nhs barking and dagenham clinical commissioning group ......27 may 2014 . 2.00pm – 3.00pm ....

NHS Barking and Dagenham Clinical Commissioning Group Governing Body

Extraordinary Meeting

27 May 2014 2.00pm – 3.00pm

Boardrooms, Becketts House, Ilford, IG1 2QX

Item Time Lead Attached, verbal or to follow

1.0 1.1

Welcome, introductions and apologies Declaration of conflicts of interest

2.00pm Chair Verbal

2.0 2.1 2.2

CCG Annual Report and Annual Accounts External Auditor’s Report to those charged with Governance (ISA260) External Auditor’s Letter of Representation

2.05pm MP/TT TT TT

Attached Attached Attached

3.0 Any Other Business 2.50pm

Glossary of terms and abbreviations

Term Explanation

AO Accountable Officer

ADL Activities of Daily Living

APC Area Prescribing Committee

ASH Accredited Safe Haven

BCF Better Care Fund

BHR Barking and Dagenham, Havering and Redbridge

BHRUT Barking, Havering and Redbridge University Trust

BPPC Better Payment Practice Code

CAPS Clinical Application Services

CCG Clinical Commissioning Group

CCS Complex Care Service

CDOP Child Death Overview Panel

CEO Chief Operating Officer

CFO Chief Finance Officer

CHC Continuing Healthcare

CHSCS Community Health and Social Care Services

CIL Community Infrastructure Levies

COB Corporate Objectives

COO Chief Operating Officer

CQC Care Quality Commission

CQRM Clinical Quality Review Meeting

CQUIN Commissioning for Quality and Innovation

CSU Commissioning Support Unit

CTT Community Treatment Team

CVS Council of Voluntary Services

CYPP Children and Young Person Plan

DI Discovery Interview

DOH Department of Health

DTOC Delayed Transfer of Care

ECG Electrocardiogram

EHC Education, Health and Care

EoI Expression of Interest

EOL End of Life Care

FNP Family Nurse Partnership

FT Foundation Trust

FYE Full Year Effect

GBAF Governance Board Assurance Framework

GP General Practitioner

H4NEL Health for North East London

HCAIs Healthcare Associated Infections

HE NCEL Health Education North Central and East London

HSC Health Scrutiny Committee

HWBB Health & Wellbeing Board

IAPT Improving Access to Psychological Therapies

ICC Integrated Care Coalition

ICM Integrated Case Management

ICSG Integrated Care Joint Health and Social Care Steering Group

IFR Individual Funding Request

IRS Intensive Rehabilitation Service

IST Intensive Support Team

JAD Joint Assessment and Discharge Service

JET Joint Executive Team

JHWS Joint Health & Wellbeing Strategy

JMT Joint Management Team

JSNA Joint Strategic Needs Assessment

KGH King George Hospital

KPIs Key Performance Indicators

LAC Looked After Children

LAS London Ambulance Service

LETB Local Education and Training Boards

LMCs Local Medical Committees

LPC Local Pharmaceutical Committee

LSCB Local Safeguarding Children’s Board

LTC Long Term Conditions

MASH Multiagency Safeguarding Assessment Hub

MLU Mid-wife Led Unit

MSRB Maternity Systems Readiness Board

NEL North East London

NELCSU North East London Commissioning Support Unit

NELFT North East London Foundation Trust

NHS National Health Service

NHSE NHS England

NICE National Institute for Health and Care Excellence

OFSTED Office for Standards in Education, Children’s Services and Skills

OD Organisation Development

ONEL Outer North East London

PALS Patient Advice and Liaison Service

PEFs Patient Engagement Forums

PELC Partnership of East London Cooperatives

PMCF Prime Minister’s Challenge Fund

PMO Project Management Office

POD Point of Delivery

POLCV Procedures of Limited Clinical Value

PPGs Patient Participation Groups

PSED Public Sector Equality Duty

PTL Patient Tracking List

QIPP Quality, Innovation, Productivity and Prevention

RAG Red. Amber, Green

RTT Referral To Treatment

SAB Safeguarding Adults Board

SCN Strategic Clinical Network

TDA Trust Development Agency

TSCL The Transforming Services – Changing Lives

TUGT Timed Up and Go Test

UCC Urgent Care Centre

UCL University College London

UCLP University College London Partners

VFM Value for Money

WELC Waltham Forest, East London and City

WICs Walk in Centres

YTD Year to Date

Register of interests 2014/15

Declaration of governing body interests

Name Role Organisation Nature of interest

Dr Waseem Mohi

Chair Markyate Surgery Together First Limited (from May 2014) London Wellbeing Care Ltd

Salaried GP Shareholder Director

Dr Arun Sharma Clinical director on secondment to GP Practice Federation

Laburnum Health Centre Primary Clinical Partnership Ltd Primary Clinical Partnership Services Ltd Together First Limited (May 2014)

GP Partner Director/ownership/shareholder Director/ part ownership/shareholder Shareholder Seconded from the CCG in July 2014 as Interim Chair of the Federation.

Dr Chandra Mohan

Clinical director Urswick Medical Centre Primary Clinical Partnership Ltd Primary Clinical Partnership Services Ltd

GP Principal Director/ownership or part ownership/shareholder Director/ownership or part ownership/shareholder


Together First Limited (from May 2014)

Shareholder

Dr Ravali Goriparthi

Clinical director Tulasi Medical Centre Venkat Health Centre Health & Happiness Clinic Ltd North East London Foundation Trust Boerrhinger Ingelheim Research Network Barts & the London School of Medicine Pharmaceutical Industries Together First Limited (from May 2014) Barking, Dagenham and Havering LMC Royal College of General Practitioners Diabetes UK Primary Care Diabetes Society

GP Partner GP Partner Director GPwSI in Diabetes Principle Investigator for Phase 3 trials Commissioned research projects GP Tutor Speaker at Educational events Shareholder Member Member Member Member


National Diabesity (Diabetes & Obesity) Forum

Member

Dr Jagan John Clinical director King Edward Medical Group LMC Department of Health Royal College of GPs NHS Improving Quality /NHS England NHS England North East London Foundation Trust Together First Limited (from May 2014) Health 1000 (December 2014)

GP Partner, other GPs are family members. Chair National health and wellbeing partnership champion Expert panel of the care planning programme member National clinical associate for domain 2 London clinical senate member GPwSI in Cardiology BD CHS Shareholder Director

Dr Rami Hara Clinical director Urswick Medical Centre Pharmaceutical company speaker fee Together First Limited (from May 2014)

GP Principal Speaker at meetings Shareholder


Dr Gurkirit Kalkat

Clinical director Thames View Health Centre Primary Clinical Partnership Ltd Apex Healthcare Ltd Queen Mary Medical School, London Together First Limited (from May 2014)

GP Principal Director/owner or part owner/ Share holder Director/owner or part owner/ Share holder Honorary Lecturer Shareholder

Tan Vandal (resigned from post 31/3/14)

Secondary care consultant

Essex Urology Services Spire Hartswood Hospital Havering, Tower Hamlets, Bromley, Lambeth, Southwark & Lewisham CCG Governing Bodies

Co-Director and shareholder Consultant Urological Surgeon Secondary Care consultant member

Sahdia Warraich

Lay member The Forum for Health and Wellbeing The Forum for Health and Wellbeing Trading Ltd (social enterprise arm of above) Healthwatch Newham

Healthwatch Waltham Forest

Director Company Director Company Director Company Director


London Borough of Redbridge Spouse is a Councillor

Kash Pandya Lay member - Governance

Hillcroft College for women, Surbiton Essex Ministry of Justice Advisory Committee Health & Safety Executive Her Majesty’s Inspector of Constabulary Brentwood Citizen’s Advice Bureau Havering CCG Redbridge CCG PricewaterhouseCoopers

Council Member and Audit Chair Lay Member for appointment magistrates Independent Audit Committee Member Associate Inspector Generalist advisor Lay Member Lay Member Kiren Pandya (son) Management consultant

Charles Beaumont

Associate Independent Lay Voting Member for Audit Committee and Individual Funding Request Panel

North Essex Partnership Foundation Trust

Non-Executive Director

Conor Burke Accountable officer Your business works (not trading) Redbridge college Accenture UK Consultancy (Sept 2014)

Director Former Audit committee member Son is an employee


Sharon Morrow Chief operating officer None

None

Martin Sheldon Deputy chief officer Novus Generation Limited Somerset Sight

Director/shareholder Trustee

Tom Travers Chief financial Officer Barnet and Chase Hospitals

Spouse is financial controller

Jacqui Himbury Nurse director None None

To: Meeting of NHS Barking and Dagenham Clinical Commissioning Group Governing Body From: Marie Price, Director of Corporate Services and Tom Travers, Chief Finance Officer Date: 27 May 2015 Subject: CCG Annual Report and Annual Accounts 2014/15

Executive summary As a statutory requirement, Clinical Commissioning Groups (CCGs) are required to publish, as a single document, an Annual Report, Accountable Officer Statement and Annual Accounts. Detailed national Annual Reporting Guidance (over 360 pages) was provided in early April 2014 and updated in January 2015. The guidance refers to compliance with the Manual of Accounts issued by the Department of Health and this in turn complies with the Government’s Financial Reporting Manual. There is a common format for ease of national collation. The national timetable required submission of draft documents to NHS England (NHSE) and external auditors by 23 April; this deadline was met. Having reviewed the documents the auditors and NHSE provided feedback to the CCGs, which was reflected in the draft documents considered by the Audit and Governance Committee on 19 May 2015. Committee Members had reviewed the finalised accounts and had received comments back on them, including the actions taken where appropriate. The Committee had no further comments to make on the financial statements. The Committee confirmed that they were satisfied that all due processes had been carried out and relevant documents pertaining to the financial statements and Annual Report for 2014/15 had been considered In particular:

• The Annual Report and Annual Accounts had been reviewed in detail and commented on by officers and Committee Members.

• The Committee were assured by the Head of Internal Audit Opinion which had given a

Significant Assurance on the CCG’s financial systems and internal control arrangements and raised no matters of concern that need to be drawn to the attention of the Governing Body

• The Committee had considered the LCFS Annual Report and this had not identified any issues of

concern.

• The Committee had considered the External Auditor’s report to those charged with governance on their audit of the accounts (the ISA260 report). The Committee were assured that there were no significant matters of concern and that he was proposing to issue an unqualified opinion on the CCG’s accounts for 2014/15 and an unqualified conclusion about the CCG’s arrangements for securing economy, efficiency and effectiveness.

• The Committee were assured that NHSE had given a green rating to the draft Annual Report with a request that further detail on the performance of Barking, Havering and Redbridge University Hospitals Trust against the national standards be included within the report (this was added by the CCG).

Final documentation is required to be submitted no later than 29 May 2015 having been signed off by the CCG Accountable Officer. CCGs are required to publish the documentation by 30 September. A fully designed report and summary will be presented to the CCG’s annual general meetings during September for wider member and public discussion. Recommendations The Audit and Governance Committee recommends to the Governing Body that:

• they adopt the Annual Accounts, and Annual Report; and • the Accountable Officer be authorised to certify the CCG’s annual accounts and

supporting documents by the NHSE submission deadline date of 29th May 2015. 1.0 Purpose of the report 1.1 To provide assurance to the Governing Body that the process to complete the annual accounts

and report has been carried out in line with requirements, and the final products, which have been reviewed by NHSE England, external auditors and the CCG’s Audit and Governance Committee are suitable for sign-off and final submission.

2.0 Production process 2.1 Since the receipt of updated national guidance in January 2015, production of the draft annual

reports and accounts has been underway. 2.2 The first drafts were considered in detail by the Audit and Governance Committee on 10 March

2015, a second draft of the annual reports came to the committee on 21 April 2015 where internal and external auditors participated in the discussion. Committee members provided further feedback; the Chairs were provided with a copy of the reports for their consideration and patient engagement forum chairs and vice chairs were invited to comment on the lay member report on patient and public engagement.

2.3 Since receiving the draft documentation in April, external auditors have undertaken detailed

scrutiny. They have provided feedback and raised questions that have been responded to. The external auditor’s final clearance meeting with the CCG took place on 18 May 2015.

2.4 NHS England also carried out a thorough review against set criteria and gave an overall green

rating to the CCG. They asked that the CCG add further detail on local acute trust performance against national standards. This was included in the version submitted to the CCG Audit and Governance Committee for consideration on 19 May.

2.5 The Audit and Governance Committee on 19 May considered the accounts and annual report in

detail and subject to some minor changes recommended that the Governing Body approve the accounts and report for final submission by 29 May.

3.0 Resources/investment 3.1 The final section of the Annual Accounts clarifies the CCG’s financial position at 31 March 2015

and confirms that the CCG has met its statutory end of year targets. The Annual Accounts and Report will be available for public inspection and discussion at the Annual General Meetings in September.

4.0 Equalities 4.1 An equalities report is included as part of the Annual Report. 5.0 Risk 5.1 The key risk to the CCG is that the Annual Report and Annual Accounts are not submitted to

meet national timelines. However all deadlines so far have been met and subject to agreement at this meeting, the final deadline will also be met.

Attachments: 2014/15 Annual Report, Accountable Officer Statement and Annual Accounts.

Author: Marie Price, Director of Corporate Services Date: 20 May 2015

Barking and Dagenham Clinical Commissioning Group

Annual report and accounts

2014/15

Contents

1. Annual Report ......................................................................................................... 4

1.1. Strategic Report ........................................................................................................ 4

Introduction ............................................................................................................... 4

Our history, background and structure ...................................................................... 4

Our population........................................................................................................... 5

Our commissioning activity ........................................................................................ 5

Our corporate objectives and how we measure success ........................................... 5

Discharging our statutory duties .............................................................................. 10

Our borough’s Health and Wellbeing Strategy ......................................................... 12

Development and performance overview ................................................................ 14

BHRUT performance ............................................................................................... 15

Financial performance ............................................................................................. 17

Factors that might affect our long-term performance ............................................... 18

Significant stakeholder relationships ....................................................................... 19

Report by the lay member for patient and public engagement ................................. 21

Our employees ........................................................................................................ 21

Environmental, social, community and human rights issues .................................... 22

1.2. Members’ report ...................................................................................................... 23

Details of members of the membership body and the governing body ..................... 23

Disclosure of relevant information to auditors .......................................................... 25

Pension liabilities ..................................................................................................... 25

Members’ interests .................................................................................................. 25

External audit details ............................................................................................... 26

Sickness absence data ........................................................................................... 26

Cost allocation and setting of charges for information ............................................. 26

Disclosure of personal data related incidents .......................................................... 26

Employee consultation ............................................................................................ 26

Equality disclosures ................................................................................................ 27

Health and safety .................................................................................................... 28

Tackling fraud and bribery ....................................................................................... 29

Better Payments Practice Code .............................................................................. 29

Prompt Payments Code .......................................................................................... 29

Emergency preparedness, resilience and response ................................................ 29

Principles for remedy............................................................................................... 30

CCG complaints process ......................................................................................... 30

1.3. Remuneration report ............................................................................................... 31

Remuneration and Workforce Committee (not subject to audit) ............................... 31

Contractual arrangements ....................................................................................... 32

Governing body members’ service contracts (not subject to audit) .......................... 33

Salaries and allowances of Senior Managers 2014/15 (CCG share – subject to audit) ................................................................................................................................ 34

Salaries and allowances of Senior Managers 2014/15 (Full remuneration as paid by Redbridge CCG on behalf of all BHR CCGs before recharge to Barking and Dagenham and Havering CCGs – subject to audit) ................................................. 37

Salary and pension entitlements of directors and senior managers (subject to audit) ................................................................................................................................ 39


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Cash Equivalent Transfer Values ............................................................................ 40

Member contribution rates before tax relief (gross) ................................................. 40

Termination agreements or exit packages ............................................................... 40

Off payroll engagements ......................................................................................... 41

1.4. Sustainability report ................................................................................................. 43

1.5. Statement of accountable officer’s responsibilities .................................................. 44

1.6. Governance statement ............................................................................................ 45

Introduction and Context ......................................................................................... 45

Scope of Responsibility ........................................................................................... 45

Compliance with the UK Corporate Governance Code ............................................ 45

The Clinical Commissioning Group Governance Framework ................................... 45

The Membership Body ............................................................................................ 47

The Governing Body ............................................................................................... 48

Committees of the Governing Body ......................................................................... 51

The Clinical Commissioning Group Risk Management Framework ......................... 66

The Clinical Commissioning Group Internal Control Framework .............................. 69

2. Audit opinion and report....................................................................................... 76

3. Annual accounts ................................................................................................... 79

Annual report and accounts: 2014/15

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1. Annual Report

1.1. Strategic Report

Introduction

This strategic report includes a fair review of Barking and Dagenham Clinical Commissioning

Group’s (the CCG’s) business, with a balanced and comprehensive analysis of our

development and performance during the year and of the position of the CCG at the end of

the year. It also includes a description of the key risks and uncertainties facing the CCG.

It gives details of how the CCG has discharged its duties under the National Health Service

Act 2006 (as amended) (known as the NHS Act) as required by the NHS Commissioning

Board’s (known as NHS England) CCG Assurance Framework.

The Annual Accounts contained within this Annual Report have been prepared under a

Direction issued by NHS England under the NHS Act.

Our history, background and structure

Barking and Dagenham CCG is made up of all the GP practices within the borough – our

members. Our role is to commission, or ‘buy’, safe, high quality health services – mainly

hospital, community and mental health services - for our local population and to work

together with our partners to improve the health of the people of Barking and Dagenham.

Barking and Dagenham has higher levels of deprivation than most boroughs but despite this

we believe that there is more that can be done to help improve local people’s health and life

chances. We know that local health services are not as good as they should be, particularly

when people need urgent care and A&E services. Improving access to and experience of

these services and making more available in localities, closer to people’s homes, is a priority

for the CCG.

We work very closely with our colleagues in Havering and Redbridge CCGs as we share a

main acute hospital provider in Barking, Havering and Redbridge University Hospitals NHS

Trust (BHRUT), and a mental health and community services provider in North East London

Foundation Trust (NELFT). We also face many common issues and challenges which are

outlined further in this report. Working together like this means we are also able to make

better use of our resources across the local health system, avoiding duplication and

facilitating joint working with our health and social care partners. It also means we are able

to share a single management team, which contains our finance, corporate services,

medicines management, nursing, innovations and strategic delivery teams working

alongside our local borough team. The three CCGs also have a joint Chief Officer.

The CCG is based in offices at Barking Community Hospital, Upney Lane, Barking. The

CCG employs 12 staff, with the shared management team of 89 staff1 providing a range of

support functions for the three local BHR CCGs: Barking and Dagenham, Havering and

Redbridge. For details of the structure of our membership and governing bodies please see

the Members’ report (section 1.2).

1 These numbers are headcounts of staff actually employed by the CCG or in the shared management team at the end of March 2015. It does not include clinical directors or lay members.

http://www.england.nhs.uk/wp-content/uploads/2013/11/ccg-ass-frmwrk.pdf


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Our population

The overall population of Barking and Dagenham is currently 190,560 people (based on

2012 ONS figures).

Since 2001, Barking and Dagenham has seen rapid population growth, linked to both to new

housing development and birth rate changes. The population structure has changed

significantly with particularly large increases in the numbers of younger people living in the

borough. The main component of population change across the London boroughs over the

last decade has been and remains natural increase which is the result of having more births

than deaths.

There has also been a rapid shift in the proportions of various ethnic groups, with a large

decrease in the white British ethnic group and a large increase in the black African ethnic

group. Our population faces a range of major health challenges and health outcomes are

poor for many local people because of a combination of poverty, deprivation and lifestyle.

We have higher numbers of deaths from the major diseases (heart disease, stroke, cancer,

diabetes and chronic lung disease) compared with the London average. Our residents also

experience more ill health and disability during their lifetimes.

There is a strong correlation between poverty/deprivation and poor health, for many reasons

that include poor diet/nutrition and unhealthy living and working conditions. The index of

multiple deprivations (IMD 2010) is a measure of multiple deprivations at a small area level.

In general, those who live in areas of high deprivation suffer the most from poor health and

wellbeing. Barking and Dagenham was ranked at 22 out of 326 local authorities for

deprivation in the Indices of Deprivation 2010 (1st being most deprived, 326th being least

deprived), which places it in the top 7% most deprived boroughs in England.

Our commissioning activity

We commission a range of services from a range of providers. Our main acute hospital

services provider is Barking, Havering and Redbridge University Hospitals NHS Trust,

although we also commission some acute services from Barts Health NHS Trust. Our

community and mental health services provider is North East London Foundation Trust. The

GP out-of-hours service is provided by the Partnership of East London Cooperatives, a not-

for-profit social enterprise.

Our corporate objectives and how we measure success

Objectives for Barking and Dagenham CCG specifically

1. Improve health outcomes for children and young people in our borough

Why this is important:

We have one of the largest and most rapidly growing populations of children and

young people in the country, with high rates of poverty

Their health outcomes are poor and below the national average

How we did it:

By working with our partners across health and social care and through the Health

and Wellbeing board to focus on joint initiatives and action

By deepening our understanding of and engagement arrangements with children and

young people, particularly by working closely with the council’s expert team on this


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By working together on a number of priority areas over the coming year including:

- children’s mental health and wellbeing

- children with special educational needs and disabilities

- ensuring children have the best start in life by focusing on maternal health,

support for parents and taking a more integrated approach to services for

children across health and social care

- working with vulnerable young people as part of youth offending services and

services for Looked After Children and

- continuing to focus on teenage pregnancy

What we achieved by April 2015:

A new sickle cell service to support children in particular to stay well and out of

hospital

Implemented new legislation to ensure the plans for vulnerable children with special

educational needs and disabilities are effective and holistic.

Integrated children’s service pilot – focusing on providing additional support in

general practice.

2. Improve access to and experience of primary care


Satisfaction with access to and experience of GP services is lower than the national

average

We want to relieve pressure on A&E and move more care closer to home, with GPs

at the centre of delivery

How we did it:

By working closely with NHS England on our primary care improvement plans

By developing patient participation groups (PPGs) and patient feedback

mechanisms, and acting on what we hear

Working across our BHR CCG partners to share best practice and work on joint

initiatives/policies where appropriate


We established a primary care transformation programme, with a dedicated new

director, to focus our efforts on improving services locally.

We were successful in our bid to the Prime Minister’s Challenge Fund to set up new

schemes to improve access to and experience of primary care, with a new

Federation of GPs providing out of hours primary care appointments through an

access ‘hub’ and an innovative primary care practice to better support patients with

multiple long-term conditions.

3. Continue to focus on the development and success of our organisation – our

members, governing body and staff


We believe that our corporate and operating plan objectives including achievement of

our quality innovation, productivity and prevention (QIPP) targets are essential – and

achievable with the right focus

We have started off well, and want to continue to develop – with the full engagement

of our members and key stakeholders


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We are committed to ensuring that all members, governing body members and staff

develop to their full potential and that talented individuals progress so that we have a

strong succession plan in place

We have commissioned extensive support from the NEL Commissioning Support

Unit (NEL CSU), so also need that to be effective and flexible to our needs

How we did it:

By conducting a skills audit and needs analysis across the CCG

By using the audit to refresh our existing organisational development (OD) plans

Through clear personal objective setting and appraisal arrangements for all

governing body members and staff

Through a comprehensive training and development programme – including focus on

achieving QIPP targets and managing financial risk

Developing a strong customer-supplier relationship with the CSU, undertaking

continuous review to ensure services are both effective and value for money.


We provided a new training and development programme for staff, including an offer

of coaching for all regardless of grade.

We conducted a thorough OD review, including commissioning support service

arrangements, and agreeing a new two-year OD plan.

Our OD arrangements received the highest assurance ratings by NHS England.

Our turnover and sickness levels have remained good compared to our peers, and

we are able to recruit highly skilled and experienced staff.

Collaborative objectives across Barking and Dagenham, Havering and

Redbridge:

4. Improve the quality of care from all the services we commission


The Francis report highlighted past failings and proposed solutions to improve and

deal with safety and quality concerns in the NHS

Patient experience of services at our local hospital trusts are poor and below national

and London averages

Not all care homes meet the standards that we want to see for our local residents,

and the Winterbourne review highlighted serious concerns in care for people with

learning disabilities

How we did it:

Effective contract management of all our providers against quality standards through

our collaborative and local commissioning arrangements

Robust application of our quality and safeguarding framework

Engaging with and listening to our member practices and patients to pick up

concerns early on

Adopting the recommendations within the Francis report and tailoring these to our

local circumstances in a robust action plan

Through effective partnerships through the Health and Wellbeing board


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We have seen some improvements in the quality of care at BHRUT, helped by the

positive working across the health and social care system.

We have dealt with the inherited backlog of continuing healthcare assessments,

meaning that patients are now getting the care that they require at the right level

We introduced a GP alert system for highlighting quality concerns and while not yet

widely used it is a good start and something that we intend to build on.

Primary care developments (referred to later in this report) are having a positive

impact on patient experience, with the new access hubs receiving good ratings.

5. Improve the performance of urgent and emergency care, with a particular focus at

BHRUT


Local hospital trusts, particularly BHRUT, are routinely failing to meet the national

standards for A&E

Patient experience of these services at local trusts, and particularly BHRUT is in the

bottom quartile nationally

The Care Quality Commission (CQC) has identified serious quality and safety

concerns in A&E at BHRUT

All trusts must become foundation trusts and need to demonstrate that they are on

track to achieve this, meeting national expectations for delivery

How we did it:

Through holding providers to account for delivery of improved performance and

CQUIN targets

Working with partners across the wider health economy to look at system wide

solutions, and implementing our agreed improvement plan

Through working with NHS England to commission an primary urgent care surge

scheme to relieve pressure on A&E

By engaging our practices, community and other services – through our integrated

case management model and proactively managing patients at high risk of hospital

admission

Implementing the Health for north east London changes once it is safe to do


There have been improvements in urgent and emergency care services at BHRUT

but the Trust is still in special measures.

The health and social care economy has worked together positively through an

integrated care coalition to put into place health and social care schemes to support

improvement.

Our partnership working and common goals have been outlined in a shared five year

strategic plan, supported by NHS England.

6. Strengthen community and mental health services, bringing more services to

people closer to home


Too many people are admitted to hospital because they don’t get the support they

need in the community at the time they need it


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Too many people are spending time in hospital when they would be better cared for

at or closer to home

The stays in community beds across BHR are longer than the national average,

leading to loss of independence etc

Patient outcomes are poorer than they should be, with people taking longer to

recover

Community services for prevalent conditions need to be improved given our

population’s rising needs

How we did it:

Reviewing community provision, including the bed base, to make it fit for 21st century

healthcare

Through a pilot scheme with NELFT to test our proposed model for improved

community services, improving productivity, expanding the community treatment

team and establishing an intensive rehabilitation service

Being clear what we need and ensuring all contracts deliver agreed outcomes

Developing a mental health crisis care concordat action plan and declaration

Developing a mental health commissioning framework

Development of the Better Care Fund (further information later in this report) with our

local council, the London Borough of Barking and Dagenham (LBBD)


We trialled new services – community treatment team and intensive rehabilitation

service – which demonstrated positive outcomes for patients. As a result of a 14

week consultation our governing body agreed to permanently establish these

services (more information later in this report)

We have worked extensively with LBBD to develop a set of shared programmes of

work as part of our Better Care Fund because we believe we can deliver more

effective support for local people by integrating our commissioning and strategic

approach, which we believe will help them to remain well and independent and be

less reliant on hospital-based care. These programmes include end of life care, falls

prevention and supporting carers. We have already seen some improvement in

reducing avoidable admissions to hospital and the number of injuries due to falls.

We have also been successful in increasing the numbers of people having their

dementia diagnosed – important in providing early treatment and better outcomes –

and increasing the number of people with anxiety and depression getting access to

support and recovering through our talking therapies work.

We worked more closely with the council particularly on the Better Care Fund and

that we have created three joint commissioning posts.

The CCG’s objectives are designed to deliver improvements in the quality of care from the

services we commission. At the same time, they will help us deliver our QIPP programme

and the Better Care Fund targets, by moving activity out of acute settings and into

community settings. This long term vision, along with the move to increasingly better

integrated health and social care services, will have significant financial impact. This will

enable us to continue to commission safe, high quality services for our patients, within the

resources available to us.


