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NHS BROMLEY CLINICAL COMMISSIONING GROUP

ANNUAL REPORT AND ACCOUNTS 2014/15

HELPING THE PEOPLE OF BROMLEY LIVE LONGER, HEALTHIER, HAPPIER LIVES

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CONTENTS

MEMBER PRACTICES INTRODUCTION 5

STRATEGIC REPORT 8

1. Who we are and what we do 8

1.1 Our duties 10

1.2 How we spend your money 11

1.3 Services we commission 12

1.4 Primary care services 13

1.5 Health and Social Care working together 13

1.6 Public health 14

2. Health in Bromley 15

2.1 The Bromley population 15

2.2 Health Needs 15

2.3 Health and Wellbeing Board 16

3. Our Vision for Bromley 18

3.1 Our Goals 19

3.2 Our Plans and Priority Areas 20

3.3 Our Healthier South East London 22

4. Progress during 2014/15 23

4.1 Community based care 24

4.2 Mental Health 25

4.3 Planned Care 26

4.4 Children and Young People 30

4.5 Primary Care 31

4.6 Prescribing and Medicine Management 32

4.7 Urgent Care 33

5. Looking to the future 36

5.1 Whole system transformation 37

5.2 Out of Hospital Strategy 38

6. Working in Partnership 40

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6.1 Patient Advisory Group 41

6.2 Engaging with local people 42

6.3 Learning through complaints and PALS 43

6.4 Health Overview and Scrutiny Committee 43

6.5 Stakeholder Reference Group 43

7. Performance and Quality Review 44

7.1 Quality, Innovation, Productivity and Prevention (QIPP) 44

7.2 Performance 46

8. Quality Review 48

8.1 Quality Improvement 49

8.2 Governance/Assurance Process 49

8.3 Quality Accounts 50

8.4 Commissioning for Quality and Innovation (CQUIN) 50

8.5 Quality Premium 51

8.6 Action on Francis Report 51

9. Chief Financial Officer’s Finance and Risk Review 52

9.1 Review of 2014/15 52

9.2 Looking forward 52

10. Equality and Diversity 53

10.1 Bromley Single Equality Scheme 54

10.2 Equal Opportunities at work 56

11. Sustainability 57

12. Safeguarding 60

12.1 Children and Young People 61

12.2 Vulnerable Adults 61

MEMBERS’ REPORT 63

1. Governance 65

1.1 Governance Structure 65

2. Our Staff 76

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2.1 Training and Development 77

2.2 Communicating with staff 77

3. Information Governance 77

3.1 Information Governance Framework 78

3.2 Information Governance Incidents 78

3.3 Information Governance Planning 79

4. Complaints 79

5. Emergency preparedness 81

REMUNERATION REPORT 83

SUMMARY ACCOUNTS 89

ANNUAL GOVERNANCE STATEMENT 93

INDEPENDENT AUDITOR’S REPORT 123

ANNUAL ACCOUNTS 126

NHS Bromley Clinical Commissioning Group

Beckenham Beacon

379-397 Croydon Road

Beckenham BR3 3QL

01689 866544 www.bromleyccg.nhs.uk

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MEMBER PRACTICES INTRODUCTION

On behalf of our GP member practices in Bromley, I am pleased to present our annual report

and accounts for 2014/15. The report describes the work we have done over the last year to

put patients first, improve health services in Bromley and deliver our vision of better health,

better care and better value. As clinical commissioners, we strive to understand what our

patients need and can bring this perspective to shape the commissioning and delivery of

healthcare in Bromley. I would like to thank all our member practices for their commitment

to both their patients and to the improvement of healthcare across the whole of Bromley over

the last year.

Our membership is made up of all the GP practices in Bromley. As members, we agree the

overall aims, strategic direction and governance arrangements for the CCG, but we have

delegated responsibility for the detailed planning and operational commissioning of local

health services to our Governing Body. Six GP representatives including our chair have

been elected to sit on the Governing Body with the other professional, lay and management

members to speak on behalf of the membership.

This has been a challenging year. The NHS is under immense pressure as the population

grows and people are living longer often with complex health conditions. Across the country

we are seeing huge demand for care both in hospital and community and primary care

services. This shows itself in many ways be it longer waits in A&E or the huge pressure on

general practice and difficulty in getting an appointment with a GP. Our local hospital trust

is facing financial and operational challenges and we are working very closely with them and

other partners to make improvements across the whole of the Bromley health and care

system to ensure patients receive safe, high quality services and that we are equipped to

cope with the increasing demands for care.

During our second year as a clinically led organisation we have seen our plans to improve

the health of our residents and the care they receive take effect. We have also invested

additional winter funding to help bring waiting lists down and manage the extra demand

usually seen over the colder months. A number of schemes were introduced to run over

winter, aimed at helping to reduce emergency hospital admissions and support people to

leave hospital quickly with the right package of care available once they are home. These

schemes together with delivery of our other priorities have brought many benefits to patients:

More GP appointments were provided over winter.

Seven day working and improved discharge arrangements over winter helped to get

people out of hospital quicker.

A new ambulatory care unit is caring for patients with urgent medical conditions.

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Expansion of the medical response team is providing urgent care to people at home

and helping to prevent them being admitted to hospital.

Fast response personal care for patients who need extra support is helping them to

get back on their feet after being in hospital and is providing an alternative to long

term residential care.

More intensive support is being provided to people in their last few weeks of life.

Mental health support for people in a crisis has been doubled and includes provision

for children and young people.

The diagnosis of dementia has improved and more memory clinics are available.

An extension of our integrated cardiology and diabetes services means more

patients are able to benefit.

As a membership organisation working closely with our GP member practices, we have

reflected on the 360 degree feedback we received in order to strengthen the way we work

with practices. In June 2014, the Membership Body assessed their effectiveness and

identified a number of improvements around planning and decision making, communication

and engagement, leadership and succession planning. Actions put in place as a result have

included providing a leadership programme for GPs, increasing the number of GPs working

with the CCG on developing new care pathways and providing more opportunities for GPs to

participate in areas in which they have a particular interest.

We know that the pressure on services is immense and everyone is working extremely hard

but we also understand that we need to transform the way that care is provided. Our Chief

Officer has been leading the transformation plans across the health and social care system

in Bromley. Our aim is to deliver more services in the community and provide co-ordinated,

proactive and accessible care that is focused on the needs of patients and helps them to

stay well. The establishment of the Bromley GP Alliance will enable practices to work

closely together to further develop general practice services. Also in January our

membership voted to apply to NHS England to undertake joint commissioning of primary

care services, leading to fully delegated responsibility. Our application was successful and

from April 2015 we will commence primary care co-commissioning with NHS England and

the five other CCGs in south east London. Over the last year we have also been working

with our many partners in Bromley to develop plans to deliver services through local care

networks. These networks will bring together GP services, community health, social care

and mental health services to focus on the needs of local communities and help people to

stay well. These are all exciting opportunities which we believe will, in the longer term, have

a real impact on improving health and care and help people to live longer, healthier and

happier lives. Our plans also fit with the future vision for delivering care in the NHS, as set

out in the NHS Five Year Forward View.

Delivering our plans is only possible with the help of the strong partnerships we have in

Bromley and, on behalf of the membership I would like to thank everyone who is working

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with us for their help and support to deliver better care for Bromley people. I continue to be

encouraged by the huge commitment from all parts of the health and social care system to

make a real difference to improving people’s quality of life. We are particularly indebted to

local people and patients who have continued to work with us this year on our plans. They

actively influence our decisions and provide an essential perspective on what works well and

what needs to work better for patients and the public.

This year we have continued to work together with CCGs in south east London to come up

with solutions to challenges that we all face. The Our Healthier South East London

Programme aims to improve health and wellbeing, reduce health inequalities and ensure

that services across south east London consistently meet quality standards and are

sustainable in the longer term.

During 2014/15, the GP practices in Bromley have all met together as the Membership Body

of the CCG on 3 occasions. Representatives from each practice also attend three locality

cluster meetings that take place every other month. During the Membership Body meetings

we discussed the South East London Five Year Strategy, Primary Care Co-commissioning,

the transformation of Primary Care in Bromley, acute unscheduled care, community services

and out-of-hospital care, and constitutional changes.

Our focus next year will be on delivering our plans to promote and deliver integrated services

that focus on keeping people well and enabling them to better manage their own health and

wellbeing and live independent and happier lives for longer.

Dr Andrew Parson

Clinical Chair

NHS Bromley Clinical Commissioning Group

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STRATEGIC REPORT

1 WHO WE ARE AND WHAT WE DO

NHS Bromley Clinical Commissioning Group was established on 1 April 2013 and put

general practitioners (GPs) in charge of working with their local population and other

partners to improve local health and to plan, purchase and monitor (commission) most of the

NHS services their residents need. We are a membership organisation made up of all the

GP practices in Bromley. We serve a rising population of over 320,057 and manage an

annual budget of £388 million.

As the leading clinically led NHS organisation for Bromley, our mission is to commission

health services that will enable longer, healthier and happier lives for the people of Bromley.

Our membership body meets at least twice a year and our member practices send

representatives to three (largely) geographical ‘cluster’ meetings which take place every

other month. There is a fourth ‘cluster’ comprised of locum and salaried GPs. Our

members have delegated responsibility for the detailed planning and operational

commissioning of local health services to our Governing Body which meets in public and

which is led by our clinical chair Dr Andrew Parson, a local GP with a practice in Chislehurst.

You can read more about our Governing Body on our website at www.bromleyccg.nhs.uk

Below is our Governance Structure.

Information

Information

MEMBERSHIP BODY

CCG GOVERNING BODY

REMUNERATION

COMMITTEE AUDIT COMMITTEE

INTEGRATED GOVERNANCE

COMMITTEE

CLINICAL EXECUTIVE GROUP

QUALITY ASSURANCE

SUB COMMITTEE

CLUSTER

CLUSTER

CLUSTER

SESSIONAL GPs

Recommendations

Recommendations

Recommendations

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We work with a range of partners in Bromley including; the London Borough of Bromley,

Healthwatch Bromley, Public Health, our healthcare providers including King’s College

Hospital NHS Foundation Trust, Bromley Healthcare, Oxleas NHS Foundation Trust,

Greenbrook Healthcare and the London Ambulance Service, the voluntary sector and the

public and patients. We also work closely with our neighbouring CCGs in south east

London and NHS England, particularly on shared plans to improve health and deliver high

quality and sustainable services for our populations.

As the largest geographical London borough, Bromley has an older than average population

and an increasing birth rate. Older people and those with children are more likely to

regularly use NHS services. Although Bromley is less deprived that some of our

neighbouring London boroughs there are some areas, particularly in the north of the

borough where there are increased health needs and lower life expectancy.

We commission the following services for our local population.

Hospitals.

Most Community Health Services (such as district and school nursing, health visiting,

specialist child health, therapy services and care for older people).

Some enhanced services provided by primary care.

Rehabilitation.

Urgent and emergency care.

Mental health.

Services to support people with fully funded NHS continuing healthcare (such as

people with learning disabilities or who are physically frail).

From 1 April 2015 we will jointly commission (together with NHS England) GP

general medical services.

NHS England is the organisation responsible for commissioning other primary care services

such as GPs (jointly with the CCG from April 2015), pharmacists, opticians, dentists and

some specialist health services such as neurology, renal services and some cancer

services.

Public Health services, health visiting and from 2015 school nursing are the responsibility of

the London Borough of Bromley.

We are working jointly with our neighbouring CCGs in south east London to lead the

development of a five year strategic plan (Our Healthier South East London Programme) to

deliver high quality, sustainable and improved health care across the area. This work is

clinically driven and brings together commissioners of health and social care, local

authorities and NHS England as well as our trusts and providers of acute mental health,

community services and public health.

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We have also been working in the latter part of the year with our neighbouring South East

London CCGs to jointly commission with NHS England GP services from 2015/16. This will

enable us to take a more integrated approach to improving local health services and secure

greater involvement from local GPs who understand primary care and are committed to

improving its quality. We realise that this will raise conflict of interest issues for individual

GPs so we are putting in place new and transparent arrangements for managing perceived

and actual conflicts of interest in line with recent guidance from NHS England.

The CCG headquarters is based at Beckenham Beacon, Beckenham.

1.1 Our Duties

Under the National Health Service Act 2006, CCGs have a number of powers and duties.

You can find full details of these on NHS England’s website: www.england.nhs.uk

In this annual report, we describe how we have fulfilled our duties and we certify that NHS

Bromley Clinical Commissioning Group has complied with the statutory duties laid down in

the National Health Service Act 2006 (as amended). These duties are set out in our

Constitution which is available on our website and include:

Promote a comprehensive health service

Meet the public sector equality duty

Work in partnership with the London Borough of Bromley to develop joint strategic

needs assessments, joint health and wellbeing strategic and public health services

Secure public involvement

Promote awareness of and act with a view to securing that health services are

provided in a way that promotes awareness of and have regard to the NHS

Constitution

Act effectively, efficiently and economically

Act with a view to securing continuous improvement to the quality of services

Assist and support NHS England in relation to their duty to improve the quality of

primary medical services

Have regard to the need to reduce health inequalities

Promote the involvement of patients, their carers and representatives in decisions

about their healthcare

Promote innovation

Promote research and the use of research

Promote education and training

Promote integration

Obtain appropriate advice from persons who have a broad range of professional

expertise in healthcare and public health

Ensure expenditure does not exceed the aggregate of our allotments for the financial

year

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Ensure our use of resources does not exceed the amount specified by NHS England

for the financial year

Take account of any directions issued by NHS England in respect of specified types

of resource use in a financial year to ensure the group does not exceed an amount

specified by NHS England

Publish an explanation of how we spent any payment in respect of quality

1.2 How we spend your money

Our accounts have been prepared under a Direction issued by the NHS Commissioning

Board under the National Health Service Act 2006 (as amended).

We received £388m in 2014/15 to commission health services for local residents. This

money was spent in the following ways:

Our responsibility is to balance the budget that we have been given and use it to produce

improved health outcomes for Bromley residents.

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7 6 6 Acute - South East London

Acute - Other

Non Acute - Mental Health

Non Acute - Community

Non Acute - Continuing Care

Non Acute - Other

Primary Care - Prescribing

Primary Care - Other

Running Costs

Surplus

Other

NHS Bromley CCG Annual Spend 2014/15 (£millions)

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1.3 Services We Commission

As the leading NHS organisation for Bromley, our mission is to commission services that will

provide longer, healthier and happier lives for our residents.

We commission the following health services in Bromley.

1.3.1 Hospital Care

The majority of hospital services in Bromley are provided by King’s College Hospital NHS

Foundation Trust (King’s) from the Princess Royal University Hospital (PRUH) and

Orpington Hospital. The Orpington Hospital is an orthopaedic centre treating non-urgent

patients from across King’s whole catchment area who need hip or knee replacements as

well as patients requiring upper limb, foot and ankle surgery. King’s acquired the hospitals

in October 2013 and we continue to work closely with them on the development of the

hospital and its services. This year has seen significant challenges at the PRUH,

particularly during winter, to meet the needs of local communities and we have worked very

closely as part of a whole system to ensure the best outcomes possible for patients. You

can read more about some of the additional schemes that have been put in place further in

our report.

We also commission some hospital services from Guy’s and St Thomas’ NHS Foundation

Trust and Lewisham and Greenwich NHS Trust.

1.3.2 Urgent and emergency care

The accident and emergency department at the PRUH is run by King’s. We also

commission two urgent care centres in Bromley. One is based at the Beckenham Beacon in

the north of Bromley and the second at the PRUH. Both are provided by Greenbrook

Healthcare – visit www.greenbrook.nhs.uk.

1.3.3 Rehabilitation services

The vast majority of rehabilitation services are provided by Bromley Healthcare. Bromley

Healthcare is a social enterprise company set up in April 2011.

Lewisham and Greenwich NHS Trust provide community based neuro-rehabilitation services

to Bromley residents.

1.3.4 Community health services

Community health services are largely provided by Bromley Healthcare. Visit

www.bromleyhealthcare.org.uk for more information. Some community services including

anticoagulation, musculoskeletal and audiology are provided by private companies

contracted to the NHS by the CCG.

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1.3.5 Mental health and learning disability services

Mental health services in both hospital and community settings are provided by Oxleas NHS

Foundation Trust – visit www.oxleas.nhs.uk for more information.

1.3.6 Commissioning Support Services

As a relatively small organisation, we commission some of our essential support services

from the South East Commissioning Support Unit (SECSU). This includes acute contracting,

human resources, finance, communications and others. We are required to keep within a

strict resource limit to deliver our function which is £25 per head of the registered population.

This covers our infrastructure and any other commissioning support services we procure.

1.4 Primary Care Services

NHS England commissions primary care services in Bromley, including GPs, dentists,

pharmacists and optometrists as well as some specialist services.

1.4.1 Co-commissioning of primary care services

In 2014, the members of NHS Bromley CCG voted to take responsibility for commissioning

of primary care services on the basis that these were best commissioned locally to meet the

needs of Bromley patients.

In 2015 we will be responsible for jointly commissioning primary care services with NHS

England with the aim of moving to fully devolved commissioning. The scale of ambition of

our members means the CCG, in time, will hold all key contracts to achieve integrated

commissioning of services.

We have developed our arrangements for primary care co-commissioning collaborativelywith

SEL CCGs. . These include a Primary Care Joint Commissioning Committee with lay

members’ representation to manage any perceived conflicts of interest.

This will give the assurance of full probity and transparency around our decision making

process, as well as putting our clinicians in the driving seat to commission the right services

for patients.

1.5 Health and social care working together - Better Care Fund

The London Borough of Bromley serves a population of approximately a third of a million in

partnership with Bromley CCG.

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The Better Care Fund (BCF) is a national initiative to promote integrated care, jointly

investing NHS resources to protect the growth in social care and ensure more people spend

time in the right setting of care.

We have worked closely with the Council over the winter and this joint working has

demonstrated our ability to provide better services in hospital and out of hospital care, which

reduced the number of patients waiting to go home when medically suitably fit.

Subsequently our BCF plans have been signed off by NHS England and are based on good

governance and sound planning.

Towards the end of this year, we will have implemented joint programmes to improve

dementia care in the Borough and agreed to commission a Transformation Programme

which will establish the future model of integrated care in the Borough for the next 5-10

years.

Now that the foundations are laid, and joint initiatives rapidly implemented, we are in a good

position to work with communities and partners to set out this ambitious agenda to meet the

growing demand on health and social care services in Bromley.

The Chief Executive of Bromley Council and our Chief Officer facilitate monthly joint

planning, on the basis of planning for the right model of care for Bromley and the best

interests of patients.

1.6 Public Health

The London Borough of Bromley is responsible for commissioning health improvement and

protection services. We work closely with the Bromley public health team to ensure that we

have population health information and advice to both support and inform our commissioning

decisions. We also work closely with public health commissioners to deliver joint priorities

as set out in the Bromley health and wellbeing strategy and ensure the best health outcomes

for local people.

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2 HEALTH IN BROMLEY

2.1 The Bromley population

Bromley has more older residents than any other London Borough. It also has an increasing

birth rate. This means that health services need to provide for an increasing number of

people. Older people and children are higher users of health and social care services.

Facts about the Bromley population:1

The population of over 320,057 (in 2014) is rising and is predicted to continue to rise

to 332,536 by 2019 and 343,362 by 2024.

The number of live births has increased by 22% in 2012 compared with 2002

The population of older people in Bromley is increasing, the proportion of older

people (65 years and over) is currently 17.7% and is predicted to rise to 18.3% by

2024.

There has been an increase in the proportion of the ethnic minority population from

8.4% in the 2001 Census to 22.6%2 in the 2011 Census. The 2011 Census included

Gypsy/Irish Travellers as an ethnic category with 0.2% of Bromley’s population

stating that they belong to this category.

Significant increase in the proportion of people working in higher professional

occupations.

Increase in the proportion of people who have never worked and the long term

unemployed.

2.2 Health needs

The life expectancy in Bromley has been rising steadily over the last 20 years and the latest

figures (2009-11) show a life expectancy of 80.7 years for men and 84.5 years for women.

This can vary depending on where one lives in Bromley. The infant mortality rate (2 per 1000

live births) is lower than in England as a whole and has been fairly steady over the last few

years.

Facts about health in Bromley:

Heart disease cases have been stable and mortality rates continue to decrease.

1 Taken from the Bromley Joint Strategic Needs Assessment 2 Made up of Black Caribbean, Black African, and other Black communities, Pakistani, Chinese, Bangladeshi, Indian and other Asian Groups.

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Strokes have remained fairly stable but the mortality rate continues to decrease.

Control of hypertension is less effective in Bromley than across London and England.

The prevalence of diabetes continues to rise.

Incidences of all cancers have been rising but mortality has been falling and survival

improving. The most common cancers in Bromley over the last ten years are breast,

prostate, lung and colorectal cancer.

Around 13% of deaths are caused by respiratory disease. Whilst the smoking rate is

lower than the London and England average, smoking is higher in routine and

manual workers.

Mental health problems affect a large proportion of the population with around 158

people per 1,000 aged 16 to 74 years suffering from a mild to moderate disorder

(such as anxiety and/or depression).

In 2012 it was estimated that there were 4,102 people with dementia in Bromley. By

2030 this expected to rise to 6,047.

The teenage pregnancy rate is lower than the London and England rate but

termination rates for this age group are higher.

Sexually transmitted infections (STIs) are significantly lower than the London and

England rates.

The prevalence of HIV is higher in Bromley than across England but lower than the

rates for London. The number of people living with HIV in Bromley increased by 32%

between 2009 and 2013.

Obesity is a risk factor for circulatory disease, cancer and diabetes. Bromley is the

third fattest borough in London, with 65% of the population overweight or obese.

Immunisation rates have been improving but remain lower than the World Health

Organisation’s recommended rates.

This picture of health in Bromley illustrates the need for continued action to address health

inequalities; prevention, identification and good management of long term conditions;

improve immunisation uptake; tackle rising rates of obesity and encourage more people to

give up smoking.

2.3 The Bromley Health and Wellbeing Board

Live an independent, healthy and happy life for longer

Bromley has a Health and Wellbeing Board which was established as part of the 2012 NHS

reforms. The aim of the Bromley Health and Wellbeing Board is to bring together local

commissioners, councillors, representatives of Healthwatch Bromley and other partners to

work towards improving health and developing health services in Bromley.

The Bromley Health and Wellbeing Board is a vital health partnership that encourages close

working together to share expertise, local knowledge and create better health and wellbeing

for the people of Bromley.

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It aims to:

• Ensure stronger democratic legitimacy and involvement

• Strengthen working relationships between health and social care

• Encourage the development of more integrated commissioning of services

The members of Bromley’s Health and Wellbeing Board have a range of different skills,

experience and expertise. Their local knowledge and understanding of the needs of patients

in Bromley help to shape and deliver local commissioning strategies, such as the Bromley

Health and Wellbeing Strategy 2012-2015.

The Bromley Health and Wellbeing Strategy has been jointly developed by the Local

Authority, GPs, NHS representatives and other local health and voluntary organisations.

The strategy sets out how the Bromley Health and Wellbeing Board intends to work with

partners including local residents, voluntary agencies and community groups to reduce

health inequalities and improve the health and wellbeing outcomes of our local community.

This strategy was developed to address the priorities identified from the information in the

Joint Strategic Needs Assessment (JSNA).

The strategic vision for the Health and Wellbeing Strategy is to ‘Live an independent, healthy

and happy life for longer’. It describes nine priorities to be targeted by health and local

authority commissioners working in partnership. These are:

• Diabetes

• Hypertension

• Dementia

• Support for carers

• Children referred to social care

• Obesity

• Anxiety and depression

• Children with mental and emotional health problems

• Children with complex needs and disabilities

These priorities have been determined through consultation with partnership groups across

the health and social care economy in Bromley and feature highly in our commissioning

plans.

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Since 2014 the Health and Wellbeing Board have selected four of the above as key areas of

focus. These are diabetes, dementia, obesity and children with mental and emotional health

problems.

We are working with partners in Bromley to ensure that objectives and aims of the health

and wellbeing strategy align with ours and deliver better health outcomes, a better

experience for patients and better value for money. The Bromley Joint Strategic Needs

Assessment [JSNA] and Health and Wellbeing Strategy are both available on the Bromley

Council website at www.bromley.gov.uk

Bromley CCG’s approach to equality and diversity is demonstrated through our equality

objectives and is an important part of our ambition to reduce inequalities. All new policies

and strategies are subject to an equality impact assessment. More information on equality

and diversity can be found on the Bromley CCG website.

3. OUR VISION FOR BROMLEY

HELPING THE PEOPLE OF BROMLEY LIVE LONGER, HEALTHIER, HAPPIER LIVES

Our priority is to put our patients first and improve health services in Bromley so all their

needs are met. As clinical commissioners we understand what our patients need and can

bring this perspective to shape the commissioning and delivery of healthcare. Working from

the starting point of the health and social care needs of our population in Bromley, as

described by our Joint Strategic Needs Assessment, and our assessment of the current

state of the local health economy, our Vision is;

Better Health: improve health outcomes and reduce health inequalities across Bromley.

Better Care: transform the landscape of healthcare, by developing partnerships, leading to

an integrated healthcare system with improved access and quality.

Better Value: create a sustainable health economy reinforced through collaborative working.

We build on a strong track record of local clinical commissioning and are able to

demonstrate powerful local GP leadership and support, Local Authority engagement and a

clear and credible local Quality, Innovation, Productivity and Prevention Plan (QIPP)3.

Our values support delivery of our vision and strategic programmes and run through

everything that we do:

We prioritise patients in every decision we make

All our developments are reviewed for clinical quality, access and impact on patients.

We listen and learn

3 See section seven for a description and review of our QIPP plan

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We use mechanisms such as our Patient Advisory Group to engage broadly across

the spectrum of potential changes and the priorities of local people, and we engage

with relevant groups on specific interventions.

We are evidence based

All our schemes are tested against national best practice, benchmarking, and where

most innovative a structured pilot period, to ensure the maximum benefit follows

investment.

We are open and transparent

We are committed to being open and transparent in all that we do. Our Governing

Body meets in public and is well attended by local people and partners. We also

hold a question and answer public session prior to these meetings. We strictly

follow guidance on declaration of conflicts of interest.

We are inclusive

We seek out opportunities to engage with hard to reach groups, including settled

gypsy travellers, minority ethnic groups and teenagers.

We strive for improvements

Our outcome ambitions set out a major scale of improvement, which seeks to ensure

that we are better than average for all measures of performance, and in the upper

quartile for many.

3.1 Our Goals

From our vision, we identified three Strategic Goals which provided a more detailed picture

of the changes we expect to achieve over the next three years. These goals are:

Goal 1 – Better Health

Identify and develop programmes to reduce the level of health inequalities in the

more deprived areas of Bromley.

Identify and develop programmes which will systematically demonstrate

improvements in key health outcomes.

Ensure that patients, service users and their carers are at the centre of all decisions

we take around their healthcare, are encouraged to understand and manage their

own condition and have positive experiences of care.

Reduce health inequalities by encouraging people to adopt a healthier lifestyle

through a programme of education and targeted interventions known to work to

increase the control people have over their own health and wellbeing.

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Goal 2 - Better Care

Improve access to and extend choice of services and patients, service users and

their carers ensuring that clinical pathways are fit for purpose and that the services

we commission meet the highest possible quality standards, whilst increasing the

pace of delivery of the quality, innovation, productivity and prevention (QIPP)

challenge.

Empower those people in Bromley with long term conditions, particularly older

people, to exercise control over their own lives and prevent problems arising or

worsening and enabling them to independently manage their own health and well-

being, thus improving their health, outcomes and preventing them dying prematurely.

To strengthen and integrate the infrastructure supporting this cohort of people

ensuring that their health needs are met 24/7 in a planned and structured way.

Goal 3 – Better Value

To work with our local healthcare providers and stakeholders to develop and

implement a clear and sustainable plan to manage the underlying financial position of

the local health economy.

To facilitate the reshaping of provider facilities and resources to reflect the relocation

of services closer to patients and their homes, and to encourage integrated services.

To ensure that quality and performance of services remain paramount through this

process of change.

To create and maintain a sound business framework for the development of local

healthcare services through clinical commissioning.

To undertake a process of education and reform to ensure our provider workforce

has the necessary skills to deliver new and challenging pathways of care.

3.2 Our plans and priority areas

From these broad goals we identified a range of measurable strategic objectives so that we

can demonstrate progress against our plans. These strategic objectives are set out below:

Improve the health and care given to elderly and vulnerable adults in Bromley by

implementing integrated care pathways.

Address the burden of disease caused by reducing the prevalence of the disease

and reducing longer term complications by earlier detection and better management.

Improve outcomes for patients diagnosed with cardiovascular disease, by maximising

management of diagnosis and treatment of patients with medical manageable

conditions.

Improve outcomes for patients diagnosed with respiratory disease.

Improve outcomes for patients diagnosed with mental health problems, including

dementia.

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Improve the safety of maternity services.

Reduce health inequalities across Bromley by working in partnership with the local

authority and others including patients by promoting self-care and management of

their condition.

Improve patient experience by seeking their feedback and engaging on a range of

issues.

Develop pathways to facilitate the achievement of the A&E four hour wait targets.

Develop care pathways to facilitate achievement of return to treatment 18 week

target for admitted and non-admitted patients.

Achieve financial balance.

Design sustainable services for Orpington residents within the framework of

affordability for all Bromley residents.

Develop our people through leadership, training and investment to ensure they have

the capability to commission effectively.

Support provider participation in research and development of new pathways of care.

Promote joint working with the London Borough of Bromley to maximise potential

from joint resources.

Seek engagement with partner commissioners and provider organisations to

maximise potential from joint resources

Implement the care closer to home strategy.

