Salford Clinical Commissioning Group Annual Report 2013-2014

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ContentsMember Practices Introduction 4

Strategic Report 7

History of Salford CCG 7

Population Demographics 8

External Environment 8

Our Vision, Aims and Objectives 9

Our Business Model 10

Our Key Strengths 11

Highlights of 2013/14 12

Long Term Conditions (including End of Life Care) 12

Children and Young People 13

Mental Health 14

Scheduled Care (including Cancer) 15

Older People 16

Unscheduled Care 17

Medicines Management 18

Continuing Healthcare 19

Quality of Commissioned Services 20

Primary Care Quality 21

Safeguarding 22

Public Involvement and Consultation 23

Partnership Working 24

What Does The Future Hold? 30

Risks 33

Sustainability Report 33

Equality Report 33

Report of the Chief Finance Officer 35

Members’ Report 40

Salford CCG’s Member Practices 40

Salford CCG’s Governing Body 41

Employees 42

External Audit 44

Disclosure of “Serious Untoward Incidents” 44

Cost Allocation and Setting of Charges for Information 44

Principles for Remedy 45

Emergency Preparedness, Resilience and Response 45

Statement as to Disclosure to Auditors 45

Remuneration Report 46

Statement of Accountable Officer Responsibilities 51

Governance Statement 52

Independent Auditor’s Report to the Members of Salford CCG 78

Summary of Accounts 81 Notes to the Financial Statements 85-116

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Member Practices’ IntroductionIn April 2013, the Health and Social Care Act came into force bringing with it the largest reforms in the 65-year history of the NHS.

Clinical Commissioning Groups (CCGs) became the cornerstone of the new health system and now decide how the NHS budget is spent locally on the majority of health services including emergency care, elective hospital care, maternity services, community and mental health services.

In Salford, each of the 50 GP practices became part of Salford CCG and, with support of other health colleagues, we are responsible for commissioning the best healthcare services for the 250,000 registered population in Salford.

Our city is growing as the number of children and young people living in Salford continues to rise - but Salford is also ageing with the amount of over 65s expected to increase by 30% over the next few years. As our patients live longer, the number of people with long term health conditions continues to rise.

Yet, while people are living longer, there are still massive health inequalities across the city. Life expectancy between those living in the best and poorest neighbourhoods is 12 years less for men and eight years less for women. Alcohol-related hospital admissions and the amount of people who smoke are also amongst the worst in England.

Our vision is to commission high quality services to enable our population to live longer healthier lives. To achieve this, we have four aims kept at the forefront of our decision-making to provide the best possible healthcare for our Salford patients. These are:l Prevent ill healthl Reduce health inequalitiesl Improve healthcare quality (safety, experience and effectiveness)l Improve health and wellbeing outcomes

During our first 12 months, Salford CCG has commissioned services with a clear emphasis on prevention as we focused on managing the transition from an NHS that is a sickness service to one that is focused on prevention.

For the 70,000+ people living with a long term condition across the city, we have launched community clinics for patients with vascular problems, provided exercise and lifestyle advice via clinics for patients living with COPD and introduced Diabetes Outreach Clinics.

For our patients living with mental health needs, we funded an additional total of £2 million for a Memory Assessment Treatment Service and expansion of the Mental Health Liaison Service at Salford Royal Hospital, as well as additional recurrent funds in the service for mentally disordered offenders.

We reviewed our maternity services looking at ways to reduce health inequalities and deliver the best possible start in life for Salford’s children. We also developed a new pathway ensuring the majority of children needing to be transferred from Salford Royal’s PANDA unit were able to go to Royal Bolton Hospital instead of a wide variety of hospitals further away from home.

Working in partnership with Salford City Council, Salford Royal NHS Foundation Trust and Greater Manchester West NHS Foundation Trust, we have started to redesign services to meet the challenge of our growing and ageing population via the Integrated Care Programme for Older People and focused on increasing local clinical and stakeholder involvement in decisions about how people in Salford access health services.

We delivered robust and sustainable commissioning decisions based upon analysis of the clinical, provider and prescribing data within clinical practice (referrals, prescribing methods, disease management, patient interface etc) which influence healthcare delivery, patient experience, the quality of healthcare provided and the outcomes achieved by patients.

This annual report has given us an opportunity to reflect on the impact Salford CCG has made for healthcare services in the city since our authorisation 12 months ago.

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Evaluating our effectivenessThe CCG is committed to supporting all staff, including Governing Body members, to fulfil their roles effectively.

By developing our Governing Body and its individual members, it will ensure that the CCG’s aims and objectives are successfully achieved in the next, and future, financial years.

Governing Body training and development needs will be addressed through a range of training and development techniques, including:l Governing Body development and strategy sessionsl Face-to-face and online trainingl Coaching and mentoring

During 2013/14, a number of Governing Body development and strategy sessions took place focusing on developing, nurturing and enhancing the corporate knowledge and expertise of the Governing Body to rise to future challenges. Several of these sessions have been facilitated by an external organisation.

The CCG’s Audit Committee has received regular reports concerning Governing Body governance and performance matters and has made recommendations for policy, procedural and process improvement throughout the financial year. The Audit Committee has also commissioned several reviews in the financial year under theCCG’s Internal Auditor (Mersey Internal Audit) to evaluate Governing Body effectiveness in particular areas and to make recommendations for further improvement in those areas, as appropriate. The Internal Audit Plan for 2013/14 awarded the CCG with Significant Assurance.

Strategic ReportDuring establishment, the arrangements put in place by Salford CCG and explained within the Corporate Governance Framework were developed with extensive expert external legal input to ensure compliance with the all relevant legislation. That legal advice also informed the matters reserved for Membership Body and Governing Body decision and the scheme of delegation.

Salford CCG has complied with the statutory duties laid down in the National Health Service Act 2006 (as amended) and other associated legislative and regulations. The CCG is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions.

Responsibility for each duty and power has been clearly allocated to a lead Director.Directorates have confirmed that their structures provide the necessary capability and capacity to undertake all of the clinical commissioning group’s statutory duties.The accounts have been prepared under a Direction issued by the NHS Commissioning Board under the National Health Service Act 2006 (as amended)

History of Salford CCGSalford CCG was established in April 2013 when it was licenced without conditions under the Health and Social Care Act 2012.

Previously, the local health budget and health decisions had been made by organisations called Primary Care Trusts (our local Primary Care Trust was known as NHS Salford). At the end of March 2013, all Primary Care Trusts across the country closed down and were replaced with GP practice membership organisations called Clinical Commissioning Groups (such as Salford CCG).

CCGs now have overall decision-making responsibilities on how the health budget allocated by the Department of Health should be spent locally. This new way of working is not about every GP taking time away from surgeries. It is about making sure we use the people and knowledge already based within Salford to the best of our ability and achieve the best outcome for our population – GPs have the most contact with patients, therefore the best overview of the population’s health needs.

Our offices are based on the 7th Floor within St James House on Pendleton Way in Salford. St James House is owned by Orbit Developments (part of the Emerson Group) and the CCG shares the building with multiple other organisations, including the Greater Manchester Commissioning Support Unit (GMCSU).

At the end of the 2013/14 financial year, Salford CCG was made up of:

Male Female

Governing Body 11 3

CCG employees 29 61

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Population DemographicsSalford is a city within Greater Manchester. It has a registered population of 250,000 people living across eight neighbourhoods:l Claremont and Weastel East Salfordl Ecclesl Irlam and Cadisheadl Little Hulton and Walkdenl Ordsall and Langworthyl Swinton and Worsleyl Boothstown

Although there are diverse levels of affluence within the district, Salford is ranked as one of the most deprived local authority areas in England with life expectancy lower than the England average.

There are massive health inequalities within Salford with men living in the most deprived areas having over 12 years shorter life expectancy than those from the least deprived areas, and women eight years.

The number of alcohol-related hospital admissions and premature deaths from heart disease and stroke are also amongst the worst in England.

External EnvironmentThe CCG operates in a complex external environment, influenced by political, economic, market, social, legal, policy and regulatory changes. We assess our external environment on an ongoing basis to ensure we maximise the opportunities that any changes may afford us and minimise any associated risks. This is undertaken based on our Risk Management Strategy with regular reports to the Governing Body outlining our high level risks, with strategic and operational risks being actively managed.

The CCG has assessed its areas of strategic risk as being associated with workforce, variation in quality, availability of a local primary care provider organisation, partnership working, public and patient lifestyle behaviour, research and development, conflicts of interest, political changes and its impact on public services. In each of these areas of our external environment the CCG works to maximise the opportunities we have to influence these areas to support the organisation achieve our organisational aims and deliver against our strategic programmes of work.

Our Vision, Aims and ObjectivesSalford CCG’s vision and aims were established in the two-year Integrated Strategy and Operating Plan (ISOP) 2013/14 - 2015/16.

Our vision is to commission high quality services to enable our population to live longer healthier lives.

To deliver this vision, we identified four primary aims - each supported by a number of strategic objectives - to ensure our decisions provided the best possible healthcare for people living in Salford during 2013/14.

Prevent ill healthl Help people to make healthy choices to reduce lifestyle-related harml Direct resources towards preventative interventionsl Build community assets to create population resilience to ill health

Reduce health inequalitiesl Commission according to health needl Provide additional support to vulnerable groupsl Ensure health services are equitable

Improve healthcare quality (safety, experience and effectiveness)l Commission services that are delivered to best practice safety standardsl Improve patient experience of commissioned servicesl Commission services which will have the best outcomes and provide value for moneyl Implement the recommendations from the Francis Report Improve health and wellbeing outcomesl Commission service models which maximise health and wellbeing outcomesl Locate services in the most appropriate setting where possible close to home and encouraging self carel Increase early diagnosis of cancer

Along with our objectives, Salford CCG has a set of values:l Strive for excellence through the setting of increasingly high ambitious standardsl Value people – public, patients, staff and stakeholdersl Have professional integrity – being open, honest and transparentl Be a lean organisation which is effective, efficient and safel Make the best use of available resources

Building on the strength of the CCG’s inaugural year, our core vision and values have been preserved with the aims and objectives refreshed to reflect a constantly evolving health and social care environment. See p30 for details.

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Our Business ModelTo turn our vision into reality for the people of Salford, the CCG’s business model focuses on:l Co-producing a health strategy with the local authority and our populationl Fulfilling the health components of the health and wellbeing agenda and discharging our statutory duties as a CCGl Clinically leading commissioningl Developing and implementing effective patient and public engagementl Working in partnership with othersl Robustly managing performancel Developing and implementing robust and resilient governance arrangements and internal controlsl Increasing competencyl Supporting innovationl Promoting the NHS Constitution

Our Key StrengthsSalford CCG has a number of key strengths – including a sound financial base – to achieve our objectives and subsequently our vision and aims. These have built up over a number of years from the PCT legacy and throughout the period of shadow operation in 2012/13.

We have retained a stable and talented workforce throughout our development and complemented our skills and experience by attracting new talent from other parts of the NHS and organisations. This ensures that we are – and will continue to be – well-placed to shape and commission safe, effective and patient-focused services for our registered population.

In recognition of the complex and growing healthcare needs of our patients - and the excellent track record of the CCG and predecessor organisations - NHS England has increased investment in Salford over the forthcoming five year period. Based upon past performance, the CCG is in excellent position to shape and commission well targeted services that will have a long term and positive impact on the health of the city’s population.

We also benefit from a stable and engaged membership through our 50 GP practices across Salford with our well-qualified GPs providing clinical leadership. As a group, they bring a rich mix of experience and knowledge to debates around shaping and reviewing primary care services in the city.

Salford CCG is proud to have a long history of partnership working with key health and social care stakeholders, including NHS and non-NHS providers, the local authority and third sector groups. These successful working relationships have been maintainedthroughout the transition from PCT to CCG. Partnership working will remain a core element of the CCG’s plans for the next five years, reflecting our view that collaborative approaches to health and social care across the city will ensure resources are used in the most efficient way to improve outcomes for our population.

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Highlights of 2013/14Long Term Conditions (including End of Life Care)More than 70,000 Salford patients have a long term condition, e.g. diabetes, asthma and COPD (Chronic Obstructive Pulmonary Disease), which can seriously impact their life and shorten life expectancy. An estimated 80% of GP consultations and 60% of hospital bed days are used by patients with long term conditions. During 2013/14 we:l Launched Diabetes Outreach Clinics for GPs to discuss diabetic patients with consultant diabetologists ensuring a personalised approach to patient care and providing GPs with continuous learning and developmentl Trialled a new model of care around early detection of patients with liver disease. If successful, the pilot will roll out across Salfordl Introduced clinics for COPD patients providing exercise and lifestyle advice. This has been extremely successful in helping patients manage their condition and enjoy an improved quality of lifel Commissioned a community clinic providing treatment for patients with vascular problems that otherwise would have been seen in hospital

In the next five years we will continue improving community and primary care-based initiatives for patients with long term conditions to reduce unnecessary hospital admissions and provide care closer to home. We will work with partners to maximise community assets and promote self-management and education enabling patients to stay well and independent for as long as possible.

For End of Life Care we:l Increased the number of GPs, hospital and hospice doctors, nurses and social care staff using Salford’s Electronic Palliative Care Coordination System (EPaCCS). A growing number of Salford residents are completing Advance Care Plans and sharing the information through EPaCCS to ensure preferences and choices for end of life care are met wherever possiblel With guidance for the National Leadership for the Care of Dying People, work has progressed to develop the replacement for the Liverpool Care Pathway for the Dying Patient in July 2014l Reviewed commissioned end of life care services ahead of a redesign taking place next year to make sure support at home is available whenever needed 24/7 Salford CCG will continue contributing to national end of life care initiatives, in addition to setting ourselves ambitious targets with regards to patients dying in their place of choice. Workstreams to help us achieve this are being incorporated as part of the Salford Integrated Care Plan for Older People.

Children and Young PeopleThe CCG completed a comprehensive review of maternity services in Salford during 2013/14, which found they were of high quality and in line with good practice in the great majority of areas. A new project has now been established to set the tone for the service quality over the next five years and ensure all parts of the service are geared to reduce health inequalities and deliver the best possible start in life for Salford children.

We reviewed paediatric inpatient capacity to support our local PANDA (Paediatric Assessment and Diagnosis Area) unit and successfully piloted an arrangement with Bolton NHS Foundation Trust to take secondary care patients from the unit. This ensured that, over the busy winter period, the small number of children and youngpeople attending PANDA needing to be transferred were all able to access a convenient local hospital.

Salford CCG has invested, as part of a longer term strategy, to improve the quality of care for children with long term conditions and multiple care needs. New standards have been commissioned for children living with diabetes, which complement the implementation of a shared pathway across primary and secondary care for the management of children with asthma. This work has stopped the rise of hospital admissions and aims to bring these levels down to those comparable with the best in the region in the short term.

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Mental HealthThe 2010 Salford Mental Wellbeing Needs Assessment estimates 36,500 adults and 6,000 children in Salford might have a mental wellbeing need. During 2013/14, Salford CCG and Salford City Council launched the Integrated Mental Health Commissioning Strategy and established a Mental Health Commissioning Strategy Group to oversee the commissioning of mental health services in Salford for the next five years.

We also:l Invested £1.3m in the Memory Assessment Treatment Service (MATS) to diagnose dementia patientsl Spent £1.1m expanding the Mental Health Liaison Service to provide rapid assessment and intervention for patients with mental health needs who attend Salford Royal’s emergency department or are admitted to a wardl Redesigned services for people with personality disordersl Invested additional recurrent funds in the service for mentally disordered offenders and progressed discussions with Bolton and Trafford regarding effective joint working across the localitiesl Opened a new rehabilitation ward (Copeland Ward)l Redesigned and recommissioned the Recovery and Horticulture Service at Buile Hill Garden Centrel Developed Salford’s Dementia Action Alliance, one of the first in Englandl Modernised Hollybank to become an Intermediate Support Hub providing accommodation supported by a 24-hour staff team focusing on recovery and independent livingl Reviewed Start In Salford to inform future commissioning requirements

Mental health remains one of our key priorities for 2014-19. The CCG recognises that effective management of mental health and wellbeing can have a positive impact on patients’ physical health and socio-economic wellbeing. We are dedicated to commissioning personalised care that enables recovery through prevention, education, tele-care and support services.

Scheduled Care (including Cancer)During the last year Salford CCG has worked to ensure patients receive more care closer to home. To achieve this, we reviewed hospital activity to make sure patients are not being followed up by hospitals more than would be expected - according to national ratios of first to follow up appointments - and that, where appropriate, procedures are conducted as day cases.

The CCG also implemented a community-based, consultant-led ophthalmology service. This service is currently trying out evening appointments to see if these are more suitable for patients.

A full review of local hospital-based rheumatology services has started. Working with clinical teams at Salford Royal, we will identify where pathways may need to be redesigned and where care can be safely moved into a community setting.

Throughout the year, we have monitored national access targets and are on track to achieve the targets for patients receiving treatment with 18-weeks of referral and for patients to obtain diagnostic tests within six weeks of request.

Although most of the services for cancer are commissioned regionally, we have been working to improve local cancer pathways and services wherever possible. We have:

l Reviewed the pathway for following up patients treated for prostate cancer. This identified how much the service is valued by patients and the value of specialist nurses through providing links with social care and support groups, as well as telephone support.l Designed and funded a pilot of ‘CAN Move’. Evidence shows being active can help reduce the risk of cancer progressing or returning. CAN Move provides cancer patients with access to a physical health trainer specially trained to support them with regular exercise through a 12-week structured programme and one-to-one support to get people back into regular exercise.

Over the next five years, we will support the changes to scheduled care across Salford and Greater Manchester as part of the Healthier Together programme and national shifttowards community and primary based care. Our focus will be on redesigning and commissioning scheduled care services outside a traditional acute hospital setting, where appropriate, so patients can receive high quality care closer to home.

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Older PeopleDuring 2013/14, we reviewed the Community Stroke contract, delivered by the Stroke Association. The service provides support to the discharge and rehabilitation pathway for Salford patients following an acute stroke episode. Staff from the service begin their work with patients prior to them being discharged from hospital and working alongside medical staff at SRFT to provide a seamless transfer from acute to community. Importantly they work closely with family members who are carers to ensure they are supported if they have any new responsibilities.

The service continues to support patients and carers following discharge for up to 12 month, including the six-month review and application of the Modified Rankin Scale. The service supports patient involvement through the Salford Stroke Survivors Group and delivers training to health and social care staff.

The review concluded the service was:l Appropriately positioned in the stroke pathwayl Highly valued by staff at SRFT and in primary carel An invaluable resource for users and carersl Efficiently using its staffing resource and delivering to expected levels of activityl Planning to develop responses to additional health conditions – comorbidities

We have also been working with Salford City Council, SRFT and GMW to agree plans, pilot service changes and pool almost £100 million health and social care funding for older peoples services into a single budget. The Integrated Care Programme for Older People (ICP) has been piloted during 2013/14 in two Salford neighbourhoods, Swinton and Eccles, with proactive joint care planning and management for the over-65s. See Partnership Working for more details on Integrated Care for Older People.