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Discharging our statutory duties

We certify that the clinical commissioning group has complied with the statutory duties laid

down in the National Health Service Act 2006 (as amended).

We have 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 by commissioning

services that offer patient choice. We make information available about the services we

commission and encourage the public to register with a GP. The Constitution itself has

previously been promoted and discussed at our patient engagement forum (PEF) and our

practice-based PPGs and is featured, along with links to the full documentation, on our

public website.

We have assisted and supported NHS England in discharging its duties relating to

securing the continuous improvement in the quality of primary medical services by

working with all our GP practice members to improve quality. The CCG successfully bid for

funding from the Health Education North Central and East London partnership, which has

supported primary care training for nurses and practice staff in priority areas such as

safeguarding, urgent care navigation and end of life care. We have recruited two Macmillan

GPs to support improvement in primary care and will shortly start work with a Cancer

Research UK facilitator too.

As part of the successful Prime Minister’s Challenge Fund bid, a new federation of GPs,

Together First, has been formed. The federation has opened its first access ‘hub’ at Barking

Community Hospital, offering late evening and weekend urgent GP appointments to

registered patients. The new service has proved a great success and the federation is

looking at expanding the service to other parts of the borough.

Also as part of the Prime Minister’s Challenge Fund bid, a new complex care primary care

organisation has been launched in Barking and Dagenham, Havering and Redbridge. Called

Health 1000, the organisation provides focused, coordinated care for patients living with

multiple long term conditions, mostly in people’s own homes, but with a base at King George

Hospital in Ilford. The aim is to provide joined up health and social care services to the 1000

highest end-users of services locally. Health 1000 is initially running as a pilot for two years.

We have 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 by working with public health colleagues to strengthen and promote

campaigns on issues such as cancer, stopping smoking, drinking sensibly and exercising

through our Chair’s regular newspaper column. We have worked closely with the Learning

Disabilities Partnership Board to improve services for people with learning difficulties through

the development of joint commissioning plans. Our PEF has received presentations from the

CCG on services including children’s services, mental health, cancer services and maternity

services and from others, including NHS England on care data.

We have worked in partnership with our community and mental health services provider,

NELFT, to further develop two intermediate care services – community treatment team and

the intensive rehabilitation service - through an extensive trial. Following a 14 week public

consultation in 2014, our governing body accepted a recommendation to mainstream these

highly successful and popular services and to centralise fewer community rehabilitation beds

on the site of King George Hospital.


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We have enabled patients to make choices with respect to the aspects of health

services provided to them by further refining and expanding our local ‘Not Always A&E’

campaign providing information about the entire range of urgent care services including NHS

111, urgent care centres, social care crisis teams, GP services, pharmacies, community

treatment teams, mental health services, walk-in centres and emergency dentistry. The

campaign was delivered this year primarily with patient booklets, developed with Age

Concern and aimed at older people, and a specific credit card-sized guide for ‘worried’

parents of babies and young children coming to A&E inappropriately.

Our frontline staff service guide was turned into a digital resource compatible with any

device, alongside an updated, interactive public website. Advertising was again placed in

local media - including three partner advertorials and appeared on buses. Our app for

smartphones and tablets was also widely advertised. This year we also launched our CCG

Twitter feed which carries service info and health advice on a daily basis.

We have promoted innovation, research, education and training by resourcing our

innovations team which has led on work around the development of our complex care

organisation, Health 1000. This team is also leading on the crucial work being done across

our area to introduce a shared patient record accessible across health and social care

organisations to help integrate services and care and to enable GPs and other clinicians to

access records in any location on any device, subject to patient consent. This team also

developed and led our successful bid to the Prime Minister’s Challenge Fund. We supported

the local authority in establishing a joint assessment and discharge service for health and

social care.

Our GP members are encouraged to attend ‘protected time initiative’ sessions and our staff

have a range of training opportunities available to them. Staff across grades and directorates

also have representation on our OD group.

We have consulted widely when devising our commissioning plans by engaging with a

wide group of stakeholders including our members, our coalition partners, the Health and

Wellbeing Board, the System Resilience Group (SRG) (previously called the Urgent Care

Board), local authority partners, acute and community providers and patient representatives

and patient groups.

Together with our neighbouring CCGs, we undertook a 14 week public consultation on

proposed changes to intermediate care services between July and October 2014. More than

5,000 copies of the consultation document – developed and written in conjunction with our

patient engagement forum - were distributed and displayed in GP practices and libraries. A

number of public drop-in events and specific patient group meetings were arranged and

attended by CCG clinical directors and borough staff to explain the proposals and benefits to

patients.

We will review our engagement strategy over the next year to see how we can better engage

with stakeholders to better inform our commissioning.

We have taken appropriate steps to secure that we are properly prepared for dealing

with a relevant emergency with positive feedback from NHS England on the arrangements

that we have in place. We give more details about this in the Members’ report.

We have continued to successfully discharge our functions with regard to the need to

safeguard and promote the welfare of children and young people by further embedding


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safeguarding into our governance arrangements with executive leadership through the

governing body. The Safeguarding Assurance Committee is fully established and provides

assurance on our safeguarding governance and operational delivery of statutory functions,

reporting to the Quality and Safety Committee. We are fully compliant with all our

accountabilities and responsibilities in the Safeguarding Children’s Framework and this was

confirmed by an external audit of our safeguarding arrangements which gave a green rated

outcome.

We are fully committed to ensuring all our staff are trained to the required levels for both

children’s and adults safeguarding and we have achieved the required national levels both

for children’s and adults’ safeguarding.

Strategic partnership working has been maintained through CCG membership, participation

and financial support to the Local Safeguarding Children Board and sub committees such as

the Child Death Overview Panel. We are actively working with our local authority colleagues

as statutory partners of Adults Safeguarding Boards to develop the Boards and supporting

governance arrangements to ensure we deliver all the requirements in the new Care Act.

The designated nurse has been working closely with NHS England and the named GP for

safeguarding children in providing support to general practices to enable them to fulfil their

safeguarding responsibilities.

We have cooperated with our Health and Wellbeing Board in relation to the discharge

of the Health and Wellbeing Board’s functions by attending meetings with our partners to

better coordinate health and wellbeing across Barking and Dagenham and by bringing

together resources and expertise from the NHS, the Council, Healthwatch and others. We

are taking forward joint planning through a number of subgroups including children and

maternity, mental health, learning disabilities, public health and integrated care. This

enables us all to provide better and more joined-up care for all residents of Barking and

Dagenham.

More details on our borough’s health and wellbeing strategy are below.

We have cooperated in relation to the preparation of Joint Strategic Needs

Assessments (JSNA) by undertaking the assessment in partnership with the local authority

and by using the information it contains to inform the commissioning of services for our

patients and public. The work is undertaken each year to provide a shared, evidence-based,

consensus about key local priorities and support commissioning to improve health and

wellbeing outcomes and reduce health inequalities.

Our borough’s Health and Wellbeing Strategy

In this section we summarise the key elements of our Health and Wellbeing (HWB) Strategy

2012-15, along with our contribution to developing and delivering it. We have shared this

section with our HWB Board colleagues and incorporated their feedback where received.

Our joint Health and Wellbeing Strategy sets out a vision for improving the health and

wellbeing of residents and reducing inequalities at every stage of people’s lives by 2018. It

aims to help residents improve their health by identifying the key priorities based on the

evidence in our Joint Strategic Needs Assessment, and what can be done to address them

and what outcomes are intended to be achieved. Three particular challenges continue to

dominate our thinking:


Page | 13

The first is the burden of ill health demonstrated by the significant number of our

population in poor health and the high premature mortality rates, especially from

coronary heart disease, stroke, cancers and respiratory disease.

The second is to continue the essential development and investment in primary care

and social care provision to deliver the ‘better care outside the hospital’ agenda,

without which our hospital services are unsustainable.

The third is to take account of our rapidly changing population in our commissioning

strategies and delivery plans, so that services keep pace with changing needs and

numbers. This is particularly true when considering the new housing developments

and the increasing child population.

The direction given by the Health and Wellbeing Board is to deliver an innovative approach

tailored to local needs that tackles the diseases and consequences of modern living, as well

as strives to raise standards of care and address health inequalities. Growth and

regeneration provide an opportunity by developing and using our community assets,

strengthening partnership between those who deliver and those who benefit from our

services, and looking beyond needs and treatments to a healthy and prosperous community

where residents and businesses contribute as well as gain.

In supporting the concept of wellness the Board has continued to advocate shifting care

away from traditional paternalistic approaches to the redesign of patient pathways focusing

on prevention, on keeping people out of hospital and encouraging residents to take personal

responsibility for managing their own and their family’s health, and social responsibility for

the health of their neighbours and communities. To achieve this, we want to see innovations

that fundamentally change the shape and scope of health and caring services and meet

local needs in new ways within a tighter financial framework.

The JSNA was updated in October 2014 and the HWB Strategy and related delivery plan are

in the process of being revised.

How we were involved in developing the HWB strategy

The CCG has played a significant part in developing the current health and wellbeing

strategy and informing the current refresh. This has involved:

Input into drafting content of strategy and delivery plan and review of JSNA

recommendations and revised delivery plan and outcome measures.

Chairing and programme managing delivery plan in respect of two of the HWB sub

groups – Integrated Care and Children and Maternity and taking a central role in Mental

Health sub-group.

Alignment of commissioning intentions to HWB priorities including contracting process

and review of service areas identified in JSNA

Joint stakeholder engagement on Health and Wellbeing Strategy and CCG

Commissioning intentions

How we have contributed to delivering the HWB strategy in 2014/15

Making progress against a range of CCG led delivery plan actions – this has included the

development of a sickle cell service, work with providers to increase births in lower

intensity setting such as Barking Birthing Centre and other Midwifery led units, working

with children’s services to develop a pilot integrating primary and early years services to

focus on providing greater support to parents in community settings as part of wider early


Page | 14

intervention work and to help parents know the best place to get urgent care,

development of Macmillan GPs to improve cancer care locally, focus on making

improvements in primary care access.

Contributing to actions led by other organisations – in particular mental health delivery

plan and related improvement programmes – Mental Health Needs Assessment and

Crisis Concordat.

Development of joint commissioning arrangements to ensure most effective use of

commissioner resources in support of HWB delivery plan – in particular around S75 for

Learning Disabilities and the Better Care Fund and funding joint commissioner/PMO

roles for Integrated Care, Learning Disabilities and Children.

Development and performance overview

The CCG continues to strengthen joint working arrangements with the local authority and

other partners, both directly, and via the Health and Wellbeing Board, the Integrated Care

Coalition (ICC) and its subgroups, thus enabling all partners to provide better and more

joined-up care for our residents. This is supported by a number of joint posts, shared

between the CCG and local authority.

The performance of our main acute provider, BHRUT, and the fact that the Trust is currently

in ‘special measures’, continue to impact on much of our work. More information on their

performance issues, and how we are working with them to address them, is in the section

below.

We are supporting the Trust by improving access to and experience of primary care which

also supports our objective to move more care closer to home, with GPs at the centre of

delivery. We have been building on last year’s work to increase the number urgent primary

care appointments following our successful joint bid to the Prime Minister’s Challenge Fund,

by increasing access to primary care via the commissioning of services in new, innovative

ways as described in the previous section. Our work to promote alternative urgent care

services to A&E continues, with a ‘winter’ campaign continuing on through the year and an

ongoing focus on urgent care at the SRG of which we are a key part.

The CCG adheres to legislation that governs the award of contracts by public bodies,

including the Public Contracts Regulations 2006, and needs to satisfy the obligations of

transparency, equal treatment and non-discrimination set out in those regulations. We also

comply with the regulations implemented under section 75 of the Health and Social Care

Act, which place requirements on commissioners to ensure that they adhere to good practice

in relation to procurement, do not engage in anti-competitive behaviour, and protect and

promote the right of patients to make choices about their healthcare.

Subject to Department of Health (DH) regulations on procurement choice and competition

and subject to current procurement rules set out in the Public Contracts Regulations 2006,

the CCG will decide where it is appropriate to commission community-based services

through competitive tender or an Any Qualified Provider (AQP) approach and where through

single tender. In general, commissioning through competitive tender or AQP will introduce

greater transparency and help reduce the scope for conflicts, while improving patient choice.

We are required to set out our strategic and operational plans for the forthcoming years in

line with financial allocations and central planning guidance. The NHS planning guidance

‘Everyone Counts: Planning for patients 2014/15 to 2018/19’ identifies the requirements for a

balanced financial plan, an Operating Plan (at CCG Level) and a five-year Strategic Plan


Page | 15

(BHR system wide). Our plans are available through the governing body papers on our

public website.

Barking and Dagenham CCG is also required to submit, with the local authority, a two year

Better Care Fund (BCF) plan. The Health and Wellbeing Board considered the final version

of the BCF plan at its meeting on 25 March along with a paper setting out detail of the CCG

operating plan and BHR-wide draft strategic plan. Following this, we and the local authority

are entering into a Section 75 agreement to pool both our funding related to the Better Care

Fund and to make joint decisions on how these funds are spent in future for maximum

benefit for local people under a S75 agreement. The operating plan includes the key

operational metrics needed to support the assurance of, and measure performance against,

strategic plans.

The CCG was also required to develop a QIPP plan for the financial year to drive

improvements in both quality and efficiency of services, through innovation. For 2014/15,

Barking and Dagenham CCG had to deliver a QIPP target of £10.92m. We are expecting to

deliver 89% of that plan (£9.76m) by the end of the financial year and will be required to

deliver a further QIPP plan of £7.8m during 2015/16.

2014/15 QIPP delivery has been supported by the agreement of a fixed price contract with

BHRUT, which has minimised the financial impact of QIPP under achievement. Under

achievement against the QIPP could impact on the CCG’s ability to invest in services (as

savings have not been released to be used elsewhere) or slow the pace of improvement of

services in the borough. The CCG is therefore actively working to reduce the risk of non-

delivery by ensuring robust project management processes are in place, and by developing

a pipeline of QIPP schemes to offset the impact of any underperforming schemes.

Our performance is monitored via monthly assurance meetings with NHS England and we

have received positive feedback on our Operating Plan and Better Care Fund plan. At these

meetings, our performance is discussed across a range of areas and NHS England has

been reassured and satisfied of our progress. In addition our Governing Body meetings are

able to scrutinise performance via updates from our Chief Officer.

We have summarised our performance against our corporate objectives in the previous

section.

BHRUT performance

During 2014/15 there have been performance issues at BHRUT around targets relating to

waits in A&E, for referral to treatment (RTT) and cancer appointments. These issues are all

included in the CCG’s risk register and the governing body assurance framework published

in our governing body papers and available on our website.

A&E

The Trust failed to achieve the national standard of 95% of patients being seen, treated and

discharged or admitted within four hours during 2014/15. The A&E year-to-date published

data for the Trust to March 2015 showed 85.2% of patients (all types) were seen within four

hours.

There was a significant improvement in A&E performance in the fourth quarter, with the Trust

overall hitting the 95% target for the first time in over a year in February and the King George

Hospital site meeting the target for five consecutive weeks in January and February. This


Page | 16

improvement has been credited to a range of aligned schemes agreed and managed across

the local health system by NHS and social care organisations working in partnership.

The Trust remains focused on the implementation of its improvement plan and focusing hard

on the patient flow throughout the Emergency Department. We continue to monitor the A&E

performance on a daily basis in order to hold the Trust to its contractual obligations.

Cancer

Performance overall on cancer pathways improved over the last six months of the year, with

most of the national standards being met. There are, however, two pathways where the

performance is of concern.

62 day target for start of treatment for cancer

There is a national target that says 85% of patients with cancer should start

treatment within 62 days of referral by a GP to a specialist. BHRUT has not achieved

this since June 2014. Their initial recovery plan was strengthened following

contractual action by the CCGs in July and performance was meant to return to the

national standard in November 2014. The Trust has failed to achieve this, with the

October 62-day performance at 82% and 83% in November. The Trust is on track,

however, to recover performance from April 2015.

Two week target for suspected breast cancer

Where cancer is suspected, 93% of patients should be seen by a specialist within

two weeks of referral by a GP. Performance relating to suspected breast cancer has

not been met since April 2014, although performance has improved to approximately

90% since August 2014.

Since October, for both standards, the BHR CCGs have used contractual levers to seek a

revised recovery plan that sets out a detailed action plan and updates on supporting actions

and the wider improvement work on cancer:

Cancer performance remains on the weekly Performance Assurance Group agenda and

continues to be monitored on a weekly basis to ensure the performance improves. It is also

monitored at the monthly contractual Service and Performance Review. The recovery plan

was also reviewed positively with NHSE and the TDA at a February escalation meeting.

18 week RTT target

Patients have a right to start their non-emergency NHS consultant-led treatment within a

maximum of 18 weeks from referral, unless they choose to wait longer or it is clinically

appropriate that they wait longer.

In December 2013, BHRUT identified significant issues following their upgrade to a new

Patient Administration System (PAS), which have affected their performance against the

RTT standard. They had to suspend national reporting of RTT data, but are due to discuss

reinstating this at their Trust Board in May 2015.

Progress against the recovery plan is discussed at the weekly Performance Assurance

Group between the CCGs and the Trust, to ensure it remains focused on the key risks to

patients. It is also reviewed in the monthly Oversight and Escalation Group meeting with

NHS England and the Trust Development Authority.


Page | 17

£'000

Services from other NHS trusts 120,513

Services from foundation trusts 67,919

Services from other CCGs and NHS England 5,056

Healthcare from non-NHS organisations 27,857

Prescribing 24,873

Other Costs 6,313

252,531

Financial performance

The financial statements contained with the report provide a summary of the CCG’s financial

position and performance for 2014/15. This section of the report talks about how we manage

our money and how our financial performance is measured.

We are accountable for how we spend public money and achieve good value for money for

our patients. This is the second year of the CCG, and good financial control and

management is vital for the development of the organisation.

Funding

In 2014/15 Barking and Dagenham CCG was given funding of £256.2m from NHS England.

Within this funding the CCG is allowed to spend £5.1m on the running costs of the

organisation.

The CCG is funded above the ‘target level’ of funding that has been set by NHS England.

The CCG funding level will move closer to the ‘target level’ in future years which means that

the CCG must use the money it does have even more effectively and efficiently.

How we spent the money

The majority of the CCG’s spend is used to purchase services from NHS Trusts and NHS

Foundation Trusts. In 2014/15 we spent £188.4m, which is 75% of our gross spend.

In summary we spent the money as follows:

48%

27%

2%

11%

10% 2% Services from other NHStrusts

Services from foundationtrusts

Services from other CCGs andNHS England

Healthcare from non-NHSorganisations

Prescribing

Other Costs


Page | 18

Investments

In 2014/15 the CCG invested money in services within the community which try and prevent

people from being admitted to hospital.

In the future the CCG will continue to invest in these types of services. It is also planning to

invest in schemes linked to the Prime Minister’s Challenge Fund. This will focus on access to

services and services for patients with complex needs. There will also be investment in

Mental Health Services.

Risks

We successfully managed our financial risks in 2014/15. We identified the top financial risks

as:

The risk of increased acute activity

The delivery of savings programmes.

To mitigate the risks we took a proactive approach to financial monitoring, which means we

can identify potential problems and resolve them in good time.

In addition we maintained contingencies to address in year unforeseen risks and help

generate the surplus position.

How we did

We agreed with NHS England to deliver a 2.1% surplus. We have been successful in

delivering this, and have achieved a surplus of £5.5m. We remained with our running costs

allocation.

Future years

For 15/16 the CCG is planning to deliver a 2% surplus. The CCG will receive a funding

increase of 3.14%, which will move them closer to their ‘target level’ of funding set by NHS

England.

Factors that might affect our long-term performance

We have already talked about some of the issues that might impact on the future, such as

the commissioning of new services or commissioning in different ways, in the section on our

development, performance and the external environment. Other factors are covered below.

Key strengths and resources

Our staff are a key strength. In our member practices and the CCG team, they have the local

knowledge and expertise to bring the necessary local focus to our work, and the shared

management team enables us to work collaboratively across the local health system and at

scale as and when appropriate.

We are committed to integrating health and social care across the local health economy and

effective partnership working, with our neighbouring CCGs and health and social care

providers, is essential to the delivery of this aim. We have worked hard over the past year to

develop our partnership working and we believe this puts us in a strong position to achieve

our objectives in the longer term. We have described our significant stakeholder

relationships in more detail below.


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We are also supported in our work by NEL CSU, recognised as one of the country’s leading

CSUs, which provides a range of commissioning support services and back office functions

that are more effectively and efficiently provided at scale.

Principal risks

The risk management framework sets out how risk is assessed and managed. There is a

clear process and criteria for both the escalation and de- escalation of risk. The Governing

Body Assurance Framework (GBAF) describes our major risks, the most serious being

BHRUT performance improvement. This remains a serious risk going into 2015/16 and will

feature in the 2015/16 GBAF and other reports to the governing body. We are continuing to

work with the Trust, Monitor and the NHS Trust Development Authority (TDA) to achieve

change and see real improvements for patients.

BHRUT performance improvement includes the following risks, BHRUT 18 weeks RTT,

poor cancer performance against the 62 day waiting times.

Management and mitigation:

BHRUT being held to account by via weekly operational performance monitoring

meetings, escalated to monthly strategic review, reporting to the governing body, quality

and safety committee and executive committee

Agreed remedial action plans in place (with TDA / CQC / NHS England and CCGs) with

monthly whole system oversight and escalation group to review progress against the

plan.

Weekly Performance Assurance Group on progress with issues escalated to monthly

strategic review meeting.

Clinical harm reviewed through External Harm Panel

Full contract levers used

CCG to work closely with lead commissioner to monitor and improve trust performance

on patient experience

Significant stakeholder relationships

We have a good working relationship with the London Borough of Barking and Dagenham,

working closely together through the Health and Wellbeing Board and its sub-groups. We

have worked particularly closely in 2014/15 on the development of the Better Care Fund,

joint commissioning of learning disabilities services and the children and maternity agenda.

One of our most significant stakeholder relationships is that with our main acute provider,

BHRUT. The Trust was placed in special measures by the TDA in December 2013 following

a series of CQC inspection reports which highlighted quality and safety concerns. A new

Chair and Chief Executive joined the Trust in February and March 2014 respectively and the

CCG has supported it to produce an improvement plan, aligned to proposals to reconfigure

services that will achieve the necessary improvements to services for our local population.

The CCG recognises that the Trust cannot meet the current challenge alone and that this is

a task that requires the support of the whole health economy.

We have worked closely with our community and mental health services provider, NELFT, in

2014/15 to develop new innovative services, in particular the intermediate care services. The

community treatment team and intensive rehabilitation service work together to help mainly

older, people to receive care in their own homes, where appropriate, reducing ambulance


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call outs and admissions to hospital. The services, which were subject to a major public

consultation this year, have proved hugely successful in terms of the number of patients

receiving care, and the satisfaction scores of both patients and carers. The CCG aims to

mainstream these services in the coming year.

We also work closely with Barts Health, for example in providing maternity services at the

Barking Community Birth Centre.

Senior leaders across health and social care in Barking and Dagenham, Havering and

Redbridge, including our CCG Chair, are committed to working together in a guiding coalition

of strategic partners that is developing a joint approach to integrated care to build a

sustainable health and social care system. The ICC was established as an advisory board to

oversee strategic change across health and social care.

The Coalition brings together senior leaders in the BHR health and social care economy to

support the three BHR clinical commissioning groups and the three local authorities in

commissioning integrated care and ensuring a sustainable health and social care system. It

also includes our two main providers – BHRUT and NELFT.

The ICC is responsible for:

Developing recommendations for a system-wide integrated care strategy for

consideration by the system’s health and social care commissioners: the health and

wellbeing boards and CCGs

Developing the system’s five year strategic plan (delegating authority for the co-

ordination of the plan to the Coalition sub group: Integrated Care Steering Group)

Driving improvement in urgent care at a pace across the BHR system (delegating

authority to the Coalition sub group, the SRG

The ICC also receives updated reports from BHRUT and all partners on its improvement

programme (Long Term Financial Model/ Clinical Strategy and A&E improvement plan) and

agrees areas and actions where a system response is required.

Our patient engagement forum (PEF) has further developed this year with a number of new

members contributing to a welcome widening of the make-up of the forum. The forum

continues to hold its six regular meetings throughout the year with some additional meetings

added if the group feels this is necessary. Agendas are set following discussion between the

PEF chair, the CCG chief operating officer and the patient and public engagement adviser,

and include CCG priority projects and the concerns of members expressed at the meetings.

A number of high-profile presenters were invited to the meetings this year including

BHRUT’s chief executive and representatives from NHS England.

We continue to work closely with the local Healthwatch to help us understand the views and

concerns of our residents and patients. Healthwatch representatives attend many of our

senior partnership meetings. They are represented on the SRG and also help the CCG with

some specific engagement work streams and facilitating some patient/public events.


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Report by the lay member for patient and public engagement

The Chief Officer and lay member regularly meet with the lead officer of Healthwatch

Barking and Dagenham. Healthwatch are also members of our Patient Engagement Forum

where they feed back on their work areas and provide community intelligence to the Forum.

This link is really valuable to us as it helps us keep patients at the centre of planning.

The CCG recognises the important roles of Barking and Dagenham’s voluntary and

community sectors and their work to support, or advocate for, people in need of key health

and social care services. Over this period the lay member, along with the CCG’s patient and

public engagement adviser, have visited a wide range of these groups including those

representing people with disabilities, minority ethnic peoples, and other vulnerable people.

This engagement has been very well received, and the groups have expressed the need to

be kept informed about CCG developments.

During this year we further developed the PEF, increasing its membership and diversity. For

example, we were successful in getting young people involved for the first time. We also

worked hard to ensure that the PEF could directly influence decision-making processes by

reviewing governing body papers a week in advance of meetings and their views being

presented at governing body meetings by the lay member.

The PEF has also held a number of additional meetings, focusing on areas such as the

CCG’s commissioning intentions, so that people can have a greater understanding of our

work and plans and to ensure their feedback is therefore more informed.

During this year we held a PPG event inviting patients from GP practices in the borough.

This helped us to understand the challenges and barriers they face as well as gathering

information on their support needs. An action plan is being developed for the PPGs and will

be reviewed regularly with local patients. We are also promoting the support available to

PPGs in the area.

We are now in the process of delivering a training package for patients on patient

involvement in the CCG. This is so that they have the background knowledge to be actively

involved in their roles in representing the local community and their health needs.

Finally, thanks are due to the Chair, Miriam Greenwood, Vice Chair, Nicholas Hurst, and all

the other voluntary members of the group whose positive contributions have been so helpful

this year.

Our employees

The CCG monitors staff diversity and a workforce report is presented to each meeting of our

Remuneration and Workforce committee. Our year end analysis shows the following gender

distribution against the following categories:

Governing body members2: three women, 11 men

Senior managers (directors not included above)3: two women, one man

All other employees4: 66 women and 28 men

2 Includes clinical directors, lay members and directors. 3 Includes the CCG and the shared management team. 4 Includes the CCG and the shared management team.


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More information about our approach to equalities and ensuring equality of opportunity is

given in the Equality disclosures section of the Members’ report below.

Environmental, social, community and human rights issues

NHS organisations are required to produce a sustainability report. This covers environmental

matters and is included at section 1.4 below. We do not consider there are any particular

social, community and human rights issues not covered elsewhere that are relevant to

understanding the business of the CCG.

Conor Burke

Accountable Officer

[ date]


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1.2. Members’ report

Details of members of the membership body and the governing body

Unless otherwise specified, the time period relating to the membership of all committees is

for the financial year and up to the signing of the annual report and accounts.

The Chair and Accountable Officer

The Chair of the CCG is Dr Waseem Mohi and the Accountable Officer, known as the Chief

Officer, is Conor Burke.

