ANNUAL REPORT AND ACCOUNTS 2014/15

THE BEST OF HEALTH FOR WEST SUFFOLK Section 1 MAIN REPORT Page 4 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

Introduction

When the NHS West Suffolk Clinical We have made it our priority to listen to Commissioning Group (CCG) formed in our member practices and the people we 2013, we brought together members serve, and have used these comments who had a shared vision to deliver to help set our priorities. We are already high quality, fully joined up health care developing ways of more integrated services. Added to this was the ethos working in west Suffolk so that: of asking people what they needed to see in their services. • People can manage their own health and social care with the right support This annual report and accounts marks and when needed. records our second year where we have • Communities are easy and supportive built on our first year. We have seen major places to live with a health or care need. Dr Christopher improvements to stroke services, cancer • There is a health and care system that is Browning care and mental health provision. We have co-ordinated and effective. focused on services for children and young • Higher cost interventions are replaced Chair, NHS West people, investing in eating disorders, with those that are equally effective and Suffolk CCG autism, asthma and epilepsy services. cost less.

In October 2014, NHS England published We have invested in new services for the its Five Year Forward View, in which it people of west Suffolk. An example of this sets out how the health service needs to was the opening of the new community change going forward, arguing for a more health centre for people in Sudbury and its engaged relationship with patients, carers surrounding areas. and the public to promote health and wellbeing and prevent ill-health. It sets out We have worked to spend money wisely, the vision for the NHS of the future and making changes where needed and the steps that need to be taken to ensure a investing in plans, shaped by the public, sustainable health service which continues our partners and clinicians. As well as to provide comprehensive and high quality helping to deliver improved services, this care for all. has ensured we remained within our £280.8m budget. The case for change in our own health and care system is strong and we are already We have successfully delivered the majority taking action to meet this challenge for of the patients’ rights as set out in the NHS change, and to develop a health and care Constitution, including: system that works well for people. It will be a system that supports people to lead • Maximum of 18 weeks from referral to healthy and independent lives, but when treatment. they do need help, it provides this swiftly • Cancer waiting times for referral and and effectively, with a view to getting them treatment. back to their own lives, in their own homes • Waiting times for access to with access to the people and activities psychological therapies and treatment. that they enjoy. It will be a system that seeks to prevent health and care needs, I am very proud of our work so far. We, as not simply to treat them when they arise. It a Governing Body, are keen to do better will be a system that puts people in charge and want to continue to deliver the best of their own health and care plans, and possible care in the future. Although there takes account of what matters to people. will be challenges ahead, we will face them with integrity and build on the solid foundations we have already put in place as we continue to drive through further improvements for the people we serve. West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 5

Member Practices’ Introduction

The CCG is pleased to present this Organisations in west Suffolk are already report which reflects on the significant committed to creating an integrated progress we have made in addressing health and care system that supports our the health priorities of the local population to keep well and to remain community, whilst delivering financial living independently with a good quality balance and meeting most of the of life for as long as possible. All partners performance targets set out within the aim to deliver high quality services, which NHS Constitution. are centred on people. They agree that the only way to do this effectively is to The CCG has developed its own distinctive work together to remove barriers and ambition and underpinning priorities which costs, and ensure that we spend as much will provide a local approach for delivery of as possible of our budgets on the direct the Suffolk Health and Wellbeing Strategy. provision of care. By doing so, it will At the heart of this ambition is the view help us to manage the increasing levels that more joined up working with our of demand on health and social care partners and communities is the primary services, as well as give us the ability to way to improve the quality of those use our funding more effectively. services locally. Supporting delivery of the CCG’s ambition are six clinical priorities, The CCG recognises that primary care which have been aligned to both national plays a critical role in the prevention and local frameworks: of ill health and the management of people with long term conditions. The 1. Develop clinical leadership. CCG places primary care at the very 2. Demonstrate excellence in patient heart of its joint plan to support people experience and patient engagement. at home through the implementation 3. Improve the health and care of older of risk stratification, integrated people. community teams, case management 4. Improve access to mental health and care coordination. The CCG has been services. approved to jointly commission primary 5. Improve health and wellbeing through care services, and will be working with partnership working. NHS England on the local Implementation 6. Deliver financial sustainability through of the new arrangements from April quality improvement. 2015.

The strategic report sets out how these The CCG will also be enhancing the joint priorities have supported delivery of the commissioning arrangements with local highest quality of health services in west government. Suffolk through our work with patients and stakeholders. During the year, we have During 2014/15, we started the process worked hard to engage with our local of system reform and redesign in the way patients, listening to their feedback and the local health and social care systems responding to their healthcare needs. work. This was initially in Sudbury through the “Connect Sudbury” programme of The strategic report details how the work where the concepts and practical CCG has responded to patients in the applications of a new health and care “You Said…We Did”, whilst also setting model will be tested in that town and out the delivery of the key financial and its surrounding areas, and used as an performance targets. opportunity to further understand the key components of building a more cohesive We have made significant progress locally health and care system with cross- in delivering our vision of a sustainable organisational working. health service which continues to provide comprehensive and high quality care for This work will continue into 2015/16 and all and we have established a determined beyond, as we further progress delivery leadership to build a system that works of a sustainable health service which for our customers and patients, and is continues to provide comprehensive and financially sustainable into the longer term. high quality care for local people. Page 6 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

Strategic Report

Legislative requirements

We are responsible for discharging a range of duties on behalf of patients in line with the NHS Act 2006. This includes:

• Involving patients and the public in shaping health services. • Improving the quality of services we commission. • Reducing health inequalities.

We act effectively and economically by delegating responsibility for making decisions to our Governing Body, with lead responsibility from the Chief Officer. The Audit Committee monitors the controls in place to ensure we provide value for money. We certify that NHS West Our history Health Service Commissioning Suffolk Clinical Commissioning Board in exercise of powers Group has complied with the The way in which healthcare conferred on it by the National statutory duties laid down in the services are run changed Health Service Act 2006. National Health Service Act 2006 significantly as a result of the (as amended). Health and Social Care Act 2012. It now buys, manages and pays for Primary Care Trusts ceased to health services such as emergency exist, with the majority of their hospital care, rehabilitation, most responsibilities taken over by community healthcare, mental CCGs. health and learning disability Julian Herbert services for the people of west Accountable Officer In west Suffolk, GPs chose to Suffolk. West Suffolk Clinical form a CCG that would embrace Commissioning Group commissioning from the acute, Our Constitution mental health and community 20 May 2015 sector. From the 25 member GP A legal document, called a practices, eight GPs were elected Constitution, sets out the to sit on the CCG’s Governing arrangements the CCG has made Body. We also have two practice to ensure it meets its responsibilities managers and a lay member each for commissioning high quality for governance and patient and health care for the people of west public engagement. Suffolk.

The Clinical Commissioning Group It describes the governing was licensed from 1 April 2013 principles, rules and procedures under provisions enacted in the which will ensure integrity, honesty Health & Social Care Act 2012, and accountability in the CCG’s day which amended the National to day running. Also, it commits Health Service Act 2006. the CCG to making decisions in an open and transparent way and As at 1 April 2014, the Clinical places the interests of patients and Commissioning Group was public at its heart. licensed without conditions. Our Constitution can be The Clinical Commissioning downloaded at: Groups’ Annual Report is prepared www.westsuffolkccg.nhs.uk/ under Directions by the National about-us/our-constitution/ West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 7

Strategic Report

The population we serve 9.7% in the number of children Our headquarters aged 0-4. The CCG provides healthcare In July 2014, the CCG relocated services for around 240,000 West Suffolk has similar levels to West Suffolk House in Bury St people in west Suffolk. In 2015/16 of deprivation to Suffolk overall. Edmunds, meaning that we are it will spend around £280m The areas of highest deprivation now co-located with colleagues on commissioning healthcare are located in parts of the towns, from Suffolk County Council and services for these people. The including areas within Bury St St Edmundsbury Borough Council. CCG’s population is registered Edmunds, Brandon, Mildenhall, with 25 west Suffolk practices Newmarket, Haverhill and West Suffolk House is a purpose and is predominantly rural Sudbury as well as the more rural built public sector office building with the population scattered areas which have relatively poor and is designed to integrate in small towns and villages. geographical access to services. staff from different organisations Geographically, the area includes 42% of Suffolk residents live in under one roof. The building the whole of Forest Heath and rural areas, and a great proportion provides flexible open plan office St. Edmundsbury local authority of the county population are space, along with conference districts and part of Mid Suffolk claiming incapacity or Department and meeting rooms, public access and Babergh districts. of Work and Pension benefits, or areas, and a staff café, all of which living with a limiting long term are shared by CCG and council The town of Bury St. Edmunds illness. colleagues. (43,000 residents) is at the centre of the area, which also includes Overall the population of west Our wider management the small towns of Haverhill Suffolk is generally healthy delivery team, made up of (27,000), Mildenhall (14,000) and with high life expectancy. Life contracting, quality and safety, Newmarket (20,000) in the west, expectancy at birth for males was finance, corporate services and Brandon (9,000) in the north and 80.6 years and females 84.1 years communications, is shared with Sudbury (22,000) in the south-east in west Suffolk compared with neighbouring NHS Ipswich and (based on 2011 Census Built Up 78.9 and 82.3 years respectively East Suffolk CCG and is based in Area data). for England. Life expectancy at Bramford, near Ipswich. This team birth in 2008-2012 for both males delivers contracted services to both Several main roads, including the and females was higher than in CCG’s and is headed by a shared A14, A11, A134 and A143, cross England as a whole by 1.7 and 1.3 Chief Officer. The hot desk facilities the area, as does the railway line years respectively. However, there available at West Suffolk House from Ipswich to Cambridge, with are significant health inequalities means that the wider management stations at Bury St Edmunds and with a 5.5 year gap for men and delivery team are able to work Newmarket and the villages in a 4.3 year gap for women in life even more closely with colleagues between. The United States Air expectancy between those living based in Bury St Edmunds. Force also has large airbases at in the most and the least deprived Lakenheath and Mildenhall. areas.

16% of the CCG’s registered population are under age 15 (England average 17.2%) and 9.5% are aged 75 or over (England average 7.8%).

The overall population of west Suffolk is projected to increase by over 7% between 2014 and 2024, with nearly a 40% increase in people aged over 70 years old. Between 2001 and 2011 the absolute numbers of children in the 5-7, 8-9 and 10-14 age bands actually fell across Suffolk as a whole. The numbers of older teenagers rose slightly, whilst there was a relatively sharp increase of Page 8 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

Services that the CCG commissions

We mainly commission services from:

• West Suffolk NHS Hospital Foundation Trust. • Norfolk and Suffolk NHS Foundation Trust. • Serco, which manages community services Suffolk Community Healthcare. • Care UK. • East of England Ambulance Service NHS Trust. • Papworth NHS Hospital. recent Care Quality Commission East of England Ambulance • Suffolk County Council. (CQC) report. Service NHS Trust • Cambridgeshire University Hospital NHS Foundation Trust. Serco (Suffolk Community The ambulance service delivers Healthcare) both emergency and non-urgent We also hold contracts with patient transport services to the around 200 organisations. Community services have CCG’s population. The CCG is continued to progress changes the co-ordinating commissioner West Suffolk NHS Foundation to their services to enable their for the East of England and is Trust staff to spend more time with working with the service through patients. Suffolk Community some challenging times in order West Suffolk NHS Foundation Trust Healthcare works with the CCG to improve response times and is the largest provider of services and other health and social care quality. to the CCG’s population. It delivers partners to support and inform emergency and planned specialist the wider commissioning plans. The service is engaged in proposed health care from its hospital Community services play an system wide reforms of urgent site, which is set in a 19 hectare integral role in supporting the care. parkland site on the edge of Bury CCG’s plans, caring for adults and St Edmunds. It has around 430 children in the community. Suffolk County Council beds open at any one time. The CCG closely monitors the The CCG works with other The hospital is responsible for contract and has worked over commissioners such as delivering many of the CCG’s the last year to improve access to neighbouring CCGs and Suffolk performance objectives and community equipment which had County Council to secure joined up is actively involved in service been problematic. services for patients. With Suffolk redesign. County Council the CCG jointly Care UK commissions a range of children’s Norfolk and Suffolk NHS services, mental health services Foundation Trust Care UK provides out of hours and services to ensure safe and GP and 111 services to the effective discharge from hospital. Norfolk and Suffolk NHS CCG’s population. Out of hours Foundation Trust delivers mental GP services are performing well Other providers health and learning disabilities and meet most of their key services for the populations of performance indicators. 111 The CCG also commissions Suffolk and Norfolk. The Trust services will play a key role in services from Cambridge University has worked closely with the CCG the CCG’s urgent care plans in Hospitals NHS Foundation Trust in 2014/15 to embed the new 2015/16 and Care UK is actively (Addenbrookes) and Ipswich models of care described in the engaged in the System Resilience Hospital NHS Trust, the community Trust’s Service Strategy. The CCG is Group. and voluntary sector, General working with Norfolk and Suffolk Practice, community providers, NHS Foundation Trust to address other acute providers and the the deficiencies highlighted in the independent sector. West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 9

