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AA

Annual Report and Accounts

2016/17

Version: FINAL (V 7.0)

Date: 25 May 2017

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Contents

Contents 2

Foreword from the Clinical Chair 4

Performance Report 6

Performance Overview 7

Performance Analysis 19

Accountability Report 34

Members Report 35

Statement of Accountable Officer Responsibilities 44

Governance Statement 46

Biographies 62

Remuneration and Staff Report 70

Parliamentary Accountability and Audit Report 85

Internal Auditors Report 86

Independent Auditors Report 93

Annual Accounts 99

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Annual Report

South Kent Coast

Clinical Commissioning Group 2016/2017

NHS South Kent Coast Clinical Commissioning Group (CCG) is responsible for

commissioning services to meet the health needs of the population of South Kent

Coast. The report is published in accordance with the National Health Service Act 2006

(as amended) which requires CCGs to prepare their Annual Report and Accounts in

accordance with Directions issued by NHS England. It is in three parts:

A Performance Report

An Accountability Report

The Members’ Report

Statement Made by Accountable Officer

Annual Governance Statement

Remuneration and Staff Report

The Annual Accounts (Financial Statements)

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FOREWORD from the Clinical Chair This is the fourth Annual Report from NHS South Kent Coast CCG. The South Kent Coast CCG

Annual Report and Accounts 2016/17 covers the period from 1st April 2016 to 31st March 2017.

It tells a story of significant achievements as well as some considerable challenges, particularly

around the performance of our key providers.

The last year in South Kent Coast, and the NHS at large, has been a time of change and

challenge and we have been working hard to ensure that services for our communities have

been continued at the same time as innovating for the future shape of health and social care

provision.

One of the areas of focus for the last year has been beginning to reshape health and social

services to work in a more integrated fashion across the South Kent Coast area. The many

different organisations and agencies involved in delivering health and social care to our

population have come together and signed a compact to work more closely with the aim of

forming an Integrated Accountable Care Organisation as supported by the Kent and Medway

Sustainability and Transformation Plan.

As well as the overarching changes mentioned above, we have been working on local solutions

to care provision and over the last year we have commissioned new services to try to ensure

people can get the right care, first time, closer to home. In efforts to create local solutions, our

GP membership has agreed to work in four localities: Deal, Dover, Folkestone and Hythe and

rural. This has enabled these areas to work to deliver local solutions to meet local care needs as

well as trialling things for use across the whole area. Examples of this include virtual clinic trials

in Hythe, Lyminge and Romney Marsh, where patients can see consultants based in the hospital

via telemedicine and drop in sessions in the Rainbow Centre in Folkestone to try to improve

health inequalities in the area. In Deal, partnership with the Paramedic Practitioners and GPs

allowed for patients to be seen more rapidly at home and a rheumatology clinic was successfully

established at Deal hospital.

South Kent Coast wide initiatives have included the Personal Independence Programme, in

partnership with Age UK, which is aiming to provide more help to those over 65 who need

assistance in remaining healthy and independent in their own home. Mental Health Link

Workers and Primary Care workers have begun to work in GP surgeries to provide patients with

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much needed extra support and treatment options. We have established an Integrated

Rehabilitation and Enablement Service which means that social services and health services

assess patients together to provide rapid support to people in their own home, rather than two

separate assessments as was done previously. GPs across the area now have access to their

patient’s notes via mobile technology which makes home visiting safer.

All of the above changes have been implemented alongside the CCG working with trusts to

ensure that our patients receive treatment within hospital settings if they need them.

The future will see further developments involving GPs planning services more locally for their

patients, to ensure that they receive treatment in a community setting as much as possible.

Local hubs will be set up, one in each locality, providing more capacity for appointments with GP

services over 7 days a week and to act as signposting centres for patients to receive timely help,

from the right professional, when they need it.

The year ahead will be building on the changes we have made in the last 12 months and we

look forward to working with those living in South Kent Coast to create the health and social care

service that they need.

Dr Jonathan Bryant

Clinical Chair on behalf of 30 GP practices of Dover, Deal and Shepway

25 May 2017

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PERFORMANCE REPORT

Hazel Carpenter

Chief Accountable Officer

25 May 2017

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Performance Overview

The purpose of this overview is to summarise the CCGs strategic objectives and progress against plans,

addressing risks and challenges faced in the year and mitigation against risks.

The Responsibilities of the CCG

South Kent Coast CCG was established in April 2013 under the Health and Social Care Act 2012 as a

corporate body. The CCG has responsibilities for commissioning services to meet the healthcare needs

for approximately 200,000 people registered with GP practices in South Kent Coast. The services we

commission include:

Community health services (except where part of the public health service)

Maternity services

Urgent and emergency care including Accident and Emergency, ambulance and out- of-hours

services

Elective hospital care

Older people’s healthcare services

Healthcare services for children including those with complex healthcare needs

Rehabilitation services

Wheelchair services

Healthcare services for people with mental health conditions

Healthcare services for people with learning disabilities

NHS continuing healthcare.

Although the CCG does not commission pharmaceutical services, we are responsible for the costs of

prescriptions written by local GPs. We do not commission dental services or sight tests. Specialist

health services, such as secure psychiatric services, continue to be commissioned by NHS England.

From 1 April 2017 the CCG took on the responsibility for the commissioning of Primary Care. In

preparation for this the CCG has established a Primary Care Commissioning Committee and recruited

an additional Lay Member to be the Chair of this Committee.

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NHS England Assessment

NHS England’s assessment of the CCG’s performance at the start of April 2016 was overall “Assured

with Support”. This was made up of “Assured as Good” in relation to financial management and

performance but “Limited Assurance: Requires Improvement” because our acute trust has failed to meet

significant constitutional and access standards:

South Kent Coast CCG is currently not meeting the national target of 95% of patients at East Kent

Hospitals staying less than four hours in A&E.

Compliance with the referral to treatment (RTT) standard was not sustained.

Unable to meet cancer waiting times standards.

Our Vision

We established our vision in consultation with all our GP colleagues and with the public. Our long-term

strategic goals are to:

Do all that we can to improve the health and outcomes of the people who live in our area,

prioritising and tackling mental health and cancer

Address the variation in quality of local healthcare services and the inequality of health outcomes

that this can cause

Ensure that local health and social care services are integrated and that patients experience

‘joined-up’ care

Ensure that services are provided locally wherever possible

Work with partners to help prevent ill health

Commissioning the Health Care Needs of Local People Our strategy to enable us to meet our responsibilities takes account of the health needs of the

population and has been developed in consultation with local people.

Health challenges facing South Kent Coast

The CCG considers the national context against our local health needs when defining our long

term ambitions. Joint Strategic Needs Assessments (JSNAs) for the area are available on the South

Kent Coast CCG website. These assessments are used to inform us and our local authority partners

about the health needs of our local population.

Population

The resident population of South Kent Coast that is 65 years or over is 22.8%. This is higher than

the national average of 21.9%.

Life expectancy for SKC (80.97 years) is marginally lower than the Kent average of 81.78 years.

Within South Kent Coast wards the average life expectancy ranges between 77.5 years (at its

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lowest) up to a high of 87.8 years.

The biggest issue for the gap in life expectancy is Heart Disease.

Inequalities

Causes of Death

The three main causes of death in South Kent Coast are cancer (28%), circulatory diseases

(27%), and respiratory conditions (15 %).

Lifestyles

Lifestyle Shepway Average

Dover Average

National Average

Smoking Rate

23.8% 18.6% 18.0%

Childhood Obesity at Reception Age 9.1% 10.0% 9.3%

Childhood Obesity at Year 6 Age 19.6% 19.2% 20.1%

Adult Excess Weight

64.4% 67.6% 64.8%

Chlamydia Detection Rate (per 100,000) 1239 1220 1887

Long Term Conditions

South Kent Coast has a higher rate than average in Kent for premature deaths (<75 years) from

Coronary Heart Disease (CHD).

Only 8 out of the 30 GP practices identified 75% or more of patients expected to have Coronary

Heart Disease (CHD).

16 of the 30 GP practices identified over 60% of patients expected to have Chronic Obstructive

Pulmonary Disease (COPD).

8 out of the 30 GP practices identified 60% of patients expected to have hypertension and 2

general practices reached just over 70% of patients.

55.8% of people in South Kent Coast experience lower than average levels of deprivation

compared to the national average.

The gap in the number of years of life expectancy at birth between the most deprived and least

deprived areas of South Kent Coast is just under 13.5 years.

Folkestone Harbour (5.7%), Folkestone Harvey Central (4.6%) and Folkestone East (3.2%) have

the highest ward unemployment rates for the population aged 16-64 years.

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If you would like further information regarding any of the health challenges discussed, please feel free

to visit the following links:

Public Health Outcomes Framework

Indices of Multiple Deprivation

Office of National Statistics

Key objectives for 2016/17

South Kent Coast’s key objectives for 2016/17 are set out below;

Develop a high quality Sustainability and Transformation Plan (STP) with the partner

organisations within the Kent and Medway STP footprint

Continue to implement our plans to address the sustainability and quality of general practice

We will learn from the work that has been piloted locally, through the Prime Minister’s Challenge

Fund (PMCF) to develop improved access to primary care services seven days a week.

Recover and maintain the access standards for A&E and ambulance pathways

Recover the NHS Constitution 62-day cancer waiting standard, maintain all other cancer waiting

standards, and improve upon the 2015/16 position

Achieve and maintain the two new mental health access standards

Continue to deliver actions set out in our local plans to transform care for people with learning

disabilities

Continue to implement our plans to improve the quality and safety of services for our patients

Continue to maintain financial balance, including our planned contribution to efficiency savings.

The detail regarding the steps we have taken in order to meet these objectives is included in the pages

that follow.

Financial Overview

The CCG has met its statutory duty to achieve financial balance.

The CCG has completed its fourth year of operation and has achieved its statutory financial

targets as it has in all previous years.

The cost improvement programmes included within the Quality Innovation, Productivity and

Prevention (QIPP) achieved an overall reduction in expenditure of £9.08m.

The CCG managed to achieve its planned 1% surplus of £2.811m, as agreed with NHS England.

As set out in the 2016/17 NHS Planning Guidance, CCGs were required to hold a 1 percent reserve

uncommitted from the start of the year, created by setting aside the monies that CCGs were otherwise

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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 South Kent Coast CCG has released its 1% reserve to the bottom line, resulting in an

additional surplus for the year of £2.734m. This additional surplus has will be carried forward for

drawdown in future years.

The Statement of Financial Position, in the Annual Accounts sets out the net worth of the CCG as at 31

March 2017. The negative figure on taxpayers’ equity is due to the CCG not holding a cash balance

equivalent to its liabilities. This is in accordance with Treasury accounting rules. The cash required to

pay the balance will be drawn down in 2017/18.

As a result of this the overall surplus posted by the CCG is £5.54m

The CCG has approved its budget for 2017/18 to enable it to deliver its strategic objectives. The CCG

will be taking on delegated commissioning next year as a result the CCG has an annual budget of

£310 million to pay for healthcare for the 200,000 people registered with a GP practice within the South

Kent Coast area of Deal, Dover and Shepway.

We commission health services primarily from 3 local providers: East Kent Hospital University

Foundation Trust (EKHUFT), Kent and Medway Partnership Trust (KMPT) and Kent Community

Healthcare Foundation Trust (KCHFT). The CCG also commissions services from South East Coast

Ambulance (SECAmb) and other providers, including tertiary providers (for example, Guys and St

Thomas Hospital and Kings College Hospital) and an out of hours’ service from IC24 until October 2016

when it was taken over by Primecare.

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Sustainability and Transformation

WHAT WE PLANNED TO

ACHIEVE IN 2016/17

WHAT WE ACHIEVED

To develop a Sustainability and

Transformation Plan (STP) with public

sector commissioning and health and

social care provider organisations

across Kent and Medway.

The STP set out the current and future

gaps within SKC CCG and across Kent

and Medway in terms of the quality of

services, health outcomes and financial

challenges to the NHS and how SKC

CCG and our partner organisations

intend to close these gaps

South Kent Coast CCG is part of the East Kent Delivery

Board, to deliver the STP plans in our area. We host the

east Kent programme office which is supporting the

delivery of the programme with analysis and engagement.

In August 2016 we published a Case for Change in east

Kent and in March 2017 we published the case for

change for the whole of Kent and Medway.

Public engagement to develop our plans has been

ongoing throughout the year. A Public and Patient

Engagement Group for the east Kent plans has met

monthly and we held a public listening event in

Folkestone in February, one of four across east Kent.

These are in addition to our routine patient engagement

programme.

We have made good progress with the development of

our IACO

To set out the case and plan for

developing an ‘Integrated Accountable

Care Organisation’ (IACO) in line with

the Five-Year Forward View.

Engaged with local, national and international

organisations to develop the very best local care.

Invited local organisations, as well as those from across

the country and internationally to tell us how they could

help develop the IACO and devolve more clinical and

financial decision-making responsibilities to the primary

care teams.

To publish the Sustainability and

Transformation Plan (STP) by June

2016 with public consultation on the

plan scheduled for late summer/ autumn

2016.

The Sustainability and Transformation Plan (STP) for

Kent and Medway was published in November 2016.

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General Practice and Primary Care

WHAT WE PLANNED TO

ACHIEVE IN 2016/17

WHAT WE ACHIEVED

To support the development of good

quality and sustainable general practice,

including access to a range of services

not traditionally accessible by individual

practices.

The CCG has worked with NHS England to identify

practices that are most in difficulty and would benefit from

some form of structured support. The aim is to secure

improvements in vulnerable GP practices building

resilience in primary care and supporting delivery of new

models of care. This provides support to practices under

pressure, increasing capability and capacity whilst ensuring

patients have continued access to high quality care.

To support each locality further to

develop their own central ‘hub’, to

provide a base for the local urgent care

model. This will include additional GP

access, minor injury units, integrated

intermediate care, one-stop outpatient’s

services and virtual consultations

including access to medical specialties

to support primary care.

The CCG provided structured support for developing

practices as hubs and as individual providers.

The CCG is in the process of developing hubs in alignment

with and to support wider health and social care strategies,

for example the development of the Kent and Medway

Urgent and Emergency Care Network (UECN).

We have learnt from the Prime Ministers Challenge Fund

(PMCF) pilot (GP access 8am-8pm/7days a week) which

has provided the opportunity to look at different ways of

working in general practice. It helped us understand how

GP services could be designed in the future with

opportunities for patients to be seen at their local ‘hub’ by

another GP or another appropriate health care professional

(for example, pharmacist, paramedic practitioner, MIU

nurse practitioner (out-reaching) or rapid response nurse).

Integrated Primary Care Teams - further developed the

multi-disciplinary/ agency team at practice level,

integrated nursing teams, mental health, social care, care

navigation, voluntary agencies, health trainers, children’s

community nursing and health visiting- maximising the

use of all available resources.

The CCG procured an integrated OOH/111 service which

included; an East Kent NHS 111 hub, an advanced care

navigation service, transformation of the existing out of

hours provision and integrated immediate care.

To prepare our member practices for

primary care co-commissioning.

Engaged with our member practices to develop and

prepare them for the delegated responsibilities of primary

care co-commissioning in 2017/18.

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To develop Information Technology (IT)

to improve efficiency and reduce

clinicians’ workload whilst improving

care and services for patients.

Enabled practices and wider providers to share patient

records, reducing workload by seamlessly sharing

records that would normally be requested via telephone,

email or fax

Supported practices to ensure plans are in place for

seven-day working and sharing of records across our

locality areas

Secured funding to allow mobile working to give GPs and

nurses the ability to update the patient record whilst

visiting patients without the need for carrying paper

Reduced the need to provide home visits and improve

demand management with the use of video consultations

Increased time with patients by reducing the need for

healthcare professionals to make long journeys to

meetings and education by using of video conferencing

(these would previously be in person)

All practices have signed up to a text messaging service

with two thirds actively using it to:-

- Provide a text messaging reminder service to

patients, reducing Did Not Attends (DNAs) and

improving take up of health campaigns

- Link patients to their GP records allowing patients to

automatically cancel appointments thus creating

resilience across the system and supporting

practices with demand management

- Gather data for other initiatives such as Quality

Outcomes Framework (QOF), for example, gathering

smoking status and health readings.

- Offers a patient facing app that supports self-care,

booking of appointments, medication reminders,

prescription ordering, submission of health readings,

access to medical records and be notified of test

results

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Primary Care Workforce Development

WHAT WE PLANNED TO

ACHIEVE IN 2016/17

WHAT WE ACHIEVED

To develop initiatives that will support the

development of a primary care

workforce, allowing them to achieve their

potential and expand traditional roles.

A pilot with local Higher Education Institutions (HEIs) to

enable physician’s associate training within local training

practices

Successful funding bid for advanced clinical

practitioners

Increased number of nurse prescribers

Implemented the national pilot for pharmacy placements

in primary care

Increased number of training practices

Increased opportunities for allied healthcare

professionals such as paramedic students to experience

primary care

Increased the number of practices willing to take

aspiring medical students

Created an opportunity for returning to nursing students

to have a placement in primary care

Increased number of nurse mentors to support student

nurses experience primary care and choose as a career

option

Primary care nurse pilot with one practice working

across the community and primary care interface to

ensure a seamless service for patients

Widened participation opportunities for all academic

capabilities to access a career in health and social care

via the apprenticeship route.

A GP recruitment fair for east Kent

To develop a series of professional

development programmes to equip

healthcare professionals to ensure that

the Local Health Economy (LHE)

provides the ‘right skills in the right place

at the right time’

One-day dermatology study day with an additional

follow up day to support appropriate referrals to

dermatology service;

Two-day anticoagulation study day to support primary

care staff to increase the amount of providers to provide

anticoagulation therapy services;

Minor surgery course for healthcare assistants;

One-day management of minor illness in adults;

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Diabetes and insulin initiation for healthcare

professionals;

Development of monthly free educational events for all

care home staff across South Kent Coast;

Development of recognition of early deterioration of

service user programme roll out across domiciliary care

agencies.

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Constitutional targets

WHAT WE PLANNED TO

ACHIEVE IN 2016/17

WHAT WE ACHIEVED

To implement collaborative projects

with east Kent CCGs and providers to

re-design elements of urgent care

pathways to support achievement of

A&E waiting times standards

The CCG continues to work with its partners to deliver its

commitments against the Transforming Care Programme.

An effective acute medical model has been developed.

Medical and Nursing Leadership in Emergency

Department have been improved.

Implementation of Safer Flow Bundle to improve patient

care and efficiency of treatment.

Effective Site Management implemented

Agreement of a local target and

trajectory with EKHUFT to improve

waiting times for elective care

A programme has been implemented to reduce the

waiting list for the longest waiting specialties through use

of additional elective care providers.

A range of demand management programmes have been

initiated including providing specialist advice and

guidance to primary care in higher volume specialty

areas.

Patients are supported to choose where they receive

elective treatment through the implementation of a choice

navigation programme.

To improve standards and quality of

care for people with Learning

Disabilities

Integrated commissioning for learning disability has now

been firmly established between the CCG, KCC and the

other Kent CCGs under a Section 75 Agreement with a

pooled budget.

A joint commissioning plan has been developed for

learning disabilities which includes Annual Health Checks

Integrated care for people with a learning disability will be

delivered under an Alliance Agreement between

commissioners from KCC integrated commissioning

team, the community NHS trust and mental health NHS

trust from April 2017.

Community Learning Disability (LD) forensic services

have been commissioned and plans are being developed

to address the needs of children and young people who

are placed in out of area specialist hospitals/residential

placements and adults with complex autism.

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A gap analysis by commissioners and

mental health providers to ensure that

sufficient capacity has been

commissioned to achieve the new

access standards in 2016/17.

Early Intervention Program (EIP) – Gap analysis

completed and increased funding provided for 2017-18 in

order to move service towards full compliance by end

2017.

