Richmond Clinical Commissioning Group Annual Report and Financial Accounts 2018/19 Contents PERFORMANCE REPORT Welcome from Accountable Officer and Chair Page 3 Performance overview Page 4 Corporate objectives Page 4 The Richmond story Page 6 Summary of achievements during 2018/19 Page 8 Performance analysis Monitoring the quality of health services Page 29 Patient advice and liaison services and complaints Page 30 Freedom of Information (FOI) Page 31 Performance summary Page 31 Sustainability report Page 37 Patient and public engagement (PPE) Page 40 Equality report Page 47 Reducing health inequalities Page 47 Health and wellbeing strategy Page 53 ACCOUNTABILITY REPORT Corporate governance report Members’ report Page 58 Statement of Accountable Officer’s responsibilities Page 75 Governance statement Page 77 Risk management arrangements and effectiveness Page 79 Head of internal audit opinion Page 87 Remuneration and staff report Remuneration report Page 91 Staff report Page 98 Parliamentary accountability and audit report Page 107 Annual Accounts Annex 1 External Audit Opinion Annex 2 2 | Page Welcome from Accountable Officer and Chair Welcome to NHS Richmond Clinical Commissioning Group’s Annual Report for the financial year 2018/19. We have been working as part of the South West London Alliance with our partners Kingston, Sutton, Merton and Wandsworth CCGs for two years now, sharing expertise and making more efficient use of resources. Richmond and Kingston CCGs have also been working together during this time as a local delivery unit within the Alliance headed by Tonia Michaelides as Managing Director. Merton and Wandsworth CCGs have also been operating in this way. In July 2018, the NHS turned 70 and we celebrated the occasion with a range of activities with our partners across the borough. On the day itself a group of our staff attended a service in Westminster Abbey in celebration of the NHS’s 70th birthday. Following publication of the NHS Long Term Plan in January 2019, our governing bodies in south west London are now discussing a potential merger of all six south west London CCGs which would be implemented by April 2020. This would bring a number of benefits, such as reducing duplication, pooling resources and, cutting management costs by 20% – money that will be redirected to patient care. We are now working with our staff and all of our partners on how we can make this happen. We are also working with our GP membership to support the development of primary care networks, which aim to spread best practice more easily, reduce bureaucracy, help alleviate workload pressures and allow GPs to concentrate on the most complex patients. In 2018/2019, we are already seeing the benefits of working together in south west London. One example of this is south west London‘s Health and Care Partnership commitment to champion children and young peoples’ mental health and well-being. This year has seen exciting developments in a new programme bringing together school leadership teams with health and social care professionals to deliver training 3 | Page and support for children and young people, their families and teachers. You can read more about it in this report. Health and care organisations across south west London have formed local partnerships to develop local health and care plans. To help shape our plans, we hosted a partnership engagement event in Twickenham which brought together health and care staff, local people and representatives from different community organisations to talk about what’s important for health and care in Richmond. The local partnership has identified priority areas for improvement and it is clear that health and care organisations must be more joined up, particularly in areas where no single organisation can make progress alone, like improving mental health, combating childhood obesity, and encouraging active, resilient and inclusive communities that support older people to live at home independently. It was fantastic to hear from local people who are clearly very passionate about improving health and care in Richmond and who brought a range of fresh ideas. We are also pleased that we have been shortlisted for a Health Service Journal Value Award for these local partnership events. The nomination shines a light on the importance of engaging residents and frontline staff when bringing together health and care services. Finally, we would like to say a huge thank you to our GP members, staff, health providers, our partners and stakeholders for all your support over the year. I am grateful for your hard work and dedication which helps us to provide the best possible healthcare we can for the people of Richmond. We are looking forward to working with you all further in the year ahead. Sarah Blow, Accountable Officer South West London Alliance (Kingston, Richmond, Merton, Wandsworth and Sutton CCGs) Date: Dr Graham Lewis, Chair of Richmond CCG Date: 4 | Page Performance overview This section of the annual report gives an overview of the CCG’s corporate objectives, the health profile of its communities and a review of its activities during 2018/19. Richmond CCG (the CCG) has a vision to deliver the best possible health and wellbeing outcomes for the local community, within the resources available. It does this through using a combined leadership of local GPs, a nurse and secondary care clinician, independent lay people, public health, local authority and NHS commissioning staff. Richmond CCG works with patients, partners and member practices to commission safe, effective health services that continuously improve health outcomes, patient experience and reduce health inequalities. We strive to deliver cost effective, sustainable and integrated health services. The CCG works in partnership with colleagues within the South West London Alliance (Kingston, Richmond, Merton, Wandsworth and Sutton CCGs), from NHS England, NHS trusts and other providers, CCGs, Richmond Health & Wellbeing Board, local authorities and the voluntary sector. Corporate objectives Working together Kingston and Richmond CCG has developed a shared set of corporate objectives for 2018 to 2020 which has guided our work and influenced our commissioning decisions. They are as follows: 1. Enable local people, patients, carers and stakeholders to have greater influence on the services we commission and keep the patient voice at the centre of what we do. 2. Improve the quality, safety and effectiveness of healthcare services and ensure that national performance targets are met and that people experience high quality care. 3. Work in partnership with local health and care providers, commissioners and the voluntary sector to improve and transform services that achieve better health outcomes, are accessible and reduce inequalities. 5 | Page 4. Ensure the continued development of the CCG as a clinically-led and well governed organisation with strong leadership, and effective membership and staff engagement. 5. Achieve a financially sustainable health economy balancing the need for effective use of resources and better value for money with the need for innovation. Statutory duties Deliver our statutory and organisational duties and ensure the CCG is a highly effective membership organisation. The Richmond story See Richmond’s Strategic Needs Assessment for more information about local health and social care needs https://www.richmond.gov.uk/jsna 6 | Page 7 | Page Summary of achievements during 2018/19 Children and young people’s mental health Across south west London we are working to do more to ensure that children and young people get the mental health and emotional wellbeing support they need. Our partnership approach brings together school leadership teams with health and social care professionals to deliver training and support for children and young people, their families and teachers. “A lot of teachers are really lacking the confidence when it comes to addressing or talking about mental health issues in children and young people. Improving their awareness and confidence (as well as their own wellbeing) is key.” – teacher feedback Support workers will be put in place in schools to offer both one-to-one support and group-work sessions for pupils and parents. The sessions they will deliver will give children and young people practical skills for managing a range of feelings and offer parents an opportunity to practise the conversations that encourage better mental health and wellbeing. Where needed, they will also signpost or refer to specialist child and adolescent mental health services. This new way of working will initially be piloted in around 15% of schools in south west London. We will be seeking to gather evidence to demonstrate that this new way of working makes a difference. Our ambition is to ensure that all schools across south west London will be included in the future. Neuro-developmental assessments for children and young people in Richmond During 2018/19 we piloted a new local specialist assessment clinic for children and young people aged 6-18 years with suspected autism (without complex co-morbid problems, such as additional physical and / or mental health problems.) The service delivered by Richmond Council’s Achieving for Children team proved to be successful in delivering 73 local assessments with an average wait time of 2–4 weeks. This pilot service will now be commissioned on a longer term in Richmond and introduced in Kingston from April 2019. 8 | Page Access target for treatment for children and young people with mental health conditions NHS England has set a national target that by 2021/2 at least 70,000 additional children and young people each year will received evidence based treatment for mental health conditions. This target means that at least 35% of children and young people with a diagnosable mental health condition will receive treatment from an NHS funded community mental health service. This target will be delivered over five years with year on year percentage increases. In Richmond we are well on the way to achieving the 32% target for 2018/19.