ANNUAL REPORT AND ACCOUNTS - Morecambe Bay CCG

ANNUAL REPORT AND ACCOUNTS

ORGANISATIONAL CODE 01K

2016/17

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ContentsForeword

Member practice introduction

Performance report

Accountability report

Remuneration report

Staff report

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06

08

38

62

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Lancashire North Clinical Commissioning Group Annual Report 2016/17 03

Foreword2016/17 has been an absorbing year for the CCG: implementing the new care models set out in our Better Care Together strategy, working closely with our colleagues from our partner agencies across Morecambe Bay and planning for the future. Of great significance, we have agreed with NHS England and Cumbria CCG to extend the boundary of Lancashire North CCG to include the localities of South Cumbria. The effect of this change is to create Morecambe Bay CCG which will be responsible for the planning and buying of local health services for the residents of North Lancashire, South Lakeland and Furness (including Millom in the Copeland district) from 1st April 2017.

In this our last Annual Report as Lancashire North CCG, we will reflect on the successes and challenges of the past four years. We have continued to build on our effective partnerships with health professionals from a range of local organisations across Morecambe Bay to improve the planning and delivery of local services as part of our Better Care Together strategy. This strategy forms the local delivery plan for Morecambe Bay as part of the Lancashire and South Cumbria Strategic Transformation Plan (STP). We know that STPs will become increasingly important for the NHS and its partners to demonstrate how we will work together to address the health, care quality and financial challenges facing local services in the future.

We have continued our focus on a holistic approach to the health of our local population, holding conversations with local communities about what “health” means now and in the future. We are grateful to a number of local schools, community and faith groups and statutory partners for the exciting opportunities these discussions have created.

We have prioritised work on joining up community and primary care services outside of the hospital setting, improving the coordination of care through our integrated care community model. We are starting to see improved outcomes, reduced waste and increased value for money.

The CCG has retained its priority to improve the quality of local health services, working closely with the University Hospitals of Morecambe Bay NHS Foundation Trust ahead of their inspection by the Care Quality Commission. The Trust has now achieved a “Good” rating.

In considering our priorities and plans for 2017/18, we remain conscious of our continued responsibility to patients and the public to commission services that are not only deliverable now but also remain sustainable for the future. This is a major challenge given that demand is outstripping the financial and other resources we have. We have maintained our focus on supporting our patients and the wider community to look after themselves better and for communities to look after each other. We recognise problems remain but we are committed to continuously improving the experiences of our patients, the services the NHS offers and reducing the health inequalities that exist in our locality.

We continue to involve our local clinicians at the heart of commissioning and provide a firm foundation to deal with the challenges facing the NHS over the next few years. We remain very grateful to our member practices, staff, partners and local groups for their support and challenge to the organisation. As a CCG we will continue to build on these foundations to improve the health and wellbeing of the population we serve.

Lancashire North Clinical Commissioning Group Annual Report 2016/17 Lancashire North Clinical Commissioning Group Annual Report 2016/1704 05

Our vision To secure safe, high quality health services in partnership with professionals and patients and to give local people the best opportunity to live longer and healthier lives.

Dr Alex GawClinical Chair Morecambe Bay CCG

Mr Andrew BennettChief Officer Morecambe Bay CCG


Member practice introduction Member practices have continued to play a significant role throughout this year, supported by the national Vanguard programme, which has seen us move towards the implementation of the Better Care Together Strategy.

The Integrated Care Communities (ICCs) , the model of integrated services that deliver care close to home built around the needs of patients, have already delivered some compelling individual patient stories where services have worked seamlessly together for patients to ensure their care has been appropriate, timely and delivered locally.

GP’s have stepped up in leadership roles within these ICCs to coordinate innovate and support the joined-up working required to deliver an increased level of high quality care in the community. Along with colleagues in partner organisations it’s starting to feel like we can really work ‘better together’ to support patients at home and intervene earlier when people are becoming unwell to prevent deterioration in their health and an unnecessary hospital admission.

The closer working of member practices through ICCs has supported some practices to align more formally, to offer a better and more consistent offer, by merging to become a larger practice. This has tangibly removed some of the organisational barriers that have previously hindered progress.

Clinical Leads continue to provide leadership a number of work streams established in response to key priorities, such as:

• Urgent Care

• Planned Care – testing pathways delivering more service locally in ophthalmology and musculoskeletal services

• Developing Out of Hospital initiatives, Integrated Care Communities and care co-ordination

• Self-care and Health and Wellbeing – we have developed health champions and trained staff as health coaches, getting communities involved in staying healthy

• IT and digital solutions – extending sharing of important clinical information with health professionals to reduce clinical risk for patients and improve safety

• Working to improve access to mental health services.

Working with our colleagues in Public Health at Lancashire County Council we have provided each of our Integrated Care Communities with a profile for the patients and communities they serve. These health profiles will allow the Integrated Care Communities to develop their services according to the needs of their communities. We have already seen hospital consultants delivering some of their expertise and care with the

ICC’s into community settings in paediatrics and in care of the frail elderly and we hope to build further on this.

Care for our patients classified as being at high risk of admission to hospital is seen as a priority as they are our most vulnerable. Having worked with our GP practices to develop and standardise care plans across North Lancashire and South Cumbria we are now using these to better support for their needs, particularly in times of crisis preventing unnecessary admissions to hospital and addressing the preferences expressed by patients .

Over the past 12 months the NHS Lancashire North CCG has been working in partnership with our GP Federation to support the development of our member practices. This has taken the form of training to support the quality agenda.

The CCG’s progress and performance has been reviewed during Governing Body and Membership Council meetings, both formally and informally. Governing Body meetings are held in public and the papers are shared on the CCG website. All member practices can access these and are able to respond and contribute to them directly, or through their practice representatives.


The Clinical Chair and Executive GPs have maintained a strong focus on the needs and experiences of member practices and have maintained good communication links with them through ongoing visits and GP development days.

The member practices have contributed to the National 360 Degree Assurance survey that takes place annually and will review the results when available in May. Any identified learning will be discussed at future Membership Council meetings.

This annual evaluation was drafted by and circulated to all member practices via their CCG representatives. Amendments and additions were integrated and adopted to create this final version.

Overall, member practices are satisfied with both progress and performance. Member practices recognise the scale of the challenges that the CCG faces and, equally, recognise that the CCG has worked in partnership with its members, partners and other stakeholders to meet these challenges.

The member practices have supported the alignment of commissioning to fit with the geography and patient flows and are looking forward to working with their South Cumbrian Colleagues in the coming year.

The Annual General Meeting will provide a further opportunity for the Governing Body and the Membership Council to come together to review and celebrate another year of operation.


Performance reportAbout usNHS Lancashire North Clinical Commissioning Group was established in April 2013 under the Health and Social Care Act 2012. As of April 2015, the CCG was licensed without any conditions. Based at Moor Lane Mills in Lancaster city centre, the CCG is a membership organisation that comprises 10 GP practices, 9 of which are within the local authority area Lancaster District. The remaining two practices are situated in Garstang in the borough of Wyre.

The member practices have delegated responsibility to the Governing Body of NHS Lancashire North CCG, which ensures that the CCG operates efficiently and in the best interests of the population it serves. Full details of the Membership Council, Governing Body and CCG committees are provided later in this report (pages 38-61).

The full range of legislative powers is set out in our Constitution document which can be accessed on our website: http://www.morecambebayccg.nhs.uk/download/MBCCG-Constitution-v3.1.pdf

The Constitution describes the governing principles, rules and procedures that the member practices have established to ensure accountability and probity in the day-to-day running of the CCG and to ensure that we remain able to fulfil our legislative duties.

Ongoing assurance of the CCG is undertaken by NHS England on a quarterly basis through the CCG Assurance Framework. The assurance process identifies whether CCGs are operating effectively to commission safe, high quality and sustainable services within their resources. Through this process we have continued to be assured throughout the year.

We are responsible for commissioning planned and emergency hospital care, rehabilitation, most community services and mental health and learning disability services. We are also responsible for engaging with local people to ensure that the services they are paying for meet the health needs of the community.

Declaration: We certify that the Clinical Commissioning

Group has complied with the statutory duties laid down in the

National Health Service Act 2006 (as amended).

Acute Services• University Hospitals

of Morecambe Bay NHS Foundation Trust

• Lancashire Teaching Hospitals NHS Foundation Trust

• Blackpool Teaching Hospitals NHS Foundation Trust.

Our main providers are as follows:

Mental Health and Learning Disability Services • Lancashire Care

NHS Foundation Trust• Mersey Care

NHS Foundation Trust.

We also commission services from the voluntary, community and faith sector, care homes, independent sector and local authorities.

Community Services • Blackpool Teaching Hospitals

NHS Foundation Trust.

Patient Transport Services

• North West Ambulance Services NHS Trust.


Our population and social environment NHS Lancashire North CCG covers an area of approximately 780 km² of town, coast and countryside and primarily serves the local authority area of Lancaster City Council, with 89% of the total registered population coming from this area. Of the remaining 11% the majority (10%) come from the Wyre area and 0.8% from the Preston district. As of April 2016, 159,643 individuals were registered to this CCG, with 32% under the age of 25 and 19% aged 65 or over.

The CCG has a fairly mixed population in terms of deprivation, with 39% of the registered population living within areas classified as being within either deprivation quintiles one or two, and 45% of the population living within areas classified as being within either deprivation quintiles four or five. Quintile one represents the most deprived areas in England and quintile five the least deprived (IMD2015).

The population of Lancashire North CCG is considerably less ethnically diverse than the population of England. Black and minority ethnic groups account for only 8% of the area’s population compared to 16% nationally. Of these 3% are White non-British and 2% are Asian.

Profiles for Lancashire North CCG and its constituent integrated care communities are available at: http://www.lancashire.gov.uk/lancashire-insight/area-profiles/clinical-commissioning-groups/nhs-lancashire-north-ccg.aspx


Our challengesThere are a number of challenges facing the NHS nationally, many of which we are experiencing in North Lancashire too. These include improving the quality of services, recruiting qualified staff and ensuring each pound is spent wisely to improve the health of the population. Advances in medicine, an ageing population and an increase in those living with long term conditions and complex care needs mean that many people would now prefer to receive care closer to where they live as opposed to in a hospital environment.

Locally we need to ensure that we keep within our allocated budget across all NHS health services. There are no easy answers, but, through the Better Care Together programme, Lancashire North CCG is working in partnership to develop solutions which are clinically safe and proven for the short, medium and long-term.


A review of the yearAs a CCG we have continued to work with a range of statutory and non-statutory partners, organisations and multi-agency groups. These include the Lancashire Health and Wellbeing Board, the Lancaster Health and Wellbeing Partnership, NHS Cumbria CCG and the other Lancashire CCGs, local healthcare services and providers, mental health services, children’s services, Healthwatch and voluntary sector organisations.

During 2016-17 the role of the Lancashire Clinical Commissioning Group Network evolved into the Lancashire and South Cumbria Sustainable Transformation Plan (STP) Programme Board. The CCGs has remained an active member of the ongoing STP programme.

The CCG continues to joint commission (level 2) general practice services with NHS England. This is on the basis that co-commissioning offers a clear opportunity to work much more closely with practices and NHS England to respond to the Better Care Together Strategy as well as the structural challenges facing the health economy e.g. workforce, estates, sustainability and efficiency.

Our strong links with the local GP Federation have enabled us to work together across the primary care system to improve quality and ensure sustainability of our services.

Our strategic direction continues to be aligned with the Lancashire Health and Wellbeing Board strategy and we support the development of the Joint Strategic Needs Assessment (JSNA) with our partners.

As a member of the Lancashire Health and Wellbeing Board we agreed in March of 2016 the process for the CCG to engage around the preparation of their annual reports i.e. to review their annual report against the joint health and wellbeing strategy with advice from the Director of Public Health and Wellbeing; to share their review with our local Health and Wellbeing Partnership and to table our draft report at the next HWBB meeting.

Our health economy has faced ongoing challenges over the past year with significant pressures in the system. This was related to an increased number of acute admissions, delayed transfers of care, reductions in social care provision and funding and an ongoing workforce recruitment issue across the system, particularly in medical and nursing posts, which has exacerbated the problems.

Boundary changeThroughout the year we have continued to work closely with Cumbria CCG particularly with the local hospitals and general practices across Morecambe Bay. Following the decision by both Governing Bodies to consider proposals for a more formal approach to joint working in 2016/17 NHS Lancashire North CCG and NHS Cumbria CCG submitted proposals to NHS England to combine their resources for commissioning across the whole of Morecambe Bay.

This proposal was agreed by NHS England and the two CCGs have been working together to support a smooth transition of the boundary. From April 1st 2017 the boundary of the current Lancashire North CCG will expand to include the general practices in South Cumbria, covering the CCG localities of Furness and South Lakes and it will become known as Morecambe Bay CCG. General practices in the localities of Allerdale, Carlisle, Copeland and Eden will remain in Cumbria CCG.

This is a very positive move for the population of Lancashire and South Cumbria, and follows the clear development of two health systems – one in West, North and East Cumbria and the other in Morecambe Bay (North Lancashire and South Cumbria). It also means that the health economy can better align to support the planning and implementation of the ‘Sustainability and Transformation Programme (STP) footprints’.


Better Care Together (BCT)Our overarching strategic programme continues to be Better Care Together (BCT), which provides the vision for the Lancashire North and South Cumbria (Morecambe Bay) health economy working together in partnership with 10 other NHS and local government organisations.

Over the past twelve months we have made progress with:

• Developing our plans for a system-wide health and care service

• Implemented improvements in people’s care that crosses traditional boundaries by improving integrated care

• Created local partnerships to ensure that people have a greater say over their health

We received £4.73m of Vanguard funding for the year to pursue our priorities of introducing new care models – which have helped us to move faster and at a greater scale than we otherwise would have been able to. The Five Year Forward View published by NHS England aligns with our proposals for integrated services in and out of hospitals with self-care models and community-led initiatives across Morecambe Bay.

Accountable care system (ACS) Organisations have worked together to develop Bay Health and Care Partners, a formal alliance of all the partners within Better Care Together. The alliance have been developing the accountable care concept in Morecambe Bay, the basis being that a group of providers agree to take responsibility for delivery of all care for the population of 365,000 people for a defined period of time, under a contractual agreement with a commissioner. The vision of the ACS is built upon a triple aim model of improving population health, improving quality and experience of care and reducing cost per capita, as set out below:

In the late summer the BCT organisational leaders signed the memorandum of understanding for Bay Health and Care Partners which means that in our area health and social care is working more closely together than ever before – providing a more seamless service to our population.

There is still work to do and throughout the year the partners have been finalising:

• The vision, values and key objectives of the shadow ACS

• Key areas of work to pursue together across our three main aims

• The leadership arrangements for the shadow ACS


Out of hospitalOur vision of integrated care has moved on a pace over the past twelve months and we now have a developing workforce model of General Practice working in a more integrated way with secondary care, community health services and social care through Integrated Care Communities.

The Integrated Care Community is a dynamic system of working that supports those patients who have active health and care needs, with a greater requirement for joined up working. This includes non-health and social care organisations such as the Police, Fire Service and third sector organisations

During 2016-17 the five Integrated Care Communities across Lancashire North have continued to develop and are now established to reflect General Practice mergers in local communities. Clinical Leads have taken up their roles and all ICCs now understand their population health profiles and are developing new ways of working. This includes case finding of the most vulnerable patients so that proactive work can be done to enhance wellbeing and prevent ill health.

ICCs have also undertaken some innovative cross organisational working where they have identified specific needs e.g. management of children who are frequent attenders in hospital; people with early diagnosis of long term conditions (osteoarthritis) and a delivering interventions differently to positive effect.

We have supported staff to take up new ‘Care Co-ordination’ roles within the ICCs and are evaluating these as part of our future workforce.

This year has also seen an increased focus on self-care and engagement, building on the work in Carnforth. By focusing on health and wellbeing, rather than ill health, we aim to listen to the community to understand what health means to them and what keeps them well. We have continued to hold a number of community events and conversations which have led to us supporting the introduction of several new initiatives e.g. setting up peer support groups, developing health cafes and supporting a number of community and voluntary organisations to come together and support each other as well as the communities they serve.

Recognising that staff on the frontline are best placed to support patients to care for their own conditions, we have worked with the Federation to provide them with motivational interviewing and coaching for health training. This enables them to empower patients to take greater responsibility for their own long term conditions.

