Annual report and accounts 2017 - 2018 - North East Hampshire ...

Annual report and accounts 2017 - 2018

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This document is available in Braille, large print, other languages or audio format on request. To request an alternative format, email [email protected], call 01252 335154 or write to: NHS North East Hampshire and Farnham Clinical Commissioning Group Fourth floor, Aldershot Centre for Health Hospital Hill Aldershot Hampshire GU11 1AY

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Contents Foreword............................................................................................................................... 8 Performance Report ............................................................................................................ 10 Preparing the annual accounts ........................................................................................ 10 About us .......................................................................................................................... 10 Overview of the performance report ................................................................................ 11 The history of the CCG .................................................................................................... 11 Our achievements 2017-2018 ......................................................................................... 12 Happy, Healthy, at Homme programme in review ........................................................ 14 Our partnerships.............................................................................................................. 16 Frimley Health and Care Integrated Care System ........................................................ 16 Hampshire CCG Partnership........................................................................................ 18 Hampshire and Isle of Wight Sustainability and Transformation Partnership ................ 20 Collaborative commissioning for mental health ................................................................ 21 Primary care .................................................................................................................... 22 Hampshire children’s and maternity services ................................................................... 24 Performance analysis ...................................................................................................... 27 Achievements in 2017/18 ............................................................................................. 27 CCG Performance: NHS Constitution .......................................................................... 28 Mental health performance targets ............................................................................... 29 Overall summary of financial performance 2017/18 ......................................................... 29 Summary of key issues and risks .................................................................................... 31 Financial plan 2018-19 .................................................................................................... 32 The assurance process ................................................................................................... 32 Sustainable development ................................................................................................ 33 Performance ................................................................................................................ 33 CCG sustainability initiatives ........................................................................................ 33 Partnerships................................................................................................................. 33 Improve quality ................................................................................................................ 34 CCG Quality Assurance ............................................................................................... 34 Providing safe services ................................................................................................ 35 Learning Disabilities Mortality Review (LeDeR) Programme ........................................ 38 Serious Incidents ......................................................................................................... 38 Reporting incidents in Primary Care ............................................................................. 38 Practice Support Programme ....................................................................................... 38 Reducing Healthcare Associated Infections ................................................................. 39 A Positive Experience of Care...................................................................................... 39

Page |4 Datix Clinical Concerns System & Friends and Family Test ......................................... 39 Complaints, Concerns, Compliments and Feedback ....................................................... 40 Overview of the CCG complaints process .................................................................... 40 Internal Audit................................................................................................................ 40 Complaints, Concerns, Enquiries and Compliments Received ..................................... 40 Learning and developments related to complaints and concerns ................................. 41 Parliamentary Health Service Ombudsman.................................................................. 41 Care Quality Commission Inspections .......................................................................... 42 GP Practices ................................................................................................................ 43 Continuing Healthcare.................................................................................................. 45 Medicines Management .................................................................................................. 46 Antibiotic prescribing .................................................................................................... 46 Medicines safety .......................................................................................................... 46 Development of prescribing guidelines and formularies ............................................... 46 Care homes pharmacist ............................................................................................... 46 CCG community dietitian ............................................................................................. 46 Public engagement on national consultations regarding medicines .............................. 47 Engaging people and communities .................................................................................. 48 Carers .......................................................................................................................... 50 Empowering Engagement Programme ........................................................................ 51 2020 Leadership Programme ....................................................................................... 52 Innovation Conference ................................................................................................. 54 Local Patient Participation Groups ............................................................................... 55 Building relationships with our community .................................................................... 55 Hampshire and Surrey Healthwatch organisation......................................................... 55 Social media and CCG website .................................................................................... 55 Get in touch ................................................................................................................. 56 Reducing inequality ......................................................................................................... 56 Background.................................................................................................................. 57 Equality and Diversity Steering Group.......................................................................... 58 Health and Wellbeing Boards .......................................................................................... 59 Surrey Health and Wellbeing Board priorities ............................................................... 59 Hampshire Health & Wellbeing priorities ...................................................................... 61 Improving children's emotional health and wellbeing............................................. 61 Operating Plan 2017- 2019.............................................................................................. 63 Challenges, priorities and impacts................................................................................ 64 Our Delivery Programmes ............................................................................................ 65

Page |5 New Models of Care .................................................................................................... 65 Prevention and self care .............................................................................................. 65 Primary Care................................................................................................................ 65 Mental Health and Learning Disabilities ....................................................................... 65 Community Services redesign...................................................................................... 65 Integrated Urgent Care procurement............................................................................ 65 Planned Care ............................................................................................................... 66 Children’s and Maternity .............................................................................................. 66 Continuing Healthcare.................................................................................................. 66 Medicines Optimisation ................................................................................................ 66 Accountability Report .......................................................................................................... 67 Corporate Governance Report ........................................................................................ 67 Members Report .......................................................................................................... 67 Member practices of the CCG in 2017/18 ........................................................................ 67 Governing Body Membership .......................................................................................... 67 Hampshire CCG Partnership........................................................................................ 68 Changes to the Governing Body Members................................................................... 68 Governing Body Public Attendance .............................................................................. 70 Sub-committees of the Governing Body .......................................................................... 72 Audit and Risk Committee April 2017 to September 2017 ............................................ 72 Remuneration and Nominations Committee ................................................................. 75 Quality Improvement Committee .................................................................................. 77 Quality Improvement Committee attendance ............................................................... 78 Clinical Executive Committee ....................................................................................... 78 Patient and Public Engagement Committee ................................................................. 81 Finance and Performance Committee .......................................................................... 82 Delegated Primary Care Commissioning Committee ................................................... 84 External Audit .................................................................................................................. 87 Internal Audit Services ..................................................................................................... 87 Serious Incidents Requiring Investigation ........................................................................ 87 Emergency Preparedness, Resilience and Response ..................................................... 87 Modern Slavery Act ......................................................................................................... 87 Register of interests......................................................................................................... 87 Research ......................................................................................................................... 87 Pensions Liabilities .......................................................................................................... 88 Statement as to Disclosure to Auditors ............................................................................ 88 Statement of Accountable Officer’s Responsibilities ............................................................ 89

Page |6 Governance Statement ....................................................................................................... 91 Introduction and context .................................................................................................. 91 Scope of responsibility ..................................................................................................... 91 Governance arrangements and effectiveness.................................................................. 91 UK Corporate Governance Code ..................................................................................... 91 Discharge of Statutory Functions ..................................................................................... 92 Risk management arrangements and effectiveness ........................................................ 92 Capacity to Handle Risk .................................................................................................. 92 Risk Assessment ............................................................................................................. 93 Other sources of assurance............................................................................................. 93 Internal Control Framework .......................................................................................... 93 Annual audit of conflicts of interest management ......................................................... 93 Data Quality ................................................................................................................. 94 Information Governance............................................................................................... 94 Business Critical Models .............................................................................................. 95 Third party assurances................................................................................................. 95 Control Issues ................................................................................................................. 95 Review of economy, efficiency & effectiveness of the use of resources ........................... 95 Delegation of functions .................................................................................................... 96 Counter fraud arrangements ........................................................................................ 96 Head of Internal Audit Opinion ..................................................................................... 97 Review of the effectiveness of governance, risk management and internal control ...... 97 Conclusion ................................................................................................................... 98 Remuneration Report .......................................................................................................... 99 Definition of senior manager ............................................................................................ 99 Remuneration Committee ................................................................................................ 99 Statement of Policy.......................................................................................................... 99 Senior Managers Service Contracts .............................................................................. 100 Salaries and allowances ................................................................................................ 100 Pension Benefits ........................................................................................................... 102 Cash Equivalent Transfer Values .................................................................................. 103 Real Increase in CETV............................................................................................... 103 Pay Multiples ................................................................................................................. 103 Staff Report....................................................................................................................... 104 Staff Composition .......................................................................................................... 104 Sickness Absence Data ................................................................................................. 105 Cost Allocation and Setting of Charges for Information .................................................. 105

Page |7 Principles for Remedy ................................................................................................... 105 Employee Consultation .................................................................................................. 106 Staff Partnership Forum ............................................................................................. 106 Staff policies .................................................................................................................. 107 Staff training .................................................................................................................. 107 Equality ......................................................................................................................... 107 Disabled Employees ...................................................................................................... 107 Trade Union................................................................................................................... 108 Expenditure on Consultancy .......................................................................................... 108 Off Payroll Engagements ............................................................................................... 108 Exit packages, including special (non-contractual) payments ........................................ 110 Table 1: Exit Packages .............................................................................................. 110 Parliamentary Accountability and Audit Report .............................................................. 110 Independent Auditor's Report…………………………………………………………………….111 Annual Accounts 2017-2018 ............................................................................................. 116

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Foreword This year marks a special milestone for the NHS - on 5th July we celebrate 70 years since the ‘New National Health Service’ was set up to, as it was publicised at the time, ‘provide you with medical, dental and nursing care’ that would allow ‘everyone – rich or poor, man, woman or child’ to access care when needed. Seven decades on and the NHS has become a valued national institution and it is heartening to see that the values that were important then still hold true today. Back then, services and health professionals were uniting to work together for the first time under the banner of the National Health Service. They formed new ways of working and innovative partnerships, with the promise of working from revolutionary ‘health centres’ to accommodate family doctors and which could “also offer dentistry and other services on the spot”. Now, 70 years later, we are continuing to evolve, design and develop ways in which health and care professionals (such as social care and the local voluntary sector) can work even closer together for the benefit of their local population, in a coordinated and innovative way. By working together and listening to what our communities tell us about their experiences, we can offer people the right support to manage their conditions confidently and appropriately, wherever possible, away from hospital. We all recognise the NHS today is facing some of the toughest challenges it has ever had to address. Increasing demand and pressure on finances and difficulties with recruitment of trained staff are just some of the recurring themes we face. Our role is to ensure people still receive high quality and effective care, shaped by our clinical leaders, workforce and local communities. We are encouraged to see that the new initiatives we have put in place are beginning to have real impact as we seek to work more effectively together. This report highlights some these positive examples which are beginning to make a difference for patients and which, with careful nurturing, have the potential to be extended to benefit other areas too. We know that delivering effective local GP services is vital to all our people. They have told us repeatedly that they want to be able to get an appointment with a GP when they need one. By working with GPs we have introduced extended opening hours for surgeries. We have also made it easier for patients to get the most appropriate care in their time of need – such as through E-consult, where people can contact a GP online, but also get advice about the most appropriate help. We have recently reached the conclusion of a three year nationally funded programme called Happy, Healthy, at Home which saw us at the forefront of developing ways in which people receive care and support. Creating better care, and community services designed with, and around, the experiences and needs of local people. This is better for patients, as

Page |9 well as having the additional benefit of reducing emergency admissions into hospital. This year also marks the five year anniversary of the introduction of CCGs. One of our aims back in 2013 was that we would work to ensure that the people of North East Hampshire and Farnham would receive the right care, at the right time, in the right place. Since then, we have seen the value in working together to achieve our aims, with the result that in 2017 a formal working relationship was established with three other clinical commissioning groups across Hampshire (Fareham and Gosport, North Hampshire and South Eastern Hampshire). This partnership allows us to work together to share resources and ideas, reduce duplication and identify areas of positive working that could be shared proactively between us. The Hampshire CCG Partnership formally came into being on 1st April 2017 and is helping us to plan more effectively to meet many different demands across our area, including for increasingly complex demand for urgent care services and working within primary care to help people to be seen by a GP or other health professional more quickly. The Isle of Wight CCG became a fifth member of the Partnership on 1st April 2018 which affords us an even greater opportunity to join together to deliver a new commissioning model. We plan to work together at scale, across Hampshire and the Isle of Wight, as well as through our local delivery systems in Frimley, North and mid Hampshire and Portsmouth and South Eastern Hampshire. Looking forward, it is more important than ever to ensure the NHS is sustainable for the future and we believe the Partnership approach will be fundamental in helping us to do that. We will ensure that whatever we do, local people remain at the heart of our decision making. By working together to channel resources and capacity to where they will make the most impact, we can focus far more on outcomes for people and local communities and far less on organisational boundaries. This will be important for the CCG, too, in working locally, within our own health system. Within North East Hampshire and Farnham we are delivering exciting new approaches to working collectively, in ways that enable us to pool our available resources to work even more effectively on behalf of our patients. We can only achieve what we want to do by continuing the valued work we are doing work with our colleagues in the NHS, in our local authorities and in the voluntary sector, whilst trying to reduce the impact of organisational boundaries on the work that we do together. We believe we are well on the way to making this happen and it is only by working together that we can fully deliver our vision to provide our local residents with health and care services delivered in the right way, in the right place and at the right time. Maggie MacIsaac Chief Executive Hampshire CCG Partnership

Dr Peter Bibawy Interim Clinical Chair NHS North Hampshire and Farnham CCG

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Performance Report Preparing the annual accounts The annual accounts have been prepared under a direction issued by NHS England under the National Health Service Act 2006.

About us Our responsibilities cover the commissioning of acute care, primary care, community health services, mental health services and ambulance services for the local population. The geographical position of the CCG, (straddling two counties), results in services for the CCG population being provided by multiple organisations. The figure below shows the main providers of health and social care services to our population.

Main providers of primary, community, mental health, social and acute care for NHS North East Hampshire and Farnham CCG

General Practice  

23 practices within North East Hampshire and Farnham Out of hours care – North Hampshire Urgent Care

Mental Health Services   

Acute care  

Frimley Health NHS Foundation Trust Royal Surrey County Hospital NHS Foundation Trust

Ambulance Services  

Community and Extended Primary Care Services   

Virgin Care Ltd FICS – Farnham Integrated Care services Salus Medical Services

Surrey and Borders Partnership NHS Foundation Trust Sussex Partnership NHS Foundation Trust – Children and Adolescent Mental Health Services TalkPlus – Improving Access to Psychological Therapies Service

South East Coast Ambulance NHS Foundation Trust South Central Ambulance Service NHS Foundation Trust

There is also a wide range of independent and voluntary sector providers for our population.

P a g e | 11 As well as working with providers, the CCG works closely with the bodies that have responsibility for commissioning other aspects of health and care services for local people: 

Hampshire County Council and Surrey County Council are responsible for commissioning public health and social care for the population, including residential and nursing home care.

We work with and commission a range of services from the voluntary sector, such as:         

Andover Mind and Catalyst – Adult Safe Haven Just Wellbeing – Young Persons Safe Haven and the Oasis Hart Voluntary Action (lead organisation in coalition) – Making Connections Macmillan Cancer Support – joint commissioning Rushmoor Healthy Living – Desmond diabetes training Diocese of Portsmouth – Good Neighbour schemes Action for Carers Surrey and the Princess Royal Trust for Carers (Hampshire) Disability Challengers Stroke Association

In addition, the three borough councils for voluntary services (Hart, Rushmoor and South West Surrey) work in partnership with us on delivering our strategy and the Happy, Healthy, at Home programme. This collaborative working enables us to commission the best quality care for our population.

Overview of the performance report This annual report covers the work we do in designing, developing and ensuring the delivery of health and care services for the people of North East Hampshire and Farnham. This section of the report provides some background information to the changing context of the NHS in which we operate, as well as reviewing the past 12 months in terms of our performance. In the below you will find out about our key achievements, our engagement and collaboration with local people and how we have done this while delivering on our budget with a planned surplus of £1.6m.

The history of the CCG Following the Health and Social Care Act 2012 (later amended in 2016) the CCG was licensed from April 1, 2013. As a clinical commissioning group we assumed the duties passed to it by the Southampton, Hampshire, Isle of Wight and Portsmouth Cluster Primary Care Trust Boards when it became a statutory body in April 2013.

Aldershot Centre for Health is home to NHS North East Hampshire and Farnham Clinical Commissioning Group.

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Our achievements 2017-2018 The year 2017/18 has been outstanding for NHS North East Hampshire and Farnham Clinical Commissioning Group. NHS England rated our performance as outstanding in its annual CCG appraisals. This recognition is a tribute to the huge amount of work being carried out by our staff, together with local people and our many partners, to develop and maintain high-quality and safe health services to meet the needs of our local population.

We have been rated as an ‘outstanding’ CCG by NHS England

It has been a year of transition, evaluation and preparation for the future. Transition - the way that health and social care services are commissioned and provided is changing and moving much more towards working at a system level. We are involved with the Hampshire CCG Partnership, the Frimley Health and Care Integrated Care System (was Sustainability and Transformation Partnership) and the Hampshire and Isle of Wight Sustainability and Transformation Partnership. Working together across a larger geography with our partners brings with it a whole range of new and exciting opportunities for the NHS, social care and for patients. Evaluation and preparation - with the end of the year comes the formal end of the national vanguard programme, after which we no longer receive additional funding for the services developed by our three year Happy, Healthy, at Home programme which designed and tested new models of care. We are now incorporating our innovative new services into ‘business as usual’. It has been a privilege to be one of the national vanguard sites and we have been able to make real progress in many areas, to the benefit of local people. The Happy, Healthy, at Home programme has enabled us to transform areas of primary and community care. Each of our five localities (Aldershot, Farnborough, Farnham, Fleet and Yateley) has been supported to create its own integrated care teams – incorporating GP services, mental health, social care, physiotherapy and community services – to care for the needs of those members of their communities with the most chronic and complex needs. In Farnham the programme has helped us to support GP practices to create an Integrated Care Centre, at Farnham Hospital, to enable patients to access urgent same-day GP appointments, reducing the need for people to attend A&E. In Yateley the Urgent Care Centre fulfils the same objective. It has also enabled us to engage with local people better and we are working more closely with them than ever, thanks to our Community Ambassador programme. Community Ambassadors are local people from all walks of life who support and advise us in a wide range of ways, from attending meetings and steering groups to reviewing documents, spreading information in their communities, helping to gauge public opinion and providing the CCG with feedback. The Happy, Healthy, at Home programme has also helped to develop the workforce across our system. The 2020 Leadership Programme was launched to help foster a culture of cross-organisation, collaborative leadership to drive the new models of care work. This year it took in its second cohort of course members (called Fellows), from wide-ranging clinical, managerial and administrative roles, to support and encourage them and to equip them to

P a g e | 13 find solutions to problems they encounter within health and care services. The CCG’s Empowering Engagement programme also welcomed new recruits. The programme brings together colleagues from all teams across the organisation, including clinical leads (GPs), to work on projects specifically aimed at ensuring that patient and public engagement is central to the way the CCG works. Hampshire Healthwatch and Wessex Voices have been key supporters of this project. As well as working on all of the above, as a vanguard site (our Happy, Healthy, at Home programme) it has been our responsibility to share what we have learned from designing and testing new models of care. This has included hosting visitors from the NHS and social care, Parliament, the media and other interested people from the UK and around the world. We welcomed the Health Select Committee as part of their visit to the wider Frimley Health and Care System. We were visited by King’s Fund Chief Executive Chris Ham and his colleague Professor Don Berwick, and we also hosted health system leaders from New Zealand, as well as welcoming a mental health leader from Australia to the Aldershot Safe Haven. We also welcomed colleagues from Buckinghamshire HealthCare and a delegation from the NHS Confederation and the Local Government Association. Services the CCG commissions have featured in the media, notably in The Times, The Financial Times, on BBC radio and on local ITV, as well as in the local media. Topics covered have included the Adult’s Safe Haven, the Young Persons Safe Haven, the Farnham Integrated Care Centre and the broader Frimley Health and Care Sustainability and Transformation Partnership (now the Frimley Health and Care Integrated Care System). As each year passes the CCG grows stronger and develops firmer links with local people and its partners. Those links will be crucial as the momentum builds towards greater system working in the future, to address the ever growing demand on health and care services. We look forward to meeting the challenge.

We were visited by King’s Fund Chief Executive Chris Ham and Professor Don Berwick to find out more about our innovative work.

P a g e | 14 Happy, Healthy, at Homme programme in review The success of the Happy, Healthy, at Home programme has been consolidated this year and we have had consistently good outcomes for patients over the last 12 months. The programme has made a significant difference to the performance of the local health and care system, with people reporting better care and support, and the workforce experiencing improved job satisfaction. Our aim to keep people happy, healthy, and at home has been underpinned by co-designed services, locally tailored to meet communities’ needs, and built around the person who needs care, not the organisations providing it.

“As a result of this work, for the first time in the 29 years I have served as a chief executive, demand for hospital care has fallen.” Sir Andrew Morris, Chief Executive, Frimley Health NHS Foundation Trust

Our key impacts this year have been:      

 

emergency admissions have reduced by 2% compared to last year, a significant achievement given that eight demographically similar CCGs all have increased activity on last year. our new models of care are successfully managing and treating people more effectively in the community, reducing potentially “avoidable” emergency admissions by 10% on last year; new ways of working have seen a 4% reduction in GP referrals on last year; we are successfully holding A&E attendances at the same level as last year whereas four demographically similar CCGs have increased activity on last year; patients needing integrated care are reporting significant improvements in health status, personal wellbeing, patient experience and health confidence; the adult’s Safe Haven in Aldershot continues to be a key part of how people access mental health support, with indications that it is also now reducing mental health related police deployments and Section 136 suite detentions, as well as hospital activity; our staff report that they are happier at work, feel more a part of the overall care team, and that services are talking to each other better since the start of the Happy, Healthy, at Home programme; and GPs say that having paramedics and other health and care professionals working alongside them in general practice is making a real difference on a day to day basis.

We have been working hard to share our findings and spread good practice across the NHS and even internationally. We have hosted visits from other our local partners, other health systems, the Health Select Committee representatives and NHS Confederation. We were also privileged to have an international delegation from Auckland, New Zealand, come to learn from our experiences, with a hope to replicate some of the models there. We have been Frimley Park Hospital

P a g e | 15 committed to sharing our story and helping others to navigate some of the challenges more easily, but always with the understanding that it takes time to develop relationships, build trust and empower people to try something new. The vast majority of services have all been able to prove that they have made an impact, or that they merit an extension to the pilot over the coming year which is testament to the hard work and commitment of the teams involved in putting them together, and in the way we have ensured local people are engaged with service developments. For the last year we have been planning how we transfer the work which was started in the Happy, Healthy, at Home programme to part of our business as usual local approach to health and care. We have been combining team meetings with the programme office from Frimley Health and Care and have seen this period as a transition from discreet projects, to being how we work as a CCG with our partners. The benefits of programme has been recognised locally and will be extended not only across the five localities of the CCG, but also across the wider Frimley Health and Care Integrated Care System footprint, with a commitment to taking the core of a service that works but enabling communities to shape the details to ensure it meets their needs to have the maximum impact.

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Our partnerships Since 1948, the NHS has constantly adapted itself and must continue to do so as the world and our health needs change. As life expectancy increases, we have a larger population of older, frail people with chronic conditions such as heart failure and arthritis and we are now able to treat people with drugs and clinical care that was not available in the past. There are also big opportunities to improve care by making common-sense changes to how the NHS works, like making it easier to see a GP, speeding up cancer diagnosis and offering help faster to people with mental ill health. This is why the CCG, has started to work even closer together with its health and social care (council) partners. These partnerships and collaborations give nurses, doctors and care staff the best chance to deliver effective services in the best place for patients. The CCG works in a number of partnerships as described below, when it makes sense to for our population, such as improving the consistency and equity of our local services, where we can work more efficiently and effectively across a broader geography or where we need to avoid duplication in what we do. Frimley Health and Care Integrated Care System NHS North East Hampshire and Farnham CCG is a From April 1, 2018, the key partner in the Frimley Health and Care Integrated Frimley Health and Care Care System. This is a partnership of organisations Sustainability Partnership working together to improve health and care services has become the Frimley for the 800,000 people in the local area, with a shared Health and Care Integrated vision for how we best use our combined resources to make a positive difference for our communities, Care System residents, patients and staff. It aims to improve health and care services – delivering the right care, in the right place at the right time for local people. There are seven main transformation initiatives that are being developed throughout the partnership, with best practice from across the system being shared and replicated more widely, to bring all services up to the same high level. A key element of this is the Happy, Healthy, at Home programme, from North East Hampshire and Farnham. The partnership is working to roll out GP services transformation, and replicate the work seen around integrated care teams and co-located hubs. It is also focusing on creating stronger links between health and social care, with key action workstreams made up of system leaders and front end delivery teams looking at how we can improve the way we work together between hospital and care homes and also how best to recruit and retain people working in the care sector such as people who carry out home visiting services. Other areas of focus include improving health outcomes for people in the footprint, as well as enabling people to self-care and help them to stay well. System transformation within the NHS and social care has featured in the national news over the past year and with the Frimley system being a high-performer, particular focus has been placed on it. Sir Andrew Morris, the then Chief Executive of Frimley Health NHS Foundation Trust, was interviewed by The Financial Times and The Times, among others, on what could be done to solve the NHS funding crisis and how the Frimley system was bucking the national trend. Clinicians and other leaders from services across the system,

P a g e | 17 including in North East Hampshire and Farnham, were also visited or interviewed by print and broadcast media to provide specific local examples of how service transformation and innovation are improving patient experience and outcomes, improving staff morale and efficiency savings. Over the last year Frimley Health and Care has been working to strengthen its relationships across the system to enable it to become Frimley Health and Care Integrated Care System (formerly known as a Sustainability and Transformation Partnershp) , from 1st April 2018, which will help to co-ordinate system changes more quickly and efficiently. As well as moving forward with the work plan, the last year has been focused on putting strong foundations in place to have a single operating plan across all the organisations involved. There will also be a system financial control total for the health organisations, which means thinking about how best the money can be used across a number of organisations to follow patient health and care pathways, rather than just the budgets of individual organisations. Each organisation will still have its statutory responsibility and accountability, but they will be committed to the wider priorities of the partnership and making the biggest impact across the system for the benefit of local people.

The Frimley Health and Care plan on a page

P a g e | 18 Hampshire CCG Partnership The clinical commissioning groups of Fareham and Gosport, North East Hampshire and Farnham, North Hampshire and South Eastern Hampshire established a formal partnership on 1 April, 2017. The CCGs in the Partnership share a single Chief Executive and a single executive team.

The Partnership is designed to simplify commissioning, enabling the CCGs to accelerate improvements in patient care, to be more effective, and to reduce duplication. By working together with one leadership team the four CCGs are able to be more efficient, share management capacity and skills, reduce the use of expensive interim managers, and operate with greater consistency in our approach with providers and other partners. The four CCGs in the partnership serve a population of 850,000 people and manage a budget of £1.1 billion, and many of the challenges faced by CCGs are common across the Partnership. Where it makes sense, the Partnership do things once across all four CCGs, which means that we are able to bring a more consistent commissioning voice The clinical chairs from the Hampshire across our systems, reduce duplication CCG Partnership – (from left) Dr David and focus the limited people and Chilvers, Dr Nicola Decker, Dr Barbara resources more effectively. A Partnership Rushton and Dr Andy Whitfield. Board, with a non-executive chair, is in place which provides overall strategic leadership to the Partnership and is the decision making body for our collaborative. In the Partnership we have been careful to maintain and support a local focus. Each CCG remains focussed on delivery and service improvement for its local population. Dr Andy Whitfield (for North East Hampshire and Farnham), Dr Nicola Decker (for North Hampshire), Dr David Chilvers (for Fareham & Gosport) and Dr Barbara Rushton (for South Eastern

P a g e | 19 Hampshire) continue to chair each CCG, and a Director of Delivery has been appointed to each of the local delivery systems in which we work – the Frimley Health and Care system; the North and Mid Hampshire system and the Portsmouth and South East Hampshire system. The priorities for the Partnership reflect what we are able to do at scale, enabling us to continue to design and plan new models of care in natural local communities. The aim will be to continue to shape services that:     

By working together, the Partnership supports people to stay well and achieves economies of scale, ensuring the health system is more sustainable for the future.

support people to stay well, join up care for people with complex needs, deliver integrated urgent and emergency care, have effective step-up and step-down services to prevent unnecessary emergency admissions and get people out of hospital sooner improve specialist care with GPs and consultants, working together in new ways.

As we head into the new financial year, the Partnership will continue to look where greater collaboration will achieve economies of scale for the benefit the patient population. This includes expanding our collaboration to our CCG colleagues in the Isle of Wight. This allows us the opportunity to work together to deliver a new commissioning model and work together at scale, across the Hampshire and Isle of Wight Integrated Care System, as well as through our delivery systems in Frimley, mid Hampshire and Portsmouth. Maggie MacIsaac took on the role of interim Accountable Officer for the Isle of Wight CCG for the interim period, effective from 1st April 2018.