Member practices

Abbey Medical Centre 1 Harpour Road IG11 7RJ

Barking Group Practice 130 Upney Lane IG11 9LT

Becontree Medical Centre 645 Becontree Avenue RM8 3HP

Broad Street Medical Centre Morland Road RM10 9HU

Child and Family Doctors' Surgery 79 Axe Street IG11 7LX

Church Elm Lane Medical Centre Church Elm Lane RM10 9RR

Dewey Road Surgery 36 Dewey Road RM10 8AR

Faircross Health Centre 51 Upney Lane IG11 9LP

First Avenue Surgery 2 First Avenue RM10 9AT

Five Elms Medical Practice Five Elms Road RM9 5TT

Gables Surgery 50 Markyate Road RM8 2LD

Green Lane Surgery 872 Green Lane RM8 1BX

Halbutt Street Surgery 2 Halbutt Street RM9 5AS

Heathway Medical Centre 585 Heathway RM9 5AZ

Hedgemans Surgery 92 Hedgemans Road RM9 6HT

Highgrove Surgery Barking Community Hospital IG11 9LX

John Smith Medical Centre 145-207 Bevan Avenue IG11 9NS

Julia Engwell Clinic Woodward Road RM9 4SR

King Edwards Medical Centre 1 King Edward's Road IG11 7TB

Laburnum Health Centre 11 Althorne Way RM10 7DF

Lawns Medical Care Lawn Farm Grove RM6 5LL

Longbridge Road Surgery 620 Longbridge Road RM8 2AJ

Marks Gate Health Centre Lawn Farm Grove RM6 5BJ

Markyate Surgery 50 Markyate Road RM8 2LD

Oval Road Practice 69 Oval Road North RM10 9ET

Parkview Medical Centre 199 Reede Road RM10 8EJ

Parsloes Avenue Surgery 370 Parsloes Avenue RM9 5QP

Porters Avenue Health Centre Porters Avenue RM8 2EQ

Ripple Road Surgery 364 -370 Ripple Road IG11 7RJ

Salisbury Avenue Medical Centre 7 Salisbury Avenue IG11 9XQ

Shifa Medical Practice Orchard Health Centre, Gasgoigne Road IG11 7RS

Thames View Health Centre Bastable Avenue IG11 0LG


Page | 24

Third Avenue Surgery 2 Third Avenue RM10 9BA

Tulasi Medical Centre 10 Bennetts Castle Lane RM8 3XU

Urswick Medical Centre Urswick Road RM9 6EA

Valence Medical Centre 563 Valence Avenue RM8 3RH

Victoria Medical Centre 1 Queens Road IG11 8GD

Victoria Road Surgery 60 Victoria Road IG11 8PY

White House Surgery 12 Movers Lane IG11 7UN

Membership body representatives

Dr Adedeji Dr Haider Dr N Teotia Dr M Ehsan

Dr Fateh Dr Kendal Dr Atal Dr Ola

Dr Isra Moghal Dr John Dr Mittal Dr Anju Gupta

Dr Alex Duodu Dr Sharma Dr Kalkat Dr Kalra

Dr F Bhatia Dr K Kashyap Dr Asma Moghal Dr Dallas

Dr Parveen Masud Dr Rai Dr Islam Dr Jagen

Dr Mohan Dr S Neal Dr Shah Dr Randhawa

Dr Ahmad Dr Bila Dr M Garcia Dr R Shama

Dr Pervez Dr Ghosh Dr A Arif Dr Lawrence

Dr Jaiswal Dr Chibber Dr Y Rashid Susan Neal

Dr Prasad Dr Ansari Dr A Annan Dr Nandra

Dr Niranjan Dr Goriparthi

The Governing Body

Name Role

Dr Waseem Mohi Chair of the CCG

Dr Arun Sharma Clinical Director (on secondment out of the CCG from July

2015)

Dr Chandra Mohan Clinical Director

Dr Jagan John Clinical Director

Dr Ramneek Hara Clinical Director

Dr Gurkirit Kalkat Clinical Director

Dr Ravali Goriparthi Clinical Director

Kash Pandya Vice Chair; Lay Member - Governance

Sahdia Warraich Lay Member - Patient and Public Involvement (or PPI)

Mr Tan Vandal Secondary Care Consultant (until March 2015)

Anne Bristow Director of Adult Services


Page | 25

Name Role

Matthew Cole Director of Public Health

Conor Burke Chief Officer

Martin Sheldon Interim Chief Finance Officer (to 30 April 2014)

Tom Travers Chief Finance Officer (from 1 May 2014)

Jacqui Himbury Nursing Director

Sharon Morrow Chief Operating Officer

The Audit Committee

Name Role

Kash Pandya (Chair) Lay Member (Governance), BHR CCGs

Sahdia Warraich Lay Member (PPI), Barking and Dagenham CCG

Richard Coleman Lay Member (PPI), Havering CCG

Khalil Ali Lay Member (PPI), Redbridge CCG

Charles Beaumont Co-opted Independent Member, BHR CCGs

Dr Ah-fee Chan Secondary Care Consultant, Redbridge CCG

Mr Tan Vandal Secondary Care Consultant, BHR CCGs (until March 2015)

Disclosure of relevant information to auditors

Each individual who is a member at the time the Members’ Report is approved confirms:

so far as they are aware, that there is no relevant audit information of which the clinical

commissioning group’s external auditor is unaware; and,

that they have taken all the steps that they ought to have taken as a member in order to

make them self aware of any relevant audit information and to establish that the clinical

commissioning group’s auditor is aware of that information.

Pension liabilities

For details of how pension liabilities are treated in the accounts, see the accounting policy

note in the Financial Statements and in the Remuneration Report.

Members’ interests

We publish a register of members’ and senior managers’ interests on the CCG’s website:

www.barkingdagenhamccg.nhs.uk. This is updated as and when changes are notified to the

CCG.

The register gives details of company directorships or other significant interests held by

members and senior managers where those companies are likely to do business, or are

http://www.barkingdagenhamccg.nhs.uk/


Page | 26

possibly seeking to do business with the NHS, where this may conflict with their managerial

responsibilities.

External audit details

The CCG’s external auditor is PricewaterhouseCoopers LLP and the cost of the work they

performed was as below.

Category and description of work Cost

Audit services

Statutory audit and services carried out in relation to the statutory

audit

£76,320 (inc VAT)

Further assurance services £nil

Other services £nil

Sickness absence data

For information on sickness absence within the CCG, see the employee benefits note to the

Financial Statements.

Cost allocation and setting of charges for information

We certify that the clinical commissioning group has complied with HM Treasury’s guidance

on cost allocation and the setting of charges for information.

Disclosure of personal data related incidents

During the reporting period, the CCG has had no serious incidents involving data loss or confidentiality breaches that require investigation.

Employee consultation

The CCG provides information to employees through a series of channels including a weekly

staff e-newsletter and regular all staff briefings attended by senior management and the

CCG Chair, enabling us to make staff aware of the financial and economic factors affecting

the performance of the clinical commissioning group and their part in that. At these meetings

teams present to their colleagues to share good work and to answer questions.

Employees are consulted via our online staff surveys and the results of these are fed back to

staff at staff briefings. Our staff intranet hosts news, CCG policies and relevant work

documents, training and development opportunities and a staff-side section for unions. In

December 2014 we launched the CCG’s own Twitter account which carries news and

information and is active on a daily basis. Staff are encouraged to follow the CCG on Twitter

via a standing item in the weekly staff e-news.


Page | 27

Equality disclosures

From April 2013, clinical commissioning groups took on legal responsibility for demonstrating

compliance with the Equality Act 2010, specifically the Public Sector Equality Duty. In so

doing, we must have due regard to three aims of the ‘general duty’ which states we must:

eliminate unlawful discrimination, harassment and victimisation and other conduct

prohibited by the Act

advance equality of opportunity between people who share a protected characteristic

and those who do not

foster good relations between people who share a protected characteristic and those

who do not.

Over the past year, we have been working to embed equality and diversity in our policy

development, commissioning, engagement, current workforce and in the recruitment of staff

from diverse backgrounds.

It is essential that not only do we comply with the Act, but that the makeup of our staff

reflects the diversity of the wider population here in our part of east London. This enables us

better to commission safe, high quality services that are designed around the diverse needs

of our patients and the public, as we represent those communities directly. We also work

closely with our providers to identify the needs of all communities.

The CCG has no legal duty to publish our workforce data because we employ fewer than

150 staff, but as we are committed to employing a diverse workforce we do monitor staff

equality data.

We are mindful of our legal responsibilities under the Equality Act 2010 and we review the

applicants for posts, the number shortlisted and those appointed, to determine if they might

fall under the relevant protected characteristic which includes age, disability and race. This

enables us to review our recruitment and selection practices and assure ourselves that these

practices are robust and we do not directly or indirectly discriminate against anyone. The

turnover of staff is low so our level of recruitment is equally quite low, but as a small local

employer we welcome applications from our local community and people with a diverse

background.

We aim to develop an inclusive working culture which values diversity and supports staff to

feel confident to challenge any harassment, bullying or perceived victimisation. All staff have

direct access to our accountable officer via a contact ‘button’ on our staff intranet and are

encouraged to use this to raise any concerns directly with him that they might have. Training

on equality and diversity is mandatory for all staff and managers closely monitor uptake of

this.

Our governing body report cover sheet includes a section specifically about equality impact

prompting managers to carrying out an equality analysis of the policy or the function they are

reporting to the governing body. We maintain a log for all our equality analyses and ensure

the actions arising from the analyses are implemented and monitored.

Implementing the Equality Delivery System2 (EDS2)

The CCG is fully committed to promoting equal opportunities within its workforce and within

the services it commissions for patients and the public.


Page | 28

In implementing the EDS from a workforce perspective we can report that we have a fair and

transparent recruitment process, as detailed above. We have flexible working policies and

support our staff through personal development planning and training.

Equality impact assessments (EIAs) are carried out when we procure new services or

redesign service models and when developing new policies for use both externally and

internally. We have recently reviewed our EIA documentation and process to ensure that

EIAs are being carried out appropriately.

We also take part in the NHS England Pan London Equality and Diversity Network meeting

held each quarter and the new local health economy EDS2 Steering Group. These meetings

are hosted by NELFT and attended by BHRUT, patient representatives, London Ambulance

Service and local Healthwatch organisations.

Examination of the organisation against the first NHS Workforce Race

Equality Standard

The CCG monitors staff diversity and a workforce report is presented to each meeting of our

Remuneration and Workforce committee. Although we do not have an obligation to report

publicly in the same way as larger NHS organisations (as mentioned above, due to the

number of staff employed), we recognise the benefits of this, given the introduction of the

first NHS Workforce Race Equality Standard (WRES) which starts from 1 April 2015.

Equality strategy

We have an equality strategy that runs until March 2016. Over the coming year, this will be

reviewed and updated to include the mandatory workforce race equality standards that came

into effect on 1 April 2015 as well as progress against the EDS2.

Health and safety

The CCG has an obligation to ensure that the Health and Safety Act of 1974, covering

occupational health and safety, is complied with by all officers and employees of the CCG.

To ensure that all are aware of the act and understand their responsibilities mandatory

health and safety and fire training are required to be undertaken every two years. Staff

compliance is monitored on a quarterly basis and staff and their line managers are reminded

as necessary.

The CCG has a health and safety lead who ensures that all issues raised are dealt with in a

timely manner and links in with NHS Property Services or landlord staff as necessary who

provide the CCG with facilities management services. Fire drills are conducted every 6

months with fire alarm testing on a weekly basis. Each departmental team has a nominated

fire warden and approved fire warden training is provided on a yearly basis.

A health and safety audit has been carried out with an action plan and mitigations to resolve

all issues. A further audit is planned by the end of April 2015.

The CCG has an established incident reporting processes and incidents are documented

and reviewed. Lessons learned are fed back to the CCG’s facilities lead who ensures that

recommended actions are dealt with swiftly. In the two years since the CCG’s establishment

there have been a handful of minor incidents recorded to date.


Page | 29

Tackling fraud and bribery

The CCG does not tolerate fraud and bribery within the NHS and we are committed to taking

all necessary steps to counter this. We have adopted the seven-stage approach developed

by NHS Protect:

1. The creation of an anti-fraud culture

2. Maximum deterrence of fraud

3. Successful prevention of fraud which cannot be deterred

4. Prompt detection of fraud which cannot be prevented

5. Professional investigation of detected fraud

6. Effective sanctions, including appropriate legal action against people committing

fraud and bribery, and

7. Effective methods of seeking redress in respect of money defrauded.

We have established a policy and procedure to eliminate NHS fraud and bribery as far as

possible, protecting the property and finances of the NHS and of patients in our care.

The policy applies to all CCG employees, members of the Governing Body and its

committees, sub-committees and working groups and any person working on behalf of the

CCG, such as agency staff. It also applies to consultants, vendors, contractors and any other

parties who have a business relationship with the CCG.

The policy also provides advice on dealing with fraud or suspected fraud and details our

arrangements for such concerns to be raised by employees or members of the public.

We have brought the policy to the attention of all employees through an all-staff briefing

session and e-newsletter. It forms part of the induction process for new staff and members.

Better Payments Practice Code

Details of compliance with the code are given in note six to the accounts.

Prompt Payments Code

The CCG has not yet signed up to the prompt payments code but will review this position

during the next financial year.

Emergency preparedness, resilience and response

Under the Civil Contingencies Act (2004), NHS organisations must show that they can deal

with incidents while maintaining services to patients. This work is referred to as ‘emergency

preparedness resilience and response’ (EPRR).

While NHS England, as a ‘Category One’ responder, bears the majority of responsibilities in

preparing for and responding to incidents and emergencies, the CCG, as a ‘Category Two’

responder, has a duty to participate in preparations and provide a cooperative and

supportive role to NHS England should an incident occur. As a ‘Category Two’ responder

there are also a number of core standards that CCGs must meet.

Following an assurance review and test by NHS England in 2014/15 regarding our

adherence to the core standards, the CCG was issued with a compliance rating of

‘substantial’. We have a programme to regularly review, test and make improvements to our

major incident plans, and report on this work to the Governing Body. We make sure that any


Page | 30

staff involved in EPRR have regular training to ensure they have the skills and competencies

to carry out their responsibilities.

Principles for remedy

The CCG manages any complaints about our work in accordance both with the NHS

complaints procedures and the health service ombudsman’s principles for remedy as set out

below:

Getting it right

Where maladministration or poor service has led to injustice or hardship, as the public

body responsible we take steps to provide an appropriate and proportionate remedy.

Being customer focused

We promptly identify and acknowledge maladministration and poor service, and

apologise for them.

Being open and accountable

Where necessary we provide clear guidance about the criteria we use for deciding

remedies. Our staff know the circumstances in which they may offer remedies, and what

they may and may not offer.

Acting fairly and proportionately

Remedies will be fair, reasonable and proportionate to the injustice or hardship suffered.

Putting things right

Where maladministration or poor service has led to injustice or hardship, we will try to

offer a remedy that returns the complainant to the position they would have been in

otherwise. If that is not possible, the remedy will compensate them appropriately.

Remedies will also be offered, where appropriate, to others who have suffered injustice

or hardship as a result of the same maladministration or poor service.

Seeking continuous improvement

Part of a remedy may be to ensure that changes are made to our policies, procedures,

systems, staff training or all of these, to ensure that the maladministration or poor

service is not repeated. It is important for us to ensure that lessons learnt are put into

practice.

CCG complaints process

The CCG manages all its complaints through NEL CSU. The corporate services team, part

of the joint BHR CCGs management team, is responsible for complaints management and

oversees the process. We try to fully investigate all complaints as soon as possible and

respond to all issues raised by the complainant. Where a complainant may not be satisfied

with our response they may follow this up with us or may wish to raise with the Parliamentary

Health Services Ombudsman.

Conor Burke

Accountable Officer

[ date]


Page | 31

1.3. Remuneration report

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 clinical commissioning

group. This means those who influence the decisions of the clinical commissioning group as

a whole rather than the decisions of individual directorates or departments. Such persons

will include advisory and lay members. This report outlines how those recommendations

have been implemented by the CCG in the year to 31 March 2015.

Remuneration and Workforce Committee (not subject to audit)

Clinical commissioning groups are required to have a remuneration committee to oversee

the pay, terms and conditions of service of senior managers. Because we have a joint

management team across Barking and Dagenham, Havering and Redbridge CCGs, which

includes a number of joint director level, lay member and secondary care consultant posts,

we operate a number of ‘committees in common’. What this means is all three CCG

committees meet at the same time, and some members are there to represent two or more

committees in the same meeting.

The main function of the committee is to make recommendations to the board on the

remuneration, allowances and terms of service of other officer members to ensure they are

fairly rewarded for their individual contribution to the organisation, having regard for the

organisation’s circumstances and performance, and taking into account national

arrangements.

Name Role

Members







Dr Waseem Mohi Chair, Barking and Dagenham CCG

Dr Atul Aggarwal Chair, Havering CCG

Dr Anil Mehta Chair, Redbridge CCG

In regular attendance

Conor Burke Chief Officer, BHR CCGs

Marie Price Director of Corporate Services (from September 2014)

Sue Assar Interim Director of Corporate Services (to September 2014)

Martin Hayes Head of Human Resources, NEL CSU


Page | 32

The Committee met on the dates below and with the following member attendance:

6 May 2014 Kash Pandya, Sahdia Warraich, Richard Coleman, Khalil Ali, Ah-fee

Chan, Waseem Mohi, Anil Mehta

15 July 2014 Kash Pandya, Sahdia Warraich, Richard Coleman, Khalil Ali, Tan

Vandal, Anil Mehta

9 September 2014 Kash Pandya, Sahdia Warraich, Richard Coleman, Khalil Ali, Ah-fee

Chan, Atul Aggarwal, Waseem Mohi, Anil Mehta

11 November 2014 Kash Pandya, Sahdia Warraich, Richard Coleman, Khalil Ali, Tan

Vandal, Ah-fee Chan, Anil Mehta, Atul Aggarwal

3 February 2015 Kash Pandya, Sahdia Warraich, Khalil Ali, Tan Vandal, Anil Mehta,

Atul Aggarwal

10 March 2015 Kash Pandya, Sahdia Warraich, Richard Coleman, Khalil Ali, Tan

Vandal, Ah-fee Chan, Atul Aggarwal, Waseem Mohi, Anil Mehta

The committee received professional HR advice from Martin Hayes, employed by NEL CSU,

whose remit is to advise BHR CCGs on all workforce matters. The committee is satisfied that

the advice received was objective and independent. The service is provided under terms of

the service level agreement with the CSU.

Contractual arrangements

The chair, clinical directors and lay members are appointed by the CCG. Clinical directors

and lay members are on fixed term contracts of up to five years in length, depending on

individual circumstances.

The Accountable Officer and other Executive Directors are on permanent contracts, subject

to the notice periods listed below.

The remuneration of senior managers is determined by the Remuneration and Workforce

Committee in line with national NHS ‘Agenda for Change’ and very senior manager pay

guidance. The Committee reviews information about director and governing body members’

responsibilities, as well as comparing remuneration in similar organisations to set pay.


Page | 33

Governing body members’ service contracts (not subject to audit)

Name Position Term of office Type of contact Notice

period

Dr Waseem

Mohi Chair of the CCG

1 April 2014 – 31 March

2018

Elected by CCG

Clinical Directors 3 months

Dr Arun

Sharma

Clinical Director –

on secondment


2017

Elected by CCG

membership 3 months

Dr Chandra

Mohan Clinical Director


2018

Elected by CCG

membership 3 months

Dr Jagan

John Clinical Director


2017

Elected by CCG

membership 3 months

Dr Ramneek

Hara Clinical Director


2016

Elected by CCG

membership 3 months

Dr Gurkirit

Kalkat Clinical Director


2016

Elected by CCG

membership 3 months

Dr Ravali

Goriparthi Clinical Director


2018

Elected by CCG

membership 3 months

Kash Pandya

Vice Chair; Lay

Member –

Governance


2015

(new contract to 2017)

Fixed term contract 3 months

Sahdia

Warraich

Lay Member –

Patient and Public

Involvement


2015

(new contract to 2017)

Fixed term contract 3 months

Mr Tan

Vandal

Secondary Care

Consultant


2015 Fixed term contract 3 months

Conor Burke Chief Officer From 1 April 2013

Permanent contract

NHS Very Senior

Manager (VSM)

3 months

Martin

Sheldon

Interim Chief

Finance Officer

From 1 April 2013 – 30

April 2014 Consultant N/A

Tom Travers

Chief Finance

Officer (from May

2014)

From 1 May 2014

Permanent contract

NHS Very Senior

Manager (VSM)

6 months

Jacqui

Himbury Nursing Director From 1 April 2013

Permanent contract

NHS Agenda for

Change (AFC) Band

9

3 months

Sharon

Morrow

Chief Operating

Officer From 1 April 2013

Permanent contract

NHS Agenda for

Change (AFC) Band

9

3 months


Page | 34

Salaries and allowances of Senior Managers 2014/15 (CCG share – subject to audit)

2014/15 2013/14

Name and Title Salary

(bands

of

£5,000)

Expense

Payments

(taxable) to

nearest

£100

All

Pension

related

benefits

(bands of

£2,500)

Total

(bands

of

£5,000)

Salary (bands of

£5,000)

Expense

Payments

(taxable)

to nearest

£100

All

Pension

related

benefits

(bands of

£2,500)

Total (bands

of £5,000)

Executive Director £000 £00 £000 £000 £000 £00 £000 £000

Conor Burke

Chief Accountable Officer

Commenced 01/04/13

35-40 n/a 7.5-10 45-50 35-40 n/a 12.5-15

50-55

Tom Travers

Chief Finance Officer

Commenced 01/05/14

35-40 n/a 20-22.5 55-60 n/a n/a n/a n/a

Martin Sheldon **

Interim Chief Finance Officer

Commenced 01/04/13 to 30/04/14

5-10 n/a n/a 5-10 40-45 n/a n/a

40-45

Jacqui Himbury

Nurse Director

Commenced 01/04/13

25-30 n/a 7.5-10 35-40 20-25 n/a 5-7.5 30-35

Marie Price

Director of Corporate Services

Commenced 01/04/13

15-20 n/a 7.5-10 20-25 15-20 n/a 5-7.5 25-30

Sue Assar **

Interim Director of Corporate Services

Commenced 01/09/13 to 31/08/14

10-15 n/a n/a 10-15 15-20 n/a n/a 15-20

Rob Meaker

Programme Director Innovation

Commenced 01/04/14

30-35 n/a 10-12.5 40-45 20-25 n/a 7.5-10 30-35

Jane Gateley

Director of Strategic Delivery 20-25 n/a nil 20-25 25-30 n/a 2.5-5 30-35


Page | 35

2014/15 2013/14


(bands

of

£5,000)

Expense

Payments

(taxable) to

nearest

£100

All

Pension

related

benefits

(bands of

£2,500)

Total

(bands

of

£5,000)

Salary (bands of

£5,000)

Expense

Payments

(taxable)

to nearest

£100

All

Pension

related

benefits

(bands of

£2,500)

Total (bands

of £5,000)

Commenced 01/04/13

Sarah See **

Interim Director of Primary Care

Improvement

Commenced 01/07/14

25-30 n/a n/a 25-30 n/a n/a n/a n/a

Sharron Morrow

Chief Operating Officer

Commenced 01/04/13

100-105 n/a 55-57.5 155-160 95-100 n/a 50-52.5* 145-150

Clinical Directors

Dr Waseem Mohi**

Chair

Commenced 01/04/13

60-65 n/a n/a 60-65 60-65 n/a n/a 60-65

Dr Rajesh Kumar**

Clinical Director

Commenced 01/04/13 to 31/03/14

n/a n/a n/a n/a 50-55 n/a n/a 50-55

Dr Jagan John**

Clinical Director

Commenced 01/04/13

30-35 n/a n/a 30-35 25-30 n/a n/a 25-30

Dr Richard Burack**

Clinical Director

Commenced 01/04/13 to 31/03/14

n/a n/a n/a n/a 30-35 n/a n/a 30-35

Dr Gurkirit Kalkat**

Clinical Director

Commenced 01/04/13

30-35 n/a n/a 30-35 25-30 n/a n/a 25-30

Dr Arun Sharma**

Clinical Director 30-35 n/a n/a 30-35 20-25 n/a n/a 20-25


Page | 36

2014/15 2013/14


(bands

of

£5,000)

Expense

Payments

(taxable) to

nearest

£100

All

Pension

related

benefits

(bands of

£2,500)

Total

(bands

of

£5,000)

Salary (bands of

£5,000)

Expense

Payments

(taxable)

to nearest

£100

All

Pension

related

benefits

(bands of

£2,500)

Total (bands

of £5,000)

Commenced 01/04/13

Dr Ramneek Hara**

Clinical Director

Commenced 01/04/13

30-35 n/a n/a 30-35 25-30 n/a n/a 25-30

Dr Chandra Mohan**

Clinical Director

Commenced 01/04/13

30-35 n/a n/a 30-35 25-30 n/a n/a 25-30

Dr Ravali Goriparthi**

Clinical Director

Commenced 01/04/14

30-35 n/a n/a 30-35 n/a n/a n/a n/a

Secondary Care Consultant and lay members

Mr Tan Vandal

Secondary Care Consultant

Commenced 01/04/13 to 31/03/15

15-20 n/a n/a 15-20 15-20 n/a n/a 15-20

Mrs Sahdia Warraich

Lay Member PPI

Commenced 01/04/13

10-15 n/a n/a 10-15 10-15 n/a n/a 10-15

Kash Pandya

Vice Chair; Lay Member – Governance

Commenced 01/04/13

10-15 n/a n/a 10-15 10-15 n/a n/a 10-15

*Estimated based upon best known information

**Individuals paid off payroll and not included within salary and pension entitlements below


Page | 37

Salaries and allowances of Senior Managers 2014/15 (Full remuneration as paid by Redbridge CCG on behalf of

all BHR CCGs before recharge to Barking and Dagenham and Havering CCGs – subject to audit)

2014/15 2013/14


(bands

of

£5,000)

Expense

Payments

(taxable) to

nearest

£100

All

Pension

related

benefits

(bands of

£2,500)

Total

(bands

of

£5,000)

Salary

(bands of

£5,000)

Expense

Payments

(taxable)

to nearest

£100

All

Pension

related

benefits

(bands of

£2,500)

Total

(bands of

£5,000)

Executive Director £000 £00 £000 £000 £000 £00 £000 £000

Conor Burke

Chief Accountable Officer

Commenced 01/04/13

140-145 n/a 30-32.5 175-180 140-150 n/a 55-57.5 195-200

Tom Travers

Chief Finance Officer

Commenced 01/05/14

130-135 n/a 75-77.5 205-210 n/a n/a n/a n/a

Martin Sheldon**

Interim Chief Finance Officer

Commenced 01/04/13 to 30/04/14

25-30 n/a n/a 25-30 275-280 n/a n/a 275-280

Jacqui Himbury

Nurse Director

Commenced 01/04/13

95-100 n/a 30-32.5 130-135 85-90 n/a 22.5-25 110-115

Marie Price

Director of Corporate Services

Commenced 01/04/13

55-60 n/a 30-32.5 85-90 70-75 n/a 27.5-30 100-105

Sue Assar**

Interim Director of Corporate Services

Commenced 01/09/13 to 31/08/14

35-40 n/a n/a 35-40 60-65 n/a n/a 60-65

Rob Meaker

Programme Director Innovation

Commenced 01/04/14

95-100 n/a 35-37.5 135-140 90-95 n/a 27.5-30 115-120


Page | 38

2014/15 2013/14


(bands

of

£5,000)

Expense

Payments

(taxable) to

nearest

£100

All

Pension

related

benefits

(bands of

£2,500)

Total

(bands

of

£5,000)

Salary

(bands of

£5,000)

Expense

Payments

(taxable)

to nearest

£100

All

Pension

related

benefits

(bands of

£2,500)

Total

(bands of

£5,000)

Jane Gateley

Director of Strategic Delivery

Commenced 01/04/13

75-80 n/a nil 75-80 105-110 n/a 15-17.5 120-125

Sarah See**

Interim Director of Primary Care

Improvement

Commenced 01/07/14

90-95 n/a n/a 90-95 n/a n/a n/a n/a

Secondary Care Consultant and lay members

Mr Tan Vandal

Secondary Care Consultant

Commenced 01/04/13 to 31/03/15

35-40 n/a n/a 35-40 35-40 n/a n/a 35-40

Kash Pandya

Vice Chair; Lay Member – Governance

Commenced 01/04/13

40-45 n/a n/a 40-45 35-40 n/a n/a 35-40

No performance pay and bonuses were paid during the year ended 31 March 2015 (2013/14 £nil)

No long term performance pay and bonuses were paid during the year ended 31 March 2015 (2013/14 £nil)

** Individuals paid off payroll and not included within salary and pension entitlements below


Page | 39

Salary and pension entitlements of directors and senior managers (subject to audit)

The following schedules disclose further information regarding remuneration and pension entitlements.

