ANNUAL REPORT 2020/21 | NHS Brighton and Hove Clinical Commissioning Group 1 of 149

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Contents

Section 1: Performance Report Performance Overview

Section 2: Accountability Report Corporate Governance report Statement of Accountable Officer’s responsibilities Governance statement Remuneration and staff report Parliamentary accountability and audit report

Section 3: Annual Accounts Finance report Appendix A: Independent Auditor’s Report Appendix B: Financial statements 2020/21

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Performance overview

The purpose of this Performance overview is to present information about the CCG to help patients, stakeholders, and the public to understand the organisation including its purpose, the key risks to the achievement of its objectives, and how it has performed during the year.

This overview includes detail of how the CCG has met its statutory duties to:  Have regard to the need to reduce health inequalities  Improve the quality of services  Involve the public in commissioning activities and to explain the impact of that engagement activity

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Statement from the Clinical Chair and Accountable Officer

Welcome to the NHS Brighton and Hove Clinical Commissioning Group (CCG) Annual Report 2020/21 which provides a comprehensive overview of our performance, progress, and challenges during the last twelve months.

The year was undoubtedly one of the most challenging in the history of the NHS with the coronavirus (COVID-19) pandemic and subsequent vaccine roll out, but also a year in which we saw the most incredible response from our people to care for our patients and our most vulnerable residents, and to keep our population and workforce as safe and as well as possible through an extraordinary time.

A new way of working for Sussex CCGs In April 2020, a new way of working was introduced for the CCGs across Sussex which has improved how NHS services are planned, paid for and monitored. The CCGs across East and West Sussex merged to become two new statutory bodies – NHS East Sussex CCG and NHS West Sussex CCG – and now work closely together with NHS Brighton and Hove CCG as “Sussex NHS Commissioners”.

The three statutory bodies have a single management team and a consistent way of working that ensures services can be commissioned more effectively and efficiently across the health and care system, as well as across local areas. This has also supported greater collaboration with other health and care organisations, in particular the local authorities, to ensure local populations’ health and care needs can be better met.

Forming an Integrated Care System In May 2020, NHS England and Improvement (NHSE/I) announced that the Sussex Health and Care Partnership (SHCP), which is made up of all health and care organisations across the county including NHS Brighton and Hove CCG, successfully met the criteria to become an Integrated Care System (ICS). An ICS is a way of working across health and care organisations that allows them to work closer together to take collective responsibility for the health and wellbeing of populations across large areas.

The collaborative way of working has been beneficial in the way health and care organisations across Sussex have responded to the COVID-19 crisis, with partners working together as part of the ongoing emergency to ensure our populations get the care they need. Read more about the Sussex ICS on page 12.

The pandemic response in Sussex The first case of COVID-19 in the UK was confirmed as a Brighton resident last year and the CCG has seen incredible changes to the way it works and how we all live our lives since then. From the first day of response and throughout the whole year, the commitment and dedication of our GPs and other health and care teams from across the City has been phenomenal, giving their time tirelessly to make sure we can continue to provide care for those who need it.

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As the coronavirus pandemic really took hold at the end of March 2020, a Major Incident for Sussex was declared. Sussex NHS Commissioners took a coordinating role in making sure the local health and care system was able to cope with the urgent demand and ensure local populations got the care they needed throughout this time of emergency – whether for COVID-19 or other health and care needs.

Like the rest of the health and care system, GP practices across Brighton and Hove swiftly transformed the way they worked to ensure local patients remained safe and got the care they needed during the pandemic. Practices introduced safety measures to protect all patients and staff, with initial telephone and online assessments to enable the prioritisation of appointments for those most in need. Specific clinics were established to help support patients with COVID-19 symptoms who were not in need of hospital treatment but did need to see a GP for other conditions, so that they were kept isolated from other patients. The use of telephone appointments and video consultations were promoted wherever possible to order repeat prescriptions; view health records, including test results; and book, check or cancel appointments.

In May 2020, the SHCP established the Sussex Black, Asian and Minority Ethnic Disparity Programme in response to the evidence emerging from the Office for National Statistics around the disproportionate impact of COVID-19 on Black, Asian and Minority Ethnic (BAME) communities. The programme team examined all the factors which have an impact on health outcomes, experience and wellbeing for people from ethnically diverse backgrounds including structural, institutional and interpersonal racism. Significant ongoing engagement with health and care organisation leadership teams, workforce and our communities continues. One of the key outcomes from this programme to date has been the introduction of a COVID-19 Emergency Locally Commissioned Service in general practice, specifically supporting BAME and vulnerable groups. The service supported primary care to identify BAME patients from their list who might benefit from specific interventions to reduce their risk of COVID-19 related mortality; improve communication and engagement with local BAME communities; and offer a supportive monitoring protocol for patients in vulnerable groups who develop COVID-19.

People across Sussex struggling with their mental health during the coronavirus outbreak were offered additional telephone and crisis support to help them cope. Working with our largest mental health service provider we expanded the Sussex Mental Healthline to offer a 24/7 service to people needing urgent help. As well as crisis support it provided psychological support to people who have general concerns about their mental health.

Sussex COVID-19 vaccination programme roll out The NHS in Sussex has made outstanding progress with the roll out of the COVID- 19 vaccination programme. By the end of the financial year (2020/21), one million people in Sussex had received the COVID-19 vaccination.

Sussex NHS Commissioners took a leading role in co-ordinating the vaccination programme and, working alongside our partners in a matter of weeks had developed local vaccination services, vaccination centres and were providing health and care staff vaccinations at hospital hubs. From December 2020 onwards, each

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week saw more and more vaccination services being launched, supported by one or several GP practices, with their teams working collectively to vaccinate those identified as priority groups, including outreach to care home residents. It took significant commitment from our primary care teams across Sussex, working rapidly in a short space of time to plan for the vaccination roll out, redesign local sites and put in place safe processes to meet the tough logistical challenges of offering the vaccination – all while continuing to provide general practice services to their registered patients.

Sussex met the national target of offering the vaccination to the top priority cohorts and has been continuing to vaccinate thousands of people every week. This has required an enormous collective effort across the system and the dedication and commitment of those working on the programme to vaccinate residents as soon as possible has been extraordinary. This is a huge programme of work but we are currently in a strong position to continue into 2021/22.

In January, the Brighton Racecourse GP-led vaccination service opened, followed by sites at County Oak and Portslade Health Centre, offering further local support in the battle against coronavirus. Their opening meant all GP practices in the city were covered by the roll out of the vaccination programme. GP practices in Brighton and Hove have worked closely with the Brighton-based healthcare social enterprise, Here (Care Unbound), which has coordinated the Brighton Racecourse site, from planning and operations, to clinical recruitment and appointment bookings. Together, GPs and partnership teams worked flat out to set up sites that have enabled as many people as possible to be vaccinated quickly and safely.

Virtual Pride shows even a pandemic cannot stop celebrations Brighton and Hove Pride is one of the city’s largest events, in usual years drawing thousands to celebrate by taking part in its parade and Preston Park event. Due to the ongoing coronavirus pandemic, Pride 2020 was always set to be different with a digital Pride celebration – FABULOSO – planned by the organisers of the official annual city event. While the Pride event was not taking place due to COVID-19 and the challenges it brings to social distancing safely, its significance could not be cancelled. NHS Brighton and Hove CCG proudly supported the event and were integral to the planning of the city’s Digital Pride - a fantastic way for friends from around the world to tune in and join in our annual Pride celebrations safely from the comfort of their homes.

Flu Champions launched in city This influenza season, Influenza Vaccination Community Champions were launched in Brighton and Hove - members of local communities across the city, who link with the groups we want to target for influenza vaccination. They typically have links or reach within these groups, and are able to cascade information and answer questions. The links they already have support them in the role of being a trusted information source.

Hospitals together In 2020, Western Sussex Hospitals NHS Foundation Trust (WSHFT) and Brighton and Sussex University Hospitals Trust (BSUH) proposed to merge to create a single trust from April 2021. The two trusts have been working in partnership with a shared

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leadership team for nearly four years and during this time WSHFT became the first non-specialist acute hospital trust to be awarded ‘outstanding’ in all the Care Quality Commission’s (CQC’s) key inspection areas and BSUH became the fastest improving acute hospital trust in England, and is now rated ‘good’ overall and ‘outstanding’ for caring by the CQC.

Following engagement with stakeholders, the public and regulators the two trusts are on target to merge formally creating one acute trust called University Hospitals Sussex NHS Foundation Trust.

The 3Ts Redevelopment The 3Ts Redevelopment is a construction programme to modernise the front half of the Royal Sussex County Hospital in Brighton. Split over three stages, the redevelopment will replace all of the buildings on the front of the site with two new clinical facilities and a much needed logistics yard. The redevelopment will provide state-of-the-art accommodation for more than 40 wards and departments. It will improve patient experience across all these services and provide a care environment that enables the best possible healthcare for all. The improvements will benefit patients, staff, visitors and healthcare students. The new facilities will make it easier to deliver care at the bedsides of patients and will help fulfil the Trust’s teaching role as a university hospital. The outpatient facilities will be spacious and modern with innovations that maximise patients’ privacy and dignity. Overall the redevelopment will support the Trust’s roles as a district general hospital, specialist tertiary centre, teaching hub and major trauma centre.

Through 2020/21, construction of the Stage 1 Building has progressed significantly. It is the first of the two new buildings that the 3Ts Redevelopment will provide to house inpatient wards and services and outpatient and diagnostic services. A new helideck is also complete in the centre of the hospital, which will allow patients brought in by air ambulance to be taken directly to the Emergency Department in a dedicated lift.

Once complete the 3Ts Redevelopment will benefit more than one hundred thousand patients, visitors and staff every year.

NHS Brighton and Hove CCG leads ICON launch NHS Brighton and Hove CCG led the Sussex CCGs and their local partners in November 2020 to launch a new campaign to help parents and carers to understand why babies cry and provide a strategy to cope with a crying baby. Research suggests that some parents / care givers may lose control when a baby’s crying becomes too much and this momentary lack of control may result in a baby being shaken with devastating consequences. Shaken baby, now referred to as Abusive Head Trauma, can cause catastrophic brain and physical injuries, which may lead to significant long-term health needs, learning disabilities or even death.

The campaign is designed for practitioners to learn how they can use ICON to support families by helping them to cope with a crying baby, and share the ICON coping techniques with families across their networks.

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Our leadership As we welcomed five new Governing Body members to NHS Brighton and Hove CCG in January 2021, we have also said a fond farewell to our outgoing members: Mike Holdgate, Lay Member Patient and Public Engagement and Charles Turton, Independent Clinical Member Secondary Care. Mike and Charles have both made a huge contribution to the work of NHS Brighton and Hove CCG and have championed many important pieces of work during their time as Governing Body members.

During the past year, the NHS has been through the greatest test in its existence. And we will continue to deal with the many challenges brought about by COVID-19 for the foreseeable future. Every single one of our staff has worked tirelessly throughout this extraordinary period to ensure our local health and care system continues to meet the needs of local people. We once again extend our heartfelt thanks for their dedication and commitment.

Dr Andrew Hodson Adam Doyle Clinical Chair Chief Executive Officer NHS Brighton and Hove Sussex NHS Commissioners Clinical Commissioning Group

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Who we are and what we do

NHS Brighton and Hove Clinical Commissioning Group is a clinically-led statutory NHS body responsible for commissioning the majority of health services for local people.

The CCG is responsible for the health of our entire local population in Brighton and Hove (more than 290,885 people), and is measured by how much we improve health outcomes.

The CCG commissions (pays for) local health services including mental health care, urgent and emergency care, primary care, elective hospital services, and community care.

The CCG is responsible for improving and maintaining the health and wellbeing of people living in Brighton and Hove and for making sure everyone has access to high quality care across the city.

The Governing Body oversees and directs the work of the CCG and the overall aims, commissioning objectives, and priorities are set out by GPs and healthcare professionals.

In addition to commissioning services for people when they are unwell the CCG also makes sure it’s working to prevent the main causes of ill health and premature death, working in partnership with a number of organisations including the membership (Brighton and Hove GPs and primary health care professionals), hospital trusts, mental health trust, community trust, Brighton and Hove City Council, Healthwatch, the local community and voluntary sector, and carers and their families.

The CCG comprises the following directorates:  Chief Executive’s Office  Chief Finance Officer Directorate  Chief Medical Officer Directorate  Communications and Public Involvement Directorate  Corporate Governance Directorate  Estates  Operations Directorate  People Directorate  Primary Care Directorate  Quality and Safeguarding Directorate  Strategy Directorate

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Sussex Health and Care Partnership

Across Sussex, the NHS and local councils that look after social care and public health are working together to improve health and care.

The Sussex Health and Care Partnership (SHCP) brings together 13 organisations into what is known as an integrated care system (ICS). The SHCP takes collective action to improve the health of local people, ensure that health and care services are high quality and to make the most efficient use of our resources.

The NHS Long Term Plan, published in January 2019, set the target for each area of the country to become an ICS by April 2021. An ICS is a way of working across health and care organisations that allows them to work closer together to take collective responsibility for the health and wellbeing of populations across large areas.

This new way of working is based on the priorities and outcomes that matter to local communities and allows all organisations to work together towards the same plan to improve health and wellbeing. This helps local people to stay healthy for longer, to receive more support and treatment at home and, if they do get ill, to ensure they get the right care in the right place at the right time.

Working as an ICS does not affect or replace the existing statutory responsibilities and accountability of health and care organisations.

Over the last few years, health and care organisations across Sussex have increasingly worked together as the SHCP to make sure the experience of local people using services is more joined up and better suits their individual needs. The collaborative way of working has been beneficial in the way health and care organisations across Sussex have responded to the COVID-19 crisis, with partners working together as part of the ongoing emergency to ensure our populations get the care they need.

Looking forward to the year ahead

The Government has published a blueprint for NHS and social care reform which will largely determine the future structure of the health and care system in Sussex in the coming years. The new proposals aim to join up health and care services and embed lessons learnt from the coronavirus (COVID-19) pandemic.

The White Paper www.gov.uk/government/publications/working-together-to-improve- health-and-social-care-for-all is based on proposals that were put forward by NHSE/I in November that outlined the potential future development of ICSs and a preferred option for legislative change. It details some important and significant changes to come through the legislative process, which has implications for the CCG. These include greater partnership working and integration; stripping out needless

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bureaucracy; enhancing public confidence and accountability; and additional proposals to support social care, public health, and quality and safety.

The CCG Governing Body has been discussing the proposals and there is planned engagement across system partners and GP membership in the future development of our health and care system. This will involve more change for CCG staff and they will be central in discussions around how the Sussex system is shaped in the future. The CCG started the new financial year in a very strong position. The work already done to improve the efficiency and effectiveness of how it works means we should look at the future developments with optimism.

The role of commissioning will continue within the new Sussex ICS, and be further strengthened through our close working relationships with our Local Authority colleagues.

The COVID-19 pandemic generated significant clinical innovations and ways of working across the NHS working in partnership with the local authority and the voluntary and community sectors. Many of the changes have been delivered at a pace not previously considered possible. Working together across the SHCP, NHS Brighton and Hove CCG is committed to locking in these innovations that have resulted in improvements to care, safety, patient experience, staff health and wellbeing, and efficiency as we head into the recovery phase. During the past year we have strengthened our system by formalising a new way of working across our organisations. We created collaborations between our acute Trusts, across mental health, and primary and community care, as well as developing further our health and care partnerships across Brighton and Hove, East Sussex and West Sussex. These provided a way in which organisations could work closer together to make collective decisions and actions for the benefits of our populations and staff; a crucial part of effective working in the context of COVID-19. Our collaboratives and partnerships will play a pivotal role as we go into 2021/22 of collectively working to deliver the system-wide and ‘place-based’ priorities for health and care set out by our strategic plans, in response to the commitments made in the NHS Long Term Plan.

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Our local population

The graphic below shows some of the key top-level population data that local health commissioners use to plan services for our communities. This information is pulled from the latest available Joint Strategic Needs Assessment (JSNA), produced by the HWB, which analyses and identifies the current and future health and wellbeing needs of the local population.

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Quality and safety

The delivery of high quality care is core to the CCG’s vision and values. The CCG is dedicated to ensuring high quality services are commissioned and delivered with dignity and compassion to ensure a positive experience for our population.

In line with the CCG’s statutory duty for continuous quality improvement and its vision for quality, through utilising the extensive clinical skills and knowledge of the Quality and Safeguarding team, the CCG can be assured of the quality of care provided, and influence each stage of the commissioning cycle.

One of the ways this has been achieved has been the implementation of a revised Quality Impact Assessment (QIA) protocol in early 2021 for use across the organisation. An internal audit of this process resulted in a positive assurance rating. To ensure continuous improvement, a new QIA policy was also written and approved in March 2021.

Patient Safety The CCG has maintained its statutory function throughout the year to manage serious incidents (SIs) reported by service providers. A dedicated Patient Safety team coordinates this function via fortnightly SI scrutiny panels, to ensure compliance for both the CCG and providers with the national Serious Incident Framework. During 2020/21 the CCG managed 60 SIs (a reduction from 73 in 2019/20).

A plan is in place and on schedule for implementation locally of a new national Patient Safety Incident Response Framework. This was initially due to be implemented in 2021, but has a revised timeline for spring 2022, with full implementation by October 2022. Named Patient Safety Specialists are in place at the CCG in readiness for the new strategy. The CCG has also convened a new Patient Safety Specialists’ forum, which started in December 2020, to enable the sharing of learning across providers, and is planning for a Patient Safety Conference to take place in September 2021 to coincide with World Patient Safety Day.

Patient Experience Patients and their families should always be treated with compassion, dignity and respect. Through established mechanisms, patient experience is regularly measured and learning from service user experiences is widely shared. This important information informs commissioning intentions and quality improvement plans.

In order to improve the quality of services for patients, the CCG has implemented a new feedback system in 2020 called the Provider Quality Improvement Tool (PQIT). This system allows General Practice to report where there is a quality issue in services or pathways. The feedback from this is analysed to identify what actions are needed.

A total of 65 PQIT reports were received in 2020 by the CCG. Actions undertaken include access to faecal immunochemical (FIT) test availability addressed by the Cancer team, an agreed process in relation to direct access computed tomography (CT) scans and pathology specimen collection times being adjusted.

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The CCG has also strengthened the complaints process by ensuring there is clinical quality oversight of complaints received that relate to care and treatment received by our patients.

Infection Prevention and Control Specialist infection prevention training was offered by the Quality team virtually across health, social care and the independent sector due to the pandemic. Across Brighton and Hove 49 out of 91 care homes undertook the training which is a take up rate of 54%. This training programme continues, being regularly updated to reflect current national guidance and is supported by the Local Authority. CCG staff undertook bespoke training from the team, as part of the mandatory training programme, with over 550 attendees.

During the first wave of the pandemic the team delivered specialist training regarding personal protective equipment (PPE) to ensure health and social care staff were protected when delivering respiratory care. This was delivered via a ‘train the trainer’ approach to ensure a wider cascade.

Influenza Vaccination programme The National Influenza Vaccination programme commenced on 1 September 2020. The Sussex ICS has seen an overall increase in influenza vaccination uptake rates across all eligible cohorts during the 2020/21 season with figures above the national average for England. Over 80% of care home residents received a vaccination. Nationally, influenza season has not been announced and ‘flu like illness remains low at 1.0 per 100,000 as at 4 March 2021. As part of the Influenza Vaccination campaign this season, the Sussex CCGs developed a programme for Influenza Vaccination Community Champions with over 25 Sussex Champions receiving additional training and support to encourage uptake across a wide number of local communities.

The final position (as at 28 February 2021) is as follows:

Table: Influenza vaccination results Eligible Cohort NHS Brighton and All Sussex South East Region Hove CCG 65+ years 76.5% 81.8% 81.3% 6m – 65 years 48.5% 54.5% 54.6% at risk Pregnant 45.1% 49.5% 46.3% 2-3 years 61.2% 64.5% 61.8%

Safeguarding The CCG has continued to meet all of its statutory duties in relation to safeguarding, and has gained assurance across its commissioned services. The CCG has established effective safeguarding arrangements inclusive of clear lines of accountability for safeguarding and effective governance. These include specific responsibilities for Looked After Children and for supporting the Child Death Overview process. The Sussex-wide Safeguarding team continues to develop an

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integrated ‘think family’ approach, with aligned portfolios linked to both CCG and NHSE/I priorities.

This year the ICON programme, to support coping with crying babies, has been implemented across the multi-agency partnership. The CCG team hosted a Sussex- wide launch to multi-agency professionals with the aim of raising awareness and promoting messages to prevent Abusive Head Trauma and injuries to babies. ICON stands for:

I – Infant crying is normal C - Comforting methods can help O – It’s OK to walk away N – Never, ever shake a baby

A series of Level 3 blended training packages for safeguarding adults, children and looked after children has been developed and shared to ensure the professional safeguarding competences of CCG and primary care staff are met. These have been well evaluated, and recognised nationally as innovative excellence. In addition, a fortnightly safeguarding newsletter and a quarterly child death review newsletter have been developed to highlight national and local safeguarding guidance, emerging safeguarding issues, and learning from deaths.

Throughout the pandemic the numbers of safeguarding incidents has fluctuated, initially seeing a reduction. In response to this the CCG, in conjunction with the safeguarding partnerships, launched a ‘See something, say something’ media campaign to encourage members of the public to report risks or concerns regarding children, and to prevent ‘hidden harm’.

As each lockdown ended, there was a national surge in safeguarding referrals, and the CCG funded additional health resources in the Multi-Agency Safeguarding Hub to ensure this demand was met.

A key area of focus was understanding and responding to the potential impacts of COVID-19 and pandemic restrictions on looked after children. Identifying health needs in a timely manner continued to be a priority area as statutory health assessments transitioned from face-to-face assessments to virtual appointments. Training packages and supervision were also adapted. Lockdown disrupted the flows of children into care with higher than usual numbers immediately following the ending of lockdowns. Overall there has been a slight increase in the number of children in care in Brighton and Hove.

Reducing health inequalities

NHS Brighton and Hove CCG has the legal duties to reduce health inequalities and give due regard to the requirements of the Equality Act 2010 and also to ensure the equality of service delivery to different groups. In addition, the NHS Long Term Plan commits the NHS to a greater focus on preventing ill health and reducing health inequalities by increasing the NHS’s role in tackling some of the most significant causes of ill health.

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The pandemic has shone a harsh light on pre-existing health inequalities. In August 2020, as part of the third phase of the NHS response to COVID-19, CCGs were asked to work collaboratively with local communities and partners to take eight urgent actions to address inequalities in NHS provision and outcomes. In response the Brighton and Hove place-based system partners came together to approve overarching principles for embedding Health Inequalities into commissioning, transformation, and delivery plans.

This work was informed by an Equalities and Access Cell which was established at the beginning of the pandemic response. The cell produced a report of the impact of the COVID-19 lockdown on women, BAME, faith, lesbian, gay, bisexual, transgender and queer (LGBTQ) and disabled communities and recommendations were directly fed into the plans.

Other work has included:  A pilot project funded to provide services to Transgender people in two GP practices focussed on hormone prescribing and annual health checks  Commissioning the Staying Well Service (mental health crisis café) which provides an out of hours (post 17.00 and weekends) community space, where anyone on the verge of, or experiencing, a self-defined mental health crisis can access non-clinical mental health support  Continued work by Digital Brighton and Hove and Befriending to minimise the impact of COVID-19 for isolated and vulnerable people  Extensive work on homelessness health and care services including the development of the Care and Protect Model recognised as an exemplar nationally together with the successful achievement of Health Foundation, Common Ambition funding awarded to Arch Homeless Healthcare  Specific direction and focus on BAME communities both in regards to addressing health inequalities and restoring services impacted by COVID-19, including the BAME Locally Commissioned Services in GP practices  The Carers’ Centre Brighton and Hove has been awarded £10,000 to complete a scoping exercise that will co-produce and analyse the views on priorities and access to support among unpaid family / friend carers from the LGBTQ, BAME and traveller communities in Brighton. This work will feed directly into the local Carers’ Strategy Group to enable us to ensure our work is inclusive and works to reduce the identified barriers for vulnerable carers in the City  The CCG worked with the local authority’s Public Health team, providers, and community groups to identify areas of low COVID-19 vaccination take-up, primarily in areas of deprivation, and commissioned outreach resources including mobile and ‘pop up’ clinics to ensure access for all patients.

The Sussex CCGs have produced a comprehensive Tackling Health Inequalities Progress Report and Action Plan which includes information about our progress in this area, detail of next year’s priorities and of our new arrangements for oversight and governance.

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Engaging people and communities

Involving People and Communities The CCG has a legal duty to ensure the services it commissions meet the needs of the local population by engaging with and involving patients, carers, communities and the wider public in order to make sure the services commissioned are responsive to need, and deliver the best possible outcomes and standards of care.

The CCG builds local networks and partnerships in order to make sure that the views of our people and communities are heard and responded to, and that we work with people to shape local health services. The insight gathered informs and influences the commissioning work of the CCG. Over the past year, the CCG has worked closely with NHS East Sussex and NHS West Sussex CCGs to align public involvement processes and good practice, whilst ensuring that the need to engage with the unique nature of our local communities is maintained.

Responding to the pandemic The start of the COVID-19 pandemic meant the CCG’s Public Involvement team had to adapt the way it worked, and was repurposed to become Community Connectors. The team linked with contacts in communities, organisations and patient groups to help ensure that they are getting the right information on COVID-19 in the right formats. They supported the cascade of information in alternative formats, developed this information where it did not exist, and provided information and response to questions on issues about accessing health and care services that were affected or where access changed due to COVID-19.

The team has been supporting our communities with accurate and up-to-date information. The team has produced a regular Community Briefing drawing together key national and local updates including information for particular groups and communities on accessing health and care services during the pandemic. The briefing has been cascaded widely through local networks. Most recently, with the launch of the COVID-19 vaccination programme, the team has led targeted engagement with communities to increase uptake. This has involved coordinating community leader meetings to discuss hesitancy and barriers to people receiving their vaccination. In particular there has been targeted work in East Brighton, Moulsecoomb and Bevendean which are some of the most deprived areas of Sussex and as a result these residents have been offered additional opportunities to take up their vaccination closer to home.

