islington ccg ccg... · 1 annual report 1 performance report 1.1 purpose and activities islington...

Islington CCG

ANNUAL REPORT AND ACCOUNTS

2015/16

Table of Contents Annual Report ..................................................................................................................... 1

1 Performance report ...................................................................................................... 1

1.1 Purpose and activities .............................................................................................. 1

1.2 Chief Officer summary of performance ..................................................................... 2

1.3 Social and community issues ................................................................................... 4

1.4 Issues and risks ....................................................................................................... 5

1.5 Thank you to our partners in Islington ...................................................................... 6

1.6 Performance measurement ...................................................................................... 6

1.7 Financial review ..................................................................................................... 10

1.8 Quality, Innovation, Productivity and Prevention .................................................... 12

1.9 Financial outlook .................................................................................................... 12

1.10 Development and performance ............................................................................ 14

1.11 Patient and public involvement ............................................................................. 17

1.12 Assurance framework statement introduction ....................................................... 18

1.13 Promoting the NHS Constitution ........................................................................... 18

1.14 Assisting NHS England in improving primary medical services ............................ 20

1.15 Promoting patient involvement in decisions .......................................................... 20

1.16 Enabling patient choice in health services ............................................................ 21

1.17 Promoting innovation, research, education and training ....................................... 23

1.18 Consulting widely on commissioning plans........................................................... 25

1.19 Preparing for dealing with an emergency ............................................................. 26

1.20 Co-operating with the Islington Health and Wellbeing Board ................................ 27

1.21 Discharging function regarding safeguarding ....................................................... 28

1.22 Co-operating in preparation of Joint Strategic Needs Assessments ..................... 33

1.23 Sustainability ........................................................................................................ 33

1.24 Reducing inequality .............................................................................................. 34

2 Accountability report.................................................................................................. 35

2.1 Corporate governance report ................................................................................. 35

2.2 Statement of Accountable Officer’s responsibilities ................................................ 40

2.3 Governance statement ........................................................................................... 41

2.4 Remuneration and staff report ................................................................................ 52

3 Financial statements .................................................................................................. 61

3.1 Independent auditor’s report to the members of the Governing Body of NHS

Islington CCG .............................................................................................................. 61

3.2 Annual accounts .................................................................................................... 64

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Annual Report 1 Performance report 1.1 Purpose and activities Islington Clinical Commissioning Group (CCG) is responsible for planning and commissioning health services for all those people with an Islington GP. Set up in 2013, our CCG is made up of 34 member GP practices across the borough. Our GP member practices decide how the CCG operates through a constitution and a Governing Body made up of lay members, clinicians (GPs, nurses and a hospital doctor) and NHS managers. With a population of about a quarter of a million living in an area under six square miles, Islington is the most densely populated borough in the United Kingdom. We have a number of health and wellbeing challenges in the borough, including:

being London’s fifth most deprived borough and the fourteenth most deprived in England

approximately 20% of residents enter and leave the borough each year (one of London’s most mobile populations)

at least 35,000 registered patients have one long-term condition, such as diabetes, and it is believed many more may be undiagnosed

a diverse population with a wide range of distinct health needs across both mental and physical health

about 10% of registered patients have a diagnosis of depression (amongst the highest in London)

about 25% of children aged six are obese, higher than the England average.

To help us provide the best service, make life easier for patients and take better care of them,

we work together with Islington Council to tackle these challenges.

To help us provide the best service, we also work with and listen carefully to what local people

tell us. We meet regularly with them so they can ask questions, tell us what works well and

what they think needs to change.

In addition we work with other clinical commissioning groups across London (particularly with

Barnet, Camden, Enfield and Haringey).

We buy a range of services including hospital services, rehabilitation services, urgent and

emergency care (including the NHS 111 phone answering service and GP Out of Hours

services), most community health services (such as podiatry, district nursing and

physiotherapy) and mental health and learning disability services. Our total budget for 2015/16

was £338,598k.

Most of these services are provided by local NHS organisations such as Whittington Health

NHS Trust, Moorfields NHS Foundation Trust, Camden and Islington NHS Foundation Trust,

University College London Hospitals NHS Foundation Trust and Royal Free London NHS

Foundation Trust. We also buy services from not-for-profit organisations based in the local

community, as well as other types of providers.

This report sets out the CCG’s progress and performance on our priorities over the past year,

with examples of where we have been successful in improving the health and wellbeing of

people in Islington.

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1.2 Chief Officer summary of performance The CCG’s member GP practices have agreed their collective aim as:

to develop a new partnership between patients and their clinicians that together commissions health services of high quality and good value for money and meets the needs of the population.

Four objectives will help us to achieve our vision:

1. Ensuring every child has the best start in life. 2. Preventing and managing long-term conditions to extend both length and quality of life

and reduce health inequalities. 3. Improving mental health and wellbeing. 4. Delivering high quality, efficient services within the resources available.

As commissioners of healthcare services for Islington, we want to use the clinical expertise of our GPs to plan, develop and buy the best possible services that will improve the health and wellbeing of everyone in Islington. Over the past year our work has focused on working together with a variety of partners, patients and local people. This has seen us continue our work as an ‘integrated care pioneer’ which means we’re working with Islington Council and other partners to link health and social care together to make life easier for patients and take better care of them. This has seen the development of integrated networks across Islington to pool the knowledge and skills of health and social care practitioners, breaking down barriers that have previously hampered truly integrated care for patients. The networks involve weekly multidisciplinary team meetings about people who have long-term conditions. The networks and meetings aim to improve patient experiences and outcomes by bringing together social care and other professionals with clinicians, bridging the gap between health and social care. To support the staff and equip them with the right skills and knowledge we have also provided training from Islington’s Community Education Provider Network. We work collaboratively with all our partners to plan and deliver training, education and development across health and social care. In order to continue improving patient experience and outcomes, the health and social care services involved in an individual’s care need to be able to share data with one another. To enable this, we have procured an Integrated Digital Care Records system and are developing a Person Held Record. Each of these will help provide greater coordination between services in Islington. By spring 2016 there will be seven networks in place bringing health and social care professionals together to share knowledge, bridge gaps between services and improve experiences and outcomes for complex patients. The networks will cover an estimated 127,051 patients which is just over 50 per cent of the Islington population and we expect more to be formed throughout 2016. In addition to our Annual General Meeting which we held in September 2015, we held a series of small scale, face to face events with our partners in the borough including Age UK, Manor Gardens, St Luke’s Community Centre, as well as HealthWatch Islington.

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These are some of the ways that we invite the views of all those in our community. We have taken particular care to listen to those who may not be heard as often or as easily, owing to language barriers, social exclusion or other factors. Our ambitious programme of work to develop Islington’s primary care continues in partnership with our member practices. Islington’s residents are now able to access additional GP appointments following a successful bid for funding from the Prime Minister’s Challenge Fund. This has allowed the launch of three iHubs in the borough which offer appointments with doctors and nurses when patients are unable to see someone at their regular practice. We have also listened carefully to what people tell us about how they want to access their GP. We’ve learnt what works well and what needs to change. As part of this we are continuing to work with our member practices to help them to form a GP Federation (a group of GP practices working in collaboration, sharing responsibility for developing and delivering high quality, patient focussed services for their local community). This will allow practices to provide primary care services on a larger scale, helping to ensure similar levels of care across the borough. To help us provide the best service, we have listened to what local people tell us and looked again at the way services operate to see if they can be improved. Working with Haringey CCG, we have been developing services focused on outcomes for people living with diabetes, and working with Camden CCG for people living with psychosis. To inform our work we have carried out a series of “listening” workshop events with patients, providers and commissioners to find out what is important to those living with diabetes and psychosis. With this feedback we are working together to develop services that are focused on the health outcomes that have been identified as priorities for these groups of patients. Involving patients has also meant we understand the frustration they feel at having to tell their story more than once and the importance of a single of point of access to a service. With this in mind, changes patients can expect to see include an improved infrastructure making services easier to navigate and more services offered from a single location. These developments amongst others will help people to reduce the time spent in contact with healthcare services. Over the past year, the five North Central London CCGs (Barnet, Camden, Enfield, Haringey and Islington) have been working to commission a single, integrated NHS 111 phone answering service and GP Out of Hours service for their collective population. Last year with the end of the contract approaching, we took the opportunity to look at the way the service operates, consider the views of the local population and see if it can be improved. With the feedback from a series of community events where local people asked us questions and told us their concerns, we involved the people of Islington in the tender and procurement processes, working with them to shape the future service. The new contract was awarded in April to London Central and West Unscheduled Care Collaborative a GP-led not-for-profit organisation and will begin in October this year. The length of time from GP referral through to planned treatment has remained stable across all providers. Cancer and diagnostic waits at University College London Hospitals (UCLH) are longer than we would like. Working with Camden CCG as lead commissioner for UCLH there is an action plan and timeline to address these with the aim of creating a more efficient, resilient service for the future. Increasing demand on emergency services continues to affect NHS organisations across the country. We recognise the need to confront this challenge whilst continuing to provide quality of care and a positive patient experience.

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By staying in regular contact with Whittington Health, we are working together to better understand the pressures providers face and improve performance. Last year we introduced a number of innovative interventions to improve performance. Services such as ambulatory care, which allow patients with specific conditions to be seen, diagnosed and treated without admission to hospital continues to prove successful in improving care and helping to alleviate pressure on emergency services. The introduction of a clinical team with specialist expertise in acute mental ill health has also resulted in a better care experience for patients and relieved the need to admit as many patients into the hospital.

1.3 Social and community issues The CCG is committed to playing a full and active role within the wider community. The relationship between health and wider social influences is well established. In November 2014 the report of the Islington Employment Commission was published and the CCG has since committed to its role in implementing the recommendations. We will continue to promote good employment practices, such as taking forward recommendations to support the London Living Wage, as well as support programmes helping people back into work, when they feel it is right for them. We are already doing some of this work with our partners in the non-profit sector, such as Hillside Clubhouse which we helped to set up. We commissioned Hillside Clubhouse to run a now established and successful programme that supports people with mental health issues who would like to get back into work after a period of absence. In 2014 we established the Community Education Provider Network site, which is helping us to develop a well-trained and motivated workforce, an essential component of Islington’s health and care economy. Given the expected changes in our population in the coming years, we need to be working now to ensure we have the workforce with the right mix of skills for our community’s future needs.

We continue to develop and create new relationships through our work. We hold between two and three third sector (voluntary and community organisations) open discussion forums each year in Islington. At these forums we are able to share our commissioning intentions for the year ahead and hear feedback from organisations working on the ground with the different communities in Islington. As part of this, we work with these local partners:

Women’s Strategy Group (mental health)

Islington Borough Users Group (mental health)

HealthWatch Islington

Body and Soul (HIV)

Voluntary Action Islington

Diabetes UK (Islington)

Cripplegate Foundation. These forums also help to link up local organisations and build an understanding of the different ways they can support the local community. As well as developing relationships this helps us reach out to those who experience barriers in accessing health services. Last year the CCG developed the Community Wellbeing Project. Working in partnership with Islington Giving, the project is delivered by the local charity Help on your Doorstep in the New River Green Estate.

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Help on your Doorstep already has a lot of local knowledge and runs the Good Neighbours scheme on the estate. As a result the charity has a positive relationship with the local community which helps it to deliver this project. The project contains four elements:

research and insight into the local community’s needs and skills

involvement of the local community so it meets their needs and uses their skills

delivery by the local community

evaluation by the local community. The purpose of this project is to support the local community to deliver a project which supports their wellbeing. It has given us an opportunity to evaluate these projects and understand this work and learn what the successes and areas for improvement are. A key part of the work is this insight gathering. The project which is now in its third year has been highly successful. Wellbeing support through a series of activities has been set up on the estate as well as a local football team (which was set up by young men living on the estate who received support with its development). The success of the project has seen Islington Council use it as a model for further community development work in the borough and we plan to use the same method on other estates in the coming year.

1.4 Issues and risks The CCG is responsible for planning and buying hospital, community and mental health services for the population of the borough. Every year we consider the Joint Strategic Needs Assessment (JSNA), which sets out clinical and public health evidence about our local population. The Governing Body is established through a constitution agreed by all our 34 member GP practices and is currently chaired by Islington GP, Dr Jo Sauvage. The previous Chair Dr Gillian Greenhough stood down in February as she was moving from the area. Dr Sauvage was previously a Vice-Chair of the CCG and she is supported by a Governing Body that includes GPs, nurses, lay members, a practice manager, CCG managers and a hospital specialist. Most of our commissioning team is based in our main office in Goswell Road, Islington. Some of our commissioning team are employed jointly between ourselves and Islington Council, reflecting our long standing partnership approach to health and social care across the borough. Our Governing Body works with our patients and partner organisations, including local authorities, the North East London Commissioning Support Unit and partner CCGs across North Central London (Barnet, Camden, Enfield, Haringey and Islington), to improve the health of the people of Islington as well as the health services that we all use. These priorities are being delivered through strategic plans across primary care, integrated care, urgent care and planned care. All are underpinned by patient and public engagement. The CCG’s strategic approach is also informed by national guidance designed to help us get the best outcomes for our local population. Initially established in 2013, the CCG’s corporate risk register and Board Assurance Framework (BAF) ensures risks go through the following regular review cycle described in the

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corporate governance report (section 2.1 of this report). All risks are linked to the CCG’s key priorities and the mitigation and assurance of risks is scrutinised as part of the internal audit work-plan. Under the National Health Service Act 2006 (as amended), NHS England has directed each CCG to prepare for each financial year, statements in the form and on the basis set out in the Accounts Direction. The financial statements are prepared on an accruals basis and must give a true and fair view of the state of affairs of the CCG and of its net expenditure, changes in taxpayers’ equity and cash flows for the financial year. We certify that the CCG has complied with the statutory duties laid down in the National Health Service Act 2006 (as amended). As at 31st March 2016, the CCG had net liabilities of £32,015k (£32,182k as at 31st March 2015). The ability of the CCG to continue as a going concern is dependent upon its ability to secure future funding from NHS England. The budget for 2016/17 has already been agreed with NHS England. On this basis, there is no reason to believe that sufficient funding will not be made available to the CCG in the twelve months from the date of approval of the financial statements. As such, the financial statements at section 3 of this report have been prepared on a going concern basis.

1.5 Thank you to our partners in Islington We acknowledge and thank all those across the borough who have given their time and energy to help inform our decisions. Whether it has been on the development of primary care, improving NHS 111 and GP Out of Hours services, or one of the many other projects, we are very grateful.

1.6 Performance measurement Performance measures are factors by reference to which the development, performance or position of the entity’s business can be measured effectively. Key measures that the CCG reports on are outlined below. Financial performance Financial performance measurement is discussed in the financial review at section 1.7 of this report. As is typically the case, the CCG met its key financial duties during the year. The only marginal failure to meet targets was in performance against the relatively insignificant Better Payment Practice Code. The CCG assurance framework NHS England’s first assurance framework was based on the CCG authorisation process and was structured around six domains:

1. Are patients receiving clinically commissioned, high quality services? 2. Are patients and the public actively engaged and involved? 3. Are CCG plans delivering better outcomes for patients? 4. Does the CCG have robust governance arrangements? 5. Is the CCG working in partnership with others? 6. Does the CCG have strong and robust leadership?

Much has changed since the authorisation process was undertaken, giving rise to the need for a refreshed approach to assurance. The NHS has had to respond to more challenging performance and financial positions, as well as changes within the commissioning landscape.

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As commissioners of secondary care, and with responsibility for the GP IT budget, the CCG is uniquely placed to achieve safe, digital record keeping and the digital transfer of patient information across care settings within its health economy. This framework applied to 2015/16 acknowledges that CCGs have different starting positions, with different populations and challenges, requiring different leadership responses. Some are operating in an extremely difficult environment, within challenged health economies or with legacy financial issues. Assurance covers the overall delivery of a CCG, and takes place continuously throughout the year, rather than as a one-off inspection. The 2015/16 assurance framework recognises that assurance is a continuous process that considers the breadth of a CCG’s responsibilities. It consisted of the following components:

being a well-led organisation

performance: delivery of commitments and improved outcomes

financial management

planning.

The 2015/16 assurance process introduced a more risk-based approach which differentiates high performing CCGs, those whose performance gives cause for concern, and those in between. It provided a robust, supportive and structured framework for those in more challenged circumstances, with a lighter touch approach for the best performers. CCGs were assessed as being in one of four assurance categories:

1. outstanding 2. good 3. limited assurance, requiring improvement 4. not assured.

Following the assurance meeting with NHS England in August 2015, the CCG was rated ‘good’ across each of the four components in the framework for the year. Better Care Fund metrics The Better Care Fund is a national scheme creating locally held pooled budgets to drive integration of health and social care, aiming to reduce non-elective admissions to hospitals by 3.5% by the end of 2015/16. In Islington, the BCF is split between schemes for which either the CCG or Islington Council is the lead commissioner, with a range of performance measures or metrics. The only metric measured by the CCG is to slow the rate of increase in non-elective admissions. During 2015/16, the 3.5% target equated to £13,214k, which was achieved before the year end. The Friends and Family Test The Friends and Family Test was launched in April 2013 with a phased roll out to most English NHS services, in the form of a questionnaire collecting feedback from patients and staff. It asks if people would recommend services used and when combined with supplementary questions, provides a mechanism to measure experience. Responses to requests for recommending services for the period April 2015 to February 2016, the last month measured, are indicated in the following table. Results for the organisations measured are generally more favourable than the London average, but where this is not the case, the CCG works with the service providers to understand the feedback and take corrective action.

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Table 1. Friends and Family Test

Whittington Moorfields Camden and

Islington London Region

% Yes % No % Yes % No % Yes % No % Yes % No

A&E 92.6% 4.6% 93.2% 1.7% -- -- 87.8% 6.4%

Inpatient 93.6% 2.8% 99.0% 0.4% -- -- 94.8% 1.9%

Maternity (Birth) 96.2% 0.8%

-- -- -- -- 95.2% 1.9%

Outpatient 89.6% 5.1% 96.7% 1.5% -- -- 92.3% 3.1%

Mental Health

-- -- -- -- 83.8% 8.0% 82.8% 6.3%

Community 96.8% 1.1% -- -- -- -- 94.3% 2.1%

* The percentage of responses do not add up to 100% because we have omitted the ‘neither/don’t know’ responses.

NHS Constitution standards The NHS Constitution sets out rights for patients, public and staff. It outlines NHS commitments to patients and staff, and the responsibilities that the public, patients and staff owe to one another to ensure that the NHS operates fairly and effectively. The rights are underpinned by a series of pledges, one of which is that patients have the right to access NHS services, and will not be refused access on unreasonable grounds. The CCG monitors performance against the Constitution access targets throughout the year, and this performance is reported to the Quality and Performance Committee and the Governing Body. Where performance is below the standard, the CCG seeks assurance from providers of the recovery actions and timescales. The CCG’s performance against the targets is discussed in Promoting the NHS Constitution at section 1.13 of this report. Activity indicators A summary of the CCG’s activity figures compared with the plan for each of the main acute providers is shown below. Accident and Emergency Attendances Accident and Emergency activity was generally higher than plan across the main acute providers, but the discrepancies were relatively low in most cases. Table 2. Accident and Emergency attendances

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Outpatient Attendances There were significant variances in outpatient activity across the main acute providers. All providers’ outturns were above plan, with the Whittington’s variance of 9.5% being of particular concern. A coding change during 2015/16 resulting in day-case activity for anaesthetics which contributed to the increase. Revised NICE guidelines regarding treatment of patients with atrial fibrillation increased anti-coagulant outpatient activity. Table 3. Outpatient attendances

Elective Activity Elective activity was below plan across the main acute providers in 2015/16. This is due entirely to lower activity levels at the Whittington (19.4%), partially offset over performance at other providers. Factors in the low Whittington activity include the anaesthetics recoding issue mentioned above, and the correction of previously overstated medical oncology and clinical haematology activity relating to NHS England. Table 4. Elective activity

Non-Elective Activity Activity levels were broadly in line with plan for all providers with the exception of the Barts Health NHS Trust over performance. Much of the increase is due to the transfer of the cardiology service from UCLH to Barts.