P a g e | 20 Hampshire and Isle of Wight Sustainability and Transformation Partnership Over the last year, the 21 health and care organisations across Hampshire and the Isle of Wight have been working together as a partnership, to address the many opportunities and challenges facing the population. We have been developing ways by which local people know how to stay well while making sure we provide safe, high quality, consistent and affordable health and care for the population. Where it makes sense to work at scale, the partnership has developed a plan to tackle issues such as reducing the amount of time it takes people to recover from illness, offering patients more choice about when and where to receive treatment, reducing waiting times for appointments, diagnostic tests and test results, whilst supporting people to manage their day-to-day health. The plan for the Hampshire and Isle of Wight Sustainability and Transformation Partnership is long-term, well-thought through, based on feedback from the local population and devised by people who work in the local NHS and social care system. If we are to have services that are sustainable in the future, we must build on new ways of planning and providing them - and that means changing how our local NHS works. Individual organisations, such as hospital trusts or GP practices, cannot provide the answers on their own because many of these issues affect more than just one organisation or community. As a partnership, we are committed to ensuring health and social care services are about helping keep people well for longer – allowing them to live independent lives and avoid being admitted to hospital. Below are just some of our achievements as a partnership during 2017/18:    





our NHS staff have been trained to make every contact count, supporting local people to live healthier lifestyles; integrated hubs were established across the area supporting people to manage their health within their local community and to reduce the need to go to hospital; online consultations have been rolled out improving patient access to GPs and making appointments; cancer patients are now receiving assessments aimed at supporting both their physical and mental health needs following their diagnosis; a number of children’s hubs are operational supporting families by improving access to advice and supporting when their child has an illness; and specialist community perinatal services support women who suffer from mental illness during and one year after their pregnancy.

Children’s hubs have been set up across Hampshire to support families.

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Collaborative commissioning for mental health Since the inception of CCGs in April 2013, NHS North East Hampshire and Farnham CCG has led on the strategic commissioning and operational assurance, oversight and redesign of the Surrey and North East Hampshire-wide mental health and learning disabilities services. This was done on behalf of our CCG, East Surrey CCG, North West Surrey CCG, Surrey Heath CCG, Surrey Downs CCG and Guildford and Waverley CCG. Following review of the collaborative commissioning arrangements, and driven by the emerging Sustainability and Transformation Partnerships, and a requirement for a greater level of localised control, the decision was taken to split the existing mental health collaborative function into two new footprints.

By working together with our partners, we can improve the health and care of our patients.

During this time the lead for Learning Disability collaborative commissioning was transferred from North East Hampshire and Farnham CCG to be hosted by Guildford and Waverley CCG. The new footprints are the Blackwater Mental Health Alliance - covering North East Hampshire and Farnham CCG and Surrey Heath CCG - and the ‘Heartlands and East Surrey CCG Collaborative’ - covering Guildford and Waverley, North West, Surrey Downs and East Surrey CCGs. The Blackwater Mental Health Alliance is led by North East Hampshire and Farnham CCG and has already formed a strong partnership and clinically-driven work plan, supporting the continued commissioning and delivery of high-quality, innovative mental health services, and achievement of national mental health standards. The Alliance is working across the two CCGs to support work at local, alliance and cross-county levels to continue to benefit from a wider collaborative approach but also embrace more local control, with an alliance-level contract with the secondary care mental health provider Surrey and Borders Partnership NHS Foundation Trust. In a collaborative arrangement the CCG has contracted the newly formed Surrey and North East Hampshire Independent Service User and Carer Network. This independently-run network provides an over-arching framework and support structure to empower people who use mental health services and those that care for them, to be able to impact and influence commissioning of mental health services, ensuring they meet their needs.

P a g e | 22

Primary care The CCG has continued to build on its strong relationships with local people, GPs and the wider primary care workforce, to improve local services. One standout example in 2017 was the Primary Care Survey where local people were asked to help shape how extended access to GP services, from 8am-8pm weekdays and at weekends, would be provided within the CCG area. More than 4,400 people took the time to tell us their views, with the CCG, GP surgeries and patient participation groups working together to encourage such a fantastic response.

GP receptionists have been trained to help patients access the most appropriate care for them.

Overwhelmingly people wanted access to Saturday morning appointments within their communities, and so the teams have worked together to provide this in all five of our localities. People were also given the opportunity to express a preference from a range of potential services such as blood tests, smear tests, asthma reviews and health checks, and the CCG is continuing to work with the teams locally to help tailor the services, so that we can help to make the biggest impact for each community. To further support GP practices in the increasing demands they are experiencing and to ensure patients continue to have a good experience of care, the CCG has been working to develop new ways of providing health care.  



In all our localities the CCG has integrated care teams where health, social care and voluntary sector colleagues come together to look holistically at complex patient needs and are freed from being constrained by organisational boundaries. E-consult is being rolled out in phases across all localities offering a new way to contact their GP online 24 hours a day, seven days a week and get a response by the end of the next working day. This service is proving very popular and is an excellent additional way to access primary care services. Paramedics are now able to help people in their own homes as part of the new rapid home visiting service. This enables a much faster response to patients requiring a GP home visit. The patient is first triaged by a GP then, if appropriate, a paramedic will be sent to the patient’s home to provide treatment and reassurance to patients who may have previously ended up attending A&E before a GP could traditionally attend.

E-consult allows patients to contact their GP online from their homes 24 hours a day.

P a g e | 23 





Communities are benefitting from clinical The CCG continues to pharmacists who are able to review and ensure that services are potentially streamline peoples’ medication to co-designed by local people. help them better manage their health. The variety of services is changing at GP surgeries and because of this receptionists have been trained to help patients access the most appropriate care for them, as quickly as possible whilst making the best use of available skills within the surgery. Paramedic practitioners are being rolled out within the community who can see patients directly without a GP referral.

While lots of great work has already taken place the CCG will continue working to ensure quality, safe and effective services are available across North East Hampshire and Farnham. We are committed to co-designing with local communities and workforce to get the best results for local people.

P a g e | 24

Hampshire children’s and maternity services North East Hampshire and Farnham CCG leads on the commissioning of children and young people’s services on behalf of the five Hampshire CCGs (Fareham and Gosport, North East Hampshire and Farnham, North Hampshire, South Eastern Hampshire and West Hampshire) and works closely in partnership with Hampshire County Council and other partners to ensure services are commissioned in order to address all levels of need universal, targeted, specialist and acute. Over the last year we committed to achieving the below six actions: 1.

Improve the transition process from paediatric care to adult care

We developed a local paediatric transition service specification to enable safe and supportive transition for young people. This sets out the generic principles applicable across paediatric and adult specialist health services and specifically looks at young people aged 13-25 years and outlines the Six Quality Standards for Transition. All local services have signed up to the transition protocols. 2.

Improve maternity services

The CCG continues to lead the ‘Better Births’ Pioneer site for Southampton, Hampshire, Isle of Wight and Portsmouth. This project is changing the landscape of maternity services locally. We have created a seamless, standardised model of care which enables choice and empowers women and their families to take control of their personal journey. Their ante-natal, intra-partum and postnatal experience will be safe, positive and centred around them. The service is on track to deliver more than 2,000 personalised maternity care packages, so women have choice and a personalised plan on how and where their baby will be born. The My Maternity Choices app has been developed for women to help them further understand their choices. 3. Improve services for children and young people with additional health needs We have continued to support the local offer established with parents and managed by the third sector. The Designated Clinical Officer supports the work in relation to educational health care plans and the roll-out of personal health budgets through the ‘My Life, My Way’ integrated personal commissioning project. We continue to work in partnership with Hampshire County Council through the Joint Commissioning Board. The team has been working with the Transforming Care Partnership Board to improve services for children and young people with learning disabilities and/or autism. Key areas of work have been working with the local authority to improve:  provision of early intervention and prevention support;  transition from children’s health and social care teams to adult services;  housing/accommodation options for young people going through transition; and  working with young ‘peer leaders’ to co-produce commissioned services and their evaluation.

P a g e | 25 4.

Improve the emotional health and wellbeing of children and young people

The Child and Adolescent Mental Health Service continues to offer a single point of access for referrals, including self-referrals. The ‘Future in Mind’ funding has been invested in eating disorder service and continues to fund counselling services from No Limits and parenting programmes from Barnardo’s. A Young Persons’ Safe Haven for those aged 10-17 continues to operate in Aldershot. This service operates an out of hours mental health crisis service for young people. All local providers have signed up to the Transition Protocol from the Child and Adolescent Mental Health Services to Adult Mental Health Services and learning disability services so that transition is as smooth as possible between provision. It is based upon the evidence that proper planning results in better mental health outcomes for young people. Events have been held for children and young people to improve the health and happiness of Hampshire's young people. Targeted events for parents have also been provided, with more planned in the future. 5.

Ensure the needs of children and young people are included in Sustainability and Transformation Partnerships

The CCG leads the children’s work programme for the Hampshire and Isle of Wight Sustainability and Transformation Partnership. There is a detailed work plan that focuses on physical health, mental health and integrated working opportunities. The programme includes the following:

P a g e | 26 Successes during 2017/18:

The CCG supported the A successful bid was put forward to NHS England to development of a website, develop a new model of care to reduce out of area made by parents, to help admission to psychiatric units and to deliver care closer signpost families to where to home for acutely unwell children. The successful £0.5m is enabling commissioners and providers to work they can access support, together for the benefit of patients. Additional training is help and advice. being provided to professionals within Accident and www.braain.co.uk Emergency departments in acute hospitals to help them to identify and manage risk when young people present, putting in place clear pathways to provide the best possible support within a timely manner. Another successful bid of £0.2m was awarded from NHS England to develop urgent and emergency care, called Connecting Care, hubs for children. A number of pilots are being rolled out across the Hampshire and Isle of Wight Sustainability and Transformation Partnership footprint to test out new ways of working with primary and secondary care. The purpose of the pilots is to reduce the need for attendance at emergency departments by educating parents and carers to manage minor ailments in the community or at home. Through winter pressures funding of £0.1m a pilot is also being implemented to increase capacity within the Accident and Emergency departments in acute hospital with additional mental health support for young people. 6. Engagement events Working closely with parents, the CCG supported the development of the BRAAIN website. Through co-production, parents developed a much needed resource to help signpost families to where they can get support, help and advice.

The CCG continues to work with families to co-produce a sustainable provision of services to support the increasing number of children with neuro-developmental needs.

P a g e | 27

Performance analysis This section of the annual report looks at how our system has performed over the last financial year. More specifically, it sets out how we have performed against nationallyagreed quality standards which are very important for our patients and the public as they relate to key areas such as access, treatment times and quality of care. Performance against these targets, and the plans we have to improve them, is overseen by our Finance and Performance Committee on a monthly basis. Achievements in 2017/18 Referral to Treatment Times (RTT) Standard: 92% of patients on an incomplete pathway should receive treatment within 18 weeks The CCG has met its Referral to Treatment time target, with 92.2% of patients waiting less than 18 weeks. The CCG has made strong improvements in this area and the number of patients waiting for treatment has reduced by 1,350 compared to this time last year (5.9%). Cancer Targets The CCG has met all eight constitutional metrics for cancer, whilst the only nonconstitutional metric has failed for the year. The CCG has made strong improvements in this area as we have seen the number of breaches dropping by 62 (18.5%) compared to this time last year, whilst activity has dropped by 177 patients (2.1%). Improving Access to Psychological Therapies (IAPT) The CCG has met all four Improving Access to Psychological Therapies metrics for the year so far and is1.4% above the access trajectory target. On average 53.5% of patients recover against a target of 50% and on average 98.2% of patients are seen within six weeks against a target of 75%. Challenges There are some areas where the CCG will be working with providers to improve in 2018/19: Accident and Emergency waiting times Standard: 95% of patients to be seen within four hours Treating patients within four hours in Accident and Emergency departments have been a national challenge through 2017/18. Locally we have performed well compared to our peers, with 90% of patients treated at Frimley Park Hospital seen within four hours. This remains a key area of challenge for 2018/19 and the CCG will be working hard towards the new targets laid out by NHS England. Ambulance Response Times These are calls that are classified as immediately life threatening and require an emergency response (with blue lights). There are different targets dependent on the scale of the emergency. Ambulance services are provided to the CCG by South East Coast Ambulance Service NHS Foundation Trust. The CCG is working collaboratively with local commissioners, national bodies, and system partners to support the ambulance trust to improve performance against their core targets. Locally, we are working with Frimley Health NHS Foundation Trust to reduce handover delays to ensure that ambulances are turned around as quickly as possible.

P a g e | 28 Children and Adolescent Mental Health Services (CAMHS) Our Children and Adolescent Mental Health Services providers have seen an estimated 13.8% more referrals than planned for the year to date. This combined with a backlog of patients from the previous year has seen waiting times deteriorate for both assessment and treatment. The service is being closely monitored by commissioners and NHS England to ensure they get back on track and are able to sustain good waiting times for patients. CCG Performance: NHS Constitution Are patients rights under the NHS Constitution being promoted? Red - Target missed; Amber - w ithin 5% of target; Green - Target met

Target

YTD 2017/18

92.00%

92.18%

>99.00%

98.96%

95.00%

89.36%

93.00%

96.87%

93.00%

94.89%

Maximum one month (31-day) wait from diagnosis to first definitive trreatment for all cancers

96.00%

98.89%

Maximum 31-day wait for a subsequent treatment where the treatment is surgery

94.00%

97.09%

Maximum 31-day wait for subsequent treatment where that treatment is an anti-cancer drug regime

98.00%

99.33%

Maximum 31-day wait for subsequent treatment where the treatment is a course of radiotherapy

94.00%

94.43%

85.00%

88.27%

90.00%

98.98%

86.00%

77.78%

00:07:00

00:07:53

00:18:00

00:17:30

Category 3 is for urgent calls, resulting in a response within 120 minutes (Cat 3)

02:00:00

01:25:50

Category 4 is for less urgent calls, resulting in a response within 180 minutes (Cat 4)

03:00:00

02:18:20

NHS Constitution Measures Referral to Treatment waiting times for non-urgent consultant-led treatment Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks from referral Diagnostic test waiting times Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral A&E waits Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department (CCG) Cancer waits - 2 week wait Maximum 2-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) Cancer waits 31 days:

Cancer Waits 62 days: Maximum two month (62-days) 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 consultants decision to upgrade the priority of the patient (all cancers) Category 1-4 Ambulance calls: Category 1 is for calls about people with life-threatening injuries and illnesses, resulting in an emergency response arriving within 7 minutes (Cat 1) Category 2 is for emergency calls, resulting in an emergency response arriving within 18 minutes (Cat 2)

P a g e | 29 Mental health performance targets Are patients rights under the NHS Mental Health measures being promoted? Red - Target missed; Amber - w ithin 5% of target; Green - Target met

Target

YTD 2017/18

Early Intervention in Psychosis waiting times Patients experiencing first episode psychosis will be treated with a NICE-approved care package within two weeks of referral Dementia Diagnosis Rate

50.00%

72.00%

Patients aged 65+ with dementia should be formally diagnosed

66.70%

63.60%

19.60%

21.00%

Patients referred to this service should start treatment within 6 weeks of referral

75.00%

98.20%

Patients referred to this service should start treatment within 18 weeks of referral

95.00%

100.00%

Patients who complete treatment should recover

50.00%

53.50%

Patients referred to this service should receive an assessment within 4 weeks of referral

95.00%

45.61%

Patients referred to this service should receive a treatment within 8 weeks of referral

95.00%

57.00%

Patients referred to these services as an urgent referral should be seen within 1 week

95.00%

40.00%

Patients referred to these services as a routine referral should be seen within 4 weeks

95.00%

71.40%

NHS Mental Health Measures

Improving Access to Psychological Therapies Services should be providing timely access to treatment for at least 15% of those who could benefit (people with anxiety disorders and depression)

Children and Adolescent Mental Health Services

Children and Young People Eating Disorder Services

Overall summary of financial performance 2017/18 The NHS in Hampshire and Surrey continues to operate in a challenging financial environment, as is the case for much of the NHS in England. Despite this, the CCG successfully managed the delivery of its 2017/18 financial plan and all of its statutory requirements. The key results for the CCG are as follows:    

a surplus of £1.6m was delivered against an in-year revenue resource allocation of £305.1m, resulting from the nationally mandated release of the 0.5% Risk Reserve and the return of nationally retained drug price savings; cash was managed within the cash limits available; administrative running costs delivered a saving of £203k within the allocation of £4.7m; and the CCG delivered a total Quality, Improvement, and Productivity Programme (QIPP) of £9.1m.

P a g e | 30 A summary of our 2017/18 financial performance is below. For further details please refer to the CCG’s full set of financial accounts which follow on at the end of this report. 2017/18 £’m Core Allocation

272.5

Delegated Primary Care

27.9

Running Cost Allocation

4.7

Total Allocation

305.1

Expenditure

299

Running Cost Expenditure

4.5

Total Expenditure Surplus

303.5 1.6

As a result of the shared executive structure across the Hampshire CCG Partnership in 17/18 North East Hampshire and Farnham CCG saw a reduction in gross employee costs of £122K, which is also disclosed in the financial accounts. For 2017/18, the CCG set out a plan to deliver a breakeven position against its in year allocation. This included the recognition of a 0.5% risk reserve and the national reprocurement of drugs as stipulated by NHS England. In light of the national financial positions, CCGs were asked to hold this allocation, resulting in an in-year surplus of £1.6m. NHS England recognised the pressures that this caused for the local health economies. The CCG commissions a wide range of healthcare services across North East Hampshire and Farnham for its population. As our new care models embed themselves our main acute service provider, Frimley Health NHS Foundation Trust, has seen activity remain flat compared to previous years. The pie chart on the following page shows how our financial resources were applied in 2017/18 compared with 2016/17.

P a g e | 31

2016/17 £11.2m, 4%

2017/18 £11.2m, 4%

£4.7m, 2%

£4.5m, 1%

£20.2m, 7%

£18.4m, 6%

£19.4m, 7% £25.7m, 8% £21.7m, 8%

£19.4m, 6%

£156.6m, 52%

£149.2m, 51% £65.2m, 22%

£65.9m, 22%

Acute Services

Primary Care Services

Continuing Care Services

Community Health Services

Other Programme Services

Running Costs

Mental Health Services

Primary care services includes the commissioning of core primary care services delegated to the CCG by NHS England, primary care prescribing, as well as locally commissioned primary care services. Note: In 2017/18 £3m of acute activity previously commissioned by NHS England Specialised transferred to the responsibility of North East Hampshire and Farnham CCG. Mental health and learning disabilities continuing healthcare have been reclassified as ‘Mental Health Services’ from ‘Continuing Care Services’ in 2017/18 in line with national policy. Better Payment Practice Code All CCGs are expected to meet the requirements of the ‘Better Payments Practice Code’ and aim to pay all relevant creditors within 30 days. Performance against this standard is detailed in note 6 of the financial accounts.

Summary of key issues and risks The CCG operates a robust approach to identifying and managing its key risks. The Governance Body Assurance Framework (GBAF) focuses on the risks relating to the strategic objectives of the CCG and is reviewed by the Governing Body quarterly. The following strategic themes are being managed by the CCG: improving services, outcomes, and care quality for our population; system reform and engagement and partnerships. The following notable risks are being managed in year: 1. Loss of control over provider activity, quality and system finances. The CCG has successfully completed its third year of the Happy, Healthy, at Home programme and mitigated this risk in year. 2. Capacity within the CCG to commission new ways of working to embrace the future vision and opportunities in Health and Social Care. A number of actions have been

P a g e | 32 taken in year to mitigate this risk most notably the establishment of the Hampshire CCG Partnership which enables strategic commissioning at scale. 3. Engagement with general practice, in order to collectively implement the five year forward view and a sustainable primary care service, has been a key focus for the organisation. Sustainable primary care underpins the strategic vision for our Happy, Healthy, at Home programme and training programmes for 2018/19 are being developed in response to a survey where 4,402 patients commented on services within our geography.

Financial plan 2018-19 The CCG’s financial plan for 2018-19 has been developed as part of a refresh of the CCG's 2017-2019 Operating Plan, using activity projections planned alongside our local health system partners. The CCG's financial plans for 2018-19 assume delivery of an in-year break even position again in 2018/19, based on published allocation of £306.5m. From 2018/19 national Vanguard funding is ending, and the CCG will be delivering these new models of care from its own allocations. This £3.7m investment is a key part of the CCG’s wider investment programme for the coming year, which also includes investments in primary care transformation, mental health and support for carers. In order to deliver a balanced financial plan, the CCG needs to make efficiency savings of £9.4m. The Happy, Healthy, at Home programme has been successful in delivering more care outside of a hospital setting, reducing growth in expenditure with acute providers. Maintaining this trend is a vital component of the CCG’s efficiency programme and therefore the overall financial plan in 18/19. The Mental Health Investment Standard, which requires the CCG to increase the proportion of expenditure on mental health, will be exceeded with a 10.1% increase in mental health expenditure against a 3.3% overall programme allocation increase. The CCG will continue to deliver against the targets set out in the Five Year Forward View for Mental Health, supported by £0.85m additional investment.

The assurance process As statutory organisations, CCGs are responsible to their Governing Bodies for the delivery of both their statutory and constitutional duties and improvements in the health outcomes of their populations. NHS England approaches assurance from the assumption that CCGs will deliver against these requirements. The process uses information derived from a variety of sources including, where necessary, face-to-face visits. The nature of the oversight, including the expected frequency of assurance meetings, is agreed between NHS England and individual CCGs. The assurance process introduces a more risk-based approach, which differentiates highperforming CCGs, those whose performance gives cause for concern, and those in between. It consists of the following components:     

well-led organisation; performance: delivery of commitments and improved outcomes; financial management; planning; and delegated functions.

P a g e | 33 NHS North East Hampshire and Farnham CCG is expecting to receive “green” assurance on all domains assessed.

Sustainable development The CCG does not own any property. Estates management functions are undertaken by NHS Property Services, which oversees the Aldershot Centre for Health and Farnham Hospital buildings. Information for this report has been provided by NHS Property Services and applies to Aldershot Centre for Health only, this being the headquarters of the CCG. Performance As a part of the NHS, public health and social care system, it is our duty to contribute towards the level of ambition set in 2014 of reducing the carbon footprint of the NHS, public health and social care system by 34% (from a 1990 baseline) equivalent to a 28% reduction from a 2013 baseline by 2020. The graphs below compare our energy use and carbon footprint.

Carbon Emissions - Energy Use

Proportions of Carbon Footprint 2%

8%

7%

Carbon (tCO2 e)

150

Core

100

Commissioning 50

Supply chain Community

0 2014/15 Gas

Oil

Coal

2015/16

2016/17

Electricity

2017/18

83%

Green Electricity

CCG sustainability initiatives We have introduced a number of initiatives to reduce the CCG’s carbon footprint:     

increased use of teleconference facilities; increased video conferencing/webex facilities; use of an electronic document management system to reduce print runs and costs; the use of electronic devices (e.g. tablets) in the move towards a paperless office; and increased number of office consumables which are recycled (e.g. printer toners).

Partnerships We require effective contract mechanisms to deliver our ambitions of sustainable healthcare delivery. The NHS policy framework already sets the scene for commissioners and providers to operate sustainably and we will continue to work with our partners to ensure ongoing improvement. Looking forward, we aim to continue to work towards reducing energy consumption and supporting staff to help them honour our carbon reduction obligations.

P a g e | 34

Improve quality The NHS Constitution clearly articulates the patient’s right to high quality patient care. Under the Health and Social Care Act 2014, North East Hampshire and Farnham CCG holds the responsibility for ensuring continual quality improvement of all locally commissioned NHS services, now and in the future. A quality service is one that recognises the individual needs and circumstances of the patient and ensures services are accessible, appropriate and effective for all and that workplaces support and empower staff to deliver high-quality patient care. Quality in the NHS can be defined in three dimensions to quality that must be present to provide a high quality service (Darzi, 2008): 1. Patient Safety 2. Clinical Effectiveness 3. Experience of patients. The requirements for quality from our providers are set out in their contracts, which include a quality dashboard of key indicators with thresholds set for acceptable levels of care. Our quality assurance system ensures that we have early warning of any concerns and can address issues with providers to drive improvement. Scrutiny of the quality of care includes a number of processes to collate and triangulate information gathered from regular inspections and quality walk rounds from within the system and by external bodies such as; Care Quality Commission, NHS England and NHS Improvement. The processes in place include:  Clinical Quality Review Meetings. These meetings are established with each organisation commissioned to provide services. The purpose of this meeting is to seek assurance that commissioned providers deliver high quality care that is safe and clinically effective. The patient voice and staff feedback play an integral role in the information reviewed.  Quality Assurance site visits. Quality assurance site visits consist of speaking to managers, staff, patients and visitors, observing practices and processes and examining pertinent records and documents. Feedback is given to the staff present at the time and in writing shortly after. All quality assurance site visit reports are subject to discussion at the quality groups within the CCGs and the Governing Body meetings.  Serious Incident Learning and Review Panels - these panels provide opportunities for provider organisations and representatives from the CCG to learn from investigations of reportable serious incidents. Serious incidents are triangulated with other data such as complaints and soft intelligence to ensure learning supports and sustain robust quality improvements across organisations.  Contractual incentives, for example, Commissioning for Quality and Innovation schemes, are used to enable improvements in local services, to share and continually improve how care is delivered.  Clinical Governance. Providers are held to account for necessary improvements and action plans and to report themes and trends to their boards and through annual reports and quality accounts. CCG Quality Assurance Quality Improvement Committee This committee meets on a monthly basis and is chaired by one of the CCG’s non-executive. The role of the Quality Improvement Committee is to promote and assure quality through the implementation of the CCG’s Quality Strategy. It aims to ensure that commissioning decisions are based on evidence of clinical effectiveness, protect patient safety and provide

P a g e | 35 a positive patient experience in line with the principles of the NHS Constitution. The purpose of the committee is to bring together all of the quality intelligence from across the healthcare economy and discuss in detail. Standing agenda items for this meeting include:  escalations from the CCG’s Safeguarding Sub-Committee, which also meets on a bimonthly basis, with a sole focus on all aspects of safeguarding;  reviewing and actioning escalations from the Regional Safeguarding Adults and Children’s Boards;  ensuring implementation of key agendas such as anti-radicalisation training, domestic violence, looked after children, asylum seekers, missing and exploited individuals;  robustly reviewing all safeguarding alerts and ensuring key learning is shared widely;  risk management - the CCG’s quality risk register is discussed monthly and provider risk registers reviewed quarterly;  monthly reporting of all serious incidents with quarterly thematic reviews, including timeliness and quality of reporting;  monthly reporting of all complaints and concerns received by the CCG with quarterly thematic reviews, including response rates; and  to undertake detailed quality reviews of commissioned service, for example hospice care and community adult nursing services. An enhanced quality dashboard supports the Quality Improvement Committee by providing a wide range of quality metrics to ensure a high level of assurance and scrutiny the committee needs to fulfil its role. Providing safe services Better Care Included in the quality oversight process for the CCG is the Better Care and Better Health Data which is collected nationally. The data was published in 2017/18 for the 2016/17 CCG IAF Assessment period: Better Care 2016/17

Area

Baseline (2015/16)

Assessment - Cancer

Needs Improvement

Good

-

Cancers diagnosed at Early Stage

51.9%

52.8%

51.8%

People with urgent GP referral having 1st definitive treatment within 62 days of referral

86.4%

93.4%

80.8%

One year Survival from all cancers

72.2%

75.6%

72.3%

Cancer Patient Experience

8.7

8.7

8.7

(published 2017)

National

The better care data for North East Hampshire and Farnham Clinical Commissioning Group shows an assessment of ‘good’ which is an improvement on the initial assessment which was ‘needs improvement’.

P a g e | 36 During 2017/18, the CCG has been working to improve our early diagnosis rates and improving the quality of support for those living with and beyond cancer. Initiatives included: 

Implemented a primary care project focussing on improving the coverage of the NHS England bowel cancer and breast screening programmes. This project has included an element to support people from hard to reach groups such as those whose first language is not English, those from deprived areas and people with learning disabilities.

The All Parliamentary Group on cancer recognised NHS North East Hampshire and Farnham CCG as one of the top 20 CCGs who have made progress on improving one year survival rates. 1999- 2015



Working with our local provider, Frimley Health NHS Foundation Trust, on embedding the suspected cancer referral forms and guidance which supports increasing the one-year survival rates of patients with cancer. The All Parliamentary Group on cancer recognised NHS North East Hampshire and Farnham CCG as one of the top 20 CCGs who have made progress on improving one year survival rates between 1999 until 2015.