The team has also established a Vaccine Enquiry line to respond to concerns and questions from the public and communities in relation to the vaccination programme.

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Big Health and Care (socially distanced) Conversation

In the past year face-to-face engagement with local people ceased and there was a rapid increase in online engagement. The CCG developed the Sussex Health and Care, Your Say online engagement portal to provide a platform for continued involvement: www.sussexhealthandcare.uk/get-involved/

The ‘Big Health and Care (socially distanced) Conversation’ has been a way to gather views and insight to inform how the CCGs across Sussex responded to COVID-19. Feedback was used to shape our communications to the range of communities across Sussex, and was also used to ensure that health services were responding to the needs of local people.

As part of the Big Conversation, views were sought on the changing nature of, and access to, health and care services. This feedback was instrumental in shaping information on how services have changed and our ‘Right Care, Right Place’ information on how to access care appropriately.

In addition, a deliberative piece of engagement known as the “Big Debate” was held whereby a panel of people from across Sussex discussed the topic of self- responsibility in health and care. The results of our ‘Big Debate’ will influence both local and Sussex-wide work to ensure people are informed and supported to self- care effectively, that the voluntary, community and social enterprise sector (VCSE) continue to play a major role in providing information and support, and that people are able to access health and care services appropriately.

It has been important to ensure that there are ways other than online engagement to capture the views of those who cannot engage in this way. Whilst this has been difficult during lockdown, valuable insight has been received through partners such as the VCSE sector, who have maintained relationships with individuals and communities throughout.

Involving our diverse communities Reaching those who cannot engage online has been a priority. In October 2020, the CCGs across Sussex awarded grants to VCSE organisations and partnerships to help support and facilitate engagement with some of our most marginalised communities including Trust for Developing Communities, Switchboard and Hangleton and Knoll project in Brighton and Hove. Insight has been focused primarily on the impact of COVID-19, and the needs of particular groups and communities in this challenging environment. Each grant supports a project which is unique to the needs of that particular community and is supported individually through the Public Involvement team.

As part of the Sussex-wide Black, Asian, and Minority Ethnic (BAME) Disparity Programme, a VCSE partnership in the city was commissioned to undertake research into the experiences and views of our BAME communities. This research, together with similar research carried out in other key areas of Sussex, delivered insights that have been used to ensure our BAME communities are protected from COVID-19 and that steps are taken to address the negative experiences and

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inequalities experienced by some of these communities. As a result, a Brighton and Hove BAME network has been formed to support a solution-focussed approach to the issues raised through the work.

The CCG continues to work with the Local Authority and D/deaf people in our Deaf Services Liaison Forum, which has been instrumental in guiding some of our communications and involvement work to ensure the availability of surveys and information in British Sign Language.

Working in partnership Partnerships have been key to our public involvement work over the past year, and the CCG has built on existing good relationships.

A Brighton and Hove communications and engagement network has been established, drawing together partners in the Local Authority, CCG and Healthwatch to ensure that communications are aligned, and that there is a collaborative approach to hearing from our communities, minimising duplication and making best use of existing insight.

The CCG has participated in groups and cells that brought together partners to respond to COVID-19, including those with a focus on vulnerable people, the homeless, and on providing food to those in need during lockdown. Ongoing participation in the city’s Learning Disability Partnership Board, Volunteering Partnership, and West Hove Forum, and a range of online forums and webinars have assisted in hearing the views of local people.

Patient Participation Groups (PPGs) PPGs are a key way for our local population to become involved with primary care and wider local health services. The citywide PPG Network has moved to virtual meetings over the past year, chaired by an elected PPG representative. The Network continues to have senior CCG attendance, and discussion topics have focused on the impact of COVID-19 and how our PPGs can support robust information sharing, be a source of insight for local GP practices and support the planning for and delivery of COVID-19 vaccinations.

Community Ambassadors Over the past year the CCG launched a Community Ambassador project, and 15 members of the public have now been trained and are supported to participate in our work including bringing a public view to strategic developments and gathering insight from some of our diverse communities. The Community Ambassadors support a wide range of projects and programmes and have participated in staff interview panels, public consultation reviews and in our COVID-19 Vaccination Communications and Engagement Advisory Group.

NHSE Assessment of our public involvement The CCG takes part annually in the national assessment of public involvement, which focuses on public involvement in governance and how the CCG carries out its public involvement responsibilities. In 2019/20, the CCG was assessed as ‘good’ and the result for 2020/21 is expected to be published in summer 2021.

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Health and Wellbeing Board

The CCG is a key member of the Brighton and Hove Health and Wellbeing Board (HWB), which leads on improving the co-ordination of commissioning across the NHS, social care and public health services.

The purpose of the Board is to provide system leadership to the health and local authority functions relating to health and wellbeing in Brighton and Hove. It promotes the health and wellbeing of the people in its area through the development of improved and integrated health and social care services, especially for people, places and communities who currently have the worst health outcomes. It exists to make sure there is a shared and comprehensive understanding of local health and wellbeing needs, and a clear strategy to meet them.

It is responsible for the co-ordinated delivery of services across adult social care, public health, and children and young peoples’ services. This includes decision- making in relation to those services within Adult Services, Children’s Services, Public Health and decisions relating to the joint commissioning of children’s and adult social care and health services (by means of section 75 agreements).

The Board brings together council directors, elected members, Healthwatch, NHS leaders and the VCS to work together and support one another to improve the health and wellbeing of the local population and reduce health inequalities. The Brighton and Hove Health and Wellbeing Strategy provides a bridge between the plans produced by local health and care services and other plans that impact on health and wellbeing in Brighton and Hove. The content of this strategy is reflected in the development and delivery of these plans.

The HWB is established as a Committee of the Council pursuant to Section 194 of the Health and Social Care Act 2012 and the Local Authority (Public Health, Health and Wellbeing Board and Health Scrutiny) Regulations 2013.

Our joint approach to improving health and wellbeing in Brighton and Hove Social, economic and environmental factors have a major impact on our health and wellbeing. Therefore, to achieve our vision, we need Brighton and Hove to be a city where health and wellbeing is everyone’s business.

Partners across the city all have a part to play in ensuring everyone in Brighton and Hove has the best opportunity to live a healthy, happy and fulfilling life.

Key areas for action in Brighton and Hove  Our city: Brighton and Hove will be a place which helps people to be healthy  Starting well: The health and wellbeing of children and young people in Brighton and Hove will be improved  Living well: The health and wellbeing of working age adults in Brighton and Hove will be improved  Ageing well: Brighton and Hove will be a place where people can age well

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 Dying well: The experiences of those at the end of their life, whatever their age, will be improved

The above statement has been drafted in consultation with the Chair of the Health and Wellbeing Board.

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Performance summary: Performance against national standards

The NHS Constitution Standards The NHS Constitution establishes the principles and values of the NHS in England; it sets out the legal rights of patients, the public, and staff and further pledges that the NHS is committed to achieving these. It also sets out the responsibilities of the public, patients and staff. There are a number of core standards against which the CCG is measured in the following areas: planned care and diagnostics; cancer; mental health and dementia; urgent care and continuing health care.

COVID-19 is the greatest challenge the health and care system has faced in living memory, which has made significant impacts on demand, capacity and the performance of NHS services. Thanks to the vaccination rollout, we are moving to restore Sussex service provision while remaining prepared for any future waves of the virus. We aim to build on what we learned to bring about positive change and renewal so that the Sussex system can deliver improvements in health and wellbeing for our population.

Despite an extremely difficult year, the CCG is on track to deliver a number of the NHS Constitutional targets over 2020/21. In areas where the CCG did not achieve the required standards it continues to work in partnership with its health and care providers to agree actions to improve performance and in turn the healthcare that local people receive as summarised below. Further detail about each of the standards can be found in the table at the end of this section.

Urgent and Emergency Care

Four-hour Accident and Emergency (A&E) Standard The NHS Constitution standard states that 95% of patients should be seen and either treated and discharged or admitted within a maximum of four hours of arrival in A&E.

Year-to-date (YTD) (April 2020 to March 2021) for Brighton and Sussex University Hospitals NHS Trust (BSUH) the performance was 84.2% unmapped (86.3% including mapped type 3 activity).

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BSUH percentage in 4 hours or less (trust total - before mapping) 100%

95%

90%

85%

80%

75%

70% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2020-21 National Standard Percentage in 4 hours or less

The sustainability and further improvement in reducing the numbers of beds occupied by patients who are medically ready for discharge (MRD) is a key component of elective recovery, as well as of COVID-19 and winter resilience. The number of Mental Health MRD patients waiting has successfully been reduced, as has the number of patients in out of area placements. Work is ongoing to ensure full system capacity is being utilised. Some improvements have been dependent on delivery of NHSE/I capital funded estates expansion projects which were delayed due to COVID-19, and are now being accelerated, such as the planned modular build at RSCH.

Planned Care and Diagnostics

Referral to Treatment The NHS Constitution states that 92% of patients should wait no longer than 18 weeks from a GP referral to starting treatment. This is known as the 18-week Referral to Treatment (RTT) standard. Locally YTD (April 2020 to March 2021) 58.1% of patients were waiting less than 18 weeks, out of an average of 24,108 patients waiting at the end of each month.

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B&H CCG percentage incomplete within 18 weeks 100%

90%

80%

70%

60%

50%

40% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2020-21 National Standard Percentage incomplete within 18 weeks

The NHS Constitution states that no patients should wait no longer than 52 weeks from a GP referral to starting treatment. Locally YTD (April 2020 to March 2021) 5.6% of waits were greater than 52 weeks, out of an average of 24,108 patients waiting at the end of each month.

B&H CCG percentage incomplete waiting 52 weeks or more 12%

10%

8%

6%

4%

2%

0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2020-21 Percentage incomplete within 18 weeks

Diagnostic waiting times The diagnostic waiting time standard states that no more than 1% of patients should wait longer than six weeks for a diagnostic test.

Locally 41.5% of patients were waiting longer than six weeks (April 2020 to March 2021), out of an average of 5,747 patients waiting at the end of each month. In the

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latest month (March 2021) 16.3% (1,068) of patients were waiting 13 weeks or longer. Whilst this target has not been met during 2020/21, it should be noted that waiting times are very dependent on demand and can be impacted by the demand and capacity of other nearby trusts.

B&H CCG percentage diagnostics waits >6 weeks 70%

60%

50%

40%

30%

20%

10%

0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2020-21 National Standard Percentage of diagnostics >6 weeks

Recovery and restoration of elective services will focus on cancer and high priority patients followed by the longest waiters, as the backlog of demand built-up during the pandemic is cleared. Progress against improvement plans and recovery trajectories continues to be prioritised.

Cancer access The NHS Constitution standards for cancer treatment are:  93% of patients should be seen by a specialist doctor within two weeks of a referral by their GP for suspected cancer  96% of patients should be seen within 31 days from when a decision is made to treat  85% of patients should be seen within 62 days from an urgent referral to the first definitive treatment for all cancers

The CCG has focused closely on improving early diagnosis and timely treatment for cancer patients in Brighton and Hove.

The performance for the standard Two Week Wait From GP Urgent Referral to First Consultant Appointment was 92.7% of CCG patients treated within the 93.0% target.

The performance for the standard One Month Wait from a Decision to Treat to a First Treatment for Cancer was 96.7% of CCG patients treated within the 96% target.

The performance for the standard Two Month Wait from GP Urgent Referral to a First Treatment for Cancer was 75.1% of CCG patients treated within the 85% target.

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B&H CCG percentage first definitive treatment within 62 days of GP referral 90% 85% 80% 75% 70% 65% 60% 55% 50% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2020-21 National Standard Percentage within 62 days of GP Referral

Recovery and restoration of elective services will focus on cancer and high priority patients followed by the longest waiters, as the backlog of demand built-up during the pandemic is cleared. Progress against improvement plans and recovery trajectories continues to be prioritised.

Mental Health Access Targets The NHS has a number of measures for mental health covering children, eating disorders, psychological therapy, dementia and support for those with severe mental illness. The CCG has met four of the standards in 2020/21.

B&H CCG IAPT recovery rate (rolling 3 months) 60%

50%

40%

30%

20%

10%

0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2020-21 National Standard Percentage at caseness who recovered

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B&H CCG IAPT percentage entering treatment within 6 weeks 100%

90%

80%

70%

60%

50% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2020-21 National Standard Percentage entering treatment within 6 weeks

Plans are in place to improve access to psychological therapies (IAPTs) by securing additional capacity sought through on-line packages and on-going focus on recruitment and retention.

Other Commitments Continuing Healthcare (CHC) eligibility decisions made within 28 days of referral was 32.1% of CCG patients receiving a decision within the 80%+ target. Normal CHC assessment processes were suspended nationally for Quarters 1 and 2 as part of the NHS response to the pandemic and alternative provisions were put in place to meet the care needs of this patient group. This resulted in a number of assessments being deferred to Quarters 3 and 4. Recovery and completion of those deferred assessments through Quarter 3 is reflected in the performance figure provided. All deferred assessments in Brighton and Hove were completed by the end of the year. CHC assessments taking place in an acute setting performance was 0% of assessments completed in an acute setting, meeting the less than 15% target. The CCG’s CHC team has reviewed how it works and put in place quality improvement measures that have led to improvements in performance.

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Summary of Current Performance against NHS Constitution Standards Target / Current Performance Measure Threshold B&H Period RTT and Diagnostics YTD average to Mar- RTT 18 weeks incomplete >=92% 58.1% 21 YTD average to Mar- RTT 52+ week waiters 0% 5.60% 21 YTD average to Mar- Diagnostics six weeks <=1% 41.5% 21 Cancer

Cancer - Two week wait >=93% 92.7% YTD to Mar-21

Cancer - Two week wait (breast) >=93% 96.7% YTD to Mar-21

Cancer - 31 day first treatment >=96% 96.7% YTD to Mar-21

Cancer - 31 day surgery >=94% 91.7% YTD to Mar-21

Cancer - 31 day anti-cancer drugs >=98% 100.0% YTD to Mar-21

Cancer - 31 day radiotherapy >=94% 92.4% YTD to Mar-21

Cancer - 62 day GP referral >=85% 75.1% YTD to Mar-21

Cancer - 62 day screening >=90% 73.3% YTD to Mar-21

Cancer - 62 day consultant upgrade >=86% 87.0% YTD to Mar-21

Mental Health and Dementia YTD average to Mar- Dementia estimated diagnosis rate >=66.7% 64.5% 21 IAPT roll-out >=5.5% 2.8% YTD to Feb-21

IAPT recovery >=50% 33.1% YTD to Feb-21

IAPT waiting times - six weeks >=75% 75.6% YTD to Feb-21

IAPT waiting times - 18 weeks >=95% 98.5% YTD to Feb-21 Psychosis treated within two weeks of >=60% 75.7% YTD to Feb-21 referral Improve access rate to Children’s and >=35% 50.1% YTD to Feb-21 Young People’s Mental Health Routine referrals to Children’s and Young People’s Eating Disorder >=95% 52.0% 12 months to Q4 20-21 Services (CYP EDS) (four weeks)

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Urgent referrals to CYP EDS (one >=95% 36.8% 12 months to Q4 20-21 week) Urgent Care (provider - BSUH)

A&E four hours excluding mapped* >=95% 84.2% YTD to Mar-21

A&E four hours including mapped* >=95% 86.3% YTD to Mar-21

A&E twelve hours waiters 0 16 YTD to Mar-21

Other Commitments CHC - eligibility decisions made within >=80% 32.1% YTD to Q4 20-21 28 days CHC - assessments taking place in an <= 15% 0.0% YTD to Q4 20-21 acute setting E-Referral coverage (first outpatient >=92% 12.2% YTD to Feb-21 referrals via eReferral service)

*Mapped’ refers to patients who are classified as using a type three A&E department (that treats minor injuries and illnesses) being allocated to the closest A&E provider for the purposes of monitoring the target

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Key issues and risks The key issues and risks to the organisation are captured in the Board Assurance Framework (BAF). The BAF provides a structure and process that enables the organisation to focus on the risks that might compromise achieving its most important goals and objectives. This is achieved by mapping the controls that are in place to manage those strategic risks and by confirming that the Governing Body has gained sufficient assurance regarding the effectiveness of those controls.

The Governing Body has agreed five overarching corporate goals for 2020/21; these are:

1. Improved population health outcomes and patient experience 2. Restoring high quality and safe services prioritised to meet clinical needs 3. Improved financial performance 4. Delivering system reform 5. Effective and well led organisation with an empowered and inclusive workforce

The BAF captures these five corporate goals and the strategic risks applicable to them. Each goal is assigned to a committee of the Governing Body for scrutiny, monitoring, and testing of the evidence provided to substantiate the levels of control applied.

The eleven strategic risks contained in the BAF during 2020/21 are as follows:

1. Failure to discharge our safeguarding responsibilities effectively 2. Failure to maintain and / or improve the quality and safety of patient care 3. Failure to meet the restoration of NHS services in accordance with the requirements of the Phase 3 letter 4. Failure to improve population health outcomes and to reduce health inequalities 5. Failure to support the recruitment, development, health and wellbeing, and retention of an engaged workforce within the CCGs and the broader system 6. Failure to achieve our financial plans and maintain financial balance 7. Failure to establish effective corporate governance arrangements that enable us to comply with our statutory obligations 8. Failure to effectively plan for a further pandemic situation 9. Failure to effectively implement and manage systems, processes, and an organisational culture that protects the CCG’s reputation with our communities and stakeholders 10. Failure to discharge our system leadership responsibilities and support the effective integration of the Sussex integrated care system 11. Failure to engage effectively with our partners, communities and member practices in the development of partnerships at place and the development of new models of care

In addition to strategic risks, the CCG has also identified a number of operational risks. These are risks to the achievement of the CCG’s corporate objectives. The detail of these operational risks and the way in which they are managed is provided

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in the Governance statement later in this report. The BAF includes the opportunity for committees to escalate concerns from the operational risk register to the attention of the Governing Body.

The BAF includes an assurance update (by exception) on the delivery of the corporate objectives underpinning each corporate goal. In this way the Governing Body has full visibility of the issues and risks that could be impacting on delivery of the overall corporate goals and can gain assurance about the effectiveness of the controls in place to manage them.

The BAF is presented at each meeting of the Governing Body and can be accessed in the papers for the meeting which can be found on the CCG’s website.

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Going concern The annual accounts have been prepared on a ‘going concern’ basis.

Public sector bodies, including NHS Brighton and Hove Clinical Commissioning Group, are assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as evidenced by inclusion of financial provision for that service in published documents. CCGs must therefore prepare their accounts on a going concern basis unless informed by the Department of Health and Social Care (DHSC) of the intention for dissolution without transfer of services or function to another entity.

In February 2021 the Government published a White Paper setting out planned reforms to the health and care system, with a broad move away from competition and internal markets and towards integration and collaboration between services. CCGs will be abolished and Integrated Care Systems (ICSs) established on a statutory footing through both an NHS ICS board and an ICS health and care partnership. The reforms are expected to take effect from April 2022. The commissioning of health services (continuation of service) will continue after April 2022 but may be located in a different structure within the DHSC umbrella. Mergers or a change to the NHS structure, such as an ICS way of working, is not considered to impact on going concern.

In 2019/20 the CCG submitted a five year plan, the Long Term Plan. This established financial plans for the period up to and including 2023/24, and allocations were published covering this period, which evidences the continuation of the provision of services.

The NHS will continue to work in a COVID-19 emergency financial regime for the first six months of 2021/22. Allocations have been issued by NHSE/I for the period 1 April to 30 September 2021 to match expenditure for the period with the expectation of a breakeven outturn. The Treasury will set the NHS funding for the second half of the year in September at which point system allocations will be issued.

The CCG has contributed plans to the system plans submitted to NHSE/I for the first half of 2021/22. The NHSE/I focus in 2021/22 is on system control totals rather than individual control totals. The system plans have been approved by the SHCP Executive and the individual organisations’ Executive Management Teams.

Management is satisfied that the CCG should continue to prepare accounts on a going concern basis due to the aforementioned factors above and because:  NHS Brighton and Hove CCG has received notification of April to September 2021 financial allocations from NHSE/I. We also have no reason to believe that NHSE/I will not continue with these financial allocations to NHS Brighton and Hove Clinical Commissioning Group for October 2021 to March 2022 and subsequent periods thereafter  A draft April to September 2021 financial plan for NHS Brighton and Hove CCG has been prepared and submitted to NHSE/I  This draft financial plan underscores the ongoing financial viability of NHS Brighton and Hove CCG

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In addition, the CCG has identified no threats to operational stability from finance or income that has not yet been approved, which further supports preparing the financial statements on a going concern basis.

Financial summary The CCG’s financial performance for 2020 / 21 is set out in the annual accounts. In summary, the CCG delivered a £113k surplus position and met its running costs target for the year.

The chart below shows how the £496.5m expenditure was shared across the services that the CCG commissioned in 2020 / 21.

NHS Brighton and Hove CCG Net Expenditure £'000

Acute

Community 6,340 63,982 1% 13% 213,164 43% Mental Health

41,409 8% Continuing Health 14,197 Care/Learning 3% Disabilities Other Commissioning 30,883 6%

Prescribing

69,133 14%

57,353 Primary Care and 12% Delegated Commissioning Running Costs

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Financial Overview and Summary The CCGs developed a Long Term Plan (LTP) for 2020/21 and a draft Operational Plan to outline delivery of the LTP. However the COVID-19 pandemic has required an extraordinary response from the NHS to manage the crisis and new financial arrangements and plans have been put in place as a result. A novel financial regime was directed by NHSE/I for 2020/21 designed to support the COVID-19 response and ensure robust financial management of reasonable associated costs.

April – September 2020 For the six-month period from April to the end of September this comprised:  Acute providers being funded through mandated block contracts, and being paid a month in advance  COVID-19 related cost pressures being claimed back directly from NHSE/I subject to reasonable cost assessments  A Hospital Discharge Programme was put in place to promote timely, appropriate discharge from hospital  NHSE/I directly funded some contracts including with Independent Sector Providers and national arrangements with hospices  CCGs operating in a break-even environment with all evidenced overspends being matched by the receipt of additional Revenue Allocations received in arrears. These have been classified to differentiate between COVID-19 related cost pressures and non-COVID-19 related cost pressures  The formal requirement to deliver savings was suspended in recognition of operational pressures and the need to focus resources on the incident response

October 2020 – March 2021 From October 2020 until the end of March 2021, a significantly different financial regime was put in place. The CCG was required to submit financial plans to NHSE/I for this six-month period.

Following discussions with NHSE/I NHS Brighton and Hove CCG moved from its original planned break even position to a planned surplus of £1.067m. The final year end position was an actual surplus of £113k; this was £954k less than planned.

Block contractual arrangements, paid one-month in advance, remained in place for NHS providers throughout the year.

The CCG reclaimed reasonable costs for the Hospital Discharge Programme monthly in arrears. This is the CCG’s most significant area of direct COVID-19 related expenditure.

In 2020/21 the CCG has worked closely with ICS partners to ensure that the system remains within its financial envelope and that, in line with the NHS financial regime, all organisations achieve a break-even position. The system has worked closely and successfully to manage finances and to ensure robust financial governance during a period of significant uncertainty and change.

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Performance Report

Adam Doyle Accountable Officer 14 June 2021

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Corporate Governance Report

This section of the Annual Report enables the CCG to meet key accountability requirements to Parliament. In this section you will find the Corporate Governance Report, which includes:  The Members’ Report  The Statement of Accountable Officer’s Responsibilities  The Governance Statement

Members’ Report

The CCG is formed of local GP practices. The table below shows the practices that make up the membership of the CCG.

Practice name Address

Albion Street Surgery 9 Albion Street, Brighton, BN2 9PS Arch Healthcare Morley Street, Brighton, BN2 9DH Ardingly Court Surgery 1 Ardingly Street, Brighton, BN2 1SS Avenue Surgery 1 The Avenue, Moulsecoomb, Brighton, BN2 4GF Beaconsfield Medical 175 Preston Road, Brighton, BN1 6AG Practice Benfield Valley Healthcare Old Shoreham Road, Portslade, BN41 1XR Hub Brighton Health and 18/19 Western Road, Hove, BN3 1AE Wellbeing Centre Brighton Station Health Aspect House, 84 - 87 Queens Road, Brighton, Centre BN1 2BE Broadway Surgery 179 Whitehawk Road, Brighton, BN2 5FL Carden Surgery County Oak Medical Centre, Carden Hill, Brighton, BN1 8DD Charter Medical Centre 88 Davigdor Road, Hove, BN3 1RF Haven Practice 100 Beaconsfield Villas, Brighton, BN1 6HE Hove Medical Centre West Way, Hove, BN3 8LD Links Road Surgery 27 - 29 Links Road, Portslade, BN41 1XH Mile Oak Medical Centre Chalky Road, Portslade, BN41 2WF Montpelier Surgery 2 Victoria Road, Brighton, BN1 3FS Park Crescent Health Centre 1 Lewes Road, Brighton, BN2 3HP

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Practice name Address

Pavilion Surgery 2 - 3 Old Steine, Brighton, BN1 1EJ Portslade Health Centre Church Road, Portslade, BN41 1LX Preston Park Surgery 2A Florence Road, Brighton, BN1 6DJ Regency Surgery 4 Old Steine, Brighton, BN1 1FZ Saltdean and Rottingdean Grand Ocean, Longridge Avenue, Brighton, BN2 Medical Practice 8BU School House Surgery Hertford Road, Brighton, BN1 7GF Seven Dials Medical Centre 24 Montpelier Crescent, Brighton, BN1 3JJ Ship Street Surgery 65 - 67 Ship Street, Brighton, BN1 1AE St Luke's Surgery Grand Ocean, Longridge Avenue, Brighton, BN2 8BU St Peter's Medical Centre 30 - 36 Oxford Street, Brighton, BN1 4LA Stanford Medical Centre 175 Preston Road, Brighton, BN1 6AG Trinity Medical Centre 1 Goldstone Villas, Hove, BN3 3AT University of Sussex Health University of Sussex, Falmer, Brighton, BN1 9RW Centre Warmdene Surgery County Oak Medical Centre, Carden Hill, Brighton, BN1 8DD Wellsbourne Health Centre Wellsbourne Centre, Whitehawk Road, Brighton, BN2 5FL Wish Park Surgery 191 Portland Road, Hove, BN3 5JA Woodingdean Medical Warren Road, Woodingdean, Brighton, BN2 6PE Centre

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Our Governing Body The Governing Body oversees the decisions that the CCG makes about local health services, ensuring our activities meet the best standards of quality for the local population. The members of the Governing Body as at 31 March 2021 are as shown below.