Prevention is a key element of the self-care and population approach and we have continued to work with several of our primary schools to introduce “Let’s get Moving”, whereby all pupils and staff run a mile a day. A year on staff, pupils and parents are telling us that this intervention is showing significant benefits, with reports of better sleep patterns and improved behaviour both at home and school. There is significant national interest in this intervention and the CCG has been asked to work on the national evaluation of this prgoramme.


Elective CareSince April 2013, Lancashire North CCG has made a range of significant improvements and changes to the delivery of Elective Care services. A selection of these is provided below:

The CCG, in conjunction with Morecambe Bay Hospitals NHS Foundation Trust have developed an electronic Advice and Guidance service which has allowed primary care and secondary care clinicians to discuss and mutually agree care plan decisions. This has avoided unnecessary outpatient appointments for patients, speeded up the agreement of care planning and decisions and has provided a strong platform for improving communication and decision making between primary and secondary care teams. The service has been shortlisted twice for the Health Service Journal awards and is being adopted across the Lancashire and South Cumbria STP.

The CCG commissioned a Community Nutrition and Dietetics Service which has llowed the CCG to communicate the ‘Food First’ message and reduced the unnecessary use and wastage of Oral Nutritional Supplements. The service has worked with primary care to improve local knowledge and skills when managing nutritional issues and has worked closely with local Care Homes to ensure that our most vulnerable patients receive the right dietary support to help manage their recovery and or condition.

The CCG has worked closely with GPs to review referral practices and has bucked the national trend for acute hospital referrals. Nationally there has been a significant increase in hospital referrals; however the CCG has successfully limited this growth in Lancashire North through peer review, the use of Advice and Guidance, education and the development direct access services. The CCG has introduced Protocol Based Access to Diagnostics, e.g. for MRI of the Knee and the Lumbar spine. These protocols will now be further developed and rolled out across the new Morecambe Bay CCG footprint.

The CCG launched an Integrated Musculoskeletal Service (iMSK) through partnership working with Blackpool Teaching Hospitals and the University Hospitals of Morecambe Bay. This service offers integrated physiotherapy, orthopaedic and pain management services to ensure that patients with common musculoskeletal conditions can rapidly receive a diagnosis and appropriate care. The development has reduced the number of referrals to the hospital orthopaedic services by 20%, allowing the hospital to focus on more complex surgical cases.

As part of the Better Care Together programme the CCG has commissioned a Community Ophthalmology Service in partnership with the University Hospitals of Morecambe Bay and the high street optometrists. Patients can now access minor eye condition services and cataracts follow up via local optometrist providers. This has reduced waiting times and allowed the local acute hospital to focus on more complex cases

The CCG has participated in university research with the University of Central Lancashire on alternative approached to cancer patient follow up. This work supports the CCGs priority of improving the experience of cancer patients post diagnosis and treatment.

Going into 2017-18 the CCG will be looking further improve and redesign the pathways of care for Orthopaedic, Ophthalmology, Rheumatology, ENT, Pain Management and Maxillofacial pathways.

The CCG is committed to fully implementing Electronic Referrals and ensuring patients receive the maximum level of choice on service providers and appointment times. As part of this development the CCG will also be implementing the Map of Medicine to ensure that all clinical teams in Morecambe Bay have access to a single consistent set of agreed clinical pathways.


Improving maternity careThe CCG has worked alongside and supported UHMBT on its improvement journey with maternity services. The recent CQC inspection rated maternity services as good and identified elements of the work with service users as being excellent.

Highlights of the maternity work supported by the CCG include:

• An integrated Maternity Care Pathway has been co-produced with wide engagement of service users, midwives, obstetricians, GPs, Health Visitors and others. The first stage of implementation is now underway.

• The Maternity Strategic Partnership is now established with Central Manchester Hospitals and Lancashire Teaching Hospitals.

• The CCG has worked with colleagues in the Trust to ensure that commissioning arrangements for maternity are robust and that there is clear performance monitoring.

• The CCG led the establishment of a Bay-wide Maternity Services Liaison Group, which commenced in November 2015. Its first annual report is available at http://www.morecambebayccg.nhs.uk/get-involved/maternity-services-liaison-committee/.

• During the CQC inspection, the MSLC was able to report over 40 ways in which they have provided service user views to help improve maternity services.

• As one specific example, the MSLC initiated a project regarding the way that women are communicated with during their maternity journey. The Trust was successful in getting “Challenge Funding” for this. The project has developed a creative training video which will be used with all staff involved in delivering maternity services.


Improving care for children and young people Improving services for children in the area continues to be one of the CCGs key priorities. The CCG inherited a number of challenges in terms of the services available for children and the CCG has worked to address these within its financial constraints.

• A service has been established for children with a learning disability

• The capacity of the Community Paediatric Service has been increased

• A service is being established for children with ADHD

• There will be assessment for children with urgent mental health problems 7 days a week from July.

• The numbers of children attending hospital and the length of time they spend in hospital has been reduced.

Whilst considerable progress has been made, there are still a number of challenges, which will continue to be a focus of work going forward into the new CCG.

Exciting work has taken place through Better Care Together to improve services for children across the health system, bringing together health professionals to find new ways of working that mean children don’t need to attend hospital as frequently and that more resource can be invested in community-based services. This has included:

• The launch of pathways for common conditions and self-help videos to support parents and carers in looking after their children when they are ill.

• A trial of a community nurse working with a small number of families who have been frequent attenders to hospital, reducing their attendance by 31%.

• Paediatricians starting to undertake clinics in the community and developing much closer links with GPs.

• The launch of an assessment tool to support GPs in deciding which children need to attend hospital, a telephone triage system so that GPs can talk to a senior clinician on the children’s’ ward and the development of Rapid Access appointments for those who could be seen the next day.

• Improvements in dispensing of medicines so that children can be discharged more quickly from the hospital.


Improving Mental Health servicesLancashire North CCG has worked with Blackburn with Darwen CCG, as the lead commissioner for adult mental health services, to support service development and improvement with our main provider Lancashire Care Foundation Trust. Work has continued this year to:

• Progress the actions required to deliver the Five Year Forward View for Mental Health

• Develop the Sustainability and Transformation Plan (STP)

• Deliver Key Mental Health National Standards

Lancashire north CCG has worked in partnership with other CCGs across lancashire and South Cumbria to begin to develop the way forward for developing mental health services. After number of workshops the focus for future areas of development will be on five identified areas of work. These are:

1 Crisis Access and Prevention

2 Memory Assessment Services and Dementia

3 Primary Care Prevention and Integration

4 Care Homes and Rehabilitation

5 Delayed Transfer of Care and Out of Area Placements

Over the next twelve months commissioners will work together to develop and implement these programmes.


Learning Disabilities LNCCG’s Commissioning for people with Learning Disabilities (LD) and/or Autistic Spectrum Disorder (ASD) has concentrated on delivering the principles of the national Transforming Care Programme and the objectives of the Pan Lancashire Transforming Care Plan:

We have made significant progress with facilitating the discharge of our most challenging cohort of in-patients who have LD and/or ASD. We have successfully discharged 2 very complex patients from long stay forensic hospital beds back to the community, being supported by bespoke packages of care. Providers have been identified for 2 more patients who will start transition to their long-term homes in the community over the next few weeks. We have worked closely with our local providers and local authority colleagues to develop a comprehensive discharge pathway to ensure all discharges progress as smoothly as possible.

All people with Learning Disability and/or ASD who are in-patients in a specialist LD hospital or a mental health hospital have had a comprehensive review of their care and treatment in line with the national Care and Treatment Review (CTR) policy and standards. The CTR process for 2 of our long stay, complex patients has resulted in their transfer to different care pathways where their needs will be more fully met and from which their eventual move back to the community will be facilitated. We have also carried out several community CTR’s and have started work with Education colleagues to align the CTR with the Education, Health and Care Plan (EHCP) review process for children and young people.

We have developed a locally held dynamic register of people with LD and/or ASD who may be at risk of hospital admission. By carefully and regularly reviewing their care and support needs in the community, we have prevented a number of potential hospital admissions.

We have increased the community LD service for children and young people so that there is more access to specialist LD psychiatrist appointments and more support for parents in managing challenging behaviour at home. This has already prevented 2 young people from being admitted to hospital.

Lancashire North CCG has taken the lead in developing a new Pan Lancashire service specification for an all-age community LD and Autism service which will be commissioned in the very near future.

We have achieved a 53% up-take of Annual Health Checks for people with LD – this was the best performance of all Lancashire CCG’s.

Better Care Fund (BCF)The Lancashire Better Care Fund (BCF), of which we are a part, continues to further develop the integrated working that we have had in place for several years. The BCF continue to focus on four key themes:

• Out of hospital care with integrated neighbourhood teams - patient centred coordinated community and primary care, working in partnership with the social and voluntary sectors.

• Reablement services - keeping patients at home independently, or through appropriate interventions delivered in the community setting.

• Intermediate care services - community based services delivered around the clock, both step-up and step-down.Supporting carers: Improving the quality of life for people with support needs and for their carers so they are supported to manage their own health and wellbeing wherever they can and for as long as possible.

Combined with the approach to health and wellbeing, self-care and prevention, we expect BCT and BCF plans to result in measured improved health outcomes and patient experiences of health and social care, and ultimately in increased life expectancy for both existing and future generations of citizens. Our health economy has clear objectives for improving patient outcomes, experience, and reducing the growing reliance on inpatient hospital care.


Future PlansAs we move into 2017/18 our focus will remain on working with our partners to continue delivery of our Better Care Together strategy. This strategy forms the local delivery plan for Morecambe Bay as part of the Lancashire and South Cumbria Strategic Transformation Plan (STP). We know that STPs will become increasingly important for the NHS and its partners to demonstrate how we will work together to address the health, care quality and financial challenges facing local services in the future.

Morecambe Bay Health and Care Partners will continue to develop as an accountable care system with a focus on the integration of health and social care and ensuring we are able to create a sustainable health and care system long into the future.

Morecambe Bay CCG, as a new organisation, will look to build on the work of Lancashire North CCG and Cumbria CCG to ensure that our commissioning arrangements result in consistency of services across the Bay and that we have equity of provision for our population. The CCG will maintain its focus on quality and continue to support our providers in continuous improvement.

Principal risk and uncertainties The principal risk for Lancashire North CCG and the health economy is the significant risk related to ensuring a safe and sustainable service across Morecambe Bay within available resources. The CCG, together with its partners, is working together to mitigate these risks through the Better Care Together programme.

The CCG’s approach to risk management and identification of risks is highlighted in the Annual Governance Statement within this report (pages 42-61).


Improvement in quality of servicesThe Quality Improvement Committee provides assurance to the Governing Body that the services the CCG commissions are safe and effective, that quality and patient experience is central to our work and that there is continuous improvement in the quality of commissioned services and patient outcomes.

Through the CCG’s established assurance processes the Quality Improvement Committee have received unique insights into how local providers deliver good, effective care. This has included review and consideration of local clinical service user intelligence and performance information. Information has then been triangulated with patient stories, service delivery, Clinical Audit and Clinical Effectiveness presentations. This approach has enhanced the committee’s ability to put what we learn from peoples’ experiences of care at the centre of what we do.

When poor care delivery is reported, we have systems, processes and responses that seek to promptly correct and minimise the impact to patient care, and to ensure that the commissioned services respond in a timely and effective manner to address the concerns. We also undertake local walk round quality inspections to provide assurance that these commissioned services have implemented actions and learning to ensure a cycle of continuous improvement.

Committee members continue to collectively and individually gain momentum as system leaders, building relationships with all parts of the health economy through delivery of the Better Care Together Strategy, Federation(s) and Integrated Care Community developments. This helps to address identified gaps along the patient pathway, often between services/sectors, and recognises workforce capacity and expertise as an enabler to improvement and influence and realigning national directives to ensure a local focus.

Over the past year the committee has been overseeing the quality assurance aspects of the transition from Lancashire North CCG into the new Morecambe Bay CCG effective from the 1st April 2017, this included the development of a Quality Transition document to highlight to the CCG Board and committees areas of risk and mitigation in relation to Quality and Safeguarding during, and following this transition.

In the coming year we aim to build the commissioning expertise of our committee members across the new Morecambe Bay CCG footprint, ensuring that systems and processes enable commissioning decisions to take into full account the quality of care received, we will continue to build local intelligence, involving further clinicians across the CCG in the quality agenda of the Committee to drive improvement, in line with the CCG’s statutory requirements, and to demonstrate continued improved outcomes for the care commissioned by the CCG on behalf of our population.


Safeguarding The CCG has Statutory Responsibility for Safeguarding roles, functions and responsibilities in accordance with NHS Accountability and Assurance Framework 2015, Children Act 1989, 2004, Promoting the health and well-being of looked-after children (2015), Working Together 2015 and the Care Act 2014. CCGs as commissioners of local health services need to assure themselves that the organisations from which they commission services have effective safeguarding arrangements in place.

Arrangements for safeguarding assurance for Lancashire North CCG with commissioned services and providers have included assurance visits and quality reports, CCG Safeguarding Standards Audit, Section 11 Audit and attendance at provider safeguarding performance and operational committees. The Safeguarding team have maintained full representation at Safeguarding Adults and Children’s multiagency meetings as relevant to fulfil its commissioning, primary care and statutory safeguarding responsibilities, including contribution to Serious Case Reviews (SCR), Safeguarding Adult Reviews (SAR) and Domestic Homicide Reviews (DHR). We have engaged in significant work streams with our partners in Public Health, Social Care and the Police to secure and influence commissioning and funding agreements for specialist safeguarding roles and universal services, particularly for children and adults who are most vulnerable including children looked after and those at risk of exploitation.

The wider safeguarding context continues to change in response to the findings of large scale inquiries, such as the Francis and Lampard Inquiries, recommendations from Regulated Inspections and new legislation, such as the Care Act 2014. There has also been revised statutory and intercollegiate guidance relating to safeguarding skills and competencies required for roles depending on degree of contact with children, young people and adults. However, fundamentally, it remains the responsibility of every NHS funded organisation and each individual healthcare professional working in the NHS to ensure that the principles and duties of safeguarding adults and children are holistically, consistently and conscientiously applied, with the well-being of those adults and children at the heart of what we do. For adult safeguarding this also needs to respect the autonomy of adults and the need for empowerment of individual decision making, in keeping with the Mental Capacity Act and its Code of Practice. The Safeguarding team have networked and worked closely with Providers including Primary Care to influence and support safeguarding arrangements including sharing and embedding of the lessons learnt from practice reviews, delivery training and provided a leadership forum to engage with safeguarding leads across Primary Care and the Care Home Providers.


Performance and Business IntelligenceThe CCG has worked hard to ensure that patients in Lancashire North receive the highest standard of care in line with national and local performance targets. 2016-17 has been a challenging year with deterioration nationally on many of the key constitutional targets such as the A&E 4 hour target, the 18 week target and the 62 day cancer standard.

The CCG has worked hard with local stakeholders to secure improvements in the provision of urgent and elective care to ensure that robust plans are in place to address key issues and risks. The CCG has not achieved the A&E and 18 week targets for 2016-17 however clear plans have been developed through the A&E delivery board to ensure that all parties, including Social Care, Ambulance Services and acute hospitals are working together for maximum effect.

The CCG has reported significantly improved performance on the management of Health Care Acquired infections with the MRSA and Clostridium Difficile targets achieved for the financial year. The CCGs achievement of the dementia standards remains above the national and regional average and performance on the IAPT (Improving Access to Psychological Therapies) standards is back to target level in March 2017.

There has been significant progress locally as well on priority standards such as the delivery of electronic discharge summaries within 24 hours and the reporting and sharing of performance information. The CCG has worked closely with its acute providers to ensure that performance data is openly and transparently shared and that culture of openness is maintained.


Key performance indicators (KPIs)We have developed a Performance Management Framework that is based upon the national CCG Assurance Process which is available at: https://www.england.nhs.uk/commissioning/ccg-auth/

NHS England introduced a new Improvement and Assessment Framework for CCGs (CCG IAF) from 2016/17 onwards, which replaced both the existing CCG Assurance Framework and separate CCG performance dashboard. In the Government’s Mandate to NHS England, this new framework takes an enhanced and more central place in the overall arrangements for public accountability of the NHS.

