CCG Annual Report and Accounts...

East Leicestershire and Rutland Clinical Commissioning Group

CCG Annual Report and Accounts 2016-17

Contents

Chairman’s welcome 4

Member Practices’ Introduction 5

The Performance Report: 14

Accountable Officer’s Introduction 14

Performance Analysis 24

The Accountability Report: 42

Corporate Governance Report: 42

a. Members of the Governing Body report 42

b. Statement of Accounting Officer’s responsibilities 46

c. Annual governance statement 47

Remuneration and Staff Report 60

Audit Report 67

The Financial Statements 71

Appendices 104

Our Annual Report and Accounts highlight

our performance and achievements in 2016/17

along with the challenges we faced. It also explains

who we are, how we work and the partnerships in which we are involved.

Chairman’s welcome

It gives me great pleasure to present the fourth Annual Report and Accounts for East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG).

Our Annual Report and Accounts highlight our performance and achievements in 2016/17 along with the challenges we faced. It also explains who we are, how we work and the partnerships in which we are involved.

Our successes

Our continued desire to champion the needs of our patients and make things better drives my work for the CCG. I know I can speak for my fellow GPs on the Governing Body, our member practices, as well as our CCG managers and staff, when I say that this is a shared desire and commitment.

This report highlights successes, such as, how we have helped our GPs to improve diagnosis of dementia and diabetes which means patients have received earlier access to support and treatment. We have also achieved a number of national standards as described in the Performance Report.

The work behind many of our achievements has been undertaken in partnership and I would like to take this opportunity to acknowledge the continued collaboration and support we receive. Our thanks go to our patients, GP member practices, providers and partners across health, social care and the voluntary sector for their contributions towards improving healthcare for people across East Leicestershire and Rutland.

Shared challenges

There is no question that the progress we have made as an organisation, and in partnership with others, has been made difficult against a backdrop of significant financial challenges faced across the public and voluntary sectors.

Despite the hard work and achievements of 2016/17, there is still much to do to improve health outcomes and services for local people. The pressures we have faced since our organisation was established have not diminished and 2016/17 has been an extremely challenging year. Looking ahead it is likely that these pressures and challenges will continue into 2017/18.

Strong leadership

It is truly a privilege to be supported on the Governing Body by a caring and loyal team of clinicians and lay members.

I am grateful to our Accountable Officer, Karen English, and to all executive members of the team who have provided leadership during an incredibly challenging year.

Finally, on behalf of the Governing Body members I also express our gratitude to all our staff and clinicians who have worked so hard to turn plans into better care and services for patients. The achievements outlined in this Annual Report are testament to their continued efforts and commitment.

Dr Richard Palin Chairman

East Leicestershire and Rutland Clinical Commissioning Group Annual Report 2016/17 4 | 5

Member Practices’ Introduction

All 31 of the GP practices in East Leicestershire and Rutland are members of the CCG and part of one of our three localities: Melton Mowbray, Rutland and Market Harborough; Oadby and Wigston; and Blaby and Lutterworth.

It is four years since we took on formal responsibility for planning, commissioning and monitoring local health services in East Leicestershire and Rutland and in that time we have made great progress towards ensuring the best possible healthcare for local people.

The power of clinical leadership

Our Governing Body includes GP clinical leads, representing our locality GPs; a board nurse; and a secondary care clinician. This strong emphasis on clinical leadership means our decisions are informed by direct real time experience of patient care, addressing problems and challenges in looking after the needs of patients, their families and carers.

We estimate that during a typical year, over two million individual consultations take place in doctors’ surgeries in our area; that is an average of 5,500 every day. The information gathered by family doctors and other health professionals during these consultations offer a powerful and unique insight into the health needs of our local people and their experience of the local healthcare system. Insights gathered by our GPs provide real opportunities for the clinicians to identify issues; and opportunities to resolve them in discussion with other clinicians, whether from hospitals or other health settings, that could really make a difference to patients.

We believe clinical leadership is all about harnessing this knowledge and placing it at the heart of our decision-making and local strategies.

Primary Care Strategic Aims

The focus of our primary care responsibility across East Leicestershire and Rutland covered three main areas during 2016/17 and will continue to do so in 2017/18:

• Primary care commissioning: overall contractual monitoring, assurance and quality of core primary care services;

• Primary care development: engagement with member practices, local service delivery, patient engagement; and

• Medicines quality: prescribing and medicines quality assurance.

Primary Care Commissioning

Since 1 April 2015 we have had full delegation of primary medical care commissioning (hereafter referred to as primary care commissioning) from NHS England. This means we commission the day to day services that our patients receive from their GP practice. Primary care commissioning has meant exciting opportunities to develop community-based healthcare that delivers better outcomes for patients.

The aim of primary care commissioning is to focus on general practice to act as an enabler to facilitate the changes needed both for improved patient outcomes and new ways of working, with a focus on implementing our plans for the GP Five Year Forward View in 2017/18. This means there is a need to reconsider traditional ways of delivering health care and redevelop how the following services/people interact:

• Individual GPs or groups of GPs

• Specialists

• District Nursing / Intermediate Care Team

• Health and Social care coordinators / Social Care / Crisis Response teams

• Community / virtual beds

• Mental Health Services

• Voluntary sector.

The desired outcome is an integrated service for our patients, with shared planning and management by professionals who work together not just within their organisations, but with our patients ensuring care is organised and developed in partnership with our patients. There are many challenges facing General Practice, including workforce, funding and rising demand. We have developed our plan to implement the GP Five Year Forward View in conjunction with Leicester City CCG and West Leicestershire CCG during December 2016 – February 2017 to enable us to work together to develop and co-design a resilient and sustainable model in which general practice can thrive.

We want solutions that work for the longer term for all our general practices, and our patients; and look to more efficient ways of working to make best use of scarce skills and resources. Specific achievements in relation to delegated responsibilities include:

• primary care premises review of GP premises rent review process and co-ordination;

• establishment of robust reporting arrangements to assist with end of year returns and enhanced services for our GP practices. This has helped to streamline the administrative burden on our GPs so that they can spend more time on providing clinical care for our patients;

• supporting GP practices in various ways, including with Care Quality Commission inspections and reviews.

This delegation of primary care commissioning has brought with it additional scrutiny of our governance processes, in particular how we manage our conflicts of interest process. In 2016/17 we reviewed our internal governance processes further in line with the revised guidance from NHS England. This has enabled continued transparency in our decision making and appropriate action taken to mitigate risks.

Primary Care Development

In 2016/17 we continued to support our member practices through the implementation of the CCG’s GP Support and Investment Plan (GP SIP) for General Practice. This is one of the mechanisms by which we have engaged and involved our member practices in

the delivery of the key quality and outcome priorities as set out in our Operating Plan:

• Supporting people to live independently for longer;

• Improve outcomes for people living with long term conditions (LTC);

• Improving quality of life;

• Reduce Inequalities in access to healthcare;

• Reduce utilisation of the acute sector through integrated community services;

• Listen to patients and the public; and

• High quality, cost effective prescribing.

Our annual GP SIP for General Practice has been the vehicle through which we have also supported development across our member practices to improve clinical quality; and where discretionary CCG investment has been made into primary care to deliver key clinical and national priorities. These clinical outcomes are deemed over and above already commissioned activity through the core General Medical Services (GMS) contracts, enhanced services and Quality and Outcomes Framework. Some of the key successes during 2016/17 include:


• Development of a quality dashboard - based on our existing practice profile we developed a suite of quality indicators across the range of NHS Outcome Framework quality domains. These were agreed with our member practices and used to assess potential areas of emerging risk so that appropriate action can be taken early to support our practices in mitigating these risks. The dashboard is used as part of our wider quality monitoring processes of primary care to gain assurance of the quality of primary care.

• System wide primary care assurance – throughout 2016/17 we worked closely with NHS England and the local CCGs to agree to share information and identification of risks across primary care in Leicester, Leicestershire and Rutland.

• Service developments – throughout 2016/17 we have worked to amalgamate a number of community based services such as the anti-coagulation monitoring service (i.e. international normalised ration (INR) monitoring); minor surgery; extended opening hours; end of life care service; chronic obstructive pulmonary disease (COPD) programme to help reduce the administration for delivery.

• Workforce, education and upskilling of primary care workforce – we developed informal joint working arrangements across our member practices. This included, sharing training sessions for GPs; sharing skills of nurses; joint learning of operating systems and processes; care home cover (one practice covering one home); developing clinical templates and joint Practice Learning Time learning events. Our Practice Learning Time events covered a number of topics to support our member practices.

Other training undertaken by our GPs and practice staff includes safeguarding training in respect of vulnerable adults and children. It is positive to note that 98% or our GPs completed the safeguarding children’s training; and 96% of our GPs completed the safeguarding adults training.

During 2016/17 the CCG successfully recruited to two extra Practice Nurse Facilitator posts. These are active Practice Nurses, who work part time within the CCG to support Practice Nurses across East Leicestershire and Rutland on clinical and professional issues. We are also working with partnership organisations in the pilot of the Trainee Nursing Associate role and currently have health care assistants from General Practice on this programme. We are also promoting and supporting the role of Assistant Practitioners within General Practice.

The Leicester, Leicestershire and Rutland GP Workforce Group is a vehicle through which workforce planning, training and development

issues are identified across General Practice and discussed. The Group meets on a monthly basis with representation from the GP Practices and the CCG supported by the Health Education East Midlands, Local Medical Committee and the Local Pharmaceutical Committee. The Group is aligned to the General Practice element of the STP and GP 5 Year Forward View.

• Developing primary care at scale – the ELR GP Federation became a legal entity from April 2016; and it will be key in delivering the General Practice 5 Year Forward View in 2017/18.

• Primary care engagement through our member practices and patient groups – we actively engaged with the local Patient Participation Groups (PPGs) to ensure we involve and inform them in local changes to services and provide information about future plans. The PPGs are also encouraged to provide feedback to us about the issues affecting our patients and their experiences of NHS services.

In our 2017/18 GP SIP there are additional areas of focus including renal/CKD management and detection, cancer screening and a renewed focus on demand and activity management. The clinical priorities included in the 2017/18 scheme are:

• Dementia

• End of Life Care

• Care Homes

• Respiratory/COPD

• Stroke Prevention

• Diabetes

• IAPT Access

• Renal/CKD management (new addition for 2017/18)

• Cancer Screening (new addition for 2017/18)

• Demand and Activity Management (new addition for 2017/18)

• Governance/Oversight and Engagement.

Performance and clinical achievements

In 2016/17 we faced real challenges in delivery of improved outcomes and accessible high quality care for patients against a backdrop of increased demand and constrained financial resources. More detailed information about our performance as a CCG can be found in the Performance Report section of this report and on the CCG website at www.eastleicestershireandrutlandccg,nhs.uk.

We are pleased however to report a number of key achievements in our areas of clinical priorities and primary care strategic aims that are making a real difference to patients in our area:

Diabetes

• The number of patients on our diabetes registers across our member practices have increased overall by (age 17+) 3.4%, for those patients that have been diagnosed they are supported in managing the condition; and

• EMPOWER was commissioned in 2016/17 as the new provider for structured diabetes education for newly diagnosed type 2 diabetic patients. With the change in the provider although there has been an initial reduction in the number of patients seen during the year, a total of 190 patients attended the course in 2016/17.

• we continued to promote the national diabetes prevention programme (NDPP). The target for 2016/17 was referral of 748 patients, and we achieved 569 as at 31 March 2017; of the East Midlands CCGs, ELR is the second highest achieving CCG. The target for 2017/18 is referral of 1019 patients.

Cardiovascular Disease

• Atrial Fibrillation (AF) / Heart Failure (HF) Training – atrial fibrillation is a heart condition that causes an irregular and often abnormally fast heart rate; people with AF are more at risk of getting a stroke and therefore it is important to reduce or prevent the likelihood of having a stroke. Ensuring our clinicians receive the appropriate training to diagnose and prescribe the appropriate treatment is important. Our member practices have all installed a web-based clinical tool that helps to manage patients with AF and also prompt informed discussions on the choice of medication. As at 31 December 2016, our local data shows that we have prevented 206 patients, across East Leicestershire and Rutland, from having a stroke in the next year through the use of anticoagulation

treatment, in comparison to the data from 2015/16 which showed 40 cases. Furthermore, in 2016/17 it is predicted that we have possibly prevented approximately 28 deaths through use of dual therapy for management of patients with HF / left ventricular systolic dysfunction.

• Chronic Obstructive Pulmonary Disease (COPD): COPD is a condition where the airways become inflamed and the air sacs in the lungs are damaged. This causes airways to become narrower, which makes it harder to breathe. Therefore it is important to diagnose patients as soon as possible so that that appropriate treatment can be prescribed. Over the last year, our GP Practice registers show that patients diagnosed with COPD increased overall by 3.4%.

Cancer

• During 2016/17 we have continued to encourage the use of the local Pathway and Referral Implementation SysteM (PRISM) database, which has been agreed by both primary and secondary care; this embeds National Institute of Clinical Excellence (NICE) guidance on cancer referrals to allow for quicker diagnosis. We have the highest usage of the new forms across our CCG compared to the other two local CCGs, which is extremely important for our patients. In 2016/17 we implemented a fully electronic referral service via PRISM.

• Cancer performance has been challenging during 2016/17, and the CCG has worked in conjunction with University Hospitals of Leicester NHS Trust (UHL) to develop new pathways to enable early diagnosis of cancer. An example of this is the implementation of Computed Tomography Colonography (CTC) as a first line of testing for lower GI cancers. We have also pioneered a thyroid straight to test service, using allied professionals so patients can be quickly informed if they have cancer or not.

• We developed a bowel screening programme in 2016/17 in conjunction with the local CCGs focusing on Black, Minority and Ethnic (BME) patients and encouraging uptake and patient information going forwards. This was co-developed with patients.

• We have offered both clinical and administrative support via the Leicester, Leicestershire and Rutland CCG Cancer and Referral to Treatment (RTT) Board meetings to improve and monitor cancer performance. The CCG, in collaboration with other stakeholders, including University Hospitals of Leicester NHS Trust (UHL), the Cancer Alliance, public health, Macmillan, and Health Watch Leicestershire and Rutland, continues to work to transform cancer care for 2020 to ensure patients are seen and diagnosed with cancer at the earliest opportunity. This is to ultimately improve the survival rates of cancer, and the quality of life after cancer.


• To sustain the improvements and ensure improvements in other areas of cancer, we have met with local providers and helped facilitate new ways of working to improve cancer performance via the “Next Steps Programme”, which means that patients would have their next appointment and / or test scheduled before leaving the department.

• With local cancer specialists we have arranged a learning event for primary care, which highlighted the most common cancers and their treatments.

• We will continue to work with University Hospitals of Leicester NHS Trust to look to ways of improving delivery of all of the cancer standards in 2017/18.

Dementia

• In 2016/17 we implemented an enhanced service across primary care to improve timely diagnosis and treatment of people with dementia. This increased diagnosis of dementia (from 60.5% in April 2016 to 64.1% of the targeted age group (age 65+) at the end of March 2017) meaning more of our patients benefitted from receiving personalised care planning tailored to their needs.

• We developed and implemented a bespoke dementia template across our GP practices; this has brought together all the different elements of dementia reporting and care into one place meaning GPs can offer a more effective service to patients.

• Implementation of the dementia Shared Care Agreement commenced during 2015/16 and continued in 2016/17 in order to improve the capacity of the Memory Assessment Service so patients can be seen in a more timely way. A shared care agreement outlines suggested ways

in which the responsibilities for managing the prescribing of a drug can be shared between the specialists in hospital and our GP practices.

• Working in partnership with Leicestershire County and Leicester City Councils, and Leicester City and West Leicestershire CCGs, we have developed an integrated dementia support service for Leicestershire and Leicester City. This service will support people living with dementia and their carers’ in the community and also if an individual has a hospital stay at University Hospitals Leicester. The service will work closely with health and social care professionals and is planned to commence in the Autumn of 2017. The service will work closely with the older person’s service that is provided in Rutland for people living in Rutland.

Mental health and Learning Disabilities

• We have continued to maintain waiting times targets in Improving Access to Psychological Therapies (IAPT), whilst maintaining recovery rates which are currently 6% higher than the national average.

• In line with the national guidance on Transforming Care (refreshed in January 2016), the CCG developed a comprehensive plan to deliver actions set out in local plans to transform care for people with learning disabilities. This included implementing enhanced community provision, reducing inpatient capacity, and rolling out care and treatment reviews in line with published policy.

• Significant partnership work with Leicestershire Partnership NHS Trust (LPT) helped to reduce our out of area mental health placements during the year meaning patients and their families benefited from specialist care closer to home.

End of Life Care

• The number of palliative care patients on our GP practice registers has risen by 7.5% since 2014/15.

• In 2016/17 work began to scope and map end of life care with a plan to transform services from 2017/18 onwards. By developing a framework for end of life care supported by community based palliative care teams to support people to die in their place of choice. We have continued to promote advanced care planning by encouraging people to have conversations with their families and care professionals about their preferences for end of life care. The development of the Summary Care Record v2 enables those decisions and care plans to be communicated to the care professionals across different organisations so that people can die in their place of choice. In 2016/17 there were a total of 902 patients who died in their place of choice, which is a significant increase on 2015/16 when 222 patients were reported to have died in their place of choice.

• Furthermore, additional LOROS clinics were made available within the community based at the Uppingham Surgery and thus increasing access to local patients.

Support for Carers

• In 2016/17 a Carers Delivery Group was established working across Leicester, Leicestershire, and Rutland. We have been a key member of the Group and have had the opportunity to work closely with our social care partners as well as health partners to develop and drive forward a number of initiatives to support carers.

• Carer identification questions on the new patient GP registration forms for adults, and for people under 16 years.

• A specific area for the identification and recording of carers and their needs within the bespoke dementia template for use of practice systems.

• The inclusion of raising awareness of carers within educational programmes for staff working in general medical practices.

• Working with Leicestershire County Council and Rutland County Council to commission support for carers from voluntary sector organisations.

Other notable improvements for patients include:

• First steps to a new opportunity – ELR GP Federation – throughout 2016/17 the ELR GP Federation has evolved into the ‘vehicle’ in which local practices are able to consider working at scale to deliver future services.

The business priorities for 2017-2019 will help us to achieve our mission placing primary care at the core of care for East Leicestershire and Rutland patients within an arrangement where there is greater responsibility for all partners involved in delivering health and care services.

• Supporting vulnerable practices – we have established a process during 2015/16 to secure external support for our practices where they are identified as being “vulnerable” to ensure that our practices are able to continue to provide good quality care for our patients. This process proved extremely useful in 2016/17 in supporting some of our practices.

• Patient Participation Groups (PPG) - the frequency and type of meetings continued in line with previous years with three locality meetings twice a year and two network meetings. Attendance averaged at 10-15 for each locality meeting with the numbers attending the Oadby and Wigston PPG group greatly increased in comparison to previous years. Our network meetings are well attended and continue to be a valuable engagement forum with patients and service users. We have continued to build into the presentations networking/group based activities and the members obtain great value from these sessions. It is an opportunity for groups to learn from each other and also make connections for some joint working across PPGs. The meetings also enable invaluable two-way communication to take place between the CCG and PPGs, allowing the patient voice to be heard and acted on.

Partnership working

As our Chairman highlighted in his welcome, many of the successes we have had and much of the progress we have made, is the result of partnership working. We are particularly pleased to highlight our significant contribution to the Better Care Together programme and the draft Sustainability and Transformation Plan (STP), a five-year programme that is aiming to transform health and social care services to meet the challenges of a growing and ageing population with increasingly complex health needs. These challenges mean that we are working more closely than ever with partners across the NHS and Local Authorities, towards the aim of providing integrated health and social care services. ELR CCG is providing clinical leadership across the clinical work streams underpinning this programme, in particular with work on improving care and services for people, frail older people and mental health.

Furthermore, in 2016/17 the CCG faced a significant challenge with a Quality, Innovation, Productivity and Prevention (QIPP) target of £17,989,672 which equated to 4% of our CCG’s total budget. To achieve this target we were required to identify service developments both within the CCG specific services as


(until 30 September 2016)

well as wider in partnership with Leicester City CCG and West Leicestershire CCG, that would not only deliver service improvements to patients but would enable the CCG to make efficiencies that would deliver the financial target. As part of the process we embraced the RightCare programme as part of the prioritisation process in identifying areas for service development, linking to the Better Care Together work streams.

In addition, our member GP practices from across our locality were pivotal in the delivery of the QIPP programme and in putting forward potential schemes for the CCG to consider and support with continuing efficiencies.

Championing our patient’s voices

At a number of our Governing Body meetings we have heard a story from someone living in our area about their experiences of local health and social care services. This powerful introduction to our meeting helps ensure our patients remain the focus of our decision-making and at the heart of everything we do. We have also worked with providers to implement a number of changes as a result of the patient experiences we have heard.

Our priorities for 2017/18

Looking ahead, we know that 2017/18 brings even greater financial challenges and we will inevitably have to make some very tough decisions about the services we commission. Our Operational Plan for 2017/18 and 2018/19 details our priorities for the next couple of years.

There will be greater emphasis on the radical changes we and our partners need to make to how we commission and design services that meet expectations and demand yet remain safe, reliable and financially sustainable for the future. Our contribution to the draft Sustainability and Transformation Plan; and our partnership working through the Better Care Funds in Leicestershire and in Rutland will be crucial in meeting these challenges.

Our draft Sustainability and Transformation Plan and with the publication of the national 5 Year Forward View for Mental Health present opportunities to refresh and articulate the direction of travel for mental health care in the next 5 years and beyond. We will be working with our partners to integrate and implement national initiatives including the Crisis Prevention Concordats, 5 Year Forward View and Parity of Esteem in the context of our diverse community.

Our priorities for 2017/18 include delivery of an integrated urgent care system. Leicester, Leicestershire and Rutland is one of eight areas across the country to be awarded Emergency Care Vanguard status in 2015/16 to enable wide scale transformative change in the urgent care system. The Vanguard brings together

all our providers of health and social care to work as one network, collaborating to establish new models of urgent care. Our aim is to simplify services for patients, to ensure they can access the care that they need, without having to worry about having to navigate a complex and sometimes disjointed system. From 2017/18 onwards Leicester, Leicestershire and Rutland will no longer be a vanguard. However, our priorities will remain in order to embed the transformation within the local urgent care system.

We have always been committed to public and patient involvement, strong system leadership and partnership working across health and social care and the voluntary sector. You will see evidence of this more than ever as we tackle the issues we face and make the decisions we need to make.

We will continue to be open and transparent in how we work. Our Governing Body meetings will continue to be held in public and we will regularly publish information about our performance and finances in our Governing Body meeting papers on our website: www.eastleicestershireandrutlandccg.nhs.uk

About Us

Our staff: Number of staff = 100

31

The CCG:

GP practices

325,087Population =

Our population:

We are listening:

In 2016/17:

Over

locations visited by the Listening Booth

Over

pieces of individual patient feedback collected, half of which is from carers

13 257

Average life expectancy for men

Average life expectancy for women

80.5 years

84.2 years

22.6% of the population are

over 65 – higher than the England average

In the next ten years, 19,000 more people over

65; 3,715 of these will be over 85


The Performance Report

Accountable Officer’s introduction

There is no doubt that 2016/17 has been a year of challenges. Despite significant financial pressures and issues with performance by our providers as well as the longer term pressures posed by an increasingly elderly population with complex health needs, I am pleased to report that we have delivered several key improvements across local healthcare which are making a real difference to our patients, their families and carers and which are paving the way for the planned future transformation of local health and social care services.

We have also balanced our financial position in the face of major financial challenges, which was no easy task and is testament to the continued commitment of our staff, clinicians and collaborative commissioning arrangements.

Who we are and what we do

NHS East Leicestershire and Rutland Clinical Commissioning Group was legally established in April 2013 under the provisions of the Health and Social Care Act 2012.

All 31 of our GP practices in East Leicestershire and Rutland are members of the CCG and part of one of our three localities: Melton Mowbray, Rutland and Market Harborough; Oadby and Wigston; and Blaby and Lutterworth. The CCG Governing Body comprises GPs from member practices who represent their

practice and locality to shape local healthcare for our registered population of 325,087 patients (for further information about the Governing Body please see the Accountability Report).

In 2016/17 ELR CCG was entrusted with an allocation (our budget) of £411,116,000 with which to plan and buy the health services needed by people living in East Leicestershire and Rutland. The services we are responsible for planning and buying include:

• hospital treatment

• rehabilitation services

• urgent and emergency care

• community health services

• continuing healthcare

• primary medical services

• mental health

• learning disability services

We do not provide these services ourselves; we pay organisations to deliver them for patients on our behalf. We work hard to ensure services are delivered to the standards that we expect for our patients. We work very closely with all of these provider organisations to thoroughly scrutinise the care patients are receiving, identify any concerns at an early stage and help providers to improve the situation where standards may have fallen.

We hold contracts ranging from small agreements with the voluntary sector, to a circa £136m contract with the main acute provider, University Hospitals of Leicester NHS Trust (UHL).

Our patch

Improving health

In addition to planning and buying healthcare, our role is also to help people to live long and healthy lives and to prevent ill health where possible. We encourage people to take greater responsibility for their own health, manage existing conditions better and reduce the impact that factors such as smoking, drinking alcohol, poor diet and lack of exercise may have on their health in the future.

ELR CCG GP practices, urgent care centres and hospitals


Vision, values and our strategic aims

Our vision, values and strategic aims are based on the views of our member practices, clinicians, our patients and carers, our staff and partner organisations. Over the years we have spent time talking and listening to people about the changes they would like to see in local healthcare and where we should be focusing our efforts.

The development and implementation of our strategic aims and priorities also has input from our public health colleagues at Leicestershire County Council and Rutland County Council; and is based on the Joint Strategic Needs Assessment (JSNA) and the Health and Wellbeing strategies of our two local authorities.

Our vision

To improve health by meeting our patients’ needs with high quality and efficient services, led by clinicians and delivered closer to home.

Our strategic aims

• Transform Services and enhance quality of life for people with long term conditions - with a particular focus on COPD, diabetes, dementia, mental health and learning disabilities

• Improve the quality of care - focusing on clinical effectiveness, safety and patient experience, with specific goals to deliver excellent community health services, acute care, mental health care and improve the quality of primary care

• Reduce inequalities in access to healthcare - targeting areas and population groups with the greatest need

• Improve integration of local services - between health and social care and between acute and primary/community care

• Listening to our patients and public - our commitment is to listen, and to act on, what our patients and public tell us

• Living within our means - the effective use of public money

Our aim and strategic priorities feed into the joint strategic plan for 2014-19 (the Leicester, Leicestershire and Rutland Five Year Strategy) which is implemented through the Better Care Together Programme. The Strategy sets out a shared vision to reform health and care services, providing suitable, affordable and sustainable solutions that will improve outcomes for the local people.

It is aligned to the three Joint Health and Wellbeing Strategies and Better Care Fund (BCF) plans across Leicester, Leicestershire and Rutland with an emphasis across the system on reducing health inequalities, reducing avoidable admission to hospital, redesign of alternative pathways and prevention of illness.

Our values

Our vision and strategic aims guide what we are trying to achieve. The way in which we go about achieving them is determined by the values we choose to work by.

Our values reflect the spirit of our organisation:

Our Values

The values are now reflected in our annual staff appraisals.

One TeamWe are at our best when we work together

ExcellenceWe strive to be the best we can be

OwnershipWe do what we say and take personal responsibility

Patient-centredCompassion for patients at the heart of everything we do

IntegrityWe act in the way we would want to be treated and are aware of our personal impact on others

Our population and their health needs

Our population:

• the average life expectancy in East Leicestershire and Rutland is 80.5 years for men, and 84.2 years for women, both of which are higher than the England average;

• the proportion of people aged 60 and over is higher than the England average (22.6%), and our older population is predicted to increase over the next 10 years, with an estimated 19,000 additional people aged 60 years and over. 3,715 of this population will be aged over 85 years;

• the health of our local population is generally better than the overall population of England. However, there is a significant number of people affected by ill health, including GP-diagnosed coronary heart disease (10,564 people), hypertension (49,493 people), and diabetes (17,494 people).

In ELR CCG only a small proportion of people live in deprivation when compared to other parts of England.

Within the CCG, there are areas that have poorer health outcomes. The main areas affected are in Oadby and Wigston. In one area of Wigston for example, residents have a significantly higher rate of mortality from all causes and mortality from respiratory diseases than the England average. Although not significantly higher, rates of mortality from stroke are higher than the England average.

Evidence suggests that the most effective way to reduce the gap in life expectancy in the short term is to improve the management of diseases (including cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) and their risk factors, including smoking, alcohol, hypertension and diabetes that predominately affect the socially excluded.

There were 2,967 deaths per year, on average of patients registered with one of our member practices; and cancer, CVD and respiratory disease accounted for 69% of these deaths. Many of these deaths could have been avoided through earlier diagnosis and better treatment. This has directly influenced our clinical work in relation to diabetes, cardiovascular disease, COPD, dementia, access to primary care services and mental health.

The CCG is working with Public Health, particularly within Better Care Together and the Better Care Fund, to improve the levels of premature mortality in key areas including cancer, CVD, lung disease and liver disease; and prioritising improving the earlier detection of disease and management of these conditions.

The main clinical areas of focus for the CCG in 2016/17 have continued to be: cancer, cardiovascular disease (CVD), and respiratory disease.

Significant health inequalities exist for our patients from minority and seldom heard groups, including patients from our Black and Minority Ethic (BME); Lesbian Gay Bi and Trans (LGBT) community; travelling families; and young people suffering with mental health. During 2016/17 we reviewed our equalities objectives to focus on specific groups of patients. More information about this can be found in the update on equalities section of our Annual Report and our annual Equality and Inclusion Report available on our website www.eastleicestershireandrutlandccg.nhs.uk.

In our area there are an increasing number of children living longer with life-limiting and complex health conditions. There are also a significant number of children attending hospital services that could be cared for more appropriately in a community or home setting.

Children, young people and carers have also told us they are worried about a range of issues that affect their mental health and wellbeing. These include academic pressure, peer pressure, family breakdown, sexual exploitation and cyber-bullying. They would like more support in school or through confidential help-lines and websites. In 2016/17, the three CCGs across Leicester, Leicestershire and Rutland (including East Leicestershire and Rutland CCG) had £2m in their baseline to address these issues, this continues to be used alongside existing funds from local commissioners to implement the plan.

Across the country it is predicted the number of births will increase each year which will put significant pressure on our maternity and neonatal services. Our aim is to provide high quality, safe maternity and neonatal services based on best practice and which are easily accessible. These services will be supported by the appropriate infrastructure across both primary and secondary care. The proposals for the future of maternity services will form part of a public consultation under the Better Care Together programme.

As a CCG we strive to improve services to deliver better quality patient care and experience, whilst reducing clinical variation, eliminating waste and delivering better value for money. The feedback that patients provide is extremely valuable to us in being able to carry out this aspect of our role.


Legal duties

We have embraced our legal duties in the delivery of our vision and strategic aims. The CCG has a legal responsibility to involve and inform patients and members of the public by ensuring that involving, listening to, and acting on the views of local people are at the heart of delivering our vision for local healthcare.

This commitment also extends to other legal duties placed upon the CCG, including: duty to improve quality, to reduce inequalities and contribute to delivery of joint health and wellbeing strategy; in compliance with the Equality Act 2010.

Partnership working

Partnership working is vital to East Leicestershire and Rutland Clinical Commissioning Group and it is the best way to bring about many of the changes we wish to see implemented.

In 2016/17 we actively engaged with partner organisations to build on existing relationships and develop new and improved relationships with clinicians, patients and their carers, the public, staff, partner organisations, including local authorities, and other commissioning agencies.

