NHS Corby Clinical Commissioning 2018/19 · NHS Corby CCG Annual Report and Accounts 2018-19 3 Clinical Chair Foreword It is my pleasure to present NHS Corby Clinical Commissioning

NHS Corby CCG Annual Report and Accounts 2018-19

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NHS Corby Clinical

Commissioning Group

Annual Report 2018/19


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Contents

PERFORMANCE REPORT………………………………………….28

Performance Overview……………………………………………….44

Performance analysis…………………………………………………45

ACCOUNTABILITY REPORT……………………………………….100

Corporate Governance Report………………………………………100

Members Report………………………………………………………100

Statement of Accountable Officer’s Responsibilies………………..103

Governance Statement …………………………………………...154

Remuneration and Staff Report………………………………………156

Remuneration Report…………………………………………………156

Staff Report…………………………………………………………….166

Parliamentary Accountability and Audit Report…………………….178

ANNUAL ACCOUNTS…………………………………………………186


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Clinical Chair Foreword

It is my pleasure to present NHS Corby Clinical Commissioning Group’s (CCG’s) 2018/19 annual report which details the progress we have made in commissioning high quality health services on behalf of our local population over the past year. I would like to begin by thanking our member practices and our staff members for their hard work and support throughout a challenging year. We are all committed to the delivery of high-quality patient care and are grateful to those who have played a key role in supporting our CCG and to our Governing Body members.

NHS Corby CCG receives an allocation of money to be spent on health services for the people registered with a Corby GP practice. This includes the cost of hospital outpatient appointments, inpatient stays and operations, prescribed medicines, investigations, GP practice appointments and care, GP out of hours’ services, Corby Urgent Care Centre, community and mental health facilities, and many other services.

This document describes how we have worked closely with patients and members of the public to understand the needs of our community and used this information to influence how the money is spent. We also cooperate with our partners across health and social care and this includes Kettering General Hospital, Northampton General Hospital, Northamptonshire Healthcare Foundation Trust, Corby Borough Council, Northamptonshire County Council as well as the Voluntary and charitable sector and other organisations.

We are living though a challenging time for the NHS and we continue to aim to deliver high quality care for our population. Our priorities continue to include developing a greater emphasis on prevention for both physical and mental health, improving well-being and facilitating the coordination of health and social care. We will do this by working with patients, partners and stakeholders to ensure financial sustainability and cost-effective services while aiming to achieve and maintain the NHS constitutional standards.

During 2018/19 NHS Corby CCG continued to strengthen our partnership working with NHS Nene CCG. Our joint commissioning team has worked on shared commissioning plans and county-wide care coordination. We are looking forward to the year ahead when both CCGs will continue to work collaboratively as part of Northamptonshire Health and Care Partnership, formerly known as the Northamptonshire STP, with the best interests of the people of Corby and the county at the heart of everything we do. Our joint vision is a positive lifetime of health, wellbeing and care in our community.

Dr Joanne Watt, Clinical Chair NHS Corby CCG


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Accountable Officer’s Introduction

Welcome to the annual report for NHS Corby Clinical Commissioning Group (CCG) which covers the period 1 April 2018 to 31 March 2019. This report is retrospective by nature and details both the achievements and challenges of the year gone by. Last year was an extremely difficult year for the CCG. Many issues regarding the proposed Same Day Access Hub were played out in public, including the challenge of a Judicial Review. Our annual internal audit also brought to our attention weaknesses in the framework of governance, risk management and control. We now have revised

internal systems in place, a new provider securing a two-year future of the Urgent Care Centre and we are living through an exciting year of change following the publication of the NHS Ten-Year Plan. I am confident we are in a strong position to look to a promising future.

This document is designed to give you an overview of our organisation, staff and GP member practices. It tells you a little about how we work through robust governance arrangements and how we assure ourselves and others that services are delivered safely and to a high standard of quality, and that the patient experience is positive. The report also talks about our mission, goals and achievements and the partnerships we rely on to ensure the best possible outcomes for patients. It also highlights our connection with different communities in Corby and across Northamptonshire and how we engage, understand and learn from what people tell us about their experiences of care and ensure that it influences the commissioning decisions that we make.

I was delighted to begin my role in November last year and would like to take this opportunity to acknowledge the excellent work of my predecessor Carole Dehghani, who worked passionately for Corby CCG from early in its formation five years ago. I took over at a time when collaborative working with Nene Clinical Commissioning Group, our neighbouring CCG, was well underway and this has been a key focus throughout everything we have done in 2018/19, across health and social care and with providers, commissioners, voluntary and community sector and stakeholders and most importantly, patients. This integrated way of working has been most prominent through the development of Northamptonshire’s Health and Care Partnership. This is based on the development of Local Healthcare Partnership - which proposes how local services will evolve and become sustainable which in turn should result in better health, wellbeing and care for our patients.

The strides we have made in 2018/19 have been delivered in a climate of change and continuous financial pressure which is some cases has resulted in us not achieving some of our key constitutional standards and targets. We are responding by implementing robust actions plans to ensure that health and well-being outcomes for the people of Corby are the best they can be for the people we serve.

Toby Sanders, Chief Executive, Joint Accountable Officer of NHS Corby and NHS Nene Clinical Commissioning Groups


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Who we are and what we do?

About NHS Corby Clinical Commissioning Group (CCG)

NHS Corby Clinical Commissioning Group (Corby CCG) was established on 1 April 2013 under the Health and Social Care Act 2012. The CCG was formed to improve the health services for the people of Corby and to ensure the best possible outcomes from services within GP services, our hospitals and within the community. We are a clinically led membership organisation made up of five General Practices and we are responsible for understanding and addressing the health needs of the people of Corby.

NHS Corby CCG strives to ensure services best meet the needs of the local population through partnership working with NHS England, NHS Nene CCG, Corby Borough Council, Northamptonshire County Council and a wide range of other local organisations and stakeholders including those in the voluntary sector. As part of our NHS duty to improve quality we are committed to providing best value-for-money and the most effective, fair and sustainable use of finite resources. With this at the forefront of our minds NHS Corby CCG and NHS Nene CCG have worked together to identify opportunities to maximise their effectiveness as commissioners. This has included aligning programmes of work, managerial and clinical leadership, governance and staffing. To oversee these new arrangements an ongoing Transition Programme was established and is underway. Our Headquarters is based at: NHS Corby Clinical Commissioning Group Corby Enterprise Centre London Road Corby NN17 5EU.

Our website: http://www.corbyccg.nhs.uk/

http://www.corbyccg.nhs.uk/


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Our commissioning responsibilities

Our responsibilities are delegated to us from NHS England, the national body with a formal mandate to oversee the commissioning of health services in England by the Secretary of State for Health and Social Care. Those known as Public Health services are now commissioned by local authorities.

The money allocated to CCGs is determined by NHS England and approved by the Secretary of State for the Department of Health and Social Care, currently Matt Hancock MP. This is delivered under the following legislation: Health and Social Care Act 2012 c.7 Schedule 2 s.17.

Our Allocation from NHS England for Commissioning in 2018/19 was £112, 626,000 and the services we commission discharge our functions under Section 14Z15 Paragraph 2 of the National Health Service Act 2006, as amended by the Health and Social Care Act 2012.

The services we commission include:

• Urgent and emergency care including emergency department, ambulance and out of hours’ services (unplanned care) and the Urgent Care Centre in Corby

• Planned hospital care

• Community health services

• Mental health inpatient and community services

• Healthcare services for Older people

• Healthcare services for children and young people

• Healthcare services for people with learning disabilities

• Maternity Services

• Rehabilitation Services

• Continuing Healthcare

• Termination of pregnancy services

• Infertility Services

• Wheelchair Services

• Home Oxygen Services

• Treatment of infectious diseases


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Who do we commission (or buy) services from?

The CCG works hard to commission high quality services making every effort to ensure that resources have been used economically, effectively and efficiently.

The CCG commissions services primarily from the following providers:

• Kettering General Hospital NHS Foundation Trust (KGHFT)

• Northamptonshire Healthcare Foundation Trust (NHFT)

• Lakeside + Ltd (Corby Urgent Care Centre)

• Ramsey Healthcare (Woodlands Hospital)

• Northampton General Hospital (NGH)

• East Midlands Ambulance Services (EMAS)

The CCG also has a range of other provider contracts including NHS 111, as well as other small contracts with various providers for specific services. More detail on how we spend our money can be found in the Performance Report in Chapter 2.

Our Purpose and Activities

NHS Corby Clinical Commissioning Group’s mission is:

“To create a culture where individuals are supported to manage their own healthcare: enabling people in Corby to live healthier, fuller lives.”

Our Constitution

Our constitution describes the governing principles, rules and procedures which we have established to ensure probity and accountability in our day to day running. This ensures decisions are taken in an open and transparent way; and that the interests of patients and the public remain central to our goals. The constitution can be found here on the CCG website https://corbyccg.nhs.uk/modules/downloads/download.php?file_name=1406

https://corbyccg.nhs.uk/modules/downloads/download.php?file_name=1406


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Our key strategic objectives

1. Prevention: to prevent people becoming ill and to support people to live healthy lives. Targeting people at highest risk by working closely with our Member Practices, Public Health, Healthcare Providers and Local Authorities.

2. Early Diagnosis: to ensure that when people become unwell their condition is diagnosed early to ensure prompt treatment and secure better outcomes.

3. Better Care: to commission the right services for patients at the right time, in

the right place, including end of life care.

4. Commission: to commission services in a way which provides a seamless transition between providers, where patients need the support or intervention of primary care, community care, secondary care, social services or the voluntary sector.

5. Quality: to improve quality within all providers to ensure services are safe,

efficient and effective.

6. Engagement: to engage patients, public and partner organisations to ensure that services are delivered at the right time, in the right place and to the highest quality.

7. Sustainable: to ensure a sustainable financial future for the CCG

8. Accountable: to be truly accountable to our population and have appropriate

arrangements in place to discharge our functions effectively, efficiently and economically, and in accordance with the statutory framework and best practice principles of good governance and transparency.

In September 2017 the Governing body added two overarching strategic corporate objectives, these are:

• Statutory Duties including finance, governance, cooperation.

• Health Inequalities and Access - five rights: Person, Condition, Place, Professional and Time.

The CCG has developed an Operational Plan 2017-2019 which details the activity and financial planning assumptions necessary to deliver these objectives in line with achieving national performance targets and priorities. The Performance Report sets out the CCG’s performance against national targets, priorities for 2018/19 and our key priorities for this period.


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Our local challenges Our local challenges mirror the national challenges set out in what is known as the ‘Five Year Forward View.

These are as follows:

• Our population’s health needs and personal preferences are changing, and our services do not always align with this change in demand

• The opportunity to use new technologies and approaches needs to be maximised further and faster

• Our population demographics are changing and require a different response from services to maintain and improve quality and ensure safety

• We have workforce shortages, key skills gaps and issues with modern working practices. These issues are driving up service cost and affecting our ability to provide the quality of service our patients require to keep them well

• General Practice is experiencing significant pressure and recruitment and retention has been impacted.

There are a number of more Corby specific factors which impact on health and care outcomes:

• Our health and care sector includes a number of large independent providers which has an impact on our local population accessing services

• There is significant population growth across all age groups in relation to new community developments

• Recruitment and retention are significantly influenced by the position of Northamptonshire with impact in relation to GPs, Paramedics, nurses and other key groups including social care professionals

• There is significant variation in the demographics across the county requiring different targeted solutions

• The configuration of our providers and the current commissioning landscape impact on cost and financial sustainability

• Some of our patients are experiencing poor access and quality of care from a range of our local providers. This is reflected in poor performance of the Accident and Emergency (A&E) 4-hour wait, Referral to Treatment Time (RTT) waiting times, (EMAS) response time and handover times and cancer waits. We are working with providers to support actions for improvement.


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Local Operating Context

There are a number of critical operating factors within Northamptonshire which impact on the position of health and care services within the county. This operating context supports the drive for change within the county in a bid to ensure high quality care for all together with the most appropriate use of resource to ensure sustainability. See the three-pronged approach below.

• Quality, safety and minimising harm

➢ The health care system has not been able to routinely maintain core constitutional standards in relation to A&E, RTT and Cancer

➢ Care Quality Commission (CQC) reports highlight a number of areas which require improvement

➢ Agency spend in some organisations falls into the highest agency spend band for England.

• Infrastructure and Estate

➢ The local model for community services has a high bed base and high overheads associated with investments to that estate and infrastructure

➢ Some local estate provides challenges in regard to its age and suitability for the provision of modern healthcare services

➢ Long term PFI contracts within the care sector are less able to move at pace to meet changing patterns of demand

➢ New contractual models that drive different outcomes from the estate are required ICT arrangements pose a challenge to delivery.

• Integration and models of care delivery

➢ Our Local Authority is recognised to be financially challenged which impacts on the ability to deliver change through enabling frameworks such as the Better Care Fund (BCF)

➢ The pace behind the integration of health and care continues to impact on patient flow.


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Working together as a single system CCGs across England are coming together in a move towards strategic commissioning and integrated care systems, in line with Sustainability and Transformation plans which were published in 2016. Whilst NHS Corby CCG and NHS Nene CCG will remain as separate statutory bodies for the immediate future, the two significantly strengthened their partnership working in 2018/19.

This was good news for the people of Northamptonshire because a move towards county-wide commissioning enables CCGs to develop arrangements which are truly integrated around local people, with the aim of both improving services and driving up outcomes for people who live and work across the patch. Through this closer working we are better placed to harness the benefits of greater collaboration across the system with fellow NHS organisations, local authorities and the voluntary and community sector. This arms us with a great opportunity to align and ensure consistency across our work programmes.

This means as two CCGS we also now have county-wide responsibilities for both our senior managerial and clinical leadership roles, all supported by a robust and aligned governance framework.

As part of the work which has been undertaken in bringing the leadership and governance of the CCGs more closely aligned, a set of joint CCG corporate objectives was agreed at Corby CCG’s Governing Body meeting on 24 April 2018 and Nene CCG’s Governing Body meeting on 15 May 2018.

The agreed objectives for both Corby and Nene CCGs were:

• Quality To improve quality within all providers to ensure services are safe, efficient and effective

• Transformation To create the environment to enable the commissioning and delivery of high-quality services to reduce health inequalities and improve health outcomes and resilient communities.

• Commission sustainable services To ensure the development of seamless transition between providers, where patients need the support or intervention of primary care, community care, secondary care, social services or the voluntary sector, within resources available, ensuring high quality provision and best value for money

• Engagement To engage patients, public, members and partner organisations to ensure that services are delivered at the right time, in the right place and to the highest quality


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• Workforce and Culture To develop and support a motivated workforce equipped with the required capabilities, culture and competencies to meet the evolving needs of Primary Care and the progression towards a strategic commissioning function.

• Accountability To be truly accountable to our population and have appropriate arrangements in place to discharge our functions effectively, efficiently and economically, and in accordance with the statutory framework and best practice principles of good governance and transparency.

The two governing bodies also agreed a number of principles which underpinned the transition, they were:

• Both CCGs will continue as sovereign bodies and will have their own governing bodies and work to their individual constitutions for assurance purposes

• Both governing bodies will retain their separate statutory accountabilities and responsibilities

• Maintaining an approach that is clinically led and informed

• Patient and public involvement and engagement will have key role in the development of our commissioning plans

• Both CCGs will retain member elected clinical roles, e.g. GP Chairs, Commissioning and Member Engagement Execs (Nene) and Corby Clinical Executives

• Enshrine the principle that our individual communities and membership voices are heard in any new arrangements

In November 2017, the two CCGs established a Joint Transition Board which reported to both governing bodies. The Joint Transition Board was a time-limited committee, and which continued to meet up until January 2019. It was chaired by a lay member and its membership included lay members and executives from both governing bodies as well as the chair of the joint staff forum. A detailed programme of work was developed to support the alignment of commissioning functions and a new framework for governance was set up to support the new commissioning and organisational arrangements. Through the new joint governing body, decisions could be taken on services and developments which affected both CCGs.

The following governance changes supported transition:

• The Joint Transition Board met monthly, chaired by Tansi Harper (lay member from Corby CCG) and with lay members and executives from both governing bodies (GBs).

• A monthly Joint Executive Management meeting started in April 2017, involving clinicians and managers from both CCGs. Chaired by the Joint Accountable Officer, this replaces Corby’s Joint Management Team and Nene’s Board of Directors.

• A fortnightly Executive Operational Group (EOG) oversaw transition and operational delivery for both CCGs. This is chaired by the Joint Accountable Officer and included the managerial executives from both CCGs.


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The joint operational plan 2017-19

NHS Corby CCG and NHS Nene CCG are a part of the leadership model for Northamptonshire’s Health and Social Care Partnership, formerly referred to as the Northamptonshire Sustainability and Transformation plan (STP). Both organisations have always worked closely in the development of population-based strategy; however, they have not historically delivered integrated Operating Plans.

The 2017-19 Operating Plan submission to NHS England is the first integrated Operating Plan for the two CCGs and follows the formal issuing of Integrated Commissioning Intentions in September 2016. The plan sets out the CCGs commitment to jointly meeting the nine ‘must do’s’3 for 2017-19 and the processes supporting local delivery to provide assurance against key milestones and phasing plans.

NHS Corby and NHS Nene CCGs are working together to answer the leadership challenge posed to us by our providers, stakeholders and populations.

We aim to speak with one voice to our providers, https://www.england.nhs.uk/wp-content/uploads/2016/09/NHS-operational-planning-guidance-201617-201819 .

In so doing we will reduce complexity and increase clarity for delivery. The system has commissioned a significant Organisational Development programme to support cultural change to deliver the single system approach.

The CCGs are committed to drawing on national learning, best practice and targeted support programmes including the Right Care programme to drive change at pace and scale and ensure the clinical case and population case for change are co-produced.

https://www.england.nhs.uk/wp-content/uploads/2016/09/NHS-operational-planning-guidance-201617-201819

https://www.england.nhs.uk/wp-content/uploads/2016/09/NHS-operational-planning-guidance-201617-201819


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Northamptonshire Health and Care Partnership Northamptonshire Health and Care Partnership (NHCP), formerly known as the Northamptonshire STP, consists of key health and care providers in the county. While we all remain as separate organisations with our own local responsibilities for the services we provide, we are committed to working together to work towards a positive future for our community. By working more closely in partnership we are being ambitious about doing things differently and clear on our local priorities; so together we can improve the quality of care and the health and wellbeing of our community.

NHCP’s Mission, vision, values and ambitions In 2018 NHCP confirmed its vision, mission, values and ambitions:

• Our vision for the future of Northamptonshire’s health and care services is for a positive lifetime of health, wellbeing and care in our community.

• Our mission in working together, the reason we do what we do, is to empower positive futures. Wherever we work and whatever our role we all want people in Northamptonshire to be able to choose well, stay well, live well.

• Each day our shared values will help to guide our decisions and what is most important to us; o Our patients and our local population come first o We work together in an open and accountable way o We trust, challenge and support each other o We do what we say we will do.

At the core of all these things, in our future planning and our daily work, we share the following ambitions: We want a positive lifetime of health, wellbeing and care so we will:

• empower positive futures by creating the conditions for people to choose well, stay well and live well

• consider how to make the best use of technology, work together more efficiently and focus on the needs of our local communities in all our planning

• work closely together so our health and care services are joined up across all our organisations – so the care people receive is seamless and easy to access

• always keep our collective focus on our vision for the future.


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We want better standards of care so we will:

• focus on quality standards, be proactive about detecting and preventing illness, and have an equal focus on physical and mental health

• improve access to services so people get the right care and support in the right place, at the right time

• develop different and more collaborative ways of working so we are ready to respond to the extra pressures our health and care services experience in winter

• support people to manage their own care, where safe to do so, in particular focusing on those at most risk.

We want better collaborative working so we will:

• work together to deliver high-quality, joined-up health and social care that focuses on the needs of our communities first

• focus on our hospitals working together more closely so everyone has access to the best care, wherever they live in the county

• create more opportunities to share our learning, skills and expertise – and make Northamptonshire a great place for health and care staff to work

• work together to share our progress and make sure the voices of our staff, our stakeholders and our community are heard.

We want better management of our resources so we will:

• strive to better meet people’s needs within the funding we have available

• plan our workforce needs collaboratively across all organisations – so our staff and volunteers aren’t too busy to look after their own wellbeing as well as those they care for.

• make the best use of the resources we have between us for the benefit of all

• improve, develop and create health and care services that are sustainable for years to come.

Our Partnership is about shaping the future; it is about creating a positive lifetime of health, wellbeing and care for Northamptonshire’s community.

Transformation priorities The first four transformation priorities for Northamptonshire Health and Care Partnership are outlined below. In some parts of the county we are already starting work on these.

• Urgent and emergency care

• Bringing care together across our hospitals (Unified acute model)

• Care in your area (Primary, community and social care)

• How we plan, buy and monitor services (Strategic commissioning)


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By outlining these four priorities, this does not mean there aren’t other areas in which we are working together differently. We are very proud of the hard work of many of our colleagues who are truly transforming care in Northamptonshire, and they will continue to plan and deliver local improvements in our other areas of focus. However, as a Partnership we must be realistic in our daily focus and how we jointly spend our time. In the next few months and years we will progress to look at other areas of health and care until we have them all aligned across our organisations. Alongside our four transformation priorities, we will continue we will continue to drive improvements across the Northamptonshire health and care system to align with the objectives of the Five Year Forward View as part of our business as usual work. These areas of work include cancer, children and young people, health and wellbeing, learning disabilities, maternity and mental health.

Governance The governance framework for Northamptonshire Health and Care Partnership is summarised in the table below:

Governance group Membership Role Partnership Board Chairs, CEOs and key roles To provide strategic

direction and leadership to NHCP

Strategic Executive Group CEOs and Executive leads To drive planning, delivery and assurance of NHCP workstreams and plans.

Collaborative Stakeholder Forum

Key leads from all Partnership organisations

To ensure involvement and engagement of patients, public and stakeholders, supporting the aims, objectives and aspirations of NHCP

Strategic Clinical Group Clinical Leaders To ensure NHCP delivers clinically safe transformational change under the guidance of appropriate clinical involvement

Strategic Finance Group Directors of Finance To ensure financial sustainability for balanced organisational and system plans, to support workstreams to develop robust financial plans, and to provide overall assurance on investments to NHCP

SROs Group Senior Responsible Officer and programme leads

To work with the NHCP Delivery Support Unit to drive the progression of workstreams and deliver NHCP’s objectives and aspirations


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What we have already achieved together

✓ Urgent care Productive partnership working to explore and find resolutions for our challenging pressure on the system

✓ Health system led investment in provider digitisation £5.177m funding secured over three years to develop system-wide digital solutions, including electronic patient record solutions at scale; extending system capacity management; improving staff rostering, completeness of information availability and access to clinical information and support; and sharing of health and social care information

✓ Launch of SHREWD (Single Health Resilience Early Warning Database) A new web-based portal providing a consolidated, real-time view of system capacity across the county health economy, simplifying responses to system pressure and enabling health and social care organisations to share data to proactively tackle the causes of pressure

✓ Medical interoperability gateway Linking key health care information to joining people’s information together to support care

✓ Perinatal mental health service Much-needed, targeted intervention and support for mothers and their families in with mental health needs

✓ Primary care at scale GPs working together at scale to improve access to local primary care

✓ Stroke services NHCP partners and key stakeholders including patients and carers, have worked together on redesigning the Northamptonshire stroke pathway

✓ Kettering Homes Health and borough council working in partnership to meet peoples housing needs on discharge from hospital

✓ Breathing Space Working with the voluntary sector to effectively manage COPD patients

✓ Best of Both Worlds – a joint recruitment campaign between providers, sharing our resource to recruit people into Northamptonshire

✓ Communications – launch of monthly staff update newsletters and NHCP website (www.northamptonshirehcp.co.uk)

http://www.northamptonshirehcp.co.uk/


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GP Forward View As with the Operating Plan and the Health and Social Care Partnership, NHS Corby CCG and NHS Nene CCG have chosen to work together to deliver the GP Forward View which aims to improve and make more sustainable the delivery of GP services for Northamptonshire patients. For the majority of our populations, their first point of contact with health services comes with a visit to their local GP. The plan adds the context of what will need to happen in the delivery of primary care and specifically general practice to link these developments within the plans of the Northamptonshire Health and Social Care Partnership. These themes continue with the plan which details our current intentions for primary care investment in line with operating plan guidance and in line with transformation plans. The document is not intended to replicate the narrative plan of the STP but demonstrate the alignment between the STP and the plans for implementation of the GP Forward View. NHS Corby CCG has had fully delegated responsibility from NHS England for general practice contracts since April 2016. Our approach is to base our foundations of delivery in the individual practices that our populations have as a first point of contact with the health system. We have a plan of action which describes how through supporting individual practices, we will enable them to work with other practices ‘primary care at scale’ to improve their offer to their own patients. Finally, the plan describes how primary care delivery will fit into the new models of care that will meet the changing needs of our population, as part of a new care model. Our new care models are beginning to integrate primary, community and other out of hospital providers with specialist support from the acute trusts to develop a robust, comprehensive out of hospital care offer.

Every Practice Our vision is that there is consistent high-quality care across all Corby GP Practices, by providing consistent approaches to access and navigation so that local people understand better what their general practice can do for them and what services are available as an alternative.


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Primary Care at Scale We are supporting the development of Primary Care at Scale and further detail can be found later in the Performance Report.

Key Issues in Primary Care for 2018/19

Our priorities for 2018/19 are enshrined in our commissioning intentions; the key highlights are:

• As separate statutory bodies Corby and Nene CCGs are speaking with one voice to all providers

• This year the commissioning Intentions start with the patient pathway at their centre and focus on quality and clinical variation. This approach will demonstrate the changes required in each setting of care (prevention and self-management, primary care, enhanced primary and community care, intermediate care and acute care) to improve the overall management of health conditions.

• We aim to clarifying the balance between emergency care, non-elective spells and the elective options we need to offer our population.

We will:

• Improve health outcomes and reduce variation

• Lead the way to safety and quality through commissioning

• Make best use of resources

• Build a health system fit for our population and maximise the opportunity to deliver across health and social care

• Our commissioning intentions are set within the context of unprecedented sustained and significant financial challenge across health and social care requiring new models of care, greater collaboration and joint working, a focus on prevention and self-care

• The move away from a traditional commissioner/provider split will reduce transactional costs and the move to an Accountable Care System (ACS) must ensure that best value opportunities are realised. This cannot reduce a focus on safety and quality across services and organisations and the necessity to drive continuous improvement across care pathway.


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What does this mean for GP services? This means working through our GP Forward View plans to secure high quality primary care services for the population of Northamptonshire from each of our practices.

Continuing to utilise Personal Medical Services (PMS) reinvestment monies to:

• Increase the use of e-referral across the County

• Improve access to 24-hour blood pressure monitoring

• Support leg ulcer management and spirometry in general practice

• Commission ear syringing from general practice and

• Secure other services from general practice not remunerated through the core contracts

• Continue to encourage practices to work in partnership over populations of 30-50,000 to provide same day care at scale and develop their shared multidisciplinary team at the same time. We will continue to use the GPFV transitional OD monies to support this transformation.

• Continue to encourage provision of local enhanced services at scale through practices working together and secure safe and sustainable services for the whole population not by virtue of the practice people are registered with.

• Complete the review of near patient testing we have already started and look at services that are related to this like anticoagulation and phlebotomy to ensure adequate community capacity for these services is commissioned in accordance with the evidence base.

• Review the provision of ECGs in primary care to ensure adequate community capacity is used to the maximum.

In 2018/19 the CCGS supported further development and reconfiguration of priority community services around primary care homes (specifically physiotherapy, community nursing and mental health support).

✓ Explore elective services within primary care homes that are either underutilised currently or need additional capacity to support primary care home needs.

✓ Continue to support practice clusters and their extended family to innovate in the use of technology to share information and process across services.

✓ Work with all providers to actively support the coming together and development of multidisciplinary extended primary care family teams in our primary care homes.

✓ Extend work done in 2017/18 on in hour’s access at scale to establish a sustainable approach to provision of extended hours in primary care as part of the GP Forward View that utilises the extended primary care team.

✓ Continue engagement with the public about where the gaps are today and what their priorities might be for joined up services in primary care.


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How we consider our changing population Corby CCG’s priorities for health and care in 2018/19 were based upon on the needs of our local population.

We are responsible for commissioning most local NHS health services for the registered population of around 76,785 patients, and rapidly growing including 10,000 patients registered to our practices from outside the borough boundaries of Corby.

Corby is in the county of Northamptonshire which continues to experience significant population growth, set to increase by 12% by 2020. Whilst the population has grown across all age groups, it has been particularly high for over 65-year olds and these trends are expected to continue.

Corby is a town and Borough in the North East of Northamptonshire. It has a number of areas of deprivation which are in the top 20% most deprived areas in England, particularly located in and around the town centre. Socio-economic deprivation is an important health and wellbeing determinant. There are notable differences in life expectancy between the most and least deprived areas in Northamptonshire and nationally.

The Borough is also expanding at a fast pace, growing by approximately 12,000 to circa 66,9007 in the past 13 years. The Office of National Statistics has reported the Borough to be in the top ten nationally for growth.

Demography

NHS Corby, as a small CCG, has a fast-growing population with an above-average level of social deprivation and a relatively high prevalence of smoking and obesity. Corby Borough is expanding at a fast pace, growing by approximately 12,000 in the past 13 years, to circa 66,900. The CCG’s registered population has grown at a similar rate to circa 76,000. There are particular pressure points with a 44% growth in the 85+ population by 2026 and 22% growth in under 19s.


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The resident Corby Population is 64,000, whilst the registered practice population is 76,785.

The health of people in Corby is varied compared with the England average: • About 20% (2,700) of children live-in low-income families; • Life expectancy for both men and women is lower than the England average; • Life expectancy is 10.4 years lower for men in the most deprived areas of Corby than in the least deprived areas; • 23.1% (167) of year 6 children are classified as obese, worse than the average for England; • Levels of GCSE attainment, breastfeeding initiation and smoking at time of delivery are worse than the England average; • The rate of smoking related deaths is worse than England average as are the estimated levels of adult excess weight and smoking.

Ethnicity

Corby is less ethnically diverse than Northamptonshire or the East Midlands. Overall 95% of the population is estimated to be white, in particularly in the older age groups. Young people in Corby are more ethnically diverse, 88% of children pre-reception class were white.

As the largest proportion of the population is the under 19s and over 65s, the urgent care needs will require increased children’s urgent care and a focus on preventative primary care to reduce the need for reactive urgent care treatment.

Population Growth

NHS Corby CCG is one of the fastest growing populations in England with a considerable number of new housing developments planned across the borough. This growth in the population will need to be taken into account for the planning of health and care services in the new models of care.

Key characteristics of the local population are: • 0-19-year olds - the younger people population in Corby will have the biggest increase across Northamptonshire (5 year 10.9%, 10 year 21.8%); • 20-64-year olds - the working age population in Corby will increase again by 17% in 10 years’ time (5 year 8.5%, 10 year 17%); • 65-84-year olds - the over-65-year age group is predicted to increase by 25 % over 10 years (5 year 11%, 10 year 22%); and • 85+ year olds - once people reach 85+, the increase is even more marked to nearly 45% over 10 years (5 year 22%, 10 year 44%).

Growth in the Corby population is largely driven by existing ageing residents (of the 65+ age group) and the migration of younger, working people moving to the new housing developments as a commuter zone for London. The two populations have not merged and engage with local services in line with national patterns that match their differing demographics.


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What Did Corby CCG Achieve in 2018/19? Below is a list of headline achievements followed by a section explaining accomplishments in greater detail.

✓ Urgent care Productive partnership working to explore and find resolutions

for our challenging pressure on the system

✓ Health system led investment in provider digitisation £5.177m

funding secured over three years to develop system-wide digital solutions,

including electronic patient record solutions at scale; extending system

capacity management; improving staff rostering, completeness of information

availability and access to clinical information and support; and sharing of

health and social care information

✓ Launch of ‘Single Health Resilience Early Warning Database’

A new web-based portal providing a consolidated, real-time view of system

capacity across the county health economy, simplifying responses to system

pressure and enabling health and social care organisations to share data to

proactively tackle the causes of pressure

✓ Medical interoperability gateway Linking key health care information

to joining people’s information together to support care

✓ Perinatal mental health service Much-needed, targeted intervention

and support for mothers and their families in with mental health needs

✓ Primary care at scale GPs working together at scale to improve access

to local primary care

✓ Stroke services NHCP partners and key stakeholders including patients

and carers, have worked together on redesigning the Northamptonshire

stroke pathway

✓ Kettering Homes Health and borough council working in partnership to

meet peoples housing needs on discharge from hospital

✓ Breathing Space Working with the voluntary sector to effectively manage

COPD patients


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✓ Best of Both Worlds A joint recruitment campaign between providers,

sharing our resource to recruit people into Northamptonshire

✓ Communications Launch of monthly staff update newsletters and GP

Portal

NHS CCG Rated as ‘Good’ by NHS England

In July 2018 Corby Clinical Commissioning Groups achieved a ‘good’ rating following an annual assessment from NHS England. Under NHS England’s ‘Improvement and Assessment’ framework, and in line with the Five Year Forward View, all CCGs are evaluated and given a rating according to performance, delivery, outcomes, finance and leadership. NHS Corby CCG’S key areas of strength and good practice were noted by NHS England as follows:

• Overall cancer performance

• Contribution to Northamptonshire's Sustainability and Transformation Partnership refresh

• Achievement of overall financial targets for 17/18

• Building a shared management team with Nene Clinical Commissioning Group

• The well led and managed move to a single accountable officer and single portfolios across the clinical and director teams

Oversight of Referral to Treatment Times at Kettering General Hospital (KGH) was also recognised as "very effective," as was the joint clinical approach to harm reviews, which has now been extended to Radiology. KGH has now reduced their numbers of patients waiting 52-weeks to zero.

Smoking Rates Dropped Dramatically The number of smokers in Corby is at a record low, just two years after the town had the highest rate in the country. Corby’s current smoking rate is the lowest for the town since Public Health England’s tobacco control statistics began. Data from 2015 showed almost one in three - 32.3 per cent - of people living there were classed as a current smoker but latest Public Health England statistics for 2017 data show the rate is now down to just 16 per cent - ranked at 118 out of more than 300 UK districts. We are delighted statistics are showing such a significant reduction over the past year and we hope this trend will continue. The numbers of people choosing to stop smoking are a result of a myriad of measures. GPs have been working hard to promote and carry out NHS health checks, midwives have been actively targeting smoking in pregnancy which we know can lead to premature birth and poor foetal development and services to help people stop smoking were readily available last year.


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Bed State Tracker

Following a successful bid NHS England provided NHS Corby CCG and NHS Nene CCG with £30,000 to implement and pilot a single tool that identifies all care home bed vacancies in Northamptonshire. The BedState Tracker was launched in June 2018 and is a piece of specially developed software providing real-time updates and key information about care home vacancies to enable patients to be moved into care home placements more quickly and efficiently.

All nursing and residential care homes have been loaded on to the system, which indicates:

• Number of vacant beds in each home

• Care homes CQC rating

• Category and type of bed

• If top up fees are expected

• If expected to pay rate is accepted

• If the care home accepts Trusted Assessor assessments

Specialist Community Perinatal Mental Health Service

In 2018 Corby and Nene CCGs and Northamptonshire Healthcare NHS Foundation Trust (NHFT) was successful in securing Community Services Development funding to provide a community specialist perinatal mental health service for women who are at risk of, or who are experiencing severe mental health conditions during pregnancy and during the first year following delivery.

As part of the service design, women who have experienced severe mental illness during their pregnancy or following the birth of their child were involved to ensure the service has a “Think Family” approach, with the best interests of women and her infant at the heart of the service. This engagement process continues with service users.

A multidisciplinary team has been recruited to provide a comprehensive Perinatal Mental Health Service, which responds to local need by:

• Intervening earlier at preconception, during pregnancy and up to 1 year following delivery

• Delivering on-going training of professionals from across children’s’ & Maternity services

• Improving the experience, pathways and processes for mothers, their families and professionals


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• Delivering a multi-disciplinary specialist perinatal mental health service to at least 456 women annually (5% of the STP birth rate) in accordance with CR197 staffing recommendations and delivery of NICE recommended intervention.

The new community specialist perinatal mental health service in Northamptonshire will make a real difference to mothers who have severe or complex mental health and will support them to plan a pregnancy and positively and proactively manage the risks whilst maintaining their mental health and wellbeing.

Re-signing the Armed Forces Covenant To those who proudly protect our nation, who do so with honour, courage and commitment, the Armed Forces Covenant is the nation’s commitment to you. It is a pledge that together we acknowledge and understand that those who serve or who have served in the armed forces, and their families, should be treated with fairness and respect in the communities, economy and society they serve with their lives. Seventeen other organisations also signed the Covenant including, NHS Corby CCG, Northampton General Hospital NHS Trust and Northamptonshire Healthcare NHS Foundation Trust.

Celebrating 70 Years of the NHS

On 5th July 2018, the NHS celebrated its NHS birthday. This event was marked across the country by NHS organisations, including NHS Nene CCG. In the build up to the birthday, the CCG engaged with staff about how they wanted to mark the day. The majority of staff voted for a tea party. A high tea was held over lunchtime and any staff who wished to be given the option to attend in 1940s attire or dressed as a medical professional.

Defence Employer Recognition Scheme NHS Corby CCG remains committed to ensure that ‘our military family’ are not disadvantaged compared to other citizens in the provision of public and commercial services and fully supported in the work place.

The Defence Employer Recognition Scheme encourages employers to support defence and inspire others to do the same. The scheme encompasses bronze, silver and gold

awards for employer organisations that pledge, demonstrate or advocate support to defence and the armed forces community, and align their values to the Armed Forces Covenant. In May 2018 NHS Corby CCG was officially informed that we had been successful in our ESR Silver nomination.


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Multi-Disciplinary Foot Team Service

In November 2018 Northamptonshire was chosen by NHSE to be an evaluation site for the Diabetes Transformation Project as it was seen to have made significant improvements to its diabetic foot care using this funding.

18 months into a 2-year project had already seen waiting times for high and moderate risk patients referred from a GP cut from 53 weeks to 32 weeks and waits for orthotic footwear decrease from 7+ weeks to 2 weeks.

The funding allowed for access to the MDFT clinics to be extended, having a knock-on effect of improved access to vascular, with patients typically being seen within a week, instead of 6-12 weeks as previously. This has meant earlier intervention and a reduction in both amputation numbers and severity.

The clinics have also improved the patient journey, with some patients now being able to be treated at home, or still in hospital but with a reduced length of stay.


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How has NHS Corby CCG performed against national standards this year?

Performance Report

This part of the document is to inform you about the CCG’s work and performance in 2018/19.

NHS Corby CCG holds a monthly operational contract meeting with each of the providers to review their performance either directly or through national reporting systems and in a bid to gain assurance that robust action is being taken where issues arise. In addition, regular meetings are held between the relevant performance leads to discuss each issue in detail.

Northamptonshire also has working groups in place to ensure performance is delivered in key areas, including the Urgent Care Working Groups and the Cancer Improvement Working Group.

All performance issues are escalated to the Corby CCG and Nene CCG Joint Quality Committee and the NHS Corby CCG Governing Body. The Governing Body notes performance at every meeting.

