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NHS Halton CCG Annual Report and Accounts 2015-2016
ANNUAL REPORT
2015/2016
NHS Halton CCG Annual Report and Accounts 2015-2016
FOREWORD
Welcome to the third Annual Report produced by NHS Halton Clinical
Commissioning Group (CCG). This Annual Report sets out how we fulfilled our
statutory duties and obligations as an NHS organisation in the financial year
2015/16. The document also describes our governance and leadership
arrangements and the work we have taken forward in partnership with local people,
practices, communities and organisations to deliver our commissioning intentions.
Looking back at 2015/16 there have been many highlights that we want to celebrate.
We secured £1.6m of additional, non-recurrent investment through the Prime
Minister’s Challenge Fund to test some new and innovative approaches to improving
general practice services in the borough. We worked with Community Integrated
Care to transform St Luke’s Care Home into a centre for excellence in dementia
care. We opened two new Urgent Care Centres – one in Runcorn and one in Widnes
– to offer an alternative to attendance at a local A&E. These centres have been well
received and utilised by local people and have begun to reduce demand in certain
areas of A&E activity. Our Annual General Meeting was delivered as a month long
art installation at the Brindley Centre in Runcorn. Using the theme of creative
conversations we worked with local artists and local people to engage them in
discussing our work and the importance of health and wellbeing. We also hosted a
visit from the renowned NHS commentator Roy Lilley, who was impressed by our
work in partnership with local community groups and also with Widnes Vikings, our
local rugby league club, in promoting health and wellbeing.
We have also been fortunate enough to have been recognised for our work through
a number of awards and accolades. We were nominated and shortlisted finalists in
the Health Service Journal Awards in three categories – Innovation in Mental Health,
Commissioning for Carers and Innovation in Primary Care. We won the award for
Innovation in Primary Care for our work in developing the Community Wellbeing
Practices model with Wellbeing Enterprises. Our Chair, Dr Cliff Richards, was
chosen as the Inspirational Leader of the Year in the NHS North West Leadership
Academy Awards. Our Director of Transformation, Dave Sweeney, gained the Social
Value Leadership Award for an Individual in the Social Value Awards 2016.
NHS Halton CCG faces a number of challenges as we move towards 2016/17,
challenges that are shared by all public sector organisations of scarce resources and
increasing demands and expectation. Our One Halton programme, developed and
delivered in partnership with local people, communities and organisations, will
formulate and implement our response as a borough to the Five Year Forward View.
Through this programme we will implement the national priorities for 2016/17 and the
2020 goals to close the health and wellbeing gap, the care and quality gap, and the
finance and efficiency gap. One Halton will provide an excellent platform from which
we can engage in place based planning and delivery of health and care within the
NHS Halton CCG Annual Report and Accounts 2015-2016
2
borough, with neighbours in Knowsley, St Helens and Warrington, across Liverpool
City Region and indeed across the whole of Cheshire and Merseyside.
Not all of our work can be covered in an Annual Report. There is so much that we
could share about what we do and how we do it but there is not enough room. We do
hope that you find this Annual Report informative, and we invite you to contact us if
you want to know more about NHS Halton CCG.
Simon Banks
Chief Officer
NHS Halton CCG Annual Report and Accounts 2015-2016
CONTENTS
Pages
Section 1: Performance Report
About Us 1
Review of the Year 14
Our Challenges 18
Financial Performance 18
Looking Forward to 2016/17 and beyond 20
Section 2: Accountability Report
Member Practices 24
Governing Body 25
Audit Committee 26
Statement of Chief Officer’s Responsibilities 27
Annual Governance Statement 29
Remuneration & Staff Report 49
Section 3: The Financial Statements
Auditors Report 56
Financial Statements 59
Notes to the Financial Statements 63
Appendices
Appendix 1 99
Appendix 2 106
Appendix 3 107
NHS Halton CCG Annual Report and Accounts 2015-2016
1
PERFORMANCE REPORT
About us
The NHS was launched in 1948 and was born out of the ideal that good healthcare
should be available to all, regardless of wealth – a principle that remains at its core
today.
The work of the NHS is extremely complex but can be summarised in the diagram1
below:
NHS Halton CCG is the leader of the local NHS and essentially acts as the bank with
a budget that is set by the Government. We are responsible for the planning and
purchasing (commissioning) of health services for the people who are registered with
the 17 GP practices in Halton.
This includes:
Elective hospital care
Rehabilitation care
Urgent and emergency care
Most community health services
Mental health and learning disability services
Prescribing
GP services (from 1st April 2015) 1 NHS Mandate 2014. The Mandate. A mandate from the Government to NHS England: April 2014 to March 2015. Published November 2013. Accessed 01/03/16 https://www.gov.uk/government/publications/nhsmandate-2014-to-2015
NHS Halton CCG Annual Report and Accounts 2015-2016
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We are clinically-led by GPs and other healthcare professionals, including a Chief
Nurse, one registered nurse and a secondary care doctor. Each practice has
nominated a GP as its lead for liaison with the CCG and this group meets regularly.
Additionally, each commissioning intention is owned by a clinical lead who leads
delivery of the work.
Our local population
A significant proportion of Halton’s resident population live in two main towns -
Runcorn and Widnes, whilst a smaller number live in the surrounding parishes and
villages. Halton’s population has increased over the last 10 years and it is now
estimated at approximately 128,000 residents.
Health has been steadily improving in the borough. Overall death rates have
decreased, mostly because of falling death rates from heart disease and cancers.
This means that the people of Halton are living an average of around two years
longer than a decade ago. However, they are still not living as long as the national
average.
Other improvements include:
The number of adults who smoke has fallen.
There has been an improvement in the diagnosis and management of
common health conditions such as heart disease and diabetes.
Detection and treatment of cancers has improved.
The percentage of children and older people having their vaccinations and
immunisations has improved.
The number of adults and children killed and seriously injured in road traffic
accidents has reduced.
The percentage of children participating in at least three hours of sport/
physical activity per week is above the national average.
Ensuring the best services for our population
As well as working with clinicians and healthcare providers to ensure services best
meet the needs of the population, NHS Halton CCG works in partnership with Halton
Borough Council to ensure health and social care is as integrated and joined up as
possible. This is evidenced in our shared vision and values.
NHS Halton CCG has within its constitution an agreed vision to:
involve everybody in the health and wellbeing of the people of Halton,
this is shared with all partners and key stakeholders. The CCG’s vision and values
can be accessed here.
NHS Halton CCG Annual Report and Accounts 2015-2016
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Our Purpose
NHS Halton CCG intends to achieve this vision in a number of ways:
1. We will improve the health and wellbeing of the population of Halton by
preventing ill-health, promoting self-care and independence, arranging local,
community-based support whenever possible and ensuring high quality
hospital services for those who need it. In doing so, we aim to empower and
support local people from the start to the end of their lives
2. We intend to support people to keep well and supported in their homes,
particularly avoiding crises of care that result in hospital admission. Practices
will be the building blocks around which we will support and empower
individuals and communities, promoting prevention, self-care, independence
and resilience.
3. We will work with local people and organisations, including Halton Borough
Council, healthcare providers and the voluntary sector to ensure that the
people of Halton experience smooth, coordinated, integrated and high quality
services to improve their health and wellbeing.
Our approach as a CCG, which is being taken into all our work, particularly in One
Halton, has collaboration as one of 6Cs that guide us. Collaboration recognises that
individuals, communities and organisations need to work together to bring about
meaningful change. It is about achieving the best possible outcome from a
challenging situation as well as the quality of the creative conversations to get them
there. The others Cs are compassion, communication, common purpose,
cooperation and coproduction. We understand these can be difficult to put into
action, but without them we will not deliver the services that local people want and
need.
We are already working with partners to develop a Sustainability and Transformation
Plan, which will support the NHS Five Year Forward View and is consistent with
the One Halton approach. It covers three levels – (i) the Halton health and care
economy, (ii) Halton and neighbouring health and care economies and (iii) Liverpool
City Region. This will provide an opportunity to build on our achievements of recent
years and move at pace to transform health and care services so that they improve
health outcomes, provide excellent levels of quality and are financially and clinically
sustainable.
NHS Halton CCG has been actively involved and engaged in the development of the
Joint Health and Wellbeing Strategy for Halton. Working in partnership with the
Public Health team with the borough council the Joint Strategic Needs Assessment
has been reviewed and each practice has its own practice based version. The Health
and Wellbeing Board partners have reviewed local health needs and clear priorities
have been agreed which have been triangulated across into the One Halton
Transformation programmes
NHS Halton CCG Annual Report and Accounts 2015-2016
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NHS Halton CCG takes its duty to improve quality under Section 14R of the Health
and Social Care Act 2012 seriously. NHS Halton CCG has worked with local people
and all providers to ensure effective measurement and monitoring of quality of
service provision. NHS Halton delivers this through surveillance of both performance
data/intelligence and through soft intelligence from local feedback through
contractual processes alongside other commissioner, and through attendance at
Quality Surveillance processes with NHS England and other key partners.
NHS Halton CCG has worked in partnership with other commissioners to drive
quality improvements in a local provider which has been subject to an enhanced
level of quality surveillance following identification of some potential quality issues.
The provider has worked hard to improve in the area identified and progress has
been made.
NHS Halton CCG has been actively driving improvements in Child and Adolescent
Mental Health services through commissioning of a new pathway designed with
young people delivered by a new provider. The quality performance in this area has
improved in this year. NHS Halton CCG has also been working hard to drive
transformation plans and improvements in services for people with learning
disabilities and whilst continued work is required much progress has been made.
Reducing Inequalities
Every day the NHS in Halton helps people to stay healthy, recover from illness and
live independent and fulfilling lives, and although Halton residents are now living
longer, they are still not living as long as the national average. The local population is
also living a greater proportion of their lives with an illness or health problem that
limits their daily activities and there are significant differences (inequalities) in how
long people live (life expectancy) across the borough. In partnership with our
stakeholders we plan to tackle these inequalities over the next four years to enable
local people to live healthier and happier lives.
Halton’s Health and Wellbeing service brings together a number of teams to combine
the expertise from Public Health, Primary Care and Adult Social Care with the aim of
reducing the health gap between Halton and the England average. The Health and
Wellbeing Board is currently working in collaboration with GPs to identify the 40% of
the Halton population who do not access GP services. Evidence shows this
approach can have the biggest impact on reducing the inequalities gap by identifying
those at risk and targeting effective interventions to prevent and improve ill health
and reduce premature mortality. NHS Halton CCG recognises the inequalities risk to
those in the population who do not access primary care services, the missing 40%,
and has taken action in this year to enable its practices and other provider to offer
alternative access to care and support. Wellbeing Services, Public Health services
and partnerships with Third Sector and other organisations including the Vikings are
part of the work programme. The Primary Care Commissioning Committee is
NHS Halton CCG Annual Report and Accounts 2015-2016
5
reviewing the success of these services
As our population ages it is also predicted that there will be more people with
conditions like dementia and diabetes, and these health challenges will impact upon
service requirements. We want a health and social care system that not only delivers
excellence but is also a positive experience for those who require its services.
Demand for health and social care services is rising and the financial resources we
have to meet this demand are increasingly scarce and constrained. Without action,
these pressures threaten to overwhelm the health and social care system and we will
need to find new ways of delivering services to ensure they meet the future needs of
the population.
Creating a Cultural Manifesto
Three years ago we initiated our Wellbeing services offer to all of the population of
Halton wrapped around all of our GP practices. This year we have given thought to
how we can build upon this to understand how our communities can support each
other to improve health and wellbeing. There are great strengths in the communities
within Halton and there is no doubt that with positive facilitation and peer support our
communities can become stronger and more able to improve wellbeing.
NHS Halton CCG AGM
NHS Halton CCG Annual Report and Accounts 2015-2016
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Our AGM this year was a visual art exhibition held at the Brindley entitled “Creative
Conversations” within which we premiered the AGM film “A Conversation about
Health and Wellbeing”. We initiated many conversations and these continue and
have led to the evolution of a Cultural Manifesto (diagram 1) covering the themes of
Sport, The Arts, The Environment and Social Value.
We have entered into a series of strategic partnerships with Widnes Vikings, The
Bluecoat Gallery Liverpool, Halton Housing Association and Hazlehurst Studio
Runcorn and St Helens and Halton VCA. These partnerships bring the possibility of
engaging with our communities in new, interesting and different ways to increase
physical exercise, creativity, reduce isolation and more positively engage in healthier
activities.
Along with our Local Authority colleagues we have been successful in the Well North
Initiative and the Healthy New Towns project; both emphasising partnership and
entrepreneurship to enhance the possibilities of the built environment, coupled with
connecting and supporting people differently, to enhance Health and Well Being.
This approach is developing and building alliances for us all to understand the real
value of the wealth of cultural activities across the borough, and to be able to enable
and build partnerships to sustain our communities and allow them to invest in their
health and wellbeing again.
Diagram 1 – Cultural Manifesto
Promoting Equality and Diversity
Promoting equality is at the heart of everything NHS Halton CCG does. We want to
ensure we commission services fairly and no individual, community or group is left
behind in the changes that will be made to health services to meet the challenges
the NHS face.
NHS Halton CCG Annual Report and Accounts 2015-2016
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More information about how we have met our statutory requirements is contained in
the Governance Report.
Creating Social Value
The Public Services (Social Value) Act 2012 requires public sector agencies, when
commissioning a public service, to consider how the service they are procuring could
bring added economic, environmental and social benefits.
During 2015/16 NHS Halton CCG continued its Social Value collaborative approach
with Halton Borough Council and a wide range of voluntary sector partners. Halton
BC have implemented our social value charter to work through several procurements
bringing in a wide range of financial savings but more important encouraging added
value and innovation across the whole sector. Social Value is now embedded in all
our contracted providers offering training and social value champions to drive
change.
The Core team based the areas of focus on the MARMOT principles and focus of
need driven by the agreed integrated health and social care priorities
1. Give every child the best start in life
Ensuring local access to pre and postnatal education and wellness support for
all families
2. Enable all children, young people and adults to maximise their
capabilities and have control over their lives
Utilising local people and assets to inspire and empower, supporting all
citizens to overcome barriers and improve their self- worth and aspirations
‘In order to maximise capability, you first have to maximise opportunity’
3. Create fair employment and good work for all
Getting practical help to get the right job [with a living wage], at the right time,
and in the right environment
4. Ensure a healthy standard of living for all
A borough where everyone has a decent home, good connections and
relationships, opportunities and choices, access to good healthcare and a
living wage
5. Create and develop healthy and sustainable places and communities
Supporting a thriving voluntary, community and social enterprise sector with
solutions co-created within communities alongside education and integrated
service support packages for those that need them
6. Strengthen the role and impact of ill health prevention
Build community resilience in tackling poor health through awareness,
engagement, recognition of assets and developing community-led
approaches.
NHS Halton CCG Annual Report and Accounts 2015-2016
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Areas of which our Social Value Procurement Framework has applied to date
include:
Property Consultancy
Security Services
Child & Adolescent Mental Health Services Tier 2
Specialist Youth and Treatment Service
Floating Support Service
Housing Support Service for single Homeless People
Healthy Weight Management Service Level 3
School Nursing Service
Integrated Youth Provision
CCG’s Director of Transformation receives national Social Value Award
Sustainable Development
Sustainable development is ‘development that meets the needs of the present,
without compromising the ability of future generations to meet their own needs’. It is
about balancing the environmental, social and economic decisions so that no one
area outweighs another.
In the past, economic factors have often taken precedence in decision making –
leading to situations we face today such as global warming (where the environment
NHS Halton CCG Annual Report and Accounts 2015-2016
9
has not been considered highly enough in the decision making process), or poverty
and inequality (where social factors have not been considered highly enough in the
decision making process).
For health and social care the precedent is even higher; social and environmental
factors impact on a person’s health and wellbeing. By limiting negative impacts, or
promoting positive ones, we can reduce the need for the treatment of health
conditions and care needs; and in turn, the pressure on the health service as a
whole – leading to a more sustainable healthcare system.
This approach is set out clearly in the National Sustainability Strategy for Health and
Care1 which sets out the requirements on the health and care system to incorporate
sustainable development into its ethos. It describes a sustainable health and care
system being achieved by ‘delivering high quality care and improved public health
without exhausting natural resources or causing severe ecological damage’.
In Autumn 2015, NHS Halton CCG contracted sustainability experts WRM to
undertake a gap analysis of the organisation in readiness for the 2016 requirement
for all NHS Clinical Commissioning Groups to have a Sustainability Plan detailing
their proposals for CO² reductions, efficient energy use and climate change.
Following the gap analysis WRM produced a Sustainable Development Management
Plan (SDMP) 2016-2019. The plan describes how NHS Halton CCG and its partners
can help achieve a sustainable Halton and future proof against risk (e.g. climate
change), requirement (e.g. future legislation) and expectation (e.g. benchmarking
against peers outside of the Borough) by identifying and prioritising:
Best practice across the partnership and providing opportunities to share and
learn
Improvement areas for:
Cost and CO² reduction
Potential savings by scale energy provision
Social and Cultural Value; and
Removing duplication and expanding partnership working
Identifying where legislation, compliance and national requirements are not
yet being met and suggesting steps to rectify this
There are requirements that must be adhered to and met as an individual
organisation and others which can be better met by working in partnership and
sharing responsibilities. Therefore the plan was divided into two halves; part one sets
1 Sustainable, Resilient, Healthy People and Places – A Sustainable Development Strategy for the NHS, Public Health
and Social Care System’
NHS Halton CCG Annual Report and Accounts 2015-2016
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out actions that the CCG must meet and part two tackles the areas that were agreed
with partners during the gap analysis exercise as shared priorities and action plans
against them.
The internal plan will ensure that as a CCG, we will focus on the elements that we
have direct control over and will include:
Having a clear governance structure and accountability;
Showing a strong leadership in sustainable development;
Measuring and reducing our resource impact;
Designing and re-designing services that encourage sustainable care
pathways;
Influencing sustainable development through our supply chain; and
Evaluating and reporting in line with national standards.
The wider plan, named the One Halton Sustainable Development Management Plan,
has a slightly different focus as it supports the collective focus for all the partners.
Common priorities were identified during the gap analysis and grouped into themes
which support all the individual and collective sustainable development objectives for
the CCG and its partners.
While the outcomes for both plans are expected to be delivered over a three-year
time line, the targets within the action plans have 2016/17 targets. The plans
themselves will be reviewed on an annual basis to update and ensure that the best
course of action for the coming year is taken.
Our Estates Strategy and Sustainable Estates
NHS and wider estate is an integral part of what the NHS and its partners can offer
the community. In 2015 NHS Halton CCG launched its Estates strategy. We have
been leading on a piece of work to align our neighbouring CCGs into a consistent
way of managing Estate.
The Five Year Forward View recognises the challenges facing the NHS and presents
the models of care that are required to deal with population changes against a
backdrop of reducing public finances. The new models of care are changing the way
healthcare is provided in a number of ways that will impact on local estates.
Across NHS Halton, St Helens, Knowsley and Warrington CCGs it is recognised that
property and the built environment is an important component to delivering high
quality, accessible, and efficient public services. In response in 2015 the CCG
formed a Strategic Estates Group, tasked with development and on-going
management of a fluid Strategic Estates Plan in order to use property to deliver a
more integrated, accessible, innovative, and efficient range of public services, and as
an enabler to develop shared services, and support community regeneration.
NHS Halton CCG Annual Report and Accounts 2015-2016
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To ensure sustainability we also undertook a future proofing of all our estate. This
gave a very clear map of what we could extend, renovate, share or dispose of.
Patient and Public Involvement
NHS Halton CCG is dedicated to 'Involving everybody in improving the health and
wellbeing of the people of Halton'. This year we have engaged with approximately
3,250 people through a number of different platforms including:
Halton People’s Health Forum
These events take place quarterly and provide the public with an opportunity to listen
to presentations and ask questions on topics they want to know more about. The
events are held in Runcorn and Widnes during afternoons and evenings. Topics
ranged from medicines management to urgent care and cancer. Approximately 280
people have attended these particular events throughout the year.
Patient Participation Groups
The Patient Participation Group (PPG) is a group of patients registered with the
surgery who wish to feedback and help improve their practice and health services
provided. We are one of the only CCGs to have a patient participation group
attached to each of practice. Every 6 months we hold a PPG plus event, which is
about providing support to PPGs and sharing best practice.
CCG Health Show on Halton Community Radio
We have a two hour show on Halton Community Radio each month. The show
provides an opportunity for listeners to find out about key services in the area and
receive health messages. They also have an opportunity to pose questions to the
range of experts being made available.
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One Halton Launch
Events
A number of engagement events have been held throughout the year including the ,
DAD - disability awareness day, Vintage Rally, One Halton launch, Improving
Maternity Services, Care Home summit and Fact or Fiction event with Healthwatch.
These events provided a platform for the CCG to engage with a wide range of
clinicians, partner organisations, representatives from the voluntary sector as well as
patients and public.
Roy Lilley visits the CCG Stand at the Vintage Rally
NHS Halton CCG Annual Report and Accounts 2015-2016
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Partnerships and networks
This year we have strengthened our partnerships with the Widnes Vikings and
Voluntary Sector, who have established links into the community groups. They have
engaged on our behalf with key groups on a range of issues including anti-bullying,
exercise fun sessions, confidence building, health checks, the Urgent Care Centres,
pharmacy promotion and primary care.
Focus on young people
We have striven to improve our engagement with young people. As well as building
links into schools and colleges, we have provided young people with platforms to
begin conversations with us. This has included a young people’s takeover day,
question time with local MP and CCG Governing Body members, and a number of
events for schools who were invited into the CCG and their pupils were able to ask
questions and find out more about the NHS and local services. We have also worked
with a local school to produce a Flu poster campaign with 30 young primary children
and developed our relationship with Cronton and Riverside College’s Health and
Social Care students. As well as our health professionals giving career talks, the
students and tutors are helping to run joint health events with the CCG as part of
their curriculum.
Following our successful World Record Attempt for the most people participating in
an exercise video which involved thousands of local school children and young
people, we undertook a survey to understand the effects of the event. From the
number of schoolchildren who responded:
92% said participating in the World Record event had a positive effect on their
wellbeing
80% said the event had inspired them to keep active
76% said they would take part in similar activities in the future
NHS Halton CCG Annual Report and Accounts 2015-2016
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Review of the Year
NHS Halton CCG is now in its third year of being a statutory organisation. During
that period it has worked hard to establish a strong organisational identity and
culture, and is widely respected among regional partners and NHS organisations.