Unscheduled CareContinuing to meet patients’ urgent care needs continues to be one of the biggest challenges facing the NHS nationally. Whilst the Salford health economy benchmarks relatively well against many other areas, there continues to be significant variation in the quality of care provided to patients in different districts and at different times.

Some key local developments in 2013/14 have included:l Full implementation of the NHS 111 service locally. More than 1,000 calls to NHS 111 are made by Salfordians every week and links have been established between it and other services such as GP out-of-hours, GP practices, A&E and community servicesl The development of a new pathway for children so during the busy winter months the majority of children who needed to be transferred from Salford Royal’s PANDA unit go to Royal Bolton and not hospitals further afieldl Long term funding has been identified for a number of pilots aiming to help people, especially older people, regain their confidence and return to the activities of daily living and self-care after an urgent health need (these include use of equipment, services provided by the Stroke Association and Age UK, community geriatricians, etc.). These schemes will be taken forward via our Integrated Care Programme for Older People.

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Medicines ManagementMedicines are the most frequent health care intervention in the NHS which, if prescribed and taken correctly, can make a major impact to improve the health and wellbeing of a population. Inappropriate use of medicines can, however, result in unnecessary harm to patients, poorer outcomes and a financial risk to the CCG.

With this in mind, the Medicines Management team at the CCG have worked on several projects throughout 2013/14 including:l Review of Atrial Fibrillation patients in Salford prescribed warfarin intervening in those with poor control. 696 patients had poor control and, through a variety of methods, we improved this and improved outcomes and reduced harm for the patientsl Engaged with partner organisations and established networks to ensure effective joint decision-making to deliver innovative, quality and safe prescribing and use of medicines across health care services. This involved supporting the Greater Manchester Medicines Management Group (GMMMG) and its subgroups with GP, commissioner and medicines management inputl On-going workstreams to assure safe, effective and affordable medicines usage in Salford have focused on reducing variation in prescribing and reducing medicines-related healthcare acquired infections (C.diff and MRSA). Practices have audited their cephalosporin and quinolone prescribing against local guidelines, and carried out laxative reviews and NSAID reviews. Reviews of lithium monitoring, shared care prescribing and simvastatin and co- prescribed drugs have ensured we are implementing MHRA guidance and alerts. We support all primary care prescribers by providing a query answering service directly relating to patient care.

We continue to monitor NICE technology assessments relating to medicines used in primary care and ensure they are available within our formulary and horizon scan for new drug developments.

This year we have provided medicines management expertise into on-going projects including Integrated Care, management of long-term conditions and the development of a new malnutrition in the community pathway to ensure effective and timely prescribing of nutritional feeds. We also continue to support education and training at specific events including supporting patient groups in Salford, which educates patients and aids the implementation of the self-care agenda.

For 2014/15, the Medicines Management division have identified five objectives to support the CCG’s delivery of its strategic priorities. These include: effective decision making, medicines safety, primary care prescribing, effective commissioning and community pharmacy.

Continuing HealthcareContinuing Healthcare is a package of NHS arranged and funded by the CCG for people who are not in hospital, but have complex ongoing health needs.

During 2013/14:l The number of referrals to the NHS Funded Care Team continues to increase, mainly via Salford Royal Hospital Trust although significant numbers are received from other hospitals, social services and community nursing servicesl Costs related to funding individuals continue to rise but within the forecasted perimetersl All patients receiving funding, either NHS Continuing Healthcare or NHS Funded Nursing Care in care homes and their own homes, are reviewed routinely often generating the need for further assessments in respect of NHS Continuing Healthcarel Improved reporting procedures from district nursing services have shown a significant increase in the number of people receiving care in their own homesl We initially received 260 enquiries regarding the Government’s initiative in respect of Previously Un-assessed Periods of Care. This figure reduced to 225 due to duplication and some individuals with GPs outside the Salford boundary. A significant number of cases have been closed, but work is on-going to examine the remaining enquires and formal assessments will be completed where appropriate to do sol The CCG completed a procurement exercise to renew the tender for delivery of 15 specialist continuing care beds within Salford during the next three years. Once again, Swinton Hall was the successful provider.

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The CCG has developed a Quality and Safety Strategy for 2014-18 which outlines how these arrangements will be strengthened and developed. The strategy includes a systematic quality assurance framework which will add rigour to existing processes. We also intend to increase our efforts in securing patient feedback to ensure that we remain focused on what matters most to the people using services that we commission.

Primary Care QualityThe CCG has a clear responsibility to improve and develop the quality of primary care, reduce variation of standards and support our member practices to improve health outcomes. It is our ambition to establish a gold standard of service – the ‘Salford Standard’.

In 2013/14, we:l Held quality improvement workshops with GPs, Practice Managers and Practice Nurses communicating the CCG’s strategic plans and to understand their priorities to driving quality improvementl Established a work programme focusing on patient safety, experience and clinical effectivenessl Provided education, training and support to GPs and their staff on safeguarding children, young people and vulnerable adults. This has resulted in a significant increase in the numbers of GPs trained in safeguarding as well as improvements in the quality and timeliness of safeguarding case conference reports

The CCG has established a Primary Care Quality Group to assess and monitor the quality of primary care general practice. The group works to the Quality Improvement Framework, which sets out the parameters and process to identify practices requiring support to improve quality standards, but also identify areas of best practice. We intend to design and develop a quality dashboard to highlight practices requiring support for improvement.

This group is also overseeing initiatives to drive the standard of primary care and set the ‘Salford Standard’. In 2014/15, quality improvement programmes are planned in:l Incident reportingl Safeguardingl Integrated Care for Older People

We will continue engaging with member practices through monthly neighbourhood meetings, practice managers’ forum and a practice nurse forum.

Quality of Commissioned ServicesThe CCG receives a range of information on the quality of commissioned services from a variety of sources. This information is reviewed and scrutinised to enable us to gain an overview of the quality of care provided. Regular meetings with our main providers are used to discuss areas of under-performance and include broader discussions around key aspects of quality and safety. Where issues are identified, actions for improvement are agreed which are monitored through the monthly meetings.

In addition to these meetings:l Commissioner-led walk rounds of provider services have been carried out throughout the year to gain further assurance of how services operate in providing safe and effective care to patients.l Feedback on patient experience in using commissioned services has been sought to ensure that the patient voice is heardl Quality reports have been reviewed by the Governing Body to provide assurance that the quality of services is being monitored and steps are being taken to work with providers on quality improvement. These reports include a patient story to highlight the experience of an individual in using services l Relationships with NHS England though the Quality Surveillance Group and Quality Collaborative enable the CCG to receive assurance that providers across Greater Manchester are scrutinised and held to account for their performance.

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Public Involvement and ConsultationSalford CCG spends a significant amount of time engaging with the public and patients of Salford to get a good idea of exactly what they want from their local health services.

This year, our main objectives around public engagement were to:

l Develop and deliver the 2013-2018 Engagement Strategy and the 2013-2014 Engagement Delivery Planl Give as many stakeholders as possible the opportunity to understand what the CCG is and the chance to feed back their opinions, questions and concerns around their local health servicel Make better links into existing Salford-based engagement networks and create a more robust mechanism for embedding the intelligence we gather during our engagement work into the business decisions In terms of achieving these objectives, we are pleased to report:l The Engagement Strategy has been formally approved and published on the Salford CCG websitel The 2013-14 Engagement Delivery plan has been fully implementedl We have engaged with thousands of people from a variety of communities and geographical areas within Salford (all with different health conditions and health needs) by attending community-based events/meetings and holding our own events/meetingsl We have built closer working relationships with Healthwatch Salford, the Service User Development Workers at Salford City Council and with Healthy Communities Collaborative – ensuring that they spread our messages as well as us helping them to spread theirs. Other major successes from the last 12 months include:

l Two daytime city-wide Panel events and one evening city-wide Panel event, allowing people who work to actively be involved with the CCG engagement workl Three Neighbourhood Panel evening events at Lower Kersal/Charlestown Eccles / Winton and Walkden / Little Hulton, allowing residents of each area to focus on l Four Panel newsletters informing over 2000 stakeholders per edition the latest news around CCG engagementl The rollout of ‘All in the Mind’ drama production and workshop series looking at mental health issues that are important to teenagers (taken up by 95% of high schools in Salford)

SafeguardingThe CCG Safeguarding Team has taken a lead role in ensuring arrangements for safeguarding children and vulnerable adults have remained robust over the last 12 months.

Two specialist safeguarding nurse team members were appointed to support the additional work required to further improve safeguarding, and the team now come under the remit of the CCG’s Head of Quality and Innovation.

We have been working with care home providers to develop and maintain robust safeguarding arrangements, supporting GP practices in their management of patients who are experiencing domestic abuse and continued to expand the safeguarding training programme.

The safeguarding team, along with the CCG executive leads for safeguarding and the CCG GP neighbourhood leads with additional safeguarding responsibilities, have all ensured the CCG continues to contribute to the work of the Salford Safeguarding Children and Safeguarding Adults Boards and their subgroups.

Along with providing safeguarding training for GPs and practice staff, we have supported GPs to increase their involvement in the multi-agency child protection meetings.

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Partnership WorkingHealth and Wellbeing Board Salford’s Health and Wellbeing Board is a partnership between local government, the NHS, voluntary sector, business sector and the people of Salford. The Board is responsible for publishing the Joint Health and Wellbeing Strategy which identifies three priorities to guide how we commission health and wellbeing services between now and 2016:

l Ensure all children have the best start in life and continue to develop well during their early years, with a particular focus on: - Promoting healthy weight in targeted schools - Increasing breastfeeding initiation - Reducing teenage conceptions

l Local residents achieve and maintain a sense of wellbeing by leading a healthy lifestyle supported by resilient communities, with a particular focus on: - Supporting vulnerable people with more effective joined up services (reducing violent crime) - Positively influence individual and neighbourhood health and wellbeing (reducing alcohol-related admissions to hospital) - Local communities have resilience to respond to and support community wellbeing (improve social connectedness)

l All local residents can access quality health and social care and use it appropriately, with a particular focus on: - Timeliness of access (increase uptake of Health Checks) - Ensuring people feel supported to manage their condition] - Enhanced quality of life for carers (inclusion in care plans and discussions)

Three priority groups meet quarterly to work on expanding the outcomes with membership drawn from the HWBB and with at least one CCG (GP) member.

Joint Strategic Needs Assessment (JSNA)A JSNA executive group made up of senior leaders from Salford City Council representing adult and children’s services and public health and a CCG Governing Body GP (and latterly the Chair of the CCG) have met monthly.

The group is a sub-group of the Health and Wellbeing Board and is responsible for producing and publishing the JSNA, ensuring it is informed by consistent data sources, is open to feedback and contributions from its users, including the public, and that it aligns with the Joint Health and Wellbeing Strategy.

Integrated Care Programme for Older People (ICP)The Health and Social Care Act 2012 sets out the CCGs’ statutory duty to promote integration. This requires CCGs to make sure health services are joined up with health-related or social care services to improve quality of care or reduce inequalities.

Beginning with services for older people, Salford has made a significant step forward with integrated care during 2013/14. We have been working with Salford City Council, SRFT and GMW to agree plans, pilot service changes and pool almost £100 million health and social care funding for older peoples services into a single budget.

The changes have been piloted in Swinton and Eccles with proactive joint care planning and management for frail, elderly individuals by GPs, district nurses, social workers, specialist doctors and mental health staff. This includes those living in their own homes - either alone or with carers - and those in care homes. The needs of carers are also being considered.

Plans have also been developed to merge public-facing call centre services provided by the local authority and health services so that all the needs of individuals may be responded to in one place, reducing the complexity that face individuals when trying to navigate health and social care services.

In addition, we have been working with community and voluntary groups in Salford and older people themselves to help understand what would help them be happier, healthier and more independent.

The four organisations have agreed a financial plan which includes additional investment in Salford’s community nursing services, social workers, GP practices and community and voluntary groups over the next four years. This is supplemented with Salford’s plan for its proportion of the national Better Care Fund. We hope that this will help older people to live confidently and happily in their own homes for longer and reduce the time spent in hospital in their later years.

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Healthwatch SalfordHealthwatch Salford’s mission is to encourage local people, especially those who are most vulnerable and marginalised, to get the best out of health and social care by getting involved in shaping services.

The Local Authority commissioned a social enterprise company, Unlimited Potential, to steward Healthwatch in its development during 2013/14. The CCG, represented by a Governing Body GP lead, has supported council colleagues to oversee Healthwatch implementation during this year.

The same clinical lead has, with a CCG commissioning colleague, supported the Integrated Engagement Board, where local citizen representatives have been able toengage with commissioners from health and social care around national policies, commissioned services and, in particular, the work of the Health and Wellbeing Board and integrated working.

Salford Health and Social ValueThe CCG has been an active partner in the Salford Health and Social Value programme, one of four Department of Health funded national social value pilots. The programme brings together partners from across Salford, including the CCG, local authority, community and voluntary groups and social enterprises, to further develop opportunities for social value across the city using public funds for maximum community benefit.

The programme is nearing the end of year one of three and the CCG has made a valuable contribution to the existing work streams, including the on-going development of a social value charter and a toolkit to support commissioners, providers and procurers. We have also been working with colleagues in Greater Manchester CSU procurement to embed social value criteria into existing tender processes. Neighbourhood Clinical Commissioning Groups

Salford has a very diverse population with significant health inequalities and therefore very differing health needs.

To ensure these varying needs are represented throughout all work done by the CCG, the organisation has developed a neighbourhood structure, whereby GP practices who are located within the same geographical areas within Salford work more closely together to tackle the issues that are most relevant to their patients.

Each neighbourhood group meets monthly to discuss local topics and to work on initiatives that they believe will bring benefit to their immediate area. Each neighbourhood group is led by a GP who works in a practice within that area. All Neighbourhood Leads are members of the CCG Governing Body, ensuring that the voice of each area of Salford is represented at the decision making level of the organisation.

Likewise, a significant effort has been put in this year into delivering neighbourhood based engagement activities, ensuring that we get a mapped view of what each area of Salford is thinking and not just a blanket view of the city, which is likely to be unrepresentative to most.

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Making Every Contact Count/Way 2 Wellbeing PortalThe CCG has been involved in the strategic development and implementation of these two local authority and Public Health projects, with the support of a GP clinical lead.Making Every Contact Count (MECC) has involved training of frontline staff in the major organisations in health, social care and some third sector providers to offer signposting advice to service users in health, social and environmental matters.

The Way 2 Wellbeing Portal is an online interactive tool to complement MECC and can help Salford residents to make the right choices for healthy living and management of some long term conditions. It currently focuses on smoking, healthy weight, keeping active, mental wellbeing, alcohol, housing, money and sexual health. It allows individuals to carry out an online ‘wellbeing check’ and monitor progress against personally set goals.

Association of Greater Manchester CCGsWorking as an Association, the CCGs across Greater Manchester pool ideas, expertise and resources to improve the health of everybody living in Greater Manchester.

Much of the current work through the Association is linked to the Greater Manchester health and social care reforms, including the Healthier Together programme.

Salford CCG is currently the lead CCG for:l Centralisation of stroke care services so that all patients presenting with symptoms of a stroke are taken to one of the Greater Manchester specialist centres to be assessed and receive initial treatmentl Supporting specialised commissioners and NHS England in the re-procurement of the neuro-rehabilitation system in Greater Manchester.l Supporting Greater Manchester West NHS Mental Health Trust’s continued provision of a Rapid Alcohol Detox Acute Referral (RADAR) service for all Greater Manchester acute trustsl The Greater Manchester TB collaborativel Medicines Managementl Member of the North West Specialised Commissioning Oversight Group

HaeloHaelo is a joint venture between the CCG, Salford Royal NHS Foundation Trust and Salford City Council working with local partners to improve population health and healthcare for Salford. It is an innovation and improvement centre working with improvement experts, clinicians, improvement fellows and researchers.

In Salford, we are working on two programmes with Haelo – the Integrated Care Programme for Older People (ICP) and vascular health checks. Haelo has been responsible for providing the monthly data for ICP and sharing learning between the teams and, for the vascular health checks, Haelo devised a project plan to increase uptake which is now being implemented across the city.

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Manchester Academic Health Science Centre (MAHSC)Salford CCG is one of six partners working with The University of Manchester to give patients and clinicians rapid access to the latest research discoveries to improve the quality and experience of patient care.

One of only six Academic Health Science Centres in the country, MAHSC is underpinned by six domains, of which the CCG is predominately active in Population Health and Implementation.

The CCG has a team in cohort 2 of the Improvement Science for Academics (IS4Ac) programme, developed by MAHSC in conjunction with Haelo to support experienced clinical academics to close the gap between research and clinical practice. The team’s project is looking at gaining an understanding of the current issues in relation to access to GPs in Salford by:l Reviewing the factors that may impact on poor access and identify where improvements can be madel Testing new ideas about how access can be improvedl Develop a standard approach to GP access

Salford Lung StudyThe Salford Lung Study is a unique collaboration between Salford CCG, GlaxoSmithKline (GSK), North West e-Health (NWeH), The University of Manchester, Salford Royal NHS Foundation Trust, local GPs and local community pharmacists. The study is investigating the effectiveness of a GSK new respiratory medicine in patients with Chronic Obstructive Pulmonary Disease (COPD) or asthma over a 12 month period.

Patients who opt into the study are randomised to either continue to take their current medication or the new trial medication. To date, 1,894 Salford patients with COPD have enrolled in the study, making us two-thirds towards our target of 2,800, and we are now starting to recruit asthma patients. In order to complete recruitment, the study has now extended to some areas of South Manchester and Trafford.

The Salford Lung Study was designed primarily to deliver evidence of clinical effectiveness in the ‘real-world’ across a large population. It is attracting global interest as no other study in the world can currently provide this in the robust setting of a randomised clinical trial and it is setting a new standard in the delivery of real-world evidence, which will be applicable in other disease areas and healthcare settings in the future.

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What Does The Future Hold?Salford CCG’s vision and aims were originally established in the two-year Integrated Strategy and Operating Plan (ISOP) 2013/14-2015/16. This has now been reworked as a five year strategic plan and two year operational plan for 2014-2019 which meet the national planning requirements set out in Everyone Counts: Planning for Patients 2014/15 to 2018/19.

We are on a very strong foundation going forward, but we want to be more ambitious and move faster to best meet the expected needs of current and future populations of Salford. Building on the strength of the CCG’s inaugural year, our core vision and values from 2014/15 onwards remain the same.