New Improving Access to Psychological Therapies (IAPT)

providers have been commissioned.

Implemented the Dementia Assessment, Diagnosis and

Treatment Framework across the CCG four Locality

areas. There is steady and ongoing improvement in

dementia diagnostic rates across primary care, and

identification in Care Homes being supported by the

Older People Nurse Specialist.

To provide commissioning leadership

across the east Kent CCGs for cancer.

Specialty level capacity reviews and patient treatment list

reviews have improved performance in high risk specialty

areas.

Risks have been identified in diagnostics. Timely access

to diagnostic tests remains a challenge and work is

underway across Kent and Medway to maximise the use

of all available capacity.

South Kent Coast CCG is working to develop Rightcare

projects around early identification and endoscopy

services.

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Performance Analysis

South Kent Coast Clinical Commissioning Group (CCG) monitors provider’s performance through

monthly quality and performance meetings, and reviews the CCGs progress toward delivering these

targets through the monthly Quality, Performance and Delivery committee with quarterly reports to the

Governing Body. The CCG collects and monitors performance data through national statutory reports

submitted by providers to NHS Digital and through data flows compiled by the Commissioning Support

Unit (CSU) and made available through a data warehouse accessible by the CCG. New standards are

discussed and data collections planned through provider technical meetings, and monitored through

performance meetings. The CCG has an in-house analytical team tasked with ensuring new data flows

not provided through the CSU are collected and included in the Integrated Quality and Performance

Report which is delivered monthly to clinical and executive leads through the performance and delivery

committee and quarterly through the governing body.

The following is a summary of year to date performance against our key constitutional and assurance

targets, and the actions in place to improve performance where targets are not consistently delivered.

Ambulance Response times

Target Achieved 2016/17

Risks and Actions taken to mitigate risks

Longer term Plans

Red 1 - life-threatening conditions within 8 minutes

75% 56.5% Hospital handover waits have grown across the region resulting in delays to turnaround times. SECAMB is participating in national despatch on disposition pilot project. Computer Aided Despatch to be launched in summer 2017. Workforce plans under review.

A collaboration pilot with Fire and Rescue is under discussion across Kent.

Red 2 - serious within 8 minutes

75% 44.5%

Category A Incidents Attended in 19 Minutes

95% 80.9%

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A&E Waiting Times

Target Achieved 2016/17

Risks and Actions taken to mitigate risks

Longer term Plans

A&E waiting times

95% 79.9%

A&E waiting times have exceeded targets nationally due to workforce and discharge challenges. Improvement plans are in place focusing on streaming, flow, ambulance handovers, discharge and workforce

Development of urgent care hubs to reduce pressure on A&E.

Performance Summary

A&E waits have shown a deteriorating position in the year.

A review of the joint health and social care urgent care improvement programme is underway

across East Kent following the appointment of a designated urgent care lead for the region.

Improving Access to Psychological Therapies (IAPT)

Target Achieved 2016/17

Risks and Actions taken to mitigate risks

Longer term Plans

Access (% of estimated prevalence accessing treatment)

15% 22.9%

An action plan to improve recovery rates has been submitted by each provider. Local data shows recovery rates have improved and are now meeting the target.

Commissioners and providers have attended the IAPT clinical networks and intensive support sessions with the IAPT national support team. An action plan to further increase recovery rates has been agreed with all providers.

Recovery rate 50% 45.2%

Referral to treatment in 6 Weeks 75% 79.7%

Referral to treatment in 18 Weeks

95% 99.7%

Performance Summary

Following the transfer of IAPT services to new providers this year SKC experienced a reduction in

performance around treatment waits and recovery rates.

The CCG supported providers to work collectively to reduce the waiting list leading to the recovery

of performance targets.

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Early Intervention in Psychosis (EIP)

Target Achieved 2016/17

Risks and Actions taken to mitigate risks

Longer term Plans

Early Intervention in Psychosis referral to first outpatient appointment within 2 weeks

50% 63.2%

Plans are in place to improve capacity to deliver CBT and family therapy and physical health monitoring.

Performance Summary

Waiting time targets for early intervention in psychosis have been met across East Kent.

Cancer Waiting Times

Target Achieved 2016/17

Risks and Actions taken to mitigate risks

Longer term Plans

GP referral to first appointment within 2 weeks

93% 95.2% Some specialty areas have experienced capacity challenges, and have put in place recruitment and theatre utilisation improvement programmes to recover performance with cancer waiting times. Gynaecology pathway review completed with provider, with anticipated improvement from April 2017. Prostate, Colorectal and Breast Stratified Pathway work underway. Macmillan GP and nurse posts in development across East Kent.

The newly formed Kent and Medway Cancer Alliance will impact on transformation and change within Kent and Medway Cancer delivery and services.

Breast symptoms referral to first appointment within 2 weeks

93% 94.8%

Diagnosis to first treatment for all cancers within 31 days

96% 94.5%

Subsequent treatment (surgery) within 31 days

94% 91.7%

Subsequent treatment (anti-cancer drug regime) within 31 days

98% 98.7%

Subsequent treatment (radiotherapy) within 31 days

94% 96.1%

Referral to treatment for cancer within 62 days

85% 71.8%

Referral from screening service to first treatment within 62 days

90% 93.1%

Consultant Upgrade to first definitive treatment within 62 days

n/a 75.61%

Performance Summary

A revised cancer waiting time compliance trajectory is in development taking into account

programmes of work described above.

We have seen a reduction in the number of long waits, improved performance in waits for first

appointment and will see the impact on referral to treatment times in the coming year.

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Referral to Treatment waiting times

Target Achieved 2016/17

Risks and Actions taken to mitigate risks

Longer term Plans

Referral to Treatment waiting times

92.0% 86.3%

Increasing demand on acute care has resulted in waiting lists exceeding the provider’s capacity to deliver within expected waiting times. Demand management models put in place and in development include peer review of referrals, shared decision making, patient choice, advice and guidance, alternatives to outpatient services, consultant to consultant referral protocols, direct access to diagnostics, and management and monitoring of outpatient follow-up appointments.

Theatre Review to optimise capacity including utilisation, conversions, equipment, scheduling, referral rates, skill mix, standard operating procedures, and pre-assessment

Performance Summary

2016/17 trajectory to recover compliance with the referral to treatment waiting times target has not

been met.

A programme of reducing the waiting list for the longest waiting specialties through use of additional

elective care providers has been initiated. This programme has resulted in more long waiters

completing treatment toward the end of 2016/17, resulting in lower target compliance and higher

activity, with a longer term aim of achieving a sustainable waiting list and improved performance in

the coming year.

Dementia diagnosis rate

Target Achieved 2016/17

Risks and Actions taken to mitigate risks

Longer term Plans

Dementia diagnosis rate

66.7% 65.8%

Mental health provider has received accreditation as a gold standard dementia support service. Work ongoing between MH services, GPs and Care Homes to improve diagnosis and post diagnostic support.

East Kent Dementia Transformation Group established to review the Dementia Pathway. Work underway to improve secondary care coding of dementia diagnosis to facilitate communication and links between providers.

Performance Summary

Dementia diagnosis rates have improved in year and are on track to meet targets by year end.

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Sustainable Development

The CCG is required to report on sustainability as part of our annual reporting process. We continue to

strive towards achieving our sustainable development aims and principles:

Ensuring a strong and healthy society

Living within environmental limits

Achieving a sustainable economy

Promoting good governance

Using reliable science responsibly

A key aspect of our approach to sustainable development is through our strategy on integrating care.

The Integrated Accountable Care Organisation (IACO), as already discussed, will put in place more

streamlined care pathways for patients to receive care closer to home.

Using the NHS Standard Contract, we require our providers to state how they are supporting sustainable

development. The CCG is engaged, through the Health and Wellbeing Board and other local agencies,

with resilience planning and creating a secure infrastructure that will help the local community remain

sustainable when faced with sudden or disruptive events.

The CCG remains committed to minimising waste. This commitment includes an ongoing public

communications campaign aimed at reducing medicines waste, which is a significant cost pressure on

the CCG. We also encourage a paperless office and other waste reduction and recycling initiatives such

as food waste bins in offices.

In 2016 the CCG Staff Engagement forum reviewed a sustainability policy with the aim of integrating

sustainability considerations into all commissioning decisions by ensuring suppliers, partners and

providers are aware of the sustainability policy and encouraging them to adopt appropriate sustainability

management practices, for example through the tendering process and contract management.

We will continue to develop plans to assess risks, enhance our performance and reduce our impact. We

will ensure the CCG complies with its obligations under the Climate Change Act 2008, including the

Adaptation Reporting power, and the Public Services (Social Value) Act 2012. We will focus on how we

can encourage our staff to adopt sustainable habits personally; and we will review how, as an

organisation, the CCG can adopt sustainable approaches to its business. We are also setting out our

commitments as a socially responsible employer.

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Using media and social media to talk about sustainability

Health Help Now App: We have a responsibility to ensure people can access health services, which

includes communications, to encourage people to use the services that are available in the most

appropriate way. A key part of this for us is Health Help Now, the mobile optimised website and apps

for Kent and Medway.

The Health Help Now web app has been used 271,758 times by people using 226,151 devices (such

as smartphones, tablets or computers).

Users stay on for just over one minute on average.

Forty one per cent of users are aged 18 to 34, 24 per cent are 35 to 44, 17 per cent 45 to 54, 10 per

cent 55 to 64, and eight per cent 65 plus.

Just over two-thirds of usage is by women.

The downloadable app, which launched on 9 December 2014, had been used 36,113 times and

downloaded 17,966 times.

People typically stay on for almost three and half minutes and look at 12 screens

Medicines waste: An article appeared in the Dover Mercury, featuring Dr Chee Mah, advising people

about medicines waste in the area.

Social Media – Twitter: Our Twitter account @southkentccg has 2,500 followers. This is used to

promote news releases, opportunities for engagement and events such as governing body meetings, as

well as public health messaging.

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Improve quality

The CCG has continued to improve the quality of services that we commission. The Quality strategy and

commissioning tool kits are available to underpin commissioning and service development.

The CCG have developed Clinical Quality Review groups for several contracts. Through these meetings

we explore in greater detail the quality and safety of the services provided. Provider action plans are

monitored and reviewed and triangulated with quality indicators to understand how services are improved

and to identify where further improvement and innovation is required. All Serious Incidents are robustly

reviewed by the Serious Incident Review Group before being considered for closure by the quality

committee. Action plans from serious incidents are reflected back through the commissioning process to

ensure learning is shared.

Leadership and workforce concerns have been identified though monitoring quality and CQC inspections.

The CCG have monitored both in terms of delivery of care and development of new working practices.

To meet the HCAI Statutory requirements we have effective monitoring and reporting processes in

place. Training for care home and primary care staff has been successful and link workers have been

recruited.

The care home dashboard supports the care home forum to identify concerns early and for multiagency

plans to be developed to support homes that are showing early warning signs of not being able to cope.

There has been significant work through the safeguarding teams to ensure system wide learning from

serious case reviews, case reviews and domestic homicide reviews. There has been significant work with

providers to improve safeguarding compliance and assurance.

Through locally set CQUINs the CCG have been able to focus on developing core workforce skills and

competency that have led to improved wound healing rates. Close scrutiny of patient harms through

quality visits with providers has led to supported work and innovation within organisations. Community

handovers are now shorter, more effective and provide learning opportunities. Patient education has

enabled patients to self-administer clexane and insulin. These innovations have led to improved

partnership working between providers and improved continuity of care for patients. Success stories

include patients being able to successfully stop insulin.

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Patient and Public Involvement

We aim to ensure the patient and community voice is embedded into our commissioning cycle so that we

are a valuable, high-performing and successful local NHS organisation. Our approach to communication

and engagement is influenced by three main objectives:

Listening to, and acting on, the views of our community by involving and engaging with as wide a

range of the public as possible.

Targeting services effectively to areas of particular need by using information and research about

different communities’ needs.

Increasing our reach into communities where evidence shows further engagement is needed.

The CCG has a statutory duty to involve patients and the public in commissioning planning and decisions

(Section 14Z2 of the National Health Service Act 2006) (as amended) and promoted through the NHS

Constitution. We are also required to report on how we have fulfilled our public involvement duty which

we do regularly through our governing body reports, and here in the annual report.

Handling Complaints

The CCG welcomes any feedback including complaints, comments, suggestions or expressions of

concern from local people about either our own service or the quality of the services we commission,

and view them as an opportunity for improvement. When a complaint is received from a member of the

public or an MP, work is undertaken to establish who should investigate the complaint, as it may be that

one of the CCG’s providers is best placed to answer the queries raised. The CCG works closely with our

Commissioning Support Unit (CSU) to establish how best to respond to any concerns brought to our

attention, and to ensure that that any ‘lessons learnt’ are clearly identified when responding to complaints.

Further work will be undertaken during 2017/18 to produce a robust monitoring process for the CCG to

track that any changes recommended as a result of a complaint are indeed subsequently implemented.

Learning from Complaints

The Quality and Performance Committee receives a bi-monthly complaints report which highlights to

them the nature of the complaints being received by the CCG as well as the numbers of complaints both

received and closed during that timeframe. The committee also reviews a quarterly report, produced by

the CCG’s performance team, of complaints received by our providers. This provides us with important

intelligence which can be used to triangulate the information we have about providers’ performance.

Over the course of this year South Kent Coast CCG has received 126 complaints in total; 49 of these

related to the CCG directly, 70 complaints regarded other providers and the final 7 related to both the

CCG and its’ providers. Of the complaints received the most frequent complaint regarded NHS

continuing health care (CHC), more commonly regarding the criteria for eligibility and a lack of

patient/carer understanding surrounding this. We have further received a number of complaints regarding

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local access to services.

In the year 2016-17 one case was referred to Public Health Services Ombudsman (PHSO) for

investigation. This case related to access to mental health services. The PHSO having completed their

investigations concluded that there was some evidence of a breakdown of communication however; this

was predominantly on the part of third parties. As a result it was concluded that no further action was

required however, the CCG endeavours to maintain excellent lines of communication with all third parties

and providers to guarantee a high level of patient care at all times.

Freedom of Information Requests (FOI)

Members of the public have the right to request in writing any recorded information held by the public

sector; this is known as a Freedom of Information Request (FOI). The table below outlines the number

of requests for information under the Freedom of Information Act received by the CCG during 2016-17.

South Kent Coast CCG Freedom of Information (FOI) Requests 2016-17

Number of FOI Requests Received 292

Number of FOI Requests Responded to < 20 Working Days 290

Number of FOI Requests Responded to > 20 Working Days 2

Number of Requests for Internal Review of FOI Response 0

Number of FOI Responses Referred to the Information Commissioner 0

How community engagement works

The CCG has a Lay member for Patient and Public Involvement on the Governing Body. He reports to

the Governing Body at every meeting and brings questions raised by the Health Reference Group.

Patient Participation Groups (PPG)

Each GP practice should have a PPG; in addition the CCG has three locality patient participation groups

(PPG) in Shepway, Dover and Deal. Their roles include:

Providing a vital link between the CCG and local patients

Co-coordinating views and issues from individual practice groups

Working with the CCG to help plan and evaluate local health services

This year our Lay Member Patient and Public Engagement lead, Clive Davison, has extended NHS

South Kent Coast CCG’s engagement work with PPGs in the area. Working closely with the three locality

PPGs from Dover, Deal and Shepway he has offered his support to any individual GP surgeries wishing

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to set up or revitalise their GP practice PPGs.

Health Reference Group

This group ensures that patient participation group members and representatives from the community

and voluntary sector have a key part in the work of the CCG. Their role includes:

Providing community links to a wide range of patients and members of the public

Sharing information they have heard from commissioners with their networks and community

links

Participating in focus groups on specific healthcare issues

In order to provide valuable feedback on all aspects of healthcare provision, the Health Reference

Group (HRG) this year has:

Looked at self-care and how NHS money is spent on medicines which are readily available in

supermarkets and pharmacies, supporting plans to challenge people’s use of prescriptions to get

treatments that are cheaper in shops and pharmacies.

Contributed feedback to a Patient Choice leaflet which will be distributed across Deal, Dover and

Shepway.

Supported the Lay member in the work of the East Kent Patient and Public Engagement Group and

driving forward the Sustainable Transformation Plan at a local level. By sharing information with

their community links and networks about the Sustainable and Transformation Plan and the Local

Care Plan.

Members have shared information and promoted patient online and ensuring Practices are offering

online services to their patients.

The group have regularly contributed their views on the development of local care and the efforts

the CCG has made over the last year to improve and integrate out of hospital services.

Expert patients

Patient and carer views and experience is often sought when improving services, often joining clinical

staff and commissioners on key tasks, this year patients and carers have worked on end of life

information, and improving cardiac and respiratory care. Our thanks to all those who give up their time,

and expertise.

The Health Network

South Kent Coast Health Network is a virtual group of patients, members of the public and voluntary

groups from Deal, Dover and Shepway. Feedback from the network helps the CCG decide how local

health services are planned and designed. Anyone who becomes a member is given the opportunity to

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participate as often or as little as they like. This year views have been sought on the development of an

east Kent mental health strategy, the review of the new patient transport service provider, same day

services and the delivery of urgent care as well as Kent wide programmes such as the Kent and

Medway Stroke Review.

Integrated Accountable Care Organisation/Local Health and Care

“Our aim is to ensure that South Kent Coast people are supported to be well and healthy in their own

homes and communities, by delivering a connected system, designed and delivered around local

people, located in their neighbourhood.”

We are working with local communities to improve health and social care. GPs, nurses and other

professionals working in health and social care locally have developed an exciting shared vision to

address our challenges, improve people’s experience of care and develop healthier communities. The

new way of working will break down traditional organisational barriers by bringing the vast range of NHS,

social care and voluntary sector services together into one convenient place - one service, one team,

one budget. Colleagues of every discipline will work together, drawing on their full range of skills,

experience and insight to help people get the right care and support. More and more care will be

delivered by multi-skilled teams in convenient community locations rather than in large hospital sites.

Over the last two years, we set up four Local Delivery groups covering Deal, Dover, Folkestone, Hythe

and the surrounding rural villages. The groups are made up of GP’s, health and care providers, patients,

voluntary and community organisations and representatives from statutory organisations. The purpose

of the groups are to work together to look at health and care provision being delivered locally and what

could be and how it could be improved in the future, ensuring the needs of the population are met.

Over the next 12 months, we will be working with the public, staff and all others to agree how to best

deliver these improvements as part of the wider Sustainability and Transformation plan.

Public meetings

We hold meetings with our community to explore people’s views on local health services: in February

2017 we held a listening event with 81 people to look at the emerging plans for the STP. Our governing

body also meets in public regularly. People who are interested in hearing about our plans are welcome

to come along and observe and there is always an opportunity to ask questions.

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Press releases

We issued some 60 pro-active press releases this year and continued to receive balanced media

coverage. Press releases were issued on a wide range of subjects, including:

Calls for people to make the right decisions about accessing health services, particularly during

high-demand periods such as bank holidays.

Information about junior doctor’s strikes.

Promoting governing body meetings.

Updates on transformation programmes – particular the Kent and Medway Sustainability and

Transformation Plan.

Promoting South Kent Coast Health Network.

Promoting public engagement in particular projects such as mental health, patient transport.

Service changes and re-procurement.

Public health messaging (flu etc.).

Patient newsletter

The CCG issued three South Kent Coast Health Network patient newsletters in 2016/17. Printed copies

were distributed via GP practices, local libraries, council offices and information points. They were also

circulated online via the South Kent Coast Health Network, the CCG website and Twitter.

Newsletter features this year included the news of the CCG’s rheumatology pilot, how we are bridging

the gap between mental and physical health care, our primary care transformation plans, updates from

the wider east Kent transformation programmes, promotion of the health network plus information about

service re-procurements including patient transport and GP out-of-hours.

