achievement against national indicators, for example delivery of Learning Disability Healthchecks, and reports from other organisations that assess practices, especially the Care Quality Commission (CQC). There are also routes for practices and other providers to report concerns to the CCG through the Make a Difference Alerts system and those relating to primary care are also reviewed by the PCQRG. Where potential issues are identified, either at practice or borough level support is offered to practices to address and improve on these areas.

The challenge over 2020-21 has been that due to the Covid-19 pandemic much of the data normally reviewed to assess quality was not being collected, as practices focused on changing their ways to working to deliver the Covid response. However there has been ongoing communication between the CCG, practices and clinical leads to ensure issues and concerns are raised, and the CCG has been able to provide support to practices to address these.

Making a Difference

The Make A Difference (MkAD) system is a quality alert, management and monitoring system that implemented across South West London this year. The system was designed to implement the recommendations of the Francis Inquiry (2013).

The system is a simple, user-friendly online form for healthcare professionals to flag any concerns (usually relatively minor ones), issues, compliments, and good practice that they have become aware of through contact with their patients. This feedback is relayed to the relevant provider, who is responsible for investigating and resolving anything that is raised as a concern, and for responding to the healthcare professional that reported the alert.

The Make A Difference system was implemented across Wandsworth GP practices as an early adopter in 2013. The system was introduced in Merton in 2018, in Sutton in 2019, and Kingston and Richmond in July 2020. Make a Difference was implemented in Croydon in January 2021.

Whilst initially the Make A Difference system was set up for GPs and healthcare professionals in primary care to highlight any concerns to the CCG, the system is also available for any healthcare professionals from other providers to raise an alert and is not exclusive to those in primary care.

An MkAD alert can be used to raise concerns regarding a range of issues, including poor quality of clinical care, issues with referral or discharge processes, clinical pathways, or service provision and may relate to clinical or non-clinical issues. It is not a replacement for the complaint mechanism, nor is it for reporting serious clinical concerns or incidents. It is intended to act as an early warning/feedback system, providing intelligence that can be used to address any wider quality issues, facilitate shared learning with services and inform the commissioning process and service redesign.

Care homes

Although we have no formal commissioning or oversight role with many care homes, this year we have worked closer than ever with our partners in the care sector supporting them through the pandemic, particularly on infection prevention and control. We value the commitment the care homes have taken with us in providing the safest possible services for the most vulnerable people in our community.

We have put together a series of measures to further support care homes residents and staff this year. Some of the measures were prescribed by the national guidance, so now all care homes:

• Have a nominated GP lead. • Are supported by primary care with weekly check ins and multi-disciplinary team support.

• Have access to pharmacy support. • Are aligned to a Primary Care Network (PCN), apart from one care home that is registered with a GP in Westminster.

In addition to the national guidance, we have provided ongoing nursing and therapy support to care homes for older people through the In-Reach and therapy teams alongside wider support from dieticians and speech therapists.

Our Behaviour and Challenging Communication Team has been supporting staff in care homes to care for their residents who are experiencing behavioural and emotional difficulties associated with a mental health diagnosis and/or dementia. The team have also provided mental health and wellbeing support to the staff in care homes during the pandemic.

We have had an intensive focus on infection prevention and control in our care homes this year and have provided intensive training course for care home staff. This training is supplemented by weekly Infection Prevention and Control webinars for all health and care providers in South West London.

Over the last year we have provided telehealth kits to nursing homes and are working with care homes and clinical leads across South West London on a wider roll out. As well as care homes for older people, this year we will be providing telehealth kits to care homes for mental health patients and people with learning disabilities.

We have supported care homes in South West London to begin using NHS mail, which has accelerated the discharge process for patients from hospital back to their care homes. This is because patient identifiable information like medical records can be transferred securely through this system. Most care homes are now using NHS Mail, and we hope to support all care homes in South West London to use NHS Mail or other secure email services this year.

We introduced our E-Red bag initiative, which sees documents being sent electronically by the care home to acute hospitals when residents are transferred by ambulance, across South West London this year. These documents are linked to residents’ personal records, allowing a smoother and safer handover of care between providers. We are now working with our acute hospitals and care homes to accelerate the uptake of this initiative, with particular focus on making sure that care homes meet the required data security and protection standards.

We have provided training to care home staff on spotting the soft signs of deterioration in residents (RESTORE2/NEWS 2 training).

100 Infection prevention and control

All our providers in South West London have a governance framework in place for the management of infection prevention and control (IPC), working in line with the Health and Social Care Act (2008), the guidance updated in 2015. Infection prevention and control work is led by Dr Gloria Rowland, who took the position of Chief Nurse at both South West London Health and Care Partnership and NHS South West London CCG in early January 2021.

Through a weekly South West London provider forum, the IPC medical and nursing teams across the area have undertaken a programme of work in the last year covering a wide range of areas including:

• IPC policies and procedures have been updated in line with the most recent guidance. • Developing testing arrangements for staff and patients. • Infection outbreak management. • FIT testing for staff and personal protective equipment (PPE) • Pathway management in accordance with Public Health England’s “Covid 19: Guidance for the remobilisation of services within health and care settings. Infection Prevention and Control Recommendations” (September 2020).

We have completed infection prevention and control assurance assessment peer reviews to give us a deeper understanding of infection prevention and control practice across South West London. These peer reviews focussed on:

• The Director of Infection Prevention and Control role and the infection control team at each organisation. • IPC governance and policies and procedures. • IPC information provision. • the testing and communication approaches for staff and patients. • Reviewed individual Trust Board Assurance Framework (BAF) documents that had previously been reviewed by the Care Quality Commission (CQC) earlier in the year.

Learning was incorporated into key lines of enquiry arising from Covid-19 outbreak incident at The Hillingdon Hospitals NHS Foundation Trust and other infection outbreaks.

101 Our infection prevention and control group publishes weekly reports which are reviewed by the CCG’s Clinical Leadership Group.

This year we have prioritised supporting care homes in South West London by providing comprehensive training packages, webinars and networking and support sessions. During the first wave of the pandemic, we offered all care homes in the area training for working safely, including training for donning and doffing protective and personal equipment and basic hand decontamination through a team of super trainers and trainers. During the second wave we developed an IPC training package that is tailored specifically to working safely in care homes and offered this training to all 366 care homes in South West London.

Serious incidents and never events

There have been no serious incidents or never events in the CCG during 2020/21.

We are responsible for performance managing serious incidents that take place in any NHS or independent provider that we commission service from, allowing us to quickly identify any recurring themes and trends. Incidents are managed in line with the National Serious Incident Framework. It is vital that we learn lessons from serious incidents to help reduce patient harm in the future.

Safeguarding adults and children

Safeguarding aims to support adults, young people and children to live a life that is free from abuse and neglect. It involves a range of measures to protect people in the most vulnerable circumstances.

This year the pandemic and lockdowns have meant increased of violence and abuse. We have worked closely with our partners in policing, education, care and local authority departments to risk assess and protect the most vulnerable children and adults.

We have increased the work of our Joint Intelligence Groups to highlight any safety and safeguarding concerns in our care homes during the pandemic.

We do everything we can to make sure the services we commission are safe and compliant with all statutory safeguarding regulations. We also have procedures to help us recognise, report and respond to safeguarding issues promptly.

102 Pathways and processes have been introduced across the health and social care partnerships to help identify the safeguarding needs of vulnerable children and adults. In commissioning safe and effective services to meet these needs, the outcomes for those children and young people who are care experienced are greatly improved.

Our safeguarding team supports our colleagues in primary care to develop their own safeguarding systems and processes. The safeguarding team have strengthened the quality assurance process for primary care, offering peer review and support for safeguarding leads.

1.5.8.1 Domestic violence

Since the start of the pandemic there has been an increase in incidences relating to domestic violence and abuse. Local boroughs adopted new ways of working and increased the frequency of Multi Agency Risk Assessment Conference (MARAC) to ensure oversight of domestic violence and abuse. The MARAC is a regular strategic partnership meeting chaired by the police public protection lead, and includes representatives from the NHS, local authority social services and education departments. All partners review and provide an update on the status of identified risks and raise new risks and concerns.

In September 2020 we implemented the Identification and Referral to Improve Safety (IRIS) in Croydon. This is a training and support programme for GP practices, giving staff the confidence and skills to talk to patients about domestic violence and abuse. The other five South West London boroughs’ Domestic Violence Forums are reviewing how the IRIS system is working in Croydon with a view to implementing in their boroughs.

The designated professionals continue to work collaboratively across the statutory partnership with local domestic abuse services to disseminate updated guidance relating to this issue and represent the CCG at all commissioned domestic homicide reviews. NHS South West London CCG is represented and proactively involved with the London domestic violence and abuse clinical reference group to ensure national updates are reflected at a local and regional level.

1.5.8.2 Modern slavery and human trafficking

Modern slavery is the recruitment, movement, harbouring or receiving of children, women or men through the use of force, coercion, abuse of vulnerability, deception or other means for the purpose of exploitation. Individuals may be trafficked into, out of or within the UK, and they may be trafficked

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for a number of reasons including sexual exploitation, forced labour, domestic servitude and organ harvesting.

We are committed to ensuring that there is no modern slavery or human trafficking in any part of our business activity and, in so far as is possible, to hold our suppliers to account to do likewise.

1.5.8.3 Prevent

Safeguarding duties include the Prevent strategy, which aims to protect vulnerable individuals from being groomed into terrorist activity or supporting terrorism. Visit gov.uk to report illegal or harmful information, pictures or videos you’ve found on the internet about terrorism or extremism. All of our safeguarding mandatory training now includes Prevent.

1.5.8.4 The Learning Disability Mortality Review (LeDeR)

The Learning Disability Mortality Review (LeDeR) programme supports local areas to review the deaths of people with learning disabilities (deaths include from age 4 and above), helping to promote and implement the review process, and providing support to local areas to take forward the lessons learned in the reviews to make improvements to service provision. The LeDeR also collate and share anonymised information about the deaths of people with learning disabilities so that common themes, learning points and recommendations can be identified and taken forward into policy and practice improvements.

Our LeDeR steering group is attended by representatives from adult social care, reviewers, managers of services and practitioners, family/carers representative and advocates, Health representative for example, GPs, psychiatrist in Learning Disabilities services, Child Death Overview Panel members, patient representatives.

We have been commended for our performance in the LeDeR reviews by NHS England.

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1.5.8.5 How to report a safeguarding concern

Safeguarding concerns can be raised with the relevant Local Authority safeguarding team 24 hours a day seven days a week by any person who feels they are being abused as well as relatives, teachers, friends, carers, neighbours, members of the public, health and social care staff or any person who has any concerns.

In an emergency always call 999.

Safeguarding contact details for Croydon, Kingston, Merton, Richmond, Sutton and Wandsworth are available on our website at www.swlondonccg.nhs.uk/about/governance/safeguarding

Continuing Healthcare

From April 2020, NHS South West London CCG took a single approach to the oversight of Continuing Healthcare (CHC) as part of the Moving Forward Together programme. This has included:

• The development and recruitment to a central support team who bring together the borough teams data and information to enable reporting as NHS South West London CCG. • Development of work around contracts to ensure compliance, quality and standardisation. • Developing a set of principles for CHC in South West London, allowing a South West London approach with local delivery mechanisms.

As a result of the Covid-19 pandemic, CHC has been suspended twice during the year which led to teams dealing with uncertainty and delays and a backlog of assessments which has provided some unique challenges for the local and central teams. To address this we have utilised additional staff to assess the backlog of patients, used a trusted assessor model and worked with local authorities to agree the cases in a timely manner.

PALS and complaints

As part of our commitment to continually improve the quality of local health services we value all feedback we receive, either as a compliment or a complaint. This information is used to help us manage our performance and highlight any areas where we could make improvements. All

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complaints received are responded to individually via our complaints process. To make sure that complaints are reviewed and monitored at the highest level our Accountable Officer reviews all responses to complaints and our Quality Committee receives regular reports detailing complaints received including how they have been handled.

Our complaints policy and procedure has adopted the principles as outlined in the Parliamentary and Health Service Ombudsman’s principles of good complaints handling, principles of good administration and principles of remedy. We work closely with local health service providers, monitoring the standard of complaints handling, ensuring all complainants are informed of their statutory rights under the NHS Constitution. This includes being given the information about the NHS complaints service provided by a local advocacy team and the option to take their complaint to the Parliamentary and Health Ombudsman if they are not satisfied with the way the complaint has been dealt with.

The complaints we receive and manage are about the services we commission locally, whilst complaints about GP services are handled by NHS England. We use the Parliamentary and Health Service Ombudsman’s six principles of remedy to address concerns and complaints:

• Getting it right • Being customer focused • Being open and accountable • Acting fairly and proportionately • Putting things right • Seeking continuous improvement

Last year, between 1 April 2020 to 31 March 2021, we received 232 formal complaints. Of these, 130 related to issues for which CCG is responsible for investigating and responding to. We also received 102 complaints relating to issues which we are not directly responsible for which were forwarded to the appropriate organisation for investigation and reply. These included complaints for NHS provider Trusts, GPs, dentists and community pharmacies.

Of the complaints we received in 2020/21, two have been referred to the Parliamentary and Health Service Ombudsman.

For those complaints that were within CCG’s remit, the most commonly complained about areas were:

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Continuing Healthcare (assessment for 41 Complaints eligibility process, payment)

Mental Health Commissioning (access to 12 Complaints services, availability and funding)

General Commissioning 8 Complaints

Covid-19 (Shielding status, availability of 8 Complaints vaccine)

Assisted Conception (eligibility criteria) 5 Complaints

We very much value the views of patients and other people who experience the services we commission. We consider any complaint or enquiry about these services as a vital part of reviewing and, where necessary, improving them.

1.5.10.1 Addressing complaints during the pandemic

In light of the impact of Covid-19 on NHS services, NHS England issued advice stating that the process for handling formal complaints should be paused between March and July 2020 to allow staff healthcare to concentrate on providing care to patients and responding to the challenges of the pandemic. During this time, we could only investigate and respond to complaints where urgent attention was needed. All other complaints were acknowledged and recorded and any potential patient safety actions were identified and implemented immediately, before being fully investigated and responded to.

1.5.10.2 Patient Advice and Liaison Services (PALS)

Members of the Patient Advice and Liaison Service (PALS) always listen carefully to the concerns raised by our patients and their loved ones, and provide advice or make recommendations, where possible, as to the best way forward for the patient or member of the public.

Whilst it is not always possible to resolve a concern to the service user’s satisfaction, the PALS team can give information about support services and voluntary organisations that may be able to

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help. We believe that a successful PALS service helps reduce anxiety for those who use our services and helps people navigate the health and care system, whilst also reducing the number of issues that go on to become formal complaints. Themes from PALS are escalated.

The Complaints & PALS service also deal with a significant number of enquiries and informal concerns, from the public and MPs. During 202/21 there were 655 such contacts. The areas giving rise to most contacts were:

Covid-19 (almost entirely relating to the roll 188 contacts out of the vaccine)

Primary Care (GPs, NHS Dentists, 66 contacts Community Pharmacies)

Other NHS organisations 51 contacts

Assisted Conception (eligibility criteria, can 33 contacts funding be transferred, freezing of eggs)

General Commissioning 29 contacts

Mental Health Commissioning (access to 17 contacts services, availability and funding

Continuing Healthcare (assessment for 13 contacts eligibility process, payment)

Finance (payment of invoices) 12 contacts

Compliments to the CCG 12 contacts

Individual Funding Requests (requests for 6 contacts funding for treatment/medication not routinely provided on the NHS)

Patient Transport (facilitating transport 5 contacts when necessary)

Contacting PALS

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

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How to make a complaint, comment or compliment

Write to us at:

Complaints and compliments NHS South West London Clinical Commissioning Group, 120 The Broadway, Wimbledon, London SW19 1RH

Or email [email protected] or call us on 0800 026 6082.

109 1.6 Assuring delivery of performance and constitutional standards and national performance indicators

NHS England assesses the performance of each CCG through a national Improvement and Assessment Framework. The metrics for oversight and assessment purposes were intended to include the headline measures described in the NHS Long Term Plan Implementation Framework against which the success of the NHS will be assessed. These Long Term Plan measures were to be used as the cornerstone of the mandate and planning guidance for the NHS for the next five years, with 2020/21 being the first year.

However, due to the Covid-19 pandemic and the need to release capacity across the NHS to support the response, the collection and publication of some of the performance indicators were paused between April and June with subsequent extensions into Quarters 2, 3 and 4 of 2020/21.

Below is a summary of the performance indicators that have continued to be collected as, despite the pandemic, the CCG has an obligation to meet the healthcare needs of the population within their care. The performance indicators provide a means for us to measure and assess the quality and productivity of the services we commission and to inform us where to focus our attention to improve the care our patients receive working in partnership with our service providers.

Over this financial year we have worked well together in response to both waves of Covid-19, providing mutual support at times of differential challenge in the system.

1.6.1.1 Referral to Treatment (RTT)

The operational standard is that 92% of patients should be waiting no more than 18 weeks for elective treatment.

In March 2020 NHS England issued guidance that all non-urgent elective activity be suspended for three months to free up the maximum inpatient and critical care capacity for the response to Covid- 19. Further guidance was issued in December 2020 to again reduce inpatient activity in response to the 2nd wave of Covid-19.

During the first national lockdown the Royal College of Surgeons issued guidance to support prioritisation of patients waiting on trust waiting lists for treatment. These clinical priority categories were based on the condition and treatment requirements and included a timeframe to each surgical

110 procedure. This prioritisation enabled trusts to manage patient pathways from referral through outpatient appointments, diagnostic tests and onto treatments while safeguarding patient care.

While the Covid-19 infection situation improved between August 2020 and December 2020, and providers invested in being able to deliver more patient contacts through telephone and virtual appointments, the overall reduction in available capacity for routine appointments and surgery has led to longer wait times for some patient pathways through 2020/21.

We have worked jointly with the Independent sector providers in the area to ensure use of Covid- free capacity to increase the numbers of patients treated and to ensure urgent cancer and specialist treatments continued to plan with clinical networks working closely to monitor prioritised lists and mitigating for any delays that might otherwise arise due to the pandemic.

Our performance against the standard at end January 2021 (the latest published data) is reported at 74.95% showing a decrease of 10.1 percentage points compared to 12 months previously. Throughout 2020/21 available capacity has focussed primarily on the most clinically urgent patients, this has in turn led to the number of non-urgent patients waiting more than 52 weeks to increase to 2,814 at the end of January 2021.

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1.6.1.2 Diagnostic Test Waiting Times

The operational standard is that no more than one per cent of patients should be waiting more than six weeks or more for a diagnostic test.

In light of the response to the first wave of Covid-19 at the start of 2020/21, April saw a significant reduction in performance against the diagnostic standard. Since then, performance continuously improved while providers have invested in reconfiguring estates and used independent sector and community capacity to deliver diagnostic tests safely, supporting emergency, cancer and elective pathways.

NHS South West London CCG performance against the standard at end January 2021 (the latest published data) is reported at 75.22%.

1.6.1.3 Estimated diagnosis rate for people with dementia

A timely diagnosis enables people living with dementia, and their carers/families to access treatment, care and support, and to plan in advance in order to cope with the impact of the disease. A timely diagnosis enables primary and secondary health and care services to anticipate needs, and working together with people living with dementia, plan and deliver personalised care plans and integrated services, thereby improving outcomes.

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Despite the challenges of delivering services during the coronavirus pandemic, NHS South West London CCG maintained good performance levels against this metric during 2020/21 that consistently met and exceeded the monthly national benchmark of 66.7%, with latest performance achieving 67.7% (as at the 28 February 2021) for residents aged 65 and over.

NHS South West London CCG has a dedicated Memory Assessment Service for five of the six boroughs provided by South West London St George’s Mental Health NHS Trust, this helps the CCG to offer shorter waiting times, joint care planning and a greater focus on supporting people to live well and independently.

1.6.1.4 Improving Access to Psychological Therapies (IAPT)

Around one in six adults in England suffer from a common mental health problem, such as depression or an anxiety disorder. The effectiveness of local IAPT services is measured using this indicator and the IAPT recovery rate, which focuses on the recovery of patients completing a course of treatment.

During 2020/21 the NHS in London committed to delivering an Improving Access to Psychological Therapies (IAPT) access standard of 6.25% and a recovery rate of 50% in Quarter 4. NHS South West London CCG’s access rate performance is currently 4.99% (as at 31 December 2020, for Quarter 3) and achieved an outturn of 51.3% for the recovery rate (year to date as at 31 December 2020).

These targets have proved challenging to meet during 2020/21 following the impact of the coronavirus pandemic where the number of referrals received substantially decreased, and social distancing regulations meant local providers were unable to continue to offer face to face appointments for periods of time during the year.

To maintain the delivery of these important services to our resident population during the coronavirus pandemic, the CCG has worked closely with our local providers and implemented adjustments to the IAPT service model to enable remote/online therapy sessions to take place which have worked well for most service users.

The CCG continues to meet with local providers regularly to understand the issues related to performance. The CCG scrutinises and tests action plans as needed, ensuring that the CCG understands the risks and uncertainty in continued achievement of the standards.

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1.6.1.5 A&E four hour wait standard

The national standard is that 95% of patients should have their treatment completed, or be admitted, within four hours in an A&E department.

Attendances at A&E departments at the four Acute South West London Trusts have been severely impacted by the escalation of Covid-19 infection rates over the past 12 months. Infection, prevention and control (IPC) and social distancing measures, which affect performance at the front door, ambulance offloading, A&E target and patient flow throughout the hospital have affected performance against the four hour wait standard as overall attendance figures.

Over this financial year, we have developed new ways of working and changes to patient pathways to manage patient flow through A&E and into the wider clinical care settings whilst maintaining a safe environment for patients and staff. In addition, the opening of the Primary Care Hub at the Queen Mary’s site in Roehampton has provided additional capacity for urgent and routine, booked GP and other community treatment appointments to the residents in Wandsworth.