This includes the following key domains:

• Better Health: this section looks at how the CCG is contributing towards improving the health and wellbeing of its population, and bending the demand curve;

• Better Care: this principally focuses on care redesign, performance of constitutional standards, and outcomes, including in important clinical areas;

• Sustainability: this section looks at how the CCG is remaining in financial balance, and is securing good value for patients and the public from the money it spends;

• Leadership: this domain assesses the quality of the CCG’s leadership, the quality of its plans, how the CCG works with its partners, and the governance arrangements that the CCG has in place to ensure it acts with probity, for example in managing conflicts of interest.

The 2016/17 year-end assessment for our CCG will be available on the MYNHS website at: www.nhs.uk/service-search/Performance/Search from July 2017.

Each month we collate performance information directly from providers of services and from national data sources such as the Health and Social Care Information Centre and NHS England websites. In addition, we commission Midlands and Lancashire Commissioning Support Unit to provide detailed information on contract activity and performance benchmarking.

Using this information, we produce a monthly CCG Assurance and Delivery report giving detailed commentary on the various performance standards along with a comprehensive dashboard of performance information. This report is submitted monthly to our Finance and Performance Committee, which reviews the reported delivery and challenges any areas of underperformance.

Our Governing Body is provided with a detailed performance report at each of its public meetings. This includes the CCG’s Finance Reports and Assurance and Delivery Reports as appendices and describes the overall system performance and how performance on our finance, activity, quality and operational standards interrelate.

This information is published on our website and shared with local stakeholders including NHS England and is available at: http://www.morecambebayccg.nhs.uk/about-us/governing-body/governing-body-meetings/

Urgent careIn line with the national data, 2016-17 has been a challenging year:

• An increased number of ambulance journeys (‘Red’ category) for a proportionally greater volume of complex patients who require admission via A&E

• An increasing complexity in the case mix of patients attending A&E

The increased level of acuity (the intensity of nursing care required by a patient) in the non-elective cases have also resulted in the cost increasing at a higher rate than the activity. These changes have also contributed to underperformance on the A&E 4-hour target and ambulance journey times.


Accident and Emergency – 4-hour targetThe A&E 4-hour target continues to be a challenge with health services in the area failing the A&E standard since September 2015.

This is due to:

• Delays in patient discharge

• A lack of beds for new admissions

• Increased acuity

• An increased number of attendances from the 75+ age group

• Discharge continues to be a challenge particularly for Cumbria patients

• An increase in ambulance conveyances for Cumbria patients

• Lack of patient flow and high numbers of medical outliers and Medically Fit for Discharge (MFFD) patients

• Significant staffing shortages across the acute Trust.

As a result the CCG and system wide providers have reviewed and made improvements to the emergency care recovery plan. Some of the improvements implemented are as follows:

• Same Day Health Centre (SDHC) activity remains consistent, and ambulance conveyances to the SDHC have continued to increase

• Single high level action plan which combines the themes from the UM report recommendations, ECIST action plan, ‘Safer Bundle’ action plan, and the system recovery plan

• A Falls Car service

• ‘Home Instead’ has been implemented recently and the results continue to be positive

• UHMB are part of the A&E Improvements Collaborative Cohorts (cohort 2).

Sustained delivery of the target remains challenging due to the increasing demand and complexity of the patients requiring care. The progress of all the improvement initiatives are monitored and reviewed at the Urgent Care Network on a monthly basis.


Planned careThere continues to be an increased demand on elective services, however, a number of achievements have contributed in the management of these pressures.

• Continued development of the Advice and Guidance Service

• Development of a Community Nutrition and Dietetics Service and Weight Management Pathway (Access to Tier 3 services)

• Implementation of Protocol Based Access to Diagnostics (MRI Knee)

• Development of an Integrated Musculoskeletal Service

• Move to a Community Ophthalmology Service

• University Research on Cancer Patient Follow Up

• Improvements to Anticoagulation Services.

However the CCG’s providers have continued to report an increase in the demand for elective services whilst also reporting a decrease in their capacity to deliver these services. The decreasing level of capacity is due to a combination of factors including gaps in the appropriate workforce, the closure of a significant number of hospital beds and non-elective pressures.

18 week targetsThe CCG has been closely monitoring 18-week targets at both the University Hospitals of Morecambe Bay (UHMB) and Lancashire Teaching Hospitals Foundation Trust (LTHFT) because of the continuing level of underperformance over 2016-17.

This current situation has been driven by a number of factors:

• A mismatch between demand and capacity in key specialties, particularly within Trauma & Orthopaedics and Ear, Nose and Throat (ENT) at UHMB and General Surgery, Neurology at LTH

• A lack of alternate surgical capacity within NHS or private providers through which additional work could be undertaken

To manage this situation the CCG has put the following actions in place and will continue to monitor their level of effectiveness into the new financial year across the new CCG boundary.

• The CCG is working with the North of England Commissioning Support Unit (NECSU) to review the current RTT (referral to treatment) management processes and to develop a demand management plan

• The CCG is working with NHS England to access additional Independent Sector capacity across the North West

• The CCG is working with Chorley and South Ribble CCG to put actions in place to address the demand pressures on Neurology

• Service redesign projects delivered as part of Better Care Together are now starting to have an impact.

Diagnostic waiting timesDespite the increase in demand, the 6 week diagnostic target has been met for the majority of the year. University Hospitals of Morecambe Bay have reported an increased demand and a lack of capacity in Diagnostic Imaging but long term actions have been explored which have resulted in an increase in the level of staffing and equipment for 2016-17.

Cancer targetsThe CCG’s performance against the cancer targets for the year has been achieved in all but the ’62 Day Wait’ category. The trend in breaches can be attributed to:

• Patient choice

• Complex cases

• Late tertiary referral.

The CCG is working with its providers, through the newly formed Elective Care Board, to ensure that cancer access targets are maintained and that local cancer services remain resilient. There are a number of focus areas:

• Patient tracking and escalation procedures

• Access to diagnostics

• Pathology capacity and histology turnaround

• Capacity and demand modelling.

The delivery of cancer targets is also dependant on the broader redesign initiatives under Better Care Together. Redesign work in a number of key specialities will free up non urgent service capacity to support cancer and other specialist work


Healthcare associated infectionsAlthough performance against the MRSA and C-Difficile targets remained a challenge for the Lancashire north health economy during 2016-17 the CCG remained well below the target trajectory. The CCG takes responsibility for reviewing all cases for our residents and strives to understand and prevent occurrence.

Friends and Family Test (FFT)The NHS Friends and Family Test (FFT) was created to help service providers and commissioners understand whether their patients are happy with the service provided, and where improvements are needed. UHMB performs consistently, with 2016-17 scores averaging 89% for A&E and 95% for Inpatients.

Elimination of Mixed Sex Accommodation (EMSA)From November 2016 UHMB have reported a number of breaches which have been the result of high non-elective demand and bed occupancy pressures. The Trust has indicated that breaches may continue to occur, although reporting processes are now being improved.

Improving Access to Psychological Therapies (IAPT)Improving Access to Psychological Therapies (IAPT) is an NHS programme offering interventions approved by the National Institute of Health and Clinical Excellence (NICE) for treating people with depression and anxiety disorders. NHS England has set two targets for CCGs in relation to IAPT, these are:

• IAPT Prevalence (number of clinically relevant patients offered access to IAPT Services)

• IAPT Recovery Rate (the proportion of people who complete treatment and move towards recovery).

For 2016-17 the access target has been met for half of the year with performance improving in the final months and the recovery rate has been met consistently from November 2016.

Key actions that have been taken to improve and secure access and recovery include:

• Ensuring the original assessment (Welcome Call) contains a therapeutic element where possible, and therefore treatment commences as soon as possiblet

• Sub-Contracting with other IAPT Providers to improve capacity.


Operational Performance Standards (NHS Constitution)

Subject Indicator description Basis Data Feb-17 YTD

A&E waits

Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department

UHMBGreen: >= 95% Red: <95%

Actual 81.2% 85.1%

Target 95.0% 95.0%

RAG R R

No waits from decision to admit to admission over 12 hours

UHMB Zero

Actual 3 95

Target 0 0

RAG R R

Category A Ambulance calls

Category A calls resulting in an emergency response arriving within 8 minutes (Red 1)

NWASGreen: >= 75% Red: <75%

Actual 64.7% 68.0%

Target 75.0% 75.0%

RAG R R

Category A calls resulting in an emergency response arriving within 8 minutes (Red 2)


Actual 61.0% 62.6%

Target 75.0% 75.0%RAG R R

Category A calls resulting in an ambulance arriving at the scene within 19 minutes


Actual 88.4% 88.9%

Target 95.0% 95.0%

RAG R R

Ambulance Handovers

All handovers between ambulance and A&E must ttake place within 15 minutes (Avg notification to handover time)

Royal Lancaster Infirmary

Green: <= 15 mins Red: > 15 mins

Actual 16:01 20:55Target 15:00 15:00RAG R R

Furness General

Actual 19:29 16:11Target 15:00 15.00RAG R R

Ambulance crews should be ready to accept new calls within a further 15 minutes.

NWAS

Green: <= 15 mins Red: > 15 mins

Actual 11:35 12:25

Target 15:00 15.00

RAG G G

18 week target

Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks

CommissionerGreen: >= 92% Red: <92%

Actual 89.5% 89.6%

Target 92.0% 92.0%

RAG R R

Number of patients waiting more than 52 weeks

CommissionerGreen: 0 Red: >0

Actual 0 3

Target 0 0RAG G R

Diagnostic test waiting times

Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral

CommissionerGreen: <= 1% Red: >1%

Actual 0.9% 0.7%

Target 1.0% 1.0%

RAG G G

Cancer waits - two week waits

Two week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP


Actual 97.2% 95.9%

Target 93.0% 93.0%

RAG G G

Two week wait for first outpatient appointment for patients referred urgently with breast symptoms


Actual 97.4% 95.9%

Target 93.0% 93.0%

RAG G G




Cancer waits - 31 days

One month (31 day) wait from diagnosis to first definitive treatment for all cancers

CommissionerGreen: >=96% Red: <96%

Actual 96.0% 97.9%

Target 96.0% 96.0%

RAG G G

31 day wait for subsequent treatment where that treatment is surgery


Actual 100.0% 96.5%

Target 94.0% 94.0%

RAG G G

31 day wait for subsequent treatment where the treatment is an anti-cancer drug regimen


Actual 100.0% 100.0%

Target 98.0% 98.0%

RAG G G

31 day wait for subsequent treatment where the treatment is a course of radiotherapy


Actual 100% 97.8%

Target 94.0% 94.0%

RAG G G

Cancer waits - 62 days

62 day wait from urgent GP referral to first definitive treatment for cancer


Actual 67.6% 81.1%

Target 85.0% 85.0%

RAG R R

62 day wait from referral from an NHS screening service to first definitive treatment for all cancers


Actual 100.0% 93.2%

Target 90.0% 90.0%

RAG G G

62 day wait for first definitive treatment following a consultants decision to upgrade the priority of the patient (all cancers)

CommissionerNo operational standard

Actual 96.2% 93.9%

Target 86.0% 86.0%

RAG G G

Mixed sex Accommodation Breaches

Breaches of same sex accommodation

CommissionerGreen: 0 Red: >0

Actual 1 21

Target 0 0

RAG R R

Cancelled Operations

No urgent cancelled operation to be cancelled for a second time

UHMBGreen: 0 Red: >0

Actual 0 0

Target 0 0

RAG G G

Other operational standards

Electronic discharge summaries issued within 24 hours

UHMBGreen: >= 95 Red: <95%

Actual 93.4% 91.4%

Target 90.0% 90.0%

RAG G G



Subject Indicator description Basis Threshold Data Qtr3 YTD

IAPT

IAPT access proportion Commissioner

GREEN: CCG plan to achieve at least 15% by 2015/16 AND CCG on track against plan

AMBER: CCG plan to achieve less than 15% by 2015/16 AND CCG on track against plan

RED: CCG not on track against plan

Actual 222 1752

Target 228 1824

RAG R R

IAPT recovery rate Commissioner

GREEN: CCG plan to achieve at least 50% by 2015/16 AND CCG on track against plan

AMBER: CCG plan to achieve less than 50% by 2015/16 AND CCG on track against plan

RED: CCG not on track against plan

Actual 50.4% 48.3%

Target 50.0% 50.0%

RAG G R



Friends and Family Test (Percentage Recommended)

Average A&E scoreUHMB

No RAG Rating

Actual

88.0% 88.6%

Average inpatient score 95.1% 94.9%

Average A&E scoreBTH

95.5% 93.1%


Average A&E scoreLTH

83.1% 84.3%



Financial Key Performance Indicators:The CCG’s performance against a number of financial key performance indicators is outlined below:

Key performance indicator Target Actual Result

Revenue resource use does not exceed the amount specified in Directions

Maintain expenditure within the allocated resource of £221,272K

Total expenditure £218,175K Achieved

Delivery of a 1% surplus Deliver a 1% surplus of £2,147k Total surplus £1,000k Not achieved

Maintain expenditure within the Maximum Cash Drawdown limit

Maximum cash drawdown total £217,269K

Total cash outflow £217,269K Achieved

Revenue administration resource use does not exceed the amount specified in Directions

Maintain administration (running costs) expenditure within the allocated resource of £3,418k

Total administration (running costs) expenditure £3,298K

Achieved

Non recurrent use of 1% of resource allocation

Retain 1% of resource allocation (£2,097k) for non-recurrent items

Not used, added to the target surplus (see note* below)

Achieved

QIPP savings targets are identified and savings achieved

Identify QIPP savings target of £6,892k

Total QIPP schemes identified £5,217k (of which £2,315k were non-recurrent)

Not achieved

Maintain capital expenditure on Primary Care IT within the limits set by NHS England

Maintain expenditure within the allocated Primary Care IT capital allocation of £479k

Total Primary Care IT expenditure £479k

Achieved

Comply with the Better Payment Practice Code (BPPC)

Ensure 95% (by number and volume) of all valid invoices are paid by the due date or within 30 days of receipt of a valid invoice, whichever is later

Non NHS payables 99.69% by number, 99.97% by value.

NHS payables 99.89% by number, 100.00% by value

Achieved

* As set out in the 2016-17 NHS planning guidance, CCGs were required to hold a 1% reserve uncommitted from the start of the year, created by setting aside the monies that CCGs were otherwise required to spend non-recurrently. this was intended to be released for investment in Five Year Forward View transformation priorities to the extent that evidence emerged of risks not arising or being effectively mitigated through other means.

In the event, the national position across the provider sector has been such that NHS England has been unable to allow CCGs’ 1% non-recurrent monies to be spent. Therefore, to comply with this requirement, NHS Lancashire North CCG has released its 1% reserve to the bottom line, resulting in an additional surplus for the year of £2.1m. This additional surplus has been partly offset against other cost pressures from the current financial year and will partly be carried forward for drawdown in future years.


Financial reviewThe following section provides a brief overview of the CCG’s financial performance in 2016/2017. The financial accounts have been prepared under a Direction issued by NHS England under the National Health Service Act 2006 (as amended). A full set of accounts, including associated certificates, is included later in this report.

AllocationThe total allocation to NHS Lancashire North CCG for 2016/2017 was in two parts. The CCG main allocation was £217.854m for commissioning NHS services for the local community. This included separate allocations of £4.730m for the Vanguard project across Morecambe Bay and £0.127m in respect of the achievement of the 2015/2016 Quality Premium. The CCG was also allocated £3.418m from which it was expected to cover all its running costs.

2016/2017 financial dutiesThe CCG met each of its financial duties for the 2016/2017 financial year, as follows:

• To remain within the revenue resource limit, although the CCG did not achieve a 1% surplus and therefore did not meet the NHS business rules

• To remain within the cash limit

PerformanceThe CCG has faced a number of financial pressures during 2016/2017, in particular in terms of over-performance on secondary care contracts as a result of increasing levels of activity and in Funded Nursing Care costs, which have increased significantly compared to the previous year as a result of a nationally agreed inflationary uplift on standard fees. The CCG recognised that 2016/2017 would be a challenging financial year and was in contact with NHS England from an early stage to flag the likelihood that a surplus would be difficult to achieve. In discussion with NHS England, the CCG submitted a Financial Recovery Plan which contained a number of mitigations, enabling a £1m surplus to be achieved at year end. This is below the 1% (£2.147m) surplus originally planned. The CCG’s Quality, Improvement, Productivity and Prevention (QIPP) savings target of £6.892m was only partially met in year, with a proportion of these savings being made non recurrently.

