Annual Report and Accounts - NHS Basildon and Brentwood CCG

Transcription

2015-16
Annual Report and Accounts
Working for a better NHS for everyone
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NHS Basildon and Brentwood Clinical Commissioning Group
Annual Report and Accounts 2015-16
Our third annual report
Section 14Z15 of the National Health Service Act 2006 (as amended) requires
clinical commissioning groups to prepare an Annual Report and Section 17 of
Schedule 1A of the National Health Service Act 2006 (as amended) requires clinical
commissioning groups to prepare annual accounts.
Inside this Annual Report and Accounts 2015-16:
Performance Report:
Overview
Chair and Accountable Officer’s statement page 5
Member practices introduction
page 8
What we do
page 11
Our establishment
page 11
The people we serve
page 11
Working with others to improve services
page 13
Our strategy and objectives
page 13
Reducing health inequalities
page 14
Key issues and risks
page 16
Performance summary
page 18
Involving our communities in our work
page 23
Performance analysis
Delivering the NHS Constitution
page 25
Improving the quality and safety of services page 30
Ambitions
page 30
How we monitor and ensure quality
page 30
Focus on Basildon Hospital
page 31
Infection control
page 32
Child safeguarding
page 33
Safeguarding for vulnerable adults
page 34
Promoting innovation, research,
education and training
Page 35
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Becoming a financially sustainable
organisation
page 38
Material issues and risks facing our
organisation
page 41
Serious Incidents
page 44
Equality and diversity
page 44
Sustainability Report
page 46
Accountability Report
Corporate Governance Report
Members Report
page 48
Statement of the Accountable Officer‘s
responsibilities
page 56
Governance Statement
page 58
Remuneration and staff report
page 75
Remuneration policy
page 75
Remuneration tables
page 77
Pensions table
page 79
Staff report
page 82
Board profiles
page 84
Appendix – Glossary
page 92
Annual Accounts
page 98
Report by the Auditors to the members
page 100
Financial statements
page 105
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Performance report
Overview
5
Foreword by the Chair and Accountable Officer
In our last annual report we outlined four areas of focus for the CCG and for
advancing the health and care for the people of Basildon and Brentwood
during 2015-16, and the publication of our annual report provides us with the
opportunity to report how well we have delivered against these areas.
More
information on
quality and
safety is at
page 30
Improving the quality, safety and experience of NHS services
We have continued to see significant improvements in the quality and safety of
NHS services in Basildon and Brentwood. Basildon Hospital continues to
improve and was deemed to be providing some of the best care available in
the NHS to women giving birth in a report by the Care Quality Commission. It
is a huge team effort across our local health and social care economy to
maintain and improve services. We will continue to work together to ensure
that the patient and quality of care is at the heart of all we do.
Equally, we have also seen over the course of the year significant
improvements in the experience of people who use services at hospital, as
shown through the friends and family test results where we have seen
increases in the number of people sharing their experiences of care and
improvements in the absolute score that patients have given the hospital over
the course of the year.
See page 38 for
more details on
our financial
results
Financial results
Our biggest disappointment for this year has been the inability of the
organisation to achieve its statutory duty to secure a breakeven position during
the course of the 2015-16 financial year, principally due to a range of financial
risks materialising within the financial year which we were unable to mitigate.
A significant element affecting our financial position has been the overall
financial sustainability of our local health economy, where we have seen a
number of our providers move from surplus to deficit positions. This is clearly
unacceptable and must be resolved if we are to provide the level of care and
service that our communities require and to ensure that the ambition as set out
in our five year plan is not compromised. As such in early summer we will be
publishing a ‘Sustainability Plan’ which sets out the steps we will take to
secure financial sustainability in our health and care economy over the coming
years.
See page 13 for
more details on our
plans for the future
Strategy and future plans
In Autumn 2014 we published our five year plan which sets out our ambitions
for health and care for the people of Basildon and Brentwood and the
significant transformation in the commissioning and provision of health and
care services which is required if we are to achieve this vision. This plan
provided us with the opportunity to refresh our vision as an organisation to see
transformed health outcomes for the people of Basildon and Brentwood. This
year we launched our ‘Fit for the Future’ scheme. We want to make services
clearer and simpler for patients to use and reduce complexity, waste and
duplication to create modern health and care services that are built around
patients.
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Working with the people we serve and our key partners
We have continued to transform the way we work with our community and key
partners over the course of 2015-16, including a number of very successful ‘Fit
for the Future’ engagement and discussion events considering the necessary
steps required to integrate health and care services to provide more holistic
care to local people, alongside encouraging our patient and community
reference groups to push forward improvements in care with the phlebotomy
project continuing and experience of NHS 111.
Equally we have continued to become a more active public sector partner and
chair both the Basildon Health Partnership and the Basildon Renaissance
Group.
Responding to challenges and uncertainty
Alongside the rest of the country, our unplanned care system saw significant
pressure over winter and as a result we have been unable to deliver the 95%
standard for the proportion of people who have to wait in A&E for less than 4
hours. The System Resilience Group, which includes the hospital, community
services, ambulance service and CCGs, have agreed a recovery plan to
ensure we achieve the best possible performance, with the aim of a return to
95% standard from September 2016.
Essex was designated as part of the Success Regime by NHS England in
June 2015 and work has increased in pace over the last few months. The
Success Regime is a whole system process and will involve all partners both
health and care across South and Mid Essex. It has the ambition to return the
whole Health and Care system to operational and financial sustainability within
a three year period. This is likely to require a number of changes to current
services across South and Mid Essex as well as addressing a number of
historic challenges that have beset Essex. We will be consulting with our
patients and public during the course of the coming months on a number of
potential changes to services locally.
We continue to take steps to significantly reduce the waiting times for people
with cancer as well as those waiting for elective treatments at hospital. We
have not managed to fully achieve the national standards required and further
work will continue in the current year to address this. We have also been
focusing on cutting the number of people who have been waiting a very long
time for treatment, this drive will enable us to deliver the performance
standards during the coming year.
This year has also seen a number of changes of senior leadership with Tom
Abell leaving as Accountable Officer. The position was covered, until recently,
on an interim basis. We are pleased to announce that from April 2016 John
Leslie has been appointed as our new substantive Accountable Officer
This year also saw Dr Anil Chopra’s term of office as our Chair come to an end
on 31 March 2016, although he remains a Board member. A new Chair, Dr
Aravinda Guniyangodage, who was elected in October 2015 takes over from 1
April 2016. We would like to thank Dr Chopra for his commitment to the local
health system over the last 18 years and wish him well.
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Outlook
The principal challenges for us as an organisation and for the wider health and
care system will be ensuring the operational and financial sustainability of
health and care services in our area. We will need to act with pace and
decisiveness to begin to resolve these challenges and we are committed to do
this through a process of transformation with the purpose of delivering better
health and care for our local population. We recognise this will require
unremitting focus by the CCG on becoming a more agile and enterprising
organisation which can secure excellence and sustainability for the people we
serve.
Dr Anil Chopra
Chair – to 31 March 2016
Dr Arv Guniyangodage
Chair – from 1 April 2016
John Leslie
Accountable Officer
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Member practices’ introduction
The member practices of the clinical commissioning group are required to
collectively agree a report on the reflections of how well the CCG has done over the
past year and the work of the membership body.
Local priority measures
The CCG’s Five Year Plan (published in October 2014) outlined three local priority
measures, these are detailed below.
Local priority 1: Excellence in Primary Care
Local priority 2: Named Accountable Professional Teams
Local priority 3: Specialist pathways
Delivering the NHS Constitution and improving outcomes
The CCG is committed to ensuring that the NHS Constitution is adhered to and our
performance against the standards is outlined in detail elsewhere within this report.
The membership would note for particular attention the recovery in meeting the two
week wait standard that took place over the summer and in maintaining the 31 day
cancer standards, although there is still further work to do to ensure the 62 day
standard is met. Accident and Emergency performance has been challenging this
year and we have not been able to meet the standards required, it should be noted
however that both nationally and locally there has been a considerable increase in
the numbers of people attending our local A&E departments.
The membership will expect to see improvements in the outcomes for patients in our
local area, notably as a result of the implementation of the recommendations of the
Essex Success Regime and integration work with social care.
Delivering our financial requirements
The Membership Body notes with regret that the CCG did not achieve its statutory
financial duties during 2015-16. In the coming year, we will build upon the steps
taken to date such as reviving referral management processes. Clinical leaders
from the membership will continue to work actively with CCG officers to deliver the
financial recovery plan and to ensure that the development of commissioning
priorities is clinically led.
Impact and engagement of the Governing Body and Membership
During 2015-16 the CCG principally used its four locality groups as the main
mechanism by which the membership can influence and shape the commissioning
agenda of the organisation, as well as each locality nominating Board members onto
the Governing Body. Each locality meets monthly to review issues affecting the
locality and also to be updated on CCG issues.
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Effectiveness of the Membership and Governing Body
During 2014-15, the CCG commissioned an external review of its Governance and
Governing Body development from the Good Governance Institute (GGI) who issued
their report in January 2015. Follow up to this review was undertaken by the GGI in
December 2015 which generated further recommendations. The Governing Body,
localities and the management team will work together to take forward these
recommendations during 2016-17.
The update reports to localities have been further developed over the course of the
year since their introduction in 2014-15 and the regular attendance of an executive
officer at locality meetings has further improved communication lines.
Each locality has identified its key achievements throughout the year.
All localities have worked with practices to build and foster closer working
relationships and improved communication with regards to CCG matters.
The Locality Managers have together with commissioners developed a pathway for
recording and investigating provider issues as raised by member practices which
was introduced on 1st January 2016.
Arterial Locality

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Arterial locality underwent elections for its members to represent them on the CCG
commissioning Board. Dr Joseph Arayomi and Dr Nimit Dabas were elected
Arterial locality led on service redesign focussing on community nursing
Arterial locality achieved a significant impact on the referral management compared
with other localities
Arterial locality practice managers drove an initiative to develop work processes with
the local Acute Trust and the CCG to improve:
o Discharge summaries and electronic communication
o Feedback processes to the CCG on patients discharged from Basildon
hospital to optimise care
Member practices piloting impact of aligning social care directly with practices
Member practices piloting social prescribing
Arterial locality members participated in development of ED Front Door service
redesign
Actively encourage close working and engagement with its patients through the
locality patient engagement group
Brentwood Locality
The locality has focussed more on developing plans for sustainability and
transformation this year in light of the current challenges and financial position of the
CCG


Members have looked at referral rates and patterns and are looking to develop the
peer review process going forward in terms of GP directed activity
Worked on developing the community services structure to feed into the
transformation programme of the CCG
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Reviewed the potential for co-commissioning and supported the current process to
look at the CCG taking on a co-commissioning function
Had highly positive feedback from members of the work done by the Care
Coordination GPs at practices and looking to build on this work going forward
Reviewed models of care to improve the sustainability of local health services for the
future
Development of Patient Engagement Group from all practices
Development and involvement of patient participation at practice level
Partnership – BIC Locality
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The Locality reviewed gynaecology referrals after a report of high referrals
Recognition that RMC wasn’t working as well since the review of referrals and
pathways under QP+ ceased, discussions are on-going as to how this can be
improved
Increased engagement with BTUH liaison joint working and trouble shooting
Development of Patient Engagement Group from all practices
Development and involvement of patient participation at practice level
SEMC Locality
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Locality has worked with practices to build and foster closer working relationships
and improved communication with regards to CCG matters
Appointment of care co-ordinator and development of an SEMC “virtual ward”
Accountable to the SEMC GP practices the care co-ordinator will work closely with
practices to case manage the most vulnerable patients in the over 75 age group
Working with SEMC practices to develop a provider arm which will act as the
“vehicle” to deliver innovative health services in line with national initiatives and
priorities in the future
Approved on behalf of the membership:
Dr C Williams, Chair of Arterial Locality
Dr A Guniyangodage, Chair of Brentwood Locality
Dr R Jas, Chair of Partnership-BIC Locality
Dr T Ogunsanya, Chair of SEMC Locality
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What we do
CCGs are responsible for commissioning (i.e. planning, designing and buying
NHS services) for everyone who lives in their local area. In particular CCGs
are responsible for planned hospital care, rehabilitation care, urgent and
emergency care, most community health services and mental health and
learning disability services. To fulfil these responsibilities we work with local
healthcare professionals, local authorities, voluntary organisations and others
to make sure that local people have safe health services that meet their
needs, within the financial resources that are available. We have a duty to
involve and listen to patients and our local communities when we make
decisions about local services.
For more
information on our
Board see page 84
We are led by our Governing Body (Board), which is principally formed of
clinical representatives of our four locality groups. Our Board sets our
strategy and direction, as well as ensures that the CCG is delivering its
statutory duties and ambitions for the health and care of everyone who lives
in Basildon and Brentwood.
Our establishment
We were licenced (authorised) from 1st April 2013 under the provisions
enacted in the Health and Social Care Act 2012, which amended the
National Health Service Act 2006.
The people we serve
We serve a population of 271,500 who live in Basildon District and
Brentwood Borough. Key facets of our population which inform the way we
commission services include:
The JSNA for
our area can be
found on our
website

Basildon has a generally younger population when compared to that
of England, whereas Brentwood has a considerably older population

The area we serve has some of the most affluent and deprived areas
of England, as defined by the Index of Multiple Deprivation – the
greatest area of affluence is in and around Brentwood with greatest
levels of deprivation being in Basildon Town.

These differences result in significant health inequalities with
differences in life expectancy at birth between these areas of 9.6
years for men and 5.5 years for women.
More information on the demographics and health outcomes for people in
Basildon and Brentwood can be found within the ‘Joint Strategic Needs
Assessment’ (JSNA) which the Public Health Team at Essex County Council
worked with us to produce. This document is available on our website.
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Key facts about us:

Established 1st April 2013

Made up of 42 GP practices.

Serving over 271,000 people in the Basildon District
Council and Brentwood Borough Council area.

We are based at Phoenix Place, Christopher Martin
Road, Basildon, Essex, SS14 3HG

We had a budget of £316 328 000 in 2015-16 to
commission NHS services.

We directly employ around 92 people

The main providers we work with are:

o
Basildon & Thurrock University Hospitals NHS
Foundation Trust, Southend University
Hospitals Foundation Trust, Mid Essex
Hospitals NHS Trust and Barking, Havering and
Redbridge Hospitals NHS Trust who provide
most of our local hospital services.
o
North East London NHS Foundation Trust who
provide most community services.
o
South Essex Partnership University NHS
Foundation Trust who provide most mental
health and learning disability services.
o
Spire Healthcare and Nuffield Health are the
principal independent sector hospitals who we
commission services from in our local area.
o
St Luke’s Hospice who provide most end of life
services.
We obtain commissioning support services from NHS
North and East London CSU
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Working with others to improve services
The CCG has strengthened its partnership working with a number of key
stakeholders.
In line with the development of the Better Care Fund, the CCG has undertaken
a significant programme of work with Essex County Council with a view to
broader integration of services to improve the experience and outcomes for
service users. The CCG and Essex County Council have identified two key
service developments as the initial priorities for delivery.
The CCG led the development and delivery of the System Resilience Group.
This brought together a range of stakeholders (social care, acute, community,
mental health, ambulance, out of hours, NHS 111 providers) to discuss the
operational management of the sub economy. This process has ensured that
key issues affecting the delivery of services across the health and social care
system are quickly identified and resolved through a collaborative approach.
The CCG has engaged with both Basildon and Brentwood District Councils on
both general and specific project basis.
Our strategy and objectives
Over the course of the 2015-16 year, the CCG has been working on its plans
and strategies for the future as set out in 2014-15. We set four system
objectives for health and care services in Basildon and Brentwood.
Our Vision is:
“Transform health outcomes for the people of Basildon and Brentwood”
The CCG has three aims and four core objectives for the next five years;
Aim 1: Excellent Primary Care - We will develop a new set of quality markers to
support general practice to strengthen and develop their core primary care.
Aim 2: Named Accountable Professional Teams - We will simplify the current
complex web of services for people with long term need with an aligned set of
professionals working in practice networks – radically reducing the number of
handovers in people’s pathways
Aim 3: Specialist Pathways of Care - We will roll out a set of specialist pathways
which will break down existing barriers in service delivery, be that organisational
configuration, setting of care or different disciplines for people who need
additional care.
Objective 1: Reduce avoidable harm, improve individual outcomes and improve
experience within local health and care services.
Objective 2: Consistently deliver the standards as set out in the NHS
Constitution
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Objective 3: An organisation of clinical and managerial leaders who have the
necessary skills, capacity and capability to lead positive change for the
communities we serve.
Objective 4: A financially robust health and care economy which has the
necessary resource to deliver our vision to transform outcomes for the people of
Basildon and Brentwood.
At an operational plan level, the focus of 2016-17 is to:
1. Work with our GP member practices to strengthen and develop primary
care services so that they meet the needs of our population
2. Restructure health and care services around local communities, giving
everyone with a long-term condition or need, a named person to be
accountable for getting the best possible outcome for them, working as part
of a community based team
3. Improving specialist care to ensure consistent, evidence-based care that
draws on innovative developments from the UK and abroad.
In addition, as a CCG we are required to ensure that we deliver specific
improvements in services as outlined by NHS England through the mandate
which is given to NHS England by the Department of Health, in particular this is
expressed through:


