Annual Report and Accounts 2014/15 NHS Rushcliffe Clinical Commissioning Group Annual Report 2014/15

This is the annual report for NHS Rushcliffe Clinical Commissioning Group (CCG) 2014/15. It includes information about the organisation and its activities during 2014/15. This document can be made available in large print and other formats, including translations, upon request. For more details about any of the information included within this document please contact us: Post: Easthorpe House, 165 Loughborough Road, Ruddington, Nottingham NG11 6LQ Telephone: 0115 883 7880 Email: [email protected] Website: www.rushcliffeccg.nhs.uk

2 Contents

Member Practices’ Introduction ...... 6 Strategic Report ...... 8 Introduction ...... 8 Nature, Objectives and Strategies of the Clinical Commissioning Group .... 8 About Us ...... 8 Our Team ...... 9 Organisational Development 2014/15 ...... 9 Our Population ...... 10 Our Priorities ...... 11 Our Business ...... 11 Our Commitment to Quality ...... 12 Our Achievements During 2014/15 ...... 15 Patient and Public Engagement ...... 25 Development and Performance of the CCG for 2014/15 and in the Future 30 Our Performance ...... 30 Planning for the Future ...... 33 Health and Wellbeing Strategy ...... 33 System Transformation ...... 35 Innovation, Education and Research ...... 41 Resources, Principal Risks and Relationships ...... 42 Resources ...... 42 Principal Risks ...... 43 Relationships ...... 44 Sustainability Report ...... 45 Background ...... 45 Sustainability Development Management Plan (SDMP) ...... 46 Summary of Progress ...... 49 Governance Arrangements ...... 55 Social, Community and Human Rights Report ...... 55 Equality Duty ...... 55 Signature of the Accountable Officer ...... 60 Members’ Report ...... 61 Our GP Practices ...... 61 The Governing Body ...... 61 Biographies ...... 62

3 Audit Committee Members ...... 67 Our Committees ...... 67 Register of Interests ...... 67 Political and Charitable Donations ...... 69 Future Developments ...... 69 Research and Development ...... 69 Branches Outside the UK ...... 69 Pension Liabilities ...... 69 External Auditor’s Remuneration ...... 69 Cost Allocation and Setting Charges for Information ...... 69 Disclosure of Personal Data Related Incidents ...... 69 Working With Us ...... 70 Employee Consultation ...... 70 Written Bulletins ...... 70 Face to Face Communications ...... 71 Staff Survey ...... 71 Sickness Absence ...... 71 Workplace Award Scheme ...... 72 On-Site Health and Wellbeing Visits by Occupational Health ...... 73 Disabled Employees...... 73 Health and Safety ...... 73 Fraud ...... 74 Better Payment Practice Code ...... 74 Emergency Preparedness, Resilience and Response ...... 75 Business Continuity ...... 75 Principles for Remedy ...... 75 Exit Packages ...... 76 Off Payroll Engagements ...... 76 Signature of the Accountable Officer ...... 76 Remuneration Report ...... 77 Remuneration Committee (not subject to audit) ...... 77 Salaries and Allowances (subject to audit) ...... 78 Pension Benefits (subject to audit) ...... 79 Cash Equivalent Transfer Value ...... 79 Real Increase in CETV ...... 80

4 Payments to Past Senior Managers (not subject to audit) ...... 80 Pay Multiples (subject to audit) ...... 80 Signature of the Accountable Officer ...... 80 Statement of the Accountable Officer’s Responsibilities ...... 81 Governance Statement ...... 82 Introduction ...... 82 Scope of Responsibility ...... 82 Compliance with the UK Corporate Governance Code ...... 82 The Clinical Commissioning Group Governance Framework ...... 82 The Clinical Commissioning Group Risk Management Framework ...... 99 The Clinical Commissioning Group Internal Control Framework ...... 103 Risk Assessment in Relation to Governance, Risk Management and Internal Control ...... 103 Review of Economy, Efficiency and Effectiveness of the Use of Resources ...... 106 Review of the Effectiveness of Governance, Risk Management and Internal Control ...... 108 Conclusion ...... 113 Annual Accounts ...... 114 Chief Financial Officer Commentary ...... 114 Financial Performance ...... 114 Going Concern ...... 115 Audited Financial Statements and Auditor’s Report ...... 115 Working Capital and Liquidity ...... 115 Events After Reporting Period ...... 115 Capital Expenditure ...... 116 Accounting Policies ...... 116 Efficiency ...... 116 Statement of the Accountable Officer ...... 116 Appendix 1: 2014/15 Annual Accounts and Independent Auditor’s Report

5 Member Practices’ Introduction

This report covers the second full year of operation for the CCG and from what you will read in the following pages, it is clear that it was a year full of achievements and challenges. We started the year by embarking on a comprehensive and ambitious engagement with our population to truly understand our patients’ views on future options for primary and community healthcare services. The response rate was remarkable and gave us a mandate to plan and deliver new ways of working which are efficient, effective and responsive to what our patients want. We redesigned our family doctor services and in particular the way in which we support people with long term conditions or ongoing health issues and those in care homes. We also successfully applied to the Prime Minister’s Challenge Fund to pilot seven day access to general practice. In addition, the survey prompted a review of our patient engagement to ensure that we were engaging with all groups of our population and that those who act in a representative role are clearly connected to those groups. You can read more on these achievements and many more later in this report. The year also saw some very challenging situations in the health economy, which included the performance of the urgent care system, particularly the emergency department at Nottingham University Hospitals NHS Trust. This attracted robust national scrutiny and required intense efforts from the clinical and senior managerial leaders and working with partners across south Nottinghamshire to tackle the under performance against the national four-hour wait standard. The Better Care Fund presented a further challenge requiring detailed planning in a complex and multi-organisational environment. The Nottinghamshire plan was put forward as an ‘exemplar’ and was approved in December 2014, which is a testament to the commitment of all partner organisations involved. In October 2014, NHS England published the Five Year Forward View, which recognises that the NHS has performed remarkably well despite, over the last five years, the biggest financial challenge in its history. A number of new care models are described in the document, which acknowledges that ‘one size does not fit all’ and outlines a number of radical new delivery options. One of these options is the multi-specialty community provider (MCP), which builds on the CCG’s long history of commitment to integration and care provided out of a hospital setting. The CCG supported the successful application to be a vanguard site and is to be one of 14 MCP sites across the country. In addition, the CCG successfully applied to NHS England for full delegated responsibility for primary care commissioning. This provides both challenges and opportunities, but will allow for more joined up services and care closer to home. Together with the MCP, the CCG will be in a strong position to continue to design services which respond to the views expressed by our patients about their health. With these new models of care and new responsibilities comes the need for good governance. It is essential that we manage our statutory functions robustly and to do this we have a sound governance structure which ensures we meet the required standards for financial management, quality and patient safety and information governance. We reviewed our governance structures and processes and tested our compliance against the UK Code of Corporate Governance.

6 At the annual meeting of the Membership Forum in June 2014, the member practices reviewed how the Governing Body was performing and were strongly supportive of both the individual members and the way in which they operate collectively. In addition, the Governing Body undertook a self-assessment of its own effectiveness followed by a development session facilitated by 360° Assurance Internal Audit Services. This will determine a future development plan throughout the forthcoming year. Finally, it would be remiss of us not to mention the sad and unexpected death of Dr Ian McCulloch on 30 October 2014. Ian was the senior partner in my practice but I speak on behalf of all the practices in Rushcliffe and the CCG. We would like to pay tribute to the many achievements in his career and the regard in which he was held both professionally and personally. The CCG has lost a dear and respected colleague and friend.

Dr Gavin Derbyshire GP Member – Lead for Member Practices

7 Strategic Report

Introduction NHS Rushcliffe Clinical Commissioning Group (CCG) was established on 1 April 2013, was authorised without conditions and assumed statutory responsibility from NHS Nottinghamshire County Primary Care Trust for commissioning a range of health care services for the population of Rushcliffe. This document fulfils our duty to produce an annual report on how we discharged our functions in 2014/15. It is also an opportunity to highlight our achievements in our second year of operation, note the challenges we faced and explain our plans for the future. The Annual Report will be presented alongside our annual financial accounts, which have been prepared under a Direction issued by the NHS Commissioning Board under the Health and Social Care Act 2012 c.7 Schedule 2 s.17. The form and content of this report will be agreed with the CCG’s Governing Body before being published and will also be presented at a public meeting.

Nature, Objectives and Strategies of the Clinical Commissioning Group

About Us NHS Rushcliffe CCG is responsible for commissioning hospital, community and mental health services for the population of 123,576 registered with a Rushcliffe GP practice. Our headquarters are at Easthorpe House, 165 Loughborough Road, Ruddington, Nottingham NG11 6LQ. NHS Rushcliffe CCG is a membership organisation consisting of 12 GP practices in the area supported by a small management team and led by the Governing Body. We work closely with the district and county councils and other agencies to develop and deliver strategies that improve the health and wellbeing of the local population. We cover broadly the same population as Rushcliffe Borough Council, and this allows us to truly understand and focus on the needs of our local population, which gives us an advantage in commissioning services that are designed for Rushcliffe residents. Our mission is to improve the health outcomes of people registered with a member GP practice in NHS Rushcliffe CCG, and other patients who live in the locality, by commissioning high quality and affordable health care services. Some of the organisations we commission from, such as our local hospital services, cover wider populations (e.g. the south of Nottinghamshire) so we work very closely on many transformation and service re-design projects with our neighbouring CCGs NHS Nottingham West, NHS Nottingham North and East and NHS Nottingham City, although our demographic and health challenges are in some parts very different. Alongside our local CCG partners and other local providers, we have established the South Nottinghamshire Transformation Board, a group which sets the strategic direction for the health system of South Nottinghamshire. The positive relationships we have with our neighbouring CCGs go wider than just South Nottinghamshire though, and include NHS Newark and Sherwood, NHS Mansfield and Ashfield, NHS Erewash and NHS West Leicestershire CCGs, which benefit our patients who receive services from our local providers. Together with our local councils we have the option to work alone or as part of a larger team, according to the best fit for each situation, allowing us to pool resources – people and money – and to work most efficiently.

8 Our Team We have a small core team within the CCG of 40 employees (37.95 full time equivalents) of whom 30 are female and 10 are male. We have one employee on Very Senior Manager grade, who is female. There are no male employees on Very Senior Manager grades. In addition, for economies of scale and to reduce duplication and costs, we have a number of shared teams for performance and information, finance, quality and patient safety and contracting. These staff are employed by our neighbouring CCGs with the exception of the performance and information team which is employed by Rushcliffe and included in our employee numbers above. Our Governing Body comprises 14 members. Nine are male and five are female. The Clinical Cabinet comprises 20 members – 15 male and five female. The Patient Cabinet comprises 18 members – nine male and nine female. More information about our Governing Body is provided in the Members’ Report and more information about our workforce is provided within the Social, Community and Human Rights Report - both further on in this document.

Organisational Development 2014/15 We understand how important it is to value our people and during 2014/15 we worked closely with CCG staff to identify their development and support needs and encouraged them to embrace development opportunities. Without the hard work of our most valuable assets – our employees – we would be unable to demonstrate the significant achievements in 2014/15 that we have and we know that we will continue to depend on their hard work and commitment in coming years. During 2014/15 we worked in partnership with the Greater East Midlands Commissioning Support Unit (GEM) to write a comprehensive organisational development strategy and action plan which sets out how we intend to develop our member practices, clinical leaders, Governing Body and staff, to work together in a highly performing commissioning organisation and be a recognised and respected leader of the NHS locally. We undertook a range of diagnostic interventions to provide us with information about where we were in our organisational journey and how we needed to move forward, including the 360° stakeholder survey and the NHS National Staff Survey, for which our response rate was 100 per cent. Throughout 2014/15 we implemented a range of organisational development techniques and tools across different groups and teams within the CCG, including but not limited to:  Time out events, both internally and with partner CCGs  360° feedback for individual staff members  Access to national and local leadership development programmes for individuals  Corporate mentoring schemes  Healthy workplace award champions and motivating health behaviour workshops  Local staff ‘lunch and learn’ sessions  Clinical leadership protected learning time events  Self-assessment of the effectiveness of the Governing Body  Review of governance arrangements and compliance with UK Corporate Governance Code  Review of patient cabinet roles, responsibilities and effectiveness facilitated by the NHS East Midlands Leadership Academy  Statutory and mandatory training through e-learning We made significant progress with our organisational development plans throughout 2014/15, but we also realise that we have further to go in 2015/16.

9 Our Population Rushcliffe has a registered population of 123,576. Compared to other CCGs, the local population has only small numbers of people from black and minority ethnic communities and has a relatively large number of elderly residents. Demographics  In December 2014, five per cent of the population were classed as 'early years' age; 22 per cent were of school or training age; 52 per cent were of employment and family building age and 20 per cent were in their retirement years.  Rushcliffe has more women than men, with 60,593 men and 62,815 women in December 2014.  In the 2011 census, 93.1 per cent of the population of Rushcliffe described themselves as white, 1.75 per cent were from mixed/multiple ethnic groups, 4.15 per cent were Asian/Asian British, 0.61 per cent were Black African and Caribbean/Black British and 0.39 per cent were from other ethnic groups.  In the same census, 58.93 per cent of local people said they were Christian, 0.29 per cent said Buddhist, 1.06 per cent Hindu, 0.29 per cent Jewish, 1.53 per cent Muslim, 0.81 per cent Sikh, 0.36 per cent stated they were of other religions and 36.73 per cent declared no religion or did not state.  6.5 per cent of Rushcliffe’s population was born outside the UK (2011 census figures). Health  The health of people in Rushcliffe is generally better than the England average.  Life expectancy for both men and women is higher in Rushcliffe than the England average. Life expectancy is 5.9 years lower for men and 6.0 years lower for women in the most deprived areas of Rushcliffe than in the least deprived areas.  12.2 per cent of Year 6 children (2014 figures) and 19.1 per cent of adults (2012 figures) in Rushcliffe are classified as obese – better than the average for England.  The rate of alcohol-specific hospital stays among those under 18 in Rushcliffe was 12.9 per 100,000 of population (2014 figures); for adults it was 487 per 100,000 of population (2012 figures). Both figures are better than the average for England.  In 2014 levels of breastfeeding and of smoking at the time of giving birth were worse in Rushcliffe than the England average. Levels of teenage pregnancy and GCSE attainment were better than the England average.  The rate of self-harm hospital stays was 94.7 per 100,000 of population (2012 figures) – better than the average for England.  The rate of smoking-related deaths in Rushcliffe was 206 per 100,000 of population (2012 figures) – better than the average for England.  Estimated levels of adult excess weight, smoking and physical activity are better than the England average.  The rate of people killed and seriously injured on roads is worse than average.  Rates of hip fractures, sexually transmitted infections and tuberculosis are better than average.  The rate of new cases of malignant melanoma is worse than average.  Rates of statutory homelessness, violent crime, long term unemployment, drug misuse, early deaths from cardiovascular diseases and early deaths from cancer are better than average.

10 Health Inequalities and Deprivation The English Indices of Deprivation 2010 were published by the Department for Communities and Local Government on 24 March 2011. Deprivation covers a broad range of issues and refers to unmet needs caused by a lack of resources of all kinds, not only financial. The domains used are income, employment, health, education, crime, access to services and living environment. An overall measure of multiple deprivation was calculated for every lower layer super output area (LSOA) in England. There are 32,482 LSOAs in England. The five least deprived LSOAs in Nottinghamshire are all in Rushcliffe and all five LSOAs are in the one per cent least deprived in England. The least deprived LSOA in Nottinghamshire lies within Keyworth North ward in Rushcliffe. It is ranked 32,456 out of the 32,482 LSOAs in England. The 2014 district health profile published by Public Health England estimates that at a district level Rushcliffe has an estimated 7.8 per cent of children living in poverty with the England average being 20.6 per cent. Alongside this however, the report also highlights that just over 1,500 children continue to live in poverty. Child poverty data is different to deprivation and is calculated by the number of children in families in receipt of either out of work benefits or tax credits where their reported income is less than 60 per cent of median income. Although based on different calculations, the results for both child poverty and deprivation show a similar geographical alignment within Rushcliffe. A hotspot ward for child poverty is identified as a locality where more than 16.7 per cent of children live in poverty, as defined by the government's indicator of relative poverty. As a locality Rushcliffe falls well below this percentage, but it does have six LSOAs that exceed the ‘hotspot’ percentage with child poverty ranging from 31.2 per cent in West Bingham to 18.4 per cent in Edwalton. Other ‘hotspot’ areas include Gotham and three areas in Cotgrave: Ring Leas (28.4 per cent), Saxon Way (23.9 per cent) and Candleby Lane (17.8 per cent).

Our Priorities We are committed to improving the quality of health services across our CCG. Our plans and priorities for the future – developed by clinicians and patients – are aimed at reducing health inequalities and improving health outcomes, patient safety, access to services and patient experience. We work to commission services that improve the health of the whole population of our area with better quality of care and outcomes for all patients, in line with three priority areas:  Supporting people to manage ongoing conditions  Improving mental health and wellbeing  Promoting prevention, early intervention and supporting people to make healthy lifestyle choices In working to commission high quality services in line with our priority areas, we promote the involvement of patients, carers and their representatives in decisions that relate to the prevention or diagnosis of illness in the patient, their care and treatment. The principles of the NHS Constitution are embedded in every step of the process.

Our Business Commissioning is the process of assessing health needs, identifying the services required to meet those needs and then buying those services from a wide range of healthcare providers, which can include hospitals, pharmacies, community services and voluntary organisations.

11 Clinical commissioning offers front-line clinicians the opportunity to play a major role in the development and delivery of strategies and activities that improve local health and wellbeing. We work with the borough and county council and other agencies to achieve this. We commission services from a number of other NHS, council and voluntary sector organisations as well as other agencies. The organisations from which we commission the majority of our services are:

 Nottingham University Hospitals NHS Trust  Nottinghamshire Healthcare NHS Trust (including County Health Partnerships)  Circle Nottingham Ltd (based at the Nottingham Treatment Centre)  East Midlands Ambulance Service (EMAS)

The main providers of health and wellbeing services in Rushcliffe are detailed above but in line with NHS Constitution commitments around patient choice and competition, there are a number of services that we commission from a range of providers. Independent providers contribute a significant proportion of acute healthcare to the CCG, including more than half of all day cases. This improves the choice for patients and the scope for innovation in terms of healthcare provision. In order to give patients as much choice as possible about their care, all appropriate referrals made by GPs into secondary care services are routed through our Clinical Assessment Service (CAS). The CAS offers a choice to patients about where they would like to go for their appointment.

Our Commitment to Quality Clinical commissioning groups are in a unique position to improve the quality of services they commission for their patients. GPs have direct access to feedback from their patients and can use this to identify areas for improvement, improve health and change lives. The NHS Constitution lays out the NHS’s commitment to quality of care and to ensuring that high quality care is safe, effective and focused on patient experience. Working in partnership with our local clinical commissioning groups we have established a shared quality team, whose role is to ensure that we fulfil this commitment to quality and promote the values of the NHS Constitution with our patients, staff and members of the public. The Governing Body of each of the three South Nottinghamshire CCGs uses the Manchester Patient Safety Framework (MaPSaF) to determine the safety culture of the organisation. This forms the basis of the Quality Strategy, which sets how we will ensure quality is at the heart of commissioning and provides a governance framework for achieving this. We firmly believe that primary care is the cornerstone of improvement across the local NHS, and our highest organisational priority is to transform primary care and general practice. We want to ensure an equitable standard of GP services, particularly in relation to access, and a formalised, systematic approach to both preventative care and self-care support.

12 Patient Safety In response to the Francis Report and subsequent landmark publications from Professor Don Berwick and Sir Bruce Keogh examining patient safety in the NHS, we established a task and finish group with specific responsibility for reviewing the recommendations and undertaking a gap analysis. As a result an action plan was implemented during 2014 to ensure we are fully compliant as a commissioning organisation. The Quality and Risk Committee will now review the latest Francis Report, which looks at whistleblowing in the NHS. The committee will identify any further action required by the CCG or our commissioned services in order to meet the recommendations. The safety and welfare of children and vulnerable adults is a priority for clinical commissioning groups across all commissioned and contracted services. Under our arrangements with other local clinical commissioning groups, safeguarding committees for children and vulnerable adults have been established which have embedded safeguarding governance and accountability arrangements across the clinical commissioning groups in Nottinghamshire. The Multi Agency Safeguarding Hub (MASH) has also been developed, which secured commitment from all local clinical commissioning groups to work in partnership with the local authority and other agencies to ensure prompt information sharing across the health community. MASH is the first point of contact for new safeguarding concerns and has significantly improved the sharing of information between agencies, helping to protect the most vulnerable children and adults from harm, neglect and abuse. We are also statutory members of the Nottinghamshire Safeguarding Adults Board. The Department of Health’s review of Winterbourne View Hospital sets out specific actions for the care of patients with learning disabilities and provides a salutary reminder of the failings in care for this group of vulnerable people. A county-wide Winterbourne View Project Group has been established which reports to the Safeguarding Committee. A team of experts was commissioned to review all individuals who were inpatient at 1 April 2013 and determine whether they were ready to move from hospital accommodation. Individual plans were then put in place to move those ready for discharge by the end of May 2014. Care and treatment reviews continue for individuals admitted after 1 April 2013 and we are committed to commissioning more community based services for this cohort of individuals. Nationally and locally, the quality of care delivered to individuals in care homes has had a high profile. Clinical commissioning groups in Nottinghamshire together with the local authority and the Care Quality Commission (CQC) set up a strategic review of the care home sector in Nottinghamshire. One of the group’s aims was to establish the details on current care home provision and identify any gaps in provision. We jointly developed a quality assurance framework with our local authority colleagues so that we can monitor the quality of services provided and support continual improvement. Locally, we established a Care Homes Group, which proactively monitors standards in care homes. The group is able to identify early warning signs of deteriorating standards and collect intelligence from clinicians, enabling resources to be targeted appropriately. Links with the local authority team were strengthened, allowing for joint visits, pooling of resources and information sharing, which enables effective timely interventions for care homes of concern.

13 With our main providers of health services we developed our capability to proactively scan quality data and redeployed staff to bring added rigour to this process. We combine business intelligence, survey results, patient feedback, complaints, incidents and Patient Advice and Liaison Service (PALS) contacts to give us an overall picture of our services. We hold providers to account for quality through regular quality scrutiny panels and quality visits. We actively encourage patient representatives and lay members to take part through the use of a bank of lay members who attend quality reviews and quality visits, as they provide an invaluable patient perspective on quality. We take patient stories to every Governing Body meeting to understand the human factors in delivering safe, quality services and the real impact on patients and their families when these are not delivered to an acceptable level, as well as acknowledging where services performed well and met their needs effectively. Patient Experience The NHS Constitution states that the delivery of high quality care is dependent on feedback and that organisations that welcome feedback from patients and staff are able to identify and drive areas for improvement. Within our Quality Team we have staff who are skilled in seeking and responding to complaints and patient experience. These staff analyse complaints, compliments, stories and patient satisfaction surveys. We have implemented the Patient Association standards and peer review methodology for the management of complaints and during 2014 implemented a Commissioning for Quality and Innovation (CQUIN) scheme across all our providers to improve complaints management using peer review. We also implemented an electronic issues log which enables GPs and other clinicians to capture real-time feedback from patients. All issues recorded are analysed for trends or patterns and this can then be incorporated into the quality and contract meetings with our providers. Our engagement lead works closely with the Patient Experience Team to ensure that we capture all feedback from patients and the public to identify areas of improvement and any lessons to be learned. Clinical Effectiveness Clinical effectiveness is about delivering the best possible care for patients through timely and appropriate treatments, but also ensuring the right outcome for patients – ‘right person, right place, right time’. Clinical effectiveness is made up of a range of quality improvement activities and initiatives including evidence, guidelines and standards to identify and implement best practice and quality improvement tools such as clinical audit in order to review and improve treatments and services. These activities and initiatives are based on:  The views of patients, service users and staff  Evidence from incidents, near-misses, clinical risks and risk analysis  Outcomes from treatments or services  Measurement of performance to assess whether the team/department/organisation is achieving the desired goals  Identification of areas of care that need further research  Information systems which can be used to assess current practice and provide evidence of improvement  Evidence as to whether services/treatments are cost effective  Development and use of systems and structures that promote learning.

14 By using these systems and processes there has been a significant reduction in harm from falls and pressure ulcers as a result of using targeted interventions based on thematic review and key learning; a co-ordinated approach to healthcare acquired infection is evident as a result of multi-organisational working and analysis across the healthcare economy; as part of the response to the Francis recommendations providers are reviewing their workforce transparently to ensure effective skill mix and staff is in place to deliver services; regular quality scrutiny panel meetings held with providers ensure that it is possible to discuss and determine action required to acknowledge or enhance the clinical effectiveness of specific services.

Our Achievements During 2014/15 In all areas of our work our key priority is to improve health outcomes for our patients and the quality of care that all of our population receives. There are certain areas that we feel it is extremely important to highlight specifically in this section of the report. These areas are fundamental to shaping the way in which we operate when planning and developing all services for our local population. We fully support the principle that mental health should be given equal priority to physical health (known as ‘parity of esteem’) and are continuing to invest in mental health community services and funding all the mental health activity that our residents need. We are proactively working with Nottinghamshire Healthcare NHS Trust to focus on providing mental health services in the most appropriate setting for each individual. We are also committed to strengthening the interface between mental health services and physical health services and will continue with the implementation of monitoring the use of ‘Physform’ – a physical health checklist for use with patients with mental ill health – to ensure systems are in place to support patients with serious mental illness to access essential physical health checks and interventions. We have funded the Children’s Integrated Commissioning Hub, along with our partner CCGs and Nottinghamshire County Council’s public health and children, families and cultural services to ensure focussed support and development of health services for children and young people, as we know that their needs are different from those of adults. Throughout our work we focus on quality, patient outcomes, patient experience and affordability, and these factors are our main considerations when service improvements and developments take place in Rushcliffe. We want to ensure that we continue to commission high quality, affordable services for our population. The achievements described below detail just how we did this during 2014/15, whilst demonstrating the high standards and expectations we have set for ourselves in coming years.

15 Planned Care Care Closer to Home A key element of improving planned care is moving services out into the community and closer to people’s homes where possible, so enhancing the patient experience. During 2014/15, we piloted a Trauma and Orthopaedic (T&O) Community Triage, Assessment and Treatment Clinic for the lower limb. The pilot, launched in April 2014, was a joint venture between Nottingham University Hospitals’ Orthopaedic Business Unit and St George’s Medical Practice. The clinic is based at St George’s Medical Practice and operates each Wednesday afternoon. The overall aim is to provide a comprehensive assessment for service users with musculoskeletal (MSK) conditions of the lower limb, with the expectation that they will be treated in the community where possible and only referred to hospital when there is a definite need for hospital-based specialist services. The clinic provides a combination of consultant and physiotherapist appointments and requests diagnostic tests such as MRIs where necessary. By March 2015, 665 patients had been seen at the clinic, and it had successfully reduced the number of unnecessary hospital referrals and improved waiting times, delivering increased patient satisfaction and more sustainable working relationships between primary and secondary care. Patient feedback showed that 93 per cent of patients rated the location of the service as good to excellent, and 99 per cent said the service they received was good or excellent. Based on the success of the pilot, we intend to mainstream the service, and in March 2015 began a full procurement, looking to secure a contract for the next three years. During 2014/15 we also looked at GP referral patterns for gynaecology, with the aim of delivering care in the community where clinically appropriate. We piloted a consultant-led ‘virtual clinic’, providing triage of all gynaecology referrals and offering telephone advice and guidance to clinicians. Based on this experience, we are planning to launch a Community Assessment and Treatment Gynaecology Clinic pilot in 2015. This is a joint venture between Circle’s NHS Treatment Centre and Keyworth Medical Practice. If the pilot is successful, we hope to provide the service on an ongoing basis. Update on our Pilot of Dermatoscopes in GP Practices Building on the 2012/13 pilot which involved training GPs to use dermatoscopes to diagnose and triage skin cancers and benign lesions in the practice before referring to hospital, we worked with Circle’s NHS Treatment Centre to introduce teledermatology triage before initiating a referral to secondary care. Under the scheme, a camera is attached to a dermatoscope, enabling images to be taken at the practice and sent electronically for review by a consultant dermatologist. An electronic clinical management plan is sent back when appropriate and patients can then be managed within primary care by the GP where possible. This should improve the patient experience, as individuals will only need to attend the Treatment Centre when secondary care management is needed for the condition, and the pathway will be more efficient.

16 Increasing Community Provision for Mental Health Patients During 2014/15, Nottinghamshire Healthcare NHS Trust worked with all the Nottinghamshire CCGs including Rushcliffe to increase its community provision in Adult Mental Health Services (AMHS) and Mental Health Services for Older People (MHSOP), enabling individuals to remain safely in their own homes and minimise inpatient admissions. For AMHS, the reinvestment of savings made from ward closures allowed the introduction of revised community models, including the development of a virtual ward and the opening of Haven House, a six-bedded ‘crisis house’. Haven House opened in January 2015 and offers sanctuary and short-term support for people in mental health crisis as an alternative to hospital admission. For MHSOP, investment was made in the community team to enable quicker response times for patients by providing additional occupational therapy, community psychiatric nurses and dementia outreach resources, alongside additional out-of-hours clinical cover. Additional resources were also made available for a dedicated Rushcliffe compass worker providing a personalised support service for carers of people with dementia in order that these carers remain mentally and physically well. Urgent Care Care Home Alignment In 2014/15, the Rushcliffe Care Home Programme brought together the CCG, primary care, community services and the independent sector’s Age UK, with the aim of improving care for frail older people. Under the programme, the alignment of ‘one care home to one GP practice’ has seen the majority of care home residents register with their home’s dedicated GP practice. Of the 25 frail older people’s care homes involved, 15 were 100 per cent aligned, and in total 87 per cent of care home residents were registered with their aligned GP practice at the time of writing. The aligned GPs are now providing proactive, pre-arranged fortnightly ‘resident reviews’, which has led to an improvement in proactively managing health care in frail older people’s care homes. Instead of the previous reactive and responsive urgent care service, care is now anticipated and managed proactively. Care home staff have also developed better working relationships with GPs, which ultimately facilitates joined-up health care. Age UK provided independent information about the alignment and the enhanced GP service to residents and families, as well as an advocacy support service. During 2014/15, community nursing teams also supported care homes – both residential and nursing – by providing ‘bite-sized’ education sessions for staff on topics such as continence and catheter care, tissue viability and pressure ulcer management, and falls prevention. Through this work the community teams have become an extended but integral part of the care home team, providing a network of clinical support and information. The combined work of the community teams, primary care and Age UK supported a reduction in Rushcliffe’s overall non-elective admission rate and variance. Figures for the number of emergency admissions to Nottingham University Hospitals from a care home between 1 April 2013 and 31 December 2014 show a steady downward trend. Whereas in previous years the month of December has usually seen a significant increase in emergency hospital admission, in December 2014 the downward trajectory established earlier in the year continued.

17 We also saw a reduction in the number of people dying in hospital. This was attributed, to some degree, to the increased support that care home staff felt from GPs and community nurses, enabling them to care for residents who are at the end of life confidently and competently, supporting a dignified death for those residents who wish to die at home. Medicines Management – Primary Care Pharmacists Undertaking Care Home Reviews During 2014 our Medicines Management team undertook medication reviews with GPs and care home matrons for patients within a care home setting. This work ensured we met the NICE recommendation that all care home patients who are prescribed medication have their medicines reviewed by a multidisciplinary team at least once a year. The reviews provided protected time for the pharmacist, GP and the matron of the home to discuss patients’ medication needs. This enabled them to identify any medication issues a patient may have had, review whether their medication was still required, identify and put in place any monitoring requirements, and respond to any unmet medication needs. The reviews also helped reduce medication waste. The team conducted 345 reviews from January to December 2014, resulting in 991 interventions being made across 11 care homes within Rushcliffe. The reviews provided both a quality and cost effective function, with more than £18,000 being saved in the 12- month period. They also helped foster good working relationships between the pharmacist, GP and care homes. The Medicines Management Team developed a successful business case to employ a dedicated care home pharmacist, who will help the team deliver this high quality service to all care homes within Rushcliffe over the following year. Post 48-Hour Discharge Nurses This newly-established community team provides a telephone and/or home visit by a senior nurse following an unplanned hospital admission. The aim is to reduce readmissions, and figures show the number of hospital readmissions after 24 hours has levelled out. We are now scrutinising readmissions within 24 hours to investigate any actions we can take during that period to help support people safely at home. The team gave a significant amount of support to patients, who benefited from being referred into long term conditions specialist community teams and receiving support with medicines management and community equipment support. The team contacted more than 4,000 patients throughout 2014/15, of which 364 received support to avoid being re-admitted to hospital. The service was evaluated very well by patients and carers. Urgent Care Support Service The Urgent Care Support team continues to provide a valued and supportive crisis response service, preventing hospital admission and supporting timely discharge. The team provides health and social care for patients at risk of hospitalisation, and continually evidenced value for money as well as a quality service that was, according to patient feedback, a ‘life saver’ at times of crisis. The carers in the team are able to provide basic health and social care, including personal care and help with meal preparation. They have received some training in rehabilitation support work, and can encourage and support people to regain or sustain their maximum potential of self-care. They can also provide some simple monitoring such as taking blood pressure readings on behalf of community nurses.

18 They work very closely with the County Health Partnerships community matrons, and the service continues to be a responsive and integral part of both community and primary care services. In 2014/15, the team provided support to 297 individuals. Street Triage Scheme The pioneering Street Triage scheme, launched across Nottinghamshire in April 2014, was named as the winner of the Police and Crime Commissioner’s Partnership Award. The scheme was jointly commissioned by the Nottinghamshire CCGs including Rushcliffe, and was developed by Nottinghamshire Healthcare, Nottinghamshire Police, Nottingham City Council, Nottinghamshire County Council and the Nottinghamshire Office of the Police and Crime Commissioner. Under the scheme, a team of specially-trained mental health nurses work alongside police officers to help people with mental health problems or learning disabilities receive the right care and treatment in an emergency situation. The nurses work with the police to respond to emergency calls from individuals who are in distress or in vulnerable situations because of mental health problems or learning disabilities. They attend callouts in marked street triage cars and can offer immediate, on the spot mental health support. The nurses can also offer telephone advice to police officers and help them refer individuals to the most appropriate healthcare service. In its first year, the scheme supported 156 individuals, and helped to reduce the number of people being detained or taken to a dedicated place of safety for vulnerable people requiring a psychiatric assessment. It also helped to reduce the numbers taken to emergency departments at local hospitals for problems that can be dealt with at home or in the community. Dementia The CCG is signed up to the Carers’ Call to Action, an Alzheimer’s Society initiative, and as such we continue to update and action our Dementia Action Plan as part of this and the Dementia Action Alliance (DAA). The sign-up to the Carers' Call to Action is an individual and/or organisational pledge to endorse the five aims of our shared vision to improve the support for family carers living with dementia. These aims are that carers of people with dementia:  Have recognition of their unique experience – 'given the character of the illness, people with dementia deserve and need special consideration ... that meets their and their caregivers’ needs' (World Alzheimer Report 2013 Journey of Caring – available online at www.alz.co.uk)  Are recognised as essential partners in care – valuing their knowledge and the support they provide to enable the person with dementia to live well  Have access to expertise in dementia care for personalised information, advice, support and co-ordination of care for the person with dementia  Have assessments and support to identify the ongoing and changing needs to maintain their own health and wellbeing  Have confidence that they are able to access good quality care, support and respite services that are flexible, culturally appropriate, timely and provided by skilled staff for both the carer and the person for whom they care.