Vision: To commission high quality services to enable our population to live longer healthier lives:

Aims:l Prevent ill healthl Reduce health inequalitiesl Improve healthcare quality (safety, experience and effectiveness)l Improve health and wellbeing outcomes

However, we have refreshed our strategic objectives to focus on the following areas:

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Qualityl Engage with all sections of our population to encourage their involvement in improving the quality of care provided. Actively seeking feedback on their experiences of healthcare and using this information to improve servicesl Support our members to deliver primary care that is safe, effective and accessible; minimising variation and secure continuous improvementl Work with our providers to ensure that they deliver safe, effective, accessible services and secure continuous improvement

Community Based Carel Support and invest in GP Practices to work at a bigger scale and in a federated manner to effectively deliver integrated care with community health and social care servicesl Seek opportunities to enhance the role of community pharmacists and opticians

Integrated Carel Jointly plan for integrated health and social care services with Salford City Council, Salford Royal NHS Foundation Trust, Greater Manchester West Mental Health NHS Trust and other providers to enable people to retain their independence and quality of life.l Work effectively with health and social care organisations to support the assessment and commissioning of NHS funded Continuing Care from a range of providers, including nursing homes and home care providers

In Hospital Carel Support secondary care reconfiguration/service transformation in the conurbation through the Healthier Together Programme whilst also maintaining a focus on the delivery of NHS constitutional standards

Long Term Conditionsl Increasingly support the treatment of long term conditions in primary care and community settings, with a particular focus upon cancer, circulatory and respiratory diseases

Effective Organisationl Support the CCG to deliver its priorities by embedding effective organisational processesl Organisational Development and HRl Communications and Engagementl Resilience and Business Continuityl Risk Managementl Policy Developmentl Financial Planning and Management

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l Performance Managementl Asset Management and Estatesl Equality, Diversity and Human Rightsl Corporate Supportl Governancel IM&Tl Sustainabilityl Health and Safetyl Counter Fraudl Support preventative measures aimed at improving morbidity and mortality rates in the treatment of long term conditions

When we are planning for the future, we need to take into account a number of external factors, national and local trends which will impact the way Salford CCG commissions healthcare services including: Reconfiguration of hospital servicesThere is a strong national drive for the reconfiguration of hospital services to concentrate specialist acute services at a smaller number of sites across the country. In Greater Manchester, this is being spearheaded through the Healthier Together programme. This means Salford CCG will continue to prepare to commission more primary care, community-based care and integrated care services for people in Salford to ensure the treatment provided out of hospital is of the highest standards. Our commitment to this has been cemented in the development of our strategic priorities for the next five years, which outline an expected increase in community, primary and integrated care services and a shift away from unnecessary acute hospital care.

Growing populationSalford is a growing city with the population expected to reach 246,400 by 2015. Salford CCG’s strategic plan takes into account the overall growth in the population over the coming years and analyses growth in specific groups to identify what their health needs are likely to be in the future.

Growing population living with long term conditionsThe population is also growing older with more people living longer and many with multiple long-term health conditions.

Salford CCG is working in partnership with Salford City Council, Salford Royal NHS Foundation Trust and Greater Manchester West Mental Health NHS Foundation Trust to develop the Integrated Care for Older People programme.

The aim is to redesign health and social care services and enable older people to live healthier, more independent lives at home and reduce the need for hospital and residential care.

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Reducing the gap in life expectancy Diet, lifestyle, environment and poverty are just four factors which continue to significantly impact on the mortality and morbidity rates - not just between communities in Salford, but between Salford and the rest of the country.

The CCG’s strategic plan focuses on bringing care closer to the patient. By working in a federated manner across GP practices and with our partners across the health system, we will ensure more preventative activities take place in a community setting and that earlier diagnosis and treatment can be provided in the community.

Changes to the public sectorThe CCG is working with partners across the Salford to understand the impact of public sector efficiency savings and budget cuts, in particular where partner services will be hit hardest and where the CCG can work alongside those partners, most notably the Salford City Council, to work in new or different ways to minimise the impact of the changes. This work will ensure future sustainability of services and achievement of outcomes for the local population.

Risks Our Governance Statement (p52) discloses strategic, commercial, operational and financial risks which may significantly affect Salford CCG’s strategies and development. Our policy for managing principal risks is available via our website, http://www.salfordccg.nhs.uk

Sustainability ReportSalford CCG is required to report its progress in delivering against sustainable development indicators.

We are developing plans to assess risks, enhance our performance and reduce our impact, including against carbon reduction and climate change adaptation objectives. This includes establishing mechanisms to embed social and environmental sustainability across policy development, business planning and in commissioning.

We will ensure the CCG complies with its obligations under the Climate Change Act 2008, including the Adaptation Reporting power, and the Public Services (Social Value) Act 2012.

We are also setting out our commitments as a socially responsible employer.

Equality ReportSalford CCG is required to identify and manage equality and human rights business risk as well as evidence how we consider each of the nine protected characteristic groups in our planning and decision making processes.

The aim is to engage with local vulnerable groups to identify if proposed key changes in healthcare will create an adverse impact for them. Through consultation and feedback

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Report of the Chief Finance OfficerSummary Financial Performance 2013-14Salford CCG has achieved all of its statutory financial duties and this reflects the strong financial management within the organisation.

The financial statements are detailed on pages 81 to 116.

Achievement Against Performance TargetsThe CCG has four performance management targets against which it is measured:l Revenue resource use does not exceed the amount specified in Directionsl Revenue administration resource use does not exceed the amount specified in Directionsl Capital resource use does not exceed the amount specified in Directionsl Better Payments Practice Policy Revenue Resource UseThe CCG has a legal duty to maintain spending within its resource limit i.e. total budget. There are two separate limits against which the CCG is measured: revenue and cash.

In 2013-14 the CCG met both requirements and reported:

l A £17,017k under spend (surplus) against its revenue budget (resource limit) of £341m. The CCG planned to achieve a surplus of £13,000k but has exceeded this due to delays in implementation of investments. It should be noted that the CCG inherited an underspend of £17m from its predecessor body, Salford PCT, and plans to spend this over the next five years. The full forecast of £17m will be available from 2014-15 to spend on healthcare;l The cash book balance at the end of the year was £65k which was within the £250k limit approved by NHS England.

Revenue Administration Resource UseSalford CCG has been allocated a running costs allowance of £25 per head of population and this equates to £6,050k. In 2013-14, the CCG’s running cost expenditure was £6,040k and so has remained within the allowable expenditure limit. Capital Resource UseThe CCG received no capital allocation in 2013-14 and has incurred no capital expenditure.

Better Payment Practice CodeIn line with other public sector bodies, NHS organisations are required to pay invoices within 30 days or within the agreed payment terms, whichever is the sooner. This is known as the Better Payment Practice Code. CCGs are required to ensure that at least 95% of invoices are dealt with in line with this code.

In 2013-14 the CCG exceeded this target and the details are set out on page 102.

opportunities for local groups, the vulnerable patient voice helps us to shape fair, accessible services that take account of individual needs.Our Annual Equality Data Publication is available via our website http://www.salfordccg.nhs.uk/EnD.asp and sets out five equality objectives to deliver between now and 2017:

1) Improve health and narrow the gaps in access, experience and outcomes2) Improve collection and use of data/evidence for all protected groups3) Communicate and engage with all protected groups4) Develop equality and diversity competent and well supported staff5) Develop leadership, corporate commitment and governance arrangements for equality and diversity

The annual publication is a ‘specific duty’ on all CCGs to enable transparent and accessible public reporting on what equality data we hold for each of the protected characteristic groups and the services they are using, as set out in the public sector equality duty requirements. It also identifies any significant gaps in equality data, how they link into our agreed equality objectives, and how the CCG will seek to address them going forward over a four-year cycle. We are also keen to look at any health inequalities experienced by local patients and carers from protected groups and compare this to what is happening nationally.

The data tells the story about the experiences of Salford’s most vulnerable and more marginalised patients, carers and staff. Through quantitative and qualitative data gathering and review from our provider partner organisations, the CCG can gain assurances about the quality and safety of our services for local protected groups and inclusion health groups.

We are developing an EDHR Strategy 2014-17 looking at workforce and service delivery issues and fair access to healthcare information, services, premises and any employment opportunities, for each of the local protected groups. As a result, the CCG will develop a two-year overarching EDHR Action Plan 2014-16, which includes identification of Equality Delivery System 2 (EDS2) actions.

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How Did Salford CCG Spend its Allocation of £341m in 2013-14?During 2013-14 the CCG achieved a surplus of £17m and spent £324m on the achievement of its objectives in a variety of services, as identified below:

The cost to the CCG of medicines prescribed by GPs is £38m and during 2013-14 the Medicines Management Team worked with practices to ensure that all items prescribed were cost effective and safe.

The majority of the CCG’s overall budget, £180m, is spent on acute services such as elective and non-elective care, outpatients, ambulance and accident and emergency. Whilst the majority of acute care is commissioned from Salford Royal NHS Foundation Trust (SRFT), other NHS and non NHS providers are also used. The services we buy from these providers are shown below:

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Key Messages from 2013-14We are pleased to have been successful in achieving all of our statutory financial duties during our first year of operation.

Two major investments were implemented in 2013-14 - an additional £1.3m was invested in the Memory Assessment Treatment Service (MATS) to diagnose patients living with dementia, and a further £1.1m was set aside to develop and expand the Mental Health Liaison service providing rapid assessment and intervention for patients with mental health needs who go to Salford Royal’s emergency department or are admitted to a ward.

An Innovation Fund was set up to promote integrated and partnership working and to encourage innovation through two voluntary and community sector grant pots; the Little Pot of Health Wellbeing Fund to enable community and voluntary groups with annual turnovers of £10,000 or less to undertake small projects in local communities which can really make a difference to people’s wellbeing; and the Little Pot of Health Improvement Fund to support Salford third sector groups of any size to improve the health and wellbeing work that they do.

Salford CCG - Allocation of Total Expenditure 2013-2014 £324m

Salford CCG - Purchase of Acute Services 2013-2014 - £180m

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Looking Forward Into 2014-15The draft Long Term Financial Plan through to 2018-19 was presented to the Governing Body in September 2013 with the final version of the plan being presented at the meeting in March 2014.

In 2013-14, the CCG inherited a non-recurrent surplus from Salford PCT of £17m, which Salford CCG has carried forward into future years. In addition, the allocation formula for the next two years provides additional recurrent funding to Salford CCG to that which was anticipated in the draft September allocation announcements. The funding formula that underpins the allocations has recognised the impact of deprivation on populations and Salford is regarded as being underfunded based on the relative need of its population.

Each CCG received a minimum level of uplift within the allocations announced in December 2013, however, those CCGs that were furthest away from their target allocation received an above average growth settlement. Salford CCG will receive an above average uplift in growth to narrow the distance from the target allocation. This results in an additional £15.3m of recurrent funds over the five year planning period, compared with the minimum growth settlement awarded to CCGs nationally. This is more funding than originally anticipated by Salford CCG in the three year plan presented to the Governing Body in September 2013 and is set out in the table below:

Table 1: Salford CCG allocation growth

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Salford CCG plans to make use of these recurrent and non-recurrent monies over the next 5 years to achieve better outcomes for the population of Salford. The financial plan is aligned to our strategic programmes over the next five years, for example:

l Integrated Care Programme for Older People – the CCG will receive a £6m allocation in 2015/16 in respect of the Better Care Fund and, in addition, will contribute a further £10m from the CCG’s baseline allocation. These funds will be added to baseline spend on older people’s services and create a pooled budget with Salford City Council of circa £100ml Primary Care Quality – there is a new investment in primary care quality of £1.5m within the enhanced services budget of £2.9ml Out of hospital/community-based care – an additional £4m funding for out of hospital services in 2014/15 will be invested in service provision (for example, long term conditions management), improving access to services (for example, seven-day opening) and infrastructure (for example, improving premises)l Innovation – the CCG will continue to invest £2m funding for non-recurrent pilots as well as committing £0.5m recurrent funds each year during the planning cycle to mainstream and roll out those schemes that evaluate successfully across Salford. Over this five-year period, new investment by Salford CCG will be more targeted towards Integrated Care and community-based care whilst ensuring a strong emphasis on quality throughout all of the areas that are commissioned.

Table 2: Salford CCG investment split by strategic aim:

It is evident that Salford CCG will have funds available to invest over the next five years. The challenge for Salford CCG is to target this funding to make significant inroads into addressing those areas where there are poor health outcomes in Salford.

2014/15 2015/16 2016/17 2017/18 2018/19

Minimum Growth (CCGs) 2.14% 1.70% 1.80% 1.70% 1.70% 9.04%Allocation Growth (Salford CCG) 2.72% 2.55% 2.64% 2.57% 2.52% 13.00%Additional for Salford CCG 0.58% 0.85% 0.84% 0.87% 0.82% 3.96%

TOTAL OVER 5YEARS

2014/15 2015/16 2016/17 2017/18 2018/19

£m £m £m £m £m £m

Minimum Growth (CCGs) £6.8 £5.4 £5.7 £5.4 £5.4 £28.8

Allocation Growth (Salford CCG) £8.6 £8.3 £9.0 £9.0 £9.1 £44.1

Additional for Salford CCG £1.8 £2.9 £3.3 £3.6 £3.6 £15.3

TOTAL OVER 5YEARS

Steve DixonChief Finance Officer4th June 2014

Alan CampbellAccountable Officer4th June 2014

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Members’ ReportSalford CCG’s Member Practices

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Salford CCG’s Governing BodyChair Hamish StedmanChief Accountable Officer Alan CampbellChief Finance Officer Steve DixonDirector of Public Health Melanie Sirotkin [until Nov 2013]Interim Director of Public Health David Herne [from Nov 2013]Local Authority Liaison Dr Clive BoycePerformance Clinical Lead Dr Jeremy TankelNeighbourhood Clinical Leads Dr Annette Johnson (Irlam and Cadishead) Dr Paul Bishop (Swinton) Dr Babar Farooq (Broughton) Dr Elaine Tamkin (Eccles) Dr Owain Thomas (Ordsall and Claremont) Dr Girish Patel (Little Hulton and Walkden)Lay Member for Engagement Brian WroeLay Member for Finance and Governance Edward Vitalis (Vice chair)Lay Member for Commercial Paul NewmanGoverning Body Nurse Clare ToddGoverning Body Secondary Care Clinician Dr Mansel HaeneyEx Officio Governing Body Members Cllr Margaret Morris (Salford City Council Lead Member for Health) Sue Lightup (Strategic Director for Community, Health and Social Care)Audit Committee*

Salford CCGEdward Vitalis (Chair) Non-executive DirectorDr Jeremy Tankel Performance Clinical LeadClare Todd Governing Body Nurse

In attendanceSteve Dixon Chief Finance OfficerHannah Dobrowolska Head of Corporate ServicesKaren Proctor Head of Performance and CommissioningRoger Causer Senior LCFS, Mersey Internal AuditClaude Chonzi Audit Manager, Mersey Internal AuditLeonard Cross Audit Manager Assurance, Grant ThorntonMick Waite Director Assurance, Grant ThorntonHeather Walters Audit Manager, Grant Thornton

* See the Governance Statement for details of members of other committees and sub-committees.

Neighbourhood Practice Name

Broughton, Lower Kersal and Dr Buch Irwell Riverside Dr Warburton Dr Davis, Leicester Road Medical Practice Dr Jeet Dr Kassam, Mocha Parade Medical Practice Newbury Green Medical Practice Dr Levenson, Limefield Medical Centre Dr Sultan Blackfriars Medical Practice Salford Care Homes Practice

Eccles, Barton and Winton Dr Allweis Dr Budden & Partners Dr Yates & Fletcher Dr Lindsay & Behardien Salford Health Matters Dr Singh Dr Tyrell Dr Borg-Costanzi, Monton Medical Centre Dr Tamkin & Partners

Irlam and Cadishead Dr Hope & Partners, Mosslands Medical Practice Dr Joshi, Chapel Medical Centre Dr White, Irlam Medical Centre Dr Malcomson, Irlam Clinic Dr Malloy & Shabaz, Irlam Group Practice

Ordsall and Langworthy Dr Saxby & Partners, Regents Park Medical Practice Dr Haber & Partners, Langworthy Medical Practice Dr Rahman Dr Salim Dr Tankel & Partner, Clarendon Surgery

Claremont, Weaste and Seedley Dr Austin, Pendleton Medical Centre Dr Raj & Partners, Orient Road Surgery Dr Amin, The Willows Dr Malcomson, The Cornerstone Dr Finegan & Partners, Sorrel Group Practice The Heights Medical Practice

Walkden, Boothstown, Ellenbrook Walkden Medical Centreand Worsley The Gill Medical Centre The Limes Medical Centre Dr Loomba Ellenbrook Medical Centre Orchard Medical Centre

Little Hulton Dr Ahuja Cherry Medical Centre Dr Umeadi Dr Khan

Swinton and Pendlebury The Sides Medical Centre The Poplars Medical Centre Nelson Fold Medical Practice The Lowry Medical Practice The Lakes Medical Centre

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EmployeesPension LiabilitiesAs an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the scheme regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments into the scheme are in accordance with the scheme rules, and that member pension scheme records are accurately updated in accordance with the timescales detailed in the regulations.

See accounting policy note in the Financial Statements.

SicknessDuring 2013/14, the CCG managed an average sickness absence rate of 1.4%. This is significantly lower than the reasonable threshold of 4.5% set to all NHS organisations as a result of the Boorman Review.

Management believe that this is predominantly down to the family friendly flexible working policy the CCG has adopted and the positive and caring working environment fostered by senior managers.

A table of sickness is included in the employee benefits note to the Financial Statements.

Employee ConsultationSalford CCG prides itself on its high quality staff engagement. This year, provision has been made to allow staff to have the chance to input into the organisation by a variety of mechanisms including:

l Staff Forum meetings (discussing issues raised by the staff themselves including accommodation, working conditions and new policies)l Staff Briefing sessions (updating staff on decisions made within the Governing Body meetings, the Executive Team meetings and on partnership work the CCG is involved in)l Away Days (allowing staff to help set team objectives for the upcoming financial year)l Topic-specific Focus Groups (allowing staff to give input into the car parking consultation and the development of the Communications and Engagement and Organisational Development strategies).

In addition, staff learn about events and issues relevant to them as employees via a weekly staff e-bulletin and the staff intranet.

The CCG Senior Management adopts an open-door policy should any member of staff have an issue or question, however staff also have the option of submitting anonymous comments, compliments, questions, issues or concerns via either the FAQ section of the intranet or via a Comments Box placed in the staff kitchen.

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Disabled EmployeesDisability is one of the nine protected characteristic groups listed under the Equality Act 2010. The CCG is required to evidence in a number of ways how we are legally compliant with the Public Sector Equality Duty (PSED) showing how we take ‘due regard’ of each of the protected groups in our planning and decision making processes. This includes people with disabilities i.e. physical, mental health issues, learning disabilities and other types of disability.

The CCG is required to treat disabled people as if they are more equal than any other of the protected groups, when taking ‘due regard’ in key decision making processes, at all levels.

