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Annual report and

accounts

2016/17

Contact us: Haringey CCG, River Park House, 225 High Road, Wood Green, N22 8HQ

Telephone: 020 3688 2700

Email: HARCCG.Info@nhs.net / Website: www.haringeyccg.nhs.uk

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Contents

Performance Report 3

• Overview

o Chair’s statement 4

o Purpose and activities of the organisation 6

o Key risks that could affect the CCG in delivering its objectives 23

• Performance Analysis

o Financial performance 24

o National performance targets 27

o Quality, safety and patient experience performance 38

o Haringey Better Care Fund performance 47

o Patient and public involvement and engagement 56

o Safeguarding adults and children 59

o Sustainable development 60

o Equality report 62

o Health and Wellbeing Board 65

Accountability Report 67

• Corporate Governance Report

o Members’ report 68

o Statement of Accountable Officer’s responsibilities 71

o Governance statement 73

• Remuneration and staff report

o Remuneration report 100

o Staff report 111

Financial Statements 116

Appendix 1

• Head of Internal Audit’s Opinion

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Performance Report

Overview

Analysis

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Overview The purpose of the overview section is to provide a short summary with enough

information to understand our organisation, its purpose, the key risks we are facing

and how we have performed during the year. Further detail is provided in

subsequent sections of the report.

1. Chair’s statement

On behalf of Haringey CCG’s member GP practices and staff, I

am pleased to present our annual report and accounts for the

year April 2016 – March 2017. This report highlights some of

our achievements and reflects on our performance over the past

year, including the progress we have made towards our goal of

enabling people in Haringey to live long and healthy lives with

access to safe, well co-ordinated and high quality services.

CCGs were established to give local, front-line clinicians more

responsibility for the design of local health services to deliver the

best outcomes for patients. Local clinicians are involved in the work of Haringey

CCG at lots of different levels – from our Governing Body (which I chair) that sets the

strategic direction for our organisation, to our clinical leads who are responsible for

different areas like mental health, urgent care and cancer, to the regular feedback

we receive from local GP practices about the quality of local services as part of our

insight and learning programme (p40).

All of the programmes and services that you will read about in this report have been

developed with clinical input. Examples include the development of clinics in GP

practices for children and young people which are jointly run by hospital

paediatricians and GPs (p10); the establishment of support programmes to help

people to be able to manage their diabetes and other long term conditions (p20); and

commissioning new primary care ‘hubs’ which will allow more people to be able to

see a GP or nurse at evenings and weekends (p21). We have also achieved a major

milestone this year to help us integrate our commissioning with the Council with the

signing of a section 75 partnership agreement. This agreement will enable us to

bring together our commissioning budgets for certain groups of people, including

children’s and adults’ mental health services (p16).

Nationally, many NHS trusts continue to experience pressures in their Accident and

Emergency (A&E) departments, particularly during winter time. Haringey is no

exception to this and there is lots of work that has been going on this year to provide

support to our local hospitals – both within the hospitals, and by developing

community and primary care services to support more people to stay well at home,

or to get home from hospital, with the support they need, more quickly. You can

read more about this in the performance analysis section (p27).

This year, we met all of our financial requirements in challenging circumstances.

More information on our financial performance is available on page 24. Money is

going to continue to be one of the biggest challenges for the CCG in the year ahead

as demand for services continues to grow, which stretches our resources. This

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remains one of the CCG’s highest risks (p23). We know we need to do more with

less or the same, and one of the ways we will do this is by continuing to work with

our partners to make the best use of resources; making sure services join up and

any gaps and duplications are minimised. This will include working closely with the

other CCGs, local authorities and providers in north central London on our

sustainability and transformation plan (p14); working more closely with Islington on

our wellbeing partnership (p14); and maintaining the good relationships we have with

our own local authority as we continue to work on our joint plans for integrating

services for people in Haringey (p47).

This year, we received some positive feedback from NHS England following their

annual review of how we engage and involve people in our work and the

development of services. They gave us an ‘outstanding’ rating for our collective

participation duties, and a ‘good’ rating for our individual participation duties. You can

read more about this on page 56.

I would also like to take this opportunity to formally thank Sarah Price who has been

the CCG’s Chief Officer since our inception. Sarah has moved on to a new role

which combines commissioning and public health in Manchester and we wish her all

the best. I also wanted to thank our staff, Governing Body members, partners,

patient representatives, member practices and the communities that we work with for

their contribution and support during this year.

We hope you will find this annual report informative. If you have any comments on it

or questions, please let us know.

Dr Peter Christian

Chair, Haringey CCG

2. New Accountable Officer for Haringey CCG

Helen Pettersen is the new Chief Officer and Accountable Officer for the five north

central London clinical commissioning groups (CCGs) – Barnet CCG, Enfield CCG,

Islington CCG, Haringey CCG and Camden CCG. This is a new post which has

replaced the Accountable Officers in the individual CCGs and is responsible for

leading on the delivery of the north central London Sustainability and Transformation

Plan (read about the STP on p14). Helen started in post on Monday 3 April 2017.

As the new Accountable Officer, Helen has signed all five CCG annual reports and

accounts for 2016/17. However, the content of the reports covers the year prior to

Helen’s start date (April 2016 - March 2017).

The chief officer statements have therefore been written from the perspective of the

CCG chief officers who were the accountable officers for their CCG during 2016/17,

where this is possible.

Sarah Price, Haringey CCG’s former Chief Officer and Accountable Officer, left

Haringey CCG on Friday 3 March to take up a new role in Manchester. Haringey’s

introduction has therefore been written by our Chair, Dr Peter Christian.

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3. Purpose and activities of the organisation

Who we are and what we want to achieve

Haringey Clinical Commissioning Group (CCG) came into being on 1 April 2013 and

is a clinically-led membership organisation comprising all member GP practices in

the London Borough of Haringey. You can read more about our member practices in

the Members’ Report (p68).

We are committed to serving our local people – our mission is to enable the people

of Haringey to live long and healthy lives with access to safe, well co-ordinated and

high quality services.

Our aims are to:

Commission high quality, valued and responsive services, working in

partnership with the public to make the best use of available resources

Promote wellbeing, reduce health inequalities and improve health outcomes

for local people

Improve the health and quality of life for people by commissioning integrated

health and social care delivered closer to home

You can find out more about who we are and what we do in this annual report and

on our website: www.haringeyccg.nhs.uk.

Our Governing Body

Haringey CCG’s Governing Body provides the strategic leadership of the

organisation and is responsible for making sure that the CCG always works in the

best interests of the local community. The Governing Body is chaired by a local GP

and is accountable to the public in Haringey and for the organisation’s use of public

funds.

You can find out more about our Governing Body members and the other CCG

committees in the Members’ Report. There are also short biographies of all our

Governing Body members on our website.

Our population

Haringey is an exceptionally diverse and fast-changing borough. We have an

estimated population of 267,540. Almost two-thirds of our population, and over 70%

of our young people, are from ethnic minority backgrounds, and over 100 languages

are spoken in the borough. Our population is the fifth most ethnically diverse in the

country.

The borough ranks among the most deprived in the country with pockets of extreme

deprivation in the east. Haringey is the 30th most deprived borough in England and

the 6th most deprived in London.

In the last 10 years the average life expectancy in Haringey has overtaken the

England average, with men now expecting to live over 80 years and women over 84

years. These extra years of life have been added largely by tackling the big killers

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such as heart disease and cancer through better treatments, as well as through

national and local strategies targeting risk factors such as smoking and high salt

consumption.

However, in spite of an overall improvement in life expectancy over recent years, not

all have benefitted, and inequalities in life expectancy remain. Women can still

expect to live more than 4 years longer than men in Haringey and men living in

Northumberland Park are still dying, on average, 7 years earlier than men in Crouch

End. The main causes of premature deaths in males that contribute to the gap

include cardiovascular disease, cancer and digestive system disorders.

If you’d like to know more about our population visit www.haringey.gov.uk/jsna to

view Haringey’s Joint Strategic Needs Assessment (JSNA). The JSNA describes

the health, care and wellbeing needs of the local population and is put together by

the public health team in Haringey Council. The JSNA helps the CCG and the

council commission the best services to meet the needs of the population.

Working with partners

Throughout this annual report, you will see examples of how Haringey CCG works

with a range of partners. This includes, but isn’t limited to, Haringey Council through

the Health and Wellbeing Board and integration projects; other CCGs, particularly

those in north central London; the voluntary and community sector; Healthwatch

Haringey; other NHS organisations and providers; and the Commissioning Support

Unit (CSU). CSUs provide support and advice to clinical commissioning groups. In

2016/17 Haringey CCG was supported by the North and East London

Commissioning Support Unit (www.nelondoncsu.nhs.uk). Areas of support included

HR and IT services, as well as contract management and procurement.

Our objectives and five year plan: 2014/15 – 2018/19

Haringey CCG has a ‘plan on a page’ which sets out our strategy and objectives for

a five year period which started in 2014/15. This is supported by a more detailed five

year plan document which was shaped and influenced by discussions with a number

of different stakeholders, including at public meetings, Governing Body meetings,

Health and Wellbeing Board meetings, engagement visits, Network meetings,

stakeholder events, Better Care Fund workshops, and discussions with providers,

staff and GP colleagues. Both of these documents are available on the CCG’s

website: www.haringeyccg.nhs.uk/about-us/plans.htm and the ‘plan on a page’ is on

the next page.

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Haringey CCG’s ‘plan on a page’ 2014/15 – 2018/19

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What have we done in 2016/17 to meet our objectives? The CCG is now at the end of the third year of delivering its five year plan. Here are

a few examples of the work we have done this year to support achievement of our

objectives.

Objective 1 – explore and commission new models of care

Value based commissioning - improving health outcomes Haringey CCG is strongly committed to using commissioning to drive improvements

in outcomes for our population over time. Over the past two years we have identified

the key outcomes where we are seeking to achieve improvements and we have

explored a range of ways of working together across the CCG, Council and provider

organisations to improve service delivery, improve health outcomes and make best

use of our health and care resource.

Over the past year this has led to us developing the Haringey and Islington

Wellbeing Partnership, a joint programme consisting of Haringey and Islington

councils; Haringey and Islington CCGs; Haringey and Islington GP Federations;

Whittington Health; University London College Hospital, North Middlesex University

Hospital; Barnet, Enfield and Haringey Mental Health Trust; and Camden and

Islington Foundation Trust. This partnership recognises the need to work together

across health and care organisations to a much greater degree than ever before to

meet the growing demand for care and respond to our changing population’s needs.

The work that Haringey has previously been involved in, on value based

commissioning, has formed a crucial basis for this work and has provided us with a

method for measuring outcomes of care so that we can gauge whether we are

making improvements over time. You can read more about the Haringey and

Islington Wellbeing Partnership on page 14.

The value based commissioning work for people with diabetes and older people that

we started in 2015/16 (see last year’s annual report) has continued and been further

developed. We have developed business cases for new models of delivering care for

these population groups, whilst working to make practical and immediate

improvements in how care is provided to them. The diabetes working group has, for

example, focused on reducing the variation that exists in the degree to which

people’s care is in line with the recommended treatment targets set out in NICE

guidance. It has also focused on increasing access to structured education for

people who are newly diagnosed or already diagnosed with diabetes. For people

with frailty we have particularly focused on identifying ways of moving towards earlier

intervention of frailty as a way of providing support to people before they reach a

crisis point.

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Children’s and young people’s pathways The Haringey and Islington Wellbeing Partnership (see p14) launched a Children

and Young People’s work programme in November 2016. This work programme has

three key priority areas: improvement of asthma care, reducing accident and

emergency (A&E) attendances and admissions, and improving transition from

children’s to adult services, especially for those young people with long term

conditions. Scoping work is now under way to identify some key interventions

across the two boroughs which will improve the model of care in Haringey and

Islington.

In recent weeks, Haringey CCG has also led the implementation of a Children and

Young People’s Network for North Central London which has seen clinicians,

commissioners and service managers come together to discuss improvements that

can be developed across the sector. This has led to the development of a specific

Children and Young People’s workstream for the North Central London Sustainability

and Transformation Plan (STP – see p14), which will mean improvements in care for

children across the whole sector.

At a local level, there has been a focus on collaborative working between Haringey

GP practices and the North Middlesex and Whittington Health hospitals in 2016/17.

This has led to the further development of the community allergy service for children

in Haringey which has provided more services locally and reduced the number of

referrals to secondary care. Other initiatives include the development of innovative

GP and paediatrician joint clinics in nine Haringey GP practices and the delivery of

paediatric training updates to Haringey GPs and practice nurses.

The CCG has also been working closely with North Middlesex University Hospital to

ensure there is additional paediatric consultant presence in A&E over the winter

months. In addition to this, children and young people, including young babies, can

now be seen in the urgent care centre by a GP which will ensure young children are

seen and treated as quickly as possible.

The Haringey Healthy Child Transformation Programme (for 0-5 year olds), led by

the public health team in Haringey Council, has now been fully implemented. All

Haringey families are now fully supported by their local health visitor universally

during pregnancy and the first two years of a child’s life. In particular, all 2-2 and a

half year olds now receive integrated health and development reviews to ensure

families receive the right help and information and that those who require additional

support, receive this as early as possible.

Mental health – Child and Adolescent Mental Health Services (CAMHS) Transformation As part of the national ‘Future in Mind’ programme, Haringey CCG, in close

partnership with Haringey Council, has been working with providers and

stakeholders to implement our five year local CAMHS Transformation Plan. As part

of this transformation we have addressed a number of the issues that were identified

in our 2015 review of CAMHS. These developments include:

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• The establishment of a new service called Choices, which accepts self and

parent referrals and offers a one-off appointment to discuss concerns around

emotional wellbeing and behaviour within four weeks of initial contact:

http://www.haringeychoices.org/.

• Increasing resource into pathways that have the longest waits including for

those with attention deficit hyperactivity disorder (ADHD), Learning Disabilities

and those accessing Open Door (a voluntary sector counselling and

psychotherapy service provided for young people aged 12-24).

• The development of a Section 75 agreement between the Council and CCG

to support a joint commissioning model which allows us to develop a whole

system approach to child and adolescent mental health and emotional

wellbeing.

• Trying new approaches such as peer support, parental peer support and a co-

produced lifeskills course for those approaching 18 years of age.

• Improving support to children in care through the development of a service for

those most vulnerable who have experienced multiple placement moves and

have been unable to engage with their local CAMHS service.

• Developing group support within Open Door for emerging eating disorders

and self harm.

• Improving links between CAMHS and community paediatric services, through

joint planning sessions, and the introduction of a CAMHS worker to support

the emotional wellbeing of families within the neurodevelopmental and social

communication paediatric diagnostic pathway.

• Training for a broad range of professionals working with children and young

people including GPs, Children and Young People’s Services staff, health

service staff and schools on mental health.

• Working with schools to improve attachment aware practice within the

classroom.

Haringey was also selected as one of ten boroughs to participate in a joint

Department of Education and NHS England pilot to look at developing mental health

links in schools, and one of five boroughs to be successful in the extension pilot

which we are completing around support to young carers in partnership with Family

Action, Barnet, Enfield and Haringey Mental Health NHS Trust, Haringey SHED and

Haringey Council. As part of this work there has been improved protocols for

communication between CAMHS and schools and a conference was held in July

2016 for over 100 professionals to learn more about mental health, emotional

wellbeing and available services.

The work with young carers included a number of elements aimed at supporting the

emotional resilience of young carers, working closely with schools. One of the

outcomes was the development of a video made by young carers supported by

Haringey SHED. This video is being used as part of a training package on young

carers being delivered across health, education and social care teams:

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https://youtu.be/4sETL7nZSvA. We are now using the learning from the pilot to

develop a joint strategy for young carers with the Council.

North Central London Transforming Care Programme

The three year (April 2016 to March 2019) Transforming Care Programme (TCP)

aims to reduce the number of adults and children in hospital with learning disabilities

and/or autism, with behaviour that challenges, including those with a mental health

condition, and support them to live independently in the community. The programme

is overseen by a Board of Chief Officers from North Central London (NCL) CCGs

and Local Authorities, with parent and carer representatives, NHS England

representatives and other key stakeholders.

We have a programme plan and aim to deliver the following projects:

A multi-agency team to help plan more joined up care and support for long

stay TCP patients and five Senior Care Coordinators to case manage, support

and undertake discharge planning for long stay TCP patients

A Positive Behaviour School of Excellence to develop and roll out training to

clinicians, practitioners, providers and families to help them understand

challenging behaviours, behavioural triggers and how to manage these

behaviours effectively.

An accommodation project to source suitable housing for TCP patients, with

bespoke supported living packages, particularly those with severe autism,

high risk of offending behaviour, and other complex needs

Provider engagement to develop the market to support people with complex

needs.

There were 81 north central London inpatients in April 2016, and we have a target to

reduce this to 48 by March 2019. At the end of the first year of the programme (31

March 2017) we had 71 inpatients – a 12% reduction. We are well within our target

at the end of year 1, however, targets are more ambitious in years 2 and 3 of the

programme.

QIPP programme Haringey CCG’s Quality, Innovation, Productivity and Prevention (QIPP) programme

is a clinically-led programme of work that focuses on improving the quality and

efficiency of local healthcare services and helps to reduce the number of patients

who are seen in hospital settings; helping them to be seen in the community, closer

to their homes.

This year the CCG needed to deliver a QIPP plan of £12.6m to deliver a balanced

financial position in 2016/17.

Some of the schemes that have performed well this year are:

Community Urology - where patients are seen in community clinics nearer to

home rather than in hospital.

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Community Dermatology - where patients are treated by local GPs with

expertise in dermatology rather than being referred to hospital.

Calprotectin testing in the community which is done by local GPs. This testing

relates to bowel conditions and helps to determine whether a hospital referral

is required.

Some of the schemes which have underperformed this year or experienced certain

challenges include ‘Right Care’ (www.rightcare.nhs.uk), Community Ophthalmology

and Primary Care Demand Management (this means looking at the referrals that

GPs make for their patients to hospitals and other services, and trying to reduce any

unnecessary referrals). The CCG has been actively involved with NHS England

regarding the implementation of the Right Care initiatives, and will continue to work

closely with them on these initiatives. We are also taking the following specific

recovery actions to turn around the other schemes:

Streamlining booking processes for the Community Ophthalmology service –

this means working to make it much easier for people to book appointments

and use this service in the community.

Working with our GP practices to help them to look in more detail at the

referrals they make for their patients. We will also be doing a lot more to

promote our community services to GPs and explaining the benefits they offer

to patients with certain conditions.

For 2017/18 all acute QIPP schemes were agreed with providers across the five

North Central London (NCL) CCGs. For Haringey CCG, £6.6m of acute QIPP was

agreed with providers and has been included in their contracts. Going forward, QIPP

schemes will be delivered under the Sustainability and Transformation Plans (STP).

The STP QIPP will be a shared plan between the five NCL CCGs and the main

providers who will work collaboratively to improve quality and activity.

Some local QIPPs will remain; however, 85-90% of future schemes will be part of the

STP programme.

All of Haringey’s QIPP projects and schemes continue to be overseen by the QIPP

Delivery Group whose membership includes members of the CCG’s Governing

Body, QIPP team, senior management and commissioners.

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Objective 2 – More partnership working and integration

Supporting everyone to be healthy and have a high quality of life for as long as

possible is a core aim for the Haringey CCG and our partners. As such, we have

worked closely with the local council, other CCGs and councils, GPs and providers

to implement new programmes that integrate services to improve delivery and

outcomes for local people.

North Central London (NCL) Sustainability and Transformation Plan

(STP) The health and care system across North Central London (NCL) - clinical

commissioning groups, local authorities and NHS providers – have been working

together to develop an NCL-wide sustainability and transformation plan (STP). This

sets out how local health and care services will transform and become sustainable

over the next five years, building and strengthening local relationships and ultimately

delivering the NHS Five Year Forward View strategy at a regional level. The North

Central London area includes the CCGs, borough councils and NHS Trusts in

Barnet, Camden, Enfield, Haringey and Islington.

During 2016/17, the NCL STP put a governance structure in place to enable NHS

and local government organisations to work together in a new way to develop our

plan. We are now reviewing this governance structure to ensure that it is fit for

purpose as the programme moves from planning to implementation. We have put

dedicated resources in place to support the planning process in 2016/17 and we are

currently reviewing the capacity we need to drive forward delivery from April 2017. It

is crucial that the whole system is aligned and committed to the delivery of the STP

and we have ensured the two year health contracts that are in place for 2017/18 -

2018/19 are consistent with the STP strategic framework.

The NCL STP has 13 areas of focus and each workstream is led by a senior

responsible officer. Workstreams include priorities like mental health, cancer, urgent

and emergency care and prevention. Over the past months, each workstream has

been developing proposals for how they will meet the challenges ahead through new

models of care, technology and other new ways of working.

More information about the STP, including a copy of the draft plan, is available on

the CCG’s website: www.haringeyccg.nhs.uk/about-us/sustainability-and-

transformation-plan.htm

Haringey and Islington Wellbeing Partnership Commissioners and providers of health and social care organisations in Haringey

and Islington formed the Haringey and Islington Wellbeing Partnership this year to

support the work of the Sustainability and Transformation Plan (STP) to improve the

health and wellbeing of both boroughs ’ populations.

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The partnership will support the work of the STP by helping commissioners and

providers to work differently and even more collaboratively. Haringey and Islington

already have a strong history of working together and there are many similarities in

the health and care needs of the two populations. Coming together in this way will

provide a better understanding of how services are provided across all organisations

and help identify opportunities to add value, improve outcomes and reduce

duplication and costs. The partnership’s plans are aligned with the STP and will

place both CCGs in a better position to deliver on the wider transformational change

required, as well as focus on additional improvements to meet local needs.

We are already working together successfully in some areas, but are now looking to

develop a formal alliance across health and social care. This will be between partner

organisations (CCGs, councils, NHS providers and GP Federations) and will mean

we consider how we deal with our challenges together. Work has already taken

place to identify the areas and population groups where we think we could organise

ourselves better to improve outcomes for people and reduce costs.

For example, as part of our work to improve the prevention and management of

diabetes, we have used results from local surveys of people with the condition to

understand which areas of care we need to look at. As a result, we are starting

projects on improving access to diabetes education and self-management. This will

support work to reduce complication rates from diabetes through better control of

blood pressure, blood sugar and cholesterol. In addition to improved education and

self-management we are working to ensure people with diabetes have access to

emotional and psychological support. As part of our work to help prevent strokes and

heart attacks, we secured funding from the British Heart Foundation to perform

10,000 blood pressure checks with voluntary and community organisations in

community settings over the next two years.

Musculoskeletal services are also a key focus for the partnership, and to fully

understand the pathway and challenges faced, we started the process by meeting

with clinicians and shadowing clinics. Working together with clinicians we have

looked at innovative services across the country and are currently drawing up plans

to change services locally. A number of these changes will be in the short term and

will include trials such as testing the effect of having physiotherapists and extended

scope practitioners in three Islington GP practices, with a view to extending to

Haringey if effective. Other initiatives include ensuring that notes on treatment plans

are transferred routinely between orthopaedic surgeons and physiotherapists so that

physiotherapists are clear on the patient’s requirements.

Securing a future for mental health services Haringey CCG has continued to work with Barnet, Enfield and Haringey Mental

Health Trust (BEH MHT) and Whittington Health to sustain and improve the delivery

of specialist mental health services. We are also working with NHS and Local

Authority partners across north central London on the mental health workstream of

the Sustainability and Transformation Plan. The workstream sets out how we will

address some of priorities of the Five Year Forward View for mental health, for

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example the growth of perinatal mental health services for pregnant women and new

mothers.

Haringey Council and CCG have reached a major milestone to help integrate their

commissioning with the signing of a section 75 partnership commissioning

agreement. The agreement creates a formal partnership which brings together the

commissioning budgets of both organisations for specified client groups, including

adults and children’s mental health services. The CCG is taking the lead for mental

health services on behalf of both partners, and putting in place new governance and

commissioning arrangements accordingly.

NHS 111 and Out of Hours service We are working with the four other CCGs in North Central London (Barnet, Camden,

Enfield and Islington) to develop and launch an integrated model of NHS 111 and

GP out of hours services for all patients in the North Central London area. The new

system is helping these services work better together and is designed so that people

calling NHS 111 will be able to access the help they need more quickly and

efficiently.

The five year contract for the new integrated service was awarded to London Central

and West Unscheduled Care Collaborative (LCW), a GP-led not-for-profit

organisation, and the current NHS 111 provider for Barnet, Camden, Enfield,

Haringey and Islington. The service launched in October 2016.

We have also been working with the Healthy London Partnership (see p16) and the

other North Central London CCGs to trial a new NHS 111 app, which will allow North

Central London residents to access instant, safe and accurate medical advice from a

mobile device, such as a smartphone or tablet. The trial began in January 2017 and

will run for six months. The app can be downloaded from either the App Store or

Google Play by searching for ‘NHS 111’.

Healthy London Partnership – London CCGs working together to

support the delivery of better health in London Haringey CCG, along with every other London CCG and NHS England (London),

has made a commitment through the Healthy London Partnership (HLP) to unite and

amplify the work of our partners to support the transformation of health and care in

London. Our partners include the Greater London Authority, Public Health England,

London councils and Health Education England and through Healthy London

Partnership we are working to deliver changes that are best done ‘once for London’.

Collectively we believe it is possible to achieve a healthier, more liveable global city

by 2020, by delivering on the ambitions set out in Better Health for London: Next

Steps and the national NHS Five Year Forward View.

Highlights this year include the development of London-wide standards for people

experiencing a mental health crisis endorsed by all London mental health trusts,

London Ambulance Service, London Councils and the Met Police. During 2016-17

we facilitated a year-long engagement with Londoners on childhood obesity, called

the Great Weight Debate, which reached over half a million Londoners on social

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media, saw 3,900 people fill in our survey, nearly 2,000 people attend roadshows

during October half term and culminated in 60 teenagers working through the issues

at a Hackathon in January 2017 at City Hall. London’s young people also helped us

design and launch a mobile health website and app called NHS Go that gives them

targeted health information plus health advice and signposts to services – approx.

30,000 people are now using NHS Go. Watch their launch video.

Healthy London Partnership on behalf of London CCGs has also led on the

collaboration that saw all 32 CCGs, all 33 borough councils, the Mayor of London,

NHS England and Public Health England sign the London Health and Care

Collaborative Agreement. Together with the London Devolution Agreement, this

paves the way for central government and national bodies to devolve powers and

funding to the London system to enable local, sub-regional and London-wide

transformation.

This year Healthy London Partnership has also been in a unique position to support

the developing sustainability and transformation plans (STPs).

Read more about the Healthy London Partnership’s work online at

www.healthylondon.org

18

Objective 3 – Build the population’s ability to enhance their health

and wellbeing

Joint commissioning on healthy life expectancy Haringey is a borough that faces major challenges and inequalities around health

and wellbeing. The life expectancy gap between the most and least deprived wards

is seven years for men and three years for women. The number of people with long

term conditions, such as diabetes and heart disease is increasing. Improving healthy

life expectancy is a core goal for both the CCG and the local authority.

Public health analysis indicates there are four key causes of reduced healthy life

expectancy in Haringey: Cardiovascular Disease (CVD); Diabetes; Chronic

Obstructive Pulmonary Disorder (COPD), Breast and Colorectal Cancer. We have

therefore established a joint healthy life expectancy group across public health,

primary care, medicines management and clinical commissioning so that our work

on prevention, case finding/early identification and the management of existing long-

term conditions is coordinated and targeted towards reducing these drivers of

healthy life expectancy.

A particular example of the work that is going on to improve healthy life expectancy

is an initiative to prevent the number of people who suffer from strokes. The Stroke

Prevention service was launched in Haringey CCG in September 2015. The aim of

the service is to increase the identification of the number of patients with

undiagnosed atrial fibrillation (AF) and hypertension. Once these patients are known

to their GPs, the patients can be helped to manage these conditions and thus

decrease their risk of a stroke. Since the service started, 992 people have been

diagnosed with AF and 9,942 people have been diagnosed with hypertension.

In addition to this service, Haringey CCG is also piloting the use of hand-held ECG

machines which means that people can have a diagnosis for AF within the GP

practice and may not need to be referred to hospital.

We are also proud to have been selected as a pilot for devolution, alongside the

local authority, to explore the use of flexibilities in existing planning and licensing

powers to develop new approaches to public health issues. This is part of London’s

health devolution arrangements. Our vision for prevention is fundamentally to

‘normalise good health’. This involves shifting resources towards population level

approaches that change behaviours. It is about using the Council’s place making role

to shape the physical environment in which healthier decisions are made –

recognising that where we live is the biggest determinant of our health. It is also

about breaking the cycle of inequality, poor health and unemployment by working

with employers and joining up services to prevent people with health problems

becoming locked out of employment.

19

In Haringey we put forward a plan for creating a ‘prevention’ devolution pilot with a

focus on two workstreams: creating a healthy environment and assisting people with

mental ill health to maintain employment.

