Salford Clinical Commissioning Group Annual Report 2013-2014

Contents Employees 42 External Audit 44 Member Practices Introduction 4 Disclosure of “Serious Untoward Incidents” 44 Strategic Report 7 Cost Allocation and Setting of Charges for Information 44 History of Salford CCG 7 Principles for Remedy 45 Population Demographics 8 Emergency Preparedness, Resilience and Response 45 External Environment 8 Statement as to Disclosure to Auditors 45 Our Vision, Aims and Objectives 9 Remuneration Report 46 Our Business Model 10 Statement of Accountable Officer Responsibilities 51 Our Key Strengths 11 Governance Statement 52 Highlights of 2013/14 12 Independent Auditor’s Report to the Members of Salford CCG 78 Long Term Conditions (including End of Life Care) 12 Summary of Accounts 81 Children and Young People 13 Notes to the Financial Statements 85-116 Mental Health 14 Scheduled Care (including Cancer) 15 Older People 16 Unscheduled Care 17 Medicines Management 18 Continuing Healthcare 19 Quality of Commissioned Services 20 Primary Care Quality 21 Safeguarding 22 Public Involvement and Consultation 23 Partnership Working 24 What Does The Future Hold? 30 Risks 33 Sustainability Report 33 Equality Report 33 Report of the Chief Finance Officer 35 Members’ Report 40 Salford CCG’s Member Practices 40 Salford CCG’s Governing Body 41

222 3 We reviewed our maternity services looking at ways to reduce health inequalities and Member Practices’ Introduction deliver the best possible start in life for Salford’s children. We also developed a new In April 2013, the Health and Social Care Act came into force bringing with it the largest pathway ensuring the majority of children needing to be transferred from Salford reforms in the 65-year history of the NHS. Royal’s PANDA unit were able to go to Royal Bolton Hospital instead of a wide variety of hospitals further away from home. Clinical Commissioning Groups (CCGs) became the cornerstone of the new health system and now decide how the NHS budget is spent locally on the majority of health services Working in partnership with Salford City Council, Salford Royal NHS Foundation including emergency care, elective hospital care, maternity services, community and Trust and Greater Manchester West NHS Foundation Trust, we have started to mental health services. redesign services to meet the challenge of our growing and ageing population via the Integrated Care Programme for Older People and focused on increasing local clinical In Salford, each of the 50 GP practices became part of Salford CCG and, with support of and stakeholder involvement in decisions about how people in Salford access health other health colleagues, we are responsible for commissioning the best healthcare services services. for the 250,000 registered population in Salford. We delivered robust and sustainable commissioning decisions based upon analysis of Our city is growing as the number of children and young people living in Salford continues the clinical, provider and prescribing data within clinical practice (referrals, prescribing to rise - but Salford is also ageing with the amount of over 65s expected to increase by methods, disease management, patient interface etc) which influence healthcare 30% over the next few years. As our patients live longer, the number of people with long delivery, patient experience, the quality of healthcare provided and the outcomes term health conditions continues to rise. achieved by patients.

Yet, while people are living longer, there are still massive health inequalities across the city. This annual report has given us an opportunity to reflect on the impact Salford CCG has Life expectancy between those living in the best and poorest neighbourhoods is 12 years made for healthcare services in the city since our authorisation 12 months ago. less for men and eight years less for women. Alcohol-related hospital admissions and the amount of people who smoke are also amongst the worst in England.

Our vision is to commission high quality services to enable our population to live longer healthier lives. To achieve this, we have four aims kept at the forefront of our decision-making to provide the best possible healthcare for our Salford patients.

These are: l Prevent ill health l Reduce health inequalities l Improve healthcare quality (safety, experience and effectiveness) l Improve health and wellbeing outcomes

During our first 12 months, Salford CCG has commissioned services with a clear emphasis on prevention as we focused on managing the transition from an NHS that is a sickness service to one that is focused on prevention.

For the 70,000+ people living with a long term condition across the city, we have launched community clinics for patients with vascular problems, provided exercise and lifestyle advice via clinics for patients living with COPD and introduced Diabetes Outreach Clinics.

For our patients living with mental health needs, we funded an additional total of £2 million for a Memory Assessment Treatment Service and expansion of the Mental Health Liaison Service at Salford Royal Hospital, as well as additional recurrent funds in the service for mentally disordered offenders.

4 5 Evaluating our effectiveness The CCG is committed to supporting all staff, including Governing Body members, to Strategic Report fulfil their roles effectively. During establishment, the arrangements put in place by Salford CCG and explained within the Corporate Governance Framework were developed with extensive expert By developing our Governing Body and its individual members, it will ensure that external legal input to ensure compliance with the all relevant legislation. That legal the CCG’s aims and objectives are successfully achieved in the next, and future, advice also informed the matters reserved for Membership Body and Governing Body financial years. decision and the scheme of delegation.

Governing Body training and development needs will be addressed through a range of Salford CCG has complied with the statutory duties laid down in the National Health training and development techniques, including: Service Act 2006 (as amended) and other associated legislative and regulations. The CCG l Governing Body development and strategy sessions 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. l Face-to-face and online training l Coaching and mentoring Responsibility for each duty and power has been clearly allocated to a lead Director. Directorates have confirmed that their structures provide the necessary capability and During 2013/14, a number of Governing Body development and strategy sessions took capacity to undertake all of the clinical commissioning group’s statutory duties. place focusing on developing, nurturing and enhancing the corporate knowledge and The accounts have been prepared under a Direction issued by the NHS Commissioning expertise of the Governing Body to rise to future challenges. Several of these sessions Board under the National Health Service Act 2006 (as amended) have been facilitated by an external organisation.

The CCG’s Audit Committee has received regular reports concerning Governing History of Salford CCG Body governance and performance matters and has made recommendations for Salford CCG was established in April 2013 when it was licenced without conditions policy, procedural and process improvement throughout the financial year. The Audit under the Health and Social Care Act 2012. Committee has also commissioned several reviews in the financial year under the CCG’s Internal Auditor (Mersey Internal Audit) to evaluate Governing Body effectiveness Previously, the local health budget and health decisions had been made by in particular areas and to make recommendations for further improvement in those organisations called Primary Care Trusts (our local Primary Care Trust was known as areas, as appropriate. The Internal Audit Plan for 2013/14 awarded the CCG with NHS Salford). At the end of March 2013, all Primary Care Trusts across the country Significant Assurance. closed down and were replaced with GP practice membership organisations called Clinical Commissioning Groups (such as Salford CCG).

CCGs now have overall decision-making responsibilities on how the health budget allocated by the Department of Health should be spent locally. This new way of working is not about every GP taking time away from surgeries. It is about making sure we use the people and knowledge already based within Salford to the best of our ability and achieve the best outcome for our population – GPs have the most contact with patients, therefore the best overview of the population’s health needs.

Our offices are based on the 7th Floor within St James House on Pendleton Way in Salford. St James House is owned by Orbit Developments (part of the Emerson Group) and the CCG shares the building with multiple other organisations, including the Greater Manchester Commissioning Support Unit (GMCSU).

At the end of the 2013/14 financial year, Salford CCG was made up of:

Male Female Governing Body 11 3 CCG employees 29 61

6 7 Population Demographics Our Vision, Aims and Objectives Salford is a city within Greater Manchester. It has a registered population of Salford CCG’s vision and aims were established in the two-year Integrated Strategy and 250,000 people living across eight neighbourhoods: Operating Plan (ISOP) 2013/14 - 2015/16. l Claremont and Weaste l East Salford Our vision is to commission high quality services to enable our l Eccles population to live longer healthier lives. l Irlam and Cadishead To deliver this vision, we identified four primary aims - each supported by a number of l Little Hulton and Walkden strategic objectives - to ensure our decisions provided the best possible healthcare for l Ordsall and Langworthy people living in Salford during 2013/14. l Swinton and Worsley Prevent ill health l Boothstown l Help people to make healthy choices to reduce lifestyle-related harm Although there are diverse levels of affluence within the district, Salford is ranked as one l Direct resources towards preventative interventions of the most deprived local authority areas in England with life expectancy lower than the l Build community assets to create population resilience to ill health England average. Reduce health inequalities There are massive health inequalities within Salford with men living in the most deprived l Commission according to health need areas having over 12 years shorter life expectancy than those from the least deprived l Provide additional support to vulnerable groups areas, and women eight years. l Ensure health services are equitable The number of alcohol-related hospital admissions and premature deaths from heart disease and stroke are also amongst the worst in England. Improve healthcare quality (safety, experience and effectiveness) l Commission services that are delivered to best practice safety standards External Environment l Improve patient experience of commissioned services The CCG operates in a complex external environment, influenced by political, economic, l Commission services which will have the best outcomes and provide value for money market, social, legal, policy and regulatory changes. We assess our external environment l Implement the recommendations from the Francis Report on an ongoing basis to ensure we maximise the opportunities that any changes may afford us and minimise any associated risks. This is undertaken based on our Risk Improve health and wellbeing outcomes Management Strategy with regular reports to the Governing Body outlining our high l Commission service models which maximise health and wellbeing outcomes level risks, with strategic and operational risks being actively managed. l Locate services in the most appropriate setting where possible close to home and encouraging self care The CCG has assessed its areas of strategic risk as being associated with workforce, l variation in quality, availability of a local primary care provider organisation, partnership Increase early diagnosis of cancer working, public and patient lifestyle behaviour, research and development, conflicts of interest, political changes and its impact on public services. In each of these areas of our Along with our objectives, Salford CCG has a set of values: external environment the CCG works to maximise the opportunities we have to influence l Strive for excellence through the setting of increasingly high ambitious standards these areas to support the organisation achieve our organisational aims and deliver l Value people – public, patients, staff and stakeholders against our strategic programmes of work. l Have professional integrity – being open, honest and transparent l Be a lean organisation which is effective, efficient and safe l Make the best use of available resources

Building on the strength of the CCG’s inaugural year, our core vision and values have been preserved with the aims and objectives refreshed to reflect a constantly evolving health and social care environment. See p30 for details. 9

8 9 Our Key Strengths Salford CCG has a number of key strengths – including a sound financial base – to achieve our objectives and subsequently our vision and aims. These have built up over a number of years from the PCT legacy and throughout the period of shadow operation in 2012/13.

We have retained a stable and talented workforce throughout our development and complemented our skills and experience by attracting new talent from other parts of the NHS and organisations. This ensures that we are – and will continue to be – well- placed to shape and commission safe, effective and patient-focused services for our registered population.

In recognition of the complex and growing healthcare needs of our patients - and the excellent track record of the CCG and predecessor organisations - NHS England has increased investment in Salford over the forthcoming five year period. Based upon past performance, the CCG is in excellent position to shape and commission well targeted services that will have a long term and positive impact on the health of the city’s population.

We also benefit from a stable and engaged membership through our 50 GP practices Our Business Model across Salford with our well-qualified GPs providing clinical leadership. As a group, they To turn our vision into reality for the people of Salford, the CCG’s business model bring a rich mix of experience and knowledge to debates around shaping and reviewing focuses on: primary care services in the city. l Co-producing a health strategy with the local authority and our population Salford CCG is proud to have a long history of partnership working with key health and l Fulfilling the health components of the health and wellbeing agenda and social care stakeholders, including NHS and non-NHS providers, the local authority and discharging our statutory duties as a CCG third sector groups. These successful working relationships have been maintained l Clinically leading commissioning throughout the transition from PCT to CCG. Partnership working will remain a core element of the CCG’s plans for the next five years, reflecting our view that collaborative l Developing and implementing effective patient and public engagement approaches to health and social care across the city will ensure resources are used in the l Working in partnership with others most efficient way to improve outcomes for our population. l Robustly managing performance l Developing and implementing robust and resilient governance arrangements and internal controls l Increasing competency l Supporting innovation l Promoting the NHS Constitution

10 11 Children and Young People Highlights of 2013/14 The CCG completed a comprehensive review of maternity services in Salford during Long Term Conditions (including End of Life Care) 2013/14, which found they were of high quality and in line with good practice in the More than 70,000 Salford patients have a long term condition, e.g. diabetes, asthma great majority of areas. A new project has now been established to set the tone for the and COPD (Chronic Obstructive Pulmonary Disease), which can seriously impact their life service quality over the next five years and ensure all parts of the service are geared to and shorten life expectancy. An estimated 80% of GP consultations and 60% of hospital reduce health inequalities and deliver the best possible start in life for Salford children. bed days are used by patients with long term conditions. We reviewed paediatric inpatient capacity to support our local PANDA (Paediatric During 2013/14 we: Assessment and Diagnosis Area) unit and successfully piloted an arrangement with Bolton NHS Foundation Trust to take secondary care patients from the unit. This l Launched Diabetes Outreach Clinics for GPs to discuss diabetic patients with ensured that, over the busy winter period, the small number of children and young consultant diabetologists ensuring a personalised approach to patient care and people attending PANDA needing to be transferred were all able to access a convenient providing GPs with continuous learning and development local hospital. l Trialled a new model of care around early detection of patients with liver disease. If successful, the pilot will roll out across Salford Salford CCG has invested, as part of a longer term strategy, to improve the quality of l Introduced clinics for COPD patients providing exercise and lifestyle advice. This care for children with long term conditions and multiple care needs. New standards has been extremely successful in helping patients manage their condition and enjoy have been commissioned for children living with diabetes, which complement the an improved quality of life implementation of a shared pathway across primary and secondary care for the management of children with asthma. This work has stopped the rise of hospital l Commissioned a community clinic providing treatment for patients with vascular admissions and aims to bring these levels down to those comparable with the best in problems that otherwise would have been seen in hospital the region in the short term. In the next five years we will continue improving community and primary care-based initiatives for patients with long term conditions to reduce unnecessary hospital admissions and provide care closer to home. We will work with partners to maximise community assets and promote self-management and education enabling patients to stay well and independent for as long as possible.

For End of Life Care we: l Increased the number of GPs, hospital and hospice doctors, nurses and social care staff using Salford’s Electronic Palliative Care Coordination System (EPaCCS). A growing number of Salford residents are completing Advance Care Plans and sharing the information through EPaCCS to ensure preferences and choices for end of life care are met wherever possible l With guidance for the National Leadership for the Care of Dying People, work has progressed to develop the replacement for the Liverpool Care Pathway for the Dying Patient in July 2014 l Reviewed commissioned end of life care services ahead of a redesign taking place next year to make sure support at home is available whenever needed 24/7

Salford CCG will continue contributing to national end of life care initiatives, in addition to setting ourselves ambitious targets with regards to patients dying in their place of choice. Workstreams to help us achieve this are being incorporated as part of the Salford Integrated Care Plan for Older People.

12 13 Mental Health Scheduled Care (including Cancer) The 2010 Salford Mental Wellbeing Needs Assessment estimates 36,500 adults and During the last year Salford CCG has worked to ensure patients receive more care closer 6,000 children in Salford might have a mental wellbeing need. During 2013/14, to home. To achieve this, we reviewed hospital activity to make sure patients are not being Salford CCG and Salford City Council launched the Integrated Mental Health followed up by hospitals more than would be expected - according to national ratios of Commissioning Strategy and established a Mental Health Commissioning Strategy first to follow up appointments - and that, where appropriate, procedures are conducted Group to oversee the commissioning of mental health services in Salford for the next as day cases. five years. The CCG also implemented a community-based, consultant-led ophthalmology service. We also: This service is currently trying out evening appointments to see if these are more suitable for patients. l Invested £1.3m in the Memory Assessment Treatment Service (MATS) to diagnose dementia patients A full review of local hospital-based rheumatology services has started. Working with l Spent £1.1m expanding the Mental Health Liaison Service to provide rapid clinical teams at Salford Royal, we will identify where pathways may need to be redesigned assessment and intervention for patients with mental health needs who attend and where care can be safely moved into a community setting. Salford Royal’s emergency department or are admitted to a ward Throughout the year, we have monitored national access targets and are on track to l Redesigned services for people with personality disorders achieve the targets for patients receiving treatment with 18-weeks of referral and for l Invested additional recurrent funds in the service for mentally disordered offenders patients to obtain diagnostic tests within six weeks of request. and progressed discussions with Bolton and Trafford regarding effective joint working across the localities Although most of the services for cancer are commissioned regionally, we have been working to improve local cancer pathways and services wherever possible. We have: l Opened a new rehabilitation ward (Copeland Ward) l Redesigned and recommissioned the Recovery and Horticulture Service l Reviewed the pathway for following up patients treated for prostate cancer. This at Buile Hill Garden Centre identified how much the service is valued by patients and the value of specialist l Developed Salford’s Dementia Action Alliance, one of the first in England nurses through providing links with social care and support groups, as well as l Modernised Hollybank to become an Intermediate Support Hub providing telephone support. accommodation supported by a 24-hour staff team focusing on recovery and l Designed and funded a pilot of ‘CAN Move’. Evidence shows being active can help independent living reduce the risk of cancer progressing or returning. CAN Move provides cancer patients l Reviewed Start In Salford to inform future commissioning requirements with access to a physical health trainer specially trained to support them with regular exercise through a 12-week structured programme and one-to-one support to get Mental health remains one of our key priorities for 2014-19. The CCG recognises that people back into regular exercise. effective management of mental health and wellbeing can have a positive impact on patients’ physical health and socio-economic wellbeing. We are dedicated to Over the next five years, we will support the changes to scheduled care across Salford and commissioning personalised care that enables recovery through prevention, education, Greater Manchester as part of the Healthier Together programme and national shift tele-care and support services. towards community and primary based care. Our focus will be on redesigning and commissioning scheduled care services outside a traditional acute hospital setting, where appropriate, so patients can receive high quality care closer to home.

14 15 Older People During 2013/14, we reviewed the Community Stroke contract, delivered by the Stroke Association. The service provides support to the discharge and rehabilitation pathway for Salford patients following an acute stroke episode. Staff from the service begin their work with patients prior to them being discharged from hospital and working alongside medical staff at SRFT to provide a seamless transfer from acute to community. Importantly they work closely with family members who are carers to ensure they are supported if they have any new responsibilities.

The service continues to support patients and carers following discharge for up to 12 month, including the six-month review and application of the Modified Rankin Scale. The service supports patient involvement through the Salford Stroke Survivors Group and delivers training to health and social care staff.

The review concluded the service was: l Appropriately positioned in the stroke pathway l Highly valued by staff at SRFT and in primary care l An invaluable resource for users and carers l Efficiently using its staffing resource and delivering to expected levels of activity l Planning to develop responses to additional health conditions – comorbidities

We have also been working with Salford City Council, SRFT and GMW to agree plans, Unscheduled Care pilot service changes and pool almost £100 million health and social care funding for older peoples services into a single budget. The Integrated Care Programme for Older Continuing to meet patients’ urgent care needs continues to be one of the biggest People (ICP) has been piloted during 2013/14 in two Salford neighbourhoods, Swinton challenges facing the NHS nationally. Whilst the Salford health economy benchmarks and Eccles, with proactive joint care planning and management for the over-65s. relatively well against many other areas, there continues to be significant variation in See Partnership Working for more details on Integrated Care for Older People. the quality of care provided to patients in different districts and at different times.