Expected improvements against the NHS Outcomes Framework
Delivery of the standards as outlined within the NHS Constitution
Reducing Health Inequalities
The Integrated Public Health Commissioning Programme comprised an
agreement between the CCG and Essex County Council where the county
council invested in alcohol treatment and falls prevention programmes and the
CCG would deliver increased stroke early supported discharge and integrated
continence services. The plan is to deliver system wide savings whilst
significantly improving the health of the population and reducing health
inequalities. To date this has been successful in delivering an Essex wide
continence care pathway, a comprehensive integrated falls prevention
programme comprising postural stability, medication review, home safety
assessment and eye sight checks, for 2016.
Local stop smoking services assisted 1028 (that’s 52% more than 2013-14) of
local residents to quit smoking in 2014-15 resulting in a reduction of smoking
prevalence at GP practice level.
Making Every Contact Count (MECC) launched in February 2016 and is about
encouraging and helping people to achieve positive long-term behaviour change
by:
 Systematically promoting the benefits of healthy living.
 Asking individuals about their lifestyle and changes that they may wish to
make, when there is an opportunity to do so.
 Responding appropriately to the lifestyle issue(s) once raised.
 Taking the appropriate action to either give information, signpost or refer
individuals to the support they need.
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Social Prescribing will improve the mental health of vulnerable people. We
started a pilot of an innovative primary care based social prescription
programme in two clusters of GP practices in Basildon - Pitsea North, Pitsea
South and Laindon.
Social prescribing is a mechanism for linking residents with early interventions
and prevention support within the community. Referrals can be made for people
aged 16 and over and will address conditions such as low level mental health
issues, multiple long term conditions, and issues associated with bereavement,
loneliness, social isolation, caring or domestic violence.
Social prescribers / navigators will be placed in GP hubs together with a circle of
ten trained volunteers per practice improving the relationship between GPs and
the local community and the knowledge of primary care teams about the range
of community assets available locally.
The initiative aims to:
 Build self-resilience to assist individuals with low level mental health
issues to better manage their holistic health,
 Reduce demand on primary care services and GPs from high intensity
users,
 Provide a practical mechanism to assist patients who make repeat
attendances with non-clinical issues.
The CCG is working with Public Health on diabetes prevention to ensure that
services are identifying patients at risk to have access to support services eg.
weight management or stop smoking services.
The CCG has also undertaken
work on promoting health eating
in schools:
Our member practices have
been updated on prevention
services through our GP
education sessions.
The CCG supports the “every
contact counts” model of care –
this approach is aimed at
ensuring everyone who comes
into contact with members of the
public uses the opportunity to
promote health through
behaviour change e.g. stop
smoking, reduce alcohol and
lose weight. Through this approach we hope to change behaviour and reduce
risk of developing long term conditions such as diabetes.
This work is part of the CCG’s contribution to the delivery of the Health and
Wellbeing strategies.
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Key issues and risks affecting our organisation
The key issues and risks that could affect the CCG in delivering its
objectives are in the areas of the health economy providers failing to
deliver services to the required standard of care due to changing
priorities, resources and commissioning responsibilities.
The principle risks which threaten the CCG achieving its strategic
objectives are contained within this report in detail at page 41.
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Performance Summary
How we spent your money
In 2015-16 the CCG spent £330.9m on the purchasing of health care for the residents of
Basildon and Brentwood. The breakdown of this spend is shown in the chart below.
The majority of the CCG spend is on hospital (acute) services. Of this £112.4m (61%) is
spent with Basildon and Thurrock University Hospital Foundation Trust.
Accident & Emergency
89.2%
% of patients waiting less
than 4 hours for
treatment, admission or
discharge from A&E
(Target: 95%)
The key measure related to urgent care in the NHS Constitution is
that people should wait 4 hours or less in A&E before they are treated
or admitted.
The A&E Department at Basildon Hospital, like much of the country,
has struggled to maintain the 4-hour waiting time standard over the
course of 2015-16. We plan to return to meeting the to 95% standard
from August 2016.
Therefore in collaboration with our partners across South West Essex, we have put in place
a number of services/schemes to support improvement to this standard including:

Additional primary care capacity in both Basildon and Brentwood and
Thurrock localities to deal with demand.

Developing media messages for example “Stay Well this Winter”; “A&E is
for accidents and emergencies” and “111 the smart call to make”
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Improved direct referral pathways for patients with mental health conditions
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The “first 60 minutes” programme in A&E to improve waiting times for
diagnostic tests.
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Continued recruitment of more consultants and other doctors, as well as
overseas recruitment of nursing staff.
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Programme to increase the number of patients discharged from hospital in
the morning
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Seven day a week social work team presence at the hospital
Ambulance Waits
74.02%
Red 1 Ambulance
The East of England Ambulance Service Trust (EEAST) delivers the
ambulance service for our population. North East Essex CCG hosts
the Essex part of the ambulance contract and BBCCG is an active
participant in contract management and improvement activities..
Calls with response
within 8 minutes
(Target: 75%)
62.17%
Red 2 Ambulance
calls with response
within 8 minutes
(Target: 75%)
94.57%
Category A ambulance
calls with ambulance
arrival in 19 minutes
(Target : 95%)
Ambulance response times are a significant challenge as the
performance of the ambulance service has been sub-optimal over
recent years.
In the BBCCG area, the ambulance service has struggled with Red 1
and Red 2 (response within 8 minutes) and A19 (response within 19
minutes) response times.
We have helped to put a number of things in place to help the
ambulance service improve performance:
 Better clinical review of 111 calls resulting to make sure that
ambulances are only sent when necessary.
 Measures to reduce the length of time that ambulances are at
hospitals.
 We participate in the Essex wide Ambulance Improvement Board
in which to find ways of assisting the ambulance service.
Planned Care
Patients should wait no more than 18 weeks from their GP referral to receiving treatment
(with certain exceptions).
91.1%
18 weeks (incomplete
pathways) (Target 92%)
Basildon Hospital met the standard as a whole between April and
September 2015, however, had difficulty in meeting the standard at
individual specialty level. The Trust has narrowly failed the standard
as a whole October – March 2016. The final year end position
remained below standard at 91.1%.
The hospital are working with the CCG to resolve the issue and plan to meet the standard
from May 2016.
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Diagnostics
99.6%
Basildon Hospital has delivered access to diagnostic tests within 6
weeks consistently every month over the last two years with over
99% of our patients receiving a diagnostic test within 6 weeks of
referral.
Percentage of patients
waiting under 6 weeks
for diagnostics
(Target :99%)
Cancer waiting times
91.3%
Maximum 2 week wait
for suspected cancer
referrals. (Target: 93%)
98.6%
Maximum 31 day wait
from diagnosis to first
treatment for all cancers
(Target: 96%)
70.6%
Maximum 62 day wait
from urgent GP referral to
first treatment for cancer
(Target: 85%)
2015-16 saw an unprecedented rise in demand on cancer services
particularly the 2 week wait (2ww) pathway and 91.3% of patients
with suspected cancer were seen within two weeks. Demand is
expected to rise further during 2016-17 in line with the new NICE
guidelines which aim to promote earlier diagnosis. As a result,
Basildon Hospital’s performance worsened over the summer months.
Working with the CCG the hospital met the standard (over 93% of
patients with suspected cancer being seen within 2 weeks) from
November 2015.
Basildon Hospital’s performance on the 31 day diagnosis to first
treatment standard has continued to be consistently good with the
Trust meeting the standard every month over the last two years.
Our remaining challenge is to deliver the 62 day standard (the wait
from initial referral to the start of definitive treatment). Performance
on this standard is poor nationally and often relates to the complexity
of cancer pathways, particularly where patients require diagnostic
tests and treatment at a number of different hospitals.
The CCG has continued to work with partners across Essex to better
define the treatment pathways for these complex cancers. Over
2016-17 we will continue our work to improve cancer outcomes for
patients.
Improving Access to Psychological Therapies
14.65%
Percentage of adults with
anxiety and depression
entering psychological
therapies (Target :15%)
A key government priority for the NHS is to increase the number of
people who suffer from depression who can access psychological
therapies, particularly to help improve their quality of life and gain
employment.
The national ambition for 2015-16 was that at least 15% of the
estimated number of people living in Basildon and Brentwood with
anxiety or depression would receive psychological therapies. We have
continued to work closely with South Essex Partnership University NHS
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60.0%
Percentage of adults with
anxiety and depression
reporting recovery (Target:
50%)
97.8%
Foundation Trust as the provider of this service to our local population.
We narrowly missed this target and achieved 14.65%.
Since January 60% of people accessing these services reported
‘recovery’, against the national standard of 50%. We expect to
continue to meet this standard for the remainder of the year and
throughout 2016-17.
Two new IAPT waiting times standards were introduced for 2015-16:

finishing a course of
treatment entering
treatment within 6 weeks.

(Standard 75%)
99.8%
treatment entering
(Standard 95%)
At least 75% of adults finishing a course of treatment
should have their first treatment session within six weeks of
referral;
A minimum of 95% of adults finishing a course of treatment
should be treated within 18 weeks of referral.
We have continued to work with our provider to ensure the delivery of
these standards where over 97% of patients waited less than 6 weeks
and over 99% of patients waited less than 18 weeks.
Improving choice
A specific consideration of the CCG has been how we improve the range of providers which
are available to people who need services.
To do this, the CCG commissions from a range of NHS and independent sector providers,
both within and outside of our local area. This includes both elective hospital care as well
as a range of choices for diagnostic tests, including ultrasound and MRI scans.
Improving the safety and quality of services
Our ambitions for quality and patient safety.
The CCG recognises that quality and patient safety underpins the achievement of our
strategic objectives.
The CCG therefore has the following ambitions for quality and patient safety:
 Patients and their assessed needs are at the centre of commissioning decisions,
using patient outcomes as the central measure to redesign care pathways and
commission care.
 Commissioned services are safe, clinically effective and provide a positive
experience for patients.
 Robust systems and processes are in place to deliver safe services and positive
experiences.
22
 Collaborative arrangements are in place with other health commissioners and
wider stakeholders, including our patients and population.
 We have the leadership and governance arrangements in place to demonstrate
that we are meeting our statutory responsibilities.
How we monitor and ensure quality improvement
We undertake a series of activities to monitor the safety and quality of NHS services within
Basildon and Brentwood, these activities include:
 The regular review of data and information to identify concerns and issues, this
includes patient and staff satisfaction and complaints, incidents reported by
providers as well as key measures of quality.
 Undertaking announced and unannounced visits to services within Basildon and
Brentwood to check quality and identify areas for improvement.
 Regular contract quality meetings where we question providers on the safety and
quality of their services and agree and monitor the delivery of improvement
actions.
 Working with others including the Care Quality Commission and NHS England to
identify and tackle concerns.
 Participation in the Essex Quality Surveillance Group which provides the
opportunity for commissioners and regulators across health and social care to
discuss quality and safety issues and to agree actions to investigate concerns
and tackle problems.
Looking after our most vulnerable patients
Safeguarding for Children
The CCG has a mandatory requirement to ensure that robust arrangements are in place to
safeguard and promote the welfare of all children and young people. The CCG works
together with partner agencies to prevent children suffering harm and to promote their
welfare by providing services they require to address identified needs and safeguard
children who are vulnerable. The CCG hold all providers to account, through the contract,
to ensure their safeguarding responsibilities are carried and robust processes are in place.
Safeguarding for Vulnerable Adults
The Safeguarding Adults Lead provides assurance to the CCG on the quality and safety of
safeguarding processes. The Patient Safety Team also ensure that safeguarding issues
are given a high priority within commissioned services and that safeguarding is considered
when new services are commissioned or patient pathways are redesigned.
The CCG has developed its relationship with safeguarding colleagues at Essex County
Council. Regular meetings take placed at which “soft” and “hard” intelligence is shared.
The CCG supports the Council with quality visits to gain assurances about patient safety
and quality of care.
23
Involving our communities in our work
During 2015-16, the CCG continued to embed the way it involved and engaged local people
in our work.
This included:

The Patient and Community Reference Group (PCRG) which acts as a formal
reference source for the Governing body.

The work plan of PCRG is aligned to the CCG’s priorities and in order to ensure
enough time is given to key issues workshops focussing on a single topic. The
attendance at these workshops is wider than PCRG members giving people
with an interest in specific areas opportunities to hear about and to feed into
plans.

Our PCRG is supported by active Patient Engagement Groups which are
formed around our four localities. These groups have a wide membership and
are an opportunity for people to bring concerns and suggestions for
improvements to services.

Patients have been involved in the day to day business of the CCG by
participating in the selection of senior members of the CCG team, this was
started in 2014 and patient and stakeholder panels have featured in the
selection process for the Chief Finance Officer and Accountable Officer posts in
2015-16.

The CCG is an active member of the Heart of Pitsea residents group and
regular contributes to funding decisions.

We held our second annual patient event in October 2015 where 55 patients
heard about the Care Act and the CCG’s plans for the future. Workshops
followed and people were able to contribute to the proposals.

There have been a number of events at which people have had the opportunity
to be involved in the early stages of service changes, including the second
annual patient event held in October 2015.

The CCG now commissions an improved diabetes structured education
programme after patients said that the old schemes did not work for them.

The PCRG had a tour of the new state of the art pathology laboratory in
Basildon. We saw how all blood, tissue and other samples are analysed.

We promoted the launch of the Lifestyle Essex app provided by Essex County
Council which signposts people to information, advice and services around
healthy lifestyle topics.
24
Performance report
Performance Analysis
25
NHS Constitution – Accident & Emergency
89.2%
% of patients waiting
less than 4 hours for
treatment, admission or
discharge from A&E
year to date (Target:
95%)
The key measure related to urgent care in the NHS Constitution is
that people should wait 4 hours or less in A&E before they are treated
or admitted.
The A&E Department at Basildon Hospital, like much of the country,
has struggled to maintain the 4-hour waiting time standard over the
course of 2015-16.
We view failure of the 4-hour standard very seriously and consider this a system issue
where intervention is not solely focused on the hospital. Of particular concern to the system
is the poor workforce infrastructure – a chronic national shortage of nurses, doctors and
care workers causes significant strain on performance.
Therefore in collaboration with our partners across South West Essex, we have put in place
a number of services/schemes to support improvement to this standard.
Pre-Hospital

Additional primary care capacity in both Basildon and Brentwood and
Thurrock localities to deal with demand.

Enhanced clinical triage of 111 calls that result in an ambulance
disposition, to reduce demand on ambulance services and conveyance
to hospital.

Updated the Directory of Services to support ambulance crews and 111
call handlers to direct patients to the most appropriate service.

Collaborative working on media communications messages (eg. “Stay
Well this Winter”; “A&E is for accidents and emergencies”; “111 the
smart call to make”)

Hospital Ambulance Liaison Officer role with the ambulance service, to
support ambulance handovers at A&E

Improved direct referral pathways for patients with mental health
conditions through the RAID service

The “first 60 minutes” programme in A&E to improve processing times
for waits to see a senior decision maker, diagnostic tests, etc.

Continued recruitment of additional consultants and middle-grade
doctors, as well as overseas recruitment of nursing staff.

Increased bed capacity (escalation areas) over winter
At Hospital
26
Discharge Processes

A focused programme to ensure 11 discharges occur before 11am to
support flow through the hospital – the CCG has supported this
programme via quality incentive scheme.

Development of ward “league tables” to embed early discharge
programme.

Focused discharge doctor to work at weekends to expedite and process
discharges

Appointment to an interface post (shared post between acute and
community provider) to lead the Hospital Integrated Discharge Service

Regular Multi-agency Discharge Events (MADE), learning from which
supports the system to work differently and support effective discharge

Weekly senior review of challenging discharge pathways to resolve
blocks and issues

Improved utilisation of intermediate care pathways and beds

Introduction of “Discharge to Assess” model where a patient who no
longer needs acute care is discharged to a community hospital, or home
with support, for onward assessment of need.

Seven day social work team presence at the hospital
Ensuring Sustainable Recovery for 2016-17
The System Resilience Group has agreed a recovery plan to ensure we achieve the best
possible performance for the remainder of the winter, with a return to 95% standard from
September 2016. Progress against the recovery plan is monitored via the fortnightly
System Resilience Group meetings, which is the forum where leaders from each of our
health and social care partners meet to support system resilience.
NHS Constitution – Ambulance Waits
74.02%
Red 1 Ambulance
Calls with response
A significant challenge for urgent care is the performance in relation
to ambulance response times. Performance of the East of England
Ambulance Service Trust (EEAST) has been sup-optimal over recent
years.
within 8 minutes
(Target: 75%)
62.17%
Red
2
Ambulance
calls with response
within
8
(Target: 75%)
minutes
North East Essex CCG hosts the Essex part of the ambulance contract
and BBCCG is an active participant in contract management and
improvement activities. EEAST also provide regular representation at
the System Resilience Group.
27
In the BBCCG area, the ambulance service has struggled with Red 1, Red 2 and A19
response times.
Various support mechanisms have been put in place to assist performance:
94.57%

Enhanced clinical review of 999 dispositions arising from 111
calls to reduce dispatch numbers

Intelligent conveyancing (introduced in December 2015) to
support the ambulance service to manage flow through the Essex
hospital system.