Name and Title

Real in

cre

ase

in

pen

sio

n a

t

ag

e 6

0 (

ban

ds o

f £2

,50

0)

Real in

cre

ase

in

pen

sio

n l

um

p

su

m a

t ag

ed

60 (

ban

ds

of

£2,5

00)

To

tal acc

rued

pen

sio

n a

t ag

e

60 a

t 3

1st

Marc

h 2

015 (

ba

nd

s

of

£5,0

00)

Lu

mp

su

m a

t a

ge

60 r

ela

ted

to

accru

ed

pen

sio

n a

t 31

st

Marc

h 2

015 (

ban

ds o

f £5,0

00)

Cash

eq

uiv

ale

nt

tran

sfe

r valu

e

at

31st

Marc

h 2

014 (

to t

he

neare

st

£1,0

00)

Real in

cre

ase

in

cash

eq

uiv

ale

nt

tran

sfe

r v

alu

e (

to

the n

eare

st

£1,0

00)

Cash

eq

uiv

ale

nt

tran

sfe

r valu

e

at

31st

Marc

h 2

015 (

to t

he

neare

st

£1,0

00)

Em

plo

ye

r’s c

on

trib

uti

on

to

sta

keh

old

er

pen

sio

n

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

Conor Burke

Chief Accountable Officer * 0-2.5 2.5-5 15-20 55-60 294 31 333 nil

Sharon Morrow

Chief Operating Officer

32.5-

35

105-

107.5 35-40 105-110 22 683 705 nil

Tom Travers

Chief Finance Officer * 2.5-5 7.5-10 25-30 75-80 399 67 483 nil

Jacqui Himbury

Nurse Director * 0-2.5 2.5-5 10-15 40-45 218 32 256 nil

Marie Price

Director of Corporate Services * 2.5-5 - 10-15 - 91 (11) 82 nil

Rob Meaker

Programme Director Innovation * 0-2.5 2.5-5 25-30 75-80 334 33 376 nil

Jane Gateley

Director of Strategic Delivery * nil nil 20-25 70-75 392 11 413 nil

*Full remuneration as paid by Redbridge CCG.


Page | 40

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 (or other allowable beneficiary’s) pension

payable from the scheme. CETVs are calculated in accordance with the Occupational Pension

Schemes (Transfer Values) Regulations 2008.

Real Increase in CETV

This reflects the increase in CETV effectively funded by the employer. It takes account of the

increase in accrued pension due to inflation, contributions paid by the employee (including the value

of any benefits transferred from another scheme or arrangement) and uses common market

valuation factors for the start and end of the period.

Pensions

All staff, including senior managers, are eligible to join the NHS pensions scheme. The scheme has

fixed the employer’s contribution at 14% of the individual’s salary as per the NHS Pension Agency

regulations. Employee contribution rates for CCG officers and practice staff, and the prior year

comparators, are as follows:

Member contribution rates before tax relief (gross)

Full-time

pensionable

pay/earnings used to

determine

contribution rate

Contribution rate

(before tax relief)

2014/15 (gross)

Full-time

pensionable

pay/earnings used to

determine

contribution rate

Contribution rate

(before tax relief)

2015/16 (gross)

Up to £15,431.99 5.0% Up to £15,431.99 5.0%

£15,432.00 to

£21,387.99

5.6% £15,432.00 to

£21,477.99

5.6%

£21,388.00 to

£26,823.99

7.1% £21,478.00 to

£26,823.99

7.1%

£26,824.00 to

£49,472.99

9.3% £26,824.00 to

£47,845.99

9.3%

£49,473.00 to

£70,630.99

12.5% £47,846.00 to

£70,630.99

12.5%

£70,631.00 to

£111,376.99

13.5% £70,631.00 to

£111,376.99

13.5%

£111,377.00 and over 14.5% £111,377.00 and over 14.5%

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

Past and present employees are covered by the provisions of the NHS pension scheme. For full

details of how pension liabilities are treated please see note 4 in the annual accounts.

Termination agreements or 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


Page | 41

pension scheme. Specific termination arrangements will vary according to age, length of service

and salary levels. The remuneration committee will agree any severance arrangements.

The relationship between the highest-paid director and median remuneration (subject to audit)

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.

Barking and Dagenham CCG operates within an integrated management support structure with

Redbridge CCG and Havering CCG. Shared payroll costs are recharged between the three

organisations. Due to the efficient integrated management support structure in which the three

Clinical Commissioning Groups operate median pay is considerably lower than if not operating in

such a way.

The banded remuneration of the highest paid member of the Barking and Dagenham Clinical

Commissioning Group in the financial year 2014/15 was £105,000 to £110,000 (2013/14: £95,000 to

£100,000).

This was 8.59 (2013/14: 5.09) times the median remuneration of the workforce, which was £12,573

(2013/14: £19,301). The pay multiple has increased due to additional intake of staff within NHS

Redbridge CCG which have subsequently been recharged to NHS Barking & Dagenham CCG.

Remuneration ranged from £5,000 to £110,000 (2013/14: £5,000 to £100,000). The lower figure

relates to the amount attributable to the CCG for a single member of staff in the shared

management support structure.

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.

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, clinical commissioning groups must publish information

on their off-payroll engagements.

Number

Number of new engagements, or those that reached six months in duration,

between 1 April and 31 March 2015 for more than £220 per day 2

Number of new engagements which include contractual clauses giving NHS

Barking and Dagenham CCG the right to request assurance in relation to

income tax and National Insurance obligations

2

Number of whom assurance has been requested 2

Of which:

assurance has been received 2

assurance has not been received -

Engagements terminated as a result of assurance not being received -


Page | 42

Number of off-payroll engagements of board members, and/or senior officers

with significant financial responsibility, during the year -

Number of individuals that have been deemed ‘board members, and/or senior

officers with significant responsibility’ during the financial year. This figure

includes both off-payroll and on-payroll engagements

19

Number

Number of existing engagements as of 31 March for more than £220 per day

and that have lasted longer than six months 1

Of which, the number that have existed:

For less than one year at the time of reporting 1

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

For between 2 and 3 years at the time of reporting -

For between 3 and 4 years at the time of reporting -

For 4 or more years at the time of reporting -

Conor Burke

Accountable Officer

[ date]


Page | 43

1.4. Sustainability report

The clinical commissioning group is required to report its progress in delivering against sustainable

development indicators.

We are committed to promoting environmental and social sustainability through our actions as a

corporate body as well as a commissioner. Our procurement strategy requires us to consider our

providers approaches to sustainability and carbon management.

As part of our responsibility to the Social Value Act, we will consider local providers of our services

and suppliers of goods, and associated benefits for low emissions, local job creation, local business

prosperity, retention of CCG spending within the borough/BHR economy, and the wider local social

and economic benefits.

As part of our approach to waste minimisation and management we have systems in place in our

offices for the recycling of paper, plastic and glass. We introduced ‘Boardpad’ in January 2014

which enables governing body members to receive all agendas and papers electronically,

dramatically reducing the production of paper copies. Building on this we have further rolled out the

use of Boardpad, making it available to more staff and using it for more meetings. We encourage

staff to consider the environmental impact of their actions and have launched a dedicated intranet

and resource area for our workforce. In addition, video conferencing technology is now in use,

cutting down in the need for unnecessary travel to meetings.

The CCG's two year sustainability strategy and action plan have recently been agreed, with a report

on progress against actions in 2014/15. We have a sustainability champion at governing body level

- our Chief Officer - who will report on progress against our actions for the coming year in his regular

reports at the start of governing body meetings.

We are also required to report on sustainability in a standard format, developed by the NHS

Sustainability Development Unit. This requires input from NHS Property Services. We will publish

this report on our website when the data collection is complete.


Page | 44

1.5. Statement of accountable officer’s responsibilities

The National Health Service Act 2006 (as amended) states that each Clinical Commissioning Group

shall have an Accountable Officer and that Officer shall be appointed by the NHS Commissioning

Board (NHS England). NHS England has appointed Conor Burke to be the Accountable Officer of

the Clinical Commissioning Group.

The responsibilities of an Accountable Officer, including responsibilities for the propriety and

regularity of the public finances for which the Accountable Officer is answerable, for keeping proper

accounting records (which disclose with reasonable accuracy at any time the financial position of

the Clinical Commissioning Group and enable them to ensure that the accounts comply with the

requirements of the Accounts Direction) and for safeguarding the Clinical Commissioning Group’s

assets (and hence for taking reasonable steps for the prevention and detection of fraud and other

irregularities), are set out in the Clinical Commissioning Group Accountable Officer Appointment

Letter.

Under the National Health Service Act 2006 (as amended), NHS England has directed each Clinical

Commissioning Group to prepare for each financial year financial statements in the form and on the

basis set out in the Accounts Direction. The financial statements are prepared on an accruals basis

and must give a true and fair view of the state of affairs of the Clinical Commissioning Group and of

its net expenditure, changes in taxpayers’ equity and cash flows for the financial year.

In preparing the financial statements, the Accountable Officer is required to comply with the

requirements of the Manual for Accounts issued by the Department of Health and in particular to:

Observe the Accounts Direction issued by NHS England, including the relevant accounting and

disclosure requirements, and apply suitable accounting policies on a consistent basis;

Make judgements and estimates on a reasonable basis;

State whether applicable accounting standards as set out in the Manual for Accounts issued by

the Department of Health have been followed, and disclose and explain any material departures

in the financial statements; and,

Prepare the financial statements on a going concern basis.

To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my

Clinical Commissioning Group Accountable Officer Appointment Letter.

Conor Burke

Accountable Officer

[ date]


Page | 45

1.6. Governance statement

Introduction and Context

The clinical commissioning group 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 2014, the clinical commissioning group was licensed without conditions.

Scope of Responsibility

As Accountable Officer, I have responsibility for maintaining a sound system of internal control that

supports the achievement of the clinical commissioning group’s policies, aims and objectives, whilst

safeguarding the public funds and assets for which I am personally responsible, in accordance with

the responsibilities assigned to me in Managing Public Money. I also acknowledge my

responsibilities as set out in my Clinical Commissioning Group Accountable Officer Appointment

Letter.

I am responsible for ensuring that the clinical commissioning group is administered prudently and

economically and that resources are applied efficiently and effectively, safeguarding financial

propriety and regularity.

Compliance with the UK Corporate Governance Code

Whilst the detailed provisions of the UK Corporate Governance Code are not mandatory for public

sector bodies, compliance is considered to be good practice. This Governance Statement is

intended to demonstrate the clinical commissioning group’s compliance with the principles set out in

the Code (insofar as this applies to CCGs).

For the financial year ended 31 March 2015, and up to the date of signing this statement, we

complied with the provisions set out in the Code, and applied the principles of the Code.

The Clinical Commissioning Group Governance Framework

The National Health Service Act 2006 (as amended), at paragraph 14L(2)(b) states:

The main function of the governing body is to ensure that the group has made appropriate

arrangements for ensuring that it complies with such generally accepted principles of good

governance as are relevant to it.

Compliance with the UK Corporate Governance has been achieved as follows:

The Constitution

The constitution, which was approved by NHS England as part of the authorisation process in

March 2013 provides that it is the governing body which undertakes any functions not reserved or

otherwise delegated.

The scheme of delegation included in the constitution sets out those specific decisions that are

reserved for the Members’ Committee. These are as follows:

1. Make recommendations to the NHS Commissioning Board (now called NHS England) for

changes to the Constitution of the Group

2. Amending these Standing Orders and/or the Scheme of Delegation


Page | 46

3. Change the nature of the business of the Group or do anything inconsistent with the mission,

values and aims of the Group

4. Use any other name than that specified in Clause 1.1 of the Constitution in relation to the

activities of the Group

5. Merge, amalgamate or federate the Group with any other clinical commissioning group

6. Seek to remove any Member

7. Reorganise the boundaries of or change the organisational structure of the Group

8. Approve the arrangements for appointing and removing Clinical Directors to/from the

Governing Body

In 2014/15 a number of changes were made to the Constitution in line with new legislation enabling

CCGs to form joint committees with other CCGs, the local authority and NHS England. Members of

the CCG agreed to these changes, which were proposed to enable the CCG to establish formal joint

governance arrangements with the local authority with regard to the Better Care Fund and with

other CCGs with respect to delegated primary care commissioning. In the event, the CCG was able

to set up arrangements without need to establish joint committees, but it does retain the ability to do

so should this be necessary in future.

CCG Governance structure

The CCG governance structure was created to ensure that clinicians and patients were at the heart

of decision making whilst delivering on the following strategic objectives:

1. Improve health outcomes for children and young people in our borough

2. Improve access to and experience of primary care

3. Continued focus on development and success of the CCG – members, governing body and

staff

4. Improve the quality of care from services we commission

5. Improve the performance of urgent and emergency care, with particular focus at BHRUT

6. Strengthen community and mental health services, bringing more services to people closer

to home.

Objectives 4, 5 and 6 are shared corporate objectives across BHR CCGs.

The governance structure reflects the fact that there is a shared management team and operating

model supporting the three CCGs whilst maintaining the functions of each CCG it its own right as a

statutory body with local accountability.


Page | 47

Barking and Dagenham, Havering and Redbridge CCGs’ Governance structure

The Membership Body

The members’ committee consists of practice representatives, the Accountable Officer, the Chief

Operating Officer, the Chair of the governing body and the vice chair of the governing body.

The membership committee met five times during the year to review the CCG’s achievements and

challenges moving forward.

Member practices

Abbey Medical Centre 1 Harpour Road IG11 7RJ

Barking Group Practice 130 Upney Lane IG11 9LT

Becontree Medical Centre 645 Becontree Avenue RM8 3HP

Broad Street Medical Centre Morland Road RM10 9HU

Child and Family Doctors' Surgery 79 Axe Street IG11 7LX

Church Elm Lane Medical Centre Church Elm Lane RM10 9RR

Dewey Road Surgery 36 Dewey Road RM10 8AR

Faircross Health Centre 51 Upney Lane IG11 9LP

First Avenue Surgery 2 First Avenue RM10 9AT

Five Elms Medical Practice Five Elms Road RM9 5TT

Gables Surgery 50 Markyate Road RM8 2LD

Green Lane Surgery 872 Green Lane RM8 1BX

Halbutt Street Surgery 2 Halbutt Street RM9 5AS

Heathway Medical Centre 585 Heathway RM9 5AZ

Hedgemans Surgery 92 Hedgemans Road RM9 6HT

Highgrove Surgery 113-115 Marlborough Road RM8 2ES

John Smith Medical Centre 145-207 Bevan Avenue IG11 9NS

Julia Engwell Clinic Woodward Road RM9 4SR

King Edwards Medical Centre 1 King Edward's Road IG11 7TB


Page | 48

Laburnum Health Centre 11 Althorne Way RM10 7DF

Lawns Medical Care Lawn Farm Grove RM6 5LL

Longbridge Road Surgery 620 Longbridge Road RM8 2AJ

Marks Gate Health Centre Lawn Farm Grove RM6 5BJ

Markyate Surgery 50 Markyate Road RM8 2LD

Oval Road Practice 69 Oval Road North RM10 9ET

Parkview Medical Centre 199 Reede Road RM10 8EJ

Parsloes Avenue Surgery 370 Parsloes Avenue RM9 5QP

Porters Avenue Health Centre Porters Avenue RM8 2EQ

Ripple Road Surgery 364 -370 Ripple Road IG11 7RJ

Salisbury Avenue Medical Centre 7 Salisbury Avenue IG11 9XQ

Shifa Medical Practice Orchard Health Centre, Gasgoigne Road IG11 7RS

Thames View Health Centre Bastable Avenue IG11 0LG

Third Avenue Surgery 2 Third Avenue RM10 9BA

Tulasi Medical Centre 10 Bennetts Castle Lane RM8 3XU

Urswick Medical Centre Urswick Road RM9 6EA

Valence Medical Centre 563 Valence Avenue RM8 3RH

Victoria Medical Centre 1 Queens Road IG11 8GD

Victoria Road Surgery 60 Victoria Road IG11 8PY

White House Surgery 12 Movers Lane IG11 7UN

Membership body representatives

Dr Adedeji Dr Haider Dr N Teotia Dr M Ehsan

Dr Fateh Dr Kendal Dr Atal Dr Ola

Dr Isra Moghal Dr John Dr Mittal Dr Anju Gupta

Dr Alex Duodu Dr Sharma Dr Kalkat Dr Kalra

Dr F Bhatia Dr K Kashyap Dr Asma Moghal Dr Dallas

Dr Parveen Masud Dr Rai Dr Islam Dr Jagen

Dr Mohan Dr S Neal Dr Shah Dr Randhawa

Dr Ahmad Dr Bila Dr M Garcia Dr R Shama

Dr Pervez Dr Ghosh Dr A Arif Dr Lawrence

Dr Jaiswal Dr Chibber Dr Y Rashid Susan Neal

Dr Prasad Dr Ansari Dr A Annan Dr Nandra

Dr Niranjan Dr Goriparthi

The Governing Body

The clinical commissioning group governing body is comprised of clinical directors, appointed

members and officers who have the duty to ensure the CCG exercises its functions effectively,

efficiently and economically. The governing body takes responsibility for ensuring that the CCG


Page | 49

meets all its financial obligations, including accounting and auditing and performs its functions in a

way which provides good value for money.

The governing body met on six occasions in public. There was an annual planner for business items

and the agendas were structured to deal with performance, operations, engagement,

commissioning and strategy.

The key areas of focus for the Governing Body throughout 2014/15 were:

Oversight and delivery of the Operating Plan

Reporting on finance and activity information from commissioned health providers

Reporting on and oversight of CCG finances to ensure financial balance within the CCG

Reporting on and oversight on performance and quality issues within commissioned health

providers

Reporting on patient and public engagement in the work of the CCG

Commissioning and strategy opportunities with local commissioners and providers

The management of strategic risk through scrutiny of the Governing Body Assurance

Framework

Primary care transformation and new arrangements for co-commissioning

Compliance with CCG statutory duties

Minutes and reports from the committees of the Governing Body and working groups where

appropriate

The membership of the governing body is outlined below.

Clinical directors

Name Practice Role

Dr Waseem Mohi Markyate Surgery Chair of the CCG

Dr Arun Sharma* Laburnum Health Centre Clinical Director

Dr Thota Chandra Mohan Urswick Medical Centre Clinical Director

Dr Jagan John King Edward Medical Centre Clinical Director

Dr Ramneek Hara Urswick Medical Centre Clinical Director

Dr Gurkirit Kalkat Thames View Health Centre Clinical Director

Dr Ravali Goriparthi Tulasi Medical Centre Clinical Director

* In July 2014, Dr Sharma was seconded to a leadership role with the emerging Barking and

Dagenham GP Federation so did not take part in CCG business from that date.

The governing body appointed independent lay members as follows:

Name Role

Kash Pandya Vice Chair; Lay Member – Governance

Sahdia Warraich Lay Member – Patient and Public Involvement


Page | 50

The governing body appointed a Secondary Care Consultant as follows:

Name Role

Mr Tan Vandal Secondary Care Consultant

The local authority, the London Borough of Barking and Dagenham, is represented as follows:

Name Role

Anne Bristow Director of Adult Services

Matthew Cole Director of Public Health

The following senior managers are also members of the Governing Body:

Name Role

Conor Burke Chief Officer

Tom Travers* Chief Finance Officer

Jacqui Himbury Nursing Director

Sharon Morrow Chief Operating Officer

*appointed in May 2014, prior to which Martin Sheldon was interim Chief Finance Officer

The attendance records of members at governing body meetings is summarised below:

24 June 2014 Waseem Mohi, Arun Sharma, Gurkirit Kalkat, Jagan John, Ravali Goriparthi,

Sharon Morrow, Conor Burke, Tan Vandal, Kash Pandya, Sahdia Warraich,

Tom Travers, Jacqui Himbury

23 September 2014 Waseem Mohi, Gurkirit Kalkat, Jagan John, Ramneek Hara, Thota Chandra

Mohan, Sharon Morrow, Conor Burke, Tan Vandal, Kash Pandya, Sahdia

Warraich, Tom Travers, Jacqui Himbury

25 November 2014 Waseem Mohi, Gurkirit Kalkat, Ramneek Hara, Ravali Goriparthi, Thota

Chandra Mohan, Sharon Morrow, Conor Burke, Tan Vandal, Kash Pandya,

Sahdia Warraich, Tom Travers, Jacqui Himbury

11 December 2014 Waseem Mohi, Ravali Goriparthi, Jagan John, Ramneek Hara, Thota

Chandra Mohan, Sharon Morrow, Conor Burke, Tan Vandal, Sahdia

Warraich, Tom Travers, Jacqui Himbury

27 January 2015 Waseem Mohi, Gurkirit Kalkat, Ramneek Hara, Ravali Goriparthi, Thota

Chandra Mohan, Jagan John, Sharon Morrow, Conor Burke, Kash Pandya,

Sahdia Warraich, Tom Travers, Jacqui Himbury

24 March 2015 Waseem Mohi, Thota Chandra Mohan, Jagan John, Ravali Goriparthi,

Ramneek Hara, Conor Burke, Sharon Morrow, Tom Travers, Kash Pandya,

Sahdia Warraich, Jacqui Himbury, Tan Vandal


Page | 51

Assessment of the Governing Body’s performance

The governing body has considered a wide range of important issues over the past year, with

consensus on all decisions from members, but with robust discussion and consideration. In addition

members of the public have attended and at times provided input through the public Q&A session at

the beginning or end of the meeting.

As part of the twelve week OD review, the governing body at away days and through one to one

interviews with key members reviewed the effectiveness of current arrangements. In addition the

CCG sought external input and views on this, all of which were fed into the final recommendations

and plan which was approved by the Governing Body in March 2015. The general consensus was

that much was working well, with no need for radical change. One of the key recommendations was

that the CCG adopt a ‘Clinical Cabinet ‘model akin to that in local authorities with increased

presentation of papers to meeting by the clinical directors and greater support from officers. It was

also recommended that the CCG explore and build on options for further collaboration/ joint

decision making with the BHR CCGs – as with the December meeting of the three governing bodies

in common to decide on intermediate care services across the three boroughs.

Individual members have particularly highlighted the governing body's commitment to improve

patient care and experience and have mentioned the level of scrutiny and challenge at the

governing body meetings as effective. Several colleagues from individual and a number from all

three BHR CCG governing bodies said they thought the meeting in common in December was a

good example of how meetings on BHR-wide health issues could be managed in future. The overall

leadership in the meeting from clinical directors, level of debate and good public attendance was felt

to be a real plus.

In terms of development, the view was the high volume of papers at meetings needed to be looked

at, as well as ensuring that there was better integration of papers overall. Colleagues felt that wider

attendance at the meetings by local stakeholders and the public would be a good thing and

something to encourage for 2015/16. While it had started, there was a view that there should be a

greater discussion of the quality impact of QIPP schemes. Discussions on risks were felt to be

good, but an area to focus further on in 2015/16.

Committees of the Governing Body

The Governing Body has authority under the scheme of delegation to establish sub committees or

sub groups to enable it to fulfil its role. Each of the Governing Body Committees has terms of

reference and the roles of each are set out broadly below. Each Committee is authorised by the

Governing Body to pursue any activity within their terms of reference and within the scheme of

reservation and delegation of powers.

Audit and Governance Committee – meeting as one in common

The Committee’s terms of reference are referenced within the CCG’s Constitution and are available

on the CCG’s website. They cover the following areas:

Financial reporting

monitor the integrity of the CCG’s Financial Statements and any formal announcements

relating to CCG financial performance

ensure that the systems for financial reporting to the CCG, including those of budgetary

control, are subject to review as to completeness and accuracy of information provided to

the CCG


Page | 52

review the Annual Report and Financial Statements before submission to the Governing

Body

Management

request and review reports and assurances from directors, clinicians and managers on

overall arrangements for governance, risk management and internal control

request specific reports on individual functions as appropriate to overall arrangements

Integrated Governance, Risk Management and Internal Control

review the establishment and maintenance of an effective system of integrated governance,

risk management, internal control across all CCG activities that supports achievement of the

CCG objectives

the Committee’s work will dovetail with that of the Joint Quality and Safety Committee to

seek assurance that robust clinical quality is in place

utilise the work of internal and external audit and other assurance functions but the

Committee will not be limited to these sources

seek reports and assurances from directors and managers concentrating on the over-

arching systems of integrated governance, risk management and internal control, together

with indicators of their effectiveness. This will be evidenced through the Governing Body

Assurance Framework (GBAF) to guide its work

Internal Audit

ensure there is an effective internal audit function that meets mandatory NHS Internal Audit

Standards and provides appropriate independent assurance to the Committee, the

Accountable Officer and the Governing Body

External Audit

review the work and findings of the external auditors and consider the implications and

management responses to their work

Other assurance functions

review the findings of other assurance including reviews by regulators/inspectors e.g. CQC

and professional bodies with responsibility for performance of staff or functions, like Royal

Colleges

review the work of other CCG committees, including sub-committees, within the organisation

to ensure they are fulfilling their assurance function

Counter Fraud

the Committee shall satisfy itself that there are adequate arrangements in place for

countering fraud and shall approve the counter fraud work programme and review the

outcomes of counter fraud work


Page | 53

The membership of the committee is detailed below.

Name Role

Members





Charles Beaumont Co-opted Member, BHR CCGs




Tom Travers Chief Finance Officer, BHR CCGs

Sue Assar Interim Director of Corporate Services (April - September 2014)

Marie Price Director of Corporate Services (September 2014 to present)

Rob Meaker Director of Innovation, BHR CCGs

Mark Trevallion Local Counter Fraud Service, Baker Tilly

Nick Atkinson Internal Auditor, Baker Tilly

Kevin Lowe External Auditor, PricewaterhouseCoopers LLP


22 April 2014 Kash Pandya, Khalil Ali, Charles Beaumont, Ah-fee Chan, Richard Coleman,

Sahdia Warraich

27 May 2014 Kash Pandya, Sahdia Warraich, Khalil Ali, Tan Vandal, Charles Beaumont,

Richard Coleman

15 July 2014 Kash Pandya, Sahdia Warraich, Richard Coleman, Khalil Ali, Tan Vandal,

Charles Beaumont

9 September 2014 Kash Pandya, Sahdia Warraich, Richard Coleman, Khalil Ali, Ah-fee Chan,

Charles Beaumont

11 November 2014 Kash Pandya, Sahdia Warraich, Richard Coleman, Khalil Ali, Tan Vandal,

Charles Beaumont, Ah-fee Chan

13 January 2014 Kash Pandya, Sahdia Warraich, Khalil Ali, Tan Vandal, Ah-fee Chan, Charles

Beaumont, Richard Coleman


Page | 54

10 March 2014 Kash Pandya, Sahdia Warraich, Richard Coleman, Khalil Ali, Tan Vandal, Ah-

fee Chan, Charles Beaumont

Items for consideration by the Committee in 2014/15 were:

External Audit – The Annual Management Letters, Annual Plans and regular updates on

progress.

Internal Audit – Auditors provided Head of Internal Audit Opinions at year-end, Annual Plans

and regular updates on progress of audit reviews, final reports and an ongoing follow-up of past

internal audit recommendations.

Local Counter Fraud Service (LCFS) – Annual Plans with progress reports were provided that

included updates on new cases and follow–up of on-going cases. Assurances were received on

liaison with other agencies e.g. NHS Protect. Also provided were details of proactive work

undertaken to raise the awareness on fraud prevention and detection within the organisations.

