ANNUAL REPORT 2015/2016 - NHS Halton CCG Report … · NHS Halton CCG Annual Report and Accounts 2015-2016 1 PERFORMANCE REPORT About us The NHS was launched in 1948 and was born

NHS Halton CCG Annual Report and Accounts 2015-2016

ANNUAL REPORT

2015/2016


FOREWORD

Welcome to the third Annual Report produced by NHS Halton Clinical

Commissioning Group (CCG). This Annual Report sets out how we fulfilled our

statutory duties and obligations as an NHS organisation in the financial year

2015/16. The document also describes our governance and leadership

arrangements and the work we have taken forward in partnership with local people,

practices, communities and organisations to deliver our commissioning intentions.

Looking back at 2015/16 there have been many highlights that we want to celebrate.

We secured £1.6m of additional, non-recurrent investment through the Prime

Minister’s Challenge Fund to test some new and innovative approaches to improving

general practice services in the borough. We worked with Community Integrated

Care to transform St Luke’s Care Home into a centre for excellence in dementia

care. We opened two new Urgent Care Centres – one in Runcorn and one in Widnes

– to offer an alternative to attendance at a local A&E. These centres have been well

received and utilised by local people and have begun to reduce demand in certain

areas of A&E activity. Our Annual General Meeting was delivered as a month long

art installation at the Brindley Centre in Runcorn. Using the theme of creative

conversations we worked with local artists and local people to engage them in

discussing our work and the importance of health and wellbeing. We also hosted a

visit from the renowned NHS commentator Roy Lilley, who was impressed by our

work in partnership with local community groups and also with Widnes Vikings, our

local rugby league club, in promoting health and wellbeing.

We have also been fortunate enough to have been recognised for our work through

a number of awards and accolades. We were nominated and shortlisted finalists in

the Health Service Journal Awards in three categories – Innovation in Mental Health,

Commissioning for Carers and Innovation in Primary Care. We won the award for

Innovation in Primary Care for our work in developing the Community Wellbeing

Practices model with Wellbeing Enterprises. Our Chair, Dr Cliff Richards, was

chosen as the Inspirational Leader of the Year in the NHS North West Leadership

Academy Awards. Our Director of Transformation, Dave Sweeney, gained the Social

Value Leadership Award for an Individual in the Social Value Awards 2016.

NHS Halton CCG faces a number of challenges as we move towards 2016/17,

challenges that are shared by all public sector organisations of scarce resources and

increasing demands and expectation. Our One Halton programme, developed and

delivered in partnership with local people, communities and organisations, will

formulate and implement our response as a borough to the Five Year Forward View.

Through this programme we will implement the national priorities for 2016/17 and the

2020 goals to close the health and wellbeing gap, the care and quality gap, and the

finance and efficiency gap. One Halton will provide an excellent platform from which

we can engage in place based planning and delivery of health and care within the


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borough, with neighbours in Knowsley, St Helens and Warrington, across Liverpool

City Region and indeed across the whole of Cheshire and Merseyside.

Not all of our work can be covered in an Annual Report. There is so much that we

could share about what we do and how we do it but there is not enough room. We do

hope that you find this Annual Report informative, and we invite you to contact us if

you want to know more about NHS Halton CCG.

Simon Banks

Chief Officer


CONTENTS

Pages

Section 1: Performance Report

About Us 1

Review of the Year 14

Our Challenges 18

Financial Performance 18

Looking Forward to 2016/17 and beyond 20

Section 2: Accountability Report

Member Practices 24

Governing Body 25

Audit Committee 26

Statement of Chief Officer’s Responsibilities 27

Annual Governance Statement 29

Remuneration & Staff Report 49

Section 3: The Financial Statements

Auditors Report 56

Financial Statements 59

Notes to the Financial Statements 63

Appendices

Appendix 1 99

Appendix 2 106

Appendix 3 107


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PERFORMANCE REPORT

About us

The NHS was launched in 1948 and was born out of the ideal that good healthcare

should be available to all, regardless of wealth – a principle that remains at its core

today.

The work of the NHS is extremely complex but can be summarised in the diagram1

below:

NHS Halton CCG is the leader of the local NHS and essentially acts as the bank with

a budget that is set by the Government. We are responsible for the planning and

purchasing (commissioning) of health services for the people who are registered with

the 17 GP practices in Halton.

This includes:

Elective hospital care

Rehabilitation care

Urgent and emergency care

Most community health services

Mental health and learning disability services

Prescribing

GP services (from 1st April 2015) 1 NHS Mandate 2014. The Mandate. A mandate from the Government to NHS England: April 2014 to March 2015. Published November 2013. Accessed 01/03/16 https://www.gov.uk/government/publications/nhsmandate-2014-to-2015

https://www.gov.uk/government/publications/nhsmandate-2014-to-2015


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We are clinically-led by GPs and other healthcare professionals, including a Chief

Nurse, one registered nurse and a secondary care doctor. Each practice has

nominated a GP as its lead for liaison with the CCG and this group meets regularly.

Additionally, each commissioning intention is owned by a clinical lead who leads

delivery of the work.

Our local population

A significant proportion of Halton’s resident population live in two main towns -

Runcorn and Widnes, whilst a smaller number live in the surrounding parishes and

villages. Halton’s population has increased over the last 10 years and it is now

estimated at approximately 128,000 residents.

Health has been steadily improving in the borough. Overall death rates have

decreased, mostly because of falling death rates from heart disease and cancers.

This means that the people of Halton are living an average of around two years

longer than a decade ago. However, they are still not living as long as the national

average.

Other improvements include:

The number of adults who smoke has fallen.

There has been an improvement in the diagnosis and management of

common health conditions such as heart disease and diabetes.

Detection and treatment of cancers has improved.

The percentage of children and older people having their vaccinations and

immunisations has improved.

The number of adults and children killed and seriously injured in road traffic

accidents has reduced.

The percentage of children participating in at least three hours of sport/

physical activity per week is above the national average.

Ensuring the best services for our population

As well as working with clinicians and healthcare providers to ensure services best

meet the needs of the population, NHS Halton CCG works in partnership with Halton

Borough Council to ensure health and social care is as integrated and joined up as

possible. This is evidenced in our shared vision and values.

NHS Halton CCG has within its constitution an agreed vision to:

involve everybody in the health and wellbeing of the people of Halton,

this is shared with all partners and key stakeholders. The CCG’s vision and values

can be accessed here.

http://www.haltonccg.nhs.uk/public-information/Documents/Constitution%20post%20GB080115%2826.01%29.pdf


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Our Purpose

NHS Halton CCG intends to achieve this vision in a number of ways:

1. We will improve the health and wellbeing of the population of Halton by

preventing ill-health, promoting self-care and independence, arranging local,

community-based support whenever possible and ensuring high quality

hospital services for those who need it. In doing so, we aim to empower and

support local people from the start to the end of their lives

2. We intend to support people to keep well and supported in their homes,

particularly avoiding crises of care that result in hospital admission. Practices

will be the building blocks around which we will support and empower

individuals and communities, promoting prevention, self-care, independence

and resilience.

3. We will work with local people and organisations, including Halton Borough

Council, healthcare providers and the voluntary sector to ensure that the

people of Halton experience smooth, coordinated, integrated and high quality

services to improve their health and wellbeing.

Our approach as a CCG, which is being taken into all our work, particularly in One

Halton, has collaboration as one of 6Cs that guide us. Collaboration recognises that

individuals, communities and organisations need to work together to bring about

meaningful change. It is about achieving the best possible outcome from a

challenging situation as well as the quality of the creative conversations to get them

there. The others Cs are compassion, communication, common purpose,

cooperation and coproduction. We understand these can be difficult to put into

action, but without them we will not deliver the services that local people want and

need.

We are already working with partners to develop a Sustainability and Transformation

Plan, which will support the NHS Five Year Forward View and is consistent with

the One Halton approach. It covers three levels – (i) the Halton health and care

economy, (ii) Halton and neighbouring health and care economies and (iii) Liverpool

City Region. This will provide an opportunity to build on our achievements of recent

years and move at pace to transform health and care services so that they improve

health outcomes, provide excellent levels of quality and are financially and clinically

sustainable.

NHS Halton CCG has been actively involved and engaged in the development of the

Joint Health and Wellbeing Strategy for Halton. Working in partnership with the

Public Health team with the borough council the Joint Strategic Needs Assessment

has been reviewed and each practice has its own practice based version. The Health

and Wellbeing Board partners have reviewed local health needs and clear priorities

have been agreed which have been triangulated across into the One Halton

Transformation programmes


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NHS Halton CCG takes its duty to improve quality under Section 14R of the Health

and Social Care Act 2012 seriously. NHS Halton CCG has worked with local people

and all providers to ensure effective measurement and monitoring of quality of

service provision. NHS Halton delivers this through surveillance of both performance

data/intelligence and through soft intelligence from local feedback through

contractual processes alongside other commissioner, and through attendance at

Quality Surveillance processes with NHS England and other key partners.

NHS Halton CCG has worked in partnership with other commissioners to drive

quality improvements in a local provider which has been subject to an enhanced

level of quality surveillance following identification of some potential quality issues.

The provider has worked hard to improve in the area identified and progress has

been made.

NHS Halton CCG has been actively driving improvements in Child and Adolescent

Mental Health services through commissioning of a new pathway designed with

young people delivered by a new provider. The quality performance in this area has

improved in this year. NHS Halton CCG has also been working hard to drive

transformation plans and improvements in services for people with learning

disabilities and whilst continued work is required much progress has been made.

Reducing Inequalities

Every day the NHS in Halton helps people to stay healthy, recover from illness and

live independent and fulfilling lives, and although Halton residents are now living

longer, they are still not living as long as the national average. The local population is

also living a greater proportion of their lives with an illness or health problem that

limits their daily activities and there are significant differences (inequalities) in how

long people live (life expectancy) across the borough. In partnership with our

stakeholders we plan to tackle these inequalities over the next four years to enable

local people to live healthier and happier lives.

Halton’s Health and Wellbeing service brings together a number of teams to combine

the expertise from Public Health, Primary Care and Adult Social Care with the aim of

reducing the health gap between Halton and the England average. The Health and

Wellbeing Board is currently working in collaboration with GPs to identify the 40% of

the Halton population who do not access GP services. Evidence shows this

approach can have the biggest impact on reducing the inequalities gap by identifying

those at risk and targeting effective interventions to prevent and improve ill health

and reduce premature mortality. NHS Halton CCG recognises the inequalities risk to

those in the population who do not access primary care services, the missing 40%,

and has taken action in this year to enable its practices and other provider to offer

alternative access to care and support. Wellbeing Services, Public Health services

and partnerships with Third Sector and other organisations including the Vikings are

part of the work programme. The Primary Care Commissioning Committee is


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reviewing the success of these services

As our population ages it is also predicted that there will be more people with

conditions like dementia and diabetes, and these health challenges will impact upon

service requirements. We want a health and social care system that not only delivers

excellence but is also a positive experience for those who require its services.

Demand for health and social care services is rising and the financial resources we

have to meet this demand are increasingly scarce and constrained. Without action,

these pressures threaten to overwhelm the health and social care system and we will

need to find new ways of delivering services to ensure they meet the future needs of

the population.

Creating a Cultural Manifesto

Three years ago we initiated our Wellbeing services offer to all of the population of

Halton wrapped around all of our GP practices. This year we have given thought to

how we can build upon this to understand how our communities can support each

other to improve health and wellbeing. There are great strengths in the communities

within Halton and there is no doubt that with positive facilitation and peer support our

communities can become stronger and more able to improve wellbeing.

NHS Halton CCG AGM


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Our AGM this year was a visual art exhibition held at the Brindley entitled “Creative

Conversations” within which we premiered the AGM film “A Conversation about

Health and Wellbeing”. We initiated many conversations and these continue and

have led to the evolution of a Cultural Manifesto (diagram 1) covering the themes of

Sport, The Arts, The Environment and Social Value.

We have entered into a series of strategic partnerships with Widnes Vikings, The

Bluecoat Gallery Liverpool, Halton Housing Association and Hazlehurst Studio

Runcorn and St Helens and Halton VCA. These partnerships bring the possibility of

engaging with our communities in new, interesting and different ways to increase

physical exercise, creativity, reduce isolation and more positively engage in healthier

activities.

Along with our Local Authority colleagues we have been successful in the Well North

Initiative and the Healthy New Towns project; both emphasising partnership and

entrepreneurship to enhance the possibilities of the built environment, coupled with

connecting and supporting people differently, to enhance Health and Well Being.

This approach is developing and building alliances for us all to understand the real

value of the wealth of cultural activities across the borough, and to be able to enable

and build partnerships to sustain our communities and allow them to invest in their

health and wellbeing again.

Diagram 1 – Cultural Manifesto

Promoting Equality and Diversity

Promoting equality is at the heart of everything NHS Halton CCG does. We want to

ensure we commission services fairly and no individual, community or group is left

behind in the changes that will be made to health services to meet the challenges

the NHS face.


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More information about how we have met our statutory requirements is contained in

the Governance Report.

Creating Social Value

The Public Services (Social Value) Act 2012 requires public sector agencies, when

commissioning a public service, to consider how the service they are procuring could

bring added economic, environmental and social benefits.

During 2015/16 NHS Halton CCG continued its Social Value collaborative approach

with Halton Borough Council and a wide range of voluntary sector partners. Halton

BC have implemented our social value charter to work through several procurements

bringing in a wide range of financial savings but more important encouraging added

value and innovation across the whole sector. Social Value is now embedded in all

our contracted providers offering training and social value champions to drive

change.

The Core team based the areas of focus on the MARMOT principles and focus of

need driven by the agreed integrated health and social care priorities

1. Give every child the best start in life

Ensuring local access to pre and postnatal education and wellness support for

all families

2. Enable all children, young people and adults to maximise their

capabilities and have control over their lives

Utilising local people and assets to inspire and empower, supporting all

citizens to overcome barriers and improve their self- worth and aspirations

‘In order to maximise capability, you first have to maximise opportunity’

3. Create fair employment and good work for all

Getting practical help to get the right job [with a living wage], at the right time,

and in the right environment

4. Ensure a healthy standard of living for all

A borough where everyone has a decent home, good connections and

relationships, opportunities and choices, access to good healthcare and a

living wage

5. Create and develop healthy and sustainable places and communities

Supporting a thriving voluntary, community and social enterprise sector with

solutions co-created within communities alongside education and integrated

service support packages for those that need them

6. Strengthen the role and impact of ill health prevention

Build community resilience in tackling poor health through awareness,

engagement, recognition of assets and developing community-led

approaches.


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Areas of which our Social Value Procurement Framework has applied to date

include:

Property Consultancy

Security Services

Child & Adolescent Mental Health Services Tier 2

Specialist Youth and Treatment Service

Floating Support Service

Housing Support Service for single Homeless People

Healthy Weight Management Service Level 3

School Nursing Service

Integrated Youth Provision

CCG’s Director of Transformation receives national Social Value Award

Sustainable Development

Sustainable development is ‘development that meets the needs of the present,

without compromising the ability of future generations to meet their own needs’. It is

about balancing the environmental, social and economic decisions so that no one

area outweighs another.

In the past, economic factors have often taken precedence in decision making –

leading to situations we face today such as global warming (where the environment


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has not been considered highly enough in the decision making process), or poverty

and inequality (where social factors have not been considered highly enough in the

decision making process).

For health and social care the precedent is even higher; social and environmental

factors impact on a person’s health and wellbeing. By limiting negative impacts, or

promoting positive ones, we can reduce the need for the treatment of health

conditions and care needs; and in turn, the pressure on the health service as a

whole – leading to a more sustainable healthcare system.

This approach is set out clearly in the National Sustainability Strategy for Health and

Care1 which sets out the requirements on the health and care system to incorporate

sustainable development into its ethos. It describes a sustainable health and care

system being achieved by ‘delivering high quality care and improved public health

without exhausting natural resources or causing severe ecological damage’.

In Autumn 2015, NHS Halton CCG contracted sustainability experts WRM to

undertake a gap analysis of the organisation in readiness for the 2016 requirement

for all NHS Clinical Commissioning Groups to have a Sustainability Plan detailing

their proposals for CO² reductions, efficient energy use and climate change.

Following the gap analysis WRM produced a Sustainable Development Management

Plan (SDMP) 2016-2019. The plan describes how NHS Halton CCG and its partners

can help achieve a sustainable Halton and future proof against risk (e.g. climate

change), requirement (e.g. future legislation) and expectation (e.g. benchmarking

against peers outside of the Borough) by identifying and prioritising:

Best practice across the partnership and providing opportunities to share and

learn

Improvement areas for:

Cost and CO² reduction

Potential savings by scale energy provision

Social and Cultural Value; and

Removing duplication and expanding partnership working

Identifying where legislation, compliance and national requirements are not

yet being met and suggesting steps to rectify this

There are requirements that must be adhered to and met as an individual

organisation and others which can be better met by working in partnership and

sharing responsibilities. Therefore the plan was divided into two halves; part one sets

1 Sustainable, Resilient, Healthy People and Places – A Sustainable Development Strategy for the NHS, Public Health

and Social Care System’

http://www.sduhealth.org.uk/policy-strategy/engagement-resources.aspx


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out actions that the CCG must meet and part two tackles the areas that were agreed

with partners during the gap analysis exercise as shared priorities and action plans

against them.

The internal plan will ensure that as a CCG, we will focus on the elements that we

have direct control over and will include:

Having a clear governance structure and accountability;

Showing a strong leadership in sustainable development;

Measuring and reducing our resource impact;

Designing and re-designing services that encourage sustainable care

pathways;

Influencing sustainable development through our supply chain; and

Evaluating and reporting in line with national standards.

The wider plan, named the One Halton Sustainable Development Management Plan,

has a slightly different focus as it supports the collective focus for all the partners.

Common priorities were identified during the gap analysis and grouped into themes

which support all the individual and collective sustainable development objectives for

the CCG and its partners.

While the outcomes for both plans are expected to be delivered over a three-year

time line, the targets within the action plans have 2016/17 targets. The plans

themselves will be reviewed on an annual basis to update and ensure that the best

course of action for the coming year is taken.

Our Estates Strategy and Sustainable Estates

NHS and wider estate is an integral part of what the NHS and its partners can offer

the community. In 2015 NHS Halton CCG launched its Estates strategy. We have

been leading on a piece of work to align our neighbouring CCGs into a consistent

way of managing Estate.

The Five Year Forward View recognises the challenges facing the NHS and presents

the models of care that are required to deal with population changes against a

backdrop of reducing public finances. The new models of care are changing the way

healthcare is provided in a number of ways that will impact on local estates.

Across NHS Halton, St Helens, Knowsley and Warrington CCGs it is recognised that

property and the built environment is an important component to delivering high

quality, accessible, and efficient public services. In response in 2015 the CCG

formed a Strategic Estates Group, tasked with development and on-going

management of a fluid Strategic Estates Plan in order to use property to deliver a

more integrated, accessible, innovative, and efficient range of public services, and as

an enabler to develop shared services, and support community regeneration.


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To ensure sustainability we also undertook a future proofing of all our estate. This

gave a very clear map of what we could extend, renovate, share or dispose of.

Patient and Public Involvement

NHS Halton CCG is dedicated to 'Involving everybody in improving the health and

wellbeing of the people of Halton'. This year we have engaged with approximately

3,250 people through a number of different platforms including:

Halton People’s Health Forum

These events take place quarterly and provide the public with an opportunity to listen

to presentations and ask questions on topics they want to know more about. The

events are held in Runcorn and Widnes during afternoons and evenings. Topics

ranged from medicines management to urgent care and cancer. Approximately 280

people have attended these particular events throughout the year.

Patient Participation Groups

The Patient Participation Group (PPG) is a group of patients registered with the

surgery who wish to feedback and help improve their practice and health services

provided. We are one of the only CCGs to have a patient participation group

attached to each of practice. Every 6 months we hold a PPG plus event, which is

about providing support to PPGs and sharing best practice.

CCG Health Show on Halton Community Radio

We have a two hour show on Halton Community Radio each month. The show

provides an opportunity for listeners to find out about key services in the area and

receive health messages. They also have an opportunity to pose questions to the

range of experts being made available.


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One Halton Launch

Events

A number of engagement events have been held throughout the year including the ,

DAD - disability awareness day, Vintage Rally, One Halton launch, Improving

Maternity Services, Care Home summit and Fact or Fiction event with Healthwatch.

These events provided a platform for the CCG to engage with a wide range of

clinicians, partner organisations, representatives from the voluntary sector as well as

patients and public.

Roy Lilley visits the CCG Stand at the Vintage Rally


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Partnerships and networks

This year we have strengthened our partnerships with the Widnes Vikings and

Voluntary Sector, who have established links into the community groups. They have

engaged on our behalf with key groups on a range of issues including anti-bullying,

exercise fun sessions, confidence building, health checks, the Urgent Care Centres,

pharmacy promotion and primary care.

Focus on young people

We have striven to improve our engagement with young people. As well as building

links into schools and colleges, we have provided young people with platforms to

begin conversations with us. This has included a young people’s takeover day,

question time with local MP and CCG Governing Body members, and a number of

events for schools who were invited into the CCG and their pupils were able to ask

questions and find out more about the NHS and local services. We have also worked

with a local school to produce a Flu poster campaign with 30 young primary children

and developed our relationship with Cronton and Riverside College’s Health and

Social Care students. As well as our health professionals giving career talks, the

students and tutors are helping to run joint health events with the CCG as part of

their curriculum.

Following our successful World Record Attempt for the most people participating in

an exercise video which involved thousands of local school children and young

people, we undertook a survey to understand the effects of the event. From the

number of schoolchildren who responded:

92% said participating in the World Record event had a positive effect on their

wellbeing

80% said the event had inspired them to keep active

76% said they would take part in similar activities in the future


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Review of the Year

NHS Halton CCG is now in its third year of being a statutory organisation. During

that period it has worked hard to establish a strong organisational identity and

culture, and is widely respected among regional partners and NHS organisations.