Accounting policiesThe CCG’s accounting policies are shown in full in Note 1 to the Annual Accounts and the Annual Accounts have been prepared on the going concern basis. The accounting policies follow International Financial Reporting Standards (IFRS) to the extent that they are meaningful and appropriate to the NHS, as determined by HM Treasury.

61.7%

12.0%

15.9%

3.9%

1.6%

3.4%1.5%

61.7%

12.0%

15.9%

3.9%

1.6%

3.4%1.5%

Analysis of 2016/2017

operating expenses


Sustainable development We are committed to creating an organisation that takes sustainable development and carbon reduction seriously. Our NHS property is owned/leased by NHS Property Services, who are responsible for providing appropriate property related information for annual sustainability reporting.

We also benefit from our focus on commissioning sustainable quality services that provide not only value for money but ensure added value for the communities they serve.


Patient and public involvement We are committed to developing effective and sustainable relationships – with our patients, carers, the public and partners in health, social care and the voluntary and community sector.

The statutory duties of LNCCG include promoting the NHS Constitution, driving up quality, reducing inequalities and involving individual patients, carers and representatives. These four challenges are being addressed by the CCG and are enshrined within our governance arrangements to ensure that public involvement is directly aligned to the planning of services.

Patient and community involvement is a top priority for us in order to effectively commission (buy) and oversee local services that meet the needs of local people. This is overseen by the Equality and Engagement Strategy Group, chaired by our Governing Body Lay Member lead for patient and public engagement. Over the last year we have ensured that we have engaged and listened to patients and our communities to reflect those needs in our commissioning activities through a variety of different forums.

Our public membership organisation, ‘My NHS’, continues to flourish, with over 800 members. A weekly message and regular newsletter is used to ensure that individuals and organisations can be kept informed and provided with opportunities to engage in the review and commissioning of local services. During this year the Listening Group, made up of volunteer individuals from ‘My NHS’, have been developing and agreeing their work programme for the coming year. They have also provided input into a number of commissioning activities and Better Care Together reviews of planned care pathways e.g. respiratory.

Going forward the focus of the group will be on providing an independent view of the work of the new Morecambe Bay CCG that is external to the day-to-day running of the organisation. During 2017/18 they will take a lead in the assurance process for our annual equality assessment. They will also help to ensure that, in all aspects of the CCG’s business, the public voice of the local population is heard and that opportunities are created and protected for patient and public empowerment. A member of this group attends the Equality and Engagement Strategy Group which provides a two way communication opportunity for the CCG and the group to be kept informed and up to date with all current issues.

Our member practices also have Patient Participation Groups. These offer patients interested in health and healthcare the opportunity to get involved with their local GP practice and support its work. Most groups also include members of practice staff. They meet at regular intervals to decide the ways and means of adding value to the services and facilities offered to patients.

We have continued to identify our different communities and their representatives through our approach to equality and inclusion, with the aim of ensuring that all our communities – and particularly those with protected characteristics – are able to engage with the CCG and health economy. For example, as a CCG we have held a number of events with our local communities around health and wellbeing and how we build healthy communities.

As part of the Better Care Together programme, a wide ranging engagement work stream is continuing to ensure that the public, patients, staff and stakeholders are able to be involved at all stages of the process and fully engaged in future service design. A variety of methods have been used to engage with the public and stakeholders so far, such as focus groups, events, surveys and meetings.

Healthwatch Lancashire is the local consumer champion for healthcare services. We are working alongside local Healthwatch representatives to further understand the needs and opinions of local people. We believe that by sharing experiences and ideas with Healthwatch, our residents and our communities can influence the way services are run.

The Maternity Services Liaison Committee (MSLC) has continued to be actively involved with maternity services to support continued development of local services.

In addition to direct engagement, we also analyse soft intelligence, whereby we gather information from patient experience websites, media coverage, complaints, concerns, comments and compliments so we can listen to, and act upon, the experiences of patients that are reported.

Over the last year the Quality improvement Committee has received a number of presentations related to the services we commission and the difference this has made in improving patient journeys and outcomes.


Reducing health inequalitiesThe population of Lancashire North is diverse, with small pockets of deprivation, rural isolation and a mix of city and coastal towns. Therefore, targeted work is required to support those who require it whilst not disadvantaging the majority. We have incorporated the analysis of health burden, prevalence, and outcome against spend into the development of our strategic priorities. This collective evidence leads to a number of challenges for us to consider.

We are actively participating in the Lancashire Health and Wellbeing Board, represented by the Clinical Chair, sharing priorities and collaborating with other partner agencies. This year the Health and Wellbeing Board have provided a review of the developing Strategic Transformation Plan across Lancashire and South Cumbria. There is a clear link between this action plan and the Morecambe Bay Better Care Together programme

We continue to chair the local Lancashire North Health and Wellbeing Partnership, which has recently reviewed its objectives and partners, and renewed its commitment to working together to address the determinants of health. All partners recognise that who we are, our chosen lifestyles, where we live, work, play and socialize, will determine our health and wellbeing. We have adopted a collaborative approach with partners to develop both a long term and short term approach to preventing people from dying prematurely and to address the health inequalities in our area.

QOF data continues to show that there is still a gap between expected prevalence and registered prevalence for a variety of conditions, markers and lifestyle factors that may result in a premature death e.g. hypertension. We have worked with primary care professionals to understand and respond to the local level of unmet need. During this year we have continued to develop our population health approach based around our communities.

Equality reportWe believe that equality and inclusion should be embedded into all commissioning activity.

Our vision is to secure safe, high quality health services in partnership with professionals and patients, and to give local people the best opportunity to live longer and healthier lives. As such, our strategic aim is to

provide fair access to information, services, premises and employment opportunities to all of our patients, their families, carers and staff, to proactively eliminate direct or indirect discrimination of any kind.

At Lancashire North CCG, we believe that people in our community are the experts when it comes to their own conditions, their personal characteristics, or the needs of the people they care for, and that through empowering our patients and the public to become our partners, we will ensure a world class service for all. We are keen to involve local people in the continuing development and monitoring of our strategy to ensure that we commission (buy) the right health care services, reduce inequalities and provide well-trained staff to deliver services whilst meeting our responsibilities to ensure that our providers adhere to the equality duties set out in the Equality Act 2010 and promote people’s rights.

Our Equality and Inclusion Reports (published at least annually) set out how we are meeting our commitment in regards to taking equality, inclusion and human rights into account in everything that we do – whether that’s commissioning services, employing people, developing policies, communicating with or engaging local people in our work.

• Under the Equality Act 2010 and the Public Sector Equality Duties, public sector organisations such as CCGs must publish sufficient information to demonstrate that, in the exercise of their functions, they have ‘due regard’ (give early consideration) to:

• Eliminating discrimination, harassment and victimisation

• Advancing equality of opportunity between people who share a protected characteristic and those who do not

• Fostering good relations between people who share a relevant protected characteristic and those who do not

Our Equality and Inclusion Report for 2015/16 can be viewed on our website here: http://www.morecambebayccg.nhs.uk/download/governing-body-papers/Agenda-Item-17.0.-Equality-and-Inclusion-Annual-Report-201617.pdf

The reports are produced to meet our ‘specific equality duty’, which is placed on all CCGs. This duty aims 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. This information shows how we are meeting our public sector equality duty ‘general’ requirements,


identifies any significant gaps in our equality data, how we will close the gaps by working with local communities, and how they link into our agreed equality objectives. 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.

Our Equality Reports demonstrate how we have given detailed consideration to issues of equality discrimination before making any policy decision, which is an essential requirement and an integral part of the mechanisms for ensuring that we fulfil the aims of the anti-discrimination legislation set out in the Equality Act 2010 and the Human Rights Act 1998.

The reports also provide a summary of how we are performing against selected goals and outcomes of the NHS Equality Delivery System (EDS2). The data used in this process tells a story about the experiences of Lancashire North’s most vulnerable and marginalised patients, carers and staff. Through quantitative and qualitative data gathering and review from our provider partner organisations, we can gain assurances about the quality and safety of our services for local protected groups. The EDS2 makes a significant contribution towards meeting our obligations under the Public Sector Equality Duties.

Human rights into healthcareThe Human Rights Act is underpinned by the core values of fairness, respect, equality, dignity and autonomy for all. These values are at the heart of high quality health and social care.

The Human Rights Act 1998 sets out a range of rights which have implications for the way that we buy services and manage our workforce. In practice this means that we:

• Act compatibly with the rights contained in the Human Rights Act in everything we do

• Recognise that anyone who is a ‘victim’ under the Human Rights Act can bring a claim against Lancashire North CCG (in a UK court, tribunal, hearing or complaints procedure)

• Interpret and apply existing laws that we deal with as a public body, in a way that fits with the rights in the Human Rights Act 1998

The Clinical Commissioning Group has adopted the U-assure Equality Impact and Risk Assessment tool which provides a framework for undertaking equality analysis, privacy impact assessments and human rights screening. This enables the CCG to show ‘due regard’ to the three aims of the general equality duty by ensuring that all requirements around equality, human rights and privacy are given advanced consideration before the CCGs Governing Body or Senior Managers make any policy decisions that may be affected by them. The CCG Chair and Governing Body take the embedding of Equality and Human Rights seriously; any paper going to the Governing Body for consideration must include an equality analysis and human rights risk assessment.

The Midlands and Lancashire Commissioning Support Unit (MLCSU) Equality and Inclusion team provides us with the support and assurance in regards to meeting the legal requirements of the Human Rights Act 1998 in all of our planning and decision making processes. This involves consideration of not breaching the Human Rights Act, as well as ensuring fair treatment in healthcare, fair access to information, services, premises and employment opportunities for local people from vulnerable protected characteristic groups.

The evidence set out in this report demonstrates that we continue to make good progress towards ensuring due regard and meeting our legal and statutory obligations to the way healthcare services are commissioned and delivered on behalf of the people of Lancashire North. In 2017 we will be reviewing and consulting on our Equality and Inclusion Strategy and Equality Objectives for 2017-2020.

Modern Slavery ActLancashire North CCG fully supports the Government’s objectives to eradicate modern slavery and human trafficking but does not meet the requirements for producing an annual Slavery and Human Trafficking Statement as set out in the Modern Slavery Act 2015.


Complaints (includes principles for remedy) The CCG Constitution requires us to be compliant with ‘Good Governance Standards for Public Service’. This code works in parallel with other codes of practice which, for the NHS Complaints procedure, is included within the Parliamentary and Health Service Ombudsman guide to the ‘principle of remedy’.

The six principles are:

• Getting it right

• Being customer focused

• Being open and accountable

• Acting fairly and proportionately

• Seeking continuous improvement

• Financial and non-financial remedies

The CCG Constitution embraces all of these principles, and these are also encapsulated within the vision, values and aims of the organisation.

We are fully compliant with the current NHS Complaints guidance and our financial framework allows for financial remedy if required. This may be instigated by either the CCG, or recommended by outside bodies where appropriate.

During the year April 2016–March 2017, we received 20 complaints, one less than the previous year. The majority of complaints related to Continuing Healthcare and changes to the availability of various prescription medicines. Other complaints were received about the NHS 111 service, Out of Hours service, acute services and commissioning policies.

We also received 60 concerns/enquiries during the year, 47 more than the previous year. These related to continuing health care, changes in prescribing, GP practices, community and acute services.

During the year all but one complaint were responded to and resolved within the statutory timeframe. This one complaint remains open due to the complexity of the issues and investigation required.

Health and safetyWe are fully committed to providing a vibrant working environment that values wellbeing and diversity. We recognise our wider legal and moral obligation to provide a safe and healthy working environment for our employees, visitors and members of the public that may be affected by our activities.

We have adopted a Health and Safety Management System based on the HSG65 model and are adopting a proactive stance on health and safety that aims to promote an accountable culture which is just and fair to our employees. This enables us to learn from incident reports and risk assessments in order to continuously improve our health and safety management and, where necessary, change policy/procedure to enable this to happen. To date, 50% of staff have completed their online DSE training and assessment.

It is a statutory requirement to keep a record of all accidents, incidents and near misses that occur out of work activities. Our health and safety record for 2016/17 was very good. There were no RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013) reportable accidents across our organisation.

Security managementNHS Protect leads on work to identify and tackle crime across the health service. The aim is to protect NHS staff and resources from activities that would otherwise undermine their effectiveness and their ability to meet the needs of patients and professionals. Ultimately, this helps to ensure the proper use of valuable NHS resources and a safer, more secure environment in which to deliver and receive care.

Historically, NHS bodies were required to put in place arrangements to tackle fraud and manage security under Secretary of State Directions. Provisions introduced under the Health and Social Care Act 2012 mean that, for providers of NHS services, such arrangements are now set out in the standard commissioning contract.

We have an essential role in ensuring that the services we commission are safe and secure. Commissioners should review providers’ security management arrangements to ensure that they meet the requirements of the standard commissioning contract.


We undertook a review of University Hospital of Morecambe Bay NHS Foundation Trust’s self-review against their NHS Protects Provider Standards for 2016/17, which was found to be providing a safe and secure environment.

NHS Protect’s quality assurance programme can provide some assurance to commissioners in respect of providers’ security management work, if they audit this provider. Audits are conducted by certain triggers set out by NHS Protect, which has Commissioner Standards for 2016/17, released on 1 April 2016. Midlands and Lancashire Commissioning Support Unit have provided that resource under its Direct Service Offer to the CCG.

Emergency preparedness We certify that we have incident response plans in place, which are fully compliant with the NHS Commissioning Board Emergency Preparedness Framework 2015. We regularly review and make improvements to our major incident plan and have a programme for regularly testing this plan, the results of which are reported to the Audit Committee and the Governing Body.

Statement as to disclosure to auditors Each individual who is a member of the Membership Council/Governing Body at the time the Report is approved confirms:

• So far as the member is aware, there is no relevant audit information of which the Clinical Commissioning Group’s external auditor is unaware;

• 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.

Signed

Andrew Bennett Accountable Officer


Accountability ReportMembers’ reportThe members’ report details the information related to the Membership Council and the Governing Body. The CCG is committed to being open and transparent and a register of interests is featured in the Annual Governance Statement, starting on page 42.

Member practices of the Clinical Commissioning Group • Ashtrees Surgery

• Bay Medical Group

• The Dalton Square Practice

• The King Street and University Medical Practice

• Landscape Surgery Garstang Medical Centre

• Owen Road Surgery

• Queen Square Medical Practice

• Rosebank Medical Practice

• The Westgate Medical Practice (this practice merged with Bay Medical during 2016/17)

• Windsor Surgery Garstang Medical Centre

• York Bridge Surgery

Member practice information is available on our website at: http://www.lancashirenorthccg.nhs.uk/local-services/gp-practices/

Membership CouncilThis is the overarching strategic body of the CCG, and each of the 10 general practices based in the areas of Carnforth, Garstang, Lancaster and Morecambe have a nominated representative.

It brings together the voices of practices and their patients in setting the agenda. The Membership Council also plays a role in holding elected executive members to account and holding CCG officers to account for the delivery of the our priorities. Nominated representation from across general practice ensures that the depth and breadth of the patient voice is heard.

Governing BodyThe role of the Governing Body is to provide assurance that we are compliant with our statutory obligations and that we meet the key national requirements for governance in order to be a public organisation. The Governing Body has oversight of committees such as the Audit Committee and the Quality Improvement Committee and will ensure that the key duties of the CCG are delivered. The Governing Body is chaired by the CCG’s clinical leader. It also contains four local GPs, a registered nurse member, a hospital consultant, three senior managers, and two lay members.

The primary role of the Governing Body is to ensure that we have appropriate arrangements in place to exercise our functions effectively, efficiently and economically and in accordance with CCG principles of good governance and the CCG Constitution.

Full details of the voting members of the Membership Council, Governing Body, and its constituent committees, are contained within the Governance Statement.

Other relevant disclosuresThe CCG has made no political or charitable donations during the year.

There are no important events since the end of the financial year which affect the CCG.

The CCG does not have any branches outside the UK.