We have, in close collaboration with a range of stakeholders, developed business

cases to describe this local transformation, which includes greater tobacco and

gambling controls, and have been endorsed by the Health and Wellbeing Board.

London and national partners have worked together to explore the proposals set out

in Haringey’s business cases. Where there was a clear case that proposals would

assist or accelerate improvements to the local health and care system, steps have

been taken towards devolving, delegating or sharing functions or resources currently

exercised by national partners.

Mental Health and Enablement The CCG, Council, Barnet, Enfield and Haringey Mental Health Trust (BEHMHT) and

other partners in the community – including users and carers – have been working

together to develop the “enablement” approach in mental health. This means that

we want to intervene earlier and in a holistic way, ensuring that the whole range of a

person’s needs are met.

BEHMHT has been reviewing the structure and organisation of their Haringey

services to identify how to better deliver the shared outcomes of the local

partnership, and will oversee new arrangements being put into place during

2017/18. The CCG and Council are working in partnership with BEHMHT so that

improvements to specialist health care, social care, primary care and preventative

support services are planned and designed in co-ordination. We are particularly

focusing on how to improve the interface between primary and secondary care, and

the role of partner organisations in the voluntary and community sector to support

this.

Haringey Locality Teams Haringey Locality Teams are multidisciplinary teams who work closely with GPs to

support patients who are at high risk of hospital admissions. The Locality Teams

consist of a team manager, physiotherapist, community matron, social worker,

mental health practitioner and a pharmacist. From January 2017 there are two

dementia navigators who work between the Locality Teams and the Barnet, Enfield

and Haringey Mental Health Trust memory service to support patients newly

diagnosed with dementia.

The Locality Teams support complex patients by completing a holistic assessment

and developing a care plan according to the patient’s goals. They listen to patients

and talk to other professionals about their health or care requirements to ensure that

their patient’s care is co-ordinated and joined up. Each patient under the Locality

Team has a named care co-ordinator who is their single point of contact for health or

social care needs. The team works closely with community health, mental health,

social care and voluntary services so that patients are well supported in the

community.

20

A full evaluation of the service is underway. Patient experience interviews have been

very positive, with patients reporting that having a single point of contact and a

named care co-ordinator is very helpful.

Information, Advice and Guidance (IAG) The Information, Advice and Guidance (IAG) service started on 1 April 2016 and

provides comprehensive, quality assured information, advice and guidance to people

who live or work in Haringey in relation to issues such as housing, care, finance,

employment and staying well. The IAG service signposts people to appropriate

provision as necessary.

The aim of the service is to improve the capacity of all residents in Haringey to live

independently and to access the right support at the right time, within an early help

and prevention framework. This means that individuals and communities will

manage their own information, advice and guidance needs and resolve similar

issues themselves in the future.

The service is delivered by the Citizen’s Advice Bureau in conjunction with Public

Voice and HAIL (www.hailltd.org) and is commissioned jointly by the CCG and

council.

Self-management support Whittington Health has successfully established and delivered two self-management

programmes in Haringey since January 2016:

The Expert Patients Programme for any adult living with a long term condition

or carers

The Diabetes Self-management Programme for any adult living with type 2

diabetes.

The self-management programmes provide additional support to people who are not

managing their condition well, and supports them to increase their knowledge, skills

and confidence to self-manage.

Since March 2016 six diabetes self-management courses and six expert patients

programme courses have been delivered, including three courses specifically for

Turkish speakers. 88 people have started the expert patient programme this year,

and 94 people started the diabetes programme, with 61 participants completing the

course.

Whittington Health also ran an Advanced Development Programme (ADP) for health

professionals, which trained them on effective communication tools and strategies

they could use to support patients living with long term conditions to actively self-

manage.

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Objective 4 – re-define the model for primary care

Co-commissioning primary care In 2015, Haringey CCG, together with the other four CCGs in North Central London

(Barnet, Enfield, Camden and Islington), became co-commissioners of GP services

with NHS England; first as level one commissioners (greater involvement) and then

in October 2015 as level two (joint) commissioners. From 1 April 2017 Haringey

CCG, along with the other NCL CCGs, moved to level three (delegated

commissioning) after the majority of Haringey’s GP practices voted in favour for this

arrangement. Delegated commissioning is the level of co-commissioning with NHS

England which has the greatest responsibility for CCGs. It will mean that CCGs will

have full responsibility for commissioning GP services and making decisions.

A commissioning committee for the five CCGs has been set up across NCL where

decisions are formally approved. These meetings are held in public and dates and

meeting papers can be found on the CCG’s website: www.haringeyccg.nhs.uk

Access We recognise that patients need to access GP practices in different ways according

to need and we have been working on improving access.

Since August 2016 Haringey CCG has commissioned more appointments outside

normal working hours (extended hours) via Federated for Health, Haringey’s GP

federation, which is made up of all the GP practices in Haringey.

Patients can now access more evening and weekend appointments, due to the

opening of four primary care ‘hubs’ in GP practices across Haringey. Appointments

in the hubs are available from 8:00am to 8:00pm, 7 days a week; however, opening

hours vary between the practices. Anyone who is registered with a GP in Haringey

can access the appointments at any of the hubs – appointments are made by calling

their own GP practice. Details of the hubs are available on our website.

Some patients who attend A&E may be offered an appointment at one of the hubs if

they have a condition that can be treated by a GP. In this circumstance A&E will call

the hub in advance to make sure that there is an appointment available before the

patient leaves A&E.

Future plans are to provide patients with contact details for the hubs so that they can

book appointments directly when their own practice is closed. We are also working

with the NHS 111 service to enable them to book appointments into the hubs where

patients have been assessed and need an appointment with a GP.

Haringey CCG is also working closely with GP practices to offer more online services

to patients. This includes booking appointments online, ordering repeat prescriptions

and viewing medical records, via secure sites. This will make accessing

appointments and other services much more convenient for patients.

22

Training and education 2016/17 has seen further development of the Community Education Provider

Networks (CEPN) with increased opportunities to share training and education for

staff across organisational and professional boundaries. Haringey has recruited even

more trainee practice nurses this year, continues to provide high quality Care

Certificate training to healthcare assistants (HCAs) and is also part of a successful

bid to run a national pilot training new ‘Nursing Associates’. Other innovative roles

are also being explored as part of our workforce strategy.

A variety of training sessions have been offered through the CEPN addressing

specific local needs such as preventing violence against women and girls. We are

also working closely with our public health colleagues to increase the prevention of

strokes, arranging specific training for practice staff accordingly. As the regeneration

of Haringey gathers pace, we are determined to have a highly trained workforce able

to meet the increasing demands placed upon it.

This year, Haringey CCG has also produced a recruitment video to encourage

healthcare professionals to come and work in Haringey. You can watch the video

(and share it!) on You Tube: https://www.youtube.com/watch?v=kgMEMfJYO24.

Federations Federations are a legal entity which allow groups of organisations, in this case GP

practices, to work together to provide services. In Haringey we have ‘Federated for

Health’ which is an organisation that is made up of all practices in Haringey. The

practices have come together to provide services for all patents registered with a

Haringey GP. They currently provide extended access to GP appointments in four

hubs across Haringey (see p21).

Future developments will provide the federation with the opportunity of being able to

support practices to implement new projects, or to provide services to all patients

across Haringey. For more information, please visit the federation’s website:

http://federated4health.com/

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4. Key risks that could affect the CCG in delivering its

objectives

The CCG’s highest level strategic risks this year have been:

The risk that North Middlesex University Hospital (NMUH) will fail to deliver

the sustained improvements required to improve performance on a range of

issues. This includes a risk of continued poor performance against the A&E

target (the target states that 95% of people who attend should be seen,

treated and admitted or discharged within 4 hours) and the 62 day cancer

target (that people should start treatment for cancer within 62 days of a

referral). More information about NMUH’s performance is included within the

performance analysis section.

The risk of failing to deliver a balanced financial plan in 2016/17 and 2017/18.

This risk for 2016/17 was reduced towards the end of the financial year and,

as you will see from the accounts, the CCG delivered a surplus of £3.5m at

year end, which means that the CCG has exceeded its financial plan.

The risk that Barnet, Enfield and Haringey Mental Health Trust will fail to

deliver the required ‘must do’ and ‘should do’ improvements required after the

Trust was rated as ‘requires improvement’ following an inspection by the CQC

in December 2015.

The risk that the uncertainty around the transition to the new north central

London commissioning arrangements could adversely affect key CCG

functions.

The cause and effect of each risk is outlined in the CCG’s full risk register, along with

details of the controls and actions that are in place. The management and oversight

of each risk is assigned to a relevant Governing Body committee, and the full risk

register is reviewed regularly by the CCG’s Senior Management Team and Audit

Committee.

The risk register is available on our website, along with more information about our

approach to identifying, assessing and managing risks and challenges to our

business: www.haringeyccg.nhs.uk/about-us/risk-management.htm. More

information on our approach to risk management is also included in the Governance

Statement (p73).

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Performance Report: Analysis

1. Financial Performance: 2016/17 Financial Review Executive Summary

The financial position of the NHS in Haringey in recent years has been challenging.

Since the formation of Haringey CCG in April 2013 the CCG has delivered a surplus,

which is consistent with the control totals agreed with NHS England. In order to

deliver a surplus, the CCG implemented efficiency plans which delivered savings

each year ranging from £8m to £13m.

The overall budget for Haringey CCG in 2016/17 was £354m. We are pleased to

report that Haringey CCG finished 2016/17 with a surplus of £3.5m, therefore

meeting NHS England business rules. Our financial target for 2016/17 was to deliver

a break-even position so this means that the CCG has over-delivered against its key

2016/17 financial target. This has been achieved through the delivery of

improvements in productivity and financial control during a period of significant

challenge in the NHS.

Financial Position in 2016/17

Our financial plan for 2016/17 was based upon the achievement of a break-even

position by year-end. The 2016/17 annual accounts show that Haringey CCG has

delivered a surplus of £3.5m which means that the CCG has exceeded its financial

plan.

As set out in the 2016/17 NHS Planning Guidance, CCGs were required to hold a

1% reserve uncommitted from the start of the year, created by setting aside the

monies that CCGs were otherwise required to spend non-recurrently. This was

intended to be released for investment in Five Year Forward View transformation

priorities to the extent that evidence emerged of risks not arising or being effectively

mitigated through other means. In the event, the national position across the

provider sector has been such that NHS England has been unable to allow CCGs’

1% non-recurrent monies to be spent. Therefore, to comply with this requirement,

Haringey CCG has released its 1% reserve to the bottom line, resulting in a year end

surplus for the year of £3.5m. This surplus will be carried forward for drawdown in

future years.

The achievement of this surplus was based upon the delivery of a challenging

productivity plan in 2016/17. Overall the CCG delivered efficiencies totalling £9.5m.

The achievement of this was delivered through the continuation and augmentation of

existing schemes together with new projects implemented in 2016/17. Of the £9.5m,

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£8.5m related to efficiencies delivered in acute services (including the provision of

more community services) and £1.0m related to non-acute productivity

improvements primarily in prescribing services and continuing healthcare.

Achievement of 2016/17 Financial Duties

Haringey CCG achieved all of its statutory financial duties in 2016/17, namely:

The Revenue Resource Limit was underspent by £3.5m at the year-end. This

exceeds the financial plan to breakeven;

Administrative expenditure does not exceed the notified running cost allocation;

the CCG was underspent against its running cost allocation by £27k at the year-

end; and

Expenditure not to exceed income; total expenditure was lower than income by

£3.5m.

Where your money was spent

The main element of total expenditure is hospital based secondary care. For

Haringey CCG this is largely with the North Middlesex Hospital NHS Trust and

Whittington Health NHS Trust. Other providers included the Royal Free London NHS

Foundation Trust and University College London Hospitals (UCLH) NHS Foundation

Trust. Our local community services were delivered through a contract with

Whittington Health NHS Trust. Smaller contracts are in place with other providers

and there is a range of services with voluntary and community providers.

The administration of the CCG’s acute commissioning expenditure continued to be

managed by North and East London Commissioning Support Unit in 2016/17. Acute

expenditure increased above the contract baselines due to higher than planned

levels of activity, but this was mitigated in part by a range of performance measures

targeting productivity gains and efficiency savings. As a result, acute over-

performance was limited to an overspend of around 4.6% of the annual budget; the

majority of which was in the contracts with Whittington Health, Royal Free London,

UCLH, Barts and The Homerton. Work is on-going with all providers to ensure that

activity can be managed within the agreed contract values in 2017/18.

Mainstream mental health services expenditure was broadly in line with planned

activity. Patients requiring high cost individual packages of care increased during

2016/17, resulting in an overspend in this area. Work is on-going to ensure our

contracts going forward accurately reflect the level of service required to meet

demand.

26

The CCG spent around £6.3m during the year on its administrative running costs

which is £27k less than the maximum permitted expenditure for the CCG. This is

consistent with 2015/16.

The overall budget for Haringey CCG in 2016/17 was £354 million. The chart below

sets out how Haringey CCG spent its budget during 2016/17:

NB. The spend on children’s services is around 1% of the CCG’s total budget. This is because the council and public health commission the majority of children’s services, although we do work in partnership. Similarly primary care services are commissioned

by NHS England rather than the CCG. Financial Position in 2017/18 onwards

Despite Haringey’s financial position remaining stable in recent years, the financial

outlook and the level of additional productivity improvements required to deliver a

balanced financial plan for 2017/18 are challenging.

The 2017/18 financial target for the CCG is to again achieve a balanced financial

plan at the year-end. In order for this to be achieved, the CCG has to deliver a

programme of transformational changes and improvements of around £10m. North

Central London commissioners and acute providers continue to work collaboratively

to develop and implement the Sustainability and Transformation Plan (STP)

assumptions to ensure that the Haringey CCG and the North Central London wide

control total is achieved. Contracts with all providers have been agreed for 2017/18

and 2018/19.

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2. National performance targets

Haringey CCG is committed to ensuring that our local providers provide a high quality service that meets the needs of the local

population. National performance targets are a key way in which the CCG can assure itself that this is happening. In general,

Haringey CCG and its local providers’ performance on the national performance targets has varied during the year. More details

are provided below. Please note, at the time of writing this report, the latest month that we have data for, depending on the

standard, is from December 2016 to February 2017.

Waiting times in Accident & Emergency (A&E) 2016/17

There is a national expectation that at least 95% of people who attend A&E will have been seen, treated, admitted or discharged in

under 4 hours. Our two local hospitals are North Middlesex University Hospital (NMUH) and Whittington Hospital (WH). Haringey

CCG is the lead commissioner for NMUH and Islington CCG is the lead commissioner for WH. As outlined in last year’s annual

report, in 2015/16 Haringey and Enfield CCGs had close oversight of a broad range of quality challenges within North Middlesex

University Hospital, in particular, performance within their A&E department. Work has continued this year to support the Trust to

improve the performance of the 4 hour wait for A&E. The table below shows the agreed trajectory for NMUH in 2016/17:

North Middlesex University Hospital (NMUH)

At the start of the year, a Safer Faster Better (SFB) urgent care improvement programme was initiated at NMUH, with the aim of

making a real improvement in patient experience in urgent and emergency care. The programme focused on improving

performance in four areas: the A&E department, assessment and short stay, wards and out of hospital. Haringey CCG has been

jointly running the programme with NMUH and Enfield CCG. All local providers, including social care, community health and mental

health trusts, have been involved in improvement work in these areas. The performance of these workstreams has an impact on

28

the A&E performance target, as they are supporting patient flow into the Trust and back into the community, by either returning

home from A&E or after an acute stay on a ward.

In the first half of 2016/17, NMUH were performing well against their new target, doing better than planned in 4 out of the 6 months.

One of the main aims of SFB was to reduce the time that patients waited to be seen in A&E, and early work focusing on improving

this area clearly had an impact.

Winter was a more difficult time for the local health and care system, as well across the whole country, with more acutely unwell

people attending the A&E and being admitted on to the wards. This was also at a time when there were challenges in discharging

patients back in to the community so individuals were staying in hospital longer than needed. This put a lot of pressure on

maintaining patient flow from NMUH A&E and through the hospital, as people were having to wait longer to be seen and treated in

A&E.

The CCG, NMUH and other local providers have been working closely together since Christmas to ensure that there are actions in

place to support an improvement in the A&E department performance and provide resilience for the system to ensure that patient

flow can be maintained.

‘Discharge to Assess’ is another new scheme that is being developed at NMUH. The aim is to help people who are ready to be

discharged from hospital, but who need a bit of extra support at home, get home more quickly and have an assessment by a

community health team within their home. This approach will help to keep beds on the wards available for those people who require

medical care.

There is lots of evidence as to why this approach benefits patients. Studies show that patients:

rely less on long term care

receive care that is more appropriate to meet their needs

are at lower risk of hospital acquired infections

retain their independence longer (10 days in hospital for someone over the age of 80 equates to 10 years of muscle

deconditioning)

live longer.

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The CCGs and NMUH have also agreed a new A&E performance trajectory for 2017/18 which acknowledges the current position

due to challenges over winter and the actions now agreed and in place to improve performance:

2017-18 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

NMUH proposed performance

trajectory

85% 87% 90% 92% 95% 95% 92% 90% 90% 90% 90% 95%

This trajectory expects that the Trust will continue to improve their performance throughout 2017/18, taking in to account the impact

of winter on performance overall.

Whittington Health (WH) Whittington Health’s performance against the 4 hour A&E target was 87.82% between April 2016 and January 2017, compared with

92.88% in the corresponding period of 2015/16. The Trust has agreed a recovery trajectory for the final months of 2016/17, and

commissioners are regularly monitoring performance against the trajectory.

London Ambulance Service (LAS) Response Times

The two main standards relating to LAS are Category A Red 1 calls which are the most time critical and cover cardiac arrest

patients who are not breathing and do not have a pulse, and other severe conditions. The other is Category A Red 2 calls, which

are serious but less immediately time critical and cover conditions such as stroke and fits. The standard for these calls is that on at

least 75% of occasions, the emergency response arrives within 8 minutes.

The LAS has not met either of these standards in a month since April 2014. The Care Quality Commission (CQC) assessment of

the service in June 2015 resulted in the ambulance Trust being placed in special measures and a detailed improvement plan being

agreed. The lead commissioning CCG (Brent CCG) monitors this plan closely and updates other London CCGs at regular

meetings.

30

Haringey CCG is working closely with LAS to develop an action plan to improve local performance. Some of the actions

implemented so far include providing extra resources in some areas (an extra response car in Bounds Green and motorcycle in

Tottenham), closer working with the Trusts to reduce ambulance handover times, and further integration with NHS 111 and

integrated urgent care hub for advice and discharge.

Table: LAS Response times across Haringey CCG

Improving Referral to Treatment Times (RTT)

Referral to treatment time (RTT) means the length of time you have to wait between your referral (for example, from your GP) for

your treatment to start (for example, at a hospital). In most cases, this wait should be no longer than 18 weeks for people treated as

either inpatients (admitted) or in an outpatient clinic (non-admitted). This standard is now measured by looking at the people still

waiting for treatment, so that for any month, 92% or more of patients are waiting less than 18 weeks.

The table below shows the performance for all of Haringey CCG’s registered population; green means that the target was achieved

and red means that it was not. Haringey CCG performed well on this standard throughout the year. Please note, people with

suspected cancer, are expected to wait a much shorter amount of time (see section on cancer waiting times).

Category A calls resulting in

emergency response

arriving within 8 mins (RED

1)

48.39% 51.28% 56.41% 61.90% 66.67% 67.50% 71.43% 60.53% 60.47% 63.93% 53.30% 68.00% 60.82% 75%

Category A calls resulting in

emergency response

arriving within 8 mins (RED

2)

53.55% 57.15% 52.22% 50.79% 59.11% 55.46% 56.66% 52.10% 53.81% 53.01% 53.60% 63.80% 55.11% 75%

KPI / Measure Apr-16 May-16 Jun-16 Jan-17 Feb-172016-17

YTD

2016-17

TargetMar-17Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16

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Table: Haringey CCG performance on RTT standard in 2016/17

52 week waits in 2016/17

While most patients should not be waiting more than 18 weeks for treatment, no one should be waiting more than a year for

treatment on an RTT pathway. During 2016/17, 105 Haringey CCG patients were treated having waited a very long time. These

patients were almost all at the Barnet and Chase Farm Hospital (B&CF) sites of the Royal Free London Hospital and some patients

at Imperial College London. Haringey CCG is monitoring patients waiting for treatment and working with hospitals to ensure

patients are treated more quickly.

Table: Haringey CCG’s 52 week wait performance

94.15% 94.27% 94.52% 94.69% 93.61% 93.79% 93.84% 94.04% 93.54% 93.51% 93.59% 93.46% 93.92% 92%

Apr-16 May-16 Jul-16 2016-17 TargetJun-16 Jan-17Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Mar-172016-17

YTDFeb-17

>52 week waits Admitted 0 1 1 1 0 1 1 2 3 9 9 8 36

>52 week waits Non Admitted 6 12 11 7 3 5 5 5 2 5 6 2 69

Apr-16 May-16 Jul-16KPI / Measure Jun-16 Jan-17Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Mar-172016-17

YTDFeb-17

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6 week diagnostic standard

The 6 week diagnostics target means that nearly everyone should not be waiting more than 6 weeks for tests that are needed in

order to decide which treatment they need. No more than 1% of the people receiving tests in any month should have waited more

than 6 weeks for those tests.

Table: Haringey CCG performance on 6 week Diagnostic standard in 2016/17

Table: 6 Week Diagnostic Standard Performance for Haringey CCG’s two main local providers

Haringey CCG has agreed and is implementing an action plan with NMUH to return performance for the diagnostic standard to compliance from March 2017.

> 6 Weeks Diagnostic Waits 1.89% 1.44% 0.87% 1.03% 1.14% 0.72% 1.11% 1.13% 1.36% 1.32% 0.45% 0.57% 1.08% 1%

Apr-16 May-16 Jul-16 2016-17 TargetKPI / Measure Jun-16 Jan-17Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Mar-172016-17

YTDFeb-17

North Middlesex 0.52% 0.40% 0.50% 0.90% 1.10% 0.67% 1.78% 3.05% 2.87% 2.92% 0.49% 1.41%

Whittington 0.45% 0.57% 0.11% 0.68% 0.49% 0.28% 0.49% 0.16% 0.87% 0.87% 0.42% 0.48%

Provider Apr-16 May-16 Jun-16 Jul-16 Feb-172016-17

YTD

2016-17

Target

1%

Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

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Better cancer waiting times

Table: Haringey CCG performance on cancer standards in 2016/17

2 Week Cancer Wait 95.15% 93.37% 95.51% 96.48% 95.85% 95.00% 95.47% 96.26% 94.31% 93.41% 96.54% 95.21% 93%

2 Week Cancer Wait:

Breast Symptoms89.23% 90.13% 95.40% 95.42% 95.42% 97.20% 97.37% 98.73% 94.04% 91.72% 99.29% 94.90% 93%

31 day Cancer Wait:

1st definitive treatment98.46% 97.14% 98.21% 96.97% 97.65% 96.34% 98.55% 98.70% 97.70% 98.81% 97.22% 97.79% 96%

31 Day Cancer Wait:

Subsequent treatment (Surgery)100.00% 91.67% 100.00% 91.67% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 95.00% 98.03% 94%

31 Day Cancer Wait:

Subsequent treatment (Chemotherapy)100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 96.43% 100.00% 100.00% 100.00% 100.00% 99.67% 98%

31 Day Cancer Wait:

Subsequent treatment

(Radiotherapy)

100.00% 100.00% 100.00% 100.00% 97.22% 100.00% 100.00% 93.10% 100.00% 100.00% 100.00% 99.12% 94%

62 Day Cancer Wait:

GP Referral71.43% 79.49% 91.67% 85.19% 76.92% 65.63% 75.68% 86.67% 85.71% 91.43% 81.48% 81.02% 85%

62 Day Cancer Wait:

Screening service100.00% 100.00% 100.00% 100.00% 94.12% 93.33% 83.33% 85.71% 83.33% 90.00% 85.71% 92.32% 90%

62 Day Cancer Wait:

Consultant Upgrade86.67% 93.33% 88.89% 92.31% 92.86% 77.78% 100.00% 92.31% 85.00% 88.24% 86.67% 89.46%

No

thresholds

KPI / Measure Apr-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16May-16 2016-17 Target2016-17

YTDNov-16 Dec-16 Jan-17 Feb-17

34

The chart above shows the performance for all of Haringey CCG’s registered population; green means that the target was achieved

and red means that it was not.

Table: 2 week Cancer wait Standard Performance for Haringey CCG’s two main local providers

Haringey CCG’s two local providers performed consistently well for this standard.

Table: 62 Cancer Standard Performance for Haringey CCG’s two main local providers

The 62 day screening service standard means a maximum 62 day wait from referral from an NHS cancer screening service to the

first treatment for cancer. This involves very small numbers of patients, so even when one Haringey CCG patient chooses to delay

treatment, for whatever reason, this can cause what looks like a material failure in the standard.

The 62 day waiting time standard for people with suspected cancer has been the focus of an NHS England pan-London

programme as London as a whole has not met this standard since August 2013. The North Central London Cancer Improvement

Forum has concentrated on improving the performance of those hospitals that treat the vast majority of Haringey CCG patients.

Haringey CCG agreed and implemented an action plan with NMUH which delivered compliance in November 2016.

North Middlesex93.20% 93.86% 95.87% 97.38% 95.25% 93.39% 94.48% 95.59% 95.20% 94.05% 95.84% 94.92%

Whittington97.62% 96.40% 96.41% 97.68% 97.86% 96.59% 98.72% 97.24% 93.44% 94.68% 97.14% 96.72%

Provider Apr-16 Nov-16 Dec-16 Jan-17 Feb-172016-17

YTD

2016-17

TargetMay-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16

93%

North Middlesex 73.81% 76.47% 70.97% 68.52% 67.07% 65.96% 61.11% 94.92% 88.14% 89.29% 78.57% 75.88%

Whittington 88.10% 84.21% 94.87% 83.33% 93.55% 74.55% 84.44% 84.21% 92.31% 82.67% 100.00% 86.86%

Provider Apr-16 Nov-16 Dec-16 Jan-17 Feb-172016-17

YTDMay-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16

2016-17

Target

85%

35

Summary of Haringey CCG’s performance on the main national targets in 2016/17

The chart below shows the performance of Haringey CGG compared to last year for the main national targets. Green means that

the target was achieved and red means that it was not. The arrows indicate whether performance has improved or worsened

compared to last year.

Outturn

13/14

Outturn

14/15

Outturn

15/16

YTD

16/17

(Feb 16)

Year on year

performance

(15/16-16/17)

Target/

Standard

16/17

RTT Incomplete pathway 90.9% 91.5% 93.2% 93.9% 92%

Diagnostic Waits >6 weeks 1.4% 1.3% 3.0% 1.1% 1%

52 week waiters (Incomplete) 139 25 47 11 0

A&E waits 95.5% 94.6% 87.9% 86.0% 95%

Cancer 2 weeks (GP referral 93.9% 92.95% 92.9% 95.2% 93%

Cancer 2 weeks (breast symptoms) 93.8% 93.5% 91.5% 94.9% 93%

Cancer 31 days (first definitive) 98.8% 98.7% 97.4% 97.8% 96%

Cancer 31 days (subsequent -surgery) 97.3% 97.9% 96.1% 97.5% 94%

Cancer 31 days (subsequent -drug) 100.0% 99.7% 100.0% 99.7% 98%

Cancer 31 days (subsequent -radiotherapy 99.3% 100.0% 98.1% 99.0% 94%

Cancer 62 days (GP referral) 88.1% 89.5% 80.9% 81.0% 85%

Cancer 62 days (referral NHS screening) 100.0% 90.2% 86.0% 92.3% 90%

Cat A(Red 1)calls response within 8 mins 77.4% 67.2% 51.4% 61.5% 75%

Cat A(Red 2)calls response within 8 mins 75.3% 59.7% 55.2% 55.2% 75%

Mixed-sex accommodation 71 41 24 21 0

Clostridium difficlile (C.diff) cases 37 57 66 48 50

MRSA bacteraemia 5 1 0 2 0

Proportion of people under adult mental illness specialities

on CPA who were followed up within 7 days of discharge

from psychiatric in-patient care 99.3% 98.3% 96.8% 99.3% 95%

Improved Access to Psychological Therapies

Proportion of people with depression

referred for psychological therapy 10.4% 12.40% 16.50% 8.1% 12%

Proportion who complete therapy who

are moving to recovery 40.3% 44.2% 48.5% 49.3% 50%

Ambulance response times (South east London)

National Standard Priorities 2016/17

36

Increasing Access to Psychological Therapies (IAPT)

During 2016/17, the Haringey IAPT service (www.lets-talk-iapt.nhs.uk) has proven to

be a clinically effective and well delivered service. Over the last year the service has

consistently met the challenging national standards and, as a result of the ongoing

collaborative relationship between the CCG and Whittington Health, has found ways

of increasing the quality and quantity of evidenced based therapies for people

registered with a Haringey GP without incurring extra cost.