Improve end of life care.

Ensure the delivery of high quality services.

We work to the national objectives for the NHS set out in the NHS Outcomes Framework.

The objectives are grouped into five domains covering:

Preventing people from dying prematurely

Enhancing quality of life for people with long term conditions

Helping people to recover from episodes of ill health or injury

Ensuring that people have a positive experience of care

Treating and caring for people in a safe environment and protecting them from harm

We also work to the areas for improvement in the NHS Mandate and recognise the

expectations of the NHS as laid out in the NHS Constitution.

In 2014/15 we continued to deliver against our priorities that are determined by the local

health needs of our population, identified from the Joint Strategic Needs Assessment (JSNA)

and influenced by the priority areas set out in the Bromley Health and Wellbeing Strategy.

In order for us to achieve our strategic objectives, in 2014/15 our work was broadly focused

on two core programme areas:

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Community Based Care – community care, end of life care, mental health, primary

care, as well as planned care

Urgent Care – emergency medicine, rehabilitation and recovery

We are also working with the other five clinical commissioning groups in South East London

and NHS England on a five year commissioning strategy which aims to improve health,

reduce health inequalities and ensure the provision of health services across south east

London that consistently meet high standards of safety and quality and are sustainable in the

longer term. In South East London we have common health challenges and improvements

that need to be made and working together in this way will help us to be more successful at

tackling them.

3.3 Our Healthier South East London

The six Clinical Commissioning Groups in South East London (Bexley, Bromley, Greenwich,

Lambeth, Lewisham and Southwark) and their co-commissioners from NHS England,

London region, began developing a five year commissioning strategy together in October

2013. Since October 2014, this has been known as Our Healthier South East London.

The strategy aims to improve health, reduce health inequalities and to ensure the provision

of health services across South East London that consistently meet high standards of safety

and quality and are sustainable in the longer term. It focuses on issues for people across

South East London which need collective action to address them successfully or where there

is clear added value from the commissioners working together. Many health challenges in

south east London have been around for a long time. The strategy runs for five years to give

everyone time to think about, agree and make improvements. The priority areas are

community based care, urgent and emergency care, planned care, children and young

people, maternity services and cancer, with mental health care being integral to each area.

We are working in partnership with local councils, health service providers, including

hospitals, hospices, community services, mental health services, and patients, carers and

local people. The strategy is commissioner-led and clinically-driven. It builds on what already

works well and is shaped and developed by the views of all the partners and local

stakeholders – especially patients and local people

Borough-level Joint Strategic Needs Assessments, commissioning plans and Health and

Wellbeing strategies will continue to be produced locally to identify borough-specific issues

and challenges, and to draw up plans to address them.

The programme has undertaken a range of engagement with patients and the public. During

the last year, over 30 people have been recruited to bring patient and public voices into all

the Clinical Leadership Groups and governance groups. They also meet every six weeks as

a single body – the South East London Patient and Public Advisory Group (PPAG) –

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advising the programme on all aspects of public engagement and involvement. PPAG set up

a Reading Panel in August 2014 which supports the programme by ensuring that all

published materials are understandable, jargon free and in plain English.

Further, wider engagement on the draft Case for Change and the emerging thinking has

been undertaken locally. To complement this, a market research survey was commissioned

in summer 2014 and wider engagement events across south east London with voluntary and

stakeholder organisations, patients and local people have taken place. Two deliberative

events for voluntary organisations and other stakeholders took place in June 2014 and

further events based in different boroughs took place in early 2015. Feedback from the

events is published in ‘You Said We Did’ reports, the first of which was published in

November 2014.

We have continued to make good progress on the strategy during 2014/15 and in June 2014

submitted a draft strategy to NHS England for review. This was a national milestone and

enabled NHS England to give the CCGs feedback on the strategy and progress on it. Work

has been continuing since and an update on the programme, including an outline whole

system model, was presented to Governing Bodies in public in January 2015. This is

available on our website in the January Governing Body papers. An updated Case for

Change will be published in the summer of 2015.

The whole system model, which describes how models of care in the six priorities will fit

together, is being refined. Clinical models describing how care might be delivered in the

priority areas are also being refined and checked for outcomes and impacts as well as for

compatibility with CCGs’ operational plans. Plans for future development have been drafted

for 2015/16 and beyond. These will be subject to further wide engagement, working closely

with CCG engagement leads.

Further information on the strategy, including a Plain English Summary, the Case for

Change, an Issues Paper, ‘You Said We Did’ documents and updates are available on the

programme website www.ourhealthiersel.nhs.uk

4. PROGRESS DURING 2014/15

During 2014/15 we have made progress in a number of areas but we know there is still

much to be done to meet the challenges that are faced locally. Our work was broadly

focused on two programme areas Community Based Care – community care, end of life

care, mental health, primary care, as well as planned care and Urgent Care - emergency

medicine, rehabilitation and recovery.

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4.1 Community Based Care

Long term conditions and care for older people focuses on systemic change of the way care

is delivered, integration of services and a proactive and holistic approach to managing

patients. We continue to work with the London Borough of Bromley, Bromley Healthcare, St

Christopher’s Hospice Group, Oxleas NHS Foundation Trust, King’s College Hospital NHS

Foundation Trust (King’s) and our partners in the voluntary sector to look at how we can

jointly commission integrated care. Our shared aim is to commission care services as a

whole that can not only help avoid emergency admissions but will also ensure that people

live a full and healthy life in older age.

4.1.1 Community-Based Care (CBC) strategy

During 2013/4 we began to implement with other CCGs in south east London a Community

Based Care Strategy which set out aspirations for community-based care and help to deliver

some of our priority areas. The CBC Strategy adopted an approach of ‘shared standards,

local delivery’. This means that by working collectively we can do more and also ensure

consistent standards of care across our local communities for all.

In the second year of the programme (2014/15), a number of projects and programmes of

work were successfully delivered. These include:

Community plan for frail and elderly patients over winter, jointly commissioned by the

CCG and the London Borough of Bromley.

Expansion of the Medical Response Service including referrals from the Emergency

Department.

Seven day working across health and social care enabling discharges from the

Princess Royal University Hospital over the weekend.

Fifteen healthcare assistants employed over winter to help people stay well at home.

Expansion of the Age UK service which provides practical support for patients

returning home from hospital – milk in the fridge, a warm home and daily visits if

needed.

Psychiatric Liaison Service – expanded capacity of the service for people in crisis

and children and young people.

Residential and home placements for non-weight bearing patients, for example after

surgery.

Dementia and cognitive impairment – two mental health nurses are now completing

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assessments for patients in residential homes to ensure they are diagnosed with

improved access to secondary care; with a resident psychologist and increased

access to CT scans, as well as sign posting and support for patients.

Lauriston Rehabilitation beds - reduced length of stay, 24 days average, so that

patients return to their home settings with the potential to retain independent living.

Weekend social care assessments - doubled the number of assessments from five to

10 at weekends with more social workers on site at the Princess Royal University

Hospital.

Improved discharge pathway - reduction in the number of patients waiting to go home

from 80 to 50 per day, with further reductions planned to 30.

St Christopher’s award winning service – launch of the partnership model of care to

enable more people to be supported and die in their preferred setting of care.

4.2 Mental Health

Good mental health is of critical importance in ensuring that people maintain good health

and wellbeing. Mental health issues affect one in three people at any one time. The main

focus for us over the past year has been to improve access to services and assessment;

ensuring people have high quality, appropriate and timely responses.

4.2.1 Acute Psychiatric Liaison service

In Bromley there have been recent developments in mental health services, including the

continued development of the acute psychiatric liaison service based in the emergency

department at the Princess Royal University Hospital and on general medical wards. This

ensures there is early intervention and support for patients who may attend the Emergency

Department with a mental health issue or for those on a general wards with a mental health

issue, including Dementia. The service can ensure that people discharged rapidly to a more

appropriate service or be cared for at home.

4.2.2 Memory Services

The Memory Services have also continued to be expanded and have had a particular focus

on supporting primary care (GPs) and Care Homes in identifying people who may benefit

from access to memory services for diagnosis of dementia and support with this condition.

Over the past year, there has been a significant improvement in the diagnosis rate in

Bromley and this is a national priority. In addition, the service has also been working to

ensure that people diagnosed with Dementia are supported to have the required information

to inform advance care planning in line with the NHS Quality Standard for Dementia. This

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ensures that people with dementia, while they have capacity, have the opportunity to discuss

and make decisions, together with their carer/s, about the use of advance statements,

advance decisions to refuse treatment and lasting Power of Attorney.

4.2.3 Working for Wellbeing Service

The Bromley Working for Wellbeing Service has also continued to expand, improving access

to psychological therapies within the community with the aim of moving towards the national

objective of meeting the needs of 15% of those with mild/moderate anxiety and/or

depression. The service has demonstrated improvements in reducing waiting times and

increasing the number of people entering therapy during the year.

4.2.4 Children and Young People

We have worked closely with the London Borough of Bromley to review the mental health

services for Children and Young People, and a new service model came in to operation from

December 2014. The service aims to ensure that children and young people’s needs to

maintain their emotional and mental wellbeing are met at the earliest opportunity, and is

working closely with schools and wider health services to improve the appropriate and timely

response of local services.

4.2.5 Physical Health of People with Serious Mental Illness

A further area of work is improving the physical health of people with serious mental illness.

Both national and local health inequalities data show that people with serious mental health

problems are at risk of premature mortality. Through focussed quality improvement work,

local mental health services are ensuring that people also have their physical health

assessed, with support and advice given as appropriate. This includes an assessment and

advice about areas such as smoking, lifestyle (including exercise, diet, alcohol and drugs),

Body Mass Index, Blood pressure, Glucose regulation and Blood lipids.

Further developments in all of these areas will continue to be the focus in 2015/2016, to

improve access to mental health services in the Borough.

4.3 Planned Care

Our planned care strategic programme focuses on redesigning whole system care pathways

to make sure that good quality care is provided in the right setting by the right person at the

right time. Planned care is the delivery of health services where there is a pre-arranged

appointment and the patient does not require urgent or emergency care.

4.3.1 A new model for providing Diabetes Care

To respond to the significant and growing challenge of caring for people with diabetes

effectively, a new model of integrated diabetes care has been developed which brings

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clinicians from across primary, community and hospital care together to ensure provision of

care closer to home wherever possible.

The model enables more patients to have their diabetes care managed within their own

practice by a GP team wherever possible and supported by their designated specialist

diabetes nurses as required with direct access to specialist advice and support for patients

with complex diabetes care needs.

Bromley Healthcare is working with King’s College Hospital NHS Foundation Trust to deliver

this new model of care and has provided training and education for primary care to ensure

that the workforce has the additional skills to manage a larger proportion of patients with

diabetes.

This work started in early 2014 and has continued through the last year. Currently, 60% of

practices are able to offer this additional service to support patients with diabetes and it is

hoped that this will be expanded across all practices during 2015.

4.3.2 A new model for providing Cardiology care

Bromley has an older population and age is a key factor in the incidence of heart disease. In

order to ensure that Bromley residents with cardiology concerns or conditions are receiving

the right care at the right place, a new integrated model, with the aim of providing high

quality and convenient access to cardiology assessment and treatment has been developed

by clinicians.

The new model provides swift access to a range of diagnostic tests and onward referral to a

consultant cardiologist where necessary. Clinic appointments are available at the

Beckenham Beacon and plans are underway to extend the service to Orpington during 2015.

The aim is for patients to be seen and treated at the same appointment and discharged back

to the GP wherever possible. King’s College Hospital NHS Foundation Trust is planning to

increase the range of services for heart failure, arrhythmias and cardiac rehabilitation to

support Bromley patients.

4.3.3 Anticoagulation Services in the Community

The CCG continues to commission the service from Boots which is available from nine

stores across Bromley. It is an appointment based service available seven days a week and

in the evening at selected stores. Initial appointments are via the GP and subsequently

directly between Boots and the patient. Patient feedback on the service is excellent.

4.3.4 Improving health in Orpington

The Orpington Health and Wellbeing Centre is part of a long term strategic programme to

improve health services in Orpington. The Centre will house a range of primary care,

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community, secondary care and wellbeing services, including Out-Patients, X-Ray and

Ultrasound, all under one roof in an excellent and accessible location.

The objective is to deliver quicker access to diagnosis and treatment, as well as improved

prevention and long term care services for local people.

The former Orpington Police Station site was identified as the preferred location for the

Centre some time ago and this has been subject to a lengthy process of liaison and

negotiation. The site was purchased by Berkeley Homes in 2014 who plan a major

residential development, with the NHS providing the Health and Wellbeing Centre on the

ground and first floors.

Over the past year, our plans for the Centre have been subject to a number of delays

outside our control. These have now been resolved and represent a major milestone for the

project.

Berkeley Homes and NHS Property Services (NHSPS) have agreed “Heads of Terms”

for the Commercial Deal. This provides for NHSPS to purchase a 125 year lease in order

to develop the Health and Wellbeing Centre in the Ground and first floors of the new

development. They will, in turn, offer under leases in the Centre to the clinical service

providers.

The London Borough of Bromley has approved formally the Planning Application, so that

site clearance and ground works, including the demolition of the old Police Station

building, can commence.

We have completed the Outline Business Case and this is now with the NHS England

Executive for review and approval; it is hoped that this process will be completed by

early June 2015.

In the meantime work has now started on the Full Business Case, with a target for

completion of the end of July 2015. The target date for the Full Business Case approval and

Financial Close is October 2015, with services delivery from the new Centre starting in July

2017, following the construction and fitting out of the new building.

4.3.5 GP Direct Access Physiotherapy Service (including Musculoskeletal

Physiotherapy Assessment and Treatment Service MCATS)

The CCG commissioned a GP direct access community based Physiotherapy Service

including access to a range of diagnostic tests (MRI, ultrasound, x-ray and blood tests).

Patients can be seen at a number of clinic locations across the borough.

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MCATS completes the pathway for patients in a community setting and allows treatment in

the community for a more complex group of patients that would otherwise be treated in

hospital.

Patient satisfaction for the service remains very high.

4.3.6 Review of Pathology Services

The CCG is working with King’s at the Princess Royal University Hospital on modernising

the pathology services in Bromley. The service is introducing electronic requesting and

reporting across all GP practices in Bromley.

4.3.7 Review of Patient Transport Services

We have worked with King’s to introduce clear criteria for accessing Patient Transport

Services. The service is to supply non-emergency transport for eligible patients (who are

medically unfit and registered with a Bromley GP) 24 hours a day, 7 days a week, 365 days

a year. The agreement covers patients requiring either a car or ambulance (both inwards

and outwards) to hospitals, health centres, nursing homes, hospices, satellite units and other

locations as determined by the trust.

4.3.8 Review of Urology Services

The CCG is working with King’s to consider the optimum pathway for urology services in

Bromley. The aim is to develop a single point of access and for patients to be seen on a

one-stop basis wherever possible. The service is now available at Beckenham Beacon with

access to on-site diagnostics.

4.3.9 Review of Maternity Services

We continue to work with the London Maternity Strategic Clinical Network and key

stakeholders to ensure best practice. We work with, support and commission a Maternity

Services Liaison Committee which is a forum for maternity service users, providers and

commissioners of maternity services to come together to design services that meet the

needs of local women, parents and families. In 2014/15, Dr Sally Carson, a Bromley GP

was appointed as the CCG Maternity Lead.

Specific areas of focus during 2014/15 include:

Increase the proportion of women delivering in midwife led settings.

Development of a minimum dataset for early access to maternity services with

measurable/auditable standards.

Reduction in postpartum haemorrhage.

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Reduction in still births.

Review of the Tongue Tie service.

Increase breast feeding support.

4.3.10 Community Ophthalmology Service Review

During 2014/15, we undertook a review of the current service provision delivered by

opticians. We are looking to increase provision, to improve access for patients and to

avoid unnecessary visits to hospital.

4.4 Children and young people

Our focus for Children and Young People’s Services (CYPS) includes prevention, early

intervention and safeguarding. We recognise the importance of a whole family approach to

providing care and we continue to work closely with London Borough of Bromley to address

the health and social needs of children and young people together. With the increased birth

rate in Bromley over the last ten years, demand for services is increasing.

During the last year we have continued work on the Special Educational Needs and

Disability (SEND) pathfinder to develop personal health, care and educational packages for

children with learning disabilities. This has been a collaboration with Bromley Council

planning service delivery, implementing clear processes and guidance for young people,

parents and carers as part of the SEND reform.

We have implemented the Bromley Local Offer available on our website at

http://www.bromleyccg.nhs.uk/About-

us/Children%20and%20Young%20People/Pages/default.aspx

The purpose of the local offer is to allow parents of children and young people with special

educational needs and disabled young people themselves, to clearly see what services are

available in Bromley and how they can access them. It includes provision from birth to 25

years across education, health and social care. It is being developed with children and

young people, parents and carers and local services which include pre-school provision,

schools, colleges, health and social care agencies.

We continue to develop future plans for the joint commissioning of services, involving

parents and young people in the planning and future provision of services and also working

with them to understand the current provision of information advice and support to see how

this can be suited to meet their needs.

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Together with Bromley Council, we have developed processes for assessment planning and

Education Healthcare plans and identifying services which could be provided through

personal budgets to implement in line with national timeframes.

In addition we are members of the Bromley Safeguarding Children Board, a multi-agency

partnership with responsibility for improving outcomes for children and holding all

organisations to account for their safeguarding arrangements. You can read more in section

12.

4.5 Primary Care

Primary care refers to services provided by GP practices, dental practices, community

pharmacies and optometrists. About 90% of the contacts with the NHS are made through

primary care services.

Primary care and in particular GP practices play a pivotal role in delivering and supporting

healthcare system reform within Bromley.

During 2014/15 we worked closely with our member practices and CCGs across South East

London, to develop federated working, in preparation for co-commissioning in 2015/16.

We commissioned three pilots, which started in October 2014, to support collaborative

working across primary care. Two of the pilots funded practices to employ a shared Health

Care Assistant to review and offer additional support to their frail elderly and vulnerable

patients. The third pilot has enabled a group of practices to work collaboratively to follow up

patients who have attended A&E to ensure that they have the right support to reduce further

hospital attendances.

We are currently working with Healthwatch, Local Medical Committee (LMC), Local

Pharmaceutical Committee (LPC), and Local Optical Committee (LOC) representatives to

review the range of services delivered in primary care that are commissioned by the CCG.

The aim of this review is to ensure that all services commissioned from primary care are high

quality, offer value for money, and support our strategic vision.

In addition to projects to support collaborative working, we have commissioned a number of

local improvement schemes aimed to enhance patient experience, and to support patients to

be managed out of hospital.

We commissioned an additional 6,327 appointments from General Practice to

increase primary care access over winter.

We increased access to GPs for patients who are residents in extra care housing

units through commissioning support from a visiting medical officer.

The choose and book improvement scheme means that more patients in Bromley are

now able to manage their referrals on line, including choosing where they receive

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treatment. In February 2015, Bromley was the second highest user of choose and

book in London.

4.6 Prescribing and Medicines Management

Our Prescribing and Medicines Management Plan aims to optimise the use of medicines in

primary care, in terms of quality, safety, clinical and cost effectiveness. As people live

longer, more patients will self-manage their condition in the community, this means that

more people will be on more medicines. Our overall aim is to support patients to get the

best from their medicines.

This involves working at a number of different levels, from patient, GP practice and CCG

level, to the wider south east London health economy.

4.6.1 Medicines optimisation – patient, practice, care homes

All Bromley GP practices were visited during the year with a practice-specific prescribing

report. This highlighted areas in the Medicines Management (MM) QIPP plan, as well as

areas relevant for the individual practices. Actions for practices were identified and the

Medicines Management Team worked with practices to support implementation.

A number of local prescribing guidelines have been developed in consultation with GPs,

consultants, patients and other stakeholders covering areas such as vitamin D, glucose

blood testing, gluten-free and oral nutrition prescribing. These guidelines support better

quality and cost-effective prescribing and management.

A Prescribing Incentive Scheme was developed for GP practices focussing on:

Safety and quality – an audit on prescribing for heart failure

Supporting patients to get the best from their medicines

Prescribing indicators – key areas from the MM QIPP plan.

Individual clinical medication reviews for care home residents were undertaken by a

pharmacist, supported by further technical reviews by technicians. Training on safer

handling of medicines has been provided to individual care homes and sessions for carers.

A dietician has also been working as part of the team to improve the treatment of

malnutrition, reviewing individual patients and updating guidelines.

4.6.2 Medicines in care pathways

A quality framework has been applied for all new projects or services. This included key

elements of medicines management which must be considered, encompassing quality,

safety and financial aspects.

Medicines management input has been required at all stages of service redesign, from

tendering, procurement and mobilisation, to monitoring and review. This has ensured safe

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and effective prescribing and medicines management as an integral part of commissioned

services.

4.6.3 Medicines management across the south east London health economy

The six south east London Clinical Commissioning Groups (CCGs) established an Area

Prescribing Committee. All six CCGs, three hospital Trusts and two mental health Trusts are

members. The committee aims to provide a collective clinical leadership to ensure co-

operation and consistency of approach to medicines optimisation across South East London,

ensuring that patients have safe and consistent access to medicines with the best outcomes.

The New Drugs Panel is a working group of the APC which meets monthly to assess new

medicines for prescribing within South East London where these are intended to be

prescribed in primary care or commissioned by Clinical Commissioning Groups.

Areas which have been worked on jointly during 2014/15 include gastroenterology,

cardiovascular, diabetes and various neurological conditions.

4.7 Urgent care

The aim of the unscheduled care strategic programme is to pre-empt attendances to A&E,

emergency admissions and readmissions and lengthy hospital stays by ensuring there are

improved and joined up services in place to care for patients before admission to hospital

becomes necessary or following their discharge from hospital. In order to achieve these

changes, we have worked with providers to reconfigure and develop services to maximise

the benefits for our population.

Main areas of work during 2014/15 were:

Development of a health and social care winter resilience plan and the procurement

of additional health and social care services to deliver the plan

Procurement of the Urgent Care Centre at Beckenham Beacon.

A campaign to raise awareness of the range of health services in Bromley and

encourage people to only use accident and emergency services (A&E) in life

threatening situations.

The development of a strategic vision to deliver integrated out of hospital care to

respond to local health and social care needs

4.7.1 Winter Resilience Plan

Working with local health and social care partners we launched our Winter Resilience plan in

September 2014. A wide range of new services were commissioned to support this plan,

including:

In the hospital: an Ambulatory Care Unit open 9.00 – 17.00, seven days a week, a Clinical

Decision Unit open 24 hours 7 days a week, the extension of pharmacy opening hours; three

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more paediatric beds; additional doctors in the Emergency Department as well as surgical

and medical teams on the wards.

In the community: an expansion to Bromley Healthcare’s Medical Response Team and

Home Pathway Rehabilitation Team so that up to 11 more people a day can access these

services; an expansion to the St Christopher’s’ “End of Life Care” service, so that more

people are able to die in the place of their choosing and an expansion to the mental health

liaison service so that people with urgent mental health needs, who come to the Emergency

Department, will be supported quickly.

4.7.2 NHS 111

NHS 111 continues to provide Bromley residents with a 24/7 service and makes it easier for

patients to access local NHS services if they urgently need medical help or advice but it is

not a life-threatening situation.

4.7.3 London Ambulance Alternative Care Pathways

The London Ambulance Trust have developed and implemented a number of alternative

care pathways with the Medical Response Team and the urgent care centres. These

pathways are helping local people, where clinically safe, to resolve their emergencies within

their own homes.

4.7.4 Increasing social care support

A new service was launched in December 2014 to support people living in extra shelter

housing units. This includes the services of a visiting medical officer who works with tenants,

their general practice and the housing unit managers, to provide additional medical help,

treatment and advice.

Additional funding has been made available to support people leaving hospital, who require

either assistance to settle into their home or with their personal care needs. The personal

care is typically provided in people’s own homes, but from time to time a patient is unable to

return home immediately, therefore short term residential support has also been made

available. Typically over 200 people a month are supported by this additional service.

4.7.5 Transfer of Care

In July 2014 the Transfer of Care project was launched. This project has enabled local

health and social care organisations to redesign the way people transfer from hospital back

into the community. As a result it has become easier for hospital staff to restart social care

packages; a larger equipment store has been developed at the hospital so that patients have

the equipment they need when they are discharged and the stroke and palliative care

pathway have improved.

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4.7.6 Reducing pressure on local A&E departments

A new service to support people living in extra shelter housing units was launched in

January 2015. This included the services of a visiting medical officer, working with tenants

and the housing unit managers, who provided additional medical help and treatment.

In October 2014 we launched our ‘Don’t just go to A&E’ winter campaign for the second year

to raise awareness of the range of health services in Bromley and encourage people to only

use Accident and Emergency (A&E) departments in life threatening situations.

Eye-catching, seven-foot tall yellow figures took over Bromley High Street for the day and

also appeared on bus advertising and in health centres and other public buildings across the

borough. They highlighted quicker and easier local alternatives to A&E where people can get

expert advice and treatment including: self-care at home, pharmacies, their GP and urgent

care centres. Neighbouring CCGs also ran the campaign increasing opportunities for

recognition and impact of the visuals and messages as people travel in and around local

areas.

An evaluation of the campaign’s impact across the CCGs took place in January 2015. The

findings showed:

Thirty eight percent of all of those surveyed from boroughs that ran the campaign

recognise the ‘Don’t just go to A&E’ materials when prompted.

Of those that recognised the campaign, nearly half recall posters while over one third

recall bus ads.

There is evidence that the experience of campaign materials impacts on individuals’

understanding and awareness of healthcare services. Those who have seen the

campaign materials are more likely to agree that they have a good understanding of

what A&E is and isn’t for than those who have not seen the materials.

The core messages of the campaign translate well, with the majority understanding

that A&E is not always the most appropriate place to go in the event of an accident or

illness.

Impacts of the campaign are also encouraging, with nearly half of responses made

up of ‘Will make me think more in the future about where the right place to get care

is’, ‘Will mean I can advise others better on where to go when they are ill’ and ‘Will

make me try other health services when it is more appropriate than A&E’.

4.7.7 Urgent care services at the Princess Royal University Hospital and

Beckenham Beacon

The urgent care centres at both Princess Royal University Hospital, a 24 hour, 7 day service

and Beckenham Beacon continue to offer local people with fast access to urgent care.

In 2014, following a successful procurement, Greenbrook Healthcare was awarded the

contract to operate the Urgent Care Centre at the Beckenham Beacon. This service

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operates between 8.00 and 20.00, seven days a week and also sees patients who need to

see an out of hours GP. Greenbrook Healthcare is working with local health partners,

including the London Ambulance trust, to provide a comprehensive urgent care service at

the Princess Royal University Hospital.

4.7.8 Plans for the Future

Together with partners in local health and social care organisations, we have initiated the

design of a five year integrated model of out-of-hospital care. This will shape the design and

implementation of integrated information systems as well as the development and delivery of

integrated service specifications and operational processes.

We will continue to oversee the performance of local providers and reduce the waiting times

for planned and urgent care and, through the Transfer of Care project and ensure patients

are discharged from hospital with the minimum of delay.

5 LOOKING TO THE FUTURE

Our integrated commissioning plan for 2014 – 2019 is available on the CCG website. It

includes our five year strategic plan which informs our operating plan and our Quality,

Innovation, Productivity and Prevention (QIPP) plans. Our local plans are also informing the

Our Healthier South East London five year strategy (see section 3.3).

The intention of our plan is to develop our services to:

Prevent people from dying prematurely

Ensure people with long term conditions get the best possible quality of life

Ensure patients are able to recover quickly and successfully from episodes of ill

health or injury

Ensure patients have a great experience of all their care

Ensure patients in our care are kept safe and protected from avoidable harm

Our two year operating plan is structured around five areas:

Financial performance within constrained funds

Ambitions for improving outcomes – achieving the seven key national outcomes (see

below).

NHS Constitution measures

Activity (elective, non-elective, outpatients, A&E and referrals)

Better care fund

The seven key outcome ambitions are:

Secure additional years of life for people with treatable mental and physical

conditions.

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Improve the health related quality of life of people with long term conditions.

Reduce the amount of time people spend avoidably in hospital through better and

more integrated care in the community outside of hospital.

Increase the proportion of older people living independently at home following

discharge from hospital.

Increase the number of people having a positive experience of hospital care.

Increase the number of people with mental and physical health conditions having a

positive experience of care outside hospital in general practice and in the community.

Make significant progress towards eliminating avoidable deaths in hospitals caused

by problems in care.

We will be monitored on our delivery against all these key measures through a quarterly

review process with NHS England.

In order to operate within our financial allocation we must make sensible efficiencies in

2014/15 and beyond. However, we have received additional funding to counter the historical

underfunding in the Borough.

5.1 Whole system transformation

Our focus for 2015/16 is to build on the individual initiatives of 2014/15 and facilitate whole

system transformation of health and social care.

The local health and social care economy faces a number of significant challenges in

relation to national performance agreements for patient outcomes. These should be read as

indicative of our challenges and not solely definitive of the whole system transformation

issues we wish to address.

Excellent clinical practice and leadership are evident within all providers, but this is often in

spite of the constraints of the current system rather than because of it. The challenges are

exacerbated by three unilateral contracting models, based on partnership working with our

main providers that inhibit a more alliance based approach to commissioning and provision,

such as preventing avoidable hospital admissions and discharge from hospital.

Together with the London Borough of Bromley and our partners, we have proactively been

working on a clinically led whole system Transformation Programme since October 2014;

including the procurement of a credible provider to support the local system and

stakeholders in developing an Out of Hospital strategy which will improve outcomes for

patients.

We will continue with our transformation journey by building on our strengths. Bromley has

a strong sense of place; a clear vision within our Health and Wellbeing Strategy and a

commitment to patient and stakeholder engagement.