Table 5. Non-elective activity

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1.7 Financial review The CCG’s opening resource limit for 2015/16 was £332.3m, comprising:

£319m commissioning of healthcare services

£5.1m management costs

£8.2m brought forward surplus. Various adjustments during the year totalling £6.3m resulted in a closing resource limit of £338.6m. Our main commissioning expenditure was across NHS provider contracts with Whittington Health NHS Trust, University College London Hospital NHS Foundation Trust and Camden and Islington NHS Foundation Trust. Of our total expenditure, £196m or 60%, was spent with these three providers and covered the full range of acute, community and mental health services. Smaller contracts are in place with other providers and a range of services are purchased from voluntary and community providers. Table 6 below provides an overview of the CCG’s financial performance against core financial targets in 2015/16. Table 6. Achievement against core 2015/16 financial targets

Target Plan Actual Achieved

Revenue resource use does not exceed the CCG allocation

£338.6m £329.6m √

To stay within plan and deliver a surplus of £9m £6.5m £9.0m √

To meet our running cost allowance £5.2m £5.2m √

To meet our cash target £305.1m £305.1m √

To deliver our QIPP savings programme £12.0m £11.5m √

Capital resource use does not exceed CCG allocation £1.3m £1.3m √

To meet the Better Payment Practice Code target (value)

95% 94% x

To meet the Better Payment Practice Code target (volume)

95% 89% x

Although the CCG did not deliver the full QIPP savings programme, the 96% achieved is considered a good performance. The underperformance against the Better Payment Practice Code targets was due to a 30% increase in invoice volume when compared to 2014/15. Recent reporting shows that the CCG is now meeting value targets and expects to achieve volume targets in the first quarter of 2016/17. The CCG spent a total of £329.6m across commissioning areas and management costs (see breakdown in Fig. 1).

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Fig. 1 Overall CCG spending during 2015/16

Pressures on the financial position this year included performance on acute contracts, where our plans were exceeded by £1.3m (1%). The main pressures were with Royal Free London NHS Foundation Trust and Moorfields Eye Hospital NHS Foundation Trust performance, for which activity was £1.0m (10%) and £0.3m (9%) above plan respectively. The Whittington Health NHS Trust contract operated under a £95.1m block contract with a performance range of plus or minus 2.5% (a cap and collar). The contract performed at the cap for 2015/16, but additional support of £0.8m was provided to deliver resilience arrangements over the first quarter. The CCG’s other major acute contract was with University College London Hospitals NHS Foundation Trust (£60.1m) which finished the year £0.3m below plan. This contract had been an area of material over performance in 2014/15. The mental health budget was under plan by £0.3m (0.8%), due to lower levels of charge exempt overseas visitor activity than in previous years. National funding for this activity is one year in arrears and as accounting rules prohibit accruing for income that is not certain, performance in this area is difficult to measure. The CCG increased overall expenditure in mental health services in line with the increases in the resource allocation in 2015/16 thus meeting the national Mental Health Parity of Esteem spending target. Community expenditure includes expenditure charged to the Better Care Fund (BCF) that operated under a Section 75 Pooled Budget with Islington Council during 2015/16. The total pooled fund (£18.4m) was fully committed and invested in schemes that promoted health and social care integration. The targeted 3.5% reduction in non-elective hospital admissions was achieved. Primary care expenditure incorporates locally commissioned schemes with GPs, the Out of Hours GP service, GP ‘walk-in’ services and the development of primary care in Islington. In 2015/16, primary care prescribing was £1.2m (5.1%) above plan. This was due to nationally mandated in-year changes to drug pricing which had an overall adverse impact on the CCG’s prescribing costs.

63%

14%

10%

8%

2% 2% 2%

Acute & Integrated Care

Mental Health

Community (includingBetter Care Fund)

Primary Care Prescribing

Primary Care Schemes

Other Commissioning

Running Costs

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During 2015/16, the CCG acted as financial host for the Healthy London Partnership (HLP). This supported the delivery of a series of pan-London schemes with the CCG responsible for the administration of each programme on behalf of all London CCGs and NHS England. The HLP was outside the CCG’s core business and reported a £1m underspend which was rolled forward for investment in HLP schemes next financial year. Despite the pressures described above, prudent financial management of resources meant that CCG reserves provided sufficient mitigation to cover the overall position. The actual surplus (£9m) reported in table 9 can be broken down into the original planned surplus (£6.5m), the additional non recurrent surplus in CCG reserves (£1.5m), and the roll forward of Healthy London Partnership resources (£1m). In November 2015, the CCG and Islington Council entered in to a 5-year contract with British Telecommunications (BT) to provide an Integrated Digital Care Record (IDCR) and Personally Held Record (PHR) solution for Islington residents. The cost of the system is being met through NHS capital funds, contributions from Islington Council and anticipated savings from managing hospital attendances and admissions. An example of a saving is avoiding adverse drug reactions by having records readily available to clinicians. In 2015/16, the CCG’s support to the programme was met by existing revenue funding the project management team and contributing a further £1.3m of capital awarded by the Department of Health towards the initial build costs. Future build costs will be met through the Better Care Fund, which is a pooled resource between the CCG and Islington Council.

1.8 Quality, Innovation, Productivity and Prevention In order to meet financial planning requirements and improve system efficiencies, the CCG set a challenging £12m QIPP target for 2015/16. The QIPP programme amounted to 4% of the CCG’s overall allocation with savings targets split between transactional (provider contract negotiations) and transformational schemes (referral management and out of hospital services). The CCG achieved £11.5m of the targeted £12m QIPP with strong performance in the reduction of non-elective hospital admissions most notably at University College London Hospitals NHS Foundation Trust. The £0.5m slippage against the overall target was due to higher than expected levels of hospital referrals and delays in the implementation of the community gynaecology service at Whittington Health NHS Trust. QIPP underperformance was reported within the CCG’s overall financial position and our reserves were used to manage the QIPP pressure.

1.9 Financial outlook Allocation The CCG faces a challenging year in 2016/17, with increases in provider tariff costs and national planning requirements outstripping the overall 2.17% increase to the our resource allocation. Including a growth value of £6.9m, the CCG’s allocation has been confirmed at £340.9m. Our financial operating plan has been set to achieve a 1.9% surplus or £6.5m for 2016/17. In order to achieve this position, £6.5m of the £9m 2015/16 surplus being returned to the CCG will be used to declare the 2016/17 position. The £2.5m non-recurrent surplus in 2015/16 will be used to return the £1m allocation carried forward on behalf of the Healthy London Partnership and £1.5m to meet the CCG’s cost pressures in n 2016/17.

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In addition to the contribution from the 2015/16 surplus, a challenging 3% QIPP programme has been set across the CCG’s commissioning budgets. The programme aims to deliver a £9m savings target and is split between a combination of transformational and transactional schemes. The savings achieved will go towards meeting a range of cost pressures as well as funding provider activity growth. The plan assumes that provider inflation will be a 1.1% net increase in tariff price (3.1% inflation less a 2% efficiency target). There has been a return to a single tariff for 2016/17 and the reintroduction of 2.5% CQUIN (commissioning for quality and innovation) contract payments for organisations which opted for the ‘Default Tariff Rollover’ (DTR) in 2015/16. Assumptions in financial plans include provider demographic and non-demographic and contract negotiations where appropriate. The estimated impact of these planning assumptions is increased expenditure of £12.6m, £5.7m above the allocation growth for the CCG. Planning assumptions have followed national guidelines and include:

demographic growth of 1.8%, based on the latest Office for National Statistics projections

provider inflation of 1.1% net (3.1% inflation and 2.0% efficiency)

the impact of a single tariff for all NHS contracts

non-demographic growth set at 1% to cover pressures over and above activity or cost where appropriate

prescribing inflation set at 4.9%

a QIPP target of £9.0m (3% of CCG funding allocation)

setting aside a 0.5% contingency (£1.7m) and a 1% non-recurrent (£3.3m) fund, which cannot be committed without NHSE approval.

Whilst a balanced plan has been set, reserves to meet unexpected demand or invest in strategic programmes are very limited for 2016/17. The expectation remains that resources will cover pressures and financial balance will achieved, but the focus on longer-term efficiency must take priority as the ability to deliver savings is becoming increasingly difficult. For this reason the CCG, Islington Council, other CCGs and provider organisations in North Central London (NCL) have embarked on a collaborative programme of work to review and agree the financial outlook across the local health economy over the next five years. The arrangements promote working jointly to close the gap through a clinical strategy that maximises the opportunities available. Risks The main financial risks in 2016/17 are the agreement of acute contract values to reflect the appropriate level of activity, the reduction in the acute demand reserve to offset contractual pressures, under-achievement against QIPP plans and in particular the 3.5% reduction in non-elective admissions - a requirement of the Better Care Fund, a pooled resource between the CCG and Islington Council. Strategic outlook – NCL Transformation Programme In order to improve population outcomes, ensure that all patients access safe, high quality services and recognise financial constraints, health and care organisations working in NCL, covering the boroughs of Barnet, Enfield, Camden, Islington and Haringey, are working together to transform the way care is delivered to meet the challenges of the Five Year Forward View. It is paramount that there is a clear focus on clinical and care needs and in response, a Transformation Board overseeing this challenging and ambitious programme has

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been established. The Board will also be supported by a Clinical Advisory Group to ensure that clinical ownership and oversight exists. The Transformation Board will be responsible for strategic oversight and delivery of the 5-year Strategic Transformation Plan (STP) on behalf of all partner organisations. The Transformation Board will manage cross organisational and programme level issues, risks and dependencies, oversees the development of the programme plan, its deliverables and ensures that appropriate links are made with other strategic programmes across NCL. The first priority deliverable is to develop and submit the STP for 2016-2021. The Transformation Board members will operate on a number of levels, including:

strategic – where the organisations will seek to align overall goals and support each other’s strategic objectives

operational – where the organisations will develop clear approaches to dealing coherently and effectively with a range of operational matters, particularly those relating to the quality of services provided for patients

cultural – where the organisations will seek to promote common values, and constructive behaviours.

The NCL Transformation Board currently consists of:

Islington CCG membership on the Transformation Board comprises Josephine Sauvage (Chair) and Alison Blair (Accountable Officer).

1.10 Development and performance Last year we told you about our work across seven main areas: How you experience services

1. Patient experience 2. Safety of services 3. Clinical effectiveness

How we commission services

4. Patient and community engagement 5. Primary care 6. Urgent care 7. Ensuring high quality, efficient services

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We have made progress on these areas over the past twelve months and below are some of the developments of which we are most proud. How you experience services Patient experience Over the past year the CCG has been working on an Integrated Digital Care Record which includes the development of a Person Held Record. This means the information you want shared will be available to people in your health and care team. It also means you will have easier access to your health and care records. As part of our work as an ‘integrated care pioneer’ working with Islington Council we launched several integrated networks to bring health and social care together, make life easier for patients and take better care of them. Safety of services We continue to work closely with local partners to build on the work put in place last year in the areas of child protection, adult safeguarding and community safety. The CCG has delivered six sessions in partnership with Islington Council to independent contractors on safeguarding adults, the Mental Capacity Agenda and PREVENT (part of the Government’s counter terrorism strategy which aims to prevent the risks posed by extremist views, radicalisation and extremism). A new programme has also been initiated to provide further training to GP practices to help ensure they are compliant as per the new medical colleges' intercollegiate guidance. This includes topics such as safeguarding, the Mental Capacity Agenda and PREVENT. Clinical effectiveness Working with Haringey CCG we have been developing services focussed on outcomes for people living with diabetes, and Camden CCG for people living with psychosis. Carrying out a series of “listening” workshop events with patients, providers and commissioners has allowed us to find out what is important to those living with diabetes and psychosis. This feedback has fed into the development of services that are focused on health outcomes that have been identified as priorities for patients with diabetes and psychosis. How we commission services Patient and community engagement Within the last year we have expanded and developed our involvement work and our work with the third sector to deliver wellbeing services and support for local people, including community asset building. We have built good relationships with some key organisations and are focusing on continuing to create relationships across the third sector in Islington. Some of the projects we have been working on with the third sector this year have been:

Community Wellbeing EXTENSION Project with Help on Your Doorstep and Cripplegate Foundation, which gathers insight and works with people living on New River Green Estate

delivery and development of Patient Participation Groups with Voluntary Action Islington

working with Body and Soul on a number of engagement and facilitation projects.

We have also been interested in hearing more formally about how we are doing. In April 2015, Ipsos MORI carried out a survey independently to invite views from all those who work in

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partnership with the CCG. Questions included everything from the quality of its leadership team to the way in which it engages and builds relationships with organisations involved in health and care across Islington. Over 80% of those working with the CCG say that they feel the organisation has a strong leadership team in place that is working well with local partners, according to the results of the survey. We will be able to keep receiving this feedback through our online tool Health Voice Islington that allows users of NHS services to tell the CCG their views. The online survey consists of six short questions that can be completed in as little as sixty seconds using any internet connected device, including smart phones, tablets or PCs. Primary Care Over the past year a key focus for primary care has been greater collaboration between providers. This approach has seen the development of a GP Federation which aims to develop a sustainable primary care infrastructure. The Federation (a group of practices working in collaboration, sharing responsibility for developing and delivering services) will also be able to provide primary care services on a larger scale, allowing similar levels of care to be provided across the borough. This will in turn offer greater opportunities for the CCG to commission services based on the specific needs of Islington’s population. Residents have also been able to access additional appointments in the evening and at weekends through the development of an iHub service. Following successful bids by practices for funding from the Prime Minister’s Challenge Fund, the service aims to test new ways of working and runs from Monday to Friday, 18:30 – 20:00, and Saturday and Sunday, 08:00 – 20:00. With the pilot ending in 2016/17, the CCG will review and evaluate the performance of the service in due course. Our GPs continue to strengthen relationships with other health and care professionals through the development of integrated networks and regular multidisciplinary team meetings. The experiences and outcomes of patients with complex needs are improved by bridging the gap between health and social care and collaborative care planning. To employ two pharmacists in GP practices, the CCG received funding from the North Central London pooled funds. These new roles for primary care are already providing medicines expertise to patients and supporting GPs by ensuring that where patients are taking more than one medicine, they are doing this safely. A similar bid was entered for the NHS England’s Pharmacists in GP Practices scheme. Entered in partnership with Haringey CCG and the WISH Health Ltd group of GP practices, the bid was also successful and recruitment for this national pilot is expected to begin later this year. Working with GP practices to identify patients who could benefit from anticoagulants, the CCG has increased the detection of atrial fibrillation and as a result patients with the heart condition are being managed better. This work has meant that an additional 134 patients have been anti-coagulated in Islington and the continued treatment of these patients would be expected to prevent five strokes over the course of 18 months. Urgent Care We have been speaking to local residents, stakeholders and clinicians about how we are seeking to improve urgent care in Islington, and in particular around the NHS 111 phone answering service and GP Out of Hours services. These views and feedback played a significant role throughout the commissioning of these key services. For example, a patient and public reference group was established, composed

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of residents from the five boroughs, as well as representatives of local HealthWatch organisations, to review and assist with the design of the service. The care provided by Islington’s Hospital at Home service to acutely unwell children and young people was recently evaluated by parents as “very good” or “good”. Running since August 2014, the service has treated up to 350 acutely unwell children and young people aged up to 18 in their homes or close to home. All parents who took part in the evaluation would recommend the service to a friend or relative in a similar situation. Through working together, community children’s nurses and acute paediatricians from Whittington Health NHS Trust and University College London Hospitals NHS Foundation Trust have been able to discharge children and young people from hospital sooner, helping to reduce overall admissions. We have also continued to invest in Whittington Health’s Enhanced Virtual Ward. The service which is led by community matrons with support from local GPs enables people with urgent, but not emergency needs, to see a community matron within 2 hours. Increasing the capacity of these rapid response services forms part of our commitment to enabling people to stay well in the community and reduce admissions. Ensuring high quality, efficient services Last year we launched the Patient Activation Measure, a tool to help us better understand the impact of services we commission. Based on a survey a patient fills out, the Patient Activation Measure provides a GP with information so that he or she can tailor their support and guidance. As one of six pilot sites in the UK we have been using the Patient Activation Measure to understand the perceived skill, knowledge and confidence to self-manage of patients with long-term conditions such as diabetes. With this knowledge we continue to develop our understanding of the different interventions and support that can be offered and how this can be linked to what an individual wants and needs.

1.11 Patient and public involvement Patient Participation Groups Over the past year we have worked with Voluntary Action Islington to develop and deliver Patient Participation Groups. Open to all Islington residents regardless of whether they are registered with a GP practice, these build on our Practice Patient Groups by providing the public with an opportunity to find out about and comment on CCG commissioning plans. Delivered jointly by HealthWatch and Manor Gardens, engagement conducted by both of these organisations ensures as many people as possible have the chance to engage. Community/service user groups Members of the Islington community also have the opportunity to provide feedback and comment by sitting on each of the CCG’s working groups and committees. The CCG continues its involvement with patients and the public by supporting last years of life and mental health service user groups. We have also worked with the third sector to expand and develop our involvement work. Through our work with the third sector we are continuing projects such the Community Wellbeing Project. This project is being delivered by Help on your Doorstep and Cripplegate Foundation to work with people on the New River Green Estate.

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Targeted research projects Our engagement has also been more targeted around projects such as the reprocurement of NHS 111 phone answering service and GP Out of Hours services, extended access to primary care and the development of an Integrated Digital Care Record. For example, with the NHS 111 phone answering service and GP Out of Hours contract coming to an end, we conducted a programme of engagement which included a series of community events to involve the local population, providing an opportunity for them to ask us questions and tell us their concerns. We have since worked to involve the people of Islington to understand their views, involve them in the tender and procurement and work with them to shape the future service. This has had a real impact on the way the new service providers were judged, so that much of the assessment was designed to answer questions that local people had identified as markers of quality. Other areas of community engagement have included: ophthalmology, musculoskeletal, dermatology, diabetes and psychosis. Use of Health Voice Islington We have continued to receive feedback through our online tool Health Voice Islington that allows users of NHS services to tell us their views. The online survey consists of six short questions that can be completed in as little as sixty seconds using any internet connected device, including smart phones, tablets or PCs. Over 2015/16, Health Voice Islington has heard from 387 people, the majority of which were through a community research project (see section 1.16 for more information).