Social media

The CCG has continues to be active on Twitter and now has nearly 2,500 followers. Our content is a

blend of regional and national public health messaging, promotion of South Kent Coast Health Network.

We regularly tweet about the about the benefits of the Health Help Now app, as well as promoting CCG

news and events including governing body meetings.

Sustainable Transformation Plan (STP)

There are serious challenges we face in Deal, Dover and Shepway, the same as everywhere else in the

country - limited resources, an ageing population, lack of staff and a complex and fragmented care

system. If we don’t urgently and radically change the way we work, health and social care will become

increasingly unaffordable and we will find it more and more difficult to provide safe and high quality care

to the people we serve.

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Across the country, health and care are working together to develop a more joined up approach, to

improve quality and better meet the needs of the population. This plan will focus on Kent and Medway;

however, we have to develop a local health and care plan for South Kent Coast.

Our Lay Member Patient and Public Engagement lead and one member of our Health Reference Group

are members of the Patient and Public Engagement Group which is a working group for the Kent and

Medway STP Board.

Examples of our engagement activity

The four East Kent CCGs regularly work together on planning and buying services, and this year

children and young people and their families have contributed their insights, experience and views on the

re-procurement of Children and Young People’s Mental Health services and Eating Disorder services

creating a specific ‘service standard’ that sets out the outcomes they expect from high quality care and

support, and developing a specific evaluation tool to monitor and review services against that standard.

Also children’s commissioners in east Kent working on Autism and Attention Deficit Hyperactivity

Disorder services, have sought feedback from families with children who use these services to inform

improvements needed to these services.

Case Study – Visits to the French Hospitals to increase Patient Choice

In 2016, under any qualified provider contracts, two hospitals in France were commissioned to provide

planned or elective treatments for patients. Our Lay Member Patient and Public Engagement lead and

members of the Health Reference Group were given the opportunity to be involved in working with the

commissioners on this project.

To ensure every aspect of a patients’ experience was felt, the group were asked to visit both French

hospitals, one in Calais and one in Le Touquet. The group were shown around the hospitals, from the

wards, to the operating theatres and even got to try the food the patients would have. The group

looked at the signage in the hospitals to make sure they were in English and spoke to the receptionists

and find out from them the discussions they might have with the patients. Many of the group were

concerned about communicating with the nurses and doctors once the patient had been operated on.

One of the hospitals had developed a small pocket size translation booklet for staff and had provided

folders in the patient rooms, so communication would be effective and understandable.

Having visited both hospitals, the group commented on booklets, flyers and maps the hospitals had

created which could be given to patients if they decided to have treatment in France. A delegation from

the Calais hospital visited the HRG and presented draft patient guidance and information in English for

their NHS patients. This was commented upon and improved by the HRG.

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Once this work had been done, some of the members of the Health Reference Group spoke to some of

their patients at their practices and found the French hospitals were not always being offered as a

choice to patients. The members took it upon themselves to make sure their Practice staff and patient

participation group knew these are an option for patients.

Reducing health inequality

The CCG has a statutory responsibility to reduce inequalities, working with our Health and Wellbeing

Board to do so. Our Health Inequalities Strategy has been developed in partnership with Public Health

and the local authorities in the South Kent Coast area. It focuses on improving equity in access to

treatment for all people irrespective of vulnerabilities relating to gender, ethnicity or age.

Examples of the work on inequalities is through tackling health care needs of homeless people include.

A local enhanced service for the Nepalese community

Migrant Health App pilot

Work with the homeless via the Rainbow Centre Folkestone – flu vaccination programme annually,

revisiting the health trainer, mental health specialist and counselling support

Education sessions taken place for General Practice in migrant health management via Doctors of

the World

Increasing Community Care Navigator numbers

Improved access to Personal Health Budgets for complex clients

A Cook and Nourish programme in the Romney Marsh together with the Paula Carr Trust

Bettshanger Park and Run

Healthy Cooking for Families in Deal

Gillingham Football Club ‘Shape up’ project in Shepway

Cinque Ports community kitchen for families in Dover

Health and wellbeing strategy

The South Kent Coast Health and Wellbeing Board bring together key organisations to oversee the

plans for improving health and wellbeing of people living in the South Kent Coast area. This area aligns

with the South Kent Coast Clinical Commissioning Group and covers most of the Dover and Shepway

districts.

The Board's priorities are shaped by local evidence of health set out within the Kent Joint Strategic

Needs Assessment, Kent Health and Wellbeing Strategy and local health profiles.

The following six priorities have been identified:

Priority 1: Tackling Health Inequalities

Priority 2: Urgent Care - Avoiding unnecessary hospital admissions

Priority 3: Supporting Children and Families

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Priority 4: Healthy Living and Quality of Life (Prevention of Illness)

Priority 5: Improving Long-Term Conditions

Priority 6: Improving Mental Health and Wellbeing

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ACCOUNTABILITY REPORT

Hazel Carpenter

Chief Accountable Officer

25 May 2017

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Corporate Governance Report

Members Report

NHS South Kent Coast Clinical Commissioning Group (CCG) was established in April 2013

under the Health and Social Care Act 2012 as a body corporate.

Member practices

In 2016/17 the 30 member practices formed four localities – Deal, Dover, Folkestone and

Hythe and rural:

DEAL Balmoral Surgery

The Cedars Surgery

Manor Road Surgery

St Richards Road

DOVER Aylesham Medical Practice

Buckland Medical Centre

High Street Surgery

Lydden Surgery

Pencester Health

Pencester Surgery

Peter Street Surgery

St James Surgery

White Cliff Medical Practice

FOLKESTONE Central Surgery

Church Lane Surgery [IH]

Folkestone East Family Practice

Guildhall Surgery

Manor Clinic

Martello Medical Practice [IH]

Oak Hall Surgery

Park Farm Surgery

Sandgate Road Surgery

The New Surgery

The White House Surgery

HYTHE & RURAL Hawkinge & Elham Valley

New Lyminge Surgery

Oaklands Surgery

Orchard House

Sun Lane

The Surgery Lyminge

IH = Managed by Invicta Health

For more details, please see South Kent Coast’s website: www.southkentcoastccg.nhs.uk.

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Composition of Governing Body

The practices which form the membership of NHS South Kent Coast CCG have delegated

powers to the Governing Body to run the CCG.

Dr Jonathan Bryant became Clinical Chair effective from 20 April 2016. Following five

expressions of interest for four vacancies on the SKC CCG Governing Body, Dr Aravinth

Balachandran, Dr Chee Mah, Dr Qasim Mahmood and Dr Lynne Wright were elected by the

membership practices.

Hazel Carpenter has been the Chief Accountable Officer since the CCG was established and

up to and including the time of signing the Report and Accounts.

NHS South Kent Coast CCG’s Governing Body continues to have a very strong clinical

membership and focus, with a GP as Chair and seven elected GP Governing Body members,

along with a hospital consultant and a nurse member (up to 31 January 2017). The Governing

Body also includes two independent lay members with a third appointed from 1 March 2017,

and senior members of the CCG management team. There is also a public health consultant

who is a non-voting member of the Governing Body.

The following have been members of the NHS South Kent Coast CCG up to and including

the time of signing of the accounts (unless specified):

Name Position

Alistair Smith Lay member for Governance

Aravinth Balachandran (Dr) GP Member (elected 01 April 2016)

Chee Mah (Dr) GP Member

Clive Davison Lay member for Public & Patient Engagement

Hazel Carpenter Chief Accountable Officer

Ian Mckenzie (Dr) GP Member

Joe Chaudhuri (Dr) GP Member (Deputy Clinical Chair)

Jonathan Bates Chief Finance Officer

Jonathan Bryant (Dr) Clinical Chair (elected 20 April 2016)

Lynne Wright (Dr) GP Member (elected 01 April 2016)

Martin Smits Lay Member for Primary Care Co-Commissioning (01 March 2017)

Qasim Mahmood (Dr) GP Member (elected 01 April 2016)

Sharon Gardner-Blatch Chief Nursing Officer (up to 31 January 2017)

Stewart Coltart (Dr) Secondary Care Doctor

Tuan Nguyen (Dr) GP Member

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Non-Voting Member:

Name Position

Jess Mookherjee Public Health Consultant

Details of the senior management team which support the Governing Body and the

membership are outlined below:

Name Position

Helen Robinson Company Secretary – Interim (23 January 2017 to 31 March 2017)

Karen Benbow Chief Operating Officer

Sue Martin Company Secretary (up to 31 January 2017)

See page 64 for biographies of the Governing Body members.

The Governing Body has a number of committees to help conduct its business. Their

responsibilities are set out in the Constitution and summarised in the Annual Governance

Statement by the Accountable Officer.

Committee(s)

The Clinical Cabinet Committee

The Committee met monthly during 2016/17. It has taken the lead role in overseeing the

development and implementation of the strategic priorities in the South Kent Coast Plan:

The Committee considered a number of key clinical issues including the Cancer

Strategy, Rheumatology, East Kent Mental Health Strategy, Obesity Strategy and the

East Kent Procurement of the Drug and Alcohol Service.

The Committee considered the Primary Care Locality Plan, the Primary Care Estates

Strategy, Children’s Public Health procurement, Health Visiting and ICO Primary Care

Strategy.

The members invited consultants from the local acute trust to meetings to discuss

issues such as how to improve referrals from general practice and to identify ways in

which primary and secondary care can work more effectively together.

The Committee based its work plan on the Joint Strategic Needs Assessment and

Right Care data, which compares our outcomes performance with those of other

CCG’s with similar demographics and highlights potential areas for improvement.

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Attendance of members of the Clinical Cabinet Committee

Name Role Attendance

Aravinth Balachandran (Dr) GP Member (elected 01 April 2016) 8 out of 12

Chee Mah (Dr) GP Member 10 out of 12

Hazel Carpenter Accountable Officer 6 out of 12

Ian McKenzie (Dr) GP Member 9 out of 12

Jess Mookherjee Public Health Consultant 6 out of 12

Joe Chaudhuri (Dr) GP Member (Deputy Clinical Chair) 12 out of 12

Jonathan Bates Chief Finance Officer 8 out of 12

Jonathan Bryant (Dr) Clinical Chair 10 out of 12

Karen Benbow Chief Operating Officer 11 out of 12

Lynne Wright (Dr) GP Member (elected 01 April 2016) 11 out of 12

Qasim Mahmood (Dr) GP Member (elected 01 April 2016) 10 out of 12

Sharon Gardner-Blatch Chief Nursing Officer (up to 31 January 2017) 7 out of 10

Stewart Coltart Secondary Care Doctor 10 out of 12

Sue Martin Company Secretary (up to 31 January 2017) 9 out of 10

Tina Bryne Practice Manager Representative & Quality (from 01 January 2017)

1 out of 3

Tuan Nguyen (Dr) GP Member 9 out of 12

Wendy Yambo Practice Manager Representative & Quality (Up to 31 December 2016)

2 out of 10

Quality, Performance and Delivery Committee

The committee also met on a monthly basis during 2016/17. Its focus was on monitoring the

in-year performance of providers commissioned by the CCG and of the CCG itself. The

Committee:

Reviews the management of risks and the CCG’s financial position and receives

regular reports on complaints, safeguarding adults and children, looked after children

and transforming care.

Has lead responsibility for reviewing safety and quality, considering patient

experience, for closing serious incidents and reviewing “never events” to identify

improvements and learning.

Strengthened its oversight of provider quality and performance. The Integrated

Quality and Performance Report (IQPR) has continued to highlight key performance

and quality concerns and triangulate those concerns with other data for all the CCG’s

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providers and the CCG’s constitutional targets. It is a key tool enabling the

Committee to identify issues which need to be raised with providers at an early stage

so that the providers can address these. The intelligence in the IQPR has also

informed the discussion in contract delivery meetings. The data also informs the

CCG’s decisions to undertake quality visits and deep dives, for example, into

maternity services and into A&E.

Attendance of members of the Quality, Performance and Delivery Committee

Name Role Attendance

Alistair Smith Lay Member for Governance 11 out of 11

Aravinth Balachandran (Dr) GP Member (elected 01 April 2016) 9 out of 11

Chee Mah (Dr) GP Member 11 out of 11

Clive Davison Lay Member for Public & Patient Engagement 6 out of 11

Hazel Carpenter Accountable Officer 9 out of 11

Ian McKenzie (Dr) GP Member 9 out of 11

Jess Mookherjee Public Health Consultant 1 out of 11

Joe Chaudhuri (Dr) GP Member (Deputy Clinical Chair) 11 out of 11

Jonathan Bates Chief Finance Officer 8 out of 11

Jonathan Bryant (Dr) Clinical Chair 9 out of 11

Karen Benbow Chief Operating Officer 9 out of 11

Lynne Wright (Dr) GP Member (elected 01 April 2016) 8 out of 11

Nick Morley-Smith (Dr) GP Member 9 out of 11

Qasim Mahmood (Dr) GP Member (elected 01 April 2016) 8 out of 11

Sharon Gardner-Blatch Chief Nursing Officer (up to 31 January 2017) 5 out of 9

Stewart Coltart Secondary Care Doctor 6 out of 11

Sue Martin Company Secretary (up to 31 January 2017) 8 out of 9

Tina Bryne Practice Manager Representative & Quality (from 01 January 2017)

1 out of 3

Tuan Nguyen (Dr) GP Member 7 out of 11

Wendy Yambo Practice Manager Representative & Quality (Up to 31 January 2017)

5 out of 8

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Governance and Risk Committee

The Governance and Risk Committee discharges the responsibility of an audit committee.

The Committee is charged with providing independent assurance to the Governing Body that

the CCG’s systems of risk management, internal control and governance are effective. These

include the CCG’s arrangements for preventing corruption and for countering fraud.

The Governance and Risk Committee has met jointly with the NHS Thanet CCG Governance

and Risk Committee 6 times during 2016/17. The Committee is alternately chaired by the Lay

Member for Governance of each CCG. The Lay Member for Public and Patient Engagement

is a member of the Committee as is the secondary care doctor for South Kent Coast CCG.

The Committee meetings are attended by the external auditors, the internal auditors, the

Chief Finance Officer, the Chief Nursing Officer and the Company Secretary.

The Committee Chair has financial expertise and the Chief Nursing Officer and the

Secondary Care Doctor provide expertise in clinical effectiveness and quality.

The Committee has performed a number of key tasks at my request, providing

assurance to me through their independent scrutiny and challenge and has

considered the lessons learned from a number of external reports following issues

elsewhere in the health service e.g. the Lakeland Review on child sexual health

exploitation in Kent and the Mazars Review on MH services at Southern Health.

The Committee reviewed the governance processes in relation to both the STP and

the East Kent Delivery Board and a deep dive was also undertaken into the

development of the IACO and recommendations made to the Governing Body

following these reviews.

A simpler Board Assurance Framework was developed which is more focused on the

key strategic objectives for the CCG. In addition the format of the risk registers has

recently been re-aligned to support the operation of the business. During the year,

the use of risk registers has become more embedded in the culture of the CCG with

the registers being reviewed at heads of meetings and also on a monthly basis by the

Executive Team.

The Chair of the Committee completed several submissions required by NHS

England, including the provision of assurance on the process to appoint the external

auditors and was appointed Conflict of Interests Guardian in line with NHSE

requirements.

The Committee’s annual work plan has been approved by the Governing Body. The

Committee reviewed a number of policies before these were submitted to the

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Governing Body for approval and was responsible for overseeing the establishment of

the Primary Co-Commissioning Committee.

The Committee reviewed the risk register and assurance framework at each meeting

and heard regularly from the internal auditors, TIAA Ltd, who have responsibility for

advising the Committee on whether the control arrangements which the CCG has in

place are adequate. The Committee also received reports from the Counter Fraud

Service.

The Committee received reports from the external auditors, Grant Thornton, who are

required to perform the CCG’s audit and in accordance with the Code of Practice

issued by the National Audit Office (NAO) on behalf of the Comptroller and Auditor

General in April 2016. The external auditors’ responsibilities under the Code are to:

- give an opinion on the CCG's financial statements

- give an opinion on the regularity of expenditure and income recorded in

the CCG's financial statements

- satisfy themselves that the CCG has made proper arrangements for

securing economy, efficiency and effectiveness in its use of resources

based on the following criterion: In all significant respects, the audited

body had proper arrangements to ensure it took properly informed

decisions and deployed resources to achieve planned and sustainable

outcomes for taxpayers and local people.

The Governance and Risk Committee reviewed its terms of reference in January 2017 and

recommended no changes.

Attendance at Governance and Risk Committee

Name Role Attendance

Alistair Smith Chair and Lay Member for Governance at South Kent Coast CCG

6 out of 6

Clive Davison Lay member for Patient and Public Engagement for South Kent Coast CCG

5 out of 6

Clive Hart Lay Member for Patient and Public Engagement Thanet CCG

5 out of 6

David Lewis Chair and Lay Member for Governance at Thanet CCG

6 out of 6

Robin Withington Secondary Care Doctor Thanet CCG (Joined Thanet CCG GB – September 2016)

2 out of 4

Stewart Coltart Secondary Care Doctor South Kent Coast CCG 4 out of 6

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The Remuneration and Nominations Committee

The Committee has met twice during 2016/17. The Committee has responsibility for making

recommendations to the Governing Body on remuneration of members of the Governing

Body and senior employees of the CCG, advising on contractual arrangements for the same

group of people, developing an approach to succession planning and ensuring that the

Governing Body has the right balance of skills and knowledge. It is chaired by the Lay

Member for Governance.

During the year, the committee discussed amongst other things, staff appraisals, succession

planning and feedback on the performance of governing body members.

Attendance at Remuneration and Nominations Committee

Name Role Attendance

Alistair Smith Lay Member for Governance 2 out of 2

Clive Davison Lay Member for Public and Patient Engagement 1 out of 2

Jonathan Bryant (Dr) Clinical Chair 2 out of 2

Stewart Coltart Secondary Care Doctor 2 out of 2

Register of Interests

The register of interests for South Kent CCG’s Governing Body members can be found on our

website.

Personal data related incidents

The CCG has a policy for dealing with Serious Untoward Incidents in its Risk Management

Policy. The CCG uses the Information Governance (IG) Toolkit Incident Reporting Tool to

report IG Serious Incidents Requiring Investigation (SIRI) to the Health and Social Care

Information Centre (HSCIC), Department of Health (DH), Information Commissioner's Office

(ICO) and other regulators. In the Annual Governance Statement, the Accountable Officer

has declared that there were no Serious Untoward Incidents in 2016/17.

43

Statement of Disclosure to Auditors

The Governing Body delegated responsibility at its meeting on 8th March 2017 for approving

the Annual Report and Accounts to the Governance and Risk Committee. Each Member of

the Governance and Risk Committee has stated, confirmed by the minutes, that they have

taken all reasonable steps to make themselves aware of any relevant audit information and

establish that the CCG’s auditors are aware of that information.

The Governing Body confirmed at a public meeting on 8th March 2017 that as far as they are

aware there is no relevant audit information of which the CCG’s auditors are unaware.

Modern Slavery Act

South Kent Coast CCG fully supports the Government’s objectives to eradicate modern

slavery and human trafficking. Our Slavery and Human Trafficking Statement for the financial

year ending 31 March 2017 was published on our website on 06 September 2016.

Response to the Requirement of the Modern Slavery Act 2015

44

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 Hazel

Carpenter to be the Accountable Officer of South Kent Coast 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:

45

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 judgments required for determining that it is fair, balanced and

understandable

46

Governance Statement

Introduction and context

South Kent Coast Clinical Commissioning Group is a body corporate established by NHS

England on 1st April 2013 under the National Health Service Act 2006 (as amended).

The Clinical Commissioning Group’s statutory functions are set out under the National

Health Service Act 2006 (as amended). The CCG’s general function is arranging the

provision of services for persons for the purposes of the health service in England. The

CCG is, in particular, required to arrange for the provision of certain health services to such

extent as it considers necessary to meet the reasonable requirements of its local population.