We are an active partner in the Better Care Together (BCT) programme and the draft Sustainability and Transformation Plan, working to transform the health and social care system in Leicester, Leicestershire and Rutland (LLR) by 2021. Our plans are built on collaborative relationships and consensus which we will continue to develop through new governance arrangements to ensure the success of the STP and which provide the foundations for an integrated health and social care system. In addition the CCG is implementing shared priorities for health and social care integration through two Better Care Funds alongside Leicestershire County Council, West Leicestershire CCG and Rutland County Council.

This work is strengthening our joint commissioning and working arrangements to deliver integrated care for older people and supporting people with long-term conditions (LTCs). This is particularly crucial if our CCG is to meet its financial challenges through the transformation of care systems, and improve the quality of healthcare across all our providers.

The Better Care Fund has been a critical enabler to forward the integration agenda during 2016/17. In 2016/17 our contribution to the Leicestershire Better Care Fund and Rutland Better Care Fund enabled £17.6m worth of care to be jointly commissioned locally on health and care to drive better integration of health services and improve outcomes for patients, service users and carers. The CCG, in conjunction with Leicestershire County Council and Rutland

County Council, has used this as a catalyst towards our vision for a modern model of integrated care.

From the outset of the Health and Wellbeing Boards across Leicestershire and Rutland we have been closely involved in designing and delivering the joint strategies to support the people of East Leicestershire and Rutland. The close working relationships between health, local authority and the third sector has meant that real progress has been made to enable sustainable integration that supports quality, cost - effective services.

We recognise that the alignment between the CCG’s one-year plan, the local health and social care economy (LLR) five-year plan and the Better Care Funds strengthens our capacity to deliver transformative change and will result in a sustainable high quality system for the population of East Leicestershire and Rutland.

We have also continued to build on our strong partnerships and leadership across our local economy in the focus on delivery of the NHS Constitution and Mandate standards. Our performance against the constitutional standards is detailed in the Performance Analysis section of the report.

Providers and services we commission

Although the picture of healthcare providers is becoming more complex, it offers patients a wider choice of organisations to provide their care, the local services we commission remain dominated by:

• University Hospitals of Leicester NHS Trust (UHL), which provides acute hospital services at three sites in Leicester and in local community hospitals. UHL provides secondary care to a catchment area of approximately one million people and specialised services for up to three million people. It is one of the largest acute trusts in the country.

• Leicestershire Partnership NHS Trust (LPT), which provides mental health services and manages most of the community-based teams serving ELR CCG and is also a key provider at the six community hospitals.

• East Midlands Ambulance Service NHS Trust, which provides emergency 999 and urgent care across Derbyshire, Leicestershire, Rutland, Lincolnshire (including North and North East Lincolnshire), Northamptonshire and Nottinghamshire.

We commission acute services from out-of-county NHS trusts and a range of independent sector providers such as Spire Leicester Hospital, Nuffield Leicester Hospital and Circle Nottingham Treatment Centre.

In 2016/17 we acted as the coordinating commissioning body for managing the following contracts across Leicester, Leicestershire and Rutland on behalf of the other two local CCGs:

• Mental health and learning disabilities

• Out-of-county contracts (mental health)

• Leicester, Leicestershire and Rutland Continuing Healthcare (CHC) and other individually negotiated packages of care

• Leicester, Leicestershire and Rutland voluntary sector arrangements

We continued to work with our colleagues from Leicester City CCG and West Leicestershire CCG in the management of these contracts and in line with the NHS Standard Contract Management Framework.

The health and care services commissioned across Leicester, Leicestershire and Rutland during 2016/17 included the following:

Acute and emergency provider – University Hospitals of Leicester NHS Trust (UHL)

UHL is the main acute provider for Leicester, Leicestershire and Rutland (LLR) and also has a training and development remit as a teaching hospital. In the last year, UHL experienced significant challenges which inevitably impacted on the performance of the local health economy in meeting its constitutional standards. The challenges included:

• a significant financial deficit

• challenges in cancer performance and the delivery of Accident and Emergency (A&E) performance

• following a Care Quality Commission (CQC) inspection in June 2016 /July 2016 the CQC published its report in January 2017 giving UHL an overall rating of “requires improvement”. The report also included an enforcement notice relating to the Emergency Department (ED) and 15 requirement notices. This has meant that UHL had to compile an improvement plan to implement areas of improvement which was shared with the commissioners.

One of the areas of improvement included improved performance in Referral to Treatment (RTT) standard.

Our patients also access a wide range of services from other acute providers, particularly Kettering General Hospital, Northampton General Hospital and Peterborough Hospital.

Non-emergency patient transport service - Arriva

We worked collaboratively with UHL, the local CCGs, Arriva and EMAS to address discharge issues putting in place a discharge coordinator to enable a smooth transition enabling patients to be transported home

in a timely and safe manner. We also put in place working groups to review locality issues for patient transport and identify resolutions. In 2016/17, collaboratively with Leicester City CCG and West Leicestershire CCG, the CCG re-procured one provider to deliver the Non-Emergency Patient Transport Service (NEPTS) from October 2017.

NHS 111 - Derbyshire Health United

We developed service specification for a new service which was better aligned to urgent care services across Leicester, Leicestershire and Rutland.

Out of hours – Central Nottinghamshire Clinical Services (CNCS)

We worked closely with the provider to put in place a healthcare professional telephone line for care homes across Leicester, Leicestershire and Rutland to provide direct access to clinicians in the out of hours period. We conducted a pilot for direct appointment bookings which linked to the development of the service specification for NHS 111. In conjunction with Leicester City CCG and West Leicestershire CCG the service was re-procured during 2016/17 as part of an integrated Urgent Care model and this included the redesign of out of hours and acute visiting services. A new provider has been awarded the contract from 1 April 2017, the new provider is Derbyshire Health United.

Leicester, Leicestershire and Rutland Alliance

This unique partnership of primary care providers, LPT, UHL and commissioning organisations, delivers planned care services in the community. It enables appropriate shifts of activity from the acute settings to support delivering care closer to home.

Community Services and Mental Health and Learning Disability (LD) – Leicestershire Partnership NHS Trust (LPT)

LPT provides community services and services for patients with mental health and learning disabilities. LPT has been delivering against Care Quality Commission (CQC) action plans during 2016/17, however as with many other providers in England LPT experienced frequent shortages in workforce which impacted on staffing levels on wards and are offset by additional temporary workers; accuracy and data quality issues; and financial difficulties. Service development plans were agreed with LPT to address data quality issues and timeliness of improvement is being monitored by commissioners.

LPT has not been able to provide Female Psychiatric Intensive Care (PICU) beds because it has not been possible to provide separate wards for male and female patients, and therefore some patients have had to be placed out of county. Plans have been implemented in 2016/17 to address this through increased provision of crisis and out-of-hours care. Female PICU options are being pursued to provide an improved service offer.


Primary Care General Practitioners

Since April 2015 ELR CCG has had full delegated authority from NHS England for primary medical care commissioning of General Practice and has a team in place to discharge this responsibility.

During 2015/16 ELR CCG supported practices in the development and formation of their legally constituted ELR GP Federation. The ELR GP Federation commenced in its legally constituted form in April 2016, with all 31 practices joining the federation.

During 2016/17 it is acknowledged that shifting services from hospital settings into the community closer to patients has increased the work pressures in primary care, in particular for general practitioners. Primary care is the corner stone of the NHS and it is where the majority of the public make first contact with the NHS. It is recognised that the despite the increasing pressures in primary care, our general practices have delivered and continue to deliver an excellent service and quality of care for our patient population, this is evident in our achievements during 2016/17.

Urgent Care

The current East Leicestershire and Rutland community based urgent care service is run from four Urgent Care Centres (UCC) across the locality and provided by Vocare: St Luke’s Hospital in Market Harborough, Rutland Memorial Hospital in Oakham, Melton Mowbray Hospital and the Oadby Walk-In Centre.

In addition, in 2016/17 the CCG has worked closely with the other Leicestershire, Leicestershire and Rutland CCGs to commission a new Urgent Care Visiting Service for all Leicester, Leicestershire and Rutland (LLR) patients. This 24/7 service which is accessible by GPs, care homes and patients directly via 111, offers access to Urgent Primary Care in the home setting, supporting patients to stay at home and to avoid conveyance to hospital. Our community-based Urgent Care service is coming to the end of its contract and supported by public and local clinical engagement, will be recommissioned over the 2017/18 financial year.

The Voluntary Sector

ELR CCG recognises voluntary sector organisations as key stakeholders in the local health economy and wider community. They have a wealth of knowledge and expertise in the services they provide and offer additional support to individuals outside of formal commissioning routes, often bridging the gaps between professional support agencies including health and social care.

The CCG contributes approximately £1.2million a year through grant agreements to the running of the various organisations.

Each voluntary sector organisation awarded a grant for 2016/17 aligned to specific Better Care Together workstreams. This ensured investment is made in areas

which support the aims of the CCG and deliver better outcomes for local people.

Providing assurance to NHS England

Under the Health and Social Care Act (2012), NHS England makes an annual assessment of CCGs each financial year and publishes a summary report; this assessment process also involves quarterly assurance meetings.

In 2016/17, the CCG Assurance Framework set out four new domains that reflect the key elements of a well-led effective clinical commissioner and underpin assurance discussions between CCG and NHS England, whilst identifying on-going ambitions for CCG development. The components are:

• a) Better Health (Quality): how the CCG is contributing towards improving the health and wellbeing of its population;

• b) Better Care (NHS Constitution and other core performance) principally focuses on care design, performance of constitutional standards and outcomes, including an important clinical areas;

• c) Leadership: assesses the quality of the CCGs leadership, the quality of its plans, how the CCG works with partners, governance arrangements in place and the management of conflicts of interest.

• d) Sustainability (finance indicators): how the CCG is remaining in financial balance, and is securing good value for patients and public from the money it spends.

Alongside the 4 domains are 6 clinical priority areas which received an initial assessment (from the national team), including mental health, dementia, learning disabilities, cancer, maternity and diabetes. NHS England commended the CCG for the involvement and engagement from our clinical leaders in the implementation of our key strategic aims and priorities in 2016/17. However, feedback also recognised the challenges we have faced with increasing demand for services and working against a backdrop of financial challenges. Further improvements were highlighted in relation to the performance against the constitutional standards.

Governance arrangements

We received positive feedback from NHS England in relation to our governance processes through the assurance meetings. We have developed comprehensive governance arrangements (see the Accountability Report), which support the delivery of our strategic aims and plans. This includes clear lines of accountability for delivery to ensure progress is made against our strategic aims and plans and risks are identified, monitored and reviewed. The


governance framework is regularly reviewed to ensure it remains fit for purpose to support the delivery of the strategic aims. The CCG governance structure is as at Appendix 1.

Where common areas of commissioning exist between the three CCGs across LLR, collaborative governance structures have been put in place. This includes the Commissioning Collaborative Board (CCB) and the Provider Performance Assurance Group (PPAG); and in 2016/17 the establishment of the System Leaders’ meetings. CCB and PPAG oversee a number of shared areas including assurance against quality and contractual performance of our main providers. Reports from these groups are received by the CCG Governing Body and appropriate committees. The System Leaders’ meeting was established in response to the draft Sustainability and Transformation Plan.

Financial pressure

The economic climate in which we operate remains a challenge for all NHS organisations and local authorities across Leicester, Leicestershire and Rutland.

The Better Care Fund and the Better Care Together programmes continue to be managed at a partnership and system level to maximise the savings potential and ensure the economy returns to overall financial balance.

Going forward, our five-year draft Sustainability and Transformation Plan (STP) sets out the medium-term direction for the models of healthcare and support services across Leicester, Leicestershire and Rutland (LLR) and the steps needed to realise that vision. It is led by a single Leadership Group of Chief Executives across health and social care commissioners and provider trusts, with Healthwatch representing the views of our patients and the public.

2016/17 QIPP Programme

The CCG faced a significant challenge in 2016/17 with a QIPP target of £17,989,672 which equated to 4.4% of the CCG’s total budget. Clinical leadership and engagement has been pivotal in achieving our QIPP target in 2016/17. Our staff were also engaged in the process and shared their ideas and suggestions for potential QIPP schemes, some of which were fully developed through the year to deliver benefits.

The 2016/17 final position was £18,386,795 an over delivery against the QIPP target of £397,123; a testament to the dedication of every member of the CCG in wanting to deliver the best possible services for the population of East Leicestershire and Rutland CCG whilst ensuring value for money and protecting the public purse. The CCG’s QIPP target for 2017/18 will be equally challenging.

Involving and informing

In January 2016 we updated our Listening and Engagement Strategy. This sets out our plans to further enhance our efforts to ensure local people, partners, clinicians and staff are actively involved in shaping our plans and decision making.

The update to the strategy continues the trajectory and builds on the foundations laid by our 2013-15 Informing and Involving Strategy. That strategy put in place the fundamental building blocks of a modern and imaginative capacity for listening and engagement.

The updated Strategy responds to the clear and consistent message delivered through our 2016 NHS Ipsos Mori 360° stakeholder survey as well as views and opinions gleaned from our 2016 Summer of Listening and at our 2016 Annual General Meeting.

These showed:

• the fundamentals of our existing listening and engagement activity are sound and fit for purpose;

• there are areas of particular strength that are valued by our stakeholders and partners; and

• we could improve some aspects of our activities to deliver real excellence including placing greater emphasis on demonstrating and communicating specific feedback and responses to what we had heard.

The strategy sets out our plans to improve our activities and in particular the way in which we provide feedback to our communities and stakeholders.

As we roll out plans under the strategy, we seek to increase both the reach and the impact of our engagement.

In 2016/17 we also examined in detail who we engaged with and how we engage with them and as a result have increased the number of contacts we have within each organisation and experienced different ways of engaging with them, including through our newly developed and enhanced social media channels.

Our Public and Patient Engagement Group (PPEG), launched in 2014 and has been developed further over the last couple of years with the inclusion of more members, again particularly among the seldom heard groups. PPEG provides a useful platform for informal discussion between the CCG, the public and patients and we are always keen to encourage more people to get involved by joining.

We carried out engagement and consultation on the proposed Settings of Care policy, which will be finalised in 2017/18 once the feedback and comments received during the consultation process has been analysed in detail. This policy is used to guide us in deciding the limit of additional funding for providing care in an individual’s preferred setting and includes criteria which ensures that individual clinical circumstances are

taken into account. We proposed some changes to the outdated policy and promised that no actual changes would be made until patients and the general public had the opportunity to participate in a consultation. Both engagement and consultation processes were robust and transparent and we are satisfied that we provided people with an opportunity to have their say on the proposed changes.

We also engaged with patients, asking them for their views on proposed changes to prescribing paracetamol and gluten-free products that were readily available over-the-counter. Patient feedback was then used to inform changes to prescribing. More recently we have been engaging with patients, pharmacies and GP practices to reduce medicines waste.

Over the winter and early spring we also worked with healthcare and social care providers across Leicester, Leicestershire and Rutland to deliver the national Stay Well campaign. This campaign aimed to help people stay well and chose the right services if they did become ill. As part of this we went out to a range of events and meetings, focusing on the hard to reach groups and older people, to share the stay well message and gain insight into people’s experiences of health care. This work will help us inform our approach for Winter 2017/18.

myCCG

myCCG is our public membership service launched by the CCG in the Autumn of 2015. More than 1,000 patients and local stakeholders now receive instant details of the very latest news from the CCG direct into their e-mail inbox.

This is a key part of the “We Come to You” strand of the CCG’s updated Listening, Responding, Delivering strategy. Once they have created a myCCG account, users can post comments on any page on our website, get involved in threaded discussions or ask us questions.

Any comments can be submitted and instantly translated into over 90 languages, thanks to the language support embedded in the CCG’s website. Anyone can create a myCCG account for free in six easy steps.

More information is available on our website www.eastleicestershireandrutlandccg.nhs.uk

Priorities for 2017/18

Our aim is to continue to ensure our patients and carers get a high level of care. We will continue to listen to and understand our patients’ experiences, we will design better, more person-centred services that deliver better care for our people. Our plans for 2017/18 and 2018/19 are detailed within our Operational Plan available on our website. Our plans include working with our local partners in delivering the STP and our challenging QIPP target.

In 2017/18 we will develop a programme of work to identify areas in which we will embed our new values, for example, values-based leadership, and values-based recruitment and appraisals.

The vision for primary care is for general practices to work together to provide services at a greater scale across a local area, bringing more specialists and wider primary care professionals together, in order to provide better integrated care particularly for those patients with complex needs. We will continue to work to our long-term plan to redesign primary care services and integrate health and social care and increase investment in a new community service model, in line with the GP Five Year Forward View. The role of the CCG and the aim of our delegated function is to focus on general practice to act as an enabler to facilitate the changes needed both for improved patient outcomes and new ways of working.

Going forward, we intend to embed our locally designed model of integrated care, aligning the services to our wider strategic plan in order to deliver a new model of care, promoting health and wellbeing rather than focussing upon illness and a model which can be replicated easily, as described in the Five Year Forward View.

In 2017/18 we will continue to strengthen our relationships and work with our partners across Leicester, Leicestershire and Rutland on whole system strategic transformation as set out in the draft Sustainability and Transformation Plan (STP). The STP will show how local services will evolve and become sustainable over the next five years, ultimately delivering the NHS Five Year Forward View vision of better health, better patient care and improved NHS efficiency across our local health and social care system.

Accountable Officer 30 May 2017

We will continue to listen to and understand our patients’ experiences, we will design better, more person-centred services that deliver better care for our people.


Performance Analysis

Performance Assurance

Our performance is measured by our delivery of a number of national pledges made within the NHS Constitution, along with a smaller number of locally agreed indictors. This is achieved by working with its main healthcare providers ensuring the CCG’s population receives the best possible care. In 2016/17 our focus has remained on improving our population’s health and quality of care.

The CCG’s success in 2016/17 is measured by reporting key performance indicators (KPIs) as defined in the Improvement and Assurance Framework (IAF) for CCGs, and Delivering the Forward View: NHS Planning Guidance 2016/17 – 2020/21. These documents cover the NHS Mandate and NHS Constitution.

Key performance indicators, during 2016/17, have been monitored through the CCG’s monthly Integrated Governance Committee meetings, with assurance provided to the Governing Body identifying high risk indicators and the mitigation in place to improve performance. These in turn are received by NHS England through the CCG’s quarterly assurance

meeting; and information about the CCG’s position and performance is published on NHS Digital’s website. Performance against indicators is also reported to the Provider Performance and Assurance Group (PPAG) which is a collaborative meeting across the three local CCGs, including independent lay members, and provides high level oversight, scrutiny and assurance at contract level.

Key Performance Indicators (KPIs) – NHS Mandate and NHS Constitution

The NHS Mandate for 2020 took effect from April 2016 setting the direction of the NHS ensuring accountability to Parliament and the public. The NHS Constitution ensures patients’ rights and pledges are maintained through contracts with service providers. In 2016/17 the CCG continued to ensure that both of these policies and associated KPIs are monitored through the CCG’s corporate performance report mirroring the IAF at local level as part of a Better Care Dashboard and a Better Health Dashboard. These dashboards link in with the six national clinical priorities; mental health; dementia; learning disabilities; cancer; diabetes and maternity. The end of year performance for 2016/17 is detailed in the following tables.

The indicators rated as “Red” above show where performance issues have arisen in 2016/17 and the CCG has taken action in collaboration with the local CCGs, including CCGs acting as the coordinating commissioner, and the respective providers to support improvement in performance. Some of the actions taken during 2016/17 are as follows:

• Psychological therapies – performance has fluctuated during the year for roll out of the expanded service, recovery of patients and waiting times. To improve access to the service, the focus has been on promotion to patients through

various social media channels. Extension of the service to patients with long term conditions such as diabetes, COPD and early on-set dementia is being progressed through community nursing and therapy services. Improvement to recovery will continue with funding in place for employment advisors, with an agreement in place by June 2017. Changes to service provision are being made to ensure waiting times are achieved going forward.

• Dementia Diagnosis – performance has made a gradual improvement during 2016/17 with the last recorded rate being 64.1%. To build on this

Performance Indicators 2016/17 Standard/Target

2016/17 YTD

Psychological Therapies Roll Out 15% Jan-17 13.10%

Psychological Therapies Recovery 50% Jan-17 52.00%

Psychological Therapies Waiting Times < 6 Weeks 75% Jan-17 80.00%

Psychological Therapies Waiting Times < 18 Weeks 95% Nov-16 100.00%

Psychosis - Access treatment in 2 weeks 50% Feb-17 80.00%

Dementia Diagnosis 66.7% Mar-17 64.00%

Learning Disabilities: Reliance on In-patient Specialist Care (per 100,000 population)

39.82 Q3 52.71

MRSA 0 Mar-17 0

CDIFF 78 Mar-17 86

18 Weeks Referral to Treatment (RTT) Incomplete Pathways 92% Feb-17 92.28%

Diagnostic Test Waiting Time < 6 Weeks 1% Feb-17 0.80%

52 Week Waiters 0 Mar-17 36

Accident & Emergency 4 Hour Wait (UHL) - Mar 2017 91.2% Mar-17 79.6%

12 Hour Trolley Waits – (All CCGs) 0 Mar-17 10

Cancer 2 Week Wait 93% Feb-17 93.70%

Cancer 2 Week Wait Breast Symptoms 93% Feb-17 92.20%

Cancer 31 Day Wait 96% Feb-17 95.70%

Cancer 31 Day Wait Surgery 94% Feb-17 91.00%

Cancer 31 Day Wait Drug Regimen 98% Feb-17 99.50%

Cancer 31 Day Wait Radiotherapy 94% Feb-17 94.40%

Cancer 62 Day Wait 85% Feb-17 81.1%

Ambulance Response Cat A Call (Red 1) 8 minutes (EMAS) 68.20% Mar-17 69.00%

Ambulance Response Cat A Call (Red 2) 8 minutes (EMAS) 60.10% Mar-17 57.10%

Ambulance Response Cat A Call 19 minutes (EMAS) 86.60% Mar-17 84.30%

Better Care Dashboard – covers the NHS Constitution Indicators with the reporting of data at registered population and provider level where appropriate. The indicators that are the main focus for the CCG are in the table below.


gradual improvement for 2017/18, funding has been received to implement a revised Dementia Quality Tool, and undiagnosed patients are being identified at practice level.

• Learning Disabilities In-patient Care A recovery plan has been developed by the Transforming Care Partnership outlining key actions to be undertaken by LLR partners. Performance is being monitored regionally on a monthly basis.

• Clostridium difficle (CDIFF) Although at CCG level, the standard is not being achieved, UHL is predicting achievement at provider level for this year. Locally the Infection Control Team is closely monitoring the situation with the LLR CCGs focusing on high risk areas and urgent patient safety issues.

• 52 Week Waiters UHL has provided a revised recovery plan for over 52 week waiters, predicting to clear all waiters by August 2017. All breaches are discussed at weekly access meetings, with additional capacity sourced.

• A&E 4 Hour Wait Performance did improve in early 2017 due to converting resources from elective to emergency services, with reduced Emergency Department (ED) occupancy, lower waiting times and improved patient flow through UHL and the healthcare community. The new ED Floor opened on 26 April 2017. Further improvements include additional support between the hours of 6pm and 2am.

• 12 Hour Trolley Waits The 10 trolley waits reported in January 2017 is exceptionally high and very unusual, with all patients requiring a bed. The significant pressure on ED required intervention from Social Care, with services working together to rectify the situation. There have been no 12 hour trolley waits reported since.

• Cancer Waits Performance remains good for the 2 week wait, with small number of breaches for breast symptoms due to patient choice. A planned improvement to the process was implemented in April 2017, which will ensure all referrals are on one system. For 31 day wait, the backlog continues to fluctuate. Theatre capacity and additional consultant support is in place. The 62

day wait backlog continues to reduce with UHL outsourcing non-cancer activity to protect and maximise capacity for cancer patients. Delivery actions continue to be monitored and the ‘Next Steps’ programme is being rolled out in focused patient pathways. The Cancer/RTT Board continues to closely monitor progress.

• Ambulance Response Times During 2016/17 a reduced standard was set for all three indicators at East Midlands Ambulance Service (EMAS) level to allow EMAS to concentrate on improving performance. Whilst performance for Red1 has achieved, Red 2 and A19 have continued to under-perform. A Strategic Review of the service is underway. The current level of service and the capacity required is being assessed. Staff rotas and vehicle fleet distribution are being improved.

Further detail on actions the CCG has taken to remedy shortfalls in performance against the standards can be found in the reports to the Governing Body available in the Governing Body papers on the CCG website.

Better Health Dashboard – focuses on preventative services, with monitoring on a quarterly and annual basis. The indicators included are: maternal smoking at delivery; childhood obesity; diabetes; and NHS e-referrals. In 2016/17 the CCG’s high risk areas were and continue to be as follows:

• Diabetics attending a structured education course There are two indicators; offered and attended. The CCG is above England position for offered as a whole. 11 practices took part in the diabetes audit in 2014/15 equating to 33% of practices within the CCG. Latest data shows 54.5% (18) of practices took part in 2015/16 audit. Published data for 2015/16 is awaited.

• NHS E-referrals Performance is below the national standard. A joint improvement plan between UHL and LLR CCGs has been agreed. The CCG is working to reduce appointment slot issues to improve availability to 100%, with capacity alerts for specific services. At January 2017, appointment slot issues at UHL were 78.2%, nationally this is 83%.


NHS Outcomes Framework 2016/17Rating as at December 2016

Blue Green Red

DOMAIN 1: Preventing people from dying prematurely 9 6 7

DOMAIN 2: Enhancing quality of life for people with long term conditions 1 3 9

DOMAIN 3: Helping people to recover from episodes of ill health or following injury

6 5 6

DOMAIN 4: Ensuring people have a positive experience of healthcare 7 6 6

DOMAIN 5: Treating and caring for people in a safe environment and protecting them from avoidable harm: key areas where progress will be expected.

4 2 3

A number of indicators remain in development nationally; further guidance is awaited, therefore rated blue in the table above. Areas where improvement has been made in 2016/17 and are green include:

• Life expectancy at 75 for males and females;

• Under 75 mortality rates from respiratory disease, liver disease, cancer and 1 year survival from all cancers;

• Unplanned hospitalisation for chronic ambulatory care sensitive conditions;

• Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s;

• Health-related quality of life for people with mental illness;

• Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement/rehabilitation service;

• Tooth extractions in secondary care for children under 10;

• Patient satisfaction: experience of NHS Dental Services;

• Experience of hospital care; responsiveness to inpatients personal needs;

• Women’s experience of maternity services;

• Patient experience of community mental health services; and

• As at March 2017 there have been no cases of methicillin-resistant Staphylococcus aureus (MRSA).

Areas where improvement has not been made and further targeted action could be required, these are rated red:

• Potential years of life lost (PYLL) from causes considered amendable to healthcare;

• Under 75 mortality rates from cardiovascular disease;

• Health-related quality of life for people with long-term conditions;

• Proportion of patients offered rehabilitation following discharge from acute or community hospital;

• Patient satisfaction: Access to GP services and GP out of hours; and

• Incidence of clostridium difficile (CDIFF).

NHS Outcomes Framework

The NHS Outcomes Framework is being continually developed. Locally in 2016/17 the CCG has monitored a variety of indicators under the five Domains:

Mental health and Learning Disabilities

In 2016/17 we continued to work closely with our mental health providers, clinicians and service users to improve our acute mental healthcare pathway, promoting independence and enabling individuals to be part of their communities. In times of crisis, and when patients require admission to inpatient care, we want to ensure they receive high quality care that promotes recovery in safe settings.

During 2016/17 we continued to implement and maintain the waiting time standard for Improving Access to Psychological Therapies (IAPT), with recovery rates currently 6% higher than the national average and target. The table below provides an overview of our performance against the national indicators for IAPT and actions taken to meet the targets.

Target % Outturn 2016/17

Actions to achieve targets

% of people accessing the service 15% 12.5%

Increase the number of referrals made to the service; promote the service more widely to increase awareness of the service. We are currently working with the provider to understand the reason for this.

% of people moving to recovery 50% 56% Maintain quality of patient outcomes.

Waiting Times - 6 weeks from referral to treatment

75% 72%Maintain staffing levels, ensure current waiting time is below 6 weeks.

N.B figures in table above are from April 2017 based on local data as national data is only available up until January 2017.

In line with the national guidance on Transforming Care (refreshed in January 2016), the CCG developed a comprehensive plan to deliver actions set out in local plans to transform care for people with learning disabilities. This included implementing enhanced community provision, reducing inpatient capacity, and rolling out care and treatment reviews in line with published policy.


Better Care Fund (BCF) Metrics for Leicestershire and Rutland 2016/17

The Better Care Fund has been a critical enabler to forward the integration agenda during 2016/17. In 2016/17 our contribution to the Leicestershire Better Care Fund and Rutland Better Care Fund enabled £17.6m worth of care to be jointly commissioned locally on health and care to drive better integration

of health services and improve outcomes for patients, service users and carers. The CCG, in conjunction with Leicestershire County Council and Rutland County Council, has used this as a catalyst towards our vision for a modern model of integrated care.

Performance against the Better Care Fund metrics for Leicestershire and Rutland are detailed in the following tables:

Metric Metric Performance

1. Non-Elective Admissions (General & Acute)

Over the period April 2016 to February 2018, the BCF schemes achieved 2,118 avoided admissions against a target of 1,517. The target for non-elective admissions 2016/17 is 59,030, based on a 2.49% reduction from 2015/16. Underlying patterns of rising non-elective admissions are making the target difficult to achieve, with current forecast* for 2016/17 predicted to be 61,846 admissions.* Data available up to January 2017.

2. Admissions to residential and care homes

Permanent admissions of older people (aged 65 and over) to residential and nursing care homes, per 100,000 population

The BCF impact overall over the last two years has shown a reduction in the number of admissions. In 2015/16 there were 645.6 permanent admissions per 100,000 people; by quarter three in 2016/17 this reduced to 639.4 per 100,000 people.

3. Effectiveness of Reablement

Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation services

We have clear evidence that people are receiving effective reablement on returning home from hospital and this is helping them to remain at home. In 2015/16 87.5% of reablement service users were still at home after 91 days. During 2016/17, performance has been maintained at 87.0%.

4. Delayed transfers of care (DTOC)

Delayed transfers of care from hospital per 100,000 population (average per month)

Reductions during 2015/16 in delays focused on interventions in the acute sector, therefore the target was set on reducing the number of days delayed in non-acute settings by 0.5%, while maintaining the rate of days delayed in acute settings at its low level. Numbers have increased in 2016/17, which is in line with national performance. The annual rate has increased from 2,994 per 100,000 in 2015/16 to a forecast (based on 11 months data) of 4,230 per 100,000 in 2016/17. However, benchmarking against our East Midlands neighbours shows that we have been above average for performance for April to December 2016.

BCF Leicestershire Metrics

Metric Metric Performance

1. Non-Elective Admissions (General & Acute)

Previous performance and BCF impact: For the third year in a row, Rutland is on track to meet its targets for reducing the number of nights of hospital stay attributable to Non Elective Admissions. Numbers of nights of stay have decreased year on year, from 7514 per 100,000 population in 2014-15, to 7301 in 2015-16 to a projected 7191 in 2016-17. This is a 4% reduction between 2014-15 and 2016-17.

2. Admissions to residential and care homes

Permanent admissions of older people (aged 65 and over) to residential and nursing care homes, per 100,000 population

Previous performance and BCF impact: The Rutland programme is comfortably on target for this metric. Permanent Council funded admissions to residential and care homes in Rutland have reduced year on year across the three years that BCF programmes have been running. Numbers have fallen from 522 per 100,000 65+ population in 2014-15 to 242 in 2015-16, down to a projected total in 2016-17 of just 151 per 100,000. This is the direct result of remodelled services supporting people to remain living independently in their own homes.