HALO role supported through winter funding to support faster
arrival to handover/handover to clear times
Category A ambulance
calls with ambulance
arrival in 19 minutes
(Target : 95%)
There is an Essex wide Ambulance Improvement Board, established by North East Essex
CCG, in which we participate to find ways of assisting the ambulance to perform at the
required standard.
NHS Constitution – Planned Care
91.1%
18 weeks (incomplete
pathways) (Target 92%)
During the year, the standards related to admitted and non-admitted
treatments were disbanded nationally, leaving the sole focus what it
is called on the incomplete standard (ie. 92% of patients on the
waiting list for treatment are waiting less than 18 weeks).
The Trust met the standard at aggregate level April – September
2015, however, continued to experience difficulties in meeting the
standard at individual specialty level.
The Trust has narrowly failed the standard at aggregate level October – March 2016. The
year to date position remains below standard at 91.1%.
The CCG raised a contract performance notice and agreed to a joint investigation with the
Trust to resolve the issue.
The CCG has agreed a formal recovery plan with the Trust, whereby the Trust commits to
sustainably achieving the incomplete standard from May 2016.
NHS Constitution – Diagnostics
99.6%
waiting under 6 weeks
for diagnostics
(Target :99%)
Basildon Hospital’s performance on the 6 weeks standard has
continued to be consistently good with the Trust compliant against the
standard every month over the last 2 years with over 99% of BBCCG
patients receiving a diagnostic within 6 weeks of referral.
28
NHS Constitution – Cancer waiting times
91.3%
Maximum 2 week wait
for suspected cancer
referrals. (Target:
93%)
98.6%
Maximum 31 day wait
from diagnosis to first
treatment for all
cancers. (Target: 96%)
2015-16 saw an unprecedented rise in demand on Cancer services
particularly the 2 week wait (2ww) pathway. The period April November 15 saw an increase of approx. 1350 referrals when
compared to 2014-15. Demand is expected to rise further during
2016-17 as referral behaviours change in line with the new NICE 2
week wait guidelines which aim to promote earlier diagnosis. As
such, BTUH performance on the 2 week wait deteriorated over the
summer months. The CCG issued a contract performance notice and
agreed a recovery action plan with the Trust. The position has
recovered from November, in line with the recovery action plan.
Basildon Hospital’s performance on the 31 day subsequent treatment
standard has continued to be consistently good with the Trust
compliant against the standard every month over the last 2 years.
70.6%
Our remaining challenge is in relation to delivery of the 62 day
standard (the proportion of people who have to wait longer than 62
days from their initial referral to the start of their definitive treatment).
Maximum 62 day wait
Performance on this standard is poor nationally and often in relation
from urgent GP
to the complexity of cancer pathways, particularly pathways that may
referral to first
require diagnostics and treatment at a number of different hospitals.
treatment for cancer
(Target: 85%)
For instance a patient may be diagnosed at Basildon Hospital, have
their cancer staged at a different hospital, and receive treatment at
yet another hospital in Essex. The CCG has continued to work with
partners across Essex to better define the treatment pathways for
these complex cancers – all providers had previously signed up to guidelines on timely
treatment of patients where they cross organisational boundaries and during 2015-16 the
CCG formed a multi trust cancer group that looks to define areas still subject to delay as
they occur and to encourage Trusts to take a view on recovery of this standard on a system
level, taking into account the interdependency of other local Trust performance.
We have continued to work in collaboration with Basildon Hospital as our main provider of
cancer services. Our achievements include the implementation of a Dermatology one stop
“Super Clinic” at BTUH giving patients access to a one-stop service where all diagnostics
are completed on the day of attendance.
Over 2016-17 we will continue our work to improve cancer outcomes for patients, our
activities will include:

Given the success of Basildon’s “Super Clinic” model, agreement has been
reached for Basildon to host the same model in the Southend locality. This will
ensure all Basildon and Brentwood patients have access to timely intervention
regardless of the hospital they wish to attend. The model will be implemented over
Q1.
29

Following the introduction of the new NICE 2 week wait referral guidelines the CCG
has committed to reviewing the current referral process to ensure that GP referral
forms are reflective of the most up to date guidance and processes are
streamlined.
NHS Constitution – Improving Access to Psychological Therapies
14.65%
Percentage of adults
with anxiety and
depression entering
A key government priority for the NHS is to increase the number of
people who suffer from depression who can access psychological
therapies, particularly to help improve their quality of life and gain
employment.
psychological therapies
(Target :15%)
60.0%
Percentage of adults
with anxiety and
depression reporting
recovery (Target: 50%)
The national ambition for 2015-16 is that at least 15% of the
estimated number of people living in Basildon and Brentwood with
anxiety or depression would receive psychological therapies. We
have continued to work closely with South Essex Partnership
University NHS Foundation Trust as the provider of this service to our
local population. We narrowly missed this target and achieved
14.65%.
Since January 60% of people accessing these services reported
‘recovery’, against the national standard of 50%. We expect to
continue to meet this standard for the remainder of the year and
throughout 2016-17.
Two new IAPT waiting times standards have been introduced for 2015-16:
97.8%

At least 75% of adults finishing a course of treatment
should have their first treatment session within six weeks
of referral;

A minimum of 95% of adults finishing a course of treatment
should be treated within 18 weeks of referral
treatment entering
(Standard 75%)
99.8%
treatment entering
treatment within 18
weeks. (Standard 95%)
We have continued to work with our provider to ensure the
delivery of these standards where over 97% of patients have
waited less than 6 weeks and over 99% of patients have
waited less than 18 weeks.
30
Improving the safety and quality of services we commission.
Our ambitions for quality and patient safety.
The CCG recognises that quality and patient safety underpins the achievement of our
strategic objectives as detailed earlier, in particular Objective One (reducing avoidable
harm, improving individual outcomes and improving patient experience of local health
and care services) and Objective Two (consistent delivery of the standards within the
NHS Constitution). The CCG therefore has the following ambitions for quality and patient
safety:

Patients and their assessed needs are at the centre of commissioning
decisions, using patient outcomes as the central measure to redesign care
pathways and commission care.

Commissioned services are safe, clinically effective and provide a positive
experience for patients.

Robust systems and processes are in place to deliver safe services and
positive experiences.

Collaborative arrangements are in place with other health commissioners
and wider stakeholders, including our patients and population.

We have the leadership and governance arrangements in place to
demonstrate that we are meeting our statutory responsibilities.
How we monitor and ensure quality improvement
We undertake a series of activities to monitor the safety and quality of NHS services
within Basildon and Brentwood, these activities include:





The regular review of data and information relating to quality to identify
concerns and issues, this includes patient and staff satisfaction and
complaints, incidents reported by providers as well as key measures of
quality.
Undertaking announced and unannounced visits to commissioned services
within Basildon and Brentwood to check the quality of services and identify
areas for improvement.
Regular contract quality meetings with providers where we question
providers on the safety and quality of their services and agree and monitor
the delivery of actions to improve quality and safety.
Working with others to identify and tackle concerns, this includes the Care
Quality Commission and NHS England.
Participation in the Essex Quality Surveillance Group which provides the
opportunity for commissioners and regulators across health and social care
to discuss quality and safety issues and to agree actions to investigate
concerns and tackle problems.
Within the CCG’s Operational Plan for 2015-16, there was a specific delivery plan for
patient safety and quality.
31
The plan covered areas including driving down avoidable deaths in hospital, through
ensuring that patient safety and quality are at the centre of all commissioning redesign,
improving patient experience and protecting patients from avoidable harm.
Good progress was made in the delivery of the plan, examples of achievements include:
 A sustained and continued reduction in mortality rates within our acute provider;
 Establishment of a process of quality impact assessment for all commissioning
plans;
 Reduction in avoidable pressure ulcers
 Reduction in falls
Throughout 2015-16, we have continued to develop our quality governance. The
presentation of reports has continued to develop to better enable the Board to understand
the issues and improvements being made. There is a bi-monthly update from the Chief
Nurse which includes quality governance within the CCG and an update on the
performance of our main providers in relation to patient safety and quality. The latter
continues to be developed to provide benchmarking data and detail on providers for whom
the CCG is not the lead commissioner but who serve our local population. The quarterly
Patient Voice report has particularly added value to the CCG board meetings ensuring the
patient experience is central to our understanding of quality.
The split of the Quality and Governance Committee to the Patient Safety and Quality
Committee and Governance Committee in October 2014 has worked well enabling greater
focus on relevant topics. This change has allowed for the necessary focus on safety and
quality as well as governance. Both now have sufficient time allocated for full scrutiny of
issues raised. The necessary links between the two committees are maintained through a
common core membership. The Chair of both committees also serves as a CCG board
member with speaking rights.
The patient safety and quality risks are reviewed at every meeting of the Patient Safety and
Quality Committee for inclusion in the Board Assurance Framework or the Corporate Risk
Register.
Focus on Basildon & Thurrock University Hospitals NHS Foundation Trust (BTUH)
2015-16 year has seen continued improvements with respect to patient safety and quality at
BTUH. The CCG continues to work closely with the team at BTUH and regulators to ensure
that improvements during 2015-16 are maintained going forward.
Responding to the Francis Reviews
Since the first review of compliance to the recommendations from the Francis Review into
the failings at Mid Staffordshire Hospital NHS Foundation Trust, BTUH have undertaken a
number of initiatives to address gaps in compliance. 2015-16 saw sustained compliance
which enabled focused scrutiny to be moved to “business as usual” monitoring.
32
Mortality rates (including care of the deteriorating patient)
The Standard Hospital Mortality Indices (SHMI) value for Basildon Hospital has shown a
continual improvement. The latest data shows the value to be within the expected limits,
meaning the number of people who die following treatment is within the expected range.
Given the delay in the reporting of the SHMI rate, BTUH have created a crude proxy
measure for mortality. This measures monthly hospital deaths that enabling BTUH to
produce a projected SHMI ratio. This proxy measure is now being held up as a good
example to be implemented by other Hospital Trusts.
Methodologies to improve the escalation and care of the deteriorating patient have been
another key focus this year. The key improvements have included:
 Continued staff education of the National Early Warning System (NEWS);
 Strengthening the Critical Care Outreach Team;
 Raising the profile of key care bundles; (care bundles are a group of best practice
interventions proven to deliver positive patient outcomes)
 Continued improvements to the Hospital at Night Service;
 Review of senior medical working hours.
Clostridium difficile and MRSA
37
Cases of Clostridium
difficile at Basildon
Hospital against a target
of 31
1
Cases of MRSA at Basildon
Hospital against zero
tolerance standard.
Reducing hospital acquired infections remains a key focus
area for the CCG with a focus on zero tolerance of MRSA
bacteraemias. In the case of MRSA, Basildon Hospital has
reported four contaminants, one actual MRSA
bacteraemia and 2 cases assigned as third party. All
cases are robustly reviewed for lessons to be learned
which are shared across the relevant health economy. We
will continue with a zero tolerance approach on MRSA in
2016-17.
Data as at 31st
March 2016
collected from
CCG monitoring
returns
The number of cases of Clostridium difficile (C.diff ) at Basildon Hospital was
37 during 2015-16 against a target ceiling of 31. It is important to note that a
full root cause analysis was carried out for each case and only one lapse in
care was identified.
The CCG’s infection prevention and control team attend multi-disciplinary meetings with
several main providers to ensure that focus on reducing infection rates are maintained
and that there is a review of all incidences of MRSA and C.diff infections are fully
investigated and learning identified and put into action. Furthermore, they facilitate a
quarterly South Essex Healthcare Associated Infection (HCAI) Network Group to enable
the sharing of lessons learned and best practice.
33
Mixed Sex Accommodation
The CCG is committed to eliminating mixed sex accommodation (MSA) within all
inpatient units from which it commissions unless there
is a clinically justified reason for doing so.
Data collected
Any instances of MSA are investigated fully by the
from CCG
CCG
with
specific
action
plans
developed
by
monitoring
Cases of MSA against
zero tolerance standard.
providers to ensure that this does not happen again.
returns
Alongside this, the CCG also levy fines on providers
for each unjustifiable case of MSA within inpatient
units.
18
During 2015-16, Basildon Hospital had zero breaches with regard to MSA. This is a
significant reduction in numbers from the previous year and comes following a joint
review of BTUH’s MSA processes. As such the CCG, continues to work with BTUH to
identify whether breaches are appropriately recorded. ‘True’ breaches would be those
without an agreed clinical rationale.
Safeguarding for Children
Under Section 11 of the Children Act 2004 BBCCG has a mandatory requirement to
ensure that robust arrangements are in place to safeguard and promote the welfare of all
children and young people. The quarterly report to the Board provides assurance that
BB CCG has robust child protection / safeguarding arrangements in place for 2015-16.
The CCG hold all provider organisations to account, through the contract, to ensure their
safeguarding responsibilities are carried and robust processes are in place.
The CCG works together with partner agencies to prevent children suffering harm and to
promote their welfare by providing services they require to address identified needs and
safeguard children who are vulnerable. The Designated Professionals for Safeguarding,
Child Death Review Rapid Response and Looked After Children (LAC) and Associate
Designated Nurses are directly employed by the CCG.
The CCG is fully compliant with the statutory guidance ‘Working Together to Safeguard
Children 2015’, Safeguarding Vulnerable People in the Reformed NHS: Accountability
and Assurance Framework 2015 and ‘Children Act 1989 & 2004’. The quarterly Board
Reports provides assurance that the CCG had robust child protection / safeguarding /
LAC arrangements in place for 2015-16.
The governance structure for child safeguarding has been improved during 2015-16 as
has the CCG’s relationship with the two Child Safeguarding Boards for Thurrock and
Essex.
Child Death Review
In the event of a child death, systems and processes are in place to ensure the cause of
the death is investigated with all relevant partners. (Partners can include the County
Council, through the Child Safeguarding Board, and as a service provider of social care,
the police and providers of health care).
The Child Death Review Rapid Response Service was implemented late 14/15 to
improve child death reviews. This has embedded well during 2015-16 and has now
become and established service offer advice and support to families.
34
Safeguarding for Vulnerable Adults
The Safeguarding Adults Lead provides assurance to the CCG on the quality and safety
of safeguarding processes ensuring that the organisation is able to discharges its
responsibilities under the Care Act (2014), the Mental Capacity Act (2005), the
Safeguarding Vulnerable Groups Act (2006) and the Equality Act (2010). The Patient
Safety Team also ensure that safeguarding issues are given a high priority within
commissioned services and that safeguarding is considered when new services are
commissioned or patient pathways are redesigned.
The alignment and representation on the Essex Adult Safeguarding Board to bring it into
line with that of the Essex Children’s Safeguarding Board during 2014/15 has continued
through 2015-16. Consequently, the Adults and Children’s Safeguarding Health
Executive Forum has been reviewing its systems and processes post alignment to
ensure robust focus is kept on both safeguarding agendas.
The CCG has developed its relationship with safeguarding colleagues at Essex County
Council. Regular meetings take placed at which “soft” and “hard” intelligence is shared.
The CCG supports the Council with quality visits to gain assurances about patient safety
and quality of care.







Patient Safety and Quality of Care at other providers, these include:
Queens hospital as part of Barking, Havering & Redbridge Hospitals Trust (BHRT)
North East London Foundation Trust for community services
South Essex Partnership Foundation Trust for mental health services
East of England Ambulance Trust
Private hospitals – Nuffield Brentwood and Spire Hartswood Brentwood
Hospices
NHS111
The Patient Safety Team has continued to attend Clinical Quality Review Groups for
other providers and receive data. The team has attended joint quality visits throughout
the year and has sound conduits for escalation of concerns. An update on all other
providers is presented to the Patient Safety and Quality Committee which feeds into the
Board.
.
35
Promoting innovation, research, education and training
Research
The CCG has been a member of the North Thames Clinical Research Network (CRN)1
since 2014. North Thames CRN is 1 of 15 local branches making up the National
Institute for Health Research (NIHR) Clinical Research Network with the aim of delivering
research in the NHS across all disease areas.
North Thames CRN is hosted by Barts Health NHS Trust. They are responsible for
ensuring the effective delivery of research in the Trusts, primary care organisations and
other qualified NHS providers throughout the North Thames area.
The aim of North Thames CRN is to increase the opportunities for patients to take part in
clinical research, ensuring that studies are carried out efficiently, and support the
Government’s Strategy for UK Life Sciences by improving the environment for
commercial contract clinical research in the NHS in the North Thames area.
The key focus is the strong recognition of the contribution clinical research can make to
patient care, and to work collaboratively with other NHS providers, such as our CCG, to
translate that focus into the effective delivery of studies across the Basildon and
Brentwood population.
By working with North Thames CRN we make sure that clinical research occupies the
place it deserves to in the day-to-day work of the NHS across Basildon and Brentwood
area.
Working alongside National Institute for Health Research (NIHR) Clinical Research
Network is the Health Research Authority (HRA) which was established in 2011 to
protect and promote the interests of patients and the public in health research, and to
streamline the regulation of research.
The aim of the HRA is to make sure that health research is ethically reviewed and
approved, that people are provided with the information they need to help them decide
whether they wish to take part, and that their opportunity to do so is maximised by
simplifying the processes by which high quality research is assessed. In doing this, the
HRA aim to build both public confidence and participation in health research, and so
improve the nation’s health.
Basildon and Brentwood CCG is the lead commissioner for Basildon and Thurrock
University Hospitals and as such is assured that they are an active participant of
research and have established links with the North Thames CRN and HRA.
GP practices within the Basildon and Brentwood localities are also part of the CRN. The
CRN coordinates and facilitates the conduct of clinical research and provides a wide
range of support to local research.
1
https://www.crn.nihr.ac.uk/north-thames/
36
The CCG recognises the opportunities that research, education and training have to
improve local services as well as providing attractive career opportunities for clinical
staff. Although we have a number of training practices and some practices who are
engaged in research activity, we want to expand the level of training and research
activity across Basildon and Brentwood.
Education in Primary Care - Time to Learn
The CCG funds and facilitated a monthly Time to Learn for clinical staff in GP practices
throughout 2015-16. These sessions comprised of briefings on new services,
developments in pathways of care and clinical education topics. These included,
specialist presentations on acute oncology (cancer treatment), paediatric (children’s)
pathways of care, safeguarding training and an awareness session on the Mental
Capacity Act and Deprivation of Liberties.
Practice Nurse Training
Practice Nurses are directly employed by the GP practices in which they operate. As
employers GP’s are responsible for supporting practice nurses to access necessary
training. The CCG is aware that there have been some inconsistencies to the level of
support provided by GP’s, both nationally and locally.
Locally there has been inconsistency in ways that Practice Nurses have accessed
training or continuous professional development (CPD) with some nurses being unable
to access training to support their core skills and competencies, due to a lack of funding
or local provision of necessary training.
Various models have been developed since 1997 to address educational provision in the
locality with differing levels of success. By not accessing regular CPD there is a risk to
member practices, registered and non-registered nurses and patient safety. Specifically
there may be an impact on direct care delivery in key areas such as cervical cytology
and immunisations if nurses refuse to perform these functions as they are not up to date
with the relevant training.
In response the issues and risks of inconsistent practice nurse education Basildon and
Brentwood CCG have commissioned Castle Point & Rochford CCG Clinical Education
Service to administer the 2015-16 CPD fund on their behalf to support face to face
training for Practice Nurses through the local universities.
In addition the CCG purchased e-learning packages to cover the following areas;

Safeguarding children level 1 and level 2.

Safeguarding adults.

Anaphylaxis.Infection control.

Health and safety.

Moving and handling.

Fire awareness.