Performance Summary

Corby CCG measures its performance against national NHS standards. We and our providers successfully delivered many of the required standards in 2018/19 including:

✓ 6 Week Diagnostic Wait – Corby CCG have ensured over 99% of patients have access to a diagnostic test with 6 weeks of the referral

✓ Dementia prevalence diagnosis rate has recovered and is now above the required standard

✓ Not a single patient waited more than 12 hours in A&E for admission to a hospital bed

✓ Over 98% of patients requiring Psychological Therapies have had their treatment completed within 18 weeks (standard 95%)

✓ Significantly reduced the number of patients waiting 52 weeks or longer for elective care


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The challenging areas which require our continued focus in 2019/20 are:

• A&E four-hour performance at both of Northamptonshire’s acute hospitals • Delivery of the new Ambulance Response Programme waiting times • 62-day waiting time standards at Northampton General Hospital NHS Trust • Recovering the decline in the 18-week Referral to Treatment time for planned

care • Reducing the number of 52+ week waits for planned care to zero • Improving Psychological Therapies, access and recovery rates.

All Key Performance Indicators in relation to NHS performance standards are tracked using regular data provided by the relevant providers and Corby CCG and its partners are working with all providers to ensure detailed improvement plans for each of these areas are implemented.


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How we are improving our performance Below you will find examples of how the CCG is improving our performance for the population of Corby.

Learning Disability Services

NHS Corby and Nene Clinical Commissioning Groups are working in partnership with the Local Authority and NHSE Specialised Commissioning to transform learning disability services to meet national and local expectations. This partnership is called the Northamptonshire Transforming Care Partnership (TCP).

One of the main achievements during 2018 has been the integration of health and social care services to deliver a single service to people with learning disabilities and their families/carers in Northamptonshire. This is called the ‘Northamptonshire Learning Disability Service - Working together: Improving Lives. ‘

In October 2018 a joint Health and Social Care learning disability commissioning and priority plan was agreed. This aimed to develop the provider market to improve quality and gain assurance we are spending money in the right places, on the things that matter most, and which focus on improving individual outcomes.

Other successes have been achieved within the following national key areas of work:

Maternity Services

NHS Corby and Nene Clinical Commissioning Groups (CCGs) are currently working to align local maternity services to the recommendations outlined in the NHSE Better Births report published in 2016. The Better Births report sets out the vision and approach for improving the NHS maternity services in England by 2021.

The report outlined the findings and focussed on seven key themes for improving maternity services and recommended that CCGs and maternity care providers work together as ‘Local Maternity Systems (LMS) to develop and implement the local vision.


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The following are the seven key areas outlined to improve outcomes of maternity services.

• Personalised Care and Choice

• Continuity of Carer

• Personalised Care and Choice

• Safer Care

• Better Postnatal and Perinatal Mental Healthcare

• Multi Professional Working Across Boundaries and Introduction of Electronic Maternity Records

• Working Across Boundaries

• Payment System

Getting Started – Developing the Local Strategy

In order to improve local maternity services, NHS Corby and Nene CCGs needed to understand what our local mums, dads, partners and families felt worked well and what needed to improve. To do this, the CCGs appointed Healthwatch Northamptonshire to liaise with parents who had used maternity services across Northamptonshire (within a twelve-month period at the point of the survey).

The key areas of focus were continuity of care, safety, provision of clear and consistent information to support informed choices. Mums were also asked about the support they received relating to perinatal mental health conditions. In addition, we sought out views on how local maternity services currently support breastfeeding, stop smoking and healthy eating during pregnancy. The survey covered a pregnant women’s journey through antenatal care, labour and postnatal care.

The Healthwatch report formed the foundations for developing the Northamptonshire LMS transformation plan.

Who Oversees Delivery of the Northamptonshire Maternity Systems?

The delivery of Better Births in Northamptonshire is overseen by a board which is made up NHS Nene and Corby CCGs; clinicians representing maternity services (including Neonatal Services); NHFT Perinatal Mental Health Services and Children’s 0-19 Services; NHS England; Public Health Services; Northampton County Council (NCC); and service user groups such as Healthwatch and Northamptonshire Maternity Voices Partnership (MVP).

Collectively this group of representatives is called the “Northamptonshire Local Maternity Systems (LMS) Delivery Board.”

The delivery board meet monthly to review the transformation and progress of the maternity services.


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Northamptonshire Maternity Voices Partnership (MVP)

The MVP is a local volunteer group made up of mums who have used maternity services in Northamptonshire. Their role is viewed as critical to developing a palpable and genuine change in the services.

Through this ongoing forum we will ensure that we continue to listen, respond and develop ways of enabling women and their families from all backgrounds, ages and ethnicities to share their views with us, and work with us to co-produce services and plan and monitor service improvements.

The Northamptonshire MVP was promoted at two Whose Shoes? workshops held in the north and south of the county. The event was aimed at local parents of babies and toddlers, as well as maternity service clinicians. The workshop brought the groups together to discuss the experiences of maternity services in Northampton and was well attended by both parents and clinicians, such as midwives and heads of midwifery services.

The workshop was facilitated through a fun interactive board game that incorporates key questions and encourages discussion in a relaxed environment.

A graphic artist was able to use the discussions and themes to create an info-graphic to summarise the events.

Mental Health

Mental Health continues to be an area of focus for Northamptonshire. The Five Year Forward View for Mental Health, coupled with the particular challenges presented by an ageing population and struggling social care services, have all provided areas of priority. Providing opportunities to get help at the earliest point, having reliable and effective secondary care services, and robust crisis support remain the benchmarks.

Dementia Diagnosis

Local data estimates that more than 8,300 people across Northamptonshire are living with Dementia (in various stages of development). The majority of those people are living in their own homes, or sheltered housing, rather than Care Homes. The most significant risk factor for Dementia is patient age and given that our county has a disproportionately aging community, Northamptonshire has ensured a focus on ensuring people who have dementia live well.


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What are we doing?

A Joint Dementia Strategy (covering 2016-2019) has been used to bring professionals from Northampton and Kettering General Hospitals, Northampton Health Care Foundation Trust, Northamptonshire County Council and Public Health together with Clinical Commissioning colleagues to instigate system-wide innovations to dementia care. Awareness has been raised through the production of 15,000 dementia-friendly brochures, as well as holding our Annual Memory Day event on 20th September 2018. Multi-agency partnership arrangements are aimed at bringing the timeframe from referral to diagnosis down to below six weeks. Furthermore, our UnityDem pilot is underway to support patients and carers to allow people with dementia to live in their own homes for longer, and to help prevent symptoms of dementia from escalating early. Meanwhile, our teams within acute hospitals put practical and emotional support around families to allow patients to return home sooner, following a period in hospital.

Improving Access to Psychological Therapies (IAPT)

Changing Minds (IAPT) service continues to provide person-centred psychology services for those suffering from mild to moderate depression and/or anxiety. The service receives approximately 610 new referrals per month.

What are we doing?

Our IAPT service has undergone an in-depth process of innovation and improvement. The new Referral Hub (implemented in 2017) is now embedded, and the ability for the public to self-refer has improved accessibility. The hub also allows a greater proportion of those who come forward for help to be assessment and start treatment sooner – the service now supports over 90% of service users from referral into treatment in under 6 weeks. The service has also broadened its options for treatment, allowing those who come forward greater choice and control over how they receive their support (including more options for group work and online interventions). A number of high intensity therapies are also offered, including Cognitive Behavioural Therapy and Eye Movement Desensitisation & Reprocessing therapy. The service has increased its workforce in order to keep up with the demand for support services in the county.

Early Intervention Psychosis

Providing early intervention and intensive support to those with symptoms of psychosis is an important aspect of our mental health offer in Northamptonshire. The Early Intervention for Psychosis team provides support to over 150 patients, and complete approximately 950 contacts per month. The service supports people into treatment within two weeks of referral, in over 96% of cases.


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What are we doing?

We have taken steps our strengthen Psychosis services, including the implementation of a dedicated Cognitive-Behavioural Therapist to provide family interventions. Occupational therapy and peer support are available, as well as employment support provided through the Individual Placement Service. There is a strong focus on ensuring an annual physical health check, in order to support the overall health and wellbeing standards of every patient, which includes physical health clinics available across the region. The service includes healthy walk groups, allotment in both North and South of the county, yoga and recovery group sports (swimming, martial arts, badminton and golf).

Mental Health Crisis

Services that provide support at times of crisis are under continual pressure, particularly during winter months. Our local NHS continues to provide effective, 24/7 crisis support, and our community mental health crisis services receive approximately 1,245 referrals per month.

What are we doing?

We have strengthened our crisis pathway, which now include greater options for preventing and avoiding the need to access Accident & Emergency services. A series of Crisis Cafés have been implemented seven days a week, in both North and South of the county, and we have extended the opening times for these over the winter months.

A Crisis House implemented in the South of the county has continued to provide a genuine alternative to an acute hospital admission – allowing people to receive rapid, effective support closer to their home, families and employment. Plans are now in place to replicate this service in the North of the county. Our Acute Hospital Liaison Team have been provided additional funding to increase their offer to patients in line with Core-24 standards (National Institute of Clinical Excellence). Most importantly, work has been undertaken to integrate the aspects of the pathway so that all professionals know how to ensure every patient finds the best type of support for them and can coordinate each person’s care according to their immediate needs.

Other Points to Note

Northamptonshire is working to develop an innovative Outcome-Based Commissioning Framework for all its mental health services across the region. It would mean that all measures of success would be taken directly from a set of desired goals that service users, carers, families and front-line professionals have given us. It would also mean even greater collaboration across the system, whereby NHS, third sector, local authority partners and charitable organisations would come together to design the most effective pathways to meet the needs of our population. Service users and carers would be involved from the outset and throughout, to ensure the framework continues to meet their needs, and continues to innovate and those needs change over time.


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Protecting the day-to day business The Business Continuity Plans for both NHS Corby CCG and NHS Nene CCG have been combined to reflect the joint working arrangements now in place and an overarching Business Continuity Policy was also created to support this.

The policy lays down the principles under which business continuity arrangements operate and has allowed for the streamlining of the Business Continuity Plan. Each of the organisation’s Audit & Risk Committee and Governing Body have approved the documents.

Protection against Cyber attacks

National recommendations were received following the WannaCry cyber-attack in 2017. The CCG has accepted these recommendations and work continues to ensure resilience against cyber-attacks. We have also made improvements to our IT provision with the roll out of new hardware. All staff have now been provided with new or refurbished laptop computers allowing all staff the ability to work remotely, as well as incorporating improved performance, reliability and security.

GP Practice Business Continuity Plans for all were requested for review. This process is ongoing, and at the time of writing 72% of practices have submitted plans.

Work has been ongoing through the year to ensure plans for the potential business failure of a major provider are robust and reflect our current commissioning needs.

End of Life Service

In November the CCG received notification from the end of life service provider that they were ceasing trading from mid-December. The CCG declared this as a business continuity incident and instigated a command and control team to manage the re-procurement process. The new end of life service provider was mobilised and operational by December 14th.

Severe Weather

The country experienced a very harsh winter, with an increase in winter deaths. This was followed by the hottest summer since 1977. Both of these events required business continuity plans to be invoked to ensure staff and patients were kept safe.


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Core Standards

NHS Corby CCG has undertaken the formal Core Standards review for Emergency Preparedness, Resilience and Response (EPRR) and Business Continuity for this year. The review process included meeting with the review panel consisting of NHS England, Public Health England and a representative from the Northamptonshire Public Health team. The CCG assessed itself as being fully compliant against the standards and we have since received confirmation the panel agreed with our self-assessment. We will continue to offer training and exercising opportunities to staff who will be involved in an incident response to ensure we are as prepared as possible.

Current Position

The CCG EPRR team has been fully involved with emergency planning internally, with partners in the health and social care economy and with the wider multi-agency community. Business Continuity planning and response is now a core part of the EPRR responsibilities with time allocated in the Governance and Risk Manager portfolio dedicated to this agenda.

The EPRR team will continue to engage with health and social care partners and the wider multi-agency community to ensure that there is a joined-up approach to managing incidents at a local, regional and national level.


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More about primary Care - GP Forward View NHS England published the General Practice Forward View in April 2016, setting out a programme of support for general practice over five years. It covers areas such as investment in technology and estate, workforce, workload and how to deliver care to meet the changing needs of a population living longer and with more complex needs.

It aims to provide the support Practices need to build the capacity and capabilities required to meet changing patient needs. It also includes support to adopt new ways of working (at individual, Practice and network or federation level) and to develop different ways of meeting patient need.

Last year we described our work in creating Primary Care Hubs/Primary Care Networks (PCN) around the 30,000 to 50,000 scale. The development has continued throughout 2018/2019 and to date there are 19 PCN across the Nene and Corby footprint that have been working collectively to deliver services that are wrapped around the patient.

Some really good examples have already shown how wider integration with community and social care can lead to improved outcomes for patients. The development of Collaborative Care Teams has cemented these processes and helped create mature working arrangements across organisations specifically aimed at complex patients.

Emphasis in 2019/2020 needs to further develop this excellent work and use the PCN foundations as a spring board to really engrain the 30,000 – 50,000 place-based approach within commissioners plans to really support the needs of patients. To do this we need to be able to provide support and guidance to PCNs to develop their maturity where appropriate by drawing on the local and national experiences of integrated care models.

Recent evidence confirms that the volume and complexity of work in general practice have risen considerably in the past few years. The pressure this creates has been compounded by growing challenges with the supply of doctors and nurses.

Research commissioned by NHS England also shows that at least 19 per cent of GP workload might be better handled by someone other than the GP. Helping practices to manage their workload better has therefore been a high priority for the General Practice Forward View and again excellent progress locally has been made on embedding new ways of working through the 10 High Impact Actions, examples include online consultations, social prescribing, developing the team to include pharmacists and physios and active signposting to support patients in accessing the most appropriate clinician and service for their needs.

Extended Access will be available in Corby from April 2019 offering the same benefits to patients.


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A key element of the GPFV and 10 High Impact Actions is Workforce. Attracting and retaining GPs and Practice Nurses in the workforce has been highlighted as a significant risk nationally with the vacancy rate rising from 12% in 2017 to 15% in the summer of 2018. Similar to the national picture, these risks and issues are being played out locally.

To address this in 2018/19 we developed a plan to focus on two key areas for general practice workforce, Attraction and Retention. The CCGs have worked collaboratively with other stakeholders in the system to oversee implementation of this plan, and significant achievements have been made in relation to this.

Northamptonshire has experienced a significant positive trend in practice nurse numbers over the last 18 months, with a 16% increase in this area of the workforce from where we were in 2015. Several initiatives have contributed to this achievement, including;

• Increasing student nurse exposure to general practice careers through the commitments and work of our training hubs.

• Supporting practices to run joint recruitment events to promote more widely general practice careers through a national campaign called Best of Both Worlds.

• Being the first county in the country to host a Practice Nurse Training Post development programme supported by NHS England and Health Education England.

Alongside the above initiatives to attract a workforce into general practice the following retention projects are now also underway to support our current general practice teams:

• Practice Manager training and development

• Practice Nurse up-skilling to develop more enhanced roles and career pathways

• Health Care Assistant apprenticeship opportunities to support, retain and develop our workforce

• Mental Health, wellbeing and resilience training for General Practitioners and their teams

• Implementation of a county wide staff bank to reduce the call for temporary staffing solutions and increase opportunities for current GPs and the wider practice professionals to work across practices in their area.

As well as this, a project called SWiPE has also looked at the skill mix required for general practice for the future. This ensures that we can focus our workforce plans on meeting future need and look at alternative solutions. This makes the best use of the skill sets of other professionals such as physiotherapists, pharmacists and allied health professionals as part of the practice team. Because of work like this, you may now have professionals such as pharmacists within your local practice, offering clinics where their skills are most effective in supporting you.


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Throughout 2019, this work will continue to grow, and as part of the NHCP Primary, Community and Social Care (PCS) work stream, workforce has been recognised as a key area to enable the ambitions of place-based care going forward.

Projects next on the agenda in early 2019 include the launch of our International Recruitment campaign to attract more GPs to Northamptonshire and developing plans alongside the PCS work to look at the range of other practitioners people have available to them through general practice on a population footprint to improve access to services.

A number of Practices have undertaken the Productive General Practice programme, which is designed to help general practices continue to deliver high quality care whilst meeting increasing levels of demand and diverse expectations. Practices who have rolled out the programme have reported time savings for clinical and administrative staff, improved skills in managing change and quality improvement, meaning change can happen at a greater pace and a positive change in team dynamics, and how they work together to overcome challenges.

Practices are also training their reception and clerical staff to take more of a role in helping patients find the right services. Around 550 members of staff from 68 practices have been trained in care navigation, helping to play a greater role in the navigation, or ‘queue busting’, of patient care pathways and handling of clinical paper work. This releases GP time, so they can focus on the complex conditions only they have the skills to deal with.

We have also been successful in winning bids for funding to support a number of GP practices across three localities. The purpose of this funding is to support practices to become more sustainable and better placed to tackle the challenges they face now and into the future.

The funding has enabled a number of practices to look at areas of work and identify where changes could be made to enhance clinical services, for example using allied health professionals such as physiotherapists and paediatric specialist nurses to support workload. It has also enabled practices to identify and reduce duplication as a collective and recognise the benefits of working at scale.


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What Does this Mean for Primary Care? For Primary Care this means continue working through our GP 5 Year Forward View plans to secure high quality and resilient primary care services for the population of Northamptonshire.

We continue to utilise PMS reinvestment monies to support Practices provide services not remunerated through their core GMS contract, such as:

• Spirometry diagnostic testing

• Improving access to 24-hour blood pressure monitoring

• Support leg ulcer management and spirometry in general practice

• Ear syringing

• Initiation of Direct Oral Anticoagulants

• Post-Operative wound care

In addition to the above we continue to encourage practices to work in partnership over populations of 30-50,000 to provide same day care at scale and develop their shared multi-disciplinary team at the same time. We will continue to use the GP 5 Year Forward View transitional Organisational Development monies to support this transformation.

We will continue to encourage provision of local enhanced services at scale through practices working together and secure safe and sustainable services for the whole population not by virtue of the practice people are registered with.

Support further development and reconfiguration of priority community services around primary care networks (specifically physiotherapy, community nursing and mental health support).


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As part of this we will:

• Explore elective services within primary care homes that are either underutilised currently or need additional capacity to support primary care home needs

• Continue to support practice clusters and their extended family to innovate in the use of technology to share information and process across services

• Work with all providers to actively support the coming together and development of multidisciplinary extended primary care family teams in our primary care networks.

• Provide Extended Access to Corby patients to go live April 2019

• Continue engagement with the public about where the gaps are today and what their priorities might be for joined up services in primary care

Protected Learning Time Programme

Corby and Nene CCGs support on-going education for clinical staff to ensure best medical practice for the safe and effective care of patients. Supported by a dedicated Protected Learning Time Clinical Lead, GPs and other local primary care staff are provided with opportunities to continue their professional development.

These include designated ‘protected learning time’ when practices close to allow for staff training; six sessions are provided off-site when staff join their colleagues for updates on a broad range of topics delivered by local and national experts in their fields, and five afternoons a year when mandatory training such as safeguarding, and resuscitation is provided in-practice. Training is very well attended with on average 250 GPs and 100 practice nursing staff attending protected learning time events across the county.

In addition to this, the Primary Care Portal provides information on external training available for practice staff plus resources for practices to use for their in-practice training as required.

Urgent Care

Whilst the urgent care system remains challenged there have been significant developments and progress throughout the year. A pilot programme introduced ambulance paramedics to work with GP’s as part of the GP home visiting services. Four 4 practices across the county have participated in this initiative to enable decision making and care to be delivered earlier in the day.

111 digital was successfully launched across the county during the summer, this enabled IT users to access 111 via a web application.


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The capacity and demand modelling undertaking in the summer directed a series of actions to enhance the supported discharge pathways.

• The non-weight bearing pathway which supports patients to go home or into interim supported living environments has been successfully expended

• Integrated Discharge teams were introduced at the end of October bring social care and hospital discharges teams together to support early discharge planning and joint assessment.

• Care home trusted assessors were introduced during the summer to provide liaison and communication between hospitals and care homes.

• Additional capacity in the supported home discharge pathway / services increased from October

All the above have contributed to a 51% reduction in delayed transfers of care over the last 12 months.

Surge and Escalation

The CCG has commissioned NEL CSU to provide an integrated surge and escalation management service, including the provision of a Senior Manager on-call for the out of hour’s period.

The Surge and Escalation Team have undertaken a review of the Surge and Escalation Plan, with a particular focus on updating the triggers and actions to support the Operational Pressures Escalation Level (OPEL). OPEL shares common actions with the NHS England Emergency Preparedness, Resilience and Response (EPRR) Framework and aims to provide a consistent approach in times of pressure by providing a nationally consistent set of escalation levels, triggers and protocols for local AE Delivery Boards to align with their existing escalation processes.

The Surge and Escalation Plan clearly sets out the expectations on both commissioners and providers of urgent care in working together to manage pressure in a single provider or across the whole health economy.

To support the escalation, process the Single Health Resilience Early Warning Database (SHREWD) has been commissioned. Shrewd Resilience enables front line teams and operational leaders to identify ‘where’ pressure is across the health system within three seconds. Users can get to the granular detail and root cause of ‘why’ the system is under pressure. Data is captured live or in real time wherever possible and shared with all providers across the health economy via a web interface and smartphone app. The CCG, along with NEL CSU has worked with providers to develop the metrics and weighting for each element of the system.


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On-Call Managers and Tier2 On-Call

NEL CSU has been commissioned to provide a Senior Manager On-Call role to support the surge and escalation process 24/7. Senior Managers On-Call are senior staff and have training provided to help support them in this role. Although the role is specific to surge and escalation, each Senior Manager On-Call is offered training in a range of scenario’s as many responses will involve a capacity management function.

The Tier 2 On-Call is made up of Deputy and Executive Directors of the CCG. During the course of the previous year the number of staff on the Director On-Call rota dropped to 3. This was unsustainable for both the CCG and the staff on the rota. The CCG undertook a consultation with staff employed at an 8D level, who are primarily Deputy Directors, and created the new Tier 2 On-Call level.

These staff provide the Gold/Strategic level for both the CCG and wider NHS in Northamptonshire. The new cohort of Tier 2 On-Call have undertaken initial training which centred on awareness of relevant plans, protocols and processes. They will also attend multi-agency training at the Local Resilience Forum where they will forge links with other responding organisations, such as the Blue Light Services and Local Authority.

The CCG recognises that training for these roles is important and ensures relevant staff are offered the opportunity to attend training and exercises both in-house and externally.

Major Incident Exercises

NHS England and Public Health England have developed and ran a number of exercises throughout the year based on mass casualty scenarios. These exercises were all regional wide with one centred on a scenario based in central Northampton.

The head of System Resilience and EPRR will evaluate the reports when they are released and identify any learning specific to the CCG and the whole health economy.


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Our performance analysis

Performance Overview

How we manage performance

Corby CCG measures its performance against national NHS standards. We and our providers successfully delivered many of the required standards in 2018/19 including:

• 6 Week Diagnostic Wait – Corby CCG have ensured over 99% of patients have access to a diagnostic test with 6 weeks of the referral

• Dementia prevalence diagnosis rate has recovered and is now above the required standard

• Not a single patient waited more than 12 hours in A&E for admission to a hospital bed

• Over 98% of patients requiring Psychological Therapies have had their treatment completed within 18 weeks (standard 95%)

• Significantly reduced the number of patients waiting 52 weeks or longer for elective care

The challenging areas that require our continued focus in 2019/20 are:

• A&E four-hour performance at both of Northamptonshire’s acute hospitals • Delivery of the new Ambulance Response Programme waiting times • 62-day waiting time standards at Northampton General Hospital NHS Trust • Recovering the decline in the 18-week Referral to Treatment time for planned

care • Reducing the number of 52+ week waits for planned care to zero • Improving Psychological Therapies, access and recovery rates.

Corby CCG and its partners are working with all providers to ensure detailed improvement plans for each of these areas are implemented.

All Key Performance Indicators (KPIs) in relation to NHS performance standards are tracked, using regular data provided by the relevant providers. Corby CCG holds a monthly operational contract meeting with each of the providers, to review their performance either directly or through national reporting systems and gain assurance where issues arise that robust action is being taken. In addition, regular meetings are held between the relevant performance leads to discuss the issues in detail.

Northamptonshire also has working groups in place to ensure performance is delivered in key areas, including the Urgent Care Working Groups and the Cancer Improvement Working Group.

All performance issues are escalated to the Nene CCG and Corby CCG Joint Quality Committee and the Corby CCG Governing Body. The Governing Body considers performance at every meeting.


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Performance analysis

Performance against NHS Constitution and supporting measures

Urgent Care - Patients waiting four hours or less in A&E

KEY for Performance Tables

• Standard met

• Standard not met

• Data not published • Year = Full year effect

NHS Constitution measures - quarterly

Std Organisation Q1 Q2 Q3 Q4 Year

A&E waits

Patients to be admitted,

transferred or discharged

within 4 hours of arrival at A&E

95%

NGH 89.79% 90.96% 85.37% 79.35% 86.29%

KGH 84.40% 83.33% 82.55% 76.02% 81.54%

Delivering the A&E four-hour standard is a national challenge and Northamptonshire

is no exception. There are a number of reasons: demand from patients with more

complex care needs (for example, the frail and elderly), internal hospital operational

challenges and delays in moving patients from NHS to social care services run by

the local authority. The CCG continues to work with partner organisations across the

whole health and social care system to improve urgent care performance and

resilience.

Both acute trusts – Northampton General Hospital NHS Foundation Trust and

Kettering General Hospital NHS Foundation Trust - have experienced extreme

pressure on their urgent care systems during the winter period, in spite of robust

plans and additional funding. However, both trusts have managed to avoid any

patients waiting more than 12 hours for a bed in A&E.

NHS Constitution measures

Std Organisation Q1 Q2 Q3 Q4 Year

No waits from decision to admit to admission (trolley

waits) over 12 hours 0

NGH 0 0 0 0 0

KGH 0 0 0 0 0


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Northampton General Hospital (NGH), has opened a new emergency assessment

hub this year. This new hub is designed to improve assessment and patient care for

all unplanned treatment at the hospital and should help significantly in ensuring that

patients do not wait longer than four hours in A&E.

Corby CCG and our partners are committed to ensuring that the system is resilient,

and we have developed a number of initiatives focussing on three key areas:

• Inflow - reducing the number of patients arriving at the acute A&E

• Internal flow - ensuring patients move through the hospital assessment &

treatment systems efficiently

• Outflow – making sure that once acute hospital care is no longer required the

patient has a place to transfer to or the support they need in their own home.

Examples of the key inflow initiatives include:

• Proactive care homes scheme: Ensuring that care homes are looking for the

signs of illness so that patients can be seen before their condition worsens to

the point of needing hospital admission.

• EMAS GP visiting scheme: Using paramedics to supplement the GP home

visiting service to ensure patients have timely access to primary care services

thereby reducing the number that have to use A&E as unable to access their

GP.

• Co-locating Out of Hours (OOH) GP into acute hospitals: Basing the OOH

service at the main hospital sites allows patients to be quickly directed from

A&E to OOH or vice versa, ensuring patients get timely effective care.

• Emergency Care Centres in Town centres: EMAS have provided dynamic

treatment centres in Northampton on predicted busy nights in order to reduce

demand on 999 and A&E.

Examples of key internal flow initiatives include:

• Additional medical resources being placed at the front door: The hospitals

have placed senior specialist doctors in A&E to review patients early prior to

admission. This process reduces the number of patients requiring admission.

• Criteria-led discharge: Senior medical staffs create a clear set of discharge

criteria for a patient; once this is met, the patient can be discharged without a

further consultant review. This ensures patients can leave hospital as soon as

they are ready to.

• Additional discharge facilitators: The additional discharge facilitators ensure

improved communication between hospital, community services and the

patient. This helps ensure patients can go home sooner.


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Key outflow initiatives include:

• Spot purchase of community beds: Buying nursing or care home beds for

patients that do not require hospital care but are not able to return home. This

ensures beds are available for those who do.

• Commissioning of significant additional community bed capacity, which has

significantly reduced Delayed Transfer of Care (DTOC) patients.

• Multi Agency Discharges Events (MADE) at both acute trusts: These events

bring in partners across the healthcare system to go to the acute hospitals to

review patients to ensure that they have a plan for discharge and unblock any

issues holding up discharge.

• Commissioning additional care support capacity for patients to be discharged

to their own home.

• Additional beds for community step down

Ambulance Handovers

All handovers between ambulance and A&E must take place within 15 minutes and crews should be ready to accept new calls within a further 15 minutes. Please note data for this measure is EMAS data and can differ to the acute trusts A&E data.

NHS Constitution Support Measures

(Quarterly) Standard Trust Q1 Q2 Q3 Q4 Year

Handovers between ambulance and A&E

within 15 mins and crew ready for new calls

within 15 mins (delays of over 30 mins)

0

NGH 637 574 1,141 1,767 4,119

KGH 1,349 1,287 1,305 1,758 5,699

Handovers between ambulance and A&E

within 15 mins and crew ready for new calls

within 15 mins (delays of over 1 hour)

0

NGH 61 60 141 256 518

KGH 229 182 180 291 882

What we are doing

The key driver in delays in ambulance handover is normally that A&E departments are beyond capacity. The actions we are taken which are detailed in the A&E sections will play a major role in resolving ambulance handover issues. In addition to those actions the Urgent Care Board continue to work with EMAS and both A&Es to improve processes on dealing with ambulance handover. The CCG has a clear escalation process for management of long delays.


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Cancer waiting times


Standard Organisation Q1 Q2 Q3 Q4 Year

Cancer waits – 2 week

wait

Maximum two-week

wait for first outpatient

appointment for

suspected cancer

93%

Corby CCG 95.42% 96.46% 98.00% 98.34% 97.02%

NGH 79.58% 72.83% 89.96% 76.44% 79.71%

KGH 95.44% 96.30% 98.11% 98.27% 97.05%

Maximum two-week

wait for first outpatient

appointment referred urgently

with breast symptoms

93%

Corby CCG 97.62% 96.36% 95.83% 96.49% 96.53%

NGH 55.32% 39.67% 60.46% 65.31% 55.59%

KGH 99.39% 97.98% 98.05% 99.10% 98.61%


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Cancer Waits – 31 days

Maximum one month wait from

diagnosis to first

definitive treatment

for all cancers

96%

Corby CCG 98.23% 97.50% 93.33% 95.24% 96.19%

NGH 96.43% 95.88% 96.37% 93.49% 95.59%

KGH 99.55% 98.70% 97.64% 97.94% 98.56%

Maximum one month

wait for subsequent

surgical treatment

94%

Corby CCG 93.33% 87.50% 100% 85.71% 92.11%

NGH 85.29% 96.15% 91.49% 88.89% 91.12%

KGH 100% 100% 100% 98.33% 99.43%

Maximum one month

wait for subsequent anti-cancer

drug treatment

98%

Corby CCG 100% 100% 100% 100% 100%

NGH 98.99% 98.51% 100% 98.20% 98.90%

KGH 100% 100% 100% 100% 100%

Maximum one month

wait for subsequent radiotherapy

treatment

94%

Corby CCG 97.22% 100% 100% 100% 99.02%

NGH 95.96% 96.50% 95.90% 96.98% 96.31%

KGH No pts No pts No pts No pts No pts


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Cancer Waits – 62 day

Maximum two month wait from urgent GP referral to

first definitive treatment

85%

Corby CCG 79.31% 76.74% 86.00% 76.60% 79.80%

NGH 79.24% 81.07% 80.81% 71.77% 78.29%

KGH 81.88% 88.41% 88.95% 86.74% 86.38%

Maximum two month wait from

referral from an NHS

screening service to

first definitive treatment

90%

Corby CCG 100% No pts No pts No pts 100%

NGH 91.67% 97.37% 89.71% 96.88% 93.84%

KGH 94.68% 94.74% 94.32% 92.45% 94.21%

Maximum two month wait for first

definitive treatment following a

consultant’s decision to

upgrade

None

Corby CCG 80.00% 60.00% 75.00% 62.50% 69.23%

NGH 91.80% 79.51% 85.91% 85.00% 85.55%

KGH 83.33% 85.71% 74.36% 75.86% 80.49%

Kettering General Hospital has met and maintained all the cancer standards and is currently performing at or above the required standard.

However, Northampton General struggled consistently to meet the following targets: the 62-day wait from an urgent GP referral for a patient with suspected cancer to first definitive treatment, 2-week wait from GP to specialist referral time and 2 week wait for symptomatic breast referrals. These delays were caused by issues with the way patients move through their care, and capacity restraints in diagnostics services.

What we are doing

While there are challenges specific to each hospital, some issues are faced by services across the system. In response, the Northamptonshire Cancer Board was set up, bringing together Corby and Corby CCGs, primary care, Nottingham General Hospital, Kettering General Hospital, East Midlands Cancer Alliance and NHS England. All organisations’ individual strategies and plans have been consolidated into a high-level work plan to ensure that all services are working on the same key priority areas to improve cancer services across the county. In addition, both NGH and KGH have their improvement plans and their own internal Cancer Boards.


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Corby CCG has worked closely with the East Midlands Cancer Alliance to drive a new approach to transforming care, including prevention, diagnosis, early intervention and treatment.

In 2018/19 we:

• Conducted reviews of cases where patients missed 62-day waiting time, to share learning and make improvements

• Secured funding for the implementation of the National Optimum Lung Pathways that aims to reduce the time from referral to treatment for lung cancer patients

• Secured funding for the RAPID programme for diagnosis and treatment of prostate cancer

• Started implementation of the Started implementation of the Faecal Immunochemical Test (FIT) which aims to ensure that signs of colorectal cancer are found at an early stage.

• Commenced the Living with and Beyond Cancer programme for the county to ensure that people who have cancer or have had treatment are leading as healthy and active a life as possible.

Priorities for cancer care for 2018/19

The Cancer Pathways & Performance working group has identified key issues and pathways to drive continued improvement in 201/19, including:

• Improve communication between GPs and acute hospitals regarding patient choice and delays initiated by patients

• Full implementation the Faecal Immunochemical Test (FIT) to improve diagnosis of bowel cancer.

• Begin to implement the Nation Optimal Lung Pathway to reduce referral to diagnosis times for lung cancer patients.

• Begin implementation the rapid prostate pathway to streamline the referral process for prostate cancers and cut treatment waiting times.

• Recover performance at Northampton General Hospital

In addition, the CCG will continue to monitor all aspects of the cancer pathway to ensure that rapid action is taken to correct any emerging issues.


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Planned care

Referral to treatment (RTT) (quarter data based on Jun / Sep / Dec / Mar. Year

based on Q4)


Quarterly

Standard Data

Source Organisation Q1 Q2 Q3 Q4 Year

Patients on incomplete

non-emergency pathways

(yet to start treatment)

92%

NHS England

RTT Report

Corby CCG 82.23% 81.77% 84.84% 85.94% 85.94%

NGH 84.85% 80.31% 81.48% 80.04% 80.04%

KGH 79.99% 79.21% 83.21% 86.24% 86.24%

This standard requires that at least 92% of patients waiting for consultant-led treatment have been waiting less than 18 weeks. Northampton General Hospital have not meet this standard since implementation of the new Patient Administration System.

Because of significant data quality issues, Kettering General Hospital did not submit national data for the 18-week referral to treatment standard and diagnostics between 2015 and 2017. It has a significant backlog of lengthy waits and corresponding under performance.

What we are doing

In order to improve performance at Northamptonshire, Corby CCG has worked closely with Nene CCG, to develop a plan to reduce long waits and recover RTT performance across the STP footprint.

Referral to treatment (RTT) (quarter data based on Jun / Sep / Dec / Mar. Year

based on Q4)



No patient should wait over 52 weeks from

Referral To Treatment (Incompletes)

0

Corby CCG 0 0 0 0 0

NGH 0 0 0 1 1

KGH 0 2 0 0 0

Corby and Corby CCGs are working together to transform planned care in Northamptonshire with the aim of reducing the pressure on the acute hospitals by looking at alternative ways that patients with less complex needs can be safely treated.


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Diagnostics (quarter data based on Jun / Sep / Dec / Mar. Year based on Q4)

NHS Constitution measures Standard Organisation Q1 Q2 Q3 Q4 Year

Diagnostic test waiting times

Patients waiting for a

diagnostic test

waiting less than 6 weeks

99%

Corby CCG 99.33% 99.69% 99.59% 99.89% 99.89%

NGH 99.69% 99.98% 99.76% 99.36% 99.36%

KGH 99.17% 99.66% 99.26% 99.76% 99.76%

This standard requires that no more than 1% of patients wait over 6 weeks for a

diagnostic test. Nottingham General Hospital met the diagnostics standard for all

twelve months of 2017/18. As detailed above, Kettering General Hospital had

reporting issues but as of March started reporting again.


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Mental Health

Care Programme Approach (quarter data based on Jun / Sep / Dec / Mar. Year

based on Q4)



Care Programme Approach -

Proportion of people under adult mental

illness specialties on CPA who were

followed up within 7 days of discharge.

95%

Corby CCG 100% 100% 88.89% 100% 100%

NHfT 99.19% 98.59% 97.63% 98.58% 98.58%

Dementia diagnosis



Dementia prevalence diagnosis rate 66.7% Corby CCG 83.85% 85.83% 87.75% 87.83% 86.33%

What we are doing

We have delivered training for GPs to improve diagnosis of patients with dementia. This has helped push diagnosis recognition above the standard. We will continue to monitor this to ensure compliance is maintained.

Improved Access to Psychological Therapies (IAPT)

For information Quarter 4 / YTD due to be published after 14 June 2019

NHS Other Support Measures

Standard Org. Q1 Q2 Q3 Q4 Year

IAPT access (Monthly)

1.40% per month

Corby CCG 5.31% 3.89% 3.74%

IAPT access proportion (rolling)

16.80% Corby CCG 5.31% 9.20% 12.94%

IAPT recovery rate 50% Corby CCG 44.67% 42.67% 54.00%

% completed treatment 6 weeks

75% by year end

Corby CCG 92.31% 97.44% 100%

% completed treatment 18 weeks

95% by year end

Corby CCG 100% 100% 100%

There are two performance standards for Improving Access to Psychological Therapies (IAPT); one relates to ensuring appropriate access and the other to recovery rates following IAPT. We did not consistently meet the standards in 2018/19.


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What we are doing

We are working closely with Northamptonshire Healthcare NHS Foundation Trust, who provide the majority of our community and mental health services, to address these issues.

The current referral and booking management systems have been overhauled. The hubs have had a positive impact on the quality of referrals and improved waiting list management. The data quality issues identified by the review of the IAPT service are being addressed by Northamptonshire Healthcare through improved processes and will be closely monitored by Corby CCG.

Performance against other NHS measures

NHS services are also required to meet the following standards from the NHS Constitution:



No Mixed Sex Accommodation breaches

0

Corby CCG 0 4 1 4 9

NGH 0 3 0 6 9

KGH 2 0 0 14 16

NHFT 0 0 0 0 0



No urgent operation to be cancelled for a second

time

0

NGH 0 0 0 0 0

KGH 0 0 0 0 0



Operations cancelled, on or after the day of

admission to be offered other binding date within

28 days.

0

NGH 29 24 10 14 77

KGH 0 0 0 0 0


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How does the CCG spend its money?

NHS Corby CCG) is one of the leaders of the local NHS and essentially acts as the bank with a budget that is set by the Government.

The main areas of commissioning expenditure for the CCG during 2018/19 can be seen in the pie chart below, the CCG had a total net allocation of £112,626,000 including an administration cost allocation of £ £1,572,000. This was our third year of holding fully delegated primary care budgets which accounted for £10,372,000 (9.2%) of the total allocation.

Our core allocation (not including delegated primary care) increased by 4.51% from 17/18 moving the CCG to being only 3.08% below our fair share target allocation.

Looking ahead to 2019/20 the CCG has received 6.5% growth on our non-delegated allocation which reduces the distance above target to 0.24%. Our delegated budget has increased by 5.9%.