Some key local developments in 2013/14 have included: l Full implementation of the NHS 111 service locally. More than 1,000 calls to NHS 111 are made by Salfordians every week and links have been established between it and other services such as GP out-of-hours, GP practices, A&E and community services l The development of a new pathway for children so during the busy winter months the majority of children who needed to be transferred from Salford Royal’s PANDA unit go to Royal Bolton and not hospitals further afield l Long term funding has been identified for a number of pilots aiming to help people, especially older people, regain their confidence and return to the activities of daily living and self-care after an urgent health need (these include use of equipment, services provided by the Stroke Association and Age UK, community geriatricians, etc.). These schemes will be taken forward via our Integrated Care Programme for Older People.

16 17 Medicines Management Medicines are the most frequent health care intervention in the NHS which, if prescribed and taken correctly, can make a major impact to improve the health and wellbeing of a population. Inappropriate use of medicines can, however, result in unnecessary harm to patients, poorer outcomes and a financial risk to the CCG.

With this in mind, the Medicines Management team at the CCG have worked on several projects throughout 2013/14 including: l Review of Atrial Fibrillation patients in Salford prescribed warfarin intervening in those with poor control. 696 patients had poor control and, through a variety of methods, we improved this and improved outcomes and reduced harm for the patients l Engaged with partner organisations and established networks to ensure effective joint decision-making to deliver innovative, quality and safe prescribing and use of medicines across health care services. This involved supporting the Greater Manchester Medicines Management Group (GMMMG) and its subgroups with GP, commissioner and medicines management input l On-going workstreams to assure safe, effective and affordable medicines usage in Salford have focused on reducing variation in prescribing and reducing medicines-related healthcare acquired infections (C.diff and MRSA). Practices have audited their cephalosporin and quinolone prescribing against local guidelines, Continuing Healthcare and carried out laxative reviews and NSAID reviews. Reviews of lithium monitoring, Continuing Healthcare is a package of NHS arranged and funded by the CCG for shared care prescribing and simvastatin and co- prescribed drugs have ensured people who are not in hospital, but have complex ongoing health needs. we are implementing MHRA guidance and alerts. We support all primary care prescribers by providing a query answering service directly relating to patient care. During 2013/14: l The number of referrals to the NHS Funded Care Team continues to increase, mainly We continue to monitor NICE technology assessments relating to medicines used in via Salford Royal Hospital Trust although significant numbers are received from primary care and ensure they are available within our formulary and horizon scan for other hospitals, social services and community nursing services new drug developments. l Costs related to funding individuals continue to rise but within the forecasted This year we have provided medicines management expertise into on-going projects perimeters including Integrated Care, management of long-term conditions and the development l All patients receiving funding, either NHS Continuing Healthcare or NHS Funded of a new malnutrition in the community pathway to ensure effective and timely Nursing Care in care homes and their own homes, are reviewed routinely often prescribing of nutritional feeds. We also continue to support education and training at generating the need for further assessments in respect of NHS Continuing specific events including supporting patient groups in Salford, which educates patients Healthcare and aids the implementation of the self-care agenda. l Improved reporting procedures from district nursing services have shown a significant increase in the number of people receiving care in their own homes For 2014/15, the Medicines Management division have identified five objectives to l We initially received 260 enquiries regarding the Government’s initiative in respect support the CCG’s delivery of its strategic priorities. These include: effective decision of Previously Un-assessed Periods of Care. This figure reduced to 225 due to making, medicines safety, primary care prescribing, effective commissioning and duplication and some individuals with GPs outside the Salford boundary. community pharmacy. A significant number of cases have been closed, but work is on-going to examine the remaining enquires and formal assessments will be completed where appropriate to do so l The CCG completed a procurement exercise to renew the tender for delivery of 15 specialist continuing care beds within Salford during the next three years. Once again, Swinton Hall was the successful provider.

18 19 Quality of Commissioned Services The CCG has developed a Quality and Safety Strategy for 2014-18 which outlines The CCG receives a range of information on the quality of commissioned services from how these arrangements will be strengthened and developed. The strategy includes a variety of sources. This information is reviewed and scrutinised to enable us to gain an a systematic quality assurance framework which will add rigour to existing processes. overview of the quality of care provided. Regular meetings with our main providers are We also intend to increase our efforts in securing patient feedback to ensure that we used to discuss areas of under-performance and include broader discussions around key remain focused on what matters most to the people using services that we commission. aspects of quality and safety. Where issues are identified, actions for improvement are agreed which are monitored through the monthly meetings. Primary Care Quality The CCG has a clear responsibility to improve and develop the quality of primary In addition to these meetings: care, reduce variation of standards and support our member practices to improve l Commissioner-led walk rounds of provider services have been carried out health outcomes. It is our ambition to establish a gold standard of service – throughout the year to gain further assurance of how services operate in providing the ‘Salford Standard’. safe and effective care to patients. l Feedback on patient experience in using commissioned services has been sought to In 2013/14, we: ensure that the patient voice is heard l Held quality improvement workshops with GPs, Practice Managers and Practice l Quality reports have been reviewed by the Governing Body to provide assurance Nurses communicating the CCG’s strategic plans and to understand their priorities that the quality of services is being monitored and steps are being taken to to driving quality improvement work with providers on quality improvement. These reports include a patient story l Established a work programme focusing on patient safety, experience and clinical to highlight the experience of an individual in using services effectiveness l Relationships with NHS England though the Quality Surveillance Group and Quality l Provided education, training and support to GPs and their staff on safeguarding Collaborative enable the CCG to receive assurance that providers across Greater children, young people and vulnerable adults. This has resulted in a significant Manchester are scrutinised and held to account for their performance. increase in the numbers of GPs trained in safeguarding as well as improvements in the quality and timeliness of safeguarding case conference reports

The CCG has established a Primary Care Quality Group to assess and monitor the quality of primary care general practice. The group works to the Quality Improvement Framework, which sets out the parameters and process to identify practices requiring support to improve quality standards, but also identify areas of best practice. We intend to design and develop a quality dashboard to highlight practices requiring support for improvement.

This group is also overseeing initiatives to drive the standard of primary care and set the ‘Salford Standard’. In 2014/15, quality improvement programmes are planned in: l Incident reporting l Safeguarding l Integrated Care for Older People

We will continue engaging with member practices through monthly neighbourhood meetings, practice managers’ forum and a practice nurse forum.

20 21 Safeguarding Public Involvement and Consultation The CCG Safeguarding Team has taken a lead role in ensuring arrangements for Salford CCG spends a significant amount of time engaging with the public and patients safeguarding children and vulnerable adults have remained robust over the last of Salford to get a good idea of exactly what they want from their local health services. 12 months. This year, our main objectives around public engagement were to: Two specialist safeguarding nurse team members were appointed to support the additional work required to further improve safeguarding, and the team now come l Develop and deliver the 2013-2018 Engagement Strategy and the 2013-2014 under the remit of the CCG’s Head of Quality and Innovation. Engagement Delivery Plan l We have been working with care home providers to develop and maintain robust Give as many stakeholders as possible the opportunity to understand what the CCG safeguarding arrangements, supporting GP practices in their management of patients is and the chance to feed back their opinions, questions and concerns around their who are experiencing domestic abuse and continued to expand the safeguarding local health service training programme. l Make better links into existing Salford-based engagement networks and create a more robust mechanism for embedding the intelligence we gather during our The safeguarding team, along with the CCG executive leads for safeguarding and engagement work into the business decisions the CCG GP neighbourhood leads with additional safeguarding responsibilities, have all ensured the CCG continues to contribute to the work of the Salford Safeguarding In terms of achieving these objectives, we are pleased to report: Children and Safeguarding Adults Boards and their subgroups. l The Engagement Strategy has been formally approved and published on the Salford CCG website Along with providing safeguarding training for GPs and practice staff, we have l The 2013-14 Engagement Delivery plan has been fully implemented supported GPs to increase their involvement in the multi-agency child protection meetings. l We have engaged with thousands of people from a variety of communities and geographical areas within Salford (all with different health conditions and health needs) by attending community-based events/meetings and holding our own events/meetings l We have built closer working relationships with Healthwatch Salford, the Service User Development Workers at Salford City Council and with Healthy Communities Collaborative – ensuring that they spread our messages as well as us helping them to spread theirs.

Other major successes from the last 12 months include:

l Two daytime city-wide Panel events and one evening city-wide Panel event, allowing people who work to actively be involved with the CCG engagement work l Three Neighbourhood Panel evening events at Lower Kersal/Charlestown Eccles / Winton and Walkden / Little Hulton, allowing residents of each area to focus on l Four Panel newsletters informing over 2000 stakeholders per edition the latest news around CCG engagement l The rollout of ‘All in the Mind’ drama production and workshop series looking at mental health issues that are important to teenagers (taken up by 95% of high schools in Salford)

22 23 Beginning with services for older people, Salford has made a significant step forward Partnership Working with integrated care during 2013/14. We have been working with Salford City Council, Health and Wellbeing Board SRFT and GMW to agree plans, pilot service changes and pool almost £100 million Salford’s Health and Wellbeing Board is a partnership between local government, health and social care funding for older peoples services into a single budget. the NHS, voluntary sector, business sector and the people of Salford. The Board is responsible for publishing the Joint Health and Wellbeing Strategy which identifies The changes have been piloted in Swinton and Eccles with proactive joint care planning three priorities to guide how we commission health and wellbeing services between and management for frail, elderly individuals by GPs, district nurses, social workers, now and 2016: specialist doctors and mental health staff. This includes those living in their own homes - either alone or with carers - and those in care homes. The needs of carers are also l Ensure all children have the best start in life and continue to develop well being considered. during their early years, with a particular focus on: - Promoting healthy weight in targeted schools Plans have also been developed to merge public-facing call centre services provided - Increasing breastfeeding initiation by the local authority and health services so that all the needs of individuals may be - Reducing teenage conceptions responded to in one place, reducing the complexity that face individuals when trying to navigate health and social care services. l Local residents achieve and maintain a sense of wellbeing by leading a healthy lifestyle supported by resilient communities, with a particular focus on: In addition, we have been working with community and voluntary groups in Salford - Supporting vulnerable people with more effective joined up services and older people themselves to help understand what would help them be happier, (reducing violent crime) healthier and more independent. - Positively influence individual and neighbourhood health and wellbeing (reducing alcohol-related admissions to hospital) The four organisations have agreed a financial plan which includes additional - Local communities have resilience to respond to and support community investment in Salford’s community nursing services, social workers, GP practices and wellbeing (improve social connectedness) community and voluntary groups over the next four years. This is supplemented with Salford’s plan for its proportion of the national Better Care Fund. We hope that this will l All local residents can access quality health and social care and use it appropriately, help older people to live confidently and happily in their own homes for longer and with a particular focus on: reduce the time spent in hospital in their later years. - Timeliness of access (increase uptake of Health Checks) - Ensuring people feel supported to manage their condition] - Enhanced quality of life for carers (inclusion in care plans and discussions)

Three priority groups meet quarterly to work on expanding the outcomes with membership drawn from the HWBB and with at least one CCG (GP) member.

Joint Strategic Needs Assessment (JSNA) A JSNA executive group made up of senior leaders from Salford City Council representing adult and children’s services and public health and a CCG Governing Body GP (and latterly the Chair of the CCG) have met monthly.

The group is a sub-group of the Health and Wellbeing Board and is responsible for producing and publishing the JSNA, ensuring it is informed by consistent data sources, is open to feedback and contributions from its users, including the public, and that it aligns with the Joint Health and Wellbeing Strategy.

Integrated Care Programme for Older People (ICP) The Health and Social Care Act 2012 sets out the CCGs’ statutory duty to promote integration. This requires CCGs to make sure health services are joined up with health-related or social care services to improve quality of care or reduce inequalities.

24 25 Healthwatch Salford Healthwatch Salford’s mission is to encourage local people, especially those who are most vulnerable and marginalised, to get the best out of health and social care by getting involved in shaping services.

The Local Authority commissioned a social enterprise company, Unlimited Potential, to steward Healthwatch in its development during 2013/14. The CCG, represented by a Governing Body GP lead, has supported council colleagues to oversee Healthwatch implementation during this year.

The same clinical lead has, with a CCG commissioning colleague, supported the Integrated Engagement Board, where local citizen representatives have been able to engage with commissioners from health and social care around national policies, commissioned services and, in particular, the work of the Health and Wellbeing Board and integrated working.

Salford Health and Social Value The CCG has been an active partner in the Salford Health and Social Value programme, one of four Department of Health funded national social value pilots. The programme brings together partners from across Salford, including the CCG, local authority, community and voluntary groups and social enterprises, to further develop opportunities for social value across the city using public funds for maximum community benefit.

The programme is nearing the end of year one of three and the CCG has made a valuable contribution to the existing work streams, including the on-going development of a social value charter and a toolkit to support commissioners, providers and procurers. We have also been working with colleagues in Greater Manchester CSU procurement to embed social value criteria into existing tender processes. Neighbourhood Clinical Commissioning Groups Salford has a very diverse population with significant health inequalities and therefore very differing health needs.

To ensure these varying needs are represented throughout all work done by the CCG, the organisation has developed a neighbourhood structure, whereby GP practices who are located within the same geographical areas within Salford work more closely together to tackle the issues that are most relevant to their patients.

Each neighbourhood group meets monthly to discuss local topics and to work on initiatives that they believe will bring benefit to their immediate area. Each neighbourhood group is led by a GP who works in a practice within that area. All Neighbourhood Leads are members of the CCG Governing Body, ensuring that the voice of each area of Salford is represented at the decision making level of the organisation.

Likewise, a significant effort has been put in this year into delivering neighbourhood based engagement activities, ensuring that we get a mapped view of what each area of Salford is thinking and not just a blanket view of the city, which is likely to be unrepresentative to most.

26 27 Making Every Contact Count/Way 2 Wellbeing Portal Manchester Academic Health Science Centre (MAHSC) The CCG has been involved in the strategic development and implementation of these Salford CCG is one of six partners working with The University of Manchester to give two local authority and Public Health projects, with the support of a GP clinical lead. patients and clinicians rapid access to the latest research discoveries to improve the Making Every Contact Count (MECC) has involved training of frontline staff in the quality and experience of patient care. major organisations in health, social care and some third sector providers to offer signposting advice to service users in health, social and environmental matters. One of only six Academic Health Science Centres in the country, MAHSC is underpinned by six domains, of which the CCG is predominately active in Population Health and The Way 2 Wellbeing Portal is an online interactive tool to complement MECC and can Implementation. help Salford residents to make the right choices for healthy living and management of some long term conditions. It currently focuses on smoking, healthy weight, keeping The CCG has a team in cohort 2 of the Improvement Science for Academics (IS4Ac) active, mental wellbeing, alcohol, housing, money and sexual health. It allows programme, developed by MAHSC in conjunction with Haelo to support experienced individuals to carry out an online ‘wellbeing check’ and monitor progress against clinical academics to close the gap between research and clinical practice. The team’s personally set goals. project is looking at gaining an understanding of the current issues in relation to access to GPs in Salford by: Association of Greater Manchester CCGs l Reviewing the factors that may impact on poor access and identify where Working as an Association, the CCGs across Greater Manchester pool ideas, expertise improvements can be made and resources to improve the health of everybody living in Greater Manchester. l Testing new ideas about how access can be improved l Develop a standard approach to GP access Much of the current work through the Association is linked to the Greater Manchester health and social care reforms, including the Healthier Together programme. Salford Lung Study The Salford Lung Study is a unique collaboration between Salford CCG, GlaxoSmithKline Salford CCG is currently the lead CCG for: (GSK), North West e-Health (NWeH), The University of Manchester, Salford Royal NHS l Centralisation of stroke care services so that all patients presenting with symptoms Foundation Trust, local GPs and local community pharmacists. The study is investigating of a stroke are taken to one of the Greater Manchester specialist centres to be the effectiveness of a GSK new respiratory medicine in patients with Chronic Obstructive assessed and receive initial treatment Pulmonary Disease (COPD) or asthma over a 12 month period. l Supporting specialised commissioners and NHS England in the re-procurement of the neuro-rehabilitation system in Greater Manchester. Patients who opt into the study are randomised to either continue to take their current medication or the new trial medication. To date, 1,894 Salford patients with COPD have l Supporting Greater Manchester West NHS Mental Health Trust’s continued provision enrolled in the study, making us two-thirds towards our target of 2,800, and we are now of a Rapid Alcohol Detox Acute Referral (RADAR) service for all Greater Manchester starting to recruit asthma patients. In order to complete recruitment, the study has now acute trusts extended to some areas of South Manchester and Trafford. l The Greater Manchester TB collaborative The Salford Lung Study was designed primarily to deliver evidence of clinical effectiveness l Medicines Management in the ‘real-world’ across a large population. It is attracting global interest as no other l Member of the North West Specialised Commissioning Oversight Group study in the world can currently provide this in the robust setting of a randomised clinical trial and it is setting a new standard in the delivery of real-world evidence, which will be Haelo applicable in other disease areas and healthcare settings in the future. Haelo is a joint venture between the CCG, Salford Royal NHS Foundation Trust and Salford City Council working with local partners to improve population health and healthcare for Salford. It is an innovation and improvement centre working with improvement experts, clinicians, improvement fellows and researchers.

In Salford, we are working on two programmes with Haelo – the Integrated Care Programme for Older People (ICP) and vascular health checks. Haelo has been responsible for providing the monthly data for ICP and sharing learning between the teams and, for the vascular health checks, Haelo devised a project plan to increase uptake which is now being implemented across the city.