STRATEGIES has influenced our strategic and These themes have been operational planning. incorporated into the system The Suffolk Health and Wellbeing design, and include the following Board’s vision is that people in Since November 2013, the CCG features: Suffolk live healthier, happier lives and NHS Ipswich and East Suffolk with a narrowing difference in life CCG have worked closely with • The major building blocks of the expectancy between those living partners, in particular Suffolk new system will be Integrated in our most deprived communities County Council (SCC) and Neighbourhood Teams. Social and those who are more affluent. Healthwatch Suffolk, to engage care, community health services the wider Suffolk community on and some aspects of mental Care of the elderly is a key feature the future of health and social care health services will be organised of the vision, given the rising age services in Suffolk. and delivered at neighbourhood of the local population, as well as level, serving the population improving people’s mental health A review of the feedback, local of an average of four general and wellbeing, giving children experience, national policy and practices and mindful of natural the best start in life, and ensuring evidence has identified a number geographic factors. In particular, Suffolk residents have access to of key themes which have been there will an increased emphasis a healthy environment and take progressed in the service redesign: on the teams managing their responsibility for their own health populations in a systematic and wellbeing. The strategy for • The health and care system way, using risk stratification delivering this vision is integrated should empower individuals to tools to identify individuals at care. take a more proactive role in higher risk, and placing care managing their care, including plans which are joint between The CCG is working with NHS the prevention of ill-health. all relevant agencies. Some Ipswich & East Suffolk CCG to individuals will be sufficiently develop a joint health and care • From the individual’s perspective, complex to require a case co- model that will deliver the Health the system’s response must be ordinator; the most appropriate and Wellbeing Board vision and more integrated. Many patients person for this role will depend create a health and care system have complex needs which on the team’s view on which that delivers excellent services for require close operational co- professional is most appropriate people in Suffolk which is effective operation between professionals to that individual’s needs. and sustainable. from different backgrounds, organisations and the wider • Communication between Through its six clinical priorities, community. healthcare professionals will the CCG is already committed be improved. One component to creating and delivering an This includes improving the access of this is commissioning an integrated health and care system routes into the system. Professionals NHS 111 service that goes that supports our population to in first contact with patients should beyond the national minimum remain living independently with a have the necessary knowledge of requirements. In particular, good quality of life for as long as both the individual’s history and there will be a dedicated line possible. how to work closely with other for professionals to access professionals and organisations to a strengthened Directory of Working as part of the Suffolk provide the most integrated and Services (DoS) that will allow ‘system’, including all our local efficient response leading to best them to link to partners; health services, care services, outcomes. for example, a paramedic district and borough councils, attending a patient who needs Suffolk County Council (SCC), our • The emergency departments care will be able to access local GPs and our voluntary sector of both hospitals are under community alternatives to and communities, the CCG will severe pressure, and the system hospital treatment. For patients provide determined leadership to needs to ensure that their calling NHS 111, their service create a different system - one expertise is focused on genuine experience will be improved by that works for our customers and emergencies. This is especially stronger clinical support. patients, and that is financially important given the national sustainable. shortage of emergency medicine consultants acknowledged by The CCG has worked hard to Health Education England in engage with our local patients and their December 2013 report. stakeholders and their feedback Page 10 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

• Services at West Suffolk NHS Linkage between Health and Foundation Trust will be Wellbeing Strategy and CCG Clinical Priorities supported by primary care. The Primary Care Foundation, College of Emergency Medicine Health and Wellbeing West Suffolk Clinical and Royal College of General Strategy Commissioning Group Practitioners all agree that a significant proportion of Vision: Vision: patients present to accident and emergency with a primary People in Suffolk live healthier, The CCG, with strong clinical care problem, in good faith that happier lives. We also want to leadership, will continue to they consider themselves to narrow the differences in healthy work closely in partnership with have an urgent or emergency life expectancy between those other stakeholders, to ensure that problem. The national term living in our most deprived the significant changes to the way for this element is an Urgent communities and those who that services are delivered continue Care Centre, and it will help to are more affluent through to provide value for money and protect scarce emergency centre greater improvements in more meet the needs of the local expertise and there will be an disadvantaged communities. population. increased emphasis on moving patients into the community Priorities: Priorities: rather than hospital beds. • Every child in Suffolk has the • To develop clinical leadership. During 2014/15, significant best start in life. • To demonstrate excellence in progress has been made in working • Suffolk residents have access patient experience and towards this system reform and to a health environment and patient engagement. redesigning the way health and take responsibility for their • To improve the health and care social care systems work. This work own health and wellbeing. of older people. will continue into 2015/16 and • Older people in Suffolk have • To improve access to mental beyond. a good quality of life. health services. • People in Suffolk have • To improve health and opportunities to improve their wellbeing through partnership mental health and wellbeing. working. • To deliver financial sustainability through quality improvement.

Suffolk Health and Wellbeing Strategy is available here: http://www.suffolk.gov.uk/your-council/decision-making/committees/suffolk- health-and-wellbeing-board West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 11

• Double the capacity of smoking Reducing Health Inequalities cessation services: - Reduce health inequalities through working with NHS England and Suffolk County Council to address the major The wider The health factors contributing to The lives determinants services increased risk of vascular people lead of health people use disease by encouraging practices with low levels of level 2 smoking services to increase their activity. However it is recognised Major wider Leading risk Accessibility and that the historical model of determinants factors responsiveness delivering stop smoking service and “quit Financial status Tobacco Primary care measurement” has become (e.g. GP practices) Employment and High blood less effective as the smoking work environment pressure Secondary care population and environment (e.g. hospital) have changed. Education Alcohol

Preventative care Housing Cholesterol The numbers successfully quitting (measures taken to by using NHS services has decreased Being overweight prevent diseases) nationally. Many current smokers have Community tried and failed to quit through current Source: National Audit Office literature review services services on more than one occasion and the availability of e-cigarettes has influenced smoking behaviour in some Health inequality can be defined as With our partners, the CCG is people. The CCG will support the new differences in health status or in the working on the implementation of approach to smoking agreed by the distribution of health determinants the three most cost effective high Health and Wellbeing Board (HWB) between different population impact interventions recommended focusing on prevention, protection and groups. For example, differences by the National Audit Office report cessation. in mortality rates between people on health inequalities: from different socioeconomic The CCG is also committed to groups. Some health inequalities • Increase the prescribing of drugs improving its approach to equality and are attributable to biological to control blood pressure by 40 diversity linked to health inequalities, variations or free choice and others per cent. and has set out four equality objectives: are attributable to the external • Increase the prescribing of drugs environment and conditions to reduce cholesterol by 40 per • Patients and carers experience mainly outside the control of the cent: joined-up healthcare, ensuring access individuals concerned. - Medicines management is to the right services at the right time. promoting NICE guidance • The CCG will improve use of equality The independent Acheson inquiry on the treatment of high data and information about west (1999) into inequalities in health blood pressure and cholesterol. Suffolk’s diverse population and highlighted the main determinants - The control of blood pressure communities to inform its work. and how to address them. The and cholesterol levels are • The CCG will improve the way CCG, working closely with health included in QOF. that the Governing Body and and wellbeing partners, including - Complex medication reviews Executive can learn from healthcare Public Health, have built on these identify patients who are experiences of diverse and findings to support the groups of not treated optimally in their marginalised individuals, groups and people in west Suffolk that have treatment of blood pressure carers. worse outcomes and experience and cholesterol. • Senior leaders and other managers of care. This focused piece of - Anomalies in the treatment provide leadership, support and work is aimed at closing the of blood pressure and motivation for their staff to uphold gap in inequalities by targeting raised cholesterol are flagged the CCG’s value of equality of initiatives to groups with lower life by medicines management opportunity to improve the health of expectancies. technicians to GPs. those most in need. Page 12 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

QUALITY OF SERVICES to ensure that not only do they Patient Safety has also been deliver the essential standards highlighted as of primary In its report ‘Quality in the new of quality and safety regulated importance by Professor Don health system - maintaining and by the CQC, but they also strive Berwick in his report ‘Improving improving quality from April 2013’ for excellence and innovation in the safety of patients in England’ the National Quality Board set out practice to drive up those standards stating the NHS should “Place the its expectation that quality is the for patients and their families. quality of patient care, especially ‘organising principle of the NHS’ patient safety, above all other and that a ‘relentless focus on It is imperative that the CCG aims”. The CCG has engaged with quality means a relentless focus on ensures that early warning systems the new patient safety collaborative how we can positively transform both locally and in conjunction being set up by NHS England and the lives of the people who use with NHS England’s Quality with the new systems for reporting and rely on our services’. Surveillance Group are utilised and learning from patient safety to detect the signs of a failing incidents to prevent reoccurrence The CCG is responsible for meeting service or provider organisation and to drive improvements in the needs of its population through or where patient safety is being practice and service delivery. In the commissioning of high quality compromised. Early intervention particular the culture of reporting services and ensuring patient with stakeholders and partners and learning is key to this, and the safety. As part of the whole health to prevent the major failings CCG will continue to engage with and social care system the CCG highlighted by the Francis report its providers to achieve this. works to deliver these services. has been a priority for the CCG and its systems, processes and We put patients and the public The Health and Social Care Act governance. The Government at the heart of our strategy and 2012 requires that CCGs have a response to the Francis report decision making. duty to ‘exercise their functions ‘Hard Truths: essential actions’ with a view to securing continuous outlines its commitment to a duty quality improvement in the quality of candour to patients and families of services and the outcomes that where care failings occur and the are achieved from this provision’. In CCG promotes and monitors this setting the bar high for quality the approach in its commissioned CCG has worked with its providers services.

West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 13

HOW PATIENTS AND THE PUBLIC SHAPE OUR HEALTH SERVICES

It is vital that we hear from the people for whom we manage services. Over three years we have tried and tested methods to get this feedback including:

• Our Community Engagement Group - is a panel of people who meet every two months in towns around the area. On the panel are representatives from Healthwatch Suffolk and Suffolk Congress Community Action Suffolk. This group of volunteers oversees the delivery of the CCG’s community engagement and our work to meet our duties under the Equality Act 2010. This group is a sub-committee of the CCG’s Governing Body and also links with partner organisation engagement groups. It communicates updates to our Health Forum.

• Our Health Forum - is an online forum that anyone can sign up to, and gives regular updates and asks for views on our projects and those of our partners. We currently have over 500 members.

• Our three CCG locality Live Well Suffolk, Norfolk and been using more frequently to groups - are the local focus for Suffolk NHS Foundation Trust publish our work. We also have CCG services. With local patient and Healthwatch Suffolk to a #SuffolkNHS stream which participation groups, district maximise opportunities to share we share with our partner and town councils and parish information with the public. organisations on NHS matters. councils and other local bodies, they work with us to develop Continuing the work started • Our GP Practice visits - we our plans. in 2013/14, the CCG visited visit each practice on a monthly summer events to ask for views basis to keep in touch with local • Our Patient Revolution on the Health and Care Review. issues and provide channels events - are annual events, of communication between which have seen up to 200 • Our new website - is patients, GPs and the Governing people draw up an agenda to continually updated and Body. talk about issues which matter refreshed to keep it up-to-date. to them. In 2014 the rich and www.westsuffolkccg.nhs.uk/ varied feedback we received helped us prioritise our work. • Social media - our number of Twitter (@nhswsccg) followers • Our market stalls - the CCG grew to 1,360 from 700 visits market towns to speak to last year. We use it to raise people directly. The CCG works awareness and share news. We with other partners such as launched a Facebook page in Suffolk Community Healthcare, January 2014, which we have Page 14 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

‘YOU SAID, WE DID’

People told us in 2014/15 that This year we held specific events Our seasonal communications they wanted to see NHS partners to get views from mental health campaign showed the strength better able to share information service users to help develop a new in working together. We saw an between each other, easier access strategy for 2015 and beyond. increase in use of the NHS 111 to services, improved care in the We also held events, together service and greater numbers of community and better ways of with NHS Ipswich and East Suffolk people were seen in the right place involving the voluntary, charitable CCG, to discuss improvements to at the right time. This campaign and community sector. dementia services. won an award from the Health Business Magazine. We also We have also built on people’s Our Redesign team, working translated materials to share with previous comments to invest more with service users, has shaped migrant populations how to best in mental health and children new services for those with make use of the NHS, and included and young people’s services in chronic pain, heart conditions and mental health in our messages. 2014/15. diabetes.

ACTIONS We have provided drop-in events for children and young people to By the end of 2014/15, we made discuss matters they told us they sure that all practices had been wanted to know more about, such given the correct technology and as mental health and eating more support to help them upload a healthily. Summary Care Record of every patient who had chosen to be In December 2014, over 600 part of the scheme. These records people came to look around the contain life-saving information new Sudbury Community Health At Christmas 2014, Local GP and on such things as allergies Centre. We co-produced this event former Governing Body member, that can be accessed between with Sudbury Working and Acting Dr Jon Ferdinand, re-wrote the NHS organisations, and is data Together for Community Health lyrics of Good King Wenceslas protected. (WATCH) and volunteers from with a health care focus, with the the town and Babergh District help of a Bury St Edmunds choir, During the summer, we visited councils. the Aquarius Singers. The song is a variety of shows and events to available on YouTube. share a vision of how health and social care could join-up services https://www.youtube.com/watch better. Working with NHS Ipswich ?v=ebLna30QmH8&feature=you and East Suffolk CCG and the tu.be county council, we spoke to over 5,000 people. This feedback was summarised in an independent report by Healthwatch Suffolk (available online at www. healthwatchsuffolk.co.uk). It has been used to start to develop a In partnership with local councils, project called ‘Connect Sudbury’, we have produced health guides where we are testing how police, for Brandon, Mildenhall and health and social care and other Newmarket in 2014/15, and we partners can better work together. have refreshed the Haverhill health Eventually we aim to ensure guide. One for Sudbury has been voluntary and charitable groups drafted ready for printing early in can gain better links with the 2015/16. statutory sector bodies. Once thoroughly tested, the model will be rolled out across other towns and villages. West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 15

OBJECTIVES 1. Patient safety and quality inequalities by decreasing the gap in life expectancy and adding life In partnership with our member Patient Safety to years. It will: practices, stakeholders and the public, we set a series of objectives The CCG is committed to working • Ensure that the alcohol which aim to improve the quality as part of the local Patient Safety services commissioned by the of care that our patients received Collaborative which is being CCG work seamlessly with whilst, at the same time, provide established as a further response the new integrated services value for money. These objectives to the report, ‘A Promise to Learn commissioned by Public Health, are explained in more detail over - a Commitment to Act’, which which are expected to start in the coming pages. made a series of recommendations April 2015. to improve patient safety and • Review the obesity pathway They are: called for the NHS ‘’to become, and weight management more than ever before, a system treatment services ensuring all devoted to continual learning and patients flow through a tiered 1. Patient safety and quality improvement of patient care, top programme of care to improve 2. Promoting healthy outcomes to bottom and end to end.’’ the quality of interventions for those requiring bariatric care. 3. Integrated care The CCG further endorses the • Work with Public Health and 4. End of life (EoL) aim of the ‘Sign up to Safety’ others in Suffolk County Council campaign to make the NHS to ensure that prevention is 5. Planned care the safest healthcare system in embedded into our integrated 6. Medicines management the world by creating a system care approach. We will look at devoted to continuous learning co-commissioning opportunities 7. Mental health and improvement. as Public Health re-procures the 8. Children, young people current lifestyle service. and maternity • Ensure that maternity services increase the number of 9. Cancer mothers and babies benefitting from breast feeding and also supporting mothers to start.