Following an initial drop in both the number of attendances at the start of the first national lockdown and A&E performance against the four hour standard, the attendance figures have started to

114 increase again at A&E departments in South West London trusts, though they remain lower than previous years with February 2021 seeing approximately 60% of the activity seen in February 2020.

1.6.1.6 Transforming care for people with learning disabilities (LD)

The impact of the pandemic and associated national lockdowns has been detrimental to services offering regular health checks for people on the learning disabilities register due to the reduction in face-to-face GP appointments. Whilst our primary care partners have made tremendous efforts to improve the delivery of learning disability health checks following the relaxing of the lockdown rules, the challenges associated with undertaking these appointments physically presented by social distancing and shielding inevitably puts meeting the performance target at risk.

We continue to work with individual GP practices to ensure continuous training and support is made available to GP practice staff and we remain committed to improving the provision of learning disability health checks across the patch.

115 1.6.1.7 Physical Health Checks for people with Severe Mental Illness

This indicator monitors the proportion of the people on the Severe Mental Illness (SMI) GP register receiving six physical health checks within the last 12 months.

As with the health checks for people on the learning disabilities register, the health checks for those on the SMI register have also been adversely impacted by the pandemic and associated reduction in face-to-face GP appointments and the challenges posed by social distancing and shielding.

To improve performance several actions have been taken over this past year, these include:

• Employment of dedicated staff to make tailored contact with patients to explain and underscore the importance of the health checks and encourage them to make an appointment. • Engaging with the voluntary sector to work with people with SMI to bring them to their appointments. • Appointments, or in some cases outreach, that are designed to be more enabling to those with SMI to attend. • Ensure that as much of the check is done in advance remotely to minimise contact time for the physical check to be able to reassure those with SMI that risks are being minimised. • Any other reasonable adjustments to assist with the process, such as additional dedicated time for the checks to be completed.

1.6.1.8 Cancer Waiting Times

There are nine cancer waiting time standards captured under three main groupings:

• 2 Week Waits (93% standard) • 31-Days first (96%) and subsequent treatments • 62-Days referral to treatment (85% standard)

Although NHS England asked trusts to postpone all elective treatments by the middle of April 2020, it also stipulated that ‘cancer treatment and other clinically urgent care should continue unaffected’.

In South West London we have delivered strong performance against the cancer waiting times standards in comparison with the rest of London and nationally. Working with RM Partners (the

116 West London Cancer Alliance which brings together NHS acute trusts, community services, primary care, commissioners, public health and the voluntary sector) we have been able to protect cancer surgery throughout the pandemic, with over 1,800 patients from across South West London being treated at the Royal Marsden, the designated green West London Cancer Hub. We have also worked with RM Partners on media and publicity campaigns to boost awareness of potential cancer symptoms to increase access to GPs and referrals to cancer services, and to increase public confidence.

NHS South West London CCG’s 2-Week Wait performance has exceeded the national average every month since the start of the pandemic. The CCG also achieved the 93% standard in each month except March 2020 where performance was 92.7%. However, the number of appointments completed in March was still high (4,479) compared to the following month when the number of urgent cancer referrals seen dropped to 1,870. The volume of two-week wait referrals increased each month afterward, returning to pre-pandemic levels in autumn. Despite this, performance in quarter one remained above standard indicating a reduction in urgent GP referrals in the spring months. Performance against the standard at the end of January 2021 was 95.3%, with all acute trusts in South West London performing above the national standards.

NHS South West London has been the highest performing CCG in London for the number of patients treated within 62 days of referral throughout the year, demonstrating good resilience and continued provision of cancer treatments.

117 The number of completed treatments reduced in the first quarter of the year as the country went into lockdown, and of those treated a larger proportion were treated beyond the 62-day threshold. June and July 2020 saw a larger volume of patients who had waited over 104 days from referral to receiving treatment. Treatment levels resumed from the start of quarter two with performance improving and so far, peaking in August and December with 84% of pathways treated within 62 days. However, the impact of the festive break and the second wave of Covid-19 meant that performance in January was 76.8%. However, the CCG has outperformed the national average in all months (except July) since the start of the pandemic.

In January 2021 our acute hospitals’ plans for increasing outpatient and diagnostic capacity were approved, and a number of waiting list initiatives commended focussing on further increasing capacity and access to services.

CCG assurance annual assessments

This year the NHS Oversight Framework for 2019/20 replaced the CCG Improvement and Assessment Framework (IAF) and the provider Single Oversight Framework.

In November 2020 NHS England published their annual assessments of the six former CCGs in south west London, which continued to perform well with five out of the six achieving a “Good”

118 rating. In what has been a very challenging year, we are pleased that we maintained our performance in most boroughs. Sutton’s overall assessment of ‘Requires Improvement’ was primarily due to the CCG’s financial deficit in 2019/20. The efforts of all our staff, member practices, partners and communities are key to driving improvements in our work and it is especially pleasing to see that Richmond improved its rating from the previous year. Next year instead of six assessments NHS South West London CCG will be assessed as one organisation.

2019/20 results

Borough 2016/17 2017/18 2018/19 2019/20

Croydon Inadequate Requires Good Good Improvement

Merton Good Good Good Good

Kingston Good Good Good Good

Richmond Good Good Requires Good Improvement

Sutton Good Requires Requires Requires Improvement Improvement Improvement

Wandsworth Good Good Good Good

NHSE Oversight Framework Patient and Community Engagement Indicator for 2019/20

We also received the final scores from the NHS Oversight Framework Patient and Community Engagement Indicator for 2019/20. All boroughs achieved a green or green star rating (the highest possible rating), which is an excellent result and reflects the hard work of our engagement leads in the boroughs and the commitment of our organisation to put patients at the heart of all that we do.

The criteria used to assess CCGs is grouped under five themed domains, as follows:

A. Governance B. Annual reporting

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C. Day-to-day practice D. Feedback and evaluation E. Equalities and health inequalities

2019/20 scores

NHS Croydon CCG

Domain Domain Domain Domain Domain Final 2019/20 2018/19 A B C D E score RAGG RAGG rating rating

3 3 3 1 3 13 Green Green

NHS Merton CCG

Domain Domain Domain Domain Domain Final RAGG A B C D E score Rating

3 2 3 2 3 13 Green Green

NHS Kingston CCG

Domain Domain Domain Domain Domain Final RAGG A B C D E score rating

3 3 3 3 3 15 Green Green star

NHS Richmond CCG

Domain Domain Domain Domain Domain Final RAGG A B C D E score rating

3 3 3 3 3 15 Green Green star

NHS Sutton CCG

Domain Domain Domain Domain Domain Final RAGG A B C D E score rating

3 3 3 3 3 15 Green Green star

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NHS Wandsworth CCG

Domain Domain Domain Domain Domain Final RAGG A B C D E score rating

3 2 3 2 2 12 Green Green

Read more about how we engage people and communities with our work on page XXX3

1.7 Freedom of Information

We are committed to being open and transparent. The Freedom of Information (FOI) Act 2000 gives members of the public a right to request access to all types of recorded information held by public authorities.

This year, we received 272 FOI requests. We responded to 250 of these within 20 days.

As well as responding to requests for information, we must publish information proactively. The Freedom of Information Act requires every public body to have a publication scheme, approved by the Information Commissioner’s Office (ICO), and to publish information covered by the scheme.

The scheme sets out our commitment to make certain classes of information routinely available, such as policies and procedures, minutes of meetings, annual reports and financial information.

The seven classes of information are broad and cover all the formal types of information we hold:

• Who we are and what we do. • What we spend and how we spend it. • What are our priorities and how we are doing. • How we make decisions. • Our policies and procedures. • Lists and registers. • Services we offer.

3 Insert page number on publication

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The scheme is designed to increase transparency. Members of the public should be able to routinely access information that is in the public interest and is safe to disclose. Without the publication scheme, members of the public may not know what information we have available.

Find out more about Freedom of Information, make an information request and read our publication scheme on our website at www.swlondonccg.nhs.uk/contact-us/data-protection-and-freedom-of- information

1.8 Sustainable development

The NHS Long Term Plan includes several commitments related to health and the environment, including efforts to tackle climate change, reduce single-use plastics, improve air quality, and minimise waste and water use.

Climate change poses a major threat to our health as well as our planet. The environment is changing, that change is accelerating, and this has direct and immediate consequences for our patients, the public and the NHS.

Improving health by tackling climate change

Climate change threatens the foundations of good health, with direct and immediate consequences for our patients, the public and the NHS. The situation is getting worse, with nine out of the 10 hottest years on record occurring in the last decade and almost 900 people killed by heatwaves in England, in 2019. Without accelerated action there will be increases in the intensity of heatwaves, more frequent storms and flooding, and increased spread of infectious diseases such as tick-borne encephalitis and vibriosis.

Nationwide, the NHS has already reduced its carbon emissions by 26% in the last 10 years, (NHS Carbon Footprint Plus including supply chain) exceeding its commitments under the Climate Change Act.

In doing so, we have learnt that many of the actions needed to tackle climate change directly improve patient care and health and wellbeing.

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This is because many of the drivers of climate change are also the drivers of ill health and health inequalities. For example, the combustion of fossil fuels is the primary contributor to ill-health from air pollution. Best estimates suggest that over one-third of new asthma cases might be avoided because of efforts to cut carbon emissions.

Sustainability in South West London

The Climate Change Act 2008 sets a legally binding framework to reduce carbon emissions, mitigate and adapt to climate change. At NHS South West London CCG, we are committed to the smart and efficient use of natural resources, to reduce both immediate and long term social, environmental and economic risks. We consider the impact on sustainability of our policies, decisions and actions:

• In our commissioning of healthcare services – ensuring we support environmental and social sustainability in our processes and decisions • As an organisation – taking actions to be a responsible organisation in respect of environmental and social sustainability • In our relationship with our member practices – to promote sustainable development across all our member practices.

Our contracts with providers set out requirements to ensure that they are compliant with NHS Sustainable Development policy and with the Climate Change Act. We seek to assure ourselves of their compliance annually.

Being part of an Integrated Care System has further empowered us in delivering a more integrated approach to the provision and delivery of health and social care. As well as improving outcomes for patients, we anticipate a more joined up approach will have a beneficial effect on the delivery of a more environmentally sustainable local health system through greater sharing of resources, including estate and infrastructure, that will lead to greater efficiencies over time.

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1.8.2.1 NHS Net Zero

The UK government has committed to reaching net zero carbon by 2050. This means significantly reducing emissions as well as off-setting using carbon capture. The NHS accounts for 5% of the UK’s carbon footprint, equivalent to the whole carbon footprint of Cyprus.

In Autumn 2020 The NHS Net Zero Report was published. This report sets out what the NHS has achieved to date and describes the environmental impact of health services. It also describes the opportunities in the areas of estate and facilities, medicines, supply chain, travel and transport, food, catering and nutrition and research, innovation and offsetting.

The NHS Net Zero report commits the NHS to becoming the world’s first net zero national health service with two core targets:

• For the emissions we control directly (the NHS Carbon Footprint), we will reach net zero by 2040, with an ambition to reach an 80% reduction by 2028 to 2032. • For the emissions we can influence (our NHS Carbon Footprint Plus), we will reach net zero by 2045, with an ambition to reach an 80% reduction by 2036 to 2039. As we come out of the second wave, NHS England have stepped up their scrutiny of the progress made in this agenda in individual organizations and wider systems.

We are now developing a South West London ICS Green Plan, and plan to launch a South West London Green Network made up of partner organisations and large local employers like Transport for London this year.

1.8.2.2 Working from home

The last year has seen most CCG staff working from home. The use of collaborative IT solutions has allowed us to deliver our corporate meetings virtually, which has reduced the need for travel between meeting locations which has provided environmental benefits. As the government relaxes the restrictions around Covid-19 we are planning to create more availability of office space to our teams. We will initially adopt a phased approach of allowing teams to come together in our Wimbledon office with the opening of other office premises under review.

We want to capitalise on the benefits of virtual meetings and maintain a ‘virtual by default’ approach to our main committee meetings, reducing the need for people to travel between meetings.

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We are now engaging with all our teams to find the right balance between working from home and working in the office to create the most productive and environmentally friendly ways for our teams to work.

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2 Accountability report

2.1 Corporate governance report

Members Report

NHS South West London CCG is a clinically led member organisation and covers the London boroughs of Croydon, Kingston, Merton, Richmond, Sutton and Wandsworth. This means that GPs make decisions about local health services by using their local knowledge to improve services and focus resources where there is greatest need. The CCG is made up of 180 GP practices and is responsible for a budget of around £2.6 billion. Together the GP practices have a registered population of 1,709,000 patients (as at 1 March 2021). The membership is represented by a Governing Body of local GPs, a nurse representative, a secondary care doctor and lay members, supported by a management team. The CCG’s work is overseen by an elected Governing Body which is chaired by Dr Andrew Murray, a GP at the Nelson Health Centre, in Merton. Sarah Blow is the Accountable Officer for NHS South West London CCG. All Governing Body members have specific areas of responsibility and sit on committees of the Governing Body. The members exercise their constitutional rights in respect of the CCG through a membership group. Each member practice has a representative on the membership group.

2.1.1.1 Member practices by locality

Our member practices work across 39 primary care networks spanning six boroughs. A table of member practices is at Appendix A at the end of this document.

Our Governing Body

NHS South West London CCG’s Governing Body was established following the merger of the six borough CCGs in April 2020. Under the CCG’s Constitution and Standing Orders, the Governing Body’s GP representatives either transferred to the new organisation, have been elected by their local memberships or, with local membership agreement, have been extended in their roles. Our lay members were appointed, from the previous CCGs to the Governing Body via an expression of

126 interest exercise. Our Local Medical Councils, local authorities, Healthwatch organisations and the voluntary sector from across South West London are all represented on the Governing Body.

Our Governing Body meets in public every other month, and we encourage our community to join us to find out about the work we’re doing. Details of public Governing Body meetings, and meeting papers are published on the CCG website at www.swlondonccg.nhs.uk/about/governance/our- governing-body

During 2020/21, NHS South West London CCG strengthened governance arrangements by invoking its Command and Control framework in response to the Covid-19 pandemic to support the local and national joint decision making model. In this period of uncertainty and instability, the organisation has embraced new ways of working and new technologies to ensure the appropriate scrutiny and assurance was maintained in the safe delivery of services at pace and scale. This included the deployment of remote working and meeting platforms to maintain openness and transparency with the live streaming and recording of our public meetings.

At various times over the past year, our response to the Covid-19 pandemic and our invocation of a Command and Control structure have meant we have not implemented a usual cycle of business for the Governing Body or its Committees. For example, in order to prioritise resource and in line with the guidance provided from NHS England & Improvement some meetings have not been held. Governing Body members and our key stakeholders have been kept informed of the CCG’s response to the Covid-19 pandemic throughout the year.

The role of our Governing Body is to:

• Oversee and ensure that the CCG has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with the CCG’s principles of good governance. • Make sure that decisions about changes to local health services are made in an open and transparent way.

A number of sub-committees support our Governing Body to carry out its statutory duties. Please see a summary of our Governing Body members below, followed by a table detailing their attendance at meetings of the Governing Body and its committees during 2020/21.

127 Governing Body Members

2.1.3.1 Dr Andrew Murray, Clinical Chair

Dr Andrew Murray trained at Cambridge and Oxford universities and then moved to South West London in 2000, straight after graduating. He completed his GP training in August 2004 and joined the partnership at The Church Lane Practice in Merton Park and has practised as a GP principal in Merton since then. He oversaw the merger of his practice with Cannon Hill Lane Medical Practice in April 2015 to form the Nelson Medical Practice and now practises out of the Nelson Health Centre.

Andrew was involved in practice-based commissioning, set up and led a local GP provider company, worked as a GP appraiser in Sutton and Merton for 5 years, was a member of Merton Local Medical Committee for 7 years, as well as chairing Merton, Sutton and Wandsworth Local Medical Committees from 2011 to 2013, when he moved from this role to join Merton CCG as Clinical Chair.

He also has an interest in developing world healthcare, education and community development and helped to set up a community health worker training programme in Myanmar which has so far trained nearly 1000 health workers. He served for a number of years as a trustee and chair of the charity supporting this work (Health and Hope) which received the patronage of HRH The Prince of Wales.

In the last couple of years Andrew has co-chaired the South West London clinical senate and has led work on Children and Young People’s Mental Health. He has overseen the Whole School Approach to emotional wellbeing receiving funding for 14 national trailblazer pilots, covering approximately 50% of pupils in South West London, the largest cluster in the country.

As Merton CCG Chair, Andrew promoted a community-based and holistic approach to health and ensured closer working with the Local Authority, particularly around action on health inequalities through the Health and Wellbeing Board.

Andrew was subsequently appointed Chair of NHS South West London CCG and has provided senior clinical leadership to South West London through the Covid-19 pandemic, chairing the Clinical Leadership Group and the Specialised & Cancer Recovery Programme.

128 2.1.3.2 Dr Agnelo Fernandes, GP Borough Lead for Croydon

Dr Agnelo Fernandes has been a GP in Thornton Heath, Croydon for 31 years. His interests include dermatology, quality improvement of health services through innovation and transformation and teaching and training. He is a GP Trainer and a Governor at Royal Russell School, Croydon.

He is also the Chair of the pan-London Integrated Urgent Care Clinical Governance group and Chair of the National NHS Pathways Clinical Governance group involving representatives of the royal medical colleges, and he was previously the National GP Lead for Urgent & Emergency Care for the Royal College of General Practitioners (UK).

Agnelo is also Vice Chair of Croydon’s Health and Wellbeing Board and co-Chair of the Health Board in Croydon.

He was awarded the MBE for “services to Medicine and Healthcare” by Her Majesty the Queen (2004) and Fellowship of the Royal College of General Practitioners (2006).

2.1.3.3 Dr Naz Jivani, Clinical Vice Chair and GP Borough Lead for Kingston

Dr Naz Jivani has been a GP in Kingston since 1996 and is a partner at The Groves Medical Centre, New Malden. He specialises in musculoskeletal conditions and is currently leading a programme of improvements in this area. He is also Clinical Lead for South West London and Kington Planned Care and MSK Transformation Programmes.

He is currently a Board Member of the NHS Clinical Commissioners, representing London. He also Co-Chairs the Kingston Health and Wellbeing Board.

Naz is the GP Borough Chair for Kingston. In this role he works alongside other GPs, health and care professionals, Kingston Hospital, Kingston Council, and Kingston’s local Healthwatch to take forward the integration of health and social care to better serve the needs of the Kingston community.

129 2.1.3.4 Dr Vasa Gnanapragasam GP Borough Lead for Merton

Dr Vasa Gnanapragasam has been a GP since 1996. He worked for 16 years at the Emergency department at St George’s Hospital helping to develop his awareness of NHS clinical practice in both primary care and secondary care. He finds the challenge of looking after the diverse population of London intellectually stimulating and personally rewarding. Vasa is a partner at a practice in Merton.

Vasa has an interest in diabetes, cardiovascular disease, frailty and patient engagement. Since 1999 he has held many portfolios in Merton serving as lead for cardiovascular disease, long term conditions, medicines management, community services and planned care. He is currently clinical co-lead for urology and stroke in South West London. Vasa has found leading the discussion and responding to questions at Covid vaccine webinars most fulfilling.

Vasa has been actively involved in education, training, workforce development and quality assurance since 2002. He is a GP trainer and appraiser and is also a Foundation Doctor supervisor. He was a module lead on the pioneering physician associate programme at St George’s, University of London for ten years and has been teaching since its founding in 2008. He was promoted to Senior Lecturer in PA education in 2014.

As GP Borough Lead for Merton, Vasa looks forward to supporting the effective integration and delivery of health and care services across South West London to better serve the needs of the people of Merton and South West London.

2.1.3.5 Dr Patrick Gibson, GP Borough Lead for Richmond

Dr Patrick Gibson practices at Essex House, Barnes. Patrick has held several board and clinical leadership roles, with particular focus on Whole System Work, cardiovascular and cancer. He has held liaison roles with Kingston and Queen Mary’s Hospitals.

He was a member of Richmond’s clinical executive team and chaired the Richmond and Barnes membership engagement group. In 2012, Patrick’s thinking on care management was heavily influenced by a whole system leadership programme, supported by the King’s Fund, which put relationship building at the heart of transformational work.

130 Patrick’s motivation is to reduce inequalities in health outcomes and to create life-long mental health resilience through attention in the early years.

2.1.3.6 Dr Jeffrey Croucher, GP Borough Lead for Sutton

April to October 2020

Dr Jeffrey Croucher has been the GP Borough Lead for Sutton up to October 2020, prior to which he was appointed Clinical Chair of Sutton CCG in July 2016, having previously undertaken the role of Sutton and Cheam Locality Lead. As a local GP, with a special interest in Musculoskeletal Medicine, and GP Trainer, Dr Croucher has supported Sutton residents since 2003.

Dr Croucher continues to undertake his clinical role from the Benhill and Belmont GP Centre in Sutton. He trained at St George’s Hospital, Tooting and has subsequently worked and lived locally over the last 30 years.

2.1.3.7 Dr Dino Pardhanani, GP Borough Lead for Sutton

October 2020 – present

Dr Dino Pardhanani graduated from St George’s Hospital Medical School in 1999 and has been a GP since 2003. Dino joined Mulgrave Road Surgery as a partner in 2004 and has worked as a GP with a special interest (GPwSI) in Ear, Nose and Throat disorders for 15 years and was awarded a Master’s in Business Administration in 2016.

Dino has worked with NHS Sutton CCG from its inception in 2013 and was appointed as Joint Clinical Director in 2018. Dino was elected as Joint Primary Care Network Clinical Director for Central Sutton in 2019. He is Chair of the Epsom and St Helier University Hospitals A&E Delivery Board and is NHS Sutton CCG Clinical Director Lead for the Sutton Joint Financial Recovery plan with Epsom and St Helier University Hospitals NHS Trust.

He joined the NHS South West London CCG Governing Body in October 2020.

