Governing Body Agenda Body/26 M… · 5.1 System Resilience Pla n and CCG QIPP Plan GB Presentation...

Governing Body Agenda

Thursday 26 May 2016 Drawing Room, Northwood House, Ward Avenue, Cowes, Isle of Wight, PO31 8AZ

Governing Body

AGENDA

Thursday, 26 May 2016, 10:30-13:00hrs Drawing Room, Northwood House, Ward Avenue, Cowes, Isle of Wight, PO31 8AZ

1. 1.1

Apologies for absence:

JR

10:30

1.2 Declaration of Interests JR GB16-007

1.3 Confirmation that the Meeting is Quorate JR

2. Minutes of the last Governing Body Meeting 28 April 2016 JR GB16-008 3. Matters Arising from the Minutes 3.1 Schedule of Actions from the 28 April 2016 JR GB16-009 10:35 4. Chair / Chief Officer Report JR/HS Verbal 10:40 5. Items for Assurance 5.1 System Resilience Plan and CCG QIPP Plan GB Presentation 10:45 5.2 Performance Report LK/GB/LO GB16-010 5.3 Risk Register Summary CM GB16-011 11:25 6. Items for Approval 6.1 Annual Report and Annual Accounts LO GB16-012 11:35 6.2 Governing Body Assurance Framework CM GB16-013 11:45 6.3 External Audit Report – TO FOLLOW LO GB16-014 11:55 6.4 Policy Statement - Knee Arthroscopy GB GB16-015 12:05 6.5 Policy Statement - Flexible Sigmoidoscopy in Suspected Colorectal

Cancer GB GB16-016

6.6 Policy Statement - Cholecystectomy for patients with asymptomatic gallstones

GB GB16-017

6.7 Hampshire and Isle of Wight Sustainability Transformation Plan HS Verbal 12:15 6.8 Fight the Wight – CCG Support HS Verbal 12:25 7. Items to Receive/For Discussion 7.1 Whole Integrated System Redesign (WISR) and My Life A Full Life

(MLAFL) Update Report GB GB16-018 12:35

7.2 Five Year Forward View – General Practice CM Presentation 12:50 8. Minutes to Receive 8.1 Clinical Executive Minutes 24.03.16 and 21.04.16 HS GB16-019 12:55 8.2 Quality and Patient Safety Committee Minutes 24.03.16 IR GB16-020 8.3 Audit Committee 24.03.16 LO GB16-021 9. Any Other Urgent Business JR

10. Motion to exclude the Press and Public JR 13:00 - that representatives of the press, and other members of the

public, be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest’, (Section 1 (2), Public Bodies (Admission to Meetings) Act I960)

11. Date of Next Meeting – Thursday 07 July 2016 10:30 – 13:00hrs – Arreton Community Centre, Main Road, Arreton, Newport, Isle of Wight, PO30 3AA

Circulation: Members In attendance:

For Information (Agenda):

Martyn Davies – Governing Body Lay Member - Governance Dr Joanna Hesse – CCG Clinical Executive Loretta Kinsella – Director of Quality and Clinical Services David Newton –Governing Body Lay Member – Patient and Public Involvement Loretta Outhwaite – Chief Finance Officer Dr Ian Reckless – Secondary Care Doctor Dr John Rivers – CCG Chair (Chair) Helen Shields – Chief Officer Laurence Taylor – Governing Body Lay Member- Independent Lindsay Voss – Governing Body Nurse

Tracy Richards, Governance Support Officer (Minutes) Caroline Morris, Head of Primary Care and Corporate Business.

Gillian Baker For Information (Minutes): Karen Morgan, Head of Quality Linda Rann, Sue Lightfoot, Rachael Hayes, Dawn Berryman, Eleanor Roddick - Heads of Commissioning, Teresa Day, Acting Deputy Head of Medicine’s Management, Caroline Morris – Head of Corporate Business Rebecca Wastall – Deputy Chief Finance Officer Lucy Savill, Information Governance Manager

Invited: Caroline Morris – Head of Corporate Business

Governing Body Declaration of Governing Body Members’ Interests Sponsor: Helen Shields, Chief Officer

Summary of issue:

This paper sets out the relevant and material interests of the members of the CCG Governing Body. It represents the Register of Interests as required by the Standing Orders in accordance with the NHS Code of Accountability.

This paper supports the CCG Governing Body to fulfil its Standing Orders in accordance with the NHS Code of Accountability.

Action required / recommendation:

The CCG Governing Body is being asked:

• To receive and note the register of interests of members and ensure that members play no part in discussion or decision where a conflict of interest is established.

• To receive any oral updates on the interests of members.

Principle risk(s) relating to this paper:

There are no risks relating to this paper.

Other committees where this has been considered:

This paper has not been considered at any other committee.

Financial / resource implications:

There are no financial or resource implications arising from this paper.

Legal implications / impact:

There are no legal implications arising from this paper.

Public involvement /action taken:

There has been no public involvement or action taken.

Equality and diversity impact:

This paper does not request decisions that impact on equality and diversity

Author of Paper: Tracy Richards, Governance Support Officer

Date of Paper: May 2016

Date of Meeting: 26 May2016

Agenda Item: 1.2 Paper number: GB16-007

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Declaration of Interest

1. Introduction

1.1 The NHS Code of Accountability requires the Governing Body to declare interests which are

relevant and material to the Governing Body of which they are a member.

1.2 Interests which should be regarded as “relevant and material” are:

• Directorships, including non-executive directorships held in private companies or PLCs (with the exception of those of dormant companies);

• Ownership or part-ownership of private companies, businesses or consultancies likely or

possibly seeking to do business with the NHS;

• Majority or controlling share-holdings in organisations likely or possible seeking to do business with the NHS;

• A position of authority in a charity or voluntary organisation in the field of health or social

care;

• Any connection with a voluntary or other organisation contracting for NHS services;

• Research funding/grants that be received by an individual or their department;

• Interests in pooled funds that are under separate management (any relevant company included in this fund that has a potential relationship with the CCG must be declared);

1.3 Any Governing Body Member who comes to know that the CCG Governing Body has entered

into or proposed to enter into a contract in which he/she or any person connected with him/her (as defined in the Standing Orders) has any pecuniary interest, direct or indirect, the Governing Body member shall declare his/her interest by giving notice in writing of such fact to the CCG Governing Body as soon as practicable.

1.4 The Chief Officer will ensure that a Register of Interests is established to record formally declarations of interests of Governing Body Members. Interests will be declared at Governing Body meetings to ensure they are known to the public.

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2. Register of Interests

Name Relevant and Material Interests Gillian BAKER Deputy Chief Officer

Gillian’s has no interests to declare.

Last Updated/Noted: March 2016 Martyn DAVIES Governing Body Lay Member

Martyn has no declarations of interests.

Last Updated/Noted: November 2015 Dr Joanna HESSE Clinical Executive Member

Joanna is: A GP Partner at Esplanade Surgery, Ryde, Isle of Wight. Joanna undertakes private practice within Esplanade Surgery, Ryde, Isle of Wight. Esplanade Surgery is a member of the One Wight Health IOW GP collaborative. The surgery has one share in the GP collaborative. Joanna has a contract with Isle of Wight GP Out of Hours (OOH) service to work in OOH on the Bank.

Last Updated /Noted: January 2016 Loretta KINSELLA Director of Quality and Clinical Services

Loretta has no declarations of interest. Last Updated / Noted: December 2015

Caroline MORRIS Head of Primary Care and Corporate Business

Caroline is: Parent Governor of Christ the King College. Partner of Jason Mack, current Mayor at Ventnor Town Council.

Last Updated/Noted: March 2016 David NEWTON Governing Body Lay Advisor

David is: Director of Social Enterprise Foundation CIC and Social Enterprise Foundation Members Ltd. A Senior Partner at Corporate Impact. Contracted by Priory Asset Management. A facilitator for the Patient and Public Involvement Lay Member Network. Member of the NHS England Board Level Task and Finish Group on Patient and Public Involvement. Board member of Vectis Housing Association. Is the Lay Chair for the Whole Integrated System Re-Design (WISR) Board. Has agreed to carry out a small piece of work commissioned through a National Charity for Ventnor

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Town Council. Last Updated / Noted: February 2016

Loretta OUTHWAITE Chief Finance Officer

Loretta is a School Governor at the Island Free School. Last Updated / Noted: July 2015

Dr Ian RECKLESS Secondary Care Doctor

Ian is: Employed as Medical Director and Consultant Physician by Milton Keynes University Hospital NHS Foundation Trust. He is Honorary Consultant Stroke Physician at Oxford University Hospitals NHS Foundation Trust and Honorary Senior Clinical Lecturer, Oxford University. Ian undertakes ad hoc work with the Care Quality Commission and the Parliamentary and Health Service Ombudsman. He receives occasional royalties from Oxford University Press and Blackwell-Wiley in respect of prior publications.

Last Updated / Noted: March 2016 Dr John RIVERS Chair, Clinical Executive Member

John is: President of Cruse Bereavement Care IW John works occasional (up to 5 hours a week) sessions for Beacon (OOH GP Service)

Last Updated / Noted: May 2016 Helen SHIELDS Chief Officer

Helen’s husband is Head of Podiatry and Orthopaedic Triage at IW NHS Trust.

Last Updated / Noted: September 2015 Laurence TAYLOR Governing Body Lay Member

Laurence is: Director of Bembridge Airport Ltd and Bembridge Farm Ltd. He is employed by EU & FT Taylor Ltd

Last Updated /Noted: January 2016 Lindsay VOSS Governing Body Nurse

Lindsay is: Lay member for National Catholic Safeguarding Commission Lindsay’s husband is employed in Pharmaceutical industry (Eli Lilly and Company)

Last Updated / Noted: May 2016

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Governing Body Minutes of the Governing Body 28 April 2016

Sponsor: Helen Shields, Chief Officer

Summary of issue: Minutes of the previous Governing Body Meeting 31 March 2016.

Action required/ recommendation: To approve the minutes of the Governing Body 28 April 2016.

Principle risks: There are no risks relating to this paper.


This paper has not been considered at any other committees.

Financial /resource implications: There are no financial or resource implications.

Legal implications/ impact: These minutes form a formal public record of the previous meeting.

Public involvement /action taken: The Governing Body was held in public.

Equality and diversity impact: There is no equality and diversity impact relating to this paper.

Author of paper: Tracy Richards, Governance Support Officer

Date of Paper: April 2016

Date of Meeting: 26 May 2016

Agenda Item: 2 Paper number: GB16-008

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NHS Isle of Wight Clinical Commissioning Group: Governing Body

Minutes of Part 1 of the CCG Governing Body held on Thursday 28 April 2016 at 09:30hrs at Riverside Centre, The Quay, Newport, Isle of Wight, PO30 2QR

PRESENT: Martyn Davies (MD) – Governing Body Lay Member – Governance (Chair) Gillian Baker (GB) – Deputy Chief Officer

Dr Joanna Hesse (JH) – CCG Clinical Executive Loretta Kinsella (LK) – Director of Quality and Clinical Services David Newton (|DN), Governing Body Lay Member – Patient and Public Involvement Loretta Outhwaite (LO) – Chief Finance Officer Helen Shields (HS) – Chief Officer Lindsay Voss (LV) – Governing Body Nurse

IN ATTENDANCE: Caroline Morris (CM) – Head of Primary Care and Corporate Business Rebecca Wastall (RW) – Deputy Chief Finance Officer

MINUTED BY: Tracy Richards (TR) – Governance Support Officer

1. Apologies for Absence 16-001 Apologies for absence were received from, Dr Ian Reckless, Dr John Rivers and Laurence

Taylor.

1.1 Declarations of Interest 16-002 The Governing Body received and noted paper GB16-001 Declaration of Interests. There

were no new declarations made.

The Governing Body noted the Declaration of Interest. 1.2 Confirmation the Meeting is Quorate 16-003 Confirmed. 2. Minutes of the Last Governing Body Meeting 31 March 2016 16-004 The Governing Body received paper GB16-002 Minutes of the last Governing Body

Meeting held on 31 March 2016. The minutes were approved as an accurate record.

The Governing Body approved the Governing Body Minutes of the 31 March 2016. 3. Schedule of Actions 16-005 The Governing Body received and noted paper GB16-003 Schedule of Actions from 31

March 2016. It was agreed that the Schedule of Actions will be carried forward to the next Governing Body meeting.

The Governing Body received the Schedule of Actions.

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4. Items for Approval 4.1 2016/17 Financial Plan and Budget 16-006 The Governing Body received paper GB16-004 2016/17 Financial Plan and Budget,

presented by LO and RW. The NHS Isle of Wight CCG 2016/17 Interim Financial Plan and Budget has been updated to form the final paper. The key changes are: • £1.3m increase in acute contract costs. • £0.7m increase in primary care related forecast costs. • £2.6m increase in the savings from the Quality, Innovation, Productivity and Prevention (QIPP) programme. The forecast position remains unchanged, at break-even, which means that the CCG is not meeting the national business rule of achieving a 1% surplus. To support the development of a Financial Recovery Plan and put actions in place to immediately improve the financial position, the CCG has been required to appoint a Turnaround Director, for an initial 3 month focused piece of work. This piece of work will take a health and care system approach, recognising that decisions and actions are likely to affect the financial position of health and care partners. The 2016/17 Financial Plan and Budgets will evolve, as the financial recovery work progresses. DN asked why there were more savings than increased cost? RW confirmed that the increase in QIPP is due to additional cost pressures that have materialised since the interim plan assumptions were made. LV asked if it will be the CCG employing a Turnaround Director, LO confirmed that NHS England (NHSE) will support the CCG in identifying the right person and the CCG will appoint. LV asked is there confidence that a Turnaround Director will help with partners and will this be beneficial. LO confirmed that Terms of Reference (ToR) is being drawn up and there will be monthly meetings held and the CCG, IOW NHS Trust and Local Authority (LA) will be working together. GB confirmed that Sandy Hogg, Interim Associate Director of Commissioning is currently carrying out a system-wide approach in regard to savings. DN shared that he feels this is positive and real savings across the Isle of Wight system will be identified. HS agreed that this will drive out inefficiencies. MD asked in regard to any possible consequences of not meeting the national business rule, it was confirmed that the requirement/consequence is to appoint a Turnaround Director. LO confirmed that there will be governance meetings held including monthly meetings with the Wessex Area Team and quarterly meetings with the Regional Finance Team. MD asked is the non-recurring savings achievable in this current year. LO confirmed that this is challenging, but achievable schemes are being identified to assist with 2017/18. The Governing Body approved the Final 2016/17 Financial Plan and Budget for NHS Isle of Wight CCG.

Page 3 of 8

The Governing Body approved the 2016/17 Financial Plan and Budget. 4.2 Operational Plan 16-007 The Governing Body received paper GB16-005 Operational Plan, presented by GB. This

document is the Final CCG Operational Plan. The document sets out the key requirements to be delivered in 2016/17 for the CCG in meeting its strategic intent, its financial duties, and quality and performance requirements. It incorporates all the key lines of enquiry as required by NHS England to demonstrate how we can deliver the Five Year Forward View.

A draft Operational Plan was submitted to the Governing Body on 31 March 2016 and the final Operational Plan was submitted on 18 April 2016. GB highlighted the main changes:

The CCG has now agreed the demand, capacity and performance trajectories with providers and have modelled the impact on finances. Referral to Treatment (RTT) targets will be to achieve 92% by November 2016 and A&E to achieve 92%, this area will not reach 95% (the NHS Constitution standard). The CCG also has a more detailed System Resilience Plan to help deliver this performance.

Page 13 includes an update on the Sustainability Transformation Plan (STP).

Page 25 includes the System Resilience Plan; the main focus is flow across the whole system. Page 26/27 shows a detailed plan, this has been supported and approved through a multi-agency System Resilience Group.

Page 54 – Section 6 has been updated to reflect the current position with mainland providers as well as the IOW NHS Trust.

In regard to Quality, National and Local CQUINS have been included identifying a Local CQUIN for Holistic Care including prevention and management of Slips, Trips and Falls within a Trust environment.

Page 83 is in regard to Quality Premium and three local measures have been agreed, which are:

• Percentage of patients returning to their usual place of residence following a stoke. • Percentage of pregnant women vaccinated for Flu. • Percentage of older people (65+) who receive Re-ablement/Rehabilitation services

after discharge from Hospital.

MD asked in regard patient feedback for off-Island treatment, GB confirmed that feedback in regard to patient experience has been positive, JH also confirmed this. MD commented that a lot of the public appear amenable to go to the mainland, DN advised that people need to feel cared for throughout the whole period and reassurance is required.

DN commented on how well the document has been presented and asked in regard to Page 25, Stakeholder Engagement, can the CCG give assurance that there is preparation in place for ongoing engagement. GB gave assurance that this is in place.

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GB confirmed that a person-friendly version of the Operational Plan will be prepared for the public and will be placed on the CCG website in due course.

GB advised that the Delivery Plans are incorporated within the Operational Plan, but are subject to change as priorities will be identified as the Whole Integrated System Redesign (WISR) progresses.

HS thanked the whole organisation for the preparation of this paper.

The Governing Body approved and noted the Operational Plan. 4.3 Better Care Fund (BCF) 16-008 The Governing Body received paper GB16-006 Better Care Fund (BCF), presented by GB.

The final submission for the BCF date is now 3rd May 2016 and the submission date for the Section 75 is 30 June 2016. The BCF Plan sets out how the CCG and Isle of Wight Council will meet the national requirements for 2016/17.

The Better Care Fund (BCF) is a single pooled budget for health and social care services which has been created nationally to drive integrated health and adult social care services through greater integrated commissioning and provision.

GB highlighted the following areas:

Page 2 identifies the specific requirements, which include eight national conditions. The BCF supports integrated commissioning and integration of provision.

Page 6 – The Case for Change, financial pressures are now highlighted, GB advised that the combined deficit on the Isle of Wight is vast and a system-wide approach is paramount.

Page 7 – the new community model is now included.

Page 16 – National Conditions for the BCF – Maintain the Protection of Adult Social Care.

GB advised that the BCF includes nationally funded NHS support for Social Care and the CCG provide additional support during 2015/16, but this has not been a possibility for 2016/17, although the CCG has given additional funding of £1m, the Council still has a financial gap of £1.4m.

Page 18 – Delayed Transfer of Care, this area has been updated as Mental Health delayed discharges were not identified, this has now been rectified, which impacts upon the baseline. Page 22 identifies metrics, although the data is not as robust as the CCG would like.

Page 21 still requires finalisation, the data is being provided by the Local Authority and this is in the process of being clarified and will be submitted on 29 April 2016.

Pages 24 and 25, changes have been made and Governance has been strengthened.

Page 26 – Risk Table changes have been made and it was agreed that an additional bullet point will be added to the protecting social care mitigating factors to include that the

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senior finance team will meet monthly and workforce shortages to include improvement of recruitment on the Isle of Wight.

GB confirmed that the BCF has increased by 42% from £22m to £31m and out of hospital provision has now been included.

LK requested that in regard to Delayed Transfer of Care for Mental Health that this identifies acute and dementia, as different care is required.

DN commented that if there is an expectation of treatment of patients on the Isle of Wight that a joint approach is implemented.

LV asked is there an oversight of national data for BCF. GB confirmed that there is a large infrastructure for the BCF.

MD confirmed that the deadline for the BCF is 03 May 2016 and the deadline for agreement of Section 75 is 30 June 2016, GB confirmed this and advised that the CCG anticipate end of May 2016 for the Section 75 agreement, it was confirmed that the Section 75 identifies accountabilities.

LO confirmed that the Isle of Wight is a National Vanguard site and work-streams supporting the financial elements include the BCF and going forward the BCF will feature more in transformation work.

DN asked in regard to Page 15 – Outcomes, is there an assumption of who will complete these. GB confirmed that the BCF ties everything together as an overall agreement of working together.

It was agreed that the update on the agreement/outcomes are to be submitted to the next Governing Body.

The Governing Body approved and noted the Better Care Fund. ACTION: BCF updates to be submitted to Governing Body on 26 May 2016. GB 4.4 Governing Body Assurance Framework (GBAF) 16-009 The Governing Body received paper GB16-007 Governing Body Assurance Framework

(GBAF) presented by CM. The Integrated Governance Strategy requires the CCG to have a Governing Body Assurance Framework (GBAF) which identifies the key risks to the organisation’s objectives. This is a framework which identifies CCG work consolidated into objectives, 2015/16 GBAF has been scrutinised and it was agreed that this does not meet the need for 2016/17. The paper is the first step to creating the 2016/17 GBAF. It sets out revised objectives and the critical success factors and objectives have been grouped as Transformational and Objective. There are five overall objectives proposed – one more than last year.

Objective 1 -To support system transformation and sustainability.

Objective 2 - To meet the finance, quality, commissioning and performance targets

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within the operating plan.

Objective 3 -To implement and deliver delegated commissioning of primary care (this will be for 1-year only).

Objective 4 - To deliver a change in culture and governance within the CCG, supporting the organisation through change.

Objective 5 - To create and agree an OD Plan and change in culture within the CCG.

CM advised that the CCG is recommending the critical success and objectives and the next step will be associating risk and the full document will be submitted to the next Governing Body in May 2016.

The following comments were made:

i) The Senior Management Team has discussed the change for 2016/17 and it is felt that Objective 2, Critical Success Factors 5 and 6 require amalgamation.

ii) In regard to engagement; Sustainability Transformation Plan (STP), Stakeholder Engagement and Primary Care may require further detail and be more explicit and to be separate on Objective 4.

iii) Objective 1, Critical Success Factor 5: To deliver the case for an “island premium”, is this wording now being used again, HS confirmed that this is a collective position.

iv) Objective 4, it was felt that the wording required some adjustment as supporting the organisation through change, identified that there is something wrong, as it is currently written.

v) Objective 4, Critical Success Factor 1; To embed the My Life a Full Life behavioural framework within the CCG by the end of the financial year. How will this be monitored? It was identified that this would take place through an appraisal behaviour framework and will be qualitative rather than quantitative

vi) Objective 2 - OD to be written in full.

CM advised that there are more Critical Success Factors this coming year than previously and the document is much larger.

The Governing Body was asked to approve the contents of this paper.

The Governing Body approved subject to changes the Governing Body Assurance Framework (GBAF).

ACTION: Changes to be made to GBAF and completed document to be submitted to Governing

Body on 26 May 2016 CM

5. Any Other Urgent Business 16-010 Junior Doctors Strike – HS updated identifying that the Junior Doctors Strike was locally

managed as well as possible, there was a reduction in patients attending Beacon Centre and A&E. The IOW NHS Trust met A&E targets over the two days. There has been an

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impact, whereby elected in-patient procedures and same-day cases were cancelled, but overall was managed well.

Whole Integrated System Redesign (WISR) – DN updated advising that the process is broken down into 4 stages and is moving into stage 2. ‘Time to Act’ leaflets are being circulated to raise awareness, public consultation events are underway and surveys are being completed. Views are required for the next stage and the survey submission date is 27 May 2016.

LK commented that she has read the ‘Time to Act’ leaflet and asked if there are separate work-streams to incorporate a simpler version for the public with learning disabilities. DN assured that there is work in place to identify this area and an easy-read version is available. Additional work is being carried out to gain engagement from all communities.

HS advised that observations from Nursing/Residential Homes are important and entering this arena would be beneficial. GB confirmed that she has discussed this with James Seward, Programme Director, who will be implementing this.

6. Motion to exclude the Press and Public 16-011 MD read the following statement: “that representatives of the press, and other members

of the public, be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest’, (Section 1 (2), Public Bodies (Admission to Meetings)”

7. Date of Next Meeting: 16-012 Thursday 26 May 2016 10:30 – 13:00hrs – Drawing Room, Northwood House, Ward

Avenue, Cowes, IW, PO31 8AZ

Circulation: Members In attendance:

For Information (Agenda):

Martyn Davies – Governing Body Lay Member - Governance Dr Joanna Hesse – CCG Clinical Executive Loretta Kinsella – Director of Quality and Clinical Services David Newton –Governing Body Lay Member – Patient and Public Involvement Loretta Outhwaite – Chief Finance Officer Dr Ian Reckless – Secondary Care Doctor Dr John Rivers – CCG Chair (Chair) Helen Shields – Chief Officer Laurence Taylor – Governing Body Lay Member- Independent Lindsay Voss – Governing Body Nurse

Tracy Richards, Governance Support Officer (Minutes) Gillian Baker, Deputy Chief Officer Caroline Morris, Head of Primary Care and Corporate Business. Rebecca Wastall – Deputy Chief Finance Officer

For Information (Minutes): Karen Morgan, Head of Quality Linda Rann, Sue Lightfoot, Rachael Hayes, Dawn Berryman, Eleanor Roddick - Heads of Commissioning, Teresa Day, Acting Deputy Head of Medicine’s Management, Caroline Morris – Head of Corporate Business Rebecca Wastall – Deputy Chief Finance Officer Lucy Savill, Information Governance Manager

Invited:

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Governing Body

Matters arising: Schedule of Actions – Part 1


Summary of issue: Actions identified from previous meeting together with updates on progress to date and expected completion dates

Action required/ recommendation:

To gain assurance that the actions requested by the Governing Body are in train

Principle risks: There are no risks associated with this paper.


This paper has not been considered at any other committee.

Financial /resource implications:

There are no financial or resource implications in relation to this paper.

Legal implications/ impact:

There are no legal implications or impact relating to this paper.

Public involvement /action taken: There has been no public involvement in this paper.


Author of paper: Tracy Richards, Governance Support Officer

Date of Paper: 31 March 2016



1

Isle of Wight Clinical Commissioning Group: Governing Body SCHEDULE OF ACTIONS TAKEN FROM THE MINUTES: 28 April 2016

Date of Meeting

Minute No

Action Lead Update Due Date Status

04.02.16 15-099 An update to be provided on the Isle of Wight NHS Trust staff survey.

LK March 2016 LK confirmed that the Quality Patient and Safety Committee (QPSC) discussed the Staff Survey, it was identified that a high level analysis has been undertaken. Further exploration is required. May 2016 The CG has requested the IOW NHS Trust to produce an action plan in response to the Staff Survey and how it will align with the National CQUIN on Staff Health and Wellbeing. This will be monitored via the CQRM and QPSC meetings.

May ‘16 Closed

31.03.16 15-109 LK to discuss the OOH GP Service with David Anderson, Chair of NHS 111 Clinical Governance meeting.

LK May 2016 LK has requested DA to discuss the impact of the changes at Beacon on 111 services and monitor via the NHS 111 Clinical Governance Committee.

May ‘16 Closed

31.03.16 15-110 AH to review RAG rating for the Performance Report and in regard to 18ww RTT, separate categories for the three private providers are to be added to the performance report.

AH May 2016 May ‘16 Open

31.03.16 15-119 Local Estates Strategy paper to be presented at the next Governing Body meeting.

LO April 2016 To be added as an agenda item for May 2016 May 2016 Agenda item.

May ‘16 Closed

28.04.16 16-008 BCF updates to be submitted to Governing Body on 26 May 2016.

GB May 2016 Agenda item.

May ‘16 Closed

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Isle of Wight Clinical Commissioning Group: Governing Body SCHEDULE OF ACTIONS TAKEN FROM THE MINUTES: 28 April 2016

28.04.16 16-009 Changes to be made to GBAF and completed document to be submitted to Governing Body on 26 May 2016

CM May 2016 Agenda item.

May ’16 Closed

3

Governing Body: Performance Report May 2016

Sponsor: Loretta Outhwaite, Chief Finance Officer

Summary of issues:

1. The Governing Body is presented with a CCG Performance Report in a format that seeks to provide assurance on key performance indicators associated with Quality; NHS Constitution; CCG Outcomes Framework and Financial performance to note and comment upon.


The Governing Body is invited to:

Note and comment on the content of the Performance Report.

Principle risks:

Key Risks for the Performance Report include: Complexity and wide range of metrics and indicators with differing measurement for different purposes (eg COF, Quality Premium, CCG Assurance process) – systems in development and embedding – risk of missing vital information on all indicators continuously. Availability of data due to Health & Social Care Act compliance with Patient Identifiable Data for CCGs. New systems not yet agreed at NHS England level.


Information contained in the report has been considered at: Clinical Executive Quality & Patient Safety Committee Contract Review Meetings Internal Performance Review Meetings


Over-performance on contract activity could result in financial pressure where contracts are PBR based.

Legal implications/ impact: There are no significant legal issues within the Report.


Report is publicly available and provides patients and public with information on the CCG’s financial position and use of resources.


Requirement of providers and CCG to ensure all patients are treated in line with rights set out the in the NHS Constitution.

Author of Paper: Andrew Heyes, Head of Performance and Contracts

Date of Paper: 16 May 2016

Date of Meeting: 26 May 2016 Agenda Item: 5.2 Paper number: GB16-011

Governing Body

Summary Performance Report

May 2016

(Performance Information up to March 2016)

Governing Body, Performance Report (May 2016)


Part One Quality and Safeguarding


Part 1 – Quality and Safeguarding - Summary

Highlights

• In March the CCG received one Complaint and two Concerns, while for the IWNHST the numbers of complaints received in February was the same as in January (month’s total 21).

• Slips Trips and Falls – For March a total of 58 slips/trips and falls were reported by the IWNHST, 11 of these resulted in harm half the number of incidents reported for February, while achieving the targeted reduction in month but the cumulative total of 214 incidents missed the targeted reduction for the year. For a further month there were no falls in March that had resulted in what is classed as a serious injury, and the cumulative total for the year remained at four for such events.

• Improved Access to Psychological Therapies (IAPT)

Entering treatment – The rate achieved in March had improved to 20.33%, with a cumulative rate for the year of 22.17%. Moving to recovery – The performance rate also improved in March, achieving 62.21%, achieving the target rate of 50%.

Lowlights SIRIS – The Trust reported the number of new SIRIs in March as four, half the number reported for February 2016. For a further

month there were no (zero) new SIRIS reported for the CCG.

As at the end of March, for those SIRIs from April 2015, there was one SIRIs at the Trust for which the CCG had not received a final RCA.

• There was one Never Event reported for March of a gauze like object under the skin. A further event has been indicated to have occurred in April.

• Overall, when compared with the adjusted figures for February, total numbers of Pressure Ulcers (total Grades 2-4) occurring in a Hospital setting had increased marginally in March (plus one), while in a Community setting the numbers of Grade 2 PUs had increased by four on the number reported for February. The revised YTD cumulative totals suggest that the targeted reductions were achieved for Grades 3 and 4 in a Community setting.

• While there were no (zero) additional cases of MRSA reported for March, the total of seven cases YTD resulted in it missing the annual target of zero cases.

HCAI – C.Difficile – For March, there were three reported cases of C.Difficile associated with the IWCCG, of which two cases were identified as occurring at the IWNHST (Acute). In 2015/16 the CCG had a total of 55 cases applied to it, 27 cases above the target total of 28 cases for the year.


Part 1 – Quality and Safeguarding - Commentary

• Performance Summary – Quality Dashboard This Section provides exception reports and key highlights for quality outcomes. The dashboard provides a summary of outcomes by month, Year to Date and Trend (April 2015 – March 2016).


Part 1 – Quality and Safeguarding - Commentary continued…

Serious Incidents Requiring Investigation

In April, the Trust reported four new SIRIs occurring in month, half the total number reported for the previous month. By comparison the CCG had reported no (zero) new SIRIs in month for either March or April.

As at 30 April 2016:

• IWNHST: o For SIRIs that occurred in 2015/16, there were one for which the CCG has not received a final RCA – 1 x Slip/trip/fall.

• IWCCG: o For April, there were no (zero) SIRIS from 1st April 2014 that had breached the timescale to complete investigation, which remained open.

NB: While an RCA may have been received, these cases may still be under review and answers to queries referred to the Trusts have not been resolved.



Action:

The CCG continues to hold SIRI Review panel meetings every month, to review and close IWNHST SIRIs. Joint Panel Meetings with the IWNHST are held every other month. This provides the CCG with additional assurance on the robustness of the Trust’s SIRI process and most importantly the lessons learnt arising from SIRIs to mitigate the risk of recurrence of incidents. It also provides an opportunity for more complex SIRIs to be discussed between Commissioner and provider; to follow-up SIRIs which require additional assurance before closure by the CCG and a forum for the Trust to negotiate additional time for investigations in extenuating circumstances. In addition, The Trust Executives have committed to regular slots in their diaries to review final SIRI reports at the earliest opportunity, prior to submitting to CCG. At each of these “Integrated Panel Review” meetings, a representative from the IW Clinical Commissioning Group will be invited, so that questions and queries can be addressed in a timely way, with key staff in attendance. Following this, the final investigation report will be submitted to the CCG in usual way.

Following the unexpected death of a patient in receipt of Inpatient Mental Health services, which was subject to both internal and external review, the Trust has reviewed all unexpected deaths and mental Health/Learning Disability SIRIs between 2012-2015, to identify and learn from themes and trends. This work has supported the Trust’s appraisal and response to the ‘Mazars’ report on unexpected deaths at Southern Health NHSFT.

At the CQRM on 4 March 2016, the Mazars report was presented and discussed; an update on progress against identified actions will be received at CQRM on 5 May 2016.

The CCG SIRI, outstanding from 2014/15, was the focus of a learning event organised by the CCG and held on 13 January 2016. Representatives from organisations involved in the patient’s healthcare pathway attended. The outcomes from the event have been shared with the relatives and those who attended the event.

The recommendations for action will be presented to the End of Life Steering Group on 4 May 2016. This SIRI case will now be closed from the CCG’s perspective as the investigation has been concluded. As part of this investigation process, the expectation is that the Healthcare Providers involved in the patient’s care will take forward their own actions and monitor progress through their organisation’s own governance arrangements with a formal update to the CCG in six months’ time.

A SIRI has been reported retrospectively by the IWNHST following a pre-inquest meeting with the Coroner. The CCG has requested ‘Interested Party’ status as commissioner of the District nursing Service where the SIRI occurred. The inquest was scheduled for 22 March 2016, but has been postponed and a revised date has yet to be set.



Pressure Ulcers: Local target: Reduce total numbers (Hospital / Community) against IWNHST 2015/16 target reductions.

Local Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD

Actual

Reduction in Pressure Ulcers - Hospital

Grade 2 30% reduction 17 16 13 26 17 27 27 19 15 23 31 28 259

Grade 3 50% reduction 0 2 0 0 2 2 0 3 3 3 2 4 21

Grade 4 Zero cases 2 0 0 0 2 0 0 0 0 0 0 0 4

Reduction in Pressure Ulcers - Community

Grade 2 30% reduction 15 17 14 20 14 25 14 14 13 9 8 12 175

Grade 3 50% reduction 0 4 1 1 1 0 0 0 0 0 0 0 7

Grade 4 50% reduction 2 2 0 1 2 0 0 1 1 1 0 0 10

Total numbers for reported Pressure Ulcers (Grades 2-4) in March had increased marginally in a Hospital setting when compared with the adjusted total number for February, while in a Community setting the numbers of Grade 2 PUs had increased by four on the number reported for February.

Comparing total numbers for 2015/16 against 2014/15 - in a Hospital setting a significant increase was registered in year for the numbers of Grade 2 PUs - 259 verses 148, with a less distinct variance for Grades 3 and 4 with the numbers of Grade 4 PUs being lower in 2015/16 compared with the previous year (4 against 11) but in each case the targeted reductions were missed. In a Community setting Grade 2 PUS were again up on the previous year – 175 verses 138 while he targeted reductions were achieved for both Grade 3 and 4 PUs in a Community setting.

The pressure ulcer collaborative has continued to meet. The overall trends in a Community setting are considered encouraging and recent increases in numbers may be seen as more indicative of increased awareness and reporting of lower grades, than of increasing incidence.

NB: Figures for previous months will continue to change as validation occurs during the process of investigation.

Action:

Reviews of Pressure Ulcers continue with the move, under new guidelines, to a cluster review approach. Pressure Ulcers continue to be monitored on a monthly basis at CQRM with updates from the Trust’s Safety, Effectiveness and Experience Lead.

The CCG agreed non-recurrent funding up to the end of March 2016 for a fixed-term Tissue Viability post in the community. The post has been supporting Primary Care and Care Homes.

This post is continuing for a further year as part of a local CQUIN for 2016/17.

The CCG has requested ab evaluation report for this post from the Trust, to understand the impact it has had to date.



MRSA - IWCCG Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD

2014/15 – Number in month 0 0 0 0 0 0 0 1 0 0 0 0 1

2015/16 – Number in month 0 2 0 0 0 1 1 0 3 0 0 0

2015/16 - Cumulative total 0 2 2 2 2 3 4 4 7 7 7 7 7

Wessex Area (Cumulative totals as at March 2016)

CCG March 2016

Variance to projected total. at

Mar 2016

CCG Population

YTD Total as ratio per 100,000 population

Isle of Wight 0 7 142,297 4.93

Southampton 0 3 270,353 1.11

Fareham & Gosport 0 2 202,312 0.99

South Eastern Hampshire 0 2 211,593 0.94

West Hampshire 1 3 549,353 0.55

North East Hampshire & Farnham 0 1 222,931 0.45

Dorset 1 1 782,692 0.13

Portsmouth 0 0 218,809 0.0

North Hampshire 0 0 220,801 0.0

Source: Public Health England (via South Commissioning Support Unit, Performance Portal) (Population Numbers – Health and Social Care Information Centre)

Action: Post Infection Reviews (PIRs) have been undertaken in 2015/16 for five MRSA cases: two attributed to the CCG; the third re-assigned to the IWNHST as the Trust failed to inform the GP of the patient’s MRSA status and two cases have been arbitrated by NHS England with the CCG requesting to assign to Third party (unknown), as in both case the patients were holidaymakers with no previous Island healthcare contact. This request has been upheld.

The CCG and the IWNHST continue to work together and concerns have been raised and discussed at the Clinical Quality Review Meeting (CQRM). MRSA will also be discussed at the inaugural IPC Group meeting chaired by the CCG and involving Island wide stakeholders on 16 March 2016.

HCAI: MRSA – CCG: National Target Zero tolerance

There were no additional cases of MRSA reported in Q4 2015/16 (January – March) that were associated with either the IWCCG or IWNHST. The cumulative totals remained at seven for the IWCCG and three for the IWNHST.

For the IWCCG the annual target of zero cases was subsequently missed.



Healthcare Acquired Infections – C.Difficile: National Target: 28 maximum

Wessex Area (Cumulative totals as at March 2016)

Source: Public Health England (via South Commissioning Support Unit, Performance Portal) (Population Numbers – Health and Social Care Information Centre)

CCG March 2016

YTD (2015/16)

Variance to projected total. at March 2016 CCG

Population

YTD Total as ratio per 100,000 population

No. %

Isle of Wight 3 55 27 96.4% 142,297 38.7

Southampton 7 53 7 15.2% 270,353 19.6

Fareham & Gosport 0 36 6 20.0% 202,312 17.8

Portsmouth 5 54 4 8.0% 218,809 24.7

Dorset 9 218 14 6.9% 782,692 27.8

West Hampshire 10 117 -16 -12.0% 549,353 21.3

North Hampshire 4 50 -10 -16.7% 220,801 22.6

South Eastern Hampshire 1 41 -9 -18.0% 211,593 19.3

North East Hampshire & Farnham 1 22 -11 -33.3% 222,931 9.9

CCG: There were three additional cases reported for March numbers having increased by one in February 2016. Of those reported for March, two occurred within the IWNHST (Acute) and the remaining one within the wider community. The resultant cumulative total for the year of 55 cases exceeded the target number for the year (28).

IWNHST: There were two cases reported for March with one case occurring in February. The cumulative total for the year rose to 23 for the IWNHST which exceeded the annual target of seven cases for 2015/16.

Action: The CCG and IWNHST continue to work together to review C.Difficle cases island wide, to identify areas where additional focus could impact on the numbers of cases.

Patient anonymised C.Difficle cases have been shared with the CCG Medicines Management team, to review occurrences across GP Practices in the first instance.

A RCA tool for use in Primary Care is under development locally to enable C.Difficile cases to be individually reviewed and trends, themes and learning to be clustered into a Primary care Health Care Associated Infection (HCAI) Action Plan.

The CCG has established a local IPC group with an Island-wide focussed approach. This will also act as a C.Difficile appeals panel. The inaugural meeting will include the CCG, Trust, Public Health and Trust Development Agency. The first meeting is scheduled for 16 March 2016.



Friends and Family Test: National Targets: Response rates improvement Q1-Q4 / Score Improvement Q1-Q4

It has been advised via the NHS England website (Statistics pages) that: ’Following a review undertaken by NHS England the Lead Official for Statistics has concluded that the characteristics of the Friends and Family Test (FFT) data mean it should not be classed as Official Statistics.’ It remains, however, the principal mechanism for capturing the rating of the services being offered by hospital trusts and which can provide a benchmark at both regional and national levels.

The following is a summary for the results achieved by IWNHST for the last four months up to and including March 2016:

IWNHST Dec Jan Feb Mar

Q1 15/16 Average

Q2 15/16 Average

Q3 15/16 Average

Q4 15/16 Average

Trend

A&E

Response rate 6.04% 6.87% 7.03% 5.33%

12.81% 9.86% 8.17% 6.36% Total Eligible/Responses 2,484/150 2,345/161 2,462/173 2,704/144 8,509/1,090 9,328/920 7,707/636 7,511/478

% Recommending 92.00% 91.30% 95.38% 90.28%

93.04% 91.49% 91.73% 92.32% -

% Not recommending 3.33% 4.35% 1.73% 5.56%

3.75% 3.34% 3.40% 3.88% -

Inpatients

Response rate 25.20% 20.24% 19.32% 19.43%

31.17% 23.08% 22.94% 19.66% Total Eligible/Responses 1,365//344 1,408/285 1,449//280 1,482/288 3,301/1,029 3,778/872 4,168/956 4,339/853

% Recommending 97.97% 97.54% 96.43% 97.92%

97.22% 95.75% 97.46% 97.30% -

% Not recommending 0.29% 1.05% 1.43% 1.74%

0.98% 0.94% 0.73% 1.41% -

Maternity Question 2: Birth

Response rate 16.96% 26.32% 1.20% 16.00%

26.47% 18.10% 17.59% 15.11% Total Eligible/Responses 122/19 95/25 83/1 100/16 306/81 348/63 307/54 278/42

% Recommending 95% 100% n/a 100% 99.10% 100% 98% 100% - % Not recommending 0% 0% n/a 0% 0% 0% 0% 0% -

NB: The NHS England review of the patient FFT, published in July 2014, recommended a move away from the Net Promoter Score (NPS) and the introduction of a simpler scoring

system in order to increase the relevance of the FFT data for NHS staff, patients and members of the public. Based on the findings of the review, NHS England is now calculating and presenting the FFT results as a percentage of respondents who would/would not recommend the service to their friends and family. This change was introduced with the release of the results for September and user testing of the presentation of the FFT results is being undertaken on the NHS Choices website.

A&E The response rate achieved in March of 5.33% was the second lowest reported for 2015/16. Compared with the results for March 2015, the rate achieved is ten percentage points down while the response rate achieved is broadly similar (15.73% / 91.50%).

In terms of those ‘Recommending’ the service, while for the month of March there was a decline in the rate compared with the outcome reported for February, the overall average for the quarter suggests a level of recover compared with the outcomes for the second and third quarters.

At a quarterly interval, there has been a sustained reduction in the average rate achieved from Q1 through to Q4 with the fourth quarter result being roughly half of that achieved in the first quarter but without a comparable reduction in the numbers eligible to respond.

Inpatients The response rate for Inpatients in March improved marginally on the previous months result but remains amongst the lowest results for the year and is significantly lower than the rate achieved in March 2015 (51.18%) although this was based on a much reduced number of eligible respondents for that month. Again the reported rates for those recommending were very similar, both at 97%.

At a quarterly interval the situation is similar to the one for A&E with a successive quarter’s reduction in the rate achieved, having fallen by about twelve percentage points of the one achieved in the first quarter, although the rate for those recommending has been broadly consistent across three of the four quarters in the year.



Maternity As previously reported, the only response rate available is the published rate for ‘Births’, numbers for the other three elements captured under this process not being reported by NHS England.

The improved level of response rate seen in January stalled in February with just a single response reported in that month. However, the position improved for March, although the rate achieved was not at the same level as the one reported for January. Performance had also been below the rates achieved at both a National and Regional level for both February and March.

In contrast, there has been minimal change in the rate for the percentage rate for those ‘Recommending’, which, apart from the dip recorded in February had been 100% for both March and January. While for those ‘Not Recommending’ the service remained at zero percent.

At a quarterly interval, there has been a stepped reduction seen in the average levels of response given although the numbers eligible has remained broadly consistent across each of the four quarters.

Action:

Overall, there has been a fluctuation in response rates in both the A&E and In-patient settings over the last few months, although the percentage recommending services remain fairly consistent and in line with National figures.

The downward trend of response rates has been raised at CQRM, and examples of how this is being addressed by mainland providers shared, to try and help drive improvement.



Improving Access to Psychological Therapy (IAPT): National Target for Isle of Wight 22% (Annual)

IAPT – Entering treatment (performance in month) IAPT – The proportion of people who complete treatment who are moving to recovery (performance in month)

IAPT – Entering treatment (Cumulative position)

Indicator Target 2015/16

Performance against target by month: Apr 15 May 15 Jun 15 Jul 15 Aug 15 Sep 15 Oct 15 Nov 15 Dec 15 Jan 16 Feb 16 Mar 16

Improved access to psychological services:

The proportion of people that enter treatment against the level of need in the general population.

22%

Numerator: No. of people who receive psychological therapies

276 186 214 268 244 304 283 276 150 260 209 221

Denominator: No. of people who have depression and/or anxiety disorders

1,087 1,087 1,087 1,087 1,087 1,087 1,087 1,087 1,087 1,087 1,087 1,087

Percentage 25.39% 17.11% 19.69% 24.66% 22.45% 27.97% 26.03% 25.39% 13.80% 23.92% 19.23% 20.33%

Cumulative YTD:

Numerator: No. of people who receive psychological therapies

276 462 676 944 1,188 1,492 1,775 2,051 2,201 2,461 2670 2891

Denominator: No. of people who have depression and/or anxiety disorders

13,043 13,043 13,043 13,043 13,043 13,043 13,043 13,043 13,043 13,043 13,043 13,043

Percentage 2.12% 3.54% 5.18% 7.24% 9.11% 11.44% 13.61% 15.72% 16.87% 18.87% 20.47% 22.17%

Cumulative target (%) 1.83% 3.66% 5.50% 7.33% 9.16% 11.00% 12.83% 14.06% 16.5% 18.33% 20.16% 22%



Entering treatment:

The annual target for patients entering treatment is 22%. For the three months January to March performance had fallen below this rate for two of the three months, February reporting the lowest rate of achivement for the three months.

However, the cumulative position at the end of March provided a rate of 22.17%, marginally above and threfore achieving the annual target of 22%.

NB: Bank Holidays and the pattern by which weekends can fall within a month, both have an impact on the number of clinics that can be held, directly influencing the performance rate achieved.

Moving to Recovery:

For the three months January to March, February proved to be the only one in which the target rate of 50% for ‘The proportion of people who complete treatment and who are moving to recover’ was not achieved.

Overall, there were just four months in which a rate of 50% or above was achieved although for a further five the margin by which the target was missed was within four percentage points.

It should be noted that in respect of the performance rate being achieved for those patients moving to recovery, the outcome is impacted by the inclusion of patients from clusters that imply those with more complex issues which extend the period of recovery needed.

Action:

Performance for these indicators and the outcomes achieved will remain a focus for scrutiny by commissioners via the monthly Contract Officer Level Meetings.


Part Two Provider Performance


Part 2 – Provider Performance - Summary

Highlights

• There were no (zero) breaches for Mixed Sex Accommodation assigned to IWCCG for March (YTD total 61).

• Cancer pathways were achieved both in month and in year for seven out of nine types of treatments.

• Diagnostics performance by the IWCCG for March continued to achieve the target rate in month. There were a total of nine in month the majority of which occurred at mainland trusts. An overall rate of 99.37% was the outcome for 2015/16, within the target margin of one percentage point.

• Mental Health CPA – A rate of 97.62% was achieved in month slightly down on the rate achieved in the previous month. Year to date performance at 96.62% remains within target.

Lowlights

• The reported rates by IWNHST in March for Ambulance Category A calls, demonstrated a failure to achieve target for two of the three categories, both Red 1 and Red 2 calls failing to achieve 75%.

• A&E – Performance for the IWCCG in March was reported to have been 84.51% (88.84% YTD).

IWNHST, provisional performance for April suggests that the performance achieved in month was similar to that achieved in March with a rate of c.84.57% continuing to miss the target rate of 95% by around ten percentage points.

• There were no reported occurrences for patients experiencing 12 hour trolley waits in either January or February, but for March there were four such incidents reported by the IWNHST.

• 18 week RTT – Performance for Incompletes (the principle measure of performance being applied by NHS England) remained below target for the last six months of 2015/16 with a reported rate of 88.64% for March 2016. The outcomes achieved by the IWNHST and the three main Trusts monitored contributed to this overall outcome.

In terms of Admitted and Non-admitted performance, the overall position at the end of the year would suggest that the respective target rates were both missed in year.

• In total there were 15 instances across the twelve months of the year, in which patients were reported to have been waiting 52 weeks or more for Referral to Treatment. (In some cases this may have been the same individual where the Treatment date was delayed by more than one month.)

• The revised total for the number of Contract Notices being applied across all providers stood at eleven at the end of April 2016.


Part 2 – Performance Outcomes – NHS Constitution Dashboard


Part 2 – Performance Outcomes – NHS Constitution Dashboard

Benchmarking (March 2016) – IWCCG against other CCGs in the ONS Coastal and Countryside Group


Part 2 – Provider Performance - Commentary

RED – Target missed; AMBER – Performance achieved within 5% of meeting target; GREEN – Target achieved.

Achievement of the target for Admitted continued to be missed across the final quarter of 2015/16 although with some marginal improvement in rate demonstrated for each successive month. Performance rates achieved for Non-Admitted referrals has also missed target in each successive month although the margin by which the target has been missed has been less significant. More significant has been the performance for Incompletes the principal measure for RTT performance employed by NHS England, with the target continuing to be missed across the fourth quarter and with a dip in performance rate registered for March following a slight improvement seen in the preceding month.

IWNHST - A similar pattern in achievement and failure to varying degrees has been seen for each of the categories across the last three months of the year.

Mainland Trusts The inconsistencies in performance achieved by each of the three mainland trusts monitored continued to be a feature across the fourth quarter, particulary with the performance given by both UHS and PHT. In respect of performance for March:

• UHS – Performance for Incompletes slipped significantly after a degree of improvement in rate being registered in the preceding month. The trust failed to achieve target for each of the three categories. Capacity issues have continued to impact on the performance being achieved.

• PHT – The trust has demonstrated improvement in the rate for Incompletes in successive months across the fourth quarter but hs proved to be less consistent in the rates achieved for both Admitted and Non-Admitted in the same period. Overall, teach of the targets were missed in March.

• Salisbury demonstrated a deterioration in the rate for Incompletes in successive months for the fourth quarter although achieving 1005 for Non-Admitted in the last four years of the year. Performance rates achieved across the year for admitted and Non-Admitted categories were exaggerated by the low numbers of patients involved.

