Annual Report and Accounts 2017/18 May 2018 Contents 1. Foreword from Joint Accountable Officer for Surrey Heartlands CCGs and Clinical Chair 6 2. Performance Overview 8 2.1. Introduction 8 2.2. Our population and characteristics 9 2.3. Our member practices 10 2.4. Purpose and activities of the CCG 10 2.4.1 Vision, mission and values 11 2.4.2 CCG structure 12 2.4.3 Managing conflicts of interest 12 2.5. Surrey Heartlands Health and Care Partnership 13 2.6. Key issues and/or risks that could affect the CCG’s delivery of its objectives 15 2.7. Explanation of going concern basis 15 2.8. Performance overview 16 2.8.1. A summary of our year 16 2.8.2. Children and young people 19 2.8.3. Mental healthcare for adults 20 2.8.4. Supporting people with learning disabilities 20 2.8.5. Young carers 21 2.8.6. Safeguarding adults and children 21 2.8.7. Urgent and emergency care 21 2.8.8. NHS Continuing healthcare 22 2.8.9. Medicines management 24 2.8.10. Cancer care 25 2.8.11. Improving stroke care 26 2.8.12 Primary care 27 2.8.13 Planned care 28 2.8.14 Urgent care and integration 29 2.9. Performance analysis - finance 30 2.9.1. Introduction 30 2.9.2. Financial summary 30 2.9.3. Financial expenditure and Statement of Financial Position 30 2.10. Performance analysis - sustainable development 35 2.10.1. Introduction 35 2.10.2. Modelled Carbon Footprint 35 2.10.3. Policies (Sustainable Management Development Plan) 35 2 2.10.4. Contracts (and how we work with others to ensure sustainability is met) 36 2.10.5. Rural proofing 36 2.10.6. Summary of performance 36 2.10.7. Future strategy 37 2.11. Performance analysis - improving quality 38 2.11.1. How the CCG monitors and improves quality of services 38 2.11.2. Performance against national schemes and indicators 40 2.11.3. Better Care Fund metrics 41 2.11.4. NHS Outcomes Framework and Indicators 41 2.11.5. NHS Constitution Standards 46 2.12. Engaging people and communities 50 2.12.1. Introduction 50 2.12.2. How we engaged and involved local communities and partners in 2017/18 50 2.12.3 Structure and resources 50 2.12.4. Partnership working 51 2.12.5. Key engagement activity 52 2.12.6. Involving people in their own health and care 55 2.12.7 Looking ahead 55 2.12.8. Responding to FOIs 56 2.12.9 Principles for Remedy - How the CCG manages complaints 56 2.13. Reducing health inequalities 58 2.13.1. Introduction 58 2.13.2. Equality analyses 58 2.13.3. Equality objectives 58 2.14. Health and Wellbeing Strategy . 59 2.14.1. Introduction 59 2.14.2. Improving children's health and wellbeing 59 2.14.3. Improving older adults' health and wellbeing 60 2.14.4. Promoting emotional wellbeing and mental health 62 2.14.5. Developing a preventative approach 63 2.14.6. Safeguarding the population 65 3. Corporate Governance Report 67 3.1. Members’ Report 67 3.1.1. Introduction 67 3.1.2. Council of Members – members and performance 67 3.1.3. Governing Body – members and performance 67 3 3.1.4. Registers of Interest 68 3.1.5. Governing Body Committee Framework 69 3.1.6. Audit Committee – role of committee and members 69 3.1.7. Quality Committee – role of committee and members 70 3.1.8. Finance and Performance Committee – role of committee and members 70 3.1.9. Remuneration Committee – role of committee and members 71 3.1.10. Collaborative working 71 3.1.11. Personal Data related incidents 72 3.1.12. Statement of Disclosure to Auditors 73 3.1.13. Modern Slavery Act 73 3.2. Statement of Accountable Officer’s Responsibilities 74 3.3. Governance Statement 76 3.3.1. Introduction and context 76 3.3.2. Scope of responsibility 76 3.3.3. Governance arrangements and effectiveness 76 3.3.4. UK Corporate Governance Code 77 3.3.5. Discharge of Statutory Functions 78 3.3.6. Risk management arrangements and effectiveness 78 3.3.7. Capacity to handle risk 79 3.3.8. Risk assessment 79 3.3.9. Assurance sources - Internal Control Framework 80 3.3.10. Assurance sources - Annual audit of conflicts of interest management 80 3.3.11. Assurance sources - data quality 81 3.3.12. Assurance sources - information governance 81 3.3.13. Assurance sources - Business Critical Models 81 3.3.14. Other sources of assurance – third party assurances 84 3.3.15. Control issues 84 3.3.16. Review of economy, efficiency and effectiveness of the use of resources 84 3.3.17. Delegation of functions 84 3.3.18. Counter fraud arrangements 85 3.3.19. Head of Internal Audit Opinion 85 3.3.20. Review of the effectiveness of governance, risk management and internal control 91 3.3.21. Conclusion 91 3.4. Remuneration Report 92 3.4.1. Introduction 92 3.4.2. Remuneration Committee - Members and Performance 92 4 3.4.3. Policy on the remuneration of senior managers 92 3.4.4. Remuneration of Very Senior Managers 92 3.4.5. Pension benefits 96 3.4.6. Compensation on early retirement or for loss of office 97 3.4.7. Payments to past members (directors) 97 3.4.8. Pay multiples (Fair pay disclosure) 98 3.5. Staff Report 99 3.5.1. Introduction 99 3.5.2. Number of senior managers 99 3.5.3. Staff numbers and costs 100 3.5.4. Staff composition . 