2015/16 was a landmark year for the organisation and it is now beginning to build a
national reputation for being progressive and innovative
Some of our highlights from the past 12 months include:
Establishing the two Urgent Care Centres
Prime Ministers Challenge Fund (now known as GP Access Fund)
NHS Halton CCG Annual Report and Accounts 2015-2016
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St Luke’s Care Home
CCG Recognition Awards
NHS Halton CCG Annual Report and Accounts 2015-2016
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How have we performed?
During 2015/16 Halton formally opened two new care centres in Halton; one based
on the Halton Hospital site in Runcorn replacing the existing minor injuries unit and
the other replacing the walk-in centre within Widnes. Both centres now offer services
like x-ray and ultrasound which were previously only available via local hospitals. In
addition there is now an agreement in place with the North West Ambulance Service
(NWAS) to receive ambulances for a limited number of conditions at both sites.
NHS Halton CCG Annual Report and Accounts 2015-2016
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Urgent Care Centres
There has been an immediate impact on both A&E attendances and non-elective
admissions at Warrington Hospital. As a direct result of the opening of the Runcorn
site there has been a 7% reduction in Halton patients going to Warrington A&E
department and a reduction of 9% in non-elective activity. The Widnes site opened
later in the year and we are now beginning to see reductions in A&E attendances at
Whiston Hospital. Further development of the urgent care centres will continue into
2016/17 with the introduction of additional paediatric pathways of care, giving
parents an alternative to A&E for children with less serious illnesses and injuries.
Halton has made great strides in improving the 14-day wait for outpatient
appointments for patients referred with suspected cancer by a GP. The CCG is
working closely with GPs to emphasise the importance of attending these
appointments to patients as most breaches were related to patient choice. This
message appears to be hitting home with some of the best monthly figures seen by
the CCG occurring in late 2015.
Our challenges
Waiting times in A&E for the two main local acute hospitals have been challenging
throughout 2015/16 with neither Whiston nor Warrington A&E Departments likely to
achieve the 95% target. This delay has been attributed to both difficulties in
discharging patients (meaning beds are not available for patients attending A&E).
which has been a particular issue at Warrington although we have also seen
increased activity at Whiston. Our development of the urgent care centres has
NHS Halton CCG Annual Report and Accounts 2015-2016
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improved matters for local residents with waiting times often much less than 60
minutes. Halton has also invested in Ambulance liaison officers in both hospitals to
try to relieve the pressure on the ambulance service and has taken a leading role in
attempting to reduce delayed discharges.
The 62-day cancer treatment performance continues to be a challenge for Halton. An
in-depth breach analysis indicates that there is no one cause, trust or tumour group
causing particular concern but the overall effect is causing Halton to fail this
constitutional standard. There is on-going work between the CCG and both trusts to
understand reasons for breaches and any lessons that can be learnt.
Readmissions to hospital within 30 days remain too high. Although significant
progress was made earlier in the year to reduce readmission rates from 20% to
around 16% this improvement has stalled during the second half of 2015/16.
Reducing readmission rates during 2016/17 will remain a priority and the CCG is
working with the local authority on initiatives focussed in care homes.
Recovery rates for people accessing psychological therapies remain below the target
of 50%. We are currently working with our provider to understand why recovery rates
are not improving and to commit to an improvement plan for 2016/17.
By working closely with public health and the local authority to use a place based
commissioning model we will increase and improve the service focussing on
prevention and self- care in Halton. This may involve radical changes to how General
Practice works together or which services are available in community, secondary or
specialist care settings. These plans may require us to work on a larger geographical
footprint with neighbouring CCG’s, and as part of the wider Cheshire and Merseyside
Sustainability and Transformation footprint.
Financial Performance
The CCG’s financial accounts (available at pages 59 – 98 of the Annual Report)
have been prepared under a direction issued by the NHS Commissioning Board
under the National Health Service Act 2006 (as amended). The CCG has produced
them on the basis that it is a going concern as it has no reason to believe that its
future is in doubt, either due to its own performance, or through changes in
legislation.
The CCG receives its funding from NHSE in two parts. The main element is the
Programme Allocation, which is for the commissioning of health services. The
second allocation is the CCG’s Running Cost Allowance, which covers the
administration and management of the CCG. The CCG cannot use its Programme
Allocation to increase the Running Cost Allowance, although an underspend on its
Running Costs can be used to support its Programme Allocation. The CCG must
ensure that health services are delivered within its Programme and Running Cost
Allowance and cash flow controls, as set by NHS England. In addition, it was
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19
expected to maintain the 1% surplus brought forward from 2014/15. The CCG was
successful in meeting both its’ statutory financial duties and the 1% target in both
2015/16 and 2014/15 as indicated in Table 1 below.
Table 1 – Statutory Financial Duties
Statutory Duties Target
£m
Actual
£m
Variance
£m
Met?
Expenditure not to exceed income 211.4 209.5 -1.9 √
Capital resource use does not exceed the
amount specified in Directions 0.0 0.0 0.0 √
Revenue resource use does not exceed the
amount specified in Directions 209.8 207.9 -1.9 √
Capital resource use on specified matter(s)
does not exceed the amount specified in
Directions 0.0 0.0 0.0 √
Revenue resource use on specified matter(s)
does not exceed the amount specified in
Directions 0.0 0.0 0.0 √
Revenue administration resource use does
not exceed the amount specified in
Directions 3.0 2.5 -0.5 √
Although the NHS has to some extent been protected, allocation growth has been
lower than in past years. In 2015/2016, the CCG received the national average uplift
of 2.09% growth (2014/15: 2.14%), so that it received £209.8m (2014/15; £186.7m)
for its Programme and £2.9m (2014/15; £3.08m) for its Running Cost Allocations. In
addition, the CCG also received back its previous year’s surplus of £1.8m. Although
the level of growth was historically low this was managed by the CCG as set out in
the table below to deliver the 1% target surplus agreed with NHSE.
How was the money spent in 2015/16 and 2014/15?
The Clinical Members Group (CMG), Governing Body, management team and staff
of the CCG work hard to ensure that this money is spent wisely, and that it supports
the aim of commissioning high quality healthcare, whilst ensuring effectiveness and
value for money. Allocations to the CCG were spent as shown in Table 2 below.
NHS Halton CCG Annual Report and Accounts 2015-2016
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Table 2 – CCG Allocation
* this figure is net of £1.6m (2014/15; £1.5m) income received by the CCG
The CCG’s Running Cost spending is divided between the costs associated with its
own staff and accommodation, and those of the commissioning support services,
which were purchased from the North West Commissioning Support Unit until 1st
March 2016. At that date CSU services were taken on by the Midlands & Lancashire
Commissioning Support Unit following a procurement exercise undertaken by CCGs
in Merseyside and Cheshire.
Table 3 – CCG Running Costs
*This is the ONS constrained population which equated to 130,253 in 2015/16 (2014/15; 124,626)
Looking Forward to 2016/17 and beyond
Following the General Election and the Government Spending Review, NHSE have
been able to publish firm CCG allocations for the 3 years to 2018/19 and indicative
ones for the 2 years after that. These include programme budget allocations for core
commissioned services and the delegated primary medical services together with the
separate running cost allocation. The allocation publication also showed notional
allocations in respect of specialised services which relate to Halton as NHSE is
considering delegating responsibility for commissioning some of these services to
CCGs.
CCG Spending 2015/16
£m
2014/15
£m
Programme Expenditure
Acute Services 103.4 99.1
Mental Health Services 17.7 17.0
Community Health Services 17.3 22.7
Continuing Care & HBC Pooled Budgets 10.3 11.1
Prescribing & Primary Care Services 45.6 27.9
Other Programme Services 11.1 4.1
Total Programme Spend 205.4 182.0
Running Cost (Admin) Expenditure 2.5 2.9
Total Expenditure* 207.9 184.9
Running Costs (Admin) 2015/16
£m
2015/16
£/head*
2014/15
£m
2014/15
£/head*
CCG Direct Costs Staff 0.95 7.29 1.00 8.20
CCG Direct Non-Pay 0.51 3.92 0.80 7.20
Other CCG Shared Services 0.20 1.54 0.20 1.70
Commissioning Support Unit 0.84 6.45 0.90 7.20
Total Running Costs 2.50 19.20 2.90 24.35
NHS Halton CCG Annual Report and Accounts 2015-2016
21
The CCG will receive a core programme budget funding increase of 3.0% (or £5.7m)
in 2016/17, giving a total programme allocation (excluding notional primary care
allocations) of £191.3m. This includes the pick-up of previously separately funded
allocations for GP Information Technology (£0.33m), the Enhanced Tariff Option
(£0.58m) and transformational Children and Adolescent Mental Health funding
(£0.21m). Taking these items into account, in real terms the growth in 2016/17 is
less than 2.5% rather than the notified 3.0%. Although the NHS has been protected
in relation to other public spending in a period of austerity, this is a historically very
low level of funding growth for the health service which is meeting increasing
demands from the population. The funding growth in 2017/18 and 2018/19 drops to
2.0%. Overall although the CCG does have an increase in its allocation it has many
cost pressures to face. For the first time in 4 years NHS hospital activity tariffs have
been increased by between 1.1% and 1.8% which consumes a significant proportion
of the allocation growth being received by the CCG. NHSE has delegated co-
commissioning responsibility for primary care medical services to the CCG. The
allocation in 2016/17 for these services is £17.6m an increase of 3.6% on 2015/16.
The CCG’s Running Cost Allocation (RCA) was reduced by 10% (or £0.221m) in
2015/16. NHSE have said that the RCA will be kept at the same level for the next 5
years. This allocation is linked to the population registered with CCG’s practices.
The CCG is expected to work collaboratively on a 5 year strategic Sustainability and
Transformation Plan with the other CCGs and NHS Trusts within the Cheshire and
Mersey area. The development of a satisfactory plan will allow access to national
Sustainability and Transformation Funds which totals £2.9 billion by 2017/18. The
CCG’s 5 year strategic plans will need to build into the Sustainability and
Transformation Plan of the wider Cheshire and Mersey area.
The CCG will continue to work closely with Halton Borough Council (HBC) through
the mechanism of the Health and Wellbeing Board. Together they will have a key
role on maintaining and improving performance objectives:
Ensuring that NHS Constitution waiting times targets continue to be met
and preparing for the new mental health performance targets.
Maximising the effectiveness of the Better Care Fund investment
Delivering the vision and challenges set out in the NHS England’s Five
Year Forward View published in October 2014 together with the 9 “must
do’s” set out in the NHSE 2015 planning guidance.
Working collaboratively on the proposals around devolution to the
Liverpool City Region.
In delivering these objectives, the CCG and HBC are mindful of the continued drive
for austerity and reduced level of public spending. In order to cope with this, all
NHS Halton CCG Annual Report and Accounts 2015-2016
22
CCGs continue to work to deliver NHSE’s Quality Innovation Productivity and
Prevention (QIPP) initiative, which is intended to reduce costs so that the NHS can
continue to improve services and meet the growing demand for health care. This will
be supported through further collaboration between the CCG and HBC on the
commissioning of health and social care services. In 2016/17 £9.5m will be made
available from CCG resources to be transferred to a pooled budget for health and
social care, which is to be called the Better Care Fund (BCF). The plans on how this
fund is going to be used in this borough were approved by the Health and Wellbeing
Board, the Governing Body of the CCG and HBC.
The expectation of continuing reduced growth for NHS funding means that the CCG
will continue to be faced with difficult choices on spending priorities. Although the
CCG has been able to deliver its financial duties and targets in 2015/16, the
relatively low levels of funding growth emphasises the importance of the QIPP
agenda to ensure that funds are used to achieve maximum benefit to the health of
the population whilst continuing to deliver the necessary financial targets. Clearly,
given the poor health within the borough and current high demand for secondary
care, there are still very significant challenges to be faced but the organisation with
its partners, is focussed and determined to tackle them.
As well as constraints in relation to future resources, the CCG faces other principal
risks and uncertainties that have the potential to impact on its long-term financial
performance. As part of the planning process undertaken with NHSE, the CCG is
required to quantify its key financial risks and mitigations. The CCG has identified
principal risks as follows:
Activity over performance and associated costs under Payment by
Results (PbR) arrangements;
Increased demand for community services under cost per case Any
Qualified Provider (AQP) arrangements;
The cost and volume of Continuing Healthcare cases and high cost
mental health placements out of areas;
Managing the GP prescribing budget;
Financial risk associated with the transfer of GP primary care budgets;
Achievement of the CCG’s overall QIPP programme.
Through robust internal controls and governance, strong contract management,
tackling prescribing waste and joint pooled budget arrangements with HBC in
relation to Continuing Health Care cases, the CCG will seek to manage and mitigate
these risks. The CCG has received a significant level of assurance in relation to its
financial reporting and budgetary control arrangements and a significant assurance
NHS Halton CCG Annual Report and Accounts 2015-2016
23
opinion in relation to the quality of its internal controls. The internal structures which
will help the CCG deal with these risks are set out in the Governance section of the
Annual Report.
The Spending Review of November 2015 and the subsequent planning guidance to
the NHS, Delivering the Forward View: NHS planning guidance 2016/17–2020/21
has set the tone for the future of the wider health and care system and for NHS
Halton CCG. We have to work with all our partners to accomplish three
interdependent and essential tasks: first, implement the Five Year Forward View;
second, restore and maintain financial balance; and third, to deliver core access and
quality standards for patients.
We have been fortunate to have received, across the whole NHS, an £8.4 billion real
terms funding increase by 2020/21, front-loaded. Even with these resources we still
face significant challenges to deliver the “Triple Aim” of closing the health and
wellbeing gap, the care and quality gap, and the finance and efficiency gap. Simply
we have to deliver better health outcomes, better experience of care and do so more
efficiently by reducing costs, eliminating waste and reducing demand.
We have a clear list of national priorities that we need to deliver in 2016/17. These
priorities will be the focus for our actions, anything else we do will have to deliver
value in terms of answering the “Triple Aim” questions and delivering sustainability
and transformation. We cannot focus our resources on anything that does not
deliver in these domains or does not add or generate value. We will also need to
progress and address the longer term challenges for our local health and care
systems, which are about the shape of care in the future. We will set out how we
intend to do this in two separate and connected plans:
a five year Sustainability and Transformation Plan (STP), place-based on a
Cheshire and Merseyside footprint with local delivery and driving the Five
Year Forward View; and
a one year Operational Plan for 2016/17, organisation based but consistent
with the emerging STP.
Halton has identified that prevention, self-care and wellbeing, supported by a
resilient workforce, new care models, greater partnership working between providers
and across sectors, sustainable finance and improved use of estates, are the key to
transforming Halton’s future health and wellbeing. In the next five years there will be
radical changes to health and care in our borough and beyond. No change is not an
option.
Simon Banks, Chief Officer
26th May 2016
NHS Halton CCG Annual Report and Accounts 2015-2016
24
SECTION 2
ACCOUNTABILITY REPORT
Corporate Governance
Appleton Village Surgery, 2-6
Appleton Village, Widnes, WA8 6DZ
Beaconsfield Surgery, Bevan Way,
Widnes, WA8 6TR
Beeches Medical Centre, 20 Ditchfield
Road, Widnes, WA8 8QS
Brookvale Medical Centre, Hallwood
Health Centre, Hospital Way,
Runcorn, WA7 2UT
Castlefields Health Centre The Village Square, Castlefields,
Runcorn, WA7 2HY
Grove House Practice, St Paul’s
Health Centre, High Street, Runcorn,
WA7 1AB
Heath Road Medical Centre
Heath Road, Runcorn, WA7 5TJ
Murdishaw Health Centre, Gorsewood
Road, Murdishaw, Runcorn, WA7 6ES
Newtown Health Care Centre Widnes HCRC, Oaks Place, Caldwell
Road, Widnes, WA8 7GD
Oaks Place Surgery Widnes HCRC, Oaks Place, Caldwell
Road, Widnes, WA8 7GD
Peelhouse Medical Plaza
Peelhouse Lane, Widnes, WA8 6TN
Tower House Practice St Paul’s Health Centre, High Street,
Runcorn, WA7 1AB
Hough Green Health Park
Hough Green Road, Widnes, WA8 4NJ
Upton Rocks Primary Care Widnes RUFC Car Park, Heath Road,
Widnes, WA8 7NU
Weavervale Practice Hallwood Health Centre, Hospital
Way, Runcorn, WA7 2UT
West Bank Medical Centre 2 Lower Church Street, West Bank,
Widnes, WA8 0NG
Windmill Hill Medical Centre Norton Hill, Windmill Hill, Runcorn,
WA7 6QE
CCG Member Practices
NHS Halton CCG Annual Report and Accounts 2015-2016
25
The Chief Officer is Simon Banks and the Clinical Chair is Dr Cliff Richards.
Governing Body Membership 2015/16
The members of the Governing Body and the Committees on which they serve are
outlined below. Unless stated this covers the period 1st April 2015 – 31st March 2016.
The Declarations of Interest of Governing Body Members are attached at Appendix 3
page 107.
Dr Cliff Richards – Chair
Serves on Service Development Committee; Performance and Finance Committee;
and Primary Care Commissioning Committee from 1st May 2015
Mr Simon Banks – Chief Officer
Serves on Integrated Governance Committee (Chair); Performance and Finance
Committee (Chair); HR & OD Committee; Primary Care Commissioning Committee
from 1st May 2015
Mrs Jan Snoddon – Chief Nurse
Serves on Service Development Committee; Integrated Governance Committee;
Quality Committee (Chair); Better Care Board, Primary Care Commissioning
Committee from 1st May 2015
Mr Paul Brickwood – Chief Finance Officer
Serves on Integrated Governance Committee, Performance & Finance Committee;
Primary Care Commissioning Committee from 1st May 2015
Dave Sweeney – Director of Transformation
Serves on Service Development Committee and Primary Care Commissioning
Committee from 1st May 2015
Eileen O’Meara – Director of Public Health, Halton Borough Council
Serves on Primary Care Commissioning Committee from 1st May 2015
Professor Mike Chester – Secondary Care Doctor
Serves on Quality Committee to 2nd February 2016; Primary Care Commissioning
Committee from 1st May 2015 – 2nd February 2016
Mrs Gill Frame – Registered Nurse
Serves on Audit Committee; Remuneration Committee; Quality Committee; Primary
Care Commissioning Committee from 1st May 2015
Diane Hanshaw – Practice Managers’ representative
Serves on the Quality Committee
Dr Damian McDermott – GP representative
Serves on Service Development Committee; Quality Committee
NHS Halton CCG Annual Report and Accounts 2015-2016
26
Dr Claire Forde – GP representative
Serves on Service Development Committee; Quality Committee
Dr David Lyon – GP representative
Serves on Service Development Committee; Quality Committee
Dr Michael O’Connor – GP representative
Serves on Service Development Committee (Chair); Quality Committee; Audit
Committee; Primary Care Commissioning Committee from 1st May 2015
David Merrill - Lay member
Serves on Audit Committee (Chair); Performance and Finance Committee; Primary
Care Commissioning Committee from 1st May 2015
Ingrid Fife – Lay member
Serves on Audit Committee; Remuneration Committee (Chair); HR & OD Committee
(Chair); Primary Care Commissioning Committee (Chair) from 1st May 2015
David Austin – Lay Member
Serves on Audit Committee; Integrated Governance Committee; Quality Committee
Shahzad Tahir – Lay Member
Serves on Audit Committee; HR & OD Committee
Audit Committee
The names of the individuals forming the Audit Committee throughout the year and
up to the signing of the Annual Report & Accounts are as listed above (with the
exception of David Austin whose term of office ceased on 31st March 2016).
In addition to the six Governing Body members listed, the following are in
attendance to support the Committee:
Simon Banks, Chief Officer (CCG)*
Dr Cliff Richards, Chair (CCG)*
Paul Brickwood, Chief Finance Officer (CCG)
Jan Snoddon, Chief Nurse (CCG)
Catherine Graney, Finance Lead (CCG)
Louise Cobain / Rebecca Brown (MIAA)**
Liz Temple-Murray / Mark Heap (Grant Thornton)**
Roger Causer / Virginia Martin (MIAA – Counter Fraud)***
* The Chief Officer and Chair are only expected to attend one Audit Committee
meeting per year.
NHS Halton CCG Annual Report and Accounts 2015-2016
27
**It is not expected that both of the Grant Thornton representatives or both MIAA
Representatives, will attend each meeting. Usually just one from each organisation
attends.
***The MIAA Counter Fraud representatives are only required to attend when they
have an agenda item. Again, both representatives are not expected to attend when
they do have an agenda item, usually just one attends.
Statement of Chief Officer’s Responsibilities
The National Health Service Act 2006 (as amended) states that each Clinical
Commissioning Group shall have a Chief Officer and that Officer shall be appointed
by the NHS Commissioning Board (NHS England). NHS England has appointed
Simon Banks to be the Chief Officer of NHS Halton Clinical Commissioning Group.
The responsibilities of a Chief Officer, including responsibilities for the propriety and
regularity of the public finances for which the Chief Officer is answerable, for keeping
proper accounting records (which disclose with reasonable accuracy at any time the
financial position of the Clinical Commissioning Group and enable them to ensure
that the accounts comply with the requirements of the Accounts Direction) and for
safeguarding the Clinical Commissioning Group’s assets (and hence for taking
reasonable steps for the prevention and detection of fraud and other irregularities),
are set out in the Clinical Commissioning Group Chief Officer Appointment Letter.
Under the National Health Service Act 2006 (as amended), NHS England has
directed each Clinical Commissioning Group to prepare for each financial year
financial statements in the form and on the basis set out in the Accounts Direction.
The financial statements are prepared on an accruals basis and must give a true and
fair view of the state of affairs of the Clinical Commissioning Group and of its net
expenditure, changes in taxpayers’ equity and cash flows for the financial year.
In preparing the financial statements, the Chief Officer is required to comply with the requirements of the Manual for Accounts issued by the Department of Health and in particular to:
Observe the Accounts Direction issued by NHS England, including the
relevant accounting and disclosure requirements, and apply suitable
accounting policies on a consistent basis;
Make judgements and estimates on a reasonable basis;
NHS Halton CCG Annual Report and Accounts 2015-2016
28
State whether applicable accounting standards as set out in the Manual for
Accounts issued by the Department of Health have been followed, and
disclose and explain any material departures in the financial statements; and,
Prepare the financial statements on a going concern basis.
To the best of my knowledge and belief, I have properly discharged the
responsibilities set out in my Clinical Commissioning Group Chief Officer
Appointment Letter.