18 week Referral to Treatment: National Targets: Admitted 90%; Non-Admitted 95%; Incompletes 92%

2015/16

IWCCG IWNHST UHS PHT Salisbury

Admitted Non-Adm Incompletes Admitted Non-Adm Incompletes Admitted Non-Adm Incompletes Admitted Non-Adm Incompletes Admitted Non-Adm Incompletes

April 69.75% 96.06% 92.99% 65.83% 96.30% 93.07% 81.25% 91.11% 93.00% 82.05% 89.66% 90.57% 66.67% 75.00% 80.49%

May 68.18% 96.55% 94.00% 65.01% 96.69% 94.32% 80.85% 97.62% 90.12% 93.75% 93.48% 88.83% 66.67% 50.00% 87.23%

June 66.01% 94.58% 94.05% 62.29% 94.71% 94.33% 86.00% 88.64% 92.26% 82.61% 91.84% 90.10% 66.67% 50.00% 83.72%

July 62.75% 94.09% 93.34% 57.34% 94.14% 93.41% 88.33% 100% 93.71% 86.21% 91.18% 90.76% 100% 66.67% 86.84%

August 67.45% 96.11% 92.85% 62.94% 96.32% 93.01% 82.22% 90.70% 91.86% 84.38% 92.42% 87.56% 83.33% - 87.10%

September 69.86% 95.72% 90.59% 65.02% 95.88% 90.77% 80.77% 92.73% 87.32% 94.12% 88.33% 84.91% 75.00% - 83.78%

October 63.90% 93.89% 89.29% 58.45% 94.16% 89.29% 79.55% 93.88% 83.88% 74.47% 88.24% 88.10% 100% 100% 86.11%

November 56.16% 92.74% 89.70% 51.71% 92.87% 89.63% 80.95% 90.91% 83.60% 66.67% 88.14% 90.28% 50.00% 80.00% 92.31%

December 58.79% 95.63% 87.50% 53.00% 95.75% 87.09% 78.69% 88.10% 85.53% 78.57% 93.75% 86.94% 0% 100% 93.55%

January 59.60% 93.11% 87.18% 54.28% 93.62% 87.07% 80.95% 90.91% 83.60% 85.71% 89.71% 84.65% - 100% 96.43%

February 59.73% 92.20% 89.02% 54.68% 92.56% 89.41% 78.69% 88.10% 85.53% 72.73% 88.46% 85.59% 50.00% 100% 90.63%

March 67.51% 94.69% 88.64% 63.72% 95.17% 89.23% 80.33% 86.00% 76.90% 75.00% 88.00% 87.36% - 100% 87.88%

588/871 2,317/2,447 7,043/7,946 441/697 2,147/2,256 6,158/6901 49/61 43/50 303/394 33/44 66/75 242/277 - 2/2 29/33


Part 2 – Provider Performance - Commentary continued…

Actions:

IWNHST:

The System Resilience funded schemes in place, have offered the opportunity to increase service capacity to support the recovery of RTT performance and return waiting lists to a manageable position.

A Referral to Treatment Recovery Plan has been in place since October 2015, which has concentrated on transferring patients from the IWNHST waiting list backlog to mainland hospitals in the independent sector, and encouraging GPs to offer choice to patients regarding treatment at these providers if eligible.

This plan has resulted in a number of patients being transferred from the IWNHST waiting list backlog, to the Indeendent Sector providers on the mainlan. Outsourcing of patients will cease from 31 March 2016, due to a reduction in numbers of patients willing to go to the mainland.

However, direct referrals from GPs, continues to be relatively successful and has resulted in more than 600 referrals to the mainalnd Independent Sector providers. The CCG is continuing to encourage primary care to offer patients the choice of provider and directly refer to the mainland if the patient meets the relevant clinical criteria.

Mainland Trusts:

Commissioners continue to raise with the Lead Commissioner and Trusts to highlight patient waiting times and resolve any issues relating to specific specialities.

Patients waiting >52 weeks – National Target: Zero

There was one reported breach for individuals having had to wait 52 weeks plus for treatment in March. This occurred at the IWNHST and was associated with Urology.

Admitted – This breach was incurred retrospectively, having been identified through an external validation exercise undertaken by the Trust. The initial draft timeline indicated inaccurate administration of this patient pathway (closed in the Non-admitted setting and reopened in error) but it was too late to book the patient within 52 weeks. Treated on 30 March 2016, at which point they had waited 67 weeks.



Cancer: Nine National Targets

RED – Target missed; AMBER – Performance achieved within 5% of meeting target; GREEN – Target achieved.

IWCCG – 2015/16 Target Q2 15/16 Q3 15/16 Jan 16 Feb 16 Mar 16 Year to

Date

Seen within 2 weeks of referral 93% 97.36% 95.58% 91.71% 95.86% 96.28% 18/466 96.04%

Seen within 2 weeks of referral - Breast Symptoms 93% 97.83% 96.77% 93.75% 98.59% 96.39% 3/83 97.40%

Treated in <31 days of diagnosis 96% 98.26% 97.74% 96.25% 97.37% 98.78% 1/82 97.32%

Treated in <31 days - Surgery 94% 96.00% 94.37% 93.10% 95.24% 100% 0/20 94.67%

Treated in <31 days - Drug Treatment 98% 100% 99.29% 98.15% 100% 100% 0/33 99.61%

Treated in <31 days - Radiotherapy 94% 100% 96.88% 91.30% 100% 97.56% 1/41 97.28%

Treated in <62 days - urgent referral to treatment 85% 80.60% 77.54% 75.68% 82.86% 80.49% 8/41 79.29%

Treated in <62 days - Consultant upgrade 86% 100% 100% 100% 0.0% 50.00% 1/2 60.00%

Treated in <62 days - Screening service 90% 96.43% 86.36% 100% 100% 100% 0/6 94.85%

Mainland Trusts – performance for island registered patients

IWNHST – 2015/16 Target Q215/16 Q3 15/16 Jan 16 Feb 16 Mar 16 Year to Date

Seen within 2 weeks of referral 93% 97.50% 95.61% 91.59% 95.80% 96.24% 18/479 96.06%

Seen within 2 weeks of referral - Breast Symptoms 93% 97.82% 96.74% 93.75% 98.57% 96.34% 3/82 97.38%

Treated in <31 days of diagnosis 96% 99.13% 96.08% 100% 98.33% 98.25% 1/57 99.10%

Treated in <31 days - Surgery 94% 100% 99.24% 100% 93.33% 100% 0/17 98.24%

Treated in <31 days - Drug Treatment 98% 100% 100% 98.00% 100% 100% 1/32 99.58%

Treated in <31 days - Radiotherapy 94% <<N/a>> <<N/a>> <<N/a>> <<N/a>> <<N/a>> - <<N/a>>

Treated in <62 days - urgent referral to treatment 85% 84.71% 79.84% 78.79% 84.62% 85.29% 5/34 82.54%

Treated in <62 days - Consultant upgrade 86% 100% <<N/a>> <<N/a>> 0.0% 50.00% 0.5/1 33.33%

Treated in <62 days - Screening service 90% 100% 90.24% 100% 100% 100% 0/5.5 97.22%

2015/16 UHS PHT

Q3 15/16

Jan 16 Feb 16 Mar 16 Year To

Date Q3

15/16 Jan 16 Feb 16 Mar 16

Year To Date

Seen within 2 weeks of referral 91.67% 100% 100% 100% 0/2 90.91% 100% 100% 100% 100% 0/1 100%

Seen within 2 weeks of referral - Breast Symptoms <N/a> <N/a> 100% <N/a> - 100% 100% <N/a> <Na> 100% 0/1 100%

Treated in <31 days of diagnosis 96.15% 100% 100% 100% 0/16 96.46% 84.85% 57.14% 88.89% 100% 0/9 84.31%

Treated in <31 days - Surgery 84.62% 100% 100% 100% 0/2 95.35% 100% 50.00% 100% 100% 0/1 71.43%

Treated in <31 days - Drug Treatment 100% 100% 100% 100% 0/1 100% <Na> <N/a> 100% <N/a> - 100%

Treated in <31 days - Radiotherapy 94.34% 81.82% 100% 100% 0/22 97.46% 100% 100% 100% 94.74% 1/19 97.04%

Treated in <62 days - urgent referral to treatment 50.00% 57.14% 100% 66.67% 1/3 65.12% 60.00% 0.00% 33.33% 50.00% 2/4 46.15%

Treated in <62 days - Consultant upgrade 100% <N/a> <N/a> <N/a> - <N/a> <N/a> <N/a> <N/a> 50.00% 0.5/1 33.33%

Treated in <62 days – Screening service <N/a> 100% <N/a> <N/a> - 100% 33.33% <N/a> 0.0% 100% 0/0.5 75.00%



Breach Report - IWNHST:

Seen within 2 weeks of referral:

Tumour type 2 x Suspected breast cancer Wait 20 days Patient unavailable

19 days Patient not well

Tumour type3 x Suspected gynaecological cancer Wait

17 days Patient unavailable 16 days Patient unavailable 15 days Patient unavailable

Tumour type 3x Suspected head & neck cancer Wait

23 days Patient unavailable 21 days Patient unavailable 17 days Patient cancelled on day, no reason given

Tumour type 1 x suspected skin cancer Wait 21 days Patient unavailable

Tumour type 2 x Suspected lower gastrointestinal cancer Wait 34 days Patient unavailable 28 days Patient unwell

Tumour type 1 x Suspected upper gastrointestinal cancer Wait 15 days Patient unavailable

Tumour type 6x Suspected urological malignancies (excluding testicular)

Wait

28 days Patient unavailable 27 days Transport problems

24 days Patient cancelled on day, no reason given

24 days Patient unavailable

17 days Patient unavailable

15 days Patient on holiday

Treated in <62 days urgent referral to treatment – Admitted – First seen IWNHST

Tumour type 2 x Gynaecological UHS Wait 112 days Referred to UHS on day 92

UHS Wait 76 days Delays to diagnostics

Tumour type 3 x Urological (Excluding testicular)

PHT Wait 167 days Elective capacity inadequate (patient unable to be scheduled for treatment within standard time

PHT Wait 105 days Other reason - ITR received Day 52

PHT Wait 96 days Elective capacity inadequate (patient unable to be scheduled for treatment within standard time

Treated in <62 days urgent referral to treatment – Non-Admitted – First seen IWNHST

Tumour type 1 x Lung

IWNHST

Wait 77 days Patient required non-cancer related emergency surgery - treatment rebooked outside of standard time

Tumour type 2 x Urological (Excluding testicular)

Wait 85 days Late diagnosis due to patient choice and hospital-led cancellation to investigations

Wait 98 days Elective capacity inadequate (patient unable to be scheduled for treatment within standard time

Treated in <62 days – Consultant upgrade – Consultant upgrade Trust: IWNHST

Tumour type 1 x Urological (Excluding Testicular) First treatment:

PHT Wait 113 days

Other reason - Consultant availability for diagnostic test



Year end status for the CCG, demonstrated two pathways which had failed to achieve target.

The more significant of these was the performance for ‘Treated in <62 days - urgent referral to treatment’, which has been under National scrutiny and for which a rate of 79.29% was achieved for the year (Target 85%). The target was only achieved for one month across the year with the outcome being influenced by the performance achieved at the IWNHST and by mainland trusts.

Reflectiing on the performance achieved in the last quarter of the year there had been a stepped improvement seen in the rates achieved by the IWNHST with the target being met for March. By comparison UHS had achieved the target in one from the three months the quarter, while PHT had missed the target in all three months.

The other pathway for which the target was not achieved in year was for ‘Treated in <62 days - Consultant upgrade’. An issue with this indicator remains the low numbers of patients involved, which can result in a significant swing from achieving 100% in one month to failing the targett of 90% in another. The target was missed for a total of three months in year, and achieved in four others while for five months no referrals were made. iN total there were ten patients referred in the whoile of 2015/16.

The one outcome that had a bearing on the Quality Premium reward outcome, ‘Seen within 2 weeks of referral’ achieved target at year end.

Action:

The IOW CCG achieved all cancer metrics for 2015-16 with the exception of the 62 day. All Cancer 62 day urgent referral to treatment achieved 79.29% for 2016-17 against the target of 85%.

The 62 day metric continues to be closely monitored by the CCG and the Systems Resilience Group. For the year, this equated to 105 out of 57 treated after 62 days.

Those tumour sites that did not achieve the standard for the year included head and neck (3 after 62 days), gynaecological (13 after 62 days), lower gastrointestinal (18 after 62 days), sarcoma (2 after 62 days), upper gastrointestinal (6 after 62 days), haematological (7 after 62 days), and urological (41 after 62 days).

Of these breaches, 79 were related to the Isle of Wight Trust Cancer Unit, 7.5 were at University Hospital Southampton Cancer Centre, 14 at Portsmouth Hospitals Trust Cancer Centre, 2.5 at Salisbury Foundation Trust and 2 at other hospitals. A half breach is allocated when a patient is first seen at one hospital (usually a Cancer Unit) and then the care is transferred to a hospital specialising in the cancer type (usually a Cancer Centre).

The Wessex Cancer Strategic Clinical Network is leading work to develop timed pathways for each tumour type, which will inform providers of the optimum inter provider transfer date to improve outcomes.



Category ‘A’ Ambulance Calls: National targets: Red 1 and Red 2 75%; 19 minutes 95%

Performance in April saw the targets for two of the three categories being missed for a second consecutive month, with the rates achieved in March for two of the three categories improved on those achieved in February. The one area where the target has not been achieved for four consecutive months was for Red 1 calls

The cumulative end of year position, demonstrates the target having been missed for each of the three categories of call for 2015/16.

Target April May June July Aug Sept Oct Nov Dec Jan Feb Mar YTD

Category A – Red 1 75% 75.00% 77.08% 66.67% 69.64% 68.63% 78.57% 79.49% 78.05% 70.59% 60.42% 70.27% 58.62% 71.25%

Category A – Red 2 75% 74.39% 75.65% 76.60% 75.32% 68.45% 75.77% 75.43% 76.05% 78.52% 75.10% 69.78% 70.54% 74.21%

Category A – 19 mins. 95% 96.03% 95.40% 90.22% 94.87% 94.70% 95.21% 96.43% 96.43% 96.36% 96.14% 92.36% 95.02% 94.93%

Action: Additional support to improve patient flow, as well as specific Ambulance initiatives, was in place during 2015/16, through the investment of System Resilience funds.

The service has been under extreme pressure in recent months. This has been caused by both staffing challenges within this service, combined with patient flow delays within the whole Health System. Ambulance capacity has been impacted by bed pressures and consequential delays in handing patients over to the Emergency Department.

Due to an extended period of performance beneath the national standard, the CCG has raised a Contract Performance Notice (effective 1 April 2016). The provider has provided an initial Remedial Action Plan (RAP), outlining actions to improve performance, and timescales for recovery. The trajectory plan indicated a return to National Standard, by September 2016.

Action:

A new Computer Aided Dispatch System was installed in mid-November to improve known data quality issues.

Due to the data quality issues being experienced by the IWNHST, from October onwards the Trust has not been providing the IWCCG with performance data, until they are assured of its accuracy and reliability. As a result, the CCG has formally raised an Information Breach Notice and a Contract Performance Notice.

A full Recovery Action Plan has been provided outlining how data quality and performance will improve to an acceptable level.

The Action Plan highlighted data was due to be provided for the new financial year.

Ambulance Handover: National Target 100% for Handovers and Crew Green-Up time

The IW NHST Trust has advised that for the immediate future and commencing with the outcomes for November 2015, they will not be supplying outcomes for Ambulance Handovers. The IWCCG remain in discussion going forward over this approach.



A&E <4 hour wait for admission, treatment or discharge – National target 95%

Performance rates achieved by both the IWCCG and the IWNHST remained below 90% between July and March while fluctuating between months by one to two percentage points over the nine months. Performance for March saw a dip in the rate achieved compared with February for both the CCG and the IWNHST, although well below target in both months. The 84.41% reported for the Trust represented a total of 5,940 patients attending A&E (5,342 in February), with the Easter weekend occurring in this month.

There were nine days at Black Alert in March with the Trust at Red Alert for the majority of the remainder of the month. Throughout the month general and Acute beds were reported as being 100% occupied as were critical Care beds for the majority of the month.

Provisional results from the Trust for performance in April suggest a performance rate of 84.57% and continuing to fail to achieve the target rate of 95%. Again the Trust were at Red Alert for the majority of the month with around ten days at Amber Alert (no Black Alerts declared). Numbers attending A&E in April were 4,724, marginal down on the total number reported for March.

IWCCG Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD

A&E <4 hour wait

14/15 96.15% 93.71% 96.03% 96.29% 97.00% 95.44% 94.84% 91.25% 92.54% 87.66 86.71% 92.71% 93.61%

15/16 91.91% 92.67% 92.12% 88.91% 88.97% 86.29% 87.43% 86.34% 91.66% 86.80% 87.86% 84.51% 88.84%

No Attending 14/15 5,147 5,181 6,600 5,719 6,792 4,891 4,553 5,683 4,904 4,359 4,710 6,156 64,695

No Attending 15/16 6,501 4,952 5,545 5,850 5,830 5,090 5,337 4,860 5,095 5,030 5,083 5,654 64,827

Breaches 14/15 198 326 262 212 204 223 235 497 366 538 626 449 4,136

Breaches 15/16 556 363 437 649 643 698 671 664 425 664 617 876 7,233

IWNHST Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD

Beacon WIC 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Emergency Dept. 87.4% 88.6% 88.1% 83.1% 82.6% 78.4% 79.7% 77.8% 85.9% 77.9% 79.8% 74.0% 82.1%

A&E <4 hour wait 91.89% 92.65% 92.05% 88.74% 88.85% 86.05% 87.24% 86.17% 91.69% 86.77% 87.89% 84.41% 88.78%

12 hour trolley waits – National target zero

For both January and February there were no (zero) incidents where patients were reported to have waited twelve hours or more on a trolley.

However, March there were four reported occurres that occurred at the IWNHST in that month. Provisional results suggest a further two occurred in April.

The year end total for 2015/16 was 46 at the end of March, the majority of these having occurred in September 2015 (total 29).

Action: Following a formal Contract Performance Notice being raised, the Trusts have developed a Recovery Action Plan. Bed pressures are on-going and system resilience actions are being developed and agreed to enhance system capacity into 2016/17.

Timescales for recovery have been reviewed in line with both the operational and sustainability and Transformation plans. The A&E standard should achieve 92% by September 2016and be maintained at that level for the remainder of the year.

A ‘safer stack’ exercise was implemented during early May to coincide with the Junior Doctor’s industrial action. This did see an increase in ED performance. Bed capacity remains a challenge with plans in place to provide system capacity to support the planned closure of the Poppy Ward.



Other Key Metrics

Diagnostics – National Target: >99% Performance for Diagnostics in March was 99.30%, marginally down on February’s rate of 99.57%, and represented a total of nine patients having waited longer than six weeks.

For March the majority of breaches related to delays occurring in mainland Trusts, five having been at University Hospital Southampton and one at Portsmouth Hospitals Trust. The remaining three occurred at the IWNHST.

The overall year end position was within target with a cumulative rate of 99.37%.

Cancelled Operations – National Targets: 100% / Zero

Performance for January failed to achieve target with a reported rate of 88.89% representing two failures (1 x Lack of post-operative bed and 1 x Ran out of theatre time).

The target rate continued to be missed in the following two months. In February a rate of 85.71% was achieved, representing two failures (1 x Ran out of theatre time and 1 x No surgeon available to do procedure).

While for March, the rate improved marginally to 87.50%. Again representing two patients not being offered another date within 28 days from a total of16 (1 x Ran out of theatre time (Urology) and 1 x List overbooked (Orthopaedic Surgery)).

The cumulative position at the end of 2015/16 was a total of 28 patients not having been offered another date within 28 days, translating into a rate of 84.36% (compared with 90.56% for the previous year).

(NB: Adjustments to reported occurrences may be made in subsequent months following investigation and review of occurrences).

For the period October to March, there have been no (zero) reported cases of a ‘cancelled operation being cancelled for a second time’. However, the cumulative total of 7 occurrences for an operation being cancelled for a second time, the annual target of zero cases was missed.

Mixed Sex Accommodation – National Target: Zero Performance achieved for the three months January to March has remained at zero for mixed sex accommodation breaches. However, the Year to Date total remains at 61 breaches, all of which had occurred at the IWNHST.

Mental Health Care Programme Approach – National Target: 95% Performance for January achieved a rate of 97.87%, an improvement on the rate achieved in December and this trend continued with a rate of 100% being recorded for February. There was some deterioration in performance for March with 97.62% being achieved. The target rate was only missed for two of the twelve months and the cumulative rate for the year was 96.62%.



Contract Query notices

The following Contract Query Notices are currently in place:

University Hospital Southampton (UHS) – Emergency Department – RAP – two milestones not achieved. RAP not achieving 95% target. (September 2015)

Commissioning Support Unit (CSU) – IT Performance Notice (on-going)

PHT – RTT - Failure to agree RAP (on-going)

PHT – Cancer - Failure to agree RAP (on-going)

PHT – A&E – GC9 issued and RAP provided to the CSU Contracting team for consideration (on-going)

Salisbury – Mixed Sex Accommodation (RAP in place to recover performance) (on-going)

IWNHST – A&E Performance (on-going)

IWNHST – RTT 18 Weeks Incompletes (on-going)

IWNHST – Cancer 62 day Urgent referral to treatment (on-going)

IWNHST – Ambulance Handovers (on-going)

IWNHST – Ambulance Performance, Red 1 and Red 2 (on-going)


Part Three Commissioning


Part 3 - Commissioning – Summary

Planning Update

Operational Plan 2016-17 – The CCG is currently reviewing its trajectories and activity in response to a request from NHS England to take further account of updated System Resilience and QIPP plans.

Better Care Fund 2016/17 - The IOW System (CCG & Council) has been assured with support in relation to the Better Care Fund Plan. Further information has been requested on:

Further understanding the impact of the £1.4m funding gap.

Outline of the approaches being taken to manage risks associated with recruitment and retention.

Consideration of whether the Delayed Transfer of Care target should be more ambitious.

Secondary Care Update

Urology – A review is being undertaken of the current service delivery model to identify workforce and service delivery options that would ensure the service is safe and sustainable. To complete the review further financial analysis is required on proposed options. Discussion is ongoing with the Trust regarding the notice the Trust has given on the Urology service.

Gastroenterology and Urology Activity – The Trust has a shortfall in current capacity for these services. The CCG is finalising agreements to make good this shortfall.

Urgent Care Services

Beacon Services – work is ongoing to find a solution to address current issues faced by the Walk In Centre and Out of Hours service, while the longer term solutions are identified through the System Redesign process.

Community Services

Musculoskeletal Services – The community Musculoskeletal Physiotherapy service contract was retendered in the later part of 2015/16. Integrated Care Clinics were awarded the contract. The new service is in place and appears to be working well and is meeting its performance targets.


Part Four Financial Management


Part 4 – Financial Report M12 - Summary

As at the end of March the CCG’s un-audited year end position was £2,007k better than plan, with a surplus of £4.5m.

For 2015/16 the CCG delivered an additional £1m surplus and in return, NHS England matched the increase underspend of £1m. This has enabled the CCG to carry forward £2m into 2016/17 to fund backlog waiting list activity from 2015/16 and support other financial pressures, during what will be, an extremely challenging year.

• The running cost target of £25 per head of population was achieved for 2015/16. .

• Running costs – from 1st April 2015 the allocation was reduced by £357k (10%). The CCG has a statutory responsibility to stay within the allocation. In Month 9 the national payment for the 2014/15 quality premium was added non-recurrently to the CCG’s running cost allocation. Although funded by NHS England through the running cost allocation, it can be spent as either Programme or running cost spend and the CCG spent the allocation on Programme spend.

• Key risks were around the impact of system resilience issues and recovering the constitutional targets. Prescribing remained an area of risk as did Continuing Care and Mental Health Special Placements from potential higher than forecast overspends should there have been additional, high cost patients:

o Prescribing/Primary Care – £50k overspent – Inflation has been funded for 2015/16 at net 3%. A £1.8m QIPP (savings) target has been delivered. PPA (primary care) prescribing was £143k overspent.

o Mental Health Services – £98k overspent – Special placements had overspent due to an increase in patient numbers.

o Continuing Care – £621k overspent – The overspend relates to an increase in patients and high cost complex packages, especially in Mental Health over 65’s and physical disabilities

<< Insert>>

‘Income & Expenditure: Financial Review’ – M12

a

Financial Review

MONTH 12– March

MONTH 12 – March 2016

Rebecca Wastall|Deputy Chief Finance Officer FCCA

&

Wendy Marshall| Financial Controller FCCA, PGCE

NHS South, Central & West Commissioning Support Unit

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Financial Review

MONTH 12– March

INCOME & EXPENDITURE POSITION

As at the end of March the CCG’s un-audited year end position is £2,007k better than plan, with

a surplus of £4.5m.

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For 2015/16 the CCG has delivered an additional £1m surplus and in return, NHS England has

matched the increase underspend of £1m. This has enabled the CCG to carry forward £2m

into 2016/17 to fund backlog waiting list activity from 2015/16 and support other financial

pressures, during what will be, an extremely challenging year.

Key reasons are as follows:-

Acute Services –£603k underspent. - IOW Planned SLA underspend of £1,484k. The IOW

Unscheduled Care SLA is over-performing by £1,346k giving a net position of £138k

underspent. The Southampton contract over-performed by £512k due to increased activity,

especially in critical care.

Mental Health Services –£98k overspent- Special placements have overspent due to an

increase in patient numbers.

Community Services –£142k underspent - Community NHS ECR’s (extra contractual

referrals) have underspent.

Children’s Services £173k underspent – The major contributing factor to underspend was an

underspend on children’s continuing care.

Continuing Care £621k overspent – The overspend relates to an increase in patients and high

cost complex packages, especially in Mental Health over 65’s and physical disabilities. The

year-end position is an overspend of £693k, slightly off-set by an underspend on Funded

Nursing Care of £90k.

Prescribing/Primary Care £50k overspent – Prescribing Inflation has been funded for 2015/16

at net 3%. A £1.8m QIPP (savings) target has been delivered. PPA (primary care) prescribing

is £143k overspent. This is due to December’s actual spend being significantly higher than

previous months. December’s average cost per prescribing day was £105k per day compared

to the average spend per prescribing day of £95k. January’s spend returned to the average

spend.

Running costs – from 1st April 2015 the running cost allocation was reduced by £357k (10%).

The CCG has a statutory responsibility to stay within it. In month 9 the national payment for the

2014/15 quality premium was added non-recurrently to the CCG’s running cost allocation.

Although this is funded by NHS England through the running cost allocation, it can be spent as

either Programme or running cost spend. The CCG spent the allocation on Programme spend.

The remaining underspend relates to in-year vacancies.

Other/Reserves – The balance remaining within other/general reserves is £2.3m; the

contingency has been committed to support systems resilience. In 2015/16 there has been

slippage on investments. Reserves also include the £1m matched funding from NHS England

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RESOURCE LIMIT – (Month 12)

Final 2015/16 vanguard funding of £50k was received in March’16 allocations.

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QIPP SCHEMES

The net QIPP target for 2015/16 is £2.1m. The CCG achieved its QIPP target for 2015/16.

FINES AND PENALTIES

Fines applied up to the end of December’15 have been used to fund additional capacity.

Changes in national rules have meant that any fines applied from January to March cannot be

re-invested and have to be used to improve either the CCG’s or Trust’s bottom line.

£243k for quarter 4 fines in line with the guidance was not imposed on the Trust.

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Detailed I&E Position - March (M12) 2016

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Financial Review STATEMENT OF FINANCIAL POSITION

Assets

2014/15

Outturn £k

2015/16 Plan

December

£'000

January £'000

February £'000

March £'000

Current Assets:

NHS Trade and Other Receivables 972

550

1,629 126 197 293

Non NHS Trade and Other Receivables

729

850

234 1,126 1,194 922

Deferred Expense / Prepayments 0

0

10,341 8,987 13,169 894

Cash 57

124

1,939 719 6,592 78

Total Current Assets 1,758

1,524

14,142 10,958 21,152 2,187

Total Assets 1,758

1,524

14,142 10,958 21,152 2,187

Liabilities

2014/15

Outturn £k

2015/16 Plan

£k

December

£'000

January £'000

January £'000

March £'000

Current Liabilities:

Provisions (current) (109)

(130)

(105) (105) (105) (50)

NHS Trade and Other Payables (3,979)

(3,900)

(5,070) (4,341) (16,214) (2,656)

Non NHS Trade and Other Payables (7,830)

(7,900)

(7,623) (7,251) (7,685) (10,030)

Total Current Liabilities (11,918)

(11,930)

(12,798) (11,698) (24,004) (12,736)

Total Liabilities (11,918

) (11,930

) (12,798) (11,698) (24,004) (12,736)

Total Assets Employed

(10,160)

(10,406)

1,344 (740) (2,852) 10,549

Equity

2014/15

Outturn £k

2015/16 Plan

£k

December

£'000

January £'000

January £'000

March £'000

General Fund (10,160)

(10,406)

(153,439) (169,936

) (186,594

) (199,569

)

Capital Cash Drawdown 0

0 0 0 0

Retained (Surplus) / Deficit 0

152,095 170,676 189,447 210,117

Total Equity (10,160

) (10,406

) (1,344) 740 2,852 10,549

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MONTHLY KPI DASHBOARD

Balanced Scorecard - Monthly Target Dec-15 Jan-16 Feb-16 Mar-16

Finance Efficiency: Invoice payment: <30 days % achievement - value

95% 100.00% 99.91% 99.81% 99.90%

Finance Efficiency: Invoice payment: <30 days % achievement - volume

95% 100.00% 98.53% 99.41% 99.33%

Finance Efficiency: Debtors >30 <=5% 39.60% 13.24% 11.76% 1.32%

Finance Efficiency: Creditors >30 <=5% 0.33% 30.88% -1.31% 5.76%

Finance Efficiency: Liquidity cash balance % of drawdown

1.25% 14.36% 4.96% 54.30% 1.20%

BETTER PAYMENTS PRACTICE CODE - VALUE

VALUE Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

NHS 100.00% 99.98% 100.00% 100.00% 99.99% 100.00%

NON NHS 99.95% 99.63% 100.00% 99.56% 99.51% 99.30%

TOTAL 99.99% 99.93% 100.00% 99.91% 99.81% 99.90%

100.00% NHS invoices and 99.30% of all non NHS were paid with payment terms. A total of £20k

non-NHS invoices were paid late - £6.5k due to late set up of bank account details; £12k due to

late scanning and late set up of supplier; £1k due to late resolution of potential duplicate invoice

and due to late resolution of PO holds.

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BETTER PAYMENTS PRACTICE CODE - VOLUME

VOLUME Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

NHS 100.00% 97.73% 100.00% 99.27% 97.78% 100.00%

NON NHS 99.81% 98.60% 100.00% 98.32% 99.82% 99.07%

TOTAL 99.85% 98.39% 100.00% 98.53% 99.41% 99.33%

100.00% of NHS invoices and 99.07% of all non NHS were paid with in terms. A total of 6 non-

nhs invoices were paid late - 2 invoices due to late set up of bank account details; 1 invoice due

to late scanning and set up of supplier; 1 invoice due to late resolution of potential duplicate

invoice and 2 invoices due to late resolution of PO holds.

AGED CREDITORS

Total Current less than 30

days less than 60

days Less than 90

days 90 + days

£ £ £ £ £ £

NHS 5,738 15,523 0 1,240 (11,024) 0

NON NHS 1,322,161 1,235,925 88,342 19 0 (2,125)

total 1,327,899 1,251,447 88,342 1,259 (11,024) (2,125)

The highest value aged creditor at month end was Isle of Wight NHS Trust @ £1m, which is now

paid. The other most material aged creditor over 30 days is Nottingham University Hospitals

NHST £(11)k of which a refund has been agreed. The remaining 2 creditors over 30 days totaling

£1k are awaiting refund or to be offset against future invoices.

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AGED DEBTORS

total Current 31-60 Days 61-90 Days 90 DAYS +

£ £ £ £ £

NHS 88,094 88,094 0 0 0

NON NHS 574,356 565,588 0 8,768

total 662,450 653,682 0 0 8,768

The largest debtor at month end was Isle of Wight NHS Council @£565k relating to BCF of

which is still outstanding. The largest material aged debtor over 30 days was Department of

Health @ £6k relating to injury benefits and remains outstanding. There are a further 5 aged

debtors with balances of £350 each and 1 with balance of £700 all relating to training

income/GP practice closures - all balances remain owing due to debtors awaiting copy invoices

or no response to SBS debt management requests to being chased.

.

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CASH

£000's

Maximum Cash Drawdown FY 2015/16 (including Capital) 210,148

Less: CHC Risk Pool contribution 404 PPA Cash 23,321 Total drawdown from NHS England 186,423

210,148

Remaining Cash available -

The CCG returned £450k of cash to NHSE in order to comply with guidance relating to cash

holdings at year end.

CASHFLOW

The physical cash balance at month end was £137k compared to the reconciled ledger balance

of £78k - The difference being due to cheques issued but not cashed by year end. . The year-

end cash balance was within the target 1.25% of the final cash drawdown requested for March.

2015/16 October Nov Dec January February March Total

£000 £000 £000 £000 £000 £000 £000

Receipts

CHAPS 477 1,625 952 28 2,043 1,330 12,128

CCG-Drawdown 14,000 13,500 13,500 14,500 14,500 11,423 186,423

CCG-Drawdown returned (450) (450)

Other 2 12

VAT 2 4 9 9 9 21 72

Total Receipts 14,479 15,129 14,463 14,537 16,552 12,328 198,830

Payments

Creditors NHS 13,577 12,317 12,748 11,936 6,781 16,806 150,169

Creditors CHAPS & Cheque 2,800 1,838 2,338 2,977 3,983 2,835 31,969

Salary CHAPS 164 172 165 171 174 177 2,008

Pensions 51 51 49 53 53 54 612

Tax & NI 71 69 73 71 71 75 839

Standing Orders /DD’s 3 1 2 3 - 38

Other 117 13,118

Total -Expenditure 16,666 14,448 15,375 15,211 11,062 20,064 198,753

Balance b/fwd 5,475 3,288 3,969 3,057 2,383 7,873 60

Balance c/fwd 3,288 3,969 3,057 2,383 7,873 137 137

11 | P a g e

SALARY OVERPAYMENTS

REF Balance

Remaining

Expected Recovery End

Date Comments

1 489.21 Mar-16

Salary overpayment letter received end Mar-16 and sales invoice now raised. This is sitting on debtors only (18161055)

as the amount overpaid was recovered via payroll before Finance received the overpayment letter (18169028).

2 746.45 Jul 16 Advance = £895.75 Mar 16. Repayment terms via recovery has

been agreed over 4 months

3 234.79 Apr 16 Advance payment late Mar-16 after payroll had been processed. Advance therefore to be recovered Apr-16

WRITE OFFS

The administrators for a non acute provider have confirmed that there will be no distributions

to unsecured creditors and therefore a debt of £2.5k is not recoverable. The write off of this

debt was formally approved by the audit committee.

PROVISIONS

Continuing Care YTD Actual £

Opening Balance (108,643)

Arising during year 50,061

Utilisation in year 3,439

Reversal Cont Care 105,203

Closing Balance at month end 50,061

Utilisation-Cont Care<1Yr – Payment of retrospective care fees

Fin

an

cia

l R

evie

w

BETTER CARE FUND: CASH

Pooled budgets held by Local Authorities

Deposits Made Funds returned

£000s £000s

Apr-15

May-15 13,500 -586

Jun-15 1,091 -3,062

Jul-15 -1,216

Aug-15 -1,216

Sep-15 -1,216

Oct-15 -1,216

Nov-15 -1,216

Dec-15 -1,216

Jan-16 -1,216

Feb-16 -1,216

Mar-16 -1,215

14,591 -14,591

BALANCE AS AT 31ST MARCH 2016 0

The table above shows amounts invoiced to the local authority not physical cash received. Not

all invoices are being paid in the month in which they were raised as intended and as indicated

above the IOW Council is also the CCG’s largest Debtor.

CAPITAL

The CCG currently has no capital assets.

OTHER BALANCE SHEET RELATED UPDATES

There are no other matters to report

Governing Body Risk Register Summary Report Sponsor: Helen Shields, CCG Chief Officer

Summary of issue:

The Risk Register has been completed overhauled for the new financial year with each risk undergoing an in-depth review. As a consequence a number of risks have now been closed as described in the report. Overall the risks associated with the quality agenda have diminished as capacity with the CCG has been improved and new systems and processes established. Procurements associated with both Anticoagulation and Stoma services have commenced reducing risk in relation to both of these areas. Risks associated with the achievement of NHS Constitution targets have been consolidated into a single risk as have risks associated with system resilience.


The Governing Body is asked to review the summary report and determine whether it is assured that the CCG is capturing and managing risks appropriately.

Principle risks:

Failure to produce a meaningful risk register could result in the CCG failing to take the required actions to ensure that it meets its targets and statutory duties.


All changes to risk are discussed at the Commissioning Officer’s Group as they arise. In addition, the risk register is reviewed in detail monthly at the Clinical Executive and the outcomes of that review are detailed within the Clinical Executive minutes. Individual risks are discussed with teams during performance review meetings.


The CCG is running a number of financial risks this financial year including: • Y4/1 - A reducing CCG Allocation with limited growth funding • Y4/2 - The need to establish the Island Premium remains • Y4/4 - The achievement of the quality premium this year is at risk • Y4/9 - The achievement of the Prescribing QIPP scheme is at risk

with reduced workforce in the team


Y4/12 – The CCG has taken steps to ensure that breaches associated with IT security will not occur and improvements have been made that should reduce this risk in the next month. It remains high risk until the CCG is confident that the IG toolkit submission has been passed.


The risk associated with the finances and shape of services on the Island are part of the WISR process and subject to a wide ranging public engagement exercise currently.


The risks associated with the delivery of services on the island could impact adversely on a number of protected groups. Any changes to services will need to be accompanied by a equality assessment to ensure

that all groups are able to access services appropriately.

Author of Paper: Caroline Morris, Head of Primary Care and Corporate Business.




Governing Body March 2016

GB16-011 Risk Register Summary

Months >12 >6 >3 New

Risks 5 3 4 5

Risks added to register

1 Ref Score

1 Y4/4 20Y4/7 9

Y4/10 16Y4/15 12Y4/16 20

Risks removed from the register

Y3/3 16

Y3/4 4

Y3/5 16

Y3/6 12

Y1/ Y3/17 6

Y3/19 12

Y3/22 12

Risks with Increased Score

Ref Score

Increased Scores

Reduced Scores Risks with Reduced Score

Ref Score

High RisksCommissioning

Corporate Achievement of Quality Premium Targets at risk 0

Future of Out of Hours GP services

Clincial Sustainability of Urology Services at IWNHST

Achievement of NHS Constitution Targets

Achievement of Prescribing QIPP targets

System Resilience

Resilience of System Partners

Future of Community Stoma Service

Clinical sustainability of urology services at IWNHST

17

Title

Title

Title

Gastroenterology service capacity

Achievement of NHS Consitution Targets (consolidated risk)

Care home closures or bed reductions

CQC findings at IOWNHST

Safeguarding Adults Capacity within IOWNHST

Achievement of Quality Premium Targets at risk (for new financial year)

Achivement of Better Care Fund Targets

Impact of closure of Garfield Road GP surgery

Anticoagulation service required updating

Reputational risk to CCG following Medicines management issues

Summary Risk Register

Risk Distribution by Objective

Activity

Total Time on Register

0

0

01234567

Comm Fin Qual Corp

High

Medium

Low

Governing Body Annual Report and Annual Accounts Sponsor: Helen Shields, CCG Chief Officer

Summary of issue:

The CCG is required to prepare and approve an Annual Report and Accounts which provides a fair and true statement of the CCG’s position at the end of 2015/16. This report is then consolidated by NHS England with all other CCG Annual Report and Accounts into a single report laid before Parliament.


To approve the Annual Report and Accounts and to make the appropriate declarations required.

Principle risks:

The requirement to produce an annual report and accounts is a statutory obligation. Failure to do so in the expected timeframe would call into question the management and operation of the CCG.


The process for the development of the annual report has been discussed at the Audit Committee. The final report and accounts have been approved at the Audit Committee.


The Annual Accounts provides a summary of the financial position at the end of the year 2015/16. This has been externally audited. An External Audit Letter will also be available to provide assurance to the Governing Body that the CCG has complied with the requirements in relation to the Annual Report and Accounts and will highlight any issues that they have found.


The requirement to produce an Annual Report and Accounts is a statutory obligation. Guidance in relation to its content is provided by NHS England and must be adhered to by the CCG.


The front section of the annual report is intended to be a standalone document which is written specifically for members of the public. It is designed to provide sufficient information for a lay person to understand the operation, overarching strategic intentions and performance of the CCG in the previous financial year. The CCG intends to publish this as a separate document for use to support public engagement in the coming year.


The Annual Report includes information regarding equality and diversity and the CCG’s agreed equality objectives.

Author of Paper: Loretta Outhwaite, Chief Finance Officer Caroline Morris, Head of Primary Care and Corporate Business.


Isle of Wight CCG Annual Report and Accounts 2015/16 FINAL DRAFT 10 May 2016

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Table of Contents 1. OVERVIEW ............................................................................................................................. 7

1.1. Statement from the Accountable Officer .................................................................................. 7

1.2. Isle of Wight NHS Clinical Commissioning Group ...................................................................... 9

1.2.1. Our Island – a unique set of healthcare challenges ........................................................... 9

1.2.2. Who we are and how we work .......................................................................................... 9

1.2.3. What we do ...................................................................................................................... 10

1.2.4. Our financial allocation .................................................................................................... 10

1.2.5. Our objectives and critical success factors ...................................................................... 11

1.2.6. My Life a Full Life and the Vanguard Programme ............................................................ 12

1.2.7. Better Care Fund .............................................................................................................. 13

1.3. Performance Summary ............................................................................................................ 15

1.3.1. Risk management ............................................................................................................. 16

1.3.2. Stakeholder relationships and engagement .................................................................... 16

1.4. Factors affecting future performance ...................................................................................... 16

1.4.1. Investments and budgets ................................................................................................. 16

1.4.2. Workforce ........................................................................................................................ 17

2. PERFORMANCE ANALYSIS ..................................................................................................... 18

2.1. Financial Performance ............................................................................................................. 18

2.2. Operational Performance ........................................................................................................ 18

2.3. CCG Assurance Framework 2015/16 ....................................................................................... 21

2.4. NHS Constitution Targets and other Performance Metrics ..................................................... 21

2.5. Quality measures ..................................................................................................................... 23

2.5.1. Complaints/Concerns ....................................................................................................... 24

2.5.2. Safeguarding .................................................................................................................... 25

2.6. Other Performance .................................................................................................................. 25

2.7. Sustainability Report ................................................................................................................ 25

2.7.1. Background ...................................................................................................................... 25

2.7.2. Policy and governance ..................................................................................................... 26

2.7.3. Sustainable Development Management Plan ................................................................. 26

2.8. Other disclosures ..................................................................................................................... 26

2.8.1. Going concern .................................................................................................................. 26

3. MEMBERS REPORT ............................................................................................................... 28

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3.1. The Members and Membership Council ................................................................................. 28

3.2. The Governing Body ................................................................................................................. 28

3.3. Disclosure to Auditors .............................................................................................................. 29

3.4. Members interests ................................................................................................................... 29

3.5. Disclosure of personal data related incidents ......................................................................... 29

3.6. Emergency Preparedness ........................................................................................................ 29

3.7. Employee consultation ............................................................................................................ 29

3.8. Other disclosure ....................................................................................................................... 30

3.8.1. Equality disclosure ........................................................................................................... 30

3.8.2. Health and Safety ............................................................................................................. 30

3.8.3. Fraud ................................................................................................................................ 30

3.8.4. External auditors remuneration....................................................................................... 30

3.8.5. Cost allocation and charges information ......................................................................... 30

3.8.6. Better Payments Practice Code and Prompt Payments Code ......................................... 30

3.8.7. Principles for Remedy Statement .................................................................................... 30

4. STATEMENTS BY THE ACCOUNTABLE OFFICER ....................................................................... 32

4.1. Statement of Accountable Officer Responsibility .................................................................... 32

4.2. Governance Statement ............................................................................................................ 33

5. REMUNERATION AND STAFF REPORT .................................................................................... 48

5.1. Remuneration report ............................................................................................................... 48

5.1. Senior Manager’s Remuneration ............................................................................................. 48

5.1.1. Policy on Senior Managers’ Contracts ............................................................................. 48

5.1.2. Policy on remuneration of senior managers including performance related pay ........... 49

5.2. Staff Report .............................................................................................................................. 55

5.2.1. Employment Policies and Processes ................................................................................ 56

5.2.2. Equality and Diversity ...................................................................................................... 56

5.2.3. Social, Community and Human Rights issues .................................................................. 57

Page 4 of 57

List of Tables

Table Title Page A 2015/16 QIPP Programme B Summary of budgets C Attendance at Governing Body Meetings D Attendance at Membership Council E Attendance at the Clinical Executive F Attendance at Quality and Patient Safety Committee G Attendance at Audit Committee H Attendance at remuneration committee I Attendance at Joint Committee for Primary Care J Senior Manager Service contract details K Senior manager salaries and allowances 2015/16. L Senior Manager Pension Benefits M Pay Multiples N Off-Payroll Engagements as of 31st March 2016 O Assurance sought in relation to Income Tax & NI Obligations P Senior Managers who are off-payroll engagements

List of Figures

Fig Title Page 1 CCG investment in NHS services 2015/16 2 NHS Constitution achievement 2015/16 3 Staff by professional group 4 Governing Body by gender 5 Staff by gender 6 Senior Managers and GPs by gender

Page 5 of 57

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1. OVERVIEW

Statement from the Accountable Officer 1.1.

Welcome to the Isle of Wight Clinical Commissioning Group Annual Report and Accounts for the financial year 2015/16. This report summarises the CCG financial and operational performance for this year highlighting both the positive changes that we have made and outlining how we intend to progress the ongoing and complex problems we are facing.

2015/16 has been our most challenging year to date. The CCG has been tackling a range of performance and quality issues whilst engaged in the most comprehensive transformational change programme experienced by the Island for many years.

We have achieved financial balance in year and met all of our statutory financial targets across both programme and running costs. At the end of the financial year we were able to increase our surplus in return for additional funding in 2016/17. This will be vital to support an increasingly financially challenged position for next financial year. During the year we received notification of our future funding envelope which has been developed in line with the new NHS Allocation Formula. This shows the island as £X million over its target allocation which in turn means the island will receive no funding growth for the next three years despite an increasingly elderly and dependent population and the financial challenges that are inherent in running health care on an Island. While the Governing Body embraces the need to be more efficient and use our resources effectively, the Governing Body also sought a meeting with our local Member of Parliament and the Health Minister, Dr Dan Poulter, early in the year to raise awareness of the situation that the island finds itself in. We will continue to raise the issue of the “Island Premium” - that is the extra costs that are incurred when running health services on an island.

Achievement of key NHS Constitution targets, particularly the 18 week Referral to Treatment Target (RTT) began to slip early in the year. The CCG started with a backlog of patients waiting for treatment, and the target was first failed in June. In August the 4 hour A&E target was missed and in September the CCG reported a number of 12 hour trolley waits and a high level of escalation across the month which has continued. Despite the approval of a system resilience plan which included significant investment in additional capacity and beds, the system remains under significant pressure.

As part of the resilience plan, the CCG has undertaken a campaign to promote a patient’s right to choose their place of referral, encouraging patients to travel to the mainland to receive prompt treatment. This has been well received with a significant increase in the number of patients willing to travel, particularly for those most challenged specialities such as orthopaedics and urology. We will continue to promote informed choices in the coming year, to enable patients to choose where they are referred to for treatment.

Significant progress has been made in year against many aspects of the quality agenda. The CCG has increased its own capacity and capability in this area with new roles developed first to increase the ability of the CCG to oversee the quality agenda and second specifically to focus on supporting quality improvement in care homes, particularly focused on supporting people to remain in their usual place

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of residence an avoid unnecessary hospital admission. Following the resignation of both the Adult and Child Safeguarding leads in year (posts which were share with Portsmouth CCG), the CCG successfully recruited a single Safeguarding lead able to focus full time on Isle of Wight issues.

The CCG continues to engage with local providers to reduce the number and severity of pressure ulcers experienced by our patients, and we remain concerned at the high number of Healthcare Acquired Infections and falls experienced while people are in hospital or being looked after by a healthcare professional. Through improved review processes and better root cause analysis, we believe we will drive the learning that will make significant improvement in all three of these areas in the next year.

The CCG has worked closely with the Isle of Wight Council in year. We agreed a pooled budget for services of £X Million and formed a Joint Adult Commissioning Board to oversee joint working. We have agreed to move towards integrated commissioning in 2016/17 and increased the pooled budget to £X Million.

2015/16 saw the CCG engaged in Joint Commissioning of Primary Care with NHS England. To respond to these new responsibilities, the CCG increased its capacity to manage primary care issues, particularly as in year it applied for fully delegated commissioning responsibilities. This new responsibility will enable the CCG to integrate primary care into the local commissioning strategy and tackle the growing issues with capacity and workforce that are emerging in primary care. To support the Governing Body with these new responsibilities we appointed an additional lay member to chair the Primary Care Committee.

We had to dismiss a senior member of the medicines management team in year but this gave an opportunity to review the purpose and function of the medicines management team. We also reviewed the suite of policies and procedures that relate to the management of conflicts of interest and provided additional training both to the Governing Body and Clinical Executive. An internal audit report in year has provided the Governing Body with assurance in relation to the way in which the CCG is managing potential conflicts of interest.

The progress with the system transformation received a boost when the Island was awarded “Vanguard” status for the My Life a Full Life programme, which offered significant opportunities to bid for money to support the transformation effort. This programme is a vital part of the longer term sustainability for island health and care services working across not only statutory partners but also with local GPs and the voluntary sector.

A Whole Integrated System Review of services has been commissioned which will report in July 2016 and will fundamentally review how services are delivered and whether there are more effective or efficient ways of achieving the same outcomes for patients whilst maintaining high quality sustainable services.

There are huge challenges moving forward, however the transformation programme is an opportunity for the Health and Care system together with wider partners to determine the future of services for island residents.

Helen Shields 10 May 2016

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Isle of Wight NHS Clinical Commissioning Group 1.2.

The Isle of Wight NHS Clinical Commissioning Group (CCG) was formed on the 1st April 2013 following the changes that took place in the NHS as a result of the Health & Social Care Act 2012. One of the key changes involved putting clinicians in charge of commissioning the healthcare services their local community needs for both Island residents and visitors.

We have forged unique partnerships with colleagues from primary care, hospital and community services, social care, independent and the voluntary sectors and are working closely together to make real improvements to the health and wellbeing of every person on the Isle of Wight. This collaborative approach is key to addressing the unprecedented challenges we are facing as the demand for health services increases. By integrating services so they are more efficient, we will be able to deliver better value for money for local residents and ensure sustainability of services.

Our Island – a unique set of healthcare challenges 1.2.1.

The Island is a wonderful place to live and work, but it is also a location that presents unique challenges in commissioning healthcare services.

The Island has distinct needs with nearly a quarter of its population aged 65 and over. As this number increases and residents live longer, more people will be living with long-term conditions (LTC). Currently it is estimated 45,000 people locally have one or more LTC such as coronary heart disease, stroke and diabetes. There is also an increasing prevalence of dementia on the Island which will affect 21% of those aged over 65 by 2020. Addressing these challenges puts increased demand on services.

With around 16,000 people on the Island suffering common mental health problems there is a need to address the emotional wellbeing of residents.

We also see great economic disparity between areas on the Island which gives rise to corresponding inequalities in health and life expectancies.

Commissioning services to meet these challenges places increasing demands on local services, whilst at the same time there is a requirement to improve quality and make efficiency savings to ensure services are sustainable in the long term.

Who we are and how we work 1.2.2.

In 2015/6 the CCG was made up of 17 GP practices supported by professional commissioning staff. It is responsible for commissioning - planning, purchasing and monitoring - healthcare services for the Isle of Wight.

At the centre of the CCG are three key bodies which are described in detail later in this report.

• The Membership Council, on which every Island GP practice has a nominated Practice Representative and collectively holds to account and sets the strategic direction for the Governing Body.

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• The Governing Body is responsible for overseeing the CCG’s commissioning responsibilities ensuring the group uses its resources effectively to provide quality services meeting the needs of Island residents.

• The Clinical Executive manages the day-to-day functioning of the organisation, and is accountable to the Governing Body.

To ensure clinical input in every level of CCG work, the Island GP practices are clustered into three Locality Groups – North & East, West & Central and South Wight. These groups look at the health needs of their local communities and work collaboratively to improve primary care services.

For more information about the various bodies and committees visit our website www.isleofwightccg.nhs.uk/who we are.

What we do 1.2.3.

We commission services from NHS and independent providers on and off the Island.

Together with our partners, we are developing person-centred, coordinated health and social care on the Isle of Wight, our vision is to commission high quality, sustainable and integrated services.

We work to improve the quality of services, to keep patients safe and ensure services can be delivered when and where people need them. We are integrating services to make efficient use of the resources that we have and to meet the healthcare challenges we face as a community both now and in the future.