At the end of Q3, there had been 107 admissions per 100,000 population aged 65 and over (target ceiling: 269 to Q3).

3. Effectiveness of Reablement

Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation services

Previous performance and BCF impact: As in 2014-15 and 2015-16, the rate of people receiving reablement services and remaining at home 91 days after discharge from hospital has remained consistently above the target of 83.3% in 2016-17 (varying from 88% to 97% across the first three quarters). At the same time, the service is being delivered to a growing cohort (numbers doubling between Q1 and Q3).

Formal BCF reporting will be based on whether people discharged between 1 October and 31 December 2016 are still at home 91 days later.

4. Delayed transfers of care (DTOC)

Delayed transfers of care from hospital per 100,000 population (average per month)

Previous performance and BCF impact: Following a very challenging start to 2016-17, delayed transfer of care rates have been driven down, quarter on quarter across this year, bucking national trends and reaching a point where monthly rates are well below our ambitious local targets. (February 2017 saw 112 nights per 100,000 18+ population, just over half our local monthly target of 217, and just over a quarter of the England average for February of 429 and the East Midlands average of 420). This is as a result of implementing a ‘pull’ model for transfers of care, strengthened by a lean-style rapid cycle improvement approach which has successfully addressed a series of root causes of delays.

Performance in 2016-17 taken as a whole has not been quite as good as the exceptionally low DTOC numbers achieved in 2015-16. However, delayed transfers of care for 2016-17 are still down by 30% relative to 2014-15, with an 83% reduction in social care attributable delays and a 24% reduction in NHS attributable delays.

As the Rutland BCF programme set extremely ambitious DTOC targets based on improving on exceptional 2015-16 performance, we will exceed our BCF target for the year. Nevertheless, local performance by Q3 and Q4 had improved to the extent that DTOC rates were in line with the two best performing regions in the country, London and the North East.

BCF Rutland Metrics

Commissioning for qualityQuality, patient safety, clinical effectiveness and the experience of patients underpins the delivery of our health and social care services.

A number of recent high profile cases, including recommendations from the Winterbourne View (Department of Health 2012); the Report of the Mid Staffordshire NHS Public Enquiry by Robert Francis QC (2013); and the Saville Inquiry (2013) all identified vulnerable people were not afforded basic standards of care and their fundamental rights to dignity. We must not allow this scale of poor quality care and abuse to occur in the services we commission.

We recognise the need for service improvements to deliver better quality of patient care and experience in the long-term, whilst reducing clinical variation, eliminating waste and delivering better value for money. We worked on this through CCG contractual arrangements with providers to ensure effective quality indicators are in place which allow for a greater understanding of the impact of health interventions on patients; and the standard of services commissioned.

During 2016/17 we have made considerable progress in monitoring, challenging and scrutinising provider performance to ensure improvements in the quality of care commissioned. Some examples of this are:

• the continued assessment of patient experience dashboards for all of our out-of-county acute contracts;

• regular contacts through our Quality Contracting Teams with our neighbouring CCGs to monitor the quality of care being provided by our out of county providers;

• continued work with our local HealthWatch organisations to act on intelligence received about provider performance;

• refinement and continued monitoring of quality schedules for optometry, pharmacy and general practice community based services contracts. This will allow the CCG to assure itself of the quality of care being provided by these services, and work with providers to improve where necessary;

• reporting of poor quality of care across the CCG by our GP member practices;

• undertaking announced and unannounced quality visits to providers, with our Governing Body members being involved in this process;

• understanding and scoping quality assurance systems within primary care and development of the Primary Care Quality Dashboard;

• agreeing systems with NHS England to establish closer links and share intelligence of primary care quality risks including establishing systems of escalation where necessary;

• development of a Care Home Strategy Group to ensure all teams in the CCG, whose work involves care homes, is executed in a streamlined manner. This will ensure care is delivered and compliance is monitored effectively by maintaining an overview of work streams to deliver a care home plan setting out aims, objectives, metrics, leads and time scales;

• systematic scrutiny and oversight of settings of care for people in inpatient settings in learning disability services to ensure safe and effective discharge arrangements are in place; and

• we have embedded systems which allow for feedback from service users using HealthWatch members and stakeholder events.


Patient experience

Improving patient experience has been a key area of continued focus for the CCG during 2016/17.

Patient Participation or Patient Reference Groups (PPGs/PRGs) are in place at the majority of our GP practices as described earlier in our Members’ Report. The CCG engages regularly with the PPGs / PRGs to strengthen the voice of the patient in the work of the CCG.

The CCG Deputy Chair is the Chair of the Patient and Public Engagement Group (PPEG). The group comprises representatives from local third sector organisations, PPG/PRG Chairs, and members of HealthWatch and meets as required through the year. The group provides a sense-check on CCG plans and supports two way communications.

In 2016/17 the We are Listening project, using our Listening Booth, captured over 200 items of individual feedback of how patients feel about services they have accessed. The We are Listening project allows us to have a discussion with patients and residents of East Leicestershire and Rutland to better understand their experiences of our local healthcare services; and their view on what could be improved. The feedback we receive enables us to draw themes and trends which we feed back to our key providers, influencing changes in the way we commission services, and also to influence improvements in the quality of care being provided, where patients have highlighted issues.

In 2016/17, patient stories continued to be an integral part of the CCG’s Governing Body meetings. We use patient stories to drive changes and influence commissioning decisions through clinical discussions in public governing body meetings. In the last year

we have been able to demonstrate meaningful changes arising out of the use of patient stories; some highlights include a focus on the impact of living with dementia on families and carers, and the positive impact a community can have.

During 2016/17, the CCG complaints management policy was reviewed and refreshed.

Each quarter, the Integrated Patient Experience Report is presented to the Governing Body. This report outlines the patient experience and engagement activities undertaken by ELR CCG. The report brings together feedback received by the CCG through the Listening Booth, complaints, enquiries and Freedom of Information Requests.

We continue to be committed to improving the quality of patient care, by a focus on clinical effectiveness, patient safety and patient experience with specific goals to deliver excellent health services and improve the quality of patient care.

Use of CQC Inspections and monitoring arrangements / CQC ratings for providers: ensuring safety and quality

We routinely review data published by the Care Quality Commission (CQC) to inform our quality monitoring arrangements. Where providers have received action plans following inspection visits we monitor progress against these through our quality contracting processes. During 2016/17 this was extended to include CQC intelligence in our quality data sets for care homes and GP practices.

We have built positive relationships with our local CQC inspectors and have developed joint meetings with local authority and police colleagues to ensure

intelligence sharing around providers. Furthermore, for primary care providers, following a CQC inspection, support is provided to the practice by CCG Quality and Primary Care teams, this will continue into 2017/18.

Quality monitoring of primary medical services

Based on our existing practice profile we developed a suite of quality indicators across the range of NHS Outcome Framework quality domains as described earlier in our Members’ Report.

The Francis Inquiry

We welcomed the publication of the Francis Inquiry in February 2013 and actively engaged our Governing Body members, staff, member practices and the practice nursing community. During 2015 this work was extended to include the response to the Freedom to Speak Up review and in 2016 the ELR CCG action plan developed in response to both reports was signed off by the Integrated Governance Committee. ELR CCG continues to work with NHS England nationally to progress the implementation of Freedom to Speak Up in Primary Care.

In response, we formed the Freedom to Speak Up Steering Group and a staff focus group to address the issues identified in the Freedom to Speak Up report. As a result, the CCG was able to work with staff to develop and relaunch new values for the CCG in December 2015. These values have been embedded throughout 2016/17 and are now included in the recruitment and appraisal processes.

One of the key outcomes associated with the Francis report has been the development and implementation of an automated GP intelligence reporting system. This enables real time reporting of GP concerns relating to patient safety and experience in any provider organisation.

Contractual mechanisms continue with the strengthening of our approach to the monitoring of quality in providers. This has included the revision of quality schedules to ensure they reflect the Francis recommendations and a proactive approach to unannounced quality visits. The new approach to quality visits continues to incorporate a multi professional desk top review of various data sources to inform areas to visit, providers continue to welcome the increased level of scrutiny and respond positively to this approach.

Locally the thematic analysis of GP concerns has identified two specific workstreams that continue to be a priority. These are addressing quality of discharge letters from University Hospitals of Leicester, and scoping of quality and capacity within the district nursing services provided by Leicestershire Partnership Trust across Leicester, Leicestershire and Rutland (LLR).

Winterbourne View

The CCG continues to be committed to delivering against the Winterbourne View Concordat and the national Transforming of Care programme. This is to transform the way services are commissioned and delivered to:

• ensure people are appropriately supported in the community and their own homes to prevent an unnecessary hospital admission;

• ensure people are discharged from hospital with appropriate packages of care to keep them healthy and safe out of hospital;

• provide the right model of care and drive up the quality of care; and

• continue to see further education in hospital placements for this group of people.

Furthermore we have continued to systematically review placements for patients within inpatient settings commissioned by the CCG by undertaking Care and Treatment Review (CTR) panels for ELR commissioned placements to ensure appropriate arrangements were in place for ensuring effective discharge when service users are deemed medically fit to transfer to other settings.

In 2016/17, as part of the wider Transforming Care Programme, the CCG introduced CTRs for children as well as adults with learning disabilities or autistic spectrum disorders. The children’s CTRs are led by the children’s commissioning team.

As part of the CCG Transforming Care Programme, the CCG has undertaken “Blue Light Meetings”. These meetings are held to facilitate additional support for patients to remain in the community and prevent unnecessary admission to hospital.

Throughout 2016/17 we have continued to promote the values as outlined in Compassion in Practice and Leading Change Adding Value. We have actively promoted the NHS Care Maker programmes. These are ambassadors for the 6Cs of Nursing Care, and are tasked with inspiring people, encouraging and spreading best practice and helping to spread the word about compassion in practice.

ELR CCG has supported this national programme since the outset. Following the CCG’s successful application for a non- clinical Commissioning Care Maker in 2015, during 2016/17, the CCG hosted two student nurse Care Makers from the local Acute and Mental Health Trusts. We supported these Care Makers to understand more about NHS Commissioning, and to learn about the role of nurses in a CCG.


Safeguarding

We continued to have a strong focus on safeguarding vulnerable people in accordance with the NHS England Safeguarding Vulnerable People in the NHS: Accountability and Assurance Framework 2015.

The Integrated Governance Committee (formerly the Quality and Performance Committee) of the Governing Body has oversight and scrutiny of safeguarding arrangements for the CCG. The Chief Nurse and Quality Officer is the Executive Lead for safeguarding and is a member of the Leicestershire and Rutland Local Safeguarding Children Board (LSCB) and Safeguarding Adult Board (SAB). The CCG is supported in its statutory duties by Designated Nurses and a Designated Doctor for safeguarding. In partnership with the Quality Contracting Team the Designated Safeguarding Professionals ensure commissioned services provide the evidence to demonstrate safeguarding compliance with NHS Standard Contract (Service Condition 32):

• ensure the performance monitoring of the safeguarding vulnerable people element of the NHS Contract (SC32 Safeguarding, including PREVENT) is delivered by health provider organisations;

• ensure performance monitoring of safeguarding arrangements delivered by health provider organisations evidences arrangements to recognise and respond to Child Sexual Exploitation, Female Genital Mutilation and management of pre-mobile babies with bruising;

• continue to support Safeguarding Children and Adult Board programme groups and workstreams (supporting the delivery of board business plans);

• continue to provide and develop supervision arrangements for safeguarding named professionals following a 2015 baseline supervision audit;

• maintain Serious Case Review Assurance Framework;

• develop a Domestic Homicide Review Assurance Framework;

• develop the role of the LLR Named GP for Safeguarding Children; and

• develop a Safeguarding Assurance Action Plan for GP Practices that includes:

- supporting safeguarding knowledge and expertise of GP Practice Safeguarding Lead;

- refresh GP Level 3 safeguarding training, to improve recognition and response to safeguard children and adults;

- embed lessons from local children and adult safeguarding reviews (e.g. Serious Case Reviews, Domestic Homicide Reviews) within GP practice;

- improve safeguarding awareness and participation by including safeguarding policies, referrals forms and safeguarding documentation onto GP IT Systems; and

- improve GP recognition and response to Domestic Abuse and contribution to Multi Agency Risk Assessment Conference (MARAC).

Financial performance and risk

The CCG had a total allocation (our budget) of £411,116,000 in 2016/17. NHS England had set a target for the CCG to achieve a surplus of £3,680,631.

The financial performance of the CCG has been monitored on a monthly basis by the Financial Turnaround Committee (formerly the Finance and Activity Committee) with regular reports to the Governing Body.

The key financial risks that the CCG faced throughout the year were as follows:

• non achievement of QIPP savings (particularly Acute, Prescribing and Continuing Healthcare);

• finalisation of CHC patient package costs;

• UHL over performance; and

• resolution of a number of ongoing contract discussion areas including:

- UHL to Alliance “left shift”;

- Out Of County and Independent Sector provider over performance due to capacity constraints at UHL; and

- cost per case mental health inpatient services.

These risks were mitigated following extensive review by the Executive Management Team (EMT) and the Financial Turnaround Committee. Mitigations included the identification of further in year QIPP schemes and a level of underspending in other areas.

In addition to the targeted surplus of £3,680,631, the CCG was required to hold a non recurrent reserve to support transformation equivalent to 1% of initial turnover (£3,987,870). During March, NHS England instructed CCGs to release this reserve unused, effectively increasing the CCG’s targeted surplus to £7,668,501. The final expenditure for the year was £403,434,240 and therefore the CCG over-achieved its target by delivering a surplus of £7,681,760 which is a significant achievement for the CCG and a testament to the focus of the CCG staff on ensuring value for money and efficient commissioning.

Running costs

The CCG had a total budget of £6.93m to spend on running costs in 2016/17 and a total of £6.71m was spent, resulting in an underspend of £0.22m which the CCG was able to utilise to support the delivery of patient care services.

To deliver this underspend, the CCG has maintained a level of vacancies throughout the year and undertaken a stringent review of non-pay expenditure to eliminate any waste and ensure it is well placed to meet the anticipated reductions in running costs allocations in future years.

The CCG Annual Accounts are appended in full under the Financial Statements section of this Report; and the table below sets out the 2016/17 summary financial performance for the CCG:

East Leicestershire and Rutland Clinical Commissioning Group Summary Financial Performance

Budget £

Actual £

Variance - Under/ Overspend

£

Total allocation 411,116,000 411,116,000 0

Total Acute Commissioning 189,136,471 192,194,750 3,058,279

Total Non-acute Commissioning 107,401,628 106,605,425 -796,203

Total Practice Prescribing 47,937,937 48,341,380 403,443

Total Primary Care Services * 47,670,595 46,579,486 -1,091,108

Miscellaneous (inc reserves) 8,355,739 2,999,464 -5,356,275

Total Running Costs 6,933,000 6,713,736 -219,264

Total Expenditure 407,435,369 403,434,240 -4,001,129

Surplus £ £ £

Programme control total 3,680,631 7,462,496 3,781,865

Running Costs control total 0 219,264 219,264

Total control total 3,680,631 7,681,760 4,001,129


How we spent our money

The following charts show the main areas of expenditure within the £403,440,488 we spent on patient care and related support costs:

NHS East Leicestershire and Rutland CCG - Total Expenditure by Category 2016-17

NHS East Leicestershire and Rutland CCG - Acute Expenditure 2016-17

Acute including Ambulance £192,194,750

Non Acute £106,605,425

Prescribing £48,341,380

Primary Care Co-Commissioning £39,736,760

Other £9,842,190

1% Headroom & 0.5% Contingency £0

Running Costs £6,713,736

Surplus £7,681,760

UHL Contract £136,714,975

Elective Alliance Contract £7,187,162

Out of County Contracts £26,451,438

Non Contracted Activity £2,529,276

Independent Sector £8,338,911

EMAS Contract £7,604,511

Out Of Hours £2,749,303

NHS 111 £619,174

The Woodland

Peterborough

Blatchford & Sons

United Lincolnshire

Coventry and Warwickshire

Kettering

Fitzwilliam

Nuffield

NorthamptonNottinghamOther

Spire

Other

NHS East Leicestershire and Rutland CCG - Non-Acute Expenditure 2016-17

Capital Expenditure

The CCG received a capital allocation of £482,500 that we requested from NHS England in order to support the purchase of clinical and other equipment for use in the newly developed St Lukes treatment centre in Market Harborough and certain CCG specific purchases. The CCG monitored the capital programme via the Financial Turnaround Committee and came in under budget having spent £353,320. The underspend has arisen from the lower than anticipated equipment purchases required for the St Lukes Centre as provider has been able to reuse a number of items from other sites within their services.

Better Payments Practice Code

The Better Payments Practice Code requires the CCG to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later. The NHS aims to pay at least 95% of invoices within 30 days of receipt, or within agreed contract

terms. Details of compliance with the code are given in the notes to the financial statements. In 2016/17 the CCG has exceeded the 95% target on NHS invoices measured both by number of invoices and values; and for non-NHS invoices when measured by value. Due to problems encountered by NHS Arden and Greater East Midlands Commissioning Support Unit when migrating the continuing health care computer system, the CCG did not meet the 95% target for non-NHS invoices measured by number of invoices for the first time in its history. Measures have been put in place to address this and put the CCG back on track to achieve the target in 2017/18 (see note 6 in the financial statements for further details).

External audit

The CCG’s external auditor is KPMG and the annual external audit fee for 2016/17 is £52,500 (excluding VAT) relating to the statutory audit.

LPT Contract £54,949,916

Continuing Healthcare £21,707,611

Other £11,784,310

Patient Transport £2,046,308

Learning Disabilities Pooled Budget £5,052,668

Better Care Fund Payment to councils £11,064,612

Voluntary Sector

NHS 111

Out of Hours

IAPT

Childrens Complex Care

Commissioning Scheme

Out of County Contracts Free Nursing Care

Home Oxygen

Non Contracted Activity

Other


Strategic risk management

The CCG is committed to commissioning safe and effective care and leading the organisation to deliver its objectives. We use approved risk management strategy and policy to lead the organisation forward to deliver our objectives.

We acknowledge risk can bring with it positive advantages, benefits and opportunities. We aim to create an environment where risk is considered as a matter of course and appropriately identified and managed. A culture of open reporting is promoted and upheld throughout the CCG to ensure risks are identified, evaluated, documented and managed by all who may encounter them.

Risk management is a core organisational process and is an integral part of its philosophy, practices and business planning and that responsibility for its implementation is accepted at all levels of the organisation. The CCG recognises the importance of involving local stakeholders in our risk management processes and of working in partnership to identify, prioritise and control shared risks, such as through collaborative arrangements. See Accountability Report for further details about how we identify and manage risks.

Workforce

NHS East Leicestershire and Rutland CCG employed 100 members of staff (headcount figure as at 31 March 2017) and, therefore we are not required to produce detailed staff profiles by protected characteristics. This also protects the privacy of employees as any profiles of protected characteristics may allow individuals to be identified. The table below provides an overview of the number of persons of each sex who were on the Governing Body and the number of persons of each sex who were employees of the CCG as at 31 March 2017:

The CCG is committed to ensuring the working environment is inclusive and appropriate support is provided to any member of the organisation who may require it.

All of the CCG’s internal workforce policies have been developed, and continued to be updated, in line with current legislative requirements, including the Equality Act 2010. These policies cover the recruitment, selection and appointment process as well as all aspects of working for the CCG.

Sickness absence data

Employees as at 31 March 2017 – 100 (excluding Chair, Lay members and GPs).

ELR CCG’s staff consisted of 100 employees at the end of the year. We recognise the valuable contribution made by each employee to the delivery of our services and we are committed to the promotion of their health, safety and well-being. The organisation is also committed to acting as a reasonable employer at all times in dealing with employees who suffer ill health or incapacity either of a temporary or permanent nature.

In order to maintain and promote a healthy organisation and ensure the continued provision of high quality patient care, it is essential that absence due to ill health is monitored and managed effectively and that managers and employees are aware of their responsibilities in this process. While accepting that some absence due to ill health is inevitable, high absence rates not only affect individuals but place increased pressure on colleagues which may ultimately lead to deterioration in services that ensure overall quality of patient care. To that end we have reviewed our Absence Policy to ensure it is fit for purpose. The CCG’s absence rates are outlined in the table below.

Staff Sickness Data 2016/17

Total number of staff years 94.8

Total Days Lost 514.90

Average absences per staff year 5.43

Employee Consultation

The CCG is committed to informing, communicating with and consulting with the workforce as appropriate on our strategic direction, performance and delivery, and any proposed changes that may affect staff. There are a number of mechanisms in place which include:

• Bi-annual communication events for all CCG staff

• Formal consultation processes with staff and their representatives regarding any proposed changes that affect staff. During 2016/17 the CCG initiated two consultation processes, one regarding a proposed transfer of a small number of staff to an

Governing Body

SexAll

employees

All members

of the Governing

Body

GP members

on the Governing

Body

Disclosed 100 15 7

Female 80 4 1

Male 20 11 6

Total 100 15 7

NHS provider and the other to restructure a team to create some roles that are aligned to primary care

• Informal partnership arrangements with trades unions via Arden GEM Commissioning Support Unit

• Monthly team briefings

• Bi-weekly newsletter.

The Equality Report provides further detail about the CCG’s workforce.

Staff satisfaction

The NHS National Staff Opinion Survey is a key enabler for NHS organisations to listen to and act on the views of their staff. In 2016, the CCG achieved an 81.3% response rate which, although lower than the 86.4% it achieved in the 2015 survey, was better than the average response for the 60 ‘Picker’ organisations which was 74%. The CCG recognises that some of the results have been negatively affected by the difficult and challenging year and the absolute focus on QIPP delivery and cost saving. As with previous years, the results of the survey have been shared with staff and departmental action plans will be produced to address any areas of concern.

The ‘top ranking’ results for the CCG are included below:

• percentage of staff experiencing harassment, bullying, or abuse from patients, relatives or members of the public;

• quality of non-mandatory training, learning and development;

• percentage of staff attending work in the last 3 months despite feeling unwell because they felt pressure from their manager, colleagues or themselves;

• percentage of staff experiencing physical violence from staff in the last 12 months; and

• effective use of patients / service user feedback.

The ‘bottom ranking’ results for the CCG are included below:

• staff motivation at work;

• percentage of staff experiencing harassment, bullying or abuse from staff in the last 12 months;

• percentage of staff appraised in last 12 months;

• staff satisfaction with the quality of work and care they are able to deliver; and

• percentage of staff able to contribute towards improvements at work.

The survey identified two areas that will be addressed in 2017/18. The first is a renewed emphasis on conducting staff appraisals given the reported reduction in the number of staff having an appraisal in the last 12 months and given the staff who did have an appraisal reported it had helped them improve how they do their job. The second area is to understand the reasons why an extremely high percentage of staff are putting themselves under pressure to come to work despite not feeling well enough.

Disclosure of serious untoward incidents

We place high importance on ensuring there are robust information governance systems and processes in place to help protect patient and corporate information. There are processes in place for incident reporting and investigation of serious incidents relating to information governance. Please see our Governance Statement for disclosures. We can confirm that there have been no serious or untoward incidents relating to data security breaches or confidentiality, and no other incidents that were required to be reported to the Information Commissioner.


Principles for remedy

ELR CCG’s Policy for Dealing with Complaints is guided by the Principles of Good Complaints Handling published by the Parliamentary and Health Service Ombudsman for public bodies:

• getting it right;

• being customer focussed;

• being open and accountable;

• acting fairly and proportionately;

• putting things right; and

• seeking continuous improvement.

This is how we interpret the principles and how we will handle complaints:

• complaints are dealt with efficiently and confidentially;

• complaints are properly investigated, monitored and recorded;

• complainants receive, as far as reasonably practicable, assistance to enable them to understand the procedure or advice on where assistance should be available;

• complainants receive a timely and appropriate response;

• complainants are told of the outcome of the investigation of their complaint and action is taken, if necessary, in the light of the outcome of a complaint;

• the process for dealing with complaints should be, and be seen to be, impartial and fair to both staff and complainant alike;

• complainants will be treated with respect and courtesy;

• complainants will not be discriminated against for making a complaint and making a complaint will not adversely affect future treatment;

• information will be provided to senior management to help services to be reviewed and improved;

• all complainants will receive a sympathetic and caring response and, where appropriate, an apology given or an expression of regret; and

• staff will receive appropriate training in handling complaints.

Emergency preparedness, resilience and response

We certify that the clinical commissioning group has incident response plans in place, which are fully compliant with the NHS Commissioning Board Emergency Preparedness Framework 2013. The clinical commissioning group regularly reviews and makes improvements to its major incident plan and has a programme for regularly testing this plan, the results of which are reported to the Governing Body.

Information relating to activities of the CCG

In order to structure the available evidence that demonstrates how the CCG is working to meet the Public Sector Equality Duty (PSED), the CCG utilised the following guidance:

• Technical Guidance of the Public Sector Equality Duty England, Equality and Human Rights Commission (EHRC), Jan 2013;

• Equality Delivery System (EDS) and EDS2, NHS England, Nov 2013.

Equality and inclusion work is an on-going activity for the CCG that will be consistently incorporated across all of its functions.


Statement as to disclosure to auditors

Each individual who is a member of the Governing Body, at the time of the Governing Body Members’ Report is approved, confirms:

• so far as the member is aware, that there is no relevant audit information of which the clinical commissioning group’s external auditor is unaware; and,

• that the member has taken all the steps that they ought to have taken as a member in order to make them self aware of any relevant audit information and to establish that the clinical commissioning group’s auditor is aware of that information.


The Accountability Report

Corporate Governance Report

Members of the Governing Body Report

NHS East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG or CCG) is led by a Governing Body comprising elected GP members, a secondary care clinician, a lead nurse, executive leads and independent lay members as detailed below.

Name Position


Mr Clive Wood Deputy Chair and Independent Lay Member

Dr Andrew Ker Clinical Vice Chair

Mrs Karen English Managing Director (Accountable Officer)

Dr Nicholas Glover Blaby and Lutterworth GP Locality Lead

Dr Graham Johnson Blaby and Lutterworth GP Locality Lead

Dr Hilary Fox Melton, Rutland and Harborough GP Locality Lead

Dr Richard Hurwood (up until 30 September 2016)

Melton, Rutland and Harborough GP Locality Lead

Dr Girish Purohit Melton, Rutland and Harborough GP Locality Lead

Dr Vivek Varakantam Oadby and Wigston GP Locality Lead

Mr Warwick Kendrick Independent Lay Member

Mr Alan Smith Independent Lay Member

Dr Tabitha Randell Consultant Paediatric Endocrinologist (secondary care clinician)

Mrs Carmel O’Brien Chief Nurse and Quality Officer

Ms Donna Enoux Chief Finance Officer

Mrs Jane Chapman (up until December 2016)

Chief Strategy and Planning Officer

Mr Tim Sacks Chief Operating Officer

Dr Tim Daniel Consultant in Public Health Medicine (in attendance)

Mrs Karen English Managing Director (Accountable Officer)

Karen English was appointed Accountable Officer of East Leicestershire and Rutland Clinical Commissioning Group in March 2015. She previously held the post of Chief Finance Officer for the organisation and originally joined the NHS as a graduate trainee in 1983.

Dr Graham Johnson Locality Lead – Blaby and Lutterworth

In his role as Governing Body Member for East Leicestershire and Rutland Clinical Commissioning Group, Dr Graham Johnson is a Locality Lead and also clinical lead for mental health across the three CCGs in Leicester, Leicestershire and Rutland. He is a partner at Wycliffe Medical Practice in Lutterworth and has previously worked as a clinical assistant in cardiology at Glenfield Hospital in Leicester.

Dr Nick Glover Locality Lead – Blaby and Lutterworth

Dr Nick Glover is a Locality Lead representing Blaby and Lutterworth on the Governing Body. His main area of responsibility is primary care and he is a member of the quality and clinical governance committee, the primary care commissioning committee, and the primary care delivery group. Dr Glover became a GP partner at Northfield Medical Centre in Blaby in 1997 and has been training doctors coming into general practice since 2005. Nick has previously worked as a Clinical Assistant in Dermatology.

Dr Richard S Hurwood Locality Lead – Melton, Rutland and Harborough

Dr Richard Hurwood was the Locality Lead for Melton, Rutland and Harborough up until 30 September 2016. Dr Hurwood also led on prescribing and urgent care for East Leicestershire and Rutland Clinical Commissioning Group. He has worked at the County Practice, based at Syston Health Centre, since 1984 becoming senior partner in 2000.

Dr Hilary FoxLocality Lead – Melton, Rutland and Harborough

Dr Hilary Fox’s portfolio at East Leicestershire and Rutland Clinical Commissioning Group includes planned care and end-of-life care and she is also a Locality Lead for Melton, Rutland and Harborough. Hilary is a GP in Uppingham and a GP trainer and appraiser for NHS England. She holds a Diploma in Child Health, Diploma from the Royal College of Obstetricians and a Masters in Sports and Exercise Medicine.


Dr Richard Palin was appointed Chairman of East Leicestershire and Rutland Clinical Commissioning Group in July 2015. He has been GP partner at the Bushloe End Surgery in Wigston since 2004 and was both a Locality Lead and Clinical Vice Chair for the CCG before his appointment as Chairman.

Dr Andy Ker Clinical Vice Chair

Dr Andy Ker is the Clinical Vice Chair as well as clinical lead for community service and out of county contracts for East Leicestershire and Rutland Clinical Commissioning Group. He is a senior partner at Oakham Medical Practice in Rutland which he joined in 1990. Andy has also worked as an appraiser and trainer of GPs and as a prison medical officer.


Dr Girish PurohitLocality Lead – Melton, Rutland and Harborough

Dr Girish Purohit is a Locality Lead for Melton, Rutland and Harborough and leads on dementia for the three CCGs in Leicester, Leicestershire and Rutland. He is a GP Principal at the Jubilee Medical Practice in Syston, which he joined in July 2012.

Dr Vivek Varakantam Locality Lead – Oadby and Wigston

Dr Vivek Varakantam is the Locality Lead for Oadby and Wigston, and has been a partner at the Croft Medical Centre in Oadby since 2009. He is a GP Registrar Associate and Foundation Year Trainer. Vivek is the CCG’s clinical lead for cancer and clinical quality lead for acute care.

Dr Tabitha Randell Secondary Care Clinician

Dr Tabitha Randell has been the secondary care representative on East Leicestershire and Rutland Clinical Commissioning Group’s Governing Body since November 2012. Tabitha chairs the Integrated Governance Committee and is a member of the Audit Committee and Primary Care Commissioning Committee. She is also the CCG’s clinical lead for Children, Young People and Maternity. She has been a consultant paediatrician since 2003 and is the former Deputy Head of Service for Nottingham Children’s Hospital.

Mrs Carmel O’Brien Chief Nurse and Quality Officer and Deputy Managing Director

Carmel O’Brien took up the role of Chief Nurse and Quality Officer for East Leicestershire and Rutland Clinical Commissioning Group in May 2012. She has a strong background in quality and patient safety, with over 25 years’ experience in both clinical and management roles across acute, community and primary care. Carmel became a registered nurse in 1989 and a registered midwife in 1991, as well as holding a BA in Health Studies and a Masters in Leadership across Health and Social Care.

Ms Donna EnouxChief Finance Officer

Having joined East Leicestershire and Rutland Clinical Commissioning Group as Deputy Chief Finance Officer in June 2013, Donna Enoux was appointed Chief Finance Officer in May 2015 following a brief period as interim Chief Finance Officer. She joined the NHS in 1999 as part of the National Financial Management Training Scheme and held senior finance posts in acute provider trusts, primary care trusts and NHS England.