1.12 Assurance framework statement introduction As part of CCG annual report requirements, CCG’s have a duty to provide information within their annual report which makes a self-certification about continued delivery of statutory duties. An outline of this information is included below.

1.13 Promoting the NHS Constitution

Acted with a view to ensuring that health services are provided in a way which promotes the NHS Constitution, and that it has promoted awareness of the NHS Constitution among patients, staff and members of the public. The NHS Constitution articulates a series of rights and pledges for patients, service users and staff. Many of these rights and pledges are encapsulated in performance measures, and the CCG monitors its performance against these measures. The following table forms part of the Performance Report which is discussed each month at the CCG Quality and Performance Committee.

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Table 7. Performance against the NHS Constitution

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Islington, as with many other CCGs in London, has struggled to deliver many of the access targets in 2015/16:

the 4-hour Accident and Emergency target hasn’t been achieved at many providers throughout the financial year

several of the targets relating to cancer care have also been missed in 2015/16

London Ambulance Service has continued to struggle to meet targets. Where areas of poor performance are identified, CCG representatives meet with the relevant providers to understand the associated challenges and to devise a realistic recovery plan and trajectory. The performance information is reviewed regularly by the Governing Body and the Quality and Performance and Strategy and Finance Committees. On a positive note, the referral to treatment time (the length of time from referral through to treatment) target has been achieved throughout the year. This is following additional investment which reduced the numbers of patients waiting for treatment.

1.14 Assisting NHS England in improving primary medical services Last year we worked with local GPs and practices to develop a Primary Care Strategy to improve the quality of primary care in Islington.

In October last year we began co-commissioning primary care services with NHS England. This move which has seen us jointly involved in decision making around primary care, means we can seek to influence the commissioning of these services and better reflect what local people are telling us.

We liaise directly with the Medical Director from NHS England to raise and discuss issues relating to primary care services in Islington as these are currently commissioned by NHS England. We also actively work with local GPs to raise and address issues relating to the quality of local services.

Performance indicators are reported at the monthly Quality and Performance Committee. GP colleagues contribute to the recovery plans where performance is off-target, particularly those that overlap with primary care such as infection control and GPs contributing to child case conferences.

1.15 Promoting patient involvement in decisions Promoted the involvement of patients, their carers and representatives in decisions that relate to the prevention or diagnosis of illness in the patient, their care and treatment. The CCG has a strong commitment to promoting self-care and management and it is a key part of our work and our work with partners, particularly the work which takes place within the Integrated Care programme. Personalised care and other peer support programmes The CCG has a number of programmes which support personalised care. Commissioned through Whittington Health NHS Trust, programmes such as the Expert Patient Programme and DESMOND (a diabetes self-management programme) encourage and support patients in the self-care and management of their conditions. Health Navigators The CCG commissions Age UK Islington to provide a Health Navigator service which has seen over 400 patients since the new contract started in September 2015. Offering support to some

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of our most isolated and vulnerable patients, the service helps them to find and access voluntary and statutory services, supporting them to self-manage and empowering them to take charge of their health and care. Of the patients seen, 94.8% reported they had completed personal goals such as looking after themselves, their home and feeling more confident as a result of using the service. Personal Health Budgets Personal Health Budgets offer patients and families greater choice and control by ensuring that support purchased with NHS resources is personalised, patient focused and a ‘good fit’ with day-to-day family life. To ensure Personal Health Budgets involve patients, their carers and representatives, individual patient views and experiences of having a Personal Health Budget were captured to inform their development and roll-out. Shared decision making and the Map of Medicine The Map of Medicine is a piece of software used by GPs in Islington which provides access to clinical pathways and localised content. Used during consultation, the tool allows GPs to highlight local services to patients and directly involve them in making decisions about their care.

1.16 Enabling patient choice in health services Health Voice Islington Health Voice Islington is an online survey where Islington’s residents can give anonymous feedback on NHS healthcare services they have received. This data is used to highlight any areas of concern, give patients the opportunity to provide honest feedback and help us plan for future health services. Primary care extended hours research Developing primary care services that are easy to access is a key part of our programme of work. Traditionally GP practices provide a service from Monday to Friday, 08:00 - 18:30 excluding Bank Holidays. An extended service is currently in place following the launch of three iHubs which offer appointments with doctors and nurses when patients are unable to see someone at their regular practice. As this level of access requires additional funding it is important to establish whether residents need and want to be able to access their GP later in the evenings and at the weekend. With this in mind we commissioned six local community organisations to carry out community research into this. The CCG provided questions which were used either as part of small focus groups, structured interviews and in outreach at GP practices. A total of 197 people took part in the research and 113 people in an online survey. This research included people from the following groups:

people with mental health needs and long-term conditions

black, Asian, minority, ethnic and refugee women

young carers

people over the age of 55

people from low socioeconomic backgrounds and other local residents

people with a long-term condition (e.g. HIV and AIDS).

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Last Years of Life and Islington Borough User Group Working with Islington Council we have jointly invested in a five year contract with the mental health service user group Islington Borough User Group (iBUG). This has seen iBUG promote the views of past and current mental health service users in Islington. It does this through a range of activities which include:

open monthly meetings

monthly Patients’ Council meetings at the Highgate Mental Health Centre where detained and very ill service users are able to articulate their concerns and priorities to the iBUG Patient Council volunteers

quarterly inpatient and community forums where senior managers from Camden and Islington Foundation Trust and Joint Commissioning are informed and challenged by service users

mystery shopping and service user interviews to inform commissioning and contract management.

This work has already proved fruitful by challenging clinical effectiveness, highlighting poor patient experience and successfully advocating for the development of the Camden and Islington Recovery College for service users. The CCG also commissions Voice for Change, the Last Years of Life service user group. The group, similarly to iBUG, reviews Last Years of Life services and feeds back its findings into the steering group to improve patient care. Practice Patient Participation Groups To ensure there are several routes through which the local community can provide feedback to the CCG on health issues, the CCG has set up locality and Islington-wide Patient Participation Groups (PPGs). These are open groups which anyone can attend and have a range of current topics for discussion. The groups are supported by Voluntary Action Islington, a local umbrella voluntary sector organisation in Islington. Commissioning a local voluntary organisation (Voluntary Action Islington) has enabled the patient groups to become more independent as well as providing additional resource, some of which is directed to reach out to the wider community. Feedback received at the PPGs highlighted a need for more GP appointments at more flexible times. As a result the CCG has commissioned a Locally Commissioned Service that increases the number of extended hours by 60 hours per month to improve access for patients. Community research project This year we began a new project to engage with more people across Islington. We commissioned a group led by HealthWatch and made up of nine other organisations. These organisations represent black, Asian, minority, ethnic, refugee and migrant communities. Manor Gardens and the Stroke Association are also involved in their work with refugee and migrant communities as well as housebound and older people. The aims of the project are to:

strengthen the way in which we hear from communities who face barriers to accessing services

gather research on our commissioning in a more organised way

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strengthen our relationships with grassroots organisations and support them to develop their evaluation and research skills so they can better represent the views of their local community

feed the information we gather into commissioning plans, ensuring we are meeting the needs of the local population.

The group were given a series of questions covering topics such as planned care, primary care and our commissioning intentions. Equalities and Diversity work A key part of our work is to engage with and listen to people within the community who often go unheard and yet can be among the most vulnerable group with the highest needs. Often their experiences of using services and the healthcare system is that they are difficult to access and understand, do not meet their needs and are unsupportive. We therefore, have a special strand to our engagement work which looks specifically at those groups who fall under the nine protected characteristics and inclusion health groups. This includes:

an annual meeting run in conjunction with HealthWatch which identifies equality issues in Islington

an ongoing Equalities programme which includes workshops and focus groups with groups from the nine protected characteristics to better understand their specific needs and the challenges and obstacles they face

the refugee and migrant forum and the black, Asian, ethnic, refugee and migrant forum which we attend and have made a commitment to continue attending as and when they need us to.

1.17 Promoting innovation, research, education and training The CCG has a strong record of working in a supportive and developmental manner with stakeholders. Highlights are outlined below. CCG workforce development The CCG is committed as part of its Organisational Development plan to develop both its current commissioning workforce of 61 employees, and put in place succession plans to support a future clinical commissioning workforce. Our Organisational Development plan will be updated in 2016/17 to reflect the changing needs and responsibilities of the organisation. As an organisation we use essential skills training to make sure staff incorporate core training into the decisions we make, services we commission and are compliant with statutory NHS training requirements. A robust performance management system exists for all our employees which includes appraisal, objective setting and individual as well as team Professional Development Plans (PDPs). Staff are supported to reach their PDPs by their managers and have access to an allocated staff development budget. The Governing Body and Clinical Leads are supported to meet their learning and development needs by the Chair and Clinical Director. The CCG participates in the annual NHS staff questionnaire and strives to continuously develop the organisation as a positive place to work. Organisational action plans are implemented based on the analysis of our survey results which contribute to the

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Organisational Development plan. We are committed to equality and diversity as well as the health and wellbeing of our staff. The CCG aims to attract, develop and retain skilled and valuable employees to ensure we have the right people, in the right roles with the capabilities, commitment and behaviours needed for current and future organisational success. Key to this is developing leaders at all levels of the organisation. Staff are encouraged to access NHS Leadership Academy programmes and utilise existing leadership skills through the Organisational Development group and at CCG away days. To address the current and future undersupply of practice managers in Islington, the CCG has offered a Practice Manager Development Programme (apprenticeship). All available apprenticeships have been filled and expressed interest in continuing the programme in the coming years. Community Education Provider Network In 2015/16, the Community Education Provider Network (CEPN) has continued to provide a framework for and opportunities to adopt an integrated approach to workforce development, training and education. Acting as a catalyst for change, adding strength to the well-established partnership approach across the health and social care, voluntary and third sector in Islington. The CEPN is entering in to its third year and as in previous years the key focus will be to identify what is needed to have a workforce that is flexible and able to meet the changing health and wellbeing needs of the residents of Islington. Key priorities will be how the CEPN can help to:

strengthen and develop comprehensive primary care services

build the workforce from across sectors and organisations focused on the patient or service user

provide greater emphasis on prevention, early intervention and responsiveness

provide a greater emphasis on out of hospital care

develop a workforce to deliver seven day working

co-produce with patients and service users, from delivery of care to informing commissioning of services and collaborative education for workforce

improve recruitment and retention. In 2016/17 there will be more alignment across the CEPNs in the North Central London Strategic Partnership Group (SPG) covering North Central London (Barnet, Camden, Enfield, Haringey and Islington). We will use a workforce modelling tool which will offer the SPG a baseline of the current workforce with the ability to then create adaptable models to test future needs and scenarios. This tool can be used across health and social care settings. Integrated care pioneer The past year has seen us continue to work with Islington Council as an ‘integrated care pioneer’ to link health and social care together and make life easier for patients and take better care of them. Highlights of our work include: Integrated networks To break down the barriers that have previously hampered truly integrated care for patients, we have developed integrated networks across Islington. Pooling the knowledge and skills of health and social care practitioners through weekly multidisciplinary team meetings has

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helped to bring health and social care together. More importantly this has improved patient experiences and outcomes. By spring 2016 there will be seven integrated networks in place covering an estimated 127,051 patients. This is just over half the population of the Borough and we expect more to be formed throughout 2016. Patient Activation Measures We are using innovative approaches to understand the level of skills and motivation within our local population so that we can target offers of self-management more appropriately. Sharing of data Greater coordination is vital to the success of integrated care. To support the sharing of data cross care services we have been working to procure and develop an Integrated Digital Care Record and a Person Held Record. Value Based Commissioning Working with Haringey CCG, service users and local providers, we have developed new service models in diabetes and psychosis that are focused on the health and care outcome priorities that are important to service users. As part of this work we carried out a series of ‘listening’ workshop events with patients, providers and commissioners to find out what is important to those living with diabetes and psychosis. With this information we developed contract and payment models that make a closer link between delivery of those outcomes important to service users and how services are organised and delivered. We call this process Value Based Commissioning. The key difference between current services and those which follow the process of Value Based Commissioning is that the new services are organised around patients with similar needs and providers need to work across organisational boundaries. The new service models are being introduced throughout 2016 and will support multidisciplinary team working and education. By closely monitoring the outcomes being achieved we, with service users and providers, will be able to ensure we are achieving the best possible value for service users. We will evaluate services as the work progresses and may look to roll out this approach more widely at a later stage.

1.18 Consulting widely on commissioning plans As a commissioner of health services, it is imperative that we engage and consult widely with our population during the development and confirmation of our commissioning plans. Throughout the year we consult with patients and the public regarding our forthcoming commissioning plans. This has been undertaken in 2015/16 by:

our commissioning groups pertinent to particular service areas and patient groups, for example, mental health and learning disability

our engagement programme which actively reaches out to those members of our population who are seldom heard, to gain an understanding of their needs

our engagement with HealthWatch and other third sector colleagues who have undertaken programmes of patient feedback and surveys when we are planning to improve the delivery of services that we commission

our co-production work with patients and carers for new diabetes and psychosis service models and outcome measures

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our Director of Commissioning, at a wider strategic level, presenting our plans to Islington patient groups.

Patient groups are linked with the wider CCG commissioning structure and we regularly feedback on progress on our plans. In 2015/16, a new structure has been put in place for the development of longer term Five Year Plans in line with national requirements. In Islington, we are working collaboratively on these plans with all organisations that commission and provide health and care services in North Central London (NCL). Our aim is to work together where this will help us to make more significant improvements than planning at a local level can achieve to improve:

the wellbeing of our population

the quality of outcomes achieved when people receive support and treatment

the efficiency of the services we deliver. Each of the work streams such as urgent and emergency care and primary care has patient participation integrated into the structure of service design and decision making. We are now establishing our local commissioning programme for the next five years. This will align with the NCL plan, while addressing our more local needs and opportunities to improve services for our population. This is being done working with our local partners, particularly Whittington Health NHS Trust, Camden and Islington NHS Foundation Trust and Islington Council, as well as Haringey CCG and Haringey Council. The Islington Health and Wellbeing Board provide oversight for this programme and a strategy for how we consult with patients and the public on this longer term plan is in development.

1.19 Preparing for dealing with an emergency Taken appropriate steps to secure that it is properly prepared for dealing with a relevant emergency. The CCG has taken appropriate steps to ensure that it can deal with a relevant emergency. As a category 2 responder under the Civil Contingencies Act, the CCG has developed and adopted a business continuity plan. This sets out how the CCG will respond to any one or more of a range of key scenarios:

loss of access to premises

loss of key staff

loss of key partners/stakeholders

loss of key services. As part of our business continuity planning, we have entered into a reciprocal agreement with Camden CCG whereby we can use each other’s main office in the event of an emergency that requires it and that in the event of an emergency in Camden or Islington that requires that CCG to follow its business continuity plan, the other CCG will, if need be, follow its own business continuity plan to provide such support as is needed. In addition the CCG has entered into shared on-call arrangements with the North and East London Commissioning Support Unit, and the other NCL CCGs.

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1.20 Co-operating with the Islington Health and Wellbeing Board It is a duty of the Health and Wellbeing Board to promote the integration of services across the NHS, public health and Islington Council in order to improve efficiency, secure better care and, ultimately, improve health and wellbeing outcomes for the local community. Amongst other things, the Health and Wellbeing Board is responsible for the mutual obligation on Islington Council and NHS commissioners to prepare an assessment of relevant needs and a Joint Health and Wellbeing Strategy for the Borough. The Islington Joint Health and Wellbeing Strategy 2013-2016 was developed by the Health and Wellbeing Board and is our shared vision to reduce health inequalities and improve the health and wellbeing of Islington, its communities and residents. The focus for this strategy is predominantly on the health and social care related factors that influence health and wellbeing. The important underlying determinants of health and wellbeing are addressed through other key strategies of Islington Council and partners. The strategy emphasises the importance of partnership working and the joint commissioning of services to achieve a more focused use of resources and better value for money. The strategy has been informed by our Joint Strategic Needs Assessment and consultation with residents, strategic partners and other stakeholders. We have identified three outcomes that will help deliver this vision. They are:

1. ensuring every child has the best start in life 2. preventing and managing long-term conditions to enhance both length and quality of

life and reduce health inequalities 3. improving mental health and wellbeing.

This year we have contributed to the delivery of the Islington Joint Health and Wellbeing Strategy in the following ways:

Working with Islington Council to publish the Islington Children and Families Prevention and Early Intervention Strategy 2015-2025. The strategy aims to support how we work together in Islington to make early intervention and prevention a part of our core business.

Supporting the First 21 Months programme to ensure that key services, maternity, health visiting and children’s centres, are working in an ever more integrated way. Four learning pilots have been developing work on improving early identification of need in the most vulnerable families across Islington. These pilots focus on how midwives, health visitors and parents can work more effectively in partnership.

As an ‘integrated care pioneer’ (the CCG and Islington Council’s integrated health and social care programme) has been ensuring that all work on long-term conditions is aligned to the local vision for integrated care.

Integrated care networks have been piloted and are currently being rolled out across the borough. These bring together frontline staff across key organisations to work collaboratively providing care for the most vulnerable people.

We have worked jointly with our Health and Wellbeing Board partners and local providers to develop Islington’s Better Care Fund programme. This is a national fund aimed at supporting integrated working across health and social care locally that is approved by the Health and Wellbeing Board.

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Rates of dementia diagnosis have been improved through a Directly Enhanced Service in Primary Care and a Commissioning for Quality and Innovation scheme at Whittington Health NHS Trust and University College London Hospitals NHS Foundation Trust. Key strengths locally include the good relationship between GPs and the Memory Service, with GPs confident that good services are available to support people after diagnosis.

Clinicians, service users, commissioners and other stakeholders have worked together to develop a new Value Based Commissioning approach to improve outcomes for people with psychosis. This brings together mental health and physical healthcare services, working with service users, to improve the health and wellbeing of people on serious mental illness practice registers, and help close the gap in life expectancy between people with serious mental illness and the community as a whole. The new contract takes effect from April 2016.

The CCG plays a full and active part in the Board and five of its Governing Body have been full members during the year. They are:

Dr Josephine Sauvage, Chair (from February 2016)

Dr Gillian Greenhough, Chair (to February 2016)

Alison Blair, Chief Officer

Martin Machray, Director of Quality and Integrated Governance (to January 2016)

Sorrel Brookes, Vice-Chair.

1.21 Discharging function regarding safeguarding Children The CCG complies with the requirements of the Children Acts 1989 and 2004 to discharge its duties with regards to safeguarding and promoting the welfare of children. Additionally it works in accordance with the following key national, statutory guidance:

“Working together to Safeguard Children 2015”

“Safeguarding Vulnerable People in the NHS – Accountability and Assurance Framework” o An updated framework (July 2015) that builds on the 2013 version which reaffirms

and strengthens the commitment across the health system to safeguarding vulnerable people.

Section 11 of the Children Act 2004 o Setting out the particular duties of agencies in relation to child safeguarding and

statutory membership of the local Safeguarding Children Board, the CCG undertakes a self-assessment audit of compliance with Section 11 every two years. Last completed in March 2015, with a Challenge event that took place in September 2015 by members of the Islington Safeguarding Children Board Core Business Sub Group.