Continued to work with Frimley Health NHS Foundation Trust on ensuring the CCG achieves the NHS Constitutional cancer target of number of people with an urgent GP referral having 1st definitive treatment for cancer within 62 days of referral.



Improving patients’ experience of living with and beyond cancer – rolled out across the CCG a best practice guide to cancer care reviews which were co-designed with cancer patients. Additionally held the annual cancer health and wellbeing day for those living with and beyond cancer.



Annual cancer health and wellbeing day for those living with and beyond cancer.

Our cancer events for patients living with and beyond cancer have proved popular.

P a g e | 37 Better Health Maternal Smoking at Delivery Frimley Health NHS Foundation Trust remains committed to continue to implement and monitor the implementation of the care bundle for reducing stillbirth. Percentage of expectant mothers smoked at delivery CCG Total

7.3%

Frimley Park Hospital

7.07%

A Carbon Monoxide (CO) test is carried out at an antenatal booking appointment and all midwives have received training and have necessary equipment. The smoking cessation services work closely with Frimley with clinics and visits to antenatal and postnatal wards. The percentage of expectant mothers smoking at delivery has increased slightly but this could be due to women moving and the way the data has been captured. Frimley Health NHS Foundation Trust is committed on reducing these numbers and are reviewing their processes.

Safeguarding Systems and processes are in place to fulfil specific duties of co-operation and best practice in relation to safeguarding of vulnerable people and children. The Director of Nursing and Quality is the Governing Body Lead for Safeguarding. This responsibility is further delegated to the appointed leads for Safeguarding Children and Adults. The leads represent the CCG on the Wessex Safeguarding Children’s and Wessex Safeguarding Adults Board and the Surrey Safeguarding Children’s and Surrey Safeguarding Adults Health Subgroups. All contracts and service level agreements require the providers to ensure they have robust systems in place to promote the welfare of adults and children. Safeguarding is also an integral component of the CCG providers Clinical Quality Review Meetings and Quality Committee agenda. The Quality Committee reviews the high level data on safeguarding performance of providers; the governing body receives assurance on compliance with the Safeguarding agendas through this committee. Through the established Clinical Quality Review Meetings, the CCG ensured that all commissioned providers had the following safety indicators in place:  all eligible NHS and private providers are registered with the Care Quality Commission without conditions;  ensure all staff are enabled to identify and report concerns;  incident reporting and monitoring systems that include escalation procedures for Serious Incidents are in place and work within the NHS Serious Incident Framework Guidance;

P a g e | 38  National Patient Safety guidance is implemented and includes notifications received via the Management of Medicines and Healthcare Regulatory Authority (MHRA) Central Alert Systems (CAS). Learning Disabilities Mortality Review (LeDeR) Programme In 2016, Wessex, (including North East Hampshire), became an early adopter pilot region for the Learning Disabilities Mortality Review (LeDeR) Programme. In 2017 the programme was rolled out across the country so that now both North East Hampshire and Farnham are included. The CCG co-ordinates the programme in our area and trained reviewers are in place. The Learning Disabilities Mortality Review Programme has been established as a response to the recommendations from the confidential Inquiry into premature deaths of people with learning disabilities (abbreviated to CIPOLD 2013). The inquiry reported that people with learning disabilities are more likely to die from causes of death that could have been avoided with good quality healthcare. The programme aims to make improvements to the lives of people with learning disabilities; through undertaking local reviews of deaths of people with learning disabilities (aged four years and over), to identify potential avoidable factors that may have contributed to a person’s death, and identify ways of improving health and social care service delivery in order to reduce premature deaths. Serious Incidents An external audit of the North East Hampshire and Farnham CCG Serious Incident Policy and its associated processes resulted in a rating of “Substantial Assurance”. This means that we have a robust and effective system of internal controls operating effectively to ensure that risks are managed and process objectives achieved. Our serious incident management allows us to hold providers to account and seek assurance over their arrangement for dealing with, and learning from serious incidents and never events. Our responsibility for performance management of serious incidents is clearly defined and supported by clear policy and operational procedures which are consistent with the NHS England Serious Incident Framework. Reporting incidents in Primary Care This year, via the Practice Support Programme, we have continued to build on improving primary care patient safety incident reporting on the National Reporting and Learning System with member practices. In 2016/17 two practices reported 20 incidents whereas in 2017/18 eight practices reported 39 incidents. This growth shows a significant improvement in both total numbers of reports and the number of practices reporting on the system. Through reporting on the system, practices demonstrate an open and transparent approach to incidents and sharing learning. This learning can then be used by local and national teams to support quality improvement more widely in general practice. Practice Support Programme Practice Support Programme visits have continued in 2017/18 involving clinical, commissioning and quality leads from the CCG meeting with clinicians and managers at each practice to discuss performance and quality. While still covering similar elements of quality to promote and re-inforce messaging around patient experience and incident reporting, the programme for this year also included the additional element of quality improvement methodologies and their implementation at practice level. The team has encouraged practices to adopt the use of a template that pulls together both process mapping and the ‘Plan, Do, Study, Act’ cycle in order to identify improvements as a practice

P a g e | 39 team and implement effective, lasting, positive changes that improve quality Reducing Healthcare Associated Infections The monitoring of Healthcare Associated Infections continues to take a zero tolerance approach to those that are deemed to be preventable. Where Healthcare Associates Infections occur, we work with providers to complete rigorous reporting and investigating processes using root cause analysis and post infection reviews. In line with the national guidance for 2016/2017, providers have been given the opportunity to demonstrate where implementation and practice of policies have been carried out appropriately. This has been positively embraced to demonstrate that safe patient care is being achieved and to ensure that any breaches in policy are identified and quickly addressed. In 2018/2019, we will focus on the Quality Premium across the whole health economy for E. coli bacteraemia, a blood stream infection more often associated with urinary catheters and predominantly considered as community onset. A Positive Experience of Care The Friends and Family Test In order to ensure that the services commissioned by North East Hampshire and Farnham CCG are patient-centred it is important for us to listen and review the feedback that we get from the public. The NHS Friends and Family Test was created to help service providers and commissioners understand whether their patients are happy with the service provided, or where improvements are needed. It is a quick and anonymous way for patients to give their views after receiving care or treatment across the NHS. The graph below shows the level of satisfaction of patients within Frimley Health NHS Foundation Trust from April 2017 – January 2018. Due to technical difficulties, NHS England was unable to capture maternity data for November 2017.

Datix Clinical Concerns System & Friends and Family Test During 2017/18 the CCG has seen a significant uptake in the use of the Datix Clinical Concerns System and also the Friends and Family Test by practices all of which contribute to the quality improvement agenda. These successes are considered to be strongly linked

P a g e | 40 with the continued practice support programme approach and a focus on maintaining positive working relationships with practices. Key themes from the Datix Clinical Concerns System continue to be issues with discharge arrangements from the acute care setting and access and waiting times for appointments.

Complaints, Concerns, Compliments and Feedback Overview of the CCG complaints process We welcome the feedback that complaints and compliments from members of the public can bring us. This ensures we learn lessons where we can, making improvements to the services we commission where possible. The Complaints Policy was updated in November 2017 to align processes across the Hampshire CCG Partnership. Concerns are prioritised and handled in a similar way to complaints; we have tried hard to ensure that investigations are undertaken promptly, and that full, clear and honest responses are provided. We take seriously all forms of remedy e.g. an apology, or an explanation and do our best to ensure those healthcare providers take action to ensure that mistakes are not repeated. Feedback comes from members of the public, patient groups, our local Members of Parliament and local clinicians. This feedback is shared with the CCG in order to influence commissioning decisions if necessary. The CCG provides advice to patients and their carers about the help available if they are unhappy with the NHS care that they have received; this includes assisting a discussion with the care provider at the time a concern is identified if at all possible, and providing advice about independent advocacy services and the Parliamentary Health Service Ombudsman (PHSO) as appropriate. The Quality Improvement Committee receives regular reports on complaints, identifying key themes and trends. The committee then uses this data to consider impact on quality of services commissioned by the CCG. Internal Audit During 2017/18, an internal audit was undertaken about the North East Hampshire and Farnham CCG complaints process. The audit rated the processes within North East Hampshire and Farnham CCG as ‘reasonable assurance’. North East Hampshire and Farnham CCG has since worked closely with North Hampshire CCG, Fareham and Gosport CCG and South Eastern Hampshire CCG to develop a joint complaints policy. The revised policy has been approved by Quality Committees in all of these CCGs. The CCG has also worked to ensure that the culture regarding complaints handling is one of openness and honesty. There is a plan in place to hold a complaints learning event for CCG staff in September 2018 which will be open to North Hampshire CCG. This is to ensure CCG staff members are informed of processes and made aware of the importance of the complaints process. Complaints, Concerns, Enquiries and Compliments Received The table on the following page shows the number of complaints, concerns, enquiries and compliments that have been received over the financial year 2017/18.

P a g e | 41 Complaints & Concerns 2017/18 2017/18 Complaints 11 Concerns

101

Learning and developments related to complaints and concerns Complaints and concerns raised to the CCG help to inform future service improvements, and help to identify where there is perhaps a lack of information or identify a need. The following are some of the issues identified via complaints and concerns during 2017/18: 

The CCG received multiple complaints and concerns regarding the commissioning of the Community Paediatrics Service. These were shared with commissioning colleagues in order to ensure they were fully versed on the main issues when commissioning the new service.



The CCG received a complaint from a private Consultant Psychologist having difficulty working with the NHS Child and Adolescent Mental Health Service (CAMHS). Members of the CCG and CAMHS met with the psychologist to discuss this and agree a process going forward.



The CCG has received multiple complaints and concerns relating to funding for varicose vein surgery and In Vitro Fertilisation (IVF). These are discussed with the Commissioning Support Unit to ensure the Individual Funding Request process is followed and outcomes are clearly provided to patients.

The CCG ensures individual quality leads are informed of complaints or concerns relating to their specific contracts. These are then raised at the Clinical Quality Review Meetings where necessary. Parliamentary Health Service Ombudsman There was one complaint that was escalated to the Parliamentary Health Service Ombudsman in 2016/17. The final report from the Parliamentary Health Service Ombudsman was received in July 2017 relating to a complaint raised against the CCG and Surrey and Borders NHS Foundation Trust in 2015 in relation to the mental health care and treatment of a patient. The Parliamentary Health Service Ombudsman found that the CCG acted appropriately to facilitate further input from the Trust and the provision of additional services outside the Trust. However, the report identified improvements that the CCG needed to make in its complaints handling of this case including: ensuring the complaints process is used to identify concerns with clinical care in providers and ensuring complaints responses address each concern in full, The Parliamentary Health Service Ombudsman recommended that the CCG write to the complainant acknowledging the gaps in its complaint handling and provide an apology. This was completed on 24th August 2017.

P a g e | 42 Care Quality Commission Inspections Over the course of 2017, a number of services commissioned by North East Hampshire and Farnham CCG and GP surgeries were inspected by the Care Quality Commission. Sussex Partnership NHS Foundation Trust Sussex Partnership NHS Foundation Trust’s latest Care Quality Commission inspection report was published on the 23rd of January 2018. This report relates to inspection visits that took place between the 2nd of October and the 7th of December 2017. The Trust’s Child and Adolescent Mental Health Services were included in the inspection across both Sussex and Hampshire. The overall rating for both the Trust and their Child and Adolescent Mental Health Services was good. The graphic below shows how this overall rating was made up across all five domains.

Some key highlights from the report that relate to the Hampshire Child and Adolescent Mental Health Services include: •

the service had addressed and managed the concerns raised at the last inspection;

•

clinician’s caseloads were continually monitored and managed. Risk to patients on waiting lists was well managed and mitigated;

•

all patients entering the service had thorough risk assessments and management plans in place. There were excellent safeguarding policies, procedures and lead practitioners in the service;

•

the service was managing the risk of its waiting lists well and was constantly engaging with patients, parents and carers to assess any changes in circumstances and risk. There was a consistent and effective approach across the service to dealing with crisis and emergency situations; and

•

there was clear leadership direction from senior members of staff within the service with sufficient leadership training and opportunities for all staff. Staff were extremely proud to work in the service and for the trust and morale was generally high amongst all staff.

The very few negative comments related mainly to estates issues, such as some sites not having enough therapy rooms and that not all therapy rooms had alarms. North Hampshire Urgent Care (Out of Hours care) The Care Quality Commission conducted an announced focused inspection at Frimley Primary Care Service Out of Hours GP Service North Hampshire Urgent Care (NHUC) on the 7th November 2017 and followed up on breaches of regulations identified at the previous inspection of 21st February 2017 to 23rd February 2017. The full comprehensive report of the inspection can be found by selecting the ‘all reports’ link for Frimley Primary Care Service on the CQC website at www.cqc.org.uk.

P a g e | 43 North Hampshire Urgent Care received a rating of ‘Good’ and rated as good in all areas:

From the focused inspection on 7th November 2017 the inspection found: 

all patients received an appropriate patient information leaflet when medicines were dispensed to them;



a system of daily stock checks had been introduced that ensured that there were appropriate stocks of medicines stored at the base and available for the vehicles;



systems had been introduced to ensure that small quantities of medicines could be dispensed to patients and accurately recorded without splitting boxes containing full courses of medicines;



the effectiveness of the new systems had been audited by the service;



lockable boxes in each vehicle containing prescriptions for stock medicines and all medical records were now emptied daily; and



sharps boxes were being correctly used and labelled.

GP Practices North East Hampshire and Farnham CCG continues to support practices through the Care Quality Commission inspection process. At the 2017/18 year end, the CCG can report 20 practices with a ‘Good’ overall rating, two practices with a ‘Requires Improvement’ overall rating and one practice that has yet to be inspected Care Quality Commission inspections for North East Hampshire and Farnham CCG Nursing and Residential Homes Within North East Hampshire and Farnham there are 32 adult nursing and residential homes licenced by the Care Quality Commission. The Care Quality Commission has conducted a number of inspections for Care Homes within North East Hampshire and Farnham Clinical Commissioning Group during 2017/18 and the following are a list of the inspections that were published in 2017/18.

P a g e | 44

Name of Home

Date Report Published

Safe

Effective

Caring

Responsive

WellLed

Overall

Ashton Manor Nursing Home

04-Oct-17

RI

G

G

G

RI

RI

Beacon House

18-Jan-18

RI

RI

G

G

I

RI

Devereux House

23-Aug-17

G

G

G

G

G

G

Fairhaven Residential Home

13-Oct-17

G

RI

G

G

G

G

Freelands Croft Nursing Home

12-Apr-17

G

G

G

G

G

G

Grace House Care Home Limited

05-Feb-18

G

G

G

G

G

G

Hill House

10-Oct-17

G

G

O

G

G

G

G

RI

G

G

RI

RI

RI

G

G

G

RI

RI

G

G

G

G

G

G

Full report Knellwood

11-Jan-17 Focussed visit 12-Sep-17

Manor Place Nursing Home Maple House

21-Apr-17

18-Jan-18

Marlborough House

15-Jan-18

G

G

G

G

G

G

Park View Residential Home

31-Jul-17

G

G

G

G

G

G

Ridgway Court

14-Dec-17

G

G

G

G

G

G

Wey Valley House

30-Aug-17

G

G

G

G

G

G

Willow Gardens Care Home

11-Aug-17

G

G

G

G

G

G

P a g e | 45  North East Hampshire and Farnham CCG worked with Beacon House which was the only care home that had a rating of inadequate from the Care Quality Commission. Thanks to the work with Beacon House, the Care Quality Commission identified a number of improvements and rated Beacon House as ‘Requires Improvement’ and Beacon House is continuing to work to make further improvements and sustained this excellent work, under its new leadership and aims to attain at least a rating of ‘Good’ when the Care Quality Commission reassesses.  North East Hampshire and Farnham CCG implemented proactive joint quality insight visits with care homes. The aim of these visits is to gain insight into the quality of care the residents in the care homes receive. These are proactive visits that enable health and adult social care to gain a baseline understanding of the care provided and highlights any areas for development and good practice. Where issues are identified, solutions are jointly sought early to prevent any escalating situations.  To support the joint quality insight visits, available information is used to enable resources to be focussed where needs are greatest and bring forward any visits where the data indicated there may be early warning of possible concerns, balanced with feedback from visiting community colleagues.  None of the care homes in North East Hampshire and Farnham is currently rated as ‘Inadequate’. Seven care homes improved their overall ratings and one rating downgraded within the last year. Continuing Healthcare NHS continuing healthcare is the name given to a package of care that is arranged and funded solely by the NHS for individuals who are not in hospital and have been assessed as having a ‘primary health need’. It is important that any patient eligible for continuing healthcare is reviewed on a regular basis. For North East Hampshire and Farnham CCG, this function was delivered by two lead CCGs; NHS West Hampshire CCG on behalf of all Hampshire CCGs and NHS Surrey Downs CCG on behalf of all Surrey CCGs. A Hampshire wide Performance and Governance Group Chaired by North Hampshire CCG has overseen the performance and Quality of Continuing Health Care across 2017/18. Vanguard and quality Commissioners and providers share an ambition to improve health services for local people and continue to work closely in order to deliver new models of care. This provides a strong foundation for assurance to further progress the vanguard projects as they become part of business as usual.

P a g e | 46

Medicines Management The prescribing of medicines is the most common intervention in health and so it is imperative patients get the best quality outcomes from their medicines. The CCG aims to improve the quality and safety of medicine use in order to deliver improved patient outcomes and value for money. Antibiotic prescribing The CCG is on course to meet the NHS target for reducing inappropriate antibiotic prescribing by GP practices in 2017/18. GP practices prescribe less antibiotics than the national average and below the target set for the CCG by NHS England. The CCG continues to encourage and support healthcare professionals to promote self-care and less use of antibiotics for minor coughs and colds and sore throats. Medicines safety In order to reduce harm to patients prescribed medicines that can cause unplanned hospital admissions, the CCG has implemented the audit tool known as PINCER in all practices. PINCER is recommended by NICE and identifies patients prescribed medicines who are potentially at risk of harm through prescribing errors or inadequate drug monitoring. As a result of this work, practices have identified patients requiring monitoring and some have been prescribed medicines inappropriately, leading to practices either stopping the medication or calling patients in for monitoring. The audit also resulted in some practices developing systems in order to identify and call patients in for regular monitoring as part of routine medication reviews. Development of prescribing guidelines and formularies The CCG continues to develop several prescribing and medicines optimisation guidelines and formularies for GP practices, local community pharmacies and wider healthcare professionals to aid evidence-based, cost-effective prescribing. These have included guidelines on infant feeds and formula milk and guidelines for stoma products. Care homes pharmacist In April 2017 the CCG successfully employed a dedicated pharmacist to provide a medicines optimisation service to local care homes. This service consists of residents having an annual medication review by the care homes pharmacist, in conjunction with the residents’ GP, care homes staff and, in some cases, the residents’ relatives, in order to reduce inappropriate polypharmacy (using multiple medications at the same time), reduce side effects and harm caused by medicines and improve health outcomes. The reviews cover all medicines but particularly those medications known to increase falls risk and contribute to hospital admissions. To date the pharmacist has undertaken 206 medication reviews and using a renowned scoring system estimates that the reviews have avoided nine hospital admissions due to inappropriate prescribed medicines. She has also provided training to care homes staff across the CCG on medicines use and worked in collaboration with the Care Quality Commission and local community pharmacies to improve policies and processes on the ordering, storage and administration of medicines in our care homes. The response to this new service has been positive from both doctors and care home staff. CCG community dietitian Another exciting development towards the end of the year was the appointment of a dedicated dietitian to provide oral nutritional support for malnourished patients across the CCG. The dietitian provides advice and support to GPs, care home staff, members of the

P a g e | 47 integrated care teams and community nurses as well as visiting patients to provide nutritional advice. Public engagement on national consultations regarding medicines This year NHS England launched two national consultations regarding the prescribing of medicines;  Items which should not routinely be prescribed in primary care: Guidance for CCGs; and  Conditions for which over the counter items should not routinely be prescribed in primary care: A consultation on guidance for CCGs. Clinical commissioning groups were asked to seek the views of their local population on the above consultations. As a result, the CCG undertook a public campaign involving our community ambassadors and using social media to encourage people to share their views with the CCG. The North East Hampshire and Farnham Area Patient Group provided a response to the consultation on ‘Conditions for which over the counter items should not routinely be prescribed in primary care’ and this was included with the CCG’s response.

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Engaging people and communities We want patients and the public to be at the heart of everything the CCG does. Local people have a right to be involved in the planning and decision making regarding their health and care and the right to information and support which will enable them to make informed decisions. This means getting the community involved at the very beginning of a project, not just asking them what they think of something that’s already been decided. We believe that better decisions are made when the patients and professionals work together. The CCG also has a duty, under Section 14Z2 of the NHS Act 2006, to involve the public in commissioning (planning, decision-making and proposals for change that will impact in individuals or groups and how health services are provided to them). We ensure that this is achieved through every level of the organisation, including working with patient participation groups, community ambassadors and Healthwatch. In this section of the report, we provide an overview of the consultation and engagement activities that have taken place over the past year (April 2017 – March 2018). We know from experience that engagement with patients, carers and the public can result in:  

 

better outcomes and patient experience - involving local people in decisions about their own health and care can improve care; improved services - gathering and using patient experiences can help the CCG commission (buy) and deliver services more effectively and based on what we know makes people feel they have received a good experience; reduced demand - informing and engaging people can increase self-care, improve takeup rates for healthy options, and reduce inappropriate service use; and deliver change - involving people in discussions and decisions about service changes can make it easier to manage risks and deliver difficult change successfully.

We’re driving a real culture change across the health and social care system to put engagement and co-production at the heart of everything that we do. We are developing citizen leaders, who we call community ambassadors, to help us make the radical changes needed to our services, to deliver patient-centred care in a cost-effective way. Community ambassadors are representatives from our local community who help us shape our engagement with the local community. They support and advise us in a variety of ways to help us engage with local people, to help design, build and review our services. This can include tasks like checking the language used in a report, letter or survey, designing engagement tools, or going out and asking people to complete a survey, or developing ways in which the CCG can ensure we are engaging in a sincere and meaningful way. With the community ambassadors programme (and through all actions we do with the public), we are helping residents to actively participate in design and delivery of services – now and in the future. Since the community ambassador programme started in 2016 they have had influence and impact on the design, development and on-going review of local services. Individual projects include, but are not exclusive to:

P a g e | 49 



 

   

 

Ongoing involvement with the engagement workstream – creation of both the Empowering Engagement staff programme and the Innovation Conference were due to the ideas of community ambassadors who sat on this workstream. This group, now known as the Engagement and Communications Action Group, continues to assist with the planning and review of all engagement activities and has The One You event focussed on helped design key self care and prevention. performance indicators by which the CCG can measure success. Through the Prevention Workstream – priority areas were recognised. Services such as Making Connections and Recovery College were co-designed and monitored. In 2017 a successful One You event took place in collaboration with the council and was co-designed and manned by community ambassadors. Carers review - from gathering feedback through to identifying areas requiring improvement and more recently procurement of services, Community ambassadors have been and are still involved with this on-going project. Community ambassadors have been integral in the design and development of Farnham Urgent Care Centre through: o providing their views and seeking the opinions of others during design; o planning public engagement events alongside CCG colleagues; o reviewing public information documents prior to release; o carrying out on-going service evaluation via patient surveys Assisted with the design of and participated in the both the CCG’s 2016 and 2017 annual general meetings. Continue to review and comment on the CCG’s website design as requested. Became part of the panel which judged nominees for our first local Care Home Awards in 2017, recognising outstanding contributions by both medical, non-medical and volunteer staff. Were invaluable in spreading the word on and encouraging people to complete the primary care survey of July 2017, resulting in more than 4,400 responses. Also codesigned the animation which explains changes in primary care locally (https://youtu.be/h3Xj4R-o2CE). Have attended sharing/engagement events on diabetes initiatives, social prescribing, cardio vascular pathways and involving carers to share and bring back ideas/initiatives from around the area. Are currently involved with work on musculo-skeletal, respiratory and gastro-intestinal pathways and in implementing and improving the integrated care team model.

The CCG is always looking for more volunteers to join the community ambassador programme. If you would like to find out more, visit www.northeasthampshireandfarnhamccg.nhs.uk/get-involved/community-ambassadors

P a g e | 50 Carers During 2017/18 the CCG has continued to work with local carers and carer organisations to improve the support provided to this vital sector of the community. We worked with Healthwatch Hampshire on Your Voice Counts, a project to gather the public’s experiences of using mental health services and look at the support that they receive and how it can be improved. At a special event for the programme in Fleet on January 16, Working with Healthwatch Hampshire, we have worked with carers to design carers hubs. 2018, we provided an update specifically on all the work taking place to engage with and support local carers. This included the provision of ‘Carers Hubs’ and clinics, designed as one-stop shops for people to seek advice and support on the many aspects of being a carer, including law, finance, nutrition, recreation, emotions. The hubs are delivered by the Princess Royal Trust for Carers, which works with many different organisations, reflecting the many different considerations a carer has. Much of our work to support local carers through the hubs has been driven or guided by evidence from the Princess Royal Trust for Carers and from the engagement work Healthwatch Hampshire was commissioned to complete. The work has been shared with both Hampshire and Surrey Carers Strategy groups which have young and adult carer representatives, as well as delegates from health, social care and voluntary organisations. Other CCGs in Hampshire are looking at the carers’ hub model with a view to introducing it in their areas. The CCG recognises that helping carers to provide better care and to stay well themselves, both mentally and physically, will contribute to better lives for those needing care and more effective use of NHS resources. We have been working with our partners across the broader healthcare system to explore opportunities to better support our carer population. On January 24, 2018, the CCG joined a range of other commissioners and provider organisations from within the Frimley Health and Care system. The 80 delegates came from carers’ groups, mental health, primary care, community services, acute hospital, social care and voluntary organisations. The event was aimed at promoting a whole family approach to supporting adults and young carers across the local health and care system and at including the carer community in influencing and shaping the work being done.

The CCG recognises that helping carers to provide better care and to stay well themselves contribute to better lives for those needing care.

The CCG was also shortlisted as a finalist for a prestigious Health Service Journal award for its partnership work with Hampshire County Council on carers support. Unfortunately the team was not chosen as the winner of the award, although being shortlisted was a great achievement in itself.

P a g e | 51 Empowering Engagement Programme Reflecting our commitment and objective to create a culture of engagement across all work of the CCG, we have recently delivered our Empowering Engagement Programme for the second year in a row. The programme which has members of staff and GPs working together, provides tools and shared learning to develop a work-based project to support engagement. The programme has had significant impact in creating engagement champions across the organisations and also supporting people to work across different teams. The programme was based on ideas developed by the Engagement workstream and developed by the communication and engagement team, working with local partners to build on existing work. It was delivered by the Wessex Voices Project. The programme has also attracted attention across Hampshire and Isle of Wight. Our partner CCG in North Hampshire recently ran a workshop for staff based on the Empowering Engagement programme and our colleagues in the Isle of Wight ran the six month course for health and social care colleagues.

Case study: 100% increase in confidence to do patient and public involvement Credit: Patient Public Involvement - www.patientpublicinvolvement.com February saw the showcase event for the 2017-18 Empowering Engagement cohort in North East Hampshire and Farnham. Attended by more than 50 people from inside and outside of the CCG, the group got to share their projects and learning, as well as engaging with the audience in a debate about supporting colleagues to engage with patients and the public at the start and throughout the design and improvement of services. We asked people to tell us three things they learnt from the programme, one person said: “The value that patients and the public bring in designing services that function better for patients – how to transform tokenistic conversations into constructive ones within management teams – the virtues of a good leader”. We asked people what one thing you will do differently at work now. A group member said: “Involve patients and the public in as many areas of my work as possible. The commissioning cycle has helped me to understand the timescales it takes for meaningful engagement, so I will aim to carry out engagements as early as possible”. You can view the case study posters for all Empowering Engagement Projects by visiting www.wessexvoices.org/case-studies.html Course director Jessie Cunnett said: “The Empowering Engagement Programme has been one of the best things I’ve been involved with. By working with people over a period of months, it enables a time for reflection and deeper thinking about the benefits of patient and public engagement. Exploring how it can improve the quality of services through the application of theory to practice. The group works together to create a supportive network too. It is great to see that the group is working together more closely day to day and has formed a wider network with those that did the programme last year and those who have done it on the Isle of Wight”. Cohort 2 of the Empowering Engagement Programme.