28 29 What Does The Future Hold? Quality l Engage with all sections of our population to encourage their involvement in Salford CCG’s vision and aims were originally established in the two-year Integrated improving the quality of care provided. Actively seeking feedback on their Strategy and Operating Plan (ISOP) 2013/14-2015/16. This has now been reworked as experiences of healthcare and using this information to improve services a five year strategic plan and two year operational plan for 2014-2019 which meet the l national planning requirements set out in Everyone Counts: Planning for Patients Support our members to deliver primary care that is safe, effective and accessible; 2014/15 to 2018/19. minimising variation and secure continuous improvement l Work with our providers to ensure that they deliver safe, effective, accessible We are on a very strong foundation going forward, but we want to be more ambitious services and secure continuous improvement and move faster to best meet the expected needs of current and future populations of Salford. Building on the strength of the CCG’s inaugural year, our core vision and values Community Based Care from 2014/15 onwards remain the same. l Support and invest in GP Practices to work at a bigger scale and in a federated manner to effectively deliver integrated care with community health and social Vision: To commission high quality services to enable our population care services to live longer healthier lives: l Seek opportunities to enhance the role of community pharmacists and opticians

Aims: Integrated Care l Prevent ill health l Jointly plan for integrated health and social care services with Salford City Council, l Reduce health inequalities Salford Royal NHS Foundation Trust, Greater Manchester West Mental Health NHS l Improve healthcare quality (safety, experience and effectiveness) Trust and other providers to enable people to retain their independence and quality of life. l Improve health and wellbeing outcomes l Work effectively with health and social care organisations to support the assessment However, we have refreshed our strategic objectives to focus on the following areas: and commissioning of NHS funded Continuing Care from a range of providers, including nursing homes and home care providers

In Hospital Care l Support secondary care reconfiguration/service transformation in the conurbation through the Healthier Together Programme whilst also maintaining a focus on the delivery of NHS constitutional standards

Long Term Conditions l Increasingly support the treatment of long term conditions in primary care and community settings, with a particular focus upon cancer, circulatory and respiratory diseases

Effective Organisation l Support the CCG to deliver its priorities by embedding effective organisational processes l Organisational Development and HR l Communications and Engagement l Resilience and Business Continuity l Risk Management l Policy Development l Financial Planning and Management

30 31

l Performance Management Reducing the gap in life expectancy l Asset Management and Estates Diet, lifestyle, environment and poverty are just four factors which continue to l Equality, Diversity and Human Rights significantly impact on the mortality and morbidity rates - not just between communities l Corporate Support in Salford, but between Salford and the rest of the country. l Governance The CCG’s strategic plan focuses on bringing care closer to the patient. By working in a l IM&T federated manner across GP practices and with our partners across the health system, l Sustainability we will ensure more preventative activities take place in a community setting and that l Health and Safety earlier diagnosis and treatment can be provided in the community. l Counter Fraud l Support preventative measures aimed at improving morbidity and Changes to the public sector mortality rates in the treatment of long term conditions The CCG is working with partners across the Salford to understand the impact of public sector efficiency savings and budget cuts, in particular where partner services will be hit When we are planning for the future, we need to take into account a number of hardest and where the CCG can work alongside those partners, most notably the Salford external factors, national and local trends which will impact the way Salford CCG City Council, to work in new or different ways to minimise the impact of the changes. commissions healthcare services including: This work will ensure future sustainability of services and achievement of outcomes for the local population. Reconfiguration of hospital services There is a strong national drive for the reconfiguration of hospital services to Risks concentrate specialist acute services at a smaller number of sites across the country. Our Governance Statement (p52) discloses strategic, commercial, operational and In Greater Manchester, this is being spearheaded through the Healthier Together financial risks which may significantly affect Salford CCG’s strategies and development. programme. Our policy for managing principal risks is available via our website, http://www.salfordccg.nhs.uk This means Salford CCG will continue to prepare to commission more primary care, community-based care and integrated care services for people in Salford to ensure the treatment provided out of hospital is of the highest standards. Our commitment to this Sustainability Report has been cemented in the development of our strategic priorities for the next five years, which outline an expected increase in community, primary and integrated care services Salford CCG is required to report its progress in delivering against sustainable and a shift away from unnecessary acute hospital care. development indicators.

Growing population We are developing plans to assess risks, enhance our performance and reduce our impact, including against carbon reduction and climate change adaptation objectives. Salford is a growing city with the population expected to reach 246,400 by 2015. This includes establishing mechanisms to embed social and environmental sustainability Salford CCG’s strategic plan takes into account the overall growth in the population across policy development, business planning and in commissioning. over the coming years and analyses growth in specific groups to identify what their health needs are likely to be in the future. We will ensure the CCG complies with its obligations under the Climate Change Act 2008, including the Adaptation Reporting power, and the Public Services Growing population living with long term conditions (Social Value) Act 2012. The population is also growing older with more people living longer and many with multiple long-term health conditions. We are also setting out our commitments as a socially responsible employer. Salford CCG is working in partnership with Salford City Council, Salford Royal NHS Foundation Trust and Greater Manchester West Mental Health NHS Foundation Trust Equality Report to develop the Integrated Care for Older People programme. Salford CCG is required to identify and manage equality and human rights business risk as well as evidence how we consider each of the nine protected characteristic groups in The aim is to redesign health and social care services and enable older people to our planning and decision making processes. live healthier, more independent lives at home and reduce the need for hospital and residential care. The aim is to engage with local vulnerable groups to identify if proposed key changes in healthcare will create an adverse impact for them. Through consultation and feedback

32 33 opportunities for local groups, the vulnerable patient voice helps us to shape fair, accessible services that take account of individual needs. Report of the Chief Finance Officer Our Annual Equality Data Publication is available via our website Summary Financial Performance 2013-14 http://www.salfordccg.nhs.uk/EnD.asp and sets out five equality Salford CCG has achieved all of its statutory financial duties and this reflects the strong objectives to deliver between now and 2017: financial management within the organisation.

1) Improve health and narrow the gaps in access, experience and outcomes The financial statements are detailed on pages 81 to 116. 2) Improve collection and use of data/evidence for all protected groups 3) Communicate and engage with all protected groups Achievement Against Performance Targets 4) Develop equality and diversity competent and well supported staff The CCG has four performance management targets against which it is measured: 5) Develop leadership, corporate commitment and governance arrangements l Revenue resource use does not exceed the amount specified in Directions for equality and diversity l Revenue administration resource use does not exceed the amount specified The annual publication is a ‘specific duty’ on all CCGs to enable transparent and in Directions accessible public reporting on what equality data we hold for each of the protected l Capital resource use does not exceed the amount specified in Directions characteristic groups and the services they are using, as set out in the public sector l Better Payments Practice Policy equality duty requirements. It also identifies any significant gaps in equality data, how they link into our agreed equality objectives, and how the CCG will seek to address them Revenue Resource Use going forward over a four-year cycle. We are also keen to look at any health inequalities The CCG has a legal duty to maintain spending within its resource limit i.e. total budget. experienced by local patients and carers from protected groups and compare this to what There are two separate limits against which the CCG is measured: revenue and cash. is happening nationally. In 2013-14 the CCG met both requirements and reported: The data tells the story about the experiences of Salford’s most vulnerable and more marginalised patients, carers and staff. Through quantitative and qualitative data l A £17,017k under spend (surplus) against its revenue budget (resource limit) of gathering and review from our provider partner organisations, the CCG can gain £341m. The CCG planned to achieve a surplus of £13,000k but has exceeded assurances about the quality and safety of our services for local protected groups and this due to delays in implementation of investments. It should be noted that the CCG inclusion health groups. inherited an underspend of £17m from its predecessor body, Salford PCT, and plans We are developing an EDHR Strategy 2014-17 looking at workforce and service delivery to spend this over the next five years. The full forecast of £17m will be available from issues and fair access to healthcare information, services, premises and any employment 2014-15 to spend on healthcare; opportunities, for each of the local protected groups. As a result, the CCG will develop l The cash book balance at the end of the year was £65k which was within the £250k a two-year overarching EDHR Action Plan 2014-16, which includes identification of limit approved by NHS England. Equality Delivery System 2 (EDS2) actions. Revenue Administration Resource Use Salford CCG has been allocated a running costs allowance of £25 per head of population and this equates to £6,050k. In 2013-14, the CCG’s running cost expenditure was £6,040k and so has remained within the allowable expenditure limit.

Capital Resource Use The CCG received no capital allocation in 2013-14 and has incurred no capital expenditure.

Better Payment Practice Code In line with other public sector bodies, NHS organisations are required to pay invoices within 30 days or within the agreed payment terms, whichever is the sooner. This is known as the Better Payment Practice Code. CCGs are required to ensure that at least 95% of invoices are dealt with in line with this code.

In 2013-14 the CCG exceeded this target and the details are set out on page 102.

34 35 How Did Salford CCG Spend its Allocation of £341m in 2013-14? Salford CCG - Purchase of Acute Services 2013-2014 - £180m During 2013-14 the CCG achieved a surplus of £17m and spent £324m on the achievement of its objectives in a variety of services, as identified below:

Salford CCG - Allocation of Total Expenditure 2013-2014 £324m

Key Messages from 2013-14 We are pleased to have been successful in achieving all of our statutory financial duties during our first year of operation.

Two major investments were implemented in 2013-14 - an additional £1.3m was invested in the Memory Assessment Treatment Service (MATS) to diagnose patients living with dementia, and a further £1.1m was set aside to develop and expand the Mental Health Liaison service providing rapid assessment and intervention for patients The cost to the CCG of medicines prescribed by GPs is £38m and during 2013-14 the with mental health needs who go to Salford Royal’s emergency department or are Medicines Management Team worked with practices to ensure that all items prescribed admitted to a ward. were cost effective and safe. An Innovation Fund was set up to promote integrated and partnership working and to The majority of the CCG’s overall budget, £180m, is spent on acute services such as encourage innovation through two voluntary and community sector grant pots; the Little elective and non-elective care, outpatients, ambulance and accident and emergency. Pot of Health Wellbeing Fund to enable community and voluntary groups with annual Whilst the majority of acute care is commissioned from Salford Royal NHS Foundation turnovers of £10,000 or less to undertake small projects in local communities which can Trust (SRFT), other NHS and non NHS providers are also used. really make a difference to people’s wellbeing; and the Little Pot of Health Improvement The services we buy from these providers are shown below: Fund to support Salford third sector groups of any size to improve the health and wellbeing work that they do.

36 37 Looking Forward Into 2014-15 Salford CCG plans to make use of these recurrent and non-recurrent monies over the The draft Long Term Financial Plan through to 2018-19 was presented to the Governing next 5 years to achieve better outcomes for the population of Salford. The financial plan Body in September 2013 with the final version of the plan being presented at the is aligned to our strategic programmes over the next five years, for example: meeting in March 2014. l Integrated Care Programme for Older People – the CCG will receive a £6m In 2013-14, the CCG inherited a non-recurrent surplus from Salford PCT of £17m, allocation in 2015/16 in respect of the Better Care Fund and, in addition, which Salford CCG has carried forward into future years. In addition, the allocation will contribute a further £10m from the CCG’s baseline allocation. These funds will formula for the next two years provides additional recurrent funding to Salford CCG be added to baseline spend on older people’s services and create a pooled budget to that which was anticipated in the draft September allocation announcements. with Salford City Council of circa £100m The funding formula that underpins the allocations has recognised the impact of l Primary Care Quality – there is a new investment in primary care quality of £1.5m deprivation on populations and Salford is regarded as being underfunded based on the within the enhanced services budget of £2.9m relative need of its population. l Out of hospital/community-based care – an additional £4m funding for out of hospital services in 2014/15 will be invested in service provision (for example, long Each CCG received a minimum level of uplift within the allocations announced in term conditions management), improving access to services (for example, seven-day December 2013, however, those CCGs that were furthest away from their target opening) and infrastructure (for example, improving premises) allocation received an above average growth settlement. Salford CCG will receive l Innovation – the CCG will continue to invest £2m funding for non-recurrent pilots an above average uplift in growth to narrow the distance from the target allocation. as well as committing £0.5m recurrent funds each year during the planning cycle to This results in an additional £15.3m of recurrent funds over the five year planning mainstream and roll out those schemes that evaluate successfully across Salford. period, compared with the minimum growth settlement awarded to CCGs nationally. This is more funding than originally anticipated by Salford CCG in the three year plan Over this five-year period, new investment by Salford CCG will be more targeted towards presented to the Governing Body in September 2013 and is set out in the table below: Integrated Care and community-based care whilst ensuring a strong emphasis on quality throughout all of the areas that are commissioned. Table 1: Salford CCG allocation growth Table 2: Salford CCG investment split by strategic aim: TOTAL OVER 5 2014/15 2015/16 2016/17 2017/18 2018/19 YEARS Minimum Growth (CCGs) 2.14% 1.70% 1.80% 1.70% 1.70% 9.04% Allocation Growth (Salford CCG) 2.72% 2.55% 2.64% 2.57% 2.52% 13.00% Additional for Salford CCG 0.58% 0.85% 0.84% 0.87% 0.82% 3.96%

TOTAL OVER 5 2014/15 2015/16 2016/17 2017/18 2018/19 YEARS £m £m £m £m £m £m Minimum Growth (CCGs) £6.8 £5.4 £5.7 £5.4 £5.4 £28.8 It is evident that Salford CCG will have funds available to invest over the next five years. Allocation Growth (Salford CCG) £8.6 £8.3 £9.0 £9.0 £9.1 £44.1 The challenge for Salford CCG is to target this funding to make significant inroads into Additional for Salford CCG £1.8 £2.9 £3.3 £3.6 £3.6 £15.3 addressing those areas where there are poor health outcomes in Salford.

Alan Campbell Steve Dixon Accountable Officer Chief Finance Officer 4th June 2014 4th June 2014

38 39

Salford CCG’s Governing Body Members’ Report Chair Hamish Stedman Salford CCG’s Member Practices Chief Accountable Officer Alan Campbell Chief Finance Officer Steve Dixon Neighbourhood Practice Name Director of Public Health Melanie Sirotkin [until Nov 2013] Broughton, Lower Kersal and Dr Buch Interim Director of Public Health David Herne [from Nov 2013] Irwell Riverside Dr Warburton Local Authority Liaison Dr Clive Boyce Dr Davis, Leicester Road Medical Practice Dr Jeet Performance Clinical Lead Dr Jeremy Tankel Dr Kassam, Mocha Parade Medical Practice Neighbourhood Clinical Leads Dr Annette Johnson Newbury Green Medical Practice (Irlam and Cadishead) Dr Levenson, Limefield Medical Centre Dr Sultan Dr Paul Bishop (Swinton) Blackfriars Medical Practice Dr Babar Farooq (Broughton) Salford Care Homes Practice Dr Elaine Tamkin (Eccles) Eccles, Barton and Winton Dr Allweis Dr Owain Thomas (Ordsall and Claremont) Dr Budden & Partners Dr Girish Patel (Little Hulton and Walkden) Dr Yates & Fletcher Lay Member for Engagement Brian Wroe Dr Lindsay & Behardien Salford Health Matters Lay Member for Finance and Governance Edward Vitalis Dr Singh (Vice chair) Dr Tyrell Lay Member for Commercial Paul Newman Dr Borg-Costanzi, Monton Medical Centre Dr Tamkin & Partners Governing Body Nurse Clare Todd Governing Body Secondary Care Clinician Dr Mansel Haeney Irlam and Cadishead Dr Hope & Partners, Mosslands Medical Practice Ex Officio Governing Body Members Cllr Margaret Morris (Salford City Dr Joshi, Chapel Medical Centre Dr White, Irlam Medical Centre Council Lead Member for Health) Dr Malcomson, Irlam Clinic Sue Lightup (Strategic Director for Dr Malloy & Shabaz, Irlam Group Practice Community, Health and Social Care) Ordsall and Langworthy Dr Saxby & Partners, Regents Park Medical Practice Audit Committee* Dr Haber & Partners, Langworthy Medical Practice Dr Rahman Salford CCG Dr Salim Edward Vitalis (Chair) Non-executive Director Dr Tankel & Partner, Clarendon Surgery Dr Jeremy Tankel Performance Clinical Lead Claremont, Weaste and Seedley Dr Austin, Pendleton Medical Centre Clare Todd Governing Body Nurse Dr Raj & Partners, Orient Road Surgery Dr Amin, The Willows In attendance Dr Malcomson, The Cornerstone Dr Finegan & Partners, Sorrel Group Practice Steve Dixon Chief Finance Officer The Heights Medical Practice Hannah Dobrowolska Head of Corporate Services Karen Proctor Head of Performance and Commissioning Walkden, Boothstown, Ellenbrook Walkden Medical Centre and Worsley The Gill Medical Centre Roger Causer Senior LCFS, Mersey Internal Audit The Limes Medical Centre Claude Chonzi Audit Manager, Mersey Internal Audit Dr Loomba Leonard Cross Audit Manager Assurance, Grant Thornton Ellenbrook Medical Centre Orchard Medical Centre Mick Waite Director Assurance, Grant Thornton Heather Walters Audit Manager, Grant Thornton Little Hulton Dr Ahuja Cherry Medical Centre Dr Umeadi Dr Khan * See the Governance Statement for details of members of other committees and sub-committees. Swinton and Pendlebury The Sides Medical Centre The Poplars Medical Centre Nelson Fold Medical Practice The Lowry Medical Practice The Lakes Medical Centre

40 41 Disabled Employees Employees Disability is one of the nine protected characteristic groups listed under the Equality Pension Liabilities Act 2010. The CCG is required to evidence in a number of ways how we are legally As an employer with staff entitled to membership of the NHS Pension Scheme, control compliant with the Public Sector Equality Duty (PSED) showing how we take ‘due regard’ measures are in place to ensure all employer obligations contained within the scheme of each of the protected groups in our planning and decision making processes. This regulations are complied with. This includes ensuring that deductions from salary, includes people with disabilities i.e. physical, mental health issues, learning disabilities employer’s contributions and payments into the scheme are in accordance with the and other types of disability. scheme rules, and that member pension scheme records are accurately updated in accordance with the timescales detailed in the regulations. The CCG is required to treat disabled people as if they are more equal than any other of the protected groups, when taking ‘due regard’ in key decision making processes, at all See accounting policy note in the Financial Statements. levels.

Sickness Staff awareness of both workforce and service delivery issues are included in any During 2013/14, the CCG managed an average sickness absence rate of 1.4%. This is such equality, diversity and human rights training provided. Reasonable adjustments significantly lower than the reasonable threshold of 4.5% set to all NHS organisations for patients, carers and staff is a fundamental area of awareness and delivery for as a result of the Boorman Review. NHS healthcare services which directly impacts on how disabled people can gain fair access to information, services, premises and any employment opportunities. This is an Management believe that this is predominantly down to the family friendly flexible ‘anticipatory’ duty under the Equality Act. working policy the CCG has adopted and the positive and caring working environment fostered by senior managers. CCG’s Annual Equality Data Publication, http://www.salfordccg.nhs.uk/EnD.asp, includes conclusions from the data we are aware of for each of the protected groups in A table of sickness is included in the employee benefits note to the Financial Salford. Our EDHR Action Plan contains what actions CCG will focus on during 2014-16, Statements. with Appendix 1 showing Achievements during 2013-14.

Employee Consultation Salford CCG prides itself on its high quality staff engagement. This year, provision has been made to allow staff to have the chance to input into the organisation by a variety of mechanisms including:

l Staff Forum meetings (discussing issues raised by the staff themselves including accommodation, working conditions and new policies) l Staff Briefing sessions (updating staff on decisions made within the Governing Body meetings, the Executive Team meetings and on partnership work the CCG is involved in) l Away Days (allowing staff to help set team objectives for the upcoming financial year) l Topic-specific Focus Groups (allowing staff to give input into the car parking consultation and the development of the Communications and Engagement and Organisational Development strategies).

In addition, staff learn about events and issues relevant to them as employees via a weekly staff e-bulletin and the staff intranet.

The CCG Senior Management adopts an open-door policy should any member of staff have an issue or question, however staff also have the option of submitting anonymous comments, compliments, questions, issues or concerns via either the FAQ section of the intranet or via a Comments Box placed in the staff kitchen.