Mr Tim SacksChief Operating Officer

Tim Sacks joined East Leicestershire and Rutland Clinical Commissioning Group when it operated as a shadow organisation and was appointed to his current role as chief operating officer in February 2013. He joined the NHS in 2003 through the National Management Training Scheme after eight years’ experience in the private sector and obtaining a Masters in Healthcare Management. Tim previously held strategic and operational roles in provider organisations and PCTs and, after moving to Rutland in 2005, at Leicester University Hospitals and the Leicestershire County and Rutland PCT.

Mrs Jane ChapmanChief Strategy and Planning Officer

Jane Chapman was appointed as the Chief Strategy and Planning Officer for East Leicestershire and Rutland Clinical Commissioning Group in May 2012 up until December 2016. Prior to that she was Deputy Director of Contracting, Procurement and Performance for Leicestershire County and Rutland PCT, which she joined in 2007. She also holds a post-graduate Diploma in Health and Social Care.

Mr Alan SmithIndependent Lay Member

Alan Smith has been an Independent Lay Member of East Leicestershire and Rutland Clinical Commissioning Group since January 2013. He is a member of the Audit Committee; and chairs the Finance and Activity and Remuneration Committees. In March 2017, Alan was appointed as the vice chair of the Primary Care Commissioning Committee. Alan has held a number of senior finance appointments in the private sector during his career as well as working in local authorities. He is a member of the Chartered Institute of Public Finance and Accountancy and completed an advanced management programme at Harvard Business School in 1992.

Mr Warwick Kendrick Independent Lay Member

Warwick Kendrick was appointed an Independent Lay Member of East Leicestershire and Rutland Clinical Commissioning Group in 2011. He chairs the Audit Committee; and the Competition and Procurement Panel across the three CCGs; and is a member of the Remuneration Committee. He was previously a Non-Executive Director of Leicestershire County and Rutland PCT and held senior finance appointments throughout his career. Warwick is a fellow of the Chartered Institute of Management Accountants established and ran his own consultancy business.

Mr Clive Wood Independent Lay Member / Deputy Chair

Clive Wood was appointed as an Independent Lay Member and Deputy Chair in October 2015. His particular focus in East Leicestershire and Rutland Clinical Commissioning Group Governing Body is on patient and public engagement. Clive chairs the Primary Care Commissioning Committee and is a member of the Remuneration Committee. Clive is a retired police detective superintendent, following a successful 30-year career in the Leicestershire Police. He is also currently Officer in Charge of the Leicestershire Junior Attendance Centre and has held the post of Vice Chair of the Corporation of South Leicestershire College.

Members of committees of the Governing Body

Members of the committees of the Governing Body are detailed within the Annual Governance Statement. Details in respect of Governing Body members’ declarations of interest is updated on a regular basis, the most recent version is available on the CCG’s website at www.eastleicestershireandrutlandccg.nhs.uk . Appendix 2 provides the Register of Interests as at 31 March 2017.


Statement by the Accountable Officer

Statement of the Accountable Officer’s responsibilities as the Accountable Officer of NHS East Leicestershire and Rutland Clinical Commissioning Group

The National Health Services 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 Managing Director to be the Accountable Officer of the Clinical Commissioning Group.

The responsibilities of an Accountable Officer, including 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) and for safeguarding the Clinical Commissioning Group’s assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities), are set out in the Clinical Commissioning Group Accountable Officer Appointment Letter.

Under the National Health Services 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 Manual for Accounts 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;

• State whether applicable accounting standards as set out in the Manual for Accounts 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 in my Clinical Commissioning Group Accountable Officer Appointment Letter.



Annual Governance Statement

Introduction and context

The clinical commissioning group was licenced from 1 April 2013 under provisions enacted in the Health and Social Care Act 2012, which amended the National Health Service Act 2006.

As at 1 April 2015, the clinical commissioning group was licensed without conditions.

NHS East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) is a clinically led membership organisation which comprises 31 GP member practices across three East Leicestershire and Rutland localities: Melton Mowbray, Rutland and Market Harborough; Oadby and Wigston; and Blaby and Lutterworth. ELR CCG is responsible for commissioning healthcare services for patients across the three localities. Information about the commissioning priorities and the population the CCG serves can be found in the Performance Report.

There is a need to demonstrate probity and governance commensurate with our considerable responsibilities for our patients’ healthcare and taxpayers’ money. This means ensuring that we have open, robust and transparent processes which will give the communities we service the confidence that, through the appropriate governance arrangements, we can demonstrate how we will play our part in ensuring that the services our patients receive are safe and delivered with care and compassion.

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 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.

Compliance with the UK Corporate Governance Code

We are not required to comply with the UK Corporate Governance Code. However, we have reported on our Corporate Governance arrangements by drawing upon best practice available, including those aspects of the UK Corporate Governance Code we consider to be relevant to the CCG and best practice.

For the financial year ended 31 March 2017, and up to the date of signing this statement, the CCG has applied the principles of the Code as we have considered relevant to the CCG including drawing on other best practice available. This is evident, for example through the following:

• there was clear division of responsibilities between the Membership Body, the Governing Body and the executive responsibilities for running the organisation. The Chairman was responsible for leading the Governing Body and ensuring it is effective in its role, and organising appropriate development sessions support the Governing Body’s role;

• the Committees of the Governing Body consisted of a balance of skill, knowledge, independence and experience for them to carry out duties and responsibilities;

• in the main, information was supplied to the Governing Body and its committees in a timely manner and of a quality that enables the clinical commissioning group to discharge its duties;

• the Governing Body assessed the nature and extent of the significant risks it is willing to take in achieving the strategic objectives of the clinical commissioning group; and it maintains a sound system of risk management and internal control; and

• The Remuneration Committee had oversight of the arrangements in relation to policy on the remuneration of members of the Governing Body.

The Clinical Commissioning Group Governance Framework

The National Health Service Act 2006 (as amended), at paragraph 14L(2)(b) states: The main function of the governing body is to ensure that the group has made appropriate arrangements for ensuring that it complies with such generally accepted principles of good governance as are relevant to it.

The clinical commissioning group has in place a Constitution, which provides its corporate governance framework, as agreed by its member practices. The CCG’s Constitution consists of the following: information about the membership, Standing Orders, Scheme of Reservation and Delegation and Prime Financial Policies. The Scheme of Reservation and Delegation clearly details matters reserved to the membership and authority delegated to the Governing Body, its committees and officers.

The clinical commissioning group reviewed and updated its Constitution on several occasions during the last six months of the year to ensure updated governance arrangements and policies are captured. The updated version of the Constitution is to be submitted to NHS England in May 2017 for approval. In respect of the review, legal support is obtained as required ensuring that governance arrangements remain current, robust, fit for purpose and remain in line with legal functions and duties. This includes duties being delegated to the CCG from NHS England, namely in relation to primary care commissioning. The composition of the Governing Body was refined and roles strengthened in October 2015 with the appointment of a third lay member who acts as the Deputy Chair and is the champion for patient and public involvement. In 2016/17 the composition of the Governing Body remained in line with the CCG Constitution and legal requirements.

The Prime Financial Policies and the Scheme of Reservation and Delegation are underpinned by Detailed Financial Policies and an Operational Scheme of Delegation respectively.

The clinical commissioning group Membership consists of 31 GP Practices as detailed in Appendix 3.

The clinical commissioning group is led by a Governing Body comprising elected GP members, a secondary care clinician and lead nurse and independent lay members as detailed in the ‘Members of the Governing Body Report’.

The overall responsibility for the management of internal control lies with me as the Accountable Officer. The Governing Body, in line with authority

delegated to it by the Membership, collectively and individually ensured that robust systems of internal control and management were in place. This responsibility was supported through an effective committee structure, including joint committees established with the local authorities; and collaborative arrangements established with Leicester City CCG and West Leicestershire CCG in respect of services commissioned collaboratively across the three CCGs.

Appendix 4 provides details of committees and members of each committee.

A review of the clinical commissioning group’s committees commenced in March 2016 and concluded in early 2016/17 with the Governing Body approving the changes to the governance structure in July 2016. The purpose of the review was to review the effectiveness and performance of the CCG’s committees, and identify if changes are required to ensure that the committee structure remains fit for purpose.

The committee structure has supported the identification and management of internal controls and risks as follows:

a) Audit Committee – the Audit Committee (statutory committee), which is accountable to the group’s Governing Body. The Audit Committee has responsibility for reviewing and ensuring that the organisation has established and is maintaining robust and effective systems of integrated governance, risk management and internal control across all areas of its business. It is responsible for providing assurance to the Governing Body that the Executive Management Team has appropriate and adequate systems in place to ensure links between risk management, financial risk, corporate and clinical governance. The Audit Committee terms of reference were reviewed and approved in March 2017.

The Audit Committee reviewed the Board Assurance Framework throughout the year to provide assurance to the Governing Body that the organisation’s risk management processes are effective and risks are being effectively controlled. The Committee received regular reports on the work and findings of the internal and external auditors; reports from counter fraud team and an update against the NHS Protect Standards; reports from management in relation to follow-up and progress in relation to implementation of audit recommendations. The Audit Committee received an opinion of significant assurance from the Head of Internal Audit on the degree of assurance that can be derived from the system of internal control.


The Audit Committee is chaired by an independent lay member. The Committee has a schedule to meet at least 6 times a year with an additional meeting to approve the end of year report and accounts in line with authority delegated to the Committee. The Audit Committee held 7 meetings in 2016 /17 with all meetings being quorate, well attended and supported by the Head of Corporate Governance and Legal Affairs. The Committee produced a summary report for the next meeting of Governing Body following Committee meetings.

b) Auditor Panel – the Auditor Panel (statutory group) was established in March 2016 in line with the Department of Health’s and Healthcare Financial Management Association’s (HFMA) guidance; and is accountable to the group’s Governing Body. The model terms of reference were adopted and existing members of the Audit Committee formed the membership of the Auditor Panel. The Auditor Panel advised and are responsible for overseeing the external auditor appointments. It is an advisory panel and the actual procurement and appointment of the external auditors remains with the Governing Body. The Panel held meetings throughout 2016/17 and presented a recommendation to the Governing Body in December 2016 for the appointment of the External Auditors.

c) Remuneration Committee – the Remuneration Committee (statutory committee), is accountable to the group’s Governing Body and is responsible for considering the remuneration policies appropriate to the CCG and in accordance with national guidance. The Governing Body approved the updated terms of reference for the Committee in September 2016. In addition, the Governing body has delegated the approval of arrangements for identifying the group’s proposed accountable officer as detailed within the Scheme of Reservation and Delegation. The Remuneration Committee is chaired by an Independent Lay Member. The Committee convened as required during the year with all meetings being quorate and supported by the Head of Corporate Governance and Legal Affairs in relation to corporate governance matters.

d) Quality and Performance Committee - the Quality and Performance Committee was disestablished in July 2016 following an internal governance review of committees. The Committee was accountable to the group’s governing body, had oversight of quality, performance and clinical governance mechanisms, ensuring quality and patient safety was integral to commissioning processes and to the monitoring arrangements for all commissioned services. The Committee was also responsible for seeking assurance and adopting

an integrated approach to clinical governance; performance monitoring; and research governance. The Quality and Performance Committee monitored risks in relation to patient safety (e.g. themes and trends from incidents and serious incidents), quality of care and patient experience (e.g. themes and trends from patient survey), and in addition monitored risks against performance. The Committee was chaired by the Secondary Care Clinician and met on a monthly basis. The Committee meetings held in 2016/17 were quorate. Risks identified through this Committee were brought to the attention of the Governing Body via a regular summary report from the Committee. The Committee was replaced by the Integrated Governance Committee.

e) Strategy, Planning and Commissioning Committee - the Strategy, Planning and Commissioning Committee was disestablished in July 2016 following an internal governance review. This was a committee of the Governing Body. Its purpose was to oversee the development and delivery of the CCG’s commissioning plans, strategies and intentions, ensuring effective monitoring arrangements are in place and risks associated with this escalated to the Governing Body, ensuring the total resource available is invested in good quality services that support the delivery of the commissioning intentions. This included the monitoring and review of Quality, Innovation, Productivity and Prevention (QIPP) plans to ensure delivery of plans. The Committee was chaired by the clinical vice chair. The Committee met on a monthly basis and the majority of meetings were quorate. This Committee was replaced by the Integrated Governance Committee.

f) Integrated Governance Committee – the Integrated Governance Committee was established in July 2016 following an internal governance review of committees. The review found duplication of functions across a few committees and hence the remit of the previous Quality and Performance Committee, Strategy, Planning and Commissioning Committee, and the performance and activity elements from the Finance and Activity Committee were brought together into this Committee. The Integrated Governance Committee is a committee of the Governing Body and meets on a monthly basis since August 2016. Its purpose is to oversee the development and delivery of the CCG’s commissioning plans (including collaborative commissioning), strategies and intentions, ensuring effective monitoring arrangements are in place. Its remit also includes:

• approve business cases for healthcare commissioning, disinvestments and decommissioning in line with delegated

financial authority following consultation with the Financial and Turnaround Committee;

• have oversight of quality, performance and clinical governance mechanisms, ensuring quality and patient safety is integral to commissioning processes and to the monitoring arrangements for all commissioned services’;

• seek assurance and adopt an integrated approach to clinical governance, information governance and research governance;

• oversee the arrangements for the decommissioning of services and disinvestments, and approve the processes involved in carrying out these arrangements; and

• Ensure adherence to the CCG’s Standing Orders and Prime and Detailed Financial Policies.

The Integrated Governance Committee is chaired by the Secondary Care Clinician and all meetings held in 2016/17 have been quorate.

g) Finance and Activity Committee – the Finance and Activity Committee was accountable to the group’s Governing Body and met on a monthly basis. This Committee was disestablished in July 2016 following an internal governance review. The Committee monitored the ‘in year’ and end of year financial position and activity position of the CCG ensuring systems and processes were in place to accurately report on and deliver the agreed control total; and ensure adherence to the CCG’s Prime and Detailed Financial Policies. The Finance and Activity Committee monitored risks relating to finance. The Committee also monitored income and expenditure against planned levels, this included the review of Quality, Innovation, Productivity and Prevention (QIPP) plans, and made recommendations to the Governing Body. The Committee was chaired by an Independent Lay Member and a majority of meetings in 2016/17 were quorate. This Committee was replaced by the Financial Turnaround Committee following the internal governance review.

h) Financial Turnaround Committee – the Financial Turnaround Committee was established in July 2016 following the internal governance review and due to the significant financial challenges the CCG was facing, and this Committee therefore provides an opportunity for additional scrutiny and challenge. The Committee monitors the ‘in year’ and end of year financial position and activity position of the CCG ensuring systems and processes are in place to accurately report on and deliver the agreed control total; and ensure adherence to the CCG’s Prime and Detailed Financial Policies. The Committee monitors risks relating to finance. The Committee also monitors

income and expenditure against planned levels, this includes the review of Quality, Innovation, Productivity and Prevention (QIPP) plans, and made recommendations to the Governing Body. The Committee is chaired by an Independent Lay Member and the majority of meetings in 2016/17 were quorate.

i) Primary Care Commissioning Committee – the Primary Care Commissioning Committee is a committee established by the Clinical Commissioning Group in January 2015 to exercise the primary care commissioning functions that have been delegated from NHS England as of 1 April 2015. The Committee held regular monthly meetings in public from April 2015. The meetings are chaired by an independent lay member. A summary report from the Primary Care Commissioning Committee is presented to the Governing Body at its next meeting.

The clinical commissioning group has established joint committees with the following local authorities:

• Leicestershire County Council

• Rutland County Council.

The clinical commissioning group established a joint committee to procure NHS 111 services across the East Midlands in January 2016 in line with the amendments to the NHS Act 2006 which allows CCGs to form joint committees. Furthermore the following joint committees have been established: East Midlands Affiliated Commissioning Committee; and the System Leadership Team (SLT). The Leicester, Leicestershire and Rutland SLT was established as a joint committee of the three CCGs, with local authorities and providers in attendance, to collaboratively support the delivery of the draft Sustainability and Transformation Plan.

In addition, collaborative arrangements have been established under a Memorandum of Agreement with Leicester City Clinical Commissioning Group and West Leicestershire Clinical Commissioning Group in respect of services commissioned collaboratively across the three organisations and this arrangement reports to the Governing Body. In the main this includes the Commissioning Collaborative Board, Provider Performance Assurance Group and the Competition and Procurement Panel. The Commissioning Collaborative Board oversees the coordination of strategy and approach for system-wide transformation and service improvement, and any other areas where the three CCGs deem commissioning collaboratively would be deemed appropriate.

The Provider Performance Assurance Group seeks assurance from the contract teams across the three CCGs and the host CCG for that contract. This would include holding, for instance, East Leicestershire and Rutland CCG being held to account for managing the


provider performance in relation to the Leicestershire Partnership NHS Trust contract.

The Competition and Procurement Panel advises the CCGs on the risks and issues relating to competition and procurement law in respect of its commissioning responsibilities and potential procurements. It is an advisory panel with final decisions being made by either the CCG Governing Body or the Committee with appropriate delegation.

During 2016/17 the Governing Body evaluated its own performance through facilitation by an external facilitator. Governing Body development sessions have taken place at agreed intervals during 2016 /17 which involved sessions focusing on individual and collective roles, responsibilities, enhancing leadership skills. These sessions are aimed to support members of the Governing Body to function more effectively as a Governing Body.

In addition, information sessions have also taken place for members of the Governing Body providing them with an opportunity to, for example, review national guidance / initiatives in greater depth and its implications on the clinical commissioning group’s business; develop further insight into performance issues with key providers; enhance their knowledge on a specific topics; and receive detailed information on key national requirements. For instance, in January 2017 the Governing Body members participated in a development session on risk management with a view to enhancing their understanding and knowledge and getting greater ownership of corporate risk management.

Governing Body members’ attendance record at both the Governing Body development / information sessions and the public meetings of the Governing Body are positive, all meetings of the Governing Body throughout 2016/17 have been quorate and all or the majority of the of the Governing Body members being present (see Appendix 5).

The Clinical Commissioning Group Risk Management Framework

Risk management is an integral part of good management processes; the proactive and continuous management of risk is essential to the efficient and effective delivery of an organisation’s objectives. The organisation’s Risk Management Strategy and Policy sets the strategic and operational frameworks of successful management and evaluation of risk. The CCG’s chosen method of risk scoring is based on the Australian and New Zealand risk management standard AS/NZ 4360:1999 which is now the ISO 31000 2009 – Risk Management Principles and Guidelines, a widely adopted set of principles and guidelines.

The clinical commissioning group adopted a common framework for the assessment and analysis of all risks whether they are clinical, financial, information or organisational. The actions required to manage the risks were documented on the risk registers, which were updated as risks continued to be assessed and treated.

A two-tier process involving local directorate based registers and a corporate register (Board Assurance Framework) have been implemented to reflect the organisation’s risk profile. The aim of the two tier approach was to ensure that the strategic picture did not become clouded by the day to day risk management issues that can and were dealt with as a matter of course at local level, whilst still providing a clear route for significant local issues to influence the strategic risk profile.

The Board Assurance Framework (corporate risk register), which aligned to the clinical commissioning group’s strategic aims and objectives, provided the organisation with a comprehensive method for the effective and focused management of the principle risks with action plans in place to mitigate risks identified. Risk appetite has been determined for each risk in line with the Risk Management Strategy and Policy.

During 2016/17 the Board Assurance Framework has been reviewed and updated on a regular basis. Key corporate risks identified in 2016/17 are detailed in Appendix 6. All committees of the clinical commissioning group have been critical to the review and management of risks. The Audit Committee, Governing Body members and the Executive Management Team have been integral in the review and development of the Board Assurance Framework and format; and in the review of the risk profile and oversight of individual risks and action plans. The Executive Management Team has been and continues to be responsible for ensuring corporate risks facing the CCG are current; have been captured and evaluated appropriately; and actions undertaken in a timely manner.

Each directorate had a directorate (operational) risk register where they monitored their local risks. Risks were linked to strategic aims / objectives and the likelihood and impact were assessed to ascertain risk appetite depending on the category of risk, the inherent risk and residual risk and individual leads were assigned to actions.

The CCG’s risk appetite is expressed as a boundary above which the level of risk will not be accepted and further action must be taken. The Audit Committee and the Governing Body reserve the right to vary the amount of risk the CCG is willing to tolerate on an individual risk basis.

The Board Assurance Framework was built around the proactive and reactive assessment of risks that may have an impact on the achievement of corporate objectives. This simplified reporting and the prioritisation of action plans which, in turn allowed for more effective performance management.

Strategic and operational risks on the corporate and local risk registers were regularly reviewed by the Executive Management Team with the objective of ensuring risks were effectively managed. These registers were used to record risks using the 5 x 5 risk scoring matrix. Risks were reported and escalated in line with the CCG’s Risk Management Strategy and Policy.

The review of the Risk Management Strategy and Policy was reviewed in 2016 to ensure that the governance arrangements for managing corporate business risks and operational risks continues to be robust and reflect the ongoing changing requirements of the organisation. A further review of the Strategy and Policy is planned in 2017/18 following feedback received from the Governing Body members as a result of a positive Governing Body development session in January 2017 on risk management and the Board Assurance Framework. This includes a review of the organisation’s risk appetite given the challenges faced as detailed in the Performance Report.

Summary updates and reports on the status of key risks were presented to the Executive Management Team (EMT) via the EMT meetings and at agreed intervals at both the Audit Committee and the Governing Body.

Whilst the CCG considered risks to the organisation in meeting its objectives and to its staff, it also considered those to whom a service is provided, the organisations and also the patients themselves. The CCG received risk reports and, where appropriate, assurances and mitigation plans from those organisations from which it commissioned a service.

The Internal Audit programme of work has been completed and the interim Head of Internal Audit has provided an opinion of significant assurance.

The Clinical Commissioning Group 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 system of internal control has been in place in the clinical commissioning group for the year ended 31 March 2017 and up to the date of the approval of the Annual Report and Accounts.

The organisation continued to operate through its comprehensive committee structure which ensures identification, robust management, reporting and accountability for risk management.

The Governing Body sought assurance at regular intervals of the review of the Board Assurance Framework, outcomes from the Executive Management Team meetings and the Audit Committee (e.g. in relation to effectiveness of internal control mechanisms). The Integrated Governance Committee (previously the Quality and Performance Committee and Strategy, Planning and Commissioning Committee) received assurance reports to monitor areas of risk, including, safeguarding, patient safety, serious incidents, patient complaints, performance risks; planning, procurement and commissioning of services. The Financial Turnaround Committee (and previously the Finance and Activity Committee) received assurance reports in respect of finance and QIPP activity. Regular summary reports from these Committees were presented to the Governing Body drawing the Governing Body’s attention to key financial, performance, and patient safety and quality risks. In addition, reports on specific updates and areas of risk were directly reported to the Governing Body including reports on safeguarding adults and children and serious incident reports. The Governing Body reviewed these reports and sought assurance to demonstrate that providers are learning from incidents. All these groups had a role to provide regular monitoring to identify themes and trends for learning and sustained improvements. Where provider performance risks were considered significant and escalated to the Governing Body action was taken by the Governing Body to invite the providers concerned to the Governing Body meeting to present the assurances to ensure delivery and a robust mitigation plan.

In addition the Governing Body received assurance reports demonstrating compliance with statutory obligations including compliance with the Public Sector Duty of Equality.

Delivery of the Risk Management Strategy and Policy was also achieved through the implementation of associated policies and procedures, for example, health and safety policies / procedures, incident reporting, claims policy, Counter Fraud Policy, HR policies etc. Progress and performance in achieving the aims of the strategy and adherence to the policy was monitored by the Executive Management Team; the Chief Finance Officer; the Chief Nurse and Quality Officer; and ultimately the Governing Body via the Audit Committee.


The policies and procedures in place across the CCG aimed to, as far as possible, prevent the identified risks from arising; policies, procedures and codes of conduct were made available to staff through various mechanisms including through the CCG newsletter. Statutory and mandatory training included raising awareness about countering fraud, identifying potential risks and also identifying where risks may have materialised (for example, through the incident reporting process).

Equality analysis is integral to core business processes, policies and processes across the organisation. Relevant systems and processes were implemented to support the policies and procedures, for instance the CCG’s Constitution (which includes the Standing Orders, Scheme of Reservation and Delegation and Prime Financial Policies) clearly stipulated the delegations to budget holders which were then reflected within the Shared Business Service system to ensure appropriate level of authorisation is obtained for approval of invoices. Where risks have materialised the Executive Management Team would review the controls in place to determine how the controls need to be improved and whether assurances need to be sought from alternative sources.

Control measures are in place to ensure that all the clinical commissioning group’s obligations under pensions, sustainable development and equality, diversity and human rights legislation are complied with.

Pension Obligations

As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the scheme regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments into the scheme are in accordance with the scheme rules, and that member pension scheme records are accurately updated in accordance with the timescales detailed in the regulations.

Sustainable Development Obligations

The clinical commissioning group is required to report its progress in delivering against sustainable development indicators.

The CCG continues to assess risks, enhance our performance to continue to strive to reduce our impact against carbon reduction and climate change adaptation objectives. This includes establishing mechanisms to embed social and environmental sustainability across policy development, business planning and in commissioning. In March 2016, the CCG transferred to a new office location and is operating from the Leicestershire County Council offices in Glenfield in Leicester. This has enabled the CCG to work closely with Leicestershire County Council in further developing our sustainability plans and working with the local authority to ensure water reduction, recycling and efficient use of energy are integral to the workplace.

We will ensure the clinical commissioning group complies with its obligations under the Climate Change Act 2008, including the Adaptation Reporting power, and the Public Services (Social Value) Act 2012.

We are also setting out our commitments as a socially responsible employer.

Equality, Diversity and Human Rights Obligations

Control measures are in place to ensure that the clinical commissioning group complies with the required public sector equality duty set out in the Equality Act 2010.

Equality, Inclusion and Human Rights Report

NHS East Leicestershire and Rutland CCG is committed to improving equality and respect to the whole of the community as well as patients, CCG employees and potential employees. We are committed to treating everyone who we come into contact with fairly and not discriminate against anyone because of their age, disability, gender, gender reassignment, pregnancy and maternity, race, religion or belief, sexual orientation or whether they are married or in a civil partnership.

Our aim is to ensure that we commission accessible, high-quality health services, working on prevention and intervention initiatives aimed at reducing health inequalities and establishing a culture of inclusion that enables us to meet the needs of all our diverse communities within the organisation’s culture, employment practices and commissioning systems. The CCG has produced its first Equality and Inclusion Report 2016/17 in the form of an annual report which is available on the CCG’s website.

Public Sector Equality Duty (PSED)

The CCG aims to meet the requirements of the Public Sector Equality Duty (PSED) and the three aims of the duty. The three aims are to have due regard to the need to:

• eliminate unlawful discrimination, harassment, victimisation and any other conduct that is prohibited by or under act;

• advance equality of opportunity between people who share a relevant protected characteristic and those who do not share it; and

• foster good relations between persons who share a relevant protected characteristic and persons who do not share it.

The Equality Act 2010 also outlines specific duties on public bodies to meet the PSED more effectively. These specific duties are to:

a) Publish information to demonstrate their compliance with the Equality Duty at least annually;

b) Set equality objectives at least every four years.

Equality Objectives

The CCG’s Equality Objectives for 2016 – 2018 build on the previous ones and provide a specific focus on areas for further development in line with our commissioning intentions and Operational Plan. The new objectives agreed in 2016/17 for the next couple of years are set out below:

i) Addressing needs of older people and access to services:

• Focus on supporting individuals to get home safely, be independent and safe; reduce length of stay in acute settings - implementing discharge pathway 2 and 3).

• The CCG taking the lead on the frail older people and dementia work stream across Leicester, Leicestershire and Rutland – to improve service provision and access for frail older people by focusing on 3 key areas (i.e. dementia, carers and developing an integrated offer).

ii) Targeting provision and access to seldom heard groups:

• Focus on Lesbian, Gay, Bisexual and Trans (LGBT) and rural deprivation / communities - this remains a key challenge for the CCG in ensuring we engage with seldom heard groups.

iii) Access to early intervention and prevention of Mental Health issues:

• Focus on first episode psychosis and Child Adolescent Mental Health Services (CAMHS). We have key constitutional standards regarding delivery of waiting times for people accessing mental health services during a first episode of psychosis; and delivery against CAMHS waiting times where we have had some specific challenges.

iv) Learning Disability (LD):

• Objective to be focused and linked to the CCG plan for the roll out of personal health budgets for patients with a learning disability who require support and services.

The equality objectives have been developed to make sure that they are relevant with a focus on outcomes for our patients and are aligned with the CCG’s strategic aims and refreshed commissioning intentions.

Progress against the previous 3 equality objectives over the last year has been positive and detailed within the equalities information published by the CCG. As part of our commitment to diversity and reaching out to seldom heard groups, the CCG is proud to be able to offer instant language support via our website for over 90 languages. By selecting from the Google Translate button at the bottom of any of our web pages, our entire website is instantly translated. This includes menu items and titles.

Publication of equalities information

The CCG has used the Equality Delivery System 2 (EDS2) as the framework to evidence compliance with the Public Sector Equality Duty over the last year. EDS2 is a tool to support organisations to continuously improve their equality performance and to help meet the requirements of the public sector Equality Duty of the Equality Act 2010. EDS2 has four goals supported by eighteen outcomes. The four goals are:

• Better health outcomes;

• Improved patient access and experience;

• A representative and supported workforce; and

• Inclusive leadership.

In meeting the duty to publish information the CCG has collected evidence, which should provide an understanding of how the CCG is approaching equality and inclusion in its activities. The information we have published on our website http://www.eastleicestershireandrutlandccg.nhs.uk/equality-diversity-and-human-rights includes an annual Equality and Inclusion Report 2016/17, which demonstrates how the CCG has approached equality and inclusion and how it will be continuing to develop this over the next year in line with its strategic priorities and equality objectives.

Risk Assessment in Relation to Governance, Risk Management and Internal Control

The Executive Management Team and members of the Governing Body in the main identified the risks considering the political, economic, social, technological environment (PEST analysis) in which the CCG operates. In the regular review of the Board Assurance Framework, risks identified from “bottom-up” are also considered, for example, review of directorate level risk registers, cluster of incidents, cluster of complaints, through performance management arrangements.

Risk identification and management had been incorporated into key processes within East Leicestershire and Rutland CCG ensuring embeddedness of the principles of risk management and encouraging a proactive approach to identifying risks. The core business processes, for instance, included the review of risk and the impact on strategic decision making. The organisation’s business cases required leads to identify the risk of not implementing a scheme and the benefits realisation of the scheme. In addition, it includes the requirement to undertake equality analysis for each case of need.

The principal risks identified in 2016/17 and captured within the Board Assurance Framework are detailed in Appendix 6.

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 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 framework and have developed and continue to further develop information governance processes and procedures in line with the information governance toolkit. We have ensured all staff undertake annual information governance training and have implemented a staff information governance handbook / leaflets 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 CCG had in place an Information Governance Strategy and Policy. The final year end self-assessment for 2016/17 was approved by the Executive Management Team as delegated by the Governing Body at its meeting in March 2017. Specific requirements were submitted to Internal Audit for which the Auditor’s provided an opinion of “full assurance”. Information risks are clearly defined within the Risk Management Strategy and Policy including the role of the Senior Information Risk Officer and the Information Asset Owners, which supports the requirements for identifying and managing information risk.