2015/16 was a landmark year for the organisation and it is now beginning to build a

national reputation for being progressive and innovative

Some of our highlights from the past 12 months include:

Establishing the two Urgent Care Centres

Prime Ministers Challenge Fund (now known as GP Access Fund)


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St Luke’s Care Home

CCG Recognition Awards


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How have we performed?

During 2015/16 Halton formally opened two new care centres in Halton; one based

on the Halton Hospital site in Runcorn replacing the existing minor injuries unit and

the other replacing the walk-in centre within Widnes. Both centres now offer services

like x-ray and ultrasound which were previously only available via local hospitals. In

addition there is now an agreement in place with the North West Ambulance Service

(NWAS) to receive ambulances for a limited number of conditions at both sites.


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Urgent Care Centres

There has been an immediate impact on both A&E attendances and non-elective

admissions at Warrington Hospital. As a direct result of the opening of the Runcorn

site there has been a 7% reduction in Halton patients going to Warrington A&E

department and a reduction of 9% in non-elective activity. The Widnes site opened

later in the year and we are now beginning to see reductions in A&E attendances at

Whiston Hospital. Further development of the urgent care centres will continue into

2016/17 with the introduction of additional paediatric pathways of care, giving

parents an alternative to A&E for children with less serious illnesses and injuries.

Halton has made great strides in improving the 14-day wait for outpatient

appointments for patients referred with suspected cancer by a GP. The CCG is

working closely with GPs to emphasise the importance of attending these

appointments to patients as most breaches were related to patient choice. This

message appears to be hitting home with some of the best monthly figures seen by

the CCG occurring in late 2015.

Our challenges

Waiting times in A&E for the two main local acute hospitals have been challenging

throughout 2015/16 with neither Whiston nor Warrington A&E Departments likely to

achieve the 95% target. This delay has been attributed to both difficulties in

discharging patients (meaning beds are not available for patients attending A&E).

which has been a particular issue at Warrington although we have also seen

increased activity at Whiston. Our development of the urgent care centres has


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improved matters for local residents with waiting times often much less than 60

minutes. Halton has also invested in Ambulance liaison officers in both hospitals to

try to relieve the pressure on the ambulance service and has taken a leading role in

attempting to reduce delayed discharges.

The 62-day cancer treatment performance continues to be a challenge for Halton. An

in-depth breach analysis indicates that there is no one cause, trust or tumour group

causing particular concern but the overall effect is causing Halton to fail this

constitutional standard. There is on-going work between the CCG and both trusts to

understand reasons for breaches and any lessons that can be learnt.

Readmissions to hospital within 30 days remain too high. Although significant

progress was made earlier in the year to reduce readmission rates from 20% to

around 16% this improvement has stalled during the second half of 2015/16.

Reducing readmission rates during 2016/17 will remain a priority and the CCG is

working with the local authority on initiatives focussed in care homes.

Recovery rates for people accessing psychological therapies remain below the target

of 50%. We are currently working with our provider to understand why recovery rates

are not improving and to commit to an improvement plan for 2016/17.

By working closely with public health and the local authority to use a place based

commissioning model we will increase and improve the service focussing on

prevention and self- care in Halton. This may involve radical changes to how General

Practice works together or which services are available in community, secondary or

specialist care settings. These plans may require us to work on a larger geographical

footprint with neighbouring CCG’s, and as part of the wider Cheshire and Merseyside

Sustainability and Transformation footprint.

Financial Performance

The CCG’s financial accounts (available at pages 59 – 98 of the Annual Report)

have been prepared under a direction issued by the NHS Commissioning Board

under the National Health Service Act 2006 (as amended). The CCG has produced

them on the basis that it is a going concern as it has no reason to believe that its

future is in doubt, either due to its own performance, or through changes in

legislation.

The CCG receives its funding from NHSE in two parts. The main element is the

Programme Allocation, which is for the commissioning of health services. The

second allocation is the CCG’s Running Cost Allowance, which covers the

administration and management of the CCG. The CCG cannot use its Programme

Allocation to increase the Running Cost Allowance, although an underspend on its

Running Costs can be used to support its Programme Allocation. The CCG must

ensure that health services are delivered within its Programme and Running Cost

Allowance and cash flow controls, as set by NHS England. In addition, it was


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expected to maintain the 1% surplus brought forward from 2014/15. The CCG was

successful in meeting both its’ statutory financial duties and the 1% target in both

2015/16 and 2014/15 as indicated in Table 1 below.

Table 1 – Statutory Financial Duties

Statutory Duties Target

£m

Actual

£m

Variance

£m

Met?

Expenditure not to exceed income 211.4 209.5 -1.9 √

Capital resource use does not exceed the

amount specified in Directions 0.0 0.0 0.0 √

Revenue resource use does not exceed the

amount specified in Directions 209.8 207.9 -1.9 √

Capital resource use on specified matter(s)

does not exceed the amount specified in

Directions 0.0 0.0 0.0 √

Revenue resource use on specified matter(s)

does not exceed the amount specified in

Directions 0.0 0.0 0.0 √

Revenue administration resource use does

not exceed the amount specified in

Directions 3.0 2.5 -0.5 √

Although the NHS has to some extent been protected, allocation growth has been

lower than in past years. In 2015/2016, the CCG received the national average uplift

of 2.09% growth (2014/15: 2.14%), so that it received £209.8m (2014/15; £186.7m)

for its Programme and £2.9m (2014/15; £3.08m) for its Running Cost Allocations. In

addition, the CCG also received back its previous year’s surplus of £1.8m. Although

the level of growth was historically low this was managed by the CCG as set out in

the table below to deliver the 1% target surplus agreed with NHSE.

How was the money spent in 2015/16 and 2014/15?

The Clinical Members Group (CMG), Governing Body, management team and staff

of the CCG work hard to ensure that this money is spent wisely, and that it supports

the aim of commissioning high quality healthcare, whilst ensuring effectiveness and

value for money. Allocations to the CCG were spent as shown in Table 2 below.


20

Table 2 – CCG Allocation

* this figure is net of £1.6m (2014/15; £1.5m) income received by the CCG

The CCG’s Running Cost spending is divided between the costs associated with its

own staff and accommodation, and those of the commissioning support services,

which were purchased from the North West Commissioning Support Unit until 1st

March 2016. At that date CSU services were taken on by the Midlands & Lancashire

Commissioning Support Unit following a procurement exercise undertaken by CCGs

in Merseyside and Cheshire.

Table 3 – CCG Running Costs

*This is the ONS constrained population which equated to 130,253 in 2015/16 (2014/15; 124,626)

Looking Forward to 2016/17 and beyond

Following the General Election and the Government Spending Review, NHSE have

been able to publish firm CCG allocations for the 3 years to 2018/19 and indicative

ones for the 2 years after that. These include programme budget allocations for core

commissioned services and the delegated primary medical services together with the

separate running cost allocation. The allocation publication also showed notional

allocations in respect of specialised services which relate to Halton as NHSE is

considering delegating responsibility for commissioning some of these services to

CCGs.

CCG Spending 2015/16

£m

2014/15

£m

Programme Expenditure

Acute Services 103.4 99.1

Mental Health Services 17.7 17.0

Community Health Services 17.3 22.7

Continuing Care & HBC Pooled Budgets 10.3 11.1

Prescribing & Primary Care Services 45.6 27.9

Other Programme Services 11.1 4.1

Total Programme Spend 205.4 182.0

Running Cost (Admin) Expenditure 2.5 2.9

Total Expenditure* 207.9 184.9

Running Costs (Admin) 2015/16

£m

2015/16

£/head*

2014/15

£m

2014/15

£/head*

CCG Direct Costs Staff 0.95 7.29 1.00 8.20

CCG Direct Non-Pay 0.51 3.92 0.80 7.20

Other CCG Shared Services 0.20 1.54 0.20 1.70

Commissioning Support Unit 0.84 6.45 0.90 7.20

Total Running Costs 2.50 19.20 2.90 24.35


21

The CCG will receive a core programme budget funding increase of 3.0% (or £5.7m)

in 2016/17, giving a total programme allocation (excluding notional primary care

allocations) of £191.3m. This includes the pick-up of previously separately funded

allocations for GP Information Technology (£0.33m), the Enhanced Tariff Option

(£0.58m) and transformational Children and Adolescent Mental Health funding

(£0.21m). Taking these items into account, in real terms the growth in 2016/17 is

less than 2.5% rather than the notified 3.0%. Although the NHS has been protected

in relation to other public spending in a period of austerity, this is a historically very

low level of funding growth for the health service which is meeting increasing

demands from the population. The funding growth in 2017/18 and 2018/19 drops to

2.0%. Overall although the CCG does have an increase in its allocation it has many

cost pressures to face. For the first time in 4 years NHS hospital activity tariffs have

been increased by between 1.1% and 1.8% which consumes a significant proportion

of the allocation growth being received by the CCG. NHSE has delegated co-

commissioning responsibility for primary care medical services to the CCG. The

allocation in 2016/17 for these services is £17.6m an increase of 3.6% on 2015/16.

The CCG’s Running Cost Allocation (RCA) was reduced by 10% (or £0.221m) in

2015/16. NHSE have said that the RCA will be kept at the same level for the next 5

years. This allocation is linked to the population registered with CCG’s practices.

The CCG is expected to work collaboratively on a 5 year strategic Sustainability and

Transformation Plan with the other CCGs and NHS Trusts within the Cheshire and

Mersey area. The development of a satisfactory plan will allow access to national

Sustainability and Transformation Funds which totals £2.9 billion by 2017/18. The

CCG’s 5 year strategic plans will need to build into the Sustainability and

Transformation Plan of the wider Cheshire and Mersey area.

The CCG will continue to work closely with Halton Borough Council (HBC) through

the mechanism of the Health and Wellbeing Board. Together they will have a key

role on maintaining and improving performance objectives:

Ensuring that NHS Constitution waiting times targets continue to be met

and preparing for the new mental health performance targets.

Maximising the effectiveness of the Better Care Fund investment

Delivering the vision and challenges set out in the NHS England’s Five

Year Forward View published in October 2014 together with the 9 “must

do’s” set out in the NHSE 2015 planning guidance.

Working collaboratively on the proposals around devolution to the

Liverpool City Region.

In delivering these objectives, the CCG and HBC are mindful of the continued drive

for austerity and reduced level of public spending. In order to cope with this, all


22

CCGs continue to work to deliver NHSE’s Quality Innovation Productivity and

Prevention (QIPP) initiative, which is intended to reduce costs so that the NHS can

continue to improve services and meet the growing demand for health care. This will

be supported through further collaboration between the CCG and HBC on the

commissioning of health and social care services. In 2016/17 £9.5m will be made

available from CCG resources to be transferred to a pooled budget for health and

social care, which is to be called the Better Care Fund (BCF). The plans on how this

fund is going to be used in this borough were approved by the Health and Wellbeing

Board, the Governing Body of the CCG and HBC.

The expectation of continuing reduced growth for NHS funding means that the CCG

will continue to be faced with difficult choices on spending priorities. Although the

CCG has been able to deliver its financial duties and targets in 2015/16, the

relatively low levels of funding growth emphasises the importance of the QIPP

agenda to ensure that funds are used to achieve maximum benefit to the health of

the population whilst continuing to deliver the necessary financial targets. Clearly,

given the poor health within the borough and current high demand for secondary

care, there are still very significant challenges to be faced but the organisation with

its partners, is focussed and determined to tackle them.

As well as constraints in relation to future resources, the CCG faces other principal

risks and uncertainties that have the potential to impact on its long-term financial

performance. As part of the planning process undertaken with NHSE, the CCG is

required to quantify its key financial risks and mitigations. The CCG has identified

principal risks as follows:

Activity over performance and associated costs under Payment by

Results (PbR) arrangements;

Increased demand for community services under cost per case Any

Qualified Provider (AQP) arrangements;

The cost and volume of Continuing Healthcare cases and high cost

mental health placements out of areas;

Managing the GP prescribing budget;

Financial risk associated with the transfer of GP primary care budgets;

Achievement of the CCG’s overall QIPP programme.

Through robust internal controls and governance, strong contract management,

tackling prescribing waste and joint pooled budget arrangements with HBC in

relation to Continuing Health Care cases, the CCG will seek to manage and mitigate

these risks. The CCG has received a significant level of assurance in relation to its

financial reporting and budgetary control arrangements and a significant assurance


23

opinion in relation to the quality of its internal controls. The internal structures which

will help the CCG deal with these risks are set out in the Governance section of the

Annual Report.

The Spending Review of November 2015 and the subsequent planning guidance to

the NHS, Delivering the Forward View: NHS planning guidance 2016/17–2020/21

has set the tone for the future of the wider health and care system and for NHS

Halton CCG. We have to work with all our partners to accomplish three

interdependent and essential tasks: first, implement the Five Year Forward View;

second, restore and maintain financial balance; and third, to deliver core access and

quality standards for patients.

We have been fortunate to have received, across the whole NHS, an £8.4 billion real

terms funding increase by 2020/21, front-loaded. Even with these resources we still

face significant challenges to deliver the “Triple Aim” of closing the health and

wellbeing gap, the care and quality gap, and the finance and efficiency gap. Simply

we have to deliver better health outcomes, better experience of care and do so more

efficiently by reducing costs, eliminating waste and reducing demand.

We have a clear list of national priorities that we need to deliver in 2016/17. These

priorities will be the focus for our actions, anything else we do will have to deliver

value in terms of answering the “Triple Aim” questions and delivering sustainability

and transformation. We cannot focus our resources on anything that does not

deliver in these domains or does not add or generate value. We will also need to

progress and address the longer term challenges for our local health and care

systems, which are about the shape of care in the future. We will set out how we

intend to do this in two separate and connected plans:

a five year Sustainability and Transformation Plan (STP), place-based on a

Cheshire and Merseyside footprint with local delivery and driving the Five

Year Forward View; and

a one year Operational Plan for 2016/17, organisation based but consistent

with the emerging STP.

Halton has identified that prevention, self-care and wellbeing, supported by a

resilient workforce, new care models, greater partnership working between providers

and across sectors, sustainable finance and improved use of estates, are the key to

transforming Halton’s future health and wellbeing. In the next five years there will be

radical changes to health and care in our borough and beyond. No change is not an

option.

Simon Banks, Chief Officer

26th May 2016


24

SECTION 2

ACCOUNTABILITY REPORT

Corporate Governance

Appleton Village Surgery, 2-6

Appleton Village, Widnes, WA8 6DZ

Beaconsfield Surgery, Bevan Way,

Widnes, WA8 6TR

Beeches Medical Centre, 20 Ditchfield

Road, Widnes, WA8 8QS

Brookvale Medical Centre, Hallwood

Health Centre, Hospital Way,

Runcorn, WA7 2UT

Castlefields Health Centre The Village Square, Castlefields,

Runcorn, WA7 2HY

Grove House Practice, St Paul’s

Health Centre, High Street, Runcorn,

WA7 1AB

Heath Road Medical Centre

Heath Road, Runcorn, WA7 5TJ

Murdishaw Health Centre, Gorsewood

Road, Murdishaw, Runcorn, WA7 6ES

Newtown Health Care Centre Widnes HCRC, Oaks Place, Caldwell

Road, Widnes, WA8 7GD

Oaks Place Surgery Widnes HCRC, Oaks Place, Caldwell

Road, Widnes, WA8 7GD

Peelhouse Medical Plaza

Peelhouse Lane, Widnes, WA8 6TN

Tower House Practice St Paul’s Health Centre, High Street,

Runcorn, WA7 1AB

Hough Green Health Park

Hough Green Road, Widnes, WA8 4NJ

Upton Rocks Primary Care Widnes RUFC Car Park, Heath Road,

Widnes, WA8 7NU

Weavervale Practice Hallwood Health Centre, Hospital

Way, Runcorn, WA7 2UT

West Bank Medical Centre 2 Lower Church Street, West Bank,

Widnes, WA8 0NG

Windmill Hill Medical Centre Norton Hill, Windmill Hill, Runcorn,

WA7 6QE

CCG Member Practices


25

The Chief Officer is Simon Banks and the Clinical Chair is Dr Cliff Richards.

Governing Body Membership 2015/16

The members of the Governing Body and the Committees on which they serve are

outlined below. Unless stated this covers the period 1st April 2015 – 31st March 2016.

The Declarations of Interest of Governing Body Members are attached at Appendix 3

page 107.

Dr Cliff Richards – Chair

Serves on Service Development Committee; Performance and Finance Committee;

and Primary Care Commissioning Committee from 1st May 2015

Mr Simon Banks – Chief Officer

Serves on Integrated Governance Committee (Chair); Performance and Finance

Committee (Chair); HR & OD Committee; Primary Care Commissioning Committee

from 1st May 2015

Mrs Jan Snoddon – Chief Nurse

Serves on Service Development Committee; Integrated Governance Committee;

Quality Committee (Chair); Better Care Board, Primary Care Commissioning

Committee from 1st May 2015

Mr Paul Brickwood – Chief Finance Officer

Serves on Integrated Governance Committee, Performance & Finance Committee;

Primary Care Commissioning Committee from 1st May 2015

Dave Sweeney – Director of Transformation

Serves on Service Development Committee and Primary Care Commissioning

Committee from 1st May 2015

Eileen O’Meara – Director of Public Health, Halton Borough Council

Serves on Primary Care Commissioning Committee from 1st May 2015

Professor Mike Chester – Secondary Care Doctor

Serves on Quality Committee to 2nd February 2016; Primary Care Commissioning

Committee from 1st May 2015 – 2nd February 2016

Mrs Gill Frame – Registered Nurse

Serves on Audit Committee; Remuneration Committee; Quality Committee; Primary

Care Commissioning Committee from 1st May 2015

Diane Hanshaw – Practice Managers’ representative

Serves on the Quality Committee

Dr Damian McDermott – GP representative

Serves on Service Development Committee; Quality Committee


26

Dr Claire Forde – GP representative


Dr David Lyon – GP representative


Dr Michael O’Connor – GP representative

Serves on Service Development Committee (Chair); Quality Committee; Audit

Committee; Primary Care Commissioning Committee from 1st May 2015

David Merrill - Lay member

Serves on Audit Committee (Chair); Performance and Finance Committee; Primary

Care Commissioning Committee from 1st May 2015

Ingrid Fife – Lay member

Serves on Audit Committee; Remuneration Committee (Chair); HR & OD Committee

(Chair); Primary Care Commissioning Committee (Chair) from 1st May 2015

David Austin – Lay Member

Serves on Audit Committee; Integrated Governance Committee; Quality Committee

Shahzad Tahir – Lay Member

Serves on Audit Committee; HR & OD Committee

Audit Committee

The names of the individuals forming the Audit Committee throughout the year and

up to the signing of the Annual Report & Accounts are as listed above (with the

exception of David Austin whose term of office ceased on 31st March 2016).

In addition to the six Governing Body members listed, the following are in

attendance to support the Committee:

Simon Banks, Chief Officer (CCG)*

Dr Cliff Richards, Chair (CCG)*

Paul Brickwood, Chief Finance Officer (CCG)

Jan Snoddon, Chief Nurse (CCG)

Catherine Graney, Finance Lead (CCG)

Louise Cobain / Rebecca Brown (MIAA)**

Liz Temple-Murray / Mark Heap (Grant Thornton)**

Roger Causer / Virginia Martin (MIAA – Counter Fraud)***

* The Chief Officer and Chair are only expected to attend one Audit Committee

meeting per year.


27

**It is not expected that both of the Grant Thornton representatives or both MIAA

Representatives, will attend each meeting. Usually just one from each organisation

attends.

***The MIAA Counter Fraud representatives are only required to attend when they

have an agenda item. Again, both representatives are not expected to attend when

they do have an agenda item, usually just one attends.

Statement of Chief Officer’s Responsibilities

The National Health Service Act 2006 (as amended) states that each Clinical

Commissioning Group shall have a Chief Officer and that Officer shall be appointed

by the NHS Commissioning Board (NHS England). NHS England has appointed

Simon Banks to be the Chief Officer of NHS Halton Clinical Commissioning Group.

The responsibilities of a Chief Officer, including responsibilities for the propriety and

regularity of the public finances for which the Chief 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 Chief 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 Chief 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;


28

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 Chief Officer

Appointment Letter.

Simon Banks

Chief Officer (Accountable Officer)

26th May 2016


29

ANNUAL GOVERNANCE STATEMENT

Introduction and context

The Clinical Commissioning Group (CCG) was licenced from 1 April 2013 under

provisions enacted in the Health and Social Care Act 2012, which amended the

National Health Service Act 2006.

As at 1 April 2015, the CCG was licensed without conditions. NHS England is

responsible for oversight of the organisation’s performance. The assurance opinion

for 2015/16 will be published on the CCG website when published by NHS England.

NHS Halton CCG is co-terminus with Halton Borough Council; the borough of Halton

is within Liverpool City Region. The borough is split by the River Mersey which

separates the two towns of Widnes and Runcorn with the surrounding districts which

form the borough. The local authority and NHS Halton CCG has maintained its

strong partnership working to benefit the people of Halton. The CCG is located

within the catchment area of NHS England – Cheshire & Merseyside.

NHS Halton CCG consists of 17 member practices (as listed in Members Report,

page 24). As a membership organisation all 17 GP practices are signed up to its

Constitution, which is reviewed annually through the Members Forum. In 2015/16

the local practices and clinicians have continued to work closely together to improve

the health of local people.