131 2.1.3.8 Dr Nicola Jones, Clinical Vice Chair and GP Borough Lead for Wandsworth

In addition to supporting the Chair, Nicola’s portfolio includes clinical leadership of primary care and the Covid-19 vaccine programme.

Nicola has been a GP since 1995. She has been a primary care advisor to the Department of Health and has experience of commercial organisations as well as an NHS background. She gained an MBA from London Business School in 1999 and has developed management expertise in a variety of roles but remains utterly rooted in NHS clinical practice and primary care. She enjoys the challenges of practicing in inner London with its diversity and pathology.

Nicola has an interest in cardiovascular disease and women’s health and, as well as seeing patients, is the managing partner of a group of practices in a Primary Care Network in Wandsworth. Having been the Clinical Lead for Cardiovascular Disease in Wandsworth for many years she now co-chairs the South West London Cardiology Network.

2.1.3.9 David Smith, Non-Clinical Vice Chair and Finance Chair Lay Member

David Smith is a qualified accountant and member of the Chartered Institute of Public Finance and Accountancy. After more than 42 years working in the NHS, David retired from full-time work at the end of 2017.

David’s early career was in finance roles before moving into performance management and commissioning. David has previously served in a joint post as the Director of Adult Social Services for the Royal Borough of Kingston upon Thames and Chief Officer of Kingston CCG. In this role, he led the transformation of the care systems in Kingston, integrating service delivery models, and health and adult social care commissioning. He was also Chief Executive of Oxfordshire CCG and lead the Sustainability and Transformation Partnership covering Buckinghamshire, Oxfordshire, and Berkshire West.

With his experience working in the NHS and with CCGs, David is pleased to be working in NHS South West London CCG, contributing to the strategy of the CCG and the wider system as we strive to deliver consistently high quality of care. David chairs the Finance Committee; chairs the Remuneration Committee and is a member of the Audit Committee.

132 2.1.3.10 Paul Gallagher, Audit Chair Lay Member and Conflicts of Interest Guardian

Paul Gallagher is a chartered accountant and has experience as a lay member on the Governing Bodies for the former CCGs in South West London.

Paul began his career in local government and has since held a number of senior leadership roles in the private sector, managing and supplying IT, professional and support services to both private and public sector organisations. Paul currently works in management consulting and advises companies on finance transformation, strategy and operations.

In his role as Chair of the Audit Committee and Conflicts of Interest Guardian, Paul is committed to ensuring accountable delivery of health and care for the community.

2.1.3.11 Dr Les Ross, Secondary Care Doctor

Dr Leslie (Les) Ross was clinical consultant in the women’s health department at St Helier for 25 years until retirement in October 2012, with experience in both Obstetrics, Gynaecology, ultrasound, cancer diagnostics and subfertility / IVF and was clinical director for 3 years. While retired from an NHS Consultant post since the end of 2012, Les continued to undertake some private practice held duties as the Responsible Officer and Medical Advisory Committee chair at St Anthony's hospital until 2014 and undertaking work as a FIPO (Federation of Independent Practitioner Organisations) accredited appraiser for doctors in the independent sector.

Before joining NHS Croydon CCG in September 2019, Les served six years as a Sutton CCG Governing Body member as Secondary Care representative and was particularly involved in the quality agenda where he gained his Information Governance expertise in holding the role of Caldicott Guardian.

2.1.3.12 Susan Gibbin, Patient and Public Involvement Lay Member and Freedom to Speak Up Guardian

Susan has worked in and with the NHS for more than 30 years in an executive, consultancy and more recently in a non-executive capacity. Susan has vast experience of working with

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commissioning and provider organisations in both Health and Education, offering experience in strategic and critical thinking, governance and partnership working. Susan is also the CCG’s Freedom to Speak Up Guardian.

2.1.3.13 Pippa Barber, Independent Registered Nurse

Pippa Barber has nearly 40 years’ experience in the NHS. She has significant Board experience in a number of Executive roles across a range of Provider and Commissioning Trusts, latterly as the Executive Director of Nursing and Governance at Kent and Medway Social Care Partnership Trust and Executive Nurse at NHS Medway. In addition, she has current Non-Executive Board experience for a Provider NHS Trust Board.

Pippa is currently the Independent Nurse representative for NHS South West London CCG’s Governing Body, where she maintains an essential focus on clinical quality, safety and effectiveness and Chairs the South West London Quality and Performance Committee.

2.1.3.14 Sarah Blow, Accountable Officer

Sarah has over 20 years of experience in the NHS. She is an experienced Chief Executive and has led programmes across partnerships while working widely across systems to improve services and deliver sustainability. Sarah has held operational and strategic roles with Local Authorities, providers and the Department of Health, and recognises the importance of a strong collaborative approach.

Sarah has been working in South West London as Accountable Officer for NHS South West London CCG alongside being the Senior Responsible Officer for the ICS (Integrated Care System) known as South West London Health and Care Partnership since February 2017.

In 2020 Sarah oversaw the merger of the South West London Alliance of CCGs and Croydon CCG, into the current, single, NHS South West London Clinical Commissioning Group.

Sarah is responsible for leading the partnership through the changing NHS landscape as well as being accountable for balancing financial budgets, achieving performance targets, commissioning and overseeing governance and quality, as well as ways of working and communications.

134 Sarah holds an MBA, PG Dip in Healthcare Systems Management and a BA (Hons) History and Humanities and is based in Wimbledon. She lives in Sutton with her family and has two grown up sons.

2.1.3.15 James Murray, Chief Finance Officer

James has over 30 years’ experience working within the NHS across a number of different organisations, including provider, commissioning and regulatory functions. James has been the Chief Finance Officer for the South West London Alliance of CCGs for the past three years.

Governing Body and sub-committee meetings

The Governing Body met five times in 2020/21. The January 2021 meeting was cancelled due to the CCG concentrating its resources on the response to the Covid-19 pandemic.

2.1.4.1 Governing Body membership and meeting attendance

Name Role Meetings attended

Dr Andrew Murray NHS South West London CCG Clinical Chair 5/5

Dr Agnelo Fernandes Croydon, elected GP Borough Lead 3/5*

Dr Naz Jivani Kingston, elected GP Borough Lead 4/5*

Dr Vasa Gnanapragasam Merton, elected GP Borough Lead 5/5

Dr Patrick Gibson Richmond, elected GP Borough Lead 4/5

Sutton, elected GP Borough Lead (up to Oct 3/3 Dr Jeff Croucher 2020)

Dr Dino Pardhanani Sutton, elected GP Borough Lead 2/2

Dr Nicola Jones Wandsworth, elected GP Borough Lead 5/5

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NHS South West London CCG, Deputy Chair & 5/5 David Smith Lay member Finance

Paul Gallagher Lay Member, Audit Chair 5/5

Dr Les Ross Secondary Care Doctor 5/5

Susan Gibbin Lay Member, Public & Patient Engagement 5/5

Pippa Barber Independent Registered Nurse 5/5

NHS South West London CCG Accountable 5/5 Sarah Blow Officer

James Murray NHS South West London Chief Finance Officer 5/5

* a representative deputy was present for one (September) meeting

2.1.4.2 Committees of the Governing Body

The Governing Body has established sub-committees as described below. The extent of authority to act of these committees depends on the powers delegated to them by the CCG, as described in its Scheme of Reservation and Delegation (Appendix 4b of the CCG’s constitution), which sets out:

• Decisions that are reserved to the membership as a whole. • Decisions delegated to the Governing Body and its committees. • Decisions delegated to individual members and employees.

The CCG remains accountable for all of its functions including those that it has delegated. In discharging their delegated responsibilities, the Governing Body and its committees are required to:

• Comply with the principles of good governance. • Operate in accordance with the CCG’s Scheme of Reservation and Delegation. • Comply with the CCG’s Standing Orders. • Comply with the CCG’s arrangements for discharging its statutory duties.

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• Where appropriate, ensure that members have had the opportunity to contribute to the CCG’s decision-making process through the membership group.

When discharging their delegated functions, the Governing Body and committees operate in accordance with their approved terms of reference.

2.1.4.3 Audit Committee

The Audit Committee is responsible for reviewing the establishment and maintenance of an effective system of governance, risk management and internal control, across the whole of the CCG’s activities that support the achievement of the CCG’s objectives. A key purpose of the committee is to monitor the integrity of the financial statements of the CCG and assure itself that relevant risks, particularly financial, are appropriately identified and managed within a robust system of internal control. The Committee is also responsible for seeking appropriate assurance functions on relating to ensuring arrangements for counter-fraud and audit work programmes.

The Audit Committee met seven times during 2020/21 in order to discharge its responsibilities.

Name Role Meetings attended

Paul Gallagher Lay Member, Audit Chair 7/7

NHS South West London CCG, Deputy Chair & 7/7 David Smith Lay member Finance

Dr Agnelo Fernandes Croydon, elected GP Borough Lead 6/7*

Dr Dino Pardhanani Sutton, elected GP Borough Lead 1/3

Sutton, elected GP Borough Lead (up to Oct 4/4 Dr Jeff Croucher 2020)

Dr Les Ross Secondary Care Doctor 7/7

*representative present for September 2020 meeting

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2.1.4.4 Remuneration Committee

The Remuneration Committee is responsible for advising the Governing Body in meeting their responsibilities to ensure appropriate remuneration, allowances and terms of service for the CCG Chair, Accountable Officer, senior managers remunerated under the Very Senior Manager (VSM) Pay Framework, Governing Body clinical posts, and clinical lead corporate roles; at all times having proper regard to the organisation’s circumstances and performance, the provisions of any national agreements and NHS England and Improvement guidance, where appropriate.

With the exception of Lay Members, the Committee also has the power to make recommendations on fees and other allowances for all individuals directly appointed by the CCG as workers or employees.

The Remuneration Committee met seven times during 2020/21 in order to discharge its responsibilities.

Name Role Meetings attended

NHS South West London CCG, Deputy Chair & 7/7 David Smith Lay member Finance

Paul Gallagher Lay Member, Audit Chair 7/7

Susan Gibbin Lay Member, Public & Patient Engagement 7/7

2.1.4.5 Primary Care Commissioning Committee

The Primary Care Commissioning Committee meets in public, and its purpose is to enable the members to make collective decisions on the review, planning and procurement of primary care services in South West London, under delegated authority from NHS England.

The Committee aims to ensure that appropriate primary care services are commissioned to serve the needs of residents and improve the efficiency, effectiveness, economy and quality of services, reduce inequalities and promote the involvement of patients and the public in the development of services. Patients, members of the public and other stakeholders are invited to attend the Committee.

138 Due to the impact of the pandemic and the ensuing Command and Control arrangements the Primary Care Commissioning Committee met four times in public during the year as opposed to the planned six meetings in the first year as set out in the committee’s Terms of Reference which form a part of the constitution. In addition to the public meetings, urgent decision-making meetings were established to ensure continuity of oversight and authorisation as required within the committee’s remit.

Name Role Meetings attended

Susan Gibbin Lay Member, Public & Patient Engagement 4/4

Dr Les Ross Secondary Care Doctor 4/4

Jonathan Bates Executive Director Systems Planning Performance 2/2 and Delivery (Primary Care SRO up to March 2021)

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

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

2.1.4.6 Quality, Performance and Oversight Committee

The Committee is responsible for overseeing, understanding, reviewing, and ensuring a robust quality strategy is in place and that this maximises the quality and safety of services for the population of South West London. The Committee provides assurance to the Governing Body, that required performance outcomes are delivered with associated risks identified and, where possible, mitigated.

The Quality and Performance Oversight Committee met seven times during 2020/21.

Name Role Meetings attended

139 Pippa Barber Independent Registered Nurse 7/7

Susan Gibbin Lay Member, Public & Patient Engagement 6/7

Dr Nicola Jones Wandsworth, elected GP Borough Lead 6/7

Dr Patrick Gibson Richmond, elected GP Borough Lead 6/7

Dr Les Ross Secondary Care Doctor 7/7

Gloria Rowland Chief Nurse/Executive Director of Quality 1/1

Jonathan Bates Executive Director Systems Planning Performance 6/7 and Delivery

2.1.4.7 Finance Committee

The Committee is established to ensure that a robust financial strategy is in place and to oversee the system of financial management, including the review of financial plans and the current and forecast financial position of the CCG and Borough budgets.

The Committee also aims to understand the drivers behind any variances against the plans, ensure any risks have been identified, and mitigating actions have been taken to address these whilst providing assurance to the Governing Body about delivery and sustained performance.

The Finance Committee met 11 times during 2020/21.

Name Role Meetings attended

NHS South West London CCG, Deputy Chair & 11/11 David Smith Lay member Finance, Finance Committee Chair

Dr Les Ross Secondary Care Doctor 11/11

Dr Naz Jivani Kingston, elected GP Borough Lead 8/11

Dr Vasa Gnanapragasam Merton, elected GP Borough Lead 9/11

Paul Gallagher Lay Member, Audit Chair 9/11

140 Pippa Barber Independent Registered Nurse 9/11

James Murray NHS South West London Chief Finance Officer 11/11*

*representative present at three meetings

2.1.4.8 NHS South West London CCG ‘Committees in Common’

NHS South West London CCG’s constitution provides for a mechanism that allows specified functions to be delegated to a designated committee, which may meet with delegated committees of other CCGs in a Committees in Common (CiC) arrangement, with the agreement of the Governing Body.

2.1.4.9 Improving Healthcare Together 2020-2030

During 2019/20, NHS South West London CCG alongside Surrey Heartlands CCG agreed the establishment of the Improving Healthcare Together: 2020-2030 Committees in Common (CiC) arrangement to enable the participating CCG Committees to consider the same issues at the same time in relation to any significant change to the commissioning of acute services at Epsom and St Helier University Hospitals Trust, as part of collaborative decision making for the Improving Healthcare Together (IHT) programme. Under the arrangement each CCG Committee has delegated authority to make decisions about the matters within the scope of this CiC on behalf of its own CCG and without the need to be ratified by its Governing Body.

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

There were no other CiC delegations during 2020-21.

The CCG operates a robust policy for the management of Conflicts of Interest. A register of declared interests is published on the website at www.swlondonccg.nhs.uk/wp- content/uploads/2020/07/SWL-COI-REGISTER_-June-2020.pdf

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All attendees are required to declare their interests as a standing agenda item for every Governing Body, Committee or working group meeting before the item is discussed.

To protect the integrity of decision-making, arrangements for managing conflicts of interest and potential conflicts of interest have been established. These include excusing potentially conflicted members from deliberations where appropriate.

Personal data related incidents

There have been no Serious Untoward Incidents relating to data security breaches, that required onward reporting to the Information Commissioner.

Statement of Disclosure to Auditors

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

• So far as the member is aware, there is no relevant audit information of which the CCG’s auditor is unaware that would be relevant for the purposes of their audit report • The member has taken all the steps that they ought to have taken in order to make him or herself aware of any relevant audit information and to establish that the CCG’s auditor is aware of it.

Modern Slavery Act

NHS South West London CCG fully supports the Government’s objectives to eradicate modern slavery and human trafficking. Our Slavery and Human Trafficking Statement for the financial year ending 31 March 2020 is published on our website.

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2.2 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 Sarah Blow to be the Accountable Officer of NHS South West London 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:

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• 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. • Prepare the accounts on a going concern basis. • Confirm that the Annual Report and Accounts as a whole is fair, balanced and understandable and take personal responsibility for the Annual Report and Accounts and the judgements required for determining that it is fair, balanced and understandable.

To the best of my knowledge and belief, 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. • The annual report and accounts as a whole is fair, balanced and understandable and that I take personal responsibility for the annual report and accounts and the judgments required for determining that it is fair, balanced and understandable.

Sarah Blow Accountable Officer South West London Clinical Commissioning Group Date: 11 06 21

144 2.3 Governance Statement

Introduction and context

NHS South West London Clinical Commissioning Group is a body corporate established by NHS England on 1 April 2020 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 1 April 2020, the clinical commissioning group is not subject to any directions from NHS England issued under Section 14Z21 of the National Health Service Act 2006.

Scope of responsibility

As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the clinical commissioning group’s policies, aims and objectives, whilst safeguarding the public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out under the National Health Service Act 2006 (as amended) and in my Clinical Commissioning Group Accountable Officer Appointment Letter.

I am responsible for ensuring that the clinical commissioning group is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity. I also have responsibility for reviewing the effectiveness of the system of internal control within the clinical commissioning group as set out in this governance statement.

145 Governance arrangements and effectiveness

The main function of the Governing Body is to ensure that the group has made appropriate arrangements for ensuring that it exercises its functions effectively, efficiently and economically and complies with such generally accepted principles of good governance as are relevant to it.

NHS South West London CCG’s constitution sets out how it shall fulfil its statutory duties and the primary governance rules for the CCG. It complies with National Health Service Act 2006 (as amended) and relevant guidance issued by NHS England. The CCG is a clinically led membership organisation and is accountable for exercising the statutory functions of the CCG.

The Governing Body comprises:

• One Chair – who shall be an elected GP • Six elected GPs – one from each Borough • Two Independent Members: o A Secondary Care Specialist o A Registered Nurse • The Accountable Officer • The Chief Finance Officer • Three lay members with experience of: o Finance, governance and audit o Patient and Public Involvement o Finance, planning, commercial and procurement expertise/experience within the NHS

Committees of the Governing Body and membership of each are described within the Member’s Report.

Discharge of statutory functions

The arrangements put in place by NHS South West London CCG and explained within the corporate governance framework were developed to ensure compliance with all relevant legislation.

In light of recommendations of the 2013 Harris review, the CCG has reviewed all the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other

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associated legislative and regulations. I can confirm that the CCG is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions.

Responsibility for each duty and power has been clearly allocated to members of the Senior Management Team who ensure the necessary capability and capacity to undertake all of the CCG’s statutory duties.

UK Corporate Governance Code

We are not required to comply with the UK Corporate Governance Code. However, we have reported on our Corporate Governance arrangements by drawing upon best practice available, including those aspects of the UK Corporate Governance Code and the Corporate Governance in Central Government Departments: Code of Good Practice 2011 (HM Treasury and Cabinet Office) that we consider to be relevant to the CCG. These are especially reflected in this report in describing review of Governing Body effectiveness and the CCG’s risk management arrangements.

Risk management arrangements and effectiveness

The CCG has a robust internal control mechanism to allow it to prevent, manage and mitigate risks. The Internal Control Framework section below describes the governance structure of the CCG, while the risk assessment section (described over the following pages) describes our approach to risk management and appetite for risk, explaining the key components of the internal control structure. Combined, these arrangements underpin the CCG’s ability to control risk through a combination of:

• Prevention – the CCG’s structures, governance arrangements, policies, procedures and training minimise the likelihood of risks crystallising; • Deterrence – staff are made aware that failure to comply with key policies and procedures, such as the Standards of Business Conduct Policy or the Fraud, Bribery and Corruption Policy, will be taken seriously by the CCG and could lead to disciplinary action, or dismissal;

147 • Management of risk – once risks are identified the arrangements for ongoing monitoring and reporting of progress through the Committee structure to the Governing Body ensure appropriate action is taken to manage risks.

The capacity to handle risk section describes the range of systems and processes in place to embed risk management more broadly in the CCG’s activities including the requirement for equality impact assessments to accompany papers to the Governing Body.

The CCG is fully committed to complying with the public sector equality duty set out in the Equality Act 2010, both as an employer and a commissioner of health services and publishes these arrangements on our website. The Lay Member for Patient and Public Involvement (PPI) assures the CCG's duty to engage the public is given a profile at the Governing Body. Members of the public are also able to attend meetings of the Governing Body and Primary Care Commissioning Committee.

Board assurance and risk management framework

The Board Assurance Framework (BAF) provides assurance to the Governing Body on the delivery of its corporate objectives.

The BAF has been designed to provide assurance on the delivery and impact of the priority programmes as well as the risks threatening delivery and therefore impact on corporate objectives being achieved. It sets out mitigating actions for the risks and timescales in respect of these actions being completed.

Priority areas managed under the CCG’s objectives

2.3.8.1 Capacity to handle risk

The responsibilities of Directors and Committees are set out in the NHS South West London Clinical Commissioning Group Constitution and the accompanying Scheme of Delegation, as well as the governance reporting lines. Timely and accurate information to assess risk and ensure compliance with the CCGs statutory obligations, is submitted in line with the CCG’s annual plan of committee

148

work. The Governing Body has rigorous oversight of the performance of the CCG, via formal Governing Body meetings, seminars and through assurances received from committees and audits.

The overall responsibility for the management of risk lies with the Accountable Officer. The Governing Body collectively ensures that robust systems of internal control and management are in place. These arrangements, and the enhancements that have been made to them, are described in the Risk Assessment section of this report.

Risk management capacity has been developed across the CCG in a number of ways during the year. The statutory and mandatory training programme includes numerous elements relevant to risk management, including information governance, health and safety, fire safety, safeguarding adults and children and counter fraud.

Governing Body and Committee reporting arrangements prompt authors to consider that key aspects of risk have been reviewed.

2.3.8.2 Risk assessment in relation to governance, risk management and internal control

The Senior Management Team is responsible for oversight of the risk management process, its members review both Risk Registers and the Board Assurance Framework as part of their business cycle, and the management of all NHS South West London CCG Corporate Risks are overseen by an Executive Director. It evaluates the status of risks, identifies new risks and monitors effectiveness of the CCG’s board assurance and risk management control systems.

The Audit Committee provides scrutiny and independent assurance to the Governing Body on the effectiveness of the CCG’s board assurance and risk management processes.

The Governing Body reviews the content of the BAF twice a year as a means of assessing the current level.

All other sub committees of the Governing Body review those risks specific to their area and are made aware of significant changes to the risk register at each meeting.

Operational management of the BAF is provided by the CCG’s Governance and Corporate Services team. Regular meetings are held with manager leads to review progress and performance of each of the priority areas and associated risks.

