Annual Report and Accounts - Dorset Clinical Commissioning Group
Transcription
Annual Report and Accounts - Dorset Clinical Commissioning Group
Annual Report and Accounts 2013/14 Supporting people in Dorset to lead healthier lives Front cover - thanks to Enid, Delta and their families CONTENTS Supporting people in Dorset to lead healthier lives Welcome from our Chair and Chief Officer Member Practices’ Introduction List of practices Governing Body / Members’ Report How we work and our Governing Body Pages Pages Pages Pages Pages 2-3 4-5 6-7 8 - 39 8 - 12 Progress against targets Pages 14 - 15 Our localities Pages 23 - 24 Highlights of our first year Our Clinical Commissioning Programmes Strategic Report Pages Pages Pages 16 - 22 25 - 39 40 - 66 Financial Overview Page 42 Outlook for 2014/15 and beyond - Chief Finance Officer Page 46 Progress against national Quality Standards Business Review including: Equality and Diversity Improving Quality Engagement Caring for Carers Governing Body and Senior Managers’ Profiles Remuneration Report Financial Performance Glossary of Terms Annual Accounts Addendum Pages Pages Pages Pages Pages Pages Pages Pages Pages Page Pages 43 - 45 47 - 67 51 - 53 55 - 59 61 - 62 63 - 64 67 - 77 78 - 85 86 - 89 90 91 onwards 1 WELCOME Supporting people in Dorset to lead healthier lives Welcome to the NHS Dorset Clinical Commissioning Group Annual Report and Accounts for the year 1 April 2013 to 31 March 2014. This is the first annual report produced by NHS Dorset Clinical Commissioning Group (CCG) and it marks a year since we – as a clinically led organisation – took on the role of planning and funding local healthcare across the county. In doing so, we have built on the solid foundation left by our predecessors, Bournemouth & Poole and Dorset Primary Care Trusts. The following pages demonstrate our commitment to ensuring that people get the healthcare they need and it remains accessible and appropriate. Looking Ahead The NHS in Dorset faces significant challenges in terms of meeting the health needs of the increasing population, ensuring clinical and financial sustainability of NHS services whilst responding to new national policy and guidance (e.g. 7 day working, quality standards). These challenges are no different to those set out nationally within NHS England’s document ‘A Call to Action’. In addition to financial constraints our providers of health care are facing 2 Tim Goodson, Chief Officer (left) and Chair Dr Forbes Watson pressures in terms of the profile and deployment of their existing workforce, which if we don’t work together to make realistic and sustainable commissioning decisions to re-design some services, will deepen and lead to a financial crisis for the NHS in Dorset within the next two years. Therefore in Dorset, with our providers and partners, we will undertake a clinical services review to tell us what services need to change, and how we should change them to ensure that the NHS in Dorset provides high Supporting people in Dorset to lead healthier lives quality, safe, and clinically and financially sustainable services for future generations. Further information on the outlook for 2014/15 and beyond can be found as part of the Strategic Report on page 46. With this in mind, we also took the opportunity to reflect upon these challenges by discussing our strategy through a series of engagement events with our stakeholders. As a result of this exercise, our current strategy has been refreshed to reflect their feedback. Our revised strategy 2014/19 outlines how the CCG will support three pan Dorset transformational programmes: Better Together, an integrated health and social care model where the NHS and local authorities will work together to plan and deliver seamless services. Clinical Services Review, which will review clinical services across the health and social care system within Dorset with the aim of creating clinical and financial sustainability. Urgent Care Review, that aims to transform urgent care services across Dorset by aligning and integrating them where possible, simplifying pathways and using technologies to improve patient experiences. These three transformational programmes complement our clinical priorities in our delivery plan for the next two years. They will enable us to drive the changes required to ensure the NHS in Dorset is sustainable, innovative and responsive to the needs of local people. You can read more about these programmes on page 50. We would like to take this opportunity to thank all those people working both for us and with us for their continued support since April 2013. This has helped us develop and grow from a fledgling organisation into one which delivers improvements to healthcare across the county and will continue to do so. As a membership organisation, we are grateful for the support of our 100 GP practices. Our members offer their reflections of our first year on pages 4 and 5. As with everything we do, your voice is vital and we actively encourage you to get involved. Information on how to have your say is available on our website www.dorsetccg.nhs.uk/involve or email us at [email protected]. You can also join our Health Involvement Network and get more involved with our work (see the back page of this report for more information). We hope you find the report informative and interesting. 3 MEMBER PRACTICES’ INTRODUCTION Supporting people in Dorset to lead healthier lives Introduction to the NHS Dorset CCG Annual Report on behalf of Member Practices NHS Dorset Clinical Commissioning Group comprises 100 member practices across the county of Dorset. With a registered population of around 766,000, this makes us the third largest CCG in England in terms of population and with a commissioning budget of £947M, the second largest in financial terms. All GP practices belong to a locality which is a geographic area, and each locality has a lead GP who is a member of the CCG Governing Body. You can read more about the Governing Body’s role on page 8. This, our member practices introduction, represents all practices registered in Dorset (see pages 6 and 7 for a full list of member practices). It reflects our collective thoughts on the CCG’s governance, progress, performance and impact at the end of its first year. Reflections Reflecting on the CCG’s first year, we have made a solid start in addressing the health priorities of our local communities. We have captured this in our “highlights of our first year” from page 16 to 22. There is still much to do to face the significant challenges ahead and to this end we have refreshed our strategy to reflect this. You can read more on page 14 to 15 about our progress and performance as measured against annual delivery plan targets. Impact The Membership Body came together, during the year, at a series of events, focusing on the challenges of the CCG including its first year priorities and how, as members, we saw the development and their engagement with our planned Clinical Services Review. 4 The Governing Body has also added impact to the CCG’s ambitions in embracing their new clinical leadership roles and shaping the strategy and engagement of the CCG with local stakeholders. Please read the case studies on pages 25 to 39 which feature each of our Clinical Commissioning Programmes introduced by the respective Clinical Chair. Evaluation The Governing Body and its Clinical Commissioning Committee participated, during November 2013, in an independent board observation exercise with NHS England, as part of the CCG’s development process. This evaluation exercise focused on governance, challenge, individual contributions, level of discussion, forward focus and decision making. This provided helpful and insightful feedback from which the CCG can further enhance its clinical leadership and informed the CCG organisational development planning. The CCG Governing Body is assessed quarterly by NHS England’s Local Area Team. Most recent reviews assessed us as ‘Assured’ and ‘Assured with support’ for all our domain areas. Members’ engagement The CCG has developed robust engagement mechanisms to ensure we can all participate in clinical decision making. As each of our practices belongs to a locality (a geographic area) our Locality Lead GP represents us and our patients in their role as a member of the CCG Governing Body. You can read more about these key people on pages 9 to 10. A regular cycle of engagement activity has taken place during the year to involve us in the organisation and the development MEMBER PRACTICES’ INTRODUCTION Supporting people in Dorset to lead healthier lives of the strategy and priorities, including: four membership events (all GP practices invited including practice managers). The CCG held four events throughout the year with a cumulative attendance of 500. Video summaries of these events were made available via the CCG intranet for GPs who could not attend six workshop and development events for the Governing Body, comprising clinical Board Members, Lay Members, Locality Chairs and Directors with a cumulative attendance of 216 throughout the year monthly locality meetings CCG Update – a weekly e-newsletter sent to each practice every Friday with commissioning information and links to the GP intranet. The CCG’s approach to clinical engagement formed part of our nomination for The Guardian’s inaugural Healthcare Innovation awards, which you can read more about on page 21. The member practices are supportive of the efforts of the CCG to drive engagement, however, all parties recognise the need to use technology to enable virtual collaborative discussion, given the size of the county and the demands upon local practices. Summary We are assured that any matters of concern will be flagged by the various governance arrangements that are in place to ensure our statutory obligations as leaders of healthcare services for the county of Dorset are fulfilled. As this Annual Report outlines, we recognise the difficult challenges ahead both for the NHS nationally and how that translates in Dorset. We realise we have a strong role to play in helping the healthcare system overcome these challenges by our continuing involvement and participation in the development and delivery of NHS Dorset CCG’s Strategy. Dr Forbes Watson CCG Chair and on behalf of member practices 5 OUR MEMBER PRACTICES Supporting people in Dorset to lead healthier lives North Dorset Abbey View Surgery, Shaftesbury Apples Medical Centre, Sherborne Bute House Surgery, Sherborne Eagle House Surgery, Blandford Royal Crescent Surgery, Weymouth Royal Manor Surgery, Portland The Practice Plc, Weymouth Wyke Regis Surgery, Weymouth Gillingham Medical Centre, Gillingham Purbeck Stalbridge Surgery, Stalbridge Corfe Castle Surgery, Corfe Castle Newland Surgery, Sherborne Bere Regis Surgery, Bere Regis Sturminster Newton Medical Centre, Sandford Surgery, Wareham Whitecliff Surgery, Blandford The Wellbridge Surgery, Wool Sturminster Newton Swanage Medical Centre, Swanage Yetminster Surgery, Yetminster Wareham Surgery, Wareham Bridport Medical Centre, Bridport Adam Practice, Poole West Dorset Lyme Regis Medical Centre, Lyme Regis Lyme Bay Medical Centre, Lyme Regis Charmouth Medical Practice, Charmouth Portesham Practice, Portesham Barton House Surgery, Beaminster Poole Central Carlisle House Surgery, Poole Dr Newman's Surgery, Poole Evergreen Oak Surgery, Poole Longfleet House Surgery, Poole Poole Town Surgery, Poole Tollerford Practice, Maiden Newton Rosemary Medical Centre, Poole Prince of Wales Surgery, Dorchester Birchwood Medical Centre, Poole Mid Dorset Cornwall Rd Medical Practice, Dorchester Fordington Surgery, Dorchester Poole North Canford Heath Group Practice, Poole Hadleigh Practice, Poole Queens Avenue, Dorchester Harvey Practice, Poole Broadmayne Surgery, Broadmayne Heatherview Medical Centre, Poole The Atrium Health Centre, Dorchester Puddletown Surgery, Puddletown Milton Abbas Practice, Milton Abbas Cerne Abbas Surgery, Cerne Abbas Weymouth and Portland Abbotsbury Road Surgery, Weymouth Bridges Medical Centre, Weymouth Cross Road Surgery, Weymouth Dorchester Road Surgery, Weymouth 6 Lanehouse Surgery, Weymouth Poole Bay Herbert Avenue, Poole Lilliput Surgery, Poole Madeira Medical Centre, Poole Parkstone Health Centre, Poole Poole Road Medical Centre, Poole Wessex Road Surgery,Poole Westbourne Medical Centre, Poole OUR MEMBER PRACTICES Supporting people in Dorset to lead healthier lives North Bournemouth Marine & Oakridge Partnership, Bournemouth Banks & Bearwood Medical Centre Bournemouth Shelley Manor Medical Centre, Bournemouth Alma Partnership, Bournemouth Durdells Avenue Surgery, Bournemouth Kinson Road Medical Centre, Bournemouth Leybourne Surgery, Bournemouth Northbourne Surgery, Bournemouth Talbot Medical Centre, Bournemouth Village Surgery, Bournemouth Central Bournemouth Denmark Road Medical Centre, Bournemouth Holdenhurst Road Surgery, Bournemouth Providence Surgery, Bournemouth Southbourne Surgery, Bournemouth Christchurch Barn Surgery, Christchurch Burton Medical Centre, Christchurch Farmhouse Surgery, Christchurch Grove Surgery, Christchurch Highcliffe Medical Centre, Christchurch Orchard Surgery, Christchurch Stour Surgery, Christchurch James Fisher Medical Centre, Bournemouth East Dorset Panton Practice, Bournemouth Old Dispensary, Wimborne Moordown Medical Centre, Bournemouth Cranborne Surgery, Wimborne St Albans Medical Centre, Bournemouth Orchid House Surgery, Ferndown East Bournemouth Quarter Jack Surgery, Wimborne Woodlea House Surgery, Bournemouth Beaufort Road Surgery, Bournemouth Boscombe Manor Medical Centre Bournemouth Crescent Surgery, Bournemouth Littledown Surgery, Bournemouth Penny's Hill Surgery, Ferndown Trickett's Cross Surgery, Ferndown Verwood Surgery, Verwood Village Surgery, Poole Walford Mill Surgery, Wimborne West Moors Group Practice, West Moors 7 GOVERNING BODY / MEMBERS’ REPORT Supporting people in Dorset to lead healthier lives NHS Dorset Clinical Commissioning Group (CCG) was created and fully authorised without conditions on 1 April 2013. Introduction NHS Dorset CCG is the third largest clinical commissioning group in England, in terms of population and, with a commissioning budget of £947M, the second largest in financial terms. We have a Governing Body and our own constitution which sets out how the organisation will work. Whilst we do not directly provide any health services, we have responsibility for commissioning (planning and funding) a number of them for local people. These include: planned hospital care at local hospitals urgent and emergency care e.g. A&E, ambulance services, out of hours care and the NHS 111 service community health services mental health and learning disability services rehabilitation care maternity, children’s and family services NHS continuing healthcare. Our mission Our mission, aims and strategic principles have been developed through wide consultation and engagement with stakeholders and partners across Dorset. 8 Supporting people in Dorset to lead healthier lives As leaders we will use our clinical understanding to drive forward continuous improvements in services throughout Dorset that support people to lead healthier lives for longer. Our aims We aim to be an organisation that: is trusted and builds confidence in our public, patients and stakeholders challenges and encourages its partners, members and staff to drive improvements in services and performance values its staff and membership and is a great place to work uses resources effectively and efficiently has a local focus but doesn’t lose sight of the bigger picture. Our values We have six values which underpin everything we do. These are: Caring Collaborative Courageous Honest Responsive Responsible. GOVERNING BODY / MEMBERS’ REPORT Supporting people in Dorset to lead healthier lives Our Governing Body is made up of 13 GP Locality Chairs, a Chair, a Chief Officer, a Chief Finance Officer, two Lay Members, one Nurse Lead and one Doctor Lead. Who we are: our Governing Body Our Governing Body is made up of 13 GP Locality Chairs, a chair, a Chief Officer, a Chief Finance Officer, two Lay Members, one nurse lead and one hospital (secondary care) doctor lead. The Chair is Dr Forbes Watson and the Chief Officer is Tim Goodson. The Governing Body has a responsibility to ensure there are appropriate healthcare services for the people of Dorset. All GP practices belong to a locality which is a geographic area, and each locality has a lead GP who is a member of the CCG Governing Body. The members of our Governing Body are: Dr Forbes Watson, Chair Tim Goodson, CCG Chief Officer Dr Peter Blick, Locality Chair for Central Bournemouth Dr Jenny Bubb, Locality Chair for Mid Dorset Dr Rob Childs, Locality Chair for North Dorset Dr Colin Davidson, Locality Chair for East Dorset Dr Paul French, Locality Chair for East Bournemouth Dr Richard Jenkinson, Locality Chair for Christchurch Dr Tom Knight, Locality Chair for North Bournemouth Dr Chris McCall, Locality Chair for Poole North Dr Blair Millar, Locality Chair for West Dorset Dr Andy Rutland, Locality Chair for Poole Bay Dr Patrick Seal, Locality Chair for Poole Central Dr Karen Kirkham, Locality Chair for Weymouth and Portland Dr David Haines, Locality Chair for Purbeck Paul Vater, Chief Finance Officer David Jenkins, Lay Member Lead for Patient and Public Involvement and Deputy CCG Chair Teresa Hensman, Lay Member Lead for Governance Mary Monnington, Registered Nurse Member Dr Chris Burton, Secondary Care Member. Each GP liaises between the Governing Body and practices in the locality to ensure decisions reflect local issues and needs. The Governing Body has three committees which report to it: a clinical commissioning committee, a remuneration committee and an audit and quality committee. The Audit and Quality Committee provides the Governing Body with an independent and objective view of the CCG’s financial systems, financial information and compliance with finance-related laws, regulations and directions. It gives assurance on the quality of services commissioned and promotes a culture of continuous improvement and innovation with respect to safety of services, clinical effectiveness and patient experience. 9 GOVERNING BODY / MEMBERS’ REPORT Supporting people in Dorset to lead healthier lives The Audit and Quality Committee is chaired by Teresa Hensman, Lay Member Lead for Governance. The further members are: Charles Buckle, Non-governing Body Lay Member Dr Paul French, Governing Body representative David Jenkins, Lay Member Lead for Patient and Public Involvement and Deputy CCG Chair Mary Monnington, Registered Nurse Member Tina Thompson, Non-governing Body Lay Member. The Clinical Commissioning Committee The Clinical Commissioning Committee is responsible for developing and recommending clinical priorities; promoting patient and public involvement and engagement; supporting the delivery of clinical effectiveness and ensuring a clinical perspective in the business of the CCG. It is made up of the chairs of the seven Clinical Commissioning Programmes, executive and Lay Members. The CCC is chaired by Dr Forbes Watson. Other members are: 10 Tim Goodson, Chief Officer Paul Vater, Chief Finance Officer David Jenkins, Lay Member Lead for Patient and Public Involvement and Deputy CCG Chair Dr Chris Burton, Governing Body, Secondary Care Member Dr Lionel Cartwright, Chair, Cancer and End of Life Clinical Commissioning Programme (CCP) Dr Paul French, Chair, Mental Health and Learning Disabilities CCP Dr Karen Kirkham, Chair, Maternity, Reproductive and Family Health CCP Dr Chris McCall, Chair, General Medical and Surgical CCP Dr Christian Verrinder, Chair, Musculoskeletal and Trauma CCP Dr Andy Rutland, Mid Locality Representative Dr Craig Wakeham, Chair, Cardiovascular Disease, Stroke and Diabetes CCP Dr Simon Watkins, Chair, Pan Dorset CCP Dr Peter Blick, East Locality Representative Dr Rob Childs, West Locality Representative Jane Pike, Director of Service Delivery Suzanne Rastrick, Director of Quality. Profiles of members of the Governing Body and the register of their interests can be found on pages 68 to 77. The Remuneration Committee The Remuneration Committee makes recommendations to the Governing Body about the remuneration, fees and allowances for senior employees and people who are appointed or who provide services to the CCG. The Remuneration Committee is chaired by David Jenkins, Lay Member Lead for Patient and Public Involvement and Deputy CCG Chair. Other members are: Dr Chris McCall Governing Body, Locality Lead, Assistant Clinical Chair Dr Forbes Watson, CCG Chair Teresa Hensman, Lay Member Lead for Governance / Chair of Audit & Quality Committee Mary Monnington, Registered Nurse Member GOVERNING BODY / MEMBERS’ REPORT Supporting people in Dorset to lead healthier lives Engagement: how we work with our partners Engagement is at the heart of everything we do and we are committed to meaningful external and internal engagement to help shape services and improve health outcomes for the population of Dorset. Please turn to page 61 for details of how we do this. Our future plans and priorities We have spent time with a number of our partners outlining our priorities for the coming years. Based on the Department of Health’s Quality, Innovation, Productivity and Prevention Programme (QIPP), we have integrated this approach into all our plans to make sure we are able to reinvest savings required of the NHS over the coming years. These high-level priorities are consistent with the priorities identified by both our local Health and Wellbeing Boards and are: improving health and reducing health inequalities a better quality of life for people with long-term conditions better recovery from episodes of ill health or injury a positive experience in a safe environment and protection from avoidable harm. Our strategy We have published our five-year strategy which outlines what our ambitions and priorities are over the coming years. This strategy also addresses issues and comments raised by our members, providers, partners and patients. It focuses on our four strategic principles of: services designed around people preventing ill health and reducing inequalities sustainable healthcare services care closer to home. Our initial priorities for the year 2013/14 were: improving dementia diagnosis and services reducing avoidable emergency admissions integrating and improving services for children, young people and their families improving mental health services Environmental, social and community issues integrating and improving community care for adults and older people improving end of life care services reshaping acute services, whilst maintaining access. These priorities aim to deliver: fewer premature deaths reducing preventable deaths. You can read about our progress against these priority areas on pages 14 to 15. You can read more about our commitment to the environment, community and society in our Sustainability Report on page 52. Pension liabilities For more information regarding pension benefits and costs please see page 83 in the 11 GOVERNING BODY / MEMBERS’ REPORT Supporting people in Dorset to lead healthier lives Financial Performance section (1.8.2 Retirement Benefit Costs and Note 4.5: Pension Costs). External audit and disclosure To read the external audit report, please turn to page 4 of 53 in the Accounts Addendum. Our Governing Body members’ disclosure to auditors is outlined on page 77. Information governance, complaints and compliance For information regarding data loss or confidentiality, complaint handling and other matters relating to Principles for Remedy, please see pages 50 to 59 within our Quality section. Our Annual Governance Statement on page 6 of 53 (sections 5.5 and 18) in the Accounts Addendum discloses our assurance process regarding these matters. 12 Equality, diversity and workforce Policy information regarding our commitment to equality and diversity, including disabilities and gender, is available on pages 51 to 53 within the Strategic Report section. This section also contains information regarding our approach to employee consultation, which you can read under Commissioning Support Development on page 52. Emergency preparedness, resilience and response (EPRR) Detailed information on EPRR and how we work with our partners to support the Dorset community should an incident occur can be found on page 60 to 61. Progress against targets Please see the delivery plan progress report on 14 and 15. 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W/-7)+3 <)3 A1+)X Y12 +0) @),2!)*-!'134+41*!,*@!'24124+@!>0450!0,3!*1+!2),50)-!+0)!51*+2,5+!,*-!&1D4(43,+41*!3+,7)!8-1/D()!D(/);!0,3!2)5)4.)-!,!2)-! µ12¶ QRW DFKLHYHG UDWLQJ 2588-00-5#-#.'293&"':"9' ! ;$%." J),(+0 A))-3 M33)33&)*+!4*5(/-4*7!G,+4)*+ZG/D(45!)*7,7)&)*+ G24124+43,+41*!,*-!C12[!'(,*!:).)(1'&)*+ H/22)*+ K)2.45)!=).4)> K)2.45)!:)347*!,*-!G(,**4*7 K)5/24*7!+0)!K)2.45) H1*+2,5+ ,*- I1D4(43,+41* I,*,7) G)2612&,*5)!\!:)&,*I,*,7) ]/,(4+@ \ ^/+51&)3 750-$-5#'<.%-#0$' 2588-00-5#-#.'293&" 15 HIGHLIGHTS OF OUR FIRST YEAR Supporting people in Dorset to lead healthier lives We had some notable successes during our first year in operation and have launched a range of innovative services to improve healthcare in Dorset Call 111 for medical help Telehealth referrals reach 300 The new NHS 111 service was implemented successfully across Dorset in April with few of the problems reported elsewhere in the press and media. The NHS Dorset CCG Telehealth project team received their 300th patient referral for a Homepod Telehealth system in May. April 2013 NHS 111 call handling and triage services are provided by the South Western Ambulance Service NHS Foundation Trust. The aim of the service is to make it easier for people to access local NHS healthcare services. People can call 111 when they need medical help fast and when it’s not a 999 emergency. 111 is a fast and easy way to get the right help, whatever the time, day or night, seven days a week. In excess of 200,000 calls were made to the service in the first year. 16 May 2013 A Homepod is a specialist piece of equipment that is provided in the patient’s home and is able to take readings and upload results directly to a central computer held at a surgery or hospital. The Homepod reads blood pressure, weight, pulse, temperature and oxygen levels. Once installed, the Telehealth equipment is extremely easy to use. Feedback so far from patients and healthcare professionals has been very positive. Telehealth saves time and travel for the patient as they do not have to attend routine appointments as regularly as they normally would. The value of the scheme was recognised by being shortlisted for a national award. HIGHLIGHTS OF OUR FIRST YEAR Supporting people in Dorset to lead healthier lives Personal health budgets pilot rolls out for national success Care and Compassion Conference a success The Government has committed the NHS to the national roll-out of personal health budgets (PHBs) which were successfully piloted in Dorset. Compassionate care is as important as the quality of care and we work with hospitals and services to ensure that patients and their families are treated with compassion. May 2013 From 1 April 2014, CCGs can offer PHBs to people receiving NHS continuing healthcare. By March 2015 everyone who could benefit will have the option of a PHB. Dorset is one of nine ‘Going further, faster’ sites which are already offering PHBs. A national Patient Outcome Evaluation Tool survey showed that 92% of Dorset patients receiving a PHB reported an improvement in their physical health compared to 69% nationally. Eighty per cent reported an improvement in their mental health against a national average of 64%. It also showed that all carers involved in the pilot felt their views were fully included in the care planning process. The Personal Health Budget project in Dorset was winner of the Health Service Journal Efficiency in Financial Services award in 2012. June 2013 We brought together health partners and members of the public at a conference to learn how care and compassion is everyone’s responsibility. Around 100 delegates represented hospitals, local authorities, service providers and voluntary groups. Presentations were received from National Patient Champion Ashley Brooks, who told of his experiences whilst being treated for leukaemia and MRSA, Dorset County Council and Dorset Healthcare University NHS Foundation Trust along with local hospitals. London-based Guys’ and St Thomas NHS Foundation Trust showed their awardwinning film ‘Barbara’s Story’, which tells of the experiences of an elderly patient during a hospital visit and is part of an innovative dementia training programme. 17 HIGHLIGHTS OF OUR FIRST YEAR Supporting people in Dorset to lead healthier lives The Big Ask tests temperature of local health services June 2013 Working with local partners, we launched an ambitious project to get an in-depth insight into people’s views of Dorset health services. The Big Ask sought views on a range of NHS services, from local GP and out-ofhours services to community, mental health and hospital services. We wanted to find out how well informed people were about the services available locally, how they choose healthcare and what services they used the most. We also asked how people think the NHS could provide information in the most effective way. Most importantly, we asked for individual opinions on the NHS in Dorset – what people valued most and what could be improved. This is the first time Dorset NHS organisations have worked together in this way on an exercise of this scale. The project involved Dorset County Hospital NHS Foundation Trust, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust and Poole Hospital NHS Foundation Trust and Dorset Healthcare University NHS Foundation Trust. The Big Ask was carried out by Bournemouth University’s Market Research Group to ensure its independence. More than 12,000 people were sent the survey directly but anyone could take part and more than 6,000 responses were received. This information will be invaluable when we are reviewing and improving services, for example the transformational programmes highlighted on page 50. 18 Dorset CCG looks to improve services for those affected by headaches August 2013 Headaches can take many forms and have a number of causes including stress and lack of sleep. With around 14% of Dorset residents – over 108,000 people – affected by migraine or cluster headaches alone, we gathered views on how to improve services for local sufferers. As a result of the events, draft proposals for new services along with a draft service specification have been sent to those people who have registered an interest in headaches for comment. More than 10 million people in the UK get headaches, making them one of the most common health complaints. Whilst most are not serious and can be treated with some basic remedies or lifestyle changes, some people have headaches that are so severe they need to consult medical help. HIGHLIGHTS OF OUR FIRST YEAR Supporting people in Dorset to lead healthier lives Drinkheads: health bodies warn about mixing alcohol with parenting September 2013 We joined forces with Bournemouth & Poole Local Safeguarding Children Board, Dorset Safeguarding Children Board and Public Health Dorset to highlight the dangers to parents. A hard-hitting campaign from local health partners was launched in Dorset to alert parents to the dangers of drinking alcohol when they are looking after young children. While thankfully rare in Dorset, there have been cases of children coming to harm while being under the care of adults who have had too much to drink. As part of the campaign, posters have been displayed at selected sites in Weymouth, Poole and Bournemouth with radio advertising running in parallel. An advertisement also ran in Primary Times magazine - 50,000 copies of which was distributed to parents through primary schools across Dorset. 19 HIGHLIGHTS OF OUR FIRST YEAR Supporting people in Dorset to lead healthier lives A new patient transport service October 2013 A new non-emergency patient transport service for Dorset residents was introduced in October. The county-wide service was designed in consultation with NHS treatment centres and patient groups to provide an adaptable and reliable service to the local community. Study to reduce hip arthritis pain launches in Bournemouth and Christchurch September 2013 A pioneering study to assess the link between regular cycling activity and reduced hip pain or need for hip surgery was launched in Bournemouth and Christchurch, with local residents being invited to sign up and get involved. Cycling Against Hip Pain (CHAIN) is a concept proposed by Mr Robert Middleton, consultant orthopaedic surgeon and hip specialist at the Royal Bournemouth Hospital, which is a leading centre in hip replacement surgery. The study is based on evidence that indicates that regular cycling activity and education could reduce symptoms for people with hip pain, stiffness and arthritis and reduce the need for surgery. 20 The service ensures patients with a medical need receive transport suitable for their particular health circumstances. Bookings are processed by the Dorset Patient Transport Bureau located in Bournemouth. A separate 24-hour booking line is available for NHS personnel booking transport on a patient’s behalf. To ensure all mobility requirements and weather conditions are catered for, a comprehensive fleet of vehicles ranging from 4-wheel drive ambulance cars to Patient Transport Service (PTS) ambulances are available. The new service is run by E-zec Medical, a family-run company set up by former NHS personnel in 1998. E-zec Medical operates a number of NHS contracts, including a PTS service in Hampshire. There were some initial teething problems because of heavy demand, but with the mobilisation of additional crews, E-zec Medical is now providing a reliable patient transport service. HIGHLIGHTS OF OUR FIRST YEAR Supporting people in Dorset to lead healthier lives NHS Dorset CCG shortlisted for leadership programme Christchurch Health Network wins national award We were delighted to have been shortlisted for the inaugural Guardian Healthcare Innovation Awards. Our Christchurch locality won a prestigious award for Making a Difference at the NHS Alliance Acorn Awards in November for their community health and wellbeing project. October 2013 We were one of three nominees in the category of Leadership Innovation for Great Leaders for our Leadership Development Programme. This was built into transition arrangements as we moved from our previous primary care trust status into our first year as NHS Dorset CCG. The aim of Great Leaders was to develop clinical leadership and commissioning skills across the NHS. This is important given the new role GPs have in managing budgets and planning how NHS funding is spent. We developed a high-level training and learning programme for clinicians. It was designed to enable them to become confident leaders so they can fulfil their role as commissioners, lead local health priorities and make the best use of resources as part of the Government’s recent NHS reforms. December 2013 The project, led by Jan Childs, practice manager of Stour Surgery at the time, was a winner in the best example of a ‘practice working with its community to improve health’ category. The aim of the project was to establish a Christchurch Health Network, which would strengthen links with Christchurch Borough Council, Christchurch Community Partnership and the voluntary sector. Feedback to the locality CCG group then helps them to improve the health and wellbeing of local people. Membership of the health network has now reached over 175 and includes local government councillors, representatives from the health and wellbeing board, third sector agencies, police, patients and carers. 21 HIGHLIGHTS OF OUR FIRST YEAR Supporting people in Dorset to lead healthier lives Getting active in North and East Dorset May 2013 / January 2014 Two new schemes aimed at helping people to get fit and active have been pioneered in our North and East localities. New exercise equipment that is free to use for people living in and around Blandford Forum was installed in May, funded by the Blandford Forum Town Council and our North Dorset locality. There is a slightly higher than average rate of obesity amongst adults in North Dorset so we hope to encourage them to lead a healthier and more physically active life. The locality group is working with other North Dorset towns and hopes to be able to provide similar facilities. In January 2014, our East Dorset locality worked with Christchurch and East Dorset Partnership (Moors Valley Country Park) and Dorset Partnership for Older People Programme (POPP) to encourage local people to get active. The initiative Activate East Dorset offers a range of free activities to people who are registered with local GPs. These include: wellness walks, chair-based exercise classes and a green referral scheme. 22 Video highlights our work with new mums March 2014 The work of the Maternity, Reproductive and Family Health commissioning team has been highlighted in a video. Produced by NHS England to mark them being a finalist in the NHS England Excellence in Participation Awards, the video features interviews with members of the team along with local mums (see page 35 for more details). The team was highly commended for their work in seeking feedback from local people to inform the commissioning of maternity services. The awards were celebrated at the Health Innovation EXPO 2014 which took place in Manchester. You can see the video on our website at www.dorsetccg.nhs.uk OUR LOCALITIES Supporting people in Dorset to lead healthier lives We work to ensure our services meet the different local needs across Dorset through 13 localities NHS Dorset CCG serves a population of around 766,000 people who live in a combination of widespread rural areas along with the urban conurbations of Bournemouth, Poole, Dorchester and Weymouth. All GP practices in Dorset belong to a locality which is a geographic area. Each of our 13 localities make up the CCG and each has a lead GP who also is a member of the CCG Governing Body. The Governing Body is responsible for ensuring that there are appropriate health care services for the people of Dorset. Localities can help inform and influence commissioning decisions both within their specific area and by working collaboratively with other localities to improve services across Dorset. Each locality is also represented on the local authorities Health and Wellbeing Boards where they work alongside elected council members. Whilst there are common health needs across the county, the localities ensure that local populations have a voice in planning and prioritising health services. The localities are grouped into three clusters across Dorset. The three CCG clusters are: West Dorset Mid Dorset North Dorset West Dorset Weymouth and Portland East Dorset Christchurch Central Bournemouth East Bournemouth North Bournemouth Mid Dorset East Dorset Poole Bay Poole Central Poole North Purbeck You can read more about the lead GP for each locality on page 68. Locality managers from the CCG work alongside the lead GPs, prescribing leads and local clinicians and stakeholders within each of the localities ensuring that the work of clinical commissioners for Dorset and localities is aligned. 23 OUR LOCALITIES Supporting people in Dorset to lead healthier lives Key achievements of the locality teams during the year 2013 / 2014 include: Patient Participation Week took place in early June when members of the engagement team visited venues in North Dorset, inviting members of the public to come and find out how they could get involved in shaping local healthcare in the future. As part of the implementation of a locallybased 24-hour electrocardiogram (ECG) service, practices in the Mid Dorset locality have received the equipment and training ready to start delivery, once the provider is appointed. This will improve the local cardiology pathway, giving rapid, specialist interpretation of readings and a subsequent reduction in cardiology referrals and emergency admissions for undiagnosed arrhythmia problems During the summer of 2013 members of the Weymouth and Portland locality team helped educate local people of the dangers of staying out in the sun without protection. Working in partnership with a number of stakeholders the team extended a positive, preventative message through information, awareness, non-clinical advice and a range of free merchandise including 9,000 sachets of 24 sun screen and 5,000 UV wristbands. The Safer Sun Initiative worked in partnership with a number of stakeholders, including Dorset Cancer Network, Beach Control, RNLI Lifeguards, beach traders, Weymouth Community Volunteers, Weymouth College and local pharmacies. An initiative to get people active was launched in Christchurch locality during early 2014 in conjunction with Christchurch and East Dorset Partnership (Moors Valley Country Park) and Dorset Partnership for Older People Programme (POPP). Activate East Dorset offers a range of free activities to people who are registered with local GPs. Dermatoscopes have been purchased for practices across Purbeck. These will support local dermoscopy services. This is a diagnostic technique used for mole screening and skin cancer diagnosis. We are sure they will be of great benefit to local people. The funding of new exercise equipment that is free to use for people living in and around Blandford Forum. The equipment has been funded by the Blandford Forum Town Council and NHS Dorset CCG’s North Dorset locality. CLINICAL COMMISSIONING PROGRAMMES Supporting people in Dorset to lead healthier lives We have a number of Clinical Commissioning Programmes (CCPs) working across Dorset to consider how healthcare services can be improved. CCPs are led by local GPs. The Cardiovascular Disease, Stroke and Diabetes Clinical Commissioning Programme is working to: develop a balanced approach to all aspects of care for people with heart disease ensure that people who are having a stroke or have had a TIA (mini stroke) can access specialist services 24 hours a day, seven days a week further develop community-based services for people with diabetes, helping to prevent complications of the disease and enabling them to receive care closer to home. While the CCP is working towards providing the best possible service to stroke patients, steps were also taken during the year to help prevent people having a stroke in the first place. In Weymouth and Portland, most GP practices in the area joined a pilot project to offer people a pulse check when they attended flu jab sessions. One practice carried out a one-month inhouse campaign. The aim was to identify people with atrial fibrillation (AF), an abnormally fast or irregular heartbeat that can lead to stroke in the future. If one was detected, an electrocardiogram (ECG) was offered to check electrical activity in the heart and, if that confirmed atrial fibrillation, the patient could be started on medication. A total of 6,086 patients were screened and 256 found to have an irregular pulse. Some people declined to go on for an ECG, but 165 patients did have the examination and 22 were diagnosed with AF. Mrs Peggy Hansford (86) guessed that something was wrong when she was not able to walk as far as the bus stop she had always used and was rather breathless. ‘I was not really able to do the things I used to do,’ said Mrs Hansford. But she was caring for her husband John and didn’t go to the doctors. Then she had her pulse checked when she went for her flu jab in the autumn and that gave her the reason why. A follow-up ECG confirmed that she had atrial fibrillation and she is now relieved that she is on medication to help her avoid having a stroke. She has regular checks at Lanehouse Surgery in Weymouth. ‘I have been coming to the doctor’s at Lanehouse since 1950 when the GP then held his surgeries at his home,’ said Mrs Hansford. ‘They are very good – and they were always good to my husband too. I feel very supported. They are almost like a part of my family.’ The project was not only potentially of great benefit to patients with AF who could have gone on to have a stroke, but was cost effective too. It was calculated that by avoiding potential strokes, every £1 invested in the project could lead to a saving of £220 to the NHS. 25 Cardiovascular, Stroke and Diabetes CCP Supporting people in Dorset to lead healthier lives ‘ Clinical Chair of the CCP is GP Dr Craig Wakeham. He says, Another successful project launched during the year was the self-care My Health My Way service aimed at improving the lives of people with long-term conditions, including diabetes. My Health My Way offers information and support, giving patients more control and confidence over their lives and helping them overcome some of the challenges they face. They are helped to build and maintain the confidence to self-manage problems like pain or fatigue, exercise or dietary changes, anxiety or depression. That help could be delivered through one-toone coaching, telephone support, group work, online tools or structured support groups. People can be referred by their doctor, pharmacist or other health professional or refer themselves. The service has a dedicated telephone number, email address and website www.myhealthdorset.org.uk. Patients with long-term conditions were involved in every stage of the development of the project, including during the procurement process when it was decided who should provide the service. 26 Despite significant improvements, coronary heart disease is the biggest single cause of deaths in the UK. Every year there are approximately 152,000 strokes in the country, which can lead to severe disability. There is a considerable rise in the number of people diagnosed with type 2 diabetes which can lead to serious health problems in the long term. Many more people are thought to have diabetes without knowing it. This CCP team is working in many different ways to help people lower their risk of becoming ill with these diseases. Eating healthily and taking more exercise can lower the risk of all three, so we shall look for ways of helping them to do that. We shall ensure that if they do become ill, they receive the right treatment, promptly. For example, the speed with which people who have strokes are treated can make a huge difference to the severity of any disability they may suffer. Prevention is better than cure, so we shall try to identify people at risk of developing ill health. The atrial fibrillation pilot project (see page 25) is an example of early intervention. Helping people to live healthier lives is really a joint project between them and the NHS and our partners who provide care for them. ’ We shall work to ensure that people have the information and support they need to make the healthy choices that can be of benefit to individuals and their families. Mental Health and Learnng Disabilities CCP Supporting people in Dorset to lead healthier lives The priorities for the Mental Health and Learning Disabilities Clinical Commissioning Programme (CCP) are to: review and improve the pathway for people who have acute mental health conditions review and improve older peoples’ mental health services and increase early diagnosis of dementia in our prevalent population using learning from the Confidential Inquiry into Premature Deaths of People with Learning Disabilities (CIPOLD) and the Winterbourne View report, further improve learning disability services that are provided jointly by the NHS and our local authorities improve primary care mental health services including access to psychological therapies. The CCP team is working to ensure that mental health is valued equally with physical health to achieve ‘Parity of Esteem’. It is also working to provide services that are of a consistently high quality across Dorset for people with learning disabilities, dementia and mental health conditions. Existing services are being reviewed, redesigned if necessary and commissioned in three main areas: Mental Health, which includes: services for people who are acutely ill rehabilitation services for people who are recovering Steps to Wellbeing, a free, confidential service for people aged 18 and over offering a range of different types of treatment for low mood or depression, anxiety or stress assisting people to gain employment when able specialised services for people with conditions such as adult eating disorders and Asperger’s assessment and diagnosis. During this year we have commissioned a Community Asperger’s Assessment Service across Dorset, which will go live in early 2014/15. We have also implemented the mental health urgent care service in the west of Dorset, including the launch of a recovery house in Weymouth. This led to an increase in crisis response home treatment staff, who work to keep people in their own homes, preventing hospital admissions. The recovery house run by Rethink Mental Illness was a first for Dorset CCG. It opened in April 2013 with seven beds for people recovering from acute mental health crisis. Dementia The CCG commissions services, often in partnership, for people living with dementia and their carers. This includes inpatient services, the memory assessment service and memory support and advice services. We are working with our three local authorities to commission a pan Dorset memory support and advisory service for people living with dementia and their carers. We have significantly improved dementia diagnosis rates in Dorset and piloted an innovative service to help people to gain support and advice: the Dorset Memory Gateway. Learning Disabilities The White Paper Valuing People defines learning disability as meaning the presence of: a significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence) with a reduced ability to cope independently (impaired social functioning) which started before adulthood, with a lasting effect on development. 27 Mental Health and Learning Disabilities CCP Supporting people in Dorset to lead healthier lives We commission health services specifically for people who have a learning disability. These include the community learning disability teams, which are jointly staffed by local authorities and the NHS, and an intensive support team. A key focus is to ensure that learning from the Winterbourne View Hospital in Bristol, where there was criminal abuse of patients by staff, is taken into consideration and, where clinically appropriate, as few people as possible are placed in units outside of their home area. We also work with providers to improve how people with a learning disability access services and how providers make reasonable adjustments. 28 Forum values opportunity to have a say in future services Chief executive of the West Dorset Mental Health Forum is Becky Aldridge (pictured above). She says, The Dorset Mental Health Forum is an independent local charity run and led by people with lived experience of mental health problems and access to services. We employ people with their own experiences Mental Health and Learning Disabilities CCP Supporting people in Dorset to lead healthier lives of mental health problems and we have a broad constituency of people across Dorset who are interested and engaged in our work. Being able to represent the experiences and views of people with mental health problems and advocating for services that promote wellbeing and enable recovery is a vital part of our work in Dorset. Being part of the CCP team and having a voice within commissioning projects gives us the opportunity to act as a critical friend and to bring the customer and patient experience to the heart of the CCP’s business. We believe that this perspective brings a necessary and sometimes challenging dimension to the CCP’s work in a way that can influence and shape services. We particularly support the CCP’s commitment to ensuring that mental health has equal priority with physical health. As No Health without Mental Health states, ‘good mental health and resilience are fundamental to our physical health, our relationships, our education, our training, our work and to achieving our potential.’ We also welcome the CCP’s review of existing services, ensuring that providers are delivering ‘recovery-oriented services that aim to support people to build lives for themselves outside of mental health services with an emphasis on hope, control and opportunity.’ We believe that these principles and aspirations sit firmly with ensuring that people with mental health problems have choice and access to the right services at the right time, including early intervention and availability of services as soon as they are needed, in the least disruptive, least restrictive and least stigmatising way. Clinical Chair of the CCP is GP Dr Paul French. He says, ‘ One of the principal aims of this CCP team is to ensure that people with a mental illness or condition are assessed and treated by services that are on a par with those available for people with physical ill health. This is called Parity of Esteem. One significant illness which is going to become more common as the population ages is dementia. This is a devastating illness for them, their families and carers. Before we can help to improve their lives, we need to know who they are, so prompt diagnosis is really important. We are working hard with the Dorset Dementia Partnership to identify dementia patients early and improve services overall, for them and their carers. Dementia is a progressive illness but there is much we can do to help people maintain as good a quality of life for as long as possible. For other mental illnesses, the emphasis is on recovery. To help patients we offer treatment and support, exploring ways in which they can gain employment if they are well enough, and play a positive role in their families and local communities. People with learning disabilities are at higher risk of developing certain health problems. ’ We want to ensure they have good access to health checks so that any problems can be disagnosed early and treated effectively. 29 Musculoskeletal and Trauma CCP Supporting people in Dorset to lead healthier lives Priorities for the Musculoskeletal and Trauma Clinical Commissioning Programme are to: develop a comprehensive community-based musculoskeletal service embed the new approach to the management of chronic persisting pain and extend to other areas ensure we maximise patient outcomes from elective surgery. During the year we have been developing a new care pathway for people suffering from spinal pain. A project group has been established to agree a service specification, consider the impact this will have on current services and engage with patients. We have also commissioned a new Dorset Community Persistent Pain Service from Dorset Healthcare University NHS Foundation Trust. Roll-out of the pain service began in East Dorset in 2013/14 and consultants will be in post in Bridport Hospital in West Dorset in June 2014. See next page for examples of how this service is working in action. We are ensuring that patients of the orthotics service receive the same standard of care across Dorset by drawing up a pan Dorset service specification. The orthotics service provides patients with external devices on weak or injured joints that need support, for example elbows and wrists. Oxford Score templates have been provided to GPs to help them assess whether people with hip and knee problems should be referred to a specialist. Patients are asked to ‘score’ their pain and mobility difficulties in several activities, for example washing or kneeling. This enables the GP to reach an overall assessment of their problems and to decide the best course of action for them. Use of the scoring system has led to improved referrals, a reduction in waiting times and 30 improved outcomes for patients. A review of physiotherapy services is under way. All practice managers, GPs and patients using services at our providers are being surveyed. Clinical guidelines and service specifications will then be agreed with clinicians and communication and training materials developed for primary care. The public will be consulted as the service develops. One of the most significant advances in the treatment of rheumatoid arthritis in recent years has been the development of a group of drugs called biologics. Following discussions with rheumatology specialists, a service specification has now been drawn up for the use of these drugs to treat psoriatic arthritis and ankylosing spondylitis as well. The musculoskeletal five-year vision and strategy project team has been formed to oversee the development and implementation of services from 2014/2019. Patients, carers and the general public will be at the heart of this work and their views and input will drive it forward. Their interest was demonstrated by an excellent turn-out for our first public and patient event in February. Musculoskeletal and Trauma CCP Supporting people in Dorset to lead healthier lives Patients feel the benefit thanks to new pain service For more years than she can remember, Judith Watson has been in pain. She has scoliosis, an abnormal curvature of the spine, and multi-level spondylosis that includes age-related wear and tear in her neck. ‘Everything I do is difficult and painful and that can lead to all sorts of things, including depression,’ she said. Over the years, Mrs Watson (pictured with her husband Peter, above right) has had X-rayguided injections, that helped for a time but always wore off before the next one was given. ‘Medication helps too but makes me very tired and I am fighting my eyelids by teatime,’ she said. But now, she is benefiting from the new Dorset Community Pain Service that came into operation during the year and aims to set a world-class standard. Mrs Watson now receives injections at more regular intervals that she finds beneficial. The pain service team includes, Dr Naeem Ahmed and Dr Mohamed El Toukhy, the Pain Consultants, GPs, counsellors, occupational therapists, specialist pain physiotherapists, nurses, and psychology and therapy assistants. The service includes a holistic approach to pain and Meherzin Das is the lead for this aspect of the service. It has a ‘Soaring Above Pain’ website for service users and professionals. The site features a virtual ‘patient platform’ specifically for people who can set and monitor personalised goals, obtain information about self-management of pain and generally benefit from contact with an online community that understands how they feel. Discussions are taking place with Dorset County Council to set up free bespoke classes for pain patients and free Tai Chi courses are already on offer in Poole, Bournemouth and Blandford. Coffee mornings are organised and there is a quarterly newsletter. A Pain Chain peer support system trains people who have already been through the pain service to mentor others who are struggling with their condition. 31 Musculoskeletal and Trauma CCP Supporting people in Dorset to lead healthier lives Mrs Watson has found the pain management programme particularly effective. ‘It’s very helpful to understand how pain works to try and adjust your attitude to it and “shut the pain gates” before it takes over,’ she said. On one session, Mrs Watson and her fellow participants were asked to visualise their pain and then think of something that would be an antidote to it. She visualised red hot metal and then poured cold water on it. ‘It was very, very helpful. At the end almost all of us had reduced our estimation of our pain,’ she recalled. ‘They are teaching us the tricks of the trade.’ Mrs Di Smith, who has had severe arthritis since 1976, agreed on the value of the service. ‘I believe that if I had been referred to a pain management service all those years ago, I wouldn’t be as bad as I am now,’ she said. ‘I would have been taught exercises and how to sit and stand properly to help my joints last longer.’ Her husband suffers from arthritis in his neck and spine. Both need regular X-ray-guided injections. Both couples played an important role in the consultations that took place before the new service was commissioned through focus groups and discussions, including helping to write the service specification, in which better communication was a key requirement. ‘When you ring the pain service now you nearly always get to talk to someone instead of an answerphone. If you have to leave a message they will phone you back. 32 Clinical Chair of this CCP is Dr Christian Verrinder. He says, ‘ The CCP has achieved a lot in the last year. The implementation of the new persistent pain service was always going to be a challenge but has been successfully embedded now into the Dorset Healthcare system. We have taken on some ambitious areas to review this year including physiotherapy services, a five-year vision and developing the service specification of an exciting new back pain service. ’ The engagement from patients, stakeholders and clinicians alike has been really encouraging. ‘That’s important because a lot of the time when you make that phone call you are at the end of your tether.’ Both couples welcomed the more timely guided X-ray service and hoped that when all the patients who need treatment for pain are identified the correct timetable for each patient can be maintained. They also hoped that once the service is fully up and running it will be a real ‘community’ service and available as close as possible to their homes. These are some of the challenges faced by CCGs when they are planning local healthcare and it’s why involving patients when reviewing services is so important and valuable. Maternity, Family Services and Reproductive Health CCP Supporting people in Dorset to lead healthier lives The Maternity, Reproductive and Family Health Clinical Commissioning Programme team is working to improve the health of the family in several different areas. These are listed with their individual objectives below: Maternity We will work to provide a maternity service that is of an equally high standard across Dorset and that meets the identified needs of local mothers-to-be and their families. We have worked closely with local women and families to seek their views on key priorities for development of maternity services in Dorset. This work led to us being finalists in the NHS England Excellence in Participation Awards. The results of this feedback, as well as the work we have done with our wider stakeholders, has now led to the development of a pan Dorset strategy for maternity services for the next five years. Our vision is that maternity services in Dorset work proactively with partners to support women and families to give their children the best possible start in life. We want high quality, safe and personalised services that can meet the needs of all women and families and are delivered in a sustainable, evidence based, responsive and compassionate way. Reproductive and gynaecological services We will work to ensure that all aspects of gynaecological care are of a high quality. During the year we re-commissioned fertility services and introduced changes that widen the age limits that women living in Dorset can qualify for in vitro fertilisation (IVF) from April 1 2014. We plan to consult widely on further changes during the coming year. We have also carried out a local review of termination of pregnancy services and will be implementing its recommendations during the coming year. Children with additional needs/disabilities Children and young people with additional needs/disabilities will have their healthcare needs met in the local community wherever possible. To help us do this we have commissioned additional occupational and physiotherapy 33 Maternity, Family Services and Reproductive Health CCP Supporting people in Dorset to lead healthier lives children in Dorset have access to nursing care in the community when they need it. By supporting families and carers, making sure they are well informed about the health condition their child has, and by providing training for healthcare professionals in primary care, we aim to reduce inappropriate A&E attendances and hospital admissions. Health outcomes of vulnerable children support for children with complex needs and also improved services available for children needing palliative care. A review of services for children with Attention Deficit Hyperactivity Disorder and Autistic Spectrum Disorders has been carried out and the findings will be implemented in the coming year, for example developing pan Dorset joint care pathways. Working with partners, we plan to fully implement the health elements of the Special Educational Needs and Disabilities Bill, which will simplify the assessment process for children with special educational needs and disabilities who require support from various agencies. They will receive a single education, health and care plan and every provider of services will be required to publish an offer of services to this group of children and young people. Children with chronic disease or who are in need of urgent care We will work to provide high-quality care for children and young people with chronic diseases across Dorset. For example, we have increased the provision of insulin pumps for children with diabetes. We have also reviewed community paediatric services and will be introducing a pan Dorset model of care to ensure all 34 The health outcomes of vulnerable and hardto-reach children, young people and families will be improved. During the year we enhanced services for children who are Looked After (in the care of the local authority) to ensure that each child had a timely assessment of their health needs and a plan of how these should be met. We also improved medical services for children who have been abused, ensuring they have access to health assessments. Improvements will continue to be made during the coming year. The effectiveness and quality of the services we provide will be monitored and a designated nurse appointed specifically for children who are Looked After. Comprehensive Child and Adolescent Mental Health Services (CAMHS) We will work to provide a comprehensive CAMHS to meet the identified needs of children and young people Work has continued with our partners throughout the year to implement the pan Dorset CAMHS Strategy. We have also reviewed services for children with learning disabilities and additional mental health needs and will implement the findings of this review in 2014. These include development of a pan Dorset pathway of care. Maternity, Family Services and Reproductive Health CCP Supporting people in Dorset to lead healthier lives Clinical Chair of the Maternity, Reproductive and Family Health is Dr Karen Kirkham. She says, ‘ The CCP team has had a busy year completing the work that was prioritised in 2013, including the increased provision of insulin pumps for children, more speech and language therapy services and development of a pan Dorset palliative care service for children. Mum Hannah Baker (centre) with Natalie Bain (left) and Frances Aviss of the CCG. Mums project wins praise When it comes to understanding pregnancy, childbirth and those first days and weeks of a baby’s life, there is no-one more qualified to help than new mums. So when we were deciding our priorities for the development of maternity services, we asked for their views. We made use of the social network Facebook, which has links to opinion polls and online surveys. That gave us very useful objective feedback which we could use in staff training. A young mum gave a powerful and moving account of her struggle with anxiety and depression after her baby was born which was anonymised and shared with midwives, health visitors and other members of staff developing our commissioning strategy. Another mum Hannah Baker said that at first she did not see how anything she said could contribute to future services. ‘I have been amazed that so much had been Alongside this we have been taking forward the development of the Maternity Strategy and review of community paediatric services We have built strong links with acute and community providers, and developed a strong and collaborative commissioning relationship with our local authority colleagues across Dorset, which will lead to improved commissioning of services for children. We will continue working to improve communication with our GP colleagues regarding new guidelines and improvements in services with a focus on quality and equity of access to services. ’ taken into account and there’s a huge amount of outcomes as a direct result of being part of the parents’ feedback,’ she said. An online poll also sought the views of other families to gather a range of opinions and suggestions. Mums highlighted the importance of breastfeeding support. As a result short soundbites of women talking about their experiences are now on our website and available for staff. Mum Lucinda Holman added: ‘Someone asking how it was for you and what can we do to improve services was really amazing.’ 35 General Medical and Surgical CCP Supporting people in Dorset to lead healthier lives The General Medical and Surgical Clinical Commissioning Programme is working to: develop comprehensive community services for common conditions so that patients can receive their care closer to home review, design and deliver new models of care across a number of priority areas to improve patient outcomes ensure that patients receive the right care in the right place. The new Dorset Adult Integrated Respiratory Service is one example of how the programme is meeting these priorities. This service will mainly help people with: moderate to severe chronic obstructive pulmonary disease (COPD), a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease bronchiectasis where the airways of the lungs become abnormally widened, leading to a build-up of excess mucus that can make them more vulnerable to infection pulmonary fibrosis, a rare and poorly-understood condition that causes scarring of the lungs. People who have one of these diseases are more likely to have frequent emergency admissions to hospital. To help avoid these admissions, the new service will enable them to have specialist respiratory care in the community, closer to home. The service extends existing best practice, including early discharge from hospital when admission is unavoidable. Specialist respiratory nurses working partly in the community and partly in hospitals to 36 support patients can enable them to go home earlier than otherwise might have been the case. They can also signpost patients to a range of additional services to help them live with and manage their conditions. GPs can contact the service for advice and guidance and refer to the specialist respiratory team in the first instance, which may avoid the necessity to admit a patient to hospital. The new service will be based in the three acute hospitals in Dorset which will act as hubs to serve the local population. The Royal Bournemouth Hospital, Dorset County Hospital and Poole Hospital are currently developing their plans to deliver this new service. There has been wide consultation with clinicians and GPs and a patient reference group has met regularly to comment on all stages of the process as the service specification has been drawn up. Michel Hooper-Immins, a member of the group and chairman of the Weymouth Locality General Medical and Surgical CCP Supporting people in Dorset to lead healthier lives ‘ Network and governor of Dorset County Hospital, said, ’ I enjoyed the patient respiratory reference group today. I hope it is the start of a useful exercise in patients influencing the scope and course of their future treatment. As the new service is phased in, the group will continue to provide regular feedback, which will be taken into account as it develops. In addition, a patient-reported experience measure will be used to ensure a genuine understanding of the patient’s experience. This new service will be implemented in phases from April 2014 and will include education and training for primary care staff. Events to promote the new service with primary care will continue until the new service is fully phased in. One of the more common ailments that can seriously affect people’s lives is the headache. Clinical Chair of the CCP is Dr Chris McCall, who says of the new respiratory service, ‘ This project not only delivers equitable care across Dorset, it helps to meet the wishes of those patients who told us they wanted a proactive, supportive and integrated healthcare system that responds to their needs 24 hours a day, seven days a week. ’ The links between the specialist respiratory team and the team providing ongoing care will be an important development for implementation across other clinical areas. With around 14% of Dorset residents – more than 108,000 people – affected by migraine or cluster headaches alone, we gathered views on how to improve services for local sufferers. One way we did this was to hold a headache discussion forum at Sturminster Newton. ‘ One participant said, ’ It’s great that at last people’s opinions are being listened to – it’s people living with conditions who know! 37 Cancer and End of Life CCP Supporting people in Dorset to lead healthier lives The Cancer and End of Life Clinical Commissioning Programme team is working to: reduce cancer deaths through early diagnosis improve the experience of patients recognise and support their needs throughout treatment and afterwards improve end-of-life care for all patients, whatever disease they have and wherever they spend their last weeks and days provide an effective and cost efficient service. Improvements in treatment means more people are surviving cancer but survival rates in the UK are not as high as the best in Europe and vary across the country. By diagnosing cancer at an earlier stage, and ensuring access to the best treatment, it is hoped that significant improvements in survival rates can be made. This year for example we have: supported the Be Clear on Cancer Campaign, raising awareness of the symptoms of cancer refreshed the cancer two-week wait referral guidance to make sure anybody with cancer symptoms is referred at the right time to the right place appointed two Macmillan GPs to promote best practice in cancer and end-of-life care. Most patients would prefer to receive their care and treatment closer to home, reducing the number of follow-up hospital visits and the amount of travelling they have to do. We support this where possible, with the focus initially on suitable patients with breast cancer, prostate cancer and colorectal cancer. Patients living with cancer in the long term and those who are clear of the disease after 38 treatment may still need some support, which need not necessarily be clinical. We work with partners to provide this in the community and one example is the creation of a community choir (see next page) which can have a very beneficial effect on its members. End of Life Since the launch of the national End of Life Care Strategy, we have maintained our focus on providing the best care possible for people whose lives are coming to an end. The publication Planning For Your Future guide encourages patients to ensure their last wishes are written down and can be acted upon when they die. An End of Life Care website has been launched and education and training programmes put in place to promote best practice to those involved in the care of the dying. This has included: a conference for more than 300 participants the roll-out of the national Gold Standard Framework (GSF) programme across care homes, primary care, acute and community hospitals the selection of Dorset as one of three GSF Integrated Cross Boundary Care demonstrator sites the launch of end-of-life care accredited training for people working in patients’ homes and care homes. In drawing up our priorities, we have consulted widely and made significant progress in developing joint working with patients and local, regional and national partners such as NHS England, Macmillan, Cancer Research UK and the Dorset Cancer Alliance. An independent review of all health services provided to end-of-life patients has been carried out. There is widespread consultation on the options recommended which may become part of the CCP during 2014/15. Cancer and End of Life CCP Singing the blues away . . . Rising Voices Wessex is a community choir for local people living with and beyond cancer. It was set up after the Living Well With And Beyond Cancer In Dorset conference, by Verena Cooper, lead nurse for Dorset Cancer Network, and Dr Alastair Smith, clinical adviser to the National Cancer Survivorship Initiative. The project rationale was that singing is fun, and good for you. It can help with breathing, combat fatigue and restore confidence. It doesn’t need to be complicated or expensive, you do not even need to be able to read music or sing, but it will help to regain a sense of wellbeing. ‘ You can sing for fun - everyone can! As one member commented, I want to say how much I enjoyed choir last evening! What a lovely friendly, cheerful crowd of people. I will definitely be back next week! I got home last night and couldn’t remember any of the tunes to the words I had, but woke up this morning with the melody of ‘Sing’ in my head – how amazing was that! ’ The project is a co-operative venture between the CCG, Dorset Cancer Network, Lewis Manning Hospice, Macmillan Cancer Support, Dorset Cancer Network Patient Partnership Panel and Lighthouse in Poole. Picture courtesy of Lewis Manning Hospice Supporting people in Dorset to lead healthier lives Clinical Chair of the CCP is Dr Lionel Cartwright, who says, ‘ Despite the relatively high incidence and prevalence of cancers in the CCG area, Dorset cancer patients experience outcomes, survivorship and life expectancy on a par with the best in the country. This is a tribute to the skills of our clinicians, the tenacity of our patients and the support of their families and friends. We are not complacent and we aspire to achieve health outcomes that match the best in the world. We are working to raise cancer awareness as many cancers can be treated successfully if diagnosed early. The Be Clear on Cancer campaign has led to an extra 300 cases of lung cancer being identified and treated nationally. We urge people to seek a diagnosis at the first signs of a problem. Non-clinical activities can help maintain a good sense of wellbeing, even while receiving treatment. Such projects as ‘Rising Voices Wessex’ provide a chance to have fun which, with healthy eating and regular exercise, can make a real difference to how people cope. For people nearing the end of their lives, we are working with specialist and community-based services to provide sensitive and personalised care, designed around the individual and provided closer to home. The patient will always be at the forefront of services in the future. ’ 39 STRATEGIC REPORT Supporting people in Dorset to lead healthier lives Our business model NHS Dorset CCG was created on 1 April 2013. Our mission is to support people in Dorset to lead healthier lives. To read more about our role as commissioners of healthcare for the county of Dorset, and our aims and values, please turn to pages 8 and 9 within our Governing Body / Members Report section. To understand how we work, please turn to pages 48 to 50 in this section. Our licence conditions NHS Dorset CCG was created and fully authorised without conditions. Our strategy You can read more about our strategy and priorities including the three pan Dorset transformational programmes on page 11 of our Governing Body / Members’ Report as well as within our Business Review on page 50 in this section. You can read more about how our strategy will support these challenges, including the three pan Dorset transformational programmes on page 46. CCG Assurance Framework Our assurance framework section outlines how the CCG has discharged its duties under the amended NHS Act 2006. A range of examples within this annual report evidences how we have applied the required assurance frameworks to our business. We have ensured health services are provided in line with the NHS Constitution targets – more information is available on page 44. We are committed to supporting the NHS Constitution among patients, public and staff – more information is available on page 46 onwards. We also ran a media campaign on local radio throughout Dorset from January- 40 March 2014. The aim of this campaign was to help people understand what the NHS Constitution means to them and we developed website information for them to download and comment upon. NHS Dorset CCG has supported NHS England in ensuring high quality primary medical services have been maintained. The CCG has indicated that it would want to further enhance its role to include developing primary care and is discussing with NHS England We actively encourages patient choice and the member practices promote and encourage the use of Choose and Book services, with very high levels of usage across the whole of Dorset. We promoted the involvement of patients, carers and their representatives in decisionmaking. Page 22 in our Highlights of the Year section cites an example from our work with maternity services, which was highly commended by NHS England. We have also been commended for our work in innovation, leadership, education and training in the Guardian’s Healthcare Innovation awards (see page 21). We consulted widely when drawing up our commissioning plans. From a range of engagement events with our stakeholders (see page 2) to a large-scale public survey called the Big Ask developed with our other NHS partners (see page 18). We have also developed a wide range of engagement and feedback channels to ensure people can get involved in our work. Read more on pages 61 to 62 and on our back cover. Through our dedicated emergency preparedness and resilience team, we have taken appropriate steps to ensure the CCG STRATEGIC REPORT Supporting people in Dorset to lead healthier lives and its providers are properly prepared for any incidents. More information on these plans is available on pages 60 to 61. We have cooperated with our Health and Wellbeing boards to align our strategy (see pages 11 and 62). We have also worked with our local authorities to prepare Joint Strategic Needs Assessments (page 48). Our Quality team takes responsibility for child safeguarding. Read more about their work on page 55. We also have a dedicated clinical lead – Dr Peter Blick – for child and adult safeguarding (please see page 70). NHS Dorset Clinical Commission Group certifies that it has complied with the statutory duties laid down in the NHS Act 2006 (as amended). Financial Key Performance Indicators (KPIs) More information regarding our KPIs can be found on pages 14 to 15 within our Governing Body / Members Report section. Additional information on KPIs can be found in our financial tables. Specific areas to highlight are: revenue surplus (see next page), staff costs and average persons employed (see page 87), running costs (see page 86) and Better Payments Practice Code (see page 88). 41 STRATEGIC REPORT Supporting people in Dorset to lead healthier lives Financial Overview We achieved our financial duties for 2013/14 and delivered a surplus of £12.6 million, which included a surplus of £2 million on the CCG running cost allowance, which is set nationally at £25 per head of population. This was delivered against the revenue resource limit of £928.4 million and a running cost allowance of £18.7 million, respectively. By spending less on our running costs, we are able to spend more on direct patient care. There have been a number of challenges for the CCG in the 2013/14 financial year, not least of which was ensuring that the baseline funding from the legacy PCTs was with the right commissioner. The biggest challenge in this context was in respect of specialist commissioning. Transfer adjustments were agreed in September 2013 with NHS England. The CCGs annual revenue performance is set out in Table 1. Table 1: Summary of 2013/14 Revenue Performance 2013/14 2013/14 2013/14 Programme Running Costs Total 10,614 2,000 £'000 Revenue Resource Limit Under spend against Revenue Resource Limit Percentage under spend 928,367 1.1% £'000 £'000 18,730 947,097 10.7% 1.3% 12,614 Although the CCG was only required to deliver a 1% surplus, the decision was taken to maintain the legacy Dorset PCT and Bournemouth and Poole Teaching PCT levels going forward. Analysis of Net Operating Costs 2013/14 Performance £m The final performance against the 2013/14 indicators will not be available until later in the year, the results will be published on the CCG's website. The CCG continues to monitor performance against national quality standards and performance against QP (Quality Premium) indicators. The following position is based on the latest performance. 42 STRATEGIC REPORT National Quality Standards Supporting people in Dorset to lead healthier lives Indicator definition Admitted patients to start treatment within a maximum of 18 weeks from referral (specialty level) Non-admitted patients to start treatment within a maximum of 18 weeks from referral Referral to Treatment waiting times for non-urgent (specialty level) consultant-led treatment Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks from referral (specialty level) Zero tolerance of over 52 week waiters Cancer waits - 2-week waits Cancer waits - 31 days Cancer waits - 62 days Maximum two-week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP) Maximum two-week wait for first outpatient appointment for patients referred urgently with breast symptoms (where cancer was not initially suspected) Maximum one month (31 day) wait from diagnosis to first definitive treatment for all cancers Maximum 31 day wait for subsequent treatment where that treatment is surgery Maximum 31 day wait for subsequent treatment where that treatment is an anticancer drug regime Maximum 31 day wait for subsequent treatment where the treatment is a course of radiotherapy Maximum two month (62 day) wait from urgent GP referral to first definitive treatment for cancer Maximum 62 day wait from referral from an NHS screening service to first definitive treatment for all cancers Maximum 62 day wait for first definitive treatment following a consultant's decision to upgrade the priority of the patient (all cancers) Category A Red 1 calls resulting in an emergency response arriving within 8 minutes Category A ambulance calls Category A Red 2 calls resulting in an emergency response arriving within 8 minutes Diagnostic test waiting times Category A calls resulting in an ambulance arriving at the scene within 19 minutes Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department Mixed Sex Accommodation Sleeping accommodation breach Mental Health Infection Control Rating Achieved Achieved Achieved Achieved Achieved Achieved Achieved Achieved Achieved Achieved Achieved Achieved Achieved Achieved Achieved Achieved Patients waiting for a diagnostic test should have been waiting no more than 6 weeks Not Achieved from referral A & E waits Cancelled operations 2013/14 No waits from decision to admit to admission (trolley waits) over 12 hours Achieved Not Achieved Achieved All patients who have operations cancelled, on or after the day of admission (including the day of surgery), for non-clinical reasons to be offered another binding Not Achieved date within 28 days, or the patient's treatment to be funded at the time and hospital of the patient's choice. No urgent operation to be cancelled for a 2nd time Care Programme Approach (CPA): The proportion of people under adult mental illness specialties on CPA who were followed up within 7 days of discharge from psychiatric in-patient care during the period Zero tolerance of MRSA Rates of Clostridium Difficile Achieved Achieved Not Achieved Achieved 43 STRATEGIC REPORT Supporting people in Dorset to lead healthier lives Although NHS Dorset CCG did not achieve in 2013/14 six of the national quality standards shown on page 43, we continue to make progress against them through regular contract review meetings with providers. Some further details are provided below: MRSA – 7 cases haved been reported in 2013/14 compared to 13 cases in 2012/13 for the two former PCTs a total of 21 operations cancelled were not rebooked with 28 days. However these patients were treated within a short period of time after the 28 days only 15 cases of mixed sex accommodation breaches were recorded in 2013/14, all of which related to Salisbury NHS Foundation Trust a total of 7 trolley waits over 12 hours from decision to admit were recorded in 2013/14, of which two were agreed as being clinically appropriate a total of 6 patients (to the end of January 2014) were waiting over 52 weeks for treatment, across all our commissioned providers in England. Quality Premiums The Quality Premium is intended to reward the CCG for improvements in the quality of the services that we commission and for associated improvements in health outcomes and reducing inequalities. Payment will be up to £5 per patient in the CCG as an additional fund, receivable in 2014/15. The Quality Premium is reduced if the commissioned providers do not meet the NHS Constitution requirements. 