Main areas of expenditure for the CCG during 2018/19:

Statutory Financial Duties

In 2018/19 the CCG achieved its statutory duties in relation to accounting and financial standing. Further detail can be found in the annual accounts.


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How does the CCG consider the environment?

Sustainable Development

Sustainability means spending public money well, the smart and efficient use of

natural resources and building healthy, resilient communities. By making the most of

social, environmental and economic assets we can improve health both in the

immediate and long-term, even in the context of a rising cost of natural resources.

Corby CCG’s staff are mainly based at our corporate office at Corby Enterprise

Centre, which is leased from Corby Borough Council. The organisation occupies 7%

of the building; the building is shared with other organisations.

Corby Enterprise Centre is a highly energy efficient building, including the following:

• Biomass boiler

• Solar thermal panels

• Natural ventilation

• Lighting

• Heating

• Natural gas installation

• Water saving taps

• Building Research Establishment Environmental Assessment Method -

(BREEAM)

✓ Corby Enterprise Centre has been designed to meet BREEAM Excellent

criteria. This was considered with a selective palette of construction materials

including external render, stone cladding and solar-controlled glazing panels.

Maximising natural daylight and ventilation have also been factors influencing

the building design which is evidenced by the use and control of areas of

glazing and external window openings.

✓ Internal lighting control has been designed to be as energy efficient as

possible again in line with BREEAM requirements. External lighting is

designed in accordance with Chartered Institute of Building Engineers

(CIBSE) lighting Guide 6 and the BREEAM requirements.

✓ Mechanical systems have been designed in compliance with BSD

specification in line with BREEAM standard building services’ parameters.


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Policies

At a local level the CCG is committed to embedding sustainability into staff behaviour

and other partners in shared premises, concentrating on the reduction of paper,

increased recycling, car sharing and use of local public transport where possible.

Performance

As a part of the NHS, public health and social care system, it is our duty to contribute

towards the level of ambition set in 2014 of reducing the carbon footprint of the NHS,

public health and social care system by 34% (from a 1990 baseline) equivalent to a

28% reduction from a 2013 baseline by 2020.

An assessment was carried out the Sustainable Development Assessment Tool

(SDAT) at the end of the 2018/19 financial year and Corby CCG in partnership with

Nene CCG achieved a score of 33%.


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How does the CCG improve quality?

Through our quality priorities the CCGs are focused on making the care we

commission safer and more effective and improving the experience for our patients.

In order to realise our three overarching strategic quality priorities:

• Patient safety is monitored across the county to ensure the risk of adverse

outcomes for patients are minimised and when they occur lessons are learnt,

shared and embedded

• Patient experience of NHS care across the county is monitored to ensure

lessons are learnt, shared and embedded

• The team has worked to secure continuous improvement in the quality of

services provided and in the outcomes that are achieved and, in particular,

outcomes which show the effectiveness of their services, the safety of the

services provided, and the quality of the experience of the patient

Quality Assurance Process

We have a well-developed system of quality assurance and early warning processes

in place which provides information about the safety, effectiveness and patient

experience of services we commission for our community. This enables us to be

proactive in identifying early signs of concerns and take action where standards fall

short of expectation. It also helps to inform our commissioning decisions at all stages

of the commissioning cycle.

A key part of our assurance processes is the countywide strategic clinical quality

review meeting (SCQRM). This well-established meeting works collaboratively to

support delivery of the Northamptonshire Health and Care Partnership (NHCP) to

improve the quality of care for specific cohorts of patients. This enables us to share

good practice, achievement and innovation so there can be improvement for patients

and carer outcomes across the county; identify common themes from operational

CQRMs, which the group can seek then to resolve in a collaborative fashion and to

develop a common approach to quality assurance and improvement across the

county.


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During the year meeting topics included child and adolescent mental health services

(CAMHS) and dementia/delirium services. The format of the meeting includes

sharing of patient stories to identify gaps in pathways with agreed plans on how to

improve these across the system.

A NHCP quality improvement framework is in development to support the:

• Delivery of the clinical priorities identified in our NHCP Clinical Strategy as set

within each of the six work streams (Urgent & emergency care; Primary,

community and social care; Mental health; Cancer; Health and Wellbeing;

Children and young people)

• Identification, development, commissioning and provision of best practice and

innovation.

• Achievement and maintenance of excellent performance against minimum

national and local standards

• Support improved patient experience and outcomes through the delivery of

high quality, responsive and sustainable services

Each organisation will still have its own individual quality framework with appropriate

governance arrangements and priorities; this document is not intended to replace

these but to ensure that as a system we collectively set out how we intend to support

the delivery our key local system clinical priorities and will become an appendix to

the NHCP clinical strategy.

A system wide quality impact assessment tool has also been developed that will

form part of the NHCP quality framework to ensure consistency of approach across

partner organisations.

For 2019/2020 the CCGs have developed an innovative countywide quality schedule

based upon the domains of patient safety, patient experience, clinical effectiveness,

safeguarding and collective working. The requirements for each domain are

consistent for all providers. As such this is the first year that a collaborative meeting

with each of the trusts to agree the schedule has been possible. It is intended that

the schedule will promote further development of collaborative working between

organisations and support those areas in which this ethos is already well

established.


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Infection, Prevention and Control

Methicillin-Resistant Staphylococcus Aureus (MRSA) Bacteraemia:

No secondary care cases of MRSA bacteraemia were reported across

Northamptonshire in 2018/2019. One MRSA bacteraemia was identified in an out of

county hospital was attributed to Corby CCG in April 2018. Three MRSA were

attributed to Nene CCG.

E Coli bacteraemia Public Health data indicates that at 31 January the Corby CCG cumulative total for all cases of E. coli BSI is 31 compared to 2017-18. Nene CCG cases sit at 410 with this compared to 395 in 2017-18. Given current performance Corby CCG is on track to meet the 10% quality premium reduction requirement. Combined county performance shows a small improvement on 2017-18. Clostridium Difficle (PHE data to end of January 2019)

Organisation Year to date/ceiling C Difficle ceiling (full year)

Corby CCG all apportioned

12/16 17

Nene CCG all apportioned

132/150 163

KGH Trust apportioned 17/23 25

NGH Trust apportioned 14/18 20

NHfT Trust apportioned 6/21 24

All organisations are below the nationally set ceilings.

Safer Staffing

All hospitals are required to publish information about the number of nursing and midwifery staff working on each ward, together with the percentage of shifts meeting safe staffing guidelines. This is published on each trust website. We actively seek assurance that this guidance is followed by providers and review the information each month at ward level. Any concerns regarding nurse staffing fill rates are raised with the hospital trusts through Clinical Quality Review Meetings (CQRMs) and when required quality visits are undertaken to gain further assurance.

Serious Incidents

Serious incidents in health care are defined as “adverse events, where the consequences to patients, families and carers, staff or organisations are so significant or the potential for learning is so great, that a heightened level of response is justified.”

There were 99 serious incidents reported by NHS and independent healthcare providers in 2018/19 of which 14 were subsequently downgraded as not meeting the national criteria for serious incidents. Three of the serious incidents were never events.


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The CCG has continued to foster and support the joint investigation process and

have reinforced and provided further direction on the requirement for providers to

undertake joint investigations when more than one provider has been involved in the

patient’s pathway of care leading to an incident. This supported both by the CCGs’

management of serious incidents policy and a memorandum of understanding with

providers.

What we did about it

All incidents have been subject to internal serious incident investigation scrutiny

through the CCGs’ serious incident governance processes. The CCGs always

undertakes follow up quality visits to the relevant clinical area to gain assurance on

the implementation of actions following never events. Learning has been shared

through our countywide patient safety forum.

Assurance on Primary Care quality

The end of year status of outcome ratings is shown in the table below:

NHS Nene CCG

Rating Number of practices

Outstanding 2

Good 62

Requires Improvement 1

Inadequate 2

NHS Corby CCG

Rating Number of practices

Outstanding 0

Good 4

Requires Improvement 1

Inadequate 0

The practice with a rating of requires improvement and the two rated as inadequate

will be re-inspected before the end of this financial year. Support has been offered to

each of these practices to embed improvement and prepare for re-inspection.

The primary care quality dashboard is now well established. The data is continually

refreshed as soon as national data becomes available and local indicators are

updated on a quarterly basis. Indicators to identify variation across the domains of

compliance, safety, experience and effectiveness are agreed by the primary care

operational group. This information is used to inform commissioning decisions and

provide support and education.


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The outcomes of the dashboard identify where practices are outliers in the domains

and add up to a risk score that gives an indication of the potential reduced quality of

care provided. A report is provided to primary care risk sharing group on practices

that are flagging amber or red. It is at this meeting further information is shared by

other stakeholders, such as CQC and NHSE, to establish the overall risk of quality

provision by a practice. A plan of how to support the practice is developed if

required. A report is then provided to the Primary Care Joint Co-commissioning

Committee/Commissioning Committee for assurance.

Practices showing an increased risk are receiving enhanced support; discussions of

outlying indicators are brought into these meetings, particularly results of 2017/18

GP survey in relation to overall satisfaction and access.

CQC reports on Acute Trusts and NHFT

The CQC inspection report for Kettering General Hospital was published on 27

February 2018 and rated the trust overall as requires Improvement with good for

caring. Overall, the trust has improved its ratings to ‘Requires Improvement’. The

CCGs continue to work with the trust, CQC, NHSE and NHSI colleagues through the

oversight meeting.

Northampton General Hospital was rated overall as good in November 2017.

Northamptonshire Healthcare Foundation Trust has been rated as an outstanding

service following a CQC inspection in June 2018. NHFT received the Health Service

Journal, Trust of the Year award in November 2018.

Both independent hospitals in Northamptonshire - Ramsay Woodland and BMI Three

Shires were rated by CQC as ‘good’.

Care home providers

Throughout the year the quality team has undertaken clinical review visits to all care

homes that provide services to people with health funding. The Quality team also

undertakes announced full monitoring visits. The care home provider is supplied with

a RAG rated report to include recommendations where required. Providers are given

28 days to respond with an action plan.

Supplementary monitoring visits, (often unannounced) are undertaken to ensure

continued development and provision of quality services. In 2018/19 there were:

• 90 clinical reviews (full monitoring visits) undertaken

• 161 supplementary visits undertaken.


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Domiciliary Care Providers

All domiciliary care providers with health funded clients undergo the same monitoring

review process as the care homes. During 2018/19 the CCG quality team undertook:

40 review visits to domiciliary care providers

As part of the review, services users are visited within their own homes to gain their

opinions of the services they are in receipt of.

75 visits were undertaken to see people within their own home

Safeguarding

As a commissioner of local health care, we as CCGs are responsible for

safeguarding quality assurance through contractual arrangements with all provider

organisations. The CCGs have a duty to ensure that all health providers with whom

they have commissioning arrangements discharge their functions with regard to the

need to safeguard and promote the welfare of children and adults at risk. All

providers give assurance through. The CCG have in place well-developed system for

monitoring the delivery of Safeguarding including regular training data, planned and

unplanned visits, multi-agency meeting and Section 11 audits.

Published on 4th July 2018, Working Together to Safeguard Children 2018 sets out

new requirements for improved partnerships to protect children. The strengthened

guidance sets new legal requirements for the three safeguarding partners, who will

be required to make joint safeguarding decisions to meet the needs of local children

and families. The CCG are now part of a tri-party with:

• Local Authority

• Chief Officer of Police

Additional changes to Child Death Review Partners has now identified the partners

as being:

• Local Authority

• Clinical Commissioning Group


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Accident and Emergency Departments

The CCGs visited the emergency department at KGH as part of a joint visit with NHS

Improvement. This was in keeping with monitoring progress on the trust’s CQC

improvement action plan.

Ambulance Waiting Times

During the year the CCGs’ quality team worked closely with the co-ordinating

commissioners in Derbyshire to support the trust to improve waiting time

performance. The CCGs have also worked with the trust through the CQUIN scheme

to provide a home visiting scheme to support GP practices and thereby to mitigate

admissions to hospital. The CCGs have reviewed serious incident reports provided

completed by the trust with actions followed up through the established collaborative

commissioner arrangements. The CCGs have also completed an audit of delayed

responses to category two (C2) emergency calls as part of a trust wide audit by

county.

Complaints

The CCGs are responsible for investigating all complaints or concerns raised in

relation to services that we commission on behalf of our patients. Our Complaints

Procedure is consistent with the Parliamentary Health Service Ombudsman’s

guidance:

The CCGs welcome complaints as a valuable means of receiving feedback on the

services they commission for the people of Northamptonshire and also on how as

CCGs we conduct our business. We aim to use information gathered from

complaints as a means of improving services and the effectiveness of the

organisations they commission. The CCGs will seek to identify learning points that

can be translated into positive action, and where necessary provide redress to set

right any injustice that may have occurred.

Between April 2018 and the end of March 2019, 72 complaints were received (nine for NHS Corby CCG and 63 for NHS Nene CCG) and another 82 concerns (33 for NHS Corby CCG and 49 for NHS Nene CCG) were raised by members of the public or by local Members of Parliament on behalf of their constituents.

Joint quality committee

The committee is a joint committee between Nene and Corby Clinical

Commissioning Groups (CCGs) and reports directly to both Governing Bodies. The

Joint Committee plays a vital role in ensuring that quality remains at the heart of

CCG decision-making.


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Case Studies of achievements in quality in 2018/19 BedState Tracker

NHSE provided NHS Corby and NHS Nene CCG with £30,000 to implement and

pilot a single tool that identifies all care home bed vacancies in Northamptonshire.

The BedState Tracker is the chosen system. All nursing and residential care homes

have been loaded on to the system, the system indicates:

• Number of vacant beds in each home

• Care homes CQC rating

• Category and type of bed

• If top up fees are expected

• If expected to pay rate is accepted

• If the care home accepts Trusted Assessor assessments

Northamptonshire is leading the way as one of the first counties to have a BedState Tracker Tool; this is a tool that providers a single, live system to indicate the number of care home bed vacancies throughout the county. The quality team implemented and rolled this tool out to all stakeholders and providers in July 2018. This tool is now used by trusted assessors and brokerage teams to find care home placements. It has evidenced reduced average length of stay and excess bed days.

Frail Older Peoples Toolkit Training

The Frail Older Peoples Toolkit Training is bespoke training, developed by the

quality team, with the aim to upskill care home staff and improve service quality and

outcomes for patients. The training includes subjects such as, urinary catheter

management, falls management and delirium/dementia assessment, all major

contributors to avoidable admissions. The training has evidenced improved quality

outcomes; reduced non elective admissions from 97 to 45 and produced a cost

efficiency of £198,616.


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Northamptonshire Learning Disability Services

NHS Nene and Corby Clinical Commissioning Groups (CCGs) are working in partnership with the Local Authority and NHSE Specialised Commissioning to transform learning disability services to meet national and local expectations. This Partnership is called the Northamptonshire Transforming Care Partnership (TCP).

In response to what people have told us one of the main achievements in 2018 has been the integration of health and social care services to deliver a single service to people with learning disabilities and their families/ carers in Northamptonshire. This is called the ‘Northamptonshire Learning Disability Service - Working together: Improving Lives. ‘

In October 2018 a joint Health and Social Care learning disability commissioning and priority plan was agreed in order to shape and develop the provider market with the aim of improving quality and gaining better assurance that we are spending money in the right places for the things that matter the most and that focus on improving outcomes for individuals.

Other successes have been achieved within the following national key areas of work:

• Transforming Care

Transforming care is all about improving health and care services so that more people can live in the community, with the right support, and close to home. The national plan, Building The Right Support (October 2015) tasks health, education and social care to form Transforming Care Partnerships and to develop community services and close inpatient facilities for people with a learning disability and/or autism who display behaviour that challenges, including those with a mental health condition The local Transforming Care Partnership has worked throughout the year to meet the expectations of the Transforming Care Programme. This has required developing clinical pathways of support in the community for people of all ages whose complex needs are related to forensic, mental health, challenging behaviour and/ or autism.

Enhancing our community services and upskilling our workforce has enabled a further eight people to be successfully discharged from hospital this year. Northamptonshire believes it will meet expected inpatient trajectory for discharge in March 2019. Intervening early and conducting Care (education) and Treatment Reviews has prevented a further 16 hospital admissions.


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• Learning Disabilities Mortality Review (LeDeR Programme)

Locally reviewers have been recruited and trained and to date a total of 10 reviews have been carried out. The lessons learned have been presented to the steering group and to local services and there are examples of service changes as a consequence. There are two workshops planned in the New Year that aim to educate and inform people with learning disabilities, their families and/ or support providers about health problems that are often missed or ignored and improve the long-term health outcomes of people with a learning disability and avoid unnecessary deaths.

• STOMP STOMP is a health campaign to stop the over-use of psychotropic medication to manage people’s behaviour. It is estimated that on an average day in England between 30,000 and 35,000 people with a learning disability, autism or both are taking prescribed psychotropic medication without appropriate clinical justification. The CCG has completed an audit as a baseline to continue to work on monitoring and achieving best practice locally.

• Annual Health Checks People with a learning disability often have poorer physical and mental health than other people. This does not need to be the case. Annual health checks are for adults and young people aged 14 or over with a learning disability. An annual health check helps keep people well and to identify any potential problems early, so as to avoid ill health. To date we have achieved 57% of expected health checks against a target of 66% by the end of this year.


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Reducing Health Inequality

NHS Corby CCG is committed to taking Equality, Diversity and Inclusion and Human Rights into account in everything we do through commissioning services, employing, developing policies, communicating and engaging with local people in our work. As a Public Body we will work to ensure that we meet our Public Sector Equality Duty (PSED) as set out in the Equality Act 2010 and our obligations under the Human Rights Act 1998. We will continue to promote and protect people’s dignity and rights by upholding the values set out in the NHS Constitution.

In addition NHS Corby CCG implements the NHS Equality Delivery System 2 (EDS2) to support its work to tackle discrimination and health inequalities within local communities and for staff. We have a positive culture toward employing disabled people and developing a more diverse, inclusive and engaged workforce.

The Public Sector Equality Duty NHS Corby CCG has worked to show how it is meeting the aims of the Public Sector

Equality Duty as set out in the Equality Act to:

• Eliminate discrimination

• Advance equality of opportunity

• Foster good relations between different people when carrying out their activities

https://www.gov.uk/guidance/equality-act-2010-guidance#public-sector-equality-duty

https://www.equalityhumanrights.com/en/human-rights/human-rights-act

https://www.equalityhumanrights.com/en/human-rights/human-rights-act

https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england

https://www.england.nhs.uk/about/equality/equality-hub/eds/


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This means that NHS Corby CCG must work to prevent discrimination as well as harassment and victimisation from happening. We also need to take steps to meet the health needs of people with certain protected characteristics.

As set out in the Equality Act 2010, the protected characteristics are:

• Age

• Disability

• Gender reassignment

• Marriage and civil partnership

• Pregnancy and maternity

• Race

• Religion and belief

• Sex and sexual orientation

The CCG’s staff members participate in mandatory equality diversity and inclusion training. The Equality Act requires public bodies to publish information about how it has met the Equality Duty each year and to set specific measurable equality objectives. This information is published on our website annually. You can read it here https://corbyccg.nhs.uk/equality/

Equality Objectives and Leadership

We have a Strategic Equality and Diversity Oversight Group (SEDOG) which is chaired by the Deputy Director of Quality. NHS Corby CCG has developed and published its Equality and Inclusion Strategy 2016 – 2019, which outlines the on-going approach to equality and inclusion and served as a basis for our Equality Objectives 2016 – 2019.

To ensure that our Equality Objectives remain relevant to the CCG’s business and changing priorities they are refreshed annually. We also prepare a progress report, which outlines how the equality objectives are met and embedded across CCG activities (where appropriate).

This year we undertook a review and refresh of our Equality and Inclusion Strategy for implementation from 2019 – 2022 and will be published on the website. A programme of work will underpin the refreshed strategy, which serves as a basis for delivering our refreshed Statutory Equality Objectives 2019 – 2022. These objectives are outlined below:

https://corbyccg.nhs.uk/equality/


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Equality Analysis and Due Regard

NHS Corby CCG has embedded equality and human rights by developing an integrated Quality and Equality Integrated Impact Assessment (EQIIA) Tool. This continues to ensure the CCG considers quality, equality and human rights when undertaking decisions on what healthcare to buy and what services it might change in order to meet local needs. We have developed and delivered training in Equality Impact Assessment/Equality Analysis to senior managers and staff, who are directly involved in commissioning work and service reviews to ensure the CCG gives appropriate Due Regard at every level of decision-making.

Implementing the NHS Equality Delivery System (EDS2)

NHS Corby CCG adopted the EDS2 Framework from an early stage, which supports our work to understand and reduce health inequalities. During 2018-19 we worked

towards improving our performance and outcomes against the four Goals of the EDS2 (pictured left) by undertaking a self-assessment and grading exercise against Goal 4. Further grading exercises will take place during 2019 – 2020 against Goals 1 and 2.

Continue to integrate inclusion and equality conditions

into the decisions we make

Equality Objective 2: Continue to develop as an inclusive employer to ensure

staff are aware of and supported to meet the evolving needs of the

organisation and local communities

Equality Objective 3: Continue to focus on understanding gaps in health

outcomes for the diverse local communities and working to reduce inequality

EDS2 GOAL 1

Better Health Outcomes

for all

EDS2 GOAL 2

Improved patient

access and experience

EDS2 GOAL 3

Representative and

supported workforce

EDS2 GOAL 4

Inclusive Leadership


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The Way Forward

During 2019 we will continue to work closely with providers and partners to ensure they are promoting Equality, Inclusion and Human Rights (meeting our Duties under the Equality Act 2010) to demonstrate we are working together to reduce health inequalities for the people of Northamptonshire.

The EQIIA Tool is supporting some early work to implement a consistency of approach in considering Equality Impact Assessment / Equality Analysis. We will review and update the EDS2 Evidence Portfolio and progress during 2019 for annual publication in 2020.

What Other Actions is Being Taken to Tackle Health Inequalities?

There are a number of activities that public health and partners are working on to impact on health inequalities. For example, the stop smoking service is undertaking targeted work in both of the acute trusts to offer support and with specific GP practices.

The NHS Health Check programme targets people who are at high risk of having a heart attack or stroke in the next 10 years. It is currently offered across the County in GP practices. It can help to tackle health inequalities, as the burden of early death from cardiovascular disease is higher in the most deprived communities compared with the least deprived. A new model of delivery is currently being developed for improved uptake, signposting to support and quality Support for partner organisations on opportunistic checks and pathways to treatment.

To tackle inequalities by helping people to be more physically active, Northamptonshire Sport continue to provide a universal, countywide programme. A range of actions are offered to encourage people to be more active.

These include the provision of behavioural change training and approaches, making better use of green open space for physical activity and making PE and School Sport inclusive to all, helping to build a resilient physical activity habit for life.

These actions have a focus across the County, but with an increased emphasis on those living in the most deprived areas where healthy life expectancy is known to be much worse. Eight geographical hotspots have been identified where there will be an increased focus of energy and effort.


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Understanding the Needs of our population There are an estimated 741,209 residents in Northamptonshire, with 69,540 of these living in Corby.1 There are 772,618 patients registered to general practices in the Northamptonshire health and care partnership, 79,995 in NHS Corby and 692,623 in NHS Nene CCG.2 Since 2011, the county’s population growth has increased at a greater rate than across England as a whole (7.1% v. 4.9% nationally). Over the next 5 years (2019 to 2024) the highest population growth is projected in Corby (7.4%) and this is expected to continue over the next 10 years. The greatest increase over the next 5 years in terms of absolute numbers is projected in Northampton (~8k) followed by Corby (~5k) and Kettering (~4k).3 The greatest increase in population is projected in the older age groups with an estimated 12% increase in population in those aged 65 years and over followed by 6% increase in school age children over the next five years. Demographics can drive differences in outcomes. There are nearly 300,000 residents living in areas with deprivation above the England average (highest 50%), 120,339 living in the most deprived areas (20% most deprived). This represents 16% of the population as a whole but varies across the county from 28% and 26% of the population in Northampton and Corby respectively to zero residents in South Northamptonshire living in the 20% most deprived areas nationally. The profile of the population living in deprived areas differs from the rest of the population (figure 1). For example, a higher proportion of children and young people (Figure 1) and higher concentration and variation of ethnic minority communities.

Figure 1: IMD by age groups Source: IMD 2015, DCLG, chart produced by BIPM, Northamptonshire County

Council

http://www.northamptonshireanalysis.co.uk/dataviews/view?viewId=181


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These more deprived areas are also more likely to see higher rates of unhealthy behaviours which then lead to poorer health and wellbeing outcomes. A boy born today in the most deprived parts of the county is expected to live 9.4 years less than a boy born in the most affluent parts of the county. A girl born today in the most deprived parts of the county is expected to live 6.1 years less than a girl born in the most affluent parts of the county. In addition, males and females living in the most deprived areas of the county can also expect to spend around 13 fewer years in good health compared to those living in the least deprived areas.4 Almost half of the gap in life expectancy between the most and least deprived areas of the county is due to excess deaths from heart disease, stroke and cancer.5 These are also the causes that make up a large proportion of the burden of preventable premature death in the county and England. The Global Burden of Disease Study,6 shows the main causes of early death and year’s people live in disability or illness and how these are linked to a number of risk factors. In Northamptonshire the main risk factors contributing to the burden of disease and death are tobacco, diet, obesity, raised blood pressure and cholesterol and alcohol and drugs. Many of these lifestyle factors are linked with income, education or deprivation and tend to cluster in the population. Figure 2 provides a summary of health and wellbeing needs across the life course for residents of Northamptonshire as part of the Joint Strategic Needs Assessment (JSNA). There are health challenges across the county and significant differences and inequalities between areas. District versions are available on the Northamptonshire JSNA website.

Health and wellbeing strategy

NHS Corby and NHS Nene CCG are active members of the Northamptonshire’s Health and Wellbeing Board, which brings together leaders from across the county’s health and care system to work together to:

• improve the health and wellbeing of local people

• reduce health inequalities

• promote the integration of services.

Key to this is Supporting Northamptonshire to Flourish, the five-year health and wellbeing strategy, which was launched in 2016. The document sets out the partners’ vision to improve the health and wellbeing of all people in Northamptonshire and reduce health inequalities by enabling people to help themselves.

The Board has agreed four strategic priorities:

• Every child gets the best start

• Taking responsibility and making informed choices

• Promoting independence and quality of life for older adults

• Creating an environment for all people to flourish

https://www3.northamptonshire.gov.uk/councilservices/health/health-and-wellbeing-board/northamptonshire-jsna/Pages/default.aspx#GlossaryGroupOverview


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By working together, we aim to create a better quality of life and improved outcomes for the people of Northamptonshire. Supporting Northamptonshire to Flourish sets out the vision for the county and provides an unrivalled opportunity to establish for the first time a unified approach to health and wellbeing with real potential to achieve real and meaningful change for the benefit of all.

While we must deliver progress within each priority, the Board recognises the connections and interdependencies between them.

Prevention, early help and early intervention are fundamental to the strategy. Success delivery depends on integrated plans delivered by local organisations. Seven subgroups and seven Health and wellbeing forums report into the Health and Wellbeing Board and have action plans that feed into the Joint Health and Wellbeing Strategy. The Joint Health and Wellbeing Strategy informs the work of the Northamptonshire Health and Care Partnership.


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Figure 2:


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The main health challenges locally include:

- A changing population structure including increases projected in the young and old and the challenges these bring to the health and social care system, ensuring healthy ageing and giving children the best start in life.

Giving every child the best start in life What happens in pregnancy and early childhood impacts on both physical and emotional health throughout a person’s life. Good maternal health (both physical and mental) is vital to prevent adverse health factors and children’s experiences in the first five years of life have lasting impact on wellbeing. Improved outcomes are essential to give every child the best start in life and a crucial time for services to engage with parents and young children. Inequalities can begin at very early stages, holding back development and access to opportunities. For example, nearly 70% of children in Northamptonshire are reaching a good level of development at the end of Reception, this falls to just over half for those children receiving free school meals. Levels of development overall in Northamptonshire are significantly below the England average,4 although local data is showing an encouraging increasing trend and therefore reducing this inequality. Significant improvement has been seen in teenage conceptions, tooth decay and breastfeeding initiation, however the breastfeeding drop off to 6-8 weeks remains a concern. Smoking at time of delivery remains a priority with significantly higher rates than the England average with 14.4% of mothers smoking at time of delivery. While child mortality has decreased, reported ill health among children is rising, with particular increases in respiratory diseases and emotional problems. Vaccination coverage is the best indicator of the level of protection a population will have against vaccine preventable communicable diseases. Coverage is closely correlated with levels of disease.vii Childhood vaccination rates have been declining in Northamptonshire and can be significantly improved through better universal and targeted immunisation programmes delivered in a coordinated way with the support and commitment of a wide range of health and social care organisations. Childhood obesity remains a priority area. In Northamptonshire nearly in one in four of 4 to 5-year olds and a third of 10 to 11-year olds are overweight or obese. 4 Healthy ageing Life expectancy has improved, and people are living longer, however people are not necessarily living longer in good health. Older age shows the accumulated impacts of unhealthy behaviours earlier in life and represent a significant future health burden. Therefore, there is a need to provide services to support older people often with multiple long-term conditions, managing the increase in long term conditions by improving detection rates and optimising treatment.

As well as the typical stressors common to all people, the older population can also experience more mobility problems and chronic pain as well as problems associated with frailty and a drop in socio-economic status associated with retirement and / or disability.

All these factors can lead to greater social isolation and psychological distress and define a group of older people who are at higher risk of adverse outcomes such as falls, disability, admission to hospital, or the need for long-term care.


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Therefore, focussing on prevention and interventions such as the “supporting independence programme” are able to identify those at greater risk and support healthy ageing.

Evidence suggests that by strengthening communities and integrated care systems would keep people out of hospital and ease the current pressure on our acute services.

- The increase in poor mental health and the need for preventative measures building individual and community resilience.

There is substantial burden of mental illness across the life course associated with increased risk of unhealthy behaviours and poorer outcomes. Half of all mental health problems begin by age 14 years, with delayed or no diagnosis significant numbers of children may grow into adulthood less resilient and able to flourish. Quality of personal relationships is crucial to wellbeing and caring responsibilities is associated with lower happiness ratings.1

Nearly 10,000 children are estimated to have mental health disorders in Northamptonshire and nearly 70,000 people are diagnosed with depression. People living in more deprived areas are likely to have higher levels of mental health conditions and higher need for services.

Rates of self-harm are significantly higher in Northamptonshire compared to the national average. Prevalence peaks in adolescence. Adolescence is a life stage where change is possible, the fastest change after infancy and therefore an important life stage for intervention to reduce the risk of suicide, to ensure early intervention is implemented following an episode of self-harm for all ages and to build resilience moving into adulthood.

- To tackle the top 10 risk factors that contribute a significant amount to the burden of disease locally.

Northamptonshire has high rates of unhealthy behaviors. On average around one in six people smoke with variation across the county from 9.2% in South Northamptonshire to 21.5% in Northampton and rates three times higher in lowest earners compared to the highest earners. Smoking in pregnancy rates are significantly higher than the national average. An estimated 66% of the population are overweight or obese and nearly one in four people do not do enough physical activity. There is a higher prevalence of many behavioral risk factors among more deprived areas compared with less deprived areas.

These unhealthy behaviours contribute to the development of long-term conditions such as obesity, diabetes, high blood pressure and cholesterol and respiratory conditions. All of which can be managed, improved and prevented with the right support and knowledge.

Living with these long-term conditions can be debilitating and people living with these conditions often experience more mental health difficulties and engage in more unhealthy behaviours exacerbating problems including feeling lonely and their ability to work.

Plans on a page (including a call to action for each) have been developed by Public health for all of the top 10 risk factors for global burden of disease.

- Tackle poverty through the wider determinants of health and working with partners across the health and social care system in areas including education, housing and employment.

1 Department of Health. A compendium of factsheets: Wellbeing across the Lifecourse. Wellbeing - Why it matters. 2014. [Online] Available here.

https://www3.northamptonshire.gov.uk/councilservices/health/health-and-wellbeing-board/northamptonshire-jsna/Pages/default.aspx#GlossaryGroupOverview

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/277568/Wellbeing_-_why_it_matters_to_health_summary_of_key_points.pdf


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The inequalities in outcomes are underpinned by broader social and economic influences that impact on a person’s health, such as education, employment and housing.2 For example, the health and wellbeing of the working population often impacts wider than just individual, affecting families, businesses and communities. Employment levels have been declining in the county and the proportion of children not in education, employment or training was significantly higher than the national average. Local data shows an improving trend, but this remains a priority area. Fuel poverty has also been increasing and school readiness remains an outlier. Creating environments where everyone can flourish focuses attention on the wider determinants of health and wellbeing and underpins delivery of the other challenges mentioned above.

There are a number of activities that public health and partners are working on to impact on health inequalities. For example, the stop smoking service is undertaking targeted work in both of the acute trusts to offer support and with specific GP practices.

The NHS Health Check programme targets people who are at high risk of having a heart attack or stroke in the next 10 years. It is currently offered across the County in GP practices. It can help to tackle health inequalities, as the burden of early death from cardiovascular disease is higher in the most deprived communities compared with the least deprived. A new model of delivery is currently being developed for improved uptake, signposting to support and quality Support for partner organisations on opportunistic checks and pathways to treatment.

To tackle inequalities by helping people to be more physically active, Northamptonshire Sport continue to provide a universal, countywide programme. A range of actions are offered to encourage people to be more active. These include the provision of behavioural change training and approaches, making better use of green open space for physical activity and making PE and School Sport inclusive to all, helping to build a resilient physical activity habit for life. These actions have a focus across the County, but with an increased emphasis on those living in the most deprived areas where healthy life expectancy is known to be much worse. Eight geographical hotspots have been identified where there will be an increased focus of energy and effort.

2 Public Health England. Chapter 5: Inequality in health. 2017. [Online] Available here.

https://www.gov.uk/government/publications/health-profile-for-england/chapter-5-inequality-in-health


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How we engage with people and communities

The patient voice is central to Corby CCG’s commissioning of health care services in the town and we use a range of well-structured engagement opportunities, events and fora.

To enable us to reach a cross section of our population we also have an extensive, live database of community groups and stakeholders.

We engage regularly with patients, the wider general public, stakeholders and clinical and non-clinical staff. Further details of how we have done this during 2018/19 is detailed below.

Our Engagement Structure

The Patient and Public Engagement Assurance Committee (PPEA)

The Patient and Public Engagement Assurance Committee (PPEA) meets bi-monthly and oversees our processes for engagement, providing productive input from local stakeholders into the CCG’s engagement work and ensuring that we are engaging meaningfully with local people to meet our statutory duties set out in S14Z2 of the Health and Social Care Act 2012. More information on the work of the PPEA Committee can be found in the Governance Statement in Chapter 2.

Six meetings were held between April 2018 to Apr 2019:

• On 15 May 2018: An extra-ordinary meeting was held to present the final report on the Same Day Access Hub engagement to the committee.

• 10 June 2018: Comms and engagement plan and the national consultation on over the counter medicines was discussed

• 21 August 2018 an update on the Same Day Access Hub/UCC was provided by the CCG

• 9 October 2018 was a joint meeting (committees in common with Nene and Corby) Kathryn Moody presented an Engagement Programme and Deep Dive; Caron presented on Strategic Commissioning and Commissioning Intentions

• 11 December 2018: Virtual meeting to review and approve the interim Communications and Engagement Strategy for Corby CCG


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• 19 February 2019 included a presentation on the NHS Long Term Plan; the draft annual engagement plan; Urgent Care Deep Dive Focus; update on plans for the ‘signposting’ campaign in Corby and an invitation for members to take part in a survey to help inform the new joint Communications and Engagement Strategy.

In 2018 the PPEA was replaced by the PPPC as part of the work to integrate and align working between the two CCGs. From April 2019 this two PPPCs started meeting together as committees in common.

Patient and Public Participation Committee (PPPC)

The purpose of the Committee is to provide assurance to the Governing Body on their engagement plans and to ensure that all decisions of the Governing Body have been informed by the appropriate levels of patient, carer and communities engagement. This is in line with Patient and Public Participation in Commissioning Health and Care: Statutory Guidance for CCGs and NHS England. (April 2017)

The minutes of the Committee are reported to the Governing Body, with the Chair of the Committee drawing attention to any issues that require Governing Body scrutiny via the Chair’s highlight report.

The role of the Patient and Public Participation Committee is to:

• Be assured that the CCG has robust mechanisms for identifying and responding to patient and public insight into health needs, providing assurance to the Governing Body that their engagement plan includes all appropriate decisions made by the CCG’s Governing Body and has been informed by the view of patients, carers and communities.

• Be assured that the statutory requirements for engagement have been met in relation to Section 14Z2 of the NHS Act 2006 and also ensure compliance with the core values of the NHS Constitution.

• Engage with the commissioning intentions and plans for service change to ensure that they have been informed by intelligence from patients, carers and the public.

• Be assured that the effectiveness and impact of communication and engagement activity undertaken by the CCGs has been evaluated.

• Proactively engage with the wider strategic and transformational change environment through established and emergent channels for engagement.

During 2018/19 the Committee met on a bi-monthly basis. From October 2018 it was agreed that the NHS Corby CCG Patient and Public Participation Committee and NHS Nene CCG Patient and Public Participation Committee would meet bi-annually as Committees in Common.


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Patient Participation Groups (PPGs) in each practice

Each of our five Member Practices has a Patient Participation Group which is run by patients who receive practical administrative support from the Practice. The groups meet regularly and air views on behalf of fellow patients regarding facilities and services. This is then fed directly back to practice staff. This also enables patients who wish to be involved at a very local level to discuss health services and planned service improvements in the community. The PPG Chairs meet regularly and provide input into the CCGs formal committee structure.

Patient Participation Group (PPG) Chairs Engagement

The PPG Chairs Group operates as a key forum for the CCG to raise awareness of commissioning plans and for patients to provide feedback on these plans. The CCG has a well-established PPG Chairs Group which meets quarterly and brings together each of the five-member practice PPG Chairs with the CCG. It provides the opportunity for patients to suggest and help to develop creative means of engagement with the local population, and for PPG Chairs to provide feedback from patients within their groups on how services operate, how accessible they are and how suitable they are for patients.

Corby Patient Reference Group

This group was formed in 2017 to provide an additional further reaching mechanism for engagement. To date around 90 people have joined. We’re always looking for new ways to give our patients a say about their local NHS and that’s why we put together this new ‘virtual group’ of people, to act as a sounding board for the CCG on a range of issues and projects. This group is open to anyone who lives in Corby, is registered with a Corby GP, and wants to have input into shaping NHS services.

Members of the group receive a monthly newsletter called Corby Health News, see below, which includes updates of CCG activity and engagement events and general health related activities and information. The group members were also sent the final engagement report regarding a conversation with the public around the Same Day Access Hub, see below.

Health and Wellbeing Forum

This forum is an important collection of stakeholders who are interested in the wellbeing of people of Corby. We are an active member of the group and use the meetings as an opportunity to raise issues of engagement.

A representative from our engagement team attends all the town’s Health and Wellbeing Forum to provide an update on all CCG engagement activity. Four meetings have been attended to date.


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Engaging with our Community NHS Corby CCG is committed to understanding the needs of our population and empowering patients to have more choice and control over their condition, in the development of future services and by identifying priorities. We have a legal duty under Section 14Z2 of the NHS Act 2006 to ensure that individuals to whom our services are provided or may be provided are involved in the planning, development and operation of commissioning arrangements. As an organisation this duty is fundamental to everything that we do and at the heart of our commissioning intentions.