The service has been pioneering the use of direct web based referral systems for

patients and offering web based psychological therapies which are available 24/7, as

well as continuing to offer highly effective face to face therapies across the whole of

the borough. As part of the ongoing evolution of IAPT, the service has also

expanded its support for people with a long term physical health condition who also

have depression or anxiety, as well as introducing new mental health perinatal

services including Wellbeing in Motherhood support groups.

Over this last year, Haringey IAPT has provided treatments to over 5400 people, with

just under 50% of people who have completed treatment showing clinical recovery

from their symptoms (year to date). 99% of people using IAPT in Haringey waited

less than 18 weeks to be seen, with 95% being seen within 6 weeks. 95% of people

who have used the IAPT service over the last year said they were satisfied or very

satisfied with it.

Quality Premium 2016/17

The Quality Premium (QP) is intended to reward CCGs for improvements in the

quality of the services which they commission and for associated improvements in

reductions in inequalities in access and in health outcomes. The Quality Premium

will be paid in 2017/18 based on the performance for 2016/17. The areas that the

CCG is on track to achieve are outlined below:

Cancers diagnosed at early stage

New cases of cancer diagnosed at stage 1 and 2 as a proportion of all new cases of

cancer diagnosed (20% of QP).

Increase in the proportion of GP referrals made by e-referrals

Proportion of new first outpatient appointment GP referrals into consultant-led

services (20% of QP).

Overall experience of making a GP appointment

Data from GP survey (20% of QP)

Antimicrobial resistance (AMR): improving antibiotic prescribing in primary

care

There are two indicators in this menu accounting for 10% of QP and include:

37

A reduction in the number of antibiotics prescribed in primary care by 4% -

This indicator is worth 5% of QP.

The number of co-amoxiclav, cephalosporins and quinolones as a percentage

of the total number of selected antibiotics prescribed in primary care to be

equal to or lower than 10%, or to reduce by 20% from each CCG’s 2014/15

value. This indicator is worth 5% of the QP.

Three local measures

These account for 30% of the QP (10% for each measure) and include an increased

performance of reported prevalence of hypertension; an improvement in the

percentage of pregnant women vaccinated for flu; an improvement in the percentage

of people aged 18-69 on a Care Programme Approach in employment (Mental

Health).

Find out more

More information about the performance of Haringey CCG and its main providers is

available in the Performance and Quality Summary. This is a report that is available

on the CCG’s website and is discussed at every Governing Body meeting (held in

public). The summary provides an overview of the performance of the CCG and its

main providers in relation to performance and key quality indicators.

Please visit: www.haringeyccg.nhs.uk/about-us/papers-from-previous-meetings.htm

to see the papers from previous meetings.

38

3. Quality, safety and patient experience performance

Quality is at the centre of Haringey CCG’s vision and values and we are dedicated to

ensuring that the services we commission on behalf of the people of Haringey are of

the highest quality and delivered with respect and compassion. High quality patient,

carer and family experience is a right under the NHS Constitution and has been

given central importance in the way the NHS works. The Francis Report (and the

other independent reviews commissioned by the Government) further highlighted the

need to have a clear understanding of the experiences of patients, triangulated with

other quality related information. Below are some examples of things that Haringey

CCG has done this year as part of its commitment to quality and patient safety:

3.1 Patient experience

How Haringey CCG is monitoring and working to improve patient experience in local

provider Trusts

The CCG reviews scores and trends relating to patient experience key performance

indicators at monthly Clinical Quality Review Group (CQRG) meetings with

providers. This includes looking at complaints, Friends and Family Test (FFT)

response rates and feedback on how the trusts are using this insight. At Barnet,

Enfield & Haringey Mental Health Trust (BEHMHT) quality metrics including patient

experience indicators are reviewed at the monthly Joint Performance and Quality

Committee.

Throughout 2016/17, performance on the inpatient FFT at North Middlesex Hospital

(NMUH) has been close to the average for London acute trusts (93.4%). In A&E

however, there have been only two months since April 2016, when more than 50% of

respondents said they would recommend the NMUH A&E department. In January

2017, 45% of patients seen in the A&E department and 42% of patients in the urgent

care centre would recommend the Trust, compared to the London benchmark of

87%. The Trust has reported to commissioners that the priority in the A&E

department has been on improving care and processes in the department, including

ensuring patients get treated in a timely manner. Now that standards have improved

in these areas, there will be a renewed focus on improving patient experience.

Healthwatch Haringey has also been invited by the Trust to support the A&E

department with patient experience improvements in spring 2017.

Outpatients is another service area where performance at NMUH has been below

the London average of 92%, with an average of 80% of outpatients recommending

the Trust since April 2016. The Trust has recently reported that the outpatients

department has decided to introduce paper surveys to capture feedback, and to

focus on addressing the issue of prolonged waiting times. This remains the most

common concern raised with the Patient Advice and Liaison Services (PALS) team.

39

At Whittington Health (WH) performance on the A&E FFT has been slightly below

their target of 90% with an average of 86.1% of patients recommending the

department. The outpatient target of 90% was achieved at WH, with WH having an

average performance of 90% throughout 2016/17.

At Barnet, Enfield and Haringey Mental Health Trust (BEHMHT), the mental health

patient FFT rating has continued to benchmark close to the average of other London

mental health trusts, with an average of 83% of patients recommending the Trust in

2016/17.

In terms of responsiveness to complaints, the first month that NMUH achieved the

target of ‘above 80% of complaints responded to within the 25 working day deadline’

was in December 2016. WH met the target overall - the average proportion of

complaints responded to within 25 working days was 88.2%. BEHMHT also met the

target with an average of 87% of complaints responded to within the 25 working days

target (or within a timescale agreed with the complainant).

In terms of performance on the National Inpatient Surveys in 2016, NMUH, who had

414 respondents to the survey published on 8 June 2016 performed “About the

same” as other Trusts for all sections of the survey. WH had 401 survey responses

and also performed “About the same” as other Trusts for all sections of the survey.

The BEHMHT community mental health survey was published on 15 November

2016 (207 responses) and the Trust performed “About the same” on all sections of

the survey as most other mental health trusts that took part in the survey.

In terms of 2016 CQC ratings for caring services, NMUH was rated as ‘requires

improvement’ in this domain (December 2016). The CQC stated: “We saw many

examples of caring care within most services, however we rated medical care,

maternity and gynaecology and end of life care services as requires improvement”.

At WH, the CQC report (8 July 2016) rated the trust as ‘Good’ overall for caring

services. The CQC stated: “many of the services we inspected were rated as good,

but community end of life care and community dental services were rated as

outstanding”. At BEHMHT, the CQC (24 March 2016) also rated the Trust as ‘Good’

for the Caring domain, stating: “staff were enthusiastic, passionate and

demonstrated a clear commitment to their work. Care was delivered by hard-

working, caring and compassionate staff and people, and where appropriate their

carers, were usually involved in decisions about their care. However, further work is

needed to ensure that patients are involved in the planning of their care and that this

is recorded”.

3.2 Complaints management at Haringey CCG

Haringey CCG has received three formal complaints in the past year concerning the

commissioning decisions it has made and 85 concerns and enquiries requiring a

formal written response about the NHS in Haringey. In each instance the

Complaints Policy was followed (available on the CCG’s website:

40

www.haringeyccg.nhs.uk/about-us/strategies-and-publications.htm). Haringey CCG

follows its complaints procedure to ensure that the CCG is guided by current best

practice standards and improvements are implemented as a result of complaint

investigations.

The policy describes how every complaint will be properly investigated and

responded to and how learning is identified and used to improve our commissioning

of local services. The policy adheres to The Parliamentary and Health Service

Ombudsman’s six principles for remedy when handling complaints. They are:

• Getting it right

• Being customer focused

• Being open and accountable

• Acting fairly and proportionately

• Putting things right

• Seeking continuous improvement.

Trusts provide regular complaints and patient experience reports to clinical quality

review group (CQRG) meetings with the CCG. Reports identify trends and actions

from complaints, and the learning identified as a result. The CCG also uses

complaints as a data source for intelligence gathering about local providers and to

inform the CCG’s own commissioning decisions. This intelligence is considered by

the CCG’s Insight and Learning Group (see section 3.3). Where concerns are

identified, further information is sought and necessary action is taken where

improvements can be made. The CCG’s Quality Committee (a sub-committee of the

Governing Body) receives a quarterly report on complaints, themes and actions

taken as a response to concerns raised.

3.3 Insight and Learning Programme at Haringey CCG

The CCG’s Insight and Learning Group has carried out broad horizon scanning of a

range of patient experience data this financial year, including Quality Alerts from

GPs, provider and CCG complaints and Friends and Family Test results. Where

themes of concern have emerged, in depth reviews have been commissioned and

followed through by insight visits to the relevant provider.

We have been working closely with Healthwatch in recent months and regularly

invite Healthwatch representatives to present published reports on Haringey NHS

services to ensure the CCG is sighted on and can follow-up any recommendations

with providers. An example this year has been the follow-up of a Healthwatch ‘Enter

and View’ report to Pymmes Zero Ward (elderly care) at North Middlesex University

Hospital, published 23 February 2016. Following publication and discussion of the

findings at the CCG Insight and Learning meeting in October 2016, a CCG-led visit

was arranged to see if the suggested improvements had taken place. On the visit,

we found many positive aspects of practice and were particularly impressed by the

ward manager’s leadership and the dementia friendly environment, and were also

able to highlight other areas where improvement plans could be strengthened.

41

Following the CQC’s Warning Notice earlier in the year, the A&E department and

wards at North Middlesex University Hospital have been the focus of a number of

CCG-led insight visits throughout the year, with visits led by Haringey CCG’s

Executive Nurse and Director of Quality and Integrated Governance and the CCG’s

Governing Body Nurse Member. The purpose of these visits has been to triangulate

assurances received from the hospital with the reported experiences of patients,

carers and staff in the department. Overall, more positive feedback from patients

(people who had visited before felt like things had improved) and medical and

nursing staff has been reported to the Insight Team which has been corroborated by

other external regulators including Health Education England and the CQC.

Continued concerns have included the number of agency and locum staff in post.

A final example of how the CCG has used information from complaints to raise

awareness of areas of poor patient experience was the presentation of a mental

health carer’s story on better family involvement presented at the October 2016

Insight and Learning meeting. Haringey CCG’s Mental Health Enablement Lead had

been investigating a carer complaint regarding mental health service provision at

Barnet Enfield and Haringey Mental Health Trust (BEHMHT) and summarised the

concerns in a story which he presented on the carer’s behalf. The carer’s

experience included lack of proactive involvement with mental health clinicians,

housing issues that were not adequately followed up and a lack of follow up from the

mental health team regarding submission of the complaint. The carer put forward two

key recommendations including better family involvement i.e. care workers need to

involve the family in understanding a person’s full history, and confidentiality

concerns should not be used as a barrier to involving carers. Living conditions of

people with mental health concerns need to be addressed as a priority and

communication between care staff and housing workers needs to be strengthened.

The CCG has asked for an update on the Trust Carers ’ strategy at CQRG in 2017 to

ensure these elements are adequately addressed in the strategy. Haringey CCG

also kept a close watch on the timeliness of complaints responses which is

presented to BEH’s Joint Performance and Quality meetings on a monthly basis.

3.4 Patient Safety

3.4.1 How Haringey CCG is monitoring and working to improve patient safety

in local provider Trusts

In addition to patient experience, the CCG reviews scores and trends relating to

patient safety key performance indicators at monthly Clinical Quality Review Group

meetings (CQRG) with providers. The patient safety metrics reviewed include

mortality statistics, infection control indicators, serious incidents, never events

incidences and patient safety thermometer measures including falls, urinary tract

infections, pressure ulcers and VTE (venous thromboembolism).

42

I. Infection Control

MRSA is a type of bacteria that's resistant to a number of widely used antibiotics. At

NMUH, since April 2016, there have been two Trust-attributable cases of MRSA

bacteraemia. Whittington Health has also reported two MRSA bacteraemia cases

(although both were related to the same patient re-presenting).

Clostridium difficile, also known as C. difficile or C. diff, is a bacterium that can infect

the bowel and cause diarrhoea. The infection most commonly affects people who

have recently been treated with antibiotics, but can spread easily to others.

Haringey CCG established a C. diff review panel in 2014 which aims to determine or

confirm, through Root Cause Analysis (RCA) assessment, whether C. diff cases at

NMUH are associated with lapses in care. In accordance with NHS England’s C. diff

guidance, lapses in care are defined when there is evidence of either cross-

transmission, breakdowns in cleaning or hand hygiene or where problems are

identified with choice, duration or documentation of antibiotic prescribing. Given the

success of this programme in reducing the number of C.diff cases due to lapses in

care in 2015/16, the CCG has invited NMUH to take back ownership and lead on the

C. diff Post Infection Review panel and follow the robust process that the CCG has

followed since 2014. NMUH has recently agreed to this and will receive external

scrutiny by the Commissioning Support Unit (Assistant Director Infection Prevention

and Control).

II. Safety Thermometer

The NHS Safety Thermometer is a national improvement measure for monitoring

and benchmarking patient harm. The variables used to measure harm within the

thermometer include all pressure ulcers (new and old), falls, urinary tract infections

(UTIs) and the number of patients who have venous thromboembolism (VTE). At

NMUH the Trust showed a slight improvement from a quarter 1 2016/17 average of

92.3% harm free care to a quarter 3 2016/17 average of 93%. However, this is below

the Trust target of 94.2%. Whittington Health achieved a similar small improvement

from 92.7% average in quarter 1 2016/17 to 93.0% in 2016/17, but below the Trust

target of 95%.

III. Disclosure of serious incidents

A serious incident (SI) is defined as an incident that occurred in relation to NHS-

funded services and care resulting in unexpected or avoidable death, serious harm,

a provider organisation’s inability to continue to deliver healthcare services,

allegations of abuse or adverse media coverage.

Commissioners are responsible for holding providers to account for the quality of

their serious investigation reports. The North East London Commissioning Support

Unit manages the review process of any serious incidents from local Trusts on behalf

of the CCG; quality assuring the investigation and identified learning.

43

Provider incidents, investigations and actions are reviewed at the monthly north

central and east London (NCEL) Serious Incident Panel meeting which is attended

by CCG Quality Assurance Team members in NCEL including Haringey

CCG. Further focus is given at the monthly clinical quality review group meetings

(CQRGs) which take place with our local trusts. At these meetings a Serious

Incident Tracker is reviewed and quarterly reports of serious incident themes, trends

and detail on how learning is being embedded are discussed.

An example of where the CCG and NMUH have worked together to gain a better

understanding into the root causes of SIs and put measures in place to prevent

reoccurrence is the joint review of SIs in the category of ‘suboptimal care of the

deteriorating patient’ which took place in early 2016/17. At the June 2016 NMUH

CQRG, Haringey CCG’s Head of Quality gave a presentation which outlined the

outcome of the collaborative themed review of SIs undertaken by commissioners

and the Trust. The SI analysis covered the period of the calendar year 2015 (1

January 2015 – 31 December 2015) and reviewed SIs reported by the Trust in the

category of ‘deteriorating patients with suboptimal care’. The Trust reported back a

number of recently introduced remedial actions as a result of learning from the SIs.

Throughout 2016/17 Haringey CCG has also been working jointly with NMUH to

review historical SIs that required closure with agreed actions and timescales in

place. Haringey CCG has also been represented at the NMUH monthly SI

Assurance and Learning Group Meeting where there is a focus on reviewing SI

investigation reports and action plans. Each SI is also reviewed to identify Trust wide

learning and highlight notable practice.

IV. Patient safety ratings of providers in CQC inspection reports

NMUH was rated as ‘requires improvement’ for safety in the most recent CQC

inspection (published 16 December 2016). The CQC stated in their report: “we found

examples of safe care in some of the services we inspected, however, end of life

care, medical care, urgent and emergency care, surgery, critical care, maternity and

gynaecology, outpatients and diagnostics were rated as requires improvement”.

At Whittington Health, the CQC inspection report (published 8 July 2016) similarly

rated the Trust as ‘requires improvement’ for safety. The CQC stated: “we found

examples of safe care in many of the services we inspected but urgent and

emergency services, medical care, maternity and gynaecology, end of life care,

outpatients and diagnostics and community adults services were rated as requires

improvement.

At BEHMHT the CQC inspection report (published 24 March 2016) rated the Trust as

‘requires improvement’ for patient safety. The CQC highlighted environmental

concerns in the acute wards for adults of working age at the St. Ann’s site in their

report, including: “the location of seclusion rooms meant that patients’ safety, privacy

and dignity could be compromised; clinic rooms at St Ann’s did not always provide a

safe environment for medicine storage and administration; medical equipment

44

needed cleaning; and on Downhills ward, medical emergency equipment could not

be reached easily in an emergency.”

In the community based mental health services for adults of working age the CQC

found: “staff were not all following lone working protocols; there were examples of

poor medication storage and medication was being transported unsafely; and

Haringey Community Support and Recovery Team’s clinic room was small and

unsafe”. Progress on the CQC action plan has been monitored bimonthly at the

Joint Performance and Quality meetings and commissioners have been working very

closely with the Trust to address the concerns highlighted by the CQC.

3.4.2 Patient safety in community settings

Haringey CCG has a number of patient safety programmes aimed at reducing the

likelihood of patient safety incidents occurring in community settings. Some

examples are given below.

I. Harm Free Care

The Haringey CCG Harm Free Care working group was established in April 2015 to

support the delivery of the CCG’s Harm Free Care Strategy; as defined by zero

tolerance of pressure ulcers, falls, Catheter Associated Urinary Tract Infection (CA-

UTI), Venous Thrombus Embolism (VTE). The group met quarterly in 2016/17 and

reviewed the Harm Free Care pressure ulcer and falls improvement plans for all

relevant service areas (e.g. acute providers, community provider, care homes and

primary care) and carried out data analysis across relevant service areas to monitor

outcomes.

Some outcomes of the Harm Free Care workstreams are highlighted below:

Falls Pathway: Haringey CCG has been working jointly with neighbouring CCGs

and councils to develop a falls pathway with a particular focus on reducing

ambulance conveyancing. There are plans to arrange a falls workshop and the group

has agreed to use the draft Haringey CCG Falls Prevention pathway as a template to

work on devising a single pathway for all boroughs in NCL.

Catheter Associated Urinary Tract Infections (CAUTI): Both WH and NMUH have

presented the work that is underway in each Trust regarding devising a joint catheter

passport that can be used for patients with the aim of reducing the incidence of

CAUTI. NMUH will present the final catheter passport to the April 2017 Harm Free

Care meeting for local adoption in acute and community settings.

Health Innovation Network (HIN) Pressure Ulcer Communities of Practice

Group: Haringey CCG has been involved with this group whose aim is to provide

information on pressure ulcer prevention to as many people as possible in hard to

reach communities across London, particularly patients who have had no previous

health and social care involvement. Haringey CCG worked jointly with WH Tissue

Viability team who have devised a user friendly pressure ulcer prevention factsheet

aimed at relatives/carers with links to other relevant information. This factsheet has

45

been disseminated to all care homes, domiciliary care, care agencies and voluntary

groups in Haringey as well as community pharmacies. The pressure ulcer factsheet

has also been promoted to primary care staff at the GP collaborative meetings.

Promoting Harm Free Care in Care Homes: This year, Haringey CCG has been

reviewing the falls and pressure ulcer care home policies in line with NICE guidance.

Visits were made to all 12 care homes in 2015 promoting the use of the Harm Free

Care policy checklist. All homes have been tasked to develop policies that are NICE

compliant and the policies will be re-evaluated by Haringey CCG in 2017. There has

been further work to promote the Pressure Ulcer Care Home Champion role by

devising a Pressure Ulcer Champion Peer Support checklist and 3 question survey

which will be sent out to the care homes and promoted in spring 2017.

II. Antibiotic prescribing

Haringey CCG established a working group in 2015 on antimicrobial prescribing with

representation from the CCG’s primary care and medicines management teams with

the aim of raising awareness amongst GPs on antimicrobial prescribing and C.

difficile reduction. The Haringey CCG Quality Assurance Nurse has worked jointly

with both teams over the past year and has carried out educational C. difficile

sessions with GPs regarding infection control and prescribing as part of the quality

premium work on antimicrobial prescribing. A community C. difficile factsheet has

been written and approved and was presented along with the education update on

C. difficile at the GP collaborative meetings in March, May and October 2016.

III. Haringey Suicide Prevention Group

There has been representation from Haringey CCG’s Quality team at the quarterly

Haringey Suicide Prevention Group since January 2016. This is a multi-agency

group with input from statutory and voluntary organisations with the aim of

supporting, developing and implementing suicide prevention interventions.

In 2016/17, the CCG supported the council’s public health team and BEHMHT to

undertake a borough-wide suicide audit, as well as a BEHMHT suicide prevention

audit in order to understand the nature/pattern of suicide and issues related to

Haringey.

More recently, a draft Haringey borough suicide prevention plan (2017–2020) has

been drawn up by the council’s public health team to which the CCG has contributed

by highlighting the importance of reducing stigma in mental health issues in order to

encourage people to access mental health services, the importance of the local

Crisis Concordat work and supporting the BEHMHT Trust with their local suicide

prevention plans. The draft Haringey Suicide Prevention Plan will be presented and

signed off at the March 2017 Health and Wellbeing Board. Haringey CCG will

continue to provide input into the areas relevant to the NHS for action, particularly in

the area of tailoring approaches to improve mental health in specific groups.

46

IV. Quality Matters in Care Homes programme

Haringey CCG and Haringey Council are prioritising the care of older people and

have placed particular emphasis on the quality of care provided in local nursing

homes during 2016/17. The CCG has recently refreshed its approach by

implementing the ‘Quality Matters in Care Homes’ (QMiCH) programme. The main

aim of this programme is to ensure that Haringey’s nursing and residential care

homes are systematically monitored for quality and that care homes have put

effective processes in place to ensure they are delivering good quality and safe

services. This includes looking at information and learning from complaints; making

regular quality audits and visits to homes; capturing, reviewing and acting on service

user experience; and collating and sharing good practice via the care homes forum.

This year, the QMiCH team carried out visits to 11 care homes for the frail elderly in

Haringey. These visits take the form of weekly or fortnightly routine visits, bi annual

quality assurance visits and reactive visits. The team has also been looking at data

from the London Ambulance Service (LAS) in relation to care home call outs,

including the reason for the call and the number of patients conveyed to acute

Trusts. This has informed a number of actions which the team has taken to support

care homes to reduce avoidable admissions, where possible.

Care Homes Infection Prevention and Control training day

Haringey CCG helped to facilitate a Care Homes Outbreak and Vaccination Infection

Prevention and Control (IPC) training day which took place on 14 October 2016 with

collaboration between NMUH, Public Health England (PHE), and Enfield CCG.

There was good representation from Haringey care homes. The aim of this training

event was to raise awareness of the reporting and management of diarrhoea and

vomiting outbreaks, as well as key infection, prevention and control issues. It is worth

noting that there have been no reported outbreaks in Haringey care homes since this

training was delivered.

47

4. Haringey Better Care Fund performance

The Haringey Better Care Fund (BCF) is developing a health and social care system

in which all adults are supported to live healthy, long and fulfilling lives. Haringey

CCG and Haringey Council want everyone to have more control over the health and

social care they receive, for it to be centred on their needs, supporting their

independence and provided locally wherever possible.

This will be achieved by a reorientation of health and social care provision from

reactive and fragmented care (mainly provided in acute and institutional settings) to

proactive and integrated care (mainly provided in people’s homes and by primary,

community and social care). The Haringey BCF will not define people by their

disabilities, but by their abilities, their potential and what they can do for themselves,

with and without support.

The Haringey BCF is focused on four schemes to achieve the main outcomes of

reducing emergency hospital admissions (measured through non-elective

admissions), reducing delays in hospital discharges (measured through delayed

transfers of care) and supporting health and social care integration:

Scheme 1: Admissions Avoidance - this will deliver services that will prevent

health conditions from escalating to a crisis where emergency services are

needed

Scheme 2: Effective Hospital Discharge - this will deliver services that will

facilitate discharge from hospital as quickly, safely and effectively as possible

Scheme 3: Promoting Independence - this will deliver services that build

community capacity to reduce isolation and improve health and wellbeing

Scheme 4: Integration Enablers - this will deliver services that support the

implementation of the first three schemes

There are 29 services in the Haringey BCF spread across the different schemes.

The graphs on the next few pages illustrate the progress we have made over the last

year with some of the services supported by the fund. You also can read more

about the locality teams, the information, advice and guidance service and self-

management in the performance overview section and there’s also further

information about the BCF on our website: www.haringeyccg.nhs.uk/about-us/better-

care-fund.htm

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49

50

51

52

53

54

55

Better Care Fund – summary of performance

This table summarises the performance of all the different schemes which fall under

the Better Care Fund.

Target

Target

YTD YTD

Estimated

Non-Elective

Admissions

Avoided Notes

1.1.0 Social Care Team Currently awaiting clarification

regarding performance measure for this

service.1.2.0 ICTT Nursing Individual Service Users

Currently awaiting clarification

regarding data collection for this

service.1.3.0 Locality TeamIndividual Service Users

600 600 244 24.4In total the Locality team have worked

with 264 individual clients YTD.

1.4.0 MDT Teleconferences Individual Patients discussed

1080 1080 1620 243

1.5.0 Overnight District Nursing Individual Service Users 0

1.6.0 Dementia Day Opportunities Individual Service Users

62 62 56 2.8

Due to transformation of day

opportunities there was a moratorium

on new referrals to The Haynes until

Jan 2017.

1.7.0 Whittington Falls Clinic Individual Service Users/Course Starters

(quarterly)

200 150 211 21.1Q1-3

1.8.0 Palliative Care New patients referrred

355 355 399 39.9

2.1.0 Rapid Response Individual Service Users 470 392 0

Reporting now moved to community

data set. We await the first report.

2.2.0 Reablement Individual Service Users

490 490 494 34.58

2.3.0 Stepdown Individual service users

80 80 137 6.85

2.4.0 Home From Hospital Individual Service Users

370 370 409 20.45

2.5.0 Mental Health Navigator Number of clients

50 50 55 2.75

2.6.0 7 Day Social Worker

2.7.0 Bridges RehabIndividual Service Users

136 136 155

3.1.0 Neighbourhood Connects Service users connections 500 417 564 28.2

Contract now completed.

3.2.0 Information Advice/Guidance 8300 7608 11,213

Data until Feb 17

3.3.0 Self Management SupportCourse Starters 140 140 221 11.05

4.4.0 VBC IPU Support There are no specific performance

measures to apply to this

4.5.0 Disabled Facilities Grant Individual Service Users 140 128 110 7.7

Data until Feb 17

4.6.0 Carers support? Carer or Service user count? 970 808 0

Measure currently being developed

Rag rating

Green Current performance above target tra jectory by more than or equal to 5%

Amber Green Current performance above target tra jectory by less than 5%

Amber Red Current performance below tra jectory by less than 5%

Red Current performance below tra jectory by more than or equal to 5%

Grey Insufficient information to ass ign a RAG status

Better Care Fund Service Monitoring

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5. Patient and public involvement and engagement In May 2013, the CCG’s Governing Body adopted our Patient and Public

Engagement (PPE) Strategy which focused on our aspirations for engagement as a

new NHS organisation. The PPE strategy was developed collaboratively, and

included a consultation period with stakeholders, colleagues and members of the

public. It also included an engagement cycle diagram to illustrate how the CCG

planned to systematically engage people throughout the commissioning cycle.

We refresh our engagement strategy every year in April so that it:

Reports on what we have done to deliver on the previous year's strategy for

public and patient engagement;

Sets out our commitment that we will maintain and develop the engagement

work and systems that we have started;

Identifies the CCG’s strategic priorities and the key stakeholders we need to

engage with to ensure achievement of the CCG’s five year plan;

Commits to an annual action plan to support the delivery of the strategy; and

Outlines the engagement priorities and activities for the coming year.

Our latest strategy is available on our website: www.haringeyccg.nhs.uk/about-

us/engagement. Our engagement cycle remains at the core of our strategy and can

be seen on page 57 of this annual report. We have also given some examples of

things we have done in the past year to involve people in our work on page 58.

Assessment by NHS England and our patient involvement annual report

Each year, NHS England assesses every CCG on how they are meeting their

statutory duties around patient engagement and involvement as part of their

assurance process. The CCG had to submit a report in October 2016 which

explained how we are meeting section 14z2 of the Health and Social Care Act,

including the arrangements in place for patient and public involvement within our

organisation and examples of how patients and the public have been involved in the

development of our commissioning plans. The report covered the financial year

2015-16. In the report, we also gave examples of how we work with Healthwatch

Haringey and the voluntary sector to ensure that they are engaged in our work. A

copy of this report is available on our website.