Simon Banks
Chief Officer (Accountable Officer)
26th May 2016
NHS Halton CCG Annual Report and Accounts 2015-2016
29
ANNUAL GOVERNANCE STATEMENT
Introduction and context
The Clinical Commissioning Group (CCG) was licenced from 1 April 2013 under
provisions enacted in the Health and Social Care Act 2012, which amended the
National Health Service Act 2006.
As at 1 April 2015, the CCG was licensed without conditions. NHS England is
responsible for oversight of the organisation’s performance. The assurance opinion
for 2015/16 will be published on the CCG website when published by NHS England.
NHS Halton CCG is co-terminus with Halton Borough Council; the borough of Halton
is within Liverpool City Region. The borough is split by the River Mersey which
separates the two towns of Widnes and Runcorn with the surrounding districts which
form the borough. The local authority and NHS Halton CCG has maintained its
strong partnership working to benefit the people of Halton. The CCG is located
within the catchment area of NHS England – Cheshire & Merseyside.
NHS Halton CCG consists of 17 member practices (as listed in Members Report,
page 24). As a membership organisation all 17 GP practices are signed up to its
Constitution, which is reviewed annually through the Members Forum. In 2015/16
the local practices and clinicians have continued to work closely together to improve
the health of local people.
NHS Halton CCG, through strong clinical leadership and engagement, has been able
to create the conditions to develop and implement a commissioning strategy that
aims to improve the health and wellbeing of the people of Halton. The philosophy
enabling change is recognised locally as the One Halton approach. Through this
approach the CCG has begun to implement its strategy for general practice, develop
a range of innovative programmes to support primary care through the Prime
Ministers Challenge Fund (now known as the GP access fund), and started to realise
the benefits of the two Urgent Care Centres for the people of Runcorn and Widnes.
The journey to full integration with the local authority continued its progress
throughout 2015/16, facilitated by the work of the joint appointments and joint
budgetary and commissioning arrangements. The Better Care Board provides
assurance through regular reporting to the Governing Body on the delivery of the
Better Care Fund plan as approved by NHS England. This Board ensures effective
management of pooled budgets. The effectiveness of this Board has been audited
by Merseyside Internal Audit Agency (MIAA) as part of the partnerships audit
NHS Halton CCG Annual Report and Accounts 2015-2016
30
process and an action plan has been agreed to strengthen reporting arrangements
on the Better Care Fund governance framework. Appendix 1, page 99 provides
further detail on the work of this Board.
The vision for the CCG is to deliver improvements in the health of local people using
a wellbeing approach. This requires effective engagement and involvement with
local people and decisions based on social value delivered through strong integrated
commissioning. The strategic objectives that will support the CCG to realise this
vision were refreshed in 2015 and are outlined here. The importance the CCG
places on both engagement and social value and its benefit to Halton is highlighted
on pages 11 of this report.
In its third year of the operation, the CCG has continued to build on its organisational
culture and approach to delivery. There have been challenges for all the CCGs in
this year and for NHS Halton CCG these include:
Consolidating team and capacity to ensure the delivery of commissioning
functions, and mitigating the impact of changes in our commissioning support
unit contract.
Establishing the systems and governance arrangements to undertake
delegated commissioning of primary care (general practice) responsibilities
Maintaining effective partnerships
Financial pressures in the system caused by over performance in some
areas, together with an understanding of Void costs of property and assets.
Attracting professionals of a high calibre to replace key roles on our
Governing Body, as some members reach the end of their term of office in
March 2016.
The future challenges are significant if we, along with our local partners, are to
deliver the aims set out in the national planning guidance for the Five Year Forward
View of closing the health and well-being gap, the care and quality gap, and the
finance and efficiency gap.
To provide assurance in relation to Safeguarding Children and Adults the CCG
produces a Safeguarding Annual Report which will be published in October 2016.
NHS Halton CCG Annual Report and Accounts 2015-2016
31
Scope of responsibility
As Chief Officer, I have responsibility for maintaining a sound system of internal
control that supports the achievement of the clinical commissioning group’s policies,
aims and objectives, whilst safeguarding the public funds and assets for which I am
personally responsible, in accordance with the responsibilities assigned to me in
Managing Public Money. I also acknowledge my responsibilities as set out in my
Clinical Commissioning Group Chief Officer Appointment Letter.
I am responsible for ensuring that NHS Halton Commissioning Group is administered
prudently and economically and that resources are applied efficiently and effectively,
safeguarding financial propriety and regularity.
Compliance with the UK Corporate Governance Code
We are not required to comply with the UK Corporate Governance Code. However,
we have reported on our corporate governance arrangements by drawing upon best
practice available, including those aspects of the UK Corporate Governance Code
we consider to be relevant to the clinical commissioning group and best practice.
NHS Halton Clinical Commissioning Group Governance Framework
The National Health Service Act 2006 (as amended), at paragraph 14L(2)(b) states:
The main function of the governing body is to ensure that the group has made
appropriate arrangements for ensuring that it complies with such generally
accepted principles of good governance as are relevant to it.
The CCG Constitution states that in conducting its business it will, at all times,
observe the following:
the highest standards of propriety involving impartiality, integrity and
objectivity in relation to the stewardship of public funds, the management of
the organisation and the conduct of its business;
the Good Governance Standard for Public Services;
the standards of behaviour published by the Committee on Standards in
Public Life (1995) known as the “Nolan Principles‟
the seven key principles of the NHS Constitution;
the Equality Act 2010
Standards for Members of NHS Boards and Governing Bodies in England
The CCG has developed specific policies on Standards of Business Conduct with
specific guidance on managing conflicts of interest, and Anti-Fraud, Bribery and
Corruption to support staff in understanding their responsibilities to ensure good
governance when conducting business.
NHS Halton CCG Annual Report and Accounts 2015-2016
32
The CCG’s Governance Framework is outlined in the Constitution which can be
accessed here.
NHS Halton CCG Governance Structure
The diagram below shows the current governance structure of the CCG. Further
details of the work of each sub-Committee of the Governing Body is provided in
Appendix 1, page 99
Diagram 2
Members Forum
The Members Forum is held on a quarterly basis and its agenda is set through a
collaborative approach, co-ordinated by the Primary Care Group. This Group reports
to the Service Development Committee and receives advice from the Committee in
determining priorities for debate that are aligned to the CCG commissioning plans.
All staff from practices are encouraged to attend and the format provides a mix of
educational sessions and space for CCG business to be challenged and plans
updated. Each practice has clinical lead representation on the Service Development
Committee and outputs from the Forum that may require further work can be
escalated to this Committee for further deliberation and action. The Committee is
chaired by one of the Governing Body general practice representatives and this
ensures clinical leadership and engagement in the delivery of clinical commissioning
in Halton.
NHS Halton CCG Annual Report and Accounts 2015-2016
33
In 2015 the CCG established two strategic clinical lead roles from its membership to
sit alongside the Executive Management Team of the CCG. These roles link with
the team of clinical leads and commissioning managers and are able to bring a more
in-depth understanding of the CCG business to enable effective debate and clinical
challenge within the Forum.
The decision making powers of the Members Forum are clearly outlined within the
CCG Constitution.
Governing Body
The Governing Body consists of 17 voting members, described in Section 1, page 25
of this Report. In addition there are three non-voting members representing the
local authority (adult and children’s services) and Healthwatch.
The Governing Body meets monthly in public and makes its papers accessible
through the website. Public questions are invited to be submitted in advance of the
meeting and the response is provided at the meeting and recorded in the public
minutes. The CCG encourages public questions and enables other options in
addition to its public Governing Body meeting for local people to raise an issue and
ask questions of the CCG.
The Governing Body has regularly reviewed its effectiveness and identified areas for
on-going development as part of a programme of Governing Body development.
This is encapsulated within the CCG Organisational Development Plan that is
refreshed annually. This year great significance has been placed on succession
planning, in particular for the replacement to the role of clinical chair, the secondary
care doctor and registered nurse, to ensure the CCG retains strong clinical
leadership on its Governing Body. The CCG has co-ordinated a robust recruitment
process to ensure that moving in to 2016/17 the CCG has a strong team on its
Governing Body.
During 2015/16 the CCG has continued to embed its person-centred approach to its
consultation and engagement activity with the support of our four Governing Body
Lay Members; this has been further enhanced with the support of our third sector
partners and through an innovative partnership with The Vikings. Detail of this
activity is provided on the Patient and Public Involvement Section (page 11 - 13) of
this Report. The CCG has reviewed the effectiveness of its Consultation Steering
Group and strengthened its model of consultation for 2016. The CCG’s decision to
create extra capacity through the appointment of four lay members rather than the
mandated two, has enabled greater public involvement in the work of the CCG. The
NHS Halton CCG Annual Report and Accounts 2015-2016
34
result of this investment has led to the decision to continue with four Lay members
as the Governing Body approaches its second three-year cycle from April 2016.
Audit Committee
This is the Committee of the CCG that provides the Governing Body with
independent assurance through the approval and delivery of annual audit plans,
review of internal audit reports and monitoring of actions advised. This year the
governance reviews provided varying assurance levels ranging from High to Limited.
During the year MIAA issued no audit reports with a conclusion of no assurance.
The Audit Committee through an Audit Actions tracker is able to monitor follow up
actions required in response to the finding of audits that were completed within the
audit plan for 2015/16. This showed that 21 recommendations had been accepted
and incorporated into action plans with 5 actions fully implemented, 12 partially
complete, 1 outstanding, and the remainder not yet due.
The Committee receives the Director of Auditors opinion and Annual Report. The
Audit Committee obtains external audit views and opinions ensuring appropriate
review and implementation of national guidance.
The Audit Committee also receives the Board Assurance Framework (BAF) and
Corporate Risk Register (CRR) for review and further challenge. Detail of the activity
of this Committee in 2015/16 is provided Appendix 1, page 99.
Sub Committees of the Governing Body
The Governing Body receives regular reporting from the sub-Committees as listed in
diagram 2 above. The Committees have been mapped against the functions and
duties of the CCG and enable clear escalation, accountability and assurance for the
Governing Body. Both the Performance and Finance Committee and the Quality
Committee are key governance committees that provide significant oversight to the
Governing Body on critical aspects of CCG business. A summary of all sub-
Committees, including attendance and highlights of their work in 2015/16 is attached
in Appendix 1 & 2, pages 99 – 106.
In May 2015 the CCG established a Primary Care Commissioning Committee, as a
sub-Committee of the Governing Body to enable the robust governance of its
delegated responsibility for primary care business. An internal audit review report
completed and issued in February 2016 provided a limited assurance assessment,
with recommendations for improvement to the Terms of Reference, more regular
publication of declaration of interests of all Committee members, and a review of the
Standards of Business Conduct policy to provide appropriate signposting to how
conflicts might arise, and procedures for how the CCG intends to monitor and
NHS Halton CCG Annual Report and Accounts 2015-2016
35
manage performance of practices. An action plan has been implemented to address
these recommendations.
The Better Care Board is a Committee in Common across health and social care and
has a dual reporting function to the Governing Body of both the CCG and Halton
Borough Council. This Committee reports on delivery of the Better Care Fund plan,
reporting in relation to the ‘Pooled Budget’ for Adult Health and Social Care and also
receives reports and assurance from the System Resilience Group (SRG). The SRG
is a joint group across the health economy with the key aim of managing the
response to the needs/pressure within the urgent care system which also monitors
the action plans in the health economy in relation to performance locally in Cancer
Services Improvement Plans.
The CCG has established an annual self-assessment of committee effectiveness of
the sub-Committees of its Governing Body the result of which informs a refresh of
Committee terms of reference and work plan. These self-assessments were further
supported by an internal audit assessment. This demonstrates how the CCG
recognises the vital role that its Committees undertake as part of its overall
governance framework and the importance of on-going development enabling each
Committee to identify potential areas for enhancement.
Other Key Committees and Groups
NHS Halton CCG has been an active member or a number of key committees and
groups, and has also led on the establishment of strategic groups across the wider
health care system. These committees and groups deliver a mix of advisory,
scrutiny, partnership and development functions. The CCG’s clinical engagement
and managerial / leadership presence has ensured and supported the delivery of a
range of statutory and other functions.
In 2015/16 the CCG has undertaken a system leadership role in supporting:
New Models of Care – Acute Care Collaboration Vanguard – Cheshire and
Merseyside Women’s and Children’s Service Partnership
Mid Mersey Stroke Group
Cheshire & Merseyside Urgent & Emergency Care Network
5 Borough footprint Mental Health Group
Cheshire & Merseyside Lung Cancer Group
North West Ambulance Service NHS Trust Strategic Partnership Board
NHS Halton CCG Annual Report and Accounts 2015-2016
36
The Clinical Commissioning Group’s Risk Management Framework
The CCG’s Risk Management framework adopts best practice from the NHS
Executive Controls Assurance risk management standard which includes risk
identification, risk analysis, evaluation and prioritisation and risk treatment. The
Governing Body accepts the importance of the principles of risk management and
recognises the value of taking a strategic, proactive, and comprehensive approach to
the assessment and control of risk.
All those working within the CCG have a responsibility to contribute, directly or
indirectly to the achievement of the CCG’s objectives through the efficient
management of risk. Managers or clinical leads systematically identify and assess
risks associated with the work areas and manage them to ensure they do not impede
the delivery of operational or strategic objectives; these are recorded on the
Corporate Risk Register. Major risks identified on this register are integrated into the
Board Assurance Framework which is recognised by the Governing Body as the tool
to ensure delivery of strategic objectives.
The process for managing risk is embedded in the CCG and clear ownership is
evidenced through the Committee work plans. The Integrated Governance
Committee monitors review of the process; with both the Governing Body
responsible for assessment of risk appetite and defining the risk maturity. This
enables the CCG to be more effective in identifying and managing risk and adds to
the process of assurance for the CCG.
The internal audit plan for 2015/16 included the mandated review of the CCG’s
Assurance Framework locally known as the Board Assurance Framework (BAF).
The conclusion provided the CCG with assurance that the Assurance Framework is
complaint with NHS requirements. Three areas were assessed as amber. The
improvements identified related to risk appetite and how this can be further
evidenced at Governing Body. An action plan to address this has been developed
and reported through the Audit Committee.
NHS Halton CCG Annual Report and Accounts 2015-2016
37
Diagram 3 defines the CCG Risk Process
Risk Assessment
Board Assurance Framework
The Governing Body has monitored the management of its strategic risks during the
2015/16 reporting period. The work carried out in the previous year has led to a
reduction in the number of risks on the current Board Assurance Framework (BAF),
which contains 17 risks across its five strategic objectives. Each risk is clearly
outlined, together with an initial risk rating, current rating and target to achieve.
There are clear controls and mitigating actions alongside assurances processes and
levels.
Every year internal audit review and assess the effectiveness of the BAF and deliver a
view, this year the auditors have identified some areas of good practice and areas for
improvement. An action plan has been developed in response to these findings to be
delivered during 2016.
The 17 strategic risks identified during 2015/16 fall across all five strategic objectives
as shown in Table 4 below (a risk may link to more than one strategic objective).
Only one risk is rated with a high residual score of 16.
NHS Halton CCG Annual Report and Accounts 2015-2016
38
Table 4 – Strategic Risks
Strategic Risk
High
15-25
Moderate
9-14
Low
4-8
To commission services which continually improve the health and wellbeing of Halton residents
1* 1 5
To continually improve and innovate in our engagement with local people and communities to secure their participation in improving their own health outcomes
2
To deliver improvements in the quality of the health and care services accessed by the people of Halton within the resources available to us and our partner organisations
1* 1 1
To deliver all of our statutory duties and commissioning responsibilities effectively, whilst ensuring their our robust constitutional, governance and financial controls in place
1* 3 7
To develop the skills, knowledge and competence of the people who are working with us to create a high performing organisation that will allow us to build effective partnerships with other organisations and develop leadership from within
1 2
*this is one risk relating to three objectives
Corporate Risk Register
The Corporate Risk Register contains 23 risks across the function areas of NHS
Halton CCG. There are 12 risks with a low residual rating, 11 with a medium
residual rating, and none with a high residual rating. The current risk ratings are
shown below.
Table 5 – Corporate Risks
Corporate Risk High
15-25
Medium
9-14
Low
3-8
To commission services which continually improve the health and wellbeing of Halton residents
8 1
To continually improve and innovate in our engagement with local people and communities to secure their participation in improving their own health outcomes
2 1
To deliver improvements in the quality of the health and care services accessed by the people of Halton
8 1
NHS Halton CCG Annual Report and Accounts 2015-2016
39
within the resources available to us and our partner organisations
To deliver all of our statutory duties and commissioning responsibilities effectively, whilst ensuring their our robust constitutional, governance and financial controls in place
8 9
To develop the skills, knowledge and competence of the people who are working with us to create a high performing organisation that will allow us to build effective partnerships with other organisations and develop leadership from within
1
The key risk areas for NHS Halton CCG in this year have been:
Failure to deliver financial targets due to provider over-performance on cost &
volume budgets (assurance obtained through internal Committee monitoring
of contract performance and external assessment via NHSE assurance
processes).
Lack of strategic understanding of CCG property and asset resulting in
financial risk and ineffective use of buildings (assurance obtained the
alignment of local estate working group with strategic asset management
group
Failure to commission quality services will impact detrimentally on the health
and well-being of the people of Halton (mitigation through quality metrics and
assurance obtained through contractual performance monitoring, early
warning dashboard and triangulation of data and knowledge including
attendance at NHSE Quality Surveillance Groups)
The potential risks for NHS Halton CCG in to the coming year relate to:
Financial pressures on programme costs with a £8.4 million saving is required
(mitigation for this risk is via tight financial planning against the 16/17
operational plan, and robust Strategic Transformation Plan)
Failure to commission high quality general medical services effectively and
efficiently (mitigation includes strengthening of governance arrangements
though Primary Care Commissioning Committee, and working relationship
with NHSE, appointment of Primary Care Finance lead to enable robust
finance monitoring)
Failure of the Governing Body to function effectively due to deficits in
behavioural, technical and business competencies. There are a number of
new appointments to key roles on the Governing Body from April 2016,
NHS Halton CCG Annual Report and Accounts 2015-2016
40
(assurance obtained through robust recruitment process and mitigation
against this risk through GB Development Programme and ‘buddy’ system)
Failure of the CCG to develop and deliver the required local Sustainability and
Transformation Plan (STP) and to develop and deliver in partnership with
other CCGs the wider footprint STP.
Failure of the CCG to commission sustainable new models of care as a result
of ineffective integration and partnership arrangements
Assurance Framework Review
The overall objective was to assess the approach by which the organisation
maintains and uses the Assurance Framework to support overall assessment of
governance, risk management and internal controls.
The review included an assessment of the following:
The structure of the Assurance Framework meets the requirements
There is Governing Body engagement in the review and use of the
Assurance Framework
The quality of the content of the Assurance Framework demonstrates clear
connectively with the Governing Body agenda and external environment
The report contained a number of developments / best practice considerations which
have been accepted by the organisation and for which an action plan has been
developed.
The opinion statement:
The organisation’s Assurance Framework meets the NHS Requirements.
There could be greater visibility of the use of the Assurance Framework by the
Governing Body
The Assurance Framework reflects the risks discussed by the Governing Body
Equality, Diversity and Human Rights Responsibilities
We are required to prepare and publish Equality Objectives to meet our Specific
Duty as outlined in the Equality Act 2010. To help us set our Equality Objectives the
CCG undertook an innovative approach to our Equality Delivery Systems (EDS) 2
assessment, which involved extensive engagement with national regional and local
organisations that represent the interests of people who share protected
NHS Halton CCG Annual Report and Accounts 2015-2016
41
characteristics. Our Objectives plan has been significantly revised in light or our
Equality Delivery Systems 2 assessment. Information about our objectives and E &
D plan can be accessed on here. Risks identified through our E & D governance
process are monitored through our risk management framework.
We will continue to work internally, and in partnership with our Providers, community
and voluntary sector and other key organisations to ensure that we advance equality
of opportunity and meet our exacting requirements of the Equality Act 2010.
Health & Safety and Local Security
The CCG is required to comply with relevant Health and Safety Acts and
Regulations, together with industry standards and best practice a relevant to its
operations. We accept our duty to prevent injury and ill health to our staff, visitors,
others who work on our behalf. For this reason we have developed a Health & Safety
Policy and our key objective is to minimise the number and severity of occupational
accidents and illnesses.
In 2015/2016 the CCG had no reportable health & safety incidents.
Emergency Preparedness, Resilience and Response
Clinical Commissioning Groups (CCG’s) are Category 2 responders under the Civil
Contingencies Act 2004. This requires us to share information and cooperate with
other agencies in terms of planning for emergencies.
CCGs are required to ensure they have a Business Continuity and Incident
Response Plan in place which complies with the NHS Core Standards for
Emergency Planning, Response and Resilience (EPRR) and are also required to
assure themselves that their commissioned services have plans in place to respond
to and recover from emergencies.
We certify that the CCG has incident response plans in place, which are fully
compliant with the NHS Commissioning Board Emergency Preparedness Framework
2013. The CCG regularly reviews and makes improvements to its major incident plan
and has a programme for regularly testing this plan, the results of which are reported
to the Integrated Governance Committee & the Governing Body.
The Clinical Commissioning Group Internal Control Framework
The system of internal control within NHS Halton CCG is designed 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.
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42
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.
As Chief Officer I have overall accountability for the management of risk and
discharge this duty by demonstrating leadership in the identification, promotion and
involvement of risk management; ensuring the development of policies and
procedures for the CCG in relation to risk management; and ensuring that senior
officers have managerial responsibility for supporting Committees to monitor risk and
provide regular reports to the Governing Body.
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 CCG, other organisations and to individuals that personal
information is dealt with legally, securely, efficiently and effectively.
The Integrated Governance Committee receives quarterly reports from the
Information Governance Working Group to provide evidence of progress against the
standards required for the CCG. An internal audit review in 2015/16 has received
significant assurance for its ability to demonstrate evidence in support of Level 2
Information Toolkit compliance.
NHS Halton CCG has no information breaches to report within the Statement of
Information Governance.
NHS Halton CCG places high importance on ensuring there are robust information
governance systems and processes in place to help protect patient and corporate
information, under the internal executive guidance of the SIRO and Caldicott
Guardian, and nominated deputies. We have established an information governance
management framework and information governance processes and procedures in
line with the information governance toolkit. All staff complete annual information
governance training and have access to the staff handbook to ensure they are aware
of their information governance roles and responsibilities.
There are processes in place for incident reporting and investigation of serious
incidents. Information risk assessment and management procedures have been
developed and the Information Governance Working Group is embedding an
information risk culture throughout the organisation against identified risks.