P a g e | 52 2020 Leadership Programme The 2020 Leadership Programme brings together some of the most enterprising and courageous clinicians and managers across the clinical, social care and public health systems to help redesign and lead changes for a better future to our local communities. The programme is built on cross-organisational collaboration, portraying leadership across a pioneering health system. Open to all clinicians and managers working in the Frimley Health and Care Integrated Care System, the programme breaks down organisational barriers and prides it’s richness by the diversity of seniority. Each year a cohort of 30 fellows is selected across the Frimley Health and Care Integrated Care System, spanning a diverse range of sectors and roles within their organisations. For the 2017 cohort this included practice managers, community matrons, GPs, senior managers, allied health professionals, nurses, ambulance clinical operations manager, military representation, hospital and hospice consultants and social care team leaders. Case study: Don’t stop me now! Redesigning patient care requires collaborative leadership with the courage to explore fresh ideas. Under NHS England’s New Care Models programme, North East Hampshire and Farnham vanguard launched the 2020 Leadership Programme to create an environment of collaboration, trust and freedom where leaders can step away from targets, processes and hierarchies. Megan John (pictured right) describes herself as ‘half human, half Duracell’. Juggling life as a busy GP, Megan recently led an expedition to the Atlas Mountains to deliver medicine to the Berber community – at one point finding herself on a mountain trail with a certain Richard Branson. And our intrepid physician has just returned from Namibia filming a children’s TV programme with people affected by teenage cancers. But 12 months ago, even Megan’s drive, energy and desire to transform patient care - was receding fast. “I have always wanted to be a doctor. It’s a wonderful job. But we are currently attempting to work in an incredibly difficult climate and many GPs have developed a hard resistance to the constant change expected of them,” she says. All her efforts to galvanise the GP community into a collaborative force were coming to naught. “I was trying to build connections with GP practices. I was just getting ‘nos’ all the time. The negativity could be horrendous, and I was losing my resilience and motivation.” All that changed with the 2020 Leadership Programme, which evolved from the Happy, Healthy, at Home programme, under the direction of programme director and Medical Director for the CCG, Dr Peter Bibawy, with the support of an Executive Board.

P a g e | 53 The programme enrolled 24 fellows onto the programme, including Megan. Using the networks the programme gave her, and drawing on her renewed confidence and skills in negotiation and leading change, Megan created time and headspace to discuss and plan how the GP practices could work together at scale. Megan also obtained business support to drive forward the project. “2020 helped me to get the weight of the CCG behind me and we discovered there was a huge commonality across primary care – and the energy and positivity began to resurface. We now have eight practices working together as a cluster hub. Two practices are going to formally merge next April, and we have memorandums of understanding for collaboration across six workstreams.” These include:    

sharing people, skills and organisational functions creating new and shared income stream caring for patients together (e.g. extended hours services, and specialist skill sets, such as, GPs with specialist skills in minor surgery or dermatology) creating and sharing new clinical and non-clinical roles (such as paramedics home visit services, pharmacists or physicians associates)

Rejuvenated, Megan didn’t stop there. “2020 made us redefine our interpretation of leadership and our sense of community. I am involved in training doctors and I provide peer support but I wanted to develop that further to build positivity and energy in primary care. So I posted in an online forum for primary care workers and asked who was happy? The response I got was incredible - 74 doctors posted directly to the thread. Yes, there was still some negativity but more positivity than I anticipated. “Using this momentum, and a clear desire for ‘joy’ in primary care, I contacted various organisations I’d come across through the 2020 programme, and one community interest company agreed to work with me. We are hosting an event in London in January for us to share what creates a positive and happy environment in primary care. We hope to take that learning and turn it into the DNA for great primary care.” “2020 re-invigorated me. It provided me with new networks and, with the CCG behind me, it legitimised what I had been trying to achieve,” says Megan. “At no point did the program stop us from doing more than they asked us to do. It skilled us up to move forward, to think bigger, to ‘go fly’ – and we are seeing delivery far beyond our original intentions.”

P a g e | 54 Innovation Conference The Innovation Fund and Conference was launched in early 2017 to attract individuals, community and/or voluntary groups who had ideas they felt could benefit the health and wellbeing of the local community and who needed help to realise their plans. Applications were invited for funding up to a maximum of £2,000 for each individual scheme and the CCG received a number of submissions.

The Innovation Fund offers small grants to the community to improve health and wellbeing.

The shortlisted projects were yoga for overweight women, patient-led self-help groups, cultural activities for people with mild to moderate mental illness, a wellbeing cycling project, a theatre club, an information and advice hub for Farnham Health Centre, GP sessions to raise cultural awareness of the Nepali community, and fun sessions linked to health and wellbeing for the Nepali community in Fleet, Yateley and Church Crookham. The CCG invited patients, the public, and local voluntary, community and other partner organisations to join it to appraise the schemes and decide who should receive funding. In the event all of the bids were funded and/or offered CCG support. Case study: Liz Glenn, fun health and wellbeing sessions for the Nepali community Liz Glenn, Health and Policy Project Officer at Hart District Council, worked with Hart Voluntary action on the project to hold fun health and wellbeing sessions for the Nepali community. She explained that early discussions with the Fleet Nepalese community and partners in Rushmoor helped to shape the project and resulted in modifications to the original idea including the decision to focus on engaging Nepali women and testing an approach in the Fleet area to begin with. Despite some delay in identifying a suitable Nepali facilitator, the programme launched in September 2017 at a joint event with Citizens Advice Hart, Hampshire Libraries and Making Connections. The first phase has identified aspects of health and local services that the Nepali participants would like to know more about. Each session has blended gentle physical activity with information and informal chat about topics such as healthy eating, mental health and Diabetes. Taking part in the Innovation Conference helped the project team to connect with services such as the Diabetes Specialist Nurses and adult mental health services who have contributed to sessions. Liz said: “Projects can take longer than anticipated to get off the ground and so it was really helpful to have the flexibility to extend the project until October 2018. The conference was a very helpful opportunity to get feedback and ideas from others and to meet partners who could contribute to the project. “Put in some time at the beginning of the project to engage with other local projects and services to find out what is already happening, whether you can learn any lessons from what has come before, and where there are opportunities to work together.”

P a g e | 55 Local Patient Participation Groups From 1st April 2015 it has been a contractual requirement for all English GP practices to establish and maintain a Patient Participation Group. Patient Participation Groups are the building blocks for engagement at GP practice level. Each GP practice has set up a group of patients interested in engaging with their work.

Patient Participation Groups are the building blocks for engagement at GP practice level.

Aiming to support local practices in this role, the CCG held a Patient Participation Group workshop to support practice managers and the patient groups to share resources across the footprint of the CCG, and agree how we will work together in the future. The event was a follow-up event to one held in 2016/17. The CCG wanted to bring patient participation groups together to share ideas and experience and agree a set of shared principles to underpin participation in practices. The event went well with next steps developed which included the move to more locality based models. With more than 60 attendees made up of practice managers and Patient Participation Group representatives, feedback on the event was positive with attendees requesting a similar event the following year. Building relationships with our community Increasingly we are working collaboratively with local voluntary and community sector organisations to develop effective involvement. We have commissioned voluntary organisations to undertake programmes where they have specific expertise, e.g. Making Connections, self-care and prevention. We also regularly meet with a range of community and voluntary groups, to ensure that we engage with groups including representing the nine protected equality characteristics. Hampshire and Surrey Healthwatch organisation Healthwatch is an independent organisation with a role to represent the views of local people. Healthwatch is an important patient and public engagement partner for the CCG. We meet regularly with Healthwatch representatives during the year. They are active participants in a number of our programmes including the carers consultation, and the mental health service users review. The CCG commissioned Healthwatch Hampshire to undertake ‘Your Voice Counts’ during 2017 where they facilitated a number of discussions with local people with mental health and learning disabilities. This work resulted in the development of the United Communities project, a local service-user group for people with mental health concerns. The group has now met twice and is having a positive impact on the local community. Representatives from Healthwatch sit on our Public and Patient Engagement committee. Social media and CCG website Our website provides information about our work online. We use the website to inform the public of our plans to engage, raise awareness of any consultation activity and also to provide opportunities to become involved. The website is updated regularly so we can report on the outcomes of all consultations and what we have done as a result of our activity. Our website is www.northeasthampshireandfarnhamccg.nhs.uk.

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Our Twitter account (https://twitter.com/NEHFCCG) continues to grow and we are continuing to use the channel as a friendly and informative voice about local health services – with an aim to tweet daily during the week. We also use Twitter as a route for engaging with local people and have increased our following of local partner organisations so we can help share news. As of April 1, we had 1,304 followers on Twitter. We are continuing to promote our presence on Facebook (www.facebook.com/northeasthampshireandfarnhamCCG) and are using Facebook more frequently to engage with local Facebook users, sharing information about services in the city and encouraging discussions. Our Facebook page now has 392 likes and continues to grow.

Get in touch If you would like to be involved in the future work of the CCG, please contact us via email [email protected], call 01252 335154 or write to: NHS North East Hampshire and Farnham Clinical Commissioning Group Fourth floor, Aldershot Centre for Health Hospital Hill Aldershot Hampshire GU11 1AY

Reducing inequality The CCG understands the health needs of the local population. Over the next five years action is needed to decrease inequalities in life expectancy and reduce premature deaths – increasing support for people to adopt healthier lifestyles, targeted at the least affluent and most vulnerable, and with a focus on Rushmoor district due to small areas of deprivation. The key strategic issue for the CCG in the long term is the ageing population and its impact on health needs - the prevalence of long-term conditions will increase over the next five years. The CCG recognises the diversity of the population it serves and the potential barriers that individuals and communities face to access health services. A range of methods are used to engage with the different communities and include:  face-to-face meetings;  online consultations;  written communications including Braille, large print, Easy Read and different languages;  audio records and online videos; and  social media . The CCG produces newsletters for local people. Topics covered include news on available, developing services and seasonal advice. The newsletters are:  Happy, Healthy, at Home  local partners and stakeholders email update

P a g e | 57 Patient and public views are gained via social media and they can get involved in the work of the CCG in a number of ways. These are:  The Community Ambassador programme  GP Patient participation Groups  Attending Governing Body meetings held in public  Public meetings and events on current projects.

Background According to the Joint Strategic Needs Assessment 2017 by Hampshire County Council the total population for North East Hampshire and Farnham is 209,458. Of which 24.7% are aged 0-19, 54.5% are aged 2064, 17% are 65+ and 2.3% are 90+. Our population is growing and ageing. With an ageing population, the workforce aged population is reducing which then puts pressures on health and care support services. However we have higher than national life expectancies across our area for males and female.

Across the CCG health inequalities impact differently, as shown in the life expectancy gap between most and least deprived and between genders. Main impacts are by circulatory disease, cancer and respiratory disease.

P a g e | 58 Notable differences:  

Rushmoor (respiratory and digestive disease including alcohol-related disease in women, external causes in men) Waverley (mental and behavioural, including dementia in women)

The CCG believes that focussing on prevention, improving lifestyles and self-management is the key to ensuring all of our population live long, healthy lives.

Equality and Diversity Steering Group The CCG has established an Equality and Diversity Steering Group that sits quarterly to continue working on the agenda and spread the message across the CCG. The CCG is clear that this is an area that requires some additional input over the coming year.

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Health and Wellbeing Boards The CCG participates in and supports the delivery of both the Health and Wellbeing Boards for Surrey and Hampshire (as shown below). In accordance with the Health & Social Care Act 2012, in preparing the annual report, the CCG has consulted with both of these Health and Wellbeing Boards. Surrey Health and Wellbeing Board priorities Improving children's health and wellbeing During 2017/18 the Surrey CCGs and Surrey County Council brought together a range of children’s services to support children with their physical, mental health and emotional wellbeing needs. The jointly-commissioned service provides a simplified pathway for families and helps them to navigate services in a more streamlined way. The new service delivers a range of improvements which commenced from 1 April 2017, including a “no wrong door service”, expanded operating hours and a new Behavioural Education and Neuro-disability Pathway for children with Attention Deficit Hyperactivity Disorder and Autism Spectrum Condition. Both Surrey and Hampshire successfully delivered services identified within their Future in Mind CAMHS (Child and Adolescent Mental Health Services) Transformation plans and have procured extended services including a new eating disorder service and some early intervention services delivered by the voluntary sector. North East Hampshire and Farnham CCG continues to offer a Young Persons’ Safe Haven service which mirrors the Adult Safe Haven, offering out of hours support to young people and their families with mental health crisis. There have been 432 attendances by young people and 105 attendances by parents/guardians since opening on 10th May 2016 to 30th April 2017. North East Hampshire and Farnham commissioners have worked closely through coproduction with an independent group of parents. Supporting the development of the BRAIIN (Be Ready ADHD/ASD Information Network) website which is a resource for family’s signposting them to essential help and support services. Improving older adults' health and wellbeing A series of ‘Dementia Awareness’ training days in primary care has been completed. Dementia link practitioner posts have been commissioned and recruited. Mental health posts have been developed to sit within community nursing teams, working with frail elderly. These posts will be developed into ‘Primary Care Mental Health Practitioners’ and for all ages, excluding children. The CCG invested in older persons’ mental health and community mental health recovery service teams with parity of esteem monies. The success of the Frimley System Care Home Forum has been largely due to the

P a g e | 60 engagement of all our health care partners, which includes general practitioners, community teams and Frimley Park Hospital. The forum is a half-day event that runs every other month. It provides an opportunity for our care home staff to come together and discuss clinical practice and patient pathways. The forum has been integral to the implementation of several transformational projects, which include but are not exclusive to:  HYDRATE - a project focusing on improving hydration levels within the elderly. The project was expected to both improve the health and wellbeing of older people and reduce bladder infections. In addition to the expected outcomes a reduction in high harm falls was also noted in the care homes taking part in the project, which in turn led to a reduction in hospital admissions.  Chefs masterclass: information and training days for local care home chefs.  Trusted Assessors: Provision of trained discharge assessors within Frimley Park Hospital who have an in-depth understanding of a care home’s environment and care capabilities. These assessors are trusted to make discharge decisions for patients going into a named care home, which negates the need for a staff member from the home to come to the hospital and assess the patient themselves.  Pressure Ulcer workshop  Falls protocol for care homes.  Dementia training Promoting emotional wellbeing and mental health The Safe Haven, at the Wellbeing Centre in Aldershot, continues to provide out-of-hours support to people experiencing, or on the verge of, a mental health crisis. The Safe Haven allows individuals to drop in without an appointment, to chat with other people in a similar situation or to sit by themselves in a safe environment, in the knowledge that they are supported and can talk to any of the qualified mental health professionals staffing the service. The service was co-produced with mental health service users. Progress in our mental health and learning disability services:      

The implementation of the North East Hampshire and Surrey Integrated Commissioning Strategy for Emotional Wellbeing. Delivery of the Mental Health Crisis Care Concordat across Surrey and North East Hampshire. The implementation of 16 ‘Dementia-friendly’ and community mental health primary care practices’ across North East Hampshire and Farnham. An increase in capacity for the Dementia Navigator Service. implementation of new over-65 and under-65 dementia pathways. The re-instated Wellbeing Implementation Network (supported by Healthwatch Hampshire) to improve engagement with the local population has resulted in the introduction of a new stakeholder group - United Communities.

Developing a preventative approach

1. Promoting self-care and self-management by engaging with primary and integrated care teams, initially focusing on weight loss, smoking and alcohol, and now developing a Mental Health Local Service Contract with primary care to improve Physical Health checks.

P a g e | 61 2. Working with partners and using social prescribing to strengthening communities to tackle inequalities and promote health and wellbeing. 3. Educational interventions which focus on living with and living beyond a mental health or other long-term condition. 4. Working with carers to establish what support they would like to see provided in future. 5. Educational programmes for dementia and mental health. 6. Transforming learning disabilities care and personal health budgets. 7. North East Hampshire and Farnham CCG joined a collaborative arrangement with Portsmouth and Isle of Wight CCGs to deliver a new perinatal mental health service which commenced in March 2017 and is provided by Southern Health NHS Trust. The Mental Health STP (Sustainability and Transformation Plan) workstream will deliver priorities set out in “The Five Year Forward View For Mental Health”. Safeguarding the population The CCG Safeguarding Strategy ensures that the following actions occur:  adult safeguarding training is delivered against the Bournemouth competency framework;  key performance indicators for all providers are clearly set out in contracts and monitored on a monthly basis;  continuation of the Quality Insight Programme;  safeguarding referrals and reporting are monitored through the Safeguarding Committee a subgroup of the Quality Improvement Committee which fits within the contractual process;  information sharing across the system is an integral element of the CCG’s priority, safeguarding remains a standing agenda item on all Clinical Quality Review meetings for all commissioned providers with feedback mechanisms in pace to the safeguarding boards;  the CCG continues to focus on raising the awareness of the PREVENT (short for ‘preventing violent extremism’), MET (Missing, Exploited and Trafficked) and FGM (female genital mutilation) agendas alongside existing safeguarding agendas;  the CCG has representation on the Hampshire and Surrey Health Safeguarding Children Advisory Group; and  the CCG has representation on all relevant sub-groups from both the Hampshire and Surrey Safeguarding Boards. The CCG has representation through collaborative working on the Hampshire and Surrey Safeguarding Boards. Hampshire Health & Wellbeing priorities Improving children's emotional health and wellbeing Sussex Partnership Trust continues to provide Children and Adolescent Mental Health Services through a single point of access for referrals, including self-referrals and signposting. Demand on the service is high with, at times, lengthy waiting times. However the service has responded positively to this demand, ensuring all children are appropriately safeguarded and clinical risk assessments are undertaken in a timely manner. Sussex Partnership has recently been rated Good across all areas of the service and outstanding for

P a g e | 62 ‘caring’. The CQC recognised that children are clinically managed well and the service now needs to identify further ways of bringing the waiting lists down. During 2017/18 additional investment was made into the CAMHS services increasing capacity within Sussex Partnership and bringing in Psicon as a additional provider to provide diagnosis and support for children with neuro-developmental needs. Work continues with Barnardos and No Limits providing Parenting programmes and counselling services. Again demand is high demonstrating the national picture. Commissioners continue to work in partnership with the Council to identify most effective use of resources to meet the demand. The eating disorders service continues to be delivered and the CAMHs provider has undertaken a year-long campaign called ‘Every Body Matters’ working with young people and schools to raise awareness. They recently teamed up with a resident artist to produce ceramic star fish which was then exhibited to promote self-awareness and body image. During 18/19 further work continues on Body Image videos and a campaign to raise awareness, build self-esteem and enter the Guinness book of records for the longest stretch of bunting. Each piece of bunting will have a personal message from school children promoting better self-image. The work also involves raising awareness of school staff in how to recognise and support children facing mental health issues. Specialist services have been commissioned with Hampshire County Council for the provision of children who have experienced sexual abuse. The Frankie Programme delivered in partnership with the Police and Crime Commissioner provides specialist support for young people and was developed by Frankie a young girl who was herself sexually abused. The service continues to deliver IAPT (Improving Access to Psychological Therapies), to improve the workforce, through training existing and new staff delivering mental health care for children and young people (statutory, voluntary or independent sector) in early support, targeted and specialist (Tier 2, 3 and 4) services in an agreed, standardised curriculum of NICE approved and evidence-based therapies. Improve the transition process from Paediatric Care to Adult Care The CCG developed a local paediatric transition service specification to enable safe and supportive transition for young people. This sets out the generic principles applicable across paediatric and adult specialist health services and specifically looks at young people aged 13-25 years and outline the six Quality Standards for Transition. Improve Maternity Services The CCG continues to lead the ‘Better Births’ pioneer site for Southampton, Hampshire, Isle of Wight & Portsmouth. This project is significantly changing the landscape of maternity services locally by creating a seamless, standardised model of care that enables choice and empowers women and their families to take control of their personal journey. Their antenatal, intrapartum and postnatal experience will be safe, positive and centred around them. The service is on track to deliver more than 2,000 personalised maternity care packages, so women have choice and a personalised plan on how and where their baby will be born. The ‘My Maternity Choices App’ has been developed for women to help them understand their choices.

P a g e | 63 Improve services for Children and Young People with Additional Health Needs The CCG supports the local offer established with parents and managed by the third sector. The CCG’s designated Clinical Officer supports the work in relation to Educational Health Care Plans (EHCPs) and the roll-out of personal health budgets through the ‘My Life, My Way’ Integrated Personal Commissioning project. The CCG continues to work in partnership with Hampshire County Council and has established a Joint Commissioning Board with the council to ensure the needs of children with additional needs are met. The CCG has been working with the Transforming Care Partnership Board to improve services for children and young people with learning disabilities and/or autism. Key areas of work have been working with the local authority to improve:  early intervention and prevention support provided;  transition between children’s health and social care teams to adult services;  housing/accommodation options for young people going through transition; and  working with young ‘peer leaders’ to co-produce commissioned services and how they are evaluated.

Operating Plan 2017- 2019 The operating plan set out what we planned to do over two years to improve the health outcomes and the quality of health and care services for our population within the resources allocated to us. The plan was approved by the Governing Body on 21 December 2016. For 2018-19, the plan has been refreshed to reflect our achievements to date and new priorities that have emerged in the past year. The operating plan and CCG objectives are underpinned by the objectives for the Hampshire CCG Partnership:  Performance and quality: To deliver the agreed operational performance and quality standards for our 850,000 population within the available resources, addressing areas where current performance and quality is below acceptable levels.  Service Improvement: To deliver the local and partnership-wide programme of service transformation, to bring about sustainable improvements in health outcomes, care quality and efficiency for our populations.  System Reform: To enable the development of effective local care systems and the future arrangements for strategic commissioning, strategic planning and system assurance, in order to create the environment for success.  People Development: To develop our people and member practices, our cultures and our leaders to enable innovation, excellence and high levels of staff satisfaction and productivity.  Develop the Partnership: To develop the CCG Partnership to enable the five CCGs to work together and use their combined strength and influence to deliver improvements for patients.

P a g e | 64 Challenges, priorities and impacts Challenges threatening the sustainability of high-quality services for our population include:  Demand for health and social care is rising at an unsustainable rate  Consultation with local people provides a strong mandate for change  Lifestyle factors including smoking, poor diet, lack of exercise and excessive drinking remain the most significant risk factors for chronic ill health in our area  Recruiting and retaining sufficient numbers of skilled and motivated staff  The cost of delivering services in the current model is rising more quickly than the available resources To address these challenges we are:  Changing how services are delivered – embedding our New Models of Care, investing in primary care, focusing on prevention and self care, proactively managing the needs of our population  Driving productivity and efficiencies - delivering efficiency programmes in providers and reducing the costs of commissioning. Driving system efficiencies through collaboration in back office and clinical services, estate rationalisation  Investing in technology - building a fully-integrated health and social care record accessible from any location, putting in place technology to bring care closer to home and fully utilise data for decision making  Redesigning how we work together - working as part of both the Frimley Health system and Hampshire Partnership footprints and redesigning governance arrangements Impacts and outcomes will include: Impacts for our population  Staying well and independent - people are better supported to stay well and manage their conditions  Better experience of care - more people have a positive experience of joined-up care  Better access to primary care - 8am-8pm services  More healthy years of life - through earlier diagnosis and intervention  Higher quality acute care - access to safe services with the best clinical outcomes 7 days a week  Improved mental health  Minimal delays in hospitals Impact on our health and social care system  National access targets achieved  Activity growth reduced in the acute sector  Reduced delayed transfers of care  Achieve financial control targets  More efficient use of bed capacity The plan will ensure delivery of our priorities • Improved support to help people stay well by targeted action to prevent ill health and promote self-care with a focus on long term benefits • Delivery of joined-up, accessible high-quality patient care that will result in sustainable primary care, working collaboratively to deliver 8am-8pm services, integrated community services with mental health and the voluntary sector key

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• •

partners and maintaining growth in emergency care to 1%, reducing the cost of emergency care by £2.5m over the next year Ensuring people receive hospital care when needed, which means we will extend community response services and reducing variation and health inequalities, reducing the cost of planned care by £2m over the next year Ensure timely access and quality services through delivery of constitution targets

Our Delivery Programmes In order to meet our challenges the CCG has identified the following programmes to enable delivery of its priorities for 2018-19 and beyond. The programmes are made up of a portfolio of projects to support delivery of the transformation agenda and will continue over a number of years. New Models of Care This programme will continue the roll out of the CCG’s new models of care, delivering more joined up care in a community setting. This year the CCG will focus on the delivery of equitable services across all five of our localities by March 2019, with the establishment of integrated care hubs in Farnborough and Fleet. Prevention and self care The CCG will continue to promote preventative medicines as part of all of its projects. In 2017/18 the CCG launched a new Carers service that brought equity to our population. Working with the voluntary sector we will be running our second Innovation Conference in April to support local community developed schemes. Primary Care The CCG will continue to commission and deliver the General Practice Sustainability Plan. This year all practices will have implemented online consultations and will continue to trial new models of workforce such as nursing associates and care navigators. Mental Health and Learning Disabilities The CCG will continue delivery of the objectives set out in the national Five Year Forward View for Mental Health, focusing on the integration of mental health professionals into existing multidisciplinary community teams. We will have a single point of access for all mental health services, improving response pathways for people experiencing mental health crisis. Our talking therapies programme (IAPT) will continue with its accelerated expansion. Community Services redesign The CCG will permanently embed our new models of care which we’ve tested through our Vanguard in which we will start our formal public and stakeholder engagement in 2018, with our plan to have this in place by April 2020. Integrated Urgent Care procurement Working with partners across Hampshire and Frimley, the CCG is commissioning an integrated urgent care service, bringing together existing 111 and GP Out of Hours services to begin in June 2021. This year the CCG will be engaging with our public and partners to design the new service.

P a g e | 66 Planned Care This year the CCG aims to sustain achievement of the waiting list (Referral to Treatment) and diagnostics performance standards within our acute hospitals. Working with partners across the Frimley Health and Care Integrated Care System we will improve pathways across five key specialties, as well as delivering the recommendations of the Independent Cancer Taskforce. Children’s and Maternity The CCG is working in partnership with Hampshire County Council to develop new models of integrated working. This year the programme will focus on improving waiting times for Child and Adolescent Mental Health Services, work with Frimley Health to implement national best practice in maternity care, as well as developing joint commissioning priorities across Hampshire. Continuing Healthcare To deliver excellent, right-sized care to enable patients receiving continuing healthcare to live at home or closer to their own communities with the appropriate level of support. This year the CCG will develop and implement a Discharge to Assess pathway for patients, ensuring care is delivered in the most appropriate setting with less than 15% of full continuing healthcare assessments completed in an acute hospital setting. Medicines Optimisation Aim to optimise the use of medicines across the localities and the Frimley Integrated Care System footprint, by improving patient outcomes and reducing inappropriate variations in primary care prescribing, and improving medicines safety.

Accountable Officer: Maggie MacIsaac Organisation: NHS North East Hampshire and Farnham Clinical Commissioning Group 24 May 2018

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Accountability Report Corporate Governance Report Members Report This section of the report contains information about our membership, the way we work as a CCG and some of our legal responsibilities NHS North East Hampshire and Farnham CCG covers a population of over 225,000 people registered at 23 GP practices in Rushmoor, Farnham and parts of east Hart council areas.