In January 2017, Haringey CCG received its assessment from NHS England who

stated: “Our assessment of Haringey CCG’s delivery of its statutory obligations for

the collective duty to involve is ‘Outstanding’. Our assessment of the individual duty

is ‘Good’.”

More information

More information, including our current engagement strategy, a completed action

plan for work done in 2016/17 and information on how you can get involved, can be

found in the engagement section on our website: www.haringeyccg.nhs.uk/about-

us/engagement

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Haringey CCG’s engagement cycle How we will engage and involve people in commissioning

1. We will do this through the Joint Strategic Needs

Assessment (JSNA), sections of which are updated

annually, and through ongoing engagement in the CCG’s

core programmes of work, e.g. Better Care Fund.

2. - We will have an annual review of our

strategic priorities. Through this review, we will engage stakeholders in the development of our commissioning intentions and priorities for the following year.

- We will always share our priorities on our website – www.haringeyccg.nhs.uk

- Our website will always have a comments section so that people can give their views.

- We will receive on going feedback through the CCG’s Engagement Network meetings (which will take

place throughout the year).

3. - We will involve patients, carers and

expert patient groups in the design of pathways and services

- Our Quality Committee, via the CCG’s Insight and Learning Group, will receive on going feedback through complaints, patient surveys, patient participation groups (PPGs) and the CCG’s Network.

- Our Quality Committee will hear stories on patient experience and will ‘walk the pathway’ with patients via

Insight and Learning visits.

4. We will always commission for quality and ensure that patients’ views are taken into

account in the procurement of services:

- When we review or develop new services or pathways, we will always try to involve patient, service user or Healthwatch representatives in discussions. This could include helping to develop service specifications, tender documents and key performance indicators, or simply helping us to understand patients’ experience of the service or pathway being looked at. Where appropriate, they will also have the opportunity to sit on procurement panels and be involved in the choice of successful provider(s).

- We will always make sure that patients who are involved in a procurement process are given support and training to help them

with this role.

5. - We will use a variety of patient

experience data to understand how different services are performing. This includes patient stories, patient experience surveys, complaints information, comments on social media and visits and investigations by advocacy groups.

- This information will be channelled through the Quality Committee (often via the Insight and Learning Group) and will also feed into the contract monitoring process.

- The Quality Committee also receives information on patient experience of hospitals and other service providers.

NB. This engagement cycle has been adapted from the original developed by David Gilbert of InHealth Associates

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Haringey CCG’s engagement cycle A few examples of how we have engaged and involved people in our work in 2016/17

Patient representatives on

CCG committees

This was our third year of having patient

representatives on four of our decision making committees,

including our Investment Committee - a committee that

makes recommendations to the CCG’s Governing Body

on investment and disinvestment proposals.

Having patient reps on the committee ensures we are

transparent about the decisions we are making and

have patients’ views to inform discussions. Healthwatch

Haringey are also represented on some of the

CCG’s committees, including

the Governing Body.

Engagement with young people: this year Healthwatch have supported us

with two Child and Adolescent Mental Health Service (CAMHS) projects:

To engage with children, young people and parents to develop a participation strategy for Haringey

To talk to children, young people and their parents about their

experiences of crisis care as part of our review of crisis provision. Feedback from the review was very interesting and will inform service

redesign and commissioning intentions.

Additionally we have a parent rep on our CAMHS Transformation Board who

is working with local schools to develop a network of parents who can feed into strategy and commissioning developments.

We have also commissioned Barnet, Enfield and Haringey Mental Health Trust to coproduce a Transition life skills course, and they have engaged a

number of children and young people to support this work.

We have also been working with children and young people to develop a

training resource for staff on young carers - the young people have now created a video for use in training (available on our website).

Our Insight and Learning programme is our strategic vehicle for systematically

reviewing, triangulating and acting on a wide range of patient feedback and quality

concerns. In 2016/17, the CCG’s Insight and Learning Group (which includes

Healthwatch and two patient representatives) has carried out broad

horizon scanning of patient experience data from GP Quality Alerts, Provider and

CCG complaints and more general patient

experience data (e.g. Friends and Family Test results from providers or in depth

patient stories). Where themes of concern have emerged, in depth reviews have been

commissioned and followed through by insight visits and GP surveys. Findings

and recommendations are discussed with the relevant Trust.

Mental health user enablement champions: A new group of “Haringey’s Enablement Champions” were convened to

advise Haringey’s mental health partners in the redesign of care and support services. Hail Ltd, a local social

enterprise, were commissioned to facilitate the group. 13 people brought their lived experience, including being

unpaid carers/supporters of other people, to shape the implementation of Enablement plans for the borough. The

champions were also involved in looking at a primary care enablement service model and giving feedback on

supported housing and housing pathways.

Engagement network: The CCG network – made up of voluntary sector organisations and patients from GP

practice patient participation groups – has just finished its fourth year. The network helps to inform the development of

the CCG’s commissioning intentions and direction of travel. This year, the network has heard about and given feedback

on the following areas: the North Central London Sustainability and Transformation Plan, mental health

services, stroke recovery services, primary care and partnership work across Haringey and Islington. Feedback

reports from network meetings are available on the CCG’s

website.

Successful public meetings: Around 140 Haringey residents attended our public meetings in September

2016. We worked with the Bridge Renewal Trust to get residents’ feedback on services before the meetings, to

ensure that we focused the meetings on what people wanted to hear about. The Bridge held several focus

groups with a diverse range of people from across the borough to get their views.

There were presentations about the London Ambulance Service, North Middlesex University Hospital, and the

work we are doing to make it easier for residents to access primary care services. People were then able to

discuss various services, such as primary care, mental health, and urgent care with CCG staff and Governing

Body members. They also had the opportunity to ask us questions about the work we are doing across these

services.

Feedback from the meetings and how it’s been used by

our commissioners is available on our website.

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6. Safeguarding adults and children As commissioners of local health services we need to assure ourselves that the

organisations from which we commission have effective safeguarding children and

adult arrangements in place.

Safeguarding forms part of the NHS standard contract (service condition 32) and we

agree with our providers, through local negotiation, what contract monitoring

processes are used to demonstrate compliance with safeguarding duties. CCGs

must gain assurance from all commissioned services, both NHS and independent

healthcare providers, throughout the year to ensure continuous improvement. We

are also required to demonstrate that we have appropriate systems in place for

discharging our statutory duties in terms of safeguarding. Assurance may consist of

assurance visits, section 11 and other multiagency audits, deep-dive and diagnostic

exercises and through attendance at provider safeguarding committees to measure

the impact of our own and our providers’ safeguarding arrangements.

Haringey CCG fulfils and is compliant with these safeguarding responsibilities and

duties and demonstrates this through the work of its dedicated safeguarding team

who produce regular briefings and annual safeguarding reports, focusing on

partnership working for those people who are less able to protect themselves from

harm, abuse and neglect. The annual reports, which outline key achievements,

challenges and emerging priorities, are ratified by the CCG’s Governing Body and

are published on the CCG’s website: www.haringeyccg.nhs.uk/about-us/strategies-

and-publications.htm.

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7. Sustainable development Haringey CCG is committed to embedding sustainable health care in Haringey, both

in our day to day operations and through encouraging key partners and providers to

do the same.

The CCG leases part of a floor from Haringey Council and shares this floor space

with two teams from the local authority and our Commissioning Support Unit

partners. The lease incorporates the use of all utilities and is unable to be

disaggregated due to multiple users on the one floor.

However, as tenants of a Haringey Council building, the CCG actively participates in

the local authority’s recycling programme, which has ambitious targets. This year,

the council has introduced even more recycling bins in our building and significantly

reduced the number of rubbish bins to encourage staff to think about what they are

throwing away. We have also supported the Council’s ‘wise up to waste in the office’

campaign to help staff understand the benefits of recycling (for example, that it costs

around £130 to tip a tonne of waste into landfill, but just £40 to recycle it – plus, the

council can sell the materials it collects to manufacturers to make new products like

newspapers, bottles and cans) and what can and can’t be recycled in the office.

There are limited car parking spaces available in the building, and the local authority

provides numerous bike parking spaces and a monthly free ‘bike doctor’ service on

site for staff. Haringey Council has a pool of bikes and helmets available which can

be borrowed by CCG staff to go to external meetings and visits. The CCG also has

a ‘cycle to work’ scheme; a Government initiative which uses tax incentives to give

staff savings on a range of bikes, clothing and accessories. We regularly promote

free cycle training to all staff and have close links with the Council’s Smarter Travel

team and support any travel surveys and events that they run.

For the second year running, the CCG paid for staff entry into the Global Corporate

Challenge – an international health and wellbeing programme which starts with a

100 day walking challenge with staff in teams. Staff volunteered as captains, and

every member of the senior management team participated in order to champion the

challenge and encourage their teams in the walking challenge. During this

challenge, staff were encouraged to think about walking to local meetings and using

stairs not lifts to increase their step count. Haringey CCG has also been supporting

the council’s ‘year of walking’ throughout 2016/17. This includes encouraging our

staff to attend lunchtime walks, and trying to link our GP practices up with health

walk leaders so that they start walking groups for their patients. We also invited Dr

William Bird MBE from Intelligent Health to come and speak at our annual general

meeting in July 2016 to staff, GPs and members of the public about the benefits of

physical activity on health.

Although our staff numbers have risen slightly in 2016/17, we have not needed to

purchase any additional computers or increase the floor space that we occupy

because we have continued to support our staff to ‘hot desk’ in our smart working

environment. A key component of ‘smart working’ has been to become a paper light

environment. To facilitate this, we have created shared electronic files to scan and

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store documents, removed the majority of filing cabinets and now only have two

printer/photocopiers which only allow a password protected secure print function.

Our computer system is shared with other CCGs across north and east London and

with the CSU. This means that staff are able to log on to the network from one of 13

sites which means that they can work remotely in certain circumstances, thus

reducing the need for travel. In 2016/17 we also configured a number of CCG

laptops that can access the CCG’s network to allow staff more flexibility about where

they are able to work.

We continue to actively encourage people to view meeting documents electronically.

All our Governing Body and senior management team members have tablet devices

with software called ‘BoardPad’ installed on it. Printed papers are no longer

provided which has significantly reduced the time spent printing papers and the use

of paper.

Haringey CCG recognises the responsibility and role it plays in reducing the impact it

has as an organisation on the environment. We also want to encourage health

providers to do the same through reducing use of natural resources, in particular,

carbon emissions, as described in the Public Services (Social Value) Act 2012.

As outlined in the CCG’s Clinical Procurement Corporate Governance and Strategic

Framework, the CCG intends to use e-procurement methods as far as possible, and

include tender questions and performance measures relating to environmental

considerations in the contracts tendered. The CCG will encourage providers (and

potential providers) to be innovative in reducing their environmental impact whilst

maintaining excellent clinical quality standards and improved outcomes.

There are national contractual requirements included within our provider contracts to

improve sustainability, which we as a CCG monitor. For example, the contract

states that providers must take all reasonable steps to minimise their adverse impact

on the environment and must maintain a sustainable development plan in line with

NHS Sustainable Development Guidance. Providers must also demonstrate their

progress on climate change adaptation, mitigation and sustainable development,

including performance against carbon reduction management plans, and must

provide a summary of that progress in their annual report. Health providers are

expected to do the same through reducing use of natural resources, in particular,

carbon emissions, as described in the Public Services (Social Value) Act 2012.

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8. Equality report

The Equality Act 2010 legally protects people from discrimination in the workplace

and in wider society. It replaced previous antidiscrimination laws with a single Act,

making the law easier to understand and strengthening protection in some

situations. The intention of the general equality duty is to ensure that a public

authority, like Haringey CCG, must, in the exercise of its functions, have due regard

to three main aims:

Eliminate discrimination, harassment, victimisation and any other conduct that

is prohibited by or under the Equality Act;

Advance equality of opportunity between persons who share a relevant

protected characteristic and persons who do not share it;

Foster good relations between persons who share a relevant protected

characteristic and persons who do not share it.

Haringey CCG’s Equality, Diversity and Human Rights Strategy sets out the CCG’s

approach to promoting equality and diversity and how it will meet its public sector

equality duty.

Equality information

Our Equality Information report provides an overview of how we are meeting our

public sector equality duty, both through commissioning and employment. It is an

annual performance report that we last published on our website in January 2016.

Our 2017 report will be published in June.

The report outlines the work we have done in relation to policy development,

commissioning, engagement, current workforce and recruitment of staff from diverse

backgrounds. The report also provides links to our main providers’ equality

information which sets out how they are meeting their equality duty. Our 2017 report

will amalgamate the Workforce Race Equality Standard (WRES) and Equality

Delivery System (EDS2).

Equality objectives

The CCG is required by the public sector equality duty to develop and publish

equality objectives at least once every four years. Our current equality objectives

cover the period of 2012-17, and are reviewed annually through the Equality Delivery

System (EDS2).

This year, the CCG has refreshed its Equality and Diversity Strategy for 2017-19 in

consultation with stakeholders; this will be approved and published in July 2017. The

objectives in the strategy cover commissioning, engagement, workforce and

governance. An annual action plan is being developed with managers for 2017/18

which will be monitored by the Quality Committee.

Equality analyses

We routinely analyse our existing and new policies to ensure there are no

unintended negative or disproportionate impact on groups that are protected by the

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Equality Act. At the CCG, no policy decision is made without an equality analysis of

the policy. Our Governing Body report cover sheet includes a section specifically

about equality impact prompting managers to carry out an equality analysis of the

policy or the function they are reporting to the Governing Body. We maintain a log of

all our equality analyses and ensure that actions arising from the analyses are

implemented and monitored. Our staff also receive appropriate training and support

to complete equality analyses.

Equality Delivery System (EDS2)

Haringey CCG has adopted the Equality Delivery System (EDS2) to manage our

equality and diversity performance in the organisation. We have assessed our

performance against four EDS2 goals and eighteen outcomes to determine the

grades. This has helped us to identify gaps, set priorities and develop action

plans. This year, we have set up a working group to support our EDS2 work

including helping us to review and set our equality objectives. All of our providers

are now implementing EDS2 and we receive regular assurance updates.

Further information on our EDS2 performance can be found in our annual equality

information report on our website.

Workforce Race Equality Standard

The Workforce Race Equality Standard (WRES) requires NHS organisations to

demonstrate progress against a number of indicators of workforce equality, including

a specific indicator to address the low levels of Black and Minority Ethnic (BME)

board representation. All providers, as holders of the NHS standard contract (except

‘small providers’), started to implement the WRES from April 2015.

CCGs are required to seek assurance and receive an annual report from providers,

but they are not required to apply the Workforce Race Equality Standard to

themselves, but pay due regard to it. This is because of the small size of CCG

organisations.

In October 2015 we published a baseline report, showing our compliance against the

WRES and a progress report was approved by the CCG’s Quality Committee in

October 2016 and published on our website: www.haringeyccg.nhs.uk/about-

us/EDHR.htm. The report fed into our equality objective setting and EDS2 grading

processes. We are also working with NEL Commissioning Support Unit and our

providers to implement the WRES and ensure they meet the standards.

Other areas of equality and diversity work in 2016/2017

Haringey CCG has been working jointly with North Middlesex University

Hospital (NMUH) and Haringey Council to improve deaf awareness amongst

staff and GPs. A NMUH Hearing Project Task and Finish Group was set up

and asked GPs to include details of whether a patient is deaf or has hearing

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problems when making referrals to NMUH so that double slots can be booked

for these patients.

We held a “Lunch and Learn” equality and diversity session for Haringey CCG

staff on 18 May 2016, which was well attended. The main subjects included

the CCG’s achievements regarding EDS2 and WRES compliance, annual

report highlights and consulting staff on refreshing the CCG’s equality

objectives.

Haringey CCG held an EDS2 Grading event on 7 October 2016 and invited a

range of stakeholders including providers, voluntary groups and Healthwatch

Haringey. The aim of the event was to agree on the EDS2 grading and

proposed equality objectives. The feedback from this event was used to

finalise Haringey CCG’s EDS2 evidence submission and to refresh our

equality objectives.

Haringey CCG’s WRES action plan was updated and presented to the CCG

Quality Committee in February 2017. Some of the activities undertaken

included:

o Providing recruitment and selection training for CCG managers,

including unconscious bias training. This took place in February 2017

with a further session booked in May 2017.

o Successfully established a joint Black, Asian, Minority Ethnic (BAME)

staff group with Haringey Council. The first meeting took place on 23

January 2017.

o Encouraging Governing Body members to disclose their ethnicity to

ensure that the Governing Body is representative of the workforce and

population.

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9. Health and Wellbeing Board The Health and Wellbeing Board (HWB) takes the lead in promoting a healthier

Haringey. The board is a statutory partnership set up in April 2013 in line with the

requirements of the Health and Social Care Act 2012.

It is a small, focused decision-making partnership board. Membership includes

elected members, the local authority’s adult and children’s services and Director of

Public Health, the CCG, Healthwatch and the voluntary sector. The HWB developed

a Health and Wellbeing Strategy for Haringey to enable all partners to be clear about

our agreed priorities for the next three years (2015-18).

Some of the things the HWB has been working on this year are outlined below:

• A joint Health and Wellbeing Board with Islington – Following the creation

of the Haringey and Islington Wellbeing Partnership (see p14), the

decision was made to formally join Haringey and Islington’s Health and

Wellbeing Boards, as it was considered that a joint arrangement would

strengthen the governance of the Wellbeing Partnership and provide a

platform for joint working, oversight and decision-making in the future. The

joint committee meetings will start in 2017/18.

• Haringey prevention devolution pilot – at its meeting in September 2016,

the Board was presented with a progress update on the Healthy

Environment Strand of the Haringey Prevention Pilot, which is part of

London’s health devolution arrangements. The Board discussed the pilot’s

research findings and the proposals to create a healthier environment

locally, which included extending smoke free areas across Haringey. Read

more about the devolution pilot on page 18.

• Tackling obesity in Haringey and Islington – Haringey’s Health and

Wellbeing Board monitors the work of the Haringey Obesity Alliance, a

Council led initiative which consists of a group of organisations including

Haringey CCG, social care, schools, community and voluntary groups,

local businesses and residents. The Alliance works together on a range of

projects to reduce obesity and promote healthy choices. This year, the

Board also explored opportunities for Haringey and Islington to work

together to address obesity across both boroughs.

Our Governing Body also has a presentation and discussion on a public health issue

at every meeting, for example, at the September meeting they looked at improving

health outcomes for children and young people in Haringey and in February, there

was a focus on mental health and wellbeing.

Further information on the work of Haringey’s Health and Wellbeing Board can be

found here: http://www.haringey.gov.uk/local-democracy/working-partnership/health-

and-wellbeing-board

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We will also be sharing a copy of this annual report and accounts with the Health

and Wellbeing Board for their information.

Reducing health inequality

Throughout this annual report, you will find many examples of the work we are doing

to reduce the health inequalities that exist in Haringey – it’s a core objective of

Haringey CCG (p6) and one which underpins all of our work. In particular, our work

on value based commissioning and improving outcomes (p9); our development of

improved services and pathways for children and young people (p10); our work on

mental health services and developing an enablement approach (p19); and our work

on improving people’s healthy life expectancy through different public health and

commissioning approaches (p18).

Helen Pettersen

Accountable Officer

26 May 2017

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Accountability Report

Corporate governance report

o Members’ Report

o Statement of accountable

officer’s responsibilities

o Governance statement

Remuneration and staff report

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Accountability Report

1. Corporate Governance Report

1.1 Members’ report

Haringey CCG is a membership organisation made up of all 39 GP practices in

Haringey. The practices are divided into geographical locations, as set out below.

West locality

Alexandra Surgery The 157 Medical Practice Christchurch Hall Surgery

Crouch Hall Road Surgery

Muswell Hill Practice Highgate Group Practice

Park Road Surgery Queens Avenue Surgery Queenswood Medical Practice

Rutland House Surgery Vale Practice

Central locality

Arcadian Gardens Bounds Green Group Practice

Cheshire Road Surgery

Hornsey Park Surgery Myddleton Road Surgery Stuart Crescent Health

Centre The Old Surgery The Staunton Group

Practice

Westbury Medical Centre

South east locality

Bridge House Medical Practice

Chestnuts Park Surgery Grove Road Surgery

Havergal Surgery JS Medical Practice (branches at Park Lane,

Phillip Lane and Westbury Avenue)

Spur Road Surgery

The Laurels Medical Practice

West Green Road Surgery

North east locality

Broadwater Farm Health Centre

Bruce Grove Primary Care Health Centre /

Bruce Grove Castle View

Charlton House

Dowsett Road Surgery Fernlea Surgery Lawrence House Surgery/ Lawrence House Broadwater Farm branch

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Morris House Group Practice

Somerset Gardens Family Healthcare Centre

Tottenham Health Centre

Tottenham Hale Medical Practice

Tynemouth Medical Practice

Our Constitution, supported by all member GP practices, sets out the governance

and accountability of our organisation and enables the achievement of our vision,

mission and strategic goals. An updated version of the Constitution was published in

November 2016, following approval by NHS England.

You can read more about the CCG’s structures in the Governance Statement on

page 73. The structures show how the CCG ensures the views of member practices

are represented in the running of the CCG. There are also many examples

throughout this annual report which illustrate where member practices have

opportunities to influence and inform the CCG’s work.

Governing Body

Haringey CCG’s Governing Body provides the strategic leadership of the

organisation and is responsible for making sure that the CCG always works in the

best interests of the local community. The Governing Body is chaired by a local GP

and is accountable to the public in Haringey and for the organisation’s use of public

funds.

You can find out more about our Governing Body members and the other CCG

committees, including the Audit Committee in the Governance Statement. There are

also short biographies of all our Governing Body members on our website:

www.haringeyccg.nhs.uk/about-us/who-we-are.htm

Register of Interests

Haringey CCG maintains registers of interest in accordance with NHS England’s

Statutory Guidance on Managing Conflicts of Interest and our Conflicts of Interest

Policy to ensure that decisions made by the CCG will be taken, and seen to be

taken, without any possibility of the influence of external or private interests. These

registers are published on our website and reviewed regularly. Going forward, fresh

declarations will be made on a six-monthly basis in accordance with this guidance.

Personal data related incidents

No Serious Untoward Incidents relating to data security breaches were reported

during 2016/17.

Statement of Disclosure to Auditors

Each individual who is a member of the CCG’s Senior Management Team and

Governing Body at the time the Members’ Report is approved confirms:

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so far as the member is aware, there is no relevant audit information of

which the CCG’s auditor is unaware that would be relevant for the

purposes of their audit report

the member has taken all the steps that they ought to have taken in order

to make him or herself aware of any relevant audit information and to

establish that the CCG’s auditor is aware of it.

Modern Slavery Act

Haringey CCG fully supports the Government’s objectives to eradicate modern

slavery and human trafficking but does not met the requirements for producing an

annual Slavery and Human Trafficking Statement as set out in the Modern Slavery

Act 2015.

Emergency preparedness

Haringey CCG has a Business Continuity Plan and Emergency Planning Response

and Resilience (EPRR) Policy in place, which have been reviewed in year and

approved by the Governing Body in September 2016. The plan is in accordance with

the requirements of the NHS Commissioning Board Emergency Preparedness

Framework 2013 and associated guidance.

The CCG has participated in local emergency planning exercises co-ordinated by the

Haringey Resilience Forum which have tested local agencies’ roles and

responsibilities in a number of scenarios, and in Exercise Kanikul, which brought

together CCGs and provider trusts in North East and North Central London to test

the health EPRR command and control structures, including mutual aid

arrangements, based on a scenario of day 4 of a national level 4 heatwave alert.

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1.2 Statement of Accountable Officer’s Responsibilities

The National Health Service Act 2006 (as amended) states that each Clinical

Commissioning Group shall have an Accountable Officer and that Officer shall be

appointed by the NHS Commissioning Board (NHS England). NHS England has

appointed the Chief Officer to be the Accountable Officer of Haringey CCG.

The responsibilities of an Accountable Officer are set out under the National Health

Service Act 2006 (as amended), Managing Public Money and in the Clinical

Commissioning Group Accountable Officer Appointment Letter. They include

responsibilities for:

The propriety and regularity of the public finances for which the Accountable

Officer is answerable,

For keeping proper accounting records (which disclose with reasonable

accuracy at any time the financial position of the Clinical Commissioning

Group and enable them to ensure that the accounts comply with the

requirements of the Accounts Direction),

For safeguarding the Clinical Commissioning Group’s assets (and hence for

taking reasonable steps for the prevention and detection of fraud and other

irregularities).

The relevant responsibilities of accounting officers under Managing Public

Money,

Ensuring the CCG exercises its functions effectively, efficiently and

economically (in accordance with Section 14Q of the National Health Service

Act 2006 (as amended)) and with a view to securing continuous improvement

in the quality of services (in accordance with Section14R of the National

Health Service Act 2006 (as amended)),

Ensuring that the CCG complies with its financial duties under Sections 223H

to 223J of the National Health Service Act 2006 (as amended).

Under the National Health Service Act 2006 (as amended), NHS England has

directed each Clinical Commissioning Group to prepare for each financial year

financial statements in the form and on the basis set out in the Accounts Direction.

The financial statements are prepared on an accruals basis and must give a true and

fair view of the state of affairs of the Clinical Commissioning Group and of its net

expenditure, changes in taxpayers’ equity and cash flows for the financial year.

In preparing the financial statements, the Accountable Officer is required to comply

with the requirements of the Group Accounting Manual issued by the Department of

Health and in particular to:

Observe the Accounts Direction issued by NHS England, including the

relevant accounting and disclosure requirements, and apply suitable

accounting policies on a consistent basis;

Make judgements and estimates on a reasonable basis;

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State whether applicable accounting standards as set out in the Group

Accounting Manual issued by the Department of Health have been

followed, and disclose and explain any material departures in the financial

statements; and,

Prepare the financial statements on a going concern basis.

To the best of my knowledge and belief, I have properly discharged the

responsibilities set out under the National Health Service Act 2006 (as amended),

Managing Public Money and in my Clinical Commissioning Group Accountable

Officer Appointment Letter.

I also confirm that:

as far as I am aware, there is no relevant audit information of which the

CCG’s auditors are unaware, and that as Accountable Officer, I have

taken all the steps that I ought to have taken to make myself aware of any

relevant audit information and to establish that the CCG’s auditors are

aware of that information.

that the annual report and accounts as a whole is fair, balanced and

understandable and that I take personal responsibility for the annual

report and accounts and the judgments required for determining that it is

fair, balanced and understandable.

Helen Pettersen

Accountable Officer

26 May 2017

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1.3 Governance Statement

Introduction and context

Haringey CCG is a body corporate established by NHS England on 1 April 2013

under the National Health Service Act 2006 (as amended).

The clinical commissioning group’s statutory functions are set out under the National

Health Service Act 2006 (as amended). The CCG’s general function is arranging the

provision of services for persons for the purposes of the health service in England.

The CCG is, in particular, required to arrange for the provision of certain health

services to such extent as it considers necessary to meet the reasonable

requirements of its local population.

As at 1 April 2016, the clinical commissioning group is not subject to any directions

from NHS England issued under Section 14Z21 of the National Health Service Act

2006.

Scope of responsibility

As Accountable Officer, I have responsibility for maintaining a sound system of

internal control that supports the achievement of the clinical commissioning group’s

policies, aims and objectives, whilst safeguarding the public funds and assets for

which I am personally responsible, in accordance with the responsibilities assigned

to me in Managing Public Money. I also acknowledge my responsibilities as set out

under the National Health Service Act 2006 (as amended) and in my Clinical

Commissioning Group Accountable Officer Appointment Letter.

I am responsible for ensuring that the clinical commissioning group is administered

prudently and economically and that resources are applied efficiently and effectively,

safeguarding financial propriety and regularity. I also have responsibility for

reviewing the effectiveness of the system of internal control within the clinical

commissioning group as set out in this governance statement.

Governance arrangements and effectiveness

The main function of the Governing Body is to ensure that the group has made

appropriate arrangements for ensuring that it exercises its functions effectively,

efficiently and economically and complies with such generally accepted principles of

good governance as are relevant to it.

The Governing Body comprises 18 voting members, including 11 elected GP posts

(one of which is currently vacant following the resignation of Dr Muhammed Akunjee

as the South East Lead Central Member with effect from 31 December 2016), two

executives, two lay members and three appointed posts. This includes a nurse and a

secondary care clinician. We have been unable to recruit to the secondary care

clinician post during the year following the departure of Dr Nick Jenkins.

Governing Body meetings are also regularly attended by the Director of Performance

(Jill Shattock), the Executive Nurse and Director of Quality and Integrated

Governance (Jennie Williams) and the Acting Director of Commissioning (Rachel

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Lissauer). The Chair of Haringey Healthwatch (Sharon Grant) attends meetings as

an observer with speaking rights.