The NHS Data Mapping exercise was undertaken during 2016/17 and involved identification of personal identifiable information (PII) data flows into and out of the organisation. Systems and processes are in place to ensure the security of data; and to ensure encryption of all electronic PII data transfers, e.g. via email and PII held on mobile devices such as laptops. All staff are required to complete the annual e-learning training module on information governance.


Review of economy, efficiency and effectiveness of the use of resources

The effectiveness of the use of resources and financial performance of the clinical commissioning group was monitored on a monthly basis by the Governing Body and the Financial Turnaround Committee which is a Committee of the Governing Body chaired by a lay member. Corporate risks in respect of financial performance and use of resources are captured in the Board Assurance Framework and directorate level risk registers and reported to the Audit Committee regularly and the Governing Body at least on an annual basis.

In addition, where services were commissioned collaboratively in 2016/17 with Leicester City CCG and West Leicestershire CCG provider performance was monitored via the collaborative arrangements. This in the main was through the Provider Performance Assurance Group and the Commissioning Collaborative Board arrangements for which principles of collaboration are detailed within the Memorandum of Agreement between the three CCGs.

The main financial risk that the CCG has faced throughout the year is the over performance in the acute sector against the backdrop of significant emergency activity and QIPP pressures experienced during the year. The over performance at the end of 2016/17 was mitigated.

The Audit Committee included within the internal audit plan for 2016/17 the following audit reviews: Budgetary Control and Financial Reporting; and Key Financial Systems – Payroll. Both audit reviews were provided with an opinion of “significant assurance”. These reports identified areas where efficiencies could be gained for example, the Budgetary Control audit report identified areas where the reporting system could be used to support budget holders by working with the system provider to ensure the system is user-friendly. The Finance Team in conjunction with the Financial Turnaround Committee also reviewed the content of finance reports to the Governing Body. Reassessing the adequacy of the reports ensured that information was portrayed more clearly for the Financial Turnaround Committee and the Governing Body enabling them to develop a better understanding of the finance and QIPP position and make decisions based on the information.

Feedback from delegation chains regarding business, use of resources and responses to risk

The CCG was awarded delegated authority from 1 April 2015 from NHS England for commissioning and contracting of primary medical services. The delegated functions form the remit of the Primary Care Commissioning Committee which oversees and ensures the CCG adheres to and carries out the functions delegated to it.

The CCG’s internal controls in respect of managing conflicts of interest have been enhanced as a result of this to ensure robust systems are in place to manage conflicts of interest. In particular, as the GP members of the Governing Body are members of the Primary Care Commissioning Committee, a committee level conflicts of interest register has been maintained to monitor declarations of interest and the action taken to mitigate actual and perceived conflicts. The Audit Committee provides a level of scrutiny and challenge in reviewing the processes for decision making, in particular decisions made by the Primary Care Commissioning Committee and how it manages conflicts of interest. The Primary Care Commissioning Committee’s register of interests has been presented to the Audit Committee in 2016/17 at agreed intervals for review.

In addition, in 2016/17 conflicts of interest formed part of the CCG’s annual internal audit programme and the auditors reviewed the CCG’s systems and processes in line with the NHS England’s guidance. The outcome of the review is awaited. Furthermore, the internal auditors have reviewed the CCG’s process for quarterly self-certification returns to NHS England in relation to the delegation functions and have confirmed they are supportive of the approach taken.

The CCG submits the quarterly self-certification returns to NHS England, which has aligned with the CCG’s quarterly assurance meeting with NHS England where issues and queries can be raised in respect of the CCG’s performance of the delegated functions and the management of conflicts of interest.

Review of the effectiveness of Governance, Risk Management & Internal Control

As the Accountable Officer I have responsibility for reviewing the effectiveness of the system of internal control within the clinical commissioning group.

Capacity to Handle Risk

As stated above, the overall responsibility for the management of risk lies with me as the Accountable Officer and operational implementation with the Executive Management Team. The Governing Body collectively and individually ensured that robust systems of internal control and management were in place. This responsibility was supported through an effective Governing Body and committee structure as detailed earlier.

Specialist advice on risk assessment and management has been available to the organisation through: the organisation’s Head of Corporate Governance and Legal Affairs, Health and Safety Adviser (external), the Information Security lead (external); Information Governance support (external) Local Security Management Consultant (external), and the Local Counter Fraud specialist (external). Over the last year there has been continued increase in awareness at all levels of the organisation of the importance and relevance of risk management to operational processes. This has been through team meetings, one-to-one meetings with individuals, the requirement for all staff to complete the e-learning and face-to-face training modules covering all aspects of risk (e.g. information, health and safety), circulation of a variety of policies e.g. finance budget manual, prime and operational financial policies, information security and information governance policies, clinical policies, policy on fraud, corruption and bribery, risk management strategy and policy etc.

Review of Effectiveness

My review of the effectiveness of the system of internal control is informed by the work of the internal auditors and the executive managers (the Executive Management Team) 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 reports.

The Board Assurance Framework itself provides me with evidence that the effectiveness of controls that manage risks to the clinical commissioning group achieving its principle objectives have been reviewed.

I have been advised on the implications of the result of my review of effectiveness of the system of internal control by the Governing Body; the Audit

Committee; the Integrated Governance Committee; the Financial Turnaround Committee; the Primary Care Commissioning Committee; and the performance and commissioning collaborative groups. A plan to address weaknesses and ensure continuous improvement of the system is in place.

The processes and committees that have been integral to maintaining and reviewing the effectiveness of the system of internal control include: the Governing Body; the Audit Committee; Integrated Governance Committee; Financial Turnaround Committee; Primary Care Commissioning Committee; internal audit; quarterly checkpoint assurance meetings with the NHS England Central Midlands. The specific role of the Governing Body and its committees in reviewing effectiveness of systems of internal control and risk management is provided earlier.

Head of Internal Audit Opinion

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 in the final opinion that:

In providing my opinion it should be recognised that the CCG’s current systems of control and arrangements for governance and the management of risk will need to continue to develop in the coming year, particularly reflecting on increasing cross-organisation and sector partnerships, as these arrangements will bring additional challenges in terms of the management of risk and ensuring that all partners understand the inter-relationships.

From my review of your systems of internal control, primarily through the operation of your Board Assurance Framework (BAF) in the year to date, and the outcome of individual assignments also completed in the year, I am providing a Significant Assurance that there is a generally sound system of internal control, designed to meet the organisation’s objectives, and that controls are generally being applied consistently.

During the year the Internal Audit issued one audit report with a conclusion of limited assurance, which related to cyber security. The recommendations highlighted in the report focused on ensuring that current and up to date software was installed to ensure sufficient security. Recommendations from the audit report have been agreed by the Chief Finance Officer, the executive lead responsible for security management, and actions are being implemented to mitigate the risks.


In 2016/17, Internal Audit was required to provide a specific opinion in respect of the CCG’s compliance with the Statutory Conflicts of Interest Guidance (June 2016). The CCG was provided with the following levels of compliance:

It is recognised that a significant amount of work has been undertaken during 2016/17 in order to further develop and embed processes for the management of conflicts of interest. The audit highlighted three recommendations to implement, two of which have been implemented and the remaining action will be completed in early 2017/18.

During the year the Internal Audit did not issue any audit report with a conclusion of no assurance.

I am not aware of any risks that have materialised resulting in deficiencies in internal control systems. I confirm that there have been no serious incidents in the last year involving personal data where the incident is attributable to the CCG. The CCG continues to monitor risks at both operational and corporate level, including review of systems, processes and policies to ensure ongoing continuous improvement in systems.

An internal audit was carried out by Deloitte LLP during 2016/17 which reviewed the processes / procedures of Arden and Greater East Midlands Commissioning Support Unit (AGEM CSU). The findings of the report concluded that there was reasonable assurance that appropriate controls were in place in AGEM CSU. Furthermore, many of the exceptions noted in this internal audit report did not apply to Leicestershire based customers of AGEM CSU. For those exceptions noted or process improvements that did relate to Leicestershire CCGs, AGEM CSU has confirmed that an action plan is currently being produced.

ELR CCG has therefore concluded that the findings of this report would not adversely affect the opinion given by our own internal auditors.

NHSE SCOPE AREA COMPLIANCE LEVEL

Governance arrangements Fully Compliant

Declarations of interest and gifts and hospitality Fully Compliant

Registers of interest, gifts and hospitality and procurement decisions Partially Compliant

Decision making processes and contract monitoring Partially Compliant

Identifying and managing non-compliance Fully Compliant

Data Quality

Good information underpins sound decision making within the CCG. The CCG is committed to improving data quality and information flows throughout the organisation and in particular through its committees to the Governing Body and to the membership. Following feedback throughout the year from Governing Body members and its committees the quality of both qualitative and quantitative data and information has improved. This has enabled information in relation to performance monitoring and consideration of future commissioning of services to be based on more current information. Internal audit have undertaken various audits throughout the year where the quality of both data and information was reviewed to provide assurance to the Audit Committee and the Governing Body.

Business critical models

An appropriate framework and environment is in place to provide quality assurance of business critical models, in line with the recommendations in the Macpherson report. All business critical models have been identified and information about quality assurance processes for those models. This framework is informed by the role of the Audit Committee and internal audit programme to review systems of internal control to identify areas for improvement. The CCG has a rigorous performance management framework which it uses to monitor delivery of services from its third party contractors, this includes collaborative arrangements across the 3 local CCGs.

The CCG also has business continuity arrangements which will identify those business processes which need to recover as a priority in the event of business disruption.

Furthermore, in line with the annual Information Governance Toolkit requirements we have produced and maintained an information asset register which defines business critical models and their asset owners in the organisation. Data mapping flows have been conducted which enables an understanding of the flows of information related to these key business critical models.

Data Security

We have submitted a satisfactory level of compliance with the information governance toolkit assessment.

Discharge of Statutory Functions

The arrangements put in place by the clinical commissioning group and explained within the Corporate Governance Framework have been developed with extensive expert external legal input, to ensure compliance with all relevant legislation. That legal advice also informed the matters reserved for the Membership Body and Governing Body decision and the scheme of delegation.

In light of the Harris Review, the clinical commissioning group has reviewed all of the statutory duties and powers conferred on it by the National Health Services Act 2006 (as amended) and other associated legislation 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 delegations 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.

Conclusion

There are no significant internal control issues that have been identified.



Remuneration and staff report

As a public sector body, Clinical Commissioning Groups are required to disclose information about senior managers’ remuneration. The disclosure includes the remuneration of ‘those in senior positions having authority or responsibility for directing or controlling the activities of the NHS body’; this has been interpreted as Chief Officers, Lay Members and GPs who are members of the CCG’s Governing Body many of whom are not directly employed by the CCG.

The Remuneration Committee is made up of the following members:

The Remuneration Committee, which comprises of the three Lay Members, reviews the remuneration arrangements of its most senior managers including the sessional rates for GP members of the Governing Body, taking into account market rates and agenda for change pay awards determined nationally. The Committee held 4 meetings during 2016/17 all of which were quorate and attended by all three members.

Policy on Remuneration of Senior Managers

East Leicestershire and Rutland Clinical Commissioning Group’s Accountable Officer is remunerated according to the Very Senior Manager (VSM) Framework. NHS England’s Remuneration Guidance for Chief Officers (where the senior manager also undertakes the accountable officer role) and Chief Finance Officers. This guidance has been used to set the Managing Director, Chief Finance Officer and Chief Nurse and Quality Officers’ salary.

All other chief officers employed by East Leicestershire and Rutland Clinical Commissioning Group are paid according to the NHS Agenda for Change pay scale at a level that is consistent with the contents of the officer’s job role.

East Leicestershire and Rutland Clinical Commissioning Group carried out regional benchmarking of Managing Director, GP and Lay Member CCG Governing Body members’ remuneration rates for the annual review of remuneration. Decisions approved by the Remuneration Committee were presented to the Governing Body for noting. Remuneration for Lay Members was reviewed by the Accountable Officer and the Chairman.

GP members are, for employment purposes, treated as office holders of the CCG. They are paid via the payroll, with deductions taken at source.

Senior managers’ performance related pay

The Managing Director (accountable officer) is the only officer that is eligible to receive performance related pay under the VSM Framework. The Chair of the Governing Body assesses the accountable officer’s performance against the objectives and would make a recommendation to the Remuneration Committee of any bonuses that should be awarded.

There were no bonus payments awarded in 2016/17, as bonus payments do not form part of the CCG’s Policy.

Name Position

Mr Alan Smith Independent Lay Member, Remuneration Committee Chair

Mr Warwick Kendrick Independent Lay Member, Audit Committee Chair

Mr Clive Wood Independent Lay Member, Deputy Chair, Primary Care Commissioning Committee Chair

Policy on senior managers’ contracts

All chief officers (i.e. members of the Executive Management Team), excluding the Accountable Officer, are employed under the agenda for change terms and conditions.

Senior managers’ service contracts

GP Member practices elected the GP members of East Leicestershire and Rutland CCG’s Governing Body to their posts for a period of three years. Six months’ prior notice must be given in writing by either party to terminate the agreement early. The Clinical Chairman and the Clinical Vice Chair were appointed to their respective positions following expressions of interest put forward by GPs from member practices and an interview process.

The independent lay members are appointed for a term of 3 years from when they commenced in post. The secondary care clinician position on the Governing Body was appointed to the role following an open recruitment process.

Payments to past senior managers

There have been no payments outside of contractual entitlements made to CCG senior managers in this financial year.

Salaries and allowances

The table below shows the remuneration (excluding any employer’s National Insurance contributions) for all Governing Body members irrespective of their employment status with the CCG.

Salary includes:

• all amounts paid or payable by the NHS body including recharges from any other health body;

• the gross cost of any arrangement whereby a senior manager receives a net amount and an NHS body pays income tax on their behalf;

• any financial loss allowances paid in place of remuneration;

• geographical allowances such as London weighting, and

• any other allowance which is subject to UK taxation and any ex-gratia payments.

Salary excludes:

• recharges to any other health body;

• reimbursement of out-of-pocket expenses;

• reimbursement of “travelling and other allowances” (paid under determination order) including home to work travel costs;

• taxable benefits;

• employers’ superannuation and National Insurance contributions;

• performance related bonuses (these are recorded separately);

• golden hellos and compensation for loss of office (these are recorded separately), and

• any amount paid which the director must subsequently repay.


Salary & Pension Disclosure Tables

Salaries and allowances 2016/17

(a) Salary

(bands of £5,000)

(b) Expense

payments (taxable) to nearest £100

(c) Performance

pay & bonuses (bands of £5,000)

(d) Long term

performance pay &

bonuses (bands of £5,000)

(e) All pension-

related benefits

(bands of £2,500)

(f) TOTAL

(a-e) (bands of £5,000)

£0 £0 £0 £0 £0 £0

Name and Title Note [1] Note [2]

Karen English - Managing Director and Accountable Officer

130-135 37.5 - 40 165-170

Jane Chapman - Chief Strategy and Planning Officer

85-90 12.5 - 15 100-105

Carmel O’Brien - Chief Nurse/Quality Officer and Deputy Accountable Officer

95-100 80 - 82.5 180-185

Timothy Sacks - Chief Operating Officer

90-95 1 45 - 47.5 135-140

Donna Enoux - Chief Finance Officer

95-100 57.5 - 60 155-160

Dr Hilary Fox - Locality Representative

55-60 n/a 55-60

Dr Nick Glover - Locality Representative

60-65 n/a 60-65

Dr Richard Hurwood - Locality Representative

30-35 n/a 30-35

Dr Graham Johnson - Locality Representative

60-65 n/a 60-65

Dr Andy Ker - Clinical Vice Chair

65-70 n/a 65-70

Dr Richard Palin - Governing Body Chair

85-90 n/a 85-90

Dr Girish Purohit - Locality Representative

60-65 n/a 60-65

Dr Vivek Varakantam - Locality Representative

60-65 n/a 60-65

Dr Tabitha Randell - Secondary Care Clinician

30-35 n/a 30-35

Mr Warwick Kendrick - Independent Lay Member

10-15 n/a 10-15

Mr Alan Smith - Independent Lay Member

5-10 n/a 5-10

Mr Clive Wood - Independent Lay Member

10-15 n/a 10-15

Notes

[1] The calculation of the remuneration information is in accordance with the guidance and includes all agreed remuneration allowances such as that for participating in on-call arrangements.

[2] Pension benefits are applicable to all senior managers unless they wish to opt out of membership of the NHS pension scheme. The GP members of the governing body

are not subject to this disclosure as they make their NHS pension scheme contributions via their GP practices. Similarly the Lay members of the governing body do not contribute to the NHS pension scheme and so are not subject to the disclosure.

[3] Figures shown above for Locality Representatives reflect the cost to the CCG for their part time contracts with the CCG.


Salaries and allowances 2015/16

(a) Salary

(bands of £5,000)

(b) Expense

payments (taxable) to nearest £100

(c) Performance

pay & bonuses (bands of £5,000)

(d) Long term

performance pay &

bonuses (bands of £5,000)

(e) All pension-

related benefits

(bands of £2,500)

(f) TOTAL

(a-e) (bands of £5,000)

£0 £0 £0 £0 £0 £0

Name and Title Note [1] Note [2]

Karen English - Managing Director and Accountable Officer

125-130 35 - 37.5 165-170

Jane Chapman - Chief Strategy and Planning Officer

90-95 15 - 17.5 105-110

Carmel O’Brien - Chief Nurse/Quality Officer and Deputy Accountable Officer

90-95 75 - 77.5 165-170

Timothy Sacks - Chief Operating Officer

80-85 17 67.5 - 70 155-160

Donna Enoux - Chief Finance Officer

85-90 82.5 - 85 170-175

Dr Hilary Fox - Locality Representative

60-65 n/a 60-65

Dr Nick Glover - Locality Representative

60-65 n/a 60-65

Dr Richard Hurwood – Locality Representative

60-65 n/a 60-65

Dr Graham Johnson – Locality Representative

60-65 n/a 60-65

Dr Andy Ker – Clinical Vice Chair

65-70 n/a 65-70

Dr Richard Palin – Governing Body Chair

75-80 n/a 75-80

Dr Girish Purohit – Locality Representative

60-65 n/a 60-65

Dr Vivek Varakantam – Locality Representative

60-65 n/a 60-65

Dr Tabitha Randell - Secondary Care Clinician

30-35 n/a 30-35

Mr Graham Martin - Governing Body Chair

10-15 n/a 10-15

Mr Warwick Kendrick – Independent Lay Member

15-20 n/a 15-20

Mr Alan Smith – Independent Lay Member

5-10 n/a 5-10

Mr Clive Wood – Independent Lay Member

5-10 n/a 5-10


Pay Multiples

Reporting bodies are required to disclose the relationship between the remuneration of the highest paid Director in their organisation and the median remuneration of the organisation’s workforce.

The banded remuneration of the highest paid member of the Governing Body in the Clinical Commissioning Group as at March 2017 on an annualised basis was £170,000 - £175,000 (2015/16 £170,000 - £175,000). This was 4.13

(2015/16 4.18) times the median remuneration of the workforce, which was £41,373 (2015/16 £40,964).

In 2016/17, no employees received remuneration in excess of the highest-paid member of the Governing Body.

Total remuneration includes salary, non-consolidated performance-related pay and benefits in kind. It does not include severance payments, employer pension contributions and the cash equivalent transfer value of pensions.


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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 the Occupational Pension Schemes (Transfer Values) Regulations 2008.

Real Increase in CETV

This reflects the increase in CETV effectively funded by the employer. It takes account of 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.

Exit Packages

There were no exit packages made during 2016/17 to individuals named in the Remuneration Report (see Salaries and Pensions section).

Off-payroll engagements


Off-payroll engagements Table 1:

For all off-payroll engagements as of 31 March 2017, for more than £220 per day and that last for longer than six months:

Number

Number of existing engagements as of 31 March 2017 4

Of which, the number that have existed:

for less than one year at the time of reporting 3

for between one and two years at the time of reporting 0

for between 2 and 3 years at the time of reporting 1

for between 3 and 4 years at the time of reporting 0

for 4 or more years at the time of reporting 0

All existing off-payroll engagements, outlined above, have at some point been subject to a risk based assessment as to whether assurance is required that the individual is paying the right amount of tax and, where necessary, that assurance has been sought.

Off-payroll engagements Table 2:

For all new off-payroll engagements, or those that reached six months in duration, between 1 April 2016 and 31 March 2017, for more than £220 per day and that last for longer than six months:

Number

Number of new engagements and or those that reached six months in duration, between 1 April 2016 and 31 March 2017

3

Number of new engagements which include contractual clauses giving the East Leicestershire and Rutland CCG the right to request assurance in relation to income tax and National Insurance obligations.

Number for whom assurance has been requested

Of which:

assurance has been received 1

assurance has not been received 2

engagements terminated as a result of assurance not being received

Table 3: For any off-payroll engagements of board members, and/or, senior officials with significant financial responsibility, between 1 April 2016 and 31 March 2017

Number of off-payroll engagements of board members and/or senior officers with significant financial responsibility during the year.

0

Number of individuals that have been deemed “board members& and/or senior officers with significant financial responsibility" during the financial year. This figure includes both off-payroll and on-payroll engagements.

0


Audit Report

INDEPENDENT AUDITOR’S REPORT TO THE MEMBERS OF THE GOVERNING BODY OF NHS EAST LEICESTERSHIRE & RUTLAND CCG

We have audited the financial statements of NHS East Leicestershire & Rutland CCG for the year ended 31 March 2017 on pages 1 to 32 under the Local Audit and Accountability Act 2014. These financial statements have been prepared under applicable law and the accounting polices directed by the NHS Commissioning Board with the consent of the Secretary of State as relevant to the Clinical Commissioning Groups in England. We have also audited the information in the Remuneration and Staff Report that is subject to audit.

This report is made solely to the Members of the Governing Body of NHS East Leicestershire & Rutland CCG, as a body, in accordance with Part 5 of the Local Audit and Accountability Act 2104. Our audit work has been undertaken so that we might state to the Members of the Governing Body of the CCG, as a body, those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Members of the Governing Body of the CCG, as a body, for our audit work, for this report or for the opinions we have formed.

Respective responsibilities of the Accountable Officer and auditor

As explained more fully in the Statement of Accountable Officer’s Responsibilities set out on page 46, the Accountable Officer is responsible for the preparation of financial statements which give a true and fair view and is also responsible for the regularity of expenditure and income. Our responsibility is to audit, and express an opinion on, the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors. We are also responsible for giving an opinion on the regularity of expenditure and income in accordance with the Code of Audit Practice prepared by the Comptroller and Auditor General under the Local Audit and Accountability Act 2014 (‘the Code of Audit Practice’).

As explained in the Annual Governance Statement the Accountable officer is responsible for the arrangements to secure economy, efficiency and effectiveness in the use of the CCG‘s resources. We are required under Section 21(1)(c) of the Local Audit and Accountability Act 2014 to be satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. Section 21(5)(b) of the Local Audit and Accountability Act 2014 requires that our report must not contain our opinion if we are satisfied that proper arrangements are in place.

We are not required to consider, nor have we considered, whether all aspects of the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively.

Scope of the audit of the financial statements

An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of: whether the accounting policies are appropriate to the CCG’s circumstances and have been consistently applied and adequately disclosed; the reasonableness of significant accounting estimates made by the Accountable Officer, and the overall presentation of the financial statements.

In addition we read all the financial and non-financial information in the annual report and accounts to identify material inconsistencies with the audited financial statements and to identify any information that is apparently materially incorrect based on, or materially inconsistent with, the knowledge acquired by us in the course of performing the audit. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report.

In addition, we are required to obtain evidence sufficient to give reasonable assurance that the expenditure and income recorded in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them.

Scope of the review of arrangements for securing economy, efficiency and effectiveness in the use of resources

We have undertaken our review in accordance with the Code of Audit Practice, having regard to the guidance on the specified criterion issued by the Comptroller and Auditor General in November 2016, as to whether the CCG had proper arrangements to ensure it took properly informed decisions and deployed resources to achieve planned and sustainable outcomes for taxpayers and local people. The Comptroller and Auditor General determined this criterion as that necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the CCG put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2017.

We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we undertook such work as we considered necessary to form a view on whether, in all significant respects, the CCG had put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources.

Opinion on financial statements

In our opinion the financial statements:

• give a true and fair view of the financial position of the CCG as at 31 March 2017 and of its net operating expenditure for the year then ended; and

• have been properly prepared in accordance with the accounting polices directed by the NHS Commissioning Board with the consent of the Secretary of State as relevant to Clinical Commissioning Groups in England.

Opinion on regularity

In our opinion, in all material respects the expenditure and income have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them.

Opinion on other matters

In our opinion:

• the parts of the Remuneration and Staff Report subject to audit have been properly prepared in accordance with the accounting polices directed by the NHS Commissioning Board with the consent of the Secretary of State as relevant to Clinical Commissioning Groups in England; and

• the other information published together with the audited financial statements in the Annual Report and Accounts is consistent with the financial statements.

Matters on which we are required to report by exception

We are required to report to you if:

• in our opinion, the Governance Statement does not reflect compliance with guidance issued by the NHS Commissioning Board;

• we refer a matter to the Secretary of State under section 30 of the Local Audit and Accountability Act 2014 because we have reason to believe that the CCG, or an officer of the CCG, is about to make, or has made, a decision which involves or would involve the body incurring unlawful expenditure, or is about to take, or has begun to take a course of action which, if followed to its conclusion, would be unlawful and likely to cause a loss or deficiency; or

• we issue a report in the public interest under section 24 of the Local Audit and Accountability Act 2014; or

• we make a written recommendation to the CCG under section 24 of the Local Audit and Accountability Act 2014; or

• we are not satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2017.

We have nothing to report in respect of the above responsibilities.


Certificate

We certify that we have completed the audit of the accounts of NHS East Leicestershire & Rutland CCG in accordance with the requirements of the Local Audit and Accountability Act 2014 and the Code of Audit Practice.

John Cornett for and on behalf of KPMG LLP, Statutory AuditorChartered AccountantsSt Nicholas House31 Park RowNottinghamNG1 6FQ

31 May 2017

The Financial Statements

The Primary Statements:

Statement of Comprehensive Net Expenditure for the year ended 31st March 2017 1

Statement of Financial Position as at 31st March 2017 2

Statement of Changes in Taxpayers’ Equity for the year ended 31st March 2017 3

Statement of Cash Flows for the year ended 31st March 2017 4

Notes to the Accounts

Accounting policies 5-9

Other operating revenue 10

Revenue 10

Employee benefits and staff numbers 11-12

Operating expenses 13

Better payment practice code 14

Income generation activities 14

Investment revenue 14

Other gains and losses 14

Finance costs 14

Net gain/(loss) on transfer by absorption 14

Operating leases 15

Property, plant and equipment 16-17

Intangible non-current assets 18-19

Investment property 19

Inventories 19

Trade and other receivables 20

Other financial assets 20

Other current assets 20

Cash and cash equivalents 21

Non-current assets held for sale 21

Analysis of impairments and reversals 21

Trade and other payables 22

Deferred revenue 22

Other financial liabilities 22

Borrowings 23

Private finance initiative, LIFT and other service concession arrangements 23

Finance lease obligations 23

Finance lease receivables 23

Provisions 24

Contingencies 25

Commitments 25

Financial instruments 25-26

Operating segments 27

Pooled budgets 28-29

NHS Lift investments 29

Related party transactions 30-31

Events after the end of the reporting period 32

Third party assets 32

Financial performance targets 32

Impact of IFRS 32

Analysis of charitable reserves 32

NHS East Leicestershire and Rutland CCG - Annual Accounts 2016-17

Please note, as the majority of values in these accounts are presented in £000s, minor presentational rounding errors may appear on sub-totals and totals within individual statements.