Dr Andrew Hodson – CCG Clinical Chair

Dr Andrew Hodson has been a GP Partner in Brighton and Hove since 2005, and currently works in General Practice alongside his role as Clinical Chair. He trained at Charing Cross and Westminster Medical School and graduated in 1997 with a BSc in the History of Medicine. Dr Hodson’s experience in practice and working with the membership has given him a strong insight into the needs of patients and the membership in the current challenging environment. It has also given him a passion for furthering the integration of care for patients in a tangible and meaningful way. Andrew was previously the Chief of Clinical Leadership and Engagement before he was elected by the membership into his new role as Clinical Chair in October 2019.

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Adam Doyle – Chief Executive Officer

Adam Doyle is the Chief Executive Officer for the three Sussex Clinical Commissioning Groups (CCGs) – NHS Brighton and Hove CCG, NHS East Sussex CCG and NHS West Sussex CCG. Adam is also the ICS Leader for the Sussex Health and Care Partnership and has worked within the Sussex system for the last four years. Adam has been credited with the significant turnaround of the CCGs in Sussex, having taken the previous seven CCGs in Sussex from an inadequate to good position and has led the reshaping of the Sussex ICS to be one of the most improved systems in the country. Adam has also led the local NHS response to COVID-19 and the COVID-19 vaccination programme. Adam started his NHS career as a physiotherapist and has held a number of senior healthcare roles over the past 15 years which have involved advising government departments on key strategic public policy reforms. Before working in Sussex, Adam was the Chief Executive Officer (Accountable Officer) at NHS Merton CCG in London, where he worked from its establishment in 2013. Prior to this, Adam held a number of Director roles in provider and commissioning organisations in London.

Akeela Ahmed MBE – Lay Member (Patient and Public Involvement)

Akeela Ahmed MBE is a business leader, social entrepreneur, and government advisor specialising in equalities campaigning. She has over fifteen years’ experience of supporting vulnerable individuals with complex social and mental health difficulties, providing high intensity support services to young and homeless people from diverse backgrounds, including refugees, asylum seekers, ex-offenders and Black and Asian ethnic minority groups.

As an entrepreneur in the social housing sector, she set up a Brighton-based community interest company, a social enterprise for homeless people with mental health difficulties. In 2014, Akeela founded ‘She Speaks We Hear’, an online platform bringing women’s voices together, unaltered and unadulterated.

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Faustina Kabie Bayo – Associate Governing Body Lay Member

A Ghanaian by birth, Faustina completed her MA in Rural Development at the University of Sussex in 2006 after her BA in Social Science (Economic/Geography) from KNUST Ghana (2003).

Faustina has a long career working with communities all over Sussex in Community Development and Consultation related projects. Her passion for community and public engagement has enabled her to guide successfully over 150 communities across Sussex to manage change for the benefit of local people.

She has dealt with various stakeholders from national to parish level and currently leads on the Neighbourhood Development Planning support service and Community led consultation projects at Action in rural Sussex. Her skills include, but not limited to, community engagement and consultations, project management, facilitation and steering groups governance and structure.

Karen Breen – Deputy Chief Executive Officer and Chief Operating Officer

Karen has a wealth of experience in the NHS, starting out as a nurse and midwife for many years, and has worked at a local, regional and national level. She previously worked as Chief Operating Officer and Deputy Chief Executive at Epsom and St Helier University Hospitals NHS Trust and Croydon Health NHS Trust and was Executive Director of Delivery and Improvement at Barts Health. Karen worked on national programmes at NHS England, including the integrated care system development programme, and as Programme Director, directly supported the development of the Sussex and East Surrey Sustainability and Transformation Partnership. Karen joined the Sussex Clinical Commissioning Groups in April 2019 and helped to continue the significant progress already made across the commissioning system.

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Allison Cannon – Chief Nursing Officer

Allison Cannon was appointed to the post of Chief Nursing Officer in September 2017. Allison has been a nurse for 30 years and has held a number of senior nurse leadership roles. She has also had leading roles in Quality, Safety and Safeguarding. Allison’s previous roles include Associate Director of Quality at Brighton and Sussex University Hospitals NHS Trust. Allison is a current Florence Nightingale leadership scholar.

Jane Chandler – Independent Member (Registered Nurse)

Jane is the Independent Member – Registered Nurse and is Co-chair of the Joint Quality Committee and the ‘Freedom to Speak Up Guardian’.

Jane completed her nurse training at Addenbrooke’s Hospital and has worked as a nurse in the NHS for over 30 years. Jane has held a number of senior leadership roles covering safety, compliance, quality, risk, safeguarding, clinical governance and infection control.

Jane is passionate about delivering high quality services, patient safety and patient experience.

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Dr Justin Daniels – Independent Member (Secondary Care Clinician)

Justin Daniels is a Consultant Paediatrician at North Middlesex University Hospital NHS Trust in North London. In addition to his clinical role he has held a number of senior management roles and is currently the Associate Medical Director. He is also an Honorary Senior Lecturer at University College London. He works with the National Institute of Clinical Excellence as part of their Technology Appraisal Committee and is a trustee of the Lullaby Trust.

He studied at Nottingham University and worked in New Zealand before moving to London.

As part of his Consultant Paediatric role he is very aware of the impact of deprivation on children and the importance of ensuring that commissioning and local services are integrated to give every child the best chance in life.

Samantha Durrant – Lay Member (Finance and Performance)

Samantha Durrant has had a long career as a senior leader in both the public and private sectors in organisations delivering services to the public. She is now a Portfolio Non-Executive Director. Samantha has worked in a broad range of organisations including the Pensions Regulator and National Employment Savings Trust. She was the UK Chief Operating Officer of a global Health and Benefits consulting firm. Her executive leadership experience includes Business Change, Operations, Casework, Legal, Risk, Audit, Governance, Compliance, IT, Customer Management, Sales and Marketing and Commercial and Outsourcing. Samantha is also a Member of the Board of the Disclosure and Barring Service (DBS) where she chairs the Change Management Committee and is a Member of the Audit and Risk and Quality, Finance and Performance Committees.

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May Gabriel – Associate Governing Body Lay Member

May Gabriel is a young people’s mental health advocate, having volunteered and worked in the field over the last decade. She has been a defining voice for young people’s mental health and set up the award-winning ‘It’s OK Campaign’, which as of 2020 has become ‘It’s OK’ a charity supporting young people with moderate to severe mental illness. May identifies as an LGBTQ+, disabled, woman of colour. Alongside mental health work, May’s passion lies in Equality, Diversity and Inclusion. May was previously the elected Welfare Officer at University of Sussex Students’ Union, and is currently a project manager at Rethink Mental Illness as well as being CEO of It’s OK.

Gill Galliano – Lay Vice Chair

Gill Galliano is Lay Vice Chair at NHS Brighton and Hove CCG. Her previous role was Acting Lay Chair, NHS Coastal West Sussex CCG which she fulfilled for 21 months.

Gill worked in the NHS from 1982 until 2012; her last 18 years were in very senior NHS Board positions including Chief Executive, Finance Director and Commissioning / Operations Director.

She is a founding Governing Body member of a community interest company and runs her own consultancy and coaching business.

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Dr Elizabeth Gill – Chief Medical Officer

Elizabeth qualified from St Bartholomew’s Medical School in 1996. She worked in a variety of hospital jobs at Barts, the Royal London and Homerton, including as a staff grade in the A&E at the Royal London as part of the trauma team.

Elizabeth then moved to Brighton to pursue her GP career. Elizabeth has worked at Buxted surgery since 2003 where she completed her GP training, gaining her MRCGP. She became a partner and GP trainer in May 2010.

Elizabeth became Practice Based Commissioning Chair for High Weald in October 2010, then NHS High Weald CCG Chair, and was elected as Chair of NHS High Weald Lewes Havens CCG upon its merger in May 2012. Elizabeth successfully passed the Chair Assessment unconditionally in September 2012.

Elizabeth also has a BA (Hons) in Fine Art and a Postgraduate Certificate in Education from the University of London (Institute of Education) to support her role as a GP trainer for the Kent, Surrey and Sussex Deanery.

Nina Graham – Locality Representative

Nina Graham is the managing partner at Charter Medical Centre, where she has responsibility for all aspects of business management, including service delivery, planning and processes.

Nina has 12 years’ experience in General Practice, having worked at other practices across the city before going to Charter Medical Centre.

Nina was born and raised in Brighton and is passionate about delivering high quality health care for the local population.

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Jim Hayburn – Chief Finance Officer Jim became Chief Finance Officer for the Sussex CCGs on 20 January 2021.

He is an experienced finance professional who has worked at many levels within the NHS, including at NHS England, Acute Providers, and at CCGs. Jim was appointed to his first Director of Finance post in 1994 at Sandwell NHS Trust. Since then he has had a number of board roles including Chief Executive and Accountable Officer roles in both provider and commissioner organisations. He has considerable experience of system working, including being the Director of Finance for NHS England Area Team Lancashire for two years. Most recently, Jim has been working as the interim Director of Finance at Northern Lincolnshire and Goole NHS Foundation Trust.

Dr Jerry Luke – Independent Member (GP)

Jerry qualified as a doctor in 1985 and as a GP in 1990. He was a Partner in that Practice for 30 years. Whilst a Partner he had a varied set of roles including being a forensic medical examiner, a prison doctor, and a GP specialist in a substance misuse clinic. For several years he was a GP trainer and involved in medical student education.

Jerry has just stepped down to work one day per week at a neighbouring Practice and three days per week for the Local Medical Committee (LMC). Within the LMC he has several specialist roles including being the Transgender lead and dealing with Coroners and the Police Service. Outside of work Jerry’s greatest joy is being an active, ‘hands on’ Grandad.

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Dr Sangeetha Sornalingam – Locality Representative Sangeetha is committed and passionate about general practice. She grew up in Brighton and returned to complete her GP training in 2010. She has in-depth knowledge of the area, its population health needs and the practices. She has worked in Brighton and Hove practices as a GP since qualifying and currently does so as a GP locum, which has enabled Sangeetha to work across and build relationships with multiple practices in the city.

As part of her portfolio of work, she teaches both undergraduates and postgraduates in general practice and so is up to date with the current training and needs of the future workforce. Sangeetha completed a Darzi fellowship in leadership with Benfield Valley Healthcare Hub focusing on the needs of the local population and connecting with community organisations. Having been an Associate Professor of Healthcare Systems, she has a good understanding of change management, high- performing healthcare systems and Primary Care Network priorities.

Andrew Taylor – Lay Member (Governance) Andrew chairs the Audit and Assurance Committee and is the CCG’s Conflicts of Interest Guardian. He holds a number of non-executive positions and owns his own company providing interim executive and consultancy support in the public, social housing and not for profit sectors.

He is a fellow of the Chartered Institute of Public Finance

and Accountancy (CIPFA), with significant experience in all areas of risk management, corporate governance, merger and integration, regulatory compliance and stakeholder management.

After a career in finance, including executive roles, Andrew moved into general management and from 2008 to 2016 he was Chief Executive of Sutton Housing Partnership. In that role he oversaw the transformation in performance, increasing resident satisfaction and led the delivery of capital projects.

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During 2020/21 there were the following changes to the membership of the Governing Body:  Chris Adcock was the Chief Finance Officer for the Sussex CCGs until 16 February 2021 and left the Sussex CCGs on 16 February 2021  Dr Tim Caroe was the Joint Chief Medical Officer until 19 January 2021  Malcolm Dennett was the Lay Member (Governance) until 31 May 2020  Mike Holdgate was the Lay Member for Patient and Public Engagement until 31 January 2021  Dr Charles Turton was the Independent Member – Secondary Care Clinician until 31 January 2021.

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CCG Committee Structure

The Governing Body is supported by a robust committee structure; this is illustrated in the following diagram.

CCG Governance Structure Audit and Assurance Committee

Joint Committee of the Sussex CCGs

Joint Finance and Performance Committee GP Membership Governing Body

Joint Quality Committee

Primary Care Commissioning Committee

Remuneration and Nominations Committee

Within this structure, consistent with governance best practice, each committee has a robust set of terms of reference describing its membership and the scope of its authority and has a detailed work programme. These terms of reference are reviewed at least annually and amended in respect of the evolving needs of the CCG. As part of the review of each committee, we maintain a record of attendance of the committee’s membership. These records of attendance may be found later on in this report.

Highlights of the work of the Governing Body over the year:

 BSUH system discharge improvement plan  Establishment and authorisation of the new CCG Constitution  Homelessness – Response to COVID-19 and Transformation Programme  Integrated Care System developments  NHS People Plan, specific focus on areas such as the Gender pay gap, the Learning Disability Employment Programme, the Workforce Disability Equality Standard, and the Workforce Race Equality Standard  Oversight of the CCG’s response to national guidance relating to the COVID- 19 pandemic including assurance system established by Sussex CCGs to

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assess the impact of COVID-19 related guidance from a quality, health equalities, inequalities and CCG statutory functions perspective, interim governance arrangements, and system response  Response to Health Inequalities  Restoration and Recovery  Review of strategic risks to corporate goals and objectives; Board Assurance Framework  Sussex BAME COVID-19 Disparity Response  Sussex-wide Children and Young Persons' Emotional Health and Wellbeing Services  Updates on Finance and Performance, Quality and Safety, Primary Care, via Committee Chair reports (in latter part of 2020/21)

The full terms of reference for each committee are published on the CCG’s website. A brief description of each committee is set out below:

Audit and Assurance Committee The Audit and Assurance Committee (AAC) provides the Governing Body with assurance that the CCG’s systems of internal control are working effectively and the CCG is acting in compliance with law and best practice. In addition to the normal functions of an audit committee, the AAC also has an enhanced responsibility to provide assurance in respect of the CCG’s management and oversight of risk.

The Committee is chaired by the Lay Member for Governance who has the necessary qualifications, expertise, and experience such as to enable them to express informed views about financial management and audit matters. The Lay Member for Governance does not chair any other committee in order that they remain fully independent as is consistent with good governance practice. The Lay Member for Finance and Performance and the Independent Member (GP) are also members of the AAC.

During 2020/21 the NHS Brighton and Hove CCG AAC has held most of its meetings ‘in common’ with the NHS East Sussex and NHS West Sussex CCGs’ AACs.

Highlights of the work of the Audit and Assurance Committee over the year:

 Continued monitoring of the Mental Health Investment Standard Action Plan  Deployment of Board Assurance Framework and operational risk register  Development of strategy for management and reporting of risk throughout the organisation  Oversight and assurance on a range of statutory and organisational functions including information governance, financial compliance and policies, policy review, EU Exit period preparedness, virtual meeting governance  Review of audit reports and oversight of internal and external audit programme for 2020/21

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Joint Committee of the Sussex CCGs The Joint Committee of the Sussex CCGs (JSC) has a key assurance role around planning for restoration and recovery as the CCG returns to business as usual. This will include, but not be limited to, the managed return of the CCG’s commissioning functions. The JSC will seek to capture and draw out lessons learnt from across the Sussex CCGs in their response to the Covid-19 pandemic. The JSC will ensure effective partnership working which supports the work of the Sussex Health and Care Partnership and Integrated Care System (ICS) as well as provide assurance around plans and strategies that span all of the CCGs.

The Committee is chaired by the Clinical Chairs of the Sussex CCGs on a six-month rotational basis. The membership is drawn from the Lay Vice Chairs, Lay Members for Finance and Performance, and Locality Representatives of the three Sussex CCGs.

Highlights of the work of the Joint Committee of the Sussex CCGs over the year:

 CCG Strategic developments o Corporate Objectives, ICS development, People Plan development, Sussex Vision 2025, WRES,  Focus on COVID-19 o COVID-19 decision making and governance oversight o Restoration, recovery and transformation plans and implementation o System Emergency Planning Resilience and Response  Reviewed the totality of the CCGs’ risk profiles  Updates and reviews of business cases and models for future services (including future musculo-skeletal (MSK) model of care, 3Ts addendum, IT Services re-provisioning)

Joint Finance and Performance Committee The Joint Finance and Performance Committee (JF&PC) was specifically created to advise and support the Governing Bodies of the Sussex CCGs in scrutinising and tracking delivery of key financial and service priorities, outcomes and targets as specified in the Sussex CCGs’ strategic and operational plans or such other requirements as directed by NHS England. The JF&PC also acts as a focal point for seeking assurance around in-year performance and financial issues.

The Committee is chaired by the Lay Members for Finance and Performance of the Sussex CCGs on a rotational basis and its membership includes the organisations’ Independent Clinical Member – Registered Nurses, the Lay Members for Governance, and Locality Representatives.

The Finance and Performance Committee has extensively focused on the CCG’s financial position thus providing the Governing Body with a greater degree of assurance in this key area.

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Highlights of the work of the Joint Finance and Performance Committee over the year:

 Finance contracting and performance-related operational risk scrutiny  Financial Procedures and new financial reporting  Implementation of the Sussex Integrated Urgent Care (IUC) System  IT Services Re-provisioning Programme  Mental Health Investments  Non-Emergency Patient Transport (NEPTS) – Contract Award  Performance and Planning: Phase 3 Report and Restoration Programme  Performance reporting and oversight  Prescribing Budget Cost Pressure Analysis  Procurement and Contracting  Winter Resilience Plan

Joint Quality Committee The Joint Quality Committee (JQC) is responsible for providing the Governing Bodies with assurance that there are effective quality arrangements in place and that patient safety is being monitored effectively. The JQC is additionally responsible for ensuring that the CCGs are effectively engaging with patients and the public in the commissioning of services.

The JQC supports the Governing Bodies in ensuring that commissioning decisions are based on evidence of clinical effectiveness and influenced by patient experience, feedback, and need. In this way, the Committee promotes patient safety and a positive patient experience in line with the principles of the NHS Constitution, the CCGs’ values, and the requirements of the CQC.

The Committee is chaired by the Independent Clinical Member – Registered Nurses of the Sussex CCGs on a rotational basis and its membership includes the Lay Members for Patient and Public Engagement, Independent Clinical Members – Secondary Care Clinicians, and Locality Representatives as well as the Chief Medical Officer and the Chief Nursing Officer.

Highlights of the work of the Joint Quality Committee over the year:

 Public and patient involvement and engagement reports  Review and scrutiny of provider quality reports including focus on serious incidents and related learning and impact of COVID-19 (for example, on Cancer targets)  Review of quality and safety-focused risks  Review of the progress relating to the COVID-19 Mass Vaccination Programme (from December 2020 onwards)  Quality Impact Assessment reports and oversight and focus on the assurance around the quality aspects of commissioned services (such as the Children’s and Young People’s Emotional wellbeing service)  Safeguarding, including updates on Looked After Children

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Primary Care Commissioning Committee The Primary Care Commissioning Committee (PCCC) has been established to make collective decisions on the review, planning, and procurement of primary care services in the Brighton and Hove area under delegated authority from NHS England.

The Committee’s principal function is to ensure that the local arrangements for the commissioning of primary care services are undertaken with the utmost regard to the effective management of any actual or potential conflicts of interest. It also provides assurance to the Governing Body as to the development of the Primary Care Strategy with specific focus upon Primary Care Networks.

The Committee is chaired by the Lay Vice Chair and its membership consists of the Lay Member for Patient and Public Engagement, the Independent Clinical Member – Secondary Care Clinician, the Independent Clinical Member – GP, the Chief Finance Officer, and the Chief Nursing Officer.

The operation of the Committee is consistent with NHSE guidance, which can be found at: www.england.nhs.uk/commissioning/pc-co-comms/resources/

Highlights of the work of the Primary Care Commissioning Committee over the year:

 Developments and Boundary Changes o Portslade Health Centre Additional Room Requirement o Wellsbourne Boundary changes approval  Locally Commissioned Services; reintroduction and harmonisation  Primary Care Estates  Primary Care Quality and Finance reporting  Primary Care Strategic Priorities for 2021/22  Public and key stakeholder survey regarding accessing health and care services remotely  Restoration and Recovery Workplan, GP Forward View, Extended Access and Primary Care Network developments  Review and scrutiny of primary care risks

Remuneration and Nominations Committee All CCGs are required to have a Remuneration and Nominations Committee to decide on matters relating to the remuneration policy within the CCG and considering nominations for the appointment of new members of the Governing Body. The Committee makes recommendations on the remuneration, benefits, and terms of service of employees of the CCG. Additionally the Committee oversees the appraisal process of the Governing Body members. The Committee is chaired by the CCG’s Lay Vice Chair and its membership consists of the Clinical Chair and the Lay Member for Patient and Public Engagement.

The work of this Committee during 2020/21 is outlined in the Remuneration and Staff Report.

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Annual Review of Committee Effectiveness Every year the CCG’s committees are asked to undertake a review of their effectiveness; this is consistent with good governance practice and ensures that the committees promote a cycle of continuous improvement.

This annual review considers the Committee’s functioning and its work in discharging its responsibilities, delivering its objectives and complying with its terms of reference. The Audit and Assurance Committee approved the refined approach to the Annual Review of Committee Effectiveness for 2020/21 at its meeting on 23 February 2021.

Audit and Assurance Committee Positive assurances were received regarding the value added to the CCGs, the agendas, the competencies and behaviours of the committees’ memberships, the level of participation and outcomes from discussions, how the meetings are chaired, and the overall linkage back to the Governing Body and other committees.

It was proposed that there is some work undertaken regarding the frequency and duration of meetings, the time available for discussion given the long agendas, consideration of wider membership of the Committee beyond Lay Members and the Independent Clinical Member (GP) and ensuring that there is minimal duplication of material from other committees.

Joint Finance and Performance Committee The results strongly suggested that the Committee is performing its role well. The areas identified as opportunities for improvement were relating to the frequency of meetings, the quality of papers, the linkages and information flows with other committees, the level of discussions, the time available for discussion, and the chairing approach.

The three Chairs agreed to discuss with the Chairs of the Joint Quality Committee options for improving linkage and flow between the two committees, to move some standing items to a less frequent basis to allow more time for discussion of other core items, to invite paper authors to deliver a short introduction to their paper if they wanted to, and to ask the Chief Finance Officer to review the Forward Work Plan.

Joint Quality Committee The review indicated that the Committee is performing its role well with the behaviours of those present contributing to an effective and positive meeting, the agendas being relevant, timely and clear, and everyone having the opportunity to contribute to the discussions. The areas identified as opportunities for improvement were relating to the agendas, the length of some reports, the linkage with the Joint Finance and Performance Committee, and consideration of introducing focused discussions regarding areas of achievement and of concern.

Joint Committee of the Sussex CCGs The review achieved high scores for effectiveness with 100% of respondents either agreeing or strongly agreeing that the Committee contributes to the delivery of results and adds value to the organisation, the papers being of good quality and

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issued within good time, and the behaviours of those present contributing to an effective and positive meeting.

The Chair is proposing to work with the executive lead on improvements including a clearer forward plan with clarity on the role of the Committee acting on behalf of the Governing Body, and continued work to improve the quality of papers to recognise the distinction between reassurance and assurance. It was felt that the papers should more clearly articulate the work underway and outcomes achieved and stimulate questions from Committee members.

Primary Care Commissioning Committee It was acknowledged that the arrangements had changed during the year as the Committee now meets ‘in common’ with those of the other two Sussex CCGs. Positive feedback was received on chairing and the content of agendas. It was commented that the recent changes to the responsibilities of the Primary Care Operational Group has had a positive effect on how the Committee operates.

It was acknowledged that there is a need to look at how to engage with the public more effectively and this approach can be developed with Healthwatch. The Committee is to retain the ability to be place-focused.

Remuneration and Nominations Committee The Committee has been meeting ‘in common’ with those of the other two Sussex CCGs and the meetings are being held virtually, which has been working well due to the relatively small number of people involved and the effective chairing. The review indicated that the Committee contributes to the delivery of results and adds value to the organisation, it possesses the required competencies to fulfil its duties, and there is appropriate linkage and flow with other committees and the Governing Body. It was also stated that the discussion takes place at the right level for the purpose of the Committee.

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Register of interests The CCG keeps a register of interests and a register of gifts and hospitality declarations. The registers for Governing Body members and managers classed as ‘decision makers’ (band 8a and above) can be found on the CCG’s website at: https://sussexccgs.mydeclarations.co.uk/declarations

Personal data related incidents There have been no serious untoward incidents relating to data security breaches which required reporting to the Information Commissioner’s Office (ICO) during the course of 2020/21 for the CCG.

Statement of Disclosure to Auditors Each individual who is a member of the CCG at the time the Members’ Report is approved confirms:  So far as the member is aware, there is no relevant audit information of which the CCG’s auditor is unaware that would be relevant for the purposes of their audit report  The member has taken all the steps that they ought to have taken in order to make him or herself aware of any relevant audit information and to establish that the CCG’s auditor is aware of it.

Modern Slavery Act NHS Brighton and Hove CCG fully supports the Government’s objectives to eradicate modern slavery and human trafficking but does not meet the requirements for producing an annual Modern Slavery and Human Trafficking Statement as set out in the Modern Slavery Act 2015.

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Statement of Accountable Officer’s Responsibilities

The National Health Service Act 2006 (as amended) states that each Clinical Commissioning Group shall have an Accountable Officer and that Officer shall be appointed by the NHS Commissioning Board (NHS England). NHS England has appointed the Chief Executive Officer to be the Accountable Officer of NHS Brighton and Hove Clinical Commissioning Group.