Equality and diversity.
37
Nurse Revalidation
The Nursing and Midwifery Council (NMC) has introduced revalidation for nurses and
midwives, designed to strengthen the three-yearly registration renewal process and
increase professionalism. From 18 January 2016, nurses and midwives requiring to
register in April were notified by the NMC of their requirement to revalidate, and were
required to submit their revalidation application by 1 April.
While revalidation is the responsibility of the healthcare professional, employers have a
key role in helping to provide supportive environments and resources to ensure staff
successfully revalidate.
(http://www.nhsemployers.org/your-workforce/retain-and-improve/standards-andassurance/professional-regulation/nursing-revalidation)
The CCG has a number of registered nurses all of whom are required to meet the new
revalidation requirements. Revalidation dates have been identified for all CCG nurses
and their ‘confirmers’ agreed, all confirmers are registered with the NMC. The CCG
have raised awareness and have offered various information and training opportunities
for CCG nurses. Revalidation will form part of the appraisal system.
The Chief Nurse also has a professional responsibility to support Practice Nurses with
regard to revalidation. The CCG has ensured that all revalidation communication is
shared with Practice Nurses through our Locality Managers and a training/information
session intended for Practice nurses was well attended. In addition, the Quality Team
have attended Practice Manager Meetings to present the revalidation process.
Innovation
The CCG have worked to adopt innovative approaches using the delivery agenda set out
in Innovation Health and Wealth: accelerating adoption and diffusion in the NHS to drive
improved outcomes for patients and local communities.
The CCG pro-actively engages with the work of national bodies such as the Institute for
Innovation and Improvement and Regional Innovation Fund to support and promote the
adoption of innovation and the spread of best practice across the NHS.
Additionally, the CCG uses NICE guidance to assist in the monitoring of providers, to
gain assurance about their level of compliance with new innovative models of care.
38
Becoming a financially sustainable organisation
In 2015-16 the CCG has reported a deficit. Whilst this was not in line with our statutory
financial duty of remaining within its revenue allocation, it was in line with
the recovery plan agreed with NHS England to address our longer term
Full details
financial sustainability. The CCG financial position in year has been
about our
volatile and a number of financial issues have presented themselves
finances can be
that have resulted in increased costs. These pressures have seen
found at page
greatly increased requirement for hospital and community based
98
services in year. In 2015-16 the CCG has spent £330.9m on the
purchasing of health care for the residents of Basildon and Brentwood. The
breakdown of this spend is shown in the chart below.
The majority of the CCG spend is on hospital (acute) services. Of this £112.4m (61%) is
spent with Basildon and Thurrock University Hospital Foundation Trust. The remainder is
spent as per the following chart:
Ensuring value for public money is an important principle of the CCG and is outlined in the
corporate governance framework adopted by the Board. To ensure value for money is
achieved, appropriate procurement procedures are in place, including the tendering of
goods and services where necessary. The CCG was supported by procurement
specialists via Attain.
A key priority for the CCG going forward is to ensure that maximum value for money is
being achieved through effective and efficient commissioning arrangements, as the
majority of the CCG’s expenditure is spent on commissioning healthcare. While all
healthcare providers, are expected to deliver a continuous programme of quality
improvement, the CCG must also demonstrate that it is properly considering the health
needs of the local population and commissioning services that address those needs.
During 2015-16 the CCG worked with the NHS and social care colleagues to identify
opportunities for system –wide Quality, Improvement, Productivity and Prevention (QIPP)
QIPP and agreeing how we will respond to the challenging financial climate in which the
NHS will operate over the coming years. In 2015-16 the CCG set a QIPP saving target of
£12.54m and we achieved this. The main areas of saving were on planned care
reductions and prescribing savings.
Looking forward to the next financial year 2016-17 the CCG’s financial position is going to
be equally challenging. The CCG has agreed with NHSE a planned in year deficit of
£2.5m, which will be very challenging. Even if we deliver this it will not address the
40
historic debt of £10.178m that we incurred in the 2015-16 financial year. To deliver a
deficit of £2.5m the CCG will have to deliver £11.8m of QIPP savings. We continue to
work to identify opportunities in year and these will require absolute focus by the CCG to
ensure we meet our very difficult financial targets.
The Better Payment Practice Code requires the Clinical Commissioning Group to aim to
pay all valid invoices by the due date or within 30 days of receipt of a valid invoice,
whichever is later. This year we paid 91.14% of non –NHS invoices (92.84% by value)
and 90.49% of NHS invoices (97.19% by value) within this 30 day target, of which the NHS
invoices is an improvement on the previous year, there has been a slight deterioration of
1% in the non-NHS invoices paid within target.
41
Material issues and risks affecting our organisation
We have a risk management strategy in place that is reviewed annually and
has been distributed to Governing Body members, staff and key partners.
The Audit Committee is responsible for developing and endorsing the Risk
Management Strategy, which is ultimately approved by the Governing Body.
For more information
on how we manage
risk see page 62
The principle tool we use to identify, monitor and manage risk is the Board
Assurance Framework (BAF) and the Corporate Risk Register (CRR) which
are updated on an on-going basis. We use the Australia / New Zealand 5 by
5 matrix to assess risk which assesses (a) the consequence of a risk and (b)
the likelihood the risk will materialise. The BAF records those risks with are
rated high or extreme. The CRR captures moderate and low-rated risks.
Our risk management activities have identified a number of principle risks
which could affect the success of our organisation in the future. We articulate
over the following pages these risks, the impact we think these will have and
the steps we are taking to reduce the likelihood and/or impact of these.
Material issues and risks affecting our organisation (continued)
Risk
Higher than planned expenditure
growth in hospital, prescribing and
continuing healthcare
Unsatisfactory, poor quality care
provided by East of England Ambulance
Services NHS Trust
Why is it
important?

Patients may receive sub-optimal care
or have a poor experience of using
services provided by the Ambulance
Trust.


Failure to deliver our statutory
financial duties
Loss of reputation
Reduction in commissioned
service availability / quality
What is it about?
We pay for hospital, prescribing
and continuing healthcare services
on a usage basis, therefore if more
services are used than we have
planned this creates financial
pressures on the CCG.
There have been a number of
inspections by various organisations
which have indicated that improvements
at needed at the Trust.
What are we
doing about it?
We have strengthened our financial
monitoring systems and have
engaged a substantive Chief
Finance Officer to help us build a
financially sustainable local health
economy.
We are working closely with other
Essex CCGs and with the lead
commissioner for the Trust (NHS
Suffolk CCG) to improve management
of the contract, including local
management of the Essex operation
within the Trust.
How do we
assess and
monitor this risk?
Monthly reporting to Finance and
Performance Committee and
Board.
Informal service monitoring weekly.
Formal service monitoring monthly.
42
Risk
Poor quality care at Queen’s
Hospital
Poor quality care in Care Homes
Why is it
important?
Patients may receive sub-optimal
care or have a poor experience of
using services at Queen’s Hospital
in East London.
There have been a number of
inspections at Queen’s Hospital
which have indicated that
improvements at needed at the
hospital.
We are working with CCGs in north
east London to increase the
frequency of inspection and
monitoring of the hospital to ensure
they are delivering their quality
improvement plans.
Monthly monitoring through Quality
meetings with the hospital which
are reported to the Patient Safety &
Quality and CCG Board.
or have a poor experience in a care
home in Basildon or Brentwood.
Risk
Poor engagement with member
practices
Poor care at Basildon Hospital
Why is it
important?
If our member practices do not
follow CCG care pathways then
there is a risk that costs that the
CCG have not planned for and that
the CCG may not understand the
issues being faced by practices.
The CCG has identified that
historically practices have not been
engaged very well in commissioning
activities.
or have a poor experience of using
services at Basildon Hospital.
What is it about?
What are we
doing about it?
How do we
assess and
monitor this risk?
What is it about?
What are we
doing about it?
How do we
assess and
monitor this risk?
We have appointed Clinical
Directors to enhance clinical
leadership in commissioning
activities.
We have a monthly ‘Time to Learn’
session for practices in addition to
practices being part of a locality
group which also meet monthly to
discuss commissioning activities.
Through members electing
representatives to the governing
body and reporting their
experiences.
Member practice surveys.
There have been long-standing
concerns regarding the quality of care
homes across England.
We are working with Essex County
Council to share intelligence on the
quality of care homes and meet monthly
to identify concerns, agree inspection
activity and take action where we find
problems.
Monthly meetings with Essex County
Council and contract monitoring reports
from care homes.
Bi-monthly reports to the Patient Safety
& Quality Committee and CCG Board.
There have been concerns regarding
the quality of services at Basildon
Hospital for a number of years, although
there have been significant
improvements during 2014/15. We
need to ensure that these improvements
are maintained given that BTUH is our
CCG’s main provider.
We undertake regular inspections of the
hospital and monitor data about the
quality and safety of services at
Basildon Hospital.
We have regular discussions with
Monitor and the Care Quality
Commission in their capacity as the
regulators of the Hospital.
Monthly contract quality and Keogh
review meetings with Basildon Hospital.
Regular reports to Patient Safety &
Quality Committee and CCG Board.
43
Risk
Poor systems and processes for
managing discharge and
assessing/reviewing eligibility for
NHS Continuing Healthcare
Why is it
important?
Patients may receive inappropriate
packages of care and may
therefore not achieve their optimal
outcome, also avoidable cost
pressures for the CCG
Since taking the CHC function in
house from October 2014, it has
become apparent that the
governance of CHC required
significant overhaul.
What is it about?
What are we
doing about it?
Policies and procedures have been
reviewed by an expert in the field.
Additional nurse assessors have
been recruited.
How do we
assess and
monitor this risk?
Chief Nurse is leading a review of
discharge processes across the
local health and care system.
Regular reports to Patient Safety &
Quality Committee and CCG Board.
Continual review of new and
historic CHC caseloads
The programme to assess patients for
eligibility for Previously Unassessed
Periods of Care (PUPoC) – otherwise
known as retrospective continuing
healthcare claims may not the deadline
of September 2016.
This would result in the liability for any
unassessed eligible claims for the period
between 2004 – 2012 transferring from
NHS England to the CCG.
People could ask for periods of care
going back to 2004 previously
unassessed for continuing healthcare to
be assessed. If found to eligible will be
paid the costs that would have been
made under CHC.
Robust monitoring through constant
contact and liaison with provider to hold
them to account
Investigation of alternative provision to
deliver PUPoC programme within
deadline (September 2016)
Regular progress reports to be
monitored by the Finance &
Performance Committee and CCG
Board
Material issues and risks affecting our organisation (continued)
Emerging material issues
As well as the immediate risks identified over the previous pages, we need to
remain alert to emerging material issues to the delivery of our objectives and
duties.
The key material issue facing the NHS is the financial and operational
sustainability of NHS services in the medium to long term. Sustainability in
this context can be expressed as the ability of the local NHS to provide safe,
effective and high performing services within the context of limited resource
growth and increasing difficulties in recruiting appropriately skilled staff to run
services. This issue faces not just the NHS but equally social care where
there are arguably greater resource constraints which could lead to
restrictions in service provision and greater pressure being placed on the
NHS. In addition to these issues, we have the pressure of an ageing
population who are living with more long-term conditions such as diabetes
and dementia.
44
How we will manage material issues
We outline our five year aims
on page 13
We recognise that we need to tackle this issue head-on and in publishing our
five year aims for the future are working on a detailed five year plan which will
set out the changes that we think are necessary in the way that health and
care services are commissioned and provided in the future to maintain
service quality and deliver financial sustainability for health and care
commissioners and providers for the years ahead.
Specific steps that we intend to take in 2016-17 onwards include:
For more information on how

Implementation of a recovery plan to support the restructuring of local
services which will be required to secure sustainability.

On-going development and delivery of the five year plan through the
Clinical Executive Committee which we intend to extend the membership
to include key providers and local authority commissioners to maintain.
This is in addition to our work with the Essex Health and Wellbeing
Board.

Close working with our Patient and Community Reference Group to
inform the implementation of our 5 year plans and to work with us to
monitor implementation.

Working with CCGs and local authorities across Essex through our
regular groups to tackle issues which require co-ordinated action across
more than one local health system to resolve.
we work with patients see 23
Serious Incidents
The CCG did not report any incidents arising from data loss or confidentiality
breaches during 2015-16.
Equality and diversity
Working towards an NHS that is personal, fair and diverse
Equality is about making sure people are treated fairly and given fair
chances. It’s not about treating everyone the same way, but recognising that
their needs may be met in different ways.
The CCG Board is committed to the NHS Equality Delivery System (EDS),
and has been kept updated on work in this area.
Our Equality and Diversity
Strategy is on our website
The CCG refreshed its Equality & Diversity Strategy during the year and this
was approved by the Board in November 2013. A number of steps have
already been taken to ensure that the CCG fulfils its equality duties:

Information about the composition of the CCG’s workforce has been
published on the dedicated equality & diversity section of the CCG
website;

Within the Equality & Diversity Strategy, the CCG has published its
interim EDS goals;

Equality & Diversity Policy in place;
45

Equality & Diversity is a mandatory training topic for all officers;

Chief Nurse appointed as Board-level lead for equality & diversity;

Equality impact assessments are undertaken on all CCG policies, QIPP
plans and commissioning cases and training has been provided on
conducting equality impact assessments to CCG officers.
46
Sustainability Report
Sustainability has been recognised at a national level as an integral part of high quality
healthcare. We are required to produce a Sustainability Report as part of our annual report,
covering our performance on greenhouse gas emissions, waste management, and use of
finite resources, in line with HM Treasury guidance.
A framework for reporting sustainability information as part of the annual NHS financial
reporting process has been developed by the NHS Sustainable Development Unit and the
Department of Health, to support Trusts in meeting the above mandate and to help monitor
how every NHS organisation contributes towards meeting the national target of a 10% cut in
NHS wide carbon emissions by 2015, and a 34% cut in the overall national carbon footprint
by 2020, the latter enshrined in the Climate Change Act.
Introduction
Sustainability has become increasingly important as the impact of people’s lifestyles and
business choices are changing the world in which we live. In order to fulfil our
responsibilities for the role we play, NHS Basildon & Brentwood CCG has the following
sustainability mission statement located in our Sustainable Development Management Plan
(SDMP):
“Being sustainable will help us make the most of our existing resources – money, supplies,
buildings and energy – without compromising the needs of future generations."
Policies
In order to embed sustainability within our business we have sought to include sustainability
considerations within relevant CCG policies and procedures, these are outlined further in the
table below.
Our policies and
SDMP can be
found on our
website
Area
Is sustainability considered?
Travel
Yes
Procurement (environmental)
Yes
Procurement (social impact)
Yes
Suppliers’ impact
Yes
One of the ways in which an organisation can embed sustainability is through the use of an
SDMP. The Governing Body approved our SDMP in September 2013 so our plans for a
sustainable future are well known within the organisation and clearly laid out.
One of the ways in which we measure our effectiveness as an organisation in respect to
Corporate Social Responsibility (CSR) is through the use of the Good Corporate Citizenship
(GCC) tool. We used the GCC tool to assess our performance in 2015-16, scoring 48%.
GCC Score
47
The tool itself is geared towards NHS providers, hence significant consideration of the
impact of estates which, in our case, we do not own or operate. Therefore, this section was
answered to the best of our ability in collaboration with NHS Property Services Ltd. We will
formally assess our performance again for 2016-17.
Self Certification by the Accountable Officer on the Performance Report
The Annual Accounts have been prepared under a Direction issued by the NHS
Commissioning Board under the National Health Service Act 2006 (as amended).
We certify that the Clinical Commissioning Group has complied with the statutory duties laid
down in the National Health Service Act 2006 (as amended).
John Leslie
Accountable Officer
26 May 2016
48
Accountability
Report
Members’ report
49
Member practices of the clinical commissioning group
The member practices of the clinical commissioning group are
detailed below:













