2013/14 NHS Constitution requirements for the following patient rights pledges 90% of patients during the year should wait no more than 18 weeks from referral to consultant-led treatment 95% of patients during the year should be admitted, transferred or discharged within four hours of their arrival at an A&E department 85% of patients during the year should have a maximum wait of 62 days from urgent GP referral to first definitive treatment for cancer 75% 8 minute response for Cat A (RED 1) ambulance calls (based on South West Ambulance full service) Expected Adjustment (based on Forecast Rating) Actual Expected Rating 95% Achieved 96% 87% 71% Achieved Achieved Not Achieved 25% Although South Western Ambulance Service NHS Foundation Trust has been unable to achieve the 8 minute response rate in 2013/14, continual progress is being made to improve the performance, taking the South West as a whole into account. It should also be noted that the performance for the population of Dorset continues to see response rates above the 75% target and it is the areas outside of Dorset in which South West Ambulance NHS Foundation Trust operates that are causing us not to achieve this target. 44 STRATEGIC REPORT Domain Supporting people in Dorset to lead healthier lives Domain Definition Preventing people from dying prematurely Reducing the potential years of life lost from causes considered amenable to healthcare: adults, children and young people by at least 3.2% Long-term conditions Reducing emergency admissions combined across the following areas 1) Unplanned hospitalisation for Chronic Ambulatory care sensitive conditions 2) Unplanned hospitalisation for Asthma, Diabetes and Epilepsy in under 19s 3) Emergency admissions for acute conditions that should not usually require admission 4) Emergency admissions for children with lower respiratory tract infections (LRTI) Rating Achieved Achieved Recovery from episodes of ill health or injury Ensuring that people have a positive experience of care 1) Roll out of Friends and Family Test 2) An improvement in average FFT scores for acute inpatient care and A&E services between Q1 2013/14 and Q1 2014/15 for acute hospitals that serve a CCG's population Treating and caring for people in a safe environment and protecting them from avoidable harm 1) No cases of MRSA and 2) Clostridium Difficile are at or below defined thresholds for CCG Local Priority Quality Premium Domain Domain Definition Achieved Not Achieved 2013/14 Expected Rating Knee replacements Total health gain assessed by patients by difference between the pre-operative score and post-operative score as completed by the patient Dementia Number of people diagnosed / prevalence of dementia Achieved Under-75 mortality rate Under 75 mortality rate respiratory disease - 21.5 per 100,000 population Achieved Achieved 45 STRATEGIC REPORT Supporting people in Dorset to lead healthier lives Outlook for 2014/15 and beyond The level of growth over the next two years for clinical commissioning groups has already been published nationally and NHS Dorset CCG will receive 2.14% (2014/15) and 1.7% (2015/16) respectively, although national planning commitments against the growth made available is not fully known. The current planning assumption for 2014/15 and 2015/16 is that we will continue to maintain surplus levels at £12 million by not utilising any of the brought forward surplus in either year. This is in line with NHS England planning guidelines and represents 1.3% of our total budget. The NHS is facing significant and enduring financial pressures over the forthcoming periods and our CCG and Dorset health economy is no exception. Within 2013/14 significant non-recurrent financial support had to be provided to some of our hospitals, and this has continued into 2014/15. There is recognition by the CCG that people's needs for services continue to grow. This means that we have to transform the way services are delivered to continue to deliver high quality services within the resources available. In addition to the challenges facing the local health economy, the CCG also recognises the need to continue to work with local government to develop strong plans to secure continuity of sustainable services for the future. The recognition of these challenges in the local health and care system has resulted in strong partnership working across providers and local government, including plans submitted under the Better Care Fund national initiative, to provide more integrated health and social care services, with a particular emphasis on services for the frail elderly. As part of the recognition and commitment of the CCG to provide sustainable and high quality services for the future, we will be commissioning a Clinical Services Review in 2014/15 to begin to address the challenges of financial sustainability, an increasingly ageing population, complex delivery systems and long term conditions. It is recognised that we need to be bold and innovative and have no predetermined solutions or options going into the Review, whilst extensively engaging with patients, the public, provider organisations and partner stakeholders to ensure that the 'blueprint' for services is fit for Dorset. Paul Vater Chief Finance Officer 46 STRATEGIC REPORT Supporting people in Dorset to lead healthier lives Business review NHS Dorset CCG is overseen by NHS England and in common with all other CCGs, we have a constitution which sets out our business processes. NHS Dorset CCG began from a strong platform of success with sound finances and strong clinical leadership left by the two organisations it replaced – Bournemouth & Poole and Dorset Primary Care Trusts. One of the major changes in the healthcare system has been the development of GPs as leaders of healthcare commissioning, as each practice became members of the CCG. To prepare them for this new role, we organised four engagement and development events with more than 545 GPs and practice managers attending. We recorded some milestone achievements during our first full year of operation, such as successful commissioning of the new NHS 111 non-emergency phone service which went live in Dorset during April. Despite negative media attention in other parts of the country, the 111 service for Dorset, delivered by South Western Ambulance Service Foundation Trust, is performing well and improving week by week. The commissioning teams continue to lead major programmes including the review of Urgent Care and Making Purbeck ‘Fit for the Future’ 2013 which focuses on making local healthcare sustainable. There are more details about these and other successes in Highlights of the Year on pages 16 to 22. Recent NHS reforms not only place clinicians in charge of the budgets but also put patients central to the agreement of our health priorities. We began this work in earnest by launching our strategy and public prospectus. GPs have facilitated events where more than 300 members of the public, patients and health partners fed back their views to inform our strategy. As part of our KPIs we committed to delivering three priorities by April 2014 – as detailed on page 11. The NHS has a challenging time ahead and we have to be confident about where we need to spend our budget and be creative in how we spend it – such as ensuring we join up with other healthcare and voluntary organisations to get the best out of the services on offer. We start from a robust financial position, clear clinical leadership with a commitment to make a difference to health provision and a firm foundation of working with partners and stakeholders across health and social care. We will ensure that we continue to listen to our patients and gather their feedback to make this difference felt in Dorset. Risks and uncertainties We will face an increasingly challenging financial year in 2014/15 as the NHS continues to operate within a tight financial framework during a period of further change and movement towards greater integration with social care. This should be viewed against a background of a rising number of older people in the local population, health inequalities and a significant number of people living with disability and long-term conditions. The emphasis will need to be one of continued financial control to support the CCG to commission sustainable health services and deliver the outcomes to meet our strategic objectives. This will include providing non-recurrent funding to support a full clinical services review. 47 STRATEGIC REPORT Supporting people in Dorset to lead healthier lives Although NHS Dorset CCG ended its first year of operation with a planned underspend of £12 million, financial risks emerged towards the end of the year, particularly in the area of continuing healthcare funding. The increase on emergency pressures experienced in all acute hospitals required the CCG to fund non-recurrent schemes to address the winter pressures. GP referrals grew by 4.5 percent in 2013/14 and this trend is causing pressures on hospital and community services. This increase will require changes to planned activity within the secondary care provider contracts for 2014/15. Our finance and performance teams will continue to work very closely with the localities to develop referral management and financial monitoring systems. These systems look at referral patterns and the associated financial impact. A Dorset Information Dashboard has been developed in partnership with Somerset CCG and has been offered to every practice in Dorset. Uptake for this commissioning intelligence tool has been high. The area we serve Dorset GP practices serve a population of around 766,000 living in sparsely distributed rural areas and the urban conurbations of Bournemouth, Poole and Weymouth. Overall the population of Dorset enjoys relatively good health with a higher life expectancy than the English average. The challenges are: 48 a high and rising proportion of older people – which is predicted to grow by six per cent between 2013 and 2020. This poses a significant challenge for the health and social care system inequalities in life expectancy across Dorset – although there have been reductions, gaps of 4.4 years among men and 3.5 among women still exist in certain areas cardiovascular disease (CVD) and cancer are the major causes of death which together accounted for 29 per cent of deaths in 2011 increasing numbers of people living with long-term conditions (LTCs). In 2011, 19 per cent of people in Dorset were living with a LTC or disability which impacted on their health although most people lead healthy lifestyles, some issues such as smoking, smoking in pregnancy, sexual health, alcohol consumption and obesity give cause for concern. In order to address the potential health needs of the population, Joint Strategic Health Needs Assessments (JSNAs) have been produced in conjunction with local authorities across Dorset. How we work We have two business bases: one in Poole in the east of Dorset and the other in Dorchester in the west of the county. Clinical engagement and leadership is provided via GP leads from each of the 13 localities in Dorset who sit on the Governing Body. Their key roles are: shaping the direction and supporting the implementation of the CCG and health and wellbeing strategies representing the views of their practices and patients on how services are designed and provided supporting the delivery and implementation of services within the locality. STRATEGIC REPORT Supporting people in Dorset to lead healthier lives Our member practices are at the heart of our communities and in a good position to understand the needs of their populations. Members can influence decisions and provide feedback through the locality chair and at locality meetings, so that local focus is not lost amongst the national and wider Dorset priorities. There are more details about our localities and how they work on pages 23 - 24. Patients and the public can influence and provide feedback in many ways such as via their practice, the Health Involvement Network, or patient participation groups. Read more about how you can get involved on the back cover of this report. We have internal commissioning support services, which are provided through four directorates: Quality Service Delivery Finance and Performance Engagement and Development. Suzanne Rastrick, Director of Quality Each directorate is led by an executive director, accountable to the Chief Officer, Tim Goodson. They are: Jane Pike, Director of Service Delivery Paul Vater, Chief Finance Officer Charles Summers, Director of Engagement and Development. You can read their biographies on pages 73 - 74. Providers We are able to commission services from a range of providers to ensure we get value for money and meet local needs. Providers may include local health partners e.g. community or acute hospitals, mental health organisations, local pharmacies, private businesses and other organisations. Our key providers across the county include: Dorset County Hospital NHS Foundation Trust Dorset HealthCare University NHS Foundation Trust Poole Hospital NHS Foundation Trust Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust Salisbury NHS Foundation Trust University Hospital Southampton NHS Foundation Trust Yeovil District Hospital NHS Foundation Trust South Western Ambulance Service NHS Foundation Trust. Our plans for improving care in Dorset If we are to have sustainable health and social care services in Dorset that are fit for the future, we need to work with stakeholders, partners and providers to make courageous decisions on how local services are provided. Over the next two years the CCG will focus on delivering local priorities as well as national objectives set out in the documents NHS Mandate 2013 to 2015 and Everyone Counts: Planning for Patients in 2014/15 to 2018/19. This national planning guidance sets out the challenges and priorities for NHS England. It emphasises that CCGs will need to make courageous decisions with partners and providers to change how services are delivered. It aims to ensure that the quality of care is raised to the best international standards, 49 STRATEGIC REPORT Supporting people in Dorset to lead healthier lives whilst closing a potential funding gap of £30bn by 2020/21. We are committed to delivering the national priorities and improving the health of the population in Dorset. Through the delivery of our three transformational programmes and Clinical Commissioning Programmes (CCPs) we will: improve outcomes for patients as measured through the five domains of the NHS Outcomes Framework and seven outcome ambition measures reduce inequalities improve mental health as well as physical health involve and engage stakeholders through every stage of development and change transform service models with our partners focus on access quality (patient safety, experience and effectiveness, including actions from the Francis, Berwick and Winterbourne View reports and NHS Constitution) innovation and research value and the best use of resources. To help us do this, we have a plan for 2014 to 2016 which outlines how we will deliver the first two years of our five-year strategy. This plan outlines how we will concentrate on three transformational programmes: 50 Better Together – this aims to transform health and social care across Dorset to enable and deliver a sustainable improvement in health and care through person-centred, outcome-focused, preventative, co-ordinated care Clinical Services Review – this will review clinical services across the health and social care system and those that span Dorset population boundaries to ensure high-quality, patient-centred, sustainable services Urgent Care Review – the Pan Dorset Urgent Care Programme aims to transform urgent care services across Dorset by aligning services and simplifying pathways, integration and by using technologies. These programmes are interlinked and will be delivered in partnership with the three local authorities and the four main NHS foundation trusts in Dorset. They will look for further opportunities to integrate health and social care and ensure all services are provided as close to home as possible and in community settings unless it is not appropriate to do so. The programmes will be overseen by the Better Together Sponsor Board, with each partner organisation having lead responsibility for relevant projects within them. They will be supported by our Clinical Commissioning Programmes (CCPs) and through working in partnership with stakeholders. The plan includes how our internal commissioning support team will work to help deliver these transformational programmes, support the CCPs and ensure that the CCG continues to meet all of its legal duties. Clinical commissioning The commissioning of healthcare is organised within Clinical Commissioning Programmes (CCPs). Each of these programmes is clinically led by a GP and includes members from a range of disciplines and professions. These multidisciplinary members bring together their knowledge and expertise to prioritise what needs to be done to redesign and implement improvements to services. STRATEGIC REPORT Supporting people in Dorset to lead healthier lives Each of these programmes involves other clinicians, patients and providers to consider and deliver improvements to services. The programmes support the delivery of three transformation programmes as well as specific priorities. The CCPs and their GP Leads are: General Medical Dr Chris McCall Maternity, Reproductive and Family Health Dr Karen Kirkham Cardiovascular Disease, Stroke and Diabetes Dr Craig Wakeham Musculoskeletal and Trauma Dr Christian Verrinder Mental Health and Learning Disabilities Dr Paul French Cancer and End of Life Dr Lionel Cartwright The Pan Dorset Programme for Urgent Care, Clinical Services Review and the Better Together Programme will go into operation during 2014/15 Dr Simon Watkins. Read more about how the CCPs are delivering real benefits for real people on pages 25 to 39. Equality and Diversity The CCG is committed to ensuring as an employer it provides an open and supportive environment to staff, recognising that all employees have the right to be treated with consideration, dignity and respect. The CCG ensures it meets this commitment by: its mission, aims, strategy and supporting objectives supporting employees in their professional development ensuring employees have access to statutory and mandatory training including development around equality and diversity providing a happy and fulfilling environment in which to work, where staff are engaged and involved in matters which affect their working lives attracting and retaining high calibre staff through an open and transparent recruitment and selection programme which is responsive to the diverse needs of the applicants creating an environment where staff are able to raise any concerns they may have with supporting policies in place which are open and transparent and consistently applied providing development to managers to ensure they support their members of staff supporting staff in their health and wellbeing, through manager involvement, HR intervention and through an occupational health programme as well as an employee assistance programme offering a completely confidential counselling, support and mediation service for all staff and their immediate families. The CCG recognises its obligations under the Equality Act 2010 and the supporting employment legislation, which is reflected in the CCG Dignity at Work Policy. The CCG is committed to ensuring the principles of this policy are embedded into the organisation and actively monitors its performance through the production and analysis of internal workforce data relating to each of the nine protected characteristics. Workforce and HR support Our workforce team supports the organisation with HR advice and guidance and played an important role in helping our clinicians and commissioning staff successfully manage the transition from PCTs to CCG. We have amended our HR policies to reflect the new organisation and during 2014/15 we 51 STRATEGIC REPORT Supporting people in Dorset to lead healthier lives will be strengthening the workforce function further by moving all HR transactional services in-house. Male Female 26.19% 73.81% Bands 1-7 16.75% Governing Body 76.92% Senior Managers Staff gender analysis 83.25% 23.08% Organisational development Clinical development During 2013/14 we introduced initiatives to support the development of clinicians as leaders of the CCG, ensuring they can fulfil their role as clinical commissioners, leading local health priorities and making the right resource choices. As a membership organisation comprising 100 practices in Dorset, we run regular GP membership events and Governing Body development workshops supporting our clinical leads to fulfil their role. Over 400 GPs attended these activities during 2013/14. We offer communications and public relations training and advice to equip the Governing Body and GPs with this new aspect to their role, so they can respond to the media and provide the authentic clinical voice of the CCG. We organised commissioning skills development for clinical leaders linked to each of our six Clinical Commissioning Programmes. GPs also work closely with our engagement and communications team at local events, by talking to patients and the general public about their healthcare needs and experience. Commissioning support development Throughout the year, nearly 300 people attended induction sessions aimed at helping our support teams develop a clear 52 understanding of the CCG’s role, purpose, mission and aim. Each of our four directorates run regular development days to ensure commissioning support teams are fully briefed on the CCG strategy, the challenges ahead and the changes to our business. The Chief Officer holds regular briefings where staff have the opportunity to discuss concerns and hear ‘from the top’. Staff can access inhouse and external training for their professional development, including places on the NHS leadership academy programmes. Sustainability The NHS aims to reduce its carbon footprint by 10% between 2009 and 2015. In support of this target, NHS Dorset CCG is committed to promoting sustainability and has included a requirement in the NHS contract relating to the Carbon Reduction Strategy, which includes the following elements: saving Carbon, Improving Health – this requires provider organisations to report on progress on climate change adaptation, mitigation and sustainable development including performance against carbon reduction management plans. The providers are required to incorporate the outcome in their respective annual reports Sustainable Development Strategy – provider boards are required to approve a strategy Carbon Management & Climate Change Adaptation Action Plan – providers should agree a plan and provide the performance against the agreed standards Initial/annual reassessment – providers are required to continually monitor and provide a report on progress. Clinical Commissioning Group position The CCG has a Sustainability Strategy which it STRATEGIC REPORT Supporting people in Dorset to lead healthier lives has adopted from the former Primary Care Trusts, which runs from 2010-2014. The strategy recognises the CCG’s responsibility and has aligned delivery work streams with the Good Corporate Citizenship model. The CCG is currently in the process of writing the new strategy for the 2014/15 – 2018/19 period. Good Corporate Citizenship model The key areas for action are energy, water and carbon management, sustainable procurement and food, low carbon travel, transport and access, waste reduction and recycling, green spaces, staff engagement and communication, buildings and site design, organisational and workforce development, partnership and networks, governance, IT and finance. Energy, water and carbon management The CCG is aware of its own responsibilities in supporting sustainability and has already greatly reduced the office space footprint in 2013/14 at the Canford House site from 1,899 to 941sqm and is continuing to review accommodation requirements. In order to further facilitate moves to a smaller footprint the CCG has introduced smaller desks to both maximise the space in its corporate office and also to create a paperless environment. It should be noted that the CCG does not directly pay for energy and water as the responsibility for properties within the commissioning architecture sits with NHS Property Services Ltd. Sustainable procurement The CCG is committed to reducing indirect environmental and social impacts associated with the procurement of goods and services. Purchasing procedures are constantly being refined to help minimise waste, which includes ensuring that we incorporate a sustainability section on any procurement. Waste reduction and recycling Across all sites used by the CCG, we have incorporated a paper recycling collection service. In addition the CCG has also implemented recycling of computers and related items in partnership with wider community groups. Low carbon travel, transport and access In recognising the benefits of supporting low carbon travel the CCG has removed all lease cars for staff and have introduced low emission pool cars in their place. In addition the CCG has dedicated car parking spaces for car sharers. In 2014/15 the CCG is looking to re-introduce a cycle to work scheme, (see table below). Partnership and networks The CCG as part of its wider stakeholder involvement has signed up to the In 2013/14 Dorset CCG have had the following costs and performance in relation to travel: Classification Miles Travelled Pool Car Usage 59,620 Mileage Claims 416,722 Cost £ tCO2e 20,684 44 217,975 154 (tCO2e stands for “Tonnes of CO2 equivalent”, which is a measure that allows you to compare the emissions of other greenhouse gases). 53 STRATEGIC REPORT Supporting people in Dorset to lead healthier lives Bournemouth Borough Council sustainable city plans. As part of the wider communications with staff regarding restricted parking at CCG sites, the CCG has actively promoted the use of car sharing and park and ride options operated by local authorities. Staff engagement and communications Included within the job specifications for all new members of staff there is a requirement to promote and embrace the principles of sustainable development in their daily duties and to ensure that they use energy and other natural resources as efficiently as possible to minimise their carbon footprint. In addition we have participated in the NHS Sustainability Day by encouraging a paperless day by staff which was also promoted on Twitter and internal communications. Governance, IT and finance In order to support lower waste the CCG is committed to using technologies where possible, which has resulted in the introduction of video-conferencing and mobile devices to reduce the need for travelling and waste paper. Key Provider Snapshot Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust (RBCHFT) The Trust has continued to make significant progress in improvements on sustainability and have chosen to purchase electricity from 100% combined heat & power (CHP) guaranteed sources during 2013/14. In addition it is worth noting that the Trust generates approximately 15% of its energy onsite, through solar panels and low pressure water. 54 Poole Hospital NHS Foundation Trust (PHFT) The Trust has undertaken an investment grade audit as part of an Energy Performance Contract (EPC), working with British Gas & Breathe Energy. This contract identifies measures to reduce energy consumption by 25% to support delivery towards the 2015 target. In addition schemes that have been put in place include LED lighting, cardboard compactor to support recycling and active promotion of a dedicated car share scheme. Dorset Healthcare University NHS Foundation Trust (DHUFT) The Trust is continuing to make progress on reducing carbon emissions of 10% by 2015, which has included a significant reduction in floor space (m2) since 2007/08, although at the same time staff numbers have increased. A resulting factor of this reduction is the drop in gas and electricity usage. The Trust has implemented a number of improvements including replacement of boilers, upgrading lighting to LED and installation of combined heat & power (CHP) at St Ann’s Hospital. Dorset County Hospital NHS Foundation Trust (DCHFT) The Trust has developed a Sustainable Development Management Plan where it is actively monitoring progress on the key themes identified in the Good Corporate Citizenship model, including detailed actions, which are regularly monitored. The key performance areas will be reported as part of the Trust annual report. STRATEGIC REPORT Supporting people in Dorset to lead healthier lives Improving quality Putting quality at the heart of all we do The quality team is responsible for patient safety, quality improvement, corporate governance and medicines management. The team is committed to ensuring compassionate care is equally as important as the quality of treatment. We work closely with providers of care to ensure that our patients, their families and carers are treated with compassion, respect and dignity, in safe environments and are protected from harm. Our outcomes for 2013/14 include: Infection control We continue to work in partnership with all our providers and have made progress in reducing the number of healthcare-acquired infections. These results have been achieved by the provision of training, information and advice with infection prevention and control teams across Dorset to share best practice and monitor and learn from incidents. During 2013/14 cases of MRSA in Dorset reduced from 2012/13 figures to a total of seven per year. Incidences of C-difficile are also declining, as shown overleaf. 55 STRATEGIC REPORT Supporting people in Dorset to lead healthier lives !#$%% *'+'&,--.&" ,-/0 !2" !"" !"#$%% !'()( %2" %"" 2" " Care homes !""#$%" !"%"$%% !"%%$%! !"%!$%& !"%&$!"%' ()*+,- '' '. .! &% %! /+,- '! '! !' !0 # 1*+,- 23 '. !# !! !% /*-4**5 %2# %#" %3. !%" %.# NB Dorset data in this table includes care homes, community hospitals and individuals at home We have a number of contracts with care home providers delivering nursing care to residents. To ensure that the type of care being both commissioned and provided is meeting the needs of residents, our Care Home Quality Assurance Team have undertaken joint visits with three local authorities to review current arrangements and provide guidance and support to care home staff in relation to nursing care. A key objective of the team is to ensure that all homes now receive regular reviews of their standards of nursing care in line with the recommendations highlighted in the Winterbourne View Report. The investment we have made by developing the Quality Assurance Team builds on our existing foundations and confirms our commitment to ensuring that all residents within Dorset care homes receive high-quality, safe care. Since April 2013 the team have completed 125 monitoring visits, with a further six carried 56 out by May 2014 – bringing our visits to 100% completion. The team publish a quarterly newsletter which is circulated to care homes and have recently established a successful annual care home managers’ event. The team also work closely with both internal and external partners including the Continuing Healthcare Team and the Care Quality Commission. Safeguarding children In partnership with the Dorset Safeguarding Children Board, Bournemouth & Poole Safeguarding Children Board and Public Health Dorset we launched Drinkheads – a campaign to highlight the dangers of drinking while looking after young children. Drinkheads advertisements featured in local print media and interviews with CCG experts appeared on BBC News. Safeguarding adults Adult Safeguarding within the CCG includes monthly engagement with all NHS provider safeguarding leads, three local authority STRATEGIC REPORT Supporting people in Dorset to lead healthier lives safeguarding teams and NHS England. Public engagement has been undertaken through the pan Dorset Adult Safeguarding Boards. The CCG receives regular quality reports from data analysis highlighting any areas of concern, repeated issues or significant failures in care. The safeguarding function has ensured the CCG has met its obligations and responsibilities in relation to local and national policy. The CCG is an active partner in the development of Pan Dorset strategies to improve hydration and nutrition and the reduction of pressure ulcers. Improving the patient experience - Friends and Family Test Launched in April 2013, the national Friends and Family Test asks patients who have recently visited A & E or had an overnight stay in their local hospital if they would recommend their care. It aims to improve the hospital experience and raise standards of NHS care. The results for your local hospitals – in Bournemouth, Poole or Dorchester – are available at NHS Choices website at www.nhs.uk. The test is set to be introduced into GP practices during 2014/15. Our quality team uses this ‘real-time’ feedback from our patients and carers to reduce poor experiences as we regularly monitor local results and work with providers to improve scores. Medicines management The medicines team implemented a new prescribing dataset to inform discussions on prescribing at General Practice visits. A team of CCG locality pharmacists now work closely with prescribing lead GPs in each locality. Family and Family Test Response Rates Resonse Rate (%) 25 20 15 10 5 0 July August September October DCHFT 10.1 8.2 12 17.4 20 23.1 PHFT 7.6 12.3 13.4 15.6 15.1 14.1 RBCHFT 13.5 17 17.2 19.4 21.9 21.6 DHUFT 14 20 19 22 18 16 England 16.1 17.1 18.6 19.6 20.9 19.9 57 STRATEGIC REPORT Supporting people in Dorset to lead healthier lives Information governance and compliance NHS Information Governance (IG) is a framework for handling personal information about patients and employees in a confidential and secure manner to appropriate ethical and quality standards in a modern health service. They advise prescribers and implement audits to ensure prescribing is evidence-based and meets national quality standards. In October, collaboration between us and our NHS providers saw the launch of the pan Dorset formulary on our website and a medicines advisory group which provides recommendations on the prescribing and commissioning of medicines. It is important that the public recognise the role they can play in managing their medicines. During the year, we launched an education campaign to remind patients to order repeat prescriptions in plenty of time and to encourage them to go to the local pharmacy when they run out of medicines, rather than call 111. (One third of calls to the 111 service at the weekend were due to people running out of medicines.) A series of videos on repeat prescriptions, self-managed care, flu vaccinations and general GP advice was published in our digital media channels to offer practical advice in managing healthcare needs. Learning and development Throughout the year we held a conference and events with providers and other stakeholders to share findings of the Francis Inquiry and discussed recommendations of the report. Over 100 delegates attended and agreed to share good practice in future, and to work towards improving dignity and compassion in care across the local health and social care community. 58 It provides consistent standards enabling employees to deal with the many different information handling requirements. The submission of the annual Information Governance Toolkit (IGT) to the Health and Social Care Information Centre gives assurances to the CCG, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively. (Submissions are awarded either a satisfactory or unsatisfactory status.) Successful submission of version 11 of the IGT was achieved and we were awarded satisfactory status in 31 October 2013. Information governance training is mandatory for staff within the CCG regardless of designation. Twenty IG training sessions were undertaken during the year and 96% of staff attended. We certify that NHS Dorset Clinical Commissioning Group has complied with HM Treasury’s guidance on cost allocation and the setting of charges for information. Complaints We handle complaints sympathetically. We follow the guidance provided by the NHS Complaints Procedure and the more recently published Department of Health reports relating to NHS complaints handling. Our approach is a personal one, and we endeavour to ensure concerns and questions are answered with a written response. We aim to help all those who contact us, if necessary by redirecting them to the relevant organisation, and will forward complaints onwards if required. STRATEGIC REPORT Supporting people in Dorset to lead healthier lives During the year from 1 April 2013 we have handled 198 complaints: 85 related to the CCG and have been responded to 10 are awaiting a response (as at 31/03/2014) 103 did not relate to the CCG and, with the agreement of the complainant, have been forwarded to providers who will provide a direct response. There has been one request for information for a Parliamentary Health Service Ombudsman investigation into the handling of a complaint relating to the CCG. Data management and confidentiality There have been no data / confidentiality breaches. Challenges The Care Quality Commission (CQC) has undertaken a series of inspections, new and follow up, to providers from which NHS Dorset CCG commissions services. This included one of the ‘new style’ large CQC hospital inspections to the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust in October 2013. The findings showed that standards were not being met in two areas of the hospitals and that staffing and skill mix were an issue across medical and nursing staff. An action plan is in place and the Trust is being supported by the CCG to ensure action is taken and standards maintained. Dorset Healthcare University NHS Foundation Trust consists of multiple sites and the CQC have undertaken visits to 11 individual sites throughout 2013. Five sites were completely compliant. Four sites had issues with staffing levels and management and two sites were not compliant across a number of the standards. There are robust action plans in place to ensure the areas that require action have taken the necessary steps to improve care so that standards are compliant. This is being closely monitored by the CCG in conjunction with Monitor and the CQC, and improvements have been made. Poole Hospital and Dorset County Hospital also had visits from the CQC during the year, and were found not to be meeting some of the required standards. Actions have been taken to address these issues and the CCG is working with all of these providers to ensure standards are met in the future. Future priorities for the quality team In addition to the areas outlined above, our priorities for 2014/15 include: ensuring full implementation of the ‘6Cs’ and Compassion in Practice (see diagram and link for more information http://www.england.nhs.uk/nursingvision/) roll out of seven day services across health providers improving quality of care for people as we move towards integration of services across the health and social care system reduction in the number of pressure ulcers. 