“Safeguarding children and young people; roles and competencies for healthcare staff” Intercollegiate document (March 2014)

Accountability, structure and governance arrangements The Chief Officer of the CCG has overall responsibility for the organisation’s child safeguarding arrangements and is a member of the Islington Safeguarding Children Board. The Director of Quality and Integrated Governance is the Executive lead for safeguarding.

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The CCG is responsible for securing the expertise of designated professionals on behalf of the local health system. A designated nurse for child protection whole-time-equivalent is employed by the CCG. The designated doctor for child protection (0.4 whole-time-equivalent) is employed by Whittington Health and works for the CCG through a service level agreement with the Trust. A named GP for child protection (0.2 whole-time equivalent) is in post. Responsibility for commissioning transferred from NHS England to the CCG on 1st April 2015. This transfer provided an opportunity to bring together quality aspects of safeguarding in GP practices into a single assurance process. The CCG has a Child Protection Committee which meets quarterly and is chaired by the Governing Body children’s lead. This committee reports to the Quality and Performance Committee six-monthly or more frequently by exception and has a robust work-plan focusing on the following themes:

to ensure that staff are trained to the level appropriate to their role in relation to child protection and safeguarding in accordance with “Safeguarding Children and Young People: roles and competences for healthcare staff Intercollegiate Document 3rd Edition” (March 2014)

to provide assurance that the statutory safeguarding children arrangements of healthcare providers commissioned by the CCG are being met

to maximise GP involvement in multi-agency child protection and safeguarding work in Islington

to maintain the focus upon child safeguarding arrangements and commissioning responsibilities within the CCG and ensure that the Governing Body is fully briefed about child protection and safeguarding issues in Islington

to provide assurance of appropriate health service arrangements for review of child deaths in Islington

to provide assurance of appropriate health service involvement in Serious Case Reviews and Serious Incidents involving child safeguarding issues and of the implementation of action plans and sharing of lessons learnt

to demonstrate that requirements in relation to child safeguarding are met by healthcare organisations in Islington as part of any announced or unannounced inspections by regulatory bodies

for the Child Protection Committee to consider and respond where appropriate to national and local safeguarding reports, recommendations and legislation.

An annual report on child protection and safeguarding is prepared by the designated nurse and doctor (child protection) and presented to the Quality and Performance Committee and to the Governing Body. The CCG has a Child Safeguarding policy in place which is available on the website and intranet. Achievements in children’s safeguarding 2015/16

One serious case review has been published. To contribute to the review and a requirement of the NHS England Serious Incidents process, the designated nurse and doctor completed a health overview analysis report detailing involvement of all healthcare agencies and services involved with the family as per terms of reference for the review. The designated nurse has subsequently monitored implementation of recommendations and lessons learned for the healthcare services involved.

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Healthcare professionals’ contribution and quality of input to child protection strategy meetings and conferences has been monitored, audited and improved.

Safeguarding children policies across all healthcare provider settings are clear, up to date and implementation is being monitored and audited through the providers safeguarding children committees.

Audits by healthcare providers have been presented to the Quality Assurance sub-group of the Islington Child Safeguarding Board as a measure of assurance that healthcare organisations are reviewing practice and can demonstrate quality improvement measures are in place.

Safeguarding children supervision for healthcare providers has been incorporated into the safeguarding children metrics to monitor and provide assurance that staff who need supervision receive it.

The designated doctor has collaborated with colleagues in neighbouring boroughs and NHS England to develop a new child sexual assault clinic in local provision.

The designated nurse has increased health leadership contribution to the Islington Child Safeguarding Board through the role of chairing the Policy and Practice sub-group.

The role of the Named GP has been established within the CCG.

The role out of the Identification and Referral to Improve Safety (IRIS) Project training programme has continued and funding has been agreed to enable all GP practices in Islington to be trained in identification and management of domestic abuse.

New government mandatory reporting and recording requirements for female genital mutilation (October 2015) have been widely disseminated across the Islington healthcare economy and the designated professionals have worked closely with the Islington Safeguarding Children Board to ensure female genital mutilation remains a key priority for the Board.

In October 2015, the CCG participated in an NHS England Deep Dive review of safeguarding assurance processes in CCGs. The subsequent report from NHS England provided the CCG with an overall good assurance.

Regional and local safeguarding children networks have continued to be represented by the CCG’s designated nurse and doctor.

Adults This year, the CCG has fully complied with national guidance surrounding safeguarding vulnerable people, not only adhering to the explicit requirements but in its continuing commitment to protecting the most vulnerable adults in our communities. The implementation of the Care Act 2014 has created a new legal framework for how local authorities and other parts of the health and care system should protect adults at risk of abuse or neglect. A key responsibility for the CCG is to ensure that commissioned services provide safe systems that safeguard adults at risk of abuse or neglect. This year saw the introduction of a set of regionally agreed safeguarding standards which assist when seeking the assurance that the CCG will start to monitor healthcare providers against. In the year, the workload has continued to rise. There has been a range of safeguarding activity including emerging scandals that have impacted on local and national workloads. Many emerging themes have had a significant history and are not new issues to consider.

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These include:

the emergence of the PREVENT duty (part of the Government’s counter terrorism strategy)

increasing concern regarding the identification and management of female genital mutilation (Islington has had the first prosecution case in relation to this)

extremely poor standards of care for vulnerable adults highlighted in residential and community care settings

a significant increase in Deprivation of Liberty applications

the identification of poor quality of care in many care settings of adults with learning difficulties.

National guidance The Care Act 2014 became statutory legislation at the beginning of April 2015 after it received receiving royal assent and for the first time, has given a statutory basis to Safeguarding Adults. The Act specifies the need for NHS organisations to work with local authorities to safeguard adults from abuse. CCGs are named as statutory members of the safeguarding adults’ partnership boards which are now a requirement of Act. The Act also identifies the following three additional categories of abuse: domestic violence, modern slavery and self-neglect. The “London Multi-Agency Adult Safeguarding Policy and Procedures” was issued in February 2016. Lessons learnt from enquiries such as the “Themes and lessons learnt from NHS investigations into matters relating to Jimmy Savile, Independent Report for the Secretary of State for Health” (February 2015) have highlighted the need to make safeguarding integral to care and the culture of organisations. The Counter Terrorism and Security Act 2015 received Royal Assent in February 2015 and became an Act which includes legal duty to the NHS and specifies certain actions that trusts must now take. The CCG seeks assurance of trusts that they:

assess risk of radicalisation in their area or trust

develop an action plan to reduce this risk

train staff to recognise radicalisation and extremism

work in partnership with other partners

establish referral mechanisms and refer people to Channel

maintain records and reports to show compliance.

The Department of Health also updated guidance for professionals for Female Genital Mutilation (FGM) Risk and Safeguarding (March 2015) explaining new legislative requirements under the Serious Crime Act 2015, including mandatory reporting around FGM. The NHS has also published an updated version of the Accountability and Assurance Framework for Safeguarding Vulnerable people in the NHS (July 2015). This document updates and replaces Safeguarding Vulnerable People in the Reformed NHS – Accountability and Assurance Framework issued by the NHS Commissioning Board (March 2013). Designated professional for safeguarding adults This role has been designed to build a combination of subject matter expertise and clinical expertise to ensure that safeguarding arrangements for safeguarding adults across the health economy are robust and that the residents of Islington receive safe, effective high quality care. The post holder works across the health economy to build clinical awareness of the

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safeguarding adult agenda by working with providers of commissioned services to ensure that vulnerable adults are safe from harm and abuse. The post holder is a source of professional specialist advice on ‘safeguarding adults’ issues to staff within the organisation, partner agencies and health professionals across the health economy. Assurance In the year, the CCG has been through a Deep Dive review undertaken by NHS England. This was a review of safeguarding as part of the assurance process for CCGs in 2015/16. The overall findings for the CCG were ‘Assured as Good’. Safeguarding Boards accepted the Deep Dive submission instead of having to complete the board audit tool. Network approach All the North Central London (Barnet, Camden, Enfield, Haringey and Islington) CCG designated leads have agreed a network approach to the delivery of some of the statutory strategic safeguarding functions to promote resilience, reduce variations in provision, ensure consistency in delivery and enable the development of a sustainable and flexible commissioning safeguarding workforce. Safeguarding Adult Reviews (previously known as Serious Case Reviews) In Islington there has been one review published and one underway in the year. The purpose of the reviews is to identify improvements that are needed and to consolidate good practice with the aim of delivering sustainable improvement and the prevention of death, serious injury or harm. Mental Capacity Agenda The Mental Capacity Agenda continues to evolve and increase in workload. The House of Lords Select Committee was highly critical of the implementation of Mental Capacity Agenda in all services, including the NHS. It is imperative that work continues to develop practitioner knowledge and understanding of the legislation and their roles and responsibilities. The CCG continues to work with Islington Council to focus on this area of work. The CCG has also included a specific Key Performance Indicator within the contract to gain assurance from commissioned services around effective and appropriate use of the Mental Capacity Agenda. The Deprivation of Liberty Safeguards Work also continues to evolve due to the Cheshire West ruling which significantly lowered the threshold for what constitutes a Deprivation of Liberty (DOL) application. There has been an almost tenfold increase in the number of DOL applications since the ruling. There is significant ongoing work with Islington Council around ensuring that there is a risk-led priority system to work through the increased work load, and with services in understanding the delays and the inherent challenges such an increase has caused. Safeguarding standards A review of the existing safeguarding standards currently within contractual requirements has taken place and been embedded in all contracts. For the adult agenda, the increased scrutiny and challenge for services has required significant support to embed and begin the change in culture to a patient-led approach to safeguarding. Training and development The CCG has carried out an organisational learning needs analysis for safeguarding adults and the Mental Capacity Act and commissioned relevant training programmes in partnership with Islington Council. The designated professional is working with the CCG’s Clinical Director on a safeguarding adults training programme, PREVENT and the Mental Capacity Agenda for GPs in the borough.

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In the year, the partnership board has held conferences for professionals and service users that have been well attended and highly regarded. The board has also held events to understand the implications of the Care Act, Making Safeguarding Personal, self-neglect and the Mental Capacity Agenda. Representation at regional and local networks The CCG has representation at NHS England London Safeguarding Adults and PREVENT meetings. It continues to work jointly with the Islington Council adult safeguarding team and is a leading partner in the Safeguarding Adults Partnership Board. The CCG’s Director of Quality and Integrated Governance is the Vice-Chairman of the Board and commissioners play active roles in all aspects of adult safeguarding. Supervision and support The designated professional meets regularly with the designated leads across North Central London (NCL) for peer support. The designated professional meets with the named leads from provider trusts on a monthly basis to provide supervision and support. The agenda continues to evolve and its workload continues to increase in line with national direction, new legislation, emerging scandals and findings from critical incidents and serious case reviews. The underpinning message however remains the same in that safeguarding is everyone’s business irrespective of role or position. It is a commissioning, provider and community responsibility to safeguard and protect the most vulnerable adults in our society. The vulnerable adult must remain at the centre and motivation of our actions.

1.22 Co-operating in preparation of Joint Strategic Needs Assessments The Joint Strategic Needs Assessment is a process led by Public Health to jointly describe the current and future health and wellbeing needs of the local population. The intelligence gathered has supported us in the identification of priorities and has helped determine what actions need to be taken to buy the right services for the local population to improve health and wellbeing and reduce inequalities. The production of a Joint Strategic Needs Assessment is a statutory requirement for Health and Wellbeing Boards. In Islington a publically accessible web-based ‘Evidence Hub’ has been developed which hosts evidence, data, strategies, intelligence and policies. The Evidence Hub helps to share information across and within organisations and to inform the development of evidence-based and needs-based commissioning plans and priorities. In essence, the Evidence Hub is Islington’s Joint Strategic Needs Assessment and can be accessed at: http://evidencehub.islington.gov.uk.

1.23 Sustainability We remain committed to the Government’s target for the environment including lower carbon emissions and sustainability. Reducing the amount of energy used in our organisation contributes to this goal. Below are examples of ways we are doing this.

We use smarter working to make efficient use of our office space. As part of a network across the twelve sites in NCL, our staff are able to log on from remote sites, reducing the need for travel.

We have an office recycling programme in place to minimise the amount of waste we generate.

As part of an effort to minimise use of paper, Governing Body and senior management team members all access documents on tablet computers. This reduces the time and resources involved in production of meeting papers.

http://evidencehub.islington.gov.uk/

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These efforts are part of our organisation-wide effort to be as efficient as possible and contributes to the NHS’s commitment to reduce its overall carbon footprint by 10% between 2009 and 2015.

1.24 Reducing inequality It is the policy of the CCG that all staff, public and patients will be treated equitably, fairly and with respect. Selection for employment, promotion, training or any other benefit will be on the basis of aptitude and ability. All employees will be helped and encouraged to develop their full potential and the talents and resources of the workforce will be fully utilised to maximise the efficiency of the organisation. Staff may not discriminate directly or indirectly, or harass patients, the public or anyone they come into contact with as a result of their work. The CCG is committed to reflecting in its workforce the diversity of the population we serve. We are committed to operating fully in the spirit of the Equality Act 2010. We work hard to make sure we meet our legal duties under the Act and take opportunities to promote equality in everything we do. Over the past year, we used the Equality Delivery System 2, to look at how accessible our services are for local people, and to identify specific ways that we could promote equality and diversity in Islington. Our programme of engagement over the course of the year has provided us with the views and insights of a broad cross-section of patient groups in Islington. Based on the evidence from working with these groups, and analysis using the Equality Delivery System, the following objectives were recommended:

to encourage a more effective interpreting service for the Islington community within all primary care services

to work with trusts to identify areas for improvement within the equalities data collected

to improve the way in which comments and complaints are captured, supported and monitored in the Islington healthcare system

the leadership of the CCG to make a more explicit commitment to all aspects of Equality and Diversity throughout the year.

These equality objectives have been developed through our work with our partners at Islington Council as part of the annual Joint Strategic Needs Assessment. This provides us with an 2 evidence base and framework for commissioning health and social care services. As part of our commissioning work, we also looked beyond the Joint Strategic Needs Assessment, to include the views of groups who are well known to experience significant health inequalities.

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2 Accountability report 2.1 Corporate governance report 2.1.1 Members’ report 2.1.1.1 Member practices Set up in 2013, the CCG is made up of 34 member GP practices across the borough. Member GP practices decide how the CCG operates by developing a constitution with a Governing Body made up of lay members, clinicians (GPs, nurses and a hospital doctor) and NHS managers. 2.1.1.2 Governing Body membership This section provides information about the CCG Governing Body members, including details of terms of service.1 Table 8. Governing Body membership

Elected Members Role

Gillian Greenhough (to February 2016 )

Chair (GP)

Josephine Sauvage (from February 2016)

Chair (GP)

Katie Coleman (joint position to February 2016, then sole position)

Vice-Chair (GP)

Josephine Sauvage (joint position to February 2016)

Vice-Chair (GP)

Afsana Bhuiya (from July 2015) Central Locality GP Representative

Jennie Hurley Practice Nurse Representative

Sabin Khan Salaried/Sessional GP Representative

Rathini Ratnavel (co-opted to June 2015, then elected)

South East Locality GP Representative

Stephen Rogers North Locality GP Representative

Karen Sennett South West Locality GP Representative

Deborah Snook Joint Practice Manager Representative

Ian Huckle Joint Practice Manager Representative

Appointed Members Role

Sorrel Brookes Lay Member (Vice-Chair and Audit Committee Member)

1 Information about all CCG committees is included in our Governance Statement (section 2.3.4).

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Mo Akmal Secondary Care Hospital Clinician

Bernadette Conroy (to July 2015) Interim Chair Audit Committee

Lucy de Groot (from June 2015) Lay Member (Chair Audit Committee)

Executive Members Role

Alison Blair Chief Officer (Accountable Officer)

Ahmet Koray Chief Finance Officer

Martin Machray (to January 2016) Director of Quality and Integrated Governance

Non-Voting Members Role

Paul Sinden Director of Commissioning

Phillip Watson Director of HealthWatch Islington

Simon Galczynski Service Director for Adult Social Care (Islington)

Robbie Bunt Local Medical Committee Representative

Julie Billett Director of Public Health (Camden and Islington)

2.1.1.3 Audit Committee membership Table 9. Audit Committee membership

Members Role

Bernadette Conroy (to July 2015) Interim Chair Audit Committee

Lucy de Groot (from June 2015) Lay Member (Chair Audit Committee)

Sorrel Brookes Lay Member (Vice-Chair and Audit Committee Member)

Dr Rathini Ratnavel GP Member

2.1.1.4 Profiles of Governing Body Members Our Governing Body is made up of elected and non-elected members, drawn from a range of clinical and lay backgrounds. This provides the CCG with a range of views and expertise across health and social care. Elected Members Dr Josephine Sauvage – Chair (from February 2016) Dr Sauvage is a GP at the City Road medical practice and is Chair of the CCG, having previously been Vice-Chair (Clinical) since the inception of the CCG. Dr Sauvage has led on the integrated care strategy, delivering person centred and co-ordinated care for those with

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complex or long-term conditions. Dr Sauvage has been Chair of the Strategy and Finance Committee, lead for Urgent Care as well as Workforce Development and Chair of the Community Education Provider Network Steering Group. She is currently leading the strategic work involving the NCL boroughs, as well as supporting the development of the Strategic Planning Group. Dr Gillian Greenhough – Chair (to February 2016) As an Islington GP, Dr Greenhough was Chair of the CCG for three years. She has a background in public health as well as in general practice and was elected to her position as Chair of the CCG by GPs of the 37 practices in Islington at the time. Dr Katie Coleman – Vice-Chair (Clinical) Dr Coleman is sole Vice-Chair (Clinical) of the CCG, having previously held the position jointly since the inception of the CCG in April 2013. Her clinical lead portfolio includes patient and public participation, the primary care strategy, children’s services and maternity services. Dr Coleman is currently Chair of the Patient and Public Participation Committee. Jennie Hurley – Practice Nurse Representative Ms Hurley is practice nurse representative on the Governing Body as well as a member of the Patient and Public Participation Committee. Ms Hurley is the lead on last year of life care. Dr Sabin Khan – Salaried/Sessional GP Representative Dr Khan is the salaried/sessional GP representative on the Governing Body and is the Individual Funding Request Panel Chair. Dr Khan is a member of the Quality and Performance Committee. Dr Rathini Ratnavel – South Locality GP Representative Dr Ratnavel is a local practicing GP leading on safeguarding adults and a member of the Audit Committee. Dr Stephen Rogers – North Locality GP Representative Dr Rogers is based at the Hornsey Rise practice and was co-opted onto the Governing Body, to represent the North Locality in November 2013, until his election to the position. Dr Karen Sennett – South Locality GP Representative Dr Sennett is a GP from the South Locality and is the GP Governing Body lead for quality, cancer, chronic obstructive pulmonary disease and liver pathways. Dr Sennett is a member of the Quality and Performance Committee. Deborah Snook – Practice Manager Representative Ms Snook is the Practice Manager Representative, with responsibility for learning disabilities and direct access diagnostics. Ms Snook is a member of the Strategy and Finance Committee. Ian Huckle – Practice Manager Representative Mr Huckle has been the Practice Manager of the Rise Group practice in Hornsey Rise for the past seven years. He arrived with many transferrable skills stemming from a 20-year career with Barclays Bank and subsequent roles involving large scale people and operational management. Appointed Members Mr Mo Akmal – Secondary Care Clinician Mr Akmal is a consultant orthopaedic spinal surgeon and Chief of Trauma and Orthopaedic Surgery at Imperial College Healthcare NHS Trust.