As at 1 April 2017, the Clinical Commissioning Group is not subject to any directions from

NHS England issued under Section 14Z21 of the National Health Service Act 2006.

Scope of responsibility

As Accountable Officer, I have responsibility for maintaining a sound system of internal

control that supports the achievement of the clinical commissioning group’s policies, aims

and objectives, whilst safeguarding the public funds and assets for which I am personally

responsible, in accordance with the responsibilities assigned to me in Managing Public

Money. I also acknowledge my responsibilities as set out under the National Health Service

Act 2006 (as amended) and in my Clinical Commissioning Group Accountable Officer

Appointment Letter.

I am responsible for ensuring that the clinical commissioning group is administered prudently

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

financial propriety and regularity. I also have responsibility for reviewing the effectiveness of

the system of internal control within the clinical commissioning group as set out in this

governance statement.

Governance arrangements and effectiveness

The National Health Service Act 2006 (as amended), at paragraph 14L (2) (b) states:

The main function of the governing body is to ensure that the group has made appropriate

arrangements for ensuring that it exercises its functions effectively, efficiently and

47

economically and complies with such generally accepted principles of good governance as

are relevant to it.

Our Constitution, which is published on our website, sets out the governance arrangements

we have established for ensuring that we make decisions openly and transparently, based on

an assessment of clinical need, for ensuring that we meet our financial and statutory

obligations, and for ensuring that we manage and control risk effectively. The CCG’s

Constitution has been approved by NHS England. In 2016/17 the Governance and Risk

Committee have reviewed the Constitution to ensure it remains fit for purpose for the future

and to take on board the changes for Primary Care Co-Commissioning responsibilities which

came in to effect from 1st April 2017. This work is currently ongoing and will be finalised in

early 2017/18.

The Membership

The CCG is a membership organisation comprising the 30 General Practices in the area of

South Kent Coast (see Members’ Report, page 28) Each Member Practice has signed up to

the Constitution of the CCG which sets out the Vision and Values of South Kent Coast CCG

and has agreed to participate actively in its work. Each Practice is represented by a Practice

Lead, a clinical professional, whose role is to represent the views of their Practice and act on

the Practice’s behalf in respect of matters discussed by the CCG.

During the year, the members were asked to appoint a number of GP Elected Leads to

represent them on the Governing Body and its committees. The members meet as a Clinical

Commissioning Group regularly throughout the year. At the Membership meetings, the

Governing Body accounts to the membership for its implementation of the CCG’s strategy

and takes the members’ views on important issues, including prescribing costs and the future

of primary care in South Kent Coast.

As well as providing strategic direction to the organisation, the members are actively involved

in the activities of the CCG. In addition to the Governing Body members, there are several

local GPs who actively engage with the CCG as clinical leads. They provide clinical

leadership for aspects of the CCG’s commissioning strategy, including (for example) mental

health, primary care and children’s health. It remains the members’ responsibility to approve

the CCG’s strategy and engage with and listen to the perspectives of patients expressed

through the Patient Participation Groups and elsewhere.

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The members have continued to be involved in the development of the CCG’s approach to

the Integrated Accountable Care Organisation (IACO), as part of which four localities have

emerged: Deal, Dover, Folkestone and Hythe and Rural. In each locality, the members are

involved in redesigning services at a local level to ensure that care is wrapped round the

patient.

The Governing Body is tasked by the members with ensuring that the CCG has adequate

arrangements in place to deliver the CCG’s strategic direction, to monitor its performance

and to meet its statutory responsibilities. All Governing Body Members have equal and joint

responsibility for governing the activities of the CCG and in being accountable to the

Membership and the public for the way in which it discharges its functions.

The CCG’s scheme of delegation and Committee Terms of Reference set out the level of

delegation to the Governing Body from the Membership.

The Governing Body met in public 4 times during 2016/17 and at its meetings the Governing

Body:

Reviewed the CCG strategy and approved the operating plan, and the Quality

strategy and plan.

Approved the STP.

Regularly discussed the development of the Integrated Accountable Care

Organisation and the Health and Wellbeing Board.

Provided oversight of Quality and Performance.

Reviewed the constitution and the terms of reference of the body.

Received reports from the Governance and Risk Committee, updates of the financial

position of the CCG, and approved the CCG budget and Internal Audit Plan.

Received and discussed the assurance framework.

The membership of the Governing Body is included in the Members’ Report (see page 28). I

report on their attendance at formal Governing Body meetings below.

49

Attendance of the Governing Body Members at public Governing Body meetings

Name Role Attendance

Alistair Smith Lay Member for Governance 4 out of 4

Aravinth Balachandran (Dr)

GP Member (elected 01 April 2016) 4 out of 4

Chee Mah (Dr) GP Member 4 out of 4

Clive Davison Lay Member for Public & Patient Engagement 4 out of 4

Hazel Carpenter Accountable Officer 3 out of 4

Ian McKenzie (Dr) GP Member 4 out of 4

Joe Chaudhuri (Dr) GP Member (Deputy Clinical Chair) 4 out of 4

Jonathan Bates Chief Finance Officer 4 out of 4

Jonathan Bryant (Dr) Clinical Chair 4 out of 4

Lynne Wright (Dr) GP Member (elected 01 April 2016) 3 out of 4

Qasim Mahmood (Dr) GP Member (elected 01 April 2016) 3 out of 4

Martin Smits Lay Member for Primary Care Co-Commissioning (01 March 2017)

1 out of 1

Sharon Gardner-Blatch Chief Nursing Officer (up to 31 January 2017) 2 out of 3

Stewart Coltart Secondary Care Doctor 3 out of 4

Tuan Nguyen (Dr) GP Member 3 out of 4

UK Corporate Governance Code

The CCG is not required to comply with the UK Code of Corporate Governance. However, I

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

available, especially those aspects of the UK Corporate Governance Code I consider to be

relevant to the clinical commissioning group. During the year, the Governing Body reviewed

how effectively it complied with its statutory responsibilities. The Governance and Risk

Committee had undertaken a review of the CCG’s governance in 2015/16 using the Good

Governance Institute Toolkit and followed up with a more detailed review in two specific

areas in 2016/17, reviewing decision-making and improving reporting to the CCG, in order to

ensure the CCG’s governance arrangements remain strong.

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Discharge of Statutory Functions

As the Accountable Officer, I certify that the CCG has complied with the statutory duties laid

down by the NHS Act 2006 (as amended by the Health and Social Care Act 2012). The CCG

has specific statutory duties which it must meet, set out in NHS Act 2006 as amended –

sections 14Z15 (2) (a) and (b) -- which it must discharge. These include:

a requirement to improve services. As Accountable Officer, I report on how we have

done this through setting the priorities in our strategy, through our commissioning

contracts and through monitoring performance against targets,

a requirement to reduce inequalities: in our strategy we have prioritised those issues

which will improve the health outcomes of the most vulnerable and deprived in South

Kent Coast,

a requirement to involve the public and consult on proposed changes to service

delivery: we have done this through our public engagement activities.

a requirement to contribute to the joint Health and Wellbeing strategy – we have

worked with the Kent Health and Wellbeing Board and the local South Kent Coast

Health and Wellbeing Board to help achieve this.

During establishment, the arrangements put in place by the clinical commissioning group and

explained within the Corporate Governance Framework were developed with extensive

expert external legal input, to ensure compliance with the all relevant legislation. That legal

advice also informed the matters reserved for Membership Body and Governing Body

decision and the scheme of delegation.

The clinical commissioning group has reviewed all of the statutory duties and powers

conferred on it by the National Health Service Act 2006 (as amended) and other associated

legislative and regulations. As a result, I can confirm that the clinical commissioning group is

clear about the legislative requirements associated with each of the statutory functions for

which it is responsible, including any restrictions on delegation of those functions.

Responsibility for each duty and power has been clearly allocated to a lead staff member.

Leaders of the CCG’s teams have confirmed that their structures provide the necessary

capability and capacity to undertake all of the clinical commissioning group’s statutory duties.

51

Risk management arrangements and effectiveness

Risk Strategy

The purpose of the CCG’s Managing Risk Policy is to enable the CCG to have a clear view of

the risks affecting each strand of its activity and how they should be managed. South Kent

Coast CCG recognises that managing risks within the business is critical to being a well-

governed and effective organisation. Key to this is the ability to identify and manage those

risks which might prevent the CCG from achieving its strategic objectives.

CCG and clinical leads help to identify risks in relation to their area of work. They will help to

assess the initial risk, design mitigating actions and ensure the risk is appropriately managed.

The most significant clinical risks are regularly reviewed by the Quality, Performance and

Delivery Committee through the use of both the risk register and the Integrated Quality and

Performance Report. The risks seen to be the greatest are reviewed by the executive team,

presented to the Governance and Risk Committee and ultimately the Governing Body. The

Governance and Risk Committee is responsible for providing assurance to the Governing

Body on the effectiveness of risk management within the CCG. However, overall

responsibility for managing risks and assurance continues to lie with the Governing Body

who reviews the CCGs corporate or high risks on a quarterly basis.

Risks are identified as part of any development work relating to projects or initiatives. Clinical

Leads and staff are expected to identify and record these risks, to assess them and to agree

the mitigations, and to record them on the risk register. The Risk and Assurance Manager,

works with the Clinical Leads and staff to update the risk register on a monthly basis.

“Corporate risks”, that is those assessed as most critical to the CCG, are reported to the

Committees and Governing Body as set out above.

The CCG has policies and processes in place to prevent certain risks emerging in the first

place, for example through its counter fraud policy, its bribery policy and its statement of

standards of business conduct. The CCG’s whistleblowing policy provides an opportunity for

anyone who has a concern about the conduct of the CCG to raise a concern without fear of

repercussions. All committee members are required to declare any conflicts of interest at the

start of each meeting. The CCG provides training on its policies and the Counter Fraud

specialist from the Internal Auditors, regularly reports to the Governance and Risk

Committee.

52

Capacity to Handle Risk

Risk awareness is the responsibility of all members of the Governing Body and of all staff,

particularly the senior team. The Risk Management Policy sets out the responsibilities for

managing risk. To ensure that all staff and Governing Body Members are aware of how to

manage risk, a workshop is scheduled each year to provide training on the risk register.

Risk Assessment

During the course of this year the CCG has focused on making the risk register a more

integral part of its day to day activity. Every risk on the register should have a direct impact

on one of the businesses strategic objectives and as such must be reduced in order for the

CCG to perform at its best. To ensure accountability for all risks and consistency in ratings

across East Kent, the Governance and Risk Manager along with Risk and Assurance

Support have reviewed the directorates as they previously were and implemented a

restructure in line with the East Kent Federation Work Programme.

All risks are rated in terms of the likelihood of their occurrence and their impact using the 5x5

matrix; they are reassessed once the mitigating actions have been identified, leaving the risk

score showing the residual risk level to the CCG. A decision is made as to whether the risk

can be tolerated or must be treated. If it is to be treated, additional mitigating actions are

identified and monitored so that the risk level can be reduced to a tolerable level.

In discussing its appetite for risk, the CCG Governing Body has stated that it has no

tolerance for risks where patient safety is an issue, where the ongoing financial viability of the

CCG is an issue, or where the CCG’s compliance with the law may be adversely affected.

The level of risk which can be tolerated in delivering its strategic objectives does vary; for

example, the Governing Body is willing to accept a level of risk to promote innovation or

where long-term benefits outweigh short term risks; but the CCG scrutinises the level of risk

regularly and will challenge whether the risk has reduced or why it has remained at the same

level for some time.

To help the CCG manage risks, the CCG values the contributions of local people. The CCG

monitors complaints made by the public about its services and those of the local providers.

Through its monitoring of complaints SKC CCG has been able to recognise that there is a

concern surrounding the out of hours services available. The CCG is currently working with a

new provider managing 111, care navigation and GP out of hours services and through

mobilisation and monitoring of this service the CCG will be able to identify any further

mitigating action that is required.

53

The public is able to ask questions and alert the CCG to any risks at the Health Reference

Group and at the Governing Body meetings.

The most significant risks identified by the CCG during 2016/17 were:

RISK CCG RESPONSE

The CCG has reduced assurance around

meeting its’ constitutional targets surrounding

RTT.

A series of trajectory check points have been

agreed in Jan/Feb 2017 to facilitate monitoring

of progress towards sustained achievement of

the RTT trajectory.

The CCG does not have an adequate process

in place for the compliance of legal

requirements in relation to 16-17 year old care

leavers, leading to possible breaches of

statutory targets.

A multi-agency pathway has been developed to

encompass statutory requirements. Additional

funding has been awarded by NHS England to

support increased work load and improve

compliance with statutory requirements.

The development of the IACO may be

prevented should key providers not continue to

engage.

The AO for SKC CCG is continuing to liaise with

CEO’s from providers to address the challenges

and concerns raised to ensure the

transformation agenda continues to progress.

The CCG does not have assurance that

SECAmb are able to meet its statutory

requirements.

Revised trajectories were agreed by SECAmb,

Kent, Surrey and Sussex CCGs, NHS England

and NHS Improvement with effect from October

2016. Continued monitoring of trajectories to

ensure SKC CCG are meeting targets.

The CCG has improved its analysis of risk and its impact and I expect this to continue in the

next year. During 2016/17, steps have been taken to ensure that all Board Members and

staff are aware of how the CCG defines risk and that risk is properly assessed and managed.

The CCG discusses partner/provider risks at performance meetings and when negotiating

agreements such as s75 agreements.

Other sources of assurance

Internal Control Framework

A system of internal control is the set of processes and procedures in place in the clinical

commissioning group to ensure it delivers its policies, aims and objectives. It is designed to

identify and prioritise the risks, to evaluate the likelihood of those risks being realised and the

impact should they be realised, and to manage them efficiently, effectively and economically.

54

The system of internal control allows risk to be managed to a reasonable level rather than

eliminating all risk; it can therefore only provide reasonable and not absolute assurance of

effectiveness.

The CCG’s system of internal control is a significant part of the assurance framework and is

designed to manage risk at a reasonable level. This is particularly important as a number of

risks which might undermine the CCG’s delivery of its plans are “owned” by providers of

services, not directly by the CCG. The Assurance Framework records the primary risks to the

ongoing viability of the CCG: the risk of not delivering its strategic objectives, not meeting its

financial targets, not delivering the CCG’s statutory requirements, not commissioning safe

services, not maintaining its authorisation, and not maintaining the support of the CCG

membership and the public. The Assurance Framework evaluates the strength of the internal

controls in preventing the risk materialising and identifies gaps in assurance.

The Assurance Framework has been used by the Governing Body to hear from and

challenge the Clinical Leads about progress in delivering the objective for which they are the

accountable lead. The Assurance Framework is also monitored by the Governance and Risk

Committee, the Quality Performance and Delivery Committee and the Governing Body.

Impact Assessments, including Equality Impact Assessments and Privacy Impact

Assessments, help the Governing Body identify risks which might disproportionately affect

various members of the community. Policies and business cases are expected to be

presented to the Committee and Governing Body with an appropriate Impact Assessment,

particularly an Equality Impact Assessment, to help with identification of risk. The strategies

developed by the CCG in partnership, for example the Kent Health and Wellbeing Board’s

Emotional Wellbeing Strategy, also have an Equality Impact Assessment.

The CCG’s policies relating to standards of business conduct make explicit the CCG’s

expectation that all members and staff will behave in an ethical manner. Internal audit plays a

key role in monitoring the effectiveness of the CCG’s internal control framework, and has

undertaken reviews of critical financial systems, governance processes, and information

governance. The Counter Fraud officer also reviews the effectiveness of the CCG’s

procedures in preventing and identifying fraud.

The Members’ Report contains statements about the CCG’s compliance with a number of

statutory duties which I have reviewed and which I confirm are correct.

Annual audit of conflicts of interest management

The revised statutory guidance on managing conflicts of interest for CCGs (published June

2016) requires CCGs to undertake an annual internal audit of conflicts of interest

55

management. To support CCGs to undertake this task, NHS England has published a

template audit framework.

Internal Audit has completed their annual audit of Conflict of Interests noting that South Kent

Coast achieved reasonable assurance. South Kent Coast CCG has further completed their

annual assessment on Conflicts of Interest which has been submitted demonstrating

compliance with NHS England’s 2016 statutory requirements.

Data Quality

The CCG has a contract with South East Commissioning Support Unit (SECSU) to validate

the data it uses. The CCG’s Quality and Performance teams have worked together to review

the Integrated Quality Performance Report (IQPR) to develop it into a more effective

document in order to:

Strengthen the quality of the detailed information.

Better integration of project, finance and medicines management information.

Integration with new reporting requirements for localities

Improved analysis and triangulation of the data.

Provide better focus to Membership Body and Governing Body (GB) on key issues, with

particular emphasis on decisions that may need to be taken.

Introduction of a more concise report for Governing Body.

By reducing the volume of data reported to the GB it will provide opportunities to link GB

performance reporting to the delivery of strategic objectives, organisational and operational

plans and projects designed to improve patient outcomes. This will enhance current

governance systems and provide the GB with more meaningful information with which to

direct the business of the CCG as it would be based on quality as well as quantity.

The Project Delivery Dashboards and the Delivery Report will be used to support the revised

process.

Information Governance

The NHS Information Governance Framework sets the processes and procedures by which

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

identifiable information. The NHS Information Governance Framework is supported by an

information governance toolkit and the annual submission process provides assurances to

the clinical commissioning group, other organisations and to individuals that personal

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

governance submission for 2016/17 was published on 31 March 2017 through NHS Digital

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demonstrating Level 2 compliance in all areas.

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 developing / have developed

information governance processes and procedures in line with the information governance

toolkit. 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.

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

incidents. We are developing information risk assessment and management procedures

and a programme will be established to fully embed an information risk culture throughout

the organisation against identified risks.

Business Critical Models

The CCG has in hand a number of key projects which would fall under the heading of

“business critical models” in accordance with the McPherson report, including development of

strategies and policies (for example, for children and mental health services), projects such as

the implementation of the Integrated Accountable Care Organisation model and development

of the East Kent Strategy which relies on robust modelling of capacity.

The CCG has put in place Quality Assurance (QA) arrangements which comply with the

McPherson report to monitor these developments to ensure proper control. These include

having a Senior Responsible Owner (SRO) who oversees each main project and signs it off;

external peer review; use of internal audit to check progress; scrutiny by project boards and by

independent members of the Governance and Risk Committee, and gateway reviews where

appropriate. The CCG uses checklists such as Equality Impact Assessments and a

programme dashboard to monitor progress. The model SRO is content that the QA process is

compliant and appropriate, model risks are understood by users of the model and the use of

the model outputs are appropriate.

Third party assurances

The CCG assures the activity of the providers it uses whether clinically for services

purchased on behalf of the NHS or for goods and services through use of NHS Standard

Contracts the terms of which are enforced through the CCG quality and performance teams.

Control Issues

No significant control issues have been identified.

57

Review of economy, efficiency & effectiveness of the use of

resources

The majority of expenditure of the CCG is managed through contracts with providers, based

on NHS Standard Contract Terms. These contracts are drafted to ensure that value-for-

money is at the core of service delivery to the patients of the area. During the year the

Governing Body has worked hard to improve patient pathways for the delivery of care to our

population. This work has been based on driving improved care at the same or lower cost.

During the year the CCG delivered QIPP savings of £9.08m.

Value-for-money has been reviewed by the Governance and Risk Committee of the CCG

which has looked in detail at specific areas of service delivery. In addition, our external

auditors have reviewed value-for-money and reported on this within the financial statements.

Internal Audit has also carried out work which has allowed the CCG to increase economy,

efficiency and effectiveness.