19 We made considerable progress towards the diagnosis, treatment and care of people with dementia, a priority of the Parity of Esteem Programme, including commissioning additional memory assessment clinics. In March 2014, NHS England set a national target of 67 per cent to ensure those patients who have dementia receive a formal diagnosis and access to support. Our diagnosis rates improved from 46.8 per cent at the end of 2012/13 to 52.7 per cent at the end of 2013/14 and 64.1 per cent at the end of March 2015. A change in the recording of the prevalence of dementia means that our achievement moved to 75 per cent on 1 April 2015. End of Life During 2014/15, the CCG agreed to implement a centralised electronic palliative care coordination system along with the rest of the Nottinghamshire health community. The system was developed and facilitated by Nottingham CityCare Partnership, a local community health service provider. This was in response to Sir Bruce Keogh’s urgent and emergency care review, which stressed that the current health care system is under immense pressure and requires a fundamental shift in the provision of urgent care, and that a long-term plan for better care outside Emergency Department services is required. It also identified that CCGs are now under more pressure to prevent hospital admissions and reduce the number of hospital deaths. Information about current medication, advance care plans, ‘do not attempt cardio pulmonary resuscitation’ status and preferred place of care for end of life patients is now being shared with other frontline services by all Rushcliffe GP practices. In addition, all practices are now recording this information about patients in their last 12 months of life in a standardised and systematic format, and this is being used to support patients to remain in their preferred place of care, keeping them at home if they wish and preventing an unnecessary and unwanted hospital admission. During 2015/16 practices will be working towards identifying the people in their registered population who are near the end of their life.

20 Primary Care Launching our Enhanced General Practice Specification One of Rushcliffe CCG’s highest organisational priorities is to transform primary care and general practice. To support this aim we launched our enhanced general practice specification in November 2014. The specification is being used as the mechanism to improve the quality and consistency of general practice, offering equity for patients registered with a Rushcliffe practice and introducing new investment. It was launched in response to the feedback we received from our comprehensive survey of all households registered with a Rushcliffe GP practice (see the Patient Engagement section of this report for more detail). Our first objective was that all practices would operate the standard core contract opening hours of 8am to 6.30pm, Monday to Friday. There is also a requirement for all practice receptions to be accessible to patients by phone or face-to-face during lunchtimes from Monday to Friday, and to be able to offer appointments every Thursday afternoon. One of our main clinical priorities is to provide the best possible long term condition management. This has been incorporated into the general practice enhanced specification and as a result GP practices will take a standardised, systematic, consistent and proactive approach to understanding their patients’ risk of developing a long term condition or becoming at significant risk of developing one. Long term conditions can result in, among other things, unwarranted, unplanned and avoidable hospital admissions and readmissions. Through the specification, practices will also offer patients support in self-management, individual care planning and shared decision making and a named clinician. By May 2015 all practices were utilising clinical risk profiling tools for atrial fibrillation, chronic obstructive pulmonary disease and heart failure to identify ‘at-risk’ patients, improve patient outcomes, reduce costs and avoid inappropriate treatment. During 2015/16 all patients with a long term condition, if they give their consent, will have the opportunity to agree a personalised care plan with their GP, and we plan to ensure patients will be able to access these online or via mobile tablet devices. Matching GP Capacity to Levels of Demand Rushcliffe GP practices have agreed to undertake a capacity and demand analysis of their GP access. The work is being carried out together with Productive Primary Care Ltd (who support Doctor First telephone consultation), and the analysis will be used to gain an understanding of the demand on GP practices, including the ‘hidden’ or ‘unmet’ demand, and match it to the current capacity. The aim is to identify potential changes we can make to extend the capacity and as a result reduce the demand for non-elective urgent care, particularly within Emergency Departments. The themes identified so far include:  Seven to eight per cent of the practice population receives direct care or advice each week.  Matching the GP capacity to the times and days when demand is higher should be considered, also taking into account the level of staff expertise at times of peak demand.

21 Embankment Primary Care Centre In October 2014 four Rushcliffe GP practices – Ludlow Hill Surgery, Compton Acres Medical Centre, Southview Surgery and Trent Bridge Medical Practice – merged to work together as Castle Healthcare Practice. The newly-formed practice and Musters Medical Practice (previously on Musters Road) both moved in to new custom-built premises on Wilford Lane, known as Embankment Primary Care Centre. All the GPs from the previous five practices moved into the new building and the merged practice now offers patients a wider choice of GPs and extended opening hours. The Centre includes an on-site pharmacy as well as separate areas for the two practices and a range of clinic and treatment rooms. As a result of these changes NHS England approved the variation to the CCG’s Constitution in November 2014, reducing the CCG’s member practices from fifteen to twelve. The CCG supported the merger throughout and recognised the benefits for the registered population that it has brought. Seven Day Services – Prime Minister’s Challenge Fund: Urgent Care Weekend Pilot Service During 2015 we have been piloting a new urgent care weekend service, which was introduced in response to views given as part of our major patient survey in 2014, and our subsequent successful bid to the Prime Minister’s Challenge Fund (a national allocation of money designed to improve GP access). The service, which was launched in January 2015, is staffed by GPs, nurse practitioners and receptionists from across the 12 local practices, working together to deliver urgent care to patients registered with a Rushcliffe GP practice. It operates on a Saturday and Sunday morning out of Gamston Medical Centre, chosen because of its central position in the borough, and its strong public transport and road links. Rushcliffe patients who call NHS 111 for urgent health advice can be booked into the service, on the same day, following a triage to determine whether they need a face-to-face GP consultation. The weekend service is only available by appointment and is not a walk-in service. At the time of writing, the pilot had had a successful start, providing high quality care to patients in a timely manner. There had been excellent feedback from those being treated, including: “Very fast, very efficient service, everyone was a pleasure to deal with.” The service was being further developed over the following months, with an ambition to support the wider health economy as far as possible, in particular by reducing the pressures on hospitals. It was planned to run until the end of September 2015, when it will be fully evaluated and a decision taken about its future.

22 Supporting People with Learning Disabilities In 2014/15 we completed our annual Joint Health and Social Care Learning Disability Self- Assessment Framework, which confirmed the positive improvements made during the year, such as the Annual Health Check and the support work carried out by both the learning disability facilitating nurses and the acute liaison nurses, through which we are continuing to help improve the health status for people living with learning disabilities. This also gave information to improve health and social services across the county to support people with learning disabilities during 2015/16, such as aiming to support carers and accessibility via transport to the provision of leisure, arts and cultural activities. In spring 2014, the Rushcliffe Community and Voluntary Service (RCVS) health development worker, our primary care learning disability liaison nurse and our patient and public involvement officer met with Rushcliffe Mencap during their regular sessions, to support people with learning disabilities in completing our patient survey and ensure they had a say. The relationship built between the health development worker and the Learning Disabilities Forum also helped members – who often find it hard to participate in a meaningful way in engagement activities – to attend Unwind your Mind and a coffee and chat event. Information Technology Developments Rushcliffe has taken a lead role in piloting innovative IT functionality which will greatly benefit NHS care providers and patients, not only within our local health community but across the whole of Nottinghamshire. During 2014/15 we implemented services and systems locally to allow Rushcliffe GP practices to work together on the following:  Obtaining consent to share patients’ medical records for clinical care and consultation  Standardising and improving back office functions, such as recalling patients for chronic disease management and reporting  Utilising standardised templates to improve the quality of clinical data entry and referrals to secondary care. Enabling this interaction and information sharing between Rushcliffe GP practices allowed the local GPs to have access to a patient’s record when working in the Prime Minister’s Challenge Fund weekend pilot service (see above). This greatly enhances the quality of care that is delivered. Rushcliffe is also the first CCG in Nottinghamshire to begin providing GP data from a patient’s record (with their consent) to the Medical Interoperability Gateway (MIG). The MIG enables connectivity between a broad range of primary, secondary and out-of-hours systems, allowing clinicians to provide enhanced care through better access to key areas of the medical record.

23 Improving Outcomes for Children and Young People Nottinghamshire School Nursing Review The CCG was proactive in engaging colleagues in a school nursing review and the proposed remodelling of the service. The commissioning was led by Public Health and the CCG actively disseminated information and assessed the proposed model at Clinical Cabinet meetings. It is possible that the proposed new model may have a negative impact on some primary care functions, such as incontinence work with children of school age, so the CCG is working closely with Public Health and the Children's Integrated Commissioning Hub to identify alternatives and funding if required. A new model will be in place from October 2016 and procurement will begin in 2015. Child and Adolescent Mental Health Services Review We were actively engaged in the review of Child and Adolescent Mental Health Services (CAMHS) across Nottinghamshire. The review, led by the Children’s Integrated Commissioning Hub, reported a range of strengths but also identified significant challenges. A new service model is being finalised and the CCG is working closely with the Hub to agree implementation and investment plans for 2015/16. Maternity Services Review A review of Nottingham University Hospitals NHS Trust’s maternity services was carried out jointly by Rushcliffe, Nottingham North and East, Nottingham West (led by the Integrated Commissioning Hub) and Nottingham City CCGs. This provided assurance about the quality of services locally, but also identified areas for improvement. An implementation plan and steering groups were established to drive forward the improvements identified. Health Services for Looked After Children At the time of writing, Rushcliffe CCG together with the other Nottinghamshire CCGs was working with the local authority and provider organisations to support a whole system review of current pathways and service provision for the health of ‘looked after children’ (children in care). The aim of the review is to understand whether the services being commissioned are fit for purpose, link effectively with each other and provide value for money. Actions include reviewing service provision, auditing the accuracy of data, analysing current and forthcoming legislation, and undertaking a full-scale health needs assessment. Children and Families Act 2014 – SEND Reforms The Special Educational Needs and Disability (SEND) reforms outlined in the Children and Families Act 2014 are focused on outcomes for children and young people with SEND and how education, health and social care work together to help children and young people aged 0-25 achieve the best outcomes. Between September 2013 and January 2015, 57 children and young people from Rushcliffe were referred for an education, health and care plan. At the time of writing in March 2015, 32 had a plan in place or in development. Since September 2014 CCGs have been required to work with local authorities (LAs) to:  Commission services jointly for children and young people aged 0-25 years with SEND, including those with education, health and care plans  Ensure that procedures are in place to agree a plan of action to secure provision which meets children and young people’s ‘reasonable’ health needs in every case  Contribute to the local offer  Ensure mechanisms are in place to ensure practitioners and clinicians will support the integrated education health and care assessment within 20 weeks

24  Agree personal budgets. It is also recommended that a CCG should have a designated medical/clinical officer to support it in meeting its statutory responsibilities and have a joint resolution process in place. The Children’s Integrated Commissioning Hub is delivering this work on behalf of Rushcliffe CCG and, through reporting, providing assurance that the CCG is meeting its statutory duties. Integrated Community Children and Young People’s Healthcare Programme (ICCYPH) The ICCYPH is integrating 14 services into one, to improve the commissioning and delivery of services to children and young people with acute and additional health needs. The vision is to enable children and young people with such needs, including disability and complex needs, to have their health needs met wherever they are. The services will support the child’s life choices rather than restricting them, and improve the quality of life for children and their families. Work carried out by March 2015 included a range of engagement with service users, providers and other stakeholders to co-produce outcomes and an integrated service specification. A new integrated service will be in place following procurement as part of the community services tender by April 2016. This is a Mid and South Notts programme of work, with Rushcliffe as a stakeholder.

Patient and Public Engagement Involving patients and members of the public in shaping and planning local services is a key function of the CCG. Patient representatives sit on a number of our work streams, steering groups, task and finish groups and statutory groups, and they bring the patient perspective into all aspects of the CCG. At present we have 27 members actively involved within task and finish or steering groups, with some members on more than one group. There are 281 people on our mailing list for patient forums covering cancer, carers, diabetes, learning disabilities, mental health and wellbeing and 50+ health. There are 1,157 people on our engagement database and a number of people are also involved through patient participation groups within GP practices. To ensure that our services meet the needs of the people who use them, we run a wide range of additional activities to involve and engage people from across all our local communities. Some other examples of our patient and public engagement work during 2014/15 include: Transforming Participation in Health and Care During 2014/15 the patient-led task and finish group, set up to take forward the work under the Transforming Participation in Health and Care guidance, made a number of recommendations from the scoping exercise of patient and public involvement in the CCG:  The CCG should undertake a review of its engagement and communications function to maximise the benefits of the extensive PPI activity already happening and to give opportunities to improve it further.  The CCG should review the patient groups and health forums to ensure that they represent the disease prevalence and demographics of the local population.  The CCG should support PPGs to establish a common operating framework which would create more consistency across the CCG.  PPGs should develop a mechanism to understand what patients are saying about how they are involved in their care

25  The CCG and PPGs should work together to identify and develop local champions and to provide relevant training and coaching for those who take on leadership roles Using the tools and case studies contained in the guide, a comprehensive workplan has been developed to take forward these recommendations with actions allocated to individuals or groups to progress. The Patient Cabinet is the steering group for this work and monitors progress against the plan on an on-going basis. This work is an important part of the CCG’s compliance with its statutory duty to involve patients and the public effectively and systematically Patient Experience and Engagement: the Rushcliffe Patient Survey April 2014 saw a major patient engagement initiative for the CCG, with a questionnaire on future options for primary and community healthcare services posted out to all 66,141 households. The survey included questions about new technologies for communicating with doctors and practice nurses, as well as options for visiting other local practices and receiving specialist care closer to home rather than in hospital. The questionnaire was also available online, and was widely publicised and promoted through schools, sports clubs, libraries and stakeholder organisations. The responses were managed by Seymour Research, an independent, external research company, to ensure transparency and impartiality. The response rate was fantastic with more than 14,000 returns, representing a 22 per cent reply rate. Follow-up focus groups were undertaken by Seymour Research to gather more in-depth intelligence from different patient perspectives: from working people, carers, people with long term conditions, parents, university students and young people. At the end of 2014/15 we were still developing plans to respond to everything that our patients said, but together with local GPs and other healthcare providers we had already made some big changes. For example, the survey showed that weekend GP sessions, even at another practice, were the most likely to be rated as very or extremely useful for accessing urgent healthcare outside of standard ‘opening hours’. The Prime Minister’s Challenge Fund weekend working pilot that we have now introduced mirrors those patient preferences (see primary care section above for more details). The responses also showed that people with health conditions such as diabetes and heart disease were more likely to say it’s important for them to see the same GP or other professional for all their health needs. We are now working with all the Rushcliffe GP practices through an enhanced specification (see primary care section above) to ensure that patients with long term health conditions receive consistent and high quality care, no matter which practice they are registered with. Each patient with a long term health condition will also be supported to understand and manage their own health better and will be given an individual care plan to improve their overall health and wellbeing. We hope that local people will continue to be involved, to help us develop our further proposals and tell us what they think of the changes. The full survey report is available at www.rushcliffeccg.nhs.uk.

26 Mystery Shopper The CCG supported the development of the mystery shopper programme to assess how young-people-friendly health services are. Young people were trained to go ‘under cover’ into primary care services and universal acute settings to assess them against the national ‘You're Welcome’ quality criteria. The findings were due to be shared with the Health and Wellbeing Board and the CCG in spring 2015. Findings in relation to primary care in Rushcliffe including the plans to improve some areas will also be shared locally, both to learn from and celebrate the many examples of good practice. We are hoping to repeat the programme on an annual basis with support from other CCGs and the Children's Integrated Commissioning Hub. Events with Healthwatch We held a series of three public ‘coffee and chat’ events between April and October 2014, in partnership with Healthwatch Nottinghamshire and RCVS. The two-hour events were supported by volunteers and colleagues from PALS, patient participation groups and other local organisations. Each was held in a different community, at an accessible venue, and publicised by the local groups and networks. In total 120 people came along and the comments made covered a wide range of services and themes. Only GP, hospital and ambulance services were discussed at all three events. Sunday Funday Our regular jointly funded event with Rushcliffe Borough Council was attended by more than 4,000 people in September 2014. We invited local support groups, NHS services, charities and partner organisations to promote good health and wellbeing for patients and carers, and mini health checks, advice and guidance were on offer from local practice nurses, community staff and specialist nurses. The CCG provided visitors with a free first aid bag along with a ‘Treat yourself; a self-care guide to minor illnesses’ booklet, and invited them to spin the ‘Choose Well Wheel’ – a fun and engaging way to learn about picking the right NHS service in any given situation. Supporting Carers The carers forum worked closely with the CCG to commission the Carer and Self-Care support service, which will be delivered through the Carers Federation. Two dedicated part- time support workers cover the Rushcliffe area, working closely with our GP practices and supporting individual carers. Each GP practice has a dedicated carers champion and a promotional banner to encourage carers to identify themselves to the practice. Countywide carers roadshows, funded through the Nottinghamshire Carers Implementation Group, were held at various locations with more than 690 people attending and 110 carers requesting more information.

27 Wider Public Engagement Through Rushcliffe Community and Voluntary Service (RCVS) Loneliness Leaflet The Mental Health and Wellbeing Forum, facilitated by the RCVS health development worker, met in February 2014 to discuss feedback from the October 2013 Unwind Your Mind event. This included a suggestion for a signposting card for people who were feeling lonely or isolated. An RCVS staff member put together information on services including befriending, counselling, support with transport, social and leisure services, volunteering opportunities and support groups, and printing was arranged by the CCG. The card is now widely displayed in libraries and GP surgeries and distributed by health and social care professionals. Falls Guideline Members of the Rushcliffe 50+ Forum Health Group, facilitated by the RCVS health development worker, were involved in the development of a new national resource from the College of Occupational Therapists – ‘Occupational Therapy in the prevention and management of falls in adults – practice guideline’. The guideline cites the involvement in each phase of the project, and includes several quotes from forum members, who participated in discussions at forum meetings and a focus group facilitated by Kate Robertson, Consultant Therapist in Falls Prevention. Supporting Young People Sutton Bonington University Students Our patient and public involvement officer worked closely with the student guild at the University of Nottingham’s Sutton Bonington campus to provide information for the new student intake booklet, including how to register with a GP and access other local health services. Mega Mash Up A ‘Mega Mash Up’ event was held in August 2014 by Positive Futures, which supports young people in Keyworth, Radcliffe on Trent, Bingham and Cotgrave who have been identified by schools and local partners including Targeted Support, Sure Start and Child and Adolescent Mental Health Services (CAMHS). The event aimed to address health issues with input from services including nutrition, smoking cessation, oral health and partners such as CAMHS. The majority of the young people attending were aged 10-14. The CCG took the ‘Choose Well Wheel’ to help the young people learn about different NHS services, and a leaflet which was developed for young people by the YouNG network group (supported by the CCG and Rushcliffe Borough Council) and which features seven different superheroes representing NHS services was also discussed and handed out on the day.

28 Linking With Libraries Libraries are ideally placed at the centre of communities, and we worked closely with the county council’s library services to promote patient and public engagement. Unwind Your Mind Event This regular partnership event held by the CCG, the library services and RCVS during mental health awareness fortnight each October aims to raise awareness of mental health services. Each event follows on from the previous year’s and includes feedback from attendees to ensure it is relevant, up to date and informative. On the day in October 2014, the library had an extra 432 visitors. Activities included paper craft and vintage fabric workshops, a launch of ‘memory lane bags’ from the library service, information stalls and a repeat of the ‘happiness tree’, where people could write onto a paper leaf the things that make them happy. Rural Health The patient and public involvement officer and the health development worker regularly join mobile libraries to provide rural villages with booklets and information packs. During 2014/15 they also linked with local coffee mornings in Gotham, Cropwell Bishop and Barnstone to ensure that information was readily available. Sound Doctor (COPD) Following on from the successful Sound Doctor diabetes event in February 2014, we worked with the local Breathe Easy group to organise another event, this time held at West Bridgford Library and focusing on chronic obstructive pulmonary disease (COPD). The CCG has subscribed to the Sound Doctor website to allow local residents access to this dedicated resource for supporting self-care. Health Hub January 2015 saw the launch of the first health hub within Nottinghamshire, created in partnership with the library service. The hub is a dedicated area within Bingham library which supports health promotion awareness and hosts health related books, information and local literature. A dedicated web page also offers support for self-care. We hope that by the end of 2015 there will be further health hubs in the East Leake and West Bridgford libraries. How to Get Involved and Keep in Touch As a result of the feedback from the Patient Survey, we reviewed the membership of our Patient Cabinet to reflect the groups in our population. We have started to recruit to some new roles representing these groups:  Children and Families  Teenagers and Young People  Working Age  Retired  Carers Our aim is to ensure that the Patient Cabinet is truly representative of the population the CCG serves. We will be making much greater use of our website and social media to further improve our patient and public engagement in 2015/16. There are many other ways that you can get involved with the CCG, keep in touch and have your say on how services are developed. Whether it’s coming along to meetings or receiving regular updates about our work, it’s up to you:

29  Health Network – sign up to become a member of our forum and receive regular newsletters, surveys and updates about what’s happening across the CCG. For details call 0115 883 7880 or visit the ‘Get Involved’ section of our website. There are currently more than 1,000 patients signed up to the Health Network and all members receive a link to an e-bulletin every month with items of interest to patients within Rushcliffe, news from the CCG and details of opportunities to get involved (for example consultations and patient forums), upcoming events, newsletters and reports and useful information and updates. The e-bulletin is well received in the community and feedback from patients is that they find it informative, relevant and readable.  Join our patient forums. For details please contact Sue Knowles, Health Development Worker, Rushcliffe Community and Voluntary Service on 0115 969 9060.  Log onto our website at www.rushcliffeccg.nhs.uk  Follow us on Twitter @NHSRushcliffe  Look out for our news articles in Rushcliffe Reports. A copy of this magazine is delivered to every house and business in Rushcliffe.  Contact your GP practice for further details of their patient participation group.

Development and Performance of the CCG for 2014/15 and in the Future

Our Performance We worked hard throughout the year to meet the national targets that were set. Specific details of our performance during 2014/15 are as follows: 18 Weeks from Referral to Treatment The patient right ‘to access services within maximum waiting times, or for the NHS to take all reasonable steps to offer patients a range of alternative providers if this is not possible’ remains a key element of the NHS Constitution in England. During 2014/15 we met or exceeded all the national targets for elective waiting times set by the Department of Health. In the year to 31 March 2015:  93.63 per cent of admitted patients were treated within 18 weeks (national standard 90 per cent).  97.75 per cent of non-admitted patients were treated within 18 weeks (national standard 95 per cent).  99 patients waited more than six weeks for a diagnostics test, which is within the one per cent national tolerance.  97.29 per cent of patients who were still waiting for their treatment had been waiting less than 18 weeks (national standard 92 per cent).

30 Cancer Achieving the national standards for cancer can lead to earlier diagnosis, enhanced patient experience and improved cancer outcomes. In the year to 31 March 2015:  94.28 per cent of patients with suspected cancer were seen by a consultant within 14 days of referral by their GP (national standard 93 per cent).  97.55 per cent of patients received their first treatment within 31 days following a diagnosis of cancer (national standard 96 per cent).  86.16 per cent of patients diagnosed with cancer were treated within 62 days of a referral from their GP (national standard 85 per cent). The CCG continues to work with hospitals to reduce the waiting times for patients in receiving their cancer treatment following diagnosis. Action plans are in place with major hospitals to:  Streamline processes for patients  Increase the numbers of clinical staff available to treat them.  Reduce waiting times for diagnostic tests for patients suspected of having cancer  Increase clinical capacity in anticipation of forthcoming cancer campaigns  Expedite patients referred for treatment into tertiary centres from other trusts Accident and Emergency The national threshold for performance against this standard is that 95 per cent of patients should wait no more than four hours in Accident and Emergency from arrival to admission, transfer or discharge. In the year to 31 March 2015:  87.52 per cent of patients were treated within four hours of attending Accident and Emergency (national standard 95 per cent). The local health community has faced significant challenges in delivering the Emergency Department performance standard at Nottingham University Hospitals NHS Trust. We are continuing to work with the wider Nottingham health community to improve performance for our population. NHS England assessed the CCG as ‘assured with support’, has put in place a programme to support all partners in the South Nottinghamshire locality and will continue to review the assurance level until a sustained period of delivery has been achieved. We recognise this remains a high priority going forward in 2015/16. Ambulance – East Midlands Ambulance Service In the year to 31 March 2015:  71.61 per cent of calls assigned as Red 1 (immediately life threatening cases where a defibrillator is required) were responded to within eight minutes (national standard 75 per cent).  70.20 per cent of calls assigned as Red 2 (immediately life threatening cases) were responded to within eight minutes (national standard 75 per cent).  70.28 per cent of all calls assigned as Red were responded to within eight minutes (national standard 75 per cent).

31 Ambulance Service performance data is at East Midlands level. Performance has been under close scrutiny throughout 2014/15 and we will continue to work with our provider organisation and co-ordinating commissioner NHS Erewash CCG to improve performance in this area through 2015/16. Please see the Governance Statement further on in this report for more detail. Cancelled Elective Operations – Nottingham University Hospitals In the year to 31 March 2015:  Nine elective operations were cancelled at the last minute for non-clinical reasons and not rebooked within 28 days (national standard is zero). We will continue working with our provider organisations to monitor and improve performance in this area during 2015/16. Dementia Diagnosis Rate In April 2014, NHS Rushcliffe CCG was required to submit dementia diagnosis rate targets, against which we were monitored, as part of our formal planning submission to NHS England. The diagnosis rate target for 2014/15 was 67 per cent. This will enable the CCG to achieve the Prime Minister’s target of two thirds of people (based on prevalence data) identified and given support by March 2015. As at 31 March 2015 the provisional achievement figure is:  64.1 per cent of patients estimated to have dementia have been identified. Improving Access to Psychological Therapies (IAPT) As part of NHS England’s national programme on parity of esteem, we worked hard to meet the national ambition on IAPT. The aim was that by the end of March 2015, at least 15 per cent of people with anxiety or depression would have access to a clinically proven talking therapy service (national target is 3.75 per cent achieved in the final quarter of 2014/15), and that those services would achieve 50 per cent recovery rates. In the final quarter to 31 March 2015:  3.87 per cent of patients estimated to have depression and/or anxiety disorders within the CCG had received psychological therapies (national target is 3.75 per cent – i.e. 15 per cent – by March).  59.22 per cent of patients who had completed treatment were moving to recovery (national standard 50 per cent). The recovery rate is the number of people who are moving to recovery, divided by the number of people who have completed treatment, minus the number of people who have completed treatment who were not at ‘caseness’ at initial assessment. An individual is said to be at ‘caseness’ when their outcome score exceeds the accepted threshold for a standardised measure of symptoms. Financial Performance 2014/15 NHS Rushcliffe CCG is set an allocation by the Department of Health (DH), via NHS England, for each financial year. The allocation is split into two main components. These are the programme allocation, out of which the CCG purchases the healthcare it requires for its population, and the running costs allocation against which all CCG operational costs are funded. For 2014/15, the CCG was allocated £129.7 million of recurrent and non- recurrent resources.

32 During the year we achieved all the financial key performance indicators including:  We achieved the delegated duty to keep expenditure within the available resources for the period April 2014 to March 2015.  We kept within the planned running cost (administration and management) allocation of £3.103 million.  We remained within the cash limit for the period April 2014 to March 2015.  We achieved the Better Payments Practice Code (BPPC) of paying 95 per cent of invoices both in terms of invoice volume and value within 30 days.  Delivery of the Quality, Innovation, Productivity and Prevention (QIPP) programme has presented challenges, with the overall financial position being delivered by the initial QIPP plan and additional saving schemes identified in year.  The full financial statements are detailed in Appendix 1 to this report.

Planning for the Future A rapidly ageing population is putting increasing demands on our health and social care services, while rising expectations of our patients and citizens increase the challenge we need to meet. NHS commissioners and providers are working together to identify how we as a local health community, can transform health services across South Nottinghamshire to deliver care within the shared resources we have. We are committed to our priority of improving the quality of health services across our CCG and in order to do this, we engage with and adopt national policies to implement locally. For example, since September 2014 patients in receipt of Continuing Healthcare have had a right to have a personal health budget if they would benefit from one, an option to give those people more choices around the care that they receive.

Health and Wellbeing Strategy The Health and Wellbeing Strategy is a plan to improve health and wellbeing in Nottinghamshire. It is written by the Nottinghamshire Health and Wellbeing Board. This plan is based on the Joint Strategic Needs Assessment (JSNA), which identifies current and future needs for adults and children. Rushcliffe CCG is an active member of the Health and Wellbeing Board and works closely with Nottinghamshire County Council to discharge the functions of the Health and Wellbeing Board in support of the strategy and the JSNA. The Board has identified four key ambitions for the people of Nottinghamshire in its strategy for 2014-17:  To give everyone a good start  To encourage living well  To enable coping well  To encourage and allow working together. In order to achieve this vision, 20 priority areas have been identified, each of which has an action plan attached:

33 A Good Start  Close the gap in educational attainment  Deliver integrated services for children and young people with complex needs or disabilities  Improve children and young people’s health outcomes through the integrated commissioning of services  Provide children and young people with the early help support that they need  Work together to keep children and young people safe Living Well  Improve services to reduce drug and alcohol misuse  Increase the number of eligible people who have a Healthcheck  Reduce sexually transmitted disease and unplanned pregnancies  Reduce the number of people who are overweight and obese  Reduce the number of people who smoke. Coping Well  Ensure we have sufficient and suitable housing, particularly for vulnerable people  Improve the quality of life for carers by providing appropriate support for carers and the cared for  Improve services to support victims of domestic abuse  Provide coordinated services for people with mental ill health  Provide services which work together to support individuals with dementia and their carers  Support people with long term conditions  Support older people to be independent, safe and well  Support people with learning disabilities and autistic spectrum conditions Working Together  Improve access to primary care doctors and nurses  Improve workplace health and wellbeing. Rushcliffe CCG works in partnership with Rushcliffe Borough Council and is an active member of the Rushcliffe Health Partnership. The Health and Wellbeing strategy is an integrated part of the partnership’s planning process and informs agreed actions. The partnership has representatives from the CCG, Rushcliffe Borough Council, local leisure centres, the voluntary sector, health provider organisations such as New Leaf, nutrition services and school nursing and early years centres. More information is available at www.nottinghamshire.gov.uk.

34 System Transformation NHS Rushcliffe Clinical Commissioning Group (CCG) is one of four South Nottinghamshire CCGs along with NHS Nottingham City CCG, NHS Nottingham North and East CCG and NHS Nottingham West CCG. These four CCGs form the South Nottinghamshire Unit of Planning. Whilst overall the citizens of South Nottinghamshire receive safe health and social care, services are not consistently coming together to provide joined up, quality and sustainable systems of service provision for the population served. By 2018/2019 a £100-140 million financial gap is forecast based on current models of health and social care service provision. The South Nottinghamshire CCGs have aligned their plans for 2015/16 with the principles of the South Nottinghamshire Transformation Partnership. The South Nottinghamshire Transformation Partnership was formed to develop sustainable, high quality health and social care services for the future. The partners responded to a national ‘Call to Action’ working in collaboration with citizens to develop a high level five year strategy aimed at reshaping the health and social care system and have started the mobilisation of a collective work-plan of transformational change. The partners are:  NHS Nottingham City Clinical Commissioning Group  NHS Nottingham North and East Clinical Commissioning Group  NHS Nottingham West Clinical Commissioning Group  NHS Rushcliffe Clinical Commissioning Group  NHS England  Nottingham University Hospitals NHS Trust  Nottinghamshire Healthcare NHS Trust including County Health Partnerships  Nottingham CityCare Partnership  Circle Partnership  East Midlands Ambulance Service  Nottingham City Council  Nottinghamshire County Council. The vision developed for South Nottinghamshire is: A sustainable, high quality health and social care system for everyone In the short to medium term the partnership aims to optimise the current health and care system, ensuring improvement interventions are both aligned to and support the incremental building of the new system of care. The objectives of the new system of care are to:  Increase accountability to service users and the people of South Nottinghamshire  Improve user and citizen experience  Support the maintenance and improvement of population health and outcomes  Increase value  Provide integrated systems of care  Ensure sustainability of service provision.

35 The partnership has described outcomes for the desired future state as presented below:  Care organised around individuals, not institutions  The removal of organisational barriers, enabling teams to work together  Resources shifted to preventive and proactive work and care based closer to people’s homes  Hospitals, residential and nursing homes only for people who need to be in these care settings  High quality, accessible, sustainable services based on real needs of the population. The following work streams have been set up to work towards the desired future state:  The Outcome-Based Commissioning Work Stream will enable the move to a new mechanism of commissioning and contracting as a means of enabling the level of transformation needed.  The Primary Care Work Stream will be formed to ensure a consistent approach to primary care sustainability across South Nottinghamshire within the wider context of integrated care provision.  The Urgent Care Work Stream has been formed to develop and deliver a sustainable and quality model of urgent care provision.  The Elective Care Work Stream has been formed to focus on ensuring programmes of transformational change local to individual organisations are being progressed as well as the delivery of system-wide transformational change in elective care.  The Integrated Health and Social Care Work Stream will be formed to deliver a co- ordinated and coherent approach to the development of integrated community health and social care. It will ensure that local transformational change (e.g. Better Care Funds which are being implemented through individual city and county governance arrangements) supports the achievement of the whole South Nottinghamshire ambition.  Enabling work streams have also been set up including: Workforce, IM&T, Communications and Engagement, and Citizen Engagement.  Cross cutting work streams have been set up to underpin the delivery of the work-plan including Finance, Organisational Development and Governance. Multi-Specialty Community Provider In the Rushcliffe area specifically, the health community has been successful in achieving national Vanguard status to develop a Multi-Specialty Community Provider (MCP) as part of the NHS England New Models of Care Programme. This will allow development of an integrated community care service delivering better outcomes and enhanced patient experience.

36 Mental Health During 2015/16 Rushcliffe CCG will continue to develop and improve mental health services to support parity of esteem including the following: Mental Health Crisis Care Concordat In 2014/15 Rushcliffe CCG, alongside the other six Nottinghamshire CCGs, the Nottinghamshire Police and Crime Commissioner, primary care, Nottinghamshire Healthcare NHS Foundation Trust, East Midlands Ambulance Service, Nottinghamshire Police, Nottingham City and Nottinghamshire County Councils as well as a number of third sector organisations, came together in a declaration of support for the Mental Health Crisis Care Concordat. The Concordat focuses on four main areas: access to support before crisis point; urgent and emergency access to crisis care; quality of treatment and care when in crisis; and recovery and staying well. A local joint action plan of how these organisations will work together across Nottinghamshire to improve care for people in a mental health crisis in response to the standards set out in the Mental Health Crisis Care Concordat has now been agreed. Locally, the Concordat has already prompted a number of improvements across Nottingham City and Nottinghamshire, including commissioning mental health awareness training, the award winning Street Triage pilot and the opening of a crisis house. From April 2015 we will continue to implement our action plan and there will be a focus on developing and improving services for children and young people. NHS England Choice Policy for Mental Health Since 1 April 2014 patients with mental health conditions have had the same legal rights as physical health patients to choose where they have their first outpatient appointment. They are able to choose any clinically appropriate provider in England as long as a CCG or NHS England has a contract with them (subject to some notable exemptions that apply). This move is considered a key part of the move towards establishing ‘parity of esteem’ and during 2015/16 we will establish a task and finish working group to draw up an action plan addressing the issues for commissioners and, along with providers and referrers, consider how patients will be best supported to make choices. The Introduction of Access and Waiting Times Standards for Mental Health Services in 2015/16 Improvements towards meeting the first standards will come into effect from 1 April 2015 for achievement by April 2016 and are focused on three areas where timely access to evidence- based care is of particular importance in improving longer term mental health, physical health and recovery-focused outcomes and in reducing distress experienced by individuals and their families. These are:  More than 50 per cent of people experiencing a first episode of psychosis will be treated with a NICE approved care package within two weeks of referral. The standard applies to people of all ages in line with NICE guidance.  75 per cent of people referred to the Improved Access to Psychological Therapies programme will be treated within six weeks of referral, and 95 per cent will be treated within 18 weeks of referral. This standard applies to adults.  Nationally, investment is to be targeted on effective models of liaison psychiatry in a greater number of acute hospitals. From 2015/16, when the Care Quality Commission (CQC) rates acute services, it will include a specific focus on liaison mental health services and mental health care, as well as the quality of treatment and care for physical conditions.