59 STRATEGIC REPORT Supporting people in Dorset to lead healthier lives Emergency preparedness and resilience Under the Health and Social Care Act 2012, clinical commissioning groups were classified as Category 2 responders as defined under the Civil Contingencies Act (2004). This means we have a legal duty to cooperate with other Category 1 and 2 responders (blue light services, healthcare providers, local authorities, the Environment Agency, the Met Office, utility companies) to plan for, respond to, and recover from incidents in Dorset. In addition we have signed a Memorandum of Understanding (MoU) with NHS England Wessex Area Team which outlines how we will assist them in discharging aspects of their Category 1 duties locally. Key sections include incident notification, command and control arrangements during the different levels of incident response and recovery in order to clarify how the new Emergency Preparedness, Resilience and Response (EPRR) arrangements would work locally. How this work is organised Dorset CCG is a key member of the Dorset Local Health Resilience Partnership (LHRP) which brings together the directors accountable for EPRR from all health organisations including local authority public health departments. This group meet quarterly to discuss the direction of work and to ensure that health partners are working together to meet shared goals, actions/targets and milestone achievements during the year. In June we launched on-call packs for senior managers which means all key information is now accessible from tablets, phones and any computers with an internet connection. The CCG is required to conduct a live 60 exercise every three years, a tabletop exercise every year, and two communications exercises a year. A tabletop exercise in which senior managers from the CCG and NHS England Wessex Area Team talked through an ‘incident’ was held in October, followed by a similar exercise involving the wider health community. As this is our first year, we are aiming to take part in a live exercise between 2014 and 2016. There was a real test of the emergency arrangements during the prolonged severe weather during the winter. Lessons have been learned and have led to some refinements in our emergency planning. During the period of severe weather, the CCG was actively involved in regular emergency planning calls with other agencies across Dorset. We helped with the identification of vulnerable patients living in the Winterbourne Abbas and Sixpenny Handley areas of Dorset who were in need of evacuation assistance. Our revised major incident plan has been developed. Work will now begin on developing an elearning package to teach all key response staff about the major incident plan and this will be complemented with practical major incident room training. Business continuity plans have been finalised outlining how the CCG’s critical functions would continue in the event of an interruption. We certify that the NHS Dorset Clinical Commissioning Group has incident response plans in place, which are fully compliant with the NHS Commissioning Board Emergency Preparedness Framework 2013. The NHS Dorset Clinical Commissioning Group regularly reviews and makes improvements to its major incident plans and has a programme for regularly testing this STRATEGIC REPORT Supporting people in Dorset to lead healthier lives plan, the results of which are reported to the Governing Body. How we have worked with other stakeholders / partners We work regularly with other partners to meet our legal obligation to share information and co-operate with other agencies. There are a number of multi-agency local resilience forum groups which meet regularly to develop emergency plans. Following a pilot phase in 2013/14, a civil contingencies unit (CCU) for Dorset is being launched, supported by Dorset's Local Resilience Forum, comprised of membership from Category 1 organisations. The CCG, and NHS England Wessex Area Team are supporting the development of the CCU in mutual areas of training, exercising and multiagency planning. Future plans Over the next year the EPRR team will be working with the wider health community, local resilience forums and the civil contingencies unit to develop and update the existing pandemic, mass casualty, severe weather and fuel plans. Within NHS Dorset CCG, the focus will be on distributing the e-learning packages and the development of modules for all relevant staff, in addition to practical training sessions. The final sections of the Business Continuity Plan will be completed and we will be ensuring that all of our plans will be reviewed and updated as part of an annual programme. Engagement and communications The CCG has both internal and external stakeholders. By definition our stakeholders are taken to be any person, group or organisation that affects, or can be affected by our actions. Our stakeholders include the people of Dorset, all those within the new involvement and engagement networks, localities, the CCPs, HealthWatch Dorset, health and wellbeing boards, health overview and scrutiny committees, local authorities, providers (both NHS and private), voluntary organisations, NHS England and MPs. We are always keen to involve people in our work to help us make better informed decisions about our local NHS services and work continues to develop our enabling networks. We recognise that everyone is a patient at some point in their lives and that we all have experiences, views and concerns that can be shared to help shape the future. Gathering views, listening to people and feeding back this information to our commissioning teams is a really important part of our work. We encourage people to get involved and comment on local services. This can be by contacting us by telephone, letter, email or social media. We proactively seek opinions by attending meetings, distributing surveys and running focus group discussions to canvass a wide range of views and voices to ensure we understand about specific issues in Dorset. Over the past year we have actively developed our Health Involvement Network. This is an opportunity for local people to hear more about the work we do and get involved in projects, as well as working collaboratively with other local organisations and bodies. People can get involved with the work of the CCG through: our website - www.dorsetccg.nhs.uk social media such as Facebook, Twitter and YouTube information in our newsletters 61 STRATEGIC REPORT Supporting people in Dorset to lead healthier lives information shared via our health and council partners and network local media face-to-face meetings and events by contacting Lay Members local GP practices. We know it is important to feed back the outcomes of engagement. We do this in the following ways: contacting all those involved in specific work to thank them and let them know how their views have been used publicising reports and outcomes in newsletters, bulletins and on the website producing an annual report of engagement activity reporting engagement and communications activities to our Governing Body. During 2013 we conducted a county-wide health survey – The Big Ask – along with other NHS partners. More than 6,000 people responded with views on local services and how we could improve them for the future. Through a number of events, including the Health Involvement Network, we have gathered views from the voluntary and community sector, other health professionals, partners, community representatives, carers, patients and the general public. In addition, our Clinical Commissioning Programmes have been engaging and involving providers, partners and patients to develop strategic plans for each clinical area of work. Key areas of engagement worked on during 2013/14 were: 62 developing the new NHS Dorset CCG Health Involvement Network supporting localities and their constituent GPs to undertake involvement and engagement work with local stakeholders supporting Clinical Commissioning Programmes to achieve meaningful involvement and engagement work to inform changes to health services continuing to build stakeholder relationships promoting engagement opportunities to ensure wide awareness of our engagement work and advertising opportunities for involvement continuing to develop our partnerships with local people to gather insight into their views and experiences to help shape services monitoring the effectiveness of our work and to let stakeholders know how the views of local people have informed change. Alignment with health and wellbeing strategies We work with two health and wellbeing boards, one covering Dorset County Council and one covering the Boroughs of Bournemouth and Poole. These boards are responsible for producing health and wellbeing strategies for their populations. The strategies have been developed in partnership with Dorset CCG and other stakeholders. Our principles and priorities reflect those set out in the health and wellbeing strategies. STRATEGIC REPORT Supporting people in Dorset to lead healthier lives We recognise the invaluable contribution that carers make to society by supporting them in their caring role This year our funding to support carers in our area increased to £1 million from £850,000 in 2012/13. This money has helped to provide them with what they often tell us they need the most – a break from their caring responsibilities. Our spending plans are in line with the national Carers Strategy and our local plans. We know that many people do not identify themselves as carers, regarding themselves as just a relative or friend helping someone who could not manage without their support. But we do know that 82,500 identified carers are receiving services commissioned by our partner local authorities - Dorset County Council, Bournemouth Borough Council and the Borough of Poole. We are also helping them through the Carers Individual Support Scheme (CISS) commissioned by Dorset County Council and administered by the charity Help and Care. This makes small grants to carers which can make all the difference to their lives. The scheme is much appreciated and comments have included: ‘ I am extremely appreciative and it was used to purchase a computer … it’s never too late to learn they say. I hope I become competent one day. With renewed thanks to you and your team. A much needed break for me and my husband, I am really grateful for the help. I was able to visit my 90 year old mother and pay for someone to stay with my disabled husband while I was away. ’ Around 800 carers have benefited since the grant opened in June 2012. Dorset Carers Support Project Fund Since the fund began 15 carers projects in Dorset have been awarded a share of around £45,000. The projects have been diverse and well spread geographically. Combined they have reached over 3,500 carers across the county. Some examples of the types of projects funded are: information, advice and befriending creative projects support for young carers in transition funding for carers groups, peer led training for carers of people with dementia and professional counselling for carers. The fund has just been modified to broaden the funding levels available and continues to attract lots of interest from potential projects that could benefit carers in Dorset. Dorset Carers Activity Service The carers activity service has proved to be very popular and has been busy since its inception. A regular bulletin is produced and circulated widely around the county and includes details of all the service’s activities which have been arranged including: the complementary therapy voucher scheme and day trips pre-planned activity sessions special events to mark occasions such as Carers Week and Carers Rights Day ‘Your Choice’ activity grant scheme. It also has full details of carers’ support groups that operate around the county and other opportunities of interest, such as other free activities available locally. 63 STRATEGIC REPORT Supporting people in Dorset to lead healthier lives The number of carers who access the service has consistently grown since its launch and we will continue to work hard to ensure it continues to do so. Our local authority partners in Bournemouth and Poole have started the Carers Carefree Choir and received very positive feedback from members, including a comment describing the choir as ‘one big happy family’. Our magazine Caring Matters has received a makeover and is now compact and proving very popular as a source of information and articles for all carers. Our first edition of the new format featured Tim Goodson, CCG Chief Officer, answering questions from carers, showing our commitment to them and acknowledging the vital role they play. David Jenkins, Deputy CCG Chair, is the Lay Member with specific responsibility for engagement. He is passionate about his role, making sure the voice of the public is heard when new services are planned or existing ones redesigned. So the views of carers are certainly being sought as we work to ensure they have access to the same standard of services wherever they live in Dorset, Bournemouth or Poole. These plans are set out in the document ‘Better Together – The pioneer partnership: improving health and social care with people in Bournemouth, Dorset and Poole’. 64 There is more information about the programme on the Dorset For You web site https://www.dorsetforyou.com/better-together This approach will help us to meet the needs of an ageing population by providing highquality services in difficult financial times. Dorset residents can be assured that we are all committed to rising to these challenges. Young carers receive support from the CCG and our local authority partners. Many have to put their childhoods on hold to care for a parent or sibling, foregoing some of the carefree activities of their peers. As one nine-year-old said at a recent Dorset Carers Partnership meeting, ‘ ’ I don't get to do some of the things my friends do but I don’t mind because I love my mum and dad. Giving them a break from their caring responsibilities is one way they are supported. Raising awareness of what they do is another and in October Val Mitchell, (pictured) the CCG’s carers engagement facilitator, appeared on local television in a video about a Dorset young carer who was promoting awareness about the role of young carers. The video was made by Fixers, young people using their life’s experience to fix the future, and the project comes under the umbrella of the Public Service Broadcasting Trust. STRATEGIC REPORT Supporting people in Dorset to lead healthier lives We have already discussed some of the risks and challenges that lie ahead for us. This section considers the challenges and opportunities in more detail. Future Trends: Local challenges and opportunities As well as the demographic challenges we face in Dorset, there are other challenges and opportunities which must be addressed if we are to maximise health gain and transform and improve local health and social care services. Economic Challenges: deliver Quality, Innovation, Productivity and Prevention (QIPP) within budgets deliver continuous service improvements and efficiency savings reduce the amount of money spent on avoidable admissions and re-admissions to hospital shifting the spend across different sectors of healthcare to reflect the need to provide care closer to home. doing things once across Dorset where appropriate in-house commissioning support, enabling resilience, succession planning and skill mix, learning and influence. Quality meeting the rights of our public and patients as set out in the NHS Constitution commissioning organised around healthcare pathways, services improvements and outcomes strong relationships with providers and partners and forums for feeding back quality concerns working with nursing and care homes. Challenges: promote, support and participate in collaborative working with other commissioners of health and social care services and ensure that the complexities of the system do not detract from the ability to work effectively together consider innovative solutions to encourage integrated patient centred services. Opportunities: Challenges: implementation of the findings from the NHS reports into the Francis, Berwick and Winterbourne View inquiries Collaboration and integration healthy financial position large CCG therefore have economies of scale ensuring that the providers of healthcare services understand and deliver services that meet and exceed the standards and quality of care required. Opportunities: Opportunities: delivering improved outcomes for people as set out in the NHS Mandate and NHS Outcomes Framework GP-led Clinical Commissioning Programmes coterminosity with the county of Dorset local authority boundaries public health single service across Dorset with support integrated into clinical commissioning programmes established Better Care Fund enabling health and social care integration 65 STRATEGIC REPORT Supporting people in Dorset to lead healthier lives strong relationships with partners across the health and care system history of collaborative commissioning arrangements. Patient choice / insight and engagement Challenges: 66 promote, support and participate in collaborative working with other commissioners of health and social care services and ensure that the complexities of the system do not detract from the ability to work effectively together consider innovative solutions to encourage integration. Opportunities: clinical engagement and leadership strong legacy of public and patient involvement and engagement responsive to local needs locality development into patient insight and feedback development of the CCG Health Involvement Network enhance engagement work of clinical commissioning programmes to inform and develop clinical services. GOVERNING BODY & SENIOR MANAGER PROFILES Supporting people in Dorset to lead healthier lives We have a Governing Body with a membership comprising: 13 GP Locality Chairs a Nurse Lead and a secondary care Doctor Lead. Biographies, joining dates and committee membership for each of the Governing Body members are set out in this section of the annual report. a Chair Chief Officer Chief Finance Officer The 13 GP localities, the GP Chairs for the period 1 April 2013 to 31 March 2014 and their appointment dates are set out below: two Lay Members Locality GP Chair Date appointed Central Bournemouth Dr Piers Wilde Dr Peter Blick 1 April 2013 1 August 2013 East Bournemouth Dr Paul French 1 April 2013 Christchurch East Dorset Mid Dorset North Bournemouth North Dorset Poole Bay Poole Central Poole North Dr Richard Jenkinson Dr Colin Davidson Dr Jenny Bubb Dr Carol Linnard Dr Tom Knight Dr Rob Childs Dr Andy Rutland Dr Patrick Seal Dr Chris McCall Purbeck Dr Christian Verrinder Dr David Haines Weymouth and Portland Dr Karen Kirkham West Dorset Dr Blair Millar 1 April 2013 Date stood down 31 July 2013 1 April 2013 1 April 2013 1 April 2013 1 September 2013 31 August 2013 1 April 2013 1 April 2013 1 April 2013 1 April 2013 1 April 2013 1 October 2013 1 April 2013 30 September 2013 1 April 2013 67 GOVERNING BODY & SENIOR MANAGER PROFILES Supporting people in Dorset to lead healthier lives Dr Forbes Watson Dorset CCG Chair Dorset Health and Wellbeing Board Vice Chair Dr Forbes Watson is a GP principal in Lyme Regis. Trained at the University of Glasgow, he has worked in Glasgow, Cornwall and Australia before moving to Lyme Regis, where he has been since 1997. Forbes is the Chair of the clinical commissioning group for Dorset. He is married with children and his interests include rugby union and boating - he is the honorary medical advisor and chairman of the Lyme Regis Royal National Lifeboat Institution. Tim Goodson Chief Officer (performs the function of accountable officer for NHS Dorset CCG) (Appointed 1 April 2013) Tim originally joined the NHS in 1995 as an internal auditor following his initial accountancy training with chartered accountancy practices in the private sector. Tim later moved into more mainstream finance functions with Dorset Community NHS Trust and North Dorset PCT. Prior to his current role, Tim was the Director of Finance for Dorset Primary Care Trust, Bournemouth and Poole Teaching PCT, and South West Dorset Primary Care Trust. During Tim's career in the NHS he has had a broad range of executive lead responsibilities including: Deputy Chief Executive, finance, performance, information, commissioning, primary care, sustainability, support services, information management and technology, risk management, estates and capital planning. He is a Fellow of the Association of Chartered Certified Accountants (ACCA). 68 Tim enjoys making the most of the outdoors and enjoys cycling, walking, skiing and kayaking and is a keen follower of rugby and football, although his playing days are now behind him. Paul Vater Chief Finance Officer (Appointed 1 April 2013) Paul Vater has worked in both the private sector and the NHS in a wide range of financial roles including internal and external audit. He is a Fellow of the Association of Chartered Certified Accountants (ACCA). Paul is the executive lead on finance, procurement, and performance, including contracting, and is also the CCG lead for information management and technology. As a member of the South West Healthcare Financial Management Association, he has strategic interest in the training and development of NHS finance professionals across the South West. Prior to his role with NHS Dorset CCG, he was the Deputy Director of Finance for Dorset PCT. GP Locality Lead members Dr Jenny Bubb Clinical Chair, Mid Dorset Locality Dr Jenny Bubb is a GP partner at Cerne Abbas surgery and is currently the Mid Dorset Locality Lead. She qualified from medical school in Southampton in 2001 before moving to Dorchester to complete GP training. She has worked at Cerne Abbas surgery since 2008. She lives in the Piddle Valley with her husband and son. Her interests include hiking in the beautiful Dorset countryside and playing tennis. GOVERNING BODY & SENIOR MANAGER PROFILES Supporting people in Dorset to lead healthier lives Dr Rob Childs Clinical Chair North Dorset Locality Dr Rob Childs has been a GP partner at Bute House Surgery Sherborne since 1993. He qualified from Southampton University in 1987 and has worked in the UK, Australia and the Channel Islands. He trained as a GP in Bath. He has been locality lead for North Dorset since 2008 and also represents his local GPs on the Dorset Local Medical Committee. Rob is married with two teenage sons and likes to play golf when time allows. Dr Colin Davidson Clinical Chair East Dorset Locality Dr Colin Davidson has been a principal GP working in Cranborne Dorset since 1988. He qualified at the Middlesex Hospital in London and worked there and subsequently in Brighton and Bournemouth before following the sunshine again to Australia. He followed a physician training programme to become a Fellow of the Royal College of Physicians, but finds general practice the only place to practice true general medicine. He is married to a doctor and has three children. He is a rugby referee, sails, skis and has been seen on a golf course when not at meetings; despite his body profile he has run three London Marathons. Dr Paul French Clinical Chair East Bournemouth Locality Dr Paul French is a senior partner at The Marine and Oakridge Surgery in Southbourne, Bournemouth, where he has been working since 1984. He trained at The Royal London Hospital in Whitechapel. He has been working for primary care organisations continuously since their inception. During this time he was the Professional Executive Committee (PEC) Chair of Bournemouth PCT for four years and then the interim PEC chair of Bournemouth and Poole PCT for one year. His main areas of work are care of the elderly, including stroke and dementia. He is married with one son and enjoys walking and skiing. Paul is the chair for the Mental Health and Learning Disabilities Clinical Commissioning Programme. Dr Richard Jenkinson Clinical Chair Christchurch Locality Dr Richard Jenkinson has been a partner at Burton Medical Centre, Christchurch since 1995. He qualified in London and worked there and later in Devon to complete his postgraduate training. As well as being a GP he has a special interest in ears, nose and throat. He is married with five children and enjoys walking and is a silver leader for the Duke of Edinburgh's award scheme. Dr Carol Linnard Clinical Chair North Bournemouth Locality (until 31 August 2013) Dr Carol Linnard is the senior partner of the Alma Medical Centre and has worked there for almost three decades. Throughout that time she has been involved in the education of the next generation of doctors and holds posts at Southampton Medical School, Winchester University and Wessex Deanery. Over the years she has been part of the changing structures of management affecting NHS primary care and 69 GOVERNING BODY & SENIOR MANAGER PROFILES Supporting people in Dorset to lead healthier lives is now committed to locality commissioning. Carol is married with three adult children and along with the usual leisure activities she enjoys ‘mending things’. Dr Tom Knight Clinical Chair North Bournemouth Locality (From 1 September 2013) Dr Tom Knight is a GP principal at Northbourne Surgery in Bournemouth where he has been a partner since 2009. He qualified from Charing Cross and Westminster University in 1997, and did his vocational training for General Practice in Dorset. Tom is married with three young children and his interests are in aviation and watersports. Dr Chris McCall Clinical Chair Poole North Locality Having joined The Hadleigh Practice in Broadstone and Corfe Mullen in 1982 after training in London and Devon / Cornwall but retiring from clinical practice in 2002. Dr Chris McCall is now experiencing the third iteration of GP / primary care-led commissioning but his enthusiasm remains undaunted and he has been locality lead for Poole North since its inception. He is married with a grown-up family that continues to arrive on the doorstep at frequent intervals. He is still trying to catch that elusive 30lb+ salmon. Chris is the chair for the General Medical and Surgical Clinical Commissioning Programme and assistant Clinical Chair for the CCG. Dr Blair Millar Clinical Chair West Dorset Locality Dr Alan Blair Millar is a GP principal at The Bridport Medical Centre where he has been since 70 1994. He trained at King’s College Hospital School of Medicine and he has worked in London, Poole and Exeter, which is where he did his GP training. Blair has been involved in practice-based commissioning since its inception and is now the clinical lead for the Dorset West Locality. He is married with three children and his interests include sailing and skiing. Dr Piers Wilde Clinical Chair Central Bournemouth Bournemouth (until 31 July 2013) Dr Piers Wilde has been a GP partner at Moordown Medical Centre in Bournemouth for nine years. He qualified from London’s Kings College Hospital in 1993 and completed his GP training working in London, Peterborough, Australia and Dorchester. He has been involved in commissioning for 5 years and is married, living in Poole. His interests include music, mountain biking and food. Dr Peter Blick Clinical Chair Bournemouth Central Locality From 1 August 2013) Dr Peter Blick completed his training as a GP in 1981 and was appointed as a partner in The Holdenhurst Road Surgery where he worked for 30 years. He was chairman of Dorset Local Medical Committee for eight years and has trained 20 GPs. He currently works clinical sessions in Blandford and is the GP tutor in Bournemouth. He is a GP lead in adult and children's safeguarding. Apart from his medical interests he is a keen yachtsman and skier and enjoys mountain walking with his wife. He is an active member of his local church in Sway. GOVERNING BODY & SENIOR MANAGER PROFILES Supporting people in Dorset to lead healthier lives Dr Andrew Rutland Clinical Chair Poole Bay & Parkstone Locality Dr Andrew Rutland is senior partner at The Lilliput Surgery in Poole. Having gained an initial degree at Oxford University, he qualified at Charing Cross and Westminster Medical School. He worked in Australia and locally in Dorset, before joining his current practice permanently in 1996. He is married to a GP and has two rapidly growing boys. He keeps fit running regularly, dog walking and occasional hockey, and tries to spend as much summer time as possible on the water. Professionally he is a GP trainer and appraiser, and enjoys life in a proactive practice. Dr Patrick Seal Clinical Chair Poole Central Locality Dr Patrick Seal is a GP principal at The Adam Practice in Poole where he has been a partner since 1991. He qualified from Cambridge University and University College Hospital in 1985, and did his vocational training for general practice in Dorset. Married with four children all aged over 20, he was on the Local Medical Committee for eight years and has been locality lead for Central Poole for seven years. He has been a GP trainer for the past 12 years, and is excited about opportunities for closer working with colleagues in voluntary sector organisations and with the local authority and public health. Occasional Alpine air is his favoured form of relaxation, and real coffee! Dr Karen Kirkham Clinical Chair Weymouth and Portland Locality Dr Karen Kirkham qualified in 1988 from the Middlesex Hospital Medical School, trained in general practice in Dorset and has been a partner at The Bridges Medical Centre in Weymouth since 1994. Alongside working in a busy general practice, she has developed an interest in women’s health and in particular the fields of maternity, fertility, contraception and sexual health. She is also a speciality doctor in genitourinary medicine. She is chair of the Maternity, Reproductive and Family Health Clinical Commissioning Programme. Dr Christian Verrinder Clinical Chair Purbeck Locality (until 30 September 2013) Dr Christian Verrinder is a GP principal at The Wellbridge Practice, Wool. He trained in Nottingham and worked there after qualification as well as in Derby, Warwick, Cheltenham and Australia before moving to Poole in 2002. He is married with children. His professional interests include GP training, sports and exercise medicine as well as orthopaedic medicine. Dr David Haines Clinical Chair Purbeck Locality Dr David Haines has been practising in Swanage for 24 years. After training at King’s College Hospital, London, he completed his training in general practice in Shaftesbury. Following this he worked as a single-handed locum in Bluff, New Zealand, for a year. He led fundholding for his practice in Dorset in the 1990s. He chaired the Purbeck and Blandford PCG and then the Purbeck locality of the South and East Dorset PCT. 71 GOVERNING BODY & SENIOR MANAGER PROFILES Supporting people in Dorset to lead healthier lives When the Dorset PCT formed, he chaired the Medicines Management Committee. He is an elected member of the Dorset Local Medical Committee. David has interests in ornithology and sport. He still plays cricket and coaches the game in Swanage. He is married with three children. Dr Ros Maycock Chair, Mental Health and Learning Disability Clinical Commissioning Programme (until October 2013) Dr Ros Maycock was a GP for nearly 30 years in a practice in Poole and, until October 2013, was chair of the Mental Health and Learning Disabilities CCP. Prior to appointment with the CCG, Ros was Chair of the Professional Executive Committee and a member of the Bournemouth and Poole NHS Primary Care Trust Board. Dr Chris Burton Secondary Care Member (Appointed 1 April 2013) Chris qualified in 1987 and was awarded PhD for work on pathophysiology of kidney tubular cells in 1997. He was appointed to the post of Consultant Nephrologist at North Bristol NHS Trust (NBT) in 2000. Chris has a long-standing interest in improving the quality of patient care, including patient experience. He set up the first kidney patient forum in Bristol to discuss services with patients in 2006. He was made clinical director of renal and transplantation services at NBT in 2006 and established systems of clinical governance and improved infection control in this role. Chris was made Medical Director of NBT in 2009. His focus is improving the quality of care for patients. This includes responding to individual patient concerns as well as working with colleagues within the Bristol health 72 system to improve services. He worked with Bristol PCT PEC in 2010/12. His Medical Director portfolio includes improving quality and safety, Caldicott Guardian, cancer services quality and the role of Director of Infection Prevention and Control. Mary Monnington Registered Nurse Member (Appointed 1 April 2013) Mary qualified as a Registered Nurse in 1972 at St Thomas Hospital, London. She has over 40 years’ experience in the National Health Service as both a clinical nurse and director of nursing in both acute and community provider and clinical commissioning organisations. Mary is also a registered lecturer practitioner with experienced of delivering and commissioning clinical professional education for nurses and associated health professionals. She has a special interest in professional conduct and competence encompassing all health professional groups. Mary is married with two daughters and lives in Wiltshire. Teresa Hensman Lay Member Lead for Governance (Appointed 1 April 2013) Teresa is a Fellow of the Chartered Association of Certified Accountants and a member of the Association of Fraud Examiners.Teresa qualified as an accountant in 1996 while working for the Hammersmith Hospitals NHS Trust. She has more than 13 years' senior management experience within housing associations and local government with revenue budgets in excess of £250 million. Outside of the CCG, Teresa is an independent Mental Health Act hospital manager for Dorset HealthCare, and a member of the Local Food Links parent forum. GOVERNING BODY & SENIOR MANAGER PROFILES Supporting people in Dorset to lead healthier lives David Jenkins Lay Member Lead for Patient and Public Involvement and Deputy CCG Chair (Appointed 1 April 2013) After beginning his working life as a teacher, David qualified as a solicitor, practising mainly in the public service. He worked with Oxfordshire and Hampshire County Councils, and with the Local Government Ombudsman service, before joining Dorset County Council in 1989. He became their chief executive in 1999, a post he held until 2012. David has extensive experience of the public service, having chaired the Dorset Connexions company, the Dorset Youth Offending Team Board, the Total Place Board for Bournemouth, Dorset and Poole, and the steering group that put in place the arrangements for the 2012 Olympic and Paralympic sailing events. He currently chairs a committee on waste management for Gloucestershire County Council. David is a trustee of a number of local charities, mainly involved with the arts and musical education, and is a Fellow of the Royal Society of Arts. He is president of the Dorset Association of Parish and Town Councils, and a Deputy Lieutenant of Dorset. Executive Directors The Governing Body is supported by an internal commissioning structure with services provided through four directorates: quality service development finance and performance engagement and development. Each directorate is led by an executive director, accountable to the Chief Officer. The Chief Finance Officer sits on the Governing Body. Details of the other Executive Directors are as follows: Suzanne Rastrick Director of Quality (Appointed 1 April 2013) Suzanne qualified as an occupational therapist (OT) and began her career in the acute hospital sector, moving to practise in community and primary care where she then gained her first general management role. She was one of the first allied health professionals (AHPs) to hold a substantive Director of Nursing post and has since held these roles in both providing and commissioning organisations. She has also been chief executive of a primary care trust cluster. She has a non-executive portfolio in the commercial and not-for-profit housing sector and sits on a number of national groups including NHS Employers Policy Board and Health Education England AHP Advisory Group. Jane Pike Director of Service Delivery (Appointed 1 April 2013) Jane spent the first 16 years of her career as a clinical microbiologist both in the NHS and veterinary fields. In 1997 she was successful in gaining a place on the NHS accelerated management training scheme, graduating in 2000. Since that time she has held a variety of senior management positions at local, regional and national level, spanning operational and strategic commissioning responsibilities. Jane joined NHS Dorset PCT from NHS 73 GOVERNING BODY & SENIOR MANAGER PROFILES Supporting people in Dorset to lead healthier lives Hampshire PCT, where she had been the Programme Director - Service Redesign since 2007. Prior to this she held the role of head of adult services at East Hampshire, Fareham and Gosport Primary Care Trust, managing all adult community services, including four community hospitals. Jane was appointed as director of acute and primary care service improvement for NHS Dorset and NHS Bournemouth and Poole in July 2011, and to the Director of Service Delivery (designate) for the CCG in October 2012. Charles Summers Director of Engagement and Development (Appointed 1 April 2013) Charles was formerly Director of Workforce for NHS Dorset and NHS Bournemouth and Poole from July 2011. He joined the NHS in 1993 and has worked in various health settings, developing and improving people management. He is a Fellow of the Chartered institute of Personnel and Development and a qualified executive coach. Charles provided professional advice on all aspects of workforce and organisational development practice to both local PCT boards and to the leadership of the shadow Clinical Commissioning Group for Dorset. Charles has worked at executive level with a number of NHS boards since 2005 and leads our equality and diversity, public engagement, organisational development, strategic planning and emergency planning responsibilities. Charles Buckle Non-governing Lay member Charles Buckle was appointed a non Governing Body Lay Member of Dorset CCG in April 2013 having earlier been a volunteer Lay Member of the clinical governance working group of the Dorset PCT for two and a half years. Charles had previously spent six years as a member of the senior staff and bursar of a large Dorset comprehensive upper school after his principal career in the Royal Navy from which he retired in the rank of Captain in 1993. Swanage has been home for most of his life during which he has variously been involved with the community hospital and the lifeboat. Charles is married with two children. His principal interest is sailing. Tina Thompson Non-governing Lay member Tina Thompson was appointed a non-Governing Body Lay Member of Dorset CCG in April 2013 Tina Thompson is a freelance management consultant working with voluntary and community sector organisations since 2007. She undertook a joint honours degree in economics and politics as a mature student, graduating in 1992, following which she had a career in the voluntary sector working in advocacy and advice agencies including Citizens Advice. Tina lives in Bournemouth, was a member of the Bournemouth LINK Stewardship Group and is a trustee of Friends of Boscombe Chine Gardens. She currently works with Bournemouth 2026 Trust – a community land and development trust which she helped to set up; is a lay advisor at Health Education Wessex and undertakes occasional freelance work with other voluntary and community sector organisations. Interests outside work include steam trains and she has volunteered on the Swanage Railway as a Ticket Inspector. Declaration of interests Pursuant to our values of openness and honesty, it is a requirement that all member practices of the Dorset Clinical Commissioning Group (CCG), Governing Body members, GPs who are paid to provide services to the CCG and all staff declare any interests that they have that may conflict with the interests of the CCG itself. Please see pages 75 to 77. 74 GOVERNING BODY & SENIOR MANAGER PROFILES Supporting people in Dorset to lead healthier lives Name and CCG Role Dr Peter Blick GP Locality Chair for Central Bourmemouth Governing Body Committee, CCP or Staff Governing Body, CCC Dr Jenny Bubb Governing Body GP Locality Chair for Mid Dorset Dr Chris Burton Governing Body, Secondary Care Member CCC Dr Lionel Cartwright GP Governing Body CCC CCP Lead Dr Rob Childs, GP Locality Chair for North Dorset Governing Body, CCC Dr Colin Davidson, Governing Body, GP Locality Chair for East Dorset Dr Paul French GP Locality Chair for East Bournemouth Tim Goodson Chief Officer Governing Body CCC Audit & Quality Committee CCP Lead Governing Body, CCC Interests Date Declared Adult Safeguarding Lead, GP Tutor, Bournemouth, Out of Hours Contract for New Wave Care UK, Salaried GP – Whitecliff Surgery, Blandford Partner, Cerne Abbas GP Surgery, Co-opted member of DCC for HWB purposes 17/03/2014 Member of the Trust Board of North Bristol NHS Trust which provides a small number of specialist services (not commissioned by the CCG) to the population of Dorset, Wife is a GPSI in dermatology in the Bristol region Partner, Harvey Practice, Shareholder, Solutions for Health, Medical Advisor, Magna Care Centre, Bed Fund Victoria Hospital Wimborne, Wife is a Community Matron employed by Bournemouth and Poole Community Health Services GP Partner, Bute House Surgery Sherborne, LMC Representative for North Dorset, Clinical Assistant in Endoscopy, Yeovil District Hospital, Dorset PCT Representative on Yeovil District Hospital Board of Governors, Member of Yeatman Hospital Management Group Senior Partner, The Cranborne Practice (PMS Dispensing and Training), Director, Dorset Diagnostics Ltd., Wife is a Director of Dorset Diagnostics Ltd., Community Endoscopy Lead for DHUFT, Trustee, Boveridge House School, Wife is a GP at Eagle House Surgery, Whitecliff Mill Street, Blandford Forum, Dorset DT11 7DQ, DDL hold an AQP contract for Community Endoscopy, Co-opted member of DCC for HWB purposes Co-opted members of the B&P HWB Board 17/02/2013 HFMA Member, HFMA South West Executive Branch Committee Member, Co-opted member of DCC for HWB purposes, Partner works for Bournemouth Borough Council Co-opted member of DCC for HWB purposes Prior 30/09/2009 13/04/2013 13/04/2013 16/11/2011 04/02/2014 Prior 14/11/2011 14/11/2011 12/05/2010, 19/03/2014, 19/03/2014 17/01/2012 15/01/2013 04/02/2014 05/02/2014 Dr David Haines, GP, Locality Chair for Purbeck Teresa Hensman, Lay Member Lead for Governance Chair of the Audit and Quality Committee Governing Body Governing Body, Audit & Quality Committee, Remuneration Committee Mental Health Act Hospital Manager, DHUFT 08/10/2012 Governing Body GP Partner, Northbourne Surgery, FTSE 100 index linked savings 15/01/2014 Dr Carol Linnard GP, Locality Chair for North Bournemouth Governing Body (Until 31 August 2013) Partner, Alma Partnership Programme Director for Winchester University/Wessex Deanery Practice holds PMS and Contract for providing a GU and Family Planning Service Governor, Royal Bournemouth Hospital Prior 17/11/2011 Dr Tom Knight GP Locality Chair for North Bournemouth 04/02/2014 20/01/2013 75 GOVERNING BODY & SENIOR MANAGER PROFILES Supporting people in Dorset to lead healthier lives Name and CCG Role Dr Ros Maycock GP GP Transition Lead Governing Body Committee, CCP or Staff CCP (Until October 2013) Date Declared Partner, Evergreen Oak Surgery (Training Practice) Practice is a member of the Poole Central Locality Commissioning Group Member of Poole Children Trust Board Member of Bournemouth Children Trust Board Husband employed by Purbeck CAB Prior 17/11/2011 Prior 17/11/2011 09/01/2013 09/01/2013 09/01/2013 Dr Blair Millar Governing Body GP, Locality Chair for West Dorset Mary Monnington Governing Body, Registered Nurse Member Audit & Quality Committee Remuneration Committee Dr Piers Wilde Governing Body GP, (Until 31 July 2013) Locality Chair Central Bournemouth Locality GP Partner, Bridport Medical Centre Skellern Practice, Wife (Dr Joanna Cotton) is a member of the Cancer Support Group “The Living Tree” Co-opted member of DCC for HWB purposes Council member [UKCCG] United Kingdom Council of Caldicott Guardians, Panel Member Professional Performance Committees Nursing and Midwifery Council [NMC] Nurse Member Wiltshire CCG Husband JET Monnington, Senior Solicitor Moore Blatch Resolve LLP Southampton 08/06/2010, 09/01/2013, 04/02/2014 05/2009 02/2013 04/2013 06/03/2013 Jane Pike Director of Service Delivery Dorset CCG Suzanne Rastrick Director of Quality, Dorset CCG Co-opted members of the B&P HWB Board 05/02/2014 Allied Health Professional/Healthcare Scientist Member, Policy Board, NHS Employers Member, Health Education England Advisory Group Group Board Member and Chair, Audit and Risk Committee, Spectrum Housing Group Limited which involves oversight of the following companies: Spectrum Housing Group Limited, Spectrum Property Care Limited, Signpost Homes Limited, Spectrum Premier Homes Limited Member, Council of the College of Occupational Therapists Chair of the English Board of the College of Occupational Therapists Prior to 30/04/2009 01/09/2009 01/12/2010 20/06/2012 20/06/2012 Dr Chris McCall Governing Body, GP, CCC, Locality Chair for Poole North, Remuneration Committee CCP Lead Nothing to declare Senior Partner Moordown Medical Center, Bournemouth Medical Cosmetic Medical Doctor Hyperbaric Doctor for Atlantic Enterprise Circle. Solutions For Health Governing Body, CCC Governing Body CCC Trustee of Healthcare Financial Management Association (HFMA) – South West Branch 02/04/2013 Dr Christian Verrinder GP CCC CCP Lead (Until 30 September 2013) CCC CCP Lead GP Partner, Wellbridge Practice Wool (dispensing practice also holds contract to provide 02/03/2011 medical inpatient care for Wareham and Blandford Hospitals), Employed by Orthopaedic Medical Service (OMS) former Bournemouth & Poole PCT, 01/04/2011 DHUFT from April 2011 Charles Buckle Lay Member, Member Audit and Quality Committee GP, Lilliput Surgery, Shareholder, Solutions for Health, Wife is a Partner at The Harvey Practice Nothing to declare 13/02/2012 Dr Andy Rutland GP Locality Chair for Poole Bay Charles Summers Director of Engagement and Development, Dorset CCG Paul Vater Chief Finance Officer Dr Simon Watkins GP 76 Interests Partner at Evergreen Oak Surgery, Deputy Chair, Poole Central Locality, Work Out of Hours shift for provider SWAST, Co-opted members of the B&P HWB Board Member of DHCUFT (Not on Governing Body, but to keep in touch with priorities) Member of Purbeck Health Network Prior to 17/11/2011 13/01/2013 15/03/2011 22/02/2014 22/02/2014 22/02/2014 05/02/2014 14/05/13 GOVERNING BODY & SENIOR MANAGER PROFILES Supporting people in Dorset to lead healthier lives Name and CCG Role Ms Tina Thompson Governing Body Committee, CCP or Staff Lay Member, Audit & Quality Committee David Jenkins Lay Member Lead for Patient and Public Engagement, Deputy Chairman of the Governing Body, Chairman of the Remuneration Committee Governing Body, Audit & Quality Committee, CCC, Remuneration Committee Dr Richard Jenkinson GP Locality Chair for Christchurch Governing Body Dr Patrick Seal, GP Locality Chair for Poole Central Dr Craig Wakeham GP, CCP Lead Dr Forbes Watson GP, CCG Chair, CCC Chair Governing Body Dr Karen Kirkham Governing Body, GP, CCC, Locality Chair for Weymouth CCP Lead and Portland CCC Governing Body, CCC Remuneration Committee Interests Employee of Bournemouth Borough Council working for Bournemouth 2026 Trust Lay Advisor, Health Education Wessex/Wessex Deanery Freelance Management Consultant, Third Sector Management Solutions Site Assessor, Quality Performance Mark, Action for Advocacy Secretary, Friends of Boscombe Chine Gardens Date Declared 14/11/2011 Chair of Gloucestershire County Council's Waste Working Group (2 to 3 days a month) Deputy Lieutenant, Dorset, Trustee, Bournemouth Symphony Orchestra Endowment Fund, Trustee, Richard Ely Trust for Young Musicians. Trustee, Burton Bradstock Festival, Patron, Bridport Arts Centre, President of the Dorset Association of Parish and Town Councils. GP Partner, Burton Medical Centre, GPwSI in ENT, employed by DHUFT, Director, Wessex Aviation Medical Services Ltd, Co-opted member of DCC for HWB purposes GP Partner, the Bridges Medical Centre Weymouth, Specialty Doctor in Sexual Health, employed by DCHFT, Board Member, Sexual Health South West Regional Office, Member of Children’s Trust Board, Dorset, Governor at Sunninghill Preparatory School, Husband is a GP Partner at Abbotsbury Road Surgery Weymouth, Co-opted member of DCC for HWB purposes GP, The Adam Practice, Quay Medical Care Limited, the Adam Practice’s provider vehicle for PCOS and Paediatric service Senior Partner, Cerne Abbas Surgery (PMS dispensing practice), Dorset LM 21/11/2012, 04/11/2013 Principal, GP Practice (PMS) in Lyme Regis Contract with VH Doctors Ltd for medical care. Spouse clinical employee for DHUFT. Honorary Medical Advisor and Chairman of RNLI Lyme Regis Co-opted member of DCC for HWB purposes Prior to 30/04/2009 15/05/2013 15/05/2013 15/05/2013 04/02/2014 10/05/2010 07/01/2013 10/05/2010 04/02/2014 Prior 14/11/2011 04/02/2014 Prior to 17/11/2011, 16/02/2012 26/04/2012 Each declaration is considered individually. In the main, the acts of declaring, recording and publishing declared interests are sufficient to deal with the interest declared. Where after consideration, and having regard to the Nolan principles, a member’s personal or private interests are such as to prejudice his/her ability to remain disinterested in any particular issue, they will be advised to withdraw from participating in decision making in that particular issue. 