NHS Halton CCG, through strong clinical leadership and engagement, has been able

to create the conditions to develop and implement a commissioning strategy that

aims to improve the health and wellbeing of the people of Halton. The philosophy

enabling change is recognised locally as the One Halton approach. Through this

approach the CCG has begun to implement its strategy for general practice, develop

a range of innovative programmes to support primary care through the Prime

Ministers Challenge Fund (now known as the GP access fund), and started to realise

the benefits of the two Urgent Care Centres for the people of Runcorn and Widnes.

The journey to full integration with the local authority continued its progress

throughout 2015/16, facilitated by the work of the joint appointments and joint

budgetary and commissioning arrangements. The Better Care Board provides

assurance through regular reporting to the Governing Body on the delivery of the

Better Care Fund plan as approved by NHS England. This Board ensures effective

management of pooled budgets. The effectiveness of this Board has been audited

by Merseyside Internal Audit Agency (MIAA) as part of the partnerships audit


30

process and an action plan has been agreed to strengthen reporting arrangements

on the Better Care Fund governance framework. Appendix 1, page 99 provides

further detail on the work of this Board.

The vision for the CCG is to deliver improvements in the health of local people using

a wellbeing approach. This requires effective engagement and involvement with

local people and decisions based on social value delivered through strong integrated

commissioning. The strategic objectives that will support the CCG to realise this

vision were refreshed in 2015 and are outlined here. The importance the CCG

places on both engagement and social value and its benefit to Halton is highlighted

on pages 11 of this report.

In its third year of the operation, the CCG has continued to build on its organisational

culture and approach to delivery. There have been challenges for all the CCGs in

this year and for NHS Halton CCG these include:

Consolidating team and capacity to ensure the delivery of commissioning

functions, and mitigating the impact of changes in our commissioning support

unit contract.

Establishing the systems and governance arrangements to undertake

delegated commissioning of primary care (general practice) responsibilities

Maintaining effective partnerships

Financial pressures in the system caused by over performance in some

areas, together with an understanding of Void costs of property and assets.

Attracting professionals of a high calibre to replace key roles on our

Governing Body, as some members reach the end of their term of office in

March 2016.

The future challenges are significant if we, along with our local partners, are to

deliver the aims set out in the national planning guidance for the Five Year Forward

View of closing the health and well-being gap, the care and quality gap, and the

finance and efficiency gap.

To provide assurance in relation to Safeguarding Children and Adults the CCG

produces a Safeguarding Annual Report which will be published in October 2016.

http://www.haltonccg.nhs.uk/about/vision-and-values


31

Scope of responsibility

As Chief 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 Chief Officer Appointment Letter.

I am responsible for ensuring that NHS Halton Commissioning Group is administered

prudently and economically and that resources are applied efficiently and effectively,

safeguarding financial propriety and regularity.

Compliance with the UK Corporate Governance Code

We are not required to comply with the UK Corporate Governance Code. However,

we have reported on our corporate governance arrangements by drawing upon best

practice available, including those aspects of the UK Corporate Governance Code

we consider to be relevant to the clinical commissioning group and best practice.

NHS Halton 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.

The CCG Constitution states that in conducting its business it will, at all times,

observe the following:

the highest standards of propriety involving impartiality, integrity and

objectivity in relation to the stewardship of public funds, the management of

the organisation and the conduct of its business;

the Good Governance Standard for Public Services;

the standards of behaviour published by the Committee on Standards in

Public Life (1995) known as the “Nolan Principles‟

the seven key principles of the NHS Constitution;

the Equality Act 2010

Standards for Members of NHS Boards and Governing Bodies in England

The CCG has developed specific policies on Standards of Business Conduct with

specific guidance on managing conflicts of interest, and Anti-Fraud, Bribery and

Corruption to support staff in understanding their responsibilities to ensure good

governance when conducting business.


32

The CCG’s Governance Framework is outlined in the Constitution which can be

accessed here.

NHS Halton CCG Governance Structure

The diagram below shows the current governance structure of the CCG. Further

details of the work of each sub-Committee of the Governing Body is provided in

Appendix 1, page 99

Diagram 2

Members Forum

The Members Forum is held on a quarterly basis and its agenda is set through a

collaborative approach, co-ordinated by the Primary Care Group. This Group reports

to the Service Development Committee and receives advice from the Committee in

determining priorities for debate that are aligned to the CCG commissioning plans.

All staff from practices are encouraged to attend and the format provides a mix of

educational sessions and space for CCG business to be challenged and plans

updated. Each practice has clinical lead representation on the Service Development

Committee and outputs from the Forum that may require further work can be

escalated to this Committee for further deliberation and action. The Committee is

chaired by one of the Governing Body general practice representatives and this

ensures clinical leadership and engagement in the delivery of clinical commissioning

in Halton.

http://www.haltonccg.nhs.uk/public-information/Documents/Constitution%20post%20GB080115%2826.01%29.pdf


33

In 2015 the CCG established two strategic clinical lead roles from its membership to

sit alongside the Executive Management Team of the CCG. These roles link with

the team of clinical leads and commissioning managers and are able to bring a more

in-depth understanding of the CCG business to enable effective debate and clinical

challenge within the Forum.

The decision making powers of the Members Forum are clearly outlined within the

CCG Constitution.

Governing Body

The Governing Body consists of 17 voting members, described in Section 1, page 25

of this Report. In addition there are three non-voting members representing the

local authority (adult and children’s services) and Healthwatch.

The Governing Body meets monthly in public and makes its papers accessible

through the website. Public questions are invited to be submitted in advance of the

meeting and the response is provided at the meeting and recorded in the public

minutes. The CCG encourages public questions and enables other options in

addition to its public Governing Body meeting for local people to raise an issue and

ask questions of the CCG.

The Governing Body has regularly reviewed its effectiveness and identified areas for

on-going development as part of a programme of Governing Body development.

This is encapsulated within the CCG Organisational Development Plan that is

refreshed annually. This year great significance has been placed on succession

planning, in particular for the replacement to the role of clinical chair, the secondary

care doctor and registered nurse, to ensure the CCG retains strong clinical

leadership on its Governing Body. The CCG has co-ordinated a robust recruitment

process to ensure that moving in to 2016/17 the CCG has a strong team on its

Governing Body.

During 2015/16 the CCG has continued to embed its person-centred approach to its

consultation and engagement activity with the support of our four Governing Body

Lay Members; this has been further enhanced with the support of our third sector

partners and through an innovative partnership with The Vikings. Detail of this

activity is provided on the Patient and Public Involvement Section (page 11 - 13) of

this Report. The CCG has reviewed the effectiveness of its Consultation Steering

Group and strengthened its model of consultation for 2016. The CCG’s decision to

create extra capacity through the appointment of four lay members rather than the

mandated two, has enabled greater public involvement in the work of the CCG. The


34

result of this investment has led to the decision to continue with four Lay members

as the Governing Body approaches its second three-year cycle from April 2016.

Audit Committee

This is the Committee of the CCG that provides the Governing Body with

independent assurance through the approval and delivery of annual audit plans,

review of internal audit reports and monitoring of actions advised. This year the

governance reviews provided varying assurance levels ranging from High to Limited.

During the year MIAA issued no audit reports with a conclusion of no assurance.

The Audit Committee through an Audit Actions tracker is able to monitor follow up

actions required in response to the finding of audits that were completed within the

audit plan for 2015/16. This showed that 21 recommendations had been accepted

and incorporated into action plans with 5 actions fully implemented, 12 partially

complete, 1 outstanding, and the remainder not yet due.

The Committee receives the Director of Auditors opinion and Annual Report. The

Audit Committee obtains external audit views and opinions ensuring appropriate

review and implementation of national guidance.

The Audit Committee also receives the Board Assurance Framework (BAF) and

Corporate Risk Register (CRR) for review and further challenge. Detail of the activity

of this Committee in 2015/16 is provided Appendix 1, page 99.

Sub Committees of the Governing Body

The Governing Body receives regular reporting from the sub-Committees as listed in

diagram 2 above. The Committees have been mapped against the functions and

duties of the CCG and enable clear escalation, accountability and assurance for the

Governing Body. Both the Performance and Finance Committee and the Quality

Committee are key governance committees that provide significant oversight to the

Governing Body on critical aspects of CCG business. A summary of all sub-

Committees, including attendance and highlights of their work in 2015/16 is attached

in Appendix 1 & 2, pages 99 – 106.

In May 2015 the CCG established a Primary Care Commissioning Committee, as a

sub-Committee of the Governing Body to enable the robust governance of its

delegated responsibility for primary care business. An internal audit review report

completed and issued in February 2016 provided a limited assurance assessment,

with recommendations for improvement to the Terms of Reference, more regular

publication of declaration of interests of all Committee members, and a review of the

Standards of Business Conduct policy to provide appropriate signposting to how

conflicts might arise, and procedures for how the CCG intends to monitor and


35

manage performance of practices. An action plan has been implemented to address

these recommendations.

The Better Care Board is a Committee in Common across health and social care and

has a dual reporting function to the Governing Body of both the CCG and Halton

Borough Council. This Committee reports on delivery of the Better Care Fund plan,

reporting in relation to the ‘Pooled Budget’ for Adult Health and Social Care and also

receives reports and assurance from the System Resilience Group (SRG). The SRG

is a joint group across the health economy with the key aim of managing the

response to the needs/pressure within the urgent care system which also monitors

the action plans in the health economy in relation to performance locally in Cancer

Services Improvement Plans.

The CCG has established an annual self-assessment of committee effectiveness of

the sub-Committees of its Governing Body the result of which informs a refresh of

Committee terms of reference and work plan. These self-assessments were further

supported by an internal audit assessment. This demonstrates how the CCG

recognises the vital role that its Committees undertake as part of its overall

governance framework and the importance of on-going development enabling each

Committee to identify potential areas for enhancement.

Other Key Committees and Groups

NHS Halton CCG has been an active member or a number of key committees and

groups, and has also led on the establishment of strategic groups across the wider

health care system. These committees and groups deliver a mix of advisory,

scrutiny, partnership and development functions. The CCG’s clinical engagement

and managerial / leadership presence has ensured and supported the delivery of a

range of statutory and other functions.

In 2015/16 the CCG has undertaken a system leadership role in supporting:

New Models of Care – Acute Care Collaboration Vanguard – Cheshire and

Merseyside Women’s and Children’s Service Partnership

Mid Mersey Stroke Group

Cheshire & Merseyside Urgent & Emergency Care Network

5 Borough footprint Mental Health Group

Cheshire & Merseyside Lung Cancer Group

North West Ambulance Service NHS Trust Strategic Partnership Board


36

The Clinical Commissioning Group’s Risk Management Framework

The CCG’s Risk Management framework adopts best practice from the NHS

Executive Controls Assurance risk management standard which includes risk

identification, risk analysis, evaluation and prioritisation and risk treatment. The

Governing Body accepts the importance of the principles of risk management and

recognises the value of taking a strategic, proactive, and comprehensive approach to

the assessment and control of risk.

All those working within the CCG have a responsibility to contribute, directly or

indirectly to the achievement of the CCG’s objectives through the efficient

management of risk. Managers or clinical leads systematically identify and assess

risks associated with the work areas and manage them to ensure they do not impede

the delivery of operational or strategic objectives; these are recorded on the

Corporate Risk Register. Major risks identified on this register are integrated into the

Board Assurance Framework which is recognised by the Governing Body as the tool

to ensure delivery of strategic objectives.

The process for managing risk is embedded in the CCG and clear ownership is

evidenced through the Committee work plans. The Integrated Governance

Committee monitors review of the process; with both the Governing Body

responsible for assessment of risk appetite and defining the risk maturity. This

enables the CCG to be more effective in identifying and managing risk and adds to

the process of assurance for the CCG.

The internal audit plan for 2015/16 included the mandated review of the CCG’s

Assurance Framework locally known as the Board Assurance Framework (BAF).

The conclusion provided the CCG with assurance that the Assurance Framework is

complaint with NHS requirements. Three areas were assessed as amber. The

improvements identified related to risk appetite and how this can be further

evidenced at Governing Body. An action plan to address this has been developed

and reported through the Audit Committee.


37

Diagram 3 defines the CCG Risk Process

Risk Assessment

Board Assurance Framework

The Governing Body has monitored the management of its strategic risks during the

2015/16 reporting period. The work carried out in the previous year has led to a

reduction in the number of risks on the current Board Assurance Framework (BAF),

which contains 17 risks across its five strategic objectives. Each risk is clearly

outlined, together with an initial risk rating, current rating and target to achieve.

There are clear controls and mitigating actions alongside assurances processes and

levels.

Every year internal audit review and assess the effectiveness of the BAF and deliver a

view, this year the auditors have identified some areas of good practice and areas for

improvement. An action plan has been developed in response to these findings to be

delivered during 2016.

The 17 strategic risks identified during 2015/16 fall across all five strategic objectives

as shown in Table 4 below (a risk may link to more than one strategic objective).

Only one risk is rated with a high residual score of 16.


38

Table 4 – Strategic Risks

Strategic Risk

High

15-25

Moderate

9-14

Low

4-8

To commission services which continually improve the health and wellbeing of Halton residents

1* 1 5

To continually improve and innovate in our engagement with local people and communities to secure their participation in improving their own health outcomes

2

To deliver improvements in the quality of the health and care services accessed by the people of Halton within the resources available to us and our partner organisations

1* 1 1

To deliver all of our statutory duties and commissioning responsibilities effectively, whilst ensuring their our robust constitutional, governance and financial controls in place

1* 3 7

To develop the skills, knowledge and competence of the people who are working with us to create a high performing organisation that will allow us to build effective partnerships with other organisations and develop leadership from within

1 2

*this is one risk relating to three objectives

Corporate Risk Register

The Corporate Risk Register contains 23 risks across the function areas of NHS

Halton CCG. There are 12 risks with a low residual rating, 11 with a medium

residual rating, and none with a high residual rating. The current risk ratings are

shown below.

Table 5 – Corporate Risks

Corporate Risk High

15-25

Medium

9-14

Low

3-8

To commission services which continually improve the health and wellbeing of Halton residents

8 1

To continually improve and innovate in our engagement with local people and communities to secure their participation in improving their own health outcomes

2 1

To deliver improvements in the quality of the health and care services accessed by the people of Halton

8 1


39

within the resources available to us and our partner organisations

To deliver all of our statutory duties and commissioning responsibilities effectively, whilst ensuring their our robust constitutional, governance and financial controls in place

8 9

To develop the skills, knowledge and competence of the people who are working with us to create a high performing organisation that will allow us to build effective partnerships with other organisations and develop leadership from within

1

The key risk areas for NHS Halton CCG in this year have been:

Failure to deliver financial targets due to provider over-performance on cost &

volume budgets (assurance obtained through internal Committee monitoring

of contract performance and external assessment via NHSE assurance

processes).

Lack of strategic understanding of CCG property and asset resulting in

financial risk and ineffective use of buildings (assurance obtained the

alignment of local estate working group with strategic asset management

group

Failure to commission quality services will impact detrimentally on the health

and well-being of the people of Halton (mitigation through quality metrics and

assurance obtained through contractual performance monitoring, early

warning dashboard and triangulation of data and knowledge including

attendance at NHSE Quality Surveillance Groups)

The potential risks for NHS Halton CCG in to the coming year relate to:

Financial pressures on programme costs with a £8.4 million saving is required

(mitigation for this risk is via tight financial planning against the 16/17

operational plan, and robust Strategic Transformation Plan)

Failure to commission high quality general medical services effectively and

efficiently (mitigation includes strengthening of governance arrangements

though Primary Care Commissioning Committee, and working relationship

with NHSE, appointment of Primary Care Finance lead to enable robust

finance monitoring)

Failure of the Governing Body to function effectively due to deficits in

behavioural, technical and business competencies. There are a number of

new appointments to key roles on the Governing Body from April 2016,


40

(assurance obtained through robust recruitment process and mitigation

against this risk through GB Development Programme and ‘buddy’ system)

Failure of the CCG to develop and deliver the required local Sustainability and

Transformation Plan (STP) and to develop and deliver in partnership with

other CCGs the wider footprint STP.

Failure of the CCG to commission sustainable new models of care as a result

of ineffective integration and partnership arrangements

Assurance Framework Review

The overall objective was to assess the approach by which the organisation

maintains and uses the Assurance Framework to support overall assessment of

governance, risk management and internal controls.

The review included an assessment of the following:

The structure of the Assurance Framework meets the requirements

There is Governing Body engagement in the review and use of the

Assurance Framework

The quality of the content of the Assurance Framework demonstrates clear

connectively with the Governing Body agenda and external environment

The report contained a number of developments / best practice considerations which

have been accepted by the organisation and for which an action plan has been

developed.

The opinion statement:

The organisation’s Assurance Framework meets the NHS Requirements.

There could be greater visibility of the use of the Assurance Framework by the

Governing Body

The Assurance Framework reflects the risks discussed by the Governing Body

Equality, Diversity and Human Rights Responsibilities

We are required to prepare and publish Equality Objectives to meet our Specific

Duty as outlined in the Equality Act 2010. To help us set our Equality Objectives the

CCG undertook an innovative approach to our Equality Delivery Systems (EDS) 2

assessment, which involved extensive engagement with national regional and local

organisations that represent the interests of people who share protected


41

characteristics. Our Objectives plan has been significantly revised in light or our

Equality Delivery Systems 2 assessment. Information about our objectives and E &

D plan can be accessed on here. Risks identified through our E & D governance

process are monitored through our risk management framework.

We will continue to work internally, and in partnership with our Providers, community

and voluntary sector and other key organisations to ensure that we advance equality

of opportunity and meet our exacting requirements of the Equality Act 2010.

Health & Safety and Local Security

The CCG is required to comply with relevant Health and Safety Acts and

Regulations, together with industry standards and best practice a relevant to its

operations. We accept our duty to prevent injury and ill health to our staff, visitors,

others who work on our behalf. For this reason we have developed a Health & Safety

Policy and our key objective is to minimise the number and severity of occupational

accidents and illnesses.

In 2015/2016 the CCG had no reportable health & safety incidents.

Emergency Preparedness, Resilience and Response

Clinical Commissioning Groups (CCG’s) are Category 2 responders under the Civil

Contingencies Act 2004. This requires us to share information and cooperate with

other agencies in terms of planning for emergencies.

CCGs are required to ensure they have a Business Continuity and Incident

Response Plan in place which complies with the NHS Core Standards for

Emergency Planning, Response and Resilience (EPRR) and are also required to

assure themselves that their commissioned services have plans in place to respond

to and recover from emergencies.

We certify that the CCG has incident response plans in place, which are fully

compliant with the NHS Commissioning Board Emergency Preparedness Framework

2013. The CCG regularly reviews and makes improvements to its major incident plan

and has a programme for regularly testing this plan, the results of which are reported

to the Integrated Governance Committee & the Governing Body.

The Clinical Commissioning Group Internal Control Framework

The system of internal control within NHS Halton CCG is designed 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.

http://www.haltonccg.nhs.uk/public-information/Documents/Equality%20and%20Diversity%20Annual%20Report%2015-16%20and%20Objectives%2015-18.pdf


42

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.

As Chief Officer I have overall accountability for the management of risk and

discharge this duty by demonstrating leadership in the identification, promotion and

involvement of risk management; ensuring the development of policies and

procedures for the CCG in relation to risk management; and ensuring that senior

officers have managerial responsibility for supporting Committees to monitor risk and

provide regular reports to the Governing Body.

Information Governance

The NHS Information Governance Framework sets the processes and procedures by

which the NHS handles information about patients and employees, in particular

personal identifiable information. The NHS Information Governance Framework is

supported by an information governance toolkit and the annual submission process

provides assurances to the CCG, other organisations and to individuals that personal

information is dealt with legally, securely, efficiently and effectively.

The Integrated Governance Committee receives quarterly reports from the

Information Governance Working Group to provide evidence of progress against the

standards required for the CCG. An internal audit review in 2015/16 has received

significant assurance for its ability to demonstrate evidence in support of Level 2

Information Toolkit compliance.

NHS Halton CCG has no information breaches to report within the Statement of

Information Governance.

NHS Halton CCG places high importance on ensuring there are robust information

governance systems and processes in place to help protect patient and corporate

information, under the internal executive guidance of the SIRO and Caldicott

Guardian, and nominated deputies. We have established an information governance

management framework and information governance processes and procedures in

line with the information governance toolkit. All staff complete annual information

governance training and have access to the staff handbook to ensure they are aware

of their information governance roles and responsibilities.

There are processes in place for incident reporting and investigation of serious

incidents. Information risk assessment and management procedures have been

developed and the Information Governance Working Group is embedding an

information risk culture throughout the organisation against identified risks.


43

Review of Economy, Efficiency & Effectiveness of the Use of Resources

The CCG has an obligation to use its resources efficiently, effectively and

economically. In addition it must meet financial requirements as set out by NHS

England. This includes delivering a surplus position over and above a balanced

budget. In order to mitigate and control risks associated with the CCGs use of

resources, organisational financial health is checked and reported to the Governing

Body on a monthly basis. The Governing Body has also delegated responsibility for

some aspects of financial internal control to the Performance & Finance Committee.

The CCG has produced financial plans to ensure and demonstrate that it has robust

financial mechanisms in place. These have been reported through the Performance

& Finance Committee to the Governing Body, providing assurance to the Governing

Body that the organisation is effectively managing its resources and understanding

the key financial risks.

In addition to internal controls, the CCG produces robust Quality, Innovation,

Productivity and Prevention (QIPP) plans which aim to mitigate financial pressures

and improve healthcare for the local population. The CCG also provides information

to NHS England to report upon how the CCG’s resources have been spent. The

CCG also undertakes a self-assessment against the externally monitored financial

indicators within ‘Component 4’ (Financial Management) of the national CCG

Assurance Framework which is reported through the Audit Committee.

The CCG also receives via its external auditors the VFM (Value for Money)

assessment which reviews how the CCG makes decisions to ensure the probity and

appropriateness of spend as part of the external audit process.