With the Isle of Wight NHS Trust and Isle of Wight Council, and our partners in the voluntary and independent sectors we aim to put in place the support, information and advice needed to help people improve the way they look after their own health so they can lead longer, healthier and more independent lives.

Our Constitution, Commissioning plans and other publications can be found at our website www.isleofwightccg.nhs.uk

Our financial allocation 1.2.4.

The CCG received £215m in 2015/16 for both programme and running costs. As part of its planning process, the CCG developed an investment programme. In line with the national guidance, the CCG planned 1% non-recurrent investments (£2.2m) to support service transformation. Figure 1 provides an overview of how the CCG invested its funding in each sector of health care.

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http://www.isleofwightccg.nhs.uk/who

http://www.isleofwightccg.nhs.uk/

The CCG’s Quality, Innovation, Productivity and Prevention (QIPP) programme summarised in Table A below was a key element of the investment framework. In 2015/16, the CCG invested £1.2m in QIPP schemes to generate savings of £3.4m.

Table A: 2015/16 QIPP Programme

Our objectives and critical success factors 1.2.5.

The CCG Governing Body set five objectives for the organisation in 2015/16, which are expressed in the Governing Body Assurance Framework:

• To implement our clinical commissioning strategy • To demonstrate measurable improvement in the quality and safety of our commissioned services • To meet the statutory finance and NHS Constitution targets set for us by NHS England • To work constructively with providers, partners and the public for the wellbeing of our patients and

communities. • To create an Organisational Development plan and achieve culture change within the CCG

Against these five objectives critical success factors have been set. Achievement against these can be found in the performance analysis section of this report.

Acute 50%

Mental Health 11%

Community 8%

Better Care Fund 7%

Continuing Care 6%

Primary Care 16%

Other 1%

Running Costs

1%

Figure 1: CCG investment in NHS services 2015/16

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My Life a Full Life and the Vanguard Programme 1.2.6.

The CCG together with local partners has been developing a new care model aimed at improving health, wellbeing and care of our island population, improving care and quality outcomes, delivering appropriate care at home and in the community and making health and wellbeing clinically and financially sustainable. This is known as the My Life a Full Life programme.

Care on the Island has historically been heavily reliant on statutory services, which has limited the range of care available to Island residents and based on forecast demand is no longer clinically or financially sustainable. Our new care model will mean that people will have much greater support from their community, family/friends, as it:

• builds on assets and mobilises social capital to help reshape care delivery to meet peoples changing needs

• integrates services to improve quality and increase system efficiencies using technology as the key enabler

• is based in the community / at home • is a significant shift to prevention and early intervention, self-help/care, with the aim of

reducing health inequalities and the health and wellbeing gap • reduces reliance on statutory services

In 2015/16 the MLAFL programme has been making good progress towards shaping care around people’s individual needs and keeping them happy and healthy through self-care, self-management and active communities. This has been achieved by working across organisational boundaries, sharing resources and expertise. We achieved Vanguard status which attracted £X million to support greater partnership working.

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Progress has included:

• Establishing the Family Wellbeing platform and providing coaching skills training to a number of partner organisations.

• Implementing data sharing and telephony links/processes in The Urgent Care Hub. • Establishing/rolling out care navigation and local area co-ordination. • Starting the Whole Integrated System Redesign programme • Developing locality working – including establishing Multi-Disciplinary Teams • Developing a system-wide Behavioural Framework for culture change. • Implementing a care home training project with a focus on end of life Care, falls, managing

complex behaviour and quality reporting. • Supporting development of the GP Federation (all Island practices) • Developing a Local Estates Strategy • Completed system wide stakeholder requirements IT review which underpins the delivery

for all other workstreams

Better Care Fund 1.2.7.

The Better Care Fund (BCF) was announced by the Government in June 2013, to speed transformation towards integrated health and social care. The Better Care Fund creates a local single pooled budget to incentivise the NHS and local government to work more closely together around people, placing their well-being as the focus of health and care services. To ensure closer integration between health and adult social care services, the CCG and the local authority are required to pool resources which are principally already committed to existing core activity. As the fund and the relationship between the partners develops over time, there will be a focus on developing new ways of working which are designed to drive efficiency gains out of the whole health and social care system.

On the Island, the agreed value of the budget for 2015/16 was £20,607,000, the allocation of which is shown in the table below. It is important to note that the BCF is not ‘new’ or ‘additional’ money, but rather is a pooling of existing money to be used in an integrated approach to care and support.

The CCG and the council agreed to use the BCF to fund the following nine schemes in 2015/16:

Scheme Funding 2015/16

Mental Health Reablement • Integrated reablement pathway for people with complex mental health needs • Reablement Bed: Ryde House Group This investment was designed to improve mental health/learning disabilities reablement to enable the patient to recover. It supports Individual Placement and Support (IPS) schemes, integrated care pathways and housing options. It is intended to reduce costs for the council and health.

£1,918,000 £35,000

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Crisis Response This investment is intended to improve crisis response through a new team who can help keep people at home rather than admit them to hospital or residential care. Alongside this, GP direct access to residential care beds has been reviewed. This work programme is also designed to improve take up of Assistive Technology and develop 7-day a week working where this will bring cost effective benefits.

£1,885,000

Rehabilitation/Reablement This programme of work is developing integrated rapid response and reablement service (including 7 day a week service), homecare reablement, community equipment, SPARRCS1, community care home rehabilitation beds, stroke early supportive discharge team, falls co-ordinator and fall training, support grant to Stroke Association and disabled facility grants.

£6,642,000

Integrated Locality Working During 2015/16 the CCG, Trust and Local authority have been developing a multi-disciplinary approach to providing care through a network of professionals delivering effective joint case management wrapped around primary care to prevent duplication of services and enable Island residents to be fully involved in the provision of individual care packages.

£5,140,000

Enhanced Hospital Discharge We will provide enhanced care management (7 days a week working) and additional care packages to facilitate hospital discharge.

£2,969,000

Supporting Information, Advice and Self-management We will make the best possible use of People Matter and the Independent Living Centre as we progress our Supporting Information, Advice and Self-Management programme to ensure people are more able to look after themselves, when appropriate.

£106,000

Carers Supporting carers in their caring role, Improving access to carer’s assessments, better training and information and access to respite care.

£386,000

Care Act Review of services to meet the Care Act obligations including: personalisation; carers; information, advice and support; quality assurance; safeguarding vulnerable adults; assessment and eligibility; veterans; law reform; IT; and prisons.

£519,000

Infrastructure Costs

£607,000

Local Area Co-ordination Local area coordination is a unique approach to supporting vulnerable children, adults and their families to build and pursue their vision for a good life, while developing inclusive, welcoming and supportive communities.

£400,000

The better care fund has been overseen by the Joint Adult Commissioning Board (JACB), which is a joint committee of the Local Authority and Isle of Wight CCG.

1 SPARRCS – Single Point of Access, Referral, Review and Co-ordination Services: multi-disciplinary team comprising of senior clinicians: Nurses, Occupational Therapists, Physiotherapist working as trusted assessors with telephone triage for all referrals

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Performance Summary 1.3.

The CCG monitors a series of ‘NHS Constitutional Targets’ that are set nationally. These primarily cover waiting periods for treatments and response times for emergency services. Performance across the system has been disappointing this year due to capacity pressures throughout the health and care system. Progress with major service change has started, however although small changes have been delivered, which improve care for patients, this has yet to deliver the fundamental system transformation required.

A detailed analysis of the CCG’s performance can be found in the Performance analysis section. A summary of the key targets is shown below:

Indicator Target Achievement

Patients to start treatment within a maximum of 18 weeks from referral

92% 88.64% The Hospital was unable to ring fence beds for planned treatments due to problem with patient flow through the hospital and out into the community. Temporary additional community beds were funded in October 2015 and plans are in place to recover the target by November 2016.

Patients admitted, transferred or discharged within 4 hours of arrival at A&E

95% 89.39% (as at end

February 2016)

A&E services have been affected by the problems of patient flow through the local hospital and the complex conditions of patients presenting at A&E. A review was undertaken in Nov 15 and plans are in place to improve performance to 92% by September 2016.

Maximum 62 day wait from urgent GP referral to first definitive treatment for cancer

85% 79.29% 7 of the 9 cancer targets continually met target. The CCG continually monitors the reasons that patients do not receive treatment within 62 days, this is often as a result of complex treatment requirements at mainland hospitals. Improvement plans are in place.

Ambulance response Times. (Category A, Red 1 within 8 minutes)

75% 71.25% There are number of targets for ambulance. The service failed to meet the target for the most urgent calls due to capacity issues. Handover processes with the hospital have been reviewed with plans for improvement in place.

Diagnostics people should wait less than 6 weeks for tests.

99% 99.37% Performance for diagnostic tests has been good for a number of years and the CCG has met its target again this year.

The CCG also continually looks to improve and strengthen assurance arrangements in respect of quality and safety of the services it commissions. The CCG sets quality metrics for all contractors through its contractual arrangements, collects intelligence on quality, safety and patient experience which is then used to inform its work programme. More detail on the quality agenda can be found in the Performance Analysis section of this report.

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Risk management 1.3.1.

The principle risks faced by The CCG are captured in a Governing Body Assurance Framework linked to the objectives of the Group. At the end of this reporting period, the Governing Body had identified the following key risks and uncertainties in year:

• Funding Allocation: the CCG identified risks related to NHS England’s CCG funding formula. As of 15/16 the formula indicates that the CCG is c£31m overfunded, and this means that the CCG will receive no growth for the foreseeable future. The CCG has been actively working with NHS England to understand why there is such a significant impact on the Isle of Wight.

• Provider Issues - The Isle of Wight NHS Trust requires and will continue to require funding above tariff due to the diseconomies of scale of providing services on an island. The CCG has been working with the Trust to complete a Cost Base Review exercise; however this has not been finished in 2015/16. Once this is complete, it will support the financial aspects of New Models of Care work being undertaken as part of the NHS Vanguard programme and the identification of the scale of an Island Premium.

• Speed of Delivery of Transformation programmes - there is concern at the speed at which transformation can be achieved and the rate at which cash releasing savings can be realised.

Stakeholder relationships and engagement 1.3.2.

Stakeholder relationships have been challenged during the year as the financial outlook for Island public services worsens. Relationships with local stakeholders have been maintained with close working on the My Life a Full Life programme.

The CCG works closely with HealthWatch, and they provide a representative on the Quality and Patient Safety Committee as well as the Joint Committee for Primary Care.

The Governing Body meetings continue to be held in different locations across the Island seeking to engage with as many people as possible and raising the profile of the CCG and its role locally. Although the numbers of the public who attend these meets are low, those that do report that they find the meetings welcoming and easy to access.

The CCG refreshed the stakeholder strategy this year and has increased its capacity to manage engagement both within core business and with the wider transformation programme. Patient engagement in commissioning remains particularly strong in areas concerning Mental Health, Children and Long Term Conditions.

Factors affecting future performance 1.4.

Investments and budgets 1.4.1.

Under NHS England’s CCG funding formula, the CCG’s core services allocation for 2016/17 is 11.90% (c£25m) above target. This is the fifth highest in England. For 2016/17 this has meant that CCG has received the lowest level of growth funding (£2.8m, 1.4%). The growth funding is insufficient to cover the cost of tariff inflation, demographic growth and unavoidable cost

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pressures. Therefore, the CCG’s plan reflects a break-even position for 2016/17 and does not meet the national business rule of a achieving a 1% surplus.

To illustrate how the CCG’s investment plan supports its strategic objectives, the table below provides a comparison of the 2015/16 and 2016/17 budgets.

Table B: Summary of budgets

The CCG’s over-arching investment strategy has been and will continue to be, to move investment away from the acute/hospital setting, into community and primary care services. This is in line with the Island’s My Life a Full Life, Health, Care and Wellbeing Strategy of reducing/avoiding hospital admissions through enhanced support in community and primary care settings.

Workforce 1.4.2.

The island has an ongoing issue in relation to the recruitment and retention of sufficient qualified staff to meet the needs of the local population. This is particularly acute in nursing across all sectors and in relation to GPs where a number of practices are carrying multiple vacancies. While workforce redesign can mitigate the impact of this workforce shortage to some extent, it remains a risk for the NHS and impacts on the way in which the CCG can commission services.

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2. PERFORMANCE ANALYSIS

Financial Performance 2.1.

The CCG’s financial plan and budget for 2015/16 was developed in line with the CCG’s Strategy and Operational Plan, reflecting the following guidance and policies:

• National Planning Guidance 2014/15 – Everyone Counts: Planning for Patients • Isle of Wight CCG Commissioning Intentions 2014/15 • NHS Mandate (Incorporating NHS Outcomes Framework, NHS Constitution) • Isle of Wight Joint Strategic Needs Assessment (JSNA)

The expenditure budgets were developed from discussions and negotiations with the CCG’s provider organisations. The plan and budget were approved by the Governing Body.

As demonstrated in Note 42 of the annual accounts, for the reporting period, the CCG met all of its financial duties.

The CCG delivered a surplus of £4.5m, which is £2m better than plan and remained within its administration envelope of £25 per head of population.

Financial overspends during 2015/16 were as follows, all of which have been taken into account in activity and financial planning for 2016/17:

• Portsmouth Hospitals NHS Trust contract: £0.2m (6%) cardiac and critical care activity and cardiac devices.

• University Hospital Southampton:£0.5m (11%) mainly increased critical care activity • Mental Health special placements: £0.23m (47%) • Continuing Healthcare placements: £0.7m (7%)

The major financial overspends were off-set by:

• Children’s Continuing Healthcare placements £0.2m (24%) • Underspend on running costs £0.4m (11%) • Headroom reserve not utilised £0.7m • Slippage on investments £0.6m • Additional funding from NHS england, matched by CCG underspend £1m

In relation to cash, at the year end, the CCG had a ledger balance of £78k and a physical cash balance of £137k. In accordance with NHS England Guidance, CCG’s were allowed to retain up to 1.25% of their March cash drawdown, which equated to £143k for the Isle of Wight CCG.

The CCG did not have any capital allocation or expenditure.

Operational Performance 2.2.

As part of the Governing Body Assurance Framework (GBAF), the Governing Body set critical success factors against which the organisation has monitored its progress in 2015/16. The following table offers Governing Body’s assessment of progress against these factors:

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Objective 1:To implement our clinical commissioning strategy Critical Success Factor Deliver the priorities within the Delivery Plan

Achieved The CCG has managed to recruit the additional capacity need to support the schemes of work in the delivery plan as well as engage with the My Life a Full Life programme.

Progress Joint Commissioning with the Local Authority

Achieved A Commissioning Leaders Group has been set up and agreement reached to recruit a senior joint role across the CCG and local authority. Achieving Integrated commissioning is a key workstream within the System Vanguard Programme

Develop the better care fund and establish a monitoring regime

Achieved During the year the CCG has operated the better care fund and established a monitoring regime which is overseen through the Joint Adult Commissioning Board.

Engage the public, service users and carers in the delivery of the strategy

Achieved Patient and public engagement has been at the centre of the My Life a Full Life Programme and the Whole Integrated Service Redesign and the CCG has recruited extra capacity in year

Objective 2: To demonstrate measurable improvement in the quality and safety of our commissioned services

Critical Success Factor Achieve the local CQUINs set for our providers by the end of the financial year

Partially achieved

Although there was a strong monitoring programme in place throughout the year, the Isle of Wight NHS Trust reported gaps in CQUIN achievement at the end of the year. The CCG will be reviewing how

Achieve the quality indicators in the contracting schedules throughout the year

Partially achieved

The quality indicators were all met except for one related to PU

Achieve all the local quality indicators in the contract schedules for quality and safeguarding by the end of the financial year

Partially achieved

The CCG can report a significant improvement in the oversight of safeguarding and quality in year with the redesign and strengthening of the quality team and significant progress taking forward safeguarding capability and capacity for both adults and children on the Island. This is reported as partially achieved as there is still further work to be undertaken to secure the improvements that have been made.

Objective 3: To meet the statutory finance and NHS Constitution targets set for us by NHS England

Critical Success Factor The CCG meets all its financial targets as set out in the guidance for 2015/16

Achieved For 15/16 the CCG has met all its financial targets as shown in the annual accounts.

Meet the NHS Constitution targets set by NHS England

Not achieved Achievement against a number of the NHS constitution targets has not been achieved this year, in particular The 18 week referral to treatment time target and the 4 hour wait in A&E. Recovery against these targets has been hampered by a range of issues including difficulty in recruiting nursing workforce and reduction in nursing

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home capacity. The System Resilience Group has clear recovery plans in place with significant investment being made into resolving the issues. More detail on this can be found on

Understand the IOW Trust cost base and quantify the “island premium” by 31 March 2016

Not achieved While significant progress has been made with the cost base exercise, it has not been finished and in a number of areas requires further work. The ambition to quantify the island premium remains work in progress

Agreed an action plan with NHS England regarding the CCG allocation by the end of the financial year

Not achieved The CCG has undertaken significant work to engage NHS England with the issues related to the allocation for the CCG and while some progress has been made, it has not

Objective 4: To work constructively with partners and the public for the wellbeing of our patients and communities

Critical Success Factor

Establish robust joint commissioning arrangements for primary care

Achieved The CCG has delivered a year of joint commissioning for primary care as well as being approved for delegated commissioning status. A new lay member was recruited to chair the committee strengthening the Governing Body and the Joint Committee for Primary Care. The CCG has undertaken a comprehensive review of conflicts of interest policy and processes to ensure governance arrangements are robust and fit for purpose.

Deliver the joint priorities within the MLFL programme

Partially achieved

The CCG was able to increase capacity in year to support the My Life a Full Life Programme and increasingly integrate its own work programme with that of the wider system transformation agenda. Progress was delayed in year in order to respond to the national Vanguard programme, however in the latter half of the year there has been substantial progress on establishing robust governance and capacity to deliver the programmes which will support delivery in 16/17.

Deliver the joint infrastructure strategies (estates and IT)

Partially achieved

Good progress has been made on both the IT strategy and Estates Strategy. This is reported as partially achieved as both strategies have yet to be published; however the bulk of the work on both has been completed.

Objective 5: To create and agree an OD Plan and change in culture within the CCG Critical Success Factor demonstrate improved engagement with the membership

Partially achieved

The CCG 360 survey in year indicated that there are good relationships in place between the CCG and stakeholders including the membership

Implement the stakeholder strategy

Partially achieved

Both the My Life a Full Life programme and the Vanguard has involved substantial and ongoing engagement with patients and public this year, however while the CCG has overhauled its stakeholder strategy and increased capacity in this area, there is still work to be completed to

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ensure that the Governing Body feel fully assured that the CCG is systematically and routinely involving patients at the level expected by the Governing Body.

Support the development of a joint OD plan across the system

Achieved The CCG completed its OD plan this year and has contributed to a wider system OD plan which is being developed as part of the My Life a Full Life Programme.

CCG Assurance Framework 2015/16 2.3.

A new assurance framework was introduced as NHS England has recognised that much has changed since the CCG authorisation process. The new continuous assurance process focussed on 5 key areas including: Well-led organisation; Performance; Financial management; Planning and Delegated Functions.

The CCG achieved “Limited Assurance” status at the end of Q3. The final status at the end of Q4 will not be available until July 2016. A key issue was that certain NHS Constitution targets have not been achieved such as A&E 4 hour waits and 18 week waiting times for treatment. We delivered our financial plans and are recognised for taking forward our transformation agendas, but we need to continue strengthening our system wide leadership and approach to resilience and sustainability. Internal audit reports have provided assurance that the organisation has good governance in place and is managing its business effectively.

NHS Constitution Targets and other Performance Metrics 2.4.

During 2015/16 performance against constitutional targets was compromised predominantly due to capacity pressures and patient flow issues throughout the health and care system. The CCG met 8 of the 15 national NHS Constitution Key Standards. Key problem areas were the 18 week referral to treatment (RTT) target and A&E 4 hour waits. This was despite the CCG supporting and funding projects during the year to deliver enhanced capacity in the system including the opening of 51 additional beds.

Robust monitoring and detailed reporting is made for all constitutional targets and in 2015/16 there were Remedial Action Plans (RAP’s) in place with providers for the 18 week Referral to Treatment (RTT) target, Cancer 62 day treatment target and for A & E 4 hour waits. For the beginning of a new financial year the CCG are required to carry forward updated action plans as a Service Delivery Improvement Plan (SDIP) as part of the contract.

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NB: All rates are as at end of March 2016. The end of year figure for A&E was not available at the time of going to print.

Figure 2: NHS Constitution achievement 2015/16

During 2015/16 the IOW NHS Trust has failed to deliver its contracted activity levels for planned elective treatments both for inpatients and day cases. This was predominantly due to the inability to ring fence beds for planned treatments because of problems with patient flow through the hospital and out into the community. This has had consequences for the 18 week RTT constitutional target. The CCG supported and funded projects to increase bed capacity in the system in October 2015 and an activity plan by speciality was established with the aim of recovering the target of 92% treated within 18 weeks total incomplete by March 2016. However the plan did not fully deliver the activity required due to the patient flow pressures through winter.

The CCG has actively promoted increased activity at mainland trusts and the independent sector to help alleviate the pressures on the IOW waiting list. Outsourcing from the existing IOW NHS Trust waiting list has had limited success however, by actively promoting choice through targeted media campaigns to the public and primary care, there has been an

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increasing number of direct referrals to local mainland independent sector providers by island GP’s. Accordingly there has been a drop in the number of new referrals to the IOW NHS Trust. The CCG has determined the activity and trend information available to understand the activity demand levels at the IOW NHS Trust and mainland providers for 2016/17. Throughout the next year we will continue to actively promote patient choice and demand plans have been developed with all our major providers to ensure sufficient activity levels are commissioned, including ongoing commissioning of mainland independent sector capacity. Through the Systems Resilience Group we will continue to monitor bed and service demand and capacity throughout the whole system, and amend plans if required.

Performance against the A&E target has been disappointing. A review by the Emergency Care Intensive Support Team (ECIST) in November 2015 reported significant flow issues through the system as the main cause, as demand for non-elective admissions has been contained by schemes that have been put in place. The Trust has been working closely with the Trust Development Agency (TDA) as well as ECIST to develop an action plan from recommendations that followed a series of improvement meetings and assessments. The Trust has also recently performed a ‘Safer Start’ week and good practice identified will be implemented as core practice. The Trust and the System Resilience Group will continue to work with both the TDA and ECIST to improve assessment processes in both Medical Assessment Unit and Emergency Department as part of progressing the development of the local Ambulatory Care model in order to offer sustainable and timely care.

Reflecting the pressure the system has been under, The CCG has reported 61 breaches of mixed sex accommodation during the year, the majority at the Isle of Wight NHS Trust and seven individuals have seen their operations cancelled twice. There have also been 42 individuals who waited on trolleys in A&E for more than 12 hours and 14 patients waiting more than 52 weeks for an operation or procedure both measured against a target of zero.

Performance against Cancer 62 day waits and Ambulance targets has been inconsistent during 2015/16 and trajectories for 2016/17 reflect a step change of improvement aimed at recovering and sustaining performance at the constitutional standards. These trajectories are supported by agreed action plans and capacity plans.

Quality measures 2.5.

The CCG is continually seeking to improve and strengthen assurance arrangements in respect of quality and safety of the services it commissions. The CCG sets quality metrics for all contractors through its contractual arrangements, collects intelligence on quality, safety and patient experience which is then used to inform its work programme.

The CCG achieved 41.25% of the 2014-15 Quality Premium payable in 2015/16 after deductions applied against CCG performance conditions. The performance against quality premium targets during this financial year included:

Target Increase the number of diabetic patients whose last cholesterol was 5mmol or less.

Achieved Working with GP practices throughout the year, the CCG has achieved its target of 71.85%

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Increase the number of IW patients issued with a repeat prescription for an oral NSAID in the last 90 days who have also been issued with a repeat prescription for a Proton Pump Inhibitor in the last 90 days.

Not Achieved

The CCG has missed its target of a step change to 85%. Recent trends suggest that GPs have not been prescribing NSAIDS as repeat items in the first instance, as has been done in previous years, but rather as a one off item.

Delayed Transfers of Care which are an NHS responsibility

Not Achieved

Numbers of days delay have been marginally higher than those reported for 2014/15. Difficulties reducing the length of delay were in part due to the frailty of patients and the complexity of their requirements. Also there have been closures of homes on the Island.

Increase in the number of patients admitted for non-elective reasons who are discharged at weekends or bank holidays.

Achieved The target is to be 0.5% higher than last year.

This result is currently provisional as the outcomes for March are not yet released, but was achieving in February.

Mental health – Reduction in the number of patients attending an A&E department for a mental health related need who wait more than four hours to be treated and discharged, or admitted, together with a defined improvement in the coding of patients attending A&E.

Not Achieved

Throughout 2015/16 overall performance for A&E has been below target. In terms of mental health patients, overall the breach rate missed target.

Mental health – Increase in the proportion of adults in contact with secondary mental health services that are in paid employment.

Achieved National data is yet to be released, however local data indicates an improvement to 5,23% from 1.30% in the previous year.

Patient safety – Reduction in the number of antibiotics prescribed in primary care.

Achieved (TBC)

This result is currently provisional as the outcomes for March are not yet released. Up to and including February the total number of antibiotics prescribed in 2015/16 has been 86,076 compared with 96,635 for the same period last year.

Patient safety – Reduction in the proportion of broad spectrum antibiotics prescribed in primary care.

Achieved This result is currently provisional as the outcomes for March are not yet released, a successful target for 2015/16 equates to a rate of 13.4%.The most recent data indicates a rate of 10.78%.

Patient safety – Secondary care providers validating their total antibiotic prescription data.

Not Determined

Details are awaited. There is currently no recognised performance outcome reported for this indicator.

Table D: Quality Premium Targets 2015/16

NB: against any rewards gained from the achievement of the QP targets listed above, the CCG will be subject to penalties totalling an 80% deduction and resulting from the non-achievement of Constitution target rates for five of the six indicators applied by NHS England.

Complaints/Concerns 2.5.1.

During 2015/16 the CCG received six formal complaints managed in line with the NHS complaints procedure. Of the six, two were in relation to the outcome of Individual Fund Requests (IFR).

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There were 21 concerns received during the same period by the organisation. Of these, four were in relation to IFR decisions and three were related to continuing healthcare decisions. Seven concerns related to provider services at the Isle of Wight NHS Trust.

Safeguarding 2.5.2.

The CCG, through its designated nurses for both Children and Adults, the Director of Quality and Clinical Services, actively participates in the local Safeguarding Children and Adult Boards working closely with the local authority, public health, police and the third sector to ensure oversight and scrutiny on all safeguarding issues. The CCG supports both boards financially to ensure robust serious case reviews and board administration are undertaken effectively.

Other Performance 2.6.

GP referral and prescribing rates

GP referral rates were 3.4% below plan at February 2016. Primary care prescribing was £54k over the planned budget, but overall inflation against this budget remained below the England rate.

Staff and clinical leadership

A key strength of the CCG is its experienced group of core staff, its clinical leads and the relationships that have been built up with providers, contractors and patient groups over a number of years. The CCG has invested the majority of its administration budget employing the people who carry out its functions on its behalf.

Systems and processes

The continued improvement to systems and processes is achieved through an active internal audit programme. As discussed later in this report, the CCG has received an opinion of reasonable assurance from the auditors.

The CCG places a strong focus on the management of corporate risk and performance with reporting at all key governing body sub committees and at the Governing Body itself. Clear lines of accountability are established across the organisation feeding into these committees.

Sustainability Report 2.7.

Background 2.7.1.

Sustainability has become increasingly important as the impact of peoples’ lifestyles and business choices change the world in which we live. We acknowledge this responsibility to our patients, local communities and the environment by striving to minimise our carbon footprint and adhering to sustainable development principles.

The CCG is committed to purchasing health care in a way that supports the UK sustainable development agenda and contributes to environmental improvements, regeneration and reducing health inequalities.

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Policy and governance 2.7.2.

As part of its Sustainability Policy the CCG is committed to the concept of “holistic commissioning”, which actively takes into account the determinants of health that affect individuals, groups and wider population of the Isle of Wight. The CCG works to a strategy and framework to ensure that our commissioning processes such as service design, tendering and contracting takes account of environmental sustainability and social value of services at the same time as improving quality.

Sustainable Development Management Plan 2.7.3.

In line with the SDU requirements, the CCG has a Sustainable Development Management Plan (SDMP) and strategy to progress the sustainability agenda. This plan was created jointly with the Isle of Wight NHS Trust and ratified in June 2015. In the last year we have:

• established an executive lead for sustainability • promoted the principles of sustainable development throughout the organisation • Promoted sustainable health and social care through the My Life a Full Life Programme –

supporting people to manage their own health and wellbeing whilst improving the quality of care and support that services provide

• worked towards the one Island £ - maximising the use of resources that the health and care system on the island has at its disposal

• developed and approved our social value policy and reviewed our procurement policies to ensure alignment between different regulatory requirements.

The CCG is housed in an energy efficient building with energy and water efficient technologies and has a bike pool for staff travelling short distances. The CCG has an effective recycling scheme whereby under desk bins have been removed and replaced with shared waste stations. As a result we are achieving a 50% recycling rate for our corporate premises. Systems are in place to recycle batteries and toners and cartridges, electronic and electrical waste.

Other disclosures 2.8.

Going concern 2.8.1.

NHS Isle of Wight CCG Governing Body is required to assess and satisfy itself that it is appropriate to prepare the financial statements on a “going concern” basis for at least 12 months from the date of the accounts.

To carry out the task the Governing Body has over the year considered factors that individually or collectively, might cast doubt on the going concern assumption. These issues are concerned with financial risk, operating losses (historical and current), non-achievement of savings plans or other financial targets, cash flow problems, loss of staff or management without replacement, serious non-compliance with regulatory or statutory requirements.

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The Governing Body is able to confirm there are no material uncertainties that may cast significant doubt about the Group’s ability to continue as a going concern for at least 12 months beyond the date of the 2014/15 statement of accounts.

We certify that the CCG has complied with the statutory duties laid down in the NHS Act 2006 (as amended). The accounts were prepared under Direction: NHSCB under NHS Act 2006.

Signed,

Helen Shields Accountable Officer 10 May 2016

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3. MEMBERS REPORT

This report has been produced by the Governing Body on behalf of the CCG. (See Governance statement for diagram of relationship of committees).

The Members and Membership Council 3.1.

NHS Isle of Wight Clinical Commissioning Group is made up of 17 GP practices grouped to form the three Island Localities listed below:

West and Central North and East South Wight

The Dower House, Carisbrooke Medical Centre

Medina Healthcare Brookside Health Centre Cowes Medical Centre

Tower House Surgery Esplanade Surgery

Garfield Road East Cowes Surgery

St. Helen's Medical Centre Argyll House

Shanklin Medical Centre Sandown Health Centre Ventnor Medical Centre

Beech Grove, Brading Grove House

South Wight Medical

Each practice is represented at the CCG Membership Council, which acts as the Electoral College for the CCG to elect member clinicians onto the Clinical Executive. It also approves the process for recruiting and removing non-elected members from the Governing Body and agrees the CCG’s overarching vision, values and overall strategic direction.

The Governing Body 3.2.

The Governing Body is responsible for overseeing key relationships concerning the CCG’s statutory functions.

In 2015/16, the Governing Body comprised Dr John Rivers (chairman), Helen Shields (Chief Officer and Accountable Officer), Dr Joanna Hesse (Clinical Executive GP), David Newton (Lay member Patient Public Involvement), Loretta Outhwaite (Chief Finance Officer), Frederick Psyk (Part year Deputy Chair/Lay Member Governance) Martin Davis (Part year Deputy Chair/Lay member Governance), Laurence Taylor (Part year Lay Member Chair of Primary Care Committee), Dr Ian Reckless (Secondary Care Doctor), Mark Rawlinson (part year governing body nurse) and Lindsay Voss (part year Governing Body Nurse).

Feeding into the Governing Body, were five Committees that reflect the key responsibilities of the organisation. These are:

• The Audit Committee, providing the Governing Body with an independent and objective view of Governance and financial systems, financial information and compliance with laws, regulations and directions.

• The Remuneration Committee, making recommendations to the Governing Body on determinations about the remuneration, fees and other allowances for employees and for people who provide services to the CCG.

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http://www.isleofwightccg.nhs.uk/about-us/member-practices/locality-groups/locality-groups.htm

http://www.dowerhousesurgery.co.uk/

http://www.carisbrookehealthcentre.co.uk/

http://www.medinahealthcaresurgery.nhs.uk/index.aspx

http://www.westwightpractice.co.uk/

http://www.cowesmedicalcentre.co.uk/contact1.aspx

http://www.towerhousesurgeryryde.co.uk/

http://www.theesplanadesurgery.co.uk/

http://www.garfieldroadsurgery.co.uk/index.aspx

http://www.eastcoweshealthcentre.co.uk/

http://sthelensmedicalcentre.com/

http://www.argyllhousesurgery.nhs.uk/

http://www.shanklinmedicalcentre.nhs.uk/

http://www.sandownhealthcentre.co.uk/

http://www.ventnormedicalcentre.co.uk/Core/Ventnor-Medical-Centre/Pages/Default.aspx

http://www.beechgrovesurgery.nhs.uk/opening-times.aspx

http://www.grove-house-surgery.co.uk/

http://www.southwightmedicalpractice.co.uk/

http://www.isleofwightccg.nhs.uk/about-us/our%20governing%20body/sub-committees/audit-committee.htm

• The Quality and Patient Safety Committee, ensuring that all decisions are safe and effective and that they improve the quality of care experienced by patients.

• The Clinical Executive, taking responsibility for month-on-month operational oversight of the CCG, developing and recommending strategy, undertaking the bulk of the commissioning function and ensuring that clinical decision making remains central to its work.

• The Joint Committee for Primary Care, taking responsibility for primary care commissioning in conjunction with NHS England.

Members of all these committees together with their attendance at meetings can be found in the Governance Report.

Disclosure to Auditors 3.3.

Each of the Group’s Governing Body members confirms:

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

• that the member has taken all the steps 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 CCG’s auditor is aware of that information.

Members interests 3.4.

The CCG maintains a register of members’ interest which can be accessed at www.isleofwightccg.nhs.uk

Disclosure of personal data related incidents 3.5.

There have been no incidents that have fallen within the criteria for reporting via the Information Governance Toolkit as specified by the Department of Health.

Emergency Preparedness 3.6.

The CCG complies with the NHS Commissioning Board Emergency Preparedness Framework. The CCG is a category 2 responder and works within the Wessex Emergency Preparedness Resilience Response plan (EPRR) and is an active member of the Wessex Local Resilience Forum.

Employee consultation 3.7.

The CCG is committed to the involvement of all of its key stakeholders in the process of creating and delivering its strategic aims. Formal consultation with employees takes place through a Wessex staff partnership committee and an informal CCG staff forum ensuring that all areas and levels of the organisation are able to bring issues to the CCG management.

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http://www.isleofwightccg.nhs.uk/about-us/our%20governing%20body/sub-committees/quality-and-patient-safety-committee.htm

http://www.isleofwightccg.nhs.uk/

Other disclosure 3.8.

Equality disclosure 3.8.1.

The CCG has comprehensive policies in relation to disabled employees and equal opportunities, which are available on request.

Health and Safety 3.8.2.

The CCG has an excellent record on health and safety and as a responsible employer encourages staff to report any incidents. In 2015/16, there were no reports of assaults against staff and no reports submitted to the Health and Safety Executive.

The CCG has a comprehensive policy covering health, safety and security.

Fraud 3.8.3.

The CCG has a robust and effective counter fraud service provided by Hampshire and Isle of Wight Fraud and Security Management Service. This minimises the cost of fraud and corruption and ensures funds are available to improve patient care.

During 2015/16, the CCG instigated an investigation into the activities of a member of staff following media coverage regarding their relationship with pharmaceutical companies. This investigation is ongoing. The member of staff was dismissed following an HR process. As a result of an internal audit by the CCG, procedures regarding the declaration of conflicts of interest have been strengthened and clear mitigation arrangements put in place together with additional training and awareness raising with staff.

External auditors remuneration 3.8.4.

The CCG is required to declare any remuneration paid to auditors in respect of any non-audit work undertaken by them. It can confirm that the external auditors have not undertaken any non-audit work for the CCG in 2015/16.

Cost allocation and charges information 3.8.5.

The CCG certifies that the CCG has complied with HM Treasury’s guidance on cost allocation and the setting of charges for information.

Better Payments Practice Code and Prompt Payments Code 3.8.6.

The CCG is signed up to the “Better Payments Practice Code” and the “Prompt Payments Code”. Details of the CCG’s performance are included in the relevant note to the accounts.

Principles for Remedy Statement 3.8.7.

The CCG has policies in place for handling complaints and claims management that adhere to the six principles of good practice. These are:

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• Getting it right • Being customer focused • Being open and accountable

• Acting fairly and proportionately • Putting things right • Seeking continuous improvement

This ensures that effective and timely investigation and response can be instigated for any claim, including allegations of clinical negligence, public liability or personal injury and also works to reduce the occurrence of incidents and events, which may give rise to future claims.

The CCG adheres to the Health Service Parliamentary Ombudsman and NHS Litigation Authority Guidelines which require NHS organisations to consider and provide, where appropriate, remedies for injustice or hardship resulting from maladministration or poor service. Where hardship has occurred as a result of a complaint, every effort is made to redress the injustice or hardship. The CCG will acknowledge and apologise for maladministration and poor service, explaining, if it can be determined, why the failure occurred. In addition to receiving a written response from us, a complainant may be offered a meeting with clinical or managerial staff, depending on the nature of the complaint.

A full outline can be found in the CCG Complaints, compliments and concerns policy on the CCG website.2

2http://www.isleofwightccg.nhs.uk/Downloads/publications/Complaints/Complaints%20Compliments%20and%20Concerns%20Policy.pdf

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http://www.isleofwightccg.nhs.uk/Downloads/publications/Complaints/Complaints%20Compliments%20and%20Concerns%20Policy.pdf

http://www.isleofwightccg.nhs.uk/Downloads/publications/Complaints/Complaints%20Compliments%20and%20Concerns%20Policy.pdf

4. STATEMENTS BY THE ACCOUNTABLE OFFICER

Statement of Accountable Officer Responsibility 4.1.

The National Health Service Act 2006 (as amended) states that each Clinical Commissioning Group shall have an Accountable Officer and that Officer shall be appointed by NHS England. NHS England has appointed Helen Shields, Chief Officer to be the Accountable Officer of NHS Isle of Wight 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 CCG and enable them to ensure that the accounts comply with the requirements of the Accounts Direction) and for safeguarding the CCG’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 Service Act 2006 (as amended), NHS England has directed each CCG 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 CCG 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.


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Governance Statement 4.2.

Introduction & Context NHS Isle of Wight CCG was licensed from 1 April 2013 under provisions enacted in the Health & Social Care Act 2012, which amended the National Health Service Act 2006.

The CCG has now operated successfully for a third year and as at 1 April 2016, the Group continues to be licensed without conditions.

Scope of Responsibility As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the CCG’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 CCG Accountable Officer Appointment Letter.

I am responsible for ensuring that the CCG 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 Whilst the detailed provisions of the UK Corporate Governance Code are not mandatory for public sector bodies, compliance with the principles it contains is considered to be good practice. For the financial year ended 31 March 2016, and up to the date of signing this statement, the CCG has not sought to comply with the provisions set out in the code, but has applied the principles of the Code.

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.” NHS Isle of Wight CCG has a Membership Council, Governing Body and a series of Governing Body subcommittees. Statutory responsibilities have been delegated as set out in the Strategic Scheme of Delegation within Group’s Constitution. This provides for the majority of decisions to be made by the Clinical Executive – a clinically-driven subcommittee of the Governing Body. The relationship between the committees is shown in the diagram:

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The Governing Body Remuneration Committee The Governing Body is concerned with ongoing assurance within the CCG as described within the CCG’s Constitution. It makes decisions on specific issues, largely concerned with the strategy of the CCG, as set out in the Strategic Scheme of Delegation and in the event that the Clinical Executive is unable to act due to conflicts of interest. During the reporting period, the Governing Body:

• Approved the budget and operational plan for the CCG • Approved new objectives for the organisation aligned to the operational plan • Amended the CCG’s constitution to support an application for delegated commissioning of

primary care and to enable greater flexibility over the terms of reference for the governing body sub committees

• Appointed two new members including an additional lay member to increase lay representation on the governing body

• Approved the End of Life Strategy • Received regular updates on the major risks being run by the CCG • Received regular updates on progress against NHS Constitution targets and other

performance and quality measures

The Governing Body has been particularly exercised by the CCG's inability to meet key NHS constitution targets this year, particularly the 18 week referral to treatment time target and the A&E 4 hour wait as well as key cancer and ambulance targets despite considerable additional funding being made available and detailed action plans being in place. In November, it approved a public campaign to raise awareness amongst patients that they have the right to exercise choice about their place of care and the right to be seen within 18 weeks. With the support of local GPs, this has seen the level of referrals off island increase supporting the system to return to balance in the coming financial year.

The Governing Body has also expressed considerable disappointment with the new NHS funding formula which will severely restrict new funding to the Island for the next five years. It supported a number of its members to seek a meeting both with the local MP and Health Minister to raise concerns at a national level of the impact of this formula for islanders.

Table C below indicates the members of the Governing Body during this reporting period (2015/16) and their attendance at meetings held in public:

Governing Body

Audit Committee Remuneration Committee

Quality and Patient Safety

Committee Clinical Executive

The Isle of Wight Primary Care Committee

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2015 2016

Name Title May July Sept Nov Feb Mar

RIVERS, J Chairman / / / / / /

PSYK, F Lay Member for Governance and Deputy Chair / / / X - -

DAVIES, M Lay Member for Governance and Deputy Chair - - - - / /

HESSE, J Clinical Executive Member and GP / / X / / /

NEWTON, D Lay Member for Patient and Public Involvement / / / / / /

KINSELLA. L Governing Body Nurse and Director of Quality and Clinical Services - / / / / /

OUTHWAITE, L3 Chief Finance Officer / / X / X /

RECKLESS I Secondary Care Doctor X / / / / /

SHIELDS, H Chief Officer / / / / / /

TAYLOR, L Lay Member - - - - / /

VOSS, L Governing Body Nurse / / / / / / Table C: Attendance at Governing Body Meetings

During the financial year, the Governing Body met in seminar form to review its progress, the Group’s constitution and the terms of reference for the sub committees, particularly in the light of receiving approval for delegated Commissioning of Primary Care.

It determined that the constitution would be changed such that the membership of the Governing Body could be increased to include the Deputy Chief Officer as a voting member and the Associate Director for Primary Care and Corporate Business should be in attendance to improve the resilience of the Governing Body and its sub-committees, and reflect new responsibilities within the CCG.

The Membership Council The Membership Council has specific responsibilities to ensure that the Governing Body retains the confidence of the membership and to participate in the development of the overarching clinical strategy of the CCG. It also acts as the Electoral College to the Clinical Executive on the expiry of clinical executive terms.

The Membership Council has met once during the year to agree changes to the constitution to support succession for clinical executive members and second to agree new terms of reference of committees proposed by the Governing Body and approve the application for delegated commissioning of primary care.

An election for new Clinical Executive members from April 2016 was undertaken by the Membership Council with two nominations made. A mandate vote was held after which Dr Timothy Whelan and Dr Sarah Westmore were mandated onto the Clinical Executive.

Table D below indicates the members of the Membership Council and their attendance/involvement during the reporting period:

3Rebecca Wastall deputised for LO for the Sept and Feb meetings. Andrew Heyes deputised for LO until item 5 in Nov.

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Name Practice 08.10.15

Dr Adam Poole GP Argyll House, Ryde /

Dr Andreas Lehmann GP Medina Healthcare (Chair) /

Dr Andrew Snow GP South Wight Medical Centre /

Dr Bhaswati Majumdar GP Garfield Road Surgery, Ryde X

Dr Cabrini Salter GP Shanklin Medical Centre X

Dr Chris Andrews GP East Cowes Medical Centre /

Dr David Isaac GP Carisbrooke Health Centre /

Dr George Thomson GP Brookside Health Centre, Freshwater /

Dr Himanka Rana GP Tower House Surgery, Ryde /

Dr Jagannadha Boorle GP Cowes Medical Centre /

Dr Martin Lock GP Ventnor Medical Centre /

Dr Mira Hueppe GP St Helens Medical Centre /

Dr Peter Randall GP Sandown Health Centre /

Dr Spencer Fox GP Esplanade Surgery, Ryde X

Dr Stephen Doggett GP Grove House, Ventnor / Table D – Attendance at Membership Council

The Clinical Executive The Clinical Executive is responsible for month-on-month operational oversight of the CCG, undertaking the bulk of the commissioning function and ensuring that clinical decision making remains central to its work.

Dr Michele Legg and Dr Ben Browne were elected onto the Clinical Executive with effect from 1 April 2015 and Dr Anitha Ande, resigned and stood down. The terms of both Dr Peter Coleman and Dr David Isaac came to an end. From 1 April 2016, Dr Timothy Whelan and Dr Sarah Westmore will also join the Clinical Executive

The key achievements of the Clinical Executive in the last year are as follows: • Approved funding to recruit Admiral nurses to the Island • Approved Hepatitis C pathway and funding to have a specialist nurse on the island • Extended the contract for community dermatology services • Approved further funding for project “Serenity” street triage • Approved funding for services for people with eating disorders • Extended funding for additional beds at the Earl Mountbatten Hospice • Appointed a new accountable officer for controlled drugs for the CCG • Agreed additional funding for out of hours district nurses • commissioned 30 additional beds to support system capacity • Approved the System Resilience Action plan, investing an additional money to support the

system to achieve NHS Constitution targets • Procured new providers for Musculoskeletal physiotherapy • Funded a pilot patients to use Assistive Technology to avoid admission to hospital and help

people remain at home

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• Approved additional funding to cut the time patients were waiting for orthotics to 8 weeks

• Approved the creation of an additional High Dependency bed at St Mary’s at a cost of £263k per year

• Approved the Children’s Transformation Plan • Approved the creation of a Learning Disability “transition” nurse to support patients

moving from child to adult services • Approved grant funding to OSEL to deliver employment support services to people with

mental health issues

This year issues regarding both the quality and financial sustainability of the Isle of Wight NHS Trust has continued to feature at the Clinical Executive, where updates have been received from the Trust on the financial framework agreements and the CQC Inspection. The Clinical Executive expressed concern with slow progress in taking forward the cost base exercise at the Trust.

In terms of the operation of the committee itself, the Clinical Executive reviewed its terms of reference in year and membership, and included the Deputy Chief Officer as a formal member of the committee.

The members of the Clinical Executive and their attendance during the reporting period were:

Name 2015 2016 Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar

ANDE, Anitha X / / / X - - - - - - -

BAKER, Gillian / / / X / X / / / X / /

BROWNE, Ben / / / / / / / / X / X /

ELKHEIR, Rida / / X X X / / X / / / X

HESSE, Joanna / / / / / / / / / / / X

KINSELLA, Loretta / / / X / / / / / / / /

LEGG, Michele / / / / X / / / / / X /

OUTHWAITE, Loretta4 X / / / X X X X X X X X

RIVERS, John / / / / / X / / / X / /

SHIELDS, Helen / / X X / X / / / / / / Table E: Attendance at the Clinical Executive

The Quality and Patient Safety Committee (QPSC) The Quality and Patient Safety Committee is a non- statutory committee established by the Governing Body responsible for ensuring that the CCG acts with a view to securing continuous quality improvement in commissioned services; oversees safeguarding and ensures that

4 LO was seconded to the My Life a Full Life programme from October 2015 to April 2016. Eleanor Roddick deputised for LO in April. Andrew Heyes deputised for LO in Sept, Oct and Nov. Becky Wastall deputised for LO in Dec.

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systematic assurance on the quality of services commissioned by the CCG is provided to the Governing Body.

The committee and took the opportunity to review its terms of reference. A number of small changes were made which were subsequently submitted to NHS England for approval. The Committee requested that an internal audit of some aspects of safety and quality should be undertaken. It will also receive more formal performance management reports on a regular basis and a quality dashboard has been developed. The key achievements of the Quality and Patient Safety Committee in 2015/16 are:

• Overseeing the progress of gaining feedback on Mental Health services on the Island • Requesting updates on the process of recommendations from learning lessons • Monitoring of capacity issues surrounding Looked after Children • CCG assurance visits to IWNHST have been planned for 2016/17 • Gaining assurance of quality improvement of contract reporting During the year the committee has pursued a number of areas of concern with providers including the high numbers of pressure ulcers being experienced by patients on the island, the high level of healthcare acquired infections and the number of falls experienced while under the care of a healthcare professional. In response to these concerns, the Committee has overseen increasing rigour in the way in which the healthcare system undertakes root cause analysis (RCA) in support of learning lessons and has strengthened the way the CCG manages and monitors investigations into serious incidents. Attendance at the Quality and Patient Safety Committee is as follows for the reporting period:

Name 2015 2016

May Jul Oct Nov Feb Mar

NEWTON, David / / / / / /

ISAAC, David / / / X X X

RECKLESS, Ian / / / / / /

KINSELLA, Loretta / / / / / /

SMITH, Joanna (HealthWatch) / / X / / /

RAWLINSON, Mark X - - - - -

VOSS, Lindsay - / / / / / Table F: Attendance at QPSC

The Audit Committee The Audit Committee is a statutory committee responsible for providing the Group with an independent and objective review of its financial systems, compliance with laws, guidance and regulations and overseeing the Group’s risk management and governance processes. Of particular note this year, the Audit Committee has: • Agreed to create a register of external / commercial sponsorship • Approved and reviewed the financial plan, budgets and associated risks • Reviewed the operation of the risk register and governing body assurance framework • Reviewed the external audit reports

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• Approved and monitored the delivery of the Internal audit plan The membership of the Audit Committee and their attendance at meetings during this reporting period were:

2015 2016

Name Apr May Sept Nov Mar PSYK, Fredrick (Chair) / / / - - DAVIES Martin (Chair) - - - - / COLEMAN, Peter / / / / / GRIST, David / / / / / RECKLESS, Ian / X / / /

Table G: Attendance at Audit Committee

The Remuneration Committee The Remuneration Committee is a statutory committee required to make recommendations to the Governing Body regarding the remuneration and fees for Clinical Commissioning Group employees, and for others providing services to the group and allowances under pension schemes other than the NHS pension scheme. The Remuneration Committee has reviewed the salaries and terms and conditions of the Chief Officer, Deputy Chief Officer and Chief Financial Officer. The members of the remuneration committee during the reporting period and their attendance are indicated below.

2015 2016

Name Sept Mar PSYK, F (Chair) / -

DAVIES, M (Chair) - / HESSE, J x / NEWTON, D / / VOSS, L / / RECKLESS, I / / TAYLOR, L - /

Table H: Attendance at Remuneration Committee

The Joint Committee for Primary Care The Joint Committee for Primary Care is a joint committee of the CCG and NHS England whose function is to oversee the management of primary medical care within the CCG area. This committee meets in public. Of particular note this year, the Joint Committee for Primary Care has:

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• Approved the Prescribing scheme to encourage cost effective prescribing amongst GPs • Approved the reprocurement of the Anticoagulation and DVT service • Overseen the application for delegated commissioning for primary care • Approved the approach and outcome and consequential commissioning following PMS

reviews Members of the Committee and their attendance is as follows:

2015 2016

Name July Oct Dec Jan CCG PSYK, F (Chair) / X - - CCG SHIELDS, H (Deputy Chair) / / / / CCG TAYLOR, L (Chair) - - / / CCG KINSELLA, L 5 X / / X CCG OUTHWAITE, L6 / X X X NHSE BAGSHAW, J / / / / NHSE GOOCH, S7 / X X / NHSE GILES, C / / / X LA ELKHIR, R / / / / CCG MORRIS, C / / / / CCG HESSE, J / / / / CCG VOSS, L / / / /

Table I: Attendance at Joint Committee for Primary Care

NHS Isle of Wight Clinical Commissioning Group Risk Management Framework The Clinical Commissioning Group has adopted an integrated risk management framework, which is available on the CCG web site (www.isleofwightccg.nhs.uk). The framework covers the identification, management and reporting of key corporate, service and strategic risks and outlines the responsibilities of the Governing Body and its sub committees in managing those risks. Appetite for Risk The identification of risk is threaded through all CCG business and staff is encouraged to identify risk whether financial or non- financial through normal business processes. Risk is a standing item on a number of agendas both a governing body level and at operational committees within the Group.

