Annual Report and Accounts 2019/20 Contents Performance Overview Foreword
This annual report will provide you with detailed PERFORMANCE REPORT 03 information about the work of NHS West Lancashire Clinical Commissioning Group (CCG) and the NHS Performance Overview 03 in what has been a particularly challenging time for NHS services both locally and nationally. ACCOUNTABILITY REPORT 18 Whilst writing this report we have experienced one of what might matter to someone in Newburgh for example Corporate Governance Report 18 the most unprecedented threats to public health in the may be different to what matters most to someone living history of the NHS. As services join together in response to in Skelmersdale. The hopes they have, issues they face, Members Report 22 the COVID-19 global pandemic we must first commend challenges they want to overcome, right down to the shape the incredible attitude, dedication and courage shown of their day to day lives are different. We are committed to Statement of Accountable Officer’s Responsibilities 28 by all of those working on the front line in hospitals recognising the differences between and within our three and GP practices as well as staff working behind the neighbourhoods: Ormskirk and Aughton, Skelmersdale and Governance Statement 30 scenes to ensure people remain safe and stay well. Upholland, and Burscough and the Northern Parishes, and we plan to build on early conversations and dedicate focus Remuneration and Staff Report 44 Our responsiveness and preparedness to meet this challenge and time to develop plans to improve health and healthcare has seen our teams working in partnership on an even for everyone. Our Primary Care Networks (PCN) will also help Staff Report 50 greater scale than before and we have accelerated a to champion local issues and address local needs, and in time number of planned initiatives to support our response, we will develop our plans on a neighbourhood footprint. for instance, greater use of technology to assist video Parliamentary Accountability and Audit Report 56 consultations and more agile working practices for staff. Our staff go about their work with tremendous enthusiasm and diligence. It is a time of change and great challenge ANNUAL ACCOUNTS 63 This year has also seen a shift in leadership. We have said a for local health and care organisations and we are sad farewell to former Chief Officer Mike Maguire and chair grateful for the continued support from those working Dr John Caine, both of whom will be warmly remembered across the system. I would therefore like to thank our for leading the CCG from authorisation in 2013 right up until dedicated staff for all they do to improve services for 2020. I have been supported by a fantastic management team people across West Lancashire and look forward to since coming into post in January 2020, and now at the helm, continuing to work alongside you throughout 2020/21. we have a local GP and our new Chairman Dr Peter Gregory.
Throughout 2019/20 further progress has been made in the formation of the West Lancashire Partnership. This work has brought together multiple organisations who, despite different responsibilities, all serve the same community and aim to overcome the same challenges. This has led to grassroots conversations and shared strategic thinking, some of which has not happened before. It has seen the development of draft plans and a shared vision, to make West Lancashire a place where we help each other, ourselves and our communities to be the very best we can be.
Patient engagement and involvement remains a key priority Dr Amanda Doyle OBE for us and this year we have continued to listen to our Accountable Officer community. We have taken the time to understand that 23rd June 2020
3 Performance Overview
NHS West Lancashire CCG, is a clinically led organisation and is made up of 15 GP practices, who care for around 113,000 patients making this the smallest CCG in Lancashire. The majority of patients live within West Lancashire, with the remaining patients mainly living in Wigan and Chorley but being registered with West Lancashire GP practices.
West Lancashire incorporates the towns The purpose of NHS CCGs is to work with local of Ormskirk, Skelmersdale, Burscough health and care partners to design services to and surrounding communities; the most appropriately meet the needs of the local CCG’s footprint is aligned with that of population and to then use their allocated funding West Lancashire Borough Council. to buy the best services it can for the population. CCGs are structured to put local family doctors There is a diverse population in West Lancashire (GPs), as those are best placed to understand with a mix of rural, urban, affluent and deprived the needs of their patients, in the driving seat. areas, that require us to carefully target the services we commission to meet the needs of NHS West Lancashire CCG is set performance our population. Individual health outcomes targets to achieve by the Department of can be adversely affected by lifestyle choices Health and categorises these into those including smoking, alcohol and drug misuse, relating to improving health, transforming and factors such as diet and exercise. care, controlling costs and enabling change, and managing operations. Within these it has “Our vision is to enable our population to be identified 5 priority programmes, which are: in control of their own health, commissioning the best possible care when needed.” • Developing primary care;
This year we have worked hard to progress • Transforming community care; our structures in line with the NHS Long Term Plan and our three PCNs are in place with three • Redesigning mental health services; Clinical Directors in post, the three PCNs are: • Finance and strategic transformation plans, and
Ormskirk & Aughton has roughly 33,000 • Compliance, assurance and planning. residents and has been undertaking a structured medication review to ensure that their patients are NHS West Lancashire CCG faces the same getting the best medicines for their conditions. significant challenges that confront any NHS organisation – limits on NHS funding and a Skelmersdale has approximately 47,000 growing and ageing population for example residents, this PCN has been focussing on means we fully recognise and acknowledge improving outcomes for patients with a the need to change, whilst the rapid spread of respiratory disease and a social prescribing COVID-19 pandemic in the last quarter of the year service which aims to support people with produced unparalleled pressure on services, as well needs such as loneliness or financial worries. as the brilliant health and social care staff and our Burscough and the Northern Parishes local people. Health and care services continue to has a population of approximately 33,000, evolve in order to fully support our community’s there is a higher percentage of older residents needs now and in the future. In addition to within this community with large rural areas; these pressures, its geographic position on the therefore, this PCN has developed the SHERIF edges of Lancashire, Merseyside and Greater scheme: Supporting Housebound or Elderly Manchester, creates its own unique challenges. patients affected by Rurality, Isolation or Frailty.
4 5 2019/20 - what we are proud of :
Development of IHELP Every class in every (Integrated Holistic The Well Skelmersdale The CCG has invested primary school in our Empowering Learning The Ennerdale Centre, a Programme, led by further in children’s area have been sent YOGI Programme), a new specialist new mental health support We commissioned NHS West Lancashire community services health and wellbeing service to support patients centre in Skelmersdale, PULSE, a mental health CCG, has connected by funding a specialist cards to develop living with chronic pain, was launched providing cafe that supported community groups, school nurse who will relaxation techniques they provide a range of urgent practical aid to approximately 900 social entrepreneurs and support schools and for children. Teachers supportive education advice adults experiencing mental people per month. individuals which has children with complex have been provided with and therapies delivered in distress. empowered the group to medical needs in training from the YOGI the community. The aim is make a difference in their ensuring education is Group to support the use to help patients regain their own communities. accessed safely. of these exercises. independence.
The launch of the short intensive support service Introduction of the new Extended access for (SISS), allowing frail, older Empower the Invisible, We commissioned Additional investment has hearing aid service for the mental health support people and those with a peer support group Kooth, an online been made by the CCG to over 50’s who suffer with drop-in sessions, allowing long term conditions, e.g. that provides support for digital support service facilitate a pathway for age related hearing loss, anyone who needs support asthma, diabetes, chronic adults who are the victim for children and young pre-school Autistic Spectrum offering a range of NHS with their mental health obstructive pulmonary of sexual abuse. people. Disorder (ASD) diagnosis. funded hearing aid related to access the specialist disorder (COPD), at risk of services. sessions 7 days a week. being admitted to hospital to receive care at home.
A sleep clinic was The Non-Specific (Vague Bisphosphonate service for commissioned at Twinkle Symptoms) Rapid ‘FIT’ (faecal breast cancer commenced in Macmillan Information House providing sleep Additional investment Diagnostic Service was immunochemical test) was the Summer of 2019. Working and Support Centre and counselling for families of has been provided into launched during February launched with primary in partnership with the Christie Macmillan Physical Activity children and young people the community paediatric 2020. This service is care in October 2019. This hospital in Manchester and services were recommissioned 0-19 with disabilities or service supporting designed for patients who test follows NICE guidance Virgincare, patients can now in 2019. Both services provide additional needs; and a the appointment of are presenting in primary concerning the patient receive their bisphosphonate support to patients living grant was awarded to fund an Attention Deficit care with non-specific presenting with symptoms intravenous therapy at with and beyond cancer. an immersive interactive Hyperactivity Disorder symptoms and there is a of colorectal cancer. Ormskirk Hospital. It is planned room to further enhance the (ADHD) Nurse. suspicion that there is an to expand this service. offer of the sleep service. underlying malignancy.
6 7 Financial Overview and Sustainable Development Despite all the great work the CCG has undertaken, 2019/20 was a challenging year financially as We know we need to operate mindfully that the way in which partners and communities we reported an in-year deficit of £3.903m; as such a report to the Secretary of State for Health and considering the needs of future generations in work at a neighbourhood level will be more joined Social Care under Section 30 of the Local Audit and Accountability Act (2014) has been submitted. The everything we do. As commissioners, we work up and will take account of and respond to the CCG believes that it is however correct to compile its financial statements on a going concern basis. with staff and actively highlight our Sustainable needs in specific communities. The neighbourhood Development Plan. This plan highlights everything partnerships will operate in Aughton and The CCG can be viewed as continuing in business for the foreseeable future, particularly as it is from our corporate vision, our efforts to support Ormskirk, Burscough and the Northern underwritten by the Department of Health as a whole and there is no legislative change to CCGs sustainability and how this is reflected in our Parishes, and Skelmersdale and Up Holland. at present. The CCG has been awarded an allocation for each year up to and including 2023/24. work. As an organisation, our sustainable The PCNs for Ormskirk and Aughton, Significant financial pressures were encountered particularly in relation to its hospital efforts are threaded throughout everything we do. Two examples are encouraging staff Skelmersdale and Burscough and the Northern contracts (where demand for and cost of care increased) and prescribing budget. Accordingly, Parishes are functioning networks, and each the historic surplus carried forward from previous years has reduced from £3.932m to to consider their own direct environmental impact by reducing waste and recycling; and have an appointed Clinical Director. Each of the £0.029m. The CCG did deliver against other financial duties including cash resource use Clinical Directors are currently represented on and paying suppliers in a timely manner (as per the Better Payment Practice Code). our successful medicine management waste campaigns which contributed to our objectives the West Lancashire Partnership, and will be The CCGs total resource of £181 million was spent as illustrated below. of minimising waste as a community. represented on the wider relevant Neighbourhood Partnerships, as well as the Primary Care Networks. During the 2019/20 financial year, a joint committee was established between NHS West Lancashire CCG and NHS Southport and Formby CCG to oversee the development and implementation of an acute sustainability programme for Southport and Ormskirk Hospital Acute £95.6m NHS Trust. A broad work programme has been developed and considered by the Joint Committee Ambulance £3.6m at its inaugural meeting on 23rd January 2020. The meetings of the Joint Committee and the consideration of work programme options Community £17.3m for acute sustainability will resume when the Chief Medical Officer (CMO) for England Total: Individual care packages £8.8m declares that the COVID-19 pandemic is over. The West Lancashire Partnership has taken Mental Health £17.1m further steps to work in an integrated and sustainable way with communities, commissioners, 181m providers and social partners to develop and Other £7.7m enhance new ways of integrated working aimed at improving the health and well- Prescribing £16.9m being of the West Lancashire population.
A West Lancashire Plan has been developed Primary Care £14m and has the support of all of the members of the partnership. The plan focuses on the Total: £181 following workstreams: Collective Accountability; Finance; Protecting Good Physical and Mental Health; Communications and Engagement; Care Coordination and Population Health Management; Transitional Care; and Workforce.
The West Lancashire Partnership is also developing Neighbourhood Partnerships which will ensure
8 9 Improving Quality
“By working with local people and our partners in West Lancashire and making effective use of resources, we will strive for the best possible care for our local population and enable people to be in control of their own health and health care services.” Quality remains at the heart of everything During 2019/20 regular contract and quality Prior to the impact of COVID-19 there continued NHS England and CCGs have a shared we do. As described later in this report, the meetings have been held with our main provider to be significant issues with access to acute responsibility for quality assurance and CCG’s Constitution, and our Quality and Safety Southport & Ormskirk Hospital NHS Trust to inpatient beds which had an impact on 12-hour improvement of practices. The Framework for Committee is fundamental to how we discharge allow for a forum in which we can work with A&E breaches, Section 136 breaches (patient Managing General Practice Performance and our duty under Section 14R of the NHS Act the provider alongside NHS Southport and is taken to a place of safety and remains there Quality was first approved by the Primary Care 2006 (as amended). Reports summarising the Formby CCG which is the lead commissioner for over 24 hrs) and the number of out of area Commissioning Committee in January 2019 highlights, challenges, risks and progress for for this Trust. Any quality issues that remain a placements. From February 2020, when the and was reviewed throughout 2019/20. This each area of health that we commission are concern following these meetings are escalated pandemic began to escalate within the United framework provides a clear process for the considered by the committee, taking in account to NHS Improvement/NHS England via the Kingdom, mental health bed availability started escalation of quality concerns within primary care. any actions required. We link into NHS England Southport & Ormskirk Improvement Board. to increase. During 2020/21 we will work with regionally via the Lancashire and South Cumbria partners across the Lancashire and South Cumbria The CCG’s quality team works alongside other Quality Surveillance Group where quality For those other providers where we are not the Integrated Care System (ICS) to monitor the providers such as Lancashire County Council’s issues affecting the local area are discussed. lead commissioner and our patient flow is less impact of COVID-19 and promote mental health Infection Control team and supports care homes significant, any quality concerns can be raised services to ensure our population continue to in the region via the quarterly Care Home Forum. To continue our commitment to being transparent, directly with the lead commissioner. Quality receive the quality care and support they need. we include a detailed quality update which of services provided by the third sector and In March 2020, the COVID-19 pandemic was goes to our Governing Body so both our board any small providers are monitored in line with We have continued working with our provider deemed a ‘level 4’ national incident and as and wider communities can identify ongoing the requirements laid out in the contract. of community health services and urgent care such Command and Control measures where quality issues we are working to address from services, Virgincare. A clinical quality and safety implemented by NHS England to manage the information available in the public domain. group meets monthly with this provider. Any pandemic nationally. Command and Control concerns raised at these meetings are escalated to measures will be in place until the end of the Transition and Transformation Board who are 2020 and potentially into 2021. As a result, responsible for overseeing progress and delivery of in 2020/21 our focus will be to ensure robust the community services and urgent care contracts. processes and governance systems are in This board is in two parts; contracting, quality and place to optimise the quality of services being performance followed by the second part which ‘reinstated’ as we re-build and adjust to new covers transformation and delivery against the ways of working. Quality assurance will continue transformation plan and associated workstreams. to be addressed in all our service procurement The outcomes framework which was developed, processes and service specifications. considering what the local population told us was important to them, is also overseen at this forum.
10 11 Engaging people and communities
NHS West Lancashire CCG recognises that having meaningful conversations with NHS England’s statutory guidance which is Statutory guidance for CCGs and NHS England’, those who are affected by our plans and decisions allows us to build a deeper published for CCGs entitled ‘Patient and public sets out ten principles of participation, which are understanding about what our local community want from their healthcare. This participation in commissioning health and care: listed below: involves having conversations about how we will improve and shape services with patients, public, carers and many other stakeholders.
Our Duty to Involve Report is published every the work we do as commissioners and strengthen year and can be found in the “How We Involve the level of involvement from the local community. 1. Reach out to people rather 6. Take time to plan and budget You” tab of our website, alongside our reports Alongside the main presentations delivered on the than expecting them to come for participation and start for previous years and our Communication and day, CCG staff manned several market stall style Engagement Strategy. These reports highlight pop-up stands to highlight the work we are doing to you and ask them how they involving people as early as how we have involved others in the work we have in areas such as medicine management, finance, want to be involved, avoiding possible. assumptions. undergone throughout the year. Engagement and many more. 40 people were in attendance. 7. Be open, honest and with our stakeholders can be through patient participation groups for our 15 GP practices, or The CCG continues to recognise that its 2. Strive for equality, diversity and transparent in the way you via specially organised focus groups for a more involvement duties do not just relate to the public. actively promote the respect of work; tell people about the specific conversation focus. This is about working with all stakeholders. For different beliefs and opinions. evidence base for decisions, example, working alongside the North West being clear about resource Two-way communication when engaging with Ambulance Service NHS Trust (NWAS), Police, 3. Proactively seek participation our stakeholders is hugely important, therefore we Lancashire County Council, West Lancashire limitations and other relevant from people who experience constraints. Where information employ a large range of ways to engage. These Borough Council, the local community, voluntary health inequalities and poor include surveys, public listening events, intimate and faith sector, and our statutory mental health has to be kept confidential, health outcomes. focus groups, one to one phone interviews providers to provide a streamlined mental health explain why. and more. To achieve maximum input from our service offer via the Ennerdale centre. This allows 4. Value people’s lived experience 8. Invest in partnerships, have an stakeholders, these are heavily promoted through for more joined up care and better patient and use all the strengths and social media advertisements, news releases, experience. Similarly, this year the CCG has ongoing dialogue and avoid electronic newsletters and posters. worked within the Lancashire and South Cumbria talents that people bring to tokenism; provide information, ICS to launch the new ‘Make Every Contact the table, working towards This year, 2019/20 has seen us build further on the support, training and the right Count’ (MECC) campaign to encourage changes shared goals and aiming for kind of leadership so everyone foundations we have laid out in previous years. in behaviour that have a positive effect on people’s constructive and productive Similarly, to last year 2018/19, our Annual General health and wellbeing. can work, learn and improve Meeting (AGM) this year was set out to showcase conversations. together. 5. Provide clear and easy to 9. Review experience (positive understand information and and negative) and learn from it seek to facilitate involvement by to continuously improve how all, recognising that everyone people are involved. has different needs. This includes working with advocacy 10. Recognise, record and celebrate services and other partners people’s contributions and where necessary. give feedback on the results of involvement; show people how they are valued.