Feedback from Delegation Chains regarding Business, Use of Resources and

Responses to Risk

The CCG had been given delegated commissioning authority from NHS England for

general practices services from 1st April 2015. The Governing Body has delegated

responsibility for Commissioning of Primary Care to the Primary Care Commissioning

Committee. This Committee, (which includes representation in attendance from

NHS England) reports monthly to the Governing Body, providing assurance to the

Governing Body that the organisation is developing robust governance arrangements

to effectively managing its resources and understand its key financial risks in relation

to primary care commissioning . The CCG also completes a quarterly self-

assessment of primary care commissioning which is submitted nationally to NHS

England as part of the quarterly CCG external assurance process.

To support the development of this Committee, an internal audit was undertaken

which provided limited assurance and a subsequent action plan is being monitored


44

through the Audit Committee.

Review of the effectiveness of Governance, Risk Management & Internal

Control

As Chief Officer, I have responsibility for reviewing the effectiveness of the system of

internal control within the Clinical Commissioning Group.

Capacity to Handle Risk

The Risk Management Strategy has been reviewed and approved by the Governing

Body; this outlines the roles and responsibility for handling risks of all staff and places

great emphasis on the role of all staff to be involved within the risk process. The CCG

has procured DATIX a web based risk management system that has been tailored

specifically for the organisation’s needs.

The Chief Nurse provides expert advice and guidance to Committees and staff on

how to identify and manage risk, and risk management features in the annual

Governing Body Development Plan. Sub-Committees are expected to report to the

Governing Body on monitoring and mitigation of risks for which they are responsible.

In addition to the approved Risk Management Strategy further guidance has been

developed for use by staff in handling risk.

Review of Effectiveness

My review of the effectiveness of the system of internal control is informed by the

work of the internal auditors and the executive managers and clinical leads within the

clinical commissioning group who have responsibility for the development and

maintenance of the internal control framework. I have drawn on performance

information available to me. My review is also informed by comments made by the

external auditors in their annual audit letter and other reports.

Our assurance framework provides me with evidence that the effectiveness of

controls that manage risks to the clinical commissioning group achieving its

principles objectives have been reviewed.

I have been advised on the implications of the result of my review of the

effectiveness of the system of internal control by the Governing Body, the Audit

Committee and Integrated Governance Committee and a plan to address

weaknesses and ensure continuous improvement of the system is in place.


45

Director of Internal Audit Opinion

The purpose of the Director of Audit Opinion is to contribute to the assurances

available to underpin the Governing Body’s own assessment of the effectiveness of

the organisation’s system of internal control. This opinion will therefore assist the

Chief Officer and the Governing Body in the completion of its Annual Governance

Statement.

The Director of Audit Opinion is based upon the work completed and includes an

opinion on the Assurance Framework and the risk based audit assignments across

the critical business systems, along with contributions to improving governance, risk

management and internal control.

Opinion

My overall opinion is:

Significant Assurance can be given that that there is a generally sound

system of internal control designed to meet the organisation’s objectives, and

that controls are generally being applied consistently. However, some

weaknesses in the design or inconsistent application of controls put the

achievement of a particular objective at risk

The overall opinion is provided in the context of the level of risk awareness of

the CCG and the targeted and effective use of Internal Audit as part of the

system of internal control. Going forward, the CCG faces a number of

environmental challenges, specifically the further integration of local health

and care systems, with the introduction of the Sustainability and

Transformation Plans. This alongside the challenges of performance delivery

and financial performance will need to be effectively managed in the new

financial year.

During the year, Internal Audit issued three audit reports with a conclusion of limited

assurance. These related to co-commissioning, partnership governance, and CSU

business continuity. All completed audits have actions plans agreed, the

performance of which is reviewed and monitored through the Audit committee. All

14/15 audit action plans have been delivered and reviews have been completed by

the auditors.


46

Table 6 MIAA Audit Summary

New in year Audits Assurance level High Medium Low

Commissioning Support

Unit Business continuity

Limited 1 2 0

Partnerships Limited 2 1 0

Financial High 0 0 0

HR/ESR Significant 0 2 0

Better Care Fund Significant

Co Commissioning

Baseline assessment

Limited 1 3 1

Information Governance

Toolkit

Significant 0 0 0

Committee Effectiveness Not assessed Actions for each committee in

relation to review of terms of

reference and membership.

Assurance Framework

Opinion

Meet Requirements 5

Safeguarding Review To be completed

Data Quality

During 2015/16 reporting to the Board has been adapted and data quality has

evolved to meet the expectation of Governing Body members. The data on quality

performance is provided through the North West Commissioning Support Unit. This

is analysed by the internal Contracting and Performance Team who provide the

reports to the Quality Committee and Performance and Finance Committees. The

Governing Body has sight of the Corporate Performance Report.

Any issues identified relating to the quality of data is risk assessed and discussed at

Governing Body. In 2015/16 one of our main providers switched to a new patient data

recording system and this resulted in some data items being incorrect. These issues

are being addressed at part of an on-going programme and when correct data flows this

has been reported in the corporate performance report. Incorrect data is not reported

and a narrative had been provided to explain the issue and what is being done by the

provider to address it. As at 31st January 2016 there remains one incorrect data flow

relating to diagnostic waiting times.

Having assessed the quality of data submitted to and reviewed by the Governing Body,


47

I am assured that the data is of sufficient quality that the Governing Body can carry out

its duties.

Business Critical Models

The CCG has produced and maintains an organisational Information Asset Register

which identifies business critical assets for each service within the CCG, including the

shared finance service and hosted services. Information Asset Owners and

Information Asset Administrators have been assigned and all information assets are

regularly reviewed. The SIRO is responsible for identifying and managing the

information risks and the Caldicott Guardian oversees risk relating to patient data.

Data Flow mapping has been completed which enables an understanding of the

flows of information related to all information assets with the Information Asset

Register. Information Asset Owners are responsible for providing updates and

highlighting any risks to the SIRO.

The CCG is further supported through a contract arrangement with Midlands &

Lancashire Commissioning Support Unit.

NHS Halton CCG is one of six local NHS organisations that receive its IT services

from St Helens & Knowsley Health Informatics Service. There is a joint Service Level

Agreement between the parties who have agreed to share their health informatics

service with the intention o f pooling their collective resources and expertise in

order to ensure that they have the capacity, capability and flexibility required for a

21st century health informatics service. The partner organisations are committed to

ensuring that their shared informatics service provides value for money for their

respective organisations.

The CCG is represented on the Partnership Board that is responsible for the

oversight of the service, and has both clinical and managerial representation on the

sub-group of the Board.

NHS Halton CCG confirms that an appropriate framework and environment is in

place to provide quality assurance of business critical models, in line with the

recommendations in the MacPherson report. All business critical models have been

identified and information about quality assurance processes for those models has

been provided to the Analytical Oversight Committee, chaired by the Chief Analyst in

the Department of Health.

Data Security

We have submitted a satisfactory level of compliance with the information

governance toolkit assessment, achieving Level 2 as required. This submission has


48

been reviewed by the internal audit team and received a significant assurance

assessment.

The CCG has not had any Serious Untoward Incidents relating to data security

breaches.

Discharge of Statutory Functions

I can confirm that the correct arrangements are in place for the CCG to discharge its

statutory functions. As outlined in the organisation’s constitution arrangements in

place for the discharge of statutory functions that were developed with external legal

input, to ensure compliance with the relevant legislation.

In light of the Harris Review, the clinical commissioning group has reviewed all of the

statutory duties and powers conferred on it by the National Health Service Act 2006

(as amended) and other associated legislative and regulations. As a result, I can

confirm that the clinical commissioning group is clear about the legislative

requirements associated with each of the statutory functions for which it is

responsible, including any restrictions on delegation of those functions.

Responsibility for each duty and power has been clearly allocated to a lead Director.

Directorates have confirmed that their structures provide the necessary capability

and capacity to undertake all of the clinical commissioning group’s statutory duties.

Conclusion

The CCG has no significant internal controls issues to report. Throughout the year

some deficiencies were identified through proactive self-assessment audits as well

as internal and audits. Any issues identified have been fully rectified by the

development and implementation of action plans to address the risks to the

Governance framework. I am satisfied with the work of the CCG in the financial year

of 2015/16 and look forward to continuing to deliver the CCG’s vision and progress

its priorities.

Simon Banks


26th May 2016


49

Remuneration and Staff Report

As a commissioner of health services, we believe health and wellbeing applies as

much to our employees as it does to our local population. Wellbeing can be

described as the creation of an environment which allows employees to achieve their

full potential. During 2015 we have continued to remain fully committed to the health

and positive wellbeing of our employees and understand that the health and

wellbeing of the workforce is crucial to the delivery of the improvements in patient

care to the people of Halton.

We continue to be committed to the health and positive wellbeing of our staff and we

want to do as much as we can to enable staff to be at their best, energised, healthy

and motivated. Our local staff survey has been designed to help provide an

indication as to how staff feel the CCG is working, whether we are working within our

values and principles, how their roles are contributing to the success of the CCG and

where there could be areas for improvement.

Employee consultation

Excellent partnership arrangements with external organisations and Trade Unions

ensure that we openly discuss, challenge and agree initiatives that have a positive

impact on both our staff and our organisation. NHS Halton CCG and Staff Side

organisations have a common objective of ensuring the efficient operation and

success of the organisation for the benefit of all, through working in partnership to

secure these aims and objectives. To enable this we formed a Partnership Forum.

The Forum provides a formal vehicle for the agreement of types, forms and content

of information and general consultative communication exchanges between

managers and staff. Our Partnership Agreement provides a clear framework within

which employment relations will be conducted effectively within NHS Halton CCG.

Disabled Employees

NHS Halton CCG has duties to meet under the Equality Act 2010 in relation to

workforce and organisational development. The CCG has therefore taken positive

steps to ensure that policies across the CCG deal with equality implications around

recruitment and selection, pay and benefits, flexible working hours, training and

development, policies around managing employees and protecting employees from

harassment, victimisation and discrimination. Through our recruitment processes the

CCG promotes the ‘Two Ticks’ symbol on all vacancies, to promote the CCGs

commitment to employing disabled people.


50

Equal Opportunities

NHS Halton CCG is committed to equality of opportunity for all employees and is

committed to employment practices, policies and procedures which ensure that no

employee, or potential employee, receives less favourable treatment on the grounds

of gender, race, colour, ethnic or national origin, sexual orientation, marital status,

religion or belief, age, trade union membership, disability, offending background,

domestic circumstances, social and employment status, HIV status, gender

reassignment, political affiliation or any other personal characteristic as outlined in

the Equality Act (2010) and any other status covered by the Human Rights Act

(1998). Diversity is to be viewed positively and, in recognising that everyone is

different, the unique contribution that each individual’s experience, knowledge and

skills can make is valued equally.

Staff Composition Tables (Audited)

Breakdown of persons by gender that are part of the CCG by headcount as at 31st

March 2016

Table 7

Female Male

Governing Body members 5 8

Other members of staff 55 8

Very Senior Managers (on GB) 1 2

The table below shows the average staff numbers which reconciles to note 5 in the

accounts

Table 8

Staff by Occupation Code Total

General Medical Practitioner (Public Health & Community Services) 0.40

Senior manager Central functions 1.00

Manager Central functions 8.17

Clerical & administrative Central functions 19.77

Manager Community Services 10.27

Other 1st level (Level 1 - Sub Part 1) Community Services 2.02

Scientist Pharmacy 2.90

Technician Pharmacy 1.30

45.83


51

Table 9 provides details of Senior Managers by Pay Band

Pay multiples (Audited)

Reporting bodies are required to disclose the relationship between the remuneration

of the highest paid director in their organisation and the median remuneration of the

organisation's workforce.

The banded remuneration of the highest paid member of the Governing Body in NHS

Halton CCG in the financial year 2015-16 was £150,000 - £155,000 (2014-15

£150,000 - £155,000). This was 4.57 times (2014-15 4.96 times) the median

remuneration of the workforce, which was £33,372 (2014-15 £30,576).

In 2015-16 no employees received remuneration in excess of the highest-paid

member of the Governing Body. In 2015-16, remuneration ranged from £0-5,000 to

£150,000-155,000 (2014-15; £5,000-10,000 to £150,000-155,000).

Total remuneration includes salary, non-consolidated performance-related pay,

benefits-in-kind. It does not include severance payments, employer pension

contributions and the cash equivalent transfer value of pensions.

Sickness Absence Data

In the rolling 12 month period ending March 2016 there were 481 wte days lost to

sickness absence. At the end of March 2016 the headcount of the CCG was 44

giving an average total of 10.9 days sickness absence per employee

Expenditure on consultancy

The amount spent on consultancy is £81,582

Exit packages

There were no exit packages or severance payments in 2015/16

Off Payroll Engagements

There were no Off-payroll engagements as at 31 March 2016 for more than £220 per

day and that last longer than six months.

Senior managers by

Band

Average

Numbers

Very Senior Manager 3.00

Band 9 1.00

Band 8D 0.00

Band 8C 0.00

Total 4.00


52

There are no new off-payroll engagements between 1 April 2015 and 31 March 2016

for more than £220 per day and that last longer than six months

The following are off-payroll engagements which relate to Governing Body members.

All but one of the payments to Governing Body Members are made to individual

GP’s practices and therefore assessed to be low risk with no assurance necessary

that the individual is paying the right amount of tax.

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

0

Number of individuals that have been deemed “board members, and/or senior officers with significant financial responsibility” during the financial year. This figure includes both off-payroll and on-payroll engagements

16


53

Table 10 – Salaries and Allowances 2015/16 (Audited)

* Legal Chief Officer

Notes:

1. Paul Brickwood’s remuneration is split across NHS St Helens CCG, NHS Knowsley CCG and NHS Halton CCG. The remuneration costs shown represent NHS St Helens CCG's share of the total remuneration paid by the three CCG’s. The total remuneration paid was within the band £115,000 to £120,000 and the allocation of cost to the CCG is based on percentages per the population size. St Helens 41%, Knowsley 33% and Halton 26%.

2. Professor M Chester left his post on 31st March 2016

3. Dr D McDermott left his post on 31st March 2016

4. David Austin left his post on 31st March 2016

5. Dr D Lyon left his post on 31st March 2016

Name Title Note Salary Expense Performance Long term All pension- Total Salary Expense Performance Long term All pension- Total

(bands of payments pay and performance related benefits (bands of payments pay and performance related benefits

£5,000) (rounded to bonuses pay and bonuses £5,000) (rounded to bonuses pay and bonuses

the nearest (bands of (bands of (bands of (bands of the nearest (bands of (bands of (bands of (bands of

£00) £5,000) £5,000) £2,500) £5,000) £00) £5,000) £5,000) £2,500) £5,000)

£'000 £'00 £'000 £'000 £'000 £'000 £'000 £'00 £'000 £'000 £'000 £'000

Dr C Richards Chair 60-65 1 0 0 0 60-65 60-65 1 0 0 0 60-65

David Merrill Deputy Chair 10-15 0 0 0 0 10-15 10-15 0 0 0 0 10-15

Simon Banks Chief Officer * 105-110 27 0 0 20-22.5 125-130 105-110 19 0 0 0-2.5 105-110

Jan Snoddon Chief Nurse 85-90 54 0 0 120-122.5 215-220 75-80 55 0 0 20-22.5 100-105

David Sweeney Director of Transformation 85-90 60 0 0 45-47.5 140-145 0 0 0 0 0 0

Dr M O Connor GP Board Member 15-20 0 0 0 0 15-20 15-20 0 0 0 0 15-20

Dr C Forde GP Board Member 15-20 0 0 0 0 15-20 15-20 0 0 0 0 15-20

Paul Brickwood Chief Finance Officer 1 25-30 11 0 0 0-2.5 30-35 25-30 11 0 0 0 30-35

Prof M Chester GP Board Member 2 15-20 0 0 0 0 15-20 15-20 0 0 0 0 15-20

Dr D McDermott GP Board Member 3 15-20 0 0 0 0 15-20 15-20 0 0 0 0 15-20

David Austin Lay Member 4 5-10 0 0 0 0 5-10 5-10 0 0 0 0 5-10

Dr D Lyon GP Board Member 5 15-20 0 0 0 0 15-20 15-20 0 0 0 0 15-20

D Hanshaw Practice Manager 0-5 0 0 0 0 0-5 0-5 0 0 0 0 0-5

G Frame Nurse 10-15 0 0 0 0 10-15 10-15 0 0 0 0 10-15

Ingrid Fife Lay Member 5-10 0 0 0 0 5-10 5-10 0 0 0 0 5-10

Shahzad Tahir Lay Member 5-10 0 0 0 0 5-10 5-10 0 0 0 0 5-10

2015-16 2014-15


54

Table 11 Pension Benefits (Audited)

Certain members do not receive pensionable remuneration therefore there will be no entries in respect of pensions for certain

members.

The pension entitlement above is the total pension entitlement for each Director, is not split across other organisations and may

have been partly accrued in a non senior manager capacity.

** On reaching Pensionable age employees do not have a Cash Equivalent Transfer Value.

Name Title Real increase Real increase Total accrued Lump sum at Cash Cash Real increase Employer's

in pension in pension pension at pension age Equivalent Equivalent in Cash contribution

at pension age lump sum at pension age related to Transfer Transfer Equivalent to

(bands of pension age 31st March 2016 accrued Value at 31 Value at 31 Transfer stakeholder

£2,500) (bands of (bands of pension at 31 March 2016 March 2015 Value pension

£2,500) £5,000) March 2016

(bands of

£5,000)

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Simon Banks * Chief Officer 0-2.5 0 20-25 30-35 252 322 0 0

Simon Banks Chief Officer 0-2.5 0 0-5 0 17 0 17 0

Paul Brickwood Chief Finance Officer 0-2.5 0-2.5 50-55 160-165 1153 1124 28 0

David Sweeney Director of Transformation 0-2.5 2.5-5 20-25 65-70 354 328 25 0

David Sweeney Director of Transformation 0-2.5 0 0-5 0 16 0 16 0

Jan Snoddon ** Chief Nurse 5-7.5 15-17.5 40-45 125-130 0 0 0 0


55

Cash Equivalent Transfer Values

A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of

the pension scheme benefits accrued by a member at a particular point in time. The

benefits valued are the member’s accrued benefits and any contingent spouse’s

pension payable from the scheme. A CETV is a payment made by a pension

scheme or arrangement to secure pension benefits in another pension scheme or

arrangement when the member leaves a scheme and chooses to transfer the

benefits accrued in their former scheme. This may be for more than just their service

in a senior capacity to which disclosure applies (in which case this fact will be noted

at the foot of the table). The CETV figures and the other pension details include the

value of any pension benefits in another scheme or arrangement which the individual

has transferred to the NHS pension scheme. They also include any additional

pension benefit accrued to the member as a result of their purchasing additional

years of pension service in the scheme at their own costs. CETVs are calculated

within the guidelines and framework prescribed by the Institute and Faculty of

Actuaries.

Real Increase in CETV

This reflects the increase in CETV effectively funded by the employer. It takes

account of the increase in accrued pension due to inflation, contributions paid by the

employee (including the value of any benefits transferred from another scheme or

arrangement) and uses common market valuation factors for the start and end of the

period.

Simon Banks

Chief Officer

26th May 2016


56

INDEPENDENT AUDITOR’S REPORT TO THE MEMBERS OF THE GOVERNING BODY OF HALTON CLINICAL COMMISSIONING GROUP We have audited the financial statements of Halton CCG for the year ended 31 March 2016 under the Local Audit and Accountability Act 2014 (the "Act"). The financial statements comprise the Statement of Comprehensive Net Expenditure, the Statement of Financial Position, the Statement of Changes in Taxpayers’ Equity, the Statement of Cash Flows and the related notes. The financial reporting framework that has been applied in their preparation is applicable law and International Financial Reporting Standards (IFRSs) as adopted by the European Union, and as interpreted and adapted by the 2015/16 Government Financial Reporting Manual (the 2015/16 FReM) as contained in the Department of Health Group Manual for Accounts 2015/16 (the 2015/16 MfA) and the Accounts Direction issued by the NHS Commissioning Board with the approval of the Secretary of State as relevant to the National Health Service in England (the Accounts Direction). We have also audited the information in the Remuneration and Staff Report that is subject to audit, being:

the table of salaries and allowances of senior managers and related narrative notes on page 53,

the table of pension benefits of senior managers and related narrative notes on page 54,

the table of exit packages on page 51,

the analysis of staff numbers on page 50; and

the tables of pay multiples and related narrative notes on page 51.

This report is made solely to the members of the Governing Body of Halton CCG, as a body, in accordance with Part 5 of the Act and as set out in paragraph 43 of the Statement of Responsibilities of Auditors and Audited Bodies published by Public Sector Audit Appointments Limited. Our audit work has been undertaken so that we might state to the members of the Governing Body of the CCG those matters we are required to state to them in an auditor's report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the CCG and the members of the Governing Body of the CCG, as a body, for our audit work, for this report, or for the opinions we have formed. Respective responsibilities of the Chief Officer (Accountable Officer) and auditor As explained more fully in the Statement of Chief Officer’s Responsibilities, the Chief Officer (Accountable Officer) is responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view and is also responsible for ensuring the regularity of expenditure and income. Our responsibility is to audit and express an opinion on the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors. We are also responsible for giving an opinion on the regularity of expenditure and income in accordance with the Code of Audit Practice prepared by the Comptroller and Auditor General as required by the Act (the "Code of Audit Practice"). As explained in the Annual Governance Statement the Chief Officer (Accountable Officer) is responsible for the arrangements to secure economy, efficiency and effectiveness in the use of the CCG's resources. We are required under Section 21 (1)(c) of the Act to be satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources and to report our opinion as required by Section 21(4)(b) of the Act.