With this in mind we aim to improve the local health services and respond to the health needs

of everyone in the area by ensuring patients and the public are at the heart of decision making.

‘Same Day Access’ Engagement

During 2017/18, Corby CCG carried out an extensive programme of public engagement, on an

unprecedented scale. This continued into April 2018 when the final phase of a three-phase

programme was delivered.

The aim of the three-phase engagement programme was to develop an ongoing conversation

with the people of Corby to test their experience of services, awareness of the challenges

facing the local NHS and their acceptance of the need for change. All insight gathered across

the year was analysed and presented to the CCG’s Governing Body, to inform their decisions.

Firstly, in 2017 the CCG asked about people’s experiences of using NHS services in Corby

and their understanding of the need to ensure healthcare services meet the changing demands

of the population. A further intensive period of engagement was undertaken between

September and December 2017. This focussed in more detail on the case for change in both

primary and urgent care.

This final eight-week phase between February and April 2018 was designed to provide further input from public and stakeholders into CCG plans for a new same day service.

In particular, opinions were sought around the use of appointments rather than a walk-in system and access, and the introduction of trained navigators to direct patients to the right service.

People were invited to complete a questionnaire online, or with a hard copy which could be

returned to a special Freepost address (NHS Corby Responses). Some 3,000 copies of the full

document were printed and distributed, and we received 531 responses to the phase three

questionnaire.


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As in Phase Two, there was also intensive engagement activity in public places and with community groups to explain the issues and seek views. Throughout this period the CCG’s team averaged a visit to a different venue every day, and more than 43,000 people were reached online. Stakeholders were kept up to date throughout the whole engagement process via a newsletter called Corby Health Update which was designed and written by the engagement team. The publication was sent to stakeholders, MPs, council leaders and NHS partners.

A final workshop was held in April 2018 to enable people to feed directly into a specification for a new service contract. This phase commenced after a decision taken by the Governing Body on 30 January 2018 to adopt a new model of care which included a change to the way services at the Corby Urgent Care Centre could be accessed. After Phase three concluded, that decision was quashed following a Judicial Review.

All related engagement at that time was suspended when the Judicial Review was announced, the result of which wasn’t known until August 2018.

Engaging with hard to reach groups

Addressing inequalities in health and other aspects of life is a priority for Corby CCG.

We recognise that some parts of our community are less easily heard than others and have worked hard to build a clear understanding of the opportunities we have to reach them.

Through our extensive network of contacts, those we have engaged with about access to GP services and the Urgent Care Centre include:

✓ People with visual impairment, hearing loss and other physical disabilities ✓ The traveller community ✓ People with mental ill health ✓ People with learning disabilities ✓ The Zimbabwean community ✓ The LGBT community ✓ Carers ✓ Parents with young children ✓ Older people

The CCG also ensures that where we run surveys, we capture demographic information about those who respond. You can see an example of this on page 7 of one of our engagement reports here.


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Other examples of targeted CCG engagement to reach all parts of our community include:

Through the Learning Disability Partnership Board, asking people with learning disabilities what they wanted from the care they receive. As a direct result of this engagement, the decision was made to develop an integrated service between the Community Team for People with Learning Disabilities and Northamptonshire Adult Social Services.

Attending the annual Freshers’ Fair at the University of Northampton – providing information about NHS services and encouraging students to register with a local GP.

Employing people with learning disabilities through the NHS Quality Checkers Programme – to inspect local NHS services and provide advice on how to better meet the needs of this patient group, including the delivery of Annual Health Checks for people at GP surgeries.


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Case Studies of how we engage with our local population Children’s Mental Health

Nearly 10,000 Northamptonshire children are estimated to have a mental health issue. Half of all mental health problems experienced by individuals begin by the age of 14, and these can continue into adulthood if not addressed. Poor mental health can also lead to poor physical health.

In Spring 2018, Young Healthwatch Northamptonshire was asked by the Northamptonshire Health and Care Partnership, which includes Corby CCG, to gather young people’s views on local mental health services.

To do this they devised a survey to ask young people across the county about their emotional wellbeing and access to services – specifically their frustrations and what services they would like to support them.

749 young people aged 11-19 responded, including 45 who identified as being a ‘young person in care’ and 71 who said they looked after someone with an illness or disability (carers). The resulting report produced some key recommendations:

The development of a self-help service to enable young people to access support when needed – co-designed with young people to ensure it meets their needs

More, or more specialised, mental health support in schools and colleges to enable young people to access support in an environment that suits them

An assessment of the waiting times for wellbeing services for young people (especially Child and Adolescent Mental Health Services) and finding ways to improve them.

Continuing to ensure that the voice of young people is heard in decision-making, and in the design of youth mental health and emotional wellbeing services

The main themes identified in the survey are addressed in Northamptonshire’s refreshed Children and Young People’s Local Transformation Plan for mental health services, in which Corby CCG is partner.

The plan outlines the intention to strengthen how CAMHS supports other services with an Early Intervention Model, which aims to contribute to the creation of mentally healthy communities in Northamptonshire. This is in line with the aspirations and recommendations of the national Five Year Forward View for Mental Health and Future in Mind.

There will be a range of direct work undertaken with children, families and carers, plus indirect interventions to reduce stigma, build resilience, increase knowledge and improve understanding and early identification of mental health difficulties.


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These interventions will take place in the different settings in which children find themselves:

✓ For young children, this includes Children's Centres and primary schools ✓ For older children, this includes secondary schools, GP practices, online or through

virtual communities and platforms ✓ For those with additional needs, the ‘communities’ might include Children's Services,

Youth Offending Teams or schools specialising in addressing social, emotional and mental health needs

Our Armed Forces Community

The Armed Forces Covenant is a promise by the nation ensuring that those who serve or who have served in the armed forces, and their families, are treated fairly.

The Northamptonshire Armed Forces Covenant Partnership, which includes Corby CCG, commissioned Healthwatch Northamptonshire to find out more about the health and social care needs of the Armed Forces community. This includes people serving as regulars or reservists, volunteers, ex-forces members (veterans) and family members of past and present service personnel.

More than 450 people took part in the survey in 2018 and a report on the findings has been published.

The report recommendations call for a greater awareness of the Armed Forces Covenant amongst health professionals in the county, more timely access to suitable mental health support, and further preparation for civilian life when people leave the armed forces.

The survey data is now being formally analysed by the University of Northampton. However, the Northamptonshire Armed Forces Covenant Partnership is responding to the report recommendations, as outlined below.

Awareness of the Covenant All partners on the Covenant Board, including Corby CCG, are working hard on awareness and training, although it is recognised that this commitment needs to be extended more widely. Keeping the issue high on the agenda will help to ensure that our Armed Forces community do not slip through the net. Active work has only begun in the last two years, with the aim of embedding it throughout mainstream NHS services.

Mental Health NHS England, through Ministry of Defence funding, have commissioned a new national Veterans Mental Health service. This is fully supported by Corby CCG and the local Covenant Partnership Board. It will help serving personal through transition into civilian life, in addition to our current veteran population, with specific and timely support for all types of mental health issues.

Transition into Civilian Life Corby CCG and other partners are committed to working with the transition team within the Ministry of Defence, so that individuals can be directed to the support available. We recognise the importance of ensuring that those being medically discharged or who leave early for some other reason do not slip through the net.


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The CCG undertakes a programme of tailored engagement activity with our Armed Forces community. This includes working with partners such as the British Legion and SSAFA charities, attending events like Armed Forces Day and veteran tea dances, and arranging focus groups. Corby CCG has been awarded the Ministry of Defence’s Silver Award, as an employer committed to the Armed Forces Covenant.

'We Stand Together – Stay Well this Winter’

For winter 2018/19, Corby and Nene CCGs adopted a novel approach to encourage a higher uptake of the flu vaccine by people most at risk from the disease.

The project, funded by NHS England, was inspired by a local member of the community:

‘I have been entitled to the flu jab for a while now, but I have never taken up the opportunity to have it. I didn’t feel like I needed it. This year things have changed, I have a granddaughter who was born prematurely and as a result has a lung condition. For the first time this year, I will be having my flu jab, not just for my own health but also to protect my granddaughter’s health. #ImDoingItFor my Granddaughter’ - Mr A, a very proud Granddad

The CCGs produced a promotional video featuring a song specially written for the project by local musician Chris Startup and performed by the Northamptonshire Singing 4 Breathing choir. The choir was set up by occupational therapist James Wyatt to help people diagnosed with Chronic Obstructive Pulmonary Disease (COPD). COPD causes long-term damage to the lungs and people with the condition often experience chronic breathlessness.

Singing 4 breathing has made a profound difference to local residents’ health, thanks to the natural lung exercise singing can bring.

The aim of the campaign was to encourage those members of the community who were entitled to the flu vaccination to have it to protect both themselves and the wider population - like Mr. A’s granddaughter, who features at the end of the video.

The choir, who were all eligible for a free vaccination due to respiratory conditions, became advocates for the flu jab. To encourage uptake, they accompanied CCG staff on the annual Winter Campaign roadshow to perform live at venues around the county – including at the CCG’s annual public meeting. Their video has been viewed thousands of times.

Maria, has two grown up daughters and seven grandchildren. She has been attending Singing 4 Breathing since the group started in 2015. . It has not only improved her health but also has improved her outlook on life. She has had a double lung transplant and says she has made a lot of new friends since starting the group but most importantly the singing has helped her to exercise her lungs and breathe more easily

Robert is a former prison officer who has COPD. He feels the

choir has been hugely beneficial and his latest

spirometry test show the best results ever. Choir Master, James

https://www.youtube.com/watch?v=fw82soe2rs4&feature=youtu.be

https://singing4breathing.wordpress.com/

https://singing4breathing.wordpress.com/


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Patients with Learning Disabilities

People with a learning disability often have poorer physical and mental health than other people but this doesn’t need to be the case. Corby CCG engages with such patients with learning disabilities in a number of ways to improve the care they receive and their health.

Transforming Learning Disability Services

Engagement with people with learning disabilities and their families was key in moving forward with the Learning Disability Services Transformation and the move towards outcome-based commissioning. Learning Disability Commissioners sought people’s views and opinions through the Learning Disability Partnership Board on the outcomes they wanted from the care they receive from services. Based on the outcome of this engagement the decision was made to develop an integrated service between the Community Team for People with Learning Disabilities and Northamptonshire Adult Social Services


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Longer Lives for People with Learning Disabilities Events In February 2019, Corby and Nene CCGs jointly organised two special events to educate and inform people with learning disabilities, their families, carers and support workers about health problems that are often missed or ignored.

The aim was to help people with a learning disability who are unwell to get the right help more quickly, and to improve their long-term health.

More than 120 people attended the events, which were well received. There were talks on specific health issues, plus opportunities to talk directly to doctors, nurses and other care professionals. Find out more about the events via this video.

NHS Quality Checkers Programme It is also well documented that people with learning disabilities can face significant barriers to accessing NHS services, whether it’s the use of complicated forms and language, confusing layouts of buildings, or staff who aren’t sure how to interact with them. In a bid to address this locally, NHS Corby and Nene CCGS took the opportunity to bid for funding from NHS England to participate in a pilot Quality Checker Scheme. With this funding agreed people with learning disabilities were employed through a Quality Checking organisation to inspect local NHS services and provide advice on how to improve the service to meet the needs of this patient group. In addition to this the Quality Checkers also looked at the delivery of Annual Health Checks for people with a learning disability carried out at GP surgeries.

Each service was asked to complete a service specific self-assessment. This was followed by the Quality Checkers interviewing staff and following a patient journey through the service.

The Quality Checkers also gathered the views of people with learning disabilities and their families and carers on each service.

On completion of the assessment the Quality Checkers fed back to the service with their findings and recommendations.

Feedback from the services who engaged with the Quality Checkers was extremely positive and recognised as a very valuable experience. In particular services were able to identify where changes could be made to their annual health check process to directly improve their quality and effectiveness.

Due to the success of the pilot, the quality checking of local NHS services by people with learning disabilities will continue.

https://www.corbyccg.nhs.uk/video/longer-lives-for-ld-events


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Other ways we engage Corby Health News

During 2017/18 we continued to publish a monthly newsletter called “Corby Health News.” The publication is sent to all practices where printed copies are displayed in waiting rooms for patients to read. This has proved to be an effective tool in sharing engagement activity with an audience which consumes their news in the traditional hard copy rather than social media. It also ensures that the CCG can encourage further engagement from the public and urge members of the public to sign up to the Patient Reference Group.

The newsletter is also published on the CCG’s social media and on our website and can be shared and enjoyed by a digital audience.

The aim of the publication is to engage and communicate with the people of Corby and to publicise health and wellbeing events run by the CCG and in conjunction with Corby Borough Council and voluntary organisations across the town. Corby Borough Council now shares the newsletter with its staff. Large local employers such as R.S. Components and Tata Steel also distribute the newsletter to all staff.

Health and Wellbeing Directory

The online directory Access Corby was set up by a group of young volunteers and was commissioned by Corby CCG. It was designed to make it easy for doctors and patients to find a voluntary service which can offer help close by. The site gives both professionals and public information about a wide range of third sector support and services.

The site has seen a more than a twenty-fold increase in visitors since its launch in 2016. To visit the site www.accesscorby.org.uk

Website Update

To further ensure the people of Corby can influence decisions about their NHS services Corby CCG’s updated the engagement section of their website this year and developed a page called Have Your Say https://corbyccg.nhs.uk/have-your-say

The page offers:

• A video of Dr Joanne Watt talking about her role as Quality Lead for NHS Corby CCG - and why it is important for patients to get involved and share their experiences of health services.

• How and where to complete the Same Day Access survey

• how to contact and join the patient reference group

• A list of upcoming events

• The Communications and Engagement Plan for 2018

https://corbyccg.nhs.uk/have-your-say


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Our Events We continue to engage with our local community through our CCG membership scheme, which enables local people to be kept up-to-date about local developments in health and care as well as having their say. Corby CCG contributed to a range of public engagement events in 2018/19, including:

Annual General Meeting

NHS Corby CCG held the fifth Annual General Meeting on 13 September 2018, with more than 50 people in attendance. Members of the Governing Body talked through 2018/19 year’s achievements, discussed current projects and plans for the year ahead. Examples of work included the increase in provision of mental health services in the town. Questions were taken from the audience regarding the future of The Urgent Care Centre and the challenges of the ever-increasing population.

Questions from those present on the day were submitted to the CCG. To download a document with all the questions and responses from our Executive Team https://corbyccg.nhs.uk/modules/downloads/download.php?file_name=1382

Questions formally submitted from attendees on the day of NHS Corby Clinical Commissioning Group’s Annual General Meeting can be found here https://corbyccg.nhs.uk/modules/downloads/download.php?file_name=1385

Armed Forces Day and the Armed Forces Covenant Corby CCG is one of a number of local organisations which have signed the Armed Forces Covenant. The Armed Forces Covenant partnership work with local voluntary sector service and health and social care partner organisations to provide support to our local armed forces veterans. On June 30, 2018, Corby CCG supported Armed Forces Day by taking part in an annual event. The events are for all the men and women who make up our Armed Forces community, from serving troops to service families, veterans and cadets. Corby CCG provided information to increase awareness among military veterans of the healthcare and support that is available to them




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Northampton University Fresher’s Week

Staff from NHS Corby CCG attended the annual Northampton University’s Fresher’s Fair on Monday 24 September 2018 at the Market Square in Northampton. New students were encouraged to register with a local GP and given information about local services and how and when to access them. The event was busy, and a number of students showed interest and took relevant details.

Winter Campaign

Winter is the busiest time of the year for the NHS and it is a priority to keep patients well and prevent avoidable or unnecessary admissions to hospital and attendance at A&E. During winter and throughout the festive season NHS organisations, the local authority and voluntary sector worked together to deliver the national ‘Help us Help you’ communications campaign across Northamptonshire to raise awareness of the appropriate urgent and emergency care services in the area. The message

focus was how to stay well and avoid inappropriate use of NHS services.

Corby and Nene CCGs also worked together to use a range of engagement tools including face to face, written materials, local media and social media engagement. Highlights included:

• Corby CCG took the ‘Winter Campaign’ out to shopping centres in the county to promote ‘Stay Well this Winter’. These events targeted all ages, encouraging members of the public to get the flu vaccine and health information on how to stay well.

• We carried out seven media interviews on local radio, providing key information relating to the campaign which included using services responsibly, how to get your repeat prescriptions, pharmacy, NHS 111 and accessing GP appointments. We also posted regular messages on Facebook and Twitter:

✓ 960 social media posts across Facebook and Twitter ✓ 366 Re-Tweets and 67 post shares on Facebook

✓ 241,000 combined impressions across Facebook and Twitter


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Clinical and Non-Clinical Staff Engagement

Staff Forum The Staff Forum was set up in April 2017 for the benefit of all staff of Nene and Corby CCGs, North East London Commissioning Support Unit (NEL CSU) and all other embedded staff and meets regularly to raise issues affecting all staff. During this time the forum has organised a number of events for staff including Health and Wellbeing events and fun events. Work streams were generated after the 2017 staff survey one of which was to create values and behaviours for the organisation. This work is now complete and will be the basis for the organisation's values moving forward. For the coming twelve months the focus will be to continue to push the values and behaviours throughout the organisation and those that work with us along with improving staff wellbeing and development.

National Staff Survey

The staff survey was made available to employees of Corby and Nene CCGs to complete in

November 2018. It was the first time the survey had run across both CCGs.

73% of staff completed the survey for 2018 compared to 70% for 2017; the national average is

78%. The 2017 Survey highlighted the following key area’s for improvements:

• Appraisals

• Training & Development

• Communication

• Line Management

• Job satisfaction

• Health & Wellbeing

Staff Engagement Corby CCG also engages with its staff to ensure continuous consultation and engagement on changes which may affect them. This takes the form of:

• Fortnightly informal staff briefing led by the Accountable Officer or Director

• Staff newsletter sent to all staff following the staff briefing

• Workforce Committee, chaired by a Governing Body Member

• Internal Communication and Engagement Staff Survey – This survey gave staff the opportunity to say what they liked about staff communications and engagement and if they would like to see anything additional across the organisation. As a result of the survey the fortnightly informal staff briefings were replaced with monthly formal staff briefings. Going forward these monthly staff briefings will provide a space for regular structured updates.

• In 2018 the CCG also introduced regular email briefings to staff following Governing Body meetings to provide an update on the discussion and outcomes of the meeting


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Engagement: You Said We did What you tell us directly informs the decisions made by Corby CCG. That’s why we welcome the opinions and feedback of local people about healthcare services

Here you will find some examples of how services have been shaped by the views of public, patients and carers.

Maternity Services Case Study

The Northamptonshire CCGs (Corby and Nene) are working to align local maternity services to the recommendations outlined in the NHS England Better Births report, to deliver improvements by 2021. We needed to understand what our local mums, dads, partners and families felt worked well and what needed to improve. To do this, the CCGs appointed Healthwatch Northamptonshire to liaise with parents who had used maternity services in Northamptonshire. The key areas of focus were continuity of care, safety and the provision of clear and consistent information to support informed choices. A survey of more than 500 parents covered a pregnant women’s journey before, during and after giving birth. Mums were also asked about:

• The support they received relating to perinatal mental health conditions

• How local maternity services support breastfeeding

• How services support stop smoking and healthy eating during pregnancy. The Healthwatch report formed the foundations for developing the Northamptonshire Local Maternity System transformation plan.

Partnership has been central to this process. The CCGs worked with Northamptonshire Healthcare Foundation Trust, Northampton General Hospital and Kettering General Hospital to run two local Whose Shoes? workshops in 2018. You can see a film of the Corby workshop here. The events were well attended by both parents of young children and clinicians working in maternity services, such as midwives and heads of midwifery services. They were facilitated through a fun interactive board game, to cover key questions and encourage debate in a relaxed environment.

Feedback was gathered from those who attended. 100% of service users who attended were supportive, while clinicians said the workshops had influenced their thoughts on doing things differently in future.

A graphic artist was able to use the discussions to create an infographic summarising the

events.

https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf

https://youtu.be/9-0b42pWm5k


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Recruitment for the Northamptonshire Maternity Voices Partnership (MVP) was also promoted at the workshops. The MVP is a local volunteer group made up of mums who have used maternity services in Northamptonshire. Their role is viewed as critical to developing a genuine change in the services.

Through this ongoing forum we can enable women and their families from all backgrounds, ages and ethnicities to share their views with us, and work with us to co-produce services and plan and monitor service improvements.


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How we share news with our

patients in Corby During 2017/18 the CCG continued to communicate regularly with our members, patients, public and partners; below are examples of how we did this:

• Corby Health News

During 2017/18 we continued to publish a monthly newsletter called “Corby Health News.” The publication is sent to all practices where printed copies are displayed in waiting rooms. The newsletter is also published on the CCG’s social media and on our website.

The aim of the publication is to engage and communicate with the people of Corby and to publicise health and wellbeing events run by the CCG and in conjunction with Corby Borough Council and voluntary organisations across the town. Corby Borough Council now shares the newsletter with its staff. Large local employers such as R.S. Components and Tata Steel also distribute the newsletter to all staff.

• Corby CCG News

We communicate with our GPs and practice staff on a monthly basis via this in-house publication. This newsletter contains messages from the CCG, service review and feedback surveys and general information for GPs and practice staff around national NHS campaigns and resources.

• “Knowing the Signs” Campaign

This campaign is aimed at raising awareness of prevalent health conditions in Corby including bowel Cancer, cervical, bowel and breast cancer screening, HIV, diabetes and stroke. This is an ongoing campaign aimed at educating patients to spot the early signs of each condition. More information can be found on our website. The campaign will continue into 2018/19.

• GP in the House Corby Radio

During 2017/18 Dr Joanne Watt our Clinical Chair has a regular radio slot called ‘GP in the House,’ on Corby Radio 96.3FM for an hour every second Thursday at 9am. Dr Watt discusses a range of health conditions which affect the population of Corby, with a different topic covered each month. Corby radio has a potential 80,000 listeners every day.

• Focused on Corby

Dr Joanne Watt, our Clinical Chair, has a column focusing on health care in this quarterly magazine which is delivered to 25,000 homes in Corby.


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Social Media and engaging with the local population

We have continued to utilise both Twitter and Facebook to communicate on a daily basis and the CCG recognises the value of social media in connecting with and listening to the people of Corby.

We post regular updates via Twitter and Facebook on key news stories, events and health updates we feel would be of interest to our local population.

During the past year we have continued to increase followers on both platforms and have issued 557 posts and 768 tweets which have had an audience reach 330,375 You can tweet us your queries, stay up to date with live tweeting from events or meetings and see images posted by our staff. Follow us on Twitter @NHS Corby or on Facebook look for the NHS Corby Clinical Commissioning Group page.

We currently have 952 numbers of Facebook followers and 2,680 followers on Twitter. Regular CCG notifications and useful health related messages are posted throughout the day.

Protected Learning Time Programme

Corby and Nene CCGs support on-going education for clinical staff to ensure best medical practice for the safe and effective care of patients. Supported by a dedicated Protected Learning Time Clinical Lead, GPs and other local primary care staff are provided with opportunities to continue their professional development. This time is a useful opportunity for the CCGS to engage with doctors and sense test upcoming innovative ideas or projects.

These include designated ‘protected learning time’ when practices close to allow for staff training; six sessions are provided off-site when staff join their colleagues for updates on a broad range of topics delivered by local and national experts in their fields, and five afternoons a year when mandatory training such as safeguarding, and resuscitation is provided in-practice. Training is very well attended with on average 250 GPs and 100 practice nursing staff attending protected learning time events across the county.

Primary Care Portal During 2018 NHS Corby and Nene CCGs developed a Primary Care Portal for practices. The aim of the project was to deliver a platform specifically for Primary Care colleagues to access information from both CCGs in one place.


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ACCOUNTABILITY REPORT

Corporate Governance Report

Members’ Report NHS Corby CCG has a membership of five GP practices, who all play a pivotal role in clinically-led commissioning. Clinicians and patients are at the heart of our decision-making. Our Practices continue to be represented at the Council of Members by Practice Delivery Leads from each member practice and allows us to have clarity and insight into the issues affecting our population and to be responsive in making changes to local services.

In 2018/19 we have continued to strengthen our working relationships with our local “at scale primary care providers” (GP Federations and local health care providers).

The CCG committed to ensuring that the Governing Body comprises a balanced membership of executive, clinical and lay members. The Governing Body strongly believes that it is essential to ensure continuity of corporate knowledge and experience to complement and support the new skills and experience brought to it by the changes in composition over the last 12 months.

Our member practices have continued to develop innovative ways to deliver clinical services that are high quality and more cost effective than before. Our clinicians are in a position to use daily patient contacts to inform a two-way process of patient and public engagement and directly assess our patients’ responses to the changes implemented by our CCG.

The Accountable Officer for the CCG is Toby Sanders who has held this post since November 2018. Prior to this date, Carole Dehghani undertook this role until 30 September 2018.

The Lay Members of the Governing Body bring strong, independent oversight for the organisation. All lay members, the Secondary Care Consultant and Registered Nurse Member are considered to be independent of day to day operational management of the CCG. They are also required to hold the organisation to account. Further detail on Governing Body Member Profiles can be seen under the Member Profiles section of this report.

During 2018/19 there have been changes to the composition of the Governing Body, these are detailed in the composition of the Governing Body section of this report below.

Detail relating to the composition of the Audit and Risk Committee, can be found further on in the Corporate Governance Report.


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Member practices

NHS Corby CCG is a membership organisation formed of the five GP practices in Corby who together have responsibility for commissioning the health services for their registered patients.

Member Practices:

• Great Oakley Medical Centre

• Lakeside Healthcare

• Studfall Partnership

• Studfall Medical

• Woodsend Medical Centre (Aspiro Healthcare)

• Further information about our member practices can be found on the CCG website

Composition of NHS Corby CCG Governing Body

Our system of governance begins with the Governing Body. The core activities of the Governing Body include:

• Development of strategy • Approving the annual Operational Plan and Financial Plan • Monitoring performance including the financial position, activity and progress against key

standards including NHS Constitutional Standards • Obtaining assurance that the risks are identified and that systems to manage and mitigate

risk are in place • Ensuring effective clinical leadership • Ensuring meaningful patient and public involvement in commissioning decisions • Ensuring transparent remuneration arrangements are in place for employees and others

The CCG’s Constitution sets out the Governing Body’s functions and the included Standing Orders details the procedures followed.


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Throughout 2018/19 and until the date of signing of the Annual Report and Annual Accounts, the Governing Body had 11 members, including:

Name Job Title Dates (if applicable)

Dr Joanne Watt Clinical Chair

Toby Sanders Joint Chief Executive From 01 November 2018

Stuart Rees Joint Chief Finance Officer From 01 December 2018

Stuart Rees Interim Chief Finance Officer

April 2018 – November 2018

Caron Williams Director of Health Strategy and Planning

Professor Devaka Fernando

Joint Secondary Care Doctor

From 23 October 2018

Angela Dempsey Joint Registered Nurse From 01 November 2018

Vacant Clinical Vice Chair This post has been vacant throughout 2018/19 as the current post holder is on secondment to the Northamptonshire Health and Care Partnership

Dr Sanjay Gadhia GP Governing Body Member

Dr Nathan Spencer GP Governing Body Member

Andrew Hammond Deputy Chair of the Governing Body and Lay Member for Governance

Tansi Harper Lay Member for Patient and Public Engagement

Joanne Brodrick Independent Lay Member From 19 June 2018

Carole Dehghani Accountable Officer Until 30 September 2018

Dr Sebastian Hendricks Joint Secondary Care Doctor

Until 23 September 2018

Aly Hulme Joint Registered Nurse Until 31 July 2018

Charlotte Fry Director of Primary Care Transformation


Julie Curtis Director of Primary Care and Community Integration

From 9 January 2019

Alison Kemp Director of Integrated Commissioning


Kathryn Moody Director of Contracting and Procurement

Matthew Davies Joint Medical Director Until 21 March 2019


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Northamptonshire Public Health supports the Governing Body, through attendance at meetings by the Director of Public Health.

Governing Body meetings are held in public bi-monthly and during 2018/19 eight meetings took place, two of which were extraordinary. The Governing Body meetings are normally held at the CCG Headquarters and public attendance has been varied through the year, the two extraordinary meetings were held in the Corby Cube to enable more room for public attendance.

Governing Body membership attendance is detailed in the table below, as per positions held up to 31 March 2018.

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 Toby Sanders to be the Accountable Officer of NHS Nene CCG.

The responsibilities of an Accountable Officer are set out under the National Health Service Act 2006 (as amended), Managing Public Money and in the Clinical Commissioning Group Accountable Officer Appointment Letter. They include responsibilities for:

• The propriety and regularity of the public finances for which the Accountable Officer is answerable,

• For keeping proper accounting records (which disclose with reasonable accuracy at any time the financial position of the Clinical Commissioning Group and enable them to ensure that the accounts comply with the requirements of the Accounts Direction),

• For safeguarding the Clinical Commissioning Group’s assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities).

• The relevant responsibilities of accounting officers under Managing Public Money,

• Ensuring the CCG exercises its functions effectively, efficiently and economically (in accordance with Section 14Q of the National Health Service Act 2006 (as amended)) and with a view to securing continuous improvement in the quality of services (in accordance with Section14R of the National Health Service Act 2006 (as amended)),

• Ensuring that the CCG complies with its financial duties under Sections 223H to 223J of the National Health Service Act 2006 (as amended).

Under the National Health Service Act 2006 (as amended), NHS England has directed each Clinical Commissioning Group to prepare for each financial year financial statements in the form and on the basis set out in the Accounts Direction. The financial statements are prepared on an accruals basis and must give a true and fair view of the state of affairs of the Clinical Commissioning Group and of its net expenditure, changes in taxpayers’ equity and cash flows for the financial year.

In preparing the financial statements, the Accountable Officer is required to comply with the requirements of the Group Accounting Manual issued by the Department of Health and in particular to:

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

• Make judgements and estimates on a reasonable basis;

• State whether applicable accounting standards as set out in the Group Accounting Manual issued by the Department of Health and Social Care have been followed, and disclose and explain any material departures in the financial statements; and,

• Prepare the financial statements on a going concern basis.


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Members’ Profiles

Toby Sanders

Toby Sanders is the new Joint Chief Executive for both NHS Corby and NHS Nene Clinical Commissioning Groups (CCGs). With 15 years of experience in the NHS Toby was previously the Managing Director (Accountable Officer) of West Leicestershire Clinical Commissioning Group, an organisation which he successfully helped set up and lead for seven years working with its 48 Member Practices to service the 366,000-local population. Toby has extensive experience in a variety of senior management and system leadership roles including being the Sustainability and Transformation Partnership (STP) Lead over

the last three years for the Better Care Together programme serving the one million local people of Leicester, Leicestershire and Rutland (LLR). An experienced Board Director, Toby previously held Deputy Chief Executive roles with the LLR PCT Cluster, and Leicester City PCT where he also held the role of Director of Primary and Community Care. Toby has also worked elsewhere in the NHS in an acute hospital setting and strategic health authority roles. During his time in Leicestershire some of Toby’s key achievements were: enabling the development of primary and community care through the setting up of new GP surgeries in ͚under doctored͛ areas, the growth of GP Federations and integrated locality team working with community services and social care teams; successfully leading formal public consultations to enable the redesign of urgent care and community hospital services, and; supporting and making the case for proposals to reconfigure and invest in modernising Leicester’s acute hospitals. Toby has a strong appreciation of how the NHS and wider public sector touches and impacts on most of our lives. He is passionate about the value of clinical leadership and patient involvement, working with health and care professionals across public services to achieve the best value and outcomes for local people and places. Before joining the NHS in 2003, Toby held a number of roles within local government and management consultancy with a focus on place-based regeneration in economically deprived industrial areas in the North West, South Yorkshire and Wales.


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Carole Dehghani, Chief Executive

Carole Dehghani was appointed as Chief Executive of Corby CCG in December 2013 and joined Nene CCG as interim Accountable Officer in December 2017. Carole Dehghani left the organisation on 30 September 2018. She had more than 30 years’ experience working in the NHS in a variety of senior management and leadership roles including Director of Public Health. After obtaining her MSc in Health Policy and Management, Carole developed her interest in NHS policy as an Associate Director at NHS Northamptonshire. She has successfully led local implementation programmes which engaged large numbers of primary, secondary and community care clinicians together with

patients and partner organisations in the scoping and identifying best models of care, creating high quality care for the population of Northamptonshire. Throughout her career Carole took on a number of roles which has resulted in successful pathway and service re-design for COPD, heart failure, vascular services and diabetes leading to both national and international acclaim. Stuart Rees, Chief Finance Officer

Stuart Rees was appointed as the Joint Chief Finance Officer at NHS Corby Clinical Commissioning Group on 1 April 2018. He is also the Chief Finance Officer at NHS Nene Clinical Commissioning Group. He has held a number of senior positions in the NHS. Between March and October 2015 Stuart was the Interim Accountable Officer for Nene CCG. He has also over his career held positions as Director of Finance, Contracting and Performance at Shropshire Community Health Trust and the Director of Finance and Performance at Shropshire County Primary Care Trust.

Stuart has experience of working in both secondary and primary care settings and joined the NHS as part of the National Finance Management Training Scheme. Stuart’s qualifications include membership of the Chartered Institute of Public Finance and Accountancy and Bachelor of Arts (Honours).


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Caron Williams, Director of Health, Strategy and Planning

Caron Williams has enjoyed a career which has spanned both the private and public sector with her progressive approach to projects earning her endeavours national recognition for her work in EoLC and a ministerial recommendation for the Transforming Community Services programme she undertook for NHS Warwickshire. She started her career with eleven years in private industry beginning her basic training in research and development, procurement for blue chips, and then new product development for GC Telecommunications - delivering new products to market. With a track record of delivering on time and to cost she was eventually promoted to the position of Senior Officer in worldwide

product development. Her work then took her to the Channel Islands where she diversified into the shipping industry as a General Manager supporting operations for 4 shipping lines. After moving back to the UK, she began to work in health and social care starting at Coventry City Council where she developed markets and set up services that hitherto didn’t exist - working with providers to ensure they could deliver to meet local population needs. Her career in the NHS was launched in 2008 when she started working for Solihull Care Trust developing their end of life care services and continued life care services. Those services were regarded as the best of their kind in the UK at that time. She then moved with the NHS into Warwickshire where she transferred and transformed community services in 2010 and received ministerial recommendation. This work was also cited by The Kings Fund - an independent charity working to improve health and health care in England. More recently she moved from Warwickshire to NHS West Leicestershire CCG as a board member responsible for strategy and planning and during this time delivered the Better Care Fund. During her time there she also delivered the majority of the early shaping and development work for the five-year plan in Leicestershire and Rutland.

Dr Joanne Watt, Clinical Chair

Dr Joanne Watt has been a GP at Great Oakley Medical Centre since 2005 and is now senior partner. During that time the practice has expanded from 2,500 patients to 12,300 patients and is still growing. She also works as a sexual health doctor providing confidential clinic services for non-registered patients via the department of Sexual Health. Dr Watt was her practice lead during practice-based commissioning. She then became practice delivery lead for the CCG, and in July 2012 was elected to the Governing Body as an executive GP leading on quality. In October 2015 she became interim Clinical Chair of the Governing Body and became substantive Clinical Chair in April 2016.

http://www.corbyccg.nhs.uk/profile/18


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Dr Sanjay H Gadhia, GP Governing Body Member

Dr Sanjay Gadhia qualified at the Royal Free Hospital in London in 2001. He worked in London, Stevenage and Mansfield before completing his GP vocational training scheme in Kettering. In 2006 he joined Lakeside Surgery as a partner and has been actively involved in the expansion and development of the practice. He was elected to the NHS Corby CCG board in 2013. Sanjay developed a keen interest in improving services for the community both from his work as a local GP and as a forensic medical examiner for Northamptonshire Police.

Dr Nathan Spencer, GP Governing Body member

Nathan Spencer MBChB MRCGP is a working GP at Great Oakley Medical Centre. He has special interests in mental health and sports medicine. Nathan graduated in 1999 from Leicester University and worked in a variety of hospital jobs across the country. He became a Consultant in Emergency Medicine in 2008 in the A & E Department at Kettering General Hospital. He then decided to retrain in General Practice in 2012 and completed his training last year. Nathan is delighted to be a GP member of Corby CCG and hopes to be a strong ambassador in representing the experience of patients and colleagues.


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Dr Sebastian Hendricks, Secondary Care Clinician Member Sebastian is an active clinical consultant in Audio vestibular Medicine and clinical lead for Paediatric Audiology & Audio vestibular Medicine for The Royal Free London NHS Foundation Trust. He is also a consultant at the Royal National Throat Nose & Ear Hospital (University College London Hospitals NHS Foundation Trust). His previous work includes member of the Trusts clinical governance committee in his role of chair of the children’s clinical governance, trust appraiser and educational supervisor, member of the clinical excellence awards committee and lead for patient experience for children’s services. In North Central London he led the local new-born hearing screening service to the unified NCL service. He was Trustee and Council Member of the British Society of

Audiology (BSA) for 2 terms and chaired the Paediatric Audiology Interest Group of the BSA, representing the group also on the Audiology Advisory Group at Department of Health. He held several positions within his main professional organisation, the British Association of Audio vestibular Physicians. At present he represents the organisation at the standard developments for care records (Royal College of Physicians / Professional Record Standard Body) In the past his work for the professional organisation and at the Royal College of Physicians included the Payment for Results committee, Clinical Coding, and Expert Working Group at the NHS Health and Social Care Information Centre. Within Corby CCG, Sebastian has as a governing board member shared responsibility for all aspects of the CCG, providing a broader view on health and care issues, particularly an understanding of patient care in the secondary care setting. Sebastian also presents an independent strategic clinical view on all aspects of CCG business as well as adding an understanding of how secondary care providers work within the health system He was a member of the Joint Quality Committee with NHS Nene CCG, the council of members, the primary care commissioning committee, and the finance committee. Sebastian left the organisation on September 23, 2018.


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Julie Curtis, Director of Primary and Community Integration

Julie Curtis was appointed in January 2019 and works on behalf of NHS Corby and NHS Nene CCGS to oversee all aspects of primary care including contracting, estates, GPIT, medicines management, support to GP federations/super practices and the progression of the new GP Contract including the development of local Primary Care Networks. Julie is also taking the commissioning lead for the Northamptonshire Heath & Care Partnership in the development of health and social care integration by working closely with local GP Practices, health providers and the Local Authorities. Julie started her career in Northamptonshire and since 2012 Julie

has worked in an Executive Director role with 11 CCGs across Berkshire, Hampshire, Surrey, Birmingham and Solihull. Julie has extensive experience in successfully developing new models of integrated primary, community and social care services across complex health and care systems. Professor Devaka Fernando, Secondary Care Doctor

Professor Devaka Fernando is the CCG’s secondary care doctor. Devaka was a consultant physician in diabetes and endocrinology at Sri Jayawardanapura General Hospital and was a professor of medicine in the University of Sri Jayewardenepura faculty of health sciences. Since 2005, he has been working as the head of the Sherwood Forest Hospitals Foundation Trust's Department of Diabetes and Endocrinology. He is also heavily involved in academia and has held clinical and research fellowships and senior research fellowships at the University of Manchester, visiting professorships with the University of Newcastle Upon Tyne and the University of Sheffield and an honorary professorship at Sheffield Hallam University.

Andrew Hammond, Lay Member (Governance), Audit Chair and Deputy Lay Chair

Andrew is an experienced Executive and Non-Executive Director. He spent his early career establishing a National Awareness Charity before heading to Royal Mail where he held numerous senior leadership positions from heading up advertising through to being responsible for the nation’s stamps as Managing Director of Stamps & Collectibles. Notable successes include spearheading the Gold Medal Stamps and Gold Post-boxes at the 2012 London Olympics and putting the global phenomenon of Star Wars on our stamps. Andrew is currently Chief Executive of Instructus, an education charity working in the apprenticeship area, which owns companies delivering training and development programmes. He is ultimately responsible for Instructus, Instructus Skills, CQM Ltd, and the Springboard Consultancy.