Pension liabilitiesThe CCG’s treatment of pension liabilities in the accounts is detailed in Note 4.5 to the Annual Accounts.

External AuditThe CCG’s external auditors are:

KPMG LLP St James’ Square Manchester M2 6DS

The audit fee for 2016/17 is £54,000 (including VAT) and relates to the statutory audit and services carried out in relation to the statutory audit. No other payments were made direct to KPMG LLP in the 2016/2017 financial year.

Cost allocation and setting of charges for informationWe certify that the CCG has complied with HM Treasury’s guidance on cost allocation and the setting of charges for information.

Disclosure of ‘Serious Untoward Incidents’ The Information Governance Framework ensures that all information, in particular person identifiable data related to patients, staff and corporate information, is handled in a confidential, secure, ethical and legal manner. We recognise the importance of appropriately managing information and keeping it secure, and reporting any incident or breach.

All NHS organisations are required to summarise all such incidents classified as 0-1 in their annual report and individually detail incidents classified 2-5. The latter classification of incident must also be reported to NHS England and the Office of the Information Commissioner.

During the period 1 April 2016 - 31 March 2017 three incidents were categorised 0-1 (low level) and no incidents were categorised in the higher severity levels (2-5).

Statement as to disclosure to auditors Each individual who is a member of the Membership Council/Governing Body at the time the Members’ Report is approved confirms:

• So far as the member is aware, there is no relevant audit information of which the Clinical Commissioning Group’s external auditor is unaware;

• 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.

Signed



Statement of Accountable Officer’s responsibilities

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

The responsibilities of an Accountable Officer are set out under the National Health Service Act 2006 (as amended), Managing Public Money and in the Clinical Commissioning Group Accountable Officer Appointment Letter. They include responsibilities for:

• The propriety and regularity of the public finances for which the Accountable Officer is answerable,

• For keeping proper accounting records (which disclose with reasonable accuracy at any time the financial position of the Clinical Commissioning Group and enable them to ensure that the accounts comply with the requirements of the Accounts Direction),

• For safeguarding the Clinical Commissioning Group’s assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities).

• The relevant responsibilities of accounting officers under Managing Public Money,

• Ensuring the CCG exercises its functions effectively, efficiently and economically (in accordance with Section 14Q of the National Health Service Act 2006 (as amended)) and with a view to securing continuous improvement in the quality of services (in accordance with Section14R of the National Health Service Act 2006 (as amended)),

• Ensuring that the CCG complies with its financial duties under Sections 223H to 223J of the National Health Service Act 2006 (as amended).

Under the National Health Service Act 2006 (as amended), NHS England has directed each Clinical Commissioning Group to prepare for each financial year financial statements in the form and on the basis set out in the Accounts Direction. The financial statements are prepared on an accruals basis and must give a true and fair view of the state of affairs of the Clinical Commissioning Group and of its net expenditure, changes in taxpayers’ equity and cash flows for the financial year.

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

• Observe the Accounts Direction issued by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis;

• Make judgements and estimates on a reasonable basis;

• State whether applicable accounting standards as set out in the Group Accounting Manual issued by the Department of Health have been followed, and disclose and explain any material departures in the financial statements; and,

• Prepare the financial statements on a going concern basis.


To the best of my knowledge and belief, I have properly discharged the responsibilities set out under the National Health Service Act 2006 (as amended), Managing Public Money and in my Clinical Commissioning Group Accountable Officer Appointment Letter.

I also confirm that:

• as far as I am aware, there is no relevant audit information of which the CCG’s auditors are unaware, and that as Accountable Officer, I have taken all the steps that I ought to have taken to make myself aware of any relevant audit information and to establish that the CCG’s auditors are aware of that information.

• that the annual report and accounts as a whole is fair, balanced and understandable and that I take personal responsibility for the annual report and accounts and the judgements required for determining that it is fair, balanced and understandable.

Signed



Annual Governance Statement

Introduction and contextNHS Lancashire North Clinical Commissioning Group is a body corporate established by NHS England on (1 April 2013) under the National Health Service Act 2006 (as amended).

The clinical commissioning group’s statutory functions are set under the National Health Service Act 2006 (as amended). The CCG’s general function is arranging the provision of services for persons for the purpose of the health service in England. The CCG is, in particular, required to arrange for the provision of certain health services to such extent as it considers necessary to meet the reasonable requirements of its local population.

As at 1 April 2006, the clinical commissioning group is not subject to any directions from NHS England issued under Section 14Z21 of the National Health Service Act 2006.

Scope of 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 CCG Accountable Officer Appointment Letter.

I am responsible for ensuring that the Clinical Commissioning Group is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity.

I also have responsibility for reviewing the effectiveness of the system of internal control within the clinical commissioning group as set out in the governance statement.

Compliance with the UK Corporate Governance CodeWhilst the detailed provisions of the UK Corporate Governance Code are not mandatory for public sector bodies, compliance with relevant principles of the Code is considered to be good practice. This Governance Statement is intended to demonstrate how the CCG had regard to the principles set out in the Code considered appropriate for CCGs.

The CCG 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.

Our Constitution sets out the arrangements that we have put in place to help us to deliver our vision and goals, to discharge all of our legal obligations and to engage with our members, our patients and our community and other key stakeholders and partners to achieve this. It describes our governing principles: the rules and procedures that we have established to ensure probity and accountability in the day-to-day running of our organisation, to ensure that decisions are taken in an open and transparent way and that our patients’ and public’s interests always remain central to our goals.

It applies to all of our members, to our employees, and to anyone who is a member of our Membership Council, CCG Governing Body, its committees, joint committees, sub-committees or anyone else acting on behalf of the CCG. Together we work within our resources to commission care in the most appropriate setting with the aim of our patients having the best experience and the best clinical outcomes from that care. The Constitution document is available at: http://www.lancashirenorthccg.nhs.uk/about-us/constitution/


Governance and committee arrangements include:

• Membership Council

• Governing Body

• Audit Committee

• Executive Committee

• Remuneration and Terms of Service Committee

• Quality and Improvement Committee

• Primary Care Co-commissioning Joint Committee

Management assurance to the Membership Council is through the Governing Body and its sub committees, whilst independent assurance is through the Audit Committee.

The CCG, through the Governance Framework and its reporting structures, has communicated and embedded codes of conduct and defined standards of behaviour for CCG members and staff by:

• Having codes of conduct for the Governing Body and sub-committee members showing mutual trust, respect and honesty. Members of the CCG Governing Body adhere to the seven principles of Public Life (Nolan Principles)

• All CCG staff follow a code of professional conduct which sets out the behaviours expected. These are based on values of respect, empowerment, empathy, trustworthiness, integrity and justice

• All committees authorised by the Governing Body are accountable to the Governing Body. Each committee is responsible for approving and for keeping under review the terms of reference and membership of each of their committees.

Membership CouncilThis is the overarching strategic body of the CCG, and each of the 10 general practices based in the areas of Carnforth, Garstang, Lancaster and Morecambe have a nominated representative.

It brings together the voices of practices and their patients in setting the agenda. The Membership Council also plays a role in holding elected executive members and CCG officers to account for the delivery of the CCG’s priorities. Nominated representation from across general practice ensures the depth and breadth of the patient voice is heard.

Functions of the Membership Council:

• Approving the CCG’s Constitution and proposed changes to the Constitution

• Making arrangements for members joining and leaving the CCG

• Approving the appointment of:

I. The chair of the Governing Body;

II. Clinicians to represent member practices on the Governing Body

III. All other Governing Body members

• Determining the remuneration and travelling or other allowances of members of its Governing Body, who are not employees of the CCG

• Jointly publishing with the Governing Body, the CCG’s Annual Report and Annual Accounts

• Holding the Governing Body members, both individually and collectively, to account for the performance of the Governing Body

• Influencing the recommendations and decisions of the Governing Body’s Executive Committee in respect of the CCG’s commissioning and related plans

• Agreeing initiatives for implementation by member practices to improve the quality and outcomes of patient care and better use of resources

• Contributing towards the goals of the CCG as set out in its commissioning and financial plans

• Approving an application by the CCG to enter into a merger, separation or dissolution.


Composition of the Membership Council The Membership Council has held 9 meetings between April 2016 and March 2017. Voting members of the Membership Council are as follows:

Position NameNumber of

meetings attended% attendance over the year

Clinical Chair Dr Alex Gaw 9 out of 9 100

GP Principal, Landscape Surgery Dr George Dingle 7 out of 9 89

GP Partner, Dalton Square Practice Dr Howard Fairhurst** 5 out of 9 56

GP Partner, King Street Surgery Dr Cliff Elley*** 7 out of 9 89

GP Partner, Westgate Medical Practice (this practice merged with Bay Medical in year)

Dr Sarah Maher (term of office completed in October 2016)

1 out of 9 11

GP Partner, Rosebank Medical Practice Dr Rahul Keith 6 out of 9 67

GP Partner, Owen Road Surgery Dr Mike Kingston 8 out of 9 89

GP Partner, Bay Medical Group Dr Andy Maddox 7 out of 9 78

GP Partner, Queen Square Medical Practice

Dr Sam Moon 9 out of 9 100

GP, Bay Medical Group Dr Rohan Rao 6 out of 9 67

GP Partner, Windsor Surgery Dr Jonathan Williamson* 4 out of 9 44

GP Partner, York Bridge Surgery Dr Jon Wimborne 7 out of 9 78

GP Partner, Ash Trees Surgery Dr Andy Knox**** 7 out of 9 78

Notes

- Dr Mark Denver attended on behalf of Bay Medical Group on one occasion

* Dr John Miles attended on behalf of Windsor Surgery on three occasions.

** Dr Tim Reynard attended on behalf of Dalton Square Practice on three occasions.

*** Dr Duncan Hallam attended on behalf of King Street Surgery on two occasions.

**** Dr David Wrigley attended on behalf of Ash Trees Surgery on one occasion.

**** Dr Chris Coldwell attended on behalf of Ash Trees Surgery on one occasion

Membership Council – declarations of interest 2016/17 Declarations of interest are noted on an annual basis and published on our website. They are available to view at: http://www.morecambebayccg.nhs.uk/about-us/registers-interest-procurement-decisions-contracts-awarded-gifts-hospitality/registers-interests/


Governing BodyThe role of the Governing Body is to provide assurance that the CCG is compliant with its statutory obligations and that it meets the key national requirements for governance in order to be a public organisation. The Governing Body has oversight of committees such as the Audit Committee and the Quality Improvement Committee and will ensure that the key duties of the CCG are delivered. The Governing Body is chaired by the CCG’s clinical leader. There are four local GPs, the CCG Chief Nurse, a hospital consultant, the three directors of the CCG, and two lay members.

The primary role of the Governing Body is to ensure that the CCG has appropriate arrangements in place to exercise its functions effectively, efficiently and economically, and in accordance with CCG principles of good governance and the CCG Constitution.

The Governing Body also leads and approves the setting of the CCG vision and strategy and its annual commissioning and financial plans, arrangements for financial and risk management and jointly publishing, with the CCG Membership Council, the CCG Annual Report and Annual Accounts.

The Governing Body’s main focus is to:

a. Ensure that the CCG has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with CCG principles of good governance (its main function)

b. Determine the remuneration, fees and other allowances payable to employees or other persons providing services to the CCG, including nominated practice representatives, 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 Act

c. Approve any functions of the CCG that are specified in regulations

d. With the exception of those functions reserved to the CCG Membership Council, to discharge all of the CCG’s remaining statutory functions


Composition of the Governing BodyThe Governing Body has held 6 meetings between April 2016 and March 2017. Voting members of the Governing Body are:



Clinical Chair Dr Alex Gaw 6 out of 6 100

Chief Officer Mr Andrew Bennett 6 out of 6 100

Chief Finance Officer and Director of Governance

Mr Kevin Parkinson 6 out of 6 100

GP Executive Lead - Commissioning Dr Cliff Elley 6 out of 6 100

Chief Commissioning Officer Miss Hilary Fordham 6 out of 6 100

GP Executive Lead - Finance Dr Andy Maddox 6 out of 6 100

GP Executive Lead - Practice Engagement

Dr Mike Kingston (April 2016 to 30 September 2016)

4 out of 4 100

GP Executive Lead – Health and Wellbeing

Dr Andy Knox 4 out of 6 67

Lay Member Mrs Sue McGraw 6 out of 6 100

Lay Member Mr Clive Unitt 5 out of 6 83

Governing Body’s Secondary Care Specialist

Dr Mike Flanagan 6 out of 6 100

Chief Nurse Margaret Williams 6 out of 6 100


Position Name Details of interest

Chief Officer Andrew BennettSpouse is an employee of Lancashire Teaching Hospitals NHS Foundation TrustProvide a mentoring service to Dewi W Hughes Ltd

GP - King Street Surgery, Lancaster

Dr Cliff Elley

GP Partner, King Street, Lancaster and University Medical Practice, LancasterMember and Shareholder of North Lancashire Medical Services (NLMS) GP FederationSpouse is a Clinical Nurse Specialist employed by Blackpool, Fylde and Wyre Hospitals NHS Foundation Trust

Secondary Care Doctor for the Governing Body

Dr Mike Flanagan Spouse is a volunteer for ACE, Lancaster

Chief Commissioning Officer

Hilary Fordham Nothing to declare

GP - Bay Medical Group, Morecambe and Lancashire North CCG Clinical Chair

Dr Alex Gaw

GP Partner, Bay Medical Group, MorecambeDirector of FCMSDirector PDS (Medical)Director of Greenlands Farm LtdMember of North Lancashire Medical Services Ltd (NLMS)

GP - Owen Road Surgery, Lancaster

Dr Mike Kingston Left LNCCG on 30 September 2016

GP Partner, Owen Road Surgery, LancasterSpouse is a Partner at Owen Road SurgeryMember of North Lancashire Medical Services Ltd (NLMS)GP Member of Lancashire Coastal Local Medical Committee (LMC)

GP - Ash Trees Surgery, Carnforth

Dr Andy Knox GP Partner, Ash Trees Surgery, Carnforth

GP - Bay Medical Group, Morecambe

Dr Andy Maddox

GP Partner, Coastal Medical Group, MorecambeShareholder in PDS Medical Ltd holds contract for SDS in MorecambeMember of the Local GP Federation Lancashire North Medical ServicesMember of the Cumbria and Lancashire Local Workforce and Education Group (LWEG)Health Education North West Board Board MemberCommittee member of the Bay Local Medical Committee (LMC)

Lay Member Sue McGrawChief Executive Officer, St John’s Hospice, LancasterSpouse is a North West Ambulance Service employee

Chief Finance Officer/Director of Governance

Kevin ParkinsonSpouse is a Pharmacist employed by Lancashire Care NHS Foundation Trust

Lay Member Clive UnittDirector of CLS GroupTrustee of Borough Care Services Homes (BCS) (Residential care for the elderly with a specialisation in Dementia Care)

Chief NurseMargaret Williams

Executive Chief Nurse MemberHonorary Contract with University of Cumbria, LancasterRegistered General Nurse at Alston View Care Home, Preston

Governing Body – declarations of interest 2016/17 Declarations of interest are recorded annually and are available to view at: http://www.lancashirenorthccg.nhs.uk/download/corporate-documents/registers-of-interest/LNCCG%20Governing%20Body%20Declarations%20of%20Interest%202016%2717%20v3.pdf


Committees of the Governing BodyThe following have been established as committees of the Governing Body. The minutes of the committees are submitted to the Governing Body once ratified by the committee.

Audit CommitteeThe Audit Committee provides the Governing Body with an independent and objective view of the CCG financial systems, financial information and compliance with laws, regulations and directions governing the CCG in relation to finance.

The Audit Committee also reviews the effectiveness of the system of governance, risk management and internal control, incorporating the arrangements for the Membership Council and the arrangements made by the CCG for managing conflicts of interest, whistle blowing and fraud (both clinical and non-clinical).

The main focus of the work has been in relation to establishing internal and external audit arrangements and plans, receiving internal audit reports and reports from the local counter fraud team and reviewing the internal control and risk management systems, including reviewing the assurance framework, risk register and conflict of interest policy.

Composition of the Audit CommitteeThe Audit Committee has held 5 meetings between April 2016 and March 2017. Voting members of the Audit Committee are:

Executive CommitteeThe Executive Committee is charged with delivering the routine work of the CCG. The committee is made up of four elected clinical members of the Governing Body, the Chief Officer, Chief Finance/Director of Governance, Chief Commissioning Officer, Chief Nurse and Clinical Chair.