149 The Board Assurance Framework (BAF) forms the basis for the Governing Body to assess its position regarding achieving its corporate objectives. It uses principal risks to achieve those objectives as the foundation for assessment. It considers the current level of control alongside the level of assurance that can be placed against those controls.

The BAF has been created from three core areas of the CCG’s more detailed Corporate Risk Register:

• Risks with a significant residual score, for example, those that score over 15 • Those risks that we believe are either likely to be growing in significance or that we wish to flag to the Audit Committee as posing a risk to delivering essential areas of work.

Overarching risks that collate and summarise several more detailed risks present on the risk register. For example, finance.

The CCG views risk management as key to the successful delivery of its business and remains committed to ensuring staff are equipped to assess, manage, escalate and report risks. This ensures a comprehensive overview of all the risks affecting the organisation and facilitates decision making about those risks that need immediate treatment and those that the organisation can tolerate for a specified amount of time.

The CCG uses an NHS standard risk scoring matrix (CASU 2002) to determine the scales of impact and likelihood of adverse events. The scale is scored from 1-25 (with 1 being the least severe and 25 being the most). The risk will continue to be managed at Director level with oversight by the Committee relevant to the risk as well as oversight from the Audit Committees in common. This allows:

• The appropriate level of investigation and causal analysis to be carried out. • Identification of the level at which the risk will be managed, the assigning of priorities for remedial action and determination of whether the risk will be accepted.

The areas of high risk for NHS South West London CCG are:

Using the residual risk rating (i.e. after controls are taken into account), there are three risks of significant nature (significant risks are those on the risk register scored at 15 and above):

• RRSWLCCG008 – The impact of elective Referral to Treatment (RTT) (including diagnostic and cancer pathways)

150

• RRSWLCCG051 – NHS Constitution Standards • RRSWLCCG101 – Roll out of Covid-19 Vaccination Program Across South West London

Other sources of assurance

2.3.9.1 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.

Our governance structures are used to ensure effective oversight of operational and strategic decisions and compliance with the NHS regulatory environment. Details of the Governing Body responsibilities and those of its committees are outlined above and described in further detail within the Constitution.

Ensuring effective risk management, financial management and compliance with statutory duties is high on the list of our priorities. We have implemented policies, systems and processes to reduce exposure in these areas and to ensure that we are legally compliant. Each committee and group oversees risks and policies relating to their area of responsibility. Clinicians and management work in partnership through the commissioning cycle, adding value and delivering outcomes, to ensure the procurement of quality services that are tailored to local needs and deliver sustainable outcomes and value for money.

The CCG has established an effective organisational structure with clear lines of authority and accountability which guards against inappropriate decision making and delegation of authorities enabling us to meet our statutory duties and follow best practice guidelines. Work to ensure that we promote and demonstrate the principles and values of good governance and the review of governance related risks takes place at Senior Management Team meetings and assurance is provided by the Audit Committee to the Governing Body with insight from Internal Audit. The Committee also ensures that, in non-financial and non-clinical areas that fall within the remit of its terms of reference, appropriate standards are set and compliance with them is monitored. We have

151 considered the effectiveness of our governance framework and processes and raised no significant concerns on governance related matters this year.

The system of internal control is based on an ongoing process designed to identify and prioritise the risks to the achievement of the policies, aims and objectives of the CCG, 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 has been in place in the CCG for the year ended 31 March 2021 and up to the date of approval of the annual report and accounts.

2.3.9.2 Annual audit of Conflicts of Interest management

The revised statutory guidance on Managing Conflicts of Interest for CCGs (published June 2016 and further updated in June 2017) requires CCGs to undertake an annual internal audit of Conflicts of Interest management. To support CCGs to undertake this task, NHS England has published a template audit framework.

An internal audit of the CCG’s Conflicts of Interest process was carried out in early 2021. The audit found many areas of good practice but highlighted one high priority action relating to the completeness of the CCG’s Conflict of Interests register. The CCG is in the process of delivering a number of actions to address this recommendation, further strengthening its Conflict of Interest processes.

2.3.9.3 Data quality

The Governing Body regularly receive reports that cover financial, governance, compliance, performance and quality matters for the CCG.

The CCG has a business intelligence and performance function which monitors how local providers are performing against key performance indicators. This information is reported to the Governing Body on a regular basis.

The data contained in the reports is subject to significant scrutiny and review, both by management and by Governing Body committees. The quality of information received to direct decision making is

152 also assured through the service level specification arrangements with the North East London Commissioning Support Unit (NELCSU) and the use of contractual arrangements with the commissioned providers. The Governing Body are confident that the information they are presented with has been through appropriate review and scrutiny, and that it continues to develop with organisational needs.

2.3.9.4 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 Security and Protection Toolkit (DSPT) and the annual submission process provides assurances to the Clinical Commissioning Group, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively.

The DSPT came into force for the 2018-19 financial year and replaces the Information Governance toolkit. The DSPT is now the recognised standard for cyber and data security within the NHS. The toolkit requires the CCG to demonstrate compliance with ten data security standards along with demonstrable compliance with the General Data Protection Regulations (GDPR).

We have been working with our Information Governance team from NELCSU, in respect of submission of the DSPT. The DSPT is based on the 10 National Data Guardian (NDG) standards. NHS South West London CCG completed all 89 mandatory assertions, and 43 of the 57 non- mandatory assertions. The CCG published the 2020-21 submission with ‘Standards Met’ on 31 March 2021, ahead of the submission cut off which was 30 June 2021.

The CCG places high importance on ensuring there are robust Information Governance systems and processes in place to protect patient and corporate information. We have an Information Governance management framework, including information Governance processes and procedures in line with the DSPT. We have ensured all staff undertake annual Information Governance training. There are processes in place for incident reporting and investigation of serious incidents. We continue to develop information risk assessment and management procedures and a programme is in place to fully embed an information risk culture throughout the organisation against identified risks.

153 How we look after information securely

The Senior Information Risk Owner (SIRO) for NHS South West London CCG is the Chief of Staff; he is a member of the Senior Leadership Team and attends Governing Body meetings.

In response to the Covid-19 Pandemic, RSM were requested to conduct an in-depth audit to provide assurance that:

• South West London CCG’s Information Governance response to the Covid-19 pandemic followed best practice and met all legal requirements. • The control environment designed to ensure that South West London CCG managed its data sharing arrangements in accordance with the Control of Patient Information Notice (COPI) Notice, were fit for purpose and that information was only shared as appropriate and where suitable data sharing arrangements are in place.

The outcome of the audit was that substantial assurance was provided; all recommendations were swiftly implemented.

Business critical models

The CCG confirms that an appropriate quality assurance framework is in place and is used for all business critical analytical models.

Third party assurances

The CCG relies on a number of third party providers (such as NHS SBS, NHS BSA, NEL CSU) to provide a range of transactional processing services ranging from finance to data processing. Our requirements for the assurance provided by these organisations are reviewed every year. Appropriate formal assurances are obtained to supplement routine customer/supplier performance oversight arrangements.

154 Control Issues

No significant control issues have been identified at the CCG during 2020/21.

Review of economy, efficiency & effectiveness of the use of resources

The Governing Body, through its meetings, retains primary oversight of the appropriateness of arrangements in place within the organisation to exercise its functions in an effective, economic and efficient manner. It is my role as Accountable Officer to retain overall executive responsibility for the use of our resources.

The organisation has a number of key processes and internal mechanisms that provide assurance that we are operating within our statutory authority:

• Within our constitution there are clearly defined standards for conducting business, Standing Orders, Scheme of Reservation and Delegation along with Prime Financial Policies that ensure the effective management and protection of assets and public funds. • Key policies are in operation in respect of contract management and procurement that ensure effective operational and financial performance whilst ensuring we operate within regulatory frameworks and reduce the likelihood and impact of risk. • There is a clearly defined process for the consideration of business cases and saving opportunities to ensure transparency and value for money is upheld. • The Commercial Procurement Advisory Group evaluate the robustness of proposed business cases before these are then considered by the Finance Committee. • The Quality and Performance Oversight Committee are accountable for overseeing a robust, organisation-wide system of quality and performance. • The Finance Committee ensures that the finances of the CCG are scrutinised to ensure budgets are managed in an appropriate and timely manner. It will ensure that the Governing Body is fully aware of any financial risks which may materialise throughout the year. It works alongside the Audit Committee to ensure financial probity in the organisation. • These committees have, on behalf of the Governing Body, an overview of all aspects of finances (including capital spend and cash management).

155

Counter fraud arrangements

Counter fraud arrangements are in place in the CCG to ensure compliance with standards set by the NHS Counter Fraud Authority Standards for Commissioners: Fraud, Bribery and Corruption.

• An accredited counter fraud specialist is contracted to undertake counter fraud work proportionate to identified risks. • The CCG’s Audit Committee receives progress reports throughout the year and an annual report against each of the standards for commissioners. • There is executive support and direction for a proportionate proactive work plan to address identified risks. • Regular fraud related communications are shared with CCG staff and training is delivered to all staff. • The local counter fraud specialist meets with the director of finance and Internal Audit to agree tasks to be undertaken as part of the workplan. • The local counter fraud specialist also has regular liaison with the director of finance to discuss any concerns that come to light throughout the year. • A member of the Executive Team (the Chef Finance Officer) is proactively and demonstrably responsible for tackling fraud, bribery and corruption.

There have been no assessments from the NHS Counter Fraud Authority but should one occur an action plan would be taken forward following any recommendation made.

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.

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2.3.16.1 Scope and limitations of internal audit work

The formation of the opinion is achieved through a risk-based plan of work, agreed with management and approved by the audit committee.

The opinion is subject to inherent limitations, as detailed below:

• The opinion does not imply that internal audit has reviewed all risks and assurances relating to the organisation. • The opinion is substantially derived from the conduct of risk-based plans generated from a robust and organisation-led assurance framework. As such, the assurance framework is one component that the Governing Body takes into account in making its annual governance statement (AGS). • The opinion is based on the findings and conclusions from the work undertaken, the scope of which has been agreed with management / lead individual. • The opinion is based on the testing we have undertaken, which was limited to the area being audited, as detailed in the agreed audit scope. • Where strong levels of control have been identified, there are still instances where these may not always be effective. This may be due to human error, incorrect management judgement, management override, controls being by-passed or a reduction in compliance. • Due to the limited scope of our audits, there may be weaknesses in the control system which we are not aware of, or which were not brought to attention. • It remains management’s responsibility to develop and maintain a sound system of risk management, internal control and governance, and for the prevention and detection of material errors, loss or fraud. The work of internal audit should not be seen as a substitute for management’s responsibilities around the design and effective operation of these systems.

157 • Our internal audit work for 2020/21 has been undertaken through the substantial operational disruptions caused by the Covid-19 pandemic. In undertaking our audit work, we recognise that there has been a significant impact on both the operations of the organisation and its risk profile, and our annual opinion should be read in this context.

2.3.16.2 Factors and findings which have informed our draft opinion

Based on the work undertaken in 2020/21 there is a generally sound system of internal control, designed to meet the CCG’s objectives, and controls are generally being applied consistently.

2.3.16.3 Topics judged relevant for consideration as part of the annual governance statement

Based on the work we have undertaken to date on the CCG’s system on internal control, we do not consider that within these areas there are any issues that need to be flagged as significant control issues within the Annual Governance Statement (AGS). The CCG may wish to consider the issues raised in the partial assurance internal audit reports highlighted below when determining whether anything should be highlighted within the Annual Governance Statement. The CCG should also consider whether any other issues have arisen as well as recognise the challenging environment within which the CCG is operating, including the results of any external reviews.

During the year, Internal Audit issued the following audit reports:

Area of Audit Level of Assurance Given

Data Sharing and Data Security Substantial Assurance

Financial Governance during Covid-19, Part 1 Substantial Assurance

Financial Controls Substantial Assurance

Financial Governance during Covid-19, Part 2 Substantial Assurance

Procurement and Contract Management Partial Assurance

Conflict of Interests – Part 2 Partial Assurance

Primary Care Commissioning Reasonable Assurance

158 Risk Management Part 2 (Draft) Reasonable Assurance

Advisory reports were issued in the following areas:

• Financial Governance • Conflicts of Interest – Part 1 • Risk Management – Part 1 • Governance • Data Security Protection Toolkit • Continuing Healthcare

Review of the effectiveness of governance, risk management and internal control

My review of the effectiveness of the system of internal control for this year has been informed by the work of the internal auditors, executive managers and clinical leads within the Clinical Commissioning Group who have responsibility for the development and maintenance of the internal control framework. I have also 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 principal objectives have been reviewed.

I have been advised on the implications of the result of this review by:

• The Governing Body • The Quality, Safety and Performance Committee • The Audit Committee • The Executive Management Team • Internal audit

159 2.3.17.1 Conclusion

Internal Audit has not identified any significant issues that need to be flagged as significant control issues within the Annual Governance Statement.

Sarah Blow Accountable Officer NHS South West London Clinical Commissioning Group Date: 11 06 21

2.4 Remuneration report

Under the Government Financial Reporting Manual NHS bodies are required to prepare a remuneration report that is published as part of their annual report and financial accounts. This report must contain information about the remuneration of (pay received by) senior managers.

Senior managers are defined as people in senior positions having authority or responsibility for directing or controlling the major activities of the Clinical Commissioning Group. This means those who influence the decisions of the CCG as a whole rather than the decisions of individual directorates or departments.

To ensure remuneration is in line with national guidance, current good practice and ensures value for public money, the CCG has set up a remuneration committee.

The committee, which is accountable to the Governing Body, makes recommendations on the remuneration, fees and other allowances for employees and for people who provide services to the CCG. This includes advising on salaries for the CCG’s most senior staff (known as Very Senior Managers). It would also make recommendations on allowances under any pension scheme that the CCG may establish as an alternative to the NHS pension scheme.

160 Remuneration committee report

A summary of the duties and the membership of the remuneration committee is included within the governance section of the Annual Report.

Remuneration policy

Remuneration for Governing Body members, including the Accountable Officer and Chief Finance Officer, is determined on the basis of reports to the Remuneration Committee, taking into account national guidance on pay rates, any independent evaluation of the post and national and market rates.

All other managers are covered by terms and conditions set out in the national NHS Agenda for Change arrangements. Individual staff performance is assessed as part of the staff appraisal process, which includes objective setting and annual reviews with line managers. In line with national guidance and the Agenda for Change programme, staff progress through an incremental pay scale if their performance during the year has been in line with agreed targets and objectives.

Senior managers’ performance related pay

The CCG does not have a policy of performance related pay for senior managers.

Senior managers’ service contracts

The CCG’s policy concerning permanent senior managers’ contracts is that they have no end date, with a notice period of 6 months. Payments to past senior managers - Audited

The CCG has not made any payments to past senior managers.

Senior manager remuneration - Audited

The table below discloses salaries and allowances paid by the CCG to Directors of significant influence in 2020/21.

161 Name and title Salary Taxable Annual Long-term All TOTAL and/or benefits performance performance pension fees related related related bonuses bonuses benefits

(rounded to the nearest (bands of (bands of (bands of (bands of £100) £5,000) £5,000) £2,500) £5,000) (bands of £5,000)

£ £000 £000 £000 £000 £000

Agnelo Fernandes, Elected 90 to 95 n/a n/a n/a n/a 90 to 95 GP Lead Croydon Borough

Andrew Murray, SWLCCG 100 to 105 n/a n/a n/a n/a 100 to 105 Chair

Charlotte Gawne, Director of 120 to 125 n/a n/a n/a 25 to 27.5 145 to 150 Communications and Engagement

David Smith, Governing Body 10 to 15 n/a n/a n/a n/a 10 to 15 Deputy Chair & Lay Member Finance

Dino Pardhanani, Elected GP 45 to 50 n/a n/a n/a n/a 45 to 50 Lead Sutton Borough (from October 2020)

Geoff Croucher, Elected GP 30 to 35 n/a n/a n/a n/a 30 to 35 Lead Sutton Borough (up to October 2020)

162 Gloria Rowland, Chief Nurse 25 to 30 n/a n/a n/a 55 to 57.5 80 to 85 and Director of Quality (from January 2021)

James Blythe, Locality 60 to 65 n/a n/a n/a n/a 60 to 65 Executive Director Merton and Wandsworth (up to September 2020)

James Murray, Chief Finance 145 to 150 n/a n/a n/a n/a 145 to 150 Officer

Jonathan Bates, Executive 120 to 125 n/a n/a n/a 25 to 27.5 145 to 150 Director Systems Planning Performance and Delivery

Karen Broughton, Executive 135 to 140 n/a n/a n/a 30 to 32.5 165 to 170 Director Strategy and Transformation

Les Ross, Secondary Care 10 to 15 n/a n/a n/a n/a 10 to 15 Consultant

Lucie Waters, Locality 120 to 125 n/a n/a n/a 127.5 to 130 245 to 250 Executive Director Sutton

Mark Creelman, Locality 60 to 65 n/a n/a n/a 37.5 to 40 100 to 105 Executive Director Merton and Wandsworth (from September 2020) (1)

163 Matthew Kershaw, Placed 110 to 115 n/a 10 to 15 n/a n/a 120 to 125 Based Leader for Health Croydon (2)

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

Nicola Jones, Elected 135 to 140 n/a n/a n/a n/a 135 to 140 Governing Body Member Wandsworth Borough

Patrick Gibson, Elected 80 to 85 n/a n/a n/a n/a 80 to 85 Governing Body Member

Paul Gallagher, Lay Member 10 to 15 n/a n/a n/a n/a 10 to 15 for Audit and Conflicts of Interest Guardian

Pippa Barber, Independent 15 to 20 n/a n/a n/a n/a 15 to 20 Nurse

Sarah Blow, Accountable 145 to 150 n/a n/a n/a 32.5 to 35 180 to 185 Officer

Susan Gibbin, Lay Member 10 to 15 n/a n/a n/a n/a 10 to 15 Patient Public and Engagement

Tonia Michaelides, Locality 120 to 125 n/a n/a n/a 22.5 to 25 145 to 150 Executive Director Richmond and Kingston

164 Vasa Gnanapragasam, 60 to 65 n/a n/a n/a n/a 60 to 65 Elected GP Lead Merton Borough

Notes

1. Mark Creelman is the Locality Executive Director Merton and Wandsworth since September 2020 and is on the payroll of NEL CSU, his total annual salary is in the range of £145k- £150k. South West London CCG is responsible for 82% of his costs. 2. Matthew Kershaw is the Placed Based Leader for Health Croydon and is on the payroll of Croydon Health Services NHS Trust, his total annual salary is in the range of £225k-£230k. South West London CCG is responsible for 50% of his costs.

As this is the first of year of South West London CCG it is not possible to provide equivalent prior year comparators.

165 Pensions entitlement table - Audited

Where the CCG contributed to pension schemes for senior managers, the benefits are shown in the table below:

Name and title Real Real Total Lump sum Cash Cash Real Employer’s increase increase in accrued at pension equivalent equivalent increase in contributio in pension pension at age related transfer transfer cash n to pension lump sum pension to accrued value at value at equivalent stakeholder at at pension age at 31 pension at 31 March 31 March transfer s pension pension age March 31 March 2021 2020 value age 2021 2020

(bands (bands of (bands of of (bands of £5,000) £5,000) £2,500) £2,500)

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

Charlotte Gawne, Director of Communications and Engagement 0 to 2.5 0 35 to 40 70 to 75 652 602 22 0

Gloria Rowland, Chief Nurse and Director of Quality 2.5 to 5 0 to 2.5 25 to 30 50 to 55 443 390 43 0

Jonathan Bates, Executive Director Systems Planning 0 to 2.5 0 45 to 50 90 to 95 787 732 24 0 Performance and Delivery

James Blythe, Locality n/a n/a n/a n/a n/a n/a n/a n/a Executive Director

166 Merton and Wandsworth (1)

James Murray, Chief n/a n/a n/a n/a n/a n/a n/a n/a Finance Officer (2)

Karen Broughton, Executive Director 2.5 to 5 0 45 to 50 85 to 90 812 751 28 0 Strategy and Transformation

Lucie Waters, Locality Executive Director 5 to 7.5 12.5 to 15 40 to 45 85 to 90 765 623 114 0 Sutton

Mark Creelman, Locality Executive 2.5 to 5 0 to 2.5 15 to 20 0 to 5 255 207 23 0 Director Merton and Wandsworth (3)

Sarah Blow, 2.5 to 5 0 45 to 50 85 to 90 864 797 32 0 Accountable Officer

Tonia Michaelides, Locality Executive 0 to 2.5 0 40 to 45 75 to 80 721 670 23 0 Director Richmond and Kingston

Notes

1. South West London CCG does not make any employer’s pension contribution in respect of James Blythe. 2. South West London CCG does not make any employer’s pension contribution in respect of James Murray. 3. Mark Creelman is the Locality Executive Director Merton and Wandsworth since September 2020 and is on the payroll of NEL CSU. South West London CCG is responsible for 82% of his costs, but we are showing the full benefits. 4. As this the first of year of South West London CCG is it not possible to provide equivalent prior year comparators.

167 Cash equivalent transfer values - Audited

A cash equivalent transfer value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s (or other allowable beneficiary’s) pension payable from the scheme.

A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies.

The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.

The benefits and related CETVs do not allow for a potential adjustment arising from the McCloud judgement (a legal case concerning age discrimination over the manner in which UK public service pension schemes introduced a CARE benefit design in 2015 for all but the oldest members who retained a Final Salary design).

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).

Compensation on early retirement or for loss of office

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

Payments to past members

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

168 Pay multiples - Audited

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

The banded remuneration of the highest paid governing body member in the financial year 2020/21 was £145k-£150k per annum. This was 2.6 times the median remuneration of the workforce, which was £55k. The workforce includes only permanent staff and excludes off payroll engagements.

In 2020/21, zero employees received remuneration in excess of the highest-paid director/Member. Remuneration ranged from £21k to £116k.

Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind, but not severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions.