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 aware of any relevant audit information and to establish that the clinical commissioning group's auditor is aware of that information. 77 REMUNERATION REPORT Supporting people in Dorset to lead healthier lives CCG’s business and management thereon Board and Executive Committee Members Full details of the remuneration paid to the Governing Body members and senior employees are provided within the Remuneration Report included herein, together with their pension entitlements and declaration of interest. As part of the governance structure, the CCG has in place an Audit & Quality Committee which is responsible for providing the Board with assurance across the range of CCG activities, whilst retaining a particular financial focus. The Audit & Quality Committee is chaired by Teresa Hensman, Lay Member Lead for Governance, who has relevant and recent financial experience. Other Lay Members of the Committee during 2013/14 were Tina Thompson, Charles Buckle, and David Jenkins. The Committee reviews its terms of reference and its effectiveness annually and recommends to the Governing Body any changes required as a result of the review. In 2013/14, the Audit & Quality Committee discharged its responsibilities by: 78 reviewing and recommending the CCG’s draft financial statements and the external auditors detailed reports thereon reviewing the effectiveness of the external audit process reviewing and monitoring the external auditors’ independence and objectivity and the effectiveness of the audit process, taking into account relevant UK professional and regulatory requirements reviewing the external auditors’ annual work plan, including its non-audit services and fees reviewing the risks associated with the reviewing the policies and procedures for all work related to fraud and corruption reviewing investigations as a result of the instigation of the CCGs whistle blowing policy reviewing the CCGs system of internal control and its effectiveness, reporting to the Governing Body on the results of the review and receiving regular updates on key processes for management of the risks facing the CCG reviewing the effectiveness of the internal audit function reviewing the internal audit work programme, internal audit reports and periodic progress reports on its work during the year; and reviewing governance and risk management arrangements to ensure appropriate processes are in place. The Audit & Quality Committee has wide powers to establish special investigations in the event that any wrongdoing is brought to its notice, in particular, in the case of defalcations, fraud or theft. External Audit Grant Thornton is the appointed external auditor for the CCG. The total fee paid to Grant Thornton was £122,000 including VAT and was paid to cover the cost of the statutory audit and associated services. Senior Managers Remuneration Report For the purpose of this report, senior managers are defined as being ‘those persons in senior positions having authority or responsibility for directing or controlling the major activities of the Clinical Commissioning Group’. REMUNERATION REPORT Supporting people in Dorset to lead healthier lives This means those who influence the decisions of the organisation as a whole rather than the decisions of individual directorates or departments. Such persons will include advisory and Lay Members. The CCG’s Remuneration Committee is chaired by David Jenkins, Deputy Chair of the CCG Governing Body. The Committee met on five occasions in 2013/14. It is the Remuneration Committee that determines the reward packages of Executive Directors. The policy on remuneration of senior managers has been determined reflecting a Dorset based public sector benchmarking exercise, national CCG remuneration guidance and principles established by the Department of Health within a very senior managers pay framework. In the coming year, the committee will review its policy with wider CCG benchmarking (following the publication of other CCG annual accounts) together with any further development of national remuneration guidance for CCGs. Senior CCG officers are eligible for consideration of a performance related pay award. Determination of any award is at the discretionary recommendation of the committee, determined by reference to the achievement of business objectives. Awards range from 0-5% of individual basic salary. Senior officer appointments to the CCG are offered under substantive employment terms and subject to 6 months’ notice of termination. Other appointments to the Governing body (excluding Chief Officer and Chief Finance Officer) are determined for periods of three years, renewable under terms provided for by the constitution. (Please see pages 68 to 77 for Governing Body and Senior Managers’ Profiles). Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director in their organisation and the median remuneration of the organisation’s workforce. The mid-point banded remuneration of the highest paid director in the financial year 2013/14 was £132,500. This was 3.6 times the median remuneration of the workforce, which was £36,666. In 2013/14, no employee’s full time equivalent salary was in excess of the highest paid director. Remuneration ranged from £5,000 to £132,500. Total remuneration includes salary, nonconsolidated performance-related pay, benefits-in-kind as well as severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions. Exit Packages In 2013/14 there were two exit packages, at a cost of £11,033. 79 REMUNERATION REPORT Supporting people in Dorset to lead healthier lives Salaries & Allowances (subject to audit) Name and Title Salary and Fees Taxable Benefits Annual PerformanceRelated Bonuses Long Term Performance Related Bonuses All Pensionrelated Benefits (Bands of £5,000) Rounded to the nearest £’000 Bands of £2,500) Bands of £5,000) £’000 £’000 £’000 £’000 £’000 70 – 75 0 0 0 10 – 12.5 85 –- 90 100 – 105 0 0 0 12.5 – 15 £”000 Dr Forbes Watson, Chair Mr Tim Goodson, Chief Officer 130 – 135 Mrs Suzanne Rastrick, Director of Quality 100 – 105 Mr Paul Vater, Chief Finance Officer Ms Jane Pike, Director of Service Delivery Mr Charles Summers, Director of Engagement and Development Dr Paul French, GP Locality Chair for East Bournemouth and GP Clinical Commissioning Programme (Mental Health and Learning Disabilities) Lead Dr Jenny Bubb, GP Locality Chair for Mid Dorset Dr Robert Childs, GP Locality Chair for North Dorset Dr Colin Davidson, GP Locality Chair for East Dorset Dr David Haines, GP Locality Chair for Purbeck (from 1st October 2013) Dr Chris McCall, GP Locality Chair for Poole North and GP Clinical Commissioning Programme (General Medical and Surgical) Lead Dr Blair Millar, GP Locality Chair for West Dorset Dr Andy Rutland, GP Locality Chair for Poole Bay Dr Patrick Seal, GP Locality Chair for Poole Central Dr Tom Knight, GP Locality Chair for North Bournemouth (from 1st September 2013) 80 90 – 95 90 – 95 0 0 0 1 (Bands of £5,000) 0 0 0 0 Bands of £5,000) 0 0 0 0 Total 17.5 – 20 150 – 155 12.5 – 15 115 – 120 12.5 – 15 12.5 – 15 115 – 120 105 – 110 105 – 110 55 – 60 0 0 0 0 – 2.5 55 – 60 25 – 30 0 0 0 2.5 – 5 30 – 35 25 – 30 0 0 0 0 25 – 30 25 – 30 20 – 25 0 0 0 0 0 2.5 – 5 0 2.5 – 5 30 – 35 25 – 30 65 – 70 0 0 0 0 65 – 70 25 – 30 0 0 0 0 25 – 30 25 – 30 0 0 0 2.5 – 5 30 – 35 25 – 30 25 – 30 0 0 0 0 0 2.5 – 5 0 2.5 – 5 30 – 35 30 – 35 REMUNERATION REPORT Supporting people in Dorset to lead healthier lives Salary and Fees Taxable Benefits (Bands of £5,000) Rounded to the nearest £’000 Dr Karen Kirkham, GP Locality Chair for Weymouth and Portland and GP Clinical Commissioning Programme (Maternity, Reproductive and Family Health) Lead 55 – 60 Dr Peter Blick, GP Locality Chair for Central Bournemouth (from 1st August 2013) Name and Title Dr Richard Jenkinson, GP Locality Chair for Christchurch Dr Chris Burton, Secondary Care Member Ms Mary Monnington, Registered Nurse Member Dr Piers Wilde, Former GP Locality Chair for Central Bournemouth (1st April 2013 – 31st July 2013) Dr Carol Linnard, Former GP Locality Chair for North Bournemouth (1st April 2013 – 31 August 2013) All Pensionrelated Benefits Total Bands of £2,500) Bands of £5,000) 0 7.5 – 10 65 – 70 0 0 2.5 – 5 30 – 35 0 0 0 0 20 – 25 20 – 25 0 0 0 0 20 – 25 20 – 25 0 0 0 0 – 2.5 20 – 25 10 – 15 0 0 0 0 10 – 15 0 0 0 2.5 – 5 30 – 35 (Bands of £5,000) Bands of £5,000) 0 0 25 – 30 0 20 – 25 £’000 15 – 20 Dr Christian Verrinder, Former GP Locality Chair for Purbeck (1st April 2013 – 30 September 2013) and GP Clinical 25 – 30 Commissioning Programme (Musculoskeletal and Trauma) Lead Lay Members Annual Long Term Performance- PerformanceRelated Related Bonuses Bonuses £’000 0 £’000 0 £’000 0 £’000 0 £’000 15 – 20 Mrs Teresa Hensman, Lay Member Lead for Governance, Chair of the Audit & Quality Committee 15 – 20 0 0 0 0 15 – 20 Mr David Jenkins, Lay Member Lead for Public Engagement, Deputy Chair of the Governing Body and Chair of the Remuneration Committee 0–5 0 0 0 0 0–5 15 – 20 0 0 0 0 15 – 20 0–5 0 0 0 0 0–5 Ms Tina Thompson, Lay Member, Member Audit & Quality Committee Mr Charles Buckle, Lay Member, Member Audit & Quality Committee 81 REMUNERATION REPORT Supporting people in Dorset to lead healthier lives Name and Title Salary and Fees Taxable Benefits (Bands of £5,000) Rounded to the nearest £’000 £’000 £’000 Annual Long Term Performance- PerformanceRelated Related Bonuses Bonuses (Bands of £5,000) £’000 Bands of £5,000) £’000 All Pensionrelated Benefits Total Bands of £2,500) Bands of £5,000) £’000 £’000 Clinical Commissioning Programme Chairs (not members of Governing Body) Dr Lionel Cartwright, GP Clinical Commissioning Programme (Cancer and End of Life) Lead Dr Craig Wakeham, GP Clinical Commissioning Programme (Cardiovascular Disease, Stroke, Renal and Diabetes) Lead Dr Simon Watkins, GP Clinical Commissioning Programme (Pan – Urgent Care, Clinical Services Review and Better Together) Lead Dr Ros Maycock, Former GP Clinical Commissioning Programme (Mental Health and Learning Disabilities) Lead until 31 October 2013 Notes 1. 2. 3. 4. 5. 82 25 – 30 0 0 0 0 - 2.5 30 - 35 25 – 30 0 0 0 2.5 - 5 30 – 35 25 – 30 0 0 0 0 25 – 30 30 – 35 0 0 0 2.5 - 5 35 – 40 No directors waived any allowances or remuneration during the period 1 April 2013 to 31 March 2014. Other remuneration and benefits in kind relate to on-call and mileage above taxable threshold. No payments have been made to past senior managers by the CCG in 2013/14. No payments have been made to a senior manager for loss of office in 2013/14 No member of staff formally identified as a senior manager in the CCG has been given additional payments outside of payroll or give in assets in 2013/14. REMUNERATION REPORT Supporting people in Dorset to lead healthier lives Senior Manager Pension Benefits (subject to audit) Real Real Total increase in increase in accrued pension at pension pension at age 60 lump sum at age 60 at age 60 31 March 2014 (bands of £2,500) (bands of £2,500 (bands of £5,000) 5 – 7.5 17.5 – 20 5 – 7.5 Ms Jane Pike, Director of Service Delivery Mr Charles Summers, Director of Engagement and Development Dr Chris Burton, Secondary Care Member (bands of £5,000) Cash Cash Real Employers Equivalent Equivalent increase in contribution Transfer Transfer Cash to Value at 31 Value at 31 Equivalent partnership March 2013 March 2014 Transfer pension Value £’000 £’000 £’000 £’000 £’000 30 – 35 90 – 95 366 476 102 0 15 – 17.5 25 – 30 80 – 85 370 491 114 0 (2.5) - (0) (7.5) - (5) 30 - 35 100 - 105 605 594 (25) 0 0 – 2.5 5 – 7.5 35 – 40 105 – 110 619 693 60 0 2.5 – 5 7.5 – 10 20 – 25 65 – 70 318 392 67 0 0 – 2.5 5 - 7.5 45 - 50 135 - 140 721 846 109 0 £’000 Mr Tim Goodson, Chief Officer Mr Paul Vater, Chief Finance Officer Mrs Suzanne Rastrick, Director of Quality £’000 Lump sum at age 60 related to accrued pension at 31 March 2014 £’000 Notes 1. Lay Members do not receive pensionable remuneration. 2. Full details of the accounting policy regarding pension costs can be found within Note 4 of the full set of audited financial statements. 3. As it is not possible to apportion the CETV across organisations, the full value for each senior manager is reported above. 4. Mrs Suzanne Rastrick has a decrease in Pension benefits, due to a change in role; last year’s role was Interim Chief Executive. 5. Dr Chris Burton is recharged to the clinical commissioning group by North Bristol NHS Trust which includes pension costs. In accordance with the Manual of Accounts, 100% of Dr Burton’s NHS pension entitlements are shown above, however, only 12% of the pension entitlements relate to his clinical commissioning group engagement. 6. GPs who serve on the Governing Body for the CCG are recognised as being under a ‘contract for service’ and therefore according to the NHS Pension Agency do not fall within the definition of a senior manager for disclosure under Greenbury. 83 REMUNERATION REPORT Supporting people in Dorset to lead healthier lives Cash Equivalent Transfer Values A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the members as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries. Real Increase in CETV This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period. Off-payroll Engagements Following the review of Tax arrangements of public sector appointees published by the Chief Secretary to the Treasury, clinical commissioning groups are required to publish information on their highly paid and/or senior off-payroll engagements. Off-payroll engagements as of 31 March 2014, for more than £220 per day and that last longer than 6 months are as follows: The number that have existed: For less than one year at the time of reporting Total number of existing engagements as of 31 March 2014 Number NIl Nil All existing off-payroll engagements, outlined above, have at some point been subject to a risk based assessment as to whether assurance is required that the individual is paying the right amount of tax and, where necessary, that assurance has been sought. 84 REMUNERATION REPORT Supporting people in Dorset to lead healthier lives Number of new engagements or those that reached six months in duration, between 1 April 2013 and 31 March 2014 Number of the above which include contractual clauses giving the clinical commissioning group the right to request assurance in relation to Income Tax and National Insurance obligations. Number for whom assurance has been requested. Of which, the number: For whom assurance has been received For whom assurance has not been received That have been terminated as a result of assurance not being received. Number Nil Nil Nil Nil Nil Nil Nil 85 FINANCIAL PERFORMANCE Supporting people in Dorset to lead healthier lives SUMMARY FINANCIAL STATEMENTS The statements below summarise the information contained within the full audited accounts. Statement of Comprehensive Net Expenditure Administration Costs and Programme Expenditure Gross Employee Benefits Other Costs Less: Miscellaneous Income Net Operating Costs before Financing Investment Revenue Other (Gains) & Losses Finance Costs NET OPERATING COST FOR THE FINANCIAL YEAR Other Comprehensive Net Expenditure Impairments and reversals put to the Revaluation Reserve Net (gain)/loss on revaluation of property, plant and equipment Release of reserves to Statement of Comprehensive Net Expenditure TOTAL COMPREHENSIVE NET EXPENDITURE FOR THE YEAR 13,496 926,659 (5,672) 934,483 0 0 0 934,483 0 0 0 934,483 The purpose of this statement is to summarise, on an accruals basis, the net operating costs of the CCG. The statement identifies gross operating costs, less miscellaneous income, to arrive at the net operating costs of the CCG. 86 FINANCIAL PERFORMANCE Supporting people in Dorset to lead healthier lives Overview The audited accounts show that during the year ended 31 March 2014, the CCG achieved all of its financial duties. Revenue Resource Limit The CCG has a statutory duty to maintain expenditure within the resource limits set for revenue, including managing programme and running costs allocations separately. Revenue expenditure covers the general day to day costs involved in the commissioning of healthcare. The CCG met its statutory duty to operate within its revenue resource limit and in addition is significantly under the £25 per head running cost allowance. Total net operating costs for the financial year Revenue Resource Limit REVENUE SURPLUS 2013/14 £’000 TOTAL 934,483 2013/14 £’000 Programme 917,753 2013/14 £’000 Running Costs 16,730 12,614 10,614 2,000 947,097 928,367 18,730 This note measures the CCG’s performance against its statutory duty to operate within the revenue resource limit set by the Department of Health and NHS England. The revenue resource limit is the maximum the CCG can spend on commissioning healthcare for its resident population. Staff Costs Salaries and wages Employer contributions to NHS Pensions Agency Social Security Costs 2013/14 £’000 11,396 1,235 854 Termination Benefits Other Employment Benefits TOTAL STAFF COSTS 11 0 13,496 This note includes permanently (those directly emloyed by the CCG) and other employed staff (those on secondment or loan from other organisations, bank / agency / temporary staff and contract staff). 87 FINANCIAL PERFORMANCE Supporting people in Dorset to lead healthier lives Average Number of Persons Employed Average Number of Persons Employed (Other Staff) Sickness & Absence Data Total Days Lost Total Average Number of Staff (FTE) Average Working Days Lost 2013/14 295 2013/14 Number 1,220 234 5.21 The employee absence level within the CCG is above the national target of 3% and also above the target we have set for ourselves of 2%. In light of this the CCG introduced a new Managing Absence policy in April 2014 as part of a wider re-launch of HR polices. This has been supported by a series of briefings across CCG sites for managers and employees. One of the key objectives in the Workforce Plan for 2014/15 is a review of the current managing attendance system from recording through to monitoring and engagement with managers as well as development. We will then develop a new managing attendance system with the appropriate communication, engagement and development strategy to roll out to the organisation. This note has been prepared consistently with total staff costs above. The above 2013/14 figures relate to commissioning staff only and following national guidance, the calculation of sickness absence in a financial year is calculated using working days only. The calculation of sickness absence in a financial year is calculated using only working days. Running Costs Running costs (£’000s) Weighted population (number in units) Running costs per weighted population (£ per head) 88 2013/14 16,730 749,179 £22.33 FINANCIAL PERFORMANCE Supporting people in Dorset to lead healthier lives Better Payments Practice Code In accordance with the Better Payments Practice Code, valid invoices should be paid by their due date or within 30 days of receipt, whichever is later. CCG performance is presented below, measured in terms of both the number and value of invoices received, against an NHS administrative target to pay over 95% of non-NHS trade creditors in accordance with the code. Non-NHS Payables Number 2013/14 £’000 Total bills paid in the year 27,290 130,783 Percentage of bills paid within target 96.9% 98.7% Total bills paid within target 26,441 NHS Payables Number 2013/14 129,063 £’000 Total bills paid in the year 3,601 682,215 Percentage of bills paid within target 98.1% 101.0% Total bills paid within target 3,534 688,789 The 101.0% is caused by a large credit note. If the credit note could be removed from the figures, the per centage of NHS invoices paid within target would fall to 99.7% This note shows the CCG’s performance against its administrative duty to pay all creditors within 30 calendar days of receipt of goods or valid invoice, whichever is later, unless other payment terms have been agreed. Losses and Special Payments The CCG had no losses or special payments during 2013/14. During 2013/14 the CCG had no lapses of data security. Losses or special payments are payments that Parliament would not have envisaged healthcare funds being spent on when it originally provided the funds. 89 GLOSSARY Supporting people in Dorset to lead healthier lives A&E AF Atrial Fibrillation B&P Bournemouth and Poole AHPs CAAS CAMHS CCC CCG CCP CCU CETV CHC CIPOLD COPD CQC CVD Allied health professionals Community Adult Asperger Service Child and Adolescent Mental Health Services Civil Contingencies Unit Cash Equivalent Transfer Value Continuing Health Care Confidential Inquiry into Premature Deaths of People with Learning Disabilities Chronic Obstructive Pulmonary Disease Care Quality Commission EPRR FFT GSF HR Health and Wellbeing Board Information Governance Information Governance Toolkit IV Intravenous JSNA Joint Strategic Health Needs Assessments IVF KPI LRTI LHRP LSCB LTC MRSA MSK NBT OT In Vitro Fertilisation Key Performance Indicator Local Area Team Local Health Resilience Partnership Lower Respiratory Tract Infection Bournemouth and Poole Local Safeguarding Children Board Long Term Condition Meticillin-resistant Staphylococcus Aureus, a type of bacterial infection Musculoskeletal North Bristol NHS Trust Occupational therapist Cardiovascular disease PCT Primary Care Trust Dorset County Hospital NHS Foundation Trust PHFT Poole Hospital NHS Foundation Trust Dorset Safeguarding Children Board EPC IGT Clinical Commissioning Programme Clinical Commissioning Group DSCB ECG IG LAT Dorset County Council DHUFT HWB Clinical Commissioning Committee DCC DCHFT 90 Accident and Emergency Dorset Healthcare University NHS Foundation Trust PEC PHB POPP Electrocardiogram PROM Emergency preparedness, resilience and response RBCHFT Energy Performance Contract Friends and Family Test Gold Standard Framework Human Resources PTS TIA Professional Executive Committee Personal Health Budget Dorset Partnership for Older People Programme Patient Reported Outcome Measures Patient Transport Services Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust Transient Ischaemic Attack (mini-stroke) NHS DORSET CLINICAL COMMISSIONING GROUP FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2014 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 CONTENTS Foreword to the Accounts 3 Independent Auditor's Report 4 Statement of the Signing Officer Responsibilities 5 Annual Governance Report 6-19 Head of Internal Audit Opinion 20-24 The Primary Statements: 25 Statement of Comprehensive Net Expenditure Statement of Financial Position Statement of Changes in Taxpayers' Equity Statement of Cash Flows Notes to the Accounts: Note 1 Note 2 Note 3 Note 4 Note 5 Note 6 Note 7 Note 8 Note 9 Note 10 Note 11 Note 12 Note 13 Note 14 Note 15 Note 16 Note 17 Note 18 Note 19 Note 20 Note 21 Note 22 Note 23 Note 24 Note 25 Note 26 Note 27 Note 28 Note 29 Note 30 Note 31 Note 32 Note 33 Note 34 Note 35 Note 36 Note 37 Note 38 Note 39 Note 40 Note 41 Note 42 Note 43 Note 44 26 27 28 29 30 Accounting policies Miscellaneous Revenue Revenue Employee benefits and staff numbers Operating Expenses Better payments practice code Income Generation Activity Investment Income Other gains and losses Finance costs Net Gain (Loss) 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 Deferred revenue Other financial liabilities Other liabilities Borrowings PFI and NHS LIFT contracts Finance lease obligations Provisions Contingencies Commitments Financial instruments Operating segments Pooled budget NHS LIFT investment Intra Government and other balances Related Party transactions Events after the reporting period Losses and special payments Third Party Assets Financial performance targets Impact of IFRS treatment Analysis of Charitable reserves 31-36 37 37 38-39 40 41 41 41 41 41 42 42 43-44 45 45 45 46 46 46 46 46 47 47 48 48 48 48 48 48 48 49 49 49 50 50 50 50 51 52 52 52 52 52 52 Glossary of financial terms 53 Contents Page 2 of 53 FOREWORD TO THE ACCOUNTS NHS Dorset Clinical Commissioning Group ACCOUNTS FOR THE YEAR ENDED 31 MARCH 2014 These accounts for the year ended 31 March 2014 have been prepared by the NHS Dorset Clinical Commissioning Group under section 17 of the National Health Service Act 2006 (as amended) in the form which the Secretary of State has, with the approval of the Treasury, directed. Forward Page 3 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 Independents Auditor's Report Page 4i to 4iii of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 Independents Auditor's Report Page 4i to 4iii of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 Independents Auditor's Report Page 4i to 4iii of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 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 Timothy Goodson to be the Chief 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, I have properly discharged the responsibilities set out in my Clinical Commissioning Group Accountable Officer Appointment Letter. Tim Goodson Chief Officer / Accountable Officer 4 June 2014 Page 5 of 53 Signing Officer Responsilbities NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 GOVERNANCE STATEMENT FOR NHS DORSET CLINICAL COMMISSIONING GROUP Governance Statement by Tim Goodson as the Chief Officer of NHS Dorset Clinical Commissioning Group. 1 Introduction 1.1 The NHS Dorset Clinical Commissioning Group (CCG) was licenced from 1 April 2013 under provisions enacted in the Health & Social Care Act 2012, which amended the NHS Act 2006. 1.2 The CCG operated in shadow form prior to 1 April 2013, to allow for the completion of the licencing process and the establishment of function, systems and processes prior to the CCG taking on its full statutory duties on 1 April 2013. 1.3 As at 1 April 2013, the CCG was licensed without conditions. 2 Scope of Responsibility 2.1 The Chief Officer has responsibility for maintaining a sound system of internal control that supports the achievement of the CCG’s policies, aims and objectives, whilst safeguarding public funds and departmental assets for which he is personally responsible, in accordance with the responsibilities assigned to him in Managing Public Money. He is also responsible for ensuring that the CCG is administered prudently and economically and that resources are applied efficiently and effectively. The Chief Officer also acknowledges his responsibilities as set out in his Clinical Commissioning Group Accountable Officer Appointment letter. 3 Compliance with the UK Corporate Governance Code 3.1 Whilst the detailed provisions of the UK Corporate Governance Code (the Code) are not mandatory for public sector bodies, compliance is considered to be good practice. The NHS Clinical Commissioning Groups Code of Governance has been created by extracting from the Code, parts relevant to CCG’s. This Governance Statement is intended to demonstrate the CCG’s compliance with the principles set out in the NHS Clinical Commissioning Group’s Code of Governance. 3.2 For the financial year ended 31 March 2014 and up to the date of signing this statement, the CCG complied with the provisions set out in the NHS Clinical Commissioning Groups Code of Governance and applied the principles of the Code except as follows: Annual Governance Statement Page 6 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 GOVERNANCE STATEMENT FOR NHS DORSET CLINICAL COMMISSIONING GROUP Principle 5: The CCG has just initiated plans to publish learning from Governanceand Statement by Tim Goodson asfollowing the Chiefrecommendations Officer of NHS Dorset Clinical responses to complaints in the Francis Group. report. This will beCommissioning implemented immediately; 1 1.1 4 Introduction Principle 6: The Governing Body has not received an annual summary of information that is available to the public. This will be addressed The NHS Clinical Commissioning Group May (CCG) was licenced from 1 andDorset presented at the Governing Body’s meeting. April 2013 under provisions enacted in the Health & Social Care Act 2012, which amended the NHSFramework Act 2006. The CCG Governance 1.2 4.1. TheNational CCG operated shadowAct form prior( as to 1amended) April 2013,attoparagraph allow for the The HealthinService 2006 14L(2)(b) completion of the licencing process and the establishment of states: the main function of the governing body is to ensure function, the group has systems and processes prior to the takingit on its full statutory duties on 1 made appropriate arrangements forCCG ensuring complies with such generally April 2013. accepted principles of good governance as are relevant to it. 1.3 4.2 As at 1 April the CCGorganisation was licensedcomprising without conditions. The CCG is a2013, membership of 100 GP practices throughout Dorset. Scope of Responsibility 2 4.3 2.1 4.4 4.5 3 3.1 4.6 The CCG Governing Body is committed to providing the resources and The Chief Officernecessary has responsibility for maintaining a sound system of internal support systems to support the Risk Management Framework and control that supports the achievement of the CCG’s policies, aims and will ensure that action is taken to address all risks that are identified and objectives,aswhilst safeguarding public funds and departmental assets for assessed unacceptable. which he is personally responsible, in accordance with the responsibilities assigned him in Managing Public the Money. He is also responsible for The CCG to Governing Body reviews Assurance Framework/Corporate Risk ensuringas that the CCG administered prudentlythe and economically and that Register a whole; sixismonthly, and through Audit and Quality resources are applied efficiently andFramework/Corporate effectively. The Chief Officer also Committee, reviews the Assurance Risk Register as a acknowledges his responsibilities as set out in his Clinical Commissioning whole, every quarter. Group Accountable Officer Appointment letter. The CCG Governing Body is made up of 13 Locality Chairs who are GP’s or Compliance with theChair, UK Corporate Governance Code the Chief Finance retired GP’s, the GP the Accountable Chief Officer, Officer, two lay members, the Lead Nurse and the Lead Consultant. The CCG Whilst the detailed provisions of the UK Corporate Governance Code (the Governing Body meets bi-monthly. Code) are not mandatory for public sector bodies, compliance is considered to be good The NHS Executive Clinical Commissioning Code of There arepractice. three non-voting Directors, theGroups Director of Quality, the Governance has been created by extracting from the Code, parts relevant to Director of Service Delivery and the Director of Engagement and CCG’s. This Governance Statement is intended to demonstrate the CCG’s Development that support the CCG Chief Officer. The Governing Body is compliance principles in the NHS Clinical Commissioning supported bywith thethe Chief Officer set andout Governing Body Secretary. Group’s Code of Governance. 4.7 3.2 The first standing agenda item for CCG Governing Body meetings is to For thecompliance financial year ended 31 March 2014 and to states the date of no signing this ensure with Standing Order 3.11 (I) up that that business statement, the CCG complied with the provisions set out in the NHS Clinical shall be transacted at a meeting unless at least 1/3 of the whole number of Commissioning Groups Code Governance and appliedquoracy the principles of the the Chairman and members isof present. During 2013-14 has been Code except maintained forasallfollows: CCG Governing Body meetings. 4.8 The CCG Governing Body has three committees that report to it. These are the Remuneration Committee, Clinical Commissioning Committee and the Audit and Quality Committee. Annual Governance Statement Page 7 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 GOVERNANCE STATEMENT FOR NHS DORSET CLINICAL COMMISSIONING GROUP Audit and Quality Committee Governance Statement by Tim Goodson as the Chief Officer of NHS Dorset Clinical 4.9 The Audit and Quality Committee is the committee which has delegated Commissioning Group. responsibility from the CCG Governing Body for the monitoring and oversight of risk and governance. 1 Introduction 4.10 1.1 1.2 4.11 1.3 2 2.1 4.12 4.13 3 3.1 4.14 3.2 The and Quality monitors and provides overall assurance to The Audit NHS Dorset ClinicalCommittee Commissioning Group (CCG) was licenced from 1 the Governing Body that the CCG is delivering quality care that meets the April 2013 under provisions enacted in the Health & Social Care Act 2012, standards laid out statute and that the CCG is aligning strategic direction which amended thein NHS Act 2006. with local assurance mechanisms by monitoring the Assurance Framework/Corporate Risk Register ontobehalf the Governing Body. As part The CCG operated in shadow form prior 1 Aprilof 2013, to allow for the of this committee’s remit the Audit and Quality Committee will review internal completion of the licencing process and the establishment of function, audit reports on the systems place risk management. systems and processes prior tointhe CCGfor taking on its full statutory duties on 1 April 2013. The Audit and Quality Committee membership consists of two lay members from Governing Body whom one is the Chair of the committee, two nonAs atthe 1 April 2013, the CCGofwas licensed without conditions. Governing Body lay members, one GP Governing Body member and the Lead Nurse Governing Body member. The Director of Quality and the Chief Scope of Responsibility Finance Officer also attend the meetings and support the committee. The Chief Officer has responsibility for maintaining a sound system of internal The Audit Quality meet quarterly. During aims 2013-14 control thatand supports theCommittee achievement of the CCG’s policies, and quoracy has been maintained for all Audit and Quality meetings objectives, whilst safeguarding public funds and departmental assets for which he is personally responsible, in accordance with the responsibilities The Quality Group is a working group reporting to the Audit andforQuality assigned to him in Managing Public Money. He is also responsible Committee. The Quality Group has delegated responsibility for and the that ensuring that the CCG is administered prudently and economically management, monitoring and reporting of clinical governance, governance, resources are applied efficiently and effectively. The Chief Officer also risk, patient safety and quality. There a in Quality Framework in place which acknowledges his responsibilities as set is out his Clinical Commissioning details the structures and processes to ensure quality is embedded Group Accountable Officer Appointment letter. throughout the commissioning cycle. Compliance with the UK Corporate Governance Code Clinical Commissioning Committee Whilst the detailed provisions of the UK Corporate Governance Code (the The Clinical Committee supportcompliance the Governing Body with Code) are notCommissioning mandatory for public sector bodies, is considered to delivery of clinical effectiveness and governance through: be good practice. The NHS Clinical Commissioning Groups Code of Governance has been created by extracting from the Code, parts relevant to CCG’s.support of the Audit and Quality Committee in discharging the CCG’s This Governance Statement is intended to demonstrate the CCG’s responsibility for clinical governance for commissioned services compliance with the principles set out in the NHS Clinical Commissioning including monitoring and enforcement of National Service Group’s Code of the Governance. Frameworks, National Institute of Clinical Excellence guidance and Quality standards or up other agreed standards; For theCare financial yearCommission ended 31 March 2014 and to the date of signing this statement, the CCG complied with the provisions set out in the NHS Clinical Commissioning providingGroups clinical Code oversight to contractand management on specific Clinical of Governance applied the principles of the Commissioning Code except as follows: Programme areas; providing clinical scrutiny of service quality, effectiveness and safety and advising the Governing Body; providing clinical assessment of commissioning outcomes; Annual Governance Statement Page 8 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 GOVERNANCE STATEMENT FOR NHS DORSET CLINICAL COMMISSIONING GROUP 4.15 The Clinical Commissioning Committee also support communication with partners and stakeholders through: Governance Statement by Tim Goodson as the Chief Officer of NHS Dorset Clinical Commissioning Group. supporting and promoting effective partnership working, including joint planning and commissioning, with other NHS organisations, local 1 Introduction authorities and the voluntary and independent sectors; 1.1 1.2 1.3 4.16 2 2.1 4.17 4.18 3 3.1 3.2 Dorset Clinical Group (CCG) was through licenced CCPs; from 1 The NHS encouraging andCommissioning facilitating locality engagement April 2013 under provisions enacted in the Health & Social Care Act 2012, NHS Act 2006. perspective, conflict with providers of which amended resolving,the through a clinical service; The CCG operated in shadow form prior to 1 April 2013, to allow for the of the licencing process and the establishment of function, completion maintaining effective communications and engagement with front-line systems and processes prior to the CCG taking on its full statutory duties on 1 healthcare professionals. April 2013. Remuneration Committee As at 1 April 2013, the CCG was licensed without conditions. The Remuneration Committee is constituted as a standing committee of the Scope of Responsibility CCG Governing Body. The Committee is a non-executive committee and has no executive powers other than those specifically delegated in these Terms of The Chief Officer has responsibility for maintaining a sound system of internal Reference. control that supports the achievement of the CCG’s policies, aims and objectives, whilst safeguarding and departmental for The Remuneration Committeepublic shallfunds comprise of the Chair,assets the Deputy Chair, which he isofpersonally accordanceand withtwo the other responsibilities the Chair the Audit responsible, and Quality in Committee, individuals who assigned to him Managing Public Money. He is also responsible for are members ofinthe Governing Body. ensuring that the CCG is administered prudently and economically and that resources are applied efficiently and effectively. The Chief Officer also The Remuneration Committee shall: acknowledges his responsibilities as set out in his Clinical Commissioning Accountable Officer Appointment letter. Group review the appraisal of the performance of the Chief Officer, directors and other appropriate members of the senior team; Compliance with the UK Corporate Governance Code recommend to the Governing Body the remuneration and terms of Whilst the detailed provisions of the UK Corporate Governance Code (the service of the Chief Officer, directors and other appropriate members of Code) are not mandatory for public sector bodies, compliance is considered to the senior team and annual salary awards; be good practice. The NHS Clinical Commissioning Groups Code of Governance has been created by extracting from the Code, parts relevant to recommend to the Governing Body special severance payments of the CCG’s. This Governance Statement is intended to demonstrate the CCG’s Chief Officer, directors and all other staff, subject to receiving HM compliance with the principles set out in the NHS Clinical Commissioning Treasury (if necessary) approval in accordance with any current Group’s Code of Governance. guidance; For the financial year ended 31 March 2014 and up to the date of signing this determine a matter where the Governing Body is unable to determine statement, the CCG complied with the provisions set out in the NHS Clinical the matter because of an inability to form a quorum and has specifically Commissioning Groups Code of Governance and applied the principles of the delegated to the committee a matter or matters to be determined by the Code except as follows: committee on behalf of the Governing Body. 4.19 determine any matter delegated to it by the Governing Body. The CCG Governing Body’s agenda covers all areas of financial accountability and governance including the following reports made to every meeting: • Chair’s report; • Chief Officers update; Annual Governance Statement Page 9 of 53 delegated to the committee a matter or matters to be determined by the committee on behalf of the Governing Body. determine any matter delegated to it by the Governing Body. NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 4.19 The CCG Governing Body’s agenda covers all areas of financial accountability and governance including theNHS following reports made to every meeting: GOVERNANCE STATEMENT FOR DORSET CLINICAL COMMISSIONING GROUP • Chair’s report; • Chief Officers Governance Statement by update; Tim Goodson as the Chief Officer of NHS Dorset Clinical Commissioning Group. • Finance and Performance reports; 1 Introduction • Board Assurance Framework and Risk Register; 1.1 The NHS Dorset Clinical Commissioning Group (CCG) was licenced from 1 under provisions enacted the in the HealthReport & Social Care Act 2012, April 2013 Quality Report incorporating Francis Recommendations. which amended the NHS Act 2006. 1.2 4.20 The CCG operated in shadow formtoprior to 1 April 2013,that to allow the received Other significant reports relating internal controls havefor been completion the licencing process and the establishment by the CCGofGoverning Body during 2013-14 include: of function, systems and processes prior to the CCG taking on its full statutory duties on 1 •April 2013. Annual update for safeguarding Adults and Children; 1.3 1 April 2013, the CCG was licensed without conditions. •As at Annual Complaints report; 2 of Responsibility •Scope Annual review of the Governance documents. 