The Executive Committee:

• Ensures that there is continuous engagement with the CCG’s membership and that members’ views influence and inform the development of commissioning priorities plans, and arrangements for their implementation

• Recommends to the Governing Body the CCG’s two year, five year and annual commissioning and financial plans; demonstrates that plans are informed by patients and the public and that they are patient centred; that they are effective, efficient and economic; has oversight of the delivery of those plans and ensures that risks associated with delivery are being mitigated

• Keeps under review and ensures compliance with the CCG’s governance requirements and legal duties; has operational oversight of the CCG’s responsibilities, including organisational development, and ensures that regular reports are provided to the Governing Body on the CCG’s operational and risk management

• Provides assurance to the Governing Body that the CCG’s collaborative arrangements are being discharged in accordance with the arrangements approved by the Governing Body

Its main focus of work during 2016-17 has been in ensuring the CCG maintains its ability to operate as a commissioning organisation, assured by NHS England and providing clinical expertise/leadership input to the Better Care Together programme. The committee has continued to pay particular attention to the improvement of clinical care at University Hospitals Morecambe Bay NHS Trust (UHMB) and its other providers. In relation to UHMB the CCG has worked with Cumbria CCG to assure their members regarding progress related to their CQC improvement plan. In June 2016, the CCG with members of the Quality Surveillance group signed off the Kirkup action plan. Cumbria CCG and LNCCG have an agreed accountable assurance process for ongoing monitoring.

Position NameNumber of meetings attended

% attendance

over the year

Lay Member and Chair

Mr Clive Unitt

5 out of 5 100

Lay MemberMrs Sue McGraw

5 out of 5 100


Dr Mike Flanagan

5 out of 5 100


Composition of the Executive CommitteeThe Executive Committee has held 18 meetings between April 2016 and March 2017. Voting members of the Executive Committee are:

Remuneration and Terms of Service CommitteeThe Remuneration and Terms of Service Committee makes recommendations to the Governing Body on determinations about the remuneration, fees and other allowances for employees, and for people who provide services to the CCG, and on determinations about allowances under any pension scheme that the CCG may establish as an alternative to the NHS pension scheme.

Where the Audit and Remuneration and Terms of Service Committees review or advise on matters which concern the functions of the Membership Council, they will report directly to the Membership Council.

Composition of the Remuneration and Terms of Service CommitteeThe Remuneration Committee has held 0 meetings between April 2016 and March 2017. The Remuneration Committee did not meet during 2016/17 as there were no matters relating to the remuneration of Executive’s, Lay Members or Secondary Care doctor which required discussion. Voting members of the Remuneration Committee are:



Elected Chair of the Governing Body and Membership Council

Dr Alex Gaw 15 83%

Chief Officer Mr Andrew Bennett 16 89%


Mr Kevin Parkinson 16 89%

Chief Commissioning Officer Miss Hilary Fordham 15 83%

Chief Nurse Mrs Margaret Williams 16 89%

GP Executive Lead - Commissioning Dr Cliff Elley 15 83%

GP Executive Lead - Finance Dr Andy Maddox 14 78%

GP Executive Lead - Practice EngagementDr Mike Kingston Left LNCCG on 30 September 2016

8 out of 11 73%

GP Executive Lead - Health and Wellbeing Dr Andy Knox 15 83%



Lay Member and Chair Mr Clive Unitt 0 --

Lay Member Mrs Sue McGraw 0 --

Secondary Care Doctor Dr Mike Flanagan 0 --


Quality Improvement Committee The Quality Improvement Committee provides assurance to the Governing Body that the services the CCG commissions are safe and effective, that quality and patient experience is central to the work of the CCG and that there is continuous improvement in the quality of commissioned services and patient outcomes.

Through the CCG’s established assurance processes the Quality Improvement Committee has received unique insight into how local providers deliver good, effective care. This has included review and consideration of local clinical service user intelligence and performance information. Information has then been triangulated with patient stories and service delivery presentations. This approach has enhanced the Committee’s ability to put what we learn from peoples’ experiences of care at the heart of what we do. We also undertake local walk round quality inspections to crystallise what we know. When poor care delivery is reported, we have processes and responses that seek to promptly correct and minimise impact.

A second area of growth is how Committee members are collectively and individually gaining momentum as system leaders, building relationships with all parts of the health economy system through delivery of the Better Care Together Strategy, Federation and Integrated Care Community developments. This helps to address identified gaps along the patient pathway, often between services/sectors, and recognises workforce capacity and expertise as an enabler to improvement. The final area relates to the importance of influencing and realigning national directives locally.

In the coming year we aim to continue to build the commissioning expertise of our committee members to build local intelligence and drive improvement, not only to discharge the CCG’s statutory requirements, but in order to demonstrate improved outcomes.


Composition of the Quality Improvement Committee The Quality Improvement Committee has held 6 meetings between April 2016 and March 2017. Voting members of the Quality Improvement Committee are:

Primary Care Co-commissioning Joint Committee The Joint Committee of Lancashire North CCG and NHS England is responsible for commissioning primary medical services under section 83 of the NHS Act, except those relating to individual GP performance management, which have been reserved to NHS England.

Composition of the Primary Care Co-commissioning Joint Committee The Primary Care Co-Commissioning Joint Committee has held 2 meeting between April 2016 and March 2017. Attendees at the Committee during the year have been:

Position Name Number of meetings attended

% attendance over the year

Lay Member and Chair Mrs Sue McGraw 5 out of 6 83

Governing Body’s Secondary Care Specialist Dr Mike Flanagan 4 out of 6 67

Elected GP Lead on Quality Dr David Knapper 6 out of 6 100

GP Executive Lead - Finance Dr Andy Maddox 6 out of 6 100

Chief Nurse Mrs Margaret Williams 6 out of 6 100

GP Executive Lead - Practice EngagementDr Mike Kingston - Left LNCCG 30 September 2016

3 out of 3 100


Mr Kevin Parkinson 6 out of 6 100

Senior Manager Planning and Partnerships Mrs Jacqui Thompson 5 out of 6 83

Position Name Number of meetings attended

% attendance over the year

Lay Member - NHS Lancashire North CCG Mr Clive Unitt 2 out of 2 100

Governing Body’s Secondary Care Doctor NHS Lancashire North CCG

Dr Mike Flanagan 2 out of 2 100

Chief Officer - NHS Lancashire North CCG Andrew Bennett 0 out of 2 0

Chief Finance Officer/Director of Governance NHS Lancashire North CCG

Kevin Parkinson 2 out of 2 100

Chief Commissioning Officer Hilary Fordham 1 out of 2 50

Lay Member - NHS Lancashire North CCG Sue McGraw 2 out of 2 100

Head of Primary Care - NHS England Jackie Forshaw 0 out of 2 0

Local Professional Networks Manager NHS England Stephen Gough 1 out of 2 50

Interim Assistant Head of Finance (Direct Commissioning) - NHS England

Hafiza Ugradar 1 out of 2 50

Primary Care Manager - NHS England Mark Lindsay 1 out of 2 50


Governing Body Sub-Committee’s declaration of interests 2016/17 Declarations of interest are noted on an annual basis and published on our website. They are available to view at: http://www.lancashirenorthccg.nhs.uk/download/corporate-documents/registers-of-interest/LNCCG%20Governing%20Body%20Sub-Committees%20Declarations%20of%20Interest%202016%2717%20v3.pdf

Risk Management FrameworkWe utilise the key elements of our Risk and Internal Control Framework to secure assurance for the prevention, deterrent and management of risks, as outlined within our Risk Management Strategy and Policy. The Strategy and Policy include details of the criteria used to assess risk and the governance process used to ensure that risks are controlled and escalated where necessary. This enables the CCG to recognise, manage and brief the Governing Body on significant risks and controls as required. We involve key partners and stakeholders in the identification and management of risks.

Our Risk Management Strategy and Policy outlines our appetite for risk, attitude towards risk, and the culture that will underpin its successful management and delivery. This ensures that both a systematic and consistent approach to managing risk is adopted throughout the organisation. The policy can be accessed via our website at: http://www.lancashirenorthccg.nhs.uk/download/policies/corporate-governance/LNCCG%20Risk%20Management%20Strategy%20and%20Policy %20270715.pdf

They state how the CCG:

1Defines and documents the roles and

responsibilities of the Governing Body, Executive and Lay Members, including the scrutiny and Accountable Officer functions, with clear delegated arrangements and protocols for effective management, provision and communication of risk. This is done by:

• Clearly setting out the rules for the Governing Body, Executive, Audit and Quality Improvement Committees

• Providing strategic management through the Senior Managers and bi-monthly reporting of high level risks as required into the executive team

• The Executive Committee receive regular reports on quality concerns, budgets, progress of improvement programmes, risks, controls and mitigation

• After each update, all staff are reminded of its presence and the process of update. New risks are identified outside the reviews, mainly through established risk management processes, commissioning managers and team discussions

2Captures risk, using the agreed reporting

template, to aid the discussion with Committee Members, ensuring the quality and experience of Lancashire North CCG resident population is of a consistently safe and high standard, and that services are accessed and delivered in accordance with CCG objectives and outcomes. This is done by:

• Using a range of soft intelligence feedback mechanisms, including weekly assurance group, Datix Reporting System, Commissioner Group and 1:1 meetings with key stakeholders

• Ensuring rigorous provider contract quality governance and reporting processes, including early warning triggers and escalation process

• Delivery of CCG quality strategy/framework, measuring success through performance indicators based on recognised improvement methodology

• Engaging with the public, including through the ‘My NHS’ membership scheme, the Patient Listening Group and the Maternity Liaison Group


• Being an active member in stakeholder meetings, including Lancashire Wide Quality Surveillance and Assurance Groups, Lancashire Safeguarding Children and Adults Board – ensuring the CCG contributes as a pivotal decision-maker, steering the Lancashire wide strategy

• Ensuring that any new business case is aligned to, and advances, CCG priorities and objectives.

• Maintaining and annually updating CCG fraud and bribery risk assessments

• Holding regular cross departmental team briefs led by senior executives

• Continually advancing internal governance and assurance systems through regular and timely reporting of risks, opportunities and concerns

• Regularly monitoring provider service delivery through reports to the Governing Body and Quality Improvement Committee, Executive Management Team and the Membership Council. When below target performance is significant, escalation, explanations and corrective actions are planned and implemented

3Provides effective arrangements for

whistleblowing, and for receiving and investigating complaints from the public. This is done by:

• Having a Whistleblowing Policy – a confidential reporting process which clearly documents the procedure for staff to report matters of concern, which is regularly updated and communicated to staff

• Having an annually updated Anti-Fraud, Bribery and Corruption Policy

• Maintaining an effective internal audit function

• Having a clear complaints procedure

• Using complaints and compliments as a positive improvement

Core to the successful management of risk are the Assurance Framework and Risk Register. Collectively they provide us with a simple but comprehensive method for the effective and focused management of risks that arise in meeting strategic objectives and delivering core operational functions. They also provide a structure for evidencing successful in-year delivery and therefore support the annual governance statement.

The Assurance Framework and Risk Register have been developed in consultation with the Quality Improvement Committee and Senior Managers. The Assurance Framework and Risk Register documents are reviewed by the Audit Committee quarterly and Quality Improvement Committee bi-monthly. Here, critical changes are ratified, including discussion relating to risks that may require transfer from the Risk Register to the Assurance Framework.

The Risk Management Strategy and Policy articulates the foundations that integrate governance and quality processes across the organisation.

Risk assessment Our approach to risk management encompasses the breadth of the organisation by considering financial, organisational, and reputational and project risks, both clinical and non-clinical, and for all parts of the organisation involved. Risks are assessed in accordance with our Risk Management Strategy and Procedures. Risks are identified from a number of sources, including the commissioning managers, who hold their own risk issues log. When operational issues cannot be managed, or new risks are identified, the Risk Register is completed and a risk rating assigned according to the severity and likelihood and any existing controls in place. A decision is then made, initially via the Senior Management team and nominated responsible Executive Officer, as to the most appropriate course of action for managing the risk. The Quality Improvement Committee considers risks requiring transfer to the Governing Body Assurance Framework. During the reporting period risks were identified from a variety of sources, including:

• Complaints and incidents

• Internal investigations

• Internal/external audit reports

• Commissioner meetings

• Risk issues identified and managed by/through CCG Committees and Groups

• Risk assessments

• Quality Improvement Committee meeting

• Membership Council meeting

• Governing Body meeting


We manages risks via the operation of a number of interconnected risk issues logs and a corporate risk register which holds risks which are noted to have a multi-faceted impact.

As part of the identification of the risks from various sources the following significant risks i.e. those risks that score 12 plus on the 5x5 risk matrix, were added to the Governing Body Assurance Framework and Corporate Risk Register in 2016/17:

Reference Risk description

AF145The impact of efficiency plans and financial pressures for LCC and other commissioners may have on LNCCG.

AF147Ability to recruit and retain Registered Professionals across the health economy of providers.

AF154 Risk of the CCG not meeting the CCG Assurance Standards, QIPP and other key work programmes.

AF159

Inability to produce bay wide data on activity, finance and performance results in poor planning and impacts on the delivery of better Care together and the development of the ACS.

RR148There is a risk to patient safety and service provision due to a lack of clinical GP availability within the GP Out of Hours Service.

RR149

2016/2017 QIPP: the QIPP target is likely to be c£6.9m, with schemes for delivery of £2.75m proposed. If schemes to cover the remaining target are not identified, the CCG's ability to achieve its financial targets will be compromised.

RR150 F&W CCG has given CCG notice to withdraw from Safeguarding Shared arrangement

RR151 Current Safeguarding Funding does not cover min team structure requirements

RR153

F&W CCG are at the pre-tender stage for all community health services currently provided by BTH. Should this be awarded to an alternative provider there could be stability issues for BTH teams operating in Lancashire North.

RR155The CCGs ability to maintain legal duties i.e. to reduce health inequalities, equality and inclusion and human rights and engaging with the public.

RR156

CCG requires assurance of administration in respect of the provision of CHC/IPA information. This may result in increased financial pressures for the CCG.

RR157How CCG will manage the increasing LD Patient identifiable information CCG is expected to handle within stated legal constraints

RR160 The transfer of Specialised Services back to the CCG could result in a financial pressure.

RR161Ensuring quality standards maintained, assessed and managed throughout the period of boundary change

RR162 Full detail of out of area placements for specialist placements transforming care not yet known

In accordance with the Risk Management Strategy and Policy, new risks identified for inclusion on the risk register are assessed for their likelihood and consequence using a 5x5 risk matrix. Delivery and adherence to risk management arrangements is the

responsibility of everyone within the organisation and every individual staff member has the right to identify any potential or actual risk for service users, staff and the organisation. This is supported by dedicated resources to support managers and staff to ensure compliance with the organisation’s risk management requirements.

In all instances where a risk is not acceptable at the current level, an action plan is drawn up to set out the steps to be taken to manage that risk, with a nominated responsible person and a deadline for completion of each action.

Examples of risk that have been managed and target risk met over the course of the year are:

Reference Risk description Target

ASSURANCE FRAMEWORK

AF52

CCG provider performance on the NHS Constitution targets impacts on the CCGs ability to earn the national Quality Premium

Target met on

19/08/2016

RISK REGISTER

RR78

2015/2016 QIPP: the QIPP target is likely to be £5.9m, with schemes for delivery of £2.5m proposed and a further £1.2m being pursued. If schemes to cover the remaining target are not identified, the CCG's ability to invest in other areas will be compromised.

Target met on

03/05/2016

RR104Lack of appropriate and adequate software or hardware for delivery of the CCGs Requirements.

Target met on

06/05/2016

RR107

Limited experience and training in specialist areas, e.g. statistics, data analysis, report writing leads to poor delivery of the service.

Target met on

06/05/2016

RR148

There is a risk to patient safety and service provision due to a lack of clinical GP availability within the GP Out of Hours Service.

Target met on

21/09/2016

RR150F&W CCG has given CCG notice to withdraw from Safeguarding Shared arrangement

Target met on

14/12/2016

RR151Current Safeguarding Funding does not cover min team structure requirements

Target met on

14/12/2016

RR152

Personal Health Budgets The CCG receives a challenge that it is not allowing all patients who meet the guidance criteria to access a personal health budget (it should be noted that those groups who meet the mandatory criteria are able to access).