3. Integrated care

The case for change in our health and care system is strong. In west Suffolk we are taking action to meet this challenge for change, and further developing a health and care system that works well for people. A system that:

• Supports people to lead 2. Promoting healthy outcomes healthy and independent lives, but when they do need In partnership with Public Health help, it provides this swiftly and Suffolk County Council, the and effectively, with a view programme aims to improve to getting them back to their population health by focusing own lives, in their own homes, on prevention to limit the with access to the people and onset, or reduce complications activities that they enjoy. of conditions such as diabetes, • Seeks to prevent health and cardiovascular disease, other long care needs, not simply to treat term conditions and some cancers them when they arise. which are associated with lifestyle. • Puts people in charge of their It aims to provide an evidence own health and care plans, and based approach to deliver health takes account of what matters improvement and reduce health to people. Page 16 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

Specifically we have worked with care services keeping people well sessional pharmacists to provide Suffolk County Council and other in their own homes. a joined up holistic service to partners to: care homes. 3. Create a system that is 1. Help people to be more rewarding to work in. Health 4. End of Life (EoL) independent for longer, and care organisations are whenever possible. People increasingly struggling to recruit We are committed to providing the are living longer, often with staff. Integrating care will best possible services for palliative multiple long term conditions require professionals to work care and end of life patients, and increasingly complex in a new model of health and allowing them to be cared for in needs. Their needs do not fit care and will make the sector the place of their choice. To do neatly into “social care” or more attractive and rewarding this, we have started to: “health”, and cannot be met to work in. This will contribute by addressing these in isolation. towards more motivated, • Support more people to spend People want information, advice productive staff that are better their last days in their preferred and support to help them to able to deliver improved place/usual place of residence. live independently for as long outcomes for people. • Make sure end of life care is as possible regardless of their open, accessible and equitable health diagnosis. By delivering This change will take time, but to everyone. integrated care in Suffolk people work is already well underway. • Developed and educated our will be able to get help earlier Using the strengths of working workforce using agreed training and access a wider range of together, we have already: programmes. options, including self-help, • Through education and training, which reduce the need for • Launched the new system promoted the Advance Care intensive and longer term model of care in Sudbury co- Planning (ACP) process and support. Services will be tailored designing with local providers individuals understanding of to the distinct urban and rural and the voluntary sector the Yellow Folders. communities that characterise provision of local services to • Ensured an integrated crisis Suffolk. improve the support and care to response service is available local people. 24/7 by way of a collaborative 2. Reduce costs of health and social • Introduced comprehensive approach by all providers of EoL care. Both local government geriatric assessment and care, e.g. Community Services, and the NHS are managing net interface geriatrics to support West Suffolk NHS Foundation reductions in budgets, despite people with complex care Trust and St Nicholas Hospice the increasing demand and cost needs. Care. of services. A drive to seven day • Implemented an integrated • Made links with dementia care working and increasing patient early intervention service in and EoL care in order to address and customer choice are further West Suffolk NHS Foundation patient choice around the contributing to pressures. The Trust with a range of local advance care planning process current fragmented system services working together across earlier in the patient pathway. leads to duplication, multiple the acute and community assessments and professional providers under a single We will further develop work contacts, and sometimes management approach. We programmes during 2015/16 so conflicting plans and advice. aim to build on the success of they can be fully embedded into Integrating care in Suffolk this Enhanced Early Intervention everyday clinical practice. will mean we configure our Service by extending the model systems so that people receive of delivery into the community seamless, coordinated care and during spring 2015. integrated services, which are • Implemented an integrated not duplicated and do not leave care home model that aims gaps. This will mean we use to improve the coordination resources more effectively and and management of residents take early action which prevents with complex frail care needs. long term costs in the future. The model is coordinated by For example, a reduction in a senior clinician who works the demand for hospital based alongside care home staff, emergency services through primary and acute care and community based health and West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 17

recommendations across The CCG’s approach to embedding primary and secondary care. ‘parity of esteem’ incorporates the • Promoting the traffic light following: system, which has been developed by the Suffolk • Understanding the needs and CCG’s Drug and Therapeutics barriers people with mental Committee and Clinical health issues have in accessing Priorities Group to manage the health care and developing our introduction of new drugs or plans accordingly. new licensed indications into practice. These include: • Ensuring that there is a strong focus on the alignment of • Learning from the Suffolk prescribing spends with Mental Health Joint Strategic practice prescribing budgets Needs Assessment. by promoting a range of • Development of our Mental metrics and guidelines and also Health Strategy. This will be 5. Planned Care providing hands-on prescribing taken to the Suffolk Health and support to aid implementation Wellbeing Board in May 2015. The CCG has continued to provide of these. • Co-production with Service local integrated services through Users: shared decision making, support 7. Mental Health and access to patient-centred and The Mental Health Strategy has holistic services. This will be taken The CCG is fully committed been co-produced through a series forwards under three strands of to ensuring an equal focus on of eight service user led workshops work: improving mental health as which have developed the key physical health and that patients themes of: • Strand one: GP Practice support with mental health problems do and referral refinement - not suffer inequalities as a result. a. Prevention and living well focusing on education and b. Crisis. guidance across the health The CCG has worked to ensure c. Recovery. system and in a multi-faceted that: approach that recognises clinical The CCG has also worked with and patient choice. • Mental health provision is open the Suffolk Youth Ambassador, • Strand two: Optimisation of and accessible to all people who commissioned by Health and Social current services - ensuring that need it regardless of their age Care, to actively seek the views current services are achieving and the diagnosis and severity of of children and young people, maximum outcomes and seek their mental health condition. particularly about stress experienced further opportunities. • No mental health service user by young people. • Strand three: Transformation of should need to be returned to services into the community - their GP for onward referral to We are embarking on a series continued roll out of community another mental health service. of targeted consultations with services and exploration of • It commissions mental health and children and young people in further opportunities. learning disability services which schools and local colleges about are integrated with the wider their health needs and concerns 6. Medicines Management health and social system and and this will include specific which support the recognition sessions on mental health. This Through this programme, we have that people’s mental health work is part of our ambition to made safe changes in prescribing should be seen as part of their keep service user involvement in which are appropriate and offer overall physical and mental the centre of our future planning value for money. wellbeing. This will apply to all and help to reduce the stigma people regardless of their age surrounding mental health. This has included: including those marginalised from society. • Encouraging safe, appropriate, evidence-based and cost effective prescribing. • Promoting the same prescribing Page 18 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

8. Children and Young People and Maternity

The CCG has continued to work closely with our partners, in particular with Suffolk County Council, Norfolk and Suffolk Foundation Trust (NSFT) and the members of the West Suffolk CCG Paediatric Strategy Group and Regional Children, the Young People and Maternity Clinical Network and the voluntary sector. The priority areas for attention include:

• Promoting early intervention and prevention approaches. 9. Cancer Network initiative - Transforming • Improving multi-agency/ Community Cancer Care professional working based Cancer is an illness which affects programme (TCCC). around the child and family. thousands of people every year. • Introduce a new operational • Re-commissioning of specialist There are approximately 1400 new framework to reduce emergency community paediatric medical, cancer diagnoses per year within cancer admissions by 10%. nursing and therapy services the west Suffolk CCG locality. • Extend access to endoscopy to and improved integration of We want to continue to improve support the national screening those with the wider health, outcomes by making sure cancers programme. social care and education are diagnosed early, services • Offer 95% of patients at the system. are compliant with national end of their treatment a place • Improved outcomes for best practice as outlined in the on a free wellbeing programme, vulnerable groups such as ‘Improving Outcomes Guidance: e.g. The HOPE Programme. Looked After Children (LAC). A Strategy for Cancer’, and that • Reviewing emotional health and care is equitable and accessible to There will be a continued focus on wellbeing services including the everyone and delivered in the most supporting cancer survivors and newly commissioned primary appropriate setting. improving cancer survivorship, mental health workers and providing care closer to home and autism services. More specifically, we have worked providing up to-date, quality and • Exploring opportunities for to: personalised cancer information - better integration of tier 3 and 4 linking with the Shared Decision Children and Adolescent Mental • Support cancer survivors Making process (SDM). Health Services (CAMHS). and improve survival rates • Development of personal health through access to the National High Cost Drugs and Devices budgets in accordance with Cancer Survivorship Recovery national guidelines. Programme. The CCG has ensured • Work with the commissioned • In line with the above encourage that there is a consistent, Young Persons Ambassador and supported self-management evidenced-based, cost-effective CCG Community Engagement through end of treatment commissioning programme for Group (CEG) to identify and summaries and individualised the implementation of all tariff respond to issues arising care plans being shared with excluded high cost drugs and and ensure principles of user both the GP and patient devices. This means that only co-production are followed themselves. the excluded drugs and devices in service development and • Improve early diagnosis. commissioned are those where a redesign. • Provide up-to-date, high consistent body of evidence exists • Continued management of quality and personalised cancer for a specific indication and will paediatric asthma, epilepsy and information which links with require collaboratively working diabetes, specifically community the shared decision making with Providers to identify and pathways and non-elective process; provide cancer care implement changes which provide activity. closer to home through a more cost effective pathways for regional Strategic Clinical the local health economy. West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 19

CASE STUDIES - OUR CLINICAL PRIORITIES

PLANNED CARE: INTEGRATED CARE:

West Suffolk Community Enhanced Early Intervention Team (EEIT) Diabetes Service

Since April 2014 over 1,000 • Physiotherapists. Diabetes is one of the patients have had support • Occupational therapists. major challenges facing from the new Enhanced Early • Social workers. the NHS, being the long Intervention Team (EEIT). This • Rehabilitation assistant term condition with the team integrates key services to practitioners. fastest rising prevalence. In manage admission avoidance • Age UK Suffolk support 2012/13 there were 11,139 pathways from the emergency workers. adults diagnosed in West department (ED) and the short • Dementia Intensive Support Suffolk and it is estimated stay acute medical unit at West Team liaison nurse. that a further 2,510 are Suffolk NHS Foundation Trust. • Crossroads Carers undiagnosed. This means these patients have East Anglia. either not had to be admitted to In 2013, a pilot project ran hospital or have not had to stay EEIT staff work with community with four surgeries in Forest in hospital as long, reducing colleagues to support patients Heath. Diabetic nurses from upheaval and stress for them in their own home. The nature West Suffolk NHS Foundation and their family. of this support varies depending Trust ran joint clinics with on the needs of the patient. The practice nurses on a weekly EEIT intervention sees, on team shares an office to ensure basis to engage with patients average, 35 patient discharges an integrated approach to and improve their ability to each week - and has been admission avoidance. The team manage their diabetes. The as high as 54 - from the also has access to a vehicle project team were delighted emergency department, at evenings and weekends to when they were shortlisted clinical decision unit and short enable patients who require as finalists at this year’s stay unit. Patients see the stretcher transport to be General Practice Awards. appropriate professionals who discharged out of traditional provide treatment, advice and working hours. Age UK Suffolk Inspired by the success of support enabling them to return escort those patients who can the pilot project, the CCG is home to manage their own get in a car, settling them back responding to the findings of condition rather than remain in in to their home environment, the National Diabetes Audit, hospital. which could include helping building on this successful with a meal or getting some partnership project, and The Enhanced Early Intervention shopping. working with all GP practices Team consists of a range of in West Suffolk to launch organisations: The seven day fully integrated an improved community EEIT service meets the needs diabetes service which will of a growing older population begin in April 2015. and those living with chronic conditions. Services work together to ensure patients have an individualised care plan that supports their identified needs. This ensures they feel sufficiently confident and informed to return home, with the appropriate support to manage their needs. Page 20 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

END OF LIFE: CANCER:

‘Identification of a Deteriorating Resident Cancer diagnosis rates Tool’ for use in Care Homes

Figures published by the Health and Social Care Information Centre (HSCI) show that 59% of cancers in the NHS West Suffolk CCG area are diagnosed at stage one or two, higher than anywhere else in the country and significantly above the national average of 41%.

There are four stages which determine the extent to which cancer has spread, with stage one being the earliest. By getting diagnosed at an early stage of a cancer’s development patients have a much better chance of survival and recovery.

Acute oncology services (AOS) play a critical role in managing urgent care when a cancer patient needs it. The AOS was first established at the Two nurses in the West Suffolk region have been West Suffolk NHS Foundation Trust in April 2011 working jointly with care home staff to help on the back of National Guidance. The post was them to recognise the signs of deterioration in initially supported by the Anglia Cancer Network a care home resident. They have devised a tool, (now Strategic Clinical Network) with an Acute “Identification of a Deteriorating Resident”, Oncology Nurse being recruited for a two year which uses a series of prompts to chart the subtle fixed term period. A substantive clinical nurse changes in health status of a care home resident specialist now supports the service 4 days a week. that often precedes a more serious deterioration. In addition the Trust is also benefiting from having a Consultant Clinical Oncologist as part of the Based on the Gold Standard Framework principles team supporting the AOS alongside the nurse. (2011) and the Australian Karnofsky Performance Status (2005), the tool is designed to assess Locally, the service supports the management residents on a monthly basis, and score their of patients who develop severe complications health status according to standardised criteria. following chemotherapy, patients who develop This criteria includes issues such as record of complications as a consequence of their previously hospital admissions, co-morbidity, functional diagnosed cancer, and patients who present as assessment, treatment with antibiotics, onset emergencies with previously undiagnosed cancer. of confusion and any other significant incident The following services are available to support such as a fall or bereavement. The resulting patients: score signposts the care staff to trigger a range of actions, from beginning discussions on • A dedicated telephone support/advice line deteriorating health with residents and families, available 24/7. to liaising with the resident’s GP to initiate end • An AOS that’s available to see patients of life care discussions (yellow folder), create Monday to Friday, 9am-5pm. a shared care plan and put on out-of-hours • Out of hours: advice from Addenbrookes palliative care register (111). Oncology SpR/Consultant on call. • Daily cancer patient email alerts. The tool is currently being piloted in care homes • Assessment beds on Macmillan Day Unit. and with hospice patients. Early indications are that it is proving to be very helpful for care staff In early 2015, two additional members of nursing to support conversations with GPs and to know staff, funded by Macmillan Cancer Support have when to establish residents’ wishes and make joined the team in order to extend the current plans for their future care. service provision across the working week. West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 21

MEDICINES MANAGEMENT: MENTAL HEALTH:

The Pain Ladder Perinatal Mental Health

GPs in West Suffolk currently gastrointestinal adverse effects Perinatal (or maternal) write prescriptions for over with a Non-Steroidal Anti- mental health encompasses a 300,000 analgesic drug items inflammatory Drug (NSAID). range of mental health issues per annum, costing almost £3m experienced by pregnant (based on recent prescribing A particular issue with codeine women and new mothers. data, April 2014 - January is highlighted, regarding the They are surprisingly 2015). In order to promote metabolism of codeine to common, affecting up evidence-based prescribing of morphine. There is a risk that to 20% of women at analgesics and to contain costs, this metabolism is variable and some point, and include the Medicines Management unpredictable and therefore depression, anxiety, psychosis Team at West Suffolk CCG has morphine itself is the preferred and post-traumatic stress been working in partnership opioid in the management of disorder. Many women feel with specialists from the West moderate and severe pain. reluctant to admit they are Suffolk NHS Foundation Trust to experiencing these problems produce a document known as Adjuvant therapies are promoted and will often suffer in the Pain Ladder. as useful for consideration silence for fear of being seen at any stage of treatment. as a ’bad’ mother. This is a tool that gives guidance These include gentle exercise on analgesic choice for adults programmes, transcutaneous In a recent report, it is in primary care, focussing on electrical nerve stimulation estimated that perinatal acute pain, chronic pain and (TENS) and medicines such as mental health problems neuropathic pain. It recommends anticholinergics, muscle relaxants cost the NHS £1.2 billion a step-wise approach to the and corticosteroids. per year in the UK. Over the management of pain, giving last year, organisations in details of medication doses The Pain Ladder has been Suffolk have been looking and special precautions, e.g. to circulated to all GP practices in at how to improve support consider a proton pump inhibitor West Suffolk and is available on for these women and have in patients at increased risk of the WSCCG website. been working to improve communication between health care professionals.