12 13 What does the future hold? Reducing health inequality
We believe we are meeting these above principles, but we also recognise that we The CCG aims to empower people to be in control of their own health and health should continually question our processes and look to improve our provision care services by working with local people and partners to make effective use of resources and deliver the best possible care for our local population. In 2020/21 we plan to make sure we improve to carry out even more neighbourhood-based the way we evidence how the views of others involvement during 2020/21, which will help us NHS England defines health inequalities as the Our equality and inclusion strategy sets out the have been used and the impact they have made. continue to understand what our communities “unfair and avoidable difference in health across CCG’s objectives on reducing health inequalities We also seek to strengthen the planning we do think about health and wellbeing in general, the population, and between different groups in West Lancashire. The strategy is based on the internally as an organisation, so we are engaging local services and what new initiatives could within society. Health inequalities arise because of requirements of the NHS Equality Delivery System with people as early as possible and taking them complement existing provision. the conditions in which we are born, grow, live, (EDS), which provides a robust framework against through the co-design process with us step by work and age. These conditions influence our which the CCG’s performance is assessed and step. As part of our role within the Healthier Lancashire opportunities for good health, and how we think, graded against a range of nationally determined and South Cumbria ICS, Healthwatch will also feel and act, and this shapes our mental health, indicators which are: We have been working in our neighbourhood be carrying out some additional community physical health and wellbeing.” model through 2019/20, focusing on more engagement. in-depth involvement activity within our three There is clear evidence that reducing health 1. Better health outcomes neighbourhoods: Ormskirk and Aughton, We therefore certify that during the year 2019/20 inequalities improves life expectancy and reduces Skelmersdale and Burscough and the Northern NHS West Lancashire CCG has met our duty disability across the social gradient. Our duty under 2. Improved patient access and under The NHS Act 2006 (as amended in 2012) to Parishes; allowing us to build a better Section 14T of the National Health Service Act experience understanding about what matters most to the involve the public in our commissioning. 2006 (as amended) to have regard to the need to residents of these individual areas. We would like reduce inequalities is central to everything we are 3. A representative and supported working towards as a CCG. It is underpinned by workforce our corporate priorities, particularly where we are driving forward the development, transformation 4. Inclusive leadership and redesign of services within primary care and the community to make them more accessible and personalised for our communities and the Overall, the CCG is rated as ‘achieving’ in all four neighbourhoods we serve. indicators, the outcomes for goals 1 and 2 are:
Goal 1 - Better health outcomes Goal 2 - Improved patient access and experience
1.1 Services are commissioned, procured, designed 2.1 People, carers and communities can readily access and delivered to meet the health needs of local hospital, community health or primary care services communities (achieving) and should not be denied access on unreasonable grounds (achieving)
1.2 Individual people’s health needs are assessed 2.2 People are informed and supported to be as and met in appropriate and effective ways involved as they wish to be in decisions about their (developing) care (achieving)
1.3 Transitions from one service to another, for 2.3 People report positive experiences of the NHS people on care pathways, are made smoothly (developing +) with everyone well-informed (developing)
1.4 When people use NHS services their safety is 2.4 People’s complaints about services are handled prioritised and they are free from mistakes, respectfully and efficiently (achieving) mistreatment and abuse (achieving +)
1.5 Screening, vaccination and other health promotion services reach and benefit all local communities (achieving)
14 15 Health and wellbeing
Due to the significant efforts to manage the impact of the COVID-19 pandemic, the Health and Wellbeing Board has not met to agree progress against the Health and Wellbeing Strategy. However, it is important to acknowledge the continued work that has taken place and that we have continued to participate in the Health and Wellbeing Board in Lancashire and our Chair, Dr John Caine, was our representative throughout 2019/20.
The CCG is committed towards the actions that The ICS has identified county-wide workstreams will lead to achieving improvement in health and which reflect the above Health and Wellbeing wellbeing in the short, medium and longer term strategy priorities, with Senior Responsible that include the following priorities for action; Officers identified for each. We have also create conditions for wellbeing and health; identified local West Lancashire priorities for enable sustainable behaviour and lifestyle action, in collaboration with Lancashire County changes; joined up services to provide right care Council which flow from the above Health and at the right time and right place; develop the Wellbeing strategy priorities. environment for innovation and continuous improvement.
The CCG’s direction of travel is aligned with the emerging landscape of the Healthier Lancashire and South Cumbria ICS that will hold collective responsibility for the prevention agenda, self-care strategies for patients, demand management and reducing unwarranted variation. Locally we are working together with partners to define the extent and shape of our integrated system as mentioned in the performance overview, identifying work programmes that can commence in the short to medium term such as the review of our estates and how streamlining the delivery of services can be achieved.
16 17 Accountability Report
Corporate Governance Report
Signature Members Report Dr John Caine, Composition of Governing Body Committee(s), including Audit Committee CCG Chair, CCGs are working on behalf of a membership The Governing Body ensures that the CCG Committees continue to support the role of the which includes all GP practices within the Dr Amanda Doyle, has appropriate arrangements in place so it governing body as follows: Dr Amanda Doyle OBE boundaries of West Lancashire. To enable GPs to Accountable Officer can exercise its functions effectively, efficiently Accountable Officer retain oversight when the CCG was first set up in (from 1st January 2020), and economically, with good governance and • the Audit Committee is responsible for 23rd June 2020 2013, a membership council was established, with in accordance with the terms of the CCG providing assurance to the Governing Body Mike Maguire, each GP practice nominating one of their GPs to constitution as agreed by its members. The that there is a sound system of integrated Chief Accountable Officer sit on it. A governing body also exists to manage Governing Body leads on the setting of vision and governance, risk management and internal (until 31st December 2019), the CCG’s affairs. strategy, approves commissioning plans, monitors control across the CCG’s activities including financial compliance and regulation, Claire Heneghan, performance against plan, and provides assurance Clinical leadership is fundamental to everything Chief Nurse, on strategic risks. the CCG does and this is reflected in the way it • the Remuneration Committee determines arrangements for pay and conditions for CCG is set up and run. On the 1st January 2020, Dr Paul Kingan, The Governing Body has 10 members. These employees, Amanda Doyle OBE, became our Chief Clinical Chief Finance Officer and include three local GPs (one is the CCG Chair), Officer and Accountable Officer. As Amanda is Deputy Accountable Officer, a hospital consultant, a Chief Nurse, three lay • the Quality and Safety Committee strives also the Chief Clinical Officer for Blackpool and members, a Chief Finance Officer, and a Chief to ensure that services commissioned by the Jackie Moran, Fylde and Wyre CCGs and the Healthier Lancashire Clinical Officer (a practising GP by professional CCG meet quality standards in terms of being Director of Integration and Transformation (her and South Cumbria ICS, her appointment with background) who is also our Accountable Officer. and are safe, clinically effective, and providing a role changed from 1 January 2020, she was NHS West Lancashire CCG is as the Interim Shared A full list of Governing Body members is in this good patient experience, Accountable Officer. For the remainder of this previously Director of Strategy and Operations) report (page 22). report Amanda will be referenced in her role as • the Clinical Executive Committee ensures The CCG’s Membership Council represents all our Accountable Officer. Below are the Senior Up until 30 June 2019 there were six local GPs on that items going to the governing body have the member practices of the group and reflects Officers within the CCG for 2019/20. Membership the Governing Body. Three of these GP members: had thorough clinical input, their opinion. It is responsible for the major and attendance at meetings can be found on Dr Vikul Mittal, Dr Peter Gregory and Dr Rakesh decisions affecting the Group e.g. approving the page 20-25. Jaidka were seconded to become interim Clinical • the Primary Care Commissioning constitution, nominating the CCG’s accountable Directors for the three PCNs to provide strong Committee commissions appropriate quality officer for appointment, and holding the clinical leadership at the neighbourhood level; GP services, governing body to account. they therefore, did not attend Governing Body meetings from July 2019. The Membership • the Finance and QIPP Committee oversee Council agreed to update the Governing Body the achievement of schemes designed to improve efficiency, Member profiles quoracy policy to reflect the secondments; this enabled the CCG to continue with business as A list of the GP membership council members and usual in line with the constitution. attendance is set out on page 20.
Member Practices
All GP practices within the boundaries of West Lancashire are members of the CCG. All practices can be viewed by following the link below: www.westlancashireccg.nhs.uk/about-us/gp- practices
18 19 MEMBERSHIP AND ATTENDANCE OF MEETINGS
Membership Council Membership and Attendance – Membership Council Membership and Attendance – April 2019 – March 2020 April 2019 – March 2020
Member Surgery Attendance Member Surgery Attendance
Dr A Roberts 1/12 Dr D Chang 2/12
Dr S Sur Aughton Surgery 2/12 Dr S Barnes 7/12 Dr D Harris 8/12 Dr L Roby Hall Green Surgery 4/12 Dr S Saxena 2/12 Ashurst Primary Care Dr M Rutherford 3/12 Dr I Saxena 10/12
Dr A Bisarya 4/12 Dr Gechowska 1/12 Dr A Bisarya Dr D Bisarya 7/12 Dr A Statham 9/12 Lathom House Surgery Dr B Biswas 6/12 Dr S Taylor 0/12 Dr R Bonsor 4/12 Dr H Sharma 0/12 Dr A Kazich 0/12 Dr A Sharma Manor Primary Care 8/12 Dr G Henry 0/12 Beacon Primary Care Dr R Lewis 0/12 Dr C Milton 1/12
Dr K Pollard 0/12 Dr H Bishop-Cornett 1/12
Dr A Oyeyele 0/12 Dr A Bishop-Cornet 3/12 Dr R Parish 1/12 Dr S Frampton Ormskirk Medical Practice 0/12 Dr B Biswas 5/12 Dr L Dean 0/12 Dr W Parkar Burscough Family Practice 1/12 Dr S Taylor 1/12 Dr S Panniker 0/12 Dr A Krishnamurthy 7/12 Dr D Mullen 5/12 Dr S Sur The Elms 1/12 Dr S Gullick 6/12 Dr Duddukuri 0/12 Dr J Kinsey 6/12 Dr D Bisarya 9/12 Parbold Surgery Dr R Mason 6/12 Dr S Dontula 9/12 Dr C Dongre 0/12 Dr A Hicks 0/12
Dr R Jaidka Excel Primary Care 7/12 Dr H Elias 0/12 Dr S Panniker 0/12 Dr H Saunders 5/12
Dr M Munashe 0/12 Dr P Gregory 8/12 De S Kaur 0/12 Dr J Hooson Parkgate Surgery 3/12 Dr S Roper 6/12
Dr H Billington 5/12
20 21 MEMBERSHIP AND ATTENDANCE OF MEETINGS
Membership Council Membership and Attendance – Governing Body Part II Attendance – April 2019 – March 2020 April 2019 – March 2020
Member Surgery Attendance Member Attendance
Dr R Tilley 6/12 Dr John Caine, Chair 9/9
Dr C Simpson 0/12 Dr Dheraj Bisarya, GP Executive Lead 6/9 Stanley Court Surgery Dr I Yuzgina 0/12 Dr John (Jack) Kinsey, GP Executive Lead 8/9
Dr J Graham 0/12 Dr Vikul Mittal, GP Executive Lead (seconded to clinical director role in July 0/1 2019) Dr T S Poon 6/12 Dr Rakesh Jaidka, GP Executive Lead (seconded to clinical director role in 0/1 Dr F Pilkington 7/12 July 2019)
Dr A Sears 7/12 Dr Peter Gregory, GP Executive Lead (seconded to clinical director role in 0/1 Tarleton Practice July 2019) Dr L Southern 3/12 Doug Soper, Lay Member 8/9 Dr V Mittal 9/12 Greg Mitten, Lay Member 5/9 Dr A Roberts 1/12 Steve Gross, Lay Member 9/9
Dr Adam Robinson, Secondary Care Doctor 7/9 Governing Body Membership and Attendance – Dr Amanda Doyle, Clinical Accountable Officer (commenced 1 January 2020) 1/2 April 2019 – March 2020 Mike Maguire, Chief Accountable Officer (until 1 January 2020) 7/7
Paul Kingan, Chief Finance Officer 7/9 Member Attendance Claire Heneghan, Chief Nurse 6/9 Dr John Caine, Chair 6/6
Dr Dheraj Bisarya, GP Executive Lead 3/6 Dr John (Jack) Kinsey, GP Executive Lead 5/6 Audit Committee Membership and Attendance – Dr Vikul Mittal, GP Executive Lead 0/1 April 2019 – March 2020 (seconded to clinical director role in July 2019)
Dr Rakesh Jaidka, GP Executive Lead 0/1 (seconded to clinical director role in July 2019) Member Attendance
Dr Peter Gregory, GP Executive Lead 1/1 Doug Soper, Lay Member (Chair) 5/5 (seconded to clinical director role in July 2019) Greg Mitten, Lay Member 3/5 Doug Soper, Lay Member 5/6 Dr John (Jack) Kinsey, GP Executive Lead 3/5 Greg Mitten, Lay Member 4/6 Dr Rakesh Jaidka, GP Executive Lead 1/2 Steve Gross, Lay Member 6/6 (seconded to clinical director role in July 2019)
Dr Adam Robinson, Secondary Care Doctor 5/6 Dr Adam Robinson, Secondary Care Doctor 2/5
Mike Maguire, Chief Accountable Officer (until 31st December 2019) 4/4 Claire Heneghan, Chief Nurse 2/5 Dr Amanda Doyle, Clinical Accountable Officer (commenced 1 January 2020) 1/2
Paul Kingan, Chief Finance Officer 5/6
Claire Heneghan, Chief Nurse 4/6
22 23 MEMBERSHIP AND ATTENDANCE OF MEETINGS
Clinical Executive Committee Membership and Attendance – Quality and Safety Committee Membership and Attendance – April 2019 – March 2020 April 2019 – March 2020
Member Attendance Member Attendance
Dr John Caine, Chair 15/21 Greg Mitten, Lay Member (Chair) 2/4
Dr Dheraj Bisarya, GP Executive Lead 19/21 Steve Gross, Lay Member (Cover for Chair) 2/2
Dr John (Jack) Kinsey, GP Executive Lead 16/21 Dr Jack Kinsey, Clinical lead for clinical engagement 2/4
Dr Vikul Mittal, GP Executive Lead 4/5 Dr Rakesh Jaidka, GP Executive Lead 0/1 (seconded to clinical director of the primary care network in July 2019) (seconded to clinical director role in July 2019)
Dr Rakesh Jaidka, GP Executive Lead 4/5 Claire Heneghan, Chief Nurse 3/4 (seconded to clinical director of the primary care network in July 2019) Jackie Moran, Director of Integration and Transformation 0/4 Dr Peter Gregory, GP Executive Lead 5/6 (seconded to clinical director of the primary care network in July 2019) Jo DeBacker, Practice Manager 4/4
Jo DeBacker, Practice Manager 16/21 Peter Gregory, GP Executive Lead 0/1 (seconded to clinical director role in July 2019) Dr Amanda Doyle, Clinical Accountable Officer (from 1 January 2020) 3/7
Mike Maguire, Chief Accountable Officer (until 1 January 2020) 12/15 Primary Care Commissioning Committee Membership and Paul Kingan, Chief Finance Officer 16/21 Attendance – April 2019 – March 2020
Member Attendance Remuneration Committee Membership and Attendance – April 2019 – March 2020 Steve Gross, Lay Member (Chair) 4/4 Doug Soper, Lay Member 3/4
Member Attendance Claire Heneghan, Chief Nurse 3/4 Paul Kingan, Chief Finance Officer 3/4 Doug Soper, Lay Member (Chair) 2/2 Mike Maguire, Chief Accountable Officer (until 1 January 2020) 2/2 Greg Mitten, Lay Member 2/2 Dr Adam Robinson, Secondary Care Doctor 0/4 Steve Gross, Lay Member 2/2
Dr Adam Robinson, Secondary Care Doctor 2/2
Claire Heneghan, Chief Nurse 1/2 Primary Care Commissioning Committee Part II - Membership and Attendance – April 2019 – March 2020
Member Attendance
Steve Gross, Lay Member (Chair) 8/8
Doug Soper, Lay Member 6/8
Claire Heneghan, Chief Nurse 5/8
Paul Kingan, Chief Finance Officer 7/8
Mike Maguire, Chief Accountable Officer (until 1 January 2020) 3/6
Dr Adam Robinson, Secondary Care Doctor 1/8
24 25 Register of Interests Statement of Disclosure to Auditors
Statutory guidance on managing conflicts of Each individual who is a member of the CCG Interest is available for CCGs at: www.england. at the time the Members’ Report is approved nhs.uk/publication/managing-conflicts-of-interest- confirms: revised-statutory-guidance-for-ccgs-2017/ • so far as the member is aware, there is no To ensure that our business is conducted in an relevant audit information of which the CCG’s open and fair way, all governing body members auditor is unaware that would be relevant for declare any conflicts of interest they may have. the purposes of their audit report Our conflict of interest policy was approved in September 2017 and can be found at • the member has taken all the steps that they ought to have taken in order to make www.westlancashireccg.nhs.uk/wp-content/ him or herself aware of any relevant audit uploads/Conflict-of-Interest-Policy-FINAL-Sep- information and to establish that the CCG’s 2017-review-date-March-2021.pdf auditor is aware of it.