Member practices of the CCG in 2017/18 Practice Name Alexander House Surgery Branksomewood Healthcare Centre Crondall New Surgery Downing Street Group Practice Farnham Dene Medical Practice Fleet Medical Centre Giffard Drive Holly Tree Practice Jenner House Surgery Mayfield Medical Centre Milestone Surgey Monteagle Surgery North Camp Surgery Oakley Health Group

Address 2 Salisbury Road, Farnborough, GU14 7AW Branksomewood Road, Fleet, GU51 4JX Redlands Lane, Crondall, Farnham GU10 5RF 4 Downing Street, Farnham, GU9 7PA

Farnham Centre for Health, Hale Road, Farnham, GU9 9QS Church Road, Fleet, GU51 4PE 68 Giffard Drive, Farnborough GU14 8QB 42 Boundstone Road, Wrecclesham, Farnham, GU10 4TG 159 Cove Road, Farnborough, GU14 0HQ Croyde Close, Farnborough, GU14 8UE 208 Farnborough Road, Farnborough, GU14 7JN Tesimond Drive, Monteagle Park, Yateley, GU46 6FE 2 Queens Road, Farnborough, GU14 6DH 51 Frogmore Rd, Blackwater, Camberley GU17 0DB and Yateley Medical Medical Centre, Oaklands, Yateley GU46 7LS Princes Gardens Surgery 2A High Street, Aldershot GU11 1BJ Richmond Surgery Richmond Close, Fleet GU52 7US River Wey Practice Farnham Centre for Health, Hale Road, Farnham, GU9 9QS Southlea Group Practice 276 Lower Farnham Road, Aldershot, GU11 3RB Southwood Practice Links Way, Farnborough, GU14 0NA The Border Practice Blackwater Way, Aldershot, GU12 4DN The Ferns Medical Practice Farnham Centre for Health, Hale Road, Farnham, GU9 9QS Victoria Practice Aldershot Centre for Health, Hospital Hill, Aldershot GU11 1AY Wellington Practice Aldershot Centre for Health, Hospital Hill, Aldershot GU11 1AY

Governing Body Membership The Governing Body is constituted in accordance with the Health and Social Care Act 2012. The North East Hampshire and Farnham Governing Body is the principle decision-making body in the commissioning and contracting of high-quality healthcare for our local

P a g e | 68 community. It comprises 16 voting members with a variety of backgrounds, with a wide range of skills and experience. These include members overseeing elements of governance and patient and public engagement. It is comprised of six elected GPs; five Executive Directors, four Lay Members and one Secondary Care Clinician. In addition to the voting members there are representatives from local authorities and public health. Further details regarding the roles can be found in our Constitution and biographies of our Governing Body members are also available on our website. Each Governing Body GP also known as a Clinical Director has a specific clinical portfolio and works closely with one of the five localities within our geographical area. Clinical Directors manage GP Clinical Leads working within their respective clinical areas. The Governing Body engages with its member practices at regular GP Forum Meetings these sessions provide a platform for two way dialogue on a variety of topics. The GP Forum Meetings have assumed a number of the functions which were previously undertaken by the Practice Council. Hampshire CCG Partnership On 1 April 2017 the Governing Body of North East Hampshire and Farnham CCG entered into a Partnership with other local CCG - North Hampshire CCG and Fareham and Gosport and South Eastern Hampshire CCG to form the Hampshire CCG Partnership. Maggie MacIsaac the Chief Officer for North East Hampshire and Farnham CCG was appointed as the single Chief Executive Officer across the Partnership. The purpose of the Partnership is to ensure that CCG make best use of their collective resources and work together on a larger geography, whilst retaining a local focus on ensuring high quality health care for each of its respective populations. The Hampshire CCG Partnership Board provides strategic oversight on the work of each of the CCG. The individual CCG also have opportunities to meet together on a quarterly basis as the Hampshire Partnerships CCG Joint Governing Bodies. The North East Hampshire and Farnham CCG works within the Partnership whilst remaining an autonomous sovereign body. Changes to the Governing Body Members During the course of 2017-18 there have been a number of changes to the voting membership of the Governing Body. In addition to the changes associated with the establishment of the Hampshire CCG Partnership has resulted in more collaborative working and pooling of senior talent across the Partnership. Roshan Patel has taken on additional duties as the Partnership Director of Finance and has responsibility for the oversight of finances and across the Partnership; Ros Hartley has responsibilities as Director of Partnerships leading on mental health, children’s and maternity services across the Partnership and leading on our joint work with Hampshire County Council. Ros Hartley also has executive responsibility for communication and engagement across the Partnership. To further support collaborative working across the Partnership, Dr Ed Palfrey, Secondary Care Consultant on the Governing Body of North East Hampshire and Farnham CCG has assumed the same role on the Governing Body of North Hampshire CCG. Emma Boswell (née Holden) Director of Quality and Nursing on the Governing Body of North East Hampshire and Farnham CCG has assumed the same role on the Governing Body of North Hampshire CCG. Peter Cruttenden, Lay Member for Governance at North East Hampshire and Farnham CCG

P a g e | 69 has taken the role as Chair of the Hampshire CCG Partnership Board. In September 2017, Mark Hammond, Lay Member and Chair of the Delegated Primary Care Commissioning Committee stepped down from his position on the Governing Body – the Governing Body subsequently agreed to co-opt Margaret Scott, Lay Member with South Eastern CCG to act as Convenor for the Delegated Primary Care Commissioning Committee whilst a Partnership wide review of Lay Member responsibilities is undertaken. Dr Andy Whitfield, Clinical Chair stood down from his position on the Governing Body in March 2018 in order to take up a Clinical Director role within the Hampshire Partnership (having served nearly two consecutive terms of office of three years, as allowed under the terms of the constitution). The Clinical Chair position was up for re-election in July 2018 and Dr Andy Whitfield was of the view that opting to step down early would provide continuity in clinical leadership as the new Frimley Health and Care Integrated Care System developed in the year ahead. The Wessex Local Medical Committees will start to run an independent election process to recruit his successor in the first quarter of 2018-19. In the intervening period the Governing Body voted to appoint Dr Peter Bibawy, Medical Director as Acting Clinical Chair until the formal independent election process could be completed. Dr Karl Bennett Governing Body GP was elected to the Governing Body in April 2017 following the retirement of Dr Olive Fairbairn from her position as a Governing Body GP in March 2017. Dr Hanne Hoff Governing Body GP was elected to the Governing Body in February 2018 following the retirement of Dr Jane Dempster from her position as a Governing Body GP in December 2017. An independent election process was run for both positions by the Wessex Local Medical Committees on behalf of the CCG - nominations were sought from amongst the GPs working within the 23 members practices and each of the practices were able to vote to appoint the new Governing Body GP. The three year term of office for Dr Ed Wernick Governing Body GP ended in March 2018 and the Wessex Local Medical Committees will start to run an independent election process to recruit his successor in the first quarter of 2018-19. During the course of 2017-18 the roles and responsibilities of all Governing Body GPs were reviewed to ensure that the new and existing clinical leadership continued to maintain a strategic focus on key issues. The voting members are listed below and their attendance in the table:       

Dr Andy Whitfield, CCG Chair and Clinical Lead (stood down in March 2018) Dr Peter Bibawy, Medical Director and Clinical Lead for Urgent and Emergency Care GP Southlea Practice (appointed as Acting Clinical Chair effective from 1 April 2018) Dr Steven Clarke, Clinical Director for Primary Care - GP Branksomewood Healthcare Centre and Chair of the Clinical Executive Committee Dr Jane Dempster, Clinical Director for Community Care / Integration and Safeguarding - GP Farnham Dene Medical Centre (retired December 2017) Dr Hanne Hoff, newly appointed Clinical Director (appointed in February 2018) Dr Karl Bennett, Clinical Director IT, ICT and New Models of Care, Community Services (appointed in April 2017) Dr Edward Wernick, Clinical Director for Clinical Director for Planned Care (Acute Transformation and Performance - GP Downing Street Group Practice (term of office ended in March 2018)

P a g e | 70  

       

Kathy Atkinson, Chair of the Patient and Public Engagement Committee and Lay Member with Patient and Public Involvement Portfolio and Chair of the Patient and Public Engagement Committee Peter Cruttenden, Lay Member with Governance Portfolio (Chair of the Audit and Risk Committee and Remunerations and Nominations Committee) appointed as Lay Member on the Hampshire CCG Partnership and Chair of Hampshire Partnership Remuneration and Nominations Committee in Common) Mark Hammond, Non-Clinical Lay Member and Chair of the Delegated Primary Care Commissioning Committee (stood down in September 2017) Elaine Budd, Non-Clinical Lay Member and Chair of the Finance & Performance Committee Maggie MacIsaac, Chief Executive Officer of the Hampshire CCG Partnership Roshan Patel, Partnership Director of Finance for the Hampshire CCG Partnership and Chief Finance Officer for North East Hampshire and Farnham CCG. Emma Boswell (née Holden), Director of Quality and Nursing for both North East Hampshire and Farnham CCG and North Hampshire CCG. Ros Hartley, Director of Partnerships for the Hampshire CCG Partnership (Director of Strategy & Partnerships) Ruth Colburn-Jackson, Director of Delivery Edward Palfrey, Secondary Care Clinician for both North East Hampshire and Farnham CCG and North Hampshire CCG and Chair of the Quality Improvement Committees

The attendance for the non-voting members is listed below and their attendance in the table:   

Dr Sallie Bacon, Director of Public Health, Hampshire County Council Clare Hook , Area Director for North East Hampshire Adult Services, Hampshire County Council Michelle Head– Area Director North and East Hampshire, Surrey County Council replaced Jean Boddy in November 2017.

Governing Body Public Attendance In 2017-18 meetings in public were aligned across the Hampshire CCG Partnership. During the course of 2017-18 there were three Governing Body Meetings in public; in April, October, 2017 and also in January 2018. The Governing Body has continued to evaluate its own effectiveness throughout the year and initiate changes which strengthen its decision making to support the delivery of high-quality care for the local population.

The below key is applicable for the following tables within the Members Report.  = present at meeting A = apologies received, did not attend meeting D = delegate representative attended

October 2017

January 2018

April 2017

P a g e | 71









A

Dr Edward Wernick







Dr Steven Clarke







Dr Peter Bibawy

A









Members Dr Andy Whitfield (Chair) Dr Jane Dempster (retired in December 2017)

Dr Karl Bennett Kathy Atkinson







Peter Cruttenden



A



Mark Hammond (stood down September 17)



Elaine Budd





A

Dr Ed Palfrey

A





Maggie MacIsaac

D

D



Roshan Patel (deputising for Maggie MacIsaac)







Emma Boswell (née Holden)



A



Ruth Colburn-Jackson

A





Ros Hartley



D



A

A

A



A

D

Non-Voting Attendees Dr Sallie Bacon, Public Health Hampshire County Council Clare Hook, Hampshire County Council Jean Boddy, Surrey County Council (retired April 2017) Michelle Head, Surrey Country Council (replaced Jean Boddy in November 2017)

A A

P a g e | 72

Declarations and the Register of Interests are reviewed by the Governing Body at each meeting. For details of declared conflicts of interest, please see the Remuneration Report on page 99.

Sub-committees of the Governing Body During the course of 2017-18 there have been some changes to the Governing Body Committee structure to support the collaborative working arrangements of the Hampshire CCG Partnership. Each of the individual CCG voted to establish Committees in Common for its Audit and Risk and Remuneration and Nominations Committees. The first meetings of the Committees in Common took place in September 2017. Between April and September 2017 the North East Hampshire and Farnham CCG Governing Body had seven Governing Body sub-committees, with delegated authority, set out within the CCG’s Standing Orders and Scheme of Reservation and Delegation. From September 2017 to March 2018 the Governing Body had five sub-committees and two Committees in Common. At its meeting the North East Hampshire and Farnham Governing Body receives regular reports from each of its sub-committees. The Governing Body Sub-Committees manage the risks identified on the corporate risk register, providing assurance to the Governing Body on how these risks are being mitigated. All Governing Body Sub-Committees review their performance and evaluate their own effectiveness. Work has been ongoing throughout the year to align the work programmes for the Quality Improvement Committee, the Clinical Executive and the Finance and Performance Committees - all committees receive regular “deep dive” reports on key performance issues. The Delegated Primary Care Commissioning Committee was established in 1 April 2016 and provides assurance to the Governing Body that the right primary care services are being commissioned for the local population. More information can be found within the Annual Governance Statement from page 91. Audit and Risk Committee April 2017 to September 2017 The role of the Audit and Risk Committee is to support the Governing Body by critically reviewing the governance and assurance processes that the Governing Body relies on. The Committee considers the reports and opinions from a variety of sources, including internal and external audit and Counter-Fraud Services. It acts as the senior assurance committee to the Governing Body. It has a crucial role to play in scrutinising the risks and controls affecting every aspect of the CCG, as well as maintaining its focus on finance and financial management. During the course of 2017-18 the North East Hampshire and Farnham Audit and Risk Committee met on 2 occasions, in May and August 2017 (the last meeting of the Committee in this format). From September 2017 onwards each of the Audit and Risk Committees within Hampshire CCG Partnership met together as Committees in Common.

P a g e | 73 The voting members or deputies and their attendance are listed in the table below:    

Peter Cruttenden (Chair), Lay Member with Governance Portfolio Elaine Budd, Non-Clinical Lay Member Mark Hammond, Non-Clinical Lay Member (stood down in September 2017) Dr Jane Dempster, Clinical Director for Community Care / Integration and Safeguarding - GP Farnham Dene Medical Centre (retired December 2017)

Regular attendees:    

Emma Boswell (née Holden), Director of Nursing & Quality; Maggie MacIsaac, Chief Executive; Roshan Patel, Chief Finance Officer; Representatives from Internal and External Audit and Local Counter Fraud Service

August 2017

May 2017

Attendance April – August 2017

Members Peter Cruttenden





Mark Hammond



A

Elaine Budd





Jane Dempster





Hampshire CCG Partnership Audit and Risk Committee in Common September 2017 to March 2018 The newly formed Hampshire CCG Partnership Audit and Risk Committees in Common met on three occasions. Each CCG has two voting members on the Committee in Common. The voting members or deputies and their attendance are listed in the table below:

P a g e | 74

2018

March

2017

November

2017

September

Attendance September 2017– March 2018

Members Judy Venables (North Hampshire)







Nick King (North Hampshire)

A



A

Elaine Budd (North East Hampshire and Farnham)

D



A

Ed Palfrey (North East Hampshire and Farnham)



Peter Cruttenden (North East Hampshire and Farnham)







Sarah Anderson (Fareham and Gosport)







Lucy Docherty (Fareham and Gosport)

A

A



Susanne Hasselmann (South Eastern Hampshire)





A

Nick Wilson (South Eastern Hampshire)

D





Regular attendees:         

Maggie MacIsaac, Chief Executive Officer, Hampshire CCG Partnership Roshan Patel, Director of Finance for Hampshire CCG Partnership and Chief Finance Officer for North East Hampshire and Farnham CCG Pam Hobbs, Chief Finance Officer, North Hampshire CCG Andy Wood, Chief Finance Officer, Fareham and Gosport and South Eastern CCG Ollie White, Deputy Chief Finance Officer, North East Hampshire and Farnham CCG Paul Jones, Deputy Chief Finance Officer, North Hampshire CCG David Bailey, Deputy Chief Finance Officer, Fareham and Gosport and South Eastern CCG Ann Cooper, Head of Governance, North East Hampshire and Farnham CCG Representatives from Internal and External Audit and Local Counterfraud Services

P a g e | 75 Remuneration and Nominations Committee The North East Hampshire and Farnham Remuneration and Nominations Committee oversees and monitors matters relating to CCG staff and their development. A more detailed breakdown of the work of the Remuneration Committee can be found within the Remuneration Report from page 99. During the course of 2017-18 the North East Hampshire and Farnham Remuneration and Nominations Committee met on 1 occasion, in April 2017 (the last meeting of the Committee in this format). From September 2017 onwards each of the Remuneration and Nomination Committees within Hampshire CCG Partnership met together as Committees in Common. The voting members or deputies are listed below and their attendance in the table:     

Peter Cruttenden (Chair), Lay Member with Governance Portfolio Kathy Atkinson, Lay Member with Patient and Public Involvement Portfolio Elaine Budd, Lay Member Mark Hammond, Lay Member (stood down September 2017) Edward Palfrey, Secondary Care Clinician

April 2017

Attendance April 2017

Members

Peter Cruttenden



Kathy Atkinson



Mark Hammond



Elaine Budd



Ed Palfrey



Regular attendees:  

Maggie MacIsaac, Chief Executive; Roshan Patel, Director of Finance for Hampshire CCG Partnership and Chief Finance Officer for North East Hampshire and Farnham CCG

P a g e | 76  

Elspeth Griffiths | Associate Director of HR and OD NHS South, Central and West Commissioning Support Unit Ann Cooper, Head of Governance

Hampshire CCG Partnership Remuneration and Nominations Committee in Common September 2017 to March 2018 The newly formed Hampshire CCG Partnership Remuneration and Nominations Committees in Common met on 3 occasions, in September, November 2017 and March 2018. Each CCG has two voting members on the Committee in Common. The voting members or deputies and their attendance are listed in the table below:

March 2018

February 2018

January 2018

December 2017

November 2017

October 2017

September 2017

Attendance September 2017– March 2018

Members Peter Kelly (North Hampshire)





A

Judy Venables (North Hampshire)







Kathy Atkinson (North East Hampshire and Farnham)

A





Peter Cruttenden (North East Hampshire and Farnham)







Sarah Anderson (Fareham and Gosport)



A



Pat Shirley (Fareham and Gosport)





A

Susanne Hasselmann (South Eastern Hampshire)







Margaret Scott (South Eastern Hampshire)



A

D

Key: = Present at meeting A = Apologies received, did not attend meeting D = Delegate representative attended

Regular Attendees:   

Fiona White, Director of HR and People Development Sonia Weavers, HR Business Partner, NHS South, Central and West Roshan Patel, Director of Finance for Hampshire CCG Partnership and Chief Finance Officer for North East Hampshire and Farnham CCG

P a g e | 77 Quality Improvement Committee The role of the Quality Improvement Committee is to support the Governing Body by ensuring effective quality arrangements underpin all services commissioned by the CCG, that regulatory requirements are met and patient safety is continually improved to deliver a better patient experience. It aims to ensure that commissioning decisions are based on evidence of clinical effectiveness, protect patient safety and provide a positive patient experience, in line with the principles of the NHS Constitution and requirements of the Care Quality Commission. The committee meets on a monthly basis (with the exception of August and March 2017). During the course of 2017-18 the committee met on 10 occasions. There were a number of changes to the membership of the committee during the year. The voting members or deputies are listed below and their attendance in the table:     

Edward Palfrey (Chair), Secondary Care Clinician Dr Peter Bibawy, Medical Director and Clinical Lead for Urgent and Emergency Care - GP Southlea Practice Emma Boswell (née Holden), Director of Quality and Nursing or Nominated Deputy Ruth Colburn-Jackson, Director of Delivery or Nominated Deputy Elaine Budd, Non-Clinical Lay Member

Attendance for other non-voting members is listed below:              

Robert Pears, Public Health, Hampshire County Council Jennie Fynn, Head of Medicines Management Dr Andy Whitfield, CCG Chair and Clinical Lead (pooled Governing Body GP member) Dr Edward Wernick, Clinical Director for Acute Transformation and Performance (pooled Governing Body GP member) Regular attendees: Kirsten Lawrence, Associate Director for Delivery & Commissioning the nominated Deputy for the Director of Delivery (stood down in September 2017) Emma Williams, Deputy Director of Delivery (Deputy for Director of Delivery from September 2017 onwards) Fiona Hoskins, Deputy Director of Quality and Nursing (stood down August 2017) Melanie Bessant, Acting Deputy Director of Quality and Nursing Steve Clarke, Head of Quality Phillip Shaw, Head of Quality (retired March 2018) Kathy Curtis, Quality Manager Joe Croombs, Clinical Lead for Quality in Care Homes Ann Cooper, Head of Governance

P a g e | 78

October 2017

November 2017

December 2017

January 2018

February 2018

















Emma Boswell (née Holden)

D









D





D



Elaine Budd











A







A

Peter Bibawy

A



A











A



Ruth Colburn-Jackson



D

A



A

A

D



D

D

Robert Pears

A

A







A



A

A

A

Edward Wernick











A

A





A

Andy Whitfield



A

A

A

A





A

A

A

Jennie Fynn





A



A

A



A



A

July 2017



June 2017



May 2017

Edward Palfrey (Chair)

April 2017

September 2017

Quality Improvement Committee attendance

Members

Non-Voting Members

Clinical Executive Committee On behalf of the Governing Body, the Clinical Executive Committee determines the effective arrangements and decisions which underpin all clinical services commissioned by the CCG. The committee meets on a monthly basis. During the course of 2017-18 the committee met on 12 occasions. There were a number of changes to the membership of the committee during the year. There were a number of changes to the clinical membership of the committee during the course of the year. Dr Jane Dempster, Clinical Director stood down from the committee in December 2017. Dr Ed Wernick, Clinical Director stood down in February 2018. Dr Karl Bennett, Clinical Director joined the committee in May 2017. Dr Hanne Hoff, the newly elected Clinical Director joined the committee in February 2018. The voting members or deputies are listed below and their attendance in the table: 

Dr Steven Clarke (Chair), Clinical Director for Primary Care - GP Branksomewood Healthcare Centre

P a g e | 79           

Dr Peter Bibawy, Medical Director and Clinical Lead for Urgent and Emergency Care - GP Southlea Practice Dr Karl Bennett, Clinical Director IT, ICT and New Models of Care, Community Services, End of Life Care and Mental Health Dr Jane Dempster, Clinical Director for Community Care / Integration and Safeguarding - GP Farnham Dene Medical Centre Dr Hanne Hoff, Clinical Director for Planned Care and Reducing Variation, Acute Services Pathway and Medicines Management Prescribing Dr Edward Wernick, Clinical Director for Acute Transformation and Performance (née Clinical Director for Quality, Patient Experience and Patient Engagement) - GP Downing Street Group Practice Dr Andy Whitfield, CCG Chair and Clinical Lead Ros Hartley, Director of Strategy & Partnerships or Nominated Deputy Emma Boswell (née Holden), Director of Quality and Nursing or Nominated Deputy Ruth Colburn-Jackson, Director of Delivery or Nominated Deputy Roshan Patel, Director of Finance for Hampshire CCG Partnership and Chief Finance Officer for North East Hampshire and Farnham CCG Edward Palfrey, Secondary Care Clinician

Attendance for non-voting members is listed below:  

Robert Pears, Public Health, Hampshire County Council Jennie Fynn, Head of Medicines Management

Regular attendees:      

Kirsten Lawrence, Deputy for the Director of Delivery & Commissioning (stood down in September 2017) Emma Williams, Deputy Director of Delivery (Deputy for Ruth Colburn-Jackson Director of Delivery) Angela Murphy, Deputy Director for Strategy and Partnerships and Lead for Children and Maternity (Deputy for Ros Hartley, Director of Strategy and Partnerships) Ollie White, Deputy Chief Finance Officer (Deputy for Roshan Patel, Director of Finance for Hampshire CCG Partnership and Chief Finance Officer for North East Hampshire and Farnham CCG) Fiona Hoskins, Deputy Director of Quality and Nursing (stood down August 2017) Melanie Bessant, Acting Deputy Director of Quality and Nursing

P a g e | 80

3 May 2017

7 June 2017

5 July 2017

2 August 2017

6 Sept 2017

4 October 2017

1 November 2017

6 December 2017

3 January 2018

7 February 2018

Steven Clarke, Clinical Director and Chair





A



















Peter Bibawy, Medical Director







A

A



A



A







Jane Dempster, Clinical Director







A





A





Ed Wernick, Clinical Director























Ros Hartley, Director of Strategy and Partnerships

A





D

D

D

D

D

A

D

A

D

Emma Boswell (nee Holden), Director of Quality and Nursing



A



D

D

D

D

D

D



A

D

Roshan Patel, Chief Finance Officer



D

D

D

D

D

D

D



A

D

Andy Whitfield, Clinical Lead and CCG Chair

A



A

A

A





A

A







Robert Pears, Public Health Representative

A





A







A

A







Jennie Fynn, Head of Medicines Management







A















A

Ed Palfrey, Secondary Care Consultant

A

A



A





A





A

A

A

Ruth Colburn-Jackson, Director of Delivery





D

A

D



D

D

D

D

D

D







A



















March 2018

5 April 2017

Clinical Executive Attendance

Members

Karl Bennett, Clinical Director Hanne Hoffe, Clinical Director



P a g e | 81 Patient and Public Engagement Committee The Clinical Commissioning Group (CCG) recognises the critical importance and value of engaging with patients and the public in order to improve health outcomes for the local population. The CCG has a Patient and Public Engagement (PPE) Committee, which is a formal subcommittee of the CCG, directly accountable to the Governing Body to assure the CCG that it meets its duties for engagement and to communicate in a meaningful way with the general public. Furthermore, the committee has explored ways to strengthen its scrutiny role over engagement activity and impact across the CCG. During the course of 2017-18 the committee met on 4 occasions. The committee revised its engagement structure and updated its terms of reference which were in turn ratified by the Governing Body in May 2017. It was agreed following this that a Community Ambassador Representative from an Action Group would be invited to sit on the committee and act towards quoracy. In November 2017 it was agreed that Valerie Fabry would fill this role. The voting members or deputies are listed below and their attendance in the table:            

Kathy Atkinson, Lay Member with Patient & Public Involvement portfolio (Chair) Dr Peter Bibawy, Clinical Director for Acute Transformation and Performance GP Southlea Practice Sharon Ward, Deputy Director for Communication and Engagement Kaylee Godfrey, Head of Communications Gillian Trippner, Partnerships Manager Frank Rust, Rushmoor Borough Council Representative, Patient Participation Group Member and Rushmoor Voluntary Action trustee Valerie Fabry, Community Ambassador, Co-Chair of the Healthcare Communications and Engagement Action Group and Patient Participation Group Member (joined November 2017) Steve Manley, Healthwatch Hampshire Fiona Biggs, Healthwatch Hampshire Gareth Jones, Healthwatch Surrey Lisa Sian, Healthwatch Surrey Sandy Frean, Surrey County Council Engagement and Participation Officer (joined November 2017)

P a g e | 82

November 2017

February 2018

Kathy Atkins (Chair)









Peter Bibawy









Sharon Ward (Interim Associated Director of Communication & Engagement)





A



Kaylee Godfree (Head of Communications)

A







Gillian Trippner (Partnerships Manager)









PPG Representative from Action Group





A







June 2017

September 2017

Patient and Public Engagement Committee Attendance:

Members

Community Ambassador Representative from Action Group Local Authority Representative









Healthwatch Surrey Representative









Healthwatch Hampshire Representative









Finance and Performance Committee The Finance and Performance Committee provides assurance to the Governing Body of the Clinical Commissioning Group that its financial and procurement strategies, performance and Quality, Innovation, Productivity and Prevention (QIPP) plans are robustly managed. During the course of 2017-18 the committee met on 11 occasions. There were a number of changes to the membership of the committee during the year. The voting members or deputies are listed below and their attendance in the table:    

Elaine Budd, Non-Clinical Lay Member Dr Andy Whitfield, CCG Chair and Clinical Lead Dr Peter Bibawy, Medical Director and Clinical Lead for Urgent and Emergency Care - GP Southlea Practice Peter Cruttenden, Chair of Audit & Risk and Lay Member with Governance Portfolio

P a g e | 83    

Ros Hartley, Director of Strategy & Partnerships or Nominated Deputy Emma Boswell (née Holden), Director of Quality and Nursing or Nominated Deputy Ruth Colburn-Jackson, Director of Delivery or Nominated Deputy Roshan Patel, Director of Finance for Hampshire CCG Partnership and Chief Finance Officer for North East Hampshire and Farnham CCG or Nominated Deputy Regular attendees listed below:

      

Dr Edward Wernick, Clinical Director for Acute Transformation and Performance (Clinical Director for Quality, Patient Experience and Patient Engagement) - GP Downing Street Group Practice Angela Murphy, Deputy Director for Strategy and Partnerships and Lead for Children and Maternity (Deputy for Ros Hartley, Director of Strategy and Partnerships) Fiona Hoskins, Deputy Director of Quality and Nursing (stood down August 2017) Melanie Bessant, Acting Deputy Director of Quality and Nursing replaced Fiona Hoskins Kirsten Lawrence, Deputy for the Director of Delivery & Commissioning (stood down in September 2017) Emma Williams, Deputy Director of Delivery (Deputy for Ruth Colburn-Jackson Director of Delivery) Ollie White, Deputy Chief Finance Officer (Deputy for Roshan Patel, Director of Finance for Hampshire CCG Partnership and Chief Finance Officer for North East Hampshire and Farnham CCG)

P a g e | 84 Finance and Performance Committee attendance:

Delegated Primary Care Commissioning Committee The Delegated Primary Care Commissioning Committee provides assurance to the Governing Body and NHS England that the right primary care services are being commissioned for the local population. During the course of 2017-18 the committee met on 8 occasions, there were a number of changes to the membership of the committee. In September 2017, Mark Hammond, Lay Member and Chair of the Delegated Primary Care Commissioning Committee stepped down from his position on the Governing Body – the Governing Body subsequently agreed to co-opt Margaret Scott, Lay Member with South Eastern CCG and also Lay Member on Hampshire CCG Partnership Board to act as Convenor for the Delegated Primary Care Commissioning Committee whilst a Partnership wide review of Lay Member responsibilities is undertaken. Dr David Brown, Chair of the Practice Council stepped down from this role in July 2017. The voting members or deputies are listed below and their attendance in the table:   

Mark Hammond, Lay Member (stood down September 2017) Margaret Scott, Lay Member for South Eastern CCG joined the committee as Convenor in October 2017 Peter Cruttenden, Lay Member with Governance Portfolio

P a g e | 85       

Maggie MacIsaac, Chief Executive Ruth Colburn-Jackson, Director of Delivery or Nominated Deputy Roshan Patel, Roshan Patel, Director of Finance for Hampshire CCG Partnership and Chief Finance Officer for North East Hampshire and Farnham CCG or Nominated Deputy Emma Boswell (née Holden), Director of Quality and Nursing or Nominated Deputy Dr Edward Palfrey, Secondary Care Clinician Dr Peter Bibawy, Medical Director and Clinical Lead for Urgent and Emergency Care GP Southlea Practice Dr Steven Clarke, Clinical Director for Primary Care - GP Branksomewood Healthcare Centre

Attendance for non-voting members is listed below:    

Dr David Brown – Chair of the Practice Council and GP – stood down as Chair of the Practice Council in July 2017 Wessex LMC Representative Health and Wellbeing Board Representative Healthwatch Representative



Regular attendees:

  

Lauren Pennington, Head of Primary and Planned Care Fiona Hoskins, Deputy Director of Quality and Nursing (stood down August 2017) Melanie Bessant, Acting Deputy Director of Quality and Nursing replaced Fiona Hoskins Kirsten Lawrence, Deputy for the Director of Delivery & Commissioning (stood down in September 2017) Emma Williams, Deputy Director of Delivery (Deputy for Ruth Colburn-Jackson Director of Delivery) Ollie White, Deputy Chief Finance Officer (Deputy for Roshan Patel, Director of Finance for Hampshire CCG Partnership and Chief Finance Officer for North East Hampshire and Farnham CCG) Dan Williams, Head of Financial Management and Reporting Dr Sally Johnston, Deputising for Dr Nigel Watson, Wessex LMC Dr Lisa Harding, Deputising for Dr Nigel Watson, Wessex LMC

     

P a g e | 86



14 February 2018

13 Sept 2017



10 January 2018

12 July 2017



8 November 2017

10 May 2017



11 October 2017

12 April 2017

Delegated Primary Care Commissioning Attendance:



A





Members Mark Hammond, Lay Member and Chair Margaret Scott, Lay Member and Chair Peter Cruttenden, Lay Member and Vice Chair Maggie MacIsaac, Chief Officer Ruth Colburn-Jackson, Director of Delivery Roshan Patel, Chief Finance Officer Emma Boswell (nee Holden), Director of Quality & Nursing Dr Edward Palfrey, Secondary Care Consultant Peter Bibawy, Medical Director Dr Steven Clarke, Clinical Director` Non-Voting Member Dr David Brown, Chair of the Practice Council Dr Nigel Watson, Chief Executive Wessex LMC or Nominated Deputy (stood down in Wessex LMC Deputy for Dr Nigel Watson Dr Laura Edwards, Medical Director for LMC replacing Dr Nigel Watson Health and Wellbeing Board / Public Health Representative - vacant HealthWatch Representative









A

 Chair



A



A

A

A

A

A

A

A

D

D





A

D

A

D







D



































A







A



A

























A

A

A

D

D



D

D

D

D

D















 

P a g e | 87

External Audit The CCG has secured the services of Grant Thornton to provide external audit services. The fees for the work undertaken within the CCG for the 2017/18 period were £34,000.