2.5 Staff report

Number of senior managers

The majority of roles in the CCG are paid in accordance with the national Agenda for Change pay scales

Band Number in March 2021

Very Senior Manager 9

Band 9 23

Band 8D 30

Total 62

169

These figures include only staff employed directly through South West London CCG’s payroll.

Staff numbers and costs - Audited

Permanently Other staff Total employed staff

Category Cost, Average Cost, Average Cost, Average £000 WTE £000 WTE £000 WTE

A: Ambulance staff 0 0.0 0 0.0 0 0.0

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

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

M: Medical and Dental 173 1.6 0 0.0 173 1.6 staff

N: Nursing, Midwifery 3,064 36.2 693 2.0 3,757 38.2 and health visiting staff

170

P: Nursing, midwifery and health visiting 0 0.0 0 0.0 0 0.0 learners

S: Scientific, therapeutic and 3,548 51.2 11 0.2 3,539 51.4 technical staff

U: Healthcare science 0 0.0 0 0.0 0 0.0

Total 34,746 451.0 6,238 41.1 40,984 494.1

Staff composition

Equalities for staff

An equalities breakdown of staff by six categories in line with guidance is available and key areas are presented regularly to the CCG in the form of workforce reports. Tables do not include Governing Body members and clinical leads. Monitoring will continue to identify any priority areas to address.

As at 31 March 2021

The following tables are a profile of the CCG relating to the main protected characteristics.

Tables do not include Governing Body members/clinical leads.

Disability

171 Disability HeadcountPercentageFTE No 384 82.23%361.93 Not Declared 47 10.06%44.80 Prefer Not To Answer 17 3.64%15.92 Yes 19 4.07%18.00 Grand Total 467 100.00%440.65

Ethnic origin

172 Ethinic Origin Headcount Percentage FTE A White - British 210 44.97%195.55 B White - Irish 81.71%8.00 C White - Any other White background 31 6.64%30.20 CA White English 40.86%4.00 CB White Scottish 20.43%2.00 CP White Polish 10.21%1.00 CY White Other European 10.21%1.00 D Mixed - White & Black Caribbean 20.43%1.91 E Mixed - White & Black African 40.86%3.80 F Mixed - White & Asian 30.64%3.00 G Mixed - Any other mixed background 71.50%6.60 GF Mixed - Other/Unspecified 20.43%1.60 H Asian or Asian British - Indian 42 8.99%36.33 J Asian or Asian British - Pakistani 71.50%6.24 K Asian or Asian British - Bangladeshi 61.28%5.60 L Asian or Asian British - Any other Asian background 14 3.00%13.90 LB Asian Punjabi 10.21%1.00 LF Asian Tamil 10.21%1.00 LH Asian British 20.43%2.00 LK Asian Unspecified 10.21%1.00 M Black or Black British - Caribbean 25 5.35%24.30 N Black or Black British - African 44 9.42%43.80 P Black or Black British - Any other Black background20.43%2.00 PC Black Nigerian 10.21%1.00 PD Black British 10.21%1.00 PE Black Unspecified 10.21%1.00 R Chinese 81.71%7.91 S Any Other Ethnic Group 51.07%5.00 SA Vietnamese 10.21%1.00 Z Not Stated 30 6.42%27.92 Grand Total 467 100.00%440.65

173

Sexual orientation

Sexual Orientation Headcount Percentage FTE Bisexual 2 0.43% 2.00 Gay or Lesbian 10 2.14% 10.00 Heterosexual or Straight 371 79.44% 350.19 Not stated (person asked but declined to provide a response) 83 17.77% 77.47 Undecided 1 0.21% 1.00 Grand Total 467 100.00% 440.65

174

Religious Belief

Religious Belief Headcount Percentage FTE Atheism 63 13.49% 61.99 Buddhism 2 0.43% 1.91 Christianity 202 43.25% 191.49 Hinduism 26 5.57% 21.78 I do not wish to disclose my religion/belief 121 25.91% 113.60 Islam 19 4.07% 17.87 Other 21 4.50% 19.80 Sikhism 13 2.78% 12.23 Grand Total 467 100.00% 440.65

Age Range Age Band Headcount Percentage FTE 21-25 13 2.78% 12.30 26-30 28 6.00% 27.10 31-35 58 12.42% 56.73 36-40 63 13.49% 57.78 41-45 70 14.99% 65.28 46-50 65 13.92% 62.25 51-55 83 17.77% 79.77 56-60 61 13.06% 58.09 61-65 24 5.14% 19.85 66-70 2 0.43% 1.50 Grand Total 467 100.00% 440.65

175 Gender

The following figures exclude directors and staff on the payrolls of other CCGs who are part- recharged to South West London CCG.

Gender Headcount Percentage FTE Female 347 74.30% 322.15 Male 120 25.70% 118.50 Grand Total 467 100.00% 440.65

Sickness absence data

The CCG sickness absence percentage rate is presented regularly to the CCG in the form of workforce reports. Individual sickness absence cases are managed by the line manager with advice and support from HR.

An occupational health (OH) service is available to provide professional clinical advice to line managers within the CCG.

176 The CCG also has access to an employee assistance programme which offers confidential access to emotional and practical support, including legal and financial advice.

Number of days lost in year 2,352.10

Number of staff employed in year 433.39

Average working days lost in year 5.43

Note that total staff years represents the number of potential worked days across whole of permanent workforce.

Staff turnover percentages

The staff turnover figure, based on a 12-month rolling average, at 31 March was 12.32%. This is broadly comparable with the NHS CCG average turnover rate of 12.1%.

Staff policies and other information

2.5.6.1 Staff policies related to disabilities

The CCG promotes a working environment in which all parties and procedures relating to recruitment, selection, training, promotion and employment are free from unfair discrimination, ensuring that no employee or prospective employee is discriminated against, whether directly or indirectly on the grounds of age; disability; gender reassignment; pregnancy and maternity; race including ethnic or national origins, nationality; religion belief; sex (gender); sexual orientation; marriage and civil partnership; trade union membership; responsibility for dependents or any other condition or requirement which cannot be shown to be justifiable.

Staff who have a disability are protected under the Equality Act 2010, as disability is a "protected characteristic". The CCG makes sure that the requirements and reasonable adjustments necessary for employees with a disability are considered both during each stage of the recruitment process and during employment.

177 Our Sickness Absence Policy confirms that where an employee becomes disabled during their employment, we will make any necessary reasonable adjustments required in accordance with the Equality Act to enable the employee to return and remain at work. The types of adjustments may include adjustments to work base, working hours, redeploying the employee to another suitable position and providing any necessary equipment to assist the employee to perform their role.

2.5.6.2 Pay and personal development

The majority of our staff are paid in accordance with the national NHS Agenda for Change pay scales.

We have statutory and mandatory training requirements and reporting procedures in place to ensure compliance. This training is provided both in-house and as online e-learning.

We have an annual appraisal system to support staff and set personal development plans. Training is available to staff to support personal development and career progression.

2.5.6.3 Staff consultation

Employee consultation is covered by an agreed CCG wide change management policy.

2.5.6.4 Freedom to Speak Up Guardian

The CCG has a Freedom to Speak up Guardian that staff can contact if they have a workplace issue or concern that they do not wish to bring up with their manager or through other channels. Susan Gibbin, Governing Body Member and Patient and Public Involvement Lay Member is NHS South West London CCG’s Freedom to Speak Up Guardian. No issues were raised through with the Freedom to Speak Up Guardian during 2020/21.

178 Trade union facility time reporting requirements

Between April 2020 and March 2021, we had two staff trade union representatives. Both are full time members of staff and are supported with reasonable time off within working hours to attend to trade union business as per the CCG’s Partnership Working Agreement.

Staff engagement

2.5.8.1 NHS Staff Survey

The CCG commissioned Picker Institute Europe to run an online 2020 National Staff Survey during October and November 2020. A total of 347 of the 419 eligible staff took part in the survey, giving a response rate of 83%. This was higher than the average response rate and provides more meaningful results. We are grateful to everyone who completed the survey.

The results of the survey were published in March 2021. We are pleased to see there have been significant improvements in a number of areas. However, there are a number of areas where we need to take action.

Where we’re doing well:

• 80% of respondents said that they are able to make suggestions to improve the work of their team/dept (an increase of 5% from last year) • 80% of respondents said that they are satisfied with opportunities for flexible working patterns (an increase of 1% from last year) • 75% of respondents said that care of patients/service users is the organisation's top priority (an increase of 2% from last year) • 74% of respondents said that their immediate manager takes a positive interest in their health and well-being (an increase of 2% from last year)

Where we’re doing less well:

• 43% of respondents said that senior managers try to involve staff in important decisions (compared to 51% in 2019) • 65% of respondents said that the organisation acts fairly in terms of career progression (compared to 78% in 2019) • 86% of respondents said that they have not experienced discrimination from manager/team leader or other colleagues (compared to 94% in 2019)

179 • 73% of respondents said that their immediate manager values their work (compared to 75% in 2019) • 38% of respondents said that senior managers act on staff feedback (compared to 42% in 2019)

During April 2020, we are holding interactive sessions with our teams to review the findings and develop actions to address the issues raised. A sub-group of the Governing Body will steer the development of our action plan.

2.5.8.2 Staff Pulse Check

In July 2020 we invited staff to take part in a pulse check survey to find out how they feel about working for the CCG and whether our organisational values are reflected in everyday behaviours.

Most of those who completed the survey agreed that:

• The organisation keeps staff safe, and looks after their health and wellbeing • They experience an equal, diverse, and inclusive organisation

180

• They have clear objectives and understand how their role fits in • They enjoy flexible working arrangements and having good technology • They have a supportive line manager • They have regular contact with their teams

However, feedback suggested that we seemed to be doing less well at involving and listening to our staff.

Looking at the responses from staff who identified themselves as from an ethnic minority background, these staff were less likely to feel positively about the organisation. We paid attention to the feedback from this survey and other listening events and have responded to the issues raised. Following this survey, we appointed a new Director for Equality, Diversity and Inclusion, who ran a series of listening events over the summer to learn more about the experiences of our staff. More detail about this work and the actions we are taking is available in the ‘Equality, Diversity and Inclusion’ section of this report.

We have run a series of staff focus groups and listening events to better understand the issues raised in the Staff Pulse Check and to develop solutions. Our action plan revolves around the four key areas:

• Employee voice – staff experience and health and wellbeing • Engaging managers – making sure staff get the support they need • Strategic narrative – where staff fit in • Integrity – how the organisation’s values are reflected in everyday behaviours

2.5.8.3 New Ways of Working

This year we established a New Ways of Working programme, supporting staff to work at home and making sure that people had the equipment they needed. Senior managers undertook one to one assessments with staff in July and again in December to check the wellbeing of each staff member working at home and to make sure that everyone had the IT equipment and furniture they need to do their job effectively. Staff were able to access up to £150 to buy additional IT equipment and a further £150 to buy any office equipment needed like desks and chairs.

Some people have not been able to work from home. For staff who have needed to come into the office who meet the exemption criteria, we have undertaken risk assessments at each site and

181 made sure that appropriate measures are in place to ensure their safety. The safety measures we have taken for these staff include making sure desks are socially distanced and have screens and Covid-19 infection control and cleaning processes are implemented.

As more people are vaccinated, we are talking to our staff about how we use our offices in the future. We are keen to learn what the benefits of working from home have been for staff, and what staff have missed about being in the office.

We hope to be able to reopen our offices in July 2021. Our absolute priority is keeping everyone safe, so will only reopen if we are convinced it will not put staff at unnecessary risk. We want to continue the new ways of working we have established over the last year, so at first we will only open our offices in Wimbledon. Our aim is to create a new working culture with less desk based working in the office. We believe this will allow more flexibility, innovation and collaboration, allowing our staff to structure their days around their commitments.

2.5.8.4 Staff Health and Wellbeing Network

This year we formed a new Staff Health and Wellbeing Network. Made up of staff from across the organisation, the network organises a range of activities to support all staff maintain and improve the mental and physical health and wellbeing. Activities include mindfulness sessions, exercise and activity challenges and social events.

We have published and signpost to a wide range of health and wellbeing resources on our intranet that are free for all staff.

2.5.8.5 Mental health and emotional wellbeing support

Alongside our mental health service partners we are working to understand the mental health impact of the pandemic on our staff and how we can best support those who are stressed, anxious or suffering from low moods. For many of us these are issues that will resolve themselves, but for many others these feelings may become long term concerns.

Staff are able to access an Employee Assistance Programme (EAP) which provides personal support, including counselling, and life management and is available 24 hours a day, any day of the year.

182

We have also supported a number of staff to complete either the Mental Health First Aider or Mental Health Champion training programmes. These individuals are available to provide support to staff, signposting them to professional help and to challenge mental health stigma in the workplace. We have also published a range of emotional wellbeing and mental health resources on our intranet to help staff identify sources of support such as OurNHSPeople, access to wellbeing Apps and signposting to local Improving Access to Psychological Therapies (IAPT) services.

2.5.8.6 Internal Communications Mechanisms

We have built on the progress we made last year to further develop staff communication channels and enable staff to remain and feel connected with colleagues.

2.5.8.7 South West London CCG Intranet

With the merger of the former six borough-based CCGs into one South West London CCG, it was important to bring together sources of information, news and support onto one platform that all CCG staff members could access. A new Intranet was designed, built and launched and is now the single source of internal information for our staff. It features multimedia content such as videos and photographs, a calendar of events and has user-generated content areas where staff can post their own blog, discussion, photo, or add a comment to any of the pages.

2.5.8.8 Team Talk

We hold monthly virtual staff briefings called ‘Team Talk’ which are presented by a senior director in each place/ directorate for CCG staff in each place/ directorate. In this way, scheduling has flexibility to suit local arrangements and approximately half of the scheduled time is dedicated to key local messages. To ensure consistency across the CCG, the other half of the briefing is spent on key messages for the whole of the organisation. Topics are influenced by feedback from staff and organisational priorities. These regular briefings are an important channel of staff communication and enable staff to directly speak with their local management team.

183 2.5.8.9 All staff briefings

Every six weeks, Sarah Blow, Accountable Officer, presents a virtual all staff briefing. The virtual nature of the briefing has increased staff engagement as evidenced by the numbers of staff using the meeting chat feature to either make a comment or ask a question. It has also improved attendance as there is no need to travel and attendance is not limited by the size of the room.

2.5.8.10 Listening events

Learning from the ‘Moving Forward Together’ consultation, we recognised that it was important to hold staff listening events when further organisational changes are likely to take place to capture how staff are feeling about specific topics. This year, we held a number of listening events regarding the government white paper on becoming an Integrated Care System, and we continue to hold monthly listening events as part of our equality, diversity and inclusion work.

2.5.8.11 Daily Communications Update

From Monday to Friday, we publish an email based daily communications update which goes to all CCG staff and other key people across our system. The update covers staff news, keeping well, training, vacancies, local and national news, as well as an example of a current social media campaign. The publication is highly regarded as an internal communications channel amongst our staff. The daily frequency enables fast-moving news to be cascaded, with articles often supported with links to further content on the Intranet.

2.5.8.12 Leadership Forum

The Leadership Forum brings together CCG senior managers every month to:

• enable them to manage change effectively for themselves and for their teams; • share relevant system and regional information and detail with their teams; • network and share ideas; • provide time out for learning and development.

184 People and Organisational Development Strategy

Our draft People and Organisational Development Strategy sets out our approach to shaping our organisational culture and supporting our staff. The strategy was developed with insight gathered from staff at listening events over the summer and incorporates the four priority areas set out in the NHS People Plan:

• Looking after our people with quality health and wellbeing support for everyone. • Belonging in the NHS with a particular focus on the discrimination that some staff face, ensuring the NHS is inclusive and diverse. • New ways of working capturing innovation, much of it led by NHS people. Upskilling staff, supporting staff learning and development and being flexible. • Growing for the future. How we recruit, train and keep our staff, and welcome back colleagues who want to return.

Our aim is to make NHS South West London CCG a great place to work. To achieve this we will work in partnership with our trade union colleagues and focus on:

• Caring for our staff • Supporting our staff to develop • Having the very best employment practices in place • Recognising the work and commitment of our staff • Working to make sure our staff is representative and inclusive of the populations we serve • Involving our staff to help us transform and improve the way we work • Developing compassionate and inclusive leaders

Expenditure on consultancy

The reported expenditure on consultancy was £1,261k in 2020/21.

Off-payroll engagements

For all off-payroll engagements as of 31 March 2021, for more than £245 per day and that lasted longer than six months were as follows:

185 Number

Number of existing arrangements as of 31 March 2021. 30

Of which, the number that have existed: for less than one year at the time of reporting 30 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 between 4 or more years at the time of reporting 0

The CCG confirms that all existing off-payroll engagements, outlined above, have at some point been subject to a risk based assessment as to whether assurance is required that the individual is paying the right amount of tax and, where necessary, that assurance has been sought

186 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 2020 and 31 March 2021, for more than £245 per day and that last for longer than 6 months:

Number

Number of new engagements or those that reached six months in duration 30 between 1 April 2020 and 31 March 2021.

Of which…

Number assessed as caught by IR35 15

Number assessed as not caught by IR35 15

Number engaged directly (via PSC contracted to the entity) and are on the 0 departmental payroll

Number of engagements reassessed for consistency / assurance purposes 0 during the year

Number of engagements that saw a change to IR35 status following the 0 consistency review.

Table 3: Off-payroll engagements / senior official engagements

187 For any off-payroll engagements of board members, and/or, senior officials with significant financial responsibility, between 1 April 2020 and 31 March 2021

Number

Number of off-payroll engagements of board members, and/or senior officers 0 with significant financial responsibility, during the financial year

Number of individuals that have been deemed Governing Body members, 24 and/or senior officers with significant financial responsibility during the financial year. This figure includes both off-payroll and on-payroll engagements.

2.5.11.1 Exit packages, including special (non-contractual) payments

During 2020-21 there were the following exit packages at South West London CCG.

Exit package Number of Cost of Number of Cost of Total Total cost Number of Cost of cost band compulsory compulsory other other number of of exit departures special (inc. any redundancies redundancies departures departures exit packages where payment special agreed packages special element payment payments included element have been in exit made packages Number £ Number £ Number £ Number £ Less than 1 3,450 - - 1 3,450 - - £10,000 £10,000 - 3 57,020 - - 3 57,020 - - £25,000 £25,001 - 1 30,000 - - 1 30,000 - - £50,000 £50,001 ------£100,000

188 £100,001 ------£150,000 £150,001 – ------£200,000 >£200,000 ------TOTALS 5 90,470 - - 5 90,470

2.6 Parliamentary Accountability and Audit Report

189 Independent auditor's report to the members of the Governing Body of NHS South West London Clinical Commissioning Group

Report on the Audit of the Financial Statements

Opinion on financial statements We have audited the financial statements of NHS South West London Clinical Commissioning Group (the ‘CCG’) for the year ended 31 March 2021, 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 accounting standards in conformity with the requirements of the Accounts Directions issued under Schedule 15 of the National Health Service Act 2006, as amended by the Health and Social Care Act 2012 and interpreted and adapted by the Department of Health and Social Care Group Accounting Manual 2020 to 2021. In our opinion, the financial statements:

 give a true and fair view of the financial position of the CCG as at 31 March 2021 and of its expenditure and income for the year then ended;

 have been properly prepared in accordance with international accounting standards as interpreted and adapted by the Department of Health and Social Care Group Accounting Manual 2020 to 2021; and

 have been prepared in accordance with the requirements of the National Health Service Act 2006, as amended by 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, as required by the Code of Audit Practice (2020) (“the Code of Audit Practice”) approved by the Comptroller and Auditor General. 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.

Conclusions relating to going concern We are responsible for concluding on the appropriateness of the Accountable Officer’s use of the going concern basis of accounting and, based on the audit evidence obtained, whether a material uncertainty exists related to events or conditions that may cast significant doubt on the CCG’s ability to continue as a going concern. If we conclude that a material uncertainty exists, we are required to draw attention in our report to the related disclosures in the financial statements or, if such disclosures are inadequate, to modify the auditor’s opinion. Our conclusions are based on the audit evidence obtained up to the date of our report. However, future events or conditions may cause the CCG to cease to continue as a going concern. 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 2020 to 2021 that the CCG’s financial statements shall be prepared on a going concern basis, we considered the inherent risks associated with the continuation of services currently provided by the CCG In doing so we have had regard to the guidance provided in Practice Note 10 Audit of financial statements and regularity of public sector bodies in the United Kingdom (Revised 2020) on the application of ISA (UK) 570 Going Concern to public sector entities. We assessed the reasonableness of the basis of preparation used by the CCG and the CCG’s disclosures over the going concern period. Based on the work we have performed, we have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the CCG’s ability to continue as a going concern for a period of at least twelve months from when the financial statements are authorised for issue. In auditing the financial statements, we have concluded that the Accountable Officer’s use of the going concern basis of accounting in the preparation of the financial statements is appropriate.

Grant Thornton UK LLP. 1 The responsibilities of the Accountable Officer with respect to going concern are described in the ‘Responsibilities of the Accountable Officer and Those Charged with Governance for the financial statements’ section of this report.

Other information The Accountable Officer is responsible for the other information. The other information comprises the information included in the Annual Report, 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 2020 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 NHS England 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, based on the work undertaken in the course of the audit:

 the parts of the Remuneration and Staff Report to be audited have been properly prepared in accordance with international accounting standards in conformity with the requirements of the Accounts Directions issued under Schedule 15 of the National Health Service Act 2006, as amended by the Health and Social Care Act 2012 and interpreted and adapted by the Department of Health and Social Care Group Accounting Manual 2020 to 2021; and

 based on the work undertaken in the course of the audit of the financial statements and our knowledge of the CCG, 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.

Opinion on regularity of income and expenditure 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.

Grant Thornton UK LLP. 2 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 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.