37 During 2015/16 we will ensure that there is accurate reporting of waiting times and that providers are held to account for any breaches of waiting time targets. Transforming Care of People with Learning Disabilities (Winterbourne View Hospital) The CCG will continue to ensure that people with a learning disability receive appropriate and regular assessment and are cared for in the most appropriate setting, and will look to commission services that enable them to remain in their community and close to friends and family. A cross-agency project board is in place and will continue during 2015/16. Regular meetings take place to monitor progress of the transforming care work and focus on any blockages. This group reports to the Integrated Commissioning Group, which is a sub-group of the Health and Wellbeing Board. All individual care reviews have taken place and plans are in place to monitor progress towards discharge. A patient tracker is reviewed at each meeting. This details key milestones and is RAG rated. The local authority has secured additional funding for developing additional local accommodation for people with learning disabilities. Primary Care Commissioning During 2014/15 we applied to NHS England to receive full delegated responsibility for primary medical care under new co-commissioning proposals. The new arrangements will give CCGs greater powers to directly commission primary care services, drive changes in our local health system and unlock the full potential of our statutory duty to improve the quality of general practice for our patients. Our application was approved and we assumed full delegated responsibility with effect from 1 April 2015. This change will enable primary care commissioning to be more responsive and locally sensitive to the CCG’s priorities. The CCG’s primary care transformation will be delivered by the GP Local Enhanced Delivery Specification, which aims to address persistent access inequalities by supporting improvement and standardisation in the quality and delivery of primary care. The service will offer an extended quality and service offer to Rushcliffe patients and support the development of a sustainable base of high quality local practices. It addresses themes of access, long term conditions care, interface with secondary care, relationships with other professionals and integration of care, appropriate use of resources and governance. Better Care Fund The £5.3 billion Better Care Fund (formerly known as the Integration Transformation Fund) was announced by the Government in the June 2013 spending round. It is intended to drive closer integration between services and so improve outcomes for patients, service users and carers. The fund is set up as a single pooled budget for a local area so that NHS and local government work closely together in a type of partnership arrangement to contribute an agreed level of resource into the single pot (the ‘pooled budget’), which is then used to commission or deliver health and social care services. The Better Care Fund (BCF) is a critical part of the NHS two-year operational plans and the five-year strategic plans as well as local government planning.

38 In Nottinghamshire a BCF plan has been developed between the following organisations:  NHS Bassetlaw CCG  NHS Mansfield and Ashfield CCG  NHS Newark and Sherwood CCG  NHS Nottingham North and East CCG  NHS Nottingham West CCG  NHS Rushcliffe CCG  Nottinghamshire County Council Nottinghamshire County Council will host the pooled budget and the money will be jointly managed by all the parties under the terms of a ‘section 75’ agreement that was signed on 31 March 2015. The schemes funded by the partner organisations from the BCF pooled budget are:  Seven day working  GP access  Community care coordination  Support for carers  Reablement/rehabilitation services  Transformation programme  Protecting social care services  Disabled facilities grant.  Care Act implementation These schemes aim to help reduce:  The number and frequency of patients over 65 attending A&E  Patients’ length of stay in hospital  The number of people who are permanently admitted to a residential care home but who could remain in their own home with the right support  The number of patients readmitted to hospital within 91 days of being discharged to a local community ‘reablement’ service. Organisational Development – Fit for the Future As detailed previously in this report, a rapidly aging population is putting increasing demands on our health and social care services, whilst rising expectations of our patients and citizens make us more than aware of the challenge our local health economy faces in the coming years. We know that in order to meet this challenge, we need to equip our staff to embrace opportunities, by supporting and developing them. This will require individual personal development, as well as looking at how we function as an organisation and identifying where there are areas for improvement. The organisational strategy and action plan we have developed in conjunction with the Greater East Midlands Commissioning Support Unit is intended to be an animate document that will evolve as the organisation develops and matures. Using the document as a guide we will continue to bring together culture and values, structure and process, skills review and training, appraisal and feedback, strong leadership and good management to enable us to improve the health and wellbeing of our local population.

39 Financial Plans The CCG’s financial plans for 2015/16 and beyond seek to fulfil the broader strategic objectives, whilst retaining a sound financial position. Rushcliffe CCG will receive 4.94 per cent growth in 2015/16 and the CCG’s financial plan delivers all recurrent outturn pressures. In addition the CCG’s long-term financial strategy:  Plans to make a one per cent recurrent surplus each year from 2015/16 onwards.  Sets aside a one per cent recurrent transformational reserve which will be used on a non-recurrent basis, therefore planning to have a recurrent underlying surplus of two per cent.  Provides for a non-recurrent contingency of 0.5 per cent.  Plans to remain within the CCG’s running cost allocation.  Sets aside a risk reserve each year which will mitigate against any contract/in-year risks. The one per cent non-recurrent transformational fund will be invested in-year, together with the re-admissions and marginal rate emergency tariff resources. The CCG will continue to invest in a strategic manner including the continuation of QIPP pump priming, primary care developments, community care beds and home care investment. Investments will focus on increasing community support provision to enable reduced inappropriate acute admissions and stays to support the achievement of the CCG’s objectives. The Better Care Fund (BCF) will become a pooled budget in 2015/16 (Rushcliffe’s required level of investment is £6.8 million), which brings together local NHS organisations with local government and provides an opportunity to transform local services so that people are provided with better integrated care and support. It encompasses funding to redefine the resource mix between acute sector services and services in the community and preventative setting. The BCF initiative therefore provides an opportunity to support the reconfiguration of local healthcare provision over the coming years and exists within the context of tight financial pressures for both health and local government. In line with parity of esteem and the 2015/16 planning guidance, Rushcliffe CCG is planning real-term increases in mental health spend in line with the CCG’s overall real term funding increase. Additional investments in Improving Access to Psychological Therapies (IAPT), mental health waiting times and the Child and Adolescent Mental Health Services (CAMHS) Crisis Service are included in 2015/16. During 2015/16 the CCG will need to meet an increased Quality, Innovation, Productivity and Prevention (QIPP) target of £4.5 million (3.3 per cent of expenditure) in order to ensure a stable underlying financial position is maintained. The CCG has developed robust recurrent QIPP plans for 2015/16 which will be closely scrutinised by the Finance and QIPP Group. The QIPP schemes are all recurrent and the majority of planned schemes were intended to be operational by 1 April 2015 to ensure maximum delivery of savings. There are a large number of schemes but many are common across the South Nottinghamshire CCGs in line with the strategic footprint of healthcare provision. The main risks to the delivery of the 2015/16 plan remain the delivery of the challenging QIPP target including the delivery of non-elective savings from the BCF investment and the containment of the Continuing Healthcare Provision spend in line with plans. The risk in terms of the BCF investment is that the majority of the CCG’s QIPP will need to be delivered from the investment in the Better Care Fund (BCF) as the transformational fund is reduced in 2015/16. Key risks to the financial plan will continue to be acute spend (for both NHS and non NHS providers), continuing healthcare costs and prescribing. Acute spend linked to winter pressures remains a particular risk. Prescribing costs have been successfully managed over the past few years, delivering relatively large QIPP savings, however the scope for such savings was diminishing during 2014/15.

40 Innovation, Education and Research NHS Rushcliffe CCG is a member of the East Midlands Clinical Research Network and is aware of its statutory responsibilities in this area. For example, together with partner CCGs in Nottinghamshire, the CCG has a process for considering and approving extra treatment costs (ETCs). Throughout 2014/15 the CCG continued to support research, in particular looking at opportunities to develop research capacity and capability in primary care. NHS Rushcliffe CCG and its health community are actively engaged in and benefitting from the work of the East Midlands Academic Health Science Network (AHSN) ranging from the development of evidence-based stroke early supported discharge and community rehabilitation teams through to the Patient Safety Collaborative. Our Chief Officer is on the Board of the AHSN. During 2014, the CCGs within the South Nottinghamshire Unit of Planning asked the East Midlands Academic Health Science Network to produce an evidence-based review of the characteristics of three internationally renowned systems of care (Jönköping, Sweden; Canterbury, New Zealand; and Alzira/Valencia, Spain). The findings in the resultant report will inform the development of new models of care in the local area over the course of 2015/16. NHS Rushcliffe CCG strives to adopt innovative approaches and to enable that we:  Have access to the research and development activities of the range of National Institute of Health Research (NIHR) infrastructure organisations within the East Midlands Biomedical Research Units in Nottingham and Leicester, Clinical Trials Units, the Clinical Research Network and Collaboration for Leadership in Applied Health Research and Care (CLAHRC).  Are members of the East Midlands AHSN, which offers opportunities to adopt and spread research outcomes and evidence-based practice: the translation of research and proven innovation into practice at pace and scale. Membership also enhances networking opportunities and work in partnership across the health economy to create solutions to healthcare challenges.  Are partners of CLAHRC East Midlands, to support the reduction of clinical variation in public health and chronic disease across the patient population.  Are strengthening compliance with evidence-based practice through greater adherence to NICE technology appraisals.  Have named organisational contacts working in partnership with the East Midlands Patient Safety Collaborative to identify priorities to address key patient safety challenges.  Are actively involved in AHSN/CLAHRC research and innovation projects to improve clinical and cost effectiveness in service delivery.  Have defined/are developing key metrics in order to understand organisational performance in relation to invention, adoption and spread.  Have further developed information systems to facilitate sharing of innovative ideas and service improvements.  Are working with industry partners to accelerate the adoption of proven technologies in clinical practice.  Are increasing capacity and capability for research and innovation (e.g. by supporting PhD students), accessing short courses offered by CLAHRC East Midlands (e.g. introduction to statistics, implementing change, evaluation skills etc).  Have identified ‘knowledge brokers’ (clinical champions) to work alongside CLAHRC research teams to facilitate the translation of research to practice.  Have undertaken activities to develop organisational culture to create an environment which recognises and encourages experimentation and investment in innovation.

41  Have worked with East Midlands Leadership Academy (EMLA)/Health Education East Midlands (HEEM) to develop our workforce in relation to leadership for research and innovation.  Encourage providers to ‘innovate’ through the Quality Contract/Commissioning for Quality and Innovation (CQUIN) Schedule. The research topics covered across the Nottinghamshire County CCGs in 2014/15 included dementia (three projects), medicines management (two projects), musculoskeletal disorders (two projects), and cancer, care homes, children, infectious diseases, metabolic and endocrine, psychological therapies, service delivery and skin disorders. As a CCG we also participate via our member practices in many of the research studies undertaken by research bodies. Many of these studies cross organisational boundaries as they relate to patient care. We are dedicated to delivering clinical education for our member practices and hold monthly education events for all member practices. These are open to all staff at the practices. We have a GP lead for education who works closely with the CCG practice nurse professional lead to ensure that the educational and training requirements identified by practitioners and external organisations are delivered through these events. All events are evaluated and feedback influences the content, direction and format of future events. We have supported primary care clinical education through supporting the ‘productive general practice’ programme. This has elements of education and patient safety and is a learning tool for the whole practice. The CCG has also, along with the East Midlands CCGs, funded a post at director level to be part of Health Education East Midlands to ensure that the training and educational needs of primary care are addressed. In addition, the CCG is part of the East Midlands Leadership Academy, which provides education, leadership and organisational support. Two of the CCG’s staff are on clinical leadership programmes. Our commitment to innovation is evidenced in the section on our achievements in this document and our future commitment is reflected in our five year transformational plan.

Resources, Principal Risks and Relationships

Resources In addition to the finances deployed in its commissioning role, the CCG can draw on significant additional resources as part of a wider commissioning network. The organisation benefits from a shared management structure with NHS Nottingham North and East CCG and NHS Nottingham West CCG, which includes shared finance, performance, information and IT, contracting and quality functions. This arrangement ‘hard wires’ collaborative commissioning arrangements and provides the collective CCGs with significant influence in the local health and social care community. The collaboration also enables the CCGs to recruit and retain high calibre staff whilst remaining within challenging management cost envelopes. The three south Nottinghamshire CCGs are also part of a wider network of commissioners that span the whole of Nottinghamshire County and Nottingham City. A forum known as the Collaborative Commissioning Congress hosted by Rushcliffe CCG meets on a monthly basis and includes representatives from City and County Social Care and Public Health. The group is based around a joint memorandum of understanding that ensures that partners are able to learn from best practice and co-ordinate commissioning policy.

42 NHS Rushcliffe CCG is the coordinating commissioner for the contract with Circle Nottingham Limited on behalf of all CCGs in Nottinghamshire. The organisation also holds the service level agreement with Greater East Midlands Commissioning Support Unit (GEM CSU) on behalf of the other CCGs in Nottinghamshire County. The arrangement with commissioning support services is detailed in the relationships section of this document.

Principal Risks The CCG’s Governing Body has agreed an integrated risk management policy and an Assurance Framework (AF). The AF identifies three principal risks remaining as at March 2015 as below:  Failure to provide high quality ambulance services leading to poor patient experience, poor clinical outcomes and high level of reputational risk.  Failure to achieve the four-hour Emergency Department performance target.  Quality assurance and monitoring resources are limited and the risk is that these are targeted at some providers and not others where there are equal or greater risks. The impact would be on individual patients and also on the reputation of the CCG and confidence of the wider public. No new risks were identified during the year although two risks were downgraded and stepped down to the risk registers:  QIPP 2014/15 – expenditure will exceed budget and the CCG will not deliver its required surplus due to QIPP not delivered or not delivered recurrently.  Failure to put in place appropriate arrangements for the management of the Better Care Fund could impact on the financial position of the CCG and the services commissioned for our patients. Work is ongoing to identify any new risks particularly around implementation of the Better Care Fund plan and performance against key performance indicators, primary care commissioning and the financial risks relating to co-commissioning of specialised services and QIPP 2015/16. Further details are included in the Annual Governance Statement in this document. Risk Management The CCG’s integrated risk management policy sets out the Governing Body’s policy for managing principal risks. The policy enables us to have a clear view of the risks affecting each area of our activity, how those risks are being managed, the likelihood of occurrence and their potential impact on the successful achievement of our objectives. The Governing Body has ultimate responsibility for risk management and deciding options to mitigate high risks. It has a duty to assure itself that the organisation has properly identified the risks it faces, and that it has processes and controls in place to mitigate those risks and the impact they have on the organisation and its stakeholders. The Governing Body discharges this duty by:  Identifying risks to the achievement of its strategic objectives.  Monitoring these via the Assurance Framework.  Ensuring that there is a structure in place for the effective management of risk throughout the CCG.  Approving and reviewing strategies/policies for risk management on an annual basis.  Receiving regular reports from the Audit Committee.  Receiving reports for significant risks which might impact on the CCG’s strategic objectives.

43  Demonstrating leadership, active involvement and support for risk management. To facilitate the identification and management of all risks throughout the CCG we have established and regularly populate and maintain a risk register that profiles all objectives and associated risks relating to the business planning and delivery of services. Risks are identified and challenged through a number of different mechanisms.

Relationships In addition to the CCG’s collaborative commissioning arrangements, we enjoy strong relationships with our other key stakeholders. We have a strong track record of excellence in patient and publication participation, which has already been detailed in this document, and we have built a positive working relationship with NHS England. We supported them to discharge their duties in commissioning specialised services and primary care during 2014/15, with primary care commissioning transferring to the CCG from 1 April 2015. Assurance meetings with NHS England take place where we demonstrate our achievements and discuss our challenges for the future. We also participate in System Resilience Groups (SRGs) where all the partners across the health and social care system come together to undertake the regular planning of service delivery. We have some additional support to carry out our commissioning duties. Most of this support is provided by Greater East Midlands Commissioning Support Unit (GEM CSU). GEM CSU provides a range of expert functions ensuring that we minimise the cost of these functions through GEM providing them at scale for us and CCGs in the East Midlands. The future financial environment will introduce new pressures to the Health and Social Care Community. Significant cuts to social care funding have already impacted on the level of services commissioned by Nottinghamshire County Council, and further cuts are planned. The Better Care Fund (BCF) is a critical part of the NHS two-year operational plans and the five-year strategic plans as well as local government planning. The CCG is one of seven Nottinghamshire CCGs working in partnership with Nottinghamshire County Council, which will host a pooled budget jointly managed by all the partners. It is essential that providers and commissioners work effectively together to establish services on a sustainable basis going forward, and as referenced earlier in this document, a comprehensive service planning structure via the South Nottinghamshire Transformation Partnership across the south of the county has been established to deliver the transformational agenda.

44 Sustainability Report

Background What is Meant by Sustainability? Sustainability in this context is about the smart and efficient use of natural resources, to reduce both immediate and long term social, environmental and economic risks. The cost of all natural resources is rising and there are increasing effects on health and wellbeing from the social, economic and environmental costs of natural resource extraction and use. The Mandate for Sustainability Reporting Sustainability has been recognised at a national level as an integral part of delivering high quality healthcare efficiently1. The Department of Health Manual for Accounts2 states that all NHS bodies are required to produce a sustainability report (SR) as part of their wider annual report, to cover their performance on greenhouse gas emissions, waste management, and use of finite resources, following HM Treasury guidance3. The key principle behind this type of reporting is that it provides NHS organisations with an opportunity to demonstrate how sustainability has been used to drive continuous environmental, health and wellbeing improvements in their organisation, and in doing so, unlock money to be better spent on patient treatment and care. Sustainability reporting which is published also enables organisations to showcase their achievements with staff, patients and other stakeholders, providing an opportunity to inspire positive behaviours in the wider community. Furthermore, once established across the board, organisation-wide reporting can constitute a transparent, comparable and consistent framework for assessing their own environmental impact and benchmarking it against that of other NHS organisations and public sector bodies, a commonplace practice in the private sector. A framework for reporting sustainability information as part of the annual NHS financial reporting process has been developed by the NHS Sustainable Development Unit (SDU) and the Department of Health, to support NHS organisations in meeting the above mandate and to help monitor how every NHS organisation is contributing towards meeting the national target of a 10 per cent cut in NHS-wide carbon emissions by 2015, and a 34 per cent cut in the overall national carbon footprint by 2020, in line with the Government commitment made in the Climate Change Act 20084. The guidance for CCGs has been interpreted by the NHS Sustainable Development Unit and is available at www.sduhealth.org.uk/documents/publications/SD_for_CCGs.pdf.

1 NHS SDU: www.sduhealth.org.uk/delivery/measure/reporting.aspx 2 Chapter 2, Section 2.20, in DH (2014). Manual of Financial Accounts 2014/15 3 www.hm-treasury.gov.uk/frem_sustainability.htm 4 A summary of the UK Climate Change Act (2008) key implications for the NHS is available at www.sduhealth.org.uk/documents/resources/Summary_of_the_main_provisions_of_the_climate_CCA.pdf

45 Sustainability Development Management Plan (SDMP) Through 2014/15 the CCG developed a sustainable development management plan (SDMP) in response to the NHS carbon reduction strategy (2009) and the sustainable development strategy for the health, public health and social care system launched in January 2014. This SDMP was adopted by the Governing Body in March 2015. The NHS, public health and social care system has set an ambitious goal to reduce carbon dioxide equivalent (CO2e) emissions by 34 per cent on 1990 levels by 2020 in line with the target set in the Climate Change Act. Given the progress already made between 1990 and 2013 there is still a 28 per cent reduction required to achieve this.

Our SDMP has been developed to set out our vision for becoming a leading green and sustainable organisation, and our key drivers for implementing this vision. It is the framework on which we will effectively respond to the current and emerging environmental, social and economic challenges and risks posed by climate change. The SDMP highlights key areas of focus including:  Governance  Organisational and workforce development  Community engagement  Partnerships and networks  Adaptation  Designing the built environment  Sustainable models of care  Procurement and supply chain

46  Commissioning  Low carbon travel  Water  Waste  Energy and carbon management The CCG’s 2013/14 carbon footprint was used as the baseline on which our SDMP was developed. This sustainability report demonstrates our year 1 progress against this baseline. The baseline encompasses the direct and indirect emissions of healthcare delivery across the entire organisation. The organisation’s corporate baseline footprint for 2013/14 is 87.47 tonnes CO2e. This produces a per employee carbon footprint of 2.76 tonnes CO2e per full time employee per annum. These emissions constitute our minimum annual reporting requirement. As best practice we have also calculated our procurement and commissioning impacts. The 2013/14 total organisation-wide carbon influence through contracts for commissioned healthcare services and procurement of non-healthcare products and services is 52,926 tCO2e. The direct and indirect corporate emissions are small in comparison to the impact of the CCG’s supply chain through commissioned healthcare and non-healthcare goods and services. However, the CCG will demonstrate corporate leadership in sustainability, alongside encouraging sustainability through its significant leverage in the local healthcare community. Emissions from Procurement and Commissioning Contracts

Baseline Emissions (tCO2e) from Total Area Contract Value

Non-healthcare procurement 1,011 Healthcare commissioning and 51,914 procurement Total 52,925 Having established this baseline, we have committed in our SDMP to reducing the carbon emissions from our corporate operations as far as practicable, with a target of reducing by 18 per cent by 2020. We have also committed to encourage and support local healthcare providers to contribute to the national reduction target. To achieve the 18 per cent reduction by 2020, the CCG needs to reduce its direct emissions by 2.6 per cent each year. Influencing reductions in emissions from supply chain, while excluded from UK Climate Change Act targets, is included within the national targets advocated by the NHS Sustainable Development Unit. The process of achieving the carbon emissions reductions from non-directly controlled resource use through non-healthcare procurement and healthcare commissioning is harder to evidence. Large public sector healthcare providers are required to comply with Department of Health and government targets, so we will support and encourage our providers to achieve the same targets.

47 The CCG’s role here will be to support and encourage corporate progress, but also to include requirements in commissioning and service review that ensure that providers’ approach to emissions reduction penetrates all the way down to the service level, and through service design. Supporting the achievement of the higher levels of UK emissions reduction required by the Climate Change Act will require work on developing sustainable models of care which are more efficient than before. With non-NHS and non-healthcare providers the CCG will take a role in supporting and encouraging more consistent approaches to good environmental management and practice through demanding evidence of corporate approaches in commissioning and through systematically identifying key target sectors and contracts for focussed work on improved environmental sustainability. Qualitative and quantitative evidence on actions to drive sustainability through the supply chain through commissioning and procurement activity will be reported, with absolute carbon savings per contract or from providers detailed where possible. A definitive annual report on absolute emissions reductions from procurement is not likely to be possible, due to the lack of resolution of the data and the fact that not all CCG providers report their own emissions annually. However where emissions savings have been identified from our providers, or through service innovation and redesign, these will be reported and celebrated within the CCG’s sustainability report. Our sustainable development management plan includes an action plan that sets out actions we will undertake to achieve our ambitious target of 18 per cent reduction in carbon emissions from our 2013/14 baseline in the year 2020. Included in the SDMP is the CCG’s environmental policy, demonstrating our commitment to preventing pollution and reducing the environmental impact of our activities, and our compliance with all relevant environmental legislation.

48 Summary of Progress

Area 2013/14 2014/15 (totals)

GHG emissions 88.59 76.14 (tCO2e gross)

Use (kWh) 291,909 250,744 Energy in tCO2e 80.62 67.84 buildings

tCO2e/ WTE 2.54 1.79

Consumption 295 216 (m3)

Water tCO2e 0.31 0.23

tCO2e/ WTE 0.01 0.01

Mileage 27,826 29,398 (Km)

Transport tCO2e 6.39 6.71 Expenditure 11,584 12,239 (£) Recycling 2.83 2.49 (tonnes) Recycling 0.06 0.05 (tCO2e) Waste Landfill 0.50 0.34 (tonnes) Landfill 0.12 0.08 (tCO2e) A4 sheets 250,000 240,000 Paper A3 sheets 4,000 8,500

tCO2e 1.09 1.22 Further detail in each area is provided below. Greenhouse Gas (GHG) Emissions Targets and Commentary All the CCG’s emissions are classed as Scope 3 using DEFRA foot printing methodology. This is due to the fact that the CCG occupies rented space in a shared building and neither owns nor leases vehicles. The largest areas of our corporate emissions are through our building energy use and travel. We have established 2013/14 as a baseline year for our organisation’s emissions. We have also assessed our organisation’s emissions as a result of the procurement of non-healthcare products and services and commissioning of healthcare services.

49 We are committed to reducing the greenhouse gas emissions from all our operations by at least 18 per cent by 2020, over a 2013/14 baseline; this is lower than the baseline NHS target in recognition that the CCG currently occupies a grade 2 listed building. We calculated our emissions for 2014/15 and overall, our emissions went down by 14 per cent against our baseline. We are on target to achieve our 18 per cent reduction by 2020. We have a Governing Body approved SDMP with an associated action plan that will help us achieve our targets. Also, we have appointed NetPositive to work with us in implementing the plan. Direct Impacts Commentary Whilst all our emissions are classed as scope 3, we have some direct control over our greenhouse gas emissions including those from building energy consumption, waste arising, water and sewage. As a tenant using energy within the building and as an organisation with travel emissions through staff mileage claims, we incur indirect emissions. During 2014/15 we actively encouraged sustainable travel choices and worked with our staff to encourage energy efficient behaviour. Overview of Indirect Impacts The largest area of emissions for our organisation is from our commissioned and procured services and products. Through developing sustainable procurement and low-carbon commissioning work, we aim to apply expectations on carbon management and resource efficiency in our contracts with external suppliers and providers, contributing to building resilience and making reductions in the embodied carbon of our supply chain. With this we aim to reduce cost risk to the health sector, support services to minimise the potential for incidental public health impacts such as vehicle pollution, reduce environmental damage and improve the design of efficient local health services. We have already taken steps to encourage sustainable transport in our commissioned services. We will encourage and support suppliers to develop their own SDMP or have a simple environmental management system (EMS), such as investors in the Environment (iiE). We will report annually the percentage of suppliers who have an environmental management system (EMS) in place or routinely publicly report the carbon footprint for their organisation.  We aim to commission services that provide care closer to patients’ homes; this helps to reduce carbon emissions by reducing the distance that patients need to travel to appointments.  We also commission care from Nottingham University Hospitals Trust, which provides a free Medilink service for patients and staff. The service runs between the Trust’s two hospitals and stops at two park and ride car parks, thus reducing the number of cars travelling to the hospitals and through the city.

50 Energy in Buildings and Water

2013/14 2014/15 Total 291,909 250,744 Energy Electricity (non- consumption 53,745 37,207 Non-financial indicators (KWh) renewable) Gas 238,164 213,537 Water use (M3) Total 295 216 Sewage (M3) Total 236 173

Targets and Commentary The energy consumed in our buildings is one of our main environmental impact areas. We occupy a grade 2 listed building and there is minimal potential for making the building energy efficient. Our headquarters at Easthorpe House has signs above light switches asking staff and visitors to remember to turn off lights when leaving rooms that are not in use. This helps to reduce energy levels across the building. In 2014/15, we achieved a 16 per cent carbon emissions reduction in energy use against our 2013/14 baseline. Water continued to represent less than one per cent of total carbon emissions. Water resources are increasingly under pressure and increasingly expensive however, so we have included an aim within the SDMP to ensure the efficient use of water as a precious natural resource across our estate. Travel and Transport

2013/14 2014/15 Total mileage 27,826 29,398 Non-financial indicators Owned and 0 (km) leased Grey fleet 27,826 29,398 Total expenditure 11,584 12,239 Owned and 0 0 Financial indicators (£k) leased Grey fleet 11,584 12,239

Targets and Commentary Our travel emissions and impacts for 2014/15 we calculated from staff mileage claims. At the time of writing no detailed assessment or travel plan had been undertaken to establish potential savings or improvements, however we have instigated several measures to support smarter travel choices:  Easthorpe House has two showers available for staff to use, encouraging staff to cycle to work rather than drive. This reduces the number of cars travelling to and from Easthorpe House.  Staff are encouraged to share cars when travelling to other sites. Posters in the reception of Easthorpe House encourage staff and visitors to access and use a local website to share local car journeys.

51  A ‘cycle to work’ scheme has been implemented, which enables our employees to purchase bikes and accessories tax-free through a salary sacrifice scheme.  Web conferencing (Vidyo) is used regularly to facilitate cross location meetings. This has reduced the number of cars on the road and also reduced the travel time lost for staff as well as travel costs. Emissions from our business mileage increased by five per cent in comparison with our baseline during 2014/15. We are developing an active travel plan that promotes the use of public transport, cycling and walking to drive down the emissions as a result of travel.

Waste

2013/14 2014/15 Total 3.33 2.83 (tonnes) Recycling 2.83 2.49 (tonnes) Non-financial Landfill 0.06 0.05 indicators (t) (tonnes)

% 85% 88% recycled

Targets and Commentary We increased our recycling rate by three per cent and decreased the amount of waste sent to landfill by 16.7 per cent over our baseline year.  All offices within Easthorpe House have a recycling bin for paper and plastic. Staff are encouraged to recycle non-confidential items.  We implemented several electronic systems such as Epay and ESR to minimise paper waste.  We hope to further reduce the amount of waste generated by purchasing products with less packaging.

52 Other Impacts

2013/14 2014/15 Total 254,000 248,500 Paper (sheets) A4 250,000 240,000 Paper usage Paper (sheets) A3 4,000 8,500

Paper (tCO2e) 1.09 1.22 Data transmitted (MB) Not available 94,926.32 Data transmitted Data transmitted (tCO2e) Not available 0.94

Targets and Commentary The overall paper usage fell by two per cent from our baseline year, but the emissions went up by 11 per cent. Less A4 paper was used, whilst A3 paper usage went up by more than 100 per cent, resulting in higher emissions. The CCG has implemented some measures to minimise paper use:  We encourage staff to work electronically and only print emails and documents when necessary, which helps to reduce the amount of paper used and saves energy through not using the printer.  Boardpad had previously been implemented with the Governing Body. This has now been rolled out across the Clinical Cabinet, Audit Committee and Remuneration Committee. This reduces the need to print paper copies of meeting documents and the time taken to produce hard copies.  All Easthorpe House printers are set to print double-sided as a default. This helps to reduce the amount of paper used when printing.  ESR (Electronic Staff Record) employee and manager self-service has been implemented, giving all employees the ability to view and update their personal information, such as emergency contacts and bank details. They can also view pay slips, request annual leave, participate in a development review, browse learning opportunities and request enrolment on courses. Managers have access to additional functionality and controls. This reduces paper and time wastage as staff no longer need to scan and email change of circumstance and termination forms. It provides one system for all mandatory training.  We have implemented EPAY, an electronic expense system. This reduces paper and time wastage as there is no longer a need to scan and email paper expense claims. We also monitored data transmitted in 2014/15 and in the coming year we will encourage all employees to attach files only when sending external emails. For internal emails we will encourage staff to share links instead in order to drive down emissions in this area. Last year, emission from this area was twice the amount from waste and water combined.

53 Commissioning and Procurement

Number of Providers with an % of Contract Value Area Environmental Management Covered by Providers System or SDMP with EMS or SDMP Healthcare commissioning and 3 46.6% procurement

Emissions % of CCG Contract kg CO2e Tonnes Total Provider Data Source Value per £ CO2e Contract Turnover Value Nottingham Sustainabilit University Hospitals 53,619,326 0.359 19,249 33.7% y report NHS Trust Nottinghamshire 19,310,868 0.34 6,566 Benchmarks 11.8% County Council Nottinghamshire Sustainabilit Healthcare NHS 18,838,956 0.1126 2,121 11.5% y report Foundation Trust Circle Nottingham Ltd 7,970,962 0.34 2,710 Benchmarks 4.9% Sherwood Forest Hospitals NHS 5,230,816 0.34 1,778 Benchmarks 3.2% Foundation Trust Services commissioned 4,243,098 0.34 1,443 Benchmarks 2.6% through NHS Nottingham City CCG AMG Nursing and 2,793,893 0.34 950 Benchmarks 1.7% Care services East Midlands Sustainabilit Ambulance Service 2,268,547 0.1684 382 1.4% y report NHS Trust

Targets and Commentary The CCG has calculated baseline emissions as a result of commissioned healthcare activities and as of 2013/14 three of our provider organisations regularly report their environmental performance. 46.6 per cent of commissioned spending was with these organisations; they are Nottingham University Hospitals NHS Trust, Nottinghamshire Healthcare NHS Foundation Trust and East Midlands Ambulance Service. We will support and encourage our providers and suppliers to have a simple environmental management system or SDMP and will report annually on the percentage of our providers and suppliers who have one in place or routinely publicly report the carbon footprint for their organisation. We have also calculated baseline emissions as a result of the organisation procuring non- healthcare products and services. Based on this, we will embed sustainability into our procurement policy and encourage and support suppliers to have a simple environmental management system.

54 Governance Arrangements We are committed to using a sustainable approach in commissioning healthcare services and working within the available environmental and social resources, protecting and improving health now and for future generations. To this effect, we will be working to reduce carbon emissions, minimising waste and pollution, making the best use of scarce resources, building resilience to a changing climate and nurturing community strengths and assets. The CCG recognises its responsibility as a sustainable responsible organisation through its actions as a commissioner, employer and public body. We are committed to having a positive impact on the environment, patients, employees and communities within and beyond our usual business activities. We have engaged with our local community working in partnership with Rushcliffe Borough Council to encourage a healthier lifestyle through local events such as Sunday Fun Day held at Rushcliffe Country Park in September 2014. We have continued to support local businesses and support staff to undertake activities including spending time during working hours to support the NHS student online mentoring project led by mentoring charity Brightside working with the National Skills Academy for Health. This involved five staff members mentoring students in years 11 to 13 living or studying in low socio-economic areas over a period of ten weeks to consider their career progression, support them into education and understand the diverse career options available in the NHS. The CCG staff continued to support charities including the Barnardo’s charity through donations of advent calendars at Christmas and Easter eggs at Easter. The CCG has appointed the Chief Officer as the Governing Body lead for sustainability. We will use the Good Corporate Citizenship assessment tool to monitor progress on the less easily quantifiable aspects of sustainable development in financial, social and environmental terms. This will be reviewed annually and reported to the Governing Body. We will work closely with our partners and stakeholders to embed sustainability and carbon reduction into everything we do, from our internal activities to delivering and commissioning frontline services in the communities we serve. To this end we have appointed the internationally award-winning environmental and public health social enterprise NetPositive to support us. We have joined the Investors in the Environment Network, which supports organisations to reduce their direct reliance on increasingly expensive energy and natural resources, cutting costs and emissions, while gaining a visible externally verified quality mark to evidence their progress. Based on our commitment to improving our environmental performance and ensuring environmental management – an integral part of healthcare provision, we have received the Investors in the Environment Silver Award Accreditation.

Social, Community and Human Rights Report

Equality Duty The Equality Act 2010 replaced previous anti-discrimination laws with a single Act. It simplified the law, removing inconsistencies and making it easier for people to understand and comply with. It also strengthened the law in important ways, to help tackle discrimination and inequality.