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The programme will address our local challenges:

Developing networks of care to provide consistent and coordinated care for all patients.

Supporting the development of Primary Care through co-commissioning.

Ensuring people are able to die in their preferred setting of care.

Improved outcomes in key disease areas such as cardiovascular disease,

diabetes and dementia.

There is also a significant portfolio of work, with some 28 initiatives at present that will be

part of future networks of care:

Rapid improvement in dementia care in care homes.

Redesign of elective care pathways – MSK, diabetes, gynaecology.

Commitment to improving peri-natal care.

An integrated health and social care approach to enabling discharge from

hospital.

Award winning end of life care services.

King’s has worked hard to improve quality of care at the PRUH and there have

been many excellent improvements, such as within the hyper acute stroke unit

and the improved recruitment of a wide range of clinical staff.

We have invested in additional capacity to help bring waiting lists down for Bromley

patients and to manage the extra demand that winter brings. This has enabled local

health and social care organisations to increase the supply and range of services

available to patients.

5.2 Out of Hospital Strategy

The programme will develop an Out of Hospital strategy and model of care, complete with

service specifications, for the next five to ten years. Together with the London Borough of

Bromley we have developed appropriate governance and engagement structures to deliver

the programme.

Exec Leaders Group (ELG): The clinically led group chaired by our Chair, Dr Andrew

Parson was formed in November 2014 to facilitate strategic leadership and integrated

planning to deal with immediate challenges in the economy, as well as facilitate the

development of a five to ten year strategic vision for integrated care. The group

produced the ‘One truth’ paper with agreement on the key challenges faced by the

system.

Local Programme Delivery Boards: We have recently reconfigured our transformation

programmes. Future Boards will have multi-disciplinary clinical and stakeholder

involvement to deliver the outcomes of the Transformation Programme through the

Urgent Care Board and Community Based Care Board.

South East London Strategy (SEL): Governing Body members and Patient Advisory

Group members are fully active in the SEL Strategy Programme that will ensure local

developments are connected and inform the broader SEL work.

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Integrated health and social care: Together with the London Borough of Bromley

(LBB), we have aligned commissioning and contracting strategies, which has led to

LBB exploring the integration of social care staff within Bromley Healthcare.

5.2.1 Priorities

The programme will be developed with clinical and stakeholder engagement over the

summer of 2015. This will include a shared vision for future services that meet the needs of

our population and a case for change for future service specifications. The strategy will need

to deliver a balanced financial plan and also develop specifications for key services

including:

1. Networks of integrated local care including community, end of life care, mental health,

primary care, social care and the voluntary sector.

2. To redesign the rehabilitation pathway to meet the needs of patients leaving hospital and

also to ensure more rehabilitation can take place at home.

3. Development of prevention and practical support services that promote independent

living and wellbeing.

Networks

As part of this we will develop new initiatives:

Primary care transformation that will lead to a Primary Care Offer to practices for consistent

high quality care for all patients, for example improved access to diagnostics, referral

support to improve patient experience in care pathways and moving towards 8 to 8 access.

Mental health provision including a new model of psychological therapies for all and targeted

to the needs of our elderly patients who may have different views on accessing mental

health support compared to other populations.

There are exciting new developments planned to support patients with cognitive impairment

and dementia – including a NICE compliant care pathway offering all the diagnostics and

therapies required. Further support will be provided to care homes and primary care to

ensure early intervention.

End of life care – the development of our end of life care pathway with St Christopher’s

Hospice and partners which will enable more patients to die in their preferred setting of care.

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Rehabilitation

In 2015-16, we aim to transform our rehabilitation pathway, learning from the challenges we

have faced so far.

More patients will be able to leave hospital earlier with innovation in medical practice. Whilst

we have a large number of medical beds in the Princess Royal University Hospital (PRUH)

(400) and community rehab beds, hospital is not the right place for elderly and frail people

and we hope for them to return home sooner in their recovery.

We will continue to commission our ambulatory care unit and clinical decision making unit at

the PRUH with consultants available 16 hours per day in A&E, which is a London standard.

To support this community nursing, physiotherapy and occupational therapies will continue

to be developed including our medical response team to offer urgent care for patients as an

alternative to hospital

Prevention and practical support

We need to achieve a revolution in home care to deliver this vision of our patients returning

home earlier and being supported to live independently.

There are significant pressures on care homes in the Borough, as whilst we have the most in

London, (over 60 homes), we also have the highest number of people over 75.

Through the Better Care Fund we will be working closely with the London Borough of

Bromley to provide more practical support alongside social care so that we enable patients

to receive their rehabilitation at home and also prevent readmissions to hospital within 30

days – a quarter of which are preventable.

6 WORKING IN PARTNERSHIP

We believe that health within Bromley can only be improved through effective working with

our local partners and by fully engaging clinicians to work with local communities and

patients to design services for the future. Our key partners include local people and patients,

GP members, independent contractors, King’s College Hospital NHS Foundation Trust,

Bromley Healthcare, Oxleas NHS Foundation Trust, the London Borough of Bromley,

Healthwatch Bromley and the voluntary sector. We continue to work closely with our

neighbouring CCGs in south east London to deliver a five year strategy to focus on priority

health issues for people across south east London which need collective action to address

them successfully.

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We have a number of ways in which we engage and involve stakeholders and local people

in our plans. We use these to seek feedback from local people and use what they tell us to

ensure that decisions we make about healthcare are underpinned by a clear understanding

of public views, concerns and aspirations. Knowing what people think about existing health

services in Bromley is also vital to helping us improve patient experience in the future.

We understand the importance and huge benefits of listening to the public and then acting

on what they tell us. Our quarterly stakeholder bulletin is widely circulated and published on

our website and informs the public and our partners about how we have acted on what they

have told us. It uses a ‘you said we did’ approach and some of the examples over the last

year include:

You should encourage more self-care in the

local community

We have trained our staff and will run an

expert patient programme for people with

long term conditions.

Having a walk in centre and urgent care

centre at the hospital is too confusing. We

want straight forward access to safe urgent

care, seven days a week

We developed a model for a service that will

make accessing urgent care simpler. It will

be one centre with all the benefits of the

current services plus after hours X-ray

Introduce a heart failure patient support

group

We are working with King’s to introduce a

support group in 2015

We want more support to help keep the

people we care for out of hospital

We are providing more practical healthcare

skills for carers.

We want to be healthy and independent into

our later years

We are offering free training to develop skills,

get new insights and form better links with

people in similar situations

6.1 Patient Advisory Group

Our Patient Advisory Group (PAG) established in 2013 continues to flourish. All local people

are welcome to join and can become involved as much or as little as they wish. We involve

our PAG members in a range of ways including on-line surveys and participation in focus

groups and meetings. In addition we work with local groups and the voluntary sector to seek

the views of a wider group of people including seldom heard groups. To be part of our PAG,

please email: patient.query@bromleyccg.nhs.uk or call 01689 866 643.

You said We did

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6.2 Engaging with local people

Talking to our patients about the health services available in a broad range of community

settings is an important part of our on-going work to keep people out of hospital wherever

possible and provide treatment closer to home – ensuring services stay safe and

sustainable. Over the last year we have engaged local people in the following ways:

Service changes, for example from September 2014 we reduced the number of

gluten free foods available on prescription. This decision was made after consultation

with a number of patient representatives, most of whom had intolerances

themselves, to gain their feedback on the potential changes.

Targeted engagement, for example, we are reviewing services commissioned for

children and young people and asked our PAG for feedback, by completing a survey

on what they think currently works well and not so well. This will then influence our

commissioning intentions.

Procurement of services, for example we involved our PAG in the procurement of

some services. Members are not only asked their opinion on a potential new service

or service re-design, they are offered the opportunity to sit on the panel that selects

the provider. This process involves training in the procurement process and how to

evaluate bidders.

We also engage with a wide range of people and communities, some of which are

considered harder to reach. We have worked with Bromley Council to provide talks on

areas some of these groups have asked us about such as diabetes and mental health. We

have also talked with them about the CCG in general and how they can get involved in

helping us to make decisions for patients.

We have Bromley patient and public representatives on the Clinical Leadership Groups for

the South East London five year strategy (Our Healthier South East London). This

programme is being shaped by the Clinical Leadership Groups which are focused on the

following priority areas: community based care, planned care, urgent and emergency care,

maternity, children and young people and cancer.

Most of our GP member practices have a Patient Participation Group (PPG). This provides

an opportunity for patients to get more involved in their local practice and influence the way

services are provided. Please speak to your local practice if you are interested in joining

your PPG.

Our Quality Assurance Subcommittee monitors feedback from the engagement activity that

both we and our local healthcare providers have carried out as part of the watch it keeps on

the quality and safety of local health services. We also work closely with Healthwatch

Bromley ensuring that feedback they receive via their Patient Opinion service and their

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engagement activity is also fed into our Quality Assurance process. A representative from

Healthwatch Bromley attends this committee.

6.3 Learning through complaints and the Patient Advice and

Liaison Service (PALS)

We review all complaints received by the CCG every six months with an exception report

going to the Quality Assurance Sub-Committee as required on any emergent themes; these

are mapped to engagement feedback and cross referenced with information received from

local GPs via our Quality Alerts feedback process. We also work with Healthwatch Bromley

to identify any known areas of concern so we can highlight emerging issues with local

services. See section four of the Members’ Report for a report on the complaints received

by us over the last year.

A number of NHS healthcare providers in Bromley offer a patient advice and liaison service,

generally referred to as PALS. They deal with concerns informally and are not part of the

formal NHS complaints process. PALS can also give patients and staff more information

about the complaints procedure and the Independent Complaints Advocacy Service (ICAS).

More information is available on our website www.bromleyccg.nhs.uk

6.4 Health Overview and Scrutiny

We have good relationships with the Bromley Health Overview and Scrutiny Committee

which engages Bromley’s democratically elected members in the local implementation of

national NHS reforms and in plans and proposals for service changes.

6.5 Stakeholder Reference Group

We are part of the South East London wide Stakeholder Reference Group (SRG). The

group meets four times a year and has an independent chair. Its purpose is to:

We would like enthusiastic local people to join our patient advisory group and get

involved by giving their patient feedback to make a real difference to Bromley NHS

services. You can have your say on a wide range of health topics and be involved as

little or as much as you want. Your involvement could mean answering an online

survey or perhaps attending a focus group. How much you contribute is entirely up to

you.

To be part of our patient advisory group, please email

patient.query@bromleyccg.nhs.uk or call 01689 866 645

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Consider how best to engage patients, public and local authorities in major changes

in health services that will impact on more than one CCG.

Provide independent and objective assessment and advice to the CCGs regarding

patient and public engagement in sector wide change programmes.

Advise organisations proposing changes how patients and public can be engaged in

assessing the impact of their proposals on patient choice.

Advise how the diversity of the population is recognised and engagement is

responsive to the needs of the different communities in South East London.

Enable institutions with potentially far reaching ideas about their future but which are

not yet ready to publish firm proposals, to brief a wide range of organisations on

emerging thinking.

Members of the SRG are very experienced in and committed to making sure that patients

and public have every opportunity to engage with proposals for changes in health and

related series in South East London.

7 PERFORMANCE AND QUALITY REVIEW

7.1 Quality, Innovation, Productivity and Prevention (QIPP)

The Quality, Innovation, Productivity and Prevention (QIPP) programme is all about ensuring

that each pound spent is used to bring maximum benefit and quality of care to patients.

QIPP is a large scale transformational programme for the NHS, involving all NHS staff,

clinicians, patients and the voluntary sector. It will improve the quality of care the NHS

delivers whilst making up to £20 billion of efficiency savings by 2014/15, which will be

reinvested in frontline care. We had a QIPP plan to save £12.08m in 2014/15.

Details of the plan including; scheme descriptions and values are shown on the next page.

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Programme SchemeQIPP Plan

£000s

*QIPP Actual

£000s

Contractual Acute Efficiencies 1125 1125

Contractual Investment Slippage - Current QIPP Schemes 0 800

Contractual Lucentis Tariff Implementation 300 300

Contractual Overseas Visitors Allocation Reserve 0 750

Contractual Renegotiated CSU Contract 0 100

Contractual Teatment Access Policy Review & Implementation 375 375

Long Term Conditions Long Term Conditions - End of Life Care 935 734

Long Term Conditions Long Term Conditions - Falls 699 236

Long Term Conditions Long Term Conditions - Integrated Care Teams 1200 590

Long Term Conditions Reduce UTI Admissions to Acute 217 280

Mental Health Mental Health Inpatient Beds 1364 1364

Planned Care Cardiology Pathways - Service 245 833

Planned Care Care Pathway Redesign - Dermatology 188 0

Planned Care Care Pathway Redesign - Ear, Nose & Throat 188 0

Planned Care Care Pathway Redesign - Gynaecology 188 0

Planned Care Care Pathway Redesign - MSK 75 0

Planned Care Care Pathway Redesign - Urology 188 0

Planned Care Diabetes in Primary Care 323 317

Planned Care Patient Transport Management (BBG) Management 300 300

Planned Care Phlebotomy 0 0

Planned Care Referral Management 750 750

Primary Care Local Enhanced Schemes 48 48

Primary Care Prescribing efficiency 1425 1425

Unscheduled Care Beckenham UCC 0 0

Unscheduled Care End of Life Care Packages 105 105

Unscheduled Care Step Down 356 102

Unscheduled Care Step Up 750 417

Unscheduled Care Urgent Care Centre (PRUH) increased throughput 668 652

12,008 11,601

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7.2 Performance

The following table summarises performance against key NHS Constitution measures and

National Outcome indicators in 2014/15:

Indicator Description Target Quarte

r 1

Quarte

r 2

Quarte

r 3

Quarte

r 4

Referral to Treatment - admitted Percentage of patients admitted for treatment

following a referral within 18 weeks 90% 79.0% 72.6%

78.00

% 77.1%

Referral to Treatment - non-admitted Percentage of outpatients receiving treatment

following a referral within 18 weeks 95% 95.8% 94.9% 95.5% 95.3%

Referral to Treatment - incomplete

Pathways

Percentage of patients whose pathway has not yet

completed within 18 weeks 92% 91.8% 91.5% 92.1% 91.1%

Diagnostic test waits Percentage of patients waiting 6 weeks or more for a

diagnostic test <1% 5.8% 8.3% 12.4% 8.6%

Number of patients waiting longer than

52 weeks

Number of patients who have waited longer than 52

weeks for treatment 0 11 5 1 1

A&E waits – Kings College Percentage of patients who spent 4 hours or less in

A&E 95% 88.9% 90.8% 88.4% 86.1%

A&E waits – Guys & St Thomas’ Percentage of patients who spent 4 hours or less in

A&E 95% 96.8% 96.3% 95.4% 94.6%

A&E waits – Lewisham & Greenwich Percentage of patients who spent 4 hours or less in

A&E 95% 88.2% 88.5% 86.6% 82.7%

Incidence of healthcare associated

infection – MRSA

Number of reported MRSA cases attributable to the

CCG 0 0 1 2 1

Incidence of healthcare associated

infection – C-difficile

Number of reported C-difficile cases attributable to

the CCG 64 24 23 21 22

Ambulance calls – category A – 8 min

response (Red 1)

Percentage of category A (Red 1) calls responded to

within 8 minutes 75% 73.4% 67.1% 62.4% 67.7%

Ambulance calls – category A – 8 min

response (Red 2)

Percentage of category A (Red 2) calls responded to

within 8 minutes 75% 68.0% 58.9% 53.1% 59.8%

Ambulance calls – category A – 19 min

response

Percentage of category A calls responded to within

19 minutes 95% 95.6% 92.6% 88.4% 92.0%

Breaches of same sex accommodation Number of breaches of same sex accommodation 0 1 2 2 1

Cancer 2 week wait – urgent GP

referred

Percentage of patients seen within 2 weeks of an

urgent GP referral for suspected cancer or breast

symptoms

93% 84.4% 92.1% 92.6% 93.0%

Cancer 2 week wait – urgent Breast

Symptoms

Percentage of patients seen within 2 weeks of an

urgent GP referral for breast symptoms (cancer not

initially suspected)

93% 80.5% 96.4% 97.3% 91.7%

Cancer 31 day wait – first definitive

treatment

Percentage of patients receiving first definitive

treatment within one month (31 days) of a cancer 96% 95.7% 96.3% 98.3% 97.8%

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diagnosis

Cancer 31 day wait – surgery Percentage of patients subsequent treatment

(surgery) within one month (31 days) 94% 95.7% 96.3% 92.4% 95.9%

Cancer 31 day wait – drug Percentage of patients subsequent treatment (drug)

within one month (31 days) 98% 99.4%

100.0

% 99.5% 99.4%

Cancer 31 day wait – radiotherapy Percentage of patients subsequent treatment

(radiotherapy) within one month (31 days) 94% 96.0% 97.9% 98.2% 96.3%

Cancer 62 day wait – GP referral

Percentage of patients receiving first definitive

treatment for cancer within two months (62 days) of

an urgent GP referral for suspected cancer

85% 79.8% 76.1% 81.7% 84.4%

Cancer 62 day wait – screening referral

Percentage of patients receiving first definitive

treatment for cancer within two months (62 days) of

a referral from an NHS Cancer Screening Services

90% 100.0

%

100.0

% 97.3% 90.7%

Proportion of people under mental health

illness specialties on Care Programme

Approach who were followed up with 7

days of discharge from psychiatric

inpatient care

Proportion of those patients on Care Programme

Approach discharged from inpatient care who are

followed up within seven days

90% 97.7% 98.1% 97.9% 97.9%

Note: Some quarter 4 figures are estimated as final year end data will not be available for all indicators until June

2014

7.2.1 Areas of Concern

The target of 18 weeks for Referral to Treatment (RTT) for admitted patients was missed

with average performance during 2014/15 at 76.7% compared with a target of 90%. This

was a planned failure due to the national initiative to reduce the number of long waiting

patients. Plans are now in place to ensure that our local provider, King’s College Hospital

NHS Foundation Trust (King’s), deliver this standard from the end of quarter one in 2015/16.

Diagnostics waits have been a major area of concern for us in 2014/15 with our performance

deteriorating over the year. The main reason for the breach of this target was capacity

problems at the Princess Royal University Hospital (PRUH) site. The main areas affected

were non obstetric ultrasounds, MRIs, cystoscopies and endoscopies. We are working with

King’s to ensure appropriate actions are in place to recover performance against this target

in 2015/16.

The number of patients waiting more than 52 weeks for inpatient treatment is higher than we

would like, however performance is much improved compared with previous years. At the

time of writing this report we have one patient waiting longer than 52 weeks.

A&E performance, particularly at the PRUH site, has deteriorated in 2014/15. We are

working closely with King’s, Monitor and NHS England to monitor performance on a daily

basis and to provide support on initiatives to help improve performance. A community

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escalation plan is in place to support patients being discharged from acute care. A trajectory

has been set for the PRUH to achieve the 95% target by the end of September 2015.

A zero tolerance approach to MRSA was taken again in 2014/15 and unfortunately four

cases were reported. We carry out Post Infection Reviews on all MRSA cases attributable to

the organisation to understand how a case occurred and to identify actions that will prevent

similar cases reoccurring in the future.

Performance on ambulance response times has been poor across London throughout

2014/15. Whilst locally, for Bromley, achievement was slightly higher for all three monitored

targets, we are measured against London performance as a whole.

Six mixed sex accommodation breaches were attributed to Bromley patients in 2014/15

which is a significant improvement on last year’s position.

We narrowly missed two of the cancer wait targets at the end of 2014/15; 2 week (breast

symptoms) and 62 day wait following a GP referral. We have worked with acute trusts, the

Cancer Commissioning Team and the South East Commissioning Support Unit (SECSU) to

understand the reasons behind each breach. Although the number of breaches in each

category is small, our aim is that no patient should breach these wait times. There have

been on-going problems throughout the year with provider to provider referrals.

All London providers have been tasked by the Intensive Support Team (IST) to produce

action plans demonstrating how they will achieve compliance against these indicators

moving forward. Regular meetings are held to ensure providers are progressing with their

actions plans and that they are implementing a number of recommendations made by the

IST following their review of cancer services. We continue to work closely with the IST,

Commissioning Support Unit and provider Trust colleagues to ensure patients flow

seamlessly through the system and that any potential delays are identified early, and where

possible, mitigated. We will continue to rigorously monitor all breaches to ensure the reasons

are analysed and understood. All trusts are expected to achieve the cancer wait targets in

2015-16.

8. Quality Review

Quality is integral to all that we do and we are committed to providing a culture of continuous

improvement and collaboration across the health and social care system. We learn from the

outcomes of the Francis, Berwick and Winterbourne reports. The quality of local health

services is a high priority and we have a range of measures in place to monitor the quality of

services provided for our residents including patient experience, safety and clinical

effectiveness.

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8.1 Quality Improvement and Assurance

All the healthcare providers that we commission use the standard NHS contract which has

within it a range of quality indicators which we monitor. In addition we will contract with

providers for quality improvement through a number of means available to us including a

quality schedule within contracts for our major providers, service development improvement

plans where we work with our providers over the year and commissioning of CQUINs.

CQUIN stands for Commissioning for Quality and Innovation and is commissioned over and

above the main contract. A summary of CQUINs for 2014/15 is shown in section 8.2.4.

8.2 Governance/assurance processes

8.2.1 Clinical Quality Review Group

Quality assurance is provided through contract monitoring with local providers in a Clinical

Quality Review Group (CQRG). Each of the main providers has a CQRG and we often work

in partnership with other CCGs. For example, the CQRG for King’s College Hospital NHS

Foundation Trust is attended by Southwark CCG (as co-ordinating commissioner), Lambeth

CCG and also NHS England specialised commissioning. The CQRG itself is run and

managed by the South East Commissioning Support Unit. The CQRG for Oxleas

Foundation Trust is also attended by Bexley and Greenwich CCGs with management

rotating around the three CCGs. We run and manage the Bromley Healthcare CQRG for

CCG commissioned services. The CQRGs are attended by our GP clinical leads, the

Director of Quality, Governance and Patient Safety and/or the Head of Nursing and

Safeguarding.

We have worked closely with Southwark CCG over the last year to ensure the King’s CQRG

appropriately addresses and reflects both quality improvement and quality concerns at the

Bromley sites, Princess Royal University Hospital (PRUH), Orpington Hospital and

Beckenham Beacon. The King’s CQRG has been monitoring progress against a number of

actions plans which were put in place by King’s following acquisition of the PRUH. In

addition progress reports have been received against the action plan produced by Kings

following the Care Quality Commission (CQC) inspection in December 2013.

8.2.2 Quality Assurance sub-committee

We have our own Quality Assurance sub-committee as part of our formal governance

process. The sub-committee is chaired by the nurse Governing Body member and is

attended by a governing body lay member, GP clinical leads, the Director of Quality,

Governance and Patient Safety, Head of Nursing and Safeguarding, Risk and Governance

manager as well as Healthwatch, and, from the London Borough of Bromley, Public Health

and Quality Assurance. The sub-committee receives reports from the CQRG meetings for

scrutiny and triangulates this information with data coming from the CCG’s quality alerts as

well as other soft intelligence such as site visits. Healthwatch also provides a valuable

insight into our local providers from their perspective.

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The Quality Assurance Framework has been successfully used in both CCG procurements

and in contract monitoring throughout the year. The quality team attend contract monitoring

meetings for smaller providers either if a particular issue has been raised through a quality

alert or as part of a routine engagement programme. Contract officers are clear of the route

to escalate any quality concerns to the quality team.

8.3 Quality accounts

Each provider of NHS services (over and above a certain contract value) is mandated to

produce a quality account each year. Locally these are produced by King’s, Oxleas and

Bromley Healthcare. Each account demonstrates quality improvements against targets in

each of the quality domains of patient safety, patient experience and clinical effectiveness

and also sets targets for the following year. We are required to provide a commentary on

each quality account and this is delegated to the Quality Assurance sub-committee to action.

King’s in particular runs a very inclusive approach to setting and agreeing quality priorities

for the quality account running a stakeholder event of commissioners and Healthwatch in

January of each year. Final quality accounts are publicly available on the NHS choices

website at www.nhs.uk/services

8.4 Commissioning for Quality and Innovation (CQUIN)

The CQUIN payment framework enables us to reward improvements in quality and patient

outcomes by linking a proportion (2.5% in 2014/15) of the income we pay to local providers

to the achievement of quality improvement goals over and above the baseline requirements

set out in the standard NHS contract.

During 2014/15 we had in place a number of CQUINs with our providers. As in previous

years these were a mixture of nationally mandated and locally agreed CQUINs.

National CQUINs in 2014/15 included:

Implementation of the Friends and Family Test for both patients and staff.

Targets for reduction on harm against a measure called the Safety Thermometer

(e.g. reduction in the number of falls or pressure ulcers).

Earlier identification of patients with dementia.

Improved physical health assessments for mental health patients (Oxleas only).

Each provider then has a series of local CQUINs agreed to meet local needs. In 2014/15

these included CQUINs to promote communication between primary and secondary care,

implementation of the London Quality standards for emergency care, medication reviews on

discharge, improved co-ordination and delivery of care for people with long term conditions

(COPD in 14/15), providing school nursing support for children out of education, better

management of community equipment. Although CQUINs are organisation based, some

have been designed to complement the healthcare system for the benefit of patients. For

example King’s has a CQUIN not only to reduce the number of hospital acquired pressure

ulcers at the PRUH but also to work collaboratively with our community provider to agree

51

how pressure ulcers are cared for and documented. In addition we have commissioned

Bromley Healthcare to provide additional expert advice and support to care homes in looking

after residents with pressure ulcers.

8.5 Quality Premium

We receive a quality premium for improvements in the quality of the services that we

commission and for improvements in health outcomes and in reducing health inequalities.

The 2014/15 measures cover a combination of national and local priorities.

The quality payments we will receive in 2015/16 are based on five national measures from

the NHS Outcomes Framework and one local priority. These are:

National:

Reducing potential years of lives lost through amenable mortality.

Improving access to psychological therapies.

Reducing avoidable emergency admissions.

Ensuring roll-out of the friends and family test and improving patient experience of

hospital services.

Improving the reporting of medication-related safety incidents based on a locally

selected measure.

Local:

Reduction in unplanned hospitalisation for chronic ambulatory care sensitive

conditions

8.6 Actions on Francis report

Following the publication of the Francis report in February 2013 and the subsequent reports

by Don Berwick and the Government’s response “Hard Truths: the journey to putting patients

first,” in November 2013, our steering group reviewed recommendations relevant to it and

produced an action plan. The action plan was reviewed at our Quality Assurance sub-

committee in February 2015 and is virtually completed. This does not mean that the work

has finished as the recommendations from these reports have affected many aspects of

quality improvement and assurance. For instance a number of measures are now included

in the NHS standard contract for routine reporting such as safer staffing levels (now

published monthly on the NHS choices website for acute hospitals) and Duty of Candour.

The CCG is keen to further develop the work in 2015/16 by working closely with the nursing

workforce in all our providers including primary care and practice nurses.

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9 CHIEF FINANCE OFFICER’S REVIEW

9.1 Review of 2014/15

The second year of the CCG has been no less challenging than the first in terms of finance

and performance. However we are pleased to report again that we have met all our financial

targets for the financial year 2014/15. In line with the targets set at the beginning of the year,

we have reported a 1.5% surplus of £5.9m, which will be carried forward into the next year.

We have commissioned healthcare services for the population of Bromley to the value of

£382m for 2014/15, with £161m spent with our main acute provider King’s College Hospital

NHS Foundation Trust. Our other key areas of spend were for community services, with our

main provider being Bromley Healthcare and mental health services where our key contract

is with Oxleas NHS Foundation Trust. We also purchase services for continuing healthcare

and pay for the costs of primary care prescriptions in Bromley.

We receive a fixed figure of £25 per head of population for the running costs and have a duty

to stay within the allocation of £8.0m. We are pleased to report we have stayed within the

budget by £0.7m which allowed us to invest additional funds into healthcare services.

The CCG has faced many significant challenges this year, most significantly the pressures

from our financially challenged provider King’s. Throughout the year, we have invested

significant resources into the whole health system in Bromley, such as increased capacity

and quality in the Emergency Department at King’s, additional capacity in community

services such as the medical response team and rehabilitation services as well as mental

health support into the hospital.

Our key cost pressures this year have been in the acute sector, with overspends at Guys &

St Thomas and the London Ambulance Service as well as King’s, in continuing care and

learning disabilities.

We have also delivered 99% of the £12m QIPP savings programme we set at the beginning

of the year, which was a key factor in enabling us to meet our financial targets.

Other financial targets we met this year included ensuring efficient use of our cash within the

allocation set and ensuring that over 95% of our creditors were paid within 30 days.

Section 1.2 of this report explains how our financial allocation is used.

9.2 Looking Forward

Recognising that Bromley CCG is one of the most significantly under-target CCGs in London

(i.e. we receive less money than we should for our population) we received significant

growth funding for 2015/16. However with a financially challenged acute provider, there is a

need to ensure that there is significant investment in transformation locally to support the

53

local health economy, making sure we have the appropriate out of hospital services in

primary, community and social care to meet demand and support the performance and

delivery of all services, including the acute providers. For this reason, the CCG has set the

financial plan for 2015/16 maintaining a target for a surplus at the same level as 2014/15 and

so meeting the minimum requirement of the business rules set by NHS England.

Bromley CCG continues to face significant financial pressures, particularly from the growing

healthcare demands from the increasing older population in Bromley. Specific financial

pressures in 2015/16 include:

Increasing acute pressures, not just in demand for services but also increased costs

due to the full impact of the changes to the prices paid to King’s.

Increasing demand on the CCG continuing care budgets.

