SECTION 1: PERFORMANCE REPORT fsat
Annual Report and
Accounts 2017/18
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CONTENTS
SECTION 1: Performance Report Overview Statement from Chief Officer 3 Purpose and Activities 3 Issues and Risks 7 Greater Manchester Partnership 8 Performance Summary 8
Performance Analysis Measuring Outcomes & Performance 10 Sustainability 20 Improving Quality 23 Patient & Public Involvement 25 Reducing Health Inequalities 27 Health and Wellbeing Strategy 28
SECTION 2: Accountability Report Corporate Governance Report Members Report 31 Statement of Accountable Officer’s Responsibilities 36 Governance Statement 38
Remuneration and Staff Report Remuneration Report 61 Staff Report 70
Parliamentary Accountability and Audit Report 74 SECTION 3: FINANCIAL STATEMENTS Independent Auditors Report 76 Financial Statements 80
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SECTION 1 PERFORMANCE REPORT
Trish Anderson Accountable Officer 24 May 2018
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Overview
1. Welcome to the Annual Report and Accounts for 2017/18. This overview gives you our highlights from the year from the pperspective of Trish Anderson,, our Accountable Officerr.
2. It sets out briefly what we are working to achieve, what might stop us from achieving this and a summary of our performance for the year.
Statement from Trish Anderson, our Accountable Officer
3. This year, as in previous years, I am pproud of what we have achieved at Wigan Borough CCG to support the delivery of high quality, sustainable NHS services.
4. Throughout the annual report you will see evidence of a well governed, disciplined organisation that focuses on improving the quality of care our patients receive and meeting our financial commitments.
5. We cannot do this without the involvement and support of our GP member practices and also the many patients and members of the public who work so closely with us in such a positive way.
Purpose and Activities
6. The CCG’s objectives are:
Supporting our population to sstay healthy and live longer in all areas of the Borough; Commissioning high quality services, which reflect the poopulation's needs, delivering good clinical outcomes and patient experience witthin the resources allocated and available; Functioning as an effective strategic commissioning organisation that puts the patient first; Developing a collaborative and integrated system witth partners and Updated for stakeholders to implement the outcomes of the Greaater Manchester 2017/18 Commissioning Review in order to improve the health and care of the Borough’s citizens. Functioning as an organisation that consistently delivers its statutory duties and participates fully in the Greater Manchester Health and Social Care Partnership.
7. We set about delivering these by:
Treating physical and mental wellbeing as equally important;
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Understanding that factors like debt, housing and lonelineess can make a difference to a person’s health, how well they recover and how much help they need from the NHS; Focusing on those patients who are the most vulnerable and seek the most help from services; Improving the quality of out of hospital care with a focus on creating an integrated health and care service, working in partnership with providers and Council commissioners; Improving the quality of in hospital care with an emphasis on creating a high quality, sustainable hospital; Working closely with our partners and providers to create a joined-up, sustainable service that supports people to be well.
8. On thee next pages are just a few of ouur achievements that I want to highlight.
Partnership Working
9. Working closely with our partners at the hospital, local council,, community and mental health providers is essential to delivering high quality local services.
10. We are an active partner in the Healthier Wigan Partnership whicch brings together local health and social care organisations to support the integration of services, including signing the Alliance Agreement in March 2018.
11. With the Council we have been invoolved in ongoing conversations about how we might best integrate the commissioning of local services as well as ttheir provision.
12. This partnership on transformation enables us to join up health and social care services, improve patient experience and save money.
13. We have also taken an active role in the Greater Manchester Health and Social Care Partnership (GMHSCP) and are commmitted to continuing to do so to ensure the best care for local residents.
Image: Our Annual General Meeting held in Leigh Market, September 2017
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HIGHLIGHTS FROM THE YEAR!
Recognised nationally by NICE for our work in care homes Set up a new GP service at the improving medicines hospital to support A&E. managemment and improving lives for patients.
The Medicines Management team have saved £3.8million We are the best performing whilst also improving care and Borough in Greater Manchester medicines. on canceer waiting times.
Actively encouraged new apprentices to join the Rated as ‘Outstanding’ by organisation and supported all NHS England for our apprentices from 2016/17 to Diabetes services. secure employment with us or partnner organisations.
Engaged wwith local residents in Supporrted patients in Neuro- Orrell and Billinge on the quality rehabilitation to be safely of local services. transfeerred to a new location.
Awarded the highest level of Engaged with local residents on assurance by internal auditors, the Healthier Wigan Partnership MIAA, for our work with local and whaat integrated services care homes. should look like in the area.
Succeessfully delivered a leadership and management programme over six months for Practice Managers and CCG staff.
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Offer more appointments on evenings and weekends through GP Exxtended Hours – one group of practices is piloting a same day access hub.
Worked with GP members to create new geographically based groups of practices that . can offer more services locally – one is piloting a service for housebound patients.
Introducedd the practice nurse Developed the Integrated fellowship to promote the Discharge Team with local Undertakken commissioner visits recruitment of practice nurses partners to ensure patients are to assess quality of services, into the Borough to support the discharged from hospital quickly with paatient representatives primary care workforce – and safely with the necessary being involved in the visits. recognised as best practice support. across GM.
Rolled out a big programme of Are performing above the learning development for national standards for all the practices to help them improve mental health service targets. local services.
Held our Annual General Meeting in Leigh Market to engage with over 700 local residents on what the CCG does and how we can improve local services.
Engaged with local residents and staff on a new End of Life
Strategy on what is important to them.
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Financial Stability
14. The CCG received an allocation of £530.8m. Due to national reporting guidance this have been reduced to £521.4m to remove the prior year surplus of £9.4m that the CCG has been reporting throughout the financial year. The reporting of a higher level of surplus allocation, had previously been agreed with both GM Health and Social Care Partnership, and NHS England and was maintained through all of the financial year.
15. In accordance with the financial rules set by NHS England the CCG has spent £518.5m so generating the required ‘surplus’ of £2.9m. The required surplus includes £0.05m of statutory surplus notified to the CCG at the start of the financial year; plus the release of the 0.5% funding the CCG was required to withhold for the national system reserve totalling £2.3m; and a further release of £0.6m relating to savings made as a result of the national changes applied to non-branded drug pricing.
Issues and Risks
16. The Governing Body normally receives and reviews on a quarterly basis the Assurance Framework which contains all risks rated ‘high’ or ‘extreme’ that the CCG is managing. These risks cut across all corporate objectives of the CCG covering the delivery of quality improvement; performance against national and local indicators and standards; and financial duties.
17. The Assurance Framework is also scrutinised by the Audit Committee and Corporate Governance Committee which both meet four times per year.
18. Our Annual Governance Statement found later in this report goes into greater detail describing how we have managed risk throughout the year. There have been three areas of concern reported regularly to our governing body:
Urgent and Emergency Care – performance has been below the national standard of 95% of patients being admitted, transferred or discharged within four hours of arrival – the borough health system led by the CCG will continue to work together to support the department at the Royal Albert Edward Infirmary and Leigh Walk-in-Centre to effectively manage admissions and discharges;
Ambulance performance - none of the six new performance standards was met between August 2017 and March 2018 - the CCG has been proactively working with GMHSCP throughout the year to highlight its concerns;
Financial position – the CCG has faced a number of financial pressures during the year along with many other parts of the NHS but by year-end we are able to report that we have met the financial rules set by NHS England for CCGs.
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Greater Manchester Devolution and Partnership
19. In April 2016 Greater Manchester took charge of its health and care system as one Partnership spanning NHS and local government, commissioners and providers of both physical and mental health. In doing so, we embarked upon the most radical health and care transformation programme in the country.
20. We are now approaching the third year of the delivery of our strategy, Taking Charge. Two years into our journey, we can see a health and care landscape in Greater Manchester that looks fundamentally different.
21. Our approach to this change has been guided by a core principle: identifying who contributes to health creation and how they can be better connected.
22. Through our programme of reform and investment we now see our way to the system architecture in GM that will be in place as a legacy of Taking Charge. This will comprise these recognisable and consistent features:
The establishment of 10 Local Care Organisations (LCOs) integrating provision; Pooled health and social care resources into a single budget, managed through an integrated Single Commissioning Function in all ten localities; New models of hospital provision seeing hospitals working together in Greater Manchester at a much greater scale than ever before to a set of consistent quality standards; A Greater Manchester-wide architecture where it makes sense to do things at greater scale – including the GM Commissioning Hub, Health Innovation Manchester, a Digital Collaborative, a Workforce Collaborative and a ‘one public service estate’ strategy.
Performance Summary
23. We are required to measure our performance against a number of national and local indicators. The Governing body receives monthly reports about our performance and looks to drive continual improvement.
24. The operational standards that underpin the NHS Constitution relate to:
Waiting times for elective (planned) care Non-elective (unplanned/emergency) care Treatment of cancer
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Standards around same-sex accommodation Timely access to mental health services.
25. The CCG measures and monitors performance against a number of non-financial key performance indicators (KPIs). These KPIs provide assurance in relation to the achievement of operational standards and plans, as well as the progress against delivery of improved health outcomes.
26. The CCG Performance Report is based around the NHS Operational Planning and Contracting Guidance, issued by NHS England and NHS Improvement, and includes a number of performance indicators grouped into themes: Acute Urgent Care, Acute Planned Care, Cancer, Mental Health, and Quality of Care.
27. The operational standards monitored are defined in the NHS Constitution. The NHS Constitution brings together details of what staff, patients and the public can expect from the National Health Service.
28. It is underpinned by The Health Act 2009, which includes provisions related to the NHS Constitution and came into force on 19 January 2010.
29. The Health and Social Care Act 2012 also includes provisions related to the NHS Constitution. These provisions came into force on 1 October 2012 and, in the case of the NHS Commissioning Board and CCGs, 1 April 2013.
30. Wider information about the quality of health services commissioned by CCGs and the associated health outcomes is provided by the CCG Outcomes Indicator Set (CCGOIS).
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PERFORMANCE ANALYSIS
Measuring CCG Outcomes & Performance Acute Urgent Care 31. Wigan Borough CCG aims to ensure that all patients are seen in a timely manner at our local A&E department. However, the 4 hour 95% standard has not been achieved throughout 2017/18. Winter pressures have placed a significant strain on the availability of beds in which to care for emergency patients presenting in A&E since November. The full year position at March 2018 is below standard, at 80.97%.
32. GMHSCP has worked with all localities including Wigan to develop an improvement plan to allow GM as a whole to meet the national standard by June 2018. The Wigan improvement plan has been developed collaboratively with all local NHS partners and Wigan Council to provide additional capacity and take pressure out of the system.
Full Year Performance A&E Waits Within 4 Hours at WWL 80.97%
100% 95% 90% 85% 80% 75% 70% 65% 60% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
2017/18 Performance Standard
33. To reflect the changing demands on the ambulance service, the Ambulance Response Programme was commissioned in 2015 to test new ways of working for the service. As part of this, new measurement systems were introduced from August 2017. There are six standards for ambulance response times:
Category 1 (Life Threatening) calls responded to in an average time of 7 minutes; 90% of Category 1 calls responded to before 15 minutes; Category 2 (Emergency) calls responded to in an average time of 18 minutes; 90% of Category 2 calls responded to before 40 minutes;
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90% of Category 3 (Urgent) calls responded to before 2 hours; and 90% of Category 4 (Less Urgent) calls responded to before 3 hours.
34. Across the North West Ambulance Service area, the August 2017 to March 2018 position reveals that none of the six standards has been achieved.
35. GMHSCP is progressing a significant urgent and emergency care improvement and reform programme in GM, which will help systems to develop more integrated out of hospital urgent care services and enable North West Ambulance Service to manage the lower acuity calls more directly thus reducing conveyances to hospital. The Partnership is working closely with the regional ambulance commissioners, NHS Improvement and NHS England to agree an improvement plan which will include better call trajectories across all categories.
Acute Planned Care
36. The Referral to Treatment (RTT) operational standard states that 92% of patients on incomplete pathways should have been waiting no more than 18 weeks from referral to start their treatment. The full year position at March 2018 is that the CCG is above the standard at 94.34%.
Full Year Performance 18 Wks RTT: Incomplete Pathways 94.34%
96% 95% 94% 93% 92% 91% 90% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
2017/18 Performance Standard
37. Operational standards for key diagnostic tests are in place and require that a maximum of 1% of patients wait more than 6 weeks for their test. The full year position at March 2018 is higher (worse than) standard at 1.39%.
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38. This under-performance is not with our local acute services provider, Wrightington, Wigan & Leigh NHS Foundation Trust (WWL), but the issues are with other providers where our patients are treated. This performance is being managed through the Directors of Commissioning in the North West Sector of GM and Improvement Plans are in place.
Full Year Performance Diagnostics 6+ Week Waits 1.39%
2.5%
2.0%
1.5%
1.0%
0.5%
0.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
2017/18 Performance Standard
Cancer
39. The NHS Constitution details a number of cancer waiting times standards, which cover the various stages of cancer referral pathways.
40. The full year position at March 2018 is that the CCG has achieved the standard for both of the two Seen Within 14 Days indicators.
Full Year Monthly Cancer: 2 Week Wait Standard Performance Trend
Seen Within 14 Days of GP Referral 93.00% 96.72%
Breast Symptoms Seen In 14 Days 93.00% 93.89%
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41. The full year position at March 2018 is that the CCG has achieved the standard for each of the four Diagnosis-To-Treatment Within 31 Days indicators.
Full Year Monthly Cancer: 31 Day Wait Standard Performance Trend
Treatment Within 31 Days of Diagnosis 96.00% 98.63%
Subsequent Surgery in 31 Days 94.00% 98.28%
Subsequent Drug in 31 Days 98.00% 100.00%
Subsequent Radiotherapy in 31 Days 94.00% 100.00%
42. The full year position at March 2018 is that the CCG has achieved the standard for both of the Referral-To-Treatment Within 62 Days indicators. The Consultant Upgrade indicator does not have a national standard.
Full Year Monthly Cancer: 62 Day Wait Standard Performance Trend
GP Referral To Treatment In 62 Days 85.00% 92.00%
NHS Screening Referral To Treatment In 62 Days 90.00% 91.06%
Mental Health
43. The Improving Access to Psychological Therapies (IAPT) programme expects CCGs to commission services that will achieve a minimum of 16.8% of adults with relevant disorders to access IAPT services during 2017/18.
44. The IAPT programme additionally expects services to deliver a minimum 50% recovery rate. IAPT waiting times are also measured to ensure that 75% of patients referred to IAPT will enter a course of treatment within 6 weeks of referral and 95% within 18 weeks.
45. At the present time, published data is only available to January 2018. The data shows that the CCG had achieved or was on track to achieve the full year target for all IAPT indicators.
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YTD (Apr-Jan) Monthly Improving Access To Psychological Therapies Standard Performance Trend
IAPT Access Rate 14.00% 15.80%
IAPT Recovery Rate 50.00% 53.86%
IAPT 6 Week Waits 75.00% 99.78%
IAPT 18 Week Waits 95.00% 100.00%
46. In addition to the IAPT indicators, the CCG is required to meet a number of other Mental Health standards during 2017/18. These include the standard to maintain a Dementia Diagnosis Rate of 66.7% or greater, to ensure that at least 50% of people referred with Psychosis are treated within two weeks and that 95% of patients on the Care Programme Approach are followed up within seven days of discharge from inpatient care.
47. The first two of these standards are reported on a quarterly basis, while the CPA measure is reported on a quarterly basis. All three indicators achieved the full year standard.
Full Year Monthly Mental Health Standard Performance Trend
Dementia Diagnosis Rate 66.70% 72.14%
Psychosis First Treated <2 Weeks 50.00% 93.97%
Full Year Quarterly Mental Health Standard Performance Trend
Care Programme Approach 7 Day Follow Up 95.00% 96.87%
Quality of Care
48. The NHS Constitution and Operating Plans require CCGs to ensure the quality of care, in addition to the performance of services. The standards and plans relate to infection prevention and control, as well as the elimination of mixed sex accommodation.
49. The CCG continues to work closely with healthcare providers to reduce the number of healthcare associated infections (HCAI) for our patients. As at March 2018, five
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patients had tested positive with MRSA in the 2017/18 year. The full year (April 2017 to March 2018) number of Clostridium Difficile infections is reported as 95.
50. All providers of NHS funded care are expected to eliminate mixed-sex accommodation (MSA), except where it is in the overall best interest of the patient. In the April 2017 to March 2018 period, a total of 22 CCG patients experienced breaches of the Department of Health policy on eliminating mixed sex accommodation.
51. The CCG continues to work proactively across providers where small numbers of breaches occur. The most persistent issues have been at Royal Bolton Hospital where the design and layout of some departments such as the High Dependency Unit have not allowed ready transition to a zero breach position. Patient experience views are sought in each case and none has yet reported negatively. The CCG will continue to challenge providers where breaches occur.
Full Year Full Year Monthly Quality Of Care Plan/Standard Performance Trend
Health Care Associated Infection: MRSA 0 5
Health Care Associated Infection: C-Diff 81 95
Mixed Sex Accommodation 0 22
Financial Performance 2017/18
52. The CCG was licenced from 1 April 2013 under provisions enacted in the Health & Social Care Act 2012, which amended the National Health Service Act 2006.
53. The accounts for the year ended 31 March 2018, as presented within the financial statements, have been prepared by the CCG under section 17 of schedule 1A of the National Health Service Act 2006 (as amended) in the form which the Secretary of State has, with the approval of the Treasury, directed.
54. The accounts have been prepared on the going concern basis. Details can be found in Note 1.1 of the financial statements.
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2017/18 performance against the CCG’s primary financial indicators
55. CCGs have a number of financial duties under the National Health Service Act 2006 (as amended). Note 40 of the financial statements refers to the financial performance of the CCG in relation to its statutory duties.
56. The CCG has met all of its statutory financial duties in 2017/18, and its financial control total as set by NHS England/GMHSCP.
57. As the local leader of NHS services in Wigan Borough, the CCG has:
Achieved the control total of £2.967m; The achievement includes £2.913m additional surplus as required by NHS England as further detailed in section 59 & 60; Also includes a planned surplus of £0.054m. Due to reporting guidance the planned surplus of £9.494m has been offset by the previous years surplus of £9.440m, leaving a recalculated surplus of £0.054m; Achieved its cash target; Maintained the costs of CCG administration below its budget £7.106m – 1.3% of total spend; and Spent £518.463m in the year on healthcare services for the population of Wigan Borough.
58. As set out in the 2017/18 NHS Planning Guidance, CCGs were required to hold a 0.5% reserve uncommitted from the start of the year, created by setting aside the monies that CCGs were otherwise required to spend non-recurrently. This was intended to be released for investment in the Five Year Forward View transformation priorities.
59. However, the national position across the provider sector has been such that NHS England has been unable to allow CCGs to spend the non-recurrent monies set aside. Therefore, to comply with this requirement, the CCG has released its 0.5% reserve providing an additional surplus for the year of £2.267m. This additional surplus has been used nationally to offset other national cost pressures from the current financial year.
60. A national price reduction on non-branded (Category M) drugs was agreed from August 2017. NHS England has instructed CCGs not to spend the savings achieved from Category M drugs. This has resulted in an additional surplus of £0.646m. This additional surplus has been used nationally to offset other national cost pressures from the current financial year.
61. The areas of total CCG expenditure are shown in the following graphic:
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62. Secondary care hospital costs represent over half of the CCG’s expenditure. These include services such as Accident and Emergency, Maternity, General Medicine and Surgery. The cost of ambulance services to convey people to hospital is also included.
63. The CCG has managed the contracct with its main secondary care provider, WWL, within its available financial resourcee. This was achieved by the introduction of a block contract for two years.
64. The CCG continues to face increasing demand for secondary caree services year on year. To maintain overall financial baalance in 2018/19, the second year of the two year block contract will be essential, with its focus on collaborative working and on cost base reduction.
65. The CCG is also responsible for commissioning £46.1 million of primary care services from NHS England delegated budgets. This includes payments to local GP (General Practitioner) practices for General Medical Services, Personal Medical Services and Alternative Provider Medical Services contracts, Qualiity and Outcomes Framework and enhanced services commissioned for Wigan Borough patients.
66. In addition, the CCG has invested £5.3m in GP Primary Care Standards to improve standaards and reduce variability across GP primary care.
67. The cost of prescribing in 2017/18 was £61.9m. This includes tthe cost of drugs prescribed by primary care professionals. Within the expenditure for 2017/18 is a pressure of £1.9m relating to non-branded drugs under the No Cheaper Stock Obtainable (NCSO) category. This pressure has been offset by a rigorous effficiency programmme, including resulting cost savings of £1.5m against the drug Pregabalin.
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68. Community Health Services include the cost of the services provided in a community setting or in patients’ own homes, such as District Nurses, Therapists and Community Clinics. The cost of the contract for the Out of Hours service and Walk- in Centre is also included here.
69. Mental Health services include the costs of our main contract to provide Mental Health and Learning Disability support within the Borough. This includes Psychological Therapies (counselling services) and Inpatient Medical Care for patients with Mental Health conditions.
70. The CCG has continued to invest in Mental Health services to ensure the GM Mental Health Investment Standard is achieved, aimed at giving parity to mental and physical health services.
71. Continuing Health Care is a package of medical care arranged and funded solely by the NHS for our most vulnerable patients. It can be delivered in any setting and can include the full cost of a place in a nursing home if the needs of the patient meet a rigorous set of criteria. The CCG has residents who meet these criteria, and have been assessed as eligible for fully funded NHS care, which the CCG pays for and monitors.
72. The CCG is also responsible for Funded Nursing Care for patients who do not meet the Continuing Healthcare criteria but still require nursing care when in a care home environment.