NHS Halton CCG Annual Report and Accounts 2015-2016
43
Review of Economy, Efficiency & Effectiveness of the Use of Resources
The CCG has an obligation to use its resources efficiently, effectively and
economically. In addition it must meet financial requirements as set out by NHS
England. This includes delivering a surplus position over and above a balanced
budget. In order to mitigate and control risks associated with the CCGs use of
resources, organisational financial health is checked and reported to the Governing
Body on a monthly basis. The Governing Body has also delegated responsibility for
some aspects of financial internal control to the Performance & Finance Committee.
The CCG has produced financial plans to ensure and demonstrate that it has robust
financial mechanisms in place. These have been reported through the Performance
& Finance Committee to the Governing Body, providing assurance to the Governing
Body that the organisation is effectively managing its resources and understanding
the key financial risks.
In addition to internal controls, the CCG produces robust Quality, Innovation,
Productivity and Prevention (QIPP) plans which aim to mitigate financial pressures
and improve healthcare for the local population. The CCG also provides information
to NHS England to report upon how the CCG’s resources have been spent. The
CCG also undertakes a self-assessment against the externally monitored financial
indicators within ‘Component 4’ (Financial Management) of the national CCG
Assurance Framework which is reported through the Audit Committee.
The CCG also receives via its external auditors the VFM (Value for Money)
assessment which reviews how the CCG makes decisions to ensure the probity and
appropriateness of spend as part of the external audit process.
Feedback from Delegation Chains regarding Business, Use of Resources and
Responses to Risk
The CCG had been given delegated commissioning authority from NHS England for
general practices services from 1st April 2015. The Governing Body has delegated
responsibility for Commissioning of Primary Care to the Primary Care Commissioning
Committee. This Committee, (which includes representation in attendance from
NHS England) reports monthly to the Governing Body, providing assurance to the
Governing Body that the organisation is developing robust governance arrangements
to effectively managing its resources and understand its key financial risks in relation
to primary care commissioning . The CCG also completes a quarterly self-
assessment of primary care commissioning which is submitted nationally to NHS
England as part of the quarterly CCG external assurance process.
To support the development of this Committee, an internal audit was undertaken
which provided limited assurance and a subsequent action plan is being monitored
NHS Halton CCG Annual Report and Accounts 2015-2016
44
through the Audit Committee.
Review of the effectiveness of Governance, Risk Management & Internal
Control
As Chief Officer, I have responsibility for reviewing the effectiveness of the system of
internal control within the Clinical Commissioning Group.
Capacity to Handle Risk
The Risk Management Strategy has been reviewed and approved by the Governing
Body; this outlines the roles and responsibility for handling risks of all staff and places
great emphasis on the role of all staff to be involved within the risk process. The CCG
has procured DATIX a web based risk management system that has been tailored
specifically for the organisation’s needs.
The Chief Nurse provides expert advice and guidance to Committees and staff on
how to identify and manage risk, and risk management features in the annual
Governing Body Development Plan. Sub-Committees are expected to report to the
Governing Body on monitoring and mitigation of risks for which they are responsible.
In addition to the approved Risk Management Strategy further guidance has been
developed for use by staff in handling risk.
Review of Effectiveness
My review of the effectiveness of the system of internal control is informed by the
work of the internal auditors and the executive managers and clinical leads within the
clinical commissioning group who have responsibility for the development and
maintenance of the internal control framework. I have drawn on performance
information available to me. My review is also informed by comments made by the
external auditors in their annual audit letter and other reports.
Our assurance framework provides me with evidence that the effectiveness of
controls that manage risks to the clinical commissioning group achieving its
principles objectives have been reviewed.
I have been advised on the implications of the result of my review of the
effectiveness of the system of internal control by the Governing Body, the Audit
Committee and Integrated Governance Committee and a plan to address
weaknesses and ensure continuous improvement of the system is in place.
NHS Halton CCG Annual Report and Accounts 2015-2016
45
Director of Internal Audit Opinion
The purpose of the Director of Audit Opinion is to contribute to the assurances
available to underpin the Governing Body’s own assessment of the effectiveness of
the organisation’s system of internal control. This opinion will therefore assist the
Chief Officer and the Governing Body in the completion of its Annual Governance
Statement.
The Director of Audit Opinion is based upon the work completed and includes an
opinion on the Assurance Framework and the risk based audit assignments across
the critical business systems, along with contributions to improving governance, risk
management and internal control.
Opinion
My overall opinion is:
Significant Assurance can be given that that there is a generally sound
system of internal control designed to meet the organisation’s objectives, and
that controls are generally being applied consistently. However, some
weaknesses in the design or inconsistent application of controls put the
achievement of a particular objective at risk
The overall opinion is provided in the context of the level of risk awareness of
the CCG and the targeted and effective use of Internal Audit as part of the
system of internal control. Going forward, the CCG faces a number of
environmental challenges, specifically the further integration of local health
and care systems, with the introduction of the Sustainability and
Transformation Plans. This alongside the challenges of performance delivery
and financial performance will need to be effectively managed in the new
financial year.
During the year, Internal Audit issued three audit reports with a conclusion of limited
assurance. These related to co-commissioning, partnership governance, and CSU
business continuity. All completed audits have actions plans agreed, the
performance of which is reviewed and monitored through the Audit committee. All
14/15 audit action plans have been delivered and reviews have been completed by
the auditors.
NHS Halton CCG Annual Report and Accounts 2015-2016
46
Table 6 MIAA Audit Summary
New in year Audits Assurance level High Medium Low
Commissioning Support
Unit Business continuity
Limited 1 2 0
Partnerships Limited 2 1 0
Financial High 0 0 0
HR/ESR Significant 0 2 0
Better Care Fund Significant
Co Commissioning
Baseline assessment
Limited 1 3 1
Information Governance
Toolkit
Significant 0 0 0
Committee Effectiveness Not assessed Actions for each committee in
relation to review of terms of
reference and membership.
Assurance Framework
Opinion
Meet Requirements 5
Safeguarding Review To be completed
Data Quality
During 2015/16 reporting to the Board has been adapted and data quality has
evolved to meet the expectation of Governing Body members. The data on quality
performance is provided through the North West Commissioning Support Unit. This
is analysed by the internal Contracting and Performance Team who provide the
reports to the Quality Committee and Performance and Finance Committees. The
Governing Body has sight of the Corporate Performance Report.
Any issues identified relating to the quality of data is risk assessed and discussed at
Governing Body. In 2015/16 one of our main providers switched to a new patient data
recording system and this resulted in some data items being incorrect. These issues
are being addressed at part of an on-going programme and when correct data flows this
has been reported in the corporate performance report. Incorrect data is not reported
and a narrative had been provided to explain the issue and what is being done by the
provider to address it. As at 31st January 2016 there remains one incorrect data flow
relating to diagnostic waiting times.
Having assessed the quality of data submitted to and reviewed by the Governing Body,
NHS Halton CCG Annual Report and Accounts 2015-2016
47
I am assured that the data is of sufficient quality that the Governing Body can carry out
its duties.
Business Critical Models
The CCG has produced and maintains an organisational Information Asset Register
which identifies business critical assets for each service within the CCG, including the
shared finance service and hosted services. Information Asset Owners and
Information Asset Administrators have been assigned and all information assets are
regularly reviewed. The SIRO is responsible for identifying and managing the
information risks and the Caldicott Guardian oversees risk relating to patient data.
Data Flow mapping has been completed which enables an understanding of the
flows of information related to all information assets with the Information Asset
Register. Information Asset Owners are responsible for providing updates and
highlighting any risks to the SIRO.
The CCG is further supported through a contract arrangement with Midlands &
Lancashire Commissioning Support Unit.
NHS Halton CCG is one of six local NHS organisations that receive its IT services
from St Helens & Knowsley Health Informatics Service. There is a joint Service Level
Agreement between the parties who have agreed to share their health informatics
service with the intention o f pooling their collective resources and expertise in
order to ensure that they have the capacity, capability and flexibility required for a
21st century health informatics service. The partner organisations are committed to
ensuring that their shared informatics service provides value for money for their
respective organisations.
The CCG is represented on the Partnership Board that is responsible for the
oversight of the service, and has both clinical and managerial representation on the
sub-group of the Board.
NHS Halton CCG confirms that an appropriate framework and environment is in
place to provide quality assurance of business critical models, in line with the
recommendations in the MacPherson report. All business critical models have been
identified and information about quality assurance processes for those models has
been provided to the Analytical Oversight Committee, chaired by the Chief Analyst in
the Department of Health.
Data Security
We have submitted a satisfactory level of compliance with the information
governance toolkit assessment, achieving Level 2 as required. This submission has
NHS Halton CCG Annual Report and Accounts 2015-2016
48
been reviewed by the internal audit team and received a significant assurance
assessment.
The CCG has not had any Serious Untoward Incidents relating to data security
breaches.
Discharge of Statutory Functions
I can confirm that the correct arrangements are in place for the CCG to discharge its
statutory functions. As outlined in the organisation’s constitution arrangements in
place for the discharge of statutory functions that were developed with external legal
input, to ensure compliance with the relevant legislation.
In light of the Harris Review, the clinical commissioning group has reviewed all of the
statutory duties and powers conferred on it by the National Health Service Act 2006
(as amended) and other associated legislative and regulations. As a result, I can
confirm that the clinical commissioning group is clear about the legislative
requirements associated with each of the statutory functions for which it is
responsible, including any restrictions on delegation of those functions.
Responsibility for each duty and power has been clearly allocated to a lead Director.
Directorates have confirmed that their structures provide the necessary capability
and capacity to undertake all of the clinical commissioning group’s statutory duties.
Conclusion
The CCG has no significant internal controls issues to report. Throughout the year
some deficiencies were identified through proactive self-assessment audits as well
as internal and audits. Any issues identified have been fully rectified by the
development and implementation of action plans to address the risks to the
Governance framework. I am satisfied with the work of the CCG in the financial year
of 2015/16 and look forward to continuing to deliver the CCG’s vision and progress
its priorities.
Simon Banks
Chief Officer (Accountable Officer)
26th May 2016
NHS Halton CCG Annual Report and Accounts 2015-2016
49
Remuneration and Staff Report
As a commissioner of health services, we believe health and wellbeing applies as
much to our employees as it does to our local population. Wellbeing can be
described as the creation of an environment which allows employees to achieve their
full potential. During 2015 we have continued to remain fully committed to the health
and positive wellbeing of our employees and understand that the health and
wellbeing of the workforce is crucial to the delivery of the improvements in patient
care to the people of Halton.
We continue to be committed to the health and positive wellbeing of our staff and we
want to do as much as we can to enable staff to be at their best, energised, healthy
and motivated. Our local staff survey has been designed to help provide an
indication as to how staff feel the CCG is working, whether we are working within our
values and principles, how their roles are contributing to the success of the CCG and
where there could be areas for improvement.
Employee consultation
Excellent partnership arrangements with external organisations and Trade Unions
ensure that we openly discuss, challenge and agree initiatives that have a positive
impact on both our staff and our organisation. NHS Halton CCG and Staff Side
organisations have a common objective of ensuring the efficient operation and
success of the organisation for the benefit of all, through working in partnership to
secure these aims and objectives. To enable this we formed a Partnership Forum.
The Forum provides a formal vehicle for the agreement of types, forms and content
of information and general consultative communication exchanges between
managers and staff. Our Partnership Agreement provides a clear framework within
which employment relations will be conducted effectively within NHS Halton CCG.
Disabled Employees
NHS Halton CCG has duties to meet under the Equality Act 2010 in relation to
workforce and organisational development. The CCG has therefore taken positive
steps to ensure that policies across the CCG deal with equality implications around
recruitment and selection, pay and benefits, flexible working hours, training and
development, policies around managing employees and protecting employees from
harassment, victimisation and discrimination. Through our recruitment processes the
CCG promotes the ‘Two Ticks’ symbol on all vacancies, to promote the CCGs
commitment to employing disabled people.
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50
Equal Opportunities
NHS Halton CCG is committed to equality of opportunity for all employees and is
committed to employment practices, policies and procedures which ensure that no
employee, or potential employee, receives less favourable treatment on the grounds
of gender, race, colour, ethnic or national origin, sexual orientation, marital status,
religion or belief, age, trade union membership, disability, offending background,
domestic circumstances, social and employment status, HIV status, gender
reassignment, political affiliation or any other personal characteristic as outlined in
the Equality Act (2010) and any other status covered by the Human Rights Act
(1998). Diversity is to be viewed positively and, in recognising that everyone is
different, the unique contribution that each individual’s experience, knowledge and
skills can make is valued equally.
Staff Composition Tables (Audited)
Breakdown of persons by gender that are part of the CCG by headcount as at 31st
March 2016
Table 7
Female Male
Governing Body members 5 8
Other members of staff 55 8
Very Senior Managers (on GB) 1 2
The table below shows the average staff numbers which reconciles to note 5 in the
accounts
Table 8
Staff by Occupation Code Total
General Medical Practitioner (Public Health & Community Services) 0.40
Senior manager Central functions 1.00
Manager Central functions 8.17
Clerical & administrative Central functions 19.77
Manager Community Services 10.27
Other 1st level (Level 1 - Sub Part 1) Community Services 2.02
Scientist Pharmacy 2.90
Technician Pharmacy 1.30
45.83
NHS Halton CCG Annual Report and Accounts 2015-2016
51
Table 9 provides details of Senior Managers by Pay Band
Pay multiples (Audited)
Reporting bodies are required to disclose the relationship between the remuneration
of the highest paid director in their organisation and the median remuneration of the
organisation's workforce.
The banded remuneration of the highest paid member of the Governing Body in NHS
Halton CCG in the financial year 2015-16 was £150,000 - £155,000 (2014-15
£150,000 - £155,000). This was 4.57 times (2014-15 4.96 times) the median
remuneration of the workforce, which was £33,372 (2014-15 £30,576).
In 2015-16 no employees received remuneration in excess of the highest-paid
member of the Governing Body. In 2015-16, remuneration ranged from £0-5,000 to
£150,000-155,000 (2014-15; £5,000-10,000 to £150,000-155,000).
Total remuneration includes salary, non-consolidated performance-related pay,
benefits-in-kind. It does not include severance payments, employer pension
contributions and the cash equivalent transfer value of pensions.
Sickness Absence Data
In the rolling 12 month period ending March 2016 there were 481 wte days lost to
sickness absence. At the end of March 2016 the headcount of the CCG was 44
giving an average total of 10.9 days sickness absence per employee
Expenditure on consultancy
The amount spent on consultancy is £81,582
Exit packages
There were no exit packages or severance payments in 2015/16
Off Payroll Engagements
There were no Off-payroll engagements as at 31 March 2016 for more than £220 per
day and that last longer than six months.
Senior managers by
Band
Average
Numbers
Very Senior Manager 3.00
Band 9 1.00
Band 8D 0.00
Band 8C 0.00
Total 4.00
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52
There are no new off-payroll engagements between 1 April 2015 and 31 March 2016
for more than £220 per day and that last longer than six months
The following are off-payroll engagements which relate to Governing Body members.
All but one of the payments to Governing Body Members are made to individual
GP’s practices and therefore assessed to be low risk with no assurance necessary
that the individual is paying the right amount of tax.
Number of off-payroll engagements of board members, and/or senior officers with significant financial responsibility, during the year
0
Number of individuals that have been deemed “board members, and/or senior officers with significant financial responsibility” during the financial year. This figure includes both off-payroll and on-payroll engagements
16
NHS Halton CCG Annual Report and Accounts 2015-2016
53
Table 10 – Salaries and Allowances 2015/16 (Audited)
* Legal Chief Officer
Notes:
1. Paul Brickwood’s remuneration is split across NHS St Helens CCG, NHS Knowsley CCG and NHS Halton CCG. The remuneration costs shown represent NHS St Helens CCG's share of the total remuneration paid by the three CCG’s. The total remuneration paid was within the band £115,000 to £120,000 and the allocation of cost to the CCG is based on percentages per the population size. St Helens 41%, Knowsley 33% and Halton 26%.
2. Professor M Chester left his post on 31st March 2016
3. Dr D McDermott left his post on 31st March 2016
4. David Austin left his post on 31st March 2016
5. Dr D Lyon left his post on 31st March 2016
Name Title Note Salary Expense Performance Long term All pension- Total Salary Expense Performance Long term All pension- Total
(bands of payments pay and performance related benefits (bands of payments pay and performance related benefits
£5,000) (rounded to bonuses pay and bonuses £5,000) (rounded to bonuses pay and bonuses
the nearest (bands of (bands of (bands of (bands of the nearest (bands of (bands of (bands of (bands of
£00) £5,000) £5,000) £2,500) £5,000) £00) £5,000) £5,000) £2,500) £5,000)
£'000 £'00 £'000 £'000 £'000 £'000 £'000 £'00 £'000 £'000 £'000 £'000
Dr C Richards Chair 60-65 1 0 0 0 60-65 60-65 1 0 0 0 60-65
David Merrill Deputy Chair 10-15 0 0 0 0 10-15 10-15 0 0 0 0 10-15
Simon Banks Chief Officer * 105-110 27 0 0 20-22.5 125-130 105-110 19 0 0 0-2.5 105-110
Jan Snoddon Chief Nurse 85-90 54 0 0 120-122.5 215-220 75-80 55 0 0 20-22.5 100-105
David Sweeney Director of Transformation 85-90 60 0 0 45-47.5 140-145 0 0 0 0 0 0
Dr M O Connor GP Board Member 15-20 0 0 0 0 15-20 15-20 0 0 0 0 15-20
Dr C Forde GP Board Member 15-20 0 0 0 0 15-20 15-20 0 0 0 0 15-20
Paul Brickwood Chief Finance Officer 1 25-30 11 0 0 0-2.5 30-35 25-30 11 0 0 0 30-35
Prof M Chester GP Board Member 2 15-20 0 0 0 0 15-20 15-20 0 0 0 0 15-20
Dr D McDermott GP Board Member 3 15-20 0 0 0 0 15-20 15-20 0 0 0 0 15-20
David Austin Lay Member 4 5-10 0 0 0 0 5-10 5-10 0 0 0 0 5-10
Dr D Lyon GP Board Member 5 15-20 0 0 0 0 15-20 15-20 0 0 0 0 15-20
D Hanshaw Practice Manager 0-5 0 0 0 0 0-5 0-5 0 0 0 0 0-5
G Frame Nurse 10-15 0 0 0 0 10-15 10-15 0 0 0 0 10-15
Ingrid Fife Lay Member 5-10 0 0 0 0 5-10 5-10 0 0 0 0 5-10
Shahzad Tahir Lay Member 5-10 0 0 0 0 5-10 5-10 0 0 0 0 5-10
2015-16 2014-15
NHS Halton CCG Annual Report and Accounts 2015-2016
54
Table 11 Pension Benefits (Audited)
Certain members do not receive pensionable remuneration therefore there will be no entries in respect of pensions for certain
members.
The pension entitlement above is the total pension entitlement for each Director, is not split across other organisations and may
have been partly accrued in a non senior manager capacity.
** On reaching Pensionable age employees do not have a Cash Equivalent Transfer Value.
Name Title Real increase Real increase Total accrued Lump sum at Cash Cash Real increase Employer's
in pension in pension pension at pension age Equivalent Equivalent in Cash contribution
at pension age lump sum at pension age related to Transfer Transfer Equivalent to
(bands of pension age 31st March 2016 accrued Value at 31 Value at 31 Transfer stakeholder
£2,500) (bands of (bands of pension at 31 March 2016 March 2015 Value pension
£2,500) £5,000) March 2016
(bands of
£5,000)
£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000
Simon Banks * Chief Officer 0-2.5 0 20-25 30-35 252 322 0 0
Simon Banks Chief Officer 0-2.5 0 0-5 0 17 0 17 0
Paul Brickwood Chief Finance Officer 0-2.5 0-2.5 50-55 160-165 1153 1124 28 0
David Sweeney Director of Transformation 0-2.5 2.5-5 20-25 65-70 354 328 25 0
David Sweeney Director of Transformation 0-2.5 0 0-5 0 16 0 16 0
Jan Snoddon ** Chief Nurse 5-7.5 15-17.5 40-45 125-130 0 0 0 0
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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
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. This may be for more than just their service
in a senior capacity to which disclosure applies (in which case this fact will be noted
at the foot of the table). The CETV figures and the other pension details include the
value of any pension benefits in another scheme or arrangement which the individual
has transferred to the NHS pension scheme. They also include any additional
pension benefit accrued to the member as a result of their purchasing additional
years of pension service in the scheme at their own costs. 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.
Simon Banks
Chief Officer
26th May 2016
NHS Halton CCG Annual Report and Accounts 2015-2016
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INDEPENDENT AUDITOR’S REPORT TO THE MEMBERS OF THE GOVERNING BODY OF HALTON CLINICAL COMMISSIONING GROUP We have audited the financial statements of Halton CCG for the year ended 31 March 2016 under the Local Audit and Accountability Act 2014 (the "Act"). The financial statements comprise the Statement of Comprehensive Net Expenditure, the Statement of Financial Position, the Statement of Changes in Taxpayers’ Equity, the Statement of Cash Flows and the related notes. The financial reporting framework that has been applied in their preparation is applicable law and International Financial Reporting Standards (IFRSs) as adopted by the European Union, and as interpreted and adapted by the 2015/16 Government Financial Reporting Manual (the 2015/16 FReM) as contained in the Department of Health Group Manual for Accounts 2015/16 (the 2015/16 MfA) and the Accounts Direction issued by the NHS Commissioning Board with the approval of the Secretary of State as relevant to the National Health Service in England (the Accounts Direction). We have also audited the information in the Remuneration and Staff Report that is subject to audit, being:
the table of salaries and allowances of senior managers and related narrative notes on page 53,
the table of pension benefits of senior managers and related narrative notes on page 54,
the table of exit packages on page 51,
the analysis of staff numbers on page 50; and
the tables of pay multiples and related narrative notes on page 51.
This report is made solely to the members of the Governing Body of Halton CCG, as a body, in accordance with Part 5 of the Act and as set out in paragraph 43 of the Statement of Responsibilities of Auditors and Audited Bodies published by Public Sector Audit Appointments Limited. Our audit work has been undertaken so that we might state to the members of the Governing Body of the CCG those matters we are required to state to them in an auditor's report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the CCG and the members of the Governing Body of the CCG, as a body, for our audit work, for this report, or for the opinions we have formed. Respective responsibilities of the Chief Officer (Accountable Officer) and auditor As explained more fully in the Statement of Chief Officer’s Responsibilities, the Chief Officer (Accountable Officer) is responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view and is also responsible for ensuring the regularity of expenditure and income. Our responsibility is to audit and express an opinion on the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards 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 and income in accordance with the Code of Audit Practice prepared by the Comptroller and Auditor General as required by the Act (the "Code of Audit Practice"). As explained in the Annual Governance Statement the Chief Officer (Accountable Officer) is responsible for the arrangements to secure economy, efficiency and effectiveness in the use of the CCG's resources. We are required under Section 21 (1)(c) of the Act to be satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources and to report our opinion as required by Section 21(4)(b) of the Act.