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Sorrel Brookes – Lay Vice-Chair Ms Brookes is the lay Vice-Chair on Governing Body with responsibility for patient and public participation. She chairs the Quality and Performance Committee, and is a member of the Audit Committee. Bernadette Conroy - Interim Chair of the Audit Committee (to July 2015) Ms Conroy was seconded into the role of Interim Chair of the Audit Committee from Barnet CCG, where she held a similar position on a substantive basis. Lucy de Groot - Lay Member and Chair of the Audit Committee (from June 2015) Ms de Groot has worked in senior management roles including Chief Executive of Bristol City Council and Director of Public Services at the Treasury. She is a Trustee of the Baring Foundation and Vice-Chair of Governors at the Working Men’s College in Camden. She started her working life as a community worker in North Islington and has lived in the borough for the last fifteen years. Executive Members Alison Blair – Chief Officer Ms Blair is the Chief Officer, providing executive leadership, and developing and implementing strategies involving the members, partners, the public and patients. Ahmet Koray – Chief Finance Officer Mr Koray is the Chief Finance Officer with responsibility for all aspects of finance, performance reporting and the programme management office function. Martin Machray – Director of Quality and Integrated Governance (to January 2016) Mr Machray was the Director of Quality and Integrated Governance and the Executive Nurse for the CCG until January 2016. 2.1.1.5 Register of interests The CCG publishes a full register of interests online at www.islingtonccg.nhs.uk, under About Us > Register of Interests. This includes all Governing Body members and senior managers. 2.1.1.6 Principles for remedy The Parliamentary and Health Service Ombudsman document on the principles for remedy guides public bodies on providing remedies for injustice or hardship resulting from their maladministration or poor service. Within the Parliamentary and Health Service Ombudsman’s jurisdiction, the guidance sets out what public bodies should do to put things right when they have gone wrong and the approach to recommending remedies. The CCG incorporated the principles for remedy within its complaints policy and through welcoming feedback on its services from service users and their relatives and/or carers. Complaints are treated as an ongoing learning opportunity, leading to the prevention or recurrence of incidents and complaints. Steps are taken to ensure that it is easy to make written concerns or complaints about the service, throughout the organisation. The policy aims to:

promote ease of access for complainants to raise concerns

empower staff to receive and, where appropriate, respond to complaints

http://www.islingtonccg.nhs.uk/

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support a rapid, open, fair, conciliatory approach to complaints which meets the needs of the complainant whilst supporting learning

promote a ‘one-stop shop’ approach to complaints that relate to more than one organisation, with unified handling of complaints across health and social care boundaries where possible

help the identification and management of persistent complainants

make good complaints handling a high profile organisational activity. 2.1.1.7 Data related incidents A statement of data security, including information about serious untoward incidents, is included within the Governance Statement at section 2.3.8 of this report. 2.1.1.8 External audit External audit services are being provided by KPMG LLP (12th Floor, 15 Canada Square, London E14 5GL) for the 2015/16 financial year. Costs associated with this service are as follows. Table 10. External Audit costs 2015/16

Component of audit Fee (including VAT)

Audit services £66,780

Further assurance services None

Other services None

Total £66,780

2.1.1.9 Statement as to disclosure to auditors Each individual who is a member of the Governing Body at the time the Members’ Report is approved confirms:

so far as the member is aware, that there is no relevant audit information of which the CCG’s external auditor is unaware

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

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2.2 Statement of Accountable Officer’s responsibilities

The National Health Service Act 2006 (as amended) states that each CCG shall have an Accountable Officer and that Officer shall be appointed by the NHS Commissioning Board (NHS England). NHS England has appointed the Chief Officer to be the Accountable Officer of the CCG. The responsibilities of an Accountable Officer, including responsibilities for the propriety and regularity of the public finances for which the Accountable Officer is answerable, for keeping proper accounting records (which disclose with reasonable accuracy at any time the financial position of the CCG and enable them to ensure that the accounts comply with the requirements of the Accounts Direction) and for safeguarding the CCG’s assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities), are set out in the CCG Accountable Officer Appointment Letter. Under the National Health Service Act 2006 (as amended), NHS England has directed each CCG to prepare for each financial year financial statements in the form and on the basis set out in the Accounts Direction. The financial statements are prepared on an accruals basis and must give a true and fair view of the state of affairs of the CCG and of its net expenditure, changes in taxpayers’ equity and cash flows for the financial year. In preparing the financial statements, the Accountable Officer is required to comply with the requirements of the Manual for Accounts issued by the Department of Health and in particular to:

observe the Accounts Direction issued by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis

make judgements and estimates on a reasonable basis

state whether applicable accounting standards as set out in the Manual for Accounts issued by the Department of Health have been followed, and disclose and explain any material departures in the financial statements

prepare the financial statements on a going concern basis.

To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my CCG 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 auditors are unaware, and that as Accountable Officer, I have taken all the steps 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

the annual report and accounts as a whole is fair, balanced and understandable, and that I take responsibility for the annual report and accounts and the judgements required for determining that it is fair, balanced and understandable.

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2.3 Governance statement 2.3.1 Introduction and context The CCG was licenced from 1 April 2013 under provisions enacted in the Health and Social Care Act 2012, which amended the National Health Service Act 2006. As at 1 April 2015, the CCG was licensed without conditions. 2.3.2 Scope of responsibility As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the CCG’s policies, aims and objectives, whilst safeguarding the public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out in my CCG Accountable Officer Appointment Letter. I am responsible for ensuring that the CCG is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity. 2.3.3 Compliance with the UK Corporate Governance Code We are not required to comply with the UK Corporate Governance Code. We have, however, reported on our corporate governance arrangements by drawing upon best practice available, including those aspects of the Code we consider relevant to the CCG and best practice. 2.3.4 The CCG governance framework The National Health Service Act 2006 (as amended), at paragraph 14L (2) (b) states: The main function of the Governing Body is to ensure that the group has made appropriate arrangements for ensuring that it complies with such generally accepted principles of good governance as are relevant to it. Constitution: The CCG’s constitution sets out the arrangements put in place to meet its responsibilities for commissioning healthcare for Islington residents. It sets out the membership of the CCG, accountability, the governance structure including decision-making arrangements and Governing Body roles and responsibilities, and the management of conflicts of interest. Governing Body: The Governing Body is responsible for ensuring that the CCG has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with the principles of good governance. The Governing Body comprises fifteen voting members including nine elected posts, three executives, two lay members, and a secondary care doctor. The Practice Manager Representative post is currently filled by a job share. In addition meetings are attended by the Director of Commissioning and observers with speaking rights from HealthWatch Islington, Islington Council, the Local Medical Committee and Islington Public Health. Full membership details are set out at section 2.1.1.2. During the course of the year one elected member and one executive member resigned, and two members were elected, one of whom had been co-opted previously.

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The Governing Body met in public on six occasions during 2015/16 and also held six seminar sessions. Details of the attendance at public meetings of individual members is set out in section 2.3.5. On average, members attended 90% of all such meetings. In addition to the commitment to good governance set out in the CCG’s Constitution, the Governing Body has adopted and works to the spirit of:

the Nolan Principles (selflessness, integrity, objectivity, accountability, openness, honesty and leadership)

the Code of Conduct for NHS Boards

the Code of Practice on Openness in the NHS

the Code of Conduct: Managing conflicts of interest where GP practices are potential providers of CCG commissioned services.

Conflicts of Interests and Register of Interests: The CCG is committed to the principles of transparent and open decision making. The Conflicts of Interest Policy has been adopted to ensure that decisions made by the CCG will be taken, and seen to be taken, without any possibility of the influence of external or private interests. The CCG keeps a register of interests which is reviewed regularly and updated as necessary. This is published on the CCG’s website. Review of Effectiveness: The Governing Body has been operating in either shadow or authorised status for over four years and has periodically taken time to reflect on its collective performance. Using the UK Corporate Governance Code (2014), members considered their effectiveness against the main principles of:

leadership

effectiveness

accountability

relations with stakeholders. The Governing Body’s overall reflection of 2015/16 has been that they have performed satisfactorily against all of these. They recognise, however, that the Governing Body continually needs to challenge itself to improve. Committees: The Governing Body has established five committees including two statutory committees which are the Audit Committee and the Remuneration Committee. Our non-statutory committees are the Patient and Public Participation Committee, the Quality and Performance Committee and the Strategy and Finance Committee. Details of the membership of all committees during 2015/16 is set out in section 2.3.5 and their full terms of reference are available on the CCG’s website.

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CCG Organisational Chart

Audit Committee During 2015/16, the Committee was chaired initially by Bernadette Conroy on an interim basis and thereafter by Lucy de Groot.

Purpose and aim: The Committee provides oversight of the establishment and maintenance of integrated governance, risk management and internal control systems to support the achievement of the CCG’s strategic objectives.

Highlights of reports received:

Progress against the internal audit programme from RSM Risk Assurance Services LLP (formerly Baker Tilly Business Services Ltd), including the Head of Internal Audit Opinion, an assessment of fraud risk and the counter fraud programme.

External audit issues from KPMG.

The Governing Body Assurance Framework.

Waivers to tender and quotation procedures.

A review of Governing Body committee effectiveness.

Meetings: The Committee met four times in 2015/16. The attendance of individual committee members is shown in Table 11. There was 100% attendance amongst members.

Remuneration Committee During 2015/16, the Committee had a rotating membership and chair based on the items to be discussed. No Committee member attended meetings where their remuneration was to be discussed.

Purpose and aim: The Committee makes recommendations to the Governing Body about pay, remuneration and conditions of service for employees of the CCG and others who provide services to the CCG.

Highlights: Decisions taken by the Committee in 2015/16 concerned the remuneration of Governing Body clinician members and clinical leads.

Meetings: The Committee met three times in 2015/16.

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Patient and Public Participation Committee The Committee was chaired by Dr Katie Coleman during the year.

Purpose and aim: The Committee is responsible for the development, implementation and oversight of the CCG’s Patient and Public Participation, and Equality and Diversity Strategies.

Highlights of reports received: • Patient and public participation in the CCG’s key strategic programmes including

integrated care, primary care, and urgent care. • Patient and public participation in the development of the Five Year Plan. • The work of HealthWatch. • Progress against the Equality and Diversity work plan.

Meetings: The Committee met four times in 2015/16. The attendance of individual Committee members is shown in Table 11. On average, members attended 84% of all meetings.

Quality and Performance Committee The Committee was chaired by Sorrel Brookes during the year.

Purpose and aim: The Committee is responsible for the oversight and monitoring of the quality of commissioned services including patient experience and safety, the effectiveness of commissioned services, and performance against service delivery indicators.

Highlights of reports received: • regular update reports from providers on quality and performance matters • regular performance reports on key performance indicators • complaints • Serious Incidents.

Meetings: The Committee met twelve times in 2015/16. The attendance of individual committee members is shown in Table 11. On average, members attended 88% of all meetings.

Strategy and Finance Committee The Committee was chaired by Dr Jo Sauvage during the year.

Purpose and aim: The Committee has responsibility for financial monitoring and has oversight of the development and implementation of strategic plans including associated financial plans.

Highlights of reports received: • Delivery of the financial plans and the Quality, Innovation, Productivity and

Prevention (QIPP) Programme. • The contracting process. • Performance against each of the four key strategic programmes comprising

integrated care, primary care, urgent care, and planned care. • The development of the Operating Plan and the Five Year Plan. • Locally Commissioned Services.

45

Meetings: The Committee met twelve times in 2015/16. The attendance of individual Committee members is shown in Table 11. On average, members attended 70% of all meetings.

2.3.5 Attendance records The table on the following page sets out the attendance records of individual Governing Body members and gives details of committee membership and attendance. No attendance records are shown for the Remuneration Committee, as this had a rotating membership, based on the items to be discussed. Table 11. Attendance records

Name Position

Go

ve

rnin

g

Bo

dy

Au

dit

Co

mm

ittee

Pa

tien

t a

nd

Pu

blic

Pa

rticip

atio

n

Co

mm

ittee

Qu

ality

a

nd

Pe

rform

an

ce

C

om

mitte

e

Stra

teg

y

an

d

Fin

an

ce

C

om

mitte

e

Mo Akmal Secondary care doctor 83%

Afsana Bhuyia GP representative 100% 78%

Julie Billett Director of Public Health 100%

Alison Blair Chief Officer 100%

Sorrel Brookes Lay member and Interim Vice-Chair

100% 100% 100% 100%

Robbie Bunt Local Medical Committee representative

33%

Katie Coleman Joint Vice-Chair and GP representative

100% 75%

Bernadette Conroy Interim Chair Audit Committee

100% 100%

Lucy de Groot Lay Vice-Chair 100% 100% 90%

Simon Galczynski LB Islington representative 67%

Gillian Greenhough

Chair and GP representative 80%

Ian Huckle/Deborah Snook (job share)

Practice Manager representative

100% 100% 67%

Jennie Hurley Practice Nurse representative

100% 75%

Sabin Khan GP representative 83% 67%

Ahmet Koray Chief Finance Officer 100% 75% 75%

Martin Machray Director of Quality and Integrated Governance

80% 67% 100%

Rathini Ratnavel GP representative 100% 100%

Stephen Rogers GP representative 67% 83%

Jo Sauvage Chair and GP representative 100% 67%

Karen Sennett GP representative 83% 100%

Paul Sinden Director of Commissioning 100%

Phillip Watson HealthWatch Islington representative

100%

46

2.3.6 The CCG risk management framework The CCG established a corporate risk register and board assurance framework in April 2013. Risks go through the following regular review cycle:

risk leads and Integrated Governance Manager review and update risks

risk owners (the Chief Officer and Directors) review risks

the Executive Management Team considers the risk register

the Quality and Performance, Finance and Strategy and Audit Committees consider relevant risks

the Governing Body approves the full risk register, with amendments

the Audit Committee considers the Board Assurance Framework. All risks are linked to the CCG’s key priorities and the mitigation and assurance of risks is scrutinised as part of the internal audit work plan. Through the use of its committee paper front cover sheet, the CCG requires all risks relating to the content of reports to be highlighted, including an equality impact assessment and also any patient and public involvement. In addition to this, there are a number of further mechanisms by which risks are identified, as explained below. Risk leads work collaboratively with stakeholders to identify and implement mitigating controls. Examples include joint working with Islington Council on managing risks around commissioning healthcare, or working with Patient and Public Participation groups to manage risks around the proper handling of, and learning from, patient complaints. In addition our committees and Governing Body include representation from key stakeholders. There is at least one patient representative on each committee, and our Governing Body includes observers from Public Health, HealthWatch Islington and Islington Council. Incidents, Complaints and Claims All incidents, complaints and claims are reported and managed in line with the relevant policies. Any risks identified are managed in line with these policies. Policies All risks identified through the development and implementation of policies are assessed and managed through the risk management process. External Assessments A number of external assessments and audits are undertaken each year. All risks identified in relation to the requirements of an external assessment are assessed and managed through the risk management process. National Guidance / Safety Alerts There is a process in place for managing the dissemination and implementation of relevant guidance from the National Institute for Clinical Excellence and other national bodies, and safety alerts. All risks identified in relation to implementation of guidance are assessed and managed through the risk management process.

47

Internal Audit Internal Audit provide an independent and objective opinion on the effectiveness of risk management and governance within the organisation. All risks identified through this process are assessed and managed through the risk management system. Risk Rating Matrix It is common for risks to be rated on a scale of one to five for likelihood and impact, with five being the highest. Risks rated 1-6 inclusive are green; 8-12 inclusive are amber; and those rated 15 or higher are red. Intermediate ratings are amber/green or amber/red. Likelihood The assessment of likelihood uses a scale from highly unlikely to almost certain. Anything that is certain to occur is not a risk, and should not be managed using the risk register. Impact The assessment of risk impact is described in terms of clinical impact, financial impact, or reputational impact. The Governing Body considers the guidance on risk impact in its assessment, noting that a clinical impact of 3 is defined as the minimum threshold for a risk that relates to a serious incident and as such a rating of 5 cannot be applied to anything that is not considered a serious incident Risk ‘Heat Map’ A risk ‘heat map’ is used as a basis to illustrate risks both prior to and post mitigation. This heat map also highlights additional risks for inclusion or deletion. Risks that have had their ratings increased or decreased are marked. The Review Cycle The review cycle runs from Governing Body meeting to the next. The Integrated Governance Manager, in discussion with the risk owners and risk leads, keeps the risk register updated, and drafts papers for each review meeting. Review meetings include:

Executive Team meetings

committee meetings, looking at risks relating to each committee’s remit

the Audit Committee’s consideration of the full risk register. Appropriate controls and actions are agreed and taken to reduce all risks to an acceptable level, or where it is not possible to reduce the level of risk, ensure that it is managed appropriately. The appointed Local Counter Fraud Specialist for the CCG compiles an annual work plan relating to the management of fraud related risks that was based around the key areas indicated below. Proactive Work Programme

Awareness and Development (Creating an Anti-Fraud Culture)

Managing Organisational Fraud Risk (Compliance with the NHS Counter Fraud Strategy and CIPFA Red Book “Managing the Risk of Fraud”)

Compliance, Governance and Reporting (Taking Action to Tackle the Problem).

48

Reactive Work Programme

Investigations, Sanctions and Redress (Taking Action to Tackle the Problem). Risk Assessment During 2015/16 the following risks were red-rated pre-mitigation, and amber post-mitigation: There are a number of risks facing the CCG around information governance. CCGs may generally not access patient identifiable data without explicit consent or where it is for the purposes of direct care, and we operate in an environment where there is a lack of knowledge of the standards for accessing information and of the responsibilities of individual bodies. The CCG and its stakeholders are at risk of reputational and financial consequences if appropriate processes for data collection, transmission, analysis and storage are not in place. The risk is mitigated through the establishment of information governance processes and procedures in line with the information governance toolkit, the CCG’s Accredited Safe Haven status, and regular induction and refresher training for staff. There is a risk of loss of patient confidence in the system for making complaints, arising from the fragmentation of responsibilities across a range of organisations and the consequent complexity of the system. Without this information, the CCG is unable to learn from patient experience or work with healthcare providers to implement improvements. The risk is mitigated through the provision by the CCG of clear signposting through the complaints system, the inclusion of a representative of HealthWatch Islington on key committees, and committee-level monitoring of complaints. 2.3.7 The CCG internal control framework A system of internal control is the set of processes and procedures in place in the CCG to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, 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. Each risk has an assigned risk lead and a risk owner. The risk lead is responsible for keeping the risk up to date and providing evidence of the mitigating controls. Any changes to the risk and the evidence supporting this are then signed off by the risk owner, who is typically an executive director. Every CCG committee considers and comments on the risks within its remit. The full risk register is then considered and commented upon by the Governing Body. The Audit Committee considers the full risk register to ensure the appropriate risk management systems are in place, and are being adhered to. Risk leads and owners typically review their risks monthly, while the review cycle from one Governing Body meeting to the next lasts two months. There are therefore six cycles of risk reviews each year. Information Governance The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal identifiable information. The NHS Information Governance Framework is supported by an information governance toolkit and the annual submission process provides assurances to the CCG, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively.