Finance Exception report- The CFO provided regular updates on emerging financial risk and

risk mitigation. Matters covered included arbitration for an unpaid NHS debt, disputed Property

Services charges, RTT funding issues and national accounting treatment of Continuing Health

Care costs. There were regular updates on the monthly financial position/ budget out-turn in

addition to forecasts of year-end balance and new year allocations.

Procurement-The Committee held a specific workshop to consider the NELCSU draft

procurement plan in detail.

Information Governance (IG) – the Director of Innovation attended the Committee several

times to bring draft policies for consideration and comment together with updates on IG Toolkit

compliance. Members also sought assurance on the emergence and management of cyber-

fraud.

Risk Management and the GBAF - The Committee received an annual summary of the

effectiveness of processes followed in year.

Complaints- Members sought assurance on the whole system approach and trends.

Continuing Health Care Claims Management - Members regularly sought assurances on

effective processes for clinical assessment and claims handling.

Primary Care Transformation agenda- The Committee kept pace in year with new emerging

developments and governance arrangements for the PM Challenge Fund and the Better Care

Fund.

Co-commissioning- The Committee reviewed in detail the sample documentation in support of

the BHR collaborative submission to NHS England for delegated commissioning arrangements.

The Committee’s Terms of Reference would be reviewed to accommodate the anticipated

national approval.

Annual Governance Statements, Annual Reports, Annual Accounts - the Committee will be

reviewing in detail all three sets of CCG documentation in March, April and May 2015 in

preparation for sign-off by the three Governing Bodies on 27 May and submission to the NHS

England by the 29 May 2015 deadline.

Committee Effectiveness Review

In April the Committee set an annual comprehensive work-plan that covered many of the matters

outlined above but also allowed private meetings between Members and Members with auditors or

counter fraud leads. The Committee had a number of assurance issues to address in year and


Page | 55

when required, arranged more in depth discussion on issues of concern that were perceived as

risks to the CCGs meeting their objectives.

As recommended in the Audit Committee Members Handbook, Members have considered

Committee effectiveness this year. Their comments received included:

Things that went well

A wide range of topics were covered to assure the Governing Bodies and workshops were

arranged where appropriate

The Committee covered business of three CCGs effectively and without conflict and gained

good assurances on financial processes and probity

The Committee laid the foundation for managing conflicts of interest through their early

involvement with the new co-commissioning agenda

Next steps

The Audit Committee’s priorities for 2015/16 will be:

Monitoring the implementation of delegated co-commissioning arrangements, including those for

managing potential conflicts of interests.

Reviewing the development of procurement strategies, plans and monitoring arrangements.

Reviewing the arrangements for improving the quality of data from providers.

Preparing for the proposed ‘fit and proper person’ test

Building on feedback received, continue to improve the effectiveness of the Committee.

Quality and Safety Committee – meeting as one in common

The Committee shall provide oversight and give assurance to the governing body that it is assured

on quality of services commissioned, patients’ experience, specific quality improvement initiatives

and any serious failure in quality as set out below.

The Committee shall seek assurance that the commissioning strategy for the clinical commissioning

group fully reflects all elements of quality (patient experience, effectiveness and patient safety)

which will include:

Commissioning strategy for safeguarding adults and ensure systems are in place to embed

safeguarding into all contracting and procurement processes.

Strategic, developmental and policy matters and risk relating to the quality and safety agenda, in

terms of clinical effectiveness, patient safety and patient experience.

Quality and safety risks on the GBAF and recommend courses of action to the executive

committee and governing body.

Assurance that the outcomes of Serious Incident and Never Event investigations are acted upon

and learning taken forward.

Reports relating to inequalities in access to healthcare services, quality and outcomes.

Reports that identify indicators in the Commissioning Outcomes Framework where there is

scope for local quality improvement.

Reports which benchmark improvements in quality and outcomes using the Commissioning

Outcomes Framework and other intelligence.

Provider quality assurance framework to identify all quality and patient safety issues at the

earliest opportunity.


Page | 56

Quality and safety issues arising from redesign of services and/or pathways to deliver improved

outcomes

Any payment arrangements for providers linked to quality and outcomes (e.g. through the

CQUIN scheme).

Summary reports on any regulatory action taken against the CCG and its commissioned

services.

Reports on complaints, claims and incidents for Barking and Dagenham Clinical Commissioning

Group.

Receive assurance from its sub-committee – this covers in detail risks and concerns relating to

safeguarding children and adults.

To approve relevant policies, such as the policy for procedures of limited clinical effectiveness.

To approve patient group directions.


Name Role

Members

Mr Tan Vandal (Chair) Secondary Care Consultant, BHR CCGs (until March 2015)


Sharon Morrow Chief Operating Officer, Barking and Dagenham CCG

Alan Steward Chief Operating Officer, Havering CCG

Louise Mitchell Chief Operating Officer, Redbridge CCG

Jacqui Himbury Nurse Director, BHR CCGs

Dr Ravali Goriparthi Clinical Director, Barking and Dagenham CCG

Dr Thota Chandra Mohan Clinical Director, Barking and Dagenham CCG

Dr Ashok Deshpande Clinical Director, Havering CCG

Dr Ann Baldwin Clinical Director, Havering CCG

Dr Sarah Heyes Clinical Director, Redbridge CCG

Dr Samia Azeem Clinical Director, Redbridge CCG


Diane Jones Deputy Nurse Director, BHR CCGs


1 April 2014 Tan Vandal, Ah-fee Chan, Sharon Morrow, Sarah Heyes, Jacqui Himbury

10 June 2014 Tan Vandal, Ah-fee Chan, Sharon Morrow, Louise Mitchell, Sarah Heyes,

Samia Azeem


Page | 57

5 August 2014 Tan Vandal, Jacqui Himbury, Sarah Heyes, Ravali Goriparthi, Thota Chandra

Mohan, Alan Steward

7 October 2014 Tan Vandal, Ah-fee Chan, Samia Azeem, Ravali Goriparthi, Sarah Heyes,

Jacqui Himbury, Louise Mitchell, Sharon Morrow, Alan Steward

9 December 2014 Tan Vandal, Sharon Morrow, Alan Steward, Sarah Heyes, Ah-fee Chan,

Samia Azeem

5 February 2015 Tan Vandal, Sharon Morrow, Thota Chandra Mohan, Jacqui Himbury, Ashok

Deshpande, Louise Mitchell, Sarah Heyes, Samia Azeem

The following key topics were discussed by the Committee in 2014/15:

Terms of Reference review

Committee effectiveness review

Quality Framework

Francis report implementation

Children and adults safeguarding framework

Care home quality assurance framework

Serious incident (SI) trends and non-serious incident reporting

BHRUT and Barts Assurance processes

Reports on quality assurance visits

Contract Risk stratification

Continuing Health Care quality assurance

RTT backlogs and risk

A GP alert system

Review of Individual Funding Request process

Policy approval for Lone Working, Quality Impact Assessment, Safeguarding -Supervision

and Training


To ensure effectiveness and compliance with any new national requirements the Committee carried

out a thorough review of its terms of reference mid-year. The changes made were agreed at the

November 2014 Governing Bodies. With particular regard to the special measures placed on local

Trusts the Committee is undertaking a further review of Member’s individual perceptions of the

value and effectiveness of the Committee to ensure a robust approach is taken going forward in

2015/16. The outcome of this review will be discussed at the June 2015 meeting.

Remuneration and Workforce Committee – meeting as one in common

The main purpose of the committee is to make recommendations to the governing body on

determinations about pay and remuneration for employees of the CCG and people who provide

services to the CCG and allowances under any pension scheme it might establish as an alternative

to the NHS pension scheme.

The committee’s duties also include:

Determining the remuneration and conditions of service of the senior team


Page | 58

Reviewing the performance of the AO and other senior team members and determining

annual salary awards, if appropriate

Considering the severance payments of the AO and other senior staff, seeking HM Treasury

approval as appropriate in accordance with the guidance ‘Managing Public Money’

Consider other workforce issues and receive reports on HR related issues – such as

sickness, turnover etc.

Consider and review succession planning arrangements for the CCG.

Name Role

Members





Mr Tan Vandal Secondary Care Consultant, BHR CCGs


Dr Waseem Mohi Chair, Barking and Dagenham CCG

Dr Atul Aggarwal Chair, Havering CCG

Dr Anil Mehta Chair, Redbridge CCG



Marie Price Director of Corporate Services (from September 2014)

Sue Assar Interim Director of Corporate Services (to September 2014)

Martin Hayes Head of Human Resources, NEL CSU


6 May 2014 Kash Pandya, Sahdia Warraich, Richard Coleman, Khalil Ali, Ah-fee Chan,

Waseem Mohi, Anil Mehta

15 July 2014 Kash Pandya, Sahdia Warraich, Richard Coleman, Khalil Ali, Tan Vandal, Anil

Mehta

9 September 2014 Kash Pandya, Sahdia Warraich, Richard Coleman, Khalil Ali, Ah-fee Chan,

Atul Aggarwal, Waseem Mohi, Anil Mehta

11 November 2014 Kash Pandya, Sahdia Warraich, Richard Coleman, Khalil Ali, Tan Vandal, Ah-

fee Chan, Anil Mehta, Atul Aggarwal


Page | 59

3 February 2015 Kash Pandya, Sahdia Warraich, Khalil Ali, Anil Mehta, Atul Aggarwal, Tan

Vandal

10 March 2015 Kash Pandya, Sahdia Warraich, Richard Coleman, Khalil Ali, Tan Vandal, Ah-

fee Chan, Atul Aggarwal, Waseem Mohi, Anil Mehta


HR policies

Contractual and payment arrangements

Senior staff and office holder remuneration

Performance management

OD plans

Finance and Delivery Committee

The main purpose of the committee is to provide assurance to the governing body that there are

robust and integrated mechanisms in place to ensure detailed review and oversight of the CCG’s

financial position. The committee’s role is to:

Review and consider the financial and delivery plans and make recommendations to the

governing body.

Review significant risks identified by the Committee, the Chief Finance Officer, Executive or

Governing Body. Facilitate deep dives into Finance and Activity Data where required.

Report to the governing body on the overall status of financial and operational performance,

assessing potential shortfalls and risks and recommend governing body level mitigating

actions to address them.

Review plans and progress reports on the delivery of QIPP initiatives and ensure that plans

are supported by robust activity and financial information. Review in detail QIPP schemes

that have been escalated to the group as high risk, and ensure that mitigating actions are in

place to enable recovery.

Receive reports on progress against action plans already in place.

Review and consider detailed monitoring reports and year end forecasts relating to financial

performance and performance of the CCG against core standards, national and local targets

and the operating plan as required.


Name Role

Members

Dr Arun Sharma (Chair

until July 2014) Clinical Director, Barking and Dagenham CCG

Dr Waseem Mohi (Chair

from July 2014) Chair, Barking and Dagenham CCG

Dr Gurkirit Kalkat Clinical Director, Barking and Dagenham CCG



Page | 60

Martin Sheldon Interim Chief Finance Officer, Barking and Dagenham CCG (until 30

April 2014)

Tom Travers Chief Finance Officer, Barking and Dagenham CCG (from 1 May

2014)

Kash Pandya Lay Member (Governance), BHR CCGs


22 April 2014 Arun Sharma, Waseem Mohi, Kash Pandya, Martin Sheldon

4 September 2014 Waseem Mohi, Kash Pandya, Sharon Morrow, Rob Adcock (Deputy

Chief Finance Officer)

21 October 2014 Waseem Mohi, Kash Pandya, Tom Travers, Sharon Morrow, Gurkirit

Kalkat

2 December 2014 Waseem Mohi, Kash Pandya, Tom Travers, Sharon Morrow

17 February 2015 Gurkirit Kalkat, Sharon Morrow, Kash Pandya, Rob Adcock (Deputy

Chief Finance Officer)

The following key topics were discussed by the Committee in 2014/15: -

Finance and delivery risk – including specialist commissioning funding transfers; premises costs;

contracts update; continuing care; running costs budget; legacy balance transfers,

RTT backlogs

Progress on delivery of 2014/15 QIPP initiatives

Escalated exception reports on QIPP schemes that were off target e.g. A&E attendance,

Diagnostics Demand Management, contracts position and Deep Dives into areas of over and

under performance

Risk register

Committee effectiveness review


In the last Annual Report of the Committee it was proposed that the Committee’s Terms of

Reference be reviewed in the context of Member’s views on Committee effectiveness and added

value to the CCG in 2013/14. Members wished to strengthen their assurance role, focus on key

financial risk, invite additional participants, increase the quorum and ensure no duplication of work

with other Committees.

It was agreed that there would be focus on significant risk identified by the Committee, Executive

Committee or Governing Body with deep dives planned into finance and delivery data by the

Finance and Delivery Committee. An escalation pathway from QIPP to the Finance and Delivery

Committee was introduced for schemes at risk of delivery and mitigating action plans were provided

for agreement. This allowed further detailed scrutiny by the Committee and feedback to the

Executive and Governing Bodies has been strengthened.

The Committee agreed changes to the Terms of Reference to emphasise focus on key financial risk

areas and these were ratified at the November Governing Bodies.


Page | 61

At the April Committee meetings Members will receive this draft Annual report and comment on the

effectiveness of changes made to the Terms of Reference in November and agree a work

programme for 2015/16.

Joint Executive Team

The terms of reference for the JET are as follows:

The JET sub-committee is a committee of the CCG governing body in accordance with the

CCG’s constitution

The purpose of the JET sub-committee is to facilitate joint arrangements between the three BHR

CCGs (Barking and Dagenham, Havering and Redbridge CCGs)

All three executive committee members of the CCGs meet together to monitor and continuously

review the implementation of system wide commissioning programmes

The sub-committee cannot make commissioning investment or policy decisions but is there to

hold each other to account and take action to ensure the delivery of previously agreed

collaborative plans including integrated care, acute reconfiguration and urgent care

Lead CCGs assure other CCGs on lead commissioning and contract management

arrangements discussing and informing action to mitigate key risks

The committee reviews key policy recommendations arising from collaborative areas, making

recommendations to individual CCG governing bodies and/or executive committees.


Name Role


Jacqui Himbury Nurse Director, BHR CCGs

Martin Sheldon Interim Chief Finance Officer, BHR CCGs (until 30 April 2014)

Tom Travers Chief Finance Officer, BHR CCGs (from 1 May 2014)

Marie Price Director of Corporate Services, BHR CCGs (from September 2014)

Sue Assar Interim Director of Corporate Services, BHR CCGs (to September

2014)


Alan Steward Chief Operating Officer, Havering CCG

Louise Mitchell Chief Operating Officer, Redbridge CCG

Jane Gateley Director of Strategic Delivery, BHR CCGs

Sarah See Programme Director - Primary Care Improvement (from March 2014)

Dr Waseem Mohi * Clinical Director, Barking and Dagenham CCG

Dr Arun Sharma Clinical Director, Barking and Dagenham CCG (on secondment from

July 2014)


Page | 62

Name Role

Dr Thota Chandra

Mohan Clinical Director, Barking and Dagenham CCG

Dr Gurkit Kalkat Clinical Director, Barking and Dagenham CCG

Dr Jagan John Clinical Director, Barking and Dagenham CCG

Dr Rami Hara Clinical Director, Barking and Dagenham CCG


Dr Atul Aggarwal * Clinical Director, Havering CCG

Dr Alex Tran Clinical Director, Havering CCG

Dr Ann Baldwin Clinical Director, Havering CCG

Dr Maurice Sanomi Clinical Director, Havering CCG

Dr Gurdev Saini Clinical Director, Havering CCG

Dr Ashok Deshpande Clinical Director, Havering CCG

Dr Ranjan Adur Clinical Director, Havering CCG

Dr Anil Mehta * Clinical Director, Redbridge CCG

Dr Sarah Heyes Clinical Director, Redbridge CCG

Dr Jyoti Sood Clinical Director, Redbridge CCG

Dr Syed Raza Clinical Director, Redbridge CCG

Dr Shabana Ali Clinical Director, Redbridge CCG

Dr Muhammad Tahir Clinical Director, Redbridge CCG

Dr Samia Azeem Clinical Director, Redbridge CCG

Dr Chidi Okorie Clinical Director, Redbridge CCG

Dr Mehul Mathukia Clinical Director, Redbridge CCG

Dr Heath Springer Clinical Director, Redbridge CCG

* Rotate as chair


3 April 2014 Arun Sharma, Atul Aggarwal, Anil Mehta, Sarah Heyes, Jyoti Sood, Syed

Raza, Shabana Ali, Mehul Mathukia, Maurice Sanomi, Heath Springer, Conor

Burke, Jacqui Himbury, Martin Sheldon, Louise Mitchell, Alan Steward,

Sharon Morrow

8 May 2014 Waseem Mohi, Ravali Goriparthi, Arun Sharma, Ramneek Hara, Atul

Aggarwal, Ranjan Adur, Anil Mehta, Sarah Heyes, Joyti Sood, Syed Raza,

Shabana Ali, Muhammad Tahir, Chidi Okorie, Heath Springer, Conor Burke,


Page | 63

Tom Travers, Martin Sheldon, Louise Mitchell, Alan Steward, Sharon Morrow,

Jane Gateley, Sarah See

12 June 2014 Waseem Mohi, Arun Sharma, Ramneek Hara, Atul Aggarwal, Alex Tran, Ann

Baldwin, Ranjan Adur, Anil Mehta, Sarah Heyes, Jyoti Sood, Shabana Ali,

Muhammad Tahir, Mehul Mathukia, Maurice Sanomi, Gurdev Saini, Heath

Springer, Conor Burke, Tom Travers, Martin Sheldon, Louise Mitchell, Alan

Steward, Sharon Morrow, Sarah See

10 July 2014 Arun Sharma, Ramneek Hara, Alex Tran, Ann Baldwin, Ranjan Adur, Anil

Mehta, Sarah Heyes, Jyoti Sood, Syed Raza, Muhammad Tahir, Samia

Azeem, Chidi Okorie, Mehul Mathukia, Maurice Sanomi, Heath Springer,

Conor Burke, Jacqui Himbury, Alan Steward, Sharon Morrow, Sarah See

11 September 2014 Waseem Mohi, Jagan John, Ramneek Hara, Atul Aggarwal, Alex Tran, Anil

Mehta, Sarah Heyes, Syed Raza, Shabana Ali, Muhammad Tahir, Samia

Azeem, Conor Burke, Jacqui Himbury, Tom Travers, Martin Sheldon, Marie

Price, Louise Mitchell, Alan Steward, Sharon Morrow, Jane Gateley, Sarah

See

16 October 2014 Waseem Mohi, Ravali Goriparthi, Thota Chandra Mohan, Jagan John,

Ramneek Hara, Atul Aggarwal, Alex Tran, Ann Baldwin, Ranjan Adur, Anil

Mehta, Sarah Heyes, Syed Raza, Shabana Ali, Muhammad Tahir, Chidi

Okorie, Maurice Sanomi, Gurdev Saini, Ashok Deshpande, Heath Springer,

Conor Burke, Jacqui Himbury, Tom Travers, Martin Sheldon, Marie Price,

Alan Steward, Sharon Morrow, Jane Gateley

13 November 2014 Waseem Mohi, Ravali Goriparthi, Thota Chandra Mohan, Atul Aggarwal,

Ranjan Adur, Anil Mehta, Sarah Heyes, Jyoti Sood, Muhammad Tahir, Samia

Azeem, Ashok Deshpande, Conor Burke, Tom Travers, Louise Mitchell, Alan

Steward, Sharon Morrow, Jane Gateley, Sarah See

11 December 2014 Waseem Mohi, Ravali Goriparthi, Thota Chandra Mohan, Jagan John,

Ramneek Hara, Atul Aggarwal, Anil Mehta, Sarah Heyes, Shabana Ali,

Muhammad Tahir, Samia Azeem, Mehul Mathukia, Maurice Sanomi, Ashok

Deshpande, Heath Springer, Conor Burke, Jacqui Himbury, Tom Travers,

Marie Price, Alan Steward, Sharon Morrow, Jane Gateley, Sarah See

15 January 2015 Jagan John, Sharon Morrow, Gurdev Saini, Ann Baldwin, Ranjan Adur, Alex

Tran, Alan Steward, Sarah Heyes, Chidi Okorie, Muhammad Tahir, Shabana

Ali, Conor Burke, Jane Gateley, Jacqui Himbury, Marie Price, Tom Travers

12 March 2015 Waseem Mohi, Thota Chandra Mohan, Jagan John, Ramneek Hara, Atul

Aggarwal, Ranjan Adur, Anil Mehta, Sarah Heyes, Joyti Sood, Muhammad

Tahir, Samia Azeem, Mehul Mathukia, Maurice Sanomi, Tom Travers, Marie

Price, Alan Steward, Jane Gateley


Page | 64


Collaborative risk assurance

Collaborative contract assurance

Planned care

Urgent care

Commissioning plans

Primary care

Cancer priorities

Mental Health transformation

Innovation

Executive Committee

The purpose of the executive committee is to oversee a number of functions for the governing

body. It will oversee operational delivery, budgets and development of strategy for the CCG. The

committee’s role is to:

Develop and monitor delivery of CCG operating, business, QIPP and commissioning plans

Propose arrangements to minimise clinical risk, maximise patient safety and to secure

continuous improvement in quality and patient outcomes

Ensure that the CCG has regard to the need to reduce inequalities, access to, and the

outcomes from healthcare

Propose joint working with other CCGs, the local authority and other partner organisations

where collaborative approaches will yield tangible improvements and/or efficiencies

Exercise good budget management, including regular monitoring of financial performance

and agree mitigating actions where required

Exercise good asset management

Oversee service transformation and pathway redesign

Monitor and provide assurance to the governing body of provider quality, through monitoring

and acting on performance information

Oversee process for developing and approving contracts for service delivery, commissioning

support and corporate support

Ensure regular engagement and two-way flow with member practices

Identify, review and mitigate operational risks

Will receive reports/minutes from the area prescribing committee that it has established as a

sub-committee as agreed by the governing body.

Name Role

Members

Dr Waseem Mohi Chair and Clinical Director, Barking and Dagenham CCG

Dr Arun Sharma Clinical Director, Barking and Dagenham CCG (on

secondment from July 2014)

Dr Gurkirit Kalkat Clinical Director, Barking and Dagenham CCG


Page | 65

Name Role


Dr Ramneek Hara Clinical Director, Barking and Dagenham CCG

Dr Jagan John Clinical Director, Barking and Dagenham CCG

Dr Thota Chandra Mohan Clinical Director, Barking and Dagenham CCG


Conor Burke Accountable Officer, Barking and Dagenham CCG

Martin Sheldon Interim Chief Finance Officer, Barking and Dagenham CCG

(until 30 April 2014)

Tom Travers Chief Finance Officer, Barking and Dagenham CCG (from 1

May 2014)

Jacqui Himbury Nurse Director, Barking and Dagenham CCG


24 April 2014 Waseem Mohi, Arun Sharma, Gurkirit Kalkat, Ramneek Hara, Jagan

John, Thota Chandra Mohan, Sharon Morrow, Martin Sheldon, Conor

Burke, Jacqui Himbury

29 May 2014 Waseem Mohi, Arun Sharma, Gurkirit Kalkat, Ramneek Hara, Jagan

John, Ravali Goriparthi, Sharon Morrow, Conor Burke, Jacqui

Himbury, Tom Travers

31 July 2014 Waseem Mohi, Gurkirit Kalkat, Ramneek Hara, Thota Chandra

Mohan, Sharon Morrow, Conor Burke

28 August 2014 Waseem Mohi, Jagan John, Ramneek Hara, Thota Chandra Mohan,

Sharon Morrow, Conor Burke, Jacqui Himbury

30 October 2014 Thota Chandra Mohan, Ramneek Hara, Jagan John, Ravali

Goriparthi, Sharon Morrow, Conor Burke, Tom Travers

18 December 2014 Waseem Mohi, Gurkirit Kalkat, Jagan John, Chandra Mohan, Ravali

Goriparthi, Conor Burke, Tom Travers

26 February 2015 Waseem Mohi, Ramneek Hara, Jagan John, Thota Chandra Mohan,

Ravali Goriparthi, Sharon Morrow, Conor Burke, Jacqui Himbury, Rob

Adcock (Deputy Chief Finance Officer)


Strategy development (e.g. urgent care)

Commissioning intentions

Finance

QIPP


Page | 66

Service reviews and developments

Partnership working

Risk and assurance

Operating plan

Barking and Dagenham CCG Meetings Attendance

Member’s name Role

No of GB and

its committee

meetings

attended

Dr Waseem Mohi Chair and Clinical Director, Barking and Dagenham CCG 29 / 34

Dr Gurkirit Kalkat Clinical Director, Barking and Dagenham CCG 10 / 28

Dr Thota Chandra

Mohan Clinical Director, Barking and Dagenham CCG 17 / 29

Dr Jagan John Clinical Director, Barking and Dagenham CCG 16 / 23

Dr Ravali

Goriparthi Clinical Director, Barking and Dagenham CCG 15 / 29

Dr Arun Sharma Clinical Director, Barking and Dagenham CCG (on

secondment from July 2014) 8 / 8

Dr Ramneek Hara Clinical Director, Barking and Dagenham CCG 17 / 23

Sahdia Warraich Lay Member, Barking and Dagenham CCG 19 / 19

Kash Pandya Vice Chair; Lay Member, BHR CCGs 40 / 43

Charles Beaumont Co-opted Independent Lay Audit Committee Member, BHR

CCGs 7/7

Tan Vandal Secondary Care Consultant, BHR CCGs (until March 2014) 25 / 30

Sharon Morrow Chief Operating Officer, Barking and Dagenham CCG 31 / 34

Conor Burke Accountable Officer, BHR CCGs 39 / 47

Martin Sheldon Interim Chief Finance Officer, BHR CCGs (until 30 April

2014) 6 / 6

Tom Travers Chief Finance Officer, BHR CCGs (from 1 May 2014) 53 / 55

Jacqui Himbury Nurse Director, BHR CCGs 44 / 53

The Clinical Commissioning Group Risk Management Framework

The CCG recognises that the establishment of effective risk management systems is fundamental to

ensuring effective governance. It has a risk management assurance framework (RMF) in place, the

aim of which is to continually improve the quality of health service commissioning through the

identification, prevention, control and containment of risks of all kinds. It is based on good practice

and DH guidance. The RMF supports the assessment and management of risk throughout the

organisation through a defined structure and clear systems and processes.


Page | 67

This risk management framework applies to all members and employees, permanent or temporary,

of the CCG.

Barking and Dagenham CCG

Corporate objectives

Clinical Commissioning Group

Governing body assurance framework

(GBAF)

Borough risk register

Including common collaborative BHR

risks on a shared CCGs’ risk register

Locality

risk register

Practice Practice Practice

Locality

risk register

Locality

risk register

Locality

risk register






Quality

Finance

Corporate

Strategic



The risk management structure of the CCG is shown below

Ris

k id

en

tifi

ca

tio

n

Example risks:

Initiative specific

Service transformation

Projects/programme

QIPP

Example risks:

Engagement

Referral

Local provider affecting

secondary care

Some risks go up to

the CCG GBAF from

the risk register

Risks that are

sufficiently managed

move from the

GBAF to the risk

register

Innovation/

GPIT

Primary care

The risk management structure shows the high level linkages between the operational level risks,

(categorised as risks that are managed at a locality or cluster level) and the strategic risks

(managed at senior organisational or CCG governing body level). Risks are identified via a number

of methods:

Proactive risk assessments

Incident reports (including ‘serious incidents’ and ‘never events’)


Page | 68

Complaints

Audits

Serious case reviews

Feedback from Healthwatch and the Patient Engagement Forum

Health Scrutiny Committee

Service improvement programmes

Risk Management is embedded within the organisation in the following ways:

The Governing Body Assurance Framework is presented to every meeting of the Governing

Body and is presented at the top of the agenda to provide context for later items related to

finance, quality, performance, commissioning and strategy.

Declarations of conflicts of interest features at the start of each Governing Body meeting and

the register of interests included at the start of the agenda.