The responsibilities of an Accountable Officer are set out under the National Health Service Act 2006 (as amended), Managing Public Money and in the Clinical Commissioning Group Accountable Officer Appointment Letter. They include responsibilities for:  The propriety and regularity of the public finances for which the Accountable Officer is answerable,  For keeping proper accounting records (which disclose with reasonable accuracy at any time the financial position of the Clinical Commissioning Group and enable them to ensure that the accounts comply with the requirements of the Accounts Direction),  For safeguarding the Clinical Commissioning Group’s assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities).  The relevant responsibilities of accounting officers under Managing Public Money,  Ensuring the CCG exercises its functions effectively, efficiently and economically (in accordance with Section 14Q of the National Health Service Act 2006 (as amended)) and with a view to securing continuous improvement in the quality of services (in accordance with Section14R of the National Health Service Act 2006 (as amended)),  Ensuring that the CCG complies with its financial duties under Sections 223H to 223J of the National Health Service Act 2006 (as amended).

Under the National Health Service Act 2006 (as amended), NHS England has directed each Clinical Commissioning Group to prepare for each financial year a statement of accounts in the form and on the basis set out in the Accounts Direction. The accounts are prepared on an accruals basis and must give a true and fair view of the state of affairs of the Clinical Commissioning Group and of its income and expenditure, Statement of Financial Position and cash flows for the financial year.

In preparing the accounts, the Accountable Officer is required to comply with the requirements of the Government Financial Reporting Manual and in particular to:  Observe the Accounts Direction issued by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis  Make judgements and estimates on a reasonable basis  State whether applicable accounting standards as set out in the Government Financial Reporting Manual have been followed, and disclose and explain any material departures in the accounts

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

To the best of my knowledge and belief I have properly discharged the responsibilities set out under the National Health Service Act 2006 (as amended), Managing Public Money and in my Clinical Commissioning Group Accountable Officer Appointment Letter.

I also confirm that, as far as I am aware, there is no relevant audit information of which the CCG’s auditors are unaware and that, as Accountable Officer, I have taken all the steps that I ought to have taken to make myself aware of any relevant audit information and to establish that the CCG’s auditors are aware of that information.

Adam Doyle Accountable Officer 14 June 2021

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Governance Statement

Introduction and context

NHS Brighton and Hove Clinical Commissioning Group (CCG) is a body corporate established by NHS England on 1 April 2013 under the National Health Service Act 2006 (as amended).

The CCG’s statutory functions are set out under the National Health Service Act 2006 (as amended). The CCG’s general function is arranging the provision of services for persons for the purposes of the health service in England. The CCG is, in particular, required to arrange for the provision of certain health services to such extent as it considers necessary to meet the reasonable requirements of its local population.

As at 1 April 2020, the CCG is not subject to directions from NHS England issued under Section 14Z21 of the National Health Service Act 2006.

It is fair to say that 2020/21 has been like no other in the history of the NHS. We have had to continuously review and revise where necessary our governance arrangements across the three Sussex CCGs (NHS Brighton and Hove, NHS East Sussex and NHS West Sussex CCGs), as we have sought to address the COVID-19 pandemic and deliver our statutory duties and requirements as well as planning for the restoration and recovery of services.

We started the year with a refocused and renewed CCG governed by a new Governing Body that bought together individuals with a range of experiences and backgrounds. The CCG also started 2020/21 with a new Constitution and accompanying Governance Handbook, which set out a clear governance-operating model for the CCG, based on governance best practice.

Prior to 1 April 2020 however, there were two significant contextual matters, which collectively helped to shape extensively much of our governance during 2020/21:  Firstly, the NHS declaration of a Level 4 National Incident on 30 January 2020 in response to COVID-19 and the fast-moving moving landscape thereafter, as the NHS and the country responded to COVID-19  Secondly, NHSE/I issued on 28 March 2020 guidance entitled “Reducing the burden and releasing capacity at NHS providers and commissioners to manage the COVID-19 pandemic

These contextual elements required the three Sussex CCGs to revisit and scale back non-essential functions at the start of 2020/21. This included a fundamental revisiting of both the schedule, format and purpose of Governing Body and committee meetings, with a need to focus any meetings on matters of immediate importance addressing significant risks. Consequently, from April 2020 onwards, we implemented a range of transitional governance arrangements. These transitional governance arrangements were developed through extensive discussions with Governing Body members and characterised by a set of governance measures that were robust and transparent. This included most significantly:

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 A specific Scheme of Reservation and Delegation guided our decision-making during this period. This was developed with expert governance and legal support, ensuring clarity around our decision-making processes  Maintaining a clear record of key decisions taken which ordinarily would have been discussed within a CCG committee, with the Clinical Chairs, Lay Vice Chairs, Lay Members for Governance, as well as Lay Members for Finance and Performance providing scrutiny, challenge and oversight  Refocusing our committee memberships so that clinical members of the Governing Body were rightly able to devote their time to addressing the COVID-19 pandemic  Scaling back some of our committee schedules and funnelling key governance issues and oversight of financial and performance matters through a single Joint Committee operating across the three Sussex CCGs, whilst maintaining our focus on patient quality and safety

In summer 2020 as we moved beyond the initial phase of addressing the COVID-19 pandemic, these transitional governance arrangements were revisited and revised in the light of further national guidance on ‘reducing the burden’. This meant we were able to reinstate much of our governance architecture but crucially, with all statutory committees operating from this point onwards on an ‘in common’ basis and all non- statutory committees operating on a ‘joint’ basis across the three Sussex CCGs. This recognised that a significant number of issues for which the committees were responsible had commonality across the three Sussex CCGs but also within these arrangements, space and flexibility was created to have CCG-specific discussions on items that were particular to any one of the three organisations.

The COVID-19 pandemic and the need to socially isolate in line with Government guidance also meant that in 2020/21 all our Governing Body and Committee meetings have had to be held virtually. Initially this meant that the meetings of the Governing Body and of the Primary Care Commissioning Committee, which are usually held in public, were not held in public for a number of months; instead the meetings were recorded and the recordings made available on the CCG’s website. By late summer we reinstated these meetings being held in public by introducing the functionality for members of the public to be able to observe these meetings in real time.

It is a testament to the collective strength and resilience of our Governing Body that they rapidly became accustomed to this new way of virtual working. To support this approach, an extensive and detailed development programme has been a key feature of 2020/21. This has included a range of softer initiatives designed to enable Governing Body members to get to know each other and function together effectively in this new ‘virtual world’ of work.

This new way of working was underpinned by the delivery in April 2020 of an innovative induction and orientation programme for all Governing Body members, which has been critical in ensuring all Governing Body members clearly understand their roles and responsibilities. This has been ongoing during 2020/21 with bi- monthly development sessions which have maintained a strong developmental theme, designed to enhance the collective skill set of Governing Body members and softer skills development. These bi-monthly development sessions have also

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provided the space for in-depth discussions on a range of strategic topics. These sessions have been supplemented by a whole range of informal development between Governing Body members, between Lay and Independent Governing Body members and their executive director counterparts, and with colleagues across the three Sussex CCGs. All of which have had the collective aim of promoting effective team working and developing our Governing Body as a ‘social system’, which is a key marker for good corporate governance.

We have during 2020/21 undertaken a detailed and extensive review of the way our operational risk register and Board Assurance Framework (BAF) are designed as well as taking a fundamental look at their content to ensure that they are dynamic and reflect the way risks across all domains have been affected by the COVID-19 pandemic. This work has been critical in ensuring that the risk register and BAF remain relevant and dynamic documents that are key pillars of our internal control mechanisms and we say more about that later in the Annual Governance Statement.

As part of our desire to ensure that we continuously review and revisit our thinking and approach to governance, we undertook a further review of the CCG’s Constitution and accompanying Governance Handbook in autumn and winter 2020. Underpinning this process of review has been an extensive period of engagement with Governing Body members and it has ensured that our governance arrangements remain relevant and appropriate to the way the CCG operates individually and collectively with the other two Sussex CCGs.

This context shows how much has happened in twelve months and reflects how our Governing Body has evolved and responded dynamically to the COVID-19 pandemic during 2020/21. It also highlights that the extensive period of engagement with Governing Body members at all key phases during the year, as our thinking on the CCG’s overall governance arrangements has evolved, has ensured that we have maintained a robust set of governance arrangements for the CCG throughout 2020/21. Finally, this provides a strong platform upon which to build in 2021/22.

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Scope of responsibility

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

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

Governance arrangements and effectiveness

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

The main features of the governance of NHS Brighton and Hove CCG are described in detail below, including the governance structures within the CCG and relationship between the CCG and its membership.

CCG Membership The CCG is a membership organisation for the 34 GP practices within Brighton and Hove. The membership meets collectively and the representatives of each GP practice discuss the direction of the CCG, its plans for commissioning services, and seek assurance that commissioned services are performing effectively. As a clinically led organisation, it is important for the CCG to have clinical leadership, which represents the views of the membership at the most senior level.

Under the scheme of delegation, contained within the Constitution, the CCG’s membership has reserved to it a number of key decisions. A copy of the scheme of reservation and delegation may be found on the CCG’s website.

Since 1 April 2017, the CCG has had delegated authority for the commissioning of primary medical care. This has enabled the CCG, guided by its membership, to take greater control of primary care commissioning within Brighton and Hove and to do so in a way that supports the CCG’s overall strategic plans for robust and resilient primary care services in the city.

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

The Governing Body has responsibility for ensuring good governance arrangements are in place and, as well as its main functions, the membership has assigned the following specific duties to the Governing Body:  Approving any functions of the CCG that are specified in regulations  Approving a report, received from the Chief Finance Officer, showing the total allocations received and their proposed distribution including any sums held in reserve  Approving budgets prepared and submitted by the Chief Finance Officer prior to the start of the Financial Year  Approving the timetable for producing the annual report and preparing the accounts  Determining the remuneration, fees, and other allowances payable to employees or other persons providing services to the CCG and the allowances payable under any pension scheme it may establish under paragraph 11(4) of Schedule 1A of the National Health Service Act 2006  Ensuring that the CCG has appropriate arrangements in place to exercise its functions effectively, efficiently, and economically and in accordance with the CCG’s principles of good governance (its main function)  Leading the setting of vision and strategy  Monitoring performance against plans  Performing any of the functions in the Constitution and the Scheme of Reservation and Delegation which have been identified as being delegated to the Governing Body  Providing assurance of the management of strategic risk  Receiving and approving (where necessary) reports from the Chief Finance Officer which monitor financial performance against budget and plan  Recommending to the CCG the annual commissioning plan, annual report and annual accounts by presentation of the same to the Members at a membership meeting  Such other functions as may be conferred or delegated to the Governing Body from time to time.

The Governing Body meets formally in public. The COVID-19 pandemic and the need to socially isolate in line with Government guidance meant that in 2020/21 all our Governing Body meetings have had to be held virtually. Initially this meant that the meetings of the Governing Body were not held in public for a number of months; instead the meetings were recorded and the recordings made available on the CCG’s website. By late summer we reinstated these meetings being held in public by introducing the functionality for members of the public to be able to observe these meetings in real time.

The Governing Body also meets informally to discuss matters that arise and to give an opportunity for development and training. This is part of an ongoing process

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which continues to be further strengthened through our organisational development activities.

As a clinically led organisation, it is necessary for there to be strong clinical representation on the Governing Body and on its committees.

Further details including the responsibilities, memberships and attendance records for the committees can be found elsewhere in this Governance Statement:  Information about the Membership Body and Governing Body, including key responsibilities, membership, attendance records and highlights of their work over the year  Information about the committees of the above, including key responsibilities, membership, attendance records, and highlights of their work over the year  The performance of the Membership Body and Governing Body, including their own assessment of their effectiveness.

UK Corporate Governance Code

NHS Bodies are not required to comply with the UK Code of Corporate Governance.

Discharge of Statutory Functions

In light of recommendations of the 1983 Harris Review, the CCG has reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislative and regulations. As a result, I can confirm that the CCG is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions.

Responsibility for each duty and power has been clearly allocated to a lead Director. Directorates have confirmed that their structures provide the necessary capability and capacity to undertake all of the CCG’s statutory duties.

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Risk management arrangements and effectiveness

The CCG recognises that risk management is an integral part of good management practice and to be most effective it must be embedded within the organisation’s culture. The overall structure and content of the CCG’s risk management arrangements replicate best practice principles and provides me with assurance as Chief Executive Officer that the CCG’s overall risk management arrangements are robust and fit for purpose.

The Sussex CCGs’ Risk Management Strategy and Policy was updated in 2020 to reflect the fact that risk is now managed centrally across the three CCGs. The purpose of the document is to define the strategy and policy that the CCGs use to ensure rigorous risk management processes, and provide the tools to assist staff to ensure, as far as is reasonably practicable, that all risks are identified and controlled appropriately. It also sets out the process for risk management across the CCGs including how each risk is identified, assessed, recorded, and managed.

Risks are identified from a variety of internal and external sources such as staff resource issues, workforce recruitment problems, lack of assurance on areas of quality and performance data, or information from staff and / or patients. The CCGs have engaged the services of a Counter Fraud Service to support with the identification of possible fraud risks and the associated work to prevent such occurrences.

There is now an integrated risk register, Board Assurance Framework (BAF) reflecting the strategic risks faced by the CCGs, and a set of corporate goals for the CCG. During 2020/21, the CCG had a Corporate Risk Register and BAF both of which were aligned to these corporate goals.

The new BAF brings together in summary form the headline indicators from each area of organisational performance to give an overall picture of the CCG. The document is framed by the corporate goals for 2020/21.

The CCGs are aware that not all risks can be eliminated and that a key aim of risk management is to maintain a culture of risk awareness whereby decisions are taken being mindful of the potential risks and how these can be managed effectively. To support this approach the CCGs’ Risk team works with risk owners and risk assessors to identify the risks to their areas of work and to identify the controls, assurances and mitigating actions for these. It is through the mechanism of effective controls that risk likelihood and impact are managed.

During 2020/21 the Audit and Assurance Committees recommended to the Governing Bodies a series of risk appetite statements which were approved. These set out the CCGs’ risk appetite towards the seven risk domains around which the BAF is structured.

In March 2021 the Joint Quality Committee approved a refreshed Incident Management policy which encourages the open and transparent reporting and

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management of incidents and near misses and which is aligned to the risk management processes.

The CCGs’ operational risk registers and BAF reflect the risks of system and partnership working and include system partners as risk assessors where appropriate.

Capacity to handle risk As the Chief Executive Officer I have the overall responsibility for ensuring that an effective risk management system is in place and that that there is an adequate control system in place. The work of ensuring this system is in place is, in practice, delegated to the Executive Director of Corporate Governance.

The Chief Finance Officer is responsible for ensuring that systems and structures are in place for the effective management of financial risk and organisational controls. The Senior Information Risk Owner (SIRO) has responsibility for managing information risks across the organisation. The Chief Nursing Officer is responsible for ensuring that systems and structures are in place for the effective management of clinical quality and safety. The Chief Medical Officer provides clinical leadership for the CCGs and is accountable for the governance and quality assurance of the services the CCGs commission. They have specific responsibility for providing strategic and operational leadership and management of the clinical risk within the CCGs and for organisational assurance on all matters of clinical risk and clinical outcomes to the CCGs’ Governing Bodies. The Executive Managing Directors have delegated responsibility for managing local risks within their own areas of responsibility and this is overseen by the Chief Operating Officer who has overall authority for this place-based work. The Executive Management Team regularly reviews the operational risk register and the Board Assurance Framework.

Staff are supported to manage risk as appropriate to their level of authority and duties and the policies and procedures are available on the CCGs’ websites. There is mandatory training provided to staff on risk management and on the use of the electronic risk management system. The Risk team supports risk assessors and risk owners with the timely review of their operational and strategic risks identifying learning and best practice which can be shared between directorates.

A number of systems of control underpin the Governing Bodies’ oversight of risk. The committee structures of the CCGs allow for risk to be addressed at several key levels all linking up to provide assurance to the Governing Bodies.

The Audit and Assurance Committees are primarily responsible for overseeing the management and reporting of risk throughout the organisation via its key role in overseeing the BAF and operational risk register and the systems and structures within the CCGs for regularly reviewing and overseeing these two key risk management tools.

The Joint Finance and Performance Committee considers the finance and performance-related risks, the Joint Quality Committee considers the quality and safety focused risks, the Joint Committee of the Sussex CCGs considers the totality

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of the CCGs’ risk profiles, and the Primary Care Commissioning Committee reviews the primary care risks.

When reviewing their operational risk registers the committees are asked if they wish to escalate any of their risks to the Governing Bodies by means of the BAF. The BAF is one of the tools used by the Governing Bodies to maintain oversight of the CCGs’ performance.

All risks are reviewed by risk owners and assessors on a regular basis. A formal review is undertaken with the central Risk team, which meets regularly with each risk owner to review changes in the scores, controls, assurances, and progress against actions agreed since the previous review.

The CCG works with key stakeholders on addressing and managing key areas of risk that impact on them such as health inequalities and the development of partnerships at place and new models of care. Local authority and Healthwatch colleagues have roles on some of the committees which receive and scrutinise risk reports to provide assurance to the Governing Body. Local authority colleagues attend the meetings of the Governing Body where the BAF is discussed. For members of the public this involvement is achieved through public events such as consultations on the improvement of local health and care services.

Risk assessment The CCGs recognise that it is impossible to eliminate all risk and that the aim of risk management is to mitigate risks using control measures and action plans. All risks are assessed on the basis of two elements; impact and likelihood. Each element is given a score between one and five and the multiplication of these scores generates a risk score. Risks with a score of 12 or above are managed on the operational risk register whilst lower scoring risks are managed at a team level within the CCGs. Each risk has been assigned a risk assessor and a risk owner. The assessor has operational oversight of the risk whilst the owner is the executive director of the area of work.

At year-end, the operational risk register contained the following risks with a current score of 15 and above:

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Operational risks with a score of 15 and above as at 31 March 2021

Risk ID Title Initial Current Score Score (Impact x (Impact x Likelihood) Likelihood) Goal A: Improved population health outcomes and patient experience

SX0097 – Failure to deliver Covid mass 20 (4 x 5) 16 (4 x 4) BH vaccination programme SX0098 – Failure to meet the requirements of NHS 20 (4 x 5) 16 (4 x 4) BH England on health inequalities as outlined in the Phase 3 letter of July 2020 SX0099 – Potential patient harm from long waits 16 (4 x 4) 16 (4 x 4) BH and delays to follow-up reviews in Ophthalmology SX0101 – Outbreak of viral illnesses including 20 (4 x 5) 16 (4 x 4) BH Covid-19 and seasonal influenza acquired in community and hospital settings SX0105 – Possible non-compliance with Continuity 12 (4 x 3) 16 (4 x 4) BH of Carer assurance data Goal B: Restoring high quality and safe services prioritised to meet clinical needs SX0005 – Cyber-attacks affecting providers and 16 (4 x 4) 16 (4 x 4) BH GP practices within Sussex SX0022 – Effect on Providers of Major Incidents 12 (4 x 3) 16 (4 x 4) BH SX0030 – SECAmb Ambulance Response 12 (4 x 3) 16 (4 x 4) BH Programme (ARP) standards SX0056 – Provider not meeting Cancer Waiting 15 (3 x 5) 16 (4 x 4) BH Time Standards (impacting on CCGs’ cancer performance delivery for its population) SX0069 – Management of routine referrals 16 (4 x 4) 16 (4 x 4) BH significantly impacting on RTT performance Goal C: Improved financial performance SX0110 – Uncertainty of the financial regime for 12 (4 x 3) 16 (4 x 4) BH 2021/22 Goal D: Delivering system reform SX0084 - Failure to deliver the Procurement 20 (4 x 5) 16 (4 x 4) BH Programme Goal E: Effective and well led organisation with an empowered and inclusive workforce SX0011 – CCG Cyber Security 16 (4 x 4) 16 (4 x 4) BH

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Risk ID Title Initial Current Score Score (Impact x (Impact x Likelihood) Likelihood) SX0025 – Effect on CCGs of Major Incident 12 (4 x 3) 16 (4 x 4) BH SX0045 – Workforce demand for Sussex CCG 16 (4 x 4) 16 (4 x 4) BH commissioned providers

The CCG’s operational risks are reviewed through a regular, structured programme of meetings between the risk assessors and the Risk team. Following these review meetings all updates receive approval from the risk owner (who is one of the executive directors) before they are reported to the CCG’s committees and management meetings.

During 2020/21 these risk review meetings have focused upon ensuring that the impacts of the COVID-19 pandemic are appropriately captured as well as more recently that the risk registers reflect the activity on the restoration and recovery of services.

Each operational risk is overseen by one or more of the CCG’s committees, and when receiving the risk reports the committee assesses the risk outcomes to decide either that it is assured or that it requires some further detail for a ‘deep dive’ review at a subsequent meeting. The committee has the opportunity to escalate operational risks to the BAF in order to bring them to the attention of the Governing Body.

Other sources of assurance

Internal Control Framework A system of internal control is the set of processes and procedures in place in the clinical commissioning group to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically.

The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it can therefore only provide reasonable and not absolute assurance of effectiveness.

The CCG’s internal control framework is constructed around the CCG’s risk and assurance framework and the CCG’s committee structure. The committees of the CCG have oversight of, and seek assurance in respect of, specific elements of the CCG’s responsibilities. During the course of the year, the CCG has strengthened its management arrangements which provide oversight of the ongoing operational performance and governance work of the organisation and which ensure that information, which is progressed to the CCG’s committee meetings, is of a suitable standard for those committees to obtain the requisite level of assurance.

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The Governing Body arrangements, including the BAF, are outlined above. The financial controls are outlined in more detail in the annual accounts.

The CCG has adopted a set of Standing Orders and Standing Financial Instructions / Prime Financial Policies. These are published as appendices to the CCG’s Constitution. The CCG also has more detailed financial policies and a detailed financial scheme of delegation, which have been approved by the Audit and Assurance Committee.

The Governing Body receives assurance that the organisation and commissioned providers are meeting the defined set of standards across domains of performance, safety, quality, and patient experience through the Performance Report that is presented to the Joint Finance and Performance Committee and to the Governing Body. This report provides detailed information on the performance in key areas of activity commissioned by the CCG.

Annual audit of conflicts of interest management The revised statutory guidance on managing conflicts of interest for CCGs (published June 2017) requires CCGs to undertake an annual internal audit of its management of conflicts of interest. To support CCGs to undertake this task, NHSE has published a template audit framework.

The annual internal audit of conflicts of interest was carried out in 2020/21 and provided an assessment of ‘reasonable assurance’.

Freedom to speak up (whistleblowing) The CCG has a Freedom to Speak Up policy which is based upon the template provided by NHSE/I. This policy supports any individual wishing to raise a concern at work and it helps to promote the CCG’s open and honest culture.

The policy was refreshed during 2020/21. There were no concerns raised regarding the effectiveness of the CCG’s arrangements.

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Data quality The Governing Body has in place comprehensive reporting through which it can monitor the performance of its commissioned services. The Performance Report provides assurance to the Governing Body and to the Joint Finance and Performance Committee that the organisation and commissioned providers are meeting the defined set of standards.

The data received by the Governing Body and its committees are continuously reviewed and the contents of reports are refreshed regularly to ensure that the appropriate and necessary information is available to the CCG’s committees. Throughout the year, the data outputs from the Commissioning Support Unit (CSU) and the in-house Performance and Intelligence Team are checked and any outlying or unexpected values are investigated. The reports are further checked against other available data sources such as NHSE reports, IAF indicators, and Public Health data sets.

Information Governance The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees in particular personal identifiable information. The NHS Information Governance Framework is supported by a Data Security and Protection (DSP) Toolkit and the annual submission process provides assurance to the CCG, to other organisations, and to individuals that personal information is dealt with legally, securely, efficiently, and effectively.

The CCG will complete the DSP Toolkit for 2020/21 by the extended deadline of 30 June 2021. Using the toolkit the CCG is able to demonstrate compliance with the ten data security standards, set out by Dame Fiona Caldicott’s independent review, and assess against Department of Health and Social Care IG policies and standards. The CCG is performing at the required level and will achieve the level of ‘standards met’ for the DSP Toolkit for 2020/21.

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

There are processes in place for incident reporting and the investigation of IG serious incidents. We have developed information risk assessment and management procedures and a programme to embed fully an information risk culture throughout the organisation. During 2020/21, there have been no IG Serious Incidents Requiring Investigations. We continue to monitor both root and cause of low-level IG breaches to inform training needs and potential operational review.

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Business critical models The CCG recognises the principles reflected in the Macpherson report as a direction of travel for business modelling in respect of service analysis, planning, and delivery. An appropriate framework and environment is in place to support the quality assurance of business critical models within the CCG.

The CCG’s business-critical models primarily rely on activity and financial data produced by the South, Central and West CSU, which is assured through their own processes. The CCG reviews CSU data regularly and its use is checked internally by the Performance and Intelligence team and externally through an audit of the CSU’s key systems and processes. The output of business critical models is validated by NHSE through their assurance of the CCG.

Third party assurances The CCG uses service organisations to carry out services on its behalf and these often impact on the CCG’s internal controls. Consequently there is a need to receive assurance that control procedures at the service organisations complement those operated by the CCG. In addition, the CCG’s auditors may seek information about the control procedures surrounding those services which affect an entity’s financial statements. In order to deliver assurance over the internal controls and control procedures operated by a service organisation to its customers and their auditors, many organisations engage a Reporting Accountant to prepare a report on internal controls. The objective of this is to provide assurance in a cost effective manner through reducing the duplication which would likely arise from multiple CCG internal and external auditors separately assessing controls.

The CCG has received International Standard on Assurance Engagements (ISAE) 3000/3402 reports, commonly known as Service Auditor Reports (SARs), for:  Capita Primary Care Support England (PCSE)  Electronic Staff Record Programme (ESR)  NHS Shared Business Services (SBS)  NHS Business Services Authority (BSA) Prescription Payments  NHS Digital  South Central and West Commissioning Support Unit (SCW CSU)

The service organisations will be developing action plans to address any identified gaps in control.