57

We are not required to consider, nor have we considered, whether all aspects of the CCG's arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively. Scope of the audit of the financial statements An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of: whether the accounting policies are appropriate to the CCG’s circumstances and have been consistently applied and adequately disclosed; the reasonableness of significant accounting estimates made by the Chief Officer (Accountable Officer); and the overall presentation of the financial statements. In addition, we read all the financial and non-financial information in the Annual Report to identify material inconsistencies with the audited financial statements and to identify any information that is apparently materially incorrect based on, or materially inconsistent with, the knowledge acquired by us in the course of performing the audit. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report. In addition, we are required to obtain evidence sufficient to give reasonable assurance that the expenditure and income recorded in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them. Scope of the review of arrangements for securing economy, efficiency and effectiveness in the use of resources We have undertaken our review in accordance with the Code of Audit Practice, having regard to the guidance on the specified criteria, issued by the Comptroller and Auditor General in November 2015, as to whether the CCG had proper arrangements to ensure it took properly informed decisions and deployed resources to achieve planned and sustainable outcomes for taxpayers and local people. The Comptroller and Auditor General determined these criteria as that necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the CCG put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2016, and to report by exception where we are not satisfied. We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we undertook such work as we considered necessary to form a view on whether, in all significant respects, the CCG had put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources. Opinion on financial statements In our opinion the financial statements:

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

have been prepared properly in accordance with IFRSs as adopted by the European Union, as interpreted and adapted by the 2015/16 FReM as contained in the 2015/16 MfA and the Accounts Direction.


58

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

the parts of the Remuneration and Staff Report to be audited have been properly prepared in accordance with IFRSs as adopted by the European Union, as interpreted and adapted by the 2015/16 FReM as contained in the 2015/16 MfA and the Accounts Direction; and

the other information published together with the audited financial statements in the annual report and accounts is consistent with the financial statements.

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

in our opinion the governance statement does not comply with the guidance issued by the NHS Commissioning Board; or

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

we issue a report in the public interest under section 24 of the Act; or

we make a written recommendation to the CCG under section 24 of the Act; or

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

We have nothing to report in these respects. Certificate We certify that we have completed the audit of the accounts of Halton CCG in accordance with the requirements of the Act and the Code of Audit Practice. Mark Heap for and on behalf of Grant Thornton UK LLP, Appointed Auditor Royal Liver Building, Liverpool, L3 1PS 27 May 2016


59

SECTION 3

FINANCIAL STATEMENTS

NHS Halton CCG Annual Accounts 2015-16

The notes on pages 63 to 98 form part of this statement

Statement of Comprehensive Net Expenditure for the year ended

31-March-2016

2015-16 2014-15

Note £000 £000

Total Income and Expenditure

Employee benefits 4.1.1 2,889 1,841

Operating Expenses 5 206,647 184,570

Other operating revenue 2 (1,616) (1,513)

Net operating expenditure before interest 207,920 184,898

Investment Revenue 8 0 0

Other (gains)/losses 9 0 0

Finance costs 10 0 0

Net operating expenditure for the financial year 207,920 184,898

Net (gain)/loss on transfers by absorption 11 0 0

Total Net Expenditure for the year 207,920 184,898

Of which:

Administration Income and Expenditure

Employee benefits 4.1.1 973 1,022


Other operating revenue 2 (123) (114)

Net administration costs before interest 2,511 2,921

Programme Income and Expenditure

Employee benefits 4.1.1 1,916 819


Other operating revenue 2 (1,493) (1,399)

Net programme expenditure before interest 205,409 181,977

Other Comprehensive Net Expenditure 2015-16 2014-15

£000 £000

Impairments and reversals 22 0 0

Net gain/(loss) on revaluation of property, plant & equipment 0 0

Net gain/(loss) on revaluation of intangibles 0 0

Net gain/(loss) on revaluation of financial assets 0 0

Movements in other reserves 0 0

Net gain/(loss) on available for sale financial assets 0 0

Net gain/(loss) on assets held for sale 0 0

Net actuarial gain/(loss) on pension schemes 0 0

Share of (profit)/loss of associates and joint ventures 0 0

Reclassification Adjustments

On disposal of available for sale financial assets 0 0

Total comprehensive net expenditure for the year 207,920 184,898


60


The financial statements on pages 59 to 98 were approved by the Chair & Chief

Officer on behalf of the Governing Body on 26th May, 2016 and signed on its behalf

by:


Statement of Financial Position as at

31-March-2016

2015-16 2014-15

Note £000 £000

Non-current assets:

Property, plant and equipment 13 19 24

Intangible assets 14 0 0

Investment property 15 0 0

Trade and other receivables 17 0 0

Other financial assets 18 0 0

Total non-current assets 19 24

Current assets:

Inventories 16 0 0

Trade and other receivables 17 4,653 1,922

Other financial assets 18 0 0

Other current assets 19 0 0

Cash and cash equivalents 20 6 29

Total current assets 4,659 1,951

Non-current assets held for sale 21 0 0

Total current assets 4,659 1,951

Total assets 4,678 1,975

Current liabilities

Trade and other payables 23 (9,752) (7,242)

Other financial liabilities 24 0 0

Other liabilities 25 0 0

Borrowings 26 0 0

Provisions 30 0 0

Total current liabilities (9,752) (7,242)

Non-Current Assets plus/less Net Current Assets/Liabilities (5,074) (5,267)

Non-current liabilities

Trade and other payables 23 0 0


Other liabilities 25 0 0

Borrowings 26 0 0

Provisions 30 0 0

Total non-current liabilities 0 0

Assets less Liabilities (5,074) (5,267)

Financed by Taxpayers’ Equity

General fund (5,074) (5,267)

Revaluation reserve 0 0

Other reserves 0 0

Charitable Reserves 0 0

Total taxpayers' equity: (5,074) (5,267)


61



Statement of Changes In Taxpayers Equity for the year ended

31-March-2016

General fund

Revaluation

reserve

Other

reserves

Total

reserves

£000 £000 £000 £000

Changes in taxpayers’ equity for 2015-16

Balance at 1 April 2015 (5,267) 0 0 (5,267)

Transfer between reserves in respect of assets transferred from closed NHS

bodies 0 0 0 0

Adjusted NHS Clinical Commissioning Group balance at 1 April 2015 (5,267) 0 0 (5,267)

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

Net operating expenditure for the financial year (207,920) (207,920)

Net gain/(loss) on revaluation of property, plant and equipment 0 0

Net gain/(loss) on revaluation of intangible assets 0 0

Net gain/(loss) on revaluation of financial assets 0 0

Total revaluations against revaluation reserve 0 0 0 0

Net gain (loss) on available for sale financial assets 0 0 0 0

Net gain (loss) on revaluation of assets held for sale 0 0 0 0

Impairments and reversals 0 0 0 0

Net actuarial gain (loss) on pensions 0 0 0 0

Movements in other reserves 0 0 0 0

Transfers between reserves 0 0 0 0

Release of reserves to the Statement of Comprehensive Net Expenditure 0 0 0 0

Reclassification adjustment on disposal of available for sale financial assets 0 0 0 0

Transfers by absorption to (from) other bodies 0 0 0 0

Reserves eliminated on dissolution 0 0 0 0

Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year (207,920) 0 0 (207,920)

Net funding 208,113 0 0 208,113

Balance at 31 March 2016 (5,074) 0 0 (5,074)

General fund

Revaluation

reserve

Other

reserves

Total

reserves

£000 £000 £000 £000

Changes in taxpayers’ equity for 2014-15

Balance at 1 April 2014 (4,203) 0 0 (4,203)

Transfer of assets and liabilities from closed NHS bodies as a result of the 1

April 2013 transition 0 0 0 0

Adjusted NHS Commissioning Board balance at 1 April 2014 (4,203) 0 0 (4,203)

Changes in NHS Commissioning Board taxpayers’ equity for 2014-15

Net operating costs for the financial year (184,898) 0 0 (184,898)

Net gain/(loss) on revaluation of property, plant and equipment 0 0 0 0

Net gain/(loss) on revaluation of intangible assets 0 0 0 0

Net gain/(loss) on revaluation of financial assets 0 0 0 0

Total revaluations against revaluation reserve 0 0 0 0

Net gain (loss) on available for sale financial assets 0 0 0 0

Net gain (loss) on revaluation of assets held for sale 0 0 0 0

Impairments and reversals 0 0 0 0

Net actuarial gain (loss) on pensions 0 0 0 0

Movements in other reserves 0 0 0 0

Transfers between reserves 0 0 0 0

Release of reserves to the Statement of Comprehensive Net Expenditure 0 0 0 0

Reclassification adjustment on disposal of available for sale financial assets 0 0 0 0

Transfers by absorption to (from) other bodies 0 0 0 0

Reserves eliminated on dissolution 0 0 0 0

Net Recognised NHS Commissioning Board Expenditure for the Financial Year (184,898) 0 0 (184,898)

Net funding 183,834 0 0 183,834

Balance at 31 March 2015 (5,267) 0 0 (5,267)


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Statement of Cash Flows for the year ended

31-March-2016

2015-16 2014-15

Note £000 £000

Cash Flows from Operating Activities

Net operating expenditure for the financial year (207,920) (184,898)

Depreciation and amortisation 5 5 54

Impairments and reversals 5 0 0

Movement due to transfer by Modified Absorption 0 0

Other gains (losses) on foreign exchange 0 0

Donated assets received credited to revenue but non-cash 0 0

Government granted assets received credited to revenue but non-cash 0 0

Interest paid 0 0

Release of PFI deferred credit 0 0

Other Gains & Losses 0 0

Finance Costs 0 0

Unwinding of Discounts 0 0

(Increase)/decrease in inventories 0 0

(Increase)/decrease in trade & other receivables 17 (2,731) 308

(Increase)/decrease in other current assets 0 0

Increase/(decrease) in trade & other payables 23 2,510 670

Increase/(decrease) in other current liabilities 0 0

Provisions utilised 30 0 0

Increase/(decrease) in provisions 30 0 0

Net Cash Inflow (Outflow) from Operating Activities (208,136) (183,866)

Cash Flows from Investing Activities

Interest received 0 0

(Payments) for property, plant and equipment 0 0

(Payments) for intangible assets 0 0

(Payments) for investments with the Department of Health 0 0

(Payments) for other financial assets 0 0

(Payments) for financial assets (LIFT) 0 0

Proceeds from disposal of assets held for sale: property, plant and equipment 0 0

Proceeds from disposal of assets held for sale: intangible assets 0 0

Proceeds from disposal of investments with the Department of Health 0 0

Proceeds from disposal of other financial assets 0 0

Proceeds from disposal of financial assets (LIFT) 0 0

Loans made in respect of LIFT 0 0

Loans repaid in respect of LIFT 0 0

Rental revenue 0 0

Net Cash Inflow (Outflow) from Investing Activities 0 0

Net Cash Inflow (Outflow) before Financing (208,136) (183,866)

Cash Flows from Financing Activities

Grant in Aid Funding Received 208,113 183,834

Other loans received 0 0

Other loans repaid 0 0

Capital element of payments in respect of finance leases and on Statement of Financial Position PFI and LIFT 0 0

Capital grants and other capital receipts 0 0

Capital receipts surrendered 0 0

Net Cash Inflow (Outflow) from Financing Activities 208,113 183,834

Net Increase (Decrease) in Cash & Cash Equivalents 20 (23) (32)

Cash & Cash Equivalents at the Beginning of the Financial Year 29 61

Effect of exchange rate changes on the balance of cash and cash equivalents held in foreign currencies 0 0

Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year 6 29


63

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 2015-16 issued by the

Department of Health. The accounting policies contained in the Manual for Accounts

follow International Financial Reporting Standards to the extent that they are

meaningful and appropriate to clinical commissioning groups, as determined by HM

Treasury, which is advised by the Financial Reporting Advisory Board. Where the

Manual for Accounts permits a choice of accounting policy, the accounting policy

which is judged to be most appropriate to the particular circumstances of the clinical

commissioning group for the purpose of giving a true and fair view has been

selected. The particular policies adopted by the clinical commissioning group are

described below. They have been applied consistently in dealing with items

considered material in relation to the accounts.

1.1 Going Concern

These accounts have been prepared on the going concern basis. Public sector

bodies are assumed to be going concerns where the continuation of the provision of

a service in the future is anticipated, as evidenced by inclusion of financial provision

for that service in published documents. Where a clinical commissioning group

ceases to exist, it considers whether or not its services will continue to be provided

(using the same assets, by another public sector entity) in determining whether to

use the concept of going concern for the final set of Financial Statements. If

services will continue to be provided the financial statements are prepared on the

going concern basis.

1.2 Accounting Convention

These accounts have been prepared under the historical cost convention.

1.3 Acquisitions & Discontinued Operations

Activities are considered to be ‘acquired’ only if they are taken on from outside the

public sector. Activities are considered to be ‘discontinued’ only if they cease

entirely. They are not considered to be ‘discontinued’ if they transfer from one public

sector body to another.

1.4 Movement of Assets within the Department of Health Group

Transfers as part of reorganisation fall to be accounted for by use of absorption

accounting in line with the Government Financial Reporting Manual, issued by HM

Treasury. The Government Financial Reporting Manual does not require


64

retrospective adoption, so prior year transactions (which have been accounted for

under merger accounting) have not been restated. Absorption accounting requires

that entities account for their transactions in the period in which they took place, with

no restatement of performance required when functions transfer within the public

sector. Where assets and liabilities transfer, the gain or loss resulting is recognised

in the Statement of Comprehensive Net Expenditure, and is disclosed separately

from operating costs. Other transfers of assets and liabilities within the Department

of Health Group are accounted for in line with IAS 20 and similarly give rise to

income and expenditure entries.

1.5 Charitable Funds

The CCG did not operate any charitable Funds in 2015/16 (nil in 2014/15)

1.6 Pooled Budgets

Where the clinical commissioning group has entered into a pooled budget

arrangement under Section 75 of the National Health Service Act 2006 the clinical

commissioning group accounts for its share of the assets, liabilities, income and

expenditure arising from the activities of the pooled budget, identified in accordance

with the pooled budget agreement.

If the clinical commissioning group is in a “jointly controlled operation”, the clinical

commissioning group recognises:

The assets the clinical commissioning group controls;

The liabilities the clinical commissioning group incurs;

The expenses the clinical commissioning group incurs; and,

The clinical commissioning group’s share of the income from the pooled

budget activities.

If the clinical commissioning group is involved in a “jointly controlled assets”

arrangement, in addition to the above, the clinical commissioning group recognises:

The clinical commissioning group’s share of the jointly controlled assets

(classified according to the nature of the assets);

The clinical commissioning group’s share of any liabilities incurred jointly; and,

The clinical commissioning group’s share of the expenses jointly incurred.

1.7 Critical Accounting Judgements & Key Sources of Estimation Uncertainty In the application of the clinical commissioning group’s accounting policies,

management is required to make judgements, estimates and assumptions about the

carrying amounts of assets and liabilities that are not readily apparent from other

sources. The estimates and associated assumptions are based on historical

experience and other factors that are considered to be relevant. Actual results may


65

differ from those estimates and the estimates and underlying assumptions are

continually reviewed. Revisions to accounting estimates are recognised in the period

in which the estimate is revised if the revision affects only that period or in the period

of the revision and future periods if the revision affects both current and future

periods.

1.7.1 Critical Judgements in Applying Accounting Policies

Apart from those involving estimates (see below), the CCG has made no critical

judgements in applying accounting policies.

1.7.2 Key Sources of Estimation Uncertainty

The following are the key estimations that management has made in the process of

applying the clinical commissioning group’s accounting policies that have the most

significant effect on the amounts recognised in the financial statements:

Payables estimates

Due to the time lag around the availability of data, the prescribing payable is

estimated as the difference between the prescribing expenditure profile to 31 March

2016 (as determined by the NHS Business Services Authority) and the actual

confirmed amount of expenditure recorded. The key risk is that the actual data is

different to the estimates made, resulting in the prescribing payable being either over

or understated. As at 31 March 2016, the prescribing payable was £3.8 million (31

March 2015: £3.8 million).

1.8 Revenue

Revenue in respect of services provided is recognised when, and to the extent that,

performance occurs, and is measured at the fair value of the consideration

receivable. Where income is received for a specific activity that is to be delivered in

the following year, that income is deferred.

1.9 Employee Benefits

1.9.1 Short-term Employee Benefits

Salaries, wages and employment-related payments are recognised in the period in

which the service is received from employees, including bonuses earned but not yet

taken.

The cost of leave earned but not taken by employees at the end of the period is

recognised in the financial statements to the extent that employees are permitted to

carry forward leave into the following period.


66

1.9.2 Retirement Benefit Costs

Past and present employees are covered by the provisions of the NHS Pensions

Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS

employers, General Practices and other bodies, allowed under the direction of the

Secretary of State, in England and Wales. The scheme is not designed to be run in a

way that would enable NHS bodies to identify their share of the underlying scheme

assets and liabilities. Therefore, the scheme is accounted for as if it were a defined

contribution scheme: the cost to the clinical commissioning group of participating in

the scheme is taken as equal to the contributions payable to the scheme for the

accounting period.

For early retirements other than those due to ill health the additional pension

liabilities are not funded by the scheme. The full amount of the liability for the

additional costs is charged to expenditure at the time the clinical commissioning

group commits itself to the retirement, regardless of the method of payment.

1.10 Other Expenses

Other operating expenses are recognised when, and to the extent that, the goods or

services have been received. They are measured at the fair value of the

consideration payable. 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.

1.11 Property, Plant & Equipment

1.11.1 Recognition

Property, plant and equipment is capitalise

It is held for use in delivering services or for administrative purposes;

It is probable that future economic benefits will flow to, or service potential will be supplied to the clinical commissioning group;

It is expected to be used for more than one financial year;

The cost of the item can be measured reliably; and,

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

Collectively, a number of items have a cost of at least £5,000 and individually have a

cost of more than £250, where the assets are functionally interdependent, they had

broadly simultaneous purchase dates, are anticipated to have simultaneous disposal

dates and are under single managerial control; or,

Items form part of the initial equipping and setting-up cost of a new building, ward or

unit, irrespective of their individual or collective cost. Where a large asset, for

example a building, includes a number of components with significantly different

asset lives, the components are treated as separate assets and depreciated over

their own useful economic lives.


67

1.11.2 Valuation

All property, plant and equipment are measured initially at cost, representing the cost

directly attributable to acquiring or constructing the asset and bringing it to the

location and condition necessary for it to be capable of operating in the manner

intended by management. All assets are measured subsequently at valuation.

Land and buildings used for the clinical commissioning group’s services or for

administrative purposes are stated in the statement of financial position at their re-

valued amounts, being the fair value at the date of revaluation less any impairment.

Revaluations are performed with sufficient regularity to ensure that carrying amounts

are not materially different from those that would be determined at the end of the

reporting period. Fair values are determined as follows:

Land and non-specialised buildings – market value for existing use; and,

Specialised buildings – depreciated replacement cost.

HM Treasury has adopted a standard approach to depreciated replacement cost

valuations based on modern equivalent assets and, where it would meet the location

requirements of the service being provided, an alternative site can be valued.

Properties in the course of construction for service or administration purposes are

carried at cost, less any impairment loss. Cost includes professional fees but not

borrowing costs, which are recognised as expenses immediately, as allowed by IAS

23 for assets held at fair value. Assets are re-valued and depreciation commences

when they are brought into use.

Fixtures and equipment are carried at depreciated historic cost as this is not

considered to be materially different from current value in existing use.

An increase arising on revaluation is taken to the revaluation reserve except when it

reverses an impairment for the same asset previously recognised in expenditure, in

which case it is credited to expenditure to the extent of the decrease previously

charged there. A revaluation decrease that does not result from a loss of economic

value or service potential is recognised as an impairment charged to the revaluation

reserve to the extent that there is a balance on the reserve for the asset and,

thereafter, to expenditure. Impairment losses that arise from a clear consumption of

economic benefit are taken to expenditure. Gains and losses recognised in the

revaluation reserve are reported as other comprehensive income in the Statement of

Comprehensive Net Expenditure.

The CCG had no property as at 31 March 2016 therefore there has not been any

property revaluation in the financial year 2015/16 (nil in 2014/15).


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1.11.3 Subsequent Expenditure

Where subsequent expenditure enhances an asset beyond its original specification,

the directly attributable cost is capitalised. Where subsequent expenditure restores

the asset to its original specification, the expenditure is capitalised and any existing

carrying value of the item replaced is written-out and charged to operating expenses.

1.12 Intangible Assets

The CCG had no intangible assets as at 31 March 2016 (nil as at 31 March 2015)

1.13 Depreciation, Amortisation & Impairments

Freehold land, properties under construction, and assets held for sale are not

depreciated.

Otherwise, depreciation and amortisation are charged to write off the costs or

valuation of property, plant and equipment and intangible non-current assets, less

any residual value, over their estimated useful lives, in a manner that reflects the

consumption of economic benefits or service potential of the assets. The estimated

useful life of an asset is the period over which the clinical commissioning group

expects to obtain economic benefits or service potential from the asset. This is

specific to the clinical commissioning group and may be shorter than the physical life

of the asset itself. Estimated useful lives and residual values are reviewed each year

end, with the effect of any changes recognised on a prospective basis. Assets held

under finance leases are depreciated over their estimated useful lives.

At each reporting period end, the clinical commissioning group checks whether there

is any indication that any of its tangible or intangible non-current assets have

suffered an impairment loss. If there is indication of an impairment loss, the

recoverable amount of the asset is estimated to determine whether there has been a

loss and, if so, its amount. Intangible assets not yet available for use are tested for

impairment annually.