The CCG’s Register of Interests as at 31st January 2020 can be viewed through the following link: www.westlancashireccg.nhs.uk/wp-content/ Modern Slavery Act uploads/Register-of-interests-Governing- Body-members-and-committee-members-31- West Lancashire CCG fully supports the January-2020-1.pdf Government’s objectives to eradicate modern slavery and human trafficking but does not meet the requirements for producing an annual Slavery and Human Trafficking Statement as set out in the Personal data related incidents Modern Slavery Act 2015. No Information Commissioner reportable data security breaches have occurred during this financial year.
26 27 Statement of Accountable Officer’s Responsibilities
The National Health Service Act 2006 (as amended) states that each Clinical As the Accountable Officer, I have taken all the I also confirm that: Commissioning Group shall have an Accountable Officer and that Officer shall be steps that I ought to have taken to make myself appointed by the NHS Commissioning Board (NHS England). aware of any relevant audit information and to • as far as I am aware, there is no relevant audit establish that West Lancashire CCG’s auditors are information of which the CCG’s auditors are ). NHS England appointed Dr Amanda Doyle to be Under the National Health Service Act 2006 aware of that information. So far as I am aware, unaware, and that as Accountable Officer, I the Interim Shared Accountable Officer of West (as amended), NHS England has directed each there is no relevant audit information of which the have taken all the steps that I ought to have Lancashire CCG as of the 1st January 2020; Mike Clinical Commissioning Group to prepare for each auditors are unaware. taken to make myself aware of any relevant Maguire had been the Chief Accountable Officer financial year a statement of accounts in the form audit information and to establish that the since the CCG was first established in April 2013. and on the basis set out in the Accounts Direction. CCG’s auditors are aware of that information. The accounts are prepared on an accruals basis The responsibilities of an Accountable Officer and must give a true and fair view of the state of are set out under the National Health Service Act affairs of the Clinical Commissioning Group and of 2006 (as amended), Managing Public Money and its income and expenditure, Statement of Financial in the Clinical Commissioning Group Accountable Position and cash flows for the financial year. Officer Appointment Letter. They include responsibilities for: In preparing the accounts, the Accountable Officer is required to comply with the requirements of the • The propriety and regularity of the public Government Financial Reporting Manual and in finances for which the Accountable Officer is particular to: answerable, • Observe the Accounts Direction issued by NHS • For keeping proper accounting records England, including the relevant accounting (which disclose with reasonable accuracy at and disclosure requirements, and apply any time the financial position of the Clinical suitable accounting policies on a consistent Commissioning Group and enable them to basis; ensure that the accounts comply with the requirements of the Accounts Direction), • Make judgements and estimates on a reasonable basis; • For safeguarding the Clinical Commissioning Group’s assets (and hence for taking • State whether applicable accounting reasonable steps for the prevention and standards as set out in the Government detection of fraud, bribery and corruption and Financial Reporting Manual have been other irregularities). followed, and disclose and explain any material departures in the accounts; and, • The relevant responsibilities of accounting officers under Managing Public Money, • Prepare the accounts on a going concern basis; and • Ensuring the CCG exercises its functions effectively, efficiently and economically (in • Confirm that the Annual Report and accordance with Section 14Q of the National Accounts as a whole is fair, balanced Health Service Act 2006 (as amended)) and understandable and take personal and with a view to securing continuous responsibility for the Annual Report and improvement in the quality of services (in Accounts and the judgements required for accordance with Section14R of the National determining that it is fair, balanced and Health Service Act 2006 (as amended)), understandable.
• Ensuring that the CCG complies with its financial duties under Sections 223H to 223J of the National Health Service Act 2006 (as amended).
28 29 Governance Statement
Introduction and context Governance arrangements and effectiveness UK Corporate Governance Code Discharge of Statutory Functions
NHS West Lancashire CCG is a body corporate The main function of the governing body is to NHS Bodies are not required to comply with the In light of recommendations of the 1983 Harris established by NHS England on [1 April 2013] ensure that the group has made appropriate UK Code of Corporate Governance. Review, the clinical commissioning group has under the National Health Service Act 2006 (as arrangements for ensuring that it exercises its reviewed all of the statutory duties and powers amended). functions effectively, efficiently and economically Our corporate governance arrangements have conferred on it by the National Health Service Act and complies with such generally accepted been reported on by drawing upon best practice 2006 (as amended) and other associated legislative The clinical commissioning group’s statutory principles of good governance as are relevant to it. available, including those aspects of the UK and regulations. As a result, I can confirm that functions are set out under the National Health Corporate Governance Code considered to be the clinical commissioning group is clear about the Service Act 2006 (as amended). The CCG’s general This has been achieved by operating within the relevant to the CCG and best practice. legislative requirements associated with each of function is arranging the provision of services for CCG constitution as signed by all GP practices the statutory functions for which it is responsible, persons for the purposes of the health service in West Lancashire. The constitution, which was including any restrictions on delegation of those in England. The CCG is, in particular, required updated in September 2018 and is due for review functions. to arrange for the provision of certain health in September 2020, outlines the principles of services to such extent as it considers necessary good governance which must always be adhered Responsibility for each duty and power has been to meet the reasonable requirements of its local to in the way the CCG conducts its business. clearly allocated to a lead Director. Directorates population. These include observing the highest standards of have confirmed that their structures provide the propriety, impartiality, integrity and objectivity in necessary capability and capacity to undertake all As at 1 April 2019, the clinical commissioning relation to the stewardship of public funds, the the clinical commissioning group’s statutory duties. group is not subject to any directions from NHS management of the organisation and the conduct England issued under Section 14Z21 of the of its business. National Health Service Act 2006. The CCG remains accountable for all of its functions, including those that it has delegated, Scope of responsibility and all business is conducted in the name of the group. The constitution (available at: https://www. As Accountable Officer, I have responsibility westlancashireccg.nhs.uk/resources/corporate- for maintaining a sound system of internal documents/ ) set outs a scheme of reservation and control that supports the achievement of the delegation which details the powers designated clinical commissioning group’s policies, aims and to its Membership Council, Governing Body objectives, whilst safeguarding the public funds and those decisions that are the responsibility of and assets for which I am personally responsible, individual members and employees. in accordance with the responsibilities assigned to The responsibilities of the Membership Council me in Managing Public Money. I also acknowledge and Governing Body are summarised on pages my responsibilities as set out under the National 18 and 19 within the members report which Health Service Act 2006 (as amended) and in also includes information on membership and my Clinical Commissioning Group Accountable attendance. It is my view that the Membership Officer Appointment Letter. Council and Governing Body have operated I am responsible for ensuring that the clinical effectively throughout this reporting year as commissioning group is administered prudently evidenced throughout this report. and economically and that resources are applied A number of services (such as Finance & efficiently and effectively, safeguarding financial Accounting and Primary Care Support) are propriety and regularity. I also have responsibility provided to the CCG by service organisations. for reviewing the effectiveness of the system of The ISAE 3402 Service Auditor Type II reports internal control within the clinical commissioning raised some minor issues (including restricted group as set out in this governance statement. audit access to the service provider’s sites as a result of Covid-19) but these are not considered to be significant.
30 31 Risk management arrangements and effectiveness
The CCG acknowledges that good awareness and understanding of risks associated The governing body reviews the framework and Each risk has an action plan and delivery is with managing healthcare commissioning is critical to the successful delivery of gains assurance from the appropriate risk owner monitored through the governance processes improved outcomes and experience of the population of West Lancashire. that risks are being appropriately managed already outlined. A full comprehensive record throughout the organisation. The framework of the principal risks identified in 2019/20, and The Governing Body has ultimate responsibility The CCG has an approved integrated assurance and risk register are also reviewed by the clinical how these have been mitigated and reviewed, is for risk management, as identified in the risk framework which sets out the CCG’s appetite for executive committee and the audit committee on regularly discussed at the governing body in the management strategy, which was ratified in risk, attitude towards risk and the culture that will a regular basis. Risk management is embedded in public session. September 2017. It was agreed in April 2019 it underpin its successful management and delivery. the activity of the organisation through the above was still applicable, this strategy can be found at: The framework ensures that a systematic and measures and also through assessments of specific Risk management is led through the consistent approach to managing risk is adopted risks – for example, information governance via implementation of the CCG’s integrated assurance www.westlancashireccg.nhs.uk/resources/policies- through the organisation. The framework details a the information governance steering group and framework, which highlights organisational and and-procedures/ model for implementing risk management, which equality impact assessment which is part of the individual responsibilities for the management of risk. There are other supporting policies such as The aims and objectives of our risk management is to identify, quantify, manage and mitigate each CCG’s commissioning toolkit. the information governance policy, safeguarding strategy are: presented risk, thus making it a routine process for all staff. To facilitate this all risks are recorded on a The CCG has an automated risk module, which frameworks and policies, the serious untoward • An integrated approach is taken to manage register which is saved on the network so all staff includes an electronic form to identify and assess incident (SUI) policy and procedure and the health all risks (clinical, financial, and organisational), can see all organisational risks. new risks. Once the form has been completed and safety policy. ensuring that all are identified, assessed and and approved via the automated module the risk managed appropriately. Incident reporting is encouraged in the CCG is added to the risk register and monitored on a and the constitution positively encourages monthly basis. • Commitment to ensuring the principles of risk whistleblowing as a means of gaining awareness management are embedded throughout our of potential fraud, bribery and corruption. The organisation and formulate a key element of CCG has linked policies for whistleblowing, bribery our systems and processes. and corruption with alignment to safeguarding policies. The quantification of risk along with • Maintain a risk management framework, appropriate descriptors to assist in determining the which includes providing assurance to the consequence and likelihood of the impact of the Governing Body that strategic and operational risk are detailed in the assurance framework. risks are being managed effectively as well as ensuring we are meeting all our statutory The principle risks associated with the critical obligations. outcomes are cross referenced to the risk register. The purpose is to ensure that linked operational • Our system ensures that risk becomes risks are identified and that all risks within the ‘everyone’s business’. Our approach to governing body assurance framework are risk must therefore be easily understood considered in this way. Some of these operational by our staff, those contracted to us and risks will be at a corporate level, while others our members, to enable our population to may not be, as they are being managed by understand that commissioning decisions teams and mitigated accordingly. These risks are have been based upon a detailed and sensible graded using a five by five matrix (see section understanding of the risks involved. We on Risk Assessment) and managed locally but in encourage an open culture, in which everyone the case of risk graded as ‘high’ (score of 12 or is encouraged to identify risks and report above) there is an obvious potential impact on the incidents. assurance framework and they are reported to the • We also use risk management as a tool to clinical executive committee on a monthly basis support achievement of – and continuous and to each governing body meeting. improvement against – all externally and The assurance framework provides the CCG with internally set performance measures. a comprehensive method for the effective and focused management of the significant risks that impact on the delivery of the CCG’s annual and strategic objectives.
32 33 Capacity to Handle Risk Risk Assessment
The Governing Body has overall responsibility for risk management and approves Risks are assessed by scoring them according to a matrix which scores the impact if the assurance framework at the start of the year and receives bi-monthly reports on they happened (score of between 1 and 5) and the likelihood that they will happen progress. (score of between 1 and 5). The likelihood and impact scores are then multiplied to give an overall risk score of between 1 (1 multiplied by 1) and 25 (5 multiplied by 5). The Clinical Executive Committee ensures that The Primary Care Commissioning Committee there is continuous engagement with the CCG manage risks related to the commissioning of Scores of 12 or more are reported to Governing Safeguards (DOLS) framework will be replaced membership, and that membership views are primary care services, and Finance and QIPP Body. This is to enable the Governing Body to by Liberty Protection Safeguards (LPS); this is a reflected in the work of the CCG; reviews all manages risks related to achievement of financial focus on the higher risks, and for the lower risks complex issue which could result in some patients planning documents and recommends them to targets on behalf of the governing body. to be managed by responsible officers under being unlawfully deprived of their liberty. At the the governing body after checking that they are delegated authority. time of writing the Government’s code of practice patient focused, effective, economic and efficient. The Accountable Officer is responsible for is anticipated in Spring 2020; meanwhile the CCG It also oversees the delivery of these plans and ensuring robust systems are in place regarding At the time of the March 2020 Governing Body, are aware of the new pending responsibilities ensures compliance with governance requirements corporate governance within the CCG, including the CCG was reporting 22 risks, of which 9 were which will include significant staff training and the and legal duties. risk management activities. The Chief Finance assessed as extreme. The increase in number of CCG are contributing to the Local Safeguarding Officer has delegated responsibility from the extreme risks reflects the unparalleled system Adult Board Mental Capacity Act sub group. The audit committee is responsible for providing Accountable Officer for progressing organisational pressures being experienced nationally within the assurance to the governing body that there is risk management and governance activity. NHS prior to the impact of COVID-19. In the case of the HM Prison and Probation a sound system of integrated governance, risk Guidance following MM judgement, the risk management and internal control across the All CCG employees and representatives are The extreme risks were: COVID-19, a failure relates to the impact on CCG finances. We are CCG’s activities. responsible for identifying, assessing and to achieve in year financial balance, the CCG engaging with the Lancashire and South Cumbria managing risks of all types in their work area, being effectively resourced to meet statutory (LSC) task and finish group relating to this issue, Quality and safety committee provides assurance following any codes of conduct issued by their requirements from October 2020 for the delivery raising awareness with key staff on the implication that commissioned services are clinically safe, professional bodies, etc. Appraisal processes of Liberty Protection Safeguards, HM Prison and of the new guidance and a review of the approval effective and provide good patient experience. ensure that all staff have the training and other Probation Guidance following MM judgement, processes for funding is being undertaken to resources required to equip them for their roles acute mental health system under significant ensure due regard of the guidance. Remuneration committee monitors, reviews and with regards to risk management. pressure, fragility of acute provider and failing to reduces risks relating to conflicts of interest and meet required levels of quality, performance and In respect of the acute trust frailty, the CCG financial remuneration. delivery, contracts for Continuing Health Care continues to meet with the trust to improve (CHC) patients receiving domiciliary packages and quality and contractual performance and is also the Prescription Ordering Direct (POD) Service. engaging with the health economy wide group and the Sefton transformation board to consider In the case of COVID-19, the CCG set up an clinical and financial sustainability. incident team, engaged in national webinars and conference calls, and supported provider For Continuing Health Care (CHC) patients and organisations with managing practical responses the acute mental health system being under e.g. supply of Personal Protective Equipment (PPE) significant pressure, these issues are being and access to COVID-19 testing. addressed at Lancashire level. A task group has been established to scope total numbers of CHC A failure to achieve in year financial balance patients placed out of area and strengthen quality remains a significant risk despite a financial assurance and monitoring processes and an action recovery plan being in place. The CCG continues plan is being implemented to improve the strain to work closely with neighbouring commissioners, on mental health services. providers, third sector and council colleagues to ensure that the challenges faced are approached An extensive action plan continues to be in a collaborative way and solutions are found implemented in relation to the POD Service. A to enable the best possible care for patients in significant amount of work has been undertaken a difficult financial environment. We have also in relation to governance arrangements, staff implemented intense financial scrutiny and training, access to specialists and improved line monitoring internally by the finance and QIPP management; this is reflected in the reduction of committee. the risk score from 25 to 15. The service remains under continuous review to ensure improvements In October 2020, the current Deprivation of Liberty continue to be made.