The CCG receives activity and finance data produced from SCW CSU, which is assured through their own processes. The CCG also employs its own analysts who review the data and reports provided by CSU and may comment on their accuracy. The CCG also has its own processes for checking the quality of information received by third parties recognising the importance of reliable information both in terms of commissioning services and the efficient management of the CCG’s day-to-day business and resources.

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Control issues

No control issues have been identified which are likely to be prejudicial to the CCG’s ability to meet its objectives, that will undermine the integrity or reputation of the CCG or wider NHS, that will put at risk the standards expected of the Accountable Officer, that increase the risk that the CCG will be susceptible to fraud, that will have a material impact on the accounts, or that will put at risk the security of data integrity.

Review of economy, efficiency and effectiveness of the use of resources

As described above, the membership has delegated authority to the Governing Body and its committees to act effectively, efficiently, and economically. The Joint Quality Committee oversees provider performance for the CCG. The Joint Finance and Performance Committee oversees financial performance including undertaking scrutiny of financial planning and ensuring the transparency of underlying assumptions in building financial plans and budgets. This includes having oversight of central management costs. This committee also undertakes reviews of operational performance against targets.

The Audit and Assurance Committee has delegated responsibility for providing assurance that the CCG is acting effectively, efficiently, and economically and this includes receiving and reviewing all recommendations made by the internal auditors. Formal reports on financial performance are presented at every Governing Body meeting and at every meeting of the Joint Finance and Performance Committee.

The Accountable Officer has responsibility for reviewing the effectiveness of the system of internal control within the CCG.

NHS England has a statutory duty (under the Health and Social Care Act (2012)) to conduct an annual assessment of every CCG. The 2019/20 assessment was conducted according to the NHS Oversight Framework for 2019-20 with the CCG’s performance being assessed against the indicators listed within the framework. The framework assesses how effectively the CCG work with other partners (including the Health and Wellbeing Board) to improve quality and outcomes for patients. The CCG is required to focus on the strength and effectiveness of its system relationships, using the levers and incentives available to it to make progress. The result was published in summer 2020.

The framework also assesses the CCG’s performance in each of the indicator areas across the full year, balanced with the financial management and qualitative assessment of the leadership of the CCG.

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Delegation of functions

The CCG has not made any significant arrangements to delegate its functions either internally or externally. The CCG has a Scheme of Reservation and Delegation within its Standing Financial Instructions.

NHS Brighton and Hove CCG have a formal agreement known as a Section 75 agreement in place with Brighton and Hove City Council.

A formal Memorandum of Understanding has been in place since 1 April 2020 between the three Sussex CCGs.

Counter fraud arrangements

The CCG takes its responsibilities towards fraud, bribery, and corruption very seriously and has in place thorough systems and practices to ensure that the organisation does not become a victim of fraud. We have appointed an Accredited Counter Fraud Specialist who works with the CCG to ensure that our policies are compliant with the NHS Counter Fraud Authority (CFA) Standards for Commissioners: Fraud, Bribery, and Corruption, (soon to be replaced with the Government Functional Standard: Counter Fraud (GFS:CF)). The Specialist provides staff with annual ongoing counter-fraud training.

The Chief Finance Officer has overall responsibility for the Counter Fraud Service. In addition the CCG has a nominated Fraud Champion which is a requirement of the NHS CFA, and satisfies the requirement of the GFS:CF.

The Counter Fraud Specialist is a regular attendee of the CCG’s Audit and Assurance Committee where they report on progress made against active fraud investigations where the CCG is a potential victim as well as on planned proactive work.

The Counter Fraud Specialist’s regular reporting to the Audit and Assurance Committee also includes the CCG’s progress against national standards and the compliance of the CCG’s providers against their counter fraud reporting requirements under the standard NHS contract.

The Counter Fraud Service undertakes proactive work to detect abuse or fraud as well as investigating suspicions of fraud. There is a full set of policies and procedures in place and contact information is available on the CCG intranet and included in staff newsletters. During 2020/21, the activities of the fraud service included:  Fraud Awareness presentations to staff and members  Issuing national and local Fraud Alerts to the CCG for circulation to relevant staff; the majority of these were connected to the impact of COVID-19  Issuing the NHS CFA COVID-19 Fraud Threats Updates to the CCG for circulation to relevant staff  Monitoring the National Fraud Initiative for the CCG

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 Proactive reviews into the organisation’s COVID-19 decision-making process; salary overpayments; declarations of interests and Personal Health Budgets best practice  Registration concerns at GP surgeries  Submitting the Fraud Prevention Guidance Impact Assessment Survey to the NHS CFA, to measure the impact of fraud prevention activity undertaken by NHS organisations following guidance issued during the period of 1 July 2019 to 30 June 2020  Thematic review into COVID-19 fraud risks.

During 2020/21 the Counter Fraud Service was re-procured and the new contract starts on 1 April 2021.

The CCG has not undergone any inspection by NHS CFA in the current year.

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Head of Internal Audit Opinion

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

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

During 2020/21, internal audit issued the following audit reports:

Table: Internal Audit Reports 2020/21

Area of Audit Assurance Assessment

Complaints Reasonable Assurance

Governance – Covid-19 Support Reasonable Assurance

Policies Management Reasonable Assurance

Learning Disabilities and Autism Reasonable Assurance

Reducing Health Inequality Reasonable Assurance

Corporate Recharges Substantial Assurance

GBAF and Risk Management Reasonable Assurance

Key Financial Systems – Non pay Reasonable Assurance

Key Financial Systems - Payroll Reasonable Assurance

Conflicts of Interest Reasonable Assurance

Public and Patient Engagement Reasonable Assurance

Children’s Commissioning Limited Assurance

Mandatory and Statutory Training Reasonable Assurance

Quality Governance (Quality Impact Reasonable Assurance Assessment) Part 2

Primary Care Governance Reasonable Assurance

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ICT – Home Working Information Security Reasonable Assurance

Improving Access to Psychological Therapies Limited Assurance

The outcomes of the internal audit reviews undertaken during 2020/21 demonstrate a significant commitment to the internal audit process. The CCG has used the internal audit service to investigate areas where it was felt that the CCG would benefit from independent scrutiny and, consequently, two areas of ‘limited assurance’ has been identified. During the year the audit findings have been used to enhance the systems, structures, and processes where required. The progress towards the individual management improvement actions following each review are reported and monitored by the executive management team and by the Audit and Assurance Committee.

The internal audit review into the effectiveness of the CCGs’ arrangements for the commissioning of children’s physical health, including partnership working, resulted in an opinion of ‘limited assurance’.

The key audit findings include:  The need for the development of a Sussex-wide children’s physical health strategy  The need to review children’s commissioning workforce capacity and capability  The need to establish clearer partnership working agreements.

The review also included the recommendations:  To utilise the Royal College of Paediatrics and Child Health to help underpin strategy development  To consider establishing a Sussex-wide Children’s Collaborative Forum.

A series of management actions to address the key findings and adopt the recommendations have been established. The accountability for these actions sits with the Executive Managing Director for Complex Commissioning.

The internal audit review into the effectiveness of Improving Access to Psychological Services (IAPTs) following re-procurement, including capacity management and the implementation of new contract management arrangements, resulted in an opinion of ‘limited assurance’. The key audit findings include:  There is evidence of collaborative performance and risk management within the CCG and at ICS level towards IAPTs recovery The governance that has been put in place would benefit from more current data, and the quality of information included in risk management reporting needs to be improved to ensure the effective scrutiny of this service  Variation in planned IAPTs access targets from higher national targets and from the targets in the other Sussex places needs to be clearly articulated

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 Limited assurance in this case reflects the improvements that are required to ensure that the service improves to meet the trajectory that has been put in place

A series of management actions to address the key findings and adopt the associated recommendations have been established. The accountability for these actions sits with the Executive Managing Director of NHS East Sussex CCG who is the Sussex NHS Commissioners’ executive lead for mental health. During the year the internal auditors were asked to undertake an advisory review of the CCG’s cyber security arrangements following the receipt of a limited assurance opinion for the previous cyber security review conducted during 2019/20. Although the 2020/21 review was advisory and did not carry a formal auditor opinion, given the high priority of cyber security for the CCG, the executive has accepted the findings and committed to delivering all of the actions.

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Review of the effectiveness of governance, risk management and internal control

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

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

I have been advised on the implications of the result of this review by:  The Governing Body  The Audit and Assurance Committee  The Joint Committee of the Sussex CCGs  The Joint Finance and Performance Committee  The Joint Quality Committee  The Primary Care Commissioning Committee, and  Internal audit.

The role of each of these mechanisms of internal control has been described previously in this governance statement.

Conclusion

In 2021/22 the CCG will continue to strengthen its governance structures and financial controls and build on the Head of Internal Audit Opinion which states that the CCG can take ‘reasonable assurance’ that there is a generally sound system of internal control, designed to meet the organisation’s objectives, and that controls are generally being applied consistently.

The factors described in this statement have given me increased assurance and I am therefore satisfied that the CCG operates effective and sound systems of internal control and that these will be further improved during 2021/22.

Adam Doyle Accountable Officer 14 June 2021

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Attendance* by Governing Body members at Governing Body and Committee meetings 2020/21

The following tables reflect the fact that during 2020/21 we refocused our committee memberships so that clinical members of the Governing Body and its committees were rightly able to devote their time to addressing the COVID-19 pandemic.

Governing Body Attended / Name Position Eligible to Attend

Dr Andy Hodson Clinical Chair (Chair) 6/6

Chris Adcock Chief Finance Officer 6/6

Lay Member, Patient and Public Akeela Ahmed 1/1 Engagement

Faustino Bayo Lay Member, Governance 1/1

Deputy Chief Executive Officer and Karen Breen 5/6 Chief Operating Officer

Allison Cannon Chief Nursing Officer 5/6

Dr Tim Caroe Joint Chief Medical Officer 5/5

Independent Clinical Member Jane Chandler 6/6 (Registered Nurse) Independent Clinical Member Dr Justin Daniels 1/1 (Secondary Care Clinician) Adam Doyle (or Chief Executive Officer 6/6 representative)

Samantha Durrant Lay Member, Finance and Performance 6/6

May Gabriel Associate Governing Body Lay Member 1/1

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Attended / Name Position Eligible to Attend

Gill Galliano Lay Vice Chair 6/6

Dr Elizabeth Gill (or Joint Chief Medical Officer 5/6 representative)

Nina Graham Locality Representative 6/6

Lay Member, Patient and Public Mike Holdgate 5/5 Engagement

Dr Jerry Luke Independent Clinical Member (GP) 6/6

Dr Sangeeta Locality Representative 1/1 Sornalingam

Andrew Taylor Lay Member, Governance 5/6

Independent Clinical Member Dr Charles Turton 5/6 (Secondary Care Clinician)

Audit and Assurance Committee Attended / Name Position Eligible to Attend

Andrew Taylor Lay Member, Governance (Chair) 7/7

Malcolm Dennett Lay Member, Governance 1/1

Samantha Durrant Lay Member, Finance and Performance 7/7

Dr Jerry Luke Independent Clinical Member (GP) 5/5

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Primary Care Commissioning Committee Attended / Name Position Eligible to Attend

Gill Galliano Lay Vice Chair (Chair) 5/5

Chris Adcock (or Chief Finance Officer 4/5 representative) Lay Member, Patient and Public Akeela Ahmed 1/1 Engagement Executive Managing Director (deputy for Lola Banjoko 3/5 Karen Breen) Allison Cannon (or Chief Nursing Officer 5/5 representative)

Wendy Carberry Executive Director of Primary Care 2/2

Independent Clinical Member Dr Justin Daniels (Secondary Care Clinician) 1/1

Executive Director of Primary Care Amy Galea 3/3 Commissioning Lay Member, Patient and Public Mike Holdgate 3/5 Engagement

Dr Jerry Luke Independent Clinical Member (GP) 5/5

Independent Clinical Member Dr Charles Turton (Secondary Care Clinician) 3/5

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Joint Committee of the Sussex CCGs Attended / Name Position Eligible to attend

Dr Andy Hodson Clinical Chair (Chair) 11/11

Locality Representatives, NHS Phil Abbott 5/5 East Sussex CCG

Chris Adcock Chief Finance Officer 8/8

Deputy Chief Executive Officer Karen Breen 9/11 and Chief Operating Officer

Allison Cannon Chief Nursing Officer 5/5

Wendy Carberry (or Executive Director of Primary 5/5 representative) Care

Dr Tim Caroe Joint Chief Medical Officer 7/9

Independent Clinical Member Jane Chandler 3/3 (Registered Nurse)

David Cryer Executive Director of Strategy 10/11

Lay Member, Finance and Malcolm Dennett Performance, NHS West Sussex 10/11 CCG Lay Member, Finance and Samantha Durrant 11/11 Performance Locality Representative, NHS Dr Edward Ford 4/8 West Sussex CCG Executive Director of Primary Amy Galea 2/2 Care Commissioning

Gill Galliano Lay Vice Chair 11/11

Lay Vice Chair, NHS West Sussex Mark Hammond 11/11 CCG

Jim Hayburn Chief Finance Officer 2/3

Clinical Chair, NHS West Sussex Dr Laura Hill 11/11 CCG

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Attended / Name Position Eligible to attend Independent Clinical Member Alison Lewis-Smith (Registered Nurse), NHS West 3/3 Sussex CCG Locality Representative, NHS Dr Mark Lythgoe 3/8 East Sussex CCG Independent Clinical Member Denise Matthams (Registered Nurse), NHS East 3/3 Sussex CCG Lay Member, Finance and Guy Record Performance, NHS East Sussex 11/11 CCG Lay Vice Chair, NHS East Sussex Julia Rudrum 11/11 CCG Dr Sangeeta Locality Representative 1/3 Sornalingam Clinical Chair, NHS East Sussex Dr David Warden 10/11 CCG Executive Director of Corporate Terry Willows 9/11 Governance

Joint Finance and Performance Committee of the Sussex CCGs Attended / Name Position Eligible to Attend Lay Member, Finance and Performance Samantha Durrant 5/5 (Chair)

Chris Adcock Chief Finance Officer 3/3

Lola Banjoko Executive Managing Director 3/5

Deputy Chief Executive Officer and Karen Breen 1/3 Chief Operating Officer Executive Managing Director, NHS East Jessica Britton 5/5 Sussex CCG Allison Cannon (or Chief Nursing Officer 4/5 representative) Jane Chandler Independent Clinical Member 3/5 (Registered Nurse)

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Attended / Name Position Eligible to Attend Lay Member, Finance and Performance, Malcolm Dennett 5/5 NHS West Sussex CCG Executive Managing Director, NHS West Pennie Ford 5/5 Sussex CCG Lay Member, Governance, NHS West Jeni Graham 4/5 Sussex CCG

Nina Graham Locality Representative 1/5

Jim Hayburn Chief Finance Officer 2/2

Locality Representative, NHS West Dr Ketan Kansagra 2/5 Sussex CCG Independent Clinical Member Alison Lewis-Smith (Registered Nurse), NHS West Sussex 5/5 CCG Independent Clinical Member Denise Matthams (Registered Nurse), NHS East Sussex 4/5 CCG Lay Member, Governance, NHS East Carol Pearson 5/5 Sussex CCG Locality Representative, NHS East Dr Milan Radia 4/5 Sussex CCG Locality Representative, NHS West Dr Alex Rainbow 3/5 Sussex CCG Lay Member, Finance and Performance, Guy Record 5/5 NHS East Sussex CCG Dr Sangeetha Locality Representative 1/2 Somalingam

Andrew Taylor Lay Member, Governance 4/5

Locality Representative, NHS East Teo Vogiatzis 4/5 Sussex CCG

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Joint Quality Committee of the Sussex CCGs Attended / Name Position Eligible to attend Independent Clinical Member Jane Chandler 8/8 (Registered Nurse)(Chair) Lay Member, Patient and Public Akeela Ahmed 1/1 Engagement Lay Member, Patient and Public Louise Ansari 7/8 Engagement, NHS East Sussex CCG

Allison Cannon Chief Nursing Officer 8/8

Dr Tim Caroe Joint Chief Medical Officer 5/7

Dr Daphne Locality Representative, NHS West 2/4 Coutroubis Sussex CCG Independent Clinical Member Dr Justin Daniels 1/1 (Secondary Care Clinician) Lay Member, Patient and Public Nick Deyes 7/8 Engagement, NHS West Sussex CCG Locality Representative, NHS East Karen Ford 2/3 Sussex CCG

Dr Elizabeth Gill Joint Chief Medical Officer 2/2

Nina Graham Locality Representative 4/5

Executive Director of Communication Tom Gurney 8/8 and Public Engagement Lay Member, Patient and Public Mike Holdgate 7/7 Engagement Independent Clinical Member Alison Lewis-Smith (Registered Nurse), NHS West Sussex 8/8 CCG Independent Clinical Member Dr Hugh McIntyre (Secondary Care Clinician), NHS West 7/8 Sussex CCG Independent Clinical Member Denise Matthams (Registered Nurse), NHS East Sussex 8/8 CCG

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Attended / Name Position Eligible to attend Independent Clinical Member Dr Gulzar Mufti (Secondary Care Clinician), NHS East 7/8 Sussex CCG Locality Representative, NHS East Dr Neil Myers 3/4 Sussex CCG Locality Representative, NHS West Dr Sarah Pledger 4/7 Sussex CCG Locality Representative, NHS East Dr Milan Radia 2/2 Sussex CCG Independent Clinical Member Dr Charles Turton 7/7 (Secondary Care Clinician)

Remuneration and Nominations Committee Attended/ Name Position Eligible to attend

Gill Galliano Lay Vice Chair (Chair) 4/4

Lay Member, Patient and Public Akeela Ahmed 1/1 Engagement

Dr Andrew Hodson Clinical Chair 4/4

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Special Purpose Remuneration and Nominations Committee Attended/ Name Position Eligible to attend

Bob Alexander Independent Chair 2/2

Independent Clinical Member Jane Chandler 1/1 (Registered Nurse)

Independent Clinical Member Dr Justin Daniels 1/1 (Secondary Care Clinician)

Lay Member, Finance and Malcolm Dennett Performance, NHS West Sussex 1/1 CCG

Lay Member, Finance and Samantha Durrant 1/1 Performance

Independent Clinical Member Alison Lewis-Smith (Registered Nurse), NHS West 1/1 Sussex CCG

Independent Clinical Member Denise Matthams (Registered Nurse), NHS East 1/1 Sussex CCG

Independent Clinical Member Dr Hugh McIntyre (Secondary Care Clinician), NHS 1/2 West Sussex CCG

Independent Clinical Member Dr Gulzar Mufti (Secondary Care Clinician), NHS 1/2 East Sussex CCG

Lay Member, Finance and Guy Record Performance, NHS East Sussex 1/1 CCG

Independent Clinical Member Dr Charles Turton 1/1 (Secondary Care Clinician)

* Eligibility to attend meetings varies within this reporting year due to (1) in-year changes to roles (staff structure changes / personnel changes) and (2) changes to the Committee Terms of Reference, following a regular cycle of review.

ANNUAL REPORT 2020/21 | NHS Brighton and Hove Clinical Commissioning Group 90 of 149

Remuneration and Staff Report

Remuneration Report The remuneration report discloses all relevant information with respect to senior managers in NHS Brighton and Hove CCG. Senior managers are defined as: “Those persons in senior positions having authority or responsibility for directing or controlling the major activities of the CCG. This means those who influence the decisions of the CCG as a whole rather than the decision of individual directorates or departments”.

The Accountable Officer has confirmed that the definition of senior manager in respect to NHS Brighton and Hove CCG encompasses both members and regular attendees of Governing Body meetings. This definition, for the purposes of this report, has been taken to include both employee and officer voting members of the Governing Body which includes the members listed within the Governing Body composition table on pages 82 and 83.

Where a senior manager and member of the Governing Body works across more than one CCG the appropriate proportion of remuneration is reported and their total remuneration across relevant CCGs is shown separately in order to ensure full disclosure.

Remuneration Committee The Remuneration and Nominations Committee is responsible for determining the remuneration including fees, allowances and pension contributions for senior employees and, from the Membership via the Constitution, for determining the remuneration including allowances for members of the Governing Body, which includes executive remuneration and office holders. The CCG Constitution reflects statute and requires the Remuneration and Nominations Committee to make recommendations to the Governing Body with regard to determining the remuneration, fees and allowances for CCG employees and other persons providing services to it.

Only members of the Governing Body may be members of the Remuneration and Nominations Committee.

The Remuneration and Nominations Committees of the CCGs in Sussex meet as a ‘committees in common’. The Committees in common agree which Chair will act as a Coordinating Chair for the meetings. Where a decision relates to a specific CCG, that CCG has held its own Committee meeting.

The Committee is quorate with a minimum of two members.

The Chief Executive Officer and other clinical or senior officers may attend the Committee meetings as directed by members of the Committee, but do not have voting rights.

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The Committee has met no less than twice a year, as provided in its terms of reference. The details of Committee membership and attendance are shown in the Annual Governance Statement.

The CCG contracts with a CSU under a service level agreement to deliver HR services. This includes the provision of specialist HR advice to its Remuneration and Nominations Committee. The Committee therefore has access to and takes advice from a named HR Lead, employed by the CCG’s HR provider which is the South, Central and West CSU. Specialist advice covered includes employment law, NHS terms and conditions, the interpretation of NHS England remuneration guidance for CCGs, and the provision of benchmarking information relating to local and regional CCG Governing Bodies. This support has been supplemented by the Interim Chief People Officer of the Sussex CCGs.

The information in the Remuneration Report that is subject to external audit, includes:  The table of salaries and allowances of senior managers and related narrative notes on pages 93 to 104  The table of pension benefits of senior managers and related narrative notes on pages 99 to 104  The narrative disclosure of pay multiples on page 104 and  Employee staff numbers outlined in note 3 to the Accounts and on pages 105 and 106

The work of the Remuneration Committee and decisions made The Committee has worked to its agreed annual work plan over the past year and has reached decisions on the following:  Remuneration of the Chief Executive Officer  Remuneration of the Chief Medical Officer  Remuneration of the Executive Management Team  Remuneration of Local Medical Directors  Recruitment process, remuneration and time commitment of Governing Body members for the newly formed CCGs on 1 April 2020

In reaching decisions, the Committee was provided with relevant benchmarking and up to date guidance from its specialist HR provider to ensure all decisions are robust.

Remuneration of Very Senior Managers In setting levels of remuneration, the Committee takes into account national and local pay guidance from the NHS, local, regional and national benchmarking, locally prevailing employment conditions and the levels of responsibility associated with the post.

The pay and conditions for senior managers are determined by taking into account relevant national pay frameworks and other guidance as appropriate, to ensure that remuneration is reasonable having regard to their individual contributions while having proper regard to the CCG’s circumstances and performance.

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Where interim senior managers of the CCG have been paid more than £150,000 per annum, this has been in consultation with NHS England with business cases agreed by the Committee before being submitted for NHS England review and approval.

The CCG has a number of individuals whose total remuneration (when pro-rated) exceeds £150,000pa. The CCG is satisfied that this remuneration is reasonable based on the benchmarking data and analysis undertaken by the Committee.

In determining the emoluments for Governing Body members, the Committee considers the rates for previous and current NHS organisations as well as the best practice terms of appointment provided by NHS England.

The current remuneration policy does not specify performance related rewards or targets, and amendments to remuneration are considered and determined annually by the Committee.

The performance of the senior executive team is monitored through an annual appraisal process based on organisational and individual objectives.

Members of the Governing Body are either elected by the membership, selected by the Governing Body, or employed by the CCG. The method of appointment for each role is described within the CCG’s Constitution.

Non-executive members of the Governing Body are appointed for a term of three years with the potential for reappointment. This is to ensure that their independence is maintained and that the membership can be reviewed at regular periods.

The notice periods for senior managers are generally set at such a period as to allow adequate opportunity to identify a replacement. The CCG considers that three months is generally an acceptable notice period for senior managers although certain key posts, including those on the Governing Body, have notice periods of six months.

Senior manager remuneration (including salary and pension entitlements) (Note: The disclosures in the salary and pensions tables are auditable).

The following tables detail the remuneration of the CCG’s Senior Managers. The total salary for joint appointments are shown in salary disclosure table followed by the share apportioned to the CCG. In the salary disclosure table and the pension disclosure table, all pension related benefits are calculated with respect to the total for the joint appointment.