42 43 External Audit Emergency Preparedness, Resilience Grant Thornton has been appointed by the Audit Commission as Salford CCG’s external auditor. The firm has provided statutory audit services only, at a cost of £91,600 for and Response 2013/14, and has not provided further assurance or other services in 2013/14. Salford CCG is a Category Two responder, as defined in the Civil Contingencies Act 2004. This role requires Salford CCG to have an Incident Response Plan (IRP) to outline how we plan, respond and recover from major incidents and emergencies which can Disclosure of “Serious Untoward affect health and patient care. The Salford CCG IRP supports our partnership working to keep services open and Incidents” running through all events outlined in the Civil Contingencies Act 2004. The Salford There have been no serious untoward incidents relating to data loss or confidentiality CCG IRP aligns with NHS England guidance and plans and other Greater Manchester breaches. health economy IRPs. In the event of a major incident, Salford CCG has an incident control room at St Cost Allocation and Setting of Charges James House and CCG staff are trained to National Occupational Standards for Civil for Information Contingencies. We certify that the clinical commissioning group has complies with HM Treasury’s Health Economy Resilience Group (HERG) meetings are well established in Salford’s guidance on cost allocation and the setting of charges for information health economy and attended by all relevant organisations. They are chaired by Salford CCG’s Head of Performance and Commissioning with support from Greater Manchester Principles for Remedy Commissioning Support Unit (GMCSU) Resilience Manager. The CCG has adopted the six principles set out in Principles for Remedy representing Salford CCG continues to work with the GMCSU resilience team to ensure emergency best practice: preparedness, resilience and response (EPRR) arrangements are in place. An assessment 1. Getting it right against NHS England EPRR Core Standards has been completed and an action plan 2. Being customer focused agreed to address any non-compliance issues. 3. Being open and accountable A CCG Business Continuity Management (BCM) Champion has been appointed and a 4. Acting fairly and proportionately BCM Impacts and Strategies Toolkit is being finalised. Once the toolkit is complete, the 5. Putting things right designated Resilience Manager will liaise with Salford CCG’s BCM Champion to progress 6. Seeking continuous improvement next steps.

Our Chief Accountable Officer has overall responsibility for ensuring the principles are We certify that the clinical commissioning group has incident response plans in place, implemented across Salford CCG. which are fully compliant with the NHS Commissioning Board Emergency Preparedness Framework 2013. The clinical commissioning group regularly reviews and makes improvements to its major incident plan and has a programme for regularly testing this plan, the results of which are reported to the Governing Body. Statement as to Disclosure to Auditors Each individual who is a member of the Governing Body at the time the Members’ Report if approved confirms: l So far as the member is aware, that there is no relevant audit information of which the clinical commissioning group’s external auditor is unaware; and, l That the member has taken all the steps that they ought to have taken as a member in order to make them self-aware of any relevant audit information and to establish that the clinical commissioning group’s auditor is aware of that information

Alan Campbell Accountable Officer 4th June 2014

44 45 All existing off-payroll engagements, outlined above, have at some point been subject Remuneration Report to a risk based assessment as to whether assurance is required that the individual is Salaries and allowances of Governing Body members and those senior managers who paying the right amount of tax and, where necessary, that assurance has been sought. have CCG wide decision making responsibilities are detailed in Table A. Pension benefits are detailed in Table B, where Salford CCG makes employer’s contributions to the NHS Number Pensions scheme. Number of new engagements, or those that reached six months nil in duration, between 1 April 2013 and 31 March 2014 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 Number of the above which include contractual clauses giving nil organisation’s workforce. the clinical commissioning group the right to request assurance in relation to Income Tax and National Insurance obligations The banded remuneration of the highest paid member of the Membership Body/ Governing Body in Salford Clinical Commissioning Group in the financial year 2013-14 Number for whom assurance has been requested was £145k -£147.5k. This was 2.6 times the median remuneration of the workforce, Of which, the number: which was £55.7k. l For whom assurance has been received nil In 2013-14, no employees received remuneration in excess of the highest paid member l For whom assurance has not been received nil of the Membership Body/Governing Body. Remuneration ranged from £15k to £131k l That have been terminated as a result of assurance not nil and total remuneration includes salary, non-consolidated performance-related pay, being received and benefits-in kind. It does not include severance payments, employer pension contributions and the cash equivalent transfer value of pensions. Number Following the Review of Tax Arrangements of Public Sector Appointees published by Number of off-payroll engagements of Membership Body and/or nil the Chief Secretary to the Treasury on 23 May 2012 clinical commissioning groups must Governing Body members, and/or, senior officials with significant publish information on their highly paid and/or senior off-payroll engagements. financial responsibility, during the financial year

Off-payroll engagements as of 31 March 2014, for more than £220 per day and that Number of individuals that have been deemed “ Membership 11 last longer than six months are as follows: Body and/or Governing Body members, and/or, senior officials with significant financial responsibility”, during the financial year (this figure includes both off-payroll and Number on-payroll engagements) The number that have existed l For less than one year at the time of reporting nil l For between 1 and 2 years at the time of reporting nil l For between 2 and 3 years at time of reporting nil l For between 3 and 4 years at time of reporting nil l For 4 or more years at time of reporting nil Total number of existing engagements as of 31st March 2014 nil

46 47

0 0 0 0 0 0 0 0

£000

Contribution to Growth in to Growth 5-10 5-10 Transfer Value Transfer £000 Total 45-50 75-80 10-15 10-15 75-80 30-35 10-15 65-70 45-50 55-60 50-55 40-45 50-55 55-60 Cash Equivalent Employer Funded 120-125 100-105 110-115

(Bands of £5000)

2

25 39 35 205 257 125 114 £000 in Cash Equivalent Real increase Real increase Transfer Value Transfer

£000 22.5-25 35-37.5 35-37.5 (7.5-10) 170.172.5 180.182.5 305.307.5 210-212.5 All Pension related benefits related (Bands of £2500) 94 309 194 300 575 350 246 Cash £000 1360

Transfer Equivalent Value at 31 Value March 2014 March

£000 Long term 90 performance 102 165 256 528 220 129 £000 1079 related bonuses related (Bands of £5000) 31 March 2013 31 March

Cash Equivalent Transfer Value at Value Transfer 2013-14 2013-14

£000 20-25 60-65 40-45 55-60 85-90 70-75 55-60 £000 Annual 180-185 performance Lump sum at 31 March 2014 31 March related bonuses related (Bands of £5000) age 60 related to age 60 related (Bands of £5000) accrued pension at

5-10

£000 20-25 10-15 15-20 25-30 60-65 20-25 15-20

£000 Total accrued Total (Bands of £5000) at 31 March 2014 at 31 March pension at age 60 (rounded to (rounded the nearest £00) the nearest Taxable benefits Taxable 2.5-5 5-7.5 5-7.5 £000 (2.5)-0 40-42.5 27.5-30 22.5-25 22.5-25 at aged 60

Real increase in Real increase (Bands of £2500) pension lump sum 5-10 5-10 45-50 75-80 10-15 10-15 75-80 30-35 10-15 65-70 45-50 55-60 50-55 40-45 50-55 55-60

120-125 100-105 110-115 Salary and Fees (Bands of £5000)

£000 0-2.5 0-2.5 0-2.5 (2.5)-0 7.5-10 7.5-10 7.5-10 12.5-15 Real increase in Real increase (Bands of £2500) pension at age 60

Name and Title

Name and Title Hannah Dobrowolska, Head of Corporate Services Table A – Table Salaries and Allowances Alan Campbell Chief Operating Officer* Steve Dixon, Chief Finance Officer* Proctor, Karen Head of Performance & Commissioning Support Mansel Haeney, Consultant* Secondary Care Todd, Clare Governing Body Nurse* Clive Boyce, Clinical Member* Francine Thorpe, Head of Quality & Innovation Paul Newman, Lay Member* Vitalis, Lay Member* Edward Paul Bishop, Clinical Member* Hamish Stedman, Chair* Lay Member* Brian Wroe, Babar Farooq, Clinical Member* Babar Farooq, Annette Johnson, Clinical Member* Girish Patel, Clinical Member* Elaine Tamkin, Clinical Member* Elaine Tamkin, Jeremy Tankel, Clinical Member* Tankel, Jeremy Owain Thomas, Clinical Member* Owain Thomas, Clinical Member* Francine Thorpe, Hannah Dobrowolska, Hannah Dobrowolska, Annette Johnson, Clinical Member* Alan Campbell, Chief Operating Officer* Steve Dixon, Chief Finance Officer* Head of Corporate Services Proctor, Karen Head of Performance & Commissioning Support Head of Quality & Innovation Paul Bishop, Clinical Member* Table B – Table Pensions & Benefits

48 49 Certain Members do not receive pensionable remuneration therefore there will be no entries in respect of pensions for certain Members. Statement of Accountable Officer’s Responsibilities Cash Equivalent Transfer Values A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The National Health Service Act 2006 (as amended) states that each Clinical Commissioning The benefits valued are the member’s accrued benefits and any contingent spouse’s Group shall have an Accountable Officer and that Officer shall be appointed by the NHS pension payable from the scheme. A CETV is a payment made by a pension scheme or Commissioning Board (NHS England). NHS England has appointed the Chief Operating arrangement to secure pension benefits in another pension scheme or arrangement Officer to be the Accountable Officer of NHS Salford Clinical Commissioning Group. 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 The responsibilities of an Accountable Officer, including responsibilities for the propriety has accrued as a consequence of their total membership of the pension scheme. This and regularity of the public finances for which the Accountable Officer is answerable, for may be for more than just their service in a senior capacity to which disclosure applies keeping proper accounting records (which disclose with reasonable accuracy at any time (in which case this fact will be noted at the foot of the table). The CETV figures and the financial position of the Clinical Commissioning Group and enable them to ensure the other pension details include the value of any pension benefits in another scheme that the accounts comply with the requirements of the Accounts Direction) and for or arrangement which the individual has transferred to the NHS pension scheme. They safeguarding the Clinical Commissioning Group’s assets (and hence for taking reasonable also include any additional pension benefit accrued to the member as a result of their steps for the prevention and detection of fraud and other irregularities), are set out in the purchasing additional years of pension service in the scheme at their own cost. CETVs Clinical Commissioning Group Accountable Officer Appointment Letter. are calculated within the guidelines and framework prescribed by the Institute and Under the National Health Service Act 2006 (as amended), NHS England has Faculty of Actuaries. 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. Real Increase in CETV The financial statements are prepared on an accruals basis and must give a true and This reflects the increase in CETV effectively funded by the employer. It takes account fair view of the state of affairs of the Clinical Commissioning Group and of its net of the increase in accrued pension due to inflation, contributions paid by the employee expenditure, changes in taxpayers’ equity and cash flows for the financial year. (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period. 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: Alan Campbell Accountable Officer l 4th June 2014 Observe the Accounts Direction issued by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis l Make judgements and estimates on a reasonable basis l 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, l 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.

Alan Campbell Accountable Officer 4th June 2014

50 51 Scope of Responsibility Governance Statement 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, Introduction and Context aims and objectives, whilst safeguarding the public funds and assets for which I The clinical commissioning group was licenced from 1 April 2013 under provisions am personally responsible, in accordance with the responsibilities assigned to me in enacted in the Health & Social Care Act 2012, which amended the National Health Managing Public Money. I also acknowledge my responsibilities as set out in my Clinical Service Act 2006. The clinical commissioning group operated in shadow form prior to Commissioning Group Accountable Officer Appointment Letter. 1 April 2013, to allow for the completion of the licencing process and the establishment of function, systems and processes prior to the clinical commission group taking on its I am responsible for ensuring that the clinical commissioning group is administered full powers. prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity. As at 1 April 2013, the clinical commissioning group was without conditions. Compliance with the UK Corporate Governance Code Salford Clinical Commissioning Group (Salford CCG) is responsible for most healthcare Whilst the detailed provisions of the UK Corporate Governance Code are not services available to the people of Salford. The CCG took over from NHS Salford, the mandatory for public sector bodies, compliance is considered to be good practice. This former primary care trust, in April 2013. Governance Statement is intended to demonstrate the clinical commissioning group’s compliance with the principles set out in Code. Every GP in Salford has agreed to join together and be part of Salford CCG. Each GP has signed up to take on an active role in making sure this organisation is a success; ensuring We are not required to comply with the UK Corporate Governance Code. However, that Salford CCG commission high-quality services that enable our population to live we have reported on our Corporate Governance arrangements by drawing upon best longer healthier lives. practice available, including those aspects of the UK corporate governance code we Salford CCG commissions high quality services to enable our population to live longer consider to be relevant to the CCG and best practice. healthier lives’

In 2013/14 our objectives have been to: The Clinical Commissioning Group Governance Framework The National Health Service Act 2006 (as amended), at paragraph 14L(2)(b) states: Prevent ill health: The main function of the governing body is to ensure that the group has made Helping people make healthy choices to reduce health inequalities associated with appropriate arrangements for ensuring that it complies with such generally accepted lifestyle, and direct resources towards prevention, resulting in a reduction of the number principles of good governance as are relevant to it. of people who smoke, reduce the impact of alcohol related harm, and reduce levels of obesity across all age groups. The CCG’s Constitution is available on our website, http://www.salfordccg.nhs.uk/documents/Constitution07082013.pdf Reduce health inequalities: Commissioning services that are tailored to local needs, provide additional support to The Constitution was made between the members of NHS Salford Clinical vulnerable people, and ensure that health services are equitable, leading to an increase in Commissioning Group and has been effective since the 1st day of April 2013, when the life expectancy, a reduction in health inequalities experienced by many people in Salford, NHS Commissioning Board established the group. and reduce the rate of teenage pregnancy. The geograpohical area covered by NHS Salford Clinical Commissioning Group is Improve healthcare quality (safety, experience, and effectiveness): coterminous with Salford City Council. NHS Salford Clinical Commissioning Group Commissioning high-quality value for money services that are delivered in line with best represents all practices within the Salford City Council boundaries circa 247,000 practice and safety standards; not only providing the best clinical ‘outcomes’ for patients, patients. but also providing an improved patient experience. Appendix C of the CCG’s Constitution - Scheme of Reservation and Delegation sets Improve health and wellbeing outcomes: out a) those decisions that are reserved for the membership as a whole; and b) those Buying those services that are best designed to maximize health and wellbeing outcomes decisions that are the responsibility of it’s governing body (and its committees), the and locate services in the most appropriate settings that where possible are closer to group’s committees and sub committees, individual members and employees. Table A in people’s homes. Appendix C of the Constitution provides an overview of the full Scheme of Reservation and Delegation.

52 53 Membership of the CCG Neighbourhood Practice Practice Name Address The following practices comprise the members of NHS Salford Clinical Commissioning Group: Dr Salim Salford Medical Centre, 194-198 Langworthy Road, Salford M6 5PP Dr Tankel & Partner, Neighbourhood Practice Practice Name Address Clarendon Surgery Pendleton Gateway, Salford, M6 5FX Claremont, Weaste Dr Austin, Broughton, Lower Kersal Dr Buch Lower Broughton Health Centre and Seedley Pendleton Medical Centre 1 Broadwalk, Salford, M6 5FX and Irwell Riverside Great Clowes Street Salford M7 1RD Dr Raj & Partners Orient Road Surgery 37 Orient Road, Dr Warburton Higher Broughton Health Centre Salford, M6 8LE Bevendon Square, Salford, M7 4TP Dr Amin The Willows Lords Avenue, Salford, M5 5JR Dr Davis, Leicester Road 53 Leicester Road, Salford, M7 4AS Dr Malcomson, The Cornerstone 451 Liverpool Street, Medical Practice Salford, M6 5QQ Dr Jeet Lower Broughton Health Centre Great Dr Finegan & Partners Clowes Street Salford M7 1RD Sorrel Group Practice 23 Bolton Road, Salford, M6 7HL Dr Kassam Mocha Parade Medical Practice The Heights Medical Practice Bolton Road, Salford, M6 7NU 4-5 Mocha Parade, Salford, M7 1QE Walkden, Boothstown, Walkden Medical Centre 2 Hodge Road, Walkden, Salford M28 3AT Newbury Green Medical Practice Bevendon Square, Salford, M7 4TP Ellenbrook and Worsley The Gill Medical Centre 5 Harriet Street, Walkden, Salford M28 3DR Dr Levenson, The Limes Medical Centre 10-12 Hodge Road Walkden, Salford M28 3AT Limefield Medical Centre 6-8 Limefield Road, Salford, M7 4LZ Dr Loomba Walkden Gateway, 2 Smith Street, Dr Sultan Lower Broughton Health Centre Great Walkden, Salford, M28 3EZ Clowes Street Salford M7 1RD Ellenbrook Medical Centre Ellenbrook Village Centre, Blackfriars Medical Practice FreshTowers, Chapel Street, Salford M3 6AF 14 Morston Close, Salford, M28 1PB Salford Care Homes Practice Sandringham House, Windsor Street, Orchard Medical Centre 10 Leigh Road, Boothstown, Salford, M5 4DG Salford M28 1LZ Eccles, Barton and Winton Dr Allweis St Andrews Medical Centre, 30 Russell St Little Hulton Dr Ahuja Dearden Avenue Medical Practice, Eccles, Salford, M30 0NU 1a Dearden Avenue, Little Hulton, Dr Budden & Partners St Andrews Medical Centre, 30 Russell St Salford, M38 9GH Eccles, Salford, M30 0NU Cherry Medical Centre Hulton District Centre, Haysbrook Avenue, Dr Yates & Fletcher St Andrews Medical Centre, 30 Russell St Little Hulton M28 0AY Eccles, Salford, M30 0NU Dr Umeadi Cleggs Lane Medical Practice, Little Hulton, Dr Behardien St Andrews Medical Centre, 30 Russell St Salford, M38 9RS Eccles, Salford, M30 0NU Dr Khan 152a Manchester Road East, Little Hulton Salford Health Matters Eccles Gateway, 28 Barton Lane, Salford, M38 9LQ Eccles M30 0TU The Sides Medical Centre Moorside Road, Swinton, Salford M27 0EW Swinton and Pendlebury Dr Singh Eccles Gateway, 28 Barton Lane, The Poplars Medical Centre 202 Partington Lane, Swinton, Salford M27 ONA Eccles, M30 0TU Silverdale Medical Practice 659 Bolton Road, Pendlebury, Salford M27 8HP Dr Borg-Costanzi Monton Medical Centre Canalside The Lakes Medical Centre 21 Chorley Road, Swinton, Salford M27 4AF Monton Green, M30 8AR Dr Tamkin & Partners Springfield House, 110 New Lane, Patricroft, Salford, M30 7JE All GPs in Salford have signed agreement with the Salford CCG constitution. Evidence Dr Hope & Partners Mosslands Medical Practice of this is available: MacDonald Road, Irlam, Salford M44 5LH - Upon request for inspection at NHS Salford CCG, St James’s House, Pendleton Way, Dr Joshi, Chapel Medical Centre 220 Liverpool Road, Irlam, Salford, M6 5FW Salford, M44 6FE Dr White, Irlam Medical Centre MacDonald Road, Irlam, Salford M44 5LH - By email – please send your request to [email protected] Dr Malcomson, Irlam Clinic 125 Liverpool Road, Irlam, Salford, M44 6DP Eligibility Dr Shabaz, Irlam Group Practice 523 Liverpool Road, Irlam, Salford M44 6ZS Providers of primary medical services to a registered list of patients under a General Ordsall and Langworthy Dr Saxby & Partners, Ordsall Health Surgery 118 Phoebe Street, Salford, M5 3PH Medical Services, Personal Medical Services or Alternative Provider Medical Services Dr Haber & Partners contract, will be eligible to apply for membership of this group. Langworthy Medical Practice 250 Langworthy Road, Salford, M6 5WW Dr Rahman Salford Medical Centre, 194-198 NHS Salford CCG has an open membership. Any GP practice in Salford may apply to be Langworthy Road, Salford, M6 5PP a member – as per the NHS Commissioning Board entry criteria. This does not preclude applications from practices from outside Salford. All applications will be assessed using the NHS Commissioning Board entry criteria.