West Suffolk’s psychiatric liaison service has started holding joint clinics with midwives as a 6 month pilot for pregnant women. The aim is that women should find it easier to discuss their concerns and to get adequate support at a time that is right for them. Monthly mandatory training and supervision, when required, is also offered to the midwives. Page 22 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

ACHIEVEMENTS

This is a summary of our best achievements, which have improved health services for the people of west Suffolk.

A new eating disorder service Working with Forest Heath delivers mental and physical and Mid Suffolk councils support to children and young we have produced health people who are living with guides for Haverhill, Brandon, anorexia nervosa and bulimia Mildenhall and Newmarket. nervosa. The service provides Another one for Sudbury will access to health professionals be published in April 2015. and Family Therapy support. You can view all of the NHS booklets currently available In partnership with IESCCG, the Read more in our here: CCGs were awarded NHS Publicity newsletter here: The Alternative To Admission Project http://www. Campaign 2013/14 for the winter http://www. was developed to offer people in westsuffolkccg. campaign. It was praised for westsuffolkccg.nhs. a mental health crisis a place in nhs.uk/your-health/ being innovative and far-reaching. uk/news/wsccg- supported accommodation rather leaflets-and- CCG It included a hard-hitting cinema newsletter/ than admission to hospital. publications/ advert as well as posters, leaflets Achievements and social media.

In partnership with IESCCG, the CCGs have been accredited an Investors in People for Health and West Suffolk NHS Foundation Wellbeing Good Practice award. Trust is the best performing of This recognises the broad approach all 16 hospitals in the East for Sudbury Community to health & wellbeing including stroke care. Health Centre opened in fruit of the month, community January. All the services engagement activities provided in Walnuttree and lunch and learn. Hospital, St Leonard’s Hospital, Acton Lane Clinic and Siam GP surgery were moved into the purpose-built facility. West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 23

PERFORMANCE

Our performance against the key NHS Outcomes Framework measures and the NHS Constitution measures is set out as follows.

NHS Outcomes Framework

Our latest performance against the key indicators of the NHS Outcomes Framework is summarised (below). This is based on national data collections.

West Suffolk CCG is shown as a blue circle. The yellow box shows the interquartile range and the black dotted line is the England median. We performed better than the national average in all but four of the measures of the Outcomes Framework. We continue to work with Public Health and providers to understand those areas where the CCG is below the national average, and to identify opportunities for performance involvement, using local data where available.

Indicator Spine Chart CCG Outcomes Indicator Set - domain 1 1.1 Potential Years of Life Lost amenable to healthcare - female 1.1 Potential Years of Life Lost amenable to healthcare - male 1.2 Under 75 Mortality from CVD 1.4 Myocardial infarction, stroke and stage 5 kidney disease in people with diabetes 1.6 Under 75 Mortality from respiratory disease 1.7 Under 75 Mortality from liver disease 1.8 Emergency admissions for alcohol released liver disease 1.9 Under 75 Mortality from cancer 1.10 One year survival from all cancers combined 1.11 One year survival from breast, lung and colorectal cancers 1.17 Record of stage of cancer at diagnosis CCG Outcomes Indicator Set - domain 2 2.1 Health related quality of life for people with long term conditions 2.2 % of patients with long term conditions who feel supported to manage their condition 2.6 Unplanned admissions chronic ACS conditions 2.7 Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s 2.15 Health-related quality of life for carers CCG Outcomes Indicator Set - domain 3 3.1 Emergency admissions for acute conditions that should not usually require hospitalisation 3.2 Emergency readmissions within 30 days of discharge from hospital 3.3 Hip replacement casemix adjusted health gain 3.3 Knee replacement casemix adjusted health gain 3.3 Groin hernia casemix adjusted health gain 3.3 Varicose veins casemix adjusted health gain 3.4 Emergency admissions for children with lower respiratory tract infections CCG Outcomes Indicator Set - domain 4 4.1 Patient experience of GP out-of-hours services 4.2 Patient experience of hospital care 4.5 Responsiveness to inpatients’ personal needs CCG Outcomes Indicator Set - domain 5 5.3 Incidence of healthcare associated infection - MRSA 5.3 Incidence of healthcare associated infection - C.Difficile

NHS West Suffolk CCHG England Median Region Mean Worse outcomes Interquartile range Better outcomes Page 24 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

Securing additional years of National comparison - Potential years of life lost (per 100,000 population) life for people with treatable mental and physical health conditions:

Reducing premature mortality is one of the overarching aims of the NHS. The CCG will have the most significant impact in reducing premature mortality by determining which contributing factors are of greatest impact to the local population. This analysis will continue to be undertaken jointly with Public Health.

The CCG is committed to East Anglia comparison - Potential years of life lost (per 100,000 increasing additional years of population) life for local people. This will be measured through a reduction in potential years of life lost from causes considered amenable to healthcare i.e. those causes from which premature death should not occur in the presence of timely and effective healthcare (generally relating to deaths in those aged under 75). West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 25

Improving health-related quality of life for people with Long Term Conditions, including Mental Health:

Increasing the quality of life for those people with long-term conditions is a priority within the Health and Wellbeing Board strategy, and reflected in the CCG’s clinical priorities. Performance is measured through the national GP Patient Survey, based on the numbers of patients reporting they have a long term condition, National comparison - Average health score (out of 100) for people with together with indicators around long term conditions the quality of life for such patients.

The CCG’s performance (shown in orange) is in fourth quintile nationally (2013/14) and one of the best against CCGs within East Anglia.

As part of the CCG’s strategy to integrate health and social care, there will be a focus on supporting the health and independence of individuals. This will focus on care for frail, elderly, people and those living with chronic long term conditions (including mental East Anglia comparison - Average health score (out of 100) for people health) to ensure care and support with long term conditions is driven towards improving the quality of life for such people. Page 26 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

Reducing the amount of time people spend in hospital National comparison - Avoidable emergency admissions (per 100,000 by enabling access to more population) integrated care in community:

Reducing the amount of time people spend in hospital relies on good management of long-term conditions across the health and care system to support people in managing long term conditions and to promote swift recovery and reablement after acute illness.

The CCG’s performance (shown in orange) for the number of avoidable emergency admissions is around the national average East Anglia comparison - Avoidable emergency admissions (per 100,000 (2013/14), but is higher than many population) other CCGs within East Anglia for emergency admissions that Based on a composite measure of emergency admissions for acute should not usually require hospital conditions that should not usually require hospital admission (adults); admission (adults). unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults); unplanned hospitalisation for asthma, diabetes and epilepsy in children; emergency admissions for children with lower respiratory tract infection. West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 27

Increasing proportion of Do you have confidence in managing your own health? older people living at home independently following CCGs within East Anglia % of Yes definitely discharge from hospital: & Yes to some effect This is measured through the GP Ipswich & East Suffolk CCG 67 Patient Survey (Q32), which was West Suffolk CCG 66 published in January 2015. Data has been collected on two specific Norwich CCG 66 questions. North Norfolk CCG 66 West Norfolk CCG 66 Great Yarmouth and Waveney CCG 65 NHS England average 64 South Norfolk CCG 64 Cambridgeshire and Peterborough CCG 64

In the last 6 months, have you had enough support from local services or organisations to help manage a long-term condition?

CCGs within East Anglia % of Yes very confident & Yes fairly confident Ipswich & East Suffolk CCG 95 West Suffolk CCG 94 Norwich CCG 94 North Norfolk CCG 94 West Norfolk CCG 93 Great Yarmouth and Waveney CCG 93 NHS England average 93 South Norfolk CCG 93 Cambridgeshire and Peterborough CCG 92 Page 28 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

Increasing the number of people with physical and The CCG’s performance for the proportion of patients reporting a mental health conditions who ‘poor’ experience of hospital care is one of the lowest in England have a positive experience (2013). of hospital care and positive experience of care outside of hospital, in General Practice and in the community:

Comparative performance for the proportion of patients reporting a ‘poor’ experience of care in General Practice. West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 29

Making significant progress The comparative reporting rate summary shown below provides an towards eliminating avoidable overview of incidents reported by NHS organisations to the National deaths in our hospitals caused Reporting and Learning System (NRLS) occurring between 1 October 2013 by problems in care: and 31 March 2014. West Suffolk NHS Foundation Trust reported 2,008 incidents (rate of 7.28) during this period. Patient Safety Incidents Figure 1: Comparative reporting rate per 100 admissions for 28 small Research shows that organisations acute organisations which regularly report more Patient Safety Incidents (PSI) usually have a stronger learning culture where patient safety is a high priority. Patient safety incidents are any unintended or unexpected incidents that could have, or did, lead to harm for one or more persons.

West Suffolk NHS Foundation Trust sits in the middle 50% of reporters when compared to similar small acute organisations, with 7.28 incidents reported per 100 admissions, in line with the median rate.

An analysis of the types of incidents reported during the period October 2013 to March 2014 is shown on the graph right.

This shows that West Suffolk NHS Foundation Trust has broadly the same reporting profile of similar small acute organisations. However, reporting of incidents relating to the following areas is above average:

• ‘implementation of care and ongoing monitoring/review; • ‘treatment, procedure’; and • ‘medication’ Page 30 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

The graph right shows the profile of incidents reported and by their degree of harm. At West Suffolk NHS Foundation Trust, 85.8% of incidents resulted in no harm to the patients (against a national average of 69.3%), with less than 1% per cent resulting in severe harm or death.

The CCG routinely scrutinises information and metrics relating to patient safety, including the Safety Thermometer, never event and serious incident data and the other quality metrics. This will aid the identification and consideration of emerging themes and trends in patient safety and harm. The CCG will cooperate with, and participate in, the emerging patient safety collaborative being set up by NHS England whose aim is to provide a network of patient safety learning and improvement to continually improve care at the front line and to reduce the likelihood of harm to patients.

The increase in reporting of harm and in particular the reporting of medicines related incidents will be actively promoted by the CCG through contractual and quality improvement discussions with providers and stakeholders. Monitoring of the levels of reporting through the National Reporting and Learning System (NRLS) and through Serious Incident reporting routes will support the NHS Outcomes framework aim of ‘higher reporting and the emergence of diminishing levels of harm…through the application of best practice and innovative approaches to service delivery. e.g. pressure ulcer prevalence.’

The acute contract with West Suffolk NHS Foundation Trust will place a responsibility on the provider to report all patient safety incidents on a monthly basis. This will be reviewed and monitored at monthly Quality Monitoring meetings, with contractual levers applied where appropriate. West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 31

Medication-related safety incidents

Medication incidents are PSIs which actually caused harm or had the potential to cause harm involving an error in the process of prescribing, dispensing, preparing, administering, monitoring or providing medicines advice.

For the period, October 2010 to March 2013, West Suffolk NHS Number of medication-related errors reported (Oct 12 to Mar 13). Foundation Trust reported 197 medication-related errors, slightly The CCG agreed a 2% increase in reporting of medications across providers above the average for similar small in 2014/15, based on a review of the current National Reporting and acute trusts (194). For the last Learning System (NRLS) data and in discussion with the CCG Medicines reporting period October 2013 Management team. to March 2014 West Suffolk NHS Foundation Trust reported 261 medication related safety incidents compared to the average of its peer group small acute trusts of 213.

National guidance requires commissioners to agree a specified increase in the level of reporting with providers. By improving reporting in the short term, providers and commissioners can build the foundations for driving improvement in the safety of care received by patients.