73. The CCG has invested £22.9m in conjunction with Wigan Council to the nationally mandated Better Care Fund in 2017/18. This investment will continue in 2018/19 as stated in national guidance to support work around health and social care services.
74. Other programme services include the costs of paying for clinical premises, and the NHS 111 service.
75. The CCG in 2017/18 became a member of the Healthier Wigan Partnership. An alliance agreement was signed with partners to work together from 2018/19 on innovative ways to improve the delivery of clinical services at a lower cost.
Financial planning and risks (2018/19)
76. The CCG has delivered its statutory financial duties in 2017/18. However, in keeping with the wider NHS it is still faced with significant financial challenges over the coming years.
77. The biggest risk to the financial sustainability of the CCG over the coming years continues to be the CCG’s ability to reduce the demand and costs for hospital services. One of the best ways of improving services and at the same time remaining
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in financial balance is to treat more patients, where it is appropriate, in an alternative out of hospital setting, in the community or by GP led primary care.
78. To meet the significant financial challenges, the CCG in conjunction with its locality partners has developed a detailed plan to reduce unwarranted variation, reduce inefficiencies and duplication and where possible remove non-clinical overheads.
79. This is designed to ensure quality of services going forward, whilst maintaining financial sustainability over the longer term.
80. The CCG believes that the plans that are being developed and implemented will change the delivery of healthcare services to the extent required to achieve long term financial sustainability. Failure of organisations to work together to deliver this outcome represents a significant financial risk.
81. Central to financial balance is the CCG/locality five-year plan covering 2015/16 through to 2020/21.
82. The CCG was required to refresh its detailed operational plans for 2018/19. The refreshed plans show an initial financial gap in 2018/19 of £29.6m. Work is ongoing to update the plans to ensure a balanced overall five-year plan and schemes continue to be developed to bridge the current aggregate financial gap for the health economy.
83. The plan is monitored by the GMHSCP Team and underpins our transformation work.
84. Given the financial challenges that face the locality from 2018/19 onwards, GMHSCP has asked the locality to revise its five year financial plan in order to ensure financial challenges are fully met.
85. The CCG and Wigan Council are leading on the production of this revised plan and working with provider partners. Central to this approach will be the Healthier Wigan Partnership and its alliance agreement in 2018/19.
86. It is envisaged that the work undertaken to model sustainable quality clinical services will be completed in June 2018, in order to allow reporting back to partner Governing Bodies/Boards and the Locality Health and Wellbeing Board.
87. It is hoped that proposals for the revised clinical model agreed will be agreed in time to allow efficiencies to be achieved in financial year 2018/19.
88. The full financial statements included within this document give more detail on the numbers reported within this financial review.
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Sustainability Report
89. As an NHS organisation, and as a spender of public funds, we have an obligation to work in a way that has a positive effect on the communities for which we commission and procure healthcare services. Sustainability means spending public money well, the smart and efficient use of natural resources and building healthy, resilient communities. By making the most of social, environmental and economic assets we can improve health both in the immediate and long term even in the context of the rising cost of natural resources.
90. As a part of the NHS it is our duty to contribute towards the level of ambition set in 2014 of reducing the carbon footprint of the NHS, public health and social care system by 34% (from a 1990 baseline) equivalent to a 28% reduction from a 2013 baseline by 2020. It is our aim to supersede this target by reducing our carbon emissions by 10% in 2018/19 using 2011/12 as the baseline year.
91. The CCG’s modelled carbon footprint in 2017/18 was 116,624 tonnes of carbon dioxide equivalent emissions (tCO₂e). The majority of this impact is from the services we commission. The NHS standard contract requires providers to report performance against their carbon reduction management plans.
140,000 120,000 100,000 (tCO2e)
80,000 Community 60,000 Supply chain Emission
40,000 Commissioning 20,000 Core Carbon 0
92. As a commissioning and contracting organisation, we need effective contract mechanisms to deliver our ambitions for sustainable healthcare delivery. The NHS policy framework already sets the scene for commissioners and providers to operate in a sustainable manner. Crucially for us as a CCG, evidence of this commitment will need to be provided in part through contracting mechanisms.
93. The following table provides a sustainability comparator for the main providers that we commission services from.
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On track for Healthy SD Organisation Name SDMP 34% GCC travel Adaptation Reporting reduction plan score Wrightington, Wigan And Leigh 3. No target Yes included in No No Yes Minimum NHS Foundation plan Trust Bridgewater Community 1. On track to Yes No Yes Yes Minimum Healthcare NHS meet target Foundation Trust North West Boroughs 1. On track to Yes No Yes No Good Healthcare NHS meet target Foundation Trust 4. No Salford Royal NHS Sustainable No Development No Yes No Excellent Foundation Trust Management Plan Bolton NHS 1. On track to Yes No No No Minimum Foundation Trust meet target North West 1. On track to Ambulance Yes Yes No Yes Excellent meet target Service NHS Trust
More information on these measures is available here: www.sduhealth.org.uk/policy-strategy/reporting/organisational-summaries.aspx
94. We can improve local air quality and improve the health of our community by promoting active travel – to our staff, through our providers and to the patients and public that use the services we commission.
Category Mode 2014/15 2015/16 2016/17 2017/18 miles 131,605 154,659 164,331 179,635 Staff commute tCO2e 48.36 55.93 59.39 64.01 miles 89,438 106,837 91,033 68,853 Business Travel tCO2e 32.86 38.94 34.56 24.53 miles 267,987 197,327 114,753 15,420 Active and public transport tCO2e 24.17 16.90 10.64 1.39 Owned Electric and PHEV miles 0 0 0 0 mileage tCO2e 0.00 0.00 0.00 0.00 Total cost of travel Not Not Not £ modelled modelled modelled £78,811
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95. We have reduced staff business travel year on year and aim to continue WBCCG have reviewed travel plans to ensure staff wellbeing and a C02 reduction. Travel surveys are taken annually to review staff commute and to look at initiatives that will help reduce C02. Car sharing and cycle schemes are promoted and have been well received along with on-site loan bikes for use.
96. The CCG has spent £32,974 on energy in 2017/18, which is a 3.8% decrease on energy spend from last year.
Carbon Emissions ‐ Energy Use 250
e) 200 2 150 (tCO
100
Carbon 50 0 2014/15 2015/16 2016/17 2017/18
Gas Oil Coal Electricity Green Electricity
97. Our performance on waste reduction and recycling is improving and we are looking into further methods to implement more recycling.
Waste Breakdown
20 Recycling/ reuse 15 (tonnes)
10 Other 5 Weight 0 Landfill
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Improving Quality
98. The CCG has continued to support and drive quality improvement within the health and care services that have been commissioned on behalf of local people and has summarised this within the quarterly reports to the Governing Body during 2017/18.
99. These reports were based on a number of information / data sources such as:
Provider Care Quality Commission (CQC) Quality Reports; Commissioner and Provider reports presented at the Quality, Safety and Safeguarding Groups; Quality Indicators identified through the Contract Monitoring and Performance Groups; Serious Incidents and Never Events reported via the Strategic Executive Information System (StEIS). GMHSCP Quality Board and Quality Collaborative and related sub groups i.e. HCAI, Care Home and the Practice Nursing collaborative, NHS England (NHSE) and NHS Improvement (NHSI) guidance and reports.
100. The CCG has effective systems and processes in place for monitoring and acting on a range of information about the quality of commissioned services; examples include: An established Quality Oversight Framework for 2017/18; CCG Serious Incidents and Never Events (SINE) Panel; Commissioner Quality Visits to Providers i.e. North West Boroughs Healthcare NHS Foundation Trust (NWBHFT) Child and Adolescent Mental Health Service and WWL Maternity Service. Patient / family / carer interviews form part of every visit and Healthwatch/Patient Participation Group (PPG) members are key partners in this process; Commissioning for Quality and Innovation (CQUIN) Schemes are in place with each of the NHS Foundation Trusts locally and are monitored on a quarterly basis. One of the schemes in year focused on reducing the impact of serious infections (Antimicrobial Resistance and Sepsis) and resulted in WWL implementing a sepsis improvement plan. Systems and processes that support the effective management of Healthcare Associated Infections (HCAI) are in place for example: The CCG hosts the Wigan Locality Root Cause Analysis / Post Infection Review (RCA/PIR) Group; An E.coli (Gram Negative Bloodstream Infections) Improvement Plan has been approved and is being implemented, The CCG IPC Surveillance and Audit Lead attends and contributes to the following groups: GMHSCP - E.coli Task and Finish Group
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GMHSCP - Infection Preveention and Control Collaborative Public Health England / NHS North - PIR Case Review Process (MRSA)
101. Where we identify any lapses in care the CCG embraces a cultture of open and honest co-operation where individuaals and organisations are transparent about the quality of care being provided to patients by partnership organisationns.
102. WWL continues to be an ‘outlier’ for the Summary Hospital-level Mortality Indicator (SHMI). This is the ratio between the actual number of patients who die following hospitalisation at the trust and the number that would be expected to die on the basis of average England figures, given the characteristics of the patientss treated. This has led to a number of actions being initiated in partnership with the; CCG, WWL and Wigan Council. The Trust has establlished a Mortality Group whichh is developing an action plan based on recommendaations of the Joint Mortality Review. A Wigan Borough Mortality Summit was also held in January 2018.
103. In respect of Primary Care quality the General Practices locally are all currently rated as good or outstanding by the CQC. The CCG has developed an assurance framework for Primary Care which is monitored and reviewed by tthe CCG Primary Care Commissioning Committee. A number of quality improvemeent activities have also been undertaken in year for example the; Quality Peer Reviews and the introduction of the Nurse Fellowship scheme for new-to-post nurses. The Practice Nurses were also recognised for their quality improvement work at the GMH&SCP Practice Nursing awards.
104. The CCG also effectively utilises ‘Service User Experience of Care’’ data reported by the local GP Practices to inform the overall quality assurance and improvement processs. Post analysis of the data information is fed back to local providers to ensure changes are made to drive the required improvements in quality. A focus in year has been improvements to discharge letters to local GPs.
105. There are 53 Care Homes providing a range of care services including nursing and residential care in Borough. In year we have seen an improved position in respect of the CQC Care Home ratings. A summarised position is captured in the following charts.
106. The Residential Care Homes have alsso been assessed as the third most improved in the UK over the last 12 months. 24
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107. The CCG’s Quality, Medicines Management and Safeguarding Vulnerable Adults Leads continue to provide clinical support and advice to both the Wigan Council Quality Oversight Team and the Care Home Providers. Care Home specific quality improvement schemes implemented in Borough have included:
React 2 Red Pressure Ulcer Prevention: This training pack has been produced for care homes and other care providers and is an essential resource for anyone caring for those at risk of developing pressure ulcers. Red Bag Scheme: This is a Hospital Discharge Pathway Tool that is being implemented across a pilot group of six care homes in Borough, the aim being to assist residents to achieve a smooth transition between the Hospital and the Care Home. Future plans are to roll out this wider following the evaluation of the pilot.
Engaging People and Communities
108. We are committed to involving patients and residents in the work we do.
109. This includes involving them in the development of strategies, service design and the review of the quality of local services.
110. It is important that we understand the needs, challenges and concerns of the people who use our services so we can commission high quality, efficient services that meet the needs of the people who use them.
111. We have a dedicated group of patients, our Patient Forum, who meet with us regularly to challenge us to get this right. They act as advisors and critical friends on our approach to engagement, as well as helping us to deliver it.
112. Our Patient Forum reports in to our Governing Body on a quarterly basis to give them an honest appraisal of how well we have delivered against our commitment to engage.
113. We are constantly aware of the commitment they give as volunteers and are grateful for their support and advice.
114. This is only a small part of our engagement activity.
115. We engage closely with our network of 62 GP Practice Patient Participation Groups and have this year engaged with them on a twelve month development programme. This includes delivering a series of training sessions for them and their members on diverse topics from dementia friends training, meeting skills, involving other patients and social media.
116. We bring together our 62 PPGs in to 7 geographically based groupings, that match our Governing Body structure and the local Service Delivery Footprints (SDFs). This
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allows local patients to get directly involved in the design of services for their specific communities.
117. We hold Equality Impact Assessment workshops with the local voluntary sector organisations to understand and assess the impact our work has on the protected characteristics and host an Equality Delivery System 2 event to evaluate with our community and voluntary sector delivery of our equality duties.
118. We also attend voluntary sector and community groups to engage directly with their members on specific topics. For example, this year we have atttended the Deaf Society, BYOU+ (LGBTQ+), Autism Wigan and Leigh and local residential home groups.
119. Wider public discussion, “Spotlight Sessions”, are held regularly to engage with patients and residents on topics such as the Integrated Care, Fair Processing and Primarry Care Reform.
120. This year, our Annual General Meeting was held in the local thriving market on a busy market day. We stayed in the market to talk to local residentts about the CCG for three days and involved over 700 people.
121. On specific service redesigns we also hold more formal engagement and consultation activities. For example, we have held a consultation on the future of a branch practice and undertaken engagement exercises to support the design of our End of Life Strategy and the delivery of local services in Orrell and Billinge.
Image: Trish Anderson, Chief Officer, and Donna Hall, Chief Executive off Wigan Council, at Wigan Pride 2017 which we support in both organising, delivering and engaging with the LGBTQ+ community on the day.
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Reducing Health Inequality
122. The CCG’s Commissioning Intentions Plan for 2017/18 extended the roll-out of primary care standards across all 62 of our GP practices and should result in a reduction in variation in outcomes across a number of indicators including long term condition management, proactive care and targeted support for population groups experiencing health inequalities. All our practices are rated good or outstanding by the Care Quality Commission.
123. NHS England has highlighted that residents in care homes often experience difficulties accessing the right care at the right time. Improving the clinical input into a home and tailoring care around the diverse needs of individual residents can improve the quality of care and quality of life for this group. The CCG Care Home Team reduces the inequalities faced by this vulnerable group of patients.
124. In November 2017 the following was published on the National Institute for Health and Care Excellence (NICE) website:
Wigan Borough CCG has employed a team of pharmacists and pharmacy technicians since 2014 to work with GP practices, residential and nursing homes to carry out structured medication reviews for care home residents. Reviews promote person-centred, evidence-based, safe, cost-effective prescribing in-line with NICE guidance on medicines optimisation (NICE NG5, Recommendations 1.4.1 to 1.4.3) and have led to a reduction in pill-burden and inappropriate polypharmacy.
The team works collaboratively with colleagues from the Local Authority Market Oversight Team and in addition to ensuring the safer use of medicines, has resulted in improved CQC ratings in a number of homes within the Borough.
125. During 2017/18 the CCG has incentivised its Mental Health and Community Providers to deliver improved health outcomes for patients who smoke and/or consume excess alcohol through the ‘Preventing ill health by risky behaviours – alcohol and tobacco CQUIN’.
126. This Commissioning for Quality and Innovation (CQUIN) indicator seeks to help deliver on the objectives set out in the NHS England Five Year Forward View (5YFV), particularly around the need for a ’…radical upgrade in prevention…’ and to ‘…incentivising and supporting healthier behaviour’ by increasing screening, the provision of brief advice and referral to specialist support, where needed, for patients who smoke and / or consume excess alcohol.
127. The CCG has been assured by NHS England as providing ‘Outstanding’ care for patients with Diabetes. This includes encouraging patients to go through a formal education programme to help them manage their condition and making sure patients are treated in line with NICE guidance.
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128. The CCG is committed to extending its offer of personal health budgets (PHB) to include a wider cohort of people. There is an ever-growing shift to personalisation in healthcare to improve health outcomes for people. PHBs are one way to give people with long term health conditions and disabilities more choice and control over the money spent on meeting their health and wellbeing needs. PHBs can transform people’s lives, enabling the development of a package of care that more effectively responds to them as an individual.
129. Community Link Workers are based in all our GP Practices with the aim of improving the health and wellbeing of local people through better connections to appropriate sources of support in the community. This delivers help that is easily accessible, responsive, supportive and practical to patients and residents across the borough.
130. One of our practice clusters is piloting the development and delivery of a same day access hub. By introducing same day access the cluster aims to improve access to general practice through the creation of an in-hours Acute Primary Care Access Hub which will be delivered on a collaborative basis via a multi-disciplinary team. It creates a new model of primary care where primary care access means more than just a GP appointment – it will enhance patient flow by creating a space for GPs, Nurses, Physiotherapists, and social care to interact with patients directly without multiple handovers.
131. Another of our practice clusters is piloting a service for residential care and housebound patients. Patients within this cohort receive a multidisciplinary assessment on a two weekly basis to provide proactive case management and support them to remain in their usual place of residence.
Health and Wellbeing Strategy 132. We are active members of the Wigan Borough Health and Wellbeing Board with our Chair, Dr Dalton, also co-chairing the Health and Wellbeing Board with a key Council Cabinet Member. The CCG has six voting members on the Board including the Chair - two GP Clinical Leads, the Secondary Care Clinical Lead, the Chief Officer and Chief Finance Officer. 133. The Board, with the support of the CCG, is committed to: Improving population health and reducing health inequalities Reforming the way the health and care system works Protecting the health of residents 134. It is a central part of our local partnership working and governance arrangements. 135. The Board oversees the delivery of our joint Health and Wellbeing Strategy and the Wigan Borough Locality Plan, which sets out how collectively we will transform local services and make them sustainable.
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136. The Health and Wellbeing Strategy for 2016-2018 is built on the Robert Wood Johnson Foundation methodology to ‘Create a Culture of Health’ across Wigan and generate a sense of ownership across stakeholders to ensure that health is the business of all stakeholders. The strategy sets out the four action areas that need to be applied to create such a culture, these being: To make health a shared value To foster cross sector collaboration to improve wellbeing To create healthier, more equitable communities To strengthen integration of the health service and systems
137. The creation of such a culture will translate into significant improvements in health and wellbeing and will contribute to the realisation of the vision for The Deal for Health and Wellbeing, creating stronger communities and addressing the wider determinants of health through growth and reform. The investment and the strength of the applications and innovations at the community level will support the realisation of our vision and impact on our priority areas.
138. Wigan’s four Health and Wellbeing Priorities for 2016-2018 are:
Creating a Culture of Health & Well-being Delivering Further Faster Towards 2020 Creating & Sustaining Resilient Communities Addressing Wider Determinants through Maximising the Potential of Growth & Reform
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Trish Anderson Accountable Officer 24 May 2018
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CORPORATE GOVERNANCE REPORT
Members Report
Member Practices
1. Wigan Borough CCG has 62 member practices that work together on Service Delivery Footprints (SDFs) of 30,000 – 50,000 patients. The main sites of the 62 practices are listed below:
Leigh Service Delivery Footprint Brookmill Medical Centre, College Street, Leigh Dr Esa (The Avenue Surgery), Leigh Health Centre, The Avenue, Leigh Dr Gupta, Bridgewater Medical Centre, Henry Street, Leigh Dr Khaing, Leigh Health Centre, The Avenue, Leigh Dr Wong & Partners, Old Henry Street Medical Centre, Henry Street, Leigh Foxleigh Surgery, Bridgewater Medical Centre, Henry Street, Leigh Grasmere Surgery, Leigh Health Centre, The Avenue, Leigh Intrahealth Leigh Sports Village, Leigh Sports Village, Leigh Intrahealth Leigh Sports Village (Older Persons), Leigh Sports Village, Leigh Leigh Family Practice (Integral), Bridgewater Medical Centre, Henry Street, Leigh Lilford Park Surgery, Leigh Health Centre, The Avenue, Leigh Premier Health, Bridgewater Medical Centre, Henry Street, Leigh Westleigh Medical Centre, 4-12 Westleigh Lane, Westleigh, Leigh
LIGA North Service Delivery Footprint Dr Ahmed & Partners, Alexander House Surgery, Platt Bridge Health Centre, Rivington Avenue, Platt Bridge, Wigan Dr Tun & Partners, Hindley Health Centre, 17 Liverpool Road, Hindley, Wigan Dr Ullah’s Practice, Platt Bridge Health Centre, Rivington Avenue, Platt Bridge, Wigan Higher Ince Surgery (SSP Ltd), Manchester Road, Ince-in-Makerfield, Wigan Intrahealth Platt Bridge, Platt Bridge Health Centre, Rivington Avenue, Platt Bridge, Wigan Lower Ince Surgery (SSP Ltd), Claire House, Lower Ince Health Centre, Phoenix Way, Lower Ince, Wigan Pennygate Medical Centre, 109 Ladies Lane, Hindley, Wigan
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LIGA South Service Delivery Footprint Ashton Medical Centre (Pitalia – SSP), 120 Wigan Road, Ashton-in-Makerfield, Wigan Braithwaite Road Surgery (Kadiyala SSP), 36 Braithwaite Road, Lowton, Warrington Dr Anis & Partner, Kidglove House, Golborne Health Centre, Kidglove Road, Golborne Dr Pal, Kidglove House, Golborne Health Centre, Kidglove Road, Golborne Dr Shahbazi Family Medical Practice, Kidglove House, Golborne Health Centre, Kidglove Road, Golborne Dr Xavier, 647 Liverpool Road, Platt Bridge, Wigan Slag Lane Medical Centre, 216 Slag Lane, Lowton, Warrington
North Wigan Service Delivery Footprint Aspull Surgery, Haigh Road, Aspull, Wigan Beech Hill Medical Practice, 278a Gidlow Lane, Beech Hill, Wigan Shevington Surgery, Houghton Lane, Shevington, Wigan Standish Medical Practice, 49 High Street, Standish, Wigan
SWAN Service Delivery Footprint Bryn Cross Surgery, 246 Wigan Road, Ashton-in-Makerfield, Wigan Dr Alistair Ashton, Ashton Clinic, Queens Road, Ashton-in-Makerfield, Wigan Dr Mohan Kumar & Partner, Chandler House, Worsley Mesnes Health Centre, Poolstock Lane, Wigan Dr Zaman & Partner, Chandler House, Worsley Mesnes Health Centre, Poolstock Lane, Wigan Hawkley Brook Medical Practice, Chandler House, Worsley Mesnes Health Centre, Poolstock Lane, Wigan Marus Bridge Practice, Chandler House, Worsley Mesnes Health Centre, Poolstock Lane, Wigan Medicentre, 185 Wigan Road, Ashton-in-Makerfield, Wigan Shakespeare Surgery, Chandler House, Worsley Mesnes Health Centre, Poolstock Lane, Wigan Winstanley Medical Centre, Holmes House Avenue, Winstanley, Wigan
TABA+ Service Delivery Footprint 7 Brooks Medical Practice, Seven Brooks Medical Centre, 21 Church Street, Atherton
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Astley General Practice (Pitalia SSP), 391a Manchester Road, Astley Bee Fold Lane Surgery, Bee Fold Lane, Atherton Boothstown Medical Centre, 239 Mosley Common Road, Boothstown Coldalhurst Lane Surgery, The Surgery, 1 Coldalhurst Lane, Astley Dr Atrey & Partner, Atherton Health Centre, Nelson Street, Athertonn Dr K.K. Chan, & Partners, Seven Brooks Medical Centre, 21 Church Street, Atherton Dr Vasanth & Partner, Bag Lane Surgery, Atherton Health Centre, Nelson Street, Atherton Elliott Street Surgery, 145 Elliott Street, Tyldesley Elmfield Surgery, Atherton Health Centre, Nelson Street, Atherton Intrahealth Tyldesley, Tyldesley Health Centre, Poplar Street, Tyldesley The Surgery, Astley, 10 Higher Green Lane, Astley The Surgery, Tyldesley, High Street, Tyldesley
Wigan Central Service Delivery Footprint Bradshaw Medical Practice, Bradshaw Street, Wigan Intrahealth Marsh Green, Harrow Road, Marsh Green, Wigan Longshoot Medical Practice, Scholes, Wigan Mesnees View Surgery, Mesnes Streeet, Wigan Newtown Medical Practice, Sherwood Drive, Wigan Pemberton Surgery, Sherwood Drive, Wigan Sullivan Way Surgery, Sullivan Way, Scholes, Wigan Dicconson Group Practice, Boston House, Wigan Health Centre, Froog Lane, Wigan Wrightiington Street Surgery, Wrightington Street, Wigan
Our Governing Body
2. The CCG’s Governing Body membership this year is detailed below.
3. One Clinical Exective Governing Boddy member retired on 30th June 2017 and two new Clinical Executives were elected in August 2017 following a change in the compoosition of the membership. The Governing Body had approved a change from six “Localities” to seven SDFs in March 2017, and a third Laay Member was appointed in September 2017.