54 55 Accountability Vision, aims and values The group will demonstrate its accountability to its members, local people, stakeholders Vision and the NHS Commissioning Board in a number of ways, including by: The vision of NHS Salford Clinical Commissioning Group is “Salford CCG will commission a) publishing its constitution high quality services to enable our population to live longer healthier lives”. b) appointing independent lay members and non GP clinicians to its governing body NHS Salford Clinical Commissioning Group’s strap line is “Effectively enable healthier lives”. c) holding meetings of its governing body in public (except where the group considers that it would not be in the public interest in relation to all or The group will promote good governance and proper stewardship of public resources part of a meeting) in pursuance of its goals and in meeting its statutory duties. d) publishing annually a commissioning plan e) complying with local authority health overview and scrutiny requirements Aims f) meeting annually in public to publish and present its annual report (which must NHS Salford CCG’s aims are to: be published) l Prevent ill health g) producing annual accounts in respect of each financial year which must be l Reduce health inequalities externally audited l Improve healthcare quality (safety, experience and effectiveness) h) having a published and clear complaints process l Improve health and wellbeing outcomes i) complying with the Freedom of Information Act 2000 Values j) providing information to the NHS Commissioning Board as required Good corporate governance arrangements are critical to achieving the group’s objectives. The values that lie at the heart of the group’s work are: a) Strive for excellence, through the setting of increasingly high standards Governance Structure b) Value People – public, patients, staff and stakeholders c) Be professional NHS Salford CCG d) Be honest, open and transparent Governing Body e) Be a lean organisation retaining expert advice f) Make the best use of available resources

Renumeration Clinical Commissioning Programme Executive Team and Quality Outcomes Management Group - Health Safety and Risk Committee Group Principles of Good Governance - IM&T Including Information Governance In accordance with section 14L(2)(b) of the 2006 Act , the group will at all times observe - Organisational Performance LTC and Community - Equality and Diversity “such generally accepted principles of good governance as are relevant to it” in the way Audit Broughton Neighbourhood Commissioning Strategy Group Committee Clinical Commissioning it conducts its business. These include: Group Scheduled Care and Cancer Commissioning Strategy a) the highest standards of propriety involving impartiality, integrity and objectivity Group Health Economy Eccles Neighbourhood Joint R&D Steering Resilience Group Clinical Commissioning

in relation to the stewardship of public funds, the management of the Committee Organisational Management Group Unscheduled Care and Commissioning Strategy organisation and the conduct of its business Group b) The Good Governance Standard for Public Services Salford Safeguarding Irlam Neighbourhood Clinical Commissioning Children and Young Peoples Statutory and Legal Groups Children Board c) the standards of behaviour published by the Committee on Standards in Public Group Commissioning Strategy Group Life (1995) known as the ‘Nolan Principles’ Salford Safeguarding Ordsall Neighbourhood Medicines Management Commissioning Strategy Group d) the seven key principles of the NHS Constitution Adults Board Clinical Commissioning Group e) the Equality Act 2010 Organisational Diversity Continuing Care Commissioning f) Professional Standards Authority standards for NHS boards and clinical Little Hulton and Walkden Strategy Group Neighbourhood Clinical Commissioning commissioning groups governing bodies in England Group Engagement and Experience Primary Care Commissioning Performance Primary Care Management Group

Swinton Neighbourhood Clinical Commissioning Group Contracts Management Group

Salford Practice Managers Commissioning Commissioning Panel Group

56 57 The Governing Body i) The Director of Public Health Functions - the governing body has the following functions conferred on it by sections ii) The Strategic Director for Communities, Health and Social Care 14L(2) and (3) of the 2006 Act, inserted by section 25 the 2012 Act, together with any iii) The Assistant Mayor - Health and Wellbeing other functions connected with its main functions as may be specified in this constitution. Committees of the Governing Body - the governing body has The governing body has responsibility for: appointed the following committees and sub-committees: a) ensuring that the group has appropriate arrangements in place to exercise its a) Audit Committee – the audit committee, which is accountable to the group’s functions effectively, efficiently and economically and in accordance with the governing body, provides the governing body with an independent and objective groups principles of good governance (its main function) view of the group’s financial systems, financial information and compliance with b) determining the remuneration, fees and other allowances payable to employees laws, regulations and directions governing the group in so far as they relate to or other persons providing services to the group and the allowances payable finance. The governing body has approved and keeps under review the terms of under any pension scheme it may establish under paragraph 11(4) of reference for the audit committee, which includes information on the Schedule 1A of the 2006 Act, inserted by Schedule 2 of the 2012 Act membership of the audit committee . c) will ensure that the register(s) of interest is reviewed regularly, and updated In addition the group or the governing body has conferred or delegated the as necessary following functions, connected with the governing body’s main function to its audit committee: Composition of the Governing Body i) Review the implementation and ongoing quality of integrated governance, risk The governing body must not have less than 6 members and consists of: management and internal control, across the whole of NHS Salford CCG’s a) the chair (who will be a GP) activities (both clinical and non-clinical) b) six representatives of member practices representing the following neighbourhoods ii) Act as the arbiter for any issues which may arise from conflicts of interest in i) Swinton relation of the awarding of contracts, in particular to primary care providers and/ ii) Little Hulton and Walkden or primary care independent contractors iii) Eccles b) Remuneration Committee – the remuneration committee, which is accountable iv) Irlam to the group’s governing body makes decisions on determinations about the vi) Broughton remuneration, fees and other allowances for employees and for people who c) two other GPs or primary care health professionals provide services to the group and on determinations about allowances under any i) Local Authority Liaison GP Clinical Lead pension scheme that the group may establish as an alternative to the NHS pension ii) Performance GP Clinical Lead scheme. The governing body has approved and keeps under review the terms of d) Three lay members (one of whom will be the deputy chair) reference for the remuneration committee, which includes information on the i) one to lead on audit, remuneration and conflict of interest matters membership of the remuneration committee . ii) one to lead on patient and public participation matters c) Joint Research and Development Steering Group – the Joint Research and iii) one to lead on commercial matters Development Steering Group is accountable to the group’s governing body. e) One registered nurse The overall purpose of the committee is to initiate, oversee, enable and provide i) with a lead lay role on assurance for safeguarding and quality strategic direction for the development and delivery of research and f) One secondary care specialist doctor development activity within Salford. It is also to provide a forum for discussion i) with a lead lay role on assurance associated with clinical matters including clinical of specific issues and to make relevant recommendations where appropriate to systems and research and development the Salford Royal Foundation Trust Board, NHS Salford CCG Governing Body and g) the accountable officer other emerging structures with responsibility for health care and clinical research. h) the chief finance officer The governing body has approved and keeps under review the terms of reference for the Joint Research and Development Steering Group, which includes Invitations to assist in Governing Body meetings information on the membership of the Joint Research and Development a) The Governing Body may invite such other person(s) to attend all or any of its Steering Group. meetings, or part(s) of a meeting, in order to assist it in its decision-making and in d) Salford Safeguarding Children Board – the Salford Safeguarding Children its discharge of its functions as it sees fit. Any such person may speak and participate Board, which is accountable to the group’s governing body, is a multi-agency in debate, but may not vote. arrangement to provide a strategic lead to safeguarding children at risk (vulnerable b) The Governing Body will invite the following individuals to attend its meetings: children) in Salford. The governing body has approved and keeps under review the terms of reference for the, which includes information on the membership of the Salford Safeguarding Children Board.

58 59

e) Salford Safeguarding Adults Board – the Salford Safeguarding Adults Board is Sub-committees of the Governing Body accountable to the group’s governing body, is a multi-agency arrangement is to Six Neighbourhood Clinical Commissioning Groups, are responsible for provide a strategic lead to safeguarding adults at risk (vulnerable adults) in Salford. providing help, support and encouragement to member practices to deliver the best The governing body has approved and keeps under review the terms of reference possible healthcare outcomes within the available resources and provide an effective for the Salford Safeguarding Adult’s Board, which includes information on the communication route between neighbourhoods and the CCG governing body to deliver membership of the Salford Safeguarding Adults Board. bottom up commissioning intentions. f) Clinical Commissioning and Quality Outcomes Group – the Clinical Commissioning and Quality Outcomes Group, which is accountable to the group’s The groups are: governing body, provides the CCG governing body with assurance of patient and l Broughton Neighbourhood Clinical Commissioning Group population outcomes and financial management through the active management l Eccles Neighbourhood Clinical Commissioning Group of the CCG performance process, using the Clinical Commissioning Budget l Irlam Neighbourhood Clinical Commissioning Group Monitoring Framework. This group may identify and therefore contribute l Ordsall Neighbourhood Clinical Commissioning Group improving the quality of primary care. The governing body has approved and l Little Hulton and Walkden Neighbourhood Clinical Commissioning Group keeps under review the terms of reference for the Clinical Commissioning and l Swinton Neighbourhood Clinical Commissioning Group Quality Outcomes Group, which includes information on the membership of the group Clinical Commissioning and Quality Outcomes Group. The role of the Salford Practice Managers Commissioning Group is to actively g) Programme Management Group – the Programme Management Group, which is engage with all practice managers from all member practices as they are fundamental accountable to the group’s governing body, will oversee commissioning activities to the successful delivery of clinical commissioning at a practice level. including service improvement/development, Best Value/Quality, Innovation, Prevention and Productivity (QIPP), investment/disinvestment evaluation and The Programme Management Group has appointed the following sub-committees to recommendations, provider delivery of quality (patient safety, patient experience help discharge its duties and powers. and effectiveness), engagement of public and patients and the management of contracts. The governing body has approved and keeps under review the terms of Six Commissioning Strategy Groups, that are responsible for the full reference for the Programme Management Group, which includes information on commissioning cycle within their topic area including needs assessment, planning, the membership of the Programme Management Group. service redesign, contracting, implementation and performance management. h) Executive Team – the Executive Team, which is accountable to the group’s governing body, is responsible for compliance with statutory and regulatory duties, The groups are: operational delivery of all CCG functions and performance management of the l Long-term Condition and Community Commissioning Strategy Group objectives of the organisation. It is also specifically responsible for the functions of l Scheduled Care and Cancer Commissioning Strategy Group health, safety and risk, information management and technology (IM&T) l Unscheduled Care Commissioning Strategy Group including information governance, equality and diversity and health economy l Children and Young Peoples Commissioning Strategy Group resilience. The governing body has approved and keeps under review the terms of l Medicines Management Commissioning Strategy Group reference for the Executive Team, which includes information on the membership of l Continuing Care Commissioning Strategy Group the Executive Team . i) The Governing Body may appoint such other committees as it considers may be The Engagement and Experience Management Group is responsible for promoting appropriate. The Audit Committee may include individuals who are not members of and monitoring patient and public engagement in all decision making and for the Governing Body. Other committees of the Governing Body may include promoting and monitoring improvement in patient experience. The group will link with individuals who are: HealthWatch. i) Members, officers or governing body members of the group or another clinical commissioning group The Contracts Management Group is responsible for the development, ii) Partners or employees or members of the group or another clinical implementation and effective management of the contracting strategy for all commissioning group commissioned services, ensuring that all performance meets NHS Salford CCG iii) Officers of the NHS Commissioning Board commissioning plan and its statutory and regulatory duties. The group will undertake these responsibilities covering all aspects of both quantitative and qualitative performance including quality (safety, experience and effectiveness). The purpose of the Commissioning Panel is to make decisions regarding individual

60 61 applications for treatments that are not routinely commissioned by NHS Salford CCG, Audit Committee Meetings in line with the CCG’s Effective Use of Resources Policy.

The CCG has in place alternative arrangements to make decisions regarding individual applications for treatments (usually placements) for patients with funded nursing care or continuing care needs. The CCG also has in place joint arrangements with the City

Council to make decisions regarding individual applications for treatments (usually 28.05.2013 17.09.2013 19.11.2013 18.02.2014 placements) for patients with mental health needs, learning disabilities and for children. Mr Edward Vitalis YES YES YES YES Such placements are excluded from the scope of the Commissioning Panel. Dr Jeremy Tankel YES NO NO YES Mrs Clare Todd YES YES YES YES The Executive Team has appointed the following sub-committees to help discharge its duties and powers:

The Salford Health Economy Resilience Group is responsible to ensure the Renumeration Committee Meetings emergency preparedness and business continuity planning agenda set out in the Civil Contingencies Act 2004 is coordinated, implemented, reviewed, tested and embedded throughout the CCG.

Attendance records

Throughout yes indicates attendance, no indicates non attendance and N/A is 09.07.2013 explained under the relevant table Dr Hamish Stedman YES Dr Mansel Haeney NO Governing Body meetings Mr Paul Newman YES Mrs Clare Todd YES Mr Edward Vitalis YES Mr Brian Wroe NO 24.04.2013 29.05.2013 31.07.2013 29.09.2013 27.11.2013 29.01.2014 26.03.2014 Dr Hamish Stedman YES YES YES NO YES YES YES Dr Clive Boyce YES YES YES YES YES NO YES Dr Paul Bishop YES YES YES YES NO YES NO Dr Babar Farooq YES YES NO NO YES YES YES Dr Annette Johnson YES NO YES YES YES YES YES Dr Girish Patel NO NO YES YES YES NO YES Dr Elaine Tamkin YES YES NO YES NO YES YES Dr Jeremy Tankel YES NO YES YES NO NO NO Dr Owain Thomas YES YES NO NO YES YES YES Mr Alan Campbell YES NO YES YES YES YES YES Mr Steve Dixon YES YES YES YES YES YES YES Dr Mansel Haeney NO YES YES YES NO YES YES Mr Paul Newman YES YES YES NO YES YES YES Mrs Clare Todd YES YES YES YES YES YES YES Mr Brian Wroe YES YES NO YES NO YES YES Mr Edward Vitalis YES YES NO YES YES YES YES

62 63 19.03.2014 NO NO YES YES YES YES

YES Performance 05.03.2014 The Membership Body and Governing Body’s performance including their assessment of NO YES NO YES YES YES NO YES YES NO YES YES YES YES

YES their effectiveness: 19.02.2014 The CCG’s performance is measured principally against the CCG Assurance Framework NO NO YES NO NO NO YES NO NO YES YES YES YES

and the NHS constitutional rights measures and this is regularly reported at bi-monthly 05.02.2014 Governing Body meetings and discussed at scheduled Checkpoint (now Assurance NO NO NO YES YES NO YES YES YES YES YES YES YES YES

YES meetings) with the NHS Greater Manchester Area Team. 15.01.2014 The latest balanced scorecard is available on our website at www.salfordccg.nhs.uk/ NO YES YES YES YES YES YES YES YES YES YES NO YES YES

YES and is contained as an Appendix to the organisational peformance report to the 18.12.2013 Governing Body on 28th May 2014. This provides an overview of the CCG’s performance to NA NO NO YES YES YES YES YES YES YES YES

YES the end of March 2014. 04.12.2013 The quarterly Assurance meetings with the NHS Greater Manchester Area Team focuses NO NO NO NO NO YES YES YES

YES upon how effective the CCG believes it has been, and will be in addressing past and future 20.11.2013 demands on the CCG and on the wider health and well being system in which the CCG NO NO YES NO NO NO

YES YES

YES plays a pivotal role. 06.11.2013 NA NO NO YES YES YES YES YES YES YES YES YES YES YES All Governing Body papers are available on our website,

http://www.salfordccg.nhs.uk/GoverningBodyMeetings.asp, and contain 16.10.2013 NO YES YES NO YES YES bi-monthly updates on the performance of the CCG and, relevant updates from quarterly

Checkpoint (now Assurance) meetings with the Greater Manchester Area Team. 02.10.2013 Highlights of the work of all the above committees, sub-committees and joint NO NO NO NO YES NO YES

YES committees follows. 18.09.2013 NO NA NO YES YES YES YES YES YES NO Long Term Conditions (including End of Life Care)

More than 70,000 Salford patients have a long term condition. Conditions like diabetes, 04.09.2013 NA NO YES NO YES YES YES asthma and COPD can seriously impact a person’s life, affecting the quality of their life and

shortening their life expectancy. It is estimated patients with long term conditions account

21.08.2013 for 80% of GP consultations and 60% of hospital bed days.

NO YES NO YES NO YES YES YES 07.08.2013 A number of key projects have been implemented during 2013/14 to help people in NO NO NO YES NO NO NO l The launch of a new-style Diabetes Outreach Clinics for GPs to discuss their diabetic patients with consultant diabetologists ensuring a tailored approach to patient care

17.07.2013 and providing GPs with continuous learning and development NA NO YES NO YES NO YES YES NO YES YES YES YES NO YES

l An increase in use of Salford’s Electronic Palliative Care Coordination System 03.07.2013 (EPaCCS) used by GPs, hospital and hospice doctors, nurses and social care staff. NA NO YES YES YES YES YES

YES A growing number of Salford residents are being supported to complete Advance 19.06.2013 Care Plans and share the information through EPaCCS to ensure preferences and NO YES NA NO YES

YES YES YES

YES choices for end of life care are met wherever possible 05.06.2013 NO NA NO NO YES NO YES NO YES NO YES NO YES YES NO YES YES YES YES YES Mental Health According to the most recent Salford Mental Wellbeing Needs Assessment (2010), around 36,500 adults and 6,000 children living in Salford might have some kind of mental wellbeing need. During 2013/14, Salford CCG and Salford City Council launched the Integrated Mental Health Commissioning Strategy and established a Mental Health Commissioning Strategy Group to oversee the commissioning of mental health services in Salford for the next 5 years. Dr Hamish Stedman Hamish Dr Dr Annette Johnson Annette Dr Dr Paul Bishop Paul Dr Dr Clive Boyce Clive Dr Farooq Babar Dr Dr Girish Patel Girish Dr Tamkin Elaine Dr Tankel Jeremy Dr Dr Owain Thomas Owain Dr Mrs Gunjit Bandeshi Gunjit Mrs Mr Alan Campbell Alan Mr Mr Steve Dixon Steve Mr Proctor Karen Mrs Mrs Francine Thorpe Francine Mrs Vaughan Claire Mrs Programme Management Group Programme

64 65 Key developments include: l Designed and funded a pilot of a Cancer and Exercise service, ‘CAN Move’. This l An additional £1.3m invested in the Memory Assessment Treatment Service (MATS) provides cancer patients with access to a specially trained physical health trainer to diagapse patients living with dementia and supports them in undertaking regular exercise through offering a 12-week l An additional £1.1m to develop and expand the Mental Health Liaison service structured exercise programme and one-to-one support to get people back into providing rapid assessment and intervention for patients with mental health needs regular exercise. The CCG chose to trial this service because evidence shows that who go to Salford Royal’s emergency department or are admitted to a ward being active can help to reduce the risk of your cancer progressing or returning.