The governance framework of the CCG is set out in Section 6 of the Constitution.

Appendix D of the Constitution (Scheme of Reservation and Delegation) details

which decisions are reserved for the CCG membership and which are reserved or

delegated to either the Governing Body, the Accountable Officer (i.e. Chief Officer),

the Chief Finance Officer or a Governing Body Committee/Sub-Committee.

The CCG has established eight committees and one sub-committee of the

Governing Body. The Audit Committee and the Remuneration Committee are

statutory committees and the Clinical Cabinet, the Quality Committee, the Finance

and Performance Committee, the Investment Committee, the North Central London

(NCL) Primary Care Joint Committee, the Cancer and Cardiac Committee and the

Communications and Engagement Sub-Committee are non-statutory committees.

Their accountability is set out below:

The minutes of each Committee meeting are received by the Governing Body as a

standing item after the minutes have been agreed by the relevant Committee. The

terms of reference of each Committee are available on the CCG website at:

http://www.haringeyccg.nhs.uk/Downloads/Publications/Terms%20of%20Reference

%20of%20the%20Haringey%20CCG%20Governing%20Body%20Committee.pdf

Governing Body

The Governing Body has met in public on six occasions in 2016/17 and has also

held eight informal seminar sessions.

Member Name Job title Meetings

attended

Dr Peter Christian Chair and West GP Lead 5/6

Audit

Committee

Quality

Committee

Finance & Performance

Committee

Remuneration

Committee

Clinical Cabinet

NHS Haringey CCG

Governing Body

London Borough of Haringey

Health & Wellbeing Board

Communication and

Engagement Sub-

Committee

Investment

Committee Cancer and Cardiac

Committee

NCL Primary Care Joint

Committee

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Dr Muhammed Akunjee South East GP Lead (until 31.12.16) 3/4

Dr Gino Amato North East GP Member 5/6

Dr Simon Caplan North East GP Member 4/6

Dr Dina Dhorajiwala West GP Member 3/6

Dr David Masters West GP Member 5/6

Dr Sheena Patel Central GP Lead 6/6

Dr John Rohan North East GP Lead 4/6

Sharon Seber South East Primary Care Health

Professional Member

5/6

Dr Lionel Sherman Central GP Member (from 1.8.16) 2/4

Dr Dai Tan Salaried/Sessional GP Member 5/6

Sarah Timms Nurse Member 6/6

Sarah Price Chief Officer, Haringey CCG (until

5.3.17)

5/5

David Maloney Chief Finance Officer, Haringey CCG

(until 19.2.17)

5/5

Catherine Herman Vice Chair and Lay Member with

responsibility for patient and public

involvement

6/6

Adam Sharples Lay Member with responsibility for

governance

6/6

Dr Jeanelle de Gruchy Director of Public Health, Haringey

Council

4/6

Alison Blair Chief Officer (from 6.3.17) 1/1

Ahmet Koray Chief Finance Officer (from 11.2.17) 0/1

Following the resignation of Dr Sherry Tang at the end of 2015/16, Dr Peter Christian

was elected CCG Chair and Dr John Rohan was elected Deputy Clinical Chair with

effect from 1 April 2016.

In accordance with our Constitution the selection/election/process was also run for

the Central Member vacancy created by Dr Tang’s resignation, and Dr Lionel

Sherman was duly elected, taking up his position with effect from 1 August 2016.

Following the departures of Sarah Price (Chief Officer) in March 2017 and David

Maloney (Chief Finance Officer) in February 2017 to take up new external positions,

Alison Blair was appointed interim Chief Officer and Ahmet Koray was appointed

interim Chief Finance Officer. Alison and Ahmet also hold these positions at Islington

CCG.

The gender breakdown of the Governing Body is currently eight male members and

eight female members.

The highlights of the Governing Body’s work in 2016/17 include:

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Receiving as standing items at each meeting the Finance Report, the

Performance and Quality Summary Report, the Strategic Risk Report and the

agreed minutes of the CCG’s Committees

Receiving reports/briefings on the North Central London Sustainability and

Transformation Plan, Primary Care, the Haringey and Islington Wellbeing

Partnership, the Communications and Engagement Strategy, the North

Central London Integrated Urgent Care Service mobilisation, Integrated Out of

Hospital Services, London Health and Care Devolution, NHS Operational

Planning and Contracting, Emergency Planning, Resource and Resilience

and declarations of interest

Approving the Terms of Reference of the Clinical Cabinet, the Finance and

Performance Committee, the Remuneration Committee, the Investment

Committee, the Audit Committee, the Quality Committee and the draft Primary

Care Committee in Common

Detailed discussions on quality and safety concerns at North Middlesex

University Hospital, the performance of the London Ambulance Service,

commissioning intentions, improving sexual health outcomes, improving

health outcomes for children and young people, a population health approach

to stroke and mental health and wellbeing

Approving the development of CCG commissioning arrangements in North

Central London, the submission of an expression of interest to become

Primary Care delegated commissioners and later the subsequent

recommendation that Haringey, Islington, Barnet, Enfield and Camden CCGs

mobilise delegated commissioning, the next steps for Integrated Care, the

2016/17 budget, the Section 75 Partnership Agreement with Haringey

Council, the 2017/18 funding for the Healthy London Partnership, the 2017/18

financial plan, the Clinical Procurement Corporate Governance and Strategic

Framework, the Business Continuity Plan, the Emergency Preparedness,

Resilience and Response Policy and the Conflicts of Interest Policy

Approving the recommendations of the Investment Committee

Approving the Safeguarding Children and Adult Safeguarding Annual Reports

Approving proposed changes to the CCG Constitution.

The following key decisions were made in the Part II (confidential) Governing Body

meetings during 2016/17:

Approval of the North Central London Commissioning Arrangements, the

Commissioning Strategy for 2017/18 and the Financial Strategy 2017/18 –

2020/21

Approving the Contract Award Recommendation for the Stroke Recovery

Service

Ratifying the decision via Chair’s Action to award the GPIT contract following

the procurement process

Approving the recommendations in the Investment Committee Report

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Approving the recommendation of the Remuneration Committee.

The Governing Body also received confidential briefings on North Middlesex

University Hospital Emergency Department and the development of the

Sustainability and Transformation Plan.

The Governing Body carried out a self-assessment in April 2017 which revealed that

members are satisfied overall with the Governing Body’s effectiveness and its

compliance with relevant best practice as set out in the UK Corporate Governance

Code.

Members highlighted a number of areas for further improvement, including improving

engagement with our members, having sufficient capacity to discharge Governing

Body duties, filling the two existing vacancies and giving more thought to succession

planning.

The results from the 2017 CCG stakeholder survey, run by Ipsos Mori on behalf of

NHS England, were released at the end of March 2017. Haringey CCG will be

reviewing the results and agreeing some actions with governing body members and

staff over the next few weeks. As usual, results will also be published on the CCG’s

website and shared with the stakeholders who completed the survey.

Audit Committee

The Audit Committee provides the Governing Body with an independent and

objective view of the CCG’s financial systems, financial information and compliance

with laws, regulations and directions governing the CCG in so far as they relate to

finance. It also reviews the establishment and maintenance of an effective system of

integrated governance, risk management and internal control across the whole of the

CCG’s activities in accordance with the Scheme of Reservation and Delegation.

Member Name Job title Meetings

attended

Adam Sharples Audit Committee Chair, Lay Member

with responsibility for governance

4/4

Dr Peter Christian West GP Lead 1/1

Dr Dai Tan Salaried/Sessional GP Member 3/3

Catherine Herman Lay Member with responsibility for

patient and public involvement

3/4

Karen Trew Lay Member with responsibility for

governance

3/4

Meetings are also routinely attended by the Chief Finance Officer (previously David

Maloney and now Ahmet Koray), Executive Nurse and Director of Quality and

Integrated Governance (Jennie Williams) and internal and external audit

representatives, including the Local Counter Fraud Service (LCFS).

The highlights of the Committee’s work in 2016/17 include:

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Reviewing internal and external audit plans and reports, and seeking

assurance that recommended actions were completed and that all issues

were managed comprehensively.

Receiving reports on counter-fraud and waivers to competitive tender

requirements

Providing assurance to the Governing Body on areas of governance, risk and

conflicts of interest, including detailed oversight of the Risk Register, as well

as declarations of interests and gifts and hospitality.

Obtaining assurance on designated areas of work undertaken by NELCSU on

behalf of Haringey CCG.

Approving the 2015/16 Annual Accounts and Annual Report, as delegated by

the Governing Body

Receiving reports on the effectiveness of the Clinical Cabinet, the

Communications and Engagement Sub-Committee and the Audit Committee

itself

Approving the Risk Management Framework and Risk Management

Procedure Guidance, the Clinical Procurement Corporate Governance and

Strategic Framework, the Anti-Fraud and Anti-Bribery Policy, the

Whistleblowing Policy, the Business Continuity Plan, the Emergency Planning

Resilience and Response Policy, the revised Conflicts of Interest Policy and

the revised Scheme of Delegation

Ratifying the extension of the contract for the SHREWD system

Noting the appointment of KPMG as the CCG’s external auditors (this

decision had been delegated to the Chief Finance Officer and Audit

Committee Chair)

Recommending internal audit programmes for 2017/2018 should begin to look

at common issues for alignment between the North Central London CCGs

pending future discussion of the Audit Committee’s role and approach in

respect to the STP.

Clinical Cabinet

The Clinical Cabinet drives the development of GP-led, multi-professional clinical

commissioning across all CCG members, while also communicating and

implementing the CCG’s vision. It also promotes innovation and integration in the

provision of services and advises the Governing Body and clinical commissioners to

commission improvements consistent in quality with the NHS Outcomes Framework.

Member Name Job title Meetings

attended

Dr John Rohan Clinical Cabinet Chair and North East

GP Lead

6/6

Dr Muhammed Akunjee South East GP Lead (until 31.12.16) 3/4

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Dr Gino Amato North East GP Member 3/6

Dr Simon Caplan North East GP Member 6/6

Dr Peter Christian CCG Chair and West GP Lead 1/6

Dr Dina Dhorajiwala West GP Member 1/6

Dr David Masters West GP Member 5/6

Dr Sheena Patel Central GP Lead 0/6

Sharon Seber South East Primary Care Health

Professional Member

4/6

Dr Dai Tan Salaried/Sessional GP Member 4/6

Sarah Timms Quality Committee Chair and

Governing Body Nurse Member

4/6

Dr Kate Rees Cancer and End of Life Care Lead 3/6

Dr Christiana Aride Gynaecology Lead 6/6

Rachel Lissauer Director of Commissioning (from July

2016)

4/5

Marion Lombardelli Practice Manager Representative 1/6

Will Maimaris Public Health Consultant 1/6

The highlights of the Clinical Cabinet’s work in 2016/17 include:

Receiving in depth presentations about a variety of subjects including the

stroke pathway, developments in intermediate care, changes to the

dermatology pathway, supporting self-management for people with long term

conditions, electronic booking for phlebotomy at North Middlesex; the

Haringey and Islington Wellbeing Partnership; the Safer Faster Better

programme at North Middlesex Hospital and the development of mental

health support in primary care. This enabled GPs to discuss, comment and

feedback from a local perspective on issues and achievements and advise on

areas for improvement.

Reviewing the process by which patients are discharged back to primary care.

Clinical Cabinet approved a proposal to carry out an audit to identify recurrent

themes or problems

Discussing and reviewing the implications of taking on Level 3 delegation for

primary care commissioning

Receiving updates on Quality Alerts in order to assess patterns and review

actions taken

Receiving regular updates from the quality team on quality of care at local

Trusts and having an opportunity to question actions being taken by the Trust

and CCG

Providing feedback and clinical input into community services commissioned

to manage demand for acute care (ophthalmology, ENT, dermatology, minor

eye conditions; urology and gynaecology)

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Receiving regular update reports concerning QIPP, contracts, primary care

development and co-commissioning, medicines management and advising on

policy and development where required.

Finance and Performance Committee

The Finance and Performance Committee is responsible for overseeing the financial

performance of the CCG and the associated financial planning issues and the

performance of the CCG against key service delivery indicators and targets. It also

provides assurance to the Governing Body regarding the delivery of the QIPP Plan

and that the Commissioning Support Unit is providing financial/performance services

in line with the Service Level Agreement.

Member Name Job title Meetings

attended

Dr John Rohan Finance and Performance Committee

Chair, North East GP Lead

5/6

Dr Peter Christian CCG Chair and West GP Lead 1/6

Dr Dina Dhorajiwala West GP Member 4/6

Adam Sharples Lay Member with responsibility for

governance

6/6

Sarah Price Chief Officer (until 5.3.17) 2/5

David Maloney Chief Finance Officer (until 19.2.17) 5/5

Jill Shattock Director of Commissioning (until July

2016)

Director of Performance (from July

2016)

6/6

David Graham Assistant Director, Acute Contracts

and QIPP

5/6

Rachel Lissauer Acting Director of Commissioning

(from July 2016)

4/5

Eileen Fiori Haringey CCG NELCSU MDT Lead 1/6

Alison Blair Chief Officer (from 6.3.17) 1/1

Ahmet Koray Chief Finance Officer (from 11.2.17) 0/1

The highlights of the Committee’s work in 2016/17 include:

Receiving regular reports on the delivery of financial plans and the Quality,

Innovation, Productivity and Prevention (QIPP) programme

Receiving regular Integrated Contract Monitoring Reports

Receiving regular Performance and Quality Summary Reports covering the

material CCG contracts, including detailed discussion of London Ambulance

Service and Community Services performance issues

Approving the 2017/2018 and 2018/2019 Operating Plan

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Recommending the CCG’s 2017/2018 Financial Plan for approval by the

Governing Body.

Recommending that the Governing Body approve the NCL CCGs’ Financial

Strategy for 2017/2018 to 2020/21.

Approving revised terms of reference for the Finance and Performance

Committee and the Finance and Performance Partnership Board

Receiving updates on the NCL Financial Base Case and the use of 2016/17

System Resilience Funding

Recommending the revised Individual Funding Requests (IFR) Policy for

approval by the Governing Body.

Quality Committee

The Quality Committee ensures the quality and safety of commissioned services and

assures the Governing Body on matters of clinical governance, risk, quality and

patient safety, as well as the provision of assurance on matters of patient and public

engagement.

Name Job Title Meetings Attended

Sarah Timms Governing Body Nurse Member

and Chair

6/6

Catherine Herman Governing Body Lay Member with

responsibility for patient

and public involvement

5/6

Sharon Seber Primary Care Health Professional

Governing Body Member, South

East

6/6

Jennie Williams Executive Nurse and Director of

Quality and Integrated

Governance

2/6

Cassie Williams Assistant Director, Primary Care

Quality and Development

3/6

Rosie Peregrine-Jones Head of Quality 4/6

Karen Baggaley Assistant Director for

Safeguarding and

Designated Nurse for Child

Protection (until September 2016)

3/3

Lesley Walmsley Patient Representative 6/6

Swetlana Wolf Head of Quality Assurance,

NELCSU

3/6

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The highlights of the Committee’s work in 2016/17 include:

Receiving regular reports on the performance of local trusts regarding quality

and safety, including the NMUH CQC comprehensive inspection report.

Reviewing the quality risks on the CCG Risk Register

Receiving regular Safeguarding Adults and Children reports to identify areas

of compliance, themes and trends and recommend appropriate actions

Receiving Safeguarding Adults and Safeguarding Children Annual Reports

Approving policies, including the Accessible Information Policy, the Policy and

Procedure for the Development, Approval and Implementation of Patient

Group Directions in HCCG and a Fertility Policy update.

Reviewing quality governance in medium/low value contracts included in the

Haringey CCG Service Tracker

Receiving reports on patient safety and serious incidents, local patient safety

project improvement plans, reports on GP Alerts, Complaints and updates on

the Insight and Learning Group programme and report on Freedom of

Information Requests to the CCG

Receiving reports from the Quality Matters in Care Homes team, including

their Annual Report

Receiving reports on Quality in Primary Care (quarterly)

Receiving assurance on the CCG’s work towards ensuring that Equality and

Diversity-related impacts, including risks, are reviewed and managed

including EDS2 compliance and WRES action plans

Reviewing progress against key Winterbourne View Concordat commitments

and Transforming Care Programme

Receiving regular Information Governance reports, including progress against

the Information Governance Toolkit workplan and approving via Chair’s Action

the final Toolkit submission

Receiving a Caldicott Guardian report

Reviewing the progress of the CCG’s Engagement Strategy and agreeing

revised Terms of Reference of the Communication and Engagement

subcommittee.

Receiving updates on performance against the CCG Quality Premium

measures

Receiving updates on KPIs and CQUIN performance in 2016/17 and plans for

2017/18

Receiving minutes from the sub-groups reporting to the committee

Undertaking an annual review of the Committee’s effectiveness.

Investment Committee

The Investment Committee makes recommendations to the Governing Body on

investment and disinvestment proposals in line with the financial strategy and

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budgets which are overseen by the Finance and Performance Committee. These

recommendations are based on evaluations made using the CCG’s Commissioning

Prioritisation Framework, which is reviewed annually. The establishment of the

Committee reduces the possibility of conflicts of interest in the CCG’s investment

and disinvestment decision-making process.

Member Name Job title Meetings

attended

Catherine Herman Investment Committee Chair, Lay

Member with responsibility for patient

and public involvement

3/3

Dr David Masters West GP Member 2/3

Dr Dominic Roberts GP Governing Body Member, Islington

CCG

2/3

David Maloney Chief Finance Officer (until 19.2.17) 0/1

Sarah Price Chief Officer (until 5.3.17) 2/2

Sarah Timms Nurse Member 2/3

Alison Blair Chief Officer (from 6.3.17) 1/1

Ahmet Koray Chief Finance Officer (from 11.2.17) 1/2

Susan Secher, Peter Richards and Lesley Walmsley attend Investment Committee

meetings as patient representatives. Dr Ammara Hughes resigned from the

Committee at the beginning of the financial year, before any meetings were held in

2016/17 and was replaced as the independent GP member by Dr Dominic Roberts,

who is a GP in Islington.

The highlights of the Committee’s work in 2016/17 include:

Endorsing the proposal to formally procure a GP extended access service for

patients registered in Haringey and subsequently recommending to the

Governing Body that it approves the award of the extended hours contract to

Federated4Health

Approving funding for GMS Practices to provide the management of planned

care service

Approving bids for funding under the Better Care Fund

Agreeing to recommend to the Governing Body funding for the Rapid

Response service

Agreeing funding for Citizens Advice Bureau welfare hubs

Agreeing funding for Individual Placement and Support

Approving in principle funding for Local Incentive Schemes (LIS), subject to

confirmation of the business rules

Recommending that the Primary Care Co-Commissioning Committee

approves five Estates Technology and Transformation Fund (ETTF) schemes.

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Remuneration Committee

The Remuneration Committee currently makes recommendations to the Governing

Body on determinations about pay and remuneration for employees of Haringey

CCG and people who provide services to the CCG and allowances under any

pension scheme it might establish as an alternative to the NHS pension scheme.

Member Name Job title Meetings

attended

Adam Sharples Remuneration Committee Chair, Lay

Member with responsibility for

governance

2/4

Catherine Herman Lay Member with responsibility for

patient and public involvement

3/4

Sarah Timms Nurse Member 4/4

Peter Christian CCG Chair and West GP Lead 1/4

For each of the above four meetings the Committee had delegated authority from the

Governing Body to agree job descriptions and salary packages for the newly-created

NCL executive roles.

Communications and Engagement Sub-Committee

This sub-committee is responsible for the development and implementation of the

CCG’s communications and engagement strategies and channels.

Member Name Job title Meetings

attended

Catherine Herman Communications and Engagement

Sub-Committee Chair, Lay Member

for Patient and Public Involvement

4/4

Dr Muhammed Akunjee South East GP Lead (until 31.12.16) 2/3

Caroline Rowe Head of Communications and

Engagement

4/4

Kate Thomson Primary Care Communications and

Engagement Manager (until October

2016)

2/3

Jill Shattock Director of Commissioning (until July

2016)

1/1

Rachel Lissauer Director of Commissioning (from July

2016)

2/3

Isha Richards Senior Communications Officer 4/4

Rebecca Hennell-Smith Primary Care Communications and

Engagement Officer

1/1

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Emdad Haque Equality and Diversity Manager, NEL

CSU

3/4

Mike Wilson Director, Haringey Healthwatch 2/4

Geoffrey Ocen Chief Executive, Bridge Renewal Trust 3/4

Susan Secher Patient Representative 2/4

The highlights of the Committee’s work in 2016/17 include:

• Delivery of the CCG’s Engagement Strategy 2016/17 and associated action

plan

• Achievement of an outstanding rating from NHS England for meeting our

statutory collective duty to involve people in our work.

• Overseeing a series of successful engagement events and campaigns for the

public and key stakeholders, including GPs, to inform the CCG’s

commissioning

• Maintenance and further development of the CCG’s e-communication

channels, including the CCG website, staff intranet, GP website and Twitter

account

• Overseeing the process of recruiting and supporting patient representatives

on to CCG committees, procurement panels and other engagement forums

and networks

• Recruiting Bridge Renewal Trust to the committee which has strengthened the

CCG’s relationship with Haringey’s third sector and enabled more community

engagement.

For more information, please refer to the engagement section of this annual report or

visit the CCG’s website: http://www.haringeyccg.nhs.uk/about-us/engagement

North Central London (NCL) Primary Care Joint Committee

The North Central London (NCL) Primary Care Joint Committee was established to

enable NHS England, Barnet CCG, Camden CCG, Enfield CCG, Haringey CCG and

Islington CCG to jointly commission primary medical services for the people of

Barnet, Camden, Enfield, Haringey and Islington. The role of the Committee includes

joint oversight of GP contracts, informing decision making on approving GP practice

mergers, GP retirements, and the development of local enhanced services. Where a

decision brought to the Committee relates to an individual CCG, the decision is

made jointly by that CCG and by NHS England.

The Committee is chaired by Catherine Herman, one of Haringey CCG’s lay

members. Dina Dhorajiwala is our GP representative on the Committee and Jennie

Williams is our officer representative. Katherine Gerrans, Haringey CCG Lead Nurse

and Quality Workforce Manager, is the practice nurse representative on behalf of all

five CCGs. The remaining membership consists of a GP representative and an

officer representative from the other four CCGs, three lay members from NCL CCGs

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and three representatives from NHS England. Representatives of Healthwatch, the

LMC and the Health and Well Being Boards are non-voting attendees.

Haringey CCG

Member Name

Job title Meetings

attended

Catherine Herman Chair, Lay Member 6/6

Dina Dhorajiwala West GP Member 5/6

Jennie Williams Executive Nurse and Director of

Quality and Integrated Governance

5/6

Kherine Gerrans Lead Nurse & Quality Workforce

Manager

5/6

The committee met in public six times during 2016/17 in line with the agreed model

for co-commissioning with NHS England and North Central London CCGs.

Significant work has been undertaken during the year to agree the approach for the

move to full delegation from April 2017. The committee throughout the year has

reviewed reports on primary care commissioning intentions and locally

commissioned services, agreed decisions on GMS, PMS and APMS contract

matters and has received regular quality and performance reports as well as

reviewing finance and risk status reports.

Cancer and Cardiac Committee

The Cancer and Cardiac Committee was created as a time-limited committee and

did not meet formally in 2016/17. We plan to abolish this committee as part of the

next round of proposed changes to our Constitution which will be submitted to NHS

England for approval.

UK Corporate Governance Code

NHS Bodies are not required to comply with the UK Code of Corporate Governance.

Discharge of Statutory Functions

In light of recommendations of the 1983 Harris Review, the clinical commissioning

group has reviewed all of the statutory duties and powers conferred on it by the

National Health Service Act 2006 (as amended) and other associated legislative and

regulations. As a result, I can confirm that the clinical commissioning group is clear

about the legislative requirements associated with each of the statutory functions for

which it is responsible, including any restrictions on delegation of those functions.

Responsibility for each duty and power has been clearly allocated to a lead Director.

Directorates have confirmed that their structures provide the necessary capability

and capacity to undertake all of the clinical commissioning group’s statutory duties.

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Risk management arrangements and effectiveness The CCG’s Risk Management Framework sets out the CCG policy for managing risk

by identifying risks and potential missed opportunities that threaten the achievement

of our strategic objectives, putting in place appropriate mitigating controls to manage

identified risks to an acceptable level, escalating and reporting key risk and control

information to support management decision-making and oversight at all levels, as

well as having in place an appropriate risk management framework that is aligned to

and supports the delivery of our strategic imperatives and continuously monitors the

changing risk environment, key risks, the effectiveness of mitigation strategies and

the application of the Framework.

All risks are assessed using a clearly defined risk assessment matrix by determining

the likelihood and consequence of the risk to calculate an overall risk rating. The

amount and type of risk that the CCG is willing to take on in pursuit of its strategic

objectives is determined by the Governing Body. The Governing Body’s appetite for

risk is influenced by a number of key factors, including the overall level of risk, as

well as the economic, regulatory and operational landscape.

Through the use of our Governing Body and Committee pro-forma front cover sheets

the CCG requires all risks relating to the content of any papers to be highlighted,

including any equalities impact and whether there has been any patient and public

involvement. The Incident and Serious Incident Policy also encourages staff to report

incidents so that any necessary learning can be taken forward.

A range of controls are in place to manage each individual risk and the Risk Register

documents in turn where the CCG can gain assurance that these controls are

working as stated.

Risk leads also work collaboratively with stakeholders and system leaders to identify

and implement mitigating controls. During 2016/17 the CCG has continued to ensure

close oversight of risks relating to the quality of care delivered by the emergency

department at North Middlesex University Hospital NHS Trust. The CCG has worked

collaboratively with the Trust, system leaders and stakeholders to mitigate risks

associated with ensuring patients receive high quality, safe and effective care. The

CCG risk register has provided detailed information on how the CCG has managed

both performance and quality risks identified during 2016/17. The Risk Management

Framework and Risk Management Procedure Guidance were both updated and then

approved by the Governing Body at its meeting in July 2016.

Capacity to Handle Risk

As outlined above, there is a Governing Body and management commitment to

effective risk management across the CCG. The Governing Body and all committees

have clearly defined responsibilities for risk management. In addition, directorates

regularly review risks which fall within their areas of work at team meetings. Staff

are also encouraged to identify any additional current or potential risks which might

warrant inclusion in the Risk Register. Our induction programme includes mandatory

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training on high risk areas, including information governance. Guidance provided to

staff reflects professional best practice.

Risk Assessment

The CCG’s approach to assessing risk is set out on the previous page of this

Governance Statement (‘risk management arrangements’).

The following table sets out the significant risks which have been identified in year,

the mitigations currently in place and planned actions.

Risk Mitigations in place Planned actions

Risk 10 - There is a risk of

continued poor

performance against the

A&E target at NMUH.

1. The Trust is acting on

the findings of the full

diagnostic report

commissioned from North

West Utilisation

Management Unit to

achieve agreed clinical

outcomes.

2. Report and

recommendations now

incorporated as part of

the “Safer, Faster Better”

(SFB) work programme to

implement recommended

actions via four

workstreams.

3. A&E Delivery Board is

in place, focusing on the

progress of the 5

mandated national A&E

improvement initiatives.

1. CCG acting as

convenor and lead for Out

of Hospital workstream.

Weekly project team

meetings to be set up and

partner organisation

membership agreed.

2. Recovery target to be

proposed and managed

as part of the STF

(Sustainability and

Transformation Fund)

arrangements for

2016/17.

Risk 14 - There is a risk of

that the CCG will not be

able to achieve planned

efficiency savings relating

to integrated care and

invoice validation, due to

the changed legal position

concerning the CCG’s

and the CSU’s ability to

This risk was closed in May 2016 as it is now being

managed as business as usual.

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Risk Mitigations in place Planned actions

process Personal

Confidential Data.

Risk 24 - There is a risk of

being unable to

implement health

economy-wide strategic

change across Barnet

CCG, Enfield CCG,

Haringey CCG and

BEHMHT.

This risk was closed in July 2016 as it is now being

addressed via the Sustainability and Transformation

Plan mental health workstream, which the CCG is part

of.

Risk 26 – There is a risk

that BEHMHT will fail to

deliver the required ‘must

do’ and ‘should do’

improvements required,

after the Trist was rated

as ‘requires improvement’

following an inspection by

the CQC in December

2015.

(This risk was redefined in

June 2016. It was

previously:

There is a risk that

BEHMHT will fail to

deliver the improvement

plans in place and the

quality and safety of

services may deteriorate

further).

1. Oversight of the

delivery of the BEHMHT

CQC improvement action

plan by the Joint

Performance and Quality

Group (JPQG) from June

2016.

2. Haringey CCG is

ensuring the CQC

improvement plan gives

appropriate focus to

improved outcomes for

patients accessing

services in Haringey.

1. Commissioners to

receive 6-monthly

updates on delivery via

the JPQG meeting, with

exception reporting of key

risks and remedial

actions.