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Tansi Harper, Lay Member for Patient and Public Engagement

Tansi's professional career was in education and she was Principal of two colleges as well as working in other public sector and voluntary sector positions before becoming a Regional Consultant for HEFCE for the East Midlands and Northern Ireland. She became involved on Health Boards driven by her concern that Education, Health and Social Care seemed to not work well together in the best interests of the patients, students and families and a desire to support better integration of services to meet community needs. That was 19 years ago and Tansi has been a Non-Executive Director on the Boards of a number of Health Boards since then including a Strategic Health Authority, PCTs and now Corby CCG where she represents the Patient and Public voice. She chairs a number of Committees, investing in strengthening the patient and stakeholder contribution to improving

the commissioning of Health services. She has a particular interest in vulnerable groups that may need additional support to access appropriate health and wellbeing services. Until recently she chaired the County Learning Disabilities forum and actively supports Mental Health developments through her countywide networks. Since retiring Tansi has been Chair of Northamptonshire Probation Trust and subsequently Chaired a Transformation Board bringing together the Probation Trusts from Northamptonshire, Bedfordshire, Hertfordshire and Cambridgeshire in response to national policy changes in the Criminal Justice system. She was Chair of CAN, a Northamptonshire based Substance misuse and Crisis Housing Charity, until late 2016 when she merged it with Aquarius, a larger Midlands based Charity. Both organisations are part of the Richmond Fellowship (RF) family of organisation's working nationally on supporting those with Mental Health and substance misuse challenges, and she is a member of the RF Board. Between the Summer of 2016 to Nov 2017 Tansi chaired the Northamptonshire Sustainable Transformational Plan, a countywide committee involving the CCGs, the County Council, the voluntary sector, GPs, the acute sector providers and the Mental Health trust in developing integrated health and adult social care plans based on the needs of the Northamptonshire population. She now chairs the STP Collaborative Stakeholder Forum (CSF).

Joanne Brodrick, Independent Lay Member

Jo has extensive experience in the public and private sectors including

senior leadership roles within Further Education. She is currently working in

consultancy and inspection within the training, FE and skills sector

supporting organisations to provide high quality training and development.

Prior to joining the CCG Jo was a Non-Executive Director for 8 years for a large social housing association.


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Matthew Davies, Medical Director

Matthew was the Medical Director until his departure in March 2019. He was one of the Executive Directors of the Governing Body, and had a lead role in ensuring that the Governing Body and the wider CCG behaves with utmost probity at all times. He is also a practising GP at the Abbey House Medical Practice in Daventry.

Kathryn Moody, Director of Contracting and Delivery

Kathryn has been with NHS Nene CCG since its inception, first as Chief Finance Officer and latterly as Director of Contracting and Delivery. Prior to joining the CCG, held a number of roles within Northamptonshire working at a senior level across finance. Because of her background, Kathryn is able to bring a range of skills to her role, which currently involves leading on procurement, management of contracts across all disciplines, and the redesign of in-hospital services.

Angela Dempsey, Joint Registered Nurse

Angela is a passionate and committed nurse leader with over 30 years of experience delivering and/or overseeing acute, community and primary care. She is a passionate and committed nurse leader with over 30 years of experience delivering and/or overseeing acute, community and primary care. Angela is an experienced Governing Body Nurse with six years’ experience of holding the position for Enfield CCG.


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Charlotte Fry, Director of Primary Care Transformation

Charlotte joined NHS Nene CCG in 2016 before her departure in September 2018. Charlotte had over 25 years’ experience in the NHS, starting her career as a pharmacist working in Central London Hospitals where she progressed into a number of senior prescribing advisor positions before joining a primary care trust as lead for primary care and community healthcare services.

Alison Kemp, Director of Integrated Commissioning

Alison joined NHS Nene CCG in 2016 having held a number of strategic commissioning roles in the NHS and remained with the CCG until her departure in September 2018. Alison led on integrated commissioning and a number of key transformation programmes supporting the delivery of the CCG’s system-wide vision.

Helen Storer, Lay Member

Helen has 26 years’ NHS experience and started her career as a Registered Dietitian at Leicester Royal Infirmary. She later moved to Kettering General Hospital where she ran regular community clinics in Corby. During this time, she developed an interest in public health nutrition and the prevention of diet-related problems. Helen followed this interest by becoming a Community Dietitian in Leicestershire, working with the Department of Health to set up the National School Fruit Scheme. In 2000, Helen became an Integrated Health and Social Care Manager with Nottingham CityCare Partnership. She has undertaken a variety of additional roles alongside her substantive post, including that of Professional Executive Committee Member and Board Clinician with Nottingham City PCT, Special Lecturer with Nottingham University, member of the NICE obesity guideline development group and Chair of the Nottingham School Food

Group. Helen started her role as Lay Member in December 2014 and is now the Chair of the Finance Committee. Helen left the CCG on 26 April 2018.


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Aly Hulme, Registered Nurse Member

Aly has been appointed as Governing Body Registered Nurse to provide strategic nurse and clinical leadership for quality and safeguarding, ensuring that the CCG achieves the vision to improve quality, outcomes and clinical standards for all patients. Prior to joining Nene and Corby CCG, Aly was the Director for the Patient Safety Collaborative (PSC) at the North West Coast Academic Health Science Network. She was instrumental in leading and establishing the PSC with the aim of creating an effective and sustainable collaborative improvement system in patient safety. Aly has a long-standing career in the NHS as a registered nurse and midwife with over 33 years’ working in management roles in various organisations and has been

appointed to senior nursing positions in NHS England and commissioning organisations. Aly is passionate about quality ensuring that patients are at the heart of our decision making. She has extensive expertise in patient safety and quality improvement and is a Health Foundation Quality Fellow. Aly has delivered on programmes at national level being instrumental in driving and implementing patient safety and quality improvement such as, leading on the delivery of National Patient Safety Agency (NPSA) National Learning and Reporting System and developing quality capability across the NHS. Aly left the organisation on July 31, 2018.


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Governance Statement

Introduction and context

NHS Corby CCG is a body corporate established by NHS England on 1 April 2013 under the National Health Service Act 2006 (as amended). The clinical commissioning group’s statutory functions are set out under the National Health Service Act 2006 (as amended). The CCG’s general function is arranging the provision of services for persons for the purposes of the health service in England. The CCG is, in particular, required to arrange for the provision of certain health services to such extent as it considers necessary to meet the reasonable requirements of its local population. As at 1 April 2018, the clinical commissioning group is not subject to any directions from NHS England issued under Section 14Z21 of the National Health Service Act 2006.

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

Governance arrangements and effectiveness

The 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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In accordance with this, we acknowledge within our Constitution the following principles:

• The highest standards of propriety involving impartiality, integrity and objectivity in relation to the stewardship of public funds, the management of the organisation and the conduct of its business by adopting:

• The Good Governance Standard for Public Services • The standards of behaviour published by the Committee on Standards in Public

Life (1995) known as the Nolan Principles • The seven key principles set out in the NHS Constitution • The Equality Act 2010 • Standards for Members of NHS Boards and Governing Bodies in England.

The roles and responsibilities of the Governing Body and sub-committees of the CCG are detailed within the CCG’s Constitution including the terms of reference. The CCG’s Governance Structure can be found in the diagram below. NHS Corby CCG and NHS Nene CCG Governance Structure NHS Corby CCG (the CCG) is a clinically led and managerially supported membership organisation made up of 5 member practices. Further detail in relation to the CCG membership can be found in the Members’ Report above. During 2018/19 the CCG has worked even more closely in a collaborative working arrangement with NHS Nene CCG. This collaborative arrangement has been strengthened by the appointment of the Joint Chief Executive and Joint Chief Finance Officer during 2018/19. Clarity of delegation of responsibilities to the formal committees and officers of the CCGs has been improved with the revision of the Scheme of Delegation in line with the revised governance arrangements put in place during 2018/19. NHS Corby CCG and NHS Nene CCG (collectively known as the CCGs), committed to undertake a review of the governance arrangements across the CCGs. This involved a review the CCG constitutions to ensure that these reflected and recognised the change in the governance arrangements across the CCGs. The revised governance structure detailed below sets out the governance arrangements in place, including the Transition Board which was established during 2018/19. The structure also demonstrates the establishment and changes to other sub-committees of the Governing Body during the reporting period. Further detail on each sub-committee can be seen below. The Joint Transition Board was a joint committee between NHS Corby CCG and NHS Nene CCG (the CCGs). The principle aim of the Transition Board was to oversee and direct the smooth transition for the alignment of the CCGs to work collaboratively together, providing a single focus on improving the commissioning of health services for the population of Northamptonshire. The Transition Board had a time limited purpose until January 2019 when the decision was taken by the Governing Bodies of NHS Corby CCG and NHS Nene CCG to cease the Committee.


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The role of the Transition Board was to:

• Provide direction and review the outputs required from working groups that supported the Transition Board.

• Provide assurance to the Governing Body Meeting in Common that the work was aligned and delivered within the aims as set out.

• Ensure appropriate governance was in place and that it was part of the programme of work.

• Appoint a senior responsible officer for the programme and key work-stream leads.

• Ensure clinical advice and leadership was incorporated into all programmes of works.

• Resolve any issues and risks escalated by the work streams.

• Ensure regular engagement and communication with staff, members and other key stakeholders as the transition arrangements progressed.

The Transition Board met on a monthly basis and provided assurance on the functions of the Board to the NHS Corby CCG and NHS Nene CCG Governing Body Meeting in Common. The Board also provided assurance that there were clear actions in place to address any underperformance together with timelines and leads for delivery. Further to the decision taken by the Governing Bodies of NHS Corby CCG and NHS Nene CCG, the Committee ceased to function from January 2019. The Transition Board therefore does not feature in the Governance Structure below. The structure sets out the Governing Body and Committee structure across NHS Corby CCG and NHS Nene CCG, reflecting the collaborative working arrangements in place.

The Governing Bodies and Committees in blue, reflect the requirements of both Governing Bodies as separate entities. The Joint Committee meetings are illustrated in green, demonstrating the aligned reporting approach to both Governing Bodies. Interim arrangements are illustrated in grey, as these are expected to be time limited.


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Further detail on the remit of the Governing Body and Sub-committees can be found below.

CCG Governance arrangements The CCG has established robust governance arrangements and a system of internal control. Corporate Governance is the system by which the CCG Governing Body directs and controls the organisation at the most senior level in order to achieve its objectives and meet the necessary standards of accountability and probity. The CCG’s Constitution sets out the organisation’s commitment to good governance and the arrangements the CCG has in place to help to deliver the vision, mission, objectives and aims. The Constitution also sets out how the CCG will discharge the organisation’s legal obligations and to engage with our members, our patients and our community and other key stakeholders and partners to achieve this. It states that the Governing Body of the group will throughout each year have an ongoing role in reviewing the group’s governance arrangements to ensure principles of good governance are reflected. This includes reviewing the effectiveness and the operation of Governing Body meetings and the sub-committees of this meeting. Further detail on the Governing Body can be found later in this report. Responsibilities and decision making are defined in the CCG’s prime financial policies and scheme of delegation which are reviewed annually to maintain accuracy and relevance.


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The key features of the CCG Constitution in relation to governance are:

• Discharge of functions - the arrangements made to discharge the functions of the CCG and the Governing Body. The Constitution describes how we operate, the role of the Governing Body, the appointment of Committees and the specific duties of the Chair, Joint Chief Executive (Accountable Officer) and Joint Chief Finance Officer.

• Primary decision-making processes - the primary decision-making processes and procedures to be followed by the CCG and the Governing Body including the arrangements for securing transparency in decision-making such as the provision for Governing Body meetings to be held in public.

• Conflict of Interest management – how the CCG deals with conflicts of interest, including the arrangements we have made to maintain and grant public access to registers of interest and ensure that declarations of conflicts or potential conflicts of interests are made. This is to ensure that conflicts or potential conflicts do not and do not appear to affect the integrity of the decision-making process. A copy of the CCG’s register of interests is available on the CCG website.

• Governing Body membership - details of how appointments are made to the Governing Body and how the membership of the organisation is involved in these appointments.

• Scheme of Reservation and Delegation - sets out the decisions that are the responsibility of the Governing Body and its Committees, alongside the decisions delegated to individual members and employees.

The Constitution sets out the arrangements the CCG has made for the discharge of the Governing Body’s functions, including the following:

• Established sub-committees of the Governing Body: o Audit & Risk Committee o Remuneration and Terms of Service Committee o Joint Finance Committee o Council of Members o Patient and Public Participation Committee o Primary Care Commissioning Committee o Joint Quality Committee o Joint Strategic Commissioning Committee o Joint Executive Management Team

• Delegated Governing Body functions for the approval of policies to the Joint Quality

Committee, Audit and Risk Committee, Joint Finance Committee and Joint Executive Management Team, as committees of the Governing Body.

• The Standing Orders and Scheme of Reservation and Delegation.


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Effectiveness The Governing Body throughout each year have an ongoing role in reviewing the group’s governance arrangements and effectiveness of these, to ensure principles of good governance are reflected. The Governing Body reporting structures have embedded and communicated codes of conduct and defined standards of behaviour for CCG members and staff by:

• Having a code of conduct for the Governing Body members showing mutual trust, respect and honesty.

• Members of the Governing Body adhere to the Nolan Principles for public life.

• Each Committee is authorised by and accountable to the Governing Body.

• Each Committee is responsible for approving and keeping under review the terms of reference and membership, and the Governing Body seek regular assurance that this duty is discharged accordingly.

The Governing Body is subject to statutory and mandatory training, Training and development is provided on a group basis through Governing Body workshops and through individual need as identified through appraisals. The Governing Body is provided with a range of information and using risk management mechanisms, the Governing Body brings together the various aspects of governance; corporate, clinical, financial and information to provide assurance on its direction and control across the whole organisation. In addition to the commitment by the Governing Body to assess and improve its own performance, the Committee Chairs lead an annual review of committee effectiveness review. The CCG use a tool to guide this review in the form of the Committee Effectiveness and Meeting Checklist, which was designed to help in assessing the effectiveness of each sub-committee of the Governing Body. The checklist focuses on three main areas; firstly, committee administration; secondly effective operation of the committee and thirdly a free text section for each Chair to provide any additional feedback on the effectiveness of the committee.


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Below is an overview of the feedback provided by the Committee Chairs: Committee/Meeting Process Across all Committees answered were fairly positive. However, it was highlighted that there were opportunities to improve the links between committees and aligning the emerging organisational and system priorities. It was also identified that an improvement in timely and proactive provision of information was required.

Committee/Meeting Working Responses received confirmed that there had been improvement in some areas of delivery of actions however there still remained opportunities for strengthening the consistency of papers submitted. Changes in both Governance arrangements and in senior personnel initially impacted the quoracy of meetings, however since the revision of Terms of Reference across the CCG this has been resolved. Committee/Meeting Engagement Positive responses were received overall however there were some areas where responses to challenges raised by the Committees of CCG officers and other assurance providers could be improved. Committee/Meeting Leadership General feedback was positive for this section, with some indication that there may be a need for Executive presence for Committees to enhance the delivery of the function of the Committee. Committee Effectiveness, Committee Chairs Comments Commentary provided for this section identified some challenges faced regarding additional presence or support from key assurance providers to ensure the Committees can fulfil its objectives and have the constructive challenge required. The Governing Body The Governing Body is committed to assessing and improving its own performance. All members of the Governing Body are able to demonstrate the leadership skills necessary to fulfil the responsibilities of these key roles and have established credibility with all stakeholders and partners. The CCG understands that the Governing Body must be in tune with its member practices and must secure and maintain their confidence and engagement. The Governing Body sets the strategic direction for the CCG and focuses on gaining assurance of the delivery of the CCG’s priorities, corporate objectives and statutory duties. The Governing Body has focused on key performance issues throughout the year ensuring that the CCG has appropriate arrangements in place to exercise its functions effectively, efficiently and economically in accordance with the CCG’s principles of good governance.


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The Governing Body brings together the various aspects of governance to provide assurance on the CCG’s direction of travel and control across the whole organisation, acknowledging the collaborative working arrangements with NHS Nene CCG. 2018/19 has been a challenging year for the CCG which has been reflected in the focus of the Governing Body throughout the financial year on the effectiveness of the commissioning arrangements in place across Northamptonshire, to ensure delivery of transformational and sustainable change. This has been a particular area of assurance sought through the CCG’s governance arrangements, in particular from the Joint Finance Committee and Audit and Risk Committee. Further detail can be found within the Head of Internal Audit Opinion later in the Governance Statement. Examples of the areas of review by the Governing Body are detailed below:

• Development of strategy

• Ensuring commissioning arrangements in place across Northamptonshire

• Approving the annual Operational Plan and Financial Plan

• Monitoring performance including the financial position, activity and progress against key standards including NHS Constitutional Standards

• Obtaining assurance, the risk management process is effective to manage and mitigate risk

• Ensuring effective clinical leadership

• Ensuring meaningful patient and public involvement in commissioning decisions

• Ensuring transparent remuneration arrangements are in place for employees and others In cases where one or both lay members of the committee were conflicted, the joint Secondary Care Doctor and the Joint Registered Nurse were co-opted to enact relevant business to ensure quoracy. This is reflected in the membership attendance below. The Governing Body has met in public on a bi-monthly basis, alternated with development sessions for the Governing Body, which provide protected time to develop understanding of key strategic issues. Six Governing Body meetings were held in public in 2018/19 at the CCG headquarters. During 2018/19 the Governing Bodies of NHS Corby CCG and NHS Nene CCG also met under an in-common arrangement to further strengthen the collaborative working arrangements developed throughout the financial year. Governing Body membership attendance is detailed in the table below and demonstrates that each meeting was quorate with good attendance from members from April 2018 – March 2019.


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NAME TITLE ORGANISATION 24/04/2018 26/06/2018 28/08/2018 30/10/2018 18/12/2018 26/02/2019 Total PERCENTAGE

Dr Joanne Watt Clinical Chair NHS Corby CCG 1 1 1 1 1 1 6 100%

Carole Dehghani Chief Executive NHS Corby CCG & NHS Nene 1 1 1 3 100%

Toby Sanders Joint CEO NHS Corby CCG & NHS Nene 1 1 2 100%

Stuart Rees Chief Finance Officer NHS Corby CCG & NHS Nene 1 1 0 1 1 1 5 83%

Caron Williams

Director of Health Strategy and Planning NHS Corby CCG & NHS Nene 1 1 1 1 0 1 5 83%

Jo Brodrick Independent Lay Member NHS Corby CCG & NHS Nene 1 1 1 1 1 5 100%

Aly Hulme Nurse Member GB NHS Corby CCG & NHS Nene 0 1 1 50%

Dr Nathan Spencer GP Governing Body Member NHS Corby CCG 1 1 1 1 1 1 6 100%

Dr Sanjay Gadhia GP Governing Body Member NHS Corby CCG 1 1 1 1 0 1 5 83%

Andrew Hammond Lay Member for Governance NHS Corby CCG 1 1 1 1 1 1 6 100%

Angela Dempsey Nurse Member GB NHS Corby CCG & NHS Nene 1 1 2 100%

Tansi Harper Lay Member for PPEA NHS Corby CCG 1 0 1 1 1 1 5 83%

Prof Devaka Fernando Secondary Care Doctor NHS Corby CCG & NHS Nene 1 1 1 3 100%

Sebastian Hendricks Secondary Care Consultant NHS Corby CCG 1 1 1 3 100%


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Sub-Committees of the Governing Body The established sub-committees of the Governing Body are:

• Audit and Risk Committee

• Council of Members

• Remuneration and Terms of Service Committee

• Patient and Public Participation Committee

• Primary Care Commissioning Committee

• Joint Finance Committee

• Joint Quality Committee

• Joint Strategic Commissioning Committee

• Joint Executive Management Team Audit and Risk Committee The Audit and Risk Committee’s work focuses on ensuring the organisation has appropriate governance and internal control in place and oversees the management of risk. The Committee provides the Governing Body with an independent and objective view of the CCG’s financial systems, financial information and compliance with laws, regulations and directions governing the CCG. The Committee seeks to provide assurance to the Governing Body that an appropriate system of internal control is in place. The membership of the Audit and Risk Committee as at 31 March 2019:

• Chair, currently Andrew Hammond, Lay Member for Governance

• Lay Member for Patient and Public Engagement Assurance

• Joint Secondary Care Doctor

• GP Governing Body Member During 2018/19 the Committee met 7 times. Audit and Risk Committee attendance is detailed in the table below and demonstrates that each meeting was quorate with good attendance from members. The Joint Chief Finance Officer and External and Internal Auditors, as well as the Local Counter Fraud Specialist, are regular attendees at the Committee but do not form part of the membership. The minutes of each Audit and Risk Committee are presented to the Governing Body and the Chair of the Committee draws attention to any issues that require disclosure or executive action via the Chair’s highlight report. From November 2018 onwards, the NHS Corby CCG and NHS Nene CCG Audit and Risk Committees met as Committees in Common.


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Audit and Risk Committee membership attendance is detailed below from April 2018, 2018 – March 2019.

NAME TITLE ORG. 24/04/18 22/05/18 29/05/18 17/07/18 18/09/18 20/11/18 07/02/19 TOTAL %

Dr Nathan Spencer

GP Governing Body Member

NHS Corby CCG 1 1 1 1 1 1 1 7 100%

Dr Sanjay Gadhia


NHS Corby CCG 0 1 0 0 1 0 0 2 29%

Andrew Hammond

Lay Member for Governance

NHS Corby CCG 1 1 1 1 1 1 1 7 100%

Prof Devaka Fernando


Corby & Nene 1 0 1 50%

Tansi Harper

Lay Member for PPEA

NHS Corby CCG 1 1 1 1 1 1 1 7 100%

Helen Storer Lay Member

NHS Corby CCG 1 1 100%

Sebastian Hendricks

Secondary Care Consultant

NHS Corby CCG 1 1 1 1 4 100%


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Governance, Risk Management and Internal Control

The Audit and Risk Committee Chair’s report for 2018/19 highlighted the following:

• The Audit and Risk Committee reviewed the 2018/19 end of year final financial accounts, Annual Report and Governance Statement at the Audit and risk Committee meeting held on 23 May 2019.

• The Head of Internal Audit presented the Head of Internal Audit Opinion to the Audit and Risk Committees in Common on 23 May 2019, which concluded that:

• At each meeting the Audit and Risk Committee has considered the risks, mitigations and assurance detailed within the Governing Body Assurance Framework. To ensure adequate review of risks was undertaken against identified risks to the achievement of organisational objectives a series of “deep dives” were undertaken by the Committee. For each of these the Executive Lead for the identified risk was invited to the Committee to provide assurance on the risks and mitigations for the strategic objectives for which they are responsible.

• The Committee has undertaken challenge and scrutiny of internal audit opinions received during 2018/19. The Committee has sought assurance on the CCGs’ response to the outcomes and delivery of key actions to improve systems and processes to provide further assurance. Further detail can be found within the Head of Internal Audit Opinion section of the Governance Statement.

• The Committee approved the joint revised Governing Body Assurance Framework (GBAF) and joint CCG risk management policy. The Committee has also received assurance on the introduction of the new risk management system for the CCGs.

The Audit and Risk Committee has regularly monitored the following during 2018/19:

• Regular assurance reports on the Governing Body Assurance Framework (GBAF) and delivery of associated mitigating actions, including review in line with the deep dive programme

• Regular review of the revised directorate level risk registers

• Internal and External audit reports with focus on the implementation of agreed management actions

• Updates on the work of the Local Counter Fraud Specialist

• Management of conflicts of interest and Register of Interests and Register of Gifts and Hospitality, including approval of the revised Conflicts of Interest Policy to reflect the collaborative working arrangements between the CCGs


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• Sources of assurance in support of the Annual Governance Statement and the Annual Report and Accounts

• Financial controls and monitoring correct application of the Standing Financial Instruction and Scheme of Delegation

• Governance in relation to third party governance and new ways of working including primary care commissioning and the Northamptonshire Healthcare Partnership

• Single tender waivers correct use monitoring

• Assurance on progress of General Data Protection Regulations (GDPR) Council of Members The Council of Members is a unique committee for Corby CCG, as it is a meeting which brings together representatives from all member practices. Membership of the committee includes:

• Clinical Vice Chair (Chair) • GP Governing Body Member (deputy chair) • Practice Delivery Lead (practice representative) from each of the 5 member practices • Joint Chief Executive • Joint Chief Finance Officer or Deputy Chief Finance Officer

Officers of the CCG and Practice Managers are also in attendance at the Council of Members as required. The Council of Members meets bi-monthly and during 2018/19 met 7 times. The Council of Members provides assurance to the Governing Body that the organisation has delivered effective clinically-led decision making systems and processes in order to:

• Lead the planning, delivery and performance management of commissioning • Ensure commissioning decisions meet the needs of patients, service users and wider

population • Formulate and deliver the CCG strategy in relation to member practices and

commissioned services During 2018/19 the Council of Members has considered the following items:

• Commissioning Intentions • Financial recovery Plan • QIPP plans • Same day Access • Elective demand

The minutes of the Council of Members meeting are reported to the Governing Body meeting, with the Chair of the Committee drawing attention to any issues that require Governing Body scrutiny via the Chair’s highlight report. The Council of Members membership attendance is detailed below from April 2018 – March 2019. During 2018/19 the Council of Member has been chaired by the Deputy Chair of the meeting as can be seen in the attendance register overleaf.


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Carole Dehghani Chief Executive

NHS Corby CCG 0 0 0 0 0 0%

Toby Sanders

Joint Accountable Officer

NHS Corby & Nene CCGs 0 0 1 1 33%

Caron Williams

Director of Commissioning & Development

NHS Corby CCG 0 1 1 0 0 0 0 2 29%

Bie Grobet

Assistant Director of Commissioning Development

NHS Corby CCG 1 1 1 0 1 1 0 5 71%

Andrew Burwell

Deputy Chief Finance Officer

NHS Corby & NHS Nene CCGs 1 1 0 0 2 50%

Dr Nathan Spencer


NHS Corby CCG 0 1 1 1 1 0 1 5 71%

Dr Sanjay Gadhia


NHS Corby CCG 1 0 0 1 1 1 1 5 71%

Dr Lipi Pradhan PDL

Great Oakley Medical Centre 1 1 0 0 1 0 1 4 57%

Dr Emily Taylor PDL

Lakeside Surgery 0 0 1 1 0 1 0 3 43%

Dr Satish Kumar PDL

Studfall Partnership 1 1 1 1 1 1 1 7

100%

Dr Roman Sumira PDL

Studfall Medical Centre 1 1 1 1 1 1 1 7

100%

Dr Emily Winters PDL

Woodsend Surgery 0 1 0 0 0 0 0 1 14%

Dr Sebastian Hendricks


NHS Corby CCG 0 1 1 2 67%

Nominated Deputies

Mrs Nicki Adams Deputy PDL

Woodsend Surgery 1 1 1 1 1 1 1 7

100%

Vanessa Hurling Deputy PDL

Studfall Partnership 0 0 0 0 0 0 0 0 0%

Anna Lewis Deputy PDL

Studfall Medical Centre 0 0 0 0 0 0 0 0 0%

Dr Felix Morgan Deputy PDL

Great Oakley Medical Centre 0 0 1 0 0 0 0 1 14%

Dr Pete Wilczynski Deputy PDL

Lakeside Surgery 1 0 0 0 0 0 0 1 14%


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Primary Care Commissioning Committee In accordance with its statutory powers under section 13Z of the National Health Service Act 2006 (as amended), NHS England has delegated the exercise of these functions to NHS Corby CCG. The Committee functions as a corporate decision-making body for the management of the delegated functions and the exercise of the delegated powers. The internal audit of primary care delegated commissioning identified a number of control gaps in the commissioning arrangements for the CCG. The focus of the Committee will be the development of the Primary Care Strategy and the completion of the needs assessment required for the CCG. The Committee membership includes:

• Chair (Lay Member for Patient and Public Engagement) • Deputy Chair (Independent Lay Member) • Joint Accountable Officer • Joint Chief Finance Officer/Deputy Chief Finance Officer • Director responsible for Primary Care Transformation, NHS Nene and Corby CCGs

During 2018/19 the Committee met 5 times on a Bi-monthly basis. The minutes of the Committee are reported to the Governing Body, with the Chair of the Committee drawing attention to any issues that require Governing Body scrutiny via the Chair’s highlight report. The Primary Care Commissioning Committee meets in public and papers for the meeting can be found on the CCG website. Please find the attendance register in the table below. Further detail on the outcome of the internal audit undertaken for Primary Care Commissioning can be found within the Head of Internal Audit Opinion later in the Governance Statement.

NAME TITLE ORG. 15/05/18 17/07/18 20/09/18 27/11/18 15/01/19 19/03/19 TOTAL %

Stuart Rees

Joint Chief Finance Officer

NHS Corby and NHS Nene CCGs 0 1 1 1 0 3 60%

Carole Dehghani

Chief Executive NHS Corby CCG 1 1 20%

Toby Sanders

Joint Chief Executive

NHS Corby and NHS Nene CCGs 0 0 0 0 0%

Caron Williams

Director of Commissioning & Strategy

NHS Corby and NHS Nene CCGs 0 1 1 2 40%

Kathryn Moody

Director of Contracting and Delivery

NHS Corby and NHS Nene CCGs 0 0 0 0%

Charlotte Fry

Director of Primary Care

NHS Corby and NHS Nene CCGs 1 1 20%

Julie Curtis

Interim Director of Primary Care

NHS Corby and NHS Nene CCGs 0 0 0 0%

Andrew Hammond

Lay Member for Governance NHS Corby CCG 1 0 1 1 1 4 80%

Tansi Harper

Lay Member for PPEA NHS Corby CCG 1 1 1 1 1 5 100%


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Patient and Public Participation Committee The Patient and Public Participation Committee (PPPC) provides assurance to the Governing Body that all decisions made by the Governing Body have been informed by the appropriate level of patients, carers and communities input in accordance with Section 14Z2 of the Health and Social Care Act 2012. The Committee upholds the core values of the NHS Constitution. The Committee membership includes:

• Lay Member – Patient and Public Engagement (Chair)

• Independent Lay Member (deputy chair)

• Joint Registered Nurse member

• GP Governing Body Member

• Director of Contracting and Delivery (Executive Lead for Communications and Engagement)

• Public representatives from the Corby Practice Patient Participation Group or nominated deputies

• Healthwatch representative

• Northamptonshire Carers representative

• Voluntary Impact Northamptonshire representative Other invitees include the following, although these do not form part of the formal membership of the Committee:

• Ad hoc invitations as required

• Deputy Director of Corporate Affairs

• Communications and Engagement Representative CCG

• Communications Lead, Arch Communications

• Administrative Support During 2018/19 the Committee met 6 times on a bi-monthly basis. From October 2018 it was agreed that the NHS Corby CCG Patient and Public Participation Committee and NHS Nene CCG Patient and Public Participation Committee would meet bi-annually as Committees in Common. The Committee focus is on the development of an engagement strategy that ensures engagement is embedded within the commissioning cycle, providing greater involvement from the outset. The Committee in Common arrangement under which the Committee now meets with NHS Nene CCG supports this development. The minutes of the Committee are reported to the Governing Body, with the Chair of the Committee drawing attention to any issues that require Governing Body scrutiny via the Chair’s highlight report.


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The Patient and Public Participation Committee membership attendance is detailed below from April 2018 – March 2019

NAME TITLE ORGANISATION 10/4/18 15/5/18 19/6/18 21/8/18 9/10/18 11/12/18 22/1/19 19/2/19 TO TAL

Tansi Harper

Lay Member, PPEA (Chair) NHS Corby CCG Y y Y Y Y Y 6

Ric Barnard

Patient Participation Group Chair PPG N N Y Y 2

Dawn Cummins

Deputy Chief Executive

Voluntary Impact Northamptonshire Y Y Y Y Y Y 6

Gwyn Roberts

Deputy Chief Executive Officer

Northamptonshire Carers N N N N N Y 1

Joe Sim

Patient Participation Group, Studfall Partnership PPG N N N N N N 0

Helen Storer

Independent Lay Member NHS Corby CCG N 0

Dr Sanjay Gadhia

GP Governing Body NHS Corby CCG Y N N N N N 1

Aly Hulme

Registered Nurse

NHS Corby CCG and NHS Nene CCG Y Y Y

Dr Nathan Spencer

GP Governing Body NHS Corby CCG N Y Y Y Y Y 5

Kathryn Moody

Director of Contracting & Delivery

NHS Corby CCG and NHS Nene CCG Y N Y Y 3

Joanne Brodrick

Independent Lay Member NHS Corby CCG N Y N N 1

Kate Holt Healthwatch Officer

Healthwatch N'Shire N N N N Y Y 2


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Joint Quality Committee The Joint Quality Committee is a joint committee between NHS Corby CCG and NHS Nene CCG. The Committee provides assurance to the Governing Body on the quality of services commissioned in accordance with section 14R of the Health and Social Care Act 2012 and promotes a culture of continuous improvement and innovation with respect to safety of services, clinical effectiveness and patient experience to the Governing Body. Key issues debated and reviewed by the Committee during 2018/19 included:

• Quality overview reports received for Providers

• Quality Report and Quality Risk Register

• Complaints Annual report 2018/19

• Deprivation of liberty safeguards Northamptonshire report

• Safeguarding Annual Report 2018/19

• Equality and inclusion updates

• Review of Complaints handling policy and safeguarding children and adults at risk policy

• Commissioning for Quality and Innovation (CQUIN) annual report 2018/19

• Special Educational Needs Disability (SEND) framework

• Cancer long wait assurance update report

• Patient Stories

• Individual funding requests The Committee membership is made up of:

• Joint Secondary Care Doctor, NHS Corby and Nene CCGs (Chair)

• Joint Medical Director, NHS Corby and Nene CCGs.

• Clinical Vice Chair, NHS Corby CCG

• Joint Registered Nurse, NHS Corby CCG & Nene CCGs

• Joint Accountable Officer, NHS Corby & Nene CCGs.

• Director of Contracting and Delivery, NHS Corby & Nene CCGs.

• Lay/Professional Member (non-executive), NHS Corby CCG

• Lay/Professional Member (non-executive), NHS Nene CCG

• Deputy Director of Quality, NHS Corby & Nene CCG

• Head of Nursing and Safeguarding, NHS Corby & Nene CCG

• Director of Public Health, Northamptonshire County Council

• Northamptonshire HealthWatch representative During 2018/19 the Committee met 6 times. The minutes of the Committee are reported to the Governing Body with attention drawn to any issues that require Governing Body scrutiny via the Chair’s highlight report.


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The Joint Quality Committee membership attendance is detailed below from April 2018 – March 2019.

NAME TITLE ORGANISATION 10/4/18 12/6/18 14/8/18 9/10/18 11/12/18 12/2/19 Total %

Professor Devaka Fernando (Chair)

Joint Secondary Care Consultant

Corby & Nene CCGs 1 1 2 100%

Jo Spenceley Senior Healthwatch Officer

Northamptonshire Healthwatch

0 0 0 0 1 0 1 17%

Dr Matthew Davies Medical Director

Corby & Nene CCGs 0 1 1 1 1 1 5 83%

Mrs Alison Jamson Deputy Director of Quality

Corby & Nene CCGs 1 1 1 1 1 1 6 100%

Mrs Kathryn Moody Director of Contracting and Delivery

Corby & Nene CCGs 0 1 1 1 1 1 5 83%

Mrs Angela Dempsey Registered Nurse Member


Mrs Tina Swain Head of Nursing & Safeguarding

Corby & Nene CCGs 1 1 1 1 1 1 6 100%

Mrs Lucy Wightman Director of Public Health

Northamptonshire County Council

0 0 0 0 1 0 1 17%

Mrs Kay King (Deputy for Lucy Wightman)

Contract Monitoring Officer

Public Health & Wellbeing, NCC

1 1 1 1 1 1 6 100%

Joanne Brodrick Corby & Nene Lay Member

Corby CCG 1 1 2 100%

Toby Sanders Joint Accountable Officer


Dr Sebastian Hendricks (Chair up to Sept 2018)



Stuart Rees Interim Accountable Officer

NHS Corby CCG and NHS Nene CCG

1 1 100%

Mrs Carole Dehghani Accountable Office (Corby) and Interim Accountable Office (Nene)


0 1 1 50%

Mrs Aly Hulme Registered Nurse Member of Governing Body


1 1 2 100%

Roz Horton Nene & Corby Patient Experience Member


1 0 100%


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Joint Finance Committee The Joint Finance Committee is a joint committee between NHS Corby CCG and NHS Nene CCG, and was established from April 2018, prior to this date the NHS Corby CCG Finance and Performance Committee met as a separate Committee. The Committee membership is made up of:

• Lay Member (Chair) • Lay members x2 (representing Corby and Nene including the Chair) • Joint Chief Finance Officer or nominated Deputy • Director of Contracting and Delivery/or nominated Deputy • Clinical Executive Director • Corby CCG and Nene CCG Governing Body GP Member or nominated deputy • Director of Health Strategy and Planning or nominated deputy

The Committee monitors contract activity, performance and budgets and makes recommendations to the Governing Body about achievement of financial and performance objectives. The Committee also makes recommendations on business cases for the delivery of new investments that support system financial sustainability, productivity and improvements in quality of care and outcomes for patients. During 2018/19 the Committee has and continues to seek assurance for the CCGs’ progress of developing the Commissioning plan. During 2018/19 the Committee met 11 times, on a monthly basis. The Committee has not been quorate for 6 meetings since establishment, however the CCG has enacted the required governance processes in line with the CCG Constitution to ensure that decisions have been ratified in a timely manner and business has been transacted as required. The minutes of the Joint Finance Committee are reported to the Governing Body meeting, with the Chair of the Committee drawing attention to any issues that require executive action via the Chair’s highlight report.


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The Joint Finance Committee membership attendance is detailed below from April 2018 – March 2019.

NAME TITLE ORG. 26/04/18 31/05/18 07/06/18 28/06/18 26/07/18 04/09/18 02/10/18 06/11/18 04/12/18 08/01/19 05/02/19 05/03/19 Total %

Andrew Hammond

Non Executive Director

Corby CCG

0 0 0 0 0 Cancelled 0 0 0 0 0 0 0 0%

Caron Williams

Director of Strategy

Joint 1 1 1 1 1 Cancelled 0 1 1 1 1 0 9 82%

Dr. Nathan Spencer

Clinical Executive

Corby CCG

1 1 1 1 1 Cancelled 1 1 1 1 1 0 10 91%

Joanne Broderick

Independent Lay Member

Corby CCG

0 0 0 0 1 Cancelled 0 0 1 1 1 1 5 45%

Kathryn Moody

Director of Contracting & Delivery

Joint 1 1 1 0 1 Cancelled 1 0 1 1 1 1 9 82%

Kevin Thomas Lay member for Governance

Nene CCG

1 1 1 1 1 Cancelled 1 1 1 1 1 1 11 100%

Naomi Caldwell

Clinical Executive Director for Localities & Primary Care

Nene CCG

1 1 1 1 1 Cancelled 1 1 0 0 1 0 8 73%

Paul Bevan Non Executive Director (Chair)

Nene CCG

1 0 0 1 1 Cancelled 1 1 1 1 0 1 8 73%

Stuart Rees Chief Finance Officer

Joint 1 1 1 1 1 Cancelled 0 1 1 1 1 1 10 91%

Tansi Harper Lay Member for Patient and Public Engagement

Corby CCG

1 0 0 0 0 Cancelled 0 1 0 1 1 1 5 45%


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Joint Strategic Commissioning Committee The Joint Strategic Commissioning Committee is a joint committee between NHS Corby CCG and NHS Nene CCG. The Committee was established as part of the governance review undertaken for the collaborative working arrangements across the CCGs during 2018 and the subsequent constitutional changes made. The purpose of the Joint Strategic Commissioning Committee is to provide commissioner leadership, oversight and support to the strategic commissioning plans for Northamptonshire. During 2018/19 the Joint Strategic Commissioning Committee has been in the early establishment stage and to date the Committee has not transacted any business for the CCGs.