NHS Halton CCG Annual Report and Accounts 2015-2016
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We are not required to consider, nor have we considered, whether all aspects of the CCG's arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively. Scope of the audit of the financial statements An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of: whether the accounting policies are appropriate to the CCG’s circumstances and have been consistently applied and adequately disclosed; the reasonableness of significant accounting estimates made by the Chief Officer (Accountable Officer); and the overall presentation of the financial statements. In addition, we read all the financial and non-financial information in the Annual Report to identify material inconsistencies with the audited financial statements and to identify any information that is apparently materially incorrect based on, or materially inconsistent with, the knowledge acquired by us in the course of performing the audit. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report. In addition, we are required to obtain evidence sufficient to give reasonable assurance that the expenditure and income recorded in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them. Scope of the review of arrangements for securing economy, efficiency and effectiveness in the use of resources We have undertaken our review in accordance with the Code of Audit Practice, having regard to the guidance on the specified criteria, issued by the Comptroller and Auditor General in November 2015, as to whether the CCG had proper arrangements to ensure it took properly informed decisions and deployed resources to achieve planned and sustainable outcomes for taxpayers and local people. The Comptroller and Auditor General determined these criteria as that necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the CCG put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2016, and to report by exception where we are not satisfied. We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we undertook such work as we considered necessary to form a view on whether, in all significant respects, the CCG had put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources. Opinion on financial statements In our opinion the financial statements:
give a true and fair view of the financial position of Halton CCG as at 31 March 2016 and of its expenditure and income for the year then ended; and
have been prepared properly in accordance with IFRSs as adopted by the European Union, as interpreted and adapted by the 2015/16 FReM as contained in the 2015/16 MfA and the Accounts Direction.
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Opinion on regularity In our opinion, in all material respects the expenditure and income recorded in the financial statements have been applied to the purposes intended by Parliament and the financial transactions in the financial statements conform to the authorities which govern them. Opinion on other matters In our opinion:
the parts of the Remuneration and Staff Report to be audited have been properly prepared in accordance with IFRSs as adopted by the European Union, as interpreted and adapted by the 2015/16 FReM as contained in the 2015/16 MfA and the Accounts Direction; and
the other information published together with the audited financial statements in the annual report and accounts is consistent with the financial statements.
Matters on which we are required to report by exception We are required to report to you if:
in our opinion the governance statement does not comply with the guidance issued by the NHS Commissioning Board; or
we refer a matter to the Secretary of State under section 30 of the Act because we have reason to believe that the CCG, or an officer of the CCG, is about to make, or has made, a decision which involves or would involve the body incurring unlawful expenditure, or is about to take, or has begun to take a course of action which, if followed to its conclusion, would be unlawful and likely to cause a loss or deficiency; or
we issue a report in the public interest under section 24 of the Act; or
we make a written recommendation to the CCG under section 24 of the Act; or
we are not satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of its resources for the year ended 31 March 2016.
We have nothing to report in these respects. Certificate We certify that we have completed the audit of the accounts of Halton CCG in accordance with the requirements of the Act and the Code of Audit Practice. Mark Heap for and on behalf of Grant Thornton UK LLP, Appointed Auditor Royal Liver Building, Liverpool, L3 1PS 27 May 2016
NHS Halton CCG Annual Report and Accounts 2015-2016
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SECTION 3
FINANCIAL STATEMENTS
NHS Halton CCG Annual Accounts 2015-16
The notes on pages 63 to 98 form part of this statement
Statement of Comprehensive Net Expenditure for the year ended
31-March-2016
2015-16 2014-15
Note £000 £000
Total Income and Expenditure
Employee benefits 4.1.1 2,889 1,841
Operating Expenses 5 206,647 184,570
Other operating revenue 2 (1,616) (1,513)
Net operating expenditure before interest 207,920 184,898
Investment Revenue 8 0 0
Other (gains)/losses 9 0 0
Finance costs 10 0 0
Net operating expenditure for the financial year 207,920 184,898
Net (gain)/loss on transfers by absorption 11 0 0
Total Net Expenditure for the year 207,920 184,898
Of which:
Administration Income and Expenditure
Employee benefits 4.1.1 973 1,022
Operating Expenses 5 1,661 2,013
Other operating revenue 2 (123) (114)
Net administration costs before interest 2,511 2,921
Programme Income and Expenditure
Employee benefits 4.1.1 1,916 819
Operating Expenses 5 204,986 182,557
Other operating revenue 2 (1,493) (1,399)
Net programme expenditure before interest 205,409 181,977
Other Comprehensive Net Expenditure 2015-16 2014-15
£000 £000
Impairments and reversals 22 0 0
Net gain/(loss) on revaluation of property, plant & equipment 0 0
Net gain/(loss) on revaluation of intangibles 0 0
Net gain/(loss) on revaluation of financial assets 0 0
Movements in other reserves 0 0
Net gain/(loss) on available for sale financial assets 0 0
Net gain/(loss) on assets held for sale 0 0
Net actuarial gain/(loss) on pension schemes 0 0
Share of (profit)/loss of associates and joint ventures 0 0
Reclassification Adjustments
On disposal of available for sale financial assets 0 0
Total comprehensive net expenditure for the year 207,920 184,898
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60
The notes on pages 63 to 98 form part of this statement
The financial statements on pages 59 to 98 were approved by the Chair & Chief
Officer on behalf of the Governing Body on 26th May, 2016 and signed on its behalf
by:
Chief Officer (Accountable Officer)
Statement of Financial Position as at
31-March-2016
2015-16 2014-15
Note £000 £000
Non-current assets:
Property, plant and equipment 13 19 24
Intangible assets 14 0 0
Investment property 15 0 0
Trade and other receivables 17 0 0
Other financial assets 18 0 0
Total non-current assets 19 24
Current assets:
Inventories 16 0 0
Trade and other receivables 17 4,653 1,922
Other financial assets 18 0 0
Other current assets 19 0 0
Cash and cash equivalents 20 6 29
Total current assets 4,659 1,951
Non-current assets held for sale 21 0 0
Total current assets 4,659 1,951
Total assets 4,678 1,975
Current liabilities
Trade and other payables 23 (9,752) (7,242)
Other financial liabilities 24 0 0
Other liabilities 25 0 0
Borrowings 26 0 0
Provisions 30 0 0
Total current liabilities (9,752) (7,242)
Non-Current Assets plus/less Net Current Assets/Liabilities (5,074) (5,267)
Non-current liabilities
Trade and other payables 23 0 0
Other financial liabilities 24 0 0
Other liabilities 25 0 0
Borrowings 26 0 0
Provisions 30 0 0
Total non-current liabilities 0 0
Assets less Liabilities (5,074) (5,267)
Financed by Taxpayers’ Equity
General fund (5,074) (5,267)
Revaluation reserve 0 0
Other reserves 0 0
Charitable Reserves 0 0
Total taxpayers' equity: (5,074) (5,267)
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61
NHS Halton CCG Annual Accounts 2015-16
The notes on pages 63 to 98 form part of this statement
Statement of Changes In Taxpayers Equity for the year ended
31-March-2016
General fund
Revaluation
reserve
Other
reserves
Total
reserves
£000 £000 £000 £000
Changes in taxpayers’ equity for 2015-16
Balance at 1 April 2015 (5,267) 0 0 (5,267)
Transfer between reserves in respect of assets transferred from closed NHS
bodies 0 0 0 0
Adjusted NHS Clinical Commissioning Group balance at 1 April 2015 (5,267) 0 0 (5,267)
Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2015-16
Net operating expenditure for the financial year (207,920) (207,920)
Net gain/(loss) on revaluation of property, plant and equipment 0 0
Net gain/(loss) on revaluation of intangible assets 0 0
Net gain/(loss) on revaluation of financial assets 0 0
Total revaluations against revaluation reserve 0 0 0 0
Net gain (loss) on available for sale financial assets 0 0 0 0
Net gain (loss) on revaluation of assets held for sale 0 0 0 0
Impairments and reversals 0 0 0 0
Net actuarial gain (loss) on pensions 0 0 0 0
Movements in other reserves 0 0 0 0
Transfers between reserves 0 0 0 0
Release of reserves to the Statement of Comprehensive Net Expenditure 0 0 0 0
Reclassification adjustment on disposal of available for sale financial assets 0 0 0 0
Transfers by absorption to (from) other bodies 0 0 0 0
Reserves eliminated on dissolution 0 0 0 0
Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year (207,920) 0 0 (207,920)
Net funding 208,113 0 0 208,113
Balance at 31 March 2016 (5,074) 0 0 (5,074)
General fund
Revaluation
reserve
Other
reserves
Total
reserves
£000 £000 £000 £000
Changes in taxpayers’ equity for 2014-15
Balance at 1 April 2014 (4,203) 0 0 (4,203)
Transfer of assets and liabilities from closed NHS bodies as a result of the 1
April 2013 transition 0 0 0 0
Adjusted NHS Commissioning Board balance at 1 April 2014 (4,203) 0 0 (4,203)
Changes in NHS Commissioning Board taxpayers’ equity for 2014-15
Net operating costs for the financial year (184,898) 0 0 (184,898)
Net gain/(loss) on revaluation of property, plant and equipment 0 0 0 0
Net gain/(loss) on revaluation of intangible assets 0 0 0 0
Net gain/(loss) on revaluation of financial assets 0 0 0 0
Total revaluations against revaluation reserve 0 0 0 0
Net gain (loss) on available for sale financial assets 0 0 0 0
Net gain (loss) on revaluation of assets held for sale 0 0 0 0
Impairments and reversals 0 0 0 0
Net actuarial gain (loss) on pensions 0 0 0 0
Movements in other reserves 0 0 0 0
Transfers between reserves 0 0 0 0
Release of reserves to the Statement of Comprehensive Net Expenditure 0 0 0 0
Reclassification adjustment on disposal of available for sale financial assets 0 0 0 0
Transfers by absorption to (from) other bodies 0 0 0 0
Reserves eliminated on dissolution 0 0 0 0
Net Recognised NHS Commissioning Board Expenditure for the Financial Year (184,898) 0 0 (184,898)
Net funding 183,834 0 0 183,834
Balance at 31 March 2015 (5,267) 0 0 (5,267)
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NHS Halton CCG Annual Accounts 2015-16
The notes on pages 63 to 98 form part of this statement
Statement of Cash Flows for the year ended
31-March-2016
2015-16 2014-15
Note £000 £000
Cash Flows from Operating Activities
Net operating expenditure for the financial year (207,920) (184,898)
Depreciation and amortisation 5 5 54
Impairments and reversals 5 0 0
Movement due to transfer by Modified Absorption 0 0
Other gains (losses) on foreign exchange 0 0
Donated assets received credited to revenue but non-cash 0 0
Government granted assets received credited to revenue but non-cash 0 0
Interest paid 0 0
Release of PFI deferred credit 0 0
Other Gains & Losses 0 0
Finance Costs 0 0
Unwinding of Discounts 0 0
(Increase)/decrease in inventories 0 0
(Increase)/decrease in trade & other receivables 17 (2,731) 308
(Increase)/decrease in other current assets 0 0
Increase/(decrease) in trade & other payables 23 2,510 670
Increase/(decrease) in other current liabilities 0 0
Provisions utilised 30 0 0
Increase/(decrease) in provisions 30 0 0
Net Cash Inflow (Outflow) from Operating Activities (208,136) (183,866)
Cash Flows from Investing Activities
Interest received 0 0
(Payments) for property, plant and equipment 0 0
(Payments) for intangible assets 0 0
(Payments) for investments with the Department of Health 0 0
(Payments) for other financial assets 0 0
(Payments) for financial assets (LIFT) 0 0
Proceeds from disposal of assets held for sale: property, plant and equipment 0 0
Proceeds from disposal of assets held for sale: intangible assets 0 0
Proceeds from disposal of investments with the Department of Health 0 0
Proceeds from disposal of other financial assets 0 0
Proceeds from disposal of financial assets (LIFT) 0 0
Loans made in respect of LIFT 0 0
Loans repaid in respect of LIFT 0 0
Rental revenue 0 0
Net Cash Inflow (Outflow) from Investing Activities 0 0
Net Cash Inflow (Outflow) before Financing (208,136) (183,866)
Cash Flows from Financing Activities
Grant in Aid Funding Received 208,113 183,834
Other loans received 0 0
Other loans repaid 0 0
Capital element of payments in respect of finance leases and on Statement of Financial Position PFI and LIFT 0 0
Capital grants and other capital receipts 0 0
Capital receipts surrendered 0 0
Net Cash Inflow (Outflow) from Financing Activities 208,113 183,834
Net Increase (Decrease) in Cash & Cash Equivalents 20 (23) (32)
Cash & Cash Equivalents at the Beginning of the Financial Year 29 61
Effect of exchange rate changes on the balance of cash and cash equivalents held in foreign currencies 0 0
Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year 6 29
NHS Halton CCG Annual Report and Accounts 2015-2016
63
Notes to the financial statements
1 Accounting Policies
NHS England has directed that the financial statements of clinical commissioning
groups shall meet the accounting requirements of the Manual for Accounts issued by
the Department of Health. Consequently, the following financial statements have
been prepared in accordance with the Manual for Accounts 2015-16 issued by the
Department of Health. The accounting policies contained in the Manual for Accounts
follow International Financial Reporting Standards to the extent that they are
meaningful and appropriate to clinical commissioning groups, as determined by HM
Treasury, which is advised by the Financial Reporting Advisory Board. Where the
Manual for Accounts permits a choice of accounting policy, the accounting policy
which is judged to be most appropriate to the particular circumstances of the clinical
commissioning group for the purpose of giving a true and fair view has been
selected. The particular policies adopted by the clinical commissioning group are
described below. They have been applied consistently in dealing with items
considered material in relation to the accounts.
1.1 Going Concern
These accounts have been prepared on the going concern basis. Public sector
bodies are assumed to be going concerns where the continuation of the provision of
a service in the future is anticipated, as evidenced by inclusion of financial provision
for that service in published documents. Where a clinical commissioning group
ceases to exist, it considers whether or not its services will continue to be provided
(using the same assets, by another public sector entity) in determining whether to
use the concept of going concern for the final set of Financial Statements. If
services will continue to be provided the financial statements are prepared on the
going concern basis.
1.2 Accounting Convention
These accounts have been prepared under the historical cost convention.
1.3 Acquisitions & Discontinued Operations
Activities are considered to be ‘acquired’ only if they are taken on from outside the
public sector. Activities are considered to be ‘discontinued’ only if they cease
entirely. They are not considered to be ‘discontinued’ if they transfer from one public
sector body to another.
1.4 Movement of Assets within the Department of Health Group
Transfers as part of reorganisation fall to be accounted for by use of absorption
accounting in line with the Government Financial Reporting Manual, issued by HM
Treasury. The Government Financial Reporting Manual does not require
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64
retrospective adoption, so prior year transactions (which have been accounted for
under merger accounting) have not been restated. Absorption accounting requires
that entities account for their transactions in the period in which they took place, with
no restatement of performance required when functions transfer within the public
sector. Where assets and liabilities transfer, the gain or loss resulting is recognised
in the Statement of Comprehensive Net Expenditure, and is disclosed separately
from operating costs. Other transfers of assets and liabilities within the Department
of Health Group are accounted for in line with IAS 20 and similarly give rise to
income and expenditure entries.
1.5 Charitable Funds
The CCG did not operate any charitable Funds in 2015/16 (nil in 2014/15)
1.6 Pooled Budgets
Where the clinical commissioning group has entered into a pooled budget
arrangement under Section 75 of the National Health Service Act 2006 the clinical
commissioning group accounts for its share of the assets, liabilities, income and
expenditure arising from the activities of the pooled budget, identified in accordance
with the pooled budget agreement.
If the clinical commissioning group is in a “jointly controlled operation”, the clinical
commissioning group recognises:
The assets the clinical commissioning group controls;
The liabilities the clinical commissioning group incurs;
The expenses the clinical commissioning group incurs; and,
The clinical commissioning group’s share of the income from the pooled
budget activities.
If the clinical commissioning group is involved in a “jointly controlled assets”
arrangement, in addition to the above, the clinical commissioning group recognises:
The clinical commissioning group’s share of the jointly controlled assets
(classified according to the nature of the assets);
The clinical commissioning group’s share of any liabilities incurred jointly; and,
The clinical commissioning group’s share of the expenses jointly incurred.
1.7 Critical Accounting Judgements & Key Sources of Estimation Uncertainty In the application of the clinical commissioning group’s accounting policies,
management is required to make judgements, estimates and assumptions about the
carrying amounts of assets and liabilities that are not readily apparent from other
sources. The estimates and associated assumptions are based on historical
experience and other factors that are considered to be relevant. Actual results may
NHS Halton CCG Annual Report and Accounts 2015-2016
65
differ from those estimates and the estimates and underlying assumptions are
continually reviewed. Revisions to accounting estimates are recognised in the period
in which the estimate is revised if the revision affects only that period or in the period
of the revision and future periods if the revision affects both current and future
periods.
1.7.1 Critical Judgements in Applying Accounting Policies
Apart from those involving estimates (see below), the CCG has made no critical
judgements in applying accounting policies.
1.7.2 Key Sources of Estimation Uncertainty
The following are the key estimations that management has made in the process of
applying the clinical commissioning group’s accounting policies that have the most
significant effect on the amounts recognised in the financial statements:
Payables estimates
Due to the time lag around the availability of data, the prescribing payable is
estimated as the difference between the prescribing expenditure profile to 31 March
2016 (as determined by the NHS Business Services Authority) and the actual
confirmed amount of expenditure recorded. The key risk is that the actual data is
different to the estimates made, resulting in the prescribing payable being either over
or understated. As at 31 March 2016, the prescribing payable was £3.8 million (31
March 2015: £3.8 million).
1.8 Revenue
Revenue in respect of services provided is recognised when, and to the extent that,
performance occurs, and is measured at the fair value of the consideration
receivable. Where income is received for a specific activity that is to be delivered in
the following year, that income is deferred.
1.9 Employee Benefits
1.9.1 Short-term Employee Benefits
Salaries, wages and employment-related payments are recognised in the period in
which the service is received from employees, including bonuses earned but not yet
taken.
The cost of leave earned but not taken by employees at the end of the period is
recognised in the financial statements to the extent that employees are permitted to
carry forward leave into the following period.
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66
1.9.2 Retirement Benefit Costs
Past and present employees are covered by the provisions of the NHS Pensions
Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS
employers, General Practices and other bodies, allowed under the direction of the
Secretary of State, in England and Wales. The scheme is not designed to be run in a
way that would enable NHS bodies to identify their share of the underlying scheme
assets and liabilities. Therefore, the scheme is accounted for as if it were a defined
contribution scheme: the cost to the clinical commissioning group of participating in
the scheme is taken as equal to the contributions payable to the scheme for the
accounting period.
For early retirements other than those due to ill health the additional pension
liabilities are not funded by the scheme. The full amount of the liability for the
additional costs is charged to expenditure at the time the clinical commissioning
group commits itself to the retirement, regardless of the method of payment.
1.10 Other Expenses
Other operating expenses are recognised when, and to the extent that, the goods or
services have been received. They are measured at the fair value of the
consideration payable. Expenses and liabilities in respect of grants are recognised
when the CCG has a present legal or constructive obligation, which occurs when all
of the conditions attached to the payment have been met.
1.11 Property, Plant & Equipment
1.11.1 Recognition
Property, plant and equipment is capitalise
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.
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1.11.2 Valuation
All property, plant and equipment are measured initially at cost, representing the cost
directly attributable to acquiring or constructing the asset and bringing it to the
location and condition necessary for it to be capable of operating in the manner
intended by management. All assets are measured subsequently at valuation.
Land and buildings used for the clinical commissioning group’s services or for
administrative purposes are stated in the statement of financial position at their re-
valued amounts, being the fair value at the date of revaluation less any impairment.
Revaluations are performed with sufficient regularity to ensure that carrying amounts
are not materially different from those that would be determined at the end of the
reporting period. Fair values are determined as follows:
Land and non-specialised buildings – market value for existing use; and,
Specialised buildings – depreciated replacement cost.
HM Treasury has adopted a standard approach to depreciated replacement cost
valuations based on modern equivalent assets and, where it would meet the location
requirements of the service being provided, an alternative site can be valued.
Properties in the course of construction for service or administration purposes are
carried at cost, less any impairment loss. Cost includes professional fees but not
borrowing costs, which are recognised as expenses immediately, as allowed by IAS
23 for assets held at fair value. Assets are re-valued and depreciation commences
when they are brought into use.
Fixtures and equipment are carried at depreciated historic cost as this is not
considered to be materially different from current value in existing use.
An increase arising on revaluation is taken to the revaluation reserve except when it
reverses an impairment for the same asset previously recognised in expenditure, in
which case it is credited to expenditure to the extent of the decrease previously
charged there. A revaluation decrease that does not result from a loss of economic
value or service potential is recognised as an impairment charged to the revaluation
reserve to the extent that there is a balance on the reserve for the asset and,
thereafter, to expenditure. Impairment losses that arise from a clear consumption of
economic benefit are taken to expenditure. Gains and losses recognised in the
revaluation reserve are reported as other comprehensive income in the Statement of
Comprehensive Net Expenditure.
The CCG had no property as at 31 March 2016 therefore there has not been any
property revaluation in the financial year 2015/16 (nil in 2014/15).
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1.11.3 Subsequent Expenditure
Where subsequent expenditure enhances an asset beyond its original specification,
the directly attributable cost is capitalised. Where subsequent expenditure restores
the asset to its original specification, the expenditure is capitalised and any existing
carrying value of the item replaced is written-out and charged to operating expenses.
1.12 Intangible Assets
The CCG had no intangible assets as at 31 March 2016 (nil as at 31 March 2015)
1.13 Depreciation, Amortisation & Impairments
Freehold land, properties under construction, and assets held for sale are not
depreciated.