Staff awareness of both workforce and service delivery issues are included in any such equality, diversity and human rights training provided. Reasonable adjustments for patients, carers and staff is a fundamental area of awareness and delivery for NHS healthcare services which directly impacts on how disabled people can gain fair access to information, services, premises and any employment opportunities. This is an ‘anticipatory’ duty under the Equality Act.

CCG’s Annual Equality Data Publication, http://www.salfordccg.nhs.uk/EnD.asp, includes conclusions from the data we are aware of for each of the protected groups in Salford. Our EDHR Action Plan contains what actions CCG will focus on during 2014-16, with Appendix 1 showing Achievements during 2013-14.

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Emergency Preparedness, Resilience and ResponseSalford CCG is a Category Two responder, as defined in the Civil Contingencies Act 2004. This role requires Salford CCG to have an Incident Response Plan (IRP) to outline how we plan, respond and recover from major incidents and emergencies which can affect health and patient care.

The Salford CCG IRP supports our partnership working to keep services open and running through all events outlined in the Civil Contingencies Act 2004. The Salford CCG IRP aligns with NHS England guidance and plans and other Greater Manchester health economy IRPs.

In the event of a major incident, Salford CCG has an incident control room at St James House and CCG staff are trained to National Occupational Standards for Civil Contingencies.

Health Economy Resilience Group (HERG) meetings are well established in Salford’s health economy and attended by all relevant organisations. They are chaired by Salford CCG’s Head of Performance and Commissioning with support from Greater Manchester Commissioning Support Unit (GMCSU) Resilience Manager.Salford CCG continues to work with the GMCSU resilience team to ensure emergency preparedness, resilience and response (EPRR) arrangements are in place. An assessment against NHS England EPRR Core Standards has been completed and an action plan agreed to address any non-compliance issues.

A CCG Business Continuity Management (BCM) Champion has been appointed and a BCM Impacts and Strategies Toolkit is being finalised. Once the toolkit is complete, thedesignated Resilience Manager will liaise with Salford CCG’s BCM Champion to progress next steps.

We certify that the clinical commissioning group has incident response plans in place, which are fully compliant with the NHS Commissioning Board Emergency Preparedness Framework 2013. The clinical commissioning group regularly reviews and makes improvements to its major incident plan and has a programme for regularly testing this plan, the results of which are reported to the Governing Body.

Statement as to Disclosure to AuditorsEach individual who is a member of the Governing Body at the time the Members’ Report if approved confirms:l So far as the member is aware, that there is no relevant audit information of which the clinical commissioning group’s external auditor is unaware; and,l That the member has taken all the steps that they ought to have taken as a member in order to make them self-aware of any relevant audit information and to establish that the clinical commissioning group’s auditor is aware of that information

External AuditGrant Thornton has been appointed by the Audit Commission as Salford CCG’s external auditor. The firm has provided statutory audit services only, at a cost of £91,600 for 2013/14, and has not provided further assurance or other services in 2013/14.

Disclosure of “Serious Untoward Incidents”There have been no serious untoward incidents relating to data loss or confidentiality breaches.

Cost Allocation and Setting of Charges for InformationWe certify that the clinical commissioning group has complies with HM Treasury’s guidance on cost allocation and the setting of charges for information

Principles for RemedyThe CCG has adopted the six principles set out in Principles for Remedy representing best practice:

1. Getting it right2. Being customer focused3. Being open and accountable4. Acting fairly and proportionately5. Putting things right6. Seeking continuous improvement

Our Chief Accountable Officer has overall responsibility for ensuring the principles are implemented across Salford CCG.

Alan CampbellAccountable Officer4th June 2014

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Remuneration ReportSalaries and allowances of Governing Body members and those senior managers who have CCG wide decision making responsibilities are detailed in Table A. Pension benefits are detailed in Table B, where Salford CCG makes employer’s contributions to the NHS Pensions scheme.

Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director in their organisation and the median remuneration of the organisation’s workforce.

The banded remuneration of the highest paid member of the Membership Body/Governing Body in Salford Clinical Commissioning Group in the financial year 2013-14 was £145k -£147.5k. This was 2.6 times the median remuneration of the workforce, which was £55.7k.

In 2013-14, no employees received remuneration in excess of the highest paid member of the Membership Body/Governing Body. Remuneration ranged from £15k to £131k and total remuneration includes salary, non-consolidated performance-related pay, and benefits-in kind. It does not include severance payments, employer pension contributions and the cash equivalent transfer value of pensions.

Following the Review of Tax Arrangements of Public Sector Appointees published by the Chief Secretary to the Treasury on 23 May 2012 clinical commissioning groups must publish information on their highly paid and/or senior off-payroll engagements.

Off-payroll engagements as of 31 March 2014, for more than £220 per day and that last longer than six months are as follows:

NumberThe number that have existedl For less than one year at the time of reporting nill For between 1 and 2 years at the time of reporting nill For between 2 and 3 years at time of reporting nill For between 3 and 4 years at time of reporting nill For 4 or more years at time of reporting nilTotal number of existing engagements as of 31st March 2014 nil

NumberNumber of new engagements, or those that reached six months nil in duration, between 1 April 2013 and 31 March 2014

Number of the above which include contractual clauses giving nil the clinical commissioning group the right to request assurance in relation to Income Tax and National Insurance obligations

Number for whom assurance has been requestedOf which, the number:l For whom assurance has been received nill For whom assurance has not been received nill That have been terminated as a result of assurance not nil being received

NumberNumber of off-payroll engagements of Membership Body and/or nil Governing Body members, and/or, senior officials with significant financial responsibility, during the financial year

Number of individuals that have been deemed “ Membership 11 Body and/or Governing Body members, and/or, senior officials with significant financial responsibility”, during the financial year (this figure includes both off-payroll and on-payroll engagements)

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

48 49

Tab

le A

–

Sala

ries

an

d A

llow

ance

s

Ala

n C

ampb

ell

Chi

ef O

pera

ting

Offi

cer*

12

0-12

5

210-

212.

5 12

0-12

5

Stev

e D

ixon

,C

hief

Fin

ance

Offi

cer*

10

0-10

5

170.

172.

5 10

0-10

5

Han

nah

Dob

row

olsk

a,H

ead

of C

orpo

rate

Ser

vice

s 45

-50

22

.5-2

5 45

-50

Kar

en P

roct

or,

Hea

d of

Per

form

ance

&

Com

mis

sion

ing

Supp

ort

75-8

0

35-3

7.5

75-8

0

Fran

cine

Tho

rpe,

Hea

d of

Qua

lity

& In

nova

tion

30-3

5

35-3

7.5

30-3

5

Ham

ish

Sted

man

, Cha

ir*

110-

115

110-

115

Cliv

e Bo

yce,

Clin

ical

Mem

ber*

75

-80

75-8

0

Paul

Bis

hop,

Clin

ical

Mem

ber*

65

-70

18

0.18

2.5

65-7

0

Baba

r Fa

rooq

, Clin

ical

Mem

ber*

45

-50

45-5

0

Ann

ette

Joh

nson

, Clin

ical

Mem

ber*

55

-60

30

5.30

7.5

55-6

0

Giri

sh P

atel

, Clin

ical

Mem

ber*

50

-55

50-5

5

Elai

ne T

amki

n, C

linic

al M

embe

r*

40-4

5

40

-45

Jere

my

Tank

el, C

linic

al M

embe

r*

50-5

5

50

-55

Ow

ain

Thom

as, C

linic

al M

embe

r*

55-6

0

(7.5

-10)

55

-60

Man

sel H

aene

y,Se

cond

ary

Car

e C

onsu

ltant

* 10

-15

10-1

5

Paul

New

man

, Lay

Mem

ber*

5-

10

5-10

Cla

re T

odd,

Gov

erni

ng B

ody

Nur

se*

10-1

5

10

-15

Edw

ard

Vita

lis, L

ay M

embe

r*

10-1

5

10

-15

Bria

n W

roe,

Lay

Mem

ber*

5-

10

5-10

Nam

e an

d T

itle

Sala

ry a

nd

Fee

s

(Ban

ds

of

£500

0)

Taxa

ble

ben

efits

(ro

un

ded

to

th

e n

eare

st £

00)

£000

An

nu

al

per

form

ance

re

late

d b

on

use

s (B

and

s o

f £5

000)

£000

Lon

g t

erm

p

erfo

rman

ce

rela

ted

bo

nu

ses

(Ban

ds

of

£500

0)

£000

All

Pen

sio

n

rela

ted

ben

efits

(Ban

ds

of

£250

0)£0

00

Tota

l

(Ban

ds

of

£500

0)

£000

2013

-14

Tab

le B

–

Pen

sio

ns

& B

enefi

ts

Ala

n C

ampb

ell,

C

hief

Ope

ratin

g O

ffice

r*

7.5-

10

27.5

-30

60-6

5 18

0-18

5 10

79

1360

25

7 0

Stev

e D

ixon

,C

hief

Fin

ance

Offi

cer*

7.

5-10

22

.5-2

5 20

-25

70-7

5 22

0 35

0 12

5 0

Han

nah

Dob

row

olsk

a,

Hea

d of

Cor

pora

te S

ervi

ces

0-2.

5 2.

5-5

10-1

5 40

-45

165

194

25

0

Kar

en P

roct

or,

Hea

d of

Per

form

ance

&

Com

mis

sion

ing

Supp

ort

0-2.

5 5-

7.5

15-2

0 55

-60

256

300

39

0

Fran

cine

Tho

rpe,

H

ead

of Q

ualit

y &

Inno

vatio

n 0-

2.5

5-7.

5 25

-30

85-9

0 52

8 57

5 35

0

Paul

Bis

hop,

C

linic

al M

embe

r*

7.5-

10

22.5

-25

15-2

0 55

-60

129

246

114

0

Ann

ette

Joh

nson

, C

linic

al M

embe

r*

12.5

-15

40-4

2.5

20-2

5 60

-65

102

309

205

0

Ow

ain

Thom

as,

Clin

ical

Mem

ber*

(2

.5)-

0 (2

.5)-

0 5-

10

20-2

5 90

94

2

0

Nam

e an

d T

itle

Rea

l in

crea

se in

p

ensi

on

at

age

60

(Ban

ds

of

£250

0)

£000

Rea

l in

crea

se in

p

ensi

on

lum

p s

um

at

ag

ed 6

0(B

and

s o

f £2

500)

£000

Tota

l acc

rued

pen

sio

n a

t ag

e 60

at

31

Mar

ch 2

014

(Ban

ds

of

£500

0)£0

00

Lum

p s

um

at

age

60 r

elat

ed t

oac

cru

ed p

ensi

on

at

31 M

arch

201

4(B

and

s o

f £5

000)

£000

Cas

h E

qu

ival

ent

Tran

sfer

Val

ue

at

31 M

arch

201

3£0

00

Cas

hEq

uiv

alen

tTr

ansf

erV

alu

e at

31

Mar

ch 2

014

£000

2013

-14

Rea

l in

crea

se

in C

ash

Equ

ival

ent

Tran

sfer

Val

ue

£000

Emp

loye

r Fu

nd

ed

Co

ntr

ibu

tio

n

to G

row

th in

C

ash

Eq

uiv

alen

t Tr

ansf

er V

alu

e£0

00

50 51

Certain Members do not receive pensionable remuneration therefore there will be no entries in respect of pensions for certain Members.

Cash Equivalent Transfer ValuesA Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme. This may be for more than just their service in a senior capacity to which disclosure applies (in which case this fact will be noted at the foot of the table). The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.

Real Increase in CETVThis reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period.

Statement of Accountable Officer’s Responsibilities

The National Health Service Act 2006 (as amended) states that each Clinical Commissioning Group shall have an Accountable Officer and that Officer shall be appointed by the NHS Commissioning Board (NHS England). NHS England has appointed the Chief Operating Officer to be the Accountable Officer of NHS Salford Clinical Commissioning Group.

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

In preparing the financial statements, the Accountable Officer is required to comply with the requirements of the Manual for Accounts issued by the Department of Health and in particular to:

l Observe the Accounts Direction issued by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basisl Make judgements and estimates on a reasonable basisl State whether applicable accounting standards as set out in the Manual for Accounts issued by the Department of Health have been followed, and disclose and explain any material departures in the financial statements and,l Prepare the financial statements on a going concern basis

To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my Clinical Commissioning Group Accountable Officer Appointment Letter.

Alan CampbellAccountable Officer4th June 2014

Alan CampbellAccountable Officer4th June 2014

52 53

Governance StatementIntroduction and ContextThe clinical commissioning group was licenced from 1 April 2013 under provisions enacted in the Health & Social Care Act 2012, which amended the National Health Service Act 2006. The clinical commissioning group operated in shadow form prior to 1 April 2013, to allow for the completion of the licencing process and the establishment of function, systems and processes prior to the clinical commission group taking on its full powers.

As at 1 April 2013, the clinical commissioning group was without conditions.

Salford Clinical Commissioning Group (Salford CCG) is responsible for most healthcare services available to the people of Salford. The CCG took over from NHS Salford, the former primary care trust, in April 2013.

Every GP in Salford has agreed to join together and be part of Salford CCG. Each GP has signed up to take on an active role in making sure this organisation is a success; ensuring that Salford CCG commission high-quality services that enable our population to live longer healthier lives.Salford CCG commissions high quality services to enable our population to live longer healthier lives’

In 2013/14 our objectives have been to:

Prevent ill health: Helping people make healthy choices to reduce health inequalities associated with lifestyle, and direct resources towards prevention, resulting in a reduction of the number of people who smoke, reduce the impact of alcohol related harm, and reduce levels of obesity across all age groups.

Reduce health inequalities: Commissioning services that are tailored to local needs, provide additional support to vulnerable people, and ensure that health services are equitable, leading to an increase in life expectancy, a reduction in health inequalities experienced by many people in Salford, and reduce the rate of teenage pregnancy.

Improve healthcare quality (safety, experience, and effectiveness): Commissioning high-quality value for money services that are delivered in line with best practice and safety standards; not only providing the best clinical ‘outcomes’ for patients, but also providing an improved patient experience.

Improve health and wellbeing outcomes: Buying those services that are best designed to maximize health and wellbeing outcomes and locate services in the most appropriate settings that where possible are closer to people’s homes.

Scope of ResponsibilityAs Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the clinical commissioning group’s policies, aims and objectives, whilst safeguarding the public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out in my Clinical Commissioning Group Accountable Officer Appointment Letter.

I am responsible for ensuring that the clinical commissioning group is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity.

Compliance with the UK Corporate Governance CodeWhilst the detailed provisions of the UK Corporate Governance Code are not mandatory for public sector bodies, compliance is considered to be good practice. This Governance Statement is intended to demonstrate the clinical commissioning group’s compliance with the principles set out in Code.

We are not required to comply with the UK Corporate Governance Code. However, we have reported on our Corporate Governance arrangements by drawing upon best practice available, including those aspects of the UK corporate governance code we consider to be relevant to the CCG and best practice.

The Clinical Commissioning Group Governance FrameworkThe National Health Service Act 2006 (as amended), at paragraph 14L(2)(b) states:The main function of the governing body is to ensure that the group has made appropriate arrangements for ensuring that it complies with such generally accepted principles of good governance as are relevant to it.

The CCG’s Constitution is available on our website, http://www.salfordccg.nhs.uk/documents/Constitution07082013.pdf

The Constitution was made between the members of NHS Salford Clinical Commissioning Group and has been effective since the 1st day of April 2013, when the NHS Commissioning Board established the group.

The geograpohical area covered by NHS Salford Clinical Commissioning Group is coterminous with Salford City Council. NHS Salford Clinical Commissioning Group represents all practices within the Salford City Council boundaries circa 247,000 patients.

Appendix C of the CCG’s Constitution - Scheme of Reservation and Delegation sets out a) those decisions that are reserved for the membership as a whole; and b) those decisions that are the responsibility of it’s governing body (and its committees), the group’s committees and sub committees, individual members and employees. Table A in Appendix C of the Constitution provides an overview of the full Scheme of Reservation and Delegation.

54 55

Membership of the CCGThe following practices comprise the members of NHS Salford Clinical Commissioning Group:

Neighbourhood Practice Practice Name Address

Dr Buch Lower Broughton Health Centre Great Clowes Street Salford M7 1RD Dr Warburton Higher Broughton Health Centre Bevendon Square, Salford, M7 4TP Dr Davis, Leicester Road 53 Leicester Road, Salford, M7 4AS Medical Practice Dr Jeet Lower Broughton Health Centre Great Clowes Street Salford M7 1RD Dr Kassam Mocha Parade Medical Practice 4-5 Mocha Parade, Salford, M7 1QENewbury Green Medical Practice Bevendon Square, Salford, M7 4TP Dr Levenson, Limefield Medical Centre 6-8 Limefield Road, Salford, M7 4LZ Dr Sultan Lower Broughton Health Centre Great Clowes Street Salford M7 1RD Blackfriars Medical Practice FreshTowers, Chapel Street, Salford M3 6AF Salford Care Homes Practice Sandringham House, Windsor Street, Salford, M5 4DG Dr Allweis St Andrews Medical Centre, 30 Russell St Eccles, Salford, M30 0NU Dr Budden & Partners St Andrews Medical Centre, 30 Russell St Eccles, Salford, M30 0NU Dr Yates & Fletcher St Andrews Medical Centre, 30 Russell St Eccles, Salford, M30 0NU Dr Behardien St Andrews Medical Centre, 30 Russell St Eccles, Salford, M30 0NU Salford Health Matters Eccles Gateway, 28 Barton Lane, Eccles M30 0TU Dr Singh Eccles Gateway, 28 Barton Lane, Eccles, M30 0TU Dr Borg-Costanzi Monton Medical Centre Canalside Monton Green, M30 8AR Dr Tamkin & Partners Springfield House, 110 New Lane, Patricroft, Salford, M30 7JE Dr Hope & Partners Mosslands Medical Practice MacDonald Road, Irlam, Salford M44 5LH Dr Joshi, Chapel Medical Centre 220 Liverpool Road, Irlam, Salford, M44 6FE Dr White, Irlam Medical Centre MacDonald Road, Irlam, Salford M44 5LH Dr Malcomson, Irlam Clinic 125 Liverpool Road, Irlam, Salford, M44 6DP Dr Shabaz, Irlam Group Practice 523 Liverpool Road, Irlam, Salford M44 6ZS Dr Saxby & Partners, Ordsall Health Surgery 118 Phoebe Street, Salford, M5 3PH Dr Haber & PartnersLangworthy Medical Practice 250 Langworthy Road, Salford, M6 5WW Dr Rahman Salford Medical Centre, 194-198 Langworthy Road, Salford, M6 5PP

Broughton, Lower Kersal and Irwell Riverside

Eccles, Barton and Winton

Ordsall and Langworthy

Neighbourhood Practice Practice Name Address

Dr Salim Salford Medical Centre, 194-198 Langworthy Road, Salford M6 5PP Dr Tankel & Partner, Clarendon Surgery Pendleton Gateway, Salford, M6 5FX Dr Austin, Pendleton Medical Centre 1 Broadwalk, Salford, M6 5FX Dr Raj & Partners Orient Road Surgery 37 Orient Road, Salford, M6 8LE Dr Amin The Willows Lords Avenue, Salford, M5 5JR Dr Malcomson, The Cornerstone 451 Liverpool Street, Salford, M6 5QQ Dr Finegan & Partners Sorrel Group Practice 23 Bolton Road, Salford, M6 7HL The Heights Medical Practice Bolton Road, Salford, M6 7NU Walkden Medical Centre 2 Hodge Road, Walkden, Salford M28 3AT The Gill Medical Centre 5 Harriet Street, Walkden, Salford M28 3DR The Limes Medical Centre 10-12 Hodge Road Walkden, Salford M28 3AT Dr Loomba Walkden Gateway, 2 Smith Street, Walkden, Salford, M28 3EZ Ellenbrook Medical Centre Ellenbrook Village Centre, 14 Morston Close, Salford, M28 1PB Orchard Medical Centre 10 Leigh Road, Boothstown, Salford M28 1LZ Dr Ahuja Dearden Avenue Medical Practice, 1a Dearden Avenue, Little Hulton, Salford, M38 9GH Cherry Medical Centre Hulton District Centre, Haysbrook Avenue, Little Hulton M28 0AY Dr Umeadi Cleggs Lane Medical Practice, Little Hulton, Salford, M38 9RS Dr Khan 152a Manchester Road East, Little Hulton Salford, M38 9LQ The Sides Medical Centre Moorside Road, Swinton, Salford M27 0EW The Poplars Medical Centre 202 Partington Lane, Swinton, Salford M27 ONA Silverdale Medical Practice 659 Bolton Road, Pendlebury, Salford M27 8HP The Lakes Medical Centre 21 Chorley Road, Swinton, Salford M27 4AF

Walkden, Boothstown, Ellenbrook and Worsley

Little Hulton

Swinton and Pendlebury

All GPs in Salford have signed agreement with the Salford CCG constitution. Evidence of this is available:- Upon request for inspection at NHS Salford CCG, St James’s House, Pendleton Way, Salford, M6 5FW- By email – please send your request to salccg.involve@nhs.net

EligibilityProviders of primary medical services to a registered list of patients under a General Medical Services, Personal Medical Services or Alternative Provider Medical Services contract, will be eligible to apply for membership of this group.