Explanation as to what extent the audit was considered capable of detecting irregularities, including fraud Irregularities, including fraud, are instances of non-compliance with laws and regulations. We design procedures in line with our responsibilities, outlined above, to detect material misstatements in respect of irregularities, including fraud. Owing to the inherent limitations of an audit, there is an unavoidable risk that material misstatements in the financial statements may not be detected, even though the audit is properly planned and performed in accordance with the ISAs (UK). The extent to which our procedures are capable of detecting irregularities, including fraud is detailed below:

 We obtained an understanding of the legal and regulatory frameworks that are applicable to the CCG and determined that the most significant which are directly relevant to specific assertions in the financial statements are those related to the reporting frameworks (international accounting standards and the National Health Service Act 2006, as amended by the Health and Social Care Act 2012 and interpreted and adapted by the Department of Health and Social Care Group Accounting Manual 2020 to 2021).

 We enquired of management and the Audit Committee, concerning the CCG’s policies and procedures relating to:  the identification, evaluation and compliance with laws and regulations;  the detection and response to the risks of fraud; and  the establishment of internal controls to mitigate risks related to fraud or non-compliance with laws and regulations.  We enquired of management, Internal Audit and the Audit Committee, whether they were aware of any instances of non-compliance with laws and regulations or whether they had any knowledge of actual, suspected or alleged fraud.

 We assessed the susceptibility of the CCG’s financial statements to material misstatement, including how fraud might occur, by evaluating management's incentives and opportunities for manipulation of the financial statements. This included the evaluation of the risk of management override of controls and fraudulent expenditure recognition. We determined that the principal risks were in relation to:

 Journals, management estimates and transactions outside the course of business; and  Fraudulent expenditure recognitions, and specifically the completeness of expenditure.

Grant Thornton UK LLP. 3  Our audit procedures involved:  evaluation of the design effectiveness of controls that management has in place to prevent and detect fraud;  journal entry testing, with a focus on unusual and high risk journals;  challenging assumptions and judgements made by management in its significant accounting estimate in respect of the Prescribing Accrual;

 substantive procedures to confirm the completeness of operating expenditure with a particular emphasis on year end accruals and transactions recorded close to and after 31 March 2021

 assessing the extent of compliance with the relevant laws and regulations as part of our procedures on the related financial statement item.

 These audit procedures were designed to provide reasonable assurance that the financial statements were free from fraud or error. However, detecting irregularities that result from fraud is inherently more difficult than detecting those that result from error, as those irregularities that result from fraud may involve collusion, deliberate concealment, forgery or intentional misrepresentations. Also, the further removed non-compliance with laws and regulations is from events and transactions reflected in the financial statements, the less likely we would become aware of it.

 The team communications in respect of potential non-compliance with relevant laws and regulations, including the potential for fraud in revenue and/or expenditure recognition, and the significant accounting estimates related to the CCG’s Prescribing Accrual.

 Assessment of the appropriateness of the collective competence and capabilities of the engagement team included consideration of the engagement team's:

 understanding of, and practical experience with audit engagements of a similar nature and complexity through appropriate training and participation

 knowledge of the health sector and economy in which the CCG operates  understanding of the legal and regulatory requirements specific to the CCG including:  the provisions of the applicable legislation  NHS England’s rules and related guidance  the applicable statutory provisions.  In assessing the potential risks of material misstatement, we obtained an understanding of:  the CCG’s operations, including the nature of its operating revenue and expenditure and its services and of its objectives and strategies to understand the classes of transactions, account balances, expected financial statement disclosures and business risks that may result in risks of material misstatement.

 the CCG's control environment, including the policies and procedures implemented by the CCG to ensure compliance with the requirements of the financial reporting framework.

Report on other legal and regulatory requirements – 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 – the 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 2021. Our work on the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources is not yet complete. The outcome of our work will be reported in our commentary on the CCG’s arrangements in our Auditor’s Annual Report. If we identify any significant weaknesses in these arrangements, these will be reported by exception in our Audit Completion Certificate. We are satisfied that this work does not have a material effect on our opinion on the financial statements for the year ended 31 March 2021.

Grant Thornton UK LLP. 4 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) 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. 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 undertake our review in accordance with the Code of Audit Practice, having regard to the guidance issued by the Comptroller and Auditor General in April 2021. This guidance sets out the arrangements that fall within the scope of ‘proper arrangements’. When reporting on these arrangements, the Code of Audit Practice requires auditors to structure their commentary on arrangements under three specified reporting criteria:

 Financial sustainability: how the CCG plans and manages its resources to ensure it can continue to deliver its services;

 Governance: how the CCG ensures that it makes informed decisions and properly manages its risks; and  Improving economy, efficiency and effectiveness: how the CCG uses information about its costs and performance to improve the way it manages and delivers its services. We document our understanding of the arrangements the CCG has in place for each of these three specified reporting criteria, gathering sufficient evidence to support our risk assessment and commentary in our Auditor’s Annual Report. In undertaking our work, we consider whether there is evidence to suggest that there are significant weaknesses in arrangements.

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

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

Sarah L Ironmonger

Sarah Ironmonger, Key Audit Partner for and on behalf of Grant Thornton UK LLP, Local Auditor London 15 June 2021

Grant Thornton UK LLP. 5 3 Annual accounts

190 NHS South West London CCG - Annual Accounts 2020-21

CONTENTS Page Number

The Primary Statements:

Statement of Comprehensive Net Expenditure for the year ended 31st March 2021 2 Statement of Financial Position as at 31st March 2021 3 Statement of Changes in Taxpayers' Equity for the year ended 31st March 2021 4 Statement of Cash Flows for the year ended 31st March 2021 5

Notes to the Accounts Accounting policies 6-10 Other operating revenue 11 Disaggregation of Income 12 Employee benefits and staff numbers 13-15 Operating expenses 16 Better payment practice code 17 Operating leases 18 Net gain/(loss) on transfer by absoption 19 Property, plant and equipment 20 Intangible non-current assets 21 Trade and other receivables 22 Cash and cash equivalents 23 Trade and other payables 24 Provisions 25 Contingencies 26 Commitments 26 Financial instruments 26-27 Operating segments 28 Joint arrangements - interests in joint operations 29 Related party transactions 30 Events after the end of the reporting period 31 Losses and special payments 31 Financial performance targets 31 Analysis of charitable reserves 31 NHS South West London CCG - Annual Accounts 2020-21

Statement of Comprehensive Net Expenditure for the year ended 31 March 2021

2020-21 Note £'000

Income from sale of goods and services 2 (20,728) Other operating income 2 (13,462) Total operating income (34,190)

Staff costs 4 40,984 Purchase of goods and services 5 2,664,755 Depreciation and impairment charges 5 1,010 Provision expense 5 (1,715) Other Operating Expenditure 5 1,015 Total operating expenditure 2,706,050

Net (Gain)/Loss on Transfer by Absorption 142,923 Total Net Expenditure for the Financial Year 2,814,783

Comprehensive Expenditure for the year 2,814,783

Page 2 Of 31 NHS South West London CCG - Annual Accounts 2020-21

Statement of Financial Position as at 31 March 2021 31st March 2021 1st April 2020

Note £'000 £'000 Non-current assets: Property, plant and equipment 9 347 1,232 Intangible assets 10 16 141 Total non-current assets 363 1,373

Current assets: Trade and other receivables 11 19,765 31,788 Cash and cash equivalents 12 473 687 Total current assets 20,238 32,475

Total assets 20,600 33,848

Current liabilities Trade and other payables 13 (219,954) (174,997) Provisions 14 - (904) Total current liabilities (219,954) (175,901)

Non-Current Assets plus/less Net Current Assets/Liabilities (199,354) (142,053)

Non-current liabilities Provisions 14 - (870) Total non-current liabilities - (870)

Assets less Liabilities (199,354) (142,923)

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

The notes on pages 6 to 31 form part of this statement

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

The financial statements on pages 1 to 31 were approved by the Governing Body on 10th June 2021 and signed on its behalf by:

Sarah Blow Accountable Officer 11 06 2021

Page 3 Of 31 NHS South West London CCG - Annual Accounts 2020-21

Statement of Changes In Taxpayers Equity for the year ended 31 March 2021 General fund Total reserves £'000 £'000 Changes in taxpayers’ equity for 2020-21

Balance at 01 April 2020 0 0 Adjusted NHS Clinical Commissioning Group balance at 1st April 2020 0 0

Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2020-21 Net operating expenditure for the financial year (2,671,860) (2,671,860)

Transfers by absorption to (from) other bodies (142,923) (142,923) Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial year (2,814,783) (2,814,783)

Net funding 2,615,430 2,615,430 Balance at 31 March 2021 (199,354) (199,354)

The notes on pages 6 to 31 form part of this statement

Page 4 Of 31 NHS South West London CCG - Annual Accounts 2020-21

Statement of Cash Flows for the year ended 31 March 2021 2020-21 Note £'000 Cash Flows from Operating Activities Net operating expenditure for the financial year (2,671,860) Depreciation and amortisation 5 1,010 (Increase)/decrease in trade & other receivables 10 12,023 Increase/(decrease) in trade & other payables 12 44,957 Provisions utilised 13 (59) Increase/(decrease) in provisions 13 (1,715) Net Cash Inflow (Outflow) from Operating Activities (2,615,643)

Net Cash Inflow (Outflow) before Financing (2,615,643)

Cash Flows from Financing Activities Grant in Aid Funding Received 2,615,430 Net Cash Inflow (Outflow) from Financing Activities 2,615,430

Net Increase (Decrease) in Cash & Cash Equivalents 11 (214)

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

The notes on pages 6 to 31 form part of this statement

Page 5 Of 31 South West London CCG - Annual Accounts 2020-21

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 2020-21 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 CCG Merger

NHS South West London CCG was approved by NHS England to operate from 1 April 2020 and was created from the merger of NHS Croydon, Kingston. Merton, Richmond, Sutton and Wandsworth CCGs. Closing balances from the 6 predecessor CCGs were transferred to NHS South West London CCG at 1 April 2020. The transfer of balances is detailed in Note 8 of these accounts. As a result of the merger, other than for the Statement of Financial Position and related notes, comparative figures for the previous financial year have not been provided as the CCG did not exist in 2019-20. Transfers as part of reorganisation fall to be accounted for by use of absorption accounting in line with the Government Financial Reporting Manual, issued by HM Treasury. The Government Financial Reporting Manual does not require retrospective adoption, so prior year transactions (which have been accounted for under merger accounting) have not been restated. Absorption accounting requires that entities account for their transactions in the period in which they took place, with no restatement of performance required when functions transfer within the public sector. Where assets and liabilities transfer, the gain or loss resulting is recognised in the Statement of Comprehensive Net Expenditure, and is disclosed separately from operating costs. Other transfers of assets and liabilities within the Department of Health and Social Care Group are accounted for in line with IAS 20 and similarly give rise to income and expenditure entries.

1.4 Charitable Funds From 2013-14, the divergence from Government Financial Report Manual that NHS Charitable Funds are not consolidated with bodies' own returns is removed. Under the provisions of IAS 27: Consolidated & Separate Financial Statements, those Charitable Funds fall under common control with NHS bodies are consolidated within entities' accounts. The Governing Body does not consider the activities of the charity to be material to NHS South West London CCG and accordingly has decided not to consolidate the Charitable Funds accounts with that of the CCG.

On 13th January 2021, the Corporate Trustee of the Funds (the NHS SW London CCG Governing Body) determined that the charitable funds previously held by Kingston CCG are granted to the Kingston Hospital NHS Foundation Trust Charitable Funds and as a consequence the Kingston CCGs’ Charitable Fund closed on 31st March 2021 with the net assets distributed to the Kingston Hospital NHS Foundation Trust Charitable Fund.

1.5 Joint arrangements Arrangements over which the clinical commissioning group has joint control with one or more other entities are classified as joint arrangements. Joint control is the contractually agreed sharing of control of an arrangement. A joint arrangement is either a joint operation or a joint venture. The CCG has a joint operation which are activities undertaken in conjunction with one or more parties which are performed through a separate entity. The clinical commissioning group records its share of the income and expenditure, gains and losses, assets, liabilities and cash flows in its own accounts.

1.6 Pooled Budgets South West London CCG has entered into pooled budget arrangements under Section 75 of the National Health Service Act 2006 with 5 of the Local London Boroughs (Croydon, Kingston, Merton, Richmond, Sutton and Wandsworth), relating to the commissioning of health and social care services within the Better Care Fund. The clinical commissioning group accounts for its share of the assets, liabilities, income and expenditure arising from the activities of the pooled budget, identified in accordance with the pooled budget arrangement. The Section 75 agreements clearly sets out the accounting, risk share and governance arrangements. The accountable bodies for the Better Care Fund are the Local Authorities who hold the funds apart from Croydon where the CCG holds the fund. They are managed through a joint management committee.

Page 6 Of 31 South West London CCG - Annual Accounts 2020-21

Notes to the financial statements

1.7 Critical Accounting Judgements & Key Sources of Estimation Uncertainty

In the application of the clinical commissioning group’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods.

The following are the critical judgements, those involving estimations that management has made in the process of applying the clinical commissioning group’s accounting policies that have the most significant effect on the amounts recognised in the financial statements:

- £29.4m for the final two months prescribing expenditure has been based on forecast information supplied by NHS Business Services Authority. - £12.9m as an estimate of additional continuing care expenditure based on CCG client databases and trends. - £14.6m Covid-19 accrual has been calculated and accrued based on bids collated on the CCG's central Covid-19 project database. - £11.3m estimate of Service Development Funds has been calculated from information received from budget holders cross referenced with allocations received.

1.8 Operating Segments Income and expenditure are analysed in the Operating Segments note and are reported in line with management information used within the clinical commissioning group.

1.9 Revenue In the application 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. The main source of funding for the Clinical Commissioning Group is from NHS England. This is drawn down and credited to the general fund. Funding is recognised in the period in which it is received. 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. Significant terms require that 95% of undisputed, valid invoices should be paid within 30 days. 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.

1.10 Employee Benefits

1.10.1 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.

1.10.2 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 if they were a defined contribution scheme; the cost recognised in these accounts represents the contributions payable for the year. 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. 1.11 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.

1.12 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.

Page 7 Of 31 South West London CCG - Annual Accounts 2020-21

Notes to the financial statements

1.13 Property, Plant & Equipment 1.13.1 Recognition Property, plant and equipment is capitalised if: · It is held for use in delivering services or for administrative purposes; · It is probable that future economic benefits will flow to, or service potential will be supplied to the clinical commissioning group; · It is expected to be used for more than one financial year; · The cost of the item can be measured reliably; and, · The item has a cost of at least £5,000; or, · Collectively, a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or, · Items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or collective cost. Where a large asset, for example a building, includes a number of components with significantly different asset lives, the components are treated as separate assets and depreciated over their own useful economic lives.

1.13.2 Measurement All property, plant and equipment is measured initially at cost, representing the cost directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. IT equipment and furniture and fittings that are held for operational use are valued at depreciated historic cost where these assets have short useful economic lives or low values or both, as this is not considered to be materially different from current value in existing use. NHS South West London CCG does not own any land or buildings. On the dissolution of former NHS Primary Care Trusts, all land and buildings were transferred to NHS Property Services or Community Health Partnerships.

1.13.3 Subsequent Expenditure Where subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised. Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing carrying value of the item replaced is written- out and charged to operating expenses.

1.14 Intangible Assets 1.14.1 Recognition Intangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the clinical commissioning group’s business or which arise from contractual or other legal rights. They are recognised only: · When it is probable that future economic benefits will flow to, or service potential be provided to, the clinical commissioning group; · Where the cost of the asset can be measured reliably; and, · Where the cost is at least £5,000. Software that is integral to the operating of hardware, for example an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software that is not integral to the operation of hardware, for example application software, is capitalised as an intangible asset. Expenditure on research is not capitalised but is recognised as an operating expense in the period in which it is incurred. Internally-generated assets are recognised if, and only if, all of the following have been demonstrated: · The technical feasibility of completing the intangible asset so that it will be available for use; · The intention to complete the intangible asset and use it; · The ability to sell or use the intangible asset; · How the intangible asset will generate probable future economic benefits or service potential; · The availability of adequate technical, financial and other resources to complete the intangible asset and sell or use it; and, · The ability to measure reliably the expenditure attributable to the intangible asset during its development.

1.14.2 Measurement Intangible assets acquired separately are initially recognised at cost. The amount initially recognised for internally-generated intangible assets is the sum of the expenditure incurred from the date when the criteria above are initially met. Where no internally-generated intangible asset can be recognised, the expenditure is recognised in the period in which it is incurred. Following initial recognition, intangible assets are carried at current value in existing use by reference to an active market, or, where no active market exists, at the lower of amortised replacement cost or the value in use where the asset is income generating . Internally-developed software is held at historic cost to reflect the opposing effects of increases in development costs and technological advances. Revaluations and impairments are treated in the same manner as for property, plant and equipment.

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

Otherwise, depreciation and amortisation are charged to write off the costs or valuation of property, plant and equipment and intangible non-current assets, less any residual value, over their estimated useful lives, in a manner that reflects the consumption of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over which the clinical commissioning group expects to obtain economic benefits or service potential from the asset. This is specific to the clinical commissioning group and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are depreciated over the shorter of the lease term and the estimated useful life.

At each reporting period end, the clinical commissioning group checks whether there is any indication that any of its property, plant and equipment assets or intangible non-current assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its amount. Intangible assets not yet available for use are tested for impairment annually.

A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Where an impairment loss subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the recoverable amount but capped at the amount that would have been determined had there been no initial impairment loss. The reversal of the impairment loss is credited to expenditure to the extent of the decrease previously charged there and thereafter to the revaluation reserve.

Page 8 Of 31 South West London CCG - Annual Accounts 2020-21

Notes to the financial statements

1.15 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.

1.15.1 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.

1.16 Cash & Cash Equivalents Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value. In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the clinical commissioning group’s cash management.

1.17 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.

South West London CCG was formed by the merger of six South West London CCGs (Croydon, Kingston, Merton, Richmond, Sutton and Wandsworth) on 1st April 2020. Two of these six borough places had previously held provisions for Continuing Healthcare Restitutions for periods after 31st March 2013. During the course of 2020/21 the CCG has reversed these provisions as unused and these two borough places now report restitutions in line with the four other borough places. Known certain restitution case are accounted for via accrued expenditure and is reported as part of the Continuing Healthcare spend of the CCG.

Subsequent to the above adjustment, the CCG does not hold any provisions as at 31st March 2021.

1.18 Continuing Healthcare Risk Pooling In 2014-15 a risk pool scheme was been introduced by NHS England for continuing healthcare claims, for claim periods prior to 31 March 2013. Under the scheme clinical commissioning group contribute to a pooled fund, which is used to settle the claims.

1.19 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 South West London CCG. The total value of Clinical Negligence provisions carried by the NHSLA on behalf of the CCG is disclosed at note 13

1.20 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.

1.21 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.

1.22 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.

Page 9 Of 31 South West London CCG - Annual Accounts 2020-21

Notes to the financial statements

1.22.1 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.

1.22.2 Impairment For all financial assets measured at amortised cost or at fair value through other comprehensive income (except equity instruments designated at fair value through other comprehensive income), lease receivables and contract assets, the clinical commissioning group recognises a loss allowance representing the expected credit losses on the financial asset.

The clinical commissioning group adopts the simplified approach to impairment in accordance with IFRS 9, and measures the loss allowance for trade receivables, lease receivables and contract assets at an amount equal to lifetime expected credit losses. For other financial assets, the loss allowance is measured at an amount equal to lifetime expected credit losses if the credit risk on the financial instrument has increased significantly since initial recognition (stage 2) and otherwise at an amount equal to 12 month expected credit losses (stage 1).

HM Treasury has ruled that central government bodies may not recognise stage 1 or stage 2 impairments against other government departments, their executive agencies, the Bank of England, Exchequer Funds and Exchequer Funds assets where repayment is ensured by primary legislation. The clinical commissioning group therefore does not recognise loss allowances for stage 1 or stage 2 impairments against these bodies. Additionally Department of Health and Social Care provides a guarantee of last resort against the debts of its arm's lengths bodies and NHS bodies and the clinical commissioning group does not recognise allowances for stage 1 or stage 2 impairments against these bodies.

For financial assets that have become credit impaired since initial recognition (stage 3), expected credit losses at the reporting date are measured as the difference between the asset's gross carrying amount and the present value of the estimated future cash flows discounted at the financial asset's original effective interest rate. Any adjustment is recognised in profit or loss as an impairment gain or loss.

1.23 Financial Liabilities Financial liabilities are recognised on the statement of financial position when the clinical commissioning group becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are derecognised when the liability has been discharged, that is, the liability has been paid or has expired.

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

1.25 Losses & Special Payments Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled. Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had the clinical commissioning group not been bearing its own risks (with insurance premiums then being included as normal revenue expenditure).

1.26 Accounting Standards That Have Been Issued But Have Not Yet Been Adopted The Department of Health and Social Care GAM does not require the following IFRS Standards and Interpretations to be applied in 2020-21. These Standards are still subject to HM Treasury FReM adoption, with IFRS 16 being for implementation in 2022/23, and the government implementation date for IFRS 17 still subject to HM Treasury consideration. ● IFRS 16 Leases – The Standard is effective 1 April 2022 as adapted and interpreted by the FReM. ● IFRS 17 Insurance Contracts – Application required for accounting periods beginning on or after 1 January 2021, but not yet adopted by the FReM: early adoption is not therefore permitted.