A revaluation decrease that does not result from a loss of economic value or service

potential is recognised as an impairment charged to the revaluation reserve to the

extent that there is a balance on the reserve for the asset and, thereafter, to

expenditure. Impairment losses that arise from a clear consumption of economic

benefit are taken to expenditure. Where an impairment loss subsequently reverses,

the carrying amount of the asset is increased to the revised estimate of the

recoverable amount but capped at the amount that would have been determined had

there been no initial impairment loss. The reversal of the impairment loss is credited

to expenditure to the extent of the decrease previously charged there and thereafter

to the revaluation reserve.


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1.14 Donated Assets

The CCG had no donated assets as at 31 March 2016 (nil as at 31 March 2015)

1.15 Government Grants

The value of assets received by means of a government grant is credited directly to

income. Deferred income is recognised only where conditions attached to the grant

preclude immediate recognition of the gain.

1.16 Non-current Assets Held For Sale

The CCG had no non-current assets held for sale as at 31 March 2016 (nil as at 31

March 2015).

1.17 Leases

Leases are classified as finance leases when substantially all the risks and rewards

of ownership are transferred to the lessee. All other leases are classified as

operating leases.

1.17.1 The CCG as Lessee

Property, plant and equipment held under finance leases are initially recognised, at

the inception of the lease, at fair value or, if lower, at the present value of the

minimum lease payments, with a matching liability for the lease obligation to the

lessor. Lease payments are apportioned between finance charges and reduction of

the lease obligation so as to achieve a constant rate on interest on the remaining

balance of the liability. Finance charges are recognised in calculating the clinical

commissioning group’s surplus/deficit.

Operating lease payments are recognised as an expense on a straight-line basis

over the lease term. Lease incentives are recognised initially as a liability and

subsequently as a reduction of rentals on a straight-line basis over the lease term.

Contingent rentals are recognised as an expense in the period in which they are

incurred.

Where a lease is for land and buildings, the land and building components are

separated and individually assessed as to whether they are operating or finance

leases.

1.18 Private Finance Initiative Transactions

The CCG is not party to any Private Finance Initiative (PFI) schemes as at 31 March

2016 (31 March 2015 nil)

1.19 Inventories

The CCG did not hold any inventories as at 31 March 2016 (nil as at 31 March 2015)


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1.20 Cash & Cash Equivalents

Cash is cash in hand and deposits with any financial institution repayable without

penalty on notice of not more than 24 hours. Cash equivalents are investments that

mature in 3 months or less from the date of acquisition and that are readily

convertible to known amounts of cash with insignificant risk of change in value.

In the Statement of Cash Flows, cash and cash equivalents are shown net of bank

overdrafts that are repayable on demand and that form an integral part of the clinical

commissioning group’s cash management.

1.21 Provisions

Provisions are recognised when the clinical commissioning group has a present legal

or constructive obligation as a result of a past event, it is probable that the clinical

commissioning group will be required to settle the obligation, and a reliable estimate

can be made of the amount of the obligation. The amount recognised as a provision

is the best estimate of the expenditure required to settle the obligation at the end of

the reporting period, taking into account the risks and uncertainties. Where a

provision is measured using the cash flows estimated to settle the obligation, its

carrying amount is the present value of those cash flows using HM Treasury’s

discount rate as follows:

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

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

Timing of cash flows (over 10 years): Minus 0.80% (2014/15: plus 2.20%)

All employee early departures 1.30%

When some or all of the economic benefits required to settle a provision are

expected to be recovered from a third party, the receivable is recognised as an asset

if it is virtually certain that reimbursements will be received and the amount of the

receivable can be measured reliably.

The CCG had no provisions as at 31 March 2016 (31 March 2015 nil)

1.22 Clinical Negligence Costs

The NHS Litigation Authority operates a risk pooling scheme under which the clinical

commissioning group pays an annual contribution to the NHS Litigation Authority

which in return settles all clinical negligence claims. The contribution is charged to

expenditure. Although the NHS Litigation Authority is administratively responsible for

all clinical negligence cases the legal liability remains with the clinical commissioning

group.


71

1.23 Non-clinical Risk Pooling

The clinical commissioning group participates in the Property Expenses Scheme and

the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which

the clinical commissioning group pays an annual contribution to the NHS Litigation

Authority and, in return, receives assistance with the costs of claims arising. The

annual membership contributions, and any excesses payable in respect of particular

claims are charged to operating expenses as and when they become due.

1.24 Continuing healthcare risk pooling

In 2014/15 a risk pool scheme was been introduced by NHS England for continuing

healthcare claims, for claim periods prior to 31 March 2013. Under the scheme

clinical commissioning group contribute annually to a pooled fund, which is used to

settle the claims.

The contribution made by the CCG in the financial year 2015/16 was £308k (2014/15

£261k)

1.25 Carbon Reduction Commitment Scheme

Carbon Reduction Commitment and similar allowances are accounted for as

government grant funded intangible assets if they are not expected to be realised

within twelve months, and otherwise as other current assets. They are valued at

open market value. As the clinical commissioning group makes emissions, a

provision is recognised with an offsetting transfer from deferred income. The

provision is settled on surrender of the allowances. The asset, provision and

deferred income amounts are valued at fair value at the end of the reporting period.

The CCG considers this to be immaterial therefore no provision was recognised as

at 31 March 2016 (31 March 2015 nil)

1.26 Contingencies

A contingent liability is a possible obligation that arises from past events and whose

existence will be confirmed only by the occurrence or non-occurrence of one or more

uncertain future events not wholly within the control of the clinical commissioning

group, or a present obligation that is not recognised because it is not probable that a

payment will be required to settle the obligation or the amount of the obligation

cannot be measured sufficiently reliably. A contingent liability is disclosed unless the

possibility of a payment is remote.

A contingent asset is a possible asset that arises from past events and whose

existence will be confirmed by the occurrence or non-occurrence of one or more

uncertain future events not wholly within the control of the clinical commissioning

group. A contingent asset is disclosed where an inflow of economic benefits is

probable.


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Where the time value of money is material, contingencies are disclosed at their

present value.

The CCG had no contingent assets or liabilities as at 31 March 2016 (31 March 2015

nil)

1.27 Financial Assets

Financial assets are recognised when the clinical commissioning group becomes

party to the financial instrument contract or, in the case of trade receivables, when

the goods or services have been delivered. Financial assets are derecognised when

the contractual rights have expired or the asset has been transferred.

Financial assets are classified into the following categories:

Financial assets at fair value through profit and loss;

Held to maturity investments;

Available for sale financial assets; and,

Loans and receivables.

The classification depends on the nature and purpose of the financial assets and is

determined at the time of initial recognition.

1.27.1 Financial Assets at Fair Value Through Profit and Loss

Embedded derivatives that have different risks and characteristics to their host

contracts, and contracts with embedded derivatives whose separate value cannot be

ascertained, are treated as financial assets at fair value through profit and loss. They

are held at fair value, with any resultant gain or loss recognised in calculating the

clinical commissioning group’s surplus or deficit for the year. The net gain or loss

incorporates any interest earned on the financial asset.

1.27.2 Held to Maturity Assets

Held to maturity investments are non-derivative financial assets with fixed or

determinable payments and fixed maturity, and there is a positive intention and

ability to hold to maturity. After initial recognition, they are held at amortised cost

using the effective interest method, less any impairment. Interest is recognised using

the effective interest method.

1.27.3 Available For Sale Financial Assets

Available for sale financial assets are non-derivative financial assets that are

designated as available for sale or that do not fall within any of the other three

financial asset classifications. They are measured at fair value with changes in value

taken to the revaluation reserve, with the exception of impairment losses.

Accumulated gains or losses are recycled to surplus/deficit on de-recognition.


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1.27.4 Loans & Receivables

Loans and receivables are non-derivative financial assets with fixed or determinable

payments which are not quoted in an active market. After initial recognition, they are

measured at amortised cost using the effective interest method, less any impairment.

Interest is recognised using the effective interest method.

Fair value is determined by reference to quoted market prices where possible,

otherwise by valuation techniques.

The effective interest rate is the rate that exactly discounts estimated future cash

receipts through the expected life of the financial asset, to the initial fair value of the

financial asset.

At the end of the reporting period, the clinical commissioning group assesses

whether any financial assets, other than those held at ‘fair value through profit and

loss’ are impaired. Financial assets are impaired and impairment losses recognised

if there is objective evidence of impairment as a result of one or more events which

occurred after the initial recognition of the asset and which has an impact on the

estimated future cash flows of the asset.

For financial assets carried at amortised cost, the amount of the impairment loss is

measured as the difference between the asset’s carrying amount and the present

value of the revised future cash flows discounted at the asset’s original effective

interest rate. The loss is recognised in expenditure and the carrying amount of the

asset is reduced through a provision for impairment of receivables.

If, in a subsequent period, the amount of the impairment loss decreases and the

decrease can be related objectively to an event occurring after the impairment was

recognised, the previously recognised impairment loss is reversed through

expenditure to the extent that the carrying amount of the receivable at the date of the

impairment is reversed does not exceed what the amortised cost would have been

had the impairment not been recognised.

1.28 Financial Liabilities

Financial liabilities are recognised on the statement of financial position when the

clinical commissioning group becomes party to the contractual provisions of the

financial instrument or, in the case of trade payables, when the goods or services

have been received. Financial liabilities are de-recognised when the liability has

been discharged, that is, the liability has been paid or has expired.

Loans from the Department of Health are recognised at historical cost. Otherwise,

financial liabilities are initially recognised at fair value.


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1.28.1 Financial Guarantee Contract Liabilities

Financial guarantee contract liabilities are subsequently measured at the higher of:

The premium received (or imputed) for entering into the guarantee less

cumulative amortisation; and,

The amount of the obligation under the contract, as determined in accordance

with IAS 37: Provisions, Contingent Liabilities and Contingent Assets.

1.28.2 Financial Liabilities at Fair Value Through Profit and Loss

Embedded derivatives that have different risks and characteristics to their host

contracts, and contracts with embedded derivatives whose separate value cannot be

ascertained, are treated as financial liabilities at fair value through profit and loss.

They are held at fair value, with any resultant gain or loss recognised in the clinical

commissioning group’s surplus/deficit. The net gain or loss incorporates any interest

payable on the financial liability.

1.28.3 Other Financial Liabilities

After initial recognition, all other financial liabilities are measured at amortised cost

using the effective interest method, except for loans from Department of Health,

which are carried at historic cost. The effective interest rate is the rate that exactly

discounts estimated future cash payments through the life of the asset, to the net

carrying amount of the financial liability. Interest is recognised using the effective

interest method.

1.29 Value Added Tax

Most of the activities of the clinical commissioning group are outside the scope of

VAT and, in general, output tax does not apply and input tax on purchases is not

recoverable. Irrecoverable VAT is charged to the relevant expenditure category or

included in the capitalised purchase cost of fixed assets. Where output tax is

charged or input VAT is recoverable, the amounts are stated net of VAT.

1.30 Foreign Currencies

The clinical commissioning group’s functional currency and presentational currency

is sterling. Transactions denominated in a foreign currency are translated into

sterling at the exchange rate ruling on the dates of the transactions. At the end of the

reporting period, monetary items denominated in foreign currencies are retranslated

at the spot exchange rate on 31 March. Resulting exchange gains and losses for

either of these are recognised in the clinical commissioning group’s surplus/deficit in

the period in which they arise.


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1.31 Third Party Assets

Assets belonging to third parties (such as money held on behalf of patients) are not

recognised in the accounts since the clinical commissioning group has no beneficial

interest in them.

1.32 Losses & Special Payments

Losses and special payments are items that Parliament would not have

contemplated when it agreed funds for the health service or passed legislation. By

their nature they are items that ideally should not arise. They are therefore subject to

special control procedures compared with the generality of payments. They are

divided into different categories, which govern the way that individual cases are

handled.

Losses and special payments are charged to the relevant functional headings in

expenditure on an accruals basis, including losses which would have been made

good through insurance cover had the clinical commissioning group not been

bearing its own risks (with insurance premiums then being included as normal

revenue expenditure).

The CCG made no losses or special payments in the financial year 2015/16

(2014/15 nil)

1.33 Subsidiaries

Material entities over which the clinical commissioning group has the power to

exercise control so as to obtain economic or other benefits are classified as

subsidiaries and are consolidated. Their income and expenses; gains and losses;

assets, liabilities and reserves; and cash flows are consolidated in full into the

appropriate financial statement lines. Appropriate adjustments are made on

consolidation where the subsidiary’s accounting policies are not aligned with the

clinical commissioning group or where the subsidiary’s accounting date is not co-

terminus.

Subsidiaries that are classified as ‘held for sale’ are measured at the lower of their

carrying amount or ‘fair value less costs to sell’.

The CCG had no subsidiaries in the Financial year 2015/16 (nil 2014/15)

1.34 Associates

The CCG had no associates in the Financial year 2015/16 (nil 2014/15)

1.35 Joint Ventures

The CCG had no joint ventures in the Financial year 2015/16 (2014/15 nil)


76

1.36 Joint Operations

Joint operations are activities undertaken by the CCG in conjunction with one or

more other parties but which are not performed through a separate entity. The CCG

records its share of the income and expenditure; gains and losses; assets and

liabilities; and cash flows.

The CCG are the host commissioner for the Cheshire and Merseyside Women’s and

Children’s partnership, this is a collaborative arrangement where 27 local

organisations will come together to review maternity, neo-natal, paediatric and

gynaecology services across Cheshire and Merseyside.

1.37 Research & Development

Research and development expenditure is charged in the year in which it is incurred,

except insofar as development expenditure relates to a clearly defined project and

the benefits of it can reasonably be regarded as assured. Expenditure so deferred is

limited to the value of future benefits expected and is amortised through the

Statement of Comprehensive Net Expenditure on a systematic basis over the period

expected to benefit from the project. It should be re-valued on the basis of current

cost. The amortisation is calculated on the same basis as depreciation.

1.38 Accounting Standards That Have Been Issued But Have Not Yet Been

Adopted

The Government Financial Reporting Manual does not require the following

Standards and Interpretations to be applied in 2015/16, all of which are subject to

consultation:

IFRS 9: Financial Instruments

IFRS 14: Regulatory Deferral Accounts

IFRS 15: Revenue for Contract with Customers

The application of the Standards as revised would not have a material impact on the

accounts for 2015/16, were they applied in that year.


77

2 Other Operating Revenue

Admin revenue is revenue received that is not directly attributable to the provision of

healthcare or healthcare related 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

3 Revenue

All revenue is from supply of services. The CCG receives no revenue from the sale

of goods.

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

Total Admin Programme Total

£000 £000 £000 £000

Recoveries in respect of employee benefits 0 0 0 0

Patient transport services 0 0 0 0

Prescription fees and charges 0 0 0 0

Dental fees and charges 0 0 0 0

Education, training and research 0 0 0 0

Charitable and other contributions to revenue expenditure: NHS 0 0 0 0

Charitable and other contributions to revenue expenditure: non-NHS 0 0 0 0

Receipt of donations for capital acquisitions: NHS Charity 0 0 0 0

Receipt of Government grants for capital acquisitions 0 0 0 0

Non-patient care services to other bodies 643 118 525 431

Continuing Health Care risk pool contributions 0 0 0 0

Income generation 0 0 0 0

Rental revenue from finance leases 0 0 0 0

Rental revenue from operating leases 0 0 0 0

Other revenue 973 5 968 1,082

Total other operating revenue 1,616 123 1,493 1,513

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


£000 £000 £000 £000

From rendering of services 1,616 123 1,493 1,513

From sale of goods 0 0 0 0

1,616 123 1,493 1,513


78

4.1.1 Employee benefits 2015-16

Total

Permanent

Employees Other Total

Permanent


Permanent

Employees Other

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

Employee Benefits

Salaries and wages 2,411 2,121 290 807 768 39 1,604 1,353 251

Social security costs 191 191 0 69 69 0 122 122 0

Employer Contributions to NHS Pension scheme 287 287 0 97 97 0 190 190 0

Other pension costs 0 0 0 0 0 0 0 0 0

Other post-employment benefits 0 0 0 0 0 0 0 0 0

Other employment benefits 0 0 0 0 0 0 0 0 0

Termination benefits 0 0 0 0 0 0 0 0 0

Gross employee benefits expenditure 2,889 2,599 290 973 934 39 1,916 1,665 251

Less recoveries in respect of employee benefits (note 4.1.2) 0 0 0 0 0 0 0 0 0

Total - Net admin employee benefits including capitalised costs 2,889 2,599 290 973 934 39 1,916 1,665 251

Less: Employee costs capitalised 0 0 0 0 0 0 0 0 0

Net employee benefits excluding capitalised costs 2,889 2,599 290 973 934 39 1,916 1,665 251

4.1.1 Employee benefits 2014-15

Total

Permanent


Permanent


Permanent

Employees Other

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

Employee Benefits

Salaries and wages 1,508 1,461 47 842 794 48 666 667 (1)

Social security costs 136 136 0 73 73 0 63 63 0

Employer Contributions to NHS Pension scheme 197 197 0 107 107 0 90 90 0

Other pension costs 0 0 0 0 0 0 0 0 0

Other post-employment benefits 0 0 0 0 0 0 0 0 0

Other employment benefits 0 0 0 0 0 0 0 0 0

Termination benefits 0 0 0 0 0 0 0 0 0

Gross employee benefits expenditure 1,841 1,794 47 1,022 974 48 819 820 (1)

Less recoveries in respect of employee benefits (note 4.1.2) 0 0 0 0 0 0 0 0 0

Total - Net admin employee benefits including capitalised costs 1,841 1,794 47 1,022 974 48 819 820 (1)

Less: Employee costs capitalised 0 0 0 0 0 0 0 0 0

Net employee benefits excluding capitalised costs 1,841 1,794 47 1,022 974 48 819 820 (1)

4.1.2 Recoveries in respect of employee benefits

The CCG made no recoveries in respect of employee benefits during the financial year 2015-16 ( nil 2014-15)

Admin ProgrammeTotal

Total Admin Programme


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4.2 Average number of people employed

Ill health retirement costs are met by the NHS Pension Scheme. Where the CCG

agrees early retirements, the additional costs are met by the CCG and not by the

NHS Pension Scheme.

4.4 Exit packages agreed in the financial year

No exit packages or severance payments were agreed by the CCG in the financial

year 2015/16 (2014/15, nil)

4.5 Pension costs

Past and present employees are covered by the provisions of the NHS Pension

Scheme. Details of the benefits payable under these provisions can be found on the

NHS Pensions website at www.nhsbsa.nhs.uk/Pensions.

The Scheme is an unfunded, defined benefit scheme that covers NHS employers,

GP practices and other bodies, allowed under the direction of the Secretary of State,

in England and Wales. The Scheme is not designed to be run in a way that would

enable NHS bodies to identify their share of the underlying scheme assets and

liabilities.

Therefore, the Scheme is accounted for as if it were a defined contribution scheme:

the cost to the clinical commissioning group of participating in the Scheme is taken

as equal to the contributions payable to the Scheme for the accounting period.

4.2 Average number of people employed2014-15

Total

Permanently

employed Other Total

Number Number Number Number

Total 46 42 4 27

Of the above:Number of whole time equivalent people

engaged on capital projects 0 0 0 0

4.3 Staff sickness absence and ill health retirements2015-16 2014-15Number Number

Total Days Lost 481 219Total Staff Years 44 31Average working Days Lost 10.93 7.06

2015-16 2014-15Number Number

Number of persons retired early on ill health grounds 0 0

£000 £000

Total additional Pensions liabilities accrued in the year 0 0

Ill health retirement costs are met by the NHS Pension Scheme. Where the CCG agrees early retirements, the addidtionalcosts are met by the CCG and not by the NHS Pension Scheme.

4.4 Exit packages agreed in the financial year

No exit packages or severance payments were agreed by the CCG in the financial year 2015-16 (2014-15, nil)

2015-16

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


80

The Scheme is subject to a full actuarial valuation every four years (until 2004, every

five years) and an accounting valuation every year. An outline of these follows:

4.5.1 Full actuarial (funding) valuation

The purpose of this valuation is to assess the level of liability in respect of the

benefits due under the Scheme (taking into account its recent demographic

experience), and to recommend the contribution rates to be paid by employers and

scheme members. The last such valuation, which determined current contribution

rates was undertaken as at 31 March 2012 and covered the period from 1 April 2008

to that date. Details can be found on the pension scheme website at

www.nhsbsa.nhs.uk/pensions.

For 2015/16, employers’ contributions of £288,509 were payable to the NHS

Pensions Scheme (2014/15: £197,132) were payable to the NHS Pension

Scheme at the rate of 14.3% of pensionable pay. The scheme’s actuary

reviews employer contributions, usually every four years and now based on

HMT Valuation Directions, following a full scheme valuation. The latest

review used data from 31 March 2012 and was published on the Government

website on 9 June 2014.