2.1 Officer has responsibility for maintaining a soundand system of internal •The Chief Standing Financial Instructions, Standing Orders scheme of control that supports achievement of the CCG’s policies, aims and delegation andthe committee structures. objectives, whilst safeguarding public funds and departmental assets for which he isand personally in accordance with responsibilities The Audit Qualityresponsible, committee agenda covers all the areas of financial assigned to himand in Managing Public Money.the He following is also responsible for to every accountability governance including reports made ensuring that the CCG is administered prudently and economically and that meeting: resources are applied efficiently and effectively. The Chief Officer also responsibilities as set out in his Clinical Commissioning acknowledges Customerhis Care report; Group Accountable Officer Appointment letter. changes to Assurance Framework/Corporate Risk Register; Compliance with the UK Corporate Governance Code investigations following instigation of the Employee Whistle Blowing WhilstPolicy; the detailed provisions of the UK Corporate Governance Code (the Code) are not mandatory for public sector bodies, compliance is considered to practice. The NHS Clinical Commissioning Groups Code be good updates on Litigation, Medical Negligence, Inquests and of enquiries; Governance has been created by extracting from the Code, parts relevant to Thisdive Governance Statement is intended to demonstrate the CCG’s CCG’s. deep on significant risk issues; compliance with the principles set out in the NHS Clinical Commissioning Code Governance. Group’s review ofofSignificant Providers Contracts report; 4.21 3 3.1 3.2 For the financial year ended 31 March 2014 and up to the date of signing this Safeguarding Adults report; statement, the CCG complied with the provisions set out in the NHS Clinical Commissioning Groups Code of Governance and applied the principles of the Safeguarding Children report; Code except as follows: Information Governance report; Dorset Medicines Advisory Group report; Internal Audit reports; Annual Governance Statement Page 10 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 GOVERNANCE STATEMENT FOR NHS DORSET CLINICAL COMMISSIONING GROUP External Audit reports; Governance Statement by reports. Tim Goodson as the Chief Officer of NHS Dorset Clinical Counter Fraud Commissioning Group. 1 Introduction 4.22 In relation to Risk Management, the Quality Group seeks to provide assurance to the Audit and Quality Committee by: 1.1 The NHS Dorset Clinical Commissioning Group (CCG) was licenced from 1 2013 under that provisions enacted in the Health & Social Care Act 2012, April confirming appropriate Risk Management arrangements are in place; which amended the NHS Act 2006. 1.2 1.3 2 2.1 4.23 5 5.1 3 3.1 5.2 3.2 5.3 monitoring all significant risks which may impact on the CCG business The planning CCG operated in shadow form prior to 1 April 2013, to allow for the process; completion of the licencing process and the establishment of function, systems and processes prior to the CCG taking on its full statutory duties on 1 ensuring action to improve risk management processes and systems, to April 2013. address all known and previously unidentified risks; As at 1 April 2013, the CCG was licensed without conditions. ensuring that patient safety is central to all services commissioned by the CCG including safeguarding of adults and children, via contract and Scope of Responsibility quality monitoring of secondary and tertiary providers; The Chief Officer has responsibility for maintaining a sound system of internal monitoring the CCG Assurance Framework/Corporate Risk Register. control that supports the achievement of the CCG’s policies, aims and objectives, whilst safeguarding public funds and departmental assets for The CCG Governing Body has arrangements in place via its Governance which he is personally responsible, in accordance with the its responsibilities Framework and structures to ensure that it discharges statutory functions assigned to him in Managing Public Money. He is also responsible forThe and the Chief Officer can confirm that they are legally compliant. ensuring that the CCG is completing administeredaprudently and economically that Governing Body will be self -assessment later on and in the year. resources are applied efficiently and effectively. The Chief Officer also acknowledges his responsibilities as set out in his Clinical Commissioning The CCG Risk Management Framework Group Accountable Officer Appointment letter. The CCG is committed to minimising risks to which it is exposed, strategically Compliance with the Corporate and corporately. TheUK overriding aimGovernance is to reduceCode the potential for loss of services due to adverse events, financial management or performance and Whilst detailed provisions of the UK Corporate Code (thebe of qualitythe management of commissioned services Governance that could ultimately Code) are not mandatory for public sector bodies, compliance is considered to detriment to the population the CCG serves. be good practice. The NHS Clinical Commissioning Groups Code of Governance has been created by extracting from the parts relevant In order to achieve this aim, risk management hasCode, become part of theto culture CCG’s. This Governance Statement is intended to demonstrate the CCG’s of the organisation, and become a primary concern of all staff and compliance withThe the principles set out in the NHS Clinical Commissioning stakeholders. Risk Management Strategy was approved and endorsed Group’s Code of Governance. by the Governing Body in December 2012 ready for use in April 2013 to reflect the CCG’s risk management requirements. For the financial year ended 31 March 2014 and up to the date of signing this statement, the CCG complied with the provisions set out in the NHS Clinical The Risk Management Strategy: Commissioning Groups Code of Governance and applied the principles of the Code except as follows: sets out the organisation’s objective to identify, treat and mitigate risk; defines the role and objectives of the CCG’s committees and groups. It describes the supporting strategies, policies and procedures that determine the management and ownership of risk and the management of situations in which control failure leads to material realisation of risks; Annual Governance Statement Page 11 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 GOVERNANCE STATEMENT FOR NHS DORSET CLINICAL COMMISSIONING GROUP specifies the way in which risk issues are to be considered at each level of planning, ranging from the corporate objectives setNHS out Dorset in the CCG’s Governance Statement by Tim Goodson as the Chief Officer of Clinical Delivery Plan to theCommissioning individual objectives within Directorates; Group. 1 1.1 1.2 1.3 2 5.4 2.1 5.5 3 5.6 3.1 5.7 3.2 specifies risk assessment and identification processes for new and Introduction existing activities and the resultant risk action plans and how these are within the Corporate RiskGroup Register for the The captured NHS Dorset Clinical Commissioning (CCG) wasorganisation; licenced from 1 April 2013 under provisions enacted in the Health & Social Care Act 2012, standardises and clarifies the terminology of risk management and which amended the NHS Act 2006. establishes clear, consistent and effective risk scoring systems; The CCG operated in shadow form prior to 1 April 2013, to allow for the explains Frameworks assesses of the risk and the impact completion of the the Assurance licencing process and the and establishment function, of failure, identifiesprior the control mechanisms these objectives systems and processes to the CCG taking on to its monitor full statutory duties on 1 and clarifies the assurances that are present to review and monitor the April 2013. implementation of objectives; As at 1 April 2013, the CCG was licensed without conditions. explains the risk scoring system that enables the organisation to impartially assess risk and identify high risk areas. Scope of Responsibility The Chief CCG Officer identifies requirements for completing equality impact hasthe responsibility for maintaining a sound system of internal assessments when commissioning services, changes to services, control that supports the achievement of the CCG’s policies, aims and use of information withinsafeguarding services and within the and policies that are used. objectives, whilst public funds departmental assets for which he is personally responsible, in accordance with the responsibilities assigned to him in Managing Public Money. He is also responsible for Incident reporting is openly ensuring and that Serious the CCGIncident is administered prudently andencouraged economicallyfrom and its thatstaff, GP practices the provider organisations that itThe commissions. resources and are applied efficiently and effectively. Chief OfficerThis also information is analysed and used to identify risks which may impact on the business of the acknowledges his responsibilities as set out in his Clinical Commissioning CCG. Group Accountable Officer Appointment letter. Compliance with the UK Corporate Governance Code The Quality Group and the Audit and Quality Committee have patient representatives as that attend the meetings regularly to ensure there is a voice Whilst the detailed provisions of the UK Corporate Governance Code (the for patients and public. They are integral to scrutinising the risks identified and Code) are not mandatory for public sector bodies, compliance is considered to understanding what actions are taken to mitigate and reduce these risks. be good practice. The NHS Clinical Commissioning Groups Code of Governance created by extracting from of theitsCode, parts relevant to The CCG is has ablebeen to assure itself of the validity Annual Governance CCG’s. This Governance Statement is intended to demonstrate the CCG’s Statement in a number of ways. These are: compliance with the principles set out in the NHS Clinical Commissioning Group’s Code of Governance. adherence to the Risk Management Strategy; For the financial year ended 31 March 2014 and up to the date of signing this the CCG complied withand thereporting provisionsmechanisms set out in thein NHS Clinical statement, the governance framework place for Commissioning Groups Code of Governance and applied the principles of the provision of assurance; Code except as follows: scrutiny of the draft Governance Statement by members of the Audit and Quality Committee prior to submission and sign off at the special meeting for closure of finances in June 2014; Annual Governance Statement Page 12 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 GOVERNANCE STATEMENT FOR NHS DORSET CLINICAL COMMISSIONING GROUP 5.8 The cumulative contribution of the above mechanisms assists in the assurance of commissioning services that ensure patient safety is high profile. Governance Statement by Tim Goodson as the Chief Officer of NHS Dorset Clinical Commissioning Group. 6 The CCG Internal Control Framework 1 6.1 1.1 1.2 6.2 6.3 1.3 2 7 2.1 7.1 7.2 3 3.1 7.3 7.4 3.2 Introduction A system of internal control is the set of processes and procedures in place in a clinical commissioning group to ensure that it delivers it policies, aims and The NHS Dorset Clinical Commissioning (CCG) licenced from 1the objectives. It is designed to identify andGroup prioritise thewas risks, to evaluate April 2013 of under provisions enacted in the Health & Socialshould Care Act 2012, likelihood those risks being realised and the impact they be realised which amended the NHS Act 2006. and to manage them efficiently, effectively and economically. The CCG operated in shadow priorrisk to 1toApril 2013, to allow the The system of internal controlform allows be managed to a for reasonable level completion the licencing andtherefore the establishment of function, rather than of eliminating all process risk; it can only provide reasonable and not systems and processes prior to the CCG taking on its full statutory duties on 1 absolute assurance of effectiveness. April 2013. The Assurance Framework/Corporate Risk Register has controls described for every entry. are reviewed on aconditions. monthly basis along with As at 1risk April 2013,The the controls CCG was licensed without progress for reducing risk to ensure they are still effective. Scope of Responsibility Information Governance The Chief Officer has responsibility for maintaining a sound system of internal The CCG particular importance on CCG’s risks for data security and to this control thatplaces supports the achievement of the policies, aims and end there iswhilst an Information Governance which meets quarterly. objectives, safeguarding public fundsGroup and departmental assets for This group manages risks pertaining to data security as part of its remit. This group which he is personally responsible, in accordance with the responsibilities reports quarterly the AuditPublic and Quality assigned to him into Managing Money. Committee. He is also responsible for ensuring that the CCG is administered prudently and economically and that The NHS Information Governance FrameworkThe sets the Officer processes resources are applied efficiently and effectively. Chief also and procedures byhis which the NHS handles information about patients and acknowledges responsibilities as set out in his Clinical Commissioning employees, in particular personal identifiable information. The NHS Group Accountable Officer Appointment letter. Information Governance Framework is supported by an information governance and the annual submission process Compliance toolkit with the UK Corporate Governance Code provides assurances to the clinical commissioning group, other organisations and to individuals that personal is dealtof with securely, efficientlyCode and effectively. Whilst theinformation detailed provisions thelegally, UK Corporate Governance (the Code) are not mandatory for public sector bodies, compliance is considered to be good practice. The NHS Clinical Commissioning Groups Code of The CCG has completed the Information Toolkit is to an Governance has been created by extractingGovernance from the Code, parts which relevant annual requirement and has achieved level 2 in all standards of the toolkit. CCG’s. This Governance Statement is intended to demonstrate the CCG’s compliance with the principles set out in the NHS Clinical Commissioning Group’s Code of Governance. The CCG has ensured all staff under take annual information governance training face to face have implemented a staff governance For the financial year and ended 31 March 2014 and up to information the date of signing this handbook staff arewith aware the information roles and statement, to theensure CCG complied the of provisions set out ingovernance the NHS Clinical responsibilities. Commissioning Groups Code of Governance and applied the principles of the Code except as follows: 7.5 There are processes in place for incident reporting and investigation of serious incidents pertaining to information governance. Annual Governance Statement Page 13 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 GOVERNANCE STATEMENT FOR NHS DORSET CLINICAL COMMISSIONING GROUP 8 Pension Obligations Governance by Tim Goodson Chief Officer NHS Dorset Clinical 8.1 As an Statement employer with staff entitledas tothe membership ofof the NHS Pension Commissioning Group. Scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with. This includes 1 Introduction ensuring that deductions from salary, employer’s contributions and payments into the Scheme are in accordance with the Scheme rules, and that member 1.1 The NHS Scheme Dorset Clinical Commissioning Group (CCG) licenced from 1 Pension records are accurately updated in was accordance with the April 2013 under provisions enacted in the Health & Social Care Act 2012, timescales detailed in the regulations. which amended the NHS Act 2006. 9 Equality Diversity and Human Rights Obligations 1.2 The CCG operated in shadow form prior to 1 April 2013, to allow for the of the licencing process the that establishment function,with the 9.1 completion Control measures are in place to and ensure the CCG of complies systems and processes prior to the CCG taking on its full statutory duties on 1 required public sector equality duty set out in the Equality Act 2010. April 2013. 10 Sustainable Development Obligations 1.3 As at 1 April 2013, the CCG was licensed without conditions. 10.1 The CCG is required to report its progress in delivering against sustainable 2 Scope of Responsibility development indicators. 2.1 10.2 10.3 3 11 3.1 11.1 11.2 3.2 11.3 The has responsibility maintaining sound system of internal and The Chief CCG Officer are developing plans tofor assess risks, a enhance our performance control the achievement of the CCG’s aims andadaption reducethat our supports impact against carbon reduction and policies, climate change objectives, safeguarding public funds and departmental assets for and objectives.whilst This includes establishing mechanisms to embed social which he is personally responsible, in accordance with the responsibilities environmental sustainability across policy development, business planning assigned to him in Managing Public Money. He is also responsible for and in commissioning. ensuring that the CCG is administered prudently and economically and that resources and effectively. The Chief Officer The CCG are will applied ensureefficiently that it complies with its obligations underalso the Climate acknowledges his responsibilities as set out Reporting in his Clinical Commissioning Change Act 2008 including the Adaption power and the Public Group Accountable OfficerAct Appointment Services (Social Value) 2012. We letter. are also setting out our commitments as a socially responsible employer. Compliance with the UK Corporate Governance Code Risk Assessment in Relation to Governance, Risk Management and Whilst theControl detailed provisions of the UK Corporate Governance Code (the Internal Code) are not mandatory for public sector bodies, compliance is considered to be good practice. TheaNHS Clinical of Commissioning Groups The CCG operates declaration Interest register andCode this isofchecked Governance has been created by extracting the Code, relevant to regularly and potential conflicts of interestfrom are taken in toparts account in all CCG’s. Governance Statement is intended to demonstrate the CCG’s aspectsThis of the CCG’s business. compliance with the principles set out in the NHS Clinical Commissioning The CCG operates a Governing Body Assurance Framework/Corporate Risk Group’s Code of Governance. Register which identifies the systems of internal control in place to efficiently, effectively, and year economically these assurance For the financial ended 31 manage March 2014 andrisks up toand the provide date of signing this to the CCG and the organisation’s these systems are present. statement, the CCG complied with stakeholders the provisions that set out in the NHS Clinical Commissioning Groups Code of Governance and applied the principles of the All risks identified in the Assurance Framework/Corporate Risk Register Code except as follows: require the formulation of an action plan. A member of the Patient Safety Team meets with risk leads on a monthly basis to record progress against action plans and documents the effect these are having on the residual risk score. All action plans are formally reported via the Board Assurance Framework/Risk Register. The document includes all risks that may impact on the achievement of the Corporate Objectives. Annual Governance Statement Page 14 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 GOVERNANCE STATEMENT FOR NHS DORSET CLINICAL COMMISSIONING GROUP 11.4 The Governing Body receives regular assurance on the management of internal risks and assurance both directly via six monthly reports including the Governance Statement by Tim GoodsonFramework/Corporate as the Chief Officer of NHS Clinical full Governing Body Assurance Risk Dorset Register and via Commissioning Group. assurance from the Audit and Quality Committee. 1 Introduction 11.5 The Audit and Quality Committee reviews the full Governing Body Assurance Framework/Corporate Risk Register on a quarterly basis. 1.1 The NHS Dorset Clinical Commissioning Group (CCG) was licenced from 1 April 2013 under enacted in the basis Healthby & Directors Social Care Act 2012, the 11.6 Reports are alsoprovisions received on a monthly summarising which amended the NHS Act 2006. top risks to the organisation (those scoring over twelve), new risks, closed risk and any key risk issues. Directors also review the full Governing Body Framework/Corporate Risk to Register everytoquarter. 1.2 Assurance The CCG operated in shadow form prior 1 April 2013, allow for the completion of the licencing process and the establishment of function, 11.7 There have 29 new risks identified for 2013/2014. These duties are ason follows: systems andbeen processes prior to the CCG taking on its full statutory 1 April 2013. 3 related to concerns regarding providers which Monitor and CQC have investigated; 1.3 As at 1 April 2013, the CCG was licensed without conditions. 2 of Responsibility Scope 8 related to contracts and procurement; 2.1 Officer has responsibility for maintaining a sound system of internal The2Chief related to finance being identified or adjusted; control that supports the achievement of the CCG’s policies, aims and whilst safeguarding public funds and departmental assets for objectives, 2 for staff training related to induction; which he is personally responsible, in accordance with the responsibilities to him Managing Money. He is also responsible for assigned 2 related to in targets and Public objectives; ensuring that the CCG is administered prudently and economically and that are to applied efficiently and effectively. The Chief Officer also resources 2 related performance; acknowledges his responsibilities as set out in his Clinical Commissioning Accountable Officer Appointment letter.of the CCG remit; Group 3 related to clarity of functions outside 3 the UK Corporate Compliance 3 related with to Business Continuity;Governance Code 3.1 the detailed Whilst 4 related to IT.provisions of the UK Corporate Governance Code (the Code) are not mandatory for public sector bodies, compliance is considered to be good practice. Therisks NHSrelated ClinicaltoCommissioning Code of it was set up Many of the in year the start of theGroups CCG to ensure Governance has been created by extracting from the Code, parts relevant to be able to operate effectively and fulfil its new functions. These riskstohave CCG’s. This Governance Statement is intended to demonstrate the CCG’s been mitigated over the year and are all now closed. compliance with the principles set out in the NHS Clinical Commissioning Group’s Code of Governance. The outstanding risks that are in place on 31 March 2014 will be carried over in to the new financial year and will continue to be managed within the For the financial year ended March 2014 and up to the date of signing this framework described within31 this statement. statement, the CCG complied with the provisions set out in the NHS Clinical Commissioning Groups Code of Governance and applied the principles of the Code except as follows:Efficiency and Effectiveness of the Use of Review of Economy, resources 11.8 11.9 3.2 12. 12.1 There are procurement processes which the CCG adheres to. There is a scheme of delegation which ensures that financial controls are in place across the organisation. An audit programme is followed to ensure that resources are used economically, efficiently and effectively. Annual Governance Statement Page 15 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 GOVERNANCE STATEMENT FOR NHS DORSET CLINICAL COMMISSIONING GROUP 13. Governance, Risk Management and Internal Control Governance Statement Tim Goodson as the Chief Officer ofthe NHS Dorset Clinical 13.1 The Chief Officerby has the responsibility for reviewing effectiveness of the Commissioning Group. system of internal control within the CCG. 1 14. Introduction Capacity to handle risk 1.1 14.1 The NHS Dorset Clinical for Commissioning Group (CCG) was licenced from 1 via Leadership is provided the risk management process within the CCG AprilGoverning 2013 underBody. provisions enacted in the Health & Social Care established Act 2012, in the The organisational structure has been which to amended the NHS Act 2006.and is described in the following paragraphs. order assist with this process 1.2 14.2 operated in shadow form nominated prior to 1 April to allow for the The CCG Director of Quality has been as 2013, the lead Director for Risk completion of the licencing process establishment of function, Management activity falling withinand the the remit of the CCG. systems and processes prior to the CCG taking on its full statutory duties on 1 April 2013. are responsible for compliance with the Risk Management All Directors Strategy to ensure that remedial actions are identified and taken wherever As atrisks 1 April the CCG wastheir licensed conditions. key are2013, identified within area without of responsibility. 14.3 1.3 2 14.4 2.1 14.5 3 3.1 14.6 15 3.2 15.1 Scope of Responsibility All Deputy Directors, managers and staff are responsible for compliance with the Risk Management Strategy for ensuring that remedial actions are The Chief and Officer has wherever responsibility maintaining a sound system ofarea internal identified taken keyfor risks are identified within their of control that supports the achievement of the CCG’s policies, aims and responsibility. objectives, whilst safeguarding public funds and departmental assets for whichPatient he is personally responsible, in accordance with the the consistent responsibilities The Safety Team within the CCG supports identification assigned to him inand Managing Public Money. is also responsible for and is and assessment management of riskHe across the organisation ensuringtothat CCG is administered prudently The and economically and that central thethe dissemination of best practice. Team administer the key resources act are as applied efficiently and effectively. Thefunction, Chief Officer alsoupon and systems, a central resource and advisory advise acknowledges his responsibilities as programmes set out in his Clinical Commissioning deliver key training and education to ensure staff learn through Grouppractice, Accountable Officer Appointment good ensure compliance withletter. policies, procedures and management of risk and support lead officers, groups and committees in undertaking the Compliance with the UK Corporate Governance Code requirements of their roles. Whilst the detailed provisions of the UK Corporate Governance (the The Head of Patient Safety supported by the Patient SafetyCode and Risk Code) are not mandatory for public sector bodies, compliance is considered to Manager has been appointed to monitor risk management and patient safety be good practice. The NHS Clinical Commissioning Groups Code of involves within commissioned and corporate services for the CCG, which Governance has been by and extracting from the Code, parts relevant to engagement with the created Directors Directorate risk leads to maintain the CCG’s. This Governance Statement is intended to demonstrate the CCG’s CCG’s Assurance Framework/Corporate Risk Register. compliance with the principles set out in the NHS Clinical Commissioning Group’s Code of Governance. Review of Effectiveness For the financial year ended 31 March 2014 and up to the date of signing this The review of the effectiveness of the system of internal control is informed by statement, complied withand the provisions set out in the NHS Clinical the work ofthe theCCG internal auditors the executive managers and clinical Commissioning Code of Governance andfor applied the principlesand of the leads within theGroups CCG who have responsibility the development Code except as maintenance offollows: the internal control framework. The Chief Officer has drawn on performance information available to him. His review is also informed by comments made by the external auditors in their management letter and other reports. Annual Governance Statement Page 16 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 GOVERNANCE STATEMENT FOR NHS DORSET CLINICAL COMMISSIONING GROUP 15.2 The Board Assurance Framework itself provides the Chief Officer with the evidence that the effectiveness of controls that manage risks to the CCG Governance Statement by Tim Goodsonhave as thebeen Chiefreviewed. Officer of NHS Dorset Clinical achieving its principal objectives Commissioning Group. 15.3 The Chief Officer has been advised on the implications of the result of his 1 Introduction review of the effectiveness of the systems of internal control including the Governing Body, the Audit and Quality Committee, Quality Group and 1.1 Information The NHS Dorset Clinical Commissioning Group (CCG) was licenced from Governance Group and a plan to address weaknesses and1 ensure April 2013 under provisionsofenacted in theisHealth & Social Care Act 2012, continuous improvement the system in place. which amended the NHS Act 2006. 15.4 Executive Directors within the CCG who have responsibility for the 1.2 development The CCG operated in shadow form to 1 April to allow forprovide the and maintenance of prior the system of 2013, internal control the completion of with the licencing process and the establishment of function, Chief Officer assurance. systems and processes prior to the CCG taking on its full statutory duties on 1 AprilGoverning 2013. 15.5 The Body Assurance Framework/Corporate Risk Register itself provides the Chief Officer with evidence that the effectiveness of controls that 1.3 manage As at 1 April thethe CCG was licensed without its conditions. the 2013, risks to organisation achieving principal objectives have been reviewed. 2 Scope of Responsibility 15.6 The Head of Internal Audit provides the Audit and Quality Committee with an 2.1 annual The Chief Officer has responsibility for maintaining sound system of internal report detailing the audit coverage for theayear and assessment of the control thatofsupports the achievement the CCG’s aims and significant adequacy the control environmentofthrough her policies, annual statement: objectives, whilst publicisfunds and system departmental assets for assurance can besafeguarding given that there a sound of internal control, which he istopersonally in accordance with the designed meet the responsible, organisation’s objectives, and thatresponsibilities controls are generally assigned to him in Managing Public Money. He is also responsible for being applied consistently. ensuring that the CCG is administered prudently and economically and that resources completion are applied efficiently and effectively. The Officer also 15.7 Following of the planned audit work forChief the financial year for the acknowledges his responsibilities as set out in his Clinical Commissioning CCG, the Head of Internal Audit issued an independent and objective opinion Group Officer Appointment letter. on the Accountable adequacy and effectiveness of the CCG’s system of risk management, governance and internal control. The Head of Internal Audit concluded that: 3 Compliance with the UK Corporate Governance Code Significant assurance can be given that there is a generally sound system 3.1 Whilstofthe detailed provisions of theto UK Corporate Governance Code (the and internal control, designed meet the organisation’s objectives, Code)that arecontrols not mandatory for public sector bodies, compliance is considered to are generally being applied consistently. However, some be good practice.inThe Clinical Commissioning Groups Code weakness theNHS design and/or inconsistent application ofof controls put the Governance has been created by extracting from the Code, parts relevant to achievement of particular objectives at risk. CCG’s. This Governance Statement is intended to demonstrate the CCG’s compliance with the principles set out in the NHS Clinical Commissioning Group’sthe Code of the Governance. 15.8 During year Internal Audit issued the following audit reports with a conclusion of limited assurance: 3.2 For the financial year ended 31 March 2014 and up to the date of signing this statement, the CCG complied with the provisions set out inHealthcare the NHS Clinical Contract Monitoring Arrangements for Continuing and Section Commissioning Groups Code of Governance and applied the principles of the 117 Providers. A follow up audit in this area during April 2014 confirmed Codethat except as progress follows: is being made on implementing the agreed actions good arising from the internal audit in September 2013. The key findings related to contract monitoring, contract conditions and inter-agency communications for joint contracts for the provision of care with the Local Authorities. PC Environment. A review took place in July 2013 which identified the existence of sensitive information on some office computer hard-drives. Annual Governance Statement Page 17 of 53 A follow up audit during March 2014 confirmed that there has been good progress in implementing agreed actions from the initial review. NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 GOVERNANCE STATEMENT FOR NHS DORSET CLINICAL COMMISSIONING GROUP PC Environment. A review took place in July 2013 which identified the existence of sensitive information on some office computer hard-drives. A Statement follow up audit March 2014 confirmed there hasClinical been good Governance by Timduring Goodson as the Chief Officer ofthat NHS Dorset progress in implementing agreed actions from the initial review. Commissioning Group. However, an additional high priority finding was identified which is being addressed with an associated action plan. 1 Introduction 1.1 1.2 15.9 The NHS Clinical Commissioning Programmes. number recommendations Dorset Clinical Commissioning GroupA(CCG) wasoflicenced from 1 with associated action plans have been agreed for implementation to April 2013 under provisions enacted in the Health & Social Care Act 2012, the whichaddress amended thefindings. NHS Act These 2006. included the systems and processes around project management, declaration of interest and links with other areas in the organisation in respect reporting and engagement The CCG operated in shadow form prior to 1ofApril 2013, to allow for the completion of the licencing process and the establishment of function, During year Internalprior Audit not issue a conclusion systemsthe and processes to did the CCG takingany on audit its fullreports statutorywith duties on 1 of no assurance. April 2013. 16 1.3 Data As at Quality 1 April 2013, the CCG was licensed without conditions. 16.1 2 The data by the Governing Body is obtained from various sources of Scope of used Responsibility which all are national systems. The Provider data is quality assured through contract performance monitoring and against the Secondary The Chiefand Officer has responsibility for maintaining a sound system of Uses internal Service (SUS) quality dashboard. control that supports the achievement of the CCG’s policies, aims and objectives, whilst safeguarding public funds and departmental assets for Business Models which he isCritical personally responsible, in accordance with the responsibilities assigned to him in Managing Public Money. He is also responsible for The Chiefthat Officer confirms that thereprudently is an appropriate framework ensuring the CCG is administered and economically andand that environment in place to provide quality assurance of business critical models, resources are applied efficiently and effectively. The Chief Officer also in line with the recommendations from the MacPherson report. acknowledges his responsibilities as set out in his Clinical Commissioning Group Accountable Officer Appointment letter. The Chief Officer confirms that all business critical models have been identified and that the information about quality assurance processes for Compliance with the UK Corporate Governance Code those models is currently being worked through. Once this has been completed, it will be shared with all partners including the area team within Whilst the detailed provisions of the UK Corporate Governance Code (the NHS England. Code) are not mandatory for public sector bodies, compliance is considered to be good practice. The NHS Clinical Commissioning Groups Code of Data Security Governance has been created by extracting from the Code, parts relevant to CCG’s. This Governance is intended to demonstrate the CCG’s The CCG has completedStatement the Information Governance Toolkit which is an compliance with the principles set out in the NHS Clinical Commissioning annual requirement and has achieved level 2 in all standards of the toolkit. Group’s Code of Governance. This is considered a satisfactory level of compliance 2.1 17 17.1 17.2 3 3.1 18 18.1 3.2 18.2 For thewere financial year ended 31 March 2014 to and up to the date of2013-2014 signing this that There no Serious Incidents relating data security for statement, the CCG complied with the provisions set out in the NHS Clinical required reporting to the Information Commissioner. Commissioning Groups Code of Governance and applied the principles of the Code except as follows: 19 Discharge of Statutory Functions 19.1 The Chief Officer confirms that correct arrangements are in place for the discharge of statutory functions, have been checked for any irregularities and that they are legally compliant in line with the recommendations in the Harris Review. Annual Governance Statement Page 18 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 GOVERNANCE STATEMENT FOR NHS DORSET CLINICAL COMMISSIONING GROUP 19.2 During establishment, the arrangements put in place by the CCG and Governance Statement GoodsonGovernance as the Chief Framework Officer of NHS Dorset Clinical with explained within by theTim Corporate were developed Commissioning Group. extensive expert external legal input, to ensure compliance with all the relevant legislation. The legal advice also informed the matters reserved for 1 Introduction the Governing Body and the scheme of delegation. 1.1 19.3 The NHS Clinical Commissioning Group (CCG) was licenced from 1 duties In light of Dorset the Harris Review, the CCG has reviewed all of the statutory April the 2013 under provisions Health & SocialService Care ActAct 2012, and powers conferred enacted on it by in thethe National Health 2006 (as which amended the NHS Act 2006. amended) and other associated legislative and regulations. As a result, the Chief Officer can confirm that the CCG is clear about the legislative 1.2 The CCG operated in shadow prior to 1 statutory April 2013, to allow for requirements associated withform each of the functions for the which it is completion of the licencing process and the establishment of function, responsible, including any restrictions on delegation of those functions. systems and processes prior to the CCG taking on its full statutory duties on 1 April 2013. 19.4 Responsibility for each duty and power has been clearly allocated to a lead director. Directorates have confirmed that their structures provide the 1.3 As at 1 Aprilcapability 2013, the and CCGcapacity was licensed without conditions. necessary to undertake all of the CCG’s statutory duties. 2 Scope of Responsibility 20 Conclusion 2.1 The Chief Officer has responsibility for maintaining a sound system of internal that supports achievement of the CCG’sissues policies, aims and identified. 20.1 Icontrol can confirm that nothe significant internal control have been objectives, whilst safeguarding public funds and departmental assets for which he is personally responsible, in accordance with the responsibilities assigned to him in Managing Public Money. He is also responsible for ensuring that the CCG is administered prudently and economically and that resources are applied efficiently and effectively. The Chief Officer also acknowledges his responsibilities as set out in his Clinical Commissioning Group Accountable Officer Appointment letter. Tim Goodson Chief Officer / Accountable Officer with the UK Corporate Governance Code 43June Compliance 2014 3.1 Whilst the detailed provisions of the UK Corporate Governance Code (the Code) are not mandatory for public sector bodies, compliance is considered to be good practice. The NHS Clinical Commissioning Groups Code of Governance has been created by extracting from the Code, parts relevant to CCG’s. This Governance Statement is intended to demonstrate the CCG’s compliance with the principles set out in the NHS Clinical Commissioning Group’s Code of Governance. 