5 Karen Morgan deputised for LK in January 6 Matthew Leek deputised for LO in October. Becky Wastall deputised for LO in Dec and Jan 7 Clare Bryan deputised for SG in Dec.

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The CCG has devised templates for staff to enable them to create, modify and remove risks from the risk register. These templates are moderated by senior management team before the risks are discussed at the Clinical Executive and Quality and Patient Safety Committee. Incidents and SIRIs Incidents within the local health economy are routinely reported via a local system, with the member practices encouraged to report incidents that are then reviewed internally and considered by Clinical Governance leads to embed learning points. The same system is used to report Serious Incidents Requiring Investigation (SIRIs). Service Development In the development of business cases to support new commissioning arrangements, the CCG uses equality impact assessments, along with a risk management review to determine the final shape of services. Patient and Stakeholder feedback NHS Isle of Wight Clinical Commissioning Group supports professionals, patients and the general public to provide a mix of formal and informal feedback to the CCG regarding the quality and effectiveness of the services that it commissions. Comments are fed back to the Quality and Commissioning Teams and used to compare against other information that the CCG may have. Member practices are routinely encouraged to report areas of concern – particularly in relation to clinical risk and communication issues. Issues arising from these systems are then discussed with the relevant providers and learning encouraged. Issues which have wide resonance across multiple stakeholder and patient groups are considered as part of the CCG strategy and consulted on widely. NHS Isle of Wight CCG Internal Control Framework The internal control framework is the set of processes and procedures in place in the CCG to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, and to manage them efficiently, effectively and economically. The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it can therefore only provide reasonable and not absolute assurance of effectiveness. The CCG’s key control mechanisms are as follows: Policies, procedures and guidelines The CCG has put in place a range of policies and procedures to support the proper identification and mitigation of risk, making it clear that “risk is inherent in all activity and the CCG is not risk adverse but risk aware”. These policies and procedures are kept under review. Governing Body Assurance Framework The Governing Body Assurance Framework, developed from the approved organisational aims and objectives, identifies key critical success factors for the organisation and the risks associated with achievement of those success factors. This document identifies risks before

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they arise and seeks to mitigate the likelihood of their occurrence. This document is updated for each Governing Body and Primary Care Joint Committee Meeting where it is reviewed. An Internal Audit Review of this document indicated reasonable assurance in-year. Risk Register The CCG’s Risk Register captures existing and real risk requiring risk owners to undertake regular review and seek mitigation of those risks. It is reviewed monthly at the Clinical Executive, in summary at each Governing Body meeting and at a variety of internal meetings to ensure that risk has been appropriately identified and is well managed and mitigated. Incident reporting culture The CCG has developed an incident reporting culture amongst both staff and member practices. It supports staff and members to embed improvements to processes and to pick up issues at an early stage and seek resolution. Support The CCG retains the expertise of internal audit and counter fraud services to make a deeper assessment of areas of management responsibility to ensure that processes have been properly developed and are being followed. For instance, regular newsletters regarding fraud are circulated to all staff. 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 CCG, 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 information. We have established an information governance management framework and information governance processes and procedures in line with the information governance toolkit. All staff undertake annual information governance training and a staff information governance handbook ensures staff are aware of their information governance roles and responsibilities. There are processes in place for incident reporting and investigation of serious incidents. We have developed information risk assessment and management procedures and a programme is established to fully embed an information risk culture throughout the organisation. All information flows have been mapped and risk assessed. In particular the Clinical Commissioning Group has paid attention to complying with the new rules regarding commissioner access to Personal Identifiable Information (PID) and new arrangements put in place.

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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. Equality, Diversity & Human Rights Obligations I am assured through the Equality and Diversity report as set out in the strategic report section of this annual report that control measures are in place to ensure that NHS Isle of Wight Clinical Commissioning Group complies with the required public sector equality duty set out in the Equality Act 2010. Sustainable Development Obligations The CCG is required to report its progress in delivering against sustainable development indicators and is working in partnership with the IW NHS Trust to implement a Sustainable Development Management Plan (SDMP). I am assured that the CCG has developed a plan to assesses risks, enhance our performance and reduce our impact on the environment, including ensuring we achieve our carbon reduction and climate change adaptation objectives. This incorporates mechanisms to embed social and environmental sustainability across policy development, business planning and commissioning. I am assured that the CCG complies with its obligations under the Climate Change Act 2008, including the Adaptation Reporting power, and the Public Services (Social Value) Act 2012. Risk Assessment in Relation to Governance, Risk Management and Internal Control The CCG has implemented governance, risk management and internal control processes and subjected these to both internal scrutiny through the various committees of the Governing Body as well as a comprehensive internal audit programme (see below). As discussed earlier, the CCG has dealt with serious allegations regarding a senior member of staff accused of inappropriate financial relationships with pharmaceutical companies. An internal HR investigation led to the dismissal of the individual, however the CCG also escalated the issue to NHS Protect who continue to investigate the matter. As a result of this, the CCG undertook an internal audit of arrangements for the disclosure of and management of interests. While this audit demonstrated reasonable assurance of the systems and processes in place, a number of improvements have been made including putting revised policies and procedures in place and undertaking training with both senior leaders and staff. No material gaps have been identified in relation to governance and risk management and an internal audit of governance processes has offered reasonable assurance to the CCG.

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Review of Economy, Efficiency& Effectiveness of the Use of Resources The CCG aims to maximise the impact of each pound spent supporting the health and wellbeing of those for whom we are responsible. The decision to invest in, disinvest in or redesign a commissioned service requires a judgement of whether the expected health benefits will justify the costs. The diversity in the Group’s portfolio makes it difficult to produce comparable measures of what constitutes good value for money for many services. As the CCG is relatively small and geographically isolated, we have a strong focus on ensuring the sustainability of the services we commission. This means we do not necessarily seek the cheapest or easiest solution, but we seek to understand what is driving our and our providers’ costs and make sure that we are getting the desired quality at the lowest reasonable price. I am assured that the CCG plans, implements and measures the outcomes of the services it commissions according to a commissioning cycle which informs the steps taken in order to justify investment or disinvestment. It pays particular attention to the evidence base in developing business cases for change. Through Quality Innovation Productivity and Prevention (QIPP) plans, it seeks to predict the improvement expected and where possible measures that objectively. This process is overseen by the Clinical Executive. The CCG is required to manage its business within a maximum administration budget. I am assured that in all our work, we seek to achieve our objectives with the minimum of bureaucracy consistent with good governance. The Governing Body is supported in its review of the extent to which the CCG is achieving its ambition through the Integrated Performance Report and the Governing Body Assurance Framework. This looks both at the measures we have agreed and those expected of us and the organisation’s ability to manage and mitigate any risks to us achieving our objectives. The Audit Committee, through the internal audit programme, reviews the systems and processes employed by the Group ensuring that there are no serious threats to the achievement of its aims. Finally, NHS England undertakes its own assurance processes through quarterly reviews of CCG results against key metrics based on a number of domains. Review of the Effectiveness of Governance, Risk Management & Internal Control As Accounting Officer I have responsibility for reviewing the effectiveness of the system of internal control within the CCG. Capacity to Handle Risk My review of the capacity of the organisation to handle risk is drawn from my own experience of risk management within the organisation, comprising a range of monthly reviews of the risk register together with an internal audit report reviewing the processes and procedures employed by the CCG.

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The CCG has an Integrated Risk Register covering the breadth of our operations. This is reviewed on a monthly basis by the Chief Officer in conjunction with senior management and discussed at the Clinical Executive with a summary report presented to each Governing Body. Each risk is updated monthly with an expected completion date and the steps that will be taken to mitigate the risk. This includes a clear narrative demonstrating the actions taken throughout the life of the risk. Staff have had risk management training aimed at improving the recognition and mitigation of risk. A series of templates and prompts to ensure that risks are codified and submitted to the CCG’s risk register are in place. All new risks are reviewed by the senior management team to ensure that the risk rating has been properly applied and feedback given to staff. Review of Effectiveness My review of the effectiveness of the system of internal control is informed by the work of the internal auditors, the executive officers and staff within the CCG 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 management letter and other reports. The Governing Body Assurance Framework itself provides me with evidence that the effectiveness of controls that manage risks to NHS Isle of Wight Clinical Commissioning Group achieving its principles objectives have been reviewed. During the year the Governing Body has sought to develop the internal control environment further, ensuring a thorough review of the Governing Body Assurance Framework together with the Integrated Performance Report. The Audit Committee has taken oversight of the financial budgeting, planning and key risks during the year as well as overseeing a comprehensive internal audit programme. Clinical Governance has been overseen by the Director of Quality and Clinical Services, working with the GP Clinical Governance Leads, and the Clinical Effectiveness Committee - both reporting to the Quality and Patient Safety Committee. During the year a review of internal quality process has been undertaken following the CQC inspection of IW NHS Trust to ensure that the CCG processes in support of quality were in good order. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Governing Body, the Audit Committee and Quality and Patient Safety Committee, and a plan to address weaknesses and ensure continuous improvement of the system is in place. 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. Of particular note, the CCG received no internal audit opinions that indicated no assurance.

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As part of my review of Governance, I have received the following opinion from the Head of Internal Audit on the Effectiveness of the System of Internal Control for the Year ended 31 March 2016:

SUMMARY HEAD OF INTERNAL AUDIT’S ANNUAL OPINION

I am satisfied that sufficient internal audit work has been undertaken to allow me to draw a reasonable conclusion as to the adequacy and effectiveness of NHS Isle of Wight CCG’s internal control processes. In my opinion, NHS Isle of Wight CCG has adequate and effective management and internal control processes to manage the achievement of its objectives. Data Quality I am assured that data quality is reviewed in all the tools used by the CCG to inform the Governing Body and Membership, particularly in relation to strategic planning and performance management. The Governing Body finds the reports they receive acceptable in terms of providing assurance regarding the performance of the CCG and have no material concerns regarding the quality of data provided. Business Critical Models The CCG has reviewed the business models that it uses and identified those which are considered business critical. The majority of the tools used by the CCG are nationally provided benchmarking tools or Business Intelligence tools provided through our Commissioning Support Unit. Data Security The CCG achieved compliance with level two of the information governance toolkit assessment, as audited by an internal audit report. There have been no serious incidents relating to data security breaches reported to the Information Commissioner in this reporting period. Indemnities and Insurances The CCG holds insurance with the NHS Litigation Authority. There are no outstanding balances that require reporting. Discharge of Statutory Functions The CCG has reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislative and regulations. As a result, I can confirm that the CCG is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions. Responsibility for each duty and power has been clearly allocated to a lead officer. Each function has confirmed that its structures provide the necessary capability and capacity to undertake all of the clinical commissioning group’s statutory duties. Conclusion I confirm that no significant internal control issues have been identified.

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5. REMUNERATION AND STAFF REPORT

Remuneration report 5.1.

The Group’s Remuneration Report has been prepared in line with the 2015/16 Reporting Guidance.

All CCG senior managers who hold or have held office during the reporting year are included in the report. Senior managers are defined as being:

“those persons in senior positions, having authority or responsibility for directing or controlling the major activities of the clinical commissioning group. This means those who influence the decisions of the

clinical commissioning group as a whole rather than the decisions of individual directorates or departments. Such persons include advisory and lay members.”

Taking the above definition into account, the Accountable Officer, has confirmed the following people to be Senior Managers:

• Members of the Governing Body • Members of the Clinical Executive • CCG Senior Management Team, who are members of the CCG Officers’ Group • CCG Associate Lay Member: Finance

Senior Manager’s Remuneration 5.1.

Policy on Senior Managers’ Contracts 5.1.1.

Duration of contracts and notice periods

The duration of contract and notice period for senior managers is dependent on their terms and conditions.

The Chief Officer, Chief Finance Officer, Deputy Chief Officer and Head of Primary Care and Corporate Business are appointed on a permanent basis. The Chief Officer’s notice period is six months in line with VSM. The Chief Finance Officer’s notice period was agreed by the Remuneration committee and is also set at six months. For the other senior officer posts, the notice period is three months.

Termination payments

In the event of a decision by the CCG to terminate the employment of any member of staff, “reckonable service” will be used and will be calculated on the basis of the service up to the date of the termination of the contract, based on the current Agenda for Change rules. 8

8http://www.nhsemployers.org/PayAndContracts/AgendaForChange/NHS-redundancy/Pages/NHS-redundancy.aspx

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http://www.nhsemployers.org/PayAndContracts/AgendaForChange/NHS-redundancy/Pages/NHS-redundancy.aspx

http://www.nhsemployers.org/PayAndContracts/AgendaForChange/NHS-redundancy/Pages/NHS-redundancy.aspx

Policy on remuneration of senior managers including performance related pay 5.1.2.

In setting the pay for the CCG’s Accountable Officer (AO), the committee agreed to use the VSM contract terms and conditions. The terms and conditions for the Chief Finance Officer, Deputy Chief Officer, Head of Primary Care and Corporate Business and the Director for Quality and Patient Services remain on “Agenda for Change”.

For the GP appointments, including the Chair, pay and conditions remain in line with NHS Agenda for Change policy. Lay Members continue to be paid at a rate equivalent to the non-executive directors for the Isle of Wight NHS Trust and the equivalent terms and conditions apply. The Associate Lay Member for Finance only attends Audit Committee meetings and is therefore paid on the basis of £300 per meeting attended, which includes any preparation time.

The Secondary Care Doctor is paid at a rate equivalent to his substantive positions and compensated for any expenses in relation to their travel and attendance at CCG meetings. As in 2014/15, the post-holder opted for his substantive organisation to recharge for their time and expenses. The same arrangement applied for Mark Rawlinson, who held the post of Governing Body Nurse, from 1st April’14 to 10th May’15. The new Governing Body Nurse, Lindsay Voss – in post from 28th May’15, has been paid through payroll and at the standard CCG Lay Member rate.

The Chief Finance Officer, Deputy Chief Officer, Head of Primary Care and Corporate Business, the Director for Quality and Clinical Services and all GP appointments receive an annual uplift agreed by the NHS for staff under Agenda for Change. Changes in salary for the Chief Officer and Lay Members are agreed by the Remuneration Committee.

There are no plans to change the CCG’s remuneration policy within the next financial year.

The table below provides a summary in relation to each Senior Manager’s service contract.

5.1.2.1. Senior managers’ service contract details

Name Title Contracted Hours

Date of contract

Unexpired term (end

date)

Notice period

Provision for termination

Helen Shields Chief Officer Full time 01/04/13 No end date

6 months See 3.2.3

Loretta Outhwaite

Chief Finance Officer

Full time 01/04/13 No end date

6 months See 3.2.3

Gillian Baker Deputy Chief Officer


3 months In line with A4C

Caroline Morris Head of Primary Care &

Corporate Business



Loretta Kinsella Director of Quality and

Clinical Services

Full Time 01/01/14 No end date


Dr John Rivers GP Chair 4.5 sessions per week

01/04/13 31/03/16 3 months In line with A4C

Page 49 of 57

Dr Joanna Hesse GP Executive 2 sessions per week

01/04/13 31/03/17 3 months In line with A4C

Frederick Psyk Lay Member: Governance

4 sessions

per month

01/04/13 23/11/15 - -

Martyn Davies Lay Member: Governance

4 sessions

per month

01/12/15 30/11/18 None, as fixed term

None, as fixed term

Laurence Taylor Lay Member 4 sessions

per month


None, as fixed term

David Newton Lay Member: Public & Patient

Involvement

4 sessions

per month


None, as fixed term

Dr Ian Reckless Secondary Care Doctor

4 sessions

per month


None, as fixed term

Dr Mark Rawlinson

Governing Body Nurse

4 sessions

per month

28/04/14 10/05/15 - -

Lindsay Voss Governing Body Nurse

4 sessions

per month


None, as fixed term

Dr Anitha Ande GP Executive 1 session per week

01/04/14 28/08/15 - -

Dr Michele Legg GP Executive 5 sessions per week


None, as fixed term

Dr Benjamin Browne

GP Executive 1 session per week


None, as fixed term

David Grist Associate Lay Member: Finance

8 sessions

per annum


None, as fixed term

Table J: Senior Manager Service contract details

Page 50 of 57

5.1.2.2. Salaries and allowances

Table J below provides the details in relation to senior manager’s salaries and allowances paid during 2015/16. This table is subject to audit.

2015/16 2014/15

Name and title Salaries & Fees

Expense payments (taxable)

Perf pay &

bonuses

Long-term

perf pay &

bonuses

All pension related benefits

Total Salaries & Fees

Expense payments (taxable)

Perf pay &

bonuses

Long-term

perf pay &

bonuses

All pension related benefits

Total

Bands of £5,000

Nearest £'00

Bands of

£5,000

Bands of

£5,000

Bands of £2,500

Bands of £5,000

Bands of

£5,000

Nearest £'00

Bands of

£5,000

Bands of

£5,000

Bands of

£5,000

Bands of

£5,000

£'000 £'00 £'000 £'000 £'000 £'000 £'000 £'00 £'000 £'000 £'000 £'000

SHIELDS, H Chief Officer 105-110 - - - (2.5 – 5) 100-

105 105-110 - - - 12.5-

15 120-125

OUTHWAITE, L Chief Finance Officer 95-100 - - - 55-57.5 155-

160 90-95 - - - 25-27.5

115-119

BAKER, G Deputy Chief Officer 90-95 - - - 2.5-5 90-95 90-95 - - - 12.5-

15 100-105

MORRIS, C Head of Primary Care & Corporate Business

65-70 - - - 45-47.5 115-120 65-70 - - - 27.5-

30 95-100

KINSELLA, L Director of Quality & Clinical Services

85-90 - - - 40-42.5 125-130 20-25 - - - 0-2.5 20-

25

RIVERS, J GP Chair 70-75 - - - Note 1 70-75 65-70 - - - Note

1 65-70

ANDE, A GP Exec 0-5 - - - Note 5 - 10-15 - - - 80-

82.5- 90-95

HESSE, J GP Exec 20-25 - - - 2.5-5 25-30 25-30 - - - 0-2.5 25-

30 LEGG, M GP Exec 55-60 - - - 32.5-35 90-95 - - - - - -

BROWNE, B GP Exec 10-15 - - - 30-32.5 40-45 - - - - - -

PSYK, F Lay Member: Governance 0-5 - - - Note 2 0-5 5-10 - - - Note

2 5-10

TAYLOR, L Lay Member 0-5 - - - Note 2 0-5 - - - - - -

DAVIES, M Lay Member: Governance 0-5 - - - Note 2 0-5 - - - - - -

NEWTON, D Lay Member: Public & Patient Involvement

5-10 - - - Note 2 5-10 5-10 - - - Note 2 5-10

GRIST, D Associate Lay Member: Finance

0-5 - - - Note 2 0-5 - - - - - -

VOSS, L Governing Body Nurse 5-10 - - - Note 2 5-10 - - - - - -

RAWLINSON, M Governing Body Nurse 0-5 - - - Note 3 0-5 5-10 - - - Note

3 Note

3 RECKLESS, I Secondary Care Doctor 10--15 - - - Note 4 10-15 10-

15 - - - Note 4

Note 4

Table K: Senior manager salaries and allowances 2015/16.

Notes:

• Note 1: Employee is no longer contributing to the NHS Pension Scheme. • Note 2: These are non-executive director posts and therefore do not receive pensionable

remuneration. • Note 3: Employed by Southampton University & recharged for salary plus employer’s on-

costs & expenses related to CCG attendance (4 sessions per month).

Page 51 of 57

• Note 4: Employed by Oxford University Hospitals NHS Trust & recharged for salary plus employer’s on-costs & expenses related to CCG attendance (4 sessions per month)

• Note 5: Awaiting information from NHS Pensions Agency for this employee • “All pension related benefits” is calculated on the basis of how much an employee

would receive over a 20 year period of retirement. So, for example, if an employee’s pension benefits have increased by £2,000 in the year and their lump sum receivable on retirement has gone up by £5,000 in the year, the increase shown would be £2,000 x 20 years + £5,000, so £45,000.

During the reporting period, the NHS Isle of Wight CCG has not made any payments to past senior managers.

During the reporting period, NHS Isle of Wight CCG has not made any payments made for loss of office.

5.1.2.3. Benefits

Table L below provides a summary of the Senior Manager’s pension benefits for 2015/16. This table is subject to audit.

Name and title Real increase

in pension at age

60

Real increase in

pension lump sum at age 60

Total accrued pension

at age 60 at 31st

March'16

Lump sum at age 60

related to accrued pension at 31st

March'16

Cash equivalent

transfer value

(CETV) at 31st

March'15

Cash equivalent

transfer value

(CETV) at 31st

March'16

Real increase in cash

equivalent transfer

value

Employer's contributio

n to stakeholder

pension

Bands of

£2,500

Bands of £2,500

Bands of £5,000

Bands of £5,000

£’000 £’00 £’000 £’000 £’000 £’000 £’000 £’000

SHIELDS, H Chief Officer

0-2.5 0-2.5 40-45 130-135

855 884 19 n/a

OUTHWAITE, L Chief Finance Officer

2.5-5 (15-17.5) 15-20 25-30 237 226 (10) n/a

BAKER, G Deputy Chief Officer

0-2.5 0-2.5 30-35 90-95 589 614 18 n/a

MORRIS, C Head of Primary Care & Corporate Business

2.5-5 (15-17.5) 10-15 10-15 155 153 (3) n/a

KINSELLA, L Director of Quality & Clinical Services

0-2.5 5-7.5 35-40 105-110

638 697 52 n/a

LEGG, M GP Exec

0-2.5 2.5-5 5-10 20-25 94 125 28 n/a

BROWNE, B GP Exec

2.5-5 (17.5-20) 5-10 0 TBA 40 TBA n/a

ANDE, A GP Exec

TBA TBA TBA TBA 71 TBA TBA n/a

HESSE, J GP Exec

5-10 (0-2.5) 5-10 20-25 97 101 2 n/a

Table L: Senior Manager Pension Benefits

There is no disclosure for the Lay Members, as they do not qualify for the NHS Pension Scheme or for any GP who is no longer in the pension scheme.

Page 52 of 57

There is no disclosure for any employee who is no longer in the NHS pension scheme.

The Secondary Care Doctor and Mark Rawlinson, Nurse Advisor, are employed by other bodies and their CCG related working time recharged. Their pension information is not available to the CCG and has therefore not been disclosed.

Awaiting information from NHS Pensions for B Browne and A Ande.

5.1.2.4. 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.

It should be noted that the calculations below are based on the salary people would earn if they were working full time. Within the CCG, 31% of staff work on a part-time basis.

Table M below is subject to audit.

2015/16 Lead executive total earnings £150,878 Median total earnings £34,876 Ratio 4.33

Table M: Pay Multiples

The banded remuneration of the highest paid member of the Membership Body/Governing Body in the clinical commissioning group in the financial year 2015/16 was £150,878. In 2014/15 this was £150,878.

The remuneration of the highest paid member of staff was 4.33 times the median remuneration of the workforce, which was £34,876. In 2014/15 the figures were 4.33 times and £34,876.

In 2015/16 no employees received remuneration in excess of the highest paid member of the Membership Body/Governing Body. Excluding the highest paid director, remuneration ranged from £15,100 to £130,130. In 2014/15 the figures were £17,425 to £133,130.

The majority of CCG members of staff are subject to Agenda for Change terms and conditions. For 2015/16 all staff on Agenda for Change up to Band 8B/8C overlap (point 42), received a 1% consolidated pay increase. Staff on Band 8C (point 42 and above), 8D and Band 9 received no pay increase. In addition, staff at the top of Band 7 (point 34) and above, were not eligible for incremental pay progression during the period 1st April 2015 to 31st March 2016.

Total remuneration includes salary and on-call payments. There were no bonuses or benefits-in-kind paid to staff during the year. It does not include severance payments, employer pension contributions and the cash equivalent transfer value of pensions.

Page 53 of 57

5.1.2.5. Off-payroll engagements

As part of this annual report, CCGs must publish information on their highly paid and/or senior off-payroll engagements. Off-payroll engagements as of 31 March 2016, for more than £220 per day and that last longer than six months are shown in Table N below:

No. Number that have existed: 5 For less than one year at the time of reporting 0 For between one and two years at the time of reporting 2 For between two and three years at the time of reporting 3 Total number of existing engagements as of 31 March 2016 4

Table N: Off-Payroll Engagements as of 31st March 2016

Two of the off-payroll engagements shown above relate to GP clinical leads, one who worked for half a session per week and the other undertaking ad-hoc sessions, which equated to less than half a session per week. Their costs are invoiced by their practices.

Two of the off-payroll engagements relate to the Secondary Care Doctor and Nurse Advisor (Mark Rawlinson), one of whom is employed by an NHS Trust and the other by a University, with their CCG related costs recharged to the CCG.

The final off-payroll engagement is for the independent chair of the Continuing Healthcare Panel, who invoices the CCG for the limited number of hours they work.

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. Table O below shows that the CCG has not sought formal assurance for any off-payroll engagements, in relation to Income Tax and National Insurance obligations. This is for the following reasons:

• For those engagements relating to GPs, whose Practice invoiced for their time, the Practice accountant would have ensured the individual was paying an appropriate amount of tax.

• For those engagements relating to the Secondary Care Doctor, Nurse Advisor and Interim Director of Quality and Clinical Services, their substantive employers would have ensured that the correct tax had been paid.

From 2015/16 the CCG’s policies only allowed for off-payroll engagements in the following circumstances:

• For Secondary Care Doctor, Governing Body Nurse and Lay Member appointments: where the post-holder opts for their substantive employer to be reimbursed for their CCG time and expenses.

• For Clinical Lead appointments: where the post-holder works less than two sessions per week for the CCG or is working part-time on a short, fixed-term project and their Practice invoices for their time and expenses.

Page 54 of 57

Number of new engagements, or those that reached six months in duration, between 1 April 2015 and 31 March 2016

0

Number of the above which include contractual clauses giving the CCG the right to request assurance in relation to Income Tax & National Insurance obligations

0

Number for whom assurance has been requested 0 Of which, the number: • For whom assurance has been received • For whom assurance has not been received • That have been terminated as a result of assurance not being received

Table O: Assurance sought in relation to Income Tax & NI Obligations

As explained above and as Table P below demonstrate, two employees who meet the definition of “Senior Manager” are off-payroll engagements.

Number of off-payroll engagements of Membership Body &/or Governing Body members, &/or, senior officials with significant financial responsibility, during the financial year

2

Number of individuals that have been deemed “ Membership Body9 and/or Governing Body members, and/or, senior officials with significant financial responsibility”, during the financial year (this figure includes both off-payroll and on-payroll engagements)

35

Table P: Senior Managers who are off-payroll engagements

Staff Report 5.2.

The CCG has 107 members of staff of which 84 are female and 23 are male. A number of our staff work part time so this is equivalent to 80.27 whole time staff. During the year, the CCG recruited a number of additional commissioning managers to enable the organisation to focus on delivering the transformation agenda. The staff breakdown is as follows:

Figure 3: Staff by professional group

At the end of 2015/16, the Governing Body comprised 5 males and 5 females (see fig 4 below). Within the CCG senior leadership team there are two further senior managers who are female. The gender breakdown across the organisation is as follows:

9 Not reimbursed

Staff by Professional Group

Admin & Clerical

Governing BodyMember

Manager

Page 55 of 57

The CCG sickness rate is low at 1.3%.

Employment Policies and Processes 5.2.1.

The CCG reviews and updates its employment policies and processes on a cycle in conjunction with our HR provider.

The CCG’s equality policy embraces the requirement to offer equal opportunities to all staff and job applicants recognising that it has a legal and moral responsibility to ensure that neither it nor its employees discriminate directly, indirectly or by way of victimisation.

All policies used within the CCG apply equally to both disabled and non-disabled staff with the understanding that it must have due regard and need to take steps to enable an individual with a disability to access certain types of career development or training.

Our policy applies to all staff, contractors who are on site, students and volunteers.

Equality and Diversity 5.2.2.

The CCG has published its equality objectives, reports on these annually and sets new objectives at least every four years. The targets are:

Objective one seeks to embed the advancement of equality into day to day business of the CCG and actively accelerate progress towards its objectives.

Figure 4: Governing Body by Gender

FemaleGoverningBodyMember

MaleGoverningBodyMember

Figure 5: Staff breakdown by gender

Female Staff

Male Staff

Figure 6: Senior Managers and GPs by gender

FemaleSeniorManagers

Male SeniorManagersand GPs

Page 56 of 57

The CCG ensures a narrative on equality is provided to the Governing Body and each of its subcommittees on every paper and decision; and has implemented mandatory Equality and Diversity training for all staff.

Objective two seeks to improve physical health checks amongst those with serious mental illness. This continues to be an area of work and is being implemented across mental health services through contractual mechanisms and is part of the quality improvement programme in primary care.

The third objective is about helping people to help themselves by taking control of their health and setting their own goals and ambitions. This work stream is monitored against the protected characteristics to understand what areas the CCG should particularly target in rolling out projects such as care planning and patient “passports” (access to medical records).

The Equality Act (2010) requires public organisations to eliminate unlawful discrimination, advance equality of opportunity and foster good relations between people who may or may not share a protected characteristic.

To achieve this we are required to analyse the effect of any policy, strategy, business case, and project or service change. The CCG has developed a template to support staff to consider equality impact and to identify where analysis is required.

This template particularly helps staff to make a judgement in respect of the duty of “due regard” such that decisions with greater impact are more carefully scrutinised. We encourage the use of equality analysis at an early stage and again towards the end of a project so that any evidence gaps can be considered as part of the stakeholder engagement element of the project.

The results of this analysis are reported to those committees where decisions are made to ensure that a fully rounded decision can be arrived at.

Social, Community and Human Rights issues 5.2.3.

The Human Rights Act (HRA) 1998 sets out a range of rights that have implications for the way the CCG buys services and manages its workforce. The CCG has ensured that our service specifications meet the requirements of the Act. The CCG maintains a whistleblowing policy to facilitate this process. As part of our Equality analysis, issues relating to the HRA are taken into account.

Page 57 of 57

Data entered below will be used throughout the workbook:

Entity name: NHS Isle of Wight CCG

This year 2015-16

This year ended 31-March-2016

This year commencing: 01-April-2015

These account templates are a proforma for a set of NHS England Group Entity Accounts, this is not a

mandatory layout for local accounts.

Please review and adjust to local reporting requirements

NHS Isle of Wight CCG - Annual Accounts 2015-16

Page Number

The Primary Statements:

Statement of Comprehensive Net Expenditure for the year ended 31st March 2016 1

Statement of Financial Position as at 31st March 2016 2

Statement of Changes in Taxpayers' Equity for the year ended 31st March 2016 3

Statement of Cash Flows for the year ended 31st March 2016 4

Notes to the Accounts

Accounting policies 5 - 12

Other operating revenue 13

Revenue 13

Employee benefits and staff numbers 14 - 17

Operating expenses 18

Better payment practice code 19

Income generation activities 19

Investment revenue 20

Other gains and losses 20

Finance costs 20

Net gain/(loss) on transfer by absorption 21

Operating leases 21

Property, plant and equipment 22 - 24

Intangible non-current assets 25 - 26

Investment property 27

Inventories 27

Trade and other receivables 28

Other financial assets 29

Other current assets 29

Cash and cash equivalents 30

Non-current assets held for sale 31

Analysis of impairments and reversals 32 - 35

Trade and other payables 36

Deferred revenue 36

Other financial liabilities 36

Borrowings 37

Private finance initiative, LIFT and other service concession arrangements 38 - 39

Finance lease obligations 40

Finance lease receivables 41

Provisions 42

Contingencies 43

Commitments 44

Financial instruments 44 - 45

Operating segments 46

Pooled budgets 47

NHS Lift investments 47

Related party transactions 48

Events after the end of the reporting period 49

Losses and special payments 49

Third party assets 50

Financial performance targets 50

Impact of IFRS 50

Analysis of charitable reserves 50

Purchase of on NHS Healthcare 51

CONTENTS


Statement of Comprehensive Net Expenditure for the year ended

31-March-2016

2015-16 2014-15

Note £000 £000

Total Income and Expenditure

Employee benefits 4.1.1 3,246 2,959

Operating Expenses 5 206,898 200,588

Other operating revenue 2 (27) (192)

Net operating expenditure before interest 210,117 203,355

Investment Revenue 8 0 0

Other (gains)/losses 9 0 0

Finance costs 10 0 0

Net operating expenditure for the financial year 210,117 203,355

Net (gain)/loss on transfers by absorption 11 0 0

Total Net Expenditure for the year 210,117 203,355

Of which:

Administration Income and Expenditure

Employee benefits 4.1.1 1,944 1,983



Net administration costs before interest 3,100 3,334

Programme Income and Expenditure

Employee benefits 4.1.1 1,303 977



Net programme expenditure before interest 207,017 200,021

Other Comprehensive Net Expenditure 2015-16 2014-15

£000 £000

Impairments and reversals 22 0 0

Net gain/(loss) on revaluation of property, plant & equipment 0 0

Net gain/(loss) on revaluation of intangibles 0 0

Net gain/(loss) on revaluation of financial assets 0 0

Movements in other reserves 0 0

Net gain/(loss) on available for sale financial assets 0 0

Net gain/(loss) on assets held for sale 0 0

Net actuarial gain/(loss) on pension schemes 0 0

Share of (profit)/loss of associates and joint ventures 0 0

Reclassification Adjustments

On disposal of available for sale financial assets 0 0

Total comprehensive net expenditure for the year 210,117 203,355

The notes on pages 5 to 51 form part of this statement

1


Statement of Financial Position as at

31-March-2016

2015-16 2014-15

Note £000 £000

Non-current assets:

Property, plant and equipment 13 0 0

Intangible assets 14 0 0

Investment property 15 0 0

Trade and other receivables 17 0 0

Other financial assets 18 0 0

Total non-current assets 0 0

Current assets:

Inventories 16 0 0

Trade and other receivables 17 2,109 1,701

Other financial assets 18 0 0

Other current assets 19 0 0

Cash and cash equivalents 20 78 57

Total current assets 2,187 1,758

Non-current assets held for sale 21 0 0

Total current assets 2,187 1,758

Total assets 2,187 1,758

Current liabilities

Trade and other payables 23 (12,686) (11,809)

Other financial liabilities 24 0 0

Other liabilities 25 0 0

Borrowings 26 0 0

Provisions 30 (50) (109)

Total current liabilities (12,736) (11,917)

Non-Current Assets plus/less Net Current Assets/Liabilities (10,549) (10,160)

Non-current liabilities

Trade and other payables 23 0 0


Other liabilities 25 0 0

Borrowings 26 0 0

Provisions 30 0 0

Total non-current liabilities 0 0

Assets less Liabilities (10,549) (10,160)

Financed by Taxpayers’ Equity

General fund (10,549) (10,160)

Revaluation reserve 0 0

Other reserves 0 0

Charitable Reserves 0 0

Total taxpayers' equity: (10,549) (10,160)


The financial statements on pages 1 to 51 were approved by the Governing Body on [date] and signed on its behalf by:

Chief Accountable Officer

Helen Shields

2


Statement of Changes In Taxpayers Equity for the year ended

31-March-2016

General fund

Revaluation

reserve

Other

reserves

Total

reserves

£000 £000 £000 £000

Changes in taxpayers’ equity for 2015-16

Balance at 1 April 2015 (10,160) 0 0 (10,160)

Transfer between reserves in respect of assets transferred from closed NHS

bodies 0 0 0 0

Adjusted NHS Clinical Commissioning Group balance at 1 April 2015 (10,160) 0 0 (10,160)

Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2015-16

Net operating expenditure for the financial year (210,117) (210,117)

Net gain/(loss) on revaluation of property, plant and equipment 0 0

Net gain/(loss) on revaluation of intangible assets 0 0


Total revaluations against revaluation reserve 0 0 0 0

Net gain (loss) on available for sale financial assets 0 0 0 0

Net gain (loss) on revaluation of assets held for sale 0 0 0 0

Impairments and reversals 0 0 0 0

Net actuarial gain (loss) on pensions 0 0 0 0

Movements in other reserves 0 0 0 0

Transfers between reserves 0 0 0 0

Release of reserves to the Statement of Comprehensive Net Expenditure 0 0 0 0

Reclassification adjustment on disposal of available for sale financial assets 0 0 0 0

Transfers by absorption to (from) other bodies 0 0 0 0

Reserves eliminated on dissolution 0 0 0 0

Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year (220,277) 0 0 (220,277)

Net funding 209,728 0 0 209,728

Balance at 31 March 2016 (10,549) 0 0 (10,549)

General fund

Revaluation

reserve

Other

reserves

Total

reserves

£000 £000 £000 £000

Changes in taxpayers’ equity for 2014-15

Balance at 1 April 2014 (8,257) 0 0 (8,257)

Transfer of assets and liabilities from closed NHS bodies as a result of the 1

April 2013 transition 0 0 0 0

Adjusted NHS Commissioning Board balance at 1 April 2014 (8,257) 0 0 (8,257)

Changes in NHS Commissioning Board taxpayers’ equity for 2014-15

Net operating costs for the financial year (203,355) (203,355)

Net gain/(loss) on revaluation of property, plant and equipment 0 0

Net gain/(loss) on revaluation of intangible assets 0 0


Total revaluations against revaluation reserve 0 0 0 0

Net gain (loss) on available for sale financial assets 0 0 0 0

Net gain (loss) on revaluation of assets held for sale 0 0 0 0

Impairments and reversals 0 0 0 0

Net actuarial gain (loss) on pensions 0 0 0 0

Movements in other reserves 0 0 0 0

Transfers between reserves 0 0 0 0

Release of reserves to the Statement of Comprehensive Net Expenditure 0 0 0 0

Reclassification adjustment on disposal of available for sale financial assets 0 0 0 0

Transfers by absorption to (from) other bodies 0 0 0 0

Reserves eliminated on dissolution 0 0 0 0

Net Recognised NHS Commissioning Board Expenditure for the Financial Year (211,612) 0 0 (211,612)

Net funding 201,452 0 0 201,452

Balance at 31 March 2015 (10,160) 0 0 (10,160)


3


Statement of Cash Flows for the year ended

31-March-2016

2015-16 2014-15

Note £000 £000

Cash Flows from Operating Activities

Net operating expenditure for the financial year (210,117) (203,354)

Depreciation and amortisation 5 0 0

Impairments and reversals 5 0 0

Movement due to transfer by Modified Absorption 0 0

Other gains (losses) on foreign exchange 0 0

Donated assets received credited to revenue but non-cash 0 0

Government granted assets received credited to revenue but non-cash 0 0

Interest paid 0 0

Release of PFI deferred credit 0 0

Other Gains & Losses 0 0

Finance Costs 0 0

Unwinding of Discounts 0 0

(Increase)/decrease in inventories 0 0

(Increase)/decrease in trade & other receivables 17 (408) 558

(Increase)/decrease in other current assets 0 0

Increase/(decrease) in trade & other payables 23 877 1,345

Increase/(decrease) in other current liabilities 0 0

Provisions utilised 30 (3) (22)

Increase/(decrease) in provisions 30 (55) 10

Net Cash Inflow (Outflow) from Operating Activities (209,707) (201,462)

Cash Flows from Investing Activities

Interest received 0 0

(Payments) for property, plant and equipment 0 0

(Payments) for intangible assets 0 0

(Payments) for investments with the Department of Health 0 0

(Payments) for other financial assets 0 0

(Payments) for financial assets (LIFT) 0 0

Proceeds from disposal of assets held for sale: property, plant and equipment 0 0

Proceeds from disposal of assets held for sale: intangible assets 0 0

Proceeds from disposal of investments with the Department of Health 0 0

Proceeds from disposal of other financial assets 0 0

Proceeds from disposal of financial assets (LIFT) 0 0

Loans made in respect of LIFT 0 0

Loans repaid in respect of LIFT 0 0

Rental revenue 0 0

Net Cash Inflow (Outflow) from Investing Activities 0 0

Net Cash Inflow (Outflow) before Financing (209,707) (201,462)

Cash Flows from Financing Activities

Grant in Aid Funding Received 209,728 201,452

Other loans received 0 0

Other loans repaid 0 0

Capital element of payments in respect of finance leases and on Statement of Financial Position PFI and LIFT 0 0

Capital grants and other capital receipts 0 0

Capital receipts surrendered 0 0

Net Cash Inflow (Outflow) from Financing Activities 209,728 201,452

Net Increase (Decrease) in Cash & Cash Equivalents 20 21 (10)

Cash & Cash Equivalents at the Beginning of the Financial Year 57 68

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 78 58


4


Notes to the financial statements

1 Accounting Policies

NHS England has directed that the financial statements of clinical commissioning groups shall meet the accounting requirements of the Manual

for Accounts issued by the Department of Health. Consequently, the following financial statements have been prepared in accordance with the

Manual for Accounts 2015-16 issued by the Department of Health. The accounting policies contained in the Manual for Accounts 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 Manual for Accounts permits a choice of

accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the clinical commissioning

group for the purpose of giving a true and fair view has been selected. The particular policies adopted by the clinical commissioning group are

described below. They have been applied consistently in dealing with items considered material in relation to the accounts.

1.1 Going Concern

These accounts have been prepared on the going concern basis (despite the issue of a report to the Secretary of State for Health under Section

30 of the Local Audit and Accountability Act 2014).

Public sector bodies are assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as

evidenced by inclusion of financial provision for that service in published documents.

Where a clinical commissioning group ceases to exist, it considers whether or not its services will continue to be provided (using the same

assets, by another public sector entity) in determining whether to use the concept of going concern for the final set of Financial Statements. If

services will continue to be provided the financial statements are prepared on the going concern basis.

1.2 Accounting Convention

These accounts have been prepared under the historical cost convention modified to account for the revaluation of 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 Group

Transfers 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 Funds

From 2014-15, the divergence from the Government Financial Reporting Manual that NHS Charitable Funds are not consolidated with bodies’

own returns is removed. Under 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 Pooled Budgets

Where the clinical commissioning group has entered into a pooled budget arrangement under Section 75 of the National Health Service Act 2006

the clinical commissioning group accounts for its share of the assets, liabilities, income and expenditure arising from the activities of the pooled

budget, identified in accordance with the pooled budget agreement.

If the clinical commissioning group is in a “jointly controlled operation”, the clinical commissioning group recognises:

· The assets the clinical commissioning group controls;

· The liabilities the clinical commissioning group incurs;

· The expenses the clinical commissioning group incurs; and,

· The clinical commissioning group’s share of the income from the pooled budget activities.

If the clinical commissioning group is involved in a “jointly controlled assets” arrangement, in addition to the above, the clinical commissioning

group recognises:

· The clinical commissioning group’s share of the jointly controlled assets (classified according to the nature of the assets);

· The clinical commissioning group’s share of any liabilities incurred jointly; and,

· The clinical commissioning group’s share of the expenses jointly incurred.

1.7 Critical Accounting Judgements & Key Sources of Estimation Uncertainty

In 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.

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1.7.1 Critical Judgements in Applying Accounting Policies

In 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.

1.7.2 Key Sources of Estimation Uncertainty

There have been no material critical judgements, that management has made in the process of applying the clinical commissioning group’s

accounting policies

1.8 Revenue

Revenue in respect of services provided is recognised when, and to the extent that, performance occurs, and is measured at the fair value of the

consideration receivable.

Where income is received for a specific activity that is to be delivered in the following year, that income is deferred.

1.9 Employee Benefits

1.9.1 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.

1.9.2 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.

Some employees are members of the Local Government Superannuation Scheme, which is a defined benefit pension scheme. The scheme

assets and liabilities attributable to those employees can be identified and are recognised in the clinical commissioning group’s accounts. The

assets are measured at fair value and the liabilities at the present value of the future obligations. The increase in the liability arising from

pensionable service earned during the year is recognised within operating expenses. The expected gain during the year from scheme assets is

recognised within finance income. The interest cost during the year arising from the unwinding of the discount on the scheme liabilities is

recognised within finance costs. Actuarial gains and losses during the year are recognised in the General Reserve and reported as an item of

other comprehensive net expenditure.

1.10 Other Expenses

Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair

value of the consideration payable.

Expenses and liabilities in respect of grants are recognised when the clinical commissioning group has a present legal or constructive obligation,

which occurs when all of the conditions attached to the payment have been met.

1.11 Property, Plant & Equipment

1.11.1 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.

6



1.11.2 Valuation

All 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 fair value.

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 fair value

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.

1.11.3 Subsequent Expenditure

Where 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.

1.12 Intangible Assets

1.12.1 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.

1.12.2 Measurement

The 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.

Following initial recognition, intangible assets are carried at fair value by reference to an active market, or, where no active market exists, at

amortised replacement cost (modern equivalent assets basis), indexed for relevant price increases, as a proxy for fair value. Internally-developed

software is held at historic cost to reflect the opposing effects of increases in development costs and technological advances.

7



1.13 Depreciation, Amortisation & Impairments

Freehold 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.

1.14 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.

1.15 Government Grants

The 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.

1.16 Non-current Assets Held For Sale

Non-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.

1.17 Leases

Leases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All other leases

are classified as operating leases.

1.17.1 The Clinical Commissioning Group as Lessee

Property, 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.

1.17.2 The Clinical Commissioning Group as Lessor

Amounts 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.

8



1.18 Private Finance Initiative Transactions

HM Treasury has determined that government bodies shall account for infrastructure Private Finance Initiative (PFI) schemes where the

government body controls the use of the infrastructure and the residual interest in the infrastructure at the end of the arrangement as service

concession arrangements, following the principles of the requirements of IFRIC 12. The clinical commissioning group therefore recognises the

PFI asset as an item of property, plant and equipment together with a liability to pay for it. The services received under the contract are recorded

as operating expenses.

The annual unitary payment is separated into the following component parts, using appropriate estimation techniques where necessary:

· Payment for the fair value of services received;

· Payment for the PFI asset, including finance costs; and,

· Payment for the replacement of components of the asset during the contract ‘lifecycle replacement’.

1.18.1 Services Received

The fair value of services received in the year is recorded under the relevant expenditure headings within ‘operating expenses’.

1.18.2 PFI Asset

The PFI assets are recognised as property, plant and equipment, when they come into use. The assets are measured initially at fair value in

accordance with the principles of IAS17. Subsequently, the assets are measured at fair value, which is kept up to date in accordance with the

clinical commissioning group’s approach for each relevant class of asset in accordance with the principles of IAS 16.

1.18.3 PFI Liability

A PFI liability is recognised at the same time as the PFI assets are recognised. It is measured initially at the same amount as the fair value of the

PFI assets and is subsequently measured as a finance lease liability in accordance with IAS 17.

An annual finance cost is calculated by applying the implicit interest rate in the lease to the opening lease liability for the period, and is charged to

‘finance costs’ within the Statement of Comprehensive Net Expenditure.

The element of the annual unitary payment that is allocated as a finance lease rental is applied to meet the annual finance cost and to repay the

lease liability over the contract term.

An element of the annual unitary payment increase due to cumulative indexation is allocated to the finance lease. In accordance with IAS 17, this

amount is not included in the minimum lease payments, but is instead treated as contingent rent and is expensed as incurred. In substance, this

amount is a finance cost in respect of the liability and the expense is presented as a contingent finance cost in the Statement of Comprehensive

Net Expenditure.

1.18.4 Lifecycle Replacement

Components of the asset replaced by the operator during the contract (‘lifecycle replacement’) are capitalised where they meet the clinical

commissioning group’s criteria for capital expenditure. They are capitalised at the time they are provided by the operator and are measured

initially at their fair value.

The element of the annual unitary payment allocated to lifecycle replacement is pre-determined for each year of the contract from the operator’s

planned programme of lifecycle replacement. Where the lifecycle component is provided earlier or later than expected, a short-term finance

lease liability or prepayment is recognised respectively.

Where the fair value of the lifecycle component is less than the amount determined in the contract, the difference is recognised as an expense

when the replacement is provided. If the fair value is greater than the amount determined in the contract, the difference is treated as a ‘free’ asset

and a deferred income balance is recognised. The deferred income is released to the operating income over the shorter of the remaining contract

period or the useful economic life of the replacement component.

1.18.5 Assets Contributed by the Clinical Commissioning Group to the Operator For Use in the Scheme

Assets contributed for use in the scheme continue to be recognised as items of property, plant and equipment in the clinical commissioning

group’s Statement of Financial Position.

1.18.6 Other Assets Contributed by the Clinical Commissioning Group to the Operator

Assets contributed (e.g. cash payments, surplus property) by the clinical commissioning group to the operator before the asset is brought into

use, which are intended to defray the operator’s capital costs, are recognised initially as prepayments during the construction phase of the

contract. Subsequently, when the asset is made available to the clinical commissioning group, the prepayment is treated as an initial payment

towards the finance lease liability and is set against the carrying value of the liability.

A PFI liability is recognised at the same time as the PFI assets are recognised. It is measured at the present value of the minimum lease

payments, discounted using the implicit interest rate. It is subsequently measured as a finance lease liability in accordance with IAS 17.

On initial recognition of the asset, the difference between the fair value of the asset and the initial liability is recognised as deferred income,

representing the future service potential to be received by the clinical commissioning group through the asset being made available to third party

users.

The balance is subsequently released to operating income over the life of the concession on a straight-line basis.

1.19 Inventories

Inventories are valued at the lower of cost and net realisable value using the first-in first-out cost formula. This is considered to be a reasonable

approximation to fair value due to the high turnover of stocks.

1.20 Cash & Cash Equivalents

Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents

are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with

insignificant risk of change in value.

In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an

integral part of the clinical commissioning group’s cash management.

9



1.21 Provisions

Provisions are recognised when the clinical commissioning group has a present legal or constructive obligation as a result of a past event, it is

probable that the clinical commissioning group will be required to settle the obligation, and a reliable estimate can be made of the amount of the

obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the

reporting period, taking into account the risks and uncertainties. Where a provision is measured using the cash flows estimated to settle the

obligation, its carrying amount is the present value of those cash flows using HM Treasury’s discount rate as follows:

· Timing of cash flows (0 to 5 years inclusive): Minus 1.55% (2014-15: minus 1.50%)

· Timing of cash flows (6 to 10 years inclusive): Minus 1% (2014-15: minus 1.05%)

· Timing of cash flows (over 10 years): Minus 0.80% (2014-15: plus 2.20%)

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.

1.22 Clinical Negligence Costs

The 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.

1.23 Non-clinical Risk Pooling

The 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.

1.24 Continuing healthcare risk pooling

In 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.

1.25 Carbon Reduction Commitment Scheme

Carbon Reduction Commitment and similar allowances are accounted for as government grant funded intangible assets if they are not expected

to be realised within twelve months, and otherwise as other current assets. They are valued at open market value. As the clinical commissioning

group makes emissions, a provision is recognised with an offsetting transfer from deferred income. The provision is settled on surrender of the

allowances. The asset, provision and deferred income amounts are valued at fair value at the end of the reporting period.

1.26 Contingencies

A 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.

1.27 Financial Assets

Financial assets are recognised when the clinical commissioning group becomes party to the financial instrument contract or, in the case of trade

receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the

asset has been transferred.

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.

1.27.1 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.

1.27.2 Held to Maturity Assets

Held 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.

10



1.27.3 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.

[Disclose how fair value is determined.]

1.27.4 Loans & Receivables

Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market. After

initial recognition, they are measured at amortised cost using the effective interest method, less any impairment. Interest is recognised using the

effective interest method.

Fair value is determined by reference to quoted market prices where possible, otherwise by valuation techniques.

[Disclose valuation techniques as appropriate.]

The effective interest rate is the rate that exactly discounts estimated future cash receipts through the expected life of the financial asset, to the

initial fair value of the financial asset.

At the end of the reporting period, the clinical commissioning group assesses whether any financial assets, other than those held at ‘fair value

through profit and loss’ are impaired. Financial assets are impaired and impairment losses recognised if there is objective evidence of

impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the estimated

future cash flows of the asset.

For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset’s carrying

amount and the present value of the revised future cash flows discounted at the asset’s original effective interest rate. The loss is recognised in

expenditure and the carrying amount of the asset is reduced through a provision for impairment of receivables.