Counter fraud arrangements

TIAA the providers of the internal audit service to the CCG also provide the counter fraud

service, which includes training presentations to staff and investigations at the behest of the

CCG. The arrangements allow for:

An Accredited Counter Fraud Specialist is contracted to undertake counter fraud work

proportionate to identified risks.

The CCG Governance and Risk Committee receive a report against each of the

Standards for Commissioners at least annually. There is executive support and

direction for a proportionate proactive work plan to address identified risks.

A member of the executive board is proactively and demonstrably responsible for

tackling fraud, bribery and corruption.

Appropriate action is taken regarding any NHS Protect quality assurance

recommendations.

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Head of Internal Audit Opinion

The purpose of my annual HoIA Opinion is to contribute to the assurances available to the

Accountable Officer and the Governing Body which underpin the Governing Body’s own

assessment of the effectiveness of the organisation’s system of internal control. This Opinion

will in turn assist the Governing Body in the completion of its AGS.

The CCG has delivered a year-end surplus of £2.8m, in line with the original CCG plan of

£2.8m surplus agreed with NHS England.

My opinion on the organisation’s system of internal control has taken this factor into account.

My opinion is set out as follows:

1. Overall opinion;

2. Basis for the opinion; and

3. Commentary.

Overall Opinion

My overall opinion is that Reasonable assurance can be given that there is a generally

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

controls are generally being applied consistently. However, some weakness in the design

and/or inconsistent application of controls, put the achievement of particular objectives at

risk.

Basis of Opinion

The basis for forming my opinion is as follows:

1. An assessment of the design and operation of the underpinning Assurance

Framework and supporting processes; and

2. An assessment of the range of individual opinions arising from risk-based audit

assignments, contained within internal audit risk-based plans that have been

reported throughout the year. This assessment has taken account of the relative

materiality of these areas and management’s progress in respect of addressing

control weaknesses.

3. Commentary: The CCG has received substantial assurance on the core area of IG

Toolkit and also received reasonable assurance on HR follow up, Assurance

Framework and Core Financial Assurance. One review on Variation in GP Services

received a limited opinion but is planned for a follow up in 2017/18 and this, together

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with not achieving its control total contributes to the overall reasonable assurance

assessment.

Assurance Assessments 2016/17

System Substantial

Assurance

Reasonable

Assurance

Limited

Assurance

No

Assurance

Continuing Healthcare Placements

Assurance Framework Phase 1

Assurance Framework Phase 1

IT Satisfaction Survey

Information Governance Toolkit

Variation in GP Services

Conflicts of Interest

HR Follow Up

Financial Recovery Plan

Critical Financial Assurance

Contract Management

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Review of the effectiveness of governance, risk

management and internal control

As Accountable Officer I have responsibility for reviewing the effectiveness of the system of

internal control within the clinical commissioning group, including our hosting arrangements.

Risk awareness is the responsibility of all members of the Governing Body and of all staff,

particularly the senior team. The Risk Management Policy sets out the responsibilities for

managing risk. To ensure that all staff and Governing Body Members are aware of how to

manage risk, a workshop is scheduled each year to provide training on the risk register.

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

internal auditors, who have provided significant assurance that the governance and financial

controls are effective. Feedback from them also confirmed that the CCG was diligent in

implementing any recommendations in a timely fashion. My review is also informed by

comments made by the external auditors in their management letter and other reports.

I am also informed by the Governing Body, the Executive Team and Clinical Leads within the

CCG who have responsibility for the development and maintenance of risk management and

the internal control framework. I have drawn on performance information available to me,

which is also reviewed by the Quality, Performance and Delivery Committee on a monthly

basis. I am also informed by the Governance and Risk Committee whose members provide

rigorous challenge to the way in which the CCG conducts its business.

My review is also informed by comments made by the external auditors in their annual audit

letter and other reports.

Our assurance framework provides me with evidence that the effectiveness of controls that

manage risks to the clinical commissioning group achieving its principles objectives have

been reviewed.

I have been further advised on the implications of the result of this review by:

The Governing Body

The Governance and Risk Committee

Internal audit

Other explicit review/assurance mechanisms.

61

Hazel Carpenter

Chief Accountable Officer

25 May 2017

Conclusion

No significant control issues have been identified.

62

Biographies

South Kent Coast CCG Governing Body

Dr Jonathan Bryant, Clinical Chair

Dr Jonathan Bryant qualified from Guy’s, King’s and St Thomas’ School of Medicine in 2005.

His first job after becoming a doctor was at the William Harvey Hospital and he has stayed in

the area ever since. His postgraduate training as a GP was completed spending time

working in each of the three hospitals in east Kent as well as a year working in Canterbury

as a GP. Currently Jonathan works at New Lyminge Surgery, where he has been since

2010, and is finding work as a rural GP particularly rewarding. He has been accepted into

the local community and is no longer called 'the new doctor'! Motivated by a desire to

positively influence the change the NHS is going through, and a belief that the only option to

get good outcomes for patients is to become engaged with the process, Jonathan has

become more involved with the CCG over the past two years. This culminated with an

appointment to the Governing Body in June 2014 and to his subsequent election as Clinical

Chair in April 2016. He is finding the process of clinical commissioning a "whole new world"

but is relishing the challenge of making things better for patients. Jonathan works with his

wife Hannah, also a GP, and they live in Canterbury with their three sons.

Hazel Carpenter, Accountable Officer

Hazel Carpenter is the Accountable Office for both Thanet CCG and South Kent Coast CCG.

As a non-clinician, she sees her role as that of supporting the Clinical Chairs in their

leadership role, ensuring that the Governing Bodies are able to make strong commissioning

decisions for their local populations. Hazel joined the CCGs prior to their authorisation in

2013. She has a keen interest in Organisation Design and Development and has worked with

the Clinical Chairs and membership to develop a culture and approach for each CCG that

focuses on the local health and care challenges, as well as enabling real integrity for the

clinical leadership and membership characteristics of a CCG. Hazel leads Looked After

Children (LAC) and Adoption health commissioning on behalf of all the CCGs in Kent. Prior

63

to this role, Hazel has worked across the NHS in Surrey and Kent in both provider and

commissioning roles focusing on workforce and organizational development. She also led

commissioning for maternity services across east Kent from 2007 to 2011. Educated at

Leicester University and Manchester University, Hazel has a BA in Geography – which is

invaluable as a strong background for health planning- and an MSc in strategic HR

leadership. With Dr Darren Cocker, former Clinical Chair for SKC, she was awarded the post

graduate deans GP education award in 2010 for establishing the GP Integrated Training

Programme for commissioning.

Dr Chee Mah, GP Member

Dr Chee Mah has been a GP at the Balmoral Surgery, Walmer, Deal, since 2006. He is the

CCG lead for urgent care and medicines management. He also has an interest in

gynaecology. Chee has been actively involved in practice-based commissioning for a number

of years, holding the post of Clinical Commissioner in Women’s Health in 2009 for the PCT.

Dr Mah moved to Kent in 2004 after studying at the National University of Malaysia, where he

completed his housemanship and postgraduate training in gynaecology. Chee is a member

of the Royal College of General Practitioners and the Royal College of Obstetricians and

Gynaecologists.

Dr Ian Mckenzie, GP Member

Dr McKenzie has been a GP at Pencester Surgery, Dover, since 2006. He is the planned

care lead. Ian is a GP with special interests in headache, Ear, Nose and Throat (ENT) and

minor surgery. He was previously a clinical commissioner responsible for gastroenterology

with NHS Eastern and Coastal Kent Primary Care Trust. He trained in medicine at the

University of Auckland Medical School, before moving into the Royal Air Force in 1983 to

develop a career in aviation medicine. He became a consultant in aviation medicine after

receiving a PhD in cardiovascular physiology from Imperial College. He was appointed Head

of Biomechanics Division at the Royal Air Force Institute of Aviation Medicine. In 1996, he

retrained as a GP and moved to Kent two years later to join a private sector organisation as a

drug clinician.

64

Dr Stewart Coltart, Secondary Care Doctor

Dr Stewart Coltart is a trained consultant oncologist. He is the CCG’s secondary care doctor

representative. Dr Coltart worked as a consultant oncologist at three hospitals in east Kent

between 1988 and early 2013 prior to his retirement. During this time, his main clinical

interests were the management of lymphomas, breast, head and neck and skin cancers.

Stewart trained at St Bartholomew’s Hospital, qualifying in 1976. After general medical

training in Norwich, Cambridge and Southampton, he trained in oncology at Cambridge for

five years and was also a Medical Research Council Training Fellow. He then moved to

Cardiff as a Senior Registrar. Dr Coltart was the divisional director for Maidstone and

Tunbridge Wells NHS Trust’s Cancer and Support Services division between 2008 and 2012.

He was a trustee of the Pilgrim’s Hospice from 1992 to 2008. Stewart is married with four

children and spends his spare time sailing and singing in local choral societies and chamber

choirs.

Dr Tuan Nguyen, GP Member

Dr Tuan Nguyen has been working at Sandgate Road Surgery since 2011 as a GP partner

and during this time has been involved in the role out of risk stratification and Multi-

Disciplinary Team-based case management. With the support of his fellow partners, Tuan

has been able to continue an interest in primary care redevelopment and feels the CCG has

an opportunity to start laying the foundation and building the infrastructure required to take on

the extra reliance on primary care by the NHS, as it looks to shift more work into the

community. After GP training, Tuan worked for Care UK as a salaried GP in their APMS

practice in Liverpool where he was tasked with improving quality of 3 local failing inner city

GP practices. Tuan was successful in instituting significant changes in working practice

which was reflected in achieving targets set by the PCT and was then made the area lead

GP for Care UK, covering the North West. From his experience, Tuan developed Pro-Active

Care in order to offer a complete holistic service to those individuals and families at most risk

of hospitalisation. This was subsequently taken up by the local PBC group and a successful

pilot was started. Tuan was then subsequently invited onto the PBC board; a role from which

he stepped down from when he decided to relocate.

65

Dr Lynne Wright, GP Member

I trained at Liverpool Medical School and moved to Kent in 1989 for a six-month attachment

in A&E at Medway Hospital and have stayed! I have worked at Lydden (formerly River)

surgery for 17 years having previously worked as a locum in Dover. The future of the NHS is

uncertain, and primary care as we have always known it will disappear. I feel as GPs we

need to ensure that we are part of developing the future, supporting practices and patients

and finding new ways of working. I am married, live in Dover and have three grown-up

children.

Dr Aravinth Balachandran, GP Member

Dr Balachandran graduated from the University College London Medical School in 2002 and

subsequently underwent four years’ training in an acute hospital setting before qualifying as

a GP in 2008. His first substantive post was in 2010 in which he was the lead GP for a start-

up walk-in centre in London that provided services for around 30,000 patients annually. He

then relocated to Hythe in 2013 and took up his current role as GP Partner at Oaklands

Health Centre in 2014. He feels passionate in developing innovative and efficient ways of

working. In addition to his governing body role, Dr Balachandran is currently medical director

for WebGP, overseeing development of their online consultation product eConsult.

Dr Joe Chaudhuri, GP Member

Dr Joe Chaudhuri has been a GP at The High Street Surgery, Dover, for more than 30 years.

He is a member of South Kent Coast CCG’s governing body and is assistant clinical chair.

He holds the portfolios for health and wellbeing boards, partnership working, mental health

and long-term conditions. He is also chair of South Kent Coast CCG’s clinical strategy group.

Dr Chaudhuri works for the local mental health trust once a week in adult mental health and

66

he has clinical interests in mental health and medicines management. Joe has been involved

in health service management for more than a decade, from the days of health authorities to

primary care groups and then primary care trusts. His involvement was in clinical governance

and medicines management. He feels passionately about involving partner organisations in

the future delivery and commissioning of health and doing things differently to develop a

sustainable system for the future. In his spare time he enjoys sports and world music.

Dr Qasim Mahmood, GP Member

Dr Qasim Mahmood graduated from Allama Iqbal Medical College, Lahore Pakistan. He

moved to UK in 2003 and started his medical career from Grimsby and eventually settled in

Canterbury in 2006. He completed his medical and GP training in East Kent Hospitals trust

and qualified as GP in 2012. Before becoming a GP he worked as a Medical Registrar in

Stroke medicine and Emergency medicine in East Kent Hospitals University Foundation

Trust.

Dr Mahmood has been working at Hawkinge and Elham Valley practice as a GP Partner

since 2015. He has a special interest in Cardiology, Stroke medicine and Medical Education

and training. He has extensive knowledge and experience of the local health services and is

keen to improve the health care of his patients with a passion to contribute positively in

rapidly evolving NHS. He feels that NHS is under immense pressure at the moment and we

can only survive if we adopt new modern ways of working where various health services

work in an integrated manner to produce an effective, reliable and safe service for our

patients.

He is a clinical Governing Body member of South Kent Coast CCG and Cardiovascular lead

for this area. In his spare time he likes to watch and play cricket and actively involved with

local cricket club.

67

Sharon Gardner-Blatch, Chief Nursing Officer (until 31 January 2017)

Sharon has nursed in the NHS for the past 25 years within London and the South East of

England. She has experience of nursing in hospitals including intensive care and out of

hospital care. She is passionate about and committed to supporting the total care of patients

in partnership with their families / carers. Over the last ten years, Sharon has been

committed to driving up standards to achieve high quality patient care which protects patients

from avoidable harm. Since moving into commissioning she has been involved in holding

NHS organisations to account for their quality of service delivery, service standards and

safeguarding of patients

Jonathan Bates, Chief Finance Officer

Jonathan is Chief Finance Officer for NHS South Kent Coast and Thanet CCGs. He is a

chartered accountant who started his career in the City, auditing large firms and City

institutions. After a spell working freelance for the Audit Commission he joined the London

Borough of Bromley with responsibility for the schools and colleges finances. Jonathan joined

the NHS in 1995 as Deputy Director of Finance at Maidstone Hospital, and in 2002 he

became Director of Finance for Ashford PCT. After a short period as Director of Finance for

Swale PCT he joined Medway PCT as Director of Finance and Assurance. In 2012 he was

appointed to the Kent and Medway PCT Cluster Board. Jonathan is the author of three books

on public sector finance and management.

Clive Davison, Lay Member for Public and Patient

Involvement

Clive Davison qualified as a Public Health Inspector in 1976 and for twenty years he worked

in local government alongside local communities providing public health services with the

focus on reducing inequalities in health and improving the quality of life. In 1986 Clive took

up a directorship in a private company providing advice to organisations on quality assurance

68

and people development. Some years later Clive returned to local government as a Chief

Environmental Health Officer to manage a public protection service. Following retirement last

year and wanting to continue to be involved in the field of health Clive took up the post of Lay

Member for Patient and Public Involvement with the South Kent Coast CCG. Clive has one

daughter currently at Durham University who is also an amateur ballet dancer. Clive's main

leisure interest is similar to his daughter in that it is dancing; only his dance is the Argentine

tango.

Alistair Smith, Lay Member for Governance

Alistair is the CCG’s lay member for governance. He has a lead role for the CCG in

overseeing key elements of governance. Alistair started his career with the National Audit

Office and he has held board level finance roles with multinational companies and was the

Chairman of Trustees for two large pension schemes. He is now an independent consultant

and finance director for two small companies based in the UK and France. Alistair is keen to

ensure that public funds are used to the benefit of the population and that appropriate

finance, risk and assurance systems are in place to make sure that the member practices,

the NHS Commissioning Board and, most importantly, the public, have confidence in the

governance of the new organisation.

Martin Smits, Lay Member for the Primary Care

Commissioning Committee

Martin trained as a nurse in London following completion of a degree in Geology and

Economics. He took up his first Director of Nursing job in 1990, working in Brighton followed

by directorships in Worthing, Eastbourne and Poole before retiring in 2014. He has two

research masters degrees.

Martin was appointed as Lay Member for Primary Care Governance at the High Weald,

Lewes and Havens Clinical Commissioning Group in July 2016 and became the Lay

Member for the Primary Care Commissioning Committee at the South Kent Coast Clinical

Commissioning Group in March 2017.

69

Martin has considerable board level experience and has led Trusts through regulatory

scrutiny achieving compliance and regulatory plaudits. He has worked successfully on

several “turnaround” projects. After he retired he set up his own consultancy business and

has helped NHS organisations undertake clinical service reviews, investigations of whistle

blowing concerns and serious complaints.

Martin is married with five children and is on the leadership team of his local church and a

member of the local Deanery Synod.

Senior Staff Members

Karen Benbow, Chief Operating Officer

Karen has over 20 years’ experience working in the NHS and has held a wide range of

senior commissioning, contracting and assurance roles in London and East Kent.

Sue Martin, Company Secretary (until 31 January 2017)

Sue Martin joined the CCG as Head of Governance in January 2014. She has worked in the

public and not-for-profit sector throughout her career and her most recent position being with

the Care Quality Commission (CQC). Sue is a chartered secretary and has many years’

experience of supporting Boards.

[Note: Interim Company Secretary, Helen Robinson covered 23 January – 31 March 2017]

70

Remuneration and Staff Report

Remuneration Report

Remuneration Committee

The remuneration committee is made up of the following board members:

Name Role

Alistair Smith Lay Member for Governance

Clive Davison Lay Member for Public and Patient Engagement

Jonathan Bryant (Dr) Clinical Chair

Stewart Coltart Secondary Care Doctor

Policy on the Remuneration of Senior Managers

South Kent Coast CCG has in place a remuneration policy which is reviewed and approved

by the remuneration and nominations committee who meet twice a year.

71

Senior manager remuneration (including salary and pension entitlements)

The accountable officer, chief finance officer and chief nursing officer work across both

South Kent Coast CCG and Thanet CCG. Their salaries are split between the CCGs on a

50:50 split and both net and gross costs are shown below.

Name and Title

Net Cost to SKC CCG 2016/17

(a) (b) (c) (d) (e) (f)

Salary Expense payments (taxable)

Performance pay and bonuses

Long term performance

pay and bonuses (bands of

£5,000)

All pension-related

benefits

TOTAL

(bands of £5,000)

to nearest £100

(bands of £5,000)

(bands of £2,500)

(a to e)

(bands of £5,000)

£'000 £'00 £'000 £'000 £'000 £'000

Hazel Carpenter - Accountable Officer

55-60 1 0 0 12.5-15 65-70

Jonathan Bates - Chief Finance Officer

50-55 1 0 0 7.5-10 55-60

Sharon Gardner-Blatch - Chief Nursing Officer (01/04/16 - 31/01/17)

30-35 2 0 0 25-27.5 55-60

Dr Jonathan Bryant - Clinical Chair

100-105 0 0 0 15-17.5 115-120

Dr Chee Mah - Governing Body Elected GP Member

50-55 1 0 0 10-12.5 60-65

Dr Ian McKenzie - Governing Body Elected GP Member

25-30 0 0 0 0 25-30

Dr Brighton Chireka - Governing Body Elected GP Member (01/04/016-30/09/16)

15-20 0 0 0 32.5-35 50-55

Dr Joe Chaudhuri - Governing Body Elected GP Member

50-55 0 0 0 0 50-55

Dr Lynne Wright - Governing Body Elected GP Member

45-50 0 0 0 0 45-50

Dr Qasim Mahmood - Governing Body Elected GP Member

25-30 0 0 0 0-2.5 25-30

72

Dr Aravinth Balachandran - Governing Body Elected GP Member

25-30 0 0 0 172.5-175 195-200

Dr Tuan Nguyen - Governing Body Elected GP Member

50-55 0 0 0 0 50-55

Alistair Smith - Lay Member (Governance)

10-15 3 0 0 0 10-15

Martin Smits - Lay Member for the Primary Care Commissioning Committee

0-5 0 0 0 0 0-5

Clive Davison - Lay Member (Patient and Public Engagement)

10-15 0 0 0 0 10-15

Dr Robert Coltart - Secondary Care Doctor

20-25 1 0 0 0 20-25

Name and Title

Gross Cost to SKC CCG 2016/17

(a) (b) (c) (d) (e) (f)

Salary Expense payments (taxable)

Performance pay and bonuses

Long term performance

pay and bonuses (bands of

£5,000)

All pension-related

benefits

TOTAL

(bands of £5,000)

to nearest £100

(bands of £5,000)

(bands of £2,500)

(a to e)

(bands of

£5,000)

£'000 £'00 £'000 £'000 £'000 £'000

Hazel Carpenter - Accountable Officer

110-115 2 0 0 25-27.5 135-140

Jonathan Bates - Chief Finance Officer

100-105 1 0 0 15-17.5 115-120

Sharon Gardner-Blatch - Chief Nursing Officer (01/04/16 - 31/01/17)

65-70 4 0 0 50-52.5 115-120

Please note that the figures shown in ‘All Pension Related Benefits’ are an estimate of the

increase in pension should it be paid over 20 years of life from retirement. If there is no

benefit then a zero is shown.