The contracts with main local providers will set out the requirement for the reporting of every medication error each month via the Clinical Quality Performance Report (CQPR). The CQPR report will include details of the level of harm associated with all incidents of medication errors. Page 32 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

Performance measures 2014/15

Comments Current Current Latest Indicator Quality Reporting Contractual Current VTD / Next Description Framework Period Period Applicable Ref 14/15 Premium Frequency Measure Period Actual Refresh Target Actual Target Date

Referral To Treatment waiting times for non-urgent consultant-led treatment NHS EC Annex 91.1% WS CCG EB1 The percentage of Referral to Treatment (RTT) pathways within 18 weeks for completed admitted pathways B Measure Monthly Y Mar-15 90% 86.1% 90% NHS EC Annex 92.7% 96.8% WS CCG EB2 The percentage of Referral to Treatment (RTT) pathways within 18 weeks for completed non-admitted pathways B Measure Monthly Y Mar-15 95% 95% NHS EC Annex 92.4% 95.6% WS CCG EB3 The percentage of Referral to Treatment (RTT) pathways within 18 weeks for incomplete pathways B Measure Y (redn 25%) Monthly Y Mar-15 92% 92%

Diagnostic test waiting times NHS EC Annex 1.61% WS CCG EB4 Diagnostic test waiting times B Measure Monthly Y Mar-15 1% 5.91% 1%

A&E waits NHS EC Annex 93.5% WSH EB5 A&E waiting time - total time in the A&E department B Measure Y (redn 25%) Monthly Y Mar-15 95% 95.3% 95%

Cancer waits - 2 week wait NHS EC Annex 95.9% 97.7% WS CCG EB6 All Cancer 2 week waits B Measure Y (redn 25%) Monthly Y Mar-15 93% 93% NHS EC Annex 97.6% 97.2% WS CCG EB7 Two week wait for breast symptoms (where cancer was not initially suspected) B Measure Monthly Y Mar-15 93% 93%

Cancer waits - 31 days NHS EC Annex 99.1% 99.0% WS CCG EB8 Percentage of patients receiving first definitive treatment within one month of a cancer diagnosis B Measure Monthly Y Mar-15 96% 96% NHS EC Annex 100.0% 96.7% WS CCG EB9 31-day standard for subsequent cancer treatments-surgery B Measure Monthly Y Mar-15 94% 94% NHS EC Annex 100.0% 100.0% WS CCG EB10 31-day standard for subsequent cancer treatments-anti cancer drug regimens B Measure Monthly Y Mar-15 98% 98% NHS EC Annex WS CCG EB11 31-day standard for subsequent cancer treatments-radiotherapy B Measure Monthly Y Mar-15 94% 97.9% 94% 96.4% Cancer waits - 62 days NHS EC Annex 85.1% 84.9% WS CCG EB12 Percentage of patients receiving first definitive treatment for cancer within two months (62 days) of an urgent GP referral for suspected cancer B Measure Monthly Y Mar-15 85% 85% NHS EC Annex 90.0% 93.3% WS CCG EB13 Percentage of patients receiving first definitive treatment for cancer within 62-days of referral from an NHS Cancer Screening Service B Measure Monthly Y Mar-15 90% 90% NHS EC Annex 100.0% 91.1% WS CCG EB14 Percentage of patients receiving first definitive treatment for cancer within 62-days of a consultant decision to upgrade their priority status B Measure Monthly Y Mar-15 90.4% 89.2%

Category A ambulance calls NHS EC Annex 77.0% 67.9% WS CCG EB15a Ambulance clinical quality - Category A (Red 1) 8 minute response time B Measure Y (redn 25%) Monthly Y Mar-15 75% 75% NHS EC Annex 60.2% 55.7% WS CCG EB15b Ambulance clinical quality - Category A (Red 2) 8 minute response time B Measure Quarterly Y Mar-15 75% 75%

Mixed Sex Accommodation NHS EC Annex 0 2 WSH EBS1 Mixed Sex Accommodation (MSA) Breaches B Measure Monthly Y Mar-15 0 0

Cancelled Operations NHS EC Annex EBS2 Cancelled Operations B Measure Monthly Y Mar-15 0 0 0 0 WSH

Mental Health NHS EC Annex Monthly Y Q1 14/15 95% 95% EBS3 Mental Health Measure - Care Programme Approach (CPA) B Measure 98.6% 98.6% WS CCG West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 33

Performance of the CCG for pressures over winter and ensured Resources, principal risks, the period of review and in the that the health economy met its uncertainties and long-term future nationally mandated access targets. performance

Financial performance In addition, the CCG also invested Resources the funds retained due to marginal The CCG delivered its key statutory rate rule (£4m approximately) The CCG’s Revenue Resource Limit and administrative financial duties and readmissions (£0.9m (RRL) for the year ending 31 March during the financial year ending approximately): 2015 was £280.8m. The value of 31 March 2015 with a year-end the initial RRL was based upon surplus of £2.77m on an overall • On managing the demand for the weighted capitation formula. resource limit (RRL) of £280.8m. admitted emergency care. This formula takes into account Financial performance targets can • To recovery through earlier the population served by the CCG be found in Section 3 Accounts, discharge. amended for factors including age, Note 21. • Enhanced community-based need and market forces. rehabilitation. The CCG successfully implemented • Re-ablement to prevent As a result of the national allocations a number of Quality, Innovation, inappropriate readmissions. review carried out by NHS England, Productivity and Prevention (QIPP) West Suffolk CCG was deemed to initiatives to address growth, These investments were approved be over funded and as a result will improve quality and support by the Urgent Care Network as a receive smaller increases in RRL in delivery of nationally mandated part of the Assurance Framework in future years. performance targets. October 2013 and the Area Team at the start of the year. A number Significant relationships that Growth in activity at West Suffolk of these investments have been may affect the CCG’s long term NHS Foundation Trust continued successful in terms of delivering performance to be a major risk during 2014/15. the KPI’s set for managing hospital The CCG had to absorb significant admissions. West Suffolk CCG has positive and costs relating to an increase in the productive relationships with all of number and complexity of current The CCG is currently reviewing the the key local stakeholders, specifically: continuing healthcare cases and planned investments for 2015/16 an increase in prescribing spend and while detailed business • We are a member of the Suffolk due to price increases on category cases are being developed, we Health and Wellbeing Board, M drugs and increase in volumes will be focusing on improving which brings together key of drugs prescribed within certain quality over a number of areas stakeholders across Suffolk to therapeutic areas. including reduction in emergency oversee the delivery of the county’s admissions. In addition, the CCG health and wellbeing strategy. The CCG delivered the required has also invested in a community surplus through investment pain service and Early Supported • We are a member of the Suffolk phasing, use of contingency Discharge Service for stroke patients System Leadership Partnership, funding and the successful which begins in April 2015. bringing together executive leaders implementation of a number of from health and social care to drive QIPP initiatives. Better Payment Practice Code/ the Suffolk health and care review. Prompt Payments Code Continuing healthcare (CHC) and • We lead the local urgent care prescribing spends are likely to be Note 6.1 in Section 3 Accounts network which oversees urgent on-going financial pressures and measures the CCGs compliance care performance in west Suffolk. a significant amount of work is with the Better Payment Practice being undertaken to minimise the Code. The code requires the CCG • We work with local people future impact. to aim to pay all valid invoices in various ways, including its by the due date or within 30 community engagement group Investment Expenditure days of receipt of a valid invoice, and patient revolution events. whichever is later. During the year the CCG • We are a key member of a number spent £2.2m on non-recurrent The CCG is not a signatory to the of local stakeholder forums in transformation projects and Prompt Payments Code but does west Suffolk, such as the West £2.1m on winter schemes. These adopt the good practice that the Suffolk Partnership and ONE investments focussed on relieving code promotes. Haverhill board. Page 34 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

• We convene regular GP locality Procurement Ventilation meetings for its member Natural ventilation as far as practices. The CCG reviewed and updated practicable throughout. The roof its procurement policy in 2013/14 is pitched in a manner designed • We lead a clinical liaison group with input and advice from a to improve natural ventilation meeting with clinicians from group of local residents. The buoyancy. West Suffolk NHS Foundation revised policy includes additional Trust. emphasis on the Social Value Act, Building Management System promoting tax compliance and A comprehensive BACNet building • We are a part of various NHS patient and public involvement in management system. England forums, such as the procurement processes. Quality Surveillance Group. Insulation and Glazing Facilities Management and Solar performance double glazing. Environmental and Social Energy Consumption Solar Thermal Water Heating Sustainability 20m sq solar thermal collectors West Suffolk House is a purpose which track the sun in order to The CCG is committed to built public sector office building. generate approximately 25% of the promoting environmental The four storey building provides hot water demand. sustainability throughout actions approximately 4,500m2 of flexible as a corporate body as well as a open plan office space, along with Lighting commissioner. conference and meeting rooms, Enhanced efficiency lighting systems public access areas, a flexible above the Building regulations. Sustainable development requires democratic space/council chamber Rooflights installed on the atrium the CCG to be mindful of the and ancillary support areas roof to increase daylight penetration need to safeguard the future including a staff café. West Suffolk in the office, supplemented by in all of its choices, decisions House has recently achieved a daylight dimming control linked and actions. Wherever possible BREEAM ‘Excellent’ rating, as well to artificial perimeter lighting the CCG and individuals should as being in Energy Performance installation. take opportunities to contribute Band A. positively to the local economy Rainwater Harvesting and community, reduce waste The building has been designed Rainwater harvesting to provide and utilities consumption, and to a very high energy efficiency some of the water for toilet flushing. minimise any negative impact on standard to achieve a 47% the environment both now and for Percentage Emissions Reduction Human Resources future generations. Commitment (PERC) benchmarked against conventional modern The CCG has supported remote Transport office buildings. This has been working for all staff who can work achieved through incorporation of this way and worked to align The CCG has not yet quantified the following measures into the peripatetic and outreach staff plans to reduce carbon emissions design and operation: such as medicines management and improve our environmental technicians to GP practices as close sustainability. The biggest direct Structure to home as possible to improve their impact the CCG can make relates Exposed reinforced concrete quality of working life and reduce to travel. The CCG is based at structure to provide high thermal mileage. West Suffolk House, Western mass for night cooling aided Way, Bury St Edmunds, IP33 by automatically controlled Information management 3YU. The CCG is working to ventilation. and technology minimise journeys and encourages sustainable travel by promoting Ground Source Heat Pump The CCG has adopted a ‘don’t and supporting car sharing for staff Open loop borehole type print it’ policy and encouraged use and Governing Body members ground source heat pump linked of non-colour printing whenever through its differential mileage to embedded pipework in a possible. All Governing Body, payment rates, promotional “bubbledeck” concrete floor Clinical Executive members and activities and leadership. The slab, the first of its kind to be senior staff have iPads for all CCG’s location offers benefits for constructed in the UK. This allows corporate meetings. ‘Papers’ are cyclists. The Cycle To Work scheme both heating or cooling of the uploaded to a Workshare facility is promoted. building mass to control room and not printed. The CCG continues temperatures. to invest in technologies in primary West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 35

care to reduce paper and increase To support this commitment, we What we will do the efficiency and effectiveness of have developed the Equality and services to patients. Diversity Plan 2012/15 to outline • Programmes will demonstrate our commitment and approach to as appropriate the use of local Adaptation to Climate Change equality and diversity work. data, national proxys, where this is not available or plans to The CCG has worked to consider Equality objectives collate data to identify needs of climate change in the development protected groups and address of emergency response plans The CCG initially adopted the inequalities. and procedures and raise staff three equality objectives published awareness to ensure that the CCG by NHS Suffolk in April 2012 with • Programmes will demonstrate workforce is prepared to deal with a minor amendment of the third appropriate engagement of adverse incidents connected with human resource objective, as organisations representing climate change. noted below: protected groups.

Social sustainability 1. Changes across services for • Go back to representative individual patients are discussed groups to assess the CCG’s Improving the health of those with them, and transitions are progress in conducting its most in need and promoting self- made smoothly. business so that equality is care are two of the CCG’s clinical advanced and good relations priorities which are clearly linked 2. Patients, carers and communities fostered within the organisation to achieving social sustainability. can readily access services, and and beyond as progressing from To facilitate delivery of these should not be denied access on ‘developing’ to ‘achieving’. priorities the CCG has established unreasonable grounds. a community engagement group Objective 2: senior leaders and and wide network of community 3. Senior (changed from middle) other line managers provide organisations. managers and other line leadership, support and motivation managers support and motivate for their staff to uphold the CCG’s Equality and Diversity Report their staff to work in culturally value of equality of opportunity to competent ways within a improve the health of those most Equality and diversity is an work environment free from in need. important focus for the CCG. Our discrimination. vision and our clinical priorities What we will do have been developed with equality The CCG annually reviews its and the diversity of our population performance on equality and • 100% of staff will complete in mind. Along with our lay diversity across the organisation. equality and diversity training. member for patient and public involvement we have a further two Working with the public, partners, • Equality Impact Assessments GPs who champion GP equality staff and unions we agreed two will be completed for all major and diversity alongside a GP lead objectives to concentrate on, policies and service changes. for health inequalities. which are set out below with the actions we have put together to • All Clinical Executive and The CCG is committed to achieve against these: Governing Body members, commissioning fair, accessible, including Chief Officers have appropriate and sensitive health Objective 1: to embed a completed equality and diversity services for all. We are also systematic process for collecting training consistent with the committed to being a fair, inclusive data and engaging organisations Competency Framework and diverse employer. representing protected for Equality and Diversity groups in order to establish need Leadership. The CCG has a duty to comply with and develop responsive services the Public Sector Equality Duty. It which address inequalities. A • The CCG has established and has committed to using the Equality robust action plan was put in place completed a programme of Delivery System 2, a nationally at the end of November 2013 engagement between senior developed toolkit to help support leaders with organisations objective setting and monitor which represent protected progress. groups. Page 36 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

• Community Engagement Group members assess the CCG’s progress in conducting its business so that equality is advanced and good relations fostered within the organisation and beyond as progressing from developing to achieving.

• More than 80% of staff surveyed agreed that the CCG is actively advancing equality objectives and fostering good relations within the organisation.

Meeting the equality duties

The CCG has prepared an equality and diversity plan to set out its approach to meeting the requirements of the Equality Act 2010 and the public sector equality duty.

In January 2014 the CCG published equality information about its service users and staff to help inform its work.