If, in a subsequent period, the amount of the impairment loss decreases and the decrease can be related objectively to an event occurring after

the impairment was recognised, the previously recognised impairment loss is reversed through expenditure to the extent that the carrying amount

of the receivable at the date of the impairment is reversed does not exceed what the amortised cost would have been had the impairment not

been recognised.

1.28 Financial Liabilities

Financial liabilities are recognised on the statement of financial position when the clinical commissioning group becomes party to the contractual

provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de-

recognised when the liability has been discharged, that is, the liability has been paid or has expired.

Loans from the Department of Health are recognised at historical cost. Otherwise, financial liabilities are initially recognised at fair value.

1.28.1 Financial Guarantee Contract Liabilities

Financial 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.

1.28.2 Financial Liabilities 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 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.

1.28.3 Other Financial Liabilities

After initial recognition, all other financial liabilities are measured at amortised cost using the effective interest method, except for loans from

Department of Health, which are carried at historic cost. The effective interest rate is the rate that exactly discounts estimated future cash

payments through the life of the asset, to the net carrying amount of the financial liability. Interest is recognised using the effective interest

method.

1.29 Value Added Tax

Most of the activities of the clinical commissioning group are outside the scope of VAT and, in general, output tax does not apply and input tax on

purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of

fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.

1.3 Foreign Currencies

The clinical commissioning group’s functional currency and presentational currency is sterling. Transactions denominated in a foreign currency

are translated into sterling at the exchange rate ruling on the dates of the transactions. At the end of the reporting period, monetary items

denominated in foreign currencies are retranslated at the spot exchange rate on 31 March. Resulting exchange gains and losses for either of

these are recognised in the clinical commissioning group’s surplus/deficit in the period in which they arise.

1.31 Third Party Assets

Assets 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.

1.32 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).

11



1.33 Subsidiaries

Material entities over which the clinical commissioning group has the power to exercise control so as to obtain economic or other benefits are

classified as subsidiaries and are consolidated. Their income and expenses; gains and losses; assets, liabilities and reserves; and cash flows are

consolidated in full into the appropriate financial statement lines. Appropriate adjustments are made on consolidation where the subsidiary’s

accounting policies are not aligned with the clinical commissioning group or where the subsidiary’s accounting date is not co-terminus.

Subsidiaries that are classified as ‘held for sale’ are measured at the lower of their carrying amount or ‘fair value less costs to sell’.

1.34 Associates

Material entities over which the clinical commissioning group has the power to exercise significant influence so as to obtain economic or other

benefits are classified as associates and are recognised in the clinical commissioning group’s accounts using the equity method. The investment

is recognised initially at cost and is adjusted subsequently to reflect the clinical commissioning group’s share of the entity’s profit/loss and other

gains/losses. It is also reduced when any distribution is received by the clinical commissioning group from the entity.

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’.

1.35 Joint Ventures

Material 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’.

1.36 Joint Operations

Joint operations are activities undertaken by the clinical commissioning group in conjunction with one or more other parties but which are not

performed through a separate entity. The clinical commissioning group records its share of the income and expenditure; gains and losses; assets

and liabilities; and cash flows.

1.37 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.

1.38 Accounting Standards That Have Been Issued But Have Not Yet Been Adopted

The Government Financial Reporting Manual does not require the following Standards and Interpretations to be applied in 2015-16, all of which

are subject to consultation:

· IFRS 9: Financial Instruments

· IFRS 14: Regulatory Deferral Accounts

· IFRS 15: Revenue for Contract with Customers

The application of the Standards as revised would not have a material impact on the accounts for 2015-16, were they applied in that year.

12


2 Other Operating Revenue

2015-16 2015-16 2015-16 2014-15

Total Admin Programme Total

£000 £000 £000 £000

Recoveries in respect of employee benefits 0 0 0 0

Patient transport services 0 0 0 0

Prescription fees and charges 0 0 0 0

Dental fees and charges 0 0 0 0

Education, training and research 8 8 0 4

Charitable and other contributions to revenue expenditure: NHS 0 0 0 0

Charitable and other contributions to revenue expenditure: non-NHS 0 0 0 0

Receipt of donations for capital acquisitions: NHS Charity 0 0 0 0

Receipt of Government grants for capital acquisitions 0 0 0 0

Non-patient care services to other bodies 14 10 4 140

Continuing Health Care risk pool contributions 0 0 0 0

Income generation 0 0 0 0

Rental revenue from finance leases 0 0 0 0

Rental revenue from operating leases 0 0 0 0

Other revenue 5 3 1 48

Total other operating revenue 27 21 5 192

Admin revenue is revenue received that is not directly attributable to the provision of healthcare or healthcare services.

Revenue in this note does not include cash received from NHS England, which is drawn down directly in to the bank account of the CCG and

credited to the General Fund.

3 Revenue

2015-16 2015-16 2015-16 2014-15


£000 £000 £000 £000

From rendering of services 26 21 5 192

From sale of goods 0 0 0 0

Total 26 21 5 192

13


4. Employee benefits and staff numbers

4.1.1 Employee benefits 2015-16

Total

Permanent

Employees Other Total

Permanent


Permanent

Employees Other

£000 £000 £000 £000 £000 £000 £000 £000 £000

Employee Benefits

Salaries and wages 2,692 2,692 0 1,592 1,592 0 1,100 1,100 0

Social security costs 219 219 0 139 139 0 80 80 0

Employer Contributions to NHS Pension scheme 335 335 0 212 212 0 123 123 0

Other pension costs 0 0 0 0 0 0 0 0 0

Other post-employment benefits 0 0 0 0 0 0 0 0 0

Other employment benefits 0 0 0 0 0 0 0 0 0

Termination benefits 0 0 0 0 0 0 0 0 0

Gross employee benefits expenditure 3,246 3,246 0 1,944 1,944 0 1,303 1,303 0

Less recoveries in respect of employee benefits (note 4.1.2) 0 0 0 0 0 0 0 0 0

Total - Net admin employee benefits including capitalised costs 3,246 3,246 0 1,944 1,944 0 1,303 1,303 0

Less: Employee costs capitalised 0 0 0 0 0 0 0 0 0

Net employee benefits excluding capitalised costs 3,246 3,246 0 1,944 1,944 0 1,303 1,303 0

4.1.1 Employee benefits 2014-15

Total

Permanent


Permanent


Permanent

Employees Other

£000 £000 £000 £000 £000 £000 £000 £000 £000

Employee Benefits

Salaries and wages 2,456 2,456 0 1,629 1,629 0 826 826 0

Social security costs 203 203 0 143 143 0 60 60 0

Employer Contributions to NHS Pension scheme 301 301 0 210 210 0 91 91 0

Other pension costs 0 0 0 0 0 0 0 0 0

Other post-employment benefits 0 0 0 0 0 0 0 0 0

Other employment benefits 0 0 0 0 0 0 0 0 0

Termination benefits 0 0 0 0 0 0 0 0 0

Gross employee benefits expenditure 2,959 2,959 0 1,983 1,983 0 977 977 0

Less recoveries in respect of employee benefits (note 4.1.2) 0 0 0 0 0 0 0 0 0

Total - Net admin employee benefits including capitalised costs 2,959 2,959 0 1,983 1,983 0 977 977 0

Less: Employee costs capitalised 0 0 0 0 0 0 0 0 0

Net employee benefits excluding capitalised costs 2,959 2,959 0 1,983 1,983 0 977 977 0

4.1.2 Recoveries in respect of employee benefits 2015-16 2014-15

Total

Permanent


£000 £000 £000 £000

Employee Benefits - Revenue

Salaries and wages 0 0 0 0

Social security costs 0 0 0 0

Employer contributions to the NHS Pension Scheme 0 0 0 0

Other pension costs 0 0 0 0

Other post-employment benefits 0 0 0 0

Other employment benefits 0 0 0 0

Termination benefits 0 0 0 0

Total recoveries in respect of employee benefits 0 0 0 0

Admin ProgrammeTotal

Total Admin Programme

14


4.2 Average number of people employed

2014-15

Total

Permanently

employed Other Total

Number Number Number Number

Total 72 70 2 61

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 retirements

2015-16 2014-15

Number Number

Total Days Lost 0 118

Total Staff Years 0 60

Average working Days Lost 0.0 2.0

2015-16 2014-15

Number Number

Number of persons retired early on ill health grounds 0 0

£000 £000

Total additional Pensions liabilities accrued in the year 0 0

Ill health retirement costs are met by the NHS Pension Scheme

4.4 Exit packages agreed in the financial year

Number £ Number £ Number £

Less than £10,000 0 0 0 0 0 0

£10,001 to £25,000 0 0 0 0 0 0

£25,001 to £50,000 0 0 0 0 0 0

£50,001 to £100,000 0 0 0 0 0 0

£100,001 to £150,000 0 0 0 0 0 0

£150,001 to £200,000 0 0 0 0 0 0

Over £200,001 0 0 0 0 0 0Total 0 0 0 0 0 0

Number £ Number £ Number £

Less than £10,000 0 0 0 0 0 0

£10,001 to £25,000 0 0 0 0 0 0

£25,001 to £50,000 0 0 0 0 0 0

£50,001 to £100,000 0 0 0 0 0 0

£100,001 to £150,000 0 0 0 0 0 0

£150,001 to £200,000 0 0 0 0 0 0

Over £200,001 0 0 0 0 0 0

Total 0 0 0 0 0 0

Number £ Number £

Less than £10,000 0 0 0 0

£10,001 to £25,000 0 0 0 0

£25,001 to £50,000 0 0 0 0

£50,001 to £100,000 0 0 0 0

£100,001 to £150,000 0 0 0 0

£150,001 to £200,000 0 0 0 0

Over £200,001 0 0 0 0Total 0 0 0 0

2014-15

Compulsory redundancies Other agreed departures Total

2015-16 2014-15

2015-16

2015-16 2015-16 2015-16

Compulsory redundancies Other agreed departures Total

Departures where special

payments have been made

2014-15 2014-15

Departures where special

payments have been made

15

Analysis of Other Agreed Departures

Number £ Number £

Voluntary redundancies including early retirement contractual costs 0 0 0 0

Mutually agreed resignations (MARS) contractual costs 0 0 0 0

Early retirements in the efficiency of the service contractual costs 0 0 0 0

Contractual payments in lieu of notice 0 0 0 0

Exit payments following Employment Tribunals or court orders 0 0 0 0

Non-contractual payments requiring HMT approval* 0 0 0 0

Total 0 0 0 0

No payments were made in current year (2016: £0)

Other agreed departures

2015-16 2014-15

Other agreed departures

16


4.5 Pension costs

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:

4.5.1 Full actuarial (funding) valuation

The purpose of this valuation is to assess the level of liability in respect of the benefits due under the Scheme (taking into account its

recent demographic experience), and to recommend the contribution rates to be paid by employers and scheme members. The last such

valuation, which determined current contribution rates was undertaken as at 31 March 2012 and covered the period from 1 April 2008 to

that date. Details can be found on the pension scheme website at www.nhsbsa.nhs.uk/pensions.

For 2015-16, employers’ contributions of £361,094 were payable to the NHS Pensions Scheme (2014-15: £321,773) were payable to the

NHS Pension Scheme at the rate of 14.30% of pensionable pay. The scheme’s actuary reviews employer contributions, usually every four

years and now based on HMT Valuation Directions, following a full scheme valuation. The latest review used data from 31 March 2012

and was published on the Government website on 9 June 2012. These costs are included in the NHS pension line of note 4.1.1, with the

exception of the Chair and Non-Executive's contributions which are held with non-pay as per NHS Guidance.

17


5. Operating expenses

2015-16 2015-16 2015-16 2014-15


£000 £000 £000 £000

Gross employee benefits

Employee benefits excluding governing body members 2,990 1,688 1,303 2,705

Executive governing body members 256 256 0 254

Total gross employee benefits 3,246 1,944 1,303 2,959

Other costs

Services from other CCGs and NHS England 1,243 435 807 991

Services from foundation trusts 7,248 0 7,248 6,342

Services from other NHS trusts 139,127 31 139,096 143,167

Services from other NHS bodies 0 0 0 3

Purchase of healthcare from non-NHS bodies 29,570 0 29,570 21,459

Chair and Non Executive Members 129 126 3 118

Supplies and services – clinical 794 0 794 738

Supplies and services – general 224 7 217 293

Consultancy services 369 108 261 128

Establishment 401 225 176 238

Transport 27 23 4 46

Premises 228 122 106 306

Impairments and reversals of receivables 0 0 0 0

Inventories written down 0 0 0 0

Depreciation 0 0 0 0

Amortisation 0 0 0 0

Impairments and reversals of property, plant and equipment 0 0 0 0

Impairments and reversals of intangible assets 0 0 0 0

Impairments 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 0

Impairments and reversals of non-current assets held for sale 0 0 0 0

Impairments and reversals of investment properties 0 0 0 0

Audit fees 56 33 23 74

Other non statutory audit expenditure

· Internal audit services 36 18 18 29

· Other services 0 0 0 0

General dental services and personal dental services 0 0 0 0

Prescribing costs 24,850 0 24,850 23,897

Pharmaceutical services 171 0 171 73

General ophthalmic services 1 0 1 2

GPMS/APMS and PCTMS 1,835 19 1,817 2,161

Other professional fees excl. audit 279 19 259 209

Grants to other public bodies 6 0 6 0

Clinical negligence 0 0 0 0

Research and development (excluding staff costs) 0 0 0 0

Education and training 15 10 4 11

Change in discount rate 0 0 0 0

Provisions (55) 0 (55) 10

Funding to group bodies 0 0 0

CHC Risk Pool contributions 345 0 345 293

Other expenditure 0 0 0 0

Total other costs 206,898 1,178 205,720 200,588

Total operating expenses 210,144 3,122 207,022 203,547

18


6.1 Better Payment Practice Code

Measure of compliance 2015-16 2015-16 2014-15 2014-15

Number £000 Number £000

Non-NHS Payables

Total Non-NHS Trade invoices paid in the Year 4355 42444 5538 28497

Total Non-NHS Trade Invoices paid within target 4262 41894 5474 28209

Percentage of Non-NHS Trade invoices paid within target 97.86% 98.70% 98.84% 98.99%

NHS Payables

Total NHS Trade Invoices Paid in the Year 1216 133076 1759 149403

Total NHS Trade Invoices Paid within target 1199 132992 1749 149395

Percentage of NHS Trade Invoices paid within target 98.60% 99.94% 99.43% 99.99%

6.2 The Late Payment of Commercial Debts (Interest) Act 1998 2015-16 2014-15

£000 £000

Amounts included in finance costs from claims made under this legislation 0 0

Compensation paid to cover debt recovery costs under this legislation 0 0

Total 0 0

7 Income Generation Activities

The CCG does not undertake any income generation activities

19


8. Investment revenue

2015-16 2014-15

£000 £000

Rental Revenue

PFI finance lease revenue (planned) 0 0

PFI finance lease revenue (contingent) 0 0

Other finance lease revenue 0 0

Total rental revenue 0 0

Interest Revenue

LIFT: equity dividends receivable 0 0

LIFT: loan interest receivable 0 0

Bank interest 0 0

Other loans and receivables 0 0

Impaired financial assets 0 0

Other financial assets 0 0

Total interest revenue 0 0

Total investment revenue 0 0

The CCG does not undertake any investment revenue generating activities

9. Other gains and losses

2015-16 2014-15

£000 £000

Gain/(loss) on disposal of property, plant and equipment assets other than by sale 0 0

Gain/(loss) on disposal of intangible assets other than by sale 0 0

Gain/(loss) on disposal of financial assets other than held for sale 0 0

Gain/(loss) on disposal of assets held for sale 0 0

Gain/(loss) on foreign exchange 0 0

0 0

0 0

Change in fair value of investment property 0 0

Recycling of gain/(loss) from equity on disposal of financial assets held for sale 0 0

Total 0 0

10. Finance costs

2015-16 2014-15

£000 £000

Interest

Interest on loans and overdrafts 0 0

Interest on obligations under finance leases 0 0

Interest on obligations under PFI contracts:

· Main finance cost 0 0

· Contingent finance cost 0 0

Interest on obligations under LIFT contracts:

· Main finance cost 0 0

· Contingent finance cost 0 0

Interest on late payment of commercial debt 0 0

Other interest expense 0 0

Total interest 0 0

Other finance costs 0 0

Provisions: unwinding of discount 0 0

Total finance costs 0 0

Change in fair value of financial assets carried at fair value through the statement of comprehensive

net expenditure

Change in fair value of financial liabilities carried at fair value through the statement of

comprehensive net expenditure

20


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

12. Operating Leases

12.1 As lessee

The CCG has a lease with NHS Property Services for its headquarters building (Building A, The Apex, St Cross Business Park, Newport). The

lease commenced in September 2013, for a 10 year period, with a break clause at Year 8.

12.1.1 Payments recognised as an Expense 2015-16

Land Buildings Other Total Land Buildings

£000 £000 £000 £000 £000 £000

Payments recognised as an expense

Minimum lease payments 0 110 0 111 0 100

Contingent rents 0 0 0 0 0 0

Sub-lease payments 0 0 0 0 0 0

Total 0 110 0 111 0 100

12.1.2 Future minimum lease payments 2015-16

Land Buildings Other Total Land Buildings

£000 £000 £000 £000 £000 £000

Payable:

No later than one year 0 97 0 97 0 97

Between one and five years 0 390 0 390 0 390

After five years 0 292 0 292 0 292

Total 0 292 0 292 0 779

12.2 As lessor

12.2.1 Rental revenue 2015-16 2014-15

£000 £000

Recognised as income

Rent 0 0

Contingent rents 0 0

Total 0 0

12.2.2 Future minimum rental value 2015-16 2014-15

£000 £000

Receivable:

No later than one year 0 0

Between one and five years 0 0

After five years 0 0

Total 0 0

The CCG had no transfers during this financial period

21


13 Property, plant and equipment

2015-16 Land

Buildings

excluding

dwellings Dwellings

Assets under

construction

and payments

on account

Plant &

machinery

Transport

equipment

Information

technology

Furniture &

fittings Total

£000 £000 £000 £000 £000 £000 £000 £000 £000

Cost or valuation at 01-April-2015 0 0 0 0 0 0 0 0 0

Addition of assets under construction and payments on account 0 0

Additions purchased 0 0 0 0 0 0 0 0 0

Additions donated 0 0 0 0 0 0 0 0 0

Additions government granted 0 0 0 0 0 0 0 0 0

Additions leased 0 0 0 0 0 0 0 0 0

Reclassifications 0 0 0 0 0 0 0 0 0

Reclassified as held for sale and reversals 0 0 0 0 0 0 0 0 0

Disposals other than by sale 0 0 0 0 0 0 0 0 0

Upward revaluation gains 0 0 0 0 0 0 0 0 0

Impairments charged 0 0 0 0 0 0 0 0 0

Reversal of impairments 0 0 0 0 0 0 0 0 0

Transfer (to)/from other public sector body 0 0 0 0 0 0 0 0 0

Cumulative depreciation adjustment following revaluation 0 0 0 0 0 0 0 0 0

Cost/Valuation At 31-March-2016 0 0 0 0 0 0 0 0 0

Depreciation 01-April-2015 0 0 0 0 0 0 0 0 0

Reclassifications 0 0 0 0 0 0 0 0 0

Reclassified as held for sale and reversals 0 0 0 0 0 0 0 0 0

Disposals other than by sale 0 0 0 0 0 0 0 0 0

Upward revaluation gains 0 0 0 0 0 0 0 0 0

Impairments charged 0 0 0 0 0 0 0 0 0

Reversal of impairments 0 0 0 0 0 0 0 0 0

Charged during the year 0 0 0 0 0 0 0 0 0

Transfer (to)/from other public sector body 0 0 0 0 0 0 0 0 0

Cumulative depreciation adjustment following revaluation 0 0 0 0 0 0 0 0 0

Depreciation at 31-March-2016 0 0 0 0 0 0 0 0 0

Net Book Value at 31-March-2016 0 0 0 0 0 0 0 0 0

Purchased 0 0 0 0 0 0 0 0 0

Donated 0 0 0 0 0 0 0 0 0

Government Granted 0 0 0 0 0 0 0 0 0

Total at 31-March-2016 0 0 0 0 0 0 0 0 0

Asset financing:

Owned 0 0 0 0 0 0 0 0 0

Held on finance lease 0 0 0 0 0 0 0 0 0

On-SOFP Lift contracts 0 0 0 0 0 0 0 0 0

PFI residual: interests 0 0 0 0 0 0 0 0 0

Total at 31-March-2016 0 0 0 0 0 0 0 0 0

Revaluation Reserve Balance for Property, Plant & Equipment

Land Buildings Dwellings

Assets under

construction &

payments on

account

Plant &

machinery

Transport

equipment

Information

technology

Furniture &

fittings Total

£000's £000's £000's £000's £000's £000's £000's £000's £000's

Balance at 01-April-2015 0 0 0 0 0 0 0 0 0

Revaluation gains 0 0 0 0 0 0 0 0 0

Impairments 0 0 0 0 0 0 0 0 0

Release to general fund 0 0 0 0 0 0 0 0 0

Other movements 0 0 0 0 0 0 0 0 0

At 31-March-2016 0 0 0 0 0 0 0 0 0

22


13 Property, plant and equipment cont'd

13.1 Additions to assets under construction

The CCG has no assets under construction as at 31st March 2016

13.2 Donated assets

The CCG did not receive any donated assets during this financial period

13.3 Government granted assets

The CCG did not receive any government granted assets during this financial period

13.4 Property revaluation

The CCG does not own any property

23


13 Property, plant and equipment cont'd

13.5 Compensation from third parties

13.6 Write downs to recoverable amount

13.7 Temporarily idle assets

The net book value of temporarily idle assets was as follows:

2015-16 2014-15

£000 £000

Land 0 0

Buildings excluding dwellings 0 0

Dwellings 0 0

Plant & machinery 0 0

Transport equipment 0 0

Information technology 0 0

Furniture & fittings 0 0

Total 0 0

13.8 Cost or valuation of fully depreciated assets

The cost or valuation of fully depreciated assets still in use was as follows:

2015-16 2014-15

£000 £000

Land 0 0


Dwellings 0 0





Total 0 0

13.9 Economic lives


Dwellings 0 0





0 0

The CCG received no compensation from third parties during the financial period

Minimum

Life (years)

Maximum

Life (Years)

The CCG had no assets to write down during the financial period

24


14 Intangible non-current assets

2015-16

Computer

Software:

Purchased

Computer

Software:

Internally

Generated

Licences &

Trademarks Patents

Development

Expenditure

(internally

generated) Total

£000 £000 £000 £000 £000 £000

Cost or valuation at 01-April-2015 0 0 0 0 0 0

Additions purchased 0 0 0 0 0 0

Additions internally generated 0 0 0 0 0 0

Additions donated 0 0 0 0 0 0

Additions government granted 0 0 0 0 0 0

Additions leased 0 0 0 0 0 0

Reclassifications 0 0 0 0 0 0

Reclassified as held for sale and reversals 0 0 0 0 0 0

Disposals other than by sale 0 0 0 0 0 0

Upward revaluation gains 0 0 0 0 0 0

Impairments charged 0 0 0 0 0 0

Reversal of impairments 0 0 0 0 0 0

Transfer (to)/from other public sector body 0 0 0 0 0 0

Cumulative amortisation adjustment following revaluation 0 0 0 0 0 0

Cost / Valuation At 31-March-2016 0 0 0 0 0 0

Amortisation 01-April-2015 0 0 0 0 0 0

Reclassifications 0 0 0 0 0 0

Reclassified as held for sale and reversals 0 0 0 0 0 0

Disposals other than by sale 0 0 0 0 0 0

Upward revaluation gains 0 0 0 0 0 0

Impairments charged 0 0 0 0 0 0

Reversal of impairments 0 0 0 0 0 0

Charged during the year 0 0 0 0 0 0

Transfer (to) from other public sector body 0 0 0 0 0 0

Cumulative amortisation adjustment following revaluation 0 0 0 0 0 0

Amortisation At 31-March-2016 0 0 0 0 0 0

Net Book Value at 31-March-2016 0 0 0 0 0 0

Purchased 0 0 0 0 0 0

Donated 0 0 0 0 0 0

Government Granted 0 0 0 0 0 0

Total at 31-March-2016 0 0 0 0 0 0

Revaluation Reserve Balance for intangible assets

Computer

Software:

Purchased

Computer

Software:

Internally

Generated

Licences &

Trademarks Patents

Development

Expenditure

(internally

generated) Total

£000's £000's £000's £000's £000's £000's

Balance at 01-April-2015 0 0 0 0 0 0

Revaluation gains 0 0 0 0 0 0

Impairments 0 0 0 0 0 0

Release to general fund 0 0 0 0 0 0

Other movements 0 0 0 0 0 0

At 31-March-2016 0 0 0 0 0 0

25


14 Intangible non-current assets cont'd

14.1 Donated assets

The CCG had no donated assets as at 31 March 2016

14.2 Government granted assets

The CCG had no government granted assets as at 31 March 2016

14.3 Revaluation

2015-16 2014-15

£000 £000

The major constituents of the upward revaluation are as follows:-

Previously charged to the Statement of Comprehensive Net Expenditure and now reversed:

0 0

Total 0 0

Credited to the Revaluation Reserve:

0 0

Total 0 0

The major constituents of the downward revaluation are as follows

Charged to the Statement of Comprehensive Net Expenditure:

0 0

Total 0 0

Charged to the Revaluation Reserve:

0 0

Total 0 0

26


15 Investment property

2015-16 2014-15

£000 £000

Fair value balance at 01-April-2015 0 0

Additions through subsequent expenditure 0 0

Other acquisitions 0 0

Reclassified as held for sale and reversals 0 0

Disposals other than by sale 0 0

Loss from fair value adjustments: Impairments 0 0

Gain from fair value adjustments: Reversal of impairments 0 0

Gain from fair value adjustments 0 0

Transfer (to) from other public sector body 0 0

Other changes 0 0

At 31-March-2016 0 0

15.1 Investment property

2015-16 2014-15

£000 £000

Capital revenue 0 0

Capital expenditure 0 0

Net revenue (expenditure) 0 0

16 Inventories

Drugs Consumables Energy Work in

Progress

Loan

Equipment

Other Total

£'000 £'000 £'000 £'000 £'000 £'000 £'000

Balance at 01-April-2015 0 0 0 0 0 0 0

Additions 0 0 0 0 0 0 0

Inventories recognised as an expense in the period 0 0 0 0 0 0 0

Write-down of inventories (including losses) 0 0 0 0 0 0 0

Reversal of write-down previously taken to the statement of comprehensive net expenditure 0 0 0 0 0 0 0

Transfer (to) from -Goods for resale 0 0 0 0 0 0 0

At 31-March-2016 0 0 0 0 0 0 0

27


17 Trade and other receivables Current Non-current Current Non-current

2015-16 2015-16 2014-15 2014-15

£000 £000 £000 £000

NHS receivables: Revenue 152 0 187 0

NHS receivables: Capital 0 0 0 0

NHS prepayments 545 0 619 0

NHS accrued income 141 0 166 0

Non-NHS receivables: Revenue 909 0 237 0

Non-NHS receivables: Capital 0 0 0 0

Non-NHS prepayments 349 0 312 0

Non-NHS accrued income 0 0 167 0

Provision for the impairment of receivables 0 0 0 0

VAT 13 0 9 0

Private finance initiative and other public private partnership

arrangement prepayments and accrued income 0 0 0 0

Interest receivables 0 0 0 0

Finance lease receivables 0 0 0 0

Operating lease receivables 0 0 0 0

Other receivables 1 0 3 0

Total Trade & other receivables 2,109 0 1,701 0

Total current and non current 2,109 1,701

Included above:

Prepaid pensions contributions 0 0

Please note that the above schedules contain rounding errors of £1k

17.1 Receivables past their due date but not impaired 2015-16 2014-15

£000 £000

By up to three months 490 81

By three to six months 0 1

By more than six months 8 2

Total 498 84

£196,737 of the amount above has subsequently been recovered post the statement of financial position date.

The clinical commissioning group did not hold any collatoral against receivables outstanding at 31st March 2016

17.2 Provision for impairment of receivables 2015-16 2014-15

£000 £000

Balance at 01-April-2015 0 0

Amounts written off during the year 0 0

Amounts recovered during the year 0 0

(Increase) decrease in receivables impaired 0 0

Transfer (to) from other public sector body 0 0

Balance at 31-March-2016 0 0

The CCG does not consider any receivables should be impaired during this financial period

The majority of trade receivables is with Isle of Wight Council. As the council is funded by Government to provide public services,

no credit scoring of them is considered necessary

Following the Governance procedures set down by the CCG an amount of £3k due from a non NHS supplier was written off during

the year due to the supplier becoming insolvent and the CCG being advised by the receivers that no monies would be distributed to

any of the orgnaisations creditors.

28


18 Other financial assets

The CCG had no other financial assets at 31 March 2016.

18.1 Current

2015-16 2014-15

£000 £000


Additions 0 0

Revaluation 0 0

Impairments 0 0

Impairment reversals 0 0

Transferred from non-current financial assets 0 0

Disposals 0 0

Transfer (to)/from other public sector body 0 0

At 31-March-2016 0 0

18.2 Non-current

2015-16 2014-15

£000 £000


Additions 0 0

Revaluation 0 0

Impairments 0 0

Impairment reversals 0 0

Transferred from non-current financial assets 0 0

Disposals 0 0

Transfer (to)/from other public sector body 0 0

At 31-March-2016 0 0

18.3 Non-current: capital analysis

2015-16 2014-15

£000 £000

Capital revenue 0 0

Capital expenditure 0 0

19 Other current assets

2015-16 2014-15

£000 £000

EU Emissions trading scheme allowance 0 0

Other assets 0 0

Total 0 0

29


20 Cash and cash equivalents

2015-16 2014-15

£000 £000


Net change in year 21 (11)


Made up of:

Cash with the Government Banking Service 78 57

Cash with Commercial banks 0 0

Cash in hand 0 0

Current investments 0 0

Cash and cash equivalents as in statement of financial position 78 57

Bank overdraft: Government Banking Service 0 0

Bank overdraft: Commercial banks 0 0

Total bank overdrafts 0 0


The CCG does not hold any patients money.

30


21 Non-current assets held for sale

Land

Buildings

excluding

dwellings Dwellings

Assets under

construction

and payments

on account

Plant &

machinery

Transport

equipment

Information

technology

Furniture

& fittings

Intangible

Assets Total

£000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Balance at 01-April-2015 0 0 0 0 0 0 0 0 0 0

Plus: assets classified as held for sale in the year 0 0 0 0 0 0 0 0 0 0

Less: assets sold in the year 0 0 0 0 0 0 0 0 0 0

Less: impairment of assets held for sale 0 0 0 0 0 0 0 0 0 0

Plus: reversal of impairment of assets held for sale 0 0 0 0 0 0 0 0 0 0

Less: assets no longer classified as held for sale, for reasons other

than disposal by sale 0 0 0 0 0 0 0 0 0 0

Transfer (to) from other public sector body 0 0 0 0 0 0 0 0 0 0

Revaluation 0 0 0 0 0 0 0 0 0 0

Balance at 31-March-2016 0 0 0 0 0 0 0 0 0 0

31


22 Analysis of impairments and reversals

The CCG had no impairments or reversals at 31 March 2016

22.1 Analysis of impairments and reversals: property, plant and equipment

2015-16 2014-15

£000 £000

Impairments and reversals charged to the statement of comprehensive net expenditure

Loss or damage resulting from normal operations 0 0

Over-specification of assets 0 0

Abandonment of assets in the course of construction 0 0

Total charged to departmental expenditure limit 0 0

Unforeseen obsolescence 0 0

Loss as a result of catastrophe 0 0

Other 0 0

Change in market price 0 0

Total charged to annually managed expenditure 0 0

Total impairments and reversals charged to the statement of

comprehensive net expenditure 0 0

Impairments and Reversals charged to the revaluation reserve






Other 0 0


Total Impairments and reversals charged to the revaluation reserve 0 0

0 0

Total impairments and reversals of property, plant and equipment 0 0

22.1 Analysis of impairments and reversals: Intangible assets

2015-16 2014-15

£000 £000

Impairments and reversals charged to the statement of comprehensive

net expenditure







Other 0 0



Total impairments and reversals charged to the statement of comprehensive

net expenditure 0 0







Other 0 0



0 0

Total impairments and reversals of intangible assets 0 0

Total impairments and reversals of property, plant and equipment charged to the revaluation reserve


32


22 Analysis of impairments and reversals cont'd

22.3 Analysis of impairments and reversals: investment property

2015-16 2014-15

£000 £000

Impairments and reversals charged to the statement of

comprehensive net expenditure







Other 0 0



Total impairments and reversals charged to the statement of

comprehensive net expenditure 0 0







Other 0 0



0 0

Total impairments and reversals of investment property 0 0

22.4 Analysis of impairments and reversals: inventories

2015-16 2014-15

£000 £000






Other 0 0



Total impairments and reversals charged to the statement of comprehensive net expenditure 0 0

Total impairments and reversals of inventories 0 0


33



22.5 Analysis of impairments and reversals: financial assets

2015-16 2014-15

£000 £000



Total charged to Departmental Expenditure Limit 0 0



Other 0 0


Total charged to Annually Managed expenditure 0 0






Other 0 0


Total impairments and reversals charged to the revaluation reserve 0 0

0 0

Total impairments and reversals of financial assets 0 0

22.6 Analysis of impairments and reversals: non-current assets held for sale

2015-16 2014-15

£000 £000








Other 0 0










Other 0 0



0 0

Total impairments and reversals of intangible assets 0 0



34



22.7 Analysis of impairments and reversals: totals

2015-16 2014-15

£000 £000


Departmental expenditure limit 0 0

Annually managed expenditure 0 0


Impairments and reversals charged to the revaluation reserve 0 0

Total impairments 0 0

Of the above:

Impairment on revaluation to “modern equivalent asset” basis 0 0

Property, plant & equipment charged to departmental expenditure limit 0 0

Intangible assets charged to departmental expenditure limit 0 0


Property, plant & equipment charged to annually managed expenditure 0 0

Intangible assets charged to annually managed expenditure 0 0


0 0

Impairments and reversals of donated and government granted assets charged to the statement of

comprehensive net expenditure included above:

Total impairments and reversals of donated and government granted assets charged to the

statement of comprehensive net expenditure

35


Current Non-current Current Non-current

2015-16 2015-16 2014-15 2014-15

£000 £000 £000 £000

Interest payable 0 0 0 0

NHS payables: revenue 17 0 2,739 0

NHS payables: capital 0 0 0 0

NHS accruals 2,639 0 1,239 0

NHS deferred income 0 0 0 0

Non-NHS payables: revenue 1,881 0 974 0

Non-NHS payables: capital 0 0 0 0

Non-NHS accruals 5,896 0 6,169 0

Non-NHS deferred income 0 0 0 0

Social security costs 35 0 34 0

VAT 0 0 0 0

Tax 40 0 33 0

Payments received on account 0 0 0 0

Other payables 2,179 0 621 0

Total Trade & Other Payables 12,686 0 11,809 0

Total current and non-current 12,686 11,809

Other payables include £56k outstanding pension contributions at 31st March 2016 - (£53k - 31st March 2015)

24 Other financial liabilities Current Non-current Current Non-current

2015-16 2015-16 2014-15 2014-15

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 0

Amortised cost 0 0 0 0

Total 0 0 0 0

Total current and non-current 0 0

25 Other liabilities Current Non-current Current Non-current

2015-16 2015-16 2014-15 2014-15

Private finance initiative/LIFT deferred credit 0 0 0 0

Lease incentives 0 0 0 0

Other 0 0 0 0

Total 0 0 0 0


23 Trade and other payables

36



2015-16 2015-16 2014-15 2014-15

£000 £000 £000 £000

Bank overdrafts:

· Government banking service 0 0 0 0

· Commercial banks 0 0 0 0

Total overdrafts 0 0 0 0

Loans from:

· The Department of Health 0 0 0 0

· Other entities 0 0 0 0

Total loans 0 0 0 0

Private finance initiative liabilities:

· Main liability 0 0 0 0

· Lifecycle replacement received in advance 0 0 0 0

Total private finance initiative liabilities 0 0 0 0

LIFT liabilities:

· Main liability 0 0 0 0

· Lifecycle replacement received in advance 0 0 0 0

Total LIFT liabilities 0 0 0 0

Finance lease liabilities 0 0 0 0

Other [give detail] 0 0 0 0

Total Borrowings 0 0 0 0


26.1 Repayment of principal falling dueDepartment of

Health Other Total

2015-16 2015-16 2015-16

£000 £000 £000

Within one year 0 0 0

Between one and two years 0 0 0

Between two and five years 0 0 0

Between one and five years 0 0 0

After five years 0 0 0

Total 0 0 0

26 Borrowings

37


27 Private finance initiative, LIFT and other service concession arrangements

The CCG had no PFI, LIFT or other service concession arrangements at 31 March 2016

2015-16 2014-15

£000 £000

Within one year 0 0



Total 0 0

2015-16 2014-15

£000 £000

Within one year 0 0



Total 0 0

2015-16 2014-15

£000 £000

Within one year 0 0



Sub-total 0 0

Less: Interest element 0 0

Total 0 0

2015-16 2014-15

£000 £000

Within one year 0 0



Sub-total 0 0

Less: Interest element 0 0

Total 0 0

27.1 Off-Statement of Financial Position private finance initiative and other service concession

arrangements

27.1.1 Payments committed to in respect of off-statement of financial position LIFT schemes

27.2.1 Imputed “finance lease” obligations for on-statement of financial position private finance

initiative and other service concession arrangements

27.2.2 Imputed “finance lease” obligations for on-statement of financial position LIFT schemes

38


2015-16 2014-15

£000 £000

Off-Statement of financial position arrangements 0 0

Service element of on-statement of financial position

arrangements 0 0

Total 0 0

27.3.2 In respect of LIFT schemes

2015-16 2014-15

£000 £000

Off-Statement of financial position arrangements 0 0

Service element of on-statement of financial position

arrangements 0 0

Total 0 0

2015-16 2014-15

£000 £000

Within one year 0 0



Total 0 0

27.4.2 In respect of on-statement of financial position LIFT schemes

2015-16 2014-15

£000 £000

Within one year 0 0



Total 0 0

27 Private finance initiative, LIFT and other service concession arrangements cont'd

27.3.1 In respect of private finance initiative and other service concession arrangements

27.4.1 In respect of on-statement of financial position private finance initiative and other service

concession arrangements

39


28 Finance lease obligations

The CCG had no finance lease obligations at 31 March 2016

Land Buildings Other Total

2015-16 2015-16 2015-16 2015-16

£000 £000 £000 £000

Within one year 0 0 0 0

Between one and five years 0 0 0 0

After five years 0 0 0 0

Less: future finance charges 0 0 0 0

Present value of minimum lease payments 0 0 0 0

Included in:

Current borrowings 0 0 0 0

Non-current borrowings 0 0 0 0

Total 0 0 0 0

Land Buildings Other Total

2015-16 2015-16 2015-16 2015-16

£000 £000 £000 £000

Within one year 0 0 0 0

Between one and five years 0 0 0 0

After five years 0 0 0 0

Less: future finance charges 0 0 0 0

Present value of minimum lease payments 0 0 0 0

Included in:

Current borrowings 0 0 0 0

Non-current borrowings 0 0 0 0

Total 0 0 0 0

28.1 Finance leases as lessee

2015-16 2014-15

£000 £000

Future sublease payments expected to be received 0 0

Present value of minimum lease payments

Minimum lease payments

40


29 Finance lease receivables

Land Buildings Other Total Total

2015-16 2015-16 2015-16 2015-16 2014-15

£000 £000 £000 £000 £000

Within one year 0 0 0 0 0

Between one and five years 0 0 0 0 0

After five years 0 0 0 0 0

Less: future finance charges 0 0 0 0 0

Present value minimum lease payments 0 0 0 0 0

Less: allowance for uncollectible lease receivables 0 0 0 0 0

Total finance lease receivables recognised in the statement of financial position 0 0 0 0 0

Included in:

Current finance lease receivables 0 0 0 0 0

Non-current finance lease receivables 0 0 0 0 0

Total 0 0 0 0 0

Land Buildings Other Total Total

2015-16 2015-16 2015-16 2015-16 2014-15

£000 £000 £000 £000 £000

Within one year 0 0 0 0 0

Between one and five years 0 0 0 0 0

After five years 0 0 0 0 0

Less: future finance charges 0 0 0 0 0

Present value minimum lease payments 0 0 0 0 0

Less: allowance for uncollectible lease receivables 0 0 0 0 0Total finance lease receivables recognised in the statement of financial

position 0 0 0 0 0

Included in:

Current finance lease receivables 0 0 0 0 0

Non-current finance lease receivables 0 0 0 0 0

Total 0 0 0 0 0

29.1 Finance leases as lessor

2015-16 2014-15

£000 £000

Unguaranteed residual value accruing 0 0

Accumulated allowance for uncollectible lease receivables 0 0

29.2 Rental revenue

2015-16 2014-15

£000 £000

Contingent rent 0 0

Other 0 0

Total 0 0

Present value of minimum lease payments

Gross investment in leases

41


30 Provisions


2015-16 2015-16 2014-15 2014-15

£000 £000 £000 £000

Pensions relating to former directors 0 0 0 0

Pensions relating to other staff 0 0 0 0

Restructuring 0 0 0 0

Redundancy 0 0 0 0

Agenda for change 0 0 0 0

Equal pay 0 0 0 0

Legal claims 0 0 0 0

Continuing care 50 0 109 0

Other 0 0 0 0

Total 50 0 109 0


Pensions

Relating to

Former

Directors

Pensions

Relating to

Other Staff Restructuring Redundancy

Agenda for

Change Equal Pay Legal Claims

Continuing

Care Other Total

£000s £000s £000s £000s £000s £000s £000s £000s £000s £000s

Balance at 01-April-2015 0 0 0 0 0 0 0 109 0 109

Arising during the year 0 0 0 0 0 0 0 50 0 50

Utilised during the year 0 0 0 0 0 0 0 (3) 0 (3)

Reversed unused 0 0 0 0 0 0 0 (105) 0 (105)

Unwinding of discount 0 0 0 0 0 0 0 0 0 0

Change in discount rate 0 0 0 0 0 0 0 0 0 0

Transfer (to) from other public sector body 0 0 0 0 0 0 0 0 0 0

Balance at 31-March-2016 0 0 0 0 0 0 0 50 0 50

Expected timing of cash flows:

Within one year 0 0 0 0 0 0 0 50 0 50

Between one and five years 0 0 0 0 0 0 0 0 0 0

After five years 0 0 0 0 0 0 0 0 0 0

Balance at 31-March-2016 0 0 0 0 0 0 0 50 0 50

Continuing Care provision relates to the potential CCG liability on Continuing Care restitution cases

Please note that the above schedules contain rounding errors of £1k

42


31 Contingencies

The CCG had no contingencies at 31 March 2016

2015-16 2014-15

£000 £000

Contingent liabilities

Amounts recoverable against contingent liabilities 0 0

Net value of contingent liabilities 0 0

Contingent assets

Amounts payable against contingent assets 0 0

Net value of contingent assets 0 0

43


32 Commitments

32.1 Capital commitments

The CCG does not have any capital commitments at the end of the financial period

2015-16 2014-15

£000 £000

Property, plant and equipment 0 0

Intangible assets 0 0

Total 0 0

32.2 Other financial commitments

2015-16 2014-15

£000 £000

In not more than one year 0 0

In more than one year but not more than five years 0 0

In more than five years 0 0

Total 0 0

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 Clinical Commissioning Group borrows from government for capital expenditure, subject to affordability as confirmed by NHS England.

The borrowings are for 1 to 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate,

fixed for the life of the loan. The clinical commissioning group therefore has low exposure to interest rate fluctuations.

Because the majority of the NHS Clinical Commissioning Group and revenue comes parliamentary funding, NHS Clinical Commissioning

Group 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.

NHS Clinical Commissioning Group is required to operate within revenue and capital resource limits, which are financed from resources

voted annually by Parliament. The NHS Clinical Commissioning Group draws down cash to cover expenditure, as the need arises. The NHS

Clinical Commissioning Group is not, therefore, exposed to significant liquidity risks.

The NHS Clinical Commissioning Group has entered into non-cancellable contracts (which are not leases, private finance

initiative contracts or other service concession arrangements) which expire as follows:

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 NHS Clinical Commissioning Group 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 clinical commissioning group 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 clinical commissioning group in undertaking its activities.

Treasury management operations are carried out by the finance department, within parameters defined formally within the NHS Clinical

Commissioning Group standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by

the NHS Clinical Commissioning Group and internal auditors.

The NHS Clinical Commissioning Group is principally a domestic organisation with the great majority of transactions, assets and liabilities

being in the UK and sterling based. The NHS Clinical Commissioning Group has no overseas operations. The NHS Clinical Commissioning

Group and therefore has low exposure to currency rate fluctuations.

44


33 Financial instruments cont'd

33.2 Financial assets

At ‘fair value

through profit and

loss’

Loans and

Receivables

Available for

Sale Total

2015-16 2015-16 2015-16 2015-16

£000 £000 £000 £000

Embedded derivatives 0 0 0 0

Receivables:

· NHS 0 293 0 293

· Non-NHS 0 909 0 909

Cash at bank and in hand 0 78 0 78

Other financial assets 0 1 0 1

Total at 31-March-2016 0 1,281 0 1,281

At ‘fair value

through profit and

loss’

Loans and

Receivables

Available for

Sale Total

2014-15 2014-15 2014-15 2014-15

£000 £000 £000 £000

Embedded derivatives 0 0 0 0

Receivables:

· NHS 0 187 0 187

· Non-NHS 0 237 0 237

Cash at bank and in hand 0 57 0 57

Other financial assets 0 3 0 3

Total at 31-March-2015 0 484 0 484

33.3 Financial liabilities

At ‘fair value

through profit and

loss’ Other Total

2015-16 2015-16 2015-16

£000 £000 £000

Embedded derivatives 0 0 0

Payables:

· NHS 0 2,656 2,656

· Non-NHS 0 9,955 9,955

Private finance initiative, LIFT and finance lease obligations 0 0 0

Other borrowings 0 0 0


Total at 31-March-2016 0 12,611 12,611

At ‘fair value

through profit and

loss’ Other Total

2014-15 2014-15 2014-15

£000 £000 £000

Embedded derivatives 0 0 0

Payables:

· NHS 0 3,978 3,978

· Non-NHS 0 7,764 7,764

Private finance initiative, LIFT and finance lease obligations 0 0 0

Other borrowings 0 0 0


Total at 31-March-2015 0 11,742 11,742

45


34 Operating segments

The CCG only has one operating segment, which is the commissioning of healthcare services.

46


35 Pooled budgets

The memorandum account for the pooled budget is:

2015-16 2014-15

£000 £000

Income 16,257 2,150

Expenditure (16,055) (2,225)

36 NHS Lift investments

Loan

Share

Capital Total

2015-16 2015-16 2015-16

£000 £000 £000

Balance at 01-April-2015 0 0 0

Additions 0 0 0

Disposals 0 0 0

Loan repayments 0 0 0

Revaluations 0 0 0

Loans repayable within 12 months 0 0 0

Balance at 31-March-2016 0 0 0

Loan Share Capital Total

2014-15 2014-15 2014-15

£000 £000 £000

Balance at 1 April 2014 0 0 0

Transfer of investments from closed NHS bodies as a result of the 1 April

2014 transition 0 0 0

Adjusted Balance at 1 April 2014 0 0 0

Additions 0 0 0

Disposals 0 0 0

Loan repayments 0 0 0

Revaluations 0 0 0

Loans repayable within 12 months 0 0 0

Balance at 31 March 2015 0 0 0

The CCG has entered into pooled budget arrangements with the Isle of Wight Council. Under the arrangements funds

arepooled under Section 75 of the NHS Act 2006 for NHS Funded nursing Care and the Intergrated Community Equipment

Store.

Pooled budgets for 2015/16 include the Better care fund is a single pooled budget, developed between the CCG and the

IOW Council to support integrated care.

Plans have been developed for 2016/17 to build on the previous BCF to now incorporate most of out of hospital care, other

than micro-commissioning for the individual which will be developed in year.

47


38 Related party transactions

Payments to

Related

Party

Receipts

from

Related

Party

Amounts

owed to

Related

Party

Amounts

due from

Related

Party

£000 £000 £000 £000

Esplanade GP Surgery (J.Hesse) 156 48

Shanklin GP Surgery (J. Rivers) 202 65

The Department of Health is regarded as a related party. During the year the CCG has had a significant number of

material transactions with entities for which the Department is regarded as the parent Department. For example:

NHS England;

NHS Foundation Trusts;

NHS Trusts;

NHS Litigation Authority

NHS Business Services Authority.

NHS Commissioning Support Units

In addition the CCG has had a number of material transactions with other government departments and other central

and local government bodies. Most of these transactions have been with the Isle of Wight Council.

Details of related party transactions with individuals are as follows:

The CCG's related parties are GP practices that have one or more Governing Body members and could be seen as

having significant influence. The payments made to practices relate to Locally Enhanced Services and GP prescribing

incentive scheme.

48


39 Events after the end of the reporting period

40 Losses and special payments

40.1 Losses

The CCG has had no losses of special payments expenditure during the financial period.

Total

Number of

Cases

Total Value

of Cases

Total Number

of Cases

Total Value

of Cases

2015-16 2015-16 2014-15 2014-15

Number £'000 Number £'000

Administrative write-offs 0 0 0 0

Fruitless payments 0 0 0 0

Store losses 0 0 0 0

Book Keeping Losses 0 0 0 0

Constructive loss 0 0 0 0

Cash losses 0 0 0 0

Claims abandoned 0 0 0 0

Total 0 0 0 0

40.2.2 Special payments

Total

Number of

Cases

Total Value

of Cases

Total Number

of Cases

Total Value

of Cases

2015-16 2015-16 2014-15 2014-15

Number £'000 Number £'000

Compensation payments 0 0 0 0

Extra contractual Payments 0 0 0 0

Ex gratia payments 0 0 0 0

Extra statutory extra regulatory payments 0 0 0 0

Special severance payments 0 0 0 0

Total 0 0 0 0

There are no post balance sheet events which will have a material effect on the financial statements of the CCG

The total number of NHS Clinical Commissioning Group losses and special payments cases, and their total value, was as follows:

49


41 Third party assets

The CCG does not hold any cash or cash equivalents on behalf of third parties

2015-16 2014-15

£'000 £'000

Third party assets held by NHS Isle of Wight CCG0 0

42 Financial performance targets

NHS Clinical Commissioning Group have a number of financial duties under the NHS Act 2006 (as amended).