49

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 information governance processes and procedures in line with the information governance toolkit. We have ensured all staff undertake annual information governance training and have developed a range of guidance to ensure staff are aware of their information governance roles and responsibilities. There are processes in place for incident reporting and investigation of serious incidents. We are developing information risk assessment and management procedures and a programme will be established to fully embed an information risk culture throughout the organisation. The Director of Quality and Integrated Governance is the Senior Information Risk Owner for the CCG. Review of Economy, Efficiency and Effectiveness of the Use of Resources The Governing Body is responsible for ensuring that the CCG uses its resources economically, efficiently and effectively. To achieve this, it ensures that the CCG has robust financial controls in place, including appropriate financial policies, expenditure approval limits for staff, robust procurement processes, clearly defined budget-holding responsibilities, and regular reporting of financial performance to committees, the management team, and the Governing Body. All business cases for major investment include a detailed financial analysis and are subject to scrutiny by the Strategy and Finance Committee and the Governing Body. The CCG’s internal auditors review key financial systems annually, both within the CCG and at the North and East London Commissioning Support Unit (CSU), which provides a range of financial support services to the CCG. All financial systems reviews carried out in 2015/16 have received an opinion of reasonable or substantial assurance. 2.3.8 Review of effectiveness of governance, risk management and internal control As Accountable Officer I have responsibility for reviewing the effectiveness of the system of internal control within the CCG. Capacity to Handle Risk There is a Governing Body and management commitment to effective risk management across the CCG. The Governing Body and all committees have clearly defined responsibilities for risk management. All staff are invited to undertake local risk training to ensure they can identify, describe and evaluate a risk. Our induction programme includes mandatory training on high risk areas such as information governance and equality and diversity. Guidance provided to staff reflects professional best practice. Review of Effectiveness My review of the effectiveness of the system of internal control is informed by the work of the internal auditors, and the executive managers 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 the external auditors in their annual audit letter and other reports. Our Board Assurance Framework itself provides me with evidence that the effectiveness of controls that manage risks to the CCG achieving its principal objectives have been reviewed. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Governing Body and the Audit Committee, and plans to address weaknesses and ensure continuous improvement of the system are in place.

50

Head of Internal Audit Opinion Following completion of the planned audit work for the financial year for the CCG and the quality assurance work for the CSU, the Head of Internal Audit issued an independent and objective opinion on the adequacy and effectiveness of the CCG’s system of risk management, governance and internal control. The Head of Internal Audit concluded that:

the organisation has an adequate and effective framework for risk management, governance and internal control. However, improvements are required to enhance the framework of risk management, governance and internal control to ensure that it remains adequate and effective.

During the year, all but one of the reports issued by Internal Audit received a rating of amber or better, equating to an opinion of reasonable or substantial assurance. The exception was the report on Locally Commissioned Services, which received an amber/red rating. This represents partial or limited assurance, having identified recommendations with the measurement of outcomes following investment in Locally Commissioned Services. The CCG accepted the findings and has since further strengthened the arrangements including implementing actions to systematically review the outcomes by way of performance measures. Further action is planned to ensure that performance reporting meets requirements and that systems and processes can be refined as necessary. Data Quality The Governing Body considered data quality as part of its review of its effectiveness, and concluded that the quality of data is satisfactory. It remains committed, however, to the continuous improvement of the quality of the data used in carrying out its duties. Business Critical Models An appropriate framework and environment is in place to provide quality assurance of business critical models. All business critical models have been identified and information about quality assurance processes for those models has been provided to the Analytical Oversight Committee, chaired by the Chief Analyst at the Department of Health. Data Security We have submitted a satisfactory level of compliance with the information governance toolkit assessment. There were no data breaches at or caused by the CCG during 2015/16. Discharge of Statutory Functions Correct arrangements are in place for the discharge of statutory functions. These have been checked for any irregularities and are legally compliant, in line with the recommendations of the Harris Review. Arrangements put in place by the CCG and explained within the Corporate Governance Framework were developed with extensive expert external legal input, to ensure compliance with all relevant legislation. This legal advice also informed the matters reserved for Membership Body and Governing Body decision and the scheme of delegation. In light of the Harris Review, the 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 legislation 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.

51

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 CCG’s statutory duties. Conclusion No significant internal control issues have been identified during 2015/16.

52

2.4 Remuneration and staff report 2.4.1 Remuneration report 2.4.1.1 Remuneration The NHS has adopted the recommendations outlined in the Greenbury Report in respect of the disclosure of senior managers’ remuneration and the manner in which it is determined. Senior managers are defined as those persons in senior positions having authority or responsibility for directing or controlling the major activities of the CCG. This means those who influence the decisions of the CCG as a whole rather than the decisions of individual directorates or departments. Such persons include advisory and lay members. This report outlines how those recommendations have been implemented by the CCG in the year to 31 March 2016. Policy on remuneration of senior managers The Remuneration Committee sets salaries and terms and conditions of service for all Governing Body members. Including clinicians, lay members and executive directors, on an annual basis in accordance with the CCG’s constitution. All salaries are set with regard to the guidance laid out in NHS England’s Annex 2: Principles relating to reimbursement and remuneration for Governing Body members April 2012, and also to local benchmarking provided by North East London CSU. The executive directors have their pat and terms and conditions of service set in accordance with the NHS Very Senior Manager framework and the NHS London Pay Framework for Very Senior Managers in Strategic and Special Health Authorities, CCGs and Ambulance Trusts. Pay and terms and conditions for other directors who do not sit on the Governing Body are determined by the national Agenda for Change regulations. There has been no payment of performance related pay during the year ending 31 March 2016. No compensation was payable during the year and no amounts are included that are payable to third parties for the services of senior managers. In the event of redundancy standard NHS packages will apply. Policy on senior managers’ contracts The chair, GP members and lay members of the Governing Body are all engaged via a contract for services. The duration and other terms of office are set in accordance with the CCG’s constitution. Notice periods for members engaged via a contract for service are set at one month. No termination payments are made on expiry of the contract. Executive and other directors are directly employed on permanent contracts. The Chief Officer is subject to a three-month notice period and other directors, twelve weeks. No payments are made on termination except in circumstances of redundancy.

53

Table 12. Salaries and allowances of senior managers 2015/16 (auditable)

Salary (bands

of £5,000)

All Pension Related Benefits (bands of £2,500)

Total (bands

of £5,000)

Co

mm

en

ced

an

d E

nd

ed

£'000 £’000 £’000

Executive Directors (Voting)

Ms Alison Blair Chief Officer 125-130 50-52.5 180-185 01/04/13

Mr Ahmet Koray Chief Finance Officer 110-115 52.5-55 160-165 01/04/13

Mr Martin Machray

Director of Quality and Integrated Governance

55-60 25-27.5 80-85 01/04/13 to 31/01/16

Elected Members (Voting)

Dr Gillian Greenhough*

Chair 80-85 0 80-85 01/04/13 to 18/02/16

Dr Jo Sauvage* Chair 65-70 0 65-70 01/04/13

Dr Katie Coleman*

Vice-Chair (Clinical) 60-65 0 60-65 01/04/13

Dr Afsana Bhuiya*

Central Locality GP Member

15-20 0 15-20 02/07/15

Mr Ian Huckle Joint Practice Manager Representative

0-5 0 0-5 15/06/14

Ms Jennie Hurley*

Practice Nurse Representative

5-10 0 5-10 01/04/13

Dr Sabin Khan* Salaried GP Representative

20-25 0 20-25 01/04/13

Dr Rathini Ratnavel*

South Locality GP Member 20-25 0 20-25 01/04/13

Dr Stephen Rogers*

North Locality GP Member 20-25 0 20-25 01/10/13

Dr Karen Sennett*


Ms Deborah Snook

Joint Practice Manager Representative

0-5 0 0-5 01/04/13

Lay and Appointed Members (Voting)

Ms Sorrel Brookes

Vice-Chair (Non-Clinical) 10-15 0 10-15 01/04/13

Mr Mohammed Akmal

Secondary Care Clinician 10-15 0 10-15 01/04/13 to 31/03/15

Ms Bernadette Conroy

Interim Audit Committee Chair

0-5 0 0-5 01/04/15 to 31/07/15

Ms Lucy de Groot

Audit Committee Chair 5-10 0 5-10 01/06/15

Directors (Non-Voting)

Mr Paul Sinden Director of Commissioning 105-110 35-37.5 140-145 01/04/13

Dr Dominic Roberts

Clinical Director 60-65 15-17.5 75-80 07/07/14

Dr Robbie Bunt* Local Medical Committee Representative

10-15 0 10-15 01/04/13

54

Notes *GP members with a contract for services. All except Dr Bunt are on the payroll, but classed as off-payroll according to the guidance for this report. They are therefore not included in the pensions note at section 2.4.1.2 but disclosed under off-payroll engagements at section 2.4.2.7. The Governing Body GP, practice nurse and manager posts were novated when the CCG was established, with terms that expired on 14 June 2014. They were re-elected for a term between 2 to 4 years from 15 June 2014. As in 2014-15, no short or long-term performance pay, bonuses or benefits in kind were paid during the year ending 31 March 2016. All pension related benefit applies to those receiving pension contributions only. The amount included here comprises all pension related benefits, including: the cash value of payments (whether in cash or otherwise) in lieu of retirement benefits, and, all benefits in year from participating in pension schemes. For defined benefit schemes, the amount included here is the annual increase in pension entitlement determined in accordance with the ‘HMRC’ method. In summary, this is as follows: Increase = ((20 x PE) +LSE) – ((20 x PB) + LSB), where:

PE is the annual rate of pension that would be payable to the director if they became entitled to it at the end of the financial year.

PB is the annual rate of pension, adjusted for inflation, that would be payable to the director if they became entitled to it at the beginning of the financial year.

LSE is the amount of lump sum that would be payable to the director if they became entitled to it at the end of the financial year.

LSB is the amount of lump sum, adjusted for inflation, that would be payable to the director if they became entitled to it at the beginning of the financial year.

From 24 August 2015 to his departure on 31 January 2016, Mr Machray spent half his time working for NHS England, so only half his salary is recorded for this period. Dr Sauvage replaced Dr Greenhough as Chair on 19 February 2016 having being Joint Vice-Chair (Clinical) with Dr Coleman since 1 April 2013. Dr Coleman was the sole Vice-Chair from 19 February 2016. Dr Ratnavel began the year as a co-opted member until being elected in June 2015. Ms Brookes was acting Vice-Chair (Non-Clinical) from 1 April 2015 to 31 October 2015, having been a Lay Member since 1 April 2013. She was made permanent Vice-Chair on 1 November 2015.

55

Table 13. Salaries and allowances of senior managers 2014/15 (auditable)

Salary (bands

of £5,000)

All Pension Related Benefits (bands of £2,500)

Total (bands

of £5,000)

Co

mm

en

ced

an

d E

nd

ed

£'000 £’000 £’000

Executive Directors (Voting)

Ms Alison Blair Chief Officer 120-125 (5-7.5) 115-120 01/04/13

Mr Ahmet Koray Chief Finance Officer 100-105 0-2.5 105-110 01/04/13

Mr Martin Machray

Director of Quality and Integrated Governance

90-95 30-32.5 120-125 01/04/13

Elected Members (Voting)

Dr Gillian Greenhough*

Chair 85-90 0 85-90 01/04/13

Dr Jo Sauvage* Joint Vice-Chair (Clinical) 55-60 0 55-60 01/04/13

Dr Katie Coleman*

Joint Vice-Chair (Clinical) 55-60 0 55-60 01/04/13

Dr Sharon Bennett*

Central Locality GP Member

5-10 0 5-10 01/04/13 to 14/06/14

Mr Ian Huckle Joint Practice Manager Representative

0-5 0 0-5 15/06/14

Ms Jennie Hurley*

Practice Nurse Representative

5-10 0 5-10 01/04/13

Dr Sabin Khan* Salaried GP Representative

35-40 0 35-40 01/04/13

Dr Stephen Rogers*

North Locality GP Member 15-20 0 15-20 01/10/13

Dr Karen Sennett*


Ms Deborah Snook

Joint Practice Manager Representative

0-5 0 0-5 01/04/13

Co-opted Members (Voting)

Dr Rathini Ratnavel*


Lay and Appointed Members (Voting)

Mr Mohammed Akmal

Secondary Care Clinician 10-15 0 10-15 01/04/13

Ms Sorrel Brookes

Lay Member 10-15 0 10-15 01/04/13

Ms Anne Weyman

Vice-Chair (Non-Clinical) 10-15 0 10-15 01/04/13 to 31/03/15

Directors (Non-Voting)

Mr Paul Sinden Director of Commissioning 100-105 27.5-30 130-135 01/04/13

Dr Dominic Roberts

Clinical Director 45-50 135-137.5 180-185 07/07/14

Dr Robbie Bunt* Local Medical Committee Representative

10-15 0 10-15 01/04/13

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2.4.1.2 Pensions

All staff, including senior managers, are eligible to join the NHS pension scheme. The employer’s contribution for the year was 14.3% of the individual’s salary as per the NHS Pensions regulations. Employee contribution rates for CCG officers and practice staff, and the prior year comparators, are shown in the following table. Table 14. Member contribution rates before tax relief (gross)

Annual pensionable pay Gross contribution rate 2015/16

Up to £15,431.99 5.0%

£15,432 to £21,477.99 5.6%

£21,478 to £26,823.99 7.1%

£26,824 to £47,845.99 9.3%

£47,846 to £70,630.99 12.5%

£70,631 to £111,379.99 13.5%

£111,377 and over 14.5%

Annual pensionable pay Gross contribution rate 2014/15

Up to £15,431.99 5.0%

£15,432 to £21,387.99 5.6%

£21,388 to £26,823.99 7.1%

£26,824 to £49,472.99 9.3%

£49,473 to £70,630.99 12.5%

£70,631 to £111,379.99 13.5%

£111,377 and over 14.5%

Scheme benefits are set by NHS Pensions and are applicable to all members.

Past and present employees are covered by the provisions of the NHS pension scheme. Full details of how pension liabilities are treated are shown in note 3.4 of the annual accounts.

No significant awards or payments have been made during the year in relation to compensation, loss of office or past senior managers.

The table on the following page discloses further information regarding remuneration and pension entitlements. Table 15. Pension benefits of senior managers (auditable)

Real increase in pension at

age 60

Real increase

in pension

lump sum at aged

60

Total accrued pension at age 60

at 31st March 2016

Lump sum at age 60 related to accrued

pension at 31st March

2016

Cash equivalent

transfer value at

31st March 2016

Real increase in

cash equivalent

transfer value

Cash equivalent

transfer value at

31st March 2015

(bands of £2,500)

(bands of £2,500)

(bands of £5,000)

(bands of £5,000) £’000 £’000 £’000

Board members

Ms Alison Blair 2.5-5 7.5-10 40-45 130-135 775 60 707

Mr Ahmet Koray 2.5-5 2.5-5 25-30 80-85 440 39 396

Mr Martin Machray 0-2.5 2.5-5 30-35 100-105 625 33 579

Non-voting directors

Mr Paul Sinden 0-2.5 0-2.5 20-25 65-70 384 30 350

Dr Dominic Roberts 0-2.5 0-2.5 10-15 35-40 173 18 153

There are no entries in the cases of members with non-pensionable remuneration or GP members with a contract for services.

57

2.4.1.3 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. CETVs are calculated in accordance with the Occupational Pension Schemes (Transfer Values) Regulations 2008. 2.4.1.4 Real Increase in Cash Equivalent Transfer Values This reflects the increase in cash equivalent transfer values 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. 2.4.1.5 Relationship between highest paid director and median remuneration Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director in their organisation and the median remuneration of the organisation’s workforce. The mid-point of the banded remuneration of the highest paid member of the CCG in the financial year 2015/16 was £129k (2014/15, £123k). The increase reflected additional responsibilities. This was 2.5 times (unchanged from 2014/15) the median remuneration of the workforce, which was £53k (2014/15, £48k). In 2015/16, no individuals (unchanged from 2014/15) received remuneration in excess of the highest paid member. Remuneration ranged from £5k to £129k (2014/15, £5k to £123k). Total remuneration includes salary, non-consolidated performance-related pay, and benefits-in kind. It does not include severance payments, employer pension contributions and the cash equivalent transfer value of pensions. 2.4.2 Staff report 2.4.2.1 Membership and employee statistics Table 17. Gender breakdown of Governing Body Members at 31 March 2016

Governing Body

Member Category

Male Female

Elected 2 8

Appointed 2 3

Non-Voting 3 0

Total 7 11

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Gender breakdown of all Senior Managers including managers at Very Senior Manager grade There are one female and two male Senior Managers (Directors)/Very Senior Managers at 31 March 2016. Very Senior Manager (VSM) information At 31 March 2016, there are two Senior Managers on a Very Senior Manager (VSM) grade. Senior Manager information At 31 March 2016, there is one Senior Manager on band 9. All other employees At 31 March 2016 there are 58 other employees comprising 38 female and 20 male staff members. These figures exclude the VSM, Senior Managers and agency/contractor workers. 2.4.2.2 Sickness absence data Details of sickness absence are shown in note 3.3 to the financial statements contained in this report. 2.4.2.3 Staff policies regarding disability The CCG has published its Workforce Race Equality Standard Report (WRES) in July 2015 and the annual public sector equality duty (PSED) report in January 2016. Both of these have detailed information about workforce including recruitment, starters and leavers and training by protected characteristics. They also include equality information about the CCG’s Governing Body Members. 2.4.2.4 Employee consultation The CCG continues to undertake staff engagement as necessary to:

strengthen and focus the staff establishment and structure

add new roles to the overall establishment

amend current roles to provide a clearer focus on the strategic challenges of the CCG

move from long-standing, temporary arrangements to more permanent roles and therefore provide greater certainty and assurance to current members of the CCG about their roles in the organisation.

2.4.2.5 Equality and diversity In accordance with the CCG’s Equality and Diversity policy, all staff will be treated equitably, fairly and with respect. Selection for employment, promotion, training or any other benefit will be on the basis of aptitude and ability. All employees will be helped and encouraged to develop their full potential and the talents and resources of the workforce will be fully utilised to maximise the efficiency of the organisation. The CCG is committed to reflecting in its workforce the diversity of the population it serves. The CCG undertakes annual equality reviews by examining workforce data against protected characteristics. The CCG is committed to ensure that each manager will work to:

59

create an environment in which individual differences and the contributions of all our staff are recognised and valued

ensure all staff are aware of the policy, and the reasons for the policy

support the completion of the annual equality audit and the review of findings. 2.4.2.6 Consultancy expenditure Table 17. Consultancy

2015-16

Total

£’000

2015-16

Admin

£’000

2015-16

Programme

£’000

2014-15

Total

£’000

400 12 388 1,100

2.4.2.7 Off-payroll engagements Following the Review of Tax Arrangements of Public Sector Appointees published by the Chief Secretary to the Treasury on 23 May 2012, CCGs must publish information on their highly paid and/or senior off-payroll engagements. Payments to GP practices for the services of employees and GPs are deemed to be off-payroll engagements. Table 18. Off-payroll engagements

Number

Engagements as of 31 March 2016, for more than £220 per day and that last longer than six months

24

Of which, the number that have existed:

for less than one year at the time of reporting 3

For between one and two years at the time of reporting 3

for between two and three years at the time of reporting 18

New engagements between 1 April 2015 and 31 March 2016, for more than £220 per day and that last longer than six months

4

Number of the above which include contractual clauses giving the CCG the right to request assurance in relation to income tax and National Insurance obligations

4

Number for whom assurance has been requested 4

Of which:

assurance has been received 4

Number of off-payroll engagements of Governing Body members, and/or, senior officers with significant financial responsibility, during the year

12

Number of individuals that have been deemed Governing Body members, and/or, senior officers with significant financial responsibility, during the financial year (this figure includes both off-payroll and on-payroll engagements)

21

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

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2.4.2.8 Exit packages Termination arrangements are applied in accordance with statutory regulations as modified by national NHS conditions of service agreements (specified in Agenda for Change), and the NHS pension scheme. Specific termination arrangements will vary according to age, length of service and salary levels. The remuneration committee will agree any severance arrangements. No exit packages or severance payments were made during the year.