The increase in the CCG contribution to the national pooled fund for continuing care

legacy claims.

Our significant contribution to the Better Care Fund.

Additional investment required in mental health services.

The reduction in the CCG running costs of 10%.

In order to ensure we are in a position to meet all these financial challenges, we are working

with all the stakeholders in Bromley to deliver a QIPP savings programme of £9m for

2015/16.

One of the key initiatives to ensuring financial sustainability will be joint working with the

London Borough of Bromley on further integration, particularly through the Better Care Fund

and programmes funded through this route.

We will need to build on the financial success of the first two years and use the

transformation opportunities available to us to make sure we achieve a financially

sustainable local health system delivering quality services to the population of Bromley for

years to come.

10 EQUALITY AND DIVERSITY

We have adopted a system wide approach to embed the principles of Equality & Diversity

into every aspect of its healthcare policy, planning and service commissioning, and by

providing equal access to employment and a supportive working environment for our staff.

The overriding aim is to provide fair and equitable treatment to all people who use NHS

services and to those who work, or wish to work, for the CCG. To this end our actions and

working practices have been established to meet the requirements of the Equality Act (2010)

which consolidate existing equality legislation for these protected characteristics:

Age.

Disability.

54

Gender reassignment.

Marriage and civil partnerships.

Pregnancy and maternity.

Race.

Religion or belief.

Sex.

Sexual orientation.

Our approach to equality and diversity is led by our Chief Officer and has had a significant

impact on Equality and Diversity in the following areas:

Service development based on needs assessments.

Equality analysis of all new policies, strategies and developments.

Engagement of patient representatives for all major care pathway and service

redesign work streams and systems.

Inclusion of appropriate contractual terms and conditions to comply with the Equality

Act 2010.

Development of a clinical engagement strategy.

Joint Strategic Needs Assessment has been informed by both Equality and Needs

Assessments.

We have published our Equality and Diversity Policy that underpins our systemic approach

on our website: http://www.bromleyccg.nhs.uk/About-us/How-we-work/Pages/Equality-and-

diversity.aspx

An essential element of this is the requirement to undertake an equality analysis on the likely

or actual effects of our policies and proposals to develop NHS services on the people who

use them and others who might be affected less directly . This helps us ensure the people of

Bromley’s needs are properly considered before introducing or changing policies or services.

We engage with a wide range of people, including those from Black and Minority Ethnic

Groups (BME). Last year, we worked with Bromley Council to provide more information to

these communities on topics that they had asked to know more about.

The two main areas that patients and the public had requested to know more about were

diabetes and mental health. We ran workshops with Bromley Council on both of these topics

and organised speakers who are experts in their field to come along to share information

and answer any questions that people had. Both workshops were a huge success, great

discussions took place, and some people that attended joined the Bromley CCG Patient

Advisory Group to become more involved in improving services in Bromley.

10.1 Bromley Single Equality Scheme

We have a single equality scheme with an action plan which sets out how we intend to lead

and further develop a system-wide approach to promote equality and prevent discrimination

55

in all our functions, policies and strategies. The single equality scheme was developed

following consultation across Bromley. It sets out our commissioning equality objectives up

to and including 2015 and is available on our website at:

http://www.bromleyccg.nhs.uk/About-us/How-we-work/Pages/Equality-and-diversity.aspx

In 2014 we addressed the following areas identified in our plans:

Health and Wellbeing of Older People

We have successfully rolled out training for staff in care homes and professional/voluntary

carers of those over 65 years whom they suspect may have a urinary tract infection (UTI).

This was introduced to facilitate early detection and treatment of people aged 65 and over,

thus preventing the need for an unplanned hospital admission with a UTI.

We established a community falls service delivered by Bromley Healthcare. This specialist

service for older adults aims at preventing further falls in those who have fallen or are at risk

of falls. In addition fracture liaison nurses based in the hospital setting undertake

osteoporosis case finding, and provide falls assessments to patients in the A & E and Urgent

Care Departments.

We commissioned St Christopher's Hospice to provide a coordination service for people

thought to be in their last year of life. This aims to enable people with progressive and

advanced illness or frailty to receive timely and co-ordinated care. The service helps people

die with dignity in a place of their choice and provides support for the individual and their

families'. It has increased access to end of life care for those who traditionally would not

have had access to specialist palliative care. It won the Hospice UK "Innovation in Care"

award in November 2014.

Improving outcomes for People with Learning Disabilities

The staff training for the management of UTIs (see above) has also been extended in the

last year to staff and managers working with adults with Learning Disabilities, thus improving

their health outcomes and quality of life.

Health and Wellbeing of Children and Young People

In 2014 the CCG appointed a designated nurse for Looked After Children to ensure that their

interests are appropriately addressed. This is in addition to the post of designated nurse for

child safeguarding which has been in place since the beginning of the CCG.

We have continued to work closely with the London Borough of Bromley on mental health

services for children and adolescents (CAMHS). During 2014 we jointly established a single

point of access making it easier to for those under 18 years to receive an emotional

wellbeing service. We have also worked closely with the London Borough of Bromley on a

project of self-harm protection in Bromley schools.

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10.2 Equal Opportunities at Work

At the end of 2014/15 the numbers of persons of each sex within the CCG were as follows:

Governing Body voting members – five members are female and ten are male

Membership Body – 125 GP members are female and 94 are male

CCG employees - 62 are female and 21 are male. No members of staff were on a

Very Senior Manager (VSM) level.

Below is information on our employees shown through the protected characteristics:

57

11. SUSTAINABILITY

Sustainability has become increasingly important as the impact of people’s lifestyles and

business choices are changing the world in which we live. We acknowledge this

responsibility to our patients, local communities and the environment by working hard to

minimise our footprint.

We are committed to promoting environmental and social sustainability through our actions

as a corporate body as well as a commissioner.

11.1 Modelled Carbon Footprint

The majority of the environmental and social impacts are through the services we

commission. Therefore the following information uses a scaled model based on work

performed by the Sustainable Development Unit (SDU) in 209/10. More information is

available at: www.sduhealth.org.uk/policy-strategy/reporting/nhs-carbon-footprint.aspx

As a part of the NHS, public health and social care system, it is our duty to contribute

towards the level of ambition set of reducing the carbon footprint of the NHS, public health

58

and social care system by 34% (from a 1990 baseline) equivalent to a 28% reduction from a

2013 baseline by 2020.

Energy

We were previously located on the Bassets House site in Orpington. The organisation was

spread across several buildings on the site, many of which were old and energy inefficient

(no double glazing, inefficient heating system). The move to the current headquarters at

Beckenham Beacon will have reduced our carbon impact but we were unable to compare

data for 2013/14 as the CCG does not have the PCT figures prior to this.

All rooms on the Beckenham Beacon site used by the CCG have automatic light sensors to

reduce electricity use. The building is ventilation controlled rather than air conditioned. In

addition, during 2014/15, a staff Task and Finish group has been exploring options for

recycling and energy saving within the CCG. This includes bike loans, bike parks on site

and a travel policy which includes a payment for cycle miles as well as car sharing.

Resource 2014/15

Gas

Use (kWh) 19366

tCO2e 4.06304496

Oil

Use (kWh) 0

tCO2e 0

Coal

Use (kWh) 0

tCO2e 0

Electricity

Use (kWh) 16478

tCO2e 0

Total Energy CO2e 4.06304496

Total Energy Spend

£ 35,885.00

Waste

We moved to the Beckenham Beacon site in November 2013. This is a new building and

received an environmental award in 2009. The building is managed by NHS Property

Services which includes management of waste. All non-clinical waste is collected from the

building and sorted for recycling.

59

Waste 2014/15

Recycling/ reuse

(tonnes) 23

tCO2e 0

Other

(tonnes) 0

tCO2e 0

Landfill

(tonnes) 7.52

tCO2e 1.83802153

Total Waste (tonnes) 30.1

% Recycled or Re-used 0.75016611

Total Waste tCO2e 1.83802153

Finite resource use – water

In 2014/15 we took the decision to remove water coolers from use and replace these with

jugs of water in department fridges. This has reduced consumption of plastic beakers as

well as the electricity required to run the water coolers.

Water 2014/15

Mains

m3 142

tCO2e 0

Water & Sewage Spend

£ 1,890

11.2 Policies

In order to embed sustainability within our business it is important to explain where in our

process and procedures sustainability features.

Area Is sustainability considered?

Commissioning (environmental) Yes

Commissioning (social impact) Yes

Suppliers' impact Yes

Travel No

One of the ways in which an organisation can embed sustainability is through the use of a

Sustainable Development Management Plan (SDMP). We will be putting together a SDMP

in the near future for consideration by our Governing Body.

As an organisation that acknowledges its responsibility towards creating a sustainable future

we help achieve that goal by promoting the benefits of sustainability to our staff. Climate

60

change brings new challenges to our business both in direct effects to the healthcare

estates, but also to patient health. Examples in recent years include the effects of heat

waves, extreme temperatures and prolonged periods of cold. Our Governing Body

approved plans will address the potential need to adapt the delivery of the organisation’s

activity and infrastructure to climate change and adverse weather events.

11.3 Partnerships

As a commissioning and contracting organisation, we will need effective contract

mechanisms to deliver our ambitions for sustainable healthcare delivery. The NHS policy

framework already sets the scene for commissioners and providers to operate in a

sustainable manner. Crucially for us as a CCG, evidence of this commitment will need to be

provided in part through contracting mechanisms.

We have not currently established any strategic partnerships. For commissioned services

below is the sustainability comparator for our providers:

Organisation Name

SDMP GCC Board Lead Adaptation

SD Reporting

score

King's College Hospital NHS Foundation Trust No

Response No

Response No

Response No

Response Excellent

Guy's and St Thomas' NHS Foundation Trust Yes Yes Yes Yes Excellent

Lewisham and Greenwich NHS Trust No

Response No

Response No

Response No

Response Poor

Bromley Healthcare No No Yes No #N/A

Oxleas NHS Foundation Trust Yes Yes Yes No Good

More information on these measures is available at www.sduhealth.org.uk/policy-

strategy/reporting/sdmp-annual-reporting.aspx

12 SAFEGUARDING

Safeguarding forms an integral part of our responsibilities. This is demonstrated by having

strongly embedded safeguarding arrangements in place, by working closely with the Local

Authority, health service providers and a range of other local agencies in Bromley to ensure

that children, young people and adults at risk are safe from neglect and abuse.

61

Any healthcare professional that provides care has a duty to safeguard and promote their

welfare. We have dedicated professionals on our Governing Body who make sure that the

safety and welfare of these groups are considered in all the work that we do.

12.1 Children and Young People

CCGs have a statutory responsibility to ensure that the organisations, from which they

commission services, provide safe systems to safeguard children at risk of abuse or neglect.

This includes specific responsibilities for Looked After Children and for supporting the Child

Death Overview process.

We are members of the Bromley Safeguarding Children Board, a multi-agency partnership

with responsibility for improving outcomes for children and holding all organisations to

account for their safeguarding arrangements.

We have Governing Body leads for safeguarding children and a Designated Nurse and

Designated Doctor who take the strategic professional lead for safeguarding children across

the local health economy. In addition, in 2014, we strengthened arrangements for Looked

After Children by securing a Designated Nurse for Looked After Children.

12.2 Vulnerable Adults

Some adults are less able to protect themselves than others, and some have difficulty

making their wishes and feelings known. This may make them more vulnerable to abuse. A

vulnerable adult can be defined as someone 18 years of age or over who is or may be:

In need of community care services by reason of mental or other disability, age or

illness.

Unable to take care of him or herself, or unable to protect him or herself against

significant harm or exploitation.

Adult safeguarding in Bromley, including Bromley NHS services, is led through the Bromley

Safeguarding Adults Board whose members include the local authority, the police, and the

criminal justice system. The Safeguarding Adults Board is responsible for the co-ordination

and development of work to safeguard adults at risk from abuse and neglect living in the

Borough. Leadership together with multi-agency partnership working is important factor to

the success of the Boards statutory function.

Bromley Safeguarding Adults Board aims to protect and support adults at risk of abuse by:

Improving awareness and recognition of abuse within partner agencies and by the

general public in Bromley.

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Developing, monitoring and reviewing safeguarding procedures and practice within

the borough.

Promoting effective multi-agency partnership to deliver successful prevention and

support to adults vulnerable to abuse.

12.2.1 Bromley Safeguarding Adults Annual Report

The purpose of the annual safeguarding adult’s report is to provide an overview of the

arrangements in place to safeguard and protect vulnerable adults across the London

Borough of Bromley. Detailing the Boards working objectives in delivering Bromley

Safeguarding Adults at Risk Prevention Strategy 2011-2014, demonstrating how the

Safeguarding Adults Board fulfils its statutory responsibilities in relation to vulnerable adults

in accordance with the Health & Social Care Act 2012.The annual report identifies the

significant progress made against delivering the Safeguarding Adult Board’s strategic

objectives. Recognising multi-agency working to reduce the risks of abuse and neglect to

vulnerable adults in receipt of adult social care. The latest report is available here:

http://www.bromley.gov.uk/downloads/731/safeguarding_vulnerable_adult

12.2.2 Care Act 2014 Safeguarding Adults

The Care Act 2014 puts safeguarding adults on a statutory footing providing further clarity

about the role and responsibility of public services to collaborate and work together to

safeguard vulnerable adults . This places new challenges for the Safeguarding Adults

Board, by holding partner agencies to account for safeguarding. We are actively involved

with implementing the changes required for safeguarding adults following the Care Act

receiving Royal Assent in May 2014, by working in partnership with NHS England and the

London Borough Bromley. Read more here:

http://careandsupportregs.dh.gov.uk/category/adult-safeguarding

NHS Bromley Clinical Commissioning Group Strategic Report 2014/15

Dr Angela Bhan

Chief Officer

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THE MEMBERS’ REPORT

Bromley CCG is a membership organisation made up of all Bromley GP practices. They set

the direction of the CCG and delegate responsibility for the day-to-day commissioning of

local NHS services to the Governing Body.

Our Governing Body is made up of 15 individuals including six elected GP clinical leads

(one of whom is the Clinical Chair), three lay members (people not employed by the NHS), a

registered nurse, a hospital doctor and four senior officers. Representatives from the local

authority and Healthwatch Bromley also regularly attend the meetings held in public.

Overleaf is a map showing the member practices in Bromley during 2014/15.

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65

1 Governance

We operate within a robust governance framework that provides for the effective functioning

of the Governing Body, its committees, clinical leads and managers, all of whom have clear

responsibilities and accountabilities that are understood and adhered to. This framework is

set out in our Constitution which is available on our website,

http://www.bromleyccg.nhs.uk/About-us/How-we-work/Pages/Our-constitution.aspx

The Constitution describes the governing principles, rules and procedures that we will follow

to ensure probity and accountability in our day to day running so that decisions are taken in

an open and transparent way and that the interests of patients and the public remain central

to our goals.

1.1 Governance Structure

1.1.1 The Membership Body

The 45 GP practices that comprise the membership of Bromley CCG in 2014/15 reserved to

themselves responsibility for setting and making changes to the Constitution, and for setting

the high level strategic aims of the organisation. They also ratify the appointment of GP

Clinical Leads to the Governing Body following election by local GPs.

The members met together formally on 25 June and 26 November in 2014. At their June

meeting they reviewed the progress achieved in the CCG’s first year, considered early

proposals for co-commissioning primary care with NHS England, considered what the South

East London Five Year Strategy meant for Bromley, and gave some thought to increasing

membership involvement in the operation of the CCG. The November meeting was mostly

taken up by strategic planning and commissioning intentions in 2015/16, including out of

hospital care. Members also gave further consideration to more advanced proposals for

primary care co-commissioning.

Members met together in seminar/development mode on 15 October 2014 to consider

primary care transformation on Bromley, including the development of local care networks.

All meetings were well attended with representation from more than 80% of the member

practices.

GP members also met on a bi-monthly basis throughout the year in three separate cluster

groups that are geographically determined within the Borough of Bromley. Each cluster

group is chaired by a clinical lead member of the Governing Body. At these meetings, GP

members made recommendations on the strategic developments being pursued by the CCG

which were fed into the management process through the clinical lead chair and CCG

managers present.

66

The GP member practices have delegated management responsibility for the operation of

the CCG to the Governing Body. The terms of this delegation and the governance structure

that supports it are set out in our Constitution.

1.1.2 The Governing Body

The Governing Body is the main decision taking part of the organisation. Its functions and

membership are set out in our Constitution and Standing Orders. It met formally in public,

bi-monthly, on seven occasions during 2014/15. It also met once in private in August 2014

to consider an item of commercial confidentiality. All meetings were quorate. In intervening

months it held development seminars in private. It is chaired by Dr Andrew Parson. Jim

Gunner, who is one of the Lay Members, is the Deputy Chair. The full statutory, voting

membership during the whole of 2014/15 was as follows;

Name Position

Dr Andrew Parson Clinical Chair

Jim Gunner Lay Member, Deputy Chair

Dr Ruchira Paranjape Principal Clinical Lead

Dr Jon Doyle Clinical Lead

Dr Atul Arora Clinical Lead

Dr Mandy Selby Clinical Lead

Dr Mark Essop Clinical Lead

Harvey Guntrip Lay Member

Martin Lee Lay Member

Tan Vandal Hospital Doctor Member

Sara Nelson Registered Nurse Member

Dr Angela Bhan Chief (Accountable) Officer

Mark Cheung Chief Finance Officer

Sonia Colwill Director of Quality, Governance and

Patient Safety

Meredith Collins Director of Healthcare System Reform

67

(to June 2014)

Clive Uren Interim Director of Commissioning

(from July to September 2014)

Mark Needham Director of Commissioning

(from October 2014)

A small number of non-voting attenders are also present at most of the Governing Body’s

meetings in public. The CCG values their contribution to the discussions, but they do not

participate in the final decision taking vote. They are not remunerated by the CCG for their

attendance. In 2014/15 the non-voting attenders were:

Dr Nada Lemic Director of Public Health, London

Borough of Bromley

Terry Parkin Executive Director, Education and Care

Services, London Borough of Bromley

Councillor Peter Fortune Chair, Bromley Health & Wellbeing

Board, London Borough of Bromley

Councillor Robert Evans Portfolio Holder, Care Services, London

Borough of Bromley

Linda Gabriel Chair, Healthwatch Bromley

The members of the Governing Body and non-voting attenders have declared the following

interests and conflicts:

MEMBERS (STATUTORY)

Name Title Interests Declared Gifts and

Hospitality

Dr Andrew

Parson

Clinical Chair Chislehurst Medical Practice (PMS) – Partner

(13% share)

Bromley Y (a local agency offering

None

68

therapeutic support to young people) - Wife

is an employee

Oxleas – Daughter is an employee

Bromley Public Health – GP Primary Care

Lead for Diabetes

Jim Gunner Deputy Chair,

Audit Committee

Chair, Lay Member

Nominated member of the Council of

Governors of King’s College Hospital NHS

Foundation Trust (Unpaid)

None

Dr Angela

Bhan

Chief/Accountable

Officer

Secondment to Health Education England

(Public Health education role)

None

Dr Atul Arora Clinical Lead Principal GP at Sundridge Medical Practice

Clinical Advisor for EMDOC (sessional

remuneration for advisory work)

SSAFA CIC (Charity supporting military

families) - Clinical Advisor (Consultancy

basis, fees received)

Fees received

for chairing

meetings and

speaking at

events

sponsored by

various

Pharmaceutical

Companies.

(Remuneration

received is paid

to practice,

value varies)

Dr Jon Doyle Clinical Lead GP Partner in South View GMS Partnership

South View Partnership hold contract from

Bromley Healthcare to provide Visiting

Medical Officer services at Lauriston house

Parent Governor, Holy Innocents’ Catholic

Primary School

Dinner provided

at meeting on

Management of

Atrial

Fibrillation &

Anti-

coagulation

prescribing

sponsored by

Pfizers,

September

2014

Dr Mark

Essop

Clinical lead GP Partner, Southborough Lane Surgery None

69

Dr Ruchira

Paranjape

Principal Clinical

Lead

GP Partner at Knoll Medical Practice (PMS) –

(33.3% share)

Visiting Medical Officer contract with Care UK

for Foxbridge Nursing Home

None

Dr Mandy

Selby

Clinical Lead Salaried GP at Addington Road Surgery

Employed by King’s in an educational role at

the Princess Royal University Hospital

Family member is an employee of Guy’s and

St Thomas’ NHS Foundation Trust

None

Harvey

Guntrip

Lay Member None None

Martin Lee Lay Member None Working lunch

provided by

KPMG at

March 2014

meeting

Tan Vandal Secondary Care

Doctor

Essex Urology Services (Dormant) – Co-

director and shareholder (more than 5%)

Spire Hartswood Hospital, Brentwood –

Admitting rights

Secondary Care Doctor Governing Body

member of:

NHS Tower Hamlets CCG

NHS Havering and Barking & Dagenham

CCGs

NHS Lambeth, Southwark and Lewisham

CCGs

None

Sara Nelson Registered Nurse

Member

Quality Improvement Lead – NHS England,

salaried post (0.8 WTE)

Member of Editorial Board of British Journal

of cardiac Nursing

None

70

Patient of a local practice

Member of National Atrial Fibrillation Clinical

Policy Group of UK Clinical Pharmacy

Association

Husband is GP in Lewisham & Clinical

Director of Health Improvement Network

(Academic Health Science Network, South

London)

Interim Registered Nurse Member,

Greenwich CCG, Governing Body (1 day per

month) Sept 2014 to Jan 2015

Mark Cheung Chief Finance

Officer

None None

Sonia Colwill Director of Quality,

Governance and

Patient Safety

None None

Meredith

Collins

Director of

Healthcare System

Reform (to June

2014)

Meredith Collins Consulting – Director (99%

share)

None

Clive Uren Interim Director of

Commissioning

(from July to

September 2014)

Director of Clive Uren Consultancy Ltd None

Mark

Needham

Director of

Commissioning

(from October

2014)

None None

71

NON VOTING ATTENDERS

Dr Nada

Lemic

Director of

Public Health,

LBB

Employed by London Borough of Bromley

None

Councillor

Peter

Fortune

LBB Elected Councillor of London Borough of Bromley

Non-executive Director of Affinity Sutton Homes

Member of the National Childbirth Trust

None

Councillor

Robert Evans

LBB Elected Councillor London Borough of Bromley,

Portfolio Holder for Care Services.

Governor of King's College Hospital NHS Foundation

Trust

None

Terry Parkin Executive

Director,

Education &

Care Services,

LBB

Full time employment with London Borough of

Bromley

None

Linda Gabriel Healthwatch

Bromley

Chair of Healthwatch Bromley

Chair of Bromley and Lewisham MIND

None

Each individual who is a voting member of the Governing Body at the time the Members’

Report is approved confirms:

So far as the member is aware, that there is no relevant audit information of which

the CCG’s external auditor is unaware; and:

That the member has taken all the steps that they ought to have taken as a member

in order to make them self-aware of any relevant audit information and to establish

that the CCG’s auditor is aware of that information.

1.1.3 Audit Committee

The Audit Committee is a statutory committee of the Governing Body. Its functions and

membership requirements are set out in our Constitution and it has terms of reference that

are ratified by the Governing Body. We work to the Nolan seven principles of public life

which are selflessness, integrity, objectivity, accountability, openness, honesty and

leadership.

72

It fulfils our required statutory audit functions, ensuring that the corporate governance,

clinical governance and financial and organisational systems are functioning as they should.

Its work programme includes reviewing corporate and clinical governance arrangements,

assurance mechanisms including the work of internal and external audit, local counter fraud

services, local security management services, debt and waiver management, and reviewing

the risk management arrangements to ensure that risks to our corporate objectives are

identified and addressed.

It met on five occasions during 2014/15. All meetings were quorate. Its membership during

the whole of 2014/15 was as follows:

Jim Gunner Committee Chair, Lay Member

Harvey Guntrip Lay Member

Martin Lee Lay Member

Tan Vandal Hospital Doctor Member

The appointed CCG External Auditors are PricewaterhouseCoopers LLP. The CCG incurred

£85k in fees (exclusive of VAT) for audit services in relation to the statutory audits for the

year to 31 March 2015.

1.1.4 Remuneration Committee

The Remuneration Committee is a statutory committee of the Governing Body. Its functions

and membership requirements are set out in our Constitution and it has terms of reference

that are ratified by the Governing Body.

It meets to consider the employment packages for those employees and individuals working

for the CCG, including the clinical leads, whose remuneration falls outside the scope of

Agenda for Change.

It met on one occasion during the year to consider and agree proposals for organisational

restructuring including possible redundancy and pension costs, and to review payments to

lay members in the light of changes to their responsibilities. The meeting was quorate, and

included alternative committee membership (GP and management only) when dealing with

the terms of the lay members in order to avoid any conflict of interests. Its decisions were

reported to the Governing Body.

73

The normal membership of the Remuneration Committee during 2014/15 was:

Jim Gunner Committee Chair, Lay Member

Harvey Guntrip Lay Member

Martin Lee Lay Member

Tan Vandal Hospital Doctor Member

Sara Nelson Registered Nurse Member

Independent human resources advice is provided by the South East Commissioning Support

Unit.

1.1.5 Integrated Governance Committee

The Integrated Governance Committee makes recommendations and provides assurance to

the Governing Body on the financial performance of the organisation (including the

achievement of the QIPP targets), the achievement of commissioned activity, and the quality

and safety of commissioned services. It also:

monitors the arrangements for working with NHS England to improve the quality of

specialised and primary care services

performs the role of Information Governance Steering Group, providing oversight of

the adequacy and appropriateness of our arrangements for information governance

monitors, reviews and makes recommendations to the Governing Body on the

sufficiency and quality of the services commissioned from the South East

Commissioning Support Unit

assesses the CCG’s capability to meet its information requirements, including the

sufficiency and adequacy of the data it receives.

The functions and membership requirements are set out in our Constitution and its terms of

reference are ratified by the Governing Body.

The Integrated Governance Committee met monthly during 2014/15 and all of its meetings

were quorate. Meetings are not held in public but the minutes are submitted to the

Governing Body and published on our website. Its key monitoring reports are also

considered by the Governing Body on a bi-monthly basis and published on our website.

During the whole of 2014/15 its membership was:

Harvey Guntrip Committee Chair, Lay Member

Dr Andrew Parson Clinical Chair

Dr Ruchira Paranjape Principal Clinical Lead

74

Dr Atul Arora Clinical Lead

Dr Jon Doyle Clinical Lead

Dr Mark Essop Clinical Lead

Dr Mandy Selby Clinical Lead

Jim Gunner Deputy Chair/Lay Member

Martin Lee Lay Member

Dr Angela Bhan Chief/Accountable Officer

Mark Cheung Chief Finance Officer

Meredith Collins Director of Healthcare System Reform

(to June 2014)

Clive Uren Interim Director of Commissioning (from

July to September 2014)

Mark Needham Director of Commissioning (from

October 2014)

Sonia Colwill Director of Quality, Governance and

Patient Safety

Sarah Osborn Head of Performance

Other senior managers from within the CCG and from the South East Commissioning

Support Unit regularly attend the meetings as appropriate.

1.1.6 Quality Assurance Subcommittee

The Quality Assurance Subcommittee reports to the Integrated Governance Committee and

provides assurance on the quality and safety of services we commission and the clinical

governance arrangements of proposed changed and new clinical care pathways. It may

also report directly to the Governing Body. It also:

reviews and recommends to the Integrated Governance Committee and/or

Governing Body for ratification our Quality Strategy, quality and safety policies and

procedures, and patient group directions

keeps under review and makes recommendations on the arrangements and

outcomes from patient complaints, patient surveys, quality alerts, serious incidents

75

and external reports from the Care Quality Commission, Healthwatch Bromley and

other external bodies and inquiries etc.

ensures we have appropriate arrangements for handling complaints about

commissioning and overseeing the production by its commissioned providers of

reports relating to serious incidents and near misses

keeps under review and makes recommendations on our arrangements for

safeguarding, including joint working with the London Borough of Bromley

The functions and membership requirements are set out in our Constitution and its terms of

reference are ratified by the Governing Body.

The Quality Assurance Subcommittee met monthly on eleven occasions during 2014/15. All

of the meetings were quorate. Its minutes are submitted to the Integrated Governance

Committee.

During 2014/15 its membership was as follows:

Sara Nelson Subcommittee Chair, Registered Nurse

Member

Dr Mandy Selby Clinical Lead

Dr James Heathcote Clinical Quality Lead

Harvey Guntrip Lay Member

Sonia Colwill Director of Quality, Governance and

Patient Safety

Sarah Turner Designated Nurse for Safeguarding and

Head of Quality (to June 2014)

Sadie McClue Head of Nursing and Designated Nurse

for Safeguarding Children (from

September 20140

Sheridan Morrison Deputy Designated Nurse for

Safeguarding and Looked After Children

(from July 2014)

Claire Lewin Designated Nurse, Adult Safeguarding

Dr Ade Fowler Assistant Director of Public Health,

London Borough of Bromley

Aileen Stamate Head of Quality Assurance, Education

and Care Services, London Borough of

76

Bromley

The Head of Corporate Affairs, Risk and Governance Manager, Prescribing Adviser and a

representative from Healthwatch Bromley also regularly attend meetings. Other CCG

managers and Public Health representatives attend for appropriate items.

2 Our staff

We currently employ 83 staff of these 62 are female and 21 are male.

During the last year there have been two organisational restructures which required

consultation with our staff as set out by our organisational change policy. The first was an

organisational wide restructure in the spring of 2014 which resulted in 8 staff being made

redundant. The second is currently on-going and applies to a re-structuring in the

Commissioning Directorate only. It is not expected that this will result in any redundancies.