Otherwise, depreciation and amortisation are charged to write off the costs or
valuation of property, plant and equipment and intangible non-current assets, less
any residual value, over their estimated useful lives, in a manner that reflects the
consumption of economic benefits or service potential of the assets. The estimated
useful life of an asset is the period over which the clinical commissioning group
expects to obtain economic benefits or service potential from the asset. This is
specific to the clinical commissioning group and may be shorter than the physical life
of the asset itself. Estimated useful lives and residual values are reviewed each year
end, with the effect of any changes recognised on a prospective basis. Assets held
under finance leases are depreciated over their estimated useful lives.
At each reporting period end, the clinical commissioning group checks whether there
is any indication that any of its tangible or intangible non-current assets have
suffered an impairment loss. If there is indication of an impairment loss, the
recoverable amount of the asset is estimated to determine whether there has been a
loss and, if so, its amount. Intangible assets not yet available for use are tested for
impairment annually.
A revaluation decrease that does not result from a loss of economic value or service
potential is recognised as an impairment charged to the revaluation reserve to the
extent that there is a balance on the reserve for the asset and, thereafter, to
expenditure. Impairment losses that arise from a clear consumption of economic
benefit are taken to expenditure. Where an impairment loss subsequently reverses,
the carrying amount of the asset is increased to the revised estimate of the
recoverable amount but capped at the amount that would have been determined had
there been no initial impairment loss. The reversal of the impairment loss is credited
to expenditure to the extent of the decrease previously charged there and thereafter
to the revaluation reserve.
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1.14 Donated Assets
The CCG had no donated assets as at 31 March 2016 (nil as at 31 March 2015)
1.15 Government Grants
The value of assets received by means of a government grant is credited directly to
income. Deferred income is recognised only where conditions attached to the grant
preclude immediate recognition of the gain.
1.16 Non-current Assets Held For Sale
The CCG had no non-current assets held for sale as at 31 March 2016 (nil as at 31
March 2015).
1.17 Leases
Leases are classified as finance leases when substantially all the risks and rewards
of ownership are transferred to the lessee. All other leases are classified as
operating leases.
1.17.1 The CCG as Lessee
Property, plant and equipment held under finance leases are initially recognised, at
the inception of the lease, at fair value or, if lower, at the present value of the
minimum lease payments, with a matching liability for the lease obligation to the
lessor. Lease payments are apportioned between finance charges and reduction of
the lease obligation so as to achieve a constant rate on interest on the remaining
balance of the liability. Finance charges are recognised in calculating the clinical
commissioning group’s surplus/deficit.
Operating lease payments are recognised as an expense on a straight-line basis
over the lease term. Lease incentives are recognised initially as a liability and
subsequently as a reduction of rentals on a straight-line basis over the lease term.
Contingent rentals are recognised as an expense in the period in which they are
incurred.
Where a lease is for land and buildings, the land and building components are
separated and individually assessed as to whether they are operating or finance
leases.
1.18 Private Finance Initiative Transactions
The CCG is not party to any Private Finance Initiative (PFI) schemes as at 31 March
2016 (31 March 2015 nil)
1.19 Inventories
The CCG did not hold any inventories as at 31 March 2016 (nil as at 31 March 2015)
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1.20 Cash & Cash Equivalents
Cash is cash in hand and deposits with any financial institution repayable without
penalty on notice of not more than 24 hours. Cash equivalents are investments that
mature in 3 months or less from the date of acquisition and that are readily
convertible to known amounts of cash with insignificant risk of change in value.
In the Statement of Cash Flows, cash and cash equivalents are shown net of bank
overdrafts that are repayable on demand and that form an integral part of the clinical
commissioning group’s cash management.
1.21 Provisions
Provisions are recognised when the clinical commissioning group has a present legal
or constructive obligation as a result of a past event, it is probable that the clinical
commissioning group will be required to settle the obligation, and a reliable estimate
can be made of the amount of the obligation. The amount recognised as a provision
is the best estimate of the expenditure required to settle the obligation at the end of
the reporting period, taking into account the risks and uncertainties. Where a
provision is measured using the cash flows estimated to settle the obligation, its
carrying amount is the present value of those cash flows using HM Treasury’s
discount rate as follows:
Timing of cash flows (0 to 5 years inclusive): Minus 1.55% (2014/15: minus 1.50%)
Timing of cash flows (6 to 10 years inclusive): Minus 1% (2014/15: minus 1.05%)
Timing of cash flows (over 10 years): Minus 0.80% (2014/15: plus 2.20%)
All employee early departures 1.30%
When some or all of the economic benefits required to settle a provision are
expected to be recovered from a third party, the receivable is recognised as an asset
if it is virtually certain that reimbursements will be received and the amount of the
receivable can be measured reliably.
The CCG had no provisions as at 31 March 2016 (31 March 2015 nil)
1.22 Clinical Negligence Costs
The NHS Litigation Authority operates a risk pooling scheme under which the clinical
commissioning group pays an annual contribution to the NHS Litigation Authority
which in return settles all clinical negligence claims. The contribution is charged to
expenditure. Although the NHS Litigation Authority is administratively responsible for
all clinical negligence cases the legal liability remains with the clinical commissioning
group.
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1.23 Non-clinical Risk Pooling
The clinical commissioning group participates in the Property Expenses Scheme and
the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which
the clinical commissioning group pays an annual contribution to the NHS Litigation
Authority and, in return, receives assistance with the costs of claims arising. The
annual membership contributions, and any excesses payable in respect of particular
claims are charged to operating expenses as and when they become due.
1.24 Continuing healthcare risk pooling
In 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.
The contribution made by the CCG in the financial year 2015/16 was £308k (2014/15
£261k)
1.25 Carbon Reduction Commitment Scheme
Carbon Reduction Commitment and similar allowances are accounted for as
government grant funded intangible assets if they are not expected to be realised
within twelve months, and otherwise as other current assets. They are valued at
open market value. As the clinical commissioning group makes emissions, a
provision is recognised with an offsetting transfer from deferred income. The
provision is settled on surrender of the allowances. The asset, provision and
deferred income amounts are valued at fair value at the end of the reporting period.
The CCG considers this to be immaterial therefore no provision was recognised as
at 31 March 2016 (31 March 2015 nil)
1.26 Contingencies
A contingent liability is a possible obligation that arises from past events and whose
existence will be confirmed only by the occurrence or non-occurrence of one or more
uncertain future events not wholly within the control of the clinical commissioning
group, or a present obligation that is not recognised because it is not probable that a
payment will be required to settle the obligation or the amount of the obligation
cannot be measured sufficiently reliably. A contingent liability is disclosed unless the
possibility of a payment is remote.
A contingent asset is a possible asset that arises from past events and whose
existence will be confirmed by the occurrence or non-occurrence of one or more
uncertain future events not wholly within the control of the clinical commissioning
group. A contingent asset is disclosed where an inflow of economic benefits is
probable.
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Where the time value of money is material, contingencies are disclosed at their
present value.
The CCG had no contingent assets or liabilities as at 31 March 2016 (31 March 2015
nil)
1.27 Financial Assets
Financial assets are recognised when the clinical commissioning group becomes
party to the financial instrument contract or, in the case of trade receivables, when
the goods or services have been delivered. Financial assets are derecognised when
the contractual rights have expired or the asset has been transferred.
Financial assets are classified into the following categories:
Financial assets at fair value through profit and loss;
Held to maturity investments;
Available for sale financial assets; and,
Loans and receivables.
The classification depends on the nature and purpose of the financial assets and is
determined at the time of initial recognition.
1.27.1 Financial Assets at Fair Value Through Profit and Loss
Embedded derivatives that have different risks and characteristics to their host
contracts, and contracts with embedded derivatives whose separate value cannot be
ascertained, are treated as financial assets at fair value through profit and loss. They
are held at fair value, with any resultant gain or loss recognised in calculating the
clinical commissioning group’s surplus or deficit for the year. The net gain or loss
incorporates any interest earned on the financial asset.
1.27.2 Held to Maturity Assets
Held to maturity investments are non-derivative financial assets with fixed or
determinable payments and fixed maturity, and there is a positive intention and
ability to hold to maturity. After initial recognition, they are held at amortised cost
using the effective interest method, less any impairment. Interest is recognised using
the effective interest method.
1.27.3 Available For Sale Financial Assets
Available for sale financial assets are non-derivative financial assets that are
designated as available for sale or that do not fall within any of the other three
financial asset classifications. They are measured at fair value with changes in value
taken to the revaluation reserve, with the exception of impairment losses.
Accumulated gains or losses are recycled to surplus/deficit on de-recognition.
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1.27.4 Loans & Receivables
Loans and receivables are non-derivative financial assets with fixed or determinable
payments which are not quoted in an active market. After initial recognition, they are
measured at amortised cost using the effective interest method, less any impairment.
Interest is recognised using the effective interest method.
Fair value is determined by reference to quoted market prices where possible,
otherwise by valuation techniques.
The effective interest rate is the rate that exactly discounts estimated future cash
receipts through the expected life of the financial asset, to the initial fair value of the
financial asset.
At the end of the reporting period, the clinical commissioning group assesses
whether any financial assets, other than those held at ‘fair value through profit and
loss’ are impaired. Financial assets are impaired and impairment losses recognised
if there is objective evidence of impairment as a result of one or more events which
occurred after the initial recognition of the asset and which has an impact on the
estimated future cash flows of the asset.
For financial assets carried at amortised cost, the amount of the impairment loss is
measured as the difference between the asset’s carrying amount and the present
value of the revised future cash flows discounted at the asset’s original effective
interest rate. The loss is recognised in expenditure and the carrying amount of the
asset is reduced through a provision for impairment of receivables.
If, in a subsequent period, the amount of the impairment loss decreases and the
decrease can be related objectively to an event occurring after the impairment was
recognised, the previously recognised impairment loss is reversed through
expenditure to the extent that the carrying amount of the receivable at the date of the
impairment is reversed does not exceed what the amortised cost would have been
had the impairment not been recognised.
1.28 Financial Liabilities
Financial liabilities are recognised on the statement of financial position when the
clinical commissioning group becomes party to the contractual provisions of the
financial instrument or, in the case of trade payables, when the goods or services
have been received. Financial liabilities are de-recognised when the liability has
been discharged, that is, the liability has been paid or has expired.
Loans from the Department of Health are recognised at historical cost. Otherwise,
financial liabilities are initially recognised at fair value.
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1.28.1 Financial Guarantee Contract Liabilities
Financial guarantee contract liabilities are subsequently measured at the higher of:
The premium received (or imputed) for entering into the guarantee less
cumulative amortisation; and,
The amount of the obligation under the contract, as determined in accordance
with IAS 37: Provisions, Contingent Liabilities and Contingent Assets.
1.28.2 Financial Liabilities at Fair Value Through Profit and Loss
Embedded derivatives that have different risks and characteristics to their host
contracts, and contracts with embedded derivatives whose separate value cannot be
ascertained, are treated as financial liabilities at fair value through profit and loss.
They are held at fair value, with any resultant gain or loss recognised in the clinical
commissioning group’s surplus/deficit. The net gain or loss incorporates any interest
payable on the financial liability.
1.28.3 Other Financial Liabilities
After initial recognition, all other financial liabilities are measured at amortised cost
using the effective interest method, except for loans from Department of Health,
which are carried at historic cost. The effective interest rate is the rate that exactly
discounts estimated future cash payments through the life of the asset, to the net
carrying amount of the financial liability. Interest is recognised using the effective
interest method.
1.29 Value Added Tax
Most of the activities of the clinical commissioning group are outside the scope of
VAT and, in general, output tax does not apply and input tax on purchases is not
recoverable. Irrecoverable VAT is charged to the relevant expenditure category or
included in the capitalised purchase cost of fixed assets. Where output tax is
charged or input VAT is recoverable, the amounts are stated net of VAT.
1.30 Foreign Currencies
The clinical commissioning group’s functional currency and presentational currency
is sterling. Transactions denominated in a foreign currency are translated into
sterling at the exchange rate ruling on the dates of the transactions. At the end of the
reporting period, monetary items denominated in foreign currencies are retranslated
at the spot exchange rate on 31 March. Resulting exchange gains and losses for
either of these are recognised in the clinical commissioning group’s surplus/deficit in
the period in which they arise.
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1.31 Third Party Assets
Assets belonging to third parties (such as money held on behalf of patients) are not
recognised in the accounts since the clinical commissioning group has no beneficial
interest in them.
1.32 Losses & Special Payments
Losses and special payments are items that Parliament would not have
contemplated when it agreed funds for the health service or passed legislation. By
their nature they are items that ideally should not arise. They are therefore subject to
special control procedures compared with the generality of payments. They are
divided into different categories, which govern the way that individual cases are
handled.
Losses and special payments are charged to the relevant functional headings in
expenditure on an accruals basis, including losses which would have been made
good through insurance cover had the clinical commissioning group not been
bearing its own risks (with insurance premiums then being included as normal
revenue expenditure).
The CCG made no losses or special payments in the financial year 2015/16
(2014/15 nil)
1.33 Subsidiaries
Material entities over which the clinical commissioning group has the power to
exercise control so as to obtain economic or other benefits are classified as
subsidiaries and are consolidated. Their income and expenses; gains and losses;
assets, liabilities and reserves; and cash flows are consolidated in full into the
appropriate financial statement lines. Appropriate adjustments are made on
consolidation where the subsidiary’s accounting policies are not aligned with the
clinical commissioning group or where the subsidiary’s accounting date is not co-
terminus.
Subsidiaries that are classified as ‘held for sale’ are measured at the lower of their
carrying amount or ‘fair value less costs to sell’.
The CCG had no subsidiaries in the Financial year 2015/16 (nil 2014/15)
1.34 Associates
The CCG had no associates in the Financial year 2015/16 (nil 2014/15)
1.35 Joint Ventures
The CCG had no joint ventures in the Financial year 2015/16 (2014/15 nil)
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1.36 Joint Operations
Joint operations are activities undertaken by the CCG in conjunction with one or
more other parties but which are not performed through a separate entity. The CCG
records its share of the income and expenditure; gains and losses; assets and
liabilities; and cash flows.
The CCG are the host commissioner for the Cheshire and Merseyside Women’s and
Children’s partnership, this is a collaborative arrangement where 27 local
organisations will come together to review maternity, neo-natal, paediatric and
gynaecology services across Cheshire and Merseyside.
1.37 Research & Development
Research and development expenditure is charged in the year in which it is incurred,
except insofar as development expenditure relates to a clearly defined project and
the benefits of it can reasonably be regarded as assured. Expenditure so deferred is
limited to the value of future benefits expected and is amortised through the
Statement of Comprehensive Net Expenditure on a systematic basis over the period
expected to benefit from the project. It should be re-valued on the basis of current
cost. The amortisation is calculated on the same basis as depreciation.
1.38 Accounting Standards That Have Been Issued But Have Not Yet Been
Adopted
The Government Financial Reporting Manual does not require the following
Standards and Interpretations to be applied in 2015/16, all of which are subject to
consultation:
IFRS 9: Financial Instruments
IFRS 14: Regulatory Deferral Accounts
IFRS 15: Revenue for Contract with Customers
The application of the Standards as revised would not have a material impact on the
accounts for 2015/16, were they applied in that year.
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2 Other Operating Revenue
Admin revenue is revenue received that is not directly attributable to the provision of
healthcare or healthcare related services. 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
3 Revenue
All revenue is from supply of services. The CCG receives no revenue from the sale
of goods.
2015-16 2015-16 2015-16 2014-15
Total Admin Programme Total
£000 £000 £000 £000
Recoveries in respect of employee benefits 0 0 0 0
Patient transport services 0 0 0 0
Prescription fees and charges 0 0 0 0
Dental fees and charges 0 0 0 0
Education, training and research 0 0 0 0
Charitable and other contributions to revenue expenditure: NHS 0 0 0 0
Charitable and other contributions to revenue expenditure: non-NHS 0 0 0 0
Receipt of donations for capital acquisitions: NHS Charity 0 0 0 0
Receipt of Government grants for capital acquisitions 0 0 0 0
Non-patient care services to other bodies 643 118 525 431
Continuing Health Care risk pool contributions 0 0 0 0
Income generation 0 0 0 0
Rental revenue from finance leases 0 0 0 0
Rental revenue from operating leases 0 0 0 0
Other revenue 973 5 968 1,082
Total other operating revenue 1,616 123 1,493 1,513
2015-16 2015-16 2015-16 2014-15
Total Admin Programme Total
£000 £000 £000 £000
From rendering of services 1,616 123 1,493 1,513
From sale of goods 0 0 0 0
1,616 123 1,493 1,513
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4.1.1 Employee benefits 2015-16
Total
Permanent
Employees Other Total
Permanent
Employees Other Total
Permanent
Employees Other
£000 £000 £000 £000 £000 £000 £000 £000 £000
Employee Benefits
Salaries and wages 2,411 2,121 290 807 768 39 1,604 1,353 251
Social security costs 191 191 0 69 69 0 122 122 0
Employer Contributions to NHS Pension scheme 287 287 0 97 97 0 190 190 0
Other pension costs 0 0 0 0 0 0 0 0 0
Other post-employment benefits 0 0 0 0 0 0 0 0 0
Other employment benefits 0 0 0 0 0 0 0 0 0
Termination benefits 0 0 0 0 0 0 0 0 0
Gross employee benefits expenditure 2,889 2,599 290 973 934 39 1,916 1,665 251
Less recoveries in respect of employee benefits (note 4.1.2) 0 0 0 0 0 0 0 0 0
Total - Net admin employee benefits including capitalised costs 2,889 2,599 290 973 934 39 1,916 1,665 251
Less: Employee costs capitalised 0 0 0 0 0 0 0 0 0
Net employee benefits excluding capitalised costs 2,889 2,599 290 973 934 39 1,916 1,665 251
4.1.1 Employee benefits 2014-15
Total
Permanent
Employees Other Total
Permanent
Employees Other Total
Permanent
Employees Other
£000 £000 £000 £000 £000 £000 £000 £000 £000
Employee Benefits
Salaries and wages 1,508 1,461 47 842 794 48 666 667 (1)
Social security costs 136 136 0 73 73 0 63 63 0
Employer Contributions to NHS Pension scheme 197 197 0 107 107 0 90 90 0
Other pension costs 0 0 0 0 0 0 0 0 0
Other post-employment benefits 0 0 0 0 0 0 0 0 0
Other employment benefits 0 0 0 0 0 0 0 0 0
Termination benefits 0 0 0 0 0 0 0 0 0
Gross employee benefits expenditure 1,841 1,794 47 1,022 974 48 819 820 (1)
Less recoveries in respect of employee benefits (note 4.1.2) 0 0 0 0 0 0 0 0 0
Total - Net admin employee benefits including capitalised costs 1,841 1,794 47 1,022 974 48 819 820 (1)
Less: Employee costs capitalised 0 0 0 0 0 0 0 0 0
Net employee benefits excluding capitalised costs 1,841 1,794 47 1,022 974 48 819 820 (1)
4.1.2 Recoveries in respect of employee benefits
The CCG made no recoveries in respect of employee benefits during the financial year 2015-16 ( nil 2014-15)
Admin ProgrammeTotal
Total Admin Programme
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4.2 Average number of people employed
Ill health retirement costs are met by the NHS Pension Scheme. Where the CCG
agrees early retirements, the additional costs are met by the CCG and not by the
NHS Pension Scheme.
4.4 Exit packages agreed in the financial year
No exit packages or severance payments were agreed by the CCG in the financial
year 2015/16 (2014/15, nil)
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.
4.2 Average number of people employed2014-15
Total
Permanently
employed Other Total
Number Number Number Number
Total 46 42 4 27
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 retirements2015-16 2014-15Number Number
Total Days Lost 481 219Total Staff Years 44 31Average working Days Lost 10.93 7.06
2015-16 2014-15Number Number
Number of persons retired early on ill health grounds 0 0
£000 £000
Total additional Pensions liabilities accrued in the year 0 0
Ill health retirement costs are met by the NHS Pension Scheme. Where the CCG agrees early retirements, the addidtionalcosts are met by the CCG and not by the NHS Pension Scheme.
4.4 Exit packages agreed in the financial year
No exit packages or severance payments were agreed by the CCG in the financial year 2015-16 (2014-15, nil)
2015-16
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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 2015/16, employers’ contributions of £288,509 were payable to the NHS
Pensions Scheme (2014/15: £197,132) were payable to the NHS Pension
Scheme 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 Valuation Directions, following a full scheme valuation. The latest
review used data from 31 March 2012 and was published on the Government
website on 9 June 2014.
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5. Operating expenses
Admin expenditure is expenditure incurred that is not a direct payment for the
provision of healthcare or healthcare services
2015-16 2015-16 2015-16 2014-15
Total Admin Programme Total
£000 £000 £000 £000
Gross employee benefits
Employee benefits excluding governing body members 2,717 801 1,916 1,669
Executive governing body members 172 172 0 172
Total gross employee benefits 2,889 973 1,916 1,841
Other costs
Services from other CCGs and NHS England 2,544 1,068 1,476 3,341
Services from foundation trusts 86,269 2 86,267 75,803
Services from other NHS trusts 44,902 9 44,893 53,670
Services from other NHS bodies 0 0 0 6
Purchase of healthcare from non-NHS bodies 26,918 0 26,918 21,976
Chair and Non Executive Members 52 52 0 237
Supplies and services – clinical 0 0 0 0
Supplies and services – general 90 70 20 13
Consultancy services 82 0 82 106
Establishment 231 170 61 259
Transport 22 21 1 17
Premises 680 90 590 718
Impairments and reversals of receivables 0 0 0 0
Inventories written down 0 0 0 0
Depreciation 5 5 0 54
Amortisation 0 0 0 0
Impairments and reversals of property, plant and equipment 0 0 0 0
Impairments and reversals of intangible assets 0 0 0 0
Impairments and reversals of financial assets
· Assets carried at amortised cost 0 0 0 0
· Assets carried at cost 0 0 0 0
· Available for sale financial assets 0 0 0 0
Impairments and reversals of non-current assets held for sale 0 0 0 0
Impairments and reversals of investment properties 0 0 0 0
Audit fees 54 54 0 66
Other non statutory audit expenditure
· Internal audit services 0 0 0 0
· Other services 0 0 0 0
General dental services and personal dental services 0 0 0 0
Prescribing costs 25,309 0 25,309 24,387
Pharmaceutical services 0 0 0 0
General ophthalmic services 0 0 0 0
GPMS/APMS and PCTMS 16,656 0 16,656 1,056
Other professional fees excl. audit 341 58 283 321
Grants to other public bodies 2,048 0 2,048 2,160
Clinical negligence 0 0 0 0
Research and development (excluding staff costs) 0 0 0 0
Education and training 83 62 21 47
Change in discount rate 0 0 0 0
Provisions 0 0 0 0
Funding to group bodies 0 0 0
CHC Risk Pool contributions 308 0 308 261
Other expenditure 53 0 53 72
Total other costs 206,647 1,661 204,986 184,570
Total operating expenses 209,536 2,634 206,902 186,411
NHS Halton CCG Annual Report and Accounts 2015-2016
82
6.1 Better Payment Practice Code
The Better Payment Practice Code requires the CCG to aim to pay all valid
invoices by the due date or within 30 days of receipt of a valid Invoice
whichever is later, with a target performance of 95%.