4. Governing Body Members:
Dr Tim Dalton (Chair) 33
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Mrs Trish Anderson, Chief Officer (Accountable Officer) Mr Mike Tate, Chief Finance Officer Ms Julie Southworth, Director of Quality & Safety Dr Sanjay Wahie, Clinical Executive for LIGA North SDF Other Responsibility: Clinical Lead for Medicines Management Dr Tim Dalton, our Chair Dr Mohan Kumar, Clinical Executive for SWAN SDF Other Responsibility: Chair of Finance and Performance Committee Dr Ashok Atrey, Clinical Executive for TABA+ SDF Other Responsibility: Chair of Clinical Governance Committee Dr Gen Wong, Clinical Executive for Leigh SDF Other Responsibility: Member of Wigan Health and Wellbeing Board Dr Pete Marwick, Clinical Executive for North Wigan SDF Other Responsibility: Chair of Service Design and Implementation Committee Dr Tony Ellis, Clinical Executive for Wigan Central SDF (retired June 2017) Other Responsibility: Chair of Corporate Governance Committee Dr Jayne Davies, Clinical Executive for Wigan Central SDF (Sept 2017) Dr Neeta James, Clinical Executive for LIGA South SDF (Sept 2017) Mr Frank Costello, Lay Member (Deputy Chair) Other Responsibility: Lay Member with responsibility for Patient and Public Engagement Canon Maurice Smith, Lay Member with responsibility for Governance and Conflicts of Interest Mr Peter Armer, Lay Member with responsibility for Audit and Remuneration Dr Gary Cook, Secondary Care Consultant Governing Body Member Other Responsibility: Chair of Primary Care Commissioning Committee Mrs Catherine Jackson, Nurse Governing Body Member
5. The Audit Committee members throughout the year were: Canon Maurice Smith (Chair, April 2017 – Sept 2017, Lay Member Oct 2017 – March 2018)) Mr Peter Armer (Chair, Oct 2017 – March 2018) Mr Frank Costello (Lay Member, April 2017 – Dec 2017) Dr Tony Ellis (GP Member and also Chair of Corporate Governance Committee, retired 30 June 2017) Mrs Catherine Jackson (Nurse Member, July 2017 – March 2018)
6. Details of all other committees of the Governing Body including key responsibilities, membership, attendance and highlights of their work can be seen in the governance statement section of this report.
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Register of Interests
7. For up-to-date information on the Governing Body Members’ and GP Practice declarations of interest, please see our website:
http://www.wiganboroughccg.nhs.uk/your-ccg/our-governing-body
Personal Data Related Incidents
8. There were no serious incidents relating to data security breaches at the CCG and therefore none was reported to the Information Commissioner in the year ending 31 March 2018.
Statement of Disclosure to Auditors
9. Each individual who is a member of the CCG Governing Body 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
10. Wigan Borough CCG fully supports the Government’s objectives to eradicate modern slavery and human trafficking. Our Slavery and Trafficking Statement for the financial year ending 31st March 2018 appears on our website at
http://www.wiganboroughccg.nhs.uk/here-to-help/safeguarding
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Statement of Accountable Officer’s Responsibilities
11. The National Health Service Act 2006 (as amended) states that each Clinical Commissioning Group shall have an Accountable Officer and that Officer shall be appointed by the NHS Commissioning Board (NHS England). NHS England has appointed the Chief Officer, Trish Anderson, to be the Accountable Officer of NHS Wigan Borough CCG.
12. 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 223Hto 223J of the National Health Service Act 2006 (as amended).
13. Under the National Health Service Act 2006 (as amended), NHS England has directed each Clinical Commissioning Group to prepare for each financial year financial statements in the form and on the basis set out in the Accounts Direction.
14. The financial statements 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 net expenditure, changes in taxpayers’ equity and cash flows for the financial year.
15. In preparing the financial statements, the Accountable Officer is required to comply with the requirements of the Group Accounting Manual issued by the Department of Health and in particular to:
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Observe the Accounts Direction issued by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis; Make judgements and estimates on a reasonable basis; State whether applicable accounting standards as set out in the Group Accounting Manual issued by the Department of Health have been followed, and disclose and explain any material departures in the financial statements; and, Prepare the financial statements on a going concern basis.
16. 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.
17. 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. that the annual report and accounts as a whole is fair, balanced and understandable and that I take personal responsibility for the annual report and accounts and the judgments required for determining that it is fair, balanced and understandable.
Trish Anderson
Accountable Officer
24 May 2018
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Governance Statement
Introduction and context
18. Wigan Borough Clinical Commissioning Group (the CCG) is a body corporate established by NHS England on 1 April 2013 under the National Health Service Act 2006 (as amended).
19. 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.
20. As at 1 April 2017, the CCG is not subject to any directions from NHS England issued under Section 14Z21 of the National Health Service Act 2006.
Scope of responsibility
21. 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 CCG Accountable Officer Appointment Letter.
22. 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
23. 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.
24. The CCG has adhered to the Nolan principles of standards in public life. We have also complied with the principles below contained in our published constitution:
Inclusivity: of clinicians and patients, local residents, stakeholders and partners.
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Subsidiarity: by delegation to service delivery footprints (SDFs); Locality: by commitment to reflecting the SDF requirements; Accessibility: by listening to and responding to the SDFs.
25. The membership of the CCG established a Governing Body in order to undertake the business of the CCG and to discharge its statutory functions. Membership of the Governing Body is in line with statute and in addition is representative of the membership through the elected SDF clinical executive membership.
26. Under the scheme of delegation there can be no provision to allow any SDF, practice or grouping of practices to delegate any CCG responsibilities or functions to the governing body of the CCG as the CCG is the corporate and statutory body and not the SDF or other practice grouping.
27. Each member of the governing body shares corporate responsibility as part of a team to ensure that the CCG exercises its functions effectively, efficiently and economically, with good governance and in accordance with the terms of its constitution.
28. The Governing Body has 16 voting members including the Chair. The Governing Body is clinically led and has a majority of clinicians as members. The SDF clinical executive members are practising GPs within the CCG area and GP members are on the performers list of Wigan Borough or the subsequent arrangements. The Governing Body membership comprised:
a) the Chair; b) seven SDF clinical executives elected by, and representing each SDF group of member practices; c) three lay members: one leading on audit and remuneration, one leading on governance and conflicts of interest, one leading on patient and public participation; d) one lay registered nurse; e) one lay secondary care specialist doctor; f) the Accountable Officer; g) the Chief Finance Officer h) the Director of Quality & Safety
29. The Governing Body has met in public each month between April 2017 and March 2018 except August and December. The Governing Body also meets in closed session, generally to scrutinise documents in draft before they are published. A minimum of two thirds (67%) of members and at least four of the seven SDF clinical executives must attend for meetings to be quorate.
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30. This has been achieved on each occasion except the January meeting and attendance has ranged between 69% in one month to 100% on two occasions.
See Appendix 1 for the attendance record of each member.
31. It is crucial that an interest and involvement in the local healthcare system does not also involve a vested interest in terms of financial or professional bias toward or against particular solutions or decisions. For this reason the CCG demands that members, governing body members, officers and those wishing to provide services to the CCG declare any conflict or potential conflict in relation to a decision to be made by the Group, and record them in published registers.
32. During its meeting in July 2017, the Governing Body approved the CCG’s updated Conflicts of Interest Policy following the release of the NHS England mandatory guidance earlier in the previous month. There is a request at the start of each meeting that members highlight any interests not previously declared and which may be pertinent to any agenda item or decision.
33. The Governing Body receives and reviews at its meetings:
New business items such as quality strategies and assurance reports; Current business items such as the Performance and Finance Reports which evidence how the CCG is performing against local priorities, and NHS England’s Improvement and Assessment Framework; Governing Body Committee Chairperson reports; SDF Executive Meeting Chairperson reports.
34. In addition to the above and the work of the committees, the Governing Body reviewed its effectiveness through a number of development sessions and formal meetings.
35. In 2017 the GM Commissioning Review was completed which resulted in a requirement to deliver integrated healthcare provision and commissioning locally. As a result we established the Healthier Wigan Partnership (HWP), as a partnership of health and social care providers working together to develop an integrated approach to health and social care for Wigan and to set out our journey to an Integrated Care System. 36. The jointly developed operating model for a Strategic Commissioning Function (SCF) was conditionally approved by the Governing Body in October 2017 as the governance template for a Wigan place based commissioning function.
37. There was also recognition that the governing body would benefit from the recruitment of an additional lay member with the requisite qualifications to express informed views about financial management and audit matters so this was
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completed in September 2017 when the current Chair of Audit Committee joined the governing body.
38. There are eight committees reporting into the Governing Body and their terms of reference and achievements this year are summarised as follows:
Clinical Governance Committee (9 meetings)
It is the role of the committee to Membership Members Meetings demonstrate that there is an effective Category attended and consistent process in respect of Dr Ashok 7 commissioning for quality across the Atrey (Chair) SDF Clinical CCG, also ensuring that any areas of Dr Sanjay Executives 8 concern and under-performance are Wahie identified and high standards of care Dr Gen Wong 6 and treatment are delivered. Clinician Dr Gary Cook 7 The committee provides assurance to Governing Catherine the Governing Body with regard to Body Lay 4 Clinical Governance activities in the Members Jackson appropriate areas of accountability and GP Member Dr Tankard 6 in line with its terms of reference. It Governing Julie receives reports from the Quality, Safety Body Officer 1 Southworth and Safeguarding Group meetings held Member to monitor the quality of healthcare at Sally the three large local NHS providers, Forshaw 8 Wrightington, Wigan & Leigh NHS Linda Scott / Foundation Trust, 5 Boroughs 9 Deputy Partnership NHS Foundation Trust (Mental Health) and Bridgewater CCG Officers Julie Community Healthcare NHS Foundation Crossley / 8 Trust. Deputy Debbie The committee also provides oversight 3 on: Szwandt Intermediate Care and Community Tim Dalton 0 Bed Providers Trish Open 1 Primary Care – General Practice Anderson Care Homes in the Borough Mike Tate 0 Serious Incidents and Never Events Healthcare Associated Infections Service User Experience of Care Patient Opinion Commissioner Quality Improvement Visits Safeguarding Children and Vulnerable Adults
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Corporate Governance Committee (4 meetings)
The committee provides assurance to Membership Members Meetings the Governing Body with regard to all Category Attended corporate governance issues in the Governing Maurice 4 appropriate areas of accountability Body Lay Smith (Chair) covering mostly non-clinical controls Member and regulations. The committee meets (Chair since every two months, is chaired by a Jan 2018) governing body member and provides a SDF Clinical Dr Tony Ellis 0 Chairperson’s report to the Governing Executive (retired 30 Body in the month following each (Chair for June 2017) meeting. April 2017 – June 2017) The committee received quarterly Governing 4 presentations of the Governing Body Body Lay Assurance Framework (GBAF) with the Member Frank purpose of scrutinising corporate risks, (Acting Chair Costello controls and action plans. July 2017 – Dec 2017) Progress reports were received by the Governing Julie 3 committee at each meeting covering the Body Officer Southworth CCG’s responsibilities in the areas of: Members Mike Tate/ 4 Communications Deputy Human Resources Sally 4 CCG Officer Information Management Forshaw Members Information Governance Tim Collins 4 Equality & Diversity Dr Tim - Emergency Preparedness, Open Dalton Resilience & Response (including Members Trish 2 business continuity arrangements) Anderson Health & Safety Incident Reporting Risk Management & Assurance Patient Response (enquiries, complaints, freedom of information enquiries, Member of Parliament correspondence) Sustainability
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Finance & Performance Committee (10 meetings)
The committee has implemented and Membership Members Meetings monitored the CCG arrangements category attended around Finance, Contracting and Dr Mohan SDF Clinical Performance, including nationally driven Kumar 8 Executive initiatives. (Chair) Dr Justin SDF Clinical 9 The key responsibilities of the Tankard Represent- committee are: Dr Nikesh atives (GPs) 9 Vallabh Agree the annual planning Trish timetable; Anderson / 6 Oversee the annual planning Governing Deputy process to ensure the delivery of Body Officer Mike Tate 7 the following milestones: Members Julie o Commissioning intentions; Southworth/ 8 o Financial plan; Deputy o Contracts with NHS and Non- Governing Frank NHS partners; Body Lay Costello 10 o Agree annual budget book; Member Overview the annual planning cycle Craig Hall 10 for performance targets; CCG Officer Review on behalf of the governing Julie Members body the monthly finance, QIPP and Crossley / 10 performance reports; Deputy Transformation Fund reports; Review and approve Quality, Innovation, Productivity and Prevention (QIPP) business cases; and link with the audit committee to ensure the CCG produces timely and accurate annual accounts in accordance with reporting guidance.
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Service Design & Implementation Committee (8 meetings)
The committee provides assurance to Membership Members Meetings the governing body with regard to Category Attended service strategy, design, development and implementation, driven by the Dr Peter SDF Clinical priorities of the CCG. The committee Marwick 8 Executives facilitates the planning and coordination (Chair) of initiatives, service redesign and policy development. Dr Hari 8 Sukhavasi GP Leads Dr Syed The committee built on its work from the 8 previous year and continued to receive Shah regular reports on the integration of Governing Frank community services being led by the Body Lay Costello 8 Healthier Wigan Partnership and the Member Trish Outpatient Redesign. 2 Anderson Governing Mike Tate/ Body Officer 5 The committee also provided oversight Deputy Members on progress with a number of other Julie 1 programmes: Southworth CCG Officer Jennie Transformation Fund 3 Members Gammack Wigan Locality Plan Julie Alternative Provider Medical 2 Crossley Services (APMS) contract John 7 procurement Marshall Transfer of neurological rehabilitation service GP Streaming at the acute hospital site Nursing home reform
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Audit Committee (4 meetings)
The committee reviews the Membership Members Meetings establishment and maintenance of an Category Attended effective system of integrated Maurice governance, financial oversight, internal Smith (Chair 4 control and risk management across the April 2017 – whole of the CCG’s activities (both Sept 2017) clinical and non-clinical) that support the Governing Peter Armer achievement of the objectives. Body Lay (Chair Oct 1 Members 2017 – The main responsibilities of the Audit March 2018) Committee are to: Frank Review and adopt the CCG’s Costello 3 financial statements and annual (April – Dec) report; SDF Clinical Dr Tony Ellis Review the work and the findings of Executive (retired 30 0 the CCG’s External Auditors; June 2017) Monitor the work and effectiveness Governing of the CCG’s Internal Auditors and Body Nurse Catherine Local Counter Fraud Services; Member 2 Jackson Review the effectiveness of internal (from July controls, the Governing Body 2017) Assurance Framework and risk management systems; Review any findings of Internal Audit and Local Counter Fraud Services, and ensure that action plans are in place and completed; Monitor any losses and compensation payments; Review the CCG’s gifts and hospitality register and declarations of interest
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Remuneration Committee
39. The committee makes recommendations to the governing body on determinations about pay and remuneration for employees of the CCG and people who provide services to the CCG, in line with the CCG’s procedure, and evidence based review as outlined in the scheme of delegation. Members are:
Chair of Governing Body Governing Body Lay Members and SDF Clinical Executives
40. The table below summarises the required members for various membership decisions.
Decision about: Who will be invited to attend VSM (Accountable Officer, Chief All members Finance Officer and Director of Quality and Safety) CCG Chair All members except CCG Chair Clinical Governing Body Members All members except 7 Clinical Governing Body Members Lay Members (3 lay members, All members except the 5 Lay secondary care lay member and Members nursing lay member) Clinical Directors, Clinical All members except members who Champions, Lead Practice Managers are Clinical Champions and other clinical engagement payments
41. The Remuneration Committee met three times in 2017/18. There are 13 members of this committee which is formed of all the Governing Body members except the three executive officers. The meetings were attended by 11, 10 and 12 members respectively. The Accountable Officer and Chief Finance Officer attended each meeting and a Human Resources representative was also present at each meeting.
42. The Committee is responsible for setting pay rates and uplifts for all staff not subject to national Agenda for Change pay scales. This includes Governing Body Members, Clinical Directors, Clinical Champions and Practice Nurse representatives. Rates have been set for 2017/18 and agreed for 2018/19. The Committee has also monitored the process for evaluation of Governing Body Members’ Performance.
43. Finally, the Remuneration Committee has responsibility for setting policies that relate to expenses and benefits payments, which have included the CCG Travel, Subsistence and Expenses Policy and the Patient Participation Expenses Policy.
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Greater Manchester CCGs Healthier Together Joint Committee
44. The Healthier Together Committee operated as a committee in common through 2015 until its meeting in December when it began to operate as a Shadow Joint Committee (HTSJC). It then transitioned to the Healthier Together Joint Committee in June 2016 when it decided that its future business would focus on the hospitals programme within Healthier Together and the Greater Manchester Health & Social Care Partnership’s Joint Commissioning Executive would cover the primary and integrated care elements of Healthier Together.
45. The meeting of the committee in September 2017 approved the full business case for Healthier Together. It confirmed to the committee the consistency of the model of care with the decision made in 2015; the robustness of the implementation plan, including the financial plan; and the risks associated with the programme and how they are being managed.
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Primary Care Commissioning Committee (7 meetings)
The Committee has been established in Membership Members Meetings accordance with statutory provisions to Category Attended enable the members to make collective Clinician decisions on the review, planning and Governing Dr Gary Cook 7 procurement of primary care services in Body Lay (Chair) the borough of Wigan, under delegated Member authority from NHS England. The Governing Frank majority of members are drawn from Body Lay 6 Costello existing lay members and executive Member officers of the Governing Body. Trish 6 Anderson The committee is chaired by the lay Governing Mike Tate/ 7 secondary care specialist doctor and has Body Officer Deputy a majority of lay members and officers Members Julie as members. The committee met seven Southworth/ 7 times in the year and was quorate at Deputy every meeting. A primary care GP Member Dr James operational group was established to Weems (until 6 oversee the service delivered for the Dec 2017) CCG by the NHS England Greater John 6 Manchester Primary Care Team. The CCG Officer Marshall focus for the committee was: Members Debbie 4 Szwandt Primary Care Quality Wigan Stuart Improvement Programme Council Cowley/ 3 Transformation Programme Deputy Alternative Provider Medical Healthwatch Dave Nunns 1 Services (APMS) Contracts Patient Ernie 6 Procurement Forum Rothwell Primary Care Reform Investment Members Gary Young / 3 Agreement Margaret Collaboration with Healthier Hughes Wigan Partnership GP Practice 7 day access
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UK Corporate Governance Code
46. We are not required to comply with the UK Corporate Governance Code. However, we have reported on our corporate governance arrangements by drawing upon best practice available, including those aspects of the UK Corporate Governance Code we consider to be relevant to the CCG and best practice.
Discharge of Statutory Functions
47. 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.
48. 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.