Primary Care Quality Older people The CCG has a clear responsibility around improving and developing the quality of We have been working with Salford City Council, SRFT and GMW to agree plans, pilot primary care general practice, to reduce variation ensuring that all people of Salford service changes and pool almost £100 million health and social care funding for older have access to the same high standard of care and to support our member practices to peoples services into a single budget. improve health outcomes. It is the ambition of the CCG to establish and work to a gold standard of service – the ‘Salford Standard’. The Integrated Care Programme for Older People has been piloted during 2013/14 in two Salford neighbourhoods, Swinton and Eccles, with proactive joint care planning In 2013/14, we: and management for the over-65s. During 2014/15, the programme will be extended l Held a series of Quality Improvement workshops with GPs, Practice Managers and and expanded to cover the whole city. See Partnership Working for more details on Practice Nurses to communicate the CCG strategic plans and to understand their Integrated Care for Older People. priorities to driving quality improvement l Established a work programme focusing on patient safety, clinical effectiveness and Medicines management patient experience Medicines are the most frequent health care intervention in the NHS which, if prescribed and taken correctly, can make a major impact to improve the health and wellbeing of a Children and Young People population. InAppropriate use of medicines can, however, result in unnecessary harm to The CCG completed a comprehensive review of maternity services in Salford during patients, poorer outcomes and a financial risk to the CCG. 2013/14, which found they were of high quality and in line with good practice in the great majority of areas. A new project has now been established to set the tone for the With this in mind, the Medicines Management team at the CCG have worked on several service quality over the next five years and ensure that all parts of the service are geared projects throughout 2013/14. to deliver the CCGs strategic priorities of reducing health inequalities and delivering the best possible start in life for Salford children. A key workstream this year was supporting delivery of the local quality premium work on improving the management of Atrial Fibrillation patients prescribed warfarin. This We reviewed paediatric inpatient capacity to support our local PANDA (Paediatric involved reviewing the control that all patients in Salford prescribed warfarin were Assessment and Diagapsis Area) unit and have successfully piloted an arrangement achieving and intervening in those with poor control. We reviewed 696 patients with with Bolton NHS Foundation Trust to take secondary care patients from the unit. This poor control and, by a variety of methods, improved this and improved outcomes and ensured that, over the busy winter period, the small number of children and young reduced harm for patients. people Yesending PANDA that needed to be transferred were all able to access a convenient local hospital. We have engaged with our partner organisations and established networks in order to ensure that there is effective joint decision-making to deliver innovative, quality and safe Scheduled Care (including cancer) prescribing and use of medicines across health care services. This has involved supporting During the last year Salford CCG has worked to ensure Salford patients receive more the Greater Manchester Medicines Management Group (GMMMG) and its subgroups care closer to home. In order to achieve this, we have reviewed hospital activity to make with GP, commissioner and medicines management input. sure patients are not being followed up by hospitals more than would be expected, according to national ratios of first to follow up Appointments, and that, where The Clinical Commissioning Group Risk Management Framework Appropriate, procedures are conducted as day cases. Salford Clinical Commissioning Group (SCCG) endeavours to provide a Risk Management Strategy that minimises risks to all its stakeholders through a comprehensive system of During 2013/14 we: internal controls whilst providing maximum potential for flexibility, innovation and best l Reviewed the pathway for the follow up of patients treated for prostate cancer. practice in the delivery of its strategic objectives. This identified how much the service is valued by patients and how much value the specialist nurses added to the pathway through providing links with social care and support groups, as well as telephone support.

66 67 SCCG Board seeks to gain assurance that all health services commissioned for the The audit committee advises the Governing Body on the effectiveness of the system of population of Salford are of a good quality and that any known risks to patients, staff internal control by the review of the internal audit report, external audit report and the and/or the organisation are managed Appropriately using a precise method of risk Assurance Framework. Any significant control issues would be reported to the Governing identification, assessment, treatment, monitoring and reporting. Body by the Audit Committee.

The Risk Review schedule frequency is determined by the Risk Policy, in accordance Information Governance with risk rating; The NHS Information Governance Framework sets the processes and procedures by l Weekly Review = Extreme rated risks which the NHS handles information about patients and employees, in particular personal l Monthly Review = High rated risks identifiable information. The NHS Information Governance Framework is supported l Bi Monthly = Moderate rated risks by an information governance toolkit and the annual submission process provides l Quarterly = Low rated risks assurances to the clinical commissioning group, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively. Risks may also be subject to ad-hoc review if so required. We place high importance on ensuring there are robust information governance Any risk review that exceeds 28 days overdue is also notified to the CCG Head of systems and processes in place to help protect patient and corporate information. Corporate Services for further escalation. We have established an information governance management framework and have developed information governance processes and procedures in line with the The Risk Assurance Framework (consisting of a Board Paper and a summary of the information governance toolkit. We have ensured all staff undertake annual information high and extreme risks) is submitted on a monthly basis to the Executive Team, on a governance training to ensure staff are aware of their information governance roles and bi monthly basis to the Governing body and annual basis to the Audit Committee. responsibilities; and there are processes in place for incident reporting and investigation of serious incidents. The Clinical Commissioning Group Internal Control Framework A system of internal control is the set of processes and procedures in place in the clinical We have developed information risk assessment and management procedures and a commissioning group to ensure it delivers its policies, aims and objectives. It is designed programme will be established to fully embed an information risk culture throughout the to identify and prioritise the risks, to evaluate the likelihood of those risks being realised organisation. and the impact should they be realised, and to manage them efficiently, effectively and economically. Moreover, I can confirm that we have not had any significant breaches in IG (as outlined in the report to our Governing Body on 26th March 2014). We have undertaken a The system of internal control allows risk to be managed to a reasonable level rather pro-active Approach as a CCG to Information Governance - notably in the development than eliminating all risk; it can therefore only provide reasonable and not absolute of policies and procedures, design and delivery of training, developing and conducting assurance of effectiveness. audits. As a CCG we are compliant with the Information Governance toolkit and have been awarded Accredited Safe Haven status by the Information Commission. The committee and reporting structures of the CCG provide the basis of the framework and process that maintains, monitors and reviews the effectiveness of the system of Pension Obligations internal control and risk management. The governance structure and sub-committees As an employer with staff entitled to membership of the NHS Pension Scheme, control comprise of a mix of senior managers, clinical professionals, independent contractors measures are in place to ensure all employer obligations contained within the scheme and internal audit representation to ensure effective balance between the membership, regulations are complied with. This includes ensuring that deductions from salary, executive and audit functions and that decision making is effectively triangulated. employer’s contributions and payments into the scheme are in accordance with the scheme rules, and that member pension scheme records are accurately updated in The Governing Body’s role is to provide active leadership of the CCG within a framework accordance with the timescales detailed in the regulations. of prudent and effective controls that enable risk to be managed. The assurance framework was first agreed by the Governing Body at its meeting in July 2013. Equality, Diversity & Human Rights Obligations Control measures are in place to ensure that the clinical commissioning group complies The Board Assurance Framework itself provides the Governing Body with high level with the required public sector equality duty set out in the Equality Act 2010. assurance of the progress of achievement of the CCG’s aims, objectives and priorities within a robust risk based framework; and the Governing Body also receives regular Sustainable Development Obligations reports giving internal assurances on financial, organisational and quality performance. The clinical commissioning group is required to report its progress in delivering against sustainable development indicators.

68 69 We are developing plans to assess risks, enhance our performance and reduce our Review of Economy, Efficiency and Effectiveness of the Use of Resources impact, including against carbon reduction and climate change adaptation objectives. The Governing Body and it’s committees and sub committees receive proposals that have This includes establishing mechanisms to embed social and environmental sustainability been based upon evidenced based commissioning intentions. A wide variety of sources across policy development, business planning and in commissioning. of data are used to inform the development of commissioning intentions, but chief amongst these is the Joint Strategic Needs Assessment. Summary business cases are also We will ensure the clinical commissioning group complies with its obligations under the provided for each commissioning intention drafted that comprises an assessment of the Climate Change Act 2008, including the Adaptation Reporting power, and the Public cost benefit analysis of the proposal and a risk assessment. Services (Social Value) Act 2012. The Audit Committee provides the assurance overview for the effective use of resources, We are also setting out our commitments as a socially responsible employer. and Internal Audit have an annual work programme that complements that role and focuses upon all work areas covered by the CCG. Risk Assessment in Relation to Governance, Risk Management and Internal Control While clinical commissioning groups have a responsibility to promote comprehensive Salford CCG quantifies risk in terms of both opportunities and threats. At 31st March healthcare within the resources available, this does not mean an obligation to provide 2014 the CCG had thirteen opportunity risks and twenty four threat risks. every treatment. Commissioners are entitled to take into account the resources available to them and the competing demands on those resources. Of the threat risks, none are rated as extreme risks and five are rated as ‘high’ risk. The table below details these five high risks and their management and assessment plans. GMCSU’s Effective Use of Resources team works closely with Salford CCG to facilitate and support making those judgments at an individual patient level (IFRs). RISK ID RISK DESCRIPTION EXISTING CONTROLS IN PLACE CURRENT TREATMENT ACTION TARGET CURRENT FUTURE RATING RATING YEAR RISK YEAR RISK

54 If the expected vacancy on SCCG Other CCG members can cover various 15 Identify and recruit a new Local Authority 3 NO YES Governing body of Local Authority Liaison element of the role, but could not cover Liaison Lead. GMCSU’s Effective Use of Resources team combine regional best practice and Lead from 1 April is not filled, then the all aspects. Various actions have been CCG’s co-operation and interaction with taken to encourage application to this benchmarking with local knowledge gained from a strong client relationship and deep the Local Authority will be reduced, so role, including reducing the number of resulting in sup-optimal Commissioning, sessions. Vacancy has been shared with all reduced patient outcomes and reduced CCG members. Individuals with particular knowledge and expertise. A regional overview improves consistency across boundaries, financial efficiency. interest have been approached individually. leading to an improved patient experience. 52 If SCCG does not reasonably engage Equality Analysis process embedded 12 Undertake demographic assessment to 4 YES YES with patient and carer reps from each of into practice. identify substantive ‘protected groups’ the 9 protected groups to ascertain from NHS England’s Equality Delivery System 2 within the CCG area and then ensure that the earliest stages of consideration any (EDS2) used by CCG/ the engagement process has taken place The experienced team employ internationally-used evidence and best practice potential adverse impacts upon them in Annual Equality Data Publication published with the patient and carer reps from each the provision of services, then SCCG will each January. identified ‘protected group’. Evidence not be able to reasonably consider and Regular meetings with CCG link and CSY of this specific patient and carer voice Approaches to make sure that the decision-making throughout the commissioning potentially mitigate against potential regarding EDHR service delivery. shaping inclusive services with CCG key adverse impacts in the commissioning Equality Objectives to be delivered over decision makers. process from Governing Body, through sub committees and working groups and cycle, so this may lead to sup-optimal a 4 year cycle 2013-17 were set by local commissioning decisions, adverse interest groups (April 2011, reviewed Executives is consistent, fair and of a high quality. This ensures that constrained resources impacts upon protected groups and Oct 2013) non-compliance with the public sector Governing Body have received EDHR equality duty and the requirements to Awareness Development session. can be reallocated to where they are most needed to support key strategic plans. evidence ‘due regard’. EDHR Staff Compliance training in place. EDHR staff briefings available. 49 If the current lack of GM wide clarity Designated Nurse influence in 12 Salford CCG cannot resolve this risk, so 12 YES YES GMCSU also works with us and our stakeholders to improve the level of understanding between CCG’s and GM Area Team, GM Safeguarding groups and CCG seek to share / transfer risk with GM Area in relation to safeguarding roles and Senior Management influence with GM Team. Continue to raise this issue with GM responsibilities continues, then there is Area team. Area Team through available channels and of the rationale behind not choosing to commission clinically-unsound and/or expensive a danger that safeguarding issues will encourage other GM CCG’s to undertake not be effectively identified and managed, similar action. interventions, leading to greater acceptance and satisfaction. To assist with achieving so there may be an adverse effect on the safeguarding team if a serious this, the GMCSU also works closely with communications colleagues to manage media incident occurs. and reputation management issues based on commissioning decisions informed by the 24 If there is a disruption to the IM&T service Holding project to account through the 12 Accept risk at the current level. 12 YES YES then there may be delays and/ or failures Salford IM&T Board which meet monthly EUR team. in the communication of clinical data so patient harm may occur

12 If the CSU cannot recruit and retain the Internally review CSU Performance. 12 Accept this risk, if risk continues at this 12 YES TBC right staff then the CCG may not get Executive Director from CSU attends level for 12 months - look to avoid risk by Policy recommendations are developed for CCG approval that will provide a consistent sufficient support so our objectives may Leadership team meetings, action plans sourcing alternative providers. not be met. to address areas of concern. NHS England Approach to the commissioning of procedures of limited clinical value, services for rare survey satisfaction returns. One to ones with product leads. and unusual conditions and services provided in predefined circumstances. Mersey Internal Audit is the Appointed auditor for Salford CCG, and in August 2013 Audit No 509SCCG_1314_005 was undertaken upon the Risk Management systems of Individual Funding Request (IFR): administering the process to identify those individuals Salford CCG. The Final audit report gave “Significant Assurance” upon the quality of the who should receive care based on the EUR policies. In addition the service supports the Risk Management System. running of IFR Panels in each CCG to process requests that are an exception to agreed commissioning policies. Salford CCG is not reporting any materialised Risks that have caused any significant issues.

70 71

Robust processes are in place to inform our work, with an overarching operational n Reviewing SCCG’s Risk Management Framework, on an annual basis and policy supported by a detailed operational procedure for all requests. This means providing comments and recommendations to the Board, that the Appropriate decision based on clinical-evidence and cost-effectiveness will n Ensuring that SCCG’s Risk Management Strategy is Applied consistently be delivered. throughout the CCG, n Monitoring ‘High’ risks (risks scoring 12+) via the Board Assurance Review of the Effectiveness of Governance, Risk Management Framework. and Internal Control As Accounting Officer I have responsibility for reviewing the effectiveness of the The Chief Operating Officer as the Accountable Officer has responsibility for having system of internal control within the clinical commissioning group. an effective risk management system in place within the organisation, for meeting all statutory requirements and adhering to guidance issued by the Department of Health in Capacity to Handle Risk respect of Governance. The Chief Operating Officer is specifically responsible for: n An integral part of an effective risk management framework is having explicit Ensuring there is a Risk Management Strategy in place, n accountabilities for risk. Every member of staff employed by, working on behalf of or Ensuring there is an assurance framework meeting best practice standards, engaged in the activities of SCCG has a collective and an individual responsibility for the that is reviewed at least annually by SCCG, n management of risk within their own remit. With this in mind, every individual should Ensuring that SCCG keeps an active risk register which is reviewed at least make an effort to familiarise themselves with this Risk Management Strategy and the quarterly by the audit committee, n associated Risk Management Handbook (Policy). Ensuring that a Risk Management Policy is in place and in use, that describes how risks are identified, graded, escalated and how the assurance Salford CCG has a duty to assure itself that the organisation has properly identified framework is populated. the risks it faces and that it has Appropriate controls in place to manage those risks. The Board is specifically responsible for: The SCCG Chair is specifically responsible for: n n Defining the Strategic Aims and Objectives of the CCG, Ensuring that SCCG has proper constitutional and governance n Demonstrating leadership, active involvement and support for risk arrangements in place, n management, Implementing the requirements of Corporate Governance. n Ensuring that there is a structure in place for the effective management of risk throughout the CCG, The Chief Finance Officer is specifically responsible for: n n Reviewing and approving SCCG’s Risk Management Framework on an Overseeing the robust audit and governance arrangements, leading to annual basis, propriety in the use of the group’s resources. n Agreeing policies and procedures for the management of risk within SCCG, n Identifying the key strategic risks, evaluating them and ensuring adequate To ensure the successful communication and implementation of this strategy and the responses are in place and are monitored, Risk Management Handbook (Policy), all staff working for or on behalf of SCCG will n Deciding whether SCCG will use the risk pooling schemes administered receive risk management training relevant to their role and responsibilities within the by the NHS Litigation Authority or self-insure for some or all of the risks organisation. Specific Training and Awareness events include: n (where discretion is allowed), A Risk Identification Workshop will be conducted with SCCG Board on an n Monitoring ‘Extreme’ risks (risks scoring 16+) via the Dashboard. annual basis, n Risk Assessment one to ones will be conducted with Risk Owners as and The Executive Team is responsible for compliance with statutory and regulatory when required, n duties, operational delivery of all CCG functions and performance management of Risk Treatment one to ones will be conducted with Risk Owners as and the objectives of the organisation. It is also specifically responsible for the functions when required, n of health, safety and risk, information management and technology (IM&T) including Risk Management introduction and subsequent refresher courses will be information governance, equality and diversity and health economy resilience. The available on request, n Executive Team is specifically responsible for: Risk Management Strategy and Handbook will be made available on SCCG website. n Demonstrating leadership, active involvement and support for risk management, All SCCG Staff and its contractors are required to: n Supporting the board in Identifying the key strategic risks, evaluating them n Be responsible for security of SCCG’s property, avoiding loss, exercising and ensuring adequate responses are in place and are monitored, economy and efficiency in using resources and conforming to Standing Orders, Standing Financial Instructions and financial procedures,