The register of interests is reviewed by the Audit and Governance Chair

The integrated risk management framework is available on the staff intranet. Together with

the CCG’s policies in relation to standards of business conduct, conflicts of interest, gifts and

hospitality, whistleblowing and fraud prevention.

All reports to the Governing Body, Audit and Governance and other committees require a

coversheet which asks document authors to consider the following:

Risk implications

Impact on equality and diversity

Resource/ Investment requirements

The borough risk register is built up from a locality or cluster level risk register which is

reviewed monthly with clinical leads and practice improvement managers prior to being

presented to the CCG’s Executive Committee.

The CCG works collaboratively with two other CCGs and where risks are common across the

three organisations. These are recorded on a collaborative risk register that is reviewed on a

monthly basis at the CCGs’ joint management meeting. These risks then form part of the

borough risk registers.

Based on criteria set out in the risk management framework and the current risk rating,

significant risks are escalated from the borough risk register to the GBAF. Some of the risks

that are rated as extreme risks (red rated) are escalated to the GBAF where that risk is deemed

to pose a significant threat to the achievement of the CCG’s corporate objectives. Other

factors are also taken into consideration, such as risks that are common to a number of

departments/functions/GP practices or CCGs in the BHR health economy. Also risks where

additional controls have not succeeded in reducing the risk grading are factored in.

The risk management scoring system is used systematically in each review of the risk

register. This ensures that risks are escalated appropriately to the GBAF. Risks escalated to

the GBAF are reviewed with the relevant director prior to Governing Body meetings.

The Audit and Governance Committee periodically reviews the management process that is

in place for the management of risks and receives reports on specific emerging risks and risk

mitigation.

Prevention and deterrence of risk has been promoted through staff training and development

sessions for Governing Body members. This has included specific training on counter fraud and

conflicts of interest.


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The Clinical Commissioning Group Internal Control Framework

A system of internal control is the set of processes and procedures in place in the clinical

commissioning group to ensure it delivers its policies, aims and objectives. It is designed to identify

and prioritise the risks, to evaluate the likelihood of those risks being realised and the impact should

they be realised, and to manage them efficiently, effectively and economically.

The system of internal control allows risk to be managed to a reasonable level rather than

eliminating all risk; it can therefore only provide reasonable and not absolute assurance of

effectiveness.

The GBAF is the key control measure used in the management of risk.

The strategic objectives of the clinical commissioning group were set by the governing body in June

2014. From these objectives, the main risks to their achievement were identified in order to build up

the GBAF and a lead director identified to take responsibility for the management of each risk. This

process has been in place since June 2013. The GBAF is refreshed at least five times during the

year through meetings with the lead director and senior manager risk leads. At these meetings the

risk and mitigation is reviewed in detail and the rating updated. This then feeds into the GBAF report

which is presented at each GB meeting by the Chief Operating Officer. The risk management

process is also periodically reviewed by the Audit and Governance Committee who have sought

further assurance where necessary on emerging risks and mitigation.

The organisation's ‘risk appetite’, is captured by the ‘target risk rating’ for each risk on the GBAF.

In addition risk is explicitly discussed and mitigation reviewed at the following meetings:

Cluster/locality meetings for identification and recording of cluster/locality risks

Senior management team meetings for identification and recording of borough risks

Monthly meeting with chief operating officers and risk lead for common risks

Common risks reviewed at BHR CCGs’ weekly joint management team meetings

Joint executive committee

CCG executive committee meetings

CCG finance and delivery meetings

CCG quality and safety committee

CCG audit and governance committee

CCG governing bodies

The process in place ensures that there are regular forums to collaboratively review the common

risks, raise new risks, discuss and constructively challenge the effectiveness of the mitigating

actions and suggest changes as appropriate.

The management processes for the GBAF were reviewed by the internal auditors twice in

2013/14.Both reports were satisfactory. Recommendations and examples of best practice from were

put forward to make the management of risk and the GBAF more effective. These recommendations

were fully implemented as part of GBAF for 2014/15. Internal audit conducted a review to assess

whether the process was working well in terms of controls and assurances, looking at a number of

key risks. The result was a fully compliant rating, with no further recommendations.


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Information

The NHS Information Governance Framework sets the processes and procedures by which the

NHS handles information about patients and employees, in particular personal identifiable

information. The NHS Information Governance Framework is supported by an information

governance toolkit and the annual submission process provides assurances to the clinical

commissioning group, other organisations and to individuals that personal information is dealt with

legally, securely, efficiently and effectively.

Information governance is considered a priority for the CCG. High importance is placed on ensuring

that there are robust information governance systems and processes in place to help protect patient

and corporate held information. An information governance framework has been established and

work is continuing on processes and procedures in line with the information governance toolkit.

There is an overarching Information Governance Policy, Information Security Policy, Data Protection

and Confidentiality Policy and Information Lifecycle Management Policy in place. These are

available on the staff intranet. We have ensured that all staff members undertake annual basic

information governance training. Staff with additional/specialist IG responsibilities have also

undertaken additional IG training. All staff have been issued with an information governance

guidance handbook and other supporting materials to ensure that they are fully aware of their

information governance related responsibilities. We have implemented the Senior Information Risk

Owner (SIRO) framework and have designated responsibilities to Information Asset Owners and

Administrators to ensure all patient identifiable data flows are mapped and our information assets

are managed effectively, accurate recorded and kept within an accurate and up to date information

asset register.

There are processes in place for incident reporting and the investigation of information governance

serious incidents. These are classified as serious incidents requiring investigation (SIRIs). We are

continuing to develop further our information risk assessment and management procedures and a

programme has been established to fully embed an information risk culture throughout the

organisation.

Risk Assessment in Relation to Governance, Risk Management and Internal

Control

The risk management framework sets out how risk is assessed and managed. There is a clear

process and criteria for both the escalation and de- escalation of risk. The GBAF describes our

major risks, the most serious ones in 2014/15 have been BHRUT performance improvement and

continuing healthcare backlog, which was de-escalated in January 2015 following successful action

on the CCG’s part. The mitigating actions to manage the remaining GBAF risk on BHRUT are set

out below:

BHRUT performance improvement includes the following risks: BHRUT 18 weeks RTT and poor

cancer performance against the 62 days waiting times.

Management and mitigation:

BHRUT being held to account by via weekly operational performance monitoring meetings,

escalated to monthly strategic review, reporting to the CCG governing body, quality and safety

committee and CCG executive committee

Agreed remedial action plans in place (with TDA / CQC / NHS England and CCGs) with monthly

whole system oversight and escalation group to review progress against the plan.


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Weekly Performance Assurance Group on progress with issues escalated to monthly strategic

review meeting.

Clinical harm reviewed through External Harm Panel

Full contract levers used

CCG to work closely with lead commissioner to monitor and improve trust performance on

patient experience

Review of Economy, Efficiency and Effectiveness of the Use of Resources

The CCG has a comprehensive governance and reporting framework in place to monitor use of

resources, identify any issues and ensure the appropriate measures are taken to address any

variance from plans. The Governing Body and Executive Committee receive regular summary

reports concerning the CCG’s financial performance, and the Finance and Delivery Committee,

which is chaired by a Clinical Director, has authority to conduct more detailed scrutiny and report

back.

The Finance and Delivery Committee convenes five times a year to scrutinise the detailed

operational financial performance of the CCG. Its terms of reference are set out earlier in this

statement.

The Audit and Governance Committee is chaired by the Governing Body Lay Member for

Governance. The Lay Member for Patient and Public Involvement and the Secondary Care Clinician

are also members. The Audit and Governance Committee performs the role of oversight and

scrutiny of CCG policies, procedures and systems of internal control, with a particular focus on

ensuring that conflicts of interest are managed in line with the CCG’s Constitution. Its terms of

reference are set out earlier in this statement.

Underpinning the CCG’s governance framework are the Prime Financial Policies which set out the

key business rules which govern the organisation, including internal control, audit, standards of

business conduct and budgetary control. They also incorporate the scheme of delegation. This sets

out the level of authority to act and make decisions which has been delegated from the CCG

Governing Body to the various executive committees, in addition to the authorisation limits set by

the Governing Body for the management posts within the organisation to authorise expenditure.

Much of the CCG’s commissioning spend is covered by contracts managed on our behalf by the

NEL CSU. The CCG received assurances on CSU performance through regular contractual

meetings, key performance indicator monitoring and minutes of the CSU/pan CCG assurance

meeting to the Audit and Governance Committee.

Review of the 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 clinical commissioning group.

Capacity to Handle Risk

As Accountable Officer I provide leadership to the risk management process. As a member of the

Governing Body I ensure that the CCGs approach to risk management is transparent and that the

organisational structure supports effective systems and processes. The management of risk is led

by the Chief Operating Officer with support from the corporate services team. Directors are involved


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in regular reviews of the assurance framework and the risk register. The COO presents the

Assurance Framework to each meeting of the governing body.

Training is seen as key to encouraging a culture where risk management is seen by governing body

members and our staff as an essential CCG process. Presentations on counter fraud have given to

governing body members and at a staff briefing. Governing body members have also received

training in relation to conflicts of interest.

Review of effectiveness

My review of the effectiveness of the system of internal control is informed by the work of the

internal auditors who have produced satisfactory assurance reports on our governance system

and framework. It is also informed by the directors and clinical leads within the clinical

commissioning group who have responsibility for the development and maintenance of the

internal control framework. My attendance at the Executive Committee and the Governing Body

enables me to gain assurance that the system of internal control is operating effectively. I also

meet regularly with the senior manager risk lead to review our effectiveness in managing risk

and the supporting systems and processes we have in place.

I have drawn on performance information available to me and on the minutes presented to the

Governing Body meetings from the Finance and Delivery Committee, the Quality and Safety

Committee and the Audit and Governance Committee. I regularly attend the Remuneration and

Workforce Committee (where appropriate) and am assured by the arrangements in place. I also

regularly meet with the Lay Member for Governance and with the Chair of the Governing Body

to reflect on effectiveness and improvements needed.

I have taken account of the review of effectiveness undertaken with Governing Body members

and the Audit and Governance Committee. These both reflected a good level of confidence in

our systems and processes but recognise that there are ways that we can further improve.

In addition we carried out a twelve week in-depth OD review which looked in detail at our

governance arrangements. The review included views from an independent specialist

organisation and we agreed to minor improvements rather than radical change, given the overall

assessment that our systems are working well.

My review is also informed by comments made by the external auditors in their management

letter and other reports.

The GBAF itself provides me with evidence that the effectiveness of controls that manage risks

to the clinical commissioning group 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, the Audit and Governance Committee and

other Committees of the Governing Body. Plans to address weaknesses, learn from best

practice and ensure continuous improvement of the system are in place.

Following completion of the planned audit work for the financial year for the clinical

commissioning group, the Head of Internal Audit issues an independent and objective opinion

on the adequacy and effectiveness of the clinical commissioning group’s system of risk

management, governance and internal control.

The Head of Internal Audit’s opinion is on the following pages.


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NHS Barking & Dagenham CCG Annual Internal Audit Opinion 2014/15

HEAD OF INTERNAL AUDIT OPINION ON THE EFFECTIVENESS OF THE SYSTEM OF INTERNAL CONTROL AT NHS BARKING & DAGENHAM CCG FOR THE YEAR ENDED 31 MARCH 2015 1 Roles and responsibilities

The whole Governing Body is collectively accountable for maintaining a sound system of internal control and is responsible for putting in place arrangements for gaining assurance about the effectiveness of that overall system. The Annual Governance Statement (AGS) is an annual statement by the Accountable Officer, on behalf of the Governing Body, setting out:

how the individual responsibilities of the Accountable Officer are discharged with regard to maintaining a sound system of internal control that supports the achievement of policies, aims and objectives;

the purpose of the system of internal control as evidenced by a description of the risk management and review processes, including the Assurance Framework process;

the conduct and results of the review of the effectiveness of the system of internal control including any disclosures of significant control failures together with assurances that actions are or will be taken where appropriate to address issues arising.

The organisation’s Assurance Framework is one of the key mechanisms that the Accountable Officer can use to support their AGS. In accordance with Public Sector Internal Audit Standards, the Head of Internal Audit (HoIA) is required to provide an annual opinion, based upon and limited to the work performed, on the overall adequacy and effectiveness of the organisation’s risk management, control and governance processes (i.e. the organisation’s system of internal control). This is achieved through a risk-based plan of work, agreed with management and approved by the Audit Committee, which should provide a reasonable level of assurance, subject to the inherent limitations described below. The opinion does not imply that Internal Audit have reviewed all risks and assurances relating to the organisation. The opinion is substantially derived from the conduct of risk-based plans generated from a robust and organisation-led Assurance Framework. As such, it is one component that the Governing Body takes into account in making its AGS.

2 The Head of Internal Audit Opinion

The purpose of my annual HoIA Opinion is to contribute to the assurances available to the Accounable Officer and the Board which underpin the Board’s own assessment of the effectiveness of the organisation’s system of internal control. This Opinion will in turn assist the Board in the completion of its AGS. My opinion, based on work undertaken up to 22 May 2015, is set out as follows:

Based on the work undertaken in 2014/15, significant assurance can be given that there is a generally sound system of internal control, designed to meet the organisation’s objectives, and that controls are generally being applied consistently.


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3 Further issues relevant to this Opinion

We have considered the findings of the Service Auditor report carried out by the internal auditors of NHS England at the CSU, on behalf of the CSU customers, including Barking & Dagenham CCG. Whilst we note a number of exceptions have been identified, we have liaised with the CSU and do not believe that there is anything significant requiring inclusion within the Annual Governance Statement.

4 Issues Judged Relevant to the preparation of the Annual Governance Statement

Based on the work we have undertaken on the CCG’s system on internal control we do not consider that within these areas there are any issues that need to be flagged as significant internal control issues within the AGS. However, the CCG may wish to consider whether any other issues have arisen, including the results of any external reviews which it might want to consider for inclusion in the Annual Governance Statement.

As a practising member firm of the Institute of Chartered Accountants in England and Wales (ICAEW), we are subject to its ethical and other professional requirements which are detailed at http://www.icaew.com/en/members/regulations-standards-and-guidance. The matters raised in this report are only those which came to our attention during the course of our review and are not necessarily a comprehensive statement of all the weaknesses that exist or all improvements that might be made. Recommendations for improvements should be assessed by you for their full impact before they are implemented. This report, or our work, should not be taken as a substitute for management’s responsibilities for the application of sound commercial practices. We emphasize that the responsibility for a sound system of internal controls rests with management and our work should not be relied upon to identify all strengths and weaknesses that may exist. Neither should our work be relied upon to identify all circumstances of fraud and irregularity should there be any. This report is supplied on the understanding that it is solely for the use of the persons to whom it is addressed and for the purposes set out herein. Our work has been undertaken solely to prepare this report and state those matters that we have agreed to state to them. This report should not therefore be regarded as suitable to be used or relied on by any other party wishing to acquire any rights from Baker Tilly Risk Advisory Services LLP for any purpose or in any context. Any party other than the Board which obtains access to this report or a copy and chooses to rely on this report (or any part of it) will do so at its own risk. To the fullest extent permitted by law, Baker Tilly Risk Advisory Services LLP will accept no responsibility or liability in respect of this report to any other party and shall not be liable for any loss, damage or expense of whatsoever nature which is caused by any person’s reliance on representations in this report. This report is released to our Client on the basis that it shall not be copied, referred to or disclosed, in whole or in part (save as otherwise permitted by agreed written terms), without our prior written consent. We have no responsibility to update this report for events and circumstances occurring after the date of this report.

Baker Tilly Risk Advisory Services LLP is a limited liability partnership registered in England and Wales no. OC389499 at 6th floor, 25 Farringdon Street, London EC4A 4AB. © 2013 Baker Tilly Risk Advisory Services LLP


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Data Quality

The CCG receives activity and financial data from the NEL CSU as part of a service level

agreement it has for a range of services from that organisation. The quality of the data used by

governing body is considered to be acceptable. We do however intend to mirror the leading

organisations in terms of business intelligence, and our Innovation Team are progressing this as

identified in our OD Plan work programme.

Business Critical Models

An appropriate framework and environment is in place to provide quality assurance of business

critical models via the CSU, in line with the recommendations in the Macpherson report. The CCG

has undertaken a review with the CSU and no business critical models have been identified that

require information about quality assurance processes for those models to be provided to the

Analytical Oversight Committee chaired by the Chief Analyst in the Department of Health.

Data Security

We submitted a satisfactory level of compliance with the information governance toolkit assessment

achieving level 2 and improving our percentage score from last year. We successfully retained our

accredited safe haven (ASH) status.

Discharge of Statutory Functions

During establishment, the arrangements put in place by the clinical commissioning group and

explained within the Corporate Governance Framework were developed with extensive expert

external legal input, to ensure compliance with all relevant legislation. That legal advice also

informed the matters reserved for Membership Body and Governing Body decision and the scheme

of delegation.

In the light of the Harris Review, the CCG has reviewed all of the statutory duties and powers

conferred on it by the National Service Act 2006 (as amended) and other associated legislative and

regulations. As a result I can confirm that the CCG is clear about the legislative requirements

associated with each of the statutory functions for which it is responsible, including any restrictions

on delegation of those functions.

Responsibility for each duty and power has been clearly allocated to a lead director. Directors have

confirmed that their structures provide the necessary capability and capacity to undertake all of the

CCG’s statutory functions.

Conclusion

None of the auditors’ reports considered by the Audit Committee during 2014/15 raised significant

internal control issues and I am satisfied that the systems outlined in this statement reflect an

organisation that operates with effective and sound systems of internal control. The Governing Body

is also satisfied with the CCG’s internal control systems.

Conor Burke

Accountable Officer

[ date]


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2. Audit opinion and report

Independent auditors’ report to the Members of Barking and Dagenham Clinical Commissioning Group

Report on the financial statements

Our opinion

In our opinion the financial statements, defined below:

1. give a true and fair view, of the state of the Clinical Commissioning Group’s affairs as at 31 March 2015 and of its net operating costs and cash flows for the year then ended; and

2. have been properly prepared in accordance with the accounting policies directed by the NHS Commissioning Board with the approval of the Secretary of State as being relevant to the National Health Service in England.

This opinion is to be read in the context of what we say in the remainder of this report.

What we have audited

The financial statements, which are prepared by Barking and Dagenham Clinical Commissioning Group (“CCG”), comprise:

3. the Statement of Financial Position as at 31 March 2015;

4. the Statement of Comprehensive Net Expenditure for the year then ended;

5. the Statement of Changes in Taxpayers’ Equity for the year;

6. the Statement of Cash Flows for the year; and

7. the notes to the financial statements, which include a summary of significant accounting policies and other explanatory information.

The financial reporting framework that has been applied in their preparation is the accounting policies directed by the NHS Commissioning Board with the approval of the Secretary of State as being relevant to the National Health Service in England.

In applying the financial reporting framework, the Accountable Officer has made a number of subjective judgements, for example in respect of significant accounting estimates. In making such estimates, they have made assumptions and considered future events.

We have also audited the information in the Remuneration Report that is subject to audit, being:

8. the table of salaries and allowances of senior managers on pages 34-38;

9. the table of pension benefits of senior managers on page 39; and

10. the table of pay multiples on page 41.

What an audit of financial statements involves

We conducted our audit in accordance with International Standards on Auditing (UK and Ireland) (“ISAs (UK & Ireland)”). 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:

11. whether the accounting policies are appropriate to the CCG’s circumstances and have been consistently applied and adequately disclosed;

12. the reasonableness of significant accounting estimates made by the Accountable Officer; and

13. the overall presentation of the financial statements.

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


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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.

We are also required to obtain evidence sufficient to give reasonable assurance that the expenditure and income reported in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them.

Opinions on other matters prescribed by the Code of Audit Practice

In our opinion:

the information given in the Annual Report for the financial year for which the financial statements are prepared is consistent with the financial statements;

the part of the Directors’ Remuneration Report to be audited has been properly prepared in accordance with the requirements directed by the NHS Commissioning Board with the approval of the Secretary of State; and

in all material respects the expenditure and income reflected in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them.

Other matters on which we are required to report by exception

We have nothing to report in respect of the following matters where the Code of Audit Practice issued by the Audit Commission requires us to report to you if:

in our opinion, the Governance Statement does not comply with the Annual Accounts guidance 2014/15, issued on 24 February 2015 by the NHS Commissioning Board or is misleading or inconsistent with information of which we are aware from our audit;

we refer a matter to the Secretary of State under section 19 of the Audit Commission Act 1998 because the CCG, or an officer of the CCG, is about to make, or has made, a decision involving unlawful expenditure, or is about to take, or has taken, unlawful action likely to cause a loss or deficiency; or

we issue a report in the public interest under section 8 of the Audit Commission Act 1998.

Responsibilities for the financial statements and the audit

Our responsibilities and those of the Accountable Officer

As explained more fully in the Statement of Accountable Officer’s Responsibilities set out on page 44 the Accountable Officer is responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view in accordance with the accounting policies directed by the NHS Commissioning Board with the approval of the Secretary of State.

Our responsibility is to audit and express an opinion on the financial statements in accordance with Part II of the Audit Commission Act 1998, the Code of Audit Practice 2010 for local NHS bodies issued by the Audit Commission and ISAs (UK & Ireland). Those standards require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors.

This report, including the opinions, has been prepared for and only for the Governing Body of Barking and Dagenham CCG in accordance with Part II of the Audit Commission Act 1998 as set out in paragraph 44 of the Statement of Responsibilities of Auditors and of Audited Bodies (Local NHS bodies) published by the Audit Commission in April 2014, and for no other purpose. We do not, in giving these opinions, accept or assume responsibility for any other purpose or to any other person to whom this report is shown or into whose hands it may come save where expressly agreed by our prior consent in writing.

Conclusion on the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources

Conclusion

On the basis of our work, having regard to the guidance issued by the Audit Commission on 13 October 2014, we have no matters to report with respect to whether, Barking and Dagenham CCG put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources for the year ending 31 March 2015.


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What a review of the arrangements for securing economy, efficiency and effectiveness in the use of resources involves

We have undertaken our audit in accordance with the Code of Audit Practice, having regard to the guidance issued by the Audit Commission on 13 October 2014, as to whether the CCG has proper arrangements for:

securing financial resilience; and

challenging how it secures economy, efficiency and effectiveness.

The Audit Commission has determined these two criteria as those necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the CCG has put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2015.

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 Trust had put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources.

Our responsibilities and those of the CCG

The CCG is responsible for putting in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources, to ensure proper stewardship and governance, and to review regularly the adequacy and effectiveness of these arrangements.

We are required under Section 5 of the Audit Commission Act 1998 to satisfy ourselves that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. The Code of Audit Practice issued by the Audit Commission requires us to report to you any matters that prevent us being satisfied that the CCG has put in place such arrangements, having regard to the criteria specified by the Audit Commission on 13 October 2014.

We report if significant matters have come to our attention which prevent us from concluding that the CCG has put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources. 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.

Certificate

We certify that we have completed the audit of the financial statements of Barking and Dagenham CCG in accordance with the requirements of Part II of the Audit Commission Act 1998 and the Code of Audit Practice issued by the Audit Commission.

Kevin Lowe (Senior Statutory Auditor) for and on behalf of PricewaterhouseCoopers LLP Chartered Accountants and Statutory Auditors 1 Embankment Place, London

Date:

(a) The maintenance and integrity of the Barking and Dagenham CCG website is the responsibility of the directors; the work carried out by the auditors does not involve consideration of these matters and, accordingly, the auditors accept no responsibility for any changes that may have occurred to the financial statements since they were initially presented on the website.

(b) Legislation in the United Kingdom governing the preparation and dissemination of financial statements may differ from legislation in other jurisdictions.


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3. Annual accounts

NHS Barking and Dagenham CCG

Financial Statements

For the year ended 31 March 2015

NHS Barking & Dagenham Clinical Commissioning Group - Financial Statements 2014-15

Statement of Comprehensive Net Expenditure for the year ended 31st March 2015

2014-15 2013-14

Note £000 £000

Administration costs and programme expenditure

Net employee benefits 4.1 2,501 1,894

Other costs 5 250,030 240,083

Other operating revenue 2 (1,783) (1,296)

Net operating costs for the financial year 250,748 240,681

Of which

Administration costs

Net employee benefits 4.1 1,313 1,209

Other costs 5 3,933 3,666

Other operating revenue 2 (172) (36)

Net administration costs before interest 5,074 4,839

Programme expenditure

Net employee benefits 4.1 1,188 685

Other costs 5 246,097 236,417

Other operating revenue 2 (1,611) (1,260)

Net programme expenditure before interest 245,674 235,842

Total comprehensive net expenditure for the year 250,748 240,681

The notes on pages 83 to 106 form part of these financial statements.

80


Statement of Financial Position as at 31 March 2015

31 March 2015 31 March 2014

Note £000 £000

Current assets

Trade and other receivables 8 4,240 3,266

Cash and cash equivalents 9 280 110

Total current assets 4,520 3,376

Total assets 4,520 3,376

Current liabilities

Trade and other payables 10 (22,574) (24,537)

Provisions 11 (2,001) (2,676)

Total current liabilities (24,575) (27,213)

Total assets less current liabilities (20,055) (23,837)

Total assets employed (20,055) (23,837)

Financed by taxpayers' equity

General fund (20,055) (23,837)

Total taxpayers' equity (20,055) (23,837)


Accountable Officer

Conor Burke

The financial statements on pages 80 to 106 were approved for issue by the Governing Body on

____________ and signed on its behalf by:

81


Statement of Changes In Taxpayer's Equity for the year ended 31 March 2015

2014-15 2013-14

£000 £000

Changes in taxpayers' equity for 2014-15

Balance at 1 April 2014 (23,837) -

Changes in CCG taxpayers' equity for 2014-15

Net operating cost for the financial year (250,748) (240,681)

Net recognised CCG expenditure for the financial year (274,585) (240,681)

Net funding 254,530 216,844 Balance at 31 March 2015 (20,055) (23,837)

Statement of Cash Flows for the year ended 31 March 2015

2014-15 2013-14

Note £000 £000

Cash flows from operating activities

Net operating expenditure for the financial year (250,748) (240,681)

(Increase)/decrease in trade and other receivables (974) (3,266)

Increase/(decrease) in trade and other payables (1,964) 24,537

Increase/(decrease) in provisions 11 (675) 2,676

Net cash outflow from operating activities (254,361) (216,734)

Net cash outflow before financing (254,361) (216,734)

Cash flows from financing activities

Net parliamentary funding received 254,530 216,844

Net cash inflow from financing activities 254,530 216,844

Net increase in cash and cash equivalents 170 110

Cash and cash equivalents at the beginning of the financial year 9 110 -

Cash and cash equivalents at the end of the financial year 280 110


82


Notes to the Financial Statements

1 Accounting policies

NHS England has directed that the financial statements of Clinical Commissioning Groups shall meet the

accounting requirements of the Manual for Accounts issued by the Department of Health. Consequently, the

following financial statements have been prepared in accordance with the Manual for Accounts 2014-15

issued by the Department of Health. The accounting policies contained in the Manual for Accounts follow

International Financial Reporting Standards to the extent that they are meaningful and appropriate to

Clinical Commissioning Groups, as determined by HM Treasury, which is advised by the Financial

Reporting Advisory Board. Where the Manual for Accounts permits a choice of accounting policy, the

accounting policy which is judged to be most appropriate to the particular circumstances of the Clinical

Commissioning Group for the purpose of giving a true and fair view has been selected. The particular

policies adopted by the Clinical Commissioning Group (CCG) are described below. They have been applied

consistently in dealing with items considered material in relation to the accounts.

1.1 Going concern

As at 31st March 2015 the CCG had net liabilities of £20,055,000 (£23,837,000 as at 31st March 2014).

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 2015/16 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 12 months

from the date of approval of these Financial Statements. As such the Financial Statements have been

prepared on a 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, and certain financial assets and financial

liabilities.

1.3 Critical accounting judgements & 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.

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:

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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. The CCG use's figures as agreed with local Providers.

Maternity pathways

Expenditure relating to all antenatal maternity care is made at the start of the pathway. As a result, at the

year-end part completed pathways are treated as a prepayment. The CCG use's figures as agreed with

local Providers.