NHS Clinical Commissioning Group performance against those duties was as follows:

2015-16 2015-16 2014-15 2014-15

Target Performance Target Performance

Expenditure not to exceed income 214,683 210,144 206,097 203,547

Capital resource use does not exceed 0 0 0 0

Revenue resource use does not 214,656 210,117 205,905 203,355

Capital resource use on specified

matter(s) does not exceed the amount

specified in Directions 0 0 0 0

Revenue resource use on specified

matter(s) does not exceed the amount

specified in Directions 0 0 0 0

Revenue administration resource use

does not exceed the amount specified

in Directions 3,490 3,100 3,828 3,334

43 Impact of IFRS

2015-16 2014-15

£'000 £'000

Depreciation charges 0 0

Interest expense 0 0

Impairment charge: Annually

Managed Expenditure 0 0

Impairment charge: Departmental

Expenditure Limit 0 0

Other Expenditure 0 0

Revenue receivable from subleasing 0 0

Total IFRS Expenditure (IFRIC 12) 0 0

Revenue consequences of private

finance initiative/LIFT schemes under

UK GAAP/ESA95 (net of any

sublease revenue) 0 0

Net IFRS Change (IFRIC 12) 0 0

Capital Consequences of IFRS:

private finance initiative/LIFT and

other service concession

arrangements under IFRIC 12

Capital expenditure 2014-15 0 0

UK GAAP capital expenditure 2014-

15 (reversionary interest) 0 0

44 Analysis of charitable reserves

2015-16 2014-15

£'000 £'000

Unrestricted funds 0 0

Restricted funds 0 0

Endowment funds 0 0

Total 0 0

45 Purchase of Non NHS Healthcare

Purchase of Non NHS Healthcare 2015-16

ISTCs Other Private Voluntary Other Total

£000s £000s £000s £000s £000s

Total Primary Healthcare Purchased 0 0 0 0 0

Purchase of Secondary Healthcare 0 0 0 0 0

Social Care* 0 0 0 1,302 1,302

Mental Health 0 5,987 316 143 6,446

Maternity 0 0 0 0 0

General and Acute 914 78 0 1,135 2,127

Accident and Emergency 0 0 0 0 0

Community Health Services 0 6,129 39 13,527 19,695

Other Contractual 0 0 0 0 0

Total Secondary Healthcare Purchased 914 12,194 355 16,107 29,570

Capital Grants 0 0 0 0 0

Revenue Grants 0 0 0 6 6

TOTAL HEALTHCARE PURCHASED 914 12,194 355 16,113 29,576

50

Purchase of Non NHS Healthcare 2014-15

ISTCs Other Private Voluntary Other Total

£000s £000s £000s £000s £000s

Total Primary Healthcare Purchased 0 0 0 0 0

Purchase of Secondary Healthcare 0 0 0 0

Social Care* 0 0 0 1,187 1,187

Mental Health 0 5,176 180 321 5,677

Maternity 0 0 0 0 0

General and Acute 665 137 0 877 1,679

Accident and Emergency 0 0 0 0 0

Community Health Services 0 5,532 0 7,384 12,916

Other Contractual 0 0 0 0 0

Total Secondary Healthcare Purchased 665 10,845 180 9,769 21,459

Capital Grants 0 0 0 0 0

Revenue Grants 0 0 0 0 0

TOTAL HEALTHCARE PURCHASED 665 10,845 180 9,769 21,459

51

Governing Body Governing Body Assurance Framework


Summary of issue:

Following the previous Governing Body meeting when the objectives for this year together with the critical success factors were agreed, this paper now adds the identified risks that may prevent the organisation from achieving these objectives. At this stage in the year there are still gaps in action plans which will be firmed up as the year progresses. Having said that, the work that the CCG is undertaking in relation to QIPP and transformation is being prioritised and supports achievement of multiple critical success factors identified. The highest risk areas that have been identified are: • Completing the WISR process in this financial year supporting rapid

system transformation. There is a risk that the national assurance process could delay consultation and decision making

• Achieving NHS Constitution targets – despite significant work plans in place there remains doubt at this point in the year that these will be achieved and further planning will be required.

• Achieving system resilience – as above, there remains doubt regarding achievement and close attention to plans will be required for the remainder of the year

• Failure to address underlying deficit position with the CCG. Although other areas have been assessed as medium or lower risk at this point in the year, progress will be required across all areas in order to achieve the CCG objectives.


The Governing Body is asked to note the Governing Body Assurance Framework and seek assurance that the risk which will prevent the organisation from achieving the agreed objectives and critical success factors have been identified and appropriately mitigated

Principle risks: These are identified within the paper


The Governing Body has previously agreed the objectives and critical success factors. Senior members of the CCG have developed the principle risks.


A number of the risks identified have financial implications over this year or the longer term. Through this process, the Governing Body will be able to keep track of the progress mitigating the potential for the risk to materialise. Maintenance of financial control appears to be a key factor in supporting the CCG to access national investment and innovation monies in the future.


Failure to achieve some of the critical success factors will result in the CCG receiving a reduced assurance rating from NHS England which could result in the reduction of the CCG’s scope to manage its own affairs.


A key objective within this document remains the establishment of a clear assurance process within the CCG, reported to the Governing Body in relation to stakeholder and public involvement.


The owners of action plans within this document will be required to undertake equality impact assessments as part of their work programmes to ensure that the CCG is meeting its objectives in relation to equality and diversity.

Author of Paper: Caroline Morris, Head of Primary Care and Corporate Business




Governing Body Meeting January 2016

Page 1 of 7

GOVERNING BODY ASSURANCE FRAMEWORK 2016/17

Key Controls Sources of Assurance Gaps in control/Assurance

4*3

4*2

4*3

4*3

5*3

4*4

3*4

4*3

Capacity to deliver integration in commissioning as well as major service redesign through WISR, QIPP , improved performance and system resilience

1.70

May '16 JACB and MLAFL programme monitor progress with agreed timelines. Performance review meetings with teams

May '16 Commissioning Leadership Group to review existing plan and develop revised plan by June '16.

CEGB

May'16 progress reports to MLAFL programme board and to JACB. Notes of these meetings and notes of performance review meetings.

Plan to be revised and agreed, to reflect reduced vanguard funding

1.40

May'16 Monthly monitoring of delivery by WISR programme board , MLAFL Board, Clinical Executive

Notes of meetings, programme plans. Regular update reports

No gaps in assurance identified at present

CE

1.50

GB

None at presentNo gaps in assurance identified at present

None at present

CE


The impact of the national assurance programme may cause the programme to be delayed

CE

Level of engagement to ensure effective coproduction with ownership across all stakeholders including the public and service users


No gaps in assurance identified at present

None at present

Overall ambition as a result of the redesign process may not meet the financial, workforce and demand pressures across the system

GB


Notes of meetings, programme plans. Regular update reports

Critical Success Factor 3: To integrate the commissioning function with the local authority in accordance with the agreed plan

HS CE

1.90

1.60 GB

May '16 - Systematic approach to ensuring partners are enabled to remain engaged.

Critical Success Factor 2: To complete the agreed WISR programme and meet agreed timescales

Ability to recruit to posts to support programme

1.20

Critical Success Factor 4: To agree the Sustainability Transformation Plan (STP) across Wessex including a) complete and publish the local estates strategy and b) to complete and publish the Digital Road Map

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(Where we are failing to put controls/systems in place)

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Objective 1: To support System Transformation and sustainability

Principle Risks

May 2016 - MLFL Board- Briefings/updates to Governing Body

May 16 - System not clear on rules around funding release.

(What could prevent this objective being achieved?)

(What controls do we have in place to assist in securing the delivery of this objective?)

(Where can the Governing Body gain evidence that our controls/systems on which we place reliance are effective?)

HS CE

Oct

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Year

End

Ass

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severity x likelihood

CEMay '16 - Ad hoc meetings as required- Key partners "hothouse" to agree ways of working

HS

May '16 - Workforce recruitment action plan required

Critical Success Factor 1: To complete the formal My Life full Life work programme agreed by the MLFL Board for 2016/17

1.10

Repo

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1.30

May 2016 - MLFL Board and new governance arrangements

Action plan to address gaps

Owner Review/

Completion date

Vanguard Funding not forthcoming

May 2016 - MLFL Board- Reprioritising work programme

Partners not engaging with the programme

May '16 - regular reports to MLFL Board

May'16 - Funding started as is dependent on Trust control total. Karen Baker to gain clarity from NHS Improvement

May '16 0 Workforce sub group reviewing recruitment processes

May '16 - MLFL Board

May 2016 -Finance and Workforce report presented to the MLFL Board

1.80

Plan not agreed by all organisations for 30/6/16 submission deadline

May 2016 - Identified representation of all work streams- Programme management in place

May '16 - STP Hothouse- STP Board- STP Update Reports

None at present None at present

May '16 - Strategic Estates Group- Clinical Executive- STP Estates Group

May '16 - Review IW Estates governance structure to reflect requirements to develop and deliver the resulting plan

HS CE

Failure to agree local estates strategy in time to support the STP and The Primary Care Estates and Technology Fund application

May '16 - Developed by leads from all health and care sectors- Cross system approval process in place- Based on socialised principles and at

LO CE

May '16 - Strategy to be presented in May/June meetings for approval


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Owner Review/

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4x3

4x3

4x3

4*4

4x3

4x2

4x3

4x4

CE/PCC

2.30

Higher Level Activity level/richer case mix causes contracts to overspend

May '16 -contract management arrangements in place

May '16 - As above None identified at present None at present

LO CE/PCC

2.10

Failure to meet key targets including RTT and A&E ( reference critical success factor 6)

May '16 Monthly performance review meetings, monthly system resilience meetings, monthly Clinical Executive meetings, monthly contract meetings

Notes of meetings, SRG dash board, performance reports. Recovery action plans , SRG action plans

May'16 action plans not yet delivering required outcomes and improved performance

May '16 plans to encourage patient choice and mainland providers. Detailed plans to be finalised GB CE/PCC

Critical Success Factor 2: To achieve finance balance in 2016/17 meeting statutory responsibilities including delivery of QIPP targets

CE

May '16 - Business case to be approved by NHS England- Recruitment of Turnaround Director to be recruited

May '16 - As above

CE/PCC2.40

Critical Success Factor 3: To develop a robust financial plan for 17/18

2.40

Failure to address underlying deficit position within the CCG during this financial year

May '16 - QIPP plans- Transformation programme through MLFL and WISR

May '16 - MLFL programme Board- Clinical Executive- Planning processes within CCG

May '16 - Clear programme plan to be developed together with timelines to support next financial year

May '16 - Programme plan to be put in place

LO CE

Critical Success Factor 4: To develop a plan to improve quality and safeguarding in commissioned services

LO

Failure to improve the 16/17 forecast position

May '16 - CFO to work with Trust, NHS England and NHS Improvement to complete actions

Failure to complete necessary processes and cost analysis to provide evidence

May '16 - IWNHST Cost Base Review Programme

May '16 - CCG CFO is a Cost Base Review steering group member- Quarterly updates on progress by Trust to Clinical Executive

May '16 - Council (e.g. Social Care) costs need to be better understood

May '16 - Case for an Island Premium to be overseen by the Strategic Finance Group (involving CCG, IWNHST and Council FDs and deputies)

2.20

Failure to deliver the CCG QIPP programme of C. £6m

May '16 - QIPP Governance arrangements in place- Comprehensive QIPP plans in place

May '16 - CCG Officers GroupClinical Executive- Audit Committee

May '16 - Further schemes to be identified to achieve full value

May '16 - Scheme development is being progressed by Interim Associate Director of Commissioning via newly established QIPP structure

LO

Critical Success Factor 5: To deliver the case for an "Island Premium"

LO

Objective 2: To meet the finance, quality, commissioning and performance targets within the operating planCritical Success Factor 1: To meet the "must do" performance trajectories including developing an action plan to improve services for people with learning disability

May '16 - Joint Turnaround Director with IWNHST- Financial Recovery programme

Capacity and capability within the IOW NHS Trust to deliver and sustain quality improvements in commissioned services

Monthly CQRM meetings, Bi-monthly Quality Patient Safety Committee, one to one meetings between Director of Quality and Director of Nursing

Quality dashboard and reports presented to the Quality Patient Safety Committee and Governing Body. External scrutiny including

None identified at present None at present

1.12

process

high level rather than a detailed plan

LK QPSC/PCC2.50

1.11

Failure to agree digital road map in time to support Primary Care Estate and Technology application process

May '16 - As above May '16 - MLFL IT work stream- Clinical Executive- STP digital group

May '16 - Review IT governance structure to reflect requirements to develop and deliver the resulting plan

May '16 - Road Map to go to May/June meetings for approval

LO CE


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3*3

3*3

4 x

43*

33*

4

None identified at present None at present

Critical Success Factor 2: To manage the budget in year and achieve finance balance within the delegated budget

Critical Success Factor 1: To publish a strategy for primary care

May '16 - System Resilience Plan being agreed through System Resilience Group, and linked to CCG QIPP Programme, Trust Cost improvement Programme and IOW Council plans. Plan covers delivery of year round resilience, and delivery of improvement trajectories agreed with NHS England for constitutional targets. Demand and Capacity Plan agreed with IOW Trust to reflect performance trajectories, agreed as part of 2016/17 Contract. Choice of providers being offered to patients and some Urology and Gastroenterology work will be delivered on Mainland to bridge IOW Trust capacity gap.

May 2015 Action plan being finalised by SRG and reflected in CCG/IOW Trust Contract

May 2015 System Resilience Plan and IOW contract still being finalised with deadline of 31st May

Difficulty achieving NHS constitutional targets for A&E, RTT, Cancer and diagnostics due to flow issues across the Health and Care system, and significant volume of RTT backlog {patients waiting over 18 weeks} to be treated

2.70 GB

CCG and Trust Executive Officers prioritising work to finalise Plan and Contract with support of NHSE/NHS improvement as necessary

CE

- Budget Management reports required for Primary Care

PCORG

3.10

LO

IOWNHS Trust and Director of Quality and TDA meetings, Joint SIRI panel reviews

Critical Success Factor 5: To achieve the quality indicators in the contracting schedules throughout the year

2.60

PCC

Objective 3: To implement and deliver delegated commissioning of primary care

Critical Success Factor 6: To deliver the agreed system resilience plan

None at present

PCORG

professional and lay members

May 2016 - PCC paperMay '16 - Paper to the Primary Care Committee (PCC) outlining the proposed process and timeline- Operational Management Group in place to oversee progress (PCOG)

Failure to embed new processes within the CCG associated with the monthly sign off of payments

May '16 - Signatories in place - Standard Operation Procedure required - Review of SFIs and SOs required CM

3 30

Failure to develop management reports in good time to support

May -16 - Operational Management Group to oversee monthly budget

Failure to plan effectively to ensure that there is a robust process and the CCG resources required to deliver a published plan by the end of November 2016

CM

QPSCLK

unseen pressures divert the Trust from focusing on meeting 'business as usual' core objectives. Absence of clinical leadership within the CBU

Monthly CQRM and CRM bi-monthly Safeguarding Operational Group. Regular attendance at Safeguarding boards

Quality dashboard and reports to Quality Patient Safety Committee and Governing Body

May '16 - draft management accounting spreadsheet to be developed by June 2016 at

3.20

May '16 - Internal SOP needed by for end May payment run- Review of standing orders and SFIs required to ensure appropriate permissions are in place by end May 2016


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3*3

4*3

4*3

4*3

4*2

3*3

3*3

3*3

Failure to put an effective change programme in place

None at present

May '16 - Commissioning Leadership Group

None at present May '16 - Work programme to be developed - Capacity to support programme to be allocated

May '16 - Commissioning Leadership Group to discuss how to take this forward- CCG to determine how to take forward work on local payment and pricing model

GB/LO CE

Committee and monthly operational group

CM PCC

4.30

Failure to work effectively with MLFL to integrate the CCG's OD plan with the wider system plan.

May '16 - MLFL Leadership and OD group in place

Critical Success Factor 3: To develop an outcome framework to support new contract, payment and pricing models

None at present

None at present None at present

CE

May '16 - Work programme to be developed

CM

LK PCC

Critical Success Factor 2: To create and deliver an organisational development (OD)plan building on the CCG OD Strategy and including system leadership development

4.40

- May '16 Review required of frequency of published primary care data- Review required looking at the opportunity presented by the new IT system in primary care for real time reporting and report

May '16 - Task and Finish Group described in 3.40 above to be tasked with reviewing and recommending frequency of quality reporting

4.20

May '16 - None at present

May'16 - CCG representation on the MLFL Leadership and OD Group

May '16 - Active attendance at MLFL group meetings- Oversight of programme by MLFL Board

May '16 - Lack of work programme including timelines

Critical Success Factor 4: To agree a performance dashboard and report

Objective 4: To evolve the culture and governance within the CCG to deliver transformation

4.10

3.60

May '16 - Lack of work programme including timelines

May '16 - Work programme to be developedAmbition to create a single plan for multiple organisations in a short period to have effect this year is overambitious

CM CE

May '16 - none at present

May '16 - Agree objective with member of staff; draft work plan and identify resources required.

CM CE

PCORGLO

Failure to agree a change to the behaviours already embedded within the CCG constitution

4.50

Lack of capbility and capacity to develop robust outcome based commissioning framework in year and develop new payment and

3.40

Capacity and capability within the CCG to develop appropriate metrics and monitor on a sustained basis

May '16 - None at present May '16 - none at present May '16 - Training required for staff new to primary care - Short project required to develop and agree quality framework

May ' 16 - "teach in" for performance and quality staff to understand data available and existing resources by end June 2016 - Task and Finish group to develop and propose metrics by end June 2016

LK

Critical Success Factor 3: To agree a quality framework for primary care

CM CE

May '16 - Training required for staff new to primary care - Short project required to develop and agree performance framework and reporting

Critical Success Factor 1: To embed the My Life a Full Life behavioural framework within the CCG by the end of the financial year

3.50

Ability to develop a dashboard which is meaningful throughout the year (where most data is available only once a year)

May '16 - None at present

3.30

good budget control

statements

PCC

May '16 - None at presentSee 3.40 above May ' 16 - "teach in" for performance and quality staff to understand data available and existing resources by end June 2016 - Task and Finish group to develop and propose metrics by end June 2016

May '16 - Discussion with membership required- Constitution change needs drafting

May '16 - Draft changes to constitution for consultation with membership by July 2016

high level for PCC and granular level for PCOG

None at present May '16 - Formal responsibility for this programme to be allocated within the CCG


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3*4

4*5

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GB

None at present May '16 - Plan to engage membership in dicusssion to be developed

May '16 - Plan to be created once proposals have been developed

CE

Other Serious Corporate Risks

be allocated

on local payment and pricing model

4.60

4.90

4.80

Failure to develop Governing Body assurance metrics providing assurance on the CCG's fulfilment of its statutory function

GB

CM GB

May -16 - No clear timeline in place to provide assurance on delivery

May ' 16 - Membership Meetings mechanism in place

A1

Critical Success Factor 4: To complete a review of the structure and governance of the CCG

HS GB

Failure to engage membership in discussion about future governance of organisation

Lack of clarity about the ambition for future governance structures within the CCG in the light of transformation programmes (including the STP and MLFL)

- SoEPs informed of potential procurement

- CCG to consider interim arrangements whilst notice period served by end April 2016- CCG to develop plans for consultation and procurement and identify resource to lead procurement exercise by end April 2016. CCG to inform SoEPS.

- May '15 - WISR stakeholder engagement plan in place

May '16 - Support to staff to fill in front sheets needs to be strengthened

May '16 - New Head of Governance to develop training support for staff.

GB

May '16 - Governing Body front sheets and training for staff undertaken

May '16 - Committee front sheets capture stakeholder engagement - Equality impact assessments undertaken to establish gaps in understanding of stakeholder issues.

May '16 - Governing Body front sheets

May '16 - Resources to support a more systematic approach to stakeholder engagement need to be put in place

May '16 - Review of current capacity and contracts to deliver services needs to be undertaken with a view to moving responsibility/resources to provide greater assurance

CM

The CCG is at risk of failing to meet the Quality Premium targets for this financial year, in particular those which are measured only annually

Clinical Sustainability of Urology at IWNHST -

None at present

May '16 - Ongoing engagement with the STP and MLFL process leading to a clear timeline that will support a work programme

May '16 - Committees of relevant Boards

CM

and develop new payment and pricing mechanisms.

May '16 - STP Board in place- MLFL Board in Place together with work programme to develop the Health and Wellbeing Board locally

Failure to improve reporting on public and patient involvement on Governing Body and sub-committee front sheets

A2 Quality Premium Target at Risk

Critical Success Factor 5: Implement the stakeholder strategy

none at present

Formal Contractual notice issued on provision of Urology by IOWNHST, from 25 February 2016, wishing to give 12 months’ notice.

May '16 - Plan to be put in place

4.70

QPSC


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Partner Resilience

The current agenda with system resilience issues, poor performance , financial challenges and being a vanguard site has stretched capacity of system partners.The drive to contain costs has meant that management capacity within the local authority and Trust is very stretched and there are key vacant posts and heavy reliance on key individuals. The consequence is a risk to achievement of key joint plans and misalignment of priorities across the system.

- MLFL Board- Clinical Executive- Monitoring of progress of key joint actions at JACB- Contract Meeting

A6

- Contract meetings and CCG Clinical Executive and MLFL Board - ongoing HS. - Assistant Director of Integrated Community Post agreed JD to be finalised and post to be advertised

GB CE

Concern regarding the achievement of NHS constitutional targets for A&E and RTT - formal improvement trajectories agreed with NHSE/NHS Improvement

System Resilience

System Resilience Group agree plan on 16th May to maximise operational performance, agreed with NHS England/NHS Improvement, and to improve on these trajectories wherever possible. SRG and the Urgent and Elective Care Committees accountable for delivery of the agreed plans, and meet monthly to oversee delivery. Clinical Executive and Governing Body receive assurance updates, and take decisions as appropriate to expedite delivery.

System Resilience Group agree plan on 16th May to maximise operational performance, agreed with NHS England/NHS Improvement, and to improve on these trajectories wherever possible. SRG and the Urgent and Elective Care Committees accountable for delivery of the agreed plans, and meet monthly to oversee delivery. Clinical Executive and Governing Body receive assurance updates, and take decisions as appropriate to expedite delivery.

A5 NHS Constitutional Targets

CCG fails to achieve Constitutional Targets. Overall performance will be impacted by health and care system wide pressures. Failure to achieve targets or trajectories will impact on patient quality and potentially carry financial consequences for the system.

None at present Agree 2016/17 performance / recovery trajectories by End May 2016Agree and Monitor provider action plans by end May 2016Agree and Monitor Systems Resilience plans, Agreement by end May 2016, monitoring will be OngoingGovernance arrangements to monitor, report, escalate and agree mitigations by end May 2016

LO

GB CE

CE

A4Achievement of Prescribing QIPP schemes

The CCG fails to achieve the level of cost control required over the GP prescribing budget to meet the expected level of QIPP.

QIPP plan in place JD for head of medicines management in place and recruitment strategy agreed. Interim support being sought

- Detailed QIPP Plans required with clear trajectories - End May 2016- Recruitment to Medicines Management team required, specifically pharmacist support by 31 August 2016- Interim support being sought - June 2016

LO CE/PCC

A3


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HS - Helen Shields, Chief OfficerAH - Andrew Heyes - Head of Contracting and PerformanceGB - Gillian Baker, Deputy Chief OfficerLO - Loretta Outhwaite, Chief Finance OfficerLK - Loretta Kinsella, Director of Quality and Clinical ServicesCM - Head of Corporate Business and Primary Care ER - Eleanor Roddick, Head of Community CommissioningKM - Karen Morgan, Head of QualityLR - Linda Rann, Head of Acute CommissioningSL - Sue Lightfoot - Head of Mental Health Commissioning

Current provider of OOH is struggling to fill GP OOH sessions. Provider has indicated that it does not wish to continue at end of contract in October 2016 and there are short term issues

Sustainability of GP OOH servicesA8

Ongoing negotiation with provider and intention to agreeProject group established to seek solution

Viable model needs to be developed urgently

GB PCC

A7Delivery of CCG financial plan and QIPP target

The CCG has to deliver a £6m QIPP target to support delivery of the financial plan. There is a high risk associated with delivery.

The CCG has established a formal QIPP Programme led by the Associate Director of Commissioning, with system wide schemes delivered through system resilience group. A QIPP oversight group has been established, and COG is reviewing weekly. Monthly executive performance review meetings with CCG delivery teams from June.

GB CE/PCC

A Turnaround Director is being appointed jointly with NHSE to work across the CCG and Trust, to recognise the system wide nature of financial recovery required.

Governing Body SHIP Priority Committee Statements

Sponsor: Gillian Baker, Deputy Chief Officer

Summary of issue:

The SHIP8 Priorities Committee has requested rapid evidence reviews of the Knee Arthroscopy area to assess the clinical and cost effectiveness. Following the completion of evidence summary reports compiled by Solutions for Public Health (SPH) policy recommendations have now been released by the priorities committee and require discussion and consideration by the Governing Body.


The Governing Body is requested to consider the committee recommendations for the statement. The Priorities Committee has reviewed the evidence for Knee Arthroscopy clinical area and recommendations is as follows: Knee arthroscopy as part of treatment for generalised knee pain in the over 40's - the recommendation is that arthroscopic lavage and debridement with or without partial-meniscectomy in non-traumatic and persistent knee pain with no clear history of mechanical locking is low priority.

Principle risks: None


SHIP Priorities Committee and CCG Clinical Executive


Between October 2014 and September 2015 the cost of day case/elective admissions for knee arthroscopy cost the IOW CCG £386K based on 205 arthroscopies at an average cost of £1,885.

Legal implications/ impact: None

Public involvement /action taken: None Required


None identified, however there is a possibility there may be some variation in access across providers in the SHIP8 area.

Author of Paper: SHIP Priorities Committee


Notes: Exceptional circumstances may be considered where there is evidence of significant health impairment and there is also evidence of the intervention improving health status. This policy may be reviewed in the light of new evidence or guidance from NICE.

The Priorities Committee has reviewed the evidence for knee arthroscopy as part of treatment for generalised knee pain in the over 40's and recommend that arthroscopic lavage and debridement with or without partial-meniscectomy in non-traumatic and persistent knee pain with no clear history of mechanical locking is low priority. Supporting Information Osteoarthritis (OA) of the knee is the result of progressive degeneration of the cartilage of the joint surface. It affects more than 10% of the population over 60 years old and is more common in women. It often causes pain and stiffness of the knee joint and can impair patients’ ability to perform activities of daily living and recreational activities. Arthroscopic knee surgery involves the removal of loose bodies or osteophytes in the knee using debridement with or without partial meniscectomy. A recent review of the evidence for knee arthroscopy included studies published before 27

th November 2015

and found: One Cochrane systematic review

1 on the clinical effectiveness of knee joint lavage alone which

reported no significant improvement in pain or function at 3 months and 1yr after surgery. In 2015, a systematic review and meta-analysis

2 focused on the arthroscopic debridement and/or

partial meniscectomy for patients with persistent knee pain. The key findings were that arthroscopic debridement and/or partial meniscectomy provided a very small benefit to patients in reducing pain for up to six months after surgery (2.4mm (95% C.I. 0.4mm to 4.3mm)change on a 0-100 visual analogue scale) but the pain reduction was not sustained beyond that time. There was no significant difference in knee function at any follow up time from 3 to 24 months post-surgery. The overall evidence base for arthroscopy surgery (lavage, debridement and/or partial meniscectomy) is weak and based on nine small RCTs. However, the meta-analysis attempts to correct for a variety of confounders and bias. The authors of review highlight that arthroscopic debridement with or without partial meniscectomy is no better than paracetamol, and less effective than both NSAIDS and exercise therapy. Evidence about the possible harms of knee arthroscopy indicates that the risks associated with knee arthroscopy are low, but nevertheless present. The numbers of adverse events per 1000 procedures are:

Venous thromboembolism (including DVT): 5.68 (95% CI 2.96 to 10.9)

Infection: 2.11 (95% CI 0.8 to 5.56)

Death from any cause: 0.96 (95% CI 0.04 to 23.9)

Although the quality of the evidence for harms was weak, there is evidence of some risk associated with undergoing knee arthroscopy, particularly for patients with comorbidities such as diabetes or COPD. Readmission was up to twice as likely for patients who had a history of smoking. There is no evidence to support the cost effectiveness of arthroscopic surgery, as cost effectiveness is dependent upon the clinical effectiveness of the procedure. _____________________________________ 1 Reichenbach S et al. Joint lavage for osteoarthritis of the knee. The Cochrane database of systematic

reviews.2010(5):Cd00732 2 Thorlund JB et al. Arthroscopic surgery for degenerative knee: a systematic review and meta-analysis of

benefits and harms. BMJ 2015;350:h2747 doi:10.1136/bmj.h2747

SHIP8 Clinical Commissioning Groups Priorities Committee

Policy Recommendation: The place of arthroscopy in knee pain without true locking in adults over 40 years old

Date of issue: April 2016

Isle of Wight CCG – SHIP Priorities Committee Policy Statement Template Date Policy Title SHIP Policy Recommendation - The use of arthroscopy in knee pain without true locking in adults over 40 years old

Date of Issue April 2016

CCG Clinical Lead Dr Lehmann

Description

The Priorities Committee reviewed the evidence for knee arthroscopy as part of treatment for generalised knee pain in the over 40's and recommends that arthroscopic lavage and debridement with or without partial-meniscectomy in non-traumatic and persistent knee pain with no clear history of mechanical locking is low priority.

Summary of Supporting Information (NICE Evidence, reports prepared for SHIP, Clinical Research)

The recent review of the evidence for knee arthroscopy included studies published before 27th November 2015 and found the following: One Cochrane systematic review on the clinical effectiveness of knee joint lavage alone which reported no significant improvement in pain or function at 3 months and 1yr after surgery. In 2015, a systematic review focused on the arthroscopic debridement and/or partial meniscectomy for patients with persistent knee pain. The key findings were that arthroscopic debridement and/or partial meniscectomy provided a very small benefit to patients in reducing pain for up to six months after surgery (2.4mm (95% C.I. 0.4mm to 4.3mm)change on a 0-100 visual analogue scale) but the pain reduction was not sustained beyond that time. There was no significant difference in knee function at any follow up time from 3 to 24 months post-surgery. The overall evidence base for arthroscopy surgery (lavage, debridement and/or partial meniscectomy) is weak. The authors of review highlight that arthroscopic debridement with or without partial meniscectomy is no better than paracetamol, and less effective than both NSAIDS and exercise therapy.

Applicable Guidance (NICE Guidance, Clinical Networks)

1. NICE, Arthroscopic knee washout, with or without debridement, for the treatment of osteoarthritis (IPG230) 2. Reichenbach S et al. Joint lavage for osteoarthritis of the knee. The Cochrane database of systematic

reviews.2010(5):Cd00732 3. Thorlund JB et al. Arthroscopic surgery for degenerative knee: a systematic review and meta-analysis of benefits and

harms. BMJ 2015;350:h2747 doi:10.1136/bmj.h2747

4. Solutions for Public Health Rapid Evidence Summary report, the place of arthroscopy in knee pain without true locking in adults over 40 years, (2016)

Financial and Resource implications

The total cost of day case or elective admissions for knee arthroscopy procedures across all SHIP CCGs between October 2014 and September 2015 was £8,198,602, ranging from £386,450 in Isle of Wight CCG to £2,782,773 in West Hampshire CCG. The average cost per procedure across all SHIP8 CCGs was £2,143, ranging from £1,885 in Isle of Wight CCG to £2,298 in North East Hampshire and Farnham CCG. This reflects the variable price for different procedures and variable case-mix for each CCG and provider.

Potential Risks

None

Equality and Diversity Impact

None identified

Committees Consulted (IFR Panel, Clinical Executive etc)

SHIP Priorities Committee, IOW CCG Clinical Executive

Commissioning recommendation and options

1. To commission arthroscopic lavage and debridement, with or without partial meniscectomy, only for people with both persistent knee pain and a clear history of mechanical locking.

2. Arthroscopic lavage, debridement and/or partial meniscectomy will not usually be commissioned for patients with generalised knee pain and symptoms of osteoarthritis alone.

3. To continue to commission of arthroscopic lavage and debridement, with or without partial meniscectomy, at the discretion of clinicians.

Review Date: April 2017 Head of Commissioning sign off ………………………..

Governing Body SHIP Priority Committee Statements


Summary of issue:

The SHIP8 Priorities Committee has requested rapid evidence reviews of the Flexible sigmoidoscopy in suspected colorectal cancer area to assess the clinical and cost effectiveness. Following the completion of evidence summary reports compiled by Solutions for Public Health (SPH) policy recommendations have now been released by the priorities committee and require discussion and consideration by the Governing Body.


The Governing Body is requested to consider the committee recommendations for the statement. The Priorities Committee has reviewed the evidence for Flexible sigmoidoscopy in suspected colorectal cancer clinical area and recommendations is as follows: The use of flexible sigmoidoscopy as opposed to proceeding directly to colonoscopy – the recommendation is that patients referred with rectal bleeding are offered flexible sigmoidoscopy, with colonoscopy reserved for those in whom symptoms and the results of sigmoidoscopy suggest disease proximal to the splenic flexure.





Between April 2013 and December 2016 costs to the IOW CCG for patients admitted for cholecystectomy (without cholecystitis or cholangitis) and with no admission for any other gall bladder problems in the previous 12 months was £127k.








The Priorities Committee has reviewed the evidence for diagnosis using flexible sigmoidoscopy as opposed to proceeding directly to colonoscopy and recommend that patients referred with rectal bleeding are offered flexible sigmoidoscopy, with colonoscopy reserved for those in whom symptoms and the results of sigmoidoscopy suggest disease proximal to the splenic flexure.

Reports from flexible sigmoidoscopy should include a clear management plan Supporting Information

Colorectal cancer is a relatively common cancer that presents with bleeding, change in bowel habit, anaemia, weight loss or abdominal mass.

Natural history of colorectal cancer is long and slow.

Flexible sigmoidoscopy visualises up to the splenic flexure where 55-60% of cancers occur. It is often done as an outpatient appointment, requires no sedation and takes an average of 10-20 minutes.

Colonoscopy visualises the whole colon and rectum. It requires more preparation than flexible sigmoidoscopy, including sedation, takes approximately 30-45 minutes and has a 1.8 times higher risk of bowel perforation (approximately 1 vs 2 per 1,000 procedures).

No randomised controlled trials were found. Five studies were found which used various different protocols, not providing a definitive answer as to who should and should not go on to have a colonoscopy. Both procedures miss a small number of cancers. Flexible sigmoidoscopies are particularly appropriate for bright red rectal bleeding as this symptom suggests a source in the more distal colon or rectum. The studies consistently describe the difficulty of offering colonoscopy to the large number of patients presenting with possible colorectal cancer. There is a need to balance demand with supply and provide rapid access to an appropriate investigation. A lack of colonoscopy capacity may lead to delays in diagnosis which effect outcomes. Clinicians vary the time to further follow-up or investigation depending on the symptoms and the findings of the investigation and a clear plan is important to avoid frequent repeat unnecessary investigations.


Policy Recommendation: Flexible Sigmoidoscopy in Suspected Colorectal Cancer


Isle of Wight CCG – SHIP Priorities Committee Policy Statement Template Date Policy Title SHIP Policy Recommendation - Flexible Sigmoidoscopy in Suspected Colorectal Cancer



Description

The Priorities Committee has reviewed the evidence for diagnosis using flexible sigmoidoscopy as opposed to proceeding directly to colonoscopy and recommends that patients referred with rectal bleeding are offered flexible sigmoidoscopy, with colonoscopy reserved for those in whom symptoms and the results of sigmoidoscopy suggest disease proximal to the splenic flexure.


Colorectal cancer is common and patients referred to hospital for the investigation of suspected colorectal cancer may undergo flexible sigmoidoscopy in an outpatient clinic, but some require later colonoscopy. There is uncertainty about whether flexible sigmoidoscopy is worthwhile in this clinical situation, or whether it would be better to offer early colonoscopy to all these patients. The Solutions for Public Health review compares two approaches to diagnosis, however they found no controlled study directly comparing the two approaches in similar patients, the only form of evaluation which would definitively address the key uncertainty. The advantage of colonoscopy over flexible sigmoidoscopy is that it is capable of detecting tumours and other abnormalities throughout the colon and rectum. This is the basis for the argument for offering colonoscopy to every patient with suspected colorectal cancer. The only health economic analysis that was found originates in the United States and suggests that colonoscopy offered acceptable value for its higher costs versus a policy of initial flexible sigmoidoscopy, at least in patients with rectal bleeding. However, the analysis may not be relevant to the NHS. Timeliness of investigation is important and some NHS hospitals are not able to offer timely colonoscopy to the large numbers of patients referred with suspected colorectal cancer. Some hospitals have developed alternative approaches, reserving colonoscopy for those where no cause is found for the symptoms at sigmoidoscopy, or those whose symptoms mean that a proximal cancer is more likely. Reports of their results, and of the presenting symptoms in people with colorectal cancers, support the view that such a policy can safely reduce the number undergoing colonoscopy, with very few missed cancers No randomised controlled trials were found. Five studies were found which used various different protocols, not providing a definitive answer as to who should and should not go on to have a colonoscopy. The studies consistently describe the difficulty of offering colonoscopy to the large number of patients presenting with possible colorectal

cancer. There is a need to balance demand with supply and provide rapid access to an appropriate investigation. A lack of colonoscopy capacity may lead to delays in diagnosis which effect outcomes. Clinicians vary the time to further follow-up or investigation depending on the symptoms and the findings of the investigation and a clear plan is important to avoid frequent repeat unnecessary investigations.


In November 2011, the National Institute for Health and Care Excellence published a clinical guideline on the diagnosis and management of colorectal cancer. The guideline recommended that clinicians should “offer colonoscopy to patients [with suspected colorectal cancer] without major comorbidity, to confirm a diagnosis of colorectal cancer.” They should only offer flexible sigmoidoscopy followed by barium enema to patients “with major comorbidity.” This recommendation was based on published comparisons of computed tomography colonography with endoscopic colonoscopy, and of flexible sigmoidoscopy plus air contrast barium enema with conventional colonoscopy. Solutions for Public Health found no studies comparing flexible sigmoidoscopy plus colonoscopy with an alternative investigation strategy during the research for the rapid review that supports this recommendation. 1. NICE Guidance, Colorectal Cancer: the diagnosis and management of colorectal cancer (CG131) 2. Solutions for Public Health rapid review of the use of sigmoidoscopy in suspected colorectal cancer, 2016.


SPH found only one health economic analysis relating to the subject being reviewed. This was a comparison of the costs and effectiveness of four approaches to the investigation of a 55-year-old patient with rectal bleeding. 1. Watchful waiting, followed by colonoscopy if bleeding recurs within a year 2. Flexible sigmoidoscopy, followed by colonoscopy if the findings are abnormal or the investigation is incomplete 3. Flexible sigmoidoscopy and barium enema, followed by colonoscopy if the findings are abnormal or the investigation is incomplete 4. Colonoscopy. A further approach adopted by some hospitals, is that flexible sigmoidoscopy is not followed by colonoscopy if benign disease is found at flexible sigmoidoscopy stage. Costs and activity relating to the IOW CCG benchmarks high nationally however this data may need to be revisited following recent changes to data recording. Table 1 – Flexisig Activity

Daycase, Elective & Regular day admissions Sum of Activity Total Sum of Activity Sum of PbR Final Tariff

Total Sum of PbR

Final Tariff

Average PbR

tarriff

CCG Provider 2013/ 2014

2014/ 2015

Apr-Sep

2015/ 2016 2013/2014

2014/2015

Apr-Sep 2015/2016

across whole period

NHS ISLE OF WIGHT CCG

UNIVERSITY HOSPITAL SOUTHAMPTON NHS FOUNDATION TRUST 4 10 8 22 £1,976 £4,088 £3,148 £9,212 £419 WESTERN SUSSEX HOSPITALS NHS TRUST 6 * * 6 £2,022 * * £2,022

ISLE OF WIGHT NHS TRUST * * * * * * * *

Other 9 4 2 15 £4,887 £1,715 £713 £7,315

NHS ISLE OF WIGHT CCG Total 19 14 10 43 £8,885 £5,803 £3,861 £18,549 £431

Table 2 – Colonoscopy Activity

Daycase, Elective &

Regular Day Admissions

Sum of Activity Total Sum of Activity

Sum of PbR Final Tariff Total Sum of PbR

Final Tariff

Average PbR tarriff

across whole period CCG Provider 2013/

2014 2014/2015

Apr-Sep

2015/2016

2013/ 2014

2014/ 2015

Apr-Sep 2015/ 2016

NHS ISLE OF WIGHT CCG ISLE OF WIGHT NHS TRUST 27 29 20 76 £17,896 £16,324 £18,365 £52,585 £692

UNIVERSITY HOSPITAL SOUTHAMPTON NHS FOUNDATION TRUST 16 14 11 41 £8,252 £7,195 £5,439 £20,886 £509

Other 13 15 10 38 £7,635 £8,674 £5,260 £21,569 £568

NHS ISLE OF WIGHT CCG Total 56 58 41 155 £33,783 £32,193 £29,064 £95,040 £613

The majority of diagnostic colonoscopies were performed within an outpatient setting for the Isle of Wight (hence the low inpatient numbers). Only 17 were performed in outpatients for other CCGs in the SHIP8 area. Average cost was £445, lower than the daycase tariffs recorded.

Potential Risks

None

Equality and Diversity Impact

None identified

Committees Consulted (IFR Panel, Clinical Executive etc)



1. Patients referred with suspected colorectal cancer are offered flexible sigmoidoscopy, with colonoscopy reserved for those in whom symptoms and the results of sigmoidoscopy suggest disease proximal to the splenic flexure.

2. All patients referred with suspected colorectal cancer are offered colonoscopy.


Governing Body – Part I SHIP Priority Committee Statements


Summary of issue:

The SHIP8 Priorities Committee has requested rapid evidence reviews of the Cholecystectomy for patients with asymptomatic gallstones area to assess the clinical and cost effectiveness. Following the completion of evidence summary reports compiled by Solutions for Public Health (SPH) policy recommendations have now been released by the priorities committee and require discussion and consideration by the Governing Body.


The Governing Body is requested to consider the committee recommendations for the statement. The Priorities Committee has reviewed the evidence for Cholecystectomy for patients with asymptomatic gallstones clinical area and recommendations is as follows: Cholecystectomy (removal of the gallbladder) for patients with asymptomatic gallstones – the recommendations are that:

a. Cholecystectomy for asymptomatic patients with gallstones or those where gallstones are unlikely to be the cause of the symptoms is low priority.

b. Cholecystectomy as an opportunistic intervention in an incidentally found asymptomatic patient is low priority.

c. Cholecystectomy for gallstones in the bile duct is a high priority.





Full year costs of Colonoscopy in 14/15 were £688k. Full year costs for Flexisig in 14/15 were £4k.






The Priorities Committee have reviewed the evidence for cholecystectomy (removal of the gallbladder) for patients with asymptomatic gallstones and recommend that:

1. Cholecystectomy for asymptomatic patients with gallstones or those

where gallstones are unlikely to be the cause of the symptoms is low priority.

2. Cholecystectomy as an opportunistic intervention in an incidentally found asymptomatic patient is low priority.

3. Cholecystectomy for gallstones in the bile duct is a high priority. Supporting Information

Asymptomatic gallstones are gallstones found incidentally when having an ultrasound for another reason unconnected to gallstone disease and in patients who have been symptom free for at least 12 months. The NICE Clinical Guideline (2014) on gallstone disease recommended that only symptomatic gallstones should be treated with laparoscopic cholecystectomy. The CG also recommended that surgery should be offered to patients with gallstones in the bile duct. Epidemiology

Gallstones occur most commonly in the bladder but also occur in other parts of the biliary tree. 20% of the adult population have asymptomatic gallstones and 70% of these will never have a clinical event. The incidence of developing symptoms is 2-4% per annum.

There are 3 treatment options for gallstones: non-surgical treatments (lithotripsy or ursodeoxycholic acid which are both considered to be ineffective); conservative treatment (including weight loss and low-fat diet which is considered to be effective for some patients); and laparoscopic cholecystectomy surgery.

Cholecystectomy is the most common gastro-intestinal surgical procedure performed in the UK; 128 per 100,000 population in 2013/14.

There is a 3-fold variation in rates of cholecystectomy for CCGs across England.

Risk factors for gallstones include rapid weight loss, chemotherapy and upper GI tract surgery. It is thought that because more people are being considered for bariatric surgery than 10 years ago and detection rates for abdominal cancer are higher that this is leading to an increase in incidentally discovered gallstones.

Clinical Effectiveness There is no reliable evidence of clinical effectiveness to support routine concurrent cholecystectomy in general population, bariatric population, or abdominal cancer population for incidentally discovered, asymptomatic gallstones. The limited evidence available is of poor quality. There were no RCTs and most studies were small and methodologically flawed. There were no long term outcomes, quality of life or adverse events data published. Cost Effectiveness The only evidence for cost effectiveness, concluded that concurrent cholecystectomy for asymptomatic gallstones is the least cost effective intervention and 4 times more expensive than conservative treatment. The authors suggested that it would cost €6 million per 10,000 asymptomatic patients for a concurrent cholecystectomy.


Policy Recommendation: Cholecystectomy for patients with asymptomatic gallstones


Isle of Wight CCG – SHIP Priorities Committee Policy Statement Template Date Policy Title SHIP Policy Recommendation - Cholecystectomy for patients with asymptomatic gallstones



Description

The Priorities Committee have reviewed the evidence for cholecystectomy (removal of the gallbladder) for patients with asymptomatic gallstones and recommend that: 1. Cholecystectomy for asymptomatic patients with gallstones or those where gallstones are unlikely to be the cause of the symptoms is low priority. 2. Cholecystectomy as an opportunistic intervention in an incidentally found asymptomatic patient is low priority. 3. Cholecystectomy for gallstones in the bile duct is a high priority.


Asymptomatic gallstones are gallstones found incidentally when having an ultrasound for another reason unconnected to gallstone disease and in patients who have been symptom free for at least 12 months. The NICE Clinical Guideline (2014) on gallstone disease recommended that only symptomatic gallstones should be treated with laparoscopic cholecystectomy. The CG also recommended that surgery should be offered to patients with gallstones in the bile duct. Gallstones occur most commonly in the bladder but also occur in other parts of the biliary tree. 20% of the adult population have asymptomatic gallstones and 70% of these will never have a clinical event with the incidence of developing symptoms 2-4% per annum. There are 3 treatment options for gallstones:

a. Non-surgical treatments (lithotripsy or ursodeoxycholic acid which are both considered to be ineffective) b. Conservative treatment (including weight loss and low-fat diet which is considered to be effective for some patients) c. Laparoscopic cholecystectomy surgery.

Cholecystectomy is the most common gastro-intestinal surgical procedure performed in the UK; 128 per 100,000 population in 2013/14 and there is a 3-fold variation in rates of cholecystectomy for CCGs across England. Risk factors for gallstones include rapid weight loss, chemotherapy and upper GI tract surgery. It is thought that because more people are being considered for bariatric surgery than 10 years ago and detection rates for abdominal cancer are higher that this is leading to an increase in incidentally discovered gallstones.


There are two relevant and recent guidelines that relate to the management of gallstone disease.

1. NICE published a clinical guideline (CG188) “Gallstone disease: diagnosis and initial management” in October 2014 2. The Association of Upper Gastrointestinal Surgeons (AUGIS) under the Royal College of Surgeons published a

commissioning guide for Gallstone disease in 2013 (6). 3. Solutions for Public Health Rapid Evidence Summary report, Cholecystectomy for adults with asymptomatic

gallstones, (2016)

As part of the review process for the NICE clinical guideline, a search was undertaken to assess which strategies were best to manage asymptomatic gallstone disease and no studies were found. The Society of American Gastrointestinal and Endoscopic Surgeons also recommend that asymptomatic patients do not undergo cholecystectomy with the exception of patients at high risk of gallbladder cancer, those with sickle cell disease or hereditary spherocytosis, those receiving immunosuppressive therapy or undergoing transplant and those with gallstones in the common bile duct. The AUGIS commissioning guide is due to be reviewed in October 2016 and the NICE clinical guideline in December 2016.


Financial data should be treated with caution as there are no diagnosis, procedure or HRG codes for "Cholecystectomy for Asymptomatic Gallstones". CSU analysis has looked for patients admitted for a cholecystectomy without cholecystitis or cholangitis and who have not had an admission for cholecystitis, cholangitis or any other gallbladder problems in the 12 months before. It cannot say that the patients were asymptomatic, only that they had not had an acute admission for their gallstones. Costs to the IOW CCG between 2013 to December 2016:

Sum of PbR Final Tariff Total Sum of PbR Final Tariff and

total activity 2013/2014 2014/2015 Apr-Dec 2015/2016

£51,796 £45,981 £30,120 £127,897

28 26 29 83

Potential Risks

None

Equality and Diversity Impact None identified Committees Consulted (IFR Panel, Clinical Executive etc)



1. The lack of good quality evidence to support routine cholecystectomy in patients with asymptomatic gallstones or common bile duct stones, combined with the natural history of asymptomatic gallstone disease which indicates a low incidence of the development of symptoms and complications, suggests that cholecystectomy for people without symptoms should not be routinely commissioned.

2. NHS commissioners may wish to consider commissioning cholecystectomy for people with asymptomatic common bile duct stones (in line with the NICE clinical guideline) or for people who are undergoing surgery for abdominal cancer or bariatric surgery.


Governing Body MLAFL update Sponsor: John Rivers, CCG Chair

Summary of issue:

This report provides an update on the MLAFL programme, including the WISR health and care redesign work. It advises that MLAFL governance processes are under review and as part of this work, system partners will be asked to confirm how


To note progress

Principal risks: System partner engagement; concerns about governance; tight timelines for delivering the redesign.


CCG Clinical Executive

CCG Quality & Patient Safety Committee

MLAFL & WISR Programme Boards


Capacity for system partners to engage staff in redesign; overall cost envelope/future demand to be core to the recommended redesign proposals


The content and approach to the Public Consultation will be based on the legal advice provided


Members of the public being recruited to join: • Redesign working groups • Locality (Public) redesign event in each locality (3) by each theme (6) Time to Act – Caring for our Island online survey finishes in May


The recommended changes will need to be tested in accordance with the EQIA

Author of Paper: James Seward

Date of Paper: 17th May 2016

Date of Meeting: 26th May 2016


1. This paper provides a brief update on the MLAFL programme covering:

a. Value Proposition funding and prioritisation update b. MLAFL Governance update c. WISR update d. Future reporting requirements

Recommendation 2. That the Governing Body:

• NOTE the content of the update report Value Proposition funding 2016/17 update

3. NHS England’s New Models of Care Team has confirmed that, subject to approval, the

MLAFL programme has been allocated £4.740m (revenue 2016/17) to take forward its PACS model. This is a significant reduction on the original Value Proposition bid of £14.5m.

4. This change required re-prioritisation process involving all MLAFL Board members and stakeholders to realign the MLAFL workstream priorities within the overall resource. Despite verbal assurances, we are still awaiting formal confirmation that the budget has been approved. The New Models of Care team are waiting for final approval for all Vanguard site funding from the NHS England Chief Executive’s Office.

5. As a result, the MLAFL programme is proceeding at risk against its contractual commitments pending resolution.

MLAFL Governance Update

6. The MLAFL governance arrangements are changing as part of an Island-wider review of existing governance arrangements, the implementation of a new operating model for Isle of Wight Council and a detailed review of the Health and Wellbeing Board.

7. Four key changes have been agreed:

a. Changes to governance structure and reporting for whole programme - Appendix A sets out the revised governance structure of the MLAFL Programme. This new structure incorporates changes to sub groups, moves localities to being part of the provider landscape (not part of transformation programme governance), and introduces a Clinical and Professional Reference Group at a programme level. The structure identifies a number of task and finish groups that are time limited in terms of governance. This is the future structure, not the current meetings structure. The process will begin, once agreed, to make changes and move to new model but will be respectful of work stream priorities.

b. Programme Board change of focus and name – it is proposed that the MLAFL Programme Board will change to the ‘MLAFL Operational Delivery Group’ to reflect a more operational nature of decision-making and meetings. The revised Terms of Reference for the MLAFL Operational Delivery Group are attached as Appendix B for

approval. These Terms of Reference include a review of the current membership and additional information regarding the accountabilities and responsibilities of the group. If approved, these changes are planned to take effect from June 2016.

c. Workstream Steering Groups - The revised structure identifies a Steering Group to support each workstream (with the exception of Organisational Form) where the day-to-day business of programme delivery will be managed. Steering Groups will replace existing workstream groups/boards and a standard set of Terms of Reference including clear accountabilities and delegations including budget control have been developed. The standard Terms of Reference for Steering Groups are set out in Appendix C (to follow). There will be a requirement on Workstream Leads to update any existing Terms of Reference to incorporate the terms set out in Appendix C. If approved, these changes are planned to take effect from June 2016 but again this may vary depending on work stream priorities.

d. Review of Workstream Sponsor and Lead roles – Following the recent prioritisation exercise as a result of reduced funding from the New Care Models Team, and in conjunction with the governance review, it is timely to consider the key responsibilities for each Workstream leadership team, and ensure that the right resources are assigned to these roles. It is proposed that the Board receive a clear ‘role description’ for the workstream leadership roles at the next meeting including development of workstream clinical/professional lead, alongside any proposals to change who fulfills those roles following a review of current workstream membership.

WISR update

8. By 11th May, the initial meetings of the six health and care services redesign working groups

will have been held. Working Groups have been convened for:

• Urgent Care • Planned Care • Mental Health • Frailty • Women and Children • Long Term Conditions

9. Each working group will meet four times before the end of June (the dates, times and

venues for the meetings are set-out at appendix 1) and cover the following programme: • Kick-Off Vision metring. What does good look like? Agree final scope, priorities, sub

groups, next steps • Long-Listing. What are the key pathways? • Preferred options. How do we get to the future state? What are the challenges? • Agree final plans.