Sickness absence data is reported to the CCG in workforce reports every quarter. This is

broken down into six categories in line with equality guidance. Sickness trends are

discussed with appropriate managers to ensure that the right support is provided to staff who

are absent due to sickness to enable appropriate and timely returns to work.

During 2014/15 a total of 808 working days were lost from 92 episodes due to sickness

absence (864 calendar days). This amounts to a sickness absence level of 3.21%.

Staff with disabilities are protected under the terms of the Disability Discrimination Act 1995.

The Sickness Absence Policy confirms that if an employee is disabled or becomes disabled,

we are legally required under the Equality Act 2010 to make reasonable adjustments to

enable the employee to continue working – for example, providing an ergonomic chair or a

power-assisted piece of equipment. We are responsible for ensuring that no individual is

disadvantaged because of their disability.

We provide support to our staff through a Freephone confidential helpline provided by Right

Management. This provides unlimited access to advice, information and face to face

counselling support where appropriate. The service is designed to support staff with a range

of problems, no matter how big or small, which may affect their personal lives or

performance at work. There is also access to a legal and financial advisory service.

We are supported in our work by the South East Commissioning Support Unit which

provides us with a range of support services including commissioning support, finance,

human resources and communications. Some of their staff are co-located with CCG staff at

Beckenham Beacon.

77

2.1 Training and Development

There is a robust appraisal scheme for all employees which is based on good management

practice and includes agreeing annual objectives, monitoring of achievement and agreement

of a Personal Development Plan.

We have a Training Study leave policy for supporting Training and Development with an

application policy for access to funds to support training agreed as part of personal

development plans and other vocational training. Development programmes have been

accessed by staff throughout the year including accredited programmes, ad hoc

development courses, conferences, coaching and e learning.

There is a statutory and mandatory training policy (MAST) in place and reporting procedures

for staff to undertake this training which is provided both on line via e-learning from Skills for

Health and in house face to face training. Mandatory Training activity is monitored

regularly.

2.2 Communicating with staff

The CCG undertook its first annual staff Survey in February 2014 which gave valuable

feedback on areas that the CCG can improve staff working lives. Following the results of the

survey a staff task and finish group was established to seek ideas on improvement actions

required and what was needed to support our staff. An action plan was developed and

implemented. As part of the action plan, development programmes have been broadened,

new appraisal processes introduced, staff health checks have been made available and

improved staff communication processes implemented.

We are committed to transparent, clear and regular communications with staff. A monthly

staff newsletter is produced which staff are able to contribute to. Monthly Staff Forums are

held where a range of topics are discussed openly and interactively. Team meetings and

regular one to ones with line managers are encouraged and a robust annual appraisal

scheme is in place.

3 Information Governance

We place a high importance on ensuring that there are robust information governance

systems and processes in place to help protect patient and corporate information. We have

established an information governance management framework together with processes and

procedures in line with the information governance legislation and Department of Health

policies guidance and procedures. Information Governance is an integral part of our Risk

Management Assurance Framework.

78

Our Chief Finance Officer is accountable for information risk as the ‘Senior Information Risk

Owner’ (SIRO). The Chief Officer fulfils the role of Caldicott Guardian and acts as the

conscience of the CCG on confidentiality matters.

3.1 Our IG Framework

We have appropriate systems and processes and expertise in place to ensure continued

compliance with the ever evolving national information governance landscape.

The CCG has put in place a risk based approach to Information Governance and has

established an Information Governance Working Group chaired by the SIRO to lead on

decision-making and the review of internal and external systems and processes that drive

the information governance agenda for the CCG.

We use the NHS Information Governance (IG) Toolkit to assess and demonstrate the

effectiveness of the CCG’s internal processes and system and to satisfy the rapidly evolving

national information governance agenda relating to the management and handling of

information.

During 2014/15 we submitted a Satisfactory IG Toolkit self-assessment achieving above the

minimum required level 2 score across all the IG Toolkit requirements.

We recognise that culture is a strong influence and determinant of fair and appropriate

information risk decision making outcomes. By March 2015, all our staff had undertaken IG

Training. The SIRO has in addition undertaken additional strategic information risk

management training.

3.2 Information Governance Incidents

There were no Serious Information Governance Incidents requiring investigation (SIRI) or

further escalation through last year. We have not recorded any breaches that are of Levels

2 or 1 as defined in the Guide to Information Governance Incidents issued by the Health and

Social Care Information Centre.

A Serious Information Governance Incident is defined as any incident involving the actual or

potential loss of personal information that could lead to identity fraud or have other

significant impact on individuals. Incidents of this type must be reported to the Department of

Health and the Information Commissioner’s Office.

We have appropriate processes for incident reporting and investigation of serious incidents

to ensure compliance with our legal obligations and the Department of Health policies

guidance and procedures. Our staff are encouraged to report incidents and ‘near miss’

events so they can be investigated and so that we can reduce the risk of such incidents in

future.

79

3.3 Information Governance Planning

Information Governance management within the CCG is subject to annual planning. The

CCG’s Information Governance Working Group (IGWG) monitors the information

governance improvement and action plans on a bi-monthly basis and reports to the

Integrated Governance Committee. Key policies and procedures are reviewed annually or

when there are changes to legislation or NHS guidance.

We continue to improve and further develop its approach to the management of information

risks and compliance with legislation and national information governance standards.

Our annual information governance plan ensures that we continue to handle information in a

secure way. It supports our fairness and transparency objectives and ensures patients are

given choice to determine how their information is collected and used.

4 Complaints

We have a formal Policy and Procedure for dealing with complaints that arise from the

commissioning decisions that we take. Such complaints may relate to problems associated

with setting up new care pathways that we have developed or concern over services that we

do not commission because, for example, they are not recommended by the National

Institute for Health and Care Excellence (NICE). The majority of complaints about local NHS

providers are best resolved by the hospital or organisation providing the service but we may

become involved in resolving provider complaints if there is also a commissioning element or

the complainant wishes the CCG to have overview.

The total number of complaints we received that related to our commissioning work in

2014/15 was 9. These complaints received a reply from the CCG with appropriate input from

the relevant provider where this was appropriate. We also received a further 31 complaints

about provider services which we passed on to the relevant organisation for resolution with

permission from the complainant. The following table shows the breakdown of all complaints

across the main service areas:

I certify that NHS Bromley Clinical Commissioning Group has complied with HM

Treasury’s guidance on cost allocation and the setting of charges for information.

Dr Angela Bhan, Chief Officer

80

Direct Commissioner Complaints

Corporate 2

Hydrotherapy 4

IAPT 1

Cardiac Rehabilitation 1

Staff Member 1

Provider Complaints received-CCG

overview

Acute Services 10

Primary Care 6

Specsavers 4

Bromley Healthcare 4

Crystal Palace Physiotherapy 2

Urgent Care Centre 2

Oxleas 1

Complaints received by the CCG are reviewed by the Quality Assurance Subcommittee and

the lessons learnt from them are reflected in changes to the way we commission services.

In addition all themes related to providers are discussed with them via contract and quality

review meetings.

During the year, there were no cases that the Parliamentary and Health Services

Ombudsman asked the CCG to report on or reconsider.

The Parliamentary and Health Service Ombudsman has set out “Principles for Remedy” that

describe best practice for dealing with any injustice or hardship caused by maladministration

or service failure. These principles have been fully adopted by the CCG and are set out in

Appendix E of our Complaints Policy and Procedure. During 2014/15, we did not make any

payment under these arrangements.

4.1 Serious Incidents and Never Events

A Serious Incident has been defined within the NHS England Serious Incident Framework as

an occurrence that results in avoidable death or serious harm or threatens an organisation's

ability to deliver services. Never Events are serious incidents that are considered to be

wholly preventable in line with national safety recommendations which should have been

implemented by all healthcare providers. Never Events and Serious Incidents are reported

to the CCG on an individual basis. We have robust procedures in place to work with

providers to ensure robust reporting and investigation of serious incidents and never events

and we monitor the progress of any action plans. The CCG also analyses the themes

81

arising from Serious Incidents in particular and ensures any learning is embedded into

practice within provider organisations or shared with other organisations.

Until 1st April 2015 Never Events have included incidents such as:

wrong site surgery

retained instrument post operation

wrong route administration of chemotherapy

A revised Serious Incident and Never Events Framework has been published by NHS

England to commence on 1 April 2015. This builds on the fundamental purpose of patient

safety investigations which are to learn from incidents and not to apportion

blame. Investigations carried out under this Framework are conducted for the purpose of

learning to prevent recurrence. The revised Serious Incident Framework outlines two key

operational changes:

Removal of grading – under the new framework SIs are not defined by grade – all incidents meeting the threshold of a serious incident are investigated and reviewed based on whether a concise, comprehensive or independent investigation is required

Timescale – a single timeframe (60 working days) has been agreed for the completion of investigation reports allowing providers and commissioners to monitor progress in a more consistent way.

The revised Never Events Framework follows extensive consultation which has helped

redefine the policy and Never Events list with the focus remaining on learning and

improvement.

The reporting on Serious Incidents and Never Events will be in line with the Revised Policy

and Frameworks in 2015/16.

5 Emergency Preparedness

We are a Tier 2 responder in any major incident or emergency. This means that we may be

asked to help NHS England who take the lead on any major incidents in London.

We have a Business Continuity Policy and Incident Response Plan in place which was

reviewed and updated at the end of 2014/15. Our arrangements were assessed against

NHS England’s Assurance Template in December 2014 and considered to offer substantial

assurance.

I certify that Bromley CCG has incident response plans in place, which are compliant with the

NHS England Emergency Preparedness Assurance Template 2014. The CCG regularly reviews

and makes improvements to its Business Continuity Policy and Incident Response Plan and has

a programme for testing this plan. The CCG’s arrangements and level of assurance are

reported to the Governing Body.

Dr Angela Bhan, Chief Officer

82

NHS Bromley Clinical Commissioning Group Membership Report 2014/15

Dr Angela Bhan

Chief Officer

83

REMUNERATION REPORT

The Remuneration Committee comprises of 5 members and met on 1 occasion during the

past year. Chair of the committee is Jim Gunner. A full list of members, their roles and the

number of meetings each attended is below.

Name of Member

Role Date joined committee

Date left committee (if applicable)

No of committee meetings attended

Jim Gunner Committee Chair, Lay Member

1st April 2013 n/a 1

Harvey Guntrip Lay Member 1st April 2013 n/a 1

Martin Lee Lay Member 1st April 2013 n/a 1

Tan Vandal Hospital Doctor Member

1st April 2013 31st March 2015 1

Sara Nelson Registered Nurse Member

1st April 2013 n/a 1

In addition to the members listed above, the following CCG employees provided the

committee with services and/or advice which was material to the committee’s deliberations.

Name Role Service

Angela Bhan Chief Officer Chief Officer

Keith Fowler Head of Corporate Affairs Corporate Governance

Andrew Parson GP Chair Clinical and Corporate

Ruchira Paranjape Principal Clinical Lead Clinical and Corporate

Paulette Coogan Head of Organisational Development

Human Resources

The Remuneration Committee met on one occasion during the year. The meeting was

quorate. At this meeting, the Committee reviewed staff restructuring proposals and

approved potential redundancy payments. It also approved changes to the remuneration of

the Lay Member (Patient and Public Engagement) and the Registered Nurse Member to

reflect increased roles. Neither of the members concerned was present at the meeting when

these changes were discussed and agreed upon. Its decisions were reported to the

Governing Body.

.

84

Remuneration Policy

The Committee’s deliberations are carried out within the context of national pay and

remuneration guidelines, local comparability and taking account of independent advice

regarding pay structures.

Senior Managers’ Performance Related Pay

The CCG does not have a policy of performance related pay for senior managers.

Payments to Past Senior Managers No significant awards have been made to past senior managers.

85

Senior Managers’ Service contracts

Details of the service contract for each senior manager who has served Bromley CCG from

1 April 2014 to 31 March 2015

Senior Manager

Role Contract Date

Unexpired Term at 31 March 2015

Notice Period

Early Termination Compensation Provision

A Bhan Chief Officer 1 April 2014 N/A 6 months

S Colwill Director of Quality

1 April 2014 N/A 6 months

M Cheung, Chief Finance Officer

1 April 2014 N/A 6 months

M Collins, Interim Director of Healthcare System Reform

Ended June 2014

N/A 6 months

C Uren Interim Director of Commissioning

In post between June and October 2014

N/A N/A

M Needham Director of Commissioning

Started October 2014

N/A 6 months

Dr A Parson GP Chair 1 April 2014 6 months

Dr R Paranjape

Principal Clinical Lead

1 April 2014 6 months

Dr Selby Clinical Lead 1 April 2014 6 months

Dr Arora Clinical Lead 1 April 2014 6 months

Dr Essop Clinical Lead 1 April 2014 6 months

Dr Doyle Clinical Lead 1 April 2014 6 months

J Gunner Lay Member 1 April 2014 Up to 24 months

H Guntrip Lay Member 1 April 2014 Up to 24 months

M Lee Lay Member 1 April 2014 Up to 24 months

T Vandal Hospital Doctor Member

1 April 2014 Up to 24 months

S Nelson Registered Nurse Member

1 April 2014 Up to 24 months

86

Senior Managers’ Salaries and Allowances of Governing Body Members 2014-15

Name and title Salary & Fees

(bands of £5,000)

£000

Taxable Benefits

(rounded to the nearest

£500)

£00

Annual Performance

Related Bonuses

(bands of £5,000)

£000

Long-term Performanc

e Related bonuses

(bands of £5,000)

£000

All Pension Related Benefits

(bands of £2,500)

£000

TOTAL

(bands of £5.000)

£000

A Bhan, Chief Officer 120-125 25 120-125

S Colwill, Director of Quality

70-75 22.5-25.0 95-100

M Cheung, Chief Finance Officer

95-100 20.0-22.5 115-120

M Collins, Interim Director of Healthcare System Reform

55-60 55-60

C Uren, Interim Director of Commissioning

55-60 55-60

M Needham, Director of Commissioning

45-50 35.0-37.5 85-90

Dr A Parson, GP Chair

70-75 70-75

Dr R Paranjape, Principal Clinical Lead

70-75 70-75

Dr Selby, Clinical Lead

45-50 45-50

Dr Arora, Clinical Lead

45-50 45-50

Dr Essop, Clinical Lead

45-50 45-50

Dr Doyle, Clinical Lead

45-50 10 50-55

J Gunner, Lay Member

10-15 10-15

H Guntrip, Lay Member

10-15 10-15

M Lee, Lay Member 5-10 5-10

T Vandal, Hospital Doctor Member

10-15 5-10

S Nelson, Registered Nurse Member

5-10

5-10

Note: The Chief Officers salary reported in the above table represents the remuneration in respect of her work

for Bromley CCG. In addition to this Dr Bhan is remunerated for her work at Health Education England. Dr

Bhan’s total salary for the year was £170k-£175k.

87

Senior Managers’ Pension Benefits

Name and title Real increase

in pension at age 60

(bands of

£2,500)

£000

Real increase

in pension

lump sum at aged 60

(bands of

£2,500)

£000

Total accrued pension at age 60

at 31 March 2014

(bands of

£5,000)

£000

Lump sum at age 60 related

to accrued pension

at 31 March 2014

(bands of

£5,000)

£000

Cash Equivalent Transfer Value at 31 March

2013

£000

Cash Equivalent Transfer Value at 31 March

2014

£000

Real increase in Cash

Equivalent Transfer

Value

£000

Employer’s contribution

to partnership

pension

£000

A Bhan 0.0-2.5 0.0-2.5 60-65 180-185 1,184 1,224 8

S Colwill 0.0-2.5 2.5-5.0 30-35 90-95 530 588 44

M Cheung 0.0-2.5 2.5-5.0 15-20 55-60 240 276 29

M Needham 0.0-2.5 5.0-7.5 10-15 35-40 124 156 29

Note: The CCG Chair and GP clinical leads are medical practitioners and classified as off payroll. Pension

disclosures are not required and for this reason they have been excluded from the above table.

Pay Multiples

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 director in the financial year 2014/15 was

£120k-£125k. This was 3.1 times the median remuneration of the workforce, which was

£35-40k.

The 2013/14 multiple was 5.5 times the median average. This is because the highest paid

director in this 2014/15 was an interim member of staff who fell into the pay band £215k-

£220k.

In 2014/15 no employees received remuneration in excess of the highest paid member of

the Governing Body.

For the purposes of calculating pay multiples remuneration includes salary, non-consolidated

performance-related pay and benefits-in-kind. It does not include severance payments,

employer pension contributions and the cash equivalent transfer value of pensions.

88

Off-payroll Engagements

Off-payroll engagements as of 31 March 2015, for more than £220 per day and that last

longer than six months are as follows:

Total number of existing engagements as of 31 March 2015 10

All existing off-payroll engagements, outlined above, have at some point been subject to a

risk based assessment as to whether assurance is required that the individual is paying the

right amount of tax and, where necessary, that assurance has been sought.

Number

Number of new engagements or those that reached six months in duration between 1 April 2014 and 31 March 2015.

4

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

4

Number for who assurance has been requested. 0

Of which, the number:

For whom assurance has been received.

For whom assurance has not been received.

That has been terminated as a result of assurance not being received.

Number

Number of off-payroll engagements of Governing Body members with significant financial responsibility, during the financial year

4

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

4

89

SUMMARY ACCOUNTS

The summary financial statements shown here are the primary statements of the accounts

for the year 2014/15. The full set of accounts for Bromley CCG can be found at the end of

this document.

The statement of comprehensive net expenditure summarises the total spend by the CCG

over the 12 month period, showing total (gross) spend and income, and deducting income

from gross spend to give net operating costs.

The CCG has a statutory duty to keep net operating costs within an approved spending limit

known as the resource limit.

The statement of financial position shows our financial position on 31 March 2015. The top

half of the balance sheet shows the assets and liabilities of the CCG. The bottom half shows

the amount owed to, or due from the Department of Health, as CCG assets are owned by,

and liabilities underwritten by, the Secretary of State for Health.

The statement of changes in taxpayers’ equity shows the changes to the taxpayers’

investment in the CCG and reconciles the income and expenditure shown in the statement

of comprehensive expenditure with the taxpayers' equity shown in the statement of financial

position.

The cash flow statement shows the total cash received and paid out, along with changes to

working capital (debtors and creditors).

Statement of Comprehensive Net Expenditure NHS Bromley CCG

2014-15

Administrative Costs

Programme Costs Total

£'000 £'000 £'000

Other Operating Revenue (437) (1,906) (2,343)

Gross Employee Benefits 3,988 2,575 6,563

Other Costs 3,773 374,295 378,068

Net Operating Costs before Financing 7,324 374,964 382,288

Financing 0 0 0

Net Operating Costs for the Financial Year 7,324 374,964 382,288

Revenue Resource Limit 8,527 379,631 388,158

(Surplus)/Deficit (1,203) (4,667) (5,870)

90

Statement of Financial Position NHS Bromley CCG

31-Mar-15

£'000

Total Non-current Assets 143

Current Assets

Trade & Other Receivables 5,975

Cash & Cash Equivalents 23

Total Current Assets 5,998

Total Current Liabilities (25,524)

Total Non-current Liabilities 0

Total Assets Employed (19,382)

General Fund 19,382

Total Taxpayers’ Equity 19,382

Statement of Changes in Taxpayers' Equity

NHS Bromley CCG

General

Fund Revaluation

Reserve Total

£'000 £'000 £'000

CCG 2014-15

CCG Balance at 01 April 2014 (25,811) 0 (25,811)

Transfer of assets and liabilities from closed NHS bodies as a result of the 1 April 2013 transition

0

Adjusted CCG Balance at 01 April 2014 (25,811) 0 (25,811)

Changes in CCG Taxpayers’ Equity for 2014-15

Net operating costs for the financial year (382,288) 0 (382,288)

Total revaluations against revaluation reserve 0 0 0

Net Recognised CCG Expenditure for the Financial Year

(382,288) 0 (382,288)

Net funding 388,717 0 388,717

CCG Balance at 31 March 2015 (19,382) 0 (19,382)

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Statement of Cash Flows

NHS Bromley CCG

2014-15

£'000

Cash Flows from Operating Activities

Net operating costs for the financial year (382,288)

Depreciation and amortisation 22

(Increase)/decrease in trade & other receivables 2,849

Increase/(decrease) in trade & other payables (7,848)

Provisions utilised (1,438)

Increase/(decrease) in provisions 61

Net Cash Inflow (Outflow) from Operating Activities (388,642)

Cash Flows from Investing Activities (148)

Net Cash Inflow (Outflow) from Investing Activities (148)

Net Cash Inflow (Outflow) before Financing (388,791)

Cash Flows from Financing Activities

Net funding received 388,717

Net Cash Inflow (Outflow) from Financing Activities 388,717

Net Increase (Decrease) in Cash & Cash Equivalents (74)

Cash & Cash Equivalents at the Beginning of the Financial Year 97

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

23

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Statement of Accountable Officer’s Responsibilities

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

shall have an Accountable Officer and that Officer shall be appointed by the NHS Commissioning

Board (NHS England). NHS England has appointed the Chief Officer to be the Accountable Officer of

the Clinical Commissioning Group.

The responsibilities of an Accountable Officer, including responsibilities for the propriety and regularity

of the public finances for which the Accountable Officer is answerable, for keeping proper accounting

records (which disclose with reasonable accuracy at any time the financial position of the Clinical

Commissioning Group and enable them to ensure that the accounts comply with the requirements of

the Accounts Direction) and for safeguarding the Clinical Commissioning Group’s assets (and hence

for taking reasonable steps for the prevention and detection of fraud and other irregularities), are set

out in the Clinical Commissioning Group Accountable Officer Appointment Letter.

Under the National Health Service Act 2006 (as amended), NHS England has directed each Clinical

Commissioning Group to prepare for each financial year financial statements in the form and on the

basis set out in the Accounts Direction. The financial statements are prepared on an accruals basis

and must give a true and fair view of the state of affairs of the Clinical Commissioning Group and of its

net expenditure, changes in taxpayers’ equity and cash flows for the financial year.

In preparing the financial statements, the Accountable Officer is required to comply with the

requirements of the Manual for Accounts issued by the Department of Health and in particular to:

Observe the Accounts Direction issued by NHS England, including the relevant accounting and

disclosure requirements, and apply suitable accounting policies on a consistent basis;

Make judgements and estimates on a reasonable basis;

State whether applicable accounting standards as set out in the Manual for Accounts issued by the

Department of Health have been followed, and disclose and explain any material departures in the

financial statements; and,

Prepare the financial statements on a going concern basis.

To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my

Clinical Commissioning Group Accountable Officer Appointment Letter.

Dr Angela Bhan

Accountable Officer

28th May 2015

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ANNUAL GOVERNANCE STATEMENT

Governance Statement 2014/15

1. Introduction and Context

NHS Bromley Clinical Commissioning Group (Bromley CCG) was licenced from 1 April 2013

under provisions enacted in the Health & Social Care Act 2012, which amended the National

Health Service Act 2006.

As at 1 April 2014, Bromley CCG was licensed without conditions

Bromley CCG is responsible for commissioning acute hospital services, community health

services and mental health services for the population of the London Borough of Bromley

(340,805). The Princess Royal University Hospital, part of King’s Healthcare NHS

Foundation Trust, is the main provider of acute hospital services. Bromley Healthcare, a

social enterprise company provides most community health services in the Borough, and

Oxleas NHS Foundation Trust is the main provider of acute mental health services.

The CCG’s membership comprises all the GP practices (45) situated within Bromley

Borough. The CCG is accountable to its members, local people, stakeholders and NHS

England for the services it commissions and for good governance. It has set out in its

Constitution4 how it will fulfil its statutory functions as prescribed in the Health and Social

Care Act 2012, and its governance structure and management arrangements. Its mission is

to commission health services that will provide longer, healthier and happier lives for the

people of Bromley.

4 NHS Bromley Clinical Commissioning Group Constitution effective date 23 January 2013.

http://www.bromleyccg.nhs.uk/About-us/How-we-work/Pages/Our-constitution.aspx

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2. Scope of Responsibility

As Accountable Officer, I have responsibility for maintaining a sound system of internal

control that supports the achievement of the clinical commissioning group’s policies, aims

and objectives, whilst safeguarding the public funds and assets for which I am personally

responsible, in accordance with the responsibilities assigned to me in Managing Public

Money. I also acknowledge my responsibilities as set out in my Clinical Commissioning

Group Accountable Officer Appointment Letter.

I am responsible for ensuring that Bromley CCG is administered prudently and economically

and that resources are applied efficiently and effectively, safeguarding financial propriety and

regularity.

3. Compliance with the UK Corporate Governance Code

Bromley CCG is 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 CCG and best practice.

We consider that Bromley CCG is compliant with the main principles of the code in as far as

they apply to CCGs:

Leadership – the CCG is a membership organisation which is headed by a

Governing Body rather than a Board, whose statutory membership does not directly

reflect the Code’s division of board membership between executive and non-

executive directors. The Governing Body consists of 6 GPs elected by and

representing the membership, supported by 4 senior managers. It also includes 3

Lay Members and 2 Professional Members who have no other connection with the

CCG, and provide the external challenge associated with the role of the non-

executive director on a traditional board. Otherwise, the elements of leadership

provided by the chair and the roles and functions of the members of the Governing

Body are compliant with the requirements of the Code.

Effectiveness – the CCG is fully compliant with the requirements of the Code with

regard to the committee structure that underpins the Governing Body, and the

appointment of members to the Governing Body and its committees.

Accountability – The Governing Body has the same responsibilities as a traditional

board with regard to the accountability of the organisation. These are underpinned

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by a robust and transparent corporate governance system which includes sound risk

management arrangements and internal control systems, compliant with the

requirements of the Code.

Remuneration – The CCG is fully compliant with the NHS national guidance on the

remuneration of its clinical leads, most senior managers, Lay and professional

members, staff and other people who work for it. The CCG’s Remuneration

Committee agrees the remuneration packages of the Governing Body members and

is constituted to ensure that no Governing Body member is involved in deciding his or

her own remuneration, in compliance with the Code.

Relations with shareholders – Whilst the CCG does not have shareholders as such it

fully involves its membership in the formulation of its objectives, and has forged

strong links with all its other stakeholders, including patients and the local public, the

local authority, neighbouring CCGs and NHS England, its providers, and the

voluntary sector (including Healthwatch Bromley). It takes its statutory engagement

duties very seriously and considers that these fulfil the requirements of the Code.

4. 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.

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Bromley CCG – Governance Structure 2014/15

4.1 Membership Body

The Membership Body of Bromley CCG comprises a representative from each of the 45

member GP Practices and the clinical lead members of the Governing Body. It is chaired by

the Clinical Chair. It has reserved powers to itself that include agreeing the CCG

Constitution and any changes to it, setting the aims, values and overall strategic direction of

the CCG, approving the election process and appointment of the clinical leads (GP

Governing Body members), and holding the Governing Body to account. The Membership

Body has delegated management responsibility for the operation of the CCG to the

Governing Body.

The Membership Body met three times in 2014/15.

On 25 June 2014 it met formally and received the previous year’s Annual Report and held

the Governing Body to account for the responsibilities delegated to it during that period. It

also received and considered the South East London 5 year strategy in terms of what it

meant for Bromley. It received its first briefing on proposals for CCGs taking on Primary

Care Co-commissioning with NHS England, and agreed that when more detail was known

about what this would involve, it would taking a decision on its involvement by a vote of the

Information

Information

MEMBERSHIP BODY

CCG GOVERNING BODY

REMUNERATION

COMMITTEE AUDIT COMMITTEE

INTEGRATED GOVERNANCE

COMMITTEE

CLINICAL EXECUTIVE GROUP

QUALITY ASSURANCE

SUB COMMITTEE

CLUSTER

CLUSTER

CLUSTER

SESSIONAL GPs

Recommendations

Recommendations

Recommendations

97

membership. It also considered how to strengthen membership involvement in the light of

the outcome of the 360° survey of the CCG. 35 of the 45 member practices were

represented at that meeting.

On 15 October 2014 the Membership Body met in an informal development session to

consider the need and proposals for Primary Care transformation in Bromley, including the

development of local care networks. 38 of the 45 member practices attended the seminar.

The Membership Body met formally again on 26 November 2014. At this meeting the main

focus was on the CCG’s strategic planning and commissioning intentions for 2015/16. In

particular, they considered the direction of community services provision in Bromley in the

light of the current contract expiring in March 2016. They also gave further consideration to

submitting a bid to NHS England for Primary Care co-commissioning in 2015/16, and

favoured opting for full delegated responsibility following an initial period of joint

commissioning. Those present (31 of the 45 practice members were represented at the

meeting) agreed that the final decision on the submission should be taken following a

membership vote. The vote was concluded on 21 January 2015 and resulted in a clear

decision to proceed to Option 3 (delegated responsibility), via a preliminary period at Option

2 (joint commissioning). The membership recognised that changes to the Constitution would

be required to facilitate implementation of this option.

Although not a formal part of the CCG’s governance structure, three geographical cluster

groups of practices and a group of salaried and locum GPs, chaired by clinical leads, meet

on a bi-monthly basis to receive information about the CCG and to feed into the strategic

development of commissioned services. Their contribution has been strengthened during

the year by sending the minutes of these meetings to the Clinical Executive Group, and

through the representation of their views by the clinical leads at the Governing Body,

committees and working groups.

4.2 Governing Body

The Governing Body is the main decision taking part of the CCG. Its responsibilities,

functions and membership are set out in the CCG’s Constitution, including the scheme of

delegation and the powers reserved to it. Its clinical chair has been elected by Bromley

GPs. Its membership includes a principal clinical lead and four further clinical leads who are

local GPs elected by their Bromley peers. There are three lay members, one of whom is

also the deputy chair of the CCG. There is a hospital doctor member and a registered nurse

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member in line with statutory requirements. The Chief Officer, Chief Finance Officer,

Director of Healthcare Reform and Director of Quality, Governance and Patient Safety

completed the voting membership of the Governing Body in 2013/14. The names of voting

members and other non-voting attenders are set out in the Annual Report above.