72 73 n Be responsible for Yesending and maintaining a personal record of The committee and reporting structures of the CCG provide the framework and process induction, mandatory and relevant education and training events in that maintains, monitors and reviews the effectiveness of the system of internal control relation to Risk Management, and risk management. The governance structure and sub-committees comprise of a mix n Seek to understand SCCG’s Risk Management Strategy and use the Risk of senior managers, clinical professionals, independent contractors and internal audit Management Handbook (Policy) to Apply its principles in practice, representation. n Participate in the risk management process, including risk assessment within their own area of work, The Governing Body’s role is to provide active leadership of the CCG within a framework n Notify their line manager of any perceived risk which may not have been of prudent and effective controls that enable risk to be managed. The assurance assessed. framework was first agreed by the Governing Body at its meeting in July 2013. Extreme risks are reported to each meeting of the Governing Body and identify gaps in controls A Risk Management Handbook has been developed and forms part of the overall Risk and assurances to agree and review actions. The Governing Body also receives regular Management Framework of SCCG; it describes the standard operating procedures reports giving internal assurances on financial, organisational and quality performance. involved in the identification and management of risk at all levels across the organisation, in pursuit of its Vision, Strategic Aims and Objectives. The audit committee is pivotal in advising the Governing Body on the effectiveness of the system of internal control by the review of the internal audit report, external audit report Specifically, this Risk Management Handbook will help to ensure that: and the Assurance Framework. Any significant control issues woud be reported to the n All staff have a resource available to support them in the Governing Body by the Audit Committee. management of risk, n All staff understand how to Apply the principles of SCCG’s Following completion of the planned audit work for the financial year for the clinical Risk Management Strategy, in their own areas of work, commissioning group, the Head of Internal Audit issued an independent and objective n All staff Apply consistent methods of risk management practice opinion on the adequacy and effectiveness of the clinical commissioning group’s system across the organisation. of risk management, governance and internal control. The Head of Internal Audit concluded that: Application of the methods detailed in this Risk Management Handbook (Policy) will support a cultural shift towards more a risk aware organisation that embraces Head of Internal Audit Opinion responsible and calculated risk-taking. The full report of the Head of Internal Audit is provided at Appendix 1 via www.salfordccg.nhs.uk/ Review of Effectiveness My review of the effectiveness of the system of internal control is informed by the work In summary, the Head of Internal Audit’s overall opinon is: of the internal auditors and the executive managers and clinical leads within the clinical commissioning group who have responsibility for the development and maintenance “Significant Assurance, can be given that that there is a generally of the internal control framework. I have drawn on performance information available sound system of internal control designed to meet the organisation’s to me. My review is also informed by comments made by the external auditors in their objectives, and that controls are generally being Applied consistently. management letter and other reports. However, some weaknesses in the design or inconsistent Application The Board Assurance Framework itself provides me with evidence that the effectiveness of controls put the achievement of particular objective at risk.” of controls that manage risks to the clinical commissioning group achieving its principles objectives have been reviewed. During the year Internal Audit issued two audit reports with a conclusion of limited assurance; there were no reports with a conclusion of no assurance. The limited I have been advised on the implications of the result of my review of the effectiveness assurance reports reviewed conflicts of interest and continuing healthcare and good of the system of internal control by the Governing Body, the Audit Committee and, progress has been made in implementing the recommendations, all of which were the Programme Management Group and a plan to address weaknesses and ensure accepted by management. continuous improvement of the system is in place. There are effective governance arrangements in place, underpinned by a committee The CCG contracts with the Greater Manchester Commissioning Support Unit (GM CSU) structure that provides routine assurances to the Governing Body that significant risks for a number of services and so the CCG’s internal control environment is dependent on to the CCG are being managed. controls in place at the GM CSU. The CCG obtains assurance from the GM CSU’s internal auditors on the operation of internal controls in the form of a service auditor report.

74 75 The overall objective of the internal audit work undertaken was to evaluate the Discharge of Statutory Functions effectiveness of the control environment for the GM CSU and provide assurance, to During establishment, the arrangements put in place by the clinical commissioning the GM CSU and therefore NHS England, on the adequacy and effectiveness of the group and explained within the Corporate Governance Framework were developed key controls in operation. In addition, through the performance of the assignment an with extensive expert external legal input, to ensure compliance with the all relevant assessment was provided with respect to the readiness of the processes and controls legislation. That legal advice also informed the mYesers reserved for Membership Body operated at the CSU for a service auditor report. and Governing Body decision and the scheme of delegation.

GM CSU management have provided assurance as to actions taken to address the In light of the Harris Review, the clinical commissioning group has reviewed all of the service auditor’s recommendations, and a follow up report will be issued to the CCG in statutory duties and powers conferred on it by the National Health Service Act 2006 (as May 2014 by GM CSU internal audit. It is recognised that 2013-14 is the first year of amended) and other associated legislative and regulations. As a result, I can confirm that GM CSU’s operation and that continuous improvements in internal controls are expected the clinical commissioning group is clear about the legislative requirements associated over time. with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions. Data Quality Data provided to the membership and the Governing Body to inform decision making Responsibility for each duty and power has been clearly allocated to a lead Director. has a high degree of provenance. It is obtained from trusted sources: NHS data sets; Directorates have confirmed that their structures provide the necessary capability and NICE; the Joint Strategic Needs Assessment (JSNA) etc., and from trusted advisers: the capacity to undertake all of the clinical commissioning group’s statutory duties. Greater Manchester Commissioning Support Unit (GMCSU); the NHSLA; the NHSBA etc. Conclusion The Audit Committee and Internal Audit play pivotal roles in assuring and challenging - No significant issues have occurred during 2013/14 which would have a significant where relevant - the the data and assumptions made from that data in reports destined impact upon the organisation. My review confirms that Salford CCG has a generally for the Governing Body and other decision making committees or sub groups of the sound system of internal control that supports the achievement of its policies, aims and Governing Body. objectives.

Business Critical Models Having reviewed the Macpherson report, the Business Critical Model section appears to Apply to Government Departments and their arms length bodies (NHSE) only. A statement has therefore not been included in this Annual Governance Statement Alan Campbell concerning Business Critical Models. Accountable Officer https://www.gov.uk/government/uploads/system/uploads/Yesachment_ 4th June 2014 data/file/206946/review_of_qa_of_govt_analytical_models_final_ report_040313.pdf

https://www.gov.uk/government/organisations/department-of-health/ about/our-governance”

Data Security We have submitted a satisfactory level of compliance with the information governance toolkit assessment. The full details of our compliance with Information Governance Toolkit is contained in a report to our Governing Body held on 26th March, 2014, and is available on our website.

I can confirm that there have been no Serious Untoward Incidents relating to data security breaches.

76 77 Independent Auditor’s Report to the Members of Salford CCG inconsistent with, the knowledge acquired by us in the course of performing the audit. We have audited the financial statements of Salford Clinical Commissioning Group for If we become aware of any apparent material misstatements or inconsistencies we the year ended 31 March 2014 under the Audit Commission Act 1998. The financial consider the implications for our report. statements comprise the Statement of Comprehensive Net Expenditure, the Statement of Financial Position, the Statement of Changes in Taxpayers’ Equity, the Statement of In addition, we are required to obtain evidence sufficient to give reasonable assurance Cash Flows and the related notes. The financial reporting framework that has been that the expenditure and income reported in the financial statements have been applied applied in their preparation is applicable law and the accounting policies directed by the to the purposes intended by Parliament and the financial transactions conform to the Secretary of State with the consent of the Treasury as relevant to the National Health authorities which govern them. Service in England. Opinion on regularity We have also audited the information in the Remuneration Report that is subject to In our opinion, in all material respects the expenditure and income have been applied audit, being: to the purposes intended by Parliament and the financial transactions conform to the l the table of salaries and allowances of senior managers [and related narrative authorities which govern them. notes] on page 48. l the table of pension benefits of senior managers [and related narrative notes] on Opinion on financial statements page 49. In our opinion the financial statements: l the table of pay multiples [and related narrative notes] on page 46. • give a true and fair view of the financial position of Salford Clinical Commissioning Group as at 31 March 2014 and of its net operating costs for the year then ended; and This report is made solely to the members of Salford Clinical Commissioning Group in • have been prepared properly in accordance with the accounting policies directed by the accordance with Part II of the Audit Commission Act 1998 and for no other purpose, NHS Commissioning Board with the approval of the Secretary of State. as set out in paragraph 44 of the Statement of Responsibilities of Auditors and Audited Bodies published by the Audit Commission in March 2014. To the fullest extent Opinion on other matters permitted by law, we do not accept or assume responsibility to anyone other than the In our opinion: Clinical Commissioning Group (CCG)’s directors and the CCG as a body, for our audit the part of the Remuneration Report subject to audit has been prepared properly in work, for this report, or for opinions we have formed. accordance with the requirements directed by the NHS Commissioning Board with the approval of the Secretary of State; and Respective responsibilities of the Accountable Officer and auditors the information given in the annual report for the financial year for which the financial As explained more fully in the Statement of Accountable Officer’s Responsibilities, the statements are prepared is consistent with the financial statements. Accountable Officer is responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view. Our responsibility is to audit and Matters on which we report by exception express an opinion on the financial statements in accordance with applicable law and We report to you if: International Standards on Auditing (UK and Ireland). Those standards also require us to l in our opinion the governance statement does not reflect compliance with NHS comply with the Auditing Practices Board’s Ethical Standards for Auditors. England’s Guidance; l we refer the matter to the Secretary of State under section 19 of the Audit Scope of the audit of the financial statements Commission Act 1998 because we have reason to believe that the CCG, or an An audit involves obtaining evidence about the amounts and disclosures in the financial officer of the CCG, is about to make, or has made, a decision involving unlawful statements sufficient to give reasonable assurance that the financial statements are expenditure, or is about to take, or has taken, unlawful action likely to cause a loss free from material misstatement, whether caused by fraud or error. This includes or deficiency; or an assessment of: whether the accounting policies are appropriate to the CCG’s l we issue a report in the public interest under section 8 of the Audit Commission circumstances and have been consistently applied and adequately disclosed; the Act 1998. reasonableness of significant accounting estimates made by the CCG; and the overall presentation of the financial statements. In addition, we read all the financial and We have nothing to report in these respects. non-financial information in the annual report which comprises the Member Practices Introduction, the Strategic Report, Remuneration Report, Sustainability Report, Statement of Accountable Officer’s Responsibilities, and the Annual Governance Statement to identify material inconsistencies with the audited financial statements and to identify any information that is apparently materially incorrect based on, or materially

78 79 Conclusion on the CCG’s arrangements for securing economy, efficiency and effectiveness in the use of resources Summary of Accounts We are required under Section 5 of the Audit Commission Act 1998 to satisfy ourselves Foreword to the Accounts The clinical commissioning group was licenced from 1 April 2013 under provisions that the CCG has made proper arrangements for securing economy, efficiency and enacted in the Health & Social Care Act 2012, which amended the National Health effectiveness in its use of resources. The Code of Audit Practice issued by the Audit Service Act 2006 Commission requires us to report any matters that prevent us being satisfied that the audited body has put in place such arrangements. These accounts for the year ended 31 March 2014 have been prepared by NHS Salford Clinical Commissioning Group under section 17 of schedule 1A of the National Health We have undertaken our audit in accordance with the Code of Audit Practice, having Service Act 2006 (as amended) in the form which the Secretary of State has, with the regard to the guidance issued by the Audit Commission in October 2013. We have approval of the Treasury, directed. considered the results of the following: l our review of the Governance Statement; and The National Health Service Act 2006 (as amended) requires Clinical Commissioning l the work of other relevant regulatory bodies or inspectorates, to the extent that the Groups to prepare their Annual Report and Annual Accounts in accordance with results of this work impact on our responsibilities at the CCG. Directions issued by NHS England.

As a result, we have concluded that there are no matters to report. In accordance with these Directions, as Clinical Commissioning Groups were established

on 1st April 2013, no prior year information is required. Certificate We certify that we have completed the audit of the accounts of Salford Clinical Commissioning Group in accordance with the requirements of the Audit Commission Act 1998 and the Code of Audit Practice issued by the Audit Commission. Statement of Comprehensive Net Expenditure for the year ended 31 March 2014 Mick Waite for and on behalf of Grant Thornton UK LLP, Appointed Auditor 4 Hardman Square Spinningfields Manchester M3 3EB

4 June 2014

80 81 Statement of Financial Position as at 31 March 2014 Statement of Changes of Taxpayers Equity for the year ended 31 March 2014

The notes on pages 85 to 116 form part of this statement.

The financial statements on pages 81 to 116 were approved by the membership on 4th June 2014 and signed on its behalf by:

Alan Campbell Accountable Officer 4th June 2014

82 83 Notes to the Financial Statements Statement of Cash flows for the year ended 31 March 2014 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 2013-14 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.

The accounting arrangements for balances transferred from predecessor PCTs (“legacy” balances) are determined by the Accounts Direction issued by NHS England on 12 February 2014. The Accounts Directions state that the only legacy balances to be accounted for by the CCG are in respect of property, plant and equipment (and related liabilities) and inventories. All other legacy balances in respect of assets or liabilities arising from transactions or delivery of care prior to 31 March 2013 are accounted for by NHS England. The impact of the legacy balances accounted for by the CCG is disclosed in note 1.3 to these financial statements. The CCG’s arrangements in respect of settling NHS Continuing Healthcare claims are disclosed in note17 to these financial statements.

In accordance with the Directions issued by NHS England comparative information is not provided in these Financial Statements.

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.

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. 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.

84 85 The Government Financial Reporting Manual does not require retrospective adoption, so by clinical commissioning groups with the exception of those listed below. In prior year transactions (which have been accounted for under merger accounting) have not addition, no transactions relating to the discharge of liabilities or realisation of been restated. Absorption accounting requires that entities account for their transactions assets transferred to clinical commissioning groups in accordance with transfer in the period in which they took place, with no restatement of performance required when orders issued under the Health and Social Care Act 2012 are to be accounted for functions transfer within the public sector. Where assets and liabilities transfer, the gain by clinical commissioning groups. or loss resulting is recognised in the Statement of Comprehensive Net Expenditure, and is l Inventories, non-current assets and their closely related liabilities (meaning those disclosed separately from operating costs. specific liabilities which represent the financing or similar liabilities incurredin the purchase or leasing of those non-current assets) transferred to clinical commission- Other transfers of assets and liabilities within the Department of Health Group are ing groups in accordance with transfer orders issued under the Health and Social accounted for in line with IAS 20 and similarly give rise to income and expenditure entries. Care Act 2012 are to be accounted for by the clinical commissioning group. l Provisions for Continuing Healthcare Claims, although they may be non-current in For transfers of assets and liabilities from those NHS bodies that closed on 1 April 2013, nature, are to be accounted for in the financial statements of NHS England. HM Treasury has agreed that a modified absorption approach should be applied. For these l The calculation of running costs has been undertaken in accordance with NHS transactions only, gains and losses are recognised in reserves rather than the Statement of England national guidance and definitions. However the application of the Comprehensive Net Expenditure. rules for each organisation involves an application of professional judgement to particular circumstances 1.4. Pooled Budgets 1.5.2. Key Sources of Estimation Uncertainty The CCG has entered into a pooled budget with Salford City Council Local Authority. Under the arrangement funds are pooled under S75 of the NHS Act 2006 for Learning The following are the key estimations that management has made in the process of Disabilities, Integrated Equipment services and Intermediate Care. A memorandum note to applying the clinical commissioning group’s accounting policies that have the most the accounts provides details of the joint income and expenditure. significant effect on the amounts recognised in the financial statements:

The pools are hosted by Salford City Council. As a commissioner of healthcare services, l Due to the NHS England deadline for the submission of the accounts, actual the CCG makes contributions to the pools, which are then used to purchase healthcare information is not available for the full 12 months for some material expenditure services. The CCG accounts for its share of the assets, liabilities, income and expenditure of such as prescribing expenditure and secondary care incomplete spells of the pools as determined by the pooled budget agreements. treatment. The CCG therefore estimates one or two months of expenditure in some areas using historical information, in year trends and any other available 1.5. Critical Accounting Judgements & Key Sources of Estimation Uncertainty information sources. In the application of the clinical commissioning group’s accounting policies, management l Amounts included in provisions include an element of uncertainty around both is required to make judgements, estimates and assumptions about the carrying amounts the amount and timing of the likely liability occurring. They are also frequently, of assets and liabilities that are not readily apparent from other sources. The estimates but not necessarily, one-off or unusual items for which there are fewer and associated assumptions are based on historical experience and other factors that are comparisons. The CCG currently provides for termination costs in respect of the considered to be relevant. Actual results may differ from those estimates and the estimates merger of Trafford Healthcare NHS Trust (now demised) with Central Manchester and underlying assumptions are continually reviewed. Revisions to accounting estimates Foundation Trust, where future redundancy and restructuring costs are estimated are recognised in the period in which the estimate is revised if the revision affects only that but not yet certain. period or in the period of the revision and future periods if the revision affects both current and future periods. 1.6 Revenue Revenue in respect of services provided is recognised when, and to the extent that, 1.5.1. Critical Judgements in Applying Accounting Policies performance occurs, and is measured at the fair value of the consideration receivable. The following are the critical judgements, apart from those involving estimations (see Where income is received for a specific activity that is to be delivered in the following below) that management has made in the process of applying the clinical commissioning year, that income is deferred. group’s accounting policies that have the most significant effect on the amounts recognised in the financial statements: 1.7 Employee Benefits

l In accordance with Accounts Directions issued by NHS England, no assets and 1.7.1 Short-term Employee Benefits liabilities transferred to clinical commissioning groups in accordance with transfer Salaries, wages and employment-related payments are recognised in the period in orders issued under the Health and Social Care Act 2012 are to be accounted for which the service is received from employees, including bonuses earned but not yet taken.

86 87 1.9.2 Valuation The cost of leave earned but not taken by employees at the end of the period is All property, plant and equipment are measured initially at cost, representing the cost recognised in the financial statements to the extent that employees are permitted to directly attributable to acquiring or constructing the asset and bringing it to the location carry forward leave into the following period. and condition necessary for it to be capable of operating in the manner intended by 1.7.2 Retirement Benefit Costs management. All assets are measured subsequently at fair value. Past and present employees are covered by the provisions of the NHS Pensions Scheme. Land and buildings used for the clinical commissioning group’s services or for The scheme is an unfunded, defined benefit scheme that covers NHS employers, administrative purposes are stated in the statement of financial position at their re-valued General Practices and other bodies, allowed under the direction of the Secretary of amounts, being the fair value at the date of revaluation less any impairment. 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. Revaluations are performed with sufficient regularity to ensure that carrying amounts are Therefore, the scheme is accounted for as if it were a defined contribution scheme: the not materially different from those that would be determined at the end of the reporting cost to the clinical commissioning group of participating in the scheme is taken as equal period. Fair values are determined as follows: to the contributions payable to the scheme for the accounting period. l Land and non-specialised buildings – market value for existing use; and, For early retirements other than those due to ill health the additional pension liabilities l Specialised buildings – depreciated replacement cost. 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 HM Treasury has adopted a standard approach to depreciated replacement cost the retirement, regardless of the method of payment. 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. 1.8 Other Costs Other operating expenses are recognised when, and to the extent that, the goods or services Properties in the course of construction for service or administration purposes are carried have been received. They are measured at the fair value of the consideration payable. 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 Expenses and liabilities in respect of grants are recognised when the clinical held at fair value. Assets are re-valued and depreciation commences when they are commissioning group has a present legal or constructive obligation, which occurs when brought into use. all of the conditions attached to the payment have been met. Fixtures and equipment are carried at depreciated historic cost as this is not considered to 1.9 Property, Plant & Equipment be materially different from fair value. 1.9.1 Recognition An increase arising on revaluation is taken to the revaluation reserve except when it Property, plant and equipment is capitalised if: reverses an impairment for the same asset previously recognised in expenditure, in which l It is held for use in delivering services or for administrative purposes; case it is credited to expenditure to the extent of the decrease previously charged there. l It is probable that future economic benefits will flow to, or service potential A revaluation decrease that does not result from a loss of economic value or service will be supplied to the clinical commissioning group; potential is recognised as an impairment charged to the revaluation reserve to the extent l It is expected to be used for more than one financial year; that there is a balance on the reserve for the asset and, thereafter, to expenditure. l The cost of the item can be measured reliably; and, Impairment losses that arise from a clear consumption of economic benefit are taken to l The item has a cost of at least £5,000; or, expenditure. Gains and losses recognised in the revaluation reserve are reported as other l Collectively, a number of items have a cost of at least £5,000 and comprehensive income in the Statement of Comprehensive Net Expenditure. individually have a cost of more than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated 1.9.3 Subsequent Expenditure to have simultaneous disposal dates and are under single managerial control; or, Where subsequent expenditure enhances an asset beyond its original specification, the l Items form part of the initial equipping and setting-up cost of a new building, directly attributable cost is capitalised. Where subsequent expenditure restores the asset ward or unit, irrespective of their individual or collective cost. 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. 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.