Accruals

For goods and/or services that have been delivered but for which no invoice has been received/sent, the

CCG has made an accrual based upon known commitments, contractual arrangements that are in place

and legal obligations.

Prescribing liabilities

NHS England actions monthly cash charges to the CCG for prescribing contracts. These are issued

approximately 8 weeks in arrears. The CCG uses information provided by the NHS Business Authority as

part of the estimate for full year expenditure.

Continuing healthcare retrospective case provision

Provisions comprise an estimated amount which the CCG believe it will be liable to pay in relation to

continuing healthcare retrospective claims to be received for activities for periods of care post 1st April

2012. The CCG uses the National Framework for NHS Continuing Healthcare and NHS Funded Nursing

Care to evaluate a claim and forms an opinion on the likelihood of that claim being upheld.

Pay and non pay recharges

A proportion of the pay and non pay costs incurred in the year by the CCG have been recharged to NHS

Redbridge CCG and NHS Havering CCG. NHS Barking and Dagenham CCG and these two organisations

operate within an integrated management support structure. Shared costs incurred by the other two CCGs

have also been recharged to the CCG.

Costs which are specific to the running of each CCG are not recharged and remain costs within each

specific CCG's Statement of Comprehensive Net Expenditure. Shared payroll costs are recharged across

the three CCGs based upon geographical population or an estimate of the underlying activity. Shared non

pay costs are also recharged on this basis as it is considered a reasonable proxy of the relative share of

expenditure.

Pay recharges are shown net within the Statement of Comprehensive Net Expenditure. Non pay and

agency cost items are shown net of related income.

1.4 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.

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1.5 Employee benefits

1.5.1 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.

1.5.2 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.

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.

1.6 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.

1.7 Leases

All leases are classified as operating leases.

1.7.1 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.

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.

1.8 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.

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1.9 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.

1.10 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, where the CCG undertake a clinical service, remains with

the CCG.

1.11 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.

1.12 Continuing healthcare risk pooling

In 2014-15 a risk pool scheme has been introduced by NHS England (discreet from the NHS Litigation

Authority) for continuing healthcare claims, for claim periods prior to 31 March 2013. Under the scheme

Clinical Commissioning Groups contribute annually to a pooled fund, which is used to settle the claims. On

this basis the CCG has and continues to make a provision in respect of this risk pool as per note 11.

1.13 Contingent liability

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.

1.14 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 financial

assets are classified as loans and receivables.

1.15 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 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.

1.16 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 derecognised when the liability has been discharged,

that is, the liability has been paid or has expired.

Financial liabilities are initially recognised at fair value.

1.17 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 non-current assets. Where output tax is charged or

input VAT is recoverable, the amounts are stated net of VAT.

1.18 Foreign currencies

The CCG’s functional currency and presentation currency is sterling. Transactions denominated in a foreign

currency are translated into sterling at the exchange rate ruling on the dates of the transactions. At the end

of the reporting period, monetary items denominated in foreign currencies are retranslated at the spot

exchange rate on 31 March. Resulting exchange gains and losses for either of these are recognised in the

CCG’s surplus/deficit in the period in which they arise.

1.19 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 CCG not been

bearing its own risks (with insurance premiums then being included as normal revenue expenditure).

1.20 Prime Minister's Challenge Fund

Throughout 2014/15 the CCG incurred charges related to the Prime Minister's Challenge Fund scheme.

These charges were recharged in full to NHS Redbridge CCG as administrators. As the expenditure was

incurred on behalf of NHS England the income and expenditure is not recognised within these financial

statements, other than the residual cash balance to clear outstanding liabilities as at 31st March 2015.

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1.21 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 2014-15, all of which are subject to consultation:

· IFRS 9: Financial Instruments

· IFRS 13: Fair Value Measurement

· 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 2014-15,

were they applied in that year.

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2. Other Operating Revenue

2014-15 2014-15 2014-15 2013-14

Total Admin Programme Total

£000 £000 £000 £000

Education, training and research 9 9 - 92

Non-patient care services to other bodies 1,680 133 1,547 1,133

Other revenue 94 30 64 71

Total other operating revenue 1,783 172 1,611 1,296

3. Revenue

Revenue is generated wholly from the supply of services. The CCG receives no revenue from the sale of goods.

Administration revenue is revenue received that is not directly attributable to the provision of healthcare or

healthcare services.

Revenue in this note does not include cash received from NHS England, which is drawn down directly into the

bank account of the CCG and credited to the General Fund.

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4. Employee benefits and staff numbers

4.1 Employee benefits 2014-15 2013-14

Total Permanent

Employees

Other Total Admin Permanent

Employees

Admin

Other

Admin

Total

Programme

Permanent

Employees

Programme

Other

Programme

Total

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

Employee benefits

Salaries and wages 2,386 523 1,863 1,198 523 675 1,188 - 1,188 1,761

Social security costs 49 49 - 49 49 - - - - 56

Employer contributions to NHS Pension

Scheme

66 66 - 66 66 - - - - 77

Net employee benefits expenditure 2,501 638 1,863 1,313 638 675 1,188 - 1,188 1,894

As per the Manual for Accounts the overarching principle is that transactions should be accounted for in accordance with International Financial Reporting Standards, with all

treatments having been agreed by both parties. Generally, this determines that revenue income and expenditure should be recorded gross, unless the transaction is of a non-trading

nature and an organisation is deemed to be acting solely as an agent and does not gain any economic benefit from the transaction. Therefore employee benefits are shown on a net

basis as disclosed within note 5. Only the element of the salary relating to the CCG has been recorded as expenditure as in substance the employee works for both organisations

and the recharge is merely an administrative arrangement.

As per note 1.3 a proportion of the pay costs incurred in the year by the CCG have been recharged to and from NHS Redbridge CCG and NHS Havering CCG. NHS Barking &

Dagenham CCG and these two organisations operate within an integrated management support structure.

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4.2 Average number of people employed

2013-14

Total

Permanently

employed Other Total

Number Number Number Number

Total 52 21 31 42

4.3 Staff sickness absence and ill health retirements

2014-15 2013-14

Number Number

Total Days Lost 16 17

Total Staff Years 2 8

Average working days Lost 9 2

4.4 Pension costs

4.4.1 Accounting Valuation

2014-15

As per note 1.3 a proportion of the pay costs incurred in the year by the CCG have been recharged to and from

NHS Redbridge CCG and NHS Havering CCG. NHS Barking & Dagenham CCG and these two organisations

operate within an integrated management support structure.

Past and present employees are covered by the provisions of the NHS Pensions 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 NHS Body of

participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting

period.

In order that the defined benefit obligations recognised in the financial statements do not differ materially from

those that would be determined at the reporting date by a formal actuarial valuation, the FReM requires that “the

period between formal valuations shall be four years, with approximate assessments in intervening years”. An

outline of these follows:

A valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting

period. This utilises an actuarial assessment for the previous accounting period in conjunction with updated

membership and financial data for the current reporting period, and are accepted as providing suitably robust

figures for financial reporting purposes. The valuation of the scheme liability as at 31 March 2015, is based on

valuation data as 31 March 2014, updated to 31 March 2015 with summary global member and accounting data.

In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations,

and the discount rate prescribed by HM Treasury have also been used.

As a result, included within "other" above is an element of permanent staff from NHS Redbridge CCG and NHS

Havering CCG.

The figures above are based upon a nine month period from 1st April 2014 to 31st December 2014.

No individuals retired early on ill health grounds during the year. Ill health retirement costs are met by the NHS

Pension Scheme.

Where the CCG has agreed early retirements, the additional costs are met by the CCG and not by the NHS

Pension Scheme.

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4.4.1 Accounting valuation continued

The latest assessment of the liabilities of the scheme is contained in the scheme actuary report, which forms part

of the annual NHS Pension Scheme (England and Wales) Pension Accounts, published annually. These accounts

can be viewed on the NHS Pensions website. Copies can also be obtained from The Stationery Office.

4.4.2 Full actuarial (funding) valuation

The purpose of this valuation is to assess the level of liability in respect of the benefits due under the scheme

(taking into account its recent demographic experience), and to recommend the contribution rates.

The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending

31 March 2012.

The Scheme Regulations allow contribution rates to be set by the Secretary of State for Health, with the consent of

HM Treasury, and consideration of the advice of the Scheme Actuary and appropriate employee and employer

representatives as deemed appropriate.

4.4.3 Scheme provisions

The NHS Pension Scheme provided defined benefits, which are summarised below. This list is an illustrative guide

only, and is not intended to detail all the benefits provided by the Scheme or the specific conditions that must be

met before these benefits can be obtained:

The Scheme is a “final salary” scheme. Annual pensions are normally based on 1/80th for the 1995 section and of

the best of the last three years pensionable pay for each year of service, and 1/60th for the 2008 section of

reckonable pay per year of membership. Members who are practitioners as defined by the Scheme Regulations

have their annual pensions based upon total pensionable earnings over the relevant pensionable service.

With effect from 1 April 2008 members can choose to give up some of their annual pension for an additional tax

free lump sum, up to a maximum amount permitted under HMRC rules. This new provision is known as “pension

commutation”.

Annual increases are applied to pension payments at rates defined by the Pensions (Increase) Act 1971, and are

based on changes in retail prices in the twelve months ending 30 September in the previous calendar year. From

2011-12 the Consumer Price Index (CPI) has been used and replaced the Retail Prices Index (RPI).

Early payment of a pension, with enhancement, is available to members of the scheme who are permanently

incapable of fulfilling their duties effectively through illness or infirmity. A death gratuity of twice final year’s

pensionable pay for death in service, and five times their annual pension for death after retirement is payable.

For early retirements other than those due to ill health the additional pension liabilities are not funded by the

scheme. The full amount of the liability for the additional costs is charged to the employer.

Members can purchase additional service in the NHS Scheme and contribute to money purchase AVC’s run by the

Scheme’s approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers.

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5. Operating expenses

2014-15 2014-15 2014-15 2013-14

Total Admin Programme Total

£000 £000 £000 £000

Net employee benefits

Employee benefits 2,244 1,056 1,188 1,632

Executive governing body members 257 257 - 262

Total net employee benefits 2,501 1,313 1,188 1,894

Other costs

Services from other CCGs and NHS England 5,056 2,503 2,553 4,030

Services from Foundation Trusts 67,919 - 67,919 65,739

Services from other NHS Trusts 120,513 151 120,362 113,830

Services from other NHS bodies - - - 1,831

Purchase of healthcare from non-NHS bodies 27,857 - 27,857 24,767

Chair governing body members 324 324 - 374

Supplies and services – general 1,301 368 933 265

Consultancy services 258 56 202 454

Establishment 280 231 49 203

Premises 860 61 799 506

Audit fees 76 76 - 84

Other non statutory audit expenditure

· Internal audit services 43 43 - 46

Prescribing costs 24,873 - 24,873 24,402

GPMS/APMS and PCTMS 855 - 855 687

Other professional fees excl. audit 124 118 6 164

Education and training 13 2 11 25

Provisions (675) - (675) 2,676

CHC risk pool contributions 352 - 352 -

Total other costs 250,030 3,933 246,097 240,083

Total operating expenses 252,531 5,246 247,285 241,977

6. Better payment practice code

Measure of compliance 2014-15 2014-15 2013-14 2013-14

Number £000 Number £000

Non-NHS Payables

Total Non-NHS trade invoices paid in the year 8,631 29,116 6,329 23,490

Total Non-NHS trade Invoices paid within target 8,180 25,809 5,078 19,169

Percentage of Non-NHS trade invoices paid within target 94.77% 88.64% 80.23% 81.60%

NHS Payables

Total NHS trade Invoices Paid in the year 2,791 199,558 1,154 172,541

Total NHS trade Invoices Paid within target 2,493 186,539 1,016 168,910

Percentage of NHS trade Invoices paid within target 89.32% 93.48% 88.04% 97.90%

Admin expenditure is expenditure incurred that is not a direct payment for the provision of healthcare or healthcare

services.

The better payment practice code requires the CCG to aim to pay all valid invoices by the due date or within 30 days

of receipt of a valid invoice, whichever is later.

In 2013/14 other expenditure consisted of movement in provisions, this has been re-analysed above against

provisions.

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7. Operating leases as lessee

7.1 Payments recognised as an expense 2014-15 2013-14

Total Total

£000 £000

Payments recognised as an expense

Minimum lease payments 840 396

Total 840 396

7.2 Future minimum lease payments 2014-15 2013-14

Total Total

£000 £000

Payable:

No later than one year - -

Between one and five years - -

After five years - -

Total - -

As per directions from NHS England payments made to NHS Property Services Limited and Community

Health Partnerships Limited in respect of usage of property assets are being treated as an operating lease

under IFRIC 4 and IAS 17. The amount included within minimum lease payments above includes

payments made to NHS Property Services Limited and Community Health Partnerships Limited during the

financial year.

As no formal contract is in place it is not possible to disclose forward cost arrangements. As such the

amounts reflected within note 7.2 above do not include any amounts in respect of future arrangements

with NHS Property Services Limited and Community Health Partnerships Limited.

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8. Current trade and other receivables

2014-15 2013-14

£000 £000

NHS receivables: revenue 293 325

NHS prepayments and accrued income 3,792 2,776

Non-NHS receivables: revenue 116 99

Non-NHS prepayments and accrued income 1 15

VAT 38 51

Total 4,240 3,266

Trade and other receivables are stated at their fair value.

8.1 Receivables past their due date but not impaired 2014-15 2013-14

£000 £000

By up to three months 70 132

By three to six months 17 1

By more than six months 10 -

Total 97 133

9. Cash and cash equivalents

2014-15 2013-14

£000 £000

Balance at 1 April 2014 110 -

Net change in year 170 110

Balance at 31 March 2015 280 110

Made up of:

Cash with the Government Banking Service 280 110

Cash and cash equivalents as in statement of financial position 280 110

2014-15 2013-14

£000 £000

NHS payables: revenue 3,818 13,303

NHS accruals and deferred income 6,663 2,555

Non-NHS payables: revenue 4,395 1,687

Non-NHS accruals and deferred income 7,513 6,413

Social security costs 11 13

Tax 14 15

Other payables 160 551

Total 22,574 24,537

Other payables include £20,298 (2013/14 £35,469) outstanding pension contributions at 31 March 2015.

£2,223 of the amount above has subsequently been recovered post the statement of financial position date.

10. Trade and other payables

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11. Provisions

2014-15 2013-14

£000 £000

Continuing healthcare 2,001 1,933

Other - 743

Total 2,001 2,676

Continuing

healthcare Other Total

£000s £000s £000s

Balance at 1 April 2014 1,933 743 2,676

Arising during the year 1,000 - 1,000

Utilised during the year - - -

Reversed unused (932) (743) (1,675)

Balance at 31 March 2015 2,001 - 2,001

Expected timing of cash flows:

Within one year 2,001 - 2,001

Balance at 31 March 2015 2,001 - 2,001

12. Contingencies

There were no contingent liabilities recognised as at the 31st March 2015.

The amount disclosed above as "reversed unused" relates to the original provision made in 2013/14 in

respect of the risk share arrangement. In line with NHS England guidance the risk pool charge in 2014/15

is charged directly to the statement of comprehensive net expenditure.

As described in note 1.3 the CCG continues to recognise a provision in respect of continuing healthcare

retrospective claims received for activities covering periods post 1st April 2012 which totals £1,001,000.

Provisions made by abolished Primary Care Trusts have been transferred to the ownership of NHS

England. The CCG has also provided £1,000,000 in relation to a risk share arrangement which will be

payable to NHS England in 2015/16 for claims in respect of activities for periods pre 1st April 2012. The

amount provided is based upon values notified by NHS England and adjusted based on rebates received

in 2014/15.

The CCG released the provision of £743,000 in respect of the Barking Birthing Centre as it was no longer

required.

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13 Financial instruments

13.1 Financial risk management

13.1.1 Currency risk

13.1.2 Interest rate risk

13.1.3 Credit risk

13.1.4 Liquidity risk

13.2 Financial assets

Loans and

Receivables

Loans and

Receivables

2014-15 2013-14

Receivables: £000 £000

· NHS 293 325

· Non-NHS 116 99

Cash at bank and in hand 280 110

Total at 31 March 689 534

13.3 Financial liabilities

Other Other

2014-15 2013-14

Payables: £000 £000

· NHS 10,481 15,858

· Non-NHS 12,068 8,100

Total at 31 March 22,549 23,958

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.

Because the majority of the CCG's revenue comes from 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.

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. The CCG

is not, therefore, exposed to significant liquidity risks.

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 clinical commissioning group in undertaking its activities.

Treasury management operations are carried out by the finance department, within parameters defined

formally within the NHS Clinical Commissioning Group standing financial instructions and policies agreed by

the Governing Body. Treasury activity is subject to review by the Clinical Commissioning Group and internal

auditors.

The CCG is principally a domestic organisation with the great majority of transactions, assets and liabilities

being in the UK and sterling based. The CCG has no overseas operations. The CCG therefore has low

exposure to currency rate fluctuations.

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14. Operating segments

15. Pooled budgets

The CCG has not entered into a pooled budget arrangement.

16. Intra-government and other balances

Current

Receivables

Current

Receivables

Current

Payables

Current

Payables

2014-15 2013-14 2014-15 2013-14

£000 £000 £000 £000

Balances with:

· Other Central Government bodies - - 854 -

· Local Authorities - 72 712 119

Balances with NHS bodies:

· NHS bodies outside the Departmental Group 2,458 1,594 3,110 2,731

· NHS Trusts and Foundation Trusts 1,627 1,507 7,371 13,127

Total of balances with NHS bodies: 4,085 3,101 10,481 15,858

· Public corporations and trading funds 155 93 10,526 8,560

· Bodies external to Government - - - -

Total balances 4,240 3,266 22,573 24,537

The CCG consider they have only one segment being commissioning of healthcare services.

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17. Related party transactions

Entities are considered to be a related party if NHS Barking & Dagenham CCG can:

*have direct or indirect control of the other party

The below individuals declared interests which related to the full financial year for the CCG unless stated.

Name Position in CCG Name of organisation where interest held Nature of interest

Dr Waseem Mohi Clinical Director/Chair Markyate Surgery Salaried GP

Remedy Health Care Plc Director – (not currently active)

Parsloes Practices Limited Director

London Wellbeing Care Limited Director

Together First Limited (from May 2014) Shareholder

Dr Arun Sharma Clinical Director Laburnum Health Centre GP Partner

Primary Clinical Partnership Limited Director/ownership/shareholder

Primary Clinical Partnership Services Limited Director/ownership/shareholder

Partnership of East London Co-operative Council Elected member

Together First Limited (from May 2014) Interim Chair/Shareholder

Dr Chandra Mohan Clinical Director Urswick Medical Centre GP Principal

Primary Clinical Partnership Limited Director/ownership or part ownership/shareholder

Primary Clinical Partnership Services Limited Director/ownership or part ownership/shareholder


Dr Ravali Goriparthi Clinical Director Tulasi Medical Centre GP Partner

Venkat Health Centre GP Partner

Health & Happiness Clinic Ltd Director

North East London Foundation Trust GPwSI in Diabetes

Barking, Dagneham and Havering LMC Member

Royal College of General Practitioners Member

Diabetes UK Member

Primary Care Diabetes Society Member

National Diabesity (Diabetes & Obesity) Forum Member

Boerrhinger Ingelheim Principle Investigator for Phase 3 trials

Research Network Commissioned research projects

Barts & the London School of Medicine GP Tutor

Pharmaceutical Industries Speaker at Educational events


*have influence over the financial and operational policies of the other party; or the parties are subject to common control or influence from the same source.

99




Dr Jagan John Clinical Director King Edwards Medical Group GP Partner, other GPs are family members

LMC Chair

Department of Health National health and wellbeing partnership champion

Royal College of GP’s Expert panel of the care planning programme member

NHS Improving Quality /NHS England National clinical associate for domain 2

NHS England London clinical senate member

NELFT GPwSI in Cardiology BD CHS team


Health 1000 Director

Dr Rami Hara Clinical Director Urswick Medical Centre GP Principal

Pharmaceutical company speaker fee Speaker at meetings


Dr Gurkirit Kalkat Clinical Director Thames View Health Centre GP

Primary Clinical Partnership Limited Director/owner or part owner/shareholder

Apex Healthcare Limited Director/owner or part owner/shareholder

Queen Mary Medical School, London Honorary Lecturer


Tan Vandal Secondary care Consultant Essex Urology Services Co-Director and shareholder

Spire Hartswood Hospital Consultant Urological Surgeon

Havering, Tower Hamlets, Bromley, Lambeth,

Southwark & Lewisham CCG Governing Bodies

Secondary Care Doctor Member

Sahdia Warraich Lay Member The Forum for Health and Wellbeing Director

The Forum for Health and Wellbeing Trading

Limited (social enterprise arm of above)

Company Director

Healthwatch Newham Company Director

Healthwatch Waltham Forest Company Director

London Borough of Redbridge Spouse is a Councillor

100




Kash Pandya Lay Member - Governance Hillcroft College for women, Surbiton Council Member and Audit Chair

Essex Ministry of Justice Advisory Committee Lay Member for appointment magistrates

Health & Safety Executive Independent Audit Committee Member

Her Majesty’s Inspector of Constabulary Associate Inspector

Brentwood Citizen’s Advice Bureau Generalist advisor

Havering CCG Lay Member

Redbridge CCG Lay Member

PricewaterhouseCoopers LLP Kiren Pandya (son) Management consultant

Charles Beaumont Associate Independent Lay

Voting Member for Audit

Committee

North Essex Partnership Foundation Trust Non-Executive Director and Audit Chair

Conor Burke Accountable Officer Your Business Works Limited (not trading) Director

Redbridge college Former Audit committee member

Accenture UK Consultancy (Sept 2014) Son is an employee

Martin Sheldon Novus Generation Limited Director/shareholder

Somerset Sight Trustee

Tom Travers Chief Financial Officer Barnet and Chase Hospitals Spouse is financial controller

Jacqui Himbury Nurse Director Nursing & Midwifery Council Fitness to practice panellist

Interim Chief Financial

Officer

101


17. Related party transactions cont'd

The transactions listed below are in relation to interests declared.

2014-15 2014-15 2014-15 2014-15 2013-14 2013-14 2013-14 2013-14

Payments to

Related

Party

Receipts

from

Related

Party

Amounts

owed to

Related

Party

Amounts

due from

Related

Party

Payments

to Related

Party

Receipts

from

Related

Party

Amounts

owed to

Related

Party

Amounts

due from

Related

Party

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

Primary Clinical Partnership Services Limited 317 - 62 - 355 - 28 -

North Street Medical Care & Lawns Medical Care 5 - 2 - 15 - - -

PricewaterhouseCoopers LLP 76 - - - 35 - - -

Partnership of East London Co-operative 1,105 - - - 1,040 - 94 -

Together First Ltd 58 - 92 - 1 - - -

Laburnum Health Centre 1 - 1 - 1 - 3 -

Tulasi Medical Centre 45 - - - 26 - - -

Venkat Health Centre 10 - - - - - - -

King Edward Medical Group 1 - - - - - - -

Spire Hartswood Hospital 46 - 6 - - - - -

Lambeth CCG 117 17 - - 142 - - -

Southwark CCG - - 4 - - - 9 -

Barnet & Chase Farm Hospitals 25 - 4 - 32 - 34 -

2014-15 2014-15 2014-15 2014-15 2013-14 2013-14 2013-14 2013-14

Payments to

Related

Party

Receipts

from

Related

Party

Amounts

owed to

Related

Party

Amounts

due from

Related

Party

Payments

to Related

Party

Receipts

from

Related

Party

Amounts

owed to

Related

Party

Amounts

due from

Related

Party

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

London Borough of Barking and Dagenham 2,094 105 712 - 837 - - -

The CCG has had a number of material transactions with other Government departments and other central and local government bodies. Most of these transactions

have been with Local Authorities.

102


17. Related party transactions cont'd

2014-15 2014-15 2014-15 2014-15 2013-14 2013-14 2013-14 2013-14

Payments to

Related

Party

Receipts

from

Related

Party

Amounts

owed to

Related

Party

Amounts

due from

Related

Party

Payments

to Related

Party

Receipts

from

Related

Party

Amounts

owed to

Related

Party

Amounts

due from

Related

Party

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

Barking Havering and Redbridge University Hospitals NHS Trust 90,193 - 1,432 877 84,358 - 1,704 877

North East London NHS Foundation Trust 57,516 - 1,148 - 56,796 - 1,698 -

Barts Health NHS Trust 18,671 - 364 434 18,251 - 5,814 435

London Ambulance Service NHS Trust 8,388 - 1,472 - 6,869 - 81 -

NHS North and East London CSU 2,503 - 124 - 2,772 - 33 -

Mid Essex Hospital Services NHS Trust 1,009 - - 129 1,359 - 122 -

Basildon and Thurrock University Hospital NHS Foundation Trust 722 - 249 - 499 - - 26

University College London Hospitals NHS Foundation Trust 1,683 - 291 7 1,175 - 252 7

NHS Redbridge CCG 2,283 931 2,184 1,137 1,065 811 1,501 826

NHS Havering CCG 75 561 64 535 131 - 131 23

Moorfields Eye Hospital NHS Foundation Trust 2,530 - 270 - 2,180 - 354 -

Homerton University Hospital NHS Foundation Trust 1,311 - 10 - 1,290 - 204 -

NHS England - Parent Entity 352 30 1 726 1,972 58 1,006 703

Guy's And St Thomas' NHS Foundation Trust 1,353 - 341 - 1,103 - 131 -

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 of Health is considered the parent department.

103


17. Related party transactions continued

2014-15 2014-15 2013-14 2013-14 2014-15 2014-15 2013-14 2013-14

Payments

to Related

Party

Amounts

owed to

Related

Party

Payments

to Related

Party

Amounts

owed to

Related

Party

Payments

to Related

Party

Amounts

owed to

Related

Party

Payments

to Related

Party

Amounts

owed to

Related

Party

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

Thames View Health Centre –

Dr. Kalkat

52

-

45 - Heathway Medical Centre – Dr.

Ashraff

-

-

- -

Dr. Ansari Practice - - - - Dr. Eshan Practice - - - -

King Edwards Medical Centre –

Dr. John

34

-

18 - The Surgery – Dr. Ola’s Practice 11

-

10 -

Abbey Medical Centre – Dr. Haq 47

-

22 - Laburnum Health Centre – Dr.

Sharma & Dr. Kalra

81

41

1 -

John Smith House – Dr. Jaleel 8

-

6 - Parkview Medical Centre – Dr.

Shah

13

-

19 -

Faircross Health Centre – Dr.

Prasad

9

-

11 - The Becontree Medical Centre –

Dr. Moghal

50

-

30 -

Dr. Chawla Surgery 20

-

20 - Church Elm Lane Medical Centre

– Dr. Goyal

26

-

37 -

The White House – Dr. Rai & Dr.

Sharma

34

7

40 - Dr. I.A. Moghal & Ptnrs (Parsloes

& Ripple Road)

4

-

59 -

Dr. R. Chibbers Practice 61

-

43 - Five Elms Health Centre - Dr.

Bhatia

5

-

14 -

Shifa Medical Practice – Dr.

Rashid & Dr. Esham

1

-

- - Julia Engwell Health Centre – Dr.

Bajpai & Dr. Jaiswal

47

-

33 -

The Barking Group Practice –

Dr. Tolia

94

-

53 - Gables Surgery Dr. Ghosh 15

-

26 -

Victoria Medical Centre – Dr.

Niranjar

-

-

- - Markyate Surgery – Dr. Mittal 14

-

17 -

Child & Family Centre - - - - Broad Street Medical Centre - - - -

The constitution of NHS Barking & Dagenham CCG sets out the arrangements to meet its responsibilities for commissioning care for the people who it is responsible.

The transactions listed below are in relation to GP practice members listed within the constitution.

104


17. Related party transactions continued

2014-15 2014-15 2013-14 2013-14 2014-15 2014-15 2013-14 2013-14

Payments

to Related

Party

Amounts

owed to

Related

Party

Payments

to Related

Party

Amounts

owed to

Related

Party

Payments

to Related

Party

Amounts

owed to

Related

Party

Payments

to Related

Party

Amounts

owed to

Related

Party

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

Porters Avenue – Dr. Akinsanya -

-

- - Dr. Quansah Practice 26

-

10 -

Lawns Medical Centre – Dr.