Risk management arrangements and effectiveness
49. The key elements of the risk management framework are:
Governing Body Governing Body Committees CCG Senior Leadership Team Governance and Quality Teams Risk Management Strategy & Policy Governing Body Assurance Framework (GBAF) Directorate/department risk registers
50. The GBAF is a means of identifying and quantifying strategic risks within the organisation and is the means by which the Governing Body monitors and controls the risks which may impact on the organisation’s capacity to achieve its objectives.
51. The GBAF identifies the corporate objectives of the organisation and the principal risks related to the delivery of these objectives. Key controls are made explicit together with the assurances on these controls. In addition, the GBAF identifies linkages with inter-related areas of assurance.
52. The GBAF together with the monthly Performance Report are the two primary tools used by the Governing Body to measure and monitor the CCG’s performance. The content of NHS England’s Improvement and Assessment Framework was drawn upon to populate the GBAF as the CCG is assessed on its delivery against the framework. 49
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53. The GBAF was presented to the Governing Body twice in the year and is submitted following presentation at Corporate Governance Committee which fulfils its role by focusing on risks, controls, gaps in control and resultant action plans. The Audit Committee also receives the GBAF at its meetings and focuses on the positive assurances and gaps in assurance.
54. Of the 23 risks included in the GBAF at the end of the year, three risks were rated extreme. These were described as:
If Bridgewater Community Healthcare NHS Foundation Trust does not improve its ability to evidence quality assurance there is a risk that the service is not delivering the appropriate quality of patient care. This may in turn jeopardise achievement of the transformation agenda If ambulance response times continue to be breached, patients will continue to experience delays in receiving treatment If demand exceeds capacity the urgent care system will not deliver planned performance levels as agreed with NHS Improvement
55. Acceptable risk following risk assessment can be defined as follows:
The likely consequences are insignificant. A higher risk consequence is outweighed by the chance of a much larger benefit. The occurrence is remote. The potential financial costs of minimising the risk outweigh the cost consequences of the risk itself. Mitigation of the risk could lead to further unacceptable risks in other ways.
56. Therefore it is possible that a risk with a high numerical value may be acceptable to the organisation, but that decision must be taken at Governing Body/Senior Management level.
57. In addition to the GBAF which records the risks at corporate level (those rated high or extreme) there are a number of operational risk registers managed at Assistant Director level focusing on risks assessed as medium or low.
Other sources of assurance
Internal Control Framework
58. A system of internal control is the set of processes and procedures in place in the CCG 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.
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59. 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.
60. The control environment within the CCG is established and led by the Governing Body which reserves powers for itself and delegates powers to its committees and officers of the CCG. These controls are described in the CCG’s constitution which includes standing orders, a scheme of reservation and delegation and prime financial policies. Internal controls operate over the strategic, planning, organisational, monitoring, measuring, and improvement elements of the management cycle.
61. The prime financial policies are part of the CCG’s control environment for managing the organisation’s financial affairs. They contribute to good corporate governance, internal control and managing risks. They enable sound administration; lessen the risk of irregularities and support commissioning and delivery of effective, efficient and economical services. They also help the Accountable Officer and Chief Finance Officer to effectively perform their responsibilities. They are used in conjunction with the scheme of reservation and delegation.
62. The above control environment is underpinned by an extensive portfolio of human resources and employment policies which provide, in considerable detail, instructions to members, staff and contractors how to carry out duties and roles necessary for the CCG to achieve its objectives. The policies also provide guidance on conduct and behaviour conducive to effective and efficient working.
Annual audit of conflicts of interest management
63. The revised statutory guidance on managing conflicts of interest for CCGs (published June 2017) requires CCGs to undertake an annual internal audit of conflicts of interest management. To support CCGs to undertake this task, NHS England has published a template audit framework.
64. The CCG’s internal auditors have completed this work and found the three areas of governance arrangements; declarations of interests and gifts and hospitality; and reporting concerns and identifying and managing breaches/non-compliance as fully compliant and the two areas of registers of interest; and decision making processes as partially compliant.
Data Quality
65. The Governing Body receives monthly Performance and Finance Reports that cover finance and operational performance. The data contained in the reports is subject to significant scrutiny and review, both by management and by various Governing Body committees. The Governing Body is confident that the information it is presented with has been through appropriate review and scrutiny.
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Information Governance
66. The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal confidential data. The NHS Information Governance Framework is supported by an information governance toolkit and the annual submission process provides assurances to the clinical commissioning group, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively.
67. The CCG self-assessed against the IG toolkit requirements as 8 at level 2 and 18 at level 3 giving an overall compliance level of 89%. This is a maintained position on the achievement in the previous year and has been examined in detail by the CCG’s internal auditors resulting in significant assurance.
68. 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 staff information governance handbook to ensure staff are aware of their information governance roles and responsibilities.
69. There are processes in place for incident reporting and investigation of serious incidents. We have developed information risk assessment and management procedures and a culture to address information has been fully embedded throughout the organisation.
Business Critical Models
70. No business critical models were introduced at the CCG during 2017/18. Where these are to be applied in future the CCG will ensure that quality assurance takes place in line with the recommendations in the Macpherson report.
Third party assurances
71. The CCG has received third party assurance from:
NHS Business Services Authority through its service auditor report covering governance, risk management and internal control over its prescription payments process and finance and accounting services; The report of the independent service auditors on IT general controls for the NHS Electronic Staff Record Programme;
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The Service Auditor report which NHS England has received from Capita Business Services Limited in respect of the primary care support services they provide to NHS England and CCGs.
Control Issues
72. Further to the three extreme risks referred to above, reported at the year end, the following specific actions have been taken:
Bridgewater Community Healthcare NHS Foundation Trust Commissioning Collaborative has raised a number of key concerns to NHS England Cheshire & Merseyside – in February 2018 the CCG raised quality monitoring to enhanced surveillance; A quality risk profile has been undertaken led by NHS England Cheshire & Merseyside and is to be shared with Bridgewater for their response.
Wigan Urgent Care System is developing an action plan to be presented to the Urgent & Emergency Care Board in March 2018 which will address the issues relating to handover times following NHS England/NHS Improvement guidance issued in November 2017; on 26 February the CCG wrote to the Chief Operating Officer of Greater Manchester Health & Social Care Partnership (GMHSCP) outlining the governing body’s concerns over NWAS performance and awaits a response.
In respect of emergency care performance there is a full recovery plan in place agreed with GM Urgent & Emergency Care Board with a number of work streams which should deliver improved performance; Wigan Borough has the best performance across GM for Delayed Transfers of Care and ‘stranded’ patients; Bed capacity is being explored during March to look at step up facilities; Primary care business cases are being implemented to reduce admissions.
Review of economy, efficiency & effectiveness of the use of resources
73. The CCG recognises and applies the principles of Economy: minimising the cost of resources used or required while having regard to quality; Efficiency: the relationship between the output from services and the resources to produce them; and Effectiveness: the extent to which objectives are achieved and the relationship between the intended and actual results of spending.
74. The Governing Body receives and considers a monthly Finance Report which highlights the continuing focus on efficiency including a significant underspend on running costs. The CCG self-assessed as ‘green’ for the Quality of Leadership indicator in the Improvement and Assessment Framework 2016/17.
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75. The CCG’s main efficiency saving achievement has been on prescribing efficiency and running cost reductions. Planned efficiency savings whilst maintaining national access criteria on Continuing Healthcare have not materialised so performance has been reported as under plan. Planned savings from a review of community based services have also not materialised in-year and will now be targeted in 2018/19.
76. The CCG’s internal auditors utilise an approach which is based on best practice and has been developed in accordance with professional standards. The planning methodology also ensures a contribution to supporting the CCG in achieving its strategic objectives and coverage of our business critical systems over a rolling programme. The principles of achieving value for money are included in the scope of each audit.
Delegation of functions
77. The Governing Body receives reports from its established committees and the seven SDF executive groups at each of its meetings. In this way any concerns or risks are identified and escalated where appropriate. SDFs are well-placed to take a lead on monitoring and managing performance including activity, quality and financial performance. Performance of functions operated by Greater Manchester Shared Service is quality assured through an established and regular reporting arrangement.
Counter fraud arrangements
78. The CCG’s arrangements for countering fraud and corruption are characterised by:
An Accredited Counter Fraud Specialist is contracted to undertake counter fraud work proportionate to identified risks and in accordance with the NHS Standards Contract Service Condition 24 and NHS Counter Fraud Authority’s Standards for Commissioners; The Audit Committee receiving a report against each of the Standards for Commissioners annually and progress reports at each of its meetings. There is executive support and direction for a proportionate proactive work plan to address identified risks; The Chief Finance Officer being the member of the executive team proactively and demonstrably responsible for tackling fraud, bribery and corruption.
79. NHS Counter Fraud Authority’s inspection of the CCG’s arrangements in March 2018 resulted in the following conclusion: “Based on the evidence supplied during the assessment process, all 13 standards were given a green rating. This meant the overall ratings for Strategic Governance and Inform and Involve were also green.”
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Whistleblowing Arrangements
80. The CCG is committed to ensuring the highest possible standards of service and the highest possible ethical standards in delivering this service. It is the responsibility of all staff to ensure that if they become aware that the actions of other employees or officers of the CCG or anyone working for, with or connected to it might compromise this objective, they will be expected to raise the matter.
The CCG’s Whistleblowing Policy was reviewed in July 2016 and endorsed by the staff side forum and the Corporate Governance Committee. Prior to this approval it was reviewed by the Anti-Fraud Specialist employed by Mersey Internal Audit Agency. It was rolled out to all staff by internal communication and posted on the CCG’s intranet.
Head of Internal Audit Opinion
81. Following completion of the planned audit work for the financial year for the CCG, the Head of Internal Audit issued an independent and objective opinion on the adequacy and effectiveness of the CCG’s system of risk management, governance and internal control.
My opinion is set out as follows:
Basis for the opinion;
Overall opinion; and
Commentary
2.1 Basis for the Opinion
1. An assessment of the design and operation of the underpinning Assurance Framework and supporting processes.
2. An assessment of the range of individual assurances arising from our risk- based internal audit assignments that have been reported throughout the period. This assessment has taken account of the relative materiality of systems reviewed and management’s progress in respective of addressing control weaknesses identified.
3. An assessment of the organisation’s response to Internal Audit recommendations, and the extent to which they have been implemented.
My opinion is one source of assurance that the organisation has in providing its AGS other third party assurances should also be considered. In addition the organisation should take account of other independent assurances that are considered relevant.
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Overall Opinion
My overall opinion for the period 1 April 2017 to 31 March 2018 is:
High Assurance can be given that there is a strong system of internal control which has been effectively designed to meet the organisation’s objectives, and that controls are consistently applied in all areas reviewed. Substantial Assurance can be given that that there is a good system of internal control designed to meet the organisation’s objectives, and that controls are generally being applied consistently. Moderate Assurance, can be given that there is an adequate system of internal control, however, in some areas weaknesses in design and/or inconsistent application of controls puts the achievement of some of the organisation’s objectives at risk. Limited Assurance can be given that there is a compromised system of internal control as weaknesses in the design and/or inconsistent application of controls impacts on the overall system of internal control and puts the achievement of the organisation’s objectives at risk. No Assurance can be given that there is an inadequate system of internal control as weaknesses in control, and/or consistent non-compliance with controls could/has resulted in failure to achieve the organisation’s objectives.
Commentary
The overall opinion is underpinned by the work conducted through the risk based internal audit plan including reviews of Financial Systems, Care Home Quality Improvement and Information Governance.
This opinion is provided in the context that the Clinical Commissioning Group like other organisations across the NHS is facing a number of challenging issues and wider organisational factors.
Financial Position As reported to the Governing Body in March 2018, the CCG is forecasting to achieve its statutory duties in 2017/18 and achieve the planned surplus on a statutory basis of £0.054m. QIPP The planned savings against a number of QIPP schemes have not materialised, however the CCG has identified a range of in-year mitigations that fully close the efficiency gap.
The Financial Plan for 2018/19 was reported to the Governing Body in March 2018. The latest financial planning submission
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to GMH&SCP and NHS England (NHSE) indicated a QIPP requirement of £29.6m in 2018/19. This target must be delivered to ensure the CCG meets its expected statutory financial business duties and support to the single GMH&SCP control total. The CCG has not been set a control total directly by NHSE. GMH&SCP have been assigned a combined control total that covers all Greater Manchester CCG’s. However, the CCG is required to achieve a 1.0% surplus which equates to £4.6m to support the overall GMH&SCP control total. CCG Annual The CCG has been rated as ‘Good’ by NHS England in its Assessment annual assessment of performance against key performance indicators. Senior Senior management within the CCG has largely remained Management stable during 2017/18. NHS England has rated the quality of Changes leadership at the CCG as ‘Green’. Provider The CCG has continued to regularly report providers’ Performance performance against a range of targets. The CCG’s primary providers: Wrightington, Wigan and Leigh Foundation Trust, Bridgewater Community Healthcare Foundation Trust and North West Boroughs Healthcare Foundation Trust. It is noted that the CQC carried out an inspection at Wrightington Wigan and Leigh Foundation Trust and published their report in March 2018 which rated the Trust overall as ‘Good’. STP The health and social care landscape in England is changing, with huge funding pressures across all public services. The CCGs Locality Plan is underpinned by ‘Taking charge of our Health and Social Care in Greater Manchester, The Manchester Agreement’.
In Wigan, health and social care leaders have developed the Locality Plan for the borough - ‘Further, Faster towards 2020. The Plan highlights the commitment to delivering a transformed, sustainable health and care system, which is focused on what keeps people well and in control of their lives and where the barriers that prevent joined up care have been broken down.
A fundamental enabler to the plan is the development of an Accountable Care System (ACS), where commissioners and providers work collaboratively to deliver a set of ambitious
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population outcomes for borough. This is in the context of national policy changes, as set out in ‘The Five Year Forward View’ and GM Health and Social Care Devolution, ‘Taking Charge’.
It has been agreed in the first instance is to build a strong foundation for any future model, through the development of an Alliance Agreement and to have a test bed period, where the key components of the future integrated working model can be built. The Healthier Wigan Partnership (HWP) Alliance Agreement is the first formal step towards an ACS for Wigan. The partnership includes Bridgewater Community Healthcare NHS Foundation Trust, Wigan Council, Wrightington Wigan and Leigh NHS Foundation Trust, North West Boroughs Healthcare NHS Foundation Trust, Wigan Borough Clinical Commissioning Group and GP representatives.
The purpose of the Agreement is to set out the principles on which the Partners have agreed to collaborate to progress towards a fully integrated accountable care system (the "ACS"), which will involve transformation activity.
In providing this opinion I can confirm continued compliance with the definition of internal audit (as set out in your Internal Audit Charter), code of ethics and professional standards. I also confirm organisational independence of the audit activity and that this has been free from interference in respect of scoping, delivery and reporting. g|Å VÜÉãÄxç Director of Audit, MIAA March 2018
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Review of the effectiveness of governance, risk management and internal control
82. 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.
83. Our GBAF provides me with evidence that the effectiveness of controls that manage risks to the CCG achieving its corporate objectives have been reviewed. The quarterly assurance meetings with Greater Manchester Health & Social Care Partnership have not highlighted any areas of concern in the CCG’s system of internal control.
Conclusion
84. No significant internal control issues have been identified during 2017/18 at Wigan Borough Clinical Commissioning Group.
Trish Anderson
Accountable Officer
24 May 2018
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Appendix 1
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Remuneration and Staff Report
Remuneration Report
Remuneration Committee
85. The remuneration of the Governing Body of the Clinical Commissioning Group is the responsibility of the Remuneration Committee.
86. The Remuneration Committee has the following membership:
Dr Tim Dalton – CCG Chair; Mr Frank Costello - Lay Member and Remuneration Committee Chair; Canon Maurice Smith – Lay Member; Dr Gary Cook - Secondary Care Clinical Governing Body Member; Mrs Catherine Jackson– Nursing Governing Body Member; Mr Peter Armer, Lay member ( from September 2017); Dr Ashok Atrey - Clinical Governing Body Member; Dr Neeta James - Clinical Governing Body Member( from September 2017); Dr Mohan Kumar - Clinical Governing Body Member; Dr Jayne Davies – Clinical Governing Body Member (from September 2017): Dr Pete Marwick - Clinical Governing Body Member; Dr Sanjay Wahie - Clinical Governing Body Member; and Dr Gen Wong – Clinical Governing Body Member.
87. There have been three meetings in the year, in August 2017, November 2017 and March 2018. The August 2017 meeting was attended by all members except Dr Ashok Atrey, Dr Pete Marwick and Dr Gen Wong. The November 2017 meeting was attended by all members except Canon Maurice Smith, Dr Neeta James and Dr Jayne Davies. The March 2018 meeting was attended by all members except Mr Peter Armer.
88. The Chief Finance Officer did not attend the November 2017 meeting. The Chief Officer and Director of Quality & Safety did not attend the meeting in March 2018. A Human Resources representative was also present at all three meetings.
89. The CCG has established a clear policy whereby when decisions are made; any members who are personally affected by this decision are not included in any discussions or vote to avoid any conflict of interest.
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Policy on Remuneration of Senior Managers
90. The Remuneration Committee has responsibility for setting the pay of the CCG Governing Body.
91. In considering pay awards the Remuneration Committee will consider all relevant guidance, national pay awards, affordability and will benchmark against data for similar size organisations to enable a recommendation to be reached.
92. The pay of the Governing Body is not currently directly linked to performance, that is, there is no specific performance related pay. However, both the Governing Body and its individual members are subject to performance evaluation.
Policy on Senior Managers Contracts
93. Each Executive Governing Body member (3 in total) has a permanent contract which began on 1st April 2013.
94. This contract includes a notice period which can be served by either party.
95. The CCG may exercise its discretion to pay in lieu of notice for all or part of the notice period.
96. From September 2017 the CCG has seven Clinical Governing Body members to represent the seven Service Delivery Footprints (SDF), new contracts were issued to accommodate the changes.
97. The changes also included membership on the Healthier Wigan Partnership Board.
98. Two new Clinical Governing Body members were appointed in September 2017 to fill the Governing Body vacancy and one to represent the additional SDF.
99. The Clinical Governing Body Contract for Services contracts include termination arrangements that state:
Continuation of the appointment is contingent on the continued satisfactory performance and re-election by the members as required by the Constitution; If the members do not re-elect you as a Governing Body Member in accordance with the Constitution, the appointment shall terminate automatically with immediate affect. If the Governing Body member wishes to terminate their contract, they must give six months written notice to the Chair of the CCG;
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The CCG reserves the right to terminate the appointment from office with immediate effect and without payment of compensation by written notice; If the individual is employed on a fixed term contract, their employment will terminate on the expiry of the fixed term without the need for the CCG to give any additional notice; The CCG may require an individual to take any outstanding annual leave entitlement during their notice period, whether notice to terminate is given by them or by the CCG; Once the individual or the CCG has served notice to terminate the employment, the CCG may require the individual to remain away from work and to cease to carry out normal duties for the whole or any part of the notice period.
100. There are no special provisions for termination due to redundancy other than those stated for all employees in the CCG’s Organisational Change policy.
Senior Managers Service Contracts
101. There are five lay members of the Governing Body whose services are via a Contract for Service.
102. This includes the three Lay Members, the Secondary Care Clinical Member and the Nurse Member.
103. The increase in the Lay members from four to five is due to the appointment of the Audit Committee Lay Member who was appointed in September 2017.
104. These ‘Contract for Service’ are for a three year period from 1 April 2017 until 31 March 2020 with the exception of the Audit Committee Lay member contract that is until 30 September 2020.
105. The termination arrangements for these individuals are as follows:
Continuation of their appointment is contingent on their continued satisfactory performance and re-election/selection by the members as required by the Constitution. If the members do not re-elect the individual as a Governing Body Member in accordance with the Constitution, their appointment shall terminate automatically and with immediate effect; The individual may resign from the CCG at any time by giving a three month written notice to the Chair of the CCG; The CCG reserves the right to terminate their appointment with immediate effect and without payment of compensation by written notice; On termination of the appointment, the individual shall only be entitled to accrued fees as at the date of termination, together with the reimbursement of any expenses properly incurred prior to that date;
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Due to the terms in the contract for service there is no liability to the clinical commissioning group in the event of early termination.
Payments to Past Senior Managers and Payments for Loss of Office
106. No payments have been made to past senior managers.
107. No payments have been made to senior managers for Loss of Office.
Salaries and Allowances
108. For each member of the Governing Body who has served during the financial year 2017/18, remuneration and pension benefits are shown in the table below. This table has been subject to audit. Pension related benefits data is provided by the NHS Pensions Scheme for Greenbury reporting purposes annually.
2017/18 Remuneration and Pension Benefits – Governing Body
Long Term Expense Performance Performance All Pension Salary for payments Pay and Pay and Related Governing (taxable) - Bonuses- Bonuses - Benefits - Total - Body - bands rounded to bands of bands of bands of bands of Name and of £5,000 the nearest £5,000 £5,000 £2,500 £5,000 Title £000 £100 £000 £000 £000 £000 Dr T Dalton - CCG Chair 90-95 0 0 0 60-62.5 150-155 Mrs T Anderson - Chief Officer 140-145 0 0 0 32.5-35.0 175-180 Mr M Tate - Chief Finance Officer 115-120 74 0 0 15-17.5 130-135 Mrs J Southworth - Director of Quality and Safety 115-120 0 0 0 0**** 80-85 Mr F Costello - Lay Member 20-25 1 0 0 0 20-25 Mr M Smith - Lay Member 10-15 0 0 0 0 10-15 Dr G Cook - Secondary Care Clinical GB Member 15-20 2 0 0 0 15-20 Mrs C Jackson - Nursing GB Member** 10-15 0 0 0 0 10-15 Dr A Atrey - Clinical GB Member * 55-60 0 0 0 0 55-60 Dr M Kumar - Clinical GB Member 65-70 0 0 0 15-17.5 80-85
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Dr P Marwick - Clinical GB Member 45-50 0 0 0 0**** 0**** Dr S Wahie - Clinical GB member * 45-50 0 0 0 95-97.5 140-145 Dr G Wong - Clinical GB member * 50-55 0 0 0 247.5-250 300-305 Dr J Davies - Clinical GB member** 25-30 0 0 0 120-122.5 145-150 Dr Neeta James - Clinical GB member** 15-20 0 0 0 162.5-165 180-185 Mr P Armer - Lay Member** 0-5 0 0 0 0 0-5 Mrs C Kurzeja – Acting Chief Officer*** 0-5 0 0 0 0-2.5 0-5
Note – The total figure is expressed in bandings of £5,000 based on the actual remuneration values and therefore may vary to the total of salary bands added together.
