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This may involve responding to our anticipatory equality duty to make ‘reasonable adjustments’, from requests received. 2 Contents Chair’s Introduction ............................................................................................................... 4 Performance Report .............................................................................................................. 6 Overview: About Stoke-on-Trent CCG ........................................................................... 6 Accountable Officer’s Introduction .................................................................................. 8 Performance Analysis ...................................................................................................... 11 Our principal risks ........................................................................................................ 11 Going concern ............................................................................................................. 11 Performance overview ................................................................................................. 11 Performance against key performance indicators ......................................................... 21 The CCG’s position at the end of the financial year ...................................................... 22 Sustainable Development ............................................................................................ 26 Discharge of statutory duties ........................................................................................ 28 Key Achievements in 2018/19 ...................................................................................... 53 Accountability Report .......................................................................................................... 68 Corporate Governance Report ........................................................................................ 68 Statement of Accountable Officer’s Responsibilities ..................................................... 74 Governance Statement ................................................................................................ 76 Head of Internal Audit Opinion ..................................................................................... 99 Remuneration and Staff Report ..................................................................................... 102 Remuneration Report ................................................................................................. 102 Staff Report ................................................................................................................ 115 Parliamentary Accountability and Audit Report .............................................................. 126 List of acronyms ............................................................................................................ 127 3 Chair’s Introduction This year marked the 70th anniversary of the NHS and my first as Chair of Stoke-on-Trent Clinical Commissioning Group (CCG), both landmarks of which I am extremely proud. The year 2018/19 has been both a challenging and a productive one for Stoke-on-Trent CCG, with our focus being very much on working as part of the wider Staffordshire health and care system and reinvigorating our engagement with our stakeholders and patients. As six CCGs across Staffordshire and Stoke-on-Trent operating under one Accountable Officer and executive team, we are working closely with our local authorities, hospital and community provider trusts, GP practices and the Third Sector. This is to create a more joined-up health and care system with the need for a seamless patient journey and more care delivered closer to home at its heart. We presented our proposed new model of care as part of our public consultation about the Future of Local Health Services in Northern Staffordshire. With an ageing population, and higher proportion of the population living with a long-term condition such as diabetes or heart disease, we need to find better ways to support patients to manage their health and stay well and independent for as long as possible. Our vision is that more care is delivered closer to patient’s homes, by a multi-disciplinary team of healthcare professionals considering the holistic needs of the patient, rather than the traditional condition-focussed approach. This should mean that patients feel better supported to managed their long-term conditions and that they need to go to hospital less often. When patients do need to go to hospital, they will need to spend less time there because there will be skilled teams working in the community to support them to recover at home and maintain their independence, or care for them whilst they regain it. We listened to the views of patients and the public at over 60 public events, as well as market stalls, outreach meetings and a paper and online survey over 14 weeks. The consultation closed on 17 March 2019 and we would like to thank all of the residents and patients of Northern Staffordshire who took the time to share their views with us, and indeed all of our staff who helped to deliver these events. We look forward to reading and considering all of the feedback that we have received and sharing the results in due course. We have developed new Membership Engagement Groups where the CCG meets monthly with GPs and practice managers from all of the practices in Stoke-on-Trent to ask their views on our plans and services. I attend as many of these as I can in person, to make sure that the CCG continues to live up to its fundamental design principle: that GPs are experts on the needs of their patients and our grassroots clinicians must be able to influence the health services that we commission. We have just emerged from winter where the healthcare system coped much better than it has done in the past. This year we saw patients waiting for less time in the Emergency Department and to be admitted and discharged from hospital beds; and no planned operations were cancelled this year. While there are still a lot of improvements to be made to our urgent and emergency care system, this is a hugely positive change compared with previous years and we look forward to building on these successes. I would like to personally thank all of our hard-working NHS staff across the hospital, community, general practice and social care services in Stoke-on-Trent for the continued dedication they show particularly during difficult times. 4 In January, we received the NHS Long Term Plan, which sets us challenges in terms of improving prevention of disease, as well as care quality and outcomes; and to deliver care in different ways using upgraded technology and digital solutions as well as new types of healthcare professionals. Locally, we have seen the variety of healthcare professional roles expand from Advanced Nurse Practitioners that most of us have become familiar with, to include: practice-based Pharmacists, Paramedic Practitioners, Physicians Associates and now Social Prescribers. These new roles are vital in our new model of community-based care, to ensure that patients receive the right care, in the right place at the right time - and to meet the growing healthcare needs of our population. In Stoke-on-Trent, we are also fortunate that we have a very active technology-enabled care (TECs) programme, which has received national plaudits for their innovative scheme to provide GP support to care homes via Skype. We are finalising plans for an Integrated Care Record which will make your important information available to health and care professionals working in whichever service you need to access, reducing the need to tell your story multiple times and keeping you safer. As I look forward to 2019/20 which is set to be challenging and exciting in equal measure, it would be remiss of me not to thank my predecessor Professor Ruth Chambers who stepped down as Chair at the end of December 2018. Ruth has been a champion for patient care in Stoke-on-Trent and she leaves big shoes to fill, but fortunately she continues to lead our TECs programme and so her wealth of experience and knowledge will not be lost to us. Dr Lorna Clarson Clinical Chair, Stoke-on-Trent Clinical Commissioning Group (CCG) 5 Performance Report Overview: About Stoke-on-Trent CCG Stoke-on-Trent CCG plans and buys (commissions) health services for local people. The membership of the CCG is made up of the GP practices – as GPs, they are best placed to understand what services their patients need. We are run by a ‘Governing Body’ that includes a mix of GPs, a secondary care consultant and local lay members. We buy services from hospitals, mental health and community health bodies and charities. We do this alone or in partnership with other local CCGs. We