Statement of Comprehensive Net Expenditure for the year ended31 March 2017

2016-17 2015-16Note £'000 £'000

Income from sale of goods and services 2 (5,292) (6,196)Other operating income 2 (2,447) (711)Total operating income (7,739) (6,907)

Staff costs 4 5,842 5,470Purchase of goods and services 5 404,583 398,322Depreciation and impairment charges 5 312 258Provision expense 5 287 159Other Operating Expenditure 5 155 489Total operating expenditure 411,179 404,698

Net Operating Expenditure 403,440 397,791

Finance incomeFinance expense 10 0 (0)Net expenditure for the year 403,440 397,791Net Gain/(Loss) on Transfer by Absorption 0 0Total Net Expenditure for the year 403,440 397,791Other Comprehensive ExpenditureItems which will not be reclassified to net operating costsNet (gain)/loss on revaluation of PPE 0 0Net (gain)/loss on revaluation of Intangibles 0 0Net (gain)/loss on revaluation of Financial Assets 0 0Actuarial (gain)/loss in pension schemes 0 0Impairments and reversals taken to Revaluation Reserve 0 0Items that may be reclassified to Net Operating Costs 0 0Net gain/loss on revaluation of available for sale financial assets 0 0Reclassification adjustment on disposal of available for sale financial assets 0 0Sub total 0 0

Comprehensive Expenditure for the year ended 31 March 2017 403,440 397,791

The notes on pages 5 to 32 form part of this statement

1


Statement of Financial Position as at31 March 2017

2016-17 2015-16

Note £'000 £'000Non-current assets:Property, plant and equipment 13 1,686 1,604Intangible assets 14 95 135Investment property 15 0 0Trade and other receivables 17 0 0Other financial assets 18 0 0Total non-current assets 1,780 1,739

Current assets:Inventories 16 0 0Trade and other receivables 17 6,114 3,518Other financial assets 18 0 0Other current assets 19 0 0Cash and cash equivalents 20 161 118Total current assets 6,275 3,636

Non-current assets held for sale 21 0 0

Total current assets 6,275 3,636

Total assets 8,055 5,374

Current liabilitiesTrade and other payables 23 (16,959) (19,674)Other financial liabilities 24 0 0Other liabilities 25 0 0Borrowings 26 0 0Provisions 30 (205) (199)Total current liabilities (17,164) (19,873)

Non-Current Assets plus/less Net Current Assets/Liabilities (9,109) (14,499)

Non-current liabilitiesTrade and other payables 23 0 0Other financial liabilities 24 0 0Other liabilities 25 0 0Borrowings 26 0 0Provisions 30 0 0Total non-current liabilities 0 0

Assets less Liabilities (9,109) (14,499)

Financed by Taxpayers’ EquityGeneral fund (9,112) (14,502)Revaluation reserve 3 3Other reserves 0 0Charitable Reserves 0 0Total taxpayers' equity: (9,109) (14,499)


Accountable OfficerKaren English

The financial statements on pages 1 to 32 were approved by the Audit Committee on 22nd May 2017 and signed on its behalf by:

2


Statement of Changes In Taxpayers Equity for the year ended31 March 2017

General fundRevaluation

reserveOther

reservesTotal

reserves£'000 £'000 £'000 £'000

Changes in taxpayers’ equity for 2016-17

Balance at 01 April 2016 (14,502) 3 0 (14,499)Transfer between reserves in respect of assets transferred from closed NHS bodies 0 0 0 0NHS Clinical Commissioning Group balance at 1 April 2016 (14,502) 3 0 (14,499)

Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2016-17Net operating expenditure for the financial year (403,440) (403,440)

Net gain/(loss) on revaluation of property, plant and equipment 0 0Net gain/(loss) on revaluation of intangible assets 0 0Net gain/(loss) on revaluation of financial assets 0 0Total revaluations against revaluation reserve 0 0 0 0

Net gain (loss) on available for sale financial assets 0 0 0 0Net gain (loss) on revaluation of assets held for sale 0 0 0 0Impairments and reversals 0 0 0 0Net actuarial gain (loss) on pensions 0 0 0 0Movements in other reserves 0 0 0 0Transfers between reserves 0 0 0 0Release of reserves to the Statement of Comprehensive Net Expenditure 0 0 0 0Reclassification adjustment on disposal of available for sale financial assets 0 0 0 0Transfers by absorption to (from) other bodies 0 0 0 0Reserves eliminated on dissolution 0 0 0 0Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year (403,440) 0 0 (403,440)

Net funding 408,830 0 0 408,830

Balance at 31 March 2017 (9,112) 3 0 (9,109)

General fundRevaluation

reserveOther

reservesTotal

reserves£'000 £'000 £'000 £'000

Changes in taxpayers’ equity for 2015-16

Balance at 01 April 2015 (10,601) 3 0 (10,598)Transfer of assets and liabilities from closed NHS bodies as a result of the 1 April 2013 transition 0 0 0 0NHS Clinical Commissioning Group balance at 1 April 2017 (10,601) 3 0 (10,598)

Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2015-16Net operating costs for the financial year (397,791) (397,791)

Net gain/(loss) on revaluation of property, plant and equipment 0 0Net gain/(loss) on revaluation of intangible assets 0 0Net gain/(loss) on revaluation of financial assets 0 0Total revaluations against revaluation reserve 0 0 0 0

Net gain (loss) on available for sale financial assets 0 0 0 0Net gain (loss) on revaluation of assets held for sale 0 0 0 0Impairments and reversals 0 0 0 0Net actuarial gain (loss) on pensions 0 0 0 0Movements in other reserves 0 0 0 0Transfers between reserves 0 0 0 0Release of reserves to the Statement of Comprehensive Net Expenditure 0 0 0 0Reclassification adjustment on disposal of available for sale financial assets 0 0 0 0

0 00 0 0 0

Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year (397,791) 0 0 (397,791)Net funding 393,891 0 0 393,891

Balance at 31 March 2016 (14,502) 3 0 (14,499)


Transfers by absorption to (from) other bodies

3


Statement of Cash Flows for the year ended31 March 2017

2016-17 2015-16Note £'000 £'000

Cash Flows from Operating ActivitiesNet operating expenditure for the financial year (403,440) (397,791)Depreciation and amortisation 5 312 258Impairments and reversals 5 0 0Movement due to transfer by Modified Absorption 0 0Other gains (losses) on foreign exchange 0 0Donated assets received credited to revenue but non-cash 0 0Government granted assets received credited to revenue but non-cash 0 0Interest paid 0 0Release of PFI deferred credit 0 0Other Gains & Losses 0 0Finance Costs 0 0Unwinding of Discounts 0 0(Increase)/decrease in inventories 0 0(Increase)/decrease in trade & other receivables 17 (2,597) 1,145(Increase)/decrease in other current assets 0 0Increase/(decrease) in trade & other payables 23 (2,434) 2,943Increase/(decrease) in other current liabilities 0 0Provisions utilised 30 (281) (44)Increase/(decrease) in provisions 30 287 159Net Cash Inflow (Outflow) from Operating Activities (408,153) (393,330)

Cash Flows from Investing ActivitiesInterest received 0 0(Payments) for property, plant and equipment (634) (458)(Payments) for intangible assets 0 (110)(Payments) for investments with the Department of Health 0 0(Payments) for other financial assets 0 0(Payments) for financial assets (LIFT) 0 0Proceeds from disposal of assets held for sale: property, plant and equipment 0 4Proceeds from disposal of assets held for sale: intangible assets 0 0Proceeds from disposal of investments with the Department of Health 0 0Proceeds from disposal of other financial assets 0 0Proceeds from disposal of financial assets (LIFT) 0 0Loans made in respect of LIFT 0 0Loans repaid in respect of LIFT 0 0Rental revenue 0 0Net Cash Inflow (Outflow) from Investing Activities (634) (564)

Net Cash Inflow (Outflow) before Financing (408,787) (393,894)

Cash Flows from Financing ActivitiesGrant in Aid Funding Received 408,830 393,891Other loans received 0 0Other loans repaid 0 0Capital element of payments in respect of finance leases and on Statement of Financial Position PFI and LIFT 0 0Capital grants and other capital receipts 0 0Capital receipts surrendered 0 0Net Cash Inflow (Outflow) from Financing Activities 408,830 393,891

Net Increase (Decrease) in Cash & Cash Equivalents 20 43 (3)

Cash & Cash Equivalents at the Beginning of the Financial Year 118 121

Effect of exchange rate changes on the balance of cash and cash equivalents held in foreign currencies 0 0

Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year 161 118


4


Statement of Cash Flows for the year ended31 March 2017

2016-17 2015-16Note £'000 £'000

Cash Flows from Operating ActivitiesNet operating expenditure for the financial year (403,440) (397,791)Depreciation and amortisation 5 312 258Impairments and reversals 5 0 0Movement due to transfer by Modified Absorption 0 0Other gains (losses) on foreign exchange 0 0Donated assets received credited to revenue but non-cash 0 0Government granted assets received credited to revenue but non-cash 0 0Interest paid 0 0Release of PFI deferred credit 0 0Other Gains & Losses 0 0Finance Costs 0 0Unwinding of Discounts 0 0(Increase)/decrease in inventories 0 0(Increase)/decrease in trade & other receivables 17 (2,597) 1,145(Increase)/decrease in other current assets 0 0Increase/(decrease) in trade & other payables 23 (2,434) 2,943Increase/(decrease) in other current liabilities 0 0Provisions utilised 30 (281) (44)Increase/(decrease) in provisions 30 287 159Net Cash Inflow (Outflow) from Operating Activities (408,153) (393,330)

Cash Flows from Investing ActivitiesInterest received 0 0(Payments) for property, plant and equipment (634) (458)(Payments) for intangible assets 0 (110)(Payments) for investments with the Department of Health 0 0(Payments) for other financial assets 0 0(Payments) for financial assets (LIFT) 0 0Proceeds from disposal of assets held for sale: property, plant and equipment 0 4Proceeds from disposal of assets held for sale: intangible assets 0 0Proceeds from disposal of investments with the Department of Health 0 0Proceeds from disposal of other financial assets 0 0Proceeds from disposal of financial assets (LIFT) 0 0Loans made in respect of LIFT 0 0Loans repaid in respect of LIFT 0 0Rental revenue 0 0Net Cash Inflow (Outflow) from Investing Activities (634) (564)

Net Cash Inflow (Outflow) before Financing (408,787) (393,894)

Cash Flows from Financing ActivitiesGrant in Aid Funding Received 408,830 393,891Other loans received 0 0Other loans repaid 0 0Capital element of payments in respect of finance leases and on Statement of Financial Position PFI and LIFT 0 0Capital grants and other capital receipts 0 0Capital receipts surrendered 0 0Net Cash Inflow (Outflow) from Financing Activities 408,830 393,891

Net Increase (Decrease) in Cash & Cash Equivalents 20 43 (3)

Cash & Cash Equivalents at the Beginning of the Financial Year 118 121

Effect of exchange rate changes on the balance of cash and cash equivalents held in foreign currencies 0 0

Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year 161 118


4


Notes to the financial statements

1 Accounting PoliciesNHS 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 ConcernThese accounts have been prepared on the going concern basis.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 ConventionThese accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities.

1.3 Acquisitions & Discontinued Operations

Activities are considered to be ‘acquired’ only if they are taken on from outside the public sector. Activities are considered to be ‘discontinued’ only if they cease entirely. They are not considered to be ‘discontinued’ if they transfer from one public sector body to another.

1.4 Movement of Assets within the Department of Health GroupTransfers as part of reorganisation fall to be accounted for by use of absorption accounting in line with the Government Financial Reporting Manual, issued by HM Treasury. The Government Financial Reporting Manual does not require retrospective adoption, so prior year transactions (which have been accounted for under merger accounting) have not been restated. Absorption accounting requires that entities account for their transactions in the period in which they took place, with no restatement of performance required when functions transfer within the public sector. Where assets and liabilities transfer, the gain or loss resulting is recognised in the Statement of Comprehensive Net Expenditure, and is disclosed separately from operating costs.Other transfers of assets and liabilities within the Department of Health Group are accounted for in line with IAS 20 and similarly give rise to income and expenditure entries.

1.5 Charitable FundsUnder the provisions of IAS 27: Consolidated & Separate Financial Statements, those Charitable Funds that fall under common control with NHS bodies are consolidated within the entities’ accounts.

1.6 Administration and programme costsTreasury has set performance targets in respect of non-frontline expenditure (administration expenditure); therefore the CCG's revenue income and expenditure is analysed and reported as "admin" and "programme" to reflect this requirement.

For CCGs, the Department of Health has defined administration costs in terms of "running costs", which are identified as any costs incurred which are not direct payments for the provision of healthcare or healthcare related services.

1.7 Pooled BudgetsThe clinical commissioning group has entered into pooled budget arrangements under Section 75 of the National Health Service Act 2006 and accounts for its share of the expenditure arising from the activities of the pooled budgets, identified in accordance with the pooled budget agreements.Joint operations are activities undertaken by the clinical commissioning group in conjunction with one or more parties but which are not performed through a separate entity. The clinical commissioning group records its share of the expenditure and gains and losses.The clinical commissioning group is in a “jointly controlled operation”, and recognises the expenses the clinical commissioning group incurs from the pooled budget activities.Assets and liabilities of the pooled budgets have a minimal value and are therefore not recorded. The clinical commissioning group receives no income from the pooled budgets.

1.8 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.

1.8.1 Critical Judgements in Applying Accounting PoliciesWhen calculating year end activity positions, account has been taken both of information received direct from providers and of calculations made by contract managers. Final positions combine historical data, recent trajectories and known events.

1.8.2 Key Sources of Estimation UncertaintyThe 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:The clinical commissioning group's staff routinely estimate full year spend for items such as prescribing costs, where only part year information is available at the time of annual accounts preparation. The prescribing accrual is based on NHS Business Services Authority information. Any difference between accruals made and actual expenditure incurred will be accounted for in the following year's results - such differences are not expected to have a material impact.

1.9 RevenueRevenue 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.

1.10 Employee Benefits1.10.1 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.

5



1.10.2 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.

1.11 Other ExpensesOther 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.

1.12 Property, Plant & Equipment1.12.1 Recognition

Property, plant and 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 clinical commissioning group;· 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; or,· Items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or collective cost.Where a large asset, for example a building, includes a number of components with significantly different asset lives, the components are treated as separate assets and depreciated over their own useful economic lives.

1.12.2 ValuationAll property, plant and equipment are measured initially at cost, representing the cost directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. All assets are measured subsequently at valuation.Land and buildings used for the clinical commissioning group’s services or for administrative purposes are stated in the statement of financial position at their re-valued amounts, being the fair value at the date of revaluation less any impairment.Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that would be determined at the end of the reporting period. Fair values are determined as follows:· Land and non-specialised buildings – market value for existing use; and,· Specialised buildings – depreciated replacement cost.HM Treasury has adopted a standard approach to depreciated replacement cost valuations based on modern equivalent assets and, where it would meet the location requirements of the service being provided, an alternative site can be valued.Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost includes professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for assets held at fair value. Assets are re-valued and depreciation commences when they are brought into use.Fixtures and equipment are carried at depreciated historic cost as this is not considered to be materially different from current value in existing use.An increase arising on revaluation is taken to the revaluation reserve except when it reverses an impairment for the same asset previously recognised in expenditure, in which case it is credited to expenditure to the extent of the decrease previously charged there. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Gains and losses recognised in the revaluation reserve are reported as other comprehensive income in the Statement of Comprehensive Net Expenditure.

1.12.3 Subsequent ExpenditureWhere subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised. Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing carrying value of the item replaced is written-out and charged to operating expenses.

1.13 Intangible Assets1.13.1 Recognition

Intangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the clinical commissioning group’s business or which arise from contractual or other legal rights. They are recognised only:

· When it is probable that future economic benefits will flow to, or service potential be provided to, the clinical commissioning group;· Where the cost of the asset can be measured reliably; and,· Where the cost is at least £5,000.Intangible assets acquired separately are initially recognised at fair value. Software that is integral to the operating of hardware, for example an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software that is not integral to the operation of hardware, for example application software, is capitalised as an intangible asset. Expenditure on research is not capitalised but is recognised as an operating expense in the period in which it is incurred. Internally-generated assets are recognised if, and only if, all of the following have been demonstrated:· The technical feasibility of completing the intangible asset so that it will be available for use;· The intention to complete the intangible asset and use it;· The ability to sell or use the intangible asset;· How the intangible asset will generate probable future economic benefits or service potential;· The availability of adequate technical, financial and other resources to complete the intangible asset and sell or use it; and,· The ability to measure reliably the expenditure attributable to the intangible asset during its development.

1.13.2 MeasurementThe amount initially recognised for internally-generated intangible assets is the sum of the expenditure incurred from the date when the criteria above are initially met. Where no internally-generated intangible asset can be recognised, the expenditure is recognised in the period in which it is incurred.

6



Following initial recognition, intangible assets are carried at current value in existing use by reference to an active market, or, where no active market exists, at the lower of depreciated replacement cost or the value in use where the asset is income generating . Internally-developed software is held at historic cost to reflect the opposing effects of increases in development costs and technological advances.

1.14 Depreciation, Amortisation & ImpairmentsFreehold land, properties under construction, and assets held for sale are not depreciated.Otherwise, depreciation and amortisation are charged to write off the costs or valuation of property, plant and equipment and intangible non-current assets, 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. Assets held under finance leases are depreciated over their estimated useful lives.

At each reporting period end, the clinical commissioning group checks whether there is any indication that any of its tangible or intangible non-current assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its amount. Intangible assets not yet available for use are tested for impairment annually.A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Where an impairment loss subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the recoverable amount but capped at the amount that would have been determined had there been no initial impairment loss. The reversal of the impairment loss is credited to expenditure to the extent of the decrease previously charged there and thereafter to the revaluation reserve.

1.15 Donated Assets

Donated non-current assets are capitalised at their fair value on receipt, with a matching credit to Income. They are valued, depreciated and impaired as described above for purchased assets. Gains and losses on revaluations, impairments and sales are as described above for purchased assets. Deferred income is recognised only where conditions attached to the donation preclude immediate recognition of the gain.

1.16 Government GrantsThe value of assets received by means of a government grant are credited directly to income. Deferred income is recognised only where conditions attached to the grant preclude immediate recognition of the gain.

1.17 Non-current Assets Held For SaleNon-current assets are classified as held for sale if their carrying amount will be recovered principally through a sale transaction rather than through continuing use. This condition is regarded as met when:· The sale is highly probable;· The asset is available for immediate sale in its present condition; and,· Management is committed to the sale, which is expected to qualify for recognition as a completed sale within one year from the date of classification.Non-current assets held for sale are measured at the lower of their previous carrying amount and fair value less costs to sell. Fair value is open market value including alternative uses.The profit or loss arising on disposal of an asset is the difference between the sale proceeds and the carrying amount and is recognised in the Statement of Comprehensive Net Expenditure. On disposal, the balance for the asset on the revaluation reserve is transferred to the general reserve.Property, plant and equipment that is to be scrapped or demolished does not qualify for recognition as held for sale. Instead, it is retained as an operational asset and its economic life is adjusted. The asset is de-recognised when it is scrapped or demolished.

1.18 LeasesLeases 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.

1.18.1 The Clinical Commissioning Group as LesseeProperty, plant and equipment held under finance leases are initially recognised, at the inception of the lease, at fair value or, if lower, at the present value of the minimum lease payments, with a matching liability for the lease obligation to the lessor. Lease payments are apportioned between finance charges and reduction of the lease obligation so as to achieve a constant rate on interest on the remaining balance of the liability. Finance charges are recognised in calculating the clinical commissioning group’s surplus/deficit.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.Contingent rentals are recognised as an expense in the period in which they are incurred.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.

1.18.2 The Clinical Commissioning Group as LessorAmounts due from lessees under finance leases are recorded as receivables at the amount of the clinical commissioning group’s net investment in the leases. Finance lease income is allocated to accounting periods so as to reflect a constant periodic rate of return on the clinical commissioning group’s net investment outstanding in respect of the leases.Rental income from operating leases is recognised on a straight-line basis over the term of the lease. Initial direct costs incurred in negotiating and arranging an operating lease are added to the carrying amount of the leased asset and recognised on a straight-line basis over the lease term.

1.19 Cash & Cash EquivalentsCash 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.

1.20 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. The CCG's provisions are expected to be settled within one year and are therefore not discounted. However standard NHS discount rates are 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%)

7



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.A restructuring provision is recognised when the clinical commissioning group has developed a detailed formal plan for the restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by starting to implement the plan or announcing its main features to those affected by it. The measurement of a restructuring provision includes only the direct expenditures arising from the restructuring, which are those amounts that are both necessarily entailed by the restructuring and not associated with on-going activities of the entity.

1.21 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.

1.22 Non-clinical Risk PoolingThe clinical commissioning group participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the clinical commissioning group pays an annual contribution to the NHS Litigation Authority and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due.

1.23 Continuing healthcare risk poolingIn 2014-15 a risk pool scheme was been introduced by NHS England for continuing healthcare claims, for claim periods prior to 31 March 2013. Under the scheme clinical commissioning group contribute annually to a pooled fund, which is used to settle the claims.

1.24 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.

1.25 Financial AssetsFinancial 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.Financial assets are classified into the following categories:· Financial assets at fair value through profit and loss;· Held to maturity investments;· Available for sale financial assets; and,· Loans and receivables.The classification depends on the nature and purpose of the financial assets and is determined at the time of initial recognition.

1.25.1 Financial Assets at Fair Value Through Profit and Loss

Embedded derivatives that have different risks and characteristics to their host contracts, and contracts with embedded derivatives whose separate value cannot be ascertained, are treated as financial assets at fair value through profit and loss. They are held at fair value, with any resultant gain or loss recognised in calculating the clinical commissioning group’s surplus or deficit for the year. The net gain or loss incorporates any interest earned on the financial asset. The CCG does not have any contracts with embedded derivatives but should it have any, the assessment of fair value would be undertaken on an individual contract by contract basis.

1.25.2 Held to Maturity AssetsHeld to maturity investments are non-derivative financial assets with fixed or determinable payments and fixed maturity, and there is a positive intention and ability to hold to maturity. After initial recognition, they are held at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method.

1.25.3 Available For Sale Financial Assets

Available for sale financial assets are non-derivative financial assets that are designated as available for sale or that do not fall within any of the other three financial asset classifications. They are measured at fair value with changes in value taken to the revaluation reserve, with the exception of impairment losses. Accumulated gains or losses are recycled to surplus/deficit on de-recognition. Fair value would be determined using the most appropriate methodology for that class of asset which may include the use of specialist valuers.

1.25.4 Loans & ReceivablesLoans 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.

8



1.26 Financial LiabilitiesFinancial 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.

1.26.1 Financial Guarantee Contract LiabilitiesFinancial guarantee contract liabilities are subsequently measured at the higher of:· The premium received (or imputed) for entering into the guarantee less cumulative amortisation; and,· The amount of the obligation under the contract, as determined in accordance with IAS 37: Provisions, Contingent Liabilities and Contingent Assets.

1.26.2 Financial Liabilities at Fair Value Through Profit and LossEmbedded derivatives that have different risks and characteristics to their host contracts, and contracts with embedded derivatives whose separate value cannot be ascertained, are treated as financial liabilities at fair value through profit and loss. They are held at fair value, with any resultant gain or loss recognised in the clinical commissioning group’s surplus/deficit. The net gain or loss incorporates any interest payable on the financial liability. The CCG does not have any contracts with embedded derivatives but should it have any, the assessment of fair value would be undertaken on an individual contract by contract basis.

1.26.3 Other Financial LiabilitiesAfter 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.

1.27 Value Added TaxMost 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.

1.28 Third Party AssetsAssets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the clinical commissioning group has no beneficial interest in them.

1.29 Losses & Special Payments

Losses 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).

1.30 Joint VenturesMaterial entities over which the clinical commissioning group has joint control with one or more other parties so as to obtain economic or other benefits are classified as joint ventures. Joint ventures are accounted for using the equity method.Joint ventures that are classified as ‘held for sale’ are measured at the lower of their carrying amount or ‘fair value less costs to sell’.

1.31 Joint OperationsJoint 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.

1.32 Research & Development

Research and development expenditure is charged in the year in which it is incurred, except insofar as development expenditure relates to a clearly defined project and the benefits of it can reasonably be regarded as assured. Expenditure so deferred is limited to the value of future benefits expected and is amortised through the Statement of Comprehensive Net Expenditure on a systematic basis over the period expected to benefit from the project. It should be re-valued on the basis of current cost. The amortisation is calculated on the same basis as depreciation.

1.33 Accounting Standards That Have Been Issued But Have Not Yet Been AdoptedThe 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.

9


2 Other Operating Revenue2016-17 2016-17 2016-17 2015-16

Total Admin Programme Total

£'000 £'000 £'000 £'000

Recoveries in respect of employee benefits 0 0 0 0Patient transport services 0 0 0 0Prescription fees and charges 0 0 0 0Dental fees and charges 0 0 0 0Education, training and research 38 38 0 169Charitable and other contributions to revenue expenditure: NHS 0 0 0 0Charitable and other contributions to revenue expenditure: non-NHS 0 0 0 0Receipt of donations for capital acquisitions: NHS Charity 0 0 0 0Receipt of Government grants for capital acquisitions 0 0 0 0Non-patient care services to other bodies 5,045 1,445 3,600 5,806Continuing Health Care risk pool contributions 0 0 0 0Income generation 0 0 0 0Rental revenue from finance leases 0 0 0 0Rental revenue from operating leases 210 0 210 221Other revenue 2,447 50 2,397 711Total other operating revenue 7,739 1,533 6,206 6,907

Non patient care services to other bodies includes£000

Receipt of funding in respect of Children and Mental Health Services from local authorities 1642Recharges to local providers for contributions to community inpatient services 674

Recharge of hosted corporate service teams 1366

Recharge of Urgent care attendances to other CCGs 342

Provision of funding to support Learning disabilities transformation 127

Recharge of prescribing expenditure to NHS England (Public Health) 181

3 Revenue2016-17 2016-17 2016-17 2015-16

Total Admin Programme Total£'000 £'000 £'000 £'000

From rendering of services 7,739 1,533 6,206 6,907From sale of goods 0 0 0 0Total 7,739 1,533 6,206 6,907

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11


4.2 Average number of people employed2015-16

TotalPermanently

employed Other TotalNumber Number Number Number

Total 101 96 5 93

Of the above:Number of whole time equivalent people engaged on capital projects 0 0 0 0

4.3 Staff sickness absence and ill health retirements2016-17 2015-16Number Number

Total Days Lost 526 640Total Staff Years 95 83Average working Days Lost 6 8

2016-17 2015-16Number Number

Number of persons retired early on ill health grounds 0 0

£'000 £'000Total additional Pensions liabilities accrued in the year 0 0

Ill health retirement costs are met by the NHS Pension Scheme

4.4 Exit packages agreed in the financial year

The CCG had no agreed exit packages in 2016-17 (2015-16 also £nil)

4.5 Pension costs

4.5.1 Full actuarial (funding) valuationa) Accounting valuation

b) Full actuarial (funding) valuation

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.

For 2016-17, employers’ contributions of £505,884 were payable to the NHS Pensions Scheme (2015-16: £494,540) were payable to the NHS Pension Scheme at the rate of 14.3% of pensionable pay.

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.The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 March 2012.

No non-contractual payments were made to individuals in 2016-17 (2015-16 also £nil)

2016-17

Past and present employees are covered by the provisions of the NHS Pension Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/Pensions.

The Scheme is an unfunded, defined benefit scheme that covers NHS employers, GP 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.

The Scheme is subject to a full actuarial valuation every four years (until 2004, every five years) and an accounting valuation every year. An outline of these follows:

12


5. Operating expenses2016-17 2016-17 2016-17 2015-16

Total Admin Programme Total£'000 £'000 £'000 £'000

Gross employee benefitsEmployee benefits excluding governing body members 4,614 3,760 854 4,251Executive governing body members 1,229 1,229 0 1,219Total gross employee benefits 5,842 4,988 854 5,470

Other costsServices from other CCGs and NHS England 4,814 1,764 3,050 3,050Services from foundation trusts 22,090 0 22,090 20,390Services from other NHS trusts 218,630 62 218,568 212,367Services from other WGA bodies 4 0 4 14Purchase of healthcare from non-NHS bodies 63,423 0 63,423 65,548Chair and Non Executive Members 149 149 0 117Supplies and services – clinical 1,237 0 1,237 1,126Supplies and services – general 282 75 207 765Consultancy services 162 113 48 281Establishment 599 295 303 545Transport 45 6 39 67Premises 238 220 17 369Impairments and reversals of receivables 0 0 0 0Inventories written down and consumed 0 0 0 0Depreciation 272 57 215 234Amortisation 41 19 22 25Impairments and reversals of property, plant and equipment 0 0 0 0Impairments and reversals of intangible assets 0 0 0 0Impairments and reversals of financial assets· Assets carried at amortised cost 0 0 0 0· Assets carried at cost 0 0 0 0· Available for sale financial assets 0 0 0 0Impairments and reversals of non-current assets held for sale 0 0 0 0Impairments and reversals of investment properties 0 0 0 0Audit fees 63 63 0 63Other non statutory audit expenditure· Internal audit services 0 0 0 0· Other services 3 3 0 0General dental services and personal dental services 0 0 0 0Prescribing costs 47,616 0 47,616 48,887Pharmaceutical services 356 0 356 0General ophthalmic services 42 0 42 29GPMS/APMS and PCTMS 43,811 0 43,811 42,913Other professional fees excl. audit 114 112 2 61Grants to Other bodies 0 0 0 0Clinical negligence 1 1 0 1Research and development (excluding staff costs) 3 3 0 2Education and training 365 317 48 490Change in discount rate 0 0 0 0Provisions 287 0 287 159Funding to group bodies 0 0 0CHC Risk Pool contributions 690 0 690 1,726Other expenditure 2 0 2 0Total other costs 405,337 3,258 402,079 399,228

Total operating expenses 411,179 8,246 402,933 404,698

Audit fees shown above include VAT, the values before VAT were £52,500 in each year.

13


6.1 Better Payment Practice Code

Measure of compliance 2016-17 2016-17 2015-16 2015-16Number £'000 Number £'000

Non-NHS PayablesTotal Non-NHS Trade invoices paid in the Year 8,490 39,893 9,015 43,034Total Non-NHS Trade Invoices paid within target 7,960 38,688 8,949 42,812Percentage of Non-NHS Trade invoices paid within target 93.76% 96.98% 99.27% 99.48%

NHS PayablesTotal NHS Trade Invoices Paid in the Year 3,354 249,736 3,065 225,071Total NHS Trade Invoices Paid within target 3,337 249,537 3,047 224,994Percentage of NHS Trade Invoices paid within target 99.49% 99.92% 99.41% 99.97%

6.2 The Late Payment of Commercial Debts (Interest) Act 1998

The CCG incurred no interest payments as a result of late payment in 2016-17 (2015-16 also £nil)

7 Income Generation Activities

8. Investment revenue

The CCG earned no investment revenue in 2016-17 (2015-16 also £nil)

9. Other gains and losses

The CCG had no other gains and losses in 2016-17 (2015-16 also £nil)

10. Finance costs

The CCG incurred no finance costs in 2016-17 (2015-16 also £nil)

11. Net gain/(loss) on transfer by absorption

The CCG had no transfers as part of a reorganisation in 2016-17 (2015-16 also £nil)

The CCG undertook no income generation activities in 2016-17 (2015-16 also £nil)

Transfers as part of a reorganisation fall to be accounted for by use of absorption accounting in line with the Government Financial Reporting Manual, issued by HM Treasury. The Government Financial Reporting Manual does not require retrospective adoption, so prior year transactions (which have been accounted for under merger accounting) have not been restated. Absorption accounting requires that entities account for their transactions in the period in which they took place, with no restatement of performance required when functions transfer within the public sector. Where assets and liabilities transfer, the gain or loss resulting is recognised in the Statement of Comprehensive Net Expenditure, and is disclosed separately from operating costs.

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13 Property, plant and equipment cont'd

13.1 Additions to assets under construction

The CCG held no assets under construction at 31 March 2017 (31 March 2016 also £nil)

13.2 Donated assets

The CCG received no donated assets in 2016-17 (2015-16 also £nil)

13.3 Government granted assets

The CCG received no government granted assets in 2016-17 (2015-16 also £nil)

13.4 Property revaluation

The CCG undertook no property revaluations in 2016-17 (2015-16 also £nil)

13.5 Compensation from third parties

13.6 Write downs to recoverable amount

13.7 Temporarily idle assets

The CCG had no temporarily idle assets at 31 March 2017 (31 March 2016 also £nil)

13.8 Cost or valuation of fully depreciated assets

The cost or valuation of fully depreciated assets still in use was as follows:2016-17 2015-16

£'000 £'000Land 0 0Buildings excluding dwellings 0 0Dwellings 0 0Plant & machinery 209 167Transport equipment 0 0Information technology 0 0Furniture & fittings 0 0Total 209 167

13.9 Economic lives

Buildings excluding dwellings 0 0Dwellings 0 0Plant & machinery 0 10Transport equipment 0 0Information technology 4 4Furniture & fittings 7 7

The CCG received no compensation from third parties for assets impaired, lost or given up in 2016-17 (2015-16 also £nil)

No CCG assets were written down to recoverable amounts or previous write-downs reversed in 2016-17 (2015-16 also £nil)

Minimum Life (years)

Maximum Life (Years)

17


14 Intangible non-current assets

2016-17

Computer Software:

Purchased

Computer Software: Internally Generated

Licences & Trademarks Patents

Development Expenditure (internally generated) Total

£'000 £'000 £'000 £'000 £'000 £'000Cost or valuation at 01 April 2016 174 0 0 0 0 174

Additions purchased 0 0 0 0 0 0Additions internally generated 0 0 0 0 0 0Additions donated 0 0 0 0 0 0Additions government granted 0 0 0 0 0 0Additions leased 0 0 0 0 0 0Reclassifications 0 0 0 0 0 0Reclassified as held for sale and reversals 0 0 0 0 0 0Disposals other than by sale 0 0 0 0 0 0Upward revaluation gains 0 0 0 0 0 0Impairments charged 0 0 0 0 0 0Reversal of impairments 0 0 0 0 0 0Transfer (to)/from other public sector body 0 0 0 0 0 0Cumulative amortisation adjustment following revaluation 0 0 0 0 0 0Cost / Valuation At 31 March 2017 174 0 0 0 0 174

Amortisation 01 April 2016 39 0 0 0 0 39

Reclassifications 0 0 0 0 0 0Reclassified as held for sale and reversals 0 0 0 0 0 0Disposals other than by sale 0 0 0 0 0 0Upward revaluation gains 0 0 0 0 0 0Impairments charged 0 0 0 0 0 0Reversal of impairments 0 0 0 0 0 0Charged during the year 41 0 0 0 0 41Transfer (to) from other public sector body 0 0 0 0 0 0Cumulative amortisation adjustment following revaluation 0 0 0 0 0 0Amortisation At 31 March 2017 79 0 0 0 0 79

Net Book Value at 31 March 2017 95 0 0 0 0 95

Purchased 95 0 0 0 0 95Donated 0 0 0 0 0 0Government Granted 0 0 0 0 0 0Total at 31 March 2017 95 0 0 0 0 95

Revaluation Reserve Balance for intangible assets

Computer Software: Purchased

Computer Software: Internally Generated

Licences & Trademarks Patents

Development Expenditure (internally generated) Total

£'000 £'000 £'000 £'000 £'000 £'000Balance at 01 April 2016 0 0 0 0 0 0

Revaluation gains 0 0 0 0 0 0Impairments 0 0 0 0 0 0Release to general fund 0 0 0 0 0 0Other movements 0 0 0 0 0 0Balance at 31 March 2017 0 0 0 0 0 0

18


14 Intangible non-current assets cont'd

14.1 Donated assets

The CCG received no donated assets in 2016-17 (2015-16 also £nil)

14.2 Government granted assets

The CCG received no government granted assets in 2016-17 (2015-16 also £nil)

14.3 Revaluation

The CCG undertook no revaluation of intangible non-current assets in 2016-17 (2015-16 also £nil)

14.4 Compensation from third parties

14.5 Write downs to recoverable amount

14.6 Non-capitalised assets

14.7 Temporarily idle assets

The CCG held no temporarily idle assets at 31 March 2017 (31 March 2016 also £nil)

14.8 Cost or valuation of fully amortised assets

The CCG held no fully amortised intangible non-current assets at 31 March 2017 (31 March 2016 also £nil)

14.9 Economic lives

Computer software: purchased 1 5Computer software: internally generated 0 0Licences & trademarks 0 0Patents 0 0Development expenditure (internally generated) 5 5

15 Investment property

The CCG held no investment property at 31 March 2017 (31 March 2016 also £nil)

15.1 Investment property

16 Inventories

The CCG held no inventory assets (stock) at 31 March 2017 (31 March 2016 also £nil)

The CCG received no capital revenue and incurred no capital expenditure relating to investment property in 2016-17 (2015-16 also £nil)

The CCG received no compensation from third parties for assets impaired, lost or given up in 2016-17 (2015-16 also £nil)

No CCG assets were written down to recoverable amounts or previous write-downs reversed in 2016-17 (2015-16 also £nil)

The CCG controls no significant intangible assets that are not recognised as assets because they didn’t meet the recognition criteria of IAS 38 in 2016-17 (2015-16 also £nil)

Minimum Life (years)

Maximum Life (Years)

19


17 Trade and other receivables Current Non-current Current Non-current2016-17 2016-17 2015-16 2015-16

£'000 £'000 £'000 £'000

NHS receivables: Revenue 1,430 0 207 0NHS receivables: Capital 0 0 0 0NHS prepayments 1,491 0 1,405 0NHS accrued income 1,551 0 1,147 0Non-NHS and Other WGA receivables: Revenue 772 0 265 0Non-NHS and Other WGA receivables: Capital 0 0 0 0Non-NHS and Other WGA prepayments 144 0 256 0Non-NHS and Other WGA accrued income 406 0 131 0Provision for the impairment of receivables 0 0 0 0VAT 319 0 107 0

Private finance initiative and other public private partnership arrangement prepayments and accrued income 0 0 0 0Interest receivables 0 0 0 0Finance lease receivables 0 0 0 0Operating lease receivables 0 0 0 0Other receivables and accruals 0 0 0 0Total Trade & other receivables 6,114 0 3,518 0

Total current and non current 6,114 3,518

Included above:Prepaid pensions contributions 0 0

The equivalent value at 31 March 2016 was £1,395,379.