The Governing Body met bi-monthly in public on seven occasions in 2013/14, and all of its

meetings were quorate. Its agendas and papers are available on the CCG’s website -

http://www.bromleyccg.nhs.uk/About-us/who-we-are/Pages/Governing-Body-Papers.aspx

During 2014/15 the Governing Body undertook the following business in line with the duties

and functions set out in the CCG’s Constitution:

Governance

Endorsed the CCG’s Annual Report, Annual Governance Statement and Annual

Accounts for 2013/14 and received the Annual Audit Letter

Hosted a public Annual General Meeting in September 2014 at which it presented its

report on achievements during 2013/14 and its plans for 2014/15.

Received 6-monthly reports from the Audit Committee on the CCG’s governance

arrangements and systems of control, including risk management

Received and reviewed the updated Corporate Risk Register (Assurance

Framework) on a quarterly basis

Considered risk and performance at every meeting through the receipt and review of

the integrated governance report, finance report and quality report and the minutes of

the Integrated Governance Committee

Closely monitored the management of the Princess Royal University Hospital

(Bromley’s main acute provider) by Kings College Hospital NHS Foundation Trust

Ratified new and reviewed Patient Group Directions for GP Practices in Bromley and

Bromley Healthcare

Received and noted the first annual report from Healthwatch Bromley

Received reports on public and patient communications and engagement with the

CCG

Received Annual Reports on adult and child safeguarding in Bromley

Received the Bromley Public Health Annual Report

Received, noted and managed appropriately the register of interests of members of

the Governing Body

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Strategy and Planning

Approved and adopted the Integrated Plan for 2014/16

Endorsed the Operating Plan for 2015/16

Approved the budgets for 2014/15

Received, considered and approved the South East London Commissioning Strategy

2014-2019 (“Our Healthier South East London”)

Approved business cases for new and redesigned care pathways

Approved new contracts for health services within the borough

Received and endorsed proposals for the use and administration of the Better Care

Fund

Agreed proposals for the implementation of Primary Care Co-commissioning in

accordance with the decision of the membership

Approved, as the lead CCG, a procurement strategy for the re-provision of NHS 111

services in South East London

Approved a Section 75 agreement with the London Borough of Bromley for joint

working

Endorsed a System Transformation Programme 2015-2020 providing an out of

hospital strategy and model of care for development over the next 5 years

Supported proposed priorities for the pan London Transformation Programme

involving all London CCGs and approved governance arrangements to support the

programme

Endorsed proposals for reviewed primary care commissioned services (GP members

were excluded from participating in this agenda item which was led by the Lay

Deputy Chair)

The Governing Body assessed its own performance and effectiveness at a seminar

development session in February 2014 against the six principles set out in the Code of

Governance for NHS Clinical Commissioning Groups published in November 20135.

Progress was made during 2014/15 with areas that had been identified for development and

a review using the newly published Good Governance Institute’s CCG Maturity Matrix,

endorsed by NHS England, is planned for April 2015.

5 “NHS clinical commissioning groups code of governance” November 2013, Institute of Chartered Secretaries

and Administrators (ICSA)

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During 2014/15 the Clinical Chair carried out performance appraisals for all Governing Body

members which included identifying areas for personal development. The Clinical Chair was

appraised by the Chief Officer.

4.3 Audit Committee

The Audit Committee fulfils the statutory functions as set out in the CCG’s Constitution and

its terms of reference as ratified by the Governing Body. It is chaired by the lay member

(governance) and consists only of the other two lay members and the hospital doctor

member of the Governing Body (for names of the members in 2014/15 see the Annual

Report above). It reviews the corporate and clinical governance arrangements of the CCG

(including information governance), and the financial and organisational management

systems. It monitors assurance mechanisms including the work of internal and external

audit, local counter fraud services, debt and waiver management. It reviews the CCG’s risk

management arrangements to ensure that risks associated with the corporate strategic

objectives and other organisational risks are identified and properly addressed. It met on

five occasions during 2014/15, and all of its meetings were quorate. It does not meet in

public but its minutes are received by the Governing Body, to whom it also provides 6-

monthly reports that are published on the CCG’s website.

In accordance with its terms of reference, during 2014/15 the Audit Committee:

Received and noted the annual report, annual governance statement and annual

accounts of the CCG for 2013/14, its first year of operation

Agreed the internal audit arrangements and annual audit plan.

Noted the appointment of the external auditor

Received internal and external audit update reports, including completed audit

reports and monitored the implementation of audit recommendations by CCG

management

Received regular reports on proactive and reactive counter fraud management,

including monitoring progress on an alleged procurement fraud and resulting actions.

Monitored progress against the Information Governance Toolkit and the

arrangements of the Information Governance Working Group and Integrated

Governance Committee for addressing the CCG’s Information Governance

requirements

Considered the updated Corporate Risk Register (Assurance Framework) before its

submission to the Governing Body

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Tested the CCG’s risk management arrangements through in depth presentations

from the directorates to the committee, which included the Clinical Quality Review

Group arrangements of the main providers, arrangements for identification and

management of the QIPP programme, and the arrangements for meeting the CCG’s

statutory requirements for patient and public engagement.

Received reports on the support provided to the CCG by South East Commissioning

Support Unit, including its internal audit assessments

Received progress reports on the negotiation of the main provider contracts for

2015/16

Monitored the progress development of a suite of CCG policies and procedures

Received reports on the Local Security Management process

Reviewed its terms of reference

Agreed its forward committee business plan for 2015/16

The Audit Committee will consider and review the draft annual report, governance statement

and annual accounts for 2014/15 at its meeting in April 2015, and the final accounts before

submission to the Department of Health in May 2015.

4.4 Remuneration Committee

The Remuneration Committee is a statutory committee of the Governing Body whose duties

are to determine the remuneration, allowances, payments for additional responsibilities, and

other benefits and conditions of members of the Governing Body and other individuals

working for the CCG who are not employed under Agenda for Change, and to report to the

Governing Body. It also agrees and makes recommendations to the Governing Body on any

redundancy or severance arrangements and payments for CCG employees. Its terms of

reference are ratified by the Governing Body. Its usual membership consists of the 3 lay

members and 2 professional members (registered nurse and hospital doctor members) of

the Governing Body. It is chaired by the lay member (Governance). When consideration

has to be given to the terms of conditions of lay members and or professional members of

the Governing Body, an alternative quorum of GP and management members of the CCG is

chaired by the clinical chair. Any member or other person attending meetings of the

Remuneration Committee are not allowed to be present during any discussion of their own

terms and conditions.

The Remuneration Committee met once during 2014/15, on 24 April 2014. This meeting

was quorate and the following business was undertaken:

102

Review of the CCG’s restructuring proposals in line with the Organisational Change

Policy, including the approval of proposed potential redundancy payments.

Approved changes to the remuneration of the Lay Member (Patient and Public

Engagement) and of the registered nurse member. (this decision was taken by an

alternative Quorum which excluded lay and professional members)

4.5 Integrated Governance Committee

The Integrated Governance Committee is established in the CCG’s Constitution as a

committee of the Governing Body. It is chaired by a lay member of the Governing Body. Its

terms of reference are ratified by the Governing Body. It met monthly during 2014/15 and all

its meetings were quorate. Its minutes are received by the Governing Body.

It undertook the following roles and responsibilities during 2014/15 in line with its terms of

reference:

Receive and review the Corporate Risk Register and make recommendations to the

Governing Body

Monitor and review the delivery of recurrent financial balance, the achievement of

key activity and performance targets, the management of provider contracts

Monitor and review the adequacy and appropriateness of QIPP plans and the group’s

performance against its QIPP targets

Monitor and review the performance of the CCG’s providers against key quality and

safety indicators and make recommendations to the governing body

Give particular consideration to the performance, quality and safety of local acute

services in the light of the acquisition of the Princess Royal University Hospital by

King’s College Hospital NHS Foundation Trust

Provide oversight of the adequacy and appropriateness of the CCG’s arrangements

for information governance as set out in the information governance framework

Monitor and review the CCG’s planning arrangements for 2015/16 and procurement

schedule

Monitor progress towards the implementation of primary care co-commissioning with

NHS England from April 2015.

Assess the CCG’s capability to meet its information requirements, including the

sufficiency and adequacy of the commissioning data it receives, and make

recommendations to the Governing Body

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Receive assurance on the quality and safety of commissioned services from the

Quality Assurance Subcommittee, including the minutes of its meetings.

Ratify new and reviewed CCG procedures and protocols, and approve new and

reviewed policies for ratification by the Governing Body.

4.6 Quality Assurance Subcommittee

The Quality Assurance Subcommittee is established in the CCG’s Constitution as a

committee of the Integrated Governance Committee and a subcommittee of the Governing

Body. It is chaired by the registered nurse member of the Governing Body. Its terms of

reference are agreed by the Integrated Governance Committee and ratified by the

Governing Body. Its minutes are received by the Integrated Governance Committee and it

may also report directly to the Governing Body. It held 11 meetings during 2014/15, all of

which were quorate.

It undertook the following roles and responsibilities during 2014/15:

provided assurance to the Integrated Governance Committee about the safety and

quality of commissioned services and that there were adequate plans in place to

respond to issues of poor quality.

monitored the implementation of the CCG’s Quality Strategy, to include patient

safety, clinical effectiveness and patient experience

advised the Integrated Governance Committee on the management of clinical risk,

including monitoring the Quality Directorate Risk Register

advised the Integrated Governance Committee on quality and clinical governance

aspects of new care pathway developments.

monitored patient complaints (received by the CCG, Local Authority and providers),

patient surveys, Quality Alerts, and Serious Incidents arising from services

commissioned by the CCG,

ensured that providers were reporting serious incidents (including never events and

near misses) according to the national guidelines, and that appropriate reports and

action plans were produced and implemented

kept under review and made recommendations to the Integrated Governance

Committee and the Governing Body on the arrangements for, and issues arising

from, safeguarding children and safeguarding adults, including monitoring

safeguarding reports produced by the London Borough of Bromley’s safeguarding

board and action plans contained therein, and ensuring representation on the

safeguarding board

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monitored reports on the quality and safety of services provided by care and nursing

homes in the Borough, including those that are not commissioned by the CCG

Monitored the requirements and provided assurance to the Integrated Governance

Committee on the performance of provider organisations in terms of the Care Quality

Commission, Monitor and any other relevant regulatory bodies

assessed and recommended to the Integrated Governance Committee and

Governing Body for ratification, the CCG’s quality strategy, quality and safety

policies, procedures, and patient group directions

received quarterly reports from Healthwatch Bromley on feedback they receive from

patients and the public

received the CCG’s Medicines Management Annual Report

received reports on and monitored the CCG’s compliance with anti- terrorism

requirements (Prevent)

5. Risk Management Framework

Bromley CCG has set out its approach to risk management in its Risk Management Strategy

as ratified by the Governing Body at its first meeting in April 2013. This aims to deliver a

pragmatic and effective multi-disciplinary approach to risk management, which is

underpinned by a clear accountability structure throughout the organization. The aim is to

continually improve the quality and safety of health service commissioning through the

identification, prevention, control and mitigation of risks. The Strategy recognises the need

for robust systems and processes to support continuous programmes of risk management,

enabling all staff, clinicians, the governing body, committees and working groups to integrate

risk management into their daily activities. It outlines the approach the CCG will take to

ensure that it develops throughout the organisation effective risk management processes,

which will enable the CCG to deliver its objectives and meet its statutory requirements. It

forms a key component of the CCG’s overall governance arrangements.

The CCG employs effective techniques for risk management, supported by good information

systems. It discusses and shares risk information openly at its Governing Body meetings,

and in greater, operational detail within its Integrated Governance Committee, Quality

Assurance Subcommittee, Clinical Executive Group meetings, directorate meetings, working

group meetings and line management meetings. It provides support and training for staff

and individuals working for the CCG at an appropriate level.

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It has adopted the principles of the Australia/New Zealand Management Standard (AS/NZS

4360:1999) in its approach to risk management. This is a generic model for identifying,

prioritizing and dealing with risks at corporate level and throughout the organization. It

provides an effective means of controlling and mitigating the risks associated with the

delivery of commissioned services, and the achievement of corporate objectives. The CCG

has adopted a toolkit that provides all staff and individuals working for it with the awareness

and understanding of effective risk management, and their responsibilities in respect of risk

management and assurance.

The Corporate Risk Register, or Assurance Framework, provides this assurance, and

enables the Governing Body to be assured that the controls applied in the mitigation of risk

are operating effectively. The Corporate Risk Register is reviewed at least quarterly and is

owned by the members of the Clinical Executive Group. The Group also requires risk

registers to be compiled, regularly reviewed and updated at directorate level. Directorate

level risk registers are themselves underpinned by appropriate operational risk registers (e.g.

the Information Governance Risk Register) and risk assessments are undertaken at the very

beginning of any strategic commissioning development and procurement exercise and kept

under review.

During 2014/15 the CCG implemented a Quality Impact Assessment tool to support its

assessment of risk associated with new strategic service developments. The tool provides a

means for assessing risks to the quality and safety of proposed new and revised care

pathways and is an integral component of the business case preparation. Also included in

the business case preparation process are templates for undertaking equality and privacy

impact assessments as set out in the CCG’s policies and procedures6, and a template for

the management of potential conflicts of interest where GPs might be potential service

providers7 A preliminary risk assessment of the business case at the initial stage includes

assessment of all these elements, and financial risks continue to be assessed separately

and reported up to the Clinical Executive Group, committees and/or Governing Body as

appropriate.

The risk appetite of the organization is considered in respect of each of the risks to its

strategic objectives as identified in the Corporate Risk Register. This assessment is

6 Equality and Diversity Policy – Bromley CCG – 13/03/2014

Privacy Impact Assessment Procedure – Bromley CCG – 6/02/2014 7 Conflict of Interests Policy – Appendix 3 - Bromley CCG – 30/01/2015

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undertaken at the beginning of the year in respect of the strategic plan and objectives for the

year, and subsequently reviewed at least quarterly. It is expressed in the Corporate Risk

Register by the target residual risk ratings which will be achieved when all planned mitigating

actions have been completed. The Governing Body also identifies “zero-tolerance risks”

which are those about which they wish to be constantly aware, even when the residual risk

rating falls below 9, which is the score below which risks are generally agreed to be

acceptable. Zero tolerance risks are proposed by directors, endorsed by the Clinical

Executive Group and accepted by the Governing Body. In 2014/15 the CCG identified risks

arising from safeguarding and from conflicts of interest as zero tolerance risks.

During 2014/15 the financial, performance, quality and safety composite risk associated with

King’s management of the Princess Royal University Hospital, Bromley’s main provider of

acute services, was the most significant risk to the CCG’s Corporate Objectives. It remained

at a residual risk rating score of 16 at the end of the year, after taking into account mitigating

controls. These controls included very detailed monitoring of finance, performance and

quality by the Integrated Governance Committee and the Governing Body, supported by the

Quality Assurance Subcommittee’s close scrutiny of the outcome of the Trust’s monthly

Clinical Quality Review Group. An Executive Leaders Group was established to provide

whole system oversight, and the CCG provided additional funding (£1.2 m) in Quarter 4 to

increase the hospital workforce. The CCG’s controls were reinforced by NHS England’s

“Star Chamber” assurance process. A Monitor Report and CQC Investigation are due early

in 2015/16 and the CCG is working closely with both. The CCG will oversee the recovery

and cost improvement programmes.

Financial, quality and governance (Conflicts of Interest) risks from proposals for the CCG to

take over from NHS England the commissioning of primary care, and to commission some

specialised services were also reflected in the corporate risk register by red rated residual

risks. By the end of the year, the agreement with NHS England on the arrangements for

joint commissioning of GP services (to start in 2015/16), and the adoption of measures to

strengthen the CCG’s arrangements for the management of conflicts of interest had reduced

the residual rating to an amber risk.

In the event, no proposals were developed by NHS England in 2014/15 to delegate the

commissioning of specialized services to CCGs and this was reflected in a reduction of the

residual rating to amber. The possible development of proposals in 2015/16 means that this

risk will stay on the register and be kept under review.

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The CCG places great importance on the reporting of incidents both within its own

organization and by its commissioned providers. It has adopted an Accident and Incident

Reporting Procedure8 that applies to all staff and individuals working for it. This provides an

open and non-judgmental approach to the reporting of adverse incidents. It recognises that

incidents may occur because of systems errors or failures rather than individual error. The

CCG ensures that timely and fair action is taken to manage incidents when they occur and to

help prevent such incidents occurring in the future by ensuring appropriate reporting and

action on recommendations. This includes developing a culture that is free from the

assumption of blame within the CCG, encouraging learning from incidents and making

improvements in working conditions. This culture is further reinforced by the arrangements

for staff set out in the CCG’s Whistleblowing Policy9.

The CCG has developed a Public Advisory Group (PAG) consisting of local patients and

members of the public with general and/or particular experience of local health services.

The PAG provides appropriate representatives to join working groups consisting of clinicians

and managers tasked with developing new service initiatives, including identifying and

managing potential risks. The CCG also provided a forum at its public Annual General

Meeting on 22 September 2014 where members of the public were given the opportunity to

contribute their ideas and needs to the strategic planning and risk management process.

This consisted of setting up a number of stalls dedicated to different areas of service

provision including diabetes, cardiology, long-term conditions and medicines management to

receive feedback from members of the public. The CCG also monitors, through the Quality

Assurance Subcommittee, complaints from patients and the public arising from its

commissioned services, its own business, Local Authority commissioned services, and

responses to the Care Quality Commission and Monitor. It also receives quarterly reports

from Healthwatch Bromley on health associated topics raised with them by members of the

public.

6. Internal Control Framework

A system of internal control is the set of processes and procedures in place in the CCG to

ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the

8 Accident and Incident Reporting and Management Procedure – 06/02/2014

9 Whistleblowing Policy – Bromley CCG – 13/03/2014

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risks, to evaluate the likelihood of those risks being realised and the impact should they be

realised, and to manage them efficiently, effectively and economically.

The system of internal control allows risk to be managed to a reasonable level rather than

eliminating all risk; it can therefore only provide reasonable and not absolute assurance of

effectiveness.

6.1 Control Mechanisms - The Corporate Risk Register (Assurance

Framework)

The Corporate Risk Register is completely reviewed annually in line with the strategic

objectives of the organization as identified in its annual planning process and owned by the

Clinical Executive Group. It is subsequently reviewed quarterly, with individual risks being

updated sooner if required. New and reviewed versions of the Corporate Risk Register, as

agreed by the Clinical Executive Group are considered by the Integrated Governance

Committee as part of the process of assurance that it provides to the Governing Body on the

management of risk across the whole range of the CCG’s business, including finance,

performance, quality and safety. The Committee also monitors the on-going management of

these risks through its receipt and scrutiny of monthly Integrated Governance Reports. The

Audit Committee also receives updated iterations of the Corporate Risk Register, as part of

its overview of the adequacy and effectiveness of the whole risk management system. It

draws on the identification of key risks as reflected in the Corporate Risk Register to

determine the programme of internal and external audit which provides further assurance to

the Governing Body.

The Corporate Risk Register is underpinned by directorate risk registers that are reviewed

monthly, drawing on the project/service risk registers as appropriate. Directors decide which

risks on this register need to be included in the Corporate Risk Register because they are

relevant to the CCG’s strategic objectives.

This process provides an Assurance Framework that is summarised in the following

diagram.

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Risk Management Structure/Assurance Framework

Governing Body (GB)

Receives the Corporate Risk Register

which is updated quarterly

Integrated Governance

Committee (IGC)

Reviews CRR against monthly

Integrated Governance, Finance

& Quality Reports

Audit Committee

Reviews adequacy of CRR as an

internal control mechanism on

quarterly basis. Uses CRR to

identify risk areas for “deep dives”

and for audit planning

Corporate Risk Register (CRR)

The CRR is completely refreshed at the beginning of each financial year to reflect the CCG’s

strategic objectives as set out in strategic and operational plans for the year. It is subsequently

reviewed quarterly and submitted to the IGC, GB and Audit Committee. Individual risks can be

reviewed as appropriate at any time.

Clinical Executive Group

Meets monthly to review

management of key risks and

agree and take ownership of

CRR

Directorate Risk Registers

Directorate Risk Registers are updated monthly for each directorate (Quality and

Governance, Health System Reform, Finance). Risks at this level identified by directors as

relevant to the CCG’s strategic objectives are elevated to the CRR.

Project/Service Risk Registers

Project and Service level risk registers are produced as required in accordance with the Risk

Management Strategy and fed into the Directorate Risk Registers as considered appropriate

by the managers who are the risk owners and their director.

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In addition to the control mechanisms described above, the CCG has arrangements in place

that are aimed at deterring and minimising risks arising. For example, it commissions a pro-

active counter fraud programme from TIAA that raises staff awareness of potential frauds

and provides a secure reporting process underpinned by the CCG’s Whistle Blowing Policy.

TIAA also provides support to the CCG on the local security management arrangements of

the working environment, to protect individuals working for the CCG. The CCG has an

Incident Response and Business Continuity Policy10 that includes arrangements for local

incident management, with the object of minimising possible risks to the disruption of the

CCG’s business.

In 2014/15, CCG internal controls identified one incident of potential fraud within the

organisation. Working closely with the Local Counter Fraud Service and NHS Protect, the

investigation is continuing into the alleged fraud in conjunction with the Metropolitan Police.

Whilst the fraud is not considered to be a material breach of controls, a wide ranging review

has been completed and appropriate actions have been implemented to strengthen the

controls to minimise any future potential of this fraud re-occurring. These include:

A review of all existing budget holder delegated powers and limits

Additional controls on the approval and set up of suppliers, including local sign off by

the CCG finance team

Information Governance compliant access to information required to validate invoices

This incident is actively monitored by the Audit Committee, which receives regular reports on

the progress of the investigation.

7. Information Governance

We place a high importance on ensuring that there are robust information governance

systems and processes in place to help protect patient and corporate information. We have

established an information governance management framework together with processes and

procedures in line with the information governance legislation and Department of Health

policies guidance and procedures. Information Governance is an integral part of our Risk

Management Assurance Framework.

10

Bromley CCG Incident Response and Business Continuity Policy, Plans & Procedure – 19/03/2015

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Our Chief Finance Officer is accountable for information risk as the ‘Senior Information Risk

Owner’ (SIRO). The Chief Officer fulfils the role of Caldicott Guardian and acts as the

conscience of the CCG on confidentiality matters.

7.1 Our Information Governance Framework

Bromley CCG has appropriate systems and processes and expertise in place to ensure

continued compliance with the ever evolving national information governance landscape.

The CCG has put in place a risk based approach to Information Governance and has

established an Information Governance Working Group (IGWG) chaired by the SIRO to lead

on decision-making and the review of internal and external systems and processes that drive

the information governance agenda for the CCG. The IGWG reports into the Integrated

Governance Committee acting as the Information Governance Steering Group, chaired by a

Lay Member of the CCG.

Bromley CCG uses the NHS Information Governance (IG) Toolkit to assess and

demonstrate the effectiveness of the CCG’s internal processes and system and to satisfy the

rapidly evolving national information governance agenda relating to the management and

handling of information.

During 2014/15 we submitted a Satisfactory IG Toolkit self-assessment achieving above the

minimum required level 2 score across all the IG Toolkit requirements.

We recognise that culture is a strong influence and determinant of fair and appropriate

information risk decision making outcomes. By March 2015, all our staff had undertaken IG

Training. The SIRO has in addition undertaken additional strategic information risk

management training.

7.2 Information Governance Incidents

There were no Serious Information Governance Incidents requiring investigation (SIRI) or

further escalation through last year. We have not recorded any breaches that are of Levels

1 or 2 as defined in the Guide to Information Governance Incidents issued by the Health and

Social Care Information Centre.

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A Serious Information Governance Incident is defined as any incident involving the actual or

potential loss of personal information that could lead to identity fraud or have other

significant impact on individuals. Incidents of this type must be reported to the Department of

Health and the Information Commissioner’s Office.

Bromley CCG has appropriate processes for incident reporting and investigation of serious

incidents to ensure compliance with our legal obligations and the Department of Health

policies guidance and procedures. Our staff are encouraged to report incidents and ‘near

miss’ events so they can be investigated and so that we can reduce the risk of such

incidents in future.

7.3 Information Governance Planning

Information Governance management within Bromley CCG is subject to annual planning.

The CCG’s Information Governance Steering Group (IGSG) monitors the information

governance improvement and action plans on a bi-monthly basis. Key policies and

procedures are reviewed annually or when there are changes to legislation or NHS

guidance.

Bromley CCG continues to improve and further develop its approach to the management of

information risks and compliance with legislation and national information governance

standards.

The CCG’s annual information governance plan ensures that the CCG continues to handle

information in a secure way and supports the CCG’s fairness and transparency objectives

and to ensure patients are given choice to determine how their information is collected and

used.

8. Pension Obligations

As an employer with staff entitled to membership of the NHS Pension Scheme, control

measures are in place to ensure all employer obligations contained within the scheme

regulations are complied with. This includes ensuring that deductions from salary,

employer’s contributions and payments into the scheme are in accordance with the scheme

rules, and that member pension scheme records are accurately updated in accordance with

the timescales detailed in the regulations.

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9. Risk Assessment in Relation to Governance, Risk

Management & Internal Control

The Audit Committee provides the Governing Body with a means of independent and

objective review of financial and corporate governance, assurance processes and risk

management across the whole of the CCG’s activities (clinical and non-clinical). The Audit

Committee provides six-monthly reports on its findings to the Governing Body, as well as the

minutes of its meetings. In addition to its own scrutiny of internal control processes, the

Audit Committee also receives assurances from the internal and external audit process.

In March 2015, the Audit Committee received and considered an internal audit report on

Risk Management in the CCG. The internal auditor’s (KPMG) report provided “significant

assurance with minor improvement opportunities” on the CCG’s risk management

arrangements. All the recommendations (5) for improvement were accepted by

management and action plans provided for their implementation. They included a formal

review of the Risk Management Strategy to bring it in line with the role of the Integrated

Governance Committee, and including separate assessments of “rolling” risks that continue

beyond the year end where the long term risk is different from the annualised risk.

The external auditor (PwC) provides additional assurance to the Audit Committee on the

CCG’s governance arrangements. In July 2014 it provided its Annual Audit Letter which was

received by the Audit Committee and Governing Body. This included an unqualified opinion

on the CCG’s financial statements for the year ended 31 March 2014, and a modified

opinion on the CCG’s Remuneration Report (based on the lack of availability of pension data

relating to GP Governing Body members). No significant control deficiencies were identified.

An unqualified regularity opinion (use of CCG’s money as Parliament intended) was given.

An unqualified value for money conclusion was issued. No areas of concern were identified

with the Annual Governance Statement 2013/14.

The CCG is confident that, with the robust arrangements it has in place, there is no

unmanageable risk to governance, risk management and internal control within the

organisation or to its compliance with its licence as a clinical commissioning group.

It has, however, agreed to keep a key potential governance risk, the management of the

conflicts of interest, as a zero tolerance risk on its Corporate Risk Register. With a residual

risk rating score of 8 at the end of 2014/15, this risk is within the CCG’s agreed level of

acceptability. This rating has been achieved by reviewing the CCG’s Conflict of Interests

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Policy to incorporate guidance issued by NHS England in December 2014 which strengthens

arrangements for the management of conflicts of interest as a result of the CCG taking on

primary care co-commissioning with NHS England from April 2015.

The implementation of primary care co-commissioning, jointly with the other five CCGs in

South East London and with NHS England also constituted an enhanced risk to the

governance of the CCG which it has addressed through arrangements for a Joint Committee

for Primary Care Co-commissioning, which were scrutinised and approved by NHS England

in the final quarter of 2014/15.

The CCG has also identified the implementation of the South East London 5-year

Commissioning Strategy (“Our Healthier South East London”) as a potential risk to its

governance arrangements. The CCG is working with the five other CCGs in South East

London to establish governance arrangements that support the continuing accountability of

the individual CCGs for the health services within their respective London boroughs that

might be affected by the strategy.

Proposals, as yet undefined, for the co-commissioning with NHS England of specialised

services have also been identified as constituting a potential risk to the CCG’s governance

arrangements and financial stability. This will be resolved through engagement with NHS

England in 2015/16.

10. Review of Economy, Efficiency and Effectiveness of the Use

of Resources

The CCG is committed to delivering value for money to ensure that it gets the best value for

money in terms of economy (at the lowest cost), efficiency (done the right way) and

effectiveness (achieving its goals).

The Integrated Governance Committee is a committee of the Governing Body and meets

monthly to consider the use of resources in the CCG. The committee receives regular

reports on quality, finance and performance and holds the CCG to account to ensure that

resources are used economically, efficiently and effectively. The minutes of the meeting are

reported to the Governing Body.

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The CCG has a clear governance structure in the development of new initiatives and

redesign of existing services to ensure that all business demonstrates the best use of

resources and value for money. The Project Management Office (PMO) supports the

Programme Leads in developing business cases ensuring they meet the objectives of the

CCG whilst demonstrating value for money. The PMO is also responsible for monitoring

projects to ensure their effectiveness reporting to the CCG Programme Delivery Group.

The process for approval is set out in the CCG scheme of delegation, approved by the

Governing Body, to ensure that there is appropriate scrutiny at all levels and that decision

making is transparent and clearly documented. This is supported by the CCG procurement

policy to ensure that it follows good procurement practice to achieve the best value for

money.