Ballards Walk Surgery
Chapel Street Surgery
Dipple Medical Centre East Wing (Malling Health)
Dipple Medical Centre South Wing (Dr Nasah)
Dipple Medical Centre West Wing (Dr Sims)
Dipple Medical Centre West Wing (Dr Arayomi)
Dipple Medical Centre (Dr Rao) –until 30 April 2015
The Billericay Medical Practice
Knights Surgery
The New Surgery (Billericay)
The Oakdin Surgery
South Green Surgery
Queens Park Surgery
Western Road Surgery
Rose Villa Surgery
Felmores Medical Centre (Dr Abraham)
Felmores Surgery (Dr Chandal)
Fryerns Medical Centre
Kingswood Medical Centre
Laindon Health Centre (Dr Marshall and Partners)
Laindon Health Centre (Dr Rizvi and Partners)
Murree Medical Centre
Noak Bridge Medical Centre
The Knares Surgery
Matching Green Surgery
Beechwood Surgery
Deal Tree Health Centre
Rockleigh Court Surgery
The Highwood Surgery
The New Folly Surgery
The New Surgery (Brentwood)
Mount Avenue Surgery
The Tile House Surgery
Aegis Medical Centre
Clayhill Medical Practice
Langdon Hills Medical Practice
Shotgate Surgery
Southview Park Surgery
Applewood Surgery – until July 2015 then merged with Swan Lane
to become Swan Wood Partnership
Swan Lane Surgery - – until July 2015 then merged with
Applewood Surgery to become Swan Wood Partnership
Swanwood Partnership – from July 2015
The Gore
The London Road Surgery
The Robert Frew Medical Centre
Wickford Health Centre (SEMC)
50
Chair and Accountable Officer
The Chair of the CCG for 2015-16 was Dr Anil Chopra.
The Accountable Officer of the CCG for 2015-16 was:
Governing body
member profiles
are at page 84
 Tom Abell until 18 September 2015.
 Carolyn Regan from 19 September 2015 until 3 December 2015
 John Leslie was Interim Accountable Officer from 4 December 2015
Composition of the Governing Body
The composition of the governing body during 2015-16 was:
Voting members :
Dr Anil Chopra, Chair and Partnership/BIC representative
Tom Abell, Chief Officer (until 18 September 2015)
Carolyn Regan, Chief Officer (from 18 September until 3 December 2015)
John Leslie, Interim Accountable Officer (from 4 December 2015)
Tony Cox, Deputy Chair and Lay Member (Governance)
Alison Reeve, Lay Member (Patient and Public Involvement)
Dr Arv Guniyangodage, Brentwood Locality Member
Dr Ken Wrixon, Brentwood Locality Member
Dr Sooraj Natarajan, Brentwood Locality Member
Dr Tony Ogunsanya, SEMC Locality Member
Dr Babafemi Salako, SEMC Locality Member
Dr Jojo Mampilly, Partnership/BIC Locality Member
Dr Nehal Ahmad, Arterial Locality Member (to 30 November 2015)
Dr Simon Butler, Arterial Locality Member (to 30 November 2015)
Dr Nimit Dabas, Arterial Locality Member (from 1 December 2015)
Dr Joseph Arayomi, Arterial Locality Member (from 1 December 2015)
Nick Presmeg, Director of Integration/Chief Operating Officer (until 30
November 2015)
Lisa Allen, Chief Nurse
John Leslie, Interim Chief Finance Officer (until 3 December 2015)
Louis Kamfer, Chief Finance Officer (from 16 November 2015)
Dr Julia Hale, Secondary Care Consultant
Attendees with speaking rights :
Katherine Kirk, Lay Chair of Governance Committee and Patient Safety and
Quality Committee
Cllr Ann Naylor, elected member of Essex County Council
Dr Reshma Rasheed, Assistant Clinical Director (Basildon Hospital contract)
Ian Wake, Public Health Consultant, Essex County Council (until 30 June
2015)
Krishna Ramkhelawon, Public Health Consultant, Essex County Council (from
1 July 2015)
Governing body profiles are included within the remuneration report at page
84 and details of the CCGs’ committees can be found in the Annual
Governance Statement at page 58.
51
Personal Data Security
There have been no serious incidents relating to personal data security
breaches, and therefore none were reported to the Information Commissioner.
Political and charitable donations
The CCG made no political or charitable donations during 2015-16.
52
Future developments
Performance report
starts at page 5
Full details on future developments of the CCG are included within the
Performance Report.
Significant activities in research and development
The CCG is not engaged in any significant activities in the field of research
and development.
Branches outside of the UK
The CCG does not have any branches outside of the UK.
Pension Liabilities
The CCG annual accounts detail the accounting policy adopted regarding
the NHS pension scheme liabilities and this can be found in note 4.5 of the
accounts.
External Audit
The appointed auditors for the CCG are Ernst & Young LLP. The total
planned fee for 2015-6 was £66,000 for audit services, inclusive of
irrecoverable VAT.
No other services were commissioned from the external auditors other that
the statutory audit as related services as required by NHS England.
Disclosure of Serious Incidents
The disclosure of Serious Incidents can be found at page 44.
Cost allocation and setting of charges for information
We certify that the clinical commissioning group has complied with HM
Treasury’s Guidance on cost allocation and the setting of charges for
information.
Principles for Remedy - Concerns and Complaints
Concerns and complaints provide us with valuable information about the
experiences of our patients so that we can improve the services that we
commission. Compliments help us to find out what we are doing well so that
we can share best practice, improving still further local health services.
Under the NHS Complaints Regulations which came into effect on 1 April
2009, patients and the public can make a complaint to NHS Basildon &
Brentwood CCG as a commissioner if they do not wish to complain directly
to the provider from which they received care.
53
During 2015-16, the CCG received 49 complaints and concerns about
commissioned services from patients or carers who wished to exercise this
right. In each case, the CCG worked with the complainant and the provider
to achieve resolution in the majority of cases and to identify service
improvements and learning outcomes.
The CCG also received 16 complaints or concerns during the year which
related to the CCG’s commissioning functions and decisions.
The CCG’s Complaints and Concerns Policy reflects the best practice
principles for complaints handling advocated by the Parliamentary & Health
Service Ombudsman (Principles for Remedy, Principles of Good Complaint
Handling and Principles of Good Administration). In accordance with the
Principles for Remedy, we place a strong emphasis upon putting things right
and ensuring continuous improvement and learning from complaints.
Principles for Remedy - Freedom of Information Requests
The Freedom of Information Act (2000) gives a general right of access to
recorded information held by public authorities, subject to certain conditions
and exemptions.
The CCG received 224 FOI requests during 2015-16. 100% elicited a
response from the CCG within the statutory timescale of 20 working days.
This compares with 247 requests and a response rate within the statutory
timescale of 98% during 2014-15.
Disabled Employees / Equal Opportunities
For more
information on
equality and
diversity see page
44
The organisation is committed to equal opportunities for all staff.
At 31st March 2016, there was one member of staff who had declared that
he/she had a disability.
The CCG is an equal opportunities employer and as such recruits under the
Equality ‘two ticks’ scheme. Recruitment and Selection (including both
external and internal recruitment/promotion) procedures follows NHS
Employers ‘good practice guidance’ and meets NHS Employment Checks
Standards.
The CCG has access to HR and Occupational Health advice in order to
support any employees who fall within the scope of the Equality Act 2010.
Each employee is different and the support will be tailored depending on the
circumstances
Emergency preparedness, resilience and response
Within the Civil Contingencies Act 2004 (as amended in 2012), the CCG has
a duty to be prepared for incidents and emergencies. CCGs are a category
two responder under the act and are seen as a ‘co-operating body’. We are
54
therefore less likely to be involved in the detailed planning, but we will be
heavily involved in incidents that affect the health sector through cooperation in response and sharing of information.
The CCG has incident response plans in place, which are fully compliant
with the NHS England Emergency Preparedness Framework. The CCG
emergency preparedness team regularly reviews and makes improvements
to these plans and has a programme for regularly testing them, the results of
which are reported to the Governing Body.
The CCG Incident Response Plan is a pan Essex, generic plan, shared by
all Essex CCGs, with local elements contained within it. The CCG role and
responsibilities are detailed in this plan, as well as in an action card for the
CCG Director on Call outlining their role in an incident. This meets the
requirements of a category two responder as detailed in the Civil
Contingencies Act 2004 and the Health and Social Care Act 2013. The
CCG Director on Call, when required, will also coordinate the local health
system response to a surge/capacity incident at the local acute Trust.
Suitable Plans aligned to ISO22301 are established to enable the CCG to
respond to an internal incident/disruption including an Incident Management
Plan (Business Continuity Plan), Locality Service Level Plans supported by a
Business Continuity Scope and Policy document.
Statement as Disclosure to Auditors
Each individual who is a member of the Governing Body at the time the
Members’ Report is approved confirms:

So far as the member is aware, that there is no relevant audit
information of which the clinical commissioning group’s external auditor is
unaware; and,

That the member has taken all the steps that they ought to have taken
as a member in order to make them self aware of any relevant audit
information and to establish that the clinical commissioning group’s auditor is
aware of that information.
55
Accountability
Report
Statements by the Accountable Officer
56
Statement of Accountable Officer’s Responsibilities
The National Health Service Act 2006 (as amended) states that each Clinical Commissioning Group
shall have an Accountable Officer and that Officer shall be appointed by the NHS Commissioning
Board (NHS England). NHS England has appointed the Chief Officer to be the Accountable Officer
of the Clinical Commissioning Group.
The responsibilities of an Accountable Officer, including responsibilities for the propriety and
regularity of the public finances for which the Accountable Officer is answerable, for keeping proper
accounting records (which disclose with reasonable accuracy at any time the financial position of the
Clinical Commissioning Group and enable them to ensure that the accounts comply with the
requirements of the Accounts Direction) and for safeguarding the Clinical Commissioning Group’s
assets (and hence for taking reasonable steps for the prevention and detection of fraud and other
irregularities), are set out in the Clinical Commissioning Group Accountable Officer Appointment
Letter.
Under the National Health Service Act 2006 (as amended), NHS England has directed each Clinical
Commissioning Group to prepare for each financial year financial statements in the form and on the
basis set out in the Accounts Direction. The financial statements are prepared on an accruals basis
and must give a true and fair view of the state of affairs of the Clinical Commissioning Group and of
its net expenditure, changes in taxpayers’ equity and cash flows for the financial year.
In preparing the financial statements, the Accountable Officer is required to comply with the
requirements of the 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,




There is no relevant audit information of which the CCG’s auditors are unaware
I have taken all the steps that I ought to have taken to make myself aware of any relevant
audit information and to establish the CCGs’ auditors are aware of that information
The annual report and accounts as a whole are fair, balanced and understandable and
that I take personal responsibility for the annual report and accounts and the judgements
required for determining that it is fair balanced and understandable
I have properly discharged the responsibilities set out in my Clinical Commissioning Group
Accountable Officer Appointment Letter.
John Leslie, Accountable Officer
26 May 2016
57
Accountability
Report
58
Governance Statement by John Leslie, as the Accountable Officer of NHS Basildon &
Brentwood Clinical Commissioning Group.
Introduction
The clinical commissioning group was licensed from 1st April 2013 under provisions enacted
in the Health & Social Care Act 2012, which amended the National Health Service Act 2006.
As at 1st April 2015, the clinical commissioning group was licensed with no conditions.
Scope of responsibility
As Accountable Officer, I have responsibility for maintaining a sound system of internal
control that supports the achievement of the clinical commissioning group’s policies, aims
and objectives, whilst safeguarding the public funds and assets for which I am personally
responsible, in accordance with the responsibilities assigned to me in Managing Public
Money. I also acknowledge my responsibilities as set out in my Clinical Commissioning
Group Accountable Officer Appointment Letter.
I am responsible for ensuring that the clinical commissioning group is administered prudently
and economically and that resources are applied efficiently and effectively, safeguarding
financial propriety and regularity.
Compliance with the UK Corporate Governance Code
We are not required to comply with the UK Corporate Governance Code. However, we have
reported on our corporate governance arrangements by drawing upon best practice
available, including those aspects of the UK Corporate Governance Code we consider to be
relevant to the clinical commissioning group and best practice.
Leadership
The CCG is headed by an effective Governing Body comprised of clinical leads, executive
directors and lay members each with clear understanding of individual and collective
responsibilities. There is a clear division of responsibilities with no one individual having
unrestricted decision making powers.
The Chair is responsible for leadership of the Governing Body and ensuring its effectiveness
on all aspects of its role and in particular a clear process for decision making. Our three lay
members, are valued for their impartial focus and expertise, their role is to oversee key
59
elements of governance including audit, remuneration, and engagement. We rely on their
constructive challenge as well as them assisting in the development of strategy. Our audit,
remuneration, governance and patient safety & quality committees are chaired by a Lay
Member.
The Governing Body sets the Clinical Commissioning Group’s strategic aims and, with a
revenue resource limit of £330m for programme spend and £6m for running costs for 201516, ensures that the necessary financial and human resources are in place for the
organisation to meet its objectives.
Principle of Effectiveness
The Governing Body and its committees draw their membership from a broad pool of NHS
staff, clinicians and lay members, providing the appropriate balance of skills, experience,
independence and knowledge of the organisation to enable them to discharge their
respective duties and responsibilities effectively.
A organisational development programme is in place, primarily targeting the needs of
Governing Body members at regular development sessions enabling them to regularly
update and refresh their knowledge and support the CCG’s programme for succession
planning.
To enable the Governing Body to discharge its duties, information is received in a timely
manner well in advance of meetings, in both hard and electronic formats. All papers
presented at Governing Body and Committee meetings follow a recommended format
including a standard front sheet, with three important functions:



Quickly draws members’ attention to the key issues and recommendations.
Clearly states how the main body of the paper provides assurance that identified
risks are being controlled
Provides evidence of the CCG’s compliance with the requirements of the Equality Act
2010 and its duty to secure public involvement in the planning of commissioning
arrangements.
The Governing Body reviews its own performance and that of its committees annually, with
findings and recommendations being formally reported in its public facing meetings.
Principle of Accountability
The Governing Body undertakes a balanced and understandable assessment of the
organisation’s position and forecasts via a number of routes including:



Papers presented to each Governing Body meeting, (e.g. finance, quality and
performance reports)
The development and publication of an Operational Plan
The development of publication of an Annual Report
60
The Audit Committee is chaired by an independent Lay Member with relevant financial
experience. The audit committee is responsible for reviewing the CCG’s internal control and
risk management systems.
Principle of Remuneration
The Remuneration Committee has delegated authority to determine the remuneration and
conditions of service of all Governing Body Members taking into account any national
directions or guidance on these matters. The Committee has the delegated authority to
review the performance of the Accountable Officer and other senior CCG employees and
determine any financial awards as appropriate.
Principle of Relations with Stakeholders
All Governing Body members actively engage in some form of dialogue with our
stakeholders, be they constituent practices, partner organisations or our citizens.
We seek to cultivate a mutual understanding of objectives.
We undertake this by sharing information in a variety of ways including:


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

Publishing an Annual Report
The Annual General Meeting
Cross organisational meetings
Reference to our Patient and Community Reference Group
General Public Meetings
Public facing web site
The Clinical Commissioning Group Governance Framework
The National Health Service Act 2006 (as amended), at paragraph 14 L(2) (b) states:
The main function of the governing body is to ensure that the group has made appropriate
arrangements for ensuring that it complies with such generally accepted principles of good
governance as are relevant to it.
The governance framework of NHS Basildon & Brentwood CCG is set out in the CCG’s
Constitution. This is based on the Model Constitution Framework for CCGs (NHS
England, October 2012). The Constitution has not been amended during the 2015-16
year.
The CCG operates a locality structure, with some commissioning and budgetary
responsibilities devolved to each of the four localities which comprise its Membership Body
as set out in the Constitution. These localities are Brentwood, Partnership/BIC, Arterial and
South Essex Managed Care (SEMC). Each locality elects GP representatives onto the
CCG Governing Body. The total number of member practices that make up NHS Basildon
& Brentwood CCG’s Membership Body started the 2015-16 year at 44 and ended on 42.
The reduction by two practices during the 2015-16 year follows the merger of two practices
into one contract and one practice closure.
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The Governing Body meets on a monthly basis and as of 31 March 2016 its voting
members comprised the Chair (a GP), the Interim Accountable Officer, the Chief Finance
Officer, the Director Commissioning and Performance / (Chief Operating Officer), two Lay
Members (one leading on governance and the other leading on patient and public
engagement), the Chief Nurse, a Secondary Care Specialist Doctor, and eight GP
Governing Body Members. The Lay Member for Governance is also the Deputy Chair.
The GP contract lead for Basildon Hospital is an ex-officio member with full speaking
rights. The Governing Body has co-opted two officers of Essex County Council as
attendees at Governing Body meetings with full speaking rights. These officers are a
Consultant in Public Health and an elected member of the Council. The Governing Body
has also co-opted an additional lay member who attends Governing Body meetings with
full speaking rights. This lay member chairs the Patient Safety and Quality Committee and
the Governance Committee. The average attendance at Governing Body meetings in
public during 2015-16 was 80%.
In accordance with the Financial Reporting Council (FRC) Guidance on Governing
Body Effectiveness, the Governing Body is committed to undertaking a review of its
performance on an annual basis. The CCG commissioned the Good Governance
Institute (GGI) to undertake such a review during 2014-15.
The Governing Body accepted GGI’s findings and conclusions in full and have worked on
the recommendations such as greater focus is required on key strategic issues during
Governing Body meetings such as system transformation and the future of primary care.
A follow up review was undertaken by GGI in December 2015.
To support the Governing Body in carrying out its duties effectively, sub-committees
reporting to the Governing Body are formally established. The remit and terms of
reference of these sub-committees have been reviewed during the year to ensure robust
governance and assurance. Each sub-committee submits its minutes regularly to the
Governing Body and produces an annual report of its activities and any key findings.
The main committees providing assurance to the Governing Body are:
Audit Committee – this committee has delegated authority from the Governing Body to
review and approve the Annual Accounts and Annual Report and provides assurance to
the Governing Body on the organisation’s quality and governance, risk management and
internal control, internal and external audit, counter fraud and financial reporting
arrangements. The Audit Committee is chaired by the Lay Member for Governance /
Deputy Chair of the CCG. A key focus of the Audit Committee is to oversee significant
improvements in the CCG’s risk management systems and processes. The average
attendance of members at Audit Committee meetings during the 2015-16 year was 92%.
The Audit Committee approves an annual work programme for the CCG’s Local Counter
Fraud Service (LCFS). Regular reports of progress against this programme are received
at Audit Committee meetings and the LCFS Specialist attends by invitation when there are
particular issues to be highlighted to the Committee. The Audit Committee also takes
proactive measures by identifying potential risk areas and, where necessary, calling on
management to bring forward corrective actions.
The members of the Audit Committee during 2015-16 were Tony Cox, Alison Reeve and
John Lockwood who are all lay members of the CCG.
62
Patient Safety & Quality Committee meet on alternate months and provides assurance that
quality and safety are being appropriately managed and escalated where necessary. A
key achievement of the Patient Safety & Quality Committee in 2015-16 has been to
continue to improve the scrutiny of quality risks at both committee and Board level. The
average attendance at the new Patient Safety and Quality Committee meetings has been
75%.
Governance Committee meet on alternate months. The key achievement of the
Governance Committee has been ensuring successful submission of the Information
Governance Toolkit for 2015-16 with an achievement of 100% of staff undertaking IG
training leading to the CCG’s continued ability to access patient identifiable data for
commissioning purposes. Governance Committee meetings have had an average
attendance of 83%.
Finance and Performance Committee – this committee provides assurance to the
Governing Body and the Audit Committee that financial issues are being appropriately
managed and escalated where necessary, as well as reviewing the performance of the
main services commissioned by the CCG. The average attendance of members at the
Finance & Performance Committee meetings during the 2015-16 year was 73%.
The Clinical Commissioning Group Risk Management Framework
The CCG has in place a risk management strategy that is reviewed annually and has
been distributed to Governing Body members, staff and key partners. The Audit
Committee is responsible for developing and endorsing the Risk Management Strategy,
which is ultimately approved by the Governing Body.
The Board Assurance Framework (BAF) is the CCG’s principal tool for monitoring and
managing the risks to the achievement of its strategic objectives and statutory duties. This
register captures the highest rated risks. The CCG also maintains a Corporate Risk Register
(CRR) which records and monitors the lower-rated risks, in order to ensure that such risks
are managed effectively to avoid them escalating into more significant risks where possible.
The BAF and the CRR are updated on an on-going basis, with a formal review undertaken
on a quarterly basis. This formal review involves one-to-one meetings between the Head of
Corporate Governance and each risk owner (one of the executive officers) to review
changes in the controls and assurances and progress against agreed actions since the
previous review. The BAF and CRR are then scrutinised in detail by the Governance
Committee and the Audit Committee prior to submission and formal approval by the
Governing Body at one of its meetings in public.
The CCG utilises the Australia / New Zealand risk management model. This provides a
generic framework for identifying, prioritising and dealing with risk in any situation whether at a strategic or operational level. The Australia / New Zealand model utilises a
5x5 matrix which assess the consequences for the organisation if a particular risk were to
materialise and the likelihood of the risk occurring. This process ensures a consistent
approach is taken to the evaluation and monitoring of risk in terms of the assessment of
likelihood and consequence.
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The Head of Corporate Governance and Associate Director, Involvement and
Governance have delegated responsibility for managing the strategic development
and implementation of organisational risk management and corporate governance.
Risk prevention and deterrence is also undertaken via pro-active security and counter
fraud risk reviews, pro-active risk assessments, the dissemination of guidance on the
requirements of the CCG’s Constitution, Standing Orders and Standing Financial
Instruction, monitoring compliance against key CCG policies such as information
governance, and regular staff awareness training. The above mechanisms are also used
to deter risks. Specialist training and support in managing different types of risk is made
available to Governing Body members and staff, to ensure that risk management is
embedded in all aspects of the CCG’s business. By way of illustration, an easy-read guide
to risk management was produced and circulated to all CCG Governing Body members
and staff, including a standard template for highlighting new risks.
Lessons are learnt through adverse and serious incidents, complaints and concerns,
internal audit recommendations, performance management and individual peer reviews,
benchmarking information from NHS England, regulators such as the Care Quality
Commission and from national inquiries and reviews. These lessons are shared with
appropriate staff groups and with member practices via staff briefings, bi-annual
membership events, the CCG’s newsletter and those issued by the Local Counter Fraud
Service (LCFS).
The CCG’s stakeholders support the CCG’s risk management processes in two principal
ways. Firstly, members of the public, representatives of member practices and partner
agencies such as Essex County Council attend Governing Body meetings in public where
the BAF, CRR, risk appetite, Risk Management Strategy and other risk-related issues are
discussed and debated. Secondly, risk is a standing item on the agenda of locality
meetings which are attended by representatives from member practices. Thirdly, the
Accountable Officer and other members of the executive team sit on multi-agency groups
and boards such as the Health and Wellbeing Board and the Local Safeguarding Children
Board where risks are discussed and managed collectively. Information and decisions from
these groups are reflected in the CCG’s BAF and CRR where relevant.
The Clinical Commissioning Group Internal Control Framework
A system of internal control is the set of processes and procedures in place in the clinical
commissioning group to ensure it delivers its policies, aims and objectives. It is designed to
identify and prioritise the risks, to evaluate the likelihood of those risks being realised and the
impact should they be realised, and to manage them efficiently, effectively and economically.
The system of internal control allows risk to be managed to a reasonable level rather than
eliminating all risk; it can therefore only provide reasonable and not absolute assurance of
effectiveness.
64
The Board Assurance Framework (BAF) is the key document which provides an overview of
the controls and assurances in place to ensure that the CCG is able to achieve its strategic
objectives and manage the principal risks identified.
There are a range of controls in place within the CCG which include risk prevention i.e.
ensuring the risk does not occur and includes for example the Scheme of Delegation and
Reservation and financial authorisation and authorisation levels. In addition, the CCG
produces a range of detection controls i.e. performance monitoring and quality reports.
Finally, the CCG has in place directive controls which include a suite of policies and
standard operating procedures which are monitored by the Governance Committee at each
of its meetings, such controls reduce the likelihood of a risk occurring. Additionally, the CCG
also has a statutory and mandatory training regime in place which is also a significant aspect
of control.
The CCG uses three risk scores:
• Initial Risk Score (pre-mitigation): This is the score when the risk is first identified
and is assessed with existing controls in place. This score will not change for the
lifetime of the risks and is used as a benchmark against which the effect of risk
management will be measured.
• Current Risk Score: This is the score at the time the risk was last reviewed in line
with review dates. It is expected that the current risk score will reduce and move
toward the Target Risk Score as action plans to mitigate the risks are developed and
implemented.
• Target Risk Score: This is the score that is expected after the action plan has been
fully implemented.
Our BAF is discussed in more detail on the following page.
Information Governance
The NHS Information Governance Framework sets the processes and procedures by which
the NHS handles information about patients and employees, in particular personal
identifiable information. The NHS Information Governance Framework is supported by an
information governance toolkit and the annual submission process provides assurances to
the clinical commissioning group, other organisations and to individuals that personal
information is dealt with legally, securely, efficiently and effectively.
We place high importance on ensuring there are robust information governance systems and
processes in place to help protect patient and corporate information. We have established
an information governance management framework and are developing information
governance processes and procedures in line with the information governance toolkit. We
have ensured all staff undertake annual information governance training and have
implemented a staff information governance handbook to ensure staff are aware of their
information governance roles and responsibilities.
There are processes in place for incident reporting and investigation of serious incidents.
We are developing information risk assessment and management procedures and a
65
programme will be established to fully embed an information risk culture throughout the
organisation against identified risks.
There are processes in place for incident reporting and investigation of serious incidents.
Risk Assessment in Relation to Governance, Risk Management and Internal Control
The top risks to the CCG throughout the 2015-16 year have included:
 A variety of factors, including acute over-activity, in-year Continuing Health Care