* Dr Sanjay Wahie, Dr Ashok Atrey and Dr Gen Wong also have clinical roles in the CCG. They have separate contracts for these roles and any remuneration payable for these roles is excluded from the amounts shown above.
** Dr J Davies and Dr N James and Mr P Armer have been a Governing Body member from September 2017. The amount shown represents seven months costs.
*** Mrs C Kurzeja only has been in post since 22nd March 2018, the amount shown represents six days costs.
**** The calculation of pension related benefits resulted in a negative value which is shown as zero for reporting purposes.
The figures included as pension related benefits were not salary figures paid to any staff member. They represent the potential value of their pension, which is contributed to by the CCG, less the employees own contributions. The total figures also include this value and do not in any way reflect the salary paid to the employees.
The expense payments all relate to travel and subsistence.
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109. Remuneration and pension benefits for the prior year, 2016-17 are shown below. 2016/17 Remuneration and Pension Benefits – Governing Body
Long Term Expense Performance Performance All Pension Salary for payments Pay and Pay and Related Governing (taxable) - Bonuses- Bonuses - Benefits - Total - Body - bands rounded to bands of bands of bands of bands of Name and of £5,000 the nearest £5,000 £5,000 £2,500 £5,000 Title £000 £100 £000 £000 £000 £000 Dr T Dalton - CCG Chair 90-95 0 0 0 0*** 80-85 Mrs T Anderson - Chief Officer 140-145 0 0 0 30-32.5 170-175 Mr M Tate - Chief Finance Officer 115-120 69 0 0 15-17.5 140-145 Mrs J Southworth - Director of Quality and Safety 115-120 0 0 0 115-117.5 230-235 Mr F Costello - Lay Member 25-30 0 0 0 0 25-30 Mr M Smith - Lay Member 10-15 0 0 0 0 10-15 Dr G Cook - Secondary Care Clinical GB Member 15-20 2 0 0 0 15-20 Mrs C Jackson - Nursing GB Member** 5-10 1 0 0 25-27.5 30-35 Dr A Atrey - Clinical GB Member * 55-60 0 0 0 0 55-60 Dr T Ellis - Clinical GB Member 65-70 0 0 0 0 65-70 Dr M Kumar - Clinical GB Member 65-70 0 0 0 12.5-15 75-80 Dr P Marwick - Clinical GB Member 55-60 0 0 0 20-22.5 75-80 Dr S Wahie - Clinical GB member * 40-45 0 0 0 0*** 35-40 Dr G Wong - Clinical GB member * 45-50 0 0 0 67.5-70 115-120
* Dr Sanjay Wahie, Dr Ashok Atrey and Dr Gen Wong also have clinical roles in the CCG. They have separate contracts for these roles and any remuneration payable for these roles is excluded from the amounts shown above.
** Mrs Catherine Jackson has been a Governing Body member from July 2016. The amount shown represents nine months costs. 66
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*** The calculation of pension related benefits resulted in a negative value which is shown as zero for reporting purposes.
Pension Benefits
110. For each member of the Governing Body who has served during the financial year 2017/18, pension benefits are shown below. (This table has been subject to audit) Lump sum at pension Real age Real increase Total related to increase in accrued accrued in pension pension at pension Cash pension lump pension at 31st Real equivalent at sum at age at 31st March Cash increase in transfer Employer’s pension pension March 2018. equivalent Cash value at contribution age age 2018. (Bands transfer equivalent 31st to (Bands of (Bands of (Bands of of value at 1st transfer March stakeholder Name and £2,500) £2,500) £5,000) £5,000) April 2017 value 2018 pension Title £000 £000 £000 £000 £000 £000 £000 £00 Dr T Dalton - CCG Chair* 2.5-5.0 0-2.5 20-25 50-55 312 47 362 N/A Mrs T Anderson - Chief Officer 2.5-5.0 0*** 10-15 0-5 184 44 230 N/A Mr M Tate - Chief Finance Officer 0-2.5 2.5-5.0 50-55 150-155 1039 84 1134 N/A Mrs J Southworth - Director of Quality and Safety 0*** 0** 30-35 100-105 815 0*** 0 N/A Dr M Kumar - Clinical GB Member* 0-2.5 0*** 25-30 60-65 431 22 457 N/A Dr P Marwick - Clinical GB Member* 0*** 0*** 15-20 50-55 621 0*** 396 N/A Dr S Wahie - Clinical GB member 5.0-7.5 2.5-5.0 15-20 40-45 203 69 274 N/A Dr G Wong – Clinical GB member* 10-12.5 30-32.5 15-20 50-55 136 202 340 N/A Dr J Davies - Clinical GB member 5.0-7.5 12.5-15.0 5-10 10-15 0 82 82 N/A Dr Neeta James - Clinical GB member 5.0-7.5 20-22.5 5-10 20-25 0 133 133 N/A Mrs C Kurzeja – Acting Chief Officer** 0-2.5 0-2.5 0-5 0-5 13 2 15 N/A
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* Dr Sanjay Wahie, Dr Ashok Atrey and Dr Gen Wong also have clinical roles in the CCG. They have separate contracts for these roles and any remuneration payable for these roles is excluded from the amounts shown above.
** Mrs C Kurzeja only has been in post since 22nd March 2018, the amount shown represents ten days costs.
*** The calculation of pension related benefits resulted in a negative value which is shown as zero for reporting purposes.
Cash Equivalent Transfer Values
111. 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.
112. The benefits valued are the member’s accrued benefits and any contingent spouse’s (or other allowable beneficiary’s) pension payable from the scheme.
113. 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.
114. 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.
115. 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.
116. 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.
117. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.
Real Increase in CETV
118. This reflects the increase in CETV effectively funded by the employer.
119. It does not include the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period.
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Pay Multiples
120. Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid member in their organisation and the median remuneration of the organisation’s workforce. This information is subjected to audit.
121. The banded remuneration of the highest paid member of the Governing Body in Wigan Borough CCG in the financial year 2017-18 was £167,500 (2016-17, £167,500).
122. This was 5.2 times the median remuneration of the workforce (2016-17, 5.0), which was £33,895 (2016-17 £33,560).
123. In 2017-18 there was a 1% increase to the remuneration of the highest paid member of the Governing Body, agreed through Remuneration Committee in line with Agenda for Change.
124. In 2017-18, no employees received remuneration in excess of the highest paid member of Wigan Borough CCG (none in 2016-17). Remuneration ranged from £2,500 to £167,500 (2016-17 - £2,500 to £167,500).
125. Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind, but not severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions.
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Staff Report
Staff costs 2017/18
Total Admin Programme P e rmanent P e rmanent P e rmanent Total E m ployees Other Total E m ployees Other Total E m ployees Other £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 E mployee Benefits S alaries and wages 9 4 3,806 1 3 2,625 8 1 S ocial security costs 6,431 5,938646 4 0 399 3,594399 2 0 247 2,344247 2 0 E mployer contribution s to the NHS Pension Scheme 646 O ther pension costs 747 0 461 461 0 285 285 0 A pprenticeship Lev y 747 0 00 0 00 0 0 O ther post-employme n t benefits 0 16 12 4 O ther employment be n efits 012 04 0 T ermination benefits 16 0 00 0 00 0 0 G ross employee be n efits expenditure 9 4 4,855 1 3 3,161 8 1 0 0 00 0 00 0 0 L ess recoveries in re s pect of employee be n efits (note 4.1.2) 0 (161)176 0 176 (161)176 00 00 0 176 0 (161) 00 0 T otal - Net admin e m ployee benefits inc luding capitalised c o sts 7,855 7,3617,522 4 4 9 4 4,694 4,4814,642 2 2 1 3 3,161 2,8802,880 2 2 8 1 8,016 L ess: Employee cost s capitalised 0 0 0 0 00 00 0 N et employee benef its excluding capita lised costs 7,361 4 9 4 4,694 4,481 2 1 3 3,161 2,880 2 8 1 7,855(161) Staff costs 2016/17
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126. The CCG has the following number of senior managers by band as at 31st March 2018. The CCG defines senior managers as those staff on contracts of employment who are paid on Bands 8a to Band 9 and Other (VSM/Governing Body) contracts:
Band 8 - Range A 19 Band 8 - Range B 17 Band 8 - Range C 9 Band 8 - Range D 0 Band 9 5 Other – VSM/GB 18
127. The above numbers are based on head count. It excludes workers who undertake clinical roles for the CCG on a contract for service or workers for whom the CCG is a host employer.
128. The staff composition, based on contracted Whole Time Equivalent (WTE) of staff in post as at 31st March 2018 is as follows:
Male Female
Governing Body 7 4 Senior Management (8a and above) 14 31 Other Administration 18 64 Pharmacy 1 1 Nursing 1 5 Total 41 105
129. The average staff numbers for 2017-18 are:
Senior Management (8a and above) 50 Other Administration 79 Pharmacy 3 Nursing 5
Total 137
130. The above are the contracted WTE, calculated on an average across 2017-18. It includes agency, temporary and seconded in staff but excludes staff on outward secondment, Chairman and Lay Members (as these are defined as non-staff in the Annual Accounts).
131. Note 4.3 to the accounts details the CCG’s sickness absence data. For the 12 months January 2018 to December 2018, the average sickness absence reported to the Health and Social Care Information Centre for the CCG was 3% with an average sickness per full time equivalent of 7.1 days.
132. The CCG has a range of HR policies and procedures that apply in the financial year which include Recruitment and Selection policy; Learning & Development policy;
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Appraisal Development and Pay Progression policy, Flexible Working and Working Time policy, Flexi-time policy, Managging Attendance policy, Human Rights, Equality, Diversity and Equal Opportunities pollicy and Leave of Absence policy.
133. The CCG has spent £35,780 on consultancy relating to work around modelling extended access in primary care.
Off-paayroll engagements
134. The CCG policy, set by the Remuneration Committee, is that any senior official of the CCG will be contracted as an employee and paid through payrroll. There are no senior officials or members of thhe Governing Body employeed via off-payroll arrangements.
135. The CCG has put provisions in place to receive formal assurance that anyone paid at more than £245 per day and emmployed off payroll for more than six months is meeting their income tax and NIC obligations in full. If that reaassurance is not provided when requested, the contracts will be terminated.
The CCG has no off-payroll arrangemments for specialist or interim contractors as at 31st March 2018 that meet the criteria of more than £245 per day and an arrangement that lasts longer than a six month period.
Exit Packages
136. The CCG has had two exit packages in 2017/18. (The figures are subject to audit)
137. Redundancy and other departure costs have been paid in accordance with the provision of the NHS pension scheme. Exit costs in this note are full costs of departures agreed in year. Where Wigan CCG has agreed early retirements, the additional costs are met by the CCG and not by the NHS pension scheme. Ill- health retirement costs are met by the NHS Pension Scheme and are not included in this table.
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Facility Time
138. Relevant Union Officials
Number of employees who were relevant Full-time equivalent employee union officials during the relevant period number
2 2
Union Officials - Percentage of time spent on facility time
Percentage of time Number of employees 0% - 1 – 50% 2 51 – 99% - 100% -
Percentage of pay bill spent on facility time
Description Figures Total cost of facility time £5,551 Total pay bill £7.855m Percentage of the total pay bill spent on facility time, calculated as: 0.07% (total cost of facility time ÷ total pay bill) x 100
Paid trade union activities
Time spent on paid trade union activities as a percentage of total paid facility time hours calculated as:
43% (total hours spent on paid trade union activities by relevant union officials during the relevant period ÷ total paid facility time hours) x 100
Trish Anderson
Accountable Officer
24 May 2018
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Parliamentary Accountability and Audit Report
139. Wigan Borough CCG is not required to produce a Parliamentary Accountability and Audit Report. Disclosures on remote contingent liabilities, losses and special payments, gifts, and fees and charges are included as notes in the Financial Statements of this report at page 113 to 127. An audit certificate and report is also included in this Annual Report at pages 76 to 79.
Trish Anderson
Accountable Officer
24 May 2018
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SECTION 3 FINANCIAL STATEMENTS
Trish Anderson Accountable Officer 24 May 2018
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INDEPENDENT AUDITOR’S REPORT TO THE MEMBERS OF THE GOVERNING BODY OF NHS WIGAN BOROUGH CCG
Report on the Audit of the Financial Statements Opinion We have audited the financial statements of NHS Wigan Borough Clinical Commissioning Group (the ‘CCG’) for the year ended 31 March 2018 which comprise the Statement of Comprehensive Net Expenditure, the Statement of Financial Position, the Statement of Changes in Taxpayers Equity, the Statement of Cash Flows and notes to the financial statements, including a summary of significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and the Department of Health and Social Care Group Accounting Manual 2017-18 and the requirements of the Health and Social Care Act 2012. In our opinion the financial statements: give a true and fair view of the financial position of the CCG as at 31 March 2018 and of its expenditure and income for the year then ended; and have been properly prepared in accordance with International Financial Reporting Standards (IFRSs) as adopted by the European Union, as interpreted and adapted by the Department of Health and Social Care Group Accounting Manual 2017-18; and have been prepared in accordance with the requirements of the Health and Social Care Act 2012. Basis for opinion We conducted our audit in accordance with International Standards on Auditing (UK) (ISAs (UK)) and applicable law. Our responsibilities under those standards are further described in the Auditor’s responsibilities for the audit of the financial statements section of our report. We are independent of the CCG in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK, including the FRC’s Ethical Standard, and we have fulfilled our other ethical responsibilities in accordance with these requirements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion. Who we are reporting to This report is made solely to the members of the Governing Body of the CCG, as a body, in accordance with Part 5 of the Local Audit and Accountability Act 2014. Our audit work has been undertaken so that we might state to the members of the Governing Body of the CCG those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the CCG and the members of the Governing Body of the CCG, as a body, for our audit work, for this report, or for the opinions we have formed. Conclusions relating to going concern We have nothing to report in respect of the following matters in relation to which the ISAs (UK) require us to report to you where: the Accountable Officer’s use of the going concern basis of accounting in the preparation of the financial statements is not appropriate; or the Accountable Officer has not disclosed in the financial statements any identified material uncertainties that may cast significant doubt about the CCG’s ability to continue to adopt the going concern basis of accounting for a period of at least twelve months from the date when the financial statements are authorised for issue. 76
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Other information The Accountable Officer is responsible for the other information. The other information comprises the information included in the Annual Report set out on pages 1 to 127, other than the financial statements and our auditor’s report thereon. Our opinion on the financial statements does not cover the other information and, except to the extent otherwise explicitly stated in our report, we do not express any form of assurance conclusion thereon. In connection with our audit of the financial statements, our responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or our knowledge obtained in the course of our work including that gained through work in relation to the CCG’s arrangements for securing value for money through economy, efficiency and effectiveness in the use of its resource or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether there is a material misstatement in the financial statements or a material misstatement of the other information. If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact. We have nothing to report in this regard. Other information we are required to report on by exception under the Code of Audit Practice Under the Code of Audit Practice published by the National Audit Office on behalf of the Comptroller and Auditor General (the Code of Audit Practice) we are required to consider whether the Governance Statement does not comply with the guidance issued by the NHS Commissioning Board or is misleading or inconsistent with the information of which we are aware from our audit. We are not required to consider whether the Governance Statement addresses all risks and controls or that risks are satisfactorily addressed by internal controls. We have nothing to report in this regard. Opinion on other matters required by the Code of Audit Practice In our opinion: the parts of the Remuneration Report and Staff Report to be audited have been properly prepared in accordance with IFRSs as adopted by the European Union, as interpreted and adapted by the Department of Health and Social Care Group Accounting Manual 2017-18 and the requirements of the Health and Social Care Act 2012; and based on the work undertaken in the course of the audit of the financial statements and our knowledge of the CCG gained through our work in relation to the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources, the other information published together with the financial statements in the annual report for the financial year for which the financial statements are prepared is consistent with the financial statements. Opinion on regularity required by the Code of Audit Practice In our opinion, in all material respects the expenditure and income recorded in the financial statements have been applied to the purposes intended by Parliament and the financial transactions in the financial statements conform to the authorities which govern them. Matters on which we are required to report by exception Under the Code of Audit Practice we are required to report to you if: we have reported a matter in the public interest under Section 24 of the Local Audit and Accountability Act 2014 in the course of, or at the conclusion of the audit; or 77
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we have referred a matter to the Secretary of State under Section 30 of the Local Audit and Accountability Act 2014 because we had reason to believe that the CCG, or an officer of the CCG, was about to make, or had made, a decision which involved or would involve the body incurring unlawful expenditure, or was about to take, or had 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 have made a written recommendation to the CCG under Section 24 of the Local Audit and Accountability Act 2014 in the course of, or at the conclusion of the audit. We have nothing to report in respect of the above matters. Responsibilities of the Accountable Officer and Those Charged with Governance for the financial statements As explained more fully in the Statement of Accountable Officer's responsibilities set out on page(s) 36 to 37, the Accountable Officer, is responsible for the preparation of the financial statements in the form and on the basis set out in the Accounts Directions, for being satisfied that they give a true and fair view, and for such internal control as the Accountable Officer determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, the Accountable Officer is responsible for assessing the CCG’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless the CCG lacks funding for its continued existence or when policy decisions have been made that affect the services provided by the CCG. The Accountable Officer is responsible for ensuring the regularity of expenditure and income in the financial statements. The Audit Committee is Those Charged with Governance. Auditor’s responsibilities for the audit of the financial statements Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements. A further description of our responsibilities for the audit of the financial statements is located on the Financial Reporting Council’s website at: www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditor’s report. We are also responsible for giving an opinion on the regularity of expenditure and income in the financial statements in accordance with the Code of Audit Practice. Report on other legal and regulatory requirements – Conclusion on the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources Matter on which we are required to report by exception - CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources Under the Code of Audit Practice we are required to report to you if, in our opinion we have not been able to satisfy ourselves that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2018. We have nothing to report in respect of the above matter. 78
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Responsibilities of the Accountable Officer As explained in the Governance Statement, the Accountable Officer is responsible for putting in place proper arrangements for securing economy, efficiency and effectiveness in the use of the CCG's resources. Auditor’s responsibilities for the review of the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources We are required under Section 21(3)(c) and Schedule 13 paragraph 10(a) of the Local Audit and Accountability Act 2014 to be satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources and to report where we have not been able to satisfy ourselves that it has done so. We are not required to consider, nor have we considered, whether all aspects of the CCG's arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively. We have undertaken our review in accordance with the Code of Audit Practice, having regard to the guidance on the specified criterion issued by the Comptroller and Auditor General in November 2017, as to whether in all significant respects, the CCG had proper arrangements to ensure it took properly informed decisions and deployed resources to achieve planned and sustainable outcomes for taxpayers and local people. The Comptroller and Auditor General determined this criterion as that necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the CCG put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2018, and to report by exception where we are not satisfied. We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we undertook such work as we considered necessary to be satisfied that the CCG has put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources. Report on other legal and regulatory requirements – Certificate We certify that we have completed the audit of the financial statements of NHS Wigan Borough Clinical Commissioning Group in accordance with the requirements of the Local Audit and Accountability Act 2014 and the Code of Audit Practice. Mike Thomas Director for and on behalf of Grant Thornton UK LLP 4 Hardman Square Spinningfields Manchester M3 3EB 25 May 2018
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WIGAN BOROUGH CCG FINANCIAL STATEMENTS
Foreword to the Accounts
The Clinical Commissioning Group was licenced from 1 April 2013 under provisions enacted in the Health & Social Care Act 2012, which amended the National Health Service Act 2006.
These accounts for the year ended 31 March 2018 have been prepared by Wigan Borough CCG under section 17 of schedule 1A of the National Health Service Act 2006 (as amended) in the form which the Secretary of States has, with the approval of the Treasury, directed.
The National Health Service Act 2006 (as amended) requires Clinical Commissioning Groups to prepare their Annual Report and Annual Accounts in accordance with Directions issued by NHS England.
Trish Anderson Mr Mike Tate
Chief Officer Chief Finance Officer
24 May 2018 24 May 2018
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Statement of Comprehensive Net Expenditure for the Year Ended 31 March 2018
2017-18 2016-17 Note £'000 £'000
Income from sale of goods and services 2 (7,721) (4,681) Other operating income* 2 (263) (189) Total operating income (7,983) (4,870)
Staff costs 4 8,016 7,450 Purchase of goods and services 5 517,940 498,076 Depreciation and impairment charges 5 0 0 Provision expense 5 298 (67) Other Operating Expenditure** 5 193 825 Total operating expenditure 526,446 506,283
Net Operating Expenditure 518,463 501,414
Finance income Finance expense 10 0 0 Net expenditure for the year 518,463 501,414 Net Gain/(Loss) on Transfer by Absorption 0 0 Total Net Expenditure for the year 518,463 501,414 Other Comprehensive Expenditure Items which will not be reclassified to net operating costs Net (gain)/loss on revaluation of PPE 0 0 Net (gain)/loss on revaluation of Intangibles 0 0 Net (gain)/loss on revaluation of Financial Assets 0 0 Actuarial (gain)/loss in pension schemes 0 0 Impairments and reversals taken to Revaluation Reserve 0 0 Items that may be reclassified to Net Operating Costs 00 Net gain/loss on revaluation of available for sale financial assets 0 0 Reclassification adjustment on disposal of available for sale financial assets 00 Sub total 00
Comprehensive Expenditure for the year ended 31 March 2018 518,463 501,414 *Other operating income includes staff secondments and apprenticeship government grant.