17.1 Receivables past their due date but not impaired 2016-17 2015-16£'000 £'000

By up to three months 223 278By three to six months 54 64By more than six months 296 30Total 573 372

£17k of the amount above has subsequently been recovered post the statement of financial position date.

The CCG held no collateral supporting any receivable balances at 31 March 2017 (31 March 2016 also £nil)

17.2 Provision for impairment of receivables

18 Other financial assets

18.1 Current

The CCG held no current other financial assets at 31 March 2017 (31 March 2016 also £nil)

18.2 Non-current

The CCG held no Non-current other financial assets at 31 March 2017 (31 March 2016 also £nil)

18.3 Non-current: capital analysis

None of the receivables that are past due have had their payments terms renegotiated.

No receivables have been impaired in the year (2015-16 also £nil)

The CCG received no capital revenue and incurred no capital expenditure relating to Non-current other financial assets during 2016-17 (2015-16 also £nil)

NHS Prepayments includes £1,482,934 in respect of payments made to providers at the commencement of the maternity pathway where at 31 March 2017 the pregnancy is ongoing and the birth will fall in the following year.

20


20 Cash and cash equivalents

2016-17 2015-16£'000 £'000

Balance at 01 April 2016 118 121Net change in year 43 (3)Balance at 31 March 2017 161 118

Made up of:Cash with the Government Banking Service 161 118Cash with Commercial banks 0 0Cash in hand 0 0Current investments 0 0Cash and cash equivalents as in statement of financial position 161 118

Bank overdraft: Government Banking Service 0 0Bank overdraft: Commercial banks 0 0Total bank overdrafts 0 0

Balance at 31 March 2017 161 118

Patients’ money held by the clinical commissioning group, not included above 0 0

21 Non-current assets held for sale

The CCG had no current assets held for sale at 31 March 2017 (31 March 2016 also £nil)

22 Analysis of impairments and reversals

22.1 Analysis of impairments and reversals: property, plant and equipment

22.1 Analysis of impairments and reversals: Intangible assets

22.3 Analysis of impairments and reversals: investment property

22.4 Analysis of impairments and reversals: inventories

22.5 Analysis of impairments and reversals: financial assets

22.6 Analysis of impairments and reversals: non-current assets held for sale

22.7 Analysis of impairments and reversals: totals

The CCG undertook no impairment or reversal of impairments of financial assets in 2016-17 (2015-16 also £nil)

The CCG undertook no impairment or reversal of impairments of non current assets held for sale in 2016-17 (2015-16 also £nil)

The CCG undertook no impairment or reversal of impairments 2016-17 (2015-16 also £nil)

The CCG undertook no impairment or reversal of impairments of property plant and equipment in 2016-17 (2015-16 also £nil)

The CCG undertook no impairment or reversal of impairments of intangible assets in 2016-17 (2015-16 also £nil)

The CCG undertook no impairment or reversal of impairments of investment property in 2016-17 (2015-16 also £nil)

The CCG undertook no impairment or reversal of impairments of inventories in 2016-17 (2015-16 also £nil)

21


Current Non-current Current Non-current2016-17 2016-17 2015-16 2015-16

£'000 £'000 £'000 £'000

Interest payable 0 0 0 0NHS payables: revenue 2,010 0 2,670 0NHS payables: capital 47 0 334 0NHS accruals 764 0 1,365 0NHS deferred income 29 0 0 0Non-NHS and Other WGA payables: Revenue 1,764 0 2,936 0Non-NHS and Other WGA payables: Capital 6 0 0 0Non-NHS and Other WGA accruals 11,597 0 11,994 0Non-NHS and Other WGA deferred income 0 0 3 0Social security costs 61 0 55 0VAT 0 0 0 0Tax 49 0 54 0Payments received on account 0 0 0 0Other payables and accruals 632 0 262 0Total Trade & Other Payables 16,959 0 19,674 0

Total current and non-current 16,959 19,674

24 Other financial liabilities Current Non-current Current Non-current2016-17 2016-17 2015-16 2015-16

Embedded derivatives at fair value through the statement of comprehensive net expenditure 0 0 0 0

Financial liabilities carried at fair value through profit and loss 0 0 0 0Amortised cost 0 0 0 0Total 0 0 0 0

Total current and non-current 0 0

25 Other liabilities Current Non-current Current Non-current2016-17 2016-17 2015-16 2015-16

Private finance initiative/LIFT deferred credit 0 0 0 0Lease incentives 0 0 0 0Other 0 0 0 0Total 0 0 0 0

Total current and non-current 0 0

23 Trade and other payables

Included above are liabilities of £nil, due in future years under arrangements to buy out the liability for early retirement over 5 years (31 March 2016 also £nil).

Other payables include £484k outstanding pension contributions at 31 March17 (£69k at 31 March 2016).

22


The CCG had no borrowings at 31 March 2017 (31 March 2016 also £nil)

26.1 Repayment of principal falling due

The CCG has no repayments of borrowings to report at 31 March 2017 (31 March 2016 also £nil)

27 Private finance initiative, LIFT and other service concession arrangements

27.3.2 In respect of LIFT schemes

27.4.2 In respect of on-statement of financial position LIFT schemes

28 Finance lease obligations

The CCG had no finance lease obligations at 31 March 2017 (31 March 2016 also £nil)

28.1 Finance leases as lessee

The CCG has no future sublease payments expected at 31 March 2017 (31 March 2016 also £nil)

29 Finance lease receivables

The CCG has no finance lease receivables at 31 March 2017 (31 March 2016 also £nil)

29.1 Finance leases as lessor

29.2 Rental revenue

The CCG has received no rental revenue in respect of finance leases in 2016-17 (2015-16 also £nil)

26 Borrowings

27.1 Off-Statement of Financial Position private finance initiative and other service concession arrangements

27.2.1 Imputed “finance lease” obligations for on-statement of financial position private finance initiative and other service concession arrangements

27.3.1 In respect of private finance initiative and other service concession arrangements

The CCG held no Off-Statement of Financial Position private finance initiative and other service concession arrangements at 31 March 2017 (31 March 2016 also £nil)27.1.1 Payments committed to in respect of off-statement of financial position LIFT schemes

The CCG had no payments committed to in respect of off-statement of financial position LIFT schemes at 31 March 2017 (31 March 2016 also £nil)

The CCG had no Imputed “finance lease” obligations for on-statement of financial position private finance initiative and other service concession arrangements at 31 March 2017 (31 March 2016 also £nil)

27.2.2 Imputed “finance lease” obligations for on-statement of financial position LIFT schemes

The CCG had no Imputed “finance lease” obligations for on-statement of financial position LIFT schemes at 31 March 2017 (31 March 2016 also £nil)

The CCG has no accumulated allowance for uncollectible lease receivables at 31 March 2017 (31 March 2016 also £nil)

The CCG has no unguaranteed residual value accruing at 31 March 2017 (31 March 2016 also £nil)

The CCG held no balances relating to off-Statement of financial position arrangements or the service element of on-statement of financial position arrangements at 31 March 2017 (31 March 2016 also £nil)

The CCG held no balances relating to off-Statement of financial position arrangements or the service element of on-statement of financial position arrangements at 31 March 2017 (31 March 2016 also £nil)

27.4.1 In respect of on-statement of financial position private finance initiative and other service concession arrangements

The CCG has no payments due in future years in respect of on-statement of financial position private finance initiative and other service concession arrangements at 31 March 2017 (31 March 2016 also £nil)

The CCG has no payments due in future years in respect of on-statement of financial position LIFT schemes at 31 March 2017 (31 March 2016 also £nil)

23

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24


31 Contingencies

The CCG had no contingent assets or contingent liabilities at 31 March 2017 (31 March 2016 also £nil)

32 Commitments

32.1 Capital commitments

The CCG had no capital commitments at 31 March 2017 (31 March 2016 also £nil)

32.2 Other financial commitments

33 Financial instruments

33.1 Financial risk management

33.1.1 Currency risk

33.1.2 Interest rate risk

33.1.3 Credit risk

33.1.3 Liquidity risk

The CCG has not entered into any non-cancellable contracts (which are not leases, private finance initiative contracts or other service concession arrangements) at 31 March 2017 (31 March 2016 also £nil)

The CCG is able to borrow from government for capital expenditure, subject to affordability as confirmed by NHS England. The borrowings would be for 1 to 25 years, in line with the life of any 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 revenue comes 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 CCG 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. The CCG therefore has low exposure to currency rate fluctuations.

25


33 Financial instruments cont'd

33.2 Financial assets

At ‘fair value through profit and

loss’Loans and

ReceivablesAvailable for

Sale Total2016-17 2016-17 2016-17 2016-17

£'000 £'000 £'000 £'000

Embedded derivatives 0 0 0 0Receivables:· NHS 0 2,981 0 2,981· Non-NHS 0 1,178 0 1,178Cash at bank and in hand 0 161 0 161Other financial assets 0 0 0 0Total at 31 March 2017 0 4,321 0 4,321


loss’Loans and

ReceivablesAvailable for

Sale Total2015-16 2015-16 2015-16 2015-16

£'000 £'000 £'000 £'000

Embedded derivatives 0 0 0 0Receivables:· NHS 0 1,354 0 1,354· Non-NHS 0 396 0 396Cash at bank and in hand 0 118 0 118Other financial assets 0 0 0 0Total at 31 March 2017 0 1,867 0 1,867

33.3 Financial liabilities


loss’ Other Total2016-17 2016-17 2016-17

£'000 £'000 £'000

Embedded derivatives 0 0 0Payables:· NHS 0 2,821 2,821· Non-NHS 0 13,998 13,998Private finance initiative, LIFT and finance lease obligations 0 0 0Other borrowings 0 0 0Other financial liabilities 0 0 0Total at 31 March 2017 0 16,820 16,820


loss’ Other Total2015-16 2015-16 2015-16

£'000 £'000 £'000

Embedded derivatives 0 0 0Payables:· NHS 0 4,369 4,369· Non-NHS 0 15,192 15,192Private finance initiative, LIFT and finance lease obligations 0 0 0Other borrowings 0 0 0Other financial liabilities 0 0 0Total at 31 March 2017 0 19,561 19,561

26

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and

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land

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al A

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-17

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27


35 Pooled budgets

35.1 Integrated Community Equipment Services (ICES)

The memorandum account for the Integrated Community Equipment Services pooled budget is:

LEICESTER, LEICESTERSHIRE AND RUTLAND (LLR) ICES

2016-17 POOLED BUDGET MEMORANDUM ACCOUNT

2016/17 2015/16Income : Total Total

£'000 £'000Leicester City Council (Adult Social Care) 772 885Leicester City Council (Education) 78 35Leicestershire County Council 1,196 1,461Rutland County Council 86 93NHS Leicester City CCG 1,268 1,229NHS East Leicestershire and Rutland CCG 1,188 1,356NHS West Leicestershire CCG 1,111 1,408

5,698 6,468

Expenditure :

Service Costs 1,526 3,317Administrative Costs 162 163Equipment Costs 4,010 2,989In respect of the Pool 5,698 6,468

Net under/(over) spend 0 0

Host Organisation: Leicester City Council

35.2 Learning Disabilities Services

The memorandum account for the Learning Disability pooled budget is:

LEICESTERSHIRE COUNTY COUNCILLEARNING DISABILITY POOLED BUDGET MEMORANDUM ACCOUNT 2016/17

2016/17 2015/16Funding provided to the pooled budget including risk share adjustment for overspend/underspend £'000 £'000NHS East Leicestershire and Rutland CCG 6,117 5,619NHS West Leicestershire CCG 7,136 6,554Leicestershire County Council 13,228 12,439

26,482 24,612

Expenditure met from the pooled budgetNHS East Leicestershire and Rutland CCG 6,117 5,619NHS West Leicestershire CCG 7,136 6,554Leicestershire County Council 13,228 12,439

26,482 24,612

Share of contribution to in year (overspend)/underspendNHS East Leicestershire and Rutland CCG 138 (18) NHS West Leicestershire CCG 162 (21) Leicestershire County Council 300 (39)

600 (77) Host Organisation: Leicestershire County Council

The clinical commissioning group and consolidated group had entered into a Integrated Community Equipment Services pooled budget with Leicester City Council, Leicestershire County Council, Rutland County Council, West Leicestershire CCG and Leicester City CCG. The pool is hosted by Leicester City Council.

The clinical commissioning group entered into a Learning Disability pooled budget with Leicestershire County Council and West Leicestershire CCG.

28

35.3 Better Care Fund

The memorandum account shows total expenditure of £39.4m and gross income of £39.4m.

LEICESTERSHIRE COUNTY COUNCILBETTER CARE FUND 2016/17 MEMORANDUM ACCOUNT

2016/17 2015/16Funding provided to the pooled budget £'000 £'000NHS East Leicestershire and Rutland CCG 15,560 14,687NHS West Leicestershire CCG 20,477 19,573Leicestershire County Council 3,383 3,083

39,419 37,343Expenditure met from the pooled budgetNHS East Leicestershire and Rutland CCG 15,560 14,687NHS West Leicestershire CCG 20,477 19,573Leicestershire County Council 3,383 3,083

39,419 37,343Share of Surplus / (Deficit)NHS East Leicestershire and Rutland CCG 0 0NHS West Leicestershire CCG 0 0Leicestershire County Council 0 0

0 0Host Organisation: Leicestershire County Council

RUTLAND COUNTY COUNCILBETTER CARE FUND 2016/17 MEMORANDUM ACCOUNT

2016/17 2015/16£'000 £'000

Funding Provided to the Pool

East Leicestershire and Rutland Clinical Commissioning Group (ELRCCG)2,061 2,046

Rutland County Council 186 180Use of Reserve 200 0

Total Funding 2,447 2,226Expenditure

Unified Prevention Offer 420 371Long Term Conditions 734 139Urgent Response 0 626Hospital Discharge And Reablement 0 626Crisis Response, Transfer Care and Reablement 935 0Enablers 79 147

Total Expenditure 2,168 1,909

Expenditure - repayment of funds (in line with S75 agreement)ELRCCG 277 0

Surplus / (Deficit) on Fund 2 317

Share of Surplus / (Deficit)ELRCCG 0 158RCC 2 159

Total Shared Surplus / (Deficit) 2 317

2016-17 2015-16£000 £000

Income 24,926 24,419Expenditure (24,926) (24,437)

36 NHS Lift investments

The CCG had no NHS Lift Investments at 31 March 2017 (31 March 2016 also £nil)

The NHS Clinical Commissioning Group shares of the income and expenditure handled by pooled budgets in the financial year were:

From the 1 April 2016 the Council entered into a £2.447m pooled budget arrangement (section 75 agreement) for the Better Care Fund inclusive of £200k from the BCF Reserve. Officers and Members of the Council are working across Leicester, Leicestershire and Rutland (LLR) to integrate reform and transform services. This is a budget to improve the ways health services and social care services work together, starting with services for older people and people with long term conditions. The Council and East Leicestershire and Rutland Clinical Commissioning Group (ELRCCG) have agreed a Better Care Fund plan; this has been fully approved by NHS England.

On the 1st April 2015, the Leicestershire County Council entered into a pooled budget arrangement under s75 of the NHS Act 2006 with NHS West Leicestershire Clinical Commissioning Group and NHS East Leicestershire and Rutland Clinical Commissioning Group for the Better Care Fund. The Better Care Fund provides the financial support to local authorities and the NHS to jointly plan and deliver local services, Leicestershire County Council is the host authority. The Authority Contributed £3.4m into the pool.

29

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2015

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2016

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2015

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dditi

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linic

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sact

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e be

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este

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ount

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utla

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ount

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artm

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rded

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late

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urin

g th

e ye

ar th

e cl

inic

al c

omm

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g gr

oup

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a si

gnifi

cant

num

ber o

f mat

eria

l tra

nsac

tions

with

ent

ities

for w

hich

the

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artm

ent i

s re

gard

ed a

s th

e pa

rent

Dep

artm

ent.

For e

xam

ple:

LLR

NH

S Pa

rtner

s ("

The

Allia

nce"

) is

a pa

rtner

ship

bet

wee

n th

e U

nive

rsity

Hos

pita

ls o

f Lei

cest

er N

HS

Trus

t (U

HL)

, Lei

cest

ersh

ire P

artn

ersh

ip T

rust

(LPT

) and

the

LLR

Pro

vide

r Com

pany

Ltd

(GP

mem

bers

hip

orga

nisa

tion

acro

ss L

eice

ster

, Lei

cest

ersh

ire a

nd R

utla

nd).

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LLR

Pro

vide

r Com

pany

Ltd

(the

par

t of t

he A

llian

ce w

hich

con

sist

s of

the

GPs

iden

tifie

d in

the

tabl

e ov

er) c

ompr

ises

5%

of U

HL'

s to

tal s

pend

.

2016

-17

2015

-16

2016

-17

2015

-16

2016

-17

2015

-16

In a

dditi

on, t

he c

linic

al c

omm

issi

onin

g gr

oup

has

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mbe

r of m

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ial t

rans

actio

ns w

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ther

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ent d

epar

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ts a

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ther

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tral a

nd lo

cal g

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nmen

t bod

ies.

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t of t

hese

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sact

ions

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e be

en w

ith

Leic

este

rshi

re C

ount

y C

ounc

il, R

utla

nd C

ount

y C

ounc

il an

d Le

ices

ter C

ity C

ounc

il.

31

NH

S E

ast L

eice

ster

shire

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land

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ual A

ccou

nts

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-17

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ter t

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ded)

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e C

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per

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e du

ties

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as

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ws:

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-17

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ount

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nt s

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nt s

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pact

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ld b

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pon

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e ad

optio

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lso

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naly

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old

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itabl

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ch 2

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ch 2

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also

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l)

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r the

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ng p

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d re

quiri

ng d

iscl

osur

e.

The

tota

l num

ber o

f NH

S C

linic

al C

omm

issi

onin

g G

roup

loss

es a

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peci

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aym

ents

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nd th

eir t

otal

val

ue, w

as a

s fo

llow

s:

32

Appendices

Appendix 1: NHS East Leicestershire and Rutland CCG Governing Body and committees (July 2016) i

Appendix 2: Governing Body Members’ Register of interests ii

Appendix 3: List of GP Member Practices viii

Appendix 4: Members of CCG Committees ix

Appendix 5: Attendance at Governing Body meetings held in public (April 2016 – March 2017) xi

Appendix 6: Key corporate risks 2016/17 xi

Appendix 1 NHS East Leicestershire and Rutland CCG Governing Body and committees (July 2016)

East Leicestershire and Rutland CCG Governing Body

Audit Committee

Remuneration Committee

Financial Turnaround Committee

QIPP Performance Delivery and

Monitoring Group

Primary Care Commissioning

Committee

Integrated Governance Committee

Commissioning Collaborative

Board and Provider Performance

Assurance Group

Competition and

Procurement Panel

Key: indicates collaborative meetings.

East Leicestershire and Rutland Clinical Commissioning Group Annual Report 2016/17 i

Appendix 2 Governing Body Members’ Register of interests

Declarations of Interest - 2016 - 2017 (v3, 31 March 2017) N.B. to include dates either “to” and “from” or both relating to the interest where new or circumstances have changed through the year.

Nam

eJo

b T

itle

Fin

anci

al In

tere

sts

No

n-fi

nan

cial

p

rofe

ssio

nal

in

tere

sts

No

n-fi

nan

cial

p

erso

nal

in

tere

st

Ind

irec

t In

tere

sts

Act

ion

s to

be

take

n t

o m

itig

ate

the

risk

s (s

ee C

on

flic

ts o

f In

tere

st P

olic

y fo

r d

etai

ls)

Mrs

Kar

en

Eng

lish

Man

agin

g D

irect

orN

/AM

embe

r of

C

hart

ered

In

stitu

te

of P

ublic

Fi

nanc

e an

d A

ccou

ntan

cy.

N/A

Hus

band

is t

he o

wne

r of

Gra

ham

Eng

lish

Con

sulta

ncy

Ltd.

If co

nsul

tanc

y fir

m r

equi

red

Kar

en w

ould

not

be

part

of

the

proc

urem

ent

proc

ess.

Dr

Ric

har

d

Palin

CC

G

Cha

irman

Dire

ctor

of

Bush

loe

End

Ltd.

Pro

vide

r of

cl

inic

al s

ervi

ces

to p

rison

s.

GP

Part

ner

at B

ushl

oe E

nd S

urge

ry,

Wig

ston

.

GP

at H

MY

OI G

len

Parv

a.

Leic

este

rshi

re P

artn

ersh

ip T

rust

Clin

ical

D

irect

or f

or P

rison

s. G

over

nanc

e ro

le

as p

art

of c

ontr

act

held

by

my

prac

tice

Bush

loe

Surg

ery.

Boar

d m

embe

r an

d M

edic

al D

irect

or o

f Sp

irit

Clin

ical

Ser

vice

s Lt

d. E

mpl

oyed

ro

le p

rovi

ding

gov

erna

nce

supp

ort

and

advi

ce t

o cl

inic

al s

ervi

ces

com

pany

on

limite

d pa

rt-t

ime

basi

s.

Prac

tice

is a

mem

ber

of t

he E

ast

Leic

este

rshi

re a

nd R

utla

nd G

P Fe

dera

tion.

Mem

ber

Roya

l Col

lege

of

Gen

eral

Pr

actit

ione

rs

and

Brit

ish

Med

ical

A

ssoc

iatio

n M

embe

r.

N/A

Frie

nd is

the

Man

agin

g D

irect

or f

or In

syph

er L

td

(dat

a an

alyt

ics)

; Dire

ctor

of

Your

Pro

duct

s Lt

d (m

edic

al

food

sup

plem

ents

); an

d D

irect

or o

f N

eoN

avita

s Lt

d (m

edic

al s

ales

co

nsul

tanc

y).

Frie

nd is

the

Chi

ef

Ope

ratin

g O

ffice

r of

Ard

en

and

Gre

ater

Eas

t M

idla

nds

Com

mis

sion

ing

Supp

ort

Uni

t (u

ntil

Oct

ober

201

6).

Brot

her-

in-la

w is

th

e ch

airm

an o

f th

e D

octo

rs’ a

nd D

entis

ts’

Rem

uner

atio

n C

omm

ittee

.

In r

elat

ion

to fi

nanc

ial i

nter

ests

, to

ens

ure

indi

vidu

al d

oes

not

part

icip

ate

in t

he d

ecis

ion-

mak

ing

proc

ess

in c

omm

ittee

mee

tings

(e

.g t

o ab

sent

the

mse

lves

fro

m

mee

tings

at

the

rele

vant

poi

nt o

n th

e ag

enda

); du

ring

proc

urem

ent

proc

esse

s in

divi

dual

s to

see

k ad

vice

if

and

up t

o w

hich

par

t of

the

pr

oces

s in

divi

dual

s ca

n be

invo

lved

in

, or

not

invo

lved

with

at

all e

tc.

Dr

Nic

ho

las

Glo

ver

GP

Gov

erni

ng

Body

M

embe

r, Bl

aby

and

Lutt

erw

orth

Lo

calit

y Le

ad

GP

Part

ner

at N

orth

field

Med

ical

Cen

tre,

Bl

aby.

GP

Trai

ner,

East

Mid

land

s D

eane

ry.

Mem

ber

of t

he L

eice

ster

, Lei

cest

ersh

ire

and

Rutla

nd L

ocal

Med

ical

Com

mitt

ee.

Prac

tice

is a

mem

ber

of t

he E

ast

Leic

este

rshi

re a

nd R

utla

nd G

P Fe

dera

tion.

The

Nor

thfie

ld M

edic

al C

entr

e is

a m

inor

sh

areh

olde

r in

Lei

cest

er, L

eice

ster

shire

an

d Ru

tland

Pro

vide

r C

ompa

ny L

td. (

LLR

Prov

ider

Com

pany

Ltd

).

Mem

ber

of t

he

Roya

l Col

lege

of

Gen

eral

Pr

actit

ione

rs

and

Briti

sh

Med

ical

A

ssoc

iatio

n.

N/A

N/A

In r

elat

ion

to fi

nanc

ial i

nter

ests

, to

ens

ure

indi

vidu

al d

oes

not

part

icip

ate

in t

he d

ecis

ion-

mak

ing

proc

ess

in c

omm

ittee

mee

tings

(e

.g t

o ab

sent

the

mse

lves

fro

m

mee

tings

at

the

rele

vant

poi

nt o

n th

e ag

enda

); du

ring

proc

urem

ent

proc

esse

s in

divi

dual

s to

see

k ad

vice

if

and

up t

o w

hich

par

t of

the

pr

oces

s in

divi

dual

s ca

n be

invo

lved

in

, or

not

invo

lved

with

at

all e

tc.

East Leicestershire and Rutland Clinical Commissioning Group Annual Report 2016/17 ii | iii

Nam

eJo

b T

itle

Fin

anci

al In

tere

sts

No

n-

fin

anci

al

pro

fess

ion

al

inte

rest

s

No

n-

fin

anci

al

per

son

al

inte

rest

Ind

irec

t In

tere

sts

Act

ion

s to

be

take

n t

o

mit

igat

e th

e ri

sks

(see

C

on

flic

ts o

f In

tere

st P

olic

y fo

r d

etai

ls)

Dr

Gra

ham

Jo

hn

son

GP

Gov

erni

ng

Body

M

embe

r, Bl

aby

and

Lutt

erw

orth

Lo

calit

y Le

ad

GP

Part

ner

at W

yclif

fe M

edic

al P

ract

ice.

Mem

ber

of t

he L

eice

ster

, Lei

cest

ersh

ire a

nd R

utla

nd L

ocal

M

edic

al C

omm

ittee

.

Prac

tice

is a

mem

ber

of t

he E

ast

Leic

este

rshi

re a

nd R

utla

nd G

P Fe

dera

tion.

Wyc

liffe

Med

ical

Pra

ctic

e is

a m

inor

sha

reho

lder

in L

eice

ster

, Le

ices

ters

hire

and

Rut

land

Pro

vide

r C

ompa

ny L

td. (

LLR

Prov

ider

C

ompa

ny L

td).

N/A

N/A

N/A

In r

elat

ion

to fi

nanc

ial i

nter

ests

, to

ens

ure

indi

vidu

al d

oes

not

part

icip

ate

in t

he d

ecis

ion-

mak

ing

proc

ess

in c

omm

ittee

m

eetin

gs (e

.g t

o ab

sent

th

emse

lves

fro

m m

eetin

gs a

t th

e re

leva

nt p

oint

on

the

agen

da);

durin

g pr

ocur

emen

t pr

oces

ses

indi

vidu

als

to s

eek

advi

ce if

and

up

to

whi

ch p

art

of t

he p

roce

ss

indi

vidu

als

can

be in

volv

ed in

, or

not

invo

lved

with

at

all e

tc.

Dr

Ric

har

d

Hu

rwo

od

(f

rom

O

ctob

er

2013

- 3

0 Se

ptem

ber

2016

)

GP

Gov

erni

ng

Body

M

embe

r, M

elto

n,

Rutla

nd a

nd

Har

boro

ugh

Loca

lity

Lead

GP

Prin

cipa

l at

The

Cou

nty

Prac

tice

Syst

on H

ealth

Cen

te.

Mem

ber

of t

he L

eice

ster

, Lei

cest

ersh

ire a

nd R

utla

nd L

ocal

M

edic

al C

omm

ittee

.

Prac

tice

is a

mem

ber

of t

he E

ast

Leic

este

rshi

re a

nd R

utla

nd G

P Fe

dera

tion.

Syst

on H

ealth

Con

sort

ium

(1 o

f 10

par

tner

s ow

ning

Sys

ton

Hea

lth C

entr

e)

The

Cou

nty

Prac

tice

is a

sha

reho

lder

in L

eice

ster

, Lei

cest

ersh

ire

and

Rutla

nd P

rovi

der

Com

pany

Ltd

. (LL

R Pr

ovid

er C

ompa

ny

Ltd)

.

Dep

uty

Lieu

tena

nt o

f Le

ices

ters

hire

Mem

ber

of

Briti

sh M

edic

al

Ass

ocia

tion.

Fello

w R

oyal

C

olle

ge o

f G

Ps.

N/A

Regi

ster

ed w

ith G

P in

th

e ar

ea.

Wife

is a

n ac

cupu

nctu

rist

in p

rivat

e pr

actic

e.

Indi

vidu

al h

as le

ft t

he

orga

nisa

tion.

Dr

Dav

id

An

dre

w

Jam

es K

er

GP

Gov

erni

ng

Body

M

embe

r, C

linic

al V

ice

Cha

ir

Seni

or G

P Pa

rtne

r in

Oak

ham

Med

ical

Pra

ctic

e; a

nd M

arke

t O

vert

on a

nd S

omer

by S

urge

ry.