34 35 Other sources of assurance
Internal Control Framework Annual audit of conflicts of Information Governance Business Critical Models interest management A system of internal control is the set of The NHS Information Governance Framework These are largely provided by Midlands and processes and procedures in place in the clinical The revised statutory guidance on managing sets the processes and procedures by which the Lancashire Commissioning Support Unit (MLCSU). commissioning group to ensure it delivers its conflicts of interest for CCGs (published June NHS handles information about patients and They are subject to regular external review, the policies, aims and objectives. It is designed to 2017) requires CCGs to undertake an annual employees, in particular personal identifiable outputs of which are submitted to their client identify and prioritise the risks, to evaluate the internal audit of conflicts of interest management. information. The NHS Information Governance CCGs through service auditor reports. likelihood of those risks being realised and the To support CCGs to undertake this task, Framework is supported by an information impact should they be realised, and to manage NHS England has published a template audit governance toolkit and the annual submission Within the CCG, business critical models are them efficiently, effectively and economically. framework. process provides assurances to the clinical mostly spreadsheet-based. These have all been commissioning group, other organisations and to identified and form part of the CCG’s information The system of internal control allows risk to The CCG has improved on last year, individuals that personal information is dealt with asset register, each with a suitably qualified be managed to a reasonable level rather than demonstrating that arrangements are in place legally, securely, efficiently and effectively. information asset owner. eliminating all risk; it can therefore only provide to satisfy NHS England requirements with regard reasonable and not absolute assurance of to Conflicts of Interest. Full compliance was Due to the current situation regarding COVID-19 effectiveness. documented for all the areas within the scope of NHS Digital have postponed the Data Security Third party assurances the audit in relation to system design. In relation to and Protection (DSP) Toolkit submission deadline The section entitled ‘governance arrangements operating effectiveness of the policy, for 1 of the to 30th September 2020, the 2019/20 toolkit Where the CCG relies on third party providers, and effectiveness’ describe how the internal 5 areas however (decision making processes and can be submitted any time before this date. This such as the MLCSU (delivers various management control arrangements operate. contract monitoring) the review identified partial additional flexibility will help free up some time functions on a large scale to provide greater There is a clear process for reporting, compliance. to enable staff to deal with the current COVID-19 economy and resilience) and Mersey Internal Audit pandemic. The CCG has chosen to postpone the Agency (provides internal audit services, again to management, investigation and learning from More detail is provided on the area of partial submission of the DSP Toolkit due to the fact that provide greater efficiency, specialist expertise and incidents. There is a senior information risk owner compliance in the Head of Internal Audit Opinion focus is required for the operational and strategic improved organisational resilience) contracts are to support the arrangements for managing and section of this Annual Report. controlling risks relating to information/data planning of the current crisis. Authorisation agreed with the relevant organisations together security, with information asset owners being for submission of the 2019/20 DSP Toolkit will with monitoring arrangements to ensure contract nominated and trained across functions. Our CCG be obtained at a later date to ensure that all compliance. Furthermore, the CCG receives Chair, who is a practising GP, has been nominated Data Quality mandatory evidence items are available, accurate independent reports produced by external auditors as Caldicott Guardian to ensure that patient and have been fully met. providing assurance in relation to the functions The Membership Council and Governing Body confidentiality is protected. provided by third party organisations. receive data relating to the performance of the We place high importance on ensuring there There is a scheme of delegation, standing CCG. This includes activity and financial data. are robust information governance systems and financial instructions and standing orders. The The quality of data received from providers we processes in place to help protect patient and Control Issues CCG receives assurance in relation to the internal commission services from is routinely validated to corporate information. We have established an control framework of Midlands and Lancashire ensure accuracy. If any anomalies or unexpected information governance management framework There are no significant control issues facing the Commissioning Support Unit (CSU) via update trends occur, they are investigated. The integrated and are developing/ have developed information CCG. reports presented to the audit committee. The business report is a regular item on the Governing governance processes and procedures in line with chief finance officer meets regularly with CSU Body agenda and can be found on the website. the information governance toolkit. We have representatives to discuss controls and the CCG ensured all staff undertake annual information also gains assurance through service auditor governance training and have implemented a staff reports, shared with CSU customers and their information governance handbook to ensure staff audit committees. are aware of their information governance roles and responsibilities.
There are processes in place for incident reporting and investigation of serious incidents. We are developing information risk assessment and management procedures and a programme will be established to fully embed an information risk culture throughout the organisation against identified risks.
36 37 Review of economy, efficiency & Delegation of functions effectiveness of the use of resources
The audit committee oversees these elements on behalf of the Governing Body, The Governing Body approved a scheme of delegation, identifying which functions raises any key issues and reports its minutes to the governing body in meetings held it would retain, and which would be delegated to its committees and senior officers. in public. Committees reporting to the governing body Auditors have regular progress meetings with The Accountable Officer is responsible for As public bodies, CCGs are expected to keep their operate under terms of reference approved the chief finance officer and have access to other ensuring that the CCG operates economically, running (management) costs as low as possible, by the Governing Body, which reflect their officers as required. Where functions are delegated efficiently and effectively on a day-to-day basis. consistent with delivering their functions to a high delegated roles. Committees submit their minutes to external organisations, such as MLCSU (for She is supported in this role by a senior team standard. This is to ensure that as much resource to Governing Body meetings. A management various management functions provided on and a management structure. Key functions are as possible is available to support services to structure, various communication mechanisms, a large scale to provide greater economy and performed by the chief nurse (providing assurance patients, carers and the wider public. and a system of regular line manager supervision resilience to client CCGs) and the Mersey Internal from a clinical perspective) and the Chief Finance meetings ensure that delegated functions are Audit Agency (providing internal audit services to Officer (ensuring overall economy, efficiency and Consistent with the national policy direction to followed up. a wide range of organisations again to achieve effectiveness). move to system oversight, throughout 2019/20 greater economy, concentration of specialist discussions have taken place at a system level, Internal audit provide independent assurance to expertise, and greater resilience) contracts are Internal audit services provide independent review rather than solely with individual CCGs. The inform management and the audit committee agreed with the relevant organisations together of CCG functions, according to an annual plan NHS Oversight Framework for 2019/20 has should there be failures in this regard. External with monitoring arrangements to ensure contract which reflects relative risk. Internal audit links with replaced the CCG Improvement and Assessment auditors provide an opinion on value for money compliance. the chief finance officer on a day-to-day basis Framework (IAF). The framework is intended as a secured from the CCG’s commissioning activities and reports to the audit committee as a standing focal point for joint work, support and dialogue and also give an opinion on the true and fair For externally delegated functions, the CCG item on each agenda. Internal audit have access between NHS England, NHS Improvement, CCGs, view presented to readers of the CCG’s annual also receives service auditor reports from the to whatever officers and documents (electronic or providers and sustainability and transformation accounts. This gives assurance to the CCG to assist external auditors of those organisations. These hard copy) they need to do their job. partnerships and integrated care systems. the audit committee in adopting the CCG’s annual are independent reports to inform clients of the accounts under delegated authority from the organisations concerned. The CCG reports to NHS England, which monitors governing body. its performance, again providing assurance as to its economy, efficiency and effectiveness.
A financial budget is prepared annually and approved by the Governing Body. This highlights how the CCG will spend the sums allocated to it by the Department of Health, and also demonstrates how it will comply with Department of Health business rules. Monthly integrated business reports are produced, comparing performance to date with expected performance at that point in the year, for both financial and other performance targets (being a combination of national requirements and locally determined targets). In the case of financial performance, a forecast to the financial year end is also included.
38 39 Counter fraud, bribery and corruption arrangements
The local counter-fraud specialist (LCFS) reports to the audit committee. Their reports update the committee on proactive (preventing, deterring, creating and maintaining a culture of honesty) and reactive work (responding to whistleblowing, conducting investigations, pursuing available sanction and recovering amounts due) that is being undertaken.
The audit committee approves the annual plan for The audit committee ensures that appropriate counter-fraud activities to ensure that a significant action is taken with regard to LCFS proportion of time is devoted to proactive work. recommendations and NHS Counter Fraud Authority quality assurance recommendations. The LCFS is employed by Mersey Internal Audit The NHS Counter Fraud Authority (NHSCFA) is Agency, with which the CCG holds a contract for a national organisation charged with making counter-fraud services. sure that a high level of professionalism exists The LCFS is visible within the organisation and in counter-fraud work and with undertaking meets regularly with the chief finance officer, investigations when they are needed across a who is accountable for tackling fraud, bribery and larger area. corruption, for support and direction.
40 41 Head of Internal Audit Opinion Review of the effectiveness of governance, risk management and internal control Following completion of the planned audit work for the financial year for the clinical commissioning group, the Head of My review of the effectiveness of the system of internal Internal Audit issued an independent and objective opinion on control is informed by the work of the internal auditors, the adequacy and effectiveness of the clinical commissioning executive managers and clinical leads within the clinical group’s system of risk management, governance and internal commissioning group who have responsibility for the control. The Head of Internal Audit concluded that: development and maintenance of the internal control framework.
The overall opinion for the period 1st April 2019 to 31st March 2020 provides Substantial Assurance I have drawn on performance information Conclusion that that there is a good system of internal control designed to meet the organisation’s objectives, and available to me. My review is also informed by that controls are generally being applied consistently. comments made by the external auditors in their No significant internal control issues have been annual audit letter and other reports. A summary of the reviews performed in the year is provided below: identified. Our assurance framework provides me with evidence that the effectiveness of controls that Recommendations Raised manage risks to the clinical commissioning Review Assurance Opinion group achieving its principles objectives have been reviewed. Critical High Medium Low Total I have been advised on the implications of the 1 Assurance Framework Meets Requirements Not Applicable result of this review by: 2 Complaints Management Moderate 0 0 9 1 10 • The board 3 Conflicts of Interest Full/Partial Compliance 0 0 0 2 2 DRAFT Primary medical and • The audit committee commisioning and contract- 4 High 0 0 0 0 0 • If relevant, the risk / clinical governance / ing - Contract Oversight and quality committee Management Functions Briefing note - Data security • Internal audit 5 Not Applicable Not Applicable and protection toolkit • Other explicit review/assurance mechanisms. Total 9 3 12
All audits have been completed in line with the internal audit plan with the exception of the Risk Management Deep Dive Review that has been paused due to COVID-19 pressures on CCG management and staff. Additionally, as requested by the CCG, a Data Security and Protection Toolkit Briefing Note has been provided with final reporting to be in accordance with the extended submission deadline of 30 September 2020.
42 43 Remuneration and Staff Report
NHS West Lancashire CCG - Remuneration Report 2019-20
Remuneration Committee Policy on the remuneration of senior managers The Committee was established by NHS West Lancashire CCG to approve the remuneration The policy on senior managers’ contracts is that and terms of service for the Chief Officer, they are permanent except where an explicit other staff on very senior manager (VSM) pay fixed-term role is identified. The standard terms and conditions, and GP Governing Body notice period is between three and six months, members. although the notice period of the Chief Officer is twelve months. A standard contract used for all In the first year of operation the Committee set CCG staff so there are no end dates. baseline salaries in accordance with national and local guidance, and the performance elements No bonus payments were awarded by the required of Bands 8c and above under Agenda Remuneration Committee during 2019-20. for Change.
Pay for board members and other senior staff is mainly in accordance with nationally determined Remuneration of very senior managers pay rates. Where pay is determined locally this is agreed by the Committee. No senior managers received remuneration in excess of £150,000 per annum (pro rata). For The Committee met twice in 2019-20. the purposes of this note GP Governing Body members have not been classed as very senior managers.
It was the responsibility of the Committee in its discussions to:
• include all aspects of salary (including any performance related element, bonuses and any other allowances), provisions for other benefits including pensions and car allowance, and arrangements for termination of employment and other contractual issues in decision making
• approve any non-contractual payments at any level that may be regarded as novel and/or contentious and which required Treasury approval.
44 45 Senior manager remuneration (including salary and pension entitlements)
Salaries and allowances - SUBJECT TO AUDIT Single total figure table
2019-20 2018-19 Name Title Salary Expense Performance Long-term All Pension Total Name Title Salary Expense Performance Long-term All Pension Total Payments Pay and Performance Related Payments Pay and Performance Related (Taxable) Bonuses Pay and Benefits (Taxable) Bonuses Pay and Benefits Bonuses Bonuses (Bands of (Rounded to (Bands of (Bands of (Bands of (Bands of (Bands of (Rounded to (Bands of (Bands of (Bands of (Bands of £5,000) nearest £5,000) £5,000) £2,500) £5,000) £5,000) nearest £5,000) £5,000) £2,500) £5,000) £100) £100) £000 £00 £000 £000 £000 £000 £000 £00 £000 £000 £000 £000 Mike Maguire Chief Officer 120-125 56 57.5-60 185-190 Mike Maguire Chief Officer 115-120 37 27.5-30 145-150
Amanda Doyle* Chief Clinical Officer 5-10 0 0 5-10 Paul Kingan Chief Finance Officer 100-105 59 40-42.5 150-155
Paul Kingan Chief Finance Officer 100-105 62 12.5-15 120-125 Claire Heneghan Chief Nurse 95-100 53 65-67.5 165-170
Claire Heneghan Chief Nurse 75-80 89 0 85-90 Dr John Caine Chair 105-110 22.5-25 130-135
Dr John Caine Chair 105-110 0 5-7.5 115-120 Dr John (Jack) Kinsey GP Executive Lead 35-40 17.5-20 50-55
Dr Peter Gregory GP Executive Lead 35-40 10-12.5 45-50 Dr John (Jack) Kinsey GP Executive Lead 35-40 0 92.5-95 130-135
Greg Mitten Lay Member 5-10 0 5-10 Dr Peter Gregory** GP Executive Lead 35-40 0 35-37.5 70-75
Douglas Soper Lay Member 10-15 3 0 10-15 Greg Mitten Lay Member 5-10 0 0 5-10 Dr Adam Robinson Secondary Care 10-15 0 10-15 Douglas Soper Lay Member 10-15 0 0 10-15 Consultant Dr Rakesh Jaidka GP Executive Lead 35-40 0 35-40 Dr Adam Robinson Secondary Care 15-20 0 0 15-20 Consultant Dr Vikul Mittal GP Executive Lead 35-40 22.5-25 55-60 Dr Rakesh Jaidka*** GP Executive Lead 35-40 0 15-17.5 50-55 Steve Gross Lay Member 5-10 0 5-10 Dr Vikul Mittal**** GP Executive Lead 35-40 0 12.5-15 45-50 Dr Dheraj Bisarya GP Executive Lead 25-30 157.5-160 185-190 Steve Gross Lay Member 5-10 0 0 5-10
Dr Dheraj Bisarya GP Executive Lead 35-40 0 17.5-20 50-55
Notes 3. Adam Robinson is an employee of Salford Royal NHS Foundation Trust. The value in the Salary and Fees column 1. 2018-19 figures are disclosed to enable comparison with the current year. represents the charges made by those organisations in respect of his time spent working for West Lancashire CCG. 2. From 1 January 2020 Dr Amanda Doyle OBE became the Accountable Officer for West Lancashire CCG alongside Dr 4. The taxable benefits listed above relate to lease cars and reimbursement of travel expenses. Doyle’s existing joint appointment as Accountable Officer for both Fylde Coast CCGs. The recharges from Blackpool CCG to Fylde and Wyre CCG and West Lancashire CCG are based on the population split between the three CCGs. *Dr Amanda Doyle joined the WLCCG governing body on 1 January 2020 Dr Doyle’s total salary (excluding taxable benefits) is £220-225K which is split as follows for 2019/20: ** Dr Peter Gregory left the WL CCG Governing Body on 30/06/2019 £55-60K in relation to Blackpool CCG in respect of Accountable Officer duties; *** Dr Rakesh Jaidka left the WL CCG Governing Body on 30/06/2019 £100-105K charged to the Integrated Care System (ICS, representing 30% now 45.6% of total salary) for work as the ****Dr Vik Mittal left the WL CCG Governing Body on 30/06/2019 ICS Lead; £55-60K charged to Fylde and Wyre CCG in respect of Accountable Officer duties; and £5-10K charged to West Lancashire CCG in respect of Accountable Officer duties (all figures shown in bands of £5K).
46 47 Pension benefits as at 31st March 2020 - SUBJECT TO AUDIT
Name Title Real Real Total Lump sum Cash Real Cash Employer’s Cash equivalent transfer values (CETV) Compensation on early retirement or increase in increase accrued at equivalent increase in equivalent contribution pension at in pension pension at pension transfer cash transfer to for loss of office - SUBJECT TO AUDIT Pension lump sum pension age related value equivalent value stakeholder A cash equivalent transfer value (CETV) Age at Pension age to accrued at 1 April transfer at 31 March pension is the actuarially assessed capital value of The CCG has made one payment for loss Age at 31 pension 2019 value 2020 March at 31 the pension scheme benefits accrued by a of office for the Chief Officer during the 2020 March member at a particular point in time. year. The total amount paid was £160,000 2020 (see note 4.4 of the CCG accounts) The benefits valued are the members’ accrued (Bands of (Bands of (Bands of (Bands of (nearest (nearest benefits and any contingent spouse’s pension £2,500) £2,500) £5,000) £5,000) £1,000) £1,000) payable from the scheme. A CETV is a payment £000 £000 £000 £000 £000 £000 £000 £000 made by a pension scheme or arrangement Pay multiples - SUBJECT TO AUDIT to secure pension benefits in another pension Reporting bodies are required to disclose the Mike Maguire Chief Officer 2.5-5 2.5-5 55-60 160-165 1171 92 1291 0 schemes or arrangement when the member leaves a scheme and chooses to transfer the relationship between the remuneration of Paul Kingan Chief Finance 0-2.5 0 35-40 75-80 565 27 605 0 the highest-paid director / member in their Officer benefit accrued in their former scheme. The organisation and the median remuneration Claire Heneghan Chief Nurse 0 0 30-35 95-100 801 0 0 0 pensions figures shown relate to the benefits that the individual has accrued as a consequence of the organisation’s workforce. Dr John Caine Chair 0-2.5 2.5-5 20-25 60-65 460 38 509 0 of their total membership of the pension Dr John (Jack) GP Executive Lead 2.5-5 10-12.5 15-20 40-45 211 76 292 0 The banded remuneration of the highest paid Kinsey scheme, not just their service in a senior capacity to which disclosure applies. No CETV will be director / member in NHS West Lancashire CCG in Dr Peter GP Executive Lead 0-2.5 0-2.5 15-20 35-40 220 26 251 0 the financial year 2019-20 was £182,500 (2018- Gregory* shown for members over 60 (1995 Section). 19, £182,500). This was 4.17 times (2018-19 Dr Rakesh Jaid- GP Executive Lead 0-2.5 0-2.5 20-25 50-55 294 19 320 0 4.76) the median remuneration of the workforce, ka** which was £43,772 (2018-19, £38,344). Dr Vikul Mittal GP Executive Lead 0-2.5 0-2.5 15-20 40-45 311 20 338 0 *** Real increase in CETV In 2019-20, 0 (2018-19, 0) employees received Dr Dheraj Bisarya GP Executive Lead 0-2.5 0-2.5 10-15 25-30 134 14 154 0 This reflects the increase in CETV effectively remuneration in excess of the highest-paid director funded by the employer. It takes account / member. Remuneration ranged from £7,882 of the increase in accrued pensions due to to £182,500 (2018-19 £7,882-£182,500). inflation, contributions paid by the employee Notes (including the value of any benefits transferred Total remuneration includes salary, non- 1. Figures in brackets represent negative values. from another scheme or arrangment). consolidated performance-related pay, benefits- 2. As non-executive directors do not receive pensionable remuneration, there are no entries in in-kind, but not severance payments. It does respect of pensions for non-executive directors. The method used to calculate CETVs changed, not include employer pension contributions and 3. The Pension Benefits and Benefits in Kind for Dr Amanda Doyle whose salary costs are to remove the adjustment for the Guaranteed the cash equivalent transfer value of pensions. currently being recharged from Blackpool CCG have not been apportioned and are showing in Minimum Pension (GMP) on 8 August 2019. full in Blackpool CCG’s Annual Report only A number of factors contribute to the increase in the median salary. These include annual pay awards, staff receiving incremental increases Periods of service Payments to past members in line with Agenda for Change Terms & * Dr Peter Gregory left the WL CCG Governing Body on 30/06/2019 Conditions and reflect additional responsibilities ** Dr Rakesh Jaidka left the WL CCG Governing Body on 30/06/2019 The CCG has not made any payments to undertaken by certain members of staff. As a ***Dr Vik Mittal left the WL CCG Governing Body on 30/06/2019 past members during the year 2019-20. consequence the pay multiple has decreased.