73

Pension Benefits: Comparison with Previous Year 2015/16

Net Cost to South Kent Coast CCG 2015-16

Name and Title

(a) (b) (c) (d) (e) (f)

Salary (bands of £5,000)

Expense payments (taxable) (band of

£100)

Performance Pay and Bonus

Payments (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 £'00 £'000 £'000 £'000 £'000

Hazel Carpenter - Accountable Officer

55-60 1 0 0 7.5-10 60-65

Jonathan Bates - Chief Finance Officer

50-55 0 0 0 2.5-5 55-60

Sharon Gardner-Blatch - Chief Nursing Officer

40-45 0 0 0 10-12.5 50-55

Dr Darren Cocker - Clinical Chair

70-75 0 0 0 0 70-75

Dr Chee Mah - Governing Body Elected GP Member

50-55 2 0 0 0 50-55

Dr Ian McKenzie - Governing Body Elected GP Member

20-25 0 0 0 0 20-25

Dr Brighton Chireka - Governing Body Elected GP Member

50-55 0 0 0 7.5-10 60-65

Dr Joe Chaudhuri - Governing Body Elected GP Member

50-55 0 0 0 0 50-55

Dr Jonathan Bryant - Governing Body Elected GP Member

50-55 0 0 0 22.5-25 75-80

Dr Tuan Nguyen - Governing Body Elected GP Member

50-55 0 0 0 0 50-55

Alistair Smith - Lay Member (Governance)

10-15 2 0 0 0 10-15

Brian Wash - Lay Member (Patient and Public Engagement) (01/04/2015 - 30/04/2015)

0-5 0 0 0 0 0-5

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Clive Davison - Lay Member (Patient and Public Engagement) (29/04/15 - 31/03/2016)

10-15 0 0 0 0 10-15

Dr Robert Coltart - Secondary Care Doctor

20-25 1 0 0 0 20-25

Gross Cost to South Coast Kent CCG 2015-16

Name and Title

(a) (b) (c) (d) (e) (f)

Salary (bands of £5,000)

Expense payments (taxable) (band of

£100)

Performance Pay and Bonus

Payments (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 £'00 £'000 £'000 £'000 £'000

Hazel Carpenter - Accountable Officer

110-115 01-Feb 0 0 15-17.5 125-130

Jonathan Bates - Chief Finance Officer

100-105 0 0 0 7.5-10 115-120

Sharon Gardner-Blatch - Chief Nursing Officer

80-85 0-1 0 0 22.5-25 105-110

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Pension benefits as at 31 March 2017

Name and Title

(a) (b) (c) (d)

Real increase in pension at pension age

Real increase in pension

lump sum at pension age

Total accrued pension at

pension age at 31 March 2017

Lump sum at pension age

related to accrued

pension at 31 March 2017

(bands of £2,500)

(bands of £2,500)

(bands of £5,000)

(bands of £5,000)

£0 £0 £0 £0

Hazel Carpenter - Accountable Officer 0-2.5 0 35-40 100-105

Jonathan Bates - Chief Finance Officer 0-2.5 2.5-5 25-30 80-85

Sharon Gardner-Blatch - Chief Nursing Officer 2.5-5 2.5-5 20-25 55-60

Dr Jonathan Bryant - Clinical Chair 2.5-5 7.5-10 10-15 25-30

Dr Chee Mah - Governing Body Elected GP Member

0-2.5 0 5-10 20-25

Dr Brighton Chireka - Governing Body Elected GP Member

0-2.5 2.5-5 5-10 20-25

Dr Lynne Wright - Governing Body Elected GP Member

0 0 5-10 20-25

Dr Qasim Mamood - Governing Body Elected GP Member

0-2.5 0 0-5 0

Dr Aravinth Balachandran - Governing Body Elected GP Member

7.5-10 20-22.5 0-5 5-10

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Name and Title

(e) (f) (g) (h)

Cash Equivalent

Transfer Value at 1 April 2016

Real Increase in Cash

Equivalent Transfer Value

Cash Equivalent

Transfer Value at 31 March

2017

Employers Contribution to

partnership pension

£0 £0 £0 £0

Hazel Carpenter - Accountable Officer 569 38 606 N/A

Jonathan Bates - Chief Finance Officer 575 45 620 N/A

Sharon Gardner-Blatch - Chief Nursing Officer

329 66 395 N/A

Dr Jonathan Bryant - Clinical Chair 115 50 165 N/A

Dr Chee Mah - Governing Body Elected GP Member

117 15 132 N/A

Dr Brighton Chireka - Governing Body Elected GP Member

120 32 153 N/A

Dr Lynne Wright - Governing Body Elected GP Member

164 - 7 157 N/A

Dr Qasim Mamood - Governing Body Elected GP Member

27 1 28 N/A

Dr Aravinth Balachandran - Governing Body Elected GP Member

39 96 135 N/A

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Pension Benefits: Comparison with Previous Year 2015/16

Name and Title

(a) (b) (c) (d)

Real increase

in pension

at pension

age

Real increase

in pension

lump sum at

pension age

Total accrued pension

at pension age at

31 March 2016

Lump sum at

pension age

related to

accrued pension

at 31 March 2016

(bands of £2,500)

(bands of

£2,500)

(bands of

£5,000)

(bands of

£5,000)

£'000 £'000 £'000 £'000

Hazel Carpenter - Accountable Officer 0-2.5 0 35-40 100-105

Jonathan Bates - Chief Finance Officer 0-2.5 2.5-5 25-30 80-85

Sharon Gardner-Blatch - Chief Nursing Officer 0-2.5 0-2.5 20-25 55-60

Dr Chee Mah - Governing Body Elected GP Member 0-2.5 0 5-10 20-25

Dr Brighton Chireka - Governing Body Elected GP Member 0-2.5 0 5-10 20-25

Dr Jonathan Bryant - Governing Body Elected GP Member 0-2.5 0-2.5 10-15 25-30

Name and Title

(e) (f) (g) (h)

Cash Equivalent Transfer

Value at 1 April 2015

with Inflation added

Real Increase in Cash

Equivalent Transfer

Value

Cash Equivalent Transfer Value at 31 March

2016

Employer's contribution

to stakeholder

pension

£'000 £'000 £'000 £'000

Hazel Carpenter - Accountable Officer 550 19 569 N/A

Jonathan Bates - Chief Finance Officer 550 25 575 N/A

Sharon Gardner-Blatch - Chief Nursing Officer 308 21 329 N/A

Dr Chee Mah - Governing Body Elected GP Member 119 0 119 N/A

Dr Brighton Chireka - Governing Body Elected GP Member

113 7 120 N/A

Dr Jonathan Bryant - Governing Body Elected GP Member

114 1 115 N/A

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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.

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.

Compensation on early retirement of for loss of office

No payments have been made in 2016/17.

Payments to past members

No payments have been made in 2016/17.

Pay multiples

Reporting bodies are required to disclose the relationship between the remuneration of the

highest paid member in their organisation and the median remuneration of the organisation’s

workforce.

The banded remuneration of the highest paid member in South Kent Coast CCG in the

financial year 2016/17 was £112,500 (2015/16: £112,500). This was 2.41 times (2015/16:

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2.65) the median remuneration of the workforce, which was £46,626 (2015/16: £42,612).

In 2016/17, 0 employees received remuneration in excess of the highest-paid member.

Remuneration ranged from £11,637 to £112,500 (2015/2016: £17,179 to £112,500)

Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-

kind, but not severance payments. It does not include employer pension contributions and

the cash equivalent transfer value of pensions.

The reason for the change in the multiples is that the work force has been quite static so the

difference between the median salaries is due to the staff progressing along a spine point.

The top director’s remuneration has again been static.

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Staff Report

The total number of staff employed through ESR on 31 March 2017 was 77, with 21 of those

employed as Governing Body members and/or Clinical Leads.

The FTE is 51.5 (excluding GPs and Clinical Leads).

SKC CCG Leavers April 2016 – March 2017

A total of 5 members of staff left the CCG during this period for the following reasons:

4 Voluntary Resignation– (promotion/relocation/lack of opportunity/child

dependants/other)

1 Ill-health Retirement

Calculating an average of 50.5 members of staff (excluding GPs) over the period, staff

turnover is 9.9%. The UK national average is around 15% with an expected rise of 3% over

the next 2 years due to an improving economy.

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Number of senior managers

The CCG has 16 senior managers as shown in the remuneration tables above. The Chief

Nursing Officer is the only banded post at a band 9.

Staff numbers and costs

The CCG spent £2,200,000 on staff in 2016-17. The split of this is shown below.

Total Permanent Employees

Other

£'000 £'000 £'000

Employee Benefits

Salaries and wages 1,727 1,720 7

Social security costs 220 220 0

Employer Contributions to NHS Pension scheme 253 253 0

Employee benefits expenditure 2,200 2,193 7

Admin

Total Permanent Employees

Other

£'000 £'000 £'000

Employee Benefits

Salaries and wages 1,422 1,415 7

Social security costs 172 172 0

Employer Contributions to NHS Pension scheme 192 192 0

Employee benefits expenditure 1,786 1,779 7

Programme

Total Permanent Employees

Other

£'000 £'000 £'000

Employee Benefits

Salaries and wages 305 305 0

Social security costs 48 48 0

Employer Contributions to NHS Pension scheme 61 61 0

Employee benefits expenditure 414 414 0

82

Staff Composition

Cultural Diversity

A high number of ethnicities are recorded as undefined. This is due to the information not being

fully completed on starter forms.

Sickness absence data

Sickness at SKC CCG during the period April 2016 – March 2017 averages at 31.5 working days

per month from a total availability of 1111 working days per month, giving a 2.83% sickness rate.

The national average NHS sickness absence rate ranges between 2 - 7%. CCGs specifically,

fluctuated between 2 - 3% in the period 2014-16.

83

Staff Policies

South Kent Coast CCG promotes wellbeing for its entire staff and paramount to this is equal

opportunities. The following policies have been developed in line with national guidelines for

the benefit of its employees.

Equality Disclosures

The CCG has a Disability Policy which sets out its intentions to ensure that people with

disabilities are given full and fair consideration when they apply for employment and that

staff with a disability are supported to ensure they are able to be effective as employees.

The CCG is committed to achieving its equality objectives and is reviewing the Equality

Diversity Standard 2 to identify areas for improvement

Employee Consultation

The CCG continues to run a joint staff engagement forum with NHS Thanet CCG. The

meetings are held on a monthly basis and are chaired by the Company Secretary for

both CCGs. In 2016/17 the staff forum ratified policies including sustainability and all

HR policies as well as continuing to develop a staff handbook.

The staff forum also led the annual staff survey, to keep abreast of staff issues. The

questions included whether staff felt appropriately supported by their line managers,

the training and development offered to them and questions on the mental health and

84

wellbeing of staff. The results will be collated and fed back at the staff development

days.

A weekly team meeting is held every Monday morning which gives the Executive

Team the opportunity to brief staff on any important matters concerning the business

and operations and to recap the previous week’s main issues.

In addition the staff are invited to development days to learn more about each other

and how to get the best out of colleagues. How these staff development days are

facilitated also formed part of the staff survey as the CCG aims to ensure staff get the

most out of them.

An electronic bulletin is sent to all CCG staff on a weekly basis. This provides a way

for the CCG to communicate with the membership on any internal or external issues of

relevance to the staff and CCG.

A full list of South Kent Coast’s policies including remuneration, learning and development,

conflicts of interest and Speak Out Safely Policy (whistleblowing) can be found on our website.

Expenditure on consultancy

The CCG has spent £1,125,552 on consultancy costs this year (£183,690 in 15/16). The

increase is mainly due to £907,900 spent on consultancy for the east Kent strategy board,

hosted by South Kent Coast CCG, to help with modelling and stakeholder engagement. Most of

this expenditure is covered by income received from other CCGs and healthcare providers

within east Kent. £101,835m was to support procurements as particular expertise was needed

that the CCGs do not have. The CCG also sent £51,000 on supporting primary care to improve

service offerings.

Off-payroll engagements

There were no off-payroll engagements that lasted more than six months and were over £220

per day. None of our Board members or officials with significant financial responsibility were

engaged off-payroll.

Exit packages, including special (non-contractual) payments

No exit packages were agreed or paid in 2016-17.

85

Parliamentary Accountability and Audit Report

South Kent Coast CCG is not required to produce a Parliamentary Accountability

and Audit Report but has opted to include disclosures on remote contingent

liabilities, losses and special payments, gifts, and fees and charges in this

Accountability Report at. An audit certificate and report is also included in this Annual

Report.

86

INTERNAL AUDITORS

REPORT

Internal Audit

86

NHS South Kent Coast CCG

Internal Audit Annual Report

2016/17

NHS South Kent Coast CCG

Internal Audit Annual Report 2016/17

Internal Audit Annual Report

INTRODUCTION

This is the 2016/17 Annual Report by TIAA on the internal control environment at

NHS South Kent Coast CCG. The annual internal audit report summarises the

outcomes of the reviews we have carried out on the organisation’s framework of

governance, risk management and control. This report is designed to assist the

Governing Body in making its annual governance statement.

HEAD OF INTERNAL AUDIT’S ANNUAL OPINION

I am satisfied that sufficient internal audit work has been undertaken to allow

me to draw a reasonable conclusion as to the adequacy and effectiveness of

NHS South Kent Coast CCG’S risk management, control and governance

processes. In my opinion, NHS South Kent Coast has adequate and effective

management, control and governance processes to manage the achievement of

its objectives. My formal Opinion is set out at Annex A.

INTERNAL AUDIT PLANNED COVERAGE AND OUTPUT

The 2016/17 Annual Audit Plan approved by the Governance and Risk Committee

was for 105 days of internal audit coverage in the year (including attendance at the

Governance and Risk Committee, Management, Follow Up, Annual Report and

Emerging Risks). During the year there were two changes to the Audit Plan, funded

from the time allocated to emerging risks. These changes were as follows:

An audit of the Financial Recovery Plan was added to the audit

programme at the request of the Chief Finance Officer and

approved by the Governance and Risk Committee.

NHS England mandated a review of Conflicts of Interest and this

was added to the audit plan.

The formal year-end Annual Opinion statement is set out in Annex A. All the

planned work has been carried out and reports have been issued (see Annex B).

Apart from the audits noted above, no reviews were carried out which were in

addition to the work set out in the Annual Audit Plan.

ASSURANCE

Including one audit from 2015/16 TIAA carried out 11 reviews, designed to

ascertain the extent to which internal controls in the system are sufficient to

ensure that procedures are operating to achieve NHS South Kent Coast CCG’s

objectives. For each assurance review an assessment of the effectiveness of the

controls in mitigating the key control risks was provided. Details of these are

provided in Annex B, and a summary of audits reported to the CCG to date is set

out below (excludes one review in fieldwork).

Assurance Assessments Number of Reviews Previous Year

Substantial Assurance 1 2

Reasonable Assurance 9 5

Limited Assurance 1 1

No Assurance 0 0

The areas on which the assurance assessments have been provided can only

provide reasonable and not absolute assurance against misstatement or loss, and

their effectiveness is reduced if the internal audit recommendations made have not

NHS South Kent Coast CCG

Internal Audit Annual Report 2016/17

been fully implemented.

We made the following total number of recommendations from our audit work

carried out in 2016/17:

Urgent Important Routine

6 23 11

AUDIT SUMMARY

Control weaknesses: There was one audit report where it was assessed that the

effectiveness of some of the internal control arrangements provided ‘limited'

assurance’. Recommendations were made to strengthen the control environment

for this review and the management responses indicated that the

recommendations had been accepted.

Recommendations Made: We have analysed our recommendations by risk area:

Risk Area Urgent Important Routine

Directed 3 2 4

Compliance 1 13 7

Operational 2 8 0

Reputational 0 0 0

Operational Effectiveness Opportunities: One of the roles of Internal Audit is to

add value and during the financial year we provided advice on opportunities to

enhance the operational effectiveness of the areas reviewed, and we raised six

operational effectiveness matters during the year.

INDEPENDENCE AND OBJECTIVITY OF INTERNAL AUDIT

There were no limitations or restrictions placed on the internal audit service which

impaired either the independence or objectivity of the service provided.

PERFORMANCE AND QUALITY ASSURANCE

The following Performance Targets were used to measure the performance of

internal audit in delivering the Annual Plan.

Performance Measure Target Attained

Completion of Planned Audits 100% 92%

Audits Completed in Time Allocation 100% 100%

Final report issued within 10 working days of receipt of responses

95% 78%

Compliance with Public Sector Internal Audit Standards

100% 100%

Final reporting is pending for two reports, which are both awaiting clearance from

management, and one audit is in fieldwork.

Ongoing quality assurance work was carried out throughout the year, and we

continue to comply with ISO 9001 standards. An independent external review was

carried out in 2016 of our compliance with Public Sector Internal Audit Standards

(PSIAS) which met the requirement for an independent 5 year review. The

outcome confirmed full compliance with all the standards. Our work also complies

with the IIA-UK Professional Standards.

During the last quarter of 2016/17 we undertook a perception survey across our

clients. The results showed a generally high level of satisfaction and identified a

number of areas where we will be looking to develop our service further in

NHS South Kent Coast CCG

Internal Audit Annual Report 2016/17

2017/18.

RELEASE OF REPORT

The table below sets out the history of this Annual Report.

Date Report issued: May 2017

NHS South Kent Coast CCG

InternalAudit Annual Report 2016/17

Annex A

Head of Internal Audit Opinion (HoIA) on the Effectiveness of the System of Internal Control for the Year Ended 31 March 2017

The purpose of my annual HoIA Opinion is to contribute to the assurances available to the Accountable Officer and the Governing Body which underpin the Governing Body’s own

assessment of the effectiveness of the organisation’s system of internal control. This Opinion will in turn assist the Governing Body in the completion of its AGS.

I note that the CCG is currently forecasting a year-end surplus of £2.8m (month 12), in line with the original CCG plan of £2.8m surplus. My opinion on the organisation’s system of

internal control has taken this factor into account.

My opinion is set out as follows:

4. Overall opinion;

5. Basis for the opinion; and

6. Commentary.

My overall opinion is that Reasonable assurance can be given that there is a generally sound system of internal control, designed to meet the organisation’s objectives, and that

controls are generally being applied consistently. However, some weakness in the design and/or inconsistent application of controls, put the achievement of particular objectives

at risk.

The basis for forming my opinion is as follows:

1. An assessment of the design and operation of the underpinning Assurance Framework and supporting processes; and

2. An assessment of the range of individual opinions arising from risk-based audit assignments, contained within internal audit risk-based plans that have been reported

throughout the year. This assessment has taken account of the relative materiality of these areas and management’s progress in respect of addressing control

weaknesses.