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2020-21 Salary Disclosure Table 2020-2021 2020-2021 2020-2021 2020- 2020-2021 2020-2021 2020-2021 2021 Name 2020/21 Title Total Expense All pension Total CCGs CCGs CCGs Senior payments Related Salary Share of Share Share of Manager (taxable) Benefits (bands Senior Expense Total Salary Note Salary to nearest (Bands of of Manager payments (bands of (bands of £100** £2,500) £5,000) Salary (taxable) £5,000) £5,000) (bands of to nearest £5,000) £100** Adam Doyle Chief Executive Officer 1,2 190-195 - 45-47.5 235-240 30-35 - 30-35 Karen Breen Deputy Chief Executive Officer and Chief Operating Officer 2 165-170 - 35-37.5 200-205 25-30 - 25-30 Dr Andrew Clinical Chair 10 85-90 - - 85-90 85-90 - 85-90 Hodson Allison Cannon Chief Nursing Officer 2 125-130 - 17.5-20 145-150 20-25 - 20-25 Chris Adcock Chief Finance Officer to 2 145-150 - 67.5-70 215-220 25-30 - 25-30 16/02/2021 James Hayburn Chief Finance Officer from 2, 40-45 - - 40-45 5-10 - 5-10 04/01/2021 10 Dr Elizabeth Gill Chief Medical Officer 2 100-105 - 215-217.5 315-320 15-20 - 15-20 Dr Tim Caroe Chief Medical Officer to 2 80-85 - 137.5-140 215-220 10-15 - 15-20 19/01//2021 Wendy Carberry Executive Director of Primary 2 130-135 - - 130-135 20-25 - 20-25 Care to 30/09/2020 Amy Galea Executive Director of Primary 2 45-50 - 10-12.5 55-60 5-10 - 5-10 Care from 16/11/2020 David Cryer Executive Director of Strategy 2 130-135 - 20-22.5 150-155 20-25 - 20-25 Jessica Britton Executive Managing Director 2 125-130 1 37.5-40 165-170 20-25 - 20-25 (East Sussex) Lola Banjoko Executive Managing Director 2 125-130 - 77.5-80 205-210 20-25 - 20-25 (Brighton & Hove)

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2020-2021 2020-2021 2020-2021 2020- 2020-2021 2020-2021 2020-2021 2021 Name 2020/21 Title Total Expense All pension Total CCGs CCGs CCGs Senior payments Related Salary Share of Share Share of Manager (taxable) Benefits (bands Senior Expense Total Salary Note Salary to nearest (Bands of of Manager payments (bands of (bands of £100** £2,500) £5,000) Salary (taxable) £5,000) £5,000) (bands of to nearest £5,000) £100** Pennie Ford Executive Managing Director 2 125-130 1 22.5-25 150-155 20-25 - 20-25 (West Sussex) Peter Kottlar Executive Managing Director (Complex Commissioning) 2 125-130 - 50-52.5 175-180 20-25 - 20-25 Terry Willows Executive Director of Corporate Governance 2 125-130 1 27.5-30 155-160 20-25 - 20-25 Tom Gurney Executive Director of Communications, People and Public Involvement to 18/01/2021 2 135-140 - 62.5-65 200-205 20-25 - 20-25 / Executive Director of Communications and Public Involvement from 19/01/2021 Mark Power Chief People Officer from 2,9, 40-45 - - 40-45 5-10 - 5-10 19/01/2021 10 Gill Galliano Lay Vice Chair 4 20-25 1 - 20-25 20-25 1 20-25 Andrew Taylor Lay Member (Governance) 4 15-20 - - 15-20 15-20 - 15-20 Mike Holdgate Lay Member (Patient and Public 4 15-20 - - 15-20 15-20 - 15-20 Involvement) to 31/01/2021 Akeela Ahmed Lay Member (Patient and Public MBE Involvement) from 04/01/2021 4 0-5 - - 0-5 0-5 - 0-5 Samantha Durrant Lay Member (Finance and 4 15-20 - - 15-20 15-20 - 15-20 Performance) Jane Chandler Independent Member (Registered 4 15-20 - - 15-20 15-20 - 15-20 Nurse)

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2020-2021 2020-2021 2020-2021 2020- 2020-2021 2020-2021 2020-2021 2021 Name 2020/21 Title Total Expense All pension Total CCGs CCGs CCGs Senior payments Related Salary Share of Share Share of Manager (taxable) Benefits (bands Senior Expense Total Salary Note Salary to nearest (Bands of of Manager payments (bands of (bands of £100** £2,500) £5,000) Salary (taxable) £5,000) £5,000) (bands of to nearest £5,000) £100** Dr Charles Turton Independent Member (Secondary 4 10-15 - - 10-15 10-15 - 10-15 Care Clinician) Dr Justin Daniels Independent Member (Secondary Care Clinician) from 04/02/2021 4 0-5 - - 0-5 0-5 - 0-5 Dr Jerry Luke Independent Member (GP) 7 n/a n/a n/a n/a n/a n/a n/a Faustina Kabie Associate Governing Body Lay Bayo Member from 04/02/2021 4 0-5 - - 0-5 0-5 - 0-5 May Gabriel Associate Governing Body Lay Member from 04/02/2021 4 0-5 - - 0-5 0-5 - 0-5 Nina Graham Locality Representative 4 30-35 - - 30-35 30-35 - 30-35 Dr Sangeetha Locality Representative from 4 5-10 - - 5-10 5-10 - 5-10 Sornalingam 04/02/2021 **Note: Taxable expenses and benefits in kind are expressed to the nearest £100.

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2019-20 Salary Disclosure Table 2019-20 2019-20 2019-20 2019-20 2019-20 2019-20 2019-20 Name Title Notes Senior Expense All pension Total CCG’s CCG’s CCG’s Manager payments Related Salary Share Share Share of Salary (taxable) Benefits (bands of Salary Expense Total (bands of to nearest (Bands of £5,000) (bands of payments Salary £5,000) £100** £2,500) £5,000) (taxable) (bands of to nearest £5,000) £100** £'000 £'00 £'000 £'000 £'000 £'00 £'000 Adam Doyle Chief Executive Officer 2,3 190-195 - 62.5-65 255-260 25-30 - 25-30 Allison Cannon Chief Nursing Officer 3 125-130 4 182.5-185 310-315 20-25 1 20-25 Chris Adcock Chief Finance Officer from 01/07/2019 3 125-130 3 30-32.5 155-160 15-20 - 15-20 David Cryer Chief Finance Officer to 30/06/2019 / 3,11 130-135 1 60-62.5 195-200 15-20 - 15-20 Executive Director of Strategy from 01/07/2019 Dr Elizabeth Gill Chief Medical Officer from 01/01/2020 3 20-25 - 7.5-10 30-35 0-5 - 0-5 Dr Tim Caroe Chief Medical Officer from 01/01/2020 3 20-25 - 12.5-15 35-40 0-5 - 0-5 Jessica Britton Executive Managing Director (East 3 120-125 3 62.5-65 185-190 20-25 - 20-25 Sussex) from 01/04/2019 Karen Breen Deputy Chief Executive Officer from 3 155-160 5 260-262.5 415-420 25-30 1 25-30 23/04/2019 Lola Banjoko Executive Managing Director (South – 3 120-125 - 55-57.5 175-180 15-20 - 15-20 Brighton & Hove / High Weald Lewes Havens) from 01/04/2019 Pennie Ford Executive Managing Director (West 3,11 60-65 1 22.5-25 85-90 10-15 - 10-15 Sussex) from 01/10/2019 Peter Kottlar Executive Managing Director (Complex 3 120-125 1 57.5-60 180-185 20-25 - 20-25 Commissioning) Dominic Wright Managing Director (Coastal West 3,12 60-65 - - 60-65 5-10 - 5-10 Sussex CCG) from 01/04/2019 to 30/09/2019

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2019-20 2019-20 2019-20 2019-20 2019-20 2019-20 2019-20 Name Title Notes Senior Expense All pension Total CCG’s CCG’s CCG’s Manager payments Related Salary Share Share Share of Salary (taxable) Benefits (bands of Salary Expense Total (bands of to nearest (Bands of £5,000) (bands of payments Salary £5,000) £100** £2,500) £5,000) (taxable) (bands of to nearest £5,000) £100** £'000 £'00 £'000 £'000 £'000 £'00 £'000 Terry Willows Executive Director of Corporate 3,11 125-130 2 55-57.5 180-185 20-25 - 20-25 Governance Tom Gurney Executive Director of Communications, 3 120-125 - 85-87.5 210-215 15-20 - 15-20 People and Public Involvement from 01/04/2019 Wendy Carberry Executive Director of Primary Care 3 130-135 1 130-135 20-25 - 20-25 Andy Hodson Chief of Clinical Leadership and 75-80 - - 75-80 75-80 - 75-80 Engagement to 30/09/2019 / Clinical Chair from 01/10/2019 Dr David Supple Clinical Chair to 16/10/2019 75-80 - 75-80 75-80 - 75-80 Carol Pearson Lay Member (Governance) from 5-10 - 5-10 5-10 - 5-10 01/11/2019 Dr Charles Turton Independent Member (Secondary Care) 5-10 - 5-10 5-10 - 5-10

Dr Jennifer Oates Independent Member (Nurse) 5-10 - 5-10 5-10 - 5-10 Dr Jim Graham Local Cluster Representative to 30-35 - 30-35 30-35 - 30-35 31/10/2019 Dr Tom Gayton Local Cluster Representative 30-35 - 30-35 30-35 - 30-35 Jonathan Lay Member (Finance) to 31/10/2019 5-10 - 5-10 5-10 - 5-10 Molyneux Malcolm Dennett Lay Member (Governance) (B&H) 25-30 - 25-30 15-20 - 15-20 Mike Holdgate Vice Chair and Lay Member (Patient 20-25 1 20-25 20-25 1 20-25 and Public Participation)

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2019-20 2019-20 2019-20 2019-20 2019-20 2019-20 2019-20 Name Title Notes Senior Expense All pension Total CCG’s CCG’s CCG’s Manager payments Related Salary Share Share Share of Salary (taxable) Benefits (bands of Salary Expense Total (bands of to nearest (Bands of £5,000) (bands of payments Salary £5,000) £100** £2,500) £5,000) (taxable) (bands of to nearest £5,000) £100** £'000 £'00 £'000 £'000 £'000 £'00 £'000 Alistair Hill Director of Public Health, Brighton and 13 n/a n/a n/a n/a n/a n/a n/a Hove City Council Peter Wilkinson Interim Director of Public Health, 13 n/a n/a n/a n/a n/a n/a n/a Brighton and Hove City Council Rob Persey Executive Director for Adult and Social 13 n/a n/a n/a n/a n/a n/a n/a Care, Brighton and Hove City Council

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Pension Disclosure Table In the salary disclosure table and the pension disclosure table, all pension related benefits are calculated with respect to the total for the joint appointment.

Pension benefits as at 31 March 2021 Real Real increase Total Lump sum Cash Real Cash increase in accrued at pension Equivalent Increase in Equivalent in Employers pension pension at age related Transfer Cash Transfer pension Contribution lump sum pension age to accrued Value at Equivalent Value (CETV) Name Title at to at at pension at 01/04/2020 Transfer at pension partnership pension 31/03/2021 31/03/2021 (to the Value (to 31/03/2021(to age pension age (bands of (bands of nearest the nearest the nearest (bands of (bands of £5000) £5000) £1,000) £1,000) £1,000) £2500) £2500) £000 £000 £000 £000 £000 £000 £000 £000 Adam Doyle Chief Executive Officer 2.5-5 - 20-25 - 194 11 236 - Deputy Chief Executive Officer and Chief Karen Breen 2.5-5 - 65-70 160-165 1290 46 1382 - Operating Officer Allison Cannon Chief Nursing Officer 0-2.5 - 45-50 110-115 856 20 910 - Chris Adcock Chief Finance Officer to 16/02/2021 2.5-5 - 55-60 110-115 895 49 990 - Dr Elizabeth Gill Chief Medical Officer 10-12.5 25-27.5 15-20 40-45 118 202 337 - Dr Tim Caroe Chief Medical Officer to 19/01/2021 5-7.5 15-17.5 10-15 30-35 88 105 235 - Executive Director of Primary Care from Amy Galea 0-2.5 - 10-15 - 77 2 101 - 16/11/2020 David Cryer Executive Director of Strategy 0-2.5 - 25-30 - 332 14 371 - Executive Managing Director (East Jessica Britton 2.5-5 0-2.5 35-40 65-70 547 31 606 - Sussex) Executive Managing Director (Brighton & Lola Banjoko 2.5-5 5-7.5 30-35 80-85 585 79 692 - Hove) Executive Managing Director (West Pennie Ford 0-2.5 7.5-10 50-55 120-125 997 55 1088 - Sussex) Executive Managing Director (Complex Peter Kottlar 2.5-5 2.5-5 25-30 45-50 359 32 415 - Commissioning)

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Real Real increase Total Lump sum Cash Real Cash increase in accrued at pension Equivalent Increase in Equivalent in Employers pension pension at age related Transfer Cash Transfer pension Contribution lump sum pension age to accrued Value at Equivalent Value (CETV) Name Title at to at at pension at 01/04/2020 Transfer at pension partnership pension 31/03/2021 31/03/2021 (to the Value (to 31/03/2021(to age pension age (bands of (bands of nearest the nearest the nearest (bands of (bands of £5000) £5000) £1,000) £1,000) £1,000) £2500) £2500) £000 £000 £000 £000 £000 £000 £000 £000 Executive Director of Corporate Terry Willows 0-2.5 - 5-10 - 41 10 70 - Governance Executive Director of Communications, People and Public Involvement to Tom Gurney 18/01/2021 / Executive Director of 2.5-5 - 20-25 - 213 29 264 - Communications and Public Involvement from 19/01/2021

Pension benefits as at 31 March 2020 Real Real increase increase Total Lump sum Real in Cash Cash in accrued at pension increase in pension Equivalent Equivalent Employers pension pension at age related Cash lump Transfer Transfer contribution at pension to accrued Equivalent Name Title sum at Value at Value at to pension age at pension at Transfer pension 1/4/19 (to 31/3/20 (to Stakeholder age 31/3/20 31/3/20 Value (to age the nearest the nearest pension (bands (bands of (bands of the nearest (bands £1,000) £1,000) of £5,000) £5,000) £1,000) of £2,500) £2,500) Adam Doyle Chief Executive Officer 2.5-5 - 15-20 - 144 19 194 - Allison Cannon Chief Nursing Officer 7.5-10 17.5-20 45-50 110-115 660 161 856 - Chief of Clinical Leadership and - Andrew Hodson Engagement to 30/09/2019 / Clinical Chair 0-2.5 - 10-15 30-35 237 - 248 from 01/10/2019

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Christopher - Chief Finance Officer from 01/07/2019 5-7.5 - 55-60 115-120 895 59 990 Adcock Chief Finance Officer to 30/06/2019 / - David Cryer Executive Director of Strategy from 2.5-5 - 20-25 - 266 40 332 01/07/2019 Executive Managing Director (East Sussex) - Jessica Britton 2.5-5 2.5-5 30-35 60-65 468 51 547 from 01/04/2019 Deputy Chief Executive Officer from - Karen Breen 12.5-15 27.5-30 65-70 155-160 983 244 1290 23/04/2019 Executive Managing Director (West Sussex) - Pennie Ford 0-2.5 0-2.5 45-50 110-115 913 27 997 from 01/10/2019 Executive Managing Director (Complex - Peter Kottlar 2.5-5 0-2.5 25-30 45-50 301 34 359 Commissioning) Terry Willows Executive Director of Corporate Governance 2.5-5 - 0-5 - - 21 41 - Executive Director of Communications, - Tom Gurney People and Public Involvement from 5-7.5 - 15-20 - 150 41 213 01/04/2019 Executive Managing Director (South – - Lola Banjoko Brighton & Hove and High Weald Lewes 2.5-5 7.5-10 25-30 75-80 491 67 585 Havens) from 01/04/2019 Tim Caroe Chief Medical Officer from 01/01/2020 0-2.5 12.5-15 5-10 10-15 34 10 88 - Elizabeth Gill Chief Medical Officer from 01/01/2020 0-2.5 0-2.5 5-10 15-20 71 8 118 -

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Notes to the Salary and Pension Tables Note 1: Joint appointment between NHS Sussex Commissioners from 01/04/2020; salary shares were based upon each CCG’s Administration allocation. (NHS Brighton and Hove CCG 17.35%, NHS East Sussex CCG 31.96% and NHS West Sussex CCG 50.69%).

Note 2: In 2019-20 joint appointment between Sussex and East Surrey CCGs from 01/04/2019 to 31/10/2019 and the Sussex CCGs from 01/11/2019 to 31/03/2020. (NHS Brighton and Hove CCG, NHS High Weald Lewes Havens CCG, NHS Horsham and Mid Sussex CCG, NHS Crawley CCG NHS Coastal West Sussex CCG, NHS Hastings and Rother CCG, NHS Eastbourne Hailsham and Seaford CCG and NHS East Surrey CCG to 31/10/2019). Salary shares were based upon each CCG’s Administration allocation

Note 3: Formally appointed as Chief Executive Officer in January 2019 of NHS Sussex Commissioners and holds Accountable Officer status for each of the CCGs.

Note 4: There are nil entries for annual performance related bonuses, long term performance related bonuses. The all pension related benefits are shown for those senior managers shown in salary disclosure table that are employees of the CCG.

Note 5: Lay Members, the Governing Body Independent Nurse, and Governing Body Secondary Care Consultant remuneration are non-pensionable and therefore there are no entries in respect of pensions for these members. The Locality Representatives are office holders of the CCG and are self-employed GPs. The employment status is as an 'off payroll worker' for NHS statutory accounting purposes, although the individual is paid via payroll. In accordance with HMRC guidance, they are deemed 'office holders' of the organisation requiring the organisation to deduct income tax and National Insurance at source. The practitioner pension information cannot be obtained by the CCG in respect of CETV or lump sum. As the role carried out by the GPs at the CCGs will only form a part of their overall work it is also considered inappropriate to disclose information on CETV or lump sum even if the CCGs were party to the information.

Note 6: All Pension Related Benefits: This will apply to those receiving pension contributions only. The values disclosed relate to the total remuneration. Where there is a staff sharing arrangement in place, the full pension related benefit is disclosed and not apportioned value; to do so would not provide relevant information due to the way it is calculated. The amount included here comprises all pension related benefits, including:  The cash value of payments (whether in cash or otherwise) in lieu of retirement benefits, and  All benefits in year from participating in pension schemes.

For defined benefit schemes, the amount included here is the annual increase in pension entitlement determined in accordance with the 'HMRC' method. In summary, this is as follows: Increase = ((20 x PE) +LSE) - ((20 x PB) + LSB) less employee contributions Where:  PE is the annual rate of pension that would be payable to the director if they became entitled to it at the end of the financial year  PB is the annual rate of pension, adjusted for inflation, that would be payable to the director if they became entitled to it at the beginning of the financial year  LSE is the amount of lump sum that would be payable to the director if they became entitled to it at the end of the financial year; and  LSB is the amount of lump sum, adjusted for inflation, that would be payable to the director if they became entitled to it at the beginning of the financial year.

Note 7: The inflation applied to the accrued pension, lump sum (where applicable) and CETV is the percentage (if any) by which the Consumer Prices Index (CPI) for the September before the start of the tax year is higher than it was for the previous September. The Consumer Prices Index up to September 2019 was 1.7%, therefore, an increase of 1.7% should be applied to pensions and CETV at April 2020. Applying this inflation adjustment to the 31 March 2020 value has in some cases resulted in an adjusted value which exceeds the 31 March 2021 value.

Note 8: Medical Director at Surrey and Sussex LMC and not in receipt of remuneration from the CCG.

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Note 9: Mark Power was contracted via Ekim Consulting Ltd to the 28/02/2021 and moved on to the CCGs Payroll from the 01/03/2021.

Note 10: Dr Andrew Hodson, James Hayburn and Mark Power do not contribute to the CCGs’ Employee NHS Pension Scheme.

Note 11: For part of 2019-20 these Senior Managers were on secondment from NHS England, the remuneration of the secondment and subsequent substantive contract with the CCGs are disclosed in the tables.  The secondment for Terry Willows ceased on 30/04/2019.  The secondment for David Cryer ceased on 30/6/2019.  The secondment for Pennie Ford was from 31/10/2019 to 31/01/2020.

Note 12: In 2019-20 Seconded from NHS Guildford and Waverley CCG. The secondment for Dominic Wright ceased on 30/09/2019.

Note 13: Employed by Brighton and Hove City Council and not in receipt of remuneration from the CCG.

Cash equivalent transfer values A cash equivalent transfer value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s (or other allowable beneficiary’s) pension payable from the scheme.

A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies.

The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.

Real increase in CETV This reflects the increase in CETV that is funded by the employer. It does not include the increase in accrued pension due to inflation or contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement).

Compensation on early retirement or for loss of office (Note: This disclosure is auditable).

No senior manager received payment on early retirement or for loss of office during 2020/21.

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Payments to past members (Note: This disclosure is auditable). During 2020/21 there was one instance of payments made relating to a previous Senior Manager to report.

Tim Caroe, Chief Medical Officer until 19/01/2021, remained in the employ of the CCGs following his change of Senior Manager status. His total remuneration for 2020/21 was 95-100k. The CCGs Share was 15-20k.

Pay multiples (Note: The pay multiples disclosure is auditable).

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

The values are all calculated at full time equivalent basis. The CCG, working collaboratively as Sussex NHS Commissioners, is apportioned its fair share of the costs.

The banded full time equivalent remuneration of the highest paid Senior Manager in the CCG in the financial year 2020/21 was £170-175k (2019/20: £200-205k). This was 3.8 times (2019/20: 4.6) the median remuneration of the workforce, which was £45.8k (2019/20: £44.3k).

In 2020/21, seven employees received remuneration in excess of the highest-paid Senior Manager, calculated on the share of costs apportioned to the CCG. On a full time equivalent basis nine employees received remuneration in excess of the highest-paid senior manager, including the Accountable Officer. The remaining eight were employed via agencies or companies on an interim basis.

Remuneration of all staff on full time equivalent basis ranged from £18k to £259k (2019/20: £17k to £360k). The range of the share of costs apportioned to the CCG was £0k to £243k.

Total remuneration includes salary, non-consolidated performance-related pay and benefits-in-kind. It does not include severance payments, employer pension contributions and the cash equivalent transfer value of pensions.

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Staff Report

Number of senior managers This information is incorporated into the composition table below.

Staff numbers and costs Staff Numbers and Composition (Note: This disclosure is auditable).

Staff details disclosed are permanently employed staff with a permanent (UK) employment contract with the CCG and includes the relevant CCG’s share of any shared posts. The headcount represents the establishment in post at the end of the financial year. The whole time equivalent (WTE) value shown is the average across bandings for the full financial year to better provide a view of the CCGs share of the establishment.

The composition of the Governing Body is shown below. The table below shows the staff composition by band. This includes those GPs working as clinical leads, and paid through the payroll, but who are not employees or officers.

Average Headcount WTE Governing Body Chief Executive Officer 0.2 0.2 Chair 1.0 Lay Member 4.0 Associate Governing Body Lay Member 2.0 Independent Member - Secondary Care Clinician 1.0 Independent Member (GP) 1.0 Lay Member - Independent Nurse 1.0 Chief Medical Officer 0.2 0.2 Chief Finance Officer 0.2 0.2 Executive Director 1.7 1.7 Locality Representative 2.0 Governing Body and Executive Team Total 14.3 2.3 Employees of the CCG Band 2 0.5 0.3 Band 3 4.5 3.7 Band 4 7.7 6.2 Band 5 11.1 10.6 Band 6 32.2 29.6 Band 7 29.7 24.2 Band 8A 25.8 25.3

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Band 8B 10.3 9.0 Band 8C 6.9 7.0 Band 8D 4.6 4.7 Band 9 2.4 1.6 Senior Manager 1.8 1.0 Clinical Lead 8.6 Employees Total 146.1 123.2 Other 19.3 8.7 Grand Total 178.7 134.2

Staff Costs The tables below show the total employee benefits for the costs attributable to the CCG.

2020/21 Employee Benefits Table

2020/21 total Admin Programme 2020/21 Employee Benefits Total Perm Other Total Perm Other Total Perm Other £’000 £’000 £’000 £’000 £’000 £’000 £’000 £’000 £’000 Employee Benefits Salaries and wages 7,068 6,056 1,012 2,851 2,643 208 4,217 3,413 804 Social security costs 637 637 - 308 308 - 329 329 - Employer contributions to the NHS Pension 1,274 1,274 - 897 897 - 377 377 - Scheme Other pension costs 6 6 - 2 2 - 4 4 - Apprenticeship Levy 23 23 - 23 23 - - - - Net Employee Benefits 9,008 7,996 1,012 4,081 3,873 208 4,927 4,123 804

2019/20 Employee Benefits Table 2019/20 total Admin Programme 2019/20 Employee Benefits Total Perm Other Total Perm Other Total Perm Other £’000 £’000 £’000 £’000 £’000 £’000 £’000 £’000 £’000 Employee Benefits Salaries and wages 6,396 5,062 1,334 3,014 2,600 414 3,382 2,462 920 Social security costs 563 563 - 297 297 - 266 266 - Employer contributions to the NHS 1,048 1,048 717 717 331 331 - - - Pension Scheme Other pension costs 2 2 - 1 1 - 1 1 - Apprenticeship Levy 19 19 - 19 19 - - - - Termination benefits 52 52 - 52 52 - - - - Net Employee Benefits 8,080 6,746 1,334 4,100 3,686 414 3,980 3,060 920

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Staff composition The table below details the CCG’s staff composition by gender at the end of the financial year. This details the percentage split by gender of the Governing Body and the CCG’s employees and officers on permanent and fixed term contracts, incorporating the relevant CCG’s share of any shared posts.

NHS West Sussex CCG Male Female Senior Managers as Reported in Remuneration Tables Governing Body members 52.2% 47.8% Executive Directors 50.0% 50.0% Total Governing Body and Executive Directors 51.6% 48.4% Employees of the CCG Senior Managers 57.1% 42.9% All other employees of the CCG 71.9% 28.1% Total Employees 71.8% 28.2% Total CCG 69.3% 30.7%

Sickness absence data NHS Digital publishes information on NHS Sickness Absence Rates: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-sickness- absence-rates

The Sussex CCGs continue to actively manage sickness absence.

Staff engagement percentages Consistent with our commitment to build a culture of openness and support, a significant level of engagement was undertaken with our staff during 2020/21. The CCGs are ensuring that all the staff have regular opportunities to come together via an extensive virtual programme of webinars, communications and team meetings. These regular ‘touch points’ provide the opportunity for our staff to hear directly from senior leaders and to ask questions relating to a range of issues associated with the work of the CCGs and development of the ICS, and issues affecting their working lives.

In addition, we have continued to conduct bi-monthly ‘temperature check’ surveys and to provide weekly staff newsletters. A full staff survey was undertaken in July 2020. The survey was distributed to all staff employed by the Sussex CCGs with a total of 30 questions being asked. We received a positive response to the survey with a response rate of 81%. Those areas with the greatest improvement were health and wellbeing being seen as a priority, which increased by 55%, staff happy with the level of communication they see, which increased by 36%, and staff feeling supported by their line manager, which increased by 11%.

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Staff policies The CCG has a suite of employment policies, which it keeps regularly under review. Alongside other Sussex CCGs, NHS Brighton and Hove CCG is a member of a joint committee where the CCGs and the Staff Side representatives can keep the agreed policies under review to ensure that they remain up to date.