2. To ensure the CCG

senior management team

and CCG Quality

Committee are kept

briefed on the progress

made by the Trust to

deliver the CQC

improvement plan and the

Chief Officer and Chair

are informed of any

emerging concerns

relating to quality and

safety.

Risk 30 - There is a risk of

failing to deliver a

balanced Financial Plan

in 2015/16.

This risk was closed in May 2016 as the draft annual

accounts for 2015-16 showed that the CCG was

under-spent by £75,000.

Risk 32 – There is a risk

of failing to ensure

effective systems and

processes are in place to

1. NHS Improvement is

supporting the Trust to

strengthen leadership at

executive level.

1. To share the CQC

Quality Improvement plan

with commissioners at the

February 2017 CQRG,

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Risk Mitigations in place Planned actions

support, monitor and

challenge NMUH to

deliver sustained

improvements required

by :

The NHS

Constitution targets

The CQC which

issued a section

29A Warning

Notice on 27 April

2016

Health Education

England (HEE)

which as a result of

the Trust-wide visit

in March 2016

The GMC in

respect of the Trust

meeting the GMC

Standards for

Medical

Education (2016)

(This risk was redefined in

June 2016. It was

previously: There is a risk

that NMUH will fail to

deliver the sustained

improvements required to

improve performance on

a range of known and

emerging issues).

2. The monthly Clinical

Quality Review (CQRG)

and Contract Review

Group (CRG) meetings

led by commissioners

ensure close scrutiny of

key quality and safety

metrics and performance

against the national

targets for A&E

3. A monthly Programme

Oversight Group (POG)

implemented by NHS

Improvement (NHSI)

following the ED Risk

Summit on 8.2.16 is

overseeing delivery of the

medium and longer-term

improvements required by

the CQC and HEE and

ensure short term actions

lead to sustainable

improvements.

Haringey and Enfield

CCG Chief Officers are

members of this group.

4. An Operational

Delivery Group (ODG)

chaired by NHS England

(NHSE) continues to hold

the Trust and system to

account for delivery of the

required operational

actions to support the

Trust to meet the HEE

requirements.

5. CCG staff have been

assigned to support the

Trust transformation

programme ‘Safer Faster

following the CQC Quality

Summit on 20.12.16.

2. There is a coordinated

approach to

communication to ensure

robust and consistent

communication and

engagement with

stakeholders.

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Risk Mitigations in place Planned actions

Better’ to improve patient

flow and reduce delayed

discharges.

Risk 33 - There is a risk

that the CCG is unable to

demonstrate it has

delivered its duty under

the NHS Constitution to

ensure patients “have the

right to access services

within maximum waiting

times”.

1. The Director of

Performance is working

closely with the CSU to

ensure robust monitoring of

constitutional standards for

all providers.

2. Remedial action plans

(RAP) have been agreed by

host commissioners and are

monitored at regular review

meetings and all CCGs

updated.

3. HCCG is assured that

plans are in place for agreed

trajectories to deliver

compliance.

1. Weekly cancer Patient

Tracking Lists (PTL)

supplied by RFL and

monitored by lead CCG

(Barnet) to ensure

improvement with 62 day

cancer standard.

2. To monitor recovery

against compliance with

the national standards for

Diagnostics at UCLH

compliance was achieved

as planned in December

2016, (lead commissioner

Camden CCG).

3. To ensure a robust

action plan is in place to

ensure recovery of the

diagnostic target

attainment by Inhealth,

independent sector

diagnostic provider (lead

commissioner Camden

CCG).

4. To monitor

improvement of the

cancer 62 day standard

attainment at UCLH.

Risk 34 - There is a risk of

failing to deliver a

balanced Financial Plan

in 2016/17.

1.Appropriate financial

governance systems in

place

2. Review and ongoing

scrutiny of the CCG’s

financial performance by

Finance and Performance

1. Identification of

additional areas for

2016/17 QIPP.

2. Monthly monitoring of

expenditure against

budget (C)

3. Implementation of

Recovery Plans for all

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Risk Mitigations in place Planned actions

Committee and

Governing Body.

3. Review of 2016/17

QIPP Plan at QIPP

Delivery Group and

Finance and Performance

Committee meetings.

4. 2016/17 budget setting

process.

5. Approval of Financial

Plan by Finance and

Performance Committee

and Governing Body.

6. Rigorous contract

management processes

undertaken during

2016/17.

acute contracts in NCL

(A)

4. Reach agreement with

providers regarding

2016/17 expenditure.

Risk 35 - There is a risk of

NMUH failing to achieve

the 62 cancer target.

1. Contract Performance

Notice issued via the NHS

standard contract

process.

2. Remedial Action Plan

required from (1) to detail

improvement and target

recovery.

1. Weekly Patient

Tracking List (PTL)

monitoring for all patients

waiting longer than 62

days, via teleconference.

2. RAP to be updated as

there has been no

recovery in performance.

Risk 36 - There is a risk

that the North Central

London (NCL)

Sustainability and

Transformation Plan

(STP) does not recognise

or support the work of the

Haringey and Islington

Partnership as the agreed

direction of travel across

1. Involving Haringey and

Islington programme

leads in STP level work to

ensure similar approach

and direction.

2. Structuring the

Haringey and Islington

Partnership team in line

with STP priority

1. Ensuring that Haringey

and Islington are well

represented at STP level

2. Clear structure in place

for Haringey and Islington

partnership to deliver STP

intervention

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Risk Mitigations in place Planned actions

all partners and therefore

benefits to the population

and sustainable services

are not realised.

interventions so that local

delivery leads can be

clearly identified

3. Maintaining pace and

focus for Haringey and

Islington programme so

that our structure is

embedded.

4. Effective

communication and

engagement so that

Haringey and Islington

programme has strong

local ownership across

health and social care

Risk 37 - There is a risk

that the uncertainty

around the transition to

the new NCL

commissioning

arrangements could

adversely affect key CCG

functions.

1. Regular briefings for all

staff, face to face and via

email.

2. Smaller team and

individual discussions as

needed.

3. Local team

development of structures

going forward across

Haringey and Islington.

1. NCL HR support to be

established.

2. Development of

Directorate structures for

each area in the Haringey

and Islington Team.

3. Supporting narrative for

all to outline the rationale

behind the single team.

4. Joint wider leadership

team meetings to be held

with Islington Wider

Leadership Team.

5. Confirmation about the

central functions and

consequent impact on

local staff.

6. CSU Multi-Disciplinary

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Risk Mitigations in place Planned actions

Teams to work more

flexibly together in

support of the joint team.

Risk 38 - There is a risk of

failing to deliver a

balanced Financial Plan

in 2017/18.

1.Appropriate financial

governance systems in

place

2. Review and ongoing

scrutiny of the CCG’s

financial performance by

Finance and Performance

Committee and

Governing Body.

3. Review and

identification of 2017/18

QIPP Plan at QIPP

Delivery Group and

Finance and Performance

Committee meetings.

4. 2017/18 budget setting

process.

5. Approval of Financial

Plan by Finance and

Performance Committee

and Governing Body.

6. Pan-NCL work to

implement and deliver the

STP interventions.

7. Liaison with NHS

England regarding impact

of HRG+4.

1. Implement STP

interventions.

2. Identify additional QIPP

projects, both CCG and

NCL-wide.

3. Discussions with NHS

England and NHS

Improvement regarding

overall NCL financial gap.

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Other sources of assurance

Internal Control Framework

A system of internal control is the set of processes and procedures in place in the

clinical commissioning group to ensure it delivers its policies, aims and objectives. It

is designed to identify and prioritise the risks, to evaluate the likelihood of those risks

being realised and the impact should they be realised, and to manage them

efficiently, effectively and economically.

The system of internal control allows risk to be managed to a reasonable level rather

than eliminating all risk; it can therefore only provide reasonable and not absolute

assurance of effectiveness.

The CCG Risk Register assesses the effectiveness of systems of internal control

and provides assurances that the CCG’s risk management processes are effective. It

is a dynamic document that captures the understanding of the risk environment at

any given time. The document outlines the CCG’s strategic objectives, the risks to

achieving these objectives, key controls and assurances in place, as well as gaps in

controls and assurances and the arrangements in place to mitigate these.

Risks go through the following regular review cycle:

Risk owners (i.e. lead directors) review individual risks monthly

The full Risk Register is reviewed monthly by the Senior [now Executive]

Management Team

Risks are considered by the committee which has lead responsibility for the

oversight

The full Risk Register is reviewed by the Audit Committee bi-monthly and the

Strategic Risks (i.e. those scored at 12 and above) are recommended to the

Governing Body for approval, in the form of the Strategic Risk Report, at its bi-

monthly meetings, whose papers are available here:

http://www.haringeyccg.nhs.uk/about-us/board-meetings.htm

The full Risk Register is also published on the CCG website on a bimonthly

basis.

The CCG Risk Register was reviewed by our Internal Auditors during 2016/17. While

the review was positive overall and rated amber-green, it identified a number of

management actions to enhance the register. These related to ensuring that it is

clear when actions have been completed, ensuring that actions have a dated

deadline where possible, ensuring that realistic deadlines are set and it is made clear

on the register when deadlines have passed and management placing increased

focus on risks affecting the wider NCL group of CCGs, as well as reviewing the risks

and assurances surrounding the STP. The individual CCG risk owners subsequently

reviewed each risk to address these actions. Furthermore, two new risks (risks 36

and 37 – see pages 92-93) were opened in light of this feedback.

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The CCG’s Standing Orders, Scheme of Reservation and Delegation of Powers,

Detailed Financial Policies and Standing Financial Instructions also form part of the

internal control framework.

Annual audit of conflicts of interest management

The revised statutory guidance on managing conflicts of interest for CCGs

(published June 2016) requires CCGs to undertake an annual internal audit of

conflicts of interest management. To support CCGs to undertake this task, NHS

England has published a template audit framework.

The annual internal audit of the CCG’s processes for managing conflicts of interest

was carried out in January 2017 and provided ‘reasonable assurance’. A number of

actions were agreed as a result of this review, the majority of which have already

been discharged. The CCG is ensuring that declarations of interest are a standing

agenda item for all committees, sub-committees and contract monitoring meetings,

to ensure conflicts are managed properly. In the minutes of these meetings the CCG

will detail who has the interest, the nature of the interest, the agenda item(s) which

the interest relates to, how the conflict was agreed to be managed and evidence that

it was managed as intended. The CCG has also added two fields to our Gifts and

Hospitality register in line with NHS England guidance. Lastly, the Recruitment Policy

will be updated to include the requirement for declarations of interest to be made as

part for the recruitment process.

Data Quality

Governing Body members confirmed as part of their self-assessment carried out in

April 2017 that they were satisfied overall with the quality of data they receive but it

was also noted that there are occasional issues with the timeliness and detail of

some performance data which can present challenges in terms of strategic planning.

The CCG continues to work closely with providers in order to improve data and

reporting, particularly in the areas of community services and mental health services.

Information Governance

The NHS Information Governance Framework sets the processes and procedures by

which the NHS handles information about patients and employees, in particular

personal identifiable information. The NHS Information Governance Framework is

supported by an information governance toolkit and the annual submission process

provides assurances to the clinical commissioning group, other organisations and to

individuals that personal information is dealt with legally, securely, efficiently and

effectively. We have submitted a satisfactory level of compliance (Level 2) with the

information governance toolkit assessment.

We place high importance on ensuring there are robust information governance

systems and processes in place to help protect patient and corporate information.

We have established an information governance management framework and have

developed information governance processes and procedures in line with the

information governance toolkit. Due to the in-year decommissioning of the NHS

Information Governance Training Tool (IGTT), the CCG followed the advice from

97

NHS Digital that all staff who could evidence successfully completing their IG training

in 2015/16 would not need to complete it in 2016/17. Alternative training material

was made available for new and interim staff who had not previously completed this

training. Annual mandatory IG training for all staff will recommence in 2017/18. We

have also implemented a staff information governance handbook to ensure staff 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.

The Executive Nurse and Director of Quality and Integrated Governance has been

designated as Senior Information Risk Officer (SIRO) for the CCG.

Business Critical Models

The key business critical models that the Governing Body relies on are in-year

financial forecasts, medium term financial planning and financial evaluation and

forecasting. These models are the responsibility of the Chief Finance Officer and

overseen by the Finance and Performance Committee.

The NELCSU supplies the CCG’s ICT (Information and Communication Technology)

and Business Intelligence functions. Business critical models in use within ICT are

subject to a number of quality assurance processes which link into the overall

framework and management commitment to quality.

Business critical models in use within Business Intelligence include processes which

support the identification and maintenance of a list of all business critical models and

a schedule for periodic review. These processes are subject to review by internal

audit, who review management information data and process owners, and external

audit whose work covers the quality assurance processes of financial models.

Review of economy, efficiency & effectiveness of the use of

resources Haringey CCG has a number of key processes in place to ensure that resources are

used economically, efficiently and effectively. Monthly finance reports are produced

and are a standing item at the CCG’s Finance and Performance Committee

meetings. A regular finance report is also a standing item at each CCG Governing

Body meeting. The CCG is required to submit monthly financial returns to NHS

England which form part of the regular Assurance Meetings between NHS England

and the CCG.

The CCG has contracts in place for both internal audit and the Local Counter Fraud

Service (LCFS) with RSM. The workplan for each of these contracts includes

coverage of key areas of risk for the CCG. Updates from internal audit and LCFS are

standing items on the Audit Committee agenda. In addition, RSM provides

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assurance to the Audit Committee as a result of quality assurance work undertaken

with the NELCSU.

The Integrated Contract Monitoring Report (Finance), which is reviewed at each

meeting of the Finance and Performance Committee, highlights any significant areas

of concern relating to the CCG’s main providers and actions being taken to address

them. The separate Integrated Contract Monitoring Report (Quality, Safety and

Performance) is reviewed at each meeting of the Quality Committee. The Finance

Report and the Quality and Performance Report are standing agenda items at the bi-

monthly Governing Body meetings, where they are reviewed thoroughly.

The CCG also holds monthly Clinical Quality Review Group (CQRG) meetings with

our acute providers to monitor quality and provide assurance, through the Quality

Committee, to the Governing Body.

Delegation of functions

The CCG purchases a range of support functions from NEL CSU, as mentioned

above. A Quality Assurance Group is in place to provide assurance to the North

Central and North East London CCGs on activity undertaken on their behalf. The

Group received Assurance Reports issued by the internal auditors on IT Business

Continuity and Disaster Recovery Procurement, IT Controls and Cybersecurity,

Acute/Non-Acute Contracting and Non-Contracted Activity.

No significant concerns were identified. A report on this assurance work is a standing

item at Audit Committee meetings.

Counter fraud arrangements

The CCG receives specialist support from an accredited Local Counter Fraud

Service (LCFS) to act as a deterrent against the risk of fraud and undertake counter

fraud work proportionate to identified risks. The LCFS has provided bespoke training

to the Governing Body and publishes a regular newsletter on the CCG intranet to

highlight fraud awareness. The LCFS also regularly visits the CCG office to make

itself available to staff for confidential consultation and advice.

The Audit Committee receives an annual report against each of the Standards for

Commissioners. There is executive support and direction for a proportionate

proactive work plan to address identified risks. A member of the executive board

(the Chief Finance Officer) is proactively and demonstrably responsible for tackling

fraud, bribery and corruption. Appropriate action is taken regarding any NHS Protect

quality assurance recommendations.

Head of Internal Audit Opinion (appendix 1)

Following completion of the planned audit work for the financial year for the clinical

commissioning group, the Head of Internal Audit issued an independent and

objective opinion on the adequacy and effectiveness of the clinical commissioning

group’s system of risk management, governance and internal control. The Head of

Internal Audit concluded that:

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“The organisation has an adequate and effective framework for risk management,

governance and internal control.

However, our work has identified that further enhancements are required to the framework of

risk management, governance and internal control to ensure that the framework remains

adequate and effective.”

During the year, Internal Audit issued the following audit reports:

Area of Audit Level of Assurance Given

Primary Care Co-Commissioning Advisory

Community Services Contract – Whittington Health

Partial assurance

Better Care Fund Reasonable assurance

Board Assurance Framework and Risk Management

Reasonable assurance

Conflicts of Interest Reasonable assurance

North Middlesex Contract – CCG Preparedness Review

Advisory

QIPP Reasonable assurance

Review of the effectiveness of governance, risk management and internal

control

My review of the effectiveness of the system of internal control is informed by the

work of the internal auditors, executive managers and clinical leads within the clinical

commissioning group who have responsibility for the development and maintenance

of the internal control framework. I have drawn on performance information available

to me. My review is also informed by comments made by the external auditors in

their annual audit letter and other reports.

Our assurance framework provides me with evidence that the effectiveness of

controls that manage risks to the clinical commissioning group achieving its

principles objectives have been reviewed.

I have been advised on the implications of the result of this review by the Governing

Body, the Audit committee, the Quality Committee and internal audit and a plan to

address weaknesses and ensure continuous improvement of the system is in place.

Conclusion

There have been no significant internal control issues identified during 2016/17.

Helen Pettersen

Accountable Officer

26 May 2017

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2. Remuneration and Staff Report

The NHS has adopted the recommendations outlined in the Greenbury report in

respect of the disclosure of senior managers’ remuneration and the manner in which

it is determined. Senior managers are defined as those persons in senior positions

having authority or responsibility for directing or controlling the major activities of the

clinical commissioning group. This means those who influence the decisions of the

clinical commissioning group as a whole rather than the decisions of individual

directorates or departments. Such persons will include advisory and lay members.

This report outlines how those recommendations have been implemented by the

CCG in the year to 31 March 2017.

2.1 Remuneration Report

Remuneration Committee Details on Haringey CCG’s Remuneration Committee can be found on p84 in the

Governance Statement.

Policy on the remuneration of senior managers

The Remuneration Committee sets allowances and terms and conditions of service

for all Governing Body Members, including clinical members, lay members and the

two executive directors (Chief Officer and Chief Finance Officer) on an annual basis

in accordance with the CCG’s constitution. All salaries are set with regard to the

guidance laid out in NHS England’s Annex 2: Principles relating to reimbursement

and remuneration for governing body members April 2012 and also to local

benchmarking provided by NELCSU. The executive directors have their pay and

terms and conditions of service set in accordance with the NHS Very Senior

Manager (VSM) framework and the NHS London Pay Framework for Very Senior

Managers in Strategic and Special Health Authorities, CCGs and Ambulance Trusts.

Pay and terms and conditions for other directors who do not sit on the Governing

Body are governed by the national Agenda for Change regulations.

Policy on senior managers’ contracts

The chair, GP members and lay members of the governing body are all engaged via

a contract for services. The duration and other terms of office of these are set in

accordance with the CCG’s constitution. Notice periods for governing body members

engaged via contract for services are stipulated in their contracts. No termination

payments are made on expiry of the contract.

Employed senior managers (the Executive Directors and other directors) are all

directly employed on permanent contracts and have notice periods of three months,

unless employed on interim contracts. No payments are made on termination except

in circumstances of redundancy.

101

Remuneration of Very Senior Managers

Haringey CCG have not employed any senior managers whose gross salary

exceeded £142,500 during the financial year.

102

Salaries and Allowances of Senior Managers

The table below shows the Salaries & Allowances of Senior Managers in 2016/17:

Name

Title

2016/17

Note

Salary

(bands of

£5,000)

Expense

payments

(taxable)

to nearest

£100

Performanc

e pay and

bonuses

(bands of

£5,000)

Long

term

performa

nce pay

and

bonuses

(bands of

£5,000)

All pension-

related benefits

(bands of

£2,500)

TOTAL

(bands of

£5,000)

£000 £ £000 £000 £000 £000

VOTING MEMBERS

Executiv e Directors

Sarah Price

(End date 03.03.17) Chief Officer 115-120 0 0 0 42.5-45 160-165

1

Alison Blair (Start date 06.03.17)

Interim Chief Officer 5-10 0 0 0 0-2.5 5-10

David Maloney (End date 19.02.17) Chief Finance Officer 100-105 0 0 0 67.5-70 170-175

2

Ahmet Koray (Start date 11.02.17)

Interim Chief Finance Officer

10-15 0 0 0 7.5-10 15-20

Lay Members

Catherine Herman Lay Member 10-15 0 0 0 0 10-15

Adam Sharples Lay Member 10-15 0 0 0 0 10-15

GP/Clinical Members

Muhammed Akunjee

(End date 31.12.16) South East GP Lead 35-40 0 0 0 0 35-40

3 Gino Amato North East GP Member 40-45 0 0 0 0 40-45

Simon Caplan North East GP Member 35-40 0 0 0 0 35-40

Peter Christian West GP Lead/CCG Chair 60-65 0 0 0 0 60-65

4 Dina Dhorajiwala West GP Member 60-65 0 0 0 0 60-65

103

Name

Title

2016/17

Note

Salary

(bands of

£5,000)

Expense

payments

(taxable)

to nearest

£100

Performanc

e pay and

bonuses

(bands of

£5,000)

Long

term

performa

nce pay

and

bonuses

(bands of

£5,000)

All pension-

related benefits

(bands of

£2,500)

TOTAL

(bands of

£5,000)

£000 £ £000 £000 £000 £000

5 David Masters West GP Member 40-45 0 0 0 0 40-45

John Rohan North East GP Lead 45-50 0 0 0 0 45-50

Sarah Timms Nurse Member 30-35 0 0 0 0 30-35

Sheena Patel Central GP Lead 50-55 0 0 0 0 50-55

Daijun Tan Sessional GP Member 35-40 0 0 0 0 35-40

Sharon Seber

South East Prim Care

Health Professional Member

30-35 0 0 0 0 30-35

6 Lionel Sherman

(Start date 01.08.16) Central GP Member 25-30 0 0 0 0 25-30

NON-VOTING

MEMBERS

Jil l Shattock Director of Performance 100-105 0 0 0 55-57.5 160-165

Jennie Williams

Executive Nurse & Dir of Quality & Integrated

Governance

90-95 0 0 0 42.5-45 130-135

Rachel Lissauer (start date 01.07.16)

Acting Director of Commissioning

60-65 0 0 0 67.5-70 130-135

NOTES

Follow ing the departure of certain executive directors at Haringey CCG, the follow ing interim arrangements, w hereby each individual's time w as split equally, are reflected in each

organisation's salaries & allow ances tables:

1. Alison Blair from 6 March 2017 (full salary for the year including all pension-related benefits £210-215k)

104

2. Ahmet Koray from 11 February 2017 (full salary for the year including all pens ion-related benefits £175-180k)

3. The salary f igure for this individual includes arrears 15.16 employer pension contributions. For GPs w ith a contract for service, salary f igures include employer pension

contributions.

4. The salary f igure for this individual includes an arrears gross payment of £8,915 for sessions w orked for the period October 15 to March 16. This includes employer

pension contributions.

5. The salary f igure show n for this member includes the total payments made in the year to the individual for all services provided to the CCG. The payment relating solely to

Governing Body duties is £35,662. This includes employer pension contributions.

6. The salary f igure show n for this member includes the total payments made in the year to the individual for all services provided to the CCG. The payment relating solely to

Governing Body duties is £23,774. This includes employer pension contributions.

Where a member is a GP who is also paying into the NHS Pension Scheme, the salary figures shown above include NHS Haringey CCG's

employer contribution to the scheme. This is in accordance with Department of Health guidance.

105

The table below shows the Salaries & Allowances of Senior Managers in 2015/16, for comparison purposes.

Name

Title

2015/16

Note

Salary

(bands of

£5,000)

Expense

payments

(taxable)

to nearest

£100

Performanc

e pay and

bonuses

(bands of

£5,000)

Long

term

performa

nce pay

and

bonuses

(bands of

£5,000)

All pension-

related benefits

(bands of

£2,500)

TOTAL

(bands of

£5,000)

£000 £ £000 £000 £000 £000

VOTING MEMBERS

Executiv e Directors

Sarah Price Chief Officer 115-120 0 0 0 42.5-45 160-165

David Maloney Chief Finance Officer 105-110 0 0 0 22.5-25 130-135

Lay Members

Catherine Herman Lay Member 10-15 0 0 0 0 10-15

Adam Sharples Lay Member 10-15 0 0 0 0 10-15

GP/Clinical Members

Sherry Tang

Central GP Member/CCG

Chair 100-105 0 0 0 0 100-105

Muhammed Akunjee South East GP Lead 50-55 0 0 0 0 50-55

Gino Amato North East GP Member 30-35 0 0 0 0 30-35

Simon Caplan North East GP Member 40-45 0 0 0 0 40-45

Peter Christian West GP Lead 55-60 0 0 0 0 55-60

Dina Dhorajiwala West GP Member 50-55 0 0 0 0 50-55

David Masters West GP Member 40-45 0 0 0 0 40-45

John Rohan North East GP Lead 65-70 0 0 0 0 65-70

Sarah Timms Nurse Member 20-25 0 0 0 0 20-25

106

Name

Title

2015/16

Note

Salary

(bands of

£5,000)

Expense

payments

(taxable)

to nearest

£100

Performanc

e pay and

bonuses

(bands of

£5,000)

Long

term

performa

nce pay

and

bonuses

(bands of

£5,000)

All pension-

related benefits

(bands of

£2,500)

TOTAL

(bands of

£5,000)

£000 £ £000 £000 £000 £000

Nick Jenkins (End date 30.09.15)

Secondary Care Specialist Doctor

10-15 0 0 0 0 10-15

Sheena Patel (Start date 01.10.15)

Central GP Lead 45-50 0 0 0 0 45-50

Daijun Tan

(Start date 01.10.15) Sessional GP Member 15-20 0 0 0 0 15-20

Sharon Seber (Start date 01.10.15)

South East Prim Care Health Professional

Member

15-20 0 0 0 0 15-20

NON-VOTING MEMBERS

Jil l Shattock Director of Commissioning 95-100 0 0 0 15-17.5 110-115

Jennie Williams

Executive Nurse & Dir of

Quality & Integrated Governance

85-90 0 0 0 7.5-10 90-95

107

Pension benefits

The table below shows the Pension Benefits of Senior Managers in 2016/17:

Note Name Title Real

increase in

pension at

pension

age

(bands of

£2,500)

Real

increase in

pension

lump sum

at pension

age

(bands of

£2,500)

Total accrued

pension at

pension age at

31 March 2017

(bands of

£5,000)

Lump sum at

pension age

related to

accrued

pension at 31

March 2017

(bands of

£5,000

Cash

Equiv alen

t Transfer

Value at 1

April 2016

Real

Increase

in Cash

Equiv alen

t Transfer

Value

Cash

Equiv alen

t Transfer

Value at

31 March

2017

Employer

s

Contributi

on to

partnersh

ip

pension

£000 £000 £000 £000 £000 £000 £000 £000

Sarah Price

(End date 03.03.17)

Chief Officer 2.5-5 2.5-5 35-40 105-110 641 56 702 0

1 Alison Blair Interim Chief Officer 0-2.5 0-2.5 0-5 5-10 53 1 61 0

David Maloney

(End date 19.02.17)

Chief Finance Officer 2.5-5 2.5-5 35-40 95-100 524 60 591 0

1 Ahmet Koray Interim Chief Finance Officer 0-2.5 0-2.5 0-5 10-15 58 1 68 0

Jill Shattock Director of Commissioning 2.5-5 2.5-5 25-30 75-80 426 56 482 0

Jennie Williams Executive Nurse & Dir of Quality

& Integrated Governance

0-2.5 5-7.5 20-25 70-75 408 58 466 0

Rachel Lissauer

(Start date 01.07.16)

Acting Director of

Commissioning

2.5-5 0-2.5 10-15 30-35 135 22 165 0

NOTES

1. Pension related benefits apportioned for the period served.

108

Certain individuals disclosed in the Salary and Allowances table are not included in the Pension Benefits table. The

reasons for this include:

• some non-executive members do not receive pensionable remuneration; or

• an executive director may have opted out of the pension scheme; or

• pension disclosures are not required for GP Governing Body members who have a contract for service.

The table below shows the Pension Benefits of Senior Managers in 2015/16, for comparison purposes:

Note Name Title Real

increase in

pension at

pension

age

(bands of

£2,500)

Real

increase in

pension

lump sum

at pension

age

(bands of

£2,500)

Total accrued

pension at

pension age at

31 March 2016

(bands of

£5,000)

Lump sum at

pension age

related to

accrued

pension at 31

March 2016

(bands of

£5,000

Cash

Equiv alen

t Transfer

Value at 1

April 2015

Real

Increase

in Cash

Equiv alen

t Transfer

Value

Cash

Equiv alen

t Transfer

Value at

31 March

2016

Employer

s

Contributi

on to

partnersh

ip

pension

£000 £000 £000 £000 £000 £000 £000 £000

Sarah Price Chief Officer 2.5-5 0-2.5 35-40 100-105 593 42 641 0

David Maloney Chief Finance Officer 0-2.5 -2.5-0 30-35 90-95 496 22 524 0

Jill Shattock Director of Commissioning 0-2.5 -2.5-0 25-30 70-75 404 17 426 0

Jennie Williams Executive Nurse & Dir of Quality &

Integrated Governance

0-2.5 2.5-5 20-25 65-70 384 19 408 0

109

Cash equivalent transfer values

A cash equivalent transfer value (CETV) is the actuarially assessed capital value of

the pension scheme benefits accrued by a member at a particular point in time. The

benefits valued are the member’s accrued benefits and any contingent spouse’s (or

other allowable beneficiary’s) pension payable from the scheme. CETVs are

calculated in accordance with SI 2008 No.1050 Occupational Pension Schemes

(Transfer Values) Regulations 2008.