(CHC) cases, prescribing costs and other unexpected cost pressures, the CCG
may fail to achieve its statutory financial duties for 2015-16;
Quality of care provided by East of England Ambulance Services NHS Trust
may fail to improve, be sustainable, or may deteriorate;
Quality of care provided Barking, Havering & Redbridge Hospitals NHS Trust
may fail to improve, be sustainable, or may deteriorate;
Quality of care provided by local care homes may fail to improve, be sustainable,
or may deteriorate;
The CCG’s systems and processes for managing discharge and assessing and
reviewing eligibility for NHS Continuing Healthcare (CHC) in a timely manner may
lead to patients receiving a package of care which is insufficiently tailored to their
needs, compromising achievement of their optimal outcome and creating cost
pressures for the CCG.
The programme to assess patients for eligibility for Previously Unassessed Periods
of Care (PUPoC) – otherwise known as retrospective continuing healthcare claims
may not meet the deadline of September 2016.
A variety of factors, including acute over-activity, in-year Continuing Health Care
(CHC) cases, prescribing costs and other unexpected cost pressures, the CCG
may fail to achieve its statutory financial duties for 2016-17;
During the second half of the 2015-16 year, the risk associated with the CCG’s 2015-16
financial position although still classified as extreme overall score was reduced.
The Governing Body maintains a high degree of oversight with regard to the performance
of the CCG and the providers from whom it commissions services. Management of
performance is undertaken in detail by the Finance & Performance Committee during its
monthly meetings. Performance in terms of patient safety and quality and finance is a
standing item for all Governing Body meetings.
Review of economy, efficiency and effectiveness of the use of resources
Ensuring economy, effectiveness and efficiency in the use of resources is an important
principle of the CCG and is outlined in the corporate governance framework adopted by
the Governing Body. To ensure economy, efficiency and effectiveness in the use of
resources is achieved; appropriate procurement procedures are in place, including the
tendering of goods and services where necessary. Part of the role of the internal audit
66
service that the CCG commissions involves reviewing, appraising and reporting upon the
use of resources within the organisation.
A key priority for the CCG looking forward is to ensure that maximum value for money is
being achieved through effective commissioning arrangements, as the majority of the
CCG’s expenditure is spent on commissioning healthcare services.
While all healthcare providers, are required to deliver a continuous programme of QIPP,
the CCG also must demonstrate that it is properly considering the health needs of the
local population and commissioning those services that address those needs. The CCG
uses the JSNA and the Commissioning for Value tools alongside other benchmarking
tools to identify areas for review to for potential future QIPP schemes.
Leadership for the strategy and direction in ensuring economy, efficiency and effectiveness
in the use of resources comes from the Governing Body. The on-going monitoring of CCG
progress is undertaken by the Audit Committee through the management and direction for
the internal audit programme and regular reviews of risk, and also by the Governing Body
through receipt of regular financial and commissioning updates.
During 2015-16 the CCG has continued to work with our NHS and social care colleagues
across South Essex in developing system-wide Quality, Improvement, Productivity and
Prevention (QIPP) plans setting out how the we will respond to the challenging financial
climate in which the NHS and the wider public sector will operate over the coming years.
The CCG’s overall financial management arrangements and use of resources were also
subject to review by the CCG’s external auditors as part of their annual review of the
CCG’s accounts.
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 clinical commissioning group.
Capacity to handle risk
As Accountable Officer, I have overall responsibility for ensuring that the CCG has the
necessary capacity to effectively identity and manage risk. The Accountable Officer
provides executive leadership to the risk management process. The Head of Corporate
Governance has operational responsibility for risk management, including the regular
review of the Board Assurance Framework.
The Chief Finance Officer has delegated responsibility for managing the strategic
development and implementation of financial risk management.
The Chief Nurse has delegated responsibility for managing the strategic development of
clinical risk management and clinical governance.
67
All executive officers and senior managers are responsible for ensuring that appropriate
and effective risk management processes are in place within their designated areas and
scope of responsibility.
The CCG obtains specialist support and advice in relation to the management of risk
associated with business continuity and emergency planning, resilience and response
(EPRR) from a specialist EPRR team which is hosted by NHS Mid Essex. This team
provides services to all CCGs in Essex and operates under a service level agreement
which is formally monitored on a bi-monthly basis.
Review of Effectiveness
My review of the effectiveness of the system of internal control is informed by the work of
the internal auditors, executive officers and clinical leads within the clinical commissioning
group who have responsibility for the development and maintenance of the internal control
framework. I have drawn on performance information available to me. My review is also
informed by comments made by the external auditors in their management letter and other
reports.
The Board Assurance Framework and the Corporate Risk Register provide me with
evidence that the effectiveness of controls that manage risks to the clinical commissioning
group achieving its principle objectives have been reviewed.
I have been advised on the implications of the result of my review of the effectiveness of
the system of internal control by the Governing Body and the Audit Committee. A plan
to address weaknesses and ensure continuous improvement of the system is in place.
Review of the system of internal control is a key responsibility of the Audit Committee.
Throughout the year, this committee has reviewed and endorsed key elements of the
system of internal control, including the risk management strategy, the corporate
governance manual (comprising the standing orders, standing financial instructions and
scheme of delegation), the work of the local counter fraud service (LCFS) and the
implementation of the conflicts of interest policy. The Governing Body receives assurance
on the work of the Audit Committee by means of receipt of minutes at Governing Body
meetings. The Lay Member (Governance), who is also Chair of the Audit Committee,
verbally highlights issues pertinent to the system of internal control during Governing Body
meetings. Neither the Audit Committee nor the Governing Body have expressed significant
concerns about the adequacy of the system of internal control during the 2015-16 year,
notwithstanding the conclusion of the Head of Internal Audit detailed below.
Following completion of the planned audit work for the financial year for the clinical
commissioning group, the Head of Internal Audit issued an independent and objective
opinion on the adequacy and effectiveness of the clinical commissioning group’s system of
risk management, governance and internal control. The Head of Internal Audit conclusion
follows.
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Head of Internal Audit Opinion
The purpose of my Annual Head of Internal Audit Opinion is to contribute to the assurances
available to the Accountable Officer and the Governing Body which underpin the Governing
Body’s own assessment of the effectiveness of the CCG’s system of internal control. This
Opinion will in turn assist the Governing Body in the completion of its AGS.
My opinion is set out as follows:
1. Overall Opinion;
2. Basis for the Opinion; and
3. Commentary.
Overall Opinion
My overall opinion is that:
Significant assurance can be given that there is a generally sound system of internal
control, designed to meet the CCG’s objectives, and that controls are generally being
applied consistently. However, some weakness in the design and/or inconsistent application
of controls put the achievement of particular objectives at risk;
Basis for the Opinion
The basis for forming my opinion is as follows:
1. An assessment of the design and operation of the underpinning Assurance Framework
and supporting processes; and
2. An assessment of the range of individual opinions arising from risk-based audit
assignments contained within internal audit risk-based plans that have been reported
throughout the year. This assessment has taken account of the relative materiality of these
areas and management’s progress in respect of addressing control weaknesses.
Commentary
The commentary below provides the context for my opinion and together with the opinion
should be read in its entirety.
The Design and Operation of the Assurance Framework and Associated Processes
The review consisted of an evaluation of the processes by which the Governing Body
obtains assurance on the effective management of significant risks relevant to the CCG’s
principal objectives.
An Assurance Framework has been developed aligned with organisational objectives.
Significant risks and key controls are identified and included on the framework which is
subject to regular review. Controls and assurances are evaluated to identify gaps.
Conclusion
It is my opinion that we can provide Significant* Assurance that the Assurance Framework
is sufficient to meet the requirements of the 2015/16 AGS and provide a reasonable
assurance that there is an adequate and effective system of internal control to manage the
significant risks identified by the CCG.
*The Governance, Risk Management and Assurance Framework audit was assigned an Adequate Assurance Audit Opinion,
which provides me with significant assurance that the Assurance Framework is sufficient to meet the requirements of the AGS.
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The Range of Individual Opinions Arising from Risk-Based Audit Assignments,
contained within risk-based plans that have been reported throughout the year
Planning
The Assurance Framework provides a high level governance framework to ensure that the
key risk areas likely to impact the CCG’s business objectives are properly controlled. We
therefore use the Assurance Framework to drive our annual planning.
As part of the Risk Assessment that feeds into our planning, we use information contained in
business plans, committee minutes, risk registers and the assurance framework, as well as
interviewing directors and managers to aid our understanding of organisational processes.
No limitation of scope or coverage was placed upon our internal audit work.
Results of Internal Audit Work
The CCG has faced another challenging year in terms of attempting to maintain financial
balance whilst supporting providers in the delivery of quality patient care. The CCG began
collaborating with Essex County Council to deliver its portion of the national £3.8bn Better
Care Fund (BCF) savings target, which resulted in the CCG needing to develop a new
governance model to oversee delivery of the BCF. The CCG also faced cost pressures from
Continuing Healthcare Claims and the introduction of Personal Health Budgets, as well as
from increasing demand across the system. The CCG is also involved in the Essex Success
Regime which aims to transform delivery of healthcare services in Essex. Although progress
was initially slow, the Success Regime is starting to develop plans which will directly impact
on the CCG and affect the ability of the CCG to set its strategic direction and develop plans
to remodel service delivery.
Our plan focussed on a number of areas to provide assurance to those charged with
governance that risks in these areas were being addressed. The plan therefore consisted of
audits of Financial Systems Key Controls (including Payroll); QIPP; Governance, Risk
Management and Assurance Framework; Continuing Healthcare Costs; Review of the
Medium Term Recovery Plan; Contract Management of Acute Trusts; Integration of Better
Care Fund; IG Toolkit; and Recommendation Follow Up. The table below details the
assurance levels provided for those audits where we have issued a final report to date.
Assurance Gradings
Good
Adequate
Limited
Nil
Audits Without Opinion (*)
Total
1
5
1
0
1
8
2015-16
13%
62%
13%
0%
12%
100%
2
6
0
0
1
9
2014-15
22%
67%
0%
0%
11%
100%
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During the year good progress has been made in reviewing and following up outstanding
audit recommendations both arising from audits conducted this year and recommendations
carried forward from the previous years. This focus on the implementation of
recommendations needs to continue to ensure the Audit Committee is receiving adequate
assurance that control weaknesses are being addressed. Independent verification of
successful implementation was undertaken as part of our ongoing recommendation follow up
work.
In this report, we have drawn on the findings and assessments included in all internal audit
reports issued in 2015/16, including those that, at this time, have still to be finalised. This
relates to the following audits;
Financial Systems Key Controls – Draft report issued
Governance, Risk Management and Assurance Framework – Draft report issued
Reliance Placed on Third Party Assurances
Since a number of processes in respect of the CCG’s key financial systems have been
outsourced, we have sought to rely on third party assurances where these are available.
NHS Shared Business Services (SBS) are contracted by NHS England to provide an
Integrated Single Financial Environment (ISFE) service to all CCGs. We expect to receive
the independent Service Auditor Report from Grant Thornton UK LLP in respect of the
controls in place at SBS over the ISFE once they have completed their audit work.
We have received a type II Service Auditor Report from North East London CSU’s Internal
Auditors, Deloitte, for the period from 1st April 2015 to 30th September 2015. As a result of
their work which examined Payroll; Financial Ledger; Accounts Payable; Accounts
Receivable; Financial Reporting; and Treasury and Cash Management; the CSU’s Auditors
provided a Qualified Opinion. The Qualified Opinion was based on non-achievement of the
control objectives detailed below which relate to the systems operated on behalf of the CCG:







Control objective B.1 Control accounts are reconciled on a monthly basis and
reconciling items are identified, investigated and corrected.
Control objective B.2 Suspense accounts are reviewed and cleared.
Control objective B.3 Access to ISFE is appropriate and in line with delegated
authorities.
Control objective C.2 From Month 2, payments are valid and processed in a timely
manner.
Control objective C.3 Changes to supplier data requested by the CSU are valid.
Control objective C.5 VAT returns are accurate.
Control objective F.2 Cash flow forecasts and drawdown applications prepared by
the CSU are accurate.
We have received a further type II Service Auditor Report from North East London CSU’s
Internal Auditors, Deloitte, for the period from 1st October 2015 to 29th February 2016. As a
result of their work which examined Payroll; Financial Ledger; Accounts Payable; Accounts
Receivable; Financial Reporting; and Treasury and Cash Management; the CSU’s Auditors
provided a Qualified Opinion.
The Service Auditor Report states that a control related to control objective A.4 “Access to
payroll and HR systems is appropriate and audited regularly” did not operate during the
period from 1 October 2015 to 29 February 2016. Consequently Deloitte are unable to
71
provide assurance that the control was suitably designed and operating effectively to
achieve the related control objective throughout the period. The Qualified Opinion was also
based on non-achievement of the control objectives detailed below which relate to the
systems operated on behalf of the CCG:


Control objective C.2 Payments are valid and processed in a timely manner.
Control objective C.3 Changes to supplier data requested by the CSU are valid.
We have also received a bridging letter from North East London CSU which states that there
have not been material changes to their control environment for the period 1 March 2016 to
31 March 2016 that would adversely affect the Service Auditors Opinion reached in the latest
Service Audit Report referred to above. The bridging letter goes on to state that the controls
detailed within the most recent issuance of the Service Auditor Report, as outlined above
have operated effectively.
Performance of Internal Audit
At the start of the contract, a number of performance indicators were formulated to monitor
the delivery of the Internal Audit service to the CCG. It should be noted that with two reports
still to be issued in draft the performance measure in respect of the percentage of draft audit
reports issued on time is expected to improve further once these reports are issued.
Commissioning Support Unit
The payroll service transferred to a new provider during 2015-16.
Internal Audits with Limited Assurance
During the year, Internal Audit issued the following audit reports which identified risk
management issues which were significant to the organisation:
The audit on Continuing Healthcare Costs was issued with a limited assurance grading
because of the failure to consistently meet the review schedule guidelines issued by
NHS England. This could lead to claimants continuing to receive payments after their
entitlement has ended. In addition, there is also an increased risk that patients’
continuing healthcare needs are not being fully addressed, and could result in adverse
publicity from independent inspection of CHC case handling.
An action plan has been agreed and presented to the Audit Committee on 30
November 2015. Work has progressed significantly on current CHC cases. The
retrospective claims have been entered onto the CCG’s risk register under BAF24,
which means that remedial plans are regularly reviewed and updated by the executive
lead and reported to the Board and sub-committees.
72
Data Quality
The Membership Body and the Governing Body are provided with a range of quantitative
and qualitative information throughout the year. This information relates to all aspects of
the performance of the CCG and the providers from whom the CCG commissions
services. Neither the Membership Body nor the Governing Body have expressed any
dissatisfaction with the quality or quantity of information that they have received from the
CCG during 2015-16.
Business Critical Models
The CCG confirms an appropriate framework and environment is in place to provide quality
assurance of business critical models, in line with the recommendations in the Macpherson
report.
All business critical models have been identified and that information about quality
assurance processes for those models has been provided to the Analytical Oversight
Committee, chaired by the Chief Analyst in the Department of Health.confirms that all
business critical models have been identified as part of our work around asset registers.
Data Security
We have submitted a satisfactory level of compliance with the information governance
toolkit assessment.
The CCG has nominated information asset owners who annually review the data flow
mapping and information asset registers to ensure that all relevant information assets are
logged. This is done with support from the Information Governance (IG) Team to ensure
consistency of approach. Registers include a section for risk assessing the flow/asset as it
is recorded. No red risks were indicated as part of this process. Several amber and yellow
risks were indicated but the risks have been reassessed by the Information Governance
Team as having sufficient controls and mitigation in place to support the risk level. The
Senior Information Risk Owner (SIRO) has signed off the risks as acceptable for the
organisation.
The CCG SIRO and Caldicott Guardian completed their training in February 2016.
The CCG will work with the IG Team to continue compliance with the requirements of the
Information Governance Toolkit and will, as a minimum, maintain level 2 compliance for all
criteria.
The CCG and the IG Team will continue to work with NHS England and the Health & Social
Care Information Centre (HSCIC) to provide assurance to the Confidentiality Advisory Group
on the requirements of the s251 agreements in place to ensure that the CCG retains its
interim Accredited Safe Haven (ASH) and Controlled Environment for Finance (CEfF) status.
There have been no serious incidents relating to data security breaches, and therefore none
were reported to the Information Commissioner.
73
Discharge of Statutory Functions
During establishment, the arrangements put in place by the clinical commissioning group
and explained within the Corporate Governance Framework were developed with
extensive expert external legal input, to ensure compliance with all relevant legislation.
That legal advice also informed the matters reserved for Membership Body and Governing
Body decision and the scheme of delegation.
In light of the Harris Review, the clinical commissioning group has reviewed all of the
statutory duties and powers conferred on it by the National Health Service Act 2006 (as
amended) and other associated legislation and regulations. As a result, I can confirm that
the clinical commissioning group is clear about the legislative requirements associated with
each of the statutory functions for which it is responsible, including any restrictions on
delegation of those functions.
Responsibility for each duty and power has been clearly allocated to a lead Executive
Officer. The Executive Officers have confirmed that their structures provide the necessary
capability and capacity to undertake all of the clinical commissioning group’s statutory
duties.
Conclusion
I concur with the Head of Internal Audit that during the 2015-16 year there has been a
sound system of internal control, designed to meet the organisation’s objectives, and that
controls have generally been applied consistently.
John Leslie
Accountable Officer
26 May 2016
74
Accountability
Report
Remuneration and staff report
75
REMUNERATION REPORT FOR THE YEAR ENDING 31 MARCH 2016
Remuneration Committee Report
Members of the Remuneration Committee during 2015-16 were as follows:
Tony Cox, Lay Member (Governance) and Chair of Remuneration Committee
Alison Reeve, Lay Member (PPI)
John Lockwood, Lay Member (Sessional)
The CCG Governing Body has delegated authority for the setting of very senior manager
and other related payments (including payments to clinicians for commissioning activities) to
the Remuneration Committee.
The remuneration committee is also responsible for reviewing the objectives and measures
by which the Chief Officer and other senior managers are assessed on an annual basis.
Attendance at the Remuneration Committee
The Committee met 3 times during the course of 2015-16, attendance of members at
Committee meetings were as follows:
Committee Member
Attendance / (out of possible
attendances)
Tony Cox
3/3
Alison Reeve
2/3
John Lockwood
3/3
Policy on Remuneration of Senior Managers
The CCG follows the guidance set by NHS England in respect to the remuneration of very
senior managers as set out in Clinical Commissioning Groups: Remuneration guidance for
Chief Officers (where the senior manager also undertakes the accountable officer role) and
Chief Finance Officers” 2
The guidance is based on a set of key principles, which are informed by and consistent with
the principles set out in the Will Hutton Fair Pay Review:
2

Executive remuneration should fairly reward each individual’s contribution to
their organisation’s success and should be sufficient to recruit, retain and
motivate executives of sufficient calibre. However, organisations should be
mindful of the need to avoid paying more than is necessary in order to
ensure value for money in the use of public resources.

Executive remuneration must be set through a process that is based on a
consistent framework and independent decision-making based on accurate
assessments of the weight of roles and individuals’ performance in them.
http://www.england.nhs.uk/wp-content/uploads/2012/06/Remuneration-guidance-final.pdf
76

Executive remuneration should be determined through a fair and transparent
process via bodies that are independent of the executives whose pay is
being set, and who are qualified or experienced in the field of remuneration.
No individual should be involved in deciding his or her own pay.

There should be appropriate delegated authority to CCG remuneration
committees.

Executive remuneration must be based on the principle of equal pay for
work of equal value.
Where there are very senior manager roles where there is not explicit guidance on salary
levels the remuneration committee establishes salaries using agenda for change banding as
well as benchmarking salary levels with similar CCGs.
Where senior managers have received remuneration that exceeds £142,500 in 2015-16 or
exceeds an equivalent pro rata amount, Basildon and Brentwood CCG has carried out steps
to ensure that remuneration is reasonable. All individuals who were in this category in 201516 had their proposed remuneration reviewed and agreed by NHS England and also by the
Basildon and Brentwood CCG Remuneration Committee prior to the commencement of their
employment.
During 2014-15 the Remuneration Committee adopted the process of undertaking an annual
review of executive salaries against other CCGs of similar size and complexity to assess
whether any adjustment is required in remuneration for posts and / or whether any
inflationary uplift is applied to remuneration for the financial year. This is undertaken in the
summer of each year once audited remuneration reports are available. The benchmark
group adopted is that identified by NHS England in its’ “Commissioning for Value” analysis of
the CCGs’ nearest neighbours, alongside that of CCGs in Essex and North East London to
provide a geographical perspective.
Senior Managers Performance Related Pay
The CCG does not operate a performance related pay scheme for managers.
Policy on Senior Managers Contracts
The CCG employs senior managers on a standard very senior manager contract, with
similar terms and conditions to the provisions of Agenda for Change.
Senior Managers Service Contracts
The Accountable Officer, Chief Finance Officer and Chief Nurse are employed on a
permanent basis.
Clinicians working for the CCG are employed on renewable 36 month contracts.
Payments to Past Senior Managers
There were no significant awards made to past senior managers of the CCG.
77
Basildon & Brentwood CCG
Remuneration Benefits
(subject to audit)
Alison Reeve’s total remuneration includes a pass through cost of £3100 for the NHS England PPI Network Facilitator Role.
78
79
On 16 March 2016, the Chancellor of the Exchequer announced a change in the Superannuation
Contributions Adjusted for Past Experience (SCAPE) discount rate from 3.0% to 2.8%. This rate
affects the calculation of CETV figures in this report.
Due to the lead time required to perform calculations and prepare annual reports, the CETV figures
quoted in this report for members of the NHS Pension scheme are based on the previous discount
rate and have not been recalculated.
80
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.
2015/16
2014/15
The banded remuneration of the highest paid director /
member
£115k to
£120k
£150k to
£155k
Median remuneration of the CCG workforce
£36,445
£33,356
3.2
3.3
0
0
£5k to £116k
£2k to £110k
Ratio of highest paid director / member to median paid
employee
No. of employees who were paid more than the highest paid
director / member
Remuneration ranges in the year
Total remuneration includes salary, non-consolidated performance-related pay, benefits-inkind, but not severance payments. It does not include employer pension contributions and
the cash equivalent transfer value of pensions
The movement in the banded remuneration of the highest paid director and the ratio of the
highest paid director / member to median paid employee was a result of a payment made in
2014-15 to Tracy Easton in lieu of notice. No such payments were made in 2015-16.
The pay multiples calculation excludes annualised payments to contractors in 2015-16.
Off payroll engagements (not subject to audit)
Following the Review of Tax Arrangements of Public Sector Appointees published by the
Chief Secretary to the Treasury on 23 May 2012, clinical commissioning groups must publish
information on their off-payroll engagements.
Number
Number of existing engagements as of 31st March 2016 for more than £220 per
day and that have lasted longer than six months
13
Of which, the number that have existed:
For less than one year at the time of reporting
7
For between one and two years at the time of reporting
5
81
For between 2 and 3 years at the time of reporting
1
For between 3 and 4 years at the time of reporting
0
For 4 or more years at the time of reporting
0
Number
Number of new engagements, or those that reached six months in duration,
between 1st April and 31st March 2016 for more than £220 per day
7
Number of new engagements which include contractual clauses giving NHS
Basildon and Brentwood Clinical Commissioning Group the right to request
assurance in relation to income tax and National Insurance obligations
7
Number of whom assurance has been requested
0
Of Which:
assurance has been received
0
assurance has not been received
0
Engagements terminated as a result of assurance not being received
0
Number of off-payroll engagements of board members, and/or senior officers
with significant financial responsibility, during the year
1
Number of individuals that have been deemed “board members, and/or senior
officers with significant responsibility” during the financial year. This figure
includes both off-payroll and on-payroll engagements
1
Payments for loss of office
The CCG did not make any payments for loss of office during the course of the year.
Consultancy expenditure
The CCG consultancy expenditure during the course of the year was £366 000.
Staff Report
82
NHS Workforce data shows that the proportion of females to males within the overall
healthcare workforce is 78 per cent to 22 per cent respectively. Females are proportionally
under-represented at senior levels relative to their overall presence in the workforce. While
women make up about 78 per cent of the NHS workforce, just over 30 per cent of NHS chief
executives are women. Comparative figures for the workforce of NHS Basildon and
Brentwood CCG for 2014-15 and 2015-16 (measured at 31st March each year) are shown
below.
Male
Female
Total Headcount
Total WTE
2014-15
16.17 WTE (26%)
46.04 WTE (74%)
66
62.21
2015-16
18.83 WTE (35%)
51.80 WTE (65%)
92
70.63
At Very Senior Management (VSM) level, the gender ratio in 2015-16 was 67% male to 33%
female, compared to 50% male and 50% female in 2014-15.
Our governing body
At as the 31st March 2016, the composition of the governing body (voting members and
attendees with speaking rights) was as follows (31st March 2015 information shown for
comparison):
Male
Female
Total
2014-15
15 (75%)
5 (25%)
20
2015-16
13 (65%)
7 (35%)
20
Employees – holders of very senior manager (VSM) contracts
The CCG did not employ any staff who were not on the governing body (and therefore
covered above) on VSM contracts.
Staff sickness
The total days lost for NHS Basildon and Brentwood CCG during 2015-16 stands at 735
(WTE calendar days lost), out of 24 657 (WTE calendar days available) resulting in an
average absence of 2.98%.
Absence is low within NHS Basildon and Brentwood CCG, below the NHS average of 4.20%
(December 2014 to November 2015 figures). For comparison, the CCG’s absence rate for
2014-15 was 2.14% set against an NHS average that year of 4.56%.
Absence is supportively managed within the CCG, with the absence management policy
addressing both short term and long term absence. Staff are supported through any
absences, with return to work meetings conducted following periods of absence and referrals
made to Occupational Health for support in achieving a regular sustained attendance at
work. Persistent short term absence is addressed through formal procedures. Staff
sickness absence rates are monitored by the Governance Committee.
83
Self Certification by the Accountable Officer on the Accountability Report
We certify that the Clinical Commissioning Group has complied with the statutory duties laid
down in the National Health Service Act 2006 (as amended).
John Leslie
Accountable Officer
26 May 2016
84
Governing Body Profiles
Dr Anil Chopra
Chair and Elected
Member for
Partnership/BIC
Appointment:
st
From 1 April 2013
Tom Abell
Chief Officer
Carolyn Regan
Interim Accountable
Officer
John Leslie
Interim Chief Finance
Officer / Interim
Accountable Officer
Appointment:
Appointment:
Appointment:
th
th
From 4 July 2013 to 18 From September 2015 – Interim CFO:from 19
rd
rd
September 2015
3 December 2015
March 2015 to 3
December 2015.
Interim Accountable
rd
Officer from 3
December 2015.
Profile:
Profile:
Profile:
Profile:
Dr Chopra trained as a Tom joined the CCG in Carolyn is an
John is an experienced
doctor at St Thomas’
July 2013, previous to
experienced Chief
healthcare manager and
Hospital in London and which he was an
Executive.
joined the CCG in March
has been a GP in
Executive Director of a
Prior to joining BBCCG, 2015 as interim Chief
Basildon since 1987. He NHS mental health and Carolyn was an NHS
Finance Officer. He took
was previously Chair of community services
chief executive for a
over as interim
Basildon Primary Care
provider, previous to
number of NHS strategic Accountable Officer from
Group and later the
which he was Director of organisations including 3 December 2015.
Clinical Lead for Basildon Commissioning for the
North East London
Primary Care Trust. He South Essex CCG
Strategic Health
was previously Medical cluster.
Authority, East London
Director at NHS South
He is a Chartered Public and the City Health
West Essex.
Finance Accountant
Authority and West
Hertfordshire Health
Authority.
Committee Memberships: Committee Memberships: Committee Memberships: Committee Memberships:
 Clinical Executive
 Finance &
 Finance &
 Finance &
 Finance &
Performance
Performance
Performance
Performance
 Patient Safety &
 Governance
 Audit
Quality
 Governance
Declared interests and
conflicts:
conflicts:
conflicts:
conflicts:
GP partner, Kingswood Non Executive Director, Director, Carolyn Regan None
Surgery, Basildon. Wife Eastern Academic Health Associates Ltd, Chair of
is secretary in the
Science Network
Just For Kids Law (a
practice.
charity), Member of the
Press Recognition Panel
85
Tony Cox
Alison Reeve
Dr Arv Guniyangodage Dr Ken Wrixon
Deputy Chair and Lay
Lay Member (Patient
Brentwood Elected
Brentwood Elected
Member for Governance and Public Involvement) Member
Member
Appointment:
Appointment:
Appointment:
Appointment:
st
st
st
st
From 1 April 2013
From 1 April 2013
From 1 April 2013
From 1 April 2013
Profile:
Profile:
Profile:
Profile:
Tony runs his own
Alison has worked within Dr Guniyangodage is a Dr Wrixon has practised
consultancy practice
the health and social
GP in Brentwood, having in Essex since 2002,
providing services across care sector for 18 years worked there since 2007. initially as junior doctor at
board governance and with experience in the
He is currently the Chair Broomfield Hospital, and
the commissioning of
delivery of local and
of the Brentwood locality more recently as a
housing, health and
national transformation
partner at Deal Tree
social care
programmes. Outside of
Surgery since 2007.
her CCG role she
With a Masters in Public
undertakes consultancy
Health, he has always
work in the health/social
had an interest in
care sector.
population health. He
leads on respiratory
medicine and is also the
sustainability champion
for the CCG.
Committee
Committee
Committee
Committee
Memberships:
Memberships:
Memberships:
Memberships:
 Audit (Chair)
 Audit
(Chair)