Target met on

19/05/2016

RR157

How CCG will manage the increasing LD Patient identifiable information CCG is expected to handle within stated legal constraints

Target met on

14/12/2016


Internal Control FrameworkA system of internal control is the set of processes and procedures in place to ensure we deliver our 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.

Information GovernanceThe NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personally identifiable information. The NHS Information Governance Framework is supported by an information governance toolkit and the annual submission process provides assurances to the CCG, other organisations, and to individuals, that personal information is dealt with legally, securely, efficiently and effectively.

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 share learning of information incidents with staff, encouraging them to consistently apply risk assessment and management procedures when handing data.

Control measures are in place to ensure risks to data security are managed and controlled. We have put an information risk management process in place led by the Senior Information risk owner (SIRO). Information asset owners and administrators have been identified to cover the CCG’s main systems and records stores, along with information held at team level. We have ensured all staff undertake annual Information Governance training and have implemented a staff information governance handbook to ensure staff are aware of their information governance roles and responsibilities. In addition to this, all CCG laptops

and USB sticks are encrypted, with iPads having password protection. The Information Governance Toolkit self-assessment across the CCG has indicated a Level 2 or above on all standards.

We recognise that the information we hold is one of our key assets. During the reporting period, risks to data security have been managed through the implementation and achievement of the relevant requirements within the NHS Information Governance Toolkit. The SIRO has overseen the management of data security protection via specialist support from the Midlands and Lancashire Commissioning Support Unit, and internally through the appointment of Information Asset Owners. We have completed information security risk assessments to ensure on-going pro-active risk management and data security protection.

Review of economy, efficiency and effectiveness of the use of resourcesAs part of the CCG assurance process our quality of leadership indicator continues to be rated by NHS England as green. Our latest results (Quarter 2 2016/17) are available on MyNHS and our year end results will be available from July 2017 at www.nhs.uk/service-search/scorecard/results/1175.

We have continued to operate within the context of significant financial issues across Morecambe Bay, on which we have been working jointly with both the University Hospitals of Morecambe Bay NHS Trust and NHS Cumbria CCG. This work has been concentrated on the development and implementation of the Better Care Together strategy and delivery plan, which aim to transform services in Morecambe Bay to provide both financial and clinical resilience and sustainability. As a subset of this, the Better Care Fund helps to facilitate the delivery of parts of the overall Better Care Together programme.

We received £4.73m of Vanguard funding in 2016/2017 for use across the Morecambe Bay health economy, and this has been used to continue the implementation of Better Care Together, as well as to accelerate development of an Accountable Care System, which has operated in shadow form from 1 April 2016.


Within the CCG, maintaining adequate and effective financial control and ensuring strong financial management, as well as delivering QIPP savings targets, has been a high risk during this reporting year. These risks have been managed through controls exercised within the CCG and through effective contract management. Our Finance and Performance Committee receives reports on the financial position for discussion and challenge each month, with remedial action identified where necessary. Reports are also provided to Governing Body at each meeting.

We have robust procedures for our key financial systems, which continue to be reviewed as appropriate in line with the annual audit plan, and reported to the Audit Committee.

Counter fraud arrangementsThe clinical commissioning group contracts with Mersey Internal Audit Agency for the provision of an Accredited Counter Fraud Specialist service, to undertake counter fraud work proportionate to identified risks.

The clinical commissioning group’s Audit Committee receives a counter fraud report against each of the Standards for Commissioners on an annual basis. A proportionate, proactive work plan is developed by the Accredited Counter Fraud Specialist in conjunction with the Audit Committee and Chief Finance Officer to address identified risks.

The Chief Finance Officer holds overall Executive responsibility for tackling fraud, bribery and corruption. Counter fraud newsletters and bulletins are distributed to all staff on a regular basis and ad hoc fraud notices are disseminated as and when required.

Review of the effectiveness of governance, risk management and internal controlAs Accountable Officer, I have responsibility for reviewing the effectiveness of the system of internal control within the CCG. I can report that there have been no serious lapses in internal control during 2016 -17.

Capacity to handle riskResponsibility for risk management and health and safety is brought together through the Executive Management team who work collectively to integrate both functions and oversee the work relating to operational safety. The Senior Managers take on pivotal roles in the CCG Committee structure, with a responsibility for coordinating, communicating and accelerating strategic and operational assurance issues, regularly reporting on core business activity.

We identify the development needs of members, senior officers and staff in relation to their roles, through:

• Induction training for all new CCG staff, Governing Body and committee members

• Annual risk management awareness and training with Quality Improvement Committee and CCG commissioning managers

• Being proactive partners in the NHS Leadership Academy and Advancing Quality (AQuA)

• Maintaining a performance and appraisal system so that all members of staff know what is expected of them

• Ensuring that emergencies can be appropriately addressed through regular testing of the Major Incident and Business Continuity plans and membership of the Lancashire Health Resilience Partnership

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 CCG who have responsibility for the development and maintenance of the internal control framework. I have drawn on performance information available to me. My review is also informed by comments made by the external auditors in their annual audit letter and other reports.

The Governing Body Assurance Framework itself provides me with evidence that the effectiveness of controls that manage risks to the CCG 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 Quality Improvement Committee, and a plan to address weaknesses and ensure continuous improvement of the system is in place.

My review is informed by a number of reports and audits received throughout the year, including:

• External Audit via their Annual Audit Letter, which provides a high level summary of audit work carried out

• Regular team meetings

• Reports to Audit Committee by the Local Counter Fraud Specialists

• Information Governance Toolkit submission

• Review of the corporate risk register by the CCG Governing Body and Audit Committee

• Scrutiny of the Assurance Framework by the Audit Committee

• Regular meetings with NHS England Area Team (Quality Surveillance Groups/Quarterly checkpoints)

• Attendance at Quality Committee meetings for the main providers of acute, community and mental health services

Following completion of the planned audit work for the financial year, the Director of Internal Audit issued an independent and objective opinion on the adequacy and effectiveness of our system of risk management, governance and internal control. The Director of internal Audit concluded that:

Internal Audit - Conflict of InterestFollowing the publication, in June 2016, of NHS England’s revised statutory guidance on managing conflicts of interest for CCGs, Lancashire North undertook an audit of conflicts of interest management as part of their internal audit plans. This enabled the CCG to confirm and obtain assurance that the safeguards set out in the revised statutory guidance had been embedded. NHS England has provided a framework to support CCGs’ to undertake an internal audit of conflicts of interest management, including the scope and approach. Mersey Internal Audit undertook the review on behalf of the CCG using the NHS England prescribed framework.

Overall, they found that the CCG is fully compliant with legal requirements and statutory guidance in relation to a number of the key elements assessed in respect of the management of conflicts of interest and gifts and hospitality. The CCG should ensure that its training programme is completed for all staff who have not yet received training and that all contract management meetings include declaration of interests as a standing agenda item.

Head of Internal Audit Opinion Following completion of the planned audit work for the financial year, 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:

“In accordance with Public Sector Internal Audit Standards, the Director of Internal Audit (HoIA) is required to provide an annual opinion, based upon and limited to the work performed, on the overall adequacy and effectiveness of the organisation’s risk management, control and governance processes (i.e. the organisation’s system of internal control). This is achieved through a risk-based plan of work, agreed with management and approved by the Audit Committee, which should provide a reasonable level of assurance subject to the inherent limitations described below.

The purpose of this Director of Internal Audit Opinion is to contribute to the assurances available to the Accountable Officer and the Governing Body which underpin the Governing Body’s own assessment of the effectiveness of the organisation’s system of internal control. This opinion will assist the Governing Body in the completion of its Annual Governance Statement, along with considerations of organisational performance, regulatory compliance and wider economy transformation.


Director of Internal Audit Opinion – Executive SummaryMy opinion is set out as follows:

• Basis for the Opinion;

• Overall Opinion; and

• Commentary.

2.1 Basis for the Opinion1. An assessment of the design and operation of the

underpinning Assurance Framework and supporting processes.

2. An assessment of the range of individual assurances arising from our risk-based internal audit assignments that have been reported throughout the period. This assessment has taken account of the relative materiality of systems reviewed and management’s progress in respective of addressing control weaknesses identified.

3. An assessment of the organisation’s response to Internal Audit recommendations, and the extent to which they have been implemented.My opinion is one source of assurance that the organisation has in providing its AGS other third party assurances should also be considered. In addition, the organisation should take account of other independent assurances that are considered relevant.

Overall OpinionThis early Director of Audit Opinion has been provided to support the CCG in providing information to NHS England as per requirements. The plan was profiled following discussions with the CCG and there are a small number of reviews at draft stage.

The overall opinion will be determined at the completion of the internal audit planned work for the full year (1 April 2016- 31 March 2017). As such, the opinion below is our indicative opinion, based upon the work completed to date.

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.

Title Overall Objective RecommendationsC H M L

HIGH ASSURANCE: Our work found some low impact control weaknesses which, if addressed would improve overall control. However, these weaknesses do not affect key controls and are unlikely to impair the achievement of the objectives of the system. Therefore we can conclude that the key controls have been adequately designed and are operating effectively to deliver the objectives of the system, function or process.

None of the reviews finalised had been assigned High Assurance.

SIGNIFICANT ASSURANCE: There are some weaknesses in the design and/or operation of controls which could impair the achievement of the objectives of the system, function or process. However, either their impact would be minimal or they would be unlikely to occur.

Better Care Fund To confirm whether the CCG has appropriate governance arrangements in place to ensure that the Better Care Fund objectives are met.

Information Governance Toolkit

To provide an opinion upon the policies and processes established by the CCG to develop and embed an Information Governance (IG) culture within the organisation, to collate and submit its IG return and to provide an independent assessment of the validity and accuracy of the scores submitted.

1

Vanguards/Partnership Working

To confirm that the funding allocated to the CCG has been used for it intended purpose and that schemes have delivered as proposed. 3

Quality of Services Commissioned

To confirm whether mechanisms in place at the CCG ensure that the organisation receives assurance from the main provider, University Hospitals of Morecombe Bay NHS Trust (UHMB), in relation to the quality of services commissioned.

6 2

LIMITED ASSURANCE: There are weaknesses in the design and/or operation of controls which could have a significant impact on the achievement of the key system, function or process objectives but should not have a significant impact on the achievement of organisational objectives.

None of the reviews finalised had been assigned Limited Assurance.


Data quality During 2016-17, in conjunction with Midlands and Lancashire Commissioning Support Unit, we continued to establish robust processes for managing patient identifiable information which included the processing of all identifiable information via an Accredited Safe Haven (ASH). This allows the CCG to receive anonymised data which supports:

• Contract monitoring

• Invoice payment

• Service redesign

• Business planning.

During 2016-17 we also continued to work with the University Hospitals of Morecambe Bay to develop an online information governance hub which allows all of our providers to coordinate and manage their Information Sharing Agreements. This allows the CCG and its partners to increase the level of data that can be shared in a safe and appropriate manner. This significantly contributes to the quality of the information used locally to underpin commissioning decisions.

Business Critical Models Business Critical Models are mainly provided by Midlands and Lancashire Commissioning Support Unit. They are subject to regular external review, the outputs of which are reported to Clinical Commissioning Groups through Service Auditor Reports. We have not relied on the outputs of the Service Auditor Reports as we consider that the internal controls systems and processes in place within the CCG provide sufficient assurance.

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.

Title Overall Objective RecommendationsC H M L

NO ASSURANCE: There are weaknesses in the design and/or operation of controls which [in aggregate] have a significant impact on the achievement of key system, function or process objectives and may put at risk the achievement of organisational objectives.

None of the reviews finalised had been assigned No Assurance.

CONTRIBUTION TO GOVERNANCE, RISK MANAGEMENT AND INTERNAL CONTROL ENHANCEMENTS: Areas where MIAA have supported the organisation in strengthening arrangements in respect of governance, risk management and internal control.

Local Authority Pooled Budgets Reconciliation

We have worked with the CCG in respect of the revised Conflicts of Interest Policy.

MIAA Insight Briefings and Benchmarking: To provide a range of briefing notes and benchmarking reports on topical issues to support organisations in keeping up to date on key issues, challenge questions and opportunity to compare themselves with others.MIAA Events: Our events and conference programmes attract leading speakers from the NHS, government, policy and voluntary sector, giving delegates access to the latest policy thinking, best practice and innovation across the UK, whilst also providing an ideal networking opportunity.Involvement with the organisation in respect of advice and guidance relating to the revision to the Conflicts of Interest Policy.

Ongoing discussion with Senior Officers, Managers and Lay Members throughout the year.

Effective utilisation of internal audit including in year communication, requests for changes to the audit plan to support the work in respect of Conflicts of Interest.


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 are continuing to develop information governance processes and procedures in line with the Information Governance Toolkit. We share learning of information incidents with staff, encouraging them to consistently apply risk assessment and management and procedures when handing data.

Control measures are in place to ensure risks to data security are managed and controlled. The CCG has put an information risk management process in place led by the SIRO. Information asset owners and administrators have been identified to cover the CCG’s main systems and records stores, along with information held at team level. We have ensured all staff undertake annual Information Governance Training and have implemented a staff information governance handbook to ensure staff are aware of their information governance roles and responsibilities. In addition to this all CCG laptops and USB sticks are encrypted, with iPads having password protection. The Information Governance Toolkit self-assessment across the CCG has indicated a Level 2 or above on all standards.

The CCG recognises that the information it holds is one of its key assets. During the reporting period risks to data security have been managed through the implementation and achievement of the relevant requirements within the NHS Information Governance Toolkit. The Senior Information Risk Owner (SIRO) has overseen the management of data security protection via specialist support from the Midlands and Lancashire Commissioning Support Unit and internally through the appointment of Information Asset Owners. The CCG has completed information security risk assessments to ensure on-going pro-active risk management and data security protection.

Data securityWe have submitted a satisfactory level of compliance with the Information Governance Toolkit assessment.

As a result of high profile data breaches nationally, and our commitment to embedding the Information Governance agenda across the CCG, staff awareness of the importance of reporting all information security incidents and near misses has been raised. This is reflected in the number of relatively minor (levels 0-1) internal incidents reported.

Following the issue of national criteria in 2008 the CCG has to categorise all incidents involving personal confidential data. These are considered serious untoward incidents when involving data loss or confidentiality breaches. Table one shows the classification of incident severity the CCG must apply – zero being the lowest and five the highest.

Organisations registered with the Health and Social Care Information Centre’s (HSCIC) Information Governance Toolkit are required to report incidents that are categorised at Level 2 or above via the Information Governance Incident Reporting Tool. Incidents, where appropriate, may be escalated to organisations such as the Department of Health and the Information Commissioner’s Office. The HSCIC publishes all incidents reported and categorised at Level 2 or above on a quarterly basis via the Information Governance Toolkit.

Table 1: Classification of incident severityThe Information Governance Framework ensures all information, in particular person identifiable data related to patients, staff and corporate information, is handled in a confidential, secure, ethical and legal manner. We recognise the importance of appropriately managing information and keeping it secure and reporting any incident or breach.

All NHS organisations are required to summarise all such incidents classified as 0-1 in their Annual Report, and individually detail incidents classified 2-5. The latter classification of incident must also be reported to NHS England and the Information Commissioner’s Office.

During the period 1 April 2016 to 31 March 2017 three incidents were categorised 0-1 (low level), and 0 incidents were categorised in the higher severity levels (2-5).


0 1 2 3 4 5No significant

reflection on any individual or body. Media interest very

unlikely

Damage to an individual’s

reputation. Possible media interest e.g. celebrity involved

Damage to a team’s reputation. Some

local media interest that may not go

public

Damage to a service’s reputation. Low-key local media

coverage

Damage to an organisation’s

reputation. Local media coverage

Damage to NHS reputation. National

media coverage

Minor breach of confidentiality. Only a single individual

affected

Potentially serious breach. Less than

five people affected or risk assessed as low e.g. files were

encrypted

Serious potential breach and risk

assessed high e.g. unencrypted clinical records lost. Up to 20 people affected

Serious breach of confidentiality e.g. up to 100 people

affected

Serious breach with either particular sensitivity – e.g.

sexual health details – or up to 1000 people affected

Serious breach with potential for ID

theft or over 1000 people affected

Table 2: Summary of serious untoward incidents involving person identifiable data classified 0-1 (1 April 2016 - 31 March 2017)

Category Nature of incident Total

iLoss of inadequately protected electronic equipment, devices or paper documents from secured NHS premises

0

ii

Loss of inadequately protected electronic equipment, devices or paper documents from outside secured NHS premises

0

iiiInsecure disposal of inadequately protected electronic equipment, devices or paper document

0

iv Unauthorised disclosure 3

v Other 0

Discharge of statutory functionsArrangements put in place by the CCG, and explained within the Corporate Governance Framework, were developed to ensure compliance with all the relevant legislation. That advice also informed the matters reserved for Membership Body and Governing Body decision and the scheme of delegation.

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

Responsibility for each duty and power has been clearly allocated to a lead Executive who has confirmed that their structures provide the necessary capability and capacity to undertake all of the Clinical Commissioning Group’s statutory duties.

ConclusionAs Accountable Officer, I have responsibility for reviewing the effectiveness of the system of internal control. My review is informed in a number of ways outlined above. The Head of Internal Audit has also confirmed that ‘there is a generally sound system of internal control, designed to meet the organisations objectives, and that controls are generally being applied consistently’.

My review concludes that NHS Lancashire North Clinical Commissioning Group has a generally sound system of internal control that supports the achievement of its policies, aims and objectives.

Signed:


Table 1:


Remuneration ReportRemuneration Committee Report (not subject to audit)

Members of the Remuneration Committee comprise:-

Note: There were 0 Remuneration Committee meetings held in the financial year.

Policy on Remuneration of Senior Managers (not subject to audit):Senior Managers’ remuneration and terms of condition have been determined according to national guidelines issued under Agenda for Change and Very Senior Managers’ guidance. In the case of the CCG Chair, remuneration was determined following an exercise carried out on behalf of the Lancashire Clinical Commissioning Group Network by PricewaterhouseCoopers LLP (PwC), which proposed a salary range for GP Chairs based on size of organisation and time commitment. The Membership Council, following recommendation from the Remuneration Committee, approved this arrangement.

Remuneration for other GP members of the Governing Body and Membership Council was agreed by the Membership Council.

Remuneration of Senior Managers and GP members of the Governing Body and Membership Council for future years will be assessed and recommended by the Remuneration Committee based on national guidelines in place at the time.

Senior Managers’ Performance Related Pay (not subject to audit):Performance related pay arrangements are not in place in the CCG.

Policy on Senior Managers’ Contracts (not subject to audit):The CCG Chair and Clinical Members of the Governing Body are elected by the Member practices of the Membership Council. The terms of office for the CCG Chair and GP members of the Governing Body and Membership Council are as determined by the Membership Council. These are staggered in order to maintain a level of continuity and to ensure experience and expertise are retained. These appointments are not subject to termination payments.

Other employed Senior Managers are appointed as per Agenda for Change regulations, including any provision for notice periods and termination payments. These Senior Managers are employed on permanent substantive contracts.

Position NameNumber of meetings attended

Lay Member and Chair

Mr Clive Unitt -

Lay Member Mrs Sue McGraw -


Dr Mike Flanagan -


Senior Managers’ Service Contracts (not subject to audit):The following table identifies the Governing Body members’ contract terms:

Payments for early retirement or loss of office (subject to audit):The CCG made no payments for early retirement or loss of office during the financial year.

Payments to Past Senior Managers (not subject to audit):The CCG has made no payments to any Past Senior Managers in the financial year.

NameContract start date

Contract end date

Term of office Notice period

Dr A Gaw 1 August 2016 31 July 2018 2 years 3 months

Dr C Elley 1 April 2016 31 March 2019 3 years 2 months

Dr A Maddox 1 April 2017 31 March 2020 3 years 2 months

Dr A Knox 1 April 2015 31 March 2018 3 years 2 months


Name Title Effective dates

Salary (bands of £5,000)

Expense payments (taxable) to the nearest £100

Performance pay and bonuses (bands of £5,000)

Long-term performance pay and bonuses (bands of £5,000

All pension-related benefits (bands of £2,500)

Total (bands of £5,000)

£’000 £ £’000 £’000 £’000 £’000Dr Alex Gaw *see note 1 below

Chair 100 -105 100 - 105

Mr Andrew Bennett

Chief Officer 100 - 105 22.5 - 25 125 - 130

Mr Kevin Parkinson*see note 2 below


110 - 115 4,700 15 - 17.5 130 - 135

Ms Hilary Fordham


80 - 85 45 - 47.5 130 - 135

Mrs Margaret Williams

Chief Nurse 75 - 80 72.5 - 75 145 - 150

Dr Cliff Elley *see note 1 below

Executive GP 55 - 60 55 - 60

Dr Mike Kingston *see note 1 below

Executive GPTo 30/09/ 2016

15 - 20 15 - 20

Dr Andy Maddox *see note 1 below

Executive GP 35 - 40 35 - 40

Dr Andy Knox *see note 1 below

Executive GP 75 - 80 75 - 80

Mr Clive Unitt Lay Member 5 - 10 5 - 10

Mrs Sue McGraw

Lay Member 5 - 10 5 - 10

Dr Mike Flanagan

Consultant Member

5 - 10 5 - 10

Notes

1Executive GP salaries are paid through Payroll to the relevant GP practices, not direct to individuals. The Chair’s salary includes £13K paid to the practice for employer’s superannuation contributions.

2 Expense payments relate to the costs of a lease car.

Salaries and allowances (subject to audit):


Name Title Effective dates

Salary (bands of £5,000)

Expense payments (taxable) to the nearest £100

Performance pay and bonuses (bands of £5,000)

Long-term performance pay and bonuses (bands of £5,000

All pension-related benefits (bands of £2,500)

Total (bands of £5,000)

£’000 £ £’000 £’000 £’000 £’000Dr Alex Gaw *see note 1 below

Chair100 - 105

100 - 105

Mr Andrew Bennett

Chief Officer100 - 105

15 - 17.5115 - 120

Mr Kevin Parkinson *see note 3 below


110 - 115

4,100 2.5 - 5115 - 120

Ms Hilary Fordham


75 - 80 20 - 22.5100 - 105


Chief NurseFrom 01/01/ 2016

15 - 20 0-2.5 20 - 25

Dr Cliff Elley *see note 1 below

Executive GP 55 - 60 55 - 60

Dr Mike Kingston *see note 1 below

Executive GP 35 - 40 35 - 40

Dr Andy Maddox *see note 1 below

Executive GP 35 - 40 35 - 40

Dr Andy Knox *see note 1 below

Executive GP 35 - 40 35 - 40

Mr Clive Unitt

Lay Member 5 - 10 5 - 10

Mrs Sue McGraw

Lay Member 5 - 10 5 - 10

Dr Mike Flanagan

Consultant Member

5 - 10 5 - 10

Ms Jillian McCarthy

Registered Nurse Member

To 31/12/ 2015

10 - 15 10 - 15

2015/2016 comparative figures:

Notes

1Executive GP salaries are paid through Payroll to the relevant GP practices, not direct to individuals. The Chair’s salary includes £13K paid to the practice for employer’s superannuation contributions.

2 The Registered Nurse Member salary is paid to her employer, not direct to the individual.

3 Expense payments relate to the cost of a lease car.


Payments for early retirement or loss of office (subject to audit):The CCG made no payments for early retirement or loss of office during the financial year.

Payments to past Senior Managers (subject to audit):The CCG made no payments to past Senior Managers during the financial year.

Pension benefits (subject to audit):Name Title Real

increase in pension at pension age (bands of £2,500)

Real increase in pension lump sum at pension age

(bands of £2,500)

Total accrued pension at pension age at 31 March 2017

(bands of £5,000)

Lump sum at pension age related to accrued pension at 31 March 2017 (bands of £5,000)

Cash Equivalent Transfer Value at 1st April 2016

Cash Equivalent Transfer Value at 31 March 2017

Real increase in Cash Equivalent Transfer Value

Employer’s contribution to partnership pension

£’000 £’000 £’000 £’000 £’000 £’000 £’000 £’000Dr Alex Gaw

Chair 13

Mr Andrew Bennett

Chief Officer 0 - 2.5 0 - 2.5 35 – 40 95 - 100 550 580 35

Mr Kevin Parkinson


0 – 2.5 2.5 - 5 50 – 55 160 – 165 1,137 1,201 63

Ms Hilary Fordham


2.5 – 5 2.5 - 5 15 - 20 35 - 40 219 262 43


Chief Nurse 2.5 - 5 10 – 12.5 25 - 30 75 - 80 392 470 77

Notes

1Executive GP salaries are paid through Payroll to the relevant GP practices, not direct to individuals. These persons have therefore been excluded from the above table.

2The Registered Nurse Member salary is paid to her employer, not direct to the individual. This person has therefore been excluded from the above table.

3The payments made to the Lay Members and Consultant Member do not include pension contributions. These persons have therefore been excluded from the above table.


Cash Equivalent Transfer Values:A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s (or other allowable beneficiary’s) pension payable from the scheme. 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, not just their service in a senior capacity to which disclosure applies. 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.

On 16 March 2016, the Chancellor of the Exchequer announced a change in the Superannuation Contributions Adjusted for Past Experience (SCAPE) discount rate from 3.0% to 2.8%. This rate affects the calculation of CETV figures in this report.

Due to the lead time required to perform calculations and prepare annual reports, the CETV figures quoted in this report for members of the NHS Pension scheme are based on the previous discount rate and have not been recalculated.

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

Pay multiples disclosure (subject to audit):Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director in their organisation and the medial remuneration of the organisation’s workforce.

The banded remuneration of the highest paid member of the Membership Council / Governing Body in the NHS Lancashire North CCG in the financial year 2016/2017 was £183,041 (this is the whole time equivalent figure, the post holder works 16 hours per week, actual annual salary is £78,097) (2015/2016 £183,324 / £39,109 for 8 hours per week). This was 4.01 times the median remuneration of the workforce, which was £45,664 (2015/2016 3.76 times the median, £48,764). The pay multiple increased slightly between years due to the highest paid member’s salary remaining static while there was an increase in the number of lower graded staff in the organisation.

In 2016/2017, no employees received remuneration in excess of the highest paid member of the Membership Council / Governing Body (2015/2016 nil). Remuneration ranged from £17,978 (2014/2015 £17,179) to £183,041 (this is the whole time equivalent figure, the post holder works 16 hours per week, actual annual salary is £78,097) (2015/2016 £183,324 / £39,109 for 8 hours per week).

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.

The salary range for GP Executive members was agreed at the outset of the CCG and was in line with national guidance. Although the extrapolated figure for the highest paid employee is £183.041, this individual only works part time and therefore the actual payment is significantly lower.

Off-payroll engagements (not subject to audit):Following the Review of Tax Arrangements of Public Sector Appointees published by the Chief Secretary to the Treasury on 23 May 2012, CCGs must publish information on their highly paid and/or senior off-payroll engagements.


Off-payroll engagements Table 1For all off-payroll engagements as of 31 March 2017, for more than £220 per day and that last longer than six months:

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 Income Tax and National Insurance and, where necessary, that assurance has been sought.

Of the 8 individuals outlined above, 4 are employed by agencies and the assumption is that those agencies will have treated the Tax and National Insurance liabilities correctly. The remaining 4 individuals are Executive GPs on the CCG’s Governing Body, for whom payments are made to the respective GP practices via the CCG’s Payroll. The Tax and National Insurance liabilities for these individuals have therefore been treated correctly.

Off-payroll engagements Table 2For all new off-payroll engagements between 1 April 2016 and 31 March 2017, for more than £220 per day and that last longer than six months:

Off-payroll engagements Table 3For any off-payroll engagements of board members and / or senior officials with significant financial responsibility, between 1 April 2016 and 31 March 2017:

Related party transactions:Information in respect of related party transactions is detailed in Note 38 to the Annual Accounts.

Number

Number of existing engagements as of 31 March 2017

8

Of which, the number that have existed: for less than one year at the time of reporting

3

for between one and two years at the time of reporting

1

for between two and three years at the time of reporting

4

for between three and four years at the time of reporting

0

for four or more years at the time of reporting

0

Number

Number of new engagements, or those that reached six months in duration, between 1 April 2016 and 31 March 2017

3

Number of new engagements which include contractual clauses giving the CCG the right to request assurance in relation to Income Tax and National Insurance obligations

0

Number for whom assurance has been requested

3

Of which:

assurance has been received 3

assurance has not been received 0

engagements terminated as a result of assurance not being received

0

Number

Number of off-payroll engagements of board members, and / or senior officers with significant financial responsibility, during the financial year

4

Total number of individuals on payroll and off-payroll that have been deemed “board members and / or senior officials with significant financial responsibility” during the financial year.

8


Better Payment Practice Code (BPCC):Information in respect of the Better Payment Practice Code (BPCC) is detailed in Note 6 to the Annual Accounts.

Parliamentary Accountability and Audit ReportMorecambe Bay CCG is not required to produce a Parliamentary Accountability and Audit Report. Disclosures on remote contingent liabilities, losses and special payments, gifts, and fees and charges are included as notes in the Financial Statements with this report An audit certificate and report is also included with this Annual Report.


Staff reportAverage number of people employed:

The increase in average number of people employed relates to additional staffing employed on a temporary basis to work on Vanguard work streams for which the CCG was allocated additional funding in 2016/2017.

Breakdown (end of year figures) of staff:

Total numberPermanently

employed numberOther number

2015/16 total number

Total 48 26 22 32

Of the above, number of whole time equivalent people engaged on capital projects

0 0 0 0

Male Female

Membership Council 12 0

Governing Body 8 3

Very senior managers 0 0

CCG (excluding those employed but on Governing Body)

4 11


Information about employees We have well established recruitment, retention, performance and appraisal processes to ensure that we recruit the high quality staff required to discharge our duties. We monitor our staff performance and development, and ensure that all staff undertake regular appraisals and performance reviews. Our progress in this area is monitored by the CCG executive team, with regular reports to the Governing Body.

Employee consultationWe have a strong ethos of employee engagement, communication and consultation. We have a number of mechanisms through which we communicate and consult with the 26 staff who are directly employed by the CCG (11 Governing Body, including Lay Members, and 15 other CCG staff). These include regular one-to-ones with individual staff, face-to-face briefings and a monthly team briefing session. We operate a wider leadership team where senior managers regularly contribute to and review the CCG’s performance and other matters of significance.

In addition, we routinely disseminate policies, minutes of meetings and new information electronically to all staff through a weekly newsletter. A newsletter is disseminated to all member practice staff on a bi-monthly basis, and anyone can contribute information to it.

Employees with a disability Employing people with a disability is important for any organisation providing services for the public as they need to reflect the many and varied experiences of people they serve. In the provision of health services it is perhaps even more important, as people with disabilities make up a significant proportion of the population, and those with long-term medical conditions use the services of the NHS. Our commitment to people with disabilities includes:

• Guaranteeing an interview to people with disabilities who meet the minimum criteria for a job vacancy

• Proactively considering the adjustments that people with disabilities might require in order to take up a job or continue working in a job

• Mandatory equality and diversity training, which raises awareness of a range of issues impacting on people with disabilities

• Ensuring any employee who needs training, either because they work with people with disabilities, or because they have acquired an impairment or medical condition, receives it

Sickness absence dataWe take staff sickness absence very seriously. We have an agreed sickness absence policy that seeks to:

• Encourage good attendance

• Minimise sickness absence levels and their effect on services

• Ensure that all employees are treated fairly and consistently

• Define the responsibilities of management and employees

• Provide a framework to enable managers to explore a range of actions, taking into account individual circumstances

• Set clear targets for improvement in cases of problem absence, and clearly define the consequences of failure to improve

• Promote good communications between managers and employees

• Comply with the requirements of the Disability Discrimination Act 2005

Sickness absence figures are reported on a calendar year basis i.e. for the 12 months January to December. During this period, there were a total of 106 days lost to sickness absence, which equates to an average of 4.1 days per whole time equivalent staff member (2015/16 - 46/22). Our sickness absence rate for this period is 1.1%. Further information on sickness absence is detailed in Note 4.3 to the Annual Accounts.

Consultancy expenditureDuring this financial year we have spent approximately £3K on external consultancy services.


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ANNUAL REPORT AND ACCOUNTS - Morecambe Bay CCG

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