48 49 Staff Report
The CCG’s performance regarding this is regulated by NHS England. We are a small CCG, so we Staff Composition buy in support services from the MLCSU. We also receive support from public health colleagues from Lancashire County Council. The staff composition excludes the lay members.
The member make up of the Governing Body was 2 females and 11 males until June 2019. From Female Male July 2019 the membership consisted of 2 females and 8 males. One of the members is on the Directors 2 7 very senior manager pay scale. Senior managers 5 1 Other employees of the CCG 35 6 Number of senior managers The average number of staff employed during 2019/20 is 51. We have six Senior Managers (excluding Governing body) at band 8c and above, of which one is male and five are female. The bandings are listed below: The 9 directors in the table above include:
Table of senior managers by band The CCG Chair, John Caine, and 5 other local family doctors as referred to in the Corporate Governance section of this report, 3 of which have been Band Number seconded into the Clinical Director posts for the three PCNs. 8c 5 The Chief Nurse, Claire Heneghan 9 1 The Chief Clinical Officer and Accountable Officer, Dr Amanda Doyle The Chief Finance Officer, Paul Kingan Total 6
Staff numbers and costs - SUBJECT TO AUDIT
We have a support team of 41 staff (excluding the Chief Officer, Chief Finance Officer and senior Sickness absence data managers). Of these 41 staff, 35 are female and 6 are male. An analysis of staff numbers (full time equivalent) and costs can be found in the financial statements note 3.1 and 3.2.
2019-20
Total Days Lost 446 Total Staff Years 51 Average working days lost 9
The CCG manages staff sickness in line with the agreed Staff Sickness Policy.
The CCG has not agreed any early retirements due to ill health grounds as at 31 March 2020 or the prior year ending 31 March 2019.
50 51 Staff policies Expenditure on consultancy
Total expenditure on consultancy for 2019/20 was £395k (2018/19 £307k) • Absence management An example of an ongoing stage 2 EIRA is Other corporate in relation to the work being undertaken documents which • Adoption Off payroll engagements for the Health and Wellbeing Hubs. • Annual leave have been updated this year are: • Career break Disabled employees are protected under the The CCG is required to report on certain off-payroll arrangements. protected characteristics of the Equality Act • Disciplinary • Major Incident Table 1: Off-payroll engagements longer than 6 months 2010. Our Equality and Diversity Policy and our Plan and Policy For all off-payroll engagements as of 31 March 2020 for more than £245 per day and that last • Domestic abuse and the workplace Equality and Inclusion (E&I) Strategy confirms longer than six months: • Equality and Diversity that NHS West Lancashire CCG will ensure that • Compliments • Flexible working the requirements and reasonable adjustments Complaints and Number necessary for employees with disabilities are Concerns • Freedom to Speak Up considered during their employment. The policy Number of existing engagements as of 31 March 2020 3 • Serious Untoward • Grievance also confirms the CCG’s commitment to ensuring Incident Of which, the number that have existed: • Harassment and bullying at work that people with disabilities are not discriminated for less than one year at the time of reporting 0 • Human Rights against on the grounds of their disability at • Information any stage of the recruitment process or in their • Induction Governance for between one and two years at the time of reporting 0 employment, including opportunities for training Handbook • Job evaluation and promotion. All employees involved in selection for between 2 and 3 years at the time of reporting 1 • Managing work performance for recruitment and/or training have access to for between 3 and 4 years at the time of reporting 0 • Maternity appropriate courses developed to meet specific training needs in relation to equality and diversity. for 4 or more years at the time of reporting 2 • Major Incident Plan and Policy • Ongoing review objectives We endeavour to follow the Accessible All existing off-payroll engagements as at 31st March 2020 have been subject to a risk-based • Organisational change Information Standard (which is included in our E&I Strategy) to ensure that people who assessment as to whether assurance is required that the individual is paying the right amount of • Other special leave have a disability, impairment or sensory loss tax and, where necessary, that assurance has been sought. • Parental leave are provided with information in a format that For all new off-payroll engagements between 1st April 2019 and 31st March 2020, for more they can easily read or understand, and with • Paternity leave than £245 per day and that lasted longer than six months: • Professional registration support so they can communicate effectively with health and social care services. Table 2: New off-payroll engagements • Recruiting ex-offenders Where the reformed public sector rules apply, entities must complete Table 2 for all new off- Furthermore, NHS West Lancashire CCG is wholly • Recruitments and selection payroll engagements, or those that reached six months in duration, between 1 April 2019 and 31 supportive of partnership working and as such • Retirement March 2020, for more than £245 per day and that last for longer than 6 months: is an active participant in the Staff Partnership • Shared parental leave Forum facilitated by MLCSU. The CCG utilises this Number of new engagements, or those that reached six months in 0 • Substance misuse forum as a vehicle and mechanism to support duration, between 1 April 2018 and 31 March 2019 • Training and development proactive staff engagement, consultation and, where appropriate, negotiation. The CCG does Of which: • Secondment not employ anyone who undertakes relevant Number assessed as caught by IR35 0 • Temporary promotion union official duties as outlined in the Trade Union (Facility Time Publication Requirements) Number assessed as not caught by IR35 0 The Stage One Equality Impact and Risk Regulations 2017 and therefore no time is Of which: Assessment (EIRA) was carried out on all the released from this employer in relation to official revised and new policies and commissioning duties. The CCG liaises and works with CSU TU Number engaged directly (via OSC contracted to department) and are on 0 decisions to identify any potential impact on representatives and area/regional representatives the departmental payroll the nine protected characteristics (as defined from those recognised unions whose time will Number of engagements reassessed for consistency/assurance purposes 0 in the Equality Act 2010) and ascertain if be recorded with their employing authority. during the year an in-depth Stage Two EIRA is required. Number of engagements that saw a change to IR35 status following the 0 consistency review
52 53 Table 3: Off-payroll engagements / senior official engagements Analysis of Other Departures For any off-payroll engagements of Board members and / or senior officials with significant financial responsibility, between 01 April 2019 and 31 March 2020
Number Agreements Total Value of agreements Number of off-payroll engagements of board members, and/or senior officers with significant 0 financial responsibility, during the financial year (1) Number £000s
Total no. of individuals on payroll and off-payroll that have been deemed “board members, and/ 13 Voluntary redundancies including early retirement contractual costs - - or, senior officials with significant financial responsibility”, during the financial year. This figure should include both on payroll and off-payroll engagements. (2) Mutually agreed resignations (MARS) contractual costs - -
Note Early retirements in the efficiency of the service contractual costs - - (1) There should only be a very small number of off-payroll engagements of board members and/or senior officials with Contractual payments in lieu of notice* significant financial responsibility, permitted only in exceptional circumstances and for no more than six months - - Exit payments following Employment Tribunals or court orders - - (2) As both on payroll and off-payroll engagements are included in the total figure, no entries here should be blank or zero. Non-contractual payments requiring HMT approval** - - In any cases where individuals are included within the first row of this table the department should set out: As a single exit package can be made up of several components each of which will be counted separately in this Note, the • Details of the exceptional circumstances that led to each of these arrangements. total number above will not necessarily match the total numbers in Note 3.3 which will be the number of individuals. • Details of the length of time each of these exceptional engagements lasted. *any non-contractual payments in lieu of notice are disclosed under “non-contractual payments requiring HMT approval” Exit packages, including special (non-contractual) payments - SUBJECT TO AUDIT below.
**includes any non-contractual severance payment made following judicial mediation, and X (list amounts) relating to Exit Package cost band Number of Cost of Number Cost of other Total Total cost Number of Cost of special non-contractual payments in lieu of notice. X (number) non-contractual payments (£x,000) were made to individuals (inc. any special payment compulsory compulsory of other departures number of exit departures payment element) redundancies redundancies departures agreed of exit packages where element where the payment value was more than 12 months’ of their annual salary. agreed packages special included in exit payments packages The Remuneration Report includes disclosure of exit payments payable to individuals named in that Report. have been made
WHOLE £ WHOLE £ WHOLE £ WHOLE £ NUMBERS NUMBERS NUMBERS NUMBERS ONLY ONLY ONLY ONLY Parliamentary Accountability and Audit Report Less than £10,000 ------NHS West Lancashire CCG is not required to produce a Parliamentary Accountability and Audit Report. Disclosures on £10,001 to £25,000 ------remote contingent liabilities, losses and special payments, gifts, and fees and charges are included as notes in the Financial £25,001 to £50,000 ------Statements of this report at pages 69-76. An audit certificate and report is also included in this Annual Report at pages £50,001 to £100,000 ------56-61. £100,001 to £150,000 ------£150,001 to £200,000 1 160,000 0 0 1 160,000 0 0 Over £200,000 ------Totals Agrees to A 1 160,000 below
Redundancy and other departure costs have been paid in accordance with the provisions of the NHS Pension Scheme. Exit costs in this note are the full costs of departures agreed in the year. Where the CCG has agreed early retirements, the additional costs are met by the CCG and not by the NHS Pensions Scheme. Ill-health retirement costs are met by the NHS Pensions Scheme and are not included in the table. This disclosure reports the number and value of exit packages agreed in the year. Note: the expense associated with these departures may have been recognised in part or in full in a previous period.
54 55 of uncertainty, with the full range of possible However, as we cannot predict all future events Independent auditor’s report to the members of outcomes and their impacts unknown. We or conditions and as subsequent events may the Governing Body of NHS West Lancashire CCG applied a standardised firm-wide approach in result in outcomes that are inconsistent with response to these uncertainties when assessing judgements that were reasonable at the time the CCG’s future operational arrangements. they were made, the absence of reference to However, no audit should be expected to a material uncertainty in this auditor’s report is Report on the Audit of the Financial Statements predict the unknowable factors or all possible not a guarantee that the CCG will continue in future implications for an entity associated with operation. these particular events. Opinion Basis for opinion Other information We have audited the financial statements of We conducted our audit in accordance with Conclusions relating to going concern NHS West Lancashire Clinical Commissioning International Standards on Auditing (UK) (ISAs The Accountable Officer is responsible for Group (the ‘CCG’) for the year ended 31 (UK)) and applicable law. Our responsibilities We have nothing to report in respect of the the other information. The other information March 2020, which comprise the Statement of under those standards are further described following matters in relation to which the ISAs comprises the information included in the Comprehensive Net Expenditure, the Statement in the ‘Auditor’s responsibilities for the audit (UK) require us to report to you where: Annual Report, other than the financial of Financial Position, the Statement of Changes of the financial statements’ section of our statements and our auditor’s report thereon. in Taxpayers’ Equity, the Statement of Cash report. We are independent of the CCG in • the Accountable Officer’s use of the Our opinion on the financial statements does Flows and notes to the financial statements, accordance with the ethical requirements going concern basis of accounting in the not cover the other information and, except including a summary of significant accounting that are relevant to our audit of the financial preparation of the financial statements is not to the extent otherwise explicitly stated in policies. The financial reporting framework statements in the UK, including the FRC’s appropriate; or our report, we do not express any form of that has been applied in their preparation Ethical Standard, and we have fulfilled our • the Accountable Officer has not disclosed assurance conclusion thereon. is applicable law and International Financial other ethical responsibilities in accordance with in the financial statements any identified In connection with our audit of the financial Reporting Standards (IFRSs) as adopted by these requirements. We believe that the audit material uncertainties that may cast the European Union, and as interpreted and evidence we have obtained is sufficient and statements, our responsibility is to read the significant doubt about the CCG’s ability to other information and, in doing so, consider adapted by the Department of Health and appropriate to provide a basis for our opinion. continue to adopt the going Social Care Group Accounting Manual 2019 to whether the other information is materially 2020. concern basis of accounting for a period of at inconsistent with the financial statements or our knowledge obtained in the audit or The impact of macro-economic uncertainties least twelve months from the date when the In our opinion the financial statements: otherwise appears to be materially misstated. on our audit financial statements are authorised for issue. If we identify such material inconsistencies • give a true and fair view of the financial In our evaluation of the Accountable Officer’s or apparent material misstatements, we Our audit of the financial statements requires position of the CCG as at 31 March 2020 conclusions, and in accordance with the are required to determine whether there us to obtain an understanding of all relevant and of its expenditure and income for the expectation set out within the Department is a material misstatement in the financial uncertainties, including those arising as a year then ended; and of Health and Social Care Group Accounting statements or a material misstatement of consequence of the effects of macro-economic Manual 2019 to 2020 that the CCG’s the other information. If, based on the work • have been properly prepared in accordance uncertainties such as Covid-19 and Brexit. All financial statements shall be prepared on we have performed, we conclude that there with International Financial Reporting audits assess and challenge the reasonableness a going concern basis, we considered the is a material misstatement of the other Standards (IFRSs) as adopted by the European of estimates made by the Accountable risks associated with the CCG’s operating information, we are required to report that Union, as interpreted and adapted by the Officer and the related disclosures and the activities, including effects arising from macro- fact. Department of Health and Social Care Group appropriateness of the going concern basis economic uncertainties such as Covid-19 and Accounting Manual 2019 to 2020; and of preparation of the financial statements. All Brexit. We analysed how those risks might We have nothing to report in this regard. of these depend on assessments of the future affect the CCG’s financial resources or ability • have been prepared in accordance with the economic environment and the CCG’s future to continue operations over the period of at requirements of the Health and Social Care operational arrangements. Act 2012. least twelve months from the date when the Covid-19 and Brexit are amongst the most financial statements are authorised for issue. In significant economic events currently faced accordance with the above, we have nothing by the UK, and at the date of this report their to report in these respects. effects are subject to unprecedented levels
56 57 Other information we are required to Qualified opinion on regularity required by about to take, or has begun to take a course The Audit Committee is Those Charged with report on by exception under the Code the Code of Audit Practice of action which, if followed to its conclusion, Governance. Those Charged with Governance of Audit Practice would be unlawful and likely to cause a loss are responsible for overseeing the CCG’s In our opinion, except for the effects of the or deficiency; or financial reporting process. Under the Code of Audit Practice published matter described in the basis for qualified by the National Audit Office in April 2015 on opinion on regularity section of our report, • we make a written recommendation to the behalf of the Comptroller and Auditor General in all material respects the expenditure and CCG under Section 24 of the Local Audit and Auditor’s responsibilities for the audit of the (the Code of Audit Practice) we are required to income recorded in the financial statements Accountability Act 2014 in the course of, or financial statements consider whether the Governance Statement have been applied to the purposes intended by at the conclusion of the audit. does not comply with the guidance issued by Parliament and the financial transactions in the We have nothing to report in respect of the Our objectives are to obtain reasonable the NHS Commissioning Board or is misleading financial statements conform to the authorities above matters except on 5 June 2020 we assurance about whether the financial or inconsistent with the information of which which govern them. referred a matter to the Secretary of State statements as a whole are free from material we are aware from our audit. We are not under section 30 of the Local Audit and misstatement, whether due to fraud or error, required to consider whether the Governance Accountability Act 2014 in relation to NHS and to issue an auditor’s report that includes Statement addresses all risks and controls or Basis for qualified opinion on regularity West Lancashire CCG’s breaching its breakeven our opinion. Reasonable assurance is a high that risks are satisfactorily addressed by internal duty and overspending its revenue resource level of assurance, but is not a guarantee that controls. The CCG reported expenditure of £185.5 limit for the year ending 31 March 2020. an audit conducted in accordance with ISAs million against income of £181.6 million and a We have nothing to report in this regard. (UK) will always detect a material misstatement deficit of £3.9 million in its financial statements when it exists. Misstatements can arise from for the year ending 31 March 2020. The CCG fraud or error and are considered material if, Responsibilities of the Accountable Officer thereby breached two of its duties under the individually or in the aggregate, they could and Those Charged with Governance for the Opinion on other matters required by the National Health Service Act 2006, as amended reasonably be expected to influence the financial statements Code of Audit Practice by paragraphs 223H and 223I of Section economic decisions of users taken on the basis 27 of the Health and Social Care Act 2012, As explained more fully in the Statement of of these financial statements. In our opinion: to ensure that annual expenditure does not Accountable Officer’s responsibilities, the A further description of our responsibilities for • the parts of the Remuneration and Staff exceed income and revenue resource use does Accountable Officer is responsible for the the audit of the financial statements is located Report to be audited have been properly not exceed the amount specified by direction preparation of the financial statements in the on the Financial Reporting Council’s website at: prepared in accordance with IFRSs as adopted of the NHS Commissioning Board, otherwise form and on the basis set out in the Accounts www.frc.org.uk/auditorsresponsibilities. This by the European Union, as interpreted and known as NHS England. Directions, for being satisfied that they give description forms part of our auditor’s report. adapted by the Department of Health and a true and fair view, and for such internal Social Care Group Accounting Manual 2019 control as the Accountable Officer determines We are also responsible for giving an opinion to 2020 and the requirements of the Health Matters on which we are required to report is necessary to enable the preparation of on the regularity of expenditure and income in and Social Care Act 2012; and by exception financial statements that are free from material the financial statements in accordance with the misstatement, whether due to fraud or error. Code of Audit Practice. • based on the work undertaken in the course Under the Code of Audit Practice, we are of the audit of the financial statements required to report to you if: In preparing the financial statements, the and our knowledge of the CCG gained Accountable Officer is responsible for assessing through our work in relation to the CCG’s • we issue a report in the public interest the CCG’s ability to continue as a going arrangements for securing economy, under Section 24 of the Local Audit and concern, disclosing, as applicable, matters efficiency and effectiveness in its use of Accountability Act 2014 in the course of, or related to going concern and using the going resources, the other information published at the conclusion of the audit; or concern basis of accounting unless they have together with the financial statements in • we refer a matter to the Secretary of State been informed by the relevant national body of the Annual Report for the financial year for under Section 30 of the Local Audit and the intention to dissolve the CCG without the which the financial statements are prepared Accountability Act 2014 because we have transfer of its services to another public sector is consistent with the financial statements. reason to believe that the CCG, or an officer entity. of the CCG, is about to make, or has made, The Accountable Officer is responsible for a decision which involves or would involve ensuring the regularity of expenditure and the body incurring unlawful expenditure, or is income in the financial statements.