Joint Executive Management Team The CCG established the Joint Executive Management Team (JEMT) from April 2018, which is a joint committee between NHS Corby CCG and NHS Nene CCG. The purpose of the Committee is to bring together the Executive and Clinical Leads who have the accountability and responsibility to make decisions and ensure a single united commissioning voice within Northamptonshire. The role of the Committee:

• Ensuring successful delivery of the annual plan and delivery of key quality, performance, and financial requirements

• Shared approach across localities on financial discipline and value for money is retained and further improved.

• Discuss and agree between the Executive Team and Clinical Leads the sustainability for commissioning services and how these priorities will be delivered

• Ensure there is a shared approach across localities on financial discipline and value for money is retained and further improved

• Discharge delegated responsibility for decision-making through Executive and Clinical Lead portfolios

• Support a co-ordinated approach for the delivery of the annual commissioning plan and the longer term objectives and priorities of the Northamptonshire Healthcare Partnership

• Develop and ensure alignment of the workforce and OD strategy, through the Joint Workforce Group improve organisational culture, robust and competent leadership

• Consider the requirement to establish a task and finish group to address under-performance

The Committee meets on a monthly basis, and during 2018/19 has met 10 times. The minutes of the Committee are reported to the Governing Body with attention drawn to any issues that require Governing Body scrutiny via the Chair’s highlight report.


137

JEMT membership attendance is detailed below from April 2018 – March 2019.

NAME TITLE ORGANISATION 03/04/18 01/05/18 05/06/18 03/07/18 07/08/18 04/09/18 02/10/18 06/11/18 04/12/18 08/01/19 05/02/19 05/03/19 Total %

Carole Dehghani Interim Accountable Officer (Chair)

Nene & Corby CCG 1 1 1 1 1 5 100%

Azhar Ali Clinical Executive Director Nene CCG 0 1 0 1 1 0 1 1 1 1 7 70%

Naomi Caldwell Clinical Executive Director Nene CCG 0 1 1 1 1 1 1 0 1 1 8 80%

Matthew Davies Medical Director Nene CCG 1 1 1 0 1 1 1 1 1 1 9 90%

Emma Donnelly Clinical Executive Director Nene CCG 1 1 1 0 1 1 1 1 1 8 80%

Chris Ellis Commissioning and Membership Engagement Executive

Nene CCG 1 1 1 0 0 1 1 1 1 1 8 80%

Charlotte Fry Director of Primary Care Transformation

Nene & Corby CCG 1 1 1 1 0 4 80%

Sanjay Gadhia Clinical Lead Corby CCG 1 1 1 1 0 0 1 1 1 1 8 80%

Tom Howseman Commissioning and Membership Engagement Executive

Nene CCG 0 0 1 1 1 0 0 0 1 1 5 50%

Alison Kemp Director of Partnerships, People and Integration

Nene & Corby CCG 0 1 1 1 1 4 40%

Kathryn Moody Director of Contracting & Delivery

Nene & Corby CCG 1 1 1 1 0 1 1 1 1 1 9 90%

Stuart Rees Chief Finance Officer Nene & Corby CCG 1 1 1 1 1 0 1 1 1 0 8 80%

Nathan Spencer GP Governing Body Member Corby CCG 0 1 1 1 0 1 1 1 1 1 8 80%

Philip Stevens Commissioning and Membership Engagement Executive

Nene CCG 1 1 1 1 1 1 1 1 1 1 10 100%

Caron Williams Director of Health, Strategy & Planning

Nene & Corby CCG 1 1 1 1 1 1 1 1 1 1 10 100%

Toby Sanders Joint Chief Executive, NHS Corby CCG & NHS Nene CCG

Nene & Corby CCG 0 1 1 1 3 75%

Julie Curtis Director of Primary & Community Integration

Nene & Corby CCG 1 1 2 100%


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Remuneration and Terms of Service Committee The Remuneration and Terms of Service Committee membership is made up of the following:

• Lay member for Governance (Chair)

• Lay members During 2018/19 the Committee met 7 times. The Remuneration and Terms of Service Committee makes recommendations to the Governing Body regarding the remuneration, fees and other allowances for senior employees and for people who provide services to the Group. The Remuneration and Terms of Service Committee membership attendance is detailed below from April 2018 – March 2019.


Andrew Hammond

Lay Member Governance (Lay Vice Chair Governing Body)

NHS Corby CCG 1 1 1 1 1 1 1 7 100%

Tansi Harper

Lay Member - Patient and Public Engagement

NHS Corby CCG 1 0 1 1 0 0 1 4 57%

Sebastian Hendricks



Jo Brodrick Independent Lay Member


Angela Dempsey

Joint Registered Nurse

NHS Corby CCG 1 1 2 100%

Devaka Fernando


NHS Corby CCG 1 0 1 100%

Aly Hulme GB Registered Nurse


UK Corporate Governance Code NHS Bodies are not required to comply with the UK Code of Corporate Governance, however the CCG draws upon best practice available, including those aspects of the UK Code of Corporate Governance that we consider to be relevant to the CCG and best practice. We comply with the key principles of the code, which set out good practice in the areas of leadership, effectiveness, accountability, remuneration and relationships with key stakeholders.


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Discharge of Statutory Functions

In light of recommendations of the 1983 Harris Review, the clinical commissioning group has reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislative and regulations. As a result, I can confirm that the clinical commissioning group is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions. Responsibility for each duty and power has been clearly allocated to a Lead Director. Directorates have confirmed that their structures provide the necessary capability and capacity to undertake all of the clinical commissioning group’s statutory duties.

Risk management arrangements and effectiveness The CCG is committed to having a risk management culture that underpins and supports the business of the CCG. During 2018/19 the CCG reviewed and aligned the risk management processes across NHS Corby CCG and NHS Nene CCG. The work undertaken aligned the strategic and operational policies and practice, and appropriately upskilled and trained staff. The revised Risk Management and Governing Body Assurance Policy was developed to outline the CCGs’ approach to risk management throughout the organisations. The policy sets out managing risk, identifies accountability arrangements, resources available and provides guidance on what may be regarded as acceptable risk within the CCGs. The policy recognises that for the CCGs to successfully manage risk, the CCG must:

• identify and assess risks

• take action to anticipate or manage risk

• monitor and regularly review risk to assess for the potential for further action

• ensure effective controls and contingencies are in place Risk management is part of the strategic planning process and managed operationally through a robust process of governance around decision making set out in the organisation’s scheme of delegation. Staff have received training and support through group training and focussed one to one sessions especially with those responsible for maintaining risk registers. All employees are encouraged to highlight risks and report incidents and are provided with risk management training as required within their roles. The Governing Body and employees receive training in Equality and Diversity, and Equality and Human Rights considerations are included in the development of all strategies, policies and business cases to ensure impacts on protected groups are understood and taken into account when making decisions. The Local Counter Fraud Specialist provides awareness and training for the organisation as a deterrent to fraud risks arising. Further detail on Counter Fraud arrangements can be found later in this report. Under the collaborative working arrangements between NHS Corby CCG and NHS Nene CCG, the Governing Body Assurance Framework (GBAF) records the strategic risks for both CCGs, which are those risks which significantly impact on the achievement of the CCGs’ objectives.


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The Governing Body are accountable and responsible for ensuring that the CCGs have an effective programme of managing all types of risks, which is achieved via review of the Governing Body Assurance Framework (GBAF) and the Corporate Risk Register (CRR). In 2018/19 the CCG has undertaken substantial development of the risk management process, including a review by the Governing Body of its risk appetite and the refresh of the GBAF. The Governing Body continues to recognise risk management as an important development area to improve internal controls and its own effectiveness, particularly in light of the internal audit findings during the financial year and the Head of Internal Audit Opinion received. The refreshed GBAF brings together the strategic risks across both NHS Corby CCG and NHS Nene CCGs, linked to the specific shared corporate objectives to which they relate. The refresh undertaken resulted in the reduction in the number of risks detailed in the GBAF when compared to the previous individual Board Assurance Frameworks (BAFs) held separately and respectively by NHS Corby CCG and NHS Nene CCG. This reduction was a consequence of the CCGs’ identification of the key strategic risks severe enough to require Governing Body oversight. The risks previously detailed within the individual BAFs were considered when determining the content of the GBAF and mapped accordingly either directly to the strategic risks or as causes within the strategic risks. Previous BAF risks determined to be operational in nature are now managed via the Corporate Risk Register and Directorate Risk Registers, as deemed most appropriate. Each Directorate is responsible for reviewing and maintaining their risk register on a regular basis, ensuring that the risk register accurately and appropriately reflects the level of risk, the actions taken to manage the risks and records the effectiveness of controls and the level of assurance that can be given. The Directorate Risk Registers are reviewed by the Audit and Risk Committee on a rolling annual basis, with the relevant Executive Risk Lead in attendance at the Committee to provide assurance and undertaken scrutiny and challenge from the Committee. The Directorate Risk Registers are reviewed in light of the Corporate Risk Register and GBAF to ensure that risks are escalated appropriately. The Directorate Risk Registers are linked to relevant Committees, Individual Executive Risk Leads are responsible for each individual risk to which they are linked on the GBAF, with support from the Clinical Commissioning Leaders Group. However, the CCG understands that the mitigation of these risks cannot be done in isolation and therefore the Joint Executive Management Team (JEMT) is responsible for the support of operational delivery of the required actions in response to risks and within the required timescales. Challenge and scrutiny of progress, non-completion and slippage of actions is undertaken by JEMT. JEMT focuses on the delivery of key actions within the required timescales in response to the risks recorded. Updates to the GBAF are completed by the relevant Executive Risk Lead both individually and collectively, ensuring the GBAF remains a live risk management tool for the organisations.

The GBAF is presented and reviewed by the Joint Executive Management Team (JEMT), Audit and Risk Committee and Governing Body at each meeting, for detailed discussion and scrutiny. From November 2018, the NHS Corby CCG Audit and Risk Committee and the NHS Nene CCG Audit and Risk Committee have been meeting as Committees in Common. The Audit Chairs agreed that a focus on individual actions would be undertaken by each meeting to seek assurance that actions are being taken in mitigation of the identified strategic risks. A deep dive programme for the year has been agreed and is part of the Committee work planner.


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As detailed above, the CCGs collaboratively carried out a complete review of the risk management processes across both organisations, resulting in a refreshed and revised Governing Body Assurance Framework. Revisions to the GBAF undertaken as part of the risk management review process described are presented to the Governing Body in public for consideration. Capacity to Handle Risk

In 2018/19 the CCG has undertaken substantial development of the risk management process as detailed above. The Governing Body continues to recognise risk management as an important development area to improve internal controls and its own effectiveness. The internal audit of risk management and assurance recognises the extensive work to develop the risk management process however has identified a number of improvements and work continues to embed the use of the GBAF across the CCGs. The internal audit opinion was reasonable assurance. Risk Assessment The CCG’s Risk Management and Governing Body Assurance policy clearly sets out how to assess risk. The policy and documentation ensure that each risk has a clearly identified Executive Risk Lead for each risk, which is supported by the relevant Clinical Executive linked to that area. Each strategic risk is mapped to the corporate objective to which is relates. The Governing Body Assurance Framework (GBAF) comprises the CCG’s strategic risks, which would have impact upon the whole organisation and the achievement of the CCG’s objectives. The most significant operational risks which are identified from key business activity at an operational level which would have an impact upon the whole organisation from an operational point of view, are managed via the Corporate Risk Register.


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NHS Corby CCG and NHS Nene CCG’s major risks to governance, risk management and internal control are detailed below as at 31 March 2019:

GBAF Risk Description

Mitigations and Controls

The CCGs fail to deliver their statutory duties

• Integrated Performance Report (IPR) is produced monthly presented to relevant committees.

• Business Discipline oversight – Delivery Group. Increased support from North East London Commissioning Support Unit (NELCSU).

• Provides oversight and monitors progress against all key performance indicators.

• Deputies Group established to ensure senior oversight of key operational issues.

• Planned Care Board county-wide across all providers and commissioners.

• Approved financial strategy and business plans.

• Finance Team meet with budget holders monthly to manage financial oversight and control. Contracting and Performance Team meet with Providers via the Operational and Strategic meetings and ensure escalation process in place.

• Chief Finance Officer meetings with Regulators. System plan monitored via Regulators.

• Quarterly Checkpoint review with Regulators.

• QIPP performance reports and variations / under performance reported by exception.

• Financial performance meetings with NHS England. Medium Term Financial Plan submitted to NHS England in line with National Guidance.

• Chief Finance Officer Triangulation meeting with Regulators.

• Contingency planning processes for potential major issues.

• Surge and Capacity Plan and Winter Plan.

• Staff Survey and reporting to the Joint Workforce Committee.

• Appraisals process in place for staff.

• Internal Audit Plan and additional contingency days.

• Joint Quality Team to undertake quality assurance visits as required.

• Directors of Strategy across providers and CCGs meet regularly.

• Established Joint Strategic Commissioning Committee (JSCC) providing oversight of progress of strategic commissioning.

• Review of Executive Team to ensure capacity and capability is maximised. The CCGs are not able to deliver against the national mandate and Northamptonshire Health Care Partnership for Strategic Commissioning

• Public and Patient Participation Committee operates against and supports the CCG Commissioning Engagement Plan.

• Triangulation and contract alignment process of joint system plans for 2019/20.

• Joint Executive Management Team (JEMT) ensures the Commissioning Intentions and coding and counting contract letter align to the Contracting and Business Cycle and ensure the triangulation of need is completed.

• JSCC established as part of the Governance structure to ensure appropriate priority is applied to our plans.

• Business Discipline oversight – Delivery Group. Increased support from NELCSU.

• Provides oversight and monitors progress against all key performance indicators.

• CCG undertake regular contract meetings with commissioned providers.

• Directors of Strategy across providers and CCGs meet regularly.

• Regular meetings between Chief Finance Officers.

• Joint Workforce Group to develop Staff and Organisations Development Plans.


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The CCGs fail to commission appropriate safe, effective and quality services that are sustainable

• Development of agreed commissioning framework and delivery schedule to ensure deviation from provider performance is managed.

• The Clinical Commissioning Leaders Group ensures that they have the appropriate data to analyse on a regular basis to inform commissioning decisions.

• Service specifications are agreed and developed with all providers as and when required using Quality Improvement (QI) methodology.

• Regular meetings between Finance, Contract and Delivery Team to have risk share arrangements ensuring support appropriate for financial flow that meets patient demand.

• Escalation process in place in the event of any issues raised or contract query notices.

• Joint Strategic Commissioning Committee inserted into the Governance structure to ensure appropriate priority is applied to our plans.

• NHS RightCare supporting the Commissioning Plan and priorities.

• Clinical Leaders Group input and overview as required. Formal reporting to JEMT required.

Other sources of assurance Internal Control Framework A system of internal control is the set of processes and procedures in place in the clinical commissioning group to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The Audit and Risk Committee has oversight of the internal control mechanisms on behalf of the Governing Body. Executive Directors oversee the management and delivery of internal control mechanisms. The Audit and Risk Committee bases its assessments, and therefore assurances, on the effectiveness of the CCG’s controls on assurances provided by the Governing Body and Committees’ work programmes;

• Review of the Governing Body Assurance Framework (GBAF) which provides an oversight of the effectiveness of controls in place to manage the CCG’s principle risks;

• Reviews of CCG policies and procedures;

• Provision of assurance from internal and external audit and other identified sources of assurance the committees of the Governing Body oversee the management and delivery of the internal control mechanisms.

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. During 2018/19 a number of areas identified through the internal audit process of weakness in the CCG’s arrangements with particular focus on the development of commissioning arrangements across Northamptonshire and the effectiveness of these arrangements to enable the CCGs to commission services effectively. The CCG and its members recognise the importance of managing conflicts of interest. Accordingly, a register of interests is maintained and updated regularly. A copy of the register of interests is available on the CCG’s website. All meeting agendas of the governing body and committees include guidance and definitions of interests, and time is allocated at the start of the meeting for such declarations to be made.


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Control measures are in place to ensure that all of the CCG’s obligations under equality, diversity and human rights legislation are complied with. Annual audit of conflicts of interest management The revised statutory guidance on managing conflicts of interest for CCGs (published June 2016) requires CCGs to undertake an annual internal audit of conflicts of interest management. To support CCGs to undertake this task, NHS England has published a template audit framework. The CCG undertook its annual conflict of interest audit in December 2018, which resulted in a reasonable assurance opinion. The outcomes of the audit were reported to the Audit and Risk Committee in February 2019. Assurance of the implementation of audit recommendations is reported to the Audit and Risk Committee, as part of the audit implementation oversight of the Committee. Data Quality

Information used by the Governing Body and its Committees enables the CCG to carry out our responsibilities and discharge its statutory functions. This information relates to operational, financial, performance, quality and patient experience. The Governing Body and its Committees are committed to improving the quality of the information received. There has been an improvement in the quality of data received and the Governing Body has taken action to continue to improve this position, including working with the Commissioning Support Unit to redesign the performance report during 2018/19. Information Governance The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal identifiable information. The NHS Information Governance Framework is supported by an information governance toolkit and the annual submission process provides assurances to the clinical commissioning group, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively. The General Data Protection Regulation (GDPR) as implemented by the UK Data Protection Act 2018 came into UK Law with effect from 25 May 2018. NHS Digital launched a new Data Security and Protection Toolkit, replacing the previous Information Governance Toolkit, to help keep patient information safe. The Data Security and Protection Toolkit is an online self-assessment tool that enables health and social care organisations to measure and publish their performance annually against the National Data Guardian’s (NDG) ten data security standards. All organisations that have access to NHS patient data and systems – including NHS Trusts, primary care and social care providers and commercial third parties – must complete the Toolkit to provide assurance that they are practising good data security and that personal information is handled correctly. By providing evidence and judging whether they meet the assertions, will demonstrate that the organisation is working towards or meeting the NDG standards.


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We place high importance on ensuring there are robust Data Security and Protection systems and processes in place to help protect patient and corporate information. We have an established Data Security and Protection management framework and have developed processes and procedures in line with the Data Security and Protection toolkit. We have ensured all staff undertaken annual information governance training (meeting 95% staff completion) to ensure staffs are aware of their Data Security and Protection roles and responsibilities. The Information Governance Working Group (IGWG) supports and drives the broader Data Security and Protection agenda and provides the Audit and Risk Committee and ultimately the Governing Body with the assurance that effective Data Security and Protection best practice mechanisms are in place within the organisation. There are revised processes in place for incident reporting and investigation of serious Incidents in light of the new legislation. We have strengthened our information risk assessment and management procedures and a programme has been established to fully embed an information risk culture throughout the organisation against identified risks.

Business Critical Models

In the Macpherson report ‘Review of Quality Assurance of Government Analytical Models’ published in March 2013, it was recommended that the Governance Statement should include confirmation that an appropriate Quality Assurance framework is in place and is used for all business-critical models. Business critical models were deemed to be analytical models that informed government policy. The CCG can confirm that in 2018/19 it has not developed any analytical models which have informed government policy. The CCG receives Service Auditor Reports on the business-critical systems operated by organisations that provide services to the CCG, which includes Shared Business Services and also the North East London Commissioning Support Unit (NELCSU). This enables the CCG to place reliance on the quality controls established relating to the business-critical systems and models delivered through the Service Level Agreement in place for 2018/19. Further detail is described below.

Third party assurances

NHS Corby CCG and NHS Nene CCG (the CCGs) rely on the NHS North East London (NEL) Commissioning Support Unit (CSU) as a third-party provided of commissioning support services. CSUs are part of NHS England and therefore the CCGs rely on NHS England-led internal and external audit of CSUs. The CCGs hold quarterly contract performance meetings with NELCSU

Control Issues

The Head of Internal Audit Opinion has identified that there are weaknesses in the framework of governance, risk management and control such that it could become inadequate and ineffective. Areas of no assurance are detailed within the Head of Internal Audit Opinion section of Governance Statement further on.


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Review of economy, efficiency & effectiveness of the use of resources

The CCG successfully managed its financial allocation throughout 2018/19. The Financial Strategy and Budgets for 2018/19 were considered and approved by the Governing Body at the start of the financial year, alongside the strategic and operational plans for the CCG. The CCG has an established system of financial control which is led by the Joint Chief Finance Officer with oversight from the Joint Finance Committee, the Audit and Risk Committee and the Governing Body. The Joint Finance Committee considers financial risks, including risk opportunities, which are reported to the Governing Body via the Finance Report and risks are detailed within the Governing Body Assurance Framework. This process is supported by the CCG’s prime and detailed financial policies. Matters of concern are reviewed by the Governing Body and assurance sought. Full copies of the Governing Body papers can be found on the CCG website. The Joint Chief Finance Officer and the Finance Team have worked closely with managers throughout the year to ensure that a robust annual budget has been prepared and delivered. All budget managers have a responsibility to manage their budgets and systems of internal control effectively and efficiently. The processes to achieve this are examined by internal and external audit as part of their annual activities, with a focus on the strategic risks and key financial control processes. The CCG also ensures that an annual fraud risk assessment is undertaken by an independent party, providing key actions. Further detail on the counter fraud arrangements can be found later in this report. NHS England has a statutory duty (under the Health and Social Care Act (2012)) to conduct an annual assessment of every CCG. The CCG’s overall rating for the CCG Improvement and Assessment Framework (IAF) 2017/18 was rated as good. The CCG’s current rating is requires improvement for the quality of leadership indicator of the IAF for 2018/19, a review of this indicator is undertaken as part of the NHS England quarterly assurance process. More detail can be found in the Performance Report under Chapter 1 of this annual report and more detail on the individual indicators is available via the My NHS website. The CCG also works closely with health and social care providers and partners to achieve financial balance and sustainability across the Northamptonshire health and social care economy. The CCG works with our Regulators and Trusts to gain assurance on processes to address areas of poor performance, the standard NHS contracts used with providers include detailed financial, activity and quality schedules and require providers to innovate to improve quality and efficiency. More detail of delivery of key performance indicators and constitutional standards are detailed within the Performance Report under Chapter 1 of this annual report. Delegation of functions The CCG undertakes a regular process of review of its internal control mechanisms, including an annual internal audit plan. All internal audit reports are agreed by senior officers of the CCG and reviewed by the Audit and Risk Committee. A review of the effectiveness of the CCG governance structure and processes has been undertaken during the year, including a review of each Committee’s terms of reference. This has formed part of the work undertaken to further strengthen the collaborative working arrangements between the CCGs.


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The CCG ensures that where functions are delegated either internally or externally that this is done in line with the CCG’s Scheme of Reservation and Delegation which sets out the decisions that are the responsibility of the Governing Body and its Committees, alongside the decisions that are delegated to individual members and employees. Where functions are formally delegated by the Governing Body to one of its sub-committees this is formally recorded by the Governing Body through the minutes which are presented as a true and accurate record of the meeting. Counter Fraud arrangements The Counter Fraud Service for the CCG is provided by RSM UK, who supply a dedicated Local Counter Fraud Specialist (LCFS) to deliver an on-going programme of work to counter fraud, bribery and corruption, in line with the national NHS Counter Fraud Authority (NHSCFA) ‘Standards for Commissioners: Fraud, Bribery and Corruption’. The programme is designed to ensure our staff are fully aware of the fraud and bribery risks that the organisation faces and how to report concerns, as well as ensuring relevant preventative and detection exercises are undertaken to mitigate those risks. The Joint Chief Finance Officer provides executive leadership and responsibility for the programme. During the year, the LCFS has conducted a variety of tasks, ranging from awareness initiatives as part of the annual ‘Fraud Awareness Month’ campaign in November, through to undertaking a fraud risk assessment exercise. The Audit and Risk Committee receives regular progress updates on the delivery of the counter fraud work plan and an annual report which summarises activity undertaken during the year. The CCG also completes an annual self-assessment against the NHSCFA Standards, in order to monitor compliance and address any areas of identified risk during the forthcoming year.


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Head of Internal Audit Opinion

Following completion of the planned audit work for the financial year for the clinical commissioning group, the Head of Internal Audit issued an independent and objective opinion on the adequacy and effectiveness of the clinical commissioning group’s system of risk management, governance and internal control. The Head of Internal Audit concluded that: Head of Internal Audit Opinion In accordance with Public Sector Internal Audit Standards, the head of internal audit is required to provide an annual opinion, based upon and limited to the work performance, on the overall adequacy and effectiveness of the organisation’s risk management, control and governance processes. The opinion should contribute to the organisation’s annual governance statement. For the 12 months ended 31 March 2019, the head of internal audit opinion for NHS Corby Clinical Commissioning Group is as follows:

Please see appendix A for the full range of annual opinions available to us in preparing this report and opinion. During the year we have provided the CCG with a number of audit reports for which the CCG could take no assurance or partial assurance on. These were in respect of the overall arrangements for Commissioning, including the development of QiPP plans to support the achievement of these plans. Whilst the CCG is still on track to deliver its control total for the financial period (as at month11), the absence of effective commissioning arrangements has meant that this has been achieved through non-recurrent, transactional means, as opposed to utilising the commissioning process to deliver transformational and sustainable change. In addition, our audit of Primary Care Delegated Commissioning identified that the CCG has yet to take advantage of the opportunities provided to it since becoming delegated and that there is a need for an overall strategy in this area to be developed.


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Scope and Limitations of our work The formation of our opinion is achieved through a risk-based plan of work, agreed with management and approved by the audit committee. Our opinion is subject to inherent limitations, as detailed below:

• the opinion does not imply that internal audit has reviewed all risks and assurances

relating to the organisation;

• the opinion is substantially derived from the conduct of risk-based plans generated from a robust and organisation-led assurance framework. As such, the assurance framework is one component that the board takes into account in making its annual governance reporting;

• the opinion is based on the findings and conclusions from the work undertaken, the scope of which has been agreed with management

• the opinion is based on the testing we have undertaken, which was limited to the area being audited, as detailed in the agreed audit scope;

• where strong levels of control have been identified, there are still instances where these may not always be effective. This may be due to human error, incorrect management judgement, management override, controls being by-passed or a reduction in compliance;

• due to the limited scope of our audits, there may be weaknesses in the control system which we are not aware of, or which were not brought to attention; and

• it remains management's responsibility to develop and maintain a sound system of risk management, internal control and governance, and for the prevention and detection of material errors, loss or fraud. The work of internal audit should not be seen as a substitute for management's responsibilities around the design and effective operation of these systems.

Factors and findings which have informed our opinion Factors and findings which have informed our opinion:

The following audit provided no assurance to the CCG over the effectiveness of controls in place for this area; Financial Planning and Commissioning: Our audit of the CCG's Commissioning arrangements provided the Governing Body with no assurance that effective controls were in place to enable the CCG to commission services effectively. We found that the Commissioning Intentions document provided no guidance to Contract Managers as to how QiPP plans or service transformation plans might impact on QiPP target, and as a consequence of this, these areas did not form part of contract variations. Additionally, NEL CSU (North East London Commissioning Support Unit) were not aware of where QiPP had been assigned to PODs (Point of Delivery) and therefore no QiPP elements had been included in the refreshed activity plans. Finally, through review of the QiPP Scheme Tracker, we found that the savings of schemes were phased evenly until month 12, where £12m of total QiPP had been allocated, which included the use of £8.4m withheld investment to be used to offset year-end short fall if schemes are not identified to cover that gap. Therefore, should these schemes not materialise in month 12, then the CCGs will have no headroom to be able to deliver its QiPP target for the year. In addition to the above, the following audits provided the CCG with only partial assurance over the effectiveness of controls in place for these areas;


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Delivery of the Financial Plan (including QiPP): Although audit noted some improvements in financial planning had been made since our Financial Planning and Commissioning audit, including the development of commissioning plans for 2019/20, these were not produced in line with the NHS England time-table. In addition, whilst a commissioning planning project plan had been developed, this was too late to be applied for 2018/19 and therefore the full benefits of this may not be experienced until the following year. The CCG remained heavily reliant on transactional and nonrecurrent savings to balance the financial plan which NHS England has highlighted as a medium-term financial risk to the CCGs, and recovery actions had been agreed to address this.

Delivery of Urgent Care Schemes: Our audit has identified that no financial budgets were set for Urgent and Emergency Care expenditure across the health system as a whole. We also identified that there was no formalised or consistent process to outline how the CCGs will manage and monitor Urgent Care schemes and that there were no formal requirements for the attendance of Secondary Care Practitioners at the Urgent and Emergency Care Board. Furthermore, we found there was a lack frisk management discussion noted during the CCG's Urgent Care and Emergency Working Groups and risk management responsibilities had not been formally assigned to the Urgent Care Board or Working Groups. Engagement: An overall engagement plan had yet to be developed by the CCG and as part of this there is a need to ensure that engagement is embedded within the commissioning cycle at the CCG, together with providing greater embedding and communication of training events and engagement activities that are taking place.

Primary Care Delegated Commissioning: Our audit identified a number of controls gaps in the CCG's delegated commissioning arrangements. These included the lack of a Primary Care Strategy and needs assessment not being completed as per the requirements, the Procurement Policy being out of date and not relating to delegated commissioning, and Terms of Reference not being documented for the Local Medical Committee to ensure that the remit of this committee was clear.

In addition to the above, an advisory audit was undertaken into the CCG's arrangements for meeting General Data Protection Regulations, and whilst no formal opinion was provided, a number of actions were required to be completed by the CCG in order to meet the regulations.

An advisory audit was also undertaken on the Delivery of the Better Care Fund, and whilst no formal opinion was provided, this identified a number of weaknesses in relation to the evidence available to substantiate the development, approval and monitoring of a sample of BCF services / programme delivery and the consistency of the documentation. We also identified a lack of documented review, challenge and scrutiny over the overall delivery, monitoring and challenge over the BCF performance due to multiple cancelled meetings since February 2018 of the key groups involved in BCF governance. Furthermore, as part of our review, the follow up process identified seven management actions where the actions had not been fully implemented following discussions and receipt of evidence.

The following audits however resulted in a positive (reasonable or substantial) assurance opinion, and whilst some weaknesses in controls were identified within these reviews, and management actions agreed to address them, these weaknesses do not significantly impact on the overall effectiveness of the control framework for these areas;


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• Conflicts of Interest

• Financial Planning and Reporting. This opinion related to the accuracy of the financial reporting not the quality of the financial planning process.

• Governance - Committee Structures • Key Financial Controls and Payroll • Risk Management

An advisory audit was also undertaken into the CCG's Appraisals process, and whilst this identified that the CCG's revised appraisal documentation was fit for purpose and easy to use, it identified a number of opportunities for enhancements to be made to the appraisal processes, to help both the CCG and each member of staff to derive maximum benefit from this process. It should also be noted that the CCG has demonstrated significant improvements during the year in the implementation of internal audit actions as evidenced through the recommendation tracking process, thereby ensuring that previous weaknesses identified by Internal Audit are being addressed.

The Audit Committee have been informed of the results of our work and have been supportive of our work. They have challenged the actions being taken by management to address emerging issues. It has also considered the impact of issues within the wider system. Topics judged relevant for consideration as part of the annual governance statement

The CCG should not only consider our overall opinion detailed within the section above, but also the underlying cause of this opinion, namely the lack of effective commissioning arrangements, which has adversely impacted on the opinions provided for our Financial Planning and Commissioning, Delivery of Urgent Care Schemes, Delivery of the Financial Plan and Engagement audits. This should be balanced with the actions that have been taken by the CCG during the year, and planned for the future, in respect of addressing these weaknesses and ensuring that commissioning processes are fit for the future.


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Appendix A: Annual Opinions The following shows the full range of opinions available to us within our internal audit methodology to provide you with context regarding your annual internal audit opinion.


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During the year, Internal Audit issued the following audit reports:

Area of Audit Level of Assurance Given

Financial Planning and Commissioning Commissioning No assurance

Financial Planning Reasonable assurance

Delivery of the Financial Plan (including QiPP) Partial assurance

Delivery of Urgent Care Scheme Partial assurance

Engagement Partial assurance

Primary Care Delegated Commissioning Partial assurance

General Data Protection Regulations Advisory

Delivery of Better Care Fund Advisory

Conflicts of Interest Reasonable assurance

Financial Planning and Reporting Reasonable assurance

Governance – Committee Structures Reasonable assurance

Appraisal process Advisory

Risk Management and Assurance Reasonable assurance

Workforce Planning TBC

Key Financial Controls and Payroll Substantial assurance

Procurement Substantial assurance

Follow Up of Partial Assurance Reviews TBC

Approval of Annual Accounts and Annual Report At the meeting of the Audit and Risk Committee held on 23 May 2019 the final annual accounts and annual report for 2018/19 were received and approved. The Committee had delegated authority to do this on behalf of the Governing Body. The Joint Chief Executive and Clinical Chair were also present for this meeting. The Committee also received the updated Letter of Representation and noted that other than the standard disclosures the CCG were not asked to make any further disclosures.

Review of the effectiveness of governance, risk management and internal control

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


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Remuneration and Staff Report

Remuneration Committee

More information about the committee is available in the section above.

Policy on the remuneration of senior managers

NHS Corby CCG’s remuneration policy sets out the organisation’s policy for directors, senior managers and other staff and includes information about:

• Exit packages, severance packages and off payroll engagements

• Compensation on early retirement or for loss of office

• Payments to past Directors

• Pay multiples

• Other staff info (numbers, composition, sickness absence data, consultancy)

• Staff policies for giving full and fair consideration for the application, employment and ongoing training / career development of disabled persons.

Terms of Service Committee to approve the remuneration and terms of service for the executive directors, other staff on very senior manager (VSM) pay terms and conditions and other appointments to the Nene CCG Governing Body. The Committee also approves the pay rates offered to clinicians that work for Nene CCG on a contract for services basis. It was established under the Constitution and operates within terms of reference approved by our Governing Body.

Greenbury Note 2018-19 - Period: April 2018 - March 2019

From April 2018, NHS Corby CCG and NHS Nene CCG undertook to work closer

together culminating in a combined Management Team. To reflect the closer

working arrangements the costs of the senior managers from both CCGs have been

crossed charged on a basis of 89.84% to NHS Nene CCG and 10.16% to NHS

Corby CCG. The figures included in the table below reflect the costs attributable to

NHS Corby CCG with total costs shown in the second table below.


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2018-19 NHS Corby CCG Salary & Allowances (subject to audit)

NHS Corby CCG Salary (bands of £5,000)

Expense Payments (Taxable) to nearest £100

Performance Pay and Bonuses (bands of £5,000)

Long Term Performance Pay and Bonuses (bands of £5,000)

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

Total (bands of £5,000)

£000 £ £000 £000 £000 £000

Azhar Ali - Clinical Executive Director 5 - 10 0 0 0 0 - 2.5 5 - 10

Joanne Brodrick - Lay Member (started June 2018)

5 - 10 0 0 0 0 5 - 10

Naomi Caldwell - Clinical Executive Director 5 - 10 0 0 0 5 - 7.5 10 - 15

Julie Curtis - Director of Primary & Community Integration (started Jan 2019)

0 - 5 0 0 0 0 0 - 5

Carole Dehghani - Interim Accountable Officer (up to Sept 2018) (See Note 1)

15 - 20 0 0 0 0 15 - 20

Angela Dempsey - Joint Registered Nurse (started Nov 2018)

0 - 5 0 0 0 0 0 - 5

Emma Donnelly - Clinical Executive Director 5 - 10 0 0 0 5 - 7.5 10 - 15

Matthew Davies - Medical Director (up to Mar 2019)

5 - 10 0 0 0 2.5 - 5 10 - 15

Christopher Ellis - GP Commissioning & Membership Engagement Executive

0 - 5 0 0 0 0 0 - 5

Devaka Fernando - Secondary Care Doctor (started Oct 2018)

0 - 5 0 0 0 0 0 - 5

Charlotte Fry - Director of Primary Care Transformation (up to Sept 2018)

0 - 5 0 0 0 0 0 - 5

Sanjay Gadhia - GP Member 5 - 10 0 0 0 0 5 - 10

Andrew Hammond - Lay Member 10 - 15 0 0 0 0 10 - 15

Tansi Harper - Lay Member 20 - 25 500 0 0 0 25 - 30


157

Sebastian Hendricks - Secondary Care Doctor (up to Aug 2018)

0 - 5 0 0 0 0 0 - 5

Tom Howseman - GP Commissioning & Membership Engagement Executive

0 - 5 0 0 0 0 0 - 5

Alison Hulme - Registered Nurse (up to July 2018)

0 - 5 0 0 0 0 0 - 5

Alison Kemp - Director of Partnerships, People & Integration (up to Sept 2018)

0 - 5 0 0 0 0 0 - 5

Kathryn Moody - Director of Contracting & Delivery

10 - 15 0 0 0 0 - 2.5 10 - 15

Stuart Rees - Joint Chief Finance Officer (See Note 2)

10 - 15 0 0 0 5 - 7.5 15 - 20

Toby Sanders - Joint Chief Executive (started Nov 2018)

5 - 10 0 0 0 0 5 - 10

Nathan Spencer - GP Member 0 - 5 0 0 0 0 0 - 5

Philip Stevens - GP Commissioning & Membership Engagement Executive

0 - 5 0 0 0 0 0 - 5

Helen Storer - Lay Member (up to April 2018) 0 - 5 0 0 0 0 0 - 5

Jo Watt - GP Chair 55 - 60 0 0 0 0 55 - 60

Caron Williams - Director of Health, Stategy and Planning

5 - 10 0 0 0 2.5 - 5 10 - 15

Note 1: Included within Carole Dehgahni's salary costs is redundancy & in lieu of notice payments. The total included in the above salary figure is £4,959 for redundancy and £4,318 for in lieu of notice.

Note 2: Stuart Rees was NHS Corby CCG Interim Chief Finance Officer until 30 November 2018. From the 1 September until 31 October, Mr Rees was also Interim Accountable Officer for NHS Corby CCG. From 1 December 2018 onwards, Mr Rees is the Joint Chief Finance Officer for both NHS Corby CCG and NHS Nene CCG.