3.2 For the financial year ended 31 March 2014 and up to the date of signing this statement, the CCG complied with the provisions set out in the NHS Clinical Commissioning Groups Code of Governance and applied the principles of the Code except as follows: Annual Governance Statement Page 19 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 Head of Internal Audit Opionion Page 20 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 Head of Internal Audit Opionion Page 21 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 Head of Internal Audit Opionion Page 22 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 Head of Internal Audit Opionion Page 23 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 Head of Internal Audit Opionion Page 24 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 THE PRIMARY STATEMENTS Statement of Comprehensive Net Expenditure Statement of Financial Position Statement of Changes in Taxpayers' Equity Statement of Cash Flows Primary Statements Page 25 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 Statement of Comprehensive Net Expenditure for year ended 31 March 2014 NOTE 2013-14 Admin £000 2013-14 Programme £000 2013-14 Total £000 Commissioning Other operating revenue Gross employee benefits Other Costs Net operating costs before financing 2 4 5 (40) 10,682 6,087 16,730 (5,632) 2,814 920,571 917,753 (5,672) 13,496 926,659 934,483 Financing Investment revenue Other (gains) & losses Finance costs Net operating costs for the financial year 8 9 10 0 0 0 16,730 0 0 0 917,753 0 0 0 934,483 16,730 917,753 0 934,483 £000 0 0 0 0 0 0 0 0 £000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16,730 0 917,753 0 934,483 Net Gain (Loss) on transfer by absorption Retained Net Operating Costs for the Financial Year 11 Other Comprehensive Net Expenditure Impairments & reversals Net gain (loss) on revaluation of property, plant & equipment Net gain (loss) on revaluation of intangibles Net gain (loss) on revaluation of financial assets Movements in other reserves Net gain (loss) on available for sale financial assets Net gain (loss) on assets held for sale Re-measurement of the defined benefit liability Reclassification Adjustments: On disposal of available for sale financial assets Total comprehensive net expenditure for the financial year The notes on pages 31 to 52 form part of this statement. NHS Dorset Clinical Commissioning Group became a Clinical Commissioning Group (CCG) on the 1 April 2013 and because of this, there are no prior year comparators. The CCG will be required to show prior year comparators in future years. This also applies to the notes associated with the statement. The purpose of this statement is to summarise, on an accruals basis, the net operating costs of the CCG. The statement identifies gross operating costs, less miscellaneous income, to arrive at the net operating costs of the CCG. SOCNE Page 26 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 Statement of Financial Position at 31 March 2014 31 March 2014 NOTE £000 Non-current assets Property, plant and equipment Intangible assets Investment property Trade and other receivables Other financial assets Total non-current assets 13 14 15 17 18 0 0 0 0 0 0 Current assets Inventories Trade & other receivables Other financial assets Other current assets Cash & cash equivalents Total current assets 16 17 18 19 20 576 7,279 0 0 5 7,860 21 0 7,860 7,860 23 25 26 27 30 (42,242) 0 0 0 (2,567) (44,809) (36,949) 23 25 26 27 30 0 0 0 0 (956) (956) (37,905) Non-current assets held for sale Total current assets Total assets Current liabilities Trade & other payables Other financial liabilities Other liabilities Borrowings Provisions Total current liabilities Total Assets Less Current Liabilities Non-current liabilities Trade and other payables Other financial liabilities Other liabilities Borrowings Provisions Total non-current liabilities Total Assets Employed Financed by taxpayers' equity General fund Revaluation reserve Other reserves Charitable Reserves Total taxpayers' equity (37,905) 0 0 0 (37,905) The notes on pages 31 to 52 form part of this statement. NHS Dorset Clinical Commissioning Group became a Clinical Commissioning Group (CCG) on the 1 April 2013 and because of this, there are no prior year comparators. The CCG will be required to show prior year comparators in future years. This also applies to the notes associated with the statement. The financial statements on pages 26 to 29 were approved by the Governing Body on 4 June 2014 and signed on its behalf by: Chief Officer / Accountable Officer 4 June 2014 SOFP Page 27 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 Statement of Changes In Taxpayers Equity for the year ended 31 March 2014 General fund Revaluation reserve Other reserves Total £000 £000 £000 £000 0 0 0 0 865 0 0 865 0 865 0 0 0 0 0 865 (934,483) 0 0 (934,483) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (933,618) 0 0 0 0 0 0 0 0 0 0 0 (933,618) 895,713 (37,905) 0 0 895,713 (37,905) CCG Balance at 1 April 2013 Transfer of assets and liabilities from closed NHS bodies as a result of the 1 April 2013 transition Transfer between reserves in respect of assets transferred from closed NHS bodies Adjusted CCG Balance at 1 April 2013 Changes in taxpayers’ equity for 2013-14 Net operating costs for the financial year Net gain (loss) on revaluation of property, plant and equipment Net gain (loss) on revaluation of intangible assets Net gain (loss) on revaluation of financial assets Net gain (loss) on revaluation of assets held for sale Impairments and reversals Movements in other reserves Transfers between reserves Release of reserves to the Statement of Comprehensive Net Expenditure Reclassification adjustment on disposal of available for sale financial assets Transfers by absorption to (from) other bodies Transfer between reserves in respect of assets transferred under absorption Reserves eliminated on dissolution Re-measurement of the defined benefit liability Net Recognised CCG Expenditure for the Financial Year Net funding CCG Balance at 31 March 2014 Changes in an entity's equity between the beginning and the end of the reporting period reflect the increase or decrease in its net assets during the period. The Statement has been interpreted to include figures for net operating costs for the year and funding for the year. NHS Dorset Clinical Commissioning Group became a Clinical Commissioning Group (CCG) on the 1 April 2013 and because of this, there are no prior year comparators. The CCG will be required to show prior year comparators in future years. SOCITE Page 28 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 Statement of Cash Flows for the year ended 31 March 2014 NOTE Cash Flows from Operating Activities Net operating expenses for the financial year Depreciation and amortisation Impairments and reversals Other gains (losses) on foreign exchange Donated assets received credited to revenue but non-cash Government granted assets received credited to revenue but non-cash Interest paid Release of PFI deferred credit (Increase) decrease in inventories (Increase) decrease in trade & other receivables (Increase) decrease in other current assets Increase (decrease) in trade & other payables Increase (decrease) in other current liabilities Provisions utilised Increase (decrease) in provisions Net Cash Inflow (Outflow) from Operating Activities 2&5 13 16 17 23 30 Cash flows from Investing Activities Interest received (Payments) for property, plant and equipment (Payments) for intangible assets (Payments) for investments with the Department of Health (Payments) for other financial assets (Payments) for financial assets (LIFT) Proceeds from disposal of assets held for sale: property, plant and equipment Proceeds from disposal of assets held for sale: intangible assets Proceeds from disposal of investments with the Department of Health Proceeds from Disposal of other financial assets Proceeds from the disposal of financial assets (LIFT) Loans made in respect of LIFT Loans repaid in respect of LIFT Rental revenue Net Cash Inflow (Outflow) from Investing Activities Net cash inflow (outflow) before Financing 2013-14 £000 (934,483) 0 575 0 0 0 0 0 (286) (7,279) 0 42,242 0 0 3,523 (895,708) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (895,708) Cash flows from Financing Activities Net funding received Other loans received Other loans repaid Capital element of payments in respect of finance leases and on Statement of Financial Position PFI and LIFT Capital grants and other capital receipts Capital receipts surrender Net Cash Inflow (Outflow) from Financing Activities 895,713 0 0 0 0 0 895,713 Net increase (decrease) in cash & cash equivalents 5 Cash & Cash Equivalents at the Beginning of the Financial Year Effect of exchange rate changes in the balance of cash held in foreign currencies Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year 0 0 5 20 Dorset Clinical Commissioning Group became a Clinical Commissioning Group (CCG) on the 1 April 2013 and because of this, there are no prior year comparators. The CCG will be required to show prior year comparators in future years. This also applies to the note associated with this statement. The Statement of Cash Flows provides information on CCG liquidity, viability and financial adaptability. SCF Page 29 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 NOTES TO THE ACCOUNTS The notes to the accounts provide additional details on the entries on the primary statements as well as additional disclosures, such as the accounting policies that the organisation follows when preparing its accounts. Cover Notes Page 30 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 1 ACCOUNTING POLICIES NHS England has directed that the financial statements of clinical commissioning groups shall meet the accounting requirements of the Manual for Accounts issued by the Department of Health. Consequently, the following financial statements have been prepared in accordance with the Manual for Accounts 2013-14 issued by the Department of Health. The accounting policies contained in the Manual for Accounts follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to clinical commissioning groups, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Manual for Accounts permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the clinical commissioning group for the purpose of giving a true and fair view has been selected. The particular policies adopted by the clinical commissioning group are described below. They have been applied consistently in dealing with items considered material in relation to the accounts. The accounting arrangements for balances transferred from predecessor PCTs ("legacy" balances) are determined by the Accounts Direction issued by NHS England on 12 February 2014. The Accounts Directions state that the only legacy balances to be accounted for by the CCG are in respect of property, plant and equipment (and related liabilities) and inventories. All other legacy balances in respect of assets or liabilities arising from transactions or delivery of care prior to 31 March 2013 are accounted for by NHS England. The impact of the legacy balances accounted for by the CCG is disclosed in note 11 to these financial statements. The CCG's arrangements in respect of settling NHS Continuing Healthcare claims are disclosed in note 30, Provisions, to these financial statements. 1.1 Going Concern These accounts have been prepared on the going concern basis. Public sector bodies are assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as evidenced by inclusion of financial provision for that service in published documents. Where a clinical commissioning group ceases to exist, it considers whether or not its services will continue to be provided (using the same assets, by another public sector entity) in determining whether to use the concept of going concern for the final set of Financial Statements. If services will continue to be provided the financial statements are prepared on the going concern basis. 1.2 Accounting Convention These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities. 1.3 Acquisitions & Discontinued Operations Activities are considered to be ‘acquired’ only if they are taken on from outside the public sector. Activities are considered to be ‘discontinued’ only if they cease entirely. They are not considered to be ‘discontinued’ if they transfer from one public sector body to another. 1.4 Movement of Assets within Department of Health Group Transfers as part of reorganisation are required to be accounted for by use of absorption accounting in line with the Government Financial Reporting Manual, issued by HM Treasury. The Government Financial Reporting Manual does not require retrospective adoption, so prior year transactions (which have been accounted for under merger accounting) have not been restated. Absorption accounting requires that entities account for their transactions in the period in which they took place, with no restatement of performance required when functions transfer within the public sector. Where assets and liabilities transfer, the gain or loss resulting is recognised in the Statement of Comprehensive Net Expenditure, and is disclosed separately from operating costs. Other transfers of assets and liabilities within the Department of Health Group are accounted for in line with IAS 20 and similarly give rise to income and expenditure entries. For transfers of assets and liabilities from those NHS bodies that closed on 1 April 2013, HM Treasury has agreed that a modified absorption approach should be applied. For these transactions only, gains and losses are recognised in reserves rather than the Statement of Comprehensive Net Expenditure. 1.5 Charitable Funds The clinical commissioning group has no Charitable Funds. 1.6 Pooled Budgets Where the clinical commissioning group has entered into a pooled budget arrangement under Section 75 of the NHS Act 2006 the clinical commissioning group accounts for its share of the assets, liabilities, income and expenditure arising from the activities of the pooled budget, identified in accordance with the pooled budget agreement. If the clinical commissioning group is in a “jointly controlled operation”, the clinical commissioning group recognises: • The assets the clinical commissioning group controls; • The liabilities the clinical commissioning group incurs; • The expenses the clinical commissioning group incurs; and, • The clinical commissioning group’s share of the income from the pooled budget activities. If the clinical commissioning group is involved in a “jointly controlled assets” arrangement, in addition to the above, the clinical commissioning group recognises: • The clinical commissioning group’s share of the jointly controlled assets (classified according to the nature of the assets); • The clinical commissioning group’s share of any liabilities incurred jointly; and, • The clinical commissioning group’s share of the expenses jointly incurred. Note 1 Page 31 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 1.7 Critical Accounting Judgements & Key Sources of Estimation Uncertainty In the application of the clinical commissioning group’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods. 1.7.1 Critical Judgements in Applying Accounting Policies No critical judgements with a significant effect on the amounts recognised on the financial statements were required. 1.7.2 Key Sources of Estimation Uncertainty Key estimations that management has made in the process of applying the clinical commissioning group’s accounting policies are detailed within the relevant disclosure notes to these financial statements, most notably Note 30 Provisions. 1.8 Revenue Revenue in respect of services provided is recognised when, and to the extent that, performance occurs, and is measured at the fair value of the consideration receivable. Where income is received for a specific activity that is to be delivered in the following year, that income is deferred. 1.9 Employee Benefits 1.9.1 Short-term Employee Benefits Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees, including bonuses earned but not yet taken. The cost of leave earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry forward leave into the following period. The clinical commissioning group allows a maximum of five days to be carried forward, and only in exceptional circumstances. 1.9.2 Retirement Benefit Costs Past and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the clinical commissioning group of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period. For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to expenditure at the time the clinical commissioning group commits itself to the retirement, regardless of the method of payment. 1.10 Other Expenses Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable. 1.11 Property, Plant & Equipment 1.11.1 Recognition Property, plant and equipment is capitalised if: • It is held for use in delivering services or for administrative purposes; • It is probable that future economic benefits will flow to, or service potential will be supplied to the clinical commissioning group; • It is expected to be used for more than one financial year; • The cost of the item can be measured reliably; and, • The item has a cost of at least £5,000; or, • Collectively, a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or, • Items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or collective cost. Where a large asset, for example a building, includes a number of components with significantly different asset lives, the components are treated as separate assets and depreciated over their own useful economic lives. 1.11.2 Valuation All property, plant and equipment are measured initially at cost, representing the cost directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. All assets are measured subsequently at fair value. Land and buildings used for the clinical commissioning group’s services or for administrative purposes are stated in the statement of financial position at their re-valued amounts, being the fair value at the date of revaluation less any impairment. Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that would be determined at the end of the reporting period. Fair values are determined as follows: • Land and non-specialised buildings – market value for existing use; and, • Specialised buildings – depreciated replacement cost. Note 1 Page 32 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 HM Treasury has adopted a standard approach to depreciated replacement cost valuations based on modern equivalent assets and, where it would meet the location requirements of the service being provided, an alternative site can be valued. Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost includes professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for assets held at fair value. Assets are re-valued and depreciation commences when they are brought into use. Fixtures and equipment are carried at depreciated historic cost as this is not considered to be materially different from fair value. An increase arising on revaluation is taken to the revaluation reserve except when it reverses an impairment for the same asset previously recognised in expenditure, in which case it is credited to expenditure to the extent of the decrease previously charged there. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Gains and losses recognised in the revaluation reserve are reported as other comprehensive income in the Statement of Comprehensive Net Expenditure. 1.11.3 Subsequent Expenditure Where subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised. Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing carrying value of the item replaced is written-out and charged to operating expenses. 1.12 Intangible Assets 1.12.1 Recognition Intangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the clinical commissioning group’s business or which arise from contractual or other legal rights. They are recognised only: • When it is probable that future economic benefits will flow to, or service potential be provided to, the clinical commissioning group; • Where the cost of the asset can be measured reliably; and, • Where the cost is at least £5,000. Intangible assets acquired separately are initially recognised at fair value. Software that is integral to the operating of hardware, for example an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software that is not integral to the operation of hardware, for example application software, is capitalised as an intangible asset. Expenditure on research is not capitalised but is recognised as an operating expense in the period in which it is incurred. Internally-generated assets are recognised if, and only if, all of the following have been demonstrated: • The technical feasibility of completing the intangible asset so that it will be available for use; • The intention to complete the intangible asset and use it; • The ability to sell or use the intangible asset; • How the intangible asset will generate probable future economic benefits or service potential; • The availability of adequate technical, financial and other resources to complete the intangible asset and sell or use it; and, • The ability to measure reliably the expenditure attributable to the intangible asset during its development. 1.12.2 Measurement The amount initially recognised for internally-generated intangible assets is the sum of the expenditure incurred from the date when the criteria above are initially met. Where no internally-generated intangible asset can be recognised, the expenditure is recognised in the period in which it is incurred. Following initial recognition, intangible assets are carried at fair value by reference to an active market, or, where no active market exists, at amortised replacement cost (modern equivalent assets basis), indexed for relevant price increases, as a proxy for fair value. Internally-developed software is held at historic cost to reflect the opposing effects of increases in development costs and technological advances. 1.13 Depreciation, Amortisation & Impairments Freehold land, properties under construction, and assets held for sale are not depreciated. Otherwise, depreciation and amortisation are charged to write off the costs or valuation of property, plant and equipment and intangible non-current assets, less any residual value, over their estimated useful lives, in a manner that reflects the consumption of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over which the clinical commissioning group expects to obtain economic benefits or service potential from the asset. This is specific to the clinical commissioning group and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are depreciated over their estimated useful lives. At each reporting period end, the clinical commissioning group checks whether there is any indication that any of its tangible or intangible non-current assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its amount. Intangible assets not yet available for use are tested for impairment annually. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Where an impairment loss subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the recoverable amount but capped at the amount that would have been determined had there been no initial impairment loss. The reversal of the impairment loss is credited to expenditure to the extent of the decrease previously charged there and thereafter to the revaluation reserve. Note 1 Page 33 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 1.14 Donated Assets Donated non-current assets are capitalised at their fair value on receipt, with a matching credit to Income. They are valued, depreciated and impaired as described above for purchased assets. Gains and losses on revaluations, impairments and sales are as described above for purchased assets. Deferred income is recognised only where conditions attached to the donation preclude immediate recognition of the gain. 1.15 Government Grants The value of assets received by means of a government grant are credited directly to income. Deferred income is recognised only where conditions attached to the grant preclude immediate recognition of the gain. 1.16 Non Current Assets Held for Sale Non-current assets are classified as held for sale if their carrying amount will be recovered principally through a sale transaction rather than through continuing use. This condition is regarded as met when: • The sale is highly probable; • The asset is available for immediate sale in its present condition; and, • Management is committed to the sale, which is expected to qualify for recognition as a completed sale within one year from the date of classification. Non-current assets held for sale are measured at the lower of their previous carrying amount and fair value less costs to sell. Fair value is open market value including alternative uses. The profit or loss arising on disposal of an asset is the difference between the sale proceeds and the carrying amount and is recognised in the Statement of Comprehensive Net Expenditure. On disposal, the balance for the asset on the revaluation reserve is transferred to the general reserve. Property, plant and equipment that is to be scrapped or demolished does not qualify for recognition as held for sale. Instead, it is retained as an operational asset and its economic life is adjusted. The asset is de-recognised when it is scrapped or demolished. 1.17 Leases Leases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All other leases are classified as operating leases. 1.17.1 The Clinical Commissioning Group as Lessee Property, plant and equipment held under finance leases are initially recognised, at the inception of the lease, at fair value or, if lower, at the present value of the minimum lease payments, with a matching liability for the lease obligation to the lessor. Lease payments are apportioned between finance charges and reduction of the lease obligation so as to achieve a constant rate on interest on the remaining balance of the liability. Finance charges are recognised in calculating the clinical commissioning group’s surplus/deficit. Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term. Contingent rentals are recognised as an expense in the period in which they are incurred. Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether they are operating or finance leases. 1.17.2 The Clinical Commissioning Group as Lessor Amounts due from lessees under finance leases are recorded as receivables at the amount of the clinical commissioning group’s net investment in the leases. Finance lease income is allocated to accounting periods so as to reflect a constant periodic rate of return on the clinical commissioning group’s net investment outstanding in respect of the leases. Rental income from operating leases is recognised on a straight-line basis over the term of the lease. Initial direct costs incurred in negotiating and arranging an operating lease are added to the carrying amount of the leased asset and recognised on a straightline basis over the lease term. 1.18 Private Finance Initiative Transactions The clinical commissioning group has no PFI schemes. 1.19 Inventories Inventories are valued at the lower of cost and net realisable value using the first-in first-out cost formula. This is considered to be a reasonable approximation to fair value due to the high turnover of stocks. 1.20 Cash & Cash Equivalents Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value. In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the clinical commissioning group’s cash management. 1.21 Provisions Provisions are recognised when the clinical commissioning group has a present legal or constructive obligation as a result of a past event, it is probable that the clinical commissioning group will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties. Where a provision is measured using the cash flows estimated to settle the obligation, its carrying amount is the present value of those cash flows using HM Treasury’s discount rate as follows: • Timing of cash flows (0 to 5 years inclusive): Minus 1.9% • Timing of cash flows (6 to 10 years inclusive): Minus 0.65% • Timing of cash flows (over 10 years): Plus 2.2% Note 1 Page 34 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 • All employee early departures: 1.8% When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the receivable is recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the receivable can be measured reliably. A restructuring provision is recognised when the clinical commissioning group has developed a detailed formal plan for the restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by starting to implement the plan or announcing its main features to those affected by it. The measurement of a restructuring provision includes only the direct expenditures arising from the restructuring, which are those amounts that are both necessarily entailed by the restructuring and not associated with on-going activities of the entity. 1.22 Clinical Negligence Costs The NHS Litigation Authority operates a risk pooling scheme under which the clinical commissioning group pays an annual contribution to the NHS Litigation Authority which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although the NHS Litigation Authority is administratively responsible for all clinical negligence cases the legal liability remains with the clinical commissioning group. 1.23 Non-clinical Risk Pooling The clinical commissioning group participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the clinical commissioning group pays an annual contribution to the NHS Litigation Authority and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due. 1.24 Carbon Reduction Commitment Scheme The clinical commissioning group is not party to a Carbon Reduction Scheme. 1.25 Contingencies A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the clinical commissioning group, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or the amount of the obligation cannot be measured sufficiently reliably. A contingent liability is disclosed unless the possibility of a payment is remote. A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the clinical commissioning group. A contingent asset is disclosed where an inflow of economic benefits is probable. Where the time value of money is material, contingencies are disclosed at their present value. 1.26 Financial Assets Financial assets are recognised when the clinical commissioning group becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred. Financial assets are classified into the following categories: • Financial assets at fair value through profit and loss; • Held to maturity investments; • Available for sale financial assets; and, • Loans and receivables. The classification depends on the nature and purpose of the financial assets and is determined at the time of initial recognition. 1.26.1 Financial Assets at Fair Value Through Profit and Loss The clinical commissioning group holds no Financial Assets with embedded derivatives. 1.26.2 Held to Maturity Assets The clinical commissioning group holds no Held to Maturity Assets. 1.26.3 Available for Sale Financial Assets The clinical commissioning group holds no Available for Sale Financial Assets. 1.26.4 Loans & Receivables The clinical commissioning group holds no Loans and Receivables. 1.27 Financial Liabilities Financial liabilities are recognised on the statement of financial position when the clinical commissioning group becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired. Loans from the Department of Health are recognised at historical cost. Otherwise, financial liabilities are initially recognised at fair value. 1.27.1 Financial Guarantee Contract Liabilities Financial guarantee contract liabilities are subsequently measured at the higher of: • The premium received (or imputed) for entering into the guarantee less cumulative amortisation; and, • The amount of the obligation under the contract, as determined in accordance with IAS 37: Provisions, Contingent Liabilities and Contingent Assets. 1.27.2 Financial Liabilities at Fair Value Through Profit and Loss The clinical commissioning group holds no Financial Liabilities with embedded derivatives. Note 1 Page 35 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 1.27.3 Other Financial Liabilities After initial recognition, all other financial liabilities are measured at amortised cost using the effective interest method, except for loans from Department of Health, which are carried at historic cost. The effective interest rate is the rate that exactly discounts estimated future cash payments through the life of the asset, to the net carrying amount of the financial liability. Interest is recognised using the effective interest method. 1.28 Value Added Tax Most of the activities of the clinical commissioning group are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT. 1.29 Foreign Currencies The clinical commissioning group’s functional currency and presentational currency is sterling. Transactions denominated in a foreign currency are translated into sterling at the exchange rate ruling on the dates of the transactions. At the end of the reporting period, monetary items denominated in foreign currencies are retranslated at the spot exchange rate on 31 March. Resulting exchange gains and losses for either of these are recognised in the clinical commissioning group’s surplus/deficit in the period in which they arise. 1.30 Third Party Assets Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the clinical commissioning group has no beneficial interest in them. 1.31 Losses & Special Payments Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled. Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had the clinical commissioning group not been bearing its own risks (with insurance premiums then being included as normal revenue expenditure). 1.32 Subsidiaries The clinical commissioning group has no Subsidiaries. 1.33 Associates The clinical commissioning group has no Associates, where it has the power to influence decisions. 1.34 Joint Ventures The clinical commissioning group is not party to any Joint Ventures. 1.35 Joint Operations The clinical commissioning group is not party to any Joint Operations. 1.36 Research & Development The clinical commissioning group does not undertake any Research and Development. 1.37 Accounting Standards that have been Issued but have not yet been Adopted The Government Financial Reporting Manual does not require the following Standards and Interpretations to be applied in 201314, all of which are subject to consultation: • IAS 27: Separate Financial Statements • IAS 28: Investments in Associates & Joint Ventures • IAS 32: Financial Instruments – Presentation (amendment) • IFRS 9: Financial Instruments • IFRS 10: Consolidated Financial Statements • IFRS 11: Joint Arrangements • IFRS 12: Disclosure of Interests in Other Entities • IFRS 13: Fair Value Measurement The application of the Standards as revised would not have a material impact on the accounts for 2013-14, were they applied in that year. Note 1 Page 36 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 2. Miscellaneous Revenue Recoveries in respect of employee benefits Patient transport services Prescription fees and charges Dental fees and charges Education, training and research Charitable and other contributions to expenditure: NHS Charitable and other contributions to expenditure: non-NHS Receipt of donations for capital acquisitions: NHS Charity Receipt of government grants for capital acquisitions Non-patient care services to other bodies Income generation Rental revenue from finance leases Rental revenue from operating leases Other revenue Total Admin Programme 2013-14 Total £000 £000 £000 0 0 0 0 (19) 0 0 0 0 (1) 0 0 0 (20) (40) 0 0 0 0 (175) 0 0 0 0 (5,413) 0 0 0 (44) (5,632) 0 0 0 0 (194) 0 0 0 0 (5,414) 0 0 0 (64) (5,672) This note discloses the income that relates directly to the operating activities of the CCG. It excludes cash received from NHS England by the CCG, which is credited directly to the General Fund. 3. Revenue 2013-14 Total £000 From rendering of services From sale of goods Total (5,672) 0 (5,672) Revenue received is totally from the supply of services. The clinical commissioning group receives no revenue from the sale of goods. Note 2-3 Page 37 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 4. Employee Benefits and Staff Numbers 4.1 Employee Benefits Salaries and wages Social security costs Employer contributions to the NHS Pension Scheme Termination benefits Gross CCG employee benefits expenditure Less: Recoveries in respect of employee benefits (note 4.1.2) Net CCG employee benefits expenditure including capitalised costs Less: Employee costs capitalised Net CCG employee benefits expenditure excluding capitalised costs 4.1.2 Recoveries in respect of employee benefits Salaries and wages Total CCG recoveries in respect of employee benefits 2013-14 Permanently employed £000 9,689 854 1,235 11 11,788 0 11,788 Other £000 1,707 0 0 0 1,707 0 1,707 Total £000 11,396 854 1,235 11 13,496 0 13,496 11,788 1,707 13,496 0 0 0 0 0 0 9,689 854 1,235 11 11,788 0 11,788 1,707 0 0 0 1,707 0 1,707 11,396 854 1,235 11 13,496 0 13,496 4.1.3 Net employee benefits expenditure Salaries and wages Social security costs Employer contributions to the NHS Pension Scheme Termination benefits Net CCG employee benefits expenditure including capitalised costs Less: Employee costs capitalised Net CCG employee benefits expenditure excluding capitalised costs The average salary is approximately £38,000 excluding on costs. The clinical commissioning groups average costs are higher than other NHS Bodies due to the higher skill mix required in delivering its core functions. Permanently employed staff are directly employed by the CCG and include those on outward secondment or on loan to other organisations (although the recovery of the cost of these staff is netted off). Other staff relates to those on inward secondment, on loan from other organisations, bank, agency, temporary staff or contract staff. 4.2 Staff Numbers Average Staff Numbers Other TOTAL Of the above - staff engaged on capital projects 2013-14 Permanently employed Number 266 266 Other Number 35 35 0 Total Number 301 301 0 0 This note is analysed over the same column heading as staff costs included within Note 4.1 above. The same definitions apply. 4.3 Staff Sickness Absence and Ill Health Retirements 2013-14 Number 1,220 234 5.21 Total days lost Total average number of staff (full time equivalent) Average working days lost The above figures are provided by the Health and Social Care Information Centre (HSCIC) and must be used. Please note the HSCIC figures are for the calendar year for the 9 months to December 2013, and not for the Financial Year of 2013/14. The figures the clinical commissioning group have calculated based on the Financial Year 2013/14, are shown below. Total days lost Total average number of staff (full time equivalent) Average working days lost 2013-14 Number 2,149 266 8.08 Number of persons retired early on ill health grounds 2013-14 Number 0 £000s 0 Total additional pensions liabilities accrued in the year The first part of this note identifies the days lost due to both long term and short term sickness. The second part discloses the number and average additional pension liabilities of individuals who retired early on ill health grounds during the year (this information is supplied by NHS Pensions). 4.4 Exit packages agreed in the financial year 2013-14 Other agreed departures Compulsory redundancies Less than £10,000 Total Number 2 2 £ 11,033 11,033 Number 0 0 Total £ 0 0 Number 2 2 £ 11,033 11,033 Departures where special payments have been made Total Number 0 £ 0 4.6 Severance payments Other agreed departures Number 0 0 0 0 0 0 0 Voluntary redundancies including early retirement contractual costs Mutually agreed resignations (MARS) contractual costs Early retirements in the efficiency of the service contractual costs Contractual payments in lieu of notice Exit payments following Employment Tribunals or court orders Non-contractual payments requiring HMT approval* Total £ 0 0 0 0 0 0 0 Redundancy and other departure costs have been paid in accordance with the provisions of the NHS Scheme. Exit costs in this note are accounted for in full in the year of departure. Where the CCG has agreed early retirements, the additional costs are met by the CCG and not by the NHS pensions scheme. Ill-health retirement costs are met by the NHS pensions scheme and are not included in the table. The two individuals transferred into the CCG on old PCT contracts, which should have been reviewed as part of the close down of the PCT. The roles were critically reviewed and as such it was identified that the work they covered was being picked up by Clinicians who had been appointed into roles with the CCG. The individuals were fully consulted with and suitable opportunities for employment were explored. This disclosure reports the number and value of exit packages taken by staff leaving in the year. * As a single exit package can be made up of several components each of which will be counted separately in this table, the total number will not necessarily match the total number in the table above, which will be the number of individuals. These tables report the number and value of exit packages agreed in the financial year. The expense associated with these departures may have been recognised in part or in full in a previous period. Redundancy and other departure costs have been paid in accordance with the individuals contract of employment. Exit costs are accounted for in accordance with relevant accounting standards and, at the latest, in full in the year of departure. Note 4.1-4 & 6 Page 38 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 4. Employee Benefits and Staff Numbers 4.5 Pension Costs Past and present employees are covered by the provisions of the NHS Pension Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. The Scheme is an unfunded, defined benefit scheme that covers NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The Scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the Scheme is accounted for as if it were a defined contribution scheme: the cost to the clinical commissioning group of participating in the Scheme is taken as equal to the contributions payable to the Scheme for the accounting period. The Scheme is subject to a full actuarial valuation every four years (until 2004, every five years) and an accounting valuation every year. An outline of these follows: 4.5.1 Full actuarial (funding) valuation The purpose of this valuation is to assess the level of liability in respect of the benefits due under the Scheme (taking into account its recent demographic experience), and to recommend the contribution rates to be paid by employers and scheme members. The last such valuation, which determined current contribution rates was undertaken as at 31 March 2004 and covered the period from 1 April 1999 to that date. The conclusion from the 2004 valuation was that the Scheme had accumulated a notional deficit of £3.3 billion against the notional assets as at 31 March 2004. The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 March 2004. Consequently, a formal actuarial valuation would have been due for the year ending 31 March 2008. However, formal actuarial valuations for unfunded public service schemes were suspended by HM Treasury on value for money grounds while consideration is given to recent changes to public service pensions, and while future scheme terms are developed as part of the reforms to public service pension provision due in 2015. In order to defray the costs of benefits, employers pay contributions at 14% of pensionable pay and most employees had up to April 2008 paid 6%, with manual staff paying 5%. Following the full actuarial review by the Government Actuary undertaken as at 31 March 2004, and after consideration of changes to the NHS Pension Scheme taking effect from 1 April 2008, his Valuation report recommended that employer contributions could continue at the existing rate of 14% of pensionable pay, from 1 April 2008, following the introduction of employee contributions on a tiered scale from 5% up to 8.5% of their pensionable pay depending on total earnings. On advice from the scheme actuary, scheme contributions may be varied from time to time to reflect changes in the scheme’s liabilities. 4.5.2 Accounting valuation A valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period by updating the results of the full actuarial valuation. Between the full actuarial valuations at a two-year midpoint, a full and detailed member data-set is provided to the scheme actuary. At this point the assumptions regarding the composition of the scheme membership are updated to allow the scheme liability to be valued. The valuation of the scheme liability as at 31 March 2011 is based on detailed membership data as at 31 March 2008 (the latest midpoint) updated to 31 March 2011 with summary global member and accounting data. The latest assessment of the liabilities of the Scheme is contained in the scheme actuary report, which forms part of the annual NHS Pension Scheme (England and Wales) Resource Account, published annually. These accounts can be viewed on the NHS Pensions website. Copies can also be obtained from The Stationery Office. 4.5.3 Scheme provisions The NHS Pension Scheme provides defined benefits, which are summarised below. This list is an illustrative guide only, and is not intended to detail all the benefits provided by the Scheme or the specific conditions that must be met before these benefits can be obtained: • The Scheme is a “final salary” scheme. Annual pensions are normally based on 1/80th for the 1995 section and of the best of the last three years pensionable pay for each year of service, and 1/60th for the 2008 section of reckonable pay per year of membership. Members who are practitioners as defined by the Scheme Regulations have their annual pensions based upon total pensionable earnings over the relevant pensionable service; • With effect from 1 April 2008 members can choose to give up some of their annual pension for an additional tax free lump sum, up to a maximum amount permitted under HM Revenue & Customs rules. This new provision is known as “pension commutation”; • Annual increases are applied to pension payments at rates defined by the Pensions (Increase) Act 1971, and are based on changes in retail prices in the twelve months ending 30 September in the previous calendar year; • Early payment of a pension, with enhancement, is available to members of the Scheme who are permanently incapable of fulfilling their duties effectively through illness or infirmity. A death gratuity of twice final year’s pensionable pay for death in service, and five times their annual pension for death after retirement is payable; • For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to the statement of comprehensive net expenditure at the time the clinical commissioning group commits itself to the retirement, regardless of the method of payment; and, • Members can purchase additional service in the Scheme and contribute to money purchase AVC’s run by the Scheme’s approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers. Note 4.5 Page 39 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 5. Operating Expenses Gross Employee Benefits Employee benefits excluding governing body members Executive governing body members Total gross employee benefits Other Costs Services from other CCGs and NHS England Services from foundation trusts Services from other NHS trusts Services from other NHS bodies Purchase of healthcare from non-NHS bodies Chair and lay membership body and governing body members Supplies and services – clinical Supplies and services – general Consultancy services Establishment Transport Premises Impairments and reversals of receivables Inventories written down Depreciation Amortisation Impairments and reversals of property, plant and equipment Impairments and reversals of intangible assets Impairments and reversals of financial assets • Assets carried at amortised cost • Assets carried at cost • Available for sale financial assets Impairments and reversals of non-current assets held for sale Impairments and reversals of investment properties Audit fees Other auditor’s remuneration • Internal audit services • Other services General dental services and personal dental services Prescribing costs Pharmaceutical services General opthalmic services GPMS/APMS and PCTMA Other professional fees (excluding audit) Grants to other public bodies Clinical negligence Research and development (excluding staff costs) Education and training Change in discount rate Other expenditure Total Other Costs Total Operating Expenses Admin Programme 2013-14 £000 £000 Total £000 10,387 295 10,682 2,814 0 2,814 13,201 295 13,496 167 1 4 0 281 650 0 205 11 2,605 46 1,628 0 0 0 0 0 0 748 674,739 6,147 0 119,921 0 264 303 0 1,083 2 2,632 0 0 0 0 575 0 915 674,740 6,151 0 120,202 650 264 508 11 3,688 48 4,259 0 0 0 0 575 0 0 0 0 0 0 122 0 0 0 0 0 0 0 0 0 0 0 122 76 0 0 0 0 0 0 85 0 18 0 144 0 46 6,087 16,770 0 0 0 107,928 0 574 5,273 211 71 0 20 35 0 44 920,571 923,385 76 0 0 107,928 0 574 5,273 296 71 18 20 179 0 90 926,659 940,155 Premises - The costs of premises is high in 2013/14 due to additional charges received from NHS Property Services following national guidance from NHS England, these costs will reduce in future years. GPMS/APMS and PCTMA - The costs are for enhanced services which deliver a range of primary care based enhanced services locally. Note 5 Page 40 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 6. Better Payment Practice Code 6.1 Measure of Compliance 2013-14 Number 2013-14 £000 Non-NHS Payables Total Non-NHS trade invoices paid in the year Total Non-NHS trade invoices paid within target Percentage of Non-NHS trade invoices paid within target 27,290 26,441 96.89% 130,783 129,063 98.68% NHS Payables Total NHS trade invoices paid in the year Total NHS trade invoices paid within target Percentage of NHS trade invoices paid within target 3,601 3,534 98.14% 682,215 688,789 100.96% The 100.96% is caused by a large credit note, if the credit note could be removed from the figures, the percentage of NHS Invoices paid within target would fall to 99.7%. This note shows the CCG's performance against its administrative duty to pay all creditors within 30 calendar days of receipt of goods or valid invoice, whichever is later, unless other payment terms have been agreed. There is a performance target of 95% for each measure. 