NHS Salford CCG has an open membership. Any GP practice in Salford may apply to be a member – as per the NHS Commissioning Board entry criteria.

This does not preclude applications from practices from outside Salford. All applications will be assessed using the NHS Commissioning Board entry criteria.

Claremont, Weaste and Seedley

56 57

Vision, aims and valuesVisionThe vision of NHS Salford Clinical Commissioning Group is “Salford CCG will commission high quality services to enable our population to live longer healthier lives”.NHS Salford Clinical Commissioning Group’s strap line is “Effectively enable healthier lives”.

The group will promote good governance and proper stewardship of public resources in pursuance of its goals and in meeting its statutory duties.

AimsNHS Salford CCG’s aims are to:l Prevent ill healthl Reduce health inequalitiesl Improve healthcare quality (safety, experience and effectiveness)l Improve health and wellbeing outcomes

ValuesGood corporate governance arrangements are critical to achieving the group’s objectives.The values that lie at the heart of the group’s work are: a) Strive for excellence, through the setting of increasingly high standards b) Value People – public, patients, staff and stakeholders c) Be professional d) Be honest, open and transparent e) Be a lean organisation retaining expert advice f) Make the best use of available resources

Principles of Good GovernanceIn accordance with section 14L(2)(b) of the 2006 Act , the group will at all times observe “such generally accepted principles of good governance as are relevant to it” in the way it conducts its business. These include: a) 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 b) The Good Governance Standard for Public Services c) the standards of behaviour published by the Committee on Standards in Public Life (1995) known as the ‘Nolan Principles’ d) the seven key principles of the NHS Constitution e) the Equality Act 2010 f) Professional Standards Authority standards for NHS boards and clinical commissioning groups governing bodies in England

AccountabilityThe group will demonstrate its accountability to its members, local people, stakeholders and the NHS Commissioning Board in a number of ways, including by: a) publishing its constitution b) appointing independent lay members and non GP clinicians to its governing body c) holding meetings of its governing body in public (except where the group considers that it would not be in the public interest in relation to all or part of a meeting) d) publishing annually a commissioning plan e) complying with local authority health overview and scrutiny requirements f) meeting annually in public to publish and present its annual report (which must be published) g) producing annual accounts in respect of each financial year which must be externally audited h) having a published and clear complaints process i) complying with the Freedom of Information Act 2000 j) providing information to the NHS Commissioning Board as required

Governance Structure

NHS Salford CCG Governing Body

Renumeration Committee

Renumeration Committee

Audit Committee

Joint R&D Steering Committee

Salford Safeguarding Children Board

Salford Safeguarding Adults Board

- Health Safety and Risk- IM&T Including Information Governance- Organisational Performance- Equality and Diversity

Executive Team

Health Economy Resilience Group

Org

anis

atio

nal

Man

agem

ent

Stat

uto

ry a

nd

Leg

al G

rou

ps Broughton Neighbourhood

Clinical Commissioning Group

Eccles Neighbourhood Clinical Commissioning

Group

Irlam Neighbourhood Clinical Commissioning

Group

Ordsall Neighbourhood Clinical Commissioning

Group

Little Hulton and Walkden Neighbourhood

Clinical Commissioning Group

Swinton Neighbourhood Clinical Commissioning

Group

Salford Practice Managers Commissioning

Group

Clinical Commissioning and Quality Outcomes

Group

LTC and Community Commissioning Strategy Group

Scheduled Care and Cancer Commissioning Strategy

Group

Unscheduled Care and Commissioning Strategy

Group

Children and Young Peoples Commissioning Strategy Group

Programme Management Group

Medicines Management Commissioning Strategy Group

Continuing Care Commissioning Strategy Group

Engagement and Experience Management Group

Contracts Management Group

Commissioning Panel

Org

anis

atio

nal

Div

ersi

ty

Prim

ary

Car

e C

om

mis

sio

nin

g P

erfo

rman

ce

58 59

The Governing BodyFunctions - the governing body has the following functions conferred on it by sections 14L(2) and (3) of the 2006 Act, inserted by section 25 the 2012 Act, together with any other functions connected with its main functions as may be specified in this constitution. The governing body has responsibility for:a) ensuring that the group has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with the groups principles of good governance (its main function)b) determining the remuneration, fees and other allowances payable to employees or other persons providing services to the group and the allowances payable under any pension scheme it may establish under paragraph 11(4) of Schedule 1A of the 2006 Act, inserted by Schedule 2 of the 2012 Actc) will ensure that the register(s) of interest is reviewed regularly, and updated as necessary

Composition of the Governing BodyThe governing body must not have less than 6 members and consists of:a) the chair (who will be a GP)b) six representatives of member practices representing the following neighbourhoodsi) Swintonii) Little Hulton and Walkdeniii) Ecclesiv) Irlamvi) Broughtonc) two other GPs or primary care health professionalsi) Local Authority Liaison GP Clinical Leadii) Performance GP Clinical Leadd) Three lay members (one of whom will be the deputy chair)i) one to lead on audit, remuneration and conflict of interest mattersii) one to lead on patient and public participation mattersiii) one to lead on commercial matterse) One registered nursei) with a lead lay role on assurance for safeguarding and qualityf) One secondary care specialist doctori) with a lead lay role on assurance associated with clinical matters including clinical systems and research and developmentg) the accountable officerh) the chief finance officer

Invitations to assist in Governing Body meetingsa) The Governing Body may invite such other person(s) to attend all or any of its meetings, or part(s) of a meeting, in order to assist it in its decision-making and in its discharge of its functions as it sees fit. Any such person may speak and participate in debate, but may not vote.b) The Governing Body will invite the following individuals to attend its meetings:

i) The Director of Public Healthii) The Strategic Director for Communities, Health and Social Careiii) The Assistant Mayor - Health and Wellbeing

Committees of the Governing Body - the governing body has appointed the following committees and sub-committees:a) Audit Committee – the audit committee, which is accountable to the group’s governing body, provides the governing body with an independent and objective view of the group’s financial systems, financial information and compliance with laws, regulations and directions governing the group in so far as they relate to finance. The governing body has approved and keeps under review the terms of reference for the audit committee, which includes information on the membership of the audit committee . In addition the group or the governing body has conferred or delegated the following functions, connected with the governing body’s main function to its audit committee:i) Review the implementation and ongoing quality of integrated governance, risk management and internal control, across the whole of NHS Salford CCG’s activities (both clinical and non-clinical)ii) Act as the arbiter for any issues which may arise from conflicts of interest in relation of the awarding of contracts, in particular to primary care providers and/ or primary care independent contractorsb) Remuneration Committee – the remuneration committee, which is accountable to the group’s governing body makes decisions on determinations about the remuneration, fees and other allowances for employees and for people who provide services to the group and on determinations about allowances under any pension scheme that the group may establish as an alternative to the NHS pension scheme. The governing body has approved and keeps under review the terms of reference for the remuneration committee, which includes information on the membership of the remuneration committee .c) Joint Research and Development Steering Group – the Joint Research and Development Steering Group is accountable to the group’s governing body. The overall purpose of the committee is to initiate, oversee, enable and provide strategic direction for the development and delivery of research and development activity within Salford. It is also to provide a forum for discussion of specific issues and to make relevant recommendations where appropriate to the Salford Royal Foundation Trust Board, NHS Salford CCG Governing Body and other emerging structures with responsibility for health care and clinical research. The governing body has approved and keeps under review the terms of reference for the Joint Research and Development Steering Group, which includes information on the membership of the Joint Research and Development Steering Group.d) Salford Safeguarding Children Board – the Salford Safeguarding Children Board, which is accountable to the group’s governing body, is a multi-agency arrangement to provide a strategic lead to safeguarding children at risk (vulnerable children) in Salford. The governing body has approved and keeps under review the terms of reference for the, which includes information on the membership of the Salford Safeguarding Children Board.

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61

e) Salford Safeguarding Adults Board – the Salford Safeguarding Adults Board is accountable to the group’s governing body, is a multi-agency arrangement is to provide a strategic lead to safeguarding adults at risk (vulnerable adults) in Salford. The governing body has approved and keeps under review the terms of reference for the Salford Safeguarding Adult’s Board, which includes information on the membership of the Salford Safeguarding Adults Board.f) Clinical Commissioning and Quality Outcomes Group – the Clinical Commissioning and Quality Outcomes Group, which is accountable to the group’s governing body, provides the CCG governing body with assurance of patient and population outcomes and financial management through the active management of the CCG performance process, using the Clinical Commissioning Budget Monitoring Framework. This group may identify and therefore contribute improving the quality of primary care. The governing body has approved and keeps under review the terms of reference for the Clinical Commissioning and Quality Outcomes Group, which includes information on the membership of the group Clinical Commissioning and Quality Outcomes Group.g) Programme Management Group – the Programme Management Group, which is accountable to the group’s governing body, will oversee commissioning activities including service improvement/development, Best Value/Quality, Innovation, Prevention and Productivity (QIPP), investment/disinvestment evaluation and recommendations, provider delivery of quality (patient safety, patient experience and effectiveness), engagement of public and patients and the management of contracts. The governing body has approved and keeps under review the terms of reference for the Programme Management Group, which includes information on the membership of the Programme Management Group.h) Executive Team – the Executive Team, which is accountable to the group’s governing body, is responsible for compliance with statutory and regulatory duties, operational delivery of all CCG functions and performance management of the objectives of the organisation. It is also specifically responsible for the functions of health, safety and risk, information management and technology (IM&T) including information governance, equality and diversity and health economy resilience. The governing body has approved and keeps under review the terms of reference for the Executive Team, which includes information on the membership of the Executive Team .i) The Governing Body may appoint such other committees as it considers may be appropriate. The Audit Committee may include individuals who are not members of the Governing Body. Other committees of the Governing Body may include individuals who are: i) Members, officers or governing body members of the group or another clinical commissioning group ii) Partners or employees or members of the group or another clinical commissioning group iii) Officers of the NHS Commissioning Board

Sub-committees of the Governing BodySix Neighbourhood Clinical Commissioning Groups, are responsible for providing help, support and encouragement to member practices to deliver the best possible healthcare outcomes within the available resources and provide an effective communication route between neighbourhoods and the CCG governing body to deliver bottom up commissioning intentions.

The groups are:l Broughton Neighbourhood Clinical Commissioning Groupl Eccles Neighbourhood Clinical Commissioning Groupl Irlam Neighbourhood Clinical Commissioning Groupl Ordsall Neighbourhood Clinical Commissioning Groupl Little Hulton and Walkden Neighbourhood Clinical Commissioning Groupl Swinton Neighbourhood Clinical Commissioning Group

The role of the Salford Practice Managers Commissioning Group is to actively engage with all practice managers from all member practices as they are fundamental to the successful delivery of clinical commissioning at a practice level.

The Programme Management Group has appointed the following sub-committees to help discharge its duties and powers.

Six Commissioning Strategy Groups, that are responsible for the full commissioning cycle within their topic area including needs assessment, planning, service redesign, contracting, implementation and performance management.

The groups are:l Long-term Condition and Community Commissioning Strategy Groupl Scheduled Care and Cancer Commissioning Strategy Groupl Unscheduled Care Commissioning Strategy Groupl Children and Young Peoples Commissioning Strategy Groupl Medicines Management Commissioning Strategy Groupl Continuing Care Commissioning Strategy Group

The Engagement and Experience Management Group is responsible for promoting and monitoring patient and public engagement in all decision making and for promoting and monitoring improvement in patient experience. The group will link with HealthWatch.

The Contracts Management Group is responsible for the development, implementation and effective management of the contracting strategy for all commissioned services, ensuring that all performance meets NHS Salford CCG commissioning plan and its statutory and regulatory duties. The group will undertake these responsibilities covering all aspects of both quantitative and qualitative performance including quality (safety, experience and effectiveness).The purpose of the Commissioning Panel is to make decisions regarding individual

62 63

applications for treatments that are not routinely commissioned by NHS Salford CCG, in line with the CCG’s Effective Use of Resources Policy.

The CCG has in place alternative arrangements to make decisions regarding individual applications for treatments (usually placements) for patients with funded nursing care or continuing care needs. The CCG also has in place joint arrangements with the City Council to make decisions regarding individual applications for treatments (usually placements) for patients with mental health needs, learning disabilities and for children. Such placements are excluded from the scope of the Commissioning Panel.

The Executive Team has appointed the following sub-committees to help discharge its duties and powers:

The Salford Health Economy Resilience Group is responsible to ensure the emergency preparedness and business continuity planning agenda set out in the Civil Contingencies Act 2004 is coordinated, implemented, reviewed, tested and embedded throughout the CCG.

Attendance recordsThroughout yes indicates attendance, no indicates non attendance and N/A is explained under the relevant table

Governing Body meetings

Dr Hamish Stedman YES YES YES NO YES YES YES Dr Clive Boyce YES YES YES YES YES NO YES Dr Paul Bishop YES YES YES YES NO YES NO Dr Babar Farooq YES YES NO NO YES YES YES Dr Annette Johnson YES NO YES YES YES YES YES Dr Girish Patel NO NO YES YES YES NO YES Dr Elaine Tamkin YES YES NO YES NO YES YES Dr Jeremy Tankel YES NO YES YES NO NO NO Dr Owain Thomas YES YES NO NO YES YES YES Mr Alan Campbell YES NO YES YES YES YES YES Mr Steve Dixon YES YES YES YES YES YES YES Dr Mansel Haeney NO YES YES YES NO YES YES Mr Paul Newman YES YES YES NO YES YES YES Mrs Clare Todd YES YES YES YES YES YES YES Mr Brian Wroe YES YES NO YES NO YES YES Mr Edward Vitalis YES YES NO YES YES YES YES

24.0

4.20

13

29.0

5.20

13

31.0

7.20

13

29.0

9.20

13

27.1

1.20

13

29.0

1.20

14

26.0

3.20

14

Audit Committee Meetings

Renumeration Committee Meetings

Mr Edward Vitalis YES YES YES YESDr Jeremy Tankel YES NO NO YESMrs Clare Todd YES YES YES YES

28.0

5.20

13

17.0

9.20

13

19.1

1.20

13

18.0

2.20

14

Dr Hamish Stedman YESDr Mansel Haeney NOMr Paul Newman YESMrs Clare Todd YESMr Edward Vitalis YESMr Brian Wroe NO

09.0

7.20

13

64 65

PerformanceThe Membership Body and Governing Body’s performance including their assessment of their effectiveness:

The CCG’s performance is measured principally against the CCG Assurance Framework and the NHS constitutional rights measures and this is regularly reported at bi-monthly Governing Body meetings and discussed at scheduled Checkpoint (now Assurance meetings) with the NHS Greater Manchester Area Team.The latest balanced scorecard is available on our website at www.salfordccg.nhs.uk/ and is contained as an Appendix to the organisational peformance report to the Governing Body on 28th May 2014. This provides an overview of the CCG’s performance to the end of March 2014.

The quarterly Assurance meetings with the NHS Greater Manchester Area Team focuses upon how effective the CCG believes it has been, and will be in addressing past and future demands on the CCG and on the wider health and well being system in which the CCG plays a pivotal role.

All Governing Body papers are available on our website, http://www.salfordccg.nhs.uk/GoverningBodyMeetings.asp, and contain bi-monthly updates on the performance of the CCG and, relevant updates from quarterly Checkpoint (now Assurance) meetings with the Greater Manchester Area Team. Highlights of the work of all the above committees, sub-committees and joint committees follows.

Long Term Conditions (including End of Life Care)More than 70,000 Salford patients have a long term condition. Conditions like diabetes, asthma and COPD can seriously impact a person’s life, affecting the quality of their life and shortening their life expectancy. It is estimated patients with long term conditions account for 80% of GP consultations and 60% of hospital bed days.

A number of key projects have been implemented during 2013/14 to help people in l The launch of a new-style Diabetes Outreach Clinics for GPs to discuss their diabetic patients with consultant diabetologists ensuring a tailored approach to patient care and providing GPs with continuous learning and developmentl An increase in use of Salford’s Electronic Palliative Care Coordination System (EPaCCS) used by GPs, hospital and hospice doctors, nurses and social care staff. A growing number of Salford residents are being supported to complete Advance Care Plans and share the information through EPaCCS to ensure preferences and choices for end of life care are met wherever possible

Mental HealthAccording to the most recent Salford Mental Wellbeing Needs Assessment (2010), around 36,500 adults and 6,000 children living in Salford might have some kind of mental wellbeing need. During 2013/14, Salford CCG and Salford City Council launched the Integrated Mental Health Commissioning Strategy and established a Mental Health Commissioning Strategy Group to oversee the commissioning of mental health services in Salford for the next 5 years.