Burack

10

-

16 - Dr. M. Fateh Practice 21

-

23 -

Dr. Kashyap Marks Gate Health

Centre

12

-

25 - Dr. Ahmad & Dr. Monteiro

Practice

52

-

57 -

Dr. Teotia Practice -

-

- - Urswick Medical Centre – Dr.

Mohan

21

-

44 -

Highgrove Surgery – Dr.

Lawrence

45

-

75 - Dr. Pervez Practice 35

-

36 -

The Surgery Drs. Haider &

Finnegan

21

-

29 - Dr. Alkaisy, Dr. Ahmed & Dr.

Islam

45

-

36 -

Tulasi Medical Centre – Dr.

Goripathi

45 3 26 - Dr. A. Arif & Dr. U. Afser 23

-

23 -

Health1000 - - -

105


18. Events after the end of the reporting period

19. Losses and special payments

The CCG had no losses and made no special payments during the financial year.

20. Financial performance targets

CCG's have a number of financial duties under the NHS Act 2006 (as amended).

The CCG’s performance against those duties was as follows:

2014-15

Target

£000's

2014-15

Performance

£000's

2014-15

Achievement

£000's

2013-14

Target

£000's

2013-14

Performance

£000's

Duty

Achieved

Expenditure not to exceed income - NHS Act Section 223H(1) 257,985 252,531 5,454 246,817 241,977 Yes

Revenue resource use does not exceed the amount specified in Directions - NHS Act Section

223I(3) 256,202 250,748 5,454 245,521 240,681 YesRevenue administration resource use does not exceed the amount specified in Directions - NHS

Act Section 223J(3) 5,074 5,074 - 4,840 4,839 Yes

Comparatives have been represented in line with guidance issued within the DoH group manual for accounts.

There are no subsequent events which will have a material effect on the Financial Statements of the CCG.

106

www.pwc.co.uk

Barking & Dagenham Clinical Commissioning Group Report to those charged with governance

Report to those charged with governance on the audit for the year ended 31 March 2015 (ISA (UK&I)) 260)

Government and Public Sector

May 2015

http://www.pwc.co.uk/

Barking & Dagenham Clinical Commissioning Group PwC Contents

Code of Audit Practice and

Statement of Responsibilities

of Auditors and of Audited

Bodies

In April 2010 the Audit Commission

issued a revised version of the

‘Statement of responsibilities of

auditors and of audited bodies’. It is

available from the Chief Executive

of each audited body. The purpose

of the statement is to assist auditors

and audited bodies by explaining

where the responsibilities of

auditors begin and end and what is

to be expected of the audited body in

certain areas. Our reports and

management letters are prepared in

the context of this Statement.

Reports and letters prepared by

appointed auditors and addressed

to members or officers are prepared

for the sole use of the audited body

and no responsibility is taken by

auditors to any Member or officer

in their individual capacity or to

any third party.

This Statement is still applicable for

the financial year 2014/15 under the

Audit Commission successor body

arrangements.

Executive summary 1

Audit approach 2

Significant audit and accounting matters 4

Internal controls 11

Risk of fraud 12

Fees update 14

Appendices 15

Appendix 1: Intra-NHS agreement of balances schedule 16

Appendix 2: Internal audit external quality assessments 17

Contents

Barking & Dagenham Clinical Commissioning Group PwC 1

Background This report tells you about the significant findings from our audit. We presented our audit plan to you in November 2014; we have reviewed the plan and concluded that it remains appropriate.

Audit Summary We have completed the majority of our audit work and expect to be able to issue an unqualified audit opinion on the financial statements by the 29 May 2015.

The key outstanding matters, where our work has commenced but is not yet finalised, are:

approval of the financial statements and letters of representation; and

completion procedures including subsequent events review.

Please note that this report will be sent to Public Sector Audit Appointments Limited in accordance with the Audit Commission transition requirements and to the National Audit Office as auditors of the NHS England Group Accounts.

We remain committed to providing you with a high quality service and will work with your incoming auditors to ensure a smooth transition. We have very much enjoyed working with the Clinical Commissioning Group (CCG) and the predecessor PCTs over a number of years and hope to continue our relationship with you.

We thank the management and staff of Barking & Dagenham Clinical Commissioning Group (“the CCG”) and the North

East London Commissioning Support Unit for their co-operation and assistance during the course of our term of appointment and this years audit.

Executive summary An audit of the financial statements is not designed to identify all matters that may be relevant to those charged with governance. Accordingly, the audit does not ordinarily identify all such matters.


Our audit approach was set in our audit plan which we presented to you on 13 November 2014.

As detailed in our audit plan, our audit approach consists of smart people, a smart approach and smart technology.

We have summarised below the significant risks we identified in our audit plan and the audit approach we took to address

them.

There have been no changes to the audit approach since we presented our audit plan.

Risk Rating Audit approach

Risk of management override of controls

Significant International Standards on Auditing (ISA) (UK&I) 240 requires

that we plan our audit work to consider the risk of fraud, which is presumed to be a significant risk in any audit. This includes consideration of the risk that management may override controls in order to manipulate the financial statements.

We have performed the following procedures:

Understood and evaluated key controls to mitigate the risk of material fraud through theft or misreporting;

Tested the appropriateness of journal entries using Computer Assisted Audit Techniques;

Reviewed accounting estimates for bias and evaluated whether circumstances producing any bias, represent a risk of material misstatement due to fraud;

Evaluated the business rationale underlying significant transactions; and

Performed ‘unpredictable’ procedures, including a review of the Revenue Resource Limit and ensuring transactions between the CCGs were appropriate.

We did not identify any exceptions in undertaking our work.

Audit approach

Our audit work has addressed the significant risks we set out in our audit plan.


Risk Rating Audit approach

Risk of fraud in revenue and expenditure recognition

Significant Under ISA (UK&I) 240 there is a (rebuttable) presumption that

there are risks of fraud in revenue recognition. We extend this presumption to the recognition of expenditure in the NHS.

We have obtained an understanding of key revenue and expenditure controls, and have evaluated these controls.

We have evaluated and tested the accounting policy for expenditure recognition to ensure that it is consistent with the requirements of the Department of Health Group Manual for Accounts.

We have reviewed intra NHS confirmations of balances and any disputed amounts to consider any implications on your accounts.

We have also performed detailed testing of revenue and expenditure transactions, focussing on the areas we considered to be of greatest risk.

We are satisfied that expenditure amounts recognised within your accounts are materially correct and that disclosures are in line with the Manual for Accounts.

We have not identified any exceptions in performing our work.


ISAs (UK&I) require us to tell you about relevant matters relating to the audit of the financial statements sufficiently promptly to enable you to take appropriate action.

The financial year 2014/15 saw the second year effect of the NHS reforms and the second year of existence for CCGs.

We have set out in this section the significant matters arising from our audit as well as the current outstanding matters.

Accounts

We have completed our audit of the CCG’s accounts in accordance with ISAs (UK&I), subject to the following outstanding matters:

approval of the financial statements and letters of representation;

completion procedures including subsequent events review.

Subject to the satisfactory resolution of these matters, the finalisation of the financial statements and their approval by those charged with governance we expect to issue an unqualified audit opinion.

Accounting issues

The qualitative aspects of the CCG’s accounting practices are set out below.

Agreement of balance with intra-NHS bodies

We have reviewed NHS balances within the financial statements which are subject to a national agreement exercise between NHS organisations. Where NHS bodies are not able to reach an agreement on the year-end position they are highlighted in the Department of Health’s “mismatch” report.

As in previous years the CCG, supported by the CSU, have completed a very thorough agreement of balances process but other NHS parties have not in a number of cases updated their equivalent / matching financial positions.

We identified variances in the mismatch report that were over the NAO’s reporting threshold of £250,000. For these balances, we have either obtained confirmations from the other parties or performed sufficient testing to confirm that the amounts included in Barking & Dagenham CCG’s financial statements are correct.

We have also confirmed that balances included within the accounts are consistent with underlying contracts and are consistent with those historically.

In addition, we have examined the year-end settlement position for those NHS organisations with which the CCG have material transactions in year. We have also examined post year-end movements to identify any subsequent changes to reported positions.

We have no issues to raise in respect of our work in this area. As part of our work on intra-NHS balances we have reviewed all differences above £250k and confirmed that we are

Significant audit and accounting matters Our audit work is substantially complete and we anticipate issuing an unqualified audit opinion.


satisfied that the figures in your financial statements remain materially accurate. We are required by the NAO to report all differences above £250k that remain in the agreement of balances exercise. A schedule of these has been included in Appendix 1.

Misstatements and significant audit adjustments We have to tell you about all uncorrected misstatements we found during the audit, other than those which are clearly trivial.

ISA (UK&I) 450 (revised) requires that we record all misstatements identified except those which are “clearly trivial” i.e. those which we do not expect to have a material effect on the financial statements even if accumulated. As part of our audit planning procedures we identified that all misstatements less than £250,000 [prior year £250,000] could be classed as clearly trivial and we agreed this threshold with the Audit Committee on13 November 2014. We have not identified any misstatements during the course of our audit, other than those of a trivial nature, that have not been corrected by management.

Significant accounting principles and policies Significant accounting principles and policies are disclosed in the notes to the financial statements.

Our audit opinion also considers whether the financial statements have been prepared properly in accordance with the accounting policies directed by the NHS Commissioning Board with the approval of the Secretary of State.

We will ask management to represent to us that the selection of, or changes in significant accounting policies and practices that have, or could have, a material effect on the financial

statements have been considered. Please refer to the management representation letter in Appendix 3.

Judgements and accounting estimates The CCG is required to prepare its financial statements in accordance with the Department of Health Group Manual for Accounts which specifies the accounting policies and estimation techniques that must be applied. Nevertheless, there are still many areas where management need to apply judgement to the recognition and measurement of items in the financial statements. These include areas such as year end accruals and provisions.

We have considered this and completed substantive testing as follows:

Reviewed the accuracy of accruals made in the prior year against the expense incurred in 2014/15;

Reviewed the agreement of balances exercise and considered whether the CCG has included appropriate balances in their returns and the financial statements;

Confirmed the revenue resource limit and reviewed the breakdown of the in year payments for any unusual movements;

Tested significant contracts with providers, agreeing to underlying invoices and full and final settlement agreements where relevant. We have also considered the in year performance of the providers and considered this in the context of the final outturn position for each Trust;

Reviewed and tested transactions between the CCGs in the BHR cluster; and

Reviewed and substantively tested judgments and estimates included within the financial statements to ensure they were established on a reasonable basis.

We have no issues to raise in relation to our work in this area.


Financial statement and remuneration report disclosures As part of our audit work we have reviewed, and tested, the material disclosures in the financial statements. In particular, we have considered the completeness of the individuals being reported in your disclosures for this year and that where relevant any payments to past post holders have been correctly treated.

Clinical Director pension disclosure

Clinical Directors that are GPs are members of the Governing Body of CCGs with lay members and Executive Directors. All members of the governing body are required to be disclosed within the CCGs Remuneration Report. In addition, those individuals that are pensionable officers are required to be disclosed in the pension part of the remuneration report. Lay members are not pensionable individuals and as such are normally excluded from such disclosure. The CCG appoints a number of GPs as Clinical Directors. Those individuals are registered as office holders and paid as such through the payroll system of the CCG. The DH issued guidance in 2013/14 to confirm that as NHS bodies (to comply with HMT tax arrangements) all board members (including executive, non-executive and GP clinical directors) should be included and remunerated through the payroll system of the CCG. The CCG received advice from Hempsons who confirmed the following: The nature of the relationship is neither a contract of service nor a contract for services. In the circumstances Hempsons confirmed that the approach adopted by the CCG namely considering this arrangement not to be one which gives the office holder a right to access the NHS pension scheme as reasonable. It follows that the CCG is therefore correct in not making employer pension contributions to that scheme.

We have considered the continued treatment of Clinical Directors in the context of the guidance issued by the Department of Health in 2014/15.

We identified no significant issues as part of this work.


Management representations The final draft of the representation letter that we ask management to sign is presented alongside this report.

In addition to standard representations relating to the Accounts, within this letter we have requested representations relating to the following:

completeness and accuracy of related parties and related party transactions;

settlement position of significant contracts with providers; and

completeness and accuracy of Clinical Directors’ pension information.

There were no other matters for which we requested specific representation but where management declined to provide such assurances.

Financial standing We have not identified any material uncertainties related to events and conditions that may cast significant doubt on the entity's financial standing.

Related parties In forming an opinion on the financial statements, we are required to evaluate:

whether identified related party relationships and

transactions have been appropriately accounted for and

disclosed; and

whether the effects of the related party relationships and

transactions cause the financial statements to be

misleading.

We identified only minor disclosure points, which have all been adjusted for by management, and have no further issues to raise.

We ask management to represent to us on specific matters regarding the financial statements.


Audit independence We are required to follow both the International Standard on Auditing (UK and Ireland) 260 (Revised) “Communication with those charged with governance”, UK Ethical Standard 1 (Revised) “Integrity, objectivity and independence” and UK Ethical Standard 5 (Revised) “Non-audit services provided to audited entities” issued by the UK Auditing Practices Board (“APB ES”).

Together these require that we tell you at least annually about all relationships between PricewaterhouseCoopers LLP in the UK and other PricewaterhouseCoopers’ firms and associated entities (“PwC”) and the CCG that, in our professional judgement, may reasonably be thought to bear on our independence and objectivity.

For the purposes of this report we have made enquiries of all PwC teams whose work we intend to use when forming our opinion on the truth and fairness of the financial statements.

Relationships between PwC and the CCG

We are not aware of any relationships between PwC and the CCG that in our professional judgement, may reasonably be thought to bear on our independence and objectivity.

Relationships and Investments

We have not identified any potential issues in respect of personal relationships with the CCG or investments in the CCG held by individuals.

Employment of PwC staff by the CCG

We are not aware of any former PwC partners or staff being employed, or holding discussions in respect of employment, by the CCG as a director or in a senior management position covering financial, accounting or control related areas.

Business relationships

We have not identified any business relationships between PwC and the CCG.

Services provided to the CCG

The audit of the financial statements is undertaken in accordance with the UK Firm’s internal policies. The audit is also subject to other internal PwC quality control procedures.

Fees

The analysis of our audit fees for the year ended 31 March 2015 is included on page 13.

Services to Directors and Senior Management

PwC does not provide any services e.g. personal tax services, directly to directors, senior management.

Gifts and hospitality

We have not identified any significant gifts or hospitality provided to, or received from, a member of the CCG’s Governing Body, senior management or other staff.

Conclusion

We hereby confirm that in our professional judgement, as at the date of this document:

we comply with UK regulatory and professional requirements, including the Ethical Standards issued by the Auditing Practices Board; and

our objectivity is not compromised.

We would ask the Audit Committee to consider the matters in this document and to confirm that they agree with our conclusion on our independence and objectivity.

We have not provided any additional services to the CCG nor to its Directors and/or Senior Management.

We confirm that we are independent auditors with respect to the CCG’s financial statements.

We are not aware of any relationships which may reasonably be thought to bear on our independence and objectivity.


Annual Governance Statement You are required to produce an Annual Governance Statement (“AGS”) for inclusion in the Annual Report and Accounts. The aim of the AGS is to give a sense of how successfully the CCG has coped with the challenges it faced, drawing on evidence on governance, risk management and controls.

We reviewed the AGS, having due regard of the work completed by internal audit and having seen their head of internal audit opinion and annual report, and considered whether it complied with relevant guidance and whether it was misleading or inconsistent with what we know about the CCG.We found no areas of concern to report in this context.

Economy, efficiency and effectiveness Our value for money (‘VFM’) code responsibility requires us to carry out sufficient and relevant work in order to conclude on whether the CCG has put in place proper arrangements to secure economy, efficiency and effectiveness in the use of resources.

The Audit Commission guidance (which has been adopted by the relevant successor body) includes two criteria:

The organisation has proper arrangements in place for securing financial resilience; and

The organisation has proper arrangements for challenging how it secures economy, efficiency and effectiveness.

We determine a local programme of VFM audit work based on our VFM audit risk assessment, informed by these criteria and our statutory responsibilities.

In particular we have performed a high level review of your Operating Plan for 2015/16 and noted the following key points:

The CCG is planning to achieve a surplus of 2% or

£5.3m.

The Operating Plan includes a QIPP target of £7.8m for which detailed business cases are being reviewed, challenged and confirmed.

There are a number of pressures on achievement such as over-performance by key providers, as well as achieving the QIPP target set out above.

The plan includes a 0.5% contingency.

The CCG’s Operating Plan presents a challenging year for achieving financial balance. However, the CCG has managed to achieve its targets in its first two years of existence and has been able to successfully manage the over performance at key providers either through block contracts or agreeing full and final settlements.

We have considered the findings of our review and anticipate issuing an unqualified value for money conclusion.

Regularity Opinion CCGs must comply with the regularity requirements for all items of expenditure and receipts to be dealt with in accordance with the legislation authorising them, any applicable delegated authority and the rules of Managing Public Money.

We are required to give an opinion on whether in all material respects the expenditure and income reflected in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them. We expect to issue an unqualified opinion.

We have reviewed the CCGs Annual Governance Statement and considered whether the CCG has exercised its functions economically, efficiently and effectively.


Audit Opinion on the Accounts Consolidation Template In our opinion the figures reported in the final audited statutory financial statements, on which we have issued an unqualified opinion, agree to the figures reported in the Accounts Consolidation Template.

Additional procedures for the National Audit Office The National Audit Office (‘NAO’) issued procedures via the Audit Commission for the financial year 2014/15 in respect of two aspects of their audit of the NHS England Group Account. As auditors we are required to follow the group instructions issued under ISA(UK&I) 600; and adhere to specific audit procedures to provide the NAO with additional assurance over amounts recorded in the Whole of Government Accounts schedules within the Summarisation schedules.

For 2014/15, the NAO has introduced a revised group audit approach which focusses primarily on significant components. CCGs are not deemed to be significant components within the DH group however each year the NAO selects a sample of non-significant components that will include some CCGs. Auditors are required to apply more detailed group audit procedures for sampled non-significant components. Reduced group audit procedures are required for non-significant components.

We confirm that we have complied with the requirements of the NAO for non-significant components.

We have complied with the requirements of the NAO as group auditors.


Accounting systems and systems of internal control Management are responsible for developing and implementing systems of internal financial control and to put in place proper arrangements to monitor their adequacy and effectiveness in practice. As auditors, we review these arrangements for the purposes of our audit of the financial statements and our review of the annual governance statement.

There are no significant matters that we wish to bring to your attention.

Reporting requirements We have to report to you any deficiencies in internal control that we found during the audit which we believe should be brought to your attention. We did not identify any matters that require bringing to your attention.

Internal controls We consider management systems of internal financial control as part of our audit of the financial statements.


International Standards on Auditing (UK&I) state that we, as auditors, are responsible for obtaining reasonable assurance that the financial statements taken as a whole are free from material misstatement, whether caused by fraud or error. The respective responsibilities of auditors, management and those charged with governance are summarised below:

Auditors’ responsibility

Our objectives are:

to identify and assess the risks of material misstatement of the financial statements due to fraud;

to obtain sufficient appropriate audit evidence

regarding the assessed risks of material misstatement due to fraud, through designing and implementing appropriate responses; and

to respond appropriately to fraud or suspected fraud identified during the audit.

Management’s responsibility

Management’s responsibilities in relation to fraud are:

to design and implement programmes and controls to

prevent, deter and detect fraud;

to ensure that the entity’s culture and environment promote ethical behaviour; and

to perform a risk assessment that specifically includes the risk of fraud addressing incentives and pressures, opportunities, and attitudes and rationalisation.

Responsibility of the Audit Committee

Your responsibility as part of your governance role is:

to evaluate management’s identification of fraud risk, implementation of anti-fraud measures and creation of appropriate “tone at the top”; and

to investigate any alleged or suspected instances of

fraud brought to your attention.

Your views on fraud

In our audit plan presented to the Audit Committee on 13 November 2014 we enquired:

Whether you have knowledge of fraud, either actual, suspected or alleged, including those involving management?

What fraud detection or prevention measures (e.g. whistleblower lines) are in place in the entity?

What role you have in relation to fraud?

What protocols / procedures have been established between those charged with governance and management to keep you informed of instances of fraud, either actual, suspected or alleged?

We ask that the Audit Committee considers these questions again. We ask for your confirmation that there have been no changes to your view of fraud risk and that no additional matters have arisen that should be brought to our attention. A specific confirmation from management in relation to fraud is included in the letter of representation which has been separately attached.

Risk of fraud We are responsible for obtaining reasonable assurance that the financial statements taken as a whole are free from material misstatement, whether caused by fraud or error.


Fees update for 2014/15 The Audit Commission has provided indicative scale fees for CCGs for the year ended 31 March 2015.

We reported our fee proposals in our plan and our actual fees were in line with our proposals.

Our fees charged were therefore:

2014/15 outturn

2014/15 fee proposal

Financial statements 58,600 58,600

Use of resources 5,000 5,000

TOTAL 63,600 63,600

Fees update Our audit fees are set out in the table opposite.


Appendices


We have set out below those balances greater than £250,ooo which remained as unresolved in the Department of Health’s “mismatch” report. We are required by the NAO to report all differences above £250k that remain in the agreement of balances exercise. The variances which still remained at the time of writing this report have been shown below. In all cases identified below we have seen confirmation from the counterparty that they will be amending their figures in the next submission.

Organisation Mismatch (£000’s)

Classification Reason for mismatch

Barking & Dagenham, Havering and Redbridge University Hospitals NHS Trust [BHRUT]

877 Debtor/ Creditor mismatch

The CCG have included a debtor (specifically a prepayment) for £877k that BHRUT have not included as a payable. A confirmation has been received stating that BHRUT will amend their figures to match the CCG.

North East London NHS Foundation Trust [NELFT]

359 Debtor/ Creditor mismatch

NELFT have included a debtor of £789k while the CCG have included a creditor of £359k. A confirmation has been received stating they will amend their figures to match the CCG.

North East London NHS Foundation Trust [NELFT]

349 Income/ Expenditure mismatch

NELFT have included income of £57,167k while the CCG have included expenditure of £57,516k. A confirmation has been received stating they will amend their figures to match the CCG.

Appendix 1: Intra-NHS agreement of

balances schedule


NHS 5 year forward view The planning guidance requires leaders of local and national health and care services to take action on five fronts. The document includes:

seven approaches to a radical upgrade in prevention of illness with England becoming the first country to implement a national evidence-based diabetes prevention programme;

an explanation on how £480 million of the £1.98 billion additional investment will be used to support transformation in primary care, mental health and local health economies;

clarity over how the local NHS must work together to ensure patients receive the standards guaranteed by the NHS Constitution;

underlines the NHS’s commitment to giving doctors, nurses and carers access to all the data, information and knowledge they need to deliver the best possible care; and

details how the NHS will accelerate innovation to become a world-leader in genomic and genetic testing, medicine optimisation and testing and evaluating new ideas and techniques.

In addition to The Forward View into action: planning for 2015/16, NHS England has published a technical annex and range of supporting materials. Monitor and the NHS Trust Development Authority have also published respective technical guidance documents and supporting materials for commissioners and providers

Analysis has shown that CCGs will benefit most from increases to funding, in particular:

£1.1bn in 2015-16 will go directly to CCGs, focussing

the funds on CCGs who are behind their targets;

some CCGs who were expecting to receive ‘resilience funding’ will not, and will have to reforecast their budgets based on the smaller grown percentages now given; and

analysis of the impact by parliamentary constituency, using information from consultancy Incisive Health, shows that CCGs covering areas with Conservative MPs, and to a lesser extent Liberal Democrats, have, on average, received bigger increases

What does this mean for you? All NHS organisations will have to work together to meet the 5 year vision of the NHS as the provision of care becomes more community, than hospital based. Significant changes may be needed in the current contracting process in terms of both services commissioned and the funding envelope available given the variation in funding levels across the country.

Making local health economies work for patients Monitor, NHS England and Trust Development Authority released a report in December 2014 summarising the findings from their joint project to support 11 local health economies (LHEs) to develop clinically and financially sustainable 5-year strategic plans. The 11 LHEs were Cambridge and Peterborough, Cumbria, Devon, Eastern Cheshire/Southern Sector, East Sussex, Leicestershire, Mid

Appendix 2: Sector Developments

http://www.england.nhs.uk/wp-content/uploads/2014/12/forward-view-plning.pdf

http://www.england.nhs.uk/wp-content/uploads/2014/12/forward-view-plning.pdf

https://www.gov.uk/nhs-foundation-trusts-planning-and-reporting-requirements

http://www.ntda.nhs.uk/blog/2014/12/19/planning-guidance-201516/

http://www.ntda.nhs.uk/blog/2014/12/19/planning-guidance-201516/


Essex, Northamptonshire, North East London, Staffordshire and South West London.

The aim of the project was to move to a longer term planning horizon to enable commissioners and providers in each LHE to plan and carry out radical structural changes in local health services, so they can meet patients’ diverse, changing and growing healthcare needs within the limits of the available funding. External partners (including PwC for 1 LHE) were appointed to support the project and key learnings highlighted in the report were:

understand the challenges in securing clinical and

financial sustainability;

articulate a clear case for change, based on the benefits for patients;

engage extensively with patients, the public, stakeholders and staff during both the design and delivery of change programmes;

enable clinicians to take a leading role in the design and delivery of change programmes;

prepare robust implementation plans and provide the appropriate resources for the delivery of change;

ensure the right capability and capacity are in place for managing complex changes; and

promote the right leadership behaviours to drive change forward, putting the interests of patients and carers above the interests of individuals and organisations.

What does this mean for you? The national direction of travel is for LHEs to work together to deliver the needs of the local population and therefore it is more important than ever before for commissioners and providers to work together in setting the strategic plans for services to be provided across the local health economy. If you would like some insight into how this project has worked we would be happy to introduce you to a member of our team that worked as the external partner for one of the regions.

Accounting for the Better Care Fund The Better Care Fund is due to come into being from 1 April 2015. The Department of Health and NHS England are working on finalising the accounting arrangements but our understanding is that there will be two underlying principles of the fund:

1. The fund is not an entity therefore no member should have transactions or balances in a suspense account with the fund; and

2. The cash in the fund should be treated as cash in the books of the individual members of the funds.

The default position of the Department of Health is that all members of the fund will have a joint arrangement under IFRS11 and in most cases there will be no agency or ‘pass through’ arrangements. On this basis it is expected that gross accounting of transactions will be required in most cases which means that the host of the fund will need to provide the relevant information to all members for inclusion in their individual accounts.

What does this mean for you? CCGs should start liaising early with the host of the fund to ensure that there are arrangements in place to provide information on a timely basis. This will be of particular relevance where the host of the fund is a local authority as their accounting timetables are significantly different to the NHS.

In the event that, pursuant to a request which Barking & Dagenham Clinical Commissioning Group has received under the Freedom of Information Act 2000, it is required to disclose any information contained in this report, it will notify PwC promptly and consult with PwC prior to disclosing such report. Barking & Dagenham Clinical Commissioning Group agrees to pay due regard to any representations which PwC may make in connection with such disclosure and Barking & Dagenham Clinical Commissioning Group shall apply any relevant exemptions which may exist under the Act to such report. If, following consultation with PwC, Barking & Dagenham Clinical Commissioning Group discloses this report or any part thereof, it shall ensure that any disclaimer which PwC has included or may subsequently wish to include in the information is reproduced in full in any copies disclosed.

This document has been prepared only for Barking & Dagenham Clinical Commissioning Group and solely for the purpose and on the terms agreed through our contract with the Audit

Commission and its successor bodies. We accept no liability (including for negligence) to anyone else in connection with this document, and it may not be provided to anyone else.

© 2015 PricewaterhouseCoopers LLP. All rights reserved. In this document, "PwC" refers to the UK member firm, and may sometimes refer to the PwC network. Each member firm is a separate legal entity. Please see www.pwc.com/structure for further details.

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