6.2 The Late Payment of Commercial Debts (Interest) Act 1998 2013-14 £000 Amounts included in finance costs from claims made under this legislation Compensation paid to cover debt recovery costs under this legislation Total 0 0 0 This note relates to the prompt payment code legislation which allows entities to claim interest from other entities on debts incurred under contracts. 7. Income Generation Activities The clinical commissioning group does not undertake any Income Generation Activities. 8. Investment Income The clinical commissioning group does not have any Investment Income. This note discloses the interest earned on investments. 9. Other Gains and Losses The clinical commissioning group does not have any Other Gains and Losses. The total in this note equals the amounted figure (charged)/ credited to the Statement of Comprehensive Net Expenditure. 10. Finance Costs 2013-14 Total £000 0 0 Other finance costs Total Finance Costs This note identifies the CCGs interest costs, including the unwinding of discounts on provisions, and corresponds with the amount shown on the Statement of Comprehensive Net Expenditure. Note 6-10 Page 41 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 11. Net Gain (Loss) on Transfer by Absorption The clinical commissioning group does not have any Net Gains or Losses on Transfer by Absorption. 12. Operating Leases The clinical commissioning group currently is lessee in respect of property leases and equipment rental. The most significant rents are for Trust Headquarters and related buildings across the county. The clinical commissioning group does not have any contractual option to buy these properties. 12.1 CCG as Lessee Payments recognised as an Expense Minimum lease payments Contingent rents Sub-lease payments Total Payable: No later than one year Between one and five years After five years Total Land £000 Buildings £000 Other £000 2013-14 Total £000 0 0 0 0 3,179 0 0 3,179 0 0 0 0 3,179 0 0 3,179 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 The clinical commissioning group occupies property owned and managed by NHS Property Services Ltd. For 2013-14, a transitional occupancy rent based on annual property costs allocations was agreed. While our arrangements with NHS Property Services Ltd fall within the definition of operating leases, the rental charge for future years has not been agreed. Consequently, this note does not include future minimum lease payments for these arrangements. This note identifies the amount included in operating expenses in respect of operating lease agreements. It also highlights the amounts the CCG is liable for under non-cancellable leases over the next five years. All operating leases relating to items with a purchase cost above the capitalisation limit are regarded as non-cancellable. 12.2 CCG as Lessor This relates to sub leases, mainly to healthcare contractors, with medium term leases. The clinical commissioning group does not act as a lessor. This note identifies the amount included in operating expenses in respect of operating lease agreements. It also highlights the amounts the CCG expects to receive under non-cancellable leases over the next five years. All operating leases relating to items with a purchase cost above the capitalisation limit are regarded as non-cancellable. Note 11-12 Page 42 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 13. Property, Plant and Equipment Information technology £000 0 Total 575 575 575 575 575 575 0 (575) (575) 0 0 (575) (575) 0 Purchased Donated Government Granted CCG Total at 31 March 2014 0 0 0 0 0 0 0 0 Asset financing: Owned Held on finance lease On-Statement of Financial Position private finance initiative & LIFT contracts Private finance initiative residual interests CCG Total at 31 March 2014 0 0 0 0 0 0 0 0 0 0 2013-14 CCG Cost or Valuation at 1 April 2013 Transfer of assets from closed NHS bodies as a result of the 1 April 2013 transition Adjusted CCG Cost or Valuation at 1 April 2013 CCG Cost or Valuation at 31 March 2014 CCG Depreciation at 1 April 2013 Impairments charged to operating expenses CCG Depreciation at 31 March 2014 CCG Net Book Value at 31 March 2014 £000 0 At the 1 April 2013, NHS Dorset CCG received a transfer of Information Technology Assets from NHS Dorset PCT for the assets held in the PCT's HQ and other offices. Once these assets were transferred, a decision was taken to impair the assets due to their age/obsolescence. Revaluation Reserve Balance for Property, Plant & Equipment CCG Cost or Valuation at 1 April 2013 Transfer of assets from closed NHS bodies as a result of the 1 April 2013 transition Adjusted CCG Cost or Valuation at 1 April 2013 CCG Total at 31 March 2014 Information technology Total £000's 0 £000's 0 0 0 0 0 0 0 13.1 Additions to Assets Under Construction in 2013-14 The clinical commissioning group had no Additions to AUC as at 31 March 2014. Note 13-13.1 Page 43 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 13.2 Donated Assets The clinical commissioning group had no Donated Assets as at 31 March 2014. 13.3 Government Granted Assets The clinical commissioning group had no government Granted Assets as at 31 March 2014. 13.4 Property Revaluation The clinical commissioning group has no Land and Buildings and therefore there is no Property Revaluation. Any properties that are occupied by the CCG are either owned by Private Landlords or are recorded by the Secretary of State via NHS Property Services Ltd, for which the CCG are liable to incur a charge as part of the service agreement. 13.5 Compensation from Third Parties The clinical commissioning group had no Compensation from Third Parties as at 31 March 2014. 13.6 Write Downs to Recoverable Amount The clinical commissioning group had no Write Downs to Recoverable Amount as at 31 March 2014. 13.7 Temporarily Idle Assets The clinical commissioning group had no Temporarily Idle Assets as at 31 March 2014. 13.8 Cost or Valuation of Fully Depreciated Assets The clinical commissioning group had no Fully Depreciated Assets still in use as at 31 March 2014. 13.9 Economic Lives of Property, Plant and Equipment Minimum Life (Years) 0 0 0 0 0 0 Buildings exc Dwellings Dwellings Plant & Machinery Transport Equipment Information Technology Furniture and Fittings Maximum Life (Years) 0 0 0 0 0 0 The clinical commissioning group has no Property Plant and Equipment that is depreciating in the financial year 2013/14. This note records the range of remaining useful economic lives of property, plant and equipment employed by the CCG. Note 13.2-13.9 Page 44 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 14. Intangible Non-Current Assets The clinical commissioning group had no Intangible Non-Current Assets as at 31 March 2014. 14.1 Donated Assets The clinical commissioning group had no Donated Assets as at 31 March 2014. 14.2 Government Granted Assets The clinical commissioning group had no Government Granted Assets as at 31 March 2014. 14.3 Revaluation As the clinical commissioning group had no Intangible Non- Current assets, no Revaluation has been considered. 14.4 Compensation from Third Parties The clinical commissioning group had no compensation from Third Parties as at 31 March 2014. 14.5 Write Downs to Recoverable Amount The clinical commissioning group had no Write Downs to Recoverable Amount as at 31 March 2014. 14.6 Non-capitalised Assets The clinical commissioning group had no Non-capitalised Assets as at 31 March 2014. 14.7 Temporarily Idle Assets The clinical commissioning group had no Temporarily Idle assets as at 31 March 2014. 14.8 Cost or Valuation of Fully Depreciated Assets The clinical commissioning group had no fully Depreciated Assets still in use as at 31 March 2014. 14.9 Economic Lives of Intangibles As the clinical commissioning group had no intangible non-current assets, no Economic Lives have been considered. 15. Investment Property The clinical commissioning group had no Investment Property as at 31 March 2014. 16. Inventories CCG Balance at 1 April 2013 Transfer of assets from closed NHS bodies as a result of the 1 April 2013 transition Restated Opening Balance Additions Inventories recognised as an expense in the period CCG Balance at 31 March 2014 Other £000 0 Total £000 0 290 290 2,650 (2,364) 576 290 290 2,650 (2,364) 576 The Inventories held by the clinical commissioning group relate to the proportion of the items held on its behalf by two Pooled Budgets. The transfer represents the closing balance held by Bournemouth and Poole PCT which on the 1st April 2013 was transferred to the CCG. Note 14-16 Page 45 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 17. Trade and Other Receivables Current Non-current 31 March 2014 £000 31 March 2014 £000 1,523 0 2,376 1,486 1,734 160 7,279 7,279 0 0 0 0 0 0 0 CCG NHS receivables: Revenue NHS receivables: Capital NHS prepayments and accrued income Non-NHS receivables: Revenue Non-NHS prepayments and accrued income VAT Total CCG Total CCG Current and Non-current Included in CCG NHS receivables are pre-paid pension contributions 0 The great majority of trade is with NHS England. As NHS England is funded by Government to buy NHS patient care services, no credit scoring of them is considered necessary. The level of trade with non-NHS organisations is immaterial and is covered by contractual terms, therefore no credit scoring of them is considered necessary. This note analyses the amounts owing to the CCG at the Statement of Financial Position date. 17.1 Receivables Past Their Due Date But Not Impaired By up to three months By three to six months By more than six months Total 31 March 2014 £000 721 25 52 798 This note analyses the length of time beyond their due date the amounts owing to the CCG at the Statement of Financial Position date have been outstanding. 17.2 Provision For Impairment of Receivables The clinical commissioning group has no Provision for the Impairment of Receivables. A provision for the impairment of receivables is where there is a risk of debt not being collected. 18. Other Financial Assets The clinical commissioning group had no Other Financial Assets as at 31 March 2014. 19. Other Current Assets The clinical commissioning group had no other Current Assets as at 31 March 2014. 20. Cash and Cash Equivalents Opening balance Net change in year Closing balance Made up of Cash with Government Banking Service Cash in hand Current investments Cash and cash equivalents as in statement of financial position Bank overdraft - Government Banking Service Cash and cash equivalents as in statement of cash flows Patients' money held by the CCG, not included above 31 March 2014 £000 0 5 5 4 1 0 5 0 5 0 21. Non-Current Assets Held for Sale The clinical commissioning group had no Non-Current Assets Held for Sale as at 31 March 2014. Notes 17-21 Page 46 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 22. Analysis of Impairments and Reversals Recognised in 2013-14 22.1 Analysis of Impairments & Reversals: Property, plant & equipment 31 March 2014 £000 Impairments and Reversals charged to SoCNE Total charged to Departmental Expenditure Limit Unforeseen Obsolescence Total charged to Annually Managed expenditure Total impairments and reversals charged to the Statement of Comprehensive Net Expenditure 0 575 575 575 Impairments and Reversals charged to the Revaluation Reserve Total Impairments and Reversals charged to the Revaluation Reserve Total Impairments and Reversals of Property, Plant & Equipment 0 575 22.2 Analysis of Impairments & Reversals: Intangible assets The clinical commissioning group had no Impairments or Reversals of Impairments recognised in expenditure during 2013-14. 22.3 Analysis of Impairments & Reversals: Investment property The clinical commissioning group had no Impairments or Reversals of Impairments recognised in expenditure during 2013-14. 22.4 Analysis of Impairments & Reversals: Inventories The clinical commissioning group had no Impairments or Reversals of Impairments Recognised in expenditure during 2013-14. 22.5 Analysis of Impairments & Reversals: Financial assets The clinical commissioning group had no Impairments or Reversals of Impairments recognised in expenditure during 2013-14. 22.6 Analysis of Impairments & Reversals: Non-current assets held for sale The clinical commissioning group had no Impairments or Reversals of Impairments recognised in expenditure during 2013-14. 22.7 Analysis of Impairments & Reversals: Totals 31 March 2014 £000 Total Impairments and Reversals charged to the Statement of Comprehensive Net Expenditure Departmental Expenditure Limit Annually Managed Expenditure Total Impairments and Reversals charged to the Statement of Comprehensive Net Expenditure Total Impairments charged to Revaluation Reserve Total Impairments 0 575 575 0 575 Of the above none related to Impairment on revaluation to “modern equivalent asset” basis. Of the above none related to Total impairments and reversals of Donated and Government Granted Assets charged to the Statement of Comprehensive Net Expenditure. 23. Trade and Other Payables Current 31 March 2014 £000 Non-current 31 March 2014 £000 CCG Interest payable NHS payables: revenue NHS accruals and deferred income Non-NHS payables: revenue Non-NHS accruals and deferred income Social security costs Tax Other payables Total CCG 0 (7,502) (2,805) (5,935) (25,074) (144) (149) (634) (42,242) 0 0 0 0 0 0 0 0 0 Total CCG Current and Non-current (42,242) The clinical commissioning group have not included any liabilities for people, due in future years under arrangements to buy out the liability for early retirement over 5 years. Other payables include £177,146.27 in respect of outstanding pensions contributions at 31 March 2014, and £400,000 of accruals for invoices registered on the finance ledger, but not approved at 1 April 2014. This note analyses the amounts owed by the CCG at the Statement of Financial Position date. Note 22-23 Page 47 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 24. Deferred Revenue The clinical commissioning group had no Deferred Revenue as at 31 March 2014. 25. Other Financial liabilities The clinical commissioning group had no Other Financial Liabilities as at 31 March 2014. 26. Other Liabilities The clinical commissioning group had no Other Liabilities as at 31 March 2014. 27. Borrowings The clinical commissioning group had no Borrowings as at 31 March 2014. 28. PFI & LIFT Contracts The clinical commissioning group had no Private Finance Initiative, LIFT or other service concession arrangements that were excluded from the Statement of Financial Position as at 31 March 2014. 29. Finance Lease Obligations The clinical commissioning group had no Finance Lease Obligations or receivables as at 31 March 2014. 30. Provisions Current 31 March 2014 £000s (2,567) 0 Non Current 31 March 2014 £000s (910) (46) Total CCG (2,567) (956) Total CCG Current and Non-current (3,523) Continuing care Other Comprising: CCG Balance at 01 April 2013 Transfer of assets from closed NHS bodies as a result of the 1 April 2013 transition Adjusted CCG Balance at 01 April 2013 Arising during the year CCG Balance at 31 March 2014 Expected Timing of Cash Flows: No Later than One Year Later than One Year and not later than Five Years CCG Balance at 31 March 2014 Continuing Care £000s 0 Other £000s 0 Total £000s 0 0 0 (3,477) (3,477) 0 0 (46) (46) 0 0 (3,523) (3,523) (2,567) (910) (3,477) 0 (46) (46) (2,567) (956) (3,523) Amount Included in the Provisions of the NHS Litigation Authority in Respect of Clinical Negligence Liabilities: £000s 0 As at 31 March 2014 Critical accounting judgments and key sources of estimation uncertainty: The provisions shown under the heading 'Other' relate to dilapidation costs associated with leases for Mey House, and the costs are uncertain. A provision has been made against applications for continuing healthcare support where a panel has not yet met to determine whether the application is approved. The provision is calculated on a named basis for the period that continuing healthcare may be eligible, at the probability rate of the application being awarded, which was 30% for Appeals and 15% for Retrospective Appeals in 2013/14. The provision is calculated at £1,657,350 for Appeals and £1,820,106 for Retrospective Appeals. Under the Accounts Direction issued by NHS England on 12 February 2014, NHS England is responsible for accounting for liabilities relating to NHS Continuing Healthcare claims relating to periods of care before establishment of the clinical commissioning group. However, the legal liability remains with the CCG. The total value of legacy NHS Continuing Healthcare provisions accounted for by NHS England on behalf of this CCG at 31 March 2014 is £12,708,000. This note analyses the amounts recorded as provisions by the CCG at the Statement of Financial Position date. Note 24-30 Page 48 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 31. Contingencies 31 March 2014 £000 Contingent liabilities Other - Continuing Healthcare Net Value of Contingent Liabilities 14,226 14,226 There are no contingent Assets The contingent liability above relates to retrospective continuing care claims, and is directly linked with the continuing care provision included in Note 30. An estimation has been made of the value based upon the amounts claimed. The uncertainties relate to the eligibility of the claims. Whilst possible, it has been deemed unlikely that these amounts will be reimbursed. It is not practicable to provide an estimate of the financial effect. This contingent liability is for the remainder of the risk of 70% for Appeals and 85% for Retrospective Appeals, for those applications not included as a provision within Note 30 to these accounts. The contingent liability is calculated at £3,912,398 for Appeals and £10,313,932 for Retrospective Appeals. The purpose of this note is to disclose material contingent liabilities or assets, if there is more than a remote possibility that there will be a transfer of ‘economic benefit’ as a result of events that existed before the Statement of Financial Position date. 32. Commitments The clinical commissioning group had no contracted capital commitments not otherwise included in these financial statements as at 31 March 2014. 33. Financial Instruments 33.1 Financial Risk Management Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities. Because the clinical commissioning group is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The clinical commissioning group has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the clinical commissioning group in undertaking its activities. Treasury management operations are carried out by the finance department, within parameters defined formally within the clinical commissioning group’s standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the clinical commissioning group’s internal auditors. Only where the CCG is exposed to material risk should the appropriate IFRS 7 disclosures be made. The headings in IFRS 7 should be used to the extent that they are relevant. 33.1.1 Currency Risk The clinical commissioning group is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The clinical commissioning group has no overseas operations. The clinical commissioning group therefore has low exposure to currency rate fluctuations. 33.1.2 Interest Rate Risk The clinical commissioning group borrows from government for capital expenditure, subject to affordability as confirmed by NHS England. The borrowings are for 1 to 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The clinical commissioning group therefore has low exposure to interest rate fluctuations. 33.1.3 Credit Risk Because the majority of the clinical commissioning group’s revenue comes parliamentary funding, the clinical commissioning group has low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables from customers, as disclosed in the trade and other receivables note. 33.1.4 Liquidity Risk The clinical commissioning group is required to operate within revenue and capital resource limits agreed with NHS England, which are financed from resources voted annually by Parliament. The clinical commissioning group draws down cash to cover expenditure, from NHS England, as the need arises, unrelated to its performance against resource limits. The clinical commissioning group is not, therefore, exposed to significant liquidity risks. 33.2 Financial Assets Receivables - NHS Receivables - non-NHS Cash at bank and in hand Total at 31 March 2014 33.3 Financial Liabilities NHS payables Non-NHS payables Other financial liabilities Total at 31 March 2014 At ‘fair value through profit and loss’ £000 0 0 0 0 Loans and receivables Total £000 1,523 1,486 5 3,014 £000 1,523 1,486 5 3,014 At ‘fair value through profit and loss’ £000 0 0 0 0 Other Total £000 (10,306) (31,009) 0 (41,315) £000 (10,306) (31,009) 0 (41,315) Due to the short-term nature of these transactions, the fair value of these financial assets and liabilities approximate the carrying amounts at the balance sheet date. Financial instruments are a broad range of assets and liabilities that arise from contracts and result in a financial asset being created in one entity and a financial liability in another. This note discloses the interest rate risks arising from the CCG's financial assets and liabilities, which largely comprise items due after more than one year, such as long-term debtors and creditors, and provisions made under contract. Note 31-33 Page 49 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 34. Operating Segments The clinical commissioning group has only one operating segment, that of commissioning healthcare services for the population of Dorset. An operating segment is a component of an entity: * that engages in business activities from which it may earn revenues and incur expenses; * whose operating results are regularly reviewed by the entity's chief operating decision maker to make decisions about resources to be allocated to the segment and assess its performance; and * for which discrete financial information is available. 35. Pooled Budget The clinical commissioning group has entered into two pooled budget arrangements, hosted by Dorset County Council and Bournemouth Borough Council. Under the arrangement, funds are pooled under Section 75 of the National Health Service Act 2006 for the provision of Bournemouth and Poole's Integrated Community Equipment Service and Dorset IESD. The arrangement with Bournemouth Borough Council transferred from Bournemouth and Poole PCT which is now closed. As a commissioner of health care services, Dorset CCG makes contributions to the pool, which are used to purchase health care services. At 31 March 2014, the clinical commissioning group had a total payables balance with Dorset County Council of £97,147 made up of £97,147 trade payables and no cash, which related to the trading transactions within the pooled budget arrangements. Within these arrangements the CCG's contribution to income for the pool for 2013/14 was £925,652, being £925,652 partner contribution and no other funding. The Integrated Equipment Services for Dorset (IESD) Memorandum Account for the pooled budget is reproduced below. 2013-14 £000 Revenue Dorset County Council Dorset Healthcare University NHS Foundation Trust Dorset CCG Dorset County Hospital NHS Foundation Trust Re-ablement Board Total contributions to revenue 1,419 1,891 379 233 200 4,122 Expenditure Integrated Community Equipment Service 4,122 Under/ (over) spend 0 As a commissioner of health care services, Dorset CCG makes contributions to the pool, which are used to purchase health care services. At 31 March 2014, the clinical commissioning group had a total payables balance with Bournemouth Borough Council of £50,150 made up of £50,150 trade payables and no cash, which related to the trading transactions within the pooled budget arrangements. Within these arrangements the CCG's contribution to income for the pool for 2013/14 was £1,364,090, being £1,364,090 partner contribution and no other funding. The Bournemouth & Poole ICES Memorandum Account for the pooled budget is reproduced below. 2013-14 £000 Revenue Bournemouth Borough Council Borough of Poole Dorset CCG Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust Poole Hopsital NHS Foundation Trust Risk Share Total contributions to revenue 517 479 1,364 346 175 61 2,942 Expenditure Integrated Community Equipment Service 2,942 Under/ (over) spend 0 A pooled budget is the term used to describe a project financed by several mutually interested organisations. By definition, pooled funds are flexible, intended to meet local needs and priorities. A pooled budget, such as the Integrated Community Equipment Service, is not an entity in its own right. 36. NHS LIFT Investments The clinical commissioning group had no NHS LIFT Investments as at 31 March 2014. 37. Intra-Government and Other Balances Other central government bodies Local authorities NHS bodies outside the departmental group NHS trusts & foundation trusts Bodies external to government Total balances at 31 March 2014 Current Receivables £000s 160 1,485 1 3,898 1,735 7,279 Non-current receivables £000s 0 0 0 0 0 0 Current Payables £000s (554) (1,708) (2,614) (7,692) (29,674) (42,242) Non-current payables £000s 0 0 0 0 0 0 Intra-Government balances are defined as balances between the reporting entity and other bodies within the boundary set for the Whole of Government Accounts. Note 34-37 Page 50 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 38. Related Party Transactions The Department of Health is regarded as a related party. During the year the clinical commissioning group has had a significant number of material transactions with entities for which the Department is regarded as the parent Department. For example: • NHS England (including commissioning support units); • NHS Foundation Trusts; • NHS Trusts; • NHS Litigation Authority; and, • NHS Business Services Authority. In addition, the clinical commissioning group has had a number of material transactions with other government departments and other central and local government bodies. Most of these transactions have been with [e.g. Dorset County Council, Bournemouth Borough Council and Borough of Poole Council Local Authorities in respect of joint enterprises]. The clinical commissioning group has received no revenue or capital payments from charitable funds. Dorset Clinical Commissioning Group is a body corporate established by order of the Secretary of State for Health. 1 2 3 4 Dr Forbes Watson, CCG Chair. Principal GP Practice in Lyme Bay Medical Centre, Bidder for the Lyme Regis Contract (20/6/2012), Spouse clinical employee for Dorset Healthcare University NHS FT (DHUFT), Honorary Medical Advisor and Chairman of RNLI Lyme Regis, Co-opted member of DCC for Health and Wellbeing Board purposes. Lyme Bay Medical Centre. Dr Jenny Bubb, Locality Chair - Mid Dorset . GP and Partner at Cerne Abbas Surgery, Co-opted member of Dorset County Council (DCC) for Health and Wellbeing Board purposes. Cerne Abbas Surgery. Dr Rob Childs, Locality Chair - North Dorset . GP and Partner at Bute House Practice, LMC Representative North Dorset, Clinical Assistant in Endoscopy at Yeovil District Hospital, NHS Dorset CCG Representative on Yeovil District Hospital Board of Governors, Member of Yeatman Hospital Management Group. Bute House Practice. Dr Colin Davidson, Locality Chair - East Dorset . GP and Partner at Cranborne Practice - PMS Dispensing and Training, Clinical Lead for East Dorset Locality, Director and wife a director at Dorset Diagnostics Ltd (DDL), Clinical Lead for Endoscopy - Victoria Hospital in Wimborne, Trustee at Boveridge House School, wife is a GP at Eagle House Surgery. DDL hold an AQP contract for Community Endoscopy. Co-opted member of DCC for Health and Wellbeing Board Purposes. Cranborne Practice. 5 Dr Colin Davidson a Director and his wife is a director at Dorset Diagnostics Ltd. 6 Tim Goodson, Chief Officer. Member of Healthcare Financial Management Association (HfMA), South West Branch HfMA Committee Member, Co-Member of Dorset Health and Wellbeing Board. Partner works in Finance Department for Bournemouth Borough Council. HfMA. Dr Richard Jenkinson, Locality Chair - Christchurch. GP Partner of Burton Medical Centre, GPSI in ENT employed by DHUFT, Director of Wessex Aviation Medical Services Ltd, Co-opted member of DCC for Health and Wellbeing Board purposes. Burton Medical Centre. Dr Tom Knight, Locality Chair - North Bournemouth . GP partner Northbourne Surgery, FTSE 100 index linked savings. Northbourne Surgery. Dr Blair Millar, Locality Chair - Dorset West. GP Partner of Bridport Medical Centre Skellern Practice, Wife (Dr Joanna Cotton) is a member of the Cancer Support Group “The Living Tree”, Co-opted member of Dorset County Council for Health and Wellbeing Board purposes. Bridport Medical Centre Skellern Practice. 7 8 9 10 Dr Andy Rutland, Locality Chair - Poole Bay & Parkstone . GP partner Lilliput Surgery, shareholder of solutions for health, wife is a partner at the Harvey Practice. Lilliput Surgery. 11 Dr Patrick Seal, Locality Chair - Poole Central. GP partner Adam Practice, Quay Medical Care Limited, the Adam Practice's provider vehicle for PCOS and Paediatric service. Adam Practice. 12 Dr Karen Kirkham, Locality Chair - Weymouth & Portland . GP Partner of the Bridges Medical Centre Weymouth, Specialty Doctor in Sexual Health employed by Dorset County Hospital NHS Foundation Trust, Board Member of Sexual Health South West Regional Office, Member of Children’s Trust Board Dorset, Governor at Sunninghill Preparatory School, Husband is a GP Partner at Abbotsbury Road Surgery Weymouth , Co-opted member of DCC for Health and Wellbeing Board purposes. Bridges Medical Centre. 13 Paul Vater, Chief Finance Officer. Member and Trustee of the South West Healthcare Financial Management Association (HfMA), FCCA Membership. SW HfMA. 14 David Jenkins, Lay Member - Board. Chair of Gloucestershire County Councils Waste Working Group (2 to 3 days a month), Deputy Lieutenant of Dorset, Trustee of Bournemouth Symphony Orchestra Endowment Fund, Trustee of Richard Ely Trust for Young Musicians, Trustee of Burton Bradstock Festival, Patron of Bridport Arts Centre, President of the Dorset Association of Parish and Town Councils. Gloucestershire County Council. 15 Teresa Hensman, Lay Member - Board (and Chair of Audit Committee). Mental Health Act Manager Associate, DHUFT. DHUFT. 16 Mary Monnington, Nurse Member. Council member [UKCCG] United Kingdom Council of Caldicott Guardians, Panel Member Professional Performance Committees Nursing and Midwifery Council [NMC], Nurse Member Wiltshire CCG, Husband JET Monnington, Senior Solicitor Moore Blatch Resolve LLP Southampton. Moore Blatch Resolve LLP. 17 Chris Burton, Secondary Care Member. Member of the Trust Board of North Bristol NHS Trust which provide specialist commissioning services for Dorset population commissioned by NHS England. Partner is a GPSI in dermatology in the Bristol region. North Bristol NHS Trust. 18 Suzanne Rastrick, Director of Quality. Allied Health Professional/Healthcare Scientist Member, Policy Board for NHS Employers. Member of Health Education England Advisory Group. Group Board Member and Chair, Audit and Risk Committee. Spectrum Housing Group Limited which involves oversight of the following companies: Spectrum Housing Group Limited, Spectrum Property Care Limited, Signpost Homes Limited, Spectrum Premier Homes Limited. Member of Council of the College of Occupational Therapists, Chair of the English Board of the College of Occupational Therapists. Spectrum Housing Group Limited. 19 Suzanne Rastrick, Director of Quality. Signpost Homes Limited. 20 Suzanne Rastrick, Director of Quality. Spectrum Premier Homes Limited. 21 Charles Buckle, Non Governing Body Lay Members. Member of DHUFT (Not on governing body, but to keep in touch with their priorities), Member of Purbeck Health Network, anticipate being a member of Health Watch. DHUFT. 22 Tina Thompson, Non Governing Body Lay Members. Employee of Bournemouth Borough Council working for Bournemouth 2026 Trust, Lay Advisor, Health Education Wessex/Wessex Deanery, Freelance Management Consultant for Third Sector Management Solutions, Site Assessor for Quality Performance Mark, Action for Advocacy Secretary, Friends of Boscombe Chine Gardens. Wessex Deanery. 23 Dr Ros Maycock, GP Transition Lead (Left 31 October 2013). Partner at Evergreen Oak Surgery (Training Practice), Member of Poole Children Trust Board, Member of Bournemouth Children Trust Board. Evergreen Oak Surgery. 24 Dr Piers Wilde, Locality Chair - Central Bournemouth (Left 31 July 2013). GP Moordown Medical Centre, Shareholder of Circle & Solutions for Health. Moordown Medical Centre. 25 Dr Carole Linnard, Locality Chair - North Bournemouth (Left 31 August 2013). Partner GP Alma Partnership, Programme Director for Winchester University/Wessex Deanery, Governor at Royal Bournemouth & Christchurch Hospital NHS Foundation Trust. Alma Partnership. 25 Dr Carole Linnard, Locality Chair - North Bournemouth (Left 31 August 2013). Partner GP Alma Partnership, Programme Director for Winchester University/Wessex Deanery, Governor at Royal Bournemouth & Christchurch Hospital NHS Foundation Trust. Royal Bournemouth & Christchurch Hospital NHS Foundation Trust. Payments to Related Party £’000 262 Receipts from Related Party £’000 0 Amounts owed to Related Party £’000 9 Amounts due from Related Party £’000 0 120 0 10 0 677 0 20 0 1,149 0 22 0 0 0 0 0 10 0 0 0 1,289 0 19 0 655 0 0 0 2,483 0 55 0 938 0 19 0 3,326 0 0 0 1,947 0 27 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 658 0 567 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 519 0 14 0 760 0 19 0 711 0 0 0 161,772 0 1,333 877 177,286 0 2,114 877 The CCG has detailed in this note all declarations of interest for Governing Body Members, however only related party transactions have been disclosed where they meet the criteria of having (i) control or joint control over the reporting entity, (ii) have significant influence over the reporting entity or (iii) are a member of the key management personnel. Note 38 Page 51 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 39. Events after the end of the Reporting Period The clinical commisioning group has no Events after the end of the Reporting Period. This note discloses the financial consequences of events (both favourable or unfavourable) that occur between the Statement of Financial Position date and the date on which the financial statements are approved by the Board, if appropriate. Two types of events can be identified: * those that provide evidence of conditions that existed at the end of the reporting period (adjusting events); and * those that are indicative of conditions that arose after the reporting period (non-adjusting events). 40. Losses and Special Payments The total number of losses cases in 2013-14 and their total value was as follows: Total Value Total Number of Cases of Cases £s 0 0 0 0 0 0 Losses Special payments Total losses and special payments Details of cases individually over £250,000 There were no cases over £250,000. Losses or special payments are payments that Parliament would not have envisaged healthcare funds being spent on when it originally provided the funds. The total costs included in this note are on a cash basis and will not reconcile to the amounts shown elsewhere within the accounts which are prepared on an accruals basis. 41. Third Party Assets 31 March 2014 £000 0 0 Third party assets held by the clinical commissioning group Third party assets are held by the CCG on behalf of a third party, for instance as money held on behalf of patients. As these assets do not belong to the CCG they are not included in the Statement of Financial Position or the trade payables note. 42. Financial Performance Targets Clinical commissioning groups have a number of financial duties under the NHS Act 2006 (as amended). The clinical commissioning group’s performance against those duties was as follows: 2013-14 National Health Service Act Section Duty 223J(2) Expenditure not to exceed income Capital resource use does not exceed the amount specified in Directions Revenue resource use does not exceed the amount specified in Directions Capital resource use on specified matter(s) does not exceed the amount specified in Directions Revenue resource use on specified matter(s) does not exceed the amount specified in Directions 223J(3) Revenue administration resource use does not exceed the amount specified in Directions 223H(1) 223I(2) 223I(3) 223J(1) Duty Achieved? Maximum Performance £’000 £’000 (12,614) 0 947,097 (12,614) 0 934,483 Yes Yes Yes 0 0 Yes 0 0 Yes 18,730 16,730 Yes Note: For the purposes of 223H(1); expenditure is defined as the aggregate of gross expenditure on revenue and capital in the financial year; and, income is defined as the aggregate of the notified maximum revenue resource, notified capital resource and all other amounts accounted as received in the financial year (whether under provisions of the Act or from other sources, and included here on a gross basis). The purpose of this note is to disclose the Financial Performance of the CCG. Where a clinical commissioning group breaches, or plans to breach, one of the statutory financial provisions, even if this is agreed with NHS England (e.g. setting a deficit budget) local auditors are under a duty to make a report to the Secretary of State for Health under Section 28 of the Audit Commission Act 1998. 43. Impact of IFRS Treatment There was no significant impact due to IFRS Accounting Treatment. 44. Analysis of Charitable Reserves The clinical commissioning group has no Charitable Reserves. Note 39-44 Page 52 of 53 NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14 GLOSSARY OF FINANCIAL TERMS Accruals An accounting concept. In addition to payments and receipts of cash, adjustment is made for outstanding payments, debts to be collected and stock. This means that the accounts show all of the income and expenditure that related to the financial year. Assets An item that has a value in the future. For example, a debtor (someone who owes money) is an asset, as they will in future pay. A building is an asset, because it houses activity that will provide a future income stream. Audit The process of validation of the accuracy, completeness and adequacy of disclosure of financial records. Capital Land, buildings, equipment and other non-current assets owned by the CCG, the cost of which exceeds £5,000 and has an expected life of more than one year. Cash limit A limit set by the NHS England which restricts the amount of cash drawings that the CCG can make in the financial year. There is a combined cash limit for both revenue and capital. Commissioning Purchase of healthcare from external service providers (NHS, other public sector, private and voluntary) to meet the needs of the population. Current assets Trade receivables (debtors), inventories (stocks), cash or similar, whose value is, or can be converted into, cash within the next twelve months. Governance Governance is the system by which organisations are directed and controlled . It is concerned with how the organisation is run, how it is structured and how it is led. Corporate governance should underpin all that an organisation does. In the NHS, this means it must encompass clinical, financial and organisational aspects. Gross operating costs This is the total revenue expenditure, including accruals and provisions, incurred in the course of performing all aspects of the CCG’s functions during the year. Intangible assets Brand value or some other right (for example, a software licence), which although invisible is likely to derive financial benefit for its owner in the future, and for which you might be willing to pay. Miscellaneous revenue Income that relates directly to the operating activities of the CCG. This excludes cash from NHS England, which is credited to the general fund. Non-current assets Land, buildings, equipment and other long term assets that are expected to have a life of more than one year. Resource limit Expenditure limits are determined for each NHS organisation by NHS England for both revenue and capital, which limit the amount that may be expended on revenue purchases, as assessed on an accruals basis (that is, after adjusting for debtors and creditors). Glossary Page 53 of 53 This report can be made available in other formats and languages Please contact the Engagement and Communications Team [email protected] Get in touch and have your say about your NHS Find us on Facebook www.facebook.com/NHSDorsetCCG Join the conversation on Twitter www.twitter.com/DorsetCCG Watch health information and advice www.youtube.com/DorsetCCG Visit our website: www.dorsetccg.nhs.uk Get involved - join our Health Involvement Network (HIN) The CCG’s Health Involvement Network enables people to be informed about and involved with our work. We regularly send information on opportunities for involvement where you can contribute to the redesign and commissioning of healthcare services in Dorset. We also feedback on how the views of local people are helping to shape the NHS for the future. Current members of the HIN comprise our Locality Involvement Networks, condition specific patient and carer panels, local project reference groups and other interested organisations and members of the general public. It’s free to join and there’s no obligation - the level of involvement is up to you. To join the HIN, please contact us on 01305 368908 or email [email protected] and we will add your details to our database. © Dorset Clinical Commissioning Group 2014