55 The Public Sector Equality Duty (section 149 of the Act) came into force on 5 April 2011. The Equality Duty applies to public bodies and others carrying out public functions. It supports good decision-making by ensuring public bodies consider how different people will be affected by their activities, helping them to deliver policies and services which are efficient and effective; accessible to all; and which meet different people’s needs All public bodies including CCGs have legal obligations under the Equality Duty to:  Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Act.  Advance equality of opportunities between people who share protected characteristics and those who do not.  Foster good relations between people who share a protected characteristic and those who do not. These are referred to as the three aims of the general equality duty and apply to the following nine protected characteristics:  Race  Gender  Disability  Sexual orientation  Religion and belief  Age  Pregnancy and maternity  Gender reassignment  Marriage and civil partnerships The Equality Duty is supported by specific duties, requiring public bodies to publish relevant, proportionate information demonstrating their compliance with the Equality Duty, and to set themselves specific, measurable equality objectives. In addition, based on the Brown Principles further consideration should be given to:  Understanding and awareness of the duties  Inequalities taken into account before and whilst a decision is being considered  Sound evidence and information underpinning decision-making  Considering the Duty continuously throughout the decision-making process  Keeping sound records and evidence that the duty has been considered The following are steps that have been taken to eliminate discrimination, advance equality of opportunity and foster good relations: Equality Objectives The CCG has the following equality objectives which will be carried forward into 2015/16:  Equality of opportunity – improve staff equality monitoring data and use it to inform future succession planning processes  Eliminate discrimination – have due regard to the Workforce Race Equality Standard as a CCG and as part of the local health economy  Foster good relations – improve patient and public communication by taking into consideration the needs of protected characteristics and by improving information on how and when to use health care services

56  Advance equality of opportunity – improve an understanding of how individuals fare within primary care by expanding on our project to collect equality data through GP member practices  Eliminate discrimination – improve on the decision-making process through effective use of equality impact assessments  Foster good relations – enhance engagement processes as a local health community by working closely with neighbouring CCGs and the acute trust to ensure a wider understanding of how protected characteristics fare against outcomes. Equality Delivery System Through the use of the Equality Delivery System (EDS) over the past three years, the CCG continued to deliver against its action plan during 2014/15 and this will be taken forward into 2015/16. Working in partnership with neighbouring CCGs in South Nottinghamshire, including NHS Nottingham North and East CCG and NHS Nottingham West CCG, a forum has been established to ensure accountability in advancing and mainstreaming equality and to make effective use of resources. The forum forms part of the overall governance structure as a sub-group of the Quality and Risk Committee, chaired by a lay member. During 2014 creative thinking to align the patient journey through primary and secondary care resulted in an arguably unique commissioner-provider partnership between the CCGs and the main acute trust – Nottingham University Hospitals NHS Trust (NUH). This saw NUH’s head of equality and diversity seconded to provide strategic direction across the three south CCGs and aligned with NUH. This partnership approach is unique and fundamentally different to the approach taken by most organisations for two key reasons. Firstly, it involves commissioners and a provider working together. Secondly, it enables equality and diversity as a discipline to really come to life as a reality, affecting the day-to-day work of NHS professionals, linking existing processes directly to the EDS2, enabling the EDS2 to become a living process, rather than just a table-top exercise. Specific achievements during 2014/15 include:  Signing up to the British Deaf Association British Sign Language Charter to improve services for deaf/ deafened and hard of hearing service users  A new equality and diversity policy  The creation of an equality and trans* policy (the policy uses the term trans* as an all- encompassing term and the * is representative of this overarching term)  A new flexible working policy  Effective recording of engagement linked to protected characteristic groups  Improved equality data collection – GP practices taking part in a pilot scheme to collect patient equality monitoring data and surveying patients in the Emergency Department  The implementation of equality engagement surveys to ensure a balanced approach to patient engagement  Being awarded the ‘two ticks’ positive about disability symbol by Jobcentre Plus to show commitment to employ, keep and develop the abilities of disabled staff  The partnership equality conference, which was a specific achievement in collective consultation with the Nottingham health community and diverse minority ethnic groups and communities

57 Linking engagement activities to the EDS2 grading and objective setting process has enabled the partnership to gather a true perspective of how individuals fare and the thoughts, issues and priorities of people from protected characteristic and the Inclusion Health groups which undoubtedly would not have been achieved working as separate entities. Events such as Nottinghamshire Pride, Caribbean Carnival, Muslim Women’s Festival and Nottingham MELA provided one-stop-shop opportunities to gather expert public and patient opinion on current service provision and delivery at the point of care. Through this process, each organisation has learned the benefits of putting individual organisational issues aside and focusing more on patient and employee equality outcomes. By seeing similarities rather than differences, each organisation has been able to retain its own principles, values and culture whilst still being able to fully contribute to the wider partnership goal of a joint approach to the EDS2 and principles of the NHS Constitution. The table below summarises the results of the grading process against the four EDS2 goals:

EDS2 Goal Level Better Health Outcomes for All Developing Improved Patient Access and Experience Developing A Representative and Supported Workforce Achieving Inclusive Leadership Achieving The Equality Delivery Scheme and Action Plan and the EDS2 Grading Report are published on the CCG’s website including the objectives detailed above. Equal Opportunities The CCG aspires to be representative of all the communities it serves and takes pride in being an equal opportunities employer, opposing all forms of unfair or unlawful discrimination. Accordingly it is the CCG policy that no employee or job applicant receives less favourable treatment on the grounds of his or her gender, religion and belief, age, disability, race, gender reassignment, marriage and civil partnership, pregnancy and maternity or sexual orientation (the nine protected characteristics). The CCG operates fair, inclusive and transparent recruitment and selection processes. All vacancies are advertised via the NHS Jobs website. The CCG’s recruitment process includes the following measures in order to minimise the opportunity for discrimination:  Candidates’ personal details are not made available to recruiting managers until after shortlisting has taken place.  A minimum of two people are required to be involved in the shortlisting process.  An interview is guaranteed to any candidate with a disability whose application meets all of the essential criteria for the post (Guaranteed Interview Scheme). The CCG recognises the mutual benefits to both the organisation and its employees with regard to the implementation of flexible working. The CCG has a flexible working policy offering several ways of working flexibly, including part-time working, job share, annual hours, flexible working time, flexible location and flexible retirement. At the end of March 2015, staff were asked to complete a survey ‘Valuing Difference and Promoting Equality’. All 42 staff responded. The results are shown in the table below:

58 Staff in Post at 31/3/15 Headcount Age Age 21 - 40 14 Age 41 - 60 25 Age 61 – 80 1 Did not wish to disclose 2 Gender Female 31 Male 11 Marriage and Civil Partnership Single 5 Married 27 Co-habiting/in a relationship 5 Divorced 4 Ethnic Background British 38 Mixed White and Asian 1 Indian 1 Pakistani 1 Did not wish to disclose 1 Religion and Belief Atheism 10 Christianity 21 Islam 2 Jainism 1 Other 3 Did not wish to disclose 5 Disability No disability 33 Did not wish to disclose 2 Skipped 7 Sexual Orientation Heterosexual 35 Gay 1 Bisexual 1 Did not wish to disclose 5 Maternity or Pregnancy in the Last Year Yes 1 No 39 Did not wish to disclose 2

59 The CCG mandatory training policy identifies the need for all staff to complete equality and diversity training every three years. The CCG has 100 per cent compliance for this training achieved largely through e-learning. Specific training on trans* awareness has also been undertaken. Governing Body and Patient Cabinet members completed their training through a tailored face-to-face training session. In addition, members of the Active Group (chairs of all GP practices’ patient participation groups) were invited to attend the Equality Conference in February 2015. Workforce Equality Standard The CCG is aware of the introduction of the Workforce Race Equality Standard (WRES) from 1 April 2015 which seeks to tackle one particular aspect of equality – the consistently less favourable treatment of the Black and Minority Ethnic (BME) workforce – in respect of their treatment and experience. The evidence is clear that treating all healthcare staff fairly and with respect is good for patient care. Providers must implement EDS2 and implement the National Workforce Race Equality Standard and submit an annual report to their co-ordinating commissioner CCG on progress in implementing the Standard. The regulators, the Care Quality Commission (CQC), National Trust Development Agency (NDTA) and Monitor, will also use both standards to help assess whether NHS organisations are well-led. Clinical commissioning groups will be required to demonstrate progress through the annual CCG assurance process with NHS England. Through the Equality and Diversity Forum the CCG has proactively contributed to the development of the WRES through the consultation process and by attending workshops and has given due consideration to the requirements ahead of the implementation date in preparation for implementing and reporting on it during 2015/16.

Signature of the Accountable Officer I certify that the clinical commissioning group has complied with the statutory duties laid down in the NHS Act 2006 (as amended).

Vicky Bailey Accountable Officer Signature Vicky Bailey

Date 27 May 2015

60 Members’ Report

Our GP Practices The 12 general practices in NHS Rushcliffe CCG are: 1. Belvoir Health Group (surgeries in Bingham, Cotgrave and Cropwell Bishop) 2. Castle Healthcare Practice (created in October 2014 from the four previously separate practices Compton Acres Medical Centre, Ludlow Hill Surgery, Southview Surgery and Trent Bridge Family Medical Practice.) 3. East Bridgford Medical Centre 4. East Leake Medical Group (surgeries in East Leake; Church House Surgery, Ruddington and Sutton Bonington) 5. Gamston Medical Centre 6. Keyworth Medical Practice 7. Musters Medical Practice 8. Orchard Surgery, Kegworth (additional branch at Village Hall Surgery, Gotham) 9. Radcliffe-on-Trent Health Centre 10. Ruddington Medical Centre 11. St. George’s Medical Practice 12. West Bridgford Health Centre

The Governing Body NHS Rushcliffe Clinical Commissioning Group is led by its Governing Body, which includes lay members, GPs, a nurse, a hospital doctor, local authority officers and executive members. The Governing Body has responsibility for ensuring that the organisation has appropriate arrangements in place to exercise its functions effectively, efficiently and economically in accordance with accepted principles of good governance and the Constitution of the CCG. Meetings of the Governing Body take place every other month and are held in public to ensure that decision making is transparent and open. Papers for the meetings are available on our website at www.rushcliffeccg.nhs.uk or by calling 0115 883 7880. Throughout 2014/15 our Chair was Dr Stephen Shortt and our Chief Officer was Vicky Bailey. The following people were members of the Governing Body: Voting Members  Dr Stephen Shortt – Clinical Lead and Chair of the Governing Body  Vicky Bailey – Chief Officer (Accountable Officer)  Sheila Hyde – Lay Vice Chair  Ann Greenwood – Lay Member with responsibility for audit, remuneration and conflict of interest  Ian Blair – Lay Member with responsibility for patient and public involvement  Dr Clive Rix – Lay Member and link to Clinical Cabinet  Jonathan Bemrose – Chief Finance Officer  Dr Jeremy Griffiths – GP Member – Lead for Health and Wellbeing Board  Dr Gavin Derbyshire – GP Member – Lead for member practices  Professor Christopher Hawkey – Secondary care doctor  Dr. Cheryl Crocker – Director of Quality and Patient Safety (to 31 July 2014)  Nichola Bramhall – Director of Nursing and Quality (from 2 October 2014)

61 Non-Voting Members  Jonathan Gribbin – Consultant in Public Health  Andy Hall – Director of Outcomes and Information  Caroline Baria – Service Director, Nottinghamshire County Council (Officer Representative) Statement as to Disclose to Auditors Each individual who is a member of the Governing Body at the time the Members’ Report is approved confirms:  That so far as the member is aware, there is no relevant audit information of which the clinical commissioning group’s external auditor is unaware; and,  That the member has taken all the steps that they ought to have taken as a member in order to make themselves aware of any relevant audit information and to establish that the clinical commissioning group’s auditor is aware of that information.

Biographies The members of the Governing Body are as follows: Vicky Bailey Vicky is the Chief Officer of Rushcliffe Clinical Commissioning Group. The predecessor practice based commissioning organisation Principia – Partners in Health was one of the integrated care pilots for the Department of Health and was also one of the 26 pathfinders for social enterprise. Vicky has worked in director and senior level roles in previous organisations. Vicky is a nurse/midwife by background who has worked in both hospital and primary care settings. She has an MSc in health policy. She was also Chair of the Standing Nursing and Midwifery Advisory Committee, is a trustee of the Queen’s Nursing Institute, was a member of the NHS Future Forum, and was co-chair of the public health work stream. Caroline Baria Caroline has been a member of the Governing Body since November 2013. She is a service director within the Adult Social Care, Health and Public Protection Department at Nottinghamshire County Council. Caroline qualified as a social worker and gained a Masters in social sciences at the University of Birmingham in 1992. Since then she has held a number of posts within Nottinghamshire County Council and Nottingham City Council including the post of Head of Purchasing and Market Management with responsibility for developing and commissioning care services across the county. Caroline has been a service director since 2008, leading the development of a range of health and social care services, including adult safeguarding, and leading on improving quality within care services. More recently, she has assumed lead responsibility for operational adult care services in the south of the county.

62 Jonathan Bemrose Jonathan qualified as an accountant in 1994 and has more than 20 years’ experience of working within health and local authority finance, particularly in social care. His previous roles include Director of Resources for Nottingham CityCare Partnership, where he was responsible for finance, workforce, training, organisational development, support services, estates and IT, Finance Manager at Nottingham Emergency Medical Services (NEMS), which provided him with additional business exposure and experience, and Deputy Director of Finance for NHS Nottingham City Primary Care Trust. Ian Blair Ian was City Treasurer of Nottingham City Council for 10 years until retirement, and prior to that held a similar role in Bath and senior finance posts in the NHS. He has wide experience of the management of public finances both in the UK and abroad. Since retirement, he has carried out a variety of projects ranging from the improvement of financial performance in public bodies to a major study assessing the cost effectiveness of a significant Government policy initiative on the co-ordination of services to the ‘over 50s’. He has served as a trustee on the boards of several local and national charities and is involved with patient participation groups at Nottingham University Hospitals NHS Trust. He has lived in Rushcliffe for more than 20 years and is a widower with two grown up children. Nichola Bramhall Nichola joined us in September 2014 from East Midlands Ambulance Service, where she was Deputy Director of Nursing and Quality for two and a half years. Prior to this Nichola was Deputy Director of Nursing at Chesterfield Royal Hospital where she worked for 11 years in a number of roles including Clinical Teacher, Head of Workforce Review and Head of Nursing. Nichola trained at Guy’s and Lewisham School of Nursing, qualifying as a registered general nurse in 1991. After qualifying she worked at Lewisham, Dulwich and King’s College Hospitals holding a number of roles including ward sister and vascular clinical nurse specialist until relocating to the Nottingham area in 2000. During this time Nichola obtained a BA (hons) in nurse education and also qualified as a registered nurse teacher. Nichola is the Board Registered Nurse and leads the quality team who have responsibility for monitoring the quality (including patient safety, experience and outcomes) of commissioned services for all three of the South Nottinghamshire CCGs. Nichola is the executive lead for patient safety and experience, safeguarding, infection prevention and control, continuing health care, nursing and health and safety. She is also Caldicott Guardian. Dr Cheryl Crocker Cheryl trained as a nurse in Birmingham and has held a number of roles in the acute setting. These include roles as Nurse Consultant and Lead Nurse for the Mid Trent Critical Care Network. She has also worked in the ambulance sector and joined commissioning in 2012. Cheryl is a qualified nurse tutor and worked as a lecturer at the University of Nottingham. She continues to hold an honorary lectureship. Cheryl has received training at the Institute for Health Improvement in Harvard, USA in improvement and safety science. She was also the only nurse to be awarded a fellowship to the NHS Institute for Innovation and Improvement. She therefore has a wealth of knowledge and experience in quality improvement. She remains an Improvement Fellow with the Institute.

63 Cheryl was Caldicott Guardian, lead for safeguarding and executive nurse on the Governing Body and was a member of the Clinical Cabinet, Quality and Risk Committee and IGMT Committee, until she left to take up a new role in July 2014 at the Patient Safety Collaborative, East Midlands Health Science Network. Dr Gavin Derbyshire Gavin works in West Bridgford as a full-time GP. He qualified as a doctor at Nottingham University Medical School in 1988 and completed his GP training in 1992. He worked as Medical Director for SACLA Health Project in Cape Town for four years before becoming a partner of Musters Medical Practice in 1998. He was a board member of Rushcliffe Primary Care Trust and Principia - Partners in Health Social Enterprise and was the GP representative for Principia on the NHS Nottinghamshire County Primary Care Trust Board. He is currently a GP member on the Rushcliffe CCG Governing Body acting on behalf of member practices. He is married with four children. Ann Greenwood Ann is a graduate of Nottingham University with a joint honours degree in chemistry and biochemistry. After leaving university, Ann qualified as a chartered accountant with the Nottingham office of Binder Hamlyn. She went on to work as group financial accountant for part of the Great Universal Stores Group before setting up her own chartered accountancy practice. For the last 23 years she has been Financial Director of Campbell Scientific Ltd, the European headquarters of a US-owned electronics group specialising in data logging systems and scientific monitoring equipment. In addition, for 12 years up to July 2011 she was a lay member of council for The University of Nottingham, sitting on a number of committees including finance and audit, latterly becoming chair of the audit committee. She lives in Rushcliffe and is married with one son. Jonathan Gribbin Jonathan is a consultant in Public Health in Nottinghamshire County where he currently leads on health protection and sexual health and provides support to the Nottingham University Hospitals contract. His other involvements in Rushcliffe are as a member of the CCG Clinical Cabinet, Rushcliffe Health and Wellbeing group and the QIPP team. Before moving into public health, he worked in various parts of the Boots Group in roles ranging from IT and project management to finance and procurement. Jonathan is married with three children. Dr Jeremy Griffiths Jeremy has been a practising GP in West Bridgford since 1997, initially at Ludlow Hill Surgery and now at Castle Healthcare Practice. He originates from Manchester and graduated from the University of Nottingham in 1989. He has been a local clinical leader since 2000, when he was part of the Rushcliffe Primary Care Group. Serving on the Professional Executive Committee for Rushcliffe Primary Care Trust from 2001 to 2006, he lead the work implementing the national programme for cardiovascular disease.

64 From 2006 to 2012, he served on NHS Nottinghamshire County Primary Care Trust’s Professional Executive Committee and was the clinical lead for practice based commissioning in Rushcliffe – Principia, Partners in Health, Social Enterprise from 2006 to 2011. Jeremy is currently a GP Member on the Rushcliffe CCG Governing Body, lead for Health and Wellbeing for Rushcliffe CCG and a member of the Nottinghamshire County Council Health and Wellbeing Board. He also serves on the Rushcliffe Health and Wellbeing group, the Rushcliffe Public Health group and on the Nottingham University Hospital contract clinical advisory board. For two years (from 2012 to 2014) he was lead for the SIGNs Frail Elderly Programme across South Notts. Jeremy has been club GP for Nottingham Forest Football Club since 2001 and is married with two children. Andy Hall Andy is Director of Outcomes and Information for Rushcliffe CCG and has 30 years’ experience working in the NHS. He held various senior posts in Lancashire hospitals before moving to Lincolnshire in 1998 and finally to Nottinghamshire in 2007. Andy previously held posts as Director of Commissioning and Performance within primary care trusts for four years and before that held the post of Director of Information Management and Technology at two separate health authorities. Professor Christopher Hawkey Chris is Professor of Gastroenterology at Nottingham University and was President of the British Society of Gastroenterology 2009/10. He was educated in Oxford and trained at the Middlesex Hospital, London. He has worked at The Central Middlesex Hospital, Northwick Park Hospital, and Brompton Hospital (all in London), the Radcliffe Infirmary, Oxford, and the Queen’s Medical Centre, Nottingham. Chris’ research interests include COX-2 inhibitors and inflammatory bowel disease. He is/has been lead investigator on several large pivotal studies including the 18,500-patient TARGET study of lumiracoxib, the 120,000-patient HEAT study in aspirin users and the ASTIC trial of stem cell transplantation in Crohn’s disease. He has never won any major awards (but is open to offers) although he was once identified as the UK’s most highly cited investigator in gastroenterology and hepatology. Sheila Hyde Sheila Hyde was the Managing Director of Spirita Housing Association, which managed homes and related services across the East Midlands. It included the former Rushcliffe Homes, of which she was previously Chief Executive. Before the transfer of the Rushcliffe housing stock she was Head of Housing at Rushcliffe Borough Council. She has a master’s degree in housing and has extensive employment experience in the not-for-profit, local authority and voluntary sectors in a range of roles. Sheila also has wide governance experience as an executive and non-executive director, and is a board member of two housing associations. She has lived in Rushcliffe for more than 25 years and is married with two grown-up children. Sheila brings an in-depth understanding of the needs and issues relevant to Rushcliffe and a strong track record of working in partnership to achieve the best outcomes locally.

65 Dr Clive Rix Clive is a freelance business adviser in the fields of strategic planning, marketing and regulation. He is also a part-time teaching fellow in the Department of Mathematics at the University of Leicester. He was Chief Business Adviser to the UK Competition Commission until 2002 and before that was Head of Marketing Operations for British Coal, leaving after privatisation in 1996. He has had non-executive links with the NHS locally since he moved to Rushcliffe in 1996, having been an independent lay chair on complaints panels until 2004, a director of Rushcliffe Primary Care Trust from 2005 to 2006, and Chair of Principia - Partners in Health from 2006 to 2012. He is Treasurer of Nottingham Credit Union, having previously been Chair, Chair of the East Midlands Credit Union forum and a director of ABCUL, the national trade body for credit unions. He is a vice chair and member of the Audit Committee at Central College Nottingham (formerly South Nottingham College), having been Chair of Castle College, Nottingham before the merger between the two colleges. He holds a first class honours degree in mathematics from the University of Cambridge and a PhD from the University of Bristol in the history and philosophy of mathematics. Dr Stephen Shortt Stephen has been a GP principal at East Leake Medical Group since 1992. He graduated from Nottingham University Medical School in 1986 and then gained experience in a number of hospital specialities at Queen’s Medical Centre and Nottingham City Hospital and in local general practices. He established NEMS in 1998 and NHS Direct in 1999, becoming its medical director. He established the Nottingham walk-in centre in 2000. He became a GP advisor to the Department of Health in 2000 and undertook a two-year secondment as a senior policy advisor in the Department of Health Strategy Unit. He was a board member of Rushcliffe PCG and PCT (2001) before becoming Chair of first Rushcliffe PCT (2004) and then Nottinghamshire County PCT (2006). He founded Principia in 2006. He has been chair of Rushcliffe CCG since 2013. He is married to a local GP and has two teenage children.

66 Audit Committee Members The members of the Audit Committee throughout 2014/15 were:  Mrs Ann Greenwood – Chair  Dr Clive Rix  Mr Ian Blair

Our Committees Please refer to the Governance Statement further on in this report for details of committees and joint committees including their membership.

Register of Interests The Governing Body members have declared conflicts of interest as shown in the table below:

Potential or Actual Area Where Conflict of Interest Name Position/Role Could Occur Vicky Trustee of Queen’s Nursing Institute Chief Officer Bailey Patient at Castle Healthcare (as are family) Nottinghamshire Caroline County Council Service Director, Nottinghamshire County Council Baria Officer Registered at Orchard Surgery, Kegworth Representative Director, Company Secretary and Shareholder of Ian and Jennifer Blair and Co. Ltd. Volunteer research at Arthritis UK Nottingham Medical School – involved in training Ian Blair Lay Member Partner: Volunteer with Age UK, Cancer Research, Rushcliffe Community and Voluntary Services and HealthWatch Patient at Castle Healthcare Practice Director of Nichola Nursing and NIL Bramhall Quality Chief Finance Officer at NHS Nottingham North and Jonathan Chief Finance East CCG and Nottingham West CCG Bemrose Officer Spouse: Part-time Medical Secretary at Nottingham University Hospitals Trust Director of Holds an honorary lectureship position with University Dr Cheryl Quality and of Nottingham Crocker Patient Safety Improvement Fellow with NHS Improving Quality GP Partner of Musters Medical Practice GP Member Dr Gavin Director, Embankment Primary Care Centre Lead for Board Derbyshire GP Shareholder of Nottingham Emergency Medical Development Services

67 Potential or Actual Area Where Conflict of Interest Name Position/Role Could Occur Director and Shareholder of Campbell Scientific Ltd. Group. Director of Juniper Systems Ltd Ann Lay Member and Non-Executive Director of Lacerta Ltd Greenwood Audit Chair Director of Corobor Systemes SAS Director of Campbell Scientific Spain Patient Registered at Orchard Surgery Director of Cornerstone Church Nottingham Jonathan Consultant in Spouse: Consultant in Obstetrics at Nottingham Gribbin Public Health University Hospitals Trust Partner in Castle Healthcare Practice GP Member Director, Embankment Primary Care Ltd Dr Jeremy Lead for Health Nottingham Emergency Medical Services Shareholder Griffiths and Wellbeing (less than five per cent) Board Nottingham Forest Football Club Doctor Wife: Helen Griffiths, Manager at Rushcliffe CCG Director of Andy Hall Outcomes and NIL Information Chair of Core (charitable arm of the British Society of Gastroenterology) Receives funding from National Institute for Health Dr Chris Secondary Care Research for Health Technology Assessment Hawkey Doctor Programme Receives funding for projects from University of Dundee Advisor to InDex Pharmaceuticals Non-Executive Director: Habinteg Housing Association Futures Homescape Housing Association Sheila Lay Vice-Chair Patient at Musters Medical Practice (as is husband) Hyde Spouse: Dentist in Leicestershire and Nottinghamshire; Clinical Director for Susan Working Practices; Director of Dental Business Academy; Director of Invisinet Treasurer of Nottingham Credit Union Dr Clive Lay Member Vice Chair, Central College, Nottingham Rix Director, Association of British Credit Unions Ltd GP Partner, East Leake Medical Practice Dr Stephen Spouse: Jill Langridge, GP Partner at Keyworth Clinical Lead Shortt Medical Practice Patient at East Leake Medical Practice (as are family)

68 Political and Charitable Donations We did not make any political or charitable donations from our exchequer during 2014/15.

Future Developments  The CCG has been approved to become a multispecialty community providers (MCPs) vanguard area as part of the NHS Five Year Forward View. The vanguards will take the national lead on the development of innovative new models of care.  The CCG was approved to take on full delegated responsibilities from NHS England for the commissioning of primary medical (family doctor) services from 1 April 2015. This represents a change to the CCG’s statutory functions.  The Nottinghamshire Better Care Fund (BCF) plan was approved by NHS England in December 2014 with the associated pooled budget coming into effect from 1 April 2015.

Research and Development There were no significant activities in research and development in 2014/15 for the CCG.

Branches Outside the UK We do not have any branches inside or outside the UK.

Pension Liabilities For information about how pension liabilities are treated in the accounts and statements on the relevant pension scheme(s) please see accounting policy note 1.9 Employee Benefits and the remuneration report further on in this report.

External Auditor’s Remuneration Our external auditors are KPMG LLP. During 2014/15, they focused on providing an opinion on the financial accounts and providing a Value for Money (VFM) conclusion on arrangements for securing economy, efficiency and effectiveness. The total fee for external audit for 2014/15 was £72,000 (including VAT) in respect of the completion of the statutory audit work.

Cost Allocation and Setting Charges for Information We certify that the clinical commissioning group has complied with HM Treasury’s guidance on cost allocation and the setting of charges for information.

Disclosure of Personal Data Related Incidents NHS Rushcliffe CCG is committed to reporting, managing and investigating all information governance incidents and near misses. The CCG encourages staff to report all incidents and near misses to ensure learning can be collated and disseminated within the organisation. During 2014/15 there were no disclosures of personal data related incidents recorded.

69 Summary of Other Personal Data Related Incidents in 2014/15

Category Nature of Incident Total Loss of inadequately protected electronic equipment, I 0 devices or paper documents from secured NHS premises Loss of inadequately protected electronic equipment, II devices or paper documents from outside secured NHS 0 premises Insecure disposal of inadequately protected electronic III equipment, devices or paper 0 documents IV Unauthorised disclosure 0 V Other 0 Please see the Governance Statement for details on data security.

Working With Us

Employee Consultation A number of two-way communication mechanisms are in place to make sure CCG colleagues are kept up to date and informed on activities, events and changes both within the organisation and related to the wider health economy. Colleagues are also able to feed in their thoughts and opinions on areas where decisions are likely to affect their interests or where they have ideas to improve performance. Personal communication within the CCG is facilitated through a non-hierarchical culture and an open door policy.

Written Bulletins A weekly email bulletin was launched in 2014 for all staff. It includes operational information related to topics such as mandatory training and knowledge alerts, training and development opportunities, and policies and procedures. It also contains information related to the wider environment in which the CCG works, such as messages from NHS England and the Department of Health. The bulletin is also used to engage staff and obtain their feedback. For example, colleagues were asked to complete an online counter fraud survey, updated on QIPP and asked for their ideas on achieving the targets. They were also invited to test and comment on the online patient survey. Policies and other important items of news are communicated to all staff by email as and when needed, with staff asked to confirm they have read messages related to new and updated policies. The CCG is overhauling its website to include a dedicated staff area to ensure easy access to relevant policies, procedures and forms. The staff area will also host a manager’s toolkit which is continuously added to and updated. A dedicated clinicians’ area of the CCG website hosts information and materials of particular interest to GP members and practice teams. GP members also receive a weekly bulletin via email and printed hard copies.

70 Face to Face Communications The Service Improvement Team meets fortnightly for colleagues to update each other on their current projects and priorities, and to get involved in monitoring and improving the CCG’s performance. Representatives from Governance and Finance also attend and feed back to their teams, ensuring consistent communication throughout the organisation. A monthly ‘lunch and learn’ was instigated in January 2015 to create an informal setting in which the team could bring along their lunch and listen, ask questions and get to know who’s who in the team. The session was introduced as a result of direct feedback through the staff survey and time out event in July. The team asked for more face-to-face communication. ‘Lunch and learn’ concentrates on key messages and a sharing of learning and has included topics such as the use of social media, counter fraud and wellbeing in the workplace. A summary of the ‘lunch and learn’ session is included in the weekly staff bulletin.

Staff Survey In November 2014 staff who had been in post since September 2014 were asked to complete the national NHS staff survey, undertaken by the Picker Institute. We received a response rate of 100 per cent for the second year running, and scored 4.05 out of five for overall staff engagement – a score which ranked above the national average for CCGs and showed an improvement on the 2013 response rate of 3.91 out of five. Overall staff engagement relates to staff members’ perceived ability to contribute to improvements at work, their willingness to recommend the organisation as a place to work or receive treatment and the extent to which they feel motivated and engaged with their work. The key positive trend reflecting work we undertook to support staff in 2014 is the improvement across all indicators in the perception of support from line managers. Overall the levels of training of staff increased across most areas, including in the key areas of health and safety and equality and diversity. The survey also highlighted some areas where there is room for further improvement and we are actively working with staff through ‘lunch and learn’ sessions and time-outs to improve in these aspects during 2015/16.

Sickness Absence NHS Rushcliffe CCG recognises the valuable contribution made by each employee to the delivery of its services and is committed to the promotion of employee health, safety and wellbeing. We are committed to acting as a fair and reasonable employer dealing with employees who suffer ill health or incapacity either of a temporary or permanent nature in a fair and compassionate way. We encourage the attendance of all employees throughout the working week but recognise that a certain level of absence may be unavoidable due to ill health or other reasons. Line managers take responsibility for monitoring sickness absence levels in their area, putting in place agreed procedures for reporting in and to enable employees to report their fitness to return to work after sickness absence. A return-to-work meeting is arranged which can help identify short-term absence concerns and facilitate the early identification of any problems, enabling support and assistance to be offered.

71 Line managers monitor sickness absence levels on an ongoing basis. After four separate episodes of sickness in a rolling 12 month period, a short term absence review takes place. This includes a discussion with the employee around sickness absence concerns and looks at any areas of support required. An expected level of improvement and a review date are agreed between the manager and the employee. Following a continual period of absence of four weeks or more, or repeated episodic absence for a related condition, or where an employee is experiencing absence which is due to a chronic underlying condition or long term incapacity, a formal structured review process is put in place. The table below shows staff sickness and ill health retirements for 2014/15 for Nottinghamshire County Teaching Primary Care Trust, the CCG’s predecessor organisation. The data cannot be disaggregated to Rushcliffe CCG level.

2014/15

Number

Total days lost 702 Total staff years 156 Average working days lost 4.5

For more details please see the staff sickness absence table in the annual accounts.

Workplace Award Scheme The CCG has signed up to the Nottinghamshire Wellbeing at Work: Workplace Health Award Scheme. The aims of the scheme are:  To promote and enable a healthy productive workforce with optimum levels of wellbeing.  To reduce sickness absence and improve management and recording of sickness management.  To reduce staff turnover and increase employee retention as employees feel better supported and more valued.  To increase productivity, efficiency and profitability through better recruitment and retention and reduce unplanned staff absence due to illness.  To create a culture of wellness and wellbeing with a healthy working environment within the organisation. A key element of the award scheme is being able to demonstrate improvements to the organisation and to the health and wellbeing of its employees through a portfolio of evidence. Key expectations of the award scheme include active support and involvement from senior management, employee engagement and involvement, health promotion through targeted campaigns and the recruitment of workplace champions trained to RSPH 2 (Level 2 Award in Understanding Health Improvement). As part of our work towards the Nottinghamshire Wellbeing at Work: Workplace Health Award Scheme, the CCG has signed up to the Cycle to Work scheme, which enables our employees to buy a bicycle tax-free, helping them save money and become healthier and more productive at work, and reducing the organisation’s environmental impact. The CCG has also signed up to the Nottinghamshire County and City Declaration on Tobacco Control and has an action plan in place.

72 On-Site Health and Wellbeing Visits by Occupational Health Since 1 January 2015 the CCG has received on-site health and wellbeing visits from Occupational Health on an annual basis. The visits include:  Road show – a drop-in session for staff giving information from Occupational Health and the services on offer including leaflets available and the chance to talk to occupational health advisors and find out more about the services.  Stress workshop and health check  Flu clinic

Disabled Employees NHS Rushcliffe CCG is committed to promoting equality, valuing diversity and combating unfair treatment. This has included ensuring that current staff and potential staff would not be discriminated against on the grounds of disability. The CCG’s Equality and Diversity Policy was approved by the Governing Body in October 2014 and sets out the approach to Equality and Diversity, recognising and taking account of Equality and Diversity issues in our employment practices. We proactively supported our commitment to disabled employees through:  Operating the guaranteed interview scheme for disabled candidates meeting the essential criteria.  Applying to use the Two Ticks symbol – awarded by Jobcentre Plus to recognise employers who have agreed to meet five commitments regarding the recruitment, employment, retention and career development of disabled people.  Registering with Mindful Employer for the Charter for Employers who are Positive about Mental Health – a voluntary agreement seeking to support employers in working within the spirit of its positive approach. The CCG is working towards embedding the charter into existing processes.  Supporting the ‘Liberating the Talents’ training programme which provides support around personal and career development for NHS employees who are lesbian, gay, bisexual or transgender, from a black or minority ethnic background, disabled or part of a vulnerable group.  Approving a flexible working policy which would allow any disabled employee to request a change in their working pattern for personal reasons. We are not aware of any of our employees becoming disabled during 2014/15. More details on equal opportunities can be found in the Social, Community and Human Rights Report earlier in this report.

Health and Safety The CCG has established a shared Health and Safety sub-group of the Quality and Risk Committee with NHS Nottingham West and NHS Nottingham North and East to co-ordinate activities required for each CCG to comply with the Health and Safety Act 1974 and other statutory provisions and to provide a healthy and safe environment for all people who work in, use or visit their premises. The CCG has a Governing Body-approved Health and Safety Policy and a procedure for reporting incidents and near misses which includes RIDDOR requirements.

73 During 2014/15 the sub-group continued to review and re-write health and safety policies relevant for CCGs and approved the following policies:  Working with Display Screen Equipment (DSE)  Young Persons at Work  New and Expectant Mothers The group also monitors the mandatory training uptake figures for health and safety and fire safety, which for Rushcliffe CCG at the end of March 2015 were 100 per cent and 97.5 per cent respectively. Each CCG has an IOSH-trained health and safety lead who promotes training and reporting of incidents and undertakes risk assessments. During 2014/15, for Rushcliffe CCG one incident and one near miss were reported. The table below shows the type and number of reported incidents.

Number of Incidents Type Comments Patient became verbally aggressive and Violence and 1 offensive on the telephone. Call ended when Aggression patient was not willing to listen to explanation. Vehicle and pedestrian near collision due to incorrect parking causing a hazard. 1 Near miss Reported to NHS Property Services and asked drivers to use designated car parks. The CCGs work closely with NHS Property Services and receive a quarterly building compliance report which identifies the status of all health and safety requirements and any high risk areas.