Our recruitment and selection policy states that where a person applies for a role with the CCG, who meets the essential criteria and notifies us that they have a disability, we will always offer them an interview. We will of course be happy to make any reasonable adjustment to enable the applicant to attend an interview.

In relation to staff members with disabilities, we will make all reasonable adjustments to facilitate them in their role with us. If necessary we will liaise with external professionals, such as “Access to Work” and our occupational health provider, who will assess the employee and make recommendations as to what adjustments can be made to assist them in the workplace.

It is the CCG’s policy to develop a personal development plan for each member of staff, which is kept under review as part of the staff appraisal process. Our policy on equal opportunities is clear that we will treat staff with disabilities no less favourably, if they have a disability. It is our intention to at all times comply with the Public Sector Equality Duty and meet our wider obligations under the Equality Act 2010.

Staff equality network This network covers all of the CCGs within Sussex. The network has strong leadership support and commitment, and is beginning to achieve progress.

We are proud to note that on 22 August 2019 the Sussex Commissioners (DCS012299) was certified as ‘disability confident employer’.

As a Disability Confident Committed Employer, we:  Are offering at least one activity to get the right people for our business and at least one activity to keep and develop our people  Are taking all of the core actions to be a disability confident employer  Have undertaken and successfully completed the Disability Confident self- assessment

To find out more about Disability Confident you can visit www.gov.uk/disability- confident

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Trade Union Facility Time Reporting Requirements The CCG is a relevant public sector employer as defined by the Trade Union (Facility Time Publication Requirements) Regulations 2017 and has three employees who are accredited Trade Union representatives to report, who work across the Sussex CCGs and spent 1% to 50% of their working hours on facility time.

Other employee matters All formal staff consultations have been conducted in accordance with local policy provisions and with prevailing national and NHS good practice guidance. In doing so, effective partnership working has been maintained with Trades Union and staff representatives.

Expenditure on consultancy During the year the CCG’s spend on consultancy services was £3,059k (£696k in 2019/20) as can be seen in note 4 of the Annual Accounts. This included consultancy support funded by NHS England used to plan and deliver the CCG’s response to the pandemic, £1,711k.

Exit packages, including special (non-contractual) payments (Note: This disclosure is auditable). There has been one contractual ‘payment in lieu of notice’ exit package in 2020/21 where the cost, or a share of the cost, was attributable to the CCG.

Number Total CCG’s Share Type of Exit Package £’000 £’000 Payment in Lieu of Notice 1 67 12

No non-contractual payments were made to individuals where the payment value was more than 12 months of their annual salary. The Remuneration Report includes disclosure of exit payments payable to individuals named in that Report.

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Off-payroll engagements (Note: Off-payroll engagements disclosures are not auditable).

Table 1: Off-payroll engagements longer than 6 months

For all off-payroll engagements as at 31 March 2021 for more than £245 per day and that last longer than six months:

Number Number of existing engagements as of 31 March 2021 13 Of which, the number that have existed: for less than one year at the time of reporting 4 for between one and two years at the time of reporting 5 for between 2 and 3 years at the time of reporting 4 for between 3 and 4 years at the time of reporting - for 4 or more years at the time of reporting -

The CCGs recruitment process requires an IR35 assessment be complete to ensure that the correct HMRC responsibilities are assured.

Table 2: New off-payroll engagements

Where the reformed public sector rules apply, entities must complete Table 2 for all new off-payroll engagements, or those that reached six months in duration, between 1 April 2020 and 31 March 2021, for more than £245 per day and that last for longer than 6 months: Number Number of new engagements, or those that reached six months in 11 duration, between 1 April 2020 and 31 March 2021 Of which: Number assessed as caught by IR35 5 Number assessed as not caught by IR35 6

Number engaged directly (via PSC contracted to department) and are 0 on the departmental payroll Number of engagements reassessed for consistency / assurance 0 purposes during the year Number of engagements that saw a change to IR35 status following 0 the consistency review

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Table 3: Off-payroll engagements / senior official engagements

For any off-payroll engagements of Board members and / or senior officials with significant financial responsibility, between 01 April 2020 and 31 March 2021

Number of off-payroll engagements of board members, and/or senior officers with significant financial responsibility, during the 3 financial year Total no. of individuals on payroll and off-payroll that have been deemed “board members, and/or, senior officials with significant 17 financial responsibility”, during the financial year. This figure should include both on payroll and off-payroll engagements.

There was one senior manager that was off payroll for 2 months during 2020/21. They are on payroll from March 2021 and both the payroll and the payments to the consulting company are disclosed in the Salary table in this report. The remaining two reported are the Locality Representatives as detailed in Note 4 of the ‘Notes to the Salary and Pension Tables’.

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Parliamentary Accountability and Audit Report

NHS Brighton and Hove CCG is not required to produce a Parliamentary Accountability and Audit Report. A disclosure for a special payment is included as a note in the Financial Statements of this report at note 16. There are no remote contingent liabilities, losses, gifts, or fees and charges to report. An audit certificate and report is also included in this Annual Report in Section Three.

Accountability Report

Adam Doyle Accountable Officer 14 June 2021

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Appendix A

INDEPENDENT AUDITOR’S REPORT TO THE MEMBERS OF THE GOVERNING BODY OF NHS BRIGHTON AND HOVE CLINICAL COMMISSIONING GROUP

Opinion

We have audited the financial statements of NHS Brighton and Hove Clinical Commissioning Group (the Clinical Commissioning Group) for the year ended 31 March 2021 under the Local Audit and Accountability Act 2014. The financial statements comprise the Statement of Comprehensive Net Expenditure, the Statement of Financial Position, the Statement of Changes in Taxpayers’ Equity, the Statement of Cash Flows and the related notes 1 to 17. The financial reporting framework that has been applied in their preparation is applicable law and International Financial Reporting Standards (IFRSs) as adopted by the European Union, and as interpreted and adapted by the 2020/21 HM Treasury’s Financial Reporting Manual (the 2020/21 FReM) as contained in the Department of Health and Social Care Group Accounting Manual 2020/21 and the Accounts Direction issued by the NHS Commissioning Board with the approval of the Secretary of State as relevant to the National Health Service in England (the Accounts Direction).

In our opinion the financial statements:

 give a true and fair view of the financial position of NHS Brighton and Hove Clinical Commissioning Group as at 31 March 2021 and of its net operating costs for the year then ended; and  have been prepared properly in accordance with the Health and Social Care Act 2012 and the Accounts Directions issued thereunder.

Basis for opinion

We conducted our audit in accordance with International Standards on Auditing (UK) (ISAs (UK)) and applicable law. Our responsibilities under those standards are further described in the Auditor’s responsibilities for the audit of the financial statements section of our report below. We are independent of the Clinical Commissioning Group in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK, including the FRC’s Ethical Standard and the Comptroller and Auditor General’s AGN01 and we have fulfilled our other ethical responsibilities in accordance with these requirements.

We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion.

Conclusions relating to going concern

In auditing the financial statements, we have concluded that the Accountable Officer’s use of the going concern basis of accounting in the preparation of the financial statements is appropriate. Based on the work we have performed, we have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the Clinical Commissioning Group’s ability to continue as a going concern for a period of 12 months from the date of this report from when the financial statements are authorised for issue.

Our responsibilities and the responsibilities of the Accountable Officer with respect to going concern are described in the relevant sections of this report. However, because not all future events or conditions can be predicted, this statement is not a guarantee as to the Clinical Commissioning Group’s ability to continue as a going concern.

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Other information

The other information comprises the information included in the annual report set out on pages 3 to 113, other than the financial statements and our auditor’s report thereon. The Accountable Officer is responsible for the other information contained within the annual report.

Our opinion on the financial statements does not cover the other information and, except to the extent otherwise explicitly stated in this report, we do not express any form of assurance conclusion thereon.

Our responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or our knowledge obtained in the course of the audit or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether there is a material misstatement in the financial statements themselves. If, based on the work we have performed, we conclude that there is a material misstatement of the other information, we are required to report that fact.

We have nothing to report in this regard.

Opinion on other matters prescribed by the Health and Social Care Act 2012

In our opinion the part of the Remuneration and Staff Report to be audited has been properly prepared in accordance with the Health and Social Care Act 2012 and the Accounts Directions issued thereunder.

Matters on which we are required to report by exception

We are required to report to you if:

 in our opinion the governance statement does not comply with the guidance issued by the NHS Commissioning Board; or  we refer a matter to the Secretary of State under section 30 of the Local Audit and Accountability Act 2014 because we have reason to believe that the Clinical Commissioning Group, or an officer of the Clinical Commissioning Group, is about to make, or has made, a decision which involves or would involve the body incurring unlawful expenditure, or is about to take, or has begun to take a course of action which, if followed to its conclusion, would be unlawful and likely to cause a loss or deficiency; or  we issue a report in the public interest under section 24 of the Local Audit and Accountability Act 2014; or  we make a written recommendation to the Clinical Commissioning Group under section 24 of the Local Audit and Accountability Act 2014; or  we are not satisfied that the Clinical Commissioning Group has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2021.

We have nothing to report in these respects.

Responsibilities of the Accountable Officer

As explained more fully in the Statement of Accountable Officer’s Responsibilities in respect of the Accounts, set out on page 59, the Accountable Officer is responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view and for such internal control as the Accountable Officer determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. The Accountable Officer is also responsible for ensuring the regularity of expenditure and income. In preparing the financial statements, the Accountable Officer is responsible for assessing the Clinical Commissioning Group’s ability to continue as a going concern, disclosing, as applicable, matters related to going

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concern and using the going concern basis of accounting unless the Accountable Officer either intends to cease operations, or has no realistic alternative but to do so.

As explained in the Annual Governance Statement the Accountable Officer is responsible for the arrangements to secure economy, efficiency and effectiveness in the use of the Clinical Commissioning Group's resources.

Auditor’s responsibility for the audit of the financial statements

Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements.

Explanation as to what extent the audit was considered capable of detecting irregularities, including fraud.

Irregularities, including fraud, are instances of non-compliance with laws and regulations. We design procedures in line with our responsibilities, outlined above, to detect irregularities, including fraud. The risk of not detecting a material misstatement due to fraud is higher than the risk of not detecting one resulting from error, as fraud may involve deliberate concealment by, for example, forgery or intentional misrepresentations, or through collusion. The extent to which our procedures are capable of detecting irregularities, including fraud is detailed below. However, the primary responsibility for the prevention and detection of fraud rests with both those charged with governance of the entity and management.  We obtained an understanding of the legal and regulatory frameworks that are applicable to the Clinical Commissioning Group and determined that the most significant are the Health and Social Care Act 2012 and other legislation governing NHS Clinical Commissioning Groups, as well as relevant employment laws of the United Kingdom. In addition, the Clinical Commissioning Group has to comply with laws and regulations in the areas of anti-bribery and corruption and data protection.  We understood how NHS Brighton and Hove Clinical Commissioning Group is complying with those frameworks by understanding the incentive, opportunities and motives for non- compliance, including inquiring of management, Head of Internal Audit and those charged with governance and obtaining and reviewing documentation relating to the procedures in place to identify, evaluate and comply with laws and regulations, and whether they are aware of instances of non-compliance.  We assessed the susceptibility of the Clinical Commissioning Group’s financial statements to material misstatement, including how fraud might occur by planning and executing a journal testing strategy and testing the appropriateness of relevant entries and adjustments. We have considered whether judgements made are indicative of potential bias, and considered whether the Clinical Commissioning Group is engaging in any transactions outside the usual course of business. We identified two specific fraud risks, relating to the risk of manipulation of reported financial performance and the related risk of the risk of manipulation of the corporate recharges.  Based on this understanding we designed our audit procedures to identify non-compliance with such laws and regulations. Our procedures involved enquiry of management and those charged with governance, reading and reviewing relevant meeting minutes of those charged with governance and the Governing Body and understanding the internal controls in place to mitigate risks related to fraud and non-compliance with laws and regulations.

A further description of our responsibilities for the audit of the financial statements is located on the Financial Reporting Council’s website at https://www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditor’s report.

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

We have undertaken our review in accordance with the Code of Audit Practice, having regard to the guidance on the specified reporting criteria issued by the Comptroller and Auditor General in April 2021, as to whether the Clinical Commissioning Group had proper arrangements for financial sustainability, governance and improving economy, efficiency and effectiveness. The Comptroller and Auditor General determined these criteria as that necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the Clinical Commissioning Group put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2021.

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

We are required under Section 21(1)(c) of the Local Audit and Accountability Act 2014 to be satisfied that the Clinical Commissioning Group has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. Section 21(5)(b) of the Local Audit and Accountability Act 2014 requires that our report must not contain our opinion if we are satisfied that proper arrangements are in place.

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

Report on Other Legal and Regulatory Requirements

Regularity opinion

We are responsible for giving an opinion on the regularity of expenditure and income in accordance with the Code of Audit Practice prepared by the Comptroller and Auditor General as required by the Local Audit and Accountability Act 2014 (the "Code of Audit Practice").

We are required to obtain evidence sufficient to give reasonable assurance that the expenditure and income recorded in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them.

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

Certificate

Delay in certification of completion of the audit We cannot formally conclude the audit and issue an audit certificate until we have completed our procedures on the Clinical Commissioning Group’s value for money arrangements for the year ended 31 March 2021. We are satisfied that this work does not have a material effect on the financial statements. We will report the outcome of our work on the Clinical Commissioning Group’s arrangements in our commentary on those arrangements within the Auditor’s Annual Report. Our audit completion certificate will set out any matters which we are required to report by exception. Until we have completed these procedures, we are unable to certify that we have completed the audit of the accounts in accordance with the requirements of the Local Audit and Accountability Act 2014 and the Code of Audit Practice issued by the National Audit Office.

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Use of our report

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

Helen Thompson (Key Audit Partner) Ernst & Young LLP (Local Auditor) Southampton X June 2021

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Appendix B Financial Statements as at 31 March 2021

Contents Statement of Comprehensive Net Expenditure for the year ended 31 March 2021 ...... 121 Statement of Financial Position as at 31 March 2021 ...... 122 Statement of Changes in Taxpayers' Equity for the year ended 31 March 2021 ...... 123 Statement of Cash Flows for the year ended 31 March 2021 ...... 124 Notes to the Accounts ...... 125 1. Accounting policies ...... 125 2. Other operating revenue ...... 133 3. Employee benefits and staff numbers ...... 134 4 Operating expenses ...... 137 5 Better payment practice code...... 138 6 Operating leases ...... 139 7 Property, plant and equipment ...... 140 8 Trade and other receivables...... 140 9 Cash and cash equivalents ...... 142 10 Trade and other payables ...... 142 11 Provisions ...... 143 12 Financial instruments ...... 143 13 Joint arrangements – interests in joint operations ...... 145 14 Related party transactions ...... 145 15 Events after the end of the reporting period ...... 147 16 Losses and special payments ...... 147 17 Financial performance targets ...... 148

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Statement of Comprehensive Net Expenditure for the year ended 31 March 2021

2020-21 2019-20 Note £'000 £'000

Income from sale of goods and services 2 (1,630) (2,287) Other operating income 2 (28) (23) Total operating income (1,658) (2,310)

Staff costs 3 9,008 8,080 Purchase of goods and services 4 488,206 448,829 Depreciation and impairment charges 4 60 60 Provision expense 4 16 163 Other Operating Expenditure 4 828 919 Total operating expenditure 498,118 458,051

Comprehensive Expenditure for the year 496,460 455,741

The notes on pages 125-148 form part of this statement

Surplus / Deficit for Year

2020-21 2020-21 2020-21 Total Admin Programme £'000 £'000 £'000 The CCG's performance for the year ended 31 March 2021 is as follows: Total Net Operating Cost for the Financial 496,460 6,339 490,121 Year Revenue Allocation 496,573 6,363 490,210 (Under)/Overspend Against Revenue (113) (24) (89) Resource Limit (RRL)

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Statement of Financial Position as at 31 March 2021

2020-21 2019-20

Note £'000 £'000 Non-current assets: Property, plant and equipment 7 177 237 Total non-current assets 177 237

Current assets: Trade and other receivables 8 14,843 17,679 Cash and cash equivalents 9 266 438 Total current assets 15,109 18,117

Total assets 15,285 18,354

Current liabilities Trade and other payables 10 (49,483) (43,560) Provisions 11 (224) (210) Total current liabilities (49,707) (43,770)

Non-Current Assets plus/less Net Current Assets/Liabilities (34,421) (25,416)

Financed by Taxpayers’ Equity General fund (34,421) (25,416) Total taxpayers' equity: (34,421) (25,416)

The notes on pages 125-148 form part of this statement . The financial statements on pages 121-148 were approved by the Audit and Assurance Committee, on delegated authority from the Governing Body, on 9 June 2021 and signed on its behalf by:

Adam Doyle Chief Executive Officer

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Statement of Changes in Taxpayers' Equity for the year ended 31 March 2021 2020-21 2019-20 General General fund fund £'000 £'000 Changes in taxpayers’ equity for 2020-21

Balance at 01 April (25,416) (15,762)

Changes in NHS Clinical Commissioning Group taxpayers’ equity for the Financial Year Net operating expenditure for the financial year (496,460) (455,741)

Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial year (496,460) (455,741) Net funding 487,455 446,087 Balance at 31 March (34,421) (25,416)

The notes on pages 125-148 form part of this statement .

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Statement of Cash Flows for the year ended 31 March 2021 2020-21 2019-20 Note £'000 £'000 Cash Flows from Operating Activities Net operating expenditure for the financial year (496,460) (455,741) Depreciation and amortisation 7 60 60 (Increase) /decrease in trade and other receivables 8 2,836 (725) Increase in trade and other payables 10 5,923 10,609 Provisions utilised 11 (2) (50) Increase in provisions 11 16 163 Net Cash Outflow from Operating Activities (487,627) (445,684)

Cash Flows from Financing Activities Grant in Aid Funding Received 487,455 446,087 Net Cash Inflow from Financing Activities 487,455 446,087

Net Increase (Decrease) in Cash and Cash Equivalents 9 (172) 403

Cash and Cash Equivalents at the Beginning of the Financial Year 438 35 Cash and Cash Equivalents (including bank overdrafts) at the End of the Financial Year 266 438

The notes on pages 125 to 148 form part of this statement .

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Notes to the Accounts

1. Accounting policies NHS England has directed that the financial statements of Clinical Commissioning Groups shall meet the accounting requirements of the Group Accounting Manual issued by the Department of Health and Social Care. Consequently, the following financial statements have been prepared in accordance with the Group Accounting Manual 2020-21 issued by the Department of Health and Social Care. The accounting policies contained in the Group Accounting Manual follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to Clinical Commissioning Groups, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Group Accounting Manual permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the Clinical Commissioning Group for the purpose of giving a true and fair view has been selected. The particular policies adopted by the Clinical Commissioning Group are described below. They have been applied consistently in dealing with items considered material in relation to the accounts.

1.1. Going Concern These accounts have been prepared on a going concern basis. Public sector bodies, including NHS Brighton and Hove Clinical Commissioning Group, are assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as evidenced by inclusion of financial provision for that service in published documents. Clinical Commissioning Groups must therefore prepare their accounts on a going concern basis unless informed by the Department of Health and Social Care (DHSC) of the intention for dissolution without transfer of services or function to another entity. In 2019/20 the Clinical Commissioning Group submitted a 5 year plan, the Long Term Plan. This established financial plans for the period up to and including 2023/24, and allocations were published covering this period, which evidences the continuation of the provision of services.

The NHS continues to work in a COVID-19 emergency financial regime for the first six months of 2021/22. Allocations have been issued by NHSEI for the period 1 April to 30 September 2021 to match expenditure for the period with the expectation of a breakeven outturn. The Treasury will set the NHS funding for the second half of the year in September at which point system allocations will be issued.

The Clinical Commissioning Group has contributed plans to the system plans submitted to NHSEI for the first half of the year. The NHSEI focus in 2021/22 is on system control totals rather than individual control totals. The system plans have been approved by the Sussex Health and Care Partnership (SHCP) Executive and the individual organisations’ Executive Management Teams.

Management is satisfied that the Clinical Commissioning Group should continue to prepare accounts on a ‘going concern’ basis due to the aforementioned factors above and because:

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 NHS Brighton and Hove Clinical Commissioning Group has received notification of April to September 2021 financial allocations from NHSE. We also have no reason to believe that the NHSE will not continue with these financial allocations to NHS Brighton and Hove Clinical Commissioning Group for October 2021 to March 2022 and subsequent periods thereafter  A draft April to September 2021 financial plan for NHS Brighton and Hove Clinical Commissioning Group has been prepared and submitted to NHSE/I  This draft financial plan underscores the ongoing financial viability of NHS Brighton and Hove Clinical Commissioning Group.

In addition, the Clinical Commissioning Group has identified no threats to operational stability from finance or income that has not yet been approved, which further supports preparing the financial statements on a going concern basis. 1.2. Accounting Convention These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities. 1.3. Pooled Budgets The Clinical Commissioning Group has entered into a pooled budget arrangement with Brighton and Hove City Council in accordance with section 75 of the NHS Act 2006. The arrangements relate to the Better Care Fund and note 13 to the accounts provides details of the income and expenditure. The pool is hosted by Brighton and Hove CCG. The Clinical Commissioning Group accounts for its share of the assets, liabilities, income and expenditure arising from the activities of the pooled budget, identified in accordance with the pooled budget agreement. 1.4. Revenue In the application of IFRS 15 a number of practical expedients offered in the Standard have been employed. These are as follows:  As per paragraph 121 of the Standard the Clinical Commissioning Group will not disclose information regarding performance obligations part of a contract that has an original expected duration of one year or less  The Clinical Commissioning Group is to similarly not disclose information where revenue is recognised in line with the practical expedient offered in paragraph B16 of the Standard where the right to consideration corresponds directly with value of the performance completed to date  The FReM has mandated the exercise of the practical expedient offered in C7(a) of the Standard that requires the Clinical Commissioning Group to reflect the aggregate effect of all contracts modified before the date of initial application. The main source of funding for the Clinical Commissioning Group is from NHS England. This is drawn down and credited to the general fund. Funding is recognised in the period in which it is received. Revenue in respect of services provided is recognised when (or as) performance obligations are satisfied by transferring promised services to the customer, and is

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measured at the amount of the transaction price allocated to that performance obligation. Where income is received for a specific performance obligation that is to be satisfied in the following year, that income is deferred. 1.5. Employee Benefits 1.5.1. Short-term Employee Benefits Salaries, wages and employment-related payments, including payments arising from the apprenticeship levy, are recognised in the period in which the service is received from employees, including bonuses earned but not yet taken. The cost of leave earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry forward leave into the following period. 1.5.2. Retirement Benefit Costs Past and present employees are covered by the provisions of the NHS Pensions Schemes. These schemes are unfunded, defined benefit schemes that cover NHS employers, General Practices and other bodies allowed under the direction of the Secretary of State in England and Wales. The schemes are not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the schemes are accounted for as though they were defined contribution schemes: the cost to the Clinical Commissioning Group of participating in a scheme is taken as equal to the contributions payable to the scheme for the accounting period. For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to expenditure at the time the Clinical Commissioning Group commits itself to the retirement, regardless of the method of payment. 1.6. Other Expenses Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable. Expenses and liabilities in respect of grants are recognised when the Clinical Commissioning Group has a present legal or constructive obligation, which occurs when all of the conditions attached to the payment have been met. 1.7. Property, Plant and Equipment 1.7.1. Recognition Property, plant and equipment is capitalised if:  It is held for use in delivering services or for administrative purposes  It is probable that future economic benefits will flow to, or service potential will be supplied to the Clinical Commissioning Group  It is expected to be used for more than one financial year  The cost of the item can be measured reliably and  The item has a cost of at least £5,000; or, Collectively, a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assets are functionally interdependent, they had broadly

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simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or,  Items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or collective cost. Where a large asset, for example a building, includes a number of components with significantly different asset lives, the components are treated as separate assets and depreciated over their own useful economic lives. 1.7.2. Measurement All property, plant and equipment is measured initially at cost, representing the cost directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. Assets that are held for their service potential and are in use are measured subsequently at their current value in existing use. Assets that were most recently held for their service potential but are surplus are measured at fair value where there are no restrictions preventing access to the market at the reporting date Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that would be determined at the end of the reporting period. Current values in existing use are determined as follows:  Land and non-specialised buildings – market value for existing use; and,  Specialised buildings – depreciated replacement cost. Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost includes professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for assets held at fair value. Assets are re-valued and depreciation commences when they are brought into use. IT equipment, transport equipment, furniture and fittings, and plant and machinery that are held for operational use are valued at depreciated historic cost where these assets have short useful economic lives or low values or both, as this is not considered to be materially different from current value in existing use. An increase arising on revaluation is taken to the revaluation reserve except when it reverses an impairment for the same asset previously recognised in expenditure, in which case it is credited to expenditure to the extent of the decrease previously charged there. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Gains and losses recognised in the revaluation reserve are reported as other comprehensive income in the Statement of Comprehensive Net Expenditure. 1.7.3. Subsequent Expenditure Where subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised. Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing carrying value of the item replaced is written-out and charged to operating expenses.

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1.7.4. Depreciation, Amortisation and Impairments Freehold land, properties under construction, and assets held for sale are not depreciated. Otherwise, depreciation and amortisation are charged to write off the costs or valuation of property, plant and equipment and intangible non-current assets, less any residual value, over their estimated useful lives, in a manner that reflects the consumption of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over which the Clinical Commissioning Groups expects to obtain economic benefits or service potential from the asset. This is specific to the Clinical Commissioning Groups and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are depreciated over the shorter of the lease term and the estimated useful life. At each reporting period end, the Clinical Commissioning Groups checks whether there is any indication that any of its property, plant and equipment assets or intangible non-current assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its amount. Intangible assets not yet available for use are tested for a revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Where an impairment loss subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the recoverable amount but capped at the amount that would have been determined had there been no initial impairment loss. The reversal of the impairment loss is credited to expenditure to the extent of the decrease previously charged there and thereafter to the revaluation reserve. Property, plant and equipment that is to be scrapped or demolished does not qualify for recognition as held for sale. Instead, it is retained as an operational asset and its economic life is adjusted. The asset is de-recognised when it is scrapped or demolished. 1.8. Leases Leases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All other leases are classified as operating leases. 1.8.1. The Clinical Commissioning Group as Lessee Property, plant and equipment held under finance leases are initially recognised, at the inception of the lease, at fair value or, if lower, at the present value of the minimum lease payments, with a matching liability for the lease obligation to the lessor. Lease payments are apportioned between finance charges and reduction of the lease obligation so as to achieve a constant rate on interest on the remaining balance of the liability. Finance charges are recognised in calculating the Clinical Commissioning Group’s surplus / deficit.