Prac

tice

is a

pro

vide

r of

min

or in

jury

ser

vice

s.N

/A

Prac

tice

is a

mem

ber

of t

he E

ast

Leic

este

rshi

re a

nd R

utla

nd G

P Fe

dera

tion.

Par

tner

at

the

Prac

tice

is a

Boa

rd m

embe

r on

the

EL

R Fe

dera

tion

Boar

d.

Min

or S

hare

hold

er in

the

Lei

cest

er, L

eice

ster

shire

and

Rut

land

Pr

ovid

er C

ompa

ny L

td. (

LLR

Prov

ider

Com

pany

Ltd

).

Oak

ham

Med

ical

Pra

ctic

e an

d M

arke

t O

vert

on a

nd S

omer

by

Surg

ery

are

min

ority

sha

reho

lder

s in

The

Lei

cest

er, L

eice

ster

shire

an

d Ru

tland

Pro

vide

r C

ompa

ny L

td. (

LLR

Prov

ider

Com

pany

Lt

d).

Mem

ber

of

the

Briti

sh

Med

ical

A

ssoc

iatio

n an

d Ro

yal

Col

lege

of

Gen

eral

Pr

actit

ione

rs.

N/A

Wife

is a

par

tner

at

Oak

ham

Med

ical

Pra

ctic

e an

d M

arke

t O

vert

on a

nd

Som

erby

Sur

gery

. The

Pr

actic

es a

re m

inor

ity

shar

ehol

ders

in T

he

Leic

este

r, Le

ices

ters

hire

an

d Ru

tland

Pro

vide

r C

ompa

ny L

td. (

LLR

Prov

ider

Com

pany

Ltd

).

Part

ner

at t

he P

ract

ice

is

a Bo

ard

mem

ber

on t

he

ELR

Fede

ratio

n Bo

ard.

In r

elat

ion

to fi

nanc

ial i

nter

ests

, to

ens

ure

indi

vidu

al d

oes

not

part

icip

ate

in t

he d

ecis

ion-

mak

ing

proc

ess

in c

omm

ittee

m

eetin

gs (e

.g t

o ab

sent

th

emse

lves

fro

m m

eetin

gs a

t th

e re

leva

nt p

oint

on

the

agen

da);

durin

g pr

ocur

emen

t pr

oces

ses

indi

vidu

als

to s

eek

advi

ce if

and

up

to

whi

ch p

art

of t

he p

roce

ss

indi

vidu

als

can

be in

volv

ed in

, or

not

invo

lved

with

at

all e

tc.

Appendix 2 Governing Body Members’ Register of interests (continued)

Nam

eJo

b T

itle

Fin

anci

al In

tere

sts

No

n-

fin

anci

al

pro

fess

ion

al

inte

rest

s

No

n-

fin

anci

al

per

son

al

inte

rest

Ind

irec

t In

tere

sts

Act

ion

s to

be

take

n t

o

mit

igat

e th

e ri

sks

(see

C

on

flic

ts o

f In

tere

st P

olic

y fo

r d

etai

ls)

Dr

Hila

ry

Fox

GP

Gov

erni

ng

Body

M

embe

r, M

elto

n,

Rutla

nd a

nd

Har

boro

ugh

Loca

lity

Lead

GP

Part

ner

at T

he U

ppin

gham

Sur

gery

, N

orth

gate

, Upp

ingh

am, R

utla

nd,

Leic

este

rshi

re.

GP

Trai

ner

(Hea

lth E

duca

tion

East

M

idla

nds)

GP

App

rais

er f

or N

HS

Engl

and.

Prac

tice

is a

mem

ber

of t

he E

ast

Leic

este

rshi

re a

nd R

utla

nd G

P Fe

dera

tion.

The

Upp

ingh

am S

urge

ry is

a s

hare

hold

er

in t

he L

eice

ster

, Lei

cest

ersh

ire a

nd

Rutla

nd P

rovi

der

Com

pany

Ltd

(LLR

Pr

ovid

er C

ompa

ny L

td).

Fello

w R

oyal

C

olle

ge o

f G

ener

al

Prac

titio

ners

an

d Br

itish

M

edic

al

Ass

ocia

tion

mem

ber.

N/A

N/A

In r

elat

ion

to fi

nanc

ial i

nter

ests

, to

ens

ure

indi

vidu

al d

oes

not

part

icip

ate

in t

he d

ecis

ion-

mak

ing

proc

ess

in c

omm

ittee

m

eetin

gs (e

.g t

o ab

sent

th

emse

lves

fro

m m

eetin

gs a

t th

e re

leva

nt p

oint

on

the

agen

da);

durin

g pr

ocur

emen

t pr

oces

ses

indi

vidu

als

to s

eek

advi

ce if

and

up

to

whi

ch p

art

of t

he p

roce

ss

indi

vidu

als

can

be in

volv

ed in

, or

not

invo

lved

with

at

all e

tc.

Dr

Gir

ish

Pu

roh

itG

P G

over

ning

Bo

dy

Mem

ber,

Mel

ton,

Ru

tland

and

H

arbo

roug

h Lo

calit

y Le

ad

GP

Part

ner

at T

he J

ubile

e M

edic

al

Prac

tice,

Sys

ton

Hea

lth C

entr

e, S

ysto

n,

Leic

este

rshi

re.

The

Jubi

lee

Med

ical

Pra

ctic

e is

a

mem

ber

of t

he E

ast

Leic

este

rshi

re a

nd

Rutla

nd G

P Fe

dera

tion.

The

Jubl

iee

Med

ical

Pra

ctic

e is

a

shar

ehol

der

in T

he L

eice

ster

, Le

ices

ters

hire

and

Rut

land

Pro

vide

r C

ompa

ny L

td (L

LR P

rovi

der

Com

pany

Lt

d).

The

Jubi

lee

Prac

tice

is a

Tra

inin

g H

ub

and

Aca

dem

y.

Dire

ctor

Hol

iday

Clu

b4 K

ids

Serv

ices

Ltd

an

d N

urse

ries

‘R’ U

s Lt

d -

child

car

e an

d nu

rsey

man

ned

by w

ife.

Mem

ber

of

the

Roya

l C

olle

ge o

f G

ener

al

Prac

titio

ners

.

Mem

ber

of

the

Briti

sh

Med

ical

A

ssoc

iatio

n.

N/A

Wife

is d

enta

l pr

actit

ione

r at

Pur

e D

enta

l Pra

ctic

e, M

arke

t H

arbo

roug

h (M

arch

20

17).

Dr

Phili

p G

reen

(p

artn

er a

t th

e Ju

bile

e M

edic

al P

ract

ice)

is

the

GP

Tuto

r fo

r th

e C

CG

and

sits

on

the

ELR

CC

G W

orkf

orce

G

roup

.

Blue

Sky

Ort

hopa

edic

s pr

ovid

e O

rtho

paed

ic

serv

ices

fro

m T

he

Jubi

lee

Med

ical

Pr

actic

e pr

emis

es.

In r

elat

ion

to fi

nanc

ial i

nter

ests

, to

ens

ure

indi

vidu

al d

oes

not

part

icip

ate

in t

he d

ecis

ion-

mak

ing

proc

ess

in c

omm

ittee

m

eetin

gs (e

.g t

o ab

sent

th

emse

lves

fro

m m

eetin

gs a

t th

e re

leva

nt p

oint

on

the

agen

da);

durin

g pr

ocur

emen

t pr

oces

ses

indi

vidu

als

to s

eek

advi

ce if

and

up

to

whi

ch p

art

of t

he p

roce

ss

indi

vidu

als

can

be in

volv

ed in

, or

not

invo

lved

with

at

all e

tc.

East Leicestershire and Rutland Clinical Commissioning Group Annual Report 2016/17 iv | v

Nam

eJo

b T

itle

Fin

anci

al In

tere

sts

No

n-fi

nan

cial

p

rofe

ssio

nal

in

tere

sts

No

n-

fin

anci

al

per

son

al

inte

rest

Ind

irec

t In

tere

sts

Act

ion

s to

be

take

n t

o

mit

igat

e th

e ri

sks

(see

C

on

flic

ts o

f In

tere

st P

olic

y fo

r d

etai

ls)

Dr

Viv

ek

Var

akan

tam

GP

Gov

erni

ng

Body

M

embe

r, O

adby

and

W

igst

on

GP

Part

ner

at T

he C

roft

Med

ical

Cen

tre,

O

adby

, Lei

cest

er.

Dire

ctor

Bus

hby

Lodg

e M

edic

al P

erso

nal

Hea

lth S

ervi

ces

(Out

of

Hou

rs)

Resi

gned

Dire

ctor

- L

LR P

rovi

der

Com

pany

The

Cro

ft M

edic

al C

entr

e is

a

shar

ehol

der

in t

he L

eice

ster

, Le

ices

ters

hire

and

Rut

land

Pro

vide

r C

ompa

ny L

td (L

LR P

rovi

der

Com

pany

Lt

d).

Prac

tice

is a

mem

ber

of t

he E

ast

Leic

este

rshi

re a

nd R

utla

nd G

P Fe

dera

tion.

Par

tner

at

the

Prac

tice,

Dr

Shira

z M

akda

, is

a Bo

ard

mem

ber

on

the

ELR

Fede

ratio

n Bo

ard.

FY2

Trai

ner

in g

ener

al

prac

tice

(Hea

lth

Educ

atio

n Ea

st

Mid

land

s)

Mem

ber

of t

he R

oyal

C

olle

ge o

f G

ener

al

Prac

titio

ners

and

Brit

ish

Med

ical

Ass

ocia

tion

mem

ber.

N/A

Wife

is s

hare

hold

er in

Bu

shby

Lod

ge M

edic

al

(med

ical

ser

vice

s co

mpa

ny).

Wife

com

men

ced

post

in

Inte

rser

ve in

car

e at

hom

e (t

here

fore

co

nflic

ted

with

e.g

. C

HC

) - M

arch

201

5.

In r

elat

ion

to fi

nanc

ial i

nter

ests

, to

ens

ure

indi

vidu

al d

oes

not

part

icip

ate

in t

he d

ecis

ion-

mak

ing

proc

ess

in c

omm

ittee

m

eetin

gs (e

.g t

o ab

sent

th

emse

lves

fro

m m

eetin

gs a

t th

e re

leva

nt p

oint

on

the

agen

da);

durin

g pr

ocur

emen

t pr

oces

ses

indi

vidu

als

to s

eek

advi

ce if

and

up

to

whi

ch p

art

of t

he p

roce

ss

indi

vidu

als

can

be in

volv

ed in

, or

not

invo

lved

with

at

all e

tc.

Mr

War

wic

k K

end

rick

Inde

pend

ent

Lay

Mem

ber

N/A

Mem

ber

of

Cha

rter

ed In

stitu

te

of M

anag

emen

t A

ccou

ntan

ts (C

IMA

).

N/A

N/A

N/A

Mr

Cliv

e W

oo

dD

eput

y C

hair

/ Ind

epen

dent

La

y M

embe

r

Dire

ctor

of

I Can

Ass

ocia

tes

Ltd

(tra

inin

g M

anag

emen

t C

onsu

ltanc

y)

(cea

sed

Mar

ch 2

017)

.

Offi

ce in

Cha

rge

Leic

este

r Ju

nior

A

tten

danc

e C

entr

e (D

evel

opin

g Yo

und

Off

ende

rs).

Cha

ir of

the

Le

ices

ters

hire

Bra

nch

and

Mid

land

s Re

gion

, In

tern

atio

nal P

olic

e A

ssoc

iatio

n

N/A

Son

is e

mpl

oyee

of

Tota

l Com

mun

ity C

are

Ltd

whi

ch p

rovi

des

spec

ialis

t ca

re s

ervi

ces

for

indi

vidu

als

with

sp

inal

cor

d in

jury

and

ot

her

neur

olog

ical

co

nditi

ons.

In r

elat

ion

to fi

nanc

ial i

nter

ests

, to

ens

ure

indi

vidu

al d

oes

not

part

icip

ate

in t

he d

ecis

ion-

mak

ing

proc

ess

in c

omm

ittee

m

eetin

gs (e

.g t

o ab

sent

th

emse

lves

fro

m m

eetin

gs a

t th

e re

leva

nt p

oint

on

the

agen

da);

durin

g pr

ocur

emen

t pr

oces

ses

indi

vidu

als

to s

eek

advi

ce if

and

up

to

whi

ch p

art

of t

he p

roce

ss

indi

vidu

als

can

be in

volv

ed in

, or

not

invo

lved

with

at

all e

tc.

Appendix 2 Governing Body Members’ Register of interests (continued)

Nam

eJo

b T

itle

Fin

anci

al In

tere

sts

No

n-fi

nan

cial

p

rofe

ssio

nal

in

tere

sts

No

n-fi

nan

cial

p

erso

nal

inte

rest

Ind

irec

t In

tere

sts

Act

ion

s to

be

take

n t

o

mit

igat

e th

e ri

sks

(s

ee C

on

flic

ts o

f In

tere

st

Polic

y fo

r d

etai

ls)

Mr

Ala

n

Fred

eric

k Sm

ith

Inde

pend

ent

Lay

Mem

ber

N/A

Mem

ber

of t

he

Cha

rter

ed In

stitu

te

of P

ublic

Fin

ance

and

A

ccou

ntan

cy.

N/A

N/A

N/A

Mr

Tim

Sa

cks

Chi

ef

Ope

ratin

g O

ffice

r

N/A

N/A

N/A

Wife

was

a p

artn

er a

t O

akha

m M

edic

al P

ract

ice

(fro

m 1

st J

uly

2013

- e

nd

Febr

uary

201

5).

N/A

Mrs

Car

mel

O

’Bri

enC

hief

Nur

se

and

Qua

lity

Offi

cer

N/A

Mem

ber

of R

oyal

C

olle

ge o

f N

ursi

ng.

N/A

N/A

N/A

Mrs

Do

nn

a En

ou

x

(fro

m 2

6 M

ay 2

015,

pr

evio

usly

in

terim

CFO

)

Chi

ef F

inan

ce

Offi

cer

N/A

Mem

ber

of t

he

Cha

rter

ed In

stitu

te

of M

anag

emen

t A

ccou

ntan

ts.

N/A

N/A

N/A

Mrs

Jan

e C

hap

man

(u

ntil

Dec

embe

r 20

16)

Chi

ef S

trat

egy

and

Plan

ning

O

ffice

r

N/A

Mem

ber

of t

he

Inst

itute

of

Hea

lth

Car

e M

anag

emen

t.

N/A

Hus

band

is D

eput

y C

hief

Fin

ance

Offi

cer

at

War

wic

kshi

re N

orth

CC

G.

Indi

vidu

al h

as le

ft t

he

orga

nisa

tion.

East Leicestershire and Rutland Clinical Commissioning Group Annual Report 2016/17 vi | vii

Nam

eJo

b T

itle

Fin

anci

al In

tere

sts

No

n-fi

nan

cial

p

rofe

ssio

nal

in

tere

sts

No

n-fi

nan

cial

p

erso

nal

inte

rest

Ind

irec

t In

tere

sts

Act

ion

s to

be

take

n t

o

mit

igat

e th

e ri

sks

(s

ee C

on

flic

ts o

f In

tere

st

Polic

y fo

r d

etai

ls)

Mr

Ala

n

Fred

eric

k Sm

ith

Inde

pend

ent

Lay

Mem

ber

N/A

Mem

ber

of t

he

Cha

rter

ed In

stitu

te

of P

ublic

Fin

ance

and

A

ccou

ntan

cy.

N/A

N/A

N/A

Mr

Tim

Sa

cks

Chi

ef

Ope

ratin

g O

ffice

r

N/A

N/A

N/A

Wife

was

a p

artn

er a

t O

akha

m M

edic

al P

ract

ice

(fro

m 1

st J

uly

2013

- e

nd

Febr

uary

201

5).

N/A

Mrs

Car

mel

O

’Bri

enC

hief

Nur

se

and

Qua

lity

Offi

cer

N/A

Mem

ber

of R

oyal

C

olle

ge o

f N

ursi

ng.

N/A

N/A

N/A

Mrs

Do

nn

a En

ou

x

(fro

m 2

6 M

ay 2

015,

pr

evio

usly

in

terim

CFO

)

Chi

ef F

inan

ce

Offi

cer

N/A

Mem

ber

of t

he

Cha

rter

ed In

stitu

te

of M

anag

emen

t A

ccou

ntan

ts.

N/A

N/A

N/A

Mrs

Jan

e C

hap

man

(u

ntil

Dec

embe

r 20

16)

Chi

ef S

trat

egy

and

Plan

ning

O

ffice

r

N/A

Mem

ber

of t

he

Inst

itute

of

Hea

lth

Car

e M

anag

emen

t.

N/A

Hus

band

is D

eput

y C

hief

Fin

ance

Offi

cer

at

War

wic

kshi

re N

orth

CC

G.

Indi

vidu

al h

as le

ft t

he

orga

nisa

tion.

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eJo

b T

itle

Fin

anci

al In

tere

sts

No

n-fi

nan

cial

p

rofe

ssio

nal

inte

rest

sN

on

-fi

nan

cial

p

erso

nal

in

tere

st

Ind

irec

t In

tere

sts

Act

ion

s to

be

take

n t

o m

itig

ate

the

risk

s

(see

Co

nfl

icts

of

Inte

rest

Po

licy

for

det

ails

)

Dr

Tim

D

anie

lC

onsu

ltant

in

Publ

ic H

ealth

M

edic

ine

Con

sulta

nt in

Pub

lic

Hea

lth M

edic

ine

– Le

ices

ters

hire

C

ount

y C

ounc

il (f

rom

01

.04.

2013

); E

ast

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land

s Pu

blic

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lth

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datio

n Pr

ogra

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e D

irect

or f

or L

NR;

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larie

d G

P K

egw

orth

an

d G

otha

m M

edic

al

Prac

tice;

Ses

sion

al

GP

for

Not

tingh

am

Emer

genc

y M

edic

al

Serv

ices

.

Mem

ber

of R

oyal

Col

lege

of

Gen

eral

Pra

ctiti

oner

s an

d B

ritis

h M

edic

al

Ass

ocia

tion.

Fel

low

of

Facu

lty o

f Pu

blic

Hea

lth

N/A

Wife

app

oint

ed a

s N

on-E

xecu

tive

Dire

ctor

at

Der

by H

ospi

tals

Fo

unda

tion

Trus

t (O

ctob

er 2

014)

.

Wife

is P

rofe

ssor

of

Hea

lthca

re R

esea

rch

at U

nive

rsity

of

Not

tingh

am .

In r

elat

ion

to fi

nanc

ial i

nter

ests

, to

ensu

re

indi

vidu

al d

oes

not

part

icip

ate

in t

he

deci

sion

-mak

ing

proc

ess

in c

omm

ittee

m

eetin

gs (e

.g t

o ab

sent

the

mse

lves

fro

m

mee

tings

at

the

rele

vant

poi

nt o

n th

e ag

enda

); du

ring

proc

urem

ent

proc

esse

s in

divi

dual

s to

see

k ad

vice

if a

nd u

p to

w

hich

par

t of

the

pro

cess

indi

vidu

als

can

be in

volv

ed in

, or

not

invo

lved

with

at

all

etc.

Dr

Tab

ith

a Lo

uis

e R

and

ell

Con

sulta

nt

Paed

iatr

ic

Endo

crin

olog

ist

(Boa

rd m

embe

r:

seco

ndar

y ca

re

clin

icia

n)

Con

sulta

nt P

aedi

atric

En

docr

inol

ogis

t,

Not

tingh

am U

nive

rsity

H

ospi

tals

NH

S Tr

ust.

Clin

ical

Tea

chin

g Fe

llow

, W

arw

ick

Med

ical

Sc

hool

. Rec

eive

d le

ctur

e fe

es f

rom

Nov

oNor

disk

, Li

lly a

nd A

bbot

t

Mem

ber

of B

ritis

h So

ciet

y of

Pae

diat

ric E

ndoc

rinol

ogy

and

Dia

bete

s.

Mem

ber

of B

ritis

h M

edic

al

Ass

ocia

tion.

Fello

w o

f th

e Ro

yal C

olle

ge

of P

aedi

atric

s an

d C

hild

H

ealth

.

Mem

ber

of a

dvis

ory

boar

d of

dia

bete

s.co

.uk

N/A

Hus

band

is e

mpl

oyed

by

Lei

cest

ersh

ire

Part

ners

hip

Trus

t as

Pa

edia

tric

Adv

ance

d N

urse

Pra

ctiti

oner

.

In r

elat

ion

to fi

nanc

ial i

nter

ests

, to

ensu

re

indi

vidu

al d

oes

not

part

icip

ate

in t

he

deci

sion

-mak

ing

proc

ess

in c

omm

ittee

m

eetin

gs (e

.g t

o ab

sent

the

mse

lves

fro

m

mee

tings

at

the

rele

vant

poi

nt o

n th

e ag

enda

); du

ring

proc

urem

ent

proc

esse

s in

divi

dual

s to

see

k ad

vice

if a

nd u

p to

w

hich

par

t of

the

pro

cess

indi

vidu

als

can

be in

volv

ed in

, or

not

invo

lved

with

at

all

etc.

Appendix 3 List of GP Member Practices

Blaby and Lutterworth locality

Countesthorpe Health Centre Central Street, Countesthorpe, Leicestershire, LE8 5QJ.

Wycliffe Medical Practice Gilmorton Road, Lutterworth, Leicestershire, LE17 4EB.

Kingsway Surgery 23 Kingsway Narborough Road South, Leicester, LE3 2JN.

The Limes Medical Centre 65 Leicester Road, Narborough, Leics, LE19 2DU

Glenfield Surgery 111 Station Road, Glenfield, Leicestershire, LE3 8GS.

Forest House Medical Centre 2a Park Drive, Leicester Forest East, Leicester, LE3 3FN.

Northfield Medical Centre Villers Court, Blaby, Leicestershire, LE8 4NS.

Hazelmere Medical Centre 58 Lutterworth Road, Blaby, Leicester, LE8 4DN.

Narborough Health Centre Thornton Drive, Narborough Leicestershire, LE19 2GX.

The Masharani Practice Gilmorton Road, Lutterworth, Leicestershire, LE17 4EB.

Enderby Medical Centre Shortridge Lane, Enderby Leicestershire, LE19 4LY.

Melton, Rutland and Harborough locality

Kibworth Health Centre Smeeton Road, Kibworth, Leicestershire, LE8 0LG.

Market Harborough Medical Centre 67 Coventry Road, Market Harborough, Leicestershire, LE16 9BX.

Oakham Medical Practice Cold Overton Road Oakham, Rutland, LE15 6NT.

Market Overton Surgery (& Somerby) Thistleton Road, Market Overton, Oakham, Leicestershire, LE15 7PP.

Long Clawson Medical Practice Long Clawson, Nr Melton Mowbray Leicestershire, LE14 4PA.

Billesdon Surgery 4 Market Place, Billesdon, Leicestershire, LE7 9AJ.

Dr Kilpatrick & Partners 2a Station Road Kibworth, Leicestershire, LE8 0LN.

Latham House Medical Practice Sage Cross Street, Melton Mowbray, Leicestershire, LE13 1NX.

The County Practice Syston Health Centre, Melton Road, Syston, Leicestershire, LE7 2EQ.

Empingham Medical Centre Main Street, Empingham Oakham, Rutland Leicestershire, LE15 8PR

The Uppingham Surgery Northgate Uppingham, Rutland, Leicestershire, LE15 9EG.

The Jubilee Medical Practice 1330 Melton Road Syston, Leicestershire, LE7 2EQ.

Husbands Bosworth Surgery Kilworth Road Husbands Bosworth Leicestershire, LE17 6JZ.

Oadby and Wigston locality

Bushloe End Surgery 48 Bushloe End, Wigston, Leicestershire, LE18 2BA

Central Surgery Brooksby Drive, Oadby Leicester, LE2 5AA.

Rosemead Drive Surgery 103 Rosemead Drive Oadby, Leicestershire, LE2 5PP.

The Croft Medical Centre 2 Glen Road, Oadby Leicestershire, LE2 4PE.

Wigston Central Surgery 48 Leicester Road Wigston, Leicestershire, LE18 1DR.

South Wigston Health Centre 80 Blaby Road, South Wigston, Leicestershire, LE18 4SE.

Severn Surgery 159 Uplands Road Oadby, Leicestershire, LE2 4NW.

Appendix 4 Members of CCG Committees

Titl

e

Firs

t N

ame

Last

Nam

e

Go

vern

ing

Bo

dy

Au

dit

Co

mm

itte

e

Fin

ance

an

d A

ctiv

ity

Co

mm

itte

e (d

ises

tabl

ishe

d Ju

ly 2

016)

Fin

anci

al T

urn

aro

un

d C

om

mit

tee

(est

ablis

hed

July

201

6)

Qu

alit

y an

d P

erfo

rman

ce C

om

mit

tee

(d

ises

tabl

ishe

d Ju

ly 2

016)

Inte

gra

ted

Go

vern

ance

Co

mm

itte

e (e

stab

lishe

d Ju

ly 2

016)

Rem

un

erat

ion

Co

mm

itte

e

Stra

teg

y, P

lan

nin

g a

nd

Co

mm

issi

on

ing

C

om

mit

tee

(dis

esta

blis

hed

July

201

6)

Prim

ary

Car

e C

om

mis

sio

nin

g C

om

mit

tee

Mrs. Karen English ✓ ✓ ✓ ✓

Mrs. Jane Chapman (until end Dec 2016)

✓ ✓ ✓ ✓

Mrs. Carmel O'Brien ✓ ✓ ✓ ✓ ✓ ✓

Mr. Timothy Sacks ✓ ✓ ✓ ✓ ✓ ✓

Mrs Donna Enoux ✓ ✓ ✓ ✓ ✓ ✓ ✓

Dr Nicholas Glover ✓ ✓ ✓

Dr Hilary Fox ✓ ✓ ✓

Dr Richard Hurwood (until end Sept 2016)

✓ ✓

Dr Graham Johnson ✓ ✓ ✓ ✓ ✓

Dr Girish Purohit ✓ ✓ ✓

Dr Vivek Varakantam ✓ ✓ ✓ ✓ ✓

Dr Andy Ker ✓ ✓ ✓ ✓

Dr Richard Palin Chair ✓

Dr Tabitha Randell ✓ ✓ Chair Chair

Dr Tim Daniel ✓ ✓ ✓ ✓ ✓

Mr. Warwick Kendrick ✓ Chair ✓ ✓ ✓

Mr. Alan Smith ✓ ✓ Chair Chair Chair

Mr. Clive Wood ✓ ✓ ✓ Chair

East Leicestershire and Rutland Clinical Commissioning Group Annual Report 2016/17 viii | ix

Appendix 5 Attendance at Governing Body meetings held in public (April 2016 – March 2017) (N.B. Governing Body meetings were held bi-monthly at the beginning of the year, then monthly thereafter)

TitleFirst Name

Last NameMay 2016

July 2016

Sept 2016

Oct 2016

Nov 2016

Dec 2016

Jan 2017

Feb 2017

Mar 2017

Mrs Karen English ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Mrs Jane Chapman Deputy attended ✓ ✓ ✓ X Deputy

attendedDeputy

attendedDeputy

attendedDeputy

attended

Mrs Carmel O'Brien ✓ ✓ ✓ Deputy attended ✓ ✓ ✓ ✓ ✓

Mr Timothy Sacks ✓ ✓ ✓ ✓ ✓ ✓ ✓ Deputy attended ✓

Mrs Donna Enoux ✓ ✓ ✓ ✓ ✓ ✓ ✓ Deputy attended ✓

Dr Nicholas Glover ✓ X ✓ ✓ ✓ ✓ ✓ ✓ ✓

Dr Hilary Fox ✓ ✓ X ✓ ✓ ✓ ✓ ✓ ✓

Dr Richard Hurwood ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Dr Graham Johnson ✓ X ✓ ✓ ✓ ✓ ✓ ✓ ✓

Dr Girish Purohit ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Dr Vivek Varakantam ✓ ✓ X ✓ ✓ ✓ ✓ ✓ ✓

Dr Andy Ker ✓ ✓ ✓ X ✓ ✓ X ✓ ✓

Dr Richard Palin ✓ X ✓ ✓ ✓ ✓ ✓ ✓ ✓

Dr Tabitha Randell ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Dr Tim Daniel ✓ ✓ ✓ ✓ ✓ Deputy attended ✓ ✓ ✓

Mr. Warwick Kendrick ✓ X ✓ ✓ ✓ ✓ ✓ ✓ ✓

Mr. Alan Smith ✓ ✓ ✓ X ✓ ✓ ✓ ✓ ✓

Mr. Clive Wood ✓ ✓ ✓ X ✓ X ✓ ✓ ✓

Appendix 6 Key corporate risks 2016/17

• BAF 1 - QUALITY – ACUTE: The quality of care provided by acute providers does not match commissioner’s expectation with respect to quality and safety..

• BAF 2 QUALITY – NON-ACUTE:

o BAF 2a: The quality of care provided by non- acute providers does not match commissioner’s expectation with respect to quality and safety.

o BAF 2b: EMAS remains within CQC domain of ‘inadequate’ for safety and have been issued a Section 29 Notice, therefore are subject to the delivery of a Quality Improvement Plan within agreed timescales

• BAF 3 QUALITY – PRIMARY CARE: The quality of care provided by primary care providers does not match commissioner’s expectation with respect to quality and safety.

• BAF 4 COLLABORATIVE COMMISSIONING: Collaborative commissioning arrangements fail to represent, transact, performance manage and deliver the required outcomes of the CCG’s Commissioning Intentions (risk was closed and archived during 2015/16).

• BAF 5 – QIPP:

o BAF 5a: CCG QIPP programme, comprising CCG, Better Care Fund (BCF) and Better Care Together (BCT) initiatives fail to deliver against the CCG QIPP Plan resulting in failure to deliver in-year efficiencies and transform delivery for sustainable efficiency.

o BAF 5b: Robust systems and processes are not in place to support the CCG QIPP Programme comprising of CCG, BCF and BCT initiatives.

• BAF 6 - OUT OF HOSPITAL – PRIMARY CARE: Risk in relation to Out of Hospital Services – Primary Care:

o BAF 6a - Primary Care Commissioning – ability to perform delegated duties whilst maintaining member relations.

o BAF 6b - Primary Care transformation – the workforce and capability of general practice and CCG to develop transformation.

o BAF 6c: Finance – budget inherited from NHS England covers current costs / service and therefore new development and transformation will require additional funding (e.g. premises).

• BAF 7: OUT OF HOSPITAL – COMMUNITY SERVICES: Failure to agree service model for future Out of Hospital Services further to consultation and engagement.

• BAF 8: URGENT CARE: Increased pressure on the Emergency Department which could result in sub-optimal care due to ability to access urgent care services.

• BAF 9: ORGANISATIONAL CAPACITY: Organisation is at risk of not being able to meet its statutory functions due to capacity within teams.

• BAF 10: FINANCE: Non achievement of 16/17 year end control total surplus.

• BAF 11: EPRR: Lack of systematic and continuous processes in place for Emergency Preparedness, Resilience and Response (EPRR).

• BAF 12: COMMISSIONING SUPPORT: Commissioning Support Provider fails to deliver contracted standards, KPIs and outcomes. (CCGs are accountable for CSU delivery from April 2015)

• BAF 13: CONTINUING HEALTH CARE (CHC): Lack of engagement from current Provider during procurement of CHC

East Leicestershire and Rutland Clinical Commissioning Group Annual Report 2016/17 x | xi

East Leicestershire and Rutland CCG Leicestershire County Council, Room G30, Pen Lloyd Building, County Hall, Glenfield, Leicester LE3 8TB

0116 295 3405

www.eastleicestershireandrutlandccg.nhs.uk

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