10. The next steps for both groups will be for the Project team supporting each Working Group to develop the key ideas coming from the initial discussions and to confirm individuals who can provide specialist support outside of the Project Team.

11. Between 2 and 4 public representatives have been recruited to participate in the Working Groups drawn from people expressing an interest through the Caring for our Island engagement process. These individuals will be provided with peer support through Health Watch.

12. The views of the public are being actively sought by holding public meetings for each of the

working group thematic areas in each of the Island’s three locality areas attended by approximately 80 people.

13. Co-producing solutions: a. Each Working Group will test emerging thinking with a targeted engagement

strategy with voluntary sector, staff groups, user involvement groups interested/relevant to the service area (for example, the Frailty Group will be looking at using questionnaires to test its ideas with people resident in Care Homes)

b. Public Engagement Redesign Event (29th June, Riverside 4-6pm tbc) to close the feedback loop’ with members of the public engaged in the process to date by inviting them to participate in an event led by health and social care system leaders to present the emerging redesign ideas for discussion

14. The Working Groups will be overseen by a Professional Reference Group (PRG) which will

ensure overall coherence and feasibility of the emerging care models and make final recommendations to the Board.

15. This process will be supplemented by GP and Consultant half-day events on 18th May and in June. The MLAFL Board (with extended membership) will also hold a Stock-Take session on 16th June when the Working Group chairs will each be invited to present their emerging thinking for discussion and feedback.

16. Following the completion of the redesign phase a high level case for change (or ‘blueprint’) will be produced setting-out the future care models options and recommendations. The recommendations will be presented to the MLAFL Board for approval on 14th July. Following approval, the case for change document will be submitted to NHS England to begin the external Programme Assurance process.

17. On 21st July, a WISR Implementation and Prioritisation event will take place (under the MLAFL Board) to:

• Review the outputs of the redesign phase (‘the blueprint’ for change) • Prioritise the agreed changes • Identify the changes that will require formal Public Consultation (& possible re-

procurement) and those that will not • Agree early implementation (in 16/17) commitments (in conjunction with the System

Resilience Group work programme)

18. Finally to complete the initial redesign phase, the case for change document will be considered by NHS England at a Stage 1 programme Assurance Strategic Sense Check meeting on 27th July.

APPENDIX A – My Life a Full Life Programme Governance

= MLAFL workstream groups

= MLAF Task & Finish groups

= Business as usual groups

KEY

PROVIDER LANDSCAPE

Business as usual (outside transformational programme governance)

WISR Monitoring and modelling workshop(s)

Programme Board (renamed MLAFL

Operational Delivery Group)

MLAFL Workforce development -

Centre of Excellence

Workforce Engagement Forum

(TU)

W1: Prevention and Early Intervention

W2: Integrated Access

W3: Integrated Localities

W4: Whole Integrated System Redesign

W5: One Leadership and One Empowered Workforce

W6: Information & Technology,

Information Gov. & Estatess

W7:Strategic Commissioning,

Contracting & One Island £

W8: Organisational Integration & Form

W9: Evaluation & Measurement

W10: Communications &

Engagement

North East Locality team

meeting

West & Central Locality team

meeting

Redesign working group: Urgent & Emergency

Care

Redesign working group:

Fragility


Mental health


Planned care


Women & children


Long-term conditions

Public user & carer engagement groups

Health & Well- being Board

Health & Well- Being Executive

(currently suspended)

Steering Group Steering Group Steering Group Steering Group

Steering Group Steering Group Steering Group

Steering Group

South Locality team meeting

MLAFL Workforce group (T&C)

Programme Management

Office

MLAFL Workforce development -

Leadership & OD

Professional/ clinical

reference group

Steering Group

General Practice

Five Year Forward View Summary

Clinical Executive May 2016

The Problem • Demand and complexity of appointments has grown 2.5% since 2008 • Steady rise in patient expectation • Target driven culture • Growing requirement for GPs to do work previously done in hospital • Underfunding

= - Poor morale - Fragmented system where GPs feel they have little influence - Bureaucratic burden - Workforce crisis - Workload crisis “long arduous struggle through appointments, phone calls, repeat prescriptions, results letters and home visits. Before

you get a chance to look up, much less take a break, it’s the afternoon and you have to start all over again” Dr Arvind Madan, NHS England

Workforce • Aims:

– Reduce workforce burden and free up GP time – Increase roles for other staff including nurses, pharmacists and others – Develop stronger links with voluntary sector – Better use of technology

Increase in Workforce capacity (GPs) – Increase in GP training recruitment – Major recruitment campaign (national and international) – 10 point plan – “nothing general about general practice” – £20,000 bursaries (IOW only CCG in South to receive – will be evaluated in year to id. whether to continue) – Post CCT fellowships (mainly in North to encourage more varied training) – Simplify return to work routes – Targeted financial incentives – e.g. up to £2,300 per month bursaries for people to return to general practice – Investment in leadership and coaching for GPs – Increase sense of “status” for GPs within society and address workload to encourage GPs to continue for longer

• Increase in other capacity – 3000 mental health therapists (1 per 24k patients) – clinical pharmacists (1 per 30k patients at £112m) – Pharmacy integration fund – Upskill reception and clerical staff to “care navigate” and deal with majority of clinical correspondence (£45m) – 1,000 Physician Associates by 2020 – Practice Nurse development (£15m) including career framework for community and practice nurses and increase pre-reg nurse placements – Practice Manager development programme (£6m) – Medical Assistant roles as recommended by RCGP – Multidisciplinary training hubs (13 costing £3.5m – locally linked to Centre of Excellence)

Workforce -2

• At local level it is expected that: – Local plans to address workforce issues will be

developed, especially in Vanguard sites • New Roles to be developed for GPs not wanting

to be partners offering greater flexibility but also commitment

• NHSE to set national locum rates and practices will have to report if paying above

• Working at scale will enable new job roles to be created

Workload • Aim:

– Reduce workload by increasing coordination of care and self care, moderating demand and reforming how we support and organise services

• 27% appointments could potentially be avoided with more coordinated care between GPs and hospital • Main sources of bureaucracy include: making and claiming payments, keeping up with commissioners, reporting for contracts

or regulation

• Actions – National Programme to help practices support people living with long term conditions to self care – Community Pharmacy development to be more central in supporting minor illnesses – Digital interoperability, including By 2020 all income correspondence from NHS providers to be electronic and coded – CCGs to address patient flows from 111 – Vulnerable practice programme (£10m) – (This CCG has one practice identified) – Practice Resilience Programme (£16m) – New legal requirements in the NHS Standard Contract for Hospitals including: Local Access Policies stopping hospitals automatically

discharging patients who DNA outpatients; Hospital onward referral in same speciality/urgent referral to be done by hospital & not GP; Discharge summaries received electronically within 24 hours in agreed format; outpatient clinic letters with 14 days; hospital to communicate results to patients; 7 days medication on discharge (min)

– Pilots for consultant hotline for advice and improvements to Choose and Advice system – Task automation solution for practices by 2017/18 – Streamlining regulatory requirements – CQC, etc. – Good and Outstanding Practices can expect inspection every 5 years based on risk

based approach. “sentinel” Quality indicators to be published in July ’15 Streamlined approach for inspection of federations/super practices

– National Review of QOF – MCP contracts will enable opt out of QOF for holistic team-based funding – Simplify general practice payment system

Workload – Audit tool to be published to enable all practices to review their processes against good practice – Automated appointment measuring interface to support practices with supply and demand – Reduction in mandatory training – Social prescribing – Heath and Wellbeing Board to be instructed to recognise centrality of primary care in strategies – Developing “Fit for Work” programme to support employability – Consult on whether other healthcare professionals could issue sick notes – Staff undertaking processing of clinical correspondence (in Brighton and Hove saving 40 mins per GP per day) with no

significant events reported

Practice Infrastructure • Estate

– £900m investment in general practice estate and infrastructure – biding by End June 2016 linked to Local Estates Strategy including: traditional estate issues; “at scale” project support; funding over 3 years.

– New rules on premises cost directions enabling 100% funding of schemes – New offer for practices signing leases for 100% refund of stamp duty and VAT compensation – 6 months – New routes for transitional funding for practices in leases with NHS Property Services – Work with NHS property services to underwrite leases or buy out GP/third party premises where “wider commissioning gains”

• Technology – Increase in CCG GP IT Allocations of 18% – £45m programme to support update of online consultations for every practice and setting new core requirements for practices – CCG target

for 10% by end of financial year – Online access to triage services – Approve Apps library – Paper free NHS by 2020 – Practice offering online self care and self management services – Wi-Fi in all practices for staff and patients from April 2017 – National catalogue for IT products – Increase choices of digital services for practices working with suppliers – Complete roll out of summary care record – Enhancements to the Advice and Guidance platform through e-referral – Practices can bid for technology through the Infrastructure Fund – NHS interoperability Strategy requiring approved suppliers to use APIs (Open Application Interfaces) – Clarify data security and new model for data sharing

• It is expected that CCGs will fund access the subsidiary technology services to support GP practices for instance in relation to care planning, telephone or appointment management systems, joining up pathways across the system

Care Redesign • CCG will be responsible for commissioning new services including:

– £500m additional funding to commission extra primary care capacity – 7 day working evenings and weekends based on local demand alongside OOH and urgent care

– Integration of extended access with Out of Hours and urgent care services including reformed 111 and local clinical hubs (working at scale)

– £171m one-off investment for practices to transform – New Voluntary “MCP contract” from April 2017 to integrate primary care with

community services; choice of organisational form; replace QOF and CQUIN with locally agreed metrics; new employment and independent contractor options; potential for single CQC inspection. Model procurement process to be developed.

– 10 “High Impact Actions” from Releasing time for patients programme including: a) innovation spread b) service redesign c) capacity building

– Fund local collaborative working “at scale” through access and infrastructure fund – Provide free training and coaching to support practice redesign

• CCGs have legal responsibility to improve quality of care and are expected to: – Strengthen arrangements for protected time and backfill to enable GPs time and space

for development – Support developing federations in redesign (including locally funded development for

improvement plans) – Include in STPs details of approach to provider development – Support capability-building in general practice

Governing Body

Minutes of the Clinical Executive 24 March 2016 and 21 April 2016


Summary of issue: Minutes of the Clinical Executive held on 24 March 2016 and 21 April 2016.

Action required/ recommendation: To note the minutes of the Clinical Executive.

Principle risks: There are no principle risks relating to this paper.

Other committees where this has been considered: This will be considered at the Governing Body in Public Meeting.


There are no financial or resource implications relating to this paper, other than the matters raised in the meeting.

Legal implications/ impact: There are no legal implications or impact relating to this paper.


There has been no public involvement or action taken in relation to this paper.


Author of Paper: Tracy Richards, Governance Support Officer.

Date of Paper: March and April 2016



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Clinical Executive 24 March 2016 For the attention of the Governing Body:

• Urology Service at the IOW NHS Trust discussed and added as high risk to the risk register. • Approved policies to support Information Governance and received the year end Information

Governance report. • Recommended policy statements for arthroscopy for hip impingement, adenoidectomy, continuous

glucose monitoring and snoring to the Governing Body. • Received and commented on the Draft Operational Plan, Better Care Fund and Budget 2016/17. • Reviewed the Oncology Review and agreed needed to explore the Cancer Local implementation

team to take forward.

Minutes of the Clinical Commissioning Group (CCG) Clinical Executive held on 24 March 2016 at 12:30 in Room M, Innovation Centre, St Cross Business Park

PRESENT: Helen Shields (HS) – Chief Officer (Chair) Mayada Abuaffan (MA) – Consultant for Public Health

Gillian Baker, Deputy Chief Officer Dr Benjamin Browne (BB) – CCG Executive

Andrew Heyes (AH) – Head of Performance and Contracting (for LO) Loretta Kinsella (LK) – Director of Quality and Clinical Services Dr Michele Legg (ML) – CCG Executive Dr John Rivers (JR) – CCG Chair/Clinical Executive

IN ATTENDANCE: Alison Barton-Smith (AB-S) – Commissioning Manager for Secondary Care (for Item 7.1 and

10) Steve Rowe (SR), Deputy Head of Commissioning for Secondary Care (for Item 8)

Rebecca Wastall (RW), Deputy Chief Finance Officer (for Item 6.2 and 9.3) Dr Timothy Whelan (TW), GP for The Dower House (CCG Executive from 01 April 2016) MINUTED BY: Tracy Richards – Governance Support Officer

1. Apologies for Absence 15-266 Apologies for absence were received from Loretta Outhwaite (LO), Chief Finance Officer;

Andrew Heyes attended on behalf of LO. Rida Elkheir (RE), Director of Public Health, Mayada Abuaffan attended on behalf of RE. Nicola Longson (NL), Director of My Life A Full Life (MLAFL), Dr Joanna Hesse (JH). HS confirmed that the meeting is quorate and due to the size of the agenda, all papers will be assumed as read.

2. Declarations of Interest 15-267 The Clinical Executive received paper CE15-188 Declarations of Interest. The Declaration of

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Clinical Executive Members was agreed as accurate with the following exception:

• BB advised that Yasotha Browne, his wife is the GP Lead for Paediatrics and not Mental Health and BB is working 1-day per week within Public Health. A new Declarations of Interest Form is pending.

The Clinical Executive received the Declarations of Interest. 3. Minutes of the Last Clinical Executive Meeting 15-268 The Clinical Executive received paper CE15-189 Minutes of the last Clinical Executive Meeting.

The minutes of the meeting on the 18 February 2016 were agreed as an accurate record.

The Clinical Executive received and approved the Minutes of the Last Clinical Executive

Meeting.

Matters Arising 15-269 i. Schedule of Actions from the CCG Executive 18 February 2016. The Clinical Executive received paper CE15-190 Matters Arising – Schedule of Actions. The

following was discussed: 15-049 - GB to check the CAD system has been implemented and Ambulance Handover update to be presented to the February Clinical Executive meeting. GB confirmed that the CCG is still awaiting data. It was agreed that this item would remain open. 15-121 - Contract information to be brought to the Clinical Executive for approving before publishing to the intranet. AH requested that this item be deferred to April 2016 and stated that there are 23 projects for 2016/17, due to projects being extended in 2015/16 are causing a bottleneck between January to June 2016. Next stage is the prioritisation around contracts to assist with implementation and procurement support for 2017/18. 15-250(2) - GB to request Eleanor Roddick contacts Portsmouth CCG to discuss their GP OOH model. Still awaiting information. 15-251 – Gluten Free Prescribing option paper to be developed. Verbal update on agenda. 15-252(2) - Position statement in regard to E-Referrals to be shared. HS advised that a formal update by way of a paper by CM is needed as this is a Quality Premium requirement. 15-257 - HS to feedback to CM in regard to concerns regarding the practice level data. HS advised that this was in regard to a Patient Survey for Practices and the CCG could not take a view from Practice level and confirmed that CM has actioned this. 15-264 - LK to circulate an invitation and a Survey Monkey to all GP’s in regard to the Medicines Management Review. LK updated that the Medicines Management Review took place on 14 March 2016, external people joined the review and a survey monkey was sent to GP’s, this was a facilitated event. There was a positive contribution and identified what is needed, options were considered and it was felt that a Head of Medicines Management is required and a Deputy Head of Medicines Management should be a joint post with the IOW NHS Trust. All job descriptions are to be reviewed. The Clinical Executive agreed that a write-up and proposal be presented to the next Clinical Executive on 21 April 2016.

The Clinical Executive received the Schedule of Actions. ACTION: LK to present Medicines Management Review paper including proposals to the next Clinical

Executive. LK

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For Decision/Discussion 5. Corporate/Governance 15-270 i. Risk Register The Clinical Executive received tabled paper CE15-191 Risk Register, presented by HS. The Risk

Register Summary highlighted the following:

There are no new risks to report and the Clinical Executive was asked to consider two risks:

• One risk has increased in severity (Y3/11) regarding the achievement of the quality premium where it is now clear that the CCG will miss a number of the targets. • There has been further improvement in relation to the actions taken against risks Y3/5,

Safeguarding Adults Capacity and Capability in IOWNHST. HS advised that the IOW NHS Trust has given notice for the Urology Service and this needs to be added to the Risk Register. HS confirmed that she has written to the IOW NHS Trust to ask whether they wanted to reconsider as there is a Joint Urology Review being undertaken. An Impact Assessment has also been requested, due to the ramifications on other services of not providing this service. TW confirmed that he is involved with the Urology Review and the current Consultant has also given notice from June 2016 for on-call. TW suggested that an obvious solution would be for the Isle of Wight to team up with Portsmouth, revising the Portsmouth service to include the Isle of Wight advising that the Isle of Wight is second highest nationally for Urological Cancer. It was identified that Mr Makundi has written to the CCG advising that the IOW NHS Trust has not advertised for a substantive Urologist post and has always used locum positions. GB advised that discussions with Spire are underway to increase the range of Urology treatments available. The Urology Review Report will be presented to the next Clinical Executive. The Clinical Executive agreed that Urology Service be added to the Risk Register as High Risk.

The Clinical Executive noted the Risk Register. ACTION: Urology Service to be added as High Risk to the Risk Register. CM ACTION: Urology Review Report to be added to the next Clinical Executive Agenda. GB 15-271 ii. Information Governance Policy The Clinical Executive received paper CE15-192 Information Governance Policy, presented by

HS. The policy details the IOW NHS Trust’s Information Governance Framework and highlights how the IOW NHS Trust maintains Information Governance compliance. The Clinical Executive approved that the CCG is assured that the IOW NHS Trust has a policy.

The Clinical Executive approved the Information Governance Policy. 15-272 iii. Information Technology Security Policy The Clinical Executive received paper CE15-193 Information Technology Security Policy,

presented by HS. The IOW NHS Trust’s Information Technology Security Policy was approved by

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the IOW NHS Trust in March 2015, but has to date not been formally approved by the CCG. The aim of the policy is to ensure the security of the IOW NHS Trust’s network.

The Clinical Executive approved the Information Technology Security Policy.

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15-273 iv. Portable Devices Policy The Clinical Executive received paper CE15-194 Portable Devices Policy, presented by HS. The

IOW NHS Trust’s Portable Devices Policy was approved by the IOW NHS Trust in April 2014, but has to date not been formally approved by the CCG. This policy covers the use of all portable devices capable of storing information.

LK highlighted that a link in regard to consent be taken into account when the next policy update is due i.e. photographs, if they are being used for personal/confidential use and how will these be retained/destroyed.

The Clinical Executive approved the Portable Devices Policy and made recommendations for the next iteration of the policy.

15-274 v. Annual Information Asset Owner (IAO) Report The Clinical Executive received paper CE15-195 Annual Information Asset Owner (IAO) Report,

presented by HS. The IAO report highlights and identifies Information Governance risks that have been identified throughout 2015/16; this includes Information Governance incidents and any risks identified by the Information Asset Owners. The report also identifies recommendations for 2016/17. The question was asked how are recommendations taken forward, it was confirmed that these become a part of an action plan and monthly meetings take place between the SIRO and Caldicott Guardian as an assurance process

The Clinical Executive approved the Annual Information Asset Owner (IAO) Report. 15-275 vi. Information Asset Owner and Data Custodian/Information Asset Administrator Work

Programme Report

The Clinical Executive received paper CE15-196 Information Asset Owner and Data Custodian/Information Asset Administrator Work Programme Report, presented by HS. The IAO and Data Custodian Work Programme Report are written to document the findings of the Information Asset Owner (IAO) and Data Custodian/Information Asset Administrator (IAA) Work Programme. It outlines the work programme, provides analysis of the audits undertaken and notes any actions and recommendations resulting from the audits. This report has been reviewed and approved by the SIRO.

The Clinical Executive noted and approved the Information Asset Owner and Data Custodian/Information Asset Administrator Work Programme Report.

15-276 vii. System Level Security Policy The Clinical Executive received tabled paper CE15-197 System Level Security Policy, presented

by HS. Organisations are required to have a System Level Security Policy in place for all key systems. The pro-forma template can then be completed for each organisations business critical systems.

The Clinical Executive agreed the policy and noted that this aligns with Business Continuity Plans.

The Clinical Executive noted and approved the System Level Security Policy.

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15-277 viii. Information Asset – System Level Security Return The Clinical Executive received paper CE15-198 Information Asset – System Level Security

Return, presented by HS. The Clinical Executive noted the paper.

The Clinical Executive noted the Information Asset – System Level Security Return. 15-278 ix. 2015/16 Year End Information Governance Report The Clinical Executive received paper CE15-199 2015/16 Year End Information Governance

Report, presented by HS. This is the annual Information Governance (IG) Report, which provides assurance around the CCG’s IG arrangements.

The report does not show any significant issues, but does highlight areas which can be improved and will feature in the CCG’s 2016/17 IG action plan.

Based on the information to date, the CCG will meet its required IG Toolkit Level 2, which includes 95% of CCG staff undertaking their annual IG training. It was confirmed that the CCG met 100% return for staff undertaking their annual IG training on 24 March 2016

The report highlighted the following recommendation; face to face training to be carried out for Clinical Executive and Governing Body members. The question was raised in regard to how the CCG can support Primary Care in regard to IG training and this was agreed to be explored.

It was agreed that face to face IG training be a part of a future Clinical Executive and Governing Body meeting and review what support could be given to Primary Care.

The Clinical Executive noted and approved the 2015/16 Year End Information Governance Report.

ACTION: TR to arrange face to face IG training with Lucy Savill for Clinical Executive and Governing

Body members through the individual meeting agenda’s. TR

ACTION: Review what IG support can be given to Primary Care. LO 6. Performance and Contracting 15-279 i. Performance Report The Clinical Executive received paper CE15-200 Performance Report, presented by AH. HS

suggested that the succinct report be presented to the Governing Body be the same format for the Clinical Executive, all were in agreement. LK highlighted the Quality area of the Performance Report identifying that this report is from January 2016 and there has now been 3 never events and in regard to HCAI’s, there are 5 cases of MRSA and CDifficile is a challenging area, with 52 cases report against a target of 28. LK also reported that the target for CDifficile for 2016/17 is 7. In regard to the staff survey, LK confirmed that this was being discussed at the Clinical Quality Review Meeting (CQRM). AH advised that the IOW NHS Trust was on Red Alert in January and has had 9 Black Alert days during March, this has impacted on Elective Surgery. Recovery Plans are in place for A&E, RTT and Cancer (62-day wait). In regard to A&E, it was identified that A&E is supplemented by the walk-in centre activity and

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any changes would impact on the target. TW asked how the IOW NHS Trust would improve their performance, when they do not have the capacity. It was confirmed that the focus is on capacity plans and gaining assurance is key but is very dependent on workforce, the CCG is awaiting this information. It was noted that the IOW NHS Trust is recruiting a further 100 nurses. It was agreed that the CCG will need to continue promoting choice, relaunching the campaign and communicating effectively with GP’s. TW suggested advising GP’s how to save documentation to individual desktops. In regard to IOW NHS Trust recruitment, it was identified that they have gone to the Philippines and no other areas. The workforce work-stream of My Life A Full Life (MLAFL) has been advised that this is a priority. Page 22, Patient Reported Outcome Measures (PROMs) was discussed and JR reflected on the data within the performance report and suggested that consideration is required of the expectations for the patient (decision aids). It was agreed that PROMs is a crude indicator and this will be taken through CQRM for further analysis. RW updated the Clinical Executive with Month 10 Finance Report identifying that Month 11 forecast is a £4.5million surplus. This is an increase of £2million and includes £1million matched funding received from NHSE who have agreed that this will benefit 2016/17. HS advised that the Governing Body made the decision not to support the IOW NHS Trust deficit, the IOW NHS Trust is disappointed with this position.

The Clinical Executive noted the Performance Report. ACTION: AH to action the same format for the Performance Report presented to the Governing Body is

used for Clinical Executive. AH

ACTION: LK to add Patient Reported Outcome Measures (PROMs) to CQRM agenda. LK 15-280 ii. Contracts Update The Clinical Executive received a verbal update by HS in regard to contracts, identifying that

agreeing the IOW NHS Trust contract may be problematic. It was identified that the contract has been received by NHS England today (24 March 2016) and the deadline for signature is 31 March 2016.

The Clinical Executive noted the Contracts Update. 7. Commissioning 15-281 i. Endoscopy Review - Report on progress against recommendations and new drivers The Clinical Executive received paper CE15-201 Endoscopy Review - Report on progress against

recommendations and new drivers, presented by Ali Barton-Smith (AB-S), CCG Commissioning Manager for Secondary Care. In 2014, a joint IOW NHS Trust and CCG review was undertaken of Endoscopy Services. This review was in response to the Department of Health (2012) Rapid

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Review of Endoscopy Service, and the need to relocate the Endoscopy Unit to new premises to maintain Joint Advisory Group (JAG) accreditation. The paper reflected progress against the 2014 Endoscopy Review, and new pressures and key drivers that have been published in the interim.

AB-S identified that this has been a slow process and national directives have now been received, which alters some of the recommendations. Clinical Quality Review Meeting (CQRM) is monitoring progress. The Provider has been unable to provide a referral form template, although this has been requested. It was agreed that LK and GB would discuss Endoscopy services further and this need to be discussed at CQRM.

The Clinical Executive noted Endoscopy Review - Report on progress against recommendations and new drivers.

ACTION: Endoscopy to be added to CQRM meeting. AB-S ACTION: LK and GB to discuss Endoscopy services. LK/GB 15-282 ii. Sustainability Transformation Plan (STP) The Clinical Executive received a verbal update by GB in regard to Sustainability Transformation

Footprint, it has been agreed that the STP will be Hampshire and Isle of Wight, a Steering Group has been formed, Karen Baker, Chief Executive of IOW NHS Trust will be the Chair of the STP, which will enable good input from the Isle of Wight, separate sub-groups will be formed including Finance. There is a cost of £28K per organisation. HS felt that this is good news for the Isle of Wight and will enable more leverage and working at scale. The Clinical Executive agreed that STP will remain a standard agenda item.

The Clinical Executive noted the Sustainability Transformation Plan update. 15-283 iii. Whole Integrated System Redesign (WISR) Update Report The Clinical Executive received paper CE15-202 WISR Update Report presented by GB. The

WISR redesign phase will commence in mid-April. Over the next month, the priority theme areas for this work will be tested and agreed and the working and reference group structure and membership agreed. GB advised that in regard to progress, all milestones have been achieved and documents are now available. Key areas for redesign, regarding focus, are currently work in progress. TW advised that GP’s are finding the WISR concept difficult to grasp and understanding what benefits there are. It was identified that the communications are not yet effective. GB advised that this has been raised by the CCG and the position was acknowledged by KPMG. BB raised concerns about the work of KPMG and the progress of WISR and did not feel assured about the progress/methodology. It was agreed that this is to be taken through the WISR Board and Executive Group. A weekly WISR Executive Group takes place and JR and GB attend.

The Clinical Executive noted the WISR Update Report.

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15-284 iv. Gluten Free Prescribing The Clinical Executive received a verbal update in regard to Gluten Free Prescribing, JR

confirmed that a Wessex-wide consultation is to be undertaken and will update at the next Clinical Executive.

The Clinical Executive noted the Gluten Free Prescribing update. 8. Policy Statements 15-285 i. Arthroscopy in Hip Impingement The Clinical Executive received paper CE15-203 Arthroscopy in Hip Impingement presented by

Steve Rowe (SR), Deputy Head of Commissioning for Secondary Care. Hampshire and Isle of Wight Priority Committee recommended that Arthroscopic femoro-acetabular Surgery for Hip Impingement should be considered as a second line treatment option for patients who are symptomatic, have significantly impaired activities of daily living and have undergone activity modification as a part of conservative treatment. Patients with evidence of osteoarthritis in the hip joint are not suitable for arthroscopic hip impingement surgery.

The Clinical Executive agreed to recommend approval to the Governing Body the Arthroscopy

in Hip Impingement Policy Statement.

15-286 ii. Adenoidectomy The Clinical Executive received paper CE15-204 Adenoidectomy presented by Steve Rowe (SR),

Deputy Head of Commissioning for Secondary Care. Hampshire and Isle of Wight Priority Committee recommended that Adenoidectomy for the treatment of recurrent upper respiratory tract infections in children is a low priority and will not be routinely commissioned. There is a lack of evidence to indicate that surgical intervention significantly affects the benign natural history of upper respiratory tract infections in children. It was identified that if there are exceptions, these need to be presented to IFR Panel.

The Clinical Executive agreed to recommend approval to the Governing Body the

Adenoidectomy Policy Statement.

15-286 iii. Continuous Glucose Monitoring The Clinical Executive received paper CE15-205 Continuous Glucose Monitoring presented by

Steve Rowe (SR), Deputy Head of Commissioning for Secondary Care. Hampshire and Isle of Wight Priority Committee recommended that the routine use of Continuous Glucose Monitoring without the use of a pump is considered low priority.

The Clinical Executive agreed to recommend approval to the Governing Body the Continuous

Glucose Monitoring Policy Statement.

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15-287 iv. Snoring The Clinical Executive received paper CE15-206 Snoring presented by Steve Rowe (SR), Deputy

Head of Commissioning for Secondary Care. Hampshire and Isle of Wight Priority Committee recommended that the treatment of snoring is a low priority due to the lack of evidence that treatment will prevent other diseases from occurring or progressing. It was agreed that this paper be added to the next Clinical Executive Seminar for discussion.

The Clinical Executive agreed to recommend approval to the Governing Body the Snoring

Policy Statement.

ACTION: Snoring Policy Statement to be added to the next Clinical Executive Seminar for discussion. TR 9. Planning 15-288 i. Draft Operational Plan The Clinical Executive received paper CE15-207 Draft Operational Plan presented by GB. This is

substantively the same as the one submitted on 02 March 2016 to NHS England. The document sets out the key requirements to be delivered in 2016/17 for the CCG in meeting its strategic intent, its financial duties, and quality and performance requirements. It incorporated all the key lines of enquiry as required by NHS England to demonstrate how we can deliver the Five Year Forward View. The document remains a draft as further work is required on the agreement of demand and capacity plans, contracts and system resilience plans. The final Operational Plan is due for submission on 11 April 2016. GB advised that a different version will be presented to the Governing Body on 31 March 2016. Guidance on Quality Premiums has just been issued and these were tabled by AH. There are 4 national targets and 3 local priorities required, a discussion took place identifying the options available and it was agreed that the Clinical Executive take a view based on 3 out of 5 options linked to the BCF and Operational Plan. AH to circulate options by way of email for comment to be returned prior to the submission deadline of 11 April 2016. The Clinical Executive agreed to give the Chief Officer the authority to sign off the plan for 11 April 2016 submission.

The Clinical Executive noted the Draft Operational Plan and gave authority to the Chief officer

to sign off the 11 April 2016 submission.

ACTION: AH to circulate Quality Premium Local Priorities to Clinical Executive for comment to be

returned prior to the submission deadline of 11 April 2016. AH

15-289 ii. Draft Better Care Fund The Clinical Executive received paper CE15-208 Better Care Fund (BCF) presented by GB and

provided an update on the development of the Section 75 agreement for 2016/17 between the Isle of Wight CCG and the Isle of Wight Council.

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The BCF is a single pooled budget for health and social care services which has been created nationally to drive integrated health and adult social care services through greater integrated commissioning. The BCF guidance was only issued on 24 February 2016 and the first plan has been submitted, the final submission of the BCF plan is 25 April 2016. The document is an overview of the requirement for the BCF and contains the draft proposals for the pooled fund. It was agreed that the BCF be submitted to the next Clinical Executive Seminar for discussion and for an electronic version to be circulated prior to the Seminar.

The Clinical Executive noted the Better Care Fund. ACTION: BCF to be circulated to Clinical Executive in advance of the next Clinical Executive Seminar. GB 15-290 iii. Draft Budget 2016/17 The Clinical Executive received paper CE15-209 Draft Budget 2016/17 presented by RW. The

financial plan and budget is subject to some further changes in relation to final contracts agreed with NHS providers and final discussions with NHS England. A final version will be presented at a future meeting. The Plan delivers a break-even position and therefore does not meet the national business rule of delivering a 1% surplus. The Isle of Wight has been criticised for the level of QIPP plans and are being asked to increase this. RW confirmed that the backlog for elective care at the IOW NHS Trust will impact on the demand and cost, RW also stated that new tariffs have been published this week with a 0.8% increase in C&ST Insurance premiums. RW clarified that the Governing Body will be asked to approve this interim plan and an additional meeting will be arranged to approve the final plan. The Clinical Executive recommended that the interim plan be presented to the Governing Body to approve. It was identified that the IOW NHS Trust has also submitted a deficit plan. The Clinical Executive recognising all of the risks approved in principle the Interim Draft Budget 2016/17.

The Clinical Executive agreed to recommend approval to the Governing Body the Interim Draft

Budget 2016/17.

15-291 iv. Isle of Wight Strategic Estates Plan The Clinical Executive agreed to defer this agenda item until the next Clinical Executive

scheduled for 21 April 2016.

The Clinical Executive deferred the Isle of Wight Strategic Estates Plan. 8. Childhood Immunisations 15-292 The Clinical Executive received paper CE15-211 Childhood Immunisations, apologies were

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received from Emily MacDonald (EM), Public Health Principal: Health Protection, Isle of Wight Public Health. The Clinical Executive agreed to defer this agenda item until the next Clinical Executive scheduled for 21 April 2016.

The Clinical Executive deferred Childhood Immunisations. 9. Information Management and Technology 15-293 GP/GMS IT The Clinical Executive received a verbal update by HS in regard to GP/GMS IT. The ‘SystmOne’

migration project is currently on track and additional resource has been secured from April from the CSU. The technical programme is underway and good initial feedback has been received from both Shanklin and Sandown about the process so far. There has been good feedback from GP’s about the ease of the system. INPS has been trying to persuade GP’s to move to a hosted Vision, this has been stopped by the CCG. Some Practices are increasingly struggling with Vision, the CCG is putting mitigatory measures in place pending migration, but this is having an impact on GP working. Communications Plan is in development to improve communication with Practices and patients. AH confirmed that the IOW NHS Trust is engaged.

The Clinical Executive noted GP/GMS IT. 10. Final Report of Cancer Oncology Review and Action Plan 15-294 The Clinical Executive received paper CE15-212 Final Report of Cancer Oncology Review and

Action Plan presented by AB-S. The review was conducted over 4-months and evidence was gathered from perspectives of key individuals and stakeholders working and supporting the Oncology services on the Isle of Wight, and cross referenced with data from local and national data bases.

A review of Oncology Services for the populace of the Isle of Wight arose from concerns that there had been deterioration in quality of the service with an unsatisfactory out-patient and inpatient service combined with insufficient oncologist time on the Island. The review was jointly commissioned by NHS England Specialist Commissioning and IOW CCG. The recommendations in the report are:

• A Provider Joint Oncology Board to be established and to meet urgently to address the deficiency in the Acute Oncology Service – Action Plan to be developed that addresses the recommendations.

• NHS England (NHSE) Specialised Commissioning and Isle of Wight CCG to review framework and timescale of commissioning arrangements for Oncology Services between NHSE and Isle of Wight CCG.

• Public Survey to be published end of March 2016 incorporating a brief overview/summary.

• Final report to be submitted to Clinical Executive end of March 2016 and to Kate Shields Director, NHS England or via Senior Management Team.

• Interim and any ongoing issues to be picked up by Clinical Quality Review Meeting (CQRM).

• Formal letter to be sent to the IOW NHS Trust requesting an Action Plan to address the immediate concerns regarding patient safety and quality.

HS advised that the recommendations and preferred options have been discussed at Quality

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Patient and Safety Committee (QPSC) and Healthwatch has produced a draft report, which will be produced at the next QPSC on 05 May 2016. It was identified that the areas highlighted within the Healthwatch Survey was what drove the review to be undertaken. A Joint Board has now been established, which Alan Sheward, Director of Nursing for the IOW NHS Trust chairs. It was confirmed that the Local Authority (LA) has agreed to continue with travel costs for 2016/17. The question was asked is the Clinical Executive being asked to approve all of the options on pages 62/63, it was identified that Option 7 is the preferred option, IOW NHS Trust, Portsmouth Hospital Trust and University Hospital Southampton Trust form an Accountable Clinical Care Partnership. It was identified that Cancer Local Implementation Team (LIT) is still in place and agreed that LK and GB will explore how to take forward recommendations and identify the format and membership of the LIT. The Clinical Executive approved the Oncology Review Report with the identified recommendations and it was agreed that AB-S would inform NHSE of the outcome.

The Clinical Executive approved the Final Report of Cancer Oncology Review and Action Plan. ACTION: LK and GB to explore the format and membership of the Cancer LIT and take forward

recommendations of the Oncology Review Report. LK/GB

ACTION: AB-S to inform NHSE of outcome from Clinical Executive. AB-S 11. PREVENT Summary 15-292 The Clinical Executive received paper CE15-213 PREVENT Summary presented by LK; this is the

Isle of Wight CCG position statement regarding the National PREVENT Strategy. The CCG has systems and processes in place, although Primary Care awareness needs to be improved and Mandy Tyson (MT), Head of Safeguarding for the CCG will be alerting and updating Primary care.

The Clinical Executive noted the PREVENT Summary. ACTION: Mandy Tyson to circulate PREVENT awareness paper to Primary Care on the Isle of Wight. MT 12. NHS Litigation Authority (NHS LA) Scheme Contributions for 2016/17 15-293 The Clinical Executive received paper CE15-214 NHS Litigation Authority (NHS LA) Scheme

Contributions for 2016/17 presented by HS, this is an annual approval of the CCG’s Financial Scheme of Delegation and is a continuation of the current scheme in place, as it has operated effectively during 2015/16.

The Clinical Executive noted and approved subject to the Audit Committee giving its

recommendation to approve the NHS Litigation Authority (NHS LA) Scheme Contributions for

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2016/17.

13. Minutes For Noting 15-294 The Clinical Executive noted the following minutes: i. Paper CE15-215 Joint Adult Commissioning Board (JACB) – 02 March 2016 ii. Paper CE15-216 Contract Monitoring and Service Review (CM & SR) Meeting – 23 February

2016

iii. Paper CE15-217 Clinical Quality Review Meeting (CQRM) – 04 March 2016 iv. Paper CE15-218 Locality Minutes – March 2016 14. Update Session 15-295 i. Chair No update received. 15-296 ii. Chief Officer No update received. 15. Any Other Urgent Business 15-297 There was no any other urgent business discussed. 16. Date of Next Meeting: 15-298 Thursday 21 April 2016 12.30 – 15.30hrs,Carisbrooke Room, Block A The Apex, St Cross Business

Park, Newport

Circulation: Members In attendance: For Information (Agenda): Gillian Baker – Deputy Chief Officer Benjamin Browne – CCG Executive Rida Elkheir – Associate Director of Public Health Joanna Hesse – CCG Executive Loretta Kinsella – Director of Quality and Clinical Services Michele Legg – CCG Executive Loretta Outhwaite – Chief Finance Officer John Rivers – CCG Executive Helen Shields – Chief Officer (Chair)

Tracy Richards (Notes) Ali Barton-Smith Emily MacDonald Steve Rowe Rebecca Wastall Dr Timothy Whelan

Liz Elliott For Information (Minutes): Matthew Leek, CCG Commissioning Finance Mgr. Shaun Sweatman, CCG Commissioning Finance Mgr. Linda Rann, Sue Lightfoot, Rachael Hayes, Dawn Berryman, Eleanor Roddick - Heads of Commissioning, Andrew Heyes – Head of Performance Teresa Day - Acting Deputy Head of Medicines Management Caroline Morris – Head of Corporate Business and Primary Care Rebecca Wastall – Deputy Chief Finance Officer Lucy Savill – Information Governance Mgr.

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Clinical Executive 21 April 2016 For the attention of the Governing Body:

• CCG will be actively promoting choice with the public and providing information regularly to GP’s and Practices.

• Discussed the GP Out of Hours service and requested that this is discussed at the Clinical Effectiveness Committee and Locality meetings.

• Approved the uplift for independent sector, care home and domiciliary providers for 2016/17, which takes into account the impact of the living wage.

• Noted and approved to be submitted to the Governing Body the financial plan and operational plan 2016/17.

• Noted the roll out of the GP GMS IT system which has gone live in some Practices and the positive feedback.

Minutes of the Clinical Commissioning Group (CCG) Clinical Executive held on 21 April 2016 at 12:30 in Carisbrooke Room, CCG HQ, The Apex

PRESENT: Helen Shields (HS) – Chief Officer (Chair) Gillian Baker, Deputy Chief Officer Dr Benjamin Browne (BB) – CCG Executive Dr Joanna Hesse (JH) – CCG Executive

Loretta Kinsella (LK) – Director of Quality and Clinical Services Dr Michele Legg (ML) – CCG Executive Loretta Outhwaite (LO) – Chief Finance Officer Dr Sarah Westmore (SW) – CCG Executive Dr Timothy Whelan (TW) – CCG Executive

IN ATTENDANCE: Sandy Hogg (SH) – Interim Associate Director of Commissioning

Sue Lightfoot (SL) – Head of Children, YP, Dementia, Mental Health and Learning Disability Commissioning Services Nicola Longson (NL) – Director of My Life A Full Life (MLAFL)

James Seward (JS) – WISR Programme Director Eleanor Roddick (ER), Head of Urgent Care Commissioning Services Laurence Taylor (LT), Governing Body Lay Member – Independent (Observer) MINUTED BY: Tracy Richards – Governance Support Officer

1. Apologies for Absence 16-001 Apologies for absence were received from Dr John Rivers (JR) and Rida Elkheir (RE)

HS confirmed that the meeting is quorate and due to the size of the agenda, all papers will be assumed as read.

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2. Declarations of Interest 16-002 The Clinical Executive received paper CE16-001 Declarations of Interest. The Declaration of

Clinical Executive Members was agreed.

The Clinical Executive received the Declarations of Interest. 3. Minutes of the Last Clinical Executive Meeting 16-003 The Clinical Executive received paper CE16-002 Minutes of the last Clinical Executive Meeting.

The minutes of the meeting on the 24 March 2016 were agreed as an accurate record.

The Clinical Executive received and approved the Minutes of the Last Clinical Executive

Meeting.

Matters Arising 16-004 ii. Schedule of Actions from the CCG Executive 24 March 2016. The Clinical Executive received paper CE16-003 Matters Arising – Schedule of Actions. The

following was discussed: 15-049 - GB to check the CAD system has been implemented. The CAD is fully implemented. Data is due to be provided from 31 March 2016. It was agreed that this item would remain open until data has been provided by the IOW NHS Trust. 15-121 - Contract information to be brought to the Clinical Executive for approving before publishing to the intranet. AH was not available to update the Clinical Executive, it was agreed that this item would be carried forward to the May 2016 agenda. 15-252(2) - Position statement in regard to E-Referrals to be shared. There is IT issues regarding accessing this information; the CCG is awaiting a resolution from the IT Helpdesk. It was agreed that HS would chase this. 15-265 - LK to present Medicines Management Review paper including proposals to the next Clinical Executive. LK updated on the review meeting and a paper will be presented to the May Clinical Executive. It was agreed that this item would remain open. 15-267(2) - Review what IG support can be given to Primary Care. It was identified that this requires further internal discussion in regard to resource requirements. It was agreed that this would be an item for May 2016 agenda.

The Clinical Executive received the Schedule of Actions. ACTION: 15-121 Contract Update to be carried forward to May 2016 Agenda AH/TR ACTION: 15-252(2) HS to chase action Position statement in regard to E-Referrals HS ACTION: 15-265 Medicines Management Review paper including proposals to be carried forward to

May 2016 Agenda. LK/TR

ACTION: 15-267(2) Review IG Support for Primary Care to be carried forward to May 2016 Agenda LO/TR For Decision/Discussion 5. Performance and Contracting 16-005 x. Performance Report The Clinical Executive received paper CE16-004 Performance Report, presented by HS. LK

advised that in regard to Quality there have been 3, 52-week wait breaches that credibility issues have been identified by NHSE in regard to the quality of the data being received. There

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have been 2 new cases of MRSA, these are both in the community and there has been 1 further Never Event, where a central line guidewire was left in place.

JH asked in regard to Gastroenterology, concerned that there is currently a 7-month wait. HS advised that the provider during contract negotiations had stated they did not have sufficient capacity to meet activity levels. Alternative providers were being explored including Spire. TW confirmed that there is currently 16-week wait for urgent referrals.

LK confirmed that she would explore this further from a quality perspective and discuss with Linda Rann. It was agreed there is a need to identify what had changed to lead to the service issues.

ML raised concern in regard to Neurology and the long wait for this. HS advised that the CCG will explore further and feedback.

HS confirmed that CCG sickness is above average, but the information is for one month only and is being scrutinised closely.

The Clinical Executive noted the Performance Report. ACTION: LK to discuss Gastroenterology and Neurology service concerns with Linda Rann. LK 16-006 xi. Update on Contract with IOW NHS Trust Presentation AH was not available and it was agreed that AH will circulate an update post-meeting. HS

advised that the Contract and CQUINs are awaiting finalisation. An agreement letter is currently being finalised with the IOW NHS Trust prior to the detailed contract.

HS confirmed that patient choice will be re-marketed imminently.

TW shared that he feels ‘Choose and Book’, now called ‘E-Referrals’ is a great scheme, but is not sure that all Practices use this facility and advised that having that discussion with the patient is important.

HS confirmed that the 3 private providers will reimburse travel, but NHS Trusts will not, although ferry operators will offer reduced fares.

It was identified that waiting times are not regularly shared. It was agreed that current waiting times will be published on the CCG website and weekly updates sent to GP’s, HS stated that this will only be providers that the CCG have contracts with.

It was also agreed that support for Practices to access and use the E-Referral application will be implemented.

The Clinical Executive noted the Update on Contract with IOW NHS Trust. ACTION: AH to circulate a Contracts update post-meeting LO/AH ACTION: Waiting times to be published on the CCG website and weekly updates to be sent to GP’s for

information. GB

ACTION: Support for GP Practices to access and use E-Referrals to be implemented. LO/CM

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6. Commissioning 16-007 iii. Sustainability Transformation Plan (STP) The Clinical Executive received paper CE16-005 Sustainability Transformation Plan, presented

by HS. Karen Baker, Chief Executive IOW NHS Trust chairs the group, HS expressed concern that the Isle of Wight was recorded as a separate challenge, but in the submission had been excluded, HS confirmed that this has been raised with the Chair. The full plan will be submitted at the end of June 2016. TW advised that an email was received by all GP’s today from the LMC. HS requested that this be shared with her. HS confirmed that GB or HS will attend all meetings and a 2-day event is taking place on the Isle of Wight and HS and JH will be attending.

The Clinical Executive noted the Sustainability Transformation Plan. ACTION: TW to share email from LMC with HS. TW 16-008 iv. My Life A Full Life (MLAFL) Update Report The Clinical Executive received a verbal update by Nicola Longson (NL), Director of MLAFL. NL

explained that work is required around governance; this is under review through the Health and Wellbeing Board, she stated that the 10 work-streams are currently working independently and these need to be combined. It was agreed there needs to be clear communication and a re-focus on the current work-streams. NL confirmed that access to funding is in place, £4.7m has been confirmed, the identified work-streams have been submitted to the ‘New Care Models’ and MLAFL is hoping for a response by the end of April 2016. LK asked if there is confidence to collectively stop work-streams, as scopes have been reduced. NL stated that the impact of proposals needs to be identified and this is work in progress, but that a lot can be achieved as business as usual. All agreed that MLAFL updates should be sent to Clinical Executive.

The Clinical Executive noted the MLAFL Update Report. 16-009 v. Whole Integrated System Review (WISR) Update Report The Clinical Executive received paper CE16-007 WISR Update report presented by James

Seward (JS), WISR Programme Director. JS thanked the Clinical Executive members for their commitment to WISR. The WISR redesign phase will commence in April and May 2016. The working group areas have been confirmed and system partners, including the CCG have been asked to confirm their nominations for the groups by 14 April 2016. Following this, confirmed invitations will be sent out to group members.

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JS confirmed that membership and leadership for working groups has been firmed up and that the data-pack is still to be finalised. Each group will hold 4 meetings, these have now been scheduled, JS agreed to share the identified members for each working group. Public engagement events have taken place and recruitment of the public participants is underway. JS advised that WISR is looking for members to attend and assist with the interaction at locality groups. HS identified that these will be public meetings, close links with the Isle of Wight County Press and the Press will be paramount. It was agreed that communications support is required along with media management. JS confirmed that the first Professional Reference Group date is 18 May 2016 and Loretta Kinsella (LK) and Jo Hesse (JH) will be in attendance. LK asked in regard to patient engagement, will this person be included in these groups? It was identified that an expert patient and expert carer will be included. JS agreed that he will liaise with Dave Newton and Gillian Baker and confirmed that Community Action is linking with the voluntary sector. It was suggested that attendance at Residential and Nursing Homes should be considered. JS advised in regard to next steps, there will be a rapid implementation and development during Summer 2016. In regard to the 18 May 2016, this is a hold the date at present. It was agreed that clarification is required as to the content of the meeting to ensure that the correct person attended. HS asked are all GP’s required. It was agreed that 1 GP will be identified from each Practice to ideally lead on each group and for nurses to be included as well.

The Clinical Executive noted the WISR Update report. ACTION: JS to share WISR membership list with TR for circulation. JS ACTION: JS to review GP engagement requirements for 18 May 2016. JS 16-010 vi. Attention Deficit Hyperactivity Disorder (ADHD) Shared Care Business Case The Clinical Executive received paper CE16-008 ADHD Shared Care Business Case presented by

Sue Lightfoot (SL), Head of Children, Young People, Dementia, Mental Health and Learning Disability Commissioning. This paper proposes a Local Incentive Scheme (LIS) to ensure that GPs are funded and continue to provide Adult ADHD patients with high quality and consistent care as agreed in the Shared Care Agreement, approved by the Clinical Effectiveness Committee in 2015. SL advised that the paper submitted today was for discussion and noting and approval was required from the Isle of Wight Primary Care Committee on 12 May 2016. JH advised that the Shared Care Pathway recommendations that were made at Clinical Effectiveness Committee were not included within the paper. SL recognised this and agreed that these would be included within the final paper.

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SL confirmed that there are currently 118 patients being appropriately prescribed across GP Practices. It was identified that GP’s are prescribing in good faith, while waiting for the Shared Care Pathway to be approved. There appears to be a variation across the Isle of Wight Practices as to which GP’s are prescribing. The Local Incentive Scheme (LIS) would pay each Practice £150 per patient, to include 1 consultation and 12 prescriptions. If this is not approved, GP’s will cease prescribing. It was agreed that clarification and Clinical Effectiveness Committee recommendations regarding nominated pharmacy and patient signatures to be included within the final paper. The Clinical Executive agreed that the paper is updated and then submitted for approval to the Isle of Wight Primary Care Committee.

The Clinical Executive noted the ADHD Shared Care Business Case. ACTION: SL to update the ADHD Shared Business Case paper prior to the Delegated Commissioning

for Primary Care Committee. SL

16-011 vii. Urgent and Emergency Care Strategy The Clinical Executive received paper CE16-009 Urgent and Emergency Care Strategy

presented by Eleanor Roddick (ER), Head of Urgent Care Commissioning Services. This paper has been developed following public and stakeholder consultation. The Clinical Executive noted and acknowledged development of the strategy and support it forming the basis of future service redesign of Urgent Care. It was recommended that after this paper has been through WISR, it is circulated to the Locality meetings.

The Clinical Executive noted the Urgent and Emergency Care Strategy and approved for this to

be submitted to WISR.

16-012 viii. GP Out of Hours Provision The Clinical Executive received paper CE16-010 GP Out of Hours Provision presented by

Eleanor Roddick (ER), Head of Urgent Care Commissioning Services. This paper was discussed in detail at the recent Clinical Executive Seminar. The question was asked what is a Clinical Practitioner, ER confirmed that this is being developed as an alternative workforce to assist GP’s, Beacon Out of Hours (OOH) and supporting NHS111 and front-end access to Urgent Care. Clinical standards have been taken forward and a lot of expressions of interest have been received. ER advised that District Nurses OOH ceases on 22 April 2016. ER confirmed that NHS Pathways England and the CCG are working together to look at 111 algorithms. ML identified that 111 referrals to GP’s has increased and patients are being given the wrong messages and feels that discussions with Primary Care is needed. ER confirmed that David Anderson (DA), GP Lead and Chair of NHS111 Clinical Governance Committee are fully involved. It was agreed that this should be a wider remit and TW suggested that DA attend the Locality meetings, it was also agreed this should be discussed at the next Clinical Effectiveness Committee.