Remuneration

Finance
&
 Remuneration
Performance
 Finance &
(Chair)
Performance
Quality
 Patient and
Community
Reference Group
(Chair)
Declared interests and Declared interests and Declared interests and Declared interests and
conflicts:
conflicts:
conflicts:
conflicts:
Director, Tony Cox
Network Facilitator
GP Partner and Trainer, GP Partner, Deal Tree
Consultancy Ltd; Non
(Midlands and East
New Surgery; New
Surgery; Shareholder in
Executive Director,
Region) – NHS England Surgery has a share in Brentwood Integrated
Essex Coalition of
PPI Lay Members
Brentwood Integrated
Health LLP; Dr Wrixon’s
Disabled People
Network
Healthcare
wife is a paediatric nurse
working with Great
Ormond Street Hospital
NHS Foundation Trust,
Mid Essex Hospital
Services NHS Trust and
PROVIDE (Broomfield)
86
Dr Sooraj Natarajan
Brentwood Elected
Member
Appointment:
st
From 1 April 2013
Profile:
Dr Natarajan has been a
GP at the Tile House
Surgery in Brentwood
since 2005. Before
becoming a GP, he
worked in Paediatrics.
He has been involved in
commissioning services
as a GP member in the
local practice based
Commissioning Group
and also as a Clinical
Exec member in South
West Essex CCG.
Dr Tony Ogunsanya
SEMC Elected Member
Dr Babafemi Salako
SEMC Elected Member
Dr Jojo Mampilly
Partnership/BIC Elected
Member
Appointment:
Appointment:
Appointment:
st
st
st
From 1 April 2013
From 1 April 2013
From 1 April 2013
Profile:
Profile:
Profile:
Dr Ogunsanya is a GP at Dr Salako has been a GP Dr Mampilly has been a
Robert Frew Medical
in Basildon since 2001
GP in Basildon since
Centre,
and works at Great Berry January 1997 and
Wickford, Essex. He was Surgery. He is a GP
represents the BIC
formerly Chairman South trainer and appraiser, the locality.
Essex Managed Care
Chair of the Essex
He has served as
Consortium. He was
Faculty of the Royal
Chairman and Clinical
formerly, Consultant
College of General
Lead of BIC Locality
Obstetrician and
Practitioners.
since August 2012
Gynaecologist - King
In his spare time he
onwards.
Fahd specialist Hospital follows Tottenham
Since March 2013 Dr
Saudi Arabia. He is a
Hotspurs FC.
Mampilly has served as
partner at Taylorwood
Hon Treasurer of BMA
Solicitors- Minories,
SE Division.
London. He is also a
Solicitor Advocate.
Committee Memberships Committee Memberships: Committee Memberships: Committee Memberships:
 Finance &
Performance (Chair)
Quality
Quality
conflicts:
conflicts:
conflicts:
conflicts:
GP Principal, Tile House GP Partner, Robert Frew GP Principal, Langdon
GP Principal, Felmores
Surgery, Brentwood;
Medical Centre;
Hills Medical Practice;
Medical Centre; Director,
Associate GP Trainer,
Shareholder SEMC Ltd; Vice Chair South Essex Gelmore Ltd
East of England Deanery; Partner, Taylor Wood
Managed Care Locality; ;
Children’s Safeguarding Solicitors
Chair Essex Faculty of
Lead; member of
the Royal College of GPs
Brentwood Clinical
Commissioning Group
LLP (dormant company);
Tile House Surgery is a
member of Brentwood
Integrated Health
(dormant company)
87
Dr Nehal Ahmad
Arterial Elected Member
Appointment:
st
From 1 April 2013 until
th
30 November 2015
Profile:
Dr Ahmed is a GP in
Ballards Walk Surgery,
Basildon.
He has a keen interest in
emergency services and
unplanned care and also
held the post of Clinical
Director for Unplanned
Care within the CCG.
Dr Simon Butler
Appointment:
st
From 1 April 2013 until
th
30 November 2015
Profile:
Dr Butler was an elected
representative of
Billericay and Basildon
GPs on the Governing
Body.
Dr Nimit Dabas
Appointment:
st
From 1 December 2015
Profile:
Dr Dabas is an elected
representative of
Body.
He is a member of the
He is a full time GP in
sub-committees for
Billericay, trainer and
Finance and
appraiser of fellow GPs. Performance.
Billericay.
Dr Joseph Arayomi
Appointment:
st
From 1 December 2015
Profile:
Dr Arayomi is an elected
representative of
Body.
He is a member of the
sub-committees for
Finance and
Performance.
Billericay.
 Finance &
 Finance &
Performance (Chair  Patient Safety &
Performance
until 30 November
Quality
Quality
2015)
conflicts:
conflicts:
conflicts:
conflicts:
GP Principal – Ballards Senior Partner, Western GP Principal, Queens
GP Principal – Dipple
Walk Surgery;
Road Surgery, Billericay Park Surgery and The
Medical Centre
Locality lead for
New Surgery
Chairman – We Care
unplanned care
Director of BB Healthcare Commission (a charity
Medical Director, North
Solutions Limited
arm of Salem Christian
Essex Partnership NHS
Commercial Director of Church)
Foundation Trust
ANESI
Director Jofoy (dormant
Working in out of hours
company)
and emergency
department of Basildon
Hospital under
employment of South
Essex Emergency
Doctors Service (SEEDS)
88
Lisa Allen
Chief Nurse
Louis Kamfer
Chief Finance Officer
Dr Julia Hale
Joanne Cripps
Secondary Care Member Director, Performance
and Commissioning
Appointment:
Appointment:
Appointment:
Appointment:
st
st
From 1 April 2013
From 16 November 2015 From 1 September 2014 From 1 January 2016
Profile:
Profile:
Profile:
Profile:
Lisa has a nursing
Louis joined the NHS two Dr Hale has been a
Jo joined the CCG from
background spanning 30 and half years ago after a consultant paediatrician the Royal College of
years. She specifically
career in the Private
for 14 years, currently at Surgeons where she
brings her perspective as Sector. He joined
East Kent Hospitals
spent 10 years working
a registered nurse, on
Basildon and Brentwood University NHS FT
with surgeons to develop
health and care issues to from Suffolk CCG.
specialising in
and implement
underpin the work of the
Neurodisability,
professional and clinical
CCG, especially the
Safeguarding and
standards.
contribution of nursing
Adoption. She has an
and clinical practice to
MSc in Community Child
patient safety, patient
Health and is a member
experience and quality of
of the BAAF Health
care.
Advisory Committee. She
has experience in clinical
governance, patient
experience and service
reconfiguration in
community services.
 Patient Safety and
 Finance and
 Finance and
Quality Governance
Performance
Performance
 Audit
conflicts: None
conflicts: None
conflicts:
conflicts: None
Consultant employed by
East Kent University
Hospitals NHS
Foundation Trust
89
Ian Wake
Attendee representing
Public Health
Appointment:
st
From 1 April 2013 to 30
June 2015
Profile:
During his time with the
CCG Ian was a
Consultant in Public
Health for Essex County
Council (ECC) and
public health lead for
NHS Basildon and
Brentwood CCG. His
current remit centred on
healthcare public health
for the CCG including
leading the Joint
Strategic Needs
Assessment.
.
Krishna Ramkhelawon
Attendee representing
Public Health
Appointment:
nd
From 2 July 2015
Profile:
Krishna is currently a
Consultant in Public
Health for Essex County
Council (ECC) and
public health lead for
NHS Basildon and
Brentwood CCG. His
current remit centres on
healthcare public health
for the CCG including
leading the Joint
Strategic Needs
Assessment.
Katherine Kirk MBE
Cllr Ann Naylor
Lay Member (Quality and Attendee representing
Governance)
Essex County Council
Appointment:
Appointment:
st
st
From 1 September 2014 From 1 July 2014
Profile:
Profile:
Katherine has chaired
Ann is a retired
NHS Boards over a
consultant anaesthetist
period of 15 years,
who worked in Basildon
concluding with Chairing Hospital for 28 years.
NHS South Essex which For the past 9 years she
was wound up in
has been an elected
2013. Her prior
member of Essex County
experience as a Chief
Council representing
Officer of a Community Brentwood Rural Division
Health Council,
- the villages north of
championing and
Brentwood. She lives in
representing the needs Ingatestone. As a
of patients, has
member of the Essex
underpinned her
Health & Wellbeing
subsequent roles. She Board she was invited to
also has experience as a join the board of BBCCG
local government
in the summer of 2014
officer. She was
awarded an MBE in the
2013 Queen's Birthdays
Honours for services to
public health.
Committee
Committee
Committee
Committee
Memberships:
Memberships:
Memberships:
Memberships:
 Clinical Executive  Patient Safety and  Governance (Chair)
Quality Governance  Patient Safety &
Quality (Chair)
Declared interests and Declared interests and Declared interests and Declared interests and
conflicts:
conflicts:
conflicts:
conflicts:
Director, London Leash Employee of Essex
Provides ad hoc
Elected member of
Leaders; Director 110
County Council and
remunerated consultancy Essex County Council
Blackheath Hill Property Finance Lead for the
advice to Plexus
Management Ltd
Public Health Grant;
Healthcare Ltd as Chair
Member of the Board of of the Advisory Board;
NHS Mid Essex CCG;
Non-remunerated Board
Wife is an employee of member of Dementia
NHS England (Midlands Adventure Community
and East).
Interest Company
90
Dr Reshma Rasheed
Ex-officio attendee
Appointment:
st
From 1 April 2013
Profile:
Reshma is a GP working
in Billericay with an
interest in women’s
health, previously
qualified in
gynaecology.
She joined general
practice in 2004 and has
been involved in
commissioning services
since 2005,
She is the Associate
Clinical Director,
Basildon Hospital
Contract and attends the
Basildon hospital Quality
Meetings.
Committee
Memberships:
conflicts: GP Principal &
Director, Chapel Street
Surgery Ltd,
Director of South Essex
Primary Care Support
Services Ltd, Locum GP
– Eastwood Group
Practice, Rayleigh Road,
Southend on Sea,
Member of South Essex
Emergency Doctors
Service (SEEDS).
Nick Presmeg
Director of Integration/
Chief Operating Officer
Appointment:
From 1 July 2014 to 30
November 2015
Profile:
Nick’s working
experience spans
academia within Essex
University where he held
an associated position.
He has worked in the
Mental Health Services
in NE Essex and as a
Chief Exec in the
voluntary sector.
Since joining Essex
County Council Nick has
held a variety of roles,
covering NE Essex as a
Director in Adult Services
and more recently as the
Integrated
Commissioning Director
for South West Essex
Committee
Memberships:
 Finance and
Performance
conflicts:
Trustee, South Essex
Cultural Centre
The register of interests can
be found on our website at:
http://basildonandbrentwoodccg
.nhs.uk/about-us/meet-theboard
91
Self Certification by the Accountable Officer on the Remuneration Report
We certify that the Clinical Commissioning Group has complied with the
statutory duties laid down in the National Health Service Act 2006 (as
amended).
John Leslie
Accountable Officer
26 May 2016
92
Appendix 1- GLOSSARIES OF TERMS USED IN THIS ANNUAL REPORT
Glossary of non-financial terms
Term
Care pathway
Clinical Commissioning Group
(CCG)
Civil Contingencies Act 2004
Commissioning
Community services
Commissioning Support Unit
(CSU)
Enhanced services
Equality Delivery System (EDS)
Equality Impact Assessment
(EIA)
NHS111
Palliative Care
Definition
The route that a patient will take from their first point of
contact with an NHS or Social Services member of staff
(usually their GP), through referral, to the completion of their
treatment.
Formally established on 1 April 2013, Clinical
Commissioning Groups (CCGs) are statutory bodies
responsible for commissioning most healthcare – planning,
buying and monitoring services to meet the needs of their
local communities.
Provides a single framework for UK civil protection against
any challenges to society – it focuses on local arrangements
and emergency powers.
The review, planning and purchasing of health and social
services.
Health or social care and services provided outside of
hospital. They can be provided in a variety of settings
including clinics and in people's homes. Community
services include a wide range of services such as district
nursing, health visiting services and specialist nursing
services.
Commissioning Support Units will provide capacity to clinical
commissioners as an extension of their local team to ensure
that commissioning decisions are informed and processes
structured. This approach will help achieve economies of
scale and allow clinical commissioning groups to focus on
direct commissioning of services for their patients.
Enhanced services are:
i) essential or additional services delivered to a higher
specified standard, for example, extended minor surgery
ii) services not provided through essential or additional
services
They are services provided by GPs, over and above the
core (essential and additional) services to their patients.
The EDS has been designed nationally as an optional tool
launched in 2011 to support NHS commissioners and
providers to deliver better outcomes for patients and
communities and better working environments for staff,
which are personal, fair and diverse. The EDS is all about
making positive differences to healthy living and working
lives.
An equality impact assessment involves assessing the likely
or actual effects of policies or services on people in respect
of disability, gender and racial equality. It helps us to make
sure the needs of people are taken into account when we
develop and implement a new policy or service or when we
make a change to a current policy or service.
NHS 111 is a new service introduced to make it easier for
people to access local NHS healthcare services. People can
call 111 when they need medical help fast but it’s not a 999
emergency. NHS 111 is available 24 hours a day, 365 days
a year. Calls are free from landlines and mobile phones.
The total care of patients whose disease is incurable.
Control of pain, of other symptoms, and of psychological,
social and spiritual problems is paramount. The goal of
palliative care is achievement of the best quality of life for
93
Patient and Public Involvement
(PPI)
Primary Care Trust (PCT)
patients and their families.
Patient and Public Involvement is about giving people the
chance to get involved in improving their local health
services by offering their views about these services and
making recommendations for changes in the future.
Primary Care Trusts were abolished on 31 March 2013.
Prior to that they were responsible for the planning and
securing of health services and improving the health of the
local population.
Glossary of financial terms
Term
Accounting Policies
Budget
Capital Expenditure
Capital Resource Limit
Cash Limit
Revenue Resource Limit
Depreciation
Definition
The Accounting Policies are the accounting rules that
the CCG has followed in preparing its accounts. These
policies are based on International Financial Reporting
Standards and the Treasury’s Financial Reporting
Manual. The Department of Health’s Manual for
Accounts and Capital Accounting Manual detail how
these rules should apply to CCGs. One of the main
policies is that income and expenditure is recognised on
an accruals basis, meaning it is recorded in the period in
which services are provided even though cash may or
may not have been received or paid out.
A Budget usually refers to a list of all planned and
expected future expenses and revenues. A budget is set
at the beginning of the financial year.
Capital Expenditure is money spent on buying noncurrent assets (fixed assets) or to add to the value of an
existing fixed asset with a useful life that extends
beyond a year.
The Capital Resource Limit (CRL) is the amount
allocated each year to the CCG for capital expenditure.
The CCG must not spend more than the CRL on capital
items.
The Cash Limit (CL) is a limit set by the Government on
the amount of cash which a CCG may spend during a
given financial year. The CCG must ensure that the net
amount of cash flowing out of the CCG over the financial
accounting period is not more than the CL.
The Revenue Resource Limit (RRL) is the total
amount that the CCG may spend on the services that it
commissions. This limit is set for the CCG at the start of
the financial year by the Department of Health and may
change on a monthly basis depending on changes to
allocations to the CCG for either commissioning or
provider functions. Each CCG has a statutory duty not to
spend more than its RRL. The RRL takes into account
all accrued income and expenditure irrespective of
whether income has been received or bills paid.
Depreciation refers to the fact that assets with finite
lives lose value over time. Depreciation involves
allocating the cost of the fixed asset (less any residual
value) over its useful life to the Statement of
Comprehensive Net Expenditure (SCNE). This will
cause an expense to be recognised on the SCNE while
the net value of the asset will decrease on the
Statement of Financial Position.
94
Impairments
Intangible Assets [formerly Intangible
Fixed Assets]
International Financial Reporting
Standards
Losses and Special Payments
NHS Payables (formerly known as
NHS Creditors)
Statement of Comprehensive Net
Expenditure (formerly known as
Operating Cost Statement)
Over Spend
Pooled budget
Impairments are the losses in the values of non-current
assets compared to those values recorded on the
Statement of Financial Position. A CCG is required to
undertake routinely revaluation reviews of its fixed
assets or undertake an impairment review when there is
a decline in an asset’s value. The impairment (loss) is
treated in the same way as depreciation, as a cost in the
Statement of Comprehensive Net Expenditure
(SCNE), if the change in the value of the asset is
permanent.
Intangible Assets are invisible or ‘soft’ assets of an
organisation that, nevertheless, have a real current
market value and contribute to the (future)
operation/income generation of the organisation and
may include software licences, trademarks and research
development expenditure.
International Financial Reporting Standards (IFRS)
are the international accounting standards that the
Department of Health require CCGs to follow when they
prepare their accounts. 2009-10 was the first year in
which CCGs were required to prepare IFRS compliant
accounts, having previously used UK reporting
standards.
Losses and Special Payments are payments that
Parliament would not have foreseen healthcare funds
being spent on, for example fraudulent payments,
personal injury payments or payments for legal
compensation.
An NHS Payable is an amount owed to an NHS
organisation for services rendered or goods supplied to
the CCG or to patients of the CCG.
The Statement of Comprehensive Net Expenditure
(SCNE) records the costs incurred by the CCG during
the year, net of miscellaneous income (which is income
other than the CCG’s main funding from the Department
of Health which is credited to the general fund on the
Statement of Financial Position and not treated as
income on the SCNE). It includes non cash expenses
such as depreciation.
Under government accounting rules the SCNE
shows the net resources used by the CCG in
commissioning and providing healthcare rather than the
surplus or deficit for the year as shown in the income
and expenditure account by NHS trusts. The
comprehensive net expenditure is debited to the general
fund on the Statement of taxpayers equity.
Over Spend occurs when more money is spent than
was allowed within the cash limit, revenue resource limit
or capital limit, or that was planned in the budget.
A Pooled Budget is a joint arrangement with other
bodies, such as local authorities and other CCG’s, to
pool funds for a specific purpose. Each body has to
account for its own contribution to the pool within their
accounts. Contributions would generally include the
resources normally used for the identified services,
together with partnership and other grants specific to the
services. The host partner will manage the financial
affairs of the pooled fund. The pooled budget manager
is responsible for managing the pooled fund on behalf of
95
the host authority, and for providing information to
enable the partners to monitor the effectiveness of the
pooled fund arrangements.
Procurement
Property, plant & equipment
(formerly Tangible Fixed Assets)
Provisions
Statement of Cash Flows
Statement of Changes in Taxpayers’
Equity (formerly Statement of
Recognised Gains and Losses)
Statement of Financial Position
(formerly Balance Sheet)
Tendering
Trade and other Payables (NonNHS) (formerly known as Non-NHS
Creditors)
Procurement is the acquisition of goods and/or
services, generally through a contract, at the best
possible total cost, in the right quantity and quality, at
the right time and in the right place for the direct benefit
of the CCG and its patients.
Property, plant and equipment are assets that
individually (or with integrally linked other items) cost
more than £5,000 and are held for longer than one year
and include: land, buildings, transport equipment, IT and
furniture and fittings.
A Provision is a liability arising from a past event where
it is probable the CCG will have to settle and a reliable
estimate can be made of the amount to be paid.
The Statement of Cash Flows (SCF) shows the effect
of the CCG’s operating activities on its cash position.
The purpose of the Statement of Changes in
Taxpayers’ Equity is to highlight financial transactions
that may not be reflected in the Statement of
Comprehensive Net Expenditure, but which affect the
CCG’s reserves as shown in the “Financed by” section
on the Statement of Financial Position. For example,
“(Reduction)/Additions in the General Fund due to the
transfer of assets to/from NHS bodies and the
Department of Health”.
The Statement of Financial Position provides a view
of the CCG’s financial position at a specific moment in
time – usually the end of the financial year. It shows
assets (everything the CCG owns that has monetary
value), liabilities (money owed to external parties) and
taxpayers’ equity (public funds invested in the CCG).
Tendering is the process by which one can seek prices
and terms for a particular service/project to be carried
out under a contract.
Trade and other Payables Creditors are non-NHS
organisations owed money by the CCG for goods and
services provided to the CCG, e.g. for utilities,
equipment, etc.
96
Trade and other receivables
(formerly Debtors)
Under Spend
Trade and other receivables represent money owed to
the CCG at the Statement of Financial Position date for
services rendered or goods supplied by the CCG to the
receiver.
Under Spend occurs when less money is spent than
was allowed within the cash limit or that was planned in
the budget.
97
Annual Accounts
98
CONTENTS
Page
Number
Independent Auditors Statements
100-104
The Primary Statements:
Statement of Comprehensive Net Expenditure for the year ended 31 March 2016
Statement of Financial Position as at 31 March 2016
Statement of Changes in Taxpayers' Equity for the year ended 31 March 2016
Statement of Cash Flows for the year ended 31 March 2016
105
106
107
108
Notes to the Accounts
Accounting policies
Other operating revenue
Revenue
Employee benefits and staff numbers
Operating expenses
Better payment practice code
Income generation activities
Investment revenue
Other gains and losses
Finance costs
Net gain/(loss) on transfer by absorption
Operating leases
Property, plant and equipment
Intangible non-current assets
Investment property
Inventories
Trade and other receivables
Other financial assets
Other current assets
Cash and cash equivalents
Non-current assets held for sale
Analysis of impairments and reversals
Trade and other payables
Other financial liabilities
Borrowings
Private finance initiative, LIFT and other service concession arrangements
Finance lease obligations
Finance lease receivables
Provisions
Contingencies
Commitments
Financial instruments
Operating segments
Pooled budgets
NHS Lift investments
Related party transactions
Events after the end of the reporting period
Losses and special payments
Third party assets
109-113
114
114
115-117
118
119
119
119
119
119
120
120
121-123
123
123
123
124
125
125
126
126
126
127
127
128
129
129
129
129
129
130
130-131
132
132
132
133
134
134
135
99
Financial performance targets
Impact of IFRS
Analysis of charitable reserves
135
135
135
100
INDEPENDENT AUDITOR’S REPORT TO THE MEMBERS OF NHS BASILDON AND
BRENTWOOD CCG
101
102
103
104
105
Statement of Comprehensive Net Expenditure for the year ended 31 March 2016
106
Statement of Financial Position as at 31 March 2016
107
Accounts statements
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135

Annual Report and Accounts - NHS Basildon and Brentwood CCG

Transcription

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