**Other operating expenditure includes Chair and Non Executive members remuneration and impairments.
Notes 1 to 38 also form part of this statement.
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Statement of Financial Position as at 31 March 2018
2017-18 2016-17
Note £'000 £'000 Non-current assets: Property, plant and equipment 13 0 0 Intangible assets 14 0 0 Investment property 15 0 0 Trade and other receivables 17 0 0 Other financial assets 18 0 0 Total non-current assets 00 Current assets: Inventories 16 0 0 Trade and other receivables 17 7,504 1,053 Other financial assets 18 0 0 Other current assets 19 0 0 Cash and cash equivalents 20 4 1 Total current assets 7,509 1,054
Non-current assets held for sale 21 0 0
Total current assets 7,509 1,054
Total assets 7,509 1,054
Current liabilities Trade and other payables 23 (32,823) (26,829) Other financial liabilities 24 0 0 Other liabilities 25 0 0 Borrowings 26 0 0 Provisions 30 (440) (149) Total current liabilities (33,263) (26,978)
Non-Current Assets plus/less Net Current Assets/Liabilities (25,754) (25,924)
Non-current liabilities Trade and other payables 23 0 0 Other financial liabilities 24 0 0 Other liabilities 25 0 0 Borrowings 26 0 0 Provisions 30 0 0 Total non-current liabilities 0 0
Assets less Liabilities (25,754) (25,924)
Financed by Taxpayers’ Equity General fund (25,754) (25,924) Revaluation reserve 0 0 Other reserves 0 0 Charitable Reserves 0 0 Total taxpayers' equity: (25,754) (25,924) Notes 1 to 38 also form part of this statement.
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The financial statements were approved in accordance with the Clinical Commissioning Group Scheme of Delegation on the 24th May 2018 and signed on its behalf by:
Trish Anderson Mike Tate Chief Officer Chief Finance Officer 24th May 2018 24th May 2018
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Statement of Changes in Taxpayers’ Equity for the Year Ended 31 March 2018
General Revaluation Other Total fund reserve reserves reserves £'000 £'000 £'000 £'000 Changes in taxpayers’ equity for 2017-18
Balance at 01 April 2017 (25,924) 0 0 (25,924)
Transfer between reserves in respect of assets transferred from closed NHS bodies 0000 Adjusted NHS Clinical Commissioning Group balance at 31 March 2018 (25,924) 0 0 (25,924)
Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2017-18 Net operating expenditure for the financial year (518,463) (518,463)
Net gain/(loss) on revaluation of property, plant and equipment 00 Net gain/(loss) on revaluation of intangible assets 00 Net gain/(loss) on revaluation of financial assets 00 Total revaluations against revaluation reserve 0 0 0 0
Net gain (loss) on available for sale financial assets 0 0 0 0 Net gain (loss) on revaluation of assets held for sale 0 0 0 0 Impairments and reversals 0000 Net actuarial gain (loss) on pensions 0000 Movements in other reserves 0000 Transfers between reserves 0000 Release of reserves to the Statement of Comprehensive Net Expenditure 0 0 0 0 Reclassification adjustment on disposal of available for sale financial assets 0 0 0 0 Transfers by absorption to (from) other bodies 0000 Reserves eliminated on dissolution 0000 Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year (518,463) 0 0 (518,463)
Net funding* 518,633 0 0 518,633 *Cash fundingBalance received at 31 Marchin year 2018 2017-18 (25,754) 0 0 (25,754)
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Statement of Changes in Taxpayers’ Equity for the Year Ended 31 March 2017
General Revaluation Other Total fund reserve reserves reserves £'000 £'000 £'000 £'000 Changes in taxpayers’ equity for 2016-17
Balance at 01 April 2016 (23,424) 0 0 (23,424) Transfer of assets and liabilities from closed NHS bodies as a result of the 1 April 2013 transition 0000 Adjusted NHS Clinical Commissioning Group balance at 31 March 2017 (23,424) 0 0 (23,424)
Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2016-17 Net operating costs for the financial year (501,414) (501,414)
Net gain/(loss) on revaluation of property, plant and equipment 00 Net gain/(loss) on revaluation of intangible assets 00 Net gain/(loss) on revaluation of financial assets 00 Total revaluations against revaluation reserve 0 0 0 0
Net gain (loss) on available for sale financial assets 0 0 0 0 Net gain (loss) on revaluation of assets held for sale 0 0 0 0 Impairments and reversals 0000 Net actuarial gain (loss) on pensions 0000 Movements in other reserves 0000 Transfers between reserves 0000 Release of reserves to the Statement of Comprehensive Net Expenditure 0 0 0 0 Reclassification adjustment on disposal of available for sale financial assets 0 0 0 0 Transfers by absorption to (from) other bodies 0000 Reserves eliminated on dissolution 0000 Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year (501,414) 0 0 (501,414) *Cash fundingNet funding* received in year 2016-17 498,913 0 0 498,913 Balance at 31 March 2017 (25,924) 0 0 (25,924) Notes 1 to 38 also form part of this statement.
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Statement of Cash Flows for the Year Ended 31 March 2018
2017-18 2016-17 Note £'000 £'000 Cash Flows from Operating Activities Net operating expenditure for the financial year (518,463) (501,414) Depreciation and amortisation 500 Impairments and reversals 500 Movement due to transfer by Modified Absorption 00 Other gains (losses) on foreign exchange 00 Donated assets received credited to revenue but non-cash 0 0 Government granted assets received credited to revenue but non-cash 0 0 Interest paid 00 Release of PFI deferred credit 00 Other Gains & Losses 00 Finance Costs 00 Unwinding of Discounts 00 (Increase)/decrease in inventories 00 (Increase)/decrease in trade & other receivables 17 (6,451) 759 (Increase)/decrease in other current assets 00 Increase/(decrease) in trade & other payables 23 5,994 1,994 Increase/(decrease) in other current liabilities 00 Provisions utilised 30 (7) (208) Increase/(decrease) in provisions 30 298 (67) Net Cash Inflow (Outflow) from Operating Activities (518,629) (498,935)
Cash Flows from Investing Activities Interest received 00 (Payments) for property, plant and equipment 00 (Payments) for intangible assets 00 (Payments) for investments with the Department of Health 0 0 (Payments) for other financial assets 00 (Payments) for financial assets (LIFT) 00 Proceeds from disposal of assets held for sale: property, plant and equipment 0 0 Proceeds from disposal of assets held for sale: intangible assets 0 0 Proceeds from disposal of investments with the Department of Health 0 0 Proceeds from disposal of other financial assets 00 Proceeds from disposal of financial assets (LIFT) 00 Loans made in respect of LIFT 00 Loans repaid in respect of LIFT 00 Rental revenue 00 Net Cash Inflow (Outflow) from Investing Activities 0 0
Net Cash Inflow (Outflow) before Financing (518,629) (498,935)
Cash Flows from Financing Activities Grant in Aid Funding Received 518,633 498,913 Other loans received 00 Other loans repaid 00 Capital element of payments in respect of finance leases and on Statement of Financial Position PFI and LIFT 0 0 Capital grants and other capital receipts 00 Capital receipts surrendered 00 Net Cash Inflow (Outflow) from Financing Activities 518,633 498,913
Net Increase (Decrease) in Cash & Cash Equivalents 20 3 (21)
Cash & Cash Equivalents at the Beginning of the Financial Year 1 22
Effect of exchange rate changes on the balance of cash and cash equivalents held in foreign currencies 0 0
Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year 4 1
Notes 1 to 38 also form part of this statement.
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Notes to the Financial Statements
Whilst many of the Notes to the Financial Statements can be directly cross referenced to the Statement of Net Comprehensive Expenditure and the Statement of Financial Position, some provide additional information and cannot be directly cross referenced (Note 12, 27, 28, 29, 31, 32, 35, 36, 37 and 38).
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.
Consequently, the following financial statements have been prepared in accordance with the Group Accounting Manual 2017-18 issued by the Department of Health. The accounting policies contained in the Group Accounting Manual follow International Financial Reporting Standards (IFRS) 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 (CCG) for the purpose of giving a true and fair view has been selected.
The particular policies adopted by the CCG 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 the going concern basis.
Public sector bodies are assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as evidenced by inclusion of financial provision for that service in published documents.
Where a CCG ceases to exist, it considers whether or not its services will continue to be provided (using the same assets, by another public sector entity) in determining whether to use the concept of going concern for the final set of Financial Statements. If services will continue to be provided the financial statements are prepared on the going concern basis.
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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 CCG has entered in to a pooled budget with Wigan Council under Section 75 of the National Health Service Act 2006 to support integrated health and social care, known as the Better Care Fund (BCF), hosted by Wigan Council. This is a nationally mandated scheme that commenced in 2015-16.
The pool is jointly controlled by Wigan Borough CCG and Wigan Council. The Wigan Health and Wellbeing Board, made up of Council and CCG representatives, govern the use of the fund. The fund is used to commission services that support the integration of health and social care, which seeks to ensure support for people to be well and independent and in control of their own care.
Each scheme within the BCF has been allocated a lead commissioner (either the Council or the CCG) and accounting for the pool reflects these arrangements. Details are included in Note 1.7 and 35.
The CCG accounts for its share of the assets, liabilities, income and expenditure arising from the activities of the pooled budget, identified in accordance with the pooled budget agreement.
The CCG recognises:
The assets the CCG controls; The liabilities the CCG incurs; The expenses the CCG incurs; and The CCG’s share of the income from the pooled budget activities.
In addition to the above, the CCG recognises:
The CCG’s share of the jointly controlled assets (classified according to the nature of the assets); The CCG’s share of any liabilities incurred jointly; and The CCG’s share of the expenses jointly incurred.
1.4 Critical Accounting Judgements & Key Sources of Estimation Uncertainty
In the application of the CCG’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources.
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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.
1.4.1 Critical Judgements in Applying Accounting Policies
The following are the critical judgements, apart from those involving estimations (see below) that management has made in the process of applying the CCG’s accounting policies that have the most significant effect on the amounts recognised in the financial statements.
Pooled Budget Arrangements
Wigan Borough CCG has entered into a Section 75 (S75) agreement with Wigan Council to pool resources in order to improve the health and social care outcomes for the residents of the borough. Under the terms of the S75 agreement Wigan Council will be acting as the host for the pool.
The CCG has taken into account and consideration IFRS 10, Consolidated Financial Statements and IFRS 11, Joint Arrangements.
Under IFRS 10 the CCG considers the pool to be under the joint control of the CCG and Wigan Council. The S75 agreement states that the pool will be classified as a joint operation under IFRS 11. The CCG believe this to be consistent with the governance and control arrangements of the pool.
While there is no single organisational lead commissioner individual schemes have been allocated a lead. The CCG and Wigan Council have accounted for the pool under lead commissioning arrangements.
Leases
Leases are accounted for under IAS 17. For operating leases, where no formal lease is signed but the CCG incurs costs for the utilisation of a building, the full costs of the in-year transactions are accounted for, but future minimum lease payments are not recognised.
Further details are available in Note 1.17 and Note 12.
1.4.2 Key Sources of Estimation Uncertainty
The following are the key estimations that management has made in the process of applying the CCG’s accounting policies that have the most significant effect on the amounts recognised in the financial statements.
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Prescribing Expenditure
Wigan Borough CCG receives financial information from NHS Business Services Authority (NHSBSA) relating to the costs of drugs prescribed by Wigan Borough CCG prescribers (independent GPs). The information available for actual drug costs prescribed in the year is provided in arrears, therefore the actual data received at the Statement of Financial Position date is to February only, and an estimate for March is required.
This estimate has been calculated using forecast information provided by Business NHS BSA. In 2017/18 the CCG has used the NHS BSA’s linear trend methodology which is consistent with 2016/17.
Provision for NHS Continuing Healthcare Claims for Periods of Care Post 1/4/2013
A provision has been made in the CCG accounts for an estimate of the likely future costs of claims, where patients have submitted a request to the CCG for a review of their continuing healthcare eligibility from 1 April 2013.
The provision is based upon claims made against CCG funding which have not yet been fully assessed, and where the likelihood of success is greater than 50%, a provision is made.
The likelihood of success is estimated by the Continuing Care team responsible for assessing claims. The costs are then estimated based on the average cost of nursing care per week. The cost of this provision in 2017-18 is £239,547.47. Details of provisions are found in Note 30.
The estimate is based upon the best information available at the time. However, there is a degree of uncertainty associated with this calculation and therefore a greater level of risk associated with it. However, this approach is consistent with prior years.
Provision for restructuring
A provision has been made in the CCG accounts relating to the appointment of a single Accountable Officer (AO) for the whole of the health and social care system for the Wigan Locality. As laid out in the Wigan place based strategic commissioning functions operating model approved on the 24th October 2017, there is a requirement for a single AO. This provision recognises potential future costs of this outcome.
1.5 Revenue
Revenue in respect of services provided is recognised when, and to the extent that, performance occurs, and is measured at the fair value of the consideration receivable.
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Where income is received for a specific activity that is to be delivered in the following year, that income is deferred.
1.6 Employee Benefits
1.6.1 Short-term Employee Benefits
Salaries, wages and employment-related payments 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.
1.6.2 Retirement Benefit Costs
Past and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales.
The scheme is 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 scheme is accounted for as if it were a defined contribution scheme: the cost to the CCG of participating in the 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 CCG commits itself to the retirement, regardless of the method of payment.
The assets are measured at fair value and the liabilities at the present value of the future obligations. The increase in the liability arising from pensionable service earned during the year is recognised within operating expenses. The expected gain during the year from scheme assets is recognised within finance income.
The interest cost during the year arising from the unwinding of the discount on the scheme liabilities is recognised within finance costs. Actuarial gains and losses during the year are recognised in the General Reserve and reported as an item of other comprehensive net expenditure.
1.7 Other Expenses
Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable.
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Expenses and liabilities in respect of grants are recognised when the CCG has a present legal or constructive obligation, which occurs when all of the conditions attached to the payment have been met.
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 CCG 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 CCG’s surplus/deficit.
Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term.
Contingent rentals are recognised as an expense in the period in which they are incurred.
Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether they are operating or finance leases.
1.8.2 The CCG as Lessor
Amounts due from lessees under finance leases are recorded as receivables at the amount of the CCG’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 CCG’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.
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1.9 Cash & Cash Equivalents
Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value.
In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the CCG’s cash management.
1.10 Provisions
Provisions are recognised when the CCG has a present legal or constructive obligation as a result of a past event, it is probable that the CCG will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation.
The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties.
Where a provision is measured using the cash flows estimated to settle the obligation, its carrying amount is the present value of those cash flows using HM Treasury’s discount rate as follows:
Timing of cash flows (0 to 5 years inclusive): Minus 2.420% (previously: minus 2.70%); Timing of cash flows (6 to 10 years inclusive): Minus 1.85% (previously: minus 1.95%); and Timing of cash flows (over 10 years): Minus 1.56% (previously: minus 0.80%).
When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the receivable is recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the receivable can be measured reliably.
A restructuring provision is recognised when the CCG has developed a detailed formal plan for the restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by starting to implement the plan or announcing its main features to those affected by it.
The measurement of a restructuring provision includes only the direct expenditures arising from the restructuring, which are those amounts that are both necessarily entailed by the restructuring and not associated with on-going activities of the entity.
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1.11 Clinical Negligence Costs
The NHS Litigation Authority operates a risk pooling scheme under which the CCG pays an annual contribution to the NHS Litigation Authority which in return settles all clinical negligence claims. The contribution is charged to expenditure.
Although the NHS Litigation Authority is administratively responsible for all clinical negligence cases the legal liability remains with the CCG.
1.12 Non-Clinical Risk Pooling
The CCG participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the CCG pays an annual contribution to the NHS Litigation Authority and, in return, receives assistance with the costs of claims arising.
The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due.
1.13 Continuing Healthcare Risk Pooling
In 2014-15 a risk pool scheme was been introduced by NHS England for continuing healthcare claims, for claim periods prior to 31 March 2013. The risk pool is controlled and accounted for by NHS England.
1.14 Contingencies
A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the CCG, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or the amount of the obligation cannot be measured sufficiently reliably.
A contingent liability is disclosed unless the possibility of a payment is remote.
A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the CCG. A contingent asset is disclosed where an inflow of economic benefits is probable.
Where the time value of money is material, contingencies are disclosed at their present value.
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1.15 Financial Assets
Financial assets are recognised when the CCG becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred.
Financial assets are classified into the following categories:
Financial assets at fair value through profit and loss; Held to maturity investments; Available for sale financial assets; and Loans and receivables. The classification depends on the nature and purpose of the financial assets and is determined at the time of initial recognition.
1.15.1 Financial Assets at Fair Value through Profit & Loss
Embedded derivatives that have different risks and characteristics to their host contracts, and contracts with embedded derivatives whose separate value cannot be ascertained, are treated as financial assets at fair value through profit and loss. They are held at fair value, with any resultant gain or loss recognised in calculating the CCG’s surplus or deficit for the year.
The net gain or loss incorporates any interest earned on the financial asset.
1.15.2 Held to Maturity Assets
Held to maturity investments are non-derivative financial assets with fixed or determinable payments and fixed maturity, and there is a positive intention and ability to hold to maturity. After initial recognition, they are held at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method.
1.15.3 Available For Sale Financial Assets
Available for sale financial assets are non-derivative financial assets that are designated as available for sale or that do not fall within any of the other three financial asset classifications. They are measured at fair value with changes in value taken to the revaluation reserve, with the exception of impairment losses. Accumulated gains or losses are recycled to surplus/deficit on de-recognition.
1.15.4 Loans & Receivables
Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market. After initial recognition, they are measured at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method.
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Fair value is determined by reference to quoted market prices where possible, otherwise by valuation techniques.
The effective interest rate is the rate that exactly discounts estimated future cash receipts through the expected life of the financial asset, to the initial fair value of the financial asset.
At the end of the reporting period, the CCG assesses whether any financial assets, other than those held at ‘fair value through profit and loss’ are impaired. Financial assets are impaired and impairment losses recognised if there is objective evidence of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the estimated future cash flows of the asset.
For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset’s carrying amount and the present value of the revised future cash flows discounted at the asset’s original effective interest rate.
The loss is recognised in expenditure and the carrying amount of the asset is reduced through a provision for impairment of receivables.
If, in a subsequent period, the amount of the impairment loss decreases and the decrease can be related objectively to an event occurring after the impairment was recognised, the previously recognised impairment loss is reversed through expenditure to the extent that the carrying amount of the receivable at the date of the impairment is reversed does not exceed what the amortised cost would have been had the impairment not been recognised.
1.16 Financial Liabilities
Financial liabilities are recognised on the statement of financial position when the CCG 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.
1.16.1 Financial Guarantee Contract Liabilities
Financial guarantee contract liabilities are subsequently measured at the higher of:
The premium received (or imputed) for entering into the guarantee less cumulative amortisation; and The amount of the obligation under the contract, as determined in accordance with IAS 37: Provisions, Contingent Liabilities and Contingent Assets.
1.16.2 Financial Liabilities at Fair Value through Profit & Loss
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Embedded derivatives that have different risks and characteristics to their host contracts, and contracts with embedded derivatives whose separate value cannot be ascertained, are treated as financial liabilities at fair value through profit and loss. They are held at fair value, with any resultant gain or loss recognised in the CCG’s surplus/deficit.
The net gain or loss incorporates any interest payable on the financial liability.
1.16.3 Other Financial Liabilities
After initial recognition, all other financial liabilities are measured at amortised cost using the effective interest method, except for loans from Department of Health, which are carried at historic cost.
The effective interest rate is the rate that exactly discounts estimated future cash payments through the life of the asset, to the net carrying amount of the financial liability. Interest is recognised using the effective interest method.
1.17 Value Added Tax
Most of the activities of the CCG are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.
1.18 Third Party Assets
Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the CCG has no beneficial interest in them.
1.19 Losses & Special Payments
Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled.
Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had the CCG not been bearing its own risks (with insurance premiums then being included as normal revenue expenditure).
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1.20 Joint Operations
Joint operations are activities undertaken by the CCG in conjunction with one or more other parties but which are not performed through a separate entity. The CCG records its share of the income and expenditure; gains and losses; assets and liabilities; and cash flows.
1.21 Accounting Standards that have been issued but have not yet been adopted
The DHSC Group accounting manual does not require the following Standards and Interpretations to be applied in 2017-18. These standards are still subject to FREM adoption and early adoption is not therefore permitted:
IFRS 9: Financial Instruments (application from 1 January 2018); IFRS 15: Revenue for Contract with Customers (application from 1 January 2018) IFRS 16: Leases (application from 1 January 2019) IFRS 17: Insurance Contracts (application from 1 January 2021) IFRIC 22: Foreign Currency Transactions and Advance Consideration (application from 1 January 2018) IFRIC 23: Uncertainty over Income Tax Treatments (application from 1 January 2019)
The application of the Standards as revised would not have a material impact on the accounts for 2017-18, were they applied in that year.