The role of the Audit Committee, in critically reviewing the CCG corporate and clinical

governance processes, includes gaining assurance in areas such as the risk management

system and performance management systems support the CCG in securing Economy,

Efficiency and Effectiveness of the Use of Resources.

The internal audit arrangements and internal audit plan for 2014/15 are reviewed, agreed by

and monitored by the Audit Committee. The work carried out by Internal Audit provides an

independent and objective assessment of the CCG’s risk management, governance and

control systems and how they support the CCG’s objectives.

The Bromley CCG Operating Plan for 2014/15 set financial targets including a net 1.5%

surplus of £5.9m and a QIPP (Quality, Innovation, Productivity and Prevention) savings

target of £12m. The plan was subjected to independent scrutiny by NHS England, having

been signed off by the CCG Governing Body. The CCG met its financial targets and

delivered 98% of its savings plans for the year.

11. Review of the Effectiveness of Governance, Risk Management

and Internal Control

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

internal control within the clinical commissioning group.

Capacity to Handle Risk

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The risk management process is led by the Clinical Executive Group, and all risks to the

CCG’s strategic objectives are owned by the appropriate director reporting to the

Accountable Officer. This process is overseen by the Governing Body, supported by

assurance from the Integrated Governance Committee. The Director of Quality, Governance

and Patient Safety is also responsible for co-ordinating the management of the CCG’s risk

management process across the whole organisation, ensuring that the process is effective,

robust, and up-to-date. The Audit Committee provides assurance to the Governing Body on

the appropriateness and sufficiency of this process.

Risk management training for all CCG staff is provided through the Quality, Governance and

Patient Safety directorate. This is based on the Risk Management Toolkit which is available

on a shared drive to all staff and gives detailed written guidance on effective risk

management at all levels within the organisation. The Head of Corporate Affairs and Risk

Manager provide training and guidance to staff on an individual basis where a specific need

is identified, and as part of the induction training of every new member of staff. A risk

management development session for all staff was provided in July 2014, by an independent

risk management specialist (Amberwing) and annual refresher sessions are planned form

2015. Training for the Head of Corporate Affairs and Risk and Governance Manager is

provided externally.

The CCG’s risk management arrangements are a standing item in the CCG’s annual internal

audit plans. This provides regular independent assurance and a source of benchmarking

against good practice. Our external training provider also provides a source of updating

against best practice standards.

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 Bromley CCG who

have responsibility for the development and maintenance of the internal control framework. I

have drawn on performance information available to me. My review is also informed by

comments made by the external auditors in their annual audit letter and other reports,

including internal audit reports.

The Corporate Risk Register and Assurance Framework itself provides me with evidence

that the effectiveness of controls that manage risks to Bromley CCG achieving its principal

objectives have been reviewed.

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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, the Integrated

Governance Committee and the Quality Assurance Subcommittee. Plans to address any

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

My review has been informed by the six monthly reports and minutes of the Audit

Committee, reports and minutes of the Integrated Governance Committee and reports from

the Quality Assurance subcommittee as received and monitored by the Governing Body. I

have taken account of the internal audit reports received and monitored by the Audit

Committee. Actions have been put in place to address any issues as identified earlier in this

report. I have also taken into account the opinions of the external auditor as expressed in

the Annual Audit Letter. No significant internal control issues or gaps in control have been

identified.

Following completion of the planned audit work for the financial year for Bromley CCG, the

Head of Internal Audit issued an independent and objective opinion on the adequacy and

effectiveness of the clinical commissioning group’s system of risk management, governance

and internal control. The Head of Internal Audit concluded that:

Basis of opinion for the period 1 April 2014 to 31 March 2015

Our internal audit service has been performed in accordance with KPMG's internal audit

methodology which conforms to Public Sector Internal Audit Standards (PSIAS). As a result,

our work and deliverables are not designed or intended to comply with the International

Auditing and Assurance Standards Board (IAASB), International Framework for Assurance

Engagements (IFAE) or International Standard on Assurance Engagements (ISAE) 3000.

PSIAS require that we comply with applicable ethical requirements, including independence

requirements, and that we plan and perform our work to obtain sufficient, appropriate

evidence on which to base our conclusion.

Roles and responsibilities The Governing Body is collectively accountable for maintaining a sound system of internal

control and is responsible for putting in place arrangements for gaining assurance about the

effectiveness of that overall system.

The Annual Governance Statement (AGS) is an annual statement by the Accountable

Officer, on behalf of the Governing Body, setting out:

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how the individual responsibilities of the Accountable Officer are discharged with

regard to maintaining a sound system of internal control that supports the

achievement of policies, aims and objectives;

the purpose of the system of internal control as evidenced by a description of the risk

management and review processes, including the Assurance Framework process;

and;

the conduct and results of the review of the effectiveness of the system of internal

control including any disclosures of significant control failures together with

assurances that actions are or will be taken where appropriate to address issues

arising.

The Assurance Framework should bring together all of the evidence required to support the

AGS.

The Head of Internal Audit (HoIA) is required to provide an annual opinion in accordance

with PSIAS, based upon and limited to the work performed, on the overall adequacy and

effectiveness of the organisation’s risk management, control and governance processes (i.e.

the system of internal control). This is achieved through a risk-based programme of work,

agreed with Management and approved by the Audit Committee, which can provide

assurance, subject to the inherent limitations described below.

The purpose of our HoIA opinion is to contribute to the assurances available to the

Accountable Officer and the Governing Body which underpin the Governing Body’s own

assessment of the effectiveness of the system of internal control. This opinion will in turn

assist the Governing Body in the completion of the AGS, and may also be taken into account

by other regulators to inform their own conclusions.

The opinion does not imply that the HoIA has covered all risks and assurances relating to

the organisation. The opinion is substantially derived from the conduct of risk-based plans

generated from a robust and Management-led Assurance Framework. As such it is one

component that the Governing Body takes into account in making its AGS.

A further component will be the assurances provided on the operation of the systems of

internal control the service organisations which provide financial services on behalf of the

CCG during 2014/15 as follows:

• NHS South Commissioning Support Unit (Deloitte);

• NHS Shared Business Service (Grant Thornton); and

• McKesson: NHS Electronic Staff Records (PwC).

There are no issues raised in the ISAE3402 Service Auditor Reports provided by the

auditors of the above organisations that impact on the Head of Internal Audit Opinion

Opinion

Our opinion is set out as follows: basis for the opinion; overall opinion; and commentary.

The basis for forming our opinion is as follows:

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An assessment of the design and operation of the underpinning Assurance

Framework and supporting processes; and

An assessment of the range of individual assurances arising from our risk-based

internal audit assignments that have been reported throughout the period. This

assessment has taken account of the relative materiality of these areas.

Our opinion based for the period 1 April 2014 to 31 March 2015 is that:

‘Significant with minor improvements’ assurance can be given on the overall

adequacy and effectiveness of the organisation’s framework of governance, risk

management and control.

Commentary

The commentary below provides the context for our opinion and together with the opinion

should be read in its entirety. Our opinion covers the period 1 April 2014 to 31 March 2015

inclusive, and is based on the six audits we completed in 2014/15. The design and

operation of the Assurance Framework and associated processes

Overall our review found that the Assurance Framework in place is founded on a systematic

risk management process and provides appropriate assurance to the Governing Body.

The Assurance Framework reflects the organisation’s key objectives and risks and is

reviewed on a regular basis by the Governing Body.

The range of individual opinions arising from risk-based audit assignments,

contained within our risk-based plan that have been reported throughout the year

We issued one ‘partial assurance with improvements required’ assurance ratings in respect

of 2014/15 assignments. This related to our review of business case reporting. There were

no high priority recommendations raised as part of this review and we are satisfied that

management will implement the recommendations raised in the review. The assurance

rating from this review does not prevent us from issuing a ‘significant with minor

improvements’ assurance opinion in respect of the overall adequacy and effectiveness of the

organisation’s framework of governance, risk management and control.

KPMG LLP

Chartered Accountants

London

22 May 2015

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During the year, the Internal Auditor issued six audit reports. Five provided significant

assurance with minor improvement opportunities. One gave partial assurance with

improvements required:

Business Case Development and Reporting – I am satisfied that appropriate action

has already been planned or taken to address the recommendations for improvement

as detailed in this audit report.

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

Data Quality

In line with the need to know principles set out in the Caldicott 2 Information Governance

Review Report, the CCG ensures that information presented to the Governing Body and

other governance forums does not identify individuals and is fully anonymised.

Senior Management diligently review information to be set out in governance and decision

making information prior to consideration and presentation to the relevant governance

forums.

The quality of information that the Governing Body and other governance forums receive to

consider and direct decision making is also assured through the service level specification

arrangements with the South East Commissioning Support Unit and the use of contractual

arrangements with the commissioned providers.

Business Critical Models

The Macpherson Report on the review of quality assurance (QA) of Government Analytical

Models set out the components of best practice in QA making eight key recommendations.

Bromley CCG recognises the importance of this and has been working with partners to

ensure appropriate QA processes are in place across its analytical work.

With other CCGs in South East London, the CCG has undertaken a wide ranging review of

the current Business Intelligence services provided by the South East Commissioning

Support unit. The result of this are revised service specifications and performance indicators

to ensure the quality of information received. The CCG will continue to work with the SECSU

in the further development of the models, ensuring compliance with the standards set out in

the Macpherson report.

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In 2014/15, work has also continued on the development the financial model to support the

South East London Five Year Strategy. The model brings together wide-ranging expertise

from all stakeholder organisations in South East London. This includes drawing upon clinical

input from the clinical leadership groups covering the key priority areas set out in the

strategy.

This is overseen by the Senior Responsible Officer and supported by clear governance

structure. This includes the finance leads group attended by the lead finance officers from all

commissioner and provider organisations across South East London, as well as Local

Authorities. This group is responsible for ensuring that there are effective processes

underpinning the model, including appropriate guidance, documentation and training, as well

as sharing best practice across disciplines and organisations.

Data Security

The Caldicott 2 Information Governance Review Report published in May 2013 advised a

stronger focus on the scope of what constitutes a data breach to include any breach of the

eight (8) principles of the Data Protection Act.

The CCG has not recorded any breaches that are of Level 1 / Level 2 categories as defined

in the NHS Guide to Information Governance Serious Incidents Reporting issued by the

Health and Social Care Information Centre in 2013 (i.e. no Serious Information Governance

Incident Requiring Investigation (SIRI) and/or further escalation occurred during the 2014/15

governance cycle).

Discharge of Statutory Functions

During establishment, the arrangements put in place by Bromley CCG and approved by

NHS England as part of the authorisation process, were developed in line with the detailed

guidance issued by the then NHS Commissioning Board, produced with extensive expert

external legal input, to ensure compliance with the all relevant legislation. That legal advice

also informed the matters reserved for Membership Body and Governing Body decision and

the scheme of delegation.

Bromley CCG has reviewed all of the statutory duties and powers conferred on it by the

National Health Service Act 2006 (as amended) and other associated legislative

requirements and regulations. As a result, I can confirm that the CCG is clear about the

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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

No significant internal control issues have been identified.

Dr Angela Bhan

Accountable Officer

28 May 2015

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Independent auditors’ report to the Members of NHS Bromley Clinical Commissioning Group

Report on the financial statements

Our opinion

In our opinion the financial statements, defined below:

give a true and fair view, of the state of the Clinical Commissioning Group’s affairs as at 31 March 2015 and of its net operating costs and cash flows for the year then ended 31 March 2015; and

have been properly prepared in accordance with the accounting policies directed by the NHS Commissioning Board with the approval of the Secretary of State as being relevant to the National Health Service in England.

This opinion is to be read in the context of what we say in the remainder of this report.

What we have audited

The financial statements, which are prepared by NHS Bromley Clinical Commissioning Group (“CCG”), comprise:

the Statement of Financial Position as at 31 March 2015;

the Statement of Comprehensive Net Expenditure for the year then ended;

the Statement of Changes in Taxpayers’ Equity for the year then ended;

the Statement of Cash Flows for the year then ended; and

the notes to the financial statements, which include a summary of significant accounting policies and other explanatory information.

The financial reporting framework that has been applied in their preparation is the accounting policies directed by the NHS Commissioning Board with the approval of the Secretary of State as being relevant to the National Health Service in England.

In applying the financial reporting framework, the Accountable Officer has made a number of subjective judgements, for example in respect of significant accounting estimates. In making such estimates, they have made assumptions and considered future events.

We have also audited the information in the Remuneration Report that is subject to audit, being:

the table of salaries and allowances and senior managers and related narrative notes on page 86;

the table of pension benefits of senior managers and related narrative notes on page 87; and

the table of pay multiples and related narrative notes on page 87.

What an audit of financial statements involves

We conducted our audit in accordance with International Standards on Auditing (UK and Ireland) (“ISAs (UK & Ireland)”). An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of:

whether the accounting policies are appropriate to the CCG’s circumstances and have been consistently applied and adequately disclosed;

the reasonableness of significant accounting estimates made by the Accountable Officer; and

the overall presentation of the financial statements.

In addition, we read all the financial and non-financial information in the Annual Report and Accounts to identify material inconsistencies with the audited financial statements and to identify any information that is apparently materially incorrect based on, or materially inconsistent with, the knowledge acquired by us in the course of performing the audit. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report.

We are also required to obtain evidence sufficient to give reasonable assurance that the expenditure and income reported in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them.

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Opinions on other matters prescribed by the Code of Audit Practice

In our opinion:

the information given in the Annual Report for the financial year for which the financial statements are prepared is consistent with the financial statements;

the part of the Directors’ Remuneration Report to be audited has been properly prepared in accordance with the requirements directed by the NHS Commissioning Board with the approval of the Secretary of State.

in all material respects the expenditure and income reflected in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them.

Other matters on which we are required to report by exception

We have nothing to report in respect of the following matters where the Code of Audit Practice issued by the Audit Commission requires us to report to you if:

in our opinion, the Governance Statement does not comply with the Annual Accounts guidance 2014/15, issued on 24 February 2015 by the NHS Commissioning Board or is misleading or inconsistent with information of which we are aware from our audit;

we refer a matter to the Secretary of State under section 19 of the Audit Commission Act 1998 because the CCG, or an officer of the CCG, is about to make, or has made, a decision involving unlawful expenditure, or is about to take, or has taken, unlawful action likely to cause a loss or deficiency; or

we issue a report in the public interest under section 8 of the Audit Commission Act 1998.

Responsibilities for the financial statements and the audit

Our responsibilities and those of the Accountable Officer

As explained more fully in the Statement of Accountable Officer’s Responsibilities set out on page 92 the Accountable Officer is responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view in accordance with the accounting policies directed by the NHS Commissioning Board with the approval of the Secretary of State.

Our responsibility is to audit and express an opinion on the financial statements in accordance with Part II of the Audit Commission Act 1998, the Code of Audit Practice 2010 for local NHS bodies issued by the Audit Commission and ISAs (UK & Ireland). Those standards require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors.

This report, including the opinions, has been prepared for and only for the Governing Body of NHS Bromley CCG in accordance with Part II of the Audit Commission Act 1998 as set out in paragraph 44 of the Statement of Responsibilities of Auditors and of Audited Bodies (Local NHS bodies) published by the Audit Commission in April 2014, and for no other purpose. We do not, in giving these opinions, accept or assume responsibility for any other purpose or to any other person to whom this report is shown or into whose hands it may come save where expressly agreed by our prior consent in writing.

Conclusion on the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources

Conclusion

On the basis of our work, having regard to the guidance issued by the Audit Commission on 13 October 2014, we have no matters to report with respect to whether, NHS Bromley CCG put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources for the year ending 31 March 2015.

What a review of the arrangements for securing economy, efficiency and effectiveness in the use of resources involves

We have undertaken our audit in accordance with the Code of Audit Practice, having regard to the guidance issued by the Audit Commission on 13 October 2014, as to whether the CCG has proper arrangements for:

securing financial resilience; and

challenging how it secures economy, efficiency and effectiveness.

The Audit Commission has determined these two criteria as those necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the CCG has put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2015.

We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we undertook such work as we considered necessary to form a view on whether, in all significant respects, the Trust had put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources.

125

Our responsibilities and those of the CCG

The CCG is responsible for putting in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources, to ensure proper stewardship and governance, and to review regularly the adequacy and effectiveness of these arrangements.

We are required under Section 5 of the Audit Commission Act 1998 to satisfy ourselves that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. The Code of Audit Practice issued by the Audit Commission requires us to report to you any matters that prevent us being satisfied that the CCG has put in place such arrangements, having regard to the criteria specified by the Audit Commission on 13 October 2014.

We report if significant matters have come to our attention which prevent us from concluding that the CCG has put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources. We are not required to consider, nor have we considered, whether all aspects of the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively.

Certificate

We certify that we have completed the audit of the financial statements of NHS Bromley in accordance with the requirements of Part II of the Audit Commission Act 1998 and the Code of Audit Practice issued by the Audit Commission.

Ciaran T McLaughlin (Senior Statutory Auditor) for and on behalf of PricewaterhouseCoopers LLP Chartered Accountants and Statutory Auditors London May 2015

(a) The maintenance and integrity of the NHS Bromley CCG website is the responsibility of the directors; the work carried out by the auditors does not involve consideration of these matters and, accordingly, the auditors accept no responsibility for any changes that may have occurred to the financial statements since they were initially presented on the website.

(b) Legislation in the United Kingdom governing the preparation and dissemination of financial statements may differ from legislation in other jurisdictions.

126

Page Number

The Primary Statements:

Statement of Comprehensive Net Expenditure for the year ended 31st March 2015 127

Statement of Financial Position as at 31st March 2015 128

Statement of Changes in Taxpayers' Equity for the year ended 31st March 2015 129

Statement of Cash Flows for the year ended 31st March 2015 130

Notes to the Accounts

Accounting policies 131

Other operating revenue 135

Revenue 136

Employee benefits and staff numbers 137

Operating expenses 141

Better payment practice code 142

Income generation activities 142

Investment revenue 142

Other gains and losses 142

Finance costs 142

Net gain/(loss) on transfer by absorption 143

Operating leases 143

Property, plant and equipment 144

Intangible non-current assets 147

Investment property 147

Inventories 147

Trade and other receivables 148

Other financial assets 149

Other current assets 149

Cash and cash equivalents 149

Non-current assets held for sale 149

Analysis of impairments and reversals 149

Trade and other payables 150

Other financial liabilities 150

Borrowings 150

Private finance initiative, LIFT and other service concession arrangements 150

Finance lease obligations 150

Finance lease receivables 150

Provisions 151

Contingencies 152

Commitments 152

Financial instruments 152

Operating segments 154

Pooled budgets 154

NHS Lift investments 154

Intra-government and other balances 153

Related party transactions 155

Events after the end of the reporting period 156

Losses and special payments 156

Third party assets 157

Financial performance targets 157

Impact of IFRS 157

CONTENTS

NHS Bromley Clinical Commissioning Group - Annual Accounts 2014-15

127

NHS Bromley Clinical Commissioning Group - Annual Accounts 2014-15

Statement of Comprehensive Net Expenditure for the year ended

31 March 2015

2014-15 2013-14

Note £000 £000

Total Income and Expenditure

Employee benefits 4.1.1 6,563 7,643

Operating Expenses 5 378,068 361,131

Other operating revenue 2 (2,343) (2,900)

Net operating expenditure before interest 382,288 365,874

Investment Revenue 8 0 0

Other (gains)/losses 9 0 0

Finance costs 10 0 0

Net operating expenditure for the financial year 382,288 365,874

Net (gain)/loss on transfers by absorption 11 0 0

Total Net Expenditure for the year 382,288 365,874

Of which:

Administration Income and Expenditure

Employee benefits 4.1.1 3,988 4,294

Operating Expenses 5 3,773 3,847

Other operating revenue 2 (437) (187)

Net administration costs before interest 7,324 7,954

Programme Income and Expenditure

Employee benefits 4.1.1 2,575 3,349

Operating Expenses 5 374,295 357,284

Other operating revenue 2 (1,906) (2,713)

Net programme expenditure before interest 374,964 357,920

Other Comprehensive Net Expenditure 2014-15 2013-14

£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 382,288 365,874

The notes on pages 135 to 149 form part of this statement

128

NHS Bromley Clinical Commissioning Group - Annual Accounts 2014-15

Statement of Financial Position as at

31 March 2015

31 March 2015 31 March 2014

Note £000 £000

Non-current assets:

Property, plant and equipment 13 144 17

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 144 17

Current assets:

Inventories 16 0 0

Trade and other receivables 17 5,975 8,824

Other financial assets 18 0 0

Other current assets 19 0 0

Cash and cash equivalents 20 23 97

Total current assets 5,998 8,922

Non-current assets held for sale 21 0 0

Total current assets 5,998 8,922

Total assets 6,142 8,938

Current liabilities

Trade and other payables 23 (25,382) (33,230)

Other financial liabilities 24 0 0

Other liabilities 25 0 0

Borrowings 26 0 0

Provisions 30 (142) (785)

Total current liabilities (25,524) (34,015)

Non-Current Assets plus/less Net Current Assets/Liabilities (19,382) (25,077)

Non-current liabilities

Trade and other payables 23 0 0

Other financial liabilities 24 0 0

Other liabilities 25 0 0

Borrowings 26 0 0

Provisions 30 0 (734)

Total non-current liabilities 0 (734)

Assets less Liabilities (19,382) (25,811)

Financed by Taxpayers’ Equity

General fund (19,382) (25,811)

Revaluation reserve 0 0

Other reserves 0 0

Charitable Reserves 0 0

Total taxpayers' equity: (19,382) (25,811)

The notes on pages 144 to 151 form part of this statement

The financial statements on pages 127 to 157 were approved by the Governing Body on [date] and signed on its behalf by:

Chief Accountable Officer

Dr Angela Bhan

129

NHS Bromley Clinical Commissioning Group - Annual Accounts 2014-15

Statement of Changes In Taxpayers' Equity for the year ended

31 March 2015

General

fund

Revaluation

reserve

Other

reserves

Total

reserves

£000 £000 £000 £000

Changes in taxpayers’ equity for 2014-15

Balance at 1 April 2014 (25,811) 0 0 (25,811)

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 2014 (25,811) 0 0 (25,811)

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

Net operating expenditure for the financial year (382,288) (382,288)

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(382,288) 0 0 (382,288)

Net funding 388,717 0 0 388,717

Balance at 31 March 2015 (19,382) 0 0 (19,382)

General

fund

Revaluation

reserve

Other

reserves

Total

reserves

£000 £000 £000 £000

Changes in taxpayers’ equity for 2013-14

Balance at 1 April 2013 0 0 0 0

Transfer of assets and liabilities from closed NHS bodies as a result of the 1

April 2013 transition 284 0 0 284

Adjusted NHS Commissioning Board balance at 1 April 2013 284 0 0 284

Changes in NHS Commissioning Board taxpayers’ equity for 2013-14

Net operating costs for the financial year (365,874) (365,874)

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 Commissioning Board Expenditure for the Financial Year (365,590) 0 0 (365,590)

Net funding 339,779 0 0 339,779

Balance at 31 March 2014 (25,811) 0 0 (25,811)

130

NHS Bromley Clinical Commissioning Group - Annual Accounts 2014-15

Statement of Cash Flows for the year ended

31 March 2015

2014-15 2013-14

Note £000 £000

Cash Flows from Operating Activities

Net operating expenditure for the financial year (382,288) (365,874)

Depreciation and amortisation 5 22 267

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 2,849 (8,824)

(Increase)/decrease in other current assets 0 0

Increase/(decrease) in trade & other payables 23 (7,848) 33,230

Increase/(decrease) in other current liabilities 0 0

Provisions utilised 30 (1,438) (161)

Increase/(decrease) in provisions 30 61 1,680

Net Cash Outflow from Operating Activities (388,642) (339,681)

Cash Flows from Investing Activities

Interest received 0 0

(Payments) for property, plant and equipment (149) 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 (149) 0

Net Cash Inflow (Outflow) before Financing (388,791) (339,681)

Cash Flows from Financing Activities

Grant in Aid Funding Received 388,717 339,779

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 388,717 339,779

Net Increase (Decrease) in Cash & Cash Equivalents 20 (74) 97

Cash & Cash Equivalents at the Beginning of the Financial Year 97 0

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 23 97

131

NHS Bromley Clinical Commissioning Group - Annual Accounts 2014-15

Notes to the financial statements

1 Accounting Policies

NHS England has directed that the financial statements of clinical commissioning groups shall meet the accounting requirements of the

Manual for Accounts issued by the Department of Health. Consequently, the following financial statements have been prepared in

accordance with the Manual for Accounts 2014-15 issued by the Department of Health. The accounting policies contained in the Manual for

Accounts follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to clinical commissioning

groups, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Manual for Accounts

permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the

clinical commissioning group for the purpose of giving a true and fair view has been selected. The particular policies adopted by the clinical

commissioning group 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 modified to account for the revaluation of property, plant and

equipment, intangible assets, inventories and certain financial assets and financial liabilities.

1.3 Acquisitions & Discontinued OperationsActivities 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 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

From 2014-15, the divergence from the Government Financial Reporting Manual that NHS Charitable Funds are not consolidated with bodies’

own returns is removed. Under the provisions of IAS 27: Consolidated & Separate Financial Statements, those Charitable Funds that fall

under common control with NHS bodies are consolidated within the entities’ accounts. For 2014/15 the Charitable Funds falling under

common control with Bromley CCG are not considered material for the Annual Accounts and have not been consolidated as they would have

no material affect on the financial statements. Annual Returns are submitted to the Charities Commission in compliance with the Charities

Act 2011

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 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

The following are the critical judgements, apart from those involving estimations (see below) 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:

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:

NHS Bromley CCG had no material key sources of estimation uncertainty during 2014-15.

132

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.

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.

Some employees are members of the Local Government Superannuation Scheme, which is a defined benefit pension scheme. The scheme

assets and liabilities attributable to those employees can be identified and are recognised in the clinical commissioning group’s accounts.

The assets are measured at fair value and the liabilities at the present value of the future obligations. The increase in the liability arising from

pensionable service earned during the year is recognised within operating expenses. The expected gain during the year from scheme assets

is recognised within finance income. The interest cost during the year arising from the unwinding of the discount on the scheme liabilities is

recognised within finance costs. Actuarial gains and losses during the year are recognised in the General Reserve and reported as an item of

other comprehensive net expenditure.

1.10 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 clinical commissioning group has a present legal or constructive

obligation, which occurs when all of the conditions attached to the payment have been met.

1.11 Property, Plant & Equipment

1.11.1 Recognition

Property, plant and equipment is capitalised if:

·                It is held for use in delivering services or for administrative purposes;

·                It is probable that future economic benefits will flow to, or service potential will be supplied to the clinical commissioning group;

·                It is expected to be used for more than one financial year;

·                The cost of the item can be measured reliably; and,

·                The item has a cost of at least £5,000; or,

·                Collectively, a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assets are

functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are

under single managerial control; or,

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

cost.

Where a large asset, for example a building, includes a number of components with significantly different asset lives, the components are

treated as separate assets and depreciated over their own useful economic lives.

1.11.2 Valuation

All property, plant and equipment are measured initially at cost, representing the cost directly attributable to acquiring or constructing the

asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. All

assets are measured subsequently at fair value.

Land and buildings used for the clinical commissioning group’s services or for administrative purposes are stated in the statement of financial

position at their re-valued amounts, being the fair value at the date of revaluation less any impairment.

Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that would be

determined at the end of the reporting period. Fair values are determined as follows:

·                Land and non-specialised buildings – market value for existing use; and,

·                Specialised buildings – depreciated replacement cost.

HM Treasury has adopted a standard approach to depreciated replacement cost valuations based on modern equivalent assets and, where it

would meet the location requirements of the service being provided, an alternative site can be valued.

Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost includes

professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for assets held at fair value.

Assets are re-valued and depreciation commences when they are brought into use.

Fixtures and equipment are carried at depreciated historic cost as this is not considered to be materially different from fair value.

An increase arising on revaluation is taken to the revaluation reserve except when it reverses an impairment for the same asset previously

recognised in expenditure, in which case it is credited to expenditure to the extent of the decrease previously charged there. A revaluation

decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation

reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a

clear consumption of economic benefit are taken to expenditure. Gains and losses recognised in the revaluation reserve are reported as other

comprehensive income in the Statement of Comprehensive Net Expenditure.

1.11.3 Subsequent Expenditure

Where subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised. Where

subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing carrying value of the

item replaced is written-out and charged to operating expenses.

133

1.12 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.

1.13 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.

1.13.1 The Clinical Commissioning Group as Lessee

Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised

initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term.

Contingent rentals are recognised as an expense in the period in which they are incurred.

Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether they are

operating or finance leases.

1.14 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.

1.15 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 1.50%

·                Timing of cash flows (6 to 10 years inclusive): Minus 1.05%

·                Timing of cash flows (over 10 years): 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.

A restructuring provision is recognised when the clinical commissioning group has developed a detailed formal plan for the restructuring and

has raised a valid expectation in those affected that it will carry out the restructuring by starting to implement the plan or announcing its main

features to those affected by it. The measurement of a restructuring provision includes only the direct expenditures arising from the

restructuring, which are those amounts that are both necessarily entailed by the restructuring and not associated with on-going activities of

the entity.

1.16 Clinical Negligence Costs

The NHS Litigation Authority operates a risk pooling scheme under which the clinical commissioning group pays an annual contribution to

the NHS Litigation Authority which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although the

NHS Litigation Authority is administratively responsible for all clinical negligence cases the legal liability remains with the clinical

commissioning group.

1.17 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.

1.18 Continuing healthcare risk pooling

In 2014-15 a risk pool scheme has 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.