Internal Audit Services The CCG has employed TIAA Audit Services (formerly South Coast Audit) to undertake a planned programme of internal audit work. This programme comprises both statutory audit requirements and ‘other’ audits that the CCG has deemed appropriate throughout the 2017/18 financial year. Audit fees for the CCG were £40,160.

Serious Incidents Requiring Investigation There have been no reported Serious Incidents Requiring Investigation (SIRI) involving data loss or confidentiality for 2017/18.

Emergency Preparedness, Resilience and Response We certify the clinical commissioning croup has Incident Response Plans in place, which are fully compliant with the NHS England Emergency Preparedness Framework 2015. North East Hampshire and Farnham regularly reviews and makes improvements to its emergency preparedness, resilience and response plans. The CCG has an emergency preparedness, resilience and response work programme for 18/19 which has been signed off by National Emergency preparedness, Resilience and Response Team for NHS England, progress of which is reported twice yearly to the Governing Body.

Modern Slavery Act NHS North East Hampshire and Farnham fully supports the Government’s objectives to eradicate modern slavery and human trafficking but does not meet the requirements for producing an annual Slavery and Human Trafficking Statement as set out in the Modern Slavery Act 2015.

Register of interests We maintain a register of interests which sets out any declared potential interests and conflicts of staff, directors and Governing Body members involved in the decision making of the CCG. The register of interests is reviewed by the Governing Body in public on a regular basis and can be found on our website www.northeasthampshireandfarnhamccg.nhs.uk/about-the-ccg/publication-scheme/class-6list-and-registers

Research The CCG has a duty to ‘promote research and the use of research’. The CCG has this duty within its constitution. During the 2017-18 financial year, the CCG has supported research undertaken locally.

P a g e | 88

Pensions Liabilities 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 accounted for as if it were a defined contribution scheme: the cost to the CCG of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period.

Statement as to Disclosure to Auditors Each individual who is a member of the Governing Body at the time of the Member’s 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 themselves aware of any relevant audit information and to establish that the Clinical Commissioning Group’s auditor is aware of that information.

Accountable Officer: Maggie MacIsaac Organisation: NHS North East Hampshire and Farnham Clinical Commissioning Group 24 May 2018

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Statement of Accountable Officer’s Responsibilities The National Health Service Act 2006 (as amended) states that each Clinical Commissioning Group shall have an Accountable Officer and that Officer shall be appointed by the NHS Commissioning Board (NHS England). NHS England has appointed the Chief Officer to be the Accountable Officer of North East Hampshire and Farnham CCG. The responsibilities of an Accountable Officer are set out under the National Health Service Act 2006 (as amended), Managing Public Money and in the Clinical Commissioning Group Accountable Officer Appointment Letter. They include responsibilities for:     



The propriety and regularity of the public finances for which the Accountable Officer is answerable, For keeping proper accounting records (which disclose with reasonable accuracy at any time the financial position of the Clinical Commissioning Group and enable them to ensure that the accounts comply with the requirements of the Accounts Direction), For safeguarding the Clinical Commissioning Group’s assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities). The relevant responsibilities of accounting officers under Managing Public Money, Ensuring the CCG exercises its functions effectively, efficiently and economically (in accordance with Section 14Q of the National Health Service Act 2006 (as amended)) and with a view to securing continuous improvement in the quality of services (in accordance with Section14R of the National Health Service Act 2006 (as amended)), Ensuring that the CCG complies with its financial duties under Sections 223H to 223J of the National Health Service Act 2006 (as amended).

Under the National Health Service Act 2006 (as amended), NHS England has directed each Clinical Commissioning Group to prepare for each financial year financial statements in the form and on the basis set out in the Accounts Direction. The financial statements are prepared on an accruals basis and must give a true and fair view of the state of affairs of the Clinical Commissioning Group and of its net expenditure, changes in taxpayers’ equity and cash flows for the financial year. In preparing the financial statements, the Accountable Officer is required to comply with the requirements of the Group Accounting Manual issued by the Department of Health and in particular to:    

Observe the Accounts Direction issued by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis; Make judgements and estimates on a reasonable basis; State whether applicable accounting standards as set out in the Group Accounting Manual issued by the Department of Health have been followed, and disclose and explain any material departures in the financial statements; and, Prepare the financial statements on a going concern basis.

To the best of my knowledge and belief, I have properly discharged the responsibilities set out under the National Health Service Act 2006 (as amended), Managing Public Money and in my Clinical Commissioning Group Accountable Officer Appointment Letter. I also confirm that: 

As far as I am aware, there is no relevant audit information of which the CCG’s

P a g e | 90



auditors are unaware, and that as Accountable Officer, I have taken all the steps that I ought to have taken to make myself aware of any relevant audit information and to establish that the CCG’s auditors are aware of that information. That the annual report and accounts as a whole is fair, balanced and understandable and that I take personal responsibility for the annual report and accounts and the judgments required for determining that it is fair, balanced and understandable.

Accountable Officer: Maggie MacIsaac Organisation: NHS North East Hampshire and Farnham Clinical Commissioning Group 24 May 2018

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Governance Statement Introduction and context NHS North East Hampshire and Farnham Clinical Commissioning Group (the CCG) is a body corporate established by NHS England on 1 April 2013 under the National Health Service Act 2006 (as amended). The clinical commissioning group’s statutory functions are set out under the National Health Service Act 2006 (as amended). The CCG’s general function is arranging the provision of services for persons for the purposes of the health service in England. The CCG is, in particular, required to arrange for the provision of certain health services to such extent as it considers necessary to meet the reasonable requirements of its local population. As at 1 April 2017, the clinical commissioning group is not subject to any directions from NHS England issued under Section 14Z21 of the National Health Service Act 2006.

Scope of responsibility As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the clinical commissioning group’s policies, aims and objectives, whilst safeguarding the public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out under the National Health Service Act 2006 (as amended) and in my Clinical Commissioning Group Accountable Officer Appointment Letter. I am responsible for ensuring that the clinical commissioning group is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity. I also have responsibility for reviewing the effectiveness of the system of internal control within the clinical commissioning group as set out in this governance statement.

Governance arrangements and effectiveness The main function of the governing body is to ensure that the group has made appropriate arrangements for ensuring that it exercises its functions effectively, efficiently and economically and complies with such generally accepted principles of good governance as are relevant to it. The Members Report on page 67 sets out the membership of the Governing Body and its sub-committees, including attendance records and highlights of work during the year. Good governance is essential to support robust decision-making and we have designed (as set out in the Constitution), a governance framework to enable the CCG to effectively discharge its statutory functions.

UK Corporate Governance Code NHS Bodies are not required to comply with the UK Code of Corporate Governance.

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Discharge of Statutory Functions In light of recommendations made in the 1983 Harris Review, the CCG has reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislative and regulations. As a result, I can confirm that the CCG is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions. I confirm these arrangements are formally set out in the CCG’s scheme of reservation and delegation, which summarises the delegated authority given to the CCG’s main committees and senior officers. In addition the responsibility for each duty and power has been clearly allocated to a lead Director. Directorates have confirmed that their structures provide the necessary capability and capacity to undertake all of the clinical commissioning group’s statutory duties.

Risk management arrangements and effectiveness The CCG is committed to ensuring that integrated risk management is a key part of the CCG’s role of improving the health of the local population and ensuring an outstanding level of patient safety through commissioning high quality services that meet the needs of local people. To this end:• •

Risks within the organisation are identified, assessed, treated and monitored as part of the corporate governance of the CCG; and All elements of the commissioning process, including needs assessment, tendering, contract management and evaluation, include robust risk assessment and monitoring mechanisms.

Capacity to Handle Risk The CCG continues to embed risk management into all activities. All CCG committees that support the Governing Body have a responsibility for: • • • •

identifying risks; assessing risks; putting systems in place to mitigate risks; and ensuring these are managed through their individual risk register which in turn forms part of the Corporate Risk Register.

All risks are entered onto the Corporate Risk Register and assigned to a committee reporting to the Governing Body. Risk Registers are a standing agenda item so that each committee is fully aware of the risks; and work plans and agendas reflect significant risks. The Audit and Risk Committee oversees the establishment and maintenance of effective systems of integrated governance and risk management across all areas of the CCG. This oversight is essential to ensure robust systems are in place to enable the CCG to carry out its functions effectively and in a controlled manner. The Governing Body reviews the Governing Body Assurance Framework every quarter. This ensures members are fully aware of all the risks; actions taken and that there are effective plans in place to mitigate significant risks.

P a g e | 93

Risk Assessment Key areas where the CCG has reported risks in 2017-18 include:  



Loss of control over provider activity, quality and system finances could result in the CCG being unable to ensure local people receive high quality services and ultimately breaching its statutory duties. If the CCG does not develop capacity and new ways of working to embrace the future vision and opportunities in the health and Social Care then the CCG will not be able to improve outcomes for people; and where care does not meet required standards, will not be able take action to improve the quality of these services. If general practices do not engage with the CCG to work together to implement the 5 year forward view then there could be a failure to develop a sustainable primary care model which could impact on the quality of services being provided

The CCG has clearly articulated these risks on the Governing Body Assurance Framework (GBAF) which ensures full transparency and understanding of the risks facing the CCG at Board level. The GBAF also shows the direction of travel for each strategic risk and includes reports on the current actions taking place. These papers are always available to the public on the CCG’s website to make sure the public is fully sighted on what is happening in the CCG. The CCG continues to keep NHSE aware of all strategic risks as part of the regular dialogue and reporting arrangements with NHSE.

Other sources of assurance Internal Control Framework A system of internal control is the set of processes and procedures in place in the clinical commissioning group to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it can therefore only provide reasonable and not absolute assurance of effectiveness. My review of the effectiveness of the system of internal control is informed by the work of the internal auditors and the executive managers and clinical leads within the CCG, who have responsibility for the development and maintenance of the internal control framework. I have drawn on performance information available to me. My review is also informed by comments made by external audit reports. The Board Assurance Framework itself provides me with evidence that the effectiveness of controls that manage risks to the CCG achieving its principle objectives have been reviewed. I am pleased to have received consistent assurance from the Internal Auditors on the CCG’s risk management framework and key financial systems over the past five years with improvement noted again in 2017. Annual audit of conflicts of interest management The revised statutory guidance on managing conflicts of interest for CCGs (published June 2016) requires CCGs to undertake an annual internal audit of conflicts of interest management. To support CCGs to undertake this task, NHS England has published a

P a g e | 94 template audit framework. During 2017-18 the CCG has worked with the other CCGs in the Hampshire CCG Partnership to share best practice, align conflicts of interest policy and processes; and ensure it is compliant with the statutory guidance. I am pleased with the progress made and the internal audit of conflicts of interest has given the CCG reasonable assurance on our management of conflicts of interest. Data Quality High quality data underpins every step of the commissioning cycle. It is only through the analysis of high-quality data that the CCG can move towards safe, effective, and equitable care for all. The CCG ensures data quality throughout the commissioning process and, although we rely on other NHS organisations and the CSU, we gain direct assurance from these organisations on a monthly basis and gain independent assurance from Internal Audit reports. Information Governance The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal identifiable information. The NHS Information Governance Framework is supported by an information governance toolkit and the annual submission process provides assurances to the clinical commissioning group, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively. We place high importance on ensuring there are robust information governance systems and processes in place to help protect patient and corporate information. We have established an information governance management framework and are developing information governance processes and procedures in line with the information governance toolkit. We have ensured all staff undertake annual information governance training and have implemented a staff information governance handbook to ensure staff are aware of their information governance roles and responsibilities. There are processes in place for incident reporting and investigation of serious incidents. The CCG has a Caldicott Guardian and Senior Information Responsible Officer (SIRO); both individuals holding this role are members of the CCG’s Governing Body. Information Governance issues are also managed through this process and there is a range of associated documentation for staff including a staff guide, policies and processes for the handling, management, storage and destruction of data and information. Following the publication of the second Caldicott Report, Information to Share or Not to Share during 2013, the CCG does not hold any patient data (other than that allowed for under legal requirements). All information is passed via the Data Management Centre and managed by the local CSU. In 2017-18 there were no Information Governance related incidents reported. The CCG achieved level 2 in the annual information governance toolkit self-assessment four of the IG requirements at level 3 and three at level 2 were tested, therefore meeting and exceeding the nationally-required level 2 compliance.

P a g e | 95 Business Critical Models An appropriate framework and environment is in place to provide quality assurance of business-critical models, in line with the recommendations in the Macpherson report. The business critical models of the CCG primarily rely on activity and finance data produced by the CSU which is assured through their own processes. The work of the CSU and the validity of its data is subject to further independent internal audit scrutiny. As Accountable Officer, I receive assurance through the CSU service auditor reports that relevant controls are in place and have been operating throughout the year. NHS England undertakes a quarterly assurance review which covers the output from these business critical models. All business-critical models have been identified and information about quality assurance processes for those models has been provided to Audit Committee. Third party assurances The CCG business critical-models primarily rely on activity and finance data produced by the CSU which is assured through the CSU own processes. As Accountable Officer, I receive assurance through the CSU service auditor reports that relevant controls are in place for business-critical models and have been operating throughout the year. The output of business-critical models is validated by NHS England through their quarterly assurance process of the CCG.

Control Issues During the year, Internal Audit issued a number of audit reports which identified governance, risk management and/or control issues. The Head of Internal Audit Opinion is informed by these reports and is set out within this annual report on page 97. I am pleased to have received an overall reasonable assurance rating. The internal auditors gave two limited assurance reports in respect of (1) the collaborative Continuing Healthcare Governance arrangements hosted by Surrey Downs CCG and (2) the Continuing Health Care – Phase 2 Review hosted by West Hampshire CCG. At Month 12 no significant control issues have been identified by the auditors that might prejudice or undermine the integrity or reputation of the CCG and/or wider NHS.

Review of economy, efficiency & effectiveness of the use of resources I am confident the CCG actively promotes the three E’s in all aspects of the CCG’s business. The Finance and Performance Committee and the Clinical Executive provide critical oversight on investments from both a clinical and financial perspective. Recruiting the right people to the right posts has been a fundamental approach the CCG has taken forward as part of managing its resources throughout 2016-17. It has strong leadership with clinical leadership central to the areas that CCG is responsible for commissioning. All of the achievements of the CCG have been performed within resource limits set by NHS England. CCGs are statutory organisations responsible to their Governing Body for the delivery of both their statutory and constitutional duties and improvements in the health outcomes of

P a g e | 96 their population. NHS England approaches assurance from the assumption that CCGs will deliver against these requirements. The process uses information derived from a variety of sources including, where necessary, face-to-face visits. The nature of the oversight, including the expected frequency of assurance meetings, is agreed between NHS England and individual CCGs. The assurance process introduces a more risk-based approach which differentiates high performing CCGs, those whose performance gives cause for concern, and those in between. It consists of the following components:  well-led organisation;  performance: delivery of commitments and improved outcomes;  financial management;  planning; and  delegated functions. For 2016/17 NHS North East Hampshire and Farnham CCG was evaluated by NHS England against the national derived CC Improvement and Assessment Framework. The framework constructed covers indicators located in four domains:  Better Health;  Better Care;  Sustainability; and  Leadership. To aid transparency for the public overall ratings and relative performance indicators will be published on the MyNHS website. For 2017/18 NHS North East Hampshire & Farnham CCG has received “outstanding” assurance on all domains assessed and received a ‘Green star’ rating for Quality of Leadership for continued strength over quality of finance and performance in a complex system straddling two Sustainability & Transformation plans.

Delegation of functions On April 1, 2016 assumed responsibility for commissioning local primary care services. The delegation of this role from NHS England to the CCG is an extremely important development in the planning of healthcare services provided to the local population. As the commissioner for local primary care the CCG works more closely with its 23 member practices (listed on page 67) on planning the services provided to local people. The CCG is working with them and their GP federations – Salus Medical Services Ltd and Farnham Integrated Care Ltd – to better analyse the population, to identify trends and particular areas of need, allowing us to target resources where they can have the greatest impact. Counter fraud arrangements The Local Area Counter-Fraud Team provide an active role in the prevention and deterrence of fraud, bribery and corruption through its attendance at the Audit and Risk Committee, involvement in policy-setting and sharing of information through newsletters and attendance at CCG meetings. The CCG has established a positive training and awareness culture to ensure all staff receive regular training and newsletters provided by the Local Counter-Fraud Team. There were no cases of fraud brought to the attention of the committee during the year.

P a g e | 97 Head of Internal Audit Opinion Following completion of the planned audit work for the financial year for the clinical commissioning group, the Head of Internal Audit issued an independent and objective opinion on the adequacy and effectiveness of the clinical commissioning group’s system of risk management, governance and internal control. The Head of Internal Audit concluded that: ‘My overall opinion is that Reasonable assurance can be given that there is a generally sound system of internal control, designed to meet the organisation’s objectives, and that controls are generally being applied consistently. However, some weakness in the design and/or inconsistent application of controls, put the achievement of particular objectives at risk.’ During the year, Internal Audit issued the following audit reports: System

Substantial Assurance

Limited Assurance



Complaints Review



Assurance Framework and Risk Management



Budgetary Control and Reporting



Critical Financial Assurance





Hosted Mental Health and LD Services





Vanguard-Governance Arrangements-

No Assurance



Delegated Primary Care Commissioning Serious Incidents

Reasonable Assurance









Phase 2 Cyber Security



Other Assurances Continuing Healthcare – Phase 1 (hosted by West Hampshire CCG)

Assurance level not assigned as this was a follow-up review only

Continuing Healthcare – Phase 2 (hosted by West Hampshire CCG) Continuing Healthcare –Surrey (Hosted by Surrey Downs CCG)

 

Review of the effectiveness of governance, risk management and internal control My review of the effectiveness of the system of internal control is informed by the work of the internal auditors, executive managers and clinical leads within the clinical commissioning group who have responsibility for the development and maintenance of the internal control framework. I have drawn on performance information available to me. My review is also informed by comments made by the external auditors in their annual audit letter and other reports. Our assurance framework provides me with evidence that the effectiveness of controls that

P a g e | 98 manage risks to the clinical commissioning group achieving its principles objectives have been reviewed. I have been advised on the implications of the result of this review by:     

The board The audit committee If relevant, the risk / clinical governance / quality committee Internal audit Other explicit review/assurance mechanisms.

Conclusion I am content with the assurance provided and no significant internal control issues have been identified.

Accountable Officer: Maggie MacIsaac Organisation: NHS North East Hampshire and Farnham Clinical Commissioning Group 24 May 2018

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Remuneration Report

Definition of senior manager The definition of ‘senior managers’ as per NHS England Annual Reporting guidance is: “Those persons in senior positions having authority or responsibility for directing or controlling the major activities of the clinical commissioning group.” This means those who influence the decisions of the clinical commissioning group as a whole rather than the decisions of individual directorates or departments. Such persons will include advisory or lay members. For the purpose of this remuneration report ‘senior managers’ constitute both voting and non-voting members of the CCG Governing Body.

Remuneration Committee It is a statutory requirement that a CCG’s governing body has a remuneration committee to determine and approve remuneration packages for the Chief Executive, Chief Finance Officer, Executive Directors and Board members. It will also approve policies relating to remuneration and the terms and conditions of employment for all CCG staff. Their role is to provide advice, guidance and workforce related data as required by the Committee. No committee member is present for discussions about their own remuneration or terms of service. For further details on the Remuneration committee please see page 74.

Statement of Policy The Remuneration and Nominations Committee has the responsibility to maintain awareness of statutory requirements, national guidance and directions in relation to remuneration and workforce matters and to ensure appropriate weight is given in its deliberations to the need to conserve public resources and deliver value for money. The Partnership Remuneration Committee is a Committees-in-Common of NHS Fareham and Gosport, NHS North East Hampshire and Farnham, NHS North Hampshire and NHS South Eastern Hampshire CCGs Remuneration Committees and has those executive powers specifically delegated by each CCGs’ Governing Bodies within the respective Schemes of Reservation and Delegation and in the Terms of Reference. The Committee is authorised by the respective Governing Bodies to investigate any activity within its terms of reference through the Scheme of Reservation and Delegation as supported by section 14M of the NHS Act 2006 (Duty for the CCG Governing Body to have a properly constituted remuneration committee). It is authorised to seek information it requires from any member, officer or employee.

P a g e | 100 The four CCGs will meet as Committees-in-Common and conduct business as if working as a single group.

Senior Managers Service Contracts There have been no payments made for loss of office to any senior manager who was a member of the Governing Body during 2017/18.

Salaries and allowances The table below shows the salaries and allowances paid to senior managers during 2017/18. The figures shown under “All Pension Related Benefits” in the table are a calculation of the increase in the senior manager’s accrued pension benefit at the beginning and the end of the financial year. The required formula for this item includes a factor of twenty to allow for the predicted value of the annual pension over an average period of 20 years. This table is subject to Audit

Name

Full Salary & Fees

Performance Pay and Bonuses

(Bands of £5,000) £'000 140-145 90-95 115-120 95-100 100-105 100-105 75-80 45-50 30-35 55-60 40-45 15-20 20-25 5-10 5-10 5-10 15-20

(Bands of £5,000) £'000 20-25 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Title

Margaret MacIsaac Emma Boswell (Née Holden) Roshan Patel Rosalind Hartley Ruth Colburn-Jackson Andrew Whitfield Peter Bibawy Steven Clarke Jane Dempster Edward Wernick Karl Bennett Hanne Hoff Peter Cruttenden Kathy Atkinson Mark Hammond Elaine Budd Edward Palfrey

Chief Executive (Shared) Director of Quality & Nursing (Shared) Chief Finance Officer Director of Partnerships (Shared) Director of Transformation & Delivery Chair Medical Director GP Elected Member GP Elected Member GP Elected Member GP Elected Member GP Elected Member Lay Member Lay Member Lay Member Lay Member Secondary Care Specialist Consultant

i ii iii iv

v vi vii viii ix x xi

2017/18 North East Hampshire & Farnham CCG Performance All Pension Salary & Pay and Related TOTAL Fees Bonuses Benefits (Bands of (Bands of (Bands of (Bands of £5,000) £5,000) £2,500) £5,000) £'000 £'000 £'000 £'000 35-40 10-15 0 45-50 65-70 0 0 65-70 115-120 0 12.5-15 130-135 50-55 0 2.5-5 55-60 100-105 0 37.5-40 140-145 100-105 0 45-47.5 145-150 75-80 0 12.5-15 90-95 45-50 0 0 45-50 30-35 0 0 30-35 55-60 0 0 55-60 40-45 0 175-177.5 220-225 15-20 0 222.5-225 240-245 20-25 0 0 20-25 5-10 0 0 5-10 5-10 0 0 5-10 5-10 0 0 5-10 10-15 0 0 10-15

The senior managers full Salary & Fees and Performance Pay and Bonuses are shown in the first two columns, with the amount relative to the North East Hampshire & Farnham disclosed in the following columns. i)

Margaret MacIsaac is joint Accountable Officer for the four CCGs within the Hampshire CCG Partnership. Her responsibility is split equally across all four CCGs.

ii)

From the 4th September 2017 Emma Boswell became joint Director of Quality & Nursing for North East Hampshire & Farnham CCG and North Hampshire CCG. Her responsibility is split equally between the two organisations.

iii)

From the 4th September 2017 Roshan Patel took on the role of Partnership

P a g e | 101 Director of Finance as well as continuing as Chief Finance Officer for North East Hampshire & Farnham CCG. No funding is recharged for this role. iv)

From the 4th September 2017 Rosalind Hartley works for the Hampshire CCG Partnership and is shared equally across all four CCGs. She only sits on North East Hampshire & Farnham CCGs Governing Body.

v)

Jane Dempster left the CCG on the 31st December 2017.

vi)

Edward Wernick left the CCG on the 28th February 2018.

vii)

Karl Bennett joined the Governing Body as a GP Elected Member on April 2017.

viii)

Hanne Hoff joined the Governing Body as a GP Elected Member on February 2018.

ix)

From 1 April 2017 Peter Cruttenden took on the role as Chair of the Hampshire CCG Partnership Board, as well as continuing as Lay Member for Governance. No funding is recharged for this role.

x)

Mark Hammond left the CCG in September 2017.

xi)

From the 1st December 2017, Edward Palfrey became the Secondary Care Specialist Consultant for North Hampshire CCG. He maintains his role as Secondary Care Consultant at North East Hampshire & Farnham CCG. Fiona White is an Executive Director for HR and People Development for the Hampshire CCG Partnership but does not sit on any Governing Bodies within the Partnership. She joined the Partnership on the 10th November 2017.

xii)

A performance payment was paid to the Chief Executive in 2017/18 which relates to the achievement of North East Hampshire & Farnham CCGs performance during 2016/17, this was based on the CCG attaining an Outstanding assurance rating and achieving highest quality of leadership rating from NHS England. This was authorised by the Remuneration Committee. A performance payment was made in recognition of delivering the objectives of the Hampshire Partnership in 2017/18. This was authorised by the Partnership Remuneration Committee.