58 59 Report on other legal and regulatory requirements – Conclusion on the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources Auditor’s responsibilities for the review of the CCG’s arrangements for securing economy, Report on other efficiency and effectiveness in its use of legal and regulatory Qualified conclusion This matter is evidence of weaknesses in resources proper arrangements for sustainable resource requirements – On the basis of our work, having regard to deployment in planning finances effectively to We are required under Section 21(1)(c) and the guidance issued by the Comptroller & support the sustainable delivery of strategic Schedule 13 paragraph 10(a) of the Local Certificate Auditor General in April 2020, except for the priorities and maintain statutory functions. Audit and Accountability Act 2014 to be effects of the matter described in the basis for satisfied that the CCG has made proper qualified conclusion section of our report, we arrangements for securing economy, efficiency We certify that we have completed the are satisfied that, in all significant respects, and effectiveness in its use of resources and audit of the financial statements of NHS Responsibilities of the Accountable Officer NHS West Lancashire CCG put in place proper to report where we have not been able to West Lancashire CCG in accordance with satisfy ourselves that it has done so. We the requirements of the Local Audit and arrangements for securing economy, efficiency As explained in the Governance Statement, the are not required to consider, nor have we Accountability Act 2014 and the Code of Audit and effectiveness in its use of resources for the Accountable Officer is responsible for putting considered, whether all aspects of the CCG’s Practice. year ended 31 March 2020. in place proper arrangements for securing arrangements for securing economy, efficiency economy, efficiency and effectiveness in the and effectiveness in its use of resources are use of the CCG’s resources. operating effectively. Basis for qualified conclusion Use of our report We have undertaken our review in accordance Our review of the CCG’s arrangements for This report is made solely to the members of with the Code of Audit Practice, having regard securing economy, efficiency and effectiveness the Governing Body of the CCG, as a body, in to the guidance on the specified criterion in its use of resources identified the following accordance with Part 5 of the Local Audit and issued by the Comptroller and Auditor General matter: Accountability Act 2014. Our audit work has in April 2020, as to whether in all significant been undertaken so that we might state to the The CCG agreed a financial plan with NHS respects, the CCG had proper arrangements members of the Governing Body of the CCG England to deliver a break-even budget for to ensure it took properly informed decisions those matters we are required to state to them 2019/20. During the year, the CCG’s financial and deployed resources to achieve planned and in an auditor’s report and for no other purpose. position deteriorated, and it was unable to sustainable outcomes for taxpayers and local To the fullest extent permitted by law, we do recover the position by the year end, incurring people. The Comptroller and Auditor General not accept or assume responsibility to anyone a deficit of £3.9 million. The main reason for determined this criterion as that necessary other than the CCG and the members of the the deterioration in the financial position was for us to consider under the Code of Audit Governing Body of the CCG, as a body, for our the CCG not delivering planned efficiency Practice in satisfying ourselves whether the audit work, for this report, or for the opinions savings. The CCG planned to make efficiency CCG put in place proper arrangements for we have formed. savings of £5.3 million but failed to identify securing economy, efficiency and effectiveness sufficient saving schemes, which resulted in the in its use of resources for the year ended 31 savings target being missed by £2 million. March 2020, and to report by exception where we are not satisfied. This matter identifies weaknesses in the CCG’s arrangements for setting a sustainable budget We planned our work in accordance with with sufficient capacity to absorb emerging the Code of Audit Practice. Based on our risk Alex Walling, Key Audit Partner cost pressures. assessment, we undertook such work as we for and on behalf of Grant Thornton UK LLP, considered necessary to be satisfied that the Local Auditor CCG has put in place proper arrangements for securing economy, efficiency and effectiveness Bristol in its use of resources. 25 June 2020
60 61 Financial statements
The Primary Statements::
Statement of Comprehensive Net Expenditure for the year ended 31st March 2020 Statement of Financial Position as at 31st March 2020 Statement of Changes in Taxpayers’ Equity for the year ended 31st March 2020 Statement of Cash Flows for the year ended 31st March 2020
Notes to the Accounts
Accounting policies Other operating revenue Employee benefits and staff numbers Operating expenses Better payment practice code Operating leases Inventories Trade and other receivables Cash and cash equivalents Trade and other payables Provisions Financial instruments Operating segments Joint arrangements - interests in joint operations Related party transactions Events after the end of the reporting period Financial performance targets
62 63 NHS West Lancashire CCG - Annual Accounts 2019-20 Statement of Financial Position as at 31 March 2020 Statement of Comprehensive Net Expenditure for the year ended 31 March 2020 Note 2019-20 2018-19 £000 £000 Note 2019-20 2018-19 £000 £000 The notes on pages 69-76 Non-current assets: form part of this statement Intangible assets 9 9 9 The notes on pages Other operating income 2 (1,962) (2,191) Total non-current assets 9 9 69-76 form part of Total operating income (1,962) (2,191) this statement. The financial statements Current assets: Staff costs 3 3,533 2,941 on pages 64-68 were Inventories 10 469 0 Purchase of goods and services 4 181,758 170,916 approved by the Trade and other receivables 11 3,192 8,653 Other operating expenditure 4 184 45 Governing Body on Cash and cash equivalents 12 134 127 Total operating expenditure 185,476 173,902 23rd June 2020 and Total current assets 3,794 8,780 signed on its behalf by: Total Net Expenditure for the Financial Year 183,513 171,710 Total current assets 3,794 8,780
Comprehensive Expenditure for the year 183,513 171,710 Total assets 3,803 8,789
Current liabilities Trade and other payables 13 (14,594) (15,998) Paul Kingan Total current liabilities (14,594) (15,998) Chief Finance Officer Non-Current Assets plus/less Net Current Assets/Liabilities (10,791) (7,252)
Non-current liabilities Provisions 14 (43) (43) Total non-current liabilities (43) (43)
Assets less Liabilities (10,834) (7,252)
Financed by Taxpayers’ Equity General fund (10,834) (7,252) Total taxpayers' equity: (10,834) (7,252)
64 65 Statement of Changes In Taxpayers Equity for the year ended 31 March 2020
General Revaluation Other Total General Revaluation Other Total fund reserve reserves reserves fund reserve reserves reserves £000 £000 £000 £000 £000 £000 £000 £000
Changes in taxpayers’ equity for 2019-20 Changes in taxpayers’ equity for 2018-19
Balance at 01 April 2019 (7,252) 0 0 (7,252) Balance at 01 April 2018 (6,885) 0 0 (6,885) Adjusted NHS Clinical Commissioning Group balance at 31 March 2019 (7,252) 0 0 (7,252) Adjusted NHS Clinical Commissioning Group balance at 31 March 2019 (6,885) 0 0 (6,885)
Changes in NHS Clinical Commissioning Group taxpayers’ Changes in NHS Clinical Commissioning Group taxpayers’ equity for2019-20 equity for 2018-19 Net operating expenditure for the financial year (183,513) 0 0 (183,513) Net operating costs for the financial year (171,710) (171,710)
Net Recognised NHS Clinical Commissioning Group Expenditure for the (183,513) 0 0 (183,513) Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial (171,710) 0 0 (171,710) Financial Year Year Net funding 179,931 0 0 179,931 Net funding 171,343 0 0 171,343 Balance at 31 March 2020 (10,834) 0 0 (10,834) Balance at 31 March 2019 (7,252) 0 0 (7,252) The notes on pages 69-76 form part of this statement
66 67 Notes to the financial statements
Statement of Cash Flows for the year ended 31 March 2020 1 Accounting Policies will continue to be provided (using the same assets, by another public sector entity) in NHS England has directed that the financial Note 2019-20 2018-19 determining whether to use the concept of £000 £000 statements of clinical commissioning groups going concern for the final set of financial shall meet the accounting requirements statements. If services will continue to be Cash Flows from Operating Activities of the Group Accounting Manual issued provided the financial statements are prepared Net operating expenditure for the financial year (183,513) (171,710) by the Department of Health and Social on the going concern basis. (Increase)/decrease in inventories 10 (469) 0 Care. Consequently, the following financial (Increase)/decrease in trade & other receivables 11 5,461 (4,027) statements have been prepared in accordance with the Group Accounting Manual 2019-20 Increase/(decrease) in trade & other payables 13 (1,404) 4,523 issued by the Department of Health and Social 1.2 Accounting Convention Net Cash Inflow (Outflow) from Operating Activities (179,924) (171,214) Care. The accounting policies contained in the These accounts have been prepared under the Group Accounting Manual follow International Cash Flows from Investing Activities historical cost convention modified to account Financial Reporting Standards to the extent (Payments) for property, plant and equipment 8 0 (9) for the revaluation of property, plant and that they are meaningful and appropriate to equipment, intangible assets, inventories and Net Cash Inflow (Outflow) from Investing Activities 0 (9) clinical commissioning groups, as determined certain financial assets and financial liabilities. by HM Treasury, which is advised by the Net Cash Inflow (Outflow) before Financing (179,924) (171,223) Financial Reporting Advisory Board. Where the Group Accounting Manual permits a Cash Flows from Financing Activities 1.3 Movement of Assets within Grant in Aid Funding Received 179,931 171,343 choice of accounting policy, the accounting policy which is judged to be most appropriate the Department of Health and Net Cash Inflow (Outflow) from Financing Activities 179,931 171,343 to the particular circumstances of the clinical Social Care Group Net Increase (Decrease) in Cash & Cash Equivalents 12 7 120 commissioning group for the purpose of As Public Sector Bodies are deemed to giving a true and fair view has been selected. operate under common control, business Cash & Cash Equivalents at the Beginning of the Financial Year 127 7 The particular policies adopted by the clinical reconfigurations within the Department of commissioning group are described below. Health and Social Care Group are outside Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year 134 127 They have been applied consistently in dealing the scope of IFRS 3 Business Combinations. with items considered material in relation to Where functions transfer between two public the accounts. sector bodies, the Department of Health and The notes on pages 69-76 form part of this statement Social Care GAM requires the application of absorption accounting. Absorption accounting 1.1 Going Concern requires that entities account for their transactions in the period in which they took These accounts have been prepared on a going place, with no restatement of performance concern basis despite the issue of a report to required when functions transfer within the the Secretary of State for Health and Social public sector. Where assets and liabilities Care under Section 30 of the Local Audit and transfer, the gain or loss resulting is recognised Accountability Act 2014. The report is required in the Statement of Comprehensive Net as the CCG has incurred an in-year deficit of Expenditure, and is disclosed separately from £3.903m against its allocated resources. operating costs.
Public sector bodies are assumed to be Other transfers of assets and liabilities within going concerns where the continuation of the Department of Health and Social Care the provision of a service in the future is Group are accounted for in line with IAS anticipated, as evidenced by inclusion of 20 and similarly give rise to income and financial provision for that service in published expenditure entries. documents.
Where a clinical commissioning group ceases to exist, it considers whether or not its services
68 69 1.4 Joint arrangements 1.7 Revenue 1.8 Employee Benefits 1.9 Other Expenses
Arrangements over which the clinical In the application of IFRS 15 a number of Income and expenditure are analysed in the Other operating expenses are recognised commissioning group has joint control with practical expedients offered in the Standard Operating Segments note and are reported in when, and to the extent that, the goods or one or more other entities are classified as joint have been employed. These are as follows; line with management information used within services have been received. They are measured arrangements. Joint control is the contractually the clinical commissioning group. at the fair value of the consideration payable. agreed sharing of control of an arrangement. A • As per paragraph 121 of the Standard joint arrangement is either a joint operation or the clinical commissioning group will a joint venture. not disclose information regarding performance obligations part of a contract 1.8.1 Short-term Employee Benefits 1.10 Grants Payable (where relevant) A joint operation exists where the parties that that has an original expected duration of Salaries, wages and employment-related Where grant funding is not intended to be have joint control have rights to the assets and one year or less, payments, including payments arising from directly related to activity undertaken by obligations for the liabilities relating to the • The clinical commissioning group is to the apprenticeship levy, are recognised in the a grant recipient in a specific period, the arrangement. Where the clinical commissioning period in which the service is received from clinical commissioning group recognises the group is a joint operator it recognises its share similarly not disclose information where revenue is recognised in line with the employees, including bonuses earned but not expenditure in the period in which the grant is of, assets, liabilities, income and expenses in its yet taken. paid. All other grants are accounted for on an own accounts. practical expedient offered in paragraph B16 of the Standard where the right to accruals basis. A joint venture is a joint arrangement whereby consideration corresponds directly with the parties that have joint control of the value of the performance completed to 1.8.2 Retirement Benefit Costs 1.11 Leases arrangement have rights to the net assets of date. the arrangement. Joint ventures are recognised Past and present employees are covered by Leases are classified as finance leases when as an investment and accounted for using the • The FReM has mandated the exercise of the provisions of the NHS Pensions Schemes. substantially all the risks and rewards of equity method. the practical expedient offered in C7(a) These schemes are unfunded, defined benefit ownership are transferred to the lessee. All of the Standard that requires the clinical schemes that cover NHS employers, General other leases are classified as operating leases. commissioning group to reflect the Practices and other bodies allowed under the aggregate effect of all contracts modified direction of the Secretary of State in England 1.5 Pooled Budgets before the date of initial application. and Wales. The schemes are not designed to be run in a way that would enable NHS bodies The clinical commissioning group has entered The main source of funding for the Clinical into pooled budget arrangements with to identify their share of the underlying scheme Commissioning Group is from NHS England. assets and liabilities. Therefore, the schemes Lancashire County Council [in accordance with This is drawn down and credited to the general section 75 of the NHS Act 2006]. Under the are accounted for as though they were defined fund. Funding is recognised in the period in contribution schemes: the cost to the clinical arrangements, funds are pooled separately for which it is received. Learning Difficulties and Social Care. Note 17 commissioning group of participating in a provides details of the income and expenditure. Revenue in respect of services provided scheme is taken as equal to the contributions is recognised when (or as) performance payable to the scheme for the accounting The pools are hosted by Lancashire County obligations are satisfied by transferring period. Council. The clinical commissioning group promised services to the customer, and is accounts for its share of the assets, liabilities, For early retirements other than those due measured at the amount of the transaction to ill health the additional pension liabilities income and expenditure arising from the price allocated to that performance obligation. activities of the pooled budget, identified in are not funded by the scheme. The full accordance with the pooled budget agreement Where income is received for a specific amount of the liability for the additional costs performance obligation that is to be satisfied in is charged to expenditure at the time the the following year, that income is deferred. clinical commissioning group commits itself to the retirement, regardless of the method of 1.6 Operating Segments Payment terms are standard reflecting cross payment. government principles. Income and expenditure are analysed in the The schemes are subject to a full actuarial Operating Segments note and are reported in valuation every four years and an accounting line with management information used within valuation every year. the clinical commissioning group.