Pro

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Dr

Ham

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N

O

NO

Y

ES

YES

Y

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YES

N

O

NO

N

O

NO

N

O

NO

N

O

NO

Y

ES

NO

N

O

YES

N

OD

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nnet

te J

ohns

on

NO

N

O

YES

Y

ES

YES

Y

ES

YES

Y

ES

YES

Y

ES

YES

Y

ES

YES

N

O

YES

Y

ES

NO

N

O

YES

Dr

Paul

Bis

hop

YES

Y

ES

YES

N

O

YES

N

O

NO

Y

ES

YES

N

O

NO

N

O

YES

N

O

YES

Y

ES

NO

Y

ES

NO

Dr

Cliv

e Bo

yce

NO

Y

ES

YES

Y

ES

YES

Y

ES

NO

Y

ES

NO

Y

ES

YES

Y

ES

NO

Y

ES

YES

Y

ES

YES

Y

ES

YES

Dr

Baba

r Fa

rooq

Y

ES

NO

Y

ES

YES

Y

ES

YES

Y

ES

YES

Y

ES

YES

Y

ES

YES

Y

ES

YES

Y

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YES

N

O

YES

N

OD

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Pat

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YES

Y

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YES

Y

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NO

N

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Y

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YES

Y

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YES

Y

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YES

Y

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YES

Y

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YES

Y

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YES

Dr

Elai

ne T

amki

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O

YES

Y

ES

YES

Y

ES

NO

Y

ES

NO

Y

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YES

Y

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NO

N

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N

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N

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N

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YES

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N

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N

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N

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Y

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YES

Y

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YES

Y

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YES

Y

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NO

N

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NO

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YES

N

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YES

Y

ESM

rs G

unjit

Ban

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i Y

ES

YES

Y

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YES

N

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NO

N

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YES

Y

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YES

Y

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YES

Y

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YES

Y

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NO

N

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NO

Y

ESM

r A

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Cam

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O

YES

N

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NO

N

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N

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N

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N

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N

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NO

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YES

Y

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N

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YES

N

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NO

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NO

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YES

Y

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YES

N

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Y

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NO

Mrs

Kar

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roct

or

YES

Y

ES

YES

Y

ES

NO

Y

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YES

Y

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NO

Y

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YES

Y

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YES

Y

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YES

Y

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NO

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YES

Mrs

Fra

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orpe

N

A

NA

N

A

NA

N

A

NA

N

A

NA

N

A

NA

N

A

NA

N

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NA

Y

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YES

Y

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YES

Y

ESM

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laire

Vau

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Y

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YES

Y

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N

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YES

N

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Y

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YES

Y

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YES

Y

ES

05.06.2013

19.06.2013

03.07.2013

17.07.2013

07.08.2013

21.08.2013

04.09.2013

18.09.2013

02.10.2013

16.10.2013

06.11.2013

20.11.2013

04.12.2013

18.12.2013

15.01.2014

05.02.2014

19.02.2014

05.03.2014

19.03.2014

66 67

Key developments include:l An additional £1.3m invested in the Memory Assessment Treatment Service (MATS) to diagapse patients living with demential An additional £1.1m to develop and expand the Mental Health Liaison service providing rapid assessment and intervention for patients with mental health needs who go to Salford Royal’s emergency department or are admitted to a ward

Primary Care QualityThe CCG has a clear responsibility around improving and developing the quality of primary care general practice, to reduce variation ensuring that all people of Salford have access to the same high standard of care and to support our member practices to improve health outcomes. It is the ambition of the CCG to establish and work to a gold standard of service – the ‘Salford Standard’. In 2013/14, we:l Held a series of Quality Improvement workshops with GPs, Practice Managers and Practice Nurses to communicate the CCG strategic plans and to understand their priorities to driving quality improvementl Established a work programme focusing on patient safety, clinical effectiveness and patient experience

Children and Young PeopleThe CCG completed a comprehensive review of maternity services in Salford during 2013/14, which found they were of high quality and in line with good practice in the great majority of areas. A new project has now been established to set the tone for the service quality over the next five years and ensure that all parts of the service are geared to deliver the CCGs strategic priorities of reducing health inequalities and delivering the best possible start in life for Salford children.

We reviewed paediatric inpatient capacity to support our local PANDA (Paediatric Assessment and Diagapsis Area) unit and have successfully piloted an arrangement with Bolton NHS Foundation Trust to take secondary care patients from the unit. This ensured that, over the busy winter period, the small number of children and young people Yesending PANDA that needed to be transferred were all able to access a convenient local hospital.

Scheduled Care (including cancer)During the last year Salford CCG has worked to ensure Salford patients receive more care closer to home. In order to achieve this, we have reviewed hospital activity to make sure patients are not being followed up by hospitals more than would be expected, according to national ratios of first to follow up Appointments, and that, where Appropriate, procedures are conducted as day cases. During 2013/14 we:l Reviewed the pathway for the follow up of patients treated for prostate cancer. This identified how much the service is valued by patients and how much value the specialist nurses added to the pathway through providing links with social care and support groups, as well as telephone support.

l Designed and funded a pilot of a Cancer and Exercise service, ‘CAN Move’. This provides cancer patients with access to a specially trained physical health trainer and supports them in undertaking regular exercise through offering a 12-week structured exercise programme and one-to-one support to get people back into regular exercise. The CCG chose to trial this service because evidence shows that being active can help to reduce the risk of your cancer progressing or returning. Older peopleWe have been working with Salford City Council, SRFT and GMW to agree plans, pilot service changes and pool almost £100 million health and social care funding for older peoples services into a single budget.

The Integrated Care Programme for Older People has been piloted during 2013/14 in two Salford neighbourhoods, Swinton and Eccles, with proactive joint care planning and management for the over-65s. During 2014/15, the programme will be extended and expanded to cover the whole city. See Partnership Working for more details on Integrated Care for Older People.

Medicines managementMedicines are the most frequent health care intervention in the NHS which, if prescribed and taken correctly, can make a major impact to improve the health and wellbeing of a population. InAppropriate use of medicines can, however, result in unnecessary harm to patients, poorer outcomes and a financial risk to the CCG.

With this in mind, the Medicines Management team at the CCG have worked on several projects throughout 2013/14.

A key workstream this year was supporting delivery of the local quality premium work on improving the management of Atrial Fibrillation patients prescribed warfarin. This involved reviewing the control that all patients in Salford prescribed warfarin were achieving and intervening in those with poor control. We reviewed 696 patients with poor control and, by a variety of methods, improved this and improved outcomes and reduced harm for patients. We have engaged with our partner organisations and established networks in order to ensure that there is effective joint decision-making to deliver innovative, quality and safe prescribing and use of medicines across health care services. This has involved supporting the Greater Manchester Medicines Management Group (GMMMG) and its subgroups with GP, commissioner and medicines management input.

The Clinical Commissioning Group Risk Management FrameworkSalford Clinical Commissioning Group (SCCG) endeavours to provide a Risk Management Strategy that minimises risks to all its stakeholders through a comprehensive system of internal controls whilst providing maximum potential for flexibility, innovation and best practice in the delivery of its strategic objectives.

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SCCG Board seeks to gain assurance that all health services commissioned for the population of Salford are of a good quality and that any known risks to patients, staff and/or the organisation are managed Appropriately using a precise method of risk identification, assessment, treatment, monitoring and reporting.

The Risk Review schedule frequency is determined by the Risk Policy, in accordance with risk rating;l Weekly Review = Extreme rated risksl Monthly Review = High rated risksl Bi Monthly = Moderate rated risksl Quarterly = Low rated risks

Risks may also be subject to ad-hoc review if so required.

Any risk review that exceeds 28 days overdue is also notified to the CCG Head of Corporate Services for further escalation.

The Risk Assurance Framework (consisting of a Board Paper and a summary of the high and extreme risks) is submitted on a monthly basis to the Executive Team, on a bi monthly basis to the Governing body and annual basis to the Audit Committee.

The Clinical Commissioning Group Internal Control FrameworkA system of internal control is the set of processes and procedures in place in the clinical commissioning group to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically.

The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it can therefore only provide reasonable and not absolute assurance of effectiveness.

The committee and reporting structures of the CCG provide the basis of the framework and process that maintains, monitors and reviews the effectiveness of the system of internal control and risk management. The governance structure and sub-committees comprise of a mix of senior managers, clinical professionals, independent contractors and internal audit representation to ensure effective balance between the membership, executive and audit functions and that decision making is effectively triangulated. The Governing Body’s role is to provide active leadership of the CCG within a framework of prudent and effective controls that enable risk to be managed. The assurance framework was first agreed by the Governing Body at its meeting in July 2013.

The Board Assurance Framework itself provides the Governing Body with high level assurance of the progress of achievement of the CCG’s aims, objectives and priorities within a robust risk based framework; and the Governing Body also receives regular reports giving internal assurances on financial, organisational and quality performance.

The audit committee advises the Governing Body on the effectiveness of the system of internal control by the review of the internal audit report, external audit report and the Assurance Framework. Any significant control issues would be reported to the Governing Body by the Audit Committee.

Information GovernanceThe 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.

We place high importance on ensuring there are robust information governance systems and processes in place to help protect patient and corporate information. We have established an information governance management framework and have developed information governance processes and procedures in line with the information governance toolkit. We have ensured all staff undertake annual information governance training to ensure staff are aware of their information governance roles and responsibilities; and there are processes in place for incident reporting and investigation of serious incidents.

We have developed information risk assessment and management procedures and a programme will be established to fully embed an information risk culture throughout the organisation.

Moreover, I can confirm that we have not had any significant breaches in IG (as outlined in the report to our Governing Body on 26th March 2014). We have undertaken a pro-active Approach as a CCG to Information Governance - notably in the development of policies and procedures, design and delivery of training, developing and conducting audits. As a CCG we are compliant with the Information Governance toolkit and have been awarded Accredited Safe Haven status by the Information Commission.

Pension ObligationsAs an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the scheme regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments into the scheme are in accordance with the scheme rules, and that member pension scheme records are accurately updated in accordance with the timescales detailed in the regulations.

Equality, Diversity & Human Rights ObligationsControl measures are in place to ensure that the clinical commissioning group complies with the required public sector equality duty set out in the Equality Act 2010.

Sustainable Development ObligationsThe clinical commissioning group is required to report its progress in delivering against sustainable development indicators.

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We are developing plans to assess risks, enhance our performance and reduce our impact, including against carbon reduction and climate change adaptation objectives. This includes establishing mechanisms to embed social and environmental sustainability across policy development, business planning and in commissioning.

We will ensure the clinical commissioning group complies with its obligations under the Climate Change Act 2008, including the Adaptation Reporting power, and the Public Services (Social Value) Act 2012.

We are also setting out our commitments as a socially responsible employer.

Risk Assessment in Relation to Governance, Risk Management and Internal ControlSalford CCG quantifies risk in terms of both opportunities and threats. At 31st March 2014 the CCG had thirteen opportunity risks and twenty four threat risks.

Of the threat risks, none are rated as extreme risks and five are rated as ‘high’ risk. The table below details these five high risks and their management and assessment plans.

Mersey Internal Audit is the Appointed auditor for Salford CCG, and in August 2013 Audit No 509SCCG_1314_005 was undertaken upon the Risk Management systems of Salford CCG. The Final audit report gave “Significant Assurance” upon the quality of the Risk Management System.

Salford CCG is not reporting any materialised Risks that have caused any significant issues.

Review of Economy, Efficiency and Effectiveness of the Use of ResourcesThe Governing Body and it’s committees and sub committees receive proposals that have been based upon evidenced based commissioning intentions. A wide variety of sources of data are used to inform the development of commissioning intentions, but chief amongst these is the Joint Strategic Needs Assessment. Summary business cases are also provided for each commissioning intention drafted that comprises an assessment of the cost benefit analysis of the proposal and a risk assessment.

The Audit Committee provides the assurance overview for the effective use of resources, and Internal Audit have an annual work programme that complements that role and focuses upon all work areas covered by the CCG.

While clinical commissioning groups have a responsibility to promote comprehensive healthcare within the resources available, this does not mean an obligation to provide every treatment. Commissioners are entitled to take into account the resources available to them and the competing demands on those resources.

GMCSU’s Effective Use of Resources team works closely with Salford CCG to facilitate and support making those judgments at an individual patient level (IFRs).

GMCSU’s Effective Use of Resources team combine regional best practice and benchmarking with local knowledge gained from a strong client relationship and deep knowledge and expertise. A regional overview improves consistency across boundaries, leading to an improved patient experience.

The experienced team employ internationally-used evidence and best practice Approaches to make sure that the decision-making throughout the commissioning process from Governing Body, through sub committees and working groups and Executives is consistent, fair and of a high quality. This ensures that constrained resources can be reallocated to where they are most needed to support key strategic plans.

GMCSU also works with us and our stakeholders to improve the level of understanding of the rationale behind not choosing to commission clinically-unsound and/or expensive interventions, leading to greater acceptance and satisfaction. To assist with achieving this, the GMCSU also works closely with communications colleagues to manage media and reputation management issues based on commissioning decisions informed by the EUR team.

Policy recommendations are developed for CCG approval that will provide a consistent Approach to the commissioning of procedures of limited clinical value, services for rare and unusual conditions and services provided in predefined circumstances.

Individual Funding Request (IFR): administering the process to identify those individuals who should receive care based on the EUR policies. In addition the service supports the running of IFR Panels in each CCG to process requests that are an exception to agreed commissioning policies.

RISK ID CURRENT RATING

CURRENT YEAR RISK

TARGET RATING

FUTURE YEAR RISK

RISK DESCRIPTION EXISTING CONTROLS IN PLACE TREATMENT ACTION

54

52

49

24

12

15

12

12

12

12

3

4

12

12

12

NO

YES

YES

YES

YES

YES

YES

YES

YES

TBC

If the expected vacancy on SCCG Governing body of Local Authority Liaison Lead from 1 April is not filled, then the CCG’s co-operation and interaction with the Local Authority will be reduced, so resulting in sup-optimal Commissioning, reduced patient outcomes and reduced financial efficiency.

If SCCG does not reasonably engage with patient and carer reps from each of the 9 protected groups to ascertain from the earliest stages of consideration any potential adverse impacts upon them in the provision of services, then SCCG will not be able to reasonably consider and potentially mitigate against potential adverse impacts in the commissioning cycle, so this may lead to sup-optimal commissioning decisions, adverse impacts upon protected groups and non-compliance with the public sector equality duty and the requirements to evidence ‘due regard’.

If the current lack of GM wide clarity between CCG’s and GM Area Team, in relation to safeguarding roles and responsibilities continues, then there is a danger that safeguarding issues will not be effectively identified and managed, so there may be an adverse effect on the safeguarding team if a serious incident occurs.

If there is a disruption to the IM&T service then there may be delays and/ or failures in the communication of clinical data so patient harm may occur

If the CSU cannot recruit and retain the right staff then the CCG may not get sufficient support so our objectives may not be met.

Other CCG members can cover various element of the role, but could not cover all aspects. Various actions have been taken to encourage application to this role, including reducing the number of sessions. Vacancy has been shared with all CCG members. Individuals with particular interest have been approached individually.

Equality Analysis process embedded into practice. NHS England’s Equality Delivery System 2 (EDS2) used by CCG/Annual Equality Data Publication published each January. Regular meetings with CCG link and CSY regarding EDHR service delivery.Equality Objectives to be delivered over a 4 year cycle 2013-17 were set by local interest groups (April 2011, reviewed Oct 2013)Governing Body have received EDHR Awareness Development session.EDHR Staff Compliance training in place.EDHR staff briefings available.

Designated Nurse influence in GM Safeguarding groups and CCG Senior Management influence with GM Area team.

Holding project to account through the Salford IM&T Board which meet monthly

Internally review CSU Performance. Executive Director from CSU attends Leadership team meetings, action plans to address areas of concern. NHS England survey satisfaction returns. One to ones with product leads.

Identify and recruit a new Local Authority Liaison Lead.

Undertake demographic assessment to identify substantive ‘protected groups’ within the CCG area and then ensure that the engagement process has taken place with the patient and carer reps from each identified ‘protected group’. Evidence of this specific patient and carer voice shaping inclusive services with CCG key decision makers.

Salford CCG cannot resolve this risk, so seek to share / transfer risk with GM Area Team. Continue to raise this issue with GM Area Team through available channels and encourage other GM CCG’s to undertake similar action.

Accept risk at the current level.

Accept this risk, if risk continues at this level for 12 months - look to avoid risk by sourcing alternative providers.

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Robust processes are in place to inform our work, with an overarching operational policy supported by a detailed operational procedure for all requests. This means that the Appropriate decision based on clinical-evidence and cost-effectiveness will be delivered.

Review of the Effectiveness of Governance, Risk Management and Internal ControlAs Accounting Officer I have responsibility for reviewing the effectiveness of the system of internal control within the clinical commissioning group.

Capacity to Handle RiskAn integral part of an effective risk management framework is having explicit accountabilities for risk. Every member of staff employed by, working on behalf of or engaged in the activities of SCCG has a collective and an individual responsibility for the management of risk within their own remit. With this in mind, every individual should make an effort to familiarise themselves with this Risk Management Strategy and the associated Risk Management Handbook (Policy).

Salford CCG has a duty to assure itself that the organisation has properly identified the risks it faces and that it has Appropriate controls in place to manage those risks. The Board is specifically responsible for: n Defining the Strategic Aims and Objectives of the CCG, n Demonstrating leadership, active involvement and support for risk management, n Ensuring that there is a structure in place for the effective management of risk throughout the CCG, n Reviewing and approving SCCG’s Risk Management Framework on an annual basis, n Agreeing policies and procedures for the management of risk within SCCG, n Identifying the key strategic risks, evaluating them and ensuring adequate responses are in place and are monitored, n Deciding whether SCCG will use the risk pooling schemes administered by the NHS Litigation Authority or self-insure for some or all of the risks (where discretion is allowed), n Monitoring ‘Extreme’ risks (risks scoring 16+) via the Dashboard.