6.2 The Late Payment of Commercial Debts (Interest) Act 1998
The CCG did not make any payments under the provisions of the Late Payment of
Commercial Debts (Interest) Act 1998 in the financial year 2015/16 (2014/5, nil)
7 Income Generation Activities
The CCG had no income generation activities in the financial year 2015/16
(2014/15, nil)
8 Investment revenue
The CCG had no investment revenue in the financial year 2015/16 (2014/15, nil)
9 Other gains and losses
The CCG had no other gains or losses in the financial year 2015/16(2014/15, nil)
10 Finance costs
The CCG had no finance costs in the financial year 2015/16 (2014/15, nil)
11 Net Gain/ (loss) on transfer by absorption
The CCG had no net gain or losses on transfer by absorption in the financial year
2015/16 (2014/15, nil)
12 Operating Leases
12.1 As lessee
The CCG occupies property owned and managed by Community Health
Partnerships and NHS Property services Ltd
Whilst the CCG's arrangements with Community Health Partnerships Ltd and NHS
Property Services Ltd fall within the definition of operating leases, the rental charge
Measure of compliance 2015-16 2015-16 2014-15 2014-15
Number £000 Number £000
Non-NHS Payables
Total Non-NHS Trade invoices paid in the Year 3125 34369 2279 27324
Total Non-NHS Trade Invoices paid within target 3071 34174 2033 26520
Percentage of Non-NHS Trade invoices paid within target 98.27% 99.43% 89.21% 97.06%
NHS Payables
Total NHS Trade Invoices Paid in the Year 1947 135268 1929 132972
Total NHS Trade Invoices Paid within target 1941 135223 1858 132270
Percentage of NHS Trade Invoices paid within target 99.69% 99.97% 96.32% 99.47%
NHS Halton CCG Annual Report and Accounts 2015-2016
83
for future years, including any charge for void space, has not yet been agreed.
Consequently, note 12.1.2 does not include future minimum lease payments for
these arrangements
12.1.1 Payments recognised as an Expense 2015-16 2014-15
Land Buildings Other Total Land Buildings Other Total
£000 £000 £000 £000 £000 £000 £000 £000
Payments recognised as an expense
Minimum lease payments 0 674 39 713 0 707 23 730
Contingent rents 0 0 0 0 0 0 0 0
Sub-lease payments 0 0 0 0 0 0 0 0
Total 0 674 39 713 0 707 23 730
12.1.2 Future minimum lease payments 2015-16 2014-15
Land Buildings Other Total Land Buildings Other Total
£000 £000 £000 £000 £000 £000 £000 £000
Payable:
No later than one year 0 0 27 27 0 - 20 20
Between one and five years 0 0 20 20 0 - 24 24
After five years 0 0 0 0 0 - - 0
Total 0 0 47 47 0 0 44 44
NHS Halton CCG Annual Report and Accounts 2015-2016
84
13 Property, plant and equipment
2015-16 Land
Buildings
excluding
dwellings Dwellings
Assets under
construction
and payments
on account
Plant &
machinery
Transport
equipment
Information
technology
Furniture &
fittings Total
£000 £000 £000 £000 £000 £000 £000 £000 £000
Cost or valuation at 01-April-2015 0 0 0 0 31 0 112 0 143
Addition of assets under construction and payments on account 0 0
Additions purchased 0 0 0 0 0 0 0 0 0
Additions donated 0 0 0 0 0 0 0 0 0
Additions government granted 0 0 0 0 0 0 0 0 0
Additions leased 0 0 0 0 0 0 0 0 0
Reclassifications 0 0 0 0 0 0 0 0 0
Reclassified as held for sale and reversals 0 0 0 0 0 0 0 0 0
Disposals other than by sale 0 0 0 0 0 0 0 0 0
Upward revaluation gains 0 0 0 0 0 0 0 0 0
Impairments charged 0 0 0 0 0 0 0 0 0
Reversal of impairments 0 0 0 0 0 0 0 0 0
Transfer (to)/from other public sector body 0 0 0 0 0 0 0 0 0
Cumulative depreciation adjustment following revaluation 0 0 0 0 0 0 0 0 0
Cost/Valuation At 31-March-2016 0 0 0 0 31 0 112 0 143
Depreciation 01-April-2015 0 0 0 0 8 0 111 0 119
Reclassifications 0 0 0 0 0 0 0 0 0
Reclassified as held for sale and reversals 0 0 0 0 0 0 0 0 0
Disposals other than by sale 0 0 0 0 0 0 0 0 0
Upward revaluation gains 0 0 0 0 0 0 0 0 0
Impairments charged 0 0 0 0 0 0 0 0 0
Reversal of impairments 0 0 0 0 0 0 0 0 0
Charged during the year 0 0 0 0 4 0 1 0 5
Transfer (to)/from other public sector body 0 0 0 0 0 0 0 0 0
Cumulative depreciation adjustment following revaluation 0 0 0 0 0 0 0 0 0
Depreciation at 31-March-2016 0 0 0 0 12 0 112 0 124
Net Book Value at 31-March-2016 0 0 0 0 19 0 0 0 19
Purchased 0 0 0 0 19 0 0 0 19
Donated 0 0 0 0 0 0 0 0 0
Government Granted 0 0 0 0 0 0 0 0 0
Total at 31-March-2016 0 0 0 0 19 0 0 0 19
Asset financing:
Owned 0 0 0 0 19 0 0 0 19
Held on finance lease 0 0 0 0 0 0 0 0 0
On-SOFP Lift contracts 0 0 0 0 0 0 0 0 0
PFI residual: interests 0 0 0 0 0 0 0 0 0
Total at 31-March-2016 0 0 0 0 19 0 0 0 19
NHS Halton CCG Annual Report and Accounts 2015-2016
85
Revaluation Reserve Balance for Property, Plant & Equipment
Land Buildings Dwellings
Assets under
construction &
payments on
account
Plant &
machinery
Transport
equipment
Information
technology
Furniture &
fittings Total
£000's £000's £000's £000's £000's £000's £000's £000's £000's
Balance at 01-April-2015 0 0 0 0 0 0 0 0 0
Revaluation gains 0 0 0 0 0 0 0 0 0
Impairments 0 0 0 0 0 0 0 0 0
Release to general fund 0 0 0 0 0 0 0 0 0
Other movements 0 0 0 0 0 0 0 0 0
At 31-March-2016 0 0 0 0 0 0 0 0 0
NHS Halton CCG Annual Report and Accounts 2015-2016
86
2014-15 Land
Buildings
excluding
dwellings Dwellings
Assets under
construction
and payments
on account
Plant &
machinery
Transport
equipment
Information
technology
Furniture &
fittings Total
£000 £000 £000 £000 £000 £000 £000 £000 £000
Cost or valuation at 1 April 2014 0 0 0 0 31 0 112 0 143
Addition of assets under construction and payments on account 0 0
Additions purchased 0 0 0 0 0 0 0 0 0
Additions donated 0 0 0 0 0 0 0 0 0
Additions government granted 0 0 0 0 0 0 0 0 0
Additions leased 0 0 0 0 0 0 0 0 0
Reclassifications 0 0 0 0 0 0 0 0 0
Reclassified as held for sale and reversals 0 0 0 0 0 0 0 0 0
Disposals other than by sale 0 0 0 0 0 0 0 0 0
Upward revaluation gains 0 0 0 0 0 0 0 0 0
Impairments charged 0 0 0 0 0 0 0 0 0
Reversal of impairments 0 0 0 0 0 0 0 0 0
Transfer (to)/from other public sector body 0 0 0 0 0 0 0 0 0
Cumulative depreciation adjustment following revaluation 0 0 0 0 0 0 0 0 0
Cost/Valuation At 31 March 2015 0 0 0 0 31 0 112 0 143
Depreciation 1 April 2014 0 0 0 0 4 0 61 0 65
Reclassifications 0 0 0 0 0 0 0 0 0
Reclassified as held for sale and reversals 0 0 0 0 0 0 0 0 0
Disposals other than by sale 0 0 0 0 0 0 0 0 0
Upward revaluation gains 0 0 0 0 0 0 0 0 0
Impairments charged 0 0 0 0 0 0 0 0 0
Reversal of impairments 0 0 0 0 0 0 0 0 0
Charged during the year 0 0 0 0 4 0 50 0 54
Transfer (to)/from other public sector body 0 0 0 0 0 0 0 0 0
Cumulative depreciation adjustment following revaluation 0 0 0 0 0 0 0 0 0
Depreciation at 31 March 2015 0 0 0 0 8 0 111 0 119
Net Book Value at 31 March 2015 0 0 0 0 23 0 1 0 24
Purchased 0 0 0 0 23 0 1 0 24
Donated 0 0 0 0 0 0 0 0 0
Government Granted 0 0 0 0 0 0 0 0 0
Total at 31 March 2015 0 0 0 0 23 0 1 0 24
Asset financing:
Owned 0 0 0 0 23 0 1 0 24
Held on finance lease 0 0 0 0 0 0 0 0 0
On-SOFP Lift contracts 0 0 0 0 0 0 0 0 0
PFI residual: interests 0 0 0 0 0 0 0 0 0
Total at 31 March 2015 0 0 0 0 23 0 1 0 24
Revaluation Reserve Balance for Property, Plant & Equipment
Land Buildings Dwellings
Assets under
construction &
payments on
account
Plant &
machinery
Transport
equipment
Information
technology
Furniture &
fittings Total
£000's £000's £000's £000's £000's £000's £000's £000's £000's
Balance at 1 April 2014 0 0 0 0 0 0 0 0 0
Revaluation gains 0 0 0 0 0 0 0 0 0
Impairments 0 0 0 0 0 0 0 0 0
Release to general fund 0 0 0 0 0 0 0 0 0
Other movements 0 0 0 0 0 0 0 0 0
At 31 March 2015 0 0 0 0 0 0 0 0 0
NHS Halton CCG Annual Report and Accounts 2015-2016
87
13 Property, plant and equipment cont'd
13.1 Additions to assets under construction
The CCG had no assets under construction as at 31 March 2016 (nil as at 31 March 2015).
13.2 Donated assets
The CCG received no donated assets as at 31 March 2016 (nil as at 31 March 2015).
13.3 Government granted assets
The CCG had no government granted assets as at 31 March 2016 (nil as at 31 March 2015).
13.4 Property revaluation
The CCG had no property as at 31 March 2016 therefore there has not been any property
revaluation in the financial year 2015/16 (nil in 2014/15).
13.5 Compensation from third parties
There has been no compensation received from third parties for assets impaired, lost or
given up in the financial year 2015/16 (nil in 2014/15).
13.6 Write downs to recoverable amount
There have been no assets written down to recoverable amounts and no reversals of
previous write-downs in the financial year 2015/16 (nil in 2014/15)
13.7 Temporarily idle assets
The CCG had no temporarily idle assets as at 31 March 2016 (nil as at 31 March 2015).
13.8 Cost or valuation of fully depreciated assets
The CCG had no fully depreciated assets still in use as at 31 March 2016 (nil as at 31 March
2015).
13.9 Economic Lives
Buildings excluding dwellings 0 0
Dwellings 0 0
Plant & machinery 4 7
Transport equipment 0 0
Information technology 0 0
Furniture & fittings 0 0
Minimum
Life
Maximum
Life
NHS Halton CCG Annual Report and Accounts 2015-2016
88
14 Intangible non-current assets
The CCG had no intangible non-current assets as at 31 March 2016 (nil as at 31 March
2015).
15 Investment property
The CCG had no investment property as at 31 March 2016 (31 March 2015 nil)
16 Inventories
The CCG had no inventories as at 31 March 2016 (31 March 2015, nil)
£655k of the amount above has subsequently been recovered post the statement of
financial position date.
The CCG did not hold any collateral against receivables outstanding as at 31 March
2016 (31 March 2015, nil)
17 Trade and other receivables Current Non-current Current Non-current
2015-16 2015-16 2014-15 2014-15
£000 £000 £000 £000
NHS receivables: Revenue 661 0 256 0
NHS receivables: Capital 0 0 0 0
NHS prepayments 1,350 0 578 0
NHS accrued income 45 0 0 0
Non-NHS receivables: Revenue 1,134 0 41 0
Non-NHS receivables: Capital 0 0 0 0
Non-NHS prepayments 0 0 90 0
Non-NHS accrued income 0 0 0 0
Provision for the impairment of receivables 0 0 0 0
VAT 26 0 11 0Private finance initiative and other public private
partnership arrangement prepayments and accrued
income 0 0 0 0
Interest receivables 0 0 0 0
Finance lease receivables 0 0 0 0Operating lease receivables 0 0 0 0Other receivables 1,437 0 946 0
Total Trade & other receivables 4,653 0 1,922 0
Total current and non current 4,653 1,922
Included above:
Prepaid pensions contributions 0 0
The majority of trade is with NHS England. As NHS England is funded by Government to provide funding to CCG's to commission services no
17.1 Receivables past their due date but not impaired 2015-16 2014-15
£000 £000
By up to three months 882 156
By three to six months 95 55
By more than six months 2 0
Total 979 211
credit scoring of them is considered necessary
NHS Halton CCG Annual Report and Accounts 2015-2016
89
17.2 Provision for impairment of receivables
The CCG conducted an impairment review of all receivables as at 31 March 2016. It
believes that all outstanding amounts will be recovered therefore does not have any
provision for the impairment of receivables.
18 Other financial assets
The CCG had no other financial assets as at 31 March 2016 (nil as at 31 March
2015).
19 Other current assets
The CCG had no other current assets as at 31 March 2016 (nil as at 31 March 2015).
20 Cash and Cash Equivalents
21 Non-current assets held for sale
The CCG had no non-current assets held for sale as at 31 March 2016 (31 March 2015,nil)
22 Analysis of impairments and reversals
The CCG had no impairments or reversals of impairments recognised in the financial year 2015/16(2014/15, nil)
2015-16 2014-15
£000 £000
Balance at 01-April-2015 29 61
Net change in year (23) (32)
Balance at 31-March-2016 6 29
Made up of:
Cash with the Government Banking Service 6 29
Cash with Commercial banks 0 0
Cash in hand 0 0
Current investments 0 0
Cash and cash equivalents as in statement of financial position 6 29
Bank overdraft: Government Banking Service 0 0
Bank overdraft: Commercial banks 0 0
Total bank overdrafts 0 0
Balance at 31-March-2016 6 29
Patients’ money held by the clinical commissioning group, not included above 0 0
NHS Halton CCG Annual Report and Accounts 2015-2016
90
23 Trade and other Payables
Other payables include £48,531 outstanding pension contributions at 31 March 2016
24 Other financial liabilities
The CCG had no other financial liabilities as at 31 March 2016 (31 March 2015, nil)
25 Other liabilities
The CCG had no other liabilities as at 31 March 2016 (nil as at 31 March 2015).
26 Borrowings
The CCG had no borrowings as at 31 March 2016 (31 March 2015, nil)
27 Private finance initiatives, LIFT and other service concession arrangements
The CCG had no private finance initiatives, LIFT or other service concession
arrangements as at 31 March 2016 (31 March 2015, nil)
28 Finance lease obligations
The CCG had no finance lease obligations as at 31 March 2016 (nil as at 31 March
2015).
29 Finance lease receivables
The CCG had no finance lease receivables as at 31 March 2016 (31 March 2015, nil)
30 Provisions
Current Non-current Current Non-current
2015-16 2015-16 2014-15 2014-15
£000 £000 £000 £000
Interest payable 0 0 0 0
NHS payables: revenue 801 0 1,141 0
NHS payables: capital 0 0 0 0
NHS accruals 445 0 291 0
NHS deferred income 0 0 0 0
Non-NHS payables: revenue 880 0 582 0
Non-NHS payables: capital 0 0 0 0
Non-NHS accruals 5,978 0 4,123 0
Non-NHS deferred income 0 0 0 0
Social security costs 33 0 0 0
VAT 0 0 0 0
Tax 36 0 0 0
Payments received on account 0 0 0 0
Other payables 1,579 0 1,105 0
Total Trade & Other Payables 9,752 0 7,242 0
Total current and non-current 9,752 7,242
NHS Halton CCG Annual Report and Accounts 2015-2016
91
Under the Accounts Direction issued by NHS England on 12 February 2014, NHS
England is responsible for accounting for liabilities in relation to CHC Continuing
Healthcare claims relating to periods of care before the establishment of the CCG.
However, the legal liability remains with the CCG. The total value of legacy NHS
Continuing Healthcare provisions accounted for by NHS England on behalf of the
CCG at 31 March 2016 was £0.17 million (£0.8 million at 31 March 2015).
31 Contingencies
The CCG had no contingencies as at 31 March 2016 (31 March 2015, nil)
32 Commitments
The CCG had no capital commitments as at 31 March 2016, (31 March 2015, nil)
33 Financial instruments
33.1 Financial risk management
Financial reporting standard IFRS 7 requires disclosure of the role that financial
instruments have had during the period in creating or changing the risks a body faces
in undertaking its activities.
Because 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.
33.1.1 Currency risk
The NHS Clinical Commissioning Group is principally a domestic organisation with
the great majority of transactions, assets and liabilities being in the UK and sterling
based. The NHS Clinical Commissioning Group has no overseas operations. The
NHS Clinical Commissioning Group and therefore has low exposure to currency rate
fluctuations.
33.1.2 Interest rate risk
NHS Halton CCG Annual Report and Accounts 2015-2016
92
The Clinical Commissioning Group borrows from government for capital expenditure,
subject to affordability as confirmed by NHS England. The borrowings are for 1 to 25
years, in line with the life of the associated assets, and interest is charged at the
National Loans Fund rate, fixed for the life of the loan. The clinical commissioning
group therefore has low exposure to interest rate fluctuations.
33.1.3 Credit risk
Because the majority of the NHS Clinical Commissioning Group and revenue comes
parliamentary funding, NHS Clinical Commissioning Group has low exposure to
credit risk. The maximum exposures as at the end of the financial year are in
receivables from customers, as disclosed in the trade and other receivables note.
33.1.3 Liquidity risk
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.
NHS Halton CCG Annual Report and Accounts 2015-2016
93
33.2 Financial assets
At ‘fair value
through profit
and loss’
Loans and
Receivables
Available for
Sale Total
2015-16 2015-16 2015-16 2015-16
£000 £000 £000 £000
Embedded derivatives 0 0 0 0
Receivables:
· NHS 0 706 0 706
· Non-NHS 0 1,134 0 1,134
Cash at bank and in hand 0 6 0 6
Other financial assets 0 1,437 0 1,437
Total at 31-March-2016 0 3,283 0 3,283
At ‘fair value
through profit
and loss’
Loans and
Receivables
Available for
Sale Total
2014-15 2014-15 2014-15 2014-15
£000 £000 £000 £000
Embedded derivatives 0 0 0 0
Receivables:
· NHS 0 256 0 256
· Non-NHS 0 41 0 41
Cash at bank and in hand 0 29 0 29
Other financial assets 0 946 0 946
Total at 31-March-2016 0 1,272 0 1,272
33.3 Financial liabilities
At ‘fair value
through profit
and loss’ Other Total
2015-16 2015-16 2015-16
£000 £000 £000
Embedded derivatives 0 0 0
Payables:
· NHS 0 1,246 1,246
· Non-NHS 0 8,437 8,437
Private finance initiative, LIFT and finance lease obligations 0 0 0
Other borrowings 0 0 0
Other financial liabilities 0 0 0
Total at 31-March-2016 0 9,683 9,683
At ‘fair value
through profit
and loss’ Other Total
2014-15 2014-15 2014-15
£000 £000 £000
Embedded derivatives 0 0 0
Payables:
· NHS 0 1,432 1,432
· Non-NHS 0 5,810 5,810
Private finance initiative, LIFT and finance lease obligations 0 0 0
Other borrowings 0 0 0
Other financial liabilities 0 0 0
Total at 31-March-2016 0 7,242 7,242
NHS Halton CCG Annual Report and Accounts 2015-2016
94
34 Operating segments
The CCG considers that it only has one operating segment commissioning of
healthcare services
35 Pooled budgets
The CCG entered into a Pooled Budget arrangement with Halton Borough Council on
the 1st April 2013. The pool is hosted by Halton Borough Council for the majority of
Continuing Healthcare (CHC) and share financial risk on the pooled fund with the
CCG, contributing £12.3 million of the £30.9 million.
The Better Care Fund was added to this pooled arrangement on 1st April 2015, the
budget for this is £10.5 million, with the CCG contributing £9.4 million of this.
Under the arrangements funds are pooled under Section 75 of the NHS Act 2006 for
Complex Care.
