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1 Contents Foreword: CCG Chair and Chief Officer 4 Member Practices’ Introduction 6 Strategic report 7 About us, who we are and what we do 7 Our mission 7 Our priorities 8 Our legal status 8 Where we operate from 9 The population we serve 10 Community relationships 11 Partnership working 12 Operating and financial review 13 Principal risks and uncertainties 15 Our performance 16 Financial performance 19 Disclosure: legacy balance transfers 21 Description of CCG’s Business Model 21 Our achievements 22 Future plans 25 Sustainability report 28 Our strategy 28 The ESCCG Sustainable Development Management Plan in 28 2013-14 Equality Report 32 Our People 32 Sickness 32 Members’ Report 33 Member Practices 33 Pension Liabilities 35 Sickness Absence Data 35 Staff in Post and Leavers 35 Sickness and Absence 37 External Audit 39 2 Serious untoward incidents 39 Setting of charges for information 39 Complaints 40 Employees with a disability 42 Emergency Preparedness 43 Statement as to Disclosure to Auditors 43 Remuneration Committee Report 44 Salaries and Allowances 45 Ash Equivalent Transfer Values 47 Real Increase in CETV 47 Pay Multiples 47 Off-payroll Engagements 48 Membership Body and Governing Body Profiles 49 CCG committee member profiles – who are not members of the CCG Governing Body 54 Statements by the Accountable Officer 60 Statement of Chief Officer’s Responsibilities 60 Governance Statement 62 Annual Governance Statement 2013/14 62 Annual Accounts 89 3 Foreword: CCG Chair and Chief Officer We have great pleasure in publishing this; our first Annual Report as a statutory Clinical Commissioning Group. Over the last year we have worked closely with our member practices to develop robust transformation plans to improve the health services and outcomes for the people of Herefordshire. We are a new organisation and this is our foundation year and we recognise that we have further work to do to improve health services for the people of Herefordshire. Herefordshire Clinical Commissioning Group is responsible for designing local health services for 183,600 people across Herefordshire, one of the least densely populated areas in the country. We have established our foundation on an enviable platform by working closely with our single local authority and along with our local providers; Wye Valley NHS Trust and 2gether NHS Foundation Trust; our ambition is to create a high quality, sustainable and integrated Herefordshire health care service which puts the public and patients at the heart of everything we do. Transforming the Herefordshire local health economy to achieve our vision is dependent upon providing better quality care whilst realising efficiencies through working closely with our local providers. Working towards achieving our goal, we have already mobilised several exciting and leading edge work streams to stimulate change. We have introduced virtual wards, designed to deliver more care in the community to help people stay closer to home rather than being in hospital. We have worked with our GPs and providers to create modern maps of medicine that mean that our patients’ journey is more joined up across all care settings. Our work also involves planning health care for the future that truly makes a difference to our patients’ experiences and we are keen to work innovatively to achieve this by using IT and online consultations to engage with our people. We believe that it is vital to involve local people in the design and buying of healthcare services that will serve our population robustly into the future. We want to do this through effective community engagement, to date we have developed enhanced feedback mechanisms which ensure we really understand your needs and listen to your preferences. Partnership is really important to us and we put a lot of effort into working with our key providers, 2gether Foundation Trust, Wye Valley Trust and Herefordshire County Council colleagues as well as with other CCGs and wider partners and stakeholders. Working locally within Herefordshire, we can be creative and really support people to engage with their communities in a way which promotes good health and wellbeing. We take our role in quality assurance very seriously and we continually monitor information on safety and experience to ensure all our residents get good quality care. 4 Moving forward, we are optimistic we can respond to the challenges ahead. We have built an organisation we are proud of and we want to continue to be accountable to and serve the local population of Herefordshire. Andy Watts Jo Whitehead Chair Chief Officer 5 Member Practices’ Introduction One key feature of clinical commissioning is that commissioning decisions should be grounded by input from patients and frontline health professionals. All 25 Herefordshire GP practices are members of the CCG and the CCG governing body has been successful in engaging effectively with member practices, so that GP surgeries have a clear and resonant voice in the work our governing body delivers. It has achieved this by setting up an engagement framework comprising of regular policy meetings, regular education events, practice visits, newsletters and an email feedback system to support rapid decision making. In addition, wider practice engagement is accomplished by establishing Practice Manager and Practice Nurse representation into the CCG team. At the beginning of this first year the CCG GP membership worked together with Governing Body members to formulate the work programme and strategy for the next 12 months. I am proud of our achievements and I am pleased to say that the majority of that work programme has been completed. I hope this report will demonstrate how we have worked together with our partners to make a difference locally. I would like to thank local GP practices for their supportive contributions during this first year and for their patience at this time of considerable change in the NHS. I would also like to thank the CCG executives and employees together with support unit staff. I have witnessed steadfast professionalism and a tireless work ethic that is a credit to the NHS. The integrity of the CCG can only be achieved by putting patients and the public at the heart of what the CCG is about. The voice of our local patients is therefore, extremely important to us and we are committed to involving and listening to our local population. We have run a range of events for local people including a focus on the redesign of urgent care services and call to action events. We will ensure that the feedback that the people of Herefordshire share with us via whatever channel is used to inform our work and the decisions the Governing Body makes. Throughout the report you will see a number of projects which we have launched that we believe will make a significant difference to patient experience in Herefordshire. We are championing changes in health care services that can really deliver improvements for our local people, an example of which is the set-up of hospital at home and virtual wards where patients are supported in their own homes rather than being admitted to hospital. Looking to the future, there are even greater challenges ahead. It is important we build on the foundations of this first year and the CCG is clear that what matters is the quality of services for local residents together with improved outcomes from NHS treatment. 6 Strategic report About us, who we are and what we do Herefordshire Clinical Commissioning Group is the NHS organisation responsible for planning and buying health and care services on behalf of everyone in the county of Herefordshire, and we do mean everyone in Herefordshire – however old or young you are, whatever your gender, sexual orientation, marital status, disability, race, religion or background, whether you live in Bromyard, Leominster, Ledbury, Hereford, Ross on Wye, Kington or any of the villages in between, you are important to us. We are led by GPs and pride ourselves on our depth of grass roots knowledge. We do not provide clinical services ourselves but commission them from a range of providers on behalf of our local population. The services we are responsible for include: • Urgent and emergency care (including out of hours services) • Planned, non-emergency hospital care • Rehabilitation care • Mental health and learning disability services • Most community health services including continuing healthcare • Ambulance transport We commission services from Wye Valley NHS Trust, 2gether NHS Foundation Trust and from other major acute providers including Gloucester Foundation Trust, Worcester Acute Hospitals, University Hospital of Birmingham, and other hospitals in Bristol and Wales, and a number of independent healthcare providers including Spire Healthcare, Nuffield Health, St Michael’s Hospice and Shaw Healthcare. We also commission services from Herefordshire Council. Our mission: This is how we have described our mission: “We want to create high quality health and care services that benefit everyone in Herefordshire – the kind of services that we would want available for our friends and family if they were unwell or needed help and support with a condition that impacted their lifestyle. In essence, we want to create a high quality, sustainable and integrated Herefordshire health economy with the public and patients at the heart of everything we do.” 7 Our priorities We have based our commissioning strategy on the knowledge and understanding of the local population, the local health needs that our member GPs have built up over many years and on the joint strategic needs assessment, developed with our partners. Through our GP network and through wider engagement, we continue to talk to local people in monitoring present services and planning for the future. Our Patient Prospectus sets out priorities to tackle health factors linked to deprivation and health inequality together with continuing support for other core areas such as dementia, mental health and learning disabilities.