The Clinical Executive noted the Situation Report GP Out of Hours Provision.

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ACTION: GP Out of Hours Provision to be discussed at Clinical Effectiveness Committee and David

Anderson to attend Locality meetings. JH

16-013 ix. Independent Sector, Care Home and Domiciliary Uplift 2016/17 The Clinical Executive received paper CE16-011 Independent Sector, Care Home and

Domiciliary Uplift 2016/17 presented by Gillian Baker (GB). The paper sets out the process and recommendations for the independent sector, care homes and domiciliary providers fee uplift for 2016/17. The CCG and Local Authority have worked together to review the impact of the minimum wage on fees. The offer is between 4.44% and 4.86% depending on the sector. The independent sector representatives have not agreed with this offer. The Clinical Executive was asked to approve the recommendations as set out in Option 2 to provide an inflationary increase based on the proposed increase developed taking account of all information received during that period as follows:

• Proposed uplift for residential care fees in 2016/17 is: 4.53% • Proposed uplift for nursing care fees in 2016/17 is: 4.59% • Proposed uplift for LD residential care fees in 2016/17 is: 4.44% • Proposed uplift for Homecare fees in 2016/17 is: 4.86%

GB advised that this is a difficult situation and the consequences could mean delays for patients leaving hospital.

The Clinical Executive approved the Independent Sector, Care Home and Domiciliary Uplift

2016/17 offer.

7. Planning 16-014 v. Q4 Delivery Plan Update The Clinical Executive received paper CE16-012 Q4 Delivery Plan. It details the key

achievements in Quarter 4 and areas for ongoing work.

The Clinical Executive noted the Q4 Delivery Plan. 16-015 vi. Operational Plan 2016/17 The Clinical Executive received paper CE16-013 Operational Plan 2016/17 presented by GB.

This document is the Final CCG Operational Plan and is substantively the same as the one submitted on 2nd March 2016 to NHS England. The document sets out the key requirements to be delivered in 2016/17 for the CCG in meeting its strategic intent, its financial duties, and quality and performance requirements. It incorporated all the key lines of enquiry as required by NHS England to demonstrate how we can deliver the Five Year Forward View. The main changes are that the CCG has now agreed the demand, capacity and performance trajectories with providers and have modelled the impact on finances. RTT targets will be to achieve 92% by November 2016 and A&E to achieve 92%, this area will flat line and not reach 95% (the NHS Constitution standard). The CCG also has a more detailed System Resilience Plan to help deliver this performance.

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It was agreed that System Resilience – The Way Forward will be an agenda item in May 2016 and SH will attend.

The Clinical Executive noted the Operational Plan 2016/17 and approved for the Operational

Plan 2016/17 to be submitted to the Governing Body.

ACTION: System Resilience – The Way Forward to be an agenda item for May 2016. TR 16-016 vii. Better Care Fund (BCF) Update The Clinical Executive received a verbal update by GB in regard to the Better Care Fund. The

submission date is now 3rd May 2016, GB highlighted that financial pressures, clarity in regard to community models and delayed transfers of care need to be included. The BCF includes NHS support for Social Care with the original budget of £3.5m. The CCG had given additional funding of £1m, however the Council still has a financial gap of £1.4m. The paper is being submitted to the Council Executive meeting on 21 April 2016, this has already been submitted to the Scrutiny Committee. There is a risk that this paper may not be supported. The agreement is planned for Wednesday 27 April 2016 and the paper is to be presented to the Governing Body on 28 April 2016.

The Clinical Executive noted the Better Care Fund Update. 16-017 viii. Isle of Wight Strategic Estates Plan The Clinical Executive was advised that the Isle of Wight Strategic Estates Plan will be

circulated by email in due course. The submission date is scheduled for the end of June 2016.

The Clinical Executive noted the Isle of Wight Strategic Estates Plan. 16-018 ix. Financial Plan 2016/17 The Clinical Executive received a tabled Financial Plan 2016/17 presented by HS. HS advised

that the CCG had submitted a ‘break even’ position. The IOW NHS Trust has submitted a deficit. NHSE is not happy with the position and required the CCG to appoint a turn-around director to carry out a focused piece of work. LO confirmed that the role would be an accountant and that the CCG will be required to fund the post, the specification will need to be provided, names of suggested personnel will be given and the CCG will make the choice. The post will have a system focus.

The Clinical Executive noted the Financial Plan 2016/17 and approved for the Financial Plan

2016/17 to be submitted to the Governing Body.

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8. Medicines Management Review 16-019 The Clinical Executive received a verbal update by LK in regard to the Medicines Management

Review held on 14 March 2016. LK presented GP feedback slides to the Clinical Executive, which identified the following common themes:

• GPs greatly value ScriptSwitch, Eclipse Alerts and Medication Review. • Monthly Visits to the Practices – face to face contact. • Reduction of the costs in prescribing – advice and action – medicines optimisation to

be carried out by the Team. • Recruitment of a Head of Medicines Management. • Locality Working – improved communication.

LK advised that as well as the recruitment of a Head of Medicines Management, a Joint Deputy Head of Medicines Management is being considered; this will be a joint post between the CCG and IOW NHS Trust. LK confirmed that the current Medicines Management Team is in full agreement.

The Clinical Executive noted the Medicines Management Review. 9. Childhood Immunisations 16-020 The Clinical Executive received paper CE16-015 Childhood Immunisations. It was agreed that

BB would feedback to Emily MacDonald that this paper was not the expectation of the Clinical Executive.

The Clinical Executive noted the Childhood Immunisations paper. ACTION: BB to feedback in regard to the Childhood Immunisations paper to Emily MacDonald BB 10. Information Management and Technology 16-021 i. GP/GMS IT The Clinical Executive received a verbal update by HS in regard to GP/GMS IT. Roll-out is in

place and feedback from the Practices that have gone ‘live’ is positive. TW shared his concern in regard to the decline of the current IT services as Vision the current provider is no longer assisting with performance issues. It was agreed that patient safety could potentially be compromised and HS will request that Caroline Morris (CM) explores this further.

The Clinical Executive noted GP/GMS IT. ACTION: HS to request CM explore the current IT problems in regard to Vision. HS/CM 16-022 ii.CCG IT The Clinical Executive received a verbal update by HS in regard to CCG IT; all equipment has

been delivered to the CCG. AH is agreeing a roll-out timeline in liaison with IOW NHS Trust IT services.

The Clinical Executive noted CCG IT.

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11. Minutes For Noting 16-023 The Clinical Executive noted the following minutes: v. Paper CE16-016 Contract Monitoring and Service Review (CM & SR) Meeting – 22.03.16 vi. Paper CE16-017 Clinical Effectiveness Committee Meeting – 25.02.16 vii. Paper CE16-018 Joint Adult Commissioning Board (JACB) – 06.04.16 The Clinical Executive noted the CM&SR, Clinical Effectiveness Committee and Joint Adult

Commissioning Board minutes.

12. Update Session 16-024 iii. Chair No update received. 16-025 iv. Chief Officer No further update was received. 13. Any Other Urgent Business 16-026 Quality, Innovation, Productivity and Prevention (QIPP) – Sandy Hogg, Interim Associate

Director of Commissioning presented slides in regard to QIPP, these will be circulated post-meeting. A System Resilience Leadership Group took place on 18 April 2016 and the key principles were discussed. An action plan containing 10 key areas was circulated. SH advised that if the system flow improves, RTT and A&E will improve. A work programme will be implemented and an all-day event has been planned for 25 April 2016 to produce this programme. A weekly Task and Finish Group will also be implemented and an evaluation of pilot schemes that have taken place system-wide over the past 12-months will be undertaken. It was agreed that the detail will be brought back to the next Clinical Executive. ML stated that Primary Care has been omitted from the plan. It was confirmed that Primary Care members David Anderson and Cabrini Salter are members of the System Resilience Group (SRG); it was identified through feedback that neither attend on a regular basis. It was agreed that the Terms of Reference are being reviewed. JH advised that the function of SRG has changed and an Executive GP should be considered as a member and ML would be an appropriate member.

ACTION: QIPP to be added to next Clinical Executive agenda. TR ACTION: Membership of the System Resilience Group (SRG) to be reviewed. HS/SH 14. Date of Next Meeting: 16-027 Thursday 19 May 2016 12.30 – 15.30hrs,Carisbrooke Room, Block A The Apex, St Cross

Business Park, Newport

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Circulation: Members In attendance: For Information (Agenda): Gillian Baker – Deputy Chief Officer Benjamin Browne – CCG Executive Rida Elkheir – Associate Director of Public Health Joanna Hesse – CCG Executive Loretta Kinsella – Director of Quality and Clinical Services Michele Legg – CCG Executive Loretta Outhwaite – Chief Finance Officer John Rivers – CCG Executive Helen Shields – Chief Officer (Chair) Sarah Westmore – CCG Executive Timothy Whelan – CCG Executive

Tracy Richards (Notes) Sandy Hogg Sue Lightfoot Nicola Longson Eleanor Roddick James Seward Laurence Taylor

Liz Elliott For Information (Minutes): Matthew Leek, CCG Commissioning Finance Mgr. Shaun Sweatman, CCG Commissioning Finance Mgr. Linda Rann, Sue Lightfoot, Rachael Hayes, Dawn Berryman, Eleanor Roddick - Heads of Commissioning, Andrew Heyes – Head of Performance Teresa Day - Acting Deputy Head of Medicines Management Caroline Morris – Head of Corporate Business and Primary Care Rebecca Wastall – Deputy Chief Finance Officer Lucy Savill – Information Governance Mgr.

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Governing Body

Quality and Patient Safety Committee Minutes 24 March 2016

Sponsor: Ian Reckless, Secondary Care Doctor

Summary of issue: Minutes of the Quality and Patient Safety Committee (QPSC) Meeting 24 March 2016.

Action required/ recommendation: To note the Quality and Patient Safety Committee Minutes



This document has not been considered at any other committee. QPSC minutes are reported to the Governing Body in public meetings.

Financial /resource implications: There are no financial or resource implications relating to this paper.



A member of Healthwatch is a member of QPSC. These minutes form part of the public record of events.


The Committee remains cognisant of equality and diversity issues in all matters it considers.

Author of Report: Tracy Richards, Governance Support Officer




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Quality and Patient Safety Committee Minutes of the Clinical Commissioning Group (CCG) Quality and Patient Safety Committee held on 24 March 2016 at 09:30hrs in Carisbrooke Room, Block A, The APEX, St Cross Business Park.

PRESENT: Dr Ian Reckless (IR) Secondary Care Doctor (Chair) Dr Benjamin Brown (BB) Clinical Executive Member

David Newton (DN) CCG Governing Body Lay Member Loretta Kinsella (LK) Director of Quality and Clinical Services Joanna Smith (JS) Healthwatch Locality Manager

Lindsay Voss (LV) Governing Body Nurse IN ATTENDANCE: Helen Shields (HS) Accountable Officer

Karen Morgan (KM) Head of Quality Cath Love (CL) Senior Quality Manager Samantha Johnson (SJ) Quality Manager Alison Barton-Smith (AB-S) Commissioning Manager for Secondary Care Laurence Taylor (LT) Governing Body Lay Member - Independent

MINUTED BY: Tracy Richards (TR) Governance Support Officer

15-095 Welcome and Apologies for Absence No apologies were received. Dr David Isaac and Anita Cameron-Smith were not in

attendance.

15-096 Declarations of Interest The Quality and Patient Safety Committee received paper QPS15-082 Declarations of

Interest, noting a new change for Dr Ian Reckless and Ben Browne. • As of 18 April 2016, IR will be employed as Medical Director and Consultant

For the attention of the Governing Body:

The Committee met on 24 March 2016 and discussed the following key issues:

• The results of the IOW NHS Trust staff survey were discussed. They were disappointing/concerning in several regards. The Committee was keen to receive assurance in the near future that the IOW NHS Trust had made an appropriate response to these findings.

• The Committee noted that the Urology Service was under particular pressure. • The Committee discussed the issue of patient deaths whilst under the care of mental health

services in view of the recent concerns about Southern Health NHS Foundation Trust. Some assurance was obtained.

• The interim results of the Isle of Wight Oncology review were received and discussed. • IOW NHS Trust’s low ranking for patient safety in a recent national report was discussed. This

will be brought to the attention of the CQRM at the Trust.

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Physician by Milton Keynes University Hospital NHS Foundation Trust. • BB advised that his wife (Yasotha Browne) is a GP Lead for Paediatrics and not

Mental Health and BB is working 1-day per week within Public Health. A new Declarations of Interest Form is pending. It was agreed that Yasotha Browne would be identified as a GP Lead.

15-097 Confirmation the Meeting is Quorate

Confirmed.

15-098 Minutes of the Last Quality and Patient Safety Meeting 28 January 2016 The Quality and Patient Safety Committee received QPS15-083 Minutes of the Last

Quality and Patient Safety Meeting 28 January 2016, noting the following: • Page 4, Paragraph 4 – ED Performance Q4 may not be a useful comparator, IR

suggested that annual mean may be better for comparison. LK confirmed that 2016/17 would be based on an annual average and an explanation of time comparators (reference points) used would be included.

• Page 5, Paragraph 4 states antibiotics not received, IR asked for clarification, as initially it was thought that antibiotics were given. LK confirmed that antibiotics were not given to patients.

The Quality and Patient Safety Committee Minutes were agreed as an accurate record.

The QPSC received and approved the Quality and Patient Safety Committee Minutes 28

January 2016.

15-099 Matters Arising

Schedule of Actions from 28 January 2016

The Quality and Patient Safety Committee received paper QPS15-084 Matters Arising - Schedule of Actions from 28 January 2016, presented by IR. The following discussion took place:

15-025 - DI to identify what key metrics should be included as pertinent measures in relation to end of life care. DI to discuss this with KM. KM confirmed that a meeting with IOW NHS Trust is scheduled for later on 24 March 2016, where this would be discussed. It was agreed that this item would be closed.

15-082(1) - Healthwatch to present Service Issues and Patient Experience in regard to cancer service at next QPSC on 24 March 2016. It was agreed this is an agenda item and the action would be closed.

15-082 (3) - KM to update at next QPSC on 24 March 2016 in regard to the Endoscopy decontamination incident. KM advised that there is no further update and the incident was due to the transition of relocation of the Endoscopy Unit and water quality was of concern, a new Endoscopy Unit is now in place. Antibiotics were not used. This item is closed.

15-087 - Update on the process of recommendations being implemented from Learning

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from Serious Case Reviews (SCR’s) to be brought back to QPSC. It was agreed that this is an agenda item and the action would be closed.

15-088 - Timeliness of Children in Care reviews and monitoring of mainland placements to be obtained. It was agreed that this is an agenda item and the action would be closed.

15-089(2) - LK to meet with MR to discuss staffing establishments and models for Community Nursing. LK confirmed that Community Services will be included within the QPSC work plan. It was agreed that this action would remain open.

15089(3) - MR to be invited to update in regard to Community Nursing Workforce at a future QPSC, date to be arranged. It was agreed that this action would be closed.

The QPSC received the Schedule of Actions 28 January 2016. Items for Discussion/Decision Performance 15-100 Clinical Governance Report

The Quality and Patient Safety Committee received paper QPS15-085 Clinical Governance report, presented by KM. The Clinical Governance Report identifies exceptions arising from commissioned services and the CCG that will have a direct impact on the quality of services. A schedule of CCG assurance visits to IWNHST has been planned for 2016/17. The areas to be visited have been chosen on the basis of risk, following re-design or to gain a greater understanding of the service provided. In regard to contractual reporting a formal contract letter was written to the Trust’s Executive Director of Nursing in order to improve quality reporting. This has now improved. At the Clinical Quality Review Meeting (CQRM) held on 04 March 2016, the Trust’s Hotel Services Manager presented the findings of the Patient-led Assessments of the Care Environment (PLACE) assessment. This was a comprehensive presentation and assurance was gained, KM confirmed that the next PLACE audit is planned for 14 April 2016 and information will be based on 2015 data. Update on action plans and progress reports will be monitored through CQRM. KM confirmed that joined up working is in place linking with CQC and the CCG and Healthwatch is involved and participate with Mock CQC Inspections. LK advised that the Trust’s ability in triangulating data remains one of the biggest challenges and the CCG is working with the Trust to improve this. In regard to Staff Survey, 2 ‘positive findings’ indicate the Trust’s score is in the best 20% of Trusts, or where the score has improved since 2014. 9 ‘negative findings’ indicate the

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Trust’s score is in the worst 20% of Trusts, or where the score is not as good as 2014. 21 ‘equals findings’ indicate that there has been no change of statistical significance. SJ is carrying out further analysis and this will be presented to the next QPSC. When asked if this was comparative to an Acute Trust, KM confirmed that this is based on the whole organisation and is therefore not comparable LK advised in regard to negative responses in the survey that staff want to feel supported when raising a serious incident and the CCG is working closely to ensure transparency and quick reporting takes place. The concern is that personnel feel the culture is they may not be supported in reporting n incidents. BB commented that negative findings appear to be due to staffing levels. IR asked what actions the Trust will take; KM confirmed that the CCG has requested an action plan to be presented at the May 2016 CQRM. DN commented that the survey is only one indicator and asked is the Trust responding appropriately, LK feels that further assurance is required in regard to staff feedback and how the Trust responds to this. CL advised that Improving Staff Wellbeing is a National CQUIN for 2016/17, which will focus more on outcomes and the CCG will look at both the survey and the CQUIN to assess actions taken. KM advised the Trust has given 12-month notice in regard to Urology Services, which they feel they can no longer provide. HS confirmed that a formal letter has been sent to Karen Baker; IOW NHS Trust Chief Executive recognising that there is a problem and disappointing that notice has been given. A Urology Review, commissioned by the CCG using the same consultant who undertook the Oncology Review is being undertaken. In regard to HCAI’s, KM advised that an Inaugural meeting was held on 16 March 2016 with key stakeholders to identify collectively how to improve CDifficile rates on the Island and confirmed that the CCG is becoming more directly involved with RCA’s for CDifficile within the community setting, led by Karen Morgan. Trajectories for 2016/17 remain the same at 7 for the IOW NHS Trust; the IOW NHS Trust to date has reached 22 with no lapses in care identified. Joint working is in place including Public Health. In regard to 12-hour Trolley Waits, there has been 4 reported in March and an analysis is underway and NHS England (NHSE) has been informed. In regard to Deprivation of Liberty Standards (DoLS), there is a continual rise in alerts, LK advised that the CCG Safeguarding Operational Group (SOG) took place on 23 March 2016, it was identified that DoLS alerts is primarily made by nursing staff with very few referrals made by medical staff. In order to address this, the CCG has funded bespoke training for medical staff funded by the CCG and 2 sessions will take place in the forthcoming year. LK confirmed that Mandy Tyson, CCG Head of Safeguarding is working closely with the IOW NHS Trust Safeguarding Lead. IR highlighted, if there is a death and the person has a DoLS alert in place, there is an automatic inquest and potentially autopsy. Dialogue between the IOW NHS Trust, CCG

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and Coroner may be beneficial. LK advised that a GP Educational afternoon took place on 17 March 2016 and a session on Safeguarding took place, it was identified that if a person is on End of Life (EOL) care, the DoLS can be removed, some GP’s were not aware that this could take place. It was identified that the threshold needs to be scrutinised for autopsy/inquest. In regard to seeking accountability for EOL, KM confirmed that she will be attending an EOL Steering Group to talk through recommendations and to share broader learning. In regard to SIRIs, LK confirmed that there has been 3 never events, 2 were retained swab and 1 was administration of oral medication intravenously, all are still under review. It was identified that Wessex and Providers are outliers for never events, LK confirmed that CL is scrutinising if all never events are reported.

The QPSC noted the Clinical Governance Report. ACTION: CCG Analysis of Staff Survey to be presented to next QPSC. SJ/KM 15-101 Quality Dashboard The Quality and Patient Safety Committee received paper QPS15-086 Quality Dashboard,

presented by KM. The CCG Quality Dashboards rate high level performance against key quality metrics – these dashboards are developmental; the CCG Quality Team is working with the CCG’s Performance Team to refine data collection and improve presentation. From 01 November 2015, the IOW NHS Trust re-organised into five Clinical Business Units; the dashboards have been shared with the Trust to be taken into account when reviewing internal quality reporting and data capture and to consider contract varying into 2016/17 contract to ensure the dashboards are fully populated with the required information. The following questions and discussion took place; IR asked in regard to caesarean section site infections, it was agreed that this should be green. IR requested that numbers as well as percentages are needed and CCG level of assurance on infection rates. CL confirmed that every infection identified within two weeks will have a RCA. DN suggested that numbers as well as percentages would be beneficial within the dashboards, including public impact and due to the small numbers, potentially go to quarterly reporting. IR asked about fractured neck of femur best practice tariff, showing 51%, is this correct? CL confirmed that she would explore this further. DN raised in regard to the KLOE Well Led and the numbers of appraisals completed (35.80%) are staff feeling valued and appraisals are being carried out as the IOW NHS Trust target is 90%. KM confirmed that she will explore further.

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DN asked in regard to blank areas, is this data proving difficult to obtain. KM advised that this is part of contracts negotiation and dashboards shared with the Trust and on the whole the Trust is happy to share data. LV asked for assurance that the IOW NHS Trust is doing all they can in regard to Safer Staffing and recruitment. LK confirmed that the IOW NHS Trust has recruited overseas, however staffing is and remains a concern. The CCG monitors staffing levels by ward areas against Key Performance Indicator’s (KPI’s) as early warning indicators in regard to quality KM advised that Portsmouth University is setting up a pre-registered Adult Nursing course and this has a lower entry criteria compared to Southampton. It was identified that recruitment on the Isle of Wight is particularly challenging, the Isle of Wight is unique and a strategic approach is required. HS confirmed that she has written to the Chair for My Life A Full Life and the associated Workforce Groups to flag and raise the profile in regard to recruitment and retention of an Island workforce.

The QPSC noted the Quality Dashboard. ACTION: CL to explore fractured neck of femur best practice tariff percentage further. CL ACTION: KM to explore the number of staff appraisals undertaken and the plan to meet target. KM 15-102 CQUINS Q3 Report The Quality and Patient Safety Committee received paper QPS15-087 CQUINS Q3 Report,

presented by KM. The report identifies the Isle of Wight NHS Trust Q3 performance against 2015/16 Commissioning for Quality and Innovation Schemes. KM advised that CQUIN Q4 Report is currently in draft and the current position is that 1, Physical Health: Acute Kidney Injury 2a, Physical Health: Sepsis – Screening 2b, Physical Health: Sepsis – Treatment and 3a, Mental Health: Dementia – Find, assess, investigate and refer will be partially met and there will be a reconciliation of monies. In regard to 9a, In-patient Discharges and Transfer of Care – Well planned this is partially met, due to the late start. HS advised that a proposal has been submitted to the IOW NHS Trust that partial payment will be made, which will be a reduction of £300K. KM advised that finance pay 25% on account and the CCG will reconcile monies back if CQUIN is not met. LK confirmed that concern that areas will not be achieved for several months has been raised at Contract, Monitoring and Service Review (CM&SR) meetings. IR asked what approach will be taken as 2016/17 as financially tighter than previous years. KM confirmed that National CQUINs will be implemented and discussions are underway with the IOW NHS Trust in regard to Local CQUINs, planning will include enabling achievements to be met. LK feels that the IOW NHS Trust has lost out on not receiving the CQUIN payments due to often late starts in work programmes and the Trust also recognises that the CCG will not have the same level of finance next year.

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It was suggested that CQUINs are RAG rated for 2016/17 and CQUIN guidance should include no longer than 12-months for completion. It was agreed that CQUINs will be reported as RAG rated including milestones and year end for 2016/17.

The QPSC noted the CQUINS Q3 Report. ACTION: CQUIN Reports to be RAG rated for 2016/17. CL/KM 15-103 Patient Experience Report The Quality and Patient Safety Committee received paper QPS15-088 Patient Experience

Report, presented by SJ. This paper shows the number and subject of complaints, concerns and compliments received regarding commissioned services for Quarter 3 (Oct/Nov/Dec 2015) and Complaints and concerns received regarding Isle of Wight NHS Trust Quarter 3 (Oct/Nov/Dec 2015). LK asked in regard to Page 5, Gynaecology received the highest number of complaints with 8 over 3-months could this be explored further, CL confirmed that further information has already been requested. LK asked in regard to Page 6, PALS, the Trust advised via e-bulletin dated 04 March 2016 that due to staffing issues the decision had been taken to close the PALS office until further notice, anticipated until the end of March. SJ confirmed that this was due to short-term staff sickness has impacted upon this service, people can still telephone, there is just no physical presence. LK shared concern that there was no formal notification and alternative measures could be implemented, it was confirmed that this would be monitored. In regard to the complainants survey, it was confirmed that this is people who file complaints only, which is difficult to benchmark and is handling of complaints only, not the issue of the complaint. LK confirmed that this will be monitored through CQRM. JS advised that Healthwatch has previously been involved and although this is not a current work priority, this is on the future work plan and JS will discuss this with Alan Sheward (AWS), Director of Nursing.

The QPSC noted the Patient Experience Report. ACTION: CL to explore high numbers of complaints in Gynaecological service and identify

trends/themes. CL

ACTION: JS to discuss the Complainants Survey with AWS. JS 15-104 Progress Report in regard to IOW NHS Trust Mental Health/Learning Disability

unexpected deaths

The Quality and Patient Safety Committee received paper QPS15-089 Progress Report in

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regard to IOW NHS Trust Mental Health/Learning Disability unexpected deaths, presented by KM. In December 2015 NHS England published the ‘Independent review of deaths of people with a Learning Disability or Mental Health problem in contact with Southern Health NHS Foundation Trust April 2011 to March 2015’. The review was undertaken by Mazars* in partnership with an Expert Reference Group convened by NHS England. *Mazars is an integrated, international audit, tax and advisory firm with a presence in 69 countries. IOW NHS Trust is currently reviewing the findings of the report and assessing against current practice; attached is the initial response presented to the Board of IOW NHS Trust on 03 February 2016. IR asked if the differentiation between expected death and unexpected death could be included within the final report. LK advised that this was discussed at SOG and it was felt that an analysis is required. KM advised that this is a Local Quality Indicator for the IOW NHS Trust and natural causes are identified and the whole system is currently being scrutinised.

The QPSC noted the Progress Report in regard to IOW NHS Trust Mental Health/Learning

Disability unexpected deaths.

15-105 Patient Experience in regard to Cancer Services The Quality and Patient Safety Committee received a verbal update from JS in regard to

Patient Experience for Cancer Services. The Patient Experience for Cancer Services is included within paper QPS15-091. JS advised that Healthwatch information is available and a draft report is currently awaiting approval, which is broader than the Oncology Review. It was agreed that the Healthwatch Report would be presented to the next QPSC.

The QPSC noted the Patient Experience in regard to Cancer Services ACTION: JS to present the Healthwatch Patient Experience Report to next QPSC. JS 15-106 Update on Endoscopy Decontamination Incident The Quality and Patient Safety Committee received a verbal update from KM in regard to

an Endoscopy Decontamination Incident. KM advised that there is no further update and the incident was due to the transition of relocation of the Endoscopy Unit and water quality was of concern, a new Endoscopy Unit is now in place.

The QPSC noted the update on Endoscopy Decontamination Incident 15-107 Update on the process of recommendations being implemented from Learning from

Serious Case Reviews (SCR’s)

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The Quality and Patient Safety Committee received a verbal update from LK in regard to the process of recommendations being implemented from Learning from Serious Case Reviews (SCR’s). LK confirmed that this will be a standing agenda item for the Safeguarding Operational Group (SOG). The Adults Safeguarding Conference has taken place, this was well attended. A GP Educational event has also taken place with a high turnout led by the CCG Named GP for Safeguarding and the Head of Safeguarding and Maggie Blyth, Chair for the Local Safeguarding Children’s Board also attended. LK advised that discussions are in place in regard to implementing Regional SCR’s, which has advantages and disadvantages.

The QPSC noted the update on process of recommendations being implemented from

Learning from Serious Case Reviews (SCR’s).

15-108 QPSC Workplan 2016/17 The Quality and Patient Safety Committee received a verbal update in regard to the

QPSC Workplan 2016/17, presented by LK and IR. It was identified that a paper has been written and QPSC agreed that this will be circulated for comment and agreed at next QPSC.

The QPSC noted the verbal update for QPSC Workplan 2016/17 ACTION: QPSC Workplan to be circulated for comment and to be agreed at next QPSC. LK 15-109 Research and Development Report The Quality and Patient Safety Committee received a verbal update from CL in regard to

a Research and Development Report. CL has requested the Research and Development Plan and Alex Punter, IOW NHS Trust Research and Development Lead have been tasked to complete this.

The QPSC noted the Research and Development Report. 15-110 Mock CQC Inspection Report for QGC The Quality and Patient Safety Committee received a paper QPS15-090 in regard to the

Mock CQC Inspection Report for QGC presented by LK. A mock CQC inspection was undertaken by the IOW NHS Trust to assess compliance against the Quality Improvement Plan. LK confirmed that there will always be participation by the CCG Quality team as this is a useful process to be engaged in by supporting the Trust and at the same time being able to directly assess quality of care and services delivered. A second mock inspection has taken place, which CL attended and a number of quality issues were noted which the Trust has a plan to address and the CCG will monitor via the CQRM.

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All agreed that commendation should be given to the IOW NHS Trust for undertaking this process which is transparent The question was asked in regard to the IOW NHS Trust nursing structure, is this now in place after the re-organisation. LK confirmed that there are still gaps and the CCG has identified this concern. DN confirmed that he has some assurance in regard to how the CCG is monitoring.

The QPSC noted the Mock CQC Inspection Report for QGC 15-111 Oncology Review Report The Quality and Patient Safety Committee received a paper QPS15-091 in regard to the

Oncology Review Report presented by Ali Barton Smith (AB-S), Commissioning Manager for CCG Secondary Care Hospital Commissioning Team. The Oncology service for the Isle of Wight population was reviewed by an independent management consultant. The review was conducted over 4-months and evidence was gathered from perspectives of key individuals and stakeholders working and supporting the Oncology services on the Isle of Wight, and cross referenced with data from local and national data bases.

A review of Oncology Services for the populace of the Isle of Wight arose from concerns that there had been deterioration in quality of the service with an unsatisfactory out-patient and inpatient service combined with insufficient oncologist time on the Island. In addition, the IOW NHS Trust compliance against National Cancer Peer Review, published July 2014, identified:

• Gaps in the provision of Acute Oncology Services. • Concerns regarding the level of Clinical and Medical Oncologist involvement at

Multi-Disciplinary Team with patients’ treatment decisions, • Oncologists visit the Isle of Wight for a limited number of days per week

This review was jointly commissioned by NHS England Specialist Commissioning and IOW CCG. NHS England is the responsible commissioners for radiotherapy and chemotherapy. The following recommendations were identified within the report:

• A Provider Joint Oncology Board to be established and to meet urgently to address the deficiency in the Acute Oncology Service – Action Plan to be developed that addresses the recommendations.

• NHS England (NHSE) Specialised Commissioning and Isle of Wight CCG to review framework and timescale of commissioning arrangements for Oncology Services between NHSE and Isle of Wight CCG.

• Public Survey to be published end of March 2016 incorporating a brief overview/summary.

• Final report to be submitted to Clinical Executive end of March 2016 and to Kate

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Shields Director, NHS England or via Senior Management Team. • Interim and any ongoing issues to be picked up by Clinical Quality Review

Meeting (CQRM). • Formal letter to be sent to the IOW NHS Trust requesting an Action Plan to

address the immediate concerns regarding patient safety and quality. AB-S confirmed that the CCG does not commission Radiology, Chemotherapy and Rare Cancer; the CCG does commission Common Cancer and Diagnostics. AB-S also confirmed that NHS South Senior Management Team is committed to work through the recommendations. There is a new national expectation to include a Sustainability and Transformation Plan (STP), although this needs to be clarified to enable moving forward. HS confirmed that the Isle of Wight is welcoming the STP as this enables communication for pathways to the mainland. A Joint Board has now been established, which Alan Sheward (AWS), Director of Nursing for the IOW NHS Trust chairs. AB-S and LK are formulating action plans to present to the IOW NHS Trust. IR suggested would telemedicine be beneficial, HS confirmed that further exploration would be required and the CCG could identify Channel Island models in regard to telecom facilities and that a system point of view could also be considered. DN asked in regard to patient involvement and the co-ordination of patients including transportation. It was identified that patient feedback has been shared and they will have sight of the final report. It was confirmed that the Local Authority (LA) has agreed to continue with travel costs for 2016/17. It was identified that Option 7 (Page 62/63) is the preferred option, with a less formal approach and the CCG is in the process of writing a letter to gain further information. Option 7 is the IOW NHS Trust, Portsmouth Hospital Trust and University Hospital Southampton form Accountable Clinical Care Partnership. All staff governed and managed via Cancer Management Board. To design a vision for Cancer Services for the area to include Isle of Wight, Portsmouth & Southampton. To develop a Collaboration Agreement where all Cancer Services are reconfigured to maximize sub-specialisation, economies of scale i.e. radiotherapy. The Services will be managed with Hub and Spoke principles at multi-site and a Cancer Management Board will provide Governance, Leadership and Service Delivery for the Geographical area. Staff will be managed by the Cancer Management Board for strategic direction and cancer service delivery however employed by the Host Organisation they are based at > or = to 50% of their time. AB-S confirmed that there is an action plan in place for immediate risks and concerns. It was agreed that this was a good review.

The QPSC noted the Oncology Review Report

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Papers to Receive/Note for Information 15-112 Clinical Quality Review Meeting Minutes – 05 February 2016 and 04 March 2016

The Quality and Patient Safety Committee received and noted paper QPS15-092 Clinical Quality Review Meeting Minutes dated 05 February 2016 and 04 March 2016, presented by LK. The following comments were made: IR suggested that job titles be included within the present and in attendance section at the beginning of the CQRM minutes. 05 February 2016 – BB updated that the next Junior Doctor Strike will be for 48-hours with no cover. 04 March 2016 – Page 6, Sepsis Targets reduced (CQUINs), requires a black and white approach. Baseline for Q1 negotiated 60%, the CCG implemented 80%.

The QPSC noted the Clinical Quality Review Meeting Minutes dated 06 November and 04

December 2015.

ACTION: Job titles of attendees to be included at the start of the CQRM Minutes. KM/CL 15-113 NHS 111 Clinical Governance Committee Minutes – February 2016 The Quality and Patient Safety Committee received and noted paper QPS15-093 NHS 111

Clinical Governance Committee Minutes dated February 2016, presented by LK. LK identified that she is the sponsor on the front sheet, although David Anderson chairs this meeting. It was agreed that LK would remain the sponsor.

The QPSC noted the NHS 111 Clinical Governance Committee Minutes dated February

2016.

15-114 Safeguarding Operational Group Minutes – 03 February 2016 The Quality and Patient Safety Committee received and noted paper QPS15-094

Safeguarding Operational Group Minutes dated 03 February 2016, presented by LK. It was identified that this is a useful document. LK confirmed that CIC discussion in regard to capturing data will be held separately and the IOW NHS Trust will provide a Safeguarding report, which will be included into the quarterly Safeguarding report presented to QPSC.

The QPSC noted the Safeguarding Operational Group Minutes dated 03 February 2016. 15-115 Any Other Urgent Business 15-116 Learning from Mistakes League – The Quality and Patient Safety Committee received a

verbal update for information from LK/IR in regard to a league table identifying levels of

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openness and transparency within NHS trusts and foundation trusts. The league table has been drawn together by scoring providers based on the fairness and effectiveness of procedures for reporting errors; near misses and incidents; staff confidence and security in reporting unsafe clinical practice; and the percentage of staff who feel able to contribute towards improvements at their trust. The data for 2015/16 – which is drawn from the 2015 NHS staff survey and from the National Reporting and Learning System – shows that:

• 18 providers were outstanding • 102 were good • 78 gave cause for significant concern • 32 had a poor reporting culture

There are two documents available via the following link: https://www.gov.uk/government/publications/learning-from-mistakes-league

The Isle of Wight stand at 212/230, which is within the Poor rating. It was agreed that this item be added to the next CQRM agenda for the IOW NHS Trust to respond and for awareness.

The QPSC noted the Learning from Mistakes League Information. ACTION: Learning from Mistakes League to be added to next CQRM Agenda. KM/CL 15-117 Reporting Other Providers to QPSC – HS asked in regard to the way forward how QPSC

will report other provider information i.e. Physiotherapy, Community and Beacon. LK gave an early level of assurance, advising that the CCG has identified leads for Spire Southampton and Portsmouth, who will be sharing information, which will be included on the May agenda for QPSC. In regard to Officer Level Meetings (OLM) and Heads of Commissioning (HoC), LK confirmed that reports will need to be written and brought to QPSC and this will be actioned this year 2016/17.

The QPSC noted the Reporting Other Providers to QPSC. 15-118 Beacon Centre – HS updated in regard to the Beacon Centre that immediate measures in

regard to pathways has been put in place for Easter. GP shifts are problematic, whereby shifts are being filled at a late stage. Regular meetings are in place with the Provider and this item is on the agenda to be discussed at Clinical Executive. DN confirmed that this is a priority focussed area for WISR.

The QPSC noted the Beacon Centre concerns. 15-119 Date of Next Meeting: Thursday 05 May 2016, 09:30-11:30hrs, Carisbrooke Room, Block A, The Apex, St Cross

Business Park, Newport, Isle of Wight, PO30 5XW.

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https://www.gov.uk/government/publications/learning-from-mistakes-league

Circulation: Members In attendance: For Information

(Agenda): Dr Ian Reckless – Secondary Care Doctor (Chair) David Newton – Vice Chair and CCG Governing Body Lay Member for Patient and Public Involvement Loretta Kinsella - Director of Quality and Clinical Services Lindsay Voss – Governing Body Nurse Dr Benjamin Browne – Clinical Executive Member Dr David Isaac – Co-opted Clinical Executive Member Joanna Smith - Healthwatch Representative

Tracy Richards – Governance Support Officer(Notes) Dr David Isaac – General Practitioner Samantha Johnson – Quality Manager Anita Cameron-Smith – Public Health Cath Love – Senior Quality Manager Karen Morgan – Head of Quality Helen Shields – Chief Officer Mandy Tyson - Head of Safeguarding and Designated Nurse

For Information (Minutes):

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Governing Body

Minutes of the Audit Committee Meeting 24 March 2016

Governing Body Sponsor: Martyn Davies, Governing Body Lay Member for Governance

Summary of issue: Minutes of the Audit Committee 24 March 2016.

Action required/ recommendation: To note the minutes of the Audit Committee.



This has not been considered at any other committee. Audit Committee minutes are reported to the Governing Body in public meetings.


There are no financial or resource implications associated with this paper.



Audit Committee minutes are reported to the Governing Body in public meetings.


Report Author: Emily Galt, Business Administrator for Primary Care and Corporate Business




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Audit Committee: Minutes of the Clinical Commissioning Group (CCG) Audit Committee held on 24 March 2016 at 13:00 in the Bembridge Room, Block A, The APEX, St Cross Business Park, PO30 5XW

PRESENT: Martyn Davies (MD) – Governing Body Lay Member for Governance (Chair) Dr Ian Reckless (IR) – Secondary Care Doctor David Grist (DG) – Associate Lay Member

IN ATTENDANCE: Dr Peter Coleman (PC) – GP Member

Heather Greenhowe (HG) – Counter Fraud Specialist Paul King (PK) / Martin Young (MY) – Ernst and Young – External Audit Loretta Outhwaite (LO) – Chief Finance Officer Giles Parratt (GP) – TIAA Internal Audit Caroline Morris (CM) – Head of Primary Care and Corporate Business MINUTED BY: Emily Galt (EG) – Business Administrator for Primary Care and Corporate

Business

15-045 Apologies for Absence Apologies were received from Helen Shields

15-046 Declarations of Interest The Audit Committee received paper AC15-034 Declaration of Interests paper. This was

agreed as accurate. The following declarations were made in addition to the interests outlined within the paper:

• Paul King is the E&Y Engagement Lead for the IOW Trust • Giles Parratt declared that his firm provides internal audit services to the Isle of

Wight NHS Trust.

For the attention of the Governing Body:

The Audit Committee met on 24 March 2016 and discussed the following key issues:

• The CCG has achieved level 2 compliance with the IG toolkit • The Committee advises that a risk assessment in relation to MTFA (Marauding Terrorist and Firearms

attack) be undertaken as part of the workplan for EPRR during the year • The internal audit plan has been completed for the year and reasonable assurance has been achieved

on all bar two IT related audits that received limited assurance. Plans are in place to rectify the issues identified.

• The plans for the annual external audit were reviewed and the committee received assurance that all information required for the audit was in place.

• The committee reviewed the budget proposals for the next financial year and agreed to recommend them to the Governing Body

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15-047 Confirmation that the Meeting is Quorate Confirmed.

15-048

Minutes of the Last Meeting - 26 November 2015 The Audit Committee received paper AC15-035 Minutes of the Last meeting 26 November 2015. The minutes of the meetings were noted and agreed as accurate.

Matters Arising from the last Meeting on 26 November 2015 15-049 Schedule of Actions taken from the meeting on the 26 November 2015 The Audit Committee received paper AC15-036 the Schedule of Actions from the Audit

Committee meeting on 26 November 2015, the following comments were noted. • 13-026 LO has produced a comprehensive finance report which is appended to

this meeting. Will be received at each Audit Committee. Item closed. • 15-008 LO recently returned to post after secondment. Proposed that this item is

carried forward to June 2016. CCG executives are now more involved with finalising audit reports which should improve turnaround

• 15-021 The Outcomes of the Medicines Management reports will be reviewed at the Governing Body next week.

• 15-023 The HMRC exemptions in place will be reviewed by the end of June. Staff do not need to receive advice as any financial consequences will be automatic deducted from their pay.

• 15-043 CM discussed at EPRR (Emergency Preparedness and Risk Resilience) in December. A risk assessment needs completing regarding capabilities to deal with Marauding Terrorist and Firearms Attack (MTFA). Item closed. New action for the completion of a risk assessment.

The Audit Committee noted the Schedule of Actions from 26 November 2015. ACTION: LO to check when the Meds Management audit was distributed LO ACTION: CM to undertake MTFA risk assessment CM 15-050

Quality and Patient Safety and Clinical Executive Exception Report

The Audit Committee received and noted paper AC15-037 Quality and Patient Safety and Clinical Executive Exception Report. The report highlighted the following:

• High infection rate following Caesarean Section. IR reported that while the percentage is real, it is based on a very small denominator.

The Audit Committee noted the Quality and Patient Safety and Clinical Executive

Exception Report.

Local Counter Fraud Service 15-051 Counter Fraud Progress Report The Audit Committee received paper AC15-038 Counter Fraud Progress Report,

presented by HG. The report highlighted the following: • Responsibility of fraud where various organisations are involved with one

budget. Pooled budgets are an area where there is the opportunity that fraud

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could potentially take place (eg Better Care fund). A discussion took place on how to handle this risk, however it seemed to be the case that the CCG would take responsibility over any funds that it had granted or pooled.

The Audit Committee noted the Counter Fraud Progress report. 15-052

Review and Approve Counter Fraud Annual Work Plan

The Audit Committee received paper AC15-039 Counter Fraud Annual Work Plan, presented by HG.

• Designed to reflect the required standards. • HG is to complete wider research on declarations of interest and also undertake

proactive checks throughout the year on companies that contracts are held with. • Opinion is that the risk of manipulation of data from provider organisations

(page 20) is too low. IR suggested a risk rating of 3x4=12. • Query over mandate fraud and preventions put in place to detect fraudulence

e.g. a company phoning to inform that their bank details have changed. SBS creditor service deals with all changes in data such as bank details. It is expected that any changes would be checked via online details or a call to the company’s head office.

The Audit Committee reviewed and approved the Counter Fraud Annual Work Plan. ACTION: To review the risk rating in relation to manipulation of data from provider

organisations. HG

Internal Audit 15-053 Internal Audit Progress Report The Audit Committee received paper AC15-040 Internal Audit Progress Report,

presented by GP. The report highlighted the following:

• A new audit manager, Nick MacBeath, is due to be in place soon. • The majority of findings had a ‘reasonable’ level of assurance in the ratings

however a few areas with ‘limited assurance’, both which are relating to IT, firstly End Point Protection Measures and secondly the IG Toolkit.

• End Point Security – the laptops and PCs were outdated and lacked the necessary security provisions eg the ability to use a USB memory stick without security measures. All the old devices are being replaced with new software that will comply with guidelines.

• IG toolkit – CCG achieved 100% completion of training which exceeds the 95% target. Now compliant to Level 2 with a number at Level 3.

• One area of the progress against the Annual Plan for 2015/16 has been deferred and has been agreed with Loretta Kinsella (Partnership Working).

• The audit looking at ‘Risk Management and Board Assurance Framework’ is the only area outstanding but it will be completed by the end of April.

• It was highlighted that a number of CCGs do not currently complete a register of external / commercial sponsorship. CM confirmed that it is something that the IOW CCG should be doing and there is a plan in place to encourage all individuals

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to declare sponsorship.

• The importance of clinical representation was stressed to keep the committee patient focused.

The Audit Committee noted the Internal Audit Progress Report 15-054 Final Audit Reports The Audit Committee received paper AC15-041 Final Audit Reports, presented by GP as

discussed above.

The Audit Committee noted the Final Audit Reports. 15-055 Progress Report of Management Actions The Audit Committee received paper AC15-042 Progress Report of Management Actions,

presented by GP. The report highlighted the following: • Due to maternity leave and post changes, it was agreed that TIAA would update

the Management Actions and send out before the next committee meeting

The Audit Committee noted the Progress Report of Management Actions. ACTION: TIAA to update the Management Actions and send out before the next committee

meeting GP

15-056 Internal Audit Plan The Audit Committee received paper AC15-043 Internal Audit Plan, presented by GP.

• The plan is dynamic and will change as needed • LO added that Caroline Morris, Helen Shields and Loretta Kinsella have checked

the Audit Plan.

The Audit Committee reviewed and approved the Internal Audit Plan. External Audit 15-057 External Audit Progress Report The Audit Committee received a verbal External Audit Progress Report from PK/MY • 3 financial statement risks identified:

o Accounting for the Better Care Fund. Arrangements between two providers can be complex and the accounting can depend on the terms of the individual agreements. Ernst & Young have reviewed the plans for financial structure and the procedures for gaining financial information from counterparts and are satisfied that the procedures surrounding significant risks are currently suitable.

o Risk of fraud in revenue recognition. This is a presumed risk. o Risk of management override. This is a presumed risk and uses a risk

management tool and validity test. • According to NHS England’s revised formula, the CCG is currently overfunded by

14.1%. The operating plan and finance strategy have been reviewed.

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• An Audit Results Report will be produced at the end of May after the CCG Annual

Reports and Accounts have been completed. • Ernst & Young have no independence issues with the CCG • The fee structure for 2016/17 will remain the same as 2015/16. There will be a

change for 2016/17 when the CCG make their own audit appointments.

The Audit Committee noted the verbal External Audit Progress Report. 15-058 Annual Audit Plan The Audit Committee received paper AC15-044 Annual Audit Plan presented by PK/MY.

The Audit Committee reviewed and approved Annual Audit Plan. 15-059 Budget The Audit Committee received paper AC15-045 Budget presented by LO.

• NHS England have stated that they will match funding up to £1million to help support some issues that the CCG will face in 2016/17. This would come with permission to draw down on the funding 2016/17. This is non recurrent so long term solutions will need to be sought.

• The committee agreed to recommend the financial plan to the Governing Body. • At present time, the CCG is budgeting to only achieve a break even for 2016/17,

which will not comply with the National business rule of achieving 1% surplus. • Currently no action is needed as there is not a deficit. • The interim budget for 2016/17 was recommended by the committee.

The Audit Committee noted the Budget. 15-060 Annual Report and Accounts The Audit Committee received a verbal update in regard to Annual Report and Accounts

by LO. • LO verbally updated that all is in hand and that there are regular meetings to

ensure that deadlines are being met. • The Better Care Fund will be featured within the Performance Review.

The Audit Committee noted the verbal update of Annual Report and Accounts. 15-061 Review Draft Governance Statement The Audit Committee received paper AC15-046 Review Draft Governance Statement

presented by CM. • Early draft provided to reassure the committee. • EDIT: table on page 2: spelling of ‘Davies, M’. • It was agreed the committee felt it was necessary for the Medicines

Management report be included within the Governance Statement as it was a significant issue for the CCG. Necessary legal checks will be undertaken before publishing to the public.

The Audit Committee noted the Review Draft Governance Statement. Governance, Risk and Internal Control Arrangements 15-062 Governance Risk and Internal Control Reports

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The Audit Committee received and noted paper AC15-047 Governance, Risk and Internal

Control Report, presented by LO. The report highlighted the following: • The main financial risks include a national increase in prescribing costs. • The audit committee were asked to approve a write off of £2,495 due to a

supplier going into administration.

The Audit Committee noted the Governance, Risk and Internal Control Report and approved the write off of £2,495.

ACTION: LO to review payment methods for care homes to see if this situation can be avoided in

the future LO

15-063 Review Register of Interests, Gifts and Hospitality The Audit Committee received and reviewed paper AC15-048 Register of Interests, Gifts

and Hospitality, presented by LO. The report highlighted the following: • Offers of hospitality need to be declared regardless of whether they were

accepted. • The new policy process will be brought to the next committee meeting.

The Audit Committee reviewed the Register of Interests, Gifts and Hospitality. 15-064 2015/16 Information Governance Year End Report The Audit Committee received and noted paper AC15-049 2015/16 Information

Governance Year End Report, presented by LO. The report highlighted the following: • The CCG will meet the required level 2 and have met and exceeded the target of

95% of CCG staff undertaking IG training. • A number of FOI requests exceeded the time frame due to a member of staff

going on maternity leave. • Many requests are for data and lots of information has now been published

online to reduce the time taken to answer requests.

The Audit Committee noted the 2015/16 Information Governance Year End Report. 15-065 Financial Scheme of Delegation The Audit Committee received and noted paper AC15-050 Financial Scheme of

Delegation, presented by LO. • The report was recommended for approval however some amendments need to

be made meaning that it will presented for approval at a future meeting.

The Audit Committee noted the Financial Scheme of Delegation. ACTION: LO and CM to make amendments in light of the Delegated Committee for Primary

Care. LO/CM

15-066 NHS Litigation Authority (NHS LA) Scheme Contributions for 2016/17 The Audit Committee received and noted paper AC15-051 NHS Litigation Authority (NHS

LA) Scheme Contributions for 2016/17, presented by LO.

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The Audit Committee noted the NHS Litigation Authority (NHS LA) Scheme Contributions

for 2016/17.

15-067 Any Other Urgent Business There was no any other urgent business discussed 15-068 Date of Next Meeting Thursday 19 May 2016 – 15:30-16:30hrs – short meeting to look at the accounts

Thursday 25 May 2016 – 13:00-15:00hrs – next full meeting Both to be held at CCG HQ, Carisbrooke Room, The Apex, St Cross Business Park, Newport, Isle of Wight

Circulation: Members: In attendance: Martyn Davies – Governing Body Lay Member for Governance (Chair) David Grist – Associate Lay Member Dr Ian Reckless – Secondary Care Doctor

Peter Coleman – GP Membership Helen Shields – Chief Officer (Apologies Received) Loretta Outhwaite – Chief Finance Officer Caroline Morris – Head of Primary Care and Corporate Business Emily Galt (notes) – Business Administrator for Primary Care and Corporate Business

Invited: Giles Parratt, TIAA Paul King, Ernst & Young Martin Young, Ernst & Young Heather Greenhowe, Hampshire & IW Counter Fraud

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Governing Body Agenda Body/26 M… · 5.1 System Resilience Pla n and CCG QIPP Plan GB Presentation...

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