For more information about Equality and Diversity visit our website. West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 37

Members Report

This section sets out details Governing Body Membership of the member practices of the CCG, together with the Dr Christopher Browning composition of each of the (Chair) Membership Bodies. Julian Herbert For the register of interests please (Chief Officer) see page 55. Dr Ed Garratt (Chief Operating Officer) List of member practices Dr Simon Arthur (GP and Joint Lead for Forest Heath) Angel Hill General Practice, Bury St Edmunds Bill Banks (Lay member - Governance) Avicenna, Hopton David Cripps Botesdale Health Centre, Botesdale (Practice Manager Lead) Brandon Medical Practice Dr Emma Derbyshire Christmas Maltings Surgery, (GP and Joint Lead for Bury St Edmunds) Haverhill Johanna Finn Clements & Christmas Maltings (Lay member - Public and Patient Engagement) Surgery, Haverhill Carl Goulton Forest Surgery, Brandon (Chief Finance Officer) Glemsford Surgery, Glemsford Dr Crawford Jamieson (Secondary Care Doctor) Guildhall Surgery, Bury St Edmunds Peter Knights Guildhall and Barrow Surgery, (Practice Manager Lead) Bury St Edmunds Amanda Lyes Hardwicke House Group Practice, (Chief Corporate Services Officer) Sudbury Barbara McLean Lakenheath Surgery (Chief Nursing Officer) The Long Melford Practice Dr Rakesh Raja Market Cross Surgery, Mildenhall (GP and Joint Lead for Sudbury) Mount Farm Surgery, Dr Giles Stevens Bury St Edmunds (GP and Lead for Haverhill) Oakfield Surgery, Newmarket Dr Rosalind Tandy (GP and Joint Lead for Bury St Edmunds) Orchard House Surgery, Newmarket Wendy Tankard (Chief Contracts Officer) The Rookery Medical Centre, Newmarket Dr Andy Yager (GP and Lead for Blackbourne) Siam Surgery, Sudbury Dr Dan Knowles Stourview Medical Centre, (GP and Joint Lead for Forest Heath) Haverhill Swan Surgery, Bury St Edmunds Governing Body membership is composed of 13 men and 6 women. White House Surgery, Mildenhall Profiles of members of the Governing Body are detailed within the Victoria Surgery, Bury St Edmunds Remuneration Report. Wickhambrook Surgery Anne Nicholls (Chair of the Community Engagement Group) attends the Woolpit Health Centre, Woolpit Governing Body meetings, further strengthening public involvement. Page 38 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

Members Report

WSCCG Clinical Scrutiny Committee Remuneration & HR Committee Membership

Name Organisation Bill Banks (Chair) Simon Arthur WSCCG Johanna Finn Bill Banks* Lay Member Reserve - Dr Christopher Browning Christopher Browning WSCCG All of the above have been members since commencement of the CCG in April 2013. Kevin Bernard WSCCG Dan Knowles WSCCG CCG Collaborative Group Membership Johanna Finn* Lay Member Ed Garratt WSCCG Martin Smith (Independent Chair) Carl Goulton CCGs Dr Christopher Browning Julian Herbert CCGs Bill Banks Crawford Jamieson* Secondary Care Doctor Julian Herbert David Kanka SCC Graham Leaf (Ipswich and East Suffolk CCG) Peter Knights WSCCG Dr Mark Shenton (Ipswich and East Suffolk CCG) Amanda Lyes CCGs Barbara Mclean CCGs Community Engagement Group Membership Rakesh Raja WSCCG Wendy Tankard CCGs Anne Nicholls Dr Giles Stevens WSCCG (Chair) Rosalind Tandy WSCCG Johanna Finn (Lay member - Patient and Public Engagement) Andrew Yager WSCCG Dr Ed Garratt *Observer member (non-voting) (Chief Operating Officer) Roy Banks Audit Committee Membership Jane Carpenter Carol Dalton Bill Banks (Chair) David Dawson, Suffolk Congress Peter Knights Geraldine Dougall Reserve - David Cripps Warwick Hirst Carol Mansell The following are in attendance at the Audit Committee Lukasz Nowak Peter Owen • Representative from Finance • Representatives from External Audit Jon Rapley • Representative from Internal Audit Michael Simpkin • Representative from Counter Fraud David Taylor Karen Turner (Healthwatch Suffolk) Dianne Wright Philip Worsley West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 39

Members Report

Pension liabilities 2014/15

Details of the pension scheme West Suffolk Chief Operating Office, West Suffolk CCG 0.92% and how liabilities are presented CCG Chief Redesign Office, West Suffolk CCG 2.07% are included within the Overall rate 1.12% accounting policies note of the annual accounts with additional Management Chief Corporate Services Office 6.57% information included as part of the Delivery Team Chief Contracts Office 2.48% Remuneration Report. Chief Finance Office 1.42% Chief Nursing Office 3.06% Sickness absence data Communications & External Relations 0.09% Office of the Accountable Officer 0.73% The CCG’s sickness absence rate is Overall rate 3.10% below the target of 2%. However, sickness rates for the Shared Management Delivery Team were WSCCG Gender by Banding above target. The key reasons for sickness absence are colds, coughs and flu, gastrointestinal problems and headache and migraines.

Return to work interviews and early referral to occupational health by line managers have helped reduce and manage the level of sickness absence. Other interventions have included flu jabs for all employees, a stress workshop, drop in clinics and stop smoking sessions run by Suffolk Occupational Health. Other health and wellbeing support initiatives include a walking club, a cycle to work scheme and working with social enterprise SoActive to volunteer in communities. Management Delivery Team Gender by Banding

All employees have access to a Stress Management Toolkit, which can be used to identify factors which can cause stress and be discussed with line managers and the CCG’s occupational health. The CCG has relaunched its staff Health and Wellbeing group and a number of health and wellbeing champions have been appointed. Initiatives rolled out include the following:

• Fruit of the month for all staff. • Access to Psychological Therapies (APT) workshops. • Smoking cessation workshops. • Flexible working opportunities. • Monthly activities such as looking after your heart.

Further information is included with note 4.3 of the financial statement. Page 40 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

External Audit and Complaints Audit Information

External Audit So far as the Member is aware, there is no relevant audit The CCG’s external auditor is Ernst information of which the CCG’s & Young and the cost of services external auditor is unaware; provided by them in 2014/15 was and that the Member has taken £78,000. Work undertaken was all the steps that they ought to purely in the provision of statutory have taken as a member in order audit services. to make themself aware of any relevant audit information and to Cost Allocation & Setting establish that the CCG’s auditor is of Charges for Information aware of that information.

We certify that the CCG has Principles for Remedy complied with HM Treasury’s guidance on cost allocation The Parliamentary and Health and the setting of charges for Service Ombudsman has information. issued six Principles for Remedy when handling complaints. Disclosure of “serious These principles set out for untoward incidents” complainants and bodies within the Parliamentary and Health No serious untoward incidents Ombudsman’s jurisdiction how have occurred. they think public bodies should put things right when they have gone Statement as to Disclosure wrong - as well as its approach to to Auditors recommending remedies.

Each individual who is a member The Principles for Remedy are: of the Governing Body at the time the Members’ Report is approved 1. Getting it right. confirms: 2. Being customer focused. 3. Being open and accountable. • So far as the member is aware, 4. Acting fairly and there is no relevant audit proportionately. information of which the clinical 5. Putting things right. commissioning group’s external 6. Seeking continuous auditor is unaware. improvement.

• That the member has taken all the steps that they ought to have taken as a member in order to make themself aware of any relevant audit information and to establish that the clinical commissioning group’s auditor is aware of that information.

West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 41

Patients Advice and Liaison Service Number of PALS enquiries (PALS) Dental 1627 PALS covers both CCG areas in Suffolk. It provides information and advice on NHS GP query 39 services such as GPs and Dental Practices, Continuing care 13 Pharmacies and Opticians in West Suffolk CCG area and all provider services Funding 7 including Care UK, Suffolk Community Podiatry 14 Healthcare and Allied Health Professionals Suffolk. Optical 5 Physiotherapy 5 PALS is the first point of contact for patients where there have been changes Meds/Pharmacy 24 to or gaps in service for example; patients Mental health 11 querying the reduction of Gluten Free products available on prescription and low Med cert/recs 4 priority procedures. Continence 1

It is also responsible for the running of the Screening - bowel/breast/ cervical 0 emergency dental line for Suffolk, referring Acute 27 patients to duty NHS dentists on a ‘first come first served’ basis each weekday in PALS - other area 16 Ipswich and Bury St Edmunds. The service Transport 93 acts as the appeals process for free non- urgent hospital transport provided by the Equipment 5 Patient Transport Clinical Assessment and Community Hospitals 4 Advice Service (PTCAAS). Out of hours 5 For the period April 2014 to March 2015 Child Weight Management 0 PALS had 1998 contacts to the service relating to West Suffolk CCG. Miscellaneous 79 Low Priority Procedure 3 The total figure of calls to the service is 7159 which includes 173 out of area Out of area transport 16 queries and concerns.

Complaints

West Suffolk CCG received 40 formal complaints during the period April 2014 to March 2015. Page 42 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

Employee consultation managers need to take if an committee reports activities to the applicant declares themselves as remuneration and HR committee We have developed robust disabled. We also take reasonable for their information and arrangements with our trade steps to make sure all disabled comment. unions on effective employee applicants are treated fairly, which engagement, and consult and includes making adjustments to Over the last year training has negotiate with them formally every interviewing venue, selection and continued to be provided by two months. The results of these aptitude tests where necessary. Safetyboss. This is in the form discussions are then cascaded of a two hour classroom session to all staff as appropriate. In Occupational health advice and covering manual handling, fire addition, we have established a support is offered to all staff and safety and general Health and staff partnership forum, which was specialist advice is taken for any Safety awareness. The content nationally recognised when it was disabled employee or an employee of the training was refreshed shortlisted as a finalist in the 2013 who then becomes disabled at in January and the emphasis and 2014 Health Service Journal work. was placed more on health and awards. safety in an office environment. Our staff are all appraised annually, The issue of a safe working We keep our staff informed about and equality of opportunity is environment is always on the their employment and the CCG’s always considered when their agenda and staff based at West wider activities through a variety of personal development plans are Suffolk House follow the Councils methods, including: put together. guidelines. These have been distributed to staff and include • Regular one-to-one meetings We also regularly report on our advice on maintaining a tidy with their manager, during equal opportunity key performance workplace and asking everyone to which they are encouraged to indicators to the remuneration and take a personal responsibility for table any concerns or issues. HR committee. their own actions. The guidelines also reinforced the need for staff • Monthly team briefings, which Emergency preparedness, to report maintenance issues to are led by the chief officer and resilience and response a central point so these could be give staff the chance to ask dealt with as efficiently as possible. questions, anonymously We certify that NHS West Suffolk if necessary. CCG has incident response plans Other activates have included: in place, which are fully compliant • Weekly electronic newsletter. with the NHS Commissioning • Managing the Safetyboss H&S Board Emergency Preparedness delivery contract. • Via the intranet, where details Framework 2013. The CCG • Introducing a “Self Service” of the CCG’s performance are regularly reviews and makes Display screen equipment. updated monthly. improvements to its major incident assessment for staff to use. plan and has a programme for • Receiving updates of all risk All matters concerning staff are regularly testing this plan, the activities within the CCGs. also discussed by the remuneration results of which are reported to and HR committee and the staff the Governing Body. Fraud partnership forum. Health and safety There was a robust programme Equality of counter fraud and anti- The Health & Safety and Risk bribery activity, supported by the We are committed to offering Committee meets every other Local Counter Fraud Specialist equality of opportunity in all that month to review health and (LCFS) whose annual work plan we do, including the recruitment safety and risk issues relating to of prevention, deterrence and and selection of our workforce. NHS West Suffolk CCG and NHS detection was monitored by We hold the ‘Positive about Ipswich and East Suffolk CCG. the Chief Finance Officer and Disability’ symbol, along with a The committee is chaired by the the Audit Committee. The LCFS gold ‘Investors in People’ national Chief Corporate Services Officer regularly attends Audit Committee award. and draws members from both meetings and ensures that the CCGs, property services, the CCG is compliant with the national We have a robust recruitment and CCG Health and Safety services standards for countering NHS selection policy in place which provider (Safetyboss) and the fraud. Counter Fraud material was explicitly illustrates the steps which management delivery team. The disseminated to staff regularly West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 43

Remuneration Report through the shared drive, posters Membership of Remuneration The remainder of the senior and leaflets. Fraud and Bribery Act & HR Committee managers are paid on the VSM awareness training was provided (not subject to audit) (Very Senior Manager) grade. All to staff to raise awareness of salaries having been nationally potential issues and support their Bill Banks, (Chair), Lay Member benchmarked. work. The LCFS reviewed several policies, including the Counter Johanna Finn, Lay Member for Senior Managers’ Fraud and Corruption Policy, Patient and Public Engagement Performance-Related Pay the Whistleblowing Policy, the (not subject to audit) Managing Conflicts of Interest Reserve - Dr Christopher Browning Policy, the Digital Communication There is no element of pay that is Policy and the Maternity Policy and performance related. Procedure to ensure that they were Policy on remuneration of up-to-date and accurate. Policies senior managers Policy on Senior Managers’ are reviewed in line with current (not subject to audit) Contracts legislation and from a best practice (not subject to audit) and counter fraud perspective. The policy for the remuneration of senior managers was operated All staff including senior managers The LCFS issued 10 Fraud Bulletins in accordance with Agenda for (up to and including Band 9) during 2014/15 relating to subjects Change and it is intended to follow the national terms and such as mandate fraud, increased continue with this policy for conditions of service pertaining threats from cyber-attacks, future years. The pay for both to notice periods. The maximum potential telephone fraud, tax the Chief Officer and the Chief period of notice under Agenda for refund scams, identity fraud, HM Finance Officer was in accordance Change is 3 months. Chief Officers Government - UK Anti-Corruption with recently published national are appointed in accordance with Plan, fraudulent PayPal accounts guidance. the VSM framework and have and hidden charges, which are a notice period built into their ongoing fraud issues nationally contract of employment of six within the NHS and the wider months. public sector. A Continuing Healthcare (CHC) payments Senior Managers Service Contracts Counter Fraud proactive exercise (not subject to audit) was agreed in 2014/15 and this work will be carried forward and Name Date of Notice Period Provision undertaken during 2015/16. of Contract for Early Termination

Julian Herbert 1 October Six months None Chief Officer 2006

Julian Herbert Carl Goulton 3 December Six months None Accountable Officer Chief Finance Officer 2012 West Suffolk Clinical Commissioning Group Barbara McLean 8 May Six months None Chief Nursing Officer 2012 20 May 2015 Amanda Lyes 1 April Six months None Chief Corporate 2012 Services Officer

Wendy Tankard 23 September Six months None Chief Contracts Officer 2013

Ed Garratt 29 March Three months None Chief Operating Officer 2012

For attendance to remuneration and HR committee please see page 38. Page 44 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

Management Period in Office: 2014/15 2014/15 Salaries and Allowances 2014/15 Delivery Salary Expense Performance Long term All Pension Total Management (subject to audit) Team (bands of Payments Pay and performance Related Delivery £5,000) (taxable) Bonuses pay and Benefits Team to nearest (bands of bonuses (bands of Total Salary £100 £5,000) (bands of £2,500) (bands of £5,000) £5,000)