P a g e | 102 This table is subject to Audit

2016/17

Clinical Commissioning Group Governing Body Member

Name

Margaret MacIsaac Emma Holden Roshan Patel Ros Hartley Sarah McBride Andrew Whitfield Ruth Colburn-Jackson Peter Bibawy Steven Clarke Jane Dempster Olive Fairbairn Edward Wernick Peter Cruttenden Kathy Atkinson Edward Palfrey Mark Hammond Elaine Budd Alison Edgington

Title

Chief Executive Director of Quality and Nursing Chief Finance Officer Director of Strategy and Partnership Director of Delivery and Commissioning Chair Director of Transformation & Delivery Medical Director GP Elected Member GP Elected Member GP Elected Member GP Elected Member Lay Member Lay Member Secondary Care Specialist Consultant Lay Member Lay Member Interim Director of Delivery

Salary & Fees

Performance pay and bonuses

All Pension Related Benefits

Total

(bands of £5,000) £'000

(bands of £5,000) £'000

(bands of £2,500) £'000

(bands of £5,000) £'000

140 - 145 85 - 90 105 - 110 90 - 95 30 - 35 100 - 105 10 - 15 75 - 80 45 - 50 45 - 50 25 - 30 45 - 50 15 - 20 10 - 15 10 - 15 10 - 15 10 - 15 230 - 235

10 - 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 - 2.5 25.0 - 27.5 25.0 - 27.5 32.5 - 35.0 0 - 2.5 12.5 - 15.0 302.5 - 305.0 0 - 2.5 0 - 2.5 0 - 2.5 5.0 - 7.5 0 - 2.5 0 - 2.5 0 - 2.5 0 - 2.5 0 - 2.5 0 - 2.5 0

155 - 160 115 - 120 135 - 140 125 - 130 30 - 35 115 - 120 315 - 320 75 - 80 45 - 50 45 - 50 30 - 35 40 - 45 15 - 20 10 - 15 10 - 15 10 - 15 10 - 15 230 - 235

All Very Senior Managers remuneration is agreed and reviewed by the Remuneration Committee this enables the CCG to ensure that this remuneration is reasonable. The pensions disclosure calculations are based on officer service only and do not include any benefits in respect of practitioner service.

Pension Benefits The table below illustrates the pension benefits for those members of the Governing Body who are a member of the pension scheme.

Name

Margaret MacIsaac Emma Boswell (Née Holden) Roshan Patel Rosalind Hartley Ruth Colburn-Jackson Andrew Whitfield Peter Bibawy Edward Wernick Karl Bennett Hanne Hoff

Title

Chief Executive (Shared) Director of Quality & Nursing (Shared) Chief Finance Officer Director of Partnerships (Shared) Director of Transformation & Delivery Chair Medical Director GP Elected Member GP Elected Member GP Elected Member

Real increase in pension at pension age (Bands of £2,500) £'000 0-2.5 0-2.5 0-2.5 0-2.5 0-2.5 2.5-5 0-2.5 0-2.5 7.5-10 7.5-10

Lump sum at Cash Cash Real increase Total accrued pension age Real increase equivalent equivalent in pension pension at related to in Cash transfer value transfer value lump sum at pension age at accrued Equivalent at 1st April at 31 March pension age 31 March 2018 pension at 31 Transfer Value 2017 2018 March 2018 (Bands of (Bands of (Bands of £2,500) £5,000) £5,000) £'000 £'000 £'000 £'000 £'000 £'000 0-2.5 50-55 160-165 1,025 1,064 39 0-2.5 15-20 50-55 229 255 25 2.5-5 15-20 55-60 224 262 38 0-2.5 25-30 80-85 439 481 42 5-7.5 15-20 45-50 163 208 45 7.5-10 20-25 65-70 428 496 69 0-2.5 0-5 0-5 12 12 0-2.5 5-10 20-25 98 102 4 22.5-25 5-10 20-25 134 134 27.5-30 5-10 25-30 135 135

P a g e | 103 Certain members do not receive pensionable remuneration therefore there will be no entries in respect of pensions for them. For staff shared across the Partnership 100% of their Pension benefits are reflected regardless of their proportion attributable to North East Hampshire & Farnham CCG. Where an employee holds a Senior Manager position within another Organisation 100% of their Pension will also be disclosed in their report.

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 membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. This may be for more than just their service in a senior capacity to which disclosure applies (in which case this fact will be noted at the foot of the table). 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 member 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.

Pay Multiples Reporting bodies are required to disclose the relationship between the remuneration of the highest paid director or member of the organisation and the median remuneration of the organisation’s workforce. The banded remuneration of the highest paid director or member in North East Hampshire and Farnham CCG in the financial year 2017/18 was £165K - £170K (2016/17, £155K – £160K). This was 3.6 times (2016/17 – 3.3) the median remuneration of the workforce which was £47,092 (2016/17, £48,034). Figures are based on full time salaries and no adjustment is made for staff shared across the Partnership. In 2017/18 and 2016/17 no employees received remuneration in excess of the highest paid director or member. Remuneration ranged from £165.0k to £10.0k (2016/17 £160.0k to £7.0k). Total remuneration includes salary, non-consolidated performance related pay and benefits in kind but not severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions.

P a g e | 104

Staff Report Under the Equality Act 2010 it is essential that the CCG collects and reports on its current relevant workforce information. To do this it is updated on a regular basis to ensure that current policies, practices and support mechanisms remain relevant to the needs and requirements of the workforce. The CCG employs permanent staff and also uses a limited amount of agency staff, classified as ‘other’. It also buys in services from Commissioning Support Units and other CCGs. The following table sets out the staff costs for the permanent and agency staff for 2017/18 and 2016/17:

Total

2017/18 Permanent Employees

Other

£'000

£'000

£'000

Salaries and wages Social security costs Employer Contributions to NHS Pension scheme Apprenticeship Levy Termination benefits

4,836 605 573 8 43

4,331 605 573 8 43

505 0 0 0 0

Gross employee benefits expenditure

6,065

5,560

505

Total

2016/17 Permanent Employees

Other

£'000

£'000

£'000

Salaries and wages Social security costs Employer Contributions to NHS Pension scheme Apprenticeship Levy Termination benefits

5,240 457 490 0 0

4,102 457 490 0 0

1,137 0 0 0 0

Gross employee benefits expenditure

6,187

5,050

1,137

Staff Composition

Directors/Lay Members Senior Managers All Other Staff

Female 13 26 45 84

Male 7 10 11 28

Grand Total 20 36 56 112

Note: This only reflects the headcount of staff on the CCGs Payroll.

P a g e | 105

Sickness Absence Data Information on staff absence can be found in the employee benefits note in the Financial Statements. The CCG has reviewed its policies regarding the monitoring and reporting of staff sickness and absence. The Workforce Report which includes this data is a standing agenda item for the Remuneration and Nominations Committee.

FTE-Days Available 31,038

FTE-Days Lost to Sickness Absense

Adjusted FTE days lost

1,043

643

Average Sick Day per FTE 7.6

The staff sickness rate for the past 12 months averaged 2.75%, which is considerably lower than the target of 3.5%. We have identified some trends in our sickness absence and have been working with staff to address this through a health and wellbeing programme. As part of this work, we have developed a wellbeing plan to support staff and reduce their stress through a range of initiatives, such as training and peer support, yoga and mindfulness sessions. We will work with our newly created Staff Partnership Forum, HR, Occupational Health and our Employee Assistance Programme to develop this and to ensure staff are appropriately supported.

Cost Allocation and Setting of Charges for Information We certify that the CCG has complied with HM Treasury’s guidance on cost allocation and the setting of charges for information.

Principles for Remedy The Parliamentary and Health Service Ombudsman’s six Principles for Remedy (below for information) are embedded into the Complaints Policy and Procedure in use by the CCG to ensure that the approach taken to complaints handling is reasonable, fair and proportionate and meets the needs of individuals. As commissioners, the CCG is committed to ensuring high-quality, clinically-effective services, treatments and interventions that meet the needs of patients and that through the highlighting of complaints and concerns the CCG can make improvements to these services. The six Principles for Remedy are: 1. 2. 3. 4. 5. 6.

Getting it right Being customer-focused Being open and accountable Acting fairly and proportionately Putting things right Seeking continuous improvement

P a g e | 106

Employee Consultation The CCG believes that by working in partnership with staff we can learn about peoples’ experiences and views, to help prioritise the best ways to support and work together, ultimately acting as a good employer, with strong, supported teams who share organisational learning to shape the delivery of high-quality care for all. As in previous years, the CCG continues to regularly communicate and engage with staff through monthly team briefs – a meeting where staff are informed of organisational change and are invited to be engaged and involved. Staff are also involved and invited to stakeholder events, where CCG priorities are debated and shaped, and regular communications are sent to staff via emails and one-to-one meetings are held with line managers on a frequent basis. Objective settings and personal development plans are written for staff to follow as part of their performance management plans each year too. Staff Partnership Forum The Staff Partnership Forum was established to improve communication between managers and staff, as well as to improve the working environment within the CCG and thereby staff morale. The forum is made up of representatives nominated by each team within the CCG. It is chaired by the CCG’s Governing Body Lay Member for Patient and Public Engagement and is also attended by the CCG’s HR Manager. The forum is the CCG’s primary means of consulting staff on a range of work-related issues, such as:     

Health and Wellbeing Activities Organisational Development Health and Safety Equality Act Organisational Policies and Procedures (changes to terms and conditions to be referred to South CCG Staff Partnership Forum)

Forum members also consider suggestions made by colleagues on any aspect of working conditions or environment and take decisions or make recommendations to senior management accordingly. Forum meeting notes are shared with CCG colleagues by the nominated team representatives. The representatives also consult their team members on issues raised at the forum and feed their views back to the forum, as well as supporting and encouraging colleagues to put forward suggestions or ideas. Among the highlights from 2017/18 was a W@W (Workout at Work) day, during which CCG staff were visited by members of the physiotherapy team from Frimley Health, as well as from the Chartered Society of Physiotherapists. This was to educate staff on the benefits of keeping active during the working day – and demonstrating the many ways to do this. The forum also helped to design a staff survey that delved into some of the previous responses of CCG employees to the NHS national staff survey. The CCG wanted to have more detail on certain topics to be able to harness the positive factors at play in the CCG

P a g e | 107 and also address any areas of concern. The staff suggestion system has allowed the forum to continue to reassure staff on matters such as car parking, while also responding to and resolving many other questions, concerns or requests on everyday office issues.

Staff policies We have a range of policies and procedures that we apply to govern our approach to staff recruitment and development. These include:       

Concerns and Whistleblowing Policy Leave and Flexible Working Policy Maternity, Paternity, Adoption Leave & Shared Parental Leave and Pay Guidance Organisational Change Policy Policy for the Management of Policies and Corporate Documents Recruitment and Exit Procedure Travel and Expenses Policy

Staff training All staff are required to undertake statutory and mandatory training on a variety of topics to keep standards high, ensure compliance with regulations, and to keep you safe at work. The training staff are required to do will be specific to their role. Some training is required to be completed annually and others every three years. Training includes but is not limited to:         

Display Screen Equipment Fire Safety Information Governance Equality and Diversity Health Safety and Welbeing Safeguarding Adults Safeguarding Children Fraud awareness Moving and Handling

Equality We consider equality and diversity an important part of all our workforce policies. When employment policies are drafted and reviewed, they are subject to an equality impact assessment to identify positive and negative impacts for staff from protected characteristic groups. This includes the impact for prospective and existing staff with disabilities. Where necessary, policies are amended to minimise potential negative equality impacts and better advance equal opportunities for disabled employees, via reasonable adjustments.

Disabled Employees Recruitment by the CCG is carried out in accordance with its recruitment policy. All candidates’ application forms are shortlisted anonymously and all applicants considered according to the same criteria. The organisation adheres to the Two Tick scheme in that the

P a g e | 108 CCG guarantees to interview all applicants with a disability who meet the essential criteria for a job vacancy and to consider them on their abilities. Where an individual identifies a disability the CCG will make reasonable adjustments throughout the recruitment process. Employees who become disabled in the course of their employment will have a regular review with their manager to consider how to best utilise and develop their abilities. Any adjustments which are deemed reasonable, to their employment or working conditions that would assist them in the performance of their duties should be considered.

Trade Union Public sector organisations are required to report on trade union facility time, which is the paid time off for union representatives to carry out trade union activities. During 2017/18 no staff from North East Hampshire and Farnham CCG have acted as Trade Union officials.

Expenditure on Consultancy As detailed in note 5 of the financial statements the CCG’s total expenditure on consultancy service for 2017/18 is £855k.

Off Payroll Engagements It is a Treasury requirement for public sector bodies to report arrangements whereby individuals are paid through their own companies and so are responsible for their own tax and National Insurance arrangements. In addition payments to GP practices for the services of employees and GPs are deemed to be “off-payroll” engagements. The CCG has 2 off payroll engagements still in place as at 31st March 2018. For all off payroll engagements as of 31 March 2018, for more than £245 per day and that last longer than six months:

Number of existing engagements as of 31 March 2018 Of which, the number that have existed: for less than one year at the time of reporting for between one and two years at the time of reporting for between 2 and 3 years at the time of reporting for between 3 and 4 years at the time of reporting for 4 or more years at the time of reporting

Number 0

For all new off payroll engagements between 1 April 2017 and 31 March 2018, for more than £245 per day and that last longer than six months:

P a g e | 109

Number Number of new engagements, or those that reached six months in duration, between 1 April 2017 and 31 March 2018 Of which: Number assessed as caught by IR35 Number assessed as not caught by IR35 Number engaged directly (via PSC contracted to department) and are on the departmental payroll Number of engagements reassessed for consistency / assurance purposes during the year Number of engagements that saw a change to IR35 status following the consistency review

Number of off-payroll engagements of board members, and/or senior officers with significant financial responsibility, during the financial year (1) Total no. of individuals on payroll and off-payroll that have been deemed “board members, and/or, senior officials with significant financial responsibility”, during the financial year. This figure should include both on payroll and off-payroll engagements. (2)

3

0 3 3 0 0

0

17

P a g e | 110

Exit packages, including special (non-contractual) payments Table 1: Exit Packages Exit package cost band (inc. any special payment element

Less than £10,000 £10,000 - £25,000 £25,001 - £50,000 £50,001 - £100,000 £100,001 - £150,000 £150,001 –£200,000 >£200,000 TOTALS

Number of compulsory redundancies

Cost of compulsory redundancies

Number of other departures agreed

Cost of other departures agreed

WHOLE NUMBERS ONLY

£s

WHOLE NUMBERS ONLY

£s

1 1

£11,860 £31,395

2

£43,255

-

Total number of Total cost of exit exit packages packages WHOLE NUMBERS ONLY

-

-

£s

-

Number of Cost of special departures payment where special element payments have included in exit been made packages WHOLE £s NUMBERS ONLY

-

-

Redundancy and other departure cost have been paid in accordance with the provisions of NHS Agenda for Change Terms & Conditions. Exit costs in this note are accounted for in full in the year of departure. Where North East Hampshire & Farnham CCG has agreed early retirements, the additional costs are met by the North East Hampshire & Farnham 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.

Parliamentary Accountability and Audit Report North East Hampshire and Farnham Hampshire CCG is not required to produce a Parliamentary Accountability and Audit Report. Disclosures on remote contingent liabilities, losses and special payments, gifts, and fees and charges are included as notes in the Financial Statements of this report. An external audit certificate and report is also included in this annual report.

Accountable Officer: Maggie MacIsaac Organisation: NHS North East Hampshire and Farnham Clinical Commissioning Group 24 May 2018

P a g e | 111 INDEPENDENT AUDITOR’S REPORT TO THE MEMBERS OF THE GOVERNING BODY OF NHS NORTH EAST HAMPSHIRE AND FARNHAM CCG

Report on the Audit of the Financial Statements Opinion We have audited the financial statements of NHS North East Hampshire and Farnham Clinical Commissioning Group (the ‘CCG’) for the year ended 31 March 2018, which comprise the Statement of Comprehensive Net Expenditure, the Statement of Financial Position, the Statement of Changes in Taxpayers Equity, the Statement of Cash Flows and notes to the financial statements, including a summary of significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and the Department of Health and Social Care Group Accounting Manual 2017-18 and the requirements of the Health and Social Care Act 2012. In our opinion the financial statements:  give a true and fair view of the financial position of the CCG as at 31 March 2018 and of its expenditure and income for the year then ended; and  have been properly prepared in accordance with International Financial Reporting Standards (IFRSs) as adopted by the European Union, as interpreted and adapted by the Department of Health and Social Care Group Accounting Manual 2017-18; and  have been prepared in accordance with the requirements of the Health and Social Care Act 2012.

Basis for opinion We conducted our audit in accordance with International Standards on Auditing (UK) (ISAs (UK)) and applicable law. Our responsibilities under those standards are further described in the Auditor’s responsibilities for the audit of the financial statements section of our report. We are independent of the CCG in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK, including the FRC’s Ethical Standard, and we have fulfilled our other ethical responsibilities in accordance with these requirements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion. Who we are reporting to This report is made solely to the members of the Governing Body of the CCG, as a body, in accordance with Part 5 of the Local Audit and Accountability Act 2014. Our audit work has been undertaken so that we might state to the members of the Governing Body of the CCG those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the CCG and the members of the Governing Body of the CCG, as a body, for our audit work, for this report, or for the opinions we have formed.

P a g e | 112

Conclusions relating to going concern We have nothing to report in respect of the following matters in relation to which the ISAs (UK) require us to report to you where:  the Accountable Officer’s use of the going concern basis of accounting in the preparation of the financial statements is not appropriate; or  the Accountable Officer has not disclosed in the financial statements any identified material uncertainties that may cast significant doubt about the CCG’s ability to continue to adopt the going concern basis of accounting for a period of at least twelve months from the date when the financial statements are authorised for issue. Other information The Accountable Officer is responsible for the other information. The other information comprises the information included in the Annual Report set out on pages 8 to 110 other than the financial statements and our auditor’s report thereon. Our opinion on the financial statements does not cover the other information and, except to the extent otherwise explicitly stated in our report, we do not express any form of assurance conclusion thereon. In connection with our audit of the financial statements, our responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or our knowledge obtained in the course of our work including that gained through work in relation to the CCG’s arrangements for securing value for money through economy, efficiency and effectiveness in the use of its resource or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether there is a material misstatement in the financial statements or a material misstatement of the other information. If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact. We have nothing to report in this regard. Other information we are required to report on by exception under the Code of Audit Practice Under the Code of Audit Practice published by the National Audit Office on behalf of the Comptroller and Auditor General (the Code of Audit Practice) we are required to consider whether the Governance Statement does not comply with the guidance issued by the NHS Commissioning Board or is misleading or inconsistent with the information of which we are aware from our audit. We are not required to consider whether the Governance Statement addresses all risks and controls or that risks are satisfactorily addressed by internal controls. We have nothing to report in this regard. Opinion on other matters required by the Code of Audit Practice In our opinion:  the parts of the Remuneration Report and Staff Report to be audited have been properly prepared in accordance with IFRSs as adopted by the European Union, as interpreted and adapted by the Department of Health and Social Care Group Accounting Manual

P a g e | 113



2017-18 and the requirements of the Health and Social Care Act 20121; and based on the work undertaken in the course of the audit of the financial statements and our knowledge of the CCG gained through our work in relation to the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources, the other information published together with the financial statements in the annual report for the financial year for which the financial statements are prepared is consistent with the financial statements.

Opinion on regularity required by the Code of Audit Practice In our opinion, in all material respects the expenditure and income recorded in the financial statements have been applied to the purposes intended by Parliament and the financial transactions in the financial statements conform to the authorities which govern them. Matters on which we are required to report by exception Under the Code of Audit Practice we are required to report to you if:  we have reported a matter in the public interest under Section 24 of the Local Audit and Accountability Act 2014 in the course of, or at the conclusion of the audit; or  we have referred a matter to the Secretary of State under Section 30 of the Local Audit and Accountability Act 2014 because we had reason to believe that the CCG, or an officer of the CCG, was about to make, or had made, a decision which involved or would involve the body incurring unlawful expenditure, or was about to take, or had begun to take a course of action which, if followed to its conclusion, would be unlawful and likely to cause a loss or deficiency; or  we have made a written recommendation to the CCG under Section 24 of the Local Audit and Accountability Act 2014 in the course of, or at the conclusion of the audit. We have nothing to report in respect of the above matters.

Responsibilities of the Accountable Officer and Those Charged with Governance for the financial statements As explained more fully in the Statement of Accountable Officer's responsibilities set out on pages 89 to 90, the Accountable Officer, is responsible for the preparation of the financial statements in the form and on the basis set out in the Accounts Directions, for being satisfied that they give a true and fair view, and for such internal control as the Accountable Officer determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, the Accountable Officer is responsible for assessing the CCG’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless the CCG lacks

The DHSC Group Accounting Manual 2017-18 sets out the parts of the Remuneration and Staff Report that is subject to audit. The CCG should clearly highlight which disclosures in the accountability report have been audited. 1

P a g e | 114 funding for its continued existence or when policy decisions have been made that affect the services provided by the CCG. The Accountable Officer is responsible for ensuring the regularity of expenditure and income in the financial statements.

The Audit and Risk Committee (in common) is Those Charged with Governance. Auditor’s responsibilities for the audit of the financial statements Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements. A further description of our responsibilities for the audit of the financial statements is located on the Financial Reporting Council’s website at: www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditor’s report. We are also responsible for giving an opinion on the regularity of expenditure and income in the financial statements in accordance with the Code of Audit Practice.

Report on other legal and regulatory requirements – Conclusion on the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources Matter on which we are required to report by exception - CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources Under the Code of Audit Practice we are required to report to you if, in our opinion we have not been able to satisfy ourselves that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2018. We have nothing to report in respect of the above matter. Responsibilities of the Accountable Officer As explained in the Governance Statement, the Accountable Officer is responsible for putting in place proper arrangements for securing economy, efficiency and effectiveness in the use of the CCG's resources. Auditor’s responsibilities for the review of the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources We are required under Section 21(3)(c) and Schedule 13 paragraph 10(a) of the Local Audit and Accountability Act 2014 to be satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources and to report where

P a g e | 115 we have not been able to satisfy ourselves that it has done so. We are not required to consider, nor have we considered, whether all aspects of the CCG's arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively. We have undertaken our review in accordance with the Code of Audit Practice, having regard to the guidance on the specified criterion issued by the Comptroller and Auditor General in November 2017, as to whether in all significant respects, the CCG had proper arrangements to ensure it took properly informed decisions and deployed resources to achieve planned and sustainable outcomes for taxpayers and local people. The Comptroller and Auditor General determined this criterion as that necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the CCG put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2018, and to report by exception where we are not satisfied. We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we undertook such work as we considered necessary to be satisfied that the CCG has put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources. Report on other legal and regulatory requirements – Certificate We certify that we have completed the audit of the financial statements of NHS North East Hampshire and Farnham CCG in accordance with the requirements of the Local Audit and Accountability Act 2014 and the Code of Audit Practice.

Iain Murray Director for and on behalf of Grant Thornton UK LLP 30 Finsbury Square London EC2P 2YU 25 May 2018

P a g e | 116

Annual Accounts 2017-2018 Statement of Comprehensive Net Expenditure for the year ended 31 March 2018

Note

2017-18 £'000

2016-17 £'000

Income from sale of goods and services

2

(1,153)

(1,544)

Other operating income Total operating income

2

(85) (1,238)

(79) (1,623)

Staff costs

4

6,065

6,187

Purchase of goods and services

5

298,342

284,768

Provision expense

5

(157)

369

Other Operating Expenditure Total operating expenditure

5

474 304,724

223 291,547

Total Net Expenditure for the year

303,486

289,924

Comprehensive Expenditure for the year ended 31 March 2018

303,486

289,924

The notes on pages 120 to 144 form part of this statement

P a g e | 117 Statement of Financial Position as at 31 March 2018

Note

2017-18 £'000

2016-17 £'000

Current assets: Trade and other receivables

8

2,580

2,933

Cash and cash equivalents

9

101

14

Total current assets

2,681

2,947

Total assets

2,681

2,947

Current liabilities Trade and other payables

10

(23,050)

(19,628)

Provisions Total current liabilities

12

(291) (23,341)

(480) (20,108)

Non-Current Assets plus/less Net Current Assets/Liabilities

(20,660)

(17,161)

Assets less Liabilities

(20,660)

(17,161)

General fund

(20,660)

(17,161)

Total taxpayers' equity:

(20,660)

(17,161)

Financed by Taxpayers’ Equity

The notes on pages 120 to 144 form part of this statement The financial statements on pages 116 to 119 were approved by the Audit & Risk Committee on 22 May 2018, and ratified by the Governing Body on 23 May 2018 and signed on its behalf by:

Accountable Officer: Maggie MacIsaac Organisation: NHS North East Hampshire and Farnham Clinical Commissioning Group 24 May 2018

P a g e | 118 Statement of Changes in Taxpayers Equity for the year ended 31 March 2018

General fund £'000

Total reserves £'000

Changes in taxpayers’ equity for 2017-18 Balance at 01 April 2017 Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2017-18 Net operating expenditure for the financial year Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year Net funding Balance at 31 March 2018

(17,161)

(17,161)

(303,486)

(303,486)

(303,486)

(303,486)

299,987 (20,660)

299,987 (20,660)

General fund £'000

Total reserves £'000

Changes in taxpayers’ equity for 2016-17 Balance at 01 April 2016 Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2016-17 Net operating costs for the financial year Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year Net funding Balance at 31 March 2017

The notes on pages 120 to 144 form part of this statement

(12,690)

(12,690)

(289,924)

(289,924)

(289,924)

(289,924)

285,453

285,453

(17,161)

(17,161)

P a g e | 119 Statement of Cash Flows for the year ended 31 March 2018

Note

2017-18 £'000

2016-17 £'000

Cash Flows from Operating Activities Net operating expenditure for the financial year (Increase)/decrease in trade & other receivables

8

(303,486) 353

Increase/(decrease) in trade & other payables

10

3,422

4,139

Provisions utilised Increase/(decrease) in provisions

12 5

(31) (157)

(84) 369

Net Cash Inflow (Outflow) from Operating Activities

(299,899)

(285,476)

Net Cash Inflow (Outflow) before Financing

(299,899)

(285,476)

Grant in Aid Funding Received

299,987

285,453

Net Cash Inflow (Outflow) from Financing Activities

299,987

285,453

88

(23)

14

37

102

14

(289,924) 24

Cash Flows from Financing Activities

Net Increase (Decrease) in Cash & Cash Equivalents Cash & Cash Equivalents at the Beginning of the Financial Year Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year

The notes on pages 120 to 144 form part of this statement

9

P a g e | 120 Notes to the Financial Statements 1

Accounting Policies

NHS England has directed that the financial statements of clinical commissioning groups shall meet the accounting requirements of the Group Accounting Manual issued by the Department of Health and Social Care. Consequently, the following financial statements have been prepared in accordance with the Group Accounting Manual 2017-18 issued by the Department of Health and Social Care. The accounting policies contained in the Group Accounting Manual follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to clinical commissioning groups, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Group Accounting Manual permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the clinical commissioning group for the purpose of giving a true and fair view has been selected. The particular policies adopted by the clinical commissioning group are described below. They have been applied consistently in dealing with items considered material in relation to the accounts. 1.1

Going Concern

These accounts have been prepared on the going concern basis. 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. NHS North East Hampshire and Farnham CCG was established on 1st April 2013 as a statutory body. The clinical commissioning group has an agreed Governance Framework and continuing Operational Plan and is operating within its constitution to govern its activities. The clinical commissioning group has been allocated funds from NHS England (NHSE) up until 2020-21 in line with the Government's Five Year Forward View. Alongside this the CCG has submitted financial plans to the Governing Body and NHSE up until 2020-21. Included within the operating plans are QIPP plans to mitigate any financial risk identified. The CCG is also forecasting a breakeven position for both 2018-19 and 2019-20. Due to the existence of plans going forward it is concluded that under the Government Financial Reporting Manual (FReM) North East Hampshire and Farnham Clinical Commissioning Group is a going concern for financial reporting purposes. 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.