70 71 1.11.1 The Clinical Commissioning Group as on demand and that form an integral part 1.17 Carbon Reduction Commitment events not wholly within the control of the Lessee of the clinical commissioning group’s cash Scheme clinical commissioning group. A contingent management. asset is disclosed where an inflow of economic Property, plant and equipment held under The Carbon Reduction Commitment scheme benefits is probable. finance leases are initially recognised, at the is a mandatory cap and trade scheme for inception of the lease, at fair value or, if lower, non-transport CO2 emissions. The clinical Where the time value of money is material, 1.14 Provisions at the present value of the minimum lease commissioning group is registered with the contingent liabilities and contingent assets are payments, with a matching liability for the Provisions are recognised when the clinical CRC scheme, and is therefore required to disclosed at their present value. lease obligation to the lessor. Lease payments commissioning group has a present legal surrender to the Government an allowance are apportioned between finance charges or constructive obligation as a result of a for every tonne of CO2 it emits during the and reduction of the lease obligation so as past event, it is probable that the clinical financial year. A liability and related expense is 1.19 Financial Assets to achieve a constant rate on interest on the commissioning group will be required to settle recognised in respect of this obligation as CO2 remaining balance of the liability. Finance the obligation, and a reliable estimate can be emissions are made. Financial assets are recognised when the charges are recognised in calculating the made of the amount of the obligation. The clinical commissioning group becomes party The carrying amount of the liability at the clinical commissioning group’s surplus/deficit. amount recognised as a provision is the best to the financial instrument contract or, in the financial year end will therefore reflect the estimate of the expenditure required to settle case of trade receivables, when the goods or Operating lease payments are recognised as an CO2 emissions that have been made during the obligation at the end of the reporting services have been delivered. Financial assets expense on a straight-line basis over the lease that financial year, less the allowances (if any) period, taking into account the risks and are derecognised when the contractual rights term. Lease incentives are recognised initially surrendered voluntarily during the financial uncertainties. have expired or the asset has been transferred. as a liability and subsequently as a reduction year in respect of that financial year. of rentals on a straight-line basis over the lease Financial assets are classified into the following term. The liability will be measured at the amount categories: 1.15 Clinical Negligence Costs expected to be incurred in settling the Contingent rentals are recognised as an obligation. This will be the cost of the number • Financial assets at amortised cost; expense in the period in which they are NHS Resolution operates a risk pooling scheme of allowances required to settle the obligation. incurred. under which the clinical commissioning • Financial assets at fair value through other group pays an annual contribution to NHS Allowances acquired under the scheme are comprehensive income and ; Where a lease is for land and buildings, the Resolution, which in return settles all clinical recognised as intangible assets. land and building components are separated • Financial assets at fair value through profit negligence claims. The contribution is charged and loss. and individually assessed as to whether they to expenditure. Although NHS Resolution are operating or finance leases. is administratively responsible for all clinical 1.18 Contingent liabilities and contingent The classification is determined by the cash negligence cases, the legal liability remains assets flow and business model characteristics of the with clinical commissioning group. financial assets, as set out in IFRS 9, and is 1.12 Inventories A contingent liability is a possible obligation determined at the time of initial recognition. that arises from past events and whose Inventories are valued at the lower of cost existence will be confirmed only by the 1.16 Non-clinical Risk Pooling and net realisable value. The CCG now classes occurrence or non-occurrence of one or more community equipment within individuals’ The clinical commissioning group participates uncertain future events not wholly within the homes as an inventory and has employed a in the Property Expenses Scheme and the control of the clinical commissioning group, methodology that considers the age of the Liabilities to Third Parties Scheme. Both or a present obligation that is not recognised equipment to determine its net realisable value. are risk pooling schemes under which the because it is not probable that a payment clinical commissioning group pays an annual will be required to settle the obligation or the contribution to the NHS Resolution and, in amount of the obligation cannot be measured 1.13 Cash return, receives assistance with the costs sufficiently reliably. A contingent liability is of claims arising. The annual membership disclosed unless the possibility of a payment is Cash is cash in hand and deposits with any contributions, and any excesses payable in remote. financial institution repayable without penalty respect of particular claims are charged to A contingent asset is a possible asset that on notice of not more than 24 hours. operating expenses as and when they become arises from past events and whose existence due. In the Statement of Cash Flows, cash is shown will be confirmed by the occurrence or non- net of bank overdrafts that are repayable occurrence of one or more uncertain future
72 73 1.19.1 Financial Assets at Amortised cost expected credit losses if the credit risk on the 1.20.1 Financial Guarantee Contract 1.23 Losses & Special Payments financial instrument has increased significantly Liabilities Financial assets measured at amortised cost since initial recognition (stage 2) and otherwise Losses and special payments are items that are those held within a business model whose at an amount equal to 12 month expected Financial guarantee contract liabilities are Parliament would not have contemplated when objective is achieved by collecting contractual credit losses (stage 1). subsequently measured at the higher of: it agreed funds for the health service or passed cash flows and where the cash flows are legislation. By their nature they are items that solely payments of principal and interest. HM Treasury has ruled that central government • The premium received (or imputed) for ideally should not arise. They are therefore This includes most trade receivables and bodies may not recognise stage 1 or stage entering into the guarantee less cumulative subject to special control procedures compared other simple debt instruments. After initial 2 impairments against other government amortisation; and, with the generality of payments. They are recognition these financial assets are measured departments, their executive agencies, the • The amount of the obligation under the divided into different categories, which govern at amortised cost using the effective interest Bank of England, Exchequer Funds and contract, as determined in accordance with the way that individual cases are handled. method less any impairment. The effective Exchequer Funds assets where repayment is IAS 37: Provisions, Contingent Liabilities Losses and special payments are charged to the interest rate is the rate that exactly discounts ensured by primary legislation. The clinical and Contingent Assets. estimated future cash receipts through the commissioning group therefore does not relevant functional headings in expenditure on life of the financial asset to the gross carrying recognise loss allowances for stage 1 or stage 2 an accruals basis, including losses which would amount of the financial asset. impairments against these bodies. Additionally have been made good through insurance cover Department of Health and Social Care provides 1.20.2 Other Financial Liabilities had the clinical commissioning group not been bearing its own risks (with insurance premiums a guarantee of last resort against the debts of After initial recognition, all other financial its arm’s lengths bodies and NHS bodies and then being included as normal revenue 1.19.2 Financial assets at fair value through liabilities are measured at amortised cost using the clinical commissioning group does not expenditure). other comprehensive income the effective interest method, except for loans recognise allowances for stage 1 or stage 2 from Department of Health and Social Care, Financial assets held at fair value through other impairments against these bodies. which are carried at historic cost. The effective comprehensive income are those held within interest rate is the rate that exactly discounts 1.24 Critical accounting judgements and For financial assets that have become credit a business model whose objective is achieved estimated future cash payments through the key sources of estimation uncertainty impaired since initial recognition (stage 3), by both collecting contractual cash flows and life of the asset, to the net carrying amount expected credit losses at the reporting date are In the application of the clinical commissioning selling financial assets and where the cash of the financial liability. Interest is recognised measured as the difference between the asset’s group’s accounting policies, management flows are solely payments of principal and using the effective interest method. gross carrying amount and the present value is required to make various judgements, interest. of the estimated future cash flows discounted estimates and assumptions. These are regularly at the financial asset’s original effective interest reviewed. rate. Any adjustment is recognised in profit or 1.21 Value Added Tax 1.19.3 Impairment loss as an impairment gain or loss. Most of the activities of the clinical For all financial assets measured at commissioning group are outside the scope 1.24.1 Critical accounting judgements in amortised cost or at fair value through of VAT and, in general, output tax does applying accounting policies other comprehensive income (except equity 1.20 Financial Liabilities not apply and input tax on purchases is not The following are the judgements, apart from instruments designated at fair value through recoverable. Irrecoverable VAT is charged to Financial liabilities are recognised on the those involving estimations, that management other comprehensive income), lease receivables the relevant expenditure category or included statement of financial position when the has made in the process of applying the clinical and contract assets, the clinical commissioning in the capitalised purchase cost of fixed assets. clinical commissioning group becomes party commissioning group’s accounting policies group recognises a loss allowance representing Where output tax is charged or input VAT is to the contractual provisions of the financial and that have the most significant effect the expected credit losses on the financial recoverable, the amounts are stated net of VAT. instrument or, in the case of trade payables, on the amounts recognised in the financial asset. when the goods or services have been statements. The clinical commissioning group adopts received. Financial liabilities are de-recognised the simplified approach to impairment in when the liability has been discharged, that is, 1.22 Third Party Assets accordance with IFRS 9, and measures the the liability has been paid or has expired. Assets belonging to third parties (such as loss allowance for trade receivables, lease money held on behalf of patients) are not receivables and contract assets at an amount recognised in the accounts since the clinical equal to lifetime expected credit losses. For commissioning group has no beneficial interest other financial assets, the loss allowance is in them. measured at an amount equal to lifetime
74 75 1.24.2 Sources of estimation uncertainty 1.25 Accounting Standards That Have Been Issued But Have Not Yet Been The following are assumptions about the Adopted future and other major sources of estimation uncertainty that have a significant risk of resulting in a material adjustment to the carrying amounts of assets and liabilities within The Department of Health and Social Care the next financial year. GAM does not require the following IFRS Standards and Interpretations to be applied Timing differences. There are a number of in 2019-20. These Standards are still subject accruals and prepayments (totalling a net to HM Treasury FReM adoption, with IFRS £4.048m) within the Statement of Financial 16 being scheduled for implementation in Position where estimation techniques have 2020-21. The government implementation been applied. This is because the outturn date for IFRS 17 is still subject to HM Treasury information is not available at the time of consideration. preparation of the financial statements. • IFRS 16 Leases Contract Payments to NHS Providers. The CCG has a number of contracts with NHS - Date of application: Effective for Trusts for the provision of Healthcare Services. annual periods beginning on or after 1 Where block contract arrangements apply, or January 2019 a final settlement has been agreed with the - Nature of Changes: IFRS 16 changes Trust, no estimations are required. For other the definition of a lease compared organisations the forecast has been based to IAS 17 and IFRIC 4. The current upon Month 11 contract monitoring data and distinction between operating and therefore an estimate of the value of activity finance leases is removed for lessees. undertaken in Month 12 has been made. A Lessees will recognise all leases, subject net prepayment totalling £0.275m has been to certain exceptions (e.g. short term entered in respect of these contracts. These leases and low value assets), on their estimates are included in the total value of balance sheet as a right of use asset accruals listed above. and a liability to make the lease Prescribing. The CCG has included an accrual payments. Lessor accounting will of £2.981m which relate to the estimated remain largely unchanged. charges to the CCG for medicines in February • Impact of IFRS 16: this is not known at and March 2020. The estimates are based present but is not material and can be on recent expenditure trends and seasonal reasonably estimated profiles.
76 77 2 Other Operating Revenue 3 Employee benefits and staff numbers
3.1.1 Employee benefits 2019-20 2019-20 2019-20 2018-19 Admin Programme Total Total £’000 £’000 £’000 £’000 2019-20
Admin Programme Total Other operating income Permanent Other Total Permanent Other Total Permanent Other Total Other non contract revenue 1 1,961 1,962 2,191 Employees Employees Employees Total Other operating income 1 1,961 1,962 2,191 £’000 £’000 £’000 £’000 £’000 £’000 £’000 £’000 £’000 Employee Benefits
Revenue in this note does not include cash received from NHS England, which is drawn down directly into the bank account of the clinical Salaries and wages 1,047 14 1,061 1,774 0 1,774 2,821 14 2,835 commissioning group and credited to the General Fund. Social security costs 171 0 171 84 0 84 255 0 255
Revenue is totally from the supply of services. The clinical commissioning group received no revenue from the sale of goods for the year ending Employer contributions to the NHS 331 0 331 112 0 112 443 0 443 31st March 2020 or for the prior year ending 31 March 2019 Pension Scheme Other pension costs 0 0 0 0 0 0 0 0 0 Apprenticeship Levy 0 0 0 0 0 0 0 0 0 Other post-employment benefits 0 0 0 0 0 0 0 0 0 Other employment benefits 0 0 0 0 0 0 0 0 0 Termination benefits 0 0 0 0 0 0 0 0 0 Gross employee benefits 1,549 14 1,563 1,970 0 1,970 3,519 14 3,533 expenditure
Less recoveries in respect of employee 0 0 0 0 0 0 0 0 benefits (note 3.1.1) Total - Net admin 1,549 14 1,563 1,970 1,970 3,519 14 3,533 employee benefits including capitalised costs
Less: Employee costs capitalised 0 0 0 0 0 0 0 0 Net employee benefits excluding 1,549 14 1,563 1,970 1,970 3,519 14 3,533 capitalised costs
78 79 3.1.1 Employee benefits 3.3 Exit packages agreed in the financial year
2018-19 2019-20 Admin Programme Total Compulsory redundancies Other agreed departures Total Permanent Other Total Permanent Other Total Permanent Other Total Number £ Number £ Number £ Employees Employees Employees £’000 £’000 £’000 £’000 £’000 £’000 £’000 £’000 £’000 £150,001 1 160,000 0 0 1 160,000 to Employee Benefits £200,000 Salaries and wages 915 69 984 1,394 61 1,455 2,309 130 2,439 Total 1 160,000 0 0 1 160,000 Social security costs 161 0 161 64 0 64 225 0 225 Employer contributions to the NHS 190 0 190 88 0 88 278 0 278 Pension Scheme 2018-19 Other pension costs 0 0 0 0 0 0 0 0 0 Compulsory redundancies Other agreed departures Total Apprenticeship Levy 0 0 0 0 Number £ Number £ Number £ Other post-employment benefits 0 0 0 0 0 0 0 0 0 £150,001 0 0 1 13,688 1 13,688 Other employment benefits 0 0 0 0 0 0 0 0 0 to Termination benefits 0 0 0 0 0 0 0 0 0 £200,000 Gross employee benefits 1,265 69 1,334 1,545 61 1,607 2,811 130 2,941 Total 0 0 1 13,688 1 13,688 expenditure
Less recoveries in respect of employee 0 0 0 0 0 0 0 0 0 benefits (note 3.1.1) Analysis of Other Agreed Departures Total - Net admin 1,265 69 1,334 1,545 61 1,607 2,811 130 2,941 employee benefits including capitalised costs 2019-20 2018-19 Other agreed departures Other agreed departures Less: Employee costs capitalised 0 0 0 0 0 0 0 0 0 Net employee benefits excluding 1,265 69 1,334 1,545 61 1,607 2,811 130 2,941 Number £ Number £ capitalised costs Contractual payments in lieu of notice 0 0 1 13,688 Total 0 0 1 13,688
3.2 Average number of people employed
* As a single exit package can be made up of several components each of which will be counted separately in this table, the total number will not necessarily match the total number in the table above, which will be the number of individuals. 2019-20 2018-19 These tables report the number and value of exit packages agreed in the financial year.
Permanently Other Total Permanently Other Total The expense associated with these departures may have been recognised in part or in full in a previous period. employed Number Number employed Number Number Redundancy and other departure costs have been paid in accordance with contractual terms. Number Number Exit costs are accounted for in accordance with relevant accounting standards and at the latest in full in the year of Total 54.93 0.05 54.98 51.03 4.40 55.43 departure. Total The Remuneration Report includes the disclosure of exit payments payable to individuals named in that Report.
80 81 3.4 Staff sickness absence and ill health retirements 3.5.1 Accounting valuation 3.5.2 Full actuarial (funding) valuation
A valuation of scheme liability is carried out The purpose of this valuation is to assess the level 2019-20 annually by the scheme actuary (currently the of liability in respect of the benefits due under the Number Government Actuary’s Department) as at the schemes (taking into account recent demographic end of the reporting period. This utilises an experience), and to recommend contribution rates Total Days Lost 446 actuarial assessment for the previous accounting payable by employees and employers. Total Staff Years 51 period in conjunction with updated membership The last published actuarial valuation undertaken Average working Days Lost 9 and financial data for the current reporting period, and is accepted as providing suitably for the NHS Pension Scheme was completed robust figures for financial reporting purposes. for the year ending 31 March 2016. The results The valuation of the scheme liability as at 31 of this valuation set the employer contribution The CCG manages staff sickness in line with the agreed Staff Sickness Policy. March 2020, is based on valuation data as 31 rate payable from April 2019. The Department March 2019 updated to 31 March 2020 with of Health and Social Care have recently laid The clinical commissioning group has not agreed any early retirements due to ill health grounds as at 31 March 2020 or summary global member and accounting data. Scheme Regulations confirming that the employer the prior year ending 31 March 2019. In undertaking this actuarial assessment, the contribution rate will increase to 20.6% of methodology prescribed in IAS 19, relevant FReM pensionable pay from this date. interpretations, and the discount rate prescribed The 2016 funding valuation was also expected by HM Treasury have also been used. to test the cost of the Scheme relative to the 3.5 Pension costs The latest assessment of the liabilities of the employer cost cap set following the 2012 Past and present employees are covered by the provisions of the two NHS Pension Schemes. Details of the benefits payable and scheme is contained in the report of the scheme valuation. Following a judgment from the Court rules of the Schemes can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. actuary, which forms part of the annual NHS of Appeal in December 2018 Government Pension Scheme Accounts. These accounts can announced a pause to that part of the valuation These schemes are unfunded, defined benefit schemes that cover NHS employers, General Practices and other bodies allowed be viewed on the NHS Pensions website and are process pending conclusion of the continuing under the direction of the Secretary of State in England and Wales. The schemes are not designed to be run in a way that would published annually. Copies can also be obtained legal process. enable NHS bodies to identify their share of the underlying scheme assets and liabilities. from The Stationery Office. For 2019-20, employers’ contributions of Therefore, the schemes are accounted for as though they were defined contribution schemes: the cost to the clinical £443,097 (2018-19: £279,776) were payable to commissioning group of participating in a scheme is taken as equal to the contributions payable to the scheme for the accounting the NHS Pensions Schemeat the rate of 20.68% period. of pensionable pay. The scheme’s actuary reviews employer contributions, usually every four years The schemes are subject to a full actuarial valuation every four years and an accounting valuation every year. and now based on HMT Valuation Directions, The employer contribution rate for NHS Pensions increased from 14.3% to 20.6% from 1st April 2019, £134k for the CCG. following a full scheme valuation. For 2019/20, NHS CCGs continued to pay over contributions at the former rate with the additional amount being paid by NHS The latest review used data from 31 March 2016. England on CCGs behalf. The full cost and related funding has been recognised in these accounts. These costs are included in the NHS pension line of note 3.1.