Page 10 Of 31 NHS South West London CCG - Annual Accounts 2020-21

2 Other Operating Revenue 2020-21 Total £'000

Income from sale of goods and services (contracts) Education, training and research - Non-patient care services to other bodies 20,165 Other Contract income 563 Total Income from sale of goods and services 20,728

Other operating income Rental revenue from operating leases 262 Charitable and other contributions to revenue expenditure: non-NHS 1 Other non contract revenue 13,198 Total Other operating income 13,462

Total Operating Income 34,190

Page 11 Of 31 NHS South West London CCG - Annual Accounts 2020-21

3.1 Disaggregation of Income - Income from sale of good and services (contracts)

Non-patient care Other Contract services to other income bodies £'000 £'000 Source of Revenue NHS 3,799 - Non NHS 16,366 563 Total 20,165 563

Non-patient care Other Contract services to other income bodies £'000 £'000 Timing of Revenue Point in time 20,165 563 Total 20,165 563

Page 12 Of 31 NHS South West London CCG - Annual Accounts 2020-21

4. Employee benefits and staff numbers

4.1.1 Employee benefits Permanent Total 2020-21 Employees Other Total £'000 £'000 £'000 Employee Benefits Salaries and wages 26,789 6,238 33,027 Social security costs 3,117 0 3,117 Employer Contributions to NHS Pension scheme 4,674 0 4,674 Apprenticeship Levy 60 0 60 Termination benefits 106 0 106 Gross employee benefits expenditure 34,746 6,238 40,984

Page 13 Of 31 NHS South West London CCG - Annual Accounts 2020-21

4.2 Average number of people employed 2020-21 Permanently employed Other Total Number Number Number

Total 451 43 494

4.3 Exit packages agreed in the financial year

2020-21 2020-21 Compulsory redundancies Other agreed departures Number £ Number Less than £10,000 1 3,450 - £10,001 to £25,000 3 57,020 - £25,001 to £50,000 1 30,000 - £50,001 to £100,000 - - - £100,001 to £150,000 - - - £150,001 to £200,000 - - - Over £200,001 - - - Total 5 90,470 -

As a single exit package can be made up of several components each of which will be counted separately in this table, the total number will not necessarily match the total number in the table above, which will be the number of individuals. These tables report the number and value of exit packages agreed in the financial year. The expense associated with these departures may have been recognised in part or in full in a previous period. Redundancy and other departure costs have been paid in accordance with the NHS National Terms and Conditions (Agenda for Change) guidelines. Exit costs are accounted for in accordance with relevant accounting standards and at the latest in full in the year of departure. The Remuneration Report includes the disclosure of exit payments payable to individuals named in that Report.

Page 14 Of 31 NHS South West London CCG - Annual Accounts 2020-21

4.4 Pension costs

Past and present employees are covered by the provisions of the two NHS Pension Schemes. Details of the benefits payable and 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:

4.4.1 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 2021, is based on valuation data as 31 March 2020, updated to 31 March 2021 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.

4.4.2 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% of pensionable pay. The 2016 funding valuation was also expected to test the cost of the Scheme relative to the employer cost cap that was set following the 2012 valuation. In January 2019, the Government announced a pause to the cost control element of the 2016 valuations, due to the uncertainty around member benefits caused by the discrimination ruling relating to the McCloud case.

The Government subsequently announced in July 2020 that the pause had been lifted, and so the cost control element of the 2016 valuations could be completed. The Government has set out that the costs of remedy of the discrimination will be included in this process. HMT valuation directions will set out the technical detail of how the costs of remedy will be included in the valuation process. The Government has also confirmed that the Government Actuary is reviewing the cost control mechanism (as was originally announced in 2018). The review will assess whether the cost control mechanism is working in line with original government objectives and reported to Government in April 2021. The findings of this review will not impact the 2016 valuations, with the aim for any changes to the cost cap mechanism to be made in time for the completion of the 2020 actuarial valuations.

Page 15 Of 31 NHS South West London CCG - Annual Accounts 2020-21

5. Operating expenses 2020-21 Total £'000 Purchase of goods and services Services from other CCGs and NHS England 17,259 Services from foundation trusts 917,685 Services from other NHS trusts 828,864 Services from Other WGA bodies 15 Purchase of healthcare from non-NHS bodies 384,704 Purchase of social care 3,573 Prescribing costs 180,742 Pharmaceutical services - General Ophthalmic services 42 GPMS/APMS and PCTMS 257,260 Supplies and services – clinical 2,348 Supplies and services – general 36,924 Consultancy services 1,302 Establishment 19,462 Transport 1,292 Premises 9,356 Audit fees 252 Other non statutory audit expenditure · Internal audit services 141 · Other services 72 Other professional fees 2,169 Legal fees 250 Education, training and conferences 1,044 Total Purchase of goods and services 2,664,755

Depreciation and impairment charges Depreciation 885 Amortisation 125 Total Depreciation and impairment charges 1,010

Provision expense Provisions (1,715) Total Provision expense (1,715)

Other Operating Expenditure Chair and Non Executive Members 721 Grants to Other bodies 160 Research and development (excluding staff costs) 155 Expected credit loss on receivables (34) Other expenditure 13 Total Other Operating Expenditure 1,015

Total operating expenditure 2,665,066

Limitation on auditor's liability - In accordance with the terms of engagement with the trust's external auditors, Grant Thornton UK LLP, its members, partners and staff (whether contract, negligence or otherwise) in respect of services provided in connection with or arising out of the audit shall in no circumstances exceed £2million in the aggregate in respect of all such services.

To note that Grant Thornton UK LLP do not provide Internal audit services for the CCG Audit Fees are £200k exclusive of VAT’ Other services are in respect of the Mental Health Investment Standard Returns and were £60k exclusive of VAT

Page 16 Of 31 NHS South West London CCG - Annual Accounts 2020-21

6.1 Better Payment Practice Code

Measure of compliance 2020-21 2020-21 Number £'000 Non-NHS Payables Total Non-NHS Trade invoices paid in the Year 64,304 651,334 Total Non-NHS Trade Invoices paid within target 63,430 636,417 Percentage of Non-NHS Trade invoices paid within target 98.64% 97.71%

NHS Payables Total NHS Trade Invoices Paid in the Year 6,809 1,776,085 Total NHS Trade Invoices Paid within target 6,551 1,770,243 Percentage of NHS Trade Invoices paid within target 96.21% 99.67%

Page 17 Of 31 NHS South West London CCG - Annual Accounts 2020-21

7. Operating Leases

7.1 As lessee

7.1.1 Payments recognised as an Expense 2020-21 Buildings Total £'000 £'000 Payments recognised as an expense Minimum lease payments 2,140 2,140 Total 2,140 2,140

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

7.1.2 Future minimum lease payments 2020-21 Buildings Total £'000 £'000 Payable: No later than one year 75 75 Between one and five years 211 211 After five years 500 500 Total 786 786

7.2 As lessor 7.2.1 Rental revenue 2020-21 2019-20 £'000 £'000 Recognised as income Contingent rents 262 100 Total 262 100

Page 18 Of 31 NHS South West London CCG - Annual Accounts 2020-21

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

NHS Croydon CCG, NHS Kingston CCG, NHS Merton CCG, NHS Richmond CCG, NHS Sutton CCG and NHS Wandsworth CCG merged from 1st April 2020 to form NHS South West London CCG

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 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.

The table below identifies the Statement of Financial Position at 1st April 2020 for the six former CCGs. The corresponding net debit reflecting the loss is recognised within the income and expenses as disclosed within the Statement of comprehensive Net expenditure, but outside operating activities.

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

Transfer of property plant and equipment 1,232 131 95 135 79 81 712 Transfer of intangibles 141 0 65 32 0 44 0 Transfer of inventories 0 0 0 0 0 0 0 Transfer of cash and cash equivalents 687 109 73 31 157 229 87 Transfer of receivables 31,788 4,916 2,790 3,813 2,022 2,585 15,663 Transfer of payables (174,997) (37,655) (27,637) (18,322) (23,867) (23,595) (43,921) Transfer of provisions (1,774) 0 (870) 0 (904) 0 0

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

Page 19 Of 31 NHS South West London CCG - Annual Accounts 2020-21

9. Property, plant and equipment

Buildings excluding Information Furniture & 2020-21 dwellings technology fittings Total £'000 £'000 £'000 £'000 Cost or valuation at 01 April 2020 38 5,309 52 5,399

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

Depreciation 01 April 2020 38 4,077 52 4,167

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

Net Book Value at 31 March 2021 - 347 0 347

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

Asset financing:

Owned - 347 0 347 Total at 31 March 2021 - 347 0 347

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

9.1 Economic lives Minimum Life Maximum Life (years) (Years) Buildings excluding dwellings 3 3 Information technology 3 3 Furniture & fittings 3 3

Page 20 Of 31 NHS South West London CCG - Annual Accounts 2020-21

10. Intangible non-current assets

Computer Software: 2020-21 Purchased Total £'000 £'000 Cost or valuation at 01 April 2020 1,919 1,919

Cost / Valuation At 31 March 2021 1,919 1,919

Amortisation 01 April 2020 1,778 1,778

Charged during the year 125 125 Amortisation At 31 March 2021 1,903 1,903

Net Book Value at 31 March 2021 16 16

Purchased 16 16 Total at 31 March 2021 16 16

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

10.1 Economic lives Minimum Life Maximum Life (years) (Years) Computer software: purchased 3 3

Page 21 Of 31 NHS South West London CCG - Annual Accounts 2020-21

11.1 Trade and other receivables Current Non-current 2020-21 2020-21 £'000 £'000

NHS receivables: Revenue 6,982 - NHS prepayments - - NHS accrued income 1,761 - Non-NHS and Other WGA receivables: Revenue 5,439 - Non-NHS and Other WGA prepayments 3,731 - Non-NHS and Other WGA accrued income 2,580 - Expected credit loss allowance-receivables (1,355) - VAT 620 - Other receivables and accruals 7 - Total Trade & other receivables 19,765 -

Total current and non current 19,765

Included above: Prepaid pensions contributions -

11.2 Receivables past their due date but not impaired 2020-21 2020-21 DHSC Group Non DHSC Group Bodies Bodies £'000 £'000 By up to three months 511 3,769 By three to six months 195 145 By more than six months 2,755 1,180 Total 3,461 5,094

Trade and other receivables - Non Other financial DHSC Group assets 11.3 Loss allowance on asset classes Bodies £'000 £'000 Balance at 01 April 2020 (1,389) - Lifetime expected credit losses on trade and other receivables-Stage 2 34 - Total (1,355) -

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

Page 22 Of 31 NHS South West London CCG - Annual Accounts 2020-21

12. Cash and cash equivalents

2020-21 £'000 Balance at 01 April 2020 687 Net change in year (214) Balance at 31 March 2021 473

Made up of: Cash with the Government Banking Service 473 Cash and cash equivalents as in statement of financial position 473

Balance at 31 March 2021 473

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

Page 23 Of 31 NHS South West London CCG - Annual Accounts 2020-21

Current Non-current 13. Trade and other payables 2020-21 2020-21 £'000 £'000

NHS payables: Revenue 3,104 - NHS accruals 11,039 - Non-NHS and Other WGA payables: Revenue 47,872 - Non-NHS and Other WGA accruals 85,221 - Non-NHS and Other WGA deferred income 607 - Social security costs 478 - Tax 452 - Other payables and accruals 71,182 - Total Trade & Other Payables 219,954 -

Total current and non-current 219,954

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

The 2020/21 Other Payable Figure of £71.2m Can be broken down into the following areas; £m Payroll and Pension Accruals 2.5 Approved but unpaid general invoices 0.4 Un-approved general invoices 0.6 Service Development Accruals 11.3 Covid-19 Accruals 14.6 Acute Accruals 0.3 Mental Health Accruals 7.6 Community Accruals Including Continuing Healthcare 17.5 Primary Care Accruals Including IT 10.5 Running Cost Accruals 1.4 Other Accruals 4.5 71.2

Page 24 Of 31 NHS South West London CCG - Annual Accounts 2020-21

14. Provisions Current Non-current Current Non-current 2020-21 2020-21 2019-20 2019-20 £'000 £'000 £'000 £'000 Continuing care - - 904 870 Total - - 904 870

Total current and non-current - 1,774

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

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

Utilised during the year ------(59) - (59) Reversed unused ------(1,715) - (1,715) Balance at 31 March 2021 ------

Expected timing of cash flows: Within one year ------Between one and five years ------After five years ------Balance at 31 March 2021 ------

Under the Accounts Direction issued by NHS England on 12 February 2014, NHS England is responsible for accounting for liabilities relating to NHS continuing healthcare claims relating to periods of care before the establishment of Clinical Commissioning Groups. However, the legal liability remains with the CCG. The total value of NHS Continuing Healthcare provisions accounted for by NHS England on behalf of the CCG at 31 March 2021 is £320k.

Legal claims are calculated from the number of claims currently lodged with the NHS Litigation Authority and probabilities provided by them. £7,500 is included in the provisions of the NHS Litigation Authority as at 31 March 2021 in respect of employer liabilities of NHS South West London CCG.

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

Page 25 Of 31 NHS South West London CCG - Annual Accounts 2020-21

15. Contingencies The CCG had no outstanding claims in 2020/21 that are considered to have a likelihood that deems them reportable as a contingent liability in 2020/21.

Under the Accounts Direction issued by NHS England on 12 February 2014, NHS England is responsible for accounting for liabilities relating to NHS continuing healthcare claims relating to periods of care before the establishment of Clinical Commissioning Groups. However, the legal liability remains with the CCG. The total value of NHS Continuing Healthcare contingent liabilities accounted for by NHS England on behalf of the CCG at 31 March 2021 is £1,230k.

16. Commitments NHS South West London CCG has no reportable commitments at 31st March 2021.

17. Financial instruments

The fair value of assets and liabilities as detailed in notes 17.2 and 17.3 are the same as the carrying value

17.1 Financial risk management

Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities.

Because NHS clinical commissioning group is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The clinical commissioning group has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the clinical commissioning group in undertaking its activities.

Treasury management operations are carried out by the finance department, within parameters defined formally within the NHS clinical commissioning group standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the NHS clinical commissioning group and internal auditors.

17.1.1 Currency risk

The NHS clinical commissioning group is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The NHS clinical commissioning group has no overseas operations. The NHS clinical commissioning group and therefore has low exposure to currency rate fluctuations.

17.1.2 Interest rate risk

The clinical commissioning group borrows from government for capital expenditure, subject to affordability as confirmed by NHS England. The borrowings are for 1 to 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The clinical commissioning group therefore has low exposure to interest rate fluctuations.

17.1.3 Credit risk

Because the majority of the NHS clinical commissioning group and revenue comes parliamentary funding, NHS clinical commissioning group has low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables from customers, as disclosed in the trade and other receivables note.

17.1.4 Liquidity risk

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

17.1.5 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.

Page 26 Of 31 NHS South West London CCG - Annual Accounts 2020-21

17. Financial instruments cont'd

17.2 Financial assets

Financial Equity Assets Instruments measured at designated at amortised cost FVOCI Total 2020-21 2020-21 2020-21 £'000 £'000 £'000

Trade and other receivables with NHSE bodies 7,853 7,853 Trade and other receivables with other DHSC group bodies 4,166 4,166 Trade and other receivables with external bodies 3,395 3,395 Cash and cash equivalents 473 473 Total at 31 March 2021 15,887 - 15,887

The above figure for Trade and other receivables excludes the following which are classed as non financial assets - Prepayments, £3,731k and VAT receivable, £620k.

17.3 Financial liabilities

Financial Liabilities measured at amortised cost Other Total 2020-21 2020-21 2020-21 £'000 £'000 £'000

Trade and other payables with NHSE bodies 825 825 Trade and other payables with other DHSC group bodies 45,492 45,492 Trade and other payables with external bodies 172,101 172,101 Total at 31 March 2021 218,418 - 218,418

The above figure for Trade and other payables excludes liabilities for Social security costs (£478k), Tax (452k) and Non NHS and Other WGA deferred income (607k) as these are defined as non financial liabilities.

Page 27 Of 31 NHS South West London CCG - Annual Accounts 2020-21

18. Operating segments

The CCG has just one operating segment which is the commissioning of healthcare

Page 28 Of 31 NHS South West London CCG - Annual Accounts 2020-21

19. Joint arrangements - interests in joint operations

Note 1.5 (Joint Operations) and note 1.6 (Pooled budgets) of these accounts provide further information on pooled budgets.

19.1 Interests in joint operations

South West London CCG hosts a Better Care Fund pooled budget with the London Borough of Croydon. Under these arrangements funds are pooled under section 75 of the NHS Act 2006. NHS South West London CCG contributes to the pool for the services delivered as a provider of healthcare. Members to the BCF pool account for transactions and balances directly with providers. Subject to the requirements of National Guidance and the Better Care Fund plan the agreed return of underspends is in the following proportions: CCG 70%; Council 30%

Royal Borough of Kingston hosts a Better Care Fund pooled budget for the Borough. Under these arrangements funds are pooled under section 75 of the NHS Act 2006. NHS South West London CCG contributes to the pool for the services delivered as a provider of healthcare. Members to the BCF pool account for transactions and balances directly with providers. Partners are solely liable for any overspends to services commissioned exercise of their statutory functions

London Borough of Merton hosts a Better Care Fund (including community equipment) pooled budget for the Borough. Under these arrangements funds are pooled under section 75 of the NHS Act 2006. NHS South West London CCG contributes to the pool for the services delivered as a provider of healthcare. Members to the BCF pool account for transactions and balances directly with providers. Partners are solely liable for any overspends to services commissioned exercise of their statutory functions

London Borough of Richmond hosts a Better Care Fund pooled budget for the Borough. Under these arrangements funds are pooled under section 75 of the NHS Act 2006. NHS South West London CCG contributes to the pool for the services delivered as a provider of healthcare. Members to the BCF pool account for transactions and balances directly with providers. Partners are solely liable for any overspends to services commissioned exercise of their statutory functions

London Borough of Sutton hosts a Better Care Fund pooled budget for the Borough. Under these arrangements funds are pooled under section 75 of the NHS Act 2006. NHS South West London CCG contributes to the pool for the services delivered as a provider of healthcare. Members to the BCF pool account for transactions and balances directly with providers. Under the section 75 financial risk is shared on the basis of the financial contribution to the BCF total fund.

London Borough of Wandsworth hosts a Better Care Fund pooled budget for the Borough. Under these arrangements funds are pooled under section 75 of the NHS Act 2006. NHS South West London CCG contributes to the pool for the services delivered as a provider of healthcare. Members to the BCF pool account for transactions and balances directly with providers. Partners are solely liable for any overspends to services commissioned exercise of their statutory functions

NHS South West London CCG's shares of assets/liabilities and income and expenditure handled by the pooled budgets in the financial year were:

Amounts recognised in Entities books ONLY 2020-21 Name of arrangement Parties to the arrangement Description of principal activities Assets Liabilities Income Expenditure £'000 £'000 £'000 £'000 South West London CCG & London Borough of Better Care Fund Provision of Health & Social Care 0 0 0 10,094 Croydon South West London CCG & Royal Borough of Better Care Fund Provision of Health & Social Care 0 0 0 8,167 Kingston South West London CCG & London Borough of Better Care Fund Community Health and Social Care services 0 0 (96) 13,644 Merton South West London CCG & London Borough of Better Care Fund Community Health and Social Care services 0 0 0 6,050 Richmond upon Thames South West London CCG & London Borough of Better Care Fund Community Health and Social Care services 0 0 (6,090) 13,329 Sutton South West London CCG & London Borough of Better Care Fund Community Health and Social Care services - - (363) 23,362 Wandsworth

Page 29 Of 31 NHS South West London CCG - Annual Accounts 2020-21

20. Related party transactions

Details of related party transactions with individuals are as follows: 2020/21 Amounts due Payments to Receipts from Amounts owed from Related Related Party Related Party to Related Party Party £'000 £'000 £'000 £'000 St George's University Hospitals NHS Foundation Trust 378,669 0 (8,902) 0 Croydon Health Services NHS Trust 268,529 0 (23) 136 Epsom & St Helier University Hospitals NHS Trust 256,487 (1,260) (96) 4 Kingston Hospital NHS Foundation Trust 222,856 0 (262) 41 South West London & St George's Mental Health NHS Trust 150,051 0 (350) 0 Chelsea & Westminster NHS Hospitals Foundation Trust 83,716 0 (69) 0 London Ambulance Services NHS Trust 59,807 0 (3) 0 South London and Maudsley NHS Foundation Trust 55,444 0 (338) 0 The Royal Marsden NHS Foundation Trust 43,340 (50) 0 43 Guys & St Thomas NHS Foundation Trust 37,816 0 (919) 78 King's College Hospital NHS Foundation Trust 29,983 0 (10) 0 Moorfields Eye Hospital NHS Foundation Trust 29,628 0 0 0 Houslow and Richmond Community Healthcare NHS Trust 29,126 0 (1,381) 185 London Borough of Croydon 31,644 (120) (10,128) 780 London Borough Of Sutton 22,842 (9,510) (5,418) 3,164 London Borough of Wandsworth 16,580 (1,091) (3,384) 233 London Borough of Richmond upon Thames 13,281 (84) (4,991) 208 Royal Borough of Kingston upon Thames 12,047 (4,911) (8,121) 812 London Borough of Merton 9,593 (4,550) (1,590) 391 Your Healthcare CIC 26,445 0 (25) 0 The Church Lane Practice 7,191 0 0 0 The Groves Medical Centre 4,724 0 (17) 0 Brocklebank Group Practice 3,584 0 0 0 Benhill & Belmont Practice 3,080 0 0 0 Stonecot Surgery 2,426 0 0 0 Mulgrave Road Surgery 2,092 0 0 0 South Norwood Medical Practice 1,496 0 0 0 Haling Park Medical Practice 941 0 0 0

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

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

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

Page 30 Of 31 NHS South West London CCG - Annual Accounts 2020-21

21. Events after the end of the reporting period

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

22. Loses and special payments

NHS South West London Clinical Commissioning Group suffered no reportable losses or made any special payments to report in 2020/21.

23. Financial performance targets

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

2020-21 Target Performance Variance Target £'000 £'000 £'000 Met Expenditure not to exceed income 2,706,109 2,706,050 (59) Yes Capital resource use does not exceed the amount specified in Directions - - - N/A Revenue resource use does not exceed the amount specified in Directions 2,671,919 2,671,860 (59) Yes Capital resource use on specified matter(s) does not exceed the amount specified in Directions - - - N/A Revenue resource use on specified matter(s) does not exceed the amount specified in Directions - - - N/A Revenue administration resource use does not exceed the amount specified in Directions 30,726 29,890 (836) Yes

24. Analysis of charitable reserves

NHS South West London CCG is the corporate trustee of Kingston charitable funds. The Governing Body does not consider the activities of the charity to be material to NHS South West London CCG. As set out in note 1.4 the Charity has been closed and accordingly there are no net assets at 31 March 2021.