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2 Other Operating Revenue
2017-18 2017-18 2017-18 2016-17 Total Admin Programme Total £'000 £'000 £'000 £'000
Recoveries in respect of employee benefits* 161 161 0 0 Education, training and research 19 0 19 48 Charitable and other contributions to revenue expenditure: non-NHS 0 0 0 4 Non-patient care services to other bodies** 7,701 0 7,701 4,633 Non cash apprenticeship training grants revenue 13 13 0 0 Other revenue 89 14 75 185 Total other operating revenue 7,983 188 7,795 4,870 * Recoveries in respect of employee benefits are seconded staff to Healthier Wigan Partnership hosted by Wigan Council.
** Non patient care services £6.5m relates to the approved transformation fund bid with Greater Manchester Health and Social Care Partnership and income received from Wigan Council in respect of local authority contributions to joint health and social care priorities.
3 Revenue 2017-18 2017-18 2017-18 2016-17 Total Admin Programme Total £'000 £'000 £'000 £'000 From rendering of services 7,983 188 7,795 4,870 From sale of goods 0 0 0 0 Total 7,983 188 7,795 4,870
Revenue is totally from the supply of services. They include schemes that span Health and Social Care which will result in improvements to the quality of life for the residents of the Wigan Borough.
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4 Employee Benefits and Staff Numbers
4.1 Employee benefits
4.1.1 Employee benefits expenditure 2017-18
Permanent Total Employees Other £'000 £'000 £'000 Employee Benefits Salaries and wages 6,431 5,938 494 Social security costs 646 646 0 Employer Contributions to NHS Pension scheme 747 747 0 Other pension costs 0 0 0 Apprenticeship Levy 16 16 0 Other post-employment benefits 0 0 0 Other employment benefits 0 0 0 Termination benefits (note 4.4) 176 176 0 Gross employee benefits expenditure 8,016 7,522 494
Less recoveries in respect of employee benefits (note 4.1.2) (161) (161) 0 Total - Net admin employee benefits including capitalised costs 7,855 7,361 494
Less: Employee costs capitalised 0 0 0 Net employee benefits excluding capitalised costs 7,855 7,361 494
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Employee benefits expenditure 2016-17
Permanent Total Employees Other £'000 £'000 £'000 Employee Benefits Salaries and wages 6,171 5,633 539 Social security costs 609 609 0 Employer Contributions to NHS Pension scheme 670 670 0 Other pension costs 0 0 0 Apprenticeship Levy 0 0 0 Other post-employment benefits 0 0 0 Other employment benefits 0 0 0 Termination benefits 0 0 0 Gross employee benefits expenditure 7,450 6,911 539
Less recoveries in respect of employee benefits (note 4.1.2) 0 0 0 Total - Net admin employee benefits including capitalised costs 7,450 6,911 539
Less: Employee costs capitalised 0 0 0
Net employee benefits excluding capitalised costs 7,450 6,911 539
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Permanent Total Employees Other Total £'000 £'000 £'000 £'000 Employee Benefits - Revenue Salaries and wages (127) (127) 0 0 Social security costs (15) (15) 0 0 Employer contributions to the NHS Pension Scheme (18) (18) 0 0 Total recoveries in respect of employee benefits (161) (161) 0 0 The table above relates to staff seconded to Healthier Wigan Partnership hosted by Wigan Council.
4.2 Average number of people employed
2017-18 2016-17 Permanently Total employed Other Total Number Number Number Number
Total 138 133 5 134
Of the above: Number of whole time equivalent people engaged on capital projects 0 0 0 0 Other includes seconded staff, interim contractors and pre September 18 apprentices. This is based on contracted whole time equivalents.
4.3 Staff sickness and ill health retirements
2017-18 2016-17 Number Number Total Days Lost 994 753 Total Staff Years 140 130 Average working Days Lost 7.1 5.8
The above figures are provided on a calendar year basis in line with NHS reporting requirements. There were no ill health retirements throughout the financial year (0 in 2016-17).
The CCG has not agreed any early retirements; therefore there are no costs to be met by the CCG.
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4.4 Exit packages and severance payments agreed in the financial year
2017-18 2017-18 2017-18 Compulsory redundancies Other agreed departures Total Number £ Number £Number£ Less than £10,000 0 0 0 0 0 0 £10,001 to £25,000 1 16,171 0 0 1 16,171 £25,001 to £50,000 0 0 0 0 0 0 £50,001 to £100,000 0 0 0 0 0 0 £100,001 to £150,000 0 0 0 0 0 0 £150,001 to £200,000 1 160,000 0 0 1 160,000 Over £200,001 0 0 0 0 0 0 Total 2 176,171 0 0 2 176,171
Exit costs are accounted for in accordance with relevant accounting standards and at the latest in full in the year of departure. There have been two exit packages agreed by the CCG in 2017-18 (0 in 2016-17).
There are no non-contractual severance payments made following judicial mediation, relating to non-contractual payments in lieu of notice in 2017-18. Therefore no non-contractual payments were made to individuals where the payment value was more than 12 months of their annual salary.
No early retirements have been agreed by the CCG for 2017-18. Ill-health retirement costs are met by the NHS Pension Scheme and would not be included in the CCG tables.
Where exit packages are made to Senior Managers who are included within the Remuneration Report, details of these will also be found in the Remuneration Report. The CCG had no exit packages relating to these individuals in 2017-18.
103 SECTION 3: FINANCIAL STATEMENTS 4.5 Pension Costs
Past and present employees are covered by the provisions of the two NHS Pension Schemes. Details of the benefits payable and rules of the Schemes can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions.
Both are unfunded defined benefit schemes that cover NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State in England and Wales. They are not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities.
Therefore, each scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating in each scheme is taken as equal to the contributions payable to that scheme for the accounting period.
In order that the defined benefit obligations recognised in the financial statements do not differ materially from those that would be determined at the reporting date by a formal actuarial valuation, the FReM requires that “the period between formal valuations shall be four years, with approximate assessments in intervening years”. An outline of these follows:
4.5.1 Accounting valuation
A valuation of scheme liability is carried out annually by the scheme actuary (currently the Government Actuary’s Department) as at the end of the reporting period. This utilises an actuarial assessment for the previous accounting period in conjunction with updated membership and financial data for the current reporting period, and is accepted as providing suitably robust figures for financial reporting purposes. The valuation of the scheme liability as at 31 March 2018, is based on valuation data as 31 March 2017, updated to 31 March 2018 with summary global member and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate prescribed by HM Treasury have also been used.
The latest assessment of the liabilities of the scheme is contained in the report of the scheme actuary, which forms part of the annual NHS Pension Scheme Accounts. These accounts can be viewed on the NHS Pensions website and are published annually. Copies can also be obtained from The Stationery Office.
4.5.2 Full actuarial (funding) valuation
The purpose of this valuation is to assess the level of liability in respect of the benefits due under the schemes (taking into account recent demographic experience), and to recommend contribution rates payable by employees and employers.
The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 March 2012. The Scheme Regulations allow for the level of contribution rates to be changed by the Secretary of State for Health, with the consent of HM Treasury, and consideration of the advice of the Scheme Actuary and employee and employer representatives as deemed appropriate.
The next actuarial valuation is to be carried out as at 31 March 2016 and is currently being prepared. The direction assumptions are published by HM Treasury which are used to complete 104 SECTION 3: FINANCIAL STATEMENTS the valuation calculations, from which the final valuation report can be signed off by the scheme actuary. This will set the employer contribution rate payable from April 2019 and will consider the cost of the Scheme relative to the employer cost cap. There are provisions in the Public Service Pension Act 2013 to adjust member benefits or contribution rates if the cost of the Scheme changes by more than 2% of pay. Subject to this ‘employer cost cap’ assessment, any required revisions to member benefits or contribution rates will be determined by the Secretary of State for Health after consultation with the relevant stakeholders.
For 2017-18, employers’ contributions of £760,763 were payable to the NHS Pensions Scheme (2016-17: £679,665) were payable to the NHS Pension Scheme at the rate of 14.3% of pensionable pay, plus an employers’ levy of 0.08%. The scheme’s actuary reviews employer contributions, usually every four years and now based on HMT Valuation Directions, following a full scheme valuation. The latest review used data from 31 March 2012 and was published on the Government website on 9 June 2012. These costs are included in the NHS pension line of note 4.1. In addition to the costs shown on note 4.1, the CCG pay pension on the Chairman’s costs which is included as part of the Chair and Non-Executive members costs in note 5 as these are not classed as pay and staff costs in the CCG accounts.
105 SECTION 3: FINANCIAL STATEMENTS 5 Operating Expenses
2017-18 2017-18 2017-18 2016-17 Total Admin Programme Total £'000 £'000 £'000 £'000 Gross employee benefits Employee benefits excluding governing body members* 7,189 4,028 3,161 6,557 Executive governing body members 827 827 0 893 Total gross employee benefits 8,016 4,855 3,161 7,450
Other costs Services from other CCGs and NHS England 2,085 608 1,477 2,094 Services from foundation trusts** 300,050 0 300,050 286,940 Services from other NHS trusts 19,151 0 19,151 18,589 Purchase of healthcare from non-NHS bodies 74,882 0 74,882 72,306 Chair and Non Executive Members 187 187 0 187 Supplies and services – clinical 2,102 0 2,102 2,129 Supplies and services – general*** 10,269 131 10,138 7,115 Consultancy services 36 36 0 82 Establishment 1,429 242 1,187 1,232 Transport 11 4 7 16 Premises**** 6,052 222 5,830 6,293 Impairments and reversals of receivables 4 0 4 0 Audit fees***** 54 54 0 81 Prescribing costs 59,351 0 59,351 59,238 Pharmaceutical services 197 0 197 235 General ophthalmic services 56 0 56 54 GPMS/APMS and PCTMS 41,833 7 41,826 40,716 Other professional fees excl. external audit****** 181 70 111 67 Legal fees 45 23 22 35 Grants to Other bodies 0 0 0 605 Clinical negligence 1 1 0 1 Education and training 144 92 52 187 Provisions 298 200 98 (67) CHC Risk Pool contributions 0 0 0 666 Non cash apprenticeship training grants 13 13 0 0 Other expenditure 0 0 0 31 Total other costs 518,430 1,889 516,542 498,833
Total operating expenses 526,446 6,744 519,703 506,283 In accordance with SI 2008 no.489, The Companies (Disclosure of Auditor Remuneration and Liability Limitation Agreements) Regulations 2008, where a Clinical Commissioning Group contract with its auditors provides for a limitation of the auditor's liability, the principal terms of this limitation must be disclosed in a note to the accounts. The liabilities of the external auditor are limited to £2m.
*The Executive Governing Body Members includes all Governing Body Members. This includes the Clinical Governing Body Members.
**A significant proportion of CCG expenditure is for services provided by NHS Foundation trusts including Acute, Community and Mental Health service provision. The increased expenditure in this area predominantly relates to the growth in demand for services and for the increased actual activity undertaken by the Foundation Trusts.
*** Supplies and services – general includes investment in Primary Care through the Primary Care Standards scheme which has improved GP services in the Borough.
106 SECTION 3: FINANCIAL STATEMENTS **** Premises costs include all costs payable to NHS Property Services and Community Health Partnerships £6.004m. This includes the costs of the CCG’s administrative headquarters, and the payments that cover the subsidised and void space within clinics and health centres, paid by the CCG as commissioner of those health services.
***** The Audit Fee above is the fee paid to Grant Thornton UK LLP for External Audit Services of £54,000 including VAT.
******Internal Audit Services and Counter Fraud Services which are provided by Mersey Internal Audit Agency (MIAA) (£72,710), is reported within other professional fees, in 2016/17 the fees were included within NHS trusts.
6.1 Better Payment Practice Code
Measure of compliance 2017-18 2017-18 2016-17 2016-17 Number £'000 Number £'000 Non-NHS Payables Total Non-NHS Trade invoices paid in the Year 11,534 138,228 12,041 133,397 Total Non-NHS Trade Invoices paid within target 11,333 137,066 11,710 131,014 Percentage of Non-NHS Trade invoices paid within target 98.26% 99.16% 97.25% 98.21%
NHS Payables Total NHS Trade Invoices Paid in the Year 2,500 322,754 2,371 315,679 Total NHS Trade Invoices Paid within target 2,456 322,736 2,280 315,362 Percentage of NHS Trade Invoices paid within target 98.24% 99.99% 96.16% 99.90% 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.
6.2 Late Payment of Commercial Debt
The CCG did not incur any expenses as a result of the late payment of commercial debt.
7 Income Generation Activities
The CCG does not undertake any income generating activities.
8 Investment Revenue
The CCG does not have any investment revenue.
9 Other Gains & Losses
The CCG has not made any other gains or losses.
10 Finance Costs
The CCG has not incurred any finance costs.
11 Net Gains (Loss) on Transfer by Absorption
The CCG has no Net Gains (Loss) on Transfer by Absorption as at 31 March 2018.
107 SECTION 3: FINANCIAL STATEMENTS 12 Operating Leases
12.1 As lessee
Leases shown below include:
Payment to NHS Property Services Limited (NHS PS). These include the costs of the lease for the CCG’s headquarters, General Practitioner (GP) rents and the cost of use of properties owned or leased by NHS PS where the costs are not fully recovered from the occupants. These are currently paid by the CCG as it commissions the services in these buildings. The funding sits within the CCG allocation; Payment to Community Health Partnerships Limited (CHP). These include General Practitioner (GP) rents and the cost of use of LIFT properties leased by CHP where the costs are not fully recovered from the occupants. These are currently paid by the CCG as it commissions the services in these buildings. The funding sits within the CCG allocation; and Lease cars. These are short term car leases of between one and three years.
The costs included within this note are shown within premises and establishment costs in note 5.
12.1.1 Payments Recognised as an Expense
2017-18 2016-17 Land Buildings Other Total Land Buildings Other Total £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Payments recognised as an expense Minimum lease payments 0 6,004 9 6,013 0 6,235 17 6,252 Total 0 6,004 9 6,013 0 6,235 17 6,252
12.1.2 Future Minimum Lease Payments
2017-18 2016-17 Land Buildings Other Total Land Buildings Other Total £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Payable: No later than one year 0 0 5 5 0066 Between one and five years 0 0 1 1 0022 After five years 0 0 0 0 0000 Total 0 0 6 6 0 0 8 8 Whilst our arrangements with CHP and NHS PS fall within the definition of operating leases, rental charge for future years has not yet been agreed. Consequently this note does not include future minimum lease payments for the arrangements only.
The above does not include the element of costs paid to NHS PS and CHP for the subsidised or void elements of the occupancy of health service property, as this is not a long term lease commitment for the CCG.
Only the known future minimum lease payments for lease car arrangements are included.
108 SECTION 3: FINANCIAL STATEMENTS 12.2 As Lessor
The CCG are not a lessor therefore have no income receipts as a lessor.
13 Properties, Plant & Equipment
The CCG has had no property, plant or equipment throughout the financial year.
14 Intangible Assets
The CCG has had no Intangible Assets throughout the financial year.
15 Investment Properties
The CCG had no investment property as at 31 March 2018.
16 Inventories
The CCG had no inventories as at 31 March 2018.
17 Trade & Other Receivables
Current Non-current Current Non-current 2017-18 2017-18 2016-17 2016-17 £'000 £'000 £'000 £'000
NHS receivables: Revenue 177 0 357 0 NHS prepayments 400 0 406 0 NHS accrued income* 6,648 0 0 0 Non-NHS and Other WGA receivables: Revenue 55 0 97 0 Non-NHS and Other WGA prepayments 170 0 182 0 Non-NHS and Other WGA accrued income 55 0 6 0 Provision for the impairment of receivables (4) 0 0 0 VAT 3 0 6 0 Other receivables and accruals 1 0 0 0 Total Trade & other receivables 7,504 0 1,053 0
Total current and non current 7,504 1,053
Included above: Prepaid pensions contributions 0 0 *£6.5m of the NHS accrued income relates to the agreed transformation fund bid with Greater Manchester Health and Social Care Partnership.
The majority of trade is with NHS England. As NHS England is funded by Government to provide funding to CCGs to commission health services, no credit scoring of them is considered necessary.
There is no credit risk associated with any of the receivables.
No financial assets that would otherwise be past due or impaired have had terms renegotiated.
109 SECTION 3: FINANCIAL STATEMENTS
17.1 Receivables Past their Due Date but not Impaired
2017-18 2017-18 2016-17 £'000 £'000 £'000 Non Department Department All of Health of Health receivables Group Group prior years
By up to three months 0 10 25 By three to six months 3 0 0 By more than six months 60 0 0 Total 63 10 25 The above table shows the monies owed to the CCG that are over 30 days overdue. The CCG has had confirmation that the debt over six months will be received in the first quarter of 2018/19.
The CCG did not hold any collateral against receivables outstanding at 31 March 2018.
17.2 Provision for Impairment of Receivables
2017-18 2017-18 2016-17 £'000 £'000 £'000 Non Department Department All of Health of Health receivables Group Group prior years
Balance at 01 April 2017 000
Amounts written off during the year 0 0 0 Amounts recovered during the year 0 0 0 (Increase) decrease in receivables impaired* 0 (4) 0 Transfer (to) from other public sector body 0 0 0 Balance at 31 March 2018 0 (4) 0 *The impairment relates to debt relating to a personal health budget that is currently with an external debt recovery company.
18 Other Financial Assets
The CCG had no other financial assets as at 31 March 2018.
19 Other Current Assets
The CCG had no other current assets as at 31 March 2018.
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20 Cash & Cash Equivalents
2017-18 2016-17 £'000 £'000 Balance at 01 April 2017 122 Net change in year 3 (21) Balance at 31 March 2018 4 1
Made up of: Cash with the Government Banking Service 4 1 Cash with Commercial banks 0 0 Cash in hand 0 0 Current investments 0 0 Cash and cash equivalents as in statement of financial position 4 1
Bank overdraft: Government Banking Service 0 0 Bank overdraft: Commercial banks 0 0 Total bank overdrafts 0 0
Balance at 31 March 2018 4 1
Patients’ money held by the clinical commissioning group, not included above 00
21 Non-Current Assets Held for Sale
The CCG had no non-current assets held for sale as at 31 March 2018.
22 Analysis of Impairments & Reversals – Non-current assets
The CCG had no impairments or reversals of impairments recognised in expenditure during 2017-18.
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23 Trade & Other Payables
Current Non-current Current Non-current 2017-18 2017-18 2016-17 2016-17 £'000 £'000 £'000 £'000
Interest payable 0 0 0 0 NHS payables: revenue* 6,232 0 1,700 0 NHS accruals 1,445 0 995 0 NHS deferred income 0 0 0 0 Non-NHS and Other WGA payables: Revenue** 7,517 0 2,370 0 Non-NHS and Other WGA accruals 14,735 0 17,990 0 Non-NHS and Other WGA deferred income 0 0 0 0 Social security costs 94 0 89 0 VAT 0 0 0 0 Tax 79 0 82 0 Payments received on account 0 0 0 0 Other payables and accruals 2,722 0 3,605 0 Total Trade & Other Payables 32,823 0 26,829 0
Total current and non-current 32,823 26,829 * The NHS payables includes a £4m payable to Wrightington Wigan and Leigh FT.
** The Non NHS and other WGA payables includes £1.5m for the March 2018 Better Care fund payable to Wigan Council.
There are no liabilities included above for payments due in future years under arrangements to buy out the liability for early retirement over 5 years.
24 Other Financial Liabilities
The CCG had no other financial liabilities as at 31 March 2018.
25 Other Liabilities
The CCG had no other liabilities as at 31 March 2018.
26 Borrowings
The CCG had no borrowings as at 31 March 2018.
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27 Private Finance Initiative, LIFT & Other Service Concession Arrangements
27.1 Off-Statement of Financial Position Private Finance Initiative, LIFT and Other Service Concession Arrangements
The CCG had no private finance initiative, LIFT or other service concession arrangements that were excluded from the Statement of Financial Position as at 31 March 2018.
27.2 On-Statement of Financial Position Private Finance Initiative, LIFT and Other Service Concession Arrangements
The CCG had no private finance initiative, LIFT or other service concession arrangements that were included in the Statement of Financial Position as at 31 March 2018.
28 Finance Lease Obligations
The CCG had no finance lease obligations as at 31 March 2018.
29 Finance Lease Receivables
The CCG had no finance lease receivables as at 31 March 2018.
30 Provisions
Current Non-current Current Non-current 2017-18 2017-18 2016-17 2016-17 £'000 £'000 £'000 £'000 Pensions relating to former directors 0 0 0 0 Pensions relating to other staff 0 0 0 0 Restructuring* 200 0 0 0 Redundancy 00 00 Agenda for change 0 0 0 0 Equal pay 00 00 Legal claims 0 0 0 0 Continuing care** 240 0 149 0 Other 0 0 0 0 Total 440 0 149 0 Total current and non-current 440 149
* Provision for restructuring relating to the appointment of a single Accountable Officer (AO) for the whole of the health and social care system for the Wigan Locality. As laid out in the Wigan place based strategic commissioning functions operating model approved on the 24th October 2017, there is a requirement for a single AO. This provision recognises potential future costs of this outcome.
** A provision has been made in the CCG’s accounts for an estimate of the likely future costs of NHS Continuing Healthcare claims, where patients have submitted a request to the CCG for a review of their continuing healthcare eligibility for periods of care from 1 April 2013.
The provision is based upon claims made against the CCG which have not yet been fully assessed, and where the likelihood of success is greater than 50%, a provision is made. The
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SECTION 3: FINANCIAL STATEMENTS likelihood of success is estimated by the Continuing Care team responsible for assessing claims. The costs are then estimated based on the average cost of nursing care per week.