82 83 4. Operating expenses 5.1 Better Payment Practice Code
2019-20 2018-19 Total Total Measure of compliance 2019-20 2019-20 2018-19 2018-19 £’000 £’000 Number £’000 Number £’000
Purchase of goods and services Non-NHS Payables Services from other CCGs and NHS England 1,610 1,462 Total Non-NHS Trade invoices paid in the Year 7966 63,899 8,382 60,548 Services from foundation trusts 42,439 39,105 Total Non-NHS Trade Invoices paid within target 7,888 63,280 8,311 60,089 Services from other NHS trusts 60,381 56,218 Percentage of Non-NHS Trade invoices paid 99.02% 99.03% 99.15% 99.24% Purchase of healthcare from non-NHS bodies 40,204 37,063 within target Prescribing costs 17,523 17,587 GPMS/APMS and PCTMS 15,734 14,719 NHS Payables Supplies and services – clinical 873 1,055 Total NHS Trade Invoices Paid in the Year 2125 104,630 2,215 106,254 Supplies and services – general 549 635 Total NHS Trade Invoices Paid within target 2102 104,290 2,183 105,403 Consultancy services 395 307 Percentage of NHS Trade Invoices paid 98.92% 99.68% 98.56% 99.20% within target Establishment 283 597 Transport 768 732 Premises 853 1,240 5.2 The Late Payment of Commercial Debts (Interest) Act 1998
Audit fees 46 46 The Better Payment Practice Code required the CCG to aim to pay all valid invoices by the due Other non statutory audit expenditure date or within 30 days of receipt of a valid invoice, whichever is later. The clinical commissioning - Other services 10 0 group has not made any such payments in the year ending 31 March 2020 or for the prior year ending 31 March 2019 Other professional fees 64 61 Legal fees 0 5 Education, training and conferences 26 84 Total Purchase of goods and services 181,758 170,916
Other Operating Expenditure Chair and Non Executive Members 29 29 Grants to Other bodies 155 0 Other expenditure 0 15 Total Other Operating Expenditure 184 45 Total operating expenditure 181,942 170,960
In accordance with SI 2008 no.489, The Companies (Disclosure of Auditor Remuneration and Liability Limitation Agreements) Regulations 2008, where a CCG contract with its auditors provides for a limitation of the auditor’s liability, the principal terms of this limitation must be disclosed in a note to the accounts.
The Auditors liability cap amount is £2m.
The £10k charge for ‘Other Services’ under Other Non Statutory Audit Expenditure relates to the charge for work undertaken to assess the CCG’s compliance with the Mental Health Investment Standard.
84 85 6. Operating Leases 8. Trade and other receivables
6.1 As lessee Current Non-current Current Non-current The clinical commissioning group occupies property owned and managed by NHS Property Services Limited. Included 2019-20 2019-20 2018-19 2018-19 £’000 £’000 £’000 £’000 within these charges are amounts relating to subsidies and void spaces whereby the income generated by NHS Property Services Ltd from tenants is insufficient to cover costs and the clinical commissioning group covers the shortfall. NHS receivables: Revenue 456 0 554 0 6.1.1 Payments recognised as an Expense NHS accrued income 546 0 6,829 0
Non-NHS and Other WGA receivables: Revenue 771 0 1,036 0 2019-20 2018-19 Buildings Other Total Buildings Other Total Non-NHS and Other WGA prepayments 992 0 77 0 £’000 £’000 £’000 £’000 £’000 £’000 Non-NHS and Other WGA accrued income 423 0 148 0
Payments recognised as an expense VAT 3 0 8 0 Minimum lease payments 612 3 615 1,213 13 1,226 Other receivables and accruals 0 0 - 0 Contingent rents 0 0 0 0 0 0 Total Trade & other receivables 3,192 0 8,653 0 Sub-lease payments 0 0 0 0 0 0 Total 612 3 615 1,213 13 1,226 Total current and non current 3,192 8,653 Whilst our arrangements with NHS Property Services Limited fall within the definition of operating leases, rental charge for future years has not yet been agreed . Consequently this note does not include future minimum lease payments for the arrangements only. 8.1 Receivables past their due date but not impaired The implementation of IFRS 16 was due to be introduced from April 2020. Due to the coronavirus outbreak in Spring 2020, IFRS16 will now be implemented April 2021. 2019-20 2019-20 2018-19 2018-19 Under IFRS16, it is the intention of the CCG to re-classify two operating leases as finance leases. DHSC Group Non DHSC DHSC Group Non DHSC Group Bodies Group Bodies Bodies Bodies £’000 £’000 £’000 £’000
7. Inventories By up to three months 0 7 65 483 By three to six months 0 50 0 154
Loan Equipment Total By more than six months 0 76 423 400 Total 0 133 488 1,037 £’000 £’000
The clinical commissioning group did not hold any collateral against receivables outstanding at 31 March 2020 or for the Balance at 01 April 2019 0 0 prior year ending 31 March 2019. Additions 469 469 Inventories recognised as an expense in the period 0 0 Write-down of inventories (including losses) 0 0 8.2 Provision for impairment of receivables Reversal of write-down previously taken to the 0 0 statement of comprehensive net expenditure The clinical commissioning group had no provision for impairment of receivables in the year ending 31 March 2020 or for Transfer (to) from - Goods for resale 0 0 the prior year ending 31 March 2019. Balance at 31 March 2020 469 469 The clinical commissioning group’s aged debt report is reviewed in order to determine the recovery status of the debtor balances. Each item is considered on a case by case basis.
86 87 9. Cash and cash equivalents 10. Trade and other payables
2019-20 2018-19 Current Non-current Current Non-current £’000 £’000 2019-20 2019-20 2018-19 2018-19 £’000 £’000 £’000 £’000
Balance at 01 April 2019 127 7 NHS payables: Revenue 2,413 0 6,457 0 Net change in year 7 120 NHS accruals 1,509 0 868 0 Balance at 31 March 2020 134 127 Non-NHS and Other WGA payables: Revenue 4,685 0 2,822 0
Made up of: Non-NHS and Other WGA accruals 4,284 0 4,625 0
Cash with the Government Banking Service 134 127 Social security costs 38 0 36 0
Cash with Commercial banks 0 0 Tax 33 0 42 0
Cash in hand 0 0 Other payables and accruals 1,633 0 1,148 0
Current investments 0 0 Total Trade & Other Payables 14,594 0 15,998 0
Cash and cash equivalents as in statement of financial position 134 127 Total current and non-current 14,594 15,998
Bank overdraft: Government Banking Service 0 0
Bank overdraft: Commercial banks 0 0
Total bank overdrafts 0 0
Balance at 31 March 2020 134 127
Patients’ money held by the clinical commissioning group, 0 0 not included above
88 89 11. Provisions 12 Financial instruments 12.1.2 Interest rate risk
12.1 Financial risk management The clinical commissioning group borrows Current Non-current Current Non-current from government for capital expenditure, 2019-20 2019-20 2018-19 2018-19 Financial reporting standard IFRS 7 requires subject to affordability as confirmed by NHS £’000 £’000 £’000 £’000 disclosure of the role that financial instruments England. The borrowings are for 1 to 25 years, have had during the period in creating or in line with the life of the associated assets, Continuing care 0 43 0 43 changing the risks a body faces in undertaking and interest is charged at the National Loans its activities. Total 0 43 0 43 Fund rate, fixed for the life of the loan. The Because NHS clinical commissioning group clinical commissioning group therefore has low is financed through parliamentary funding, exposure to interest rate fluctuations. Total current and non-current 43 43 it is not exposed to the degree of financial risk faced by business entities. Also, financial instruments play a much more limited role in 12.1.3 Credit risk creating or changing risk than would be typical Continuing Care Total of listed companies, to which the financial Because the majority of the NHS clinical £’000 £’000 reporting standards mainly apply. The clinical commissioning group and revenue comes commissioning group has limited powers to parliamentary funding, NHS clinical borrow or invest surplus funds and financial commissioning group has low exposure to Balance at 01 April 2019 43 43 assets and liabilities are generated by day-to- credit risk. The maximum exposures as at the day operational activities rather than being end of the financial year are in receivables from customers, as disclosed in the trade and other Expected timing of cash flows: held to change the risks facing the clinical commissioning group in undertaking its receivables note. Between one and five years 43 43 activities. Balance at 31 March 2020 43 43 Treasury management operations are carried 12.1.4 Liquidity risk out by the finance department, within The clinical commissioning group made a provision for Continuing Care claims relating to 2013/14 that may arise in future parameters defined formally within the NHS clinical commissioning group is required years. It was calculated by reference to an estimated number of claims based on historical data, their probability of success NHS clinical commissioning group standing to operate within revenue and capital resource and a typical weekly Nursing Home cost. financial instructions and policies agreed by limits, which are financed from resources the Governing Body. Treasury activity is subject voted annually by Parliament. The NHS clinical to review by the NHS clinical commissioning commissioning group draws down cash to group and internal auditors. cover expenditure, as the need arises. The NHS clinical commissioning group is not, therefore, exposed to significant liquidity risks. 12.1.1 Currency risk
The NHS clinical commissioning group is 12.1.5 Financial Instruments principally a domestic organisation with the great majority of transactions, assets and As the cash requirements of NHS England are liabilities being in the UK and sterling based. met through the Estimate process, financial The NHS clinical commissioning group has instruments play a more limited role in no overseas operations. The NHS clinical creating and managing risk than would apply commissioning group and therefore has low to a non-public sector body. The majority of exposure to currency rate fluctuations. financial instruments relate to contracts to buy non-financial items in line with NHS England’s expected purchase and usage requirements and NHS England is therefore exposed to little credit, liquidity or market risk.
90 91 12.2 Financial assets 13. Operating segments
The clinical commissioning group consider they have only one segment: commissioning of healthcare services. Financial Assets Total Total measured at 2019-20 2018-19 amortised cost 14. Joint arrangements - interests in joint operations 2019-20 CCGs should disclose information in relation to joint arrangements in line with the requirements in IFRS 12 - Disclosure of £’000 £’000 £’000 interests in other entities.
Trade and other receivables with NHSE bodies 289 289 577 14.1 Interests in joint operations Trade and other receivables with other DHSC 1,552 1,552 3,103 group bodies Amounts recognised in Entities books ONLY Amounts recognised in Entities books ONLY Trade and other receivables with external 356 356 713 2019-20 2018-19 bodies Name of Parties Descrip- Assets Liabilities Income Expendi- Assets Liabilities Income Expendi- arrange- to the tion of ture ture Cash and cash equivalents 134 134 268 ment arrange- principal ment activities Total at 31 March 2020 2,331 2,331 4,661
£’000 £’000 £’000 £’000 £’000 £’000 £’000 £’000
LD Pool LCC, Services 0 0 (379) 1,454 0 0 (379) 1,369 Chorley & for Adults South Rib- with ble CCG, Learning Greater Disabilities Preston - Central CCG Pooled Fund
12.3 Financial liabilities Better Lancashire Better 0 0 (5,363) 8,006 0 0 0 2,514 Care County Care Fund Fund Council Social Financial Total Total Care Liabilities 2019-20 2018-19 measured at amortised cost 14.2 Services for Adult Learning Difficulties 2019-20 The clinical commissioning group has a pooled budget arrangement with Lancashire County Council. £’000 £’000 £’000 The pool is hosted by Lancashire County Council. Trade and other payables with NHSE bodies 221 221 146 Under the arrangement funds are pooled under Section 75 of the NHS Act 2006 for Services for Adults with Learning Trade and other payables with other DHSC 9,843 9,843 12,811 Disabilities. group bodies
Trade and other payables with external bodies 4,460 4,460 1,815 14.3 Better Care Fund
Other financial liabilities - - 1,148 The clinical commissioning group has a pooled budget arrangement with Lancashire County Council, NHS Morecambe Bay Total at 31 March 2020 14,523 14,523 15,920 CCG, NHS Fylde and Wyre CCG, NHS Greater Preston CCG, NHS Chorley and South Ribble CCG and NHS East Lancashire CCG. The pool is hosted by Lancashire County Council.
92 93 15. Related party transactions
Details of related party transactions with individuals are as follows:
2019/20 The transactions above to Practices are in relation to Enhanced Services and Tier 2 services (such as Anti-Coagulation, Minor Surgery and Phlebotomy) provided by the above mentioned GP Payments to Receipts from Amounts owed to Amounts due from Related Party Related Party Related Party Related Party Practices and also for Primary Care Co-Commissioning.
£’000 £’000 £’000 £’000 OWLS CIC Ltd provide urgent care services to the West Lancshire population including out of hours provision and an acute visiting service.
NHS England 0 (200) 4 (268) The Department of Health is regarded as a related party. During the year the clinical commissioning group has had a significant number of material transactions with entities for PDS Medical 412 0 0 0 which the Department of Health is regarded as the parent Department. For example:
Parkgate Surgery (GP 950 0 0 0 • NHS England Exec Lead - Dr Peter Gregory) • NHS Foundation Trusts Parbold Surgery (GP Exec 782 0 0 0 Lead - Dr John Kinsey) • NHS Trusts
Dr A Bisarya (GP Exec 334 0 0 0 • NHS Litigation Authority Lead - Dr Dheraj Bisarya) • NHS Business Services Authority Excel Primary Care (GP 2,023 0 0 0 Exec Lead - Dr Dheraj • NHS Property Services Bisarya and Dr Rakesh Jaidka) • Community Health Partnerships
Tarleton Group Practice 1,057 0 0 0 In addition, the clinical commissioning group has had a number of material transactions with (GP Exec Lead - Dr Vik Mital) other government departments and other central and local government bodies. Most of these transactions have been with Lancashire County Council in respect of joint enterprises. Liverpool University Hos- 6,581 0 96 (224) pitals NHST FT
Southport & Ormskirk 50,831 0 994 0 Hospital NHS Trust
OWLS CIC Ltd 698 0 0 0
Renacres Hospital 4,573 0 0 (126)
CVS West Lancashire 65 0 0 0
Twinkle House Ltd 78 0 0 0
94 95 15. Related party transactions (continued) 16. Events after the end of the reporting period
The Coronavirus pandemic will have a significant impact on the finances of all NHS organisations, including the CCG. However as the Emergency Period was declared within a few days of the end of the 2019/20 financial year (March 23rd 2020), the CCG does not anticipate that the pandemic will materially change the validity of the estimations used in 2018/19 producing this set of accounts. Payments to Receipts from Amounts owed to Amounts due from Related Party Related Party Related Party Related Party
£’000 £’000 £’000 £’000 17. Financial performance targets
NHS Clinical Commissioning Group have a number of financial duties under the NHS Act 2006 (as amended). Beacon Primary Care (GP 2,387 0 0 0 Exec Lead - Dr Bapi S NHS Clinical Commissioning Group performance against those duties was as follows: Biswas)
Excel Primary Care (GP 181 0 0 0 Exec Lead - Dr Dheraj Bisarya and Dr Rakesh 2019-20 2019-20 2018-19 2018-19 Jaidka) Target Performance Target Performance
Dr A Bisarya (GP Exec 345 0 0 0 Lead - Dr Dheraj Bisarya) Expenditure not to exceed income 181,572 185,475 173,902 173,902
Parbold Surgery (GP Exec 821 (140) 0 0 Capital resource use does not exceed the amount - - 0 0 Lead - Dr John Kinsey) specified in Directions
Tarleton Group Practice 972 0 0 0 Revenue resource use does not exceed the amount 179,610 183,513 171,710 171,710 (GP Exec Lead - Dr Vik specified in Directions Mital) Capital resource use on specified matter(s) does not 0 0 0 0 Parkgate Surgery (GP 782 0 0 0 exceed the amount specified in Directions Exec Lead - Dr Peter Gregory) Revenue resource use on specified matter(s) does not - - 0 0 exceed the amount specified in Directions West Lancashire CVS (Lay 73 0 0 0 Member - Greg Mitten) Revenue administration resource use does not exceed 2,510 2,505 2,389 2,358 the amount specified in Directions OWLS 77 0 0 0
PDS Medical 353 0 0 0 As per the table above, the CCG did not meet its breakeven duty in 2019/20. Expenditure was £183.513m against a revenue resource limit of £179.610m, resulting in an in-year deficit of £3.903m. Renacres Hospital 4,262 0 0 0
Southport & Ormskirk 47,245 0 4,534 (6,309) Hospital NHS Trust
Lancashire Care NHS 13,428 0 1,051 0 Foundation Trust
Aintree University Hospi- 6,185 0 0 (243) tals NHS Foundation Trust
Wrightington, Wigan & 10,795 0 648 0 Leigh NHS Foundation Trust
Viran Medical Centre 226 0 0 0
96 97 [email protected] 01695 588000
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