The Executive Team is responsible for compliance with statutory and regulatory duties, operational delivery of all CCG functions and performance management of the objectives of the organisation. It is also specifically responsible for the functions of health, safety and risk, information management and technology (IM&T) including information governance, equality and diversity and health economy resilience. The Executive Team is specifically responsible for:

n Demonstrating leadership, active involvement and support for risk management, n Supporting the board in Identifying the key strategic risks, evaluating them and ensuring adequate responses are in place and are monitored,

n Reviewing SCCG’s Risk Management Framework, on an annual basis and providing comments and recommendations to the Board, n Ensuring that SCCG’s Risk Management Strategy is Applied consistently throughout the CCG, n Monitoring ‘High’ risks (risks scoring 12+) via the Board Assurance Framework. The Chief Operating Officer as the Accountable Officer has responsibility for having an effective risk management system in place within the organisation, for meeting all statutory requirements and adhering to guidance issued by the Department of Health in respect of Governance. The Chief Operating Officer is specifically responsible for: n Ensuring there is a Risk Management Strategy in place, n Ensuring there is an assurance framework meeting best practice standards, that is reviewed at least annually by SCCG, n Ensuring that SCCG keeps an active risk register which is reviewed at least quarterly by the audit committee, n Ensuring that a Risk Management Policy is in place and in use, that describes how risks are identified, graded, escalated and how the assurance framework is populated. The SCCG Chair is specifically responsible for: n Ensuring that SCCG has proper constitutional and governance arrangements in place, n Implementing the requirements of Corporate Governance. The Chief Finance Officer is specifically responsible for: n Overseeing the robust audit and governance arrangements, leading to propriety in the use of the group’s resources. To ensure the successful communication and implementation of this strategy and the Risk Management Handbook (Policy), all staff working for or on behalf of SCCG will receive risk management training relevant to their role and responsibilities within the organisation. Specific Training and Awareness events include: n A Risk Identification Workshop will be conducted with SCCG Board on an annual basis, n Risk Assessment one to ones will be conducted with Risk Owners as and when required, n Risk Treatment one to ones will be conducted with Risk Owners as and when required, n Risk Management introduction and subsequent refresher courses will be available on request, n Risk Management Strategy and Handbook will be made available on SCCG website.

All SCCG Staff and its contractors are required to: n Be responsible for security of SCCG’s property, avoiding loss, exercising economy and efficiency in using resources and conforming to Standing Orders, Standing Financial Instructions and financial procedures,

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n Be responsible for Yesending and maintaining a personal record of induction, mandatory and relevant education and training events in relation to Risk Management, n Seek to understand SCCG’s Risk Management Strategy and use the Risk Management Handbook (Policy) to Apply its principles in practice, n Participate in the risk management process, including risk assessment within their own area of work, n Notify their line manager of any perceived risk which may not have been assessed.

A Risk Management Handbook has been developed and forms part of the overall Risk Management Framework of SCCG; it describes the standard operating procedures involved in the identification and management of risk at all levels across the organisation, in pursuit of its Vision, Strategic Aims and Objectives.

Specifically, this Risk Management Handbook will help to ensure that: n All staff have a resource available to support them in the management of risk, n All staff understand how to Apply the principles of SCCG’s Risk Management Strategy, in their own areas of work, n All staff Apply consistent methods of risk management practice across the organisation.

Application of the methods detailed in this Risk Management Handbook (Policy) will support a cultural shift towards more a risk aware organisation that embraces responsible and calculated risk-taking.

Review of EffectivenessMy review of the effectiveness of the system of internal control is informed by the work of the internal auditors and the executive managers and clinical leads within the clinical commissioning group who have responsibility for the development and maintenance of the internal control framework. I have drawn on performance information available to me. My review is also informed by comments made by the external auditors in their management letter and other reports.

The Board Assurance Framework itself provides me with evidence that the effectiveness of controls that manage risks to the clinical commissioning group achieving its principles objectives have been reviewed.

I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Governing Body, the Audit Committee and, the Programme Management Group and a plan to address weaknesses and ensure continuous improvement of the system is in place.There are effective governance arrangements in place, underpinned by a committee structure that provides routine assurances to the Governing Body that significant risks to the CCG are being managed.

The committee and reporting structures of the CCG provide the framework and process that maintains, monitors and reviews the effectiveness of the system of internal control and risk management. The governance structure and sub-committees comprise of a mix of senior managers, clinical professionals, independent contractors and internal audit representation.

The Governing Body’s role is to provide active leadership of the CCG within a framework of prudent and effective controls that enable risk to be managed. The assurance framework was first agreed by the Governing Body at its meeting in July 2013. Extreme risks are reported to each meeting of the Governing Body and identify gaps in controls and assurances to agree and review actions. The Governing Body also receives regular reports giving internal assurances on financial, organisational and quality performance.

The audit committee is pivotal in advising the Governing Body on the effectiveness of the system of internal control by the review of the internal audit report, external audit report and the Assurance Framework. Any significant control issues woud be reported to the Governing Body by the Audit Committee.

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 OpinionThe full report of the Head of Internal Audit is provided at Appendix 1 via www.salfordccg.nhs.uk/ In summary, the Head of Internal Audit’s overall opinon is:

“Significant Assurance, can be given that that there is a generally sound system of internal control designed to meet the organisation’s objectives, and that controls are generally being Applied consistently. However, some weaknesses in the design or inconsistent Application of controls put the achievement of particular objective at risk.”

During the year Internal Audit issued two audit reports with a conclusion of limited assurance; there were no reports with a conclusion of no assurance. The limited assurance reports reviewed conflicts of interest and continuing healthcare and good progress has been made in implementing the recommendations, all of which were accepted by management.

The CCG contracts with the Greater Manchester Commissioning Support Unit (GM CSU) for a number of services and so the CCG’s internal control environment is dependent on controls in place at the GM CSU. The CCG obtains assurance from the GM CSU’s internal auditors on the operation of internal controls in the form of a service auditor report.

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The overall objective of the internal audit work undertaken was to evaluate the effectiveness of the control environment for the GM CSU and provide assurance, to the GM CSU and therefore NHS England, on the adequacy and effectiveness of the key controls in operation. In addition, through the performance of the assignment an assessment was provided with respect to the readiness of the processes and controls operated at the CSU for a service auditor report.

GM CSU management have provided assurance as to actions taken to address the service auditor’s recommendations, and a follow up report will be issued to the CCG in May 2014 by GM CSU internal audit. It is recognised that 2013-14 is the first year of GM CSU’s operation and that continuous improvements in internal controls are expected over time.

Data QualityData provided to the membership and the Governing Body to inform decision making has a high degree of provenance. It is obtained from trusted sources: NHS data sets; NICE; the Joint Strategic Needs Assessment (JSNA) etc., and from trusted advisers: the Greater Manchester Commissioning Support Unit (GMCSU); the NHSLA; the NHSBA etc.

The Audit Committee and Internal Audit play pivotal roles in assuring and challenging - where relevant - the the data and assumptions made from that data in reports destined for the Governing Body and other decision making committees or sub groups of the Governing Body.

Business Critical ModelsHaving reviewed the Macpherson report, the Business Critical Model section appears to Apply to Government Departments and their arms length bodies (NHSE) only. A statement has therefore not been included in this Annual Governance Statement concerning Business Critical Models. https://www.gov.uk/government/uploads/system/uploads/Yesachment_data/file/206946/review_of_qa_of_govt_analytical_models_final_report_040313.pdf

https://www.gov.uk/government/organisations/department-of-health/about/our-governance”

Data SecurityWe have submitted a satisfactory level of compliance with the information governance toolkit assessment. The full details of our compliance with Information Governance Toolkit is contained in a report to our Governing Body held on 26th March, 2014, and is available on our website.

I can confirm that there have been no Serious Untoward Incidents relating to data security breaches.

Discharge of Statutory FunctionsDuring establishment, the arrangements put in place by the clinical commissioning group and explained within the Corporate Governance Framework were developed with extensive expert external legal input, to ensure compliance with the all relevant legislation. That legal advice also informed the mYesers reserved for Membership Body and Governing Body decision and the scheme of delegation.

In light of the Harris Review, the clinical commissioning group has reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislative and regulations. As a result, I can confirm that the clinical commissioning group is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions.

Responsibility for each duty and power has been clearly allocated to a lead Director. Directorates have confirmed that their structures provide the necessary capability and capacity to undertake all of the clinical commissioning group’s statutory duties.

ConclusionNo significant issues have occurred during 2013/14 which would have a significant impact upon the organisation. My review confirms that Salford CCG has a generally sound system of internal control that supports the achievement of its policies, aims and objectives.

Alan CampbellAccountable Officer4th June 2014

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Independent Auditor’s Report to the Members of Salford CCGWe have audited the financial statements of Salford Clinical Commissioning Group for the year ended 31 March 2014 under the Audit Commission Act 1998. The financial statements comprise the Statement of Comprehensive Net Expenditure, the Statement of Financial Position, the Statement of Changes in Taxpayers’ Equity, the Statement of Cash Flows and the related notes. The financial reporting framework that has been applied in their preparation is applicable law and the accounting policies directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service in England.

We have also audited the information in the Remuneration Report that is subject to audit, being:l the table of salaries and allowances of senior managers [and related narrative notes] on page 48.l the table of pension benefits of senior managers [and related narrative notes] on page 49.l the table of pay multiples [and related narrative notes] on page 46.

This report is made solely to the members of Salford Clinical Commissioning Group in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 44 of the Statement of Responsibilities of Auditors and Audited Bodies published by the Audit Commission in March 2014. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Clinical Commissioning Group (CCG)’s directors and the CCG as a body, for our audit work, for this report, or for opinions we have formed.

Respective responsibilities of the Accountable Officer and auditorsAs explained more fully in the Statement of Accountable Officer’s Responsibilities, the Accountable Officer is responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view. Our responsibility is to audit and express an opinion on the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards also require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors.

Scope of the audit of the financial statementsAn audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of: whether the accounting policies are appropriate to the CCG’s circumstances and have been consistently applied and adequately disclosed; the reasonableness of significant accounting estimates made by the CCG; and the overall presentation of the financial statements. In addition, we read all the financial and non-financial information in the annual report which comprises the Member Practices Introduction, the Strategic Report, Remuneration Report, Sustainability Report, Statement of Accountable Officer’s Responsibilities, and the Annual Governance Statement to identify material inconsistencies with the audited financial statements and to identify any information that is apparently materially incorrect based on, or materially

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inconsistent with, the knowledge acquired by us in the course of performing the audit. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report.

In addition, we are required to obtain evidence sufficient to give reasonable assurance that the expenditure and income reported in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them.

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

Opinion on financial statementsIn our opinion the financial statements:• give a true and fair view of the financial position of Salford Clinical Commissioning Group as at 31 March 2014 and of its net operating costs for the year then ended; and• have been prepared properly in accordance with the accounting policies directed by the NHS Commissioning Board with the approval of the Secretary of State.

Opinion on other mattersIn our opinion:the part of the Remuneration Report subject to audit has been prepared properly in accordance with the requirements directed by the NHS Commissioning Board with the approval of the Secretary of State; andthe information given in the annual report for the financial year for which the financial statements are prepared is consistent with the financial statements.

Matters on which we report by exceptionWe report to you if:l in our opinion the governance statement does not reflect compliance with NHS England’s Guidance;l we refer the matter to the Secretary of State under section 19 of the Audit Commission Act 1998 because we have reason to believe that the CCG, or an officer of the CCG, is about to make, or has made, a decision involving unlawful expenditure, or is about to take, or has taken, unlawful action likely to cause a loss or deficiency; orl we issue a report in the public interest under section 8 of the Audit Commission Act 1998. We have nothing to report in these respects.

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Conclusion on the CCG’s arrangements for securing economy, efficiency and effectiveness in the use of resourcesWe are required under Section 5 of the Audit Commission Act 1998 to satisfy ourselves that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. The Code of Audit Practice issued by the Audit Commission requires us to report any matters that prevent us being satisfied that the audited body has put in place such arrangements.

We have undertaken our audit in accordance with the Code of Audit Practice, having regard to the guidance issued by the Audit Commission in October 2013. We have considered the results of the following:l our review of the Governance Statement; andl the work of other relevant regulatory bodies or inspectorates, to the extent that the results of this work impact on our responsibilities at the CCG. As a result, we have concluded that there are no matters to report. CertificateWe certify that we have completed the audit of the accounts of Salford Clinical Commissioning Group in accordance with the requirements of the Audit Commission Act 1998 and the Code of Audit Practice issued by the Audit Commission.

Mick Waite for and on behalf of Grant Thornton UK LLP, Appointed Auditor4 Hardman Square Spinningfields Manchester M3 3EB

4 June 2014

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Summary of AccountsForeword to the AccountsThe clinical commissioning group was licenced from 1 April 2013 under provisions enacted in the Health & Social Care Act 2012, which amended the National Health Service Act 2006

These accounts for the year ended 31 March 2014 have been prepared by NHS Salford Clinical Commissioning Group under section 17 of schedule 1A of the National Health Service Act 2006 (as amended) in the form which the Secretary of State has, with the approval of the Treasury, directed.

The National Health Service Act 2006 (as amended) requires Clinical Commissioning Groups to prepare their Annual Report and Annual Accounts in accordance with Directions issued by NHS England.

In accordance with these Directions, as Clinical Commissioning Groups were established on 1st April 2013, no prior year information is required.

Statement of Comprehensive Net Expenditure for the year ended31 March 2014

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Statement of Financial Position as at 31 March 2014 Statement of Changes of Taxpayers Equity for the year ended 31 March 2014

The notes on pages 85 to 116 form part of this statement.

The financial statements on pages 81 to 116 were approved by the membership on 4th June 2014 and signed on its behalf by:

Alan CampbellAccountable Officer4th June 2014

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Statement of Cash flows for the year ended 31 March 2014Notes to the Financial Statements1. Accounting PoliciesNHS England has directed that the financial statements of clinical commissioning groups shall meet the accounting requirements of the Manual for Accounts issued by the Department of Health. Consequently, the following financial statements have been prepared in accordance with the Manual for Accounts 2013-14 issued by the Department of Health. The accounting policies contained in the Manual for Accounts follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to clinical commissioning groups, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Manual for Accounts permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the clinical commissioning group for the purpose of giving a true and fair view has been selected. The particular policies adopted by the clinical commissioning group are described below. They have been applied consistently in dealing with items considered material in relation to the accounts.

The accounting arrangements for balances transferred from predecessor PCTs (“legacy” balances) are determined by the Accounts Direction issued by NHS England on 12 February 2014. The Accounts Directions state that the only legacy balances to be accounted for by the CCG are in respect of property, plant and equipment (and related liabilities) and inventories. All other legacy balances in respect of assets or liabilities arising from transactions or delivery of care prior to 31 March 2013 are accounted for by NHS England. The impact of the legacy balances accounted for by the CCG is disclosed in note 1.3 to these financial statements. The CCG’s arrangements in respect of settling NHS Continuing Healthcare claims are disclosed in note17 to these financial statements.

In accordance with the Directions issued by NHS England comparative information is not provided in these Financial Statements.

1.1. Going ConcernThese 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.

1.2. Accounting ConventionThese 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 GroupTransfers 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.

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by clinical commissioning groups with the exception of those listed below. In addition, no transactions relating to the discharge of liabilities or realisation of assets transferred to clinical commissioning groups in accordance with transfer orders issued under the Health and Social Care Act 2012 are to be accounted for by clinical commissioning groups.

l Inventories, non-current assets and their closely related liabilities (meaning those specific liabilities which represent the financing or similar liabilities incurredin the purchase or leasing of those non-current assets) transferred to clinical commission-ing groups in accordance with transfer orders issued under the Health and Social Care Act 2012 are to be accounted for by the clinical commissioning group.

l Provisions for Continuing Healthcare Claims, although they may be non-current in nature, are to be accounted for in the financial statements of NHS England.

l The calculation of running costs has been undertaken in accordance with NHS England national guidance and definitions. However the application of the rules for each organisation involves an application of professional judgement to particular circumstances

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:

l Due to the NHS England deadline for the submission of the accounts, actual information is not available for the full 12 months for some material expenditure such as prescribing expenditure and secondary care incomplete spells of treatment. The CCG therefore estimates one or two months of expenditure in some areas using historical information, in year trends and any other available information sources.

l Amounts included in provisions include an element of uncertainty around both the amount and timing of the likely liability occurring. They are also frequently, but not necessarily, one-off or unusual items for which there are fewer comparisons. The CCG currently provides for termination costs in respect of the merger of Trafford Healthcare NHS Trust (now demised) with Central Manchester Foundation Trust, where future redundancy and restructuring costs are estimated but not yet certain.

1.6 RevenueRevenue in respect of services provided is recognised when, and to the extent that, performance occurs, and is measured at the fair value of the consideration receivable.Where income is received for a specific activity that is to be delivered in the following year, that income is deferred.

1.7 Employee Benefits

1.7.1 Short-term Employee Benefits

Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees, including bonuses earned but not yet taken.

The Government Financial Reporting Manual does not require retrospective adoption, so prior year transactions (which have been accounted for under merger accounting) have not been restated. Absorption accounting requires that entities account for their transactions in the period in which they took place, with no restatement of performance required when functions transfer within the public sector. Where assets and liabilities transfer, the gain or loss resulting is recognised in the Statement of Comprehensive Net Expenditure, and is disclosed separately from operating costs.

Other transfers of assets and liabilities within the Department of Health Group are accounted for in line with IAS 20 and similarly give rise to income and expenditure entries.

For transfers of assets and liabilities from those NHS bodies that closed on 1 April 2013, HM Treasury has agreed that a modified absorption approach should be applied. For these transactions only, gains and losses are recognised in reserves rather than the Statement of Comprehensive Net Expenditure.

1.4. Pooled BudgetsThe CCG has entered into a pooled budget with Salford City Council Local Authority. Under the arrangement funds are pooled under S75 of the NHS Act 2006 for Learning Disabilities, Integrated Equipment services and Intermediate Care. A memorandum note to the accounts provides details of the joint income and expenditure.

The pools are hosted by Salford City Council. As a commissioner of healthcare services, the CCG makes contributions to the pools, which are then used to purchase healthcare services. The CCG accounts for its share of the assets, liabilities, income and expenditure of the pools as determined by the pooled budget agreements.

1.5. Critical Accounting Judgements & Key Sources of Estimation UncertaintyIn 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 below) that management has made in the process of applying the clinical commissioning group’s accounting policies that have the most significant effect on the amounts recognised in the financial statements:

l In accordance with Accounts Directions issued by NHS England, no assets and liabilities transferred to clinical commissioning groups in accordance with transfer orders issued under the Health and Social Care Act 2012 are to be accounted for

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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 Pensions Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the clinical commissioning group of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period.

For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to expenditure at the time the clinical commissioning group commits itself to the retirement, regardless of the method of payment.

1.8 Other CostsOther operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable.

Expenses and liabilities in respect of grants are recognised when the clinical commissioning group has a present legal or constructive obligation, which occurs when all of the conditions attached to the payment have been met.

1.9 Property, Plant & Equipment

1.9.1 Recognition

Property, plant and equipment is capitalised if: l It is held for use in delivering services or for administrative purposes; l It is probable that future economic benefits will flow to, or service potential

will be supplied to the clinical commissioning group; l It is expected to be used for more than one financial year; l The cost of the item can be measured reliably; and, l The item has a cost of at least £5,000; or, l 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,

l 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.

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1.9.2 Valuation

All property, plant and equipment are measured initially at cost, representing the cost directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. All assets are measured subsequently at fair value.

Land and buildings used for the clinical commissioning group’s services or for administrative purposes are stated in the statement of financial position at their re-valued amounts, being the fair value at the date of revaluation less any impairment.

Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that would be determined at the end of the reporting period. Fair values are determined as follows:

l Land and non-specialised buildings – market value for existing use; and, l Specialised buildings – depreciated replacement cost.

HM Treasury has adopted a standard approach to depreciated replacement cost valuations based on modern equivalent assets and, where it would meet the location requirements of the service being provided, an alternative site can be valued.

Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost includes professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for assets held at fair value. Assets are re-valued and depreciation commences when they are brought into use.

Fixtures and equipment are carried at depreciated historic cost as this is not considered to be materially different from fair value.

An increase arising on revaluation is taken to the revaluation reserve except when it reverses an impairment for the same asset previously recognised in expenditure, in which case it is credited to expenditure to the extent of the decrease previously charged there. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Gains and losses recognised in the revaluation reserve are reported as other comprehensive income in the Statement of Comprehensive Net Expenditure.

1.9.3 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.

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1.10 Intangible Assets

1.10.1 Recognition

Intangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the clinical commissioning group’s business or which arise from contractual or other legal rights. They are recognised only:

l When it is probable that future economic benefits will flow to, or service potential be provided to, the clinical commissioning group;

l Where the cost of the asset can be measured reliably; and, l Where the cost is at least £5,000.

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

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

l The intention to complete the intangible asset and use it; l The ability to sell or use the intangible asset; l How the intangible asset will generate probable future economic benefits or

service potential; l The availability of adequate technical, financial and other resources to complete

the intangible asset and sell or use it; and, l The ability to measure reliably the expenditure attributable to the intangible

asset during its development.

1.10.2 Measurement

The amount initially recognised for internally-generated intangible assets is the sum of the expenditure incurred from the date when the criteria above are initially met. Where no internally-generated intangible asset can be recognised, the expenditure is recognised in the period in which it is incurred.

Following initial recognition, intangible assets are carried at fair value by reference to an active market, or, where no active market exists, at amortised replacement cost (modern equivalent assets basis), indexed for relevant price increases, as a proxy for fair value. Internally-developed software is held at historic cost to reflect the opposing effects of increases in development costs and technological advances.

1.11 Depreciation, Amortisation & ImpairmentsFreehold land, properties under construction, and assets held for sale are not depreciated.

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Otherwise, depreciation and amortisation are charged to write off the costs or valuation of property, plant and equipment and intangible non-current assets, less any residual value, over their estimated useful lives, in a manner that reflects the consumption of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over which the clinical commissioning group expects to obtain economic benefits or service potential from the asset. This is specific to the clinical commissioning group and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are depreciated over their estimated useful lives.

At each reporting period end, the clinical commissioning group checks whether there is any indication that any of its tangible or intangible non-current assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its amount. Intangible assets not yet available for use are tested for impairment annually.A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Where an impairment loss subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the recoverable amount but capped at the amount that would have been determined had there been no initial impairment loss. The reversal of the impairment loss is credited to expenditure to the extent of the decrease previously charged there and thereafter to the revaluation reserve.

1.12 Donated AssetsDonated non-current assets are capitalised at their fair value on receipt, with a matching credit to Income. They are valued, depreciated and impaired as described above for purchased assets. Gains and losses on revaluations, impairments and sales are as described above for purchased assets. Deferred income is recognised only where conditions attached to the donation preclude immediate recognition of the gain.

1.13 Government GrantsThe value of assets received by means of a government grant are credited directly to income. Deferred income is recognised only where conditions attached to the grant preclude immediate recognition of the gain.

1.14 Non-current Assets Held For SaleNon-current assets are classified as held for sale if their carrying amount will be recovered principally through a sale transaction rather than through continuing use. This condition is regarded as met when:

l The sale is highly probable; l The asset is available for immediate sale in its present condition; and, l Management is committed to the sale, which is expected to qualify for

recognition as a completed sale within one year from the date of classification.

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Non-current assets held for sale are measured at the lower of their previous carrying amount and fair value less costs to sell. Fair value is open market value including alternative uses.

The profit or loss arising on disposal of an asset is the difference between the sale proceeds and the carrying amount and is recognised in the Statement of Comprehensive Net Expenditure. On disposal, the balance for the asset on the revaluation reserve is transferred to the general reserve.

Property, plant and equipment that is to be scrapped or demolished does not qualify for recognition as held for sale. Instead, it is retained as an operational asset and its economic life is adjusted. The asset is de-recognised when it is scrapped or demolished.

1.15 LeasesLeases 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.

1.15.1 The Clinical Commissioning Group as Lessee

Property, plant and equipment held under finance leases are initially recognised, at the inception of the lease, at fair value or, if lower, at the present value of the minimum lease payments, with a matching liability for the lease obligation to the lessor. Lease payments are apportioned between finance charges and reduction of the lease obligation so as to achieve a constant rate on interest on the remaining balance of the liability. Finance charges are recognised in calculating the clinical commissioning group’s surplus/deficit.

Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term.

Contingent rentals are recognised as an expense in the period in which they are incurred.

Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether they are operating or finance leases.

1.15.2 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.

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.

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1.16 Cash & Cash EquivalentsCash 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.

1.17 ProvisionsProvisions are recognised when the clinical commissioning group has a present legal or constructive obligation as a result of a past event, it is probable that the clinical commissioning group will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties. Where a provision is measured using the cash flows estimated to settle the obligation, its carrying amount is the present value of those cash flows using HM Treasury’s discount rate as follows:

l Timing of cash flows (0 to 5 years inclusive): Minus 1.90% l Timing of cash flows (6 to 10 years inclusive): Minus 0.65% l Timing of cash flows (over 10 years): Plus 2.20% l All employee early departures: 1.80%

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

A restructuring provision is recognised when the clinical commissioning group has developed a detailed formal plan for the restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by starting to implement the plan or announcing its main features to those affected by it. The measurement of a restructuring provision includes only the direct expenditures arising from therestructuring, which are those amounts that are both necessarily entailed by the restructuring and not associated with on-going activities of the entity.

1.18 Clinical Negligence CostsThe NHS Litigation Authority operates a risk pooling scheme under which the clinical commissioning group pays an annual contribution to the NHS Litigation Authority which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although the NHS Litigation Authority is administratively responsible for all clinical negligence cases the legal liability remains with the clinical commissioning group.

1.19 Non-clinical Risk PoolingThe 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

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commissioning group pays an annual contribution to the NHS Litigation Authority and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due.

1.20 ContingenciesA contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the clinical commissioning group, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or the amount of the obligation cannot be measured sufficiently reliably. A contingent liability is disclosed unless the possibility of a payment is remote.

A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the clinical commissioning group. A contingent asset is disclosed where an inflow of economic benefits is probable.

Where the time value of money is material, contingencies are disclosed at their present value.

1.21 Financial AssetsFinancial 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: l Financial assets at fair value through profit and loss; l Held to maturity investments; l Available for sale financial assets; and, l Loans and receivables.

The classification depends on the nature and purpose of the financial assets and is determined at the time of initial recognition. 1.22 Financial LiabilitiesFinancial liabilities are recognised on the statement of financial position when the clinical commissioning group becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired. Loans from the Department of Health are recognised at historical cost. Otherwise, financial liabilities are initially recognised at fair value. 1.22.1 Financial Guarantee Contract Liabilities

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Financial guarantee contract liabilities are subsequently measured at the higher of: l The premium received (or imputed) for entering into the guarantee less

cumulative amortisation; and, l The amount of the obligation under the contract, as determined in accordance

with IAS 37: Provisions, Contingent Liabilities and Contingent Assets.

1.22.2 Financial Liabilities at Fair Value Through Profit and Loss

1.22.3 Other Financial Liabilities

After initial recognition, all other financial liabilities are measured at amortised cost using the effective interest method, except for loans from Department of Health, which are carried at historic cost. The effective interest rate is the rate that exactly discounts estimated future cash payments through the life of the asset, to the net carrying amount of the financial liability. Interest is recognised using the effective interest method.

1.23 Value Added TaxMost of the activities of the clinical commissioning group are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.

1.24 Third Party AssetsAssets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the clinical commissioning group has no beneficial interest in them.

1.25 Losses & Special PaymentsLosses 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).

1.26 Joint OperationsJoint operations are activities undertaken by the clinical commissioning group in conjunction with one or more other 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 and liabilities; and cash flows.

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1.27 Research & DevelopmentResearch and development expenditure is charged in the year in which it is incurred, except insofar as development expenditure relates to a clearly defined project and the benefits of it can reasonably be regarded as assured. Expenditure so deferred is limited to the value of future benefits expected and is amortised through the Statement of Comprehensive Net Expenditure on a systematic basis over the period expected to benefit from the project. It should be re-valued on the basis of current cost. The amortisation is calculated on the same basis as depreciation.

1.28 Accounting Standards That Have Been Issued But Have Not Yet Been AdoptedThe Government Financial Reporting Manual does not require the following Standards and Interpretations to be applied in 2013-14, all of which are subject to consultation:

l IAS 27: Separate Financial Statements l IAS 28: Investments in Associates & Joint Ventures l IAS 32: Financial Instruments – Presentation (amendment) l IFRS 9: Financial Instruments l IFRS 10: Consolidated Financial Statements l IFRS 11: Joint Arrangements l IFRS 12: Disclosure of Interests in Other Entities l IFRS 13: Fair Value Measurement

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2. Other Operating Revenue

3. Revenue

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4.5 Pension CostsPast and present employees are covered by the provisions of the NHS Pension Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/Pensions

The Scheme is an unfunded, defined benefit scheme that covers NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The Scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities.

Therefore, the Scheme is accounted for as if it were a defined contribution scheme: the cost to the clinical commissioning group of participating in the Scheme is taken as equal to the contributions payable to the Scheme for the accounting period.

The Scheme is subject to a full actuarial valuation every four years (until 2004, every five years) and an accounting valuation every year. An outline of these follows:

4.5.1 Full Actuarial (Funding) Valuation

The purpose of this valuation is to assess the level of liability in respect of the benefits due under the Scheme (taking into account its recent demographic experience), and to recommend the contribution rates to be paid by employers and scheme members. The last such valuation, which determined current contribution rates was undertaken as at 31 March 2004 and covered the period from 1 April 1999 to that date. The conclusion from the 2004 valuation was that the Scheme had accumulated a notional deficit of £3.3 billion against the notional assets as at 31 March 2004.

In order to defray the costs of benefits, employers pay contributions at 14% of Pensionable pay and most employees had up to April 2008 paid 6%, with manual staff paying 5%.

Following the full actuarial review by the Government Actuary undertaken as at 31 March 2004, and after consideration of changes to the NHS Pension Scheme taking effect from 1 April 2008, his Valuation report recommended that employer contributions could continue at the existing rate of 14% of Pensionable pay, from 1 April 2008, following the introduction of employee contributions on a tiered scale from 5% up to 8.5% of their Pensionable pay depending on total earnings. On advice from the scheme actuary, scheme contributions may be varied from time to time to reflect changes in the scheme’s liabilities.

4.5.2 Accounting Valuation

A valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period by updating the results of the full actuarial valuation.

Between the full actuarial valuations at a two-year midpoint, a full and detailed member data-set is provided to the scheme actuary. At this point the assumptions regarding the composition of the scheme membership are updated to allow the scheme liability to be valued.

4. Employee Benefits and Staff Numbers

4.1 Employee Benefits

4.1.1 Recoveries in respect of employee benefits

There were no recoveries in respect of employee benefits

4.2 Average Number of People

4.3 Staff Sickness Absence and Ill Health Retirements 2013-14 NumberTotal days lost 140Total staff years 51Average working days lost per full time equivalent 2.7

The above sickness absence data is provided over a nine month period.There were no people retired on the grounds of ill health in 2013/14.

4.4 Exit packages agreed in the financial year

There were no exit packages agreed in the financial year.

The application of the Standards as revised would not have a material impact on the accounts for 2013-14, were they applied in that year.

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The valuation of the scheme liability as at 31 March 2011 is based on detailed membership data as at 31 March 2008 (the latest midpoint) updated to 31 March 2011 with summary global member and accounting data.

The latest assessment of the liabilities of the Scheme is contained in the scheme actuary report, which forms part of the annual NHS Pension Scheme (England and Wales) Resource Account, published annually. These accounts can be viewed on the NHS Pensions website. Copies can also be obtained from The Stationery Office.

4.5.3 Scheme Provisions

The NHS Pension Scheme provides defined benefits, which are summarised below. This list is an illustrative guide only, and is not intended to detail all the benefits provided by the Scheme or the specific conditions that must be met before these benefits can be obtained:

l The Scheme is a “final salary” scheme. Annual pensions are normally based on 1/80th for the 1995 section and of the best of the last three years pensionable pay for each year of service, and 1/60th for the 2008 section of reckonable pay per year of membership. Members who are practitioners as defined by the Scheme Regulations have their annual pensions based upon total pensionable earnings over the relevant pensionable service;

l With effect from 1 April 2008 members can choose to give up some of their annual pension for an additional tax free lump sum, up to a maximum amount permitted under HM Revenue & Customs rules. This new provision is known as “pension commutation”;

l Annual increases are applied to pension payments at rates defined by the Pensions (Increase) Act 1971, and are based on changes in retail prices in the twelve months ending 30 September in the previous calendar year;

l Early payment of a pension, with enhancement, is available to members of the Scheme who are permanently incapable of fulfilling their duties effectively through illness or infirmity. A death gratuity of twice final year’s pensionable pay for death in service, and five times their annual pension for death after retirement is payable;

l For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to the statement of comprehensive net expenditure at the time the clinical commissioning group commits itself to the retirement, regardless of the method of payment; and,

l Members can purchase additional service in the Scheme and contribute to money purchase AVC’s run by the Scheme’s approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers

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5. Operating Expenses

102 103

7. Income Generation ActivitiesThe clinical commissioning group does not undertake any income generation activities.

6. Better Payment Practice Code

8. Other Gains and Losses

10.1.2 Future Minimum Lease Payments

6.1 The Late Payment of Commercial Debts (Interest) Act 1998

9. Finance Costs

10. Operating Leases

10.1 As Lessee

10.1.1 Payments Recognised as an Expense

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11. Property, Plant and EquipmentThe CCG had no property, plant and equipment at 31st March 2014.

12. Intangible Non-Current Assets

12.3 Economic Lives

13. InventoriesThe clinical commissioning group had no inventories as at 31 March 2014

12.1Intangible Assets are carried at amortised replacement cost and are not revalued.The intangible assets classified as ‘Development expenditure’ relates to North West eHealth which is a collaboration with Salford Royal NHS Foundation Trust and the University of Manchester. This asset is funded through a government grant.The CCG has no fully amortised intangible assets in use.

12.2 Cost or Valuation of Fully Amortised AssetsThe cost or valuation of fully depreciated assets still in use was as follows:

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14.1 Receivables past their due date but not impaired

14.2 Provision for Impairment of Receivables

15. Cash and Cash Equivalents

14. Trade and Other Receivables

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16. Trade and Other Payables 17. Provisions

The ‘Other’ provisions relate to:Restructuring costs at Central Manchester University Hospitals Foundation Trust (CMUHFT) as a result of the closure of Trafford Hospital. The provision is based on a Heads of Terms agreement between CMUHFT and Greater Manchester CCGs. Agreement was reached in 12/13 that each Greater Manchester CCG would contribute to the costs as part of a Greater Manchester risk share agreement.

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The costs are based on an agreed transition arising as a result of the new Health Deal within Trafford and the process has been signed off by the Secretary of State and was subject to wider assurances provided in advance of the SOS decision.

The termination costs (redundancy and contracts) have a combined maximum limit of £11.0m (with a maximum of £6.5m for GM CCGs as £4.5m was previously settled by GM SHA) final actual values have to be signed off by CMUHFT and Trafford CCG as the lead responsible CCG. However, the exact value is not as yet definitive. Exact timing of the discharge of the costs is uncertain but unlikely to be wholly within the next year.

Under the Accounts Direction issued by NHS England on 12 February 2014, NHS England is responsible for accounting for liabilities relating to NHS Continuing Healthcare claims relating to periods of care before establishment of the clinical commissioning group. However, the legal liability remains with the CCG. The total value of legacy NHS Continuing Healthcare provisions accounted for by NHS England on behalf of this CCG at 31 March 2014 is £513k.

18. Commitments

18.1 Other Financial Commitments

The clinical commissioning group and consolidated group had entered into non-cancellable contracts (which are not leases, private finance initiative contracts or other service concession arrangements) which expire as follows:

19. Financial Instruments

19.1 Financial Risk Management

Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities.

Because the clinical commissioning group is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The clinical commissioning group has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the clinical commissioning group in undertaking its activities.

Treasury management operations are carried out by the finance department, within parameters defined formally within the clinical commissioning group’s standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the clinical commissioning group’s internal auditors.

19.1.2 Credit Risk

Because the majority of the clinical commissioning group’s revenue comes parliamentary funding, the clinical commissioning group has low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables from customers, as disclosed in the trade and other receivables note.

19.1.2 Liquidity Risk

The clinical commissioning group is required to operate within revenue and capital resource limits agreed with NHS England, which are financed from resources voted annually by Parliament. The clinical commissioning group draws down cash to cover expenditure, from NHS England, as the need arises. The clinical commissioning group is not, therefore, exposed to significant liquidity risks.

19.3 Financial Assets

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19.4 Financial Liabilities

20 Operating Segments

20.1 Reconciliation between Operating Segments and SoCNE

20.2 Reconciliation between Operating Segments and SoFP

22. Intra-government and Other Balances

21. Pooled BudgetsAs described in the accounting policies the CCG has pooled budget arrangements with Salford City Council. Salford City Council are the hosts.The memorandum account for the pooled budget is:

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23. Related Party TransactionsDetails of related party transactions with individuals are as follows:The wife of Hamish Stedman,chair of Salford CCG works for Salford Royal FTThe husband of Melanie Sirotkin works for Big Life currently funded by Salford CCG.

24. Events After the End of the Reporting PeriodThere are no post balance sheet events which will have a material effect on the financial statements of the clinical commissioning group or consolidated group.

25. Losses and Special Payments

25.1 Losses The CCG had no Losses in 2013/14.

25.2 Special Payments

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26. Financial Performance TargetsClinical commissioning groups have a number of financial duties under the NHS Act 2006 (as amended). The clinical commissioning group’s performance against those duties was as follows:

Note: For the purposes of 223H(1); expenditure is defined as the aggregate of gross expenditure on revenue and capital in the financial year; and, income is defined as the aggregate of the notified maximum revenue resource, notified 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).

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Further information and contactsSalford Clinical Commissioning GroupSt James’s House, Pendleton Way, Salford M6 5FW.

Telephone: 0161 212 4800

Fax : 0161 212 4801

Website: www.salfordccg.nhs.uk

Email: salccg.involve@nhs.net

Copies of this information are available in other languages and formats

i.e. Braille, audio cassette and large print. To request a copy, please contact:

Tel: 0161 212 4955 Email: salccg.involve@nhs.net