Additional areas of work that may support the opinion will be determined locally but are not required for Department of Health purposes e.g. any reliance that is being placed upon Third Party Assurances. This included the annual reviews of East Kent Shared Finance Services and Kent and Medway NHS Payroll Services which were given substantial and reasonable assurance respectively. I have also relied on the ISAE3402 reports produced by PricewaterhouseCoopers LLP (PWC), the independent service auditors for the NHS Shared Business Services (SBS) and the NHS Business Services Authority (BSA). These reports covered the Finance and Accounting and Procurement Services provided by SBS and the Dental and Prescription Payments made by the BSA and all were given reasonable assurance.

NHS South Kent Coast CCG

InternalAudit Annual Report 2016/17

Annex B

Actual against planned Internal Audit Work 2016/17

System Audit Type Planned

Days Actual Days

Assurance Assessment

Comments

Continuing Healthcare Placements Assurance N/A N/A Reasonable Carried over from 2015/16 audit plan. Final report issued in 2016/17

Assurance Framework phase 1 Assurance 3 3 Reasonable Final report issued

Assurance Framework phase 2 Assurance 3 3 Reasonable Final report issued

IT Satisfaction Survey Assurance 6 6 Reasonable Final report issued

Information Governance Toolkit Assurance 10 10 Substantial Final report issued

Variation in GP Services Assurance 12 12 Limited Final report issued

Conflict of Interest Assurance 4 4 Reasonable Final report issued

HR Follow Up Assurance 3 3 Reasonable Final report issued

Financial Recovery Plan Assurance 8 15* Reasonable Final report issued

Critical Financial Assurance Assurance 9 9 Reasonable Draft report issued

Contract Management Assurance 14 14 Reasonable Draft report issued

Integrated Care Organisation Assurance 15 8 TBC In fieldwork

*Utilised time allocated to emerging risks for this review

93

Independent Auditors

Report

INDEPENDENT AUDITOR’S REPORT TO THE MEMBERS OF THE GOVERNING BODYOF NHS SOUTH KENT COAST CLINICAL COMMISSIONING GROUP

We have audited the financial statements of NHS South Kent Coast Clinical CommissioningGroup for the year ended 31 March 2017 under the Local Audit and Accountability Act 2014(the "Act"). The financial statements comprise the Statement of Comprehensive NetExpenditure, the Statement of Financial Position, the Statement of Changes in Taxpayers’ Equity, the Statement of Cash Flows and the related notes. The financial reportingframework that has been applied in their preparation is applicable law and InternationalFinancial Reporting Standards (IFRSs) as adopted by the European Union, as interpretedand adapted by the Department of Health Group Accounting Manual 2016/17 (the “2016/17GAM”) and the requirements of the Health and Social Care Act 2012.

We have also audited the information in the Members Report that is subject to audit, being: the single total figure of remuneration for each director on pages 71 and 72; CETV disclosures for each director on pages 75 and 76; the analysis of staff numbers and costs on page 81; and the table of fair pay (pay multiples) disclosures on pages 78 and 79.

This report is made solely to the members of the Governing Body of NHS South Kent CoastClinical Commissioning Group, as a body, in accordance with Part 5 of the Act and as set outin paragraph 43 of the Statement of Responsibilities of Auditors and Audited Bodiespublished by Public Sector Audit Appointments Limited. Our audit work has been undertakenso that we might state to the members of the Governing Body of the CCG those matters weare required to state to them in an auditor's report and for no other purpose. To the fullestextent permitted by law, we do not accept or assume responsibility to anyone other than theCCG and the members of the Governing Body of the CCG, as a body, for our audit work, forthis report, or for the opinions we have formed.

Respective responsibilities of the Accountable Officer and auditor

As explained more fully in the Statement of Accountable Officer’s Responsibilities, theAccountable Officer is responsible for the preparation of the financial statements and forbeing satisfied that they give a true and fair view and is also responsible for ensuring theregularity of expenditure and income. Our responsibility is to audit and express an opinion onthe financial statements in accordance with applicable law, the Code of Audit Practicepublished by the National Audit Office on behalf of the Comptroller and Auditor General (the“Code of Audit Practice”) and International Standards on Auditing (UK and Ireland). Thosestandards require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors. We are also responsible for giving an opinion on the regularity of expenditure andincome in accordance with the Code of Audit Practice as required by the Act.

As explained in the Governance Statement the Accountable Officer is responsible for thearrangements to secure economy, efficiency and effectiveness in the use of the CCG'sresources. We are required under Section 21 (1)(c) of the Act to be satisfied that the CCGhas made proper arrangements for securing economy, efficiency and effectiveness in its useof resources and to report by exception where we are not satisfied.

We are not required to consider, nor have we considered, whether all aspects of the CCG'sarrangements for securing economy, efficiency and effectiveness in its use of resources areoperating effectively.

Scope of the audit of the financial statements

An audit involves obtaining evidence about the amounts and disclosures in the financialstatements sufficient to give reasonable assurance that the financial statements are free frommaterial misstatement, whether caused by fraud or error. This includes an assessment of:

whether the accounting policies are appropriate to the CCG’s circumstances and have been consistently applied and adequately disclosed; the reasonableness of significant accountingestimates made by the Accountable Officer; and the overall presentation of the financialstatements. In addition, we read all the financial and non-financial information in thePerformance Report and the Accountability Report to identify material inconsistencies withthe audited financial statements and to identify any information that is apparently materiallyincorrect based on, or materially inconsistent with, the knowledge acquired by us in thecourse of performing the audit. If we become aware of any apparent material misstatementsor inconsistencies we consider the implications for our report.

In addition, we are required to obtain evidence sufficient to give reasonable assurance thatthe expenditure and income recorded in the financial statements have been applied to thepurposes intended by Parliament and the financial transactions conform to the authoritieswhich govern them.

Scope of the review of arrangements for securing economy, efficiency andeffectiveness in the use of resources

We have undertaken our review in accordance with the Code of Audit Practice, havingregard to the guidance on the specified criteria issued by the Comptroller and AuditorGeneral in November 2016, as to whether the CCG had proper arrangements to ensure ittook properly informed decisions and deployed resources to achieve planned andsustainable outcomes for taxpayers and local people. The Comptroller and Auditor Generaldetermined these criteria as that necessary for us to consider under the Code of AuditPractice in satisfying ourselves whether the CCG put in place proper arrangements forsecuring economy, efficiency and effectiveness in its use of resources for the year ended 31March 2017, and to report by exception where we are not satisfied.

We planned our work in accordance with the Code of Audit Practice. Based on our riskassessment, we undertook such work as we considered necessary.

Opinion on financial statements

In our opinion: the financial statements give a true and fair view of the financial position of NHS

South Kent Coast Clinical Commissioning Group as at 31 March 2017 and of itsexpenditure and income for the year then ended; and

the financial statements have been prepared properly in accordance with IFRSs asadopted by the European Union, as interpreted and adapted by the Department ofHealth Group Accounting Manual 2016/17 and the requirements of the Health andSocial Care Act 2012.

Opinion on regularity

In our opinion, in all material respects the expenditure and income recorded in the financialstatements have been applied to the purposes intended by Parliament and the financialtransactions in the financial statements conform to the authorities which govern them.

Opinion on other matters

In our opinion: the parts of the Accountability Report to be audited have been properly prepared in

accordance with IFRSs as adopted by the European Union, as interpreted and

adapted by the Department of Health Group Accounting Manual 2016/17 and therequirements of the Health and Social Care Act 2012; and

the other information published together with the audited financial statements in thePerformance Report and the Accountability Report for the financial year for which thefinancial statements are prepared is consistent with the audited financial statements.

Matters on which we are required to report by exception

We are required to report to you if: in our opinion the Annual Governance Statement does not comply with the guidance

issued by the NHS Commissioning Board; or we have referred a matter to the Secretary of State under section 30 of the Act

because we had reason to believe that the CCG, or an officer of the CCG, was aboutto make, or had made, a decision which involved or would involve the body incurringunlawful expenditure, or was about to take, or had begun to take a course of actionwhich, if followed to its conclusion, would be unlawful and likely to cause a loss ordeficiency; or

we have reported a matter in the public interest under section 24 of the Act in thecourse of, or at the conclusion of the audit; or

we have made a written recommendation to the CCG under section 24 of the Act inthe course of, or at the conclusion of the audit; or

we have not been able to satisfy ourselves that the CCG has made properarrangements for securing economy, efficiency and effectiveness in its use ofresources for the year ended 31 March 2017.

We have nothing to report in respect of the above matters.

Certificate

We certify that we have completed the audit of the financial statements of NHS South KentCoast Clinical Commissioning Group in accordance with the requirements of the Act and theCode of Audit Practice.

Elizabeth Jackson

Elizabeth Jacksonfor and on behalf of Grant Thornton UK LLP, Appointed Auditor

Grant Thornton UK LLPGrant Thornton HouseMelton StreetLondonNW1 2EP

26 May 2017

Annual Accounts

2

Page Number

The Primary Statements:

Statement of Comprehensive Net Expenditure for the year ended 31st March 2017 3

Statement of Financial Position as at 31st March 2017 4

Statement of Changes in Taxpayers' Equity for the year ended 31st March 2017 5

Statement of Cash Flows for the year ended 31st March 2017 6

Notes to the Accounts1 Accounting policies 7

2 Other operating revenue 12

3 Revenue 12

4 Employee benefits and staff numbers 13

5 Operating expenses 16

6 Better payment practice code 17

7 Income generation activities 17

8 Operating leases 18

9 Property, plant and equipment 19

10 Inventories 19

11 Trade and other receivables 20

12 Cash and cash equivalents 20

13 Trade and other payables 21

14 Finance lease obligations 21

15 Provisions 21

16 Contingencies 21

17 Commitments 21

18 Financial instruments 22

19 Operating segments 23

20 Pooled budgets 24

21 Related party transactions 24

22 Events after the end of the reporting period 25

23 Financial performance targets 25

CONTENTS

South Kent Coast Clinical Commissioning Group - Annual Accounts 2016-17

3

Statement of Comprehensive Net Expenditure for the year ended31 March 2017

2016-17 2015-16Note £'000 £'000

Income from sale of goods and services 2 0 (0)Other operating income 2 (2,225) (574)Total operating income (2,225) (574)

Staff costs 4 2,200 1,876Purchase of goods and services 5 276,852 271,515Depreciation and impairment charges 5 25 25Other Operating Expenditure 5 587 530Total operating expenditure 279,664 273,946

Comprehensive Expenditure for the year ended 31 March 2017 277,439 273,372

The notes on pages 1 to 25 form part of this statement

South Kent Coast Clinical Commissioning Group - Annual Accounts 2016-17

4

Statement of Financial Position as at31 March 2017

2016-17 2015-16

Note £'000 £'000Non-current assets:Property, plant and equipment 9 64 89Total non-current assets 64 89

Current assets:Inventories 10 0 0Trade and other receivables 11 4,733 2,394Cash and cash equivalents 12 22 20Total current assets 4,755 2,414

Total assets 4,819 2,503

Current liabilitiesTrade and other payables 13 (22,360) (23,022)Provisions 15 0 0Total current liabilities (22,360) (23,022)

Non-Current Assets less Net Current Liabilities (17,541) (20,519)

Non-current liabilitiesTrade and other payables 13 0 0Provisions 15 0 0Total non-current liabilities 0 0

Assets less Liabilities (17,541) (20,519)

Financed by Taxpayers’ EquityGeneral fund (17,541) (20,519)Other reserves 0 0Total taxpayers' equity: (17,541) (20,519)

The notes on pages 1 to 25 form part of this statement

The financial statements on pages 1 to 25 were approved by the Governing Body on 25 May 2017 and signed on its behalf by:

Chief Accountable OfficerHazel Carpenter

South Kent Coast Clinical Commissioning Group - Annual Accounts 2016-17

5

Statement of Changes In Taxpayers Equity for the year ended31 March 2017

General FundTotal

ReservesChanges in taxpayers’ equity for 2016-17 £'000 £'000

Balance at 01 April 2016 (20,519) (20,519)

Adjusted NHS Clinical Commissioning Group balance at 31 March 2017 (20,519) (20,519)

Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2016-17

Net operating expenditure for the financial year (277,439) (277,439)

Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year (277,439) (277,439)

Net funding 280,417 280,417

Balance at 31 March 2017 (17,541) (17,541)

General fund Total reserves£'000 £'000

Changes in taxpayers’ equity for 2015-16

Balance at 01 April 2015 (15,626) (15,626)

Adjusted NHS Clinical Commissioning Group balance at 31 March 2016 (15,626) (15,626)

Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2015-16

Net operating expenditure for the financial year (273,372) (273,372)

Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year (273,372) (273,372)

Net funding 268,479 268,479

Balance at 31 March 2016 (20,519) (20,519)

The notes on pages 1 to 25 form part of this statement

South Kent Coast Clinical Commissioning Group - Annual Accounts 2016-17

6

Statement of Cash Flows for the year ended31 March 2017

2016-17 2015-16Note £'000 £'000

Cash Flows from Operating ActivitiesNet operating expenditure for the financial year (277,439) (273,372)Depreciation 5 25 25(Increase)/decrease in trade & other receivables 11 (2,339) 3,402(Decrease)/increase in trade & other payables 13 (662) 1,382Net Cash Outflow from Operating Activities (280,415) (268,563)

Cash Flows from Investing ActivitiesInterest received 0 0Payments for property, plant and equipment 0 0Net Cash Inflow (Outflow) from Investing Activities 0 0

Net Cash Outflow before Financing (280,415) (268,563)

Cash Flows from Financing ActivitiesParliamentary Funding Received 280,417 268,479Net Cash Inflow from Financing Activities 280,417 268,479

Net Increase (Decrease) in Cash & Cash Equivalents 12 2 (84)

Cash & Cash Equivalents at the Beginning of the Financial Year 20 104

Cash & Cash Equivalents at the End of the Financial Year 22 20

The notes on pages 1 to 25 form part of this statement

South Kent Coast Clinical Commissioning Group - Annual Accounts 2016-17

7

Notes to the financial statements

1 Accounting Policies

NHS England has directed that the financial statements of clinical commissioning groups shall meet the accounting requirements of the Group Accounting Manual issued by the Department of Health. Consequently, the following financial statements have been prepared in accordance with the Group Accounting Manual 2016-17 issued by the Department of Health. The accounting policies contained in the Group Accounting Manual follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to clinical commissioning groups, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Group Accounting Manual permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the clinical commissioning group for the purpose of giving a true and fair view has been selected. The particular policies adopted by the clinical commissioning group are described below. They have been applied consistently in dealing with items considered material in relation to the accounts.

1.1 Going ConcernThese accounts have been prepared on the going concern basis.In 2016/17 the CCG operated, and has agreed a budget plan for 2017/18, within its annual statutory expenditure limit. The CCG has reviewed affordability of services going forward and is satisfied that statutory financial balance is achievable.NHS South Kent Coast SKC has submitted a plan for 2017/18 to NHS England which includes QIPP and activity growth which is well within agreed planning totals.’Public sector bodies are assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as evidenced by inclusion of financial provision for that service in published documents.Where a clinical commissioning group ceases to exist, it considers whether or not its services will continue to be provided (using the same assets, by another public sector entity) in determining whether to use the concept of going concern for the final set of Financial Statements. If services will continue to be provided, the financial statements are prepared on the going concern basis.

1.2 Accounting ConventionThese accounts have been prepared under the historical cost convention.

1.3 Pooled Budgets

Where the clinical commissioning group has entered into a pooled budget arrangement under Section 75 of the National Health Service Act 2006 the clinical commissioning group accounts for its share of the assets, liabilities, income and expenditure arising from the activities of the pooled budget, identified in accordance with the pooled budget agreement.If the clinical commissioning group is in a “jointly controlled operation”, the clinical commissioning group recognises:· The assets the clinical commissioning group controls;· The liabilities the clinical commissioning group incurs;· The expenses the clinical commissioning group incurs; and,· The clinical commissioning group’s share of the income from the pooled budget activities.If the clinical commissioning group is involved in a “jointly controlled assets” arrangement, in addition to the above, the clinical commissioning group recognises:· The clinical commissioning group’s share of the jointly controlled assets (classified according to the nature of the assets);· The clinical commissioning group’s share of any liabilities incurred jointly; and,· The clinical commissioning group’s share of the expenses jointly incurred.

The CCG has reviewed the terms of the Better Care Fund. A Section 75 agreement is in place and the CCG can expend resources without reference to the other members (Kent County Council) and has full control over its element of the budget. The CCG commissions directly as if the pooled budget does not exist and so is outside the pooled budget arrangement.

South Kent Coast Clinical Commissioning Group - Annual Accounts 2016-17

8

Notes to the financial statements

South Kent Coast Clinical Commissioning Group - Annual Accounts 2016-17

1.4 Critical Accounting Judgements & Key Sources of Estimation UncertaintyIn the application of the clinical commissioning group’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods.

1.4.1 Critical Judgements in Applying Accounting PoliciesThe following are the critical judgements, apart from those involving estimations (see below) that management has made in the process of applying the clinical commissioning group’s accounting policies that have the most significant effect on the amounts recognised in the financial statements:· Accruals have been included in the financial statements to the extent that the CCG recognises an obligation as at 31 March 2017 for which it has not been invoiced. Estimates of accruals are undertaken by management based on information available at the end of the financial year, together with past experience.

The CCG has reviewed the contractual terms of the Better Care Fund. The CCG commissions directly as if the pooled budget does not exist and it is therefore considered to be outside the pooled budget arrangement.

1.4.2 Key Sources of Estimation Uncertainty

The following are the key estimations that management has made in the process of applying the clinical commissioning group’s accounting policies that have the most significant effect on the amounts recognised in the financial statements:

· Some of the clinical commissioning group’s contracts are not brought to a formal conclusion until late June or early July each year. The clinical commissioning group made estimates on these contracts using the expertise of the commissioning support unit's contracts department.

· GP drugs usage is also not known fully until 2 months after the year end. Estimates based on the Prescription PricingAuthority's annual expenditure phasings are made.

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

1.6 Employee Benefits1.6.1 Short-term Employee Benefits

Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees, including bonuses earned but not yet taken.The cost of leave earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry forward leave into the following period.

1.6.2 Retirement Benefit CostsPast and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the clinical commissioning group of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period.For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to expenditure at the time the clinical commissioning group commits itself to the retirement, regardless of the method of payment.

1.7 Other ExpensesOther operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable.Expenses and liabilities in respect of grants are recognised when the clinical commissioning group has a present legal or constructive obligation, which occurs when all of the conditions attached to the payment have been met.

9

Notes to the financial statements

South Kent Coast Clinical Commissioning Group - Annual Accounts 2016-17

1.8 Property, Plant & Equipment1.8.1 Recognition

Property, plant and equipment is capitalised if:· It is held for use in delivering services or for administrative purposes;· It is probable that future economic benefits will flow to, or service potential will be supplied to the clinical commissioning group;· It is expected to be used for more than one financial year;· The cost of the item can be measured reliably; and,· The item has a cost of at least £5,000; or,· Collectively, a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or,· Items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or collective cost.Where a large asset, for example a building, includes a number of components with significantly different asset lives, the components are treated as separate assets and depreciated over their own useful economic lives.

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

1.9 Depreciation, Amortisation & ImpairmentsDepreciation and amortisation are charged to write off the costs or valuation of property, plant and equipment, less any residual value, over their estimated useful lives, in a manner that reflects the consumption of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over which the clinical commissioning group expects to obtain economic benefits or service potential from the asset. This is specific to the clinical commissioning group and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are depreciated over their estimated useful lives.At each reporting period end, the clinical commissioning group checks whether there is any indication that any of its tangible assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its amount.

1.10 Leases All leases are classified as operating leases.

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

Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term.Contingent rentals are recognised as an expense in the period in which they are incurred.Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether they are operating or finance leases.

1.12 InventoriesInventories are valued at the lower of cost and net realisable value.

1.13 Cash & Cash EquivalentsCash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value.In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the clinical commissioning group’s cash management.