158

2018-19 Total Salary & Allowances for Crossed Charged Posts (subject to audit)

Total Costs Salary (bands of £5,000)






£000 £ £000 £000 £000 £000

Azhar Ali - Clinical Executive Director 55 - 60 0 0 0 5 - 7.5 60 - 65


NHS Corby CCG post only

Naomi Caldwell - Clinical Executive Director

60 - 65 0 0 0 62.5 - 65 125 - 130


20 - 25 0 0 0 0 20 - 25

Carole Dehghani - Interim Accountable Officer (up to Sept 2018) (See Note 1)

155 - 160 0 0 0 0 155 - 160


5 - 10 0 0 0 0 5 - 10

Emma Donnelly - Clinical Executive Director

55 - 60 0 0 0 72.5 - 75 130 - 135


55 - 60 0 0 0 42.5 - 45 100 - 105


25 - 30 0 0 0 0 25 - 30


5 -10 0 0 0 0 5 - 10


35 - 40 0 0 0 0 35 - 40



159

Andrew Hammond - Lay Member NHS Corby CCG post only

Tansi Harper - Lay Member NHS Corby CCG post only


5 - 10 0 0 0 0 5 - 10


25 - 30 0 0 0 0 25 - 30

Alison Hulme - Registered Nurse (up to July 2018)

0 - 5 0 0 0 0 0 - 5


40 - 45 0 0 0 0 40 - 45


105 - 110 0 0 0 17.5 - 20 125 - 130

Stuart Rees - Joint Chief Finance Officer 115 - 120 0 0 0 55 - 57.5 175 - 180


60 - 65 0 0 0 0 60 - 65



25 - 30 0 0 0 0 25 - 30

Helen Storer - Lay Member (up to April 2018)

NHS Corby CCG post only

Jo Watt - GP Chair NHS Corby CCG post only

Caron Williams - Director of Health, Strategy and Planning

95 – 100

0 0 0 27.5 - 30 120 - 125


160

Period: April 2017 - March 2018

2017-18 NHS Corby CCG Salary & Allowances (subject to audit)

NHS Corby CCG Salary (bands of £5,000)






£000 £ £000 £000 £000 £000

Mike Alexander - Chief Finance Officer (left March 2018)

75 - 80 0 0 0 0 75 - 80

Carole Dehghani - Accountable Officer 100 - 105 0 0 0 10 - 12.5 110 - 115


Andrew Hammond - Lay Member 10 - 15 0 0 0 0 10 - 15

Tansi Harper - Lay Member 25 - 30 1,200 0 0 0 25 - 30

Sebastian Hendricks - Secondary Care Doctor

10 - 15 0 0 0 0 10 - 15

Pauleen Pratt - Registered Nurse Member (left August 2017)

0 - 5 0 0 0 0 0 - 5

Miten Ruparelia - Clinical Lead 65 - 70 0 0 0 0 65 - 70


Helen Storer - Lay Member 5 -10 0 0 0 0 5 - 10

Joanne Watt - Clinical Chair 50 - 55 0 0 0 0 50 - 55

Caron Williams - Director of Health Strategy & Planning

85 - 90 0 0 0 37.5 - 40

125 - 130


161

Pension benefits as at 31 March 2019 (subject to audit)

2018-19 Pension Benefits

NHS Corby CCG Real increase in pension at pension age

Real increase in pension lump sum at pension age

Total accrued pension at pension age at 31 March 2019

Lump sum at pension age related to accrued pension at 31 March 2019

Cash Equivalent Transfer Value at 1 April 2018

Real Increase in Cash Equivalent Transfer Value

Cash Equivalent Transfer Value at 31 March 2019

Employer’s contribution to stakeholder pension

(bands of £2,500)

(bands of £2,500)

(bands of £5,000)

(bands of £5,000)

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

Azhar Ali - Clinical Executive Director 0 - 2.5 0 10 - 15 30 - 35 198 28 240 0


Non Pensionable

Naomi Caldwell - Clinical Executive Director 2.5 - 5 7.5 - 10 15 - 20 50 - 55 248 85 351 0


Opted Out

Carole Dehghani - Interim Accountable Officer (up to Sept 2018)

0 - 2.5 0 - 2.5 40 - 45 125 - 130 n/a n/a n/a 0


Non Pensionable

Emma Donnelly - Clinical Executive Director 2.5 - 5 5 - 7.5 15 - 20 30 - 35 178 79 271 0


162


0 - 2.5 5 - 7.5 10 - 15 35 - 40 212 65 297 0


Non Pensionable


Non Pensionable


0 0 25 - 30 65 - 70 461 18 528 0

Sanjay Gadhia - GP Member Non Pensionable

Andrew Hammond - Lay Member Non Pensionable

Tansi Harper - Lay Member Non Pensionable


Non Pensionable


Non Pensionable

Alison Hulme - Registered Nurse (up to July 2018) Non Pensionable


0 0 15 - 20 30 - 35 284 0 251 0


0 - 2.5 0 - 2.5 30 - 35 70 - 75 415 70 512 0

Stuart Rees - Joint Chief Finance Officer 2.5 - 5 2.5 - 5 35 - 40 85 - 90 556 114 703 0


Opted Out

Nathan Spencer - GP Member Non Pensionable


Non Pensionable


163

Helen Storer - Lay Member (up to April 2018) Non Pensionable

Jo Watt - GP Chair Non Pensionable

Caron Williams - Director of Health, Stategy and Planning

0 - 2.5 0 10 - 15 0 151 36 205 0

2017-18 Pension Benefits

NHS Corby CCG Governing Body Real increase in pension at pension age

Real increase in pension lump sum at pension age

Total accrued pension at pension age at 31 March 2018

Lump sum at pension age related to accrued pension at 31 March 2018

Cash Equivalent Transfer Value at 1 April 2017

Real Increase in Cash Equivalent Transfer Value

Cash Equivalent Transfer Value at 31 March 2018

Employer’s contribution to stakeholder pension

(bands of £2,500)

(bands of £2,500)

(bands of £5,000)

(bands of £5,000)

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

Mike Alexander - Chief Finance Officer (left March 2018)

0 - 2.5 0 - 2.5 35 - 40 115 - 120 732 45 784 0

Carole Dehghani - Accountable Officer 0 - 2.5 2.5 - 5 40 - 45 120 - 125 789 65 862 0

Sanjay Gadhia - GP Member Non Pensionable

Andrew Hammond - Lay Member Non Pensionable


164

Tansi Harper - Lay Member Non Pensionable

Sebastian Hendricks - Secondary Care Doctor Non Pensionable

Pauleen Pratt - Registered Nurse Member (left August 2017)

Non Pensionable

Miten Ruparelia - Clinical Lead Non Pensionable

Nathan Spencer - GP Member Non Pensionable

Helen Storer - Lay Member Non Pensionable

Joanne Watt - Clinical Chair Non Pensionable

Caron Williams - Director of Health Strategy & Planning

2.5 - 5 0 10 - 15 0 113 38 151 0

Cash Equivalent Transfer Value A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension

scheme benefits accrued by a member at a particular point in time. The benefits valued are the member's accrued benefits and

any contingent spouse's (or other allowable beneficiary's) pension payable from the scheme. The CETVs are calculated in

accordance with the Occupational Pension Schemes (Transfer Values) Regulations 2008.

Real Increase in CETV

This reflects the increase in CETV effectively funded by the employer. It does not include the increase in accrued pension due to

inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement)

and uses common market valuation factors for the start and end of the period.


165

2018-19 Pay Multiples (subject to audit)

Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director in their organisation and the median remuneration of the organisation's workforce.

The midpoint banded remuneration of the highest paid member of the Governing Body in NHS Corby CCG in the financial year 2018-19 was £157,500 (2017-18: £122,500). This was 1.97 times (2017-18: 1.77 times) the median remuneration of the workforce which was £79,826 (2017-18: £69,168).

In 2018-19 no employee received remuneration in excess of the highest paid director (2017-18: 0). Remuneration ranged from £1,579 to £100,076 (2017-18: £3,304 to £91,442).

Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind, but not severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions.

Total workforce includes both directly employed staff and staff employed through employment agencies.


166

Staff Report

Staff composition

Employee Group Staff Group

Staff Banding

Total Band

4 Band

5 Band

6 Band 8A

Band 8B

Band 8C

Band 8D

Band 9

Local -

Other VSM

GB Members Administrative and Clerical 3 3

Substantive Administrative and Clerical 1 2 1 1 1 1 1 1 1 10

Medical and

Dental 4 4

Grand Total 1 2 1 1 1 1 1 1 7 1 17

Org L2 LTR Headcount % LTR FTE %

086 Corby CCG Board L2 29.85% 28.58%


167

Sickness Absence Data

Corby CCG remains committed to the health and wellbeing of its staff and has human resources (HR) policies and procedures in place to support staff and managers accordingly. Corby CCG recognises its responsibilities for ensuring that the workplace is a healthy and safe place to be. The organisation conforms to The Health and Safety at Work Act 1974, the Data Protection Act 1998, the Equality Act 2010 and other relevant legislation and good practice guidelines.

The Governing Body Total Members 19

Male Members 33%

Female Members 67%

Senior managers (including all managers at Grade VSM but not including the Governing Body) Total 0

Male Members 50%

Female Members 50%

All other employees not included in the other two categories Total

Male Members 33%

Female Members 67%


168

Number of senior managers

The Governing Body Total Members 19

Male Members 33%

Female Members 67%

Senior managers (including all managers at Grade VSM but not including the Governing Body) Total 0

Male Members 50%

Female Members 50%

All other employees not included in the other two categories Total

Male Members 33%

Female Members 67%


169

Staff benefits

Employee Benefits Expenditure

2018-19 Permanent Employees

Other Total

£'000 £'000 £'000

Salaries and wages

766 44 810

Social security costs

90 0 90

Employer contributions to the NHS Pensions Scheme

77 0 77

Other pension costs

0 0 0

Apprenticeship Levy

0 0 0

Other post-employment benefits

0 0 0

Other employment benefits

0 0 0

Termination benefits

160 0 160

Gross employee benefits expenditure

1,092 44 1,136

Less: recoveries in respect of employee benefits (Note 4.1.2)

(77) 0 (77)

Net employee benefits expenditure including capitalised costs

1,016 44 1,060

Less: employee costs capitalised

0 0 0

Net employee benefits expenditure excluding capitalised costs

1,016 44 1,060

2017-18


170

Permanent Employees

Other Total

£'000 £'000 £'000

Salaries and wages

622 224 845

Social security costs

73 0 73

Employer contributions to the NHS Pensions Scheme

78 0 78

Other pension costs

0 0 0

Apprenticeship Levy

0 0 0

Other post-employment benefits

0 0 0

Other employment benefits

0 0 0

Termination benefits

0 0 0

Gross employee benefits expenditure

772 224 996

Less: recoveries in respect of employee benefits (Note 4.1.2)

0 0 0

Net employee benefits expenditure including capitalised costs

772 224 996

Less: employee costs capitalised

0 0 0

Net employee benefits expenditure excluding capitalised costs

772 224 996

Expenditure on consultancy

The expenditure on consultancy fees was £116,000


171

Off Pay-Roll Engagements

Table 1: Off-payroll engagements longer than 6 months

For all off-payroll engagements as of 31 March 2019, for more than £245 per day and that last longer than six months:

Number

Number of existing engagements as of 31 March 2019 0

Of which, the number that have existed:

for less than 1 year at the time of reporting 0

for between 1 and 2 years at the time of reporting 0



for 4 or more years at the time of reporting 0


172

Table2: New off-payroll engagements

For all new off-payroll engagements, or those that reached six months in duration, between 1 April 2018 and 31 March 2019, for more than £245 per day and that last for longer than six months:

Number

Number of new engagements, or those that reached six months in duration, between 1 April 2018 and 31 March 2019 0

Of which:

Number assessed as caught by IR35 0

Number assessed as not caught by IR35 0

Number engaged directly (via PSC contracted to department) and are on the department payroll 0

Number of engagements reassessed for consistency/assurance purposes during the year 0

Number of engagements that saw a change to IR35 status following the consistency review 0


173

Table 3: Off-payroll board member/senior official engagements

For any off-payroll engagements of board members, and/or, senior officials with significant financial responsibility, between 1 April 2018 and 31 March 2019

Number

Number of off-payroll engagements of board members, and/or senior officers with significant financial responsibility, during the reporting period 0

Total number of individuals on payroll and off-payroll that have been deemed "board members, and/or, senior officials with significant financial responsibility" during the reporting period 19


174

Exit packages, including special (non-contractual) payments (subject to audit) 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. Exit costs are accounted for in accordance with relevant

accounting standards and at the latest in full in the year of departure. Where the clinical commissioning group has agreed early

retirements, the additional costs are met by the clinical commissioning group and not by the NHS Pensions Scheme and are

included in the tables. Ill health retirement costs are met by the NHS Pensions Scheme and are not included in the tables.

Exit Packages Agreed in the Reporting Period (subject to audit)

2018 - 19

Compulsory Redundancies

Other Agreed Departures

Total

Departures where Special Payments have been made

Total

Number £s Number £s

Number £s

Number £s

Number £s

Less than £10,000

0 0 0 0

0 0

0 0

0 0

£10,001 to £25,000

0 0 0 0

0 0

0 0

0 0

£25,001 to £50,000

0 0 1 42,500

1 42,500

0 0

0 0

£50,001 to £100,000

0 0 0 0

0 0

0 0

0 0

£100,001 to £150,000

0 0 0 0

0 0

0 0

0 0

£150,001 to £200,000

1 160,000

0 0

1 160,000

0 0

0 0

Over £200,001

0 0

0 0

0 0

0 0

0 0

Total

1 160,00

0 1 42,50

0

2 202,50

0

0 0

0 0


175

2018-19 2018-19

Other Agreed Departures

Other Agreed


Voluntary redundancies including early retirement contractual costs

0 0 0 0

Mutually agreed resignations (MARS) contractual costs

0 0 0 0

Early retirements in the efficiency of the service contractual costs

0 0 0 0

Contractual payments in lieu of notice

1 42,500 0 0

Exit payments following Employment Tribunals or court orders

0 0 0 0

Non-contractual payments requiring HMT approval

0 0 0 0

Total

1 42,500 0 0


176

Staff policies

Positive about disability in the workplace

As an employer NHS Nene CCG demonstrates a positive commitment to disabled employees and continues to be a recognised Disability Confident Employer. This is an annual accreditation given by the Department for Work and Pensions that provides assurance the CCG welcomes applications from disabled people, and existing staff who have disabilities will have their Reasonable Adjustments reviewed and assessed


177

NHS Workforce Race Equality Standard (WRES)

In line with NHS England guidance we have continued to implement the NHS WRES and are due to publish our findings for the year. The CCG also continued to have ‘Due Regard’ to the principles of WRES in terms of its workforce and through proactive arrangements with our providers as holders of the NHS Standard Contract.

Using the WRES indicators as a basis, we will report on progress with regard to WRES and closing the gaps and differences of treatment, experiences and outcomes of White and Black and Minority Ethnic (BME) staff. NHS Nene CCG will continue to work with NHS provider organisations to seek assurance of effective implementation of WRES and progress against action plans.

The CCGs will also keep a watching brief on arrangements for the introduction of the NHS Workforce Disability Equality Standard (WDES) which is a set of specific measures (metrics) that will enable NHS organisations to compare the experiences of disabled and non-disabled staff. Making a difference for disabled staff.

The WDES is important, because research shows that a motivated, included and valued workforce helps to deliver high quality patient care, increased patient satisfaction and improved patient safety.

The implementation of the WDES will enable NHS Trusts and Foundation Trusts to better understand the experiences of their disabled staff. It will support positive change for existing employees and enable a more inclusive environment for disabled people working in the NHS. Like the Workforce Race Equality Standard (WRES) on which the WDES is in part modelled, it will also allow us to identify good practice and compare performance.


178

Other employee matters

Staff Engagement

NHS Corby CCG engages with its staff to ensure continuous consultation and engagement on changes that will affect them. These include:

• Fortnightly informal staff briefing led by the Accountable Officer or Director

• A staff newsletter which is sent to all staff following the staff briefing

• A Workforce Committee chaired by a Governing Body Member.

• Internal Communication and Engagement Staff Survey – This survey gave staff the opportunity to say what they liked about staff communications and engagement and if they would like to see anything additional across the organisation.

As a result of the survey the fortnightly informal staff briefings were replaced with monthly formal staff briefings. Going forward these monthly staff briefings will provide a space for regular structured updates.

In 2018 the CCG also introduced regular email briefings to staff following Governing Body meetings to provide an update on the discussion and outcomes of the meetings.

Staff Forum

The Staff Forum was set up in April 2017 for the benefit of all staff of Corby and Nene CCGs, North East London Commissioning Support Unit (NEL CSU) and all other embedded staff and meets regularly to raise issues affecting all staff. During this time the forum has organised a number of events for staff including Health and Wellbeing events and fun events.

Work streams were generated after the 2017 staff survey one of which was to create values and behaviours for the organisation. This work is now complete and will be the basis for the organisation's values moving forward.

For the coming twelve months the focus will be to continue to push the values and behaviours throughout the organisation and those that work with us along with improving staff wellbeing and development.


179

Health and Safety The health and safety of our staff is fundamental to the delivery of our vision and objectives. To ensure that Corby CCG has the appropriate level of expertise in this area the role of “Competent Person” for Health & Safety is undertaken internally by the CCG’s Governance and Risk Manager, who holds the NCRQ Certificate in Applied Health and Safety in is currently studying towards the NCRQ Certificate in Personal Liability and Absence Reduction and the NCRQ Diploma in Applied Health and Safety. The annual health & safety audit in July 2018 was conducted successfully, with no areas requiring action. No health and safety incidents were reported in 2018/19 and consequently none were reportable under RIDDOR (the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013) and the CCG remains a low risk environment.

How we celebrate equality and diversity at work

Equality disclosures

Corby CCG is committed to taking Equality, Inclusion and Human Rights into account in everything we do whether that’s commissioning services, employing people, developing policies, communicating with or engaging local people in our work. As a public body we will work to ensure we meet our Public Sector Equality Duty as set out in the Equality Act 2010 and our obligations under the Human Rights Act 1998. We will continue to promote and protect people’s rights by upholding the values set out in the NHS Constitution.

In addition, Corby CCG implements the NHS Equality Delivery System 2 (EDS2) to support its work to tackle discrimination and health inequalities for both staff and its local communities. We have a positive culture towards employing disabled people and developing a more diverse and inclusive workforce.

Positive about disability in the workplace

As an employer, Corby CCG visibly demonstrates its positive commitment to disabled employees and is a recognised “Disability Confident” employer. This is an accreditation given by Jobcentre Plus annually that provides assurance that Corby CCG welcomes applications from disabled people and existing disabled employees will have their reasonable adjustments constantly reviewed and assessed.


180

The Public Sector Equality Duty

Corby CCG has worked to show due regard to the aims of the Public Sector Equality Duty as set out in the Equality Act 2010. This means that Corby CCG must work to prevent discrimination, harassment and victimisation from happening in the first place, take steps to meet the health needs of people with certain protected characteristics.

As set out in the Equality Act 2010, the protected characteristics are: age, disability, gender reassignment, religion and belief, sexual orientation, sex, race, pregnancy and maternity, marriage and civil partnership. Corby CCG staff members have participated in mandatory equality and diversity training, ensuring that employees consider equality and human rights when undertaking their work.

Annually, Corby CCG complies with the specific duties under the Equality Act which requires public bodies to publish relevant, proportionate information showing how we have met the Equality Duty each year, and to set specific measurable equality objectives. In line with the new 2017 Regulations, Corby CCG has ensured its publication of information does not go beyond a 12-month cycle.

.

Equality objectives and leadership

Corby CCG has a Strategic Inclusion and Equality Oversight Group, which is chaired by the Deputy Director of Quality. Corby CCG has developed and published its Equality and Inclusion Strategy 2016 – 2019 which outlines our on-going approach to equality, inclusion and human rights and provides the basis for our statutory Equality Objectives for 2016 to 2019. Corby CCG’s Equality Objectives are to:

• Continue to integrate inclusion and equality considerations into the decisions we make

• Develop as an inclusive employer to ensure staff are aware of and supported to meet the evolving needs of the organisation and local communities

• To focus on understanding gaps in health outcomes for the diverse local communities and working to reduce inequality.

Corby CCG is now working to embed these equality objectives across all appropriate activities with regular progress updates reported through the relevant committees. These Equality Objectives are reviewed annually to ensure that they remain relevant to Corby CCG’s business and changing priorities.


181

Equality analysis and due regard

Corby CCG has embedded equality and human rights by developing an integrated Quality and Equality Integrated Impact Assessments (EQIA) tool. This ensures that Corby CCG considers both equality and human rights and quality when undertaking decisions on what healthcare to buy and what services it might change to meet local needs.

Bespoke equality analysis/due regard training is provided to the senior management team and staff directly involved in commissioning work to ensure that Corby CCG gives appropriate ‘due regard’ at every level of decision-making.

Implementing the NHS Equality Delivery System (EDS2)

Corby CCG is committed to implementing the NHS Equality Delivery System (EDS2). It adopted the EDS2 framework from an early stage and is implementing it to support its work to understand and reduce health inequalities. During 2018-2019 we will be continuing work towards improving our performance and outcomes in relation to equality by undertaking a self-assessment and external verification against the four goals of the EDS2. Corby CCG is committed to engaging with all its diverse community stakeholders. The details of this work will be published on Corby CCG website to ensure accessibility to all interested stakeholders, groups and members of the public.

NHS Workforce Race Equality Standard

During 2018/19, Corby CCG continued to implement the NHS Workforce Race Equality Standard (WRES) in line with NHS England guidance and published its findings in August 2017. Corby CCG also continued to have ‘due regard’ to the principles of WRES in terms of its workforce and through proactive arrangements

with its providers (as holders of the NHS Standard Contract).


182

The way forward

During 2018, Corby CCG will continue to work closely with all providers and partners as part of the Sustainability and Transformation Plan (STP) to ensure that the organisations are promoting Equality and Human Rights (meeting our duties under the Equality Act 2010), to demonstrate that we are working together to reduce health inequalities and inequalities for the people of Northamptonshire.

We will report on progress in starting to close the differences between the treatment and experience of White and Black and Minority Ethnic (BME) staff. We will be considering the indicators used for Workforce Race Equality Standard (WRES) and seek to “drill down” by department or profession and consider further disaggregation by individual BME groups. Corby CCG will also work with NHS Provider organisations to seek assurance of effective implementation of WRES and progress against associated action plans.

NHS Corby CCG will review and update EDS2 evidence portfolio and progress on a regular basis during 2018 for annual publication in 2019


183

Parliamentary Accountability and Audit Report

NHS Corby CCG is not required to produce a Parliamentary Accountability and Audit Report. Disclosures on remote contingent liabilities, losses and special payments, gifts, and fees and charges are included as notes in the Financial Statements of this report at Note 19 on Page 159. An audit certificate and report are also included in this Annual Report at Page 162.


184

Other languages and formats

Should you require a copy of the annual report in an alternative language or reading format, please contact us via one of the methods below:

NHS Corby Clinical Commissioning Group,

Corby Enterprise Centre,

London Road,

Corby,

NN17 5EU.

01536 560420

[email protected]


www.facebook.com/NHSCorby

@NHS CORBY

mailto:[email protected]


http://www.facebook.com/NHSCorby

https://twitter.com/NHSNene

NHS Corby CCG Annual Report 2018/19

Page 185 of 185

1 ONS 2017 mid-year population estimates [Online] Accessed 14/01/2019 2 NHS Digital, Patients registered at a GP practice in England as at January 2019. [Online] Accessed 14/01/19 3 ONS 2016 Subnational population projections [Online] Accessed 14/01/2019 4 Public Health England. Public Health Outcomes Framework. [Online] Accessed 14/01/2019 5 Public Health England. Segment Tool. [Online] Accessed 14/01/2019 6 Steel, N et al. Changes in health in the countries of the UK and 150 English Local Authority areas 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet, 392 (10158), 1647-1661, 2018. vii Northamptonshire County Council. Report by the Director of Public Health and Wellbeing. [Online] Accessed 16/01/201

https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates

https://app.powerbi.com/view?r=eyJrIjoiNjQxMTI5NTEtYzlkNi00MzljLWE0OGItNGVjM2QwNjAzZGQ0IiwidCI6IjUwZjYwNzFmLWJiZmUtNDAxYS04ODAzLTY3Mzc0OGU2MjllMiIsImMiOjh9

https://www.ons.gov.uk/releases/subnationalpopulationprojectionsforengland2016basedprojections

https://fingertips.phe.org.uk/profile/public-health-outcomes-framework

https://fingertips.phe.org.uk/profile/segment

https://www3.northamptonshire.gov.uk/councilservices/health/health-and-wellbeing-board/Pages/jsna-and-reports.aspx

2018-19Annual Accounts

186

2018-19 2017-18

Note £'000 £'000

Income from Sale of Goods and Services 2 (2,465) (120)

Other Operating Income 2 (13) (148)

Total Operating Income (2,477) (268)

Staff Costs 4 1,136 996

Purchase of Goods and Services 5 113,832 106,977

Depreciation and Impairment Charges 5 0 10

Provision Expense 5 0 0

Other Operating Expenditure 5 123 380

Total Operating Expenditure 115,092 108,363

Net Operating Expenditure 112,615 108,095

Financing 0 0

Net Gain/(Loss) on Transfer by Absorption 0 0

Other Comprehensive Expenditure 0 0

Comprehensive Expenditure for the Financial Year 112,615 108,095

Statement of Comprehensive Net Expenditure

Year Ending 31 March 2019

187

2018-19 General Fund

Revaluation

Reserve

Other

Reserves Total

£'000 £'000 £'000 £'000

Balance at 1 April 2018 (9,602) 0 0 (9,602)

Transfer between reserves in respect of assets transferred from closed NHS bodies 0 0 0 0

Adjusted Balance at 1 April 2018 (9,602) 0 0 (9,602)

Changes in Taxpayers' Equity for 2018-19

Impact of applying IFRS 9 to Opening Balances 61 61

Net operating costs for the financial year (112,615) (112,615)

Net Recognised Expenditure for the Financial Year (112,554) 0 0 (112,554)

Net parliamentary funding 105,536 0 0 105,536

Balance at 31 March 2019 (16,619) 0 0 (16,619)

2017-18 General Fund

Revaluation

Reserve

Other

Reserves Total

£'000 £'000 £'000 £'000

Balance at 1 April 2017 (9,190) 0 0 (9,190)

Transfer between reserves in respect of assets transferred from closed NHS bodies 0 0 0 0

Adjusted Balance at 1 April 2017 (9,190) 0 0 (9,190)

Changes in Taxpayers' Equity for the 2017-18

Net operating costs for the financial year (108,095) (108,095)

Net Recognised Expenditure for the Financial Year (108,095) 0 0 (108,095)

Net parliamentary funding 107,684 0 0 107,684

Balance at 31 March 2018 (9,602) 0 0 (9,602)

Statement of Changes in Taxpayers' Equity

Year Ended 31 March 2019

189

2018-19 2017-18

Note £'000 £'000

Cash Flows from Operating Activities

Net operating costs for the reporting period (112,615) (108,095)

Depreciation and amortisation 0 10

Non-cash movements arising on application of new accounting standards 61 0

(Increase)/decrease in trade & other receivables (782) 32

Increase/(decrease) in trade & other payables 7,729 319

Net Cash Outflow from Operating Activities (105,607) (107,734)

Cash Flows from Investing Activities 0 0

Net Cash Outflow from Investing Activities 0 0

Net Cash Outflow before Financing (105,607) (107,734)

Cash Flows from Financing Activities

Net parliamentary funding received 105,536 107,684

Other loans received 0 0

Other loans repaid 0 0

Capital element of payments in respect of finance leases and on SoFP PFI and LIFT 0 0

Capital grants and other capital receipts 0 0

Capital receipts surrendered 0 0

Non-cash movements arising on application of new accounting standards 0 0

Net Cash Inflow from Financing Activities 105,536 107,684

Net Increase/(Decrease) in Cash and Cash Equivalents (71) (49)

Cash and Cash Equivalents at the Beginning of the Financial Year (5) 45

Effect of exchange rate changes on the balance of cash and cash equivalents held in foreign

currencies 0 0

Cash and Cash Equivalents at the End of the Financial Year 10 (76) (5)

Statement of Cash Flows

Year Ended 31 March 2019

190

191

Notes to the Financial Statements

1. Accounting Policies

NHS England has directed that the financial statements of clinical commissioning groups shall

meet the accounting requirements of the Group Accounting Manual issued by the Department

of Health and Social Care. Consequently, the following financial statements have been prepared

in accordance with the Group Accounting Manual 2018-19 issued by the Department of Health

and Social. The accounting policies contained in the Group Accounting Manual follow

International Financial Reporting Standards to the extent that they are meaningful and

appropriate to clinical commissioning groups, as determined by HM Treasury, which is advised

by the Financial Reporting Advisory Board. Where the Group Accounting Manual permits a

choice of accounting policy, the accounting policy which is judged to be most appropriate to the

particular circumstance 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 the 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. 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

192

account for their transactions in the period in which they took place, with no

restatement of performance required when functions transfer within the public sector.

Where assets and liabilities transfer, the gain or loss resulting is recognised in the

Statement of Comprehensive Net Expenditure, and is disclosed separately from

operating costs.

Other transfers of assets and liabilities within the Department of Health and Social Care

Group are accounted for in line with IAS 20 and similarly give rise to income and

expenditure entries.

1.4. Pooled Budgets

Where the clinical commissioning group has entered into a pooled budget arrangement

under Section 75 of the NHS 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.

1.5. 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.

1.5.1. Critical Judgements in Applying Accounting Policies

The following are the critical judgements, apart from those involving estimations

(see 1.5.2) 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:

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Operating Segments

NHS Corby CCG operates under one segment which is the Commissioning of

Healthcare. Management information is produced on a monthly basis to enable the

CCG to make informed decisions.

Accounting Treatment of Pooled Budgets

Where NHS Corby CCG has entered into pooled budget arrangements under Section

75 of the NHS Act 2006 the pooled budgets are governed under joint control

arrangements and therefore the individual pooled budgets are accounted for as a

joint operation. The CCG has therefore accounted for its share of the assets,

liabilities, income and expenditure arising from the activities of the pooled budget.

1.5.2. 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:

Prescribing Creditor

Prescribing expenditure data is received from the Prescription Pricing Division (PPD)

of the NHS Business Services Authority two months in arrears. Therefore at the end

of the reporting period, NHS Corby CCG needed to take an accrual for the likely

prescribing costs for February and March. The accrual is based on forecast

expenditure provided by the PPD and amounted to £2,248,660 (31 March 2018:

£1,947,235).

Estimation Techniques for Accruals

Included within the accounts are a number of accruals which the CCG has had to

take a view on the likely level of liability. The main areas of assumption concern the

Prescribing creditor (detailed above) and the final level of activity completed by the

CCG’s healthcare providers as at 31 March 2019. Due to the time lag in receiving

actual activity data, the CCG agreed a year end position with its main providers,

Northampton General Hospital NHS Trust, Kettering General Hospital NHS

Foundation Trust and Northamptonshire Healthcare NHS Foundation Trust. Smaller

accruals were based on commitment accounting i.e. where goods or services were

received on or before 31 March 2019, an accrual was taken for the expected liability.

1.6. Revenue & Funding

The transition to IFRS 15 has been completed in accordance with paragraph C3(b) of the

Standard, applying the Standard retrospectively recognising the cumulative effects at

the date of initial application. In the adoption of IFRS 15 a number of practical

expedients offered in the Standard have been employed. These are as follows:

194

● As per paragraph 121 of the Standard the clinical commissioning group will not

disclose information regarding performance obligations part of a contract that has an

original expected duration of one year or less;

● The clinical commissioning group is to similarly not disclose information where

revenue is recognised in line with the practical expedient offered in paragraph B16 of

the Standard where the right to consider corresponds directly with value of the

performance completed to date;

● The FReM has mandated the exercise of the practical expedient offered in C7(a) of

the Standard that requires the clinical commissioning group to reflect the aggregate

effect of all contracts modified before the date of initial application.

Revenue in respect of services provided is recognised when (or as) performance

obligations are satisfied by transferring promised services to the customer, and is

measured at the amount of the transaction prices allocated to that performance

obligation. Where income is received for a specific performance obligation that is to be

satisfied in the following year, that income is deferred.

The main source of funding for the CCG is allocations (Parliamentary Funding) from the

Department of Health within an approved cash limit, which is credited to the General

Fund of the CCG. Parliamentary funding is recognised in the financial period in which

the cash is received.

1.7. Employee Benefits

1.7.1. Short-Term Employee Benefits

Salaries, wages and employment-related payments, including payments arising from

the apprenticeship levy, 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.

1.7.2. Retirement Benefit Costs

Past and present employees are covered by the provisions of the NHS Pension

Schemes. The schemes are unfunded, defined benefit schemes that cover NHS

employers, General Practices and other bodies, allowed under the direction of the

Secretary of State, in England and Wales. The schemes are not designed to be run in

a way that would enable NHS bodies to identify their share of the underlying scheme

assets and liabilities. Therefore, the schemes are accounted for as though they were

defined contribution schemes: the cost to the clinical commissioning group of

participating in a scheme is taken as equal to the contributions payable to the

scheme for the accounting period.

195

For early retirements other than those due to ill health, the additional pension

liabilities are not funded by the scheme. The full amount of the liability for the

additional costs is charged to expenditure at the time the clinical commissioning

group commits itself to the retirement, regardless of the method of payment.

1.8. Operating Expenditure

Operating expenditure, including expenditure on healthcare services with NHS and Non

NHs organisations, is 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.

Where grant funding is not intended to be directly related to activity undertaken by a

grant recipient in a specific period, the clinical commissioning group recognises the

expenditure in the period in which the grant is paid. All other grants are accounted for

on an accruals basis.

1.9. Property, Plant & Equipment

1.9.1. 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 cost 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.

1.9.2. Measurement

All property, plant and equipment are measured initially at cost, representing the

cost directly attributable to acquiring or constructing the asset and bringing it to the

location and condition necessary for it to be capable of operating in the manner

intended by management. All assets are measured subsequently at valuation.

196

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 should be taken to expenditure. Gains and losses recognised in

the revaluation reserve are reported as other comprehensive income in the

Statement of Comprehensive Net Expenditure.

1.9.3. Subsequent Expenditure

Where subsequent expenditure enhances an asset beyond its original specification,

the directly attributable cost is capitalised. Where subsequent expenditure restores

the asset to its original specification the expenditure is capitalised and any existing

carrying value of the item replaced is written-out and charged to operating

expenses.

1.10. 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

197

potential is recognised as an impairment charged to the revaluation reserve to the

extent that there is a balance on the reserve for the asset and, thereafter, to

expenditure. Impairment losses that arise from a clear consumption of economic

benefit are taken to expenditure. Where an impairment loss subsequently reverses, the

carrying amount of the asset is increased to the revised estimate of the recoverable

amount but capped at the amount that would have been determined had there been

no initial impairment loss. The reversal of the impairment loss is credited to

expenditure to the extent of the decrease previously charged there and thereafter to

the revaluation reserve.

1.11. Leases

Leases are classified as finance leases when substantially all the risks and rewards of

ownership are transferred to the lessee. All other leases are classified as operating

leases.

1.11.1. The Clinical Commissioning Group as Lessee

Property, plant and equipment held under a finance lease are initially recognised, at

the inception of the lease, at fair value or, if lower, at the present value of the

minimum lease payments, with matching liability for the lease obligation to the

lessor. Lease payments are apportioned between finance charges and reduction of

the lease obligation so as to achieve a constant rate of interest on the remaining

balance of the liability. Finance charges are recognised in calculating the clinical

commissioning group’s surplus or deficit.

Operating lease payments are recognised as an expense on a straight-line basis over

the lease term. Lease incentives are recognised initially as a liability and

subsequently as a reduction of rentals on a straight-line basis over the lease term.

Contingent rentals are recognised as an expense in the period in which they are

incurred.

Where a lease is for land and buildings, the land and building components are

separated and individually assessed as to whether they are operating or finance

leases.

1.11.2. The Clinical Commissioning Group as Lessor

Amounts due from lessees under finance leases are recorded as receivables at the

amount of the clinical commissioning group’s net investment in the leases. Finance

lease income is allocated to accounting periods so as to reflect a constant periodic

rate of return on the clinical commissioning group’s net investment outstanding in

respect of the leases.

198

Rental income from operating leases is recognised on a straight-line basis over the

term of the lease. Initial direct costs incurred in negotiating and arranging an

operating lease are added to the carrying amount of the leased asset and recognised

on a straight-line basis over the lease term.

1.12. 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.

1.13. Clinical Negligence Costs

NHS Resolution operates a risk pooling scheme under which the clinical commissioning

group pays an annual contribution to NHS Resolution which in return settles all clinical

negligence claims. The contribution is charged to expenditure. Although NHS

Resolution is administratively responsible for all clinical negligence cases the legal

liability remains with the clinical commissioning group.

1.14. Non-Clinical Risk Pooling

The clinical commissioning group participates in the Property Expenses Scheme and the

Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the

clinical commissioning group pays an annual contribution to NHS Resolution and, in

return, receives assistance with the costs of claims arising. The annual membership

contributions, and any excesses payable in respect of particular claims are charged to

operating expenses as and when they become due.

1.15. 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 amortised cost;

● Financial assets at fair value through other comprehensive income; and,

● Financial assets at fair value through profit and loss.

199

The classification is determined by the cash flow and business model characteristics of

the financial assets, as set out in IFRS 9, and is determined at the time of initial

recognition.

1.16. 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 expired.

1.17. 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.

1.18. 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).

1.19. Joint Operations

Joint operations are activities undertaken by the clinical commissioning group in

conjunction with one or more parties but which are not performed through a separate

entity. The clinical commissioning group records its share of the income and

expenditure, gains and losses, assets, liabilities and cash flows.

1.20. Accounting Standards That Have Been Issued But Have Not Yet Been Adopted

The Government Financial Reporting Manual does not require the following IFRS

Standards and Interpretations to be applied in 2018-19. These standards are still

subject to HM Treasury FReM adoption and early adoption, with IFRS 16 being for

200

implementation in 2019-20, and the government implementation date for IFRS 17 still

subject to HM Treasury consideration.

● IFRS 16: Leases – Application required for accounting periods beginning on or after

1 January 209, but not yet adopted by the FReM; early adoption is not therefore

permitted.

● IFRS 17: Insurance Contracts – Application required for accounting periods begging

on or after 1 January 2021, but not yet adopted by the FReM: early adoption is

therefore not permitted.

● IFRIC 23: Uncertainty Over Income Tax Treatments - Application required for

accounting periods beginning on or after 1 January 2019.

Note 2: Other Operating Revenue

2018-19 2017-18

Total Total

£'000 £'000

Income from Sale of Goods and Services (Contracts)

Non-patient care services to other bodies 2,346 120

Prescription fees and charges 7 0

Other contract income 35 0

Recoveries in respect of employee benefits 77 0

Total Income from Sale of Goods & Services 2,465 120

Other Operating Income

Other non contract revenue 13 148

Total Other Operating Income 13 148

Total 2,477 268

Note 3: Contract Income Recognition

3.1 Disaggregation of Income - Income from Sale of Goods and Services (Contracts)

2018-19

Education

Training &

Research

Non-Patient

Care Services

to Other

Bodies

Patient

Transport

Services

Prescription

Fees &

Charges

Dental Fees &

Charges

Income

Generation

Other

Contract

Income

Recoveries in

Respect of

Employee

Benefits

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Source of Revenue

NHS 0 1,425 0 0 0 0 0 77

Non NHS 0 921 0 7 0 0 35 0

Total 0 2,346 0 7 0 0 35 77

Timing of Revenue

Point in Time 0 2,346 0 7 0 0 35 77

Over Time 0 0 0 0 0 0 0 0

Total 0 2,346 0 7 0 0 35 77

3.2 Transaction Price to Remaining Contract Performance Obligations

NHS Corby CCG did not have any balances to declare under this note for 2018-19.

The increase in Non Patient Care Services to Other Bodies related to two new income steams for 2018-19. The

first was for a new service for 0-19 Years Childrens Service that transferred from Northamptonshire County

Council to the CCG at the start of 2018-19 and amounted to £959k. The second was for a new MOU for recharging

staffing costs between NHS Corby CCG & NHS Nene CCG following the closer working of the two CCGs. This

amounted to £1,430k of income for NHS Corby CCG in 2018-19.