Name Title Yes / No From To £000 £000 £000 £000 £000 £000 £000 Note 1 Note 2 Note 1 Dr Edmund Garratt Chief Operating Officer No 01/04/2014 31/03/2015 105 - 110 1 0 0 22.5 - 25 130 - 135 N/A

Julian Herbert Chief Officer Yes 01/04/2014 31/03/2015 50 - 55 2 0 0 10 - 12.5 60 - 65 135 - 140 Barbara McLean Chief Nursing Officer Yes 01/04/2014 31/03/2015 30 - 35 0 0 0 0 - 2.5 35 - 40 90 - 95 Amanda Lyes Chief Corporate Services Officer Yes 01/04/2014 31/03/2015 35 - 40 0 0 0 2.5 - 5 40 - 45 95 - 100 Carl Goulton Chief Finance Officer Yes 01/04/2014 31/03/2015 40 - 45 2 0 0 12.5 - 15 55 - 60 110 - 115 Wendy Tankard Chief Contracts Officer Yes 01/04/2014 31/03/2015 35 - 40 2 0 - 5 0 20 - 22.5 60 - 65 105 - 110

Dr Christopher Browning GP Chair and Joint Lead for Sudbury Locality No 01/04/2014 31/03/2015 60 - 65 0 0 0 0 60 -65 N/A Dr Emma Derbyshire Joint Lead for Bury St Edmunds Locality No 01/04/2014 31/03/2015 30 - 35 0 0 0 0 30 -35 N/A Dr Daniel Knowles GP and Lead for Newmarket Locality No 01/04/2014 31/03/2015 30 -35 0 0 0 0 30 -35 N/A Dr Rosalind Tandy Lead for Bury St Edmunds Locality No 01/04/2014 31/03/2015 30 - 35 0 0 0 0 30 - 35 N/A Dr Giles Stevens GP and Lead for the Haverhill Locality No 01/04/2014 31/03/2015 30 - 35 0 0 0 0 30 - 35 N/A Dr Andrew Yager Lead for Blackbourne Locality No 01/04/2014 31/03/2015 30 - 35 0 0 0 0 30 - 35 N/A Dr Simon Arthur GP and Joint Lead for Forest Heath Locality No 01/04/2014 31/03/2015 30 - 35 0 0 0 0 30 - 35 N/A Dr Rakesh Raja GP and Joint Lead for Sudbury Locality No 01/04/2014 31/03/2015 30 - 35 0 0 0 0 30 - 35 N/A David Cripps Practice Manager Lead No 01/04/2014 31/03/2015 15 - 20 0 0 0 0 15 - 20 N/A Peter Knights Practice Manager Lead No 01/04/2014 31/03/2015 15 - 20 0 0 0 0 15 - 20 N/A Dr Crawford Jamieson Secondary Care Doctor No 01/04/2014 31/03/2015 10 - 15 0 0 0 0 10 -15 N/A William Banks Vice Chair and Lay Member - Governance No 01/04/2014 31/03/2015 10 - 15 0 0 0 0 10 -15 N/A Johanna Finn Lay Member Patient and Public Engagement No 01/04/2014 31/03/2015 10 - 15 0 0 0 0 10 -15 N/A

Changes to the Governing Body Membership Dr Jonathan Ferdinand left his role on the Governing Body on 31st March 2014. Dr Daniel Knowles commenced his role on the Governing Body on 1st April 2014. These were the only changes to the membership of the Governing Body during the year.

Page 45 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 45 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

Management Period in Office: 2013/14 2013/14 Salaries and Allowances 2013/14 Delivery Salary & Fees Taxable Annual Long-term All Pension Total Management (subject to audit) Team (bands of Benefits Performance Performance Related Delivery £5,000) (Rounded to Related Related Benefits Team Total the nearest Bonuses Bonuses (bands of Salary and £00) (bands of (bands of £2,500) Fees (bands £5,000) £5,000) of £5,000)

Name Title Yes / No From To £000 £000 £000 £000 £000 £000 £000 Note 1 Note 2 Note 1 Dr Edmund Garratt Chief Operating Officer No 01/04/2013 31/03/2014 105 - 110 8 0 0 47.5 - 50 155 - 160 N/A James Downes Chief Redesign Officer No 01/04/2013 24/08/2013 30 - 35 0 0 0 2.5 - 5 35 - 40 N/A

Julian Herbert Chief Officer Yes 01/04/2013 31/03/2014 50 - 55 3 0 0 17.5 - 20 70 - 75 135 - 140 Carl Goulton Chief Finance Officer Yes 01/04/2013 31/03/2014 40 - 45 2 0 0 12.5 - 15 55 - 60 110 - 115 Amanda Lyes Chief Corporate Services Officer Yes 01/04/2013 31/03/2014 35 - 40 2 0 0 2.5 - 5 40 - 45 95 - 100 Barbara McLean Chief Nursing Officer Yes 01/04/2013 31/03/2014 30 - 35 1 0 0 0 30 - 35 90 - 95 Wendy Tankard Chief Contracts Officer Yes 23/09/2013 31/03/2014 20 - 25 1 0 0 5 - 7.5 25 - 30 55 - 60 Jon Reynolds Acting Chief Contracts Officer Yes 29/04/2013 30/09/2013 10 - 15 1 0 0 5 - 7.5 20 - 25 30 - 35 John Wicks Interim Chief Contracts Officer Yes 01/04/2013 28/04/2013 5 - 10 0 0 0 0 5 - 10 10 - 15

Dr Christopher Browning GP Chair and Joint Lead for Sudbury Locality No 01/04/2013 31/03/2014 60 - 65 0 0 0 0 60 - 65 N/A Dr Emma Derbyshire Joint Lead for Bury St Edmunds Locality No 01/04/2013 31/03/2014 30 - 35 0 0 0 N/A 30 - 35 N/A Dr Jon Ferdinand Joint Lead for Bury St Edmunds Locality No 01/04/2013 31/03/2014 30 - 35 0 0 0 N/A 30 - 35 N/A Dr Rosalind Tandy Lead for Bury St Edmunds Locality No 01/04/2013 31/03/2014 30 - 35 0 0 0 N/A 30 - 35 N/A Dr Andrew Yager Lead for Blackbourne Locality No 01/04/2013 31/03/2014 30 - 35 0 0 0 N/A 30 - 35 N/A Dr Simon Arthur GP and Joint Lead for Forest Heath Locality No 01/04/2013 31/03/2014 30 - 35 0 0 0 0 30 - 35 N/A Dr Rakesh Raja GP and Joint Lead for Sudbury Locality No 01/04/2013 31/03/2014 30 - 35 0 0 0 0 30 - 35 N/A Dr Giles Stevens GP and Lead for the Haverhill Locality No 24/07/2013 31/03/2014 15 - 20 0 0 0 0 15 - 20 N/A David Cripps Practice Manager Lead No 01/04/2013 31/03/2014 15 - 20 0 0 0 0 15 - 20 N/A Peter Knights Practice Manager Lead No 01/04/2013 31/03/2014 15 - 20 0 0 0 0 15 - 20 N/A Dr Crawford Jamieson Secondary Care Doctor No 01/04/2013 31/03/2014 10 - 15 0 0 0 0 10 - 15 N/A William Banks Vice Chair and Lay Member - Governance No 01/04/2013 31/03/2014 10 - 15 0 0 0 0 10 - 15 N/A Johanna Finn Lay Member Patient and Public Engagement No 01/04/2013 31/03/2014 10 - 15 0 0 0 0 10 - 15 N/A Page 46 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

Salaries and Allowances Note 2 - All Pension Related (subject to audit) Benefits

Note 1 - Management Delivery The amount included here is Team the annual increase in pension entitlement determined in West Suffolk CCG host the accordance with the ‘HMRC’ Management Delivery Team that method for defined benefit provides management support pension schemes. In summary, to both West Suffolk CCG and this is as follows: Ipswich and East Suffolk CCG. The cost of the Management Delivery Increase in pension entitlement Team is shared between both = ((20 x PE) + LSE) – ((20 x PB) + CCG’s in the proportion:- Ipswich LSB), where: and East Suffolk CCG 61.72% - West Suffolk CCG 38.28%. • PE is the annual rate of pension The Management Delivery Team that would be payable to the includes the above highlighted officer if they became entitled Chief Officers. In addition to to it at the end of the financial

showing the salary charged to year. - Annual Report and Accounts 2014/15 Clinical Commissioning Group Suffolk West West Suffolk CCG, the table also records the Chief Officer’s total • PB is the annual rate of pension, salary. As West Suffolk CCG host adjusted for inflation, that the Management Delivery Team would be payable to the officer the Ipswich and East Suffolk CCG if they became entitled to it at share of these pay costs is shown the beginning of the financial as a charge from West Suffolk year. CCG in the Ipswich and East Suffolk CCG’s accounts and not as • LSE is the amount of lump sum payroll costs. that would be payable to the officer if they became entitled to it at the end of the financial year.

• LSB is the amount of lump sum, adjusted for inflation, that would be payable to the officer if they became entitled to it at the beginning of the financial year.

The amount included is not a sum paid to the officer by the CCG. It merely represents the increase in pension entitlement that occurred during the year and is derived from data received from NHS Pensions.

Where N/A is shown in the table there is no requirement to disclose as the pensions data received includes contributions from other employment sources. Page 47 Page 47 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

Period in Office: Real Real Total accrued Lump sum Cash Cash Real Employer’s Pension Benefits 2014/15 increase / increase / pension at at age 60 Equivalent Equivalent increase/ contribution (subject to audit) decrease in decrease in age 60 at related to Transfer Value Transfer decrease to pension at pension 31 March accrued at 1 April Value at in Cash stakeholder age 60 lump sum 2015 pension at 2014 31 March Equivalent pension (bands of at aged 60 (bands of 31 March 2015 Transfer £2,500) (bands of £5,000) 2015 Value £2,500) (bands of £5,000) Name Title From To £000 £000 £000 £000 £000 £000 £000 £000

Dr Edmund Garratt Chief Operating Officer 01/04/2014 31/03/2015 0 - 2.5 2.5 - 5 10 - 15 40 - 45 156 179 19 0 Julian Herbert Chief Officer 01/04/2014 31/03/2015 0 - 2.5 2.5 - 5 20 - 25 60 - 65 298 334 29 0 Barbara McLean Chief Nursing Officer 01/04/2014 31/03/2015 0 - 2.5 0 - 2.5 35 - 40 105 - 110 648 690 24 0 Amanda Lyes Chief Corporate Services Officer 01/04/2014 31/03/2015 0 - 2.5 0 - 2.5 30 - 35 95 - 100 487 520 20 0 Carl Goulton Chief Finance Officer 01/04/2014 31/03/2015 0 - 2.5 0 - 2.5 0 - 5 0 - 5 23 41 18 0 Wendy Tankard Chief Contracts Officer 01/04/2014 31/03/2015 0 - 2.5 5 - 7.5 15 - 20 55 - 60 281 337 49 0

No pension contributions were made in respect of the following Governing Body Members.

Dr Christopher Browning Chair Dr Emma Derbyshire Joint Lead for Bury St Edmunds Locality Dr Daniel Knowles GP and Lead for Newmarket Locality Dr Rosalind Tandy Lead for Bury St Edmunds Locality Dr Giles Stevens GP and Lead for the Haverhill Locality Dr Andrew Yager Lead for Blackbourne Locality Dr Simon Arthur GP and Joint Lead for Forest Heath Locality Dr Rakesh Raja GP and Joint Lead for Sudbury Locality David Cripps Practice Manager Lead Peter Knights Practice Manager Lead Dr Crawford Jamieson Secondary Care Doctor William Banks Vice Chair and Lay Member for Governance Johanna Finn Lay Member for Patient and Public Engagement Page 48 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

Period in Office: Real Real Total accrued Lump sum Cash Cash Real Employer’s Pension Benefits 2013/14 increase / increase / pension at at age 60 Equivalent Equivalent increase/ contribution (subject to audit) decrease in decrease in age 60 at related to Transfer Transfer decrease to pension at pension 31 March accrued Value at Value at in Cash stakeholder age 60 lump sum 2014 pension at 31 March 31 March Equivalent pension (bands of at aged 60 (bands of 31 March 2013 2014 Transfer £2,500) (bands of £5,000) 2014 Value £2,500) (bands of £5,000) Name Title From To £000 £000 £000 £000 £000 £000 £000 £000

Dr Edmund Garratt Chief Operating Officer 01/04/2013 31/03/2014 0 - 2.5 5 - 7.5 10 - 15 35 - 40 123 156 30 0 James Downes Chief Redesign Officer 01/04/2013 24/08/2013 0 - 2.5 0 - -2.5 0 - 5 0 - 5 25 31 2 0 Julian Herbert Chief Officer 01/04/2013 31/03/2014 0 - 2.5 5 - 7.5 15 - 20 55 - 60 251 298 41 0 Barbara McLean Chief Nursing Officer 01/04/2013 31/03/2014 0 - -2.5 0 - -2.5 30 - 35 100 - 105 619 648 16 0 Amanda Lyes Chief Corporate Services Officer 01/04/2013 31/03/2014 0 - 2.5 0 - 2.5 30 - 35 95 - 100 456 487 21 0 Carl Goulton Chief Finance Officer 01/04/2013 31/03/2014 0 - 2.5 0 - 2.5 0 - 5 0 - 5 6 23 17 0 Jon Reynolds Acting Chief Contracts Officer 29/04/2013 30/09/2013 0 - 2.5 2.5 - 5 10 - 15 30 - 35 107 138 12 0 Wendy Tankard Chief Contracts Officer 23/09/2013 31/03/2014 0 - 2.5 0 - 2.5 15 - 20 45 - 50 258 281 9 0 Dr Emma Derbyshire (Note 1) Joint Lead for Bury St Edmunds Locality 01/04/2013 31/03/2014 N/A N/A N/A N/A N/A N/A N/A 0 Dr Jon Ferdinand (Note 1) Joint Lead for Bury St Edmunds Locality 01/04/2013 31/03/2014 N/A N/A N/A N/A N/A N/A N/A 0 Dr Rosalind Tandy (Note 1) Lead for Haverhill Locality 01/04/2013 31/03/2014 N/A N/A N/A N/A N/A N/A N/A 0 Dr Andrew Yager (Note 1) Lead for Blackbourne Locality 01/04/2013 31/03/2014 N/A N/A N/A N/A N/A N/A N/A 0

Note 1: No requirement to disclose as data provided includes contributions from other employment sources. No pension contributions were made in respect of the following Governing Body Members.