P a g e | 121 1.3

Acquisition & Discontinued Operations

Activities are considered to be ‘acquired’ only if they are taken on from outside the public sector. Activities are considered to be ‘discontinued’ only if they cease entirely. They are not considered to be ‘discontinued’ if they transfer from one public sector body to another. 1.4

Movement of Assets within the Department of Health and Social Care Group

Transfers as part of reorganisation fall to be accounted for by use of absorption accounting in line with the Government Financial Reporting Manual, issued by HM Treasury. The Government Financial Reporting Manual does not require retrospective adoption, so prior year transactions (which have been accounted for under merger accounting) have not been restated. Absorption accounting requires that entities account for their transactions in the period in which they took place, with no restatement of performance required when functions transfer within the public sector. Where assets and liabilities transfer, the gain or loss resulting is recognised in the Statement of Comprehensive Net Expenditure, and is disclosed separately from operating costs. Other transfers of assets and liabilities within the Department of Health and Social Care Group are accounted for in line with IAS 20 and similarly give rise to income and expenditure entries. 1.5

Pooled Budgets

Where the clinical commissioning group has entered into a pooled budget arrangement under Section 75 of the National Health Service Act 2006 the clinical commissioning group accounts for its share of the assets, liabilities, income and expenditure arising from the activities of the pooled budget, identified in accordance with the pooled budget agreement. If the clinical commissioning group is in a “jointly controlled operation”, the clinical commissioning group recognises:    

The assets the clinical commissioning group controls; The liabilities the clinical commissioning group incurs; The expenses the clinical commissioning group incurs; and, The clinical commissioning group’s share of the income from the pooled budget activities.

If the clinical commissioning group is involved in a “jointly controlled assets” arrangement, in addition to the above, the clinical commissioning group recognises:    1.6

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. 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

P a g e | 122 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. 1.6.1

Critical Judgements in Applying Accounting Policies

No critical accounting judgements have been made in applying the clinical commissioning groups accounting policies 1.6.2

Key Sources of Estimation Uncertainty

The following are the key estimations that management has made in the process of applying the clinical commissioning group’s accounting policies that have the most significant effect on the amounts recognised in the financial statements: (i) (ii) (iii)

(iv) 1.7

Impairment of Non NHS Receivables - The clinical commissioning group provides for non NHS balances that are considered to be at risk. Continuing Care Provision - The clinical commissioning group provides for the likely outcome of continuing care assessments. Prescribing accrual - The clinical commissioning group provides for a prescribing accrual based upon data provided by the Prescription Pricing Authority and outstanding days (two months in arrears). Accruals are based on the historic trends the clinical commissioning group has seen over four years. 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. 1.8

Employee Benefits

1.8.1

Short-term Employee Benefits

Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees, including bonuses earned but not yet taken. The cost of leave earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry forward leave into the following period. 1.8.2

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.

P a g e | 123 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. 1.9

Other Expenses

Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable. Expenses and liabilities in respect of grants are recognised when the clinical commissioning group has a present legal or constructive obligation, which occurs when all of the conditions attached to the payment have been met. 1.10

Leases

Leases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All other leases are classified as operating leases. 1.10.1 The Clinical Commissioning Group as Lessee 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. 1.11

Cash & Cash Equivalents

Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value. In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the clinical commissioning group’s cash management.

P a g e | 124 1.12

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 2.42% (previously: minus 2.70%) Timing of cash flows (6 to 10 years inclusive): Minus 1.85% (previously: minus 1.95%) Timing of cash flows (over 10 years): Minus 1.56% (previously: minus 0.80%)

When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the receivable is recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the receivable can be measured reliably. 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 ongoing activities of the entity. 1.13

Clinical Negligence Costs

The NHS Resolution operates a risk pooling scheme under which the clinical commissioning group pays an annual contribution to the NHS Resolution which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although the NHS Resolution is administratively responsible for all clinical negligence cases the legal liability remains with the clinical commissioning group. 1.14

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 Resolution 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. 1.15

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

P a g e | 125 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. 1.16

Financial Assets

Financial assets are recognised when the clinical commissioning group becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred. 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. 1.17

Loans & Receivables

Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market. After initial recognition, they are measured at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method. Fair value is determined by reference to quoted market prices where possible, otherwise by valuation techniques. The effective interest rate is the rate that exactly discounts estimated future cash receipts through the expected life of the financial asset, to the initial fair value of the financial asset. At the end of the reporting period, the clinical commissioning group assesses whether any financial assets, other than those held at ‘fair value through profit and loss’ are impaired. Financial assets are impaired and impairment losses recognised if there is objective evidence of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the estimated future cash flows of the asset. For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset’s carrying amount and the present value of the revised future cash flows discounted at the asset’s original effective interest rate. The loss is recognised in expenditure and the carrying amount of the asset is reduced through a provision for impairment of receivables. If, in a subsequent period, the amount of the impairment loss decreases and the decrease can be related objectively to an event occurring after the impairment was recognised, the previously recognised impairment loss is reversed through expenditure to the extent that the carrying amount of the receivable at the date of the impairment is reversed does not exceed

P a g e | 126 what the amortised cost would have been had the impairment not been recognised. 1.18

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. 1.19

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. 1.20

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). 1.21

Accounting Standards that have been issued but have not yet been adopted

The DHSC Group accounting manual does not require the following Standards and Interpretations to be applied in 2017-18. These standards are still subject to FREM adoption and early adoption is not therefore permitted.  IFRS 9: Financial Instruments (application from 1 January 2018)  IFRS 14: Regulatory Deferral Accounts (not applicable to DH groups bodies)  IFRS 15: Revenue for Contract with Customers (application from 1 January 2018)  IFRS 16: Leases (application from 1 January 2019)  IFRS 17: Insurance Contracts (application from 1 January 2021)  IFRIC 22: Foreign Currency Transactions and Advance Consideration (application from 1 January 2018)  IFRIC 23: Uncertainty over Income Tax Treatments (application from 1 January 2019) The application of the Standards as revised would not have a material impact on the accounts for 2017-18, were they applied in that year.

P a g e | 127 2

Other Operating Revenue 2017-18 Total £'000

Prescription fees and charges Non-patient care services to other bodies Other revenue Total other operating revenue

3

52 1,153 33 1,238

2017-18 Admin £'000 0 985 31 1,016

2017-18 Programme £'000

2016-17 Total £'000

52 168 2 222

13 1,544 66 1,623

2017-18 2017-18 Admin Programme £'000 £'000 1,016 222 0 0 1,016 222

2016-17 Total £'000 1,623 0 1,623

Revenue

From rendering of services From sale of goods Total

2017-18 Total £'000 1,238 0 1,238

P a g e | 128 4

Employee benefits and staff numbers

4.1

Employee benefits

2017-18

Total £'000

Total Permanent Employee s £'000

Other

Total

£'000

£'000

Admin Permanent Employee s £'000

Other

Total

£'000

£'000

Programme Permanent Employee s £'000

Other £'000

Employee Benefits Salaries and wages Social security costs Employer contributions to the NHS Pension Scheme Other pension costs Apprenticeship Levy Other post-employment benefits Other employment benefits Termination benefits Gross employee benefits expenditure

4,836 605 573 0 8 0 0 43 6,065

4,331 605 573 0 8 0 0 43 5,560

505 0 0 0 0 0 0 0 505

2,102 414 458 0 8 0 0 0 2,982

1,941 414 458 0 8 0 0 0 2,821

161 0 0 0 0 0 0 0 161

2,734 191 115 0 0 0 0 43 3,083

2,390 191 115 0 0 0 0 43 2,739

344 0 0 0 0 0 0 0 344

Net employee benefits excluding capitalised costs

6,065

5,560

505

2,982

2,821

161

3,083

2,739

344

2016-17

Total £'000

Employee Benefits Salaries and wages Social security costs Employer contributions to the NHS Pension Scheme Other pension costs Apprenticeship Levy Other post-employment benefits Other employment benefits Termination benefits Gross employee benefits expenditure Net employee benefits excluding capitalised costs

Total Permanent Employee s £'000

Other

Total

£'000

£'000

Admin Permanent Employee s £'000

Other

Total

£'000

£'000

0 0 0 2,694 2,694

2,244

450

2,501 85 108 0

0 0 0 3,493 3,493

2,806

687

1,137 0 0 0

2,738 372 383 0

0 0 0 6,187

0 0 0 5,050

0 0 0 1,137

6,187

5,050

1,137

The above 2016/17 values have been restated due to a change in accounting classification in 2017/18

£'000 450 0 0 0 0 0 0 0 450

687 0 0 0 0 0 0 0 687

4,102 457 491 0

Other

2,051 85 108 0 0 0 0 0 2,244

2,051 372 383 0 0 0 0 0 2,806

5,239 457 491 0

Programme Permanent Employee s £'000

P a g e | 129

4.2

Average number of people employed

2017-18 Permanently employed Number

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

4.3

2016-17 Other Number

Total Number

85

79

6

94

0

0

0

0

Exit packages agreed in the financial year

Less than £10,000 £10,001 to £25,000 £25,001 to £50,000 £50,001 to £100,000 £100,001 to £150,000 £150,001 to £200,000 Over £200,001 Total

2017-18 Compulsory redundancies Number £ 0 0 1 11,860 1 0 0 0 0 2

31,395 0 0 0 0 43,255

2017-18 Other agreed departures Number £ 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0

2017-18 Total Number 0 1 1 0 0 0 0 2

£ 0 11,860 31,395 0 0 0 0 43,255

The CCG's Vanguard Programme concluded on 31st March 2018 with two associated fixed term contracts ending on the same date.

Less than £10,000 £10,001 to £25,000 £25,001 to £50,000 £50,001 to £100,000 £100,001 to £150,000 £150,001 to £200,000 Over £200,001 Total

2016-17 Compulsory redundancies Number £ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

2016-17 Other agreed departures Number £ 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

2016-17 Total Number 0 0 0 0 0 0 0 0

£ 0 0 0 0 0 0 0 0

These tables report the number and value of exit packages agreed in the financial year. Redundancy and other departure costs have been paid in accordance with the provisions of the NHS Agenda for Change Terms and Conditions. Exit costs are accounted for in accordance with relevant accounting standards and at the latest in full in the year of departure.

P a g e | 130 4.4

Pension Costs

Past and present employees are covered by the provisions of the two NHS Pension Schemes. Details of the benefits payable and rules of the Schemes can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. Both are unfunded defined benefit schemes that cover NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State in England and Wales. They are not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, each scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating in each scheme is taken as equal to the contributions payable to that scheme for the accounting period. In 17/18 NHS North East Hampshire & Farnham CCG also offered an alternative work based pension scheme (NEST) to employees, and costs associated with this scheme are included in the other pension costs of note 4.1.1. In order that the defined benefit obligations recognised in the financial statements do not differ materially from those that would be determined at the reporting date by a formal actuarial valuation, the FReM requires that “the period between formal valuations shall be four years, with approximate assessments in intervening years”. An outline of these follows: 4.4.1

Accounting valuation

A valuation of scheme liability is carried out annually by the scheme actuary (currently the Government Actuary’s Department) as at the end of the reporting period. This utilises an actuarial assessment for the previous accounting period in conjunction with updated membership and financial data for the current reporting period, and is accepted as providing suitably robust figures for financial reporting purposes. The valuation of the scheme liability as at 31 March 2018 is based on valuation data as 31 March 2017, updated to 31 March 2018 with summary global member and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate prescribed by HM Treasury have also been used. The latest assessment of the liabilities of the scheme is contained in the report of the scheme actuary, which forms part of the annual NHS Pension Scheme Accounts. These accounts can be viewed on the NHS Pensions website and are published annually. Copies can also be obtained from The Stationery Office. 4.4.2

Full actuarial (funding) valuation

The purpose of this valuation is to assess the level of liability in respect of the benefits due under the schemes (taking into account recent demographic experience), and to recommend contribution rates payable by employees and employers. The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 March 2012. The Scheme Regulations allow for the level of contribution rates to be changed by the Secretary of State for Health, with the consent of HM Treasury, and consideration of the advice of the Scheme Actuary and employee and employer representatives as deemed appropriate. The next actuarial valuation is to be carried out as at 31 March 2016 and is currently being prepared. The direction assumptions are published by HM Treasury which are used to complete the valuation calculations, from which the final valuation report can be signed off

P a g e | 131 by the scheme actuary. This will set the employer contribution rate payable from April 2019 and will consider the cost of the Scheme relative to the employer cost cap. There are provisions in the Public Service Pension Act 2013 to adjust member benefits or contribution rates if the cost of the Scheme changes by more than 2% of pay. Subject to this ‘employer cost cap’ assessment, any required revisions to member benefits or contribution rates will be determined by the Secretary of State for Health after consultation with the relevant stakeholders. For 2017-18, employers’ contributions of £588,631 were payable to the NHS Pensions Scheme (2016-17: £504,232) at the rate of 14.3% of pensionable pay. The scheme’s actuary reviews employer contributions, usually every four years and now based on HMT Valuation Directions, following a full scheme valuation. The latest review used data from 31 March 2012 and was published on the Government website on 9 June 2012. These costs are included in the NHS pension line of note 4.1.1.

P a g e | 132 5

Operating expenses 2017-18 Total £'000

2017-18 Admin £'000

2017-18 Programme £'000

2016-17 Total £'000

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 WGA bodies Purchase of healthcare from non-NHS bodies Chair and Non Executive Members Supplies and services – clinical Supplies and services – general Consultancy services Establishment Transport Premises Audit fees Other non statutory audit expenditure · Internal audit services Prescribing costs Pharmaceutical services GPMS/APMS and PCTMS Other professional fees excl. audit Legal fees Grants to Other bodies Research and development (excluding staff costs) Education and training Provisions CHC Risk Pool contributions Other expenditure Total other costs Total operating expenses

5,243 822 6,065

2,160 822 2,982

3,083 0 3,083

5,090 1,097 6,187

3,855 179,005 4,104 1 47,556 194 399 253 855 765 5 2,075 34

1,002 0 0 0 0 194 0 131 358 267 3 380 34

2,853 179,005 4,104 1 47,556 0 399 122 497 498 2 1,695 0

2,933 168,511 4,147 0 44,957 190 492 607 805 515 2 3,676 56

40 29,703 614 28,709 0 96 216 9 274 (157) 0 54 298,659

40 0 0 0 0 26 0 0 110 0 0 0 2,545

0 29,703 614 28,709 0 70 216 9 164 (157) 0 54 296,114

40 29,505 537 27,184 193 134 19 9 314 369 160 5 285,360

304,724

5,527

299,197

291,547

Due to a change in accounting classification in 17/18 the below 16/17 values have been restated in the table above; i) ii) iii) iv)

Gross employee benefits; Chair and Non-Executive Members; Other professional fees excl. audit; and Legal fees.

In accordance with SI 2008 no.489, The Companies (Disclosure of Auditor Remuneration and Liability Limitation Agreements) Regulations 2008, where a CCG contract with its auditors provides for a limitation of the auditor’s liability, the principal terms of this limitation must be disclosed in a note to the accounts. The auditors liability for external audit work carried out for the financial year 2017/18 is limited to £500,000

P a g e | 133 6

Better Payment Practice Code

Measure of compliance

2017-18 Number

2017-18 £'000

2016-17 Number

2016-17 £'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

5,452 5,335

64,241 63,804

6,238 6,024

59,316 57,177

97.85%

99.32%

96.57%

96.39%

2,830 2,787

206,408 206,334

2,773 2,748

204,116 203,941

98.48%

99.96%

99.10%

99.91%

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

The Better Payment Practice Code requires the clinical commissioning group to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is the later.

6.1

The Late Payment of Commercial Debts (Interest) Act 1998

During the year there have been no payments under the Late Payment of Commercial Debts (Interest) Act 1998. 7

Operating Leases

7.1

As lessee

The clinical commissioning group occupies various properties, primarily Aldershot Centre for Health, which are rented to the clinical commissioning group by NHS Property Services Limited. Despite no lease being formally in place, the substance of these arrangements suggest that these should be classed as operating leases. These "operating" leases are for periods of twenty five years. 7.1.1

Payments recognised as an expense

Land Buildings £'000 £'000 Payments recognised as an expense Minimum lease payments 0 976 Contingent rents 0 0 Sub-lease payments 0 0 Total

0

976

Other £'000

2017-18 Total £'000

Land £'000

Buildings £'000

2016-17 Total £'000

Other £'000

19 0 0

995 0 0

0 0 0

2,986 0 0

16 0 0

3,002 0 0

19

995

0

2,986

16

3,002

P a g e | 134 8

Trade and Other Receivables

Current 2017-18 £'000 NHS receivables: Revenue

Current 2016-17 £'000

789

1,300

1,005

962

518

343

Non-NHS and Other WGA receivables: Revenue

64

164

Non-NHS and Other WGA prepayments

32

54

8

35

160

69

4

6

2,580

2,933

NHS prepayments NHS accrued income

Non-NHS and Other WGA accrued income VAT Other receivables and accruals Total

The majority of trade is with NHS England and other NHS bodies. As NHS England is funded by Government to provide funding to clinical commissioning groups to commission services, no credit scoring of them is considered necessary. 8.1

Receivables past their due date but not impaired

By up to three months By three to six months By more than six months Total

2017-18 £'000

2017-18 £'000

2016-17 £'000

DH Group Bodies

Non DH Group Bodies

All receivables prior years

0 0 0 0

2 3 2 7

33 5 3 41

The clinical commissioning group did not hold any collateral against receivables outstanding at 31 March 2018.

P a g e | 135 8.2

Provision for impairment of receivables

2017-18 £'000

2017-18 £'000

2016-17 £'000

DH Group Bodies

Non DH Group Bodies

All receivables prior years

Balance at 01 April 2017

0

0

(37)

Amounts written off during the year

0

0

37

Amounts recovered during the year

0

0

0

(Increase) decrease in receivables impaired

0

0

0

Transfer (to) from other public sector body

0

0

0

Balance at 31 March 2018

0

0

0

P a g e | 136 9

Cash and cash equivalents

Balance at 01 April 2017 Net change in year Balance at 31 March 2018 Made up of: Cash with the Government Banking Service Cash in hand Cash and cash equivalents as in statement of financial position

2017-18 £'000 14

2016-17 £'000 37

88

(23)

102

14

98 4

4 10

102

14

The clinical commissioning group did not hold any patients monies. The cash in hand value relates to the balance remaining against the pooled budgets. 10

Trade and other payables

Current 2017-18 £'000

Current 2016-17 £'000

NHS payables: revenue

5,989

1,029

NHS accruals

2,156

3,625

Non-NHS and Other WGA payables: Revenue

2,670

3,850

Non-NHS and Other WGA accruals

8,337

8,004

Social security costs

77

65

Tax

69

59

4

0

3,748

2,996

23,050

19,628

Payments received on account Other payables and accruals Total

Other payables include £298k outstanding pension contributions at 31 March 2018 (£345k at 31 March 2017).

P a g e | 137 11

Finance lease obligations and receivables

The Clinical Commissioning Group had no finance lease obligations or receivables as at 31 March 2018. 12

Provisions

Current 2017-18 £'000 Continuing care

Current 2016-17 £'000

291

479

Other

0

0

Total

291

479

Total current and non-current

291

479

Continuing Care £'000

Other £'000

Total £'000

Balance at 01 April 2017

479

0

479

Arising during the year

236

0

236

Utilised during the year Reversed unused

(31) (393)

0 0

(31) (393)

Unwinding of discount Change in discount rate

0 0

0 0

0 0

Transfer (to) from other public sector body Transfer (to) from other public sector body under absorption Balance at 31 March 2018

0

0

0

0

0

0

291

0

291

Expected timing of cash flows: Within one year

291

0

291

Between one and five years After five years

0 0

0 0

0 0

Balance at 31 March 2018

291

0

291

Pension payments are made quarterly and amounts are known. The pension provision is based on life expectancy. Legal claims are calculated from the number of claims currently lodged with the NHS Resolution and the probabilities provided by them.

P a g e | 138

Under the Accounts Direction issued by NHS England on 12th 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 clinical commissioning group. The total value of legacy NHS Continuing Healthcare provision accounted for by NHS England on behalf of the clinical commissioning group is £66,000. A provision of £291,000 has been created which is for the potential cost of Continuing Healthcare claims in Hampshire and Surrey. 13

Contingencies

The clinical commissioning group had no contingent liabilities as at 31st March 2018. 14

Commitments

14.1

Capital Commitments

The clinical commissioning group had no contracted capital commitments as at 31st March 2018. 15

Other financial commitments

The NHS clinical commissioning group has entered into non-cancellable contracts (which are not leases, private finance initiative contracts or other service concession arrangements) which expire as follows:

2017-18 £'000

2016-17 £'000

In not more than one year

4,289

3,199

In more than one year but not more than five years

3,941

2,960

0

0

8,230

6,159

In more than five years Total

The clinical commissioning group has reviewed its contracts that extend over more than one financial year. All of these contracts have break clauses however included above are the value of those contracts where early termination would result in a significant financial impact on the clinical commissioning group.

P a g e | 139 16

Financial Instruments

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. 16.1

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 and internal auditors. 16.1.1 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. 16.1.2 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. 16.1.3 Credit risk Because the majority of the clinical commissioning group's revenue comes from 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. 16.1.4 Liquidity risk The clinical commissioning group is required to operate within revenue and capital resource limits, which are financed from resources voted annually by Parliament. The clinical commissioning group draws down cash to cover expenditure, as the need arises. The clinical commissioning group is not, therefore, exposed to significant liquidity risks.

P a g e | 140 16 Financial instruments cont'd 16.2 Financial assets At ‘fair value through profit Loans and and loss’ Receivables 2017-18 2017-18 £'000 £'000 Receivables: · NHS · Non-NHS Cash at bank and in hand Other financial assets Total at 31 March 2018

0 0 0 0 0 At ‘fair value through profit and loss’ 2016-17 £'000

Receivables: · NHS · Non-NHS Cash at bank and in hand Other financial assets Total at 31 March 2017

16.3

Available for Sale 2017-18 £'000

1,307 73 102 4 1,486

Loans and Receivables 2016-17 £'000

0 0 0 0 0

0 0 0 0 0

Available for Sale 2016-17 £'000

1,643 199 14 6 1,862

Total 2017-18 £'000

1,307 73 102 4 1,486

Total 2016-17 £'000

0 0 0 0 0

1,643 199 14 6 1,862

Financial liabilities At ‘fair value through profit and loss’ 2017-18 £'000

Payables: · NHS · Non-NHS Total at 31 March 2018

0 0 0 At ‘fair value through profit and loss’ 2016-17 £'000

Payables: · NHS · Non-NHS Total at 31 March 2017

Other 2017-18 £'000

8,145 14,754 22,899

Other 2016-17 £'000

0 0 0

4,654 14,850 19,504

Total 2017-18 £'000

8,145 14,754 22,899

Total 2016-17 £'000

4,654 14,850 19,504

17 Operating Segments The NHS clinical commissioning group and consolidated group consider they have only one segment: commissioning of healthcare services.

P a g e | 141 18 Pooled Budgets The Clinical Commissioning Group has entered into pooled budgets with both Hampshire and Surrey County Councils as follows: i) Hampshire Better Care Fund hosted by Hampshire County Council; and ii) Surrey Better Care Fund hosted by Surrey County Council. The Better Care Fund has been established by HM Government to provide funds to local areas to support the integration of health and social care. In this arrangement funds are pooled under Section 75 of the NHS Act 2006 which gives powers to local authorities and Clinical Commissioning Groups to establish and maintain pooled funds out of which payment may be made towards expenditure incurred in the exercise of prescribed local authority functions and prescribed NHS functions. The NHS clinical commissioning group shares of the income and expenditure handled by the pooled budget in the financial year were:

Income Expenditure

2017-18 £'000 12,331 (12,331)

2016-17 £'000 12,084 (12,078)

P a g e | 142 19 Related party transactions

Payments to Related Party £'000 BRANKSOMEWOOD HEALTHCARE CENTRE - Dr S Clarke CRONDALL NEW SURGERY - Dr H Hoff DOWNING STREET GROUP PRACTICE - Dr E Wernick FARNHAM INTERGRATED CARE SERVICES LTD - Dr J Dempster. Dr E Wernick FRIMLEY HEALTH NHS FOUNDATION TRUST - Dr J Dempster. Dr H Hoff HAMPSHIRE HOSPITALS NHS FOUNDATION TRUST - DR E Wernick INSIDEVUE LTD - Dr S Clarke LLOYDS PHARMACY LTD - Dr S Clarke MILESTONE SURGERY - Dr A Whitfield NHS NORTH HAMPSHIRE CCG - Mrs E Boswell. Dr E Palfrey NHS SURREY HEATH CCG - Dr K Bennett NORTH HAMPSHIRE URGENT CARE - Dr H Hoff. Dr E Palfrey OAKLEY HEALTH GROUP - Dr K Bennett RIVER WEY PRACTICE (ODONNELL H & PARTNERS) - Dr S Clarke PHYLLIS TUCKWELL HOSPICE - Dr A Whitfield SALUS MEDICAL SERVICES - Dr P Bibawy. Dr S Clarke. Dr J Dempster. Dr E Wernick. Dr A Whitfield. Dr K Bennett. Dr H Hoff SOUTHERN HEALTH NHS FOUNDATION TRUST - Dr P Bibawy SOUTHLEA GROUP PRACTICE - Dr P Bibawy SOUTHWOOD PRACTICE - Dr A Whitfield VICTORIA PRACTICE - Dr P Bibawy FARNHAM DENE MEDICAL PRACTICE - Dr J Dempster ALEXANDER HOUSE PRACTICE - Dr O Fairbairn JENNER HOUSE - Dr O Fairbairn RUSHMOOR HEALTHLY LIVING - Dr O Fairbairn SPIRE HEALTHCARE LTD - Dr E Palfrey

Receipts from Related Party £'000

Amounts owed to Related Party £'000

1,336

119

812

61

1,352

85

Amounts due from Related Party £'000

1,436 -3 1,463

737 132,674

2016/17 Payments to Related Party £'000

792 -48

335

-420

123,439

1,217

176

1,169

327 95 1,263

23

224 87

79

389

-480

11

-216

-2 250

-65

4,208

809

2,369

311

808

79

213

1,949

78

782

-18

76

-80

4,881

1,721

115

1,839

646 1,071

49 80

732

1,277

95

1,377 1,027 1,043 9 2,012

Department of Health – The CCG has a relationship with the Department of Health as its parent department

P a g e | 143 20 Events after the end of the reporting period None 21 Third party assets The clinical commissioning group did not hold any cash or cash equivalents on behalf of other parties. 22 Financial performance targets NHS Clinical Commissioning Group have a number of financial duties under the NHS Act 2006 (as amended). NHS Clinical Commissioning Group performance against those duties was as follows:

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 Revenue administration resource use does not exceed the amount specified in Directions

2017-18

2017-18

2017-18

2016-17

Target £'000

Performance £'000

Variance £'000

Target £'000

2016-17

2016-17

Performance Variance £'000 £'000

306,338

304,724

(1,614)

298,330

291,547

(6,783)

0

0

0

0

0

0

305,100

303,486

(1,614)

296,707

289,924

(6,783)

0

0

0

0

0

0

0

0

0

0

0

0

4,715

4,512

(203)

4,706

4,701

(5)

The Resource Allocation Directions for 2017/18 are now based on 'in year' funding rather than a cumulative position. Therefore, the table above shows NHS North East Hampshire and Farnham CCG's financial performance against it’s 'in year allocation' for 2017/18, whereas in 2016/17 financial performance was measured against 'total allocation' which included the carry forward of historic allocation.

P a g e | 144

For 2017/18, the CCG set out a plan to deliver a breakeven position against its in year allocation. As set out in the 2017/18 Planning Guidance, CCGs were required to hold a 0.5% reserve uncommitted from the start of year, created by setting aside the monies that CCGs were otherwise required to spend non-recurrently. The national position across the provider sector has been such that NHS England has been unable to allow CCGs' 0.5% non-recurrent monies to be spent. Therefore NHS North East Hampshire and Farnham CCG has released its 0.5% reserve to the bottom line. Furthermore, the nationally retained drug price savings that were being held centrally were returned to CCGs, and NHS North East Hampshire and Farnham CCG took the benefit to the bottom line position as stipulated by NHS England. The total impact of both the release of the 0.5% risk reserve and the return of the nationally retained drug price savings has therefore resulted in a surplus for the year of £1.6m against our 2017/18 breakeven plan, which is shown in the above table. 23 Losses and special payments The clinical commissioning group had no losses in 2017/18. 24 Special payments

Total Number of Cases 2017-18 Number Compensation payments Extra contractual Payments Ex gratia payments Extra statutory extra regulatory payments Special severance payments

Total Value of Cases 2017-18 £'000 0 0 1 54 0 0 0 0 0 0

Total

1

54

In 2016 Guildford and Waverley CCG ran a procurement process for the Surrey Children’s Community Health Service on behalf of itself, 5 other CCGs, NHS England (together the “NHS Commissioners”) and Surrey County Council. The procurement process was challenged and, following legal advice and a mediation process, the parties involved agreed on an out of court settlement and a total payment of £1.565 million has been made in 2017-18 on behalf of all of NHS commissioners. As an organisation NHS North East Hampshire & Farnham CCG paid £54,177 of the settlement sum.