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


81

5. Operating expenses

Admin expenditure is expenditure incurred that is not a direct payment for the

provision of healthcare or healthcare services

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


£000 £000 £000 £000

Gross employee benefits

Employee benefits excluding governing body members 2,717 801 1,916 1,669

Executive governing body members 172 172 0 172

Total gross employee benefits 2,889 973 1,916 1,841

Other costs

Services from other CCGs and NHS England 2,544 1,068 1,476 3,341

Services from foundation trusts 86,269 2 86,267 75,803

Services from other NHS trusts 44,902 9 44,893 53,670

Services from other NHS bodies 0 0 0 6

Purchase of healthcare from non-NHS bodies 26,918 0 26,918 21,976

Chair and Non Executive Members 52 52 0 237

Supplies and services – clinical 0 0 0 0

Supplies and services – general 90 70 20 13

Consultancy services 82 0 82 106

Establishment 231 170 61 259

Transport 22 21 1 17

Premises 680 90 590 718

Impairments and reversals of receivables 0 0 0 0

Inventories written down 0 0 0 0

Depreciation 5 5 0 54

Amortisation 0 0 0 0

Impairments and reversals of property, plant and equipment 0 0 0 0

Impairments and reversals of intangible assets 0 0 0 0

Impairments and reversals of financial assets

· Assets carried at amortised cost 0 0 0 0

· Assets carried at cost 0 0 0 0

· Available for sale financial assets 0 0 0 0

Impairments and reversals of non-current assets held for sale 0 0 0 0

Impairments and reversals of investment properties 0 0 0 0

Audit fees 54 54 0 66

Other non statutory audit expenditure

· Internal audit services 0 0 0 0

· Other services 0 0 0 0

General dental services and personal dental services 0 0 0 0

Prescribing costs 25,309 0 25,309 24,387

Pharmaceutical services 0 0 0 0

General ophthalmic services 0 0 0 0

GPMS/APMS and PCTMS 16,656 0 16,656 1,056

Other professional fees excl. audit 341 58 283 321

Grants to other public bodies 2,048 0 2,048 2,160

Clinical negligence 0 0 0 0

Research and development (excluding staff costs) 0 0 0 0

Education and training 83 62 21 47

Change in discount rate 0 0 0 0

Provisions 0 0 0 0

Funding to group bodies 0 0 0

CHC Risk Pool contributions 308 0 308 261

Other expenditure 53 0 53 72

Total other costs 206,647 1,661 204,986 184,570

Total operating expenses 209,536 2,634 206,902 186,411


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6.1 Better Payment Practice Code

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, with a target performance of 95%.

6.2 The Late Payment of Commercial Debts (Interest) Act 1998

The CCG did not make any payments under the provisions of the Late Payment of

Commercial Debts (Interest) Act 1998 in the financial year 2015/16 (2014/5, nil)

7 Income Generation Activities

The CCG had no income generation activities in the financial year 2015/16

(2014/15, nil)

8 Investment revenue

The CCG had no investment revenue in the financial year 2015/16 (2014/15, nil)

9 Other gains and losses

The CCG had no other gains or losses in the financial year 2015/16(2014/15, nil)

10 Finance costs

The CCG had no finance costs in the financial year 2015/16 (2014/15, nil)

11 Net Gain/ (loss) on transfer by absorption

The CCG had no net gain or losses on transfer by absorption in the financial year

2015/16 (2014/15, nil)

12 Operating Leases

12.1 As lessee

The CCG occupies property owned and managed by Community Health

Partnerships and NHS Property services Ltd

Whilst the CCG's arrangements with Community Health Partnerships Ltd and NHS

Property Services Ltd fall within the definition of operating leases, the rental charge

Measure of compliance 2015-16 2015-16 2014-15 2014-15

Number £000 Number £000

Non-NHS Payables

Total Non-NHS Trade invoices paid in the Year 3125 34369 2279 27324

Total Non-NHS Trade Invoices paid within target 3071 34174 2033 26520

Percentage of Non-NHS Trade invoices paid within target 98.27% 99.43% 89.21% 97.06%

NHS Payables

Total NHS Trade Invoices Paid in the Year 1947 135268 1929 132972

Total NHS Trade Invoices Paid within target 1941 135223 1858 132270

Percentage of NHS Trade Invoices paid within target 99.69% 99.97% 96.32% 99.47%


83

for future years, including any charge for void space, has not yet been agreed.

Consequently, note 12.1.2 does not include future minimum lease payments for

these arrangements

12.1.1 Payments recognised as an Expense 2015-16 2014-15

Land Buildings Other Total Land Buildings Other Total

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

Payments recognised as an expense

Minimum lease payments 0 674 39 713 0 707 23 730

Contingent rents 0 0 0 0 0 0 0 0

Sub-lease payments 0 0 0 0 0 0 0 0

Total 0 674 39 713 0 707 23 730

12.1.2 Future minimum lease payments 2015-16 2014-15

Land Buildings Other Total Land Buildings Other Total

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

Payable:

No later than one year 0 0 27 27 0 - 20 20

Between one and five years 0 0 20 20 0 - 24 24

After five years 0 0 0 0 0 - - 0

Total 0 0 47 47 0 0 44 44


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13 Property, plant and equipment

2015-16 Land

Buildings

excluding

dwellings Dwellings

Assets under

construction

and payments

on account

Plant &

machinery

Transport

equipment

Information

technology

Furniture &

fittings Total

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

Cost or valuation at 01-April-2015 0 0 0 0 31 0 112 0 143

Addition of assets under construction and payments on account 0 0

Additions purchased 0 0 0 0 0 0 0 0 0

Additions donated 0 0 0 0 0 0 0 0 0

Additions government granted 0 0 0 0 0 0 0 0 0

Additions leased 0 0 0 0 0 0 0 0 0

Reclassifications 0 0 0 0 0 0 0 0 0

Reclassified as held for sale and reversals 0 0 0 0 0 0 0 0 0

Disposals other than by sale 0 0 0 0 0 0 0 0 0

Upward revaluation gains 0 0 0 0 0 0 0 0 0

Impairments charged 0 0 0 0 0 0 0 0 0

Reversal of impairments 0 0 0 0 0 0 0 0 0

Transfer (to)/from other public sector body 0 0 0 0 0 0 0 0 0

Cumulative depreciation adjustment following revaluation 0 0 0 0 0 0 0 0 0

Cost/Valuation At 31-March-2016 0 0 0 0 31 0 112 0 143

Depreciation 01-April-2015 0 0 0 0 8 0 111 0 119







Charged during the year 0 0 0 0 4 0 1 0 5



Depreciation at 31-March-2016 0 0 0 0 12 0 112 0 124

Net Book Value at 31-March-2016 0 0 0 0 19 0 0 0 19

Purchased 0 0 0 0 19 0 0 0 19

Donated 0 0 0 0 0 0 0 0 0

Government Granted 0 0 0 0 0 0 0 0 0

Total at 31-March-2016 0 0 0 0 19 0 0 0 19

Asset financing:

Owned 0 0 0 0 19 0 0 0 19

Held on finance lease 0 0 0 0 0 0 0 0 0

On-SOFP Lift contracts 0 0 0 0 0 0 0 0 0

PFI residual: interests 0 0 0 0 0 0 0 0 0

Total at 31-March-2016 0 0 0 0 19 0 0 0 19


85

Revaluation Reserve Balance for Property, Plant & Equipment

Land Buildings Dwellings

Assets under

construction &

payments on

account

Plant &

machinery

Transport

equipment

Information

technology

Furniture &

fittings Total

£000's £000's £000's £000's £000's £000's £000's £000's £000's

Balance at 01-April-2015 0 0 0 0 0 0 0 0 0

Revaluation gains 0 0 0 0 0 0 0 0 0

Impairments 0 0 0 0 0 0 0 0 0

Release to general fund 0 0 0 0 0 0 0 0 0

Other movements 0 0 0 0 0 0 0 0 0

At 31-March-2016 0 0 0 0 0 0 0 0 0


86

2014-15 Land

Buildings

excluding

dwellings Dwellings

Assets under

construction

and payments

on account

Plant &

machinery

Transport

equipment

Information

technology

Furniture &

fittings Total

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

Cost or valuation at 1 April 2014 0 0 0 0 31 0 112 0 143

Addition of assets under construction and payments on account 0 0

Additions purchased 0 0 0 0 0 0 0 0 0

Additions donated 0 0 0 0 0 0 0 0 0

Additions government granted 0 0 0 0 0 0 0 0 0

Additions leased 0 0 0 0 0 0 0 0 0









Cost/Valuation At 31 March 2015 0 0 0 0 31 0 112 0 143

Depreciation 1 April 2014 0 0 0 0 4 0 61 0 65







Charged during the year 0 0 0 0 4 0 50 0 54



Depreciation at 31 March 2015 0 0 0 0 8 0 111 0 119

Net Book Value at 31 March 2015 0 0 0 0 23 0 1 0 24

Purchased 0 0 0 0 23 0 1 0 24

Donated 0 0 0 0 0 0 0 0 0

Government Granted 0 0 0 0 0 0 0 0 0

Total at 31 March 2015 0 0 0 0 23 0 1 0 24

Asset financing:

Owned 0 0 0 0 23 0 1 0 24

Held on finance lease 0 0 0 0 0 0 0 0 0

On-SOFP Lift contracts 0 0 0 0 0 0 0 0 0

PFI residual: interests 0 0 0 0 0 0 0 0 0

Total at 31 March 2015 0 0 0 0 23 0 1 0 24

Revaluation Reserve Balance for Property, Plant & Equipment

Land Buildings Dwellings

Assets under

construction &

payments on

account

Plant &

machinery

Transport

equipment

Information

technology

Furniture &

fittings Total

£000's £000's £000's £000's £000's £000's £000's £000's £000's

Balance at 1 April 2014 0 0 0 0 0 0 0 0 0

Revaluation gains 0 0 0 0 0 0 0 0 0

Impairments 0 0 0 0 0 0 0 0 0

Release to general fund 0 0 0 0 0 0 0 0 0

Other movements 0 0 0 0 0 0 0 0 0

At 31 March 2015 0 0 0 0 0 0 0 0 0


87

13 Property, plant and equipment cont'd

13.1 Additions to assets under construction

The CCG had no assets under construction as at 31 March 2016 (nil as at 31 March 2015).

13.2 Donated assets

The CCG received no donated assets as at 31 March 2016 (nil as at 31 March 2015).

13.3 Government granted assets

The CCG had no government granted assets as at 31 March 2016 (nil as at 31 March 2015).

13.4 Property revaluation

The CCG had no property as at 31 March 2016 therefore there has not been any property

revaluation in the financial year 2015/16 (nil in 2014/15).

13.5 Compensation from third parties

There has been no compensation received from third parties for assets impaired, lost or

given up in the financial year 2015/16 (nil in 2014/15).

13.6 Write downs to recoverable amount

There have been no assets written down to recoverable amounts and no reversals of

previous write-downs in the financial year 2015/16 (nil in 2014/15)

13.7 Temporarily idle assets

The CCG had no temporarily idle assets as at 31 March 2016 (nil as at 31 March 2015).

13.8 Cost or valuation of fully depreciated assets

The CCG had no fully depreciated assets still in use as at 31 March 2016 (nil as at 31 March

2015).

13.9 Economic Lives

Buildings excluding dwellings 0 0

Dwellings 0 0

Plant & machinery 4 7

Transport equipment 0 0

Information technology 0 0

Furniture & fittings 0 0

Minimum

Life

Maximum

Life


88

14 Intangible non-current assets

The CCG had no intangible non-current assets as at 31 March 2016 (nil as at 31 March

2015).

15 Investment property

The CCG had no investment property as at 31 March 2016 (31 March 2015 nil)

16 Inventories

The CCG had no inventories as at 31 March 2016 (31 March 2015, nil)

£655k of the amount above has subsequently been recovered post the statement of

financial position date.

The CCG did not hold any collateral against receivables outstanding as at 31 March

2016 (31 March 2015, nil)

17 Trade and other receivables Current Non-current Current Non-current

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

£000 £000 £000 £000

NHS receivables: Revenue 661 0 256 0

NHS receivables: Capital 0 0 0 0

NHS prepayments 1,350 0 578 0

NHS accrued income 45 0 0 0

Non-NHS receivables: Revenue 1,134 0 41 0

Non-NHS receivables: Capital 0 0 0 0

Non-NHS prepayments 0 0 90 0

Non-NHS accrued income 0 0 0 0

Provision for the impairment of receivables 0 0 0 0

VAT 26 0 11 0Private finance initiative and other public private

partnership arrangement prepayments and accrued

income 0 0 0 0

Interest receivables 0 0 0 0

Finance lease receivables 0 0 0 0Operating lease receivables 0 0 0 0Other receivables 1,437 0 946 0

Total Trade & other receivables 4,653 0 1,922 0

Total current and non current 4,653 1,922

Included above:

Prepaid pensions contributions 0 0

The majority of trade is with NHS England. As NHS England is funded by Government to provide funding to CCG's to commission services no

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

£000 £000

By up to three months 882 156

By three to six months 95 55

By more than six months 2 0

Total 979 211

credit scoring of them is considered necessary


89

17.2 Provision for impairment of receivables

The CCG conducted an impairment review of all receivables as at 31 March 2016. It

believes that all outstanding amounts will be recovered therefore does not have any

provision for the impairment of receivables.

18 Other financial assets

The CCG had no other financial assets as at 31 March 2016 (nil as at 31 March

2015).

19 Other current assets

The CCG had no other current assets as at 31 March 2016 (nil as at 31 March 2015).

20 Cash and Cash Equivalents

21 Non-current assets held for sale

The CCG had no non-current assets held for sale as at 31 March 2016 (31 March 2015,nil)

22 Analysis of impairments and reversals

The CCG had no impairments or reversals of impairments recognised in the financial year 2015/16(2014/15, nil)

2015-16 2014-15

£000 £000

Balance at 01-April-2015 29 61

Net change in year (23) (32)

Balance at 31-March-2016 6 29

Made up of:

Cash with the Government Banking Service 6 29

Cash with Commercial banks 0 0

Cash in hand 0 0

Current investments 0 0

Cash and cash equivalents as in statement of financial position 6 29

Bank overdraft: Government Banking Service 0 0

Bank overdraft: Commercial banks 0 0

Total bank overdrafts 0 0

Balance at 31-March-2016 6 29

Patients’ money held by the clinical commissioning group, not included above 0 0


90

23 Trade and other Payables

Other payables include £48,531 outstanding pension contributions at 31 March 2016

24 Other financial liabilities

The CCG had no other financial liabilities as at 31 March 2016 (31 March 2015, nil)

25 Other liabilities

The CCG had no other liabilities as at 31 March 2016 (nil as at 31 March 2015).

26 Borrowings

The CCG had no borrowings as at 31 March 2016 (31 March 2015, nil)

27 Private finance initiatives, LIFT and other service concession arrangements

The CCG had no private finance initiatives, LIFT or other service concession

arrangements as at 31 March 2016 (31 March 2015, nil)

28 Finance lease obligations

The CCG had no finance lease obligations as at 31 March 2016 (nil as at 31 March

2015).

29 Finance lease receivables

The CCG had no finance lease receivables as at 31 March 2016 (31 March 2015, nil)

30 Provisions

Current Non-current Current Non-current

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

£000 £000 £000 £000

Interest payable 0 0 0 0

NHS payables: revenue 801 0 1,141 0

NHS payables: capital 0 0 0 0

NHS accruals 445 0 291 0

NHS deferred income 0 0 0 0

Non-NHS payables: revenue 880 0 582 0

Non-NHS payables: capital 0 0 0 0

Non-NHS accruals 5,978 0 4,123 0

Non-NHS deferred income 0 0 0 0

Social security costs 33 0 0 0

VAT 0 0 0 0

Tax 36 0 0 0

Payments received on account 0 0 0 0

Other payables 1,579 0 1,105 0

Total Trade & Other Payables 9,752 0 7,242 0

Total current and non-current 9,752 7,242


91

Under the Accounts Direction issued by NHS England on 12 February 2014, NHS

England is responsible for accounting for liabilities in relation to CHC Continuing

Healthcare claims relating to periods of care before the establishment of the CCG.

However, the legal liability remains with the CCG. The total value of legacy NHS

Continuing Healthcare provisions accounted for by NHS England on behalf of the

CCG at 31 March 2016 was £0.17 million (£0.8 million at 31 March 2015).

31 Contingencies

The CCG had no contingencies as at 31 March 2016 (31 March 2015, nil)

32 Commitments

The CCG had no capital commitments as at 31 March 2016, (31 March 2015, nil)

33 Financial instruments

33.1 Financial risk management

Financial reporting standard IFRS 7 requires disclosure of the role that financial

instruments have had during the period in creating or changing the risks a body faces

in undertaking its activities.

Because NHS Clinical Commissioning Group is financed through parliamentary

funding, it is not exposed to the degree of financial risk faced by business entities.

Also, financial instruments play a much more limited role in creating or changing risk

than would be typical of listed companies, to which the financial reporting standards

mainly apply. The clinical commissioning group has limited powers to borrow or

invest surplus funds and financial assets and liabilities are generated by day-to-day

operational activities rather than being held to change the risks facing the clinical

commissioning group in undertaking its activities.

Treasury management operations are carried out by the finance department, within

parameters defined formally within the NHS Clinical Commissioning Group standing

financial instructions and policies agreed by the Governing Body. Treasury activity is

subject to review by the NHS Clinical Commissioning Group and internal auditors.

33.1.1 Currency risk

The NHS Clinical Commissioning Group is principally a domestic organisation with

the great majority of transactions, assets and liabilities being in the UK and sterling

based. The NHS Clinical Commissioning Group has no overseas operations. The

NHS Clinical Commissioning Group and therefore has low exposure to currency rate

fluctuations.

33.1.2 Interest rate risk


92

The Clinical Commissioning Group borrows from government for capital expenditure,

subject to affordability as confirmed by NHS England. The borrowings are for 1 to 25

years, in line with the life of the associated assets, and interest is charged at the

National Loans Fund rate, fixed for the life of the loan. The clinical commissioning

group therefore has low exposure to interest rate fluctuations.

33.1.3 Credit risk

Because the majority of the NHS Clinical Commissioning Group and revenue comes

parliamentary funding, NHS Clinical Commissioning Group has low exposure to

credit risk. The maximum exposures as at the end of the financial year are in

receivables from customers, as disclosed in the trade and other receivables note.

33.1.3 Liquidity risk

NHS Clinical Commissioning Group is required to operate within revenue and capital

resource limits, which are financed from resources voted annually by Parliament. The

NHS Clinical Commissioning Group draws down cash to cover expenditure, as the

need arises. The NHS Clinical Commissioning Group is not, therefore, exposed to

significant liquidity risks.


93

33.2 Financial assets

At ‘fair value

through profit

and loss’

Loans and

Receivables

Available for

Sale Total

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

£000 £000 £000 £000

Embedded derivatives 0 0 0 0

Receivables:

· NHS 0 706 0 706

· Non-NHS 0 1,134 0 1,134

Cash at bank and in hand 0 6 0 6

Other financial assets 0 1,437 0 1,437

Total at 31-March-2016 0 3,283 0 3,283

At ‘fair value

through profit

and loss’

Loans and

Receivables

Available for

Sale Total

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

£000 £000 £000 £000

Embedded derivatives 0 0 0 0

Receivables:

· NHS 0 256 0 256

· Non-NHS 0 41 0 41

Cash at bank and in hand 0 29 0 29

Other financial assets 0 946 0 946

Total at 31-March-2016 0 1,272 0 1,272

33.3 Financial liabilities

At ‘fair value

through profit

and loss’ Other Total

2015-16 2015-16 2015-16

£000 £000 £000

Embedded derivatives 0 0 0

Payables:

· NHS 0 1,246 1,246

· Non-NHS 0 8,437 8,437

Private finance initiative, LIFT and finance lease obligations 0 0 0

Other borrowings 0 0 0


Total at 31-March-2016 0 9,683 9,683

At ‘fair value

through profit

and loss’ Other Total

2014-15 2014-15 2014-15

£000 £000 £000

Embedded derivatives 0 0 0

Payables:

· NHS 0 1,432 1,432

· Non-NHS 0 5,810 5,810

Private finance initiative, LIFT and finance lease obligations 0 0 0

Other borrowings 0 0 0


Total at 31-March-2016 0 7,242 7,242


94

34 Operating segments

The CCG considers that it only has one operating segment commissioning of

healthcare services

35 Pooled budgets

The CCG entered into a Pooled Budget arrangement with Halton Borough Council on

the 1st April 2013. The pool is hosted by Halton Borough Council for the majority of

Continuing Healthcare (CHC) and share financial risk on the pooled fund with the

CCG, contributing £12.3 million of the £30.9 million.

The Better Care Fund was added to this pooled arrangement on 1st April 2015, the

budget for this is £10.5 million, with the CCG contributing £9.4 million of this.

Under the arrangements funds are pooled under Section 75 of the NHS Act 2006 for

Complex Care.