Dr Christopher Browning Chair Dr Simon Arthur GP and Joint Lead for Forest Heath Locality Dr Rakesh Raja GP and Joint Lead for Sudbury Locality Dr Giles Stevens GP and Lead for the Haverhill Locality David Cripps Practice Manager Lead Peter Knights Practice Manager Lead Dr Crawford Jamieson Secondary Care Doctor William Banks Vice Chair and Lay Member for Governance Johanna Finn Lay Member for Patient and Public Engagement John Wicks Interim Chief Contracts Officer West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 49

Payments for Loss of Office Off-Payroll Engagements (not subject to audit) (not subject to audit) For all off-payroll engagements as of 31 March 2015, for more than £220 None per day and that last longer than six months:

Payment to past Senior Number Managers (not subject to audit) Number of existing engagements as of 31 March 2015 15

There were no payments to past Of which, the number that have existed: senior managers. - for less than one year at the time of reporting 7 Pay Multiples (subject to audit) - for between one and two years at the time of reporting 8

Reporting bodies are required to - for between 2 and 3 years at the time of reporting 0 disclose the relationship between the remuneration of the highest - for between 3 and 4 years at the time of reporting 0 paid director / member in their organisation and the median - for 4 or more years at the time of reporting 0 remuneration of organisation’s workforce. For all new off-payroll engagements between 1 April 2014 and 31 March The banded remuneration of 2015, for more than £220 per day and that last longer than six months: the highest paid member of the Governing Body in the financial Number year 2014/15 was £105,000 to £110,000 (2013/14 - £105,000 Number of new engagements, or those that reached six to £110,000). This was 3.27 months in duration, between 1 April 2014 and 31 March 2015 7 (2013/14 - 3.35) times the median remuneration of the workforce, Number of new engagements which include contractual which was £30,000 to £35,000 clauses giving the CCG the right to request assurance in (2013/14 - £30,000 to £35,000). relation to income tax and National Insurance obligations 7

In 2014/15 no employee received Number for whom assurance has been requested 7 remuneration in excess of the highest paid member of the Of which: Governing Body. Remuneration ranged from £5,000 to £10,000 to - assurance has been received 7 £105,000 to £110,000 (2013/14 - from £5,000 to £10,000 to - assurance has not been received 0 £105,000 to £110,000). - engagements terminated as a result of assurance Total remuneration includes salary, not being received 0 non-consolidated performance- related pay, benefits-in-kind but not severance payments. The CCG has robust contractual arrangements with all of its off-payroll It does not include employer engagements that minimises any risk to the CCG. The contractual pension contributions and the arrangements require all off-payroll engagements to provide assurance that cash equivalent transfer value of the correct amount of tax is being paid. pensions.

Julian Herbert Accountable Officer, West Suffolk Clinical Commissioning Group

20 May 2015 Page 50 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

GOVERNING BODY PROFILES

Dr Christopher Dr Simon Arthur Dr Emma Derbyshire Dr Andy Yager Browning GP and Joint Lead GP and Joint Lead GP and Lead Chair for Forest Heath locality for Bury St Edmunds for Blackbourne locality locality

Dr Christopher Browning Dr Simon Arthur has Dr Emma Derbyshire Dr Andrew Yager is a is the Chair of West been a GP in Suffolk is a GP partner at the GP partner at Botesdale Suffolk CCG and is a GP for 25 years and is the Swan Surgery in Bury St Surgery. He is the appraiser with 10 years’ lead partner at Oakfield Edmunds and is the lead GP lead for cancer experience in hospital Surgery in Newmarket. on integrated care. commissioning and medicine and 13 years’ He is the CCG’s lead is also the Macmillan experience as a GP. He on out-of-hours and facilitator for Suffolk. has had operational community services, end experience in the out- of life commissioning of-hours service and and the 111 service. many years’ experience He is also the lead representing his GP clinical commissioner colleagues on the LMC. for the East of England ambulance contract. West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 51

Dr Rakesh Raja Dr Roz Tandy Dr Giles Stevens Dr Daniel Knowles GP and Joint Lead GP and Lead GP and Lead GP and Joint Lead for for Sudbury locality for Bury St Edmunds for Haverhill locality Forest Heath locality

Dr Raja qualified in Since qualifying as a GP Dr Giles Stevens Dr Knowles is a GP 1992 and spent a in 2006, Dr Rosalind graduated from partner at The Rookery large part of his initial Tandy has worked as a Edinburgh in 2001, Medical Practice in training in hospital salaried GP, remaining and initially worked in Newmarket. He has a medicine. Before moving within the west Suffolk Scotland. He returned to keen interest in minor into general practice area. Roz is in charge Norfolk, having grown surgery, ENT and he worked in the of the mental health up there, and worked paediatrics. pharmaceutical industry, and learning disabilities around the area after developing new drugs portfolio. qualifying as a GP and Dr Knowles is one of the and designing clinical became Partner at the prescribing leads at the trials. He has now been Clements Christmas practice and uses this working in Suffolk for Maltings GP practice in experience in his role 15 years as a GP and is Haverhill in September as part of the medicines a partner at Hardwicke 2012. management team at House Group Practice in the CCG. Sudbury. He joined the executive committee of West Dr Raja is the clinical Suffolk CCG in July 2013 lead for planned care, and is a key member working closely with the of the integrated care local hospital clinicians in workstream. developing services for patients. He is actively involved in developing collaborative working across the various providers and partners in the west Suffolk area. Page 52 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

Peter Knights David Cripps Dr Crawford Jamieson Jo Finn Practice Manager Lead Practice Manager Lead Secondary Care Doctor Lay Member - Patient and Public Engagement

Peter Knights is David Cripps joined the Dr Crawford Jamieson Jo Finn is a management business partner and NHS nineteen years ago, has 13 years experience consultant working Practice Manager at since when he has been as a Consultant principally with public Mount Farm Surgery. a Practice Manager, first Gastroenterologist services, including He has been Chair in Cambridgeshire and and Physician and is developing the national of Bury St Edmunds more recently in Suffolk. currently an Associate programme for Shared Commissioning Medical Director at the Decision Making for Consortium, and He has worked on Norfolk and Norwich urology patients, Director and Secretary various projects and University Hospitals NHS reviewing Medical of West Suffolk committees, mostly Foundation Trust. Undergraduate Clinical Commissioning as a result of his Placements and setting Federation (WSCF). He IT experience. He He has gained up the prototype is a founder member of was deeply involved experience of practice arrangements for WSCCG. with Practice Based based commissioning Major Review of Health Commissioning, from the secondary and Professional Training. Prior to joining the delivering, among tertiary care perspective health sector Peter spent others, a diabetes and has seen the clear Prior to consultancy, more than 20 years service in Sudbury that benefits of good clinical she was West Suffolk in corporate banking, pioneered inter practice pathway design and Hospital’s NHS Trust corporate finance, referral, was a Board implementation in Chief Executive for eight and latterly business member of WSCF, improving the quality years. She has over planning and strategy. and has continued to of care that patients 40 years experience in He is a member of the maintain his interest in receive. He has extensive health management at CCG’s Audit Committee. commissioning. He is operational experience all levels. the joint governing body within a busy University lead for IT. Hospital and has also been an Executive Board member for the last six years. West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 53

Bill Banks Julian Herbert Dr Ed Garratt Barbara McLean Vice Chair and Lay Chief Officer Chief Operating Officer Chief Nursing Officer Member - Governance

Bill’s role as Lay Member Julian Herbert is Chief Dr Ed Garratt is the Barbara McLean is for Governance is Officer for both NHS Chief Operating Chief Nursing Officer, strategic and impartial Ipswich and East Suffolk Officer of NHS West with responsibility for and oversees key and NHS West Suffolk Suffolk Clinical improving quality and elements of governance Clinical Commissioning Commissioning Group. patient experience. including audit, Groups. He joined He was previously Making sure people’s remuneration and the NHS in 2005 as Deputy Director of voices are heard in managing conflicts of Director of Finance & Commissioning for healthcare settings interest. Bill chairs the Performance of East NHS East of England motivates her. She CCG’s Audit Committee Suffolk Primary Care and supported Sir Neil knows that bringing and the Remuneration Trust and played a major McKay in establishing individuals into the & HR Committee. He is role in resolving the NHS Midlands and planning of their care also Vice Chair of the legacy of historic debt East. He has worked on and making sure they Governing Body. both in the east and various policy areas, such have the opportunity then the west of the as the NHS Constitution, and information to Bill is a qualified county. Before joining primary care quality and truly understand what’s accountant and served the NHS, he spent a safety, and HR. happening, enhances as an examiner for his brief spell working in their experience - and professional institute. local government and He has a first class accessing the patients’ Bill worked for NHS has 15 years experience honours degree in experience drives quality. Suffolk from 2007 to in a range of commercial History from the 2013 as a Non-Executive and financial roles in the University of Sussex She has a range of Director and Chair of private sector. and a masters and a experience in the NHS, its Audit Committee. doctorate in English from being engaged Prior to that, Bill worked Literature from the directly with patients for 42 years in local University of Cambridge. as a nurse to policy government and public development at the transport, majoring Department of Health. in finance. His last employer was Suffolk County Council, where he held the posts of Director of Resource Management and Head of Strategic Finance. Page 54 West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15

Amanda Lyes Carl Goulton Wendy Tankard Chief Corporate Services Chief Finance Officer Chief Contracts Officer Officer

Amanda Lyes is the Carl is Chief Finance Wendy Tankard is Chief Corporate Services Officer for both Ipswich a Registered Nurse Officer and has a and East Suffolk and (specialist Practitioner) NHS career spanning West Suffolk Clinical with over 30 years’ 20 years. Although Commissioning experience in the NHS professionally qualified Groups. Carl joined the and private sector across in Human Resources, NHS in 2012 having acute, community and her profile now gained over 20 years’ commissioning. She has encompasses IM&T, experience in the private held positions as Director corporate governance, sector, operating at of Nursing and Director information governance Board level in FTSE of Clinical Quality for as well as HR. Her and Private Equity the North East Essex strength’s are in the field enterprises. He is a PCT, in addition to of change management, Chartered Management clinical quality and organisational Accountant, Fellow of governance she held development and the Institute of Directors the portfolio for urgent employee relations. and Fellow of the care and trauma and Institute of Leadership more recently as Director She has a wide and Management. of Service Redesign understanding of NHS in the independent service delivery and sector. She was also an is passionate about advisor on the European delivering a high Commission task force standard of service. She for e-health. is an experienced Board member having held Board level positions in two other NHS organisations and is a Fellow of the Chartered Institute of Personnel and Development and holds a MSc in Human resource Management. West Suffolk Clinical Commissioning Group - Annual Report and Accounts 2014/15 Page 55

REGISTER OF INTERESTS Peter Knights Dr Andrew Yager 2014/15 Governing Body Member . Governing Body Member • Business partner, Mount Farm • GP Partner, Botesdale Health Dr Christopher Browning Surgery Centre. Chair • Mount Farm Surgery is a • Director and shareholder of • PMS Provider: Dispensary and member of the Suffolk GP Botesdale Rural Services. Commissioning Lead. Federation. • Wife works in day surgery at • Chair, Hartest Parish Council. West Suffolk NHS Foundation • GP Medical lead for Care UK Trust. Suffolk out of hours service. Dr Daniel Knowles Governing Body Member Dr Giles Stevens • Partner at the Rookery Medical Dr Crawford Jamieson Governing Body Member Practice, Newmarket. Secondary Care Doctor • GP Partner, Christmas Maltings • Wife is a consultant physician and Clements Practice, at Ipswich Hospital. Dr Rakesh Raja Haverhill. Governing Body Member • Practice is a member of the Suffolk GP Federation. • Director & shareholder of Bill Banks Sudbury Health Partnership Lay Member - Nil providing community ultrasound Julian Herbert service in Sudbury. Chief Officer • Senior GP Partner, Hardwicke Johanna Finn House Group Practice. • Wife is employed by Suffolk Lay Member • Practice is subcontracted by County Council. • Director of Jo Finn Ltd Serco to provide cover for beds Management Consultancy. at Hazel Court Care Home. • NHS Senior Manager for many • Wife is a GP at the same Carl Goulton years. practice and works under her Chief Finance Officer - Nil • Ex-husband was a consultant maiden name - Dr Catherine obstetrician and gynaecologist. Firth. Amanda Lyes Chief Corporate Services Officer - Nil David Cripps Dr Rosalind Tandy Governing Body Member Governing Body Member Barbara McLean • Practice Manager - Hardwicke • Partner consultant for Chief Nursing Officer House Group practice. Cambridge and Peterborough • Athletics coach for West Foundation Trust (CPFT) and is • Owner/Director of Allington Suffolk AC - Sport England et clinical lead for Division 4 of the Healthcare Ltd. al sometimes commission work clinical research network. • Allington Healthcare Ltd owns from Clubs and Coaches. Beckfield House Residential • Wife is an employee of UNISON. Home, Lincolnshire. Dr Nicholas Simon Arthur • Spouse joint owner/director of Governing Body Member Alligton Healthcare Ltd. Dr Emma Derbyshire • Spouse is a shareholder of • GP Partner at Oakfield Surgery. Governing Body Member Clearwater Specialist Care • Member of the Suffolk GP Group Ltd, Learning Disabilities • Swan Surgery is a member of Federation. services provider. the Suffolk GP Federation • Senior Partner sits on the

Suffolk GP Federation Board. Ed Garratt • Shareholder with Swan Med Chief Operating Officer - Nil Pharmacy and Director. • Level 3 contracts for minor

surgery Wendy Tankard Chief Contracts Officer - Nil Published by NHS West Suffolk Clinical Commissioning Group West Suffolk House, Western Way, Bury St Edmunds, Suffolk IP33 3YU Telephone: 01284 758 010 Email: [email protected] www.westsuffolkccg.nhs.uk

@NHSWSCCG /nhswsccg