Fraud We receive a dedicated Local Counter Fraud Specialist Advice Service from 360° Assurance and have developed a comprehensive counter fraud work plan in accordance with guidance received from NHS Protect. We also have a counter fraud policy approved by the Governing Body. Anyone suspecting fraudulent activities within our services should report their suspicions to our Local Counter Fraud Specialist by telephoning the confidential hotline on 0115 883 5323. More details on the arrangements for countering fraud and corruption can be found in the Governance Statement.

Better Payment Practice Code The Better Payment Practice Code requires the clinical commissioning group to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later. The NHS aims to pay at least 95 per cent of invoices within 30 days of receipt, or within agreed contract terms. Details of compliance with the code are shown below:

2014/15 Better Payment Practice Code NHS Non NHS Performance Value 98.68% 98.56% Volume 97.57% 98.79%

74 Emergency Preparedness, Resilience and Response The CCG is a Category 2 responder for major incidents and is therefore not required statutorily to have major incident plans in place. However, in the event of a major incident, the CCG would support NHS England as Category 1 responders and work with them to implement the shared incident response plan for which they hold responsibility for the local health community. During 2014/15, core standards for EPRR were developed nationally. NHS England required all relevant organisations to complete a RAG (red, amber, green) rated self-assessment against the standards. A statement of compliance approved by the Governing Body confirmed the CCG’s responsibility in emergency planning and that the necessary processes and infrastructure were in place in relation to the core standards of a Category 2 responder. In October 2014, as part of the annual assurance process for EPRR Category 1 and 2 responders, the CCG took part in a confirm and challenge meeting which examined the plans and arrangements put in place to provide assurance that the CCG was able to respond appropriately. We certify that the clinical commissioning group has incident response plans in place, which are fully compliant with the NHS Commissioning Board Emergency Preparedness Framework 2013. NHS England, as the lead body within the shared plan, regularly reviews and makes improvements to its major incident plan and has a programme for regularly testing this plan.

Business Continuity The CCG has its own business continuity plans which would be enacted in the event of any incident that impacted on the day-to-day running of the organisation. The CCG conducted a business continuity plan exercise in October 2014 to test the plan by simulating a disruption caused by access denial to the work area or utility failure as set out in the business continuity plan. An audit tool was developed to test the information in the plan and that appropriate procedures were in place. The exercise and review highlighted that the Rushcliffe CCG business continuity plan was fit for purpose and would be effective in the event of a disruption. Some minor changes were identified including improvements to communication with other building users. The Governing Body noted the conclusions from the exercise and approved the CCG’s business continuity plan at its meeting in March 2015.

Principles for Remedy The Parliamentary and Health Service Ombudsman (PHSO) has produced guidance on how public bodies provide remedies for injustice or hardship resulting from their maladministration or poor service. These six ‘Principles for Remedy’ are:  Getting it right – by quickly putting the poor service right that has led to injustice or hardship.  Being customer focused – understanding expectations and saying sorry for poor service.  Being open and accountable – being open about how the organisation has decided on the remedy, including documentation.  Acting fairly and proportionately – treating people equally, fairly and proportionately to the hardship caused.

75  Putting things right – where possible, returning the person to the position they would have been in if the poor service hadn’t occurred.  Seeking continuous improvement – ensuring we can demonstrate that CCGs learn from patients’ experience and complaints and act upon them. NHS Rushcliffe CCG has adopted the six principles of remedy in the development of its complaints handling procedure and they form a core part of our complaints handling policy that clearly sets out the organisation’s process for handling complaints in order for the CCG to meet statutory requirements. The complaints policy sets out how the CCG takes responsibility, acknowledges failures and both apologises and uses the learning from any complaint investigation to improve its services. These remedies can be either financial or non-financial remedies.

Exit Packages The Treasury requires the disclosure of exit package information. The figures disclosed relate to exit packages agreed in the year. The actual date of departure may be in a subsequent period, and the expense in relation to the departure costs may have been accrued in a previous period. Therefore the figures disclosed are calculated differently to those included in the expenditure note within the financial accounts. There were no exit packages for Rushcliffe CCG during 2014/15.

Off Payroll Engagements Following the Review of Tax Arrangements of Public Sector Appointees published by the Chief Secretary to the Treasury on 23 May 2012 clinical commissioning groups must publish information on their highly paid and/or senior off-payroll engagements. As of 31 March 2015 there were no off-payroll engagements for more than £220 per day and that lasted longer than six months.

Signature of the Accountable Officer I certify that the clinical commissioning group has complied with the statutory duties laid down in the NHS Act 2006 (as amended).

Vicky Bailey Accountable Officer Signature Vicky Bailey

Date 27 May 2015

76 Remuneration Report

As Accountable Officer, I have reviewed the definition of ‘senior manager’ and can confirm that this covers the members of the Governing Body only.

Remuneration Committee (not subject to audit) We have established a Remuneration Committee, which is a key committee of the Governing Body. The committee has delegated responsibility to review and set the remuneration and terms of service of the directors. The committee, which comprises lay members, met on one occasion during the year. All three members attended the meeting. There were no changes to membership throughout the year. Members of the remuneration committee were:  Ann Greenwood (Chair)  Clive Rix  Ian Blair The Chief Officer attended the meeting to advise the committee except where discussions were around her own remuneration. The Chief Officer is the only senior manager not directly employed under Agenda for Change terms and conditions and was appointed in accordance with HR guidance issued by the NHS Commissioning Board and remunerated in line with: Clinical Commissioning Groups: Remuneration Guidance for Chief Officer (where the senior manager also undertakes the accountable officer role) and Chief Finance Officers applicable from when the CCG became the employing body on 1 April 2013. The agreed remuneration for the Chief Officer did not include any performance-related pay. Senior managers on Agenda for Change terms and conditions will be remunerated in line with any national changes and pay awards. Our future policy will be to remain in line with guidance issued to date or any revised guidance issued by NHS England. All senior managers are employed on substantive contracts with a minimum notice period of three months. We do not make termination payments which are in excess of contractual obligations. There were no such payments during the 2014/15 financial year. Lay members and clinical leads on the Governing Body have service contracts. The term of office, notice period, grounds and arrangements for removal from office for these individuals are detailed in the CCG’s constitution.

77 Salaries and Allowances (subject to audit)

Benefits in Other Bonus Kind Salary Remuneration Payments (rounded (bands of (bands of (bands of to the Name Title £5,000) £5,000) £5,000) nearest £000 £000 £000 £00) £00 Vicky Bailey Chief Officer 95-100 - - - Stephen GP Clinical 50-55 - - - Shortt Lead Jeremy GP Member 20-25 - - - Griffiths Ian Blair Lay Member 5-10 - - - Gavin GP Member 5-10 - - - Derbyshire Ann Lay Member 5-10 - - - Greenwood Chris Secondary 5-10 - - - Hawkey Care Member Sheila Hyde Lay Vice-Chair 10-15 - - - Clive Rix Lay Member 5-10 - - - Jonathan Chief Finance 30-35 - - - Bemrose Officer Cheryl Director of Crocker Quality and 15-20 - - - (01/04/14 – 31/12/14) Patient Safety Nichola Director of Bramhall Nursing and 10-15 - - - (from 02/10/14) Quality

78 The salaries of the members below were allocated over a number of CCGs. The allocation to Rushcliffe Clinical Commissioning Group is shown above. Their total remuneration is shown below:

Other Bonus Benefits in Salary Remuneration Payments Kind (rounded (bands of (bands of (bands of to the nearest Name Title £5,000) £5,000) £5,000) £000) £000 £000 £000 £000 Chief Jonathan Finance 95 - 100 - - - Bemrose Officer Director Cheryl of Quality Crocker and 60 - 65 - - - (01/04/14 – 31/12/14) Patient Safety Director Nichola of Bramhall Nursing 40 - 45 - - - (from 02/10/14) and Quality

Pension Benefits (subject to audit)

Real Real Total Lump Sum Increase Increase Accrued at Age 60 Cash Cash Real Employer’s in in Pension Pension at Related to Equivalent Equivalent Increase Contribution Pension Lump Age 60 at Accrued Transfer Transfer in Cash Name to at Age 60 Sum at 31 March Pension at Value at Value at Equivalent and Stakeholder (bands Age 60 2015 31 March 31 March 31 March Transfer Title Pension of (bands of (bands of 2013 (bands 2015 2014 Value £2,500) £2,500) £5,000) of £5,000) £000 £000 £000 £000 £000 £000 £000 £000 Vicky 0-2.5 5.0-7.5 40-45 120-125 757 695 62 14 Bailey Certain members do not receive pensionable remuneration, therefore there are no entries in respect of pensions for lay members.

Cash Equivalent Transfer Value A cash equivalent transfer value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies.

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

Real Increase in CETV The Government Actuary Department factors for the calculation of cash equivalent transfer values (CETVs) assume that benefits are indexed in line with the Consumer Prices Index, which is expected to be lower than the Retail Prices Index which was used previously and hence will tend to produce lower transfer values. We have used CETVs provided by NHS Pensions. The CETVs have been calculated using different actuarial factors (provided by the Government Actuary’s Department) at the beginning and the end of the period. This is contrary to guidance provided in the NHS Manual for Accounts, which states that common market factors should be used at the beginning and end of the period.

Payments to Past Senior Managers (not subject to audit) There were no payments to past senior managers in 2014/15 for the CCG.

Pay Multiples (subject to audit) Reporting bodies are required to disclose the relationship between the remuneration of the highest paid director in their organisation and the median remuneration of the organisation’s workforce. The banded remuneration of the highest paid director in the financial year 2014/15 was £95-100k. This was 2.07 times the median remuneration of the workforce, which was £47,088. In 2014/15 no employee received remuneration in excess of the highest paid director. Total remuneration includes salary, non-consolidated performance-related pay, benefits in kind as well as severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions The figure used for the highest paid member of the Governing Body in the CCG in the financial year 2014/15 is not consistent with the previous year, as there was an error in the prior year whereby a GP’s pro-rated salary was used instead of the figure for the highest paid executive director.

Signature of the Accountable Officer I certify that the clinical commissioning group has complied with the statutory duties laid down in the NHS Act 2006 (as amended).

Vicky Bailey Accountable Officer Signature Vicky Bailey

Date 27 May 2015

80 Statement of the Accountable Officer’s Responsibilities

The National Health Service Act 2006 (as amended) states that each clinical commissioning group shall have an Accountable Officer and that Officer shall be appointed by the NHS Commissioning Board (NHS England). NHS England has appointed the Chief Officer to be the Accountable Officer of the clinical commissioning group. The responsibilities of an Accountable Officer, including 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) and for safeguarding the clinical commissioning group’s assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities), are set out in the Clinical Commissioning Group Accountable Officer Appointment Letter. 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. 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. In preparing the financial statements, the Accountable Officer is required to comply with the requirements of the Manual for Accounts issued by the Department of Health and in particular to:  Observe the Accounts Direction issued by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis;  Make judgements and estimates on a reasonable basis;  State whether applicable accounting standards as set out in the Manual for Accounts 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. To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my Clinical Commissioning Group Accountable Officer Appointment Letter.

Vicky Bailey Accountable Officer Signature Vick Bailey

Date 27 May 2015

81 Governance Statement

Introduction The clinical commissioning group was licensed from 1 April 2013 under provisions enacted in the Health and Social Care Act 2012, which amended the NHS Act 2006. As at 1 April 2014, the clinical commissioning group was licensed without conditions. The CCG is a clinically led membership organisation which brings together 12 local GP practices to commission health services on behalf of around 123,500 patients registered with Rushcliffe practices. The member practices reduced during 2014/15 from 15 to 12 as a result of a four-practice merger in October 2014.

Scope of Responsibility As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the clinical commissioning group’s policies, aims and objectives, whilst safeguarding the public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out in the Clinical Commissioning Group Accountable Officer Appointment Letter. I am responsible for ensuring that the clinical commissioning group is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity.

Compliance with the UK Corporate Governance Code We are not required to comply with the UK Corporate Governance Code. However, we have undertaken a detailed assessment of the CCG’s governance arrangements against the best practice guidance available including those aspects of the UK Corporate Governance Code we consider to be relevant to the CCG and best practice. The detailed findings have been reviewed by the CCG’s internal auditors and have been reported in the governance review audit which is part of this year’s internal audit plan. This was reported to the Audit Committee in March 2015 and will be reported to the Governing Body as part of the Committee’s annual report. Whilst the report made some recommendations, it can be confirmed that for the financial year ended 31 March 2015, and up to the date of signing this statement there were no departures from the provisions of the UK Corporate Governance Code.

The Clinical Commissioning Group Governance Framework The National Health Service Act 2006 (as amended), at paragraph 14L(2)(b) states: The main function of the governing body is to ensure that the group has made appropriate arrangements for ensuring that it complies with such generally accepted principles of good governance as are relevant to it. The clinical commissioning group is a clinically led membership organisation made up of general practices. The members of the clinical commissioning group are responsible for determining the governing arrangements for the organisation, which are set out in the constitution.

82 The clinical commissioning group is accountable for exercising the statutory functions of the group. It may grant authority to act on its behalf to: any of its members, its governing body, any of its staff, including those not directly employed by the group, one or more of its committees, joint committees, sub-committees or sub-groups. The extent of the authority to act of the respective bodies and individuals depends on the powers delegated to them by the group as expressed through the group’s scheme of reservation and delegation and the terms of reference for committees, joint committees, sub- committees and sub-groups. Membership Forum The Membership Forum of the clinical commissioning group has been established as a vehicle for the member practices to hold the governing body to account for the delivery of the clinical commissioning group’s functions. It meets annually and on an ad hoc basis if called by any member practice or where business requires a meeting outside of the annual meeting. Governing Body The main function of the governing body is to ensure that the clinical commissioning group has made appropriate arrangements for ensuring that it complies with such generally accepted principles of good governance as are relevant to it and that the group exercises its functions effectively, efficiently and economically. All governing body members act in accordance with the Standards for Members of NHS Boards and Clinical Commissioning Group Governing Bodies in England. In delivering its duties the governing body considered a range of strategies, quality, financial and performance assurance reports and policies and received assurances from the governance infrastructure. The governing body met formally seven times in the period 1 April 2014 to 31 March 2015 (including one extraordinary meeting) on alternate months, in public and was quorate at each meeting. In addition, the governing body met in the intervening months for development sessions.

83 Cumulative Record of Governing Body Members’ Attendance 2014/15

Name Governing Body Role Possible Actual

Sheila Hyde Lay Vice Chair 7 6 Lay Member for audit, remuneration and Ann Greenwood 7 7 conflict of interest Lay Member – for PPI and link to the Patient Ian Blair 7 7 Cabinet Dr Clive Rix Lay Member – link to Clinical Cabinet 7 6 Dr Stephen Shortt Clinical Leader and Chair of Governing Body 7 5 GP Member Lead for Health and Wellbeing Dr Jeremy Griffiths 7 7 Board Dr Gavin GP Member Lead for Member Practices 7 7 Derbyshire Vicky Bailey Chief Officer (Accountable Officer) 7 7 6 + 1 Jonathan Bemrose Chief Finance Officer 7 deputy Professor Chris Secondary Care Doctor 7 4 Hawkey Director of Quality and Patient Safety – 1+1 Dr. Cheryl Crocker 2 (to 31’/7/14) registered nurse deputy Acting Assistant Director Quality and Patient Esther Gaskill 1 1 (18/9/14 only) Safety Director of Nursing and Quality – registered 3 + 1 Nichola Bramhall 4 (from 2/10/14) nurse deputy 6 + 1 Andy Hall Director of Outcomes and Information 7 deputy Jonathan Gribbin Consultant in Public Health 7 6 Nottinghamshire County Council (Officer Caroline Baria 7 5 Representative) The governing body is supported in its assurance responsibilities by a formal governance structure. The following committees have been established by, and are accountable to, the clinical commissioning group’s governing body:  Audit Committee  Remuneration Committee  Clinical Cabinet  Patient Cabinet  Information Governance, Management and Technology Committee – hosted by NHS Rushcliffe CCG on behalf of NHS Nottingham North and East CCG, NHS Nottingham West CCG, NHS Mansfield and Ashfield CCG and NHS Newark and Sherwood CCG

84 The following committees have also been established under a Memorandum of Understanding and provide assurance to the clinical commissioning group’s governing body:  Quality and Risk Committee – hosted by NHS Nottingham North and East CCG on behalf of NHS Rushcliffe CCG and NHS Nottingham West CCG  Safeguarding Adults and Children’s Committees – hosted by NHS Newark and Sherwood CCG on behalf of NHS Rushcliffe CCG, NHS Nottingham North and East CCG, NHS Nottingham West CCG, NHS Mansfield and Ashfield CCG and NHS Bassetlaw CCG  Individual Funding Review Panel – hosted by NHS Nottingham West CCG on behalf of NHS Rushcliffe CCG, NHS Nottingham North and East CCG, NHS Newark and Sherwood and NHS Mansfield and Ashfield CCG. Audit Committee The committee was constituted in line with the provisions of the NHS Audit Committee Handbook and meets a minimum of five times per year. The committee provides the governing body with an independent and objective view of the clinical commissioning group’s systems of integrated governance, risk management and internal control. The committee ensures that there is an effective internal audit function and that control processes around counter fraud and bribery are in place and reviews the findings of the external auditor. In early 2014/15, the committee approved on behalf of the Governing Body under delegated authority, the CCG’s first Annual Report and Annual Accounts 2013/14. The committee ensured a level of scrutiny to both the content and process which gave full assurance to the governing body that this key statutory requirement was completed successfully. The committee repeated this task under delegated authority from the governing body for 2014/15. Over the year, the committee reviewed the clinical commissioning group’s Assurance Framework and integrated risk management arrangements, requesting a programme of deep dive reviews of all of the risks identified in the Assurance Framework. This review completed in January 2015 and allowed the Governing Body to further develop its risk appetite statement. The Chief Officer also provided the committee with a review of upcoming key issues and challenges. In addition, the committee received the internal audit and counter fraud work plans including the development of the counter fraud risk assessment and received update reports on losses and special payments, waiver log and use of the common seal. The committee reviewed and recommended for approval the conflict of interest policy in the light of statutory guidance issued by NHS England and the raising concerns at work (whistleblowing) policy to support the CCG’s application for full delegated responsibility for primary care commissioning submitted in January 2015. The committee completed the annual assessment of its performance comparing the results against the baseline established last year. This will be used to shape the agenda of forthcoming meetings and inform the development sessions for the year ahead.

85 Cumulative Record of Audit Committee Members’ Attendance 2014/15

Name Audit Committee Role Possible Actual

Ann Lay Member for audit, remuneration and conflict of 8 8 Greenwood interest Lay Member for Patient and Public Involvement and Ian Blair 8 6 link to the Patient Cabinet Dr Clive Rix Lay Member – link to Clinical Cabinet 8 7

Remuneration Committee The Remuneration Committee makes recommendations to the Governing Body on determinations about the remuneration, fees and other allowances for employees and on determinations about allowances under any pension scheme that the clinical commissioning group may establish as an alternative to the NHS pension scheme. The committee meets as and when required but at least once per year. In 2014/15, the committee met on one occasion noting the Agenda for Change pay arrangements for 2015/16 and recommending to the Governing Body that there would be no increase to very senior manager (VSM) pay, GP chair and clinical leads remuneration. Cumulative Record of Remuneration Committee Members’ Attendance 2014/15

Name Remuneration Committee Role Possible Actual

Ann Lay Member for audit, remuneration and conflict of 1 1 Greenwood interest Lay Member for Patient and Public Involvement and Ian Blair 1 1 link to the Patient Cabinet Dr Clive Rix Lay Member – link to Clinical Cabinet 1 1

Clinical Cabinet The Clinical Cabinet is responsible for overseeing the development of the clinical commissioning group’s vision and strategy, providing clinical direction and ownership of commissioning plans. GP members of the Clinical Cabinet have a lead clinical role for the clinical commissioning group. Those member practices without a clinical portfolio are present in attendance. Key Areas of Work During 2014/15 for the Clinical Cabinet Business cases for a range of clinical service developments have been approved including:

86 Primary Care  Securing Prime Minister’s Challenge Funds and establishing a model for an urgent care weekend service for the local population  Implementation of a locally developed ‘GP enhanced service specification’ to improve the quality and consistency of general practice  Carrying out an extensive patient survey to each household on future options for primary and community healthcare services for patients registered with a member practice Service Improvements  Implementation of a centralised electronic palliative care coordination system to support sharing of information across organisations  Continuation of jointly funding a health development officer post with Rushcliffe Borough Council for a further three years  Implementation of a carers’ pathway to support early identification of carers registered with member practices  The CCG signing up to the Carer’s Call to Action  Age UK Notts being re-commissioned to provide a Rushcliffe residents representative and advocacy service to residents in local care homes  Implementation of a locally developed anti-coagulation community pathway Mental Health  Endorsement of the Nottinghamshire CAMHS Pathway Review report and the undertaking of a review to look at future needs Planned Care  Implementation of referral management gateway model to support timely referral to secondary care  Procurement of a trauma and orthopaedic community service following a successful pilot during 2014/15 Urgent Care  Procurement of an Urgent Care Centre for the South Nottinghamshire health community to be located in Nottingham city centre

87 Cumulative Record of Clinical Cabinet Members’ Attendance 2014/15

Name Clinical Cabinet Role Possible Actual

Stephen Shortt GP, East Leake Medical Centre (Chair) 11 11 Jeremy Griffiths GP, Ludlow Hill Surgery (Deputy Chair) 11 10 Gavin Derbyshire GP, Musters Medical Practice 11 8 Tim Daniel GP, Orchard Surgery 11 8 Neil Fraser GP, East Leake Medical Centre 11 10 Matt Jelpke GP, St George’s Medical Practice 11 9 Alex Macdonald GP, Belvoir Health Group 11 7 Ann-Marie Stewart GP, East Bridgford Medical Centre 11 9 Sean Ottey GP, West Bridgford Health Centre 11 8

Ian McCulloch GP, Musters Medical Practice 6 2 (to 30/10/14) Lynn Ovenden GP, Castle Healthcare 11 9 Nick Page GP, Castle Healthcare 11 11 Ram Patel GP, Radcliffe-on-Trent Health Centre 11 8

Bakula Patel GP, Castle Healthcare 7 3 (to 30/11/14) Vicky Bailey Chief Officer 11 9 Consultant in Public Health, NHS Nottinghamshire Jonathan Gribbin 11 8 County Helen Griffiths Assistant Chief Officer 11 10 Clive Rix Lay Member Governing Body 11 8 Stephen Andersen Head of Finance 11 11

Andy Warren Patient Cabinet Representative 9 9 (to 15/1/15)

88 Patient Cabinet The Patient Cabinet is responsible for overseeing patient and public engagement and participation arrangements, ensuring that the NHS Constitution and the voice of patients and public is embedded in the functions and business of the clinical commissioning group. Key Areas of Work During 2014/15 for the Patient Cabinet  Members of the Patient Cabinet were heavily involved in the design of the patient survey which was sent to every household in Rushcliffe, testing it out in the initial phase, supporting it and promoting the benefits of completing it.  East Midlands Leadership Academy facilitated sessions for the Patient Cabinet to review its purpose and to clarify roles and responsibilities. This was followed by a full review of the membership incorporating the results of the patient survey in order to ensure that the cabinet reflected the distinct segments of the local population and could represent their views. The new membership roles are designed to represent the following groups: o Children and families o Teenagers and students o Working age o Retired o Carers  Equality and diversity and communication were identified as cross cutting themes for the cabinet’s work.  The Patient Cabinet also developed a comprehensive work plan based on the NHS England document: Transforming Participation in Health and Care Guidance for Commissioners, establishing a task and finish group to review each section and complete a gap analysis. Following this initial review a report and action plan was produced covering both individual participation – supporting patients and carers in decisions about their own care and treatment, and public participation – involving the public in commissioning processes and decisions.  The Patient Cabinet received updates on embedding the Equality Delivery System 2 (EDS2) in the organisation and took part in the grading process.  A website focus group was hosted by the Patient Cabinet to re-design the CCG’s website ensuring that it was accessible and easy to use and had relevant and useful content.

89 Cumulative Record of Patient Cabinet Members’ Attendance 2014/15

Name Patient Cabinet Role Possible Actual

Ian Blair CCG Governing Body Lay Member for PPI 6 6 Quality and Risk Committee Patient Max Booth 6 5 Representative Clinical Commissioning Forum Patient Heather Downey 6 4 Representative

Ken Johnson Practice Manager Representative 1 0 (to 9/6/14) Mariea Kennedy Patient Advice and Liaison Service (PALS) 6 3 Nigel Lawrence Diabetes Forum Patient Representative 6 4 Helen Limb Patient and Public Involvement Manager (PPI) 6 6 Marie Males Health Network Patient Representative 6 5 PPG West Bridgford Patient Representative (Vice- Paul Midgley 6 5 Chair) Kamaljeet PPG North Patient Representative 6 3 Pentreath PPG South Patient Representative Peter Taylor 6 4

Barbara Preston 50+ Health Forum Patient Representative 6 6 Marie Smith Carers' Forum Representative 6 3 Ian Thompson Cancer Forum Patient Representative 6 5 Mental Health and Wellbeing Forum Patient Adan Walker 6 2 Representative

Andy Warren Chair and Clinical Cabinet Patient Representative 4 4 (to 15/1/15) Rushcliffe Community and Voluntary Service Carolyn Perry 6 4 (RCVS) Vicky Bailey Chief Officer 2 2 (to 10/9/14)

Lynne Sharp Head of Governance and Engagement 4 3 (from 11/9/14)

90 Information Governance, Management and Technology Committee (IGMT) The clinical commissioning group hosts a joint Information Governance, Management and Technology Committee under a memorandum of understanding with NHS Nottingham North and East CCG, NHS Nottingham West CCG, NHS Mansfield and Ashfield CCG and NHS Newark and Sherwood CCG. The IGMT Committee supports and drives the broader information governance (IG) and information management and technology (IM&T) agendas, including ensuring risks relating to information governance and health informatics are identified and managed, leading the development of community-wide IG and IM&T strategies and developing IM&T to improve communication between services for the benefit of patients. The committee meets bi- monthly and is chaired by the director of outcomes and information. Key Areas of Work During 2014/15 for the IGMT Committee  Continuing progression of the implementation of the necessary changes to ensure compliance with statutory legislation. This built on the work carried out during 2013/14 and confirmed the Accredited Safe Haven (ASH) stage 1 status of the CCG. The CCGs are also authorised as controlled environments for finance (CEfF) under section 251 of the Health and Social Care Act 2012.  Monitoring the CCGs’ progress of completion of and compliance with the Information Governance Toolkit.  Maintaining an information governance risk register for the CCGs.  Re-commissioning the Information Governance Service provided to CCGs. Since February 2015 this has been provided by NHS Nottingham City CCG through a specification and service level agreement.  Receiving quarterly data quality reports on SUS data submitted by trusts relating to their patients.  Following the progress of all local IT projects and agreed the priority of those projects.  Agreeing relevant information governance, information management and information technology policies with amendments as necessary reflecting changes in legislation or local ambition.  Introducing contract management arrangements with Nottinghamshire Health Informatics Service (NHIS) in order to demonstrate delivery of the required services to the necessary standards. This included the revision of and introduction of new key performance indicators.

91 Cumulative Record of IGMT Committee Members’ Attendance 2014/15

Member IGMT Committee Role Possible Actual

Director of Outcomes and Information (Chair) Andy Hall 6 6 and SIRO for NHS Rushcliffe CCG Dr Sean Ottey Clinical Representative 6 1 5 +1 Debbie Pallant Information Governance Lead GEM CSU 6 deputy Petra O’Mahony Freedom Of Information Lead GEM CSU 6 3 Director of Quality and Patient Safety Caldicott 1 + 1 Dr Cheryl Crocker Guardian NHS Rushcliffe, Nottingham North and 2 (to 21/7/14) deputy East and Nottingham West CCGs Acting Director of Quality and Patient Safety Rebecca Stone Caldicott Guardian NHS Rushcliffe, Nottingham 1 0 (22/10/14 to 13/10/14) North and East and Nottingham West CCGs Director of Nursing and Quality, Caldicott Nichola Bramhall Guardian NHS Rushcliffe, Nottingham North and 3 3 (from 14/10/14) East and Nottingham West CCGs Caldicott Guardian, NHS Mansfield and Ashfield 3 + 1 Dr Dean Temple 5 (to 3/3/15) CCG deputy General Practitioner (Caldicott Guardian), NHS Dr Ei Cheng Chui 6 6 Newark and Sherwood CCG Clinical Representative and SIRO for NHS Dr Mike O’Neil 6 5 Nottingham West Director of Operations (SIRO), NHIS Nottingham 4 + 2 Hazel Buchanan 6 North and East CCG deputy SIRO for NHS Newark and Sherwood CCG 1 April 2014 to 2 March 2015 SIRO for NHS Mansfield and Ashfield CCG 1 2 + 2 Elaine Moss 6 April 2014 to 2 March 2015 deputy Caldicott Guardian for NHS Mansfield and Ashfield CCG 3 March 2015 to present Simon Crowther SIRO for NHS Mansfield and Ashfield CCG 1 (3/3/15 to 29/3/15) 1 Marcus Pratt deputy (from 30/3/15) SIRO for Newark and Sherwood CCG

Ian Blair Lay Member for NHS Rushcliffe CCG 1 0 (to 30/5/14) Lay Member for NHS Newark and Sherwood Paul Morris 6 2 CCG 3 + 3 Eddie Olla Director of Health Informatics, NHIS 6 deputy 4 + 2 Jacqueline Taylor Head of Transformational ICT Services, NHIS 6 deputy Dr George Clinical Safety Officer 6 6 Ewbank

92 Member IGMT Committee Role Possible Actual

Corporate Governance Manager, NHS Mansfield 1 David Harper* 1 (to 25/714) and Ashfield CCG deputy Corporate Governance Manager, NHS Newark 1 Nicola Treece* 1 (to 25/7/14) and Sherwood CCG deputy Governance Officer, NHS Nottingham West Susan Clarke* 1 0 (to 25/7/14) CCG Head of Information and Performance, NHS 1 Diane Butcher* Mansfield and Ashfield and Newark and 1 (to 25/7/14) deputy Sherwood CCGs Primary Care Governance Officer, NHS Caroline Stevens* 1 1 (to 25/7/14) Rushcliffe CCG

Sergio Contract and Information Manager, NHS 1 1 Pappalettera* Nottingham North and East CCG (to 25/7/14) * The IGMT Committee agreed in July 2014 that CCG IG leads would no longer be members of the committee and would be recorded as ‘in attendance’ at meetings or as deputies to the SIRO and Caldicott Guardians only.

93 Quality and Risk Committee The clinical commissioning group established a joint Quality and Risk Committee under a memorandum of understanding with NHS Nottingham North and East CCG and NHS Nottingham West CCG. The Quality and Risk Committee monitors reviews and provides assurance that services commissioned by the CCGs are being delivered in a high quality and safe manner, and to promote a culture of continuous improvement and innovation by focusing on the three quality domains: patient safety, patient experience and clinical effectiveness. The committee acts on behalf of the three CCGs to fulfil their obligations in respect of the following functions:  Clinical governance  Risk management  Infection prevention and control  Equality and diversity and the equality delivery system  Complaints and PALS  Health and safety Key Areas of Work During 2014/15 for the Quality and Risk Committee  Responding to actions and recommendations from key national reports and inquiries (including the Francis, Keogh and Berwick Reports).  Managing the clinical risk register for the CCGs and escalating risks to the Assurance Framework as appropriate.  Triangulating data relating to commissioned services to provide assurance that quality of services is being maintained or where there are concerns about quality ensuring that appropriate remedial action is being taken.  Monitoring CQUIN progress for the three main providers with whom contracts are held (Circle, Nottingham, Nottingham University Hospitals NHS Trust and County Health Partnership.  Receiving updates on the work of the sub-groups, which included: health and safety, quality and diversity, care homes, and primary care quality, and reviewing progress on mandatory training.  Reviewing reports and data including the director of quality’s bi-monthly quality report, serious incidents for main providers, quality accounts and quality dashboards from main providers and associate commissioned providers.  Receiving feedback from the NHS England Area Team Quality Surveillance Group and reviewing internal audit reports (during 2014/15 the follow up report into contract and quality monitoring in care homes was received which provided significant assurance in relation to the quality monitoring aspect that the action plan delivery continues to be monitored).  Developing the South Nottinghamshire CCGs’ Quality Strategy and Sign up to Safety Campaign.  During 2014/15 the committee received a number of reviews including a review of the Quality Team (including a review of the Quality and Risk Committee), a review of primary care quality monitoring and a review of maternity services.  Lay member and lay representative involvement in scrutiny of main providers.  Review and ratification of policies and procedures.

94 Cumulative Record of Quality and Risk Committee Members’ Attendance 2014/15

Name Quality Risk Committee Role Possible Actual

Mike Wilkins Lay Member, NNE CCG (Chair) 2 2 (to 31/7/14) Director of Quality and Patient Safety, NNE, Dr Cheryl Crocker 2 1 (to 31/7/14) NW and Rushcliffe CCGs

Nichola Bramhall Director of Nursing and Quality 2 2 (from 2/10/14) Max Booth Patient Representative, Rushcliffe CCG 4 4 Shirley Inskip Patient Representative, NW CCG 4 1 Head of Governance, Engagement and Quality Craig Sharples 2 2 (from 2/10/14) NW CCG Head of Governance and Engagement, Lynne Sharp 4 4 Rushcliffe CCG 3 +1 Hazel Buchanan Director of Operations, NNE CCG 4 deputy Sheila Hyde* Lay Vice-Chair, Rushcliffe CCG 4 1 Assistant Director of Quality and Patient Becky Stone 4 2 Safety, NNE, NW and Rushcliffe CCGs Dr. John Tomlinson Consultant in Public Health 4 4 Dr Mohammed Al- Consultant Psychiatrist, Leicestershire Uzri Partnership NHS Trust/ NNE CCG Clinical 1 0 (to 30/4/14) representative Dr Ian McCulloch GP Representative – Rushcliffe CCG 4 1 Dr. Ram Patel (shared role) * Co-opted member for Francis Review only Safeguarding Adults and Children’s Committees A joint Safeguarding Committee is established under a memorandum of understanding with NHS Nottingham North and East CCG, NHS Nottingham West CCG, NHS Rushcliffe CCG, NHS Mansfield and Ashfield CCG, NHS Newark and Sherwood CCG and NHS Bassetlaw CCG. Chaired by the Newark and Sherwood CCG chief nurse, its aims are to ensure that systems and processes are in place to safeguard vulnerable adults and children. The sub-committee responds to matters referred to it by the Nottinghamshire CCG governing bodies, Nottinghamshire Safeguarding Children and Adult Boards, the Nottinghamshire Multi Agency Public Protection Strategic Management Board and the Domestic and Sexual Abuse Executive Group. Wider clinical consultation takes place across the Nottinghamshire and Nottingham City health community, the Care Quality Commission and other multi agency partnership groups and forums. The committee oversaw the health component of the Nottinghamshire Multi Agency Safeguarding Hub, which brings partner agencies together to ensure prompt information sharing across the health community to safeguard children and vulnerable adults.