The NHS Clinical Commissioning Group shares of the income and expenditure

handled by the pooled budget in the financial year were:

36 NHS Lift investments

The CCG had no lift investments as at 31 March 2016 (31 March 2015, nil)

2015-16 2014-15

£000 £000

Income 21,795 13,603

Expenditure (21,794) (13,605)


95

37 Related Party Transactions

The Department of Health is regarded as a related party. During the year the CCG has had a

significant number of material transactions with entities for which the Department is regarded

as the parent Department. For example:

NHS England (including Cheshire and Merseyside Commissioning Support Unit)

Warrington and Halton Hospitals Foundation Trust

St Helens & Knowsley Hospitals NHS Trust

Aintree University Hospitals NHS Foundation Trust

Liverpool Women’s Hospital NHS Foundation Trust

Royal Liverpool and Broadgreen University Hospitals NHS Trust

Liverpool Heart and Chest NHS Foundation Trust

Wrightington, Wigan and Leigh NHS Foundation Trust

Southport and Ormskirk Hospitals NHS Trust

Bridgewater Community Healthcare NHS Trust

Alder Hey Children’s NHS Foundation Trust

5 Boroughs Partnership NHS Foundation Trust

NHS Business Services Authority

NHS Litigation Authority

2015-16

Name Role Within CCG Role within Related Party Related PartyPayments to

Related Party

Receipts

from Related

Party

Amounts

owed to

Related

Party

Amounts

due from

Related

Party

£000 £000 £000 £000

Mr David Austin Lay Member Chair Brookvale Practice 1,178 0 57 0

Mr Paul Brickwood Chief Finance Officer Chief Finance Officer NHS Knowsley CCG 413 (128) 163 (5)

Mr Paul Brickwood Chief Finance Officer Chief Finance Officer NHS St Helens CCG 111 (160) 0 (44)

Mrs Ingrid Fife Lay Member Chair of the Joint Co-Commissioning Committee Warrington CCG 23 (22) 21 (3)

Dr Claire Forde GP Governing Body Member GP Partner Grove House Practice 1,500 (3) 3 (3)

Diane Hanshaw Practice Manager Practice Manager & Governing Body Representative Beaconsfield Surgery 1,960 (3) 287 (3)

Dr David Lyon General Practitioner GP Partner Castlefields Health Centre 2,005 0 219 0

Dr Damian McDermott General Practitioner GP Partner Tower House Practice 1,599 (3) 43 (3)

Mr David MerrillLay Member & Deputy Chair of Governing

BodyMember of Patient Participation Group Peelhouse Medical Plaza

1,855 0 93 0

Mr David MerrillLay Member & Deputy Chair of Governing

BodyRegistered with Halton Carers Group (Halton Carers Centre Ltd)

1 0 0 0

Dr Mick O'Connor GP Governing Body member and GP Partner Beaconsfield Surgery 1,960 (3) 287 (3)

Contract Lead St Helens & Knowsley Hospitals

NHS Trust

Doreen Shotton HealthWatch Representative Director / Trustee Age UK Mid Mersey 24 0 0 0

Doreen Shotton HealthWatch Representative Member of Management Committee HealthWatch 7 0 0 0

Doreen Shotton HealthWatch Representative Member of Executive Committee OPEN 0 0 0 0

Jan Snoddon Chief Nurse Associate Lecturer Edge hill University 7 0 0 0

Mr Shazid Tahir Lay Member Fostering Panel Member Together Trust 0 0 0 0

Dave Sweeney Director of Transformation Non-Executive Director Renova 98 (4) 0 0

Details of related party transactions with individuals are as follows:


96

In addition, 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 Halton Borough Council

2014-15

Name Role Within CCG Role within Related Party Related PartyPayments to

Related Party

Receipts from

Related Party

Amounts

owed to

Related

Party

Amounts

due from

Related

Party

£000 £000 £000 £000

Mr David Austin Lay Member Chair Brookvale Practice 10 -8 0 0

Mr David Austin Lay Member Director Murdshaw Community Centre 1 0 1 0

Mr Paul Brickwood Chief Finance Officer Chief Finance Officer NHS Knowsley CCG 259 -80 0 -6

Mr Paul Brickwood Chief Finance Officer Chief Finance Officer NHS St Helens CCG 300 -192 0 -4

Mr Robert Bryant Lay Member Trustee Halton Carers Group (Halton Carers Centre Ltd) 0 0 20 0

Mr Robert Bryant Lay Member Wife Works as a PA Halton Borough Council 15078 -240 47 -642

D Henshaw Practice Manager Practice Manager & Governing Body Representative Beaconsfield 10 -1 0 0

Dr D Lyon General Practitioner GP Partner Castlefields Health Centre 41 -1 1 0

Dr D McDermott General Practitioner GP Partner Tower House Practice 20 -1 1 0

Mr D Merill Lay Member & Deputy Chair of Governing Body Member of Patient Information Leaflet Ratification GroupSt Helens & Knowsley Teaching Hospitals NHS Trust 32645 0 4 0

Mr D Merill Lay Member & Deputy Chair of Governing Body Registered with Halton Carers Group Halton Carers Group (Halton Carers Centre Ltd) 0 0 20 0

Dr M O'Connor General Practitioner GP Partner Beaconsfield Surgery 10 -1 0 0


97

The Department of Health is regarded as a related party. During the year the CCG has had a

significant number of material transactions with entities for which the Department is regarded as

the parent Department. For example:

NHS England (including Cheshire and Merseyside Commissioning Support Unit)

Warrington and Halton Hospitals Foundation Trust

St Helens & Knowsley Hospitals NHS Trust

Aintree University Hospitals NHS Foundation Trust

Liverpool Women’s Hospital NHS Foundation Trust

Royal Liverpool and Broadgreen University Hospitals NHS Trust

Liverpool Heart and Chest NHS Foundation Trust

Wrightington, Wigan and Leigh NHS Foundation Trust

Southport and Ormskirk Hospitals NHS Trust

Bridgewater Community Healthcare NHS Trust

Alder Hey Children’s NHS Foundation Trust

5 Boroughs Partnership NHS Foundation Trust

NHS Business Services Authority

NHS Litigation Authority

In addition, 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 Halton Borough Council

38 Events after the end of the reporting period

There are no post balance sheet events which will have a material effect on the financial

statements of NHS Halton Clinical Commissioning Group or the Consolidated Group

39 Losses and special payments

The CCG had no losses or special payments in the financial year 2015/16 (2014/15 nil)

40 Third party assets

The CCG held no third party assets as at 31 March 2016 (31 March 2015, nil)


98

41 Financial performance targets

NHS Clinical Commissioning Group have a number of financial duties under the NHS Act 2006 (as amended). NHS Clinical Commissioning Group performance Against those duties was as follows:

* Note; For the purposes of 223H (1); expenditure is defined as the aggregate of gross expenditure on revenue and capital in the financial year; and , income is defined as the aggregate of the notified maximum revenue resource, notified resource and all other amount is defined as the aggregate of the notified maximum revenue resource, notified capital resource and all other amount year (whether under provisions of the Act or from other sources, and included here on a gross basis).

All duties have been achieved in 2015/16, and 2014/15 42 Impact of IFRS Accounting under IFRS had no impact on the results in the financial year 2015/16 (2014/15 nil) 43 Analysis of charitable reserves The CCG held no charitable reserves in the financial year 2015/16 (2014/15 nil)

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

Target Performance Target Performance

£'000 £'000 £'000 £'000

223H (1) Expenditure not to exceed income 211,435 209,536 188,251 186,411

223I (2) Capital resource use does not exceed the amount specified in Directions 0 0 0 0

223I (3) Revenue resource use does not exceed the amount specified in Directions 209,819 207,920 186,738 184,898

223J(1)Capital resource use on specified matter(s) does not exceed the amount

specified in Directions 0 0 0 0

223J(2)Revenue resource use on specified matter(s) does not exceed the amount

specified in Directions 0 0 0 0

223J(3)Revenue administration resource use does not exceed the amount

specified in Directions 2,968 2,511 3,489 2,921


99

APPENDIX 1

THE COMMITTEES OF NHS HALTON CCG GOVERNING BODY

The CCG has nine internal Committees reporting to its Governing Body and one

Committee in Common that is co-ordinated through Halton Borough Council. Each

Committee is established in accordance with the CCG Constitution and the remit,

responsibilities, and reporting arrangements shall have effect as if incorporated into

the Constitution and Standing Orders.

Membership and Terms of Reference for each Committee is reviewed annually and

the current versions are available here. Every Committee agrees an annual Work

Plan that is informed by its responsibilities, as defined in the Terms of Reference, and

is required to provide the Governing Body with a Key Issues Report followed by

approved Minutes, for information.

The Governing Body has representation on each of the Committees. Appendix 2,

page 106 provides a record of attendance for the period 1st April 2015 – 31st March

2016.

Highlights for each Committee during 15/16 are described below:

AUDIT COMMITTEE

Chair, David Merrill, Lay Member & Governing Body Deputy Chair

The duties of this Committee are driven by priorities identified by the CCG and the

associated risks. In summary, it is responsible for reviewing the establishment and

maintenance of integrated governance, risk management and internal control;

ensuring effective internal and external audit; reviewing findings of other significant

assurance functions; policies for ensuring compliance with regulatory, legal and code

of conduct requirements; counter fraud; whistle-blowing and the integrity of financial

reporting.

In year highlights include:

Provided continued assurance to the Governing Body in relation to:

the fitness for purpose of the Assurance Framework.

systems for Risk Management identify and allow for the management of

risk.

robust governance arrangements are in place.

robust systems of financial control are in place.

Undertook Effectiveness Reviews of both Internal and External Audit.

http://www.haltonccg.nhs.uk/about/ccg-committees


100

Received Significant Assurance in the Director of Audit's Opinion report

Followed up the Committee's Development Plan following its own Self-

Assessment and Effectiveness review.

HUMAN RESOURCES & ORGANISATIONAL DEVELOPMENT COMMITTEE

Chair - Ingrid Fife, Lay Member

The role of this Committee is to advise the Governing Body on all Human Resource

and Organisational Development matters. In summary responsibilities include

workforce performance targets; policy development; assurance on Public Sector

Equality Duties (as it relates workforce); ensuring CCG upholds staff values within

NHS constitution; development and implementation of OD plan; ensuring staff are

fairly rewarded; and review of workforce plans.


Approving new HR Policies, and monitoring performance against established

policies

Agreeing the annual Organisation Development and Learning & Development

Plan

Receiving the positive outcome from 2015 Staff Survey and designing 2016

survey

Understanding of new workforce policy standards for E&D, and receiving

updates

Monitoring progress of the Health & Wellbeing Group

The recruitment process for new Governing Body appointments

INTEGRATED GOVERNANCE COMMITTEE

Chair – Simon Banks, Chief Officer

The Committee reports on the development, implementation and monitoring of all

areas of integrated governance by providing assurance on the systems and

processes by which the CCG leads, directs and controls its functions in order to

achieve organisational objectives.,

In year highlights:

review of development and implementation of corporate policies

achievement of Information Governance Toolkit work plan

establishment of IT Implementation Group, agreeing strategy and receiving

updates


101

agreeing business continuity plan, emergency planning and resilience

response (EPRR) assurance process and plan

overview of risks on BAF, Corporate Risk Register, monitoring of risks specific

to committee, and agreeing a refresh of the risk management strategy

oversight of Freedom of Information, complaints/ PALs activity

PERFORMANCE & FINANCE COMMITTEE

Chair – Simon Banks, Chief Officer

This Committee advises the Governing Body on all financial matters and provides

assurance in relation to the discharge of statutory duties in line with the Standing

Financial Instructions. The Committee also ensure that the performance of

commissioned services in monitored.

In summary, is delegated by the Governing Body to, approve and monitor the annual

financial plan; ensure the CCG delivers financial balance; meets statutory financial

targets; monitors QIPP, contract expenditure and financial performance indicators;

and approves variation to planned investments.

In year highlights:

Achievement of CCG financial duty to achieve 1% surplus for 2014/15

Overseeing the transition of Commissioning Support Unit contract via the Lead

Provider Framework

Monitoring progress of completion of CHC legacy restitution claims

Regular reporting of prescribing activity / expenditure and supporting bid for

additional pharmacist capacity in general practice

Oversight of activity & expenditure against GP Access Fund

Scrutiny of provider performance (including breaches against constitution

standards) and monitoring of Quality Premium measures

PRIMARY CARE COMMISSIONING COMMITTEE

Chair – Ingrid Fife, Lay Member

NHS England has delegated to the CCG authority to exercise the primary care

commissioning functions set out in Schedule 2 in accordance with section 13Z of

NHS Action 2006 (as amended).It has been established in May 2015 to make

collective decisions on the review, planning and procurement of primary care

services in Halton. This Committee is in its development phase and will function as a

Committee held in public from April 2016.

In year highlights:


102

Understanding of risk process and identifying specific risks

Progress reports on Schemes supported through GP Access Funds

Overview of estate in primary care and establishing an Estates Working Group

PMS reviews and what this means

Receiving general medical service commissioning updates, and agreeing

process for consideration of practice list closures

Agreed funding for a range of schemes, for example, reducing unplanned

admissions in the over 75s

QUALITY COMMITTEE

Chair – Jan Snoddon, Chief Nurse

The committee reviews the risks it is responsible for at every committee, and agrees

updates and the level of assurance the controls and assurance are delivering on

each risk.

The provider performance reports including the Maternity Dashboard and Equality

and Diversity compliance reports for providers, the corporate performance report,

early warning dashboard and Clinical Quality and Performance Groups key issues

are reported to every committee. These reports provide current status reporting and

also when triangulated provide early warning of quality failures in providers. These

reports are also used as assurance to evidence on-going quality and safety

performance of providers and evidence compliance with set quality metrics and

standards. The Committee also receives provider performance reports in relation to

Advancing Quality, Hospital Mortality and Patient Safety Incidents via National

Reporting and Learning system.

The committee received and approved the Serious incident (SI) Management Policy

and has received regular reports in relation to SIs across the CCG and all providers.

The committee receives and approves actions from Medicines Management Group

and approves decisions in relation to Pan Merseyside Medicines Decisions and

advice in relation to local formulary, new drugs and NICE guidance in relation to

drugs. The committee approves policies and strategies for management of medicines

and has in this year approved the Memorandum of Understanding for Safe Use and

Management of Controlled Drugs.

The committee also receives regular reports and updates in relation to Safeguarding

Children and Vulnerable Adults, including approval on behalf of the CCG of

Safeguarding Policies and Strategies, including annual reports for both Adults and

Children’s safeguarding. The committee also receives the minutes of both

Safeguarding adults and Safeguarding Children’s boards. The committee has also


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received the Integrated Safeguarding Activity Report from the local authority

safeguarding unit.

The committee receives regular reports in relation to Learning disabilities Health

checks, independent complaints advocacy statistics, Patient Survey reports including

Children and Young People’s impatient and Day case survey, flu performance,

Patient Led Assessments of the Care Environment (PLACE), Stroke performance

update, infection control annual reports and work programmes. Other key reporting

areas and policy/strategy approval include Cross Boundary Complaints, CCG

complaints policy, review of Quality Strategy and action plan for delivery, nursing

revalidation

The committee receives regular updates on communications and public engagement

including approval of strategies and plans and receipt of regular reports against the

plans. The committee has also received in this year:

Open survey

Quarterly Individual Patient Requests report

Update regarding Coroners letters to providers

Outcomes from provider CQC inspections

Hip fracture national audit report

5 Boroughs Partnership Footprint Review (Tony Ryan Report)

The committee has also completed a deep dive into patient harms, causes and

prevention and into the development of a patient experience strategy for the CCG.

REMUNERATION COMMITTEE

Chair –Ingrid Fife, Lay Member

This Committee makes recommendations to the Governing Body on policy and

determinations about pay, remuneration and other allowances specifically for the

Executive Management Team and people who provide services to the CCG including

Governing Body, clinical leads, and payments to Practices for engagement in

commissioning activity.

The Committee has met on one occasion in the reporting period and approved

The recommendations of the pay review for Governing Body / Clinical leads

The redundancy clause for Very Senior Managers

SERVICE DEVELOPMENT COMMITTEE

Chair, Dr Michael O’ Connor, GP representative

The duties of this Committee are driven by the priorities of the CCG and in essence it

is responsible for ensuring that member practices are setting the commissioning


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agenda, supporting the setting of the operational delivery plan and monitoring

delivery of the plan. The Committee also supports and enables clinical pathway

development locally and regionally.


Monitored implementation of 2015/16 commissioning intentions

Review of treatment pathways and service specifications

Received updates on new Urgent Care Centres

Supported the procurement processes, for example, Wellbeing practices

Agreed community services new models of care; district nursing redesign, pilot

of community geriatrician to support rapid access assessment.

Considered non-elective activity and how to reduce cost and over-activity

URGENT ISSUES COMMITTEE

Chair, Simon Banks, Chief Officer

The duties of this Committee are driven by the priorities of the CCG, and its purpose

is to manage any urgent issues that develop in areas of governance and risk

management; service commissioning or provision; finance including individual

funding issues; management; CCG reputation or communication.

The Committee has had reason to convene on four occasions in 2015/16 for the

purpose of

Agreeing the Joint Working Agreement with Halton Borough Council

Approval of collaborative Transforming Care Plan for people with Learning

Disabilities and/or Autism for submission to NHSE

Approving the Contract Specification Documentation for the Procurement of

Patient Transport Services

Agreeing the Quality Premium Awards and associated measures for 2015/16

BETTER CARE BOARD

Chair, Cllr Marie Wright Portfolio Holder Health and Wellbeing Chair

The Better Care Board is a key partnership board for the CCG and Local authority

which manages on behalf of the partnership the delivery of the Better Care Fund plan

and manages the ‘Pooled Budget’.


The Better Care Plan for 2016/2017 was also presented and agreed for

submission in April 2016


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Joint Working Agreement, which had been in place since 2013, had been

revised to reflect the following changes:

the Complex Care Board was renamed the Better Care Board.

the Executive Commissioning Board was renamed the Better Care

Executive Commissioning Board.

The budget schedule for 2015/16 was revised to incorporate the

additional Better Care Fund allocation for 2015/16.

Agreed to the underspend remaining in the Pool for 2015/16

Regular finance updates

The current Section 75 agreement expires in March 2016 and a full review of this

agreement has been completed

The end of year performance in respect of the Better Care Performance

Framework for 2014/15 and regular updates through 2015/16

Quarter 2 return July to September 2015 for approval to submit to NHS

England

Regular updates from operational group and System Resilience Group

Service presentations by:

Quality Assurance Team

Social care in practice

St Luke’s One to One Provision

Continuing Health Care provision

Healthwatch enter and view reports


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APPENDIX 2

GOVERNING BODY – COMMITTEE REGISTER OF ATTENDANCE

NAME TITLE Governing

Body Audit

Committee

Human Resource &

Organisational Development

Committee

Integrated Governance Committee

Performance & Finance

Committee

Primary Care Commissioning

Committee

Quality Committee

Remuneration Committee

Service Development

Committee

Urgent Issues Committee

David Austin Lay Member 09/11 3/4 4/4 7/9

Simon Banks Chief Officer 8/11 4/4 4/4 7/9 8/10 4/4

Paul Brickwood Chief Finance Officer 10/11 4/4 3/4 6/9 1/10 4/4

Mike Chester Secondary Care Doctor 5/11 0/10 3/9

Ingrid Fife Lay Member 9/11 4/4 4/4 8/10 1/1

Claire Forde Governing Body Member, GP and Clinical Lead Medicines Management

8/11 6/9 8/11

Gill Frame Registered Nurse 9/11 3/4 7/10 5/9 1/1 8/11

Diane Hanshaw Practice Manager Representative 9/11

David Lyon Governing Body Member and GP 7/11 2/9 6/11

Damian McDermott Governing Body Member and GP 8/11 7/9 7/11

David Merrill Lay Member 9/11 4/4 7/9 7/10

Mick O'Connor Committee Chair, GB Member & Clinical Lead - StHK

9/11 3/4 2/9 4/9 7/11

Eileen O'Meara Director of Public Health 4/11 4/10

Cliff Richards Chair 5/11 6/9 3/10 5/11 4/4

Jan Snoddon Chief Nurse 8/11 4/4 3/4 3/10 5/9 4/4

Dave Sweeney Director of Transformation 7/11 4/10 4/11 3/4

Shahzad Tahir Lay Member 10/11 3/4 4/4 1/1


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APPENDIX 3

GOVERNING BODY DECLARATIONS OF INTEREST REGISTER

Name Position Organisation Declaration and Date of Declaration

Mr David Austin Lay Member NHS Halton CCG Chair of Brookvale Practice Patient Participation Group. Director of Murdishaw Community Centre. 07/05/15

Mr Simon Banks Chief Officer NHS Halton CCG Nil 16/03/15

Mr Paul Brickwood Chief Finance Officer NHS Halton CCG

Employed by NHS Knowsley CCG and provide a Chief Finance Officer role for NHS Halton CCG, NHS Knowsley CCG and NHS St Helens CCGs. Wife is Director of Gillian Brickwood Ltd, a private company which provides health consultancy services. 08/04/15

Dr Michael Chester Secondary Care Doctor Governing Body Member

NHS Halton CCG

Owner/Director of Virtual Angina Ltd. Director of Patient Centred Solutions Ltd, wife is Co-Director. Governing Body Member of East Staffordshire and Kingston CCGs. 07/05/15

Mrs Ingrid Fife Lay Member NHS Halton CCG

Husband is Director of Medtrade Ltd. Shareholdings in name of self and husband of 1% in Medtrade Ltd. Chair of Halton Housing Trust and Board Member of Regenda Homes Ltd. 07/05/15

Dr Claire Forde General Practitioner NHS Halton CCG GP Partner at Grove House Practice. Part owner at St Pauls Health Centre 07/05/15

Gill Frame Registered Nurse Governing Body Member and Clinical Lead - Children

NHS Halton CCG Independent Chair of Cheshire West and Chester Local Safeguarding Children's Board. NMC Fitness to Practice Nurse. 19/03/15


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Name Position Organisation Declaration and Date of Declaration

Diane Hanshaw Practice Manager Governing Body Member

NHS Halton CCG Practice Manager Beaconsfield Surgery, Widnes and Governing Body Representative. 01/04/15

Dr David Lyon General Practitioner NHS Halton CCG GP Partner at Castlefields Health Centre, Runcorn. 15/04/15

Dr Damian McDermott

General Practitioner NHS Halton CCG GP Partner providing PMS Services at Tower House Practice, Runcorn. Part-Owner St Paul's Health Centre, Runcorn. Trustee of Vicarage Lodge Playgroup, Runcorn. 17/04/15

Mr David Merrill Lay Member and Deputy Chair of the Governing Body

NHS Halton CCG Member of Peelhouse Medical Plaza Patient Participation Group. Registered with Halton Carers Group. 07/05/15

Dr Mick O'Connor General Practitioner NHS Halton CCG GP Partner and Partner at Beaconsfield Surgery, Bevan Way, Widnes. 07/05/15

Eileen O'Meara Director of Public Health Halton Borough Council

Nil 07/05/15

Dr Clifford Richards Chair and General Practitioner

NHS Halton CCG Partners daughter attends "stick and step" a conductive education charity. 03/03/16

Mrs Jan Snoddon Chief Nurse NHS Halton CCG Associate Lecturer at Edge Hill University 30/03/15

Shahzad Tahir Lay Member NHS Halton CCG Lay Member Together Trust Independent Fostering Agency – 13/04/15

Mr Dave Sweeney Director of Transformation NHS Halton CCG Non- Executive Director of Renova 07/05/15