A CETV is a payment made by a pension scheme or arrangement to secure pension

benefits in another pension scheme or arrangement when the member leaves a

scheme and chooses to transfer the benefits accrued in their former scheme. The

pension figures shown relate to the benefits that the individual has accrued as a

consequence of their total membership of the pension scheme, not just their service

in a senior capacity to which disclosure applies.

Real increase in CETV

This reflects the increase in CETV effectively funded by the employer. It does not

include the increase in accrued pension due to inflation, contributions paid by the

employee (including the value of any benefits transferred from another scheme or

arrangement) and uses common market valuation factors for the start and end of the

period.

Pensions

The majority of staff are eligible to join the NHS Pension Scheme. Scheme benefits

are set by NHS Pensions. Past and present employees are covered by the

provisions of the NHS Pension Scheme. The employer’s contribution rate will

change from 14.3% to 14.38% from 1 April 2017 in respect of all Scheme members.

This rate includes a scheme administration charge of 0.08%. Employee contribution

rates will remain the same for the four years from 1 April 2015 to 31 March 2019 and

are as follows:

Tier Full time pensionable pay used to

determine contribution rate

Contribution rate (before tax relief)

(gross) 1 April 2015 to 31 March 2019

1 Up to £15,431.99 5%

2 £15,432.00 to £21,477.99 5.6%

3 £21,478.00 to £26,823.99 7.1%

4 £26,824.00 to £47,845.99 9.3%

5 £47,846.00 to £70,630.99 12.5%

6 £70,631.00 to £111,376.99 13.5%

7 £111,377.00 and over 14.5%

110

Scheme benefits are set by the NHS Pensions Agency and are applicable to all

members. Past and present employees are covered by the provisions of the NHS

pension scheme. For full details of how pension liabilities are treated please see note

4 in the annual accounts.

Compensation on early retirement or for loss of office

No significant awards or payments have been made during the financial year

2016/17 (nil in 2015/16).

Payments to past directors

No significant awards or payments have been made during the financial year

2016/17 (nil in 2015/16).

Pay multiples

Reporting bodies are required to disclose the relationship between the remuneration

of the highest-paid member in their organisation and the median remuneration of the

organisation’s workforce.

The banded remuneration of the highest-paid member in Haringey CCG in the

financial year 2016/17 was £125k-£130k (2015/16: £115k-£120k). This was 2.76

times (2015/16: 2.59) the median remuneration of the workforce, which was £45,856

(2015/16: £46,227).

In 2016/17, one (2015/16: none) employee received remuneration in excess of the

highest-paid member. Remuneration ranged from £0k-5k to £125-£130k (2015/16:

£10k-£15k to £115k-£120k).

Total remuneration includes salary, non-consolidated performance-related pay,

benefits-in-kind, but not severance payments. It does not include employer pension

contributions and the cash equivalent transfer value of pension.

111

2. Staff Report

Number of senior managers

Gender breakdown of all Senior Managers including managers at Very Senior Manager grade.

There are two female Senior Managers (Directors) at 31 March 2017. Very Senior Manager (VSM) information

At 31 March 2017, there are no Senior Managers at the CCG who are on a Very Senior Manager (VSM) grade.

Senior Manager Information At 31 March 2017, there are two Senior Managers at the CCG who are on band 9.

All other employees At 31 March 2017 there are 59 employees at Haringey CCG consisting of 38 female and 21 male staff members. These figures exclude the VSM, Senior Managers and

agency/contractor workers.

Staff composition

Staff Composition

Pay Group Female Male Grand Total

Band 3 0 0 0

Band 4 2 1 3

Band 5 2 1 3

Band 6 2 3 5

Band 7 10 4 14

Band 8a 6 5 11

Band 8b 5 3 8

Band 8c 7 4 11

Band 8d 4 0 4

Office holders / Clinical Leads (all z codes) 10 15 25

Senior Managers ( Bands 9 and above incl VSM) 2 0 2

112

Staff costs

Below provides further analysis of the CCG’s employee benefits, which includes prior year comparatives. Refer to the summarised version (note 3) in the Annual Accounts:

2016-17

Total Admin Programme

Total Permanent Employees

Other Total Permanent Employees

Other Total Permanent Employees

Other

£000 £000 £000 £000 £000 £000 £000 £000 £000

Salaries and wages 4,624 3,444 1,179 2,072 1,796 276 2,551 1,648 903

Social security costs 388 388 0 215 215 0 174 174 0

Employer Contributions to NHS Pension scheme 441 441 0 244 244 0 198 198 0

Gross employee benefits expenditure 5,453 4,274 1,179 2,531 2,255 276 2,922 2,019 903

2015-16

Total Admin Programme

Total Permanent Employees

Other Total Permanent Employees

Other Total Permanent Employees

Other

£000 £000 £000 £000 £000 £000 £000 £000 £000

Salaries and wages 3,938 3,462 476 1,978 1,852 126 1,960 1,610 350

Social security costs 319 319 0 187 187 0 131 131 0

Employer Contributions to NHS Pension scheme 439 439 0 257 257 0 182 182 0

Gross employee benefits expenditure 4,696 4,220 476 2,423 2,296 126 2,273 1,924 350

113

Staff numbers

2016-17 2015-16

Total Permanently employed

Other Total

Number Number Number Number

Total 84 70 14 75

Sickness absence data

NHS bodies are required to report on staff sickness. This information is provided centrally to the CCGs by the Department of Health. (Source: NHS Digital – Sickness absence publication). See below the statistical data that has been provided for Haringey CCG: 2016-17 2015-16 Number Number

Total days lost 373 576 Total staff years 64 62 Average working days lost per FTE 6 9

114

Staff policies The CCG published its Workforce Race Equality Standard Report (WRES) in July

2016 and the annual public sector equality duty (PSED) report in January

2016. Both of these have detailed information about the CCG’s workforce including

recruitment, starters and leavers and training by protected characteristics. They also

include equality information about the CCG’s Governing Body Members. The 2017

PSED report will be published in July 2017.

Expenditure on consultancy 2016/17

Total

2016/17

Admin

2016/17

Programme

2015/16

Total

£000 £000 £000 £000

100 6 94 70

The table highlights consultancy expenditure incurred by the CCG during the last 2

financial years. Refer to note 5 in the Annual Accounts where this is disclosed.

Off-payroll engagements

Table 1: Off-payroll engagements longer than 6 months

For all off-payroll engagements as at 31 March 2017, for more than £220 per day

and that last longer than six months:

Number

Number of existing engagements as of 31 March 2017 9

Of which, the number that have existed:

for less than one year at the time of reporting 6

for between one and two years at the time of reporting 3

for between 2 and 3 years at the time of reporting 0

for between 3 and 4 years at the time of reporting 0

for 4 or more years at the time of reporting 0

Table 2: New off-payroll engagements

For all new off-payroll engagements between 01 April 2016 and 31 March 2017, for

more than £220 per day and that last longer than six months:

Number

Number of new engagements, or those that reached six months in

duration, between 1 April 2016 and 31 March 2017 9

115

Number of new engagements which include contractual clauses giving

Haringey CCG the right to request assurance in relation to income tax

and National Insurance obligations

0

Number for whom assurance has been requested 9

Of which:

assurance has been received 6

assurance has not been received 3

engagements terminated as a result of assurance not being received. 0

Table 3: Off-payroll engagements / senior official engagements

For any off-payroll engagements of Board members and / or senior officials with

significant financial responsibility, between 01 April 2016 and 31 March 2017.

Number of off-payroll engagements of board members, and/or

senior officers with significant financial responsibility, during the

financial year

0

Total no. of individuals on payroll and off-payroll that have been

deemed “board members, and/or, senior officials with significant

financial responsibility”, during the financial year. This figure should

include both on payroll and off-payroll engagements.

21

Exit Packages and Severance Payments

Termination arrangements are applied in accordance with statutory regulations as

modified by national NHS conditions of service agreements (specified in Agenda for

Change), and the NHS pension scheme. Specific termination arrangements will vary

according to age, length of service and salary levels. The remuneration committee

will agree any severance arrangements.

No exit packages or severance payments were made during the financial year.

Helen Pettersen

Accountable Officer

26 May 2017

116

Financial Statements

NHS Haringey CCG - Annual Accounts 2016-17

Page Number

1

The Primary Statements:

Statement of Comprehensive Net Expenditure for the year ended 31st March 2017 2

Statement of Financial Position as at 31st March 2017 3

Statement of Changes in Taxpayers' Equity for the year ended 31st March 2017 4

Statement of Cash Flows for the year ended 31st March 2017 5

Notes to the Accounts

Accounting policies 6-8

Other operating revenue 9

Employee benefits and staff numbers 10

Operating expenses 11

Better payment practice code 12

Operating leases 12

Property, plant and equipment 13

Trade and other receivables 14

Cash and cash equivalents 14

Trade and other payables 15

Provisions 15

Financial instruments 16

Pooled budgets 17

Related party transactions 18-19

Events after the end of the reporting period 20

Losses and special payments 20

Operating segments 20

Contingencies 20

Financial performance targets 20

CONTENTS

1

NHS Haringey CCG - Annual Accounts 2016-17

Statement of Comprehensive Net Expenditure for the year ended

31 March 2017

2016-17 2015-16

Note £'000 £'000

Income from sale of goods and services 2 (2,869) (3,663)

Other operating income 2 (263) (588)

Total operating income (3,132) (4,251)

Staff costs 3 5,453 4,695

Purchase of goods and services 4 347,504 339,411

Depreciation and impairment charges 4 17 1

Other operating expenditure 4 929 924

Total operating expenditure 353,903 345,031

Net Operating Expenditure 350,771 340,780

Comprehensive Expenditure for the year ended 31 March 2017 350,771 340,780

Financial performance

The notes on pages 6 to 20 form part of this statement.

During 2016/17 NHS Haringey CCG received a revenue resource limit of £354,229k and incurred

expenditure of £350,771k thus achieving a surplus for the year of £3,458k.

2

NHS Haringey CCG - Annual Accounts 2016-17

Statement of Financial Position as at

31 March 2017

2016-17 2015-16

Note £'000 £'000

Non-current assets:

Property, plant and equipment 7 33 51

Total non-current assets 33 51

Current assets:

Trade and other receivables 8 4,943 4,765

Cash and cash equivalents 9 60 130

Total current assets 5,003 4,895

Total assets 5,036 4,946

Current liabilities

Trade and other payables 10 (30,886) (37,583)

Total current liabilities (30,886) (37,583)

Assets less Liabilities (25,850) (32,637)

Financed by Taxpayers’ Equity

General fund SOCITE (25,850) (32,637)

Total taxpayers' equity: (25,850) (32,637)

The notes on pages 6 to 20 form part of this statement.

Accountable Officer

Helen Pettersen

The financial statements on pages 1 to 20 were approved by the Audit Committee on the 24th of May 2017 and signed on

its behalf by:

3

NHS Haringey CCG - Annual Accounts 2016-17

Statement of Changes In Taxpayers Equity for the year ended

31 March 2017

General fund

Total

reserves

£'000 £'000

Changes in taxpayers’ equity for 2016-17

Balance at 01 April 2016 (32,637) (32,637)

Net operating expenditure for the financial year (350,771) (350,771)

Net Recognised NHS Clinical Commissioning Group

Expenditure for the Financial Year (350,771) (350,771)

Net funding 357,558 357,558

Balance at 31 March 2017 (25,850) (25,850)

General fund

Total

reserves

£'000 £'000

Changes in taxpayers’ equity for 2015-16

Balance at 01 April 2015 (30,188) (30,188)

Net operating expenditure for the financial year (340,780) (340,780)

Net Recognised NHS Clinical Commissioning Group

Expenditure for the Financial Year (340,780) (340,780)

Net funding 338,331 338,331

Balance at 31 March 2016 (32,637) (32,637)

The notes on pages 6 to 20 form part of this statement.

The statement of changes in taxpayers equity represents the taxpayer's investment and analyses the cumulative

movement on reserves. The net funding represents the main actual cash funding requested by the CCG for the

year. Refer to note 19 for the financial performance of the CCG.

4

NHS Haringey CCG - Annual Accounts 2016-17

Statement of Cash Flows for the year ended

31 March 2017

2016-17 2015-16

Note £'000 £'000

Cash Flows from Operating Activities

Net operating expenditure for the financial year (350,771) (340,780)

Depreciation and amortisation 7 17 1

(Increase)/decrease in trade & other receivables 8 (178) (354)

Increase/(decrease) in trade & other payables 10 (6,696) 2,964

Net Cash Inflow (Outflow) from Operating Activities (357,628) (338,169)

Cash Flows from Investing Activities

(Payments) for property, plant and equipment 0 (52)

Net Cash Inflow (Outflow) from Investing Activities 0 (52)

Net Cash Inflow (Outflow) before Financing (357,628) (338,221)

Cash Flows from Financing Activities

Funding received 357,558 338,331

Net Cash Inflow (Outflow) from Financing Activities 357,558 338,331

Net Increase (Decrease) in Cash & Cash Equivalents 9 (70) 110

Cash & Cash Equivalents at the Beginning of the Financial Year 130 20

Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year 60 130

The notes on pages 6 to 20 form part of this statement.

The Statement of cash flows analyses the cash implications of the actions taken by the CCG during the year. The operating

activities (total operating costs for the year adjusted with payables and receivables working balances) netted off with the actual

cash funding received from NHS England, resulting in a year-end actual cashbook balance of £60k.

5

NHS Haringey CCG - Annual Accounts 2016-17

Notes to the financial statements

1 Accounting Policies

NHS England has directed that the financial statements of clinical commissioning groups shall meet the accounting requirements of the

Group Accounting Manual issued by the Department of Health. Consequently, the following financial statements have been prepared in

accordance with the Group Accounting Manual 2016-17 issued by the Department of Health. The accounting policies contained in the

Group Accounting Manual follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to

clinical commissioning groups, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the

Group Accounting Manual permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the

particular circumstances of the clinical commissioning group for the purpose of giving a true and fair view has been selected. The

particular policies adopted by the clinical commissioning group are described below. They have been applied consistently in dealing with

items considered material in relation to the accounts.

1.1 Going Concern

These accounts have been prepared on the going concern basis (despite the issue of a report to the Secretary of State for Health under

Section 30 of the Local Audit and Accountability Act 2014).

Public sector bodies are assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as

evidenced by inclusion of financial provision for that service in published documents.

Where a clinical commissioning group ceases to exist, it considers whether or not its services will continue to be provided (using the same

assets, by another public sector entity) in determining whether to use the concept of going concern for the final set of Financial

Statements. If services will continue to be provided the financial statements are prepared on the going concern basis.

1.2 Accounting Convention

These accounts have been prepared under the historical cost convention modified to account for the revaluation of equipment and certain

financial assets and financial liabilities.

1.3 Pooled Budgets

Where the clinical commissioning group has entered into a pooled budget arrangement under Section 75 of the National Health Service

Act 2006 the clinical commissioning group accounts for its share of the assets, liabilities, income and expenditure arising from the

activities of the pooled budget, identified in accordance with the pooled budget agreement.

The Section 75 partnership arrangements in the National Health Service Act 2006 have been developed to give NHS bodies and local

authorities the ability to respond effectively to improve services, either by joining up existing services or developing new, co-ordinated

services. One of the three ways in which Section 75 agreements can be agreed is in the establishment of a pooled fund, thus allowing the

ability for partners each to contribute agreed funds to a single pot, to be spent on agreed projects for designated services.

Haringey CCG entered into pooled budget arrangements with the London Borough of Haringey during 2016-17.

Details of the Clinical Commissioning Group's Section 75 arrangements are disclosed at note 13.

1.4 Critical Accounting Judgements & Key Sources of Estimation UncertaintyIn the application of the clinical commissioning group’s accounting policies, management is required to make judgements, estimates and

assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and

associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ

from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are

recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future

periods if the revision affects both current and future periods.

1.4.1 Critical Judgements in Applying Accounting Policies

The following are the critical judgements, apart from those involving estimations (see below) that management has made in the process of

applying the clinical commissioning group’s accounting policies that have the most significant effect on the amounts recognised in the

financial statements:

Pay and non pay recharges

Pay recharges are shown net within the Statement of comprehensive net expenditure. Non pay and agency payroll cost items are shown

net of related income.

Key Sources of Estimation Uncertainty

The following are the key estimations that management has made in the process of applying the clinical commissioning group’s

accounting policies that have the most significant effect on the amounts recognised in the financial statements:

Partially completed spells

Expenditure relating to patient care spells that are part-completed at the year-end are apportioned across the financial years on the basis

of length of stay at the end of the reporting period compared to expected total length of stay or costs incurred to date compared to total

expected costs. Estimate applies to a balance of £1.792m.

Accruals

For goods and/or services that have been delivered but for which no invoice has been received/sent, the CCG makes an accrual based on

the contractual arrangements that are in place and it's legal obligation. See Trade & Other Payables Note 10.

Prescribing liabilities

NHS England actions monthly cash charges to the CCG for prescribing contracts. These are issued approximately 2 months in arrears.

The CCG uses a forecast to estimate the full year expenditure. Estimate applies to a balance of £5.237m.

Maternity pathways

Expenditure relating to all antenatal maternity care is made at the start of a pathway. As a result at the year-end part completed pathways

are treated as a prepayment. The CCG agrees to use the figures calculated by the local Providers. Estimate applies to a balance of

£2.029m.

1.5 Revenue

Revenue in respect of services provided is recognised when, and to the extent that, performance occurs, and is measured at the fair value

of the consideration receivable.

Where income is received for a specific activity that is to be delivered in the following year, that income is deferred.

1.6 Employee Benefits

1.6.1 Short-term Employee Benefits

Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees,

including bonuses earned but not yet taken.

The cost of leave earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that

employees are permitted to carry forward leave into the following period.

6

NHS Haringey CCG - Annual Accounts 2016-17

Notes to the financial statements

1.6.2 Retirement Benefit Costs

Past and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an unfunded, defined benefit

scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England

and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme

assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the clinical

commissioning group of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period.

For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of

the liability for the additional costs is charged to expenditure at the time the clinical commissioning group commits itself to the retirement,

regardless of the method of payment.

1.7 Other Expenses

Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at

the fair value of the consideration payable.

Expenses and liabilities in respect of grants are recognised when the clinical commissioning group has a present legal or constructive

obligation, which occurs when all of the conditions attached to the payment have been met.

1.8 Equipment

1.8.1 Recognition

Equipment is capitalised if:

·                It is held for use in delivering services or for administrative purposes;

·                It is probable that future economic benefits will flow to, or service potential will be supplied to the CCG;

·                It is expected to be used for more than one financial year;

·                The cost of the item can be measured reliably; and,

·                The item has a cost of at least £5,000; or,

·                Collectively, a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assets

are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and

are under single managerial control.

1.9 DepreciationDepreciation is charged to write off the costs of equipment, less any residual value, over their estimated useful lives, in a manner that

reflects the consumption of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over

which the clinical commissioning group expects to obtain economic benefits or service potential from the asset. This is specific to the

clinical commissioning group and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are

reviewed each year end, with the effect of any changes recognised on a prospective basis.

1.10 Leases

Leases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All other

leases are classified as operating leases.

1.10.1 The Clinical Commissioning Group as Lessee

Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised

initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term.

Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether they are

operating or finance leases.

1.11 Cash & Cash Equivalents

Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash

equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts

of cash with insignificant risk of change in value.

In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form

an integral part of the clinical commissioning group’s cash management.

1.12 ProvisionsProvisions are recognised when the clinical commissioning group has a present legal or constructive obligation as a result of a past event,

it is probable that the clinical commissioning group will be required to settle the obligation, and a reliable estimate can be made of the

amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at

the end of the reporting period, taking into account the risks and uncertainties. Where a provision is measured using the cash flows

estimated to settle the obligation, its carrying amount is the present value of those cash flows using HM Treasury’s discount rate as

follows:

·                Timing of cash flows (0 to 5 years inclusive): Minus 2.70% (previously: minus 1.55%)

·                Timing of cash flows (6 to 10 years inclusive): Minus 1.95% (previously: minus 1.%)

·                Timing of cash flows (over 10 years): Minus 0.80% (previously: minus 0.80%)

When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the receivable is

recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the receivable can be measured

reliably.

1.13 Clinical Negligence CostsThe NHS Litigation Authority operates a risk pooling scheme under which the clinical commissioning group pays an annual contribution to

the NHS Litigation Authority which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although the

NHS Litigation Authority is administratively responsible for all clinical negligence cases the legal liability remains with the clinical

commissioning group.

1.14 Continuing healthcare risk pooling

In 2014-15 a risk pool scheme was introduced by NHS England for continuing healthcare claims, for claim periods prior to 31 March 2013.

Under the scheme clinical commissioning groups contribute annually to a pooled fund, which is used to settle the claims.

1.15 ContingenciesA contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence or

non-occurrence of one or more uncertain future events not wholly within the control of the clinical commissioning group, or a present

obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or the amount of the

obligation cannot be measured sufficiently reliably. A contingent liability is disclosed unless the possibility of a payment is remote.

A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or non-

occurrence of one or more uncertain future events not wholly within the control of the clinical commissioning group. A contingent asset is

disclosed where an inflow of economic benefits is probable.

Where the time value of money is material, contingencies are disclosed at their present value.

7

NHS Haringey CCG - Annual Accounts 2016-17

Notes to the financial statements

1.16 Financial Assets

Financial assets are recognised when the clinical commissioning group becomes party to the financial instrument contract or, in the case

of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have

expired or the asset has been transferred.

All the CCG's financial assets are classified as loans and receivables.

The classification depends on the nature and purpose of the financial assets and is determined at the time of initial recognition.

1.16.1 Loans & Receivables

Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market.

After initial recognition, they are measured at amortised cost using the effective interest method, less any impairment. Interest is

recognised using the effective interest method.

Fair value is determined by reference to quoted market prices where possible, otherwise by valuation techniques.

The effective interest rate is the rate that exactly discounts estimated future cash receipts through the expected life of the financial asset,

to the initial fair value of the financial asset.

At the end of the reporting period, the clinical commissioning group assesses whether any financial assets, other than those held at ‘fair

value through profit and loss’ are impaired. Financial assets are impaired and impairment losses recognised if there is objective evidence

of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the

estimated future cash flows of the asset.

For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset’s

carrying amount and the present value of the revised future cash flows discounted at the asset’s original effective interest rate. The loss is

recognised in expenditure and the carrying amount of the asset is reduced through a provision for impairment of receivables.

If, in a subsequent period, the amount of the impairment loss decreases and the decrease can be related objectively to an event occurring

after the impairment was recognised, the previously recognised impairment loss is reversed through expenditure to the extent that the

carrying amount of the receivable at the date of the impairment is reversed does not exceed what the amortised cost would have been had

the impairment not been recognised.

1.17 Financial Liabilities

Financial liabilities are recognised on the statement of financial position when the clinical commissioning group becomes party to the

contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received.

Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired.

All the CCG's financial liabilities are classified as other financial liabilities.

1.17.1 Other Financial Liabilities

After initial recognition, all other financial liabilities are measured at amortised cost using the effective interest method, except for loans

from Department of Health, which are carried at historic cost. The effective interest rate is the rate that exactly discounts estimated future

cash payments through the life of the asset, to the net carrying amount of the financial liability. Interest is recognised using the effective

interest method.

1.18 Value Added Tax

Most of the activities of the clinical commissioning group are outside the scope of VAT and, in general, output tax does not apply and input

tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised

purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.

1.19 Losses & Special PaymentsLosses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or

passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures

compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are

handled.

Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which

would have been made good through insurance cover had the clinical commissioning group not been bearing its own risks (with insurance

premiums then being included as normal revenue expenditure).

1.20 Joint Operations

Joint operations are activities undertaken by the clinical commissioning group in conjunction with one or more other parties but which are

not performed through a separate entity. The clinical commissioning group records its share of the income and expenditure; gains and

losses; assets and liabilities; and cash flows.

1.21 Accounting Standards That Have Been Issued But Have Not Yet Been Adopted

The Government Financial Reporting Manual does not require the following Standards and Interpretations to be applied in 2016-17, all of

which are subject to consultation:

·                IFRS 9: Financial Instruments ( application from 1 January 2018)

·                IFRS 14: Regulatory Deferral Accounts ( not applicable to DH groups bodies)

·                IFRS 15: Revenue for Contract with Customers (application from 1 January 2018)

·                IFRS 16: Leases (application from 1 January 2019)

The application of the Standards as revised would not have a material impact on the accounts for 2016-17, were they applied in that year.

8

NHS Haringey CCG - Annual Accounts 2016-17

2 Other Operating Revenue

2016-17 2016-17 2016-17 2015-16

Total Admin Programme Total

£'000 £'000 £'000 £'000

Prescription fees and charges 0 0 0 15

Non-patient care services to other bodies 2,869 263 2,606 3,663

Other revenue 263 0 263 573

Total other operating revenue 3,132 263 2,869 4,251

Administrative revenue is revenue received that is not directly attributable to the provision of healthcare or healthcare services.

Revenue in this note does not include cash received from NHS England, which is drawn down directly into the bank account of the

CCG and credited to the General Fund.

Revenue is generated wholly from the supply of services. The CCG receives no revenue from the sale of goods.

9

NHS Haringey CCG - Annual Accounts 2016-17

3. Employee benefits and staff numbers

3.1.1 Employee benefits 2016-17

Total

Permanent

Employees Other

£'000 £'000 £'000

Employee Benefits

Salaries and wages 4,624 3,445 1,179

Social security costs 388 388 0

Employer contributions to NHS pension scheme 441 441 0

Gross employee benefits expenditure 5,453 4,274 1,179

3.1.1 Employee benefits 2015-16

Total

Permanent

Employees Other

£'000 £'000 £'000

Employee Benefits

Salaries and wages 3,938 3,462 476

Social security costs 318 318 0

Employer contributions to NHS pension scheme 439 439 0

Gross employee benefits expenditure 4,695 4,219 476

3.2 Average number of people employed

2015-16

Total

Permanently

employed Other Total

Number Number Number Number

Total 84 70 14 75

3.3 Staff sickness absence and ill health retirements

2016-17 2015-16

Number Number

Total Days Lost 373 576

Total Staff Years 64 62

Average working Days Lost 6 9

2016-17 2015-16

Number Number

Number of persons retired early on ill health grounds 0 0

£'000 £'000

Total additional Pensions liabilities accrued in the year 0 0

Ill health retirement costs are met by the NHS Pension Scheme

3.4 Pension costs

3.4.1 Accounting valuation

3.4.2 Full actuarial (funding) valuation

The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 March 2012. The Scheme

Regulations allow for the level of contribution rates to be changed by the Secretary of State for Health, with the consent of HM Treasury, and

consideration of the advice of the Scheme Actuary and appropriate employee and employer representatives as deemed appropriate.

The next actuarial valuation is to be carried out as at 31 March 2016. This will set the employer contribution rate payable from April 2019 and will

consider the cost of the Scheme relative to the employer cost cap. There are provisions in the Public Service Pension Act 2013 to adjust member

benefits or contribution rates if the cost of the Scheme changes by more than 2% of pay. Subject to this ‘employer cost cap’ assessment, any required

revisions to member benefits or contribution rates will be determined by the Secretary of State for Health after consultation with the relevant

stakeholders.

For 2016-17, employers’ contributions of £441,294 (2015-16: £418,062) were payable to the NHS Pension Scheme at the rate of 14.3% of pensionable

pay. These costs are included in the NHS pension line of note 3.1. 

Past and present employees are covered by the provisions of the two NHS Pension Schemes. Details of the benefits payable and rules of the

Schemes can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions.  Both are unfunded defined benefit schemes that cover NHS

employers, GP practices and other bodies, allowed under the direction of the Secretary of State in England and Wales. They are not designed to be

run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, each scheme is accounted

for as if it were a defined contribution scheme: the cost to the NHS body of participating in each scheme is taken as equal to the contributions payable

to that scheme for the accounting period.  