134

1.19 Contingencies

A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence or

non-occurrence of one or more uncertain future events not wholly within the control of the clinical commissioning group, or a present

obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or the amount of the

obligation cannot be measured sufficiently reliably. A contingent liability is disclosed unless the possibility of a payment is remote.

A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or non-

occurrence of one or more uncertain future events not wholly within the control of the clinical commissioning group. A contingent asset is

disclosed where an inflow of economic benefits is probable.

Where the time value of money is material, contingencies are disclosed at their present value.

1.20 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.

1.21 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.

1.22 Financial Liabilities

Financial liabilities are recognised on the statement of financial position when the clinical commissioning group becomes party to the

contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial

liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired.

Loans from the Department of Health are recognised at historical cost. Otherwise, financial liabilities are initially recognised at fair value.

1.23 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.

1.24 Foreign Currencies

The clinical commissioning group’s functional currency and presentational currency is sterling. Transactions denominated in a foreign

currency are translated into sterling at the exchange rate ruling on the dates of the transactions. At the end of the reporting period, monetary

items denominated in foreign currencies are retranslated at the spot exchange rate on 31 March. Resulting exchange gains and losses for

either of these are recognised in the clinical commissioning group’s surplus/deficit in the period in which they arise.

1.25 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.

1.26 Losses & Special Payments

Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed

legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared

with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled.

Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which

would have been made good through insurance cover had the clinical commissioning group not been bearing its own risks (with insurance

premiums then being included as normal revenue expenditure).

1.27 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’.

135

1.28 Accounting Standards That Have Been Issued But Have Not Yet Been Adopted

The Government Financial Reporting Manual does not require the following Standards and Interpretations to be applied in 2014-15, all of

which are subject to consultation:

·                IFRS 9: Financial Instruments

·                IFRS 13: Fair Value Measurement

·                IFRS 14: Regulatory Deferral Accounts

·                IFRS 15: Revenue for Contract with Customers

The application of the Standards as revised would not have a material impact on the accounts for 2014-15, were they applied in that year.

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2 Other Operating Revenue

2014-15 2014-15 2014-15 2013-14

Total Admin Programme Total

£000 £000 £000 £000

Recoveries in respect of employee benefits 71 65 6 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 314 286 28 842

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 306 16 290 259

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 1,652 70 1,582 1,798

Total other operating revenue 2,344 437 1,906 2,900

Admin revenue is revenue received that is not directly attributable to the provision of healthcare or healthcare services

3 Revenue

2014-15 2014-15 2014-15 2013-14

Total Admin Programme Total

£000 £000 £000 £000

From rendering of services 2,343 437 1,906 2,895

From sale of goods 0 0 0 5

Total 2,343 437 1,906 2,900

Revenue in this note does not include cash received from NHS England, which is drawn down directly into the bank account of the

CCG and credited to the General Fund

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4. Employee benefits and staff numbers

4.1.1 Employee benefits 2014-15

Total

Permanent

Employees Other Total

Permanent

Employees Other Total

Permanent

Employees Other

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

Employee Benefits

Salaries and wages 5,806 3,710 2,096 3,476 2,479 997 2,330 1,230 1,100

Social security costs 314 314 0 217 217 0 97 97 0

Employer Contributions to NHS Pension scheme 443 443 0 295 295 0 148 148 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 6,563 4,467 2,096 3,988 2,991 997 2,575 1,475 1,100

Less recoveries in respect of employee benefits (note 4.1.2) (71) (71) 0 (65) (65) 0 (6) (6) 0

Total - Net admin employee benefits including capitalised costs 6,492 4,395 2,096 3,923 2,926 997 2,569 1,469 1,100

Less: Employee costs capitalised 0 0 0 0 0 0 0 0 0

Net employee benefits excluding capitalised costs 6,492 4,395 2,096 3,923 2,926 997 2,569 1,469 1,100

4.1.2 Recoveries in respect of employee benefits 2014-15

Total

Permanent

Employees Other

£000 £000 £000

Employee Benefits - Revenue

Salaries and wages (71) (71) 0

Social security costs 0 0 0

Employer contributions to the NHS Pension Scheme 0 0 0

Other pension costs 0 0 0

Other post-employment benefits 0 0 0

Other employment benefits 0 0 0

Termination benefits 0 0 0

Total recoveries in respect of employee benefits (71) (71) 0

Admin ProgrammeTotal

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4.2 Average number of people employed

2013-14

Total

Permanently

employed Other Total

Number Number Number Number

Total 88 67 21 90.12

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 retirements

2014-15 2013-14

Number Number

Total Days Lost 808 478

Total Staff Years 71 66

Average working Days Lost 11 7

2014-15 2013-14

Number 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

4.4 Exit packages agreed in the financial year

Number £ Number £ Number £

Less than £10,000 1 7,130 0 0 1 7,130

£10,001 to £25,000 2 39,775 0 0 2 39,775

£25,001 to £50,000 3 94,129 0 0 3 94,129

£50,001 to £100,000 0 0 0 0 0 0

£100,001 to £150,000 2 295,557 0 0 2 295,557

£150,001 to £200,000 0 0 0 0 0 0

Over £200,001 0 0 0 0 0 0

Total 8 436,591 0 0 8 436,591

Number £

Less than £10,000 0 0

£10,001 to £25,000 0 0

£25,001 to £50,000 0 0

£50,001 to £100,000 0 0

£100,001 to £150,000 0 0

£150,001 to £200,000 0 0

Over £200,001 0 0

Total 0 0

Analysis of Other Agreed Departures

Number £

Voluntary redundancies including early retirement contractual costs 0 0

Mutually agreed resignations (MARS) contractual costs 0 0

Early retirements in the efficiency of the service contractual costs 0 0

Contractual payments in lieu of notice 0 0

Exit payments following Employment Tribunals or court orders 0 0

Non-contractual payments requiring HMT approval* 0 0

Total 0 0

The Remuneration Report includes the disclosure of exit payments payable to individuals named in that Report.

2014-15

2014-15 2014-15 2014-15

Redundancy and other departure costs have been paid in accordance with the provisions of the Agenda for Change terms and conditions.

Other agreed departures

These tables report the number and value of exit packages agreed in the financial year. The expense associated with these departures may have been

recognised in part or in full in a previous period.

Compulsory redundancies Other agreed departures Total

Departures where special

payments have been made

Exit costs are accounted for in accordance with relevant accounting standards and at the latest in full in the year of departure.

Where entities has agreed early retirements, the additional costs are met by NHS Entities and not by the NHS Pension Scheme, and are included in

the tables. Ill-health retirement costs are met by the NHS Pension Scheme and are not included in the tables.

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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.

In order that the defined benefit obligations recognised in the financial statements do not differ materially from those that would be

determined at the reporting date by a formal actuarial valuation, the FReM requires that "the period between formal valuations shall be

four years, with approximate assessments in intervening years". An outline of these follows:

4.5.1 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.

The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 March 2012.

The Scheme Regulations allow contribution rates to be set by the Secretary of State for Health, with the consent of HM Treasury, and

consideration of the advice of the Scheme Actuary and appropriate employee and employer representatives as deemed appropriate.

4.5.2 Accounting valuation

A valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period. This utilises an

actuarial assessment for the previous accounting period, in conjunction with updated membership and financial data for the current

reporting period, and are accepted as providing suitably robust figures for financial reporting purposes. The valuation of the scheme

liability as at 31 March 2015, is based on valuation data as 31 March 2014, updated to 31 March 2015 with summary global member

and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations,

and the discount rate prescribed by HM Treasury have also been used

The latest assessment of the liabilities of the Scheme is contained in the scheme actuary report, which forms part of the annual NHS

Pension Scheme (England and Wales) Pension Accounts, published annually. These accounts can be viewed on the NHS Pensions

website. Copies can also be obtained from The Stationery Office.

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4.5 Pension costs

4.5.3 Scheme Provisions

The NHS Pension Scheme provides defined benefits, which are summarised below. This list is an illustrative guide only, and is not

intended to detail all the benefits provided by the Scheme or the specific conditions that must be met before these benefits can be

obtained:

• The Scheme is a “final salary” scheme. Annual pensions are normally based on 1/80th for the 1995 section and of the best of the

last three years pensionable pay for each year of service, and 1/60th for the 2008 section of reckonable pay per year of

membership. Members who are practitioners as defined by the Scheme Regulations have their annual pensions based upon total

pensionable earnings over the relevant pensionable service;

• With effect from 1 April 2008 members can choose to give up some of their annual pension for an additional tax free lump sum, up

to a maximum amount permitted under HM Revenue & Customs rules. This new provision is known as “pension commutation”;

• Annual increases are applied to pension payments at rates defined by the Pensions (Increase) Act 1971, and are based on

changes in retail prices in the twelve months ending 30 September in the previous calendar year. From 2011-12 the Consumer Price

Index (CPI) has been used and replaced the Retail Prices Index (RPI).

• Early payment of a pension, with enhancement, is available to members of the Scheme who are permanently incapable of fulfilling

their duties effectively through illness or infirmity. A death gratuity of twice final year’s pensionable pay for death in service, and five

times their annual pension for death after retirement is payable;

• For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full

amount of the liability for the additional costs is charged to the employer.

• Members can purchase additional service in the Scheme and contribute to money purchase AVC’s run by the Scheme’s approved

providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers.

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5. Operating expenses

2014-15 2014-15 2014-15 2013-14

Total Admin Programme Total

£000 £000 £000 £000

Gross employee benefits

Employee benefits excluding governing body members 5,569 2,994 2,575 6,723

Executive governing body members 994 994 0 920

Total gross employee benefits 6,563 3,988 2,575 7,643

Other costs

Services from other CCGs and NHS England 2,451 1,936 515 485

Services from foundation trusts 222,982 0 222,982 147,703

Services from other NHS trusts 30,987 0 30,987 103,753

Services from other NHS bodies 0 0 0 (492)

Purchase of healthcare from non-NHS bodies 71,045 0 71,045 62,326

Chair and Non Executive Members 60 60 0 56

Supplies and services – clinical 0 0 0 0

Supplies and services – general 188 131 57 (737)

Consultancy services 375 16 359 69

Establishment 862 495 367 1,065

Transport 8 0 8 2

Premises 1,985 571 1,414 353

Impairments and reversals of receivables 246 0 246 80

Inventories written down 0 0 0 0

Depreciation 22 0 22 267

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 0 0 0 0

·          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 85 85 0 93

Other non statutory audit expenditure

·          Internal audit services 77 77 0 0

·          Other services 0 0 0 0

General dental services and personal dental services 0 0 0 0

Prescribing costs 43,306 0 43,306 42,135

Pharmaceutical services 308 0 308 0

General ophthalmic services 44 0 44 32

GPMS/APMS and PCTMS 1,397 0 1,397 2,253

Other professional fees excl. audit 35 19 16 131

Grants to other public bodies 77 0 77 0

Clinical negligence 0 0 0 0

Research and development (excluding staff costs) 0 0 0 0

Education and training 816 464 352 435

Change in discount rate 0 0 0 0

Provisions 61 (81) 142 0

CHC Risk Pool contributions 543 0 543 0

Other expenditure 108 0 108 1,121

Total other costs 378,068 3,773 374,295 361,131

Total operating expenses 384,631 7,761 376,870 368,774

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6.1 Better Payment Practice Code

Measure of compliance 2014-15 2014-15 2013-14 2013-14

Number £000 Number £000

Non-NHS Payables

Total Non-NHS Trade invoices paid in the Year 8,613 75,504 9,519 50,715

Total Non-NHS Trade Invoices paid within target 8,343 72,688 9,311 49,714

Percentage of Non-NHS Trade invoices paid within target 96.87% 96.27% 97.81% 98.03%

NHS Payables

Total NHS Trade Invoices Paid in the Year 2,723 251,369 2,171 259,130

Total NHS Trade Invoices Paid within target 2,674 249,539 2,077 257,788

Percentage of NHS Trade Invoices paid within target 98.20% 99.27% 95.67% 99.48%

6.2 The Late Payment of Commercial Debts (Interest) Act 1998 2014-15 2013-14

£000 £000

Amounts included in finance costs from claims made under this legislation 0 0

Compensation paid to cover debt recovery costs under this legislation 0 0

Total 0 0

7 Income Generation Activities

The clinical commissioning group does not undertake any income generation activities.

8. Investment revenue

The clinical commissioning group had no investment revenue as at 31 March 2015.

9. Other gains and losses

The clinical commissioning group had no other gains and losses as at 31 March 2015.

10. Finance costs

The clinical commissioning group had no finance costs as at 31 March 2015.

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11. Net gain/(loss) on transfer by absorption

The clinical commissioning group had no gains or losses on transfer by absorption during 2014-15.

12. Operating Leases

12.1 As lessee

12.1.1 Payments recognised as an Expense 2014-15 2013-14

Land Buildings Other Total Total

£000 £000 £000 £000 £000

Payments recognised as an expense

Minimum lease payments 0 2,009 29 2,038 0

Contingent rents 0 0 0 0 0

Sub-lease payments 0 0 0 0 0

Total 0 2,009 29 2,038 0

12.1.2 Future minimum lease payments 2014-15 2013-14

Land Buildings Other Total Total

£000 £000 £000 £000 £000

Payable:

No later than one year 0 0 0 0 0

Between one and five years 0 0 0 0 0

After five years 0 0 0 0 0

Total 0 0 0 0 0

Whilst our arrangements with Community Health Partnership's Limited and NHS Property Services Limited fall within the definition of

operating leases, rental charge for future years has not yet been agreed . Consequently this note does not include future minimum lease

payments for the arrangements only

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13 Property, plant and equipment

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 34 0 250 0 284

Addition of assets under construction and payments on account 0 0

Additions purchased 0 0 0 0 0 0 149 0 149

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 2015 0 0 0 0 34 0 399 0 432

Depreciation 1 April 2014 0 0 0 0 17 0 250 0 267

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

Charged during the year 0 0 0 0 17 0 5 0 22

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

Depreciation at 31 March 2015 0 0 0 0 34 0 255 0 289

Net Book Value at 31 March 2015 0 0 0 0 0 0 144 0 144

Purchased 0 0 0 0 0 0 144 0 144

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 0 0 144 0 144

Asset financing:

Owned 0 0 0 0 0 0 144 0 144

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 0 0 144 0 144

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

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

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13 Property, plant and equipment cont'd

13.1 Additions to assets under construction

2014-15 2013-14

£000 £000

Land 0 0

Buildings excluding dwellings 0 0

Dwellings 0 0

Plant & machinery 0 0

Transport equipment 0 0

Information technology 0 0

Furniture & fittings 0 0

Total 0 0

13.2 Donated assets

The clinical commissioning group had no donated assets as at 31 March 2015.

13.3 Government granted assets

The clinical commissioning group had no government granted assets as at 31 March 2015.

13.4 Property revaluation

As NHS Bromley Clinical Commissioning Group has no Land or Buildings no property revaluation was carried out during 2014-15.

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13 Property, plant and equipment cont'd

13.5 Compensation from third parties

13.6 Write downs to recoverable amount

13.7 Temporarily idle assets

The clinical commissioning group had no temporary idle assets as at 31 March 2015.

13.8 Cost or valuation of fully depreciated assets

The clinical commissioning group had no fully depreciated assets still in use at 31 March 2015

13.9 Economic lives

Buildings excluding dwellings 0 0

Dwellings 0 0

Plant & machinery 1 10

Transport equipment 0 0

Information technology 1 3

Furniture & fittings 0 0

The clinical commissioning group has no compensation from third parties for assets impaired, lost or given

up, that is included in the Statement of Comprehensive Net Expenditure as at March 2015.

Minimum

Life (years)

Maximum

Life (Years)

The clinical commissioning group had no assets written down to recoverable amounts and any reversals of

previous write-downs during 2014-15.

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14 Intangible non-current assets

The clinical commissioning group had no intangibles non-current assets either as at 31 March 2015 or during 2014-15.

15 Investment property

The clinical commissioning group had no investment property as at 31 March 2015.

16 Inventories

The clinical commissioning group had no inventories as at 31 March 2015.

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17 Trade and other receivables Current Non-current Current Non-current

2014-15 2014-15 2013-14 2013-14

£000 £000 £000 £000

NHS receivables: Revenue 387 0 3,085 0

NHS receivables: Capital 0 0 0 0

NHS prepayments and accrued income 2,584 0 1,380 0

Non-NHS receivables: Revenue 1,276 0 2,506 0

Non-NHS receivables: Capital 0 0 0 0

Non-NHS prepayments and accrued income 1,950 0 1,913 0

Provision for the impairment of receivables (247) 0 (80) 0

VAT 20 0 21 0

Private 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 0

Operating lease receivables 0 0 0 0

Other receivables 5 0 (1) 0

Total Trade & other receivables 5,975 0 8,824 0

Total current and non current 5,975 8,824

Included above:

Prepaid pensions contributions 0 0

17.1 Receivables past their due date but not impaired 2014-15 2013-14

£000 £000

By up to three months 785 1,924

By three to six months 4 9

By more than six months 245 0

Total 1,034 1,933

£638k of the amount above has subsequently been recovered post the statement of financial position date.

17.2 Provision for impairment of receivables 2014-15 2013-14

£000 £000

Balance at 1 April 2014 (80) 0

Amounts written off during the year 0 0

Amounts recovered during the year 80 (80)

(Increase) decrease in receivables impaired (247) 0

Transfer (to) from other public sector body 0 0

Balance at 31 March 2015 (247) (80)

2014-15 2013-14

£000 £000

Receivables are provided against at the following rates:

NHS debt 0% 0%

Non NHS 121 - 180 days 50% 50%

Non NHS over 180 days 100% 100%

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18 Other financial assets

The clinical commissioning group had no other financial assets as at 31 March 2015.

19 Other current assets

The clinical commissioning group had no other current assets as at 31 March 2015.

20 Cash and cash equivalents

2014-15 2013-14

£000 £000

Balance at 1 April 2014 97 0

Net change in year (74) 97

Balance at 31 March 2015 23 97

Made up of:

Cash with the Government Banking Service 23 97

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 23 97

Bank overdraft: Government Banking Service 0 0

Bank overdraft: Commercial banks 0 0

Total bank overdrafts 0 0

Balance at 31 March 2015 23 97

Patients’ money held by the clinical commissioning group, not included above 0 0

21 Non-current assets held for sale

The clinical commissioning group had no non-current assets held for sale as at 31 March 2015.

22 Analysis of impairments and reversals

The clinical commissioning group had no impairments or reversals of impairments recognised in expenditure during 2014-15.

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Current Non-current Current Non-current

2014-15 2014-15 2013-14 2013-14

£000 £000 £000 £000

Interest payable 0 0 0 0

NHS payables: revenue 5,029 0 17,254 0

NHS payables: capital 0 0 0 0

NHS accruals and deferred income 3,064 0 643 0

Non-NHS payables: revenue 7,045 0 5,726 0

Non-NHS payables: capital 0 0 0 0

Non-NHS accruals and deferred income 9,847 0 9,274 0

Social security costs 44 0 48 0

VAT 0 0 0 0

Tax 12 0 17 0

Payments received on account 0 0 0 0

Other payables 341 0 268 0

Total Trade & Other Payables 25,382 0 33,230 0

Total current and non-current 25,382 33,230

Other payables include £90k outstanding pension contributions at 31 March 2015 (£24k as at 31 March 2014).

24 Other financial liabilities

25 Other liabilities

27 Private finance initiative, LIFT and other service concession arrangements

28 Finance lease obligations

The clinical commissioning group had no finance lease obligations as at 31 March 2015.

29 Finance lease receivables

The clinical commissioning group had no finance lease receivables as at 31 March 2015.

26 Borrowings

The clinical commissioning group had no borrowings as at 31 March 2015.

The clinical commissioning group had no private finance initiative, LIFT or other service concession

23 Trade and other payables

Included above are liabilities of £0, for 0 people, due in future years under arrangements to buy out the liability for early

retirement over 5 years.

The clinical commissioning group had no other liabilities as at 31 March 2015.

The clinical commissioning group had no other financial liabilities as at 31 March 2015.

151

NHS Bromley Clinical Commissioning Group - Annual Accounts 2014-15

30 Provisions

Current Non-current Current Non-current

2014-15 2014-15 2013-14 2013-14

£000 £000 £000 £000

Pensions relating to former directors 0 0 0 0

Pensions relating to other staff 0 0 0 0

Restructuring 0 0 280 734

Redundancy 0 0 0 0

Agenda for change 0 0 0 0

Equal pay 0 0 0 0

Legal claims 0 0 0 0

Continuing care 142 0 0 0

Other 0 0 505 0

Total 142 0 785 734

Total current and non-current 142 1,519

Pensions

Relating to

Former

Directors

Pensions

Relating to

Other Staff Restructuring Redundancy

Agenda for

Change Equal Pay Legal Claims

Continuing

Care Other Total

£000s £000s £000s £000s £000s £000s £000s £000s £000s £000s

Balance at 1 April 2014 0 0 1,014 0 0 0 0 0 505 1,519

Arising during the year 0 0 281 0 0 0 0 142 0 423

Utilised during the year 0 0 (1,015) 0 0 0 0 0 (424) (1,438)

Reversed unused 0 0 (280) 0 0 0 0 0 (82) (362)

Unwinding of discount 0 0 0 0 0 0 0 0 0 0

Change in discount rate 0 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 0

Balance at 31 March 2015 0 0 0 0 0 0 0 142 0 142

Expected timing of cash flows:

Within one year 0 0 0 0 0 0 0 142 0 142

Between one and five years 0 0 0 0 0 0 0 0 0 0

After five years 0 0 0 0 0 0 0 0 0 0

Balance at 31 March 2015 0 0 0 0 0 0 0 142 0 142

At 31 March 2014, the Governing Body provided for expected costs for the Trust Special Administrator relating to the dissolution of South London Healthcare NHS Trust.  A provision was set up over four years to reflect the

expected payments.  However, due to the timing of payments to providers, to cover costs, NHSE required the full funding to be paid in 2014/15. The provision has therefore been utilised in full in 2014/15. The provision totalled

£979k and was included in the Restructuring section.

A Continuing Care provision has been set up for retrospective claims since the CCG was established on the 1st April 2013.

Under the Accounts Direction issued by NHS England on 12 February 2014. NHS England is responsible for liabilities relating to NHS Continuing Healthcare claims relating to periods of care before the establishment of the

clinical commissioning group. However the legal liability remains with the CCG. The total value of legacy NHS Continuing Healthcare provisions accounted for by NHS England on behalf of this CCG at 31 March 2015 is

£5,841k. The total value of the prior year’s legacy NHS Continuing Healthcare provisions accounted for by NHS England on behalf of this CCG at 31 March 2014 was £11,622k.

152

NHS Bromley Clinical Commissioning Group - Annual Accounts 2014-15

31 Contingencies

The clinical commissioning group had no contingent liabilities or contingent assets as at 31 March 2015.

32 Commitments

32.1 Capital commitments

32.2 Other financial commitments

33 Financial instruments

33.1 Financial risk management

33.1.1 Currency risk

33.1.2 Interest rate risk

33.1.3 Credit risk

33.1.4 Liquidity risk

The clinical commissioning group had no contracted capital commitments not otherwise included in these financial statements as at 31

March 2015

The clinical commissioning group had no non-cancellable contracts (which were not leases, private finance initiative contracts or other

service concession arrangements) as at 31 March 2015

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.

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.

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.

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.

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.

153

NHS Bromley Clinical Commissioning Group - Annual Accounts 2014-15

33 Financial instruments cont'd

33.2 Financial assets

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 0 387 0 387

·          Non-NHS 0 1,276 0 1,276

Cash at bank and in hand 0 23 0 23

Other financial assets 0 6 0 6

Total at 31 March 2015 0 1,692 0 1,692

At ‘fair value

through profit and

loss’

Loans and

Receivables

Available for

Sale Total

2013-14 2013-14 2013-14 2013-14

£000 £000 £000 £000

Embedded derivatives 0 0 0 0

Receivables:

·          NHS 0 3,085 0 3,085

·          Non-NHS 0 2,506 0 2,506

Cash at bank and in hand 0 97 0 97

Other financial assets 0 (1) 0 (1)

Total at 31 March 2014 0 5,687 0 5,687

33.3 Financial liabilities

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 8,093 8,093

·          Non-NHS 0 17,233 17,233

Private finance initiative, LIFT and finance lease obligations 0 0 0

Other borrowings 0 0 0

Other financial liabilities 0 0 0

Total at 31 March 2015 0 25,326 25,326

At ‘fair value

through profit and

loss’ Other Total

2013-14 2013-14 2013-14

£000 £000 £000

Embedded derivatives 0 0 0

Payables:

·          NHS 0 17,898 17,898

·          Non-NHS 0 15,001 15,001

Private finance initiative, LIFT and finance lease obligations 0 0 0

Other borrowings 0 0 0

Other financial liabilities 0 0 0

Total at 31 March 2014 0 32,899 32,899

154

NHS Bromley Clinical Commissioning Group - Annual Accounts 2014-15

34 Operating segments

The clinical commissioning group consider they have only one segment: commissioning of healthcare services.

35 Pooled budgets

2014-15 2013-14

£000 £000

Income 0 0

Expenditure 0 (782)

36 NHS Lift investments

37 Intra-government and other balances

Current

Receivables

Non-current

Receivables

Current

Payables

Non-current

Payables

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

£000 £000 £000 £000

Balances with:

·          Other Central Government bodies 1 0 509 0

·          Local Authorities 1,332 0 2 0

Balances with NHS bodies:

·          NHS bodies outside the Departmental Group 387 0 1,625 0

·          NHS Trusts and Foundation Trusts 2,584 0 6,468 0

Total of balances with NHS bodies: 2,971 0 8,093 0

·          Public corporations and trading funds 0 0 0 0

·          Bodies external to Government 1,672 0 16,778 0

Total balances at 31 March 2015 5,975 0 25,382 0

Current

Receivables

Non-current

Receivables

Current

Payables

Non-current

Payables

2013-14 2013-14 2013-14 2013-14

£000 £000 £000 £000

Balances with:

·          Other Central Government bodies 459 0 64 0

·          Local Authorities 1,542 0 46 0

Balances with NHS bodies:

·          NHS bodies outside the Departmental Group 800 0 332 0

·          NHS Trusts and Foundation Trusts 3,665 0 17,566 0

Total of balances with NHS bodies: 4,465 0 17,898 0

·          Public corporations and trading funds 0 0 0 0

·          Bodies external to Government 2,358 0 15,222 0

Total balances at 31 March 2014 8,824 0 33,230 0

The clinical commissioning group had no NHS LIFT investments as at 31 March 2015.

During 2014/15 the CCG jointly reviewed all the joint funding arrangements that it has with the London Borough of Bromley. An

overarching Section 75 has been agreed for all services with no schemes classified as pooled budgets. The integrated short breaks

service for children and young people with disabilities is now classified as a non-pooled fund with set contributions from both parties.

155

NHS Bromley Clinical Commissioning Group - Annual Accounts 2014-15

38 Related party transactions

Payments

to Related

Party

Receipts

from

Related

Party

Amounts

owed to

Related

Party

Amounts

due from

Related

Party

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

£000 £000 £000 £000

Dr Andrew Parson - Chislehurst Medical Practice 206 11

Dr Ruchira Paranjape - Knoll Medical Practice 71 (4)

Dr Atul Arora - Sundridge Medical Practice 81 4 (5)

Dr Jon Doyle - South View Partnerships 84

Mr Mark Essop - Southborough Lane Surgery 84 49 (11)

Meredith Collins - Meredith Collins Consulting 59

Payments

to Related

Party

Receipts

from

Related

Party

Amounts

owed to

Related

Party

Amounts

due from

Related

Party

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

£000 £000 £000 £000

Kings College Hospital NHS Foundation Trust 159,347 2,013

Guys and St Thomas' NHS Foundation Trust 19,176 694

Oxleas NHS Foundation Trust 32,221 170

Details of related party transactions with individuals are as follows:

The payments reported in the above table relating to GPs represent the total sums paid to the respective GP

practice as a whole for all services provided to Bromley CCG.

The Department of Health is regarded as a related party. During the year the clinical commissioning group has

had a significant number of transactions (a threshold of £15m per annum has been applied) with entities for which

the Department is regarded as the parent Department.

156

NHS Bromley Clinical Commissioning Group - Annual Accounts 2014-15

39 Events after the end of the reporting period

40 Losses and special payments

40.1 Losses

Total

Number of

Cases

Total Value

of Cases

Total Number

of Cases

Total Value

of Cases

2014-15 2014-15 2013-14 2013-14

Number £'000 Number £'000

Administrative write-offs 1 246 0 0

Total 1 246 0 0

The losses included within the accounts relate to the bad debt provision.

40.2 Special payments

The clinical commissioning group made no special payments during 2014/15

There are no post balance sheet events which will have a material effect on the financial statements of the clinical commissioning group.

The total number of NHS Clinical Commissioning Group losses and special payments cases, and their total value, was as follows:

157

NHS Bromley Clinical Commissioning Group - Annual Accounts 2014-15

41 Third party assets

The clinical commissioning group held no third party assets as at 31 March 2015.

42 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:

2014-15 2014-15 2013-14 2013-14

Target Performance Target Performance

Expenditure not to exceed income 390,656 384,797 372,560 368,774

Capital resource use does not exceed the amount specified in Directions 155 150 0 0

Revenue resource use does not exceed the amount specified in Directions 388,158 382,304 369,660 365,874

Capital resource use on specified matter(s) does not exceed the amount

specified in Directions 155 150 0 0

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

specified in Directions 379,631 375,010 361,650 357,920

Revenue administration resource use does not exceed the amount

specified in Directions 8,527 7,294 8,010 7,954

43 Impact of IFRS

Accounting under IFRS had no impact on the results of the clinical commissioning group during the 2014/15 financial year.