95 Key Areas of Work and Achievements of the Safeguarding Adults and Children’s Committees  Under the Skin Safeguarding Assessment tool now being used for dedicated safeguarding quality assurance visits.  Bassetlaw pressure ulcer good practice protocol adopted by all CCG areas as a systematic approach to dealing with pressure ulcers.  Monitoring organisational progress against Adult and Children’s Safeguarding Board self-assessment performance tools.  Monitoring action plans and outcomes of serious case and serious incident reviews.  Monitoring local progress against national standards relating to child sexual exploitation.  Raising the profile of the PREVENT anti-terrorist strategy across commissioned and contracted services.  Monitoring risks relating to Child and Adolescent Mental Health Service provision and influencing commissioning arrangements.  Monitoring quality of health services relating to children in care of the local authority.  A safeguarding risk register has been established for the subcommittee, which is used to inform individual CCG governing bodies of key issues relating to safeguarding. Cumulative Record of Safeguarding Adults Committee Members’ Attendance 2014/15

Role Possible Actual

Chief Nurse and Director of Quality Newark and Sherwood and 5 5 Mansfield and Ashfield CCGs (chair) Director of Quality and Patient Safety and Executive Nurse for 3 Nottingham North and East, Nottingham West and Rushcliffe CCGs 5 (+2 (vice-chair) deputy) Nurse Consultant Safeguarding, Bassetlaw CCG 5 5 Consultant in Public Health nominated by the Director of Public 5 4 Health, Nottinghamshire County Council General practitioner - - Practice nurse - - Adult safeguarding leads from the member CCGs 5 5 Assistant Director of Quality and Patient Safety for Nottingham 5 3 North and East, Nottingham West and Rushcliffe CCGs Head of Quality and Patient Safety for Newark and Sherwood and 5 4 Mansfield and Ashfield CCGs

96 Cumulative Record of Safeguarding Children’s Committee Members’ Attendance 2014/15

Role Possible Actual

Chief Nurse and Director of Quality Newark and Sherwood and 5 5 Mansfield and Ashfield CCGs (chair) Director of Quality and Patient Safety and Executive Nurse for 3 Nottingham North and East, Nottingham West and Rushcliffe 5 (+2 deputy) CCGs (vice-chair) Chief Nurse and Executive Lead for Quality and Safety for 2 5 Bassetlaw CCG (+3 deputy) Designated Professionals Safeguarding Children CCGs 5 5 Designated Professionals Safeguarding Children in Care 5 5 Continuing Care Commissioning Manager (Children Lead) 5 1 Greater East Midlands Support Unit (GEM) Public Health Manager (Children Lead) nominated by the 5 3 Director of Public Health, Nottinghamshire County Council

Individual Funding Request Panel (IFR) The joint Individual Funding Request panel is hosted under a memorandum of understanding by NHS Nottingham West CCG in conjunction with NHS Nottingham North and East CCG, NHS Mansfield and Ashfield CCG and NHS Newark and Sherwood CCG and NHS Rushcliffe CCG. Clinical commissioning groups are required to have a process for considering funding for individuals who seek NHS commissioned services outside established commissioning policies. This may be a request for funding treatment either where there is no commissioning policy or where the medical condition is not included in a current policy or does not meet the criteria set out in the policy. The IFR panel is constituted in accordance with the scheme of reservation and delegation of Nottingham West CCG. The applicable policies and procedures are owned and maintained by Nottingham West CCG. Key Areas of Work During 2014/15 for the IFR Committee  16 individual funding request applications were processed in accordance with the IFR policy eligibility criteria. One case was approved by the panel and one case was not approved. Nine cases were screened in line with the policy, but were declined for consideration by the IFR panel as they did not demonstrate clinical exceptionality. Three cases were redirected/returned; one case was withdrawn; and at the time of writing one case was still pending, awaiting further clinical information from the requesting Trust.  Eight previously approved cases were reviewed for clinical benefit.  One patient complaint was received in response to a previous IFR application. Support was provided to the CCG clinical lead and a media statement produced.  Terms of reference were updated and ratified by NHS Nottingham West CCG Governing Body in October 2014.

97  A quarterly IFR report was provided for each CCG detailing all requests for funding including commissioned and non-commissioned procedures, for example IVF, assessment for Asperger’s Syndrome and treatment abroad. Annual reports for 2013/14 were provided to the CCGs indicating the levels of activity and type of requests for IFR applications.  Two training sessions were provided for IFR panel members including critical appraisal and defining exceptionality as per the training needs analysis. Cumulative Record of the IFR Panel Committee Members’ Attendance 2014/15

Name Individual Funding Request Committee Role Possible Actual

Peter Robinson Lay Representative (Chair) 4 4 Usha Gadhia Lay Representative (Nominated Deputy Chair) 4 3 Dr Mary Corcoran Consultant in Public Health Medicine 3 3 Dr. Jo Copping Consultant in Public Health Medicine 1 1 Oliver Newbould Chief Officer – NHS Nottingham West CCG 4 4 (Deputy Chief Officer) NHS Nottingham North Sharon Pickett 4 4 and East CCG Dr Simon GP – Lombard Medical Practice – NHS Newark 4 3 Brenchley and Sherwood CCG GP – West Bridgford Medical Practice – NHS Dr Sean Ottey 4 4 Rushcliffe CCG Jane Urquhart IFR Manager – NHS Mansfield and Ashfield CCG 4 4 Senior Prescribing Advisor (South) – Manages Nicky Bird 4 4 IFR Team – NHS Mansfield and Ashfield CCG Darrin Baines Health Economist – The University of Nottingham 4 0 GP – Huthwaite Health Centre – NHS Mansfield Dr Hilary Lovelock 4 0 and Ashfield CCG GP – The Manor Surgery – NHS Nottingham Dr James Read 4 4 West CCG

Governing Body Performance and Effectiveness The clinical commissioning group is led by an effective governing body which includes GP clinical lead members, lay members, a secondary care representative and senior officers with significant experience of operating at Board level. The CCG continues to have four lay members as opposed to the required two members. One is the lay vice-chair of the Governing Body, who normally chairs the meetings of the Governing Body. This is in line with the strongly held belief that the role of patients or ‘lay’ people in the decision-making structure of the clinical commissioning group is critical to its success, and demonstrates a clear commitment to patient engagement at the highest level. There is a clear distinction of responsibilities between the GP chair and the lay vice-chair. The combined leadership brings both a clinical and a lay perspective and has a positive impact on governance and accountability.

98 Training for governing body members was carried out throughout the year through the Governing Body development sessions, protected learning time events and the Clinical Commissioning Forum. At these sessions members were briefed on the South Nottinghamshire Transformation Programme and the Better Care Fund process and identification of schemes. In addition, local authority partners briefed the Governing Body on budget cut proposals and the implications of the Care Act. The Governing Body discussed and developed the CCG’s response to the Mid-Staffordshire NHS Foundation Trust Public Inquiry and the Francis report recommendations and participated in an interactive workshop facilitated by 360° Assurance to develop further the CCG’s risk appetite and risk tolerance for its key risks. All mandatory training was also completed and lay members have attended individual courses relevant to their roles on the Governing Body and its committees. This year the lay vice-chair developed a CCG governing body performance assessment questionnaire, which was completed by individual members to assess the performance and effectiveness of the Governing Body through the completion of an online survey. The results of the survey were analysed by 360° Assurance, which showed on the whole that there was significant positive consensus in relation to the five areas assessed:  Focus on core business  Trust and support  Contribution and execution  Engagement with stakeholders  Leadership of the Governing Body A number of actions were highlighted for the forthcoming year which will be used as a basis for ongoing training and development for Governing Body members, to produce a forward planner for development sessions for 2015/16 and to benchmark progress through the year.

The Clinical Commissioning Group Risk Management Framework Every activity that the clinical commissioning group undertakes, or commissions others to undertake on its behalf, brings with it some element of risk that has the potential to undermine – or prevent – the organisation achieving its objectives. The integrated risk management policy enables the organisation to have a clear view of the risks affecting each area of its activity, how those risks are being managed, the likelihood of occurrence and their potential impact on the successful achievement of the clinical commissioning group’s objectives. The major systems to facilitate the identification and management of all risk throughout the clinical commissioning group are to establish, populate and maintain a risk register and assurance framework that profile all objectives and associated risks relating to the business planning and delivery of services. The clinical commissioning group has one risk register with separate sections monitored by the clinical commissioning group’s committees or groups covering the following areas:  Corporate – CCG Leadership Team  Finance – Finance and QIPP Group  Clinical – South Nottinghamshire CCGs’ Quality and Risk Committee  Information Governance – Nottinghamshire IGMT Committee  Safeguarding Adults – Safeguarding Adults Committee  Safeguarding Children – Safeguarding Children’s Committee

99 The Assurance Framework includes the risks identified that could threaten the achievement of the clinical commissioning group’s strategic objectives. The Assurance Framework is reviewed thoroughly at every meeting of the Audit Committee and every four months by the Governing Body. The Governing Body reviewed and approved the integrated risk management policy in March 2015, noting the detail added to the risk appetite statement following the Governing Body facilitated development session to develop it further. Risk Management Process The integrated risk management policy promotes the philosophy of integrated governance and requires all risk management to be systematic, robust and evident. It requires that risk management and prevention processes are applied at all levels and that risk management issues should be communicated to key stakeholders where necessary. Implementation of the risk management policy is coordinated and monitored by the clinical commissioning group’s Leadership Team and overseen by the Audit Committee with routine reporting to the Governing Body. The policy clearly states the processes that the clinical commissioning group follows when identifying a risk. The process ensures that the highest risks progress through to the Assurance Framework with a systematic approach to lower risks. The process makes sure that where risks are identified, there is a requirement for action to be taken to mitigate the risks. Where risks remain at a high level, they are subject to regular scrutiny by the Governing Body, relevant committee or group or the Leadership Team so that they receive constant management attention. The process for identifying, evaluating and managing risks is set out below: Risk Identification and Challenge (Step One) Risks are identified and challenged through various mechanisms:  Discussion and challenge through Governing Body meetings and all of its committees and sub-groups  Review at leadership meetings  Discussion as part of individual projects/service redesign  Identified by an individual member of staff  Highlighted from member practices through practice visits, practice feedback forms and practice managers’ meetings  Discussion and challenge through risk management workshops Reporting Risk (Step Two) Any member of staff identifying a risk should report it to their line manager and to the head of governance and engagement, who will ensure that it is considered by the relevant committee or group as above. If the risk identified is considered to be an immediate significant risk, the Chief Officer will be informed. Risks that are identified during meetings of the Governing Body or at any of its committees should be reported to the head of governance and integration.

100 Analysing and Quantifying Risk (Step Three) Once a risk is identified it is important to establish the likelihood of it occurring and the potential impact if it did occur. This is measured by using a risk assessment matrix. The risk score is determined by multiplying the score for the likelihood of an event occurring with the impact score to produce a classification as below based on the NHS England Risk Assessment Matrix:  Green  Amber/green  Amber  Amber/red  Red This gives the risk an initial risk rating. Recording Risk (Step Four) Where a risk has an initial rating of amber or above, the risk will be recorded on the clinical commissioning group’s risk register. The actions required and any existing controls to minimise or eliminate a potential risk are then identified and recorded on the risk registers to include a timescale for expected completion of that action and the person responsible for implementation. After identifying any action(s) and controls to minimise a risk the risk should be reassessed taking into account the effect of planned actions. This is referred to as the residual risk score and should be quantified using the risk assessment matrix. Escalation of Risks (Step Five) The residual risk rating confirms the level of risk outstanding and determines the following action:  Amber, amber/green and green – risk is managed via the risk register  Amber/red, red – risk is retained on the risk register but escalated to the CCG Assurance Framework. Stepping Down and Removal of Risks (Step Six) Following completion of actions a period of monitoring action will take place. Once a risk is reduced to amber, it is stepped down from the CCG Assurance Framework to the risk register and continues to be monitored by the relevant committee or group. It is recorded in the Assurance Framework as a risk removed. Once a risk has reduced to amber/green or green, the risk is removed from the risk register and archived. If an archived risk re-emerges, the process should start again at step two. There are some risks which will retain a risk rating regardless of mitigation, controls and action. This rating is known as the inherent risk.

101 Risk Appetite Risk appetite is about an organisation’s willingness to accept risks and the sorts of risk it is willing to accept in pursuit of its strategic objectives. The benefit for an organisation of understanding its risk appetite is that it provides direction and sets the boundaries on acceptable risk for the whole organisation. It enables the organisation to determine an appropriate level of resources to manage risk avoiding inappropriate decisions exposing the organisation to risks it cannot tolerate or that are over cautious and stifle growth and development. Overall the Governing Body determined that it has a low risk appetite in respect of:  Patient safety and quality of services  Finance  Value for money  Performance  CCG reputation. It has a moderate risk appetite in respect of:  Governance of partnerships  Organisational factors  Strategic factors The Governing Body completed an initial review of the key risks on the Assurance Framework and to establish its risk tolerance. This will be further developed and embedded in the ongoing review process for the Assurance Framework. The Governing Body commits to review its risk appetite statement on an annual basis. Incident Reporting The clinical commissioning group has a Governing Body approved health and safety policy and has developed a procedure for the reporting of incidents and near misses including RIDDOR, which encourages staff to report all incidents including near misses in an open and transparent manner. There is a no blame culture, which provides an opportunity for sharing of lessons learned. There were no significant incidents or near misses reported this year. As commissioners, the clinical commissioning group has a policy for the reporting and management of serious incidents occurring in provider organisations which details the role of the clinical commissioning group in monitoring and analysing serious incidents. Incidents occurring in primary care are reported to NHS England following the national serious incidents framework and local incident reporting policy. The clinical commissioning group will support NHS England where required. Public Stakeholders Public stakeholders are members of the Governing Body and associated governance groups and are actively encouraged to contribute to and be involved in managing risks that directly and indirectly impact on them. The clinical commissioning group has appointed three lay members to the Audit Committee, where the clinical commissioning group’s performance against managing risks documented in the Assurance Framework is routinely reviewed.

102 The Clinical Commissioning Group Internal Control Framework A system of internal control is the set of processes and procedures in place in the clinical commissioning group to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it can therefore only provide reasonable and not absolute assurance of effectiveness. Information Governance The NHS Information Governance Assurance Framework sets out the processes and procedures by which the NHS handles information about patients and employees, in particular personal confidential information. 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 partner organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively. The clinical commissioning group places high importance on ensuring there are robust information governance systems and processes in place to help protect patient and corporate information. An information governance management framework has been established and information governance processes and procedures have been developed in line with the information governance toolkit. The senior information risk owner (SIRO) is a member of the Governing Body, as is the Caldicott Guardian. All staff undertake annual information governance training and a staff information governance handbook has been implemented to ensure staff are aware of their information governance roles and responsibilities. There are processes in place for incident reporting and investigation of serious incidents. Information risk assessment and management procedures have been developed and a programme will be established to fully embed an information risk culture throughout the organisation. The CCG, through the joint IGMT Committee, has documented relevant risks in the information governance risk register. The register is reviewed at every IGMT meeting along with any mitigating actions. Policies supporting the security of data and access to systems have been put in place and are regularly reviewed within the proposed timescales.

Risk Assessment in Relation to Governance, Risk Management and Internal Control The clinical commissioning group has an Assurance Framework and risks are assessed in line with the process detailed above. There is a clear link to the operational risk registers and the integrated risk management policy describes the process to escalate and downgrade risks.

103 High level risks (red and amber/red) have been identified and are managed closely through the Audit Committee and reported through to the Governing Body. The Audit Committee requested a deep dive review of each individual risk on the Assurance Framework during 2014/15 to assure itself of the effectiveness of controls and mitigations and to ensure that responsibilities for each risk were clear. This programme of reviews allowed the Audit Committee to provide detailed and rigorous oversight on behalf of the Governing Body. The risks identified as at March 2015 are listed below.

New Risks/Amendments to Risks Identified During the Year Ambulance Service Ambulance Service performance in Rushcliffe remained below target throughout the year. This was under scrutiny at each Clinical Cabinet and Governing Body meeting. Following the Clinical Risk Summit called by NHS England in October 2013, the Governing Body invited the EMAS Chief Executive to attend the July 2014 Governing Body meeting to provide an update on the subsequent Better Care Programme and Quality Improvement Plan. Prior to this the Governing Body had dedicated part of its June development session to have a full discussion about the EMAS performance and to prepare for the meeting. A deep dive review at the Audit Committee in November 2014 revealed that performance remained a significant risk for the CCG and following a further discussion at the March 2015 Governing Body, the CCG escalated it to NHS England requesting consideration of calling a Clinical Risk Summit through the Quality Surveillance process to address the underperformance issues. The Quality and Risk Committee now routinely reviews clinical audits on patients experiencing missed response times and receives regular prolonged wait reports. In addition, the CCG attends the EMAS Nottinghamshire Divisional meetings to understand specific local operational issues.

104 Emergency Department The local health system has faced significant challenges in delivering the Emergency Department (ED) performance standard at Nottingham University Hospitals NHS Trust. Since the start of the year, the outcome of the CCG Assurance Process has been that the CCG has been ‘assured with support’ specifically in relation to one of the six assurance domains: Are patients receiving clinically commissioned, high quality services? There are other national standards across the wider urgent care system that could be seen to impact on the four-hour waiting time standard. For example, the NHS 111 service’s call handling targets have not been achieved consistently throughout the year, particularly during the winter months when demand grew more rapidly than expected. The CCG is continuing to work with the co-ordinating commissioner for this service to develop a recovery plan, which is focussed on the recruitment and retention of staff. NHS England has put in place a programme to support all health partners in the South Nottinghamshire locality to work together to focus on achieving greater performance in ED for our population. NHS England will continue to review the CCG’s assurance level until a sustained period of delivery against the Emergency Department performance target has been achieved. The focus of this risk was amended to reflect the performance failure as opposed to an increased demand of admissions. The CCG’s usage of ED remained broadly constant during the year. The likelihood of this risk was increased due to the sustained period of non- achievement of the target. Care Homes The deep dive review into the quality assurance and monitoring of care homes revealed that much progress had been made since the risk was originally added to the Assurance Framework in June 2012. A review of the shared Quality Team and Safeguarding arrangements was undertaken during the year and as a result a new post was added to the team. The implications of the Care Act from 1 April 2015 and the impact on the team were unknown at the time of writing, therefore the risk remained as amber/red. New Risks No new risks were identified during the year, although two risks were downgraded and stepped down to the risk registers:  The Better Care Fund (BCF) risk was monitored throughout the year and was stepped down to the corporate risk register in March 2015 as detailed governance arrangements were put in place. The Nottinghamshire plan was signed off by NHS England as ‘Approved’ in December 2014 following further work to provide assurance around programme governance in relation to monitoring and delivery of the plan. The Section 75 pooled budget arrangement with Nottinghamshire County Council was agreed by the Governing Body in March 2015.  QIPP 2014/15 was on track to achieve the £3.8 million target by the end of March 2015 and so was downgraded to green and stepped down to the finance risk register to be archived. Work is ongoing to identify any new risks particularly around implementation of the BCF plan and performance against key performance indicators, primary care commissioning and the financial risks relating to co-commissioning of specialised services and QIPP 2015/16.

105 Cancer The clinical commissioning group’s performance against the national target of 90 per cent of patients receiving their first screening treatment following a diagnosis of cancer within 62 days was 85.7 per cent at 31 March 2015. The clinical commissioning group continues to work with its providers to reduce waiting times for patients. Performance against the national target of ninety three per cent of patients with suspected breast cancer to be seen by a consultant within two weeks was 88.9 per cent up to the end of March 2015. Action plans are in place to improve performance for patients with major hospitals to:  Streamline processes for patients  Increase the numbers of clinical staff available to treat them  Reduce waiting times for diagnostic tests for patients suspected of having cancer  Increase clinical capacity in anticipation of forthcoming cancer campaigns  Expedite patients referred for treatment into tertiary centres from other trusts MRSA There is a zero tolerance for MRSA blood stream infections and therefore the target for all organisations – provider and CCGs – is zero. During 2014/15, one case of MRSA blood stream infection was attributed to Rushcliffe CCG in July 2014. All cases are subject to a post infection review process using root cause analysis by infection prevention and control nurse specialists. This is to determine whether the case is clinically avoidable or unavoidable and in the case of avoidable cases to identify and share learning to prevent recurrence. The post infection review undertaken in relation to the July 2014 case concluded that the case was clinically unavoidable.

Review of Economy, Efficiency and Effectiveness of the Use of Resources Financial Governance The clinical commissioning group has sound financial governance arrangements in place. The Constitution documents the standing orders, scheme of reservation and delegation and the prime financial policies supported by the detailed financial policies including the operational scheme of delegation reviewed and approved at the Governing Body meeting in September 2014. The Governing Body has ensured that robust governance arrangements are in place and has established committees for Audit and Remuneration. The Clinical Cabinet has established a Finance and QIPP Group to monitor financial performance, investment and the delivery of QIPP schemes. Financial Reporting The Governing Body receives a Finance Report at each of its meetings detailing the overall financial position and forecast outturn and performance against the clinical commissioning group’s statutory financial duties. The report highlights any variances and key messages. The Audit Committee lay members provide direction on the format and content of the finance report to enable the Governing Body to make informed decisions. In addition, the Governing Body receives reports on financial planning and opening budgets.

106 Risk Pooling A financial risk pooling agreement for 2014/15 was agreed by the Nottinghamshire County and Nottingham City CCGs with the recommendations of the Risk Pool Steering Committee approved by the Governing Body in March 2014. The operation of the 2014/15 risk pool agreement is summarised as: High cost patients (i.e. a patient whose costs in the calendar year for acute secondary and critical care services within the scope of the CCG exceed £80,000) and one-off ‘major incidents’ (i.e. events that (i) are expected to occur less frequently than once in every two years; and (ii) have been recognised by Public Health England and/or an appropriate local health authority as an outbreak or emergency) would be risk shared at a city/county basis. High cost patients covered as part of this 2014/15 risk pool include acute secondary and critical care services but do not include Continuing Care and non-NHS low secure services/locked rehabilitation, which were previously risk shared across the Nottinghamshire County CCGs as part of its risk pooling agreement for 2013/14. Both chief finance officers for the north and south county CCGs agreed that these areas would continue to be risk shared between the county CCGs in 2014/15 on the same basis as 2013/14. Internal and External Audit Both Internal and External Audit carry out independent reviews of systems and processes within the organisation. Recommendations and action plans are put in place following these reviews to ensure controls are safe and adequate, providing safeguard of assets and resources. Key risks highlighted in these reports are added to the corporate risk register and escalated to the Assurance Framework if they present a threat to strategic objectives. Management action plans are routinely tracked through the Audit Committee meetings. Counter Fraud and Deterrence In accordance with its constitutional framework, the clinical commissioning group is required to have adequate arrangements in place for countering fraud, corruption and bribery. The CCG has a Governing Body approved fraud, bribery and corruption policy and has produced a risk assessment and workplan across four areas of work:  Strategic Governance  Inform and Involve  Prevent and Deter  Hold to Account Staff have received counter fraud training via face to face presentations and eLearning, and counter fraud surveys are regularly conducted, the results of which form an action plan which is considered when developing the clinical commissioning group’s counter fraud risk assessment and workplan. Regular bulletins are issued to staff which raise awareness and increase vigilance and reporting. Counter fraud reports are received at Audit Committees. These reports inform the committee of the work carried out by the counter fraud specialist (CFS) and provide an update of progress against the workplan. The CFS also reviews policy and process to ensure adequate preventative measures are in place.

107 Review of the Effectiveness of Governance, Risk Management and Internal Control As Accountable Officer I have responsibility for reviewing the effectiveness of the system of internal control within the clinical commissioning group. Capacity to Handle Risk The Chief Officer as Accountable Officer has taken ultimate responsibility for establishing and implementing a risk management system in the clinical commissioning group. This is demonstrated by:  Continually promoting risk management and demonstrating leadership, involvement and support.  Ensuring an appropriate committee structure is in place, with regular reports to the Governing Body.  Ensuring that directors and senior managers are appointed with managerial responsibility for risk management.  Ensuring appropriate policies, procedures and guidelines are in place and operating throughout the clinical commissioning group. Detailed procedures are set out in the clinical commissioning group’s integrated risk management policy, which was reviewed and approved by the Governing Body in March 2015. In conjunction with these structures, systems and processes, staff training is delivered through face to face team training sessions and dissemination of the policy. The policy provides all staff with the appropriate information and the tools to identify, score and treat risk appropriately according to level and severity. The clinical commissioning group constantly reviews its policy and procedures for managing risk in the light of the work of fellow clinical commissioning groups and in respect of Internal Audit best practice papers and benchmarking reports. Review of Effectiveness My review of the effectiveness of the system of internal control is informed by the work of the internal auditors and the executive managers and clinical leads within the clinical commissioning group who have responsibility for the development and maintenance of the internal control framework. I have drawn on performance information available to me. My review is also informed by comments made by the external auditors in their management letter and other reports. The Assurance Framework itself provides me with evidence that the effectiveness of controls that manage risks to the clinical commissioning group achieving its principle objectives have been reviewed. Throughout the year, the Assurance Framework was actively managed and regularly reviewed by the Governing Body and Audit Committee. I am satisfied that it reflected the key risks and challenges faced by the CCG and has been reviewed and revised appropriately to reflect the challenges that presented as the year advanced and the clinical commissioning group matured.

108 I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Governing Body, the Audit Committee and the Quality and Risk Committee and a plan to address weaknesses and ensure continuous improvement of the system is in place. My review was also informed by:  CCG Assurance Framework – balanced scorecard/delivery dashboard by NHS England Area Team  Delivery of audit plans by external and internal auditors  NHS staff survey results  360° stakeholder survey Head of Internal Audit Opinion Following completion of the planned audit work for the financial year for the clinical commissioning group, the Head of Internal Audit issued an independent and objective opinion on the adequacy and effectiveness of the clinical commissioning group’s system of risk management, governance and internal control. The Head of Internal Audit concluded that:

From my review of your systems of internal control, primarily through the operation of your Governing Body Assurance Framework and the individual assignments I have undertaken, I am providing significant assurance that there is a generally sound system of internal control, designed to meet the organisation’s objectives, and that controls are generally being applied consistently.

Limited Assurance During the year, Internal Audit did not issue any new reports with limited assurance. Quality and Contract Monitoring in Care Homes – Report Reference 1213/NCO/15R May 2013 for NHS Nottinghamshire County Incorporating Five Nottinghamshire CCGs The original report was inherited by the clinical commissioning group from the former PCT’s internal audit plan 2012/13. The report gave a conclusion of significant assurance for the quality monitoring mechanisms in place for ensuring that care provided by care homes is of a sufficiently high standard. However, the report provided limited assurance in respect of the mechanisms in place to monitor compliance with the contract for care homes which provide NHS Continuing Healthcare (CHC). A full review of this report was not carried out this year and therefore the assurance level was not updated. However, a follow-up review was completed in December 2014 which details the progress made against the recommendations over the last year:  Lack of effective contract monitoring – a standard contract was agreed between the CCG and care homes and the migration of care homes to the new contract was being undertaken by Greater East Midlands Commissioning Support Unit (GEM CSU). Work had commenced to re-procure these contracts when the current AQP contract expires in 2016.

109  No detailed service specification in respect of GEM’s responsibilities relating to the provision of care within care homes – the CCG undertook a full re-procurement exercise. A detailed specification was in place with GEM until the new service was mobilised, which at the time of writing was due on 1 July 2015. Lack of clarity around contract management responsibilities following the dis-establishment of the PCT was being addressed, including bringing some elements of the CHC service back in-house.  Alignment of the quality monitoring process with the quality standards in the contract – progress was made to rationalise the quality audit tool and a regional sub-group was to be set up. These tasks were linked to the AQP contracts and needed to be undertaken on an East Midlands-wide basis. The follow-up report identified that the CCG was currently reviewing services provided by GEM CSU and the approach to contract monitoring either by GEM or other options. A further follow-up will be completed in 2015/16 to review progress in implementing the remaining actions to provide assurance in this area. The Audit Committee will continue to monitor progress and will request a deep dive review of the new service following mobilisation. No Assurance There were no reports issued with a conclusion of no assurance. Significant Issues i) Greater East Midlands Commissioning Support Unit (GEM CSU) Service Auditor Report The overall objective of the service audit work undertaken (by Deloittes) is to evaluate the effectiveness of the control environment for the CSU and provide assurance to the CSU and therefore NHS England and the CCG, on the adequacy and effectiveness of the key controls in operation. During the financial year 2013/14 control weaknesses were identified during the year in Greater East Midlands Commissioning Support Unit’s (GEM CSU) ability to achieve a substantially ‘clean’ auditor report for that financial year. For the financial year 2014/15 Deloittes have undertaken two separate reviews for the periods 1 June 2014 to 30 September 2014 and 1 October 2014 to 31 March 2015. Their key conclusion for both of these periods is that the controls tested were operating with sufficient effectiveness to provide reasonable assurance that the related control objectives were achieved throughout the period 1 June 2014 through to 31 March 2015, although a number of control deficiencies were identified for both periods reviewed. These control deficiencies have been reviewed by the CCG and it has been confirmed that these have limited impact upon the CCG due to sufficient compensating controls being in place locally. For the period after 1 November 2014 it should be noted that the technical finance function, undertaken by GEM on behalf of the CCG, was brought back in-house and so a service audit report on controls in relation to technical finance for this period is no longer relevant.

110 The audit report does not cover the period 1 April 2014 to 31 May 2014. For this period the CCG recognises the limited risk that is associated with not having a reasonable assurance opinion from a service audit but assesses this risk as minimal due to a number of reasons: 1. The CCG commissioned a limited range of financial services (primarily payroll data processing, balance sheet maintenance, control account reconciliations and suspense clearance) from the CSU compared to other CCGs around the country, with the management accounting function provided by the CCG’s in-house finance team. This management accounting function includes the key spend areas of healthcare service level agreements, prescribing and continuing care. 2. As previously noted, all finance services were brought back in-house with effect from 1 November 2014. At this time of ‘take-on’ the CCG team worked closely with both Internal and External Audit to ensure issues were identified and resolved. 3. Financial services continue to be the subject of scrutiny through the combined internal audit budgetary control, financial reporting and key financial systems (including payroll). This budgetary control, financial reporting and key financial systems report, undertaken during quarter four and issued on 27 March 2015, confirms an audit opinion of significant assurance. 4. In mitigating against any further risk to the CCG, the CCG had a number of compensating controls in place:  Control account reconciliations were reviewed on a monthly basis by a member of the senior finance management, thereby limiting any risk to the reported income and expenditure accounts.  Supporting this, the management accounting function was, and continues to be, the responsibility of the CCG. Therefore variance analysis and reporting would highlight any areas to be investigated.  Nominal rolls were reviewed regularly and regular monthly variance analysis of pay- related management accounts was carried out.  The CCG held monthly performance meetings with the CSU where it discussed performance against the SLA which covers the financial services provided by the CSU.  Regular reporting of all aspects of finance information to NHS England Area and Regional team is submitted monthly. This information is subject to challenge and scrutiny by NHS England colleagues. No issues have been highlighted to CCGs relating to the service previously carried out by GEM. ii) Personal Confidential Data (PCD) At the formation of the CCGs in April 2013, the ability to validate invoices that was available to PCTs was discontinued, leaving CCGs at financial risk due to potential mis-attributed charges. To address this, NHS England introduced the Controlled Environment for Finance (CEfF) framework under s251 legislation. Under the CEfF arrangements, accredited organisations may process personal confidential data for the singular purpose of determining whether or not payment for a patient’s care is the responsibility of the invoiced CCG. The Nottinghamshire CCGs were successful in becoming accredited on 19 March 2014. Risk mitigating measures were put in place in the interim, including written communication to provider organisations setting out the intention to recover incorrect charges once the ability to validate was restored. As accreditation was confirmed very late in the financial year, decisions on how to prioritise resources for making retrospective claims for 2013/14 were taken by respective finance teams. With the CEfFs now in place and fully operational, there is no equivalent risk relating to the 2014/15 financial year.

111 iii) New Models of Care Programme Vanguard Site – Multi-Specialty Community Provider A successful bid to be a national vanguard site was submitted to NHS England to become a multi-specialty community provider (MCP). Principia Partners in Health is a community interest company which will work alongside local authorities, health providers, voluntary groups and GPs to transform and modernise community health and GP services. NHS England announced the successful bids in March 2015 under its New Models of Care Programme. The next steps include a site visit including sessions for partners and stakeholders. Full governance arrangements will be established for the MCP in 2015/16. Data Quality The clinical commissioning group has robust controls in place to ensure the required standards for data quality from all providers where it commissions services. Locally defined schedules of the NHS Standard Contract include elements requiring standards for data quality. In addition, the clinical commissioning group has signed off the provider trusts’ data quality strategies. The IGMT Committee includes a standing agenda item to receive quarterly data quality reports which summarise the data quality issues associated with key provider organisations, the relative benchmarking of data quality for these providers and any national expected standards. The report also outlines the actions being taken within and out-with the CCG to improve the quality of data to an acceptable level. A joint Data Management Team across Nottinghamshire CCGs is hosted by NHS Rushcliffe CCG. The Data Management Team is responsible for processing and validating data as well as developing business intelligence solutions and managing all data flows into and out of the clinical commissioning group, including testing the accuracy of data being submitted nationally and locally by providers. Ultimately this allows the CCG to reinstate some of the data quality checks which were suspended following the national information governance restrictions mandated under the Health and Social Care Act 2012. Business Critical Models The clinical commissioning group is undertaking work to document business critical models across its operation. Quality assurance is in place and the methods used are dependent upon the nature and purpose of the business critical model. For financial modelling the following quality assurance processes are in place:  Adherence to published NHS England planning guidance and Area Team requirements  Use of version control and in-built validation checks in the financial model  Financial plans submitted to the NHS England Area Team and details from the financial modelling as and when required  Critical evaluation via external peer review from the Area Team  Internal peer review of financial model and financial plan templates within the Finance Department  Ongoing process to inform contract team of initial envelopes and updates to financial plan and envelopes in line with contract negotiations until contracts formally signed off  Subject to Internal Audit assurance as part of the financial management audit. In addition to the above, for the development of acute contract activity plans the following processes are in place:  External confirm and challenge process with acute provider directorates  Final formalised sign off following acceptance checking by providers

112 Data Security The clinical commissioning group submitted a satisfactory level of compliance with the information governance toolkit at level 2. As per the requirements for level 2 compliance, all staff completed their mandatory information governance training during 2014/15 ensuring that all staff members were aware of their responsibilities relating to information governance. All information governance incidents are taken extremely seriously. The clinical commissioning group is committed to reporting, managing and investigating all information governance incidents and near misses. Staff are encouraged to report all incidents and near misses to ensure learning can be collated and disseminated within the organisation. The clinical commissioning group did not report any serious untoward incidents involving information, confidentiality or security between April 2014 and March 2015. Discharge of Statutory Functions During establishment, the arrangements put in place by the clinical commissioning group and explained within the corporate governance documentation were developed in line with model guidance which included extensive expert external legal input, to ensure compliance with all relevant legislation. The clinical commissioning group regularly keeps under review its statutory duties and powers. In light of the Harris Review, the clinical commissioning group reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislative requirements and regulations. As a result, I can confirm that the clinical commissioning group 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. The scheme of delegation identifies clear lines of responsibility and structures are in place supported by memoranda of understanding which have included external legal input, to ensure that the clinical commissioning group has the necessary capability and capacity to undertake all of its statutory duties.