100 3.5.5. Sickness absence data 103 3.5.6. Staff policies 104 3.5.7. Expenditure on consultancy 105 3.5.8. Off-payroll engagements 105 3.5.9. Exit packages, including special (non-contractual) payments 108 3.5.10. Recruitment 108 3.5.11. Equal opportunities for our workforce 109 3.5.12. Staff engagement and consultation 110 3.6. Parliamentary Accountability Audit Report 111 4. Audit opinion on CCG’s financial statements 112 5. Financial statements 116 5.1 Statement of Comprehensive Net Expenditure 116 5.2 Statement of Financial Position as at 31 March 2018 117 5.3 Statement of Changes in Taxpayers’ Equity for year ending 31 March 2018 118 5.4 Statement of Cash Flow for year ending 31 March 2018 119 5.5 Notes to the financial statements 120 5 1. Foreword from Joint Accountable Officer and Clinical Chair It has been a busy twelve months for us as a Clinical Commissioning Group and during that time we have seen some really exciting developments, as well as a number of changes. Following a number of changes in the CCG’s executive management team, we both took up our roles at Surrey Downs during the year. This has given the organisation continuity in its leadership and it has also helped facilitate closer working across Guildford and Waverley, North West Surrey and Surrey Downs CCGs, and across the wider Surrey Heartlands Health and Care Partnership. To further strengthen these arrangements, in November our new Joint Executive Team took up their posts. This includes a number of posts that are shared across the three organisations and signalled the start of a much more collaborative way of working across the three organisations. This closer working offers many benefits in terms of efficiency and working smarter, where we can share our resources and reduce duplication. However, the local focus remains crucial and each organisation will continue to operate as a statutory organisation, at a very local level, to commission healthcare services that are tailored to the needs of local populations and local communities. Through our coming together as the Surrey Heartlands Health and Care Partnership, which covers a population of around 850,000 people across the areas covered by the three CCGs, we can work together, with local healthcare organisations, to address some of the bigger challenges we face as a system. This will compliment and support the work happening at a local level and help us deliver improvements at scale, across a wider geography, bringing together commissioners and healthcare providers to work as one team to deliver the improvements needed to make the local health economy work more effectively. As a commissioning group, a key focus for us is looking for ways to improve care for local people and over the past twelve months we have introduced a range of new initiatives and services that have made a real difference. For example, we have introduced a new community dermatology service for people with skin problems that is helping to detect and diagnose problems much earlier, in GP practices. In the past, these patients would have been referred on for a hospital appointment so this new service, which has recently won a Health Service Journal Award for its use of new technology, is helping patients to be seen more quickly, leading to more rapid detection of skin cancer. This year we have continued to work with High Street optometrists to offer a wider range of eye care services in the community and we have launched a new community glaucoma monitoring service, which means people with cataracts who are now in a stable condition can be monitored and supported by a local community team. Given our ageing population, and that long-term health conditions are much more common as we get older, supporting our older and frail members of the community is another important area we are continuing to invest in.