There is nothing included in the provisions of the NHS Litigation Authority as at 31 March 2017 in respect of clinical negligence liabilities of the CCG.
Under the Accounts Directions issued by NHS England on 24 February 2015, NHS England is responsible for accounting for liabilities relating to NHS Continuing Healthcare claims relating to previously unassessed periods of care, before the establishment of CCGs. The legal liability to discharge these claims remains with the CCG.
The total value of legacy NHS Continuing Healthcare provisions to 31 March 2013, which is accounted for by NHS England on behalf of this CCG as at 31 March 2018 is £726,352.82.
The table below shows the breakdown of the provisions made by the CCG in 2017-18 and expected timing for discharge.
Continuing Restructuring Care Other Total £'000 £'000 £'000 £'000
Balance at 01 April 2017 0 149 0 149
Arising during the year 200 194 0 394 Utilised during the year 0 (7) 0 (7) Reversed unused 0 (97) 0 (97) Unwinding of discount 0 0 0 0 Change in discount rate 0 0 0 0 Transfer (to) from other public sector body 0 0 0 0 Transfer (to) from other public sector body under ab 00 0 0 Balance at 31 March 2018 200 240 0 440
Expected timing of cash flows: Within one year 200 240 0 440 Between one and five years 0 0 0 0 After five years 0 0 0 0 Balance at 31 March 2018 200 240 0 440
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31 Contingencies
2017-18 2016-17 £'000 £'000 Contingent liabilities Continuing Healthcare 203 117 Net value of contingent liabilities 203 117
Contingent assets GL Hearn Rates Rebates 323 0 Net value of contingent assets 323 0 The CCG has a contingent liability relating to the NHS Continuing Healthcare claims on the CCG for periods of care from 1st April 2013. This is based upon the difference between the full potential value of the liability, and the value provided for based on likelihood of success as assessed by the Continuing Healthcare team.
The CCG has a contingent asset relating to GP rates rebates which are being managed by GL Hearn and NHS England.
32 Financial Instruments
32.1 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 the CCG is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The CCG has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the CCG in undertaking its activities.
Treasury management operations are carried out by the finance department, within parameters defined formally within the CCG’s Standing Financial Instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the CCG and internal auditors.
32.1.1 Currency Risk
The CCG is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The CCG has no overseas operations. The CCG and therefore has low exposure to currency rate fluctuations.
32.1.2 Interest Rate Risk
The CCG borrows from government for capital expenditure, subject to affordability as confirmed by NHS England. The borrowings are for 1 to 25 years, in line with the life of the associated
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SECTION 3: FINANCIAL STATEMENTS assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The CCG therefore has low exposure to interest rate fluctuations.
32.1.3 Credit Risk
Because the majority of the CCG and revenue comes parliamentary funding, the CCG has low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables from customers, as disclosed in the trade and other receivables note.
32.1.4 Liquidity Risk
The CCG is required to operate within revenue and capital resource limits, which are financed from resources voted annually by Parliament.
The CCG draws down cash to cover expenditure, as the need arises. The CCG is not, therefore, exposed to significant liquidity risks.
32.2 Financial Assets
At ‘fair value through profit Loans and Available and loss’ Receivables for Sale Total 2017-18 2017-18 2017-18 2017-18 £'000 £'000 £'000 £'000
Embedded derivatives 0 0 0 0 Receivables: · NHS* 0 6,825 0 6,825 · Non-NHS 0 110 0 110 Cash at bank and in hand 0 4 0 4 Other financial assets 0 1 0 1 Total at 31 March 2018 0 6,940 0 6,940
At ‘fair value through profit Loans and Available and loss’ Receivables for Sale Total 2016-17 2016-17 2016-17 2016-17 £'000 £'000 £'000 £'000
Embedded derivatives 0 0 0 0 Receivables: · NHS 0 357 0 357 · Non-NHS 0 103 0 103 Cash at bank and in hand 0 1 0 1 Other financial assets 0 0 0 0 Total as 31 March 2017 0 461 0 461
* NHS receivables include the accrued income of £6.5m relating to the approved transformation fund bid with Greater Manchester Health and Social Care Partnership.
These balances are reported within the Statement of Financial Position and also Note 17 and Note 20.
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32.3 Financial Liabilities
At ‘fair value through profit and loss’ Other Total 2017-18 2017-18 2017-18 £'000 £'000 £'000
Embedded derivatives 0 0 0 Payables: · NHS* 0 7,676 7,676 · Non-NHS 0 24,974 24,974 Private finance initiative, LIFT and finance lease obligations 0 0 0 Other borrowings 0 0 0 Other financial liabilities 0 0 0 Total at 31 March 2018 0 32,650 32,650
At ‘fair value through profit and loss’ Other Total 2016-17 2016-17 2016-17 £'000 £'000 £'000
Embedded derivatives 0 0 0 Payables: · NHS 0 2,695 2,695 · Non-NHS 0 23,964 23,964 Private finance initiative, LIFT and finance lease obligations 0 0 0 Other borrowings 0 0 0 Other financial liabilities 0 0 0 Total at 31 March 2017 0 26,659 26,659 * The NHS payable includes a £4m payable to Wrightington Wigan and Leigh FT.
These balances are those reported within the Statement of Financial Position and also Note 23.
As required to report, the CCG has no payable to the Department of Health, and all liabilities are expected to discharge in one year or less.
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33. Operating Segments
The CCG considers that they have only one segment which is commissioning of healthcare services.
Gross Net Total Income Total assets Net assets expenditure expenditure liabilities £'000 £'000 £'000 £'000 £'000 £'000 NHS Wigan Borough CCG 526,446 (7,983) 518,463 7,509 (33,263) (25,754) Total 526,446 (7,983) 518,463 7,509 (33,263) (25,754) 34. Pooled Budgets
The CCG has entered in to a pooled budget with Wigan Council to support integrated health and social care, known as the Better Care Fund (BCF), hosted by Wigan Council. This is a nationally mandated scheme that commenced in 2015-16.
The pool is jointly controlled by Wigan Borough CCG and Wigan Council. The Wigan Health and Wellbeing Board, made up of Wigan Council and CCG representatives, govern the use of the fund. The fund is used to commission services that support the integration of health and social care, which seeks to ensure support for people to be well and independent and in control of their own care.
Each scheme within the BCF has been allocated a lead commissioner (either the Council or the CCG) and accounting for the pool reflects these arrangements.
The total value of the pool in 2017-18 is £34,966,716. The CCG contribute £22,901,369 to the pool which provides funding to the revenue schemes of the pool. The council contribute £11,943,347 to the pool of which £3,542,794 is from the Disabled Facilities Grant, which pays for the capital schemes of the pool. In 2017-18 a further contribution of £8,522,553 was made from national monies received by the council for the Improved Better Care Fund (iBCF), which funds revenue schemes.
The CCG lead commission schemes to the value of £4.5m in 2017-18. The remainder of the schemes are lead commissioned by Wigan Council.
The Council contributes 100% of the capital funds therefore the underspend on the Disabled Facilities Capital Grant is accounted for by Wigan Council. This money is specifically earmarked for the Council within the terms of the pooled budget.
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Better Care Fund Pooled Budget Memorandum
CCG Wigan Council Pool £000 £000 £000 Income Revenue 22,901 8,523 31,424 Capital Grant 3,421 3,421 Capital Grant Underspend from 2016/17 122 122 Total Income 22,901 12,066 34,967 Expenditure Revenue expenditure 4,479 26,945 31,424 Capital expenditure 2,860 2,860
Total Expenditure 4,479 29,805 34,284
Total Underspend -683
Revenue Underspend / Overspend 0 Capital Underspend -683
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35 Related Party Transactions
Governing Body Members
The following are members of the Wigan Borough CCG Governing Body, who have declared interests with organisations that the CCG conduct business with. For Governing Body members only organisations that the CCG have transacted with are listed within the payments section of this note, although all interests declared are listed in the narrative.
Mrs Anderson (Chief Officer) is a public sector director with Wigan LIFTco (non- remunerated).The CCG do not pay Wigan LIFTco but the LIFTco is administered by Community Health Partnerships (CHP) so payments to CHP have been included for transparency. Her Husband is employed with Mersey Care NHS Foundation Trust as a Consultant Psychiatrist. Mrs Anderson is also an Associate non-executive Director at NHS East Lancashire Trust (non- remunerated).
Dr Dalton (Chair) is a GP, GP Trainer and GP Appraiser. He is a director at Shakespeare Surgery Ltd and Shakespeare Services Ltd. He is also a minor shareholder in Shakespeare Surgery Ltd, a company that provides GMS GP services to the NHS and a minority shareholder in Shakespeare Services that provides services to Non NHS organisations and private individuals in the area of travel, training and health advice. Shakespeare Surgery is a shareholder of Health First ALW Community Interest Company, which acts as a provider of various health services and a mechanism for GP federated working. Dr Dalton is also a member of the North West Leadership Academy Board.
Dr Atrey (Clinical Governing Body Member) is a general practitioner at Meadowview Surgery and Atherton Health Centre. Dr Atrey’s wife is also a GP at the same practice and a Partner.
Dr Davies (Clinical Governing Body Member) is a GP partner in the Dicconson Group Practice.
Dr James (Clinical Governing Body Member) is a GP at Braithwaite Road Surgery.
Dr Kumar (Clinical Governing Body Member) is a Senior Partner at Dr Kumar’s Surgery (Russell and Partners, the Chandler Surgery). This practice is a member of the Health First Federation. He is also Associate Dean of Primary Care and Public Health Education, Health Education North West.
Dr Marwick (Clinical Governing Body Member) is a GP at Beech Hill Medical Practice. Beech Hill Medical Practice is a member of Wigan Federation but Dr Marwick is not the named shareholder.
Dr Wahie (Clinical Governing Body Member) is a GP at SSP Health Surgeries (Ashton Medical Centre, Braithwaite Road Surgery, Ince Surgery and Lower Ince Surgery). He practices at Lower Ince and Ince Surgeries. He is a shareholder of Cardium Federation. His wife works at Lancashire Teaching Hospitals NHS Foundation Trust (Royal Preston Hospitals) and he has a family member who works at County Durham and Darlington NHS Foundation Trust.
Dr Wong (Clinical Governing Body Member) is a partner at Dr Wong and partners GP Practice (Old Henry Street Medical Practice).
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Mr Armer (Lay Member) is majority shareholder of RFM Chartered Accountants.
Dr Cook (Governing Body Secondary Care Member) has no interests to declare.
Mr Costello (Lay Member) was the former Deputy Chief Executive of Wigan Council and is the Chair of Wigan & Leigh College from January 2017.
Mrs Jackson (Governing Body Nurse Member) is a Executive Director of Nursing & Quality at Bury CCG and Nurse Clinician Marple Cottage Surgery, Stockport.
Canon Smith (Lay Member) is the Diocesan Director of Education for the Church of England in the Diocese of Manchester. He is also a National Society Council member and a Manchester University General Council member.
Ms Southworth (Executive Director of Quality & Safety) has no interests to declare.
Mr Tate (Chief Finance Officer) is married to an employee of North West Boroughs NHS Foundation Trust; she is also a Governor and Audit Chair of St John Rigby Sixth Form College and Treasurer of the Wigan Branch of ‘Guide Dogs for the Blind’.
Caroline Kurzeja (Acting Chief Officer) is married to a board member of St Helens rota.
Other Member Practices
As the CCG are responsible for the co-commissioning of GP Primary Care Services, the note also includes the related parties of all member practices. The contractual (GMS/PMS/APMS) payments for services delivered are listed in the table below per practice and payments to GP federations are also listed.
Individual declarations within the narrative are only made where a practice has declared an additional interest and where the CCG has had business with the organisation.
Dr Anis is a GP shareholder for Cardium Limted.
Dr Chan is a member of the Medical Emergency Response Incident Team for North West Ambulance Services NHS Trust.
Dr Kreppel works for the Intermediate Care Physical team run by Bridgewater Community Foundation NHS Trust.
Dr Lears is employed by Wrightington, Wigan and Leigh NHS Foundation Trust.
Dr Mudugal is a Director of Health First.
Dr Ollerton is a member of Health First Federation
Dr Saxena is a member of Cardium Limited.
Dr J Van Spelde works at the out of hours service run by Bridgewater Community Foundation NHS Trust and GP Alliance.
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Dr Wan is a member of the Wigan Borough Federation.
Dr Anderson, Dr Craver, Dr Hadjidemetriou, Dr Humphreys, Dr Lancaster, Dr Mercer, Dr Morgan, Dr Munro, Dr Pollard, Dr Tankard, Dr Unwin, Dr Wan are members of Wigan Federated Healthcare.
Dr Gerlach, Dr Jacks, Dr Kelly, Dr Kirk, Dr Lokanadam, Dr Sukhavasai, Dr Vallabhaneni are members of the SWAN Cluster.
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SECTION 3: FINANCIAL STATEMENTS
Details of related party transactions in 2017-18 are as follows:
Of which Of which Payments made to Receipts from amounts owed amounts due Related Party Related Party to Related Party from Related (Expenditure) (Income) (Creditors) Party (Debtors) £000 £000 £000 £000 Health Education England 019 0 0 NHS England (including Local Area Team) 193 6,526 168 6,726 Blackpool Teaching Hospitals 169 0 0 12 Mersey Care NHS Trust 570 0 20 0 NHS Bury CCG 8 0 3 0 Lancashire Teaching Hospitals Foundation Trust 2,715 0 150 0 Northwest Boroughs NHS Foundation Trust 26,677 0 60 0 Bridgewater Community Healthcare Foundation Trust 38,827 0 562 76 Wrightington Wigan and Leigh NHS Foundation Trust 181,181 0 4,956 66 Salford Royal NHS Foundation Trust 16,609 0 443 0 Royal Bolton NHS Foundation Trust 17,582 0 288 112 County Durham And Darlington NHS Foundation Trust 2 0 0 0 East Lancashire Hospitals Trust 183 0 10 0 Community Healthcare Partnerships Ltd 4,935 0 86 0 Wigan Council 40,083 1,403 6,166 42 Wigan LMC 112 0 10 0 GP Practices (Including practice) P92001 Medicentre 719 0 51 0 P92002 Braithwaite Road Surgery 698 0 54 0 P92003 The Dicconson Group Practice 1,157 0 95 0 P92004 Hindley Health Centre 1,079 0 59 0 P92005 Dr Zaman & Partner 577 0 42 0 P92006 DR Ahmed & Partners 882 0 58 0 P92007 Old Henry Street Medical Practice 893 0 64 0 P92008 Bradshaw Street Medical Practice 1,345 0 109 0 P92010 Beech Hill Medical Practice 1,830 0 136 0 P92011 Sullivan Way Surgery 1,114 0 73 0 P92012 Dr Anis & Partner 564 0 33 0 P92014 Standish Medical Practice 1,664 0 140 0 P92015 Aspull Surgery 784 0 74 0 P92016 Pennygate Medical Centre 2,770 0 180 80 P92017 Shevington Surgery 1,805 0 156 0 P92019 Pemberton Surgery 1,298 0 150 0 P92020 Coldalhurst Lane Surgery 600 0 44 0 P92021 Newton Medical Practice 932 0 63 0 P92023 Brookmill Medical Centre 1,298 0 109 17 P92024 The Chandler Surgery 508 0 32 0 P92026 Longshoot Surgery 1,053 0 74 0 P92028 Elliott Street Surgery 661 0 58 0 P92029 Dr Trivedi & Partner 568 0 34 0 P92030 Wrightington Street Surgery 583 0 38 0 P92031 Dr Ullah Practice 439 0 21 0 P92033 The Surgery, Astley 623 0 42 0 P92034 Bryn Cross Surgery 792 0 50 0 P92035 Lilford Park Surgery 511 0 40 0 P92038 Winstanley Medical Practice 406 0 23 0 P92041 Ashton Medical Centre 1,043 0 78 0 P92042 Sevenbrooks Medical Centre 615 0 52 0 P92602 Foxleigh Surgery 407 0 29 0 P92605 Boothstown Surgery 780 0 48 0 P92607 Grasmere Surgery 1,068 0 70 0 P92615 Esa Surgery Ltd 331 0 22 0 P92616 Ince Surgery 469 0 41 0 P92619 Dr Sharma Practice 252 0 16 0 P92620 Lower Ince Surgery 515 0 37 0 P92621 Premier Health 50003418 P92623 Dr Maung & Partner 294 0 24 0 P92626 Meadowview Surgery 710 0 57 0 P92630 Dr Pal & Partner 358 0 32 0 P92633 Bee Fold Lane Surgery 285 0 15 0 P92634 Mesnes View Surgery 619 0 37 0 P92635 Dr Vasanth & Partner 287 0 16 0 P92637 Astley General Practice 345 0 22 0 P92639 Family Medical Practice 400 0 24 0 P92642 Marus Bridge Practice 726 0 94 0 P92643 Direct Access Surgery 10 0 0 P92646 Dr Khatri Surgery 415 0 25 0 P92647 Hawkley Brook 442 0 25 0 P92648 Slag Lane Medical Centre 373 0 31 0 P92651 Dr Xavier Surgery 645 0 39 0 P92652 Brooks Medical Practice 561 0 51 0 P92653 Shakespeare Surgery 384 0 27 0 Y00050 Dr Gupta Practice 374 0 28 0 Y02274 Intrahealth Platt Bridge 758 0 42 0 Y02321 Intrahealth Tyldesley 915 0 79 0 Y02322 Leigh Family Practice 1,982 0 160 32 Y02378 Dr Alistair Surgery 1,069 0 68 0 Y02885 Intrahealth Marsh Green 497 0 27 0 Y02886 Intra Health Family Practice 500 0 46 1 Y02887 Intrahealth Leigh Sports Village 320 0 12 0 Wigan Federation / Alliance 2,262 0 134 0 Clusters - SWAN 346 0 25 0 Clusters - LIGA (Cardium LTD) 312 0 50 0 Clusters - WIGAN 64 0 64 0 Clusters - TABA+ 229 0 25 0 Clusters - LEIGH 25 0 25 0
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SECTION 3: FINANCIIAL STATEMENTS
During the year, the CCG has had a significant number of material transactions with entities for which the Department is regarded as the paarent department.
The most significant of these, not already listed above, are listed below.
Payments made to Receipts from Of which amounts Of which amounts due Related Party Related Party owed to Related from Related Party (Expenditure) (Income) Party (Creditors) (Debtors) £000 £000 £000 £000 North West Ambulance Service NHS Trust 11,680 0 159 0 St Helens & Knowsley Hospitals NHS Trust 4,706 0 0 0 Central Manchester University Hospitals NHS Foundation Trust (Pre Manchester University Hospitals Acquisition) 2,309 0 0 0 Manchester University NHS Foundation Trust 3,793 0 159 0 Warrington & Halton Hospitals NHS Foundation Trust 3,355 0 0 53 2016-17 Related Party transactions are listed below for comparative purposes
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SECTION 3: FINANCIIAL STATEMENTS
2016-17 material transactions with entities for which the Department is reggarded as the parent department.
The CCG had no material transaction with other government departmentt and other central and local government bodies that have not been listed above.
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SECTION 3: FINANCIAL STATEMENTS
36 Events after the Reporting Period
There are no adjusting post balance sheet events on the financial statements of the CCG.
37 Financial Performance Duties
CCGs have a number of financial duties under the National Health Service Act 2006 (as amended).
Due to new reporting guidance the planned 2017/18 surplus of £9.494m has been offset by the surplus achieved in the prior year of £9.440m, leaving a surplus of £0.054m required to be held in-year. In addition to this the CCG was required to withhold 0.5% of its allocation for the national system reserve totalling £2.267m; and release a further £0.646m relating to savings made as a result of the national changes applied to Category M drug pricing.
The CCG’s performance against those duties was as follows:
£000
Revenue Resource Limit 521,430 Net Operating Resources (518,463) Surplus, 0.5% Withhold & Cat M 2,967
Note split Surplus 54 0.5% withhold 2,267 Cat M return 646 2,967
The table below shows the year on year comparable of the Financial Performance of the CCG.
NHS Clinical Commissioning Group have a number of financial duties under the NHS Act 2006 (as amended). NHS Clinical Commissioning Group performance against those duties was as follows:
2017-18 2017-18 2016-17 2016-17
Target Performance Target Performance Expenditure not to exceed income 529,413 526,446 515,724 506,284 Capital resource use does not exceed the amount specified in Directions 0 0 0 0 Revenue resource use does not exceed the amount specified in Directions 521,430 518,463 510,854 501,414 Capital resource use on specified matter(s) does not exceed the amount specified in Directions 0000
Revenue resource use on specified matter(s) does not exceed the amount specified in Directions 0 0 0 0 Revenue administration resource use does not exceed the amount specified in Directions 7,106 6,555 7,090 6,397
Note: Expenditure is defined as the aggregate of gross expenditure on revenue and capital in the financial year; and, income is defined as the aggregate of the notified maximum revenue resource, notified capital resource and all other amounts accounted for as received in the financial year (whether under provisions of the Act or from other sources, and included here on a gross basis).
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SECTION 3: FINANCIAL STATEMENTS
The CCG did not incur any capital expenditure throughout the financial year.
38 Losses and Special Payments
38.1 Losses
The total number of NHS clinical commissioning group losses and special payments cases, and their total value, was as follows:
Total Total Total Total Number Value of Number of Value of of Cases Cases Cases Cases 2017-18 2017-18 2016-17 2016-17 Number £'000 Number £'000 Administrative write-offs 2 4 0 0
Total 2 4 0 0
The above losses relate to the personal health budget bad debt and the loss of a low value of stamps.
The CCG did not have any special payments in 2017-18.
The CCG did not have any losses or special payments in 2016-17.
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