Annual Report and Accounts 2013-2014 Contents Member practices introduction 1 Strategic report 3 Our organisation 3 Our priorities 4 Challenges and future plans 6 Our Local Commissioning Groups (LCGs) 7 Our performance 13 Engagement and involvement 23 Where we are now 24 Strategic overview 26 Emergency planning, resilience and response 27 Better payment 28 Risk management 28 Sustainability 29 Equality report 30 Members’ report 33 Complaints handling 36 Employee consultation 37 Employees with a disability 37 Equal opportunities38 Pension liabilities 38 Sickness absence 38 External audit 39 Our Governing Body members 2013-14 39 Declarations of interest 42 Remuneration report 45 Statement of Accountable Officer’s responsibilities 49 Annual governance statement for the year ended 31 March 2014 51 Independent auditors’ report to the Members of Cambridgeshire and 65 Peterborough Clinical Commissioning Group Accounts 2013-2014 69 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14 Member practices introduction The new Health and Social Care Act came into force from April 2013 which gave responsibility for clinical commissioning to the newly established Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) which is formed from 108 Member practices across the area. As we had been running in shadow form in 2012-13, we were well placed to take on the challenges brought about by this change. Our CCG is funded per head of population according to a national formula and has the lowest per capita funding in the East of England, is the lowest in the Anglia area and one of the lowest in the country. i) In 2013-14 the CCG received £961 per head using a registered population of 883,371; ii) This was the lowest in the East Anglia area which had an average per head funding of £1,054; and iii) This information is from the NHS England‟s „Two Year Allocation‟ tables. Along with our partners, we have been calling for a revised formula for allocations that better meet the needs of our growing and ageing population. The CCG Allocations for 2014-15 and 2015-16 have been published. The new formula goes some way to address our concerns but it will be some time before we reach a fair level of funding. This past year has been focussed on improving quality and improving efficiency for our local population. Our three priorities for change and improvement are: Improving Healthcare for Older People; Improving End of Life Care; and Tackling Inequalities in Coronary Heart Disease. We have made significant progress on all of these throughout the year which we have detailed further in the Strategic Report. Our eight Local Commissioning Groups were key to developing these priorities and have worked hard to ensure our success. We have continued to develop our new organisation. Results of two Organisational Health Surveys in May and December show significant improvement in many areas. Areas of improvement included: Communications between staff and their managers; Staff feeling that good performance is recognised and rewarded in the CCG; and A strong belief that there is an opportunity for every member of staff to have a „voice‟ and raise ideas, concerns, and to influence the direction of CCG. It was encouraging to receive these results, given the challenges that we faced to drive up performance in a financially challenged environment. In March this year we moved staff based at Peterborough Town Hall into the City Care Centre. The move helped us make considerable savings to our running costs while also enabling us to work more flexibly. In the 2013-14 financial year we commenced a procurement process to provide improved services for all non-planned care for people over the age of 65 and adult community services. In March, we commenced the public consultation on the proposals by the four final bidders. We expect to appoint the successful bidder in September 2014, with new services commencing in early 2015. 1 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14 We continually monitor and measure our performance against agreed local and national targets to ensure that the services we commission on your behalf meet your needs. We are also committed to commissioning the very best quality services for our population within our resources. In summary and looking forward, as outlined in our five year plan, our overall strategic aims over the next two years are to: Implement the Government‟s Mandate to the NHS; Commission services for a rapidly growing population with differing health need; Take a fresh approach to commissioning e.g. outcomes based; More integration; and Operate successfully within a financially-challenged health economy. The Governing Body has already had a large impact in the way the CCG delivers its business objectives, as outlined above, and will continue to do so over the coming year. Members had the opportunity to consider the performance of the CCG at its quarterly Member Practices event in April 2014, looked at the response to the stakeholder survey and considered possible response to improve GP engagement. Local Commissioning Group Chairs have also agreed the Member Foreword in light of comments made by members at the meeting. The Governing Body is currently undertaking a review of its effectiveness and will have a full development day in June. The outcomes of the review will be communicated to member practices and an action plan prepared to support the CCGs continuing development. On behalf of the Governing Body, we would like to thank our staff, our Local Commissioning Groups, our partners and all those who we work with for their help and support over the past year. 2 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14 Strategic report Our organisation NHS Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) is the third largest CCG in England covering a population of over 890,000 across 108 GP practices. It has structured itself into eight Local Commissioning Groups (LCGs) so that local clinicians can commission for local need. The CCG was licenced from 1 April 2013 under provisions enacted in the Health & Social Care Act 2012, which amended the National Health Service Act 2006 with two conditions. These relate to the two following criteria: Clear and credible plans that set out how CCGs will take responsibility for service transformation that will improve quality within available resources. CCG has a clear and credible integrated plan, which includes an operating plan for 2013- 2014, draft commissioning intentions for 2013-14 and a high-level strategic plan until 2014-15. Clear and credible plans that set out how CCGs will take responsibility for service transformation that will improve quality within available resources. CCG has detailed financial plan that delivers financial balance, sets out how it will manage within its management allowance, and any other requirements set by the NHSCB and is integrated with the Strategic Plan. NHS England reviews the conditions on a quarterly basis, linked to the CCG Assurance process led by the Area Team. These two conditions remained in place during 2013-14 and remain in place to date due to the financial challenges the CCG continues to face. The accounts have been prepared under a Direction issued by the NHS Commissioning Board under the National Health Service Act 2006 (As amended). An unqualified opinion has been given with respect to the financial statements; nevertheless, a report has been issued to the Secretary of State for Health under Section 19 of the Audit Commission Act 1998 for the breach of financial duties due to the CCG‟s deficit position. Our vision Our vision is that the CCG is led locally by clinicians in partnership with their communities, commissioning quality services that ensure value for money and the best possible outcomes for those who use them. Our mission To empower our communities to keep healthy and to commission good quality healthcare for all those who need it. Our values Patient focused – Our population, patients and their families are at the centre of our thoughts and actions, and we will commission care tailored to their needs; 3 NHS Cambridgeshire & Peterborough CCG - Annual Report and Accounts 2013-14 Quality driven – We will constantly strive to be the best we can be as individuals and as an organisation and we will ensure that this is reflected in our commissioning decisions; Work locally – Through our Local Commissioning Groups working within their communities; and Excellent – Our aim is to be an excellent organisation, for our communities, clinicians and our staff. Our priorities At the start of the CCG, the members set three key strategic clinical priorities for implementation: The Older People's Programme aims to design and buy-in health and social care services for a defined population of older or vulnerable patients within the CCG's area. The aims are to deliver improved patient experience, better community care and reduce unplanned admissions to hospital where they can be safely avoided. Several bidders put forward their proposals at the end of 2013 and shortlisting took place in March 2014. At that time we felt we had reached a stage where we had enough information to hold a meaningful consultation and a public consultation was launched on 17 March 2014. Through this public consultation, views on the bidders‟ initial proposals will be fed into the development of the bidders‟ final proposals. A clinically-led programme has been established to take forward Improving end of life care. The rationale for selecting this priority acknowledged that the CCG already does relatively well at enabling patients to die in their preferred place of death, but there is significant variation geographically and in terms of disease. In Cambridge City 38% of deaths were in hospital, whereas in Peterborough/ Fenland the figure is 48%.