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3 Financial statements

3.1 Independent auditor’s report to the members of the Governing Body of NHS Islington CCG

We have audited the financial statements of NHS Islington CCG for the year ended 31 March 2016 on pages 64 to 89 under the Local Audit and Accountability Act 2014. These financial statements have been prepared under applicable law and the accounting policies directed by the NHS Commissioning Board with the consent of the Secretary of State as relevant to the Clinical Commissioning Groups in England. We have also audited the information in the Remuneration and Staff Report that is subject to audit. This report is made solely to the Members of the Governing Body of NHS Islington 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, as a body, those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Members of the Governing Body of the CCG, as a body, for our audit work, for this report or for the opinions we have formed. Respective responsibilities of the Accountable Officer and auditor As explained more fully in the Statement of Accountable Officer’s Responsibilities set out on page 40, the Accountable Officer is responsible for the preparation of financial statements which give a true and fair view and is also responsible for the regularity of expenditure and income. Our responsibility is to audit, and express an opinion on, the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors. We are also responsible for giving an opinion on the regularity of expenditure and income in accordance with the Code of Audit Practice prepared by the Comptroller and Auditor General under the Local Audit and Accountability Act 2014 (‘the Code of Audit Practice’). As explained in the Governance Statement, the Accountable Officer is responsible for the arrangements to secure economy, efficiency and effectiveness in the use of the CCG's resources. We are required under Section 21(1)(c) of the Local Audit and Accountability Act 2014 to be satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. Section 21(5)(b) of the Local Audit and Accountability Act 2014 requires that our report must not contain our opinion if we are satisfied that proper arrangements are in place. We are not required to consider, nor have we considered, whether all aspects of the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively. Scope of the audit of the financial statements An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of: whether the accounting policies are appropriate to the CCG’s circumstances and have been consistently applied and adequately disclosed; the reasonableness of significant accounting estimates made by the Accountable Officer, and the overall presentation of the financial statements.

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In addition we read all the financial and non-financial information in the annual report and accounts to identify material inconsistencies with the audited financial statements and to identify any information that is apparently materially incorrect based on, or materially inconsistent with, the knowledge acquired by us in the course of performing the audit. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report. In addition, we are required to obtain evidence sufficient to give reasonable assurance that the expenditure and income recorded in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them. Scope of the review of arrangements for securing economy, efficiency and effectiveness in the use of resources We have undertaken our review in accordance with the Code of Audit Practice, having regard to the guidance on the specified criterion issued by the Comptroller and Auditor General in November 2015, as to whether the CCG had proper arrangements to ensure it took properly informed decisions and deployed resources to achieve planned and sustainable outcomes for taxpayers and local people. The Comptroller and Auditor General determined this criterion as that necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the CCG put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2016. We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we undertook such work as we considered necessary to form a view on whether, in all significant respects, the CCG had put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources. Opinion on financial statements In our opinion the financial statements:

give a true and fair view of the financial position of the CCG as at 31 March 2016 and of its net operating expenditure for the year then ended; and

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

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

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

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

Matters on which we are required to report by exception We are required to report to you if:

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

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

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

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

we are not satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2016.

We have nothing to report in respect of the above responsibilities. Certificate We certify that we have completed the audit of the accounts of NHS Islington CCG in accordance with the requirements of the Local Audit and Accountability Act 2014 and the Code of Audit Practice. Fleur Nieboer for and on behalf of KPMG LLP, Statutory Auditor Chartered Accountants 15 Canada Square Canary Wharf London E14 5GL

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3.2 Annual accounts

Statement of Comprehensive Net Expenditure for the year ended 31 March 2016

2015-16 2014-15

Note £000 £000

Total income and expenditure

Employee benefits 3 4,818 4,030

Operating expenses 4 325,687 313,743

Other operating revenue 2 (868) (2,496)

Net operating expenditure before interest 329,638 315,277

Of which:

Administration income and expenditure



Other operating revenue 2 (115) (125)

Net administration costs before interest 5,115 5,218

Programme income and expenditure



Other operating revenue 2 (753) (2,371)

Net programme expenditure before interest 324,523 310,058

CCG final position

Revenue resource limit 338,598 323,484

Total comprehensive net expenditure (329,638) (315,277)

Surplus 8,960 8,207

The notes on pages 68 to 89 form part of this statement.

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Statement of Financial Position as at 31 March 2016

2015-16 2014-15

Note £000 £000

Non-current assets:

Property, plant and equipment 7 1,298 0

Total non-current assets 1,298 0

Current assets:

Trade and other receivables 8 2,785 4,445

Cash and cash equivalents 9 186 69

Total current assets 2,970 4,513

Total assets 4,268 4,513

Current liabilities

Trade and other payables 11 (35,383) (36,195)

Total current liabilities (35,383) (36,195)

Non-current assets less net current liabilities (31,115) (31,682)

Non-current liabilities

Trade and other payables 11 (400) 0

Provisions 12 (500) (500)

Total non-current liabilities (900) (500)

Assets less liabilities (32,015) (32,182)

Financed by taxpayers’ equity

General fund (32,015) (32,182)

Total taxpayers' equity: (32,015) (32,182)

The notes on pages 68 to 89 form part of this statement.

The financial statements were approved by the Governing Body on 24 May 2016 and signed on its behalf by:

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Statement of Changes In Taxpayers Equity for the year ended 31 March 2016

General

fund Revaluation

reserve Total

reserves

£000 £000 £000

Changes in taxpayers’ equity for 2015-16

Balance at 1 April 2015 (32,182) 0 (32,182)

Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2015-16

Net operating expenditure for the financial year

(329,638) (329,638)

Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year

(329,638) 0 (329,638)

Net funding

329,804 0 329,804

Balance at 31 March 2016

(32,015) 0 (32,015)

Changes in taxpayers’ equity for 2014-15

Balance at 1 April 2014 (27,612) 3 (27,609)

Changes in NHS Clinical Commissioning Group's taxpayers’ equity for 2014-15

Net operating costs for the financial year

(315,277) (315,277)

Release of reserves to the Statement of Comprehensive Net Expenditure

0 (3) (3)

Net Recognised NHS Clinical Group Expenditure for the Financial Year

(315,277) (3) (315,280)

Net funding

310,707 0 310,707

Balance at 31 March 2015

(32,182) 0 (32,182)

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Statement of Cash Flows for the year ended 31 March 2016

2015-16 2014-15

Note £000 £000

Cash Flows from Operating Activities

Net operating expenditure for the financial year (329,638) (315,277)

Impairments and reversals 10 0 60

(Increase)/decrease in trade and other receivables 8 1,660 (1,942)

Increase/(decrease) in trade and other payables 11 (554) 6,411

Net Cash Outflow from Operating Activities (328,531) (310,747)

Cash Flows from Investing Activities

Payments for property, plant and equipment (1,156) 0

Net Cash Outflow from Investing Activities (1,156) 0

Net Cash Inflow (Outflow) before Financing (329,688) (310,747)

Cash Flows from Financing Activities

Grant in aid funding received 329,804 310,707

Net Cash Inflow from Financing Activities 329,804 310,707

Net Increase (Decrease) in Cash and Cash Equivalents 9 117 (40)

Cash and Cash Equivalents at the Beginning of the Financial Year

69 109

Cash and Cash Equivalents (including bank overdrafts) at the End of the Financial Year

186 69

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Notes to the financial statements 1. Accounting Policies NHS England has directed that the financial statements of clinical commissioning groups (CCGs) shall meet the accounting requirements of the Manual for Accounts issued by the Department of Health. Consequently, the following financial statements have been prepared in accordance with the Manual for Accounts 2015-16 issued by the Department of Health. The accounting policies contained in the Manual follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to CCGs, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Manual permits a choice of accounting policy, the policy which is judged to be most appropriate to the particular circumstances of the CCG for the purpose of giving a true and fair view has been selected. The particular policies adopted by the CCG 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 CCG ceases to exist, it considers whether or not its services will continue to be provided (using the same assets, by another public sector entity) in determining whether to use the concept of going concern for the final set of Financial Statements. If services will continue to be provided, the financial statements are prepared on the going concern basis. 1.2 Accounting Convention These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities. 1.3 Pooled Budgets Where the CCG has entered into a pooled budget arrangement under Section 75 of the National Health Service Act 2006, the CCG 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 CCG is in a “jointly controlled operation”, it recognises:

the assets the CCG controls

the liabilities the clinical CCG incurs

the expenses the CCG incurs. 1.4 Critical Accounting Judgements and Key Sources of Estimation Uncertainty In the application of the CCG’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods.

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1.4.1 Critical Judgements in Applying Accounting Policies There have been no critical judgements, apart from those involving estimations (see below) that management has made in the process of applying the CCG’s accounting policies that have the most significant effect on the amounts recognised in the financial statements. 1.4.2 Key Sources of Estimation Uncertainty The following are the key estimations that management has made in the process of applying the CCG’s accounting policies that have the most significant effect on the amounts recognised in the financial statements: Partially Completed Spells Expenditure relating to patient care spells that are part-completed at the year-end are apportioned across the financial years on the basis of length of stay at the end of the reporting period compared to expected total length of stay. Accruals For goods and/or services that have been delivered but for which no invoice has been received/sent, the CCG makes an accrual based on the contractual arrangements that are in place and its legal obligations. Prescribing NHS England actions monthly cash charges to the CCG for prescribing contracts. These are issued approximately six-eight weeks in arrears. The CCG uses a forecast provided by the NHS Business Authority to estimate the full year expenditure. Maternity Pathways Expenditure relating to all antenatal maternity care is made at the start of a pathway. At the year-end, part completed pathways are therefore treated as prepayments. The CCG agrees to use the figures calculated by the local provider organisations. 1.5 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. 1.6. Employee Benefits 1.6.1 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. 1.6.2 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 CCG of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period.

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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 CCG commits itself to the retirement, regardless of the method of payment. Some employees are members of the Local Government Superannuation Scheme, which is a defined benefit pension scheme. The scheme assets and liabilities attributable to those employees can be identified and are recognised in the CCG’s accounts. The assets are measured at fair value and the liabilities at the present value of the future obligations. The increase in the liability arising from pensionable service earned during the year is recognised within operating expenses. The expected gain during the year from scheme assets is recognised within finance income. The interest cost during the year arising from the unwinding of the discount on the scheme liabilities is recognised within finance costs. Actuarial gains and losses during the year are recognised in the General Reserve and reported as an item of other comprehensive net expenditure. 1.7 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 CCG has a present legal or constructive obligation, which occurs when all of the conditions attached to the payment have been met. 1.8 Property, Plant and Equipment 1.8.1 Recognition Property, plant and equipment is capitalised if:

it is held for use in delivering services or for administrative purposes

it is probable that future economic benefits will flow to, or service potential will be supplied to the CCG

it is expected to be used for more than one financial year

the cost of the item can be measured reliably

the item has a cost of at least £5,000, or

collectively, a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control, or

items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or collective cost.

1.8.2 Valuation All plant and equipment are measured initially at cost, representing the cost directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. All assets are measured subsequently at valuation. HM Treasury has adopted a standard approach to depreciated replacement cost valuations based on modern equivalent assets and, where it would meet the location requirements of the service being provided, an alternative site can be valued.

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1.8.3 Subsequent Expenditure Where subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised. Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing carrying value of the item replaced is written-out and charged to operating expenses. 1.9 Intangible Assets 1.9.1 Recognition Intangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the CCG’s business or which arise from contractual or other legal rights. They are recognised only:

when it is probable that future economic benefits will flow to, or service potential be provided to, the CCG

where the cost of the asset can be measured reliably, and

where the cost is at least £5,000.

Intangible assets acquired separately are initially recognised at fair value. Software that is integral to the operating of hardware, for example an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software that is not integral to the operation of hardware, for example application software, is capitalised as an intangible asset. Expenditure on research is not capitalised but is recognised as an operating expense in the period in which it is incurred. Internally-generated assets are recognised if, and only if, all of the following have been demonstrated:

the technical feasibility of completing the intangible asset so that it will be available for use

the intention to complete the intangible asset and use it

the ability to sell or use the intangible asset

how the intangible asset will generate probable future economic benefits or service potential

the availability of adequate technical, financial and other resources to complete the intangible asset and sell or use it

the ability to measure reliably the expenditure attributable to the intangible asset during its development.

1.9.2 Measurement Following initial recognition, intangible assets are carried at current value in existing use by reference to an active market, or, where no active market exists, at the lower of amortised replacement cost or the value in use where the asset is income generating. 1.10 Depreciation, Amortisation and Impairments Depreciation and amortisation are charged to write off the costs or valuation of property, plant and equipment and intangible non-current assets, less any residual value, over their estimated useful lives, in a manner that reflects the consumption of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over which the CCG expects to obtain economic benefits or service potential from the asset. This is specific to the CCG and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis. At each reporting period end, the CCG checks whether there is any indication that any of its tangible or intangible non-current assets have suffered an impairment loss. If there is

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indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its amount. Intangible assets not yet available for use are tested for impairment annually. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Where an impairment loss subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the recoverable amount but capped at the amount that would have been determined had there been no initial impairment loss. The reversal of the impairment loss is credited to expenditure to the extent of the decrease previously charged there and thereafter to the revaluation reserve. 1.11 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. 1.11.1 The CCG as Lessee 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. 1.12 Cash and 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 CCG’s cash management. 1.13 Provisions Provisions are recognised when the CCG has a present legal or constructive obligation as a result of a past event, it is probable that the CCG will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties. Where a provision is measured using the cash flows estimated to settle the obligation, its carrying amount is the present value of those cash flows using HM Treasury’s discount rate as follows:

timing of cash flows (0 to 5 years inclusive): Minus 1.55% (2014-15: minus 1.50%)

timing of cash flows (6 to 10 years inclusive): Minus 1% (2014-15: minus 1.05%)

timing of cash flows (over 10 years): Minus 0.80% (2014-15: plus 2.20%).

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

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1.14 Clinical Negligence Costs The NHS Litigation Authority operates a risk pooling scheme under which the CCG pays an annual contribution to the NHS Litigation Authority which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although the NHS Litigation Authority is administratively responsible for all clinical negligence cases, the legal liability remains with the CCG. 1.15 Non-clinical Risk Pooling The CCG participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the CCG pays an annual contribution to the NHS Litigation Authority and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due. 1.16 Continuing Healthcare Risk Pooling In 2014-15, a risk pool scheme was introduced by NHS England for continuing healthcare claims, for claim periods prior to 31 March 2013. Under the scheme, the CCG contributes annually to a pooled fund, which is used to settle the claims. 1.17 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 CCG, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or the amount of the obligation cannot be measured sufficiently reliably. A contingent liability is disclosed unless the possibility of a payment is remote. A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the CCG. 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. 1.18 Financial Assets Financial assets are recognised when the CCG 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. All the CCG's financial assets are loans and receivables. 1.18.1 Loans and 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. 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 CCG 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.

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For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset’s carrying amount and the present value of the revised future cash flows discounted at the asset’s original effective interest rate. The loss is recognised in expenditure and the carrying amount of the asset is reduced through a provision for impairment of receivables. If, in a subsequent period, the amount of the impairment loss decreases and the decrease can be related objectively to an event occurring after the impairment was recognised, the previously recognised impairment loss is reversed through expenditure to the extent that the carrying amount of the receivable at the date of the impairment is reversed does not exceed what the amortised cost would have been had the impairment not been recognised. 1.19 Financial Liabilities Financial liabilities are recognised on the statement of financial position when the CCG 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. Financial liabilities are initially recognised at fair value. 1.20 Value Added Tax Most of the activities of the CCG 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. 1.21 Losses and 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). 1.22 Accounting Standards That Have Been Issued but Have Not Yet Been Adopted The Government Financial Reporting Manual does not require the following Standards and Interpretations to be applied in 2015-16, all of which are subject to consultation:

IFRS 9: Financial Instruments

IFRS 14: Regulatory Deferral Accounts

IFRS 15: Revenue for Contract with Customers.

The application of the Standards as revised would not have a material impact on the accounts for 2015-16, were they applied in that year.

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2 Other operating revenue

2015-16 2015-16 2015-16 2014-15

Total Admin Programme Total

£000 £000 £000 £000

Education, training and research 59 0 59 126

Non-patient care services to other bodies

779 84 695 2,343

Other revenue 31 31 0 27

Total other operating revenue 868 115 753 2,496

Admin revenue is revenue received which is not directly attributed to the provision of healthcare or healthcare services.

Revenue is totally from the supply of services. Other operating revenue includes receipt of grant funding that is not directly allocated to the General Fund. No cash was received from NHS England under this category.

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3. Employee benefits and staff numbers

3.1 Employee benefits

2015-16 Total Admin Programme

Total Permanent Employees Other Total

Permanent Employees Other Total

Permanent Employees Other

£000 £000 £000 £000 £000 £000 £000 £000 £000

Employee benefits

Salaries and wages 4,112 2,945 1,167 1,636 1,435 201 2,476 1,510 966

Social security costs 316 316 0 172 172 0 144 144 0

Employer contributions to NHS pension scheme

390 390 0 186 186 0 204 204 0

Gross employee benefits expenditure

4,818 3,651 1,167 1,995 1,793 201 2,824 1,858 966

2014-15 Total Admin Programme

Total Permanent Employees Other Total

Permanent Employees Other Total

Permanent Employees Other

£000 £000 £000 £000 £000 £000 £000 £000 £000

Employee benefits

Salaries and wages 3,473 2,681 792 1,600 1,345 254 1,873 1,336 537

Social security costs 258 258 0 139 139 0 119 119 0

Employer contributions to NHS pension scheme

299 299 0 165 165 0 135 135 0

Gross employee benefits expenditure

4,030 3,238 792 1,904 1,649 254 2,126 1,589 537

The increase in other employee benefits includes the employment of agency staff implementing the Integrated Digital Care Records project.