The NHS Clinical Commissioning Group shares of the income and expenditure
handled by the pooled budget in the financial year were:
36 NHS Lift investments
The CCG had no lift investments as at 31 March 2016 (31 March 2015, nil)
2015-16 2014-15
£000 £000
Income 21,795 13,603
Expenditure (21,794) (13,605)
NHS Halton CCG Annual Report and Accounts 2015-2016
95
37 Related Party Transactions
The Department of Health is regarded as a related party. During the year the CCG has had a
significant number of material transactions with entities for which the Department is regarded
as the parent Department. For example:
NHS England (including Cheshire and Merseyside Commissioning Support Unit)
Warrington and Halton Hospitals Foundation Trust
St Helens & Knowsley Hospitals NHS Trust
Aintree University Hospitals NHS Foundation Trust
Liverpool Women’s Hospital NHS Foundation Trust
Royal Liverpool and Broadgreen University Hospitals NHS Trust
Liverpool Heart and Chest NHS Foundation Trust
Wrightington, Wigan and Leigh NHS Foundation Trust
Southport and Ormskirk Hospitals NHS Trust
Bridgewater Community Healthcare NHS Trust
Alder Hey Children’s NHS Foundation Trust
5 Boroughs Partnership NHS Foundation Trust
NHS Business Services Authority
NHS Litigation Authority
2015-16
Name Role Within CCG Role within Related Party Related PartyPayments to
Related Party
Receipts
from Related
Party
Amounts
owed to
Related
Party
Amounts
due from
Related
Party
£000 £000 £000 £000
Mr David Austin Lay Member Chair Brookvale Practice 1,178 0 57 0
Mr Paul Brickwood Chief Finance Officer Chief Finance Officer NHS Knowsley CCG 413 (128) 163 (5)
Mr Paul Brickwood Chief Finance Officer Chief Finance Officer NHS St Helens CCG 111 (160) 0 (44)
Mrs Ingrid Fife Lay Member Chair of the Joint Co-Commissioning Committee Warrington CCG 23 (22) 21 (3)
Dr Claire Forde GP Governing Body Member GP Partner Grove House Practice 1,500 (3) 3 (3)
Diane Hanshaw Practice Manager Practice Manager & Governing Body Representative Beaconsfield Surgery 1,960 (3) 287 (3)
Dr David Lyon General Practitioner GP Partner Castlefields Health Centre 2,005 0 219 0
Dr Damian McDermott General Practitioner GP Partner Tower House Practice 1,599 (3) 43 (3)
Mr David MerrillLay Member & Deputy Chair of Governing
BodyMember of Patient Participation Group Peelhouse Medical Plaza
1,855 0 93 0
Mr David MerrillLay Member & Deputy Chair of Governing
BodyRegistered with Halton Carers Group (Halton Carers Centre Ltd)
1 0 0 0
Dr Mick O'Connor GP Governing Body member and GP Partner Beaconsfield Surgery 1,960 (3) 287 (3)
Contract Lead St Helens & Knowsley Hospitals
NHS Trust
Doreen Shotton HealthWatch Representative Director / Trustee Age UK Mid Mersey 24 0 0 0
Doreen Shotton HealthWatch Representative Member of Management Committee HealthWatch 7 0 0 0
Doreen Shotton HealthWatch Representative Member of Executive Committee OPEN 0 0 0 0
Jan Snoddon Chief Nurse Associate Lecturer Edge hill University 7 0 0 0
Mr Shazid Tahir Lay Member Fostering Panel Member Together Trust 0 0 0 0
Dave Sweeney Director of Transformation Non-Executive Director Renova 98 (4) 0 0
Details of related party transactions with individuals are as follows:
NHS Halton CCG Annual Report and Accounts 2015-2016
96
In addition, the CCG has had a number of material transactions with other government departments and other central and local
government bodies. Most of these transactions have been with Halton Borough Council
2014-15
Name Role Within CCG Role within Related Party Related PartyPayments to
Related Party
Receipts from
Related Party
Amounts
owed to
Related
Party
Amounts
due from
Related
Party
£000 £000 £000 £000
Mr David Austin Lay Member Chair Brookvale Practice 10 -8 0 0
Mr David Austin Lay Member Director Murdshaw Community Centre 1 0 1 0
Mr Paul Brickwood Chief Finance Officer Chief Finance Officer NHS Knowsley CCG 259 -80 0 -6
Mr Paul Brickwood Chief Finance Officer Chief Finance Officer NHS St Helens CCG 300 -192 0 -4
Mr Robert Bryant Lay Member Trustee Halton Carers Group (Halton Carers Centre Ltd) 0 0 20 0
Mr Robert Bryant Lay Member Wife Works as a PA Halton Borough Council 15078 -240 47 -642
D Henshaw Practice Manager Practice Manager & Governing Body Representative Beaconsfield 10 -1 0 0
Dr D Lyon General Practitioner GP Partner Castlefields Health Centre 41 -1 1 0
Dr D McDermott General Practitioner GP Partner Tower House Practice 20 -1 1 0
Mr D Merill Lay Member & Deputy Chair of Governing Body Member of Patient Information Leaflet Ratification GroupSt Helens & Knowsley Teaching Hospitals NHS Trust 32645 0 4 0
Mr D Merill Lay Member & Deputy Chair of Governing Body Registered with Halton Carers Group Halton Carers Group (Halton Carers Centre Ltd) 0 0 20 0
Dr M O'Connor General Practitioner GP Partner Beaconsfield Surgery 10 -1 0 0
NHS Halton CCG Annual Report and Accounts 2015-2016
97
The Department of Health is regarded as a related party. During the year the CCG has had a
significant number of material transactions with entities for which the Department is regarded as
the parent Department. For example:
NHS England (including Cheshire and Merseyside Commissioning Support Unit)
Warrington and Halton Hospitals Foundation Trust
St Helens & Knowsley Hospitals NHS Trust
Aintree University Hospitals NHS Foundation Trust
Liverpool Women’s Hospital NHS Foundation Trust
Royal Liverpool and Broadgreen University Hospitals NHS Trust
Liverpool Heart and Chest NHS Foundation Trust
Wrightington, Wigan and Leigh NHS Foundation Trust
Southport and Ormskirk Hospitals NHS Trust
Bridgewater Community Healthcare NHS Trust
Alder Hey Children’s NHS Foundation Trust
5 Boroughs Partnership NHS Foundation Trust
NHS Business Services Authority
NHS Litigation Authority
In addition, the CCG has had a number of material transactions with other government
departments and other central and local government bodies. Most of these transactions have
been with Halton Borough Council
38 Events after the end of the reporting period
There are no post balance sheet events which will have a material effect on the financial
statements of NHS Halton Clinical Commissioning Group or the Consolidated Group
39 Losses and special payments
The CCG had no losses or special payments in the financial year 2015/16 (2014/15 nil)
40 Third party assets
The CCG held no third party assets as at 31 March 2016 (31 March 2015, nil)
NHS Halton CCG Annual Report and Accounts 2015-2016
98
41 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:
* Note; For the purposes of 223H (1); expenditure is defined as the aggregate of gross expenditure on revenue and capital in the financial year; and , income is defined as the aggregate of the notified maximum revenue resource, notified resource and all other amount is defined as the aggregate of the notified maximum revenue resource, notified capital resource and all other amount year (whether under provisions of the Act or from other sources, and included here on a gross basis).
All duties have been achieved in 2015/16, and 2014/15 42 Impact of IFRS Accounting under IFRS had no impact on the results in the financial year 2015/16 (2014/15 nil) 43 Analysis of charitable reserves The CCG held no charitable reserves in the financial year 2015/16 (2014/15 nil)
2015-16 2015-16 2014-15 2014-15
Target Performance Target Performance
£'000 £'000 £'000 £'000
223H (1) Expenditure not to exceed income 211,435 209,536 188,251 186,411
223I (2) Capital resource use does not exceed the amount specified in Directions 0 0 0 0
223I (3) Revenue resource use does not exceed the amount specified in Directions 209,819 207,920 186,738 184,898
223J(1)Capital resource use on specified matter(s) does not exceed the amount
specified in Directions 0 0 0 0
223J(2)Revenue resource use on specified matter(s) does not exceed the amount
specified in Directions 0 0 0 0
223J(3)Revenue administration resource use does not exceed the amount
specified in Directions 2,968 2,511 3,489 2,921
NHS Halton CCG Annual Report and Accounts 2015-2016
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APPENDIX 1
THE COMMITTEES OF NHS HALTON CCG GOVERNING BODY
The CCG has nine internal Committees reporting to its Governing Body and one
Committee in Common that is co-ordinated through Halton Borough Council. Each
Committee is established in accordance with the CCG Constitution and the remit,
responsibilities, and reporting arrangements shall have effect as if incorporated into
the Constitution and Standing Orders.
Membership and Terms of Reference for each Committee is reviewed annually and
the current versions are available here. Every Committee agrees an annual Work
Plan that is informed by its responsibilities, as defined in the Terms of Reference, and
is required to provide the Governing Body with a Key Issues Report followed by
approved Minutes, for information.
The Governing Body has representation on each of the Committees. Appendix 2,
page 106 provides a record of attendance for the period 1st April 2015 – 31st March
2016.
Highlights for each Committee during 15/16 are described below:
AUDIT COMMITTEE
Chair, David Merrill, Lay Member & Governing Body Deputy Chair
The duties of this Committee are driven by priorities identified by the CCG and the
associated risks. In summary, it is responsible for reviewing the establishment and
maintenance of integrated governance, risk management and internal control;
ensuring effective internal and external audit; reviewing findings of other significant
assurance functions; policies for ensuring compliance with regulatory, legal and code
of conduct requirements; counter fraud; whistle-blowing and the integrity of financial
reporting.
In year highlights include:
Provided continued assurance to the Governing Body in relation to:
the fitness for purpose of the Assurance Framework.
systems for Risk Management identify and allow for the management of
risk.
robust governance arrangements are in place.
robust systems of financial control are in place.
Undertook Effectiveness Reviews of both Internal and External Audit.
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Received Significant Assurance in the Director of Audit's Opinion report
Followed up the Committee's Development Plan following its own Self-
Assessment and Effectiveness review.
HUMAN RESOURCES & ORGANISATIONAL DEVELOPMENT COMMITTEE
Chair - Ingrid Fife, Lay Member
The role of this Committee is to advise the Governing Body on all Human Resource
and Organisational Development matters. In summary responsibilities include
workforce performance targets; policy development; assurance on Public Sector
Equality Duties (as it relates workforce); ensuring CCG upholds staff values within
NHS constitution; development and implementation of OD plan; ensuring staff are
fairly rewarded; and review of workforce plans.
In year highlights include:
Approving new HR Policies, and monitoring performance against established
policies
Agreeing the annual Organisation Development and Learning & Development
Plan
Receiving the positive outcome from 2015 Staff Survey and designing 2016
survey
Understanding of new workforce policy standards for E&D, and receiving
updates
Monitoring progress of the Health & Wellbeing Group
The recruitment process for new Governing Body appointments
INTEGRATED GOVERNANCE COMMITTEE
Chair – Simon Banks, Chief Officer
The Committee reports on the development, implementation and monitoring of all
areas of integrated governance by providing assurance on the systems and
processes by which the CCG leads, directs and controls its functions in order to
achieve organisational objectives.,
In year highlights:
review of development and implementation of corporate policies
achievement of Information Governance Toolkit work plan
establishment of IT Implementation Group, agreeing strategy and receiving
updates
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agreeing business continuity plan, emergency planning and resilience
response (EPRR) assurance process and plan
overview of risks on BAF, Corporate Risk Register, monitoring of risks specific
to committee, and agreeing a refresh of the risk management strategy
oversight of Freedom of Information, complaints/ PALs activity
PERFORMANCE & FINANCE COMMITTEE
Chair – Simon Banks, Chief Officer
This Committee advises the Governing Body on all financial matters and provides
assurance in relation to the discharge of statutory duties in line with the Standing
Financial Instructions. The Committee also ensure that the performance of
commissioned services in monitored.
In summary, is delegated by the Governing Body to, approve and monitor the annual
financial plan; ensure the CCG delivers financial balance; meets statutory financial
targets; monitors QIPP, contract expenditure and financial performance indicators;
and approves variation to planned investments.
In year highlights:
Achievement of CCG financial duty to achieve 1% surplus for 2014/15
Overseeing the transition of Commissioning Support Unit contract via the Lead
Provider Framework
Monitoring progress of completion of CHC legacy restitution claims
Regular reporting of prescribing activity / expenditure and supporting bid for
additional pharmacist capacity in general practice
Oversight of activity & expenditure against GP Access Fund
Scrutiny of provider performance (including breaches against constitution
standards) and monitoring of Quality Premium measures
PRIMARY CARE COMMISSIONING COMMITTEE
Chair – Ingrid Fife, Lay Member
NHS England has delegated to the CCG authority to exercise the primary care
commissioning functions set out in Schedule 2 in accordance with section 13Z of
NHS Action 2006 (as amended).It has been established in May 2015 to make
collective decisions on the review, planning and procurement of primary care
services in Halton. This Committee is in its development phase and will function as a
Committee held in public from April 2016.
In year highlights:
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Understanding of risk process and identifying specific risks
Progress reports on Schemes supported through GP Access Funds
Overview of estate in primary care and establishing an Estates Working Group
PMS reviews and what this means
Receiving general medical service commissioning updates, and agreeing
process for consideration of practice list closures
Agreed funding for a range of schemes, for example, reducing unplanned
admissions in the over 75s
QUALITY COMMITTEE
Chair – Jan Snoddon, Chief Nurse
The committee reviews the risks it is responsible for at every committee, and agrees
updates and the level of assurance the controls and assurance are delivering on
each risk.
The provider performance reports including the Maternity Dashboard and Equality
and Diversity compliance reports for providers, the corporate performance report,
early warning dashboard and Clinical Quality and Performance Groups key issues
are reported to every committee. These reports provide current status reporting and
also when triangulated provide early warning of quality failures in providers. These
reports are also used as assurance to evidence on-going quality and safety
performance of providers and evidence compliance with set quality metrics and
standards. The Committee also receives provider performance reports in relation to
Advancing Quality, Hospital Mortality and Patient Safety Incidents via National
Reporting and Learning system.
The committee received and approved the Serious incident (SI) Management Policy
and has received regular reports in relation to SIs across the CCG and all providers.
The committee receives and approves actions from Medicines Management Group
and approves decisions in relation to Pan Merseyside Medicines Decisions and
advice in relation to local formulary, new drugs and NICE guidance in relation to
drugs. The committee approves policies and strategies for management of medicines
and has in this year approved the Memorandum of Understanding for Safe Use and
Management of Controlled Drugs.
The committee also receives regular reports and updates in relation to Safeguarding
Children and Vulnerable Adults, including approval on behalf of the CCG of
Safeguarding Policies and Strategies, including annual reports for both Adults and
Children’s safeguarding. The committee also receives the minutes of both
Safeguarding adults and Safeguarding Children’s boards. The committee has also
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received the Integrated Safeguarding Activity Report from the local authority
safeguarding unit.
The committee receives regular reports in relation to Learning disabilities Health
checks, independent complaints advocacy statistics, Patient Survey reports including
Children and Young People’s impatient and Day case survey, flu performance,
Patient Led Assessments of the Care Environment (PLACE), Stroke performance
update, infection control annual reports and work programmes. Other key reporting
areas and policy/strategy approval include Cross Boundary Complaints, CCG
complaints policy, review of Quality Strategy and action plan for delivery, nursing
revalidation
The committee receives regular updates on communications and public engagement
including approval of strategies and plans and receipt of regular reports against the
plans. The committee has also received in this year:
Open survey
Quarterly Individual Patient Requests report
Update regarding Coroners letters to providers
Outcomes from provider CQC inspections
Hip fracture national audit report
5 Boroughs Partnership Footprint Review (Tony Ryan Report)
The committee has also completed a deep dive into patient harms, causes and
prevention and into the development of a patient experience strategy for the CCG.
REMUNERATION COMMITTEE
Chair –Ingrid Fife, Lay Member
This Committee makes recommendations to the Governing Body on policy and
determinations about pay, remuneration and other allowances specifically for the
Executive Management Team and people who provide services to the CCG including
Governing Body, clinical leads, and payments to Practices for engagement in
commissioning activity.
The Committee has met on one occasion in the reporting period and approved
The recommendations of the pay review for Governing Body / Clinical leads
The redundancy clause for Very Senior Managers
SERVICE DEVELOPMENT COMMITTEE
Chair, Dr Michael O’ Connor, GP representative
The duties of this Committee are driven by the priorities of the CCG and in essence it
is responsible for ensuring that member practices are setting the commissioning
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agenda, supporting the setting of the operational delivery plan and monitoring
delivery of the plan. The Committee also supports and enables clinical pathway
development locally and regionally.
In year highlights include:
Monitored implementation of 2015/16 commissioning intentions
Review of treatment pathways and service specifications
Received updates on new Urgent Care Centres
Supported the procurement processes, for example, Wellbeing practices
Agreed community services new models of care; district nursing redesign, pilot
of community geriatrician to support rapid access assessment.
Considered non-elective activity and how to reduce cost and over-activity
URGENT ISSUES COMMITTEE
Chair, Simon Banks, Chief Officer
The duties of this Committee are driven by the priorities of the CCG, and its purpose
is to manage any urgent issues that develop in areas of governance and risk
management; service commissioning or provision; finance including individual
funding issues; management; CCG reputation or communication.
The Committee has had reason to convene on four occasions in 2015/16 for the
purpose of
Agreeing the Joint Working Agreement with Halton Borough Council
Approval of collaborative Transforming Care Plan for people with Learning
Disabilities and/or Autism for submission to NHSE
Approving the Contract Specification Documentation for the Procurement of
Patient Transport Services
Agreeing the Quality Premium Awards and associated measures for 2015/16
BETTER CARE BOARD
Chair, Cllr Marie Wright Portfolio Holder Health and Wellbeing Chair
The Better Care Board is a key partnership board for the CCG and Local authority
which manages on behalf of the partnership the delivery of the Better Care Fund plan
and manages the ‘Pooled Budget’.
In year highlights include:
The Better Care Plan for 2016/2017 was also presented and agreed for
submission in April 2016
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Joint Working Agreement, which had been in place since 2013, had been
revised to reflect the following changes:
the Complex Care Board was renamed the Better Care Board.
the Executive Commissioning Board was renamed the Better Care
Executive Commissioning Board.
The budget schedule for 2015/16 was revised to incorporate the
additional Better Care Fund allocation for 2015/16.
Agreed to the underspend remaining in the Pool for 2015/16
Regular finance updates
The current Section 75 agreement expires in March 2016 and a full review of this
agreement has been completed
The end of year performance in respect of the Better Care Performance
Framework for 2014/15 and regular updates through 2015/16
Quarter 2 return July to September 2015 for approval to submit to NHS
England
Regular updates from operational group and System Resilience Group
Service presentations by:
Quality Assurance Team
Social care in practice
St Luke’s One to One Provision
Continuing Health Care provision
Healthwatch enter and view reports
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APPENDIX 2
GOVERNING BODY – COMMITTEE REGISTER OF ATTENDANCE
NAME TITLE Governing
Body Audit
Committee
Human Resource &
Organisational Development
Committee
Integrated Governance Committee
Performance & Finance
Committee
Primary Care Commissioning
Committee
Quality Committee
Remuneration Committee
Service Development
Committee
Urgent Issues Committee
David Austin Lay Member 09/11 3/4 4/4 7/9
Simon Banks Chief Officer 8/11 4/4 4/4 7/9 8/10 4/4
Paul Brickwood Chief Finance Officer 10/11 4/4 3/4 6/9 1/10 4/4
Mike Chester Secondary Care Doctor 5/11 0/10 3/9
Ingrid Fife Lay Member 9/11 4/4 4/4 8/10 1/1
Claire Forde Governing Body Member, GP and Clinical Lead Medicines Management
8/11 6/9 8/11
Gill Frame Registered Nurse 9/11 3/4 7/10 5/9 1/1 8/11
Diane Hanshaw Practice Manager Representative 9/11
David Lyon Governing Body Member and GP 7/11 2/9 6/11
Damian McDermott Governing Body Member and GP 8/11 7/9 7/11
David Merrill Lay Member 9/11 4/4 7/9 7/10
Mick O'Connor Committee Chair, GB Member & Clinical Lead - StHK
9/11 3/4 2/9 4/9 7/11
Eileen O'Meara Director of Public Health 4/11 4/10
Cliff Richards Chair 5/11 6/9 3/10 5/11 4/4
Jan Snoddon Chief Nurse 8/11 4/4 3/4 3/10 5/9 4/4
Dave Sweeney Director of Transformation 7/11 4/10 4/11 3/4
Shahzad Tahir Lay Member 10/11 3/4 4/4 1/1
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APPENDIX 3
GOVERNING BODY DECLARATIONS OF INTEREST REGISTER
Name Position Organisation Declaration and Date of Declaration
Mr David Austin Lay Member NHS Halton CCG Chair of Brookvale Practice Patient Participation Group. Director of Murdishaw Community Centre. 07/05/15
Mr Simon Banks Chief Officer NHS Halton CCG Nil 16/03/15
Mr Paul Brickwood Chief Finance Officer NHS Halton CCG
Employed by NHS Knowsley CCG and provide a Chief Finance Officer role for NHS Halton CCG, NHS Knowsley CCG and NHS St Helens CCGs. Wife is Director of Gillian Brickwood Ltd, a private company which provides health consultancy services. 08/04/15
Dr Michael Chester Secondary Care Doctor Governing Body Member
NHS Halton CCG
Owner/Director of Virtual Angina Ltd. Director of Patient Centred Solutions Ltd, wife is Co-Director. Governing Body Member of East Staffordshire and Kingston CCGs. 07/05/15
Mrs Ingrid Fife Lay Member NHS Halton CCG
Husband is Director of Medtrade Ltd. Shareholdings in name of self and husband of 1% in Medtrade Ltd. Chair of Halton Housing Trust and Board Member of Regenda Homes Ltd. 07/05/15
Dr Claire Forde General Practitioner NHS Halton CCG GP Partner at Grove House Practice. Part owner at St Pauls Health Centre 07/05/15
Gill Frame Registered Nurse Governing Body Member and Clinical Lead - Children
NHS Halton CCG Independent Chair of Cheshire West and Chester Local Safeguarding Children's Board. NMC Fitness to Practice Nurse. 19/03/15
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Name Position Organisation Declaration and Date of Declaration
Diane Hanshaw Practice Manager Governing Body Member
NHS Halton CCG Practice Manager Beaconsfield Surgery, Widnes and Governing Body Representative. 01/04/15
Dr David Lyon General Practitioner NHS Halton CCG GP Partner at Castlefields Health Centre, Runcorn. 15/04/15
Dr Damian McDermott
General Practitioner NHS Halton CCG GP Partner providing PMS Services at Tower House Practice, Runcorn. Part-Owner St Paul's Health Centre, Runcorn. Trustee of Vicarage Lodge Playgroup, Runcorn. 17/04/15
Mr David Merrill Lay Member and Deputy Chair of the Governing Body
NHS Halton CCG Member of Peelhouse Medical Plaza Patient Participation Group. Registered with Halton Carers Group. 07/05/15
Dr Mick O'Connor General Practitioner NHS Halton CCG GP Partner and Partner at Beaconsfield Surgery, Bevan Way, Widnes. 07/05/15
Eileen O'Meara Director of Public Health Halton Borough Council
Nil 07/05/15
Dr Clifford Richards Chair and General Practitioner
NHS Halton CCG Partners daughter attends "stick and step" a conductive education charity. 03/03/16
Mrs Jan Snoddon Chief Nurse NHS Halton CCG Associate Lecturer at Edge Hill University 30/03/15
Shahzad Tahir Lay Member NHS Halton CCG Lay Member Together Trust Independent Fostering Agency – 13/04/15
Mr Dave Sweeney Director of Transformation NHS Halton CCG Non- Executive Director of Renova 07/05/15