In order that the defined benefit obligations recognised in the financial statements do not differ materially from those that would be determined at the

reporting date by a formal actuarial valuation, the FReM requires that “the period between formal valuations shall be four years, with approximate

assessments in intervening years”. An outline of these follows:

A valuation of scheme liability is carried out annually by the scheme actuary (currently the Government Actuary’s Department) as at the end of the

reporting period. This utilises an actuarial assessment for the previous accounting period in conjunction with updated membership and financial data

for the current reporting period, and are accepted as providing suitably robust figures for financial reporting purposes. The valuation of scheme liability

as at 31 March 2017, is based on valuation data as 31 March 2016, updated to 31 March 2017 with summary global member and accounting data. In

undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate prescribed by HM

Treasury have also been used.

The latest assessment of the liabilities of the scheme is contained in the scheme actuary report, which forms part of the annual NHS Pension Scheme

(England and Wales) Pension Accounts.  These accounts can be viewed on the NHS Pensions website and are published annually.  Copies can also

be obtained from The Stationery Office.

The purpose of this valuation is to assess the level of liability in respect of the benefits due under the schemes (taking into account their recent

demographic experience), and to recommend contribution rates payable by employees and employers.

2016-17

The other employee benefits and average staff numbers increased in year following the inclusion of other employees relating to the Healthy London

Partnership Programme hosted by Haringey CCG

Total

Total

10

NHS Haringey CCG - Annual Accounts 2016-17

4. Operating expenses

2016-17 2016-17 2016-17 2015-16

Total Admin Programme Total

£'000 £'000 £'000 £'000

Gross employee benefits

Employee benefits excluding governing body members 4,626 1,704 2,922 3,925

Executive governing body members 827 827 0 770

Total gross employee benefits 5,453 2,531 2,922 4,695

Other costs

Services from other CCGs and NHS England 5,226 2,958 2,268 4,366

Services from foundation trusts 58,423 12 58,411 53,650

Services from other NHS trusts 216,559 0 216,559 206,966

Purchase of healthcare from non-NHS bodies 34,914 0 34,914 40,688

Chair and Non Executive Members 538 538 0 627

Supplies and services – clinical 232 0 232 239

Supplies and services – general 968 7 961 597

Consultancy services 100 6 94 70

Establishment 251 101 150 634

Transport 0 0 0 1

Premises 187 155 32 375

Depreciation 17 0 17 1

Audit fees* 67 67 0 67

Prescribing costs 29,565 0 29,565 30,227

GPMS/APMS and PCTMS 193 0 193 292

Other professional fees excl. audit 390 175 215 120

Education and training 14 13 1 82

CHC Risk Pool contributions 416 0 416 1,039

Other expenditure 390 0 390 295

Total other costs 348,450 4,032 344,418 340,336

Total operating expenses 353,903 6,563 347,340 345,031

* Fee payable to the external auditors is £55,650 (2015.16 £55,650) excluding VAT £11,130 (2015.16 £11,130).

Administrative expenditure is expenditure incurred that is not a direct payment for the provision of healthcare or

healthcare services.

11

NHS Haringey CCG - Annual Accounts 2016-17

5.1 Better Payment Practice Code

Measure of compliance 2016-17 2016-17 2015-16 2015-16

Number £'000 Number £'000

Non-NHS Payables

Total Non-NHS Trade invoices paid in the Year 6,548 47,518 6,117 42,393

Total Non-NHS Trade Invoices paid within target 6,207 42,187 5,688 35,855

Percentage of Non-NHS Trade invoices paid within target 94.79% 88.78% 92.99% 84.58%

NHS Payables

Total NHS Trade Invoices Paid in the Year 3,277 281,539 3,560 265,895

Total NHS Trade Invoices Paid within target 3,094 274,748 3,241 261,643

Percentage of NHS Trade Invoices paid within target 94.42% 97.59% 91.04% 98.40%

6. Operating Leases

6.1 As lessee

6.1.1 Payments recognised as an Expense 2016-17 2015-16

Buildings Total Buildings Total

£'000 £'000 £'000 £'000

Minimum lease payments 31 31 215 215

Total 31 31 215 215

The Better payment practice code requires the CCG to aim to pay 95% of all valid invoices by the due date or within 30 days

of receipt of a valid invoice, whichever is later.

Payments made to NHS Property Services Limited in respect of usage of property assets are being treated as operating

lease under IFRIC 4 and IAS 17.

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 this

arrangement only.

In 2016-17, no payments were made in relation to claims under the Late Payment of Commercial Debts (Interest) Act 1998

(nil in 2015-16).

12

NHS Haringey CCG - Annual Accounts 2016-17

7 Property, plant and equipment

2016-17

Information

technology Total

£'000 £'000

Cost or valuation at 01 April 2016 51 51

Cost/Valuation at 31 March 2017 51 51

Depreciation 01 April 2016 1 1

Charged during the year 17 17

Depreciation at 31 March 2017 18 18

Net Book Value at 31 March 2017 33 33

Purchased 33 33

Total at 31 March 2017 33 33

Asset financing:

Owned 33 33PFI residual: interests 0 0

Total at 31 March 2017 33 33

2015-16

Information

technology Total

£'000 £'000

Cost or valuation at 01 April 2015 0 0

Additions Purchased 52 52

Cost/Valuation at 31 March 2016 52 52

Depreciation 01 April 2015 0 0

Charged during the year 1 1

Depreciation at 31 March 2016 1 1

Net Book Value at 31 March 2016 51 51

Purchased 51 51

Total at 31 March 2016 51 51

Asset financing:

Owned 51 51

Total at 31 March 2016 51 51

7.1 Economic lives

Information technology 2 5

Minimum

Life (years)

Maximum

Life (Years)

13

NHS Haringey CCG - Annual Accounts 2016-17

8 Trade and other receivables Current Current

2016-17 2015-16

£'000 £'000

NHS receivables: revenue 1,655 1,793

NHS prepayments* 2,029 1,989

NHS accrued income 111 50

Non-NHS and Other WGA receivables: revenue 1,074 660

Non-NHS and Other WGA accrued income 0 266

VAT 65 0

Other receivables and accruals 9 7

Total Trade & other receivables 4,943 4,765

Included above:

NHS maternity pathway prepayments* 2,029 1,989

8.1 Receivables past their due date but not impaired 2016-17 2015-16

£'000 £'000

By up to three months 591 807

By three to six months 13 127

By more than six months 237 128

Total 841 1,062

9 Cash and cash equivalents

2016-17 2015-16

£'000 £'000

Balance at 01 April 130 20

Net change in year (70) 110

Balance at 31 March 60 130

Made up of:

Cash with the Government Banking Service 60 130

Cash and cash equivalents as in statement of financial position 60 130

Balance at 31 March 60 130

The CCG does not hold money on behalf of patients.

£11k of the amount above has subsequently been recovered post the statement of financial position date.

14

NHS Haringey CCG - Annual Accounts 2016-17

Current Current

2016-17 2015-16

£'000 £'000

NHS payables: revenue 10,008 17,087

NHS accruals* 4,485 954

Non-NHS and Other WGA payables: revenue 6,918 8,139

Non-NHS and Other WGA accruals 9,092 10,739

Social security costs 59 52

VAT 0 14

Tax 54 54

Other payables and accruals 270 544

Total Trade & Other Payables 30,886 37,583

Included above:

*NHS partially completed spells 1,792 1,831

11 Provisions

10 Trade and other payables

Other payables include £72,029 outstanding pension contributions at 31 March 2017 (£71,322 for

31 March 2016).

Under the Accounts Direction issued by NHS England on 12 February 2014, NHS England is

responsible for accounting for liabilities relating to NHS Continuing Healthcare claims relating to

periods of care before establishment of the CCG. However, the legal liability remains with the CCG.

The total value of legacy NHS Continuing Healthcare provisions accounted for by NHS England on

behalf of this CCG at 31 March 2017 is £416k (31 March 2016: £1.039m).

15

NHS Haringey CCG - Annual Accounts 2016-17

12 Financial instruments

12.1 Financial risk management

12.1.1 Currency risk

12.1.2 Interest rate risk

12.1.3 Credit risk

12.1.4 Liquidity risk

12.2 Financial assets Loans and

Receivables

Loans and

Receivables

2016-17 2015-16

£'000 £'000

Receivables:

·          NHS 1,766 1,843

·          Non-NHS 1,074 926

Cash at bank and in hand 60 130

Other financial assets 8 8

Total at 31 March 2,908 2,907

12.3 Financial liabilities Other Other

2016-17 2015-16

£'000 £'000

Payables:

·          NHS 14,494 18,041

·          Non-NHS 16,278 19,421

Total at 31 March 30,772 37,462

The CCG borrows from government for capital expenditure, subject to affordability as confirmed by NHS England. The

borrowings are for 1 to 25 years, in line with the life of the associated assets, and interest is charged at the National Loans

Fund rate, fixed for the life of the loan. The CCG therefore has low exposure to interest rate fluctuations.

Because the majority of the CCG's revenue comes from parliamentary funding, the CCG has low exposure to credit risk. The

maximum exposures as at the end of the financial year are in receivables from customers, as disclosed in the trade and other

receivables note.

The CCG is required to operate within revenue and capital resource limits, which are financed from resources voted annually

by Parliament. The CCG draws down cash to cover expenditure, as the need arises. The CCG is not, therefore, exposed to

significant liquidity risks.

Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in

creating or changing the risks a body faces in undertaking its activities.

Because the CCG is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by

business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical

of listed companies, to which the financial reporting standards mainly apply. The CCG has limited powers to borrow or invest

surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to

change the risks facing the CCG in undertaking its activities.

Treasury management operations are carried out by the finance department, within parameters defined formally within the

CCG standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the

NHS Clinical Commissioning Group and internal auditors.

The CCG is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK

and sterling based. The CCG has no overseas operations and therefore has low exposure to currency rate fluctuations.

16

NHS Haringey CCG - Annual Accounts 2016-17

13 Pooled budgets

London Borough of Haringey - Learning disabilities services

2016-17 2015-16

£000 £000

Expenditure (1,799) (1,756)

London Borough of Haringey - Better Care Fund

2016-17 2015-16

£000 £000

Admission Avoidance (8,485) (9,788)

Effective Hospital Discharge (5,873) (3,808)

Promoting Independence (202) (876)

Integration Enablers (1,087) (970)

Better Care Fund Expenditure (15,647) (15,442)

Total Expenditure (17,446) (17,198)

The CCG has entered into a pooled budget with London Borough of Haringey. The pool is hosted by Haringey CCG. A section 75

agreement has been agreed and signed by both the CCG and the London Borough of Haringey.

The value of the pooled budget for 2016/17 is £17.7m. All of this funding is from the CCGs revenue budget for 2016/17, and all expenditure

goes through the CCG’s ledger. No income is separately invoiced for.

Financial governance of the Better Care Fund is overseen by the Finance & Partnership Board. Membership is from senior executives from

the CCG and London Borough of Haringey plus a lay member and GP representation from the CCG Governing Body. The Partnership

Board meets no more than four times during the financial year.

The CCG's expenditure balance in the statement of comprehensive expenditure that relates to this pooled budget is set out

below:

The CCG has entered into a pooled budget with London Borough of Haringey. The pool is hosted jointly by Haringey CCG and London

Borough of Haringey, with London Borough of Haringey as lead organisation in the Partnership.

Under the arrangement funds are pooled under Section 75 of the NHS Act 2006 for a pooled staffing budget and integrated

provision of learning disabilities services in Haringey, under the title of Haringey Learning Disabilities Partnership (HLDP).

The CCG's expenditure balance in the statement of comprehensive expenditure that relates to this pooled budget is set out

below:

17

NHS Haringey CCG - Annual Accounts 2016-17

14 Related party transactions

Payments

to related

party

Receipts

from

related

party

Amounts

owed to

related

party

Amounts

due from

related

party

£000 £000 £000 £000

Federation 4 Health Ltd 225 - - -

Haringey Health Connected 65 - - -

Public Voice CIC 23 - - -

RSM Risk Assurance Services LLP 63 - - -

Payments

to related

party

Receipts

from

related

party

Amounts

owed to

related

party

Amounts

due from

related

party

£000 £000 £000 £000

Allenson House Surgery (closed 30.09.16) 3 - - -

Arcadian Gardens 30 - - -

Bounds Green Group Practice 159 - - -

Bridge House Medical Practice 41 - - -

Charlton House Medical Centre 36 - - -

Cheshire Road Surgery 6 - - -

Christchurch Hall Surgery 22 - - -

Crouch Hall Surgery 72 - - -

Havergal Surgery 25 - - -

Highgate Group Practice 119 - - -

JS Medical Practice 62 (1) - -

Lawrence House Surgery 108 - - -

Morris House Group Practice 82 - - -

Morum House Medical Centre 58 - - -

Muswell Hill Practice 72 - - -

Philip Lane Surgery 5 - - -

Queenswood Medical Practice 90 (2) - -

Rutland House Surgery 14 (3) - -

Somerset Gardens Family Health Centre 120 - 18 -

Stuart Crescent Health Centre 13 - - -

The 157 Medical Practice 4 - - -

The Laurels Medical Practice 2 - - -

The Old Surgery 10 - - -

Tynemouth Road Medical Practice 45 - - -

Vale Practice 38 - - -

Westbury Medical Centre 44 - - -

Payments

to related

party

Receipts

from

related

party

Amounts

owed to

related

party

Amounts

due from

related

party

£000 £000 £000 £000

Barnet, Enfield & Haringey Mental Health NHS Trust 34,745 - 955 -

Barts Health NHS Trust 6,790 - 857 -

Camden & Islington NHS Foundation Trust 734 - 56 -

Central & North West London NHS Foundation Trust 726 - 217 -

Central London Community Healthcare NHS Trust 439 - 83 -

Chelsea And Westminster Hospital NHS Foundation Trust 520 - 5 (4)

Community Health Partnership 172 (580) 752 (580)

East London NHS Foundation Trust 218 (5) 114 (5)

Great Ormond Street Hospital for Children NHS Foundation Trust 828 - - (60)

Guy's & St Thomas' NHS Foundation Trust 2,455 - 265 -

Homerton University Hospital NHS Foundation Trust 5,470 - 1,452 -

Imperial College Healthcare NHS Trust 1,348 - 288 (14)

King's College Hospital NHS Foundation Trust 537 - 137 -

London Ambulance Service NHS Trust 10,040 - 311 -

London North West Healthcare NHS Trust 521 - 110 -

Moorfields Eye Hospital NHS Foundation Trust 4,409 - - -

NHS Enfield CCG 558 (110) 371 -

NHS England 415 (550) 1 (756)

NHS Islington CCG 106 (341) 122 (359)

NHS North & East London CSU 4,223 - 434 -

North East London NHS Foundation Trust 313 - 281 -

North Middlesex University Hospital NHS Trust 76,747 (17) 1,878 (895)

Royal Brompton & Harefield NHS Foundation Trust 416 - - (33)

Royal Free London NHS Foundation Trust 19,296 - 1,443 (74)

Royal National Orthopaedic Hospital NHS Trust 1,247 - 108 -

St George's University Hospitals NHS Foundation Trust 284 - 114 -

Tavistock & Portman NHS Foundation Trust 545 - 14 -

The Whittington Hospital NHS Trust 83,510 (55) 730 (750)

University College London Hospitals NHS Foundation Trust 20,393 - 2,790 (290)

Payments

to related

party

Receipts

from

related

party

Amounts

owed to

related

party

Amounts

due from

related

party

£000 £000 £000 £000

Haringey London Borough Council 8,317 (631) 3,786 (489)

The Department of Health is regarded as a related party. During the year the CCG has had a significant number of material

transactions with entities for which the Department of Health is regarded as the parent department.

In addition, the CCG has had a number of material transactions with other government departments and other central and

local government bodies. Most of these transactions have been with local authorities.

The transactions listed below are in relation to interests declared, other than those relating to member general practices.

Clinical commissioning groups are clinically led membership organisations made up of general practices. The members of the

clinical commissioning group are responsible for determining the governing arrangements for their organisations, which they

are required to set out in a constitution.

The members of Haringey Clinical Commissioning Group are contained within the constitution. Where payments have been

made to these practices, these are listed below. The majority of the payments are in relation to agreed locally enhanced

services and some prescribing costs.

The de minimus limit applied for disclosure of NHS organisations were £250k (based on payments made to parties), or have been identified

requires disclosure as per the register of interest declarations.

18

NHS Haringey CCG - Annual Accounts 2016-17

14 Related party transactions - prior year comparatives 2015-16

Payments

to related

party

Receipts

from

related

party

Amounts

owed to

related

party

Amounts

due from

related

party

£000 £000 £000 £000

Baker Tilly risk advisory services LLP 27 - -

Jewish Care 30 4

Payments

to related

party

Receipts

from

related

party

Amounts

owed to

related

party

Amounts

due from

related

party

£000 £000 £000 £000

Allenson House Surgery 9 1

Arcadian Gardens 8 (21)

Bounds Green Group Practice 115 4

Bridge House Medical Practice 24 -

Broadwater Farm Health Centre 2 -

Charlton House 22 1

Christchurch Hall Surgery 12 -

Crouch Hall Road Surgery 67 2

Dukes Avenue Practice 82 7

Fernlea Surgery - -

Havergal Surgery 21 -

Highgate Group Practice 102 7

JS Medical Practice 25 4

Lawrence House Surgery 207 65

Morris House Group Practice 71 4

Queenswood Medical Practice 103 3

Rutland House Surgery 16 -

Somerset Gardens Family Health Centre 113 32

Stuart Crescent Health Centre 12 -

The 157 Medical Practice 5 -

The Laurels Medical Practice 20 -

The Old Surgery 6 -

Tynemouth Road Medical Practice 97 7

Vale Practice 75 7

Westbury Medical Centre 23 3

Payments

to related

party

Receipts

from

related

party

Amounts

owed to

related

party

Amounts

due from

related

party

£000 £000 £000 £000

Barnet, Enfield & Haringey Mental Health NHS Trust 32,252 - 1,016 -

Barts Health NHS Trust 5,262 - 1,541 -

Camden & Islington NHS Foundation Trust 746 - 60 -

Central & North West London NHS Foundation Trust 1,067 - 303 -

Central London Community Healthcare NHS Trust 424 - 122 -

Chelsea And Westminster Hospital NHS Foundation Trust 546 - 10 -

East London NHS Foundation Trust 390 - 126 -

Frimley Health NHS Foundation trust 45 - - (1)

Great Ormond Street Hospital for Children NHS Foundation Trust 823 - - (34)

Guy's & St Thomas' NHS Foundation Trust 1,828 - 479 -

Homerton University Hospital NHS Foundation Trust 4,247 - 278 -

Imperial College Healthcare NHS Trust 1,340 - 238 (4)

King's College Hospital NHS Foundation Trust 387 - 293 -

London Ambulance Service NHS Trust 9,445 - 218 -

London North West Healthcare NHS Trust 448 - 25 -

Moorfields Eye Hospital NHS Foundation Trust 3,891 - 91 -

NHS Enfield CCG 330 (828) 329 (741)

NHS England 1,089 (617) 49 (310)

NHS North & East London Commissioning Support Unit 3,781 - 184 -

North Middlesex University Hospital NHS Trust 74,623 - 942 (866)

Royal Brompton & Harefield NHS Foundation Trust 461 - 205 -

Royal Free London NHS Foundation Trust 20,016 - 4,933 (67)

Royal National Orthopaedic Hospital NHS Trust 1,269 - 85 -

Tavistock & Portman NHS Foundation Trust 624 - 70 -

The Whittington Hospital NHS Trust 80,595 (667) 4,321 (1,336)

University College London Hospitals NHS Foundation Trust 17,221 - 753 (221)

The de minimus limit applied for disclosure of NHS organsations were £250k (based on payments made to parties).

Payments

to related

party

Receipts

from

related

party

Amounts

owed to

related

party

Amounts

due from

related

party

£000 £000 £000 £000

Haringey London Borough Council 9,330 (412) 4,731 (690)

In addition, the CCG has had a number of material transactions with other government departments and other central and local

government bodies. Most of these transactions have been with local authorities.

The transactions listed below are in relation to interests declared, other than those relating to member general practices.

Clinical commissioning groups are clinically led membership organisations made up of general practices. The members of the

clinical commissioning group are responsible for determining the governing arrangements for their organisations, which they

are required to set out in a constitution.

The members of Haringey Clinical Commissioning Group are contained within the constitution. Where payments have been

made to these practices, these are listed below. The majority of the payments are in relation to agreed locally enhanced

services and some prescribing costs.

The Department of Health is regarded as a related party. During the year the CCG has had a significant number of material

transactions with entities for which the Department of Health is regarded as the parent department.

19

NHS Haringey CCG - Annual Accounts 2016-17

15 Events after the end of the reporting period

Delegated CCGs 2017/18

16 Losses and special payments

17 Operating segments

18 Contingencies

Contingent liabilities

No contingent liabilities to report.

Contingent assets

No contingent assets to report.

19 Financial performance targets

NHS Clinical Commissioning Groups have a number of financial duties under the NHS Act 2006 (as amended).

The performance of Haringey CCG against these duties were as follows:

Target Performance

Surplus/

(deficit)

Duty

achieved Target Performance

Surplus/

(deficit)

Duty

achieved

Expenditure not to exceed income 357,361 353,903 3,458 Yes 345,158 345,083 75 YesCapital resource use does not exceed the amount specified in

Directions 0 0 0 n/a 52 52 0 Yes

Revenue resource use does not exceed the amount specified in

Directions 354,229 350,771 3,458 Yes 340,855 340,780 75 Yes

Capital resource use on specified matter(s) does not exceed the

amount specified in Directions 0 0 0 n/a 0 0 0 n/a

Revenue resource use on specified matter(s) does not exceed the

amount specified in Directions 0 0 0 n/a 0 0 0 n/a

Revenue administration resource use does not exceed the amount

specified in Directions 6,327 6,300 27 Yes 6,274 6,259 15 Yes

NHS England recently announced details of the Clinical Commissioning Groups approved to take on greater delegated responsibility or to jointly commission GP

services from the 1st of April. The new primary care co-commissioning arrangements are part of a series of changes set out in the NHS Five Year Forward Review.

Haringey CCG has been approved under delegated commissioning arrangements which mean that the CCG will assume full responsibility for contractual GP

performance management, budget management and the design and implementation of local incentive schemes from the 1st of April 2017.

2016-17 2015-16

The CCG consider they have only one segment: Commissioning of healthcare services.

The CCG had no losses and made no special payments during the financial year (nil in 15.16).

20

HARINGEY CLINICAL

COMMISSIONING GROUP

Head of Internal Audit Opinion 2016/2017

31 March 2017

This report is solely for the use of the persons to whom it is addressed.

To the fullest extent permitted by law, RSM Risk Assurance Services LLP

will accept no responsibility or liability in respect of this report to any other party.

Appendix 1

Haringey Clinical Commissioning Group / Head of Internal Audit Opinion 2016/17 | 1

1.1 The head of internal audit opinion

Our opinion, based on work undertaken up to 16 March 2017, is set out as follows

Head of internal audit opinion 2016/2017

The organisation has an adequate and effective framework for risk

management, governance and internal control.

However, our work has identified that further enhancements are

required to the framework of risk management, governance and

internal control to ensure that the framework remains adequate and

effective.

1.2 Factors and findings which have informed our opinion

CCG Internal Audit plan

We did not issue any ‘No Assurance’ (Red) opinions in 2016/17.

We issued one partial assurance report for the Community Services Contract. The main issues were as follows:

Significant gaps in reporting of the community health services performance indicators. The quality of services

may not be monitored effectively if reporting against KPIs is not in place. This could have an adverse effect

on patient care and experience.

Action plans were not in place to address the underperformance of two community indicators. Ongoing

performance issues may result in poor patient care and experience.

Service line cost and activity figures have not been determined for the Community Service Disaggregation

Project set up by Whittington Health. Performance may not be monitored appropriately if the costings and

activity are not fully understood by the CCG.

We issued four reasonable assurance opinions on the reviews of Better Care Fund, Board Assurance Framework,

Conflicts of Interest and QIPP. We also issued an Advisory report relating to the Well Led Review.

Furthermore, all 22 management actions due for implementation by 31st March 2017 have been implemented.

1 HEAD OF INTERNAL AUDIT OPINION

In accordance with the Public Sector Internal Audit Standards, the head of internal audit is required

to provide an annual opinion, based upon and limited to the work performed, on the overall

adequacy and effectiveness of the organisation’s risk management, control and governance

processes. The opinion should contribute to the organisation's annual governance statement.

This document provides our annual internal audit opinion for 2016/17. The final opinion will be set

out in our annual internal audit report after year end.

Haringey Clinical Commissioning Group / Head of Internal Audit Opinion 2016/17 | 2

CSU Quality Assurance plan

To date we have issued Reasonable Assurance opinions on our work on Data Quality and Performance Management,

Procurement, Business Continuity and Disaster Recovery plan, Acute and Non Acute Contracting, Medicines

Management and Provider Quality Management. We also issued an advisory opinion on Information Governance

Toolkit.

We provided Partial Assurance on the review of IT Controls and Cyber Security as part of our work on the CSU Quality

Assurance Plan. Key issues included a lack of periodic reviews of firewall rules, and absence of a software inventory

for software installed on the network, failure to disable user accounts for leavers, and an absence of formalised user

access reviews over administrator accounts on a periodic basis.

1.3 Further issues relevant to this opinion

We reviewed the findings of the interim Service Auditor report carried out by the internal auditors of NHS England at

the CSU, on behalf of the CSU customers, including NHS Haringey CCG, for the first six months of the year. We also

reviewed the draft Service Auditor Report for the second half of the year, alongside the draft bridging letter for the final

month of the financial year. Whilst we note some minor exceptions have been identified, we have liaised with the CSU

and do not believe that there is anything significant requiring inclusion within the Annual Governance Statement. We

have also reviewed the Service Auditor Report from the internal auditors of NHS Shared Business Services who, via a

contract with NHS England, provide services to the CCG. No significant issues were noted which would impact on this

Opinion.

1.4 Issues judged relevant to the preparation of the annual governance statement

Based on the work we have undertaken on the CCG’s system on internal control, we do not consider that within these

areas there are any issues that need to be flagged as significant control issues within the Annual Governance

Statement (AGS). However, the CCG may wish to consider whether any other issues have arisen, including the results

of any external reviews which it might want to consider for inclusion in the Annual Governance Statement.

1.5 Scope of the opinion

The opinion does not imply that internal audit has reviewed all risks and assurances relating to the organisation. The

opinion is substantially derived from the conduct of risk-based plans generated from a robust and organisation-led

assurance framework. As such, the assurance framework is one component that the board takes into account in

making its annual governance statement (AGS).

Haringey Clinical Commissioning Group / Head of Internal Audit Opinion 2016/17 | 3

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The matters raised in this report are only those which came to our attention during the course of our review and are not necessarily a comprehensive statement of all the weaknesses that exist or all improvements that might be made. Recommendations for improvements should be assessed by you for their full impact before they are implemented. This report, or our work, should not be taken as a substitute for management’s responsibilities for the application of sound commercial practices. We emphasise that the responsibility for a sound system of internal controls rests with management and our work should not be relied upon to identify all strengths and weaknesses that may exist. Neither should our work be relied upon to identify all circumstances of fraud and irregularity should there be any.

This report is solely for the use of the persons to whom it is addressed and for the purposes set out herein. This report should not therefore be regarded as suitable to be used or relied on by any other party wishing to acquire any rights from RSM Risk Assurance Services LLP for any purpose or in any context. Any third party which obtains access to this report or a copy and chooses to rely on it (or any part of it) will do so at its own risk. To the fullest extent permitted by law, RSM Risk Assurance Services LLP will accept no responsibility or liability in respect of this report to any other party and shall not be liable for any loss, damage or expense of whatsoever nature which is caused by any person’s reliance on representations in this report.

This report is released to you on the basis that it shall not be copied, referred to or disclosed, in whole or in part (save as otherwise permitted by agreed written terms), without our prior written consent.

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Haringey Clinical Commissioning Group / Head of Internal Audit Opinion 2016/17 | 4

The following shows the full range of opinions available to us within our internal audit methodology to provide you with

context regarding your internal audit opinion.

Annual opinions

The organisation has an adequate and effective framework for risk

management, governance and internal control.

The organisation has an adequate and effective framework for risk

management, governance and internal control.

However, our work has identified that further enhancements are required to

the framework of risk management, governance and internal control to

ensure that the framework remains adequate and effective.

There are weaknesses in the framework of governance, risk management

and control such that it could be, or could become, inadequate and

ineffective.

The organisation does not have an adequate framework of risk

management, governance or internal control.

APPENDIX A: ANNUAL OPINIONS

Haringey Clinical Commissioning Group / Head of Internal Audit Opinion 2016/17 | 5

Clive Makombera, Director

RSM Risk Assurance Services LLP

Email address:

Clive.Makombera@rsmuk.com

Contact telephone number:

+44 (0)7980 773852

Sharonjeet Kaur, Manager

RSM Risk Assurance Services LLP

Email address:

Sharonjeet.Kaur@rsmuk.com

Contact telephone number:

+44 (0)7528 970219

FOR FURTHER INFORMATION CONTACT