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Note 4: Employee Benefits & Staff Numbers (continued)

Note 4: Employee Benefits & Staff Numbers

4.1.1 Employee Benefits Expenditure

Permanent

Employees Other Total

Permanent


£'000 £'000 £'000 £'000 £'000 £'000

Salaries and wages 766 44 810 622 224 845

Social security costs 90 0 90 73 0 73

Employer contributions to the NHS Pensions Scheme 77 0 77 78 0 78

Other pension costs 0 0 0 0 0 0

Termination benefits 160 0 160 0 0 0

Gross employee benefits expenditure 1,092 44 1,136 772 224 996

Less: recoveries in respect of employee benefits (Note 4.1.2) (77) 0 (77) 0 0 0

Net employee benefits expenditure including capitalised costs 1,016 44 1,060 772 224 996

Less: employee costs capitalised 0 0 0 0 0 0

Net employee benefits expenditure excluding capitalised costs 1,016 44 1,060 772 224 996

4.1.2 Recoveries in Respect of Employee Benefits

Permanent


Permanent


£'000 £'000 £'000 £'000 £'000 £'000

Salaries and wages (61) 0 (61) 0 0 0

Social security costs (7) 0 (7) 0 0 0

Employer contributions to the NHS Pensions Scheme (9) 0 (9) 0 0 0

Total recoveries in respect of employee benefits (77) 0 (77) 0 0 0

4.2 Average Number of People Employed

Permanent


Permanent


Number Number Number Number Number Number

Total 11 1 12 14 2 16

Of the above:

Number of whole time equivalent people engaged on capital projects 0 0 0 0 0 0

2017-182018-19

2017-182018-19

2018-19 2017-18

Total Total

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4.3 Exit Packages Agreed in the Reporting Period

Number £s Number £s Number £s Number £s Number £s

Less than £10,000 0 0 0 0 0 0 0 0 0 0

£10,001 to £25,000 0 0 0 0 0 0 0 0 0 0

£25,001 to £50,000 0 0 1 42,500 1 42,500 0 0 0 0

£50,001 to £100,000 0 0 0 0 0 0 0 0 0 0

£100,001 to £150,000 0 0 0 0 0 0 0 0 0 0

£150,001 to £200,000 1 160,000 0 0 1 160,000 0 0 0 0

Over £200,001 0 0 0 0 0 0 0 0 0 0

Total 1 160,000 1 42,500 2 202,500 0 0 0 0


Voluntary redundancies including early retirement contractual costs 0 0 0 0

Mutually agreed resignations (MARS) contractual costs 0 0 0 0

Early retirements in the efficiency of the service contractual costs 0 0 0 0

Contractual payments in lieu of notice 1 42,500 0 0

Exit payments following Employment Tribunals or court orders 0 0 0 0

Non-contractual payments requiring HMT approval 0 0 0 0

Total 1 42,500 0 0

2018-19 2017-18

Compulsory

Redundancies Other Agreed Departures Total

Departures where Special

Payments have been

made Total

Where the clinical commissioning group has agreed early retirements, the additional costs are met by the clinical commissioning group and not by the NHS Pensions Scheme, and are included in the tables. Ill health

retirement costs are met by the NHS Pensions Scheme and are not included in the tables.

2018-19 2017-18

Other Agreed Departures Other Agreed

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.

Exit costs are accounted for in accordance with relevant accounting standards and at the latest in full in the year of departure.

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4.4 Pension Costs

4.4.1 Accounting Valuation

4.4.2 Full Actuarial (Funding) Valuation

Past and present employees are covered by the provisions of the two NHS Pension Schemes. Details

of the benefits payable and rules of the schemes can be found on the NHS Pensions website at

www.nhsbsa.nhs.uk/pensions. Both are undefined benefit schemes that cover NHS employers, GP

practices and other bodies, allowed under the direction of the Secretary of State for Health in England

and Wales. They are not designed to be run in a way that would enable NHS bodies to identify their

share of the underlying scheme assets and liabilities. Therefore, each scheme is accounted for as if it

were a defined contribution scheme: the cost to the NHS body of participating in each scheme is taken

as equal to the contributions payable to that scheme for the accounting period.

A valuation of scheme liability is carried out annually by the scheme actuary (currently the

Government Actuary's Department) as at the end of the reporting period. This utilises an actuarial

assessment for the previous accounting period in conjunction with updated membership and financial

data for the current reporting period, and is accepted as providing suitably robust figures for financial

reporting purposes. The valuation of the scheme liability as at 31 March 2019, is based on valuation

data as at 31 March 2018, updated to 31 March 2019 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 purpose of this valuation is to assess the level of liability in respect of the benefits due under the

schemes (taking into account recent demographic experience), and to recommend contribution rates

payable by employees and employers.

The latest actuarial valuation undertaken for the NHS Pension Scheme was completed as at March

2016. The results of this valuation set the employer contribution rate payable from April 2019. The

Department of Health and Social Care have recently laid Scheme Regulations confirming that the

employer contribution rate will increase to 20.6% of pensionable pay from this date.

The 2016 funding valuation was also expected to test the cost of the scheme relative to the employer

cost cap set following the 2012 valuation. Following a judgement from the Court of Appeal in

December 2018 Government announced a pause to that part of the valuation process pending

conclusion of the continuing legal process.

The latest assessment of the liabilities of the scheme is contained in the report of the scheme actuary,

which forms part of the annual NHS Pension Scheme Accounts. These accounts can be viewed on the

NHS Pensions website and are published annually. Copies can also be obtained from The Stationery

Office.

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:

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Note 5: Operating Expenditure

2018-19 2017-18

Total Total

£'000 £'000

Purchase of Goods and Services

Services from other CCGs and NHS England 1,967 1,797

Services from Foundation Trusts 58,612 55,094

Services from Other NHS Trusts 7,322 7,373

Purchase of Healthcare from Non-NHS Bodies 22,041 18,870

Purchase of Social Care 747 733

Prescribing costs 10,527 11,036

Pharmaceutical services 167 178

General ophthalmic services 15 11

GPMS/APMS and PCTMS 11,135 10,404

Supplies and services - clinical 45 270

Supplies and services - general 384 10

Consultancy services 116 121

Establishment 292 500

Premises 144 221

Audit fees 34 43

Other professional fees ex audit 38 44

Legal fees 233 242

Education and training 15 30

Total Purchase of Goods and Services 113,832 106,977

Depreciation and Impairment Charges

Depreciation 0 10

Total Depreciation and Impairment Charges 0 10

Other Operating Expenditure

Chair & Non-Executive Members 123 324

Expected credit loss on receivables (0) 56

Total Other Operating Expenditure 123 380

Total Operating Expenditure 113,956 107,367

Note 6: Better Payment Practice Code

6.1 Measure of Compliance

Number Number £'000

Non-NHS Payables

Total Non-NHS trade invoices paid in the Reporting Period 2,575 2,052 14,373

Total Non-NHS trade invoices paid within target 2,547 2,039 14,299

Percentage of Non NHS trade invoices paid within target 98.91% 99.37% 99.49%

NHS Payables

Total NHS trade invoices paid in the Reporting Period 1,720 1,585 73,492

Total NHS trade invoices paid within target 1,719 1,579 73,281

Percentage of NHS trade invoices paid within target 99.94% 99.62% 99.71%

2017-182018-19

In accordance with SI 2008 no.489, The Companies (Disclosure of Auditor Remuneration and Liability Limitation Agreements)

Regulations 2008, the CCG must disclose the principal terms of the limitation of the auditors liability. This is detailed as follows:

For all defaults resulting in direct loss or damage to the property of the other party - £2m limit.

In respect of all other defaults, claims, losses or damages arising from breach of contract, misrepresentation, tort, breach of

statutory duty or otherwise - not exceed the greater of the sum of £2m or a sum equivalent to 125% of the contract charges paid

or payable to the supplier in the relevant year of the contract.

The Better Payment Practice Code requires NHS Corby CCG to aim to pay all valid invoices by the due date or within 30 days of

receipt of a valid invoice, whichever is later.

£'000

15,536

15,039

96.80%

79,458

79,455

100.00%

205

Note 7: Operating Leases

7.1 As Lessee

7.1.1 Payments Recognised as an Expense

2017-18

Land Buildings Other Total Total

£'000 £'000 £'000 £'000 £'000

Minimum lease payments 0 79 0 79 48

Contingent rents 0 0 0 0 0

Sub-lease payments 0 0 0 0 0

Total 0 79 0 79 48

7.1.2 Future Minimum Lease Payments

NHS Corby CCG has nothing to disclose under this note for 2018-19 or for 2017-18.

7.2 As Lessor

NHS Corby CCG has nothing to disclose under this note for 2018-19 or for 2017-18.

At 31 March 2019, NHS Corby CCG has recognised a total liability of £79,000 (2017-18: £48,000) with NHS

Property Services Ltd in respect of healthcare properties and Corby Borough Council for the rent of the

CCG headquarters.

Whilst the arrangements with NHS Property Services Ltd fall within the definition of operating leases, the

rental charge for future years has not yet been agreed. Consequently this note does not include future

minimum lease payments for these arrangements.

2018-19

The agreement with Corby Borough Council is for a Tenancy at Will which is terminable at any time by

either party. As such there are no future payments to be disclosed.

206

Note 8: Property, Plant & Equipment

2018-19

Buildings

(excluding

dwellings)

Plant &

Machinery

Information

Technology Total 2017-18

Buildings

(excluding

dwellings)

Plant &

Machinery

Information

Technology Total

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Cost or valuation at 1 April 2018 19 82 11 112 Cost or valuation at 1 April 2017 19 82 69 170

Additions purchased 0 0 0 0 Additions purchased 0 0 (58) (58)

Cost of valuation at 31 March 2019 19 82 11 112 Cost of valuation at 31 March 2018 19 82 11 112

Depreciation at 1 April 2018 19 82 11 112 Depreciation at 1 April 2017 11 82 9 102

Charged during the reporting period 0 0 0 0 Charged during the reporting period 8 0 2 10

Depreciation at 31 March 2019 19 82 11 112 Depreciation at 31 March 2018 19 82 11 112

Net Book Value at 31 March 2019 0 0 0 0 Net Book Value at 31 March 2018 0 0 0 0

2018-19

Buildings

(excluding

dwellings)

Plant &

Machinery

Information

Technology Total 2017-18

Buildings

(excluding

dwellings)

Plant &

Machinery

Information

Technology Total

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Purchased 0 0 0 0 Purchased 0 0 0 0

Donated 0 0 0 0 Donated 0 0 0 0

Government granted 0 0 0 0 Government granted 0 0 0 0

Total at 31 March 2019 0 0 0 0 Total at 31 March 2018 0 0 0 0

Asset Financing Asset Financing

Owned 0 0 0 0 Owned 0 0 0 0

Held on finance lease 0 0 0 0 Held on finance lease 0 0 0 0

On-SoFP PFI & LIFT contracts 0 0 0 0 On-SoFP PFI & LIFT contracts 0 0 0 0

PFI residual interests 0 0 0 0 PFI residual interests 0 0 0 0

Total at 31 March 2019 0 0 0 0 Total at 31 March 2018 0 0 0 0

207

Note 8: Property, Plant & Equipment (continued)

● Revaluation Reserve for Property, Plant & Equipment,

● Additions to Assets Under Construction,

● Donated Assets,

● Government Granted Assets,

● Property Revaluation,

● Compensation to Third Parties,

● Write Down to Recoverable Amount,

● Temporarily Idle Assets,

8.1 Economic Lives

Minimum Life Maximum Life

Years Years

Buildings excluding dwellings 1 5

Plant & machinery 1 10

Information technology 3 5

8.2 Cost or Valuation of Fully Depreciated Assets

31 March

2019

31 March

2018

£'000 £'000

Buildings excluding dwellings 19 19

Plant & machinery 82 82

Information technology 11 11

Total 112 112

NHS Corby CCG did not hold any balances or incur any expenditure under the following categories

during 2018-19 or 2017-18:

208

Note 9: Trade & Other Receivables

Current Non-Current Current Non-Current

31 March 2019 31 March 2019 31 March 2018 31 March 2018

£'000 £'000 £'000 £'000

NHS receivables: revenue 93 0 949 0

NHS prepayments 288 0 288 0

NHS accrued income 1,441 0 123 0

Non-NHS and Other WGA receivables: revenue 173 0 85 0

Non-NHS and Other WGA prepayments 54 0 3 0

Non-NHS and Other WGA accrued income 171 0 47 0

Expected credit loss allowance-receivables (0) 0 (61) 0

VAT 21 0 25 0

Total 2,241 0 1,459 0

Total Current and Non-Current 2,241 1,459

Included in NHS receivables are pre-paid pension contributions 0 0

9.1 Receivables Past Their Due Date But Not Impaired

31 March 2019 31 March 2019 31 March 2018

DHSC Group Bodies Non DHSC Group Bodies All Receivables

£'000 £'000 £'000

By up to three months 22 48 216

By three to six months 0 0 36

By more than six months 2 3 83

Total 24 51 335

£14,263 of the amount above has subsequently been recovered post the statement of financial position date.

9.2 Impact of Application of IFRS 9 on Financial Assets at 1 April 2018

There was no impact on Financial Assets due to the application of IFRS 9 at 1 April 2018.

The great majority of trade is with NHS England. As NHS England is funded by Government to provide funding to clinical commissioning groups to commission services, no credit scoring

of them is considered necessary.

NHS Corby CCG did not hold any collateral against receivables outstanding at 31 March 2019 (31 March 2018: None).

209

Note 9: Trade & Other Receivables (continued)

9.3 Movement in Loss Allowances Due to the Application of IFRS 9

Trade and Other

Receivables -NHSE

Bodies

Trade and Other

Receivables - Other

DHSC Group Bodies

Trade and Other

Receivables -

External

Other Financial

Assets Total

£'000 £'000 £'000 £'000 £'000

Impairment and provisions allowances under IAS 39 as at 31st March 2018

Financial Assets held at Amortised cost 0 0 (61) 0 (61)

Financial assets held at FVOCI 0 0 0 0 0

Total at 31st March 2018 0 0 (61) 0 (61)

Loss allowance under IFRS 9 as at 1st April 2018

Financial Assets measured at amortised cost 0 0 0 0 0

Financial Assets measured at FVOCI 0 0 0 0 0

Total at 1st April 2018 0 0 0 0 0

Change in loss allowance arising from application of IFRS 9 0 0 61 0 61

9.4 Loss Allowance on Asset Classes

Trade & Other

Receivables - Non

DHSC Group Bodies

Other Financial

Assets Total

£'000 £'000 £'000

Balance at 1 April 2018 (61) 0 (61)

Allowance for credit losses at 1 April 2018 (61) 0 (61)

Recognition of loss allowance on application of IFRS9 61 0 61

Lifetime expected credit loss on credit impaired financial assets 0 0

Lifetime expected credit loss on trade and other receivables - Stage 2 0 0

Lifetime expected credit loss on trade and other receivables - Stage 3 0 0

Credit losses recognised on purchase originated credit impaired financial assets 0 0 0

Amounts written off 0 0 0

Financial assets that have been derecognised 0 0 0

Changes due to modifications that did not result in derecognition 0 0 0

Other changes 0 0 0

Allowance for credit losses at 31 March 2019 0 0 0

Note 9.5 Provision Matrix on Lifetime Credit Loss

31 March 2018

Lifetime Expected

Credit Loss Rate

Gross Carrying

Amount

Lifetime Expected

Credit Loss

Lifetime Expected

Credit Loss

% £'000 £'000 %

Between 0 to 60 days 0% 47 0 0%

Over 60 days 9% 4 0 15%

Total Expected Credit Loss 51 0

31 March 2019

210

Note 10: Cash & Cash Equivalents

2018-19 2017-18

£'000 £'000

Balance at 1 April (5) 45

Net Change during the reporting period (71) (49)

Balance at 31 March (76) (5)

31 March 2019 31 March 2018

£'000 £'000

Made up of:

Cash with the Government Banking Service (0) 0

Cash with Commercial Banks 0 0

Cash in Hand 0 0

Current Investments 0 0

Cash and Cash Equivalents as in SoFP (0) 0

Bank Overdraft: Government Banking Service (76) (5)

Bank Overdraft: Commercial Banks 0 0

Balance at 31 March (76) (5)

Patients' money held by NHS Corby CCG not included above 0 0

NHS England require CCGs to manage the cleared bank account balance at the end of the month to a target of 1.25% of that month's

drawdown or £250,000, whichever is the greater. Where CCGs are required to make payments by BACs at the end of the month to meet

contractual commitments, the payment will be included in the CCG's cashbook and financial ledger but will not clear the bank account

until the following month as it takes 3 working days for the payments to clear the bank account. Where this occurs, NHS England has

confirmed that this is acceptable as it only reflects a timing difference in the cash drawdown process and cash being made available by

the bank.

211

Note 11: Trade & Other Payables



£'000 £'000 £'000 £'000

NHS payables: revenue 2,405 0 1,015 0

NHS accruals 2,592 0 2,585 0

Non-NHS & Other WGA payables: revenue 282 0 437 0

Non-NHS & Other WGA accruals 13,279 0 6,873 0

Social security costs 13 0 13 0

Tax 15 0 14 0

Other payables 197 0 118 0

Total 18,784 0 11,056 0

Total Current and Non-Current 18,784 11,056

11.1 Impact of Application of IFRS 9 on Financial Liabilities at 1 April 2018

There was no impact on Financial Liabilities due to the application of IFRS 9 at 1 April 2018.

Note 12: Borrowings



£'000 £'000 £'000 £'000

Bank overdrafts:

● Government Banking Service 76 0 5 0

● Commercial banks 0 0 0 0

Total 76 0 5 0

Total Current and Non-Current 76 5

Note 12.1: Repayment of Principal Falling Due

Department of

Health Other

Department of

Health Other

£'000 £'000 £'000 £'000

Within one year 76 0 5 0

Between one and two years 0 0 0 0

Between two and five years 0 0 0 0

After five years 0 0 0 0

Total 76 0 5 0

Note 13: Provisions

Note 14: Contingencies

NHS Corby CCG did not have any provisions to disclose as at 31 March 2019 (31 March 2018: None).

NHS Corby CCG did not have any contingent assets or liabilities to disclose as at 31 March 2019 (31 March 2018: None).

There are no liabilities included above that are due in future years under the arrangements to buy out the liability for early

retirement over 5 years as at 31 March 2019 or 31 March 2018. Other payables include £187,000 outstanding pension

contributions at 31 March 2019 (31 March 2018: £115,000).

31 March 2019 31 March 2018

212

Note 15: Financial Instruments

15.1 Financial Risk Management

15.1.1 Currency Risk

15.1.2 Interest Rate Risk

15.1.3 Credit Risk

15.1.4 Liquidity Risk

NHS Corby CCG is required to operate within revenue and capital resource limits agreed with NHS England,

which are financed from resources voted annually by Parliament. NHS Corby CCG draws down cash to

cover expenditure, from NHS England, as the need arises, unrelated to its performance against resource

limits. NHS Corby CCG is not, therefore, exposed to significant liquidity risks.

International Financial Reporting Standard 7: Financial Instrument: Disclosure 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 Corby CCG is financed through parliamentary funding, it is not exposed to the degree of

financial risk faced by business entities. Also, financial instruments play a much more limited role in

creating or changing risk than would be typical of listed companies, to which the financial reporting

standards mainly apply. NHS Corby CCG 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 NHS Corby CCG in undertaking its activities.

Treasury management operations are carried out by the finance department, within parameters defined

formally within NHS Corby CCG's standing financial instructions and policies agreed by the Governing Body.

Treasury activity is subject to review by NHS Corby CCG's internal auditors.

NHS Corby CCG is principally a domestic organisation with the great majority of transactions, assets and

liabilities being in the UK and sterling based. NHS Corby CCG has no overseas operations. NHS Corby CCG

therefore has low exposure to currency rate fluctuations.

NHS Corby CCG borrows from government for capital expenditure, subject to affordability as confirmed by

NHS England. The borrowings are for 1 to 25 years, in line with the life of the associated assets, and

interest is charged at the National Loans Fund rate, fixed for the life of the loan. NHS Corby CCG therefore

has low exposure to interest rate fluctuations.

Because the majority of NHS Corby CCG's revenue comes from parliamentary funding, NHS Corby CCG has

low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables

from customers, as disclosed in the trade and other receivables note.

Disclosure of Fair Value is not required when the carrying amount is a reasonable approximation of Fair

Value.

213

Note 15: Financial Instruments (continued)

15.2 Financial Assets

2018-19

Financial

Assets

Measured at

Amortised

Cost

Equity

Instruments

Designated at

FVOCI Total

£'000 £'000 £'000

Trade and other receivables with NHSE bodies 1,527 1,527

Trade and other receivables with other DHSC group bodies 177 177

Trade and other receivables with other external bodies 173 173

Total at 31 March 2019 1,878 0 1,878

15.3 Financial Liabilities

2018-19

Financial

Liabilities

Measured at

Amortised

Cost Other Total

£'000 £'000 £'000

Trade and other payables with NHSE bodies 3,196 3,196

Trade and other payables with other DHSC group bodies 4,238 4,238

Trade and other payables with other external bodies 11,125 11,125

Other financial liabilities 273 273

Total at 31 March 2019 18,831 0 18,831

15.4 Maturity of Financial Liabilities

2018-19 Payable to DH

Payable to

Other Bodies Total

£'000 £'000 £'000

In one year or less 7,434 11,397 18,831

In more than one year but not more than two years 0 0 0

In more than two years but not more than five years 0 0 0

In more than five years 0 0 0

Total at 31 March 2019 7,434 11,397 18,831

2017-18 Payable to DH

Payable to

Other Bodies Total

£'000 £'000 £'000

In one year or less 3,600 7,433 11,033

In more than one year but not more than two years 0 0 0

In more than two years but not more than five years 0 0 0

In more than five years 0 0 0

Total at 31 March 2018 3,600 7,433 11,033

214

Note 16: Operating Segments

NHS Corby CCG consider there is only one segment: commissioning healthcare services.

Note 17: Pooled Budgets

17.1 Adult Mental Health Pooled Budget

17.2 Children and Adolescent Mental Health Pooled Budget

17.3 Better Care Fund (Including Community Equipment)

Note 1.4 Pooled Budgets and Note 1.19 Joint Operations of these accounts provide further information on

Pooled Budgets.

NHS Nene CCG is the host of a pooled budget for the commissioning of Adult Mental Health Services

across the county with Northamptonshire County Council, NHS Corby CCG and NHS Cambridgeshire &

Peterborough CCG. Under the arrangement, funds are pooled under S75 of the NHS Act 2006 for mental

health commissioning activities. An unaudited memorandum note to the accounts detailing the joint

income and expenditure in the form of a memorandum trading account is not available for inclusion in

these accounts. These do not form part of the financial statements. Partners are solely liable for any

overspends to services commissioned in exercise of their statutory functions.

NHS Nene CCG is the host of a pooled budget for the commissioning of Children and Adolescent Mental

Health Services across the county with Northamptonshire County Council (Public Health), NHS Corby CCG

and NHS Cambridgeshire & Peterborough CCG. Under the arrangement, funds are pooled under S75 of

the NHS Act 2006 for mental health commissioning activities. An unaudited memorandum note to the

accounts detailing the joint income and expenditure in the form of a memorandum trading account is not

available for inclusion in these accounts. These do not form part of the financial statements.

Northamptonshire County Council host the Better Care Fund pooled budget for the county. Under the

arrangements, funds are pooled under S75 of the NHS Act 2006. NHS Corby CCG contribute to the pool for

services to be delivered as a provider of healthcare. Members to the BCF pool account for transactions and

balances directly with providers. The pooled budget memorandum trading account is not available for

inclusion in the accounts.

215

Note 17: Pooled Budgets (continued)

17.4 Pooled Budgets Income & Expenditure

Name of Arrangement Parties to the Arrangement Description of Principal Activities Assets Liabilities Income Expenditure Assets Liabilities Income Expenditure

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Adult Mental Health NHS Nene CCG, NHS Corby CCG, NHS

Cambridgeshire & Peterborough

CCG, Northamptonshire County

Council

Provision of support and services for

adults with mental health needs,

providing inpatient and community

specialist services.

0 0 0 6,124 0 0 0 5,786

Children and Adolescent Mental Health NHS Nene CCG, NHS Corby CCG, NHS



Council (Public Health)

Provision of specialist mental health

support for children within the

community.

0 0 0 630 0 0 0 613

Better Care Fund NHS Nene CCG, NHS Corby CCG, NHS



Council

Provision of services which are

enablers to reduce non elective

admissions, to reduce delayed

transfers of care.

0 0 0 4,514 0 0 0 4,421

Residential Shortbreaks NHS Nene CCG, NHS Corby CCG,

Northamptonshire County Council

Provision of residential short breaks

for disabled and young people

service

0 0 0 0 0 0 0 26

NHS Corby CCG's shares of assets/liabilities and income/expenditure handled by the pooled budgets in the financial year were:

Amounts Recognised in CCG's Accounts Only

2018-19

Amounts Recognised in CCG's Accounts Only

2017-18

216

Note 18: Related Party Transactions

Senior Manager Position Related Party Relationship to Related Party

Payments to

Related Party

Receipts from

Related Party

Amounts Owed to

Related Party

Amounts Due

from Related

Party

£'000 £'000 £'000 £'000

Azhar Ali Clinical Executive Director 3Sixty Care Ltd GP Federation Member 27 0 0 0

Angela Dempsey (from

November 2018)

Joint Registered Nurse RSM UK Associated Director 27 0 1 0

Chris Ellis GP Commissioning & Membership Engagement Executive 3Sixty Care Ltd Subcontractor for clinical services 27 0 0 0

Devaka Fernando (from

October 2018)

Joint Secondary Care Doctor Sherwood Forest Hospital NHS Foundation Trust Consultant 6 0 0 0

Sanjay Gadhia GP Governing Body Member Lakeside Healthcare Partner 5,950 0 1 0

Lakeside Plus Shareholder 3,543 (21) 0 0

Kettering General Hospital NHS Foundation Trust Honorary contract 43,348 0 566 (288)

Nuffield Health Wife is Physiotherapist 10 0 0 0

Sebastian Hendricks (up

to August 2018)

Secondary Care Doctor Royal Free London NHS Foundation Trust Consultant 28 0 9 0

University College London NHS Foundation Trust Consultant 75 0 8 0

Roz Horton (up to

December 2018)

Lay Member Kettering General Hospital NHS Foundation Trust Member 43,348 0 566 (288)

Alison Kemp (up to

September 2018)

Director of Partnerships, People & Integration University Hospitals Coventry & Warwickshire NHS Trust Partner is employee 153 0 14 0

Nathan Spencer GP Governing Body Member Great Oakley Medical Centre GP at practice 1,353 0 0 0

3Sixty Care Ltd GP Federation Member 27 0 0 0

Joanne Watt Clinical Chair Great Oakley Medical Centre GP at practice 1,353 0 0 0

Northamptonshire Healthcare NHS Foundation Trust Independent contractor 14,301 (77) 14 (7)

Kettering General Hospital NHS Foundation Trust Husband is consultant 43,348 0 566 (288)

3Sixty Care Ltd GP Federation Member 27 0 0 0

● NHS England, NHS Nene CCG, NHS Cambridgeshire & Peterborough CCG, NHS NEL CSU, NHS Arden & GEM CSU

● Kettering General Hospital NHS Foundation Trust, Northamptonshire Healthcare NHS Foundation Trust, Oxford University Hospitals NHS Foundation Trust

● Northampton General Hospital NHS Trust, University Hospitals of Leicester NHS Trust, University Hospitals Coventry & Warwickshire NHS Trust, East Midlands Ambulance Services NHS Trust

● NHS Resolution; and,

● NHS Business Service Authority.

Due to the close working arrangements adopted by NHS Nene CCG & NHS Corby CCG during 2018-19, senior managers from both CCGs who have a declared interest in a third party have been included within this note.

The Department of Health is regarded as a related party. During the reporting period, NHS Corby CCG has had a significant number of material transactions with entities for which the Department is regarded as the parent Department. For example:

In addition, NHS Corby CCG has had a number of material transactions with other government departments and other central and local government bodies. Most of these transactions have been with Northamptonshire County Council.

NHS Corby CCG has not received any revenue or capital payments from charitable funds where members of the Governing Body are trustees of the Charitable Funds.

217

Note 19: Events After the Reporting Period

Note 20: Losses & Special Payments

Total Number of Cases Total Value of Cases Total Number of Cases Total Value of Cases

Number £'000 Number £'000

Losses 0 0 1 56

Special Payments 0 0 0 0

Total 0 0 1 56

Note 21: Financial Performance Targets

Clinical commissioning groups have a number of financial duties under the NHS Act 2006 (as amended).

NHS Corby CCG's performance against those duties was as follows:

NHS Act Section Target Performance Duty Target Performance Duty

£'000 £'000 Achieved £'000 £'000 Achieved

223H (1) Expenditure not to exceed income - Surplus/(Deficit) 115,103 115,092 Yes 110,364 108,363 Yes

223I (2) Capital resource use does not exceed the amount specified in Directions 0 0 Yes 0 0 Yes

223I (3) Revenue resource use does not exceed the amount specified in Directions 112,626 112,615 Yes 108,116 108,095 Yes

223J (1) Capital resource use on specified matter(s) does not exceed the amount specified in Directions 0 0 Yes 0 0 Yes

223J (2) Revenue resource use on specified matter(s) does not exceed the amount specified in Directions 0 0 Yes 0 0 Yes

223J (3) Revenue administration resource use does not exceed the amounts specified in Directions 1,572 1,571 Yes 1,558 1,540 Yes

Note 22: Effect of Application of IFRS 15 on Current Year Closing Balances

The application of IFRS 15 has not had any effect on the closing balances for the current financial year.

2018-19 2017-18

Note 1: For the purposes of 223H(1); expenditure is defined as the aggregate of gross expenditure on revenue and capital in the financial year; and, income is defined as the aggregate of the notified maximum revenue resource,

notified capital resource and all other amounts accounted as received in the financial year (whether under provisions of the Act or from other sources, and included here on a gross basis).

There are no post balance sheet events which will have a material effect on the financial statements of NHS Corby CCG.

2018-19 2017-18

The Losses balance reported above relates to the increase in the Bad Debt Provision for 2017-18 and is reported in line with NHS

England's guidance. The majority of this relates to a provision against the outstanding debt with Northamptonshire County

Council.

Duty

218

Grant Thornton UK LLP. 1

Independent auditor's report to the members of the Governing Body of

NHS Corby Clinical Commissioning Group

Report on the Audit of the Financial Statements

Opinion

We have audited the financial statements of NHS Corby Clinical Commissioning Group (the ‘CCG’) for

the year ended 31 March 2019, which comprise the Statement of Comprehensive Net Expenditure, the

Statement of Financial Position, the Statement of Changes in Taxpayers Equity, the Statement of Cash

Flows and notes to the financial statements, including a summary of significant accounting policies. The

financial reporting framework that has been applied in their preparation is applicable law and

International Financial Reporting Standards (IFRSs) as adopted by the European Union, and as

interpreted and adapted by the Department of Health and Social Care Group Accounting Manual 2018-

19.

In our opinion, the financial statements:

• give a true and fair view of the financial position of the CCG as at 31 March 2019 and of its

expenditure and income for the year then ended; and

• have been properly prepared in accordance with International Financial Reporting Standards

(IFRSs) as adopted by the European Union, as interpreted and adapted by the Department of Health

and Social Care Group Accounting Manual 2018-19; and

• have been prepared in accordance with the requirements of the Health and Social Care Act 2012.

Basis for opinion

We conducted our audit in accordance with International Standards on Auditing (UK) (ISAs (UK)) and

applicable law. Our responsibilities under those standards are further described in the ‘Auditor’s

responsibilities for the audit of the financial statements’ section of our report. We are independent of the

CCG in accordance with the ethical requirements that are relevant to our audit of the financial

statements in the UK, including the FRC’s Ethical Standard, and we have fulfilled our other ethical

responsibilities in accordance with these requirements. We believe that the audit evidence we have

obtained is sufficient and appropriate to provide a basis for our opinion.

Conclusions relating to going concern

We have nothing to report in respect of the following matters in relation to which the ISAs (UK) require

us to report to you where:

• the Accountable Officer’s use of the going concern basis of accounting in the preparation of the

financial statements is not appropriate; or

• the Accountable Officer has not disclosed in the financial statements any identified material

uncertainties that may cast significant doubt about the CCG’s ability to continue to adopt the going

concern basis of accounting for a period of at least twelve months from the date when the financial

statements are authorised for issue.

Other information

The Accountable Officer is responsible for the other information. The other information comprises the

information included in the Annual Report, other than the financial statements and our auditor’s report

thereon. Our opinion on the financial statements does not cover the other information and, except to the

extent otherwise explicitly stated in our report, we do not express any form of assurance conclusion

thereon.

In connection with our audit of the financial statements, our responsibility is to read the other information

and, in doing so, consider whether the other information is materially inconsistent with the financial

statements or our knowledge obtained in the audit or otherwise appears to be materially misstated. If we

identify such material inconsistencies or apparent material misstatements, we are required to determine

whether there is a material misstatement in the financial statements or a material misstatement of the


other information. If, based on the work we have performed, we conclude that there is a material

misstatement of the other information, we are required to report that fact.

We have nothing to report in this regard.

Other information we are required to report on by exception under the Code of Audit Practice

Under the Code of Audit Practice published by the National Audit Office on behalf of the Comptroller

and Auditor General (the Code of Audit Practice) we are required to consider whether the Governance

Statement does not comply with the guidance issued by the NHS Commissioning Board or is misleading

or inconsistent with the information of which we are aware from our audit. We are not required to

consider whether the Governance Statement addresses all risks and controls or that risks are

satisfactorily addressed by internal controls.

We have nothing to report in this regard.

Opinion on other matters required by the Code of Audit Practice

In our opinion:

• the parts of the Remuneration and Staff Report to be audited have been properly prepared in

accordance with IFRSs as adopted by the European Union, as interpreted and adapted by the

Department of Health and Social Care Group Accounting Manual 2018-19 and the requirements of

the Health and Social Care Act 2012; and

• based on the work undertaken in the course of the audit of the financial statements and our

knowledge of the CCG gained through our work in relation to the CCG’s arrangements for securing

economy, efficiency and effectiveness in its use of resources, the other information published

together with the financial statements in the Annual Report for the financial year for which the

financial statements are prepared is consistent with the financial statements.

Opinion on regularity required by the Code of Audit Practice

In our opinion, in all material respects the expenditure and income recorded in the financial statements

have been applied to the purposes intended by Parliament and the financial transactions in the financial

statements conform to the authorities which govern them.

Matters on which we are required to report by exception

Under the Code of Audit Practice, we are required to report to you if:

• we issue a report in the public interest under Section 24 of the Local Audit and Accountability Act

2014 in the course of, or at the conclusion of the audit; or

• we refer a matter to the Secretary of State under Section 30 of the Local Audit and Accountability

Act 2014 because we have reason to believe that the CCG, or an officer of the CCG, is about to

make, or has made, a decision which involves or would involve the body incurring unlawful

expenditure, or is about to take, or has begun to take a course of action which, if followed to its

conclusion, would be unlawful and likely to cause a loss or deficiency; or

• we make a written recommendation to the CCG under Section 24 of the Local Audit and

Accountability Act 2014 in the course of, or at the conclusion of the audit.

We have nothing to report in respect of the above matters.

Responsibilities of the Accountable Officer and Those Charged with Governance for the

financial statements

As explained more fully in the Statement of Accountable Officer's responsibilities set out on pages 103

to 104, the Accountable Officer, is responsible for the preparation of the financial statements in the form

and on the basis set out in the Accounts Directions, for being satisfied that they give a true and fair view,

and for such internal control as the Accountable Officer determines is necessary to enable the

preparation of financial statements that are free from material misstatement, whether due to fraud or

error.


In preparing the financial statements, the Accountable Officer is responsible for assessing the CCG’s

ability to continue as a going concern, disclosing, as applicable, matters related to going concern and

using the going concern basis of accounting unless they have been informed by the relevant national

body of the intention to dissolve the CCG without the transfer of its services to another public sector

entity.

The Accountable Officer is responsible for ensuring the regularity of expenditure and income in the

financial statements.

The Audit Committee is Those Charged with Governance. Those charged with governance are

responsible for overseeing the CCG’s financial reporting process.

Auditor’s responsibilities for the audit of the financial statements

Our objectives are to obtain reasonable assurance about whether the financial statements as a whole

are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that

includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an

audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists.

Misstatements can arise from fraud or error and are considered material if, individually or in the

aggregate, they could reasonably be expected to influence the economic decisions of users taken on

the basis of these financial statements.

A further description of our responsibilities for the audit of the financial statements is located on the

Financial Reporting Council’s website at: www.frc.org.uk/auditorsresponsibilities. This description forms

part of our auditor’s report.

We are also responsible for giving an opinion on the regularity of expenditure and income in the

financial statements in accordance with the Code of Audit Practice.

Report on other legal and regulatory requirements – Conclusion on the

CCG’s arrangements for securing economy, efficiency and effectiveness

in its use of resources

Matter on which we are required to report by exception - CCG’s arrangements for securing

economy, efficiency and effectiveness in its use of resources

Under the Code of Audit Practice, we are required to report to you if, in our opinion we have not been

able to satisfy ourselves that the CCG has made proper arrangements for securing economy, efficiency

and effectiveness in its use of resources for the year ended 31 March 2019.

We have nothing to report in respect of the above matter.

Responsibilities of the Accountable Officer

As explained in the Governance Statement, the Accountable Officer is responsible for putting in place

proper arrangements for securing economy, efficiency and effectiveness in the use of the CCG's

resources.

Auditor’s responsibilities for the review of the CCG’s arrangements for securing economy,

efficiency and effectiveness in its use of resources

We are required under Section 21(1)(c) and Schedule 13 paragraph 10(a) of the Local Audit and

Accountability Act 2014 to be satisfied that the CCG has made proper arrangements for securing

economy, efficiency and effectiveness in its use of resources and to report where we have not been

able to satisfy ourselves that it has done so. We are not required to consider, nor have we considered,

whether all aspects of the CCG's arrangements for securing economy, efficiency and effectiveness in its

use of resources are operating effectively.

We have undertaken our review in accordance with the Code of Audit Practice, having regard to the

guidance on the specified criterion issued by the Comptroller and Auditor General in November 2017, as

to whether in all significant respects, the CCG had proper arrangements to ensure it took properly

informed decisions and deployed resources to achieve planned and sustainable outcomes for taxpayers

and local people. The Comptroller and Auditor General determined this criterion as that necessary for us

http://www.frc.org.uk/auditorsresponsibilities


to consider under the Code of Audit Practice in satisfying ourselves whether the CCG put in place

proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the

year ended 31 March 2019, and to report by exception where we are not satisfied.

We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we

undertook such work as we considered necessary to be satisfied that the CCG has put in place proper

arrangements for securing economy, efficiency and effectiveness in its use of resources.

Report on other legal and regulatory requirements – Certificate

We certify that we have completed the audit of the financial statements of NHS Corby Clinical

Commissioning Group in accordance with the requirements of the Local Audit and Accountability Act

2014 and the Code of Audit Practice.

Use of our report

This report is made solely to the members of the Governing Body of the CCG, as a body, in accordance

with Part 5 of the Local Audit and Accountability Act 2014. Our audit work has been undertaken so that

we might state to the members of the Governing Body of the CCG those matters we are required to

state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we

do not accept or assume responsibility to anyone other than the CCG and the members of the

Governing Body of the CCG, as a body, for our audit work, for this report, or for the opinions we have

formed.

J Gregory

John Gregory, Director

for and on behalf of Grant Thornton UK LLP

Birmingham

24 May 2019

Documents

NHS Corby Clinical Commissioning 2018/19 · NHS Corby CCG Annual Report and Accounts 2018-19 3 Clinical Chair Foreword It is my pleasure to present NHS Corby Clinical Commissioning