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3.2 Average number of people employed

2015-16 2014-15

Total Permanently

employed Other Total

Number Number Number

Number (restated)

Total 69 64 5 54

3.3 Staff sickness absence

2015-16 2014-15

Number Number

Total days lost 154 190

Total staff years 60 42

Average working days lost 3 5

Staff years constitutes the average full time equivalent of staff and therefore the average days available for work. 3.4 Pension costs Past and present employees are covered by the provisions of the NHS Pension Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/Pensions. The Scheme is an unfunded, defined benefit scheme that covers NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The Scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the Scheme is accounted for as if it were a defined contribution scheme: the cost to the CCG of participating in the Scheme is taken as equal to the contributions payable to the Scheme for the accounting period. The Scheme is subject to a full actuarial valuation every four years (until 2004, every five years) and an accounting valuation every year. An outline of these is available below in section 3.4.1. 3.4.1 Full actuarial (funding) valuation The purpose of this valuation is to assess the level of liability in respect of the benefits due under the Scheme (taking into account its recent demographic experience), and to recommend the contribution rates to be paid by employers and scheme members. The last such valuation, which determined current contribution rates was undertaken as at 31 March 2012 and covered the period from 1 April 2008 to that date. Details can be found on the pension scheme website at www.nhsbsa.nhs.uk/pensions. For 2015-16, employers’ contributions of £403,651 were payable to the NHS Pensions Scheme (2014-15: £276,638) were payable to the NHS Pension Scheme at the rate of 14.3% of pensionable pay (2014-15:14%). 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 2014.

http://www.nhsbsa.nhs.uk/Pensions

http://www.nhsbsa.nhs.uk/pensions

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4. Operating expenses

2015-16 2015-16 2015-16 2014-15

Total Admin Programme Total

£000 £000 £000 £000

Gross employee benefits Employee benefits excluding Governing Body members

4,305 1,498 2,806 3,504

Executive Governing Body members 514 496 18 526

Total gross employee benefits 4,818 1,995 2,824 4,030

Other costs

Services from other CCGs and NHS England

3,961 1,903 2,057 3,485

Services from foundation trusts 126,651 0 126,651 129,376

Services from other NHS trusts 121,518 0 121,518 122,118

Purchase of healthcare from non-NHS bodies (see note below)

41,558 0 41,558 27,874

Chair and Non-executive members 366 366 0 205

Supplies and services – general 49 24 25 242

Consultancy services 400 13 388 1,100

Establishment 798 65 733 757

Transport 3 2 1 2

Premises 1,054 680 374 843

Impairments and reversals of property, plant and equipment

0 0 0 60

Audit fees 67 67 0 89

Prescribing costs 25,814 0 25,814 23,872

GPMS/APMS and PCTMS 2,309 47 2,263 2,884

Other professional fees excluding audit 342 52 290 242

Education and training 272 15 258 150

CHC Risk Pool contributions 524 0 524 445

Total other costs 325,687 3,235 322,453 313,743

Total operating expenses 330,506 5,229 325,276 317,773

Revenue (868) (115) (753) (2,496)

Net operating expenses 329,638 5,115 324,523 315,277

The purchase of healthcare from non-NHS bodies includes the 2015/16 investment in the Better Care Fund under a Section 75 agreement with the London Borough of Islington (see note 14, Pooled Budget).

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5. Better Payment Practice Code

Measure of compliance 2015-16 2014-15

Number £000 Number £000

Non-NHS Payables

Total non-NHS trade invoices paid in the year 6,209 49,976 5,101 35,619

Total non-NHS trade invoices paid within target 5,598 45,316 4,806 31,286

Percentage of non-NHS trade invoices paid within target

90.16% 90.68% 94.22% 87.84%

NHS Payables

Total NHS trade invoices paid in the year 3,854 258,357 2,752 250,864

Total NHS trade invoices paid within target 3,319 244,279 2,271 244,890

Percentage of NHS trade invoices paid within target

86.12% 94.55% 82.52% 97.62%

6. Operating Leases

6.1 As lessee

6.1.1 Payments recognised as an expense

2015-16 2014-15

Buildings Total Buildings Total

£000 £000 £000 £000

Payments recognised as an expense

Minimum lease payments 797 797 468 468

Total 797 797 468 468

Whilst our arrangements with NHS Property Services Limited fall within the definition of operating leases, rental charges for future years have not yet been agreed. Consequently this note does not include future minimum lease payments for these arrangements.

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7. Property, plant and equipment

2015-16 Assets under construction

£000

Cost or valuation at 01 April 2015 0

Addition of assets under construction (see note 7.1 below) 1,298

Cost/valuation at 31 March 2016 1,298

Net book value at 31 March 2016 1,298

Purchased 1,298

Total at 31 March 2016 1,298

Owned 1,298

Total at 31 March 2016 1,298

7.1 Additions to assets under construction

2015-16

£000

Information technology (Integrated Digital Care Record) 1,298

Total 1,298

8. Trade and other receivables

Current Current

2015-16 2014-15

£000 £000

NHS receivables: revenue 805 1,291

NHS prepayments 1,629 1,752

NHS accrued income 80 382

Non-NHS receivables: revenue 151 920

Non-NHS prepayments 84 86

VAT 12 (0)

Other receivables 25 13

Total trade and other receivables 2,785 4,445

Included above: NHS maternity pathways prepayment 1,629 1,752

The great majority of trade is with NHS England. As NHS England receives funding from the Department of Health which it then distributes to CCGs for the purpose of commissioning health services, no credit scoring is considered necessary.

8.1 Receivables past their due date but not impaired 2015-16 2014-15

£000 £000

By up to three months 103 3

By more than six months 9 7

Total 112 10

None of the above balances have been recovered subsequent to the statement of financial position date, although none are considered doubtful.

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9. Cash and cash equivalents 2015-16 2014-15

£000 £000

Balance at 01 April 2015 69 109

Net change in year 117 (40)

Balance at 31 March 2016 186 69

Made up of: Cash with the Government Banking Service 186 69

Cash and cash equivalents as in statement of financial position 186 69


10 Analysis of impairments and reversals

10.1 Analysis of impairments and reversals: property, plant and equipment

Impairments and reversals charged to the statement of comprehensive net expenditure

2015-16 2014-15

£000 £000

Other 0 (60)

Total charged to annually managed expenditure 0 (60)

Total impairments and reversals of property, plant and equipment 0 (60)

11. Trade and other payables

2015-16 2014-15

Current Non-

current Current Non-

current

£000 £000 £000 £000

NHS payables: revenue 10,995 0 10,877 0

NHS accruals 9,300 400 12,847 0

Non-NHS payables: revenue 3,620 0 3,987 0

Non-NHS payables: capital 142 0 0 0

Non-NHS accruals 10,612 0 7,784 0

Non-NHS deferred income 21 0 148 0

Social security costs 49 0 39 0

Tax 56 0 45 0

Payments received on account 68 0 0 0

Other payables 521 0 466 0

Total trade and other payables 35,383 400 36,195 0

Total current and non-current 35,783 36,195

NHS accruals include £1,776k for partially completed spells (2014-15: £339k). Other payables include £61k outstanding pension contributions at 31 March 2016.

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12. Provisions

2015-16 2014-15

Non-

current Total Non-

current Total

£000 £000 £000 £000

Other 500 500 500 500

Total 500 500 500 500

Other Total £000s £000s

Balance at 01 April 2015 500 500


Expected timing of cash flows:

Between one and five years 500 500


Under the Accounts Direction issued by NHS England on 12 February 2014, NHS England is responsible for accounting for liabilities relating to NHS Continuing Healthcare claims relating to periods of care before establishment of the CCG. However, the legal liability remains with the CCG. The total value of legacy NHS Continuing Healthcare provisions accounted for by NHS England on behalf of this CCG at 31 March 2016 is £50k (31 March 2015: £1,112k).

The provision Is in respect of the CCG's share of potential restructuring costs arising from the reconfiguration of North London provider services.

13. Financial instruments 13.1 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 CCG is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The 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 CCG in undertaking its activities. Treasury management operations are carried out by the finance department, within parameters defined formally within the NHS CCG standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the CCG and internal auditors. 13.1.1 Currency risk The CCG is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The NHS Clinical Commissioning Group has no overseas operations and therefore low exposure to currency rate fluctuations. 13.1.2 Interest rate risk The CCG 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 CCG therefore has low exposure to interest rate fluctuations.

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13.1.3 Credit risk Because the majority of its revenue comes parliamentary funding, the CCG has low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables from customers, as disclosed in the trade and other receivables note. 13.1.4 Liquidity risk The CCG is required to operate within revenue and capital resource limits, which are financed from resources voted annually by Parliament. The CCG draws down cash to cover expenditure, as the need arises and is not, therefore, exposed to significant liquidity risks.

13.2 Financial assets

2015-16 2014-15

Loans and

Receivables Total

Loans and Receivables Total

£000 £000 £000 £000

Receivables:

NHS 884 884 1,291 1,291

Non-NHS 151 151 920 920

Cash at bank and in hand 186 186 69 69

Other financial assets 25 25 13 13

Total at 31 March 1,245 1,245 2,294 2,294

13.3 Financial liabilities

2015-16

2014-15

Other Total Other Total

£000 £000 £000 £000

Payables:

NHS 20,695 20,695 23,725 23,725

Non-NHS 14,894 14,894 12,386 12,386

Total at 31 March

35,589 35,589 36,111 36,111

14. Pooled budget

The CCG's share of the expenditure handled by the pooled budget in the financial year was:

2015-16 2014-15

£000 £000

Expenditure

28,639 12,811

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15 Intra-government and other balances

Current

Receivables Non-current Receivables

Current Payables

Non-current

Payables

2015-16 2015-16 2015-16 2015-16

£000 £000 £000 £000

Balances with:

Other central Government bodies 12 0 634 0

Local authorities 137 0 1,820 0

Balances with NHS bodies:

NHS bodies within the NHS England Group

728 0 814 400

NHS trusts and foundation trusts 1,785 0 19,481 0

Total of balances with NHS bodies

2,513 0 20,295 400

Bodies external to Government 123 0 12,634 0

Total balances at 31 March 2016

2,785 0 35,383 400

Current

Receivables Non-current Receivables

Current Payables

Non-current

Payables

2014-15 2014-15 2014-15 2014-15

£000 £000 £000 £000

Balances with:

Other central Government bodies 0 0 891 0

Local authorities 859 0 2,649 0

Balances with NHS bodies:

NHS bodies outside the departmental group

1,238 0 522 0

NHS trusts and foundation trusts 2,188 0 23,203 0

Total of balances with NHS bodies

3,426 0 23,725 0

Bodies external to Government 160 0 8,930 0

Total balances at 31 March 2015

4,445 0 36,195 0

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16 Related party transactions 2015-16

Details of related party transactions with individuals are as follows:

Individual and position in CCG Payments to Related

Party

Receipts from

Related Party

Amounts owed to Related Party

Amounts due from Related Party

£000 £000 £000 £000

Dr Gillian Greenhough - Chair (to 18 February 2016)

South Islington GP Alliance Ltd 577 0 87 0

Dr Josephine Sauvage - Chair (from 19 February 2016, previously Vice-Chair)


Dr Katie Coleman - Vice-Chair


Dr Rathini Ratnavel - South Locality GP Member


Dr Karen Sennett - South Locality GP Member


South Islington GP Alliance Ltd (SIGPAL) is a company providing primary care and community services to the local population. The practices in which the GPs listed above are partners hold shares in SIGPAL. The payments during the year related to a monthly ENT contract (£340k), a pilot pharmacy project (£102k) and the GP Federation Development Initiative £135k).

Mr Ian Huckle and Dr Stephen Rogers are both members of the CCG and shareholders in Wish Limited, a consortium of eight general practices providing doctors for the Urgent Care Centre at the Whittington Hospital NHS Trust. The CCG commissions services provided from the Trust as part of a block contract. The Trust then contracts directly with Wish Limited, with which the CCG has no direct contract.

CCGs are clinically led membership organisations made up of general practices. The members of the CCG are responsible for determining the governing arrangements for their organisations, which they are required to set out in a constitution. The members of the CCG are contained within Appendix B of the constitution. Where payments have been made to these practices, these are listed below. The majority of the payments are in relation to agreed locally commissioned services and some prescribing costs.

86

Payments to Related

Party

Receipts from

Related Party



£000 £000 £000 £000

Amwell Group Practice 168 0 0 0

Andover Medical Centre 81 0 1 0

Archway Medical Centre 153 0 2 0

Barnsbury Medical Centre 4 0 1 0

Beaumont Practice 39 0 1 0

Bingfield Street Surgery (closed 29 May 2015) 3 0 0 0

City Road Medical Centre 128 0 18 0

Clerkenwell Medical Practice 90 0 9 0

Dartmouth Park Practice 65 0 5 0

Elizabeth Avenue Group Practice 167 0 20 0

Family Practice London 33 0 5 0

Goodinge Group Practice 157 0 22 0

Group Practice at River Place 172 0 22 0

Hanley Primary Care Centre 59 0 6 0

Highbury Grange Medical Practice 80 0 11 0

Holloway Medical Clinic (closed 24 July 2015) 3 0 0 0

Islington Central Medical Centre 206 0 28 0

Killick Street Health Centre 273 0 20 0

Ko and Partner 57 0 12 0

Medical Centre Holloway Road 108 0 17 0

Mildmay Medical Practice 117 0 13 0

Miller Practice 102 0 10 0

Mitchison Road Surgery 27 0 8 0

New North Health Centre 24 0 5 0

Northern Medical Centre 149 0 10 0

Partnership Primary Care Centre 43 0 5 0

Pine Street Medical Centre 18 0 4 0

Rise Group Practice 108 0 13 0

Ritchie Street Group Practice 938 0 69 0

Roman Way Medical Centre 59 0 15 0

Sobell Medical Centre 39 0 5 0

St John's Way Medical Centre 175 0 22 0

St Peter's Street Medical Practice 113 0 12 0

Stroud Green Medical Practice 57 0 11 0

Tufnell Surgery 44 0 9 0

Village Practice 106 0 11 0

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16 Related party transactions 2015-16 (continued)

The Department of Health is regarded as a related party. During the year the CCG has had a significant number of material transactions with entities for which the Department is regarded as the parent.

Payments to Related

Party

Receipts from

Related Party



£000 £000 £000 £000

The Whittington Hospital NHS Trust 101,890 (22) 8,907 (631)

University College London Hospitals NHS Foundation Trust

61,570 0 1,877 (1,004)

Camden and Islington NHS Foundation Trust

35,935 0 1,483 0

Royal Free London NHS Foundation Trust 11,129 0 2,134 (31)

London Ambulance Service NHS Trust 8,529 0 195 0

Barts Health NHS Trust 6,050 0 1.336 0

In addition, the CCG has had a number of material transactions with local government bodies. Most of these transactions have been with Islington Council in respect of joint enterprises.

Mr Simon Galczynski is both a non-voting member of the CCG's Governing Body and Service Director for Adult Social Care for Islington Council.

Payments to Related

Party

Receipts from

Related Party



£000 £000 £000 £000

Islington Council 23,624 (432) 1,820 (137)

16.1 Related party transactions 2014-15

Details of related party transactions with individuals are as follows:

Individual and position in CCG Payments to Related

Party

Receipts from

Related Party



£000 £000 £000 £000

Dr Gillian Greenhough - Chair


Dr Katie Coleman – Vice-Chair


Dr Josephine Sauvage – Vice-Chair


Dr Karen Sennett - South Locality GP Member

South Islington GP Alliance Ltd 269 0 0 0 Dr Rathini Ratnavel - Co-opted GP Representative


88

Payments to Related

Party

Receipts from

Related Party



£000 £000 £000 £000

Amwell Practice 152 0 0 0

Andover Medical Centre 92 0 0 0

Archway Primary Care Team 149 0 0 0

Beaumont Practice 48 0 0 0

Barnsbury Medical Practice 33 0 0 0

Bingfield Street Surgery 16 0 0 0

City Road Medical Centre 177 0 0 0

Clerkenwell Medical Practice 197 0 0 0

Dartmouth Park Practice 83 0 0 0

Elizabeth Avenue Group Practice 184 0 0 0

Family Practice London 66 0 0 0

Goodinge Group Practice 182 0 0 0

Group Practice at River Place 242 0 0 0

Hanley Primary Care Centre 56 0 0 0

Highbury Grange Medical Practice 112 0 0 0

Holloway Medical Clinic 37 0 0 0

Islington Central Medical Centre 230 0 0 0

Killick Street Health Centre 284 0 0 0

Ko and Partner 64 0 0 0

Medical Centre Holloway Road 70 0 0 0

Mildmay Medical Practice 148 0 0 (7)

Miller Practice 201 0 0 0

Mitchison Road Surgery 123 0 0 0

Northern Medical Centre 195 0 0 0

Partnership Primary Care Centre 65 0 0 0

Pine Street Medical Centre 40 0 0 0

New North Health Centre 32 0 0 0

Rise Group Practice 113 0 0 0

Ritchie Street Group Practice 154 0 0 0

Roman Way Medical Centre 60 0 0 0

Sobell Medical Centre 48 0 0 0

St Johns Way Medical Centre 219 0 0 0

St Peters Street Medical Centre 168 0 0 0

Stroud Green Medical Practice 92 0 0 0

Tufnell Surgery 58 0 0 0

Village Practice London 105 0 0 0

The Department of Health is regarded as a related party. During the year the CCG has had a significant number of material transactions with entities for which the Department is regarded as the parent.

Payments to Related

Party

Receipts from

Related Party



£000 £000 £000 £000 NHS North and East London Commissioning Support Unit

3,826 (18) 226 (18)

The Whittington Hospital NHS Trust 104,462 (31) 5,439 (609)

University College London Hospitals NHS Foundation Trust

61,629 0 7,788 (1,173)

89

Camden and Islington NHS Foundation Trust 36,649 0 2,215 0

Royal Free London NHS Foundation Trust 10,428 0 2,071 (31)

London Ambulance Service NHS Trust 7,838 0 110 0

Moorfields Eye Hospital NHS Foundation Trust 6,491 0 2,513 0

In addition, the CCG has had a number of material transactions with local government bodies. Most of these transactions have been with Islington Council in respect of joint enterprises.

Payments to Related

Party

Receipts from

Related Party



£000 £000 £000 £000

Islington Council 13,638 (825) 2,649 (859)

17 Financial performance targets

CCGs have a number of financial duties under the NHS Act 2006 (as amended). Performance against these duties was as follows.

2015-16 Target Measure Target Performance Duty

Achieved £000 £000

Expenditure not to exceed income Surplus 6,449 8,960 Yes

Capital resource use does not exceed the amount specified in Directions

Total expenditure compared with target

1,301 1,298 Yes

Revenue resource use does not exceed the amount specified in Directions

Net operating expenditure

338,598 329,638 Yes

Revenue resource use on specified matters does not exceed the amount specified in Directions

Net programme expenditure

327,034 324,523 Yes

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

Net admin expenditure

5,115 5,115 Yes

2014-15 Target Measure Target Performance Duty

Achieved £000 £000

Expenditure not to exceed income Surplus

6,449 8,207 Yes

Revenue resource use does not exceed the amount specified in Directions

Net operating expenditure

323,484 315,277 Yes

Revenue resource use on specified matter(s) does not exceed the amount specified in Directions

Net programme expenditure

311,666 310,058 Yes

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

Net admin expenditure

5,369 5,218 Yes

Target net operating expenditure is the sum of net programme, net admin expenditure and the surplus.

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