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Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term. Contingent rentals are recognised as an expense in the period in which they are incurred. Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether they are operating or finance leases. 1.8.2. The Clinical Commissioning Group as Lessor Amounts due from lessees under finance leases are recorded as receivables at the amount of the Clinical Commissioning Group’s net investment in the leases. Finance lease income is allocated to accounting periods so as to reflect a constant periodic rate of return on the Clinical Commissioning Group’s net investment outstanding in respect of the leases. Rental income from operating leases is recognised on a straight-line basis over the term of the lease. Initial direct costs incurred in negotiating and arranging an operating lease are added to the carrying amount of the leased asset and recognised on a straight-line basis over the lease term. 1.9. Cash and Cash Equivalents Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value. In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the Clinical Commissioning Group’s cash management. 1.10. Provisions Provisions are recognised when the Clinical Commissioning Group has a present legal or constructive obligation as a result of a past event, it is probable that the Clinical Commissioning Group will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties. 1.11. Financial Assets Financial assets are recognised when the Clinical Commissioning Group becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred. The Clinical Commissioning Group's financial assets are all classified as financial assets at amortised cost. The classification is determined by the cash flow and business model characteristics of the financial assets, as set out in IFRS 9, and is determined at the time of initial recognition.

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1.11.1. Financial Assets at Amortised cost Financial assets measured at amortised cost are those held within a business model whose objective is achieved by collecting contractual cash flows and where the cash flows are solely payments of principal and interest. This includes most trade receivables and other simple debt instruments. After initial recognition these financial assets are measured at amortised cost using the effective interest method less any impairment. The effective interest rate is the rate that exactly discounts estimated future cash receipts through the life of the financial asset to the gross carrying amount of the financial asset. 1.11.2. Impairment For all financial assets measured at amortised cost or at fair value through other comprehensive income (except equity instruments designated at fair value through other comprehensive income), lease receivables and contract assets, the Clinical Commissioning Group recognises a loss allowance representing the expected credit losses on the financial asset. The Clinical Commissioning Group adopts the simplified approach to impairment in accordance with IFRS 9, and measures the loss allowance for trade receivables, lease receivables and contract assets at an amount equal to lifetime expected credit losses. For other financial assets, the loss allowance is measured at an amount equal to lifetime expected credit losses if the credit risk on the financial instrument has increased significantly since initial recognition (stage 2) and otherwise at an amount equal to 12 month expected credit losses (stage 1). HM Treasury has ruled that central government bodies may not recognise stage 1 or stage 2 impairments against other government departments, their executive agencies, the Bank of England, Exchequer Funds and Exchequer Funds assets where repayment is ensured by primary legislation. The Clinical Commissioning Group therefore does not recognise loss allowances for stage 1 or stage 2 impairments against these bodies. Additionally Department of Health and Social Care provides a guarantee of last resort against the debts of its arm's lengths bodies and NHS bodies and the Clinical Commissioning Group does not recognise allowances for stage 1 or stage 2 impairments against these bodies. For financial assets that have become credit impaired since initial recognition (stage 3), expected credit losses at the reporting date are measured as the difference between the asset's gross carrying amount and the present value of the estimated future cash flows discounted at the financial asset's original effective interest rate. Any adjustment is recognised in profit or loss as an impairment gain or loss. 1.12. Financial Liabilities Financial liabilities are recognised on the statement of financial position when the Clinical Commissioning Group becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired. The Clinical Commissioning Group’s financial liabilities are all classified as other financial liabilities measured at amortised cost.

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1.13. Value Added Tax Most of the activities of the Clinical Commissioning Group are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT. 1.14. Critical accounting judgements and key sources of estimation uncertainty In the application of the Clinical Commissioning Group's accounting policies, management is required to make various judgements, estimates and assumptions. These are regularly reviewed. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods. 1.14.1. Sources of estimation uncertainty The main sources of estimation uncertainty in 2020/21 are in Continuing Health Care, Prescribing and Delegated Co-Commissioning where not all the required information was available at the time of drafting the accounts. None of these sources of estimation uncertainty have a significant risk of resulting in a material adjustment to the total carrying amount of assets and liabilities within the next financial year. 1.15. Accounting Standards That Have Been Issued But Have Not Yet Been Adopted The Department of Health and Social Care GAM does not require the following IFRS Standards and Interpretations to be applied in 2020-21. These Standards are still subject to HM Treasury FReM adoption.  IFRS 16 Leases – The Standard is effective 1 April 2022 as adapted and interpreted by the FReM  IFRS 17 Insurance Contracts – Application required for accounting periods beginning on or after 1 January 2023, but not yet adopted by the FReM: early adoption is not therefore permitted. The application of the Standards as revised would not have a material impact on the 2020-21 financial statements, were they applied in that year.

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2. Other operating revenue 2020-21 2019-20 Total Total £'000 £'000

Income from sale of goods and services (contracts) Education, training and research - 21 Non-patient care services to other bodies 158 424 Prescription fees and charges 115 438 Other Contract income 1,357 1,404 Total Income from sale of goods and services 1,630 2,287

Other operating income Rental revenue from operating leases 23 - Charitable and other contributions to revenue expenditure: non- NHS 5 23 Total Other operating income 28 23

Total Operating Income 1,658 2,310

2.1. Disaggregation of Income - Income from sale of good and services (contracts) Non-patient Prescription Other care fees and Contract services to charges income other bodies £'000 £'000 £'000 Source of Revenue NHS 90 - 1,300 Non NHS 68 115 57 Total 158 115 1,357

Non-patient Prescription Other care fees and Contract services to charges income other bodies £'000 £'000 £'000 Timing of Revenue Point in time 158 115 1,357 Total 158 115 1,357

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3. Employee benefits and staff numbers 3.1. Employee benefits Total 2020-21 Permanent Other Total Employees £'000 £'000 £'000 Employee Benefits Salaries and wages 6,056 1,011 7,067 Social security costs 637 1 638 Employer Contributions to NHS Pension scheme 1,274 1 1,275 Other pension costs 5 - 5 Apprenticeship Levy 23 - 23 Net employee benefits excluding capitalised costs 7,995 1,013 9,008

Total 2019-20 Permanent Other Total Employees £'000 £'000 £'000 Employee Benefits Salaries and wages 5,062 1,334 6,396 Social security costs 563 - 563 Employer Contributions to NHS Pension scheme 1,048 - 1,048 Other pension costs 2 - 2 Apprenticeship Levy 19 - 19 Termination benefits 52 - 52 Net employee benefits excluding capitalised costs 6,746 1,334 8,080

3.2. Average number of people employed 2020-21 2019-20 Permanently Other Total Permanently Other Total employed employed Number Number Number Number Number Number

Total 123.25 8.70 131.95 106.88 10.03 116.91

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3.3. Exit packages agreed in the financial year The Clinical Commissioning Group has one exit package agreed in the year. The total payment made by Sussex NHS Commissioners was £67k. The share for the CCG is £12k (2019-20 4 exit packages, CCG share £59k).

Redundancy and other departure costs were paid in accordance with the provisions of the employee contract.

3.4. Pension costs Past and present employees are covered by the provisions of the two NHS Pension Schemes. Details of the benefits payable and rules of the Schemes can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. Both are unfunded defined benefit schemes that cover NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State for Health and Social Care in England and Wales. They are not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, each scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating in each scheme is taken as equal to the contributions payable to that scheme for the accounting period. The schemes are subject to a full actuarial valuation every four years and an accounting valuation every year. The employer contribution rate for NHS Pensions increased from 14.38% to 20.68% from 1st April 2019. From 2019/20, NHS CCGs continued to pay over contributions at the former rate with the additional amount being paid by NHS England on CCGs behalf. The full cost and related funding has been recognised in these accounts. 3.4.1. Accounting valuation A valuation of scheme liability is carried out annually by the scheme actuary (currently the Government Actuary’s Department) as at the end of the reporting period. This utilises an actuarial assessment for the previous accounting period in conjunction with updated membership and financial data for the current reporting period, and is accepted as providing suitably robust figures for financial reporting purposes. The valuation of the scheme liability as at 31 March 2021, is based on valuation data as 31 March 2020, updated to 31 March 2021 with summary global member and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate prescribed by HM Treasury have also been used. The latest assessment of the liabilities of the scheme is contained in the report of the scheme actuary, which forms part of the annual NHS Pension Scheme Accounts. These accounts can be viewed on the NHS Pensions website and are published annually. Copies can also be obtained from The Stationery Office. 3.4.2. Full actuarial (funding) valuation The purpose of this valuation is to assess the level of liability in respect of the benefits due under the schemes (taking into account recent demographic experience), and to recommend contribution rates payable by employees and employers.

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The latest actuarial valuation undertaken for the NHS Pension Scheme was completed as at 31 March 2016. The results of this valuation set the employer contribution rate payable from April 2019 to 20.6% of pensionable pay. The 2016 funding valuation was also expected to test the cost of the Scheme relative to the employer cost cap that was set following the 2012 valuation. In January 2019, the Government announced a pause to the cost control element of the 2016 valuations, due to the uncertainty around member benefits caused by the discrimination ruling relating to the McCloud case. The Government subsequently announced in July 2020 that the pause had been lifted, and so the cost control element of the 2016 valuations could be completed. The Government has set out that the costs of remedy of the discrimination will be included in this process. HMT valuation directions will set out the technical detail of how the costs of remedy will be included in the valuation process. The Government has also confirmed that the Government Actuary is reviewing the cost control mechanism (as was originally announced in 2018). The review will assess whether the cost control mechanism is working in line with original government objectives and reported to Government in April 2021. The findings of this review will not impact the 2016 valuations, with the aim for any changes to the cost cap mechanism to be made in time for the completion of the 2020 actuarial valuations. For 2020-21, employers’ contributions of £1,275k were payable to the NHS Pensions Scheme (2019-20: £1,048k) at the rate of 14.38% of pensionable. The costs net of and including recharges are included in the NHS pension line of note 3.1.

Central payments have been made by NHS England and the Department of Health and Social Care (‘DHSC’) for their respective proportions of the outstanding 6.3% on local employers’ behalf.

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4. Operating expenses 2020-21 2019-20 Total Total £'000 £'000 Purchase of goods and services Services from other CCGs and NHS England 2,097 1,655 Services from foundation trusts 115,850 103,184 Services from other NHS trusts 160,128 154,040 Purchase of healthcare from non-NHS bodies 101,030 90,006 Purchase of social care 7,146 5,089 Prescribing costs 39,242 36,284 Pharmaceutical services (1) 1 General Ophthalmic services (41) 72 GPMS/APMS and PCTMS 48,466 45,308 Supplies and services – clinical 65 72 Supplies and services – general 7,717 6,281 Consultancy services 3,059 696 Establishment 2,107 2,013 Transport 156 2,584 Premises 76 365 Audit fees * 65 67 Other professional fees 741 557 Legal fees 53 48 Education, training and conferences 250 507 Total Purchase of goods and services 488,206 448,829

Depreciation and impairment charges Depreciation 60 60 Total Depreciation and impairment charges 60 60

Provision expense Provisions 16 163 Total Provision expense 16 163

Other Operating Expenditure Chair and Non-Executive Members 255 291 Clinical negligence - 9 Expected credit loss on receivables 564 564 Other expenditure 9 55 Total Other Operating Expenditure 828 919

Total Operating Expenditure 489,110 449,971

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Notes on Operating Expenses COVID 19 – Pandemic Where additional costs were incurred directly as a result of the COVID 19 pandemic additional funding allocations were received. The total additional costs and funds related to the pandemic in 2020/21 were £20,216k. This sum has been analysed against the appropriate category and is included in the total of operating expenditure. Limitation on auditor's liability Limitation on auditor's liability for external audit work carried out in 2020-21 is £2 million. * Audit Fees excluding VAT are £54,020 for 2020/21. Other Professional Fees include Internal Audit Fees of £82k.

5. Better payment practice code

Measure of compliance 2020-21 2020-21 2019-20 2019-20 Number £'000 Number £'000 Non-NHS Payables Total Non-NHS Trade invoices paid in the Year 14,994 144,358 12,854 120,490 Total Non-NHS Trade Invoices paid within target 14,641 141,384 12,420 117,434 Percentage of Non-NHS Trade invoices paid within target 97.65% 97.94% 96.62% 97.46%

NHS Payables Total NHS Trade Invoices Paid in the Year 1,504 308,112 3,612 290,320 Total NHS Trade Invoices Paid within target 1,444 307,641 3,491 288,992 Percentage of NHS Trade Invoices paid within target 96.01% 99.85% 96.65% 99.54%

The Better Payment Practice Code requires the CCG to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later. The target percentage to be reached is 95% and in 2020-21 the CCG achieved this across all measures.

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6. Operating leases 6.1. As a Lessee 6.1.1. Payments recognised as an Expense 2020-21 2019-20 Buildings Other Total Buildings Total £'000 £'000 £'000 £'000 £'000

Minimum lease payments 43 5 48 224 224 Total 43 5 48 224 224

6.1.2. 6.1.3. Future minimum lease payments

2020-21 2019-20 Buildings Total Buildings Other Total £'000 £'000 £'000 £'000 £'000 Payable: No later than one year 215 215 243 8 251 Between one and five years 905 905 1,020 - 1,020 After five years 139 139 427 - 427

Total 1,259 1,259 1,690 8 1,698

6.2. As a Lessor 6.2.1. Recognised as income 2020-21 2019-20 £'000 £'000

Rent 23 - Contingent rents - - Total 23 -

6.2.2. 6.2.3. Future minimum rental value 2020-21 2019-20 £'000 £'000 NHSE Non DH Bodies Group Bodies Receivable: No later than one year 23 - Total 23 -

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7. Property, plant and equipment

2020-21 2019-20 Information Information technology technology £'000 £'000 Cost or valuation at 01 April 302 302

Cost/Valuation at 31 March 302 302

Depreciation 01 April 65 5 Charged during the year 60 60 Depreciation at 31 March 125 65

Net Book Value at 31 March 177 237

Purchased 177 237 Total at 31 March 177 237

7.1. Economic lives Minimum Maximum Life Life (years) (Years) Information technology 1 4

8. Trade and other receivables Current Current 2020-21 2019-20 £'000 £'000 NHS receivables: Revenue 3,981 1,950 NHS prepayments 331 1,566 NHS accrued income 1,070 1,128 NHS Contract Receivable not yet invoiced/non-invoice 126 1,810 Non-NHS and Other WGA receivables: Revenue 799 2,735 Non-NHS and Other WGA prepayments 7,543 7,619 Non-NHS and Other WGA accrued income 1,967 1,334 Expected credit loss allowance-receivables * (1,128) (564) VAT 144 78 Other receivables and accruals 10 23 Total Trade and other receivables 14,843 17,679

* Expected credit loss allowance – receivables The expected credit loss of £1,128k relates to the balance included as an accrual for the recovery of debts in relation to patient transport in the pre-merger bodies.

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The seven Sussex Clinical Commissioning Groups were jointly taking legal steps to enforce the terms of a parent company guarantee submitted as part of the non- emergency patient transport services contract, which was terminated with effect from 31 March 2017, to recover these amounts. The three successor CCGs are continuing to take legal steps but recognise the risk associated with this.

8.1. Receivables past their due date but not impaired

2020-21 2020-21 2019-20 2019-20 DHSC Non DHSC DHSC Non DHSC Group Group Group Group Bodies Bodies Bodies Bodies £'000 £'000 £'000 £'000

By up to three months 2,838 90 10 2,600 By three to six months 16 27 55 - By more than six months 702 545 1,118 21 Total 3,556 662 1,183 2,621

8.2. Loss allowance on asset classes Trade and other receivables - Non DHSC Group Bodies £'000 Balance at 01 April 2020 (564) Lifetime expected credit losses on trade and other receivables (564) Total (1,128)

The three Sussex Clinical Commissioning Groups have reviewed the expected credit loss at the balance sheet date. Best estimates of the expenditure required to settle obligations have been recognised in line with IFRS 9. For Brighton and Hove CCG the figure (£564k) represents a net increase in the irrecoverable debt. This is due to a reassessment of the likelihood of recovering outstanding sums.

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9. Cash and cash equivalents

2020-21 2019-20 £'000 £'000 Balance at 01 April 438 35 Net change in year (172) 403 Balance at 31 March 266 438

Made up of: Cash with the Government Banking Service 265 437 Cash in hand 1 1 Balance at 31 March 266 438

10. Trade and other payables Current Current 2020-21 2019-20 £'000 £'000 NHS payables: Revenue 1,539 3,211 NHS accruals 56 4,786 NHS deferred income - 130 Non-NHS and Other WGA payables: Revenue 2,027 2,386 Non-NHS and Other WGA accruals 40,242 21,571 Non-NHS and Other WGA deferred income - 321 Social security costs 168 117 Tax 151 120 Other payables and accruals 5,300 10,918 Total Trade and Other Payables 49,483 43,560

Other payables include £647k outstanding pension contributions at 31 March 2021.

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11. Provisions

Current Current 2020-21 2019-20 £'000 £'000 Legal claims 63 49 Continuing care 161 161 Total 224 210

Legal Continuing Total Claims Care

£'000 £'000 £'000

Balance at 01 April 2020 49 161 210

Arising during the year 16 - 16 Utilised during the year (2) - (2) Balance at 31 March 2021 63 161 224

Expected timing of cash flows: Within one year 63 161 224 Balance at 31 March 2021 63 161 224

12. Financial instruments 12.1. Financial risk management Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities. Because NHS Clinical Commissioning Group is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The Clinical Commissioning Group has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the Clinical Commissioning Group in undertaking its activities. Treasury management operations are carried out by the finance department, within parameters defined formally within the NHS Clinical Commissioning Group standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the NHS Clinical Commissioning Group and internal auditors.

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12.1.1. Credit risk Because the majority of the NHS Clinical Commissioning Group and revenue comes parliamentary funding, NHS clinical commissioning group has low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables from customers, as disclosed in the trade and other receivables note. 12.1.2. Liquidity risk NHS Clinical Commissioning Group is required to operate within revenue and capital resource limits, which are financed from resources voted annually by Parliament. The NHS Clinical Commissioning Group draws down cash to cover expenditure, as the need arises. The NHS Clinical Commissioning Group is not, therefore, exposed to significant liquidity risks. 12.1.3. Financial Instruments As the cash requirements of NHS England are met through the Estimate process, financial instruments play a more limited role in creating and managing risk than would apply to a non-public sector body. The majority of financial instruments relate to contracts to buy non-financial items in line with NHS England's expected purchase and usage requirements and NHS England is therefore exposed to little credit, liquidity or market risk. 12.2. Financial assets 2020-21 2019-20 £'000 £'000

Trade and other receivables with NHSE bodies 4,188 1,807 Trade and other receivables with other DHSC group bodies 2,956 4,509 Trade and other receivables with external bodies 809 2,664 Cash and cash equivalents 266 438 Total at 31 March 8,219 9,418

12.3. Financial liabilities 2020-21 2019-20 £'000 £'000

Trade and other payables with NHSE bodies 941 1,960 Trade and other payables with other DHSC group bodies 7,631 11,973 Trade and other payables with external bodies 40,592 28,939 Total at 31 March 49,164 42,872

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13. Joint arrangements – interests in joint operations Better Care Fund In 2020-21 the CCG was engaged in a Pooled budget arrangement under section 75 of the NHS Act with Brighton and Hove City Council for the Better Care Fund. The CCG hosts this arrangement. The principle of the BCF is a transition toward a healthier society supported by a more proactive care approach. The BCF utilises the section 75 agreement for Health and Social Care to use funding jointly. It is a mandated NHS England venture. The table below shows the contributions from each party:

Contributions to the Pooled Fund 2020-21 BandHC BandH CCG Council Health Care Social Care

£’000 £’000 Increasing System Capacity 333 0 Integrated Discharge Planning 10,482 2,962 Protecting Social Care 4,398 8,049 Supporting Recovery and 3,350 459 Independence Person Centered Integrated Care 775 0 Dementia Planning 156 0 Homelessness 919 20 ICP Programme Director 60 0 20,473 11,490

14. Related party transactions The Clinical Commissioning Group is required to disclose all transactions in the year with any parties that are related to or connected with members of the Governing Body or members of key management staff at any time in that year. Members of the Governing Body have declared an interest in the following organisations; these organisations are therefore regarded as related parties, and the details of the Clinical Commissioning Group's transactions with these organisations are as follows: Payments Receipts Amounts Amounts to from owed to due from Related Related Related Related Party Party Party Party Name Role Provider Name £'000 £'000 £'000 £'000 Tom Gurney Executive St Andrews Healthcare - 107 - - (1) Director of Brother-in-law holds the Communications, role of Director of People and Strategy at Northampton Public based mental health Involvement to charity St Andrews 18/01/2021 / Healthcare Executive

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Payments Receipts Amounts Amounts to from owed to due from Related Related Related Related Party Party Party Party Name Role Provider Name £'000 £'000 £'000 £'000 Director of Communications and Public Involvement from 19/01/2021 Dr Tim Caroe Chief Medical Integrated Care 24 Ltd - 2,298 - 3 - Officer to contracted by Integrated 19/01/2021 Care 24 (IC24) Dr Tim Caroe Chief Medical Here Ltd - undertaking 7,145 - 294 (2,747) Officer to some Extended Access 19/01/2021 shift work through Here Ltd Mark Power Chief People Ekim Consulting Ltd – 35 - - - Officer from Partner at Ekim 19/01/2021 Consulting Ltd Dr Nina Graham Locality Here Ltd - Shareholder 7,145 - 294 (2,747) Representative Here Ltd Dr Nina Graham Locality Charter Medical Centre - 3,037 - - - Representative Managing Partner – Charter Medical Centre Dr Andrew Clinical Chair Here Ltd - One of my 7,145 - 294 (2,747) Hodson partners at Preston Park Surgery is a non- Executive Director of Here Ltd.

Dr Andrew Clinical Chair Preston Park Surgery - 1,343 - 8 - Hodson Wife is a partner at Preston Park Surgery Andrew Taylor Lay Member YMCA Downslink Group 46 - - - (Governance) - Non-executive Director and Chair of Business Planning Committee YMCA Downslink Group Dr Jerry Luke Independent Surrey and Sussex Local 163 - - - Member (GP) Medical Committees -– Medical Director Surrey and Sussex Local Medical Committee

A related party is someone who has significant influence over the CCG or is a member of the key management personnel of the CCG. This note provides details of any significant transactions that related parties, or their relations or any bodies that they may control, have undertaken with the CCG and any outstanding balances with them. All transactions recorded between the CCG and the organisations with which

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the Governing Body members are associated have been undertaken at arms-length using national tariff or local tariff where national tariff does not apply. The CCG Executive Management Team, as detailed in the Remuneration Report, work across all Sussex NHS Commissioners and therefore have a declared interest in NHS Brighton and Hove CCG, NHS West Sussex CCG and NHS East Sussex CCG.

The Department of Health is regarded as a related party. During the year the Clinical Commissioning Group has had a significant number of material transactions with entities for which the Department is regarded as the parent Department. The NHS organisations listed below are those where transactions during the year 2020-21 have exceeded £500k: Brighton and Sussex University Hospitals NHS Trust East Sussex Healthcare NHS Trust Surrey and Sussex Healthcare NHS Trust Guy's and St Thomas' NHS Foundation Trust King's College Hospital NHS Foundation Trust South Central Ambulance Service NHS Foundation Trust South East Coast Ambulance Service NHS Foundation Trust Sussex Community NHS Foundation Trust Sussex Partnership NHS Foundation Trust Queen Victoria Hospital NHS Foundation Trust The Royal Marsden NHS Foundation Trust University College London Hospitals NHS Foundation Trust Western Sussex Hospitals NHS Foundation Trust NHS NEL Commissioning Support Unit NHS South, Central and West Commissioning Support Unit

In addition, the Clinical Commissioning Group has had a number of material transactions with other government departments and other central and local government bodies. Transactions with other bodies over the year which have exceeded £500,000: Brighton and Hove City Council

15. Events after the end of the reporting period The Clinical Commissioning Group has no events after the end of the reporting period to disclose.

16. Losses and special payments There was one special payments case in 2020-21 for £174 this related to the Brighton and Hove CCG share of a complaint against East Sussex CCG upheld by the Local Government and Social Care Ombudsman and Health Service Ombudsman and recommended that East Sussex CCG should pay £1,000, to act as

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a tangible acknowledgement of the impact on the complainant. As an administration cost this payment has been shared across the Sussex CCGs.

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

2020-21 2020-21 2019-20 2019-20 National Duty Target Performance Target Performance Health Service Act Section Expenditure not to exceed 223H(1) income 498,231 498,118 458,175 458,052 Capital resource use does 223I(2) not exceed the amount specified in Directions n/a n/a n/a n/a Revenue resource use does not exceed the 223I(3) amount specified in Directions 496,573 496,460 455,865 455,741 Capital resource use on specified matter(s) does 223J(1) not exceed the amount specified in Directions n/a n/a n/a n/a Revenue resource use on specified matter(s) does 223J(2) not exceed the amount specified in Directions n/a n/a n/a n/a Revenue administration resource use does not 223J(3) exceed the amount specified in Directions 6,363 6,339 6,829 6,621

The CCG has achieved all of its set performance duties for 2020-21

The CCG has recorded a surplus of £113k against its in year revenue resource limit target for 2020-21 (£124k surplus in 2019-20). The CCG has recorded an underspend of £24k on administration costs.

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