Conclusion My review confirms that the clinical commissioning group has a generally sound system of internal control that supports the achievement of its values, objectives and policies. Remedial actions taken and compensating controls put in place to address control issues pertaining to the arrangements for the contract monitoring of care homes and control weaknesses at GEM CSU identified in the previous reporting year, have been reported in this Governance Statement. This Governance Statement was discussed at the Audit Committee and with Governing Body members and their views were taken into account in the preparation prior to formal submission. Vicky Bailey Accountable Officer Signature Vicky Bailey

Date 27 May 2015

113 Annual Accounts

Chief Financial Officer Commentary The Financial Statements provide an overview of our performance for 2014/15. The full Statutory Accounts, including the Auditor’s Report are attached at Appendix 1. Rushcliffe Clinical Commissioning Group achieved all key financial NHS England Group Requirements for the year, including remaining within resources available, delivering our planned surplus, achieving our agreed year end cash balance, not exceeding our running costs allocation and delivering against the Better Payment Practice Code target. The CCG started the year in a financial position that required delivery of a £3.8 million savings target (QIPP – Quality, Innovation, Productivity and Prevention – target). This target was delivered in full, albeit with an element delivered non-recurrently. The CCG also experienced cost pressures, mainly across acute and continuing healthcare programme areas. However, utilising our contingency reserve the surplus target of £1.697 million, as set by NHS England, was achieved. The CCG exited 2014/15 with an underlying recurrent surplus position that reflected the going concern declaration. The CCG continues to face financial challenges and a QIPP target of circa £4.5 million is required to be delivered in 2015/16 in order to achieve our surplus target of one per cent. The Better Care Fund (BCF) started at the start of 2015/16, and this sees a £6.8 million investment by the CCG. The operation of the BCF is described in more detail in the Strategic Report section of the Annual Report. It is key that the financial and operational objectives of the BCF schemes are delivered and the CCG will work with all local stakeholders, including the local authorities, healthcare and social care providers and other clinical commissioning groups, to ensure resources continue to be used and invested to improve the health and wellbeing of the residents of Rushcliffe CCG. Finally, thanks go to all staff, managers and members for the notable success in delivering the 2014/15 financial targets.

Financial Performance Our annual report and accounts cover the 12 month period from 1 April 2014 to 31 March 2015. Rushcliffe Clinical Commissioning Group achieved all key financial requirements for the year, including remaining within resources available and delivering against the Better Payment Practice Code target.

114 Target Actual NHS England Group Requirements £’000 £’000 The national requirement to deliver surplus 1,395 1,700 requirements (Note 1) Remained within cash limit 95 47 Identification of two per cent funding 3,120 3,120 committed non recurrently Identification of 0.5 per cent contingency to 647 647 meet in year cost pressures Running cost to be within notified allowances 3,103 2,437 (Note 2) Note 1 The CCG planned surplus was £1,395k. During the year, NHS England returned £302k to the CCG in respect of a refund to the continuing healthcare risk pool contribution, which resulted in an increase to the surplus. Note 2 The notified running cost allowance for Rushcliffe CCG for 2014/15 included a non-recurrent allocation for the quality premium of £76k. Our accounts were prepared in accordance with directions given by the Department of Health. They were also prepared to comply with the International Financial Reporting Standards (IFRS) and are designed to present a true and fair view of our financial activities.

Going Concern Our accounts were prepared on the basis that the clinical commissioning group is a ‘going concern’. This means that our assets and liabilities reflect the ongoing nature of our activities.

Audited Financial Statements and Auditor’s Report The Audited Financial Statements and Auditor’s Report are attached at Appendix 1.

Working Capital and Liquidity We ended 2014/15 with a cash balance of £47k (0.6 per cent), as directed by NHS England.

Events After Reporting Period During 2015/16:  Responsibility for GP primary care commissioning will transfer from NHS England to the CCG under delegated authority. The anticipated level of resource transfer for Rushcliffe CCG is £15,139k.  The CCG will enter into a joint arrangement for a pooled budget for the Better Care Fund. The CCG will contribute £6,180k to the pool.

115 Capital Expenditure There was no capital expenditure during the financial year.

Accounting Policies We have detailed accounting policies approved by the Audit Committee which comply with the NHS Manual of Accounts and International Financial Reporting Standards (IFRS). Our accounting policies are detailed in the full set of financial accounts.

Efficiency We generated recurrent efficiency savings and contributions from new initiatives of £3,246k during 2014/15. A summary of our main savings delivered during the year is shown below:

2014/15 QIPP Programme Areas £’000 Contracting 893 Mental Health 305 Planned Care 252 Prescribing 298 Unplanned Care 1,406 Other 92 Total 3,246

Statement of the Accountable Officer I certify that the clinical commissioning group has complied with the statutory duties laid down in the NHS Act 2006 (as amended).

Vicky Bailey Accountable Officer Signature Vicky Bailey

Date 27 May 2015

116 Appendix 1: 2014/15 Annual Accounts and Independent Auditor’s Report

NHS Rushcliffe Clinical Commissioning Group

2014/15

Annual Accounts and Independent Auditor’s Report

1 NHS Rushcliffe CCG - Annual Accounts 2014-15

CONTENTS Page Number

Independent Auditor's Report To The Members of NHS Rushcliffe CCG 3-5

The Primary Statements:

Statement of Comprehensive Net Expenditure for the year ended 31st March 2015 6 Statement of Financial Position as at 31st March 2015 7 Statement of Changes in Taxpayers' Equity for the year ended 31st March 2015 8 Statement of Cash Flows for the year ended 31st March 2015 9

Notes to the Accounts Accounting policies 10-16 Other operating revenue 17 Revenue 17 Employee benefits and staff numbers 18-20 Operating expenses 21 Better payment practice code 22 Income generation activities 22 Investment revenue 22 Other gains and losses 22 Finance costs 22 Net gain/(loss) on transfer by absorption 22 Operating leases 23 Property, plant and equipment 24-25 Intangible non-current assets 26-27 Investment property 27 Inventories 27 Trade and other receivables 28 Other financial assets 28 Other current assets 28 Cash and cash equivalents 29 Non-current assets held for sale 29 Analysis of impairments and reversals 29 Trade and other payables 30 Other financial liabilities 30 Other liabilities 30 Borrowings 30 Private finance initiative, LIFT and other service concession arrangements 30 Finance lease obligations 30 Finance lease receivables 30 Provisions 31 Contingencies 31 Commitments 32 Financial instruments 32-33 Operating segments 34 Pooled budgets 34 NHS Lift investments 34 Intra-government and other balances 35 Related party transactions 35 Events after the end of the reporting period 36 Losses and special payments 36 Third party assets 36 Financial performance targets 36 Impact of IFRS 36 Analysis of charitable reserves 36

2 ~

INDEPENDENT AUDITOR'S REPORT TO THE MEMBERS OF NHS RUSHCLIFFE CCG

We have audited the financial statements of NHS Rushcliffe CCG for the year ended 31 March 2015 on pages 6 to 36 of Appendix 1. These financial statements have been prepared under applicable law and the accounting polices directed by NHS England with the consent of the Secretary of State as relevant to the Clinical Commissioning Groups in England. We have also audited the information in the Remuneration Report that is subject to audit.

This report is made solely to the Members of NHS Rushcliffe CCG, as a body, in accordance with Part II of the Audit Commission Act 1998. Our audit work has been undertaken so that we might state to the Members of the CCG, as a body, those matters we are required to state to them in an auditor's report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Members of the CCG, as a body, for our audit work, for this report or for the opinions we have formed.

Respective responsibilities of the Accountable Officer and auditor

As explained more fully in the Statement of Accountable Officer's Responsibilities set out on page 81, the Accountable Officer is responsible for the preparation of financial statements which give a true and fair view. Our responsibility is to audit, and express an opinion on, the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards requ ire us to com ply with the Auditing Practices Board's Ethical Standards for Auditors.

Scope of the audit of the financial statements

An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of: whether the accounting policies are appropriate to the CCG's circumstances and have been consistently applied and adequately disclosed; the reasonableness of significant accounting estimates made by the Accountable Officer, and the overall presentation of the financial statements.

In addition we read all the financial and non-financial information in the Annual Report to identify material inconsistencies with the audited financial statements and to identify any information that is apparently materially incorrect based on, or materially inconsistent with, the knowledge acquired by us in the course of performing the audit. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report.

Opinion on regularity

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

Opinion on financial statements

In our opinion the financial statements:

• give a true and fair view of the financial position of the CCG as at 31 March 2015 and of its net operating costs for the year then ended; and

• have been properly prepared in accordance with the accounting polices directed by NHS England with the consent of the Secretary of State as relevant to Clinical Commissioning Groups in England.

3 Opinion on other matters prescribed by the Code of Audit Practice 2010 for local NHS bodies

In our opinion:

 the part of the Remuneration Report subject to audit has been properly prepared in accordance with the accounting polices directed by the NHS England with the consent of the Secretary of State as relevant to Clinical Commissioning Groups in England; and

 the information given in the Strategic Report and Members’ Report for the financial year for which the financial statements are prepared is consistent with the financial statements.

Matters on which we are required to report by exception

We have nothing to report in respect of the following matters where the Code of Audit Practice 2010 for local NHS bodies requires us to report to you if:

 in our opinion, the Governance Statement does not reflect compliance with NHS England’s Guidance;

 any referrals to the Secretary of State have been made under section 19 of the Audit Commission Act 1998; or

 any matters have been reported in the public interest under the Audit Commission Act 1998 in the course of, or at the end of the audit.

Conclusion on the CCG’s arrangements for securing economy, efficiency and effectiveness in the use of resources

Respective responsibilities of the CCG and auditor

The CCG is responsible for putting in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources, to ensure proper stewardship and governance, and to review regularly the adequacy and effectiveness of these arrangements.

We are required under Section 5 of the Audit Commission Act 1998 to satisfy ourselves that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. The Code of Audit Practice 2010 for local NHS bodies issued by the Audit Commission requires us to report to you our conclusion relating to proper arrangements, having regard to relevant criteria specified by the Audit Commission.

We report if significant matters have come to our attention which prevent us from concluding that the CCG has put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources. We are not required to consider, nor have we considered, whether all aspects of the CCGs arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively.

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

We have undertaken our work in accordance with the Code of Audit Practice 2010 for local NHS bodies, having regard to the guidance on the specified criteria, published by the Audit Commission in October 2014, as to whether the CCG has proper arrangements for:

 securing financial resilience; and

 challenging how it secures economy, efficiency and effectiveness.

The Audit Commission has determined these two criteria as those necessary for us to consider under the Code of Audit Practice 2010 for local NHS bodies 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 2015.

4

We planned and performed our work in accordance with the Code of Audit Practice 2010 for local NHS bodies. Based on our risk assessment, we undertook such work as we considered necessary to form a view on whether, in all material respects, the CCG had put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources.

Conclusion

On the basis of our work, having regard to the guidance on the specified criteria published by the Audit Commission in October 2014, we are satisfied that, in all material respects, NHS Rushcliffe CCG put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2015.

Certificate

We certify that we have completed the audit of the accounts of NHS Rushcliffe CCG in accordance with the requirements of the Audit Commission Act 1998 and the Code of Audit Practice 2010 for local NHS bodies issued by the Audit Commission.

T Crawley

Tony Crawley for and on behalf of KPMG LLP, Statutory Auditor

Chartered Accountants St Nicholas House 31 Park Row Nottingham NG1 6FQ

28 May 2015

5

NHS Rushcliffe CCG - Annual Accounts 2014-15

Statement of Comprehensive Net Expenditure for the year ended 31 March 2015 2014-15 2013-14 Note £000 £000

Total Income and Expenditure Employee benefits 4.1.1 2,100 1,850 Operating Expenses 5 179,713 172,363 Other operating revenue 2 (53,841) (47,577) Net operating expenditure before interest 127,972 126,636

Investment Revenue 800 Other (gains)/losses 900 Finance costs 10 0 0 Net operating expenditure for the financial year 127,972 126,636 Net (gain)/loss on transfers by absorption 11 0 0 Total Net Expenditure for the year 127,972 126,636

Of which: Administration Income and Expenditure Employee benefits 4.1.1 1,699 1,624 Operating Expenses 5 1,321 1,567 Other operating revenue 2 (583) (593) Net administration costs before interest 2,437 2,598

Programme Income and Expenditure Employee benefits 4.1.1 401 226 Operating Expenses 5 178,392 170,796 Other operating revenue 2 (53,258) (46,984) Net programme expenditure before interest 125,535 124,038

Other Comprehensive Net Expenditure 2014-15 2013-14 £000 £000 Impairments and reversals 22 0 0 Net gain/(loss) on revaluation of property, plant & equipment 0 0 Net gain/(loss) on revaluation of intangibles 0 0 Net gain/(loss) on revaluation of financial assets 0 0 Movements in other reserves 00 Net gain/(loss) on available for sale financial assets 0 0 Net gain/(loss) on assets held for sale 00 Net actuarial gain/(loss) on pension schemes 0 0 Share of (profit)/loss of associates and joint ventures 0 0 Reclassification Adjustments 00 On disposal of available for sale financial assets 0 0 Total comprehensive net expenditure for the year 127,972 126,636

The notes on pages 10 to 36 form part of this statement.

6 NHS Rushcliffe CCG - Annual Accounts 2014-15

Statement of Financial Position as at 31 March 2015 31 March 2015 31 March 2014

Note £000 £000 Non-current assets: Property, plant and equipment 13 3 7 Intangible assets 14 1 51 Investment property 15 0 0 Trade and other receivables 17 0 0 Other financial assets 18 0 0 Total non-current assets 4 58 Current assets: Inventories 16 0 0 Trade and other receivables 17 8,093 8,544 Other financial assets 18 0 0 Other current assets 19 0 0 Cash and cash equivalents 20 (604) 58 Total current assets 7,489 8,602

Non-current assets held for sale 21 0 0

Total current assets 7,489 8,602

Total assets 7,493 8,660

Current liabilities Trade and other payables 23 (13,092) (13,441) Other financial liabilities 24 0 0 Other liabilities 25 0 0 Borrowings 26 0 0 Provisions 30 (85) (42) Total current liabilities (13,177) (13,483)

Non-Current Assets plus/less Net Current Assets/Liabilities (5,684) (4,823)

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 (5,684) (4,823)

Financed by Taxpayers’ Equity General fund (5,684) (4,823) Revaluation reserve 00 Other reserves 00 Charitable Reserves 00 Total taxpayers' equity: (5,684) (4,823)

The notes on pages 10 to 36 form part of this statement.

The financial statements on pages 1 to 36 were approved by the Audit Committee on 27 May 2015 and signed on its behalf by:

Vicky Bailey

Chief Accountable Officer

7 NHS Rushcliffe CCG - Annual Accounts 2014-15

Statement of Changes In Taxpayers Equity for the year ended 31 March 2015 Revaluation General fund reserve Other reserves Total reserves £000 £000 £000 £000 Changes in taxpayers’ equity for 2014-15

Balance at 1 April 2014 (4,823) 0 0 (4,823)

Transfer between reserves in respect of assets transferred from closed NHS bodies 0000 Adjusted NHS Clinical Commissioning Group balance at 1 April 2014 (4,823) 0 0 (4,823)

Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2014-15 Net operating expenditure for the financial year (127,972) (127,972)

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 0000

Net gain (loss) on available for sale financial assets 0000 Net gain (loss) on revaluation of assets held for sale 0000 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 0000 Reclassification adjustment on disposal of available for sale financial assets 0000 Transfers by absorption to (from) other bodies 0000 Reserves eliminated on dissolution 0000 Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year (127,972) 0 0 (127,972)

Net funding 127,111 0 0 127,111 Balance at 31 March 2015 (5,684) 0 0 (5,684)

Revaluation General fund reserve Other reserves Total reserves £000 £000 £000 £000 Changes in taxpayers’ equity for 2013-14

Balance at 1 April 2013 0000 Transfer of assets and liabilities from closed NHS bodies as a result of the 1 April 2013 transition 112 0 0 112 Adjusted NHS Commissioning Board balance at 1 April 2013 112 0 0 112

Changes in NHS Commissioning Board taxpayers’ equity for 2013-14 Net operating costs for the financial year (126,636) (126,636)

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 0000

Net gain (loss) on available for sale financial assets 0000 Net gain (loss) on revaluation of assets held for sale 0000 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 0000 Reclassification adjustment on disposal of available for sale financial assets 0000 Transfers by absorption to (from) other bodies 0000 Reserves eliminated on dissolution 0000 Net Recognised NHS Commissioning Board Expenditure for the Financial Year (126,636) 0 0 (126,636) Net funding 121,701 0 0 121,701 Balance at 31 March 2014 (4,823) 0 0 (4,823)

The notes on pages 10 to 36 form part of this statement.

8 NHS Rushcliffe CCG - Annual Accounts 2014-15

Statement of Cash Flows for the year ended 31 March 2015 2014-15 2013-14 Note £000 £000 Cash Flows from Operating Activities Net operating expenditure for the financial year (127,972) (126,636) Depreciation and amortisation 55454 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 00 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 17 451 (8,544) (Increase)/decrease in other current assets 00 Increase/(decrease) in trade & other payables 23 (349) 13,441 Increase/(decrease) in other current liabilities 00 Provisions utilised 30 0 0 Increase/(decrease) in provisions 30 43 42 Net Cash Inflow (Outflow) from Operating Activities (127,773) (121,643)

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 00 (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 00 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 (127,773) (121,643)

Cash Flows from Financing Activities Net Funding Received 127,111 121,701 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 127,111 121,701

Net Increase (Decrease) in Cash & Cash Equivalents 20 (662) 58

Cash & Cash Equivalents at the Beginning of the Financial Year 58 0

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 (604) 58

The notes on pages 10 to 36 form part of this statement.

9 NHS Rushcliffe CCG - Annual Accounts 2014-15

Notes to the financial statements

1 Accounting Policies NHS England has directed that the financial statements of clinical commissioning groups shall meet the accounting requirements of the Manual for Accounts issued by the Department of Health. Consequently, the following financial statements have been prepared in accordance with the Manual for Accounts 2014-15 issued by the Department of Health. The accounting policies contained in the Manual for Accounts follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to clinical commissioning groups, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Manual for Accounts permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the clinical commissioning group for the purpose of giving a true and fair view has been selected. The particular policies adopted by the clinical commissioning group are described below. They have been applied consistently in dealing with items considered material in relation to the accounts. 1.1 Going Concern These accounts have been prepared on 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 clinical commissioning group ceases to exist, it considers whether or not its services will continue to be provided (using the same assets, by another public sector entity) in determining whether to use the concept of going concern for the final set of Financial Statements. If services will continue to be provided the financial statements are prepared on the going concern basis. 1.2 Accounting Convention These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities. 1.3 Acquisitions & Discontinued Operations Activities are considered to be ‘acquired’ only if they are taken on from outside the public sector. Activities are considered to be ‘discontinued’ only if they cease entirely. They are not considered to be ‘discontinued’ if they transfer from one public sector body to another. 1.4 Movement of Assets within the Department of Health Group Transfers as part of reorganisation fall to be accounted for by use of absorption accounting in line with the Government Financial Reporting Manual, issued by HM Treasury. The Government Financial Reporting Manual does not require retrospective adoption, so prior year transactions (which have been accounted for under merger accounting) have not been restated. Absorption accounting requires that entities account for their transactions in the period in which they took place, with no restatement of performance required when functions transfer within the public sector. Where assets and liabilities transfer, the gain or loss resulting is recognised in the Statement of Comprehensive Net Expenditure, and is disclosed separately from operating costs. Other transfers of assets and liabilities within the Department of Health Group are accounted for in line with IAS 20 and similarly give rise to income and expenditure entries. 1.5 Charitable Funds From 2014-15, the divergence from the Government Financial Reporting Manual that NHS Charitable Funds are not consolidated with bodies’ own returns is removed. Under the provisions of IAS 27: Consolidated & Separate Financial Statements, those Charitable Funds that fall under common control with NHS bodies are consolidated within the entities’ accounts. 1.6 Pooled Budgets Where the clinical commissioning group has entered into a pooled budget arrangement under Section 75 of the National Health Service Act 2006 the clinical commissioning group accounts for its share of the assets, liabilities, income and expenditure arising from the activities of the pooled budget, identified in accordance with the pooled budget agreement. If the clinical commissioning group is in a “jointly controlled operation”, the clinical commissioning group recognises: · The assets the clinical commissioning group controls; · The liabilities the clinical commissioning group incurs; · The expenses the clinical commissioning group incurs; and, · The clinical commissioning group’s share of the income from the pooled budget activities. If the clinical commissioning group is involved in a “jointly controlled assets” arrangement, in addition to the above, the clinical commissioning group recognises: · The clinical commissioning group’s share of the jointly controlled assets (classified according to the nature of the assets); · The clinical commissioning group’s share of any liabilities incurred jointly; and, · The clinical commissioning group’s share of the expenses jointly incurred. 1.7 Critical Accounting Judgements & Key Sources of Estimation Uncertainty In the application of the clinical commissioning group’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods. 1.7.1 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 clinical commissioning group’s accounting policies that have the most significant effect on the amounts recognised in the financial statements: · Gross Accounting The Clinical Commissioning Group has entered into an arrangement with the other Nottinghamshire Clinical Commissioning Groups in adopting Gross Accounting in relation to transactions between DH Group Bodies, except transactions deemed to be in the nature of a "recharge". This is consistent with the requirements contained within IAS 8. · Maternity Pathway Costs The Clinical Commissioning Group prepays out Maternity Pathway Costs which span the end of the Financial Year. 1.7.2 Key Sources of Estimation Uncertainty The following are the key estimations that management has made in the process of applying the clinical commissioning group’s accounting policies tha have the most significant effect on the amounts recognised in the financial statements: · Partially Completed Spells The Clinical Commissioning Group includes estimations for partially completed spells which span the end of the financial year. The provider produces activity information to the Clinical Commissioning Group on which to base the estimation value.

10 NHS Rushcliffe CCG - Annual Accounts 2014-15

Notes to the financial statements

1.8 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. Where income is received for a specific activity that is to be delivered in the following year, that income is deferred. 1.9 Employee Benefits 1.9.1 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. 1.9.2 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 clinical commissioning group 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 clinical commissioning group commits itself to the retirement, regardless of the method of payment. 1.10 Other Expenses Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable. Expenses and liabilities in respect of grants are recognised when the clinical commissioning group has a present legal or constructive obligation, which occurs when all of the conditions attached to the payment have been met. 1.11 Property, Plant & Equipment 1.11.1 Recognition Property, plant and equipment is capitalised if: · It is held for use in delivering services or for administrative purposes; · It is probable that future economic benefits will flow to, or service potential will be supplied to the clinical commissioning group; · It is expected to be used for more than one financial year; · The cost of the item can be measured reliably; and, · The item has a cost of at least £5,000; or, · Collectively, a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or, · Items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or collective cost. Where a large asset, for example a building, includes a number of components with significantly different asset lives, the components are treated as separate assets and depreciated over their own useful economic lives. 1.11.2 Valuation All property, plant and equipment are measured initially at cost, representing the cost directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. All assets are measured subsequently at fair value. Land and buildings used for the clinical commissioning group’s services or for administrative purposes are stated in the statement of financial position at their re-valued amounts, being the fair value at the date of revaluation less any impairment. Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that would be determined at the end of the reporting period. Fair values are determined as follows: · Land and non-specialised buildings – market value for existing use; and, · Specialised buildings – depreciated replacement cost. HM Treasury has adopted a standard approach to depreciated replacement cost valuations based on modern equivalent assets and, where it would meet the location requirements of the service being provided, an alternative site can be valued. Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost includes professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for assets held at fair value. Assets are re-valued and depreciation commences when they are brought into use. Fixtures and equipment are carried at depreciated historic cost as this is not considered to be materially different from fair value. An increase arising on revaluation is taken to the revaluation reserve except when it reverses an impairment for the same asset previously recognised in expenditure, in which case it is credited to expenditure to the extent of the decrease previously charged there. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Gains and losses recognised in the revaluation reserve are reported as other comprehensive income in the Statement of Comprehensive Net Expenditure. 1.11.3 Subsequent Expenditure Where subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised. Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing carrying value of the item replaced is written-out and charged to operating expenses.

11 NHS Rushcliffe CCG - Annual Accounts 2014-15

Notes to the financial statements

1.12 Intangible Assets 1.12.1 Recognition Intangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the clinical commissioning group’s business or which arise from contractual or other legal rights. They are recognised only: · When it is probable that future economic benefits will flow to, or service potential be provided to, the clinical commissioning group; · Where the cost of the asset can be measured reliably; and, · Where the cost is at least £5,000. Intangible assets acquired separately are initially recognised at fair value. Software that is integral to the operating of hardware, for example an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software that is not integral to the operation of hardware, for example application software, is capitalised as an intangible asset. Expenditure on research is not capitalised but is recognised as an operating expense in the period in which it is incurred. Internally-generated assets are recognised if, and only if, all of the following have been demonstrated: · The technical feasibility of completing the intangible asset so that it will be available for use; · The intention to complete the intangible asset and use it; · The ability to sell or use the intangible asset; · How the intangible asset will generate probable future economic benefits or service potential; · The availability of adequate technical, financial and other resources to complete the intangible asset and sell or use it; and, · The ability to measure reliably the expenditure attributable to the intangible asset during its development. 1.12.2 Measurement The amount initially recognised for internally-generated intangible assets is the sum of the expenditure incurred from the date when the criteria above are initially met. Where no internally-generated intangible asset can be recognised, the expenditure is recognised in the period in which it is incurred. Following initial recognition, intangible assets are carried at fair value by reference to an active market, or, where no active market exists, at amortised replacement cost (modern equivalent assets basis), indexed for relevant price increases, as a proxy for fair value. Internally-developed software is held at historic cost to reflect the opposing effects of increases in development costs and technological advances. 1.13 Depreciation, Amortisation & Impairments Freehold land, properties under construction, and assets held for sale are not depreciated. Otherwise, depreciation and amortisation are charged to write off the costs or valuation of property, plant and equipment and intangible non-current assets, less any residual value, over their estimated useful lives, in a manner that reflects the consumption of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over which the clinical commissioning group expects to obtain economic benefits or service potential from the asset. This is specific to the clinical commissioning group and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are depreciated over their estimated useful lives. At each reporting period end, the clinical commissioning group checks whether there is any indication that any of its tangible or intangible non-current assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its amount. Intangible assets not yet available for use are tested for impairment annually. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Where an impairment loss subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the recoverable amount but capped at the amount that would have been determined had there been no initial impairment loss. The reversal of the impairment loss is credited to expenditure to the extent of the decrease previously charged there and thereafter to the revaluation reserve. 1.14 Donated Assets Donated non-current assets are capitalised at their fair value on receipt, with a matching credit to Income. They are valued, depreciated and impaired as described above for purchased assets. Gains and losses on revaluations, impairments and sales are as described above for purchased assets. Deferred income is recognised only where conditions attached to the donation preclude immediate recognition of the gain. 1.15 Government Grants The value of assets received by means of a government grant are credited directly to income. Deferred income is recognised only where conditions attached to the grant preclude immediate recognition of the gain. 1.16 Non-current Assets Held For Sale Non-current assets are classified as held for sale if their carrying amount will be recovered principally through a sale transaction rather than through continuing use. This condition is regarded as met when: · The sale is highly probable; · The asset is available for immediate sale in its present condition; and, · Management is committed to the sale, which is expected to qualify for recognition as a completed sale within one year from the date of classification. Non-current assets held for sale are measured at the lower of their previous carrying amount and fair value less costs to sell. Fair value is open market value including alternative uses. The profit or loss arising on disposal of an asset is the difference between the sale proceeds and the carrying amount and is recognised in the Statement of Comprehensive Net Expenditure. On disposal, the balance for the asset on the revaluation reserve is transferred to the general reserve. Property, plant and equipment that is to be scrapped or demolished does not qualify for recognition as held for sale. Instead, it is retained as an operational asset and its economic life is adjusted. The asset is de-recognised when it is scrapped or demolished.

12 NHS Rushcliffe CCG - Annual Accounts 2014-15

Notes to the financial statements

1.17 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. 1.17.1 The Clinical Commissioning Group as Lessee Property, plant and equipment held under finance leases are initially recognised, at the inception of the lease, at fair value or, if lower, at the present value of the minimum lease payments, with a matching liability for the lease obligation to the lessor. Lease payments are apportioned between finance charges and reduction of the lease obligation so as to achieve a constant rate on interest on the remaining balance of the liability. Finance charges are recognised in calculating the clinical commissioning group’s surplus/deficit. Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term. Contingent rentals are recognised as an expense in the period in which they are incurred. Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether they are operating or finance leases. 1.17.2 The Clinical Commissioning Group as Lessor Amounts due from lessees under finance leases are recorded as receivables at the amount of the clinical commissioning group’s net investment in the leases. Finance lease income is allocated to accounting periods so as to reflect a constant periodic rate of return on the clinical commissioning group’s net investment outstanding in respect of the leases. Rental income from operating leases is recognised on a straight-line basis over the term of the lease. Initial direct costs incurred in negotiating and arranging an operating lease are added to the carrying amount of the leased asset and recognised on a straight-line basis over the lease term. 1.18 Private Finance Initiative Transactions HM Treasury has determined that government bodies shall account for infrastructure Private Finance Initiative (PFI) schemes where the government body controls the use of the infrastructure and the residual interest in the infrastructure at the end of the arrangement as service concession arrangements, following the principles of the requirements of IFRIC 12. The clinical commissioning group therefore recognises the PFI asset as an item of property, plant and equipment together with a liability to pay for it. The services received under the contract are recorded as operating expenses. The annual unitary payment is separated into the following component parts, using appropriate estimation techniques where necessary: · Payment for the fair value of services received; · Payment for the PFI asset, including finance costs; and, · Payment for the replacement of components of the asset during the contract ‘lifecycle replacement’. 1.18.1 Services Received The fair value of services received is recorded under the relevant expenditure headings within ‘operating expenses'. 1.18.2 PFI Asset The PFI assets are recognised as property, plant and equipment, when they come into use. The assets are measured initially at fair value in accordance with the principles of IAS17. Subsequently, the assets are measured at fair value, which is kept up to date in accordance with the clinical commissioning group’s approach for each relevant class of asset in accordance with the principles of IAS 16. 1.18.3 PFI Liability A PFI liability is recognised at the same time as the PFI assets are recognised. It is measured initially at the same amount as the fair value of the PFI assets and is subsequently measured as a finance lease liability in accordance with IAS 17. An annual finance cost is calculated by applying the implicit interest rate in the lease to the opening lease liability for the period, and is charged to ‘finance costs’ within the Statement of Comprehensive Net Expenditure. The element of the annual unitary payment that is allocated as a finance lease rental is applied to meet the annual finance cost and to repay the lease liability over the contract term. An element of the annual unitary payment increase due to cumulative indexation is allocated to the finance lease. In accordance with IAS 17, this amount is not included in the minimum lease payments, but is instead treated as contingent rent and is expensed as incurred. In substance, this amount is a finance cost in respect of the liability and the expense is presented as a contingent finance cost in the Statement of Comprehensive Net Expenditure. 1.18.4 Lifecycle Replacement Components of the asset replaced by the operator during the contract (‘lifecycle replacement’) are capitalised where they meet the clinical commissioning group’s criteria for capital expenditure. They are capitalised at the time they are provided by the operator and are measured initially at their fair value. The element of the annual unitary payment allocated to lifecycle replacement is pre-determined for each year of the contract from the operator’s planned programme of lifecycle replacement. Where the lifecycle component is provided earlier or later than expected, a short-term finance lease liability or prepayment is recognised respectively. Where the fair value of the lifecycle component is less than the amount determined in the contract, the difference is recognised as an expense when the replacement is provided. If the fair value is greater than the amount determined in the contract, the difference is treated as a ‘free’ asset and a deferred income balance is recognised. The deferred income is released to the operating income over the shorter of the remaining contract period or the useful economic life of the replacement component.

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Notes to the financial statements

1.18.5 Assets Contributed by the Clinical Commissioning Group to the Operator For Use in the Scheme Assets contributed for use in the scheme continue to be recognised as items of property, plant and equipment in the clinical commissioning group’s Statement of Financial Position. 1.18.6 Other Assets Contributed by the Clinical Commissioning Group to the Operator Assets contributed (e.g. cash payments, surplus property) by the clinical commissioning group to the operator before the asset is brought into use, which are intended to defray the operator’s capital costs, are recognised initially as prepayments during the construction phase of the contract. Subsequently, when the asset is made available to the clinical commissioning group, the prepayment is treated as an initial payment towards the finance lease liability and is set against the carrying value of the liability. 1.19 Inventories Inventories are valued at the lower of cost and net realisable value using the first-in first-out cost formula. This is considered to be a reasonable approximation to fair value due to the high turnover of stocks. 1.20 Cash & Cash Equivalents Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value. In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the clinical commissioning group’s cash management. 1.21 Provisions Provisions are recognised when the clinical commissioning group has a present legal or constructive obligation as a result of a past event, it is probable that the clinical commissioning group will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties. 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 1.50% · Timing of cash flows (6 to 10 years inclusive): Minus 1.05% · Timing of cash flows (over 10 years): Plus 2.20% · All employee early departures: 1.30% 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. 1.22 Clinical Negligence Costs The NHS Litigation Authority operates a risk pooling scheme under which the clinical commissioning group 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 clinical commissioning group. 1.23 Non-clinical Risk Pooling The clinical commissioning group participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the clinical commissioning group pays an annual contribution to the NHS 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. 1.24 Carbon Reduction Commitment Scheme Carbon Reduction Commitment and similar allowances are accounted for as government grant funded intangible assets if they are not expected to be realised within twelve months, and otherwise as other current assets. They are valued at open market value. As the clinical commissioning group makes emissions, a provision is recognised with an offsetting transfer from deferred income. The provision is settled on surrender of the allowances. The asset, provision and deferred income amounts are valued at fair value at the end of the reporting period. 1.25 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 clinical commissioning group, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or the amount of the obligation cannot be measured sufficiently reliably. A contingent liability is disclosed unless the possibility of a payment is remote. A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the clinical commissioning group. A contingent asset is disclosed where an inflow of economic benefits is probable. Where the time value of money is material, contingencies are disclosed at their present value.

14 NHS Rushcliffe CCG - Annual Accounts 2014-15

Notes to the financial statements

1.26 Financial Assets Financial assets are recognised when the clinical commissioning group becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred. Financial assets are classified into the following categories: · Financial assets at 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. 1.26.1 Financial Assets at Fair Value Through Profit and 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 clinical commissioning group’s surplus or deficit for the year. The net gain or loss incorporates any interest earned on the financial asset. 1.26.2 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. 1.26.3 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. 1.26.4 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. 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 clinical commissioning group 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. 1.27 Financial Liabilities Financial liabilities are recognised on the statement of financial position when the clinical commissioning group becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired. Loans from the Department of Health are recognised at historical cost. Otherwise, financial liabilities are initially recognised at fair value. 1.27.1 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. 1.27.2 Financial Liabilities at Fair Value Through Profit and 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 liabilities at fair value through profit and loss. They are held at fair value, with any resultant gain or loss recognised in the clinical commissioning group’s surplus/deficit. The net gain or loss incorporates any interest payable on the financial liability. 1.27.3 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.

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Notes to the financial statements

1.28 Value Added Tax Most of the activities of the clinical commissioning group are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT. 1.29 Foreign Currencies The clinical commissioning group’s functional currency and presentational currency is sterling. Transactions denominated in a foreign currency are translated into sterling at the exchange rate ruling on the dates of the transactions. At the end of the reporting period, monetary items denominated in foreign currencies are retranslated at the spot exchange rate on 31 March. Resulting exchange gains and losses for either of these are recognised in the clinical commissioning group’s surplus/deficit in the period in which they arise. 1.30 Third Party Assets Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the clinical commissioning group has no beneficial interest in them. 1.31 Losses & Special Payments Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled. Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had the clinical commissioning group not been bearing its own risks (with insurance premiums then being included as normal revenue expenditure). 1.32 Subsidiaries Material entities over which the clinical commissioning group has the power to exercise control so as to obtain economic or other benefits are classified as subsidiaries and are consolidated. Their income and expenses; gains and losses; assets, liabilities and reserves; and cash flows are consolidated in full into the appropriate financial statement lines. Appropriate adjustments are made on consolidation where the subsidiary’s accounting policies are not aligned with the clinical commissioning group or where the subsidiary’s accounting date is not co-terminus. Subsidiaries that are classified as ‘held for sale’ are measured at the lower of their carrying amount or ‘fair value less costs to sell’. 1.33 Associates Material entities over which the clinical commissioning group has the power to exercise significant influence so as to obtain economic or other benefits are classified as associates and are recognised in the clinical commissioning group’s accounts using the equity method. The investment is recognised initially at cost and is adjusted subsequently to reflect the clinical commissioning group’s share of the entity’s profit/loss and other gains/losses. It is also reduced when any distribution is received by the clinical commissioning group from the entity. Joint ventures that are classified as ‘held for sale’ are measured at the lower of their carrying amount or ‘fair value less costs to sell’. 1.34 Joint Ventures Material entities over which the clinical commissioning group has joint control with one or more other parties so as to obtain economic or other benefits are classified as joint ventures. Joint ventures are accounted for using the equity Joint ventures that are classified as ‘held for sale’ are measured at the lower of their carrying amount or ‘fair value less 1.35 Joint Operations Joint operations are activities undertaken by the clinical commissioning group in conjunction with one or more other parties but which are not performed through a separate entity. The clinical commissioning group records its share of the income and expenditure; gains and losses; assets and liabilities; and cash flows. 1.36 Research & Development Research and development expenditure is charged in the year in which it is incurred, except insofar as development expenditure relates to a clearly defined project and the benefits of it can reasonably be regarded as assured. Expenditure so deferred is limited to the value of future benefits expected and is amortised through the Statement of Comprehensive Net Expenditure on a systematic basis over the period expected to benefit from the project. It should be re-valued on the basis of current cost. The amortisation is calculated on the same basis as depreciation. 1.37 Accounting Standards That Have Been Issued But Have Not Yet Been Adopted The Government Financial Reporting Manual does not require the following Standards and Interpretations to be applied in 2014-15, all of which are subject to consultation: · IFRS 9: Financial Instruments · IFRS 13: Fair Value Measurement · IFRS 14: Regulatory Deferral Accounts · IFRS 15: Revenue for Contract with Customers The application of the Standards as revised would not have a material impact on the accounts for 2014-15, were they applied in that year.

16 NHS Rushcliffe CCG - Annual Accounts 2014-15

2 Other Operating Revenue 2014-15 2014-15 2014-15 2013-14 Total Admin Programme Total £000 £000 £000 £000

Recoveries in respect of employee benefits 0000 Patient transport services 0000 Prescription fees and charges 0000 Dental fees and charges 0000 Education, training and research 0000 Charitable and other contributions to revenue expenditure: NHS 0000 Charitable and other contributions to revenue expenditure: non-NHS 0000 Receipt of donations for capital acquisitions: NHS Charity 0000 Receipt of Government grants for capital acquisitions 0000 Non-patient care services to other bodies 49,236 576 48,660 45,633 Income generation 0000 Rental revenue from finance leases 0000 Rental revenue from operating leases 0000 Other revenue 4,605 7 4,598 1,944 Total other operating revenue 53,841 583 53,258 47,577

3 Revenue 2014-15 2014-15 2014-15 2013-14 Total Admin Programme Total £000 £000 £000 £000 From rendering of services 53,841 583 53,258 47,577 From sale of goods 0000 Total 53,841 583 53,258 47,577

17 NHS Rushcliffe CCG - Annual Accounts 2014-15

4 Employee benefits and staff numbers

4.1.1 Employee benefits 2014-15 Total Admin Programme 2013-14

Permanent Permanent Permanent Total Employees Other Total Employees Other Total Employees Other Total £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 Employee Benefits Salaries and wages 1,794 1,766 28 1,445 1,417 28 349 349 0 1,528 Social security costs 116 116 0 98 98 0 18 18 0 107 Employer Contributions to NHS Pension scheme 190 190 0 156 156 0 34 34 0 171 Other pension costs 0000000000 Other post-employment benefits 0000000000 Other employment benefits 0000000000 Termination benefits 00000000044 Gross employee benefits expenditure 2,100 2,072 28 1,699 1,671 28 401 401 0 1,850

Less recoveries in respect of employee benefits (note 4.1.2) 0000000000 Total - Net admin employee benefits including capitalised costs 2,100 2,072 28 1,699 1,671 28 401 401 0 1,850

Less: Employee costs capitalised 0000000000 Net employee benefits excluding capitalised costs 2,100 2,072 28 1,699 1,671 28 401 401 0 1,850

4.1.2 Recoveries in respect of employee benefits

There were no recoveries in respect of employee benefits (2013/14: £nil).

18 NHS Rushcliffe CCG - Annual Accounts 2014-15

4.2 Average number of people employed 2014-15 2013-14 Permanently Total employed Other Total Number Number Number Number

Total 39 39 0 35

Of the above: Number of whole time equivalent people engaged on capital projects 0000

4.3 Staff sickness absence and ill health retirements 2014-15 2013-14 Number Number

Total days lost 702 974 Total staff years 156 292 Average working days lost 4.50 3.34

The numbers above are the total for the old Nottinghamshire County PCT area, of which Rushcliffe is a part These figures are unable to be split. 2014-15 2013-14 Number Number

Number of persons retired early on ill health grounds 00

£000 £000

Total additional Pensions liabilities accrued in the year 00

Ill health retirement costs are met by the NHS Pension Scheme

4.4 Exit packages agreed in the financial year 2014-15 2014-15 2014-15 2013-14 Compulsory redundancies Other agreed departures Total Total Number £ Number £ Number £ Number £

Less than £10,000 000000422,479 £10,001 to £25,000 000000121,589 £25,001 to £50,000 00000000 £50,001 to £100,000 00000000 £100,001 to £150,000 00000000 £150,001 to £200,000 00000000 Over £200,001 00000000 Total 000000544,068

Departures where special 2013-14 payments have been made Number £ Number £

Less than £10,000 0000 £10,001 to £25,000 0000 £25,001 to £50,000 0000 £50,001 to £100,000 0000 £100,001 to £150,000 0000 £150,001 to £200,000 0000 Over £200,001 0 0 0 0 Total 0000

Analysis of Other Agreed Departures Other agreed departures 2013-14 Number £ Number £

Voluntary redundancies including early retirement contractual costs 0 0 0 0 Mutually agreed resignations (MARS) contractual costs 0 0 0 0 Early retirements in the efficiency of the service contractual costs 0 0 0 0 Contractual payments in lieu of notice 0 0 0 0 Exit payments following Employment Tribunals or court orders 0 0 0 0 Non-contractual payments requiring HMT approval 0 0 0 0 Total 0000

Exit costs are accounted for in accordance with relevant accounting standards and at the latest in full in the year of departure.

Where entities have agreed early retirements, the additional costs are met by NHS Entities and not by the NHS Pension Scheme, and are included in the tables. Ill-health retirement costs are met by the NHS Pension Scheme and are not included in the tables.

The Remuneration Report includes the disclosure of exit payments payable to individuals named in that Report.

19 NHS Rushcliffe CCG - Annual Accounts 2014-15

4.5 Pension costs

Past and present employees are covered by the provisions of the NHS Pensions Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. The scheme is an unfunded, defined benefit scheme that covers NHS employers, GP 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 NHS Body of participating in the scheme is taken as equal to the contributions payable to the 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 the scheme liability is carried out annually by the scheme actuary 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 are accepted as providing suitably robust figures for financial reporting purposes. The valuation of the scheme liability as at 31 March 2015, is based on valuation data as 31 March 2014, updated to 31 March 2015 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 scheme actuary report, which forms part of the annual NHS Pension Scheme (England and Wales) Pension Accounts, published annually. These accounts can be viewed on the NHS Pensions website. 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 scheme (taking into account its recent demographic experience), and to recommend the contribution rates.

The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 March 2012.

The Scheme Regulations allow contribution rates to be set by the Secretary of State for Health, with the consent of HM Treasury, and consideration of the advice of the Scheme Actuary and appropriate employee and employer representatives as deemed appropriate.

4.5.3 Scheme Provisions

The NHS Pension Scheme provides defined benefits, which are summarised below. This list is an illustrative guide only, and is not intended to detail all the benefits provided by the Scheme or the specific conditions that must be met before these benefits can be obtained:

• The Scheme is a “final salary” scheme. Annual pensions are normally based on 1/80th for the 1995 section and of the best of the last three years pensionable pay for each year of service, and 1/60th for the 2008 section of reckonable pay per year of membership. Members who are practitioners as defined by the Scheme Regulations have their annual pensions based upon total pensionable earnings over the relevant pensionable service;

• With effect from 1 April 2008 members can choose to give up some of their annual pension for an additional tax free lump sum, up to a maximum amount permitted under HM Revenue & Customs rules. This new provision is known as “pension commutation”;

• Annual increases are applied to pension payments at rates defined by the Pensions (Increase) Act 1971, and are based on changes in retail prices in the twelve months ending 30 September in the previous calendar year;

• Early payment of a pension, with enhancement, is available to members of the Scheme who are permanently incapable of fulfilling their duties effectively through illness or infirmity. A death gratuity of twice final year’s pensionable pay for death in service, and five times their annual pension for death after retirement is payable;

• 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 the statement of comprehensive net expenditure at the time the clinical commissioning group commits itself to the retirement, regardless of the method of payment; and,

• Members can purchase additional service in the Scheme and contribute to money purchase AVC’s run by the Scheme’s approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers.

20 NHS Rushcliffe CCG - Annual Accounts 2014-15

5 Operating expenses 2014-15 2014-15 2014-15 2013-14 Total Admin Programme Total £000 £000 £000 £000 Gross employee benefits Employee benefits excluding governing body members 1,745 1,344 401 1,456 Executive governing body members 355 355 0 394 Total gross employee benefits 2,100 1,699 401 1,850

Other costs Services from other CCGs and NHS England 2,292 227 2,065 6,843 Services from foundation trusts 5,124 0 5,124 3,781 Services from other NHS trusts 74,663 25 74,638 75,348 Services from other NHS bodies 36 0 36 (2) Purchase of healthcare from non-NHS bodies 74,862 0 74,862 63,824 Chair and Non Executive Members 0000 Supplies and services – clinical 125 0 125 0 Supplies and services – general 1,695 22 1,673 78 Consultancy services 71 38 33 110 Establishment 2,634 557 2,077 3,447 Transport 20 0 20 14 Premises 1,245 270 975 1,057 Impairments and reversals of receivables 0 0 0 0 Inventories written down 0000 Depreciation 4404 Amortisation 50 50 0 50 Impairments and reversals of property, plant and equipment 0 0 0 0 Impairments and reversals of intangible assets 0 0 0 0 Impairments and reversals of financial assets 0 0 0 0 · Assets carried at amortised cost 0 0 0 0 · Assets carried at cost 0000 · Available for sale financial assets 0 0 0 0 Impairments and reversals of non-current assets held for sale 0 0 0 0 Impairments and reversals of investment properties 0 0 0 0 Audit fees 72 72 0 79 Other non statutory audit expenditure · Internal audit services 0000 · Other services 0000 General dental services and personal dental services 0 0 0 0 Prescribing costs 15,879 0 15,879 15,685 Pharmaceutical services 0000 General ophthalmic services 0000 GPMS/APMS and PCTMS 313 0 313 325 Other professional fees excl. audit 36 36 0 138 Grants to other public bodies 231 0 231 250 Clinical negligence 1101 Research and development (excluding staff costs) 76 0 76 35 Education and training 27 18 9 39 Change in discount rate 0000 Provisions 43 0 43 0 CHC Risk Pool contributions 184 0 184 0 Other expenditure 30 1 29 1,257 Total other costs 179,713 1,321 178,392 172,363

Total operating expenses 181,813 3,020 178,793 174,213

21 NHS Rushcliffe CCG - Annual Accounts 2014-15

6.1 Better Payment Practice Code

Measure of compliance 2014-15 2014-15 2013-14 2013-14 Number £000 Number £000 Non-NHS Payables Total Non-NHS Trade invoices paid in the Year 17,961 82,801 13,844 60,002 Total Non-NHS Trade Invoices paid within target 17,743 81,606 13,585 59,100 Percentage of Non-NHS Trade invoices paid within target 98.79% 98.56% 98.13% 98.50%

NHS Payables Total NHS Trade Invoices Paid in the Year 2,102 87,947 1,717 91,222 Total NHS Trade Invoices Paid within target 2,051 86,789 1,677 90,063 Percentage of NHS Trade Invoices paid within target 97.57% 98.68% 97.67% 98.73%

6.2 The Late Payment of Commercial Debts (Interest) Act 1998

There were no late payments of commercial debt during the year (2013/14: £nil).

7 Income Generation Activities

There were no income generation activities during the year (2013/14: £nil).

8 Investment revenue

There was no investment revenue during the year (2013/14: £nil).

9 Other gains and losses

There were no other gains and losses during the year (2013/14: £nil).

10 Finance costs

There were no finance costs during the year (2013/14: £nil).

11 Net gain/(loss) on transfer by absorption

Transfers as part of a reorganisation fall to be accounted for by use of absorption accounting in line with the Government Financial Reporting Manual, issued by HM Treasury. The Government Financial Reporting Manual does not require retrospective adoption, so prior year transactions (which have been accounted for under merger accounting) have not been restated. Absorption accounting requires that entities account for their transactions in the period in which they took place, with no restatement of performance required when functions transfer within the public sector. Where assets and liabilities transfer, the gain or loss resulting is recognised in the Statement of Comprehensive Net Expenditure, and is disclosed separately from operating costs.

There was no gians/(loss) on transfer by absorption during the year (2013/14: £nil).

22 NHS Rushcliffe CCG - Annual Accounts 2014-15

12 Operating Leases

12.1 As lessee

12.1.1 Payments recognised as an Expense 2014-15 2013-14 Land Buildings Other Total Total £000 £000 £000 £000 £000 Payments recognised as an expense Minimum lease payments 0 1,242 0 1,242 1,051 Contingent rents 0 0 0 0 0 Sub-lease payments 0 0 0 0 0 Total 0 1,242 0 1,242 1,051

Whilst our arrangements with Community Health Partnership's Limited and NHS Property Services Limited 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 payment.

12.1.2 Future minimum lease payments 2014-15 2013-14 Land Buildings Other Total Total £000 £000 £000 £000 £000 Payable: No later than one year 0 0 0 0 0 Between one and five years 0 0 0 0 0 After five years 0 0 0 0 0 Total 00000

12.2 As lessor

12.2.1 Rental revenue 2014-15 2013-14 £000 £000 Recognised as income Rent 00 Contingent rents 00 Total 00

12.2.2 Future minimum rental value 2014-15 2013-14 £000 £000 Receivable: No later than one year 00 Between one and five years 00 After five years 00 Total 00

23 NHS Rushcliffe CCG - Annual Accounts 2014-15

13 Property, plant and equipment 2014-15 2013-14 Information Information technology Total technology Total £000 £000 £000 £000

Cost or valuation at 1 April 11 11 0 0 Transfer of assets from closed NHS bodies as a result of the 1 April 2013 transition 01111 Addition of assets under construction and payments on account 0 0 Additions purchased 0000 Additions donated 0000 Additions government granted 0000 Additions leased 0000 Reclassifications 0000 Reclassified as held for sale and reversals 0000 Disposals other than by sale 0000 Upward revaluation gains 0000 Impairments charged 0000 Reversal of impairments 0000 Transfer (to)/from other public sector body 0000 Cumulative depreciation adjustment following revaluation 0000 Cost or valuation at 31 March 11 11 11 11

Depreciation at 1 April 4400 Reclassifications 0000 Reclassified as held for sale and reversals 0000 Disposals other than by sale 0000 Upward revaluation gains 0000 Impairments charged 0000 Reversal of impairments 0000 Charged during the year 4444 Transfer (to)/from other public sector body 0000 Cumulative depreciation adjustment following revaluation 0000 Depreciation at 31 March 8844

Net Book Value at 31 March 3377

Purchased 3377 Donated 0000 Government Granted 0000 Total at 31 March 3377

Asset financing:

Owned 3377 Held on finance lease 0000 On-SOFP Lift contracts 0000 PFI residual: interests 0000 Total at 31 March 3377

Revaluation Reserve Balance for Property, Plant & Equipment:

Balance at 1 April 0000 Revaluation gains 0000 Impairments 0000 Release to general fund 0000 Other movements 0000 Balance at 31 March 0000

24 NHS Rushcliffe CCG - Annual Accounts 2014-15

13 Property, plant and equipment cont'd

13.1 Additions to assets under construction

The CCG had no additions to assets under construction during the year end (2013/14: £nil).

13.2 Donated assets

The CCG has no donated assets at the year end (2013/14: £nil).

13.3 Government granted assets

The CCG has no Government granted assets at the year end (2013/14: £nil).

13.4 Property revaluation

The CCG undertook no property revaluations during the year end (2013/14: £nil).

13.5 Compensation from third parties

The amount of compensation from third parties for assets impaired, lost or given up, that is included in the Statement of Comprehensive Net Expenditure is £nil (2013/14: £nil).

13.6 Write downs to recoverable amount

There were no assets written down to recoverable amounts and any reversals of previous write-downs (2013/14: £nil).

13.7 Temporarily idle assets

The CCG has no temporarily idle assets at the year end (2013/14: £nil).

13.8 Cost or valuation of fully depreciated assets

The CCG has no fully depreciated assets at the year end (2013/14: £nil).

13.9 Economic lives 2014-15 2013-14 Minimum Life Maximum Life Minimum Life Maximum Life (years) (Years) (years) (Years) Buildings excluding dwellings 0 0 0 0 Dwellings 0 0 0 0 Plant & machinery 0 0 0 0 Transport equipment 0 0 0 0 Information technology 2 2 2 2 Furniture & fittings 0 0 0 0

25 NHS Rushcliffe CCG - Annual Accounts 2014-15

14 Intangible non-current assets 2014-15 2013-14 Computer Computer Software: Software: Purchased Total Purchased Total £000 £000 £000 £000

Cost or valuation at 1 April 101 101 0 0 Transfer of assets from closed NHS bodies as a result of the 1 April 2013 transition 101 101 Additions purchased 0000 Additions internally generated 0000 Additions donated 0000 Additions government granted 0000 Additions leased 0000 Reclassifications 0000 Reclassified as held for sale and reversals 0000 Disposals other than by sale 0000 Upward revaluation gains 0000 Impairments charged 0000 Reversal of impairments 0000 Transfer (to)/from other public sector body 0000 Cumulative amortisation adjustment following revaluation 0000 Cost or valuation at 31 March 101 101 101 101

Amortisation 1 April 50 50 0 0 Reclassifications 0000 Reclassified as held for sale and reversals 0000 Disposals other than by sale 0000 Upward revaluation gains 0000 Impairments charged 0000 Reversal of impairments 0000 Charged during the year 50 50 50 50 Transfer (to) from other public sector body 0000 Cumulative amortisation adjustment following revaluation 0000 Amortisation at 31 March 100 100 50 50

Net Book Value at 31 March 1 1 51 51

Purchased 1 1 51 51 Donated 0000 Government Granted 0000 Total at 31 March 1 1 51 51

Revaluation Reserve Balance for intangible assets

Balance at 1 April 0000 Revaluation gains 0000 Impairments 0000 Release to general fund 0000 Other movements 0000 Balance at 31 March 0000

26 NHS Rushcliffe CCG - Annual Accounts 2014-15

14 Intangible non-current assets cont'd

14.1 Donated assets

The CCG has no donated assets at the year end (2013/14: £nil).

14.2 Government granted assets

The CCG has no Government granted assets at the year end (2013/14: £nil).

14.3 Revaluation

The CCG undertook no revaluations during the year end (2013/14: £nil).

14.4 Compensation from third parties

The amount of compensation from third parties for assets impaired, lost or given up, that is included in the Statement of Comprehensive Net Expenditure is £nil (2013/14: £nil).

14.5 Write downs to recoverable amount

There were no assets written down to recoverable amounts and any reversals of previous write-downs (2013/14: £nil).

14.6 Non-capitalised assets

There were no significant intangible assets controlled by the NHS Clinical Commissioning Group, but not recognised as assets because they didn’t meet the recognition criteria of IAS 38 (2013/14: £nil).

14.7 Temporarily idle assets

The CCG has no temporarily idle assets at the year end (2013/14: £nil).

14.8 Cost or valuation of fully amortised assets

The CCG has no fully amortised assets at the year end (2013/14: £nil).

14.9 Economic lives 2014-15 2013-14 Minimum Life Maximum Life Minimum Life Maximum Life

Computer software: purchased 1212 Computer software: internally generated 0000 Licences & trademarks 0000 Patents 0000 Development expenditure (internally generated) 0000

15 Investment property

The CCG has no investment property at the year end (2013/14: £nil).

16 Inventories

The CCG has no inventories at the year end (2013/14: £nil).

27 NHS Rushcliffe CCG - Annual Accounts 2014-15

17 Trade and other receivables Current Non-current Current Non-current 2014-15 2014-15 2013-14 2013-14 £000 £000 £000 £000

NHS receivables: Revenue 6,418 0 8,322 0 NHS receivables: Capital 0000 NHS prepayments and accrued income 969 0 (80) 0 Non-NHS receivables: Revenue 186 0 112 0 Non-NHS receivables: Capital 0000 Non-NHS prepayments and accrued income 475 0 167 0 Provision for the impairment of receivables 0000 VAT 45 0 23 0 Private finance initiative and other public private partnership arrangement prepayments and accrued income 0000 Interest receivables 0000 Finance lease receivables 0000 Operating lease receivables 0000 Other receivables 0000 Total trade & other receivables 8,093 0 8,544 0

Total current and non current 8,093 8,544

Included above: Prepaid pensions contributions 0 0

17.1 Receivables past their due date but not impaired 2014-15 2013-14 £000 £000

By up to three months 4,262 167 By three to six months 00 By more than six months 20 0 Total 4,282 167

£121,412 of the amount above has subsequently been recovered post the statement of financial position date (2013/14: £73,000).

17.2 Provision for impairment of receivables 2014-15 2013-14 £000 £000

Balance at 1 April 2014 00 Amounts written off during the year 0 0 Amounts recovered during the year 0 0 (Increase) decrease in receivables impaired 0 0 Transfer (to) from other public sector body 0 0 Balance at 31 March 2015 0 0

2014-15 2013-14 £000 £000 Receivables are provided against at the following rates: NHS debt 00

18 Other financial assets

The CCG has no other financial assets at the year end (2013/14: £nil).

19 Other current assets

The CCG has no other current assets at the year end (2013/14: £nil).

28 NHS Rushcliffe CCG - Annual Accounts 2014-15

20 Cash and cash equivalents 2014-15 2013-14 £000 £000 Balance at 1 April 2014 58 0 Net change in year (662) 58 Balance at 31 March 2015 (604) 58

Made up of: Cash with the Government Banking Service (604) 57 Cash with commercial banks 0 0 Cash in hand 01 Current investments 00 Cash and cash equivalents as in statement of financial position (604) 58

Bank overdraft: Government Banking Service 0 0 Bank overdraft: Commercial banks 0 0 Total bank overdrafts 00

Balance at 31 March 2015 (604) 58

Patients’ money held by the clinical commissioning group, not included above 00

21 Non-current assets held for sale

The CCG has no non-current assets held for sale at the year end (2013/14: £nil).

22 Analysis of impairments and reversals

The CCG has no impairments and reversals in during the year (2013/14: £nil).

29 NHS Rushcliffe CCG - Annual Accounts 2014-15

23 Trade and other payables Current Non-current Current Non-current 2014-15 2014-15 2013-14 2013-14 £000 £000 £000 £000

Interest payable 0 0 0 0 NHS payables: revenue 799 0 1,329 0 NHS payables: capital 0 0 0 0 NHS accruals and deferred income 801 0 471 0 Non-NHS payables: revenue 2,943 0 2,989 0 Non-NHS payables: capital 0 0 0 0 Non-NHS accruals and deferred income 8,349 0 8,526 0 Social security costs 19 0 16 0 VAT 0 0 0 0 Tax 22 0 20 0 Payments received on account 0 0 0 0 Other payables 159 0 90 0 Total trade & other payables 13,092 0 13,441 0

Total current and non-current 13,092 13,441

Other payables include £26,000 outstanding pension contributions at 31 March 2015 (2013/14: £18,000).

24 Other financial liabilities

The CCG has no other financial liabilities at the year end (2013/14: £nil).

25 Other liabilities

The CCG has no other liabilities at the year end (2013/14: £nil).

26 Borrowings

The CCG has no borrowings at the year end (2013/14: £nil).

27 Private finance initiative, LIFT and other service concession arrangements

The CCG has no private finance initiative, LIFT or other service concession arrangements at the year end (2013/14: £nil).

28 Finance lease obligations

The CCG has no finance lease obligations at the year end (2013/14: £nil).

29 Finance lease receivables

The CCG has no finance lease receivables at the year end (2013/14: £nil).

30 NHS Rushcliffe CCG - Annual Accounts 2014-15

30 Provisions Current Non-current Current Non-current 2014-15 2014-15 2013-14 2013-14 £000 £000 £000 £000 Continuing care 85 0 42 0 Other 0000 Total 85 0 42 0

Total current and non-current 85 42

2013-14 Continuing Care Other Total Total £000s £000s £000s £000s

Balance at 1 April 2014 42 0 42 0 Arising during the year 43 0 43 42 Utilised during the year 0 0 0 0 Reversed unused 0 0 0 0 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 Balance at 31 March 2015 85 0 85 42

Expected timing of cash flows: Within one year 85 0 85 42 Between one and five years 0000 After five years 0000 Balance at 31 March 2015 85 0 85 42

31 Contingencies 2014-15 2013-14 £000 £000 Contingent liabilities Equal Pay 00 NHS Litigation Authority Legal Claims 0 0 Employment Tribunal 0 0 Other employee related litigation 0 0 Redundancy 00 NHS Property Services 1,084 0 Net value of contingent liabilities 1,084 0

During 14/15, the CCG received various versions of the pricing model from NHS Property Services. The CCG was unable to confrim the figures, and as a result the CCG wrote to NHSPS proposing payment in line with 13/14 charges. At the date of the Accounts, NHSPS has not responded to this request. A Contingent Liability has been recognised in the accounts in the event that NHSPS do not agree to the CCG proposal.

2014-15 2013-14 £000 £000 Contingent assets Amounts payable against contingent assets 0 0 Net value of contingent assets 00

31 NHS Rushcliffe CCG - Annual Accounts 2014-15

32 Commitments

32.1 Capital commitments 2014-15 2013-14 £000 £000

Property, plant and equipment 00 Intangible assets 00 Total 00

32.2 Other financial commitments

The NHS Clinical Commissioning Group has entered into non-cancellable contracts (which are not leases, private finance initiative contracts or other service concession arrangements) which expire as follows:

2014-15 2013-14 £000 £000 In not more than one year 00 In more than one year but not more than five years 0 0 In more than five years 00 Total 00

33 Financial instruments

33.1 Financial risk management

Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities.

Because NHS Clinical Commissioning Group is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The clinical commissioning group has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the clinical commissioning group in undertaking its activities.

Treasury management operations are carried out by the finance department, within parameters defined formally within the NHS Clinical Commissioning Group standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the NHS Clinical Commissioning Group and internal auditors.

33.1.1 Currency risk

The NHS Clinical Commissioning Group is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The NHS Clinical Commissioning Group has no overseas operations. The NHS Clinical Commissioning Group and therefore has low exposure to currency rate fluctuations.

33.1.2 Interest rate risk

The Clinical Commissioning Group borrows from government for capital expenditure, subject to affordability as confirmed by NHS England. The borrowings are for 1 to 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The clinical commissioning group therefore has low exposure to interest rate fluctuations.

33.1.3 Credit risk

Because the majority of the NHS Clinical Commissioning Group and revenue comes parliamentary funding, NHS Clinical Commissioning Group has low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables from customers, as disclosed in the trade and other receivables note.

33.1.4 Liquidity risk

NHS Clinical Commissioning Group is required to operate within revenue and capital resource limits, which are financed from resources voted annually by Parliament. The NHS Clinical Commissioning Group draws down cash to cover expenditure, as the need arises. The NHS Clinical Commissioning Group is not, therefore, exposed to significant liquidity risks.

32 NHS Rushcliffe CCG - Annual Accounts 2014-15

33 Financial instruments cont'd

33.2 Financial assets At ‘fair value through profit Loans and Available for and loss’ Receivables Sale Total 2014-15 2014-15 2014-15 2014-15 £000 £000 £000 £000

Embedded derivatives 0000 Receivables: · NHS 0 6,418 0 6,418 · Non-NHS 0 186 0 186 Cash at bank and in hand 0 (604) 0 (604) Other financial assets 0000 Total at 31 March 2015 0 6,000 0 6,000

At ‘fair value through profit Loans and Available for and loss’ Receivables Sale Total 2013-14 2013-14 2013-14 2013-14 £000 £000 £000 £000

Embedded derivatives 0000 Receivables: · NHS 0 8,322 0 8,322 · Non-NHS 0 112 0 112 Cash at bank and in hand 0 58 0 58 Other financial assets 0000 Total at 31 March 2014 0 8,492 0 8,492

33.3 Financial liabilities At ‘fair value through profit and loss’ Other Total 2014-15 2014-15 2014-15 £000 £000 £000

Embedded derivatives 000 Payables: · NHS 0 1,600 1,600 · Non-NHS 0 11,451 11,451 Private finance initiative, LIFT and finance lease obligations 0 0 0 Other borrowings 000 Other financial liabilities 000 Total at 31 March 2015 0 13,051 13,051

At ‘fair value through profit and loss’ Other Total 2013-14 2013-14 2013-14 £000 £000 £000

Embedded derivatives 000 Payables: · NHS 0 1,800 1,800 · Non-NHS 0 11,579 11,579 Private finance initiative, LIFT and finance lease obligations 0 0 0 Other borrowings 000 Other financial liabilities 000 Total at 31 March 2014 0 13,379 13,379

33 NHS Rushcliffe CCG - Annual Accounts 2014-15

34 Operating segments

The clinical commissioning group and consolidated group consider they have only one segment: commissioning of healthcare services.

35 Pooled budgets The clinical commissioning group entered into a pooled budget arrangement for Integrated Community Equipment Schemes on 1st April 2014 ending 31 March 2015 with Nottinghamshire County Council. Under the arrangement funds are pooled under Section 75 of the NHS Act 2006 for Integrated Community Equipment Scheme activities.

The pool is hosted by Nottinghamshire County Council. As a commissioner of healthcare services the clinical commissioning group makes contributions to the pool, which is then used to purchase healthcare services

2014-15 2013-14 £000 £000

Balance Brought Forward 544 0

Income Nottingham City Council 1,349 1,286 Nottinghamshire County Council 2,328 2,313 Bassetlaw CCG 437 466 Nottinghamshire County CCGs 2,400 2,210 Nottingham City CCG 1,229 1,314 Other 222 968 Total income 7,965 8,557

Expenditure Partnership Management & Administration Costs 360 287 Contract Management Fee 1,191 1,091 ICES Equipment 5,445 5,545 Continuing Healthcare Specialist Equipment 235 286 Minor Adaptations 849 804 Project Provision Expenditure 76 0 Total expenditure 8,156 8,013

Remaining Balance under/(overspend) 353 544

The Rushcliffe CCG contribution to the pool is £564,000 (2013/14: £300,000).

36 NHS LIFT investments

The CCG has no NHS LIFT investments at the year end (2013/14: £nil).

34 NHS Rushcliffe CCG - Annual Accounts 2014-15

37 Intra-government and other balances Current Non-current Current Non-current Receivables Receivables Payables Payables 2014-15 2014-15 2014-15 2014-15 £000 £000 £000 £000 Balances with: · Other Central Government bodies 0000 · Local Authorities 176 0 2,334 0

Balances with NHS bodies: · NHS bodies outside the Departmental Group 6,756 0 105 0 · NHS Trusts and Foundation Trusts 631 0 1,495 0 Total of balances with NHS bodies: 7,387 0 1,600 0

· Public corporations and trading funds 0000 · Bodies external to Government 530 0 9,158 0

Total balances at 31 March 2015 8,093 0 13,092 0

Current Non-current Non-current Receivables Receivables Current Payables Payables 2013-14 2013-14 2013-14 2013-14 £000 £000 £000 £000 Balances with: · Other Central Government bodies 23 0 63 0 · Local Authorities 0000

Balances with NHS bodies: · NHS bodies outside the Departmental Group 7,594 0 586 0 · NHS Trusts and Foundation Trusts 625 0 1,151 0 Total of balances with NHS bodies: 8,219 0 1,737 0

· Public corporations and trading funds 0000 · Bodies external to Government 301 0 11,641 0

Total balances at 31 March 2014 8,543 0 13,441 0

38 Related party transactions

IAS 24 applies to material transactions between NHS bodies and related parties.

Details of related party transactions with individuals are as follows:

Related Party transactions for CCG relate to payments made to GP Practices which have a GP who sits on the CCG Governing Body.

Details of related party transactions with individuals are as follows:

Amounts due Payments to Receipts from Amounts owed from Related Related Party Related Party to Related Party Party £000 £000 £000 £000

East Leake Medical Group 78 0 12 0 Ludlow Hill Surgery 15 0 6 0

Details of related party transactions with other bodies are as follows:

The Department of Health is regarded as a related party. During the year the clinical commissioning group has had a significant number of material transactions with entities for which the Department is regarded as the parent Department as follows:

Amounts due Payments to Receipts from Amounts owed from Related Related Party Related Party to Related Party Party £000 £000 £000 £000

NHS England; 2,653 53,184 105 6,278 NHS Foundation Trusts; 7,514 0 715 144 NHS Trusts; 74,689 0 682 585 NHS Special Health Authorities 7000 NHS Property Services/Community Health Partnerships 1,245 0 1 0

35 NHS Rushcliffe CCG - Annual Accounts 2014-15

39 Events after the end of the reporting period

Co-Commisioning

Early in 2015 the CCG received confirmation that it had been approved for full delegated primary care co-commissioning status for 2015/16. This will cover the commissioning of some GP services previously commissioned by NHS England and will allow the CCG whole system integration to support the delivery of a single out of hospital health and well- being network and strengthen the CCGs ability to create a whole systems integrated care solution. The CCG will receive an allocation of £18.186m in 2015/16.

Better Care Fund

The Better Care Fund was announced by the Government in June 2013 spending round, to ensure a transformation in integrated health and social care. In 2015/16 an additional £1bn has been transferred from NHS England Area Teams for former Section 256 schemes to CCGs to create the total fund at £3.8bn. The CCG has received an additional £2.309m, which has been put towards creation of a Better Care Fund pooled budget in Rushcliffe of £6.180m in 2015/16 and a contingency has been agreed of £436k which is being withheld from the amount paid into the pool.

The impact of these two events on future accounts is represented as follows:

Note 5 Note 35 Pooled Operating Budget - CCG Description of Event Expenses Share £'000 £'000

Creation of Better Care Fund 2015/16 6,180 6,180 Implementation of primary care co-commissioning 2015/16 15,139 Total 21,319 6,180

40 Losses and special payments

40.1 Losses

There were no losses or special payments during the year (2013/14: £nil).

41 Third party assets 2014-15 2013-14 £'000 £'000 Third party assets held by NHS Rushcliffe CCG 0 0

42 Financial performance targets

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

2014-15 2014-15 2013-14 2013-14 Target Performance Target Performance

Expenditure not to exceed income 183,512 181,813 175,366 173,969 Capital resource use does not exceed the amount specified in Directions 00 00 Revenue resource use does not exceed the amount specified in Directions 129,671 127,972 128,033 126,636 Capital resource use on specified matter(s) does not exceed the amount specified in Directions 00 00

Revenue resource use on specified matter(s) does not exceed the amount specified in Directions 00 00 Revenue administration resource use does not exceed the amount specified in Directions 3,103 2,437 2,697 2,599

43 Impact of IFRS

There has been no impact of IFRS on the CCG during the year (2013/14: £nil).

44 Analysis of charitable reserves

The CCG has no charitable reserves at the year end (2013/14: £nil).

36