88 89 1.10 Intangible Assets 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 1.10.1 Recognition value, over their estimated useful lives, in a manner that reflects the consumption of Intangible assets are non-monetary assets without physical substance, which are economic benefits or service potential of the assets. The estimated useful life of an asset capable of sale separately from the rest of the clinical commissioning group’s business is the period over which the clinical commissioning group expects to obtain economic or which arise from contractual or other legal rights. They are recognised only: 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 l When it is probable that future economic benefits will flow to, or service lives and residual values are reviewed each year end, with the effect of any changes potential be provided to, the clinical commissioning group; recognised on a prospective basis. Assets held under finance leases are depreciated over l Where the cost of the asset can be measured reliably; and, their estimated useful lives. l Where the cost is at least £5,000. At each reporting period end, the clinical commissioning group checks whether there is Intangible assets acquired separately are initially recognised at fair value. Software that any indication that any of its tangible or intangible non-current assets have suffered an is integral to the operating of hardware, for example an operating system, is capitalised impairment loss. If there is indication of an impairment loss, the recoverable amount of as part of the relevant item of property, plant and equipment. Software that is not the asset is estimated to determine whether there has been a loss and, if so, its amount. integral to the operation of hardware, for example application software, is capitalised Intangible assets not yet available for use are tested for impairment annually. as an intangible asset. Expenditure on research is not capitalised but is recognised as an A revaluation decrease that does not result from a loss of economic value or service operating expense in the period in which it is incurred. Internally-generated assets are potential is recognised as an impairment charged to the revaluation reserve to the extent recognised if, and only if, all of the following have been demonstrated: 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 l The technical feasibility of completing the intangible asset so that it will be to expenditure. Where an impairment loss subsequently reverses, the carrying amount available for use; of the asset is increased to the revised estimate of the recoverable amount but capped l The intention to complete the intangible asset and use it; at the amount that would have been determined had there been no initial impairment l The ability to sell or use the intangible asset; loss. The reversal of the impairment loss is credited to expenditure to the extent of the l How the intangible asset will generate probable future economic benefits or decrease previously charged there and thereafter to the revaluation reserve. service potential; l The availability of adequate technical, financial and other resources to complete 1.12 Donated Assets the intangible asset and sell or use it; and, Donated non-current assets are capitalised at their fair value on receipt, with a l The ability to measure reliably the expenditure attributable to the intangible matching credit to Income. They are valued, depreciated and impaired as described asset during its development. 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 1.10.2 Measurement conditions attached to the donation preclude immediate recognition of the gain. 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. 1.13 Government Grants Where no internally-generated intangible asset can be recognised, the expenditure The value of assets received by means of a government grant are credited directly to is recognised in the period in which it is incurred. income. Deferred income is recognised only where conditions attached to the grant preclude immediate recognition of the gain. 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 1.14 Non-current Assets Held For Sale (modern equivalent assets basis), indexed for relevant price increases, as a proxy for Non-current assets are classified as held for sale if their carrying amount will be recovered fair value. Internally-developed software is held at historic cost to reflect the opposing principally through a sale transaction rather than through continuing use. This condition effects of increases in development costs and technological advances. is regarded as met when:

1.11 Depreciation, Amortisation & Impairments l The sale is highly probable; Freehold land, properties under construction, and assets held for sale are not l The asset is available for immediate sale in its present condition; and, depreciated. l 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.

90 91 Non-current assets held for sale are measured at the lower of their previous carrying 1.16 Cash & Cash Equivalents amount and fair value less costs to sell. Fair value is open market value including Cash is cash in hand and deposits with any financial institution repayable without penalty alternative uses. 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 The profit or loss arising on disposal of an asset is the difference between the amounts of cash with insignificant risk of change in value. 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 In the Statement of Cash Flows, cash and cash equivalents are shown net of bank revaluation reserve is transferred to the general reserve. overdrafts that are repayable on demand and that form an integral part of the clinical commissioning group’s cash management.

Property, plant and equipment that is to be scrapped or demolished does not qualify 1.17 Provisions for recognition as held for sale. Instead, it is retained as an operational asset and its Provisions are recognised when the clinical commissioning group has a present legal economic life is adjusted. The asset is de-recognised when it is scrapped or demolished. 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 1.15 Leases can be made of the amount of the obligation. The amount recognised as a provision is Leases are classified as finance leases when substantially all the risks and rewards the best estimate of the expenditure required to settle the obligation at the end of the of ownership are transferred to the lessee. All other leases are classified as reporting period, taking into account the risks and uncertainties. Where a provision is operating leases. measured using the cash flows estimated to settle the obligation, its carrying amount is 1.15.1 The Clinical Commissioning Group as Lessee the present value of those cash flows using HM Treasury’s discount rate as follows:

Property, plant and equipment held under finance leases are initially recognised, at the l Timing of cash flows (0 to 5 years inclusive): Minus 1.90% inception of the lease, at fair value or, if lower, at the present value of the minimum l Timing of cash flows (6 to 10 years inclusive): Minus 0.65% lease payments, with a matching liability for the lease obligation to the lessor. Lease l Timing of cash flows (over 10 years): Plus 2.20% payments are apportioned between finance charges and reduction of the lease l All employee early departures: 1.80% 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 When some or all of the economic benefits required to settle a provision are expected surplus/deficit. 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 Operating lease payments are recognised as an expense on a straight-line basis over the measured reliably. 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. A restructuring provision is recognised when the clinical commissioning group has developed a detailed formal plan for the restructuring and has raised a valid expectation Contingent rentals are recognised as an expense in the period in which they are incurred. in those affected that it will carry out the restructuring by starting to implement the plan or announcing its main features to those affected by it. The measurement of a Where a lease is for land and buildings, the land and building components are restructuring provision includes only the direct expenditures arising from the separated and individually assessed as to whether they are operating or finance leases. restructuring, which are those amounts that are both necessarily entailed by the restructuring and not associated with on-going activities of the entity. 1.15.2 The Clinical Commissioning Group as Lessor 1.18 Clinical Negligence Costs Amounts due from lessees under finance leases are recorded as receivables at the The NHS Litigation Authority operates a risk pooling scheme under which the amount of the clinical commissioning group’s net investment in the leases. Finance clinical commissioning group pays an annual contribution to the NHS Litigation Authority lease income is allocated to accounting periods so as to reflect a constant periodic rate which in return settles all clinical negligence claims. The contribution is charged to of return on the clinical commissioning group’s net investment outstanding in respect of expenditure. Although the NHS Litigation Authority is administratively responsible for all the leases. clinical negligence cases the legal liability remains with the clinical commissioning group. 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 1.19 Non-clinical Risk Pooling basis over the lease term. 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

92 93 commissioning group pays an annual contribution to the NHS Litigation Authority and, Financial guarantee contract liabilities are subsequently measured at the higher of: in return, receives assistance with the costs of claims arising. The annual membership l The premium received (or imputed) for entering into the guarantee less contributions, and any excesses payable in respect of particular claims are charged to cumulative amortisation; and, operating expenses as and when they become due. l The amount of the obligation under the contract, as determined in accordance with IAS 37: Provisions, Contingent Liabilities and Contingent Assets. 1.20 Contingencies

A contingent liability is a possible obligation that arises from past events and whose 1.22.2 Financial Liabilities at Fair Value Through Profit and Loss 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 1.22.3 Other Financial Liabilities a payment will be required to settle the obligation or the amount of the obligation After initial recognition, all other financial liabilities are measured at amortised cost cannot be measured sufficiently reliably. A contingent liability is disclosed unless the using the effective interest method, except for loans from Department of Health, which possibility of a payment is remote. 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 A contingent asset is a possible asset that arises from past events and whose existence of the financial liability. Interest is recognised using the effective interest method. 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. 1.23 Value Added Tax Most of the activities of the clinical commissioning group are outside the scope of VAT Where the time value of money is material, contingencies are disclosed at their present value. 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 1.21 Financial Assets capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT. 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 1.24 Third Party Assets rights have expired or the asset has been transferred. 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 Financial assets are classified into the following categories: interest in them. l Financial assets at fair value through profit and loss; l Held to maturity investments; 1.25 Losses & Special Payments l Available for sale financial assets; and, Losses and special payments are items that Parliament would not have contemplated l Loans and receivables. 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 The classification depends on the nature and purpose of the financial assets and is procedures compared with the generality of payments. They are divided into different determined at the time of initial recognition. categories, which govern the way that individual cases are handled.

1.22 Financial Liabilities 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 Financial liabilities are recognised on the statement of financial position when the through insurance cover had the clinical commissioning group not been bearing its own clinical commissioning group becomes party to the contractual provisions of the risks (with insurance premiums then being included as normal revenue expenditure). financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired. 1.26 Joint Operations Loans from the Department of Health are recognised at historical cost. Otherwise, Joint operations are activities undertaken by the clinical commissioning group in financial liabilities are initially recognised at fair value. 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 1.22.1 Financial Guarantee Contract Liabilities expenditure; gains and losses; assets and liabilities; and cash flows.

94 95 1.27 Research & Development 2. Other Operating Revenue 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.

1.28 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 2013-14, all of which are subject to consultation:

l IAS 27: Separate Financial Statements l IAS 28: Investments in Associates & Joint Ventures l IAS 32: Financial Instruments – Presentation (amendment) l IFRS 9: Financial Instruments l IFRS 10: Consolidated Financial Statements l IFRS 11: Joint Arrangements l IFRS 12: Disclosure of Interests in Other Entities l IFRS 13: Fair Value Measurement 3. Revenue

96 97 4. Employee Benefits and Staff Numbers 4.5 Pension Costs Past and present employees are covered by the provisions of the NHS Pension Scheme. 4.1 Employee Benefits 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 clinical commissioning group of participating in the Scheme is taken as equal to the contributions payable to the Scheme for the accounting period.

4.1.1 Recoveries in respect of employee benefits The Scheme is subject to a full actuarial valuation every four years (until 2004, every five years) and an accounting valuation every year. An outline of these follows: There were no recoveries in respect of employee benefits 4.5.1 Full Actuarial (Funding) Valuation

The purpose of this valuation is to assess the level of liability in respect of the benefits 4.2 Average Number of People due under the Scheme (taking into account its recent demographic experience), and to recommend the contribution rates to be paid by employers and scheme members. The last such valuation, which determined current contribution rates was undertaken as at 31 March 2004 and covered the period from 1 April 1999 to that date. The conclusion from the 2004 valuation was that the Scheme had accumulated a notional deficit of £3.3 billion against the notional assets as at 31 March 2004.

In order to defray the costs of benefits, employers pay contributions at 14% of Pensionable pay and most employees had up to April 2008 paid 6%, with manual staff paying 5%.

4.3 Staff Sickness Absence and Ill Health Retirements Following the full actuarial review by the Government Actuary undertaken as at 31 2013-14 March 2004, and after consideration of changes to the NHS Pension Scheme taking Number effect from 1 April 2008, his Valuation report recommended that employer contributions Total days lost 140 could continue at the existing rate of 14% of Pensionable pay, from 1 April 2008, Total staff years 51 following the introduction of employee contributions on a tiered scale from 5% up to Average working days lost per full time equivalent 2.7 8.5% of their Pensionable pay depending on total earnings. On advice from the scheme actuary, scheme contributions may be varied from time to time to reflect changes in the The above sickness absence data is provided over a nine month period. scheme’s liabilities. There were no people retired on the grounds of ill health in 2013/14. 4.5.2 Accounting Valuation 4.4 Exit packages agreed in the financial year A valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period by updating the results of the full actuarial valuation. There were no exit packages agreed in the financial year. Between the full actuarial valuations at a two-year midpoint, a full and detailed member The application of the Standards as revised would not have a material impact on the data-set is provided to the scheme actuary. At this point the assumptions regarding the accounts for 2013-14, were they applied in that year. composition of the scheme membership are updated to allow the scheme liability to be valued.

98 99

5. Operating Expenses The valuation of the scheme liability as at 31 March 2011 is based on detailed membership data as at 31 March 2008 (the latest midpoint) updated to 31 March 2011 with summary global member and accounting data.

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) Resource Account, published annually. These accounts can be viewed on the NHS Pensions website. Copies can also be obtained from The Stationery Office.

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:

l 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; l 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”; l 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; l 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; l 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, l 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

100 101 6. Better Payment Practice Code 9. Finance Costs

10. Operating Leases 6.1 The Late Payment of Commercial Debts (Interest) Act 1998 10.1 As Lessee

10.1.1 Payments Recognised as an Expense

7. Income Generation Activities The clinical commissioning group does not undertake any income generation activities.

8. Other Gains and Losses

10.1.2 Future Minimum Lease Payments

102 103 11. Property, Plant and Equipment The CCG had no property, plant and equipment at 31st March 2014.

12. Intangible Non-Current Assets

12.1 Intangible Assets are carried at amortised replacement cost and are not revalued. The intangible assets classified as ‘Development expenditure’ relates to North West eHealth which is a collaboration with Salford Royal NHS Foundation Trust and the University of Manchester. This asset is funded through a government grant. The CCG has no fully amortised intangible assets in use.

12.2 Cost or Valuation of Fully Amortised Assets The cost or valuation of fully depreciated assets still in use was as follows:

12.3 Economic Lives

13. Inventories The clinical commissioning group had no inventories as at 31 March 2014

104 105 14. Trade and Other Receivables 14.2 Provision for Impairment of Receivables

15. Cash and Cash Equivalents

14.1 Receivables past their due date but not impaired

106 107 16. Trade and Other Payables 17. Provisions

The ‘Other’ provisions relate to: Restructuring costs at Central Manchester University Hospitals Foundation Trust (CMUHFT) as a result of the closure of Trafford Hospital. The provision is based on a Heads of Terms agreement between CMUHFT and Greater Manchester CCGs. Agreement was reached in 12/13 that each Greater Manchester CCG would contribute to the costs as part of a Greater Manchester risk share agreement.

108 109 The costs are based on an agreed transition arising as a result of the new Health Deal 19. Financial Instruments within Trafford and the process has been signed off by the Secretary of State and was subject to wider assurances provided in advance of the SOS decision. 19.1 Financial Risk Management Financial reporting standard IFRS 7 requires disclosure of the role that financial The termination costs (redundancy and contracts) have a combined maximum limit of instruments have had during the period in creating or changing the risks a body faces in £11.0m (with a maximum of £6.5m for GM CCGs as £4.5m was previously settled by undertaking its activities. GM SHA) final actual values have to be signed off by CMUHFT and Trafford CCG as the lead responsible CCG. However, the exact value is not as yet definitive. Exact timing of Because the clinical commissioning group is financed through parliamentary funding, it the discharge of the costs is uncertain but unlikely to be wholly within the next year. 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 Under the Accounts Direction issued by NHS England on 12 February 2014, NHS typical of listed companies, to which the financial reporting standards mainly apply. England is responsible for accounting for liabilities relating to NHS Continuing The clinical commissioning group has limited powers to borrow or invest surplus funds Healthcare claims relating to periods of care before establishment of the clinical and financial assets and liabilities are generated by day-to-day operational activities commissioning group. However, the legal liability remains with the CCG. The total value rather than being held to change the risks facing the clinical commissioning group in of legacy NHS Continuing Healthcare provisions accounted for by NHS England on undertaking its activities. behalf of this CCG at 31 March 2014 is £513k. Treasury management operations are carried out by the finance department, within parameters defined formally within the clinical commissioning group’s standing financial 18. Commitments instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the clinical commissioning group’s internal auditors. 18.1 Other Financial Commitments The clinical commissioning group and consolidated group had entered into non- 19.1.2 Credit Risk cancellable contracts (which are not leases, private finance initiative contracts or other service concession arrangements) which expire as follows: Because the majority of the clinical commissioning group’s revenue comes parliamentary funding, the 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.

19.1.2 Liquidity Risk

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

19.3 Financial Assets

110 111 19.4 Financial Liabilities 21. Pooled Budgets As described in the accounting policies the CCG has pooled budget arrangements with Salford City Council. Salford City Council are the hosts. The memorandum account for the pooled budget is:

20 Operating Segments 22. Intra-government and Other Balances

20.1 Reconciliation between Operating Segments and SoCNE

20.2 Reconciliation between Operating Segments and SoFP

112 113 23. Related Party Transactions 24. Events After the End of the Reporting Period Details of related party transactions with individuals are as follows: There are no post balance sheet events which will have a material effect on the financial The wife of Hamish Stedman,chair of Salford CCG works for Salford Royal FT statements of the clinical commissioning group or consolidated group. The husband of Melanie Sirotkin works for Big Life currently funded by Salford CCG.

25. Losses and Special Payments

25.1 Losses The CCG had no Losses in 2013/14.

25.2 Special Payments

114 115 26. Financial Performance Targets Clinical commissioning groups have a number of financial duties under the NHS Act 2006 (as amended). The clinical commissioning group’s performance against those duties was as follows:

Note: For the purposes of 223H(1); expenditure is defined as the aggregate of gross expenditure on revenue and capital in the financial year; and, income is defined as the aggregate of the notified maximum revenue resource, notified capital resource and all other amounts accounted as received in the financial year (whether under provisions of the Act or from other sources, and included here on a gross basis).

116 117 Further information and contacts Salford Clinical Commissioning Group St James’s House, Pendleton Way, Salford M6 5FW.

Telephone: 0161 212 4800 Fax : 0161 212 4801 Website: www.salfordccg.nhs.uk Email: [email protected]

Copies of this information are available in other languages and formats i.e. Braille, audio cassette and large print. To request a copy, please contact: Tel: 0161 212 4955 Email: [email protected]