Page 31 Of 31 Appendix A: Member practices by Locality 2021

No. Practice Name Address PCN Croydon (49 Practices)

1 Addington Medical Practice 7 Gravel Hill, Addington, Croydon, CR0 0JA Selsdon Addington & Shirley

Parkway, New Addington, Croydon, CR0 0JA 2 Ashburton Park Medical 416 Lower Addiscombe Road, Addiscombe, Croydon GP Super Network Centre Croydon, CR0 7AG

3 Auckland Surgery 84a Auckland Road, Upper Norwood, SE19 2DF One Thornton Heath 4 Birdhurst Medical Practice 1 Birdhurst Avenue, South Croydon, CR2 7DX GPnet5

5 Bramley Avenue Surgery 1b Bramley Avenue, Coulsdon, CR5 2DR Selsdon Purley & Coulsdon Health

6 Brigstock and South Norwood 141 Brigstock Road, Thornton Heath, CR7 7JN Primary Care North Croydon Medical Partnership

7 Brigstock Family Practice 83 Brigstock Road, Thornton Heath, CR7 7JH Primary Care North Croydon

8 Broom Road Medical Practice 23 Broom Road, Shirley, Croydon, CR0 8NG Selsdon Addington & Shirley 9 Broughton Corner Medical 87 Thornton Road, Thornton Heath, CR7 6BH Primary Care North Croydon Centre

10 Country Park Practice Woodside Health Centre, 3 Enmore Road, South Croydon GP Super Network Norwood, SE25 5NT 11 Denmark Road Surgery Woodside Health Centre, 3 Enmore Road, South Croydon GP Super Network Norwood, SE25 5NT

12 East Croydon Medical Practice 59 Addiscombe Road, Croydon, CR0 6SD Croydon Link 13 Edridge Road Community Impact House, 2 Edridge Road, Croydon, CR0 Croydon Link Health Centre 1FE

14 Eversley Medical Practice 501 London Road, Thornton Heath, CR7 6AR Mayday South

15 Fairview Medical Centre 69 Fairview Road, Norbury, SW16 5PX Primary Care North Croydon 16 Farley Road Medical Practice 53 Farley Road, South Croydon, Surrey, CR2 Selsdon Addington & Shirley 7NG

125 Holmbury Grove, Forestdale, Croydon, Surrey, CR0 9AQ 17 Friends' Road Medical 49-51 Friends Road, Croydon, CR0 1ED GPnet5 Practice

18 Greenside Group Practice 88 Greenside Road, Croydon, CR0 3PN Croydon GP Super Network 26 Lennard Road, Croydon, CR0 2UL

19 Haling Park Partnership 96 Brighton Road, South Croydon, CR2 6AD GPnet5

20 Hartland Way Surgery 1 Hartland Way, Croydon, CR0 8RG Croydon GP Super Network

i 21 Headley Drive Surgery 117a Headley Drive, New Addington, Croydon, Selsdon Addington & Shirley CR0 0QL

22 Keston Medical Practice Purley War Memorial Hospital, 856 Brighton Keston Moorings & Parkside Road, Purley, CR8 2YL

23 Leander Family Practice 949 London Road, Thornton Heath, CR7 6JE Primary Care North Croydon

24 London Road Medical Practice 515 London Road, Thornton Heath, CR7 6AR Mayday South 25 Mersham Medical Centre 30 Norbury Road, Thornton Heath, CR7 8JN One Thornton Heath

26 Mitchley Avenue Surgery 116 Mitchley Avenue, South Croydon, CR2 9HH Selsdon Purley & Coulsdon Health

27 Moorings Medical Practice 2a Valley Road, Kenley, CR8 5DN Keston Moorings & Parkside 28 Morland Road Surgery 1 Morland Road, Croydon, CR0 6HA Croydon GP Super Network

29 New Addington Group Fieldway, 15a Danebury, New Addington, Selsdon Addington & Shirley Practices Croydon, CR0 9EU 30 Norbury Health Centre 2b Pollards Hill North, Norbury, SW16 4NL Primary Care North Croydon

31 North Croydon Medical Centre 518 London Road, Thornton Heath, CR7 7HQ Mayday South

32 Old Coulsdon Medical Practice 2a Court Avenue, Coulsdon, CR5 1HF Selsdon Purley & Coulsdon Health

33 Parchmore Medical Centre 97 Parchmore Road, Thornton Heath, CR7 8LY One Thornton Heath

34 Parkside Group Practice 27 Wyche Grove, South Croydon, CR2 6EX Keston Moorings & Parkside

35 Portland Medical Centre 184 Portland Road, South Norwood, SE25 4QB Croydon GP Super Network 36 Queenhill Medical Practice 31 Queenhill Road, South Croydon, CR2 8DU Selsdon Addington & Shirley

37 Selhurst Medical Centre 27 Selhurst Road, South Norwood, SE25 5QA Croydon GP Super Network 38 Selsdon Park Medical Practice 97 Addington Road, South Croydon, CR2 8LG Selsdon Purley & Coulsdon Health

39 Shirley Medical Centre 334/370 Wickham Road, Shirley, Croydon, CR0 Croydon GP Super Network 8BH

40 South Norwood Hill Medical 103a South Norwood Hill, London, SE25 6BY One Thornton Heath Centre

41 St James' Medical Centre 189a St. James's Road, Croydon, CR0 2BZ Croydon Link

1a Castle Hill Avenue, Croydon, CR0 0TH 42 Stovell House Surgery 188 Lower Addiscombe Road, Addiscombe, GPnet5 Croydon, CR0 6AH

43 The Addiscombe Surgery 139 Northway Road, Croydon, CR0 6JJ Croydon GP Super Network 395a Addiscombe Road, Croydon, CR0 7LJ

44 Thornton Heath Medical 61a Gillett Road, Thornton Heath, CR7 8RL One Thornton Heath Centre

45 299 Thornton Road, Croydon, CR0 3EW Mayday South

ii Thornton Road and Valley Valley Park Surgery, Healthy Living Centre, Park Surgery Franklin Way, Croydon, CR0 4YD

46 Upper Norwood Group 130 Church Road, Upper Norwood, SE19 2NT One Thornton Heath Practice

47 Violet Lane Medical Practice 231 Violet Lane, Croydon, CR0 4HN GPnet5

48 Whitehorse Practice 87 Whitehorse Road, Croydon, CR0 2JJ Croydon GP Super Network 49 Woodcote Medical 32 Foxley Lane, Purley, CR8 3EE Selsdon Purley & Coulsdon Health 140 Chipstead Valley Road, Coulsdon, CR5 3BB

Kingston (21 Practices) 50 Berrylands Surgery Ewell Road, Surbiton, KT6 6EZ Canbury Churchill Orchard Berrylands

51 Brunswick Surgery Ewell Road, Surbiton, KT6 6EZ Surbiton Health Centre

52 Canbury Medical Centre 1 Elm Road, Kingston Upon Thames, KT2 6HR Canbury Churchill Orchard Berrylands

53 Central Surgery Surbiton Health Centre, Ewell Road, Surbiton, Surbiton Health Centre KT6 6EZ

54 Chessington Park Surgery Merritt Gardens, Chessington, KT9 2GY Chessington and Surbiton

55 Churchill Medical Centre Clifton Road, Kingston Upon Thames, KT2 6PG Canbury Churchill Orchard Berrylands 1 Evesham Terrace, St Andrew’s Road, Surbiton, KT6 4DS 164 Tudor Drive, Kingston-Upon-Thames, KT2 5QG

56 Claremont Medical Centre 2a Glenbuck Road, Surbiton, KT6 6BS Chessington and Surbiton 57 Fairhill Medical Practice 81 Kingston Hill, Kingston Upon Thames, KT2 Kingston 7PX

14 Fairfield South, Kingston Upon Thames, KT1 2UJ Penrhyn Rd, Kingston Upon Thames, KT1 2EE

58 Groves Medical Centre 171 Clarence Avenue, New Malden, KT3 3TX New Malden & Worcester Park

59 Holmwood Corner Surgery 134 Malden Road, New Malden, KT3 6DR New Malden & Worcester Park 60 Hook Surgery The Merritt Medical Centre, Merritt Gardens, Chessington and Surbiton Chessington, KT9 2GY

61 Kingston Health Centre 10 Skerne Road, Kingston Upon Thames, KT2 Kingston 5AD 62 Langley Medical Practice Surbiton Health Centre, Ewell Road, Surbiton, Surbiton Health Centre KT6 6EZ

63 Manor Drive Medical Centre 3 The Manor Drive, Worcester Park, KT4 7LG New Malden & Worcester Park

64 Orchard Practice Orchard Gardens, Chessington, KT9 1AG Canbury Churchill Orchard Berrylands

iii 65 Red Lion Road Surgery 1a Red Lion Road, Surbiton, KT6 7QG Chessington and Surbiton

66 Roselawn Surgery 149 Malden Road, New Malden, KT3 6AA New Malden & Worcester Park 67 St Alban's Medical Centre 212 Richmond Road, Kingston Upon Thames, Kingston KT2 5HF

68 Sunray Surgery 97 Warren Drive South, Tolworth, Surbiton, KT5 Chessington and Surbiton 9QD 69 Village Surgery 157-159 High Street, New Malden, KT3 4BH New Malden & Worcester Park

70 West Barnes Surgery 229 West Barnes Lane, New Malden, KT3 6JD New Malden & Worcester Park

Merton (22 Practices) 71 Alexandra Road Surgery 39 Alexandra Road, Wimbledon, SW19 7JZ North West Merton

72 Central Medical Centre 42-46 Central Road, Morden, SM4 5RT Morden

73 Colliers Wood Surgery 58 High Street Colliers Wood, Colliers Wood, North Merton SW19 2BY Lavender Fields Surgery, 182 Western Road, Mitcham, CR4 3RB

74 Cricket Green Medical Practice 75-79 Miles Road, Mitcham, CR4 3DA East Merton 75 Figges Marsh Surgery 182 London Road, Mitcham, CR4 3LD East Merton

76 Francis Grove Surgery The Courtyard, 8 Francis Grove, Wimbledon, West Merton SW19 4DL

77 Grand Drive Surgery 132 Grand Drive, Raynes Park, SW20 9EA South West Merton 78 Lambton Road Medical 1 Lambton Road, Raynes Park, Wimbledon, West Merton Practice SW20 0LW

79 Merton Medical Practice 12-17 Abbey Parade, South Wimbledon, SW19 North Merton 1DG

80 Mitcham Family Practice 55 Mortimer Road, Mitcham, CR4 3HS North Merton

81 Mitcham Medical Centre 81 Haslemere Avenue, Mitcham, CR4 3PR North Merton

886 Garratt Lane, Tooting, SW17 0NB

82 Morden Hall Medical Centre 256 Morden Road, SW19 3DA Morden

83 Nelson Medical Practice Kingston Road, London SW20 8DA South West Merton 84 Ravensbury Park Medical Ravensbury Lane, Morden Road, Mitcham, CR4 Morden Centre 4DQ

85 Riverhouse Surgery East Road, Wimbledon, SW19 1YG North Merton

86 Rowans Surgery 1 Windermere Road, Streatham, SW16 5HF East Merton 87 Stonecot Surgery 115-117 Epsom Road, Sutton, SM3 9EY Morden

88 Tamworth House Medical 341 Tamworth Lane, Mitcham, CR4 1DL East Merton Centre 89 Vineyard Hill Road Surgery 67 Vineyard Hill Road, Wimbledon, SW19 7JL North West Merton

iv 90 Wide Way Medical Centre Wide Way, Mitcham, CR4 1BP East Merton

91 Wimbledon Medical Practice 79 Pelham Road, Wimbledon, SW19 1NX North West Merton 92 Wimbledon Village Surgery 35a High Street Wimbledon, SW19 5BY North West Merton

Richmond (25 Practices)

93 Acorn Practice 29-35 Holly Road, Twickenham, TW1 4EA West Twickenham 94 Broad Lane Surgery 71 Broad Lane, Hampton, TW12 3AX Hampton

95 Crane Park Surgery Whitton Corner Health and Social Care Centre, East Twickenham Percy Road, Twickenham, TW2 6JL

96 Cross Deep Surgery 4 Cross Deep, Twickenham, TW1 4QP East Twickenham 97 Dr Johnson & Partners Sheen Lane Health Centre, 70 Sheen Lane, Sheen & Barnes SW14 8LP

98 Essex House Surgery Station Road, Barnes, SW13 0LW Sheen & Barnes 99 Glebe Road Surgery 1 Glebe Road, Barnes, SW13 0DR Sheen & Barnes

100 Hampton Hill Medical Centre 94-102 High Street, Hampton Hill, Hampton, Teddington TW12 1NY

101 Hampton Medical Centre Lansdowne, 49a Priory Road, Hampton, TW12 Hampton 2PB

102 Hampton Wick Surgery Tudor House, 26 Upper Teddington Road, Teddington Kingston Upon Thames, KT1 4DY

103 Jubilee Surgery Whitton Corner Health and Social Care Centre, West Twickenham Percy Road, Twickenham, TW2 6JL

104 Kew Medical Practice 14 High Park Road, Kew, Richmond, TW9 4BH Richmond

105 Paradise Road Surgery Paradise Road Practice, 37 Paradise Road, Richmond Richmond, TW9 1SA

106 Park Road Surgery 37 Park Road, Teddington, TW11 0AU Hampton

107 Parkshot Medical Practice 18 Parkshot, Richmond, TW9 2RG Richmond

108 Richmond Lock Surgery Richmond Lock Surgery, 300 St. Margarets Road, West Twickenham Twickenham, TW1 1PS

109 Richmond Medical Group Quadrant House, Levett Square, Kew, Richmond, Sheen & Barnes TW9 4FF Sheen Lane Health Centre, 70 Sheen Lane, SW14 8LP

110 Seymour House & Lock Road 55a Lock Road Ham TW10 7LJ Richmond Surgeries 154 Sheen Road, Richmond, TW9 1UU

111 Staines Road Medical Centre 325 Staines Road, Twickenham, TW2 5AU West Twickenham

112 Thameside Medical Practice Thames House, 180-194 High Street, Teddington, Teddington TW11 8HU

v 113 The Green Surgery & Fir Road The Green Surgery, 1b The Green, Twickenham, Teddington Surgery TW2 5TU Fir Road Surgery, 50 Fir Road, Hanworth, TW13 6UJ

114 Twickenham Park Surgery 17 Rosslyn Road, Twickenham, TW1 2AR West Twickenham

115 Vineyard Surgery 35 The Vineyard, Richmond, TW10 6PP Richmond 116 Woodlawn & Oak Lane Woodlawn Medical Centre, 19 Powder Mill Lane, East Twickenham Medical Centres Twickenham, TW2 6EE

Oaklane Medical Centre, 6 Oak Lane, Twickenham, TW1 3PA 117 York Medical Practice St Johns Health Centre, Oak Lane, Twickenham, East Twickenham TW1 3PA

Sutton (23 Practices)

118 Beeches Surgery 9 Hill Road, Carshalton, SM5 3RB Wallington 119 Benhill & Belmont GP Centre 54 Benhill Avenue, Sutton, SM1 4EB Cheam and South Sutton

1 Station Approach, Belmont, Sutton, SM2 6DD

120 Bishopsford Road Practice 191 Bishopsford Road, Morden, SM4 6BH Carshalton

121 Carshalton Fields Surgery 11 Crichton Road, Carshalton, SM5 3LS Carshalton

122 Cheam Family Practice The Knoll, Parkside, Cheam, Sutton, SM3 8BS Cheam and South Sutton

263 Gander Green Lane, Sutton, SM1 2HD 123 Cheam GP Centre 322 Malden Road, Cheam, SM3 8EP Cheam and South Sutton

124 Chesser Practice Elmhurst Court, 121 Wrythe Lane, Carshalton, Carshalton SM5 2RT 125 Faccini House Surgery 64 Middleton Road, Morden, SM4 6RT Carshalton

126 Green Wrythe Surgery 411a Green Wrythe Lane, Carshalton, SM5 1JL Carshalton

127 Grove Road Practice 83 Grove Road, Sutton, SM1 2DB Central Sutton 128 Hackbridge Medical Centre 138 London Road, Hackbridge, Wallington, SM6 Carshalton 7HF

129 James O'Riordan Practice 70 Stonecot Hill, Sutton, SM3 9HE Cheam and South Sutton 130 Maldon Road Surgery 35 Maldon Road, Wallington, SM6 8BL Wallington

131 Manor Road Practice 6 Mollison Square, Wallington, SM6 9DW Wallington

57 Manor Road, Wallington, SM6 0DE 132 Mulgrave Road Surgery 48 Mulgrave Road, Belmont, Sutton, SM2 6LX Central Sutton

133 Park Road Surgery 1a Park Road, Wallington, SM6 8AW Wallington

134 Robin Hood Lane Medical Robin Hood Lane, Sutton, SM1 2RJ Central Sutton Centre (The Health Centre)

vi 135 Shotfield Medical Practice Jubilee Health Centre, Shotfield, Wallington, SM6 Wallington 0HY

136 Sutton Medical Centre 181 Carshalton Road, Sutton, SM1 4NG Carshalton 137 The Old Court House Surgery Throwley Way, Sutton, SM1 4AF Central Sutton

138 Wallington Family Practice Jubilee Health Centre West, Shotfield, Wallington, Wallington SM6 0HY 139 Wallington Medical Centre 52 Mollison Drive, Wallington, SM6 9BY Wallington

140 Wrythe Green Surgery Wrythe Lane, Carshalton, SM5 2RE Carshalton

Wandsworth (40 Practices) 141 Alton Practice 208-210 Roehampton Lane, Roehampton, SW15 West Wandsworth 4LE

142 Balham Health Centre 120 Bedford Hill, Balham, SW12 9HS Balham, Tooting & Furzedown

143 Balham Park Surgery 236 Balham High Road, SW17 7AW Nightingale 144 Battersea Fields Practice 3 Austin Road, Battersea, SW11 5JP Battersea

115 Thessaly Road, SW8 4EJ

145 Battersea Rise Group Practice 17 Battersea Rise, Battersea, SW11 1HG Battersea

146 Bedford Hill Family Practice 120-124 Bedford Hill, Balham, SW12 9HS Balham, Tooting & Furzedown

147 Begg Practice - St John's Hill Entrance B, 162 St John's Hill, Wandsworth, Wandsworth Surgery SW11 1SW 148 Bolingbroke Medical Centre Wakehurst Road, Battersea, SW11 6BF Wandsworth

149 Bridge Lane Group Practice 20 Bridge Lane, Battersea, SW11 3AD Battersea

150 Brocklebank Group Practice 249 Garratt Lane, Wandsworth, SW18 4DU Brocklebank 151 Chartfield Surgery The Surgery, 30 Chartfield Avenue, Putney, Prime Wandsworth SW15 6HG

152 Chatfield Health Care Chatfield Road, Battersea, SW11 3UJ Wandsworth

153 Clapham Junction Medical 7 Farrant House, Winstanley Road, SW11 2EJ Wandsworth Practice

154 Danebury Avenue Surgery 351 Danebury Avenue, Roehampton, SW15 4DU West Wandsworth

155 Earlsfield Surgery 2-4 Steerforth Street, SW18 4HH Wandle 156 Elborough Street Surgery 81 Elborough Street, Wandsworth, SW18 5DS Wandle

157 Falcon Road Medical Practice 47 Falcon Road, Battersea, SW11 2PH Wandsworth

158 Grafton Medical Partners Trevelyan House, 160 Tooting High Street, SW17 Grafton Medical Partners 0RT

103 Macmillan Way, SW17 6AT

219 Upper Tooting Rd, Tooting, SW17 7TG 159 Greyswood Practice 66 Eastwood Street, Streatham, SW16 6PX Balham, Tooting & Furzedown

vii 160 Heathbridge Practice Heathbridge Med Practice, 125 Upper Richmond Prime Wandsworth Road, Putney, SW15 2TL

161 Junction Medical Centre Arches 5-8, Clapham Junction Station, 5-8 Grant Wandsworth Road, SW11 2NU

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

163 Mayfield Surgery 246 Roehampton Lane, Roehampton, SW15 4AA Prime Wandsworth 164 Nightingale Practice 105 Nightingale Lane, Balham, SW12 8NB Nightingale

165 Open Door & Bec Family 62 Upper Tooting Road, Tooting, SW17 7PB Balham, Tooting & Furzedown Practice 47 Boundaries Road, Balham, SW12 8EU 166 Putneymead Group Medical 266 Upper Richmond Road, SW15 6TQ West Wandsworth Practice

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

168 Southfields Group Practice 492 Merton Road, Wandsworth, SW18 5AE Wandle 169 St Paul’s Cottage Surgery 114 Augustus Road, SW19 6EW Brocklebank

170 Streatham Park Surgery 91 Mitcham Lane, Streatham, SW16 6LY Balham, Tooting & Furzedown

139 Franciscan Road, SW17 8DS

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

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

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

174 Thurleigh Road Practice 88a Thurleigh Road, Balham, SW12 8TT Nightingale 175 Tooting Bec Surgery 313 Balham High Road, SW17 7BA Balham, Tooting & Furzedown

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

177 Triangle Surgery Triangle House, 2 Broomhill Road, Wandsworth, Wandle SW18 4HX 178 Trinity Medical Centre (Drs 278-280 Balham High Road, Balham, SW17 7AL Balham, Tooting & Furzedown Shah & Partners)

179 Tudor Lodge Health Centre 8c Victoria Drive, Wimbledon, SW19 6AE Prime Wandsworth 180 Wandsworth Medical Centre 90-92 Garratt Lane, Wandsworth, SW18 4DD Wandle

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