10

Notes to the financial statements

South Kent Coast Clinical Commissioning Group - Annual Accounts 2016-17

1.14 ProvisionsProvisions are recognised when the clinical commissioning group has a present legal or constructive obligation as a result of a past event, it is probable that the clinical commissioning group will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties.

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

1.16 Non-clinical Risk PoolingThe clinical commissioning group participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the clinical commissioning group pays an annual contribution to the NHS Litigation Authority and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due.

1.17 Continuing healthcare risk poolingIn 2014-15 a risk pool scheme was been introduced by NHS England for continuing healthcare claims, for claim periods prior to 31 March 2013. Under the scheme clinical commissioning group contribute annually to a pooled fund, which is used to settle the claims.

1.18 Financial AssetsFinancial assets are recognised when the clinical commissioning group becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred.Financial assets are classified into the following categories:· Financial assets at fair value through profit and loss;· Held to maturity investments;· Available for sale financial assets; and,· Loans and receivables.The classification depends on the nature and purpose of the financial assets and is determined at the time of initial recognition.

1.19 Financial LiabilitiesFinancial liabilities are recognised on the statement of financial position when the clinical commissioning group becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired.

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

11

Notes to the financial statements

South Kent Coast Clinical Commissioning Group - Annual Accounts 2016-17

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

1.21 Accounting Standards That Have Been Issued But Have Not Yet Been AdoptedThe Government Financial Reporting Manual does not require the following Standards and Interpretations to be applied in 2016-17, all of which are subject to consultation:· IFRS 9: Financial Instruments (application from 1 January 2018)· IFRS 14: Regulatory Deferral Accounts (not applicable to DH groups bodies)· IFRS 15: Revenue for Contract with Customers (application from 1 January 2018)· IFRS 16: Leases (application from 1 January 2019)The application of the Standards as revised would not have a material impact on the accounts for 2016-17, were they applied in that year.

12

2 Other Operating Revenue2016-17 2016-17 2016-17 2015-16

Total Admin Programme Total

£'000 £'000 £'000 £'000

Income from Sale of Goods and Services 0 0 0 0Other revenue 2,225 1,918 307 574Total other operating revenue 2,225 1,918 307 574

3 Revenue2016-17 2016-17 2016-17 2015-16

Total Admin Programme Total£'000 £'000 £'000 £'000

From rendering of services 2,225 1,918 307 574Total 2,225 1,918 307 574

Revenue in this note does not include cash received from NHS England which is drawn down directly into the bank account of the CCG and credited to the general fund.

Other Revenue includes prescribing rebates and monies received from NHS England in respect of unaccompanied asylum seeker children.

Revenue is totally from the supply of services. The clinical commissioning group receives no revenue from the supply of goods.

South Kent Coast Clinical Commissioning Group - Annual Accounts 2016-17

13

4. Employee benefits and staff numbers

4.1.1 Employee benefits

TotalPermanent Employees Other

£'000 £'000 £'000Employee BenefitsSalaries and wages 1,727 1,720 7Social security costs 220 220 0Employer Contributions to NHS Pension scheme 253 253 0Gross employee benefits expenditure 2,200 2,193 7

Less recoveries in respect of employee benefits (note 4.1.2) 0 0 0Net employee benefits excluding capitalised costs 2,200 2,193 7

TotalPermanent Employees Other

£'000 £'000 £'000Employee BenefitsSalaries and wages 1,556 1,548 8Social security costs 133 133 0Employer Contributions to NHS Pension scheme 187 187 0Gross employee benefits expenditure 1,876 1,868 8

Less recoveries in respect of employee benefits (note 4.1.2) 0 0 0Net employee benefits excluding capitalised costs 1,876 1,868 8

4.1.2 Recoveries in respect of employee benefits

There were no recoveries in respect of employee benefits in 2016-17 (2015-16 - Nil).

South Kent Coast Clinical Commissioning Group - Annual Accounts 2016-17

2016-17

2015-16

14

4.2 Average number of people employed2015-16

TotalPermanently

employed Other TotalNumber Number Number Number

Total 60 59 1 51

Of the above:Number of whole time equivalent people engaged on capital projects 0 0 0 0

4.3 Staff sickness absence and ill health retirements2016-17 2015-16Number Number

Total Days Lost 379 260Total Staff Years 51 40Average working Days Lost 7 6

2016-17 2015-16Number Number

Number of persons retired early on ill health grounds 1 0

£'000 £'000Total additional Pensions liabilities accrued in the year 0 0

Ill health retirement costs are met by the NHS Pension Scheme

4.4 Exit packages agreed in the financial year

There were no recharged redundancies agreed by the Clinical Commissioning Group in 2016/17 (2015/16 - Nil)

2016-17

There were no exit packages agreed by the Clinical Commissioning Group in 2016/17 for South Kent Coast staff members (2015/16- Nil).

South Kent Coast Clinical Commissioning Group - Annual Accounts 2016-17

15

South Kent Coast Clinical Commissioning Group - Annual Accounts 2016-17

4.5 Pension costs

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

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

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

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

4.5.1 Full actuarial (funding) valuation

The purpose of this valuation is to assess the level of liability in respect of the benefits due under the Scheme (taking into account its recent demographic experience), and to recommend the contribution rates to be paid by employers and scheme members. The last such valuation, which determined current contribution rates was undertaken as at 31 March 2012 and covered the period from 1 April 2008 to that date. Details can be found on the pension scheme website at www.nhsbsa.nhs.uk/pensions.

For 2016/17, employers’ contributions of £297,649 were payable to the NHS Pensions Scheme (2015/16: £217,436) at the rate of 14.3%of pensionable pay. The scheme’s actuary reviews employer contributions, usually every four years and now based on HMT ValuationDirections, following a full scheme valuation. The latest review used data from 31 March 2012 and was published on the Governmentwebsite on 9 June 2012. These costs are included in the NHS pension line of note 4.1.1.

16

5. Operating expenses2016-17 2016-17 2016-17 2015-16

Total Admin Programme Total£'000 £'000 £'000 £'000

Gross employee benefitsEmployee benefits excluding governing body members 1,502 1,121 381 1,687Executive governing body members 698 665 33 189Total gross employee benefits 2,200 1,786 414 1,876

Other costsServices from other CCGs and NHS England 2,042 950 1,092 2,280Services from foundation trusts 168,516 0 168,516 161,527Services from other NHS trusts 24,036 0 24,036 19,912Services from other WGA bodies 1 0 1 0Purchase of healthcare from non-NHS bodies 40,237 0 40,237 43,434Chair and Non Executive Members 587 587 0 530Supplies and services – clinical 1,026 0 1,026 3,498Supplies and services – general 1,241 1,078 163 185Consultancy services 1,125 1,074 51 184Establishment 567 211 356 592Transport 2 2 0 5Premises 1,438 49 1,389 1,504Depreciation 25 25 0 25Audit fees 60 60 0 60Prescribing costs 34,580 0 34,580 36,270General ophthalmic services 8 0 8 17GPMS/APMS and PCTMS 1,153 0 1,153 1,152Other professional fees excl. audit 490 459 31 169Education and training 46 41 5 15CHC Risk Pool contributions 284 0 284 711Total other costs 277,464 4,536 272,928 272,070

Total operating expenses 279,664 6,322 273,342 273,946

Admin Expenditure is that which is not a direct payment for the provision of healthcare or healthcare services.

South Kent Coast Clinical Commissioning Group - Annual Accounts 2016-17

17

6.1 Better Payment Practice Code

Measure of compliance 2016-17 2016-17 2015-16 2015-16Number £'000 Number £'000

Non-NHS PayablesTotal Non-NHS Trade invoices paid in the Year 12,731 63,379 11,110 58,102 Total Non-NHS Trade Invoices paid within target 12,539 62,458 10,721 57,454 Percentage of Non-NHS Trade invoices paid within target 98.49% 98.55% 96.50% 98.88%

NHS PayablesTotal NHS Trade Invoices paid in the Year 2,628 196,480 2,527 185,500 Total NHS Trade Invoices paid within target 2,597 195,950 2,491 185,178 Percentage of NHS Trade Invoices paid within target 98.82% 99.73% 98.58% 99.83%

7 Income Generation Activities

The clinical commissioning group does not undertake any income generation activities.

The better payment practice code is summarised as follows: Pay all trade creditors within 30 days of receipt of goods or a valid invoice (whichever is later) unless other payment terms have been agreed.

South Kent Coast Clinical Commissioning Group - Annual Accounts 2016-17

18

8. Operating Leases

8.1 As lesseeAll property assets are owned by NHS Property Services Limited currently charged at actual cost under annual notification.

8.1.1 Payments recognised as an ExpenseLand Buildings Other Total Land Buildings Other Total£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Payments recognised as an expenseMinimum lease payments 0 1,434 8 1,442 0 1,493 8 1,501Total 0 1,434 8 1,442 0 1,493 8 1,501

8.1.2 Future minimum lease payments

Land Buildings Other Total Land Buildings Other Total£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Payable:No later than one year 0 0 0 0 0 - - 0Between one and five years 0 0 0 0 0 - - 0After five years 0 0 0 0 0 - - 0Total 0 0 0 0 0 0 0 0

South Kent Coast Clinical Commissioning Group - Annual Accounts 2016-17

The operating lease in respect of the buildings are stated at the total cost to the CCG.

Whilst our arrangements with NHS Property Services Limited fall within the definition of operating leases, rental charge for future years has not yet been agreed. Consequently this note does not include future minimum lease payments.

2016-17 2015-16

2015-162016-17

19

9 Property, plant and equipment

2016-17Furniture & fittings Total

Furniture & fittings Total

£'000 £'000 £'000 £'000Cost or valuation at 01 April 2016 124 124 124 124

Cost/Valuation at 31 March 2017 124 124 124 124

Depreciation 01 April 2016 35 35 10 10Charged during the year 25 25 25 25Depreciation at 31 March 2017 60 60 35 35

Net Book Value at 31 March 2017 64 64 89 89

Purchased 64 64 89 89Total at 31 March 2017 64 64 89 89

Asset financing:

Owned 64 64 89 89Total at 31 March 2017 64 64 89 89

9.1 Economic livesMinimum

Life (years)

Maximum Life

(Years)

Minimum Life

(years)

Maximum Life

(Years)Furniture & fittings 5 10 5 10

10 InventoriesThe Clinical Commissioning Group had no inventories as at 31 March 2017 (31 March 2016 - Nil).

2016-17 2015-16

2016/17 2015/16

South Kent Coast Clinical Commissioning Group - Annual Accounts 2016-17

20

11 Trade and other receivables Current Current2016-17 2015-16

£'000 £'000

NHS receivables: Revenue 2,570 1,267NHS prepayments 584 526NHS accrued income 83 9Non-NHS and Other WGA receivables: Revenue 362 276Non-NHS and Other WGA prepayments 452 96Non-NHS and Other WGA accrued income 615 179Provision for the impairment of receivables 0 0VAT 67 41Total Trade & other receivables 4,733 2,394

Total current and non current 4,733 2,394

Included above:Prepaid pensions contributions 0 0

The CCG considers all trade debtors recoverable. (2015/16 - all trade debtors considered recoverable)

11.1 Receivables past their due date but not impaired 2016-17 2015-16£'000 £'000

By up to three months 352 404By three to six months 510 0By more than six months 194 0Total 1,056 404

12 Cash and cash equivalents

2016-17 2015-16£'000 £'000

Balance at 01 April 2016 20 104Net change in year 2 (84)Balance at 31 March 2017 22 20

Made up of:Cash with the Government Banking Service 22 20Cash in hand 0 0Cash and cash equivalents as in statement of financial position 22 20

Balance at 31 March 2017 22 20

No patients’ money is held by the CCG. (2015/16 - Nil)

South Kent Coast Clinical Commissioning Group - Annual Accounts 2016-17

21

Current Current2016-17 2015-16

£'000 £'000

NHS payables: revenue 5,001 2,866NHS accruals 1,800 879NHS deferred income 0 0Non-NHS and Other WGA payables: Revenue 2,434 6,460Non-NHS and Other WGA accruals 12,642 12,604Social security costs 41 28VAT 0 0Tax 37 30Other payables and accruals 405 155Total Trade & Other Payables 22,360 23,022

Total current 22,360 23,022

14 Finance lease obligations

15 Provisions

The Clinical Commissioning Group has no provisions. (31 March 2016 - Nil)

16 Contingencies

17 Commitments

The Clinical Commissioning Group has entered into a number of contracts with providers where the contract value is in excess of £1m. All are under standard NHS contract terms which contain break clauses of 12 months or less, and as such are not recognised as financial commitments.

South Kent Coast Clinical Commissioning Group - Annual Accounts 2016-17

13 Trade and other payables

Other payables include £45,562 outstanding pension contributions as at 31 March 2017. (31 March 2016 - £19,652)

The Clinical Commissioning Group has no significant finance lease obligations. ( 31 March 2016 - Nil)

The Clinical Commissioning Group has no significant contingent liabilities or assets as at 31 March 2017. (31 March 2016 - Nil).

22

18 Financial instruments

18.1 Financial risk management

18.1.1 Currency risk

18.1.2 Interest rate risk

18.1.3 Credit risk

18.1.4 Liquidity risk

Clinical Commissioning Group can borrow from government for capital expenditure, subject to affordability as confirmed by NHS England. The borrowings are for 1 to 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The clinical commissioning group has no capital expenditure and therefore low exposure to interest rate fluctuations.

Because the majority of the NHS Clinical Commissioning Group revenue comes from parliamentary funding, the NHS Clinical Commissioning Group has low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables from customers, as disclosed in the trade and other receivables note.

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

South Kent Coast Clinical Commissioning Group - Annual Accounts 2016-17

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

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

Treasury management operations are carried out by the finance department, within parameters defined formally within the NHS Clinical Commissioning Group standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the NHS Clinical Commissioning Group and internal auditors.

The NHS Clinical Commissioning Group is a domestic organisation with all transactions, assets and liabilities being in the UK and sterling based. The NHS Clinical Commissioning Group has no overseas operations, but has Sterling contracts for services with three French providers, The clinical commissioning group therefore has low exposure to currency rate fluctuations.

23

18 Financial instruments cont'd

18.2 Financial assetsLoans and

Receivables Total2016-17 2016-17

£'000 £'000

Receivables:· NHS 2,653 2,653· Non-NHS 977 977Cash at bank and in hand 22 22Other financial assets 0 0Total at 31 March 2017 3,652 3,652

Loans and Receivables Total

2015-16 2015-16£'000 £'000

Receivables:· NHS 1,276 1,276· Non-NHS 454 454Cash at bank and in hand 20 20Other financial assets 0 0Total at 31 March 2016 1,750 1,750

18.3 Financial liabilities

Other Total2016-17 2016-17

£'000 £'000Payables:· NHS 6,801 6,801· Non-NHS 15,481 15,481Total at 31 March 2017 22,282 22,282

Other Total2015-16 2015-16

£'000 £'000Payables:· NHS 3,745 3,745· Non-NHS 19,220 19,220Total at 31 March 2016 22,965 22,965

There is no difference between the carrying value of financial assets and liabilities and their fair value.As at 31 March 2017 all financial liabilities are due within one year (31 March 2016 - all due within one year)

19 Operating segmentsThe clinical commissioning group consider they have only one segment: commissioning of healthcare services.

South Kent Coast Clinical Commissioning Group - Annual Accounts 2016-17

24

20 Pooled budgets

2016-17 2015-16£'000 £'000

Income 0 0Expenditure 161 112

21 Related party transactions

The clinical commissioning group expenditure with Invicta Health CIC is as stated:

Payments to Related

Party

Receipts from

Related Party

Amounts owed to Related Party

Amounts due from Related Party

£000 £000 £000 £000Invicta Health CIC 325 - 19 -

Payments to Related

Party

Receipts from

Related Party

Amounts owed to Related Party

Amounts due from Related

Party

£000 £000 £000 £000Integrated Care 24 LTD 1,758 3 - Invicta Health CIC 36 -

The payments are subject to the Better Payment Practice Code and there is no provision for bad debt.

East Kent Hospitals University NHS Foundation TrustKent Community Health NHS Foundation TrustKent and Medway NHS and Social Care Partnership TrustSouth East Coast Ambulance Service NHS Foundation TrustSouth East Commissioning Support Unit (Hosted by NHS England)Sussex Partnership NHS Foundation TrustKings College Hospitals NHS Foundation TrustGuys & St Thomas NHS Foundation TrustNHS Property Services

South Kent Coast Clinical Commissioning Group - Annual Accounts 2016-17

The NHS Clinical Commissioning Group shares of the income and expenditure handled by the pooled budget in the financial year

The pooled budget expenditure relates to the Integrated Community Equipment Service (ICES). This is subject to a s75 agreement with Kent County Council.

The CCG has reviewed the contractual terms of the Better Care Fund. The CCG commissions directly as if the pooled budget does not exist and it is therefore considered to be outside the pooled budget arrangement. The expenditure by the CCG under the Better Care Fund in the year to 31 March 2017 was £4.37m (31 March 2016 - £4.36m)

Governing body members Dr Aravinth Balachandran, Dr Chee Mah, Dr Ian McKenzie, Dr Jo Chaudhuri, Dr Jonathan Bryant, Dr Lynn Wright, Dr Qasim Mahmood and Dr Tuan Nguyen; and GP Clinical Leads Dr Nick Morley Smith, Dr Darren Cocker, Dr Julian Mead, Dr Farida Latiff, Dr Neil Banik and Dr Stephanie De Giorgio have declared an interest in Invicta Health CIC. The company is a not for profit organisation that provides GP services. In 2015/16 Governing Body member Dr Ian McKenzie declared an interest in Integrated Care 24 Ltd. The company is a not for profit organisation that provides GP services. The interest ended in 2015/16.

All above Governing Body members and GP Clinical Leads, have also declared an interest in the Channel Health Alliance Limited, a private limited company incorporated on 18 April 2017.

The Department of Health is regarded as a related party. During the year the clinical commissioning group has had a significant number of material transactions (over £1m for the year) with entities for which the Department is regarded as the parent Department. These are:

In addition, the clinical commissioning group has had a number of material transactions with other government departments and other central and local government bodies. Most of these transactions have been with Kent County Council (KCC).

Payments have been made by the CCG to medical practices where members of the governing board are partners. These have not been disclosed as transactions with the individual medical practices are below £400,000 and not considered material.

2016/17

2015/16

25

22 Events after the end of the reporting period

Delegated CCGs 2017/18

23 Financial performance targets

NHS Clinical Commissioning Group have a number of financial duties under the NHS Act 2006 (as amended).NHS Clinical Commissioning Group performance against those duties was as follows:

2016-17 2016-17 2015-16 2015-16

Target Performance Target PerformanceExpenditure not to exceed income 285,205 282,399 276,757 273,946Capital resource use does not exceed the amount specified in Directions 0 0 0 0Revenue resource use does not exceed the amount specified in Directions 282,979 277,439 276,183 273,372Capital resource use on specified matter(s) does not exceed the amount specified in Directions 0 0 0 0Revenue resource use on specified matter(s) does not exceed the amount specified in Directions 0 0 0 0Revenue administration resource use does not exceed the amount specified in Directions 4,414 4,403 4,553 4,423

NHS England recently announced details of the Clinical Commissioning Groups approved to take on greater delegated responsibility or to jointly commission GP services from 1st April 2017. The new primary care co-commissioning arrangements are part of a series of changes set out in the NHS Five Year Forward View.

NHS South Kent Coast CCG has been approved under delegated commissioning arrangements which means that the CCG will assume full responsibility for contractual GP performance management, budget management and the design and implementation of local incentive schemes from 1st April 2017.

NHS South Kent Coast CCG met all of its statutory financial targets, and delivered a 1% surplus in line with directions. The CCG also delivered a 1% top slice to NHS England.

